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 Creatinine phosphokinase: 890 U/L C-reactive protein  : 14 mg/L A urine dipstick test is positive for hemoglobin. Muscle biopsy and electromyography are not performed. What is the most likely cause for this patient’s complaints?]]
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: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Drug induced myopathy, WBRKeyword::Steroid induced mypoathy
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::