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117 Cards in this Set
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Wystemicd slceroderm amy be dividd into two major subsets: diffuse cuatnousw systemic sclerosis and limited cuanteous systemci sclerosis. The grou pwot hlmitied cutaneou systemic sclerosis is also knwos as?
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Teh CREST varisant
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What do the letters CREST, stand for in this variant?
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Calcinosis, Raynaud's esphagitis, sclerdactyly, and tleangiectsioa
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Is nailfold capilalary microsopy as usefu tool itn he diagnos sif systemic slcerosi
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Yews the observaito fo capillary dilation, capillary destruction, and capillary hemorhag ear ehtpositive findings.
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Can psoriatic arthritis preced the develpment of psoriatic skin lesion?
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yes this ahppens in appraoxiamtely 15-20% of cases of psoriatic arthits
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Do all patitn with posriasis develop psorationtic arthritis
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no only about 6-20% of patietn with posorias will dvevelop pasoraitc arthrits. It usually follows months to years of skin involvement but occaswionally develops simultatenously.
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What are the patterns of invovement of psoriasis int he nails?
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pitting, transverse or longitudinal ridign, "oil droplet" discoloration, subungual hyperketatrosis, and oncyolysis
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Which are the sero-negative arthtides
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reiter's diseas, psoraitic arthits, anklylosng spondylits, and the arhtitos of the inflammatory bowel diseas (chron's diseas and ulcerative colits)
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The plaques of psorisasis conataqio lare coutrnsof whic bacteria
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streptocooccus par ticualar group A
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What are the criteria fo rhte classification of rheumatoid arthritis according to the america rhemmatology associationt
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1. monting stiffness for at leastg 6weeks
arthris of 3 or m ore joit area (6 weeks) arthitris of hand joints (6 wk symmetri arthris 6 wk rhuematoid nodules serum reumatoid factor radiographic chnages need 4 out of 7 criteria |
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In reference ot rheumatology what is a DMARD
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disease modfiying antiruematic drug
also know as slow acting antirheumatic drusgs. These durgs are thoght to favoable mdifyt hte profession foreumatoidarhtits as measued by radiographic evidence such as jonteroison or joitn destruction |
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What ar ehte factors pedisposingot acute bacterialinfeciton in a jont?
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underlying jojnt diease such as rhumatoid arhtitris, osteoarhtites, diabetes melliusimmunosuppressive threapya, advance age, alcohism, and prosthes or other foreing body in the joint
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What is the most frewqent cause of septic artritis in immunocopmoeteind individuals ounger htan 40 years of age
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disseminaged gonoccoccal infection
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What is the classsic traid seen in disseminated gonococcal infeciton
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migratory tenosynovitis, vesiculopustular skin lesions, nad oligoarthraqlgis. THis triad only occurs in about 50% of patients however
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What is the most urgnet reason for perfoming synovial fluid analysis
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to rule ot infectious arthtiis
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What are the characteristics of normal synovial fluid?
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normal synovial jont fluid is clear (transparent) the color ranges form colorless ot straaw colored, it is highly viscuous, with less htan 200 WBC/mm3 of whic less than 25% are PMN' it contaitns to bactier no crystls and the glucose level is nearly equal tot htat of blood
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What are the charteris tis ofnflammoatory jont fluid
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inflammatory jont fluid is usually translucent or opque, th e color ranges form a yellowish to yellowish -gree. It has diecreaed viscoisty, with greter than 2000 WBC/mm3 of which greter than 50% are PMN's it may contain bacteior or crystals dedning on the etiology of hte inflammation
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What i s the proliferaitn synoviu seen in rhjematoid arthitis
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pannus
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What is the course of jont destruction seen in rheumatoid arthiritis
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erosion of juxta artricular bone around hte margins of hte pannus and invasion fo subchondral tissue by the pannus
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What is the serious complication seen i the cervical spine in rheumatoid patients?
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progressive erosio of the cervical vertebrae leading ot atlantoaxial subluxation which can give rise to spinal compression
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Behind the knee, enlargmen t o fthe semeimenbran ous bursa into the popliteal apces is refered to as
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baker';s cyst the se someitme srupture and micm sympotoms of acutoe htomophlebits
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What is themost common clinical lesion of rehmatoid arthits iseen i nthe heel?
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retrocalacaneal bursitis
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Higher titers of rematoid factore are most commonly seen in the presnce of
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reumatoid nodules
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What is the significance of very high titters of rheumatoid factor?
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high titers are gernally associated with a more gernalized systemic diease process and amore erosive dstructive arthritic process
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What i thte histology of rehumatoid nodule
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fibrionoid necrisis with i a palisade of radially elongate dconnective tissue cells that forma corone around the necorsis. Thsi si encloes by an outer layer of graulaiotn tissue consisting of chrnoic inflammatory cells, mostly lymphocytes and palsma cells
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What are the noarticular manfiestations of rheumatoid arthrits
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Subtaneous ndoules vasuclit, easy brusiing, percarditis
rarely precadial tampnoand, myaocardidts, coranatry atrerits, vavluar insdffujciens........syjogens....neruoapth ....felty's dyndrom'....anemia |
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What are the creiterai for the classfication fo systemic lupus erythematossus accodign to the american rheumatollogy association?
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Mala rash
discoid rash photosentiivy oral ulcers --or nasopharyngeal arthritis sersitis renal disorder neurologic disorder hematologic disorder immunologic disorder antnuclear antibody need 4 out of 11 |
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What ar elupus anticoagluants
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paradoxiacally named blood coagulation inhibitors which are associated with thrbmbosis not with hemorrhatge . They are found in lupus as wellas other condition. Andticardiolipin andtibiodes and lupus anbtocagular ae r both antiphsopholipid antibodies. The thrombotic manfestaions, in additon to DVT and pulmonary emboli, mya involve retinal vasuclature, renal viens, coranary ore mesenteric vessels and large peripheral arteris
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which drug is the most frequent cause of a drugn induced lupus syndrome
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procainamide. other durgse whcih have been reported to cause lupus like syndroms include hydralzaine, hantooid, anticonculsants, isonaizid, alpha mehtydopa, prpylthioucraceil, methmiatzole, quinidine and the sulfonameides as well as penicillin
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what is th standard screening test for SLE?
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the fluorescent antinuclear antibody test
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localized slceroderma, whic bengis with one or more areas of erthematoud or volacous discolraiton fo skin which evolve ot beocm escerlotic and waxy is refered to as:
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morphea
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What are the common manfestation fo cuanteos involvemnt i ssystemic vasculitis?
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cutaneous clonical ma nifestations incllude palpable prupura, ulcraion, leivedo reticularis, and digital tip infarcts
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What is Chug-Strauss syndrome
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Allergicv granulomatosis and angiitis. It can be diagnosed on the basis of a history of asthma or allergic rhinitis, perpehral eosinophilia an dhte devlelopment of as systemic vasculitis
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What is a henoch-schonlein purpura?
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A disorder characterized by nonthrompcytopenic purpura, abdominal comnmplaints, arhtralgias, and renal involvment. It is also knon a sanaphjylactoid or allergic purpura and usually occrus in children or yon adults. Usually the first manifestation is palapble purpura of the lower extremites
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What is the characteristic pathology of goodpasture's syndrome/
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glomerulopnephritis and pulmonary hemorrhge
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What are cryoglobulins?
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immunoglubulin molecules htat have hte unusual prpoerty of revresbily precipitqating at low tempatures
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What are the clinical mafestations of cryoglublinemia?
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Monoclonal or mixed cryoglobulins cause vascular occlusive problems such as Raynaud's phenomena, cutaneous uldrs,and gangrene of fingers and toes, and cold-induced urticaria or arthralgias, purpua, nephritis and neuropathy.
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What is the sicca complex?
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diminished salivary gland and lacrimal gland secretions
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What is the treiad originally described as Sjorgen's syndrome?
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dry eyes, dry moth, and rhematoid arthtis
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Can ohter diease repalce RA as apart of Sjogren's sydnroms?
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yes other connective tisuse disease sucha sSLe, systemic sclerosis or polymosisits may be present in polace of RA
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What is the laboratory test used to measure lacrimal gland secretion
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the Schirmer filter paper test
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An arthitis caused by the spirochete Borrelia burgdorferi is trnasmitted by the Ixodes dammini tick. What is thename of htis disease?
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lyme disease
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What disease often begins with the skin rahs , erythema chronicum migrans?
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lyme disease
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The rheumatic diseas characterized by progressive los sof articular cartlage nad by reactive changes at the margins of hte jojnts and in subchondral bone Is?
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osteooarthritis
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Descrbe cthe comon clinical manfiestaion of osteoarthitis
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slowly dieveloping ojint pain whic is at first presnt with activity and releived with rest but later itn eh disease my be present with minmal motion or even at rest. joint stiffnes is relativle y short lived (less thatn 60 minutes) and localized. joint enlargement with limitation of moiton. pain on passive motion and crpius are comon. Associate seconcaary synovitis is comon
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Osteoarthritis of hte distal interpahalngeal jontsi of hte hands is referred to as
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heberden's nodes
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What is the variant of ostoearthtis whic involes primarily the distal or proximal interphalngeal jonts of hte hadns and whose paiful inflammatory episoed are associated with eventual joint deformity nand ankyloissi
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erosive nflammatory ostoearthritsis
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What is hte signficant radiographic finding of resovie nflammatory ostoearthritis which is gerally not seen in promary osteoarthitis?
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bony erosions
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What are the typical dignostic laboratory findings een in promary ostoearthirts?
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there are non. laboaratory findings are helpful in excluding other dignoses only.
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What is the eitology of neuropathic ostoearthropatyh or charot jont.
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this is co....
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What are the most comon clinical presentation of a charcot foot?
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the typical patient is a diabetic (or has some other cause of neuropathy_ with sensor neuropathy , and autonomic vasomootor neuropahty. thus the patient will not appreciate the 5.07 Semmes-Weinstient monfilament. The pusles are ususally bounding, with diestned dorsal vens and the foot is war and very swollen. Fndings depend onthe Stage of the neuroarthropathy.
Stage I (pecollapse): peraticular swelling jont effusion, normal foot alaignment normal rediographs except soft tissue swelling. Stage II (collapse): increased swellling, increased local temperature, hypermobility, malalignemnt, fracutrres, faragmentation, and o/or dislcation is seen on radiographs. Stage III (healing): swelling and termpartatue decreases but htis presents les shypermobility, hypertrophic bone formation and resoriton of fine debries. Aligment unchange. Stage IV (arrest): no swelling, normal local termpaerature, decrease jont motion, aligment unchange. RAdiographs demonstarte consolidatio fo fragments and fracturess. |
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What is the most important differntial diagnosis of an acute Charcot joint?
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must rule out sepsis
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How oftne is sepitc arthritis monoarticualr ?
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septic arthitis is monarticualr 90% of hte time and usually involves hte large jnoints of hte lower extremity. When it is polyarticular, it is ususlally in elderly patients wiht RA or who are reeving systemic corticosteroids
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What is the most common bacteria causeing nongonococcal septic arthitis?
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staph aureus accoutnso for 40-70% purulent arthitis
also staph epedermsi soemtimes stetptocoocus. |
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What is the most common form of granulmatous arthitis
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joint sepsoi with mycobactrium tuberculosis is th most common form of granulomatous arthitis
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Whic is more common, primary gout or secndary gout?
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promary gout accounts fo r90% of case
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What is the name of an inthetid case of "overporduction gout' charactreized by hyper uricemia, metna rtardation , eolf mutilation, choreathetois, and uric ascid nephtolithiases
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lesch nyhan syndrome
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Lesch nyhna syndroms is the reuslt of a toatla deficiens of what enzyem?
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hypoxanthine guantine phoshoroisly trnasferase
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what are the stage so fgout?
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asympotmatic hyyepruricemia
acute gout arthitis itnercritical gout choneic toahcoeosu gout |
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list the classfication creria fo racute gout arthitis
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A. the presecne of charateristic urat ecryistanso in the jont fluid or
B a tophus proved ot contain urated cryhstals by chemical menas aor polarized light mocroscopy, or the presenceo f six orf hte following twelve lcincial, laboratory, nd x-ray phenomenba listed below: more than one attack of acute arthritis maximal inflammation devleoped iwhnt one day attack fo mnonarticualr arethitis jont redness observed 1st mpj pianful or swollen unilatra attack involving 1st MPJ unilateral attack involving tarsal jont suspected tophus huyperuciema asymmetric swelling wiht a jont (roentgenogram) subocrtical cyusts wihtout erisoin (roientgenogram) engative culture of jiont fluid for micriorgansims during attck of jion inflammaitn |
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What is themost common cause of acute monarticualr or loigioarticular arthitis int he leederly
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cute pseudogout
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What jonts ar most commonly involve din pseudogout/
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KNE (58%), WRIST (33%), ANKLE JIONT\
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What is the most common joint involoved inthe foot?
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talonavicular joint? Psudogout involves the foot in only 5% of cases
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what is the differences in clinical presentation between gout and pseudogout?
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patients iwth psoeudogout tned ot be older, and complain less of apain. males and femalsea re involved equally. Pseudogout does nto respond as dramatically to colchicine as does gout
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does the findgs of CPPD crystls in synovial fluid exclude the diagnosis of ougt, RA, or infiection?
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no! pseudogout cna coexist with these other dieseae
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Chronic arhtropathy of CPPD may ovleapt iwth ostoarthritis. Examination mya reveal limited ROM, crepitus, mild mpian,, and synovits. How can chrnic pyrohposphate arhtoapth be distnguehed form osteoarthtis
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by having more severe destruciotn of the jonts and adjcent bone.
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Tottrons' papule s and gottron's sign ar epahtongomonic for what idiopathic inflammatory nyopathy?
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dermatomyositis
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What are gottron's papules?
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These are violaceous, flat-topped paules overlying the dorsal surface of the interpahalngeal jonts of hte nands. The can develop cetnar atrohy, with tlenagectasia and hyppigmentation. The occur in on thrid of patients with poymosistis. The cutaneous manfestationf of deramtomyisitis may preced follow, or devolp conocomitantly wsiht msucle involvment.
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What is Gottron's sign
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erytmatous smoot or scaly patches with or witout associatied edema over th edorsa lnterphalngea or metarcapphlangela jonts, elbows, knees or media malleoi. Gottron's sign is seen more comonly htan Gottron's papule.
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Describe the facial rash sometimes seen in deramtomyositis.
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This is a heliotrope rash, whic his dusky purple and occurs over the oftne edematous uper eyeleids, especially along hte edges. Ths is sometime photosensitive. A simlar raswh may develop on the V0are of the neck, shoulders and upper back.
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What is ht eclincial hallmark of polymositis and deratomyisits?
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proximal muscle limb and neck weanness sometimes associated iwth msucle pain.
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What are hte laboarator hallmarks of polymosisits and dermatomyositis?
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Proximal muscle limb and neck weakness sometimes associated iwht msucle pain.
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What are the laboratory hallmarks of polymositis and deratmyisits?
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Elevated Creatine phsophknase (CPK) aldolas, lactic dehdrogenas, ansd thrasaminases. A more less characteristic EMG pattern is also seen.
Myolbulinema and myglunurea are commonly present Autaontibodes are preent in most paietns These include anti-jo-1 , anti-RNP, anti-PM-Scl, anti-Ro, anit-La, and anitMi. msulce bipsy isusually indicated ot establish the diganosis. |
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Dewscribe the clnical sndrome of polymalgia Rhematica.
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This is a relatively comon syndorme whic is characterized by sever achng snd stiffnes in the neck., shoulder girlde or pelvic gird muscle areas that lasts for a mont or lenger i intreate. The stiffness is wrose in the morning and after periods of rest. The syndrom is genrally seen in patients over 50 years of age and women predominate 2:1. Systemci csymptos are presng in many patients and inmclude malise, wigh tlsos, and low grad fever.
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What laboratory finding is considered an improtant dignostic feature of oplymalgis rheuatica?
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an elevated ertyhocyte sedmintation rate to at least 20 or 50 mm in 1 hout.
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What are some synonyms for gigtn cell arterits?
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tmeporal arteritis, crania arteritis, and ganulomatous arterits.
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What is the most dreaded complicaton of temrporatl arterits?
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blindness due to the narrowing of ht eopthalmic or postieri ciliar aateries. Prmantent vision loss is seen i n8015 % of patients.
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Can temporal arterits affect the arteries of the lower exxtermites?
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ye slthough the vesssels most commonly affected are branche so gfhte arteris origniatng form th earch of hte aorta.
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What diseaswe oftne presens with tendreneess or enlargment of involved portions of hte artieris of hte head and neck?
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tmeporal arterits
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What is the terament for poymalgia rehmatica?
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systemic steroids
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What is the trament of rtemrpora arterits?
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systemic steroids
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Unexplaind proeinur9is, peripheral neuropathy, nelargment of hte tongue, cardiomegaly, inestinal malbasorpiton, blialeral carpal tunnel syndrome or hte orthostatic hypotnesion should laer th clinican to thpossible diagnos o f ?
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primary amyloidosis
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In ankylosing spondylitis, what is the differnnce in involved joint distribution betwen men and women?
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In men, AS is an arthitis of hte sacriiac joints, to a varyuing degree the rest of hte spin andt o lesser extent perpheral joints. Women ar less likely ot hav eprogressiv espinal diseaswe. The tend ot have more peripoheral jont manifewstations. This leads ot the misdagnois of seronegative rehumatoid arthits.
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What is the pthaognomonic test for ank]yuloisng spondylits
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the is none. HLA-B27 is positive in 90-95% of patients. SEd. RAte may be levated. RAdiographic evinde of saciliitis is seen . AS is genarlly diagnosed on clincial gorunds
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Whic peripheral jonts are most comomonly invovoed in ankylosing sponlylits
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shoulders and hips. Peripherla jont invovlment is een in 20-30% of paitents
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Whre i enthesisits seen in the foot in ankyolosing spondylits?
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achilles tendon insertion and the clacaneal plantar fascial insertion.
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Do patients with ankylosing spondylitis dvelop eye problems (uveitis)
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upt ot 25% of patients will dvelop uvieit sdurng their illness. It is more mcommonly seen in patient who are HLA-B27 posoitive a, nad have peripheral joint disease
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Why is REiter's syndorme considered a reactive disease?
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Because it usually follos an infetiious episode, ehtir GI or GU (nongonococcal)
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In terms of REiter's syndrom, what i meant by the "complete syndrome"
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The orignal description of REtier's dyndorme consisited of a triad of arthtiis, urethritis, nd conjunctivitis. Pateint wit these thre componets are said to have ht complete syndrome.
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What are the cutaneousl manifestations of Reiter's Syndrome?
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circinate balanitis, and keratoderma blennorrhagicum, superficial oral ulcers may also be seen i nth e mout.
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What other skin disease is indisctinguishable form ketatoderma blennorrhagicum, macoscopically and micrscopiclaly?
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pustular psoriaisi
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What is the most common location for keratoderma blennorrhagicum?
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The sole of the feet, but it can also be seen on the palms, the scrotum and elsewhere
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What percentage of patients with REiter's syndrome will be HLA-B27 positive?
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80-90%
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Will treatmetn with antibiotics alter the couse of paients with REiter's syndrome?
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No there is no evidence fo this?
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Describe the musculoskeletgal findings in REtier's syndrome?
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Acute onset of an symmetric olyarthritis or oligoarthtis involving the knees or ankles . Other joint involvemtn is less common. dactylitis or sausage digits (fingres or toes) are sene. Tenderness and swelling athe tendo achilles insertion and tenrderness of hte calcanea insertion of the planttr fascia. Lower ack pian nd/or sacroiliitis
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What desease is asscoaited with the term "Lover's heel"
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REtier's syndrome
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What percentage of the geral white population will be HLA-B27 positive?
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about 6%
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What percentage of patient with inflammatory bowel diseae will devleo peripheral arthitis?
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about 15-20%
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Whic perpipheral joints are most oftne affected b inflammoagory bowel disease?
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knees and anklse.
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What percentage of paitents with inflammatory bowel disease will develop sacoriliitis
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about 20%
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What percnetageof patients with inflammatory bowel disease and sacroilitis will divelp spondylitis
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aobut 20%; this is aobut 4-5% of all paieents with inflammatory bowel diease
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What percentage of patients with inflammaotyro blwel disase , saxcroilitis, and spenyilitis with be HLA-B27%
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about half of them?
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Does the enteropathic spondylitis follow hte course of the bowel disease?
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no.
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Carditis, acut polyarthritis, chorea, erythema marginatum and subcuaneous nodules are charateristic of what illness?
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acute rheumatic fever.
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What is the most common eitiolgoy of acute rheumjatic fever?
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a preceding beta-hemolyitc streptococcal pharyngitis
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A multisystem disoder of unknown eitolgy chracgterized histologically by the presenceo fnoncaseating epitheliodi cell granulomas in affected tissues is knon as?
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sarcoidosis?
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What tissues are affected most commonly early inte course fo sarcoidsosi
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lung,s kin, eyes
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What is the most common rheumatic manfiestaion of sarcoidsosi?
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acute arthits (15%)
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A form of sarcoidosis, in which the tirad of bilataral hilar adenopathy, erythema, nodosum and arthitis is present, is known as?
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Lofgren's syndrome
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Which jonts are commnly affect by sarcoidosis?
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Ankles, knees, PIPJ's wrists, and elbows
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Patients with fiborsitis complain of three major symptoms. What are they?
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musculoskeletal pian, stiffness and easy fatagability. Sleep distubnaces are aslo acommon feature.
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The hallmark of the examination of a fibrsitis patient is the lack of objecive fining sin realtin oth the plethora of sympotms. What is the ony abnoral finding/
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The prencesw of numeruosu discreet tneder pints, which should not be confues with trigger pitns.
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What iis th diffence between the tender pitns seen in fibrositis and the treigger pitns i seen in myofascial pain syndromes?
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Palpaltion of trigger pint cause pain to be referred to a nearby regional site , whreas palpation of a tender point cause onyl local pain.
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Clubbing of the digits in association iwht periostiits of the long obnes shoud make one suspicious of what?
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Hypertrophic (pulmonary) ostoeparhtopathy (HOA). This is oftne associated with sever internal illness,k often bronchiogenic carcinoma
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The following radiographic criteria establish the diagnosis of what disease?
Flowing calcification and ossification along the anterolateral aspect of at lest four contiguous vertebral bodies. Relative preservation fo intervertebral dic heigh absence of intrarticular bony ankylosis of the sacroiliac and apohyseal joints |
Diffuse Idiopathic skeltal hyperostosis (DISH)
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What is the Schober test
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This tests the restrictio n of lumbar moiton in patietn with spondylits. Two midlne points separated by 10 cm are palced on the skin fo the paeint's lower aback while standing. The firs tmark is at the lvel of hte posterio superior ieliac spins. The seocnd 10 cm above. Teh patient is then asked to bed forward ina n ttampt to touch the toes. Knees are kept straight. this shoudl reverse the normal lumbar lordosis. S the skin o ve the lumbar ara streteches. Teh two marks should now separate by at leas 5 cm. to a total distance of 16-22 cm
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A bengin disease of unkown etiology charaterized by cicumscribed or diffuse thickentg of hte synovial ingin of joints, tendon sheaths, or bursae dn the productio of locally ivasive , tumorlike growths is called?
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pgmented villonodular synovitis
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What is the name of pigmented villonodulaar synovits when it si manfiested as an isolate discrete lesion iviolving tendon sheath?
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giant cell tumor of tendon sheath (or lolcalized nodular tenosynovitis).
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