<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 32-year-old woman comes to the physician because of increasing muscle weakness in her shoulders and legs for 6 weeks. She is unable to climb stairs or comb her hair. She has also had difficulty swallowing food for the past week. Her symptoms do not improve with rest. Physical examination shows normal muscle tone. There is bilateral weakness of the iliopsoas, hamstring, deltoid, and biceps muscles. Deep tendon reflexes are 2 bilaterally. Sensation to pinprick, temperature, and vibration is intact. The remainder of the examination shows no abnormalities. Laboratory studies show:Hemoglobin 10.7 gdLLeukocyte count 10.800mm3Erythrocyte sedimentation rate 100 mmhSerumGlucose 60 mgdLCreatine kinase 7047 ULLactate dehydrogenase 2785 ULThyroid-stimulating hormone 4.0 μUmLWhich of the following is the most appropriate next step in management?? A: Lumbar puncture, B: Electromyography, C: Tensilon test, D: Temporal artery biopsy, E: Skin biopsy,  <response>: This is a clinical case scenario describing a 32-year-old woman with progressive muscle weakness over 6 weeks. Key findings include proximal muscle weakness, dysphagia, no improvement with rest, normal muscle tone, intact reflexes and sensation. Lab tests show mild anemia, normal WBC, elevated ESR, normal glucose, very elevated CK and LDH, and normal TSH. This presentation is most consistent with an inflammatory myopathy such as polymyositis or dermatomyositis. The proximal and symmetric muscle weakness, dysphagia, elevated muscle enzymes and inflammatory markers point towards this. Lumbar puncture and temporal artery biopsy would not be helpful next steps. Tensilon test is used to diagnose myasthenia gravis, which does not fit with the case presentation. Electromyography would be helpful to confirm the diagnosis of an inflammatory myopathy. Skin biopsy may show diagnostic changes of dermatomyositis but would not be the most appropriate next step.B: Electromyography 