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[PBR] MSK Radiology > Arthritis > Flashcards

Arthritis Flashcards

1
Q

most common arthritide

A

osteoarthritis of DJD

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2
Q

etiology of DJD

A

caused by trauma– either overt or as an accumulation of microtrauma over years

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3
Q

hereditary form of DJD occurs primarily at what population

A

middle-aged women

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4
Q

hallmarks of DJD

A

joint space narrowing, sclerosis, osteophytosis

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5
Q

the only disorder that will cause osteophytosis without sclerosis or joint space narrowing is

A

diffuse idiopathic skeletal hyperostosis

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6
Q

DISH is a common bone-forming disorder that at first glance resembles DJD, except that there is no ____ and no _____

A

no joint space narrowing and there is no sclerosis

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7
Q

DJD are common in what 4 body parts

A

hands, knees, hips and spine

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8
Q

primary DJD are commonly seen in what 4 body part

A

hands, DIP, PIP and base of thumb in bilaterally symmetrical fashion

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9
Q

type of osteoarthritis that can be very painful and debilitating is

A

erosive osteoarthritis/Kellgren arthritis

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10
Q

there are few exceptions to the classic triad of findings seen in DJD. Several joints may also exhibit erosions, that can be seen in these 4 body parts

A

TNJ, acromioclavicular joint, SI joints and symphysis pubis

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11
Q

cystic formations that occur around joints in various disorders, including, in addition to DJD, RA, calcium pyrophosphate dihydrate crystal deposition disease and AVN

A

geode

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12
Q

one method of geode formation

A

synovial fluid is forced into the subchondral bone, causing a cystic collection of joint fluid; could also cyst from contused bone

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13
Q

4 radiographic hallmarks of RA

A

soft tissue swelling, osteoporosis, joint space narrowing, marginal erosion

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14
Q

characteristic of erosion in RA

A

marginal; away from weight bearing portion of joint

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15
Q

In the hip, femoral head tends to migrate ____ in RA

A

axially

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16
Q

femoral heads tend to migrate _____ in OA

A

superolaterlally

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17
Q

in RA, humeral head tends to appear

A

high-riding

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18
Q

high-riding humeral head can be seen in (3)

A

RA, torn rotator cuff and CPPD

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19
Q

these disorders are linked to HLA-B27 histocompatibility antigen (4)

A
  • ankylosing spondylitis,
  • IBD,
  • psoriatic arthritis,
  • reactive arthritis (also called Reiter syndrome)
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20
Q

these group of arthritides are characterized by bony ankylosis, proliferative new bone formation, predominantly axial (spinal) involvement

A

HLA-B27 spondyloarthropathies

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21
Q

syndesmophytes can be seen in

A

HLA-B27 spondyloarthropathies

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22
Q

a paravertebral ossification that resembles an osteophyte, except it runs vertically

A

syndesmophytes

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23
Q

orientation of osteophyte

A

horizontal

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24
Q

bamboo spine is classic finding in (2)

A

ankylosing spondylitis and IBD

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25
Q

characteristic of syndesmophyte in ankylosing spondylitis

A

marginal and symmetrical

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26
Q

characteristic of syndesmophyte in IBD

A

nonmarginal, asymmetrical, large and bulky

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27
Q

characteristic of syndesmophyte in psoriatic arthritis and reactive arthritis

A

unilateral, asymmetrical

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28
Q

ankylosing spondylitis and IBD tyically cause unilateral or bilateral SI joint disease?

A

bilateral

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29
Q

large joint involvement with HLA-B27 spondyloarthropathies is uncommon, but when it occurs, the arthropathy will resemble _____ and what body part is involved 50% of the time

A

RA, hips

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30
Q

cause a distinctive arthropathy that is characterized by its distal predominance, proliferative erosions, soft tissue swelling and periostitis

A

psoriasis

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31
Q
  1. proliferative erosions are different from the clean-cut, sharply marginated erosions, seen in all arthritides in that they have
A
  1. fuzzy margins with wisps of periostitis emanating from them
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32
Q
  1. reactive arthritis occurs almost exclusively in men or women?
A
  1. men
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33
Q

commonly affected body part in reactive arthritis

A

interphalangeal joint of great toe

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34
Q

A. crystal-induce arthritides include (4)

B. The abnormal pigmentation, brown-black in color, may be observed in various connective
tissues in patients with alkaptonuria. It describes the bluish-black pigmentation of connective tissue that may be apparent at such sites as the skin, sclera, and ear in patients with alkaptonuria

C. associated with distinctive skeletal abnormalities, including osteopenia, bone fragmentation
and cyst formation, ossicles, poorly defined subchondral bone, and osteochondritis dissecans. These findings superficially resemble the changes in hemochromatosis and idiopathic CPPD crystal deposition disease.

A

A.

  • gout and
  • pseudogout,
  • onchronosis and
  • Wilson disease

B. Ochronosis

C. Wilson’s disease

Wilson’s disease (hepatolenticular degeneration) is a rare autosomal recessive disorder characterized by degenerative changes in the brain, particularly the basal ganglia; cirrhosis of the liver; and diagnostic Kayser-Fleischer rings of greenish brown pigment at the limbus of the cornea. The primary abnormality in Wilson’s disease is not known. It is certain, however, that the clinical symptoms and signs of Wilson’s disease result from the relentless accumulation of copper in the body. The copper concentration is increased in the liver, brain, and other tissues; levels of serum copper and copper-binding protein
(ceruloplasmin) are generally decreased.

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35
Q

metabolic disorder that results in hyperuricemia and leads to monosodium urate crystals being deposited in various sites in the body, especially joints

A

Gout

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36
Q

4 hallmarks of gout

A

well-defined erosions (sclerotic margins, overhanging edge),
soft tissue nodules,
random distribution,
no osteoporosis

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37
Q

it takes how many years before gout becomes radiographically apparent

A

4 to 6 years

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38
Q

soft tissue nodules in gout calcify if there is accompanying what condition

A

renal failure

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39
Q

gout typically affects what body part

A

metatarsophalangeal joint of great toe

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40
Q

patients with gout often have

A

CPPD

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41
Q

triad of CPPD

A
  • pain,
  • cartilage calcification and
  • joint destruction

CPPD = CPD

42
Q

most common location of chondrocalcinosis in CPPD (3)

A

KTS

  • knee,
  • triangular fibrocartilage of wrist,
  • symphysis pubis
43
Q

DJD of CPPD has a proclivity for what body parts (5)

A

SPERM

  • shoulder,
  • elbow,
  • radiocarpal joint in the wrist,
  • patellofemoral joint of the knee,
  • metacarpophalangeal joints in the hand
44
Q

three diseases that have a high degree of association with CPPD

A

PGH

  • primary hyperparathyroidism,
  • gout,
  • hemochromatosis
45
Q

drooping osteophytes are often seen in (2)

A

CPPD and hemochromatosis

46
Q

elbow is an unusual place for DJD to occur except in the setting of (2)

A

CPPD or trauma

47
Q

hallmarks of SLE in the hand

A

marked soft tissue wasting as noted by the concavity in the hypothenar eminence, with ulnar deviation of phalanges

48
Q

collagen vascular diseases causing arthritis include (4)

A

SS-DM

  • scleroderma,
  • SLE,
  • dermatomyositis,
  • mixed connective tissue disease
49
Q

striking abnormality of the hands in collagen vascular diseases

A

osteoporosis and soft tissue wasting

50
Q

erosions are generally not a feature of these disorders

A

collagen vascular diseases

51
Q

soft tissue calcifications are typically present in what collagen vascular disease (2)

A

scleroderma and dermatomyositis

52
Q

calcifications in scleroderma are typically

A

subcutaneous

53
Q

calcifications in dermatomyositis are

A

intramuscular in location

54
Q

mixed connective tissue disease is an overlap of (4)

A
  • scleroderma,
  • SLE,
  • polymyositis,
  • RA
55
Q

disease that causes if deposition of granulomatous tissue in the body, primarily in the lungs, but also in bones

A

sarcoidosis

56
Q

in skeletal sytem, sarcoidosis has a predilection for the

A

hands, where it causes lytic destructive lesions in the cortex (lace-like appearance)

57
Q

disease of excess iron deposition in tissues throughout the body leading to fibrosis and eventual organ failure

A

hemachromotosis

58
Q

in this condition, classic radiographic changes are essentially DJD, which involves second through the fourth MCP joints

A

hemochromatosis

59
Q

squaring of metacarpal heads are seen in

A

hemochromatosis

60
Q

classic triad of neuropathic or charcot joint

A
  • joint destruction,
  • dislocation and
  • heterotopic new bone formation
61
Q

progressive joint destruction occurs in a ____ because the joint is rendered unstable by inaccurate muscle action and is unprotected by intact nerve reflexes

A

neuropathic joint

62
Q

has also been termed debris or detritus and consists of soft tissue calcification or clumps of ossification adjacent to the joint

A

heterotopic new bone

63
Q

most commonly seen charcot joint today is

A

foot of a diabetic patient

64
Q

in charcot joint of DM foot, it typically affects the

A

first and second tarsometatarsal joints in a fashion similar to a Lisfranc fracture-dislocation

65
Q

classic findings of JRA and hemophilia are

A

overgrowth of the ends of the bones (epiphyseal enlargement) associated with gracile diaphyses

66
Q

process that can mimic the findings in JRA and hemophilia is a

A

joint that has undergone disuse from paralysis

67
Q

common denominator shared by JRA, hemophilia and paralysis is

A

disuse

68
Q

relatively common disorder caused by a benign neoplasia of the synovium, resulting in deposition of nodules of cartilage in the joint

A

synovial chondromatosis

69
Q

synovial chondromatosis is most commonly seen in the (3)

A
  • knee,
  • hip and
  • elbow
70
Q

loose bodies are tightly packed in a joint giving the appearance on MRI of a tumor. this has been termed

A

tumefactive synovial chondromatosis

71
Q

true or false: no malignant tumors arise in joints

A

true

72
Q

apple core appearance of bone due to pressure erosion of multiple nonossified chondral bodies. this condition is called

A

nonossified synovial chondromatosis

73
Q

uncommon chronic inflammatory process of the synovium that causes synovial proliferation

A

pigmented villonodular synovitis

74
Q

has been termed giant cell tumor of tendon sheath and tendon sheath xanthoma when it occurs in a tendon sheath

A

pigmented villonodular synovitis

75
Q

pigmented villonodular synovitis are radiographically identical to

A

noncalcified synovial chondromatosis

76
Q

characteristic appearance of pigmented villonodular synovitis in MRI

A

low-signal intensity hemosiderin seen lining the synovium on both T1 and T2

77
Q

also known as shoulder-hand syndrome, reflex sympathetic dystrophy and chronic regional pain syndrome. it is a poorly understood joint affliction that typically occurs after minor trauma to an extremity, resulting in pain, swelling and dysfunction

A

sudeck atrophy

78
Q

radiographically seen in sudeck atrophy (2)

A

severe patchy osteoporosis and soft tissue swelling

79
Q

sudeck atrophy typically affects

A

distal part of an extremity such as a hand or foot

80
Q

most joint effusion are clinically obvious and do not require radiographic validation. _____ is an exception,, if effusion is found in that body part, a fracture is present

A

elbow

81
Q

the only fat pad around the hip that gets displaced with an effusion is the _____

A

obturator internus

82
Q

the radiographic sign for a knee effusion that seems to be the most reliable is the

A

measurement of between the suprapatellar fat pad and anterior femoral fat pad (more than 10 mm is definite evidence of effusion)

83
Q

normal measurement between the suprapatellar fat pad and anterior femoral fat pad

A

less than 5 mm

84
Q

can occur around almost any joint for a host of reasons including steroids, trauma, various underlying disease states and even idiopathic. often seen in renal transplant patients

A

avascular necrosis or osteonecrosis

85
Q

hallmark of AVN

A

increased bone density at an otherwise normal joint

86
Q

earliest sign of VN is

A

joint effusion

87
Q

next sign of AVN after joint effusion

A

patchy or mottled density

88
Q

next sign of AVN after patchy or mottled density

A

subchondral lucency

89
Q

final sign of AVN

A

collapse if articular surface and joint fragmentation; only on one side of the joint

90
Q

focal area of AVN that is most likely due to trauma is called

A

osteochondritis dessicans

91
Q

most sensitive imaging in detecting AVN

A

MRI

92
Q

AVN of lunate is called

A

Kienbock malacia

93
Q

type of ulnar variance that is said to have a high association with Kienbock malacia

A

negative ulnar variance

94
Q

osteochondritis dessicans usually occur in what body part (2)

A

knee at the medial epicondyle,

zone of talus

95
Q

osteochondritis dessicans frequently leads to a small fragment of bone becoming a free fragment in the joint called a

A

joint mouse

96
Q

it is the only condition in which a geode can occur in a normal joint

A

AVN

97
Q

AVN of tarsal navicular

A

Kohler disease

98
Q

AVN of metatarsal heads

A

Freiberg infarction

99
Q

AVN of femoral head

A

Legg-Perthes disease

100
Q

AVN of apophyseal ring epiphyses of the spine

A

Scheuermann disease

101
Q

AVN of tibial tubercle

A

Osgood-Schlatter disease also termed surfer knees

[PBR] MSK Radiology (12 decks)

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