NRNP 6560 Midterm exam Questions An
kh kh kh kh kh
d Answers
kh
Surgerykhriskkhclasseskh-khcorrectkhans-Classkh1:khbenefitskhoutweighkhrisk,khshouldkhbekhdone
Classkh2a:khreasonablekhtokhperform
Classkh2b:khshouldkhbekhconsidered
Classkh3:khrarelykhappropriate
Generalkhruleskhforkhsurgery:khtestingkh-khcorrectkhans-
ECGkhbeforekhsurgerykhonlykhifkhcoronarykhdisease,khexceptkhwhenkhlowkhriskkhsurgery
Stresskhtestkhnotkhindicatedkhbeforekhsurgery
Dokhnotkhdokhprophylactickhcoronarykhrevascularization
Medskhbeforekhsurgerykh-khcorrectkhans--
khDiabetickhagents:khUsekhinsulinkhtherapykhtokhmaintainkhglycemickhgoals(iii)khDiscontinuekhbig
uanides,khalphakhglucosidasekhinhibitors,khthiazolidinediones,khsulfonylureas,khandkhGLP-
1khagonists
-khDokhnotkhstartkhaspirinkhbeforekhsurgery
-khStopkhWarfarinkh5khdayskhbeforekhsurgery.khMaykhbekhbridgedkhwithkhLovenox.kh
-khDokhnotkhstopkhstatinkhbeforekhsurgery
-khDokhnotkhstartkhbeta-blockerkhonkhdaykhofkhsurgery,khbutkhmaykhcontinue
Assessmentkhofkhsurgicalkhriskkh-khcorrectkhans--
khUnstablekhcardiackhconditionkh(recentkhMI,khactivekhangina,khactivekhHF,khuncontrolledkhHTN,kh
severekhvalvularkhdisease),khconcernkhwithkhCAD,khCHF.kharrhythmia,khCVD
-khpatientkhstablekhorkhunstable?
-khurgencykhofkhthekhprocedurekh(oncologykhwillkhbekhtimekhsensitive)
-khriskkhofkhprocedure
-khnutritionalkhstatuskh
-khimmunekhcompetence
-
khdeterminekhfunctionalkhcapacitykh(needkhtokhbekhmorekhthankh4khMETS,khmorekhthankh10khMETs
khmakeskhlowkhrisk)
Lowkhriskkhsurgerieskh-khcorrectkhans-catarcts
breastkhbiopsy
cystoscopy,khvasectomy
laporascopickhprocedures
Plastickhsurgery
intermediatekhriskkhsurgerieskh-khcorrectkhans-Head/khneckkhsurgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/khknee
Hysterectomy
cholecystectomy
,nephrectomy
nonkhmajotkhintrathoracic
Highkhriskkhsurgerieskh-khcorrectkhans-aortic/khcabg
transplants
spinalkhreconstruction
peripheralkhvascularkhsurgery
Lee'skhrevisedkhcardiackhriskkhindexkh-khcorrectkhans-6khpoints:
Highkhriskkhsurgerykh=kh1
CADkh=kh1
CHFkh=kh1
Cerebrovascularkhdiseasekh=kh1
DMkh1khonkhinsulinkh=kh1
Creatkhgreaterkhthankh2kh=kh1
1kh=khlowkhrisk
2kh=khmoderatekhrisk
3kh=khhighkhrisk
SCIPkhpre-operativekhinfectionkhmeasureskh-khcorrectkhans--
khProphylactickhantibioticskhshouldkhbekhreceivedkhwithinkh1khhkhpriorkhtokhsurgicalkhincision
-khbekhselectedkhforkhactivitykhagainstkhthekhmostkhprobablekhantimicrobialkhcontaminantskh
-khbekhdiscontinuedkhwithinkh24khhkhafterkhthekhsurgerykhend-time
Postoperativekhinfectionkhreductionkhmethodskh-khcorrectkhans--khpre-
opkhhairkhremovalkh(clippers)
-khwashkhhands
-khnormothermia
-khmaintainkheuglycemia
-khurinarykhcatheterskharekhtokhbekhremovedkhwithinkhthekhfirstkhtwokhpostoperativekhdays
Osteoarthritis:khwhat,khincidencekh-khcorrectkhans-
Slowkhdestructionkhofkhbones/khjointkhfollowedkhbykhproductionkhofkhreplacementkhcollagenkhwhi
chkhcauseskhinflammatorykhchanges
-kholderkhthankh60
-khmorekhfemalekhafterkh55
-khmorekhblackkhthankhwhitekhwomen
-khmenkhandkhwomenkhequalkhriskkhbetweenkh45kh-kh55
-khabnormalkhheightkhorkhweightkh(obesity)
-khrepetitivekhmovement
-khpriorkhtraumakh(sprains/khdislocations)
-khdiabetickhneuropathy
-khgenetic
Osteoarthritiskhfindingskhandkhdiagnosticskh-khcorrectkhans--khPainkhinkhweightkhbearingkhjoints
-khstiffnesskhafterkhsitting,khgetskhbetterkhwhenkharising
-khfeelingkhofkhinstabilitykhonkhstairs
-khfinekhmotorkhskillskhdeficit
-khlargerkhaffectedkhjoints
-khHeberdenkhnoduleskh(bonykhbumpskhonkhthekhfingerkhjointkhclosestkhtokhthekhfingernail)
,-khBouchard'skhnoduleskh(bonykhbumpskhonkhthekhmiddlekhjointkhofkhthekhfinger)
-khlimitedkhROMkhwithkhcrepitus
-
khxrkhshowskhnarrowingkhofkhjointkhspacekh(needkhanteroposteriorkhandkhlateralkhkneekhfilmskhbilat
erally)
-khsynovialkhfluidkhiskhclearkhandkhwithoutkhWBC
Osteoarthritiskhtreatmentkh-khcorrectkhans-
Goalkhiskhtokhrelievekhsymptoms,khmaintain/khimprovekhfunction,khandkhavoidkhdrugkhtoxicity
HandkhOA:
-khrest/khjointkhprotection,khwithkhsplinting
-khheat/khcoldkhtherapy
-khtopicalkhcapsaicin
-khtopicalkhNSAIDkh(trolaminekhsalicylate)kh(especiallykhforkholderkhthankh75)
-
khOralkhNSAIDS,khinclkhCOX2khinhibitorskhsuchkhaskhcelecoxibkh(Celebrex)kh(maykhcausekhcardi
ackhproblems)
-khtramadol
-khnokhopioids
Hip/khkneekhOA:
-khweightkhreduction,khcardiovascularkhexercises
-khtranscutanouskhexternalkhnervekhstimulator
-khacetaminophen
-khTopicalkhNSAIDSkh(knee)
-khintraarticularkhcorticosteroidkhinjections
-khsurgerykh(jointkhreplacement)
Rheumatoidkharthritis:khwhat,khwhokh-khcorrectkhans-
chronic,khsystemickhautoimmunekhdiseasekhthatkhcauseskhinflammationkhofkhconnectivekhtissu
e,khfirstkhthatkhofkhjiontskhthemkhotherkhsoftkhtissueskh(renal,khcardiovascular,khpulm).khTNF-
alphakhplayskhakhbigkhrole
-khmorekhwomenkhthankhmen
-khunknownkhcausekh
-khEpsteinkhBarrkhvirus
Rheumatoidkharthritis:khFindingskhandkhdiagnosticskh-khcorrectkhans--
khsymmetrickhjoint/khmusclekhpain,khworsekhinkhthekhmorningkhthenkhgetskhbetter
-khweakness,khfatigue
-khanorexia,khweightkhloss
-khgeneralizedkhmalaise
-khswollenkhjoints/khboggykhfeelingkhofkhjointskhwithkhdeformitykhofkhjoints
-khwarm,khredkhskinkhonkhaffectedkhjoints
later:
-khpleuralkheffusionskhandkhpulmonarykhnodules
-khinflammationkhofkhsclereakh(scleritis)
, -khpericarditis,khmyocarditis
-khsplenomegalykh(Felty'skhsyndrome)
-khanemiakh(hypochromic,khmicrocytic)khwithkhlowkhferritin
-khpossibly:khpositivekhrheumatoidkhfactor
-khXR:khjointkhswelling,khlaterkhcorticalkhandkhspacekhthinning
-khsynovialkhfluid:khyellow,khthickkhwithkhelevatedkhWBCkhupkhtokh100.000
Felty'skhsyndromekh-khcorrectkhans-rheumatoidkharthritis,khsplenomegaly,khneutropenia
Rheumatoidkharthritiskhtreatmentkh-khcorrectkhans--khearlykhtreatmentkhbetterkhthankhstepwise
-khearlykhreferralkhrheumatologist
-khdisease-modifyingkhanti-rheumatickhdrugskh(DMARDs):kh
-khmethotrexatekh(khnokhalcohol,khmonitorkhrenalkhandkhliver,khgivekhwithkhfolickhacid)
-khcyclosporine
-khGoldkhpreparationskh(cankhcausekhthrombocytopenia)
-khHydroxychloroquine:khantimalarialkhdrugkh(maykhcausekhvisualkhchanges,khmonitor)
-khsulfasalazine,khmoderatekhRA
-khLeflunomide,khmoderatekhtokhseverekhRA
-khEtanercept
-khmonitorkhliverkhfunctionkhwithkhDMARDs
-khscreenkhforkhTBkh(skinkhtest)khandkhHepkhB
-khsurgery:khjointkhdebridement,khjointkhreplacement
Gout:khwhat,khwhokh-khcorrectkhans-
Inflammatorykhdisorderkhinkhresponsekhtokhhighkhurickhacidkhproduction/khlevelskhinkhbloodkhandkh
synovialkhfluidkhcausingkhcrystallizationkhwhichkhcauseskhinflammationkh(TypekhAkhandkhMediter
ranean)
- impairedkhrenalkhfunctionkhwhichkhcauseskhexcesskhurickhacid
kh kh
-khfoodskhhighkhinkhpurine,khsuchkhaskhdairy,khredkhmeat,khshellfish,khbeer
Goutkhfindings,khdiagnosticskh-khcorrectkhans--
khacutekhpainfulkhjoint,khoftenkhgreatkhtoekh(warm,khswollen)
-khpainkhatkhnight
-khflankkhpainkhbecausekhofkhrenalkhcalculi
-khfever
-khleukocytosis
-khelevatedkherythrocytekhsedimentationkhrate
-khtophikh(bumpkhunderkhskin)khonkhear
-khlimitedkhjointkhmotion
-khelevatedkhserumkhurickhacidkh(greaterkhthankh7mg/dl)
-khuratekhcrystalskhseenkhwithkhjointkhaspiration
-khxr:khjointkherosionkhandkhrenalkhstones
Goutkhtreatmentkh-khcorrectkhans--khNSAIDS:khnaproxen,khondomethacin,khsulindac
-
khColchicinekhforkhthosekhwhokhdokhnotkhtoleratekhNSAIDSkh(cautionkhwithkhrenalkhimpairment).kh
Alsokhforkhprophylaxis
-khCorticosteroids,khifkhNSAIDSkhandkhcolchicinekhnotkhtolerated
kh kh kh kh kh
d Answers
kh
Surgerykhriskkhclasseskh-khcorrectkhans-Classkh1:khbenefitskhoutweighkhrisk,khshouldkhbekhdone
Classkh2a:khreasonablekhtokhperform
Classkh2b:khshouldkhbekhconsidered
Classkh3:khrarelykhappropriate
Generalkhruleskhforkhsurgery:khtestingkh-khcorrectkhans-
ECGkhbeforekhsurgerykhonlykhifkhcoronarykhdisease,khexceptkhwhenkhlowkhriskkhsurgery
Stresskhtestkhnotkhindicatedkhbeforekhsurgery
Dokhnotkhdokhprophylactickhcoronarykhrevascularization
Medskhbeforekhsurgerykh-khcorrectkhans--
khDiabetickhagents:khUsekhinsulinkhtherapykhtokhmaintainkhglycemickhgoals(iii)khDiscontinuekhbig
uanides,khalphakhglucosidasekhinhibitors,khthiazolidinediones,khsulfonylureas,khandkhGLP-
1khagonists
-khDokhnotkhstartkhaspirinkhbeforekhsurgery
-khStopkhWarfarinkh5khdayskhbeforekhsurgery.khMaykhbekhbridgedkhwithkhLovenox.kh
-khDokhnotkhstopkhstatinkhbeforekhsurgery
-khDokhnotkhstartkhbeta-blockerkhonkhdaykhofkhsurgery,khbutkhmaykhcontinue
Assessmentkhofkhsurgicalkhriskkh-khcorrectkhans--
khUnstablekhcardiackhconditionkh(recentkhMI,khactivekhangina,khactivekhHF,khuncontrolledkhHTN,kh
severekhvalvularkhdisease),khconcernkhwithkhCAD,khCHF.kharrhythmia,khCVD
-khpatientkhstablekhorkhunstable?
-khurgencykhofkhthekhprocedurekh(oncologykhwillkhbekhtimekhsensitive)
-khriskkhofkhprocedure
-khnutritionalkhstatuskh
-khimmunekhcompetence
-
khdeterminekhfunctionalkhcapacitykh(needkhtokhbekhmorekhthankh4khMETS,khmorekhthankh10khMETs
khmakeskhlowkhrisk)
Lowkhriskkhsurgerieskh-khcorrectkhans-catarcts
breastkhbiopsy
cystoscopy,khvasectomy
laporascopickhprocedures
Plastickhsurgery
intermediatekhriskkhsurgerieskh-khcorrectkhans-Head/khneckkhsurgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/khknee
Hysterectomy
cholecystectomy
,nephrectomy
nonkhmajotkhintrathoracic
Highkhriskkhsurgerieskh-khcorrectkhans-aortic/khcabg
transplants
spinalkhreconstruction
peripheralkhvascularkhsurgery
Lee'skhrevisedkhcardiackhriskkhindexkh-khcorrectkhans-6khpoints:
Highkhriskkhsurgerykh=kh1
CADkh=kh1
CHFkh=kh1
Cerebrovascularkhdiseasekh=kh1
DMkh1khonkhinsulinkh=kh1
Creatkhgreaterkhthankh2kh=kh1
1kh=khlowkhrisk
2kh=khmoderatekhrisk
3kh=khhighkhrisk
SCIPkhpre-operativekhinfectionkhmeasureskh-khcorrectkhans--
khProphylactickhantibioticskhshouldkhbekhreceivedkhwithinkh1khhkhpriorkhtokhsurgicalkhincision
-khbekhselectedkhforkhactivitykhagainstkhthekhmostkhprobablekhantimicrobialkhcontaminantskh
-khbekhdiscontinuedkhwithinkh24khhkhafterkhthekhsurgerykhend-time
Postoperativekhinfectionkhreductionkhmethodskh-khcorrectkhans--khpre-
opkhhairkhremovalkh(clippers)
-khwashkhhands
-khnormothermia
-khmaintainkheuglycemia
-khurinarykhcatheterskharekhtokhbekhremovedkhwithinkhthekhfirstkhtwokhpostoperativekhdays
Osteoarthritis:khwhat,khincidencekh-khcorrectkhans-
Slowkhdestructionkhofkhbones/khjointkhfollowedkhbykhproductionkhofkhreplacementkhcollagenkhwhi
chkhcauseskhinflammatorykhchanges
-kholderkhthankh60
-khmorekhfemalekhafterkh55
-khmorekhblackkhthankhwhitekhwomen
-khmenkhandkhwomenkhequalkhriskkhbetweenkh45kh-kh55
-khabnormalkhheightkhorkhweightkh(obesity)
-khrepetitivekhmovement
-khpriorkhtraumakh(sprains/khdislocations)
-khdiabetickhneuropathy
-khgenetic
Osteoarthritiskhfindingskhandkhdiagnosticskh-khcorrectkhans--khPainkhinkhweightkhbearingkhjoints
-khstiffnesskhafterkhsitting,khgetskhbetterkhwhenkharising
-khfeelingkhofkhinstabilitykhonkhstairs
-khfinekhmotorkhskillskhdeficit
-khlargerkhaffectedkhjoints
-khHeberdenkhnoduleskh(bonykhbumpskhonkhthekhfingerkhjointkhclosestkhtokhthekhfingernail)
,-khBouchard'skhnoduleskh(bonykhbumpskhonkhthekhmiddlekhjointkhofkhthekhfinger)
-khlimitedkhROMkhwithkhcrepitus
-
khxrkhshowskhnarrowingkhofkhjointkhspacekh(needkhanteroposteriorkhandkhlateralkhkneekhfilmskhbilat
erally)
-khsynovialkhfluidkhiskhclearkhandkhwithoutkhWBC
Osteoarthritiskhtreatmentkh-khcorrectkhans-
Goalkhiskhtokhrelievekhsymptoms,khmaintain/khimprovekhfunction,khandkhavoidkhdrugkhtoxicity
HandkhOA:
-khrest/khjointkhprotection,khwithkhsplinting
-khheat/khcoldkhtherapy
-khtopicalkhcapsaicin
-khtopicalkhNSAIDkh(trolaminekhsalicylate)kh(especiallykhforkholderkhthankh75)
-
khOralkhNSAIDS,khinclkhCOX2khinhibitorskhsuchkhaskhcelecoxibkh(Celebrex)kh(maykhcausekhcardi
ackhproblems)
-khtramadol
-khnokhopioids
Hip/khkneekhOA:
-khweightkhreduction,khcardiovascularkhexercises
-khtranscutanouskhexternalkhnervekhstimulator
-khacetaminophen
-khTopicalkhNSAIDSkh(knee)
-khintraarticularkhcorticosteroidkhinjections
-khsurgerykh(jointkhreplacement)
Rheumatoidkharthritis:khwhat,khwhokh-khcorrectkhans-
chronic,khsystemickhautoimmunekhdiseasekhthatkhcauseskhinflammationkhofkhconnectivekhtissu
e,khfirstkhthatkhofkhjiontskhthemkhotherkhsoftkhtissueskh(renal,khcardiovascular,khpulm).khTNF-
alphakhplayskhakhbigkhrole
-khmorekhwomenkhthankhmen
-khunknownkhcausekh
-khEpsteinkhBarrkhvirus
Rheumatoidkharthritis:khFindingskhandkhdiagnosticskh-khcorrectkhans--
khsymmetrickhjoint/khmusclekhpain,khworsekhinkhthekhmorningkhthenkhgetskhbetter
-khweakness,khfatigue
-khanorexia,khweightkhloss
-khgeneralizedkhmalaise
-khswollenkhjoints/khboggykhfeelingkhofkhjointskhwithkhdeformitykhofkhjoints
-khwarm,khredkhskinkhonkhaffectedkhjoints
later:
-khpleuralkheffusionskhandkhpulmonarykhnodules
-khinflammationkhofkhsclereakh(scleritis)
, -khpericarditis,khmyocarditis
-khsplenomegalykh(Felty'skhsyndrome)
-khanemiakh(hypochromic,khmicrocytic)khwithkhlowkhferritin
-khpossibly:khpositivekhrheumatoidkhfactor
-khXR:khjointkhswelling,khlaterkhcorticalkhandkhspacekhthinning
-khsynovialkhfluid:khyellow,khthickkhwithkhelevatedkhWBCkhupkhtokh100.000
Felty'skhsyndromekh-khcorrectkhans-rheumatoidkharthritis,khsplenomegaly,khneutropenia
Rheumatoidkharthritiskhtreatmentkh-khcorrectkhans--khearlykhtreatmentkhbetterkhthankhstepwise
-khearlykhreferralkhrheumatologist
-khdisease-modifyingkhanti-rheumatickhdrugskh(DMARDs):kh
-khmethotrexatekh(khnokhalcohol,khmonitorkhrenalkhandkhliver,khgivekhwithkhfolickhacid)
-khcyclosporine
-khGoldkhpreparationskh(cankhcausekhthrombocytopenia)
-khHydroxychloroquine:khantimalarialkhdrugkh(maykhcausekhvisualkhchanges,khmonitor)
-khsulfasalazine,khmoderatekhRA
-khLeflunomide,khmoderatekhtokhseverekhRA
-khEtanercept
-khmonitorkhliverkhfunctionkhwithkhDMARDs
-khscreenkhforkhTBkh(skinkhtest)khandkhHepkhB
-khsurgery:khjointkhdebridement,khjointkhreplacement
Gout:khwhat,khwhokh-khcorrectkhans-
Inflammatorykhdisorderkhinkhresponsekhtokhhighkhurickhacidkhproduction/khlevelskhinkhbloodkhandkh
synovialkhfluidkhcausingkhcrystallizationkhwhichkhcauseskhinflammationkh(TypekhAkhandkhMediter
ranean)
- impairedkhrenalkhfunctionkhwhichkhcauseskhexcesskhurickhacid
kh kh
-khfoodskhhighkhinkhpurine,khsuchkhaskhdairy,khredkhmeat,khshellfish,khbeer
Goutkhfindings,khdiagnosticskh-khcorrectkhans--
khacutekhpainfulkhjoint,khoftenkhgreatkhtoekh(warm,khswollen)
-khpainkhatkhnight
-khflankkhpainkhbecausekhofkhrenalkhcalculi
-khfever
-khleukocytosis
-khelevatedkherythrocytekhsedimentationkhrate
-khtophikh(bumpkhunderkhskin)khonkhear
-khlimitedkhjointkhmotion
-khelevatedkhserumkhurickhacidkh(greaterkhthankh7mg/dl)
-khuratekhcrystalskhseenkhwithkhjointkhaspiration
-khxr:khjointkherosionkhandkhrenalkhstones
Goutkhtreatmentkh-khcorrectkhans--khNSAIDS:khnaproxen,khondomethacin,khsulindac
-
khColchicinekhforkhthosekhwhokhdokhnotkhtoleratekhNSAIDSkh(cautionkhwithkhrenalkhimpairment).kh
Alsokhforkhprophylaxis
-khCorticosteroids,khifkhNSAIDSkhandkhcolchicinekhnotkhtolerated
