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MSKJaz > myopathies > Flashcards

myopathies Flashcards

1
Q

drugs that can cause myopathy

A

steroids
alcohol
statins

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2
Q

inflammatory myopathies -

A

polymyositis
dermatomyositis
Inclusion body myositis

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3
Q 
Poly+dermatomyositis:
cause =
F:M
age of peak incidence
increased\_\_\_ risk
A

idiopathic
F2:1M
40-50yo
malig

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4
Q

histology of poly+dermatomyositis

A

muscle fibre necrosis
degeneration
regeneration and inflammatory infliltrate

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5
Q

cutaneous signs in dermatomyositis

A

Gottrons sign (back of hands)
heliotrope rash
shawl sign

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6
Q

poly+dermatomyositis usually have an ___ onset
worsen over ___ and main feature = ___ - only 25-50% have ___
usually a/symmetrical? and ___ muscles

A 
insidious
months
muscle weakness
mild myalgia
asymmetrical
proximal
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7
Q

other organ involvement in poly+dermatomyositis

A 
ILD10%, resp muscle weakness
dysphagia
myocarditis
fever
wt loss
Raynauds
nonerosive polyarthritis
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8
Q

malignancies ass with poly and dermatomyositis
most at risk pop group =
which is more ass with malig?

A

ovarian, breast, stomach, lung, bladder + colon
M >45yo
dermatomyositis

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9
Q

examination tests for poly/dermatomyositis

A

muscle wasting
rashes
confrontational test (direct power test)
isotonic testing ( repeat stand and sit for 30s - use to monitor)

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10
Q

endomyseal inflammation with CD8+ cells

A

polymyositis

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11
Q

perimyseal inflammation with CD4+ cells and perifascicular atrophy

A

dermatomyositis

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12
Q

Ix for poly+dermatomyositis

A

bloods - CK, inflam markers, electrolytes, Ca2+, PTH and TSH, ANA and Anti Jo-1
EMG
MRI
muscle biopsy (definitive)

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13
Q

results of blood tests in poly+dermatomyositis

A

CK in the 1000s (v high)
inflam markers high
ANA and anti-Jo1 maybe

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14
Q

results of EMG in poly+dermatomyositis

A

increased fibrillations
abnormal motor potentials
complex repetitive discharges

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15
Q

MRI results in early and late poly+dermatomyositis

A 
early = muscle inflam and oedema
late = fibrosis and muscle calcification
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16
Q

muscle biopsy result inpoly+dermatomyositis

A

perivascular inflam and muscle necrosis

17
Q

definitive test for poly+dermatomyositis

A

muscle biopsy

18
Q

Rx for poly+dermatomyositis

A

prednisolone 40mg and taper
Is (methotrexate, azathioprine, ciclosporin)
if resistant = rituximab
IV Ig for skin disease

19
Q 
inclusion body myositis:
age =
M:F
more \_\_ than poly+dermatomyositis
\_\_ muscle weakness often a/symmetrical
\_\_ risk
A 
>50yo
M3:1F
insidious
distal
asymmetrical
no malig
20
Q

sites of weakness in inclusion body myositis

A

wrist and finger flexors
quadriceps
anterior tibial

21
Q

in inclusion body myositis __ is elevated by not as high as in polymyositis

A

CK

22
Q

muscle biopsy findings in inclusion body myositis

A

… inclusion bodies … duh

23
Q

dont give __ in inclusion body myositis as is ineffective and has side effects
responds poorly to therapy

A

IS

24
Q

polymyalgia rheumatica (PMR):
age
higher incidence in __ regions
15% ass with __

A

> 50yo
Northern
GCA

25
Q

presentation of PMR
usually comes on in __ with an __ in __+___ usually a/symmetrical
intense ___ better when ___
muscle __ normal but + decrease function

A 
wks
ache in shoulder and hip girdles
symmetrical
morning stiffness - better on movement
strength normal
pain and stiffness
26
Q

tender enlarged non-pulsatile temporal arteries =

A

GCA

27
Q

diagnosis of PMR =

A

increased ESR, PV and CRP

28
Q

treatment for PMR =

A

15mg low dose steroids - rapid and dramatic response
if also have GCA = 40-60mg prednisolone to prevent blindness
reduce over 18m-2yrs

29
Q 
fibromyalgia
F:M
trigger may be _/_
no \_\_\_
main 2 features =
A

F6:1M
eotional /physical trauma
no inflammation
chronic pain and sleep disorder

30
Q

commonest cause of MSK pain in F 22-50 yo =

A

fibromyalgia

31
Q

some examples of how fibromyalgia can present (11)

A 
debilitating fatigue
sleep unrefreshing
generalised pain
cognitive difficulties
headache/migraine
IBS
ENT
oeso dysmotility
hypotension
wt loss
night sweats
32
Q 
pain in fibromyalgia:
sites 
= \_\_+\_\_\_
worse on exertion, fatigue and stress
\_\_ sensation 
_+_ sensation
A

neck - shoulders - lower back - chest wall
chronic and diffuse
swelling sensation
pins and needles

33
Q

examination findings in fibromyalgia

diagnosis =

A

excessive tenderness on soft tissue palpation (11/18 sites for diagnosis)
other tests and exam normal

34
Q

treatment of fibromyalgia

A 
educate
OT
physio
CBT
antidepressants, analgesia, pregabalin + gabapentin

MSKJaz (28 decks)

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