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Fundamentals of Imaging > Crystal and Metabolic Arthropathies > Flashcards

Crystal and Metabolic Arthropathies Flashcards

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1
Q

What develops as a result of hyperuricemia and subsequent deposition of monosodium urate monohydrate crystals in and around the joint?

A

Gouty arthropathy

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2
Q

What type of gout involves an inborn error of metabolism of purines. Idiopathic gout (M>F)?

A

Primary Gout

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3
Q

What type of gout develops from either overproduction or decreased removal of uric acid?

A

Secondary Gout

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4
Q

What is the end-stage by-product of purine metabolism of cells that is normally removed by the healthy kidneys?

A

Uric acid

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5
Q

What causes oversaturation of tissues with uric acid and precipitation of urate salts forming crystals?

A

Hyperuricemia

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6
Q

What body parts are typically effected by Acute attacks of gouty arthritis?

A

Big toe (Podagra)
Knee
Ankle
Wrist

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7
Q

Which of the body parts is most commonly effected by Gout?

A

1st MTP of Big toe (Podagra)

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8
Q

What is the earliest sign of Gout?

A

Joint effusion

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9
Q

What is a key X-Ray feature of Gout?

A

Bone erosions with “overhanging edges”

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10
Q

What erosion feature makes Gout different from other arthritises?

A

sclerotic rim

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11
Q

Where is the most common site for spinal gout?

A

Lumbar spine

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12
Q

What kind of fluid can be taken from an area affected by tophacious gout?

A

Synovial fluid

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13
Q

What is a common condition in the elderly resulting with the deposition of calcium pyrophosphate crystals in the soft tissues and the joints, especially intra-articular fibrocartilage including hyaline cartilage

A

CPPD (Calcium Pyrophosphate Crystal Deposition)

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14
Q

What consists of the radiographic features of CPPD?

A

Chondrocalcinosis
Subchondral cysts
Osteophytes

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15
Q

What is known as a hyaline or fibrocartilage calcification due to CPPD?

A

Chondrocalcinosis

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16
Q

What is known as a specific term used for chondrocalcinosis d/t CPPD crystals?

A

CPPD crystal deposition disease

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17
Q

What resembles DJD but affects joints that are not typically affected by DJD (MCP, wrist, elbow) and may appear more cystic?

A

Pyrophosphate arthropathy

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18
Q

What resembles acute attacks of gout?

A

Pseudogout

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19
Q

What is elevated during attacks from pseudogout?

A

WBC and ESR

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20
Q

What does joint aspiration reveal with individuals with CPPD?

A

birefringent rhomboid-shaped CPP crystals

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21
Q

Where is chonedrocalcinosis most commonly seen?

A

Menisci
TFC (triangular fibrocartilage) at the wrist
symphysis pubis
Glenoid labrum

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22
Q

What is the dominant feature of CPPD?

A

Subchondral cysts

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23
Q

In CPPD, how do the osteophytes look like on the hand?

A

hook-like projections on MCPs

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24
Q

What is it called when CPPD affects the odontoid process?

A

Crowned dense sign

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25
What is known as the deposition of Ca+ hydroxyapatite crystals in the soft tissues in and around the joint, mostly at the terminal tendons’ insertion sites?
HADD (Calcium Hydroxyapatite Deposition Disease)
26
What is another name for HADD?
Calcific periarthritis
27
What joint is the most affected by HADD?
Shoulder
28
What is the radiographic feature of HADD?
Homogenous round soft tissue calcifications
29
What are the target sites of the shoulder for HADD?
greater humeral tuberosity insertion of supra/infraspinatus muscle tendons subscapularis/long head of the biceps m.
30
What radiographic view is best to see infraspinatus HADD?
AP shoulder with external humeral rotation
31
What radiographic view is best to see supraspinatus HADD?
AP shoulder in internal humeral rotation
32
What can develop as erosive destructive process during reactive inflammatory destructive process induced by HADD crystals of the shoulder?
Milwaukee Shoulder
33
What is a rare autosomal recessive abnormality that results in the deposition of homogentisic acid (HGA) in the peripheral tissues?
Ochronosis
34
What is the clinical presentation of alkaptonuria (ochronosis)?
black discolouration of urine
35
What do the symptoms of ochronosis arthropathy resemble?
Osteoarthritis
36
Why does tissue resemble a dark blue discoloration in ochronosis?
HGA deposits
37
What are the 2 amino acids that are high in alkaptonuria (ochronosis)?
Phenylalanine and Tyrosine
38
What radiographic findings would be present with ochronosis?
intradiscal calcification narrowed disc height Homogenous mineralization of auricular & nasal cartilage
39
What is the key radiographic feature of Ochronosis?
intradiscal calcifications
40
What is a rare familial condition of abnormal phosphate metabolism that results in painless mineralized peri-articular masses and develops d/t FGF 23 gene defect located on osteoblasts that regulates phosphate, resulting in abnormal phosphate accumulation in peri-articular regions?
Tumoral calcinosis
41
What ethnicity is Tumoral calcinosis most common seen in?
African Americans
42
Where is the most common site of Tumoral Calcinosis?
Shoulder
43
What is the key radiographic finding for Tumoral Calcinosis?
“cloud-like” amorphous soft tissue mineralizations
44
What is excessive growth hormone (GH) production in skeletally matured individuals?
Acromegaly
45
What is the most common cause of Acromegaly?
Pituitary micro/macro adenoma
46
What condition is often associates with Charcot joint, adhesive capsulitis (frozen shoulder), and CTS?
Diabetes Mellitus
47
What is a multi-system granulomatous disease of unknown origin with immune-mediated activation of T-lymphocytes, mononuclear phagocytes (monocyte-macrophage origin) and NON-CASEATING granulomas with extensive distribution within the body (lungs, skin, ocular, salivary, reticuloendotheleal tissues, CNS, bones & joints)
Sarcoidosis
48
Where is the most common site affected by sarcoidosis?
Hands
49
What is the key radiographic feature of sarcoidosis?
“Lace-like” expansile lesions
50
What stage of Pulmonary sarcoidosis contains "potato nodes?"
Stage 1
51
What stage of Pulmonary sarcoidosis contains nodal and pulmonary sarcoid?
Stage 2
52
What stage of Pulmonary sarcoidosis contains primary pulmonary interstitial disease?
Stage 3
53
What stage of Pulmonary sarcoidosis contains pulmonary fibrosis and irreversible changes?
Stage 4
54
What is a destructive arthropathy due to bacterial organisms gaining access to the joint via typical routes?
Septic arthritis
55
What is the most common bacterial agent associated with septic arthritis?
Staph aureus
56
In what age group of septic arthritis does it affect when blood vessels perforate open growth plate region?
0-1 years
57
In what age group of septic arthritis does it affect when blood vessels do not penetrate cartilagenous growth plate
1-16 years
58
In what age group of septic arthritis does it affect when blood vessels penetrate closed growth plate and supply the epiphysis?
16+ years
59
Where is the greatest risk for septic arthritis?
Large joints with good blood perfusion
60
T/F: X-rays are less sensitive at detecting early septic arthritis and special imaging is recommended
True

Fundamentals of Imaging (16 decks)

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