Approach to differentiating lesions (muscle) Quiz: Ace Your Exams
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A 52-year-old woman presents to the primary care clinic for evaluation of weakness. For the past year, she has noticed gradually progressive, persistent weakness. She has increasing difficulty combing her hair and getting out of a chair. Her past medical history includes major depressive disorder for which she takes citalopram. There is no family history of similar symptoms. The patient's temperature is 37.0°C (98.6°F), pulse is 84/min, respirations are 12/min, and blood pressure is 120/80 mmHg. On physical exam, she is alert and has normal facial muscle strength. There is weakness with bilateral shoulder abduction and hip flexion. Reddish-purplish papules are present over the metacarpophalangeal and interphalangeal joints of the fingers on both hands, and the skin appears rough, with cracking. Sensation is intact throughout. Which of the following additional features is most likely present in this patient?
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