the GALS screen

Question 1

purpose of GALS examination (locomotor ie movement)

Answer 1

find which joints are ABNORMAL- then the NATURE of the abnormality (mechanical or inflammatory ie swelling/tenderness), the EXTENT of the joint involvement (ie how many joints, is it symmetrical ie RA), and OTHER FEATURES (eg butterfly rash ie SLE)

Question 2

key questions in GALS

Answer 2

any pain/stiffness in joints- indicates inflammatory arthritis if in morning (ie worsens after rest)- also can you dress/ walk up stairs without difficulty

Question 3

what are you testing in GALS

Answer 3

gait, arms, leg, and spine

Question 4

GAIT examination

Answer 4

look at patient walking and turning back- is stride length normal, is there symmetry of leg/arm movements- can they turn fine

Question 5

spine examination

Answer 5

is spine straight- look at cervical spine movements, movements of lumbar spine (flat lumbar spine= AS) etc.

Question 6

arms examination

Answer 6

look at extension of elbow, supination/pronation, extending wrist, and fine finger movements ie MCP’s for RA

Question 7

legs examination

Answer 7

look at hip movement, knee joint, MTP’s for RA

Question 8

define arthritis

Answer 8

inflammation of joint ie swelling

Question 9

define arthralgia

Answer 9

pain in joint without inflammation ie looks normal

Question 10

dislocation

Answer 10

articulating surface no longer in contact

Question 11

subluxartion

Answer 11

partial dislocation

Question 12

varus deformity

Answer 12

lower limb deformity- distal part of knee goes TOWARDS midline

Question 13

valgus deformity

Answer 13

lower limb deformity- distal part of knee goes AWAY from midline

Question 14

what is gout- cause, joint mostly affected, and key feature

Answer 14

arthritis of a single joint, mostly 1st MTP joint- due to deposits of uric acid (called TOPHI)-VERY painful

Question 15

analysing joint swelling

Answer 15

bony areas indicate osteoarthritis, synovium indicates inflammation

Question 16

enthesopathy

Answer 16

inflammation at enthesis ie where tendon inserts into boen ie achiles

Question 17

analysing pattern of arthritis- RA vs reactive arthritis

Answer 17

bilateral and symmetrical of large AND small joints= RA- asymmetrical OLIGOARTHRITIS with AXIAL involvement (2-4 joints)= reactive arthritis

Question 18

joints spared in rheum

Answer 18

DIP and lumbar spine

Question 19

joints spared in OA

Answer 19

wrist, elbow, ankle

Question 20

joint spared in gout

Answer 20

axial

Question 21

other features of Rheu

Answer 21

subcutaenous nodules eg in elbow (due to immune complexess)

Question 22

other features of gout

Answer 22

tophi

Question 23

other features of SLE

Answer 23

butterfly rash

Question 24

synovial fluid analysis- done for what, and why ie what does it distinguish from

Answer 24

often for a monoarthritis of eg knee joint- as may be due to infection ie septic arthritis or than inflammatory arthritis ie gout, hence fluid sent for culture- if monourate crystals present ie uric acid, indicates gout, if not, indicates infection

Question 25

what are synovial effusions+ appearance+ what rich in

Answer 25

abnormal increase in synovial fluid- looks very turbid in infection (opaque), and high in HYALURONIC ACID

Question 26

arthalgia and arthritis effect on bone ie what it doesn't do

Answer 26

NON-EROSIVE

Question 27

raynauds phenomeonon

Answer 27

common in connective tissue disorders- vasospasm of digits when exposed to cold ie becomes very white

Question 28

what occurs in sjoegrens syndrome

Answer 28

autoimmune destruction of exocrine galnds= dry eyes and mouth