CME Objectives\Questions
January 1, 2012
CME Objectives
Upon completion of this activity, participants should be able to:
- Summarize recent, significant studies related to the practice of primary care medicine;
- Evaluate the credibility of published data and recommendations related to primary care medicine;
- Discuss advantages and disadvantages of new diagnostic and therapeutic procedures in the primary care setting.
CME Questions
1. A 65-year-old male without significant past medical history, other than hypertension for the past 10 years, comes to your office complaining of progressive weakness in his legs for the past 3 months. He experiences difficulty getting up from the chair. He also noticed a 10-pound weight loss at the same time. On exam, you do not find any specific muscle weakness. A muscle biopsy showed non-specific muscle fiber atrophy. His laboratory tests show he has a normal CBC, normal electrolytes, AST: 78, ALT: 67, T.Bil:1.1, CK: 840 (normal < 150), Aldolase 21 (normal < 8). What is your next step?
a. EMG for weakness evaluation
b. MRI of the thighs to locate an ideal biopsy site
c. Antisynthetase antibody level
d. Start prednisone 60-80 mg empirically
2. Which of the following antibodies are associated with a better prognosis in inflammatory myopathies?
a. Anti-JO-1 antibody
b. Anti-SRP antibody
c. Anti-Mi-2 antibody
d. Anti-PM-SCL antibody
3. A 45-year-old previously healthy Caucasian male visits your office. Two months ago, he started running 3-5 miles a day in an attempt to lose weight. For the past week, he noticed increasing pain and stiffness in his thigh and calve muscles. He denies taking any prescription medicine. He also has a sunburn rash on his face and shoulders. His thighs and calves muscles are stiff and mildly tender to touch without noticeable weakness. Preliminary bloodwork shows normal CBC and electrolytes, CK: 14,000 (normal < 150). You admit the patient to hospital and start hydration of patient. Three days later the CK decreased to 1500 and his leg pain and stiffness mildly improved. What is your next step?
a. MRI of the thighs
b. EMG
c. Start prednisone 80 mg/day
d. Discharge the patient, ask the patient not exercise for a while, and repeat the CK in a week
4. You started atorvastatin on a 65-year-old Hispanic female with a past medical history of type II diabetes, hypertension, and dyslipidemia. After 2 months, she notices generalized body pain and stiffness especially in her arms and hip area. You checked her lab tests which show a normal CBC and electrolytes, CK: 250, AST: 56, ALT: 45, and a T.Bil:0.8. You stopped the atorvastatin. Three months later the patient still has significant stiffness and pain in her hip area. She has mild-to-moderate weakness in her left quadriceps muscle, which is a new finding. New lab tests reveal a CK of 780 (normal < 150). What you first impression?
a. Persistent drug-induced myopathy
b. Relapsing drug-induced myopathy
c. Auto-immune necrotizing myopathy
d. Inclusion body myositis
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