Page 1 of 114
NRNP 6560 FINAL| NRNP 6560 MIDTERM EXAM
QUESTIONS WITH CORRECT ANSWERS TESTED
AND APPROVED!!!
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
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
, Page 2 of 114
- xr: joint erosion and renal stones
Gout treatment -- ANSWER--- NSAIDS: naproxen, ondomethacin, 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
Osteoarthritis findings and diagnostics -- ANSWER--- Pain in weight bearing
joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
- larger affected joints
- Heberden nodules (bony bumps on the finger joint closest to the
fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the finger)
- limited ROM with crepitus
- xr shows narrowing of joint space (need anteroposterior and lateral knee
films bilaterally) - synovial fluid is clear and without WBC
, Page 3 of 114
Osteoarthritis treatment -- ANSWER--Goal is to relieve symptoms, maintain/
improve function, and avoid drug toxicity
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than 75)
Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause
cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)
, Page 4 of 114
Rheumatoid arthritis: what, who -- ANSWER--chronic, systemic autoimmune
disease that causes inflammation of connective tissue, first that of jionts 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 sclerea (scleritis)
- pericarditis, myocarditis
- splenomegaly (Felty's syndrome)
- anemia (hypochromic, microcytic) with low ferritin - possibly: positive
rheumatoid factor
- XR: joint swelling, later cortical and space thinning
NRNP 6560 FINAL| NRNP 6560 MIDTERM EXAM
QUESTIONS WITH CORRECT ANSWERS TESTED
AND APPROVED!!!
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
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
, Page 2 of 114
- xr: joint erosion and renal stones
Gout treatment -- ANSWER--- NSAIDS: naproxen, ondomethacin, 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
Osteoarthritis findings and diagnostics -- ANSWER--- Pain in weight bearing
joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
- larger affected joints
- Heberden nodules (bony bumps on the finger joint closest to the
fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the finger)
- limited ROM with crepitus
- xr shows narrowing of joint space (need anteroposterior and lateral knee
films bilaterally) - synovial fluid is clear and without WBC
, Page 3 of 114
Osteoarthritis treatment -- ANSWER--Goal is to relieve symptoms, maintain/
improve function, and avoid drug toxicity
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than 75)
Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause
cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)
, Page 4 of 114
Rheumatoid arthritis: what, who -- ANSWER--chronic, systemic autoimmune
disease that causes inflammation of connective tissue, first that of jionts 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 sclerea (scleritis)
- pericarditis, myocarditis
- splenomegaly (Felty's syndrome)
- anemia (hypochromic, microcytic) with low ferritin - possibly: positive
rheumatoid factor
- XR: joint swelling, later cortical and space thinning
