FOR MORE EXAMS
EMAIL:
NR509 Mid-Term Study Guide+
Accurate expert curated questions
and answers 2025-2026
• Articular structures include joint capsule and articular
cartilage, the synovium and synovial fluid, intra-articular
ligaments and juxta-articular bone o Articular disease
involves:
Swelling
Tenderness of the joint
Crepitus
Instability “locking”
Deformity
Limits active and passive range of motion due to
stiffness or pain
• Extra-articular structures include periarticular
ligaments, tendons, bursae, muscle, fascia, bone, nerve and
overlying skin o Extra-articular disease involves:
“point of focal tenderness in regions adjacent to
articular structures
Limits active range of motion
RARELY causes swelling, instability, joint deformity
Know the sources of joint pain (pg. 627 algorithm)
• Nonarticular conditions: trauma/fracture, fibromyalgia,
polymyalgia rheumatica, bursitis, tendinitis
• Intra-articular (acute, < 6 weeks): acute arthritis o
infectious arthritis
o gout
o pseudogouto Reiter syndrome
• Intra-articular (chronic, > 6 weeks): chronic
inflammatory arthritis vs chronic noninflammatory arthritis
o Chronic inflammatory arthritis with 1-3 joints
involved:
FOR MORE EXAMS
EMAIL:
, FOR MORE EXAMS
EMAIL:
Indolent infection
Psoriatic arthritis
Reiter syndrome
Periarticular JA o Chronic inflammatory arthritis
with >3 joints involved:
Psoriatic arthritis or Reiter syndrome (no symmetry)
rheumatoid arthritis if not RA then systemic lupus,
scleroderma, polymyositis
*Know what causes saddle numbness and urinary retention (pg. 678?)
• CES (cauda equina syndrome) most commonly results from a
massive herniated disc in the lumbar region.
• A single excessive strain or injury may cause a herniated disc.
• However, disc material degenerates naturally as a person ages,
and the ligaments that hold it in place begin to weaken. As this
degeneration progresses, a relatively minor strain or twisting
movement can cause a disc to rupture.
The following are other potential causes of CES:
• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Violent injuries to the lower back (gunshots, falls, auto accidents)
• Birth abnormalities
• Spinal arteriovenous malformations (AVMs)
• Spinal hemorrhages (subarachnoid, subdural, epidural)
• Postoperative lumbar spine surgery complications
• Spinal anesthesia
Know how retinal detachment presents (p.217)
• Sudden, painless vision loss that is unilateral
Know what the word obtunded means (p. 769)
FOR MORE EXAMS
EMAIL:
, FOR MORE EXAMS
EMAIL:
• The obtunded patient opens eyes and looks at you but responds
slowly and is somewhat confused. Alertness and interest in the
environment are decreased.
Know what cranial nerve you’re assessing when checking lateral
gaze (p. 237)
• Cranial nerve VI: abducens
Know what should be listed under adult illnesses in health
history (pg. 10)
• Medical illnesses: such as diabetes, hypertension, hepatitis,
asthma, and HIV. Also hospitalizations, number and gender of
sexual partners, and risk-taking sexual practices Surgical:
dates, indications, and types of operations
• Obstetric/Gynecologic: obstetric history, menstrual history,
methods of contraception, and sexual function
• Psychiatric: illness and timeframe, diagnoses, hospitalizations,
and treatments
Know what conditions do not have red reflexes (p. 239)
• Absence of red reflex suggests an opacity of the lens (cataract), or
possibly the vitreous (or even an artificial eye).
• Less commonly, a detached retina, or in children a
retinoblastoma may obscure this reflex.
Know the signs of seasonal allergies (p. 27)
• itching, watery eyes, sneezing, ear congestion, postnasal drainage
Know how optic neuritis presents (p. 217)
• Sudden visual loss that is unilateral and can be painful,
associated with multiple sclerosis
Know how pityriasis rosacea presents (p. 912)
• Oval lesions on trunk, in older children often in a Christmas tree
pattern, sometimes a Harold patch (a large patch that appears
first)
FOR MORE EXAMS
EMAIL:
, FOR MORE EXAMS
EMAIL:
Know what is listed under present illness (p. 9)
• Complete, clear, and chronologic description of the problems
prompting the patient’s visit, including the onset of the problem,
the setting in which it developed, it’s manifestation and any
treatments to date.
• (OLDCART) Onset, Location, Duration, Characteristics,
Aggravating factors, Relieving factors, Treatments (past)
Know where the acromion process is (be able to identify it on
a picture)
• Located between the clavicle and the shoulder
*Know what to do if you have a + finding on physical exam but
otherwise negative work-up (p.
30)
Know what can cause falsely high BP’s (p. 127)
• If the brachial artery is below the heart level, the blood pressure
reading will be higher. If the cuff is too small (narrow) the blood
pressure will read high.
• If the cuff is too large (wide) the BP will read high on a large arm
FOR MORE EXAMS
EMAIL:
EMAIL:
NR509 Mid-Term Study Guide+
Accurate expert curated questions
and answers 2025-2026
• Articular structures include joint capsule and articular
cartilage, the synovium and synovial fluid, intra-articular
ligaments and juxta-articular bone o Articular disease
involves:
Swelling
Tenderness of the joint
Crepitus
Instability “locking”
Deformity
Limits active and passive range of motion due to
stiffness or pain
• Extra-articular structures include periarticular
ligaments, tendons, bursae, muscle, fascia, bone, nerve and
overlying skin o Extra-articular disease involves:
“point of focal tenderness in regions adjacent to
articular structures
Limits active range of motion
RARELY causes swelling, instability, joint deformity
Know the sources of joint pain (pg. 627 algorithm)
• Nonarticular conditions: trauma/fracture, fibromyalgia,
polymyalgia rheumatica, bursitis, tendinitis
• Intra-articular (acute, < 6 weeks): acute arthritis o
infectious arthritis
o gout
o pseudogouto Reiter syndrome
• Intra-articular (chronic, > 6 weeks): chronic
inflammatory arthritis vs chronic noninflammatory arthritis
o Chronic inflammatory arthritis with 1-3 joints
involved:
FOR MORE EXAMS
EMAIL:
, FOR MORE EXAMS
EMAIL:
Indolent infection
Psoriatic arthritis
Reiter syndrome
Periarticular JA o Chronic inflammatory arthritis
with >3 joints involved:
Psoriatic arthritis or Reiter syndrome (no symmetry)
rheumatoid arthritis if not RA then systemic lupus,
scleroderma, polymyositis
*Know what causes saddle numbness and urinary retention (pg. 678?)
• CES (cauda equina syndrome) most commonly results from a
massive herniated disc in the lumbar region.
• A single excessive strain or injury may cause a herniated disc.
• However, disc material degenerates naturally as a person ages,
and the ligaments that hold it in place begin to weaken. As this
degeneration progresses, a relatively minor strain or twisting
movement can cause a disc to rupture.
The following are other potential causes of CES:
• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Violent injuries to the lower back (gunshots, falls, auto accidents)
• Birth abnormalities
• Spinal arteriovenous malformations (AVMs)
• Spinal hemorrhages (subarachnoid, subdural, epidural)
• Postoperative lumbar spine surgery complications
• Spinal anesthesia
Know how retinal detachment presents (p.217)
• Sudden, painless vision loss that is unilateral
Know what the word obtunded means (p. 769)
FOR MORE EXAMS
EMAIL:
, FOR MORE EXAMS
EMAIL:
• The obtunded patient opens eyes and looks at you but responds
slowly and is somewhat confused. Alertness and interest in the
environment are decreased.
Know what cranial nerve you’re assessing when checking lateral
gaze (p. 237)
• Cranial nerve VI: abducens
Know what should be listed under adult illnesses in health
history (pg. 10)
• Medical illnesses: such as diabetes, hypertension, hepatitis,
asthma, and HIV. Also hospitalizations, number and gender of
sexual partners, and risk-taking sexual practices Surgical:
dates, indications, and types of operations
• Obstetric/Gynecologic: obstetric history, menstrual history,
methods of contraception, and sexual function
• Psychiatric: illness and timeframe, diagnoses, hospitalizations,
and treatments
Know what conditions do not have red reflexes (p. 239)
• Absence of red reflex suggests an opacity of the lens (cataract), or
possibly the vitreous (or even an artificial eye).
• Less commonly, a detached retina, or in children a
retinoblastoma may obscure this reflex.
Know the signs of seasonal allergies (p. 27)
• itching, watery eyes, sneezing, ear congestion, postnasal drainage
Know how optic neuritis presents (p. 217)
• Sudden visual loss that is unilateral and can be painful,
associated with multiple sclerosis
Know how pityriasis rosacea presents (p. 912)
• Oval lesions on trunk, in older children often in a Christmas tree
pattern, sometimes a Harold patch (a large patch that appears
first)
FOR MORE EXAMS
EMAIL:
, FOR MORE EXAMS
EMAIL:
Know what is listed under present illness (p. 9)
• Complete, clear, and chronologic description of the problems
prompting the patient’s visit, including the onset of the problem,
the setting in which it developed, it’s manifestation and any
treatments to date.
• (OLDCART) Onset, Location, Duration, Characteristics,
Aggravating factors, Relieving factors, Treatments (past)
Know where the acromion process is (be able to identify it on
a picture)
• Located between the clavicle and the shoulder
*Know what to do if you have a + finding on physical exam but
otherwise negative work-up (p.
30)
Know what can cause falsely high BP’s (p. 127)
• If the brachial artery is below the heart level, the blood pressure
reading will be higher. If the cuff is too small (narrow) the blood
pressure will read high.
• If the cuff is too large (wide) the BP will read high on a large arm
FOR MORE EXAMS
EMAIL:
