WBR1031
| Author | PageAuthor::Vendhan Ramanujam |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Community Medical Health Center, MainCategory::Primary Care Office |
| Sub Category | SubCategory::Musculoskeletal/Rheumatology |
| Prompt | [[Prompt::A 49 year old man presents to his primary care physician with complaints of generalized muscle weakness and pain present all throughout the day for the past three days. It started as a vague neck pain before progressing to generalized muscle pain and weakness. He also complains of drooping of his upper eyelids and inability to open his car doors because of hand weakness. Over-the-counter acetaminophen has not been helpful. He denies any history of fever, difficulty in breathing or swallowing and facial muscle weakness. He has a past medical history of gastroesophageal reflux disease and plantar fasciitis that was diagnosed before 1 week for which he is currently taking methylprednisolone. He has a history of smoking 1 pack of cigarette per day for the past 25 years and denies taking alcohol. On examination, his vital signs are blood pressure of 130/85 mm Hg, pulse rate of 80 beats/min, respiratory rate of 15 breaths/min and temperature of 37.2 °C. Bilateral ptosis is noticed and there is pain on palpation of both the upper and lower extremity. Muscle strength is 2 in both the upper and lower extremities. Handgrip is weak, and he has difficulty standing up from sitting position. Sensations are bilaterally normal and symmetrical. Normal deep tendon reflexes are noted. His complete blood count and basic metabolic profile are normal. His other lab tests revealed the following ESR : 10 mm/hr |
| Answer A | AnswerA::Polymyositis |
| Answer A Explanation | AnswerAExp:: |
| Answer B | AnswerB::Dermatomyositis |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::Neuromuscular junction disease |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::Drug induced myopathy |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE::Polymyalgia rheumatic |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation:: Educational Objective: |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Drug induced myopathy, WBRKeyword::Steroid induced mypoathy |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |