ME/CFS Flashcards
what is myalgic encephalomyelitis/chronic fatigue syndrome?
dysregulation of CNS, immune system, cellular energy metabolism, ion transport, CV abnormalities
hypometabolic state - measured with seahorse technology
presentation of ME/CFS needed for Dx
impairment of daily function
post exertion malaise
unrefreshing sleep
plus one of:
cognitive impairment
orthostatic intolerance
Canadian consensus criteria for ME/CFS
pathological fatigue post exertion malaise unrefreshing sleep chronic pain neurocognitive symptom autonomic symptom (difficulty standing) endocrine symtoms (temp control) immune symptoms (flu, sensitivity)
how to measure post-exertional malaise
unable to perform as well on dy 2 of a 2-day maximal cardiopulmonary test protocol
goals of treatment for ME/CFS
increase QoL
treat orthostatic intolerance
add salt
help sleep
major differences between CFS and fibromyalgia
ME/CFS is more severe
people with FM benefit from moderate activity, in CFS it is not
FM is chronic widespread pain and fatigue
difference bw CFS and depression
immune, autonomic and endocrine symptoms are not seen in depression
what is polymyalgia rheumatica?
inflammatory disease
proximal muscle pain and stiffness with rest
flu-like symptoms
PE findings of polymyalgia rheumatica?
no loss of muscle bulk
unable to raise arms, standing up from seated/bed position
reduced shoulder ROM
lab findings of polymyalgia rheumatica?
elevated ESR (inflammation)
normal muscle enzymes
normal EMG
management of PE?
prednisone maintenance dose
presentation of giant cell arteritis
fatigue, scalp tenderness, jaw claudication, fever
new onset severe headache
PE findings of giant cell arteritis
temporal artery is tender tot ouch or has decreased pulsation
occipital artery may be tender
lab findings of giant cell arteritis
ESR elevated
temporal artery biopsy is abnormal (skip lesions, mononuclear cells and granulomatous inflammation)
US: halo sign
Tx for giant cell arteritis
prednisone
DMARDs
biologics
golfer’s elbow is pain over
medial epicondyle
wrist flexors
tennis elbow is pain over
lateral epicondyle
what is fibromyalgia
widespread pain on both sides of the body
pain in 11/18 tender points on digital palpation
not a muscle, immunologic, psychological or arthritic disease
epi of fibromyalgia
F > M
40-50yr
Tx for fibromyalgia
no specific drug therapy
medication for sleep can be beneficial
exercise could help symptoms
fibromyalgia is a:
a. Muscle disease
b. Form of arthritis
c. Psychiatric disorder
d. Chronic pain disorder
Chronic pain disorder
Fibromyalgia is caused by
a. A virus
b. Trauma or injury
c. Stress
d. Severe illness
e. None of the above
none of the above
Fibromyalgia symptoms respond to:
a. Anti-inflammatory medications
b. Narcotic medications
c. Inactivity
d. None of the above
None of the above
what is Marfan syndrome?
genetic disorder of connective tissue
single gene mutation (AD) of fibrillin gene
pathophysiology of Marfan syndrome
abnormal TGF-beta signalling
breakdown of connective tissue
breakdown of vasculature
clinical manifestation of Marfan syndrome
Arachnodactyly Steinberg/Thumb sign Walker-Murdoch sign Foot deformities Scoliosis Pectus carinatum/excavatum (Protruding/in-pouching of chest wall) High palate inside mouth Ectopia lentis (pathognomonic for this disease)
investigations for Marfan syndrome
CBC, cre, lytes, LFT, autoimmune disease
annual optho exam
annual echo
Tx for Marfan syndrome
low impact exercise
BP control
ortho surgery
what is achondroplasia?
single gene mutation (AD)
physeal dysplasia (abnormal growth)
increased mortality
clinical manifestations of achondroplasia
macrocephaly midface hypoplasia otitis media short limbs flexion contractures lumbar lordosis, scoliosis spinal stenosis high BMI
Tx for achondroplasia
no good drug therapies
research for inhibition of FGFR3
vosoritide (cartilage natriuretic peptide)
surgical: limb lengthening, spinal surgery
what is Ehlers-Danlos syndrome?
structural abnormalities of skin, ligaments, blood vessels
presentation of hypermobility, dislocations, stretchy skin, bruising, mitral value prolapse
