NS 832 Exam 3 Questions and Correct Answers
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Gout - CORRECT ANSWER -Flare up of a red, painful toe due to an elevation of serum uric
above 6.8 mgs/dl, purine metabolism with higher the levels the more likely to develop gout
-Systemic metabolic disease with a seasonal aspect to the disease with spring being the most
likely time to see it
-not all patients with hyperuricemia develop gout
-in chronic cases monosodium urate crystals get deposited into joints and tissues
Definitive lab level for Gout - CORRECT ANSWER -finding urate crystals in the tissues
Gout management - CORRECT ANSWER --Control lifestyle issues such as obesity, alcohol,
hyperlipidemia
-First use NSAIDs for 5-8 days unless contraindicated to control flare up
-Colchicine can be used for an initial flare. It is an antiinflammatory and does not alter serum
urate levels. It does help to decrease the depositing of urate crystals
-Steroids are helpful if cannot use NSAIDs and Colchcine
-Chronic use: urate lowering drugs are needed
Osteoarthiritis - CORRECT ANSWER -Very common disorder often beginning in the 2nd or 3rd
decade without symptoms but by the 4th decade pathologic changes are evident on articular
surfaces
-By the 4th-6th decades, symptoms begin
Symptoms of osteoarthritis - CORRECT ANSWER --Pain, stiffness, and limited ROM bring
patients in to be seen. It progresses especially in weight bearing joints
-May be symmetric but not necessarily. This is not a systemic disease so no serologic marker
exist
,Osteoarthritis diagnosis - CORRECT ANSWER -Xrays will eventually show changes
Osteoarthritis treatment - CORRECT ANSWER --Acetaminophen is mainstay
-NSAIDs such as COX-2 inhibitors, Mobic, Ibuprofen, Naprosyn are all used
-Glucosamine and/or chondroitin have not been found to be helpful in studies. If someone wants
to try it, use for no more than 3 months if it doesn't help at all
-Weight loss, mild exercise, heat and/or ice
-Injections and for some surgery to replace the joints are all additional modalities
Fibromyalgia - CORRECT ANSWER --central nervous system dysregulation whose cause is
unknown
-often follows a viral illness, trauma, and stress
-it is a primary female disorder by a factor of 8 or 9
How is fibromyalgia diagnosed? - CORRECT ANSWER -pain must be of three months or more
in duration
-can be above or below the waist, is bilateral, and is also present on palpation
-Chronic fatigue is also present
Fibromyalgia treatment - CORRECT ANSWER --to help sleep: low dose amitriptyline is useful
-SSRIs of SNRIs such as cymbalta or prozac are useful
-Neurotin and Lyrica are useful for pain
-NSAIDs have not been shown to be helpful
-Exercise and cognitive behavioral therapy are the cornerstones fo therapy
-exercise for someone not used to doing it has to be encouraged but with time it is very helpful. It
can improve pain, sleep, and funciton
,**No damage to the muscles despite the pain
Sprains and Strains - CORRECT ANSWER -While sometimes used interchangeably, sprains and
strains refer to differing anatomy
Sprain - CORRECT ANSWER -A tearing of the ligaments which support the joints
Grading:
1-miscroscopic tears
2-incomplete tear which causes functional impairment
3-complete tear compromising the joint integrity If this occurs in a lower extremety, weight
bearing is problematic
Strain - CORRECT ANSWER -overstretching or overuse of a muscle
Low back pain - CORRECT ANSWER -*2nd most common reason for a clinic visit
-Acute episodes resolve in 90% of people by six weeks
-Chronic back pain affects 15% of adults and 27% of the elderly. There is a psychosocial
component to this which includes lower socioeconomic status and poor job satisfaction
Low back pain presentation - CORRECT ANSWER --with initial presentation, and no trauma,
avoid xrays
-present in a large variety of ways with variable symptoms
-If radicular symptoms are present, a straight leg raise tests or a cross leg test are helpful. If
neither is positive, one can be assured reasonably that it is not a disc problem (nerve root
compression)
Low Back Pain treatment - CORRECT ANSWER --For most cases of acute back pain, rest, work
modification, NSAIDs, muscle relaxers, ice, and reassurance are your best modalities
-Physical therapy after at least a few days or a week may be necessary. It helps prevent loss of
conditioning and gets people back to their lives more quickly, Not all patients need it.
, -One can order that the physical therapist evaluate and treat the back pain for a week then have
the patient come back to you
Diabetes Mellitus - CORRECT ANSWER -Most common metabolic disorder in primary care
-Characterized by hyperglycemia- decreased insulin secretion, action, or both
Type 1: insulin deficiency from autoimmune beta cell destruction
-needs exogenous insulin
-Typically starts in childhood or young adult onset
-Rapid and dramatic onset
Type 2: insulin resistance and deficiency of insulin
-more common
-can begin at any age, runs in families, related obesity
Prediabetes - CORRECT ANSWER --Intermediate stage, impaired fasting glucose, and impaired
glucose tolerance
-progression to diabetes delayed or prevented with healthy diet, regular exercise, and weight loss
Gestational DM - CORRECT ANSWER --Glucose tolerance onset during pregnancy
-At risk for type 2 DM within 5-10 years after diagnosis of Gestational DM
DM 2 presentation - CORRECT ANSWER -Often asymptomatic or subtle symptoms
Symptoms of persistent hyperglycemia in DM are:
-increasedWthirstW(polydipsia)
-increasedWhungerW(polyphagia)
-weaknessWandWfatigue
-recurrentWblurredWvision
|Already Graded A+||Brand New Version!!!
Gout - CORRECT ANSWER -Flare up of a red, painful toe due to an elevation of serum uric
above 6.8 mgs/dl, purine metabolism with higher the levels the more likely to develop gout
-Systemic metabolic disease with a seasonal aspect to the disease with spring being the most
likely time to see it
-not all patients with hyperuricemia develop gout
-in chronic cases monosodium urate crystals get deposited into joints and tissues
Definitive lab level for Gout - CORRECT ANSWER -finding urate crystals in the tissues
Gout management - CORRECT ANSWER --Control lifestyle issues such as obesity, alcohol,
hyperlipidemia
-First use NSAIDs for 5-8 days unless contraindicated to control flare up
-Colchicine can be used for an initial flare. It is an antiinflammatory and does not alter serum
urate levels. It does help to decrease the depositing of urate crystals
-Steroids are helpful if cannot use NSAIDs and Colchcine
-Chronic use: urate lowering drugs are needed
Osteoarthiritis - CORRECT ANSWER -Very common disorder often beginning in the 2nd or 3rd
decade without symptoms but by the 4th decade pathologic changes are evident on articular
surfaces
-By the 4th-6th decades, symptoms begin
Symptoms of osteoarthritis - CORRECT ANSWER --Pain, stiffness, and limited ROM bring
patients in to be seen. It progresses especially in weight bearing joints
-May be symmetric but not necessarily. This is not a systemic disease so no serologic marker
exist
,Osteoarthritis diagnosis - CORRECT ANSWER -Xrays will eventually show changes
Osteoarthritis treatment - CORRECT ANSWER --Acetaminophen is mainstay
-NSAIDs such as COX-2 inhibitors, Mobic, Ibuprofen, Naprosyn are all used
-Glucosamine and/or chondroitin have not been found to be helpful in studies. If someone wants
to try it, use for no more than 3 months if it doesn't help at all
-Weight loss, mild exercise, heat and/or ice
-Injections and for some surgery to replace the joints are all additional modalities
Fibromyalgia - CORRECT ANSWER --central nervous system dysregulation whose cause is
unknown
-often follows a viral illness, trauma, and stress
-it is a primary female disorder by a factor of 8 or 9
How is fibromyalgia diagnosed? - CORRECT ANSWER -pain must be of three months or more
in duration
-can be above or below the waist, is bilateral, and is also present on palpation
-Chronic fatigue is also present
Fibromyalgia treatment - CORRECT ANSWER --to help sleep: low dose amitriptyline is useful
-SSRIs of SNRIs such as cymbalta or prozac are useful
-Neurotin and Lyrica are useful for pain
-NSAIDs have not been shown to be helpful
-Exercise and cognitive behavioral therapy are the cornerstones fo therapy
-exercise for someone not used to doing it has to be encouraged but with time it is very helpful. It
can improve pain, sleep, and funciton
,**No damage to the muscles despite the pain
Sprains and Strains - CORRECT ANSWER -While sometimes used interchangeably, sprains and
strains refer to differing anatomy
Sprain - CORRECT ANSWER -A tearing of the ligaments which support the joints
Grading:
1-miscroscopic tears
2-incomplete tear which causes functional impairment
3-complete tear compromising the joint integrity If this occurs in a lower extremety, weight
bearing is problematic
Strain - CORRECT ANSWER -overstretching or overuse of a muscle
Low back pain - CORRECT ANSWER -*2nd most common reason for a clinic visit
-Acute episodes resolve in 90% of people by six weeks
-Chronic back pain affects 15% of adults and 27% of the elderly. There is a psychosocial
component to this which includes lower socioeconomic status and poor job satisfaction
Low back pain presentation - CORRECT ANSWER --with initial presentation, and no trauma,
avoid xrays
-present in a large variety of ways with variable symptoms
-If radicular symptoms are present, a straight leg raise tests or a cross leg test are helpful. If
neither is positive, one can be assured reasonably that it is not a disc problem (nerve root
compression)
Low Back Pain treatment - CORRECT ANSWER --For most cases of acute back pain, rest, work
modification, NSAIDs, muscle relaxers, ice, and reassurance are your best modalities
-Physical therapy after at least a few days or a week may be necessary. It helps prevent loss of
conditioning and gets people back to their lives more quickly, Not all patients need it.
, -One can order that the physical therapist evaluate and treat the back pain for a week then have
the patient come back to you
Diabetes Mellitus - CORRECT ANSWER -Most common metabolic disorder in primary care
-Characterized by hyperglycemia- decreased insulin secretion, action, or both
Type 1: insulin deficiency from autoimmune beta cell destruction
-needs exogenous insulin
-Typically starts in childhood or young adult onset
-Rapid and dramatic onset
Type 2: insulin resistance and deficiency of insulin
-more common
-can begin at any age, runs in families, related obesity
Prediabetes - CORRECT ANSWER --Intermediate stage, impaired fasting glucose, and impaired
glucose tolerance
-progression to diabetes delayed or prevented with healthy diet, regular exercise, and weight loss
Gestational DM - CORRECT ANSWER --Glucose tolerance onset during pregnancy
-At risk for type 2 DM within 5-10 years after diagnosis of Gestational DM
DM 2 presentation - CORRECT ANSWER -Often asymptomatic or subtle symptoms
Symptoms of persistent hyperglycemia in DM are:
-increasedWthirstW(polydipsia)
-increasedWhungerW(polyphagia)
-weaknessWandWfatigue
-recurrentWblurredWvision
