MSK Arthritis Flashcards
(152 cards)
1
Q
arthritis –> 5 broad categories?
A
- degen
- inflamm
- xl deposit
- hematologic
- metab
2
Q
OA –> key XR findings? (5)
A
- jt space narrow –> asymm
- subchondral sclerosis
- osteophyte
- subchondral cyst
- no periarticular osteopenia
3
Q
XR findings of OA –> +extensive subchondral cysts –> ddx? (2)
A
- OA
- calcium pyrophosphate dihydrate xl deposit dz (CPPD)
4
Q
what is Heberden node? Bouchard node?
A
Heberden: OA –> DIP –> lrg osteophyte –> ST swelling
Bouchard: PIP
5
Q
what is Grashey view?
A
shoulder –> 40deg obliqued ext rot –> glenohumeral jt in profile
6
Q
OA –> foot –> 2 common locations?
A
- 1st MTP
- talonavicular jt
7
Q
OA –> 1st MTP –> potential complication?
A
dorsal osteophytes –> stiff big toe (hallux rigidus)
8
Q
differentiate –> hip –> OA vs inflamm arthritis –> femoral head migration?
A
- OA: #1 superolat; less common med
- inflamm: axial
9
Q
RA –> hip –> potential comp?
A
severe axial migration –> protrusio acetabuli
10
Q
intervertebral discs –> 3 components?
A
- nucleus pulposus
- annulus fibrosus
- cartilaginous endplates
11
Q
uncovertebral jt –> what levels?
A
C3-C7
12
Q
what is degen disc dz (DDD)? charact by what findings? (3)
A
spectrum of intervertebral disc degen:
- disc dessication
- endplate sclerosis
- osteophytosis
13
Q
vacuum phenomenon –> pathognomic for what condition?
A
degen disc dz (DDD)
14
Q
what is Kummel dz?
A
trauma –> avascular necrosis –> wks-months later –> progressive vertebral body collapse –> gas within vertebral body
15
Q
diffuse idiopathic skeletal hyperostosis (DISH) –> definition? (3)
A
- flowing bridging ant osteophytes –> 4 levels
- normal disc space
- normal SI jts
16
Q
diffuse idiopathic skeletal hyperostosis (DISH) –> assoc condition?
A
osiffication of post long lig (OPLL) –> spinal stenosis
17
Q
diffuse idiopathic skeletal hyperostosis (DISH) –> potential comp?
A
cervical spine –> dysphagia
18
Q
sacroiliac jt –> superior portion is what type of jt? inf?
A
- sup –> syndesmotic
- inf –> synovial
19
Q
OA –> SI jt –> which part is affected?
A
inf –> synovial jt
20
Q
erosive OA –> what is similar to OA? RA?
A
RA –> clinical findings –> ie swelling
OA:
- distribution
- imaging findings
21
Q
erosive OA –> distribution?
A
hands only –> DIP, PIP, 1st CMC
22
Q
erosive OA –> characteristic xray finding?
A
DIP –> central erosion + marginal osteophyte –> “gull wing” appearance
23
Q
rheumatoid arthritis –> MOA?
A
autoimmune disorder –> immune response –> wax & wane –> synovium
24
Q
RA –> key XR findings? (5)
A
- symm jt space narrow
- marginal erosion
- periarticular osteopenia
- jt subluxation
- ST swelling
25
RA --> earliest XR findings? (2)
synovitis & hyperemia:
- ST swell
- periarticular osteopenia
26
RA --> hand --> early erosions --> typical locations (3)
- 2nd & 3rd metacarpal --> head --> radial aspect
- prox phalanx --> base --> radial & ulnar aspect
- ulnar styloid
27
RA --> hand --> jt sublux --> 3 common deformities?
- Boutonniere: PIP flex, DIP hyperext
- Swan neck: PIP hyperext, DIP flex
- MCP --> digits --> ulnar sublux
28
RA --> wrist --> late-stage dz --> potential comp?
complete cartilage loss --> fibro-osseous jt fusion --> carpal ankylosis
29
RA --> foot --> which jts? (2)
- MTP
| - talocalcaneonavicular
30
protrusio acetabuli --> measuremts?
femoral head --> medial deviation --> past ilioischial line:
- M: >3mm
- F: >6mm
31
knee --> all 3 compartmts --> symm jt space narrow --> osteophytes --> ddx? (1)
2ary OA
32
knee --> what XR finding indicates presence of OA? what XR finding indicates severity of OA?
- osteophyte --> presence of OA
| - jt space narrow --> severity of OA
33
RA --> knee --> which compartmt MC involve?
all 3
34
RA --> knee --> erosions NOT prominent manifestation --> T/F?
T
35
RA --> cervical spine --> atlantoaxial sublux --> 5 types?
- ant
- post
- vertical (AA impaction)
- rotatory
- lat
36
RA --> cervical spine --> atlantoaxial sublux --> ant type --> MOA?
adj bursa --> inflamm --> transverse lig --> lax
37
RA --> cervical spine --> atlantoaxial sublux --> ant type --> measuremts?
atlanto-dental interval:
- adult: >2.5mm
- child: >5mm
38
RA --> cervical spine --> atlantoaxial sublux --> ant type --> what kind of image view?
flexion
39
RA --> cervical spine --> atlantoaxial sublux --> vertical (AA impaction) type --> MOA?
C1-C2 facet --> erosion --> collapse --> odontoid --> protrude into foramen magnum
40
RA --> cervical spine --> atlantoaxial sublux --> vertical (AA impaction) type --> potential comp?
compress midbrain
41
RA --> shoulder --> potential comp?
chronic rotator cuff tears --> high riding humerus
42
high riding humerus --> ddx? (3)
- rotator cuff tear
- RA
- CPPD
43
RA --> shoulder --> erosions --> MC locations? (2)
- humerus --> lat aspect
| - AC jt --> distal clavicle "penciling"
44
seroneg spondyloarthropathy --> assoc w what lab finding?
+HLA-B27
45
what are the 4 seroneg spondyloarthropathies?
- ank spondylitis
- psoriatic arthritis
- reactive arthritis (Reiters)
- IBD-assoc arthropathy
46
seroneg spondyloarthropathies --> hallmark finding?
sacroiliitis
47
seroneg spondyloarthropathies --> sacroiliitis --> involves which portion of SI jt?
inf portion --> synovial jt
48
sacroiliitis --> bilat --> symm --> ddx? (2)
- IBD
| - ank spond
49
sacroiliitis --> bilat --> asymm --> ddx? (2)
- psoriatic arthritis
| - reactive arthritis
50
sacroiliitis --> unilat --> ddx? (1)
septic arthritis
51
what conditions assoc w IBD-sacroiliitis? (4)
- ulc colitis
- Crohns
- Whipple dz
- s/p gastric bypass
52
ank spond --> assoc lung/heart conditions? (3)
- pulm fibrosis
- aortitis
- cardiac conduction defect
53
ank spond --> earliest XR findings?
symm sacroiliitis:
- erosions
- widening
- sclerosis
54
ank spond --> what is Romanus lesion?
vertebral body --> endplate --> anterior --> sup or inf --> enthesitis --> erosion
55
ank spond --> what is shiny corner?
Romanus lesion --> sclerosis
56
ank spond --> what is "squaring"?
vertebral body --> loss of normal concavity of the anterior border --> "squaring"
57
ank spond --> what is Andersson lesion?
spine --> completely ankylosed --> pseudoarthrosis
58
psoriatic arthritis --> MC location? 2nd MC?
```
#1 hands
#2 feet
```
59
ivory phalanx --> dx?
specific sign for psoriatic arthritis
60
differentiate: psoriatic arthritis vs degenerative --> plantar calcaneal spur?
PsA spur --> periosteal rxn
degen spur: no periosteal rxn
61
reactive arthritis --> potential comp of what conditions? (3)
infxn:
- diarrhea
- urethritis
- cervicitis
62
reactive arthritis --> MC location?
feet --> particularly calcaneus
63
reactive arthritis --> XR findings? (6)
- diffuse ST swell
- jt space narrow
- marginal erosions --> aggressive
- periarticular osteopenia
- bony prolif
- enthesitis
64
reactive arthritis --> imaging appearance --> similar to what other condition?
psoriatic arthritis
65
ballcatcher's (Norgaard) view --> purpose?
better visualize jt erosion
66
systemic lupus erythematosus (SLE) --> arthritis --> key XR finding?
MCP & PIP --> sublux --> reducible (seen on Norgaard view, normal on PA)
67
MCP & PIP --> reducible subluxations --> ddx? (2)
- SLE
| - Jaccoud arthropathy
68
what is scleroderma?
systemic --> collagen vascular dz --> collagen deposited --> skin, soft tissue
69
scleroderma --> 1st affected location?
fingertips --> soft tissue atrophy
70
acro-osteolysis --> ddx? (6)
- collagen vascular dz (ie scleroderma)
- neuropathy
- polyvinyl chloride exposure
- thermal injury
- hyperPTH
- Hajdu-Cheney
71
Hajdu-Cheney --> synd? (3)
autosomal dominant:
- short stature
- craniofacial changes
- progressive acro-osteolysis
72
scleroderma --> jt contracture --> MOA?
calc --> soft tissue & periarticular -> skin tighten & fibrosis --> jt contracture
73
dermato/polymyositis --> imaging hallmark?
ST calc --> intra-musc
74
what is calcium hydroxyapatite deposition dz (HADD) (aka calcific tendinitis)?
hydroxyapatite xls --> deposit in tendons
75
calcium hydroxyapatite deposition dz (HADD) (aka calcific tendinitis) --> MC location?
rotator cuff --> supraspinatus tendon
76
what is Milwaukee shoulder?
HADD --> intra-articular variant --> rotator cuff, glenohum jt --> rapid destruct
77
calcium hydroxyapatite deposition dz (HADD) (aka calcific tendinitis) --> longus coli --> can clinically mimic what condition?
prevertebral abscess:
- neck pain
- odynophagia
- fever
- prevertebral effusion
78
differentiate: CPPD vs gout: birefringence?
gout: neg
CPPD: positive
79
calcium pyrophosphate dihydrate deposition dz (CPPD) --> etiology? (4)
- idiopathic
- hemochromatosis
- hyperPTH
- hypoPhosphate
80
calcium pyrophosphate dihydrate deposition dz (CPPD) --> key XR finding?
chondrocalcinosis
81
calcium pyrophosphate dihydrate deposition dz (CPPD) --> can clinically similar to what conditions? (5)
great mimicker:
- asympt
- gout
- OA
- RA
- neuropathic
82
calcium pyrophosphate dihydrate deposition dz (CPPD) --> wrist --> MC location?
triangular fibrocartilage complex (TFCC)
83
calcium pyrophosphate dihydrate deposition dz (CPPD) --> wrist --> potential complication?
scapholunate advanced collapse (SLAC)
84
scapholunate advanced collapse (SLAC) --> etiology? (3)
- CPPD
- RA
- trauma
85
scapholunate dissociation --> sign? measuremt?
Terry thomas sign: scapholunate interval >4mm
86
knee --> what findings are highly suggestive of CCPD? (2)
- degen changes --> patellofemoral cmpt only
| - prominent subchondral cysts
87
CPPD --> hand --> MC location? charact finding?
2nd & 3rd MCP --> radial aspect --> "hook-like"/"drooping" osteophyte
88
hand --> MCP heads --> "hook-like" osteophytes --> ddx? (2) how differentiate?
- CPPD: 2nd & 3rd
| - hemochromatosis: all
89
gout --> hallmark findings? (3)
- erosions --> sharp margins
- overhanging margins
- soft tissue gouty tophi
90
gout --> etiology?
excess uric acid:
- #1 under-excrete (ie. renal insuff)
- over-produce
91
gout --> jt space --> normal vs narrow?
normal --> until late dz
92
hemochromatosis arthropathy --> MOA?
deposit:
- iron
- calcium pyrophosphate dihydrate xls
93
hemochromatosis --> clinical presentation (5)
- bronze pigmentation
- DM
- cirrhosis
- CHF
- arthritis
94
acromegaly --> arthritis --> MOA?
articular cartilage --> enlrg --> jt space widen --> later --> 2ary OA --> jt space narrow
95
acromegaly --> arthritis --> hand --> charact findings? (2)
- metacarpal head --> "beak-like" osteophytes
| - terminal tufts --> "spade-like" enlrg
96
amyloidosis --> RF? (3)
- monoclonal plasma cell dyscrasia
- chronic inflamm/infx
- chronic dialysis
97
amyloid arthropathy --> charact finding?
shoulder --> bulky soft tissue nodules + muscle atrophy --> "shoulder pad" sign
98
amyloid arthropathy --> imaging findings can be similar to what condition?
RA
99
what is ochronosis?
connective tissue manifestation of alkaptonuria: homogentisic acid oxidase --> defect --> homogentisic acid --> accum --> organs, jts, discs
100
ochronosis/alkaptonuria --> arthropathy --> key finding?
every level intervert disc --> calc & narrow
101
what is multicentric reticulohistiocytosis?
rare --> lipid-laden macrophage --> deposit in soft tissues, tendons --> skin nodules, erosions
102
multicentric reticulohistiocytosis --> XR findings? (3)
- erosions --> sclerotic margins
- ST nodule
- normal bone density
103
multicentric reticulohistiocytosis --> MC distribution?
DIP --> symm
104
multicentric reticulohistiocytosis --> potential comp?
rapid jt destuct --> arthritis mutilans
105
hemophilia --> arthropathy --> MOA?
recurrent hemarthrosis --> synovium --> hyperemia & hypertrophy --> epiphysis enlrg --> early fusion --> 2ary arthritis
106
hemophilia --> arthropathy --> MC locations? (3)
- knee
- ankle
- elbow
107
hemophilia --> arthropathy --> elbow --> charact appearance? (2)
- enlrg radial head
| - wide trochlear notch
108
hemophilia --> arthropathy --> knee --> charact appearance? (2)
- square patella
| - wide intercondylar notch
109
elbow --> enlrg radial head --> ddx? (2)
- hemophilia
| - juvenile idiopathic arthritis (JIA)
110
knee --> wide intercondylar notch --> ddx? (2)
- hemophilia
| - juvenile idiopathic arthritis (JIA)
111
what is pseudotumor of hemophilia?
recurrent intraosseous/subperiosteal bleed --> ST mass --> bony scallop, pressure erosion
112
pseudotumor of hemophilia --> XR appearance? MRI?
XR: benign --> well-circum, sclerotic margin
MRI: complex --> diff stage blood products
113
juvenile idiopathic arthritis (JIA) --> age?
<16yo
114
what is Still dz?
JIA variant --> systemic
115
Still dz --> age?
<5yo
116
Still dz --> synd? (5)
- acute febrile illness
- rash
- adenopathy
- pericarditis
- mild arthralgia
117
juvenile idiopathic arthritis (JIA) --> types? (3) MC?
- #1 pauciarticular
- monoarticular
- polyarticular
118
juvenile idiopathic arthritis (JIA) --> key finding?
skeletally immature --> bone length/morphology --> abnormal
119
juvenile idiopathic arthritis (JIA) --> bone shortening, abnormal morphology --> MOA?
hyperemia --> epiphysis:
- overgrow & enlrg ("ballooning")
- premature physeal fusion --> brachydactyly
120
JIA --> knee --> imaging appearance? (3) similar to what condition?
- wide intercondylar notch
- metaphyseal flare
- uniform jt narrow
similar to hemophilia
121
JIA --> elbow --> imaging appearance? (3) similar to what condition?
- wide trochlea notch
- radial head enlrg
- uniform jt narrow
similar to hemophilia
122
JIA --> hip --> imaging appearance? (3)
- uniform jt narrow
- protrusio deformity
- femoral shaft --> gracile appearance
123
child --> cervical spine --> ankylosis --> ddx? (2)
- JIA
| - Klippel-Feil synd
124
what is Klippel-Feil synd?
dev disorder --> fail cervical segmentation --> fusion of 2 or more cervical vertebrae
125
JIA --> advanced dz --> ankylosis --> location? (2)
- wrist
| - cervical spine --> facet jts
126
cervical ankylosis --> MC in JIA or RA?
JIA
127
neuropathic arthropathy (Charcot jt) --> 2 types?
- #1 hypertrophic
| - atrophic
128
neuropathic arthropathy (Charcot jt) --> hypertrophic variant --> imaging appearance?
"anarchy in a jt":
- destrucxn
- sublux/dislocate
- debris
- disorg
- no demin
129
neuropathic arthropathy (Charcot jt) --> atrophic variant --> MC location? imaging appearance?
shoulder --> humeral head resorption --> sharp surg-like margin
130
neuropathic arthropathy (Charcot jt) --> UE --> next step?
suspect syringomyelia --> MRI cervical
131
sarcoidosis --> MSK manifestation? (2)
- bone lesion
| - polyarthritis
132
sarcoidosis --> bone lesion --> imaging appearance?
mid or distal phalanx --> lytic lesion --> "lace-like"
133
b/l ankle --> arthritis & erythema nodosum --> next step?
suspect sarcoidosis --> CXR
134
diffuse osteopenia --> assoc arthritis?
advanced RA
135
periarticular osteopenia --> assoc arthritis? (2)
- RA
| - any inflamm arthropathy --> early stage
136
DIP ankylosis --> what arthritis?
psoriatic arthritis
137
hand --> DIP & PIP --> osteophytes --> what arthritis?
OA
138
hand --> DIP & PIP --> osteophytes + erosions --> what arthritis?
erosive OA
139
hand --> DIP & PIP --> erosions, no osteophytes --> what arthritis?
psoriatic OA
140
RA --> distal radioulnar jt --> sequential extensor tendon rupture --> in what order?
ulnar to radial: 5 --> 4 --> 3 --> 2
141
tenosynovitis --> focal --> etiology? (2)
- penetrating infx
| - overuse
142
tenosynovitis --> diffuse --> etiology? (2)
- TB or non-TB mycobact
| - RA
143
TB --> diffuse tenosynovitis --> classic imaging finding?
"rice bodies" --> discrete filling defects in fluid-filled sheaths
144
RA --> distal radioulnar jt --> ruptures of extensor tendons 5, 4, 3, 2 --> dx?
Vaughan-Jackson synd
145
flexor tendon --> tenosynovitis --> next step? why?
can spread rapidly to common flexors of wrist --> surg emergency --> call provider/go to OR
146
De Quervain's tenosynovitis --> involves which extensor compt?
1st extensor compt
147
wrist --> 1st extensor compt --> comprised of what struct? (2)
- ext pollicis brevis
| - abductor pollicis longus
148
intersection synd --> epidermiology?
rower
149
wrist --> intersection synd --> involves which extensor compt?
2nd extensor compt
150
2nd extensor compt --> comprised of what struct? (2)
ext carpi radialis brevis & longus
151
wrist --> 3rd extensor compt --> tenosynovitis --> epidemiology?
drummer
152
3rd extensor compt -->comprised of what struct? (1)
ext pollicus longus
