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YR2: Musculoskeletal > 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

Arthritis: definite inflammation of a joint
Arthralgia: Pain within a joint without demonstrable inflammation
Subluxation: Partial dislocation of a joint
Synovitis: Inflammation of the synovium
Dislocation: Articulating surfaces are displaced + 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

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

Gouty arthritis

Tophi: aggregated deposits of MSU in tissue

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5
Q

Which joint is commonly affected by gouty arthritis?

A

1st Metatarsophalangeal joint

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6
Q

List 3 signs of irreversible joint damage.

A

Joint deformity
Crepitus
Loss of joint range or abnormal movement

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7
Q

List 2 signs of a mechanical defect in the joint.

A

Painful restriction of motion in the absence of features of inflammation e.g. knee locking
Instability

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8
Q

Distinguish between monoarthritis, oligoarthritis and polyarthritis

A

Monoarthritis: Single joint affected
Oligoarthritis: 2-4 joints involved
Polyarthritis: >4 joints involved

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9
Q

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

a. Rheumatoid arthritis
b. Reactive arthritis
c. Gout

A

Rheumatoid: Bilateral + symmetrical polyarthritis involving large + small joints
Reactive: Lower limb asymmetrical oligoarthritis + axial involvement
Gout: exclusive 1st metatarsophalangeal joint

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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

Type 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 syonovial effusion and describe the synovial fluid composition in each of them.

A

Abnormal mechanical stimulation: can stimulate fibroblasts to produce more hyaluronic acid
Increases oncotic pressure + synovial volume= normal composition
In synovitis due to inflammation, effusion is inflammatory exudate= Abnormal composition with inflammatory cells + 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

Presence + quantity of inflammatory cells (WCC + neutrophils)

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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 risk of bleeding e.g. anti-coagulant drugs
Overlying skin infection

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17
Q

List 3 possible complications of arthrocentesis

A

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

18
Q

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

A

Polarising light microscopy

19
Q

What is a common feature of most connective tissue diseases?

A

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

20
Q

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

A 
AI exocrinopathy (destruction of lacrimal + salivary glands)
Symptoms: 
Dry eyes
Dry mouth 
Parotid gland enlargement  
Non-erosive arthritis + Raynaud’s
21
Q

Which antibodies are associated with Sjogren’s syndrome?

A

ANA

Rheumatoid factor

22
Q

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

A

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

23
Q

Describe the skin changes that take place in dermatomyositis.

A

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

24
Q

What is systemic sclerosis?

A

Thickened skin with Raynaud’s phenomenon
Dermal fibrosis
Cutaneous calcinosis
Telangiectasia

25
Q

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

A 
Diffused systemic sclerosis 
Proximal to elbows or knees  
Pulmonary fibrosis + renal involvement 
SHORT history of Raynaud’s  
Limited systemic sclerosis  
Hands, forearms, feet, neck + face 
Pulmonary hypertension
LONG history of Raynaud’s
26
Q

What is overlap syndrome?

A

When features of >1 connective tissue disease are present

27
Q

List 5 clinical manifestations of SLE

A 
Malar rash (nasolabial fold sparing)
Photosensitive rash
Mouth ulcers
Hair loss
Raynaud's phenomenon
28
Q

What are the signs of inflammation?

A 
Swelling
tenderness
Redness
Warmth
Loss of function
29
Q

What lifestyle choice predisposes one to gout?

A

Purine rich diet (e.g. red meat)

30
Q

Give 4 characteristics of gout

A

Abrupt onset
Extremely painful
Joint swollen, tender, red + warm
Resolves spontaneously with 10 days

31
Q

Give 2 examples of enthesopathies other than ankylosing spondylitis

A

Achilles tendinitis

Plantar fasciitis

32
Q

What is an enthesopathy?

A

Pathology at the enthesis (where ligament or tendon inserts into bone)

33
Q

Give an example of a chronic condition in which joint deformity may occur

A

Ankylosing spondylitis

34
Q

Which joints are spared in Rheumatoid arthritis?

A

DIP
Thoracic spine
Lumbar spine

35
Q

Which joints are spared in Osteoarthritis?

A 
MCP
Wrist
Elbow
Shoulder
Ankle
Tarsal joints
36
Q

Which joints are spared in polyarticular gout?

A

Axial

37
Q

What are the main extra-articular feature of rheumatoid arthritis?

A

Subcutaneous nodules

38
Q

What is the main extra-articular feature of SLE?

A

Malar rash (spares nasolabial folds)

39
Q

What is synovial fluid, and what increases it’s viscosity?

A

Viscous fluid in joint space of synovial joints

Hyaluronic acid increases viscosity

40
Q

What type of crystal is present in pseudogout?

A

CPPD

YR2: Musculoskeletal (10 decks)

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