NSG 555 Quiz 3 UPDATED ACTUAL Exam
Questions and CORECT Answers
workup for suspected bone ca - CORRECT ANSWER - often labs are normal. if chronic
indolent bone infection elevated WBC, ESR, CRP. ALP elevated, Ca, phos, uric acid, LFTs, etc.
orthogonal digital radiographs, or possibly bone scan, pet scan, etc. coordinate with orthopedic
oncology if needed.
bursitis - CORRECT ANSWER - inflammation of a the fluid sac between joints. common
in pseudogout, repetition, RA, TB, DM, immunosupression, etc.
neer and hawkins impingement signs - CORRECT ANSWER - shoulder
(subacromial)bursitis
olecranon bursitis - CORRECT ANSWER - posterior elbow swelling, often due to septic
bursitis by staph aureu. dx for this would be fluid aspiration for culture and start abx
hip bursitis - CORRECT ANSWER - Over greater trochanter of the femur - can
Create pressure over the bursa
Bursa - fluid filled sac that reduces friction
Of tendons that cross the bony prominence.
When the bursa is irritated from too much
Pressure from the tendons, it becomes
Inflamed.
S/S - snapping of the hip when they climb
Stairs
TX - PRICES - reduce activity
fibromyalgia widespread pain index - CORRECT ANSWER - # of areas the pt has had
pain over last week, score # of areas.
,Then score symptom severity during last 6 months and add if HA, pain/cramps in low abd. and
depression.
fibromyalgia diagnostic criteria - CORRECT ANSWER - 1. widespread pain index >7 and
symptoms severity score >5 OR wpi of 4-6 and SSS of >9
2. generalized pain (pain in at least 4 out of 5 regions)
3. symptoms present for at least 3 months
4. dx of fibromyalgia irrespective of other dx, does not exclude the presence of other clinically
important illnesses
pathophysiology FMS - CORRECT ANSWER - unclear. more likely a CNS dysfunction
and not muscle, autoimmune or viral.
pain at periphery processed in spinal cord and transmitted to brain. for some reason becomes
loud @ level of spinal cord and brain (central sensitization). prain responds with pain recognition
@ lower thershold
decreased GH, insulin like growth factor (IGF) and possibly prolactin may contribute in FMS
patients, these are released during sleep, disturbance with non-REM sleep-->fatiuge
tx with GH inc. IGF and improves pain and sleep but is $$$$$$$$$$$$$$$$
PE and presentation of fibromyalgia and myofascial pain syndrome - CORRECT
ANSWER - widespread pain + chronic fatiuge. may have other somatic fomplaints:
cognitive difficulties, nonrestorative sleep, auditory, ocular, rhinitis, ax, migraines, palpitations,
I/bs, etc
workup for fibromyalgia - CORRECT ANSWER - mainly to rule out other differentials:
CBC, ESR or CROP
vit D
TSH
, ANA, rheum. factor and ACPA ONLY if suggestive of RA or SLE
differential dx for fibromyalgia - CORRECT ANSWER - lupus, myofascial pain
syndrome, hypothyroid, bursitis, depression/anxiety, RA, polymyalgia rheumatic, polymositis
tx of fibromyalgia - CORRECT ANSWER - CBT, sleep, exercise, TCAs @ low toses like
amitriptyline 10 mg 2-3 hrs before bedtime
flexeril (also a TC med)
SSRI or SNRI (SNRI preferred)
gabapentin, pregabalin, zolpidem,
NSAIDs do not help.
determine pain generator and treat these
gout - CORRECT ANSWER - systemic metabolic disease due to accumulation of uric
acid instead of converting it to excretable substance. Many people with hyperuricemia never
develop gout.
can be caused by low dose asa, obesity, ckd, metabolic syndrome, and diuretics
uricase - CORRECT ANSWER - end product of purine metabolism (purines in meats,
fermented etoh), converts uric acid to allantoid which can be urinated out. If unable to excrete
uricase then microtophi form on cooler parts of body like joints, and earlobes
gout - CORRECT ANSWER - usually recurrent episodes of painful arthritis in 1 joint in
men or 4 or less joints in postmenopausal womena nd in men with subsequent flares. if not
treated causes structural damage
4 stages of gout - CORRECT ANSWER - asymptomatic hyperuricemia
acute gout attacks
intercritical gout (intervals between acute attacks)
and chronic tophaceous gout
Questions and CORECT Answers
workup for suspected bone ca - CORRECT ANSWER - often labs are normal. if chronic
indolent bone infection elevated WBC, ESR, CRP. ALP elevated, Ca, phos, uric acid, LFTs, etc.
orthogonal digital radiographs, or possibly bone scan, pet scan, etc. coordinate with orthopedic
oncology if needed.
bursitis - CORRECT ANSWER - inflammation of a the fluid sac between joints. common
in pseudogout, repetition, RA, TB, DM, immunosupression, etc.
neer and hawkins impingement signs - CORRECT ANSWER - shoulder
(subacromial)bursitis
olecranon bursitis - CORRECT ANSWER - posterior elbow swelling, often due to septic
bursitis by staph aureu. dx for this would be fluid aspiration for culture and start abx
hip bursitis - CORRECT ANSWER - Over greater trochanter of the femur - can
Create pressure over the bursa
Bursa - fluid filled sac that reduces friction
Of tendons that cross the bony prominence.
When the bursa is irritated from too much
Pressure from the tendons, it becomes
Inflamed.
S/S - snapping of the hip when they climb
Stairs
TX - PRICES - reduce activity
fibromyalgia widespread pain index - CORRECT ANSWER - # of areas the pt has had
pain over last week, score # of areas.
,Then score symptom severity during last 6 months and add if HA, pain/cramps in low abd. and
depression.
fibromyalgia diagnostic criteria - CORRECT ANSWER - 1. widespread pain index >7 and
symptoms severity score >5 OR wpi of 4-6 and SSS of >9
2. generalized pain (pain in at least 4 out of 5 regions)
3. symptoms present for at least 3 months
4. dx of fibromyalgia irrespective of other dx, does not exclude the presence of other clinically
important illnesses
pathophysiology FMS - CORRECT ANSWER - unclear. more likely a CNS dysfunction
and not muscle, autoimmune or viral.
pain at periphery processed in spinal cord and transmitted to brain. for some reason becomes
loud @ level of spinal cord and brain (central sensitization). prain responds with pain recognition
@ lower thershold
decreased GH, insulin like growth factor (IGF) and possibly prolactin may contribute in FMS
patients, these are released during sleep, disturbance with non-REM sleep-->fatiuge
tx with GH inc. IGF and improves pain and sleep but is $$$$$$$$$$$$$$$$
PE and presentation of fibromyalgia and myofascial pain syndrome - CORRECT
ANSWER - widespread pain + chronic fatiuge. may have other somatic fomplaints:
cognitive difficulties, nonrestorative sleep, auditory, ocular, rhinitis, ax, migraines, palpitations,
I/bs, etc
workup for fibromyalgia - CORRECT ANSWER - mainly to rule out other differentials:
CBC, ESR or CROP
vit D
TSH
, ANA, rheum. factor and ACPA ONLY if suggestive of RA or SLE
differential dx for fibromyalgia - CORRECT ANSWER - lupus, myofascial pain
syndrome, hypothyroid, bursitis, depression/anxiety, RA, polymyalgia rheumatic, polymositis
tx of fibromyalgia - CORRECT ANSWER - CBT, sleep, exercise, TCAs @ low toses like
amitriptyline 10 mg 2-3 hrs before bedtime
flexeril (also a TC med)
SSRI or SNRI (SNRI preferred)
gabapentin, pregabalin, zolpidem,
NSAIDs do not help.
determine pain generator and treat these
gout - CORRECT ANSWER - systemic metabolic disease due to accumulation of uric
acid instead of converting it to excretable substance. Many people with hyperuricemia never
develop gout.
can be caused by low dose asa, obesity, ckd, metabolic syndrome, and diuretics
uricase - CORRECT ANSWER - end product of purine metabolism (purines in meats,
fermented etoh), converts uric acid to allantoid which can be urinated out. If unable to excrete
uricase then microtophi form on cooler parts of body like joints, and earlobes
gout - CORRECT ANSWER - usually recurrent episodes of painful arthritis in 1 joint in
men or 4 or less joints in postmenopausal womena nd in men with subsequent flares. if not
treated causes structural damage
4 stages of gout - CORRECT ANSWER - asymptomatic hyperuricemia
acute gout attacks
intercritical gout (intervals between acute attacks)
and chronic tophaceous gout
