Rheumatology: inclusion body myositis: 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.

Try it

General Medicine · Rheumatology: inclusion body myositis

Sample item

A 68-year-old man has had slowly progressive weakness of quadriceps and wrist and finger flexors for three years, causing falls and difficulty gripping. Creatine kinase is 700 U/L. There was no response to a 3-month trial of prednisolone. Biopsy shows rimmed vacuoles and endomysial inflammation. What is the diagnosis?

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

The answer and the reasoning

B. Inclusion body myositis

Inclusion body myositis is the commonest acquired myopathy over 50 years, with asymmetric weakness of quadriceps and finger flexors and a modest rise in CK. Biopsy shows rimmed vacuoles, inclusions and endomysial inflammation. It is largely resistant to immunosuppression.

Option by option

  • A. Myasthenia gravis

    Myasthenia gravis causes fatigable weakness with normal CK and normal muscle histology.

  • B. Inclusion body myositis (correct)

    Correct. Distal finger flexor involvement, steroid resistance and rimmed vacuoles point to this disease.

  • C. Polymyositis

    Polymyositis is subacute, proximal, and responds to steroids, without rimmed vacuoles.

  • D. Dermatomyositis

    Dermatomyositis has a skin rash and perifascicular atrophy.

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 B, Inclusion body myositis. Inclusion body myositis is the commonest acquired myopathy over 50 years, with asymmetric weakness of quadriceps and finger flexors and a modest rise in CK.

Why is "Myasthenia gravis" not the answer?

Myasthenia gravis causes fatigable weakness with normal CK and normal muscle histology.

Why is "Polymyositis" not the answer?

Polymyositis is subacute, proximal, and responds to steroids, without rimmed vacuoles.

Why is "Dermatomyositis" not the answer?

Dermatomyositis has a skin rash and perifascicular atrophy.

What concept does this question test?

It tests Rheumatology: inclusion body myositis in General Medicine. Biopsy shows rimmed vacuoles, inclusions and endomysial inflammation. It is largely resistant to immunosuppression.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: inclusion body myositis?

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.