GALS screen

Question 1

What is subluxation?

Answer 1

Partial dislocation

Question 2

What is arthralgia?

Answer 2

Subjective joint pain without demonstrative inflammation

Question 3

What is arthritis?

Answer 3

Inflammation of a joint seen in a clinical setting

Question 4

Give an example of acute arthritis

Answer 4

Gout

Question 5

Explain the pathophysiology of gout and give the name used to describe this phenomenon

Answer 5

Depositions of monosodium urate crystals (TOPHI) causes pain

Question 6

Which joint is commonly affected in gout?

Answer 6

Knee
Ankle
1st MTP (big toe)

Question 7

What is another name for the 1st MTP being affected in gout?

Answer 7

Podagra

Question 8

Which joints are typically spared in polyarticular gout?

Answer 8

Axial joints (spine)

Question 9

List four sites of swelling

Answer 9

Bone
Articular soft tissue
Periarticular soft tissue
Non - articular synovial areas

Question 10

Which tissue is involved in swelling of the articular soft tissue?

Answer 10

Synovium or effusion

Question 11

Which tissue is involved in swelling of the periarticular soft tissue?

Answer 11

Subcutaneous tissue

Question 12

Give two examples of tissues involved in non-articular synovial swelling

Answer 12

Bursa

Tendon sheaths

Question 13

Swelling of which sites would be indicative of osteoarthritis?

Answer 13

Swelling of the articular ends of bones

Question 14

Swelling of which sites would be indicative of inflammatory joint disease?

Answer 14

Synovium/periarticular soft tissue/subcutaneous tissue

Question 15

What would swelling of non-articular synovial areas e.g. bursa and tendon sheath suggest?

Answer 15

Inflammation of the structure involved

Question 16

Give three signs of irreversible joint damage

Answer 16

Joint deformity
Crepitus
Loss of joint range or movement

Question 17

What is Reiter’s syndrome?

Answer 17

Triad of:
Conjunctivitis
Urethritis
Arthritis following infection

Question 18

In which condition does one see Reiter’s syndrome?

Answer 18

Reactive arthritis

Question 19

Give two signs of mechanical defect

Answer 19

Instability e.g. side to side movement of tibia on femur

Painful restriction of movement in absence of inflammation

Question 20

What is the official name for synovial fluid examination?

Answer 20

Arthrocentesis

Question 21

When would you do arthrocentesis?

Answer 21

To confirm suspected crystal arthritis e.g. gout

If joint infection is suspected

Question 22

What are the contraindications for arthrocentesis?

Answer 22

Bleeding disorders
Low platelet count
Anti coagulant drugs
Overlying skin infection

Question 23

List three complications of arthrocentesis

Answer 23

Introduction of infection into joint
Haemarthrosis (bleeding into joint)
Damage to structures within joint

Question 24

What examinations are done on the fluid?

Answer 24

Gram staining
Ab sensitivity assay
Polarising light microscopy (birefringence)

Question 25

What is the birefringence outcome for gout crystals?

Answer 25

Negative

Question 26

What is the differential for gout and what is the birefringence of this?

Answer 26

Pseudogout, positive

Question 27

What shape are the crystals in pseudogout and what crystals are these?

Answer 27

Brick shaped | Calcium pyrophosphate dihydrate crystals

Question 28

What shape are the crystals in gout and what crystals are these?

Answer 28

Urate crystals | Needle shaped

Question 29

What colour is normal aspirated fluid and what causes this colour?

Answer 29

Clear/pale yellow - due to hyaluronic acid

Question 30

If the fluid is slightly turbid, what does this suggest?

Answer 30

Non inflammatory condition such as osteoarthritis or mechanical defects

Question 31

If the fluid is quite turbid, what does this suggest?

Answer 31

Inflammation; gout or RA

Question 32

If the fluid is very turbid, what does this suggest?

Answer 32

Bacterial infection

Question 33

List three risk factors for septic arthritis

Answer 33

Impaired host defence Direct penetration Joint damage

Question 34

Explain Raynaud's phenomenon

Answer 34

White - vasospasm Blue - venous blood red - reactive hyperaemia