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Old 06-11-2011
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Skin Muscle Weakness and tenderness and these skin lesions

A 40-year-old woman presents to the family physician for chronic muscle weakness and tenderness. She states she has experienced progressive difficulty in raising her arms and climbing stairs for the past 6 months. She also describes difficulty swallowing. Physical examination reveals a violaceous eruption on the upper eyelids, accompanied by swelling of the eyelid (see figure). It also shows a violaceous erythematous eruption over the knuckles and along the sides of the fingers. This patient is at increased risk of developing which condition?

Muscle Weakness and tenderness and these skin lesions-image1.jpg
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Muscle Weakness and tenderness and these skin lesions-image2.jpg
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Answer Choices
A. Amyloid myopathy
B. Inclusion body myositis
C. Malignancy
D. Motor neuron disease
E. Myasthenia gravis
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  #2  
Old 06-11-2011
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i think that E
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Default Inflammatory myopathy-DM!

Classical features of dermatomyositis!

Gottron's papule

Heliotrope rash

Muscluar weakness

But it is not in options!
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Default DM-malignancy!

Malignancy is possible in any patient with dermatomyositis but is more common in adults older than 60 years.

So I would go with C.

Definitely not the other 4 options.
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Old 06-11-2011
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I agree with C

Here are my notes on dermatomyositis from UW and Kaplan qbanks:

-inflammatory myopathy of proximal extensor muscles
-6x more common in women

-violaceous poikiloderma throughout body
--heliotrope sign (due to inflammation of underlying orbicularis oculi muscle)
--shawl sign
--Gottron's sign (on knuckles, elbows and knees)
--Gottron's papules: lichenoid papules over joints

-increased internal malignancies
--over 10% of pts with DM have one,
--MC are ovarian, but also breast, lung and female urogenital
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Old 06-13-2011
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Option C (Malignancy) is correct. The heliotrope rash and Gottron's papules are suggestive of dermatomyositis, which is associated with a higher risk of malignancy.

Option A (Amyloid myopathy) is incorrect. Amyloid myopathy is part of the differential diagnosis for muscle weakness, but it would not present with the other characteristics of this case.

Option B (Inclusion body myositis) is incorrect. Inclusion body myositis should also be distinguished from dermatomyositis. It is not associated with Gottron's papules or a heliotrope rash.

Option D (Motor neuron disease) is incorrect. Motor neuron disease should also be differentiated from dermatomyositis. The signs depicted in the figures are specific for dermatomyositis.

Option E (Myasthenia gravis) is incorrect. Myasthenia gravis should be differentiated from dermatomyositis, but it would not present with a heliotrope rash or Gottron's papules.

High-yield Hit 1
Dermatomyositis
Dermatomyositis is closely related to polymyositis. In addition to muscular symptoms, there are associated skin changes:
A characteristic purple heliotrope rash, usually on the eyelids, although it may spread to other sites.
An erythematous rash on the face, scalp, shoulders, and hands.

From Crash Course: Musculoskeletal System by Walji
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i think ptosis and all other optios favours option E Myasthenia gravis
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Old 06-15-2011
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thanks for the question
i was going to say c but ppl answered before me
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