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Musculoskeletal Y2 > The GALS Screen > Flashcards

The GALS Screen Flashcards

1
Q

What is the GALS screen for?

A

Designed to rapidly express whether somebody has joint problems

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2
Q

Aims of the locomotor examination to find out? (4)

A

Are any of the joints abnormal?
What is the nature of the joint abnormality?
What is the extent (distribution) of the joint involvement?
Are any other features of diagnostic importance present?

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3
Q

Key screening questions for the GALS exam? (3)

A

Have you any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?

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4
Q

What do you do to assess gait?

A

observe patient walking, turning and walking back

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5
Q

What do you look for when assessing gait? (3)

A

smoothness and symmetry of leg, pelvis and arm movements
normal stride length
ability to turn quickly

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6
Q

What do you look for when assessing spine? (11)

A 
is paraspinal and shoulder girdle 
muscle bulk symmetrical? 
 is the spine straight? 
 are the iliac crests level? 
 is the gluteal muscle bulk normal? 
 are there popliteal swellings? 
 are the Achilles tendons normal? 
Assess for fibromyalgia 
note the normal spinal curvatures 
assess lumbar spine and hip flexion 
tests lateral cervical flexion
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7
Q

How do you assess for fibromyalgia?

A

press over mid-point of each supraspinatus and squeeze skinfold over trapezius

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8
Q

How do you note the normal spinal curvatures

A

from the side

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9
Q

How do you assess lumbar spine and hip flexion

A

ask patient to bend forward and touch their toes, with knees straight

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10
Q

How do you assess lateral cervical flexion

A

try to place ear on the shoulder each side

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11
Q

What do you look for when assessing arms? (8)

A

normal girdle muscle bulk
and symmetry
elbows are straight and in
full extension
attempt to place both hands behind the head,
then push elbows back
examine hands palms down, with fingers straight
observe normal supination and pronation
observe normal grip
place tip of each finger on to the tip of the thumb
to assess normal dexterity and precision grip
squeeze across 2nd to 5th metacarpal (metacarpal ‘squeeze’ test) - discomfort suggests synovitis

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12
Q

What do you look for when assessing legs? (6)

A

observe any knee or foot
deformity
assess flexion of hip and knee, whilst supporting the knee
passively internally rotate each hip, in flexion
examine each knee for presence of fluid using ‘bulge’ sign and ‘patella tap’ sign
squeeze across the metatarsals to detect any synovitis
inspect soles of the feet for rashes and/or callosities

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13
Q

How do you define nature of joint abnormality? (3)

A

Is there active inflammation?

Is there irreversible joint damage?

Is there a mechanical defect?

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14
Q

What does the detailed examination of abnormal joints consist of? (4)

A

inspection
palpation
movement
function

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15
Q

What do you inspect an abnormal joint for? (3)

A

swelling, redness, deformity

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16
Q

What do you palpate an abnormal joint for? (3)

A

warmth, crepitus, tenderness

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17
Q

what movements do you check in an abnormal joint? (3)

A

warmth, crepitus, tenderness

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18
Q

what is arthritis?

A

definite inflammation of a
joint(s) i.e. swelling, tenderness and warmth of
affected joints

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19
Q

What is arthralgia?

A

refers to pain within a joint(s) without demonstrable inflammation by physical examination

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20
Q

Arthralgia vs arthritis?

A

arthritis is definite inflammation, arthralgia has no demonstrable inflammation by physical examination

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21
Q

5 signs of inflammation?

A 
swelling (tumor)
warmth (calor)
erythema (rubor)
tenderness (dolor)
loss of function (functio laesa)
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22
Q

What is loss of function known as?

A

functio laesa

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23
Q

What is tenderness known as?

A

dolor

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24
Q

What is swelling known as?

A

tumor

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25
Q

What is warmth known as?

A

calor

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26
Q

What is erythema known as?

A

rubor

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27
Q

What is rubor

A

Warmth

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28
Q

What is calor

A

Erythema

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29
Q

What is dolor

A

Tenderness

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30
Q

What is functio laesa

A

Loss of function

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31
Q

What is tumor

A

Swelling

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32
Q

What is gout?

A

disease in which tissue deposition of monosodium urate (MSU) crystals occurs as a result of hyperuricaemia and leads to one or more of the following:
Gouty arthritis
Tophi (aggregated deposits of MSU in tissue)

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33
Q

What does gout lead to?

A

Gouty arthritis

Tophi (aggregated deposits of MSU in tissue)

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34
Q

What is deposited in gout

A

Monosodium urate (MSU)

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35
Q

Which joint does gouty arthritis commonly affect

A

Gouty arthritis commonly affects the MTP joint of the big toe (first MTP joint)

36
Q

Site of swelling:
articular soft tissue

Tissue involved?

Indicative of?

A

joint synovium or effusion

inflammatory joint disease

37
Q

Site of swelling:
periarticular soft tissue

Tissue involved?

Indicative of?

A

subcutaneous tissue

inflammatory joint disease

38
Q

Site of swelling:
non-articular synovial

Tissue involved?

Indicative of?

A

bursa/tendon sheath

inflammation of structure

39
Q

Site of swelling:
bony areas

Tissue involved?

Indicative of?

A

articular ends of bone

osteoarthritis

40
Q

What is joint deformity defined as

A

malalignment of two articulating bones

41
Q

What crepitus? what is it a feature of

A

audible and palpable sensation resulting from movement of one roughened surface on another
classic feature of osteoarthritis e.g. patellofemoral crepitus on flexing the knee

42
Q

What does irreversible joint damage result in?

A

loss of joint range or abnormal movement

43
Q

Define dislocation:

A

articulating surfaces are displaced and no longer incontact

44
Q

Define subluxation:

A

partial dislocation

45
Q

Define valgus:

A

lower limb deformity whereby distal part is directed away from the midline e.g. hallux valgus

46
Q

Define varus:

A

lower limb deformity whereby distal part is directed towards the midline e.g. varus knee with medial compartment OA

47
Q

What is the site where tendons and ligaments insert into bone called

A

Entheses

48
Q

Entheses are…?

A

the site where tendons and ligaments insert into bone

49
Q

Rheumatoid factor is [positive/negative] in ankylosing spondylitis?

A

neg

50
Q

What does ankylosing spondylitis affect? (4)

A 
Sacroiliac joints (sacroiliitis) and spine
leads to spinal fusion (ankylosis) and deformity
Enthesopathy
Non-axial joints – hips and shoulders (common), others less frequently involved
51
Q

4 examples of Spondyloarthropathies?

A

Reactive arthritis and Reiter’s syndrome
Ankylosing spondylitis
Arthritis associated with psoriasis (psoriatic arthritis)
Arthritis associated with gastrointestinal inflammation (enteropathic synovitis

52
Q

What causes mechanical joint defects? (3)

A

consequence of inflammation, degenerative arthritis or trauma

53
Q

Identifying mechanical joint defects? (2)

A

painful restriction of motion in absence of features of inflammation
e.g. knee ‘locking’ due to meniscal tear or bone fragment

instability
e.g. side-to-side movement of tibia on femur due to ruptured collateral knee ligaments

54
Q

Types of irreversible joint damage?

A

Joint deformity
Crepitus
Loss of joint range or abnormal movement

55
Q

Common finger deformities in RA? (2)

A

Swan-neck and Boutonnière deformities

Swan-neck and Boutonnière deformities

56
Q

How to determine the extent of joint involvement? (4)

A

determine number of joints involved:
note if involvement is symmetrical
note the size of the involved joints
is there axial involvement?

57
Q

bilateral and symmetrical involvement of large and small joints is typical of X

A

RA

58
Q

lower limb asymmetrical oligoarthritis and axial involvement would be typical of X

A

reactive arthritis

59
Q

exclusive inflammation of the distal interphalangeal joints of th/e fingers is highly suggestive of X

A

psoriatic arthritis

60
Q

Joints commonly spared in RA? (3)

A

DIP
thoracic spine
lumbar spine

61
Q

Joints commonly spared in osteoarthritis? (6)

A

MCP, wrist, elbow, shoulder, ankle, tarsal joints

62
Q

Joints commonly involved? in osteoarthritis (9)

A

1st CMC, DIP, PIP, cervical spine, thoracolumbar spine, hip, knee, 1st MTP, toe IP

63
Q

Joints commonly involved in RA? (11)

A

PIP, MCP, wrist, elbow, shoulder, cervical spine, hip, knee, ankle, tarsal, MTP

64
Q

Joints commonly involved in polyarticular gout? (3)

A

1st MTP, ankle, knee

65
Q

Joints commonly spared in polyarticular gout?

A

axial

66
Q

Other features of diagnostic importance to look out for? What disease do they suggest?

A

rheumatoid nodules - RA

tophi - Gout

67
Q

What is synovial effusion

A

Abnormal increase in synovial fluid volume

68
Q

What cells in the synovium lining secrete what which contributes to the viscosity of the fluid

A

Type B fibroblast like cells secrete the hyaluronic acid which results in the increased viscosity of synovial fluid

69
Q

What does normal synovial fluid look like?

A

Clear or pale yellow and viscous

70
Q

What does non-inflammatory synovial fluid look like?

A

Slightly turbid

71
Q

What does inflammatory synovial fluid look like?

A

Turbid

72
Q

What does infected synovial fluid look like?

A

Very turbid

73
Q

What does slightly turbid synovial fluid suggest? (2)

A

Osteoarthritis

Mechanical defects

74
Q

What does turbid synovial fluid suggest? (2)

A

Gout

Rheumatoid arthritis

75
Q

What does very turbid synovial fluid suggest? (2)

A

Bacterial Infections

76
Q

When and how do you examine synovial fluid?

A

mandatory when joint infection is suspected

needle aspiration under aseptic conditions (termed arthrocentesis)

77
Q

What is Raynauds phenomenon

A

Intermittent vasospasm of digits on exposure to cold

78
Q

What HLA serotype is SLE associated with?

A

HLA-DR3

79
Q

Clinical manifestations of SLE? (9)

A

Malar rash – erythema that spares the nasolabial fold
Photosensitive rash
Mouth ulcers
Hair loss
Raynaud’s phenomenon
Arthralgia and sometimes arthritis
Serositis (pericarditis, pleuritis, less commonly peritonitis)
Renal disease – glomerulonephritis (‘lupus nephritis’)
Cerebral disease – ‘cerebral lupus’ e.g. psychosis

80
Q

What is Sjogrens syndrome? Who is it more common in? What are the symptoms? (3) What antibodies are associated with it? (2)

A

Autoimmune exocrinopathy
Typically diagnosed in middle-aged female
Typically diagnosed in middle-aged female
Antinuclear antibody - Anti-Ro and Anti-La antibodies
Rheumatoid factor

81
Q

What is inflammatory muscle disease?

A

Proximal muscle weakness due to autoimmune-mediated inflammation either with (dermatomyositis) or without (polymyositis) a rash

82
Q

Skin changes in inflammatory muscle disease?

A

Lilac-coloured (heliotrope) rash on eyelids, malar region and naso-labial folds
Red or purple flat or raised lesions on knuckles (Gottron’s papules)
Subcutaneous calcinosis
Mechanic’s hands (fissuring and cracking of skin over finger pads)

83
Q

Antibodies associated with inflammatory muscle disease?

A

Antinuclear antibody – Anti-tRNA synthetase antibodies

84
Q

CPK in inflammatory muscle disease?

A

Elevated

85
Q

What is systemic sclerosis?

A

Thickened skin with Raynaud’s phenomenon
caused by:
Dermal fibrosis, cutaneous calcinosis and telangiectasia

86
Q

What is overlap syndrome?

A

When features of more than 1 connective tissue disorder are present e.g. SLE and inflammatory muscle disease we can use the term overlap syndrome

87
Q

What are connective tissue diseases? (5)

A 
SYSTEMIC SCLEROSIS
INFLAMMATORY MUSCLE DISEASE
SJÖGREN’S SYNDROME
SYSTEMIC LUPUS ERYTHEMATOSUS
RAYNAUD’S PHENOMENON

Musculoskeletal Y2 (11 decks)

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