William Cope
Yerko Berrocal
Richard Tapping
Anthony Dwyer
Alisha Punjwani
Dean WatkinsTBL Group 10 - E-Team Based Learning’s Updates
Application Question #3
Question #3
The patient returns a week later to discuss her lab results. You’ve made a tentative diagnosis of polymyositis. She has developed a rash on the face that is not painful or itching her, but seems to be getting progressively darker and denser. You ask the patient to put on a robe, so that you can repeat a full physical exam.
Which of the following is the best next step?
A. work-up for occult malignancy
B. immunosuppression through high dose corticosteroids
C. immunosuppression through methotrexate
D. a muscle biopsy
E. a swallow study and pulmonary function tests to determine if the smooth muscle in the gastrointestinal and/or pulmonary systems has been affected
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.
Alright B it was!
I think B is the best option since it might be dermatomyositis and corticosteroids would treat the systemic inflammation for this.
Should I go with B?
I apologize if there are like 4 comments, my computer glitched
sure.
sure.
sure.
sure.
I think so. Immediate treatment I think is best option vs work up
I think the diagnosis for dermatomyositis could probably be made clinically here. I think corticosteroids would be the first line of treatment, but I think the swallow study and pulmonary function tests may be the best option in the immediate future because interstitial lung disease is associated with this condition and can be quite harmful.
That's a good point since those might have more immediate and adverse effects.
So I think because of this we are looking more at dermatomyositis. This means that there is an increased risk of occult malignancy (first aid). Therefore, A?
She's starting to have skin manifestations, so maybe this has evolved into dermatomyositis? Corticosteroids are the first-line treatment so I'm thinking B.
My guess is corticosteroids since there seems to be systemic inflammation?