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Dermatology · Connective tissue disease
Sample itemA 50-year-old woman has a violaceous rash over the upper eyelids, scaly erythematous papules over the knuckles and progressive difficulty climbing stairs. What should be done besides confirming the diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Screen for an underlying malignancy
Heliotrope rash and Gottron's papules with proximal muscle weakness indicate dermatomyositis. In adults it carries an increased risk of an associated malignancy, such as ovarian, lung and breast cancer, so age-appropriate screening is needed. Treatment is with corticosteroids and steroid-sparing agents.
Option by option
A. Check the patient for pemphigus antibodies
Pemphigus antibodies are unrelated to this presentation.
B. Test for HLA-B27
HLA-B27 is linked to spondyloarthropathies.
C. Start oral isotretinoin
Isotretinoin is for acne and has no role.
D. Screen for an underlying malignancy (correct)
Correct. Adult dermatomyositis is a paraneoplastic risk, particularly in the first few years.
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.
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