NURS 5433 FAMILY 2 Understanding Musculoskeletal Issues and
Assessments Part 2 With Correct answers (A+)
What is the preferred test for diagnosis Rotator Cuff injury?
MRI
What is the initial Pharmacologic treatment for a Rotator Cuff injury?
NSAIDs
followed by subacromial steroid injections if NSAIDs fail
- injections may weaken the tendon and accelerate rotator cuff tear
Follow up in 2-4 weeks
* if a thickness tear is suspected, refer out
Plantar Fasciitis
an inflammation of the plantar fascia on the sole of the foot
- caused by overuse of the plantar fascia, increased activity, weight, or age
- direct impact on the heel through gait or repetitive trauma or overloading of the front
of the foot
What are the signs and symptoms of Plantar Fasciitis?
- Heel pain worse with first steps in the morning or after sitting for several minutes
(decreases with activity)
- Sharp pain in the heel
- Point tenderness in the anteromedial region of calcaneus/calcaneal tuberosity
- Pain increases with dorsiflexion of toes
- Achilles Tendon tightness
,If no improvement of Plantar Fasciitis after six weeks, what should the NP do next?
Refer to a Podiatrist
Which medications can increase a gout flare up?
Diuretics
- thiazide and loop
Potassium-sparing diuretics are not associated with rising uric acid levels
Aspirin
Cyclosporine
Which of the following laboratory diagnostics are used to determine gout?
WBC-elevated
ESR-elevated
X-ray-soft tissue swelling, Tophi present on imaging
Serum Uric Acid levels more important when following tx and not initially
Synovial Fluid Aspiration-presence of monosodium urate crystals diagnostic for gout
If a patient has HTN and Gout and is on Hydrochlorothiazide, what does the NP do?
Change the Hydrochlorothiazide to Losartan if possible
What is first-line treatment for gout?
Allopurinol (Xanthine Oxidase Inhibitor ***needed*** for uric acid formation)
- start at =100 mg daily ***can be titrated*** (every 2-5 wks) up to 800 mg daily
- to reduce serum urate levels to <6
*start lower if =Stage 3 CKD
, *reduces blood uric acid levels, prevents new tophus formation and regression of tophi
that have already formed and decreases the risk of nephropathy
*if given with Warfarin, warfarin dose should be lowered
What should the NP consider prior to starting Allopurinol if a patient is of Southeast
Asian or African American descent?
Testing the patient for HLA-B *5801
- affects 7% of Southeast Asian descent and 4% of African American descent
What are other Urate Lowering Therapies for Gout?
Febuxostat/Uloric (Xanthine Oxidase Inhibitor)
- start at <=40 mg daily with a max dose of 80 mg daily
* switch to another agent if hx of CVD or new CV event
Probenecid (Uricosuric)
- start 100 mg once or twice daily
- can increase to 1 gram twice daily
Pegloticase/Krystexxa (Uricase)
- 8 mg IV every two weeks
- only recommended if other treatments fail
How long after the institution of urate lowering therapies should anti-inflammatory
medications such as Colchicine or NSAIDs continue?
3-6 months after the institution of therapy
Assessments Part 2 With Correct answers (A+)
What is the preferred test for diagnosis Rotator Cuff injury?
MRI
What is the initial Pharmacologic treatment for a Rotator Cuff injury?
NSAIDs
followed by subacromial steroid injections if NSAIDs fail
- injections may weaken the tendon and accelerate rotator cuff tear
Follow up in 2-4 weeks
* if a thickness tear is suspected, refer out
Plantar Fasciitis
an inflammation of the plantar fascia on the sole of the foot
- caused by overuse of the plantar fascia, increased activity, weight, or age
- direct impact on the heel through gait or repetitive trauma or overloading of the front
of the foot
What are the signs and symptoms of Plantar Fasciitis?
- Heel pain worse with first steps in the morning or after sitting for several minutes
(decreases with activity)
- Sharp pain in the heel
- Point tenderness in the anteromedial region of calcaneus/calcaneal tuberosity
- Pain increases with dorsiflexion of toes
- Achilles Tendon tightness
,If no improvement of Plantar Fasciitis after six weeks, what should the NP do next?
Refer to a Podiatrist
Which medications can increase a gout flare up?
Diuretics
- thiazide and loop
Potassium-sparing diuretics are not associated with rising uric acid levels
Aspirin
Cyclosporine
Which of the following laboratory diagnostics are used to determine gout?
WBC-elevated
ESR-elevated
X-ray-soft tissue swelling, Tophi present on imaging
Serum Uric Acid levels more important when following tx and not initially
Synovial Fluid Aspiration-presence of monosodium urate crystals diagnostic for gout
If a patient has HTN and Gout and is on Hydrochlorothiazide, what does the NP do?
Change the Hydrochlorothiazide to Losartan if possible
What is first-line treatment for gout?
Allopurinol (Xanthine Oxidase Inhibitor ***needed*** for uric acid formation)
- start at =100 mg daily ***can be titrated*** (every 2-5 wks) up to 800 mg daily
- to reduce serum urate levels to <6
*start lower if =Stage 3 CKD
, *reduces blood uric acid levels, prevents new tophus formation and regression of tophi
that have already formed and decreases the risk of nephropathy
*if given with Warfarin, warfarin dose should be lowered
What should the NP consider prior to starting Allopurinol if a patient is of Southeast
Asian or African American descent?
Testing the patient for HLA-B *5801
- affects 7% of Southeast Asian descent and 4% of African American descent
What are other Urate Lowering Therapies for Gout?
Febuxostat/Uloric (Xanthine Oxidase Inhibitor)
- start at <=40 mg daily with a max dose of 80 mg daily
* switch to another agent if hx of CVD or new CV event
Probenecid (Uricosuric)
- start 100 mg once or twice daily
- can increase to 1 gram twice daily
Pegloticase/Krystexxa (Uricase)
- 8 mg IV every two weeks
- only recommended if other treatments fail
How long after the institution of urate lowering therapies should anti-inflammatory
medications such as Colchicine or NSAIDs continue?
3-6 months after the institution of therapy
