Rheumatology: dermatomyositis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: dermatomyositis

Sample item

A 58-year-old woman has a heliotrope rash, Gottron papules, difficulty climbing stairs and a creatine kinase of 4,500 U/L. Muscle biopsy shows perifascicular atrophy. Besides immunosuppression, which step is important?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. A systematic search for an occult malignancy

Adult-onset dermatomyositis is associated with malignancy in a substantial minority, particularly within 3 years of diagnosis. Ovarian, lung, breast, colorectal and, in Asian populations, nasopharyngeal cancers are frequent, and anti-TIF1-gamma antibody raises the risk. Age-appropriate screening with imaging is recommended at diagnosis.

Option by option

  • A. Starting a TNF inhibitor

    TNF inhibitors are not effective in myositis and can worsen it.

  • B. Genetic testing for dystrophinopathy

    Dystrophinopathy is an inherited disease of childhood with a different pattern and no rash.

  • C. Skin biopsy and no further work-up

    Missing an underlying cancer is the main danger, so further work-up is essential.

  • D. A systematic search for an occult malignancy (correct)

    Correct. Screening for paraneoplastic dermatomyositis is part of the standard work-up in adults.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, A systematic search for an occult malignancy. Adult-onset dermatomyositis is associated with malignancy in a substantial minority, particularly within 3 years of diagnosis.

Why is "Starting a TNF inhibitor" not the answer?

TNF inhibitors are not effective in myositis and can worsen it.

Why is "Genetic testing for dystrophinopathy" not the answer?

Dystrophinopathy is an inherited disease of childhood with a different pattern and no rash.

Why is "Skin biopsy and no further work-up" not the answer?

Missing an underlying cancer is the main danger, so further work-up is essential.

What concept does this question test?

It tests Rheumatology: dermatomyositis in General Medicine. Ovarian, lung, breast, colorectal and, in Asian populations, nasopharyngeal cancers are frequent, and anti-TIF1-gamma antibody raises the risk. Age-appropriate screening with imaging is recommended at diagnosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: dermatomyositis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.