Questions
Questions
Questions
Questions
100
Other than morning stiffness, painful swelling, and the development of deformities like rheumatoid nodules, what other s/sx might a patient expect to find with RA? Are there any complications associated with RA?
s/sx: unsteady gait, increased risk of infection, constipation, nausea, fatigue, self care deficit
complications: decreased function of joints, joint deformities, permanent disabilities, psychological impacts
100
Scleroderma is a chronic hardening and tightening of connective tissues. Localized scleroderma affects only the skin, whereas systemic scleroderma can affect skin, lungs, heart, kidney, musculoskeletal, etc. Systemic can be divided into two groups, limited and diffused. what are the differences between limited and diffued?
limited: slow onset, involves skin distal to elbows and knees, internal organ onset less likely, raynaud's phenomenon may precede diagnosis years before scleroderma diagnosis
diffused: rapid onset, involves skin of extremities and trunk, most likely to affect internal organs usually within 2 years, raynauds can occur concurrently or after diagnosis
100
The swelling of the joints in the fingers is a tell-tale sign of osteoarthritis. Swelling of the distal and proximal joints cause pain, deformity, and stiffness making use of the hands difficult. What are the names of the different locations of arthritis?
distal - heberden
proximal - bouchard
100
A woman in her 40's presents to the hospital with peripheral joint pain and morning stiffness even after a hot shower. She has a history of smoking, her physical assessment shows bilateral swelling in knees, ankles, and elbows. Whats her diagnosis and what tests would you expect to run to confirm?
Rheumatoid arthritis
Labs: rheumatoid factors, antibodies, C-reactive proteins (CRP), erythrocyte sedimentation rate (ESR), renal and hepatic functions (before starting therapy)
Diagnostics: MRI and ultrasound to track severity
200
Systemic lupus is an autoimmune disorder causing inflammation affecting all body systems. Of the labs and physical findings, there are 17 manifestations associated with lupus, how many do you have to have to be diagnosed with lupus?
4 out of 17
200
A chronic inflammatory disease of the spine with systemic affects with a forward lean of 30 degrees is called _______ ______
ankylosing spondylitis
200
Scleroderma is a diagnosed by looking at all s/sx and performing many tests and labs. A physician may start with the physical examination, looking for primary physical s/sx such as puffy, thickened skin and raynaud's phenomenon. What are some test and labs run to confirm a diagnosis of scleroderma?
lab: antinuclear antibody (ANA)
tests: subcutaneous calcification, pulmonary fibrosis, pulmonary function test, echocardiogram
200
An elderly patient presents to the hospital with knee and hip joint pain, swelling, and some deformity. There is pain in the morning that goes away after 30 minutes and with a warm shower. What is the diagnosis and how would you verify?
Osteoarthritis
h&p, x-rays (narrowing of space, bone spurs), mris (more info), blood test (rule out), joint fluid (rule out)
300
Scleroderma can affect many body systems, what are some clinical manifestations you might expect to find in each body system? (skin, GI, pulmonary, cardiac, renal, musculoskeletal)
skin: thickened skin, digital ulcers, puffy hands, pruritis, superficial skin tenderness, diffuse, hyperpigmentation
GI: frequent heartburn, dysphagia, esophageal stricture, erosive esophagitis, postprandial bloating, constipation, malabsorptive diarrhea
pulmonary: generalized fatigue, SOB, dry cough, lung fibrosis
cardiac: arrhythmias, heart failure, pericarditis
renal: renal insufficiency, renal failure
musculoskeletal: joint contractures, tendon friction rubs, muscle pain and weakness, synovitis
300
The patient has been taking NSAIDs for pain to deal with their lupus s/sx. What are some non-pharm treatment for lupus? What might be prescribed for treatment of lupus?
non-pharm: diet (well-balanced diet of fruit, vegetables, whole grains), sunblock use (photosensitive), exercise (helps reduce inflammation, strengthen cardiac/skeletal muscle and joints/bones)
pharm: antimalarial (hydroxychloroquine)(calm overactive immune system), NSAIDs, immunosuppressives (methotrexate)(calm immune system)
300
Rheumatoid arthritis can cause issues with hand and finger joints. Describe boutonniere deformity and swan neck deformity as best as you can.
300
A patient has been newly diagnosed with lupus and is ready to go home on their meds. What patient teaching should you review with your patient before discharge?
use sunscreen*
avoid live vaccines
avoid oral contraceptives (estrogen-containing contraceptives increase the risk of venous thromboembolism)
400
Psoriatic arthritis is similar to RA in s/sx but differs in its affects on the skin (red, scaly rashes) and thickened, pitted _____.
nails
400
A patient recently diagnosed with RA wants to know what her chances of being cured are and what treatments she will be receiving. Educate your patient on the disease and what pharm, nonpharm, and surgical treatments are available.
no cure
nonpharm: ROM, physical/occupational therapy, nutrition
pharm: analgesics, NSAIDs, glucocorticosteroids, DMARDs (disease modifying antirheumatic drugs) (synthetic and biological)
surgery: joint replacement or fusion, removal of nodules
400
Osteoarthritis has no medical cure, what are some nonpharm and pharm treatments available?
nonpharm - weight management, hot and cold compresses, aerobic exercise, physical therapy
pharm - tylenol, NSAIDs, intra-articular injections
400
Reactive arthritis is arthritis caused by an immune response to an infection, usually GI in origin or sometimes STDs (chlamydia). A patient experiencing reactive arthritis will receive treatment for the underlying cause and NSAIDs for comfort, steroids may be used in serious cases. A patient will complain that they "Can't ___, can't ____, and can't _____ _ ____". Are there any tests that can be done to confirm or rule out other disorders.
Can't see, can't pee, can't climb a tree
conjunctivitis, urethritis (painful urination), arthritis
test: synovial fluid aspiration and c&s
500
A patient present to the hospital complaining of fever, fatigue, muscle and joint pain, and episodes of depression and anxiety. Upon physical inspection, you see the patient has what appears to be red patches on their cheeks and across the nose. You complete your assessment and hear crackles in the lungs, and evidence of hair loss. All s/sx are indicative of _____. whats the most common and indicative of the patients diagnosis?
lupus
butterfly rash/red patches on face across the cheeks
500
RA can cause many complications with inflammation throughout the body. One location of inflammation is the eye, what are the 2 manifestations of inflammation of the eye caused by RA called?
episcleritis and scleritits
500
Scleroderma is an autoimmune disease, so treatment is focused on treating the s/sx. Keeping in mind all the body systems scleroderma affects, what are some medications you would expect to be ordered for your patient?
immunosuppresive agents (methotrexate), steroids (prednisone), analgesics (acetaminophen), NSAIDs (ibuprofen), PPIs (omeprazole), calcium channel blockers (amlodipine), ACE inhibitors (lisinopril)
500
Osteoarthritis can cause the patient to have complications with other conditions, decrease function, and cause chronic pain. What are some surgical procedures a doctor can perform for treatment of osteoarthritis?
arthroscopic irrigation, arthroscopic synovectomy, surgical fusion, joint replacement