MSK weakness

Question 1

ALS presentation

Answer 1

upper motor neuron (hyperreflexia and spasticity) and lower motor neuro (atrophy, fasciculation) symptoms. Can have distal muscle weakness. no pain seen

Question 2

Extramedullary tumor with compressive myelopathy presentation

Answer 2

sensory loss, hyperreflexia, spasticity, incontinence.

Question 3

Polymyositis

Answer 3

symmetrical proximal muscle weakness with or without pain. ESR, CRP, and CPK and aldolase levels are increased.

Question 4

anterior or cutaneous nerves compression presentation

Answer 4

only sensory nerves and so compression doesn’t cause muscle weakness or absent reflexes

Question 5

Presentation of acute asymmetrical focal lower extremity weakness in DM2 (well controlled) and see muscle atrophy and areflexia and autonomic dysfunction and unintentional weight loss

Answer 5

diabetic amyotrophy

Question 6

Treatment of diabetic amyotrophy

Answer 6

PT, pain control, strict glycemic control and most make partial functional recovery.

Question 7

Differential for myopathy

Answer 7

steroid induced myopathy, polymyaglia rheumatica, inflammatory myopathies, statin induced myopathy, hypothyroid myopathy

Question 8

clinical features of steroid induced myopathy

Answer 8

progressive proximal muscle weakness and atrophy, without pain or tenderness, lower extremity muscles involved.

Question 9

inflammatory markers of steroid induced myopathy

Answer 9

Normal ESR and CK

Question 10

clinical features of polymyalgia rheumatica

Answer 10

muscle pain and stiffness in shoulder and pelvic girdle and tenderness with decreased range of motion at shoulder, neck, and hip responds rapidly to low dose (prednisone 20 mg/daily)

Question 11

inflammatory markers of steroid induced myopathy

Answer 11

high ESR and CK normal

Question 12

inflammatory myopathies clinical presentation

Answer 12

muscle pain, tenderness and proximal muscle weakness, skin rash and inflammatory arthritis may be present

Question 13

inflammatory markers of inflammatory myopathies

Answer 13

high ESR and CK

Question 14

Inflammatory myopathies are:

Answer 14

dermatomyositis and polymyositis

Question 15

statin induced myopathy clinical features

Answer 15

prominent muscle pain and tenderness with or without weakness rarely rhabdomyolysis

Question 16

hypothyroid myopathy clinical features

Answer 16

muscle pain, cramps, weakness involving the proximal muscles, delayed tendon reflexes and myoedema and occasional rhabdomyolysis and severe myopathy

Question 17

laboratory findings of hypothyroid myopathy

Answer 17

normal and high CK (usually <10 times the upper limit of normal)

Question 18

laboratory findings of steroid induced myopathy

Answer 18

normal ESR and high CK

Question 19

what condition can precipitate statin myopathy?

Answer 19

hypothyroidism - thus 1st test to screen for is hypothyroidism prior to starting statin therapy and if someone complains of statin induced myopathy, check the thyroid function.

Question 20

what labs support a diagnosis of polymyositis?

Answer 20

ANA and EMG makes diagnosis. Can see proximal muscle weakness and elevated CK levels

Question 21

What two conditions have proximal muscle weakness?

Answer 21

hypothyroid myopathy and polymyositis

Question 22

Can coenzyme q10 prevent statin myopathy?

Answer 22

no the evidence is weak and so no don’t supplement with coenzyme q 10.

Question 23

prolonged vitamin D deficency

Answer 23

can cause muscle weakness and bone pain. Also this can lead to secondary hyperparathyroidism and osteomalacia. Would also se low phos and elevated bone turnover makres (alkaline phosphatase)

Question 24

Complications of dermatomyositis

Answer 24

pulmonary: interstitial lung dx, respiratory muscle weakness GI: dysphagia, nasal regurgitation, aspiration cardiac: myocarditis Malignancy: adenocarcinoma (lung, breast, ovarian) and lymphoma.

Question 25

velcro crakles and diffuse reticulonodular interstitial opacities in the lung bases and dysphagia with proximal muscle weakness

Answer 25

dermatomyositis

Question 26

Does polymyalgia rheumatica have muscle weakness

Answer 26

no, it only has pain related to dx and so may see weakness which is really related to pain and not true weakness

Question 27

age\>50, bilateral pain and morning stiffness \>1 month of 2 of the following areas: neck or torso, shoulders or proximal arms proximal thigh or hip, constitutional fever, malaise or weight loss

Answer 27

polymyalgia rheumatica clinical features

Question 28

physical exam of polymyalgia rheumatica

Answer 28

decreased ROM of shoulders, neck and hips

Question 29

Lab findings of polymyalgia rheumatica

Answer 29

ESR\>40 and sometimes \>100 elevated CRP\>10 in 90% of individuals normocytic anemia possible 20% can have normal studies 20% of people can have normal ESR and still have PMR CRP is elevated in most people but if there's still uncertainty can start empiric low dose prednisone at 10-15mg/day and slow taper over 1-2 years. PMR pts should see improvement in about 3 days after starting prednisone.

Question 30

treatment of PMR or polymyalgia rheumatica

Answer 30

prednisone 15-20 mg daily provides rapid relief and this distinguishes this from other myopathies

Question 31

diabetic amyotrophy presentation

Answer 31

acute asymmetrical pain followed by gradual worsening proximal lower extremity and back weakness and autonomic failure and weight loss

Question 32

wide spread MSK pain fatigue, stiffness and aching on characteristic tender points

Answer 32

fibromyalgia Normal CRP and ESR and prevalence increases with age

Question 33

myaglias, weakness and elevated creatine kinase

Answer 33

hypothyroid myopathy See high TSH

Question 34

chart of myopathies

Answer 34

Question 35

morning stiffness of shoulders, hips girdles, neck

Answer 35

PMR or polymyalgia rheumatica

Question 36

Diagnosis of meralgia peresthetica is:

Question 37

Treatment of meralgia paresthetica

Answer 37

self limited condition and conservative treatment is needed in \>90% of pts avoid tight garments weight loss anticonvulsants (gabapentin) or local nerve block

Question 38

injury to lateral femoral cutaneous nerve or compression at inguinal ligament or injury during local surgery or seat belt injury from MVA causes this:

Answer 38

meralgia paresthetica

Question 39

risk factors for meralgia paresthetica

Answer 39

obesity with heavy panniculus diabetes pregnancy tight clothing and belts at waist

Question 40

paresthesias and decreased sensation at the upper lateral thigh no motor deficits

Answer 40

meralgia paresthetica presentation

Question 42

MRI of the diagnosing the radiculopathy spinal stenosis or spondylolisthesis

Answer 42

see weakness and sensory loss of the affected spinal root nerves