NSGl 555/l NSG555l Examl 4l –l Nursel
Practitionersl inl Primaryl Carel IIl Guide|l
Wilkesl (Latestl 2026/l 2027l Update)l 100%l
Verifiedl Questionsl &l Answersl |l Gradel A
Q:l Raynaudl phenomenonl diagnosis
Answer:
Well-demarcatedl bilaterall digitall pallorl and/orl cyanosisl followedl byl rubor
Precipitatedl byl coldl orl emotionall stress,l relievedl byl warmth
Affectsl youngl women
Primaryl vsl secondary
Q:l Raynaudl phenomenonl treatment
Answer:
Keepl thel bodyl warm
Protectl handsl froml injury
Usel lotionl frequently
Stopl smoking
Avoidl decongestantsl andl amphetamines
Q:l Raynaudl phenomenonl pharml tx
Answer:
CCBsl (nifedipine,l amlodipine)l forl primary
ARBs,l topicall nitrates,l PDEl inhibitorsl (sildenafil,l etc),l orl fluoxetinel forl secondary
Q:l Rheumatoidl arthritis
,Answer:
Insidiousl onset
Morningl stiffnessl andl jointl pain
Symmetricl polyarthritis
Affectsl smalll jointsl ofl handsl andl feet
Deformitiesl commonl withl progressivel disease
X-rayl -l jointl erosions,l jointl spacel narrowing,l bonel lossl nearl joints
Subcutaneousl nodules
Dryl eyes,l mouth,l mucusl tissue
Interstitiall lungl dz
Pleurall effusion
Pericarditis
Splenomegaly
Scleritis
Vasculitis
Q:l Rheumatoidl arthritisl labs
Answer:
RFl andl anti-CCPl presentl 70-80%l ofl thel time
Q:l RAl vsl OA
Answer:
Symmetricl swellingl ofl multiplel jointsl withl tendernessl andl pain
Stiffnessl persistsl longerl thanl 30l minutes,l commonl inl thel morning,l morel severel afterl
activity
-PIPl joints,l MCPl joints,l wrists,l knees,l ankles,l andl MTP
-OAl sparesl thel MCPsl andl wrists
Q:l RAl tx
Answer:
DMARDsl shouldl bel startedl asl soonl asl thel diagnosisl isl made,l adjustedl tol suppressl dzl
activity
,Low-dosel corticosteroidsl (prednisonel 5-10mgl POl daily)l tol bridgel inl ptsl needingl promptl
relief,l notl morel thanl 3l monthsl (dosesl higherl thanl 10mgl dailyl notl appropriate)
NSAIDsl forl symptomaticl reliefl (onlyl inl conjunction,l ifl atl all)
-usel standardizedl assessmentsl likel Diseasel Activityl Scorel 28l Jointsl orl Clinicall Diseasel
Activityl Index
Q:l DMARDs
Answer:
Methotrexatel -l firstl line.l
Effectsl inl 2-6l weeks.l
Synthetic.l
7.5l orl 10mgl POl weeklyl initiall dose.
Teratogenic
Contraindications:l eGFRl <30,l hepatitis,l pregnancy,l alcohol
Monitorl liverl fxl Q3mos,l &l CBC
Drugl intx:l TMP/SMX,l amoxicillin,l probenecid
Q:l Otherl DMARDs
Answer:
Sulfasalazinel -l usedl inl combinationl withl methotrexate,l monitorl CVCl Q2-4l weeksl forl 3l
months,l thenl Q3l mos.l Checkl G6PDl deficiencyl beforel starting.
Leflunomidel (pyrimidinel synthesisl inhibitor)l -l alternativel forl thosel whol cannotl takel
methotrexate.l Teratogenic.l
Antimalarialsl
Janusl kinasel inhibitorsl (Tofacitinib)l forl severel RAl refractoryl tol methotrexatel orl otherl
agents.l Screenl forl TB.l Increasesl riskl ofl infx.
Q:l Biologicl DMARDs
Answer:
TNFl inhibitorsl (addedl tol methotrexate).l Screenl forl TBl beforel starting.l
Abataceptl blocksl T-celll stimulation.
Rituximabl -l depletesl Bl cells.
, Q:l RAl stepwisel tx
Answer:
1-methotrexate
2-methotrexatel +l sulfasalazinel +l hydroxychloroquine
3-methotrexatel +l DMARD
Q:l SLE
Answer:
occursl mainlyl inl youngl women
-rashl inl areasl exposedl tol sun
-jointl sxl inl 90%
-anemia,l leukopenia,l thombocytopenia
-glomerulonephritis,l CNSl dz,l complicationsl ofl antiphospholipidl syndromel =l morbidity
Q:l SLEl labl results
Answer:
ANAl antibodiesl (100%)
anti-dsDNAl antibodiesl (2/3)
lowl seruml complementl levelsl (duringl flares)
elevatedl ESRl duringl flares
CRPl usuallyl normal
Q:l Inl SLE,l hematuria
Answer:
withl orl withoutl casts,l andl proteinurial canl indicatel activel lupusl nephritis
Q:l SLEl goldl standardl ofl testing
Answer:
Practitionersl inl Primaryl Carel IIl Guide|l
Wilkesl (Latestl 2026/l 2027l Update)l 100%l
Verifiedl Questionsl &l Answersl |l Gradel A
Q:l Raynaudl phenomenonl diagnosis
Answer:
Well-demarcatedl bilaterall digitall pallorl and/orl cyanosisl followedl byl rubor
Precipitatedl byl coldl orl emotionall stress,l relievedl byl warmth
Affectsl youngl women
Primaryl vsl secondary
Q:l Raynaudl phenomenonl treatment
Answer:
Keepl thel bodyl warm
Protectl handsl froml injury
Usel lotionl frequently
Stopl smoking
Avoidl decongestantsl andl amphetamines
Q:l Raynaudl phenomenonl pharml tx
Answer:
CCBsl (nifedipine,l amlodipine)l forl primary
ARBs,l topicall nitrates,l PDEl inhibitorsl (sildenafil,l etc),l orl fluoxetinel forl secondary
Q:l Rheumatoidl arthritis
,Answer:
Insidiousl onset
Morningl stiffnessl andl jointl pain
Symmetricl polyarthritis
Affectsl smalll jointsl ofl handsl andl feet
Deformitiesl commonl withl progressivel disease
X-rayl -l jointl erosions,l jointl spacel narrowing,l bonel lossl nearl joints
Subcutaneousl nodules
Dryl eyes,l mouth,l mucusl tissue
Interstitiall lungl dz
Pleurall effusion
Pericarditis
Splenomegaly
Scleritis
Vasculitis
Q:l Rheumatoidl arthritisl labs
Answer:
RFl andl anti-CCPl presentl 70-80%l ofl thel time
Q:l RAl vsl OA
Answer:
Symmetricl swellingl ofl multiplel jointsl withl tendernessl andl pain
Stiffnessl persistsl longerl thanl 30l minutes,l commonl inl thel morning,l morel severel afterl
activity
-PIPl joints,l MCPl joints,l wrists,l knees,l ankles,l andl MTP
-OAl sparesl thel MCPsl andl wrists
Q:l RAl tx
Answer:
DMARDsl shouldl bel startedl asl soonl asl thel diagnosisl isl made,l adjustedl tol suppressl dzl
activity
,Low-dosel corticosteroidsl (prednisonel 5-10mgl POl daily)l tol bridgel inl ptsl needingl promptl
relief,l notl morel thanl 3l monthsl (dosesl higherl thanl 10mgl dailyl notl appropriate)
NSAIDsl forl symptomaticl reliefl (onlyl inl conjunction,l ifl atl all)
-usel standardizedl assessmentsl likel Diseasel Activityl Scorel 28l Jointsl orl Clinicall Diseasel
Activityl Index
Q:l DMARDs
Answer:
Methotrexatel -l firstl line.l
Effectsl inl 2-6l weeks.l
Synthetic.l
7.5l orl 10mgl POl weeklyl initiall dose.
Teratogenic
Contraindications:l eGFRl <30,l hepatitis,l pregnancy,l alcohol
Monitorl liverl fxl Q3mos,l &l CBC
Drugl intx:l TMP/SMX,l amoxicillin,l probenecid
Q:l Otherl DMARDs
Answer:
Sulfasalazinel -l usedl inl combinationl withl methotrexate,l monitorl CVCl Q2-4l weeksl forl 3l
months,l thenl Q3l mos.l Checkl G6PDl deficiencyl beforel starting.
Leflunomidel (pyrimidinel synthesisl inhibitor)l -l alternativel forl thosel whol cannotl takel
methotrexate.l Teratogenic.l
Antimalarialsl
Janusl kinasel inhibitorsl (Tofacitinib)l forl severel RAl refractoryl tol methotrexatel orl otherl
agents.l Screenl forl TB.l Increasesl riskl ofl infx.
Q:l Biologicl DMARDs
Answer:
TNFl inhibitorsl (addedl tol methotrexate).l Screenl forl TBl beforel starting.l
Abataceptl blocksl T-celll stimulation.
Rituximabl -l depletesl Bl cells.
, Q:l RAl stepwisel tx
Answer:
1-methotrexate
2-methotrexatel +l sulfasalazinel +l hydroxychloroquine
3-methotrexatel +l DMARD
Q:l SLE
Answer:
occursl mainlyl inl youngl women
-rashl inl areasl exposedl tol sun
-jointl sxl inl 90%
-anemia,l leukopenia,l thombocytopenia
-glomerulonephritis,l CNSl dz,l complicationsl ofl antiphospholipidl syndromel =l morbidity
Q:l SLEl labl results
Answer:
ANAl antibodiesl (100%)
anti-dsDNAl antibodiesl (2/3)
lowl seruml complementl levelsl (duringl flares)
elevatedl ESRl duringl flares
CRPl usuallyl normal
Q:l Inl SLE,l hematuria
Answer:
withl orl withoutl casts,l andl proteinurial canl indicatel activel lupusl nephritis
Q:l SLEl goldl standardl ofl testing
Answer:
