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Rheumatology USMLE Step 3 > Section 3: PM, DM, Fibromyalgia, PMR > Flashcards

Section 3: PM, DM, Fibromyalgia, PMR Flashcards

1
Q

Diagnosis

  • The patient cannot get up from a seated position without using the arms
  • There can also be muscle pain and tenderness.
  • Proximal muscle weakness
  • Signs of muscle inflammation on blood tests, electromyography, and biopsy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

A

Polymyositis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

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2
Q

Diagnosis

  • The patient cannot get up from a seated position without using the arms
  • There can also be muscle pain and tenderness.
  • Proximal muscle weakness
  • Signs of muscle inflammation on blood tests, electromyography, and biopsy
  • Gottron’s papules: Over metocarpophalangeal joint surfaces
  • Heliotrope rash: Periorbital and purplish lesion around the eyes
  • Shawl sign: Shoulder and neck erythema

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

A

Dermatomyositis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

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3
Q

Diagnosis

Weakness + ↑ CPK + ↑ Aldolase + Biopsy

A

Polymyositis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

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4
Q

Diagnosis

Weakness + ↑ CPK + ↑ Aldolase + Biopsy + Skin rash

A

Dermatomyositis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

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5
Q

Single most accurate test for polymyositis and dermatomyositis

A

Biopsy

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6
Q

CF of Polymyositis

A
  • The patient cannot get up from a seated position without using the arms
  • There can also be muscle pain and tenderness.
  • Proximal muscle weakness
  • Signs of muscle inflammation on blood tests, electromyography, and biopsy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

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7
Q

CF of dermatomyositis

A

Diagnosis

  • The patient cannot get up from a seated position without using the arms
  • There can also be muscle pain and tenderness.
  • Proximal muscle weakness
  • Signs of muscle inflammation on blood tests, electromyography, and biopsy
  • Gottron’s papules: Over metocarpophalangeal joint surfaces
  • Heliotrope rash: Periorbital and purplish lesion around the eyes
  • Shawl sign: Shoulder and neck erythema

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4503-4515). . Kindle Edition.

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8
Q

Diagnostic tests in polymyositis and dermatomyositis

A
  • Elevated CPK
  • Elevated aldolase
  • An abnormal electromyogram (EMG)

For CCS, order all the liver function tests as well as ANA. Biopsy is the single most accurate test of PM/ DM

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4517-4521). . Kindle Edition.

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9
Q

Rx of polymyositis and dermatomyositis

A

Glucocorticoids

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10
Q

A 50-year-old patient presents with muscle weakness of the girdle with an increased CPK and aldolase. Her anti-Jo-1 antibody is positive. Which of the following is most likely to happen to her?

a. Stroke
b. Myocardial infarction
c. Septic arthritis
d. DVT
e. Interstitial lung disease

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4522-4538). . Kindle Edition.

A

E. PM/ DM presents with weakness and increased markers of muscle inflammation. The presence of anti-Jo-1 indicates a markedly increased risk of interstitial lung disease

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4522-4538). . Kindle Edition.

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11
Q

What is the most common serious complication of PM/ DM?

a. Rhabdomyolysis
b. Hyperkalemia
c. Metabolic acidosis
d. Malignancy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4522-4538). . Kindle Edition.

A

D. For unclear reasons, the most common serious threat to life from PM/ DM is malignancy. DM has a greater risk than PM.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4522-4538). . Kindle Edition.

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12
Q

Diagnosis:

Female

Muscle aches and stiffness with trigger points on palpation

Nonrefreshing sleep

Depression and anxiety are common

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4542-4553). . Kindle Edition.

A

Fibromyalgia

This condition is 10 times more common in females

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4542-4553). . Kindle Edition.

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13
Q

Diagnostic findings in fibromyalgia

A

All blood tests are normal. There is no objective evidence of disease. This is a pain syndrome with tender trigger points

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4542-4553). . Kindle Edition.

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14
Q

Rx of fibromyalgia

A
  • Exercise
  • Milnacipran, duloxetine, or pregabalin (the best initial therapy)
  • Tricyclic antidepressants, such as amitriptyline, are effective but have more adverse effects

NSAIDs are not first line for fibromyalgia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4542-4553). . Kindle Edition.

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15
Q

Diagnosis:

Patient age > 50 years

Profound pain and stiffness of the proximal muscles, such as shoulders and pelvic girdle

The stiffness is worse in the morning and is localized to the muscles rather than to the joints

The ESR is elevated, and there is an amazing response to steroids

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4556-4592). . Kindle Edition.

A

Polymyalgia rheumatica

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16
Q

Age > 50 + Proximal muscle pain + ↑ ESR

A

Polymyalgia rheumatica (PMR)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4556-4592). . Kindle Edition.

17
Q

List the non-specific features of PMR

A
  • Fever
  • Weight loss
  • Malaise
  • Normocytic anemia
  • Normal CPK, EMG, aldolase, and muscle biopsy
  • No muscle atrophy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4556-4592). . Kindle Edition.

18
Q

Compare and contrast chronic fatigue syndrome (CFS), fibromyalgia, and polymyalgia rheumatica (PMR)

A

Chronic fatigue syndrome (CFS) has significant fatigue/malaise while in fibromyalgia and polymyalgia rheumatica the fatigue/malaise is not as prominent.

Chronic Fatigue Syndrome is associated with significant non-refreshing sleep, slightly so in Fibromyalgia but sleep is fine in Polymyalgia Rheumatica

Neither CFS and PMR have trigger pain points but fibromyalgia is associated with trigger pain points.

ERS is elevated in PMR but all blood tests are normal in CFS and fibromyalgia

No Rx for CFS; pain relief for fibromyalgia and predinisone is used for Rx of PMR

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4556-4592). . Kindle Edition.

19
Q

True or False:

NSAIDs are first line Rx for fibromyalgia

A

False

Rheumatology USMLE Step 3 (5 decks)

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