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Pocket Primary Care > Muscle Pain > Flashcards

Muscle Pain Flashcards

1
Q

Myalgia

A

muscle pain

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2
Q

Myopathy

A

muscle disease

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3
Q

Myositis

A

muscle inflammation

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4
Q

cramps

A

painful, involuntary muscle contraction

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5
Q

contractures

A

failure of muscles to relax, assoc w/glycolytic and neurologic disease

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6
Q

Etiologies

A

Range from benign to life-threatening

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7
Q

Dematomyositis and Polymyositis

A

Immune-mediated inflammatory myopathy; insidious onset of mild myalgias in 25-50% of pts + symmetric, proximal weakness (deltoids, neck, hiops -> difficulty climbing stairs, carrying heavy loads); may p/w dysphagia, ILD, polyarthritis; skin changes seen in DM but no PM

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8
Q

Pyomyositis

A

Skeletal muscle infection, typically from hematogenous source assoc w/ trauma, HIV, IVDU, malnutrition, most frequently caused by S. aureus

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9
Q

DD of myalgias

A 
Infectious
Pain syndromes
Rheumatologic
Metabolic
Endocrine
Medications
Localized
Nocturnal leg cramps
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10
Q

Infectious - Myalgias

A

Viral (enterovirus, hepatitis, B/C, influenza, dengue, HIV), bacterial (s. aureus, s viridans), spirochetes, necrotizing fasciitis

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11
Q

Pain syndromes - Myalgias

A

Fibromyalgia, chronic fatigue syndrome

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12
Q

Rheumatologic - Myalgias

A

PMR, polymyositis/dermatomyositis, RA, SLE, spondyloarthropathy, vasculitis

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13
Q

Metabolic - Myalgias

A

Scurvy, metabolic myopathy, vit d deficiency

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14
Q

Endocrine - Myalgias

A

adrenal insufficiency, hypothyroidism, neuropathy

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15
Q

Medications - Myalgias

A

Statins, antipsychotics, fibrates, colchicine, AZT, cocaine, methadone, labetalol, cimetidine, CsA, cipro, bisphosphonates, aromatase inhibitors, alcohol and antidepressant withdrawal

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16
Q

Localized - Myalgias

A

Exercise/overus, trauma, pyomyositis, infarction, compartment syndrome, bursitis, necrotizing fasciitis, muscle strain/sprain

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17
Q

Nocturnal leg cramps - Myalgias

A

Foot d/o (flat feet), prolonged sitting/standing, diuretics, HD, pregnancy, spinal stenosis, PD, radiculopathy, exercise, meds, claudication, decrease mag and ca, neuropathy, DVT

18
Q

Pain out of proportion to exam

A

nec fasciitis/cellulitis/myositis, compartment syndrome

19
Q

Sudden onset

A

acute bacterial or viral illness

20
Q

Gradual onset

A

Statins, hep c, endocrinopathy, pain syndrome, PM/D

21
Q

Joint involvement

A

PMR, RA

22
Q

Fever, HA, malaise

A

Viral infection (influenza), pyomyositis

23
Q

Weakness

A

PM/DM, hypothyroidism, statin-induced

24
Q

Dysphagia, dyspnea

A

Dermatomyositis, polymyositis

25
Q

Red/brown urine + weakness

A

Rhabdomyolysis (increase serum CK, increase urine myoglobing)

26
Q

Redness, swelling, asymmetry

A

Pyomyositis, compartment syndrome

27
Q

Delayed reflexes

A

Hypothyroidism

28
Q

Hyperpigmentation

A

adrenal insuff

29
Q

Malar rash

A

SLE

30
Q

Erythema migrans

A

Lyme

31
Q

Mechanic hands

A

Polymyositis

32
Q

Gottrons papules

A

Occur on dorsal MCP and IP joints

Dermatomyositis

33
Q

Gottron sign

A

Papules/patches/macules on elbows, knees, ankles

Dermatomyositis

34
Q

Facial erythema

A

Dermatomyositis

35
Q

Heliotrope eruption on upper eyelids

A

Dermatomyositis

36
Q

Workup

A

CBC, U/A, Cr, LFTs; consider Ca, albumin, phos, TSH, CK, 25OH vit D, BCx, ESR, CRP, ANA, RF, Anti-CCP, ACTH stimulation test; imaging generally reserved for eval of inflammatory muscle disease, pyomyositis, muscle infarction; EMG used to dx myopathy (along w/nerve conduction studies): bx occasionally necessary

37
Q

Dermatomyositis/polymyositis workup

A

Increase CK, LDH; + ANA, + anti-Jo1; CXR to evaluate for ILD; consider muscle or skin bx, EMG, MRI

38
Q

Pyomyositis workup

A

CT or MRI, BCx; high index of suspicion (& r/o necrotizing fasciitis

39
Q

Management

medication-induced

A

Stop medication, may take mos to wks to resolve

40
Q

Management

Chronic fatigue syndrome

A

Cognitive behavioral therapy and graded exercise RX (no evidence for meds or diet changes)

41
Q

Management

Dematomyositis/polymyositis

A

Glucorticoids (1mg/kg [max dose = 80mg] -> taper after 4-6 weeks); comanagement w/rheum +/- derm; physical therapy; SLP eval if dysphagia present; PCP Ppx if long-term high dose steroids used

42
Q

Management

Pyomyositis

A

Abx (assess risk of MRSA infection) and/or drainage

Pocket Primary Care (18 decks)

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