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Fundamentals of Imaging > Crystal and Metabolic Arthropathies > Flashcards

Crystal and Metabolic Arthropathies Flashcards

1
Q

What develops as a result of hyperuricemia and subsequent deposition of monosodium urate monohydrate crystals in and around the joint?

A

Gouty arthropathy

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2
Q

What type of gout involves an inborn error of metabolism of purines. Idiopathic gout (M>F)?

A

Primary Gout

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3
Q

What type of gout develops from either overproduction or decreased removal of uric acid?

A

Secondary Gout

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4
Q

What is the end-stage by-product of purine metabolism of cells that is normally removed by the healthy kidneys?

A

Uric acid

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5
Q

What causes oversaturation of tissues with uric acid and precipitation of urate salts forming crystals?

A

Hyperuricemia

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6
Q

What body parts are typically effected by Acute attacks of gouty arthritis?

A

Big toe (Podagra)
Knee
Ankle
Wrist

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7
Q

Which of the body parts is most commonly effected by Gout?

A

1st MTP of Big toe (Podagra)

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8
Q

What is the earliest sign of Gout?

A

Joint effusion

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9
Q

What is a key X-Ray feature of Gout?

A

Bone erosions with “overhanging edges”

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10
Q

What erosion feature makes Gout different from other arthritises?

A

sclerotic rim

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11
Q

Where is the most common site for spinal gout?

A

Lumbar spine

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12
Q

What kind of fluid can be taken from an area affected by tophacious gout?

A

Synovial fluid

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13
Q

What is a common condition in the elderly resulting with the deposition of calcium pyrophosphate crystals in the soft tissues and the joints, especially intra-articular fibrocartilage including hyaline cartilage

A

CPPD (Calcium Pyrophosphate Crystal Deposition)

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14
Q

What consists of the radiographic features of CPPD?

A

Chondrocalcinosis
Subchondral cysts
Osteophytes

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15
Q

What is known as a hyaline or fibrocartilage calcification due to CPPD?

A

Chondrocalcinosis

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16
Q

What is known as a specific term used for chondrocalcinosis d/t CPPD crystals?

A

CPPD crystal deposition disease

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17
Q

What resembles DJD but affects joints that are not typically affected by DJD (MCP, wrist, elbow) and may appear more cystic?

A

Pyrophosphate arthropathy

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18
Q

What resembles acute attacks of gout?

A

Pseudogout

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19
Q

What is elevated during attacks from pseudogout?

A

WBC and ESR

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20
Q

What does joint aspiration reveal with individuals with CPPD?

A

birefringent rhomboid-shaped CPP crystals

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21
Q

Where is chonedrocalcinosis most commonly seen?

A

Menisci
TFC (triangular fibrocartilage) at the wrist
symphysis pubis
Glenoid labrum

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22
Q

What is the dominant feature of CPPD?

A

Subchondral cysts

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23
Q

In CPPD, how do the osteophytes look like on the hand?

A

hook-like projections on MCPs

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24
Q

What is it called when CPPD affects the odontoid process?

A

Crowned dense sign

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25
Q

What is known as the deposition of Ca+ hydroxyapatite crystals in the soft tissues in and around the joint, mostly at the terminal tendons’ insertion sites?

A

HADD (Calcium Hydroxyapatite Deposition Disease)

26
Q

What is another name for HADD?

A

Calcific periarthritis

27
Q

What joint is the most affected by HADD?

A

Shoulder

28
Q

What is the radiographic feature of HADD?

A

Homogenous round soft tissue calcifications

29
Q

What are the target sites of the shoulder for HADD?

A

greater humeral tuberosity insertion of supra/infraspinatus muscle tendons
subscapularis/long head of the biceps m.

30
Q

What radiographic view is best to see infraspinatus HADD?

A

AP shoulder with external humeral rotation

31
Q

What radiographic view is best to see supraspinatus HADD?

A

AP shoulder in internal humeral rotation

32
Q

What can develop as erosive destructive process during reactive inflammatory destructive process induced by HADD crystals of the shoulder?

A

Milwaukee Shoulder

33
Q

What is a rare autosomal recessive abnormality that results in the deposition of homogentisic acid (HGA) in the peripheral tissues?

A

Ochronosis

34
Q

What is the clinical presentation of alkaptonuria (ochronosis)?

A

black discolouration of urine

35
Q

What do the symptoms of ochronosis arthropathy resemble?

A

Osteoarthritis

36
Q

Why does tissue resemble a dark blue discoloration in ochronosis?

A

HGA deposits

37
Q

What are the 2 amino acids that are high in alkaptonuria (ochronosis)?

A

Phenylalanine and Tyrosine

38
Q

What radiographic findings would be present with ochronosis?

A

intradiscal calcification
narrowed disc height
Homogenous mineralization of auricular & nasal cartilage

39
Q

What is the key radiographic feature of Ochronosis?

A

intradiscal calcifications

40
Q

What is a rare familial condition of abnormal phosphate metabolism that results in painless mineralized peri-articular masses and develops d/t FGF 23 gene defect located on osteoblasts that regulates phosphate, resulting in abnormal phosphate accumulation in peri-articular regions?

A

Tumoral calcinosis

41
Q

What ethnicity is Tumoral calcinosis most common seen in?

A

African Americans

42
Q

Where is the most common site of Tumoral Calcinosis?

A

Shoulder

43
Q

What is the key radiographic finding for Tumoral Calcinosis?

A

“cloud-like” amorphous soft tissue mineralizations

44
Q

What is excessive growth hormone (GH) production in skeletally matured individuals?

A

Acromegaly

45
Q

What is the most common cause of Acromegaly?

A

Pituitary micro/macro adenoma

46
Q

What condition is often associates with Charcot joint, adhesive capsulitis (frozen shoulder), and CTS?

A

Diabetes Mellitus

47
Q

What is a multi-system granulomatous disease of unknown origin with immune-mediated activation of T-lymphocytes, mononuclear phagocytes (monocyte-macrophage origin) and NON-CASEATING granulomas with extensive distribution within the body (lungs, skin, ocular, salivary, reticuloendotheleal tissues, CNS, bones & joints)

A

Sarcoidosis

48
Q

Where is the most common site affected by sarcoidosis?

A

Hands

49
Q

What is the key radiographic feature of sarcoidosis?

A

“Lace-like” expansile lesions

50
Q

What stage of Pulmonary sarcoidosis contains “potato nodes?”

A

Stage 1

51
Q

What stage of Pulmonary sarcoidosis contains nodal and pulmonary sarcoid?

A

Stage 2

52
Q

What stage of Pulmonary sarcoidosis contains primary pulmonary interstitial disease?

A

Stage 3

53
Q

What stage of Pulmonary sarcoidosis contains pulmonary fibrosis and irreversible changes?

A

Stage 4

54
Q

What is a destructive arthropathy due to bacterial organisms gaining access to the joint via typical routes?

A

Septic arthritis

55
Q

What is the most common bacterial agent associated with septic arthritis?

A

Staph aureus

56
Q

In what age group of septic arthritis does it affect when blood vessels perforate open growth plate region?

A

0-1 years

57
Q

In what age group of septic arthritis does it affect when blood vessels do not penetrate cartilagenous growth plate

A

1-16 years

58
Q

In what age group of septic arthritis does it affect when blood vessels penetrate closed growth plate and supply the epiphysis?

A

16+ years

59
Q

Where is the greatest risk for septic arthritis?

A

Large joints with good blood perfusion

60
Q

T/F: X-rays are less sensitive at detecting early septic arthritis and special imaging is recommended

A

True

Fundamentals of Imaging (16 decks)

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