AHN 554 Exam 5 Guide With
Complete Solution
Sx of RA - ANSWER - AM stiffness > 30min
- symmetric polyarthritis with small joints (hands/feet)
- middle age
- rheumatoid nodules (bony prominences)
RA initial lab results - ANSWER elevated CRP and ESR
Anemia
Elevated platelets
RA DX lab result - ANSWER Elevated anti-CCP present 70-805 of patients
Characteristic findings on xray for RA - ANSWER uxta-articular osteoporosis,
joint erosions, space narrowing
Best approach to mgmt of RA - ANSWER - early, aggressive tx
- DMARDs
- Methotrexate
- Refer to rheumatologist
- NSAIDs and low dose steroid
Sx of OA - ANSWER - pain relieved with rest, brief AM stiffness
,- pain gets worse throughout day, asymmetrical
- WB joints, fingers, hands, wrists
OA findings on xray - ANSWER narrowing of the joint space and
osteophyte/bone spurs
Name the OA nodules and their locations - ANSWER - Herbandens nodules
(distal DIP)
- Buchards nodules (proximal PIP)
Treatment of OA - ANSWER - NSAIDs
- exercise
- weight loss
alternate ice/heat
- Cox2-inhibitors, Duloxetine, joint injections, topical, tylenol
sx of GOUT - ANSWER - Swollen, tender, skin tense, warm/dusky red
- fever is common, intense pain
- sudden onset, frequently nocturnal
Diagnostic test of gout - ANSWER - serum uric acid can be normal
- WBC may be elevated
-***DX: sodium urate crystals in joint fluid
- xray: chronic punched-out erosions
Acute and chronic tx of gout - ANSWER acute: NSAIDs, colchicine (don't use
in liver/kidney impairment), corticosteroids, Interleukin-1 inhibitors
, chronic: allopurinol ir febuxostat
- between attacks: colchicine, diuretics, ASA, niacin, avoid organ meats,
ETOH, high fructose corn syrup
sx of septic arthritis - ANSWER *** acute onset of monoarticular joint pain,
erythema, heat and immobility
-limited ROM
- joint effusion
- fever
- knee and hip = most common sites
- most common organisms: staph, strep and GNB
Diagnostic test for septic arthritis - ANSWER Joint aspiration ***
workup: joint aspiration, gram stain, culture of fluid, immediate
arthrocentesis before abx and other studies
risk factors for septic arthritis - ANSWER - RA
- prosethetic joints
- advanced age
- immunocompromised (HIV, CA, DM)
- sexual activity (STDs)
- skin infections
- cutaneous ulcers
- recent joint surgery
Complete Solution
Sx of RA - ANSWER - AM stiffness > 30min
- symmetric polyarthritis with small joints (hands/feet)
- middle age
- rheumatoid nodules (bony prominences)
RA initial lab results - ANSWER elevated CRP and ESR
Anemia
Elevated platelets
RA DX lab result - ANSWER Elevated anti-CCP present 70-805 of patients
Characteristic findings on xray for RA - ANSWER uxta-articular osteoporosis,
joint erosions, space narrowing
Best approach to mgmt of RA - ANSWER - early, aggressive tx
- DMARDs
- Methotrexate
- Refer to rheumatologist
- NSAIDs and low dose steroid
Sx of OA - ANSWER - pain relieved with rest, brief AM stiffness
,- pain gets worse throughout day, asymmetrical
- WB joints, fingers, hands, wrists
OA findings on xray - ANSWER narrowing of the joint space and
osteophyte/bone spurs
Name the OA nodules and their locations - ANSWER - Herbandens nodules
(distal DIP)
- Buchards nodules (proximal PIP)
Treatment of OA - ANSWER - NSAIDs
- exercise
- weight loss
alternate ice/heat
- Cox2-inhibitors, Duloxetine, joint injections, topical, tylenol
sx of GOUT - ANSWER - Swollen, tender, skin tense, warm/dusky red
- fever is common, intense pain
- sudden onset, frequently nocturnal
Diagnostic test of gout - ANSWER - serum uric acid can be normal
- WBC may be elevated
-***DX: sodium urate crystals in joint fluid
- xray: chronic punched-out erosions
Acute and chronic tx of gout - ANSWER acute: NSAIDs, colchicine (don't use
in liver/kidney impairment), corticosteroids, Interleukin-1 inhibitors
, chronic: allopurinol ir febuxostat
- between attacks: colchicine, diuretics, ASA, niacin, avoid organ meats,
ETOH, high fructose corn syrup
sx of septic arthritis - ANSWER *** acute onset of monoarticular joint pain,
erythema, heat and immobility
-limited ROM
- joint effusion
- fever
- knee and hip = most common sites
- most common organisms: staph, strep and GNB
Diagnostic test for septic arthritis - ANSWER Joint aspiration ***
workup: joint aspiration, gram stain, culture of fluid, immediate
arthrocentesis before abx and other studies
risk factors for septic arthritis - ANSWER - RA
- prosethetic joints
- advanced age
- immunocompromised (HIV, CA, DM)
- sexual activity (STDs)
- skin infections
- cutaneous ulcers
- recent joint surgery
