Question 1

You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR).Which two clinical findings are common in patients with PMR?&#10;A) Neutropenia and hypochromic,normocytic anemia&#10;B) Normochromic,normocytic anemia and thrombocytosis&#10;C) Microcytic,hypochromic anemia and reticulocytopenia&#10;D) Macrocytic,hyperchromic anemia and leukocytopenia

Accepted Answer

Normochromic, normocytic anemia and thrombocytosis are commonly seen in patients with polymyalgia rheumatica. Neutropenia and hypochromic, normocytic anemia are not typically associated with this condition. Microcytic, hypochromic anemia and reticulocytopenia are more commonly seen in iron deficiency anemia or anemia of chronic disease. Macrocytic, hyperchromic anemia and leukocytopenia are more commonly seen in megaloblastic anemia, such as vitamin B12 deficiency.

Question 2

In considering the specificity of laboratory data,the most reliable diagnostic test listed below would be:&#10;A) Elevated erythrocyte sedimentation rate (ESR)to rule out inflammation&#10;B) CBC to rule out infection&#10;C) Antinuclear Antibody (ANA)test to rule out a collagen disease&#10;D) Synovial fluid analysis to differentiate between an infectious versus an inflammatory infusion

Accepted Answer

Synovial fluid analysis is the most specific test listed because it can determine whether an infusion is infectious or inflammatory. The other tests listed can indicate the presence of inflammation, infection, or collagen disease, but they are not specific to a particular diagnosis.

Question 3

Which of the following differential diagnosis for patients presenting with polymyalgia rheumatica (PMR)can be ruled out with a muscle biopsy?&#10;A) Parkinson's disease&#10;B) Polymyositis&#10;C) Late onset rheumatoid arthritis&#10;D) Giant Cell Arteritis

Accepted Answer

A muscle biopsy can help to confirm the diagnosis of polymyositis, which can present with similar symptoms to PMR. Parkinson's disease, late onset rheumatoid arthritis, and giant cell arteritis are not typically diagnosed with a muscle biopsy.

Question 4

Patients with osteoarthritis of the hip and knee often have a distinguishable gait described as:&#10;A) Ataxic&#10;B) Festinating&#10;C) Antalgic&#10;D) Steppage

Accepted Answer

An antalgic gait is characterized by a limp or shortened stride on the affected side, as the individual tries to avoid pain while walking. Patients with osteoarthritis of the hip and knee often adopt an antalgic gait. Ataxic gait is unsteady and uncoordinated; festinating gait is a type of shuffling gait often seen in patients with Parkinson's disease; and steppage gait is a high-stepping gait seen in individuals with foot drop due to nerve damage or muscle weakness.

Question 5

Joint effusions typically occur later in the course of OA,especially in the:&#10;A) Knee&#10;B) Elbow&#10;C) DIP joints&#10;D) Hips

Accepted Answer

Knee joints are the most commonly affected joints in OA and are more likely to develop joint effusions as the disease progresses.

Question 6

Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR)will begin treatment with corticosteroids until the condition has resolved.You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider.In prioritizing your management plan,your first orders should include:

A) Recommending she increase her dietary intake of Calcium and Vitamin D
B) Ordering once a year bisphosphonate and a proton pump inhibitor
C) Participate in a fall prevention program
D) Dual-energy x-ray (DEXA)scan and updating immunizations

Accepted Answer

Since the patient is starting on corticosteroids, it is recommended to have a baseline DEXA scan to assess for potential bone loss and fracture risk. Additionally, it has been 2 years since her last physical exam, so it is important to update her immunizations as needed. While calcium and vitamin D intake and fall prevention programs are important for overall health, they are not the top priority in this case. Bisphosphonates and proton pump inhibitors may be considered as preventive measures for osteoporosis in patients on long-term corticosteroid therapy, but they should not be ordered without a baseline DEXA scan.

Question 7

Which of the following best describes the pain associated with osteoarthritis?&#10;A) Constant,burning,and throbbing with an acute onset?&#10;B) Dull and primarily affected by exposure to cold and barometric pressure&#10;C) Begins upon arising and after prolonged weight bearing and/or use of the joint&#10;D) Begins in the morning but decreases with activity

Accepted Answer

Pain associated with osteoarthritis typically begins upon arising and after prolonged weight bearing and/or use of the joint. This pain may be described as a dull ache.

Question 8

The best method of verifying a diagnosis of gout in a joint is which of the following:&#10;A) Radiographic examination of the joint with two views&#10;B) Ultrasound&#10;C) Palpation&#10;D) Joint aspiration and polarized-light microscopy

Accepted Answer

Joint aspiration and polarized-light microscopy is the best method of verifying a diagnosis of gout in a joint. This technique involves aspirating synovial fluid from the joint and then examining it under a polarized-light microscope for the presence of monosodium urate crystals, which are indicative of gout. Radiographic examination and ultrasound may show characteristic findings in advanced cases, but they are not reliable for making an early diagnosis. Palpation can suggest but cannot confirm a diagnosis of gout.

Question 9

You suspect that your patient has polymyalgia rheumatica and now are concerned that the patient may also have Giant Cell Arteritis (GCA).Which of the following two symptoms are most indicative of GCA and PMR?

A) Jaw pain and heart murmur
B) Joint swelling and sudden loss of central vision bilaterally
C) Hoarseness and the total inability to grasp small objects
D) Scalp tenderness and aching in shoulder and pelvic girdle

Accepted Answer

Scalp tenderness and aching in shoulder and pelvic girdle are the two most indicative symptoms of both PMR and GCA. Although other symptoms may be present in both conditions, these two symptoms are the most specific, especially for GCA. Jaw pain may also be present in GCA, but it is not as specific as the other symptoms mentioned. Joint swelling and sudden loss of central vision bilaterally are not usually seen in PMR and are more specific to GCA. Hoarseness and inability to grasp small objects are not typically associated with either condition.

Question 10

The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk):&#10;A) Indomethacin 50 mg TID for 2 days;then 25 mg TID for 3 days&#10;B) Doxycycline 100 mg BID for 5 days&#10;C) Prednisolone 35 mg QD for 5 days&#10;D) Ice therapy

Accepted Answer

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) and is considered first-line treatment for acute gout flares. It works by reducing inflammation and pain associated with the flare. The dosing regimen mentioned in option A is a commonly used regimen. Option B is not a recommended treatment for acute gout flares. Prednisolone is a steroid and can be used as an alternative to NSAIDs, but is not typically first-line. Ice therapy may provide some relief for symptoms, but is not considered first-line treatment.

Question 11

Which of the following is the most appropriate laboratory test for monitoring gout therapy over the long-term?&#10;A) Erythrocyte sedimentation rate (ESR)&#10;B) Completer blood count (CBC)&#10;C) Serum urate level&#10;D) Serum albumin

Accepted Answer

The answer of Which of the following is the most...

Question 12

In reviewing laboratory results for patients suspected with polymyalgia rheumatica (PMR),you realize that there is no definitive test to diagnosis PRM,rather clinical response to treatment.Results you would expect to see include:

A) Elevated erythrocyte sedimentation rate (ESR)greater than 50mm per hour
B) Elevated rheumatoid factor and anti-citrullinated protein antibodies (RF and ACPA)
C) Decreased C-reactive protein level (CR-P)
D) Elevated thyroid stimulating hormone (TSH)

Accepted Answer

The answer of In reviewing laboratory results for patients suspected...

Question 13

The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma.The nurse practitioner suspects elderly onset rheumatoid arthritis.The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be:

A) Symmetric joint space narrowing
B) Soft tissue swelling
C) Subluxations of the joints
D) Joint erosions

Accepted Answer

The answer of The nurse practitioner orders bilateral wrist X-rays...

Question 14

When examining the spine of an older adult you notice a curvature with a sharp angle.This is referred to as a:&#10;A) Gibbus&#10;B) Scoliosis&#10;C) Kyphosis&#10;D) Lordosis

Accepted Answer

The answer of When examining the spine of an older...

Question 15

Osteoarthritis of the cervical and lumbar spine causes pain that is related to all of the following except:&#10;A) Bone spur formation&#10;B) Pressure of the ligaments&#10;C) Reactive muscle spasm&#10;D) Crystal deposition

Accepted Answer

The answer of Osteoarthritis of the cervical and lumbar spine...

Question 16

The nurse practitioner is examining the hands of a 55-year-old woman with rheumatoid arthritis and notes bilateral spindle shaped deformities on the middle interphalangeal joints.These are known as:&#10;A) Haygarth's nodes&#10;B) Heberden's nodes&#10;C) Bouchard's nodes&#10;D) Benediction hands

Accepted Answer

The answer of The nurse practitioner is examining the hands...

Question 17

In differentiating osteoarthritis from chronic gout,pseudogout,or septic arthritis,the most valuable diagnostic study would be:&#10;A) Erythrocyte sedimentation rate (ESR)&#10;B) Synovial fluid analysis&#10;C) C-reactive protein analysis&#10;D) Complete blood cell count

Accepted Answer

The answer of In differentiating osteoarthritis from chronic gout,pseudogout,or septic...

Question 18

Which of the following statements about osteoarthritis is true?&#10;A) It affects primarily weight-bearing joints&#10;B) It is a systemic inflammatory illness&#10;C) The metacarpal phalangeal joints are commonly involved&#10;D) Prolonged morning stiffness is common

Accepted Answer

The answer of Which of the following statements about osteoarthritis...

Question 19

A 72-year-old female patient has been diagnosed with gout.She also has a long history of chronic congestive heart failure.The most likely contributing factor to the development of gout in this older female is:

A) Lead intoxication
B) Illegal whiskey
C) Binge-eating
D) Thiazide diuretics

Accepted Answer

The answer of A 72-year-old female patient has been diagnosed...

Question 20

In providing health teaching related to dietary restrictions,the nurse practitioner should advise a patient with gout to avoid which of the following dietary items:&#10;A) Green leafy vegetables&#10;B) Beer,sausage,fried seafood&#10;C) Sugar&#10;D) Gluten and bread items

Accepted Answer

The answer of In providing health teaching related to dietary...

Deck 12: Musculoskeletal Disorders