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Clinical lectures: Yr1 > Myalgia (muscle pain) > Flashcards

Myalgia (muscle pain) Flashcards

1
Q

What are the 2 ways in which myalgia can present in patients, in terms of radiation?

A

Localised or widespread

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2
Q

What are the 2 ways in which myalgia can present in patients, in terms of exacerbating symptoms?

A

Worse during movement or rest

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3
Q

What are the 2 ways in which myalgia can present in patients, in terms of how constant the pain is?

A

Occurs for several minutes before disappearing or is always constant

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4
Q

What usually determines how myalgia presents in each patient?

A

The underlying condition that is causing myalgia

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5
Q

If a patient with myalgia also presents with fever, what 3 underlying conditions are suspected?

A

Sepsis, infection, pyomyositis

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6
Q

What is pyomyositis?

A

Bacterial infection of muscle that results in abscess formation

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7
Q

If a patient with myalgia also presents with hypotension, why is this a red flag?

A

Hypotension could indicate sepsis, which needs to be confirmed and treated immediately

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8
Q

What is postural hypotension, and if a patient with myalgia presents with this what underlying condition is suspected?

A

Blood pressure suddenly drops after standing up from sitting/lying position

Presents in Cushing’s disease

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9
Q

If a patient with myalgia also presents with cutaneous lesions, what 5 underlying conditions are suspected?

A

PsA
Systemic lupus erythematosus
Endocarditis
Vasculitis
Lyme disease

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10
Q

If a patient with myalgia also presents with joint inflammation in peripheral joints, what 3 underlying conditions are suspected?

A

RA
PsA
SLE

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11
Q

If a patient with myalgia also presents with tender/trigger points, what 2 underlying conditions are suspected?

A

Fibromyalgia
Myofascial pain syndrome

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12
Q

If a patient with myalgia also presents with limited active movements and slightly limited passive movements, what soft tissue injuries are suspected?

A

Bursitis
Tendonitis
Strain
Sprain
Overuse injury

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13
Q

If a patient with myalgia has the underlying condition hypothyroidism, what 4 other symptoms can they present with?

A

Hoarse voice
Delayed relaxation of reflexes
Slowed speech
Dry skin

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14
Q

If a psychological condition is they underlying cause of myalgia in a patient, give 3 examples of the observed behaviour of the patient?

A

Depressed/tense/stressed state

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15
Q

What is the initial investigation of myalgia?

A

It is a diagnostic process to determine what underlying condition is causing the myalgia

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16
Q

Why is it important to check patient history when initially investigating myagia?

A

Past incidents and activities that could have triggered myalgia

Past/current medications and side effects

Family conditions

Allergies

17
Q

What are the 3 initial lab investigations for myalgia?

A

Full blood count
Renal function
Liver function

18
Q

If sepsis is suspected, what lab investigation is done?

A

Blood culture is sent to lab, can also be tested for another infection

19
Q

In lab investigations of myalgia, why is the creatine kinase test performed?

A

Elevated serum creatine kinase (CK) can indicate muscle damage

20
Q

In lab investigations of myalgia, what do elevated levels of ESR and CRP indicate?

A

Systemic inflammation, which suggests presence of infection or inflammatory diseases

21
Q

In lab investigations of myalgia, what underlying condition can be indicated due to normal ESR level?

A

Fibromyalgia

22
Q

What 3 body fluids can be used for the cortisol test, and in a patient in myalgia what do elevated cortisol levels indicate?

A

Cortisol test can be performed using blood, salvia or urine

Elevated cortisol level suggests Cushing’s disease

23
Q

Why should autoantibody testing be performed only if a particular underlying condition is suspected in a patient with myalgia?

A

Widespread testing in all patients with myalgia can produce high rate of false-positives

24
Q

What are ANA test, and what condition are they elevated in?

A

Antinuclear Antibody test, elevated level in SLE

25
Q

What is the ANCA ELISA test, and what underlying condition is it used to diagnose, that causes myalgia in patients?

A

Anti-Neutrophil Cytoplasmic Antibodies (ANCA) ELISA test: autoantibodies that target neutrophils, are present in ANCA-associated vasculitis

26
Q

In lab investigations of myalgia, what does presence of RF and anti-CCP suggest?

A

RA is possible underlying cause of myalgia

27
Q

Is radiological investigation necessary in diagnosis of underlying cause of myalgia?

A

Not necessary, but can be used to assess damage caused by inflammatory arthritis, muscle disease, fractures, soft tissue injuries

28
Q

What 4 imaging mediums are commonly used in radiological investigation of myalgia?

A

X-ray, CT, MRI, ultrasound

29
Q

What 2 neurophysiological investigations are performed when particular underlying causes of myalgia are suspected, and what are these causes?

A

Electromyography and NCDs used to measure electrical activity in nerves supplying painful muscles if neuropathic process due to inflammatory/metabolic myopathy is indicated

30
Q

What are the 5 types of key differential diagnosis for myalgia?

A

Mediation-induced myalgia
Soft tissue injury
Infection
Autoimmune disease
Neurovascular disorder

31
Q

What is the initial management of myalgia, until the underlying condition is diagnosed?

A

Use conservative treatments, watchful wait and treat symptomatically if needed

32
Q

Give 3 examples of conservative treatments used for initial management of myalgia?

A

Rest and elevate painful muscle

Alternate between ice and heat to decrease swelling and inflammation (ice) and improve blood flow (heat)

NSAIDs

33
Q

Give 4 examples of differential diagnosis of myalgia, which are autoimmune diseases?

A

Inflammatory arthritis
SLE
Vasculitis
Pyomyositis

34
Q

Give 4 examples of differential diagnosis of myalgia, which are infections?

A

Malaria
Lyme disease
Sepsis
Cold and flu

35
Q

Give 5 examples of differential diagnosis of myalgia, which are soft tissue injuries?

A

Strains
Sprains
Tendonitis
Bursitis
Myofascial pain syndrome

36
Q

Give 4 examples of medications that can cause medication-induced myalgia?

A

Statins
Chemotherapy
Radiotherapy
High bp drugs such as ACE inhibitors

37
Q

Give one example of a neurovascular disorder that can cause myalgia?

A

Spinal Muscular Atrophy (SMA)

38
Q

When would you obtain muscle biopsy/aspiration from a patient presenting with myalgia?

A

Patients with suspected abscess, inflammatory myopathy, vasculitis, or SLE

Clinical lectures: Yr1 (28 decks)

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