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MSK Patrick Stenhouse > Muscle Disease > Flashcards

Muscle Disease Flashcards

(51 cards)

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1
Q

Polymyositis and dermatomyositis are examples of which type of myopathy?

A

Inflammatory myopathy

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2
Q

Inflammatory myopathies more commonly affect whch gender?

A

Females

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3
Q

What is the most common clinical feature of the inflammatory myopathies?

A

Muscle weakness

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4
Q

What is the onset like with polymyositis and dermatomyositis?

A

Gradual

(over months)

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5
Q

Which muscles are commonly affected with polymoyositis and in which pattern (symmetrical/asymmetrical)?

A

Proximal muscles

(symmetrical pattern)

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6
Q

Which cutaneous signs are classic for dermatomyositis?

A
  1. Gottron’s sign
  2. Heliotrope rash
  3. Shawl sign
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7
Q

Describe Gottron’s sign

A
  • A purple/violet colouring of the skin over the MCP and PIP joints
  • This can be painful and may bleed
  • Often worsens in sunlight
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8
Q

How is the respiratory system affected by polymyositis or dermatomyositis?

A

Interstitial lung disease

Respiratory muscle weakness

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9
Q

How can the cardiovascular system be affected by polymyositis or dermatomyositis?

A

Myocarditis

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10
Q

Which symptom associated with polymyositis and dermatomyositis involves oesophageal issues?

A

Dysphagia

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11
Q

Which other non-specific symptoms besides the specific systems symptoms can be seen in polymyositis and dermatomyositis?

A
  • Fever
  • Weight loss
  • Raynaud’s
  • Non-erosive polyarthritis
  • SOB
  • Cough
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12
Q

Which patient with polymyositis (or dermatomyositis) is most at risk of malignancy?

a) John 75
b) Bertha 70

A

John

Men >45 have greatest risk of malignancy

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13
Q

Which types of malignancy can be associated with polymyositis or dermatomyositis?

A
  • Ovarian
  • Breast
  • Stomach
  • Lung
  • Bladder
  • Colon
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14
Q

Which inflammatory myositis (dermatomyositis or polymyositis) is most prone to malignancy?

A

Dermatomyositis

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15
Q

Which drug class can bring on symptoms similar to those seen in polymyositis or dermatomyositis?

A

Statins

(or steroids)

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16
Q

Which worrying signs in a social history would strengthen your suspision for dermatomyositis or polymyositis?

A
  • High alcohol consumption
  • Illicit drug use
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17
Q

What are the two main methods for testing a patient’s muscle strength?

A
  1. Confrontational (direct test of power)
  2. Isotonic (test how much of a certain exercise they can do in a time limit)
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18
Q

Which muscle enzyme will be raised in dermatomyositis or polymyositis?

A

Creatinine kinase

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19
Q

Which antibodies will be found in polymyositis or dermatomyositis?

A
  • Anti-nuclear antibody (ANA)
  • Anti-Jo-1
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20
Q

How are inflammatory markers impacted in polymyositis or dermatomyositis?

A

They are raised

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21
Q

What is electromyography?

Study These Flashcards
A

The passing of a low volatge electric current through the affected muscle to check normal activity

22
Q

What is the only definitive test for polymyositis or dermatomyositis and what does it show?

Study These Flashcards
A

Muscle biopsy

Perivascular inflammation and necrosis of muscle

23
Q

What can MRI of muscle show in patients with polymyositis or dermatomyositis?

Study These Flashcards
A
  • Muscle inflammation
  • Oedema
  • Fibrosis
  • Calcification
24
Q

What are the treatment options for polymyositis or dermatomyositis?

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A
  • Glucocorticoids
  • Immunosuppressants
  • IV immunoglobulin
  • Rituximab
25
Why, when treating inflammatory myositis, are glucocorticoids given in initially high doses and then reduced to lower doses?
Glucorticoids have many negative side effects including muscle weakness, which is one of the man complaints of inflammatory myositis
26
Inclusion body myositis is often misdiagnosed for what?
Polymyositis
27
Describe the key differences between inclusion body myositis and polymyositis?
* It is not an autoimmune condition * It is commoner in men * It generally affects the distal muscles rather than the proximal muscles * It is usually asymmetrical * It has slower onset * Creatinine kinase levels are lower
28
How does inclusion body myositis respond to therapy?
Poorly
29
Weakness in muscles is often symmetrical/asymmetrical in inclusion body myositis?
Asymmetrical
30
What is polymyalgia rheumatica?
A potentially autoimmune condition (cause is unknown) which causes neck, shoulder and hip girdle pain
31
Polymyalgia affects people of what age bracket?
Almost exclusively those \>50
32
Polymyalgia rheumatica can cause dramatic muscle _________ but not muscle \_\_\_\_\_\_\_\_\_
Stiffness Weakness
33
Polymyalgia rheumatica is associated with what?
Temporal arteritis Giant cell arteritis
34
What is seen on a muscle biopsy with someone who has polymyalgia rheumatica?
Nothing abnormal
35
Why may vision loss occur in those with temporal arteritis?
The temporal artery supplies the optic nerve
36
How does temporal arteritis affect the termporal artery?
1. Tender and enlarged 2. Non-pulsatile 3. Prominent
37
How is the jaw impacted in temporal arteritis?
Jaw claudication when in use
38
What is the vision loss associated with temoral arteritis called?
Amaurosis fugax (painless and temporary loss of vision in one or both eyes)
39
How can temporal arteritis be diagnosed?
* Raised ESR, CRP and PV * Temporal artery biopsy
40
Temporal arteritis/giant cell arteritis and polymyalgia rheumatica are ____ - _________ conditions
Self-limiting
41
What is the treatment for polymyalgia rheumatica?
Low dose steroids (this causes a drastic and rapid improvement, which can even be used to test if it is polymyalgia rheumatica as this response is unique)
42
What are the following doses for polymyalgia rheumatica? a) Starting dose b) With temporal arteritis c) With eye problems due to temporal arteritis
a) 15mg b) 40mg c) 60mg
43
Fibromyalgia is an inflammatory condition. True or false
False
44
Name some symptoms and syndromes associated with fibromyalgia?
* Irritable bowel syndrome * Depression * Poor sleep and fatigue * Migraines * Poor concentration and memory
45
When can fibromyalgia come on?
After physical or emotional trauma
46
Where are the most commonly painful areas in fibromyalgia?
* Neck * Shoulders * Lower back * Chest wall
47
Is fibromyalgia diffuse or localised?
Diffuse
48
What can make fibromyalgia worse?
Exercise
49
What are the clinical findings for fibromyalgia?
* Excessive tenderness on palpation * No other abnormalities (all blood tests normal)
50
What are the treatment options for fibromyalgia?
* Tricyclic antidepressants e.g. amitriptyline * Gabapentin, pregabalin * Analgesia * Acupuncture * Graded exercise
51
What are some of the negative side effects of steroids?
* Weight gain * Osteoporosis (Ca2+, vitamin D + biphosphonates can be given to counteract) * Infection

MSK Patrick Stenhouse (60 decks)

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