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Old 07-15-2011
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Question Rash and dysphagia

A 11 y old child presents with difficulty in swallowing since few days. He also complaints of difficulty from getting up from chair. Past h/o is significant for fever and wt loss. On examination rash is found near periorbital area and fingers which is considered normal by mother as she considered it to be herediatory. What is the most likely diagnosis?
1. Polymyositis
2. Myasthenia gravis
3. Inclusion body myosities
4. Lambert eaton myasthenic syndrome
5. Dermatomyositis

Last edited by Ace3; 07-16-2011 at 04:59 AM.
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Old 07-15-2011
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Typicall rash around eye (heliotrope rash) n over knuckles of hand (grotton patch) signifies diagnosis of Dermatomyositis
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Ok i got dermatomyostis when i went thru the question answers ,

A question though about general question answering on going thru the question i had an idea about what was going on but i wasnt able to name the problem till i saw the answers. My method is do the question then go thru the answers and rule them out or in according to the info presented in the stem.

like going thru this question i was able to rule out 2 and 4 easily cuz of the presentaion myasthenia usaually shows occular problems first same with lambert eton also if it was one of them they would give the hx of getting worse ( myasthenia) or better ( lambert) with use.

number 3 though i dont remember what that one is at all. so i put it to the side

now on reaching number 5 i was like hmm this is probably it has it has the proximal muscle weakness and the face racoon rash ( i had totally forgotten about the rash on the fingers) so i choose Dermatomyositis ,

MY question is to the people who are done with IM what methodology did u use to answer were u able to answer as soon as u read the question without looking at the answers or what? I want to see how well/badly off i am in my knowledge base and what can i do to make it better.
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Old 07-15-2011
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Quote:
Originally Posted by docnas View Post
Ok i got dermatomyostis when i went thru the question answers ,

A question though about general question answering on going thru the question i had an idea about what was going on but i wasnt able to name the problem till i saw the answers. My method is do the question then go thru the answers and rule them out or in according to the info presented in the stem.

like going thru this question i was able to rule out 2 and 4 easily cuz of the presentaion myasthenia usaually shows occular problems first same with lambert eton also if it was one of them they would give the hx of getting worse ( myasthenia) or better ( lambert) with use.

number 3 though i dont remember what that one is at all. so i put it to the side

now on reaching number 5 i was like hmm this is probably it has it has the proximal muscle weakness and the face racoon rash ( i had totally forgotten about the rash on the fingers) so i choose Dermatomyositis ,

MY question is to the people who are done with IM what methodology did u use to answer were u able to answer as soon as u read the question without looking at the answers or what? I want to see how well/badly off i am in my knowledge base and what can i do to make it better.
Well, for most of the high yield diseases you should be able to get the answer before looking the options, however, I have realized that is better if you check first what they are asking because you spend a lot of time reading the vignette, making a diagnosis and after all that process you find the diagnosis at the end of the vignette (very annoying ) and they ask you something different.

You should be careful when you discard options, sometimes the vignette has some clues that are traps and they make you think a different diagnosis. That is why is better to have an answer first, and if you find it in the choices, probably is the correct answer. However, make sure you read all the choices just in case. ( Polymyositis - Dermatomyositis : Pretty similar except the cutaneous involment of the latter. )

When something doesn't fit, that is a big deal, because usually you will get in the situation of choosing between two options. In those cases, it is not uncommon that a third option is the correct answer. So be careful with those.

When you don't have idea about the answer, then you can discard known options.... sometimes this works very well, and it is better than a blind guess.

The exam covers a lot of material and I realized that I can't learn everything because you will get to a time when you learn something, you forget something also.

The only way is to learn the high yield material and develop a good test taking technique. You can have tons of knowledge but the exam will try to trick you, so be prepared.

All the best and good luck!
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Quote:
Originally Posted by docnas View Post
Ok i got dermatomyostis when i went thru the question answers ,

A question though about general question answering on going thru the question i had an idea about what was going on but i wasnt able to name the problem till i saw the answers. My method is do the question then go thru the answers and rule them out or in according to the info presented in the stem.

like going thru this question i was able to rule out 2 and 4 easily cuz of the presentaion myasthenia usaually shows occular problems first same with lambert eton also if it was one of them they would give the hx of getting worse ( myasthenia) or better ( lambert) with use.

number 3 though i dont remember what that one is at all. so i put it to the side

now on reaching number 5 i was like hmm this is probably it has it has the proximal muscle weakness and the face racoon rash ( i had totally forgotten about the rash on the fingers) so i choose Dermatomyositis ,

MY question is to the people who are done with IM what methodology did u use to answer were u able to answer as soon as u read the question without looking at the answers or what? I want to see how well/badly off i am in my knowledge base and what can i do to make it better.
For me i try to give a quick reading of everything q and options since some of dd are very close and u can answer by searching for minor clues. But thing is that when u are well versed with subject u tend to reach to the answer very quickly by reading first or second line but to pick right one u have to read entire thing. But for me if i am not able to diagnose a condition after reading 1, 2 or entire frame it indicates i am lacking knowledge. But if i could not answer even after seeing options then i am poor at that particular system and wanted to give that part one quick reading. That is my method.


For example above u can see options are different types of muscle disorder and myosities are mentioned. From q frame i try to rule out it is muscle disorder or myosities age and congenital or aquired...when u keep whole thing together and u remember the theory u can immidiatly say answer. But if u read first 2 lines it is seen in most of the condition so u have to read entire thing for diagnosing. Thats what i do and think..plz any critics to my methadology is most welcome . I will be more than happy to correct myself
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Old 07-15-2011
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Quote:
Originally Posted by docnas View Post
Ok i got dermatomyostis when i went thru the question answers ,

A question though about general question answering on going thru the question i had an idea about what was going on but i wasnt able to name the problem till i saw the answers. My method is do the question then go thru the answers and rule them out or in according to the info presented in the stem.

like going thru this question i was able to rule out 2 and 4 easily cuz of the presentaion myasthenia usaually shows occular problems first same with lambert eton also if it was one of them they would give the hx of getting worse ( myasthenia) or better ( lambert) with use.

number 3 though i dont remember what that one is at all. so i put it to the side

now on reaching number 5 i was like hmm this is probably it has it has the proximal muscle weakness and the face racoon rash ( i had totally forgotten about the rash on the fingers) so i choose Dermatomyositis ,

MY question is to the people who are done with IM what methodology did u use to answer were u able to answer as soon as u read the question without looking at the answers or what? I want to see how well/badly off i am in my knowledge base and what can i do to make it better.
And after all if still q is wrong see answer how they ruled the option you were thinking to be correct....
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Old 07-15-2011
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5. Dermatosities
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Old 07-16-2011
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Quote:
Originally Posted by confident View Post
A 11 y old child presents with difficulty in swallowing since few days. He also complaints of difficulty from getting up from chair. Past h/o is significant for fever and wt loss. On examination rash is found near periorbital area and fingers which is considered normal by mother as she considered it to be herediatory. What is the most likely diagnosis?
1. Polymyosities
2. Myasthenia gravis
3. Inclusion body myosities
4. Lambert eaton myasthenic syndrome
5. Dermatomyositis
Answer is 1. Its Dermatomyositis. Its inlammatory myopathy which are of 3 types:

a) Polymyositis:It shares similar feature to dermatomyositis but dermatomyositis is more common in children, dark bodies are suggestive, T cells predominate, CD8 cells predominent, mostly endomyosial and perimysial involvement, NO capillaries are involved so no necrosis seen.

b) Dermatomyositis: It is mostly seen in children, B>T cells seen, CD4 predominates, capillaries are involved so necrosis seen, mostly confined to septa, Tubulointerstitial is highly suggestive , 20% chance of having malignency, Heliotrope rash and gottrons papule seen. Seen in families.

c) Inclusion body myositis: mostly seen in elderly, Inclusion bodies are seen on muscle biopsy.

Lambert eaton myasthenic syndrome: Dysartheria, small cell lung cancer, ptosis, xerostomia, dysphagia, areflexia etc are seen, sometimes autoimmune disorder is associated. Its not the option

Myasthenia gravis will have mostly eye lid drop, diplopia, dysphagia, improves with rest...not an option here.
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