Welcome back to CGScholar! In this TBL, you will engage in oral interaction in Zoom with written discussion in CGScholar.

• Application Questions 1-3: Groups 1-5 will discuss in Zoom, Groups 6-10 in CGScholar.
• Application Questions 3-6 Groups 1-5 will discuss in CGScholar, Groups 6-10 in Zoom.

INSTRUCTIONS

• Step 1: Answer the question, providing medical reasoning to back up your answer. Your answer should be at least 3-5 sentences. DO NOT REFRESH YOUR BROWSER UNTIL YOU HAVE FINISHED YOUR ANSWER.
• Step 2: Now, refresh your browser, and respond to as many others in your team as you can. Responses should provide evidence of your thinking processes (not just "I agree", or "answer is X"). Regularly refresh your browser as others' responses come in.
• Step 3: Based on the discussion recorded in CGScholar, your team reporter should now enter your team's answer in Benware. The whole-class discussion of this application exercise will take place verbally as usual.

Application Problem #1

Mrs. Jones is a 57-year-old female with a history of hypertension, nicotine abuse who presents with weakness for the last three months. She has trouble climbing stairs, brushing her hair and comes in today as it has been difficult to pick up her grandkids for the last week. She has achiness of her muscles but denies any stiffness or pain in the joints. She denies any rash. She has felt generally fatigued, but no weight loss, night sweats or fevers.

Her social history is notable for a 35 pack-year history of smoking. Her family history is notable for a mother with rheumatoid arthritis.

Your exam is without active tenosynovitis of the hands, wrists or shoulders. She is objectively weak bilaterally with abduction of the shoulders and flexion of the hips. There is no rash. The cardiopulmonary and abdominal exam is unremarkable.

Question #1

What is at the top of your differential at this point?

A. Polymyositis
B. Dermatomyositis
C. Inclusion body myositis
D. Fibromyalgia
E. Polymyalgia rheumatica