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75 Cards in this Set
- Front
- Back
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What is the place of union between hard and soft tissues
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Enthesis
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Nonarticular joint disease is a disease of... What is another name for it?
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the soft tissues. Soft Tissue rheumatism.
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Are non-articular diseases painful or non-painful?
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Painful
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What kind of diseases (location-wise) cause soft tissue rhematism: localized, regional, or generalized?
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all three
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Give some examples of localized nonarticular joint disease.
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Tendinitis, bursitis, carpal tunnel, trigger finger, etc
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Give some examples of regional nonarticular joint disease.
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Neck pain, low back pain, chest wall pain syndrome.
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Give some examples of generlized nonarticular joint disease.
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Fibromyalgia
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What is a true connective disorder? What are some examples?
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A typically inherited disorder in which the structure of the soft tissue has been compromised. Marfan's syndrome, Erhlers Danlos, alkoptonuria, etc.
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A joint specific process involving any or all of the intraarticular structures defined by the joint capsule with the potential for damage and deformity to the joint is....
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the definition of true arthritis
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Calor, rubor, tumor, dolor, functio laeasa (loss of function), and rigor of a joint are all signs and symptoms of
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Arthritis
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What is the definition of monoarthritis?
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Arthritis involving one joint
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What is the definition of oligoarthritis?
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Arthritis involving less than or equal to 4 joints.
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What is the definition of Polyarthritis?
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Arthritis involving > 4 joints
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What is the difinition of axial arthropathy?
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Arthritis involving the SI, hip, and shoulder joints.
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What are 4 causes of axial arthritis?
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Ankylosing spondylitis, Reiter's syndrome, Reactive arthritis, Psoriatic arthritis
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What is the difference between a migratory, additive, and progressive Course.
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Migratory - It was here, now its there
Additive - Now its here and there Progressive - Now its worse |
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A 65 YOF presents with bilateral painful knees and pain in her neck and lower back. She complains of soreness and swelling in the cmall joints of her hands making it difficult for her to button buttons and get her rings on and off. She is currently taking aspirin, motrin, and Aleve OTC. The patient wants to know if she as a crippling form of arthritis and asks if you can make her joints feel better. You tell her...
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You have osteoarthritis. It will get worse over time. To treat we will Rx???
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What is the classic pattern of progression of osteoarthritis (OA) as far as number of joints are concerned?
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Monoarthritis...oligoarthritis...polyarthritis
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You have a pt that first presents with monoarthrits, then oligoarthritis, and finally develops polyarthritis. What do you think she has?
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Osteoarthritis
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Which disease process primarily involves Hyaline Cartilage?
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Osteoarthritis
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What must you rule out to Dx osteoarthritis?
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Mechanical Injury
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What is a resulting secondary change in osteoarthritis (OA)?
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Bone Change
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A 32 YOF has bilateral hand pain with joint swelling. She has morning stiffness that lasts at lease 30-60 minutes every day. She is also experiencing, jaw soreness, and upper neck pain. She is unable to wear her rings, has problems washing her hair b/c of shoulder and elbow pain, has problems with shoes w/ heals. Several of her joints feel feverish (esp. her wrists) What does she have?
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Rheumatoid Arthritis
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What disease prototypically involves inflammation of the synovial lining of the joint?
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Rheumatoid Arthritis
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In terms of number of joints, how does rheumatoid arthritis typically present?
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Polyarthritis
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Is rheumatoid arthritis symmetric or asymmetric?
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Symmetric
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What age group does Rheumatoid Arthritis typically affect the most?
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Young, Middle, and elderly
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• 28 year white male with lower back/gluteal pain with the discomfort present for the last six months
• Stiffness on early morning awakening that “loosens up” in approximately one hour • No discomfort in any peripheral joints • Right thigh and groin pain episodically • One episode in the past of right eye discomfort requiring treatment by an ophthalmologist • Family history of a maternal grand father with severe back pain and history of disability in his mid 40’s - What is your Dx and how did you come to that conclusion? |
Ankylosing Sponylitis. Axial Arthritis
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What are the focal joints of spondyloparthropathies?
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SI Joints
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What is a syndesmophate?
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Calcification of the annulus fibrosus
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What is a prototypic spondyloarthropathy that is focused on the enthesis as its basic pathobiological target? What is this question asking?
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Ankylosing Spondylitis. What disease mainly deals with problems of the place where the soft tissue and bone meet?
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What axial joints does ankylosing spondylitis affect?
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SI joints, lumbar, thoracic, cervical, and SHOULDER
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What is the HLA antigen associated with ankylosing spondylitis?
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HLA B27
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What disease has the extra-articular manifestations of the eye, lung, blood vessels, spleen, and skin?
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Rheumatoid Arthritis
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What disease has the extra-articular manifestations of the eye, heart, lungs?
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Ankylosing spondylitis
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What disease can cause cauda equina syndrome?
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Ankylosing spondylitis
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• 26 year male with right index finger pain and swelling of his entire finger
• Sexually active • History of recent urethral discharge • Some mid back discomfort especially in the morning that gets better with exercise • Right knee pain and swelling for the last six months with a history of previous meniscal injury in high school with arthroscopic surgery • Thick skin on his feet with peeling of the skin • Poor response to OTC NSAIDs. - Dx? |
Reiter's Syndrome
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What disease causes diffuse digital swelling and wrist soft tissue swelling (STS) and often follows an infection? What other diseases present this way, without the infection?
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Reiter's. ???come back to this one
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You "can't pee, can't see, and can't climb a tree." What disease do you have?
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Reiter's.
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With reference to number of involved joints, what kind of arthritis is Reiter's syndrome?
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Oligoarthritis
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What kind of infections precipitate reactive arthritis (Reiter's)?
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Dysentery or GU
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What age group does Reiter's affect?
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Young Adults.
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What is the differential Dx for reiter's?
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Disseminated Gonococcemia
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With what HLA antigen subtype is Reiter's reactive arthritis associated?
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HLA B27
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• 62 year male with a history of long low back
pain • Acute onset of right foot pain awakening the patient from sleep • Prior history of intermittent twinges of pain in his right foot especially after ingesting certain foods rich in protein • Chronic bilateral knee pain and thumb pain • Low grade temperature on examination • Exquisitely tender right great toe to palpation -Dx? |
Gouty Arthritis. "podagra"
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In terms of number of joints involved, what kind of arthritis is Gouty arthritis?
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Monoarthritis.
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What is the differential Dx of gouty arthritis? What rules out this differential?
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pseudogout, septic arthritis. ??
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What disease commonly involves the 1st MTP, is erythematous, is swollen, painful, and can feel warm?
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Gouty arthritis (podagra)
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• 44 year old female with a history of
bilateral hand and foot pain for the last 6-9 months • 15 year history of intermittent skin rash involving both elbows and knees • Hand and foot examination with diffuse swelling of both hands and feet • Psoriatic skin lesions of both elbows • Digital fingernail pitting of multiple digits • Erosive x-ray changes with remodeling of distal joints “pencil-in-cup deformity” - Dx? |
Arthritis Dermatitis
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What disorder can cause digital pitting oncholysis? What is digital pitting oncholysis?
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Psoriatic Arthritis. A pitting, dystrophic nail change.
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How can you tell if it is prepatellar bursitis?
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Not primarily above the knee, but diffuse
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If you've got someone saying, my joint hurts, what are the four locations the could be talking about?
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True Joint
Soft Tissue disease peri-articular process Referred pain from a viceral source Neuropathic Pain |
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Answer the following for inflammatory arthritis:
Duration Morning Routine Improvement/worsening with activity Other disease |
Lasts greater than 30 minutes
Associated with AM rituals Improves with activity |
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Answer the following for inflammatory arthritis:
Duration Morning Routine Improvement/worsening with activity Other disease |
Short duration <5-10 minutes
Not present with AM rituals Worsens with activity Present with advanced degenerative joint disease |
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What is a disease typified by cartilaginous damage with fraying cracking and fissuring of cartilage with secondary changes in the subchondral bone and the absence of systemic symptoms?
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Osteoarthritis
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What is the most common articular disorder?
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Osteoarthritis
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What gender has the earliest onset of OA?
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Males
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When does osteoarthritis (OA) begin in people?
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2nd or 3rd decade
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What is a Heberen's Node?
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The OA of the DIP joint
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What is a Bouchard's node?
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The OA of the PIP joint
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What joints are NOT involved in OA?
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Ankle and Shoulder
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What does the health and maintenance of cartilage require?
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Repetitive compression and release of weight on the joint. It is avascular, aneural, and alymphatic
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What is the general mechanism for OA?
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The cartilage erodes over time causing eburnation (degredation of bone into hard, irregular mass). This also causes cystic changes and osteophyte formation. Eventually, the tendons and ligaments become lax, causing joint instability, and it becomes tender on palpation and passive motion.
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How might the arthroscopic inspection of an arthritic joint appear?
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Fraying, fibrillatory
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How does the cartilage look microscopically?
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Fractured and fissured
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How might someone with OA present?
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Bony thickening
Decreased ROM Crepitus |
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Is Osteoarthritis (OA) symmetrical or asymmetrical?
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Asymmetric Joint involvement
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You see "eagle beak" formations on the X-ray of a vertebrae. You proudly tell your attending that this is indicative of...because these are clearly called....
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OA...osteophytes
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Why is there a low frequency of radiculopathy in OA despite the fact that there is a thickening of the anterior longitudinal ligament and ligamentum flava?
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Because the cord is well protected by the intervertebral foramina.
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Characterize the local pain of OA?
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Generally a deep, aching pain resulting from soft tissue and vertebral body irritation
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Characterize radicular pain in OA.
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Generally a sharp, stabbing pain resulting from compression of the dorsal nerve roots which projects in a dermatomal distribution
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What does DISH stand for?
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Diffuse Idiopathic Skeletal Hyperostosis
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What sex is DISH predominant in?
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Males
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What disorder is characterized by the following X-Ray findings:
- Large ligamentous ossifications bridging several vertebrae - Affecting the cervical and lower thoracic spine - Floating Osteophytes |
DISH
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In DISH, how are the disk heights affected?
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Preserved...absence of excessive disk disease
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