Tiff
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A 56 year old female has had increasing generalized muscle weakness for the past 2 months. On pysical examination, she has 3/5 motor strength in both upper and lower extremities. She is afebrile but has a blood pressure of 155/90 mm Hg. A gastrocnemius muscle biopsy is performed, and histochemical staining of the biopsy shows type II muscle fiber atrophy. Which of the following conditions is she most likely to have?
A. Cushing syndrome
B. McArdle disease
C. Duchenne muscular dystrophy
D. Myasthenia gravis
E. Polymyositis
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| new_n_lost
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A. Cushing syndrome
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| jean robert
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D. Myasthenia gravis
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| SILVER
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A
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| basophilia
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A
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| doctor123
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Why A Where is Obesity,thining of skin , moon like face etc etc
Why D Myasthenia gravis- though muscle weakness is there also TypeII muscle Atrophy/Disuse Atrophy
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| Tiff
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The answer is A - Cushings Syndrome.
Apparently we are to assume that the patient has this disease and is taking glucocorticoids though nothing in the question stem suggests Cushings. For those who confidently answered A, please explain how you got to that answer. and why not any of the others like polymyositis.
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| new_n_lost
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The Ages of the patient, the histology of the muscle and the mentioning of the BP and the BP itself all lead to one scenario
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| doctor123
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Polymyositis (itis) --------------- refers to etiology --------- infection ----------- but pt afebrile
BP elevated but no h/o or predisposing factor for inc. glucorticoid use -- could be glucorticoid excess-- not typical ppresentation. usullay presents with weight gain, thinning of sin, inc BP.
Myasthenia --- usually localised to one muscle group for years.
http://www.aafp.org/afp/20050401/1327.html
DR.123
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| new_n_lost
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doctor123 wrote:Polymyositis (itis) --------------- refers to etiology --------- infection ----------- but pt afebrile BP elevated but no h/o or predisposing factor for inc. glucorticoid use -- could be glucorticoid excess-- not typical ppresentation. usullay presents with weight gain, thinning of sin, inc BP. Myasthenia --- usually localised to one muscle group for years. http://www.aafp.org/afp/20050401/1327.html DR.123
Whats the Histological Picture of Polymyositis ??
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| basophilia
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what it make me decided for cushing sd is , general weakness , different of polyomyositis that is proximal muscles weakness , and the other reason the blood pressure .
they dont give you more information about ck or antibodies antiribonucleotideprotein.
the bx of polyomyositis you can find since necrosis of mycrofibrillin or just perivascular inflamation
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| jean robert
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Tiff, where is the question from ?
Plz,may u post the explanation.
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| Tiff
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Question is from Robbins
(A) Type II atrophy can be seen with glucocorticoid excess and after prolonged immobilization. With routine light microscopy, it may be difficult to distinguish from denervation atrophy, and histochemical staining for ATPase must be performed. There is a deficiency of myophosphorylase enzyme with McArdle disease, leading to muscle pain and cramping with vigorous exercise. Duchenne muscular dystrophy is an X-linked condiion, making it rare in females, with onset in early childhood. Antibodies to the acetylcholine receptor cause the muscular weakness in myasthias gravis. Polymyositis is an inflammatory condtion affecting all fiber types.
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