FNP 2 Musculoskeletal-Exam Questions with
Complete Solutions| Verified Answers
What is OA?
progressive destruction of the articular cartilage and subchondral bone; osteophyte
formation, and sclerosis.
Destruction of cartilage and narrowing of joint space
What are some S/sx of OA?
Asymmetric larger joint pain (fingers, knees, hips, spine)
Morning stiffness < 1hr that resumes towards the end of the day and after activity.
Joints are cool with crepitus and limited ROM
Usually later in life
Whats the difference between Herberdon's and Bouchard's nodes in OA?
Herberdons are located on the distal interphalangeal joint
Bouchard's are located on the proximal interphalangeal joint
Whats the best treatment for OA?
Start with nonpharm: heat, exercise, weight loss
PHARM: acetaminophen 1st. then NSAIDs
When do you need to consider COX-2 inhibitors for OA?
For GI protection (risk for GI bleeds decreased but its still there)
What do you need to monitor for its on NSAIDs?
CBC, BUN/Cr, liver function. occult blood test=They need to be off NSAID 2-3 days prior
to testing
What is RA?
An autoimmune disorder that attacks the synovial tissues in the joints.
What are some symptoms of RA?
non-axial, small to large joint swelling( except C1-C2 the is OA), tenderness, pain, hot
and red joints, decreased ROM, deformity later on, Usually symmetrical involvement of
the joints, small joints 1st before big joints, Can have rapid onset. Fatigue, fever, night
,sweats, malaise, depression.
"wax & wane" symptoms
What are the criteria needed for a DX of RA? (7 total)
Need 5 of the 7. the 1st 4 must be present @ least 6 weeks
1. Morning stiffness >1hr
2. soft tissue swelling of 3 or more joints (PIP, MCP, wrist, elbow, knee, ankle, MTP)
3. swelling of at least 1 joint in the hand/wrist
4. Symmetrical joint swelling
5. Rheumatoid nodules
6. serum rheumatoid factor
7. body erosions demonstrable by x-ray
What is the dx criteria for juvenile RA? (4 total)
Before age 16
1 or more joints with swelling or effusion
decreased ROM, tenderness, localized heat
duration 6w-3mt
How do you complete the PE for RA?
focused exam q3-4mo during treatment.
What dx labs are needed for RA?
RACE
1. RF (RA antibody)
2. Anti-CCP
3.CRP
4. ESR
When do need an MRI for RA?
If theres joint derangement or axial skeleton C1/C2 problems.
Will show bone marrow edema (HALLMARK of early RA)
What's some nonpharm management of RA?
rest, heat, ice, splinting
, Pharm management of RA?
drugs to decrease pain/inflammation= Aspirin/NSAIDs
Disease modifying antirhematic drugs
What 2 drugs are given for remission and prevention for RA?
methotrexate (Pregnancy X, Nausea)
Hydroycloroquine (Preg C, retinal exams)
What can you give along with methotrexate to decrease the nausea side effect?
folate supplements
How do you dx fibromyalgia?
in absence of systemic disease
*widespread pain
*Mild or greater tenderness in 11 of 18 tender points
*No response to steroids
Pt may have widespread musculoskeletal pain, fatigue, non-restorative sleep,
depression, HA, and GI complaints
What are some treatment options for fibromyalgia? (4)
Tricyclic antidepressants for pain and sleep
cyclovenaprines for muscle pain
SSRI for daytime pain
Lyrica
What 2 things are hallmark for fibromyalgia?
persistent widespread pain
chronic fatigue
What are some things that you'll see on the PE for fibromyalgia?
1. Pain + fatigue
2. somatic complaints (chronic rhinitis, allergies, IBS, migraine)
3. "tenderpoints" where pain is the only objective finding
4. muscle strength is normal although effect may be affected by pain and theres no
evidence of synovitis or soft tissue inflammation
Complete Solutions| Verified Answers
What is OA?
progressive destruction of the articular cartilage and subchondral bone; osteophyte
formation, and sclerosis.
Destruction of cartilage and narrowing of joint space
What are some S/sx of OA?
Asymmetric larger joint pain (fingers, knees, hips, spine)
Morning stiffness < 1hr that resumes towards the end of the day and after activity.
Joints are cool with crepitus and limited ROM
Usually later in life
Whats the difference between Herberdon's and Bouchard's nodes in OA?
Herberdons are located on the distal interphalangeal joint
Bouchard's are located on the proximal interphalangeal joint
Whats the best treatment for OA?
Start with nonpharm: heat, exercise, weight loss
PHARM: acetaminophen 1st. then NSAIDs
When do you need to consider COX-2 inhibitors for OA?
For GI protection (risk for GI bleeds decreased but its still there)
What do you need to monitor for its on NSAIDs?
CBC, BUN/Cr, liver function. occult blood test=They need to be off NSAID 2-3 days prior
to testing
What is RA?
An autoimmune disorder that attacks the synovial tissues in the joints.
What are some symptoms of RA?
non-axial, small to large joint swelling( except C1-C2 the is OA), tenderness, pain, hot
and red joints, decreased ROM, deformity later on, Usually symmetrical involvement of
the joints, small joints 1st before big joints, Can have rapid onset. Fatigue, fever, night
,sweats, malaise, depression.
"wax & wane" symptoms
What are the criteria needed for a DX of RA? (7 total)
Need 5 of the 7. the 1st 4 must be present @ least 6 weeks
1. Morning stiffness >1hr
2. soft tissue swelling of 3 or more joints (PIP, MCP, wrist, elbow, knee, ankle, MTP)
3. swelling of at least 1 joint in the hand/wrist
4. Symmetrical joint swelling
5. Rheumatoid nodules
6. serum rheumatoid factor
7. body erosions demonstrable by x-ray
What is the dx criteria for juvenile RA? (4 total)
Before age 16
1 or more joints with swelling or effusion
decreased ROM, tenderness, localized heat
duration 6w-3mt
How do you complete the PE for RA?
focused exam q3-4mo during treatment.
What dx labs are needed for RA?
RACE
1. RF (RA antibody)
2. Anti-CCP
3.CRP
4. ESR
When do need an MRI for RA?
If theres joint derangement or axial skeleton C1/C2 problems.
Will show bone marrow edema (HALLMARK of early RA)
What's some nonpharm management of RA?
rest, heat, ice, splinting
, Pharm management of RA?
drugs to decrease pain/inflammation= Aspirin/NSAIDs
Disease modifying antirhematic drugs
What 2 drugs are given for remission and prevention for RA?
methotrexate (Pregnancy X, Nausea)
Hydroycloroquine (Preg C, retinal exams)
What can you give along with methotrexate to decrease the nausea side effect?
folate supplements
How do you dx fibromyalgia?
in absence of systemic disease
*widespread pain
*Mild or greater tenderness in 11 of 18 tender points
*No response to steroids
Pt may have widespread musculoskeletal pain, fatigue, non-restorative sleep,
depression, HA, and GI complaints
What are some treatment options for fibromyalgia? (4)
Tricyclic antidepressants for pain and sleep
cyclovenaprines for muscle pain
SSRI for daytime pain
Lyrica
What 2 things are hallmark for fibromyalgia?
persistent widespread pain
chronic fatigue
What are some things that you'll see on the PE for fibromyalgia?
1. Pain + fatigue
2. somatic complaints (chronic rhinitis, allergies, IBS, migraine)
3. "tenderpoints" where pain is the only objective finding
4. muscle strength is normal although effect may be affected by pain and theres no
evidence of synovitis or soft tissue inflammation
