A 56-year-old female has bilateral, asymmetric, and slowprogressive weakness of the knee extensors, ulnar finger flexors, and the wristwith no facial muscle involvement. What is the most likely diagnosis?

Which of the following tests can confirm a diagnosis ofdermatomyositis?Choices:

A 45-year-old female presents with several months ofweakness, malaise, and dyspnea on exertion. She has had weight loss, low-gradefevers, and problems brushing her hair or getting up from a chair. The physicalexam shows proximal muscle weakness, bilateral dry lung crackles, and a lowgradefever. A chest x-ray shows bilateral interstitial infiltrates, pulmonaryfunction tests show lung volumes only at 75 percent of predicted, creatine kinaseis elevated, and the anti-Jo-1 antibody is present. What is the most likelydiagnosis?

A patient has been treated with high dose prednisone forpolymyositis and initiated on mycophenolic acid for its steroid-sparing effect.The steroid taper has not caused any flare in symptoms, and creatine kinase isstable at 1300 U/L. Select the next step.

Which groups of muscles are weak secondary topolymyositis?

A 77-year-old female complains of muscle pain andstiffness, progressive weight loss, and malaise for 2 months. Laboratories shownormal CBC, TSH, and CPK but erythrocyte sedimentation rate is 90 mm/hour.What is the most likely diagnosis?

Which of the following is not associated with polymyositis?

A 65-year-old female complains of upper and lower extremitypain and weakness. She has difficult arising from low chairs and climbing stairs.She also notes a facial rash. Exam shows proximal muscle weakness, reddishpurpleskin discoloration around the eyes, purple nodules over the knees andelbows, and erythema over the joints of the fingers. What is the most probablediagnosis?

A 45-year-old female presents with several months ofweakness, malaise, and dyspnea on exertion. She has had weight loss, low-grade fevers, and problems brushing her hair or getting up from a chair. The physical exam shows proximal muscle weakness, bilateral dry lung crackles, and a lowgrade fever. A chest x-ray shows bilateral interstitial infiltrates, pulmonary function tests show lung volumes only at 75 percent of predicted, creatine kinase is elevated, and the anti-Jo-1 antibody is present. What is the most likely diagnosis?

A 46-year-old woman is evaluated for a 3-month history of a rash during the summertime. She is otherwise well and takes no medications. On physical examination, vital signs are normal. BMI is 23. Examination of the skin reveals eyelid swelling and a periorbital violaceous rash, erythema of the anterior chest and upper back, and an erythematous papular rash on the hands; there is no malar eruption, skin thickening, or digital ulcers. Muscle strength and reflexes are normal. The appearance of the hands is show Gottron papules over the extensor surface of small joints of the hands Laboratory studies: Complete blood count Normal Chemistry panel Normal Aldolase 5.1 U/L (normal range, 1.0-8.0 U/L) Creatine kinase 100 U/L Antinuclear antibodies Titer of 1:640 Anti–Jo-1 antibodies Negative Urinalysis Normal Which of the following is the most likely diagnosis?

A 42-year-old woman is evaluated for a 4-year history of diffuse muscle and joint pain, most notably of her shoulders, low back, hips, and knees. The pain is present in the morning and throughout the day. She wakes unrefreshed and reports problems with her memory. She also describes diarrhea alternating with constipation with no blood or mucus in the stool. She reports no weight loss. She quit working 2 years ago due to her symptoms, which were made worse by her work as a baker. She has been to multiple medical providers who have not established a diagnosis despite numerous tests.On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 134/88 mm Hg, pulse rate is 92/min, and respiration rate is 16/min. BMI is 36. Muscles are generally tender to light palpation but without weakness on muscle strength testing. The remainder of the examination is normal.Laboratory studies, including complete blood count, Which of the follOWing is the most likely diagnosis?

A 67-year-old man is evaluated for a 1-year history of weakness,with increased tripping on curbs and diflculty withhandwriting, which is not as neat as in the past. He reports no muscle cramping. He takes no medications. On physical examination, vital signs are normal. Thereis no rash. There is symmetric weakness of the forearm andthigh muscles. Reduced grip strength and reduced wrist and finger flexion are noted. Reflexes are normal. There is atrophy of the muscles of the foream1s and interosseous muscles of the right hand greater rhan rhe left. There are no fasciculations.Laboratory studies show a serum creatine kinaselevel of 1150 U/L and a normal thyroid-stimulating hormone level; antinuclear and anti- Jo-1 antibody testing isnegative.Electromyogram and nerve conduction studies show myopathic changes in the proximal and distal muscles of the extremities, as well as some neurogenic changes.Which of the follOWing is the most likely diagnosis?

A 64 -year-old woman Is evaluated for worsening leg weakness. She was evaluated 2 weeks ago for a 3-week history of lower extremity weakness; laboratory studies showed a serum creatine kinase level of23,000 U/L. History is notable for hypercholesterolemia treated with lovastatin, which was discontinued at the initial visit. On physical examination, vital signs are normaL There is no rash. Examination shows 3/5 strength of the quadriceps and hamstrings (4/S strength 2 weeks ago);4/5 strength in the deltoids. biceps, and triceps; and S/5strength of the neck flexors. neck extensors. and distalupper and lower extremities. the remainder of the examination is normal.Current laboratory studies show an erythrocyte sedimentation rate of 25 mmlh and a serum creatine kinase level of20,876 U/L.In addition to a muscle biopsy, which of the following ismost likely to establish the diagnosis?

A 42-year-old woman is evaluated for a 3-month history of symmetric proximal muscle weakness. She takes no medications.On physical examination, vital signs are normal. Symmetric weakness of the arm and thigh muscles is noted. There are no skin findings.Laboratory studies are significant for a serum creatine kinase level of 2000 U/L and a normal thyroid-stimulating hormone level.Electromyogram shows increased insertional activity, spontaneous fibrillations, and polyphasic motor unit potentials in the proximal muscles. MRI of the thighs shows inflammatory changes in the quadriceps.A muscle biopsy is recommended, but the patient refuses.Which of the following is the most appropriate treatment at this time?