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academic weapon > MS1: Introduction to Rheumatology > Flashcards

MS1: Introduction to Rheumatology Flashcards

1
Q

most common type of joint

A

synovial joint

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2
Q

what is a synovial joint

A

fluid filled joint cavity covered by a fibrous capsule

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3
Q

3 main features of a synovial joint

A

articular capsule
articular cartilage
synovial fluid

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4
Q

what is the articular capsule

A

surrounds the joint and is continous w periosterum of the bones

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5
Q

layers of the articular capsule

A

fibrous layer and synovial layer

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6
Q

what is the capsular ligament

A

holds together articulating bones and supports synovium

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6
Q

what is the fibrous layer

A

consists of white fibrous tissue - capsular ligament

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7
Q

what is the synovial layer

A

highly vascularized serous connective tissue - absorbs and secretes synovial fluid

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8
Q

function of synovium

A

mediates nutrient exchange betw blood and joint fluid

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9
Q

what are the cell types of synovium

A

type A
type B
type C

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10
Q

what are type A cells

A

from macrophage - antigen ability = phagocytosis

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11
Q

what are type B cells

A

fibroblast like - rich in rough ER and dendritic processes

produces synovial fluid, hyaluronic acid, fibronectin and collagen

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12
Q

what are type C cells

A

intermediate cell type - precursor to either type A or B

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13
Q

cells found on superficial layer of the synovium

A

type A

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14
Q

cells found on deep layer of the synovium

A

type B

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15
Q

function of synovial fluid

A

lubricates articular cartilage and nourishment through diffusion

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16
Q

origin of of synovial fluid

A

from unltrafiltrate of blood plasma and regulated by synovium

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17
Q

how much synovial fluid in a healthy knee

A

2 mL

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18
Q

what is synovial fluid consist of

A

hyaluronin
lubricin
proteinase
collageneses
prostaglandins

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19
Q

function of hyaluronin

A

increases viscosity and elasticity of articular cartilage
lubricates surface betw synovuim and cartilage

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20
Q

function of lubricin

A

key lubricating glycoprotein - boundary layer lubrication
reduces friction betw opposing surfaces of cartilage

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21
Q

2 main roles of articular cartialge

A

minimize friction and absorbs shock

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22
Q

functions of synovial fluid

A

lubrication
nutrient distrbution
shock absroption

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23
Q

how does articular cartilage get nutrients

A

avascular and relies from passive diffusion of synovial fluid

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24
Q

what are accessory ligaments

A

separate ligaments or parts of joint capsule

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25
Q

what are bursae

A

small sac lined by synovial membrane and filled with synovial fluid - become inflamed following infection or irritation by over-use of the joint (bursitis)

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26
Q

location of bursae

A

key points of friction in a joint

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27
Q

desrcibe the nerve supply of synovial joints

A

rich supply from articular nerves - proprioceptive and nociceptive

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28
Q

what is hilton’s law

A

nerves supplying a joint also supply the muscles moving the joint and the skin covering

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29
Q

what is arthritis

A

joint disorder w inflammation and joint pain

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30
Q

what is arthralgia

A

joint pain

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31
Q

areas affected in articular arthritis

A

synovium
synovial fluid
articular cartilage
intraarticular ligaments
joint capsule
artciular bone

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32
Q

characteristics of articular arthritis

A

deep diffuse pain - crepitation
pain and LOM on active and passive movement
swelling
instability, locking and deformity

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33
Q

areas affected in non-articular arthritis

A

ligaments, tendons, bursae
muscle, fascia, bone
nerve and skin

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34
Q

characterisitcs of non-articular arthritis

A

painful on active only not passive motion

focal tenderness in adjacent regions

finding remote from capsule

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35
Q

findings of inflammatory arthritis

A

four cardinal signs
systemic symptoms
laboratory evidence

morning stiffness - severe and lasts for hours may improve w activity and AIF

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36
Q

four cardinal signs of inflammation

A

erythema - rubor
warmth - calor
pain - dolor
swelling - tumor

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37
Q

causes of inflammatory arthritis

A

infectious
crystal induced
immune related
reactive
idiopathic

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38
Q

example of infectious inflammatory arthritis

A

Neisseria gonorrhoea or Mycobacterium tuberculosis

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39
Q

example of crystal-induced inflammatory arthritis

A

gout

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40
Q

example of immune related inflammatory arthritis

A

RA and SLE

41
Q

example of reactive inflammatory arthritis

A

rheumatic fever and Reiter’s syndrome

42
Q

causes of non-inflammatory disorders

A

degeneration
pain amplification
trauma related to rotator cuff tear
repetitive use
neoplasm

43
Q

symptoms of non-inflammatory arthritis

A

intermittent stiffness - daytime gel and only <60 min

pain w/o swelling or warmth
absence of inflammatory or systemic features
day time gel

44
Q

arthritis common in male

A

gout and spondyloarthropathies

45
Q

arthritis common in female

A

RA, SLE, fibromyalgia

46
Q

arthritis common in young

A

16 below

SLE and reactive arthritis

47
Q

arthritis common in middle age

A

fibromyalgia and RA

48
Q

arthritis common in elderly

A

OA and polymyalgia rheumatica

49
Q

what to ask for in patient’s profile

A

sex
age
familial predilection
race

50
Q

arthritis common in abrupt onset

A

septic and gout

51
Q

arthritis common in insidous onset

A

OA, RA, fibromyalgia

52
Q

arthritis common in chronic evolution

A

OA

53
Q

arthritis common in chronic intermittent

A

crystal induced, lyme

54
Q

arthritis common in migratory evolution

A

rheumatic fever, gonococcal or viral arthritis

55
Q

arthritis common in additive evolution

A

RA. psoriatic

56
Q

arthritis common in acute

A

infectious, crystal induced, reactive

57
Q

arthritis common in chronic

A

OA, RA, fibromyalgia

58
Q

what to ask for progression of disease

A

onset - abrupt/insidious
evolution - chronic/intermittent/migratory/additive
duration - acute/chronic

59
Q

monoarticular

A

1

60
Q

oligoarticular or pauciarticular

A

2-3 joints - crystal and infectious

61
Q

polyarticular

A

more than 3 joints - OA and RA

62
Q

classification of articular

A

mono. oligo, poly

63
Q

classification of non-articular

A

focal - CTS and tendinitis
diffuse - polymyosistis and fibromyalgia

64
Q

common arthritis for symmetric joint involvememt

A

RA

65
Q

common arthritis for asymmetric joint involvememt

A

gout, spondyloarthropathy

66
Q

common arthritis for UE joint involvememt

A

RA and OA

67
Q

common arthritis for LE joint involvememt

A

reactive arthritis and hout

68
Q

common arthritis for axial skeleton involvement

A

OA and ankylosing spondylitis

not so much RA excdpt s cervical common dun

69
Q

what are precipitating events

A

trauma
intake of drugs
comorbidities

70
Q

conditions associated w eyes

A

Behcet’s, sarcoidis, spondyloarthritis

71
Q

conditions associated w GI tract

A

scleroderma, inflammatory bowel disease

72
Q

conditions associated w genitourinary tract

A

reactive arthritis, gonococcemia

73
Q

conditions associated w nervous system

A

lyme disease, vasculitis

74
Q

when is xray useful

A

trauma
chronic infection
progressive disability
monoarticular involvement

75
Q

common xray findings for chronic

A

calcification
joint space narrowing, erosion, ankylosis
new bone forms
subchondral cysts

76
Q

what is ultrasound for

A

for soft tissue abnormalities - bakers cyst

77
Q

macroscopic laboratory findings

A

volume
color
clarity
viscosity
mucin clot

78
Q

normal volume of synovial fluid analysis

A

normal is 3.5 mL ; inflamed up to 25 mL

79
Q

color of normal synovial fluid

A

pale yellow and clear

80
Q

color of hemmorhage synovial fluid

A

red, brown or xanthochromic

81
Q

color of non-inflammatory synovial fluid

A

yellow clear

82
Q

color of inflammatory synovial fluid

A

yellow cloudy

83
Q

color of crystal synovial fluid

A

white, cloudy and milky

84
Q

color of non-inflammatory and inflammatory effusions synovial fluid

A

deep yellow

85
Q

normal mucin clot

A

4-6 c,

86
Q

clarity, color and viscosity of normal synovial fluid

A

transparent, clear, high

87
Q

clarity, color and viscosity of non-inflamatorry synovial fluid

A

transparent. yellow, high

88
Q

clarity, color and viscosity of inflammatory synovial fluid

A

translucent, yellow, low

89
Q

clarity, color and viscosity of septic synovial fluid

A

opaque, dirty yellow, variable

90
Q

clarity, color and viscosity of hemmorhagic synovial fluid

A

bloody, red, variable

91
Q

WBC/mm3 of normal

A

<200

92
Q

WBC/mm3 of non-inflammatory

A

200-2,000

93
Q

WBC/mm3 of inflammatory

A

2000-10000-100000

94
Q

WBC/mm3 of septic

A

> 80000

95
Q

WBC/mm3 of hemorrhagic

A

200-2000

96
Q

group 1 non-inflammatory

A

Osteoarthritis, degenerative diseases

97
Q

group 2 inflammatory

A

Gout, pseudogout, spondyloarthropathies, rheumatoid arthritis, Lyme’s disease, systemic lupus erythematosus

98
Q

group 3 septic

A

Non-gonococcal or gonoccal septic arthritis

99
Q

group 4 hemorrhagic

A

Hemophilia. Trauma tumors

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