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Flashcards in Arthritis: Deck (74):
1

This disorder will cause osteophytes without sclerosis or joint space narrowing

Idiopathic skeletal hyperostosis

2

This condition affects the hands only.

It affects the distal/ proximal IPJ and the base of the thumb in a bilaterally symmetrical fashion.

Q image thumb

Primary osteoarthritis

 

It affects the distal interphalangeal joints (Heberden nodes): Distal IPJ

(Bouchard nodes):  proximal IPJ 

(mnemonic H-D, B-P)

3

This condition has identical distribution for primary OA and is associated with osteoporosis of the hands, as well as erosion.

Gull-wing appearance of DIP joint

Q image thumb

Erosive OA aka Kellgren arthritis

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4

Hallmarks of rheumatoid arthritis (6):

1. soft tissue swelling

2. osteoporosis

3. joint Space narrowing

4. marginal erosions

5. bilaterally symmetrical

6. proximal distribution (Hands)

The femoral head migrates axially where as in OA it migrates superiolaterally.

5

Name the HLA B-27 positive spondyloarthropathies: (4)

  1. Ankylosing spondylitis
  2. Inflammatory bowel disease- IBD
  3. Psoriatic arthritis
  4. Reiter syndrome also called reactive arthritis

 

PAIR

6

Paravertebral ossification that runs vertically is known as...

 

 

 

bamboo spine with a single central radiodense line related to ossification of supraspinous and interspinous ligaments which is called dagger sign. (Ank Spon)

Q image thumb

Syndesmophytes

7

Causes of high riding shoulder (3)

  1. Rheumatoid arthritis
  2. CPPD (aka Pseudogout)
  3. Torn rotator cuff

8

These 2 conditions may cause asymmetrical unilateral SI joint disease :

  1. Reiter syndrome
  2. Psoriatic arthritis

9

Hallmarks of gout

  • Well defined erosions/ sclerotic margins
  • Soft tissue nodules
  • No osteoporosis
  • Random distribution

10

Classic triad for CPPD/ Pseudogout:

1. pain

2. cartilage Ca / aka chondrocalcinosis

3. Joint destruction

11

What are the most commonly affected locations for chondrocalcinosis in CPPD: (3)

  • Medial and lateral compartment of the knee
  • Triangular fibre cartilage of the wrists
  • Pubic symphysis

12

Most common location of arthropathy in CPPD: (5)

  1. Shoulder
  2. Elbow
  3. MCP joint in hand
  4. Radiocarpal joint
  5. Patellofemoral joint

13

Name three diseases with high associations with CPPD

  1. Gout
  2. Primary Hyper PTH
  3. Haemochromatosis

14

What is the difference between soft tissue calcification in scleroderma and dermatomyositis

In scleroderma, Soft tissue calcification is subcutaneous where as in dermatomyositis it is intramuscular.

15

What is the diagnosis?

Lacelike appearance of the hands with associated skin Nodules

Sarcoid

16

What is the diagnosis?

The metacarpal heads are square shaped, block like and there is Drooping appearance of the osteophytes

Haemochromatosis

 

Ddx: CPPD

17

Classic triad for Charcot joint

  1. joint destruction,
  2. dislocation and
  3. heterotopic new bone (soft tissue calcification or clumps of ossification adjacent to the joint.)

18

What are the radiological findings in juvenile rheumatoid arthritis and the haemophilia?

Overgrowth of the ends of the bone (epiphyseal enlargement) associated with gracile diaphyses.

19

Characteristic appearance of PVNS on MRI

Low signal hemosiderin seen

Lining the synovium on both T1 and T2.

Blooming on GE

20

What is the Ddx for PVNS?

non calcified synovial osteochondromatosis

21

What is Sudeck atrophy?

Also named as shoulder hand syndrome, Reflex sympathetic dystrophy, And chronic regional pain syndrome.

It occurs after minor trauma to an extremity resulting in pain, swelling and dysfunction.

Severe patchy osteoporosis soft tissue swelling are seen radiologically.

22

Which part of the femoral head is affected in AVN?

Anterior Superior portion of the femoral head. If the anterior portion is not involved, The diagnosis should be questioned. Posterior AVN can happen post posterior dislocation

23

what is Kienbock malacia?

Avascular necrosis of lunate is called Kienbock malacia.

24

Kohler disease

Frightening and sclerosis of the tarsal navicular in children due to AVN

25

Describe neuropathic joint:

Deformity with Debris and Dislocation and having Dense subchondral bone and Destruction of articular cortex

26

first spot in the foot affected by Rheumatoid arthritis

5th MT head

27

RA, splenomegaly and neutropenia

Felty syndrome high Rh factor titre weight loss, leg ulceration and brown skin pigmentation

28

RA and pneumoconiosis

Caplan syndrome

29

Pencil sharpening effect

psoriatic Arthritis

30

Name some BUZZWORDS associated with psoriatic arthritis

  • Pencil in cup deformity
  • Fuzzy appearance around the joint- Sausage digit
  • Ivory phalanx
  • Mouse ears
  • Acral osteolysis

31

when i say ankylosis in hand, you say .... and ....

  1. Erosive OA
  2. Psoriasis

32

Bamboo spine and shiny corners

ankylosing spondylitis

33

Gout on MRI (2)

1. Juxta articular soft tissue mass (low on T2)

2. Tophus will typically enhance

34

Earliest sign of Gout

joint effusion

35

" Punched out lesion with overhanging edges"

Gout

36

Gout mimickers (5)

  1. Amyloid
  2. RA
  3. Sarcoid
  4. Hyperlipidaemia
  5. Reticular histiocytosis

37

Degenerative change in an unusual joint

CPPD

38

CPPD can cause ...... wrist by degenerating the SL ligament

SLAC

39

Milwaukee shoulder, or destructive shoulder arthropathy, usually affects elderly women, associated with the deposition of ........ with joint effusion and rotator cuff tear.

hydroxyapatite crystals

40

This condition usually affects elderly women, associated with the deposition of hydroxyapatite crystals with joint effusion and rotator cuff tear.

Milwaukee shoulder

41

Name some signs associated with hyperPTH

1. subperiosteal bone resorption- radial aspect of 2/3rd fingers ]

2. Rugger Jersey spine

3. Brown tumours

4. Terminal tuft erosion

42

Diagnosis?

Superior and inferior rib notching- bone resorption pelvis wit narrowing of femoral neck and wide SI joint

HyperPTH

43

Causes of cervical spine fusion (2)

1. congenital (Klippel Feil)

2. juvenile rheumatoid arthritis

44

Causes of erosions of dens (2)

  1. CPPD
  2. RA

45

Bad kyphosis

NF1

46

Diagnosis?

Reducible deformity of joints without articular erosion.

Hand X-ray : reversible ulnar subluxation at the MCP on Norgaard view and PA view

SLE

47

Post-rheumatic fever the hand X-ray shows non erosive arthropathy with ulnar deviation of fingers. Findings are very similar to SLE

Jacoud's arthropathy

48

How to differentiate between DISH and AS

There is no sacroiliitis in DISH

49

OPPL is associated with... (3)

1. DISH

2. ossification of ligament flavuum.

3. AS

50

This condition is associated with patients on renal dialysis, And it most commonly affects the cervical spine.

Destructive spondyloarthropathy

51

RNP antibody is positive

Mixed connective tissue disease

52

Proximal distribution and premature fusion of growth plates.

Negative serology.

Enlargement of epiphysis and widened intercondylar notch

Juvenile idiopathic arthritis

53

Findings in juvenile idiopathic arthritis is similar to…

Haemophilia- you also get blooming artefact secondary to haemosiderin (DDX: PVNS)

54

Bilateral involvement of shoulders, Hips, carpals and knees Carpal tunnel syndrome is a clinical manifestation. The Joint space is typically preserve until later in the disease

Amyloid arthropathy

55

Double line sign is best seen on this sequence? what is it a sign of?

seen on T2 osteonecrosis/AVN

56

elevated level of serum trytase and osteosclerosis and thickening of SB folds

mastocytosis

57

Where is Baker's cyst located?

Medial head of gastrocnemius and semimembranosis.

58

Most common location for hydroxyapatite deposition

Supraspinatous muscle

Longus coli

59

Secondary causes of calcific tendonitis

  1. Chronic renal disease
  2. Collagen vascular disease
  3. Tumoral calcinais
  4. Hypervitaminosis D

60

This is a progressive diaphysial dysplasia (PDD).

It causes fusiform bone enlargement with sclerosis of the long bones. It starts in childhood.

Engelmann's disease

61

Engelmann's disease

- This is a progressive diaphysial dysplasia (PDD).

It causes fusiform bone enlargement with sclerosis of the long bones.

- bilateral and symmetrical

- hot on bone scan

- can you involve the skull and cause optic nerve compression

62

Widening of the joint space in an adult hip

Pituitary Gigantism

63

This is typically found in hand (palmer tendons).

Can cause erosion on the underlying bone.

Will be soft tissue density and T1 and T2 dark

Giant cell tumour of the tendon sheath (PVNS tendon)

64

Giant cell tumour of the tendon sheath versus glomus tumour

Glomus tumour is T1 dark and T2 bright and will enhance uniformly

65

Frond like deposition of fatty tissue affecting the synovial lining of the joints and bursa

Lipoma arborescens

66

AVN of the hip usually affects the .... articular border

superior

67

Causes of hip AVN (4)

  1. Perthes -
  2. Sickle cell -
  3. Gauchers -
  4. Steroid

68

Which one obliterates sinuses

Thalassaemia or sickle-cell?

Thalassaemia

69

Erlenmeyer flask - Causes:

1. anaemias (thalassaemia, SCD),

2. storage disorders (Gaucher’s, Niemann–Pick), and

3. skeletal dysplasias (Pyle’s disease, craniometaphyseal dysplasia, Melnick–Needles syndrome).

70

Gracile Bone causes:

NIMROD

  • N: neurofibromatosis
  • I: immobilisation/paralysis
  • M: muscular dystrophy, e.g. Duchenne muscular dystrophy
  • R: rheumatoid arthritis (juvenile RA)
  • O: osteogenesis imperfecta
  • D: dysplasia, e.g. Marfan syndrome, homocysteinuria

71

female in 3rd trimester of pregnancy with hip pain

transient osteoporosis of the hip

72

Findings in transient osteoporosis of the hip

X ray: Osteopenia

MRI: Oedema

NM: Increased uptake on bone scan.

73

AVN of calcanea apophysis

severs

74

AVN of capitulum

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