NRNP 6560 Midterm exam
QUESTIONS AND VERIFIED
CORRECT ANSWERS
GRADED A+ LATEST 100%
GUARANTEED PASS
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than 75)
- Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)
,Rheumatoid arthritis: what, who - CORRECT ANSWER-chronic, systemic autoimmune disease
that causes inflammation of connective tissue, first that of jionts them other soft tissues (renal,
cardiovascular, pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
- Epstein Barr virus
Rheumatoid arthritis: Findings and diagnostics - CORRECT ANSWER-- symmetric joint/ muscle
pain, worse in the morning then gets better
- weakness, fatigue
- anorexia, weight loss
- generalized malaise
- swollen joints/ boggy feeling of joints with deformity of joints
- warm, red skin on affected joints
later:
- pleural effusions and pulmonary nodules
- inflammation of sclerea (scleritis)
- pericarditis, myocarditis
- splenomegaly (Felty's syndrome)
- anemia (hypochromic, microcytic) with low ferritin
- possibly: positive rheumatoid factor
- XR: joint swelling, later cortical and space thinning
- synovial fluid: yellow, thick with elevated WBC up to 100.000
,Felty's syndrome - CORRECT ANSWER-rheumatoid arthritis, splenomegaly, neutropenia
Rheumatoid arthritis treatment - CORRECT ANSWER-- early treatment better than stepwise
- early referral rheumatologist
- disease-modifying anti-rheumatic drugs (DMARDs):
- methotrexate ( no alcohol, monitor renal and liver, give with folic acid)
- cyclosporine
- Gold preparations (can cause thrombocytopenia)
- Hydroxychloroquine: antimalarial drug (may cause visual changes, monitor)
- sulfasalazine, moderate RA
- Leflunomide, moderate to severe RA
- Etanercept
- monitor liver function with DMARDs
- screen for TB (skin test) and Hep B
- surgery: joint debridement, joint replacement
Gout: what, who - CORRECT ANSWER-Inflammatory disorder in response to high uric acid
production/ levels in blood and synovial fluid causing crystallization which causes inflammation
(Type A and Mediterranean)
- impaired renal function which causes excess uric acid
- foods high in purine, such as dairy, red meat, shellfish, beer
Gout findings, diagnostics - CORRECT ANSWER-- acute painful joint, often great toe (warm,
swollen)
- pain at night
- flank pain because of renal calculi
, - fever
- leukocytosis
- elevated erythrocyte sedimentation rate
- tophi (bump under skin) on ear
- limited joint motion
- elevated serum uric acid (greater than 7mg/dl)
- urate crystals seen with joint aspiration
- xr: joint erosion and renal stones
Gout treatment - CORRECT ANSWER-- NSAIDS: naproxen, ondomethacin, sulindac
- Colchicine for those who do not tolerate NSAIDS (caution with renal impairment). Also for
prophylaxis
- Corticosteroids, if NSAIDS and colchicine not tolerated
- 24hr urine for uric acid
- Allopurinol after flare is over (100mg PO daily)
- Biological modifiers of disease (BMD): Pegloticase. Not for asymptomatic. Treat with
prophylaxis first. Monitor serum uric acid
ANA. Tests in rheumatic disease: what, normal level, abnormal with. - CORRECT ANSWER-
Antinuclear antibody (ANA).
Normal: Titer 1.32
POsitive with: Sjogren's (SS), SLE (lupus),
C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with. - CORRECT
ANSWER-Determines hemolytic activity which speaks to level of inflammatory response
Normal: men: 12-72. Women: 13-75 mg/dl
QUESTIONS AND VERIFIED
CORRECT ANSWERS
GRADED A+ LATEST 100%
GUARANTEED PASS
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than 75)
- Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)
,Rheumatoid arthritis: what, who - CORRECT ANSWER-chronic, systemic autoimmune disease
that causes inflammation of connective tissue, first that of jionts them other soft tissues (renal,
cardiovascular, pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
- Epstein Barr virus
Rheumatoid arthritis: Findings and diagnostics - CORRECT ANSWER-- symmetric joint/ muscle
pain, worse in the morning then gets better
- weakness, fatigue
- anorexia, weight loss
- generalized malaise
- swollen joints/ boggy feeling of joints with deformity of joints
- warm, red skin on affected joints
later:
- pleural effusions and pulmonary nodules
- inflammation of sclerea (scleritis)
- pericarditis, myocarditis
- splenomegaly (Felty's syndrome)
- anemia (hypochromic, microcytic) with low ferritin
- possibly: positive rheumatoid factor
- XR: joint swelling, later cortical and space thinning
- synovial fluid: yellow, thick with elevated WBC up to 100.000
,Felty's syndrome - CORRECT ANSWER-rheumatoid arthritis, splenomegaly, neutropenia
Rheumatoid arthritis treatment - CORRECT ANSWER-- early treatment better than stepwise
- early referral rheumatologist
- disease-modifying anti-rheumatic drugs (DMARDs):
- methotrexate ( no alcohol, monitor renal and liver, give with folic acid)
- cyclosporine
- Gold preparations (can cause thrombocytopenia)
- Hydroxychloroquine: antimalarial drug (may cause visual changes, monitor)
- sulfasalazine, moderate RA
- Leflunomide, moderate to severe RA
- Etanercept
- monitor liver function with DMARDs
- screen for TB (skin test) and Hep B
- surgery: joint debridement, joint replacement
Gout: what, who - CORRECT ANSWER-Inflammatory disorder in response to high uric acid
production/ levels in blood and synovial fluid causing crystallization which causes inflammation
(Type A and Mediterranean)
- impaired renal function which causes excess uric acid
- foods high in purine, such as dairy, red meat, shellfish, beer
Gout findings, diagnostics - CORRECT ANSWER-- acute painful joint, often great toe (warm,
swollen)
- pain at night
- flank pain because of renal calculi
, - fever
- leukocytosis
- elevated erythrocyte sedimentation rate
- tophi (bump under skin) on ear
- limited joint motion
- elevated serum uric acid (greater than 7mg/dl)
- urate crystals seen with joint aspiration
- xr: joint erosion and renal stones
Gout treatment - CORRECT ANSWER-- NSAIDS: naproxen, ondomethacin, sulindac
- Colchicine for those who do not tolerate NSAIDS (caution with renal impairment). Also for
prophylaxis
- Corticosteroids, if NSAIDS and colchicine not tolerated
- 24hr urine for uric acid
- Allopurinol after flare is over (100mg PO daily)
- Biological modifiers of disease (BMD): Pegloticase. Not for asymptomatic. Treat with
prophylaxis first. Monitor serum uric acid
ANA. Tests in rheumatic disease: what, normal level, abnormal with. - CORRECT ANSWER-
Antinuclear antibody (ANA).
Normal: Titer 1.32
POsitive with: Sjogren's (SS), SLE (lupus),
C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with. - CORRECT
ANSWER-Determines hemolytic activity which speaks to level of inflammatory response
Normal: men: 12-72. Women: 13-75 mg/dl
