Name that Myopathy
A 45-year-old patient presents with progressive, symmetric proximal muscle weakness, difficulty climbing stairs, and difficulty rising from a chair. What general pattern of muscle disease does this presentation suggest?
What is a proximal myopathic pattern of weakness?
Which commonly prescribed class of lipid-lowering medications can cause muscle symptoms ranging from myalgia to rhabdomyolysis?
What is Statins (HMG-CoA reductase inhibitors)?
A patient with fatigue, cold intolerance, weight gain, muscle cramps, and proximal weakness has elevated CK. Which endocrine disorder is the most likely cause?
What is hypothyroidism?
Which serum enzyme is most commonly used as an initial laboratory marker of skeletal muscle injury?
What is Creatine kinase (CK)?
What is the primary intervention for most medication-induced toxic myopathies?
What is discontinuation, dose reduction, or substitution of the offending agent when clinically appropriate?
A patient receiving prolonged high-dose glucocorticoid therapy develops progressive, painless proximal weakness with normal CK levels. What is the most likely diagnosis?
What is corticosteroid-induced myopathy?
Corticosteroids induce damage to this time of muscle fibers in corticosteroid induced myopathy.
What is selective type II muscle fiber atrophy?
A patient presents with acute generalized muscle weakness and a serum electrolyte level of 2.1 mEq/L. Which electrolyte abnormality is responsible?
What is severe hypokalemia?
What is the classic EMG myopathic pattern?
What is short-duration, low-amplitude motor unit potentials with early recruitment?
A patient presents with severe hypokalemia and acute proximal muscle weakness. What is the primary treatment?
What is potassium replacement with cardiac monitoring as indicated, alongside identification and correction of the underlying cause?
A hospitalized patient with sepsis and multi-organ failure develops diffuse flaccid weakness and difficulty weaning from mechanical ventilation. What muscle disorder should be suspected?
What is critical illness myopathy?
A patient receiving medication for gout develops proximal weakness, elevated CK, and an associated axonal neuropathy. The risk is increased in renal impairment. What is the diagnosis?
What Is Colchicine-induced toxic neuromyopathy?
A patient with weight loss, heat intolerance, tachycardia, and proximal muscle weakness has a suppressed TSH and elevated free T4. What is the diagnosis?
What is Thyrotoxic myopathy?
A patient taking hydroxychloroquine develops progressive proximal weakness and dysphagia. Muscle biopsy demonstrates particular pattern changes, and electron microscopy reveals curvilinear bodies. What type of myopathy does this represent?
What is autophagic vacuolar myopathy (hydroxychloroquine-induced)?
A patient presents with severe rhabdomyolysis, CK of 35,000 U/L, and dark urine. What intervention is essential to reduce the risk of acute kidney injury?
What is prompt intravenous isotonic fluid resuscitation, individualized to volume status, with close monitoring of renal function, electrolytes, and urine output?
A patient presents with muscle cramps, exercise intolerance, and episodic dark-colored urine following strenuous physical activity. Which potentially life-threatening muscle complication should be suspected?
What is rhabdomyolysis.
A patient receiving prolonged treatment for atrial fibrillation develops progressive proximal muscle weakness, muscle atrophy, and reduced deep tendon reflexes. Which medication is responsible for this toxic neuromyopathy?
What is amiodarone?
A patient with chronic alcohol use presents with acute muscle pain, swelling, profound weakness, and markedly elevated CK after binge drinking. What is the most likely diagnosis?
What is acute alcohol-associated myopathy with rhabdomyolysis?
Muscle biopsy in a critically ill patient demonstrates preferential loss of myosin thick filaments, without significant inflammatory infiltrates. What is the most likely diagnosis?
What is Critical illness myopathy (thick-filament myopathy)?
A patient with statin-associated proximal weakness and marked CK elevation continues to deteriorate despite stopping the medication. Anti-HMGCR antibodies are positive. What additional treatment approach is required?
What is immunomodulatory therapy, often involving IVIG, corticosteroids, and/or steroid-sparing immunosuppressive agents, rather than statin withdrawal alone?
A patient develops progressive proximal weakness and CK elevation above 5,000 U/L while taking a statin. Weakness and CK elevation persist despite statin discontinuation, and anti-HMGCR antibodies are positive. What is the most likely diagnosis?
What is Anti-HMGCR immune-mediated necrotizing myopathy?
A patient receiving sedation infusion in the ICU develops severe metabolic acidosis, rhabdomyolysis, hyperkalemia, and cardiac dysfunction. What potentially fatal complication should be suspected?
What is propofol infusion syndrome?
A patient with lung cancer develops progressive proximal weakness, muscle pain, and elevated muscle enzymes. Myositis-specific antibody testing reveals anti-TIF1γ positivity. What important underlying association should be considered?
What is cancer-associated dermatomyositis. Anti-TIF1γ positivity in adult dermatomyositis is associated with an increased risk of malignancy.
What is endomysial inflammation?
What are the mnemonic use for ACUTE DIALYSIS indications?
What is A E I O U?
A: acidosis
E: electrolytes
I: intoxications
O: overload
U: Uremia