Objectives:

• Recognize symptoms and signs of dermatomyositis and polymyositis
• Describe how inflammatory myopathies are evaluated and diagnosed
• Appreciate the relationship between malignancy and inflammatory myopathy

1		A 52-year-old female patient presents to your office for an initial visit. She complains of mild pain and weakness in her hips and thighs. The symptoms have been present for months. About 2 years ago another doctor diagnosed her with psoriasis because of a rash on her hands and elbows, which has since resolved. Otherwise, she reports being relatively healthy and taking no medications. She is a smoker. The review of systems reveals some fatigue and a 5-pound weight loss. On physical exam, her vitals are normal. She has considerable difficulty getting out of her chair. Her strength is symmetrically diminished in the quadriceps and hip flexors. Sensation and reflexes are intact. The rest of the exam is unremarkable. Which of the following laboratory tests do you order first?
			A)	Muscle biopsy.
			B)	Electromyography (EMG).
			C)	TSH.
			D)	ANA.
			E)	Troponin-T.
2		You order TSH and CBC, which are normal. ESR, CK, and AST are elevated. An EMG demonstrates abnormalities of the paraspinal muscles. Your patient returns to discuss her test results and complains that her psoriasis is back. There are violaceous plaques on her knuckles and elbows and around her eyes. You recommend the following management plan for the rash:
			A)	Ultraviolet light therapy.
			B)	Topical steroids.
			C)	Oral steroids.
			D)	Topical emollients.
3		You diagnose dermatomyositis. Which of the following tests should now be ordered?
			A)	Urinalysis.
			B)	Chest radiograph.
			C)	Blood cultures.
			D)	A and B.
			E)	A and C.