myopathies

Question 1

drugs that can cause myopathy

Answer 1

steroids
alcohol
statins

Question 2

inflammatory myopathies -

Answer 2

polymyositis
dermatomyositis
Inclusion body myositis

Question 3

Poly+dermatomyositis:
cause =
F:M
age of peak incidence
increased\_\_\_ risk

Answer 3

idiopathic
F2:1M
40-50yo
malig

Question 4

histology of poly+dermatomyositis

Answer 4

muscle fibre necrosis
degeneration
regeneration and inflammatory infliltrate

Question 5

cutaneous signs in dermatomyositis

Answer 5

Gottrons sign (back of hands)
heliotrope rash
shawl sign

Question 6

poly+dermatomyositis usually have an ___ onset
worsen over ___ and main feature = ___ - only 25-50% have ___
usually a/symmetrical? and ___ muscles

Answer 6

insidious
months
muscle weakness
mild myalgia
asymmetrical
proximal

Question 7

other organ involvement in poly+dermatomyositis

Answer 7

ILD10%, resp muscle weakness
dysphagia
myocarditis
fever
wt loss
Raynauds
nonerosive polyarthritis

Question 8

malignancies ass with poly and dermatomyositis
most at risk pop group =
which is more ass with malig?

Answer 8

ovarian, breast, stomach, lung, bladder + colon
M >45yo
dermatomyositis

Question 9

examination tests for poly/dermatomyositis

Answer 9

muscle wasting
rashes
confrontational test (direct power test)
isotonic testing ( repeat stand and sit for 30s - use to monitor)

Question 10

endomyseal inflammation with CD8+ cells

Answer 10

polymyositis

Question 11

perimyseal inflammation with CD4+ cells and perifascicular atrophy

Answer 11

dermatomyositis

Question 12

Ix for poly+dermatomyositis

Answer 12

bloods - CK, inflam markers, electrolytes, Ca2+, PTH and TSH, ANA and Anti Jo-1
EMG
MRI
muscle biopsy (definitive)

Question 13

results of blood tests in poly+dermatomyositis

Answer 13

CK in the 1000s (v high)
inflam markers high
ANA and anti-Jo1 maybe

Question 14

results of EMG in poly+dermatomyositis

Answer 14

increased fibrillations
abnormal motor potentials
complex repetitive discharges

Question 15

MRI results in early and late poly+dermatomyositis

Answer 15

early = muscle inflam and oedema
late = fibrosis and muscle calcification

Question 16

muscle biopsy result inpoly+dermatomyositis

Answer 16

perivascular inflam and muscle necrosis

Question 17

definitive test for poly+dermatomyositis

Answer 17

muscle biopsy

Question 18

Rx for poly+dermatomyositis

Answer 18

prednisolone 40mg and taper
Is (methotrexate, azathioprine, ciclosporin)
if resistant = rituximab
IV Ig for skin disease

Question 19

inclusion body myositis:
age =
M:F
more \_\_ than poly+dermatomyositis
\_\_ muscle weakness often a/symmetrical
\_\_ risk

Answer 19

>50yo
M3:1F
insidious
distal
asymmetrical
no malig

Question 20

sites of weakness in inclusion body myositis

Answer 20

wrist and finger flexors
quadriceps
anterior tibial

Question 21

in inclusion body myositis __ is elevated by not as high as in polymyositis

Answer 21

CK

Question 22

muscle biopsy findings in inclusion body myositis

Answer 22

… inclusion bodies … duh

Question 23

dont give __ in inclusion body myositis as is ineffective and has side effects
responds poorly to therapy

Answer 23

IS

Question 24

polymyalgia rheumatica (PMR):
age
higher incidence in __ regions
15% ass with __

Answer 24

> 50yo
Northern
GCA

Question 25

presentation of PMR usually comes on in __ with an __ in __+___ usually a/symmetrical intense ___ better when ___ muscle __ normal but _+_ decrease function

Answer 25

``` wks ache in shoulder and hip girdles symmetrical morning stiffness - better on movement strength normal pain and stiffness ```

Question 26

tender enlarged non-pulsatile temporal arteries =

Answer 26

GCA

Question 27

diagnosis of PMR =

Answer 27

increased ESR, PV and CRP

Question 28

treatment for PMR =

Answer 28

15mg low dose steroids - rapid and dramatic response if also have GCA = 40-60mg prednisolone to prevent blindness reduce over 18m-2yrs

Question 29

``` fibromyalgia F:M trigger may be _/_ no ___ main 2 features = ```

Answer 29

F6:1M eotional /physical trauma no inflammation chronic pain and sleep disorder

Question 30

commonest cause of MSK pain in F 22-50 yo =

Answer 30

fibromyalgia

Question 31

some examples of how fibromyalgia can present (11)

Answer 31

``` debilitating fatigue sleep unrefreshing generalised pain cognitive difficulties headache/migraine IBS ENT oeso dysmotility hypotension wt loss night sweats ```

Question 32

``` pain in fibromyalgia: sites = __+___ worse on exertion, fatigue and stress __ sensation _+_ sensation ```

Answer 32

neck - shoulders - lower back - chest wall chronic and diffuse swelling sensation pins and needles

Question 33

examination findings in fibromyalgia | diagnosis =

Answer 33

excessive tenderness on soft tissue palpation (11/18 sites for diagnosis) other tests and exam normal

Question 34

treatment of fibromyalgia

Answer 34

``` educate OT physio CBT antidepressants, analgesia, pregabalin + gabapentin ```