Rheumatology: dermatomyositis and malignancy: 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 and malignancy

Sample item

A 58-year-old woman has heliotrope rash, Gottron papules and proximal weakness. Her myositis-specific antibody panel is positive for anti-TIF1-gamma. What is the most important implication?

AGood response to steroids alone with no further testsBRisk of scleroderma renal crisisCHigher risk of underlying cancer, so screening is neededDHigh risk of rapidly progressive interstitial lung disease

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

The answer and the reasoning

C. Higher risk of underlying cancer, so screening is needed

Anti-TIF1-gamma and anti-NXP2 antibodies in adult dermatomyositis are linked to cancer-associated disease. Age-appropriate and directed malignancy screening should be done. Anti-MDA5 is the antibody tied to rapidly progressive lung disease.

Option by option

A. Good response to steroids alone with no further tests
Steroid response does not remove the need to look for malignancy.
B. Risk of scleroderma renal crisis
Renal crisis is a complication of systemic sclerosis.
C. Higher risk of underlying cancer, so screening is needed (correct)
Correct. This antibody marks cancer-associated dermatomyositis.
D. High risk of rapidly progressive interstitial lung disease
Rapidly progressive lung disease is the association of anti-MDA5.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Higher risk of underlying cancer, so screening is needed. Anti-TIF1-gamma and anti-NXP2 antibodies in adult dermatomyositis are linked to cancer-associated disease.

Why is "Good response to steroids alone with no further tests" not the answer?

Steroid response does not remove the need to look for malignancy.

Why is "Risk of scleroderma renal crisis" not the answer?

Renal crisis is a complication of systemic sclerosis.

Why is "High risk of rapidly progressive interstitial lung disease" not the answer?

Rapidly progressive lung disease is the association of anti-MDA5.

What concept does this question test?

It tests Rheumatology: dermatomyositis and malignancy in General Medicine. Age-appropriate and directed malignancy screening should be done. Anti-MDA5 is the antibody tied to rapidly progressive lung disease.

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 and malignancy?

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.