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(Created page with "{{WBRQuestion |QuestionAuthor=Mugilan Poongkunran |ExamType=USMLE Step 3 |MainCategory=Primary Care Office |SubCategory=Musculoskeletal/Rheumatology |MainCategory=Primary Care...") |
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|SubCategory=Musculoskeletal/Rheumatology | |SubCategory=Musculoskeletal/Rheumatology | ||
|Prompt=A 60 year old male comes to office with complaints of muscle weakness and cramps while climbing stairs for the past 3 months. He denies any rash, arthralgia and difficulty in swallowing. His symptoms are progressively getting worse. He has no other medical problems. He is a non-smoker and non-alcoholic. His vitals are BP:120/80 mmHg, pulse:72/min, temperature:98F and respirations 14/min. On physical examinations there is proximal weakness in both upper and lower limbs. There is no muscle tenderness. Skin examination is normal. Cardiovascular and respiratory examinations are normal. CPK levels are grossly elevated. Which of the following findings would be seen in this patient? | |Prompt=A 60 year old male comes to office with complaints of muscle weakness and cramps while climbing stairs for the past 3 months. He denies any rash, arthralgia and difficulty in swallowing. His symptoms are progressively getting worse. He has no other medical problems. He is a non-smoker and non-alcoholic. His vitals are BP:120/80 mmHg, pulse:72/min, temperature:98F and respirations 14/min. On physical examinations there is proximal weakness in both upper and lower limbs. There is no muscle tenderness. Skin examination is normal. Cardiovascular and respiratory examinations are normal. CPK levels are grossly elevated. Which of the following findings would be seen in this patient? | ||
|Explanation=[[Dermatomyositis]] (DM) and [[polymyositis]] (PM) are idiopathic inflammatory myopathies, characterized by the shared features of proximal skeletal muscle weakness and by evidence of muscle inflammation. Dermatomyositis, unlike polymyositis, is associated with a variety of characteristic skin manifestations. Other differential diagnosis for myopahty are hypothyroidism, glucocorticoids, drugs and malignancy. | |Explanation=[[Dermatomyositis]] (DM) and [[polymyositis]] (PM) are idiopathic inflammatory myopathies, characterized by the shared features of proximal skeletal muscle weakness and by evidence of muscle inflammation. Dermatomyositis, unlike polymyositis, is associated with a variety of characteristic skin manifestations. Other differential diagnosis for myopahty are hypothyroidism, glucocorticoids, drugs and malignancy. | ||
|AnswerA= | |AnswerA=High eosinophil count | ||
|AnswerAExp=High eosinophil is seen in [[eosinophilic fasciitis]], however these patients usually presents with muscle pain, weakness, symmetrical induration of the skin and normal CPK levels. | |AnswerAExp='''Incorrect''' : High eosinophil is seen in [[eosinophilic fasciitis]], however these patients usually presents with muscle pain, weakness, symmetrical induration of the skin and normal CPK levels. | ||
|AnswerB= | |AnswerB=High neutrophil count | ||
|AnswerBExp=High neutrophilic count is a non-specific finding and it can be seen in conditions having infectious etiology. | |AnswerBExp='''Incorrect''' : High neutrophilic count is a non-specific finding and it can be seen in conditions having infectious etiology. | ||
|AnswerC= | |AnswerC=High serum ferritin | ||
|AnswerCExp=Serum [[ferritin]] is an [[acute phase reactant]] and is likely to be elevated in any inflammatory disorder. | |AnswerCExp='''Correct''' : Serum [[ferritin]] is an [[acute phase reactant]] and is likely to be elevated in any inflammatory disorder. | ||
|AnswerD= | |AnswerD=High serum albumin | ||
|AnswerDExp=Inflammatory disorder have no relation to the serum albumin levels. | |AnswerDExp='''Incorrect''' : Inflammatory disorder have no relation to the serum albumin levels. | ||
|AnswerE= | |AnswerE=Normal ESR | ||
|AnswerEExp=[[ESR]] is likely to be elevated in any inflammatory muscle disorder and not normal. | |AnswerEExp='''Incorrect''' : [[ESR]] is likely to be elevated in any inflammatory muscle disorder and not normal. | ||
|RightAnswer=C | |RightAnswer=C | ||
|Approved=Yes | |Approved=Yes | ||
}} | }} | ||
Revision as of 16:07, 4 September 2013
| Author | PageAuthor::Mugilan Poongkunran |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Primary Care Office |
| Sub Category | SubCategory::Musculoskeletal/Rheumatology |
| Prompt | [[Prompt::A 60 year old male comes to office with complaints of muscle weakness and cramps while climbing stairs for the past 3 months. He denies any rash, arthralgia and difficulty in swallowing. His symptoms are progressively getting worse. He has no other medical problems. He is a non-smoker and non-alcoholic. His vitals are BP:120/80 mmHg, pulse:72/min, temperature:98F and respirations 14/min. On physical examinations there is proximal weakness in both upper and lower limbs. There is no muscle tenderness. Skin examination is normal. Cardiovascular and respiratory examinations are normal. CPK levels are grossly elevated. Which of the following findings would be seen in this patient?]] |
| Answer A | AnswerA::High eosinophil count |
| Answer A Explanation | [[AnswerAExp::Incorrect : High eosinophil is seen in eosinophilic fasciitis, however these patients usually presents with muscle pain, weakness, symmetrical induration of the skin and normal CPK levels.]] |
| Answer B | AnswerB::High neutrophil count |
| Answer B Explanation | AnswerBExp::'''Incorrect''' : High neutrophilic count is a non-specific finding and it can be seen in conditions having infectious etiology. |
| Answer C | AnswerC::High serum ferritin |
| Answer C Explanation | [[AnswerCExp::Correct : Serum ferritin is an acute phase reactant and is likely to be elevated in any inflammatory disorder.]] |
| Answer D | AnswerD::High serum albumin |
| Answer D Explanation | AnswerDExp::'''Incorrect''' : Inflammatory disorder have no relation to the serum albumin levels. |
| Answer E | AnswerE::Normal ESR |
| Answer E Explanation | [[AnswerEExp::Incorrect : ESR is likely to be elevated in any inflammatory muscle disorder and not normal.]] |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::Dermatomyositis (DM) and polymyositis (PM) are idiopathic inflammatory myopathies, characterized by the shared features of proximal skeletal muscle weakness and by evidence of muscle inflammation. Dermatomyositis, unlike polymyositis, is associated with a variety of characteristic skin manifestations. Other differential diagnosis for myopahty are hypothyroidism, glucocorticoids, drugs and malignancy. Educational Objective: |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |