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Musculoskeletal system


Pediatric musculoskeletal conditions
Musculoskeletal injuries and trauma
Bone disorders
Joint disorders
Muscular disorders
Neuromuscular junction disorders
Other autoimmune disorders
Musculoskeletal system pathology review



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High Yield Notes
6 pages


10 flashcards

USMLE® Step 1 style questions USMLE

2 questions

A 52-year-old man comes to the outpatient provider for evaluation of muscle weakness that began 5 months ago. The patient reports having difficulty at work as a librarian reaching for books on the top shelves. Past medical history is notable for hypertension currently managed with lisinopril. Temperature is 37.9°C (100.2°F), blood pressure is 148/91 mmHg, pulse is 64/min, and respiratory rate is 14/min. Physical examination reveals 4/5 strength in the deltoids and quadriceps. Strength is 5/5 in the rest of the body. Cardiovascular, pulmonary, and abdominal examination are non-contributory. No rashes are found on examination. Which of the following findings is most likely to confirm the diagnosis?  

External References

In polymyositis, “myos-“ refers to the muscles, “poly-“ means many, and “-itis” refers to inflammation, so polymyositis is an inflammatory disorder which involves many muscle groups around the body.

Polymyositis is an immune- mediated disease, meaning that the immune system attacks the muscles in our own body.

Normally, the cells of the immune system are ready to spot and destroy anything foreign that could cause the body harm.

To help with this, most cells in the body have a set of proteins that combine together to form something called a major histocompatibility complex, or MHC, class I molecule that sits on the surface of their cell membrane.

These surface proteins act kind of like a serving platter, presenting molecules from within the cell for the immune system to continually sample.

Normally though the molecule’s just a sample from the cell, and the immune system recognizes it as harmless, and this is known as a self-antigen, and there’s no response.

But when a cell is actually invaded by a pathogen like a virus, viral antigens are presented on the MHC class I molecule, and that sparks a different immune response.

A type of T-lymphocyte, called a CD8+ T-cell, also known as a cytotoxic T-cell, uses its T-cell receptors to bind to the antigen presented by the MHC class I molecule.

If the cytotoxic T-cell binds strongly, than the antigen is recognized as foreign, and the cytotoxic T-cell secretes a whole lot of perforin and granzymes.

Perforin forms big holes in the infected cell and that allows the granzymes to enter the cell.

Once inside, the granzymes induce apoptosis, or programmed cell death.

As if that weren’t enough, the cytotoxic T-cells have a protein called Fas ligand on their surface, and it binds to a molecule called Fas on the surface of the infected cell.

When these two combine, it triggers a cascade of signaling events inside the target cell that also leads to apoptosis.

Meanwhile, B- lymphocytes that react to the pathogen, can also start producing a whole lot of antibodies.

These antibodies bind the pathogen, and typically prevent it from attacking the host’s cells and, at the same time, “tag” the pathogen for further destruction by other immune cells.

In polymyositis, healthy muscle cells present normal muscle proteins on the MHC class I molecule, and the cytotoxic T-cells inappropriately react and get activated.

That’s because it’s thought that the muscle proteins might look similar to a foreign pathogen.

This is called molecular mimicry, because from the perspective of the cytotoxic T-cell, a host protein is mimicking a foreign protein.


Polymyositis is an inflammatory disorder of the muscles, caused mainly by cytotoxic T- cells destroying muscle tissue due to molecular mimicry and resulting in bilateral proximal muscle weakness of large muscle groups. It is characterized by muscle weakness, muscle pain, and difficulty with activities of daily living. Its diagnosis involves elevated serum creatinine kinase and myositis- specific antibodies, and it is treated with corticosteroids and specialized physical exercise.

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