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Y2 Musculoskeletal > The GALS Screen > Flashcards

The GALS Screen Flashcards

1
Q

What are the 3 main questions explored when investigating an abnormal joint

A

What is the nature of the joint abnormality?

What is the extent (distribution) of the joint involvement?

Are any other features of diagnostic importance present?

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2
Q

What is looked for in examination of the legs

A 
Look for knee or foot deformity
Assess flexion of hip and knee
Look for knee swellings
Test for synovitis at the metatarso-phalangeal joints (MTP joints)
Inspect soles of the feet
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3
Q

What kind of things are you looking for in inspection, palpation, movement and function during GALS

A 
Inspection - swelling, redness, deformity
Palpation - warmth, crepitus, tenderness
Movement - Active, passive, against resistance
function - Loss of function
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4
Q

What questions are asked to determine nature of joint abnormality

A

Is there inflammation?
Is there irreversible joint damage?
Is there a mechanical defect?

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5
Q

What is gout

A

Tissue deposition of monosodium urate (MSU) crystals as a result of hyperuricaemia and leads to one or more of the following:
Gouty arthritis
Tophi (aggregated deposits of MSU in tissue)

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6
Q

What joint does gout commonly affect

A

metatarsophalangeal joint of the big toe (‘1st MTP joint’)

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7
Q

Describe the clinical features of gout

A

Abrupt onset
Extremely painful
Joint red, warm, swollen and tender
Resolves spontaneously over 3-10 days

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8
Q

What are some signs of irreversible joint damage

A

Joint deformity
Crepitus
Loss of joint range or abnormal movement

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9
Q

What are some signs of a mechanical defect in the joints

A

painful restriction of motion in absence of features of inflammation
e.g. knee ‘locking’ due to meniscal tear or bone fragment

instability
e.g. side-to-side movement of tibia on femur due to ruptured collateral knee ligaments

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10
Q

What are the names given to arthritis of different numbers of joints

A

polyarthritis - > 4 joints involved
oligoarthritis - 2-4 joints involved
monoarthritis - single affected joint

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11
Q

Describe the pattern of arthritis in rheumatoid arthritis, including the joints that are commonly affected and spared

A

Symmetrical polyarthritis involving large and small joints

Joints spared: DIP, lumbar spine, thoracic spine
Joints involved: most others

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12
Q

Which joints are commonly affected in arthritis

A

Lower limb asymmetrical oligoarthritis and axial involvement

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13
Q

Which joints are commonly affected and spared in gout

A

Exclusive inflammation of the 1st metatarsophalangeal joint

Joints commonly spared: axial

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14
Q

What are some other features of musculoskeletal diseases that might be of diagnostic importance

A

Subcutaneous nodules - rheumatoid arthritis

Tophi - Gout

Malar rash - lupus

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15
Q

What is synovial fluid and describe its appearance

A

Viscous fluid present in joint space of synovial joints (diarthroses)

Colourless or pale yellow transparent viscous film covering synovium and cartilage with few cells

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16
Q

What does synovium contain

A

lining cells 1-3 cells deep in a matrix mainly containing type I collagen and proteoglycans

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17
Q

What are the types of synovial lining cells

A

type A = macrophage-like

type B = fibroblast-like
Cells secrete the hyaluronic acid which results in the increased viscosity of synovial fluid

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18
Q

What is a synovial effusion

A

Abnormal increase in synovial fluid volume

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19
Q

What might cause a synovial effusion

A

Abnormal mechanical stimulation

Increase production of hyaluronic acid by synovial fibroblasts due to mechanical forces

Excess hyaluronic acid increases oncotic pressure and increases synovial volume – normal composition

20
Q

Describe the synovial fluid in synovitis due to inflammation

A

effusion is inflammatory exudate – abnormal composition: inflammatory cells and mediators, reduced hyaluronic acid

21
Q

How is synovial fluid examination carried out

A

needle aspiration under aseptic conditions (termed arthrocentesis)

22
Q

When is synovial fluid examination performed?

A

When joint infection is suspected

Suspected crystal arthritis

23
Q

Give some possible complications of arthrocentesis

A

Risk of introducing infection (i.e. creating a septic arthritis)
Bleeding into joint (haemarthrosis)
Damage to structures within the joint e.g. cartilage

24
Q

What are some contraindications for arthrocentesis?

A

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

Overlying skin infection

25
Q

What technique is used to examine synovial fluid for crystals

A

Polarising light microscopy to detect crystals which can be seen in arthritis due to gout or pseudogut

26
Q

What technique is used to examine synovial fluid for pathogens

A

Rapid Gram stain followed by culture and antibiotic sensitivity assays

27
Q

How is gout distinguished from pseudo gout

A

Gout - urate Crystal, needle shape, -ve light microscopy

Psuedogout - CPPD, brick-shaped, +ve light microscopy

28
Q

Serum autoantibodies are characteristic and…

A

May aid diagnosis
Correlate with disease activity
May be directly pathogenic

29
Q

What it Raynaud’s phenomenon

A

Intermittent vasospasm of digits on exposure to cold

Typical colour changes – white to blue to red

30
Q

What is Sjogrens syndrome

A

Autoimmune exocrinopathy

lymphocytic infiltration of especially exocrine glands and sometimes of other organs (extra-glandular involvement)

31
Q

What are the symptoms of Sjogrens syndrome

A 
Dry eyes (xerophthalmia)
Dry mouth (xerostomia)
Parotid gland enlargement
32
Q

What are the most common extra-glandular manifestations Sjogrens syndrome

A

non-erosive arthritis and Raynaud’s phenomenon

33
Q

Which antibodies are associated with Sjogren’s syndrome?

A

Antinuclear antibody - Anti-Ro and Anti-La antibodies

Rheumatoid factor

34
Q

What is inflammatory muscle disease

A

Autoimmune-mediated inflammation either with (dermatomyositis) or without (polymyositis) a rash
Causes proximal muscle weakness

35
Q

Which antibodies are associated with inflammatory muscle diseases

A

Antinuclear antibody – Anti-tRNA synthetase antibodies

36
Q

What re the skin changes in dermatomyositis

A

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

37
Q

What other diseases is inflammatory muscle disease associated with?

A

Malignancy

Pulmonary fibrosis

38
Q

What is systemic sclerosis

A

Thickened skin with Raynaud’s phenomenon

Dermal fibrosis, cutaneous calcinosis and telangiectasia

39
Q

What are the 2 types of systemic sclerosis

A

Diffuse systemic sclerosis

Limited systemic sclerosis

40
Q

Describe diffuse systemic sclerosis (which areas it affects, antibodies seen, other system involvement, Raynaud’s phenomenon)

A

Fibrotic skin proximal to elbows or knees (excluding face and neck)
Anti-topoisomerase-1 antibodies
Pulmonary fibrosis, renal involvement
Short history of Raynaud’s phenomenon

41
Q

Describe limited systemic sclerosis (which areas it affects, antibodies seen, other system involvement, Raynaud’s phenomenon)

A

Fibrotic skin hands, forearms, feet, neck and face
Anti-centromere antibodies
Pulmonary hypertension
Long history of Raynaud’s phenomenon

42
Q

What is overlap syndrome

A

When features of more than 1 connective tissue disorder are present e.g. SLE and inflammatory muscle disease

43
Q

Define arthritis

A

refers to definite inflammation of a joint(s) i.e. swelling, tenderness and warmth of affected joints

44
Q

Define arthralgia

A

refers to pain within a joint(s) without demonstrable inflammation by physical examination

45
Q

Define dislocation

A

articulating surfaces are displaced and no longer in contact

46
Q

Define subluxation

A

Partial dislocation

47
Q

Define synovitis

A

Inflammation of the synovium

Y2 Musculoskeletal (9 decks)

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