Muscle diseases and crystal arthropathies (cortex)

Question 1

relatively common chronic inflammatory condition of unknown etiology that affects elderly individuals?

Answer 1

Polymyalgia rheumatica

Question 2

Approximately 15% of patients with polymyalgia rheumatica develop ?

Answer 2

giant cell arteritis

Question 3

There is no specific diagnostic test for PMR but it is almost always associated with ?

Answer 3

raised CRP and PV/ESR

Question 4

In PMR Symptoms respond very dramatically to ? this is sometimes used as a diagnostic tool.

Answer 4

low dose steroids - prednisolone 15mg

dose is gradually reduced over the course of around 18 months (usually resolved)

Question 5

GCA presentation?

Answer 5

Jaw claudication
temporal artery thickened and tender to touch
visual disturbances
fatigue, malaise, and fever

Question 6

The most definitive test for GCA is?

Answer 6

temporal artery biopsy

Question 7

Therapy for GCA?

Answer 7

prednisolone 40mg if no visual impairment and 60mg if visual symptoms
dose is gradually tapered over around 2 years (usually resolved)

Question 8

Typical biopsy findings GCA?

Answer 8

mononuclear infiltration or granulomatous inflammation, usually with multinucleated giant cells

Question 9

what is polymyositis?

Answer 9

idiopathic inflammatory myopathy that causes symmetrical, proximal muscle weakness

Question 10

Polymyositis and dermatomyositis are more common in women

Answer 10

T

Question 11

dermatomyositis is clinically simmilar to polymyositis but also has typical cutaneous manifestations

Answer 11

T

Question 12

female 45 y/old notices gradual increasing difficulty climbing stairs and dysphagia

Answer 12

polymyositis

Question 13

Which investigations in suspected polymyositis?

Answer 13

bloods -Serum creatine kinase (CK) level is usually raised, often more than 10 times the normal level.

-Autoantibodies include ANA, anti-Jo-1 and anti-SRP.

Muscle biopsy is crucial in helping to diagnose

MRI may be useful to localize the extent of muscle involvement

Electromyographic

Question 14

Management of polymyositis?

Answer 14

prednisolone (initially around 40mg) combined with immunosuppressive drugs such as methotrexate or azathioprine.

Question 15

Scarf rash (V shape over chest)
Gottrons papules
Helio trope rash

Answer 15

Dermatomyositis

Question 16

There is an associated risk of malignancy with Polymyositis and dermatomyositis

Answer 16

T

Question 17

middle aged women widespread muscle pain and fatigue anxiety and/or depression irritable bowel syndrome

Answer 17

Fibromyalgia

Question 18

Fibromyalgia diagnosis?

Answer 18

no specific investigations and diagnosis is made on a clinical basis
•Persistent (≥ 3 months) widespread pain
rule out other styff

Question 19

Fibromyalgia management?

Answer 19

validate the patient’s illness
Advice regarding graded exercise and activity pacing is useful.
Atypical analgesia including tricyclics (e.g. amitriptyline), gabapentin and pregabalin
CBT

Question 20

Uric acid crystals precipitate in joints and this can be triggered by?

Answer 20

dehydration, trauma or surgery.

Question 21

Where is the clASSIC site of disease in gout?

Answer 21

first metatarsalphalangeal (MTP) joint

Question 22

intensely painful red, hot swollen joint differential?

Answer 22

Septic arthritis
gout
pseudogout

Question 23

In gout symptoms usually last for ? if untreated then resolve.

Answer 23

7-10 days

Question 24

Hyperuricaemia can be caused by?

Answer 24

renal underexcretion (which can be exacerbated by diuretics or renal failure) or due to excessive intake of alcohol, red meat and seafood.

Question 25

What are gouty tophi?

Answer 25

painless white accumulations of uric acid which can occur in the soft tissues and occasionally erupt through the skin

Question 26

Chronic gout can result in a destructive erosive arthritis.

Answer 26

T

Question 27

How can a diagnosis of gout be made?

Answer 27

sample of synovial fluid with polarised microscopy (the fluid is also analysed with Gram stain and culture to exclude infection).

Question 28

What do uric acid crystals look like under microscope?

Answer 28

needle shaped and display negative birefringence (change from yellow to blue when lined across the direction of polarization).

Question 29

What is pseudogout caused by?

Answer 29

calcium pyrophosphate crystals

Question 30

How are acute attacks of gout treated?

Answer 30

NSAIDs, Corticosteroids, opoid analgesics and colchicine for patients who cannot tolerate NSAIDs

Question 31

Urate lowering therapy should NOT be started until acute attacks of gout have been settled

Answer 31

T

Question 32

Sufferers of recurrent attacks of gout should be treated with?

Answer 32

allopurinol (urate lowering therapy)

Question 33

What is chondrocalcinosis?

Answer 33

calcium pyrophosphate deposits in cartilage and other soft tissue (pseudogout) 

Question 34

Calcium pyrophosphate deposition diseasetends to affect the knee, wrist and ankle

Answer 34

T

Question 35

The cause of psudogout is unknown but it can coexist with hyperparathyroidism, hypothyroidism, Wilson#s disease and OA

Answer 35

T

Question 36

pseudogout can cause osteoarthritic change

Answer 36

T

Question 37

Uric acid is the final compound in the breakdown and metabolism of what?

Answer 37

purines in DNA

Question 38

There is evidence of genetic predisposition in gout

Answer 38

T