Myopathies - Newman

Question 1

Discuss the importance of monitoring development in children

Answer 1

Diseases don’t always show up right away, so continuous monitoring over the years is important

Question 2

Name the four general domains of pediatric development.

Answer 2

• Gross motor
• Fine motor
• Language
• Cognitive/Behavioral/Emotiona

Question 3

Explain the importance of early intervention in children with developmental
delay.

Answer 3

The sooner they get help, the better their chances are in the long run.

Question 4

Understand that not hitting developmental milestones can be serious, but
hitting milestones and then regressing is even more ominous.

***If a child fails a developmental screen, what do you do?

Answer 4

REFER FOR FURTHER EVALUATION

Question 5

• **List the gross motor developmental milestones discussed during this
  session. …
  
  • 6 mo?
  • 9 mo?
  • 1 year?
  • 2 years?
  • 3 years?
  • 4 years?
  • 6 years?

Answer 5

6 mo = sits up briefly
9 mo = sits up well, pulls up, words
1 year = separation anxiety, 3 blocks
2 years = 2 words together, 2/4 understood by outsider, 6 blocks, copies a line
3 years = 3 words together, 3/4 understood, 9 blocks, tricycle
4 years = sentences, 4/4 understood, past tense, copies a cross
6 years = ties shoes, skips, draw person

Question 6

Describe the clinical presentation, **inheritance pattern, and genetic
abnormality seen in DMD.
Common cause of death?

Almost all will develop ___ and need surgery

Answer 6

Inheritence = X-recessive
Genetic = dystrophin mutation (frameshift --> absence of it)
Clinical = delayed walking, difficulty running, waddling gait, lumbar hyperlordosis, forward protrusion of abdomen, Gowers sign, enlarged calf/thigh muscles, toe walking (tendon contracture), limited hip flexion (IT contracture).

Cause of death = respiratory failure

Scloliosis

Question 7

Describe the clinical presentation, inheritance pattern, and genetic
abnormality seen in BMD.

Answer 7

Inheritence = X-recessive
Genetic = dystrophin mutation (point mutation --> dysfunctional)
Clinical = late-onset proximal muscle weakness, loss of walking much later, neck muscle strength preserved, later death (30s-50s)

Question 8

Describe the presentation of congenital muscular dystrophies.

Answer 8

Present at birth or soon after w/ hypotonia, severe muscle weakness, contractures, and other malformations (eyes, brain, heart, spine).

Question 9

Explain the importance of GGTP in differentiating between muscle disease
and liver disease

Answer 9

GGTP level determines if liver is involved or not for ANY muscle disease

Question 10

Explain the role dystrophin plays in muscular dystrophies.

Answer 10

Connects cytoskeleton of muscle fiber to surrounding extracellular matrix, anchoring actin to other support proteins

Question 11

Know that congenital myasthenia syndrome does NOT involve ___

Answer 11

Antibodies

Question 12

Describe the clinical picture seen with Spinal Muscular Atrophy.

Answer 12

Progressive proximal muscle weakness and absence of DTRs DUE TO degeneration of brainstem nuclei and motor neurons. Progression to respiratory failure.

Question 13

List the major clinical findings of juvenile dermatomyositis.

Answer 13

Child w/ proximal muscle weakness, heliotrope rash over eyelids, raised papules over extensor joint surfaces, thrombi or hemorrhage

Question 14

Describe statin induced myopathy

Answer 14

Statins can cause necrotizing and inflammatory myopathy as a side effect. CK is greatly elevated with muscle weakness, pain, and tenderness.

Question 15

Understand the importance of serum creatine kinase measurement in
genetic or acquired muscle diseases.

Answer 15

Got it

Question 16

Know the course and prognosis of mitochondrial myopathies.

Answer 16

Young or older kids start developing problems w/ the heart, skeletal muscles and/or brain.