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Y2 MSK > Muscle diseases > Flashcards

Muscle diseases Flashcards

1
Q

What is dermatomyositis

A

inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions

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2
Q

Cause of dermatomyositis

A

Idiopathic
Associated with other connective tissue disorders or malignancy

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3
Q

What malignant conditions are associated with dermatomyositis

A

ovarian cancer
breast cancer
lung cancer

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4
Q

What is polymyositis

A

A variant of dermatomyositis but without dermatological features (skin lesions), only muscle weakness and myalgia

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5
Q

Symptoms of dermatomyositis

A

Symmetrical, proximal muscle weakness
Myalgia
Muscle wasting
Raynaud’s
Skin involvement
Other organ involvement (lungs, oesophagus, heart)
Fever

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6
Q

What will patients complain of if they have dermatomyositis

A

Difficulty combing hair
Difficulty walking up the stairs
Difficulty rising from a chair
Difficulty raising objects

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7
Q

What are the skin features of dermatomyositis

A

Heliotrope rash
Gottron’s papules
Shawl rash - across back and shoulders
Very dry and scaly hands
Nail fold erythema

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8
Q

Where is heliotrope rash seen

A

Purple rash on eyelids

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9
Q

Where are Gottron’s papules seen

A

red papules on the dorsal aspect of the finger joints
In dermatomyositis

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10
Q

What are the other organ involvement of dermatomyositis

A

Lung
- respiratory muscle weakness
- Interstitial lung disease
Oesophagus
- dysphagia
Heart
- myocarditis

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11
Q

Investigations for dermatomyositis

A
  1. Creatine kinase level (raised)
    Muscle biopsy
    auto-antibody screen
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12
Q

Autoantibodies specific to dermatomyositis

A

Anti-Jo1
Anti-SRP

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13
Q

What are the non-specific autoantibodies that can present in dermatomyositis but also other conditions

A

Anti-Mi2
Anti-RNP

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14
Q

Management of dermatomyositis

A

Oral steroids (prednisolone)
Screen for malignancy (because it is associated with malignancy)

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15
Q

Which steroid is used for dermatomyositis

A

Prednisolone

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16
Q

What is the most common chronic MSK pain in women 20-40 years old

A

Fibromyalgia

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17
Q

What is fibromyalgia

A

Neurosensory disorder characterised by chronic MSK pain

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18
Q

Risk factors of fibromyalgia

A

Women
20-40
Family history

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19
Q

Fibromyalgia is associated with which other conditions

A

RA (seen in 25% of patients with RA)
SLE (seen in 50% of patients with SLE)

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20
Q

Cause of fibromyalgia

A

disorder of central pain processing causing lower threshold of pain and of other stimuli, amplifying pain

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21
Q

Symptoms of fibromyalgia

A

Persistent widespread pain
Fatigue (due to disrupted sleep cuz of pain)
Headaches
Anxiety, Depression
Non-cardiac chest pain

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22
Q

What is considered as widespread pain

A

Pain in
- both sides of the body
- above and below the waist
- including axial spine

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23
Q

What clinical findings may be present in fibromyalgia

A

at least 11 out of 18 tender points on palpation
Pain on palpating those tender points

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24
Q

Where are the 18 possible tender points of fibromyalgia

A

Around the lower neck
Hips
Shoulder
Upper back
Outer knee
Elbows

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25
Q

Investigations for fibromyalgia

A

Clinical
- patient experiencing widespread persistent pain and associated symptoms
- Symptoms present for >3m
- no other explanation of the pain

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26
Q

Management for fibromyalgia

A

Antidepressants (tricyclics)
Analgesia (tricyclics, gabapentin and pregabalin)
CBT
Exercise programmes and relaxation techniques

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27
Q

Which tricyclic is used for analgesia for fibromyalgia

A

Amitryptyline

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28
Q

What analgesia are used for fibromyalgia

A

Amitryptyline
Gabapentin
Pregabalin

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29
Q

What is myasthenia gravis

A

Autoimmune neurological disorder causing muscular weakness and progressive fatigue

30
Q

Causes of myasthenia gravis

A

Autoantibodies against acetylcholine receptors limits the ability of acetylcholine to cause muscle contraction

31
Q

Risk factors of myasthenia gravis

A

Women
60-70

32
Q

Conditions associated with myasthenia gravis

A

SLE
RA
thyrotoxicosis
Thymic hyperplasia (in 50-70% of patients)
Thymoma

33
Q

Symptoms of myasthenia gravis

A

Progressive muscular weakness
Progressive muscular fatigues
Drooping eyelids
Diplopia
Change in speech or swallowing
Difficulty in swallowing
Difficulty in smiling

34
Q

Which muscles are often affected first in myasthenia gravis

A

Eyes
Face
Mouth
Throat

35
Q

Which muscles are not commonly affected by MG

A

Neck
shoulder
Hip flexors

36
Q

What are the hip flexor muscles

A

Psoas
Iliacus
Rectus femoris
Pectineus
Sartorius

37
Q

Why may MG become life-threatening

A

Due to involvement of respiratory muscles causing impaired respiration

38
Q

Investigations for MG

A

Clinical
Autoantibodies in blood
Imaging

39
Q

What clinical findings may be seen in MG

A

Bilateral ptosis (drooping eyelids)
Difficulty speaking
Myasthenic snarl

40
Q

What autoantibodies is found in blood tests for MG? Is it specific and sensitive?

A

Anti-ACHr (acetycholine receptor antibodies)
Yes it is both specific and sensitive (present in 90% of patients and 99% of those who have it have MG)

41
Q

Why should imaging be done for MG

A

Because MG is associated with thymoma and thymus hyperplasia

42
Q

Management of MG

A
  1. Anticholinesterase
  2. Steroids
  3. Surgery - thymectomy if associated with thymoma
43
Q

Examples of anti cholinesterase

A

pyridostigmine
neostigmine

44
Q

Use of anticholinesterase

A

inhibit the breakdown of acetylcholine in the synaptic cleft so increase activation of the receptors

45
Q

Side effects of anti cholinesterase

A

diarrhoea
salivation
lacrimation
urinary frequency

46
Q

Which steroid is used first line for MG

A

Prednisolone

47
Q

What is myonecrosis

A

Life-threatening necrotizing soft tissue infection

48
Q

Cause of myonecrosis

A

Clostridium perfringens from a contaminated wound

49
Q

Symptoms of myonecrosis

A
  • Disproportionate muscle pain
  • Massive edema with skin discoloration that progresses from bronze to red-purple to black and overlying bullae
  • Can progress to systemic infection
50
Q

Progression of cutaneous manifestation of myonecrosis

A

Skin discolouration that changes colour from bronze -> red purple -> black + bullae

51
Q

Investigations for myonecrosis

A

Imaging
Wound culture / blood culture

52
Q

What would imaging show in myonecrosis

A

Feathering pattern

53
Q

Management of myonecrosis

A

Immediate surgical debridement
Antibiotics

54
Q

What is pyomyositis

A

Acute intramuscular infection secondary to haematogenous spread of the microorganism

55
Q

Risk factors of pyomyositis

A

Person who inject drugs
Diabetes
Immunosuppressed

56
Q

Most common causative pathogen of pyomyositis

A

S aureus

57
Q

Pyomyositis in immunosuppressed patients is most commonly caused by

A

Pseudomonas
Beta haemolytic strep
Enterococcus

58
Q

Pyomyositis in tropical climates is mostly caused by

A

MSSA (Meticillin sensitive S aureus)

59
Q

Symptoms of pyomyositis

A

Pain
Swelling
Fever
Abscess in muscle

60
Q

Investigations for pyomyositis

A

CT / MRI
Pus discharge culture

61
Q

Management for pyomyositis

A

Surgical debridement, drain the pus
Antibiotics

62
Q

Causative pathogens of viral myositis

A

Influenza
HIV
CMV
Rabies
Dengue

63
Q

Presentation of viral myositis

A

Fever
Pain
tenderness
Weakness
Swelling

64
Q

Investigations for viral myositis

A

Blood tests - show elevated creatinine kinase

65
Q

Cause of tetanus

A

Clostridium tetani

66
Q

Pathophysiology of tetanus

A
  1. C. tetani release neurotoxins
  2. the toxins bind to inhibitory neurons
  3. and prevents release of inhibitory neurotransmitters
  4. which causes widespread activation of motor neurons and spasming of muscles
67
Q

Symptoms of tetanus

A

Trismus (lock jaw)
Risus sardonicus
Muscular spasms
Dysphagia

68
Q

what is risus sarconicus

A

abnormal, sustained spasm of the facial muscles that appears to produce grinning

69
Q

Complications of tetanus

A

laryngospasm (causing asphyxia)
respiratory failure

70
Q

Investigations for tetanus

A

Clinical
Culture if not sure

71
Q

Management for tetanus

A

IV tetanus immunoglobulin (antitoxin)
Supportive

72
Q

Prevention of tetanus

A

Vaccination
Wound management

Y2 MSK (19 decks)

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