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Answer: A, C, D
A: Referral to a neurologist for evaluation of possible systemic conditions, neuromuscular diseases, myositis, or secondary myopathies. A referral to a neurologist, electromyography/nerve conduction studies, and a biopsy of the neck extensor musculature are needed to determine whether this patient has isolated cervical extensor myopathy.
C: Electromyography/nerve conduction velocity testing, including the cervical paraspinal muscles. A referral to a neurologist as well as obtaining electromyography/nerve conduction studies and a biopsy of the neck extensor musculature are needed to determine whether this patient has isolated cervical extensor myopathy.
D: Biopsy of the neck extensor musculature. A referral to a neurologist as well as obtaining electromyography/nerve conduction studies and a biopsy of the neck extensor musculature are needed to determine whether this patient has isolated cervical extensor myopathy.