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The Musculoskeletal System > Muscle Disease > Flashcards

Muscle Disease Flashcards

1
Q

Polymyositis and dermatomyositis are examples of which type of myopathy?

A

Inflammatory myopathy

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2
Q

Inflammatory myopathies more commonly affect whch gender?

A

Females

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3
Q

What is the most common clinical feature of the inflammatory myopathies?

A

Muscle weakness

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4
Q

What is the onset like with polymyositis and dermatomyositis?

A

Gradual

(over months)

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5
Q

Which muscles are commonly affected with polymoyositis and in which pattern (symmetrical/asymmetrical)?

A

Proximal muscles

(symmetrical pattern)

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6
Q

Which cutaneous signs are classic for dermatomyositis?

A
  1. Gottron’s sign
  2. Heliotrope rash
  3. Shawl sign
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7
Q

Describe Gottron’s sign

A
  • A purple/violet colouring of the skin over the MCP and PIP joints
  • This can be painful and may bleed
  • Often worsens in sunlight
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8
Q

How is the respiratory system affected by polymyositis or dermatomyositis?

A

Interstitial lung disease

Respiratory muscle weakness

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9
Q

How can the cardiovascular system be affected by polymyositis or dermatomyositis?

A

Myocarditis

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10
Q

Which symptom associated with polymyositis and dermatomyositis involves oesophageal issues?

A

Dysphagia

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11
Q

Which other non-specific symptoms besides the specific systems symptoms can be seen in polymyositis and dermatomyositis?

A
  • Fever
  • Weight loss
  • Raynaud’s
  • Non-erosive polyarthritis
  • SOB
  • Cough
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12
Q

Which patient with polymyositis (or dermatomyositis) is most at risk of malignancy?

a) John 75
b) Bertha 70

A

John

Men >45 have greatest risk of malignancy

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13
Q

Which types of malignancy can be associated with polymyositis or dermatomyositis?

A
  • Ovarian
  • Breast
  • Stomach
  • Lung
  • Bladder
  • Colon
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14
Q

Which inflammatory myositis (dermatomyositis or polymyositis) is most prone to malignancy?

A

Dermatomyositis

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15
Q

Which drug class can bring on symptoms similar to those seen in polymyositis or dermatomyositis?

A

Statins

(or steroids)

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16
Q

Which worrying signs in a social history would strengthen your suspision for dermatomyositis or polymyositis?

A
  • High alcohol consumption
  • Illicit drug use
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17
Q

What are the two main methods for testing a patient’s muscle strength?

A
  1. Confrontational (direct test of power)
  2. Isotonic (test how much of a certain exercise they can do in a time limit)
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18
Q

Which muscle enzyme will be raised in dermatomyositis or polymyositis?

A

Creatinine kinase

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19
Q

Which antibodies will be found in polymyositis or dermatomyositis?

A
  • Anti-nuclear antibody (ANA)
  • Anti-Jo-1
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20
Q

How are inflammatory markers impacted in polymyositis or dermatomyositis?

A

They are raised

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21
Q

What is electromyography?

A

The passing of a low volatge electric current through the affected muscle to check normal activity

22
Q

What is the only definitive test for polymyositis or dermatomyositis and what does it show?

A

Muscle biopsy

Perivascular inflammation and necrosis of muscle

23
Q

What can MRI of muscle show in patients with polymyositis or dermatomyositis?

A
  • Muscle inflammation
  • Oedema
  • Fibrosis
  • Calcification
24
Q

What are the treatment options for polymyositis or dermatomyositis?

A
  • Glucocorticoids
  • Immunosuppressants
  • IV immunoglobulin
  • Rituximab
25
Q

Why, when treating inflammatory myositis, are glucocorticoids given in initially high doses and then reduced to lower doses?

A

Glucorticoids have many negative side effects including muscle weakness, which is one of the man complaints of inflammatory myositis

26
Q

Inclusion body myositis is often misdiagnosed for what?

A

Polymyositis

27
Q

Describe the key differences between inclusion body myositis and polymyositis?

A
  • It is not an autoimmune condition
  • It is commoner in men
  • It generally affects the distal muscles rather than the proximal muscles
  • It is usually asymmetrical
  • It has slower onset
  • Creatinine kinase levels are lower
28
Q

How does inclusion body myositis respond to therapy?

29
Q

Weakness in muscles is often symmetrical/asymmetrical in inclusion body myositis?

A

Asymmetrical

30
Q

What is polymyalgia rheumatica?

A

A potentially autoimmune condition (cause is unknown) which causes neck, shoulder and hip girdle pain

31
Q

Polymyalgia affects people of what age bracket?

A

Almost exclusively those >50

32
Q

Polymyalgia rheumatica can cause dramatic muscle _________ but not muscle _________

A

Stiffness

Weakness

33
Q

Polymyalgia rheumatica is associated with what?

A

Temporal arteritis

Giant cell arteritis

34
Q

What is seen on a muscle biopsy with someone who has polymyalgia rheumatica?

A

Nothing abnormal

35
Q

Why may vision loss occur in those with temporal arteritis?

A

The temporal artery supplies the optic nerve

36
Q

How does temporal arteritis affect the termporal artery?

A
  1. Tender and enlarged
  2. Non-pulsatile
  3. Prominent
37
Q

How is the jaw impacted in temporal arteritis?

A

Jaw claudication when in use

38
Q

What is the vision loss associated with temoral arteritis called?

A

Amaurosis fugax

(painless and temporary loss of vision in one or both eyes)

39
Q

How can temporal arteritis be diagnosed?

A
  • Raised ESR, CRP and PV
  • Temporal artery biopsy
40
Q

Temporal arteritis/giant cell arteritis and polymyalgia rheumatica are ____ - _________ conditions

A

Self-limiting

41
Q

What is the treatment for polymyalgia rheumatica?

A

Low dose steroids

(this causes a drastic and rapid improvement, which can even be used to test if it is polymyalgia rheumatica as this response is unique)

42
Q

What are the following doses for polymyalgia rheumatica?

a) Starting dose
b) With temporal arteritis
c) With eye problems due to temporal arteritis

A

a) 15mg
b) 40mg
c) 60mg

43
Q

Fibromyalgia is an inflammatory condition.

True or false

44
Q

Name some symptoms and syndromes associated with fibromyalgia?

A
  • Irritable bowel syndrome
  • Depression
  • Poor sleep and fatigue
  • Migraines
  • Poor concentration and memory
45
Q

When can fibromyalgia come on?

A

After physical or emotional trauma

46
Q

Where are the most commonly painful areas in fibromyalgia?

A
  • Neck
  • Shoulders
  • Lower back
  • Chest wall
47
Q

Is fibromyalgia diffuse or localised?

48
Q

What can make fibromyalgia worse?

49
Q

What are the clinical findings for fibromyalgia?

A
  • Excessive tenderness on palpation
  • No other abnormalities (all blood tests normal)
50
Q

What are the treatment options for fibromyalgia?

A
  • Tricyclic antidepressants e.g. amitriptyline
  • Gabapentin, pregabalin
  • Analgesia
  • Acupuncture
  • Graded exercise
51
Q

What are some of the negative side effects of steroids?

A
  • Weight gain
  • Osteoporosis (Ca2+, vitamin D + biphosphonates can be given to counteract)
  • Infection

The Musculoskeletal System (58 decks)

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