Exam 2 Flashcards
(157 cards)
1
Q
How many different arthritic conditions are there and how big of a deal is it anyway?
A
Over 100 arthritic conditions
More than 14 billion
2
Q
infectious/septic arthritis incidence is most common below what age?
A
30
3
Q
infectious/septic arthritis most common type
A
monoarticular
4
Q
how does infectious/septic arthritis develop
A
from blood bourne pathogens and direct implantation
5
Q
What is the most common organism for infectious/septic arthritis?
A
Staphylococcus aureus
6
Q
What kind of findings lag behind the other associated with infectious/septic arthritis?
a. radiographic findings
b. clinical findings
A
a
7
Q
What are the ABCs fo joint disease?
A
Alignment Bone Cartilage Distribution Soft Tissue
8
Q
What are the three altered substances that affect the loss of joint space?
A
Fissures, flaking, vascularization
9
Q
What type of osteoarthritis results in a “gull wing” appearance of DIP joint?
A
Erosive Osteoarthritis
10
Q
Erosive osteoarthritis is most common in what age population?
A
middle age females
11
Q
How many compartments make us the knee
A
3
12
Q
What compartment of the knee is most commonly involved in DJD?
A
medial
13
Q
thickened cortex at the medial femoral neck as the result of biomechanical changes across the joint.
A
Buttressing
14
Q
what do subarticular cysts represent?
A
synovial intrusion through cartilage cracks and fissures, large cysts are termed geodes
15
Q
What are the 6 D’s associated with hypertrophic neurotrophic joints
A
distended joints density increase debris dislocation disorganization destruction
16
Q
What are the typical radiographic findings associated with DDD?
A
Decreased disc height osteophyte formation endplate sclerosis vacuum phenomenon subluxation
17
Q
What are the categories of disc degeneration as described by Resnick and Niwayama?
A
Spondylosis deformans (outer disc) (marked by osteophtes) Intervertebral chondrosis (inner disc) marked by reduced IVD space
18
Q
What are some findings of intervertebral disc osteochondrosis?
A
- primary degeneration of nucleus pulposis
- loss of disc height
- Knutson’s vacuum phenomenon
19
Q
A radiolucent collections of nitroen gas within annular fissures is known as what
A
Knutson’s vacuum phenomena
20
Q
Where is a knutson phenomenon normall seen
A
anterior margin of the IVD on extension films
21
Q
What does a Knutson’s phenomena normall indicate?
A
DDD
22
Q
What are findings associated with spondylosis deformans?
A
Degeneration fo the annulus
prominent osteophytosis
23
Q
Comes from stressed anterior longitudinal ligaments that com from separated intervertebral disc tissue
A
osteophytes
24
Q
Where do osteophytes develop in the vertebra
A
Where the vertebral body and cartilaginous rim unite
25
Which direction does osteophytes develop first?
extend in the horizaontal direction and then in the vertical direction
26
What does the presence of intercalary ossicle mean?
annulus degeneration
27
Exaggerated endplate sclerosis associate with DDD is known as?
Hemispherical spondylosclerosis
28
What are the Modic end plate MRI changes associated with on a Modic Type I model?
Dark T1 and Bright T2 = inflammation
29
What are the Modic end plate MRI changes associated with on a Modic Type II model?:
Bright T1 and T2 = Fat
30
What are the Modic end plate MRI changes associated with on a Modic Type III model?
Dark T1 and T2 = sclerosis
31
Schmorl's nodes, endplate irregularity, and decreased anterior vertebral body height are all part of what diagnosis?
scheuermann's disease aka Juvenile Discogenic disease
32
What allows a anterior subluxation?
posterior joint degeneration
33
degenerative anterior displaement is also known as?
Grade I Degenerative spondyloslisthesis
34
What is the significance of uncinate hypertrophy?
potential IVF encroachment
35
What is a pathological osseous proliferation at a tendon or ligament insertion?
Enthesopathy
36
An enthesopathy is caused by what?
Degenerative chages
| Inflammatory changes
37
The DISH phenomenon occurs at what area of the vertebre?
Anterior vertebral body
38
DISH and what other clincial possibility is associated with it?
Diabetes mellitus
39
Ossification of the PLL is also known as?
OPLL
40
What is the one of the most serious complications of disc herniations?
Cauda equina syndrome
41
What are the symptoms of Cauda equina syndrome?
altered bowel and bladder function
impotence
saddle paresthesia
progressive muscle atrophy
42
midline disc herniaions in the cervical spine create what?
myelopathies
43
lateral disc herniation of the cervical spine do what?
compresses the nerve root below
44
Midline/paracentral disc herniation in the lumbar spine does what?
compresses the nerve root below
45
Foraminal disc herniation in the lumbar spine will involve what?
the nerve root at the same level
46
What is a typical disc herniation?
A. Midline
B. Lateral
C. Foraminal
A
47
Does a typical lumbar disc herniation compromise the exiting nerve root or the traversing nerve root?
Traversing nerve root
48
What are the contents of the spinal canal?
```
Thecal sac
epidural fat
internal vertebral plexus
ligamentum flavum
posterior longitudinal ligament
```
49
What is contained in the thecal sac?
cord and cauda equina
50
When looking at a disc herniation what two things should be considered?
is the herniation contained or non contained
51
```
What disc classification is circumferential symmetric extension of the disc beyond the interspace (around the end plates)
A. Bulge
B. Protrusion
C. Extrusion
D. Sequstration
```
A
52
```
What disc classification is focal or asymmetric extension of the disc beyond the interspace, with the base against the disc of origin broader than any other dimension of the protrusion
A. Bulge
B. Protrusion
C. Extrusion
D. Sequstration
```
b
53
```
What disc classification is more extreme extension of the disc beyond the interspace, with the base against the disc of origin narrower than the extruded
portion
A. Bulge
B. Protrusion
C. Extrusion
D. Sequstration
```
C
54
```
What disc classification has no connection between the material and the disc of origin
A. Bulge
B. Protrusion
C. Extrusion
D. Sequstration
```
D
55
What do you look for during a myelogram?
indention of contrast column
56
What does the contrast column in a myelogram mean?
disc lesion
57
What are the measurements to consider possible stenosis in the cervical spine?
Canal stenosis less than 12 mm
58
What are the measurements to consider possible stenosis in the lumbar spine?
Canal stenosis less than 15mm
59
What is the preferred method to evaluate potential stenosis?
Axial slices of a CT or MRI
60
What are the two major types of inflammatory joint disease?
```
Rheumatoid types (seropositive)
Rheumatoid Variants (seronegative)
```
61
What are three examples of seropositive inflammatory disease?
rheumatoid arthritis
Systemic lupus erythematorsis
scleroderma
62
What are four examples of Rheumatoid variants?
Ankylosing spondylitis
Reiter's disease
Psoriatic arthritis
Enteropathic arthritis
63
A generalized connective tissue autoimmune disease involving synovial tissue resulting in polyarticular joint inflammation
Rheumatoid Arthritis
64
conditions associated with RA, (five conditions)
```
Arthritis mutilans
Baker's cyst
Boutonniere deformity
Felty's syndrome
Haygarth's nodes
```
65
severe joint deformity/destruction
ARthritis mutilans
66
enlargement of the gastrocnemius bursa
Baker's cyst
67
PIP flexion, DIP extension
Boutonniere Deformtiy
68
leukopenia, splenomegaly and RA
Felty’s syndrome
69
soft tissue swelling at the MCP
Haygarth’s nodes
70
stiff joints after inactivity
Jelling phenomena
71
accumulation of inflammatory cells, with
| necrotic area and fibrosis seen on extensor surfaces
Rheumatoid nodule
72
flexion of DIP and extension of the PIP
Swan neck deformity
73
intermittent absence of the articular
| cortex due to erosion
Dot-dash appearance
74
pocket erosions localized loss of
intraarticular cortex adjacent to the capsular insertion due to
pannus erosion at the anatomical bare area
Marginal erosion; rat bite
75
loss of joint space in RA is normally
A. symmetrical
B. Asymetrical
a
76
What are two findings in RA?
Marginal erosion and decreased joint space3
77
ulnar styloid erosion is normally found in what condition?
Rheumatoid arthritis
78
Marginal erosion is found in RA due to _______ formation?
pannus
79
What is the most likely areas of involvement for RA in the wrist and hand?
MCP
PIP
Ulnar aspect of the wrist
80
Someone with Boutonniere Deformity would have PIP __________ and DIP __________
flexion; extension
81
Boutonniere deformity is caused by the central slip of the?
extensor digitorum communis
82
Swan Neck Deformity is cause by PIP _________ and DIP __________
extension; Flexion
83
A synovial cyst that extends into the soft tissues posterior to the knee.
Bakers Cyst
84
Flexion and extension studies should be performed to evaluate the atlantodental interval (ADI). This should not exceed _______mm
3
85
What should be done if the patient is neurologically compromised?
MRI examination
86
Ballooned epiphyses is an indicator of what condition?
Juvenile Chronic ARthritis
87
What age is Juvenile RA onset?
less than 16
88
Are most cases of Juvenile Rheumatoid seropositive or seronegative?
seronegative for Rheumatoid factor
89
systemic Lupus Erythematosus is positive or negative for rheumatoid factor
positive
90
Systemic Lupus Erythematosus has what kind of deformity in the hands?
Swan-neck deformity
91
Scleroderma is also known as...
progressive systemic sclerosis
92
generalized systemic inflammatory connective tissue disorder involving skin, lungs, GI tract, kidneys and musculoskeletal system, causes small vessel disease and fibrosis in multiple organ systems.
progressive systemic sclerosis (Scleroderma)
effects females 3:1
30-50 years
93
cyclic vascular changes usually of the hands which is precipitated by the cold or emotional upset
Raynaud's Phenomenon
94
What is CREST Syndrome?
```
Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Teangiectasia
```
95
dilated subdermal blood vessels are known as ?
Telangiectasia
96
What are some radiographic findings associated with scleroderma?
acral tapering of the soft tissues
osseous resorption (acro-osteolysis) extensive subcutaneous soft tissue calcification
flexion contractures
97
If Rheumatoid Factor is negative what test is positive?
HLA B27
98
What four conditions are HLA B27 positive?
Ankylosing apondylitis
Psoriatic arthritis
Reiter's disease
Enteropathic arthritis
99
What are some synonyms for ankylosing spondylitis?
Marie Strumpell's disease
100
50% of AS patients will have peripheral disease especially of the hip and shoulders, what is the condition?
Spondylitis Rhizomelique
101
What is the most common seronegative spondyloarthropathy?
Ankylosing spondylitis
102
AS is most common in what gender?
male 1:10
103
AS is ________% positive HLA-B27
90
104
Initial changes in AS consist of synovial proliferation, inflammatory cellular infiltrate producing what?
pannus
105
What is the anatomical site of attachment of a ligament or tendon to bone via Sharpey's fibers
Enthesis
106
What occurs to the SI joint in AS
lossof subchondral definition ->Erosion and joint spacewidening -> fusion (50% of the time)
107
SI joint ankylosis progresses from what seronegative condition?
AS
108
Don't confuse Osteitis Condensans Ilii with what other condition?
AS
109
Osteitis Condensans Ilii is seen in what population?
post partum females
110
What condition may also be found in AS in the spine
syndesmophytes (bamboo spine)
111
On an x-ray a shiny corner sign is likely what diagnosis?
AS
112
Would a HLA B-27 test be helpful is diagnosing AS?
Yes
113
vertically oriented spurs that represent the sequalae of inflammatory disease of the spinal ligaments. They are ossification of the outer fibers of the annulus and the inner fibers of the ALL
syndesmophytes
114
Vertebral body squaring is an early sign of what condition?
Early AS
115
the presence of a Dagger sign would indicate a diagnosis of what?
Woudl a HLA B2-7 exam be benificial?
AS
No
116
What ligament is ossified with a dagger sign?
calcification of the capsular ligament
117
What causes the trolley tract sign?
capsule and inter/supraspinous ossification
118
Sclerosis, irregularity, endplate destruction created by Hypermobility through a fractured previously ankylosed segment
Andersson lesion
119
Are there postural changes associate with AS?
yes
120
A patient with SI fusion who also has an inflammatory bowel disease such as crohn's disease you might consider what diagnosis?
enteropathic arthritis
121
Can AS involve other sites?
Appendicular (hip and shoulder)
| Pelvis, calcaneus,bondy proliferation and erosion at the enthesis
122
Enteropathic arthritis is associated with what other disorders?
gut
123
Psoriatic arthritis affects ______% of patients with psoriasis
5-7
124
Psoriatic arthritis is mediated by what?
immune system
125
What are the main targets of Psoriatec arthritis?
Hands and to a lesser extend feet
126
The axial skeleton is involved in _______%
20-40
127
Psoriatic is an immune reaction similiar to what condition?
RA
128
Is Psoriatic arthritis in the hands and feet symmetric or asymmetric small joint involvement?
asymmetric
129
What is the main joint involved in psoriatic arthritis?
DIP
130
What are some other conditions involved in psoriatic arthritis?
peripheral erosions w/ periostitis (“mouse ears”)
central erosions (“pencil-and-cup”)
soft tissue swelling (Sausage digit)
normal mineralization (normal bone density)
bony ankylosis is a common sequela
deformity
131
What are some clinical feature of psoriatic arthritis?
```
young adults males and females
psoriasis
nail pitting
"sausage" digit fusiform
swelling of entire digit
“cocktail sausage digit”
```
132
What is unique about psoriatic arthritis?
more prominent along one digit instead of joint
133
What may develop from psoriatic arthritis?
acroosteolysis
134
is psoriatic arthritis a debilitating form of arthritis?
no
135
Psoriatic arthritis mimics what other condition but is less symmetric and thend to have normal bone density?
RA
136
Is there bulkier syndesmophytes in AS or psoriatic arthritis
psoriatic arthritis nonmarginal syndesmophytes
137
"mouse ears" or periostitis is found in what kind of arthritis
psoriatic arthristis
138
is psoriatic arthritis seropositive or negative?
negative but HLA B27 positive
139
how do you know that psoriatic arthritis is different from RA?
pencil and cup
140
T/F there is nonmarginal syndesmophytes in Psoriatic arthritis
True
141
A patient with sausage digits should be diagnosed with what?
psoriasis
142
What is the triad of symptoms associated with Reiter's arthritis?
Urethritis
conjunctivitis
arthritis
143
What gender has a high predominance to Reiter's disease?
males
144
Thick nonmarginal syndesmophytes known as "lover's heels" is present in what condition?
Reiter's arthritis
145
Reiter's arthritis is similiar to what other condition? What is the main difference?
psoriatic arthritis
| involves the lower extremities
146
heel spurs and retrocalcaneal bursitis known as "Lover's heels" is present in what condition?
Reiter's arthritis
147
If the patient is a male and complains of a burning sensation on urination then likely what condition?
Reiter's Arthritis
148
What are the various etiologies of Chondrocalcinosis?
Cartilage degeneratoin
Crystal deposition
Cation disease
149
What is an example of Cartilage degeneration of chondrocalcinosis?
degenerative joint disease
150
What are some examples of crystal deposition in Chondrocalcinosis?
primary CPPD
| Gout
151
What are some cation disease in Chondrocalcinosis?
hemchromatosis (iron)
hyperparathyroidism (calcium)
Wilsoms disease (copper)
152
What anatomy is calcified in chondrocalcinosis?
the meniscus
153
degenerative joint disease at an unusual location should raise suspicion of what entity?
A crystal desposition disease such as CPPD
154
Hook osteophyte's at the 2nd and 3rd metacarpal suggest what diagnosis?
hemochromatosis
155
A finding of an olecranon erosion and soft tissue tophi is known as what?
Gout
156
a "lumpy bumpy joint disease" is known as what?
Gout
157
Gout in the big toe is known as what?
podagra
