NRNP 6540 MIDTERM 2026 ACTUAL TEST
PAPER QUESTIONS SOLUTIONS VERIFIED
COMPLETE STUDY PACKAGE
◉ Osteoarthritis treatment.
Answer: Goal is to relieve symptoms, maintain/ improve function,
and avoid drug toxicity
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.
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.
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.
Answer: rheumatoid arthritis, splenomegaly, neutropenia
◉ Rheumatoid arthritis treatment.
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.
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.
Answer: - acute painful joint, often great toe (warm, swollen)
- pain at night
- flank pain because of renal calculi
PAPER QUESTIONS SOLUTIONS VERIFIED
COMPLETE STUDY PACKAGE
◉ Osteoarthritis treatment.
Answer: Goal is to relieve symptoms, maintain/ improve function,
and avoid drug toxicity
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.
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.
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.
Answer: rheumatoid arthritis, splenomegaly, neutropenia
◉ Rheumatoid arthritis treatment.
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.
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.
Answer: - acute painful joint, often great toe (warm, swollen)
- pain at night
- flank pain because of renal calculi
