Rosh Internal Medicine Boost Practice Exam

In a patient suspected of polymyositis, which physical exam finding would be most indicative of the condition?

1. Painful proximal muscles without weakness

2. Positive Homan's sign

3. Several positive tender points

4. Weakness of the proximal muscles without pain

The correct answer is: Weakness of the proximal muscles without pain

In polymyositis, the hallmark physical exam finding is the weakness of proximal muscles without accompanying pain. Patients often present with difficulty in performing tasks that require the use of proximal muscles, such as climbing stairs, lifting objects, or raising their arms. This weakness is due to the inflammatory damage to muscle fibers that occurs in this condition. Unlike other conditions, polymyositis typically does not present with muscle pain; therefore, patients may not report any discomfort, setting this condition apart from other myopathies. The presence of weakness alone is a more specific indicator of polymyositis, as other conditions that involve muscle pain, such as fibromyalgia or muscular injuries, do not typically lead to the same degree of proximal muscle weakness. The other options do not align with the characteristic presentation of polymyositis. Painful proximal muscles without weakness suggests an alternative etiology like myalgias or strain rather than the specific muscle weakness experienced in polymyositis. A positive Homan's sign indicates possible deep vein thrombosis, which is unrelated to muscle weakness. Several positive tender points point towards fibromyalgia rather than polymyositis, emphasizing tenderness rather than the distinct muscular weakness associated with polymyositis.