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Y2 Muscskel (LCRS2) > The GALS Screen > Flashcards

The GALS Screen Flashcards

1
Q

Define the following terms:

a. Arthritis
b. Arthralgia
c. Subluxation
d. Synovitis
e. Dislocation

A

a. Arthritis
Refers to definite inflammation of a joint

b. Arthralgia
Refers to pain within a joint without demonstrable inflammation by physical examination

c. Subluxation
Partial dislocation of a joint

d. Synovitis
Inflammation of the synovium

e. Dislocation
Articulating surfaces are displaced and are no longer in contact

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2
Q

What does GALS stand for?

A

Gait
Arms
Legs
Spine

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3
Q

What is gout caused by?

A

It is caused by deposition of monosodium urate (MSU) crystals as a result of hyperuricaemia

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4
Q

What are the key clinical features of gout?

A

Tophi – subcutaneous depositions of aggregated monosodium urate crystals

Gouty arthritis

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5
Q

Which joint is commonly affected by gouty arthritis?

A

1st Metatarsophalangeal joint – this is called podagra

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6
Q

List some signs of irreversible joint damage.

A

Joint deformity

Crepitus

Loss of joint range or abnormal movement

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7
Q

List some signs of a mechanical defect in the joint.

A

Painful restriction of movement in the absence of features of inflammation

Instability

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8
Q

How many joints have to be involved for arthritis to be classified as ‘monoarthritis’ ‘oligoarthritis’ and ‘polyarthritis’?

A

polyarthritis > 4 joints involved

oligoarthritis 2-4 joints involved

monoarthritis single affected joint

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9
Q

Describe the pattern of arthritis in the following diseases including the joints that are commonly affected and spared:

a. Rheumatoid arthritis
b. Reactive arthritis
c. Gout

A

a. Rheumatoid arthritis
Symmetrical polyarthritis involving large and small joints

Joints spared: DIP, lumbar spine, thoracic spine

Joints involved: most others

b. Reactive arthritis
Lower limb asymmetrical oligoarthritis and axial involvement

c. Gout
Exclusive inflammation of the 1st metatarsophalangeal joint

Joints commonly spared: axial

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10
Q

What is the main extra-articular feature of gout?

A

Tophi – subcutaneous deposits of uric acid

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11
Q

What are the two types of synovial lining cell?

A

Typa A – macrophage-like

Type B – fibroblast-like (secrete hyaluronic acid)

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12
Q

What is a synovial effusion?

A

Abnormal increase in synovial fluid volume

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13
Q

State two causes of spinal effusion and describe the synovial fluid composition in each of them.

A

Abnormal mechanical stimulation – can stimulate the fibroblasts to produce more hyaluronic acid – normal composition

Inflammation – inflammatory exudate – abnormal composition with inflammatory mediators and reduced hyaluronic acid

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14
Q

What features of the synovial fluid are examined to determine the cause of the synovial effusion?

A

How turbid it is

The presence and quantity of inflammatory cells (neutrophils in particular)

Non-inflammatory – slightly turbid – osteoarthritis or mechanical defects

Inflammatory – turbid – reactive arthritis or gout

Infection – very turbid – bacterial infection

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15
Q

When is synovial fluid examination performed?

A

When joint infection is suspected

Useful for confirming diagnosis of crystal arthritis

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16
Q

What are some contraindications for arthrocentesis?

A

Conditions that increase bleeding e.g. coagulopathy or anti-coagulant drugs

Overlying skin infection

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17
Q

List some possible complications of arthrocentesis

A

Risk of introducing infection
Bleeding into the joint
Damage to structures of the joint

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18
Q

What technique is used to detect crystals in the synovial fluid?

A

Polarising light microscopy

19
Q

How is gout distinguished from pseudogout in synovial fluid examination?

A 
Gout  
 Urate crystals 
 Needle shaped 
 Negative birefringence (polarising light microscopy)
Pseudogout 
 Calcium pyrophosphate dehydrate (CPPD) crystals  
 Brick shaped  
 Positive birefringence
20
Q

What is a common feature of most connective tissue diseases?

A

Raynaud’s phenomenon (intermittent vasospasm of the digits on exposure to the cold)

21
Q

What is Sjogren’s syndrome and what are its symptoms?

A 
Autoimmune exocrinopathy  
Symptoms: 
Dry eyes (xerophthalmia) 
Dry mouth (xerostomia) 
Parotid gland enlargement  
Extra-glandular features: non-erosive arthritis + Raynaud’s
22
Q

Which antibodies are associated with Sjogren’s syndrome?

A

ANA
Anti-Ro
Anti-La
Rheumatoid factor

23
Q

What is inflammatory muscle disease and what are the two types?

A

Proximal muscle weakness due to autoimmune-mediated inflammation either with a rash (dermatomyositis) or without a rash (polymyositis)

24
Q

Describe the skin changes that take place in dermatomyositis.

A

Lilac rash on eyelid, malar region and naso-labial folds
Red or purple lesions on knuckles (Gottron’s papules)
Subcutaneous calcinosis
Mechanic’s hands (fissuring and cracking of the skin over the finger pads)

25
Q

Which antibodies are associated with inflammatory muscle disease?

A

ANA
Anti-tRNA transferase antibodies
NOTE: also associated with elevated creatine phosphokinase, abnormal EMG and abnormal muscle biopsy

26
Q

What other diseases is inflammatory muscle disease associated with?

A

Pulmonary fibrosis and Malignancy

27
Q

What is systemic sclerosis?

A

Thickened skin with Raynaud’s phenomenon Features include:
 Dermal fibrosis
 Cutaneous calcinosis
 Telangiectasia

28
Q

What are the two types of systemic sclerosis and what are the differences between them?

A

Diffused systemic sclerosis
 Fibrotic skin proximal to elbows or knees
 Anti-Scl-70 antibodies
 Pulmonary fibrosis and renal involvement
 SHORT history of Raynaud’s
Limited systemic sclerosis
 Fibrotic skin on hands, forearms, feet, neck and face
 Anti-centromere antibodies
 Pulmonary hypertension
 LONG history of Raynaud’s

29
Q

What is overlap syndrome?

A

When feature of more than one connective tissue disease are presen

30
Q

What are the signs of active inflammation?

A

swelling (tumor)

warmth (calor)

erythema (rubor)

tenderness (dolor)

loss of function (functio laesa)

31
Q

What are the aims of the locomotor examination?

A
  1. Are any of the joints abnormal?
  2. What is the nature of the joint abnormality?
  3. What is the extent (distribution) of the joint involvement?
  4. Are any other features of diagnostic importance present?
32
Q

What are the components of the locomotor examination?

A

GALS

Detailed examination of abnormal joints

33
Q

What is the detailed examination of abnormal joints comprised of?

A

inspection:
swelling, redness, deformity

palpation:
warmth, crepitus,

tenderness:
movement
active, passive, against resistance

function:
loss of function

34
Q

Define enthesopathy

A

pathology at the enthesis i.e. the site where ligament or tendon inserts into bone

35
Q

Give examples of 2 types of enthesopathy

A

plantar fasciitis

Achilles tendinitis

36
Q

Define dislocation

A

articulating surfaces are displaced and no longer incontact

37
Q

Define subluxation

A

partial dislocation

38
Q

Define valgus

A

lower limb deformity whereby distal part is directed away from the midline e.g. hallux valgus

39
Q

Define varus

A

lower limb deformity whereby distal part is directed towards the midline e.g. varus knee with medial compartment OA

40
Q

What are the names for the hand deformities seen in rheumatoid arthritis?

A

Swan-neck and Boutonnière deformities

41
Q

What are the names for the hand deformities seen in rheumatoid arthritis?

A

Swan-neck and Boutonnière deformities

42
Q

What are the features of ankylosing spondulitis?

A

Chronic inflammatory disease affecting:

Sacroiliac joints (sacroiliitis) and spine - leads to spinal fusion (ankylosis) and deformity

Enthesopathy

Non-axial joints – hips and shoulders (common), others less frequently involved

43
Q

What is ankylosing spondylitis associated with?

A

Strong association with HLA-B27

Rheumatoid factor is negative

Y2 Muscskel (LCRS2) (11 decks)

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