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Movement > General Rheummatology > Flashcards

General Rheummatology Flashcards

0
Q 
What type of joint is each of the following:
Ball and socket (eg.?)
Intervertebral
Pubic symphysis
Costochondral
Sacroilliac
Hinge (eg?)
A 
Synovial
Fibrocartilaginous
Cartilaginous (fibrocartilaginous?)
Cartilaginous 
Synovial or fibrous??!!
Synovial
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1
Q

What are the 3 types of joint?

A

Fibrous
Fibrocartilaginous
Synovial

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2
Q

What is arthralgia?

A

Joint pain when joint appears normal on examination

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3
Q

What is arthritis?

A

Objective evidence of joint inflammation?

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4
Q

3 signs of ‘objective evidence’ of joint inflammation?

A

Swelling, deformity, effusion

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5
Q

In history taking, what must you always ask about stiffness?

A

Is there morning stiffness? >30mins in inflamm arthropathies

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6
Q

What is an arthropathy?

A

Disease of the joint

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7
Q

Synovial joints:
What is an enthesis?
What is epiphyseal bone?

A

A point at which ligaments and tendons insert into bone

Bone that abuts the joint and is structurally different from the shaft

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8
Q

What is another name for a shaft of bone?

A

Lol

Metaphysis

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9
Q

What is the role of a synovial joint? How does it achieve this?

A

To act as a shock absorber and distribute the load over the joint surface
By being a highly compressible structure

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10
Q

Joint capsule:
What is it lined by?
What is it connected to?

A

Synovium

Periosteum

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11
Q

What is periosteum?

A

A membrane that covers the outer surface of all bones

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12
Q

Synovial fluid - what is it secreted by and into where?

A

Synovial cells into the synovial cavity

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13
Q

What is articular cartilage? What is it composed of (3)?

A

Hyaline cartilage

Water, type II collagen, proteoglycans

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14
Q

What is the difference between a tendon and a ligament?

A

Tendon - muscle to bone

Ligament - bone to bone

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15
Q

Between which structures is the bursa?

A

Between the tendon/ligament/muscle and the joint capsule

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16
Q

What is periarticular pain? 3 causes?

A

Pain from structures surrounding the joint

Enthesitis, bursitis, tendinitis

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17
Q

Pain arising from the joint itself is known as what sort of pain?

A

Articular pain

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18
Q

What is oligoarthritis?

A

Arthritis affecting one to four joints during the first six months of disease

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19
Q

What is a common cause of acute, non-traumatic monoarthritis or oligoarthritis in young adults?

A

Disseminated gonococcal infections

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20
Q

What is the key investigation in acute monoarthritis?

A

Synovial fluid aspiration with Gr stain and culture and analysis for crystals in gout and pseudogout

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21
Q

What is the most common type of anaemia in musculoskeletal disease?

A

Normocytic normochromic

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22
Q

Why might you get hypochromic, microcytic anaemia in musculoskeletal disease?

A

NSAID induced GI bleeding –> iron deficient anaemia

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23
Q

Which factors are positive in seropositive RA?

A

Rheumatoid factor and anti-CCP antibodies

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24
Q

What does bone scintigraphy localise?

A

Sites of increased bone turnover and blood circulation

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25
Q

5 examples where bone scintigraphy will see ‘hotspots’?

A 
Osetomyelitis
Septic arthritis
Post surgery/traua
Malignancy
Paget's disease
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26
Q

When can ultrasound be used to assess bone density?

A

At the heel, as a screening procedure prior too DXA (dual energy Xray absorptiometry

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27
Q

When is MRI particularly useful (2)?

A

Articular disease

Spinal disorders

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28
Q

What does DXA do? Why is it used?

A

Measures bone mineral density in diagnosis and monitoring of ossteoporosis

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29
Q

When is arthroscopy useful?

A

Means off visualizing the inside of a joint, espec knee and shoulder.
Biopsy, small surgery, removal of loose bodies

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30
Q

What is most common iindication for joint aspiration?

A

Evaluation for sepsis in an inflamed joint

31
Q

How can you use joint aspiration too diagnose gout/pseudogout

A

Use polarized light

32
Q

What are the 4 main categories of rheumatological disease?

A

Inflammatory
Degenerative
Neuropathy
Functional

33
Q

Muscular spasm in neck and shoulder is often associated with what sort of headaches?

A

Tension

34
Q

2 causes of nerve root compression –> neck pain?
What kind of neck pain?
Radiates where?
What else is it associated with?

A

Cervical disk prolapse and spondylotic osteophytes
Unilateral
Interscapular and shoulder regions
Pins and needles and neurological signs in the arms

35
Q

Causes of neck pain? (5)

A 
Muscle spasm
Nerve root compression
RA
Ankylosing spondylitis
Fibromyalgia
36
Q

Cause of pain in shoulder girdle?

A

Polymyalgia rrheumatica

37
Q

Name the rotator cuff muscles

A

Supraspinatus
Infraspinatus
Subsccapularis
Teres minor

38
Q

What does each of the following rotator cuff problems cause?
Tendinitis?
Impingement?
Tear?

A

Painful arc on shoulder abduction (70-120 degrees)
Painful arc on shoulder abduction (70-120 degrees)
Prevention of active abduction (first 90 degrees)

39
Q

What does adhesive capsulitis cause? What is slang name for it?

A

Severe shoulder pain with all movements

Frozen shoulder

40
Q

What is tennis elbow?

A

Inflammation of insertion site of wrist extensor tendon into lateral epicondyle

41
Q

What is golfer’s elbow?

A

Inflammation of the wrist flexor tendon into the medial epicondyle

42
Q

2 causes of pain over trochanter which is worse when going up stairs and abducting the hip
How can you differentiate between the two?

A

Tronchanteric bursitis
Tear of gluteus medius tendon at its insertion into trochanter
MRI

43
Q

Which nerve does meralgia paraethetica involve? What does it cause?

A

Lateral cutaneous nerve of the thigh

Numbness and incr sensitivity to light tough over anterolateral thigh

44
Q

What is bleeding into the joint called?

A

Haemarthrosis

45
Q

What will you find on examination with an effusion?

A

Patellar tap

46
Q

What knee problem might be confused with a DVT? How would you diagnose it?

A

Rupture of a Baker’s cyst –> fluid into soft tissue of popliteal fossa and upper calf, sudden and severe pain

47
Q

What is a Baker’s cyst?

A

When fluid from a knee effusion escapes to form a popliteal cyst in a sub-gastrocnemius bursa

48
Q

How does bone remodel with age? Problems with this?

A 
Net loss (if severe = osteoporosis), but thickening around joints and ligament attachments.
--> friction on other tissues. Most common reason for bone/joint pain
49
Q

What is another big reason for joint paint (1/4 population)

A

Articular cartilage disintergration

50
Q

In inflammatory arthritis, what is inflaming?

A

Synovial lining

51
Q

Causes of acute synovitis (synovial lining inflammation)? (2)
Chronic synovitis?

A

Infection or crystals (gout/pseudogout)

Abnormal immune system regulation - e.g. RA

52
Q

What are synovial joints made up of (5 classes of tissue). How does this differ in fibrous joints?

A 
Bone
Cartilage
Synovium
Synovial fluid
Tensile tissue (ligament, tendon)

Fibrous joints don’t have synovium or synovial fluid

53
Q

In which areas will hyaline cartilage not regenerate?

A

Load bearing areas after they are damaged

54
Q

What is the vascular status in hyaline cartilage?

A

Avascular

55
Q

Where is fiibrocartilage found? (4)

A

Intervertebral disks

Discs, menisci and ring pads in peripheral joints

56
Q

What feature of synovium allows it to trap synovial fluid within the synovial cavity?

A

Impermeable to hyaluronan (that makes synovial fluid viscous)

57
Q

Which substance provides the lubrication in a synovial joint?

A

Lubricin

58
Q

What holds the bones together in fibrous joints?

A

Fibrocartillage

59
Q

What is the central semiliquid contained in intervertebral disks? What can happen to them?

A

Nucleus pulposus

They can herniate through a damaged outer fibrous annulus

60
Q

How do you distinguish joint pain from nerve root pain?

A

Moving the joint in isolation, in specific directions, makes the pain worse

61
Q

What does pain immediately on weight bearing suggest?

A

Sunbchondral bone exposure

62
Q

What does pain that is worse after rest, eased on short exercise, but then worsens again after prolonged use, indicate?

A

Chronic inflammation

63
Q

Why can it be difficult to diagnose an infection when it is superimposed on chronic arthritis?

A

The joints is already lax and so accommodates the effusion more easily –> less severe pain

64
Q

Severe pain without trauma suggests what (3)?

A

Infection
Reaction to crystals
Pathological fracture

65
Q

What is a pathological fracture?

A

Fracture caused by disease process that –> weakening of the bone

66
Q

What generally improves stiffness?

A

Movement

67
Q

How long can stiffness take to go in chronic inflammation?

A

3-4 hours

68
Q

4 types of swelling?

A

Bony/cartillaginous swelling
Synovial swelling
Effusion
Periarticular oedema

69
Q

Classic example of bony swelling? Where are they found? What are they associated with?

A

Heberdens nodes.
PIP joint
Osteoarthritis

70
Q

Where can you distinguish effusion from synovial swelling? How?

A

The knee. Demonstrating fluid flow.

71
Q

What does periarticular oedema (with redness) around the ankle indicate?

A

Acute sarcoid periarthritis

72
Q

2 physical signs of articular cartilage loss?

A

Ligament laxity

Bony crepitus

73
Q

What does a juddering shoulder on arm raising indicate?

A

Rotator cuff tear

74
Q

What is a bursa?

A

Fluid filled sac lined by synovial membrane

Movement (4 decks)

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