Correct!
4. 1 and 3

It is rarely necessary to repeat surgical biopsies.  Given that the Gottron nodules, a rheumatology panel is justified (Table 1).

Table 1. Serum rheumatology panel.

• SS-A/Ro Ab, IgG, S: <0.2
• SS-B/La Ab, IgG, S: <0.2
• Sm Ab, IgG, S: <0.2
• RNP Ab, IgG, S: <0.2
• Scl 70 Ab, IgG, S: <0.2
• Jo 1 Ab, IgG, S: <0.2
• CPK and aldolase were both normal

Repeating the CT scan is also reasonable (Figure 3).

Figure 3. Representative image in lung windows from the repeat thoracic CT scan.

Which of the following are true regarding the patient’s repeat thoracic CT scan and serum rheumatology panel? (Click on the correct answer to be directed to the fifth of seven pages)

1. The new lung nodules are dermatomyositis nodules and indicative of progressive disease
2. The new lung nodules raise a concern for metastatic cancer
3. The normal serum rheumatology panel is inconsistent with a diagnosis of dermatomyositis
4. 1 and 3
5. All of the above

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