General Rheummatology Flashcards by Hellie Cumming

What type of joint is each of the following:
Ball and socket (eg.?)
Intervertebral
Pubic symphysis
Costochondral
Sacroilliac
Hinge (eg?)

Synovial
Fibrocartilaginous
Cartilaginous (fibrocartilaginous?)
Cartilaginous 
Synovial or fibrous??!!
Synovial

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What are the 3 types of joint?

Fibrous
Fibrocartilaginous
Synovial

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What is arthralgia?

Joint pain when joint appears normal on examination

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What is arthritis?

Objective evidence of joint inflammation?

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3 signs of ‘objective evidence’ of joint inflammation?

Swelling, deformity, effusion

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In history taking, what must you always ask about stiffness?

Is there morning stiffness? >30mins in inflamm arthropathies

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What is an arthropathy?

Disease of the joint

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Synovial joints:
What is an enthesis?
What is epiphyseal bone?

A point at which ligaments and tendons insert into bone

Bone that abuts the joint and is structurally different from the shaft

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What is another name for a shaft of bone?

Lol

Metaphysis

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What is the role of a synovial joint? How does it achieve this?

To act as a shock absorber and distribute the load over the joint surface
By being a highly compressible structure

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Joint capsule:
What is it lined by?
What is it connected to?

Synovium

Periosteum

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What is periosteum?

A membrane that covers the outer surface of all bones

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Synovial fluid - what is it secreted by and into where?

Synovial cells into the synovial cavity

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What is articular cartilage? What is it composed of (3)?

Hyaline cartilage

Water, type II collagen, proteoglycans

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What is the difference between a tendon and a ligament?

Tendon - muscle to bone

Ligament - bone to bone

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Between which structures is the bursa?

Between the tendon/ligament/muscle and the joint capsule

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What is periarticular pain? 3 causes?

Pain from structures surrounding the joint

Enthesitis, bursitis, tendinitis

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Pain arising from the joint itself is known as what sort of pain?

Articular pain

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What is oligoarthritis?

Arthritis affecting one to four joints during the first six months of disease

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What is a common cause of acute, non-traumatic monoarthritis or oligoarthritis in young adults?

Disseminated gonococcal infections

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What is the key investigation in acute monoarthritis?

Synovial fluid aspiration with Gr stain and culture and analysis for crystals in gout and pseudogout

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What is the most common type of anaemia in musculoskeletal disease?

Normocytic normochromic

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Why might you get hypochromic, microcytic anaemia in musculoskeletal disease?

NSAID induced GI bleeding –> iron deficient anaemia

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Which factors are positive in seropositive RA?

Rheumatoid factor and anti-CCP antibodies

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What does bone scintigraphy localise?

Sites of increased bone turnover and blood circulation

5 examples where bone scintigraphy will see 'hotspots'?

``` Osetomyelitis Septic arthritis Post surgery/traua Malignancy Paget's disease ```

When can ultrasound be used to assess bone density?

At the heel, as a screening procedure prior too DXA (dual energy Xray absorptiometry

When is MRI particularly useful (2)?

Articular disease | Spinal disorders

What does DXA do? Why is it used?

Measures bone mineral density in diagnosis and monitoring of ossteoporosis

When is arthroscopy useful?

Means off visualizing the inside of a joint, espec knee and shoulder. Biopsy, small surgery, removal of loose bodies

What is most common iindication for joint aspiration?

Evaluation for sepsis in an inflamed joint

How can you use joint aspiration too diagnose gout/pseudogout

Use polarized light

What are the 4 main categories of rheumatological disease?

Inflammatory Degenerative Neuropathy Functional

Muscular spasm in neck and shoulder is often associated with what sort of headaches?

Tension

2 causes of nerve root compression --> neck pain? What kind of neck pain? Radiates where? What else is it associated with?

Cervical disk prolapse and spondylotic osteophytes Unilateral Interscapular and shoulder regions Pins and needles and neurological signs in the arms

Causes of neck pain? (5)

``` Muscle spasm Nerve root compression RA Ankylosing spondylitis Fibromyalgia ```

Cause of pain in shoulder girdle?

Polymyalgia rrheumatica

Name the rotator cuff muscles

Supraspinatus Infraspinatus Subsccapularis Teres minor

What does each of the following rotator cuff problems cause? Tendinitis? Impingement? Tear?

Painful arc on shoulder abduction (70-120 degrees) Painful arc on shoulder abduction (70-120 degrees) Prevention of active abduction (first 90 degrees)

What does adhesive capsulitis cause? What is slang name for it?

Severe shoulder pain with all movements | Frozen shoulder

What is tennis elbow?

Inflammation of insertion site of wrist extensor tendon into lateral epicondyle

What is golfer's elbow?

Inflammation of the wrist flexor tendon into the medial epicondyle

2 causes of pain over trochanter which is worse when going up stairs and abducting the hip How can you differentiate between the two?

Tronchanteric bursitis Tear of gluteus medius tendon at its insertion into trochanter MRI

Which nerve does meralgia paraethetica involve? What does it cause?

Lateral cutaneous nerve of the thigh | Numbness and incr sensitivity to light tough over anterolateral thigh

What is bleeding into the joint called?

Haemarthrosis

What will you find on examination with an effusion?

Patellar tap

What knee problem might be confused with a DVT? How would you diagnose it?

Rupture of a Baker's cyst --> fluid into soft tissue of popliteal fossa and upper calf, sudden and severe pain

What is a Baker's cyst?

When fluid from a knee effusion escapes to form a popliteal cyst in a sub-gastrocnemius bursa

How does bone remodel with age? Problems with this?

``` Net loss (if severe = osteoporosis), but thickening around joints and ligament attachments. --> friction on other tissues. Most common reason for bone/joint pain ```

What is another big reason for joint paint (1/4 population)

Articular cartilage disintergration

In inflammatory arthritis, what is inflaming?

Synovial lining

Causes of acute synovitis (synovial lining inflammation)? (2) Chronic synovitis?

Infection or crystals (gout/pseudogout) | Abnormal immune system regulation - e.g. RA

What are synovial joints made up of (5 classes of tissue). How does this differ in fibrous joints?

``` Bone Cartilage Synovium Synovial fluid Tensile tissue (ligament, tendon) ``` Fibrous joints don't have synovium or synovial fluid

In which areas will hyaline cartilage not regenerate?

Load bearing areas after they are damaged

What is the vascular status in hyaline cartilage?

Avascular

Where is fiibrocartilage found? (4)

Intervertebral disks | Discs, menisci and ring pads in peripheral joints

What feature of synovium allows it to trap synovial fluid within the synovial cavity?

Impermeable to hyaluronan (that makes synovial fluid viscous)

Which substance provides the lubrication in a synovial joint?

Lubricin

What holds the bones together in fibrous joints?

Fibrocartillage

What is the central semiliquid contained in intervertebral disks? What can happen to them?

Nucleus pulposus | They can herniate through a damaged outer fibrous annulus

How do you distinguish joint pain from nerve root pain?

Moving the joint in isolation, in specific directions, makes the pain worse

What does pain immediately on weight bearing suggest?

Sunbchondral bone exposure

What does pain that is worse after rest, eased on short exercise, but then worsens again after prolonged use, indicate?

Chronic inflammation

Why can it be difficult to diagnose an infection when it is superimposed on chronic arthritis?

The joints is already lax and so accommodates the effusion more easily --> less severe pain

Severe pain without trauma suggests what (3)?

Infection Reaction to crystals Pathological fracture

What is a pathological fracture?

Fracture caused by disease process that --> weakening of the bone

What generally improves stiffness?

Movement

How long can stiffness take to go in chronic inflammation?

3-4 hours

4 types of swelling?

Bony/cartillaginous swelling Synovial swelling Effusion Periarticular oedema

Classic example of bony swelling? Where are they found? What are they associated with?

Heberdens nodes. PIP joint Osteoarthritis

Where can you distinguish effusion from synovial swelling? How?

The knee. Demonstrating fluid flow.

What does periarticular oedema (with redness) around the ankle indicate?

Acute sarcoid periarthritis

2 physical signs of articular cartilage loss?

Ligament laxity | Bony crepitus

What does a juddering shoulder on arm raising indicate?

Rotator cuff tear

What is a bursa?

Fluid filled sac lined by synovial membrane

General Rheummatology Flashcards

(75 cards)