Exam 2 Flashcards
How many different arthritic conditions are there and how big of a deal is it anyway?
Over 100 arthritic conditions
More than 14 billion
infectious/septic arthritis incidence is most common below what age?
30
infectious/septic arthritis most common type
monoarticular
how does infectious/septic arthritis develop
from blood bourne pathogens and direct implantation
What is the most common organism for infectious/septic arthritis?
Staphylococcus aureus
What kind of findings lag behind the other associated with infectious/septic arthritis?
a. radiographic findings
b. clinical findings
a
What are the ABCs fo joint disease?
Alignment Bone Cartilage Distribution Soft Tissue
What are the three altered substances that affect the loss of joint space?
Fissures, flaking, vascularization
What type of osteoarthritis results in a “gull wing” appearance of DIP joint?
Erosive Osteoarthritis
Erosive osteoarthritis is most common in what age population?
middle age females
How many compartments make us the knee
3
What compartment of the knee is most commonly involved in DJD?
medial
thickened cortex at the medial femoral neck as the result of biomechanical changes across the joint.
Buttressing
what do subarticular cysts represent?
synovial intrusion through cartilage cracks and fissures, large cysts are termed geodes
What are the 6 D’s associated with hypertrophic neurotrophic joints
distended joints density increase debris dislocation disorganization destruction
What are the typical radiographic findings associated with DDD?
Decreased disc height osteophyte formation endplate sclerosis vacuum phenomenon subluxation
What are the categories of disc degeneration as described by Resnick and Niwayama?
Spondylosis deformans (outer disc) (marked by osteophtes) Intervertebral chondrosis (inner disc) marked by reduced IVD space
What are some findings of intervertebral disc osteochondrosis?
- primary degeneration of nucleus pulposis
- loss of disc height
- Knutson’s vacuum phenomenon
A radiolucent collections of nitroen gas within annular fissures is known as what
Knutson’s vacuum phenomena
Where is a knutson phenomenon normall seen
anterior margin of the IVD on extension films
What does a Knutson’s phenomena normall indicate?
DDD
What are findings associated with spondylosis deformans?
Degeneration fo the annulus
prominent osteophytosis
Comes from stressed anterior longitudinal ligaments that com from separated intervertebral disc tissue
osteophytes
Where do osteophytes develop in the vertebra
Where the vertebral body and cartilaginous rim unite
Which direction does osteophytes develop first?
extend in the horizaontal direction and then in the vertical direction
What does the presence of intercalary ossicle mean?
annulus degeneration
Exaggerated endplate sclerosis associate with DDD is known as?
Hemispherical spondylosclerosis
What are the Modic end plate MRI changes associated with on a Modic Type I model?
Dark T1 and Bright T2 = inflammation
What are the Modic end plate MRI changes associated with on a Modic Type II model?:
Bright T1 and T2 = Fat
What are the Modic end plate MRI changes associated with on a Modic Type III model?
Dark T1 and T2 = sclerosis
Schmorl’s nodes, endplate irregularity, and decreased anterior vertebral body height are all part of what diagnosis?
scheuermann’s disease aka Juvenile Discogenic disease
What allows a anterior subluxation?
posterior joint degeneration
degenerative anterior displaement is also known as?
Grade I Degenerative spondyloslisthesis
What is the significance of uncinate hypertrophy?
potential IVF encroachment
What is a pathological osseous proliferation at a tendon or ligament insertion?
Enthesopathy
An enthesopathy is caused by what?
Degenerative chages
Inflammatory changes
The DISH phenomenon occurs at what area of the vertebre?
Anterior vertebral body
DISH and what other clincial possibility is associated with it?
Diabetes mellitus
Ossification of the PLL is also known as?
OPLL
What is the one of the most serious complications of disc herniations?
Cauda equina syndrome
What are the symptoms of Cauda equina syndrome?
altered bowel and bladder function
impotence
saddle paresthesia
progressive muscle atrophy
midline disc herniaions in the cervical spine create what?
myelopathies
lateral disc herniation of the cervical spine do what?
compresses the nerve root below
Midline/paracentral disc herniation in the lumbar spine does what?
compresses the nerve root below
Foraminal disc herniation in the lumbar spine will involve what?
the nerve root at the same level
What is a typical disc herniation?
A. Midline
B. Lateral
C. Foraminal
A
Does a typical lumbar disc herniation compromise the exiting nerve root or the traversing nerve root?
Traversing nerve root
What are the contents of the spinal canal?
Thecal sac epidural fat internal vertebral plexus ligamentum flavum posterior longitudinal ligament
What is contained in the thecal sac?
cord and cauda equina
When looking at a disc herniation what two things should be considered?
is the herniation contained or non contained
What disc classification is circumferential symmetric extension of the disc beyond the interspace (around the end plates) A. Bulge B. Protrusion C. Extrusion D. Sequstration
A
What disc classification is focal or asymmetric extension of the disc beyond the interspace, with the base against the disc of origin broader than any other dimension of the protrusion A. Bulge B. Protrusion C. Extrusion D. Sequstration
b
What disc classification is more extreme extension of the disc beyond the interspace, with the base against the disc of origin narrower than the extruded portion A. Bulge B. Protrusion C. Extrusion D. Sequstration
C
What disc classification has no connection between the material and the disc of origin A. Bulge B. Protrusion C. Extrusion D. Sequstration
D
What do you look for during a myelogram?
indention of contrast column
What does the contrast column in a myelogram mean?
disc lesion
What are the measurements to consider possible stenosis in the cervical spine?
Canal stenosis less than 12 mm
What are the measurements to consider possible stenosis in the lumbar spine?
Canal stenosis less than 15mm
What is the preferred method to evaluate potential stenosis?
Axial slices of a CT or MRI
What are the two major types of inflammatory joint disease?
Rheumatoid types (seropositive) Rheumatoid Variants (seronegative)
What are three examples of seropositive inflammatory disease?
rheumatoid arthritis
Systemic lupus erythematorsis
scleroderma
What are four examples of Rheumatoid variants?
Ankylosing spondylitis
Reiter’s disease
Psoriatic arthritis
Enteropathic arthritis
A generalized connective tissue autoimmune disease involving synovial tissue resulting in polyarticular joint inflammation
Rheumatoid Arthritis
conditions associated with RA, (five conditions)
Arthritis mutilans Baker's cyst Boutonniere deformity Felty's syndrome Haygarth's nodes
severe joint deformity/destruction
ARthritis mutilans
enlargement of the gastrocnemius bursa
Baker’s cyst
PIP flexion, DIP extension
Boutonniere Deformtiy
leukopenia, splenomegaly and RA
Felty’s syndrome
soft tissue swelling at the MCP
Haygarth’s nodes
stiff joints after inactivity
Jelling phenomena
accumulation of inflammatory cells, with
necrotic area and fibrosis seen on extensor surfaces
Rheumatoid nodule
flexion of DIP and extension of the PIP
Swan neck deformity
intermittent absence of the articular
cortex due to erosion
Dot-dash appearance
pocket erosions localized loss of
intraarticular cortex adjacent to the capsular insertion due to
pannus erosion at the anatomical bare area
Marginal erosion; rat bite
loss of joint space in RA is normally
A. symmetrical
B. Asymetrical
a
What are two findings in RA?
Marginal erosion and decreased joint space3
ulnar styloid erosion is normally found in what condition?
Rheumatoid arthritis
Marginal erosion is found in RA due to _______ formation?
pannus
What is the most likely areas of involvement for RA in the wrist and hand?
MCP
PIP
Ulnar aspect of the wrist
Someone with Boutonniere Deformity would have PIP __________ and DIP __________
flexion; extension
Boutonniere deformity is caused by the central slip of the?
extensor digitorum communis
Swan Neck Deformity is cause by PIP _________ and DIP __________
extension; Flexion
A synovial cyst that extends into the soft tissues posterior to the knee.
Bakers Cyst
Flexion and extension studies should be performed to evaluate the atlantodental interval (ADI). This should not exceed _______mm
3
What should be done if the patient is neurologically compromised?
MRI examination
Ballooned epiphyses is an indicator of what condition?
Juvenile Chronic ARthritis
What age is Juvenile RA onset?
less than 16
Are most cases of Juvenile Rheumatoid seropositive or seronegative?
seronegative for Rheumatoid factor
systemic Lupus Erythematosus is positive or negative for rheumatoid factor
positive
Systemic Lupus Erythematosus has what kind of deformity in the hands?
Swan-neck deformity
Scleroderma is also known as…
progressive systemic sclerosis
generalized systemic inflammatory connective tissue disorder involving skin, lungs, GI tract, kidneys and musculoskeletal system, causes small vessel disease and fibrosis in multiple organ systems.
progressive systemic sclerosis (Scleroderma)
effects females 3:1
30-50 years
cyclic vascular changes usually of the hands which is precipitated by the cold or emotional upset
Raynaud’s Phenomenon
What is CREST Syndrome?
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Teangiectasia
dilated subdermal blood vessels are known as ?
Telangiectasia
What are some radiographic findings associated with scleroderma?
acral tapering of the soft tissues
osseous resorption (acro-osteolysis) extensive subcutaneous soft tissue calcification
flexion contractures
If Rheumatoid Factor is negative what test is positive?
HLA B27
What four conditions are HLA B27 positive?
Ankylosing apondylitis
Psoriatic arthritis
Reiter’s disease
Enteropathic arthritis
What are some synonyms for ankylosing spondylitis?
Marie Strumpell’s disease
50% of AS patients will have peripheral disease especially of the hip and shoulders, what is the condition?
Spondylitis Rhizomelique
What is the most common seronegative spondyloarthropathy?
Ankylosing spondylitis
AS is most common in what gender?
male 1:10
AS is ________% positive HLA-B27
90
Initial changes in AS consist of synovial proliferation, inflammatory cellular infiltrate producing what?
pannus
What is the anatomical site of attachment of a ligament or tendon to bone via Sharpey’s fibers
Enthesis
What occurs to the SI joint in AS
lossof subchondral definition ->Erosion and joint spacewidening -> fusion (50% of the time)
SI joint ankylosis progresses from what seronegative condition?
AS
Don’t confuse Osteitis Condensans Ilii with what other condition?
AS
Osteitis Condensans Ilii is seen in what population?
post partum females
What condition may also be found in AS in the spine
syndesmophytes (bamboo spine)
On an x-ray a shiny corner sign is likely what diagnosis?
AS
Would a HLA B-27 test be helpful is diagnosing AS?
Yes
vertically oriented spurs that represent the sequalae of inflammatory disease of the spinal ligaments. They are ossification of the outer fibers of the annulus and the inner fibers of the ALL
syndesmophytes
Vertebral body squaring is an early sign of what condition?
Early AS
the presence of a Dagger sign would indicate a diagnosis of what?
Woudl a HLA B2-7 exam be benificial?
AS
No
What ligament is ossified with a dagger sign?
calcification of the capsular ligament
What causes the trolley tract sign?
capsule and inter/supraspinous ossification
Sclerosis, irregularity, endplate destruction created by Hypermobility through a fractured previously ankylosed segment
Andersson lesion
Are there postural changes associate with AS?
yes
A patient with SI fusion who also has an inflammatory bowel disease such as crohn’s disease you might consider what diagnosis?
enteropathic arthritis
Can AS involve other sites?
Appendicular (hip and shoulder)
Pelvis, calcaneus,bondy proliferation and erosion at the enthesis
Enteropathic arthritis is associated with what other disorders?
gut
Psoriatic arthritis affects ______% of patients with psoriasis
5-7
Psoriatic arthritis is mediated by what?
immune system
What are the main targets of Psoriatec arthritis?
Hands and to a lesser extend feet
The axial skeleton is involved in _______%
20-40
Psoriatic is an immune reaction similiar to what condition?
RA
Is Psoriatic arthritis in the hands and feet symmetric or asymmetric small joint involvement?
asymmetric
What is the main joint involved in psoriatic arthritis?
DIP
What are some other conditions involved in psoriatic arthritis?
peripheral erosions w/ periostitis (“mouse ears”)
central erosions (“pencil-and-cup”)
soft tissue swelling (Sausage digit)
normal mineralization (normal bone density)
bony ankylosis is a common sequela
deformity
What are some clinical feature of psoriatic arthritis?
young adults males and females psoriasis nail pitting "sausage" digit fusiform swelling of entire digit “cocktail sausage digit”
What is unique about psoriatic arthritis?
more prominent along one digit instead of joint
What may develop from psoriatic arthritis?
acroosteolysis
is psoriatic arthritis a debilitating form of arthritis?
no
Psoriatic arthritis mimics what other condition but is less symmetric and thend to have normal bone density?
RA
Is there bulkier syndesmophytes in AS or psoriatic arthritis
psoriatic arthritis nonmarginal syndesmophytes
“mouse ears” or periostitis is found in what kind of arthritis
psoriatic arthristis
is psoriatic arthritis seropositive or negative?
negative but HLA B27 positive
how do you know that psoriatic arthritis is different from RA?
pencil and cup
T/F there is nonmarginal syndesmophytes in Psoriatic arthritis
True
A patient with sausage digits should be diagnosed with what?
psoriasis
What is the triad of symptoms associated with Reiter’s arthritis?
Urethritis
conjunctivitis
arthritis
What gender has a high predominance to Reiter’s disease?
males
Thick nonmarginal syndesmophytes known as “lover’s heels” is present in what condition?
Reiter’s arthritis
Reiter’s arthritis is similiar to what other condition? What is the main difference?
psoriatic arthritis
involves the lower extremities
heel spurs and retrocalcaneal bursitis known as “Lover’s heels” is present in what condition?
Reiter’s arthritis
If the patient is a male and complains of a burning sensation on urination then likely what condition?
Reiter’s Arthritis
What are the various etiologies of Chondrocalcinosis?
Cartilage degeneratoin
Crystal deposition
Cation disease
What is an example of Cartilage degeneration of chondrocalcinosis?
degenerative joint disease
What are some examples of crystal deposition in Chondrocalcinosis?
primary CPPD
Gout
What are some cation disease in Chondrocalcinosis?
hemchromatosis (iron)
hyperparathyroidism (calcium)
Wilsoms disease (copper)
What anatomy is calcified in chondrocalcinosis?
the meniscus
degenerative joint disease at an unusual location should raise suspicion of what entity?
A crystal desposition disease such as CPPD
Hook osteophyte’s at the 2nd and 3rd metacarpal suggest what diagnosis?
hemochromatosis
A finding of an olecranon erosion and soft tissue tophi is known as what?
Gout
a “lumpy bumpy joint disease” is known as what?
Gout
Gout in the big toe is known as what?
podagra
