A 35-year-old woman presents for evaluation of symmetric proximal muscle weakness. The patient also presents with a blue-purple discoloration of the upper eyelids accompanied by rashes on the knuckles, as shown in the picture below. What is the most likely cause?
ADermatomyositis
BInclusion body myositis
CDuchenne muscular dystrophy
DPolymyositis
EHypothyroidism
A 47-year-old woman comes to the physician because of body aches for the past 9 months. She also has stiffness of the shoulders and knees that is worse in the morning and tingling in the upper extremities. Examination shows marked tenderness over the posterior neck, bilateral mid trapezius, and medial aspect of the left knee. A complete blood count and erythrocyte sedimentation rate are within the reference ranges. Which of the following is the most likely diagnosis?
ASystemic lupus erythematosus
BFibromyalgia
CRheumatoid arthritis
DPolymyositis
EMajor depressive disorder
A 48-year-old woman comes to the physician because of a 6-month history of muscle stiffness, myalgia, and a 7-kg (15-lb) weight gain. Her last menstrual period was 4 months ago. Physical examination shows cold, dry skin, and proximal muscle weakness. Deep tendon reflexes are 2+ bilaterally, with delayed relaxation. The creatine kinase level is 2,940 U/L. Which of the following is the most appropriate next step in diagnosis?
AThyroid function tests
BRepetitive nerve stimulation
CSerum electrolytes
DMuscle biopsy
ESerum assay for muscle specific tyrosine kinase antibody
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