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Rheumatology > MSK weakness > Flashcards

MSK weakness Flashcards

1
Q

ALS presentation

A

upper motor neuron (hyperreflexia and spasticity) and lower motor neuro (atrophy, fasciculation) symptoms. Can have distal muscle weakness. no pain seen

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2
Q

Extramedullary tumor with compressive myelopathy presentation

A

sensory loss, hyperreflexia, spasticity, incontinence.

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3
Q

Polymyositis

A

symmetrical proximal muscle weakness with or without pain. ESR, CRP, and CPK and aldolase levels are increased.

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4
Q

anterior or cutaneous nerves compression presentation

A

only sensory nerves and so compression doesn’t cause muscle weakness or absent reflexes

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5
Q

Presentation of acute asymmetrical focal lower extremity weakness in DM2 (well controlled) and see muscle atrophy and areflexia and autonomic dysfunction and unintentional weight loss

A

diabetic amyotrophy

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6
Q

Treatment of diabetic amyotrophy

A

PT, pain control, strict glycemic control and most make partial functional recovery.

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7
Q

Differential for myopathy

A

steroid induced myopathy, polymyaglia rheumatica, inflammatory myopathies, statin induced myopathy, hypothyroid myopathy

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8
Q

clinical features of steroid induced myopathy

A

progressive proximal muscle weakness and atrophy, without pain or tenderness, lower extremity muscles involved.

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9
Q

inflammatory markers of steroid induced myopathy

A

Normal ESR and CK

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10
Q

clinical features of polymyalgia rheumatica

A

muscle pain and stiffness in shoulder and pelvic girdle and tenderness with decreased range of motion at shoulder, neck, and hip responds rapidly to low dose (prednisone 20 mg/daily)

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11
Q

inflammatory markers of steroid induced myopathy

A

high ESR and CK normal

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12
Q

inflammatory myopathies clinical presentation

A

muscle pain, tenderness and proximal muscle weakness, skin rash and inflammatory arthritis may be present

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13
Q

inflammatory markers of inflammatory myopathies

A

high ESR and CK

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14
Q

Inflammatory myopathies are:

A

dermatomyositis and polymyositis

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15
Q

statin induced myopathy clinical features

A

prominent muscle pain and tenderness with or without weakness rarely rhabdomyolysis

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16
Q

hypothyroid myopathy clinical features

A

muscle pain, cramps, weakness involving the proximal muscles, delayed tendon reflexes and myoedema and occasional rhabdomyolysis and severe myopathy

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17
Q

laboratory findings of hypothyroid myopathy

A

normal and high CK (usually <10 times the upper limit of normal)

18
Q

laboratory findings of steroid induced myopathy

A

normal ESR and high CK

19
Q

what condition can precipitate statin myopathy?

A

hypothyroidism - thus 1st test to screen for is hypothyroidism prior to starting statin therapy and if someone complains of statin induced myopathy, check the thyroid function.

20
Q

what labs support a diagnosis of polymyositis?

A

ANA and EMG makes diagnosis. Can see proximal muscle weakness and elevated CK levels

21
Q

What two conditions have proximal muscle weakness?

A

hypothyroid myopathy and polymyositis

22
Q

Can coenzyme q10 prevent statin myopathy?

A

no the evidence is weak and so no don’t supplement with coenzyme q 10.

23
Q

prolonged vitamin D deficency

A

can cause muscle weakness and bone pain. Also this can lead to secondary hyperparathyroidism and osteomalacia. Would also se low phos and elevated bone turnover makres (alkaline phosphatase)

24
Q

Complications of dermatomyositis

A

pulmonary: interstitial lung dx, respiratory muscle weakness GI: dysphagia, nasal regurgitation, aspiration cardiac: myocarditis Malignancy: adenocarcinoma (lung, breast, ovarian) and lymphoma.

25
Q

velcro crakles and diffuse reticulonodular interstitial opacities in the lung bases and dysphagia with proximal muscle weakness

A

dermatomyositis

26
Q

Does polymyalgia rheumatica have muscle weakness

A

no, it only has pain related to dx and so may see weakness which is really related to pain and not true weakness

27
Q

age>50,

bilateral pain and morning stiffness

>1 month of 2 of the following areas: neck or torso, shoulders or proximal arms proximal thigh or hip, constitutional fever, malaise or weight loss

A

polymyalgia rheumatica clinical features

28
Q

physical exam of polymyalgia rheumatica

A

decreased ROM of shoulders, neck and hips

29
Q

Lab findings of polymyalgia rheumatica

A

ESR>40 and sometimes >100 elevated CRP>10 in 90% of individuals normocytic anemia possible 20% can have normal studies

20% of people can have normal ESR and still have PMR

CRP is elevated in most people

but if there’s still uncertainty can start empiric low dose prednisone at 10-15mg/day and slow taper over 1-2 years. PMR pts should see improvement in about 3 days after starting prednisone.

30
Q

treatment of PMR or polymyalgia rheumatica

A

prednisone 15-20 mg daily provides rapid relief and this distinguishes this from other myopathies

31
Q

diabetic amyotrophy presentation

A

acute asymmetrical pain followed by gradual worsening proximal lower extremity and back weakness and autonomic failure and weight loss

32
Q

wide spread MSK pain fatigue, stiffness and aching on characteristic tender points

A

fibromyalgia Normal CRP and ESR and prevalence increases with age

33
Q

myaglias, weakness and elevated creatine kinase

A

hypothyroid myopathy See high TSH

34
Q

chart of myopathies

A
35
Q

morning stiffness of shoulders, hips girdles, neck

A

PMR or polymyalgia rheumatica

36
Q

Diagnosis of meralgia peresthetica is:

A
37
Q

Treatment of meralgia paresthetica

A

self limited condition and conservative treatment is needed in >90% of pts

avoid tight garments

weight loss

anticonvulsants (gabapentin) or local nerve block

38
Q

injury to lateral femoral cutaneous nerve or compression at inguinal ligament or injury during local surgery or seat belt injury from MVA causes this:

A

meralgia paresthetica

39
Q

risk factors for meralgia paresthetica

A

obesity with heavy panniculus

diabetes

pregnancy

tight clothing and belts at waist

40
Q

paresthesias and decreased sensation at the upper lateral thigh

no motor deficits

A

meralgia paresthetica presentation

41
Q
A
42
Q

MRI of the diagnosing the radiculopathy spinal stenosis or spondylolisthesis

A

see weakness and sensory loss of the affected spinal root nerves

Rheumatology (29 decks)

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