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Flashcards in Muscle Disease Deck (40):
1

What does "Myalgia" mean?

Muscle Pain

2

What does "My arms feel heavy and tired, i struggle to do things" imply about the muscle?

Muscle Weakness

3

What does "My muscle are stiff when i first wake up and then get a bit better when I've walked about for a bit" imply about the muscle?

Inflammation

4

Which muscle disease(s) have an increased risk of malignancy associated?

Myositis
(especially dermatomyositis)

5

What type of disease are Polymyositis and Dermatomyositis?

Idiopathic Inflammatory Myopathies
Autoimmune

6

Who's more like to get polymyositis? (male/female) (ages 10-20/ 20-30/30-40/40-50/50-60/60-70/65+)

Females (2:1)
40-50 years peak

7

What is seen on biopsy of Polymyosits?

Muscle fibre necrosis
Degeneration
Regeneration
An inflammatory cell infiltrate

8

What is the most common presenting complaint of a patient with polymyosits?

Muscle weakness

9

List some clinical features of Myositis:

Muscle weakness
Insidious onset, worsening over months.
Usually symmetrical, proximal muscles
Mild myalgia in some patients (25-50%)

10

Was cutaneous signs are seen in dermatomyositis?

Gottron's sign (hands)
Heliotrope rash (face/eyes) (purple/pink discoloration and swelling)
Shawl Sign (Back)

11

Which drugs are known to cause proximal muscle weakness?

Steroids

12

What other presentations can be important to pick up in a history of tired muscles and functional difficulty?

Raynauds Phenomenon
Weight loss
Cough
Breathlessness
Dysphagia
Fever
Non-erosive Polyarthritis

13

What is the difference between Confrontational Testing and Isotonic Testing?

Confrontational = Direct testing of power (pushing)
Isotonic = Repeated movement (e.g. 30 second sit to stand)

14

Which is a better test of muscle power? (Confrontational, Isotonic)

Isotonic testing

15

Why are Creatine Kinase enzymes raised in Myositis?

Muscle inflammtion and breakdown of muscle causes release of muscle enzymes during break down. Creatine Kinase is a muscle enzyme so levels of this rise (up into thousands) in myositis

16

What is a specific antibody of polymyositis and drmatomyositis?

Anti-Jo-1

17

What is an EMG?

Electromyography
Shows pattern of how muscle conducts electricity

18

What is seen on an EMG of a patient with polymyositis?

Increased fibrillations, abnormal motor potentials, complex repetitive discharges

19

Treatment for Myositis:

Prednisolone daily - decrease dose over time
Use immunosuppression at same time as steroid
(steroids - short term)

20

What is typical of Inclusion body myositis?

Distal muscle weakness
Weakness wrist and finger flexors in upper limbs and quadriceps and anterior tibial muscles in legs
Weakness often asymmetrical
Patients >50

CK levels lower than polymyositis
Muscle biopsy shows inclusion bodies
Responds poorly to therapy

21

How high are the CK levels in IBM and PM?

High
(Not up into thousands in IBM)
(Into thousands in PM, much higher)

22

What is the best test for myositis?

Biopsy

23

What are the main symptom of myositis?

Muscle Weakness

24

Which drugs may cause a presentation similar to myositis?

Statins

25

Who gets Polymyalgia Rheumatica?
(age)
(Almost exclusively)

Over 50 year olds

26

What condition is associated with Polymyalgia Rheumatica?

Temporal Arteritis/ Giant Cell Arteritis (15%)

27

What are the clinical manifestations of Polymyalgia Rheumatica?

Ache in shoulder and hip girdle
Morning stiffness
Usually symmetrical
Fatigue, anorexia, weight loss and fever may occur
Reduced movement of shoulders, neck and hips due to pain and stiffness
Comes on quite quickly (within a few weeks)
Worst first thing in the mornign
Struggle to get out of bed
Better after walking about a bit
MUSCLE STRENGTH NORMAL

28

Whats "the fear" with GCA (temporal arteritis)?

Blindness

29

What would be raised in polymyalgia rheumatica?

ESR, plasma viscosity, CRP

30

Is polymyalgia rheumatica autoimmune?

NO
INFLAMMATORY CONDITION

31

Treatment for polymyalgia rheumatica:
(no temporal arteritis)

15mg Prednisolone
(feel dramatically better)

32

Treatment for polymyalgia rheumatica:
(WITH temporal arteritis)

40-60mg Prednisolone
(to prevent visual loss)

33

Is fibromyalgia an inflammatory or non-inflammatory problem?

Non-inflammatory

34

Main symptoms of Fibromyalgia:

Pain
Extreme fatigue
Poor sleep pattern

35

Does exercise make symptoms of fibromyalgia better or worse?

Worse

36

Where is the pain in fibromyalgia?

Neck
Shoulder
Lower back
Chest wall

37

What is fibromyalgia pain like?

Diffuse
Chronic
Varies in intensity
Worse with exertion, fatigue, stress
Sensation of swelling

38

How many tender points need to be present to make a diagnosis of fibromyalgia?

11 out of 18

39

Are the inflammatory markers raised in fibromyalgia?

No
They are normal
It is a non-inflammatory

40

Treatment for Fibromyalgia:

Better to not give medication initially
Try to minimise drugs
Use non-drug therapies, e.g. CBT, graded exercise
Start with Paracetamol, then Amitrptyline