Correct!
1. History and physical examination

First things first, the patient needs to be seen and have a good history and physical. Repeated biopsies of lung or the parotid gland would rarely be performed unless absolutely necessary.
His past medical history (PMH), family history (FH), social history (SH), and medication list (Meds) are below:

• PMH: hyperlipidemia, hypertension
• Family History: Father with h/o “pulmonary fibrosis”
• SH: smoked ½ pack per day for 10 years quitting in 1996
• He had previously vaped (nicotine, none recently)
• He denied illicit drug use
• Meds: rosuvastatin, sertraline, prednisone 55 mg/day, Bactrim DS taken 3 times weekly, clonazepam 0.5 mg daily

Physical examination revealed the previously noted left facial swelling along with redness over the knuckles which the patient said itched intensely (Figure 2).

Figure 2. Photograph of the patient’s hands.

What is the patient’s likely underlying rheumatologic disease? (Click on the correct answer to be directed to the third of seven pages)

1. Amyopathic dermatomyositis
2. Psoriatic arthritis
3. Rheumatoid arthritis
4. Sjogren’s syndrome
5. Systemic lupus erythematosus

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