NSCA CPSS EXAM 2 QUESTIONS AND CORRECT DETAILED AND VERIFIED
ANSWERS |ALREADY GRADED A+
@#$%^&*(
1. What is the enthuses?: where a ligament or tendon attaches to the bone
target: ankylosing spondylitis, bowel-ralted arthritis, psoriatic arthritis
2. What are the indications of Arthrocentesis?: - undiagnosed poly or mono
arthritis with effusion
- infection
- crystalline arthritis
- joint effusion after trauma
- therapeutic infection
- uncertain dx
*DRAIN JOINT FLUID COMPLETELY*
3. How do you know when to stop draining fluid from an arthrocentesis?: will
see a ting of blood (aspirating the synovial sac)
4. What are the contraindications for Arthrocentesis?: - overlying cellulitis,
wound, bacteremia
- *Do not inject steroids into joint suspected of infection or hemoarthrosis* --> will
grow the bacteria like crazy
- neuropathic joint (Charcot joint)
- coagulopathies (check INR in Coumadin users)
- uncontrolled DM
- prothetic joints
- inaccessible joints (hip, SI, pubic synthesis)
- lack response to previous injections
,5. Synovial Fluid Analysis: *Culture*
*Crystals*
- monosodium urate (gout_
- calcium pyrophosphate (pseudo gout)
*Cell count with diff*
- poly = bacteria
- lymphocytes = TB, virus
- Eosinophil = allergic or parasitic or lyme
6. What does normal synovial fluid look like?: clear pale yellow (should be able to
read print through it)
WBC <200
7. What is the most common non-inflammatory disease? how does this syn-
ovial fluid look?: *Osteoarthritis*
Trauma
Osteonecrosis
SLE
8. Trauma - what will the synovial fluids look like?: Trauma
Fx
Ligament tear
Charcot foot
PVS
,9. Why do you inject joints?: can be the joint or soft tissue (tendon sheath) --> do
not insert into tendon, will rupture
-inflammation (degenerative joint disease, bursitis, tendonitis)
- corticosteroid injection helps decrease inflammatory reaction (limiting capillary
dilation and vascular permeability)
, 10. What should you do before starting arthrocentesis?: 1) hx and examination
2) conservative (RICE) treatment first (NSAIDS and continue after injection)
3) pt selection, verbal consent documented in chart, ANATOMY
4) undertake as few injections as possible to settle the problem
MAX 3 in a single joint per year
11. What happens if you give more than 3 injections in one joint in a year?: in-
creased risk of systemic absorption and joint damage
12. What are the indications for injection?: OA
RA
Gouty Arthritis
Synovitis
Bursitis
Tendonitis
Muscle Trigger Points
Carpal Tunnel Syndrome
13. Which conditions should you be VERY cautious when injecting?: Charcot
joint (neuropathic sensory loss)
Tumor
Neurogenic disease Active
infections (TB) immune-
suppressed hosts
ANSWERS |ALREADY GRADED A+
@#$%^&*(
1. What is the enthuses?: where a ligament or tendon attaches to the bone
target: ankylosing spondylitis, bowel-ralted arthritis, psoriatic arthritis
2. What are the indications of Arthrocentesis?: - undiagnosed poly or mono
arthritis with effusion
- infection
- crystalline arthritis
- joint effusion after trauma
- therapeutic infection
- uncertain dx
*DRAIN JOINT FLUID COMPLETELY*
3. How do you know when to stop draining fluid from an arthrocentesis?: will
see a ting of blood (aspirating the synovial sac)
4. What are the contraindications for Arthrocentesis?: - overlying cellulitis,
wound, bacteremia
- *Do not inject steroids into joint suspected of infection or hemoarthrosis* --> will
grow the bacteria like crazy
- neuropathic joint (Charcot joint)
- coagulopathies (check INR in Coumadin users)
- uncontrolled DM
- prothetic joints
- inaccessible joints (hip, SI, pubic synthesis)
- lack response to previous injections
,5. Synovial Fluid Analysis: *Culture*
*Crystals*
- monosodium urate (gout_
- calcium pyrophosphate (pseudo gout)
*Cell count with diff*
- poly = bacteria
- lymphocytes = TB, virus
- Eosinophil = allergic or parasitic or lyme
6. What does normal synovial fluid look like?: clear pale yellow (should be able to
read print through it)
WBC <200
7. What is the most common non-inflammatory disease? how does this syn-
ovial fluid look?: *Osteoarthritis*
Trauma
Osteonecrosis
SLE
8. Trauma - what will the synovial fluids look like?: Trauma
Fx
Ligament tear
Charcot foot
PVS
,9. Why do you inject joints?: can be the joint or soft tissue (tendon sheath) --> do
not insert into tendon, will rupture
-inflammation (degenerative joint disease, bursitis, tendonitis)
- corticosteroid injection helps decrease inflammatory reaction (limiting capillary
dilation and vascular permeability)
, 10. What should you do before starting arthrocentesis?: 1) hx and examination
2) conservative (RICE) treatment first (NSAIDS and continue after injection)
3) pt selection, verbal consent documented in chart, ANATOMY
4) undertake as few injections as possible to settle the problem
MAX 3 in a single joint per year
11. What happens if you give more than 3 injections in one joint in a year?: in-
creased risk of systemic absorption and joint damage
12. What are the indications for injection?: OA
RA
Gouty Arthritis
Synovitis
Bursitis
Tendonitis
Muscle Trigger Points
Carpal Tunnel Syndrome
13. Which conditions should you be VERY cautious when injecting?: Charcot
joint (neuropathic sensory loss)
Tumor
Neurogenic disease Active
infections (TB) immune-
suppressed hosts
