USMLE Forum Archives - USMLE Step 2 CK - IM 40
IM 40
TheOne - 05-24-07 19:30
A 56 years old woman comes to the physician because of progressive weakness for several months. At first, she became aware of increasing difficulty in climbing stairs, then lifting objects above head level. In the past week, the muscles of the shoulder girdle have become sore. She has had fever up to 38.3 C (101.0 F). On examination, proximal muscles of the upper and lower extremities are somewhat tender to palpation but not atrophic. There is periorbital edema associated with a purple discoloration of the upper eyelids. Scaly erythematous patches are seen on the dorsal aspect of hands and fingers. Laboratory studies show:
Hemoglobin..............................12.2 g/dL
Leukocyte count..............................8300/mm3
Creatine kinase..............................2600 U/L
Erythrocyte sedimentation rate (ESR)......32 mm/hr
Antinuclear antibody (ANA) titer............Positive at 1:1280
Rheumatoid factor..............................Positive at 1:512
A biopsy of the deltoid muscle shows atrophy of muscle fibers and interstitial lymphocytic infiltration. Which of the following is the most appropriate treatment at this time?
A. Azathioprine
B. Methotrexate
C. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Plasma exchange
E. Prednisone
TheOne - 05-24-07 19:30
A 56 years old woman comes to the physician because of progressive weakness for several months. At first, she became aware of increasing difficulty in climbing stairs, then lifting objects above head level. In the past week, the muscles of the shoulder girdle have become sore. She has had fever up to 38.3 C (101.0 F). On examination, proximal muscles of the upper and lower extremities are somewhat tender to palpation but not atrophic. There is periorbital edema associated with a purple discoloration of the upper eyelids. Scaly erythematous patches are seen on the dorsal aspect of hands and fingers. Laboratory studies show:
Hemoglobin..............................12.2 g/dL
Leukocyte count..............................8300/mm3
Creatine kinase..............................2600 U/L
Erythrocyte sedimentation rate (ESR)......32 mm/hr
Antinuclear antibody (ANA) titer............Positive at 1:1280
Rheumatoid factor..............................Positive at 1:512
A biopsy of the deltoid muscle shows atrophy of muscle fibers and interstitial lymphocytic infiltration. Which of the following is the most appropriate treatment at this time?
A. Azathioprine
B. Methotrexate
C. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Plasma exchange
E. Prednisone
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#1
Re: IM 40 Sarahhh - 05-25-07 02:38 this could be either Dermatomyositis( due to the helitopre rash ) or mixed connective tissue disorder...
i would give prednisone in an acute case.. E
#2
Re: IM 40
TheOne - 06-06-07 17:50 The correct answer is E. The clinical picture is diagnostic of dermatomyositis. Women are more frequently affected than men. Muscle weakness and pain, along with the characteristic periorbital edema and purple discoloration of the upper eyelids, suggest the diagnosis, which is confirmed by muscle biopsy. The patches on the dorsal aspects of interphalangeal and metacarpophalangeal joints are referred to as Gottron sign. Anti-nuclear antibodies (ANAs) are found in the majority of patients, and rheumatoid factor is positive in a minority. Corticosteroids provide rapid relief in most patients. Prednisone is administered at high doses (40-60 mg daily).
#3
Re: IM 40 bingousmle - 06-20-10 08:46 periorbital edema associated with a purple discoloration and proximal myopathy suggests dermatomyositis which has to be treated with prednisone
#4
Re: IM 40 babbu5508 - 06-20-10 13:54 proximal myopathy,periorbital edema,biopsy of the deltoid muscle shows atrophy of muscle fibers and interstitial lymphocytic infiltration...dermatomyositis..treated with prednisolone initially
#6
Re: IM 40 babbu5508 - 06-21-10 14:15 dermatomyositis..This disease has no known cure. Specialized exercise therapy may supplement treatment to enhance quality of life.
Medications to help relieve symptoms include:
Prednisolone
Methotrexate
Mycophenolate
Intravenous immunoglobulin
Azathioprine
Cyclophosphamide
Rituximab
#8
Re: IM 40 bingousmle - 06-30-10 17:48 its important to remember that the lady needs a further detailed work up as the condition she has dermatomyositis which is known to be associated with internal tumors
#9
Re: IM 40 babbu5508 - 07-10-10 03:37 On the muscle biopsy, there are two classic microscopic findings of dermatomyositis. They are:
A mixed B- and T-cell perivascular inflammatory infiltrate
Perifascicular muscle fiber atrophy
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