Disease that causes progressive PROXIMAL muscle weakness. See ENDOMYSIAL inflammation with CD8+ cells and often involves shoulders.
Symptoms include pain, with marked weakness and/or loss of muscle mass in the muscles of the head, neck, torso and upper arms and legs. The hip extensors are often severely affected, leading to particular difficulty in ascending stairs and rising from a seated position.
Pt has proximal muscle weakness, difficulty rising from chair and has a heliotrope rash around eyes and cheeks as wells as over shoulders. Rough appearing hands.
Dermatomyositis, Perimysial inflammation and atrophy with CD4+T Cell
+ANA, +anti-jo-1, +anti-SRP +anti-Mi-2-antibodies
How is dermatomyositis and polymyositis different?
How are they the same?
Dermatomyositis = CD4+T cells and Perimysial inflammation with rashes
Polymyositis = CD8+T cell inflammation with Endomysial inflammation
Simular: both proximal muscle weakness, Elevated CK, +ANA, +anti-Jo-1, +anti-SRP, +anti-Mi-2 antibodies and both are treated with steroids
Autoantibody disease to presynaptic Ca++ channels causing decreased Ach release, cauases proximal muscle weakness and autonomic symptoms such as dry mouth and impotence. Symptoms improve with muscle use.
Lambert Eaton Syndrome
Patient presents to office with a chief complaint of headache. He explains it happens at the end of the day, he is a computer programmer and says he spends the day staring at his computer. He states his eyes get tired and feels like he is straining to look at his computer. You believe this is a NMJ disease. What is the pathophysiology and associations with this disease?
AutoantiB to the postynaptic ACh receptor causing ptosis, dipoloplia and weakness that gets worse with use.
Associated with THYMOMA and Thymic hyperplasia
Tx with pyridostigmine
35 yo female presents to her Primary Care because she has been experiencing daytime fatigue and trouble sleeping. She used to excercise regularly but has not since the birth of her 2 yo daughter. She mentions she feels much older then she should for her age, stating she feels stiffness in her joints and her lower back hurts. You note she has diffuse musculoskeletal pain and paresthesia and deterine this is a musckuloskeletal disease. Dx and tx?
Fibromyalgia (stiffness, paresthesia and diffuse mskuloskeletal pain, often have palpable triggers)
Encourage regular exercise, can use antidepressntes (TCA or SNRI) and anticonvulsants like pregalilin or minaciprain.
What is the mainstay treatment for pts that present with RA?
What is the mechanism of action?
What levels do we need to monitor?
Methotrexate (may add Leflunomide and TNF-alhpa blocker)
inhibits enZ dihydrofolate reductase and blocks folic acid synthesis
Common sides = painful mouth ulcers and HEPATOTOXIC and MYELOSUPPRESION, as well as increase risk for opportunistic infection, B cell lymphoma, pulmonary fibrosis
Damage to the Left 12th rib is most likely to affect which organ?
What about damage to the 9th, 10th and 11th rib on the left?
What about damage to the 3rd rib?
will hit the kidney
will hit the spleen
damage to the 1-6th rib can damage the visceral pleura of the lung
The posterior forearm and arm is innervated by;
The medial foremarm is innervated by:
The thenar eminence is innervated by:
The Lateral forearm is innervated by:
Posterior forearm and arm: branch of radial nerve (posterior cutaneous)
Medial forearm: branch of Ulnar (medial cutaneous)
Thenar eminence: recurrent of the Median
Lateral forearm: Musculocutaneous
7 yo has a right leg cast and complians of numbness on the dorsum of his right foot and cannot dorsiflex his right ankle. Which nerve is being compressed?
The common peroneal (fibular nerve)
most commonly injured never in leg; very superficially located and wraps around the neck of the fibula
Laceration from lateral blows, compression in casts
You are working with a 70 yo man with a Hx of MI several years ago and recurrent ischemic attaks. He is currently on metoprolol, clopidogrel and rosuvastatin. He still has elevate BP and you are considering adding Rampiril to help manage his HTN. Whatdo you need to monitor when starting your patient on this medication and why?
Pt likely has cerebrovascular and coronary atherosclerosis. It is likely that the athersclerosis involves the renal arteries as well which means the kidneys likely are already poorly perfused and depend on RAS (ang II preferentially constricts efferent arteriole)
blocking this with an ACE inhibitor you drop the filtration pressure and further reduce GFR