1 of 78
NRNP 6540 MIDTERM EXAM LATEST/NRNP6540 MIDTERM EXAM
PREPARATION/ NRNP 6540 MIDTERM EXAM 200 PRACTICE
QUESTIONS AND ANSWERS 2025/2026 (VERIFIED ANSWERS)
Rheumatoid arthritis: what, who - ......ANSWER........chronic, systemic autoimmune
disease that causes inflammation of connective tissue, first that of joints them other soft
tissues (renal, cardiovascular, pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
- Epstein Barr virus
Rheumatoid arthritis: Findings and diagnostics - ......ANSWER........- symmetric joint/
muscle pain, worse in the morning then gets better
- weakness, fatigue
- anorexia, weight loss
- generalized malaise
- swollen joints/ boggy feeling of joints with deformity of joints
- warm, red skin on affected joints
later:
- pleural effusions and pulmonary nodules
- inflammation of sclerae (scleritis)
- pericarditis, myocarditis
- splenomegaly (Felty's syndrome)
- anemia (hypochromic, microcytic) with low ferritin
- possibly: positive rheumatoid factor
,2 of 78
- XR: joint swelling, later cortical and space thinning
- synovial fluid: yellow, thick with elevated WBC up to 100.000
Felty's syndrome - ......ANSWER........rheumatoid arthritis, splenomegaly, neutropenia
Rheumatoid arthritis treatment - ......ANSWER........- early treatment better than stepwise
- early referral rheumatologist
- disease-modifying anti-rheumatic drugs (DMARDs):
- methotrexate (no alcohol, monitor renal and liver, give with folic acid)
- cyclosporine
- Gold preparations (can cause thrombocytopenia)
- Hydroxychloroquine: antimalarial drug (may cause visual changes, monitor)
- sulfasalazine, moderate RA
- Leflunomide, moderate to severe RA
- Etanercept
- monitor liver function with DMARDs
- screen for TB (skin test) and Hep B
- surgery: joint debridement, joint replacement
Gout: what, who - ......ANSWER........Inflammatory disorder in response to high uric acid
production/ levels in blood and synovial fluid causing crystallization which causes
inflammation (Type A and Mediterranean)
- impaired renal function which causes excess uric acid
- foods high in purine, such as dairy, red meat, shellfish, beer
,3 of 78
Gout findings, diagnostics - ......ANSWER........- acute painful joint, often great toe (warm,
swollen)
- pain at night
- flank pain because of renal calculi
- fever
- leukocytosis
- elevated erythrocyte sedimentation rate
- tophi (bump under skin) on ear
- limited joint motion
- elevated serum uric acid (greater than 7mg/dl)
- urate crystals seen with joint aspiration
- xr: joint erosion and renal stones
Gout treatment - ......ANSWER........- NSAIDS: naproxen, indomethacin, sulindac
- Colchicine for those who do not tolerate NSAIDS (caution with renal impairment). Also,
for prophylaxis
- Corticosteroids, if NSAIDS and colchicine not tolerated
- 24hr urine for uric acid
- Allopurinol after flare is over (100mg PO daily)
- Biological modifiers of disease (BMD): Pegloticase. Not for asymptomatic. Treat with
prophylaxis first. Monitor serum uric acid
ANA. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Antinuclear antibody (ANA).
Normal: Titer 1.32
Positive with: Sjogren's (SS), SLE (lupus),
, 4 of 78
C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Determines hemolytic activity which speaks to level of inflammatory
response
Normal: men: 12-72. Women: 13-75 mg/dl
Increased with inflammatory disease
Decreased with: RA, lupus, SS
The radioallergosorbent test (RAST). Tests in rheumatic disease: what, normal level,
abnormal with. - ......ANSWER........measures presence/ increase antigen IgE
normal: 0.01 - 0.04 mg/dl
Increased with allergic reaction
Erythrocyte sedimentation rate (ESR). Tests in rheumatic disease: what, normal level,
abnormal with. - ......ANSWER........rate at which RBC settle out of unclotted blood in 1 hr.
Normal: men: 0-7mm/hr., women: 0 - 25 mm/hr.
Increased with inflammation
CRP. Tests in rheumatic disease: what, normal level, abnormal with. - ......ANSWER........C-
reactive protein, a non-specific antigen antibody
Normal: trace to 6mg/ml
Increased with infection and inflammation, RA. Decreased with successful RA treatment
RF. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Rheumatoid factor. antibody against IgG.
Positive RF in most people with RA
NRNP 6540 MIDTERM EXAM LATEST/NRNP6540 MIDTERM EXAM
PREPARATION/ NRNP 6540 MIDTERM EXAM 200 PRACTICE
QUESTIONS AND ANSWERS 2025/2026 (VERIFIED ANSWERS)
Rheumatoid arthritis: what, who - ......ANSWER........chronic, systemic autoimmune
disease that causes inflammation of connective tissue, first that of joints them other soft
tissues (renal, cardiovascular, pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
- Epstein Barr virus
Rheumatoid arthritis: Findings and diagnostics - ......ANSWER........- symmetric joint/
muscle pain, worse in the morning then gets better
- weakness, fatigue
- anorexia, weight loss
- generalized malaise
- swollen joints/ boggy feeling of joints with deformity of joints
- warm, red skin on affected joints
later:
- pleural effusions and pulmonary nodules
- inflammation of sclerae (scleritis)
- pericarditis, myocarditis
- splenomegaly (Felty's syndrome)
- anemia (hypochromic, microcytic) with low ferritin
- possibly: positive rheumatoid factor
,2 of 78
- XR: joint swelling, later cortical and space thinning
- synovial fluid: yellow, thick with elevated WBC up to 100.000
Felty's syndrome - ......ANSWER........rheumatoid arthritis, splenomegaly, neutropenia
Rheumatoid arthritis treatment - ......ANSWER........- early treatment better than stepwise
- early referral rheumatologist
- disease-modifying anti-rheumatic drugs (DMARDs):
- methotrexate (no alcohol, monitor renal and liver, give with folic acid)
- cyclosporine
- Gold preparations (can cause thrombocytopenia)
- Hydroxychloroquine: antimalarial drug (may cause visual changes, monitor)
- sulfasalazine, moderate RA
- Leflunomide, moderate to severe RA
- Etanercept
- monitor liver function with DMARDs
- screen for TB (skin test) and Hep B
- surgery: joint debridement, joint replacement
Gout: what, who - ......ANSWER........Inflammatory disorder in response to high uric acid
production/ levels in blood and synovial fluid causing crystallization which causes
inflammation (Type A and Mediterranean)
- impaired renal function which causes excess uric acid
- foods high in purine, such as dairy, red meat, shellfish, beer
,3 of 78
Gout findings, diagnostics - ......ANSWER........- acute painful joint, often great toe (warm,
swollen)
- pain at night
- flank pain because of renal calculi
- fever
- leukocytosis
- elevated erythrocyte sedimentation rate
- tophi (bump under skin) on ear
- limited joint motion
- elevated serum uric acid (greater than 7mg/dl)
- urate crystals seen with joint aspiration
- xr: joint erosion and renal stones
Gout treatment - ......ANSWER........- NSAIDS: naproxen, indomethacin, sulindac
- Colchicine for those who do not tolerate NSAIDS (caution with renal impairment). Also,
for prophylaxis
- Corticosteroids, if NSAIDS and colchicine not tolerated
- 24hr urine for uric acid
- Allopurinol after flare is over (100mg PO daily)
- Biological modifiers of disease (BMD): Pegloticase. Not for asymptomatic. Treat with
prophylaxis first. Monitor serum uric acid
ANA. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Antinuclear antibody (ANA).
Normal: Titer 1.32
Positive with: Sjogren's (SS), SLE (lupus),
, 4 of 78
C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Determines hemolytic activity which speaks to level of inflammatory
response
Normal: men: 12-72. Women: 13-75 mg/dl
Increased with inflammatory disease
Decreased with: RA, lupus, SS
The radioallergosorbent test (RAST). Tests in rheumatic disease: what, normal level,
abnormal with. - ......ANSWER........measures presence/ increase antigen IgE
normal: 0.01 - 0.04 mg/dl
Increased with allergic reaction
Erythrocyte sedimentation rate (ESR). Tests in rheumatic disease: what, normal level,
abnormal with. - ......ANSWER........rate at which RBC settle out of unclotted blood in 1 hr.
Normal: men: 0-7mm/hr., women: 0 - 25 mm/hr.
Increased with inflammation
CRP. Tests in rheumatic disease: what, normal level, abnormal with. - ......ANSWER........C-
reactive protein, a non-specific antigen antibody
Normal: trace to 6mg/ml
Increased with infection and inflammation, RA. Decreased with successful RA treatment
RF. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Rheumatoid factor. antibody against IgG.
Positive RF in most people with RA
