Test #3 Flashcards
(179 cards)
1
Q
5 types of degenerative disorders?
A
OA (DJD), Erosive OA, DISH, Neurotropic Arthropathy, Synoviochondrometaplasia
2
Q
4 types of inflammatory disorders?
A
RA, JRA, SLE, Scleroderma
3
Q
4 types of Rheumatoid variants of inflammatory disorders?
A
Ankylosis Spondylitis, Enteropathic Arthropathy, Psoriatic Arthropathy, Reiter’s Syndrome
4
Q
Rheumatoid variants will be positive for what & negative for what?
A
Positive for HLA-B27 & negative for RF
5
Q
4 types of endocrine & metabolic related disorders?
A
Gout, CPPD crystal deposition disease (Pseudogout), calcium hydroxyapatite crystal deposition disease, ochronosis
6
Q
2 types of primary synovial disorders?
A
Synoviochondrometaplasia & pigmented villonodular synovitis
7
Q
2 types of infectious arthritis?
A
Pyogenic (septic) arthritis & non-pyogenic arthritis
8
Q
Pyogenic arthritis is m/c caused by what organisms?
A
Staph. aureus
9
Q
Non-pyogenic arthritis is m/c caused by what?
A
Tuberculosis
10
Q
Motion at synarthrosis joint?
A
fixed or rigid
11
Q
Motion at amphiarthrosis joint?
A
Slightly moveable
12
Q
Motion at diarthrosis joint?
A
Freely moveable
13
Q
Fibrous joints are composed of what type of tissue?
A
Interposed fibrous connective tissue
14
Q
Cartilaginous joints are composed of what type of tissue?
A
Usually hyaline or fibrocartilage
15
Q
Synovial joints are composed of what type of tissue?
A
Articular cavity is lined w/ synovial tissue
16
Q
What is the procedure of choice for making diagnosis for arthritides?
A
Conventional Radiography
17
Q
ABCDS of arthritis stands for what?
A
Alignment, Bony mineralization, Cartilage Space, Distribution, Soft Tissue
18
Q
What type of imaging is used to evaluate degenerative & inflammatory changes in a joint & to document & assess spinal stenosis?
A
CT
19
Q
What is bone scintigraphy used for?
A
Differentiate active disease from arthritis in remission
20
Q
What is one use for MRI & arthritis?
A
Demonstrates rheumatoid nodules & synovial abnormalities
21
Q
What is a negative for MRI & arthritis?
A
Can’t distinguish b/w inflammatory & non-inflammatory fluid
22
Q
What are routine lab studies for arthritis?
A
Auto antibodies (RF, ANA) Uric acid, ESR, C-Reactive protein
23
Q
What labs are not part of a routine study?
A
Histocompatability antigen (HLA-B27, HLA-DR4) & joint fluid aspiration
24
Q
According to Resnick, radiographic diagnosis is based on what 2 fundamental parameters?
A
Morphology & distribution
25
Radiographic presentation is dependent upon what?
Type & stage of the disease
26
What type of changes occur when articular cartilage is site of original insult?
Degenerative changes
27
What type of changes occur when synovial membrane is site of original insult?
Inflammatory changes
28
What are 4 morphologic changes seen on xray?
Abnormalities of opposing joint margins
Changes in the radiographic joint space
Malalignment
Evidence of intra-articular disease
29
What is (Willy) Sutton's Law?
When diagnosing, one should first consider the most obvious.
30
Types of appendicular arthritis from M/C to L/C?
```
OA
RA
CPPD
Gout
Septic artritis
```
31
Types of axial arthritis from M/C to L/C
```
OA
DDD
DISH
RA
Ankylosing spondylitis
CPPD
```
32
Original site of injury for DJD is what?
Cartilage
33
DJD is AKA?
OA, OA spondylosis, DDD
34
What is the M/C form of arthritis?
DJD/OA
35
What are risk factors for DJD?
Heredity, gender, diet, obesity, age, physical activity
36
DISH is AKA
Forestier Disease
| Senile Ankylosing hyperostosis
37
This is a generalized articular disorder w/ an axial predilection characterized by ligamentous ossification
DISH (Diffuse idiopathic skeletal hyperostosis
38
What is the etiology of DISH?
Unknown
39
What are some possible diseases assoc. w/ DISH?
Diabetes (30% of pts)
Dyslipidemia
Alcohol intake
Poor dietary habits postulated
40
Who does DISH M/C affect?
>50yr old, caucasian males
41
What are some clinical manifestations of DISH?
```
Intermittent spinal stiffness
Restricted ROM that's worse in morning, after activity, or cold weather
Pain related to enthesitis, tendonitis
Dysphagia
Increased predisposition to fx
```
42
What is occasionally the initial presenting complaint of DISH?
Dysphagia
43
What occurs mainly in the C-spine of approx. 50% of pts w/ DISH that may lead to neural compromise?
Ossification of the PLL
44
What is the definitive criteria for the spine on a imaging study of DISH?
Calcification/ossification along anterolateral aspect of 4 contiguous vertebrae
Relative preservation of disc height
Absence of pos. joint & SI joint ankylosis
45
What differentiates DISH from ankylosing spondylitis?
Absence of pos. joint & SI joint ankylosis
46
Where is DISH M/C frequently seen in the C-spine?
C4-C7, anteroinferior margin, extending down
47
Horizontal radiolucent clefts on an xray in the C-spine of a pt w/ DISH may result from?
Ant. disc bulges
48
Fxs in a DISH pt M/C occur in what spinal region?
Cervical
49
What is the M/C site of involvement for DISH in the thoracic region?
T7-T11
50
DISH in the lumbar region?
Upper segments & extends upwards
51
This has a definite assoc. w/ DISH
OPLL
52
What ethnicity is predisposed to develop OPLL?
Japanese
53
What age group is OPLL M/C seen in?
>50 yr old
54
What ratio does OPLL affect men vs. women?
Men 2:1
55
What is the M/C complaint w/ OPLL?
Difficulty in walking d/t cord compression
56
What are typical signs of an upper motor neuron lesion?
Spastic weakness
Hyperreflexia w/ clonus
Pathological reflexes
57
What is the typical sign of a lower motor neuron lesion?
Spasm
58
What is the best clue for OPLL on an xray?
Flowing multilevel ossification pos. to the vertebral bodies
59
What are two specific radiographic features of OPLL?
Minimal disc disease
| Absent facet ankylosis
60
Where does OPLL M/C occur?
Cervical spine (C3-C5)
61
How is asymptomatic OPLL managed?
observation, non-operative
62
How is symptomatic OPLL managed?
Decompression laminectomy
63
What is a lab test that can tell if a pt has DISH?
HLA-B8
64
After what age does primary DJD occur?
age 50
65
What is the main clinical manifestation of OA in the spine?
Neural deficits
66
What are common causes of canal stenosis?
DDD & facet arthrosis
67
Where are the M/C locations in the skeleton for OA?
```
Hips & knees
Spine
1st MTP joint
AC joint
1st Metacarpal-trapezium
DIP & PIP
```
68
What are hallmarks for DJD in the extremities?
Reduced joint space (non-uniform)
Osteophyte formation
Subchondral sclerosis
Subchondral cysts
69
What are 4 hallmarks for DDD?
Reduced joint space (non-uniform)
Osteophyte formation
Subchondral sclerosis
Vacuum phenomena
70
What are the M/C radiographic features of DJD in the hip?
Sup. joint space compartment & subchondral cysts
71
What are subchondral cysts of the hip called?
Egger's cysts
72
What are advanced changes in the hip for DJD?
Coxarthrosis
Malum coxae
Senilis
73
Narrowing of axial compartment is a red flag for what?
Inflammatory process, not degeneration
74
What is the primary etiology of DJD in the knee?
Chronic microtrauma
75
What are secondary joint disorders that cause DJD in the knee?
Previous trauma
Joint instability
AVN
76
What is the clinical profile for DJD in the knee?
Pain w/ utilization of joint
Variable joint swelling
Catching, locking, grinding in older pt
77
What is the M/C radiographic features of the knee w/ DJD?
Narrowing of med. femorotibial joint space
78
What are radiographic features of the knee w/ DJD?
```
Small osteophytes
Mild subchondral sclerosis
Subchondral cysts <10%
Varus or valgus deformity
Osteochondral bodies
Patellar tooth sign
```
79
What is degenerative enthesopathy AKA?
Patellar tooth sign
80
If only the patellofemoral joint compartment is involved, it's not which type of OA?
Not primary OA
81
What is indicated by patellofemoral joint pain & crepitus accentuated by knee flexion?
Chondromalacia patella
82
Chondromalacia patella may be idiopathic or secondary to what?
Patellar trauma
83
Chondromalacia patella occurs most often in who?
Adolescents & young adults
84
What conditions predispose people to chondromalacia patella?
Patella alta
Increased valgus angle
Femoral condyle hyperplasia
85
What is the best imaging procedure for chondromalacia patella?
MRI
86
DJD in the ankle is usually secondary to what?
Trauma
87
What joint in the foot is M/C affected by DJD?
1st MTP joint
88
Osteophytes of the MTP M/C grow where?
Dorsal & medial aspect
89
Is a valgus or varus deformity common in MTP joints w/ DJD
Valgus deformity
90
M/C joint for DJD in the shoulder?
AC joint
91
Ant. displacement of humeral head into the acromial process indicates what?
Rotator cuff injury, typically supraspinatus
92
M/C location for DJD in the hands?
DIPs
93
Heberden's nodes are located by which joints?
DIPs
94
Bouchard's nodes are located at which joints?
PIPs
95
Nodes are caused by what?
Osteophytes
96
M/C location for degenerative spine disease?
C5-C7
T6-T12
L4-S1
97
Degenerative changes may involve the spine at which sites?
```
Synovial joints
Intervertebral disc
Vertebral bodies & annulus fibrosus
Fibrous articulation ligs.
Sites of lig. attachment
```
98
Degenerative changes in the vert. bodies & annulus fibrous is called what?
Spondylosis deformans
99
Degenerative changes in the fibrous articulations, ligs, sites of lig. attachment is known as what?
DISH
100
If osteophyte is projecting off the endplate of a vert. body its called what?
Spondylophyte
101
Radiographic features of degenerative spine disease in synovial joints?
Decreased joint space
Eburnation
Osteophytes
102
Eburnation is AKA?
Subchondral sclerosis
103
Not common, but can cause occipitocervical pain?
Atlantoaxial arthrosis
104
Facet joint involvement is M/C in what part of the spine?
Mid & lower cervical & lower lumbar spine
105
Best views to see facet involvement in degenerative spine disease?
AP & oblique
106
M/C location for costovertebral involvement w/ degenerative spine disease?
Lower thoracic
107
Syndrome where a person w/ costovertebral degeneration that gives rise to symptoms suggesting pt has a GI disorder?
Robert's Syndrome
108
Lower thoracic facet arthrosis that causes pain to be projected or radiated down into lower lumbar area?
Maigne's syndrome
109
Nuclear vacuum is pathoneumonic to what?
DDD
110
Radiographic findings of DDD?
```
Loss of disc height
Osteophytes
Eburnation
Vaccuum phenomena
Subluxation
```
111
This is due to uncovertebral joint arthrosis & facet joint arthrosis at the same time
Hour glass appearance to IVF
112
Kissing spinouses is AKA?
Baastrup's Syndrome
113
Degenerative spondylolisthesis is M/C in the C-spine at what level & M/C in the spine overall at what level?
C7; L4
114
Osteophytes that have turned up or down?
Claw osteophytes
115
Thought tot be caused by tears in Sharpey's fibers?
Annular vacuum phenomena
116
Nuclear vacuum phenomena tells you what 3 things?
Pt has DDD, doesn't have infection, & the segment moves
117
Ant. & lat. osteophytes d/t ant. & anterolateral disc herniation initiated by abnormalities of peripheral fibers of annulus & vert. body?
Spondylosis Deformans
118
Degeneration of innermost portion of annulus, dehydration of nucleus, breakdown of cartilage plate?
Intervertebral chondrosis/osteochondrosis
119
Where do osteophytes occur in SI joints that are degenerating?
Ant. aspect of synovial portion at sup. or inf. aspect
120
This is a clinical & radiographic variant of DJD that is AKA inflammatory osteoarthritis?
Erosive Osteoarthritis
121
Erosive osteoarthritis is M/C in who?
Middle aged females
122
What symptoms manifest clinically w/ erosive osteoarthritis?
Episodic acute inflammation of DIP & PIP
Symmetric
Pain, edema, redness, nodules, decreased ROM
123
What type of laboratory manifestations are encountered w/ erosive osteoarthritis?
Normal to slightly elevated ESR
| Negative for rheumatoid factor
124
What are two pathological features of erosive osteoarthritis?
Cartilage degeneration
| Synovial proliferation
125
What radiographic sign is assoc. w/ erosive osteoarthritis?
Gull wings sign
126
What is the Gull Wings Sign?
central erosion proximal & peripheral erosions distal
127
What are some radiographic manifestations of erosive osteoarthritis?
Osteophytes, loss of joint space, sclerosis
| Erosions, periostitis, ankylosis
128
Destructive arthropathy which occurs when pain & proprioception are diminished & mobility maintained is known as what?
Neurotrophic Arthropathy
129
What is neurotrophic arthropathy AKA?
Charcot joint
130
What are some underlying conditions assoc w/ neurotrophic arthropathy?
```
Diabetes mellitus (M/C)
Syphilis
Syringomyelia
Congential indifference to pain
Spina bifida
```
131
What are clinical manifestations of Neurotrophic Arthropathy?
```
Recurrent painless effusions
Relatively painless instability
Enlargement, crepitus, "bag of bones"
Gait disturbances
Loss of DTRs, pain insensitivity
```
132
Where is neuortrophic arthropathy manifest in diabetes?
Ankle, subtalar joints, feet
133
Where does neuortrophic arthropathy manifest in syphilis?
Lumbar, knee, ankle
134
Where does neuortrophic arthropathy manifest in alcoholism?
Tarsals, metatarsals
135
Where does neuortrophic arthropathy manifest in syringomyelia?
Shoulder, elbow, wrist
136
What are two types of neuortrophic arthropathy seen on xrays?
Hypertrophic & atrophic
137
What are the 6 D's of hypertrophic neuortrophic arthropathy?
```
Distention
Density
Debris
Disorganization
Dislocation
Destruction
```
138
Where is hypertrophic neuortrophic arthropathy most pronounced?
In weight-bearing joints
139
What are terms assoc. w/ neuortrophic arthropathy?
```
Bag of bones
Licked candy stick
Tumbling building block spine
Jigsaw spine
Surgical amputation
```
140
What are the top DDx for neuortrophic arthropathy?
Pyogenic infections
Non-pyogenic infections
DDD
Hemophilia
141
This is a benign arthropathy where synovial tissue undergoes metaplastic transformation to produce foci of cartilage
Synoviochondrometaplasia
142
Where is the M/C location for Synoviochondrometaplasia?
Knee
143
Secondary Synoviochondrometaplasia is often seen in cases of what?
DJD
144
Who does Synoviochondrometaplasia affect more, males or females?
Males 3,2:1
145
What age group is most affected by Synoviochondrometaplasia?
third to fifth decade (20-40yrs)
146
What are some radiographic manifestations of Synoviochondrometaplasia?
```
Joint effusion (Hoffa's fat is obliterated)
Many radiopaque joint bodies
```
147
What is the best imaging method to see Synoviochondrometaplasia?
CT
148
What are skeletal locations affected by Synoviochondrometaplasia?
```
Knee (M/C)
Hip
Elbow
Ankle
Shoulder
Wrist
```
149
Chronic & progressive autoimmune system inflammatory disorder that primarily affects the synovium & characterized by destruction of bone & cartilage; M/C chronic inflammatory arthritide
RA
150
What is the most frequently assoc. human leukocyte antigen w/ the development of RA?
HLA-DR4
151
What is the ratio of males to females affected by RA?
3:1 females to males
152
What age group is M/C affected by RA?
20-60 yrs w/ a peak b/w 40-60 yrs
153
RA increases a pt's risk of developing what diseases?
Cardiovascular disease, lymphoma, leukemia
154
What are some typical clinical symptoms assoc. w/ RA?
Stiffness in morning & at times of inactivity (Jelling Phenomenon)
Often bilateral & symmetric joint involvement
Joint deformity
Malaise, weakness, weight loss, myalgias, fever
Neuropathy median & ulnar nerve distribution
Non-tender rheumatoid nodules (20%)
155
In this syndrome a pt has RA, dry eyes, & dry mouth?
Sjogren's syndrome
156
In this syndrome a pt has RA, leukopenia, & splenomegaly
Felty's syndrome
157
In this syndrome, a pt has RA & pneumoconiosis
Caplan's syndrome
158
MCP joint nodes are called what?
Hagar's nodes
159
What lab results would a person w/ RA have?
```
+RF test
Normochromic, normocytic anemia
Increased ESR
+ANA
C-reactive protein
```
160
Acute synovitis in RA leads to what?
edema, effusion hyperemia
161
Synovial proliferation in RA leads to what?
Pannus that spreads over the articular surface
162
Pannus plus "bare areas" leads to what in RA?
Marginal erosions
163
In RA, articular cartilage breaks down d/t what?
Pannus enzymes & interference w/ nutrition
164
In RA, intraosseous pannus &/or synovial fluid leads to what?
Synovial cysts
165
Where is the M/C location to see early manifestations of RA?
Hand & wrist, specifically 2nd & 3rd MCP joints, 2nd & 3rd prox. phalangeal joints
166
Approx. 80% of pts w/ RA that shows up in the hands have involvement in what area of the spine?
C-spine
167
What is the M/C imaging procedure to assess suspected cases of RA?
X-ray
168
What are the earliest radiographic findings of RA?
Soft tissue swelling & osteopenia
169
What is MRI good for w/ RA?
Sensitive in detection of erosions & synovial proliferation
170
What is the main radiographic manifestation of RA?
bilateral symmetry (may by unilateral initially)
171
What are some radiographic manifestations of RA?
```
Periarticular soft tissue swelling
Juxta-articular osteoporosis
Uniform loss of joint space
Marginal erosion (rat bite)
Juxta-articular periostitis
Subchondral cysts
Deformity
Ankylosis
```
172
Where is the earliest place to see marginal erosion?
bare areas, where synovium contacts bone
173
What is the M/C radiographic manifestations of RA in the C-spine?
Atlantoaxial instability (PADI less than 14mm)
174
This is d/t loss of disc height, apophyseal joint disease, & lig. laxity
Stepladder or doorstep deformity
175
This is bilateral protusion of acetabulum; M/C cause is RA
Otto's pelvis
176
This deformity is caused by extension of the DIP joint & flex at the PIP joint; typically seen in thumb
Boutonniere Deformity
177
This deformity is caused by flexion at the DIP & extension at the PIP
Swan neck deformity
178
What is the main ddx for spotty carpal sign?
Gout
179
Seronegative chronic arthritis is AKA
Still's disease
