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MSK > Muscle Disease > Flashcards

Muscle Disease Flashcards

1
Q

name 7 possible causes of myopathy

A 
inflammatory
Endocrine disroders
Electrolyte disorders
metabolis myopathies
drugs and toxins
infection
rhabdomylysis
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2
Q

general presentation of muscle disease?

A

muscle pain (myalgia)
muscle weakness/tiredness
stiffness
abnormal blood tests

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3
Q

name 2 idiopathic inflammatory myopathies

A

polymyositis

dermatomyolitis

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4
Q

who gets idiopathic inflammatory myopathy?

A

more females than men

onset usually 40-50 y/o

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5
Q

does inflammatory myopathy increase cancer risk?

A

yes

greatest risk in men >45

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6
Q

histological features of inflammatory myopathy (IM)?

A

muscle fibre necrosis
degeneration
regeneration
inflammatory infiltrate

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7
Q

clinical features of IM?

A 
muscle weakness = main feature
incidious onset - worsening over months
symmetrical, proximal muscles
often specific problems - i.e cant brush hair etc
myalgia in 25-50%
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8
Q

what is dermatomyositis?

A

inflammatory myopathy which affects the skin
Gottrons sign = inflammation on the knuckles
heliotrope rash
shawl sign

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9
Q

what organs can IM affect?

A

lungs - ILD, resp muscle weakness
oesophagus - dysphagia
cardiac - myocarditis
systemic - fever, weight loss, raynauds, non-erosive polyarthritis

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10
Q

IM history?

A 
muscle symptoms
PMH - DM, thyroid
DH - steroids, statins
FH 
SH - alcohol/drug use
Other - weight loss, cough, breathless, raynauds
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11
Q

how can IM affect muscles?

A

can cause atrophy and loss of muscle power

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12
Q

2 types of testing for muscle power?

A

conformational - direct test (push against)

isotonic - 30 secs to stand and sit

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13
Q

how can IM be diagnosed?

A 
History
Bloods
electromyography
muscle biopsy
MRI
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14
Q

muscle biopsy features?

A

perivascular inflammation

muscle necrosis

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15
Q

MRI features?

A

muscle inflammation
oedema
fibrosis
calcification

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16
Q

blood test features?

A

CK enzyme
inflammatory markers
Autoantibodies - ANA, anti-Jo-1
electrolytes, calcium, PTH, TSH (to exclude other things)

17
Q

EMG features?

A

increased fibrillations
abnormal motor potentials
complex repetitive discharges

18
Q

how is IM treated?

A

steroids
azathioprine/methotrexate/ciclosporin?
IV immunoglobulin
Rituximab

19
Q

what is a heliotrope rash associated with?

A

dermatomyositis

20
Q

what is the definitive test for polymyositis?

A

muscle biopsy

21
Q

main symptoms in inflammatory myositis?

A

muscle weakness

22
Q

what drug might cause a presentation similar to myositis?

A

statins

23
Q

who gets polymyalgia rheumatica?

A

over 50s

associated with giant cell arteritis and temporal arteritis

24
Q

clinical features of PR?

A 
aching in shoulder and hip
morning stiffness
usually symmetrical
fatigue, weight loss, fever sometimes
reduced movement
normal muscle strength
25
Q

how is PR diagnosed?

A

mainly focused on clinical features and examination
exclude other diagnosis
bloods - raised inflammatory markers
temporal artery biopsy

26
Q

how is PR treated?

A

steroids
higher dose if temporal arteritis
gradually reduce dose over 18 months to 2 years

27
Q

what is fibromyalgia?

A

non-inflammatory cause of chronic MSK pain

more common in women 22-50

28
Q

what can trigger fibromyalgia?

A

physical or emotional trauma

29
Q

what causes the sensation of pain in fibromyalgia?

A

central sensitization

30
Q

fibromyalgia cycle?

A

emotional and physical pain etc lead to less movement leads to worse symptoms etc

31
Q

can fibromyalgia affect other systems?

A

yes

almost all

32
Q

clinical features of fibromyalgia?

A 
widespread pain
diffuse and chronic
symptoms worsen with exertion, fatigue and stress
sensation of swelling
poor sleep
pins and needles
headaches
depression
abdo pain (IBS)
poor cognition
33
Q

clinical finding of fibromyalgia?

A

excessive tenderness on palpation of soft tissues (11/18 points)
no actual abnormality

34
Q

how is fibromyalgia diagnosed?

A

clinically
widespread pain with associated symptoms
present 3 or more months
no other explanation

35
Q

associated symptoms?

A

bad sleep
cognitive symptoms
fatigue
other somatic symptoms

36
Q

how is fibromyalgia medically treated?

A

analgesia (usually not opiates)
anti-depression
gabapentin and pregabalin

37
Q

non medical fibromyalgia treatment?

A

education
graded exercise programme
CBT
complementary medicine (e.g acupuncture)

MSK (66 decks)

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