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Clin Med IV - Ortho > Learning Radiology Book - Arthritis > Flashcards

Learning Radiology Book - Arthritis Flashcards

1
Q

Types of arthritis that are diagnosed clinically (4)

A
  • Septic (pyogenic) arthritis
  • Psoriatic arthritis
  • Gout
  • Hemophilia
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2
Q

Types of arthritis that are diagnosed radiologically (6)

A
  • Osteoarthritis
  • Early rheumatoid arthritis
  • Calcium pyrophosphate deposition
  • Ankylosing spondylitis
  • Septic (TB)
  • Charcot (neuropathic) joint, late
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3
Q

Earliest structure involved in arthritis

A

Synovial membrane

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4
Q

Synovial membrane, synovial fluid and articular cartilage are not visible on ______ but are visible on _______

A

Not visible on X-ray

Visible on MRI, but X-ray still first

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5
Q

Arthritis almost always includes _______

A

Joint space narrowing

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6
Q

3 types of arthritis

A
  • Hypertrophic arthritis → bone formation
  • Erosive arthritis → inflammation, irregularly-shaped lytic lesions (erosions)
  • Infectious arthritis
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7
Q

Osteophyte

A

Bone formation that protrudes from parent bone

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8
Q

How does infectious arthritis occur?

A

Hematogenous seeding of synovial membrane from infected source in body or direct extension from osteomyelitis near joint

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9
Q

Types of hypertrophic arthritis (4)

A
  • Osteoarthritis/DJD
  • Erosive osteoarthritis
  • Charcot arthropathy (neuropathic joint)
  • Calcium pyrophosphate deposition dz (CPPD)
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10
Q

Pathophysiology of primary osteoarthritis

A

Degeneration of articular cartilage from wear/tear in weight-bearing joints

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11
Q

Most common joints involved in primary osteoarthritis

A
  • Hips (superior and lateral)
  • Knees (medial)
  • Hands (1st CMC joint, DIP joints)
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12
Q

What would you see on imaging of primary OA?

A
  • Marginal osteophyte formation
  • Subchondral sclerosis
  • Subchondral cysts
  • Narrowing of joint space
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13
Q

How would you differentiate secondary OA from primary?

A

Degeneration d/t underlying condition, e.g. trauma

  • Younger patient (e.g. 20’s)
  • Unilateral/asymmetrical
  • Atypical locations
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14
Q

Erosive osteoarthritis is more common in what pt population?

A

Perimenopausal women

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15
Q

Commonly affected joints in erosive OA (3)

A

PIP and DIP joints

1st digit joints

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16
Q

What might you see on imaging of erosive OA?

A
  • Gull-wing deformity → central erosions within joint w/ small osteophytes
  • Bony ankylosis (uncommon in DJD)
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17
Q

Pathophysiology of Charcot arthropathy

A

Neuropathic joint → disturbance in sensation leads to multiple microfractures, autonomic imbalance, hyperemia, bone resorption/fragmentation

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18
Q

Clinical presentation of Charcot arthropathy

A
  • Sensory disturbance but associated pain

- Soft tissue swelling

19
Q

Most common cause of Charcot arthropathy is _______

A

Diabetes

20
Q

Charcot arthropathy commonly affects _______

A

Lower extremities, esp. feet & ankles

21
Q

Hallmarks of Charcot arthropathy

A
  • Fragmentation (numerous, small bony densities)

- Eventual destruction of joint

22
Q

Charcot arthropathy and osteomyelitis can share similar radiologic findings. How do you differentiate the two?

A

Radioisotope-tagged white cell bone scan

23
Q

Pathophysiology of calcium pyrophosphate deposition dz

A

Deposition in mostly hyaline cartilage and fibrocartilage

24
Q

Ca++ pyrophosphate deposition dz most common affects _______ and _______

A

Triangular fibrocartilage of wrist

Menisci of knee

25
Q

Radiologic findings of Ca++ pyrophosphate deposition dz

A
  • Subchondral cysts (larger and more numerous than DJD)

- Hook-shaped bony excrescences along 2nd and 3rd metacarpal heads

26
Q

Characteristic findings of Ca++ pyrophosphate deposition dz in wrist

A
  • Calcification of triangular fibrocartilage
  • Narrowing of radiocarpal joint
  • Scapholunate dissociation and advanced collapse
27
Q

Types of erosive arthritis (4)

A
  • Rheumatoid arthritis
  • Gout
  • Psoriatic arthritis
  • Ankylosing spondyitis
28
Q

Clinical presentation of rheumatoid arthritis

A
  • Bilateral, symmetrical
  • Soft tissue swelling
  • Osteoporosis
  • Frequently affects proximal joints of hands and wrists
29
Q

Pathophysiology of gout

A

Deposition of calcium urate crystals in joints

30
Q

Dx gout

A
  • Clinical diagnosis, not radiological b/c extremely long latent period (5-7 yrs) b/w sx onset and visible bone changes
  • Monoarticular at onset then asymmetrical later
31
Q

Gout most often affects ______

A

MTP joint of great toe

32
Q

Hallmark of gout

A

Rat-bites → sharpy marginated juxtaarticular erosion that tends to have sclerotic border

33
Q

Difference b/w Rheumatoid Arthritis and Gout

A

RA is more common in females, affects hands/wrists, bilateral, early changes include ostEoporosis

34
Q

Findings in gout

A
  • Asymmetrical
  • Most often affects MTP joint of big toe
  • Rat-bites
  • Late findings: joint space narrowing, tophi (urate crystals in soft tissues)
  • Olecranon bursitis
35
Q

Hallmarks of psoriatic arthritis

A
  • Juxtaarticular erosions, esp. DIP joints
  • Enthesophytes → bony proliferations at tendon insertion sites
  • Resorption of terminal phalanges or DIP joints with pencil-in-cup deformity
  • Bilateral but asymmetric sacroiilitis
36
Q

Pathophysiology of ankylosing spondylitis

A

Inflammation and eventual fusion of SI joints, spinal facet joints and involvement of paravertebral soft tissue

37
Q

Findings of ankylosing spondylitis

A
  • Ascends spine, starting at SI joint
    +HLA-B27
  • Sacroiilitis (hallmark)
  • Ossification of outer fibers of annulus fibrosis → syndesmophytes → bamboo-spine
38
Q

Most common causes of pyogenic (septic) arthritis

A

Staphylococcus

Gonococcus

39
Q

Most common cause of nonpyogenic arthritis

A

M. tuberculosis from lungs

40
Q

Risk factors for infectious arthritis

A
  • IVDA
  • Steroids
  • Joint prosthesis
  • Recent joint trauma
41
Q

Most frequently affected joints in infectious arthritis

A

Knee

Knee + hip in peds

42
Q

Dx infectious arthritis

A

Aspiration of joint (plain films insensitive)

43
Q

Hallmark of infectious arthritis

A

Destruction of articular cartilage and long, contiguous segments of adjacent cortex d/t proteolytic enzymes released by inflamed synovium

Clin Med IV - Ortho (7 decks)

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