FNP 3 Exam 3 Rheumatology Latest
Questions And Correct Answers.
Rheumatoid Arthritis Incidence - Answer Peaks in 40s-50s.
2.5 times more common in females than males.
Rheumatoid Arthritis Scoring - Answer Applies to those who have at least 1 joint involved with definite
clinical synovitis that isn't explained by other disease.
Rheumatoid Scoring Categories - Answer Joint Involvement, Serology (RF and anti-CCP), Acute phase
reactants (CRP, ESR), Duration of symptoms. **Need 6 out of 10 to be diagnosed with RA.
Key Features of RA - Answer Sx > 6 weeks
Inflammatory Synovitis- palpable swelling
Morning stiffness for > 1 hour
Fatigue
Symmetrical
Usually involves 3 joints: MCP, PIP, wrists
**NOT SEEN IN THORACOLUMBAR SPINE, DIPs, IPs of toes.
RA Serologies - Answer RF not specific, + in many diseases, but high titer early in disease is a bad sign.
Anti-CCP: Most sensitive/specific marker for RA.
*If both RF and CCP are +- higher correlation with erosive disease.
RA on Xray - Answer Marginal Erosion
Narrowing of joint space
, Extra-articular RA - Answer Splinter hemorrhages (vasculitis)
Fatigue
Raynaud's
Dry eyes/moth: Sjogren's
Interstitial Lung disease
Pleuritis/pericarditis
1st step in RA Management - Answer Confirm Dx and refer to rheumatology, determine where patient
stands in course of disease. CXR, Xray of joint to look for erosion, joint space narrowing.
RA treatment - Answer ROM, conditioning/strengthening.
2400mg daily NSAIDs, immunosuppressants, cytotoxic, biologic.
Can do intra-articular steroids if flare in one joint.
Prednisone for RA - Answer Low dose < 10mg per day. Substitute for NSAIDs. Used as bridge therapy,
used for flares.
If used long term needs prophylactic treatment for osteoporosis.
DMARDs - Answer sulfasalazine: Monitor CBC
Hydroxychloroquine (Plaquenil): safest, but watch retinal toxicity. ** Can develop plaque on back of eye-
need eye exam at 6 months and 1 year then once per year.
Methotrexate - Answer Most effective, gold standard. Max Dose 25 mg. Need to add folic acid
supplement.
Hepatotoxicity and Bone Marrow suppression: monitor LFTs and Blood counts: best time is just before
3rd dose for accuracy.
Increased risk of lymphoma, but RA patients already have increased risk of lymphoma.
DMARDs/Biologics Monitoring - Answer CBC, BUN/Cr, LFTs.
Blood work every 2 weeks during early treatment.
Questions And Correct Answers.
Rheumatoid Arthritis Incidence - Answer Peaks in 40s-50s.
2.5 times more common in females than males.
Rheumatoid Arthritis Scoring - Answer Applies to those who have at least 1 joint involved with definite
clinical synovitis that isn't explained by other disease.
Rheumatoid Scoring Categories - Answer Joint Involvement, Serology (RF and anti-CCP), Acute phase
reactants (CRP, ESR), Duration of symptoms. **Need 6 out of 10 to be diagnosed with RA.
Key Features of RA - Answer Sx > 6 weeks
Inflammatory Synovitis- palpable swelling
Morning stiffness for > 1 hour
Fatigue
Symmetrical
Usually involves 3 joints: MCP, PIP, wrists
**NOT SEEN IN THORACOLUMBAR SPINE, DIPs, IPs of toes.
RA Serologies - Answer RF not specific, + in many diseases, but high titer early in disease is a bad sign.
Anti-CCP: Most sensitive/specific marker for RA.
*If both RF and CCP are +- higher correlation with erosive disease.
RA on Xray - Answer Marginal Erosion
Narrowing of joint space
, Extra-articular RA - Answer Splinter hemorrhages (vasculitis)
Fatigue
Raynaud's
Dry eyes/moth: Sjogren's
Interstitial Lung disease
Pleuritis/pericarditis
1st step in RA Management - Answer Confirm Dx and refer to rheumatology, determine where patient
stands in course of disease. CXR, Xray of joint to look for erosion, joint space narrowing.
RA treatment - Answer ROM, conditioning/strengthening.
2400mg daily NSAIDs, immunosuppressants, cytotoxic, biologic.
Can do intra-articular steroids if flare in one joint.
Prednisone for RA - Answer Low dose < 10mg per day. Substitute for NSAIDs. Used as bridge therapy,
used for flares.
If used long term needs prophylactic treatment for osteoporosis.
DMARDs - Answer sulfasalazine: Monitor CBC
Hydroxychloroquine (Plaquenil): safest, but watch retinal toxicity. ** Can develop plaque on back of eye-
need eye exam at 6 months and 1 year then once per year.
Methotrexate - Answer Most effective, gold standard. Max Dose 25 mg. Need to add folic acid
supplement.
Hepatotoxicity and Bone Marrow suppression: monitor LFTs and Blood counts: best time is just before
3rd dose for accuracy.
Increased risk of lymphoma, but RA patients already have increased risk of lymphoma.
DMARDs/Biologics Monitoring - Answer CBC, BUN/Cr, LFTs.
Blood work every 2 weeks during early treatment.
