PPT 8

Question 1

HADD is calcifying

Answer 1

tendinitis and bursitis

Question 2

HADD characteristics

Answer 2

• 40-70 yoa

- M=F

Question 3

HADD MC in _____ specifically _____ but also affects elbow, wrist, fingers, hip, knee, foot, spine

Answer 3

single joint, shoulder (rotator cuff, hip, upper C spine)

Question 4

What is the most definitive method of Dx for HADD

Answer 4

xray

Question 5

HADD etiology

Answer 5

unknown

Question 6

HADD the area of degeneration is ____ and you see what type of deposition?

Answer 6

focal, crystal deposition

Question 7

HADD tendon calcification

Answer 7

• At insertion site
• Does not blend into cortex of adjacent bone
• Ovoid calcifications, sharp margins
• Disappear with U/S and active mobilization

Question 8

HADD bursal calcification

Answer 8

• Impossible differentiation from tendon Ca++ radiographically
• MC subacromial, subdeltoid and ischial bursae

Question 9

CPPD is a what type of disease

Answer 9

crystal deposition disease

Question 10

What produces gout like symptoms?

Answer 10

pseudo-gout

Question 11

CPPD characteristics

Answer 11

• > 30 yoa
• Chronic progressive joint pain
• Peripheral joints (Knees, wrists, hands, ankles, hips, elbows)

Question 12

CPPD crystal deposition into which cartilage?

Answer 12

hyaline and fibrous types

Question 13

CPPD is in and around which joints

Answer 13

• knee

- wrist

Question 14

CPPD radiologic features: Chondrocalcinosis - Hyaline Cartilage

Answer 14

• thin, linear, parallel to articular cortex

- MC – wrist, knee, elbow, hip and shoulder

Question 15

CPPD radiologic features: Chondrocalcinosis - Fibrocartilage

Answer 15

• thick, irregular, shaggy poorly defined margin

- MC – periphery of the meniscus of the knee, triangular fibrocartilage of wrist, symphysis pubis, annulus fibrosus

Question 16

CPPD - Pyrophosphate arthropathy chracteristics

Answer 16

• Structural joint changes occurring due to CPPD crystals within a joint
• Similar DJD changes

Question 17

Erosive OA is known as

Answer 17

inflammatory OA

Question 18

Erosive OA is an episodic and acute inflammation of which joints?

Answer 18

DIP and PIP

Question 19

Erosive OA is unilateral or bilateral?

Answer 19

bilateral

Question 20

Erosive OA is symmetric or asymmetric

Answer 20

symmetric

Question 21

Erosive OA characteristics

Answer 21

• Middle-aged females
• Pain, edema, redness, nodules, ROM
• 15% develop RA after >12 yrs
• Familial?

Question 22

EOA radiologic changes

Answer 22

• DJD changes WITH bone erosions
• –*DIP joints
• CENTRAL EROSIONS
• –“GULL WINGS SIGN”

Question 23

EOA main DDX for RA

Answer 23

rarely involves the DIP joints, has +’ve lab results

Question 24

EOA main DDX for PA

Answer 24

marginal erosions with adjacent periostitis

Question 25

EOA main DDX for non-inflammatory DJD

Answer 25

no erosions, identical to EOA

Question 26

RA is what type of tissue disorder?

Answer 26

CT

Question 27

RA etiology

Answer 27

unknown

Question 28

RA attacks which tissues

Answer 28

synovial

Question 29

RA characteristics

Answer 29

``` 20-60 yoa Female, 3:1 (in 20-40 yoa group) 1:1 (>40 yoa) Pain, tenderness, stiffness, swelling “Jelling phenomenon” ```

Question 30

RA is unilateral or bilateral

Answer 30

bilateral

Question 31

In RA, what is the joint involvement?

Answer 31

peripheral

Question 32

RA begins at ___ and ___ joints

Answer 32

IP & MCP

Question 33

RA progresses proximally or distally?

Answer 33

proximally

Question 34

RA - firm non-tender rheumatoid nodules characteristics

Answer 34

- Accumulation of inflammatory cells - In 20% of patients - severe cases - 5mm to 3cm - On extensor surfaces

Question 35

RA: Haygarth’s nodes

Answer 35

- soft tissue swelling | - MCP joints

Question 36

RA - Lab Values

Answer 36

- ↑ ESR and ↑ C-reactive protein | - Presence of rheumatoid factor (not specific for RA)

Question 37

Felty's syndrome which conditions combined?

Answer 37

Rheumatoid arthritis + Leukopenia + Splenomegaly

Question 38

In RA you have a poor prognosis if

Answer 38

- Presence of subcutaneous nodules and high levels of rheumatoid factor - Exacerbation of disease for more that 1 year - Onset earlier than 30 yoa - Extra-articular manifestations

Question 39

RA Pathology

Answer 39

- acute synovitis with edema - periarticular edema - juxta-articular hyperemia

Question 40

In RA, synovial proliferation forms

Answer 40

pannus

Question 41

Pannus is ___ tissue that spreads over what surface of bone and cartilage?

Answer 41

vascular tissue, intra-articular

Question 42

In RA Bare Area, where intra-articular bone is in direct contact with synovium there are _____ erosions

Answer 42

marginal

Question 43

In RA, there are ____ cavities because ___ enters marrow space of the ____ bone

Answer 43

cyst-like, pannus, subchondral

Question 44

In RA, the joint fills with pannus and leads to

Answer 44

progressive fibrous ankylosis

Question 45

RA MC sites

Answer 45

- Hand - Wrist - Foot - Knee - Hip - Cervical spine

Question 46

RA of the hands which joint is NOT involved?

Answer 46

DIP

Question 47

In RA of the hands there are ____ changes

Answer 47

irreversible

Question 48

In RA of the hands there are _____ erosions, MC at

Answer 48

- marginal - radial margins of 2nd and 3rd metacarpal heads - Radial margins of the distal and proximal ends of the proximal phalanges

Question 49

In RA of the hands you see

Answer 49

Boutonniere deformity Swan-neck deformity Digital ulnar deviation (zig zag deformity) Carpal radial deviation