NUR 524 Exam 4 Questions and Answers Already Passed Latest Update 2025-2026
Erythrocyte Sedimentation Rate (ESR) - Answers timed test that measures the rate at which red
blood cells settle through a volume of plasma
Non Specific marker of inflammation (Clumping from inflammation causes RBCs to sink faster)
Rheumatoid Factor (RF) - Answers An immunoglobulin IgM antibodydirected against IgG
Usually present in RA, but can be present with other disorders
Presence of RF in RA usually signifies more severe disease
Antinuclear Antibody (ANA) - Answers Pathogenic autoantibodies
Present in 95% of SLE patients; Also present in 25-30% normal patints
HLA-B27 - Answers immunogenetic marker associated with spondyloarthropathies: present in
95% of pts with ankylosingspondylitis
50-80% of patients with spondyloarthropathy of inflammatory bowel disease, Reiter's syndrome
or psoriasis
Ankylosing Spondylitis - Answers chronic, progressive arthritis with stiffening of joints, primarily
of the spine; Seronegative spondyloarthropathies: group of inflammatory arthritides with many
shared features
Anklosing spondylitis
Reactive arthritis & Reiter's syndrome
psoriatic arthritis
Arthritis associated with inflammatory bowel disease(IBD)
These illnesses are characterized by: sacroiliitis, peripheral joint inflammation & eye
inflammation and
Ankylosing Spondylitis Patho and Presentation - Answers Inflammation of bony insertions of
ligaments & tendons -> new bone formation
Ligamentous inflammatory granulation tissue is gradually replaced by fibrocartilage & then
ossifies
,Insidious low back pain development with periods of exacerbation & remission. Diffuse, poorly
localized, described as a deep ache, nagging discomfort in low back below waist, buttocks or in
the hips; Worsens with rest improves exercise
Ankylosing Spondylitis S/S - Answers Asymmetric joint involvement, often large joints• Extra
articular manifestations: low-grade fever, fatigue and wt. loss• acute anterior uveitis: painful, red
eye, up to 30% of pts.• Cardiac involvement: aortic valve insufficiency, mild or severe
PE: Loss of normal lumbar lordosis
Often palpable muscle spasm Para spinal muscles
Decreased spine mobility
Ankylosing Spondylitis Diagnostics - Answers Rheumatology has 3 clinical criteria for diagnosis:
1. low back pain & stiffness >3 months, improving with exercise, not relieved by rest• 2. limited
ROM of lumbar spine• 3. Limited chest expansion
Presence of sacroiliitis on radiologic exam + 1 clinical criterion is diagnostic
Ankylosing Spondylitis Management - Answers Should be co-managed with rheumatology, &
refer to PT, ortho & ophthalmology
First line: NSAIDs: particularly indomethacin, tolmetin & sulindac. Other NSAIDs such as
ibuprofen & naproxen are variably effective.
High dose ASA not effective
TNF's: tumor necrosis factor agents are effective but are costly.
Pain management very important to minimize spinal deformity and allow pts.to exercise
Variety of neurological issues: 1. cord compression 2° to spinal fx of fusedspine, 2. Atlantoaxial
subluxation from chronic cervical involvement, 3.Cauda equina syndrome
Reactive Arthritis & Reiter's Syndrome - Answers Reactive arthritis = acute sterile inflammatory
arthropathy after an infection & no microbial invasion of the synoviumor or joint space & prior
infection is remote from joint
Reiter's syndrome: an example of reactive arthritis defined by classic triad of conjunctivitis,
urethritis &arthritis
, Reactive arthritis is the preferred term as many patients are first seen with an incomplete
syndrome without all 3 criteria
Reactive Arthritis: seen after Stds and GI infections: common causative agent: salmonella,
shigella, Yersinia, campylobacter & chlamydia
Reactive Arthiritis and Reiter's Incidence - Answers One study 260 individuals with Salmonella
infection 19 or 7% developed reactive arthritis.
Peak incidence of RA/RS is in 3rd decade of life
Postveneral Reiter's syndrome affects men more than women ranging from 9:1 to 5:1
Reactive Arthiritis and Reiter's Presentation - Answers When there is a documented infection:
arthritic s/s occur 10-20days later.
Less than 40% of pts. Present with the classic triad
Arthropathy of RS is distinctive: lower extremity, asymmetric joint involvement, "sausage digits",
heel pain, Achilles tendinitis, plantarfasciitis & sacroiliitis.
Dactylitis: "sausage digit" result of inflammation of insertions of ligaments/tendons:
characteristic of Reiter's & psoriatic arthritis
Course of disease is variable: initial episode 2-3 mos., may have recurrent acute attacks, 1/3 of
pts. Have sustained disease activity/chronicity
Less than 20% of patients have chronic/destructive/debilitating disease
Reactive Arthiritis and Reiter's Diagnostics - Answers Labs are non-specific, ESR & CRP will be
elevated, leukocytosis with thrombocytosis & often mild anemia.
X-ray shows sausage digits, Achilles tendinitis/plantarfasciitis & periosteal rxn of new bone
formation.
Periarticular demineralization/osteopenia notably absent in RS vs. RA
Erythrocyte Sedimentation Rate (ESR) - Answers timed test that measures the rate at which red
blood cells settle through a volume of plasma
Non Specific marker of inflammation (Clumping from inflammation causes RBCs to sink faster)
Rheumatoid Factor (RF) - Answers An immunoglobulin IgM antibodydirected against IgG
Usually present in RA, but can be present with other disorders
Presence of RF in RA usually signifies more severe disease
Antinuclear Antibody (ANA) - Answers Pathogenic autoantibodies
Present in 95% of SLE patients; Also present in 25-30% normal patints
HLA-B27 - Answers immunogenetic marker associated with spondyloarthropathies: present in
95% of pts with ankylosingspondylitis
50-80% of patients with spondyloarthropathy of inflammatory bowel disease, Reiter's syndrome
or psoriasis
Ankylosing Spondylitis - Answers chronic, progressive arthritis with stiffening of joints, primarily
of the spine; Seronegative spondyloarthropathies: group of inflammatory arthritides with many
shared features
Anklosing spondylitis
Reactive arthritis & Reiter's syndrome
psoriatic arthritis
Arthritis associated with inflammatory bowel disease(IBD)
These illnesses are characterized by: sacroiliitis, peripheral joint inflammation & eye
inflammation and
Ankylosing Spondylitis Patho and Presentation - Answers Inflammation of bony insertions of
ligaments & tendons -> new bone formation
Ligamentous inflammatory granulation tissue is gradually replaced by fibrocartilage & then
ossifies
,Insidious low back pain development with periods of exacerbation & remission. Diffuse, poorly
localized, described as a deep ache, nagging discomfort in low back below waist, buttocks or in
the hips; Worsens with rest improves exercise
Ankylosing Spondylitis S/S - Answers Asymmetric joint involvement, often large joints• Extra
articular manifestations: low-grade fever, fatigue and wt. loss• acute anterior uveitis: painful, red
eye, up to 30% of pts.• Cardiac involvement: aortic valve insufficiency, mild or severe
PE: Loss of normal lumbar lordosis
Often palpable muscle spasm Para spinal muscles
Decreased spine mobility
Ankylosing Spondylitis Diagnostics - Answers Rheumatology has 3 clinical criteria for diagnosis:
1. low back pain & stiffness >3 months, improving with exercise, not relieved by rest• 2. limited
ROM of lumbar spine• 3. Limited chest expansion
Presence of sacroiliitis on radiologic exam + 1 clinical criterion is diagnostic
Ankylosing Spondylitis Management - Answers Should be co-managed with rheumatology, &
refer to PT, ortho & ophthalmology
First line: NSAIDs: particularly indomethacin, tolmetin & sulindac. Other NSAIDs such as
ibuprofen & naproxen are variably effective.
High dose ASA not effective
TNF's: tumor necrosis factor agents are effective but are costly.
Pain management very important to minimize spinal deformity and allow pts.to exercise
Variety of neurological issues: 1. cord compression 2° to spinal fx of fusedspine, 2. Atlantoaxial
subluxation from chronic cervical involvement, 3.Cauda equina syndrome
Reactive Arthritis & Reiter's Syndrome - Answers Reactive arthritis = acute sterile inflammatory
arthropathy after an infection & no microbial invasion of the synoviumor or joint space & prior
infection is remote from joint
Reiter's syndrome: an example of reactive arthritis defined by classic triad of conjunctivitis,
urethritis &arthritis
, Reactive arthritis is the preferred term as many patients are first seen with an incomplete
syndrome without all 3 criteria
Reactive Arthritis: seen after Stds and GI infections: common causative agent: salmonella,
shigella, Yersinia, campylobacter & chlamydia
Reactive Arthiritis and Reiter's Incidence - Answers One study 260 individuals with Salmonella
infection 19 or 7% developed reactive arthritis.
Peak incidence of RA/RS is in 3rd decade of life
Postveneral Reiter's syndrome affects men more than women ranging from 9:1 to 5:1
Reactive Arthiritis and Reiter's Presentation - Answers When there is a documented infection:
arthritic s/s occur 10-20days later.
Less than 40% of pts. Present with the classic triad
Arthropathy of RS is distinctive: lower extremity, asymmetric joint involvement, "sausage digits",
heel pain, Achilles tendinitis, plantarfasciitis & sacroiliitis.
Dactylitis: "sausage digit" result of inflammation of insertions of ligaments/tendons:
characteristic of Reiter's & psoriatic arthritis
Course of disease is variable: initial episode 2-3 mos., may have recurrent acute attacks, 1/3 of
pts. Have sustained disease activity/chronicity
Less than 20% of patients have chronic/destructive/debilitating disease
Reactive Arthiritis and Reiter's Diagnostics - Answers Labs are non-specific, ESR & CRP will be
elevated, leukocytosis with thrombocytosis & often mild anemia.
X-ray shows sausage digits, Achilles tendinitis/plantarfasciitis & periosteal rxn of new bone
formation.
Periarticular demineralization/osteopenia notably absent in RS vs. RA
