Muscle Disease

Question 1

name 2 types of inflammatory myopathies

Answer 1

polymyositis

dermatomyositis

Question 2

Polymyositis and Dermatomyositis are __________ ____________ myopathies

Answer 2

idiopathic inflammatory

Question 3

the female to male ratio in polymyositis and dermatomyositis is 1:2

true or false?

Answer 3

false

F:M
2:1

Question 4

what is the peak incidence age in polymyositis and dermatomyositis?

Answer 4

40-50 years

Question 5

what is there an increased incidence of in polymyositis and dermatomyositis?

Answer 5

malignancy

Question 6

what are the histological features of polymyositis and dermatomyositis?

Answer 6

muscle biopsy include muscle fibre necrosis, degeneration, regeneration and an inflammatory cell infiltrate.

Underlying cause is not clear

Question 7

what is the most common clinical feature in polymyositis and dermatomyositis?

Answer 7

muscle weakness

Question 8

what cutaneous sign is seen in dermatomyositis in the hands?

Answer 8

gottrons sign

Question 9

what cutaneous rash is seen in dermatomyositis on the face?

Answer 9

heliotrope rash

Question 10

what cutaneous sign is seen in dermatomyositis on the back?

Answer 10

shawl sign

Question 11

what other organs are involved in dermatomyositis?

Answer 11

lung - ILD
oesophageal - dysphagia
cardiac - myocarditis
other - Raynaulds

Question 12

there is a __% incidence of malignancy in dermatomyositis and _% incidence of malignancy in polymyositis

Answer 12

15% - dermatomyositis

9% - polymyositis

Question 13

outline the typical history in dermatomyositis and polymyositis?

Answer 13

tired muscles and pain
DM and thyroid disease
steroids and statins
alcohol, drug use
weight loss, cough, breathlessness, Raynaulds

Question 14

what 2 tests are performed in dermatomyositis and polymyositis?

Answer 14

confrontational (power) and isotonic (30 sec sit and stand)

Question 15

what is seen in the blood of someone with dermatomyositis and polymyositis?

Answer 15

CK
inflammatory markers
ANA
Anti Jo-1

Question 16

what other investigations can help diagnose in dermatomyositis and polymyositis?

Answer 16

electromyography - EMG
muscle biopsy
MRI

Question 17

what is seen on biopsy of the muscle of someone with dermatomyositis and polymyositis?

Answer 17

Perivascular inflammation and muscle necrosis

Question 18

what is the treatment in dermatomyositis and polymyositis?

Answer 18

Glucocorticoids
Azathioprine
Methotrexate
Ciclosporin
IV immunoglobulin
Rituximab

Question 19

Polymyalgia Rheumatica is seen in people over the age of what?

Answer 19

50 years old

Question 20

Incidence of Polymyalgia Rheumatica is higher in southern regions

true or false?

Answer 20

false

northern

Question 21

what conditions is Polymyalgia Rheumatica associated with

Answer 21

Associated with temporal arteritis/giant cell arteritis (15%)

Question 22

what are the clinical manifestations seen in Polymyalgia Rheumatica?

Answer 22

ache is shoulder and hip
morning stiffness
strength is normal

Question 23

what does temporal arteritis cause?

Answer 23

headache
scalp tenderness
jaw claudication
visual loss

Question 24

how do you diagnose Polymyalgia Rheumatica?

Answer 24

raised ESR, PV, CRP

temporal artery biopsy

Question 25

what is the treatment in Polymyalgia Rheumatica?

Answer 25

low dose steroids

Question 26

fibromyalgia is associated with inflammation true or false?

Answer 26

false! Not associated with inflammation

Question 27

in what sex and age is fibromyalgia most common?

Answer 27

female (6:1) | 22-50 years old

Question 28

what are the clinical manifestations in fibromyalgia?

Answer 28

``` pain in neck, shoulder and lower back chronic worse with exception swelling fatigue pins and needles general unwellness ```

Question 29

what are the clinical findings in fibromyalgia?

Answer 29

excessive tenderness on palpitation

Question 30

what is the diagnosis criteria in fibromyalgia?

Answer 30

widespread pain >/= 3 months unrefreshing sleep, fatigue no other condition explains pain

Question 31

what is the treatment in fibromyalgia?

Answer 31

``` exercise acupuncture anti-depressants analgesia gabapentin and pregablin ```

Question 32

diagnose: ``` 63 year old male pain in shoulders and hips raised PV and CRP normal CK ```

Answer 32

Polymyalgia Rheumatica

Question 33

what is the treatment in Polymyalgia Rheumatica? drug? mg? duration?

Answer 33

Prednisolone 15mg reducing course over 6 months

Question 34

diagnose: ``` 64 year old man heavy arm for 6 months tiring climbing stairs EMG suggests myositic change in the proximal muscles raised CK and CRP ```

Answer 34

dermatomyositis

Question 35

how does Alan Muldoon make his boyfriend scream during sex?

Answer 35

he calls him and tells him about it