Module 3 extras

Question 1

Which of the following is strongly recommended AGAINST in Osteoarthritis?

a. KT tape
b. TENS
c. Tai Chi
d. Acupuncture

Answer 1

b. TENS

per 2019 American College of Rheumatology/Arthritis article
https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf

Question 2

Which of the following m is strongly recommended AGAINST in Osteoarthritis?

a. NSAID
b. Methotrexate
c. Bisphosphonates
d. Tramadol
e. B and C

Answer 2

b. Methotrexate
c. Bisphosphonates

per 2019 American College of Rheumatology/Arthritis article
https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf

Question 3

Which of the following is NOT recommended for osteoarthritis?
A. NSAIDs
B. Balance training 
C. Cognitive behavioral therapy 
D. Non-tramadol Opioids

Answer 3

D. Non-tramadol Opioids

Question 4

According to Ottawa Ankle rules, An Ankle X-ray is only required if:
There is any pain in the malleolar zone; AND
Any one of the following:
Bone tenderness along the distal 6 cm of the posterior edge of the TIBia or tip of the MEDial
malleolus, OR
Bone tenderness along the distal 6 cm of the posterior edge of the FIBula or tip of the LATeral
malleolus, OR
_________________

Answer 4

An inability to bear weight both immediately and in the emergency department for four steps.

Question 5

Ottawa Ankle Rules include necessity to palpate the entire distal 6 cm of the _____ and _____

Answer 5

tibia and fibula

• *Note: It also says:
  2. Do Not neglect the importance of medial malleolar tenderness
  3. Use the rules only on those over the age of 18

Question 6

Pittsburgh Knee Rules 
Recommends XR IF mechanism:\_\_\_\_\_\_\_\_
AND any one of the following:
-Age <12
-Age>50
-Unable to bear weight in ED (4 steps, limping is allowed)

Answer 6

mechanism: blunt trauma or fall

* all patients with an acute knee injury in the past 1 week old (without surg or ED eval)

Question 7

True or False:
NSAIDS, corticosteroids by mouth and/or an injection into the joint are all appropriate means of controlling inflammation and pain in osteoarthritis

Answer 7

TRUE

Question 8

Are steroids and NSAIDs often effective for fibromyalgia?

Answer 8

No

Question 9

Are antidepressants and anticonvulsants often effective to treat fibromyalgia?

Answer 9

yes

Question 10

What non-medication treatments can you recommend to a patient with fibromyalgia?

Answer 10

-Exercise
relaxation therapy
-Cognitive behavioral therapy 
-Tai Chi and Yoga 
-Acupuncture
-Multidisciplinary care

Question 11

A _____ flare is typically monoarticular and intensely inflammatory

Answer 11

GOUT

Question 12

True or False:

Alcohol consumption can trigger a gout flare?

Answer 12

True

This includes beer, spirit, wine

Question 13

At least 80 % of gout flares involve a single joint, most often the ______

Answer 13

base of the great toe (first metatarsophalangeal joint, known as podagra)

or the knee.

Question 14

Do gout flares more often occur at night or during the day?

Answer 14

More often at night.

Patient’s may wake up with the new symptoms without “cause”

Question 15

The two main symptoms of Sjogren’s syndrome are:

Answer 15

Dry Eyes

Dry Mouth

Question 16

Is Sjogren’s syndrome an autoimmune disorder?

Answer 16

YES, the immune system first targets the glands that make tears and saliva

Question 17

It is Common for people with Sjogren’s syndrome to also have a rheumatic disease.

It is also more common in people
Age: () 40?
Gender: M or F

Answer 17

Age. Sjogren’s syndrome is usually diagnosed in people older than 40.

Gender. Women are much more likely to have Sjogren’s syndrome.

Question 18

Complications of Sjogren’s syndrome:

a. Dental cavities
b. oral yeast infections
c. vision problems
d. all of the above

Answer 18

d. all of the above

Dental cavities. saliva helps protect the teeth from the bacteria that cause cavities,

Yeast infections. Sjogren’s syndrome are much more likely to develop oral thrush, a yeast infection in the mouth.

Vision problems. Dry eyes can lead to light sensitivity, blurred vision and corneal damage.

Question 19

______ measures the rate at which the red blood cells separate from the plasma and fall to the bottom of a test tube. The rate is measured in (mm/hr).

Answer 19

ESR

erythrocyte sedimentation rate

Question 20

What does an elevated ESR indicate?

Answer 20

If certain proteins cover red cells, these will stick to each other and cause the red cells to fall more quickly. So, a high ESR indicates that you have some inflammation, “somewhere” in the body.

Question 21

____ increases when you have certain diseases which cause inflammation.

Answer 21

CRP

C-Reactive protein or “acute phase protein”

Question 22

____ test measures the level of one specific protein, whereas the ______ takes account of many proteins.

Answer 22

CRP test measures the level of one specific protein, whereas the ESR takes account of many proteins.

Question 23

Fibromyalgia is defined as ____ or more pain sites from a total of nine possible sites

Answer 23

SIX

Question 24

In addition to pain sites, __________

must have been present for at least 3 months

Answer 24

Moderate to severe sleep problems or fatigue

BOTH pain sites and sleep problems/fatigue must be be present x3+ months

Question 25

Intra-articular injections can be given _____ times per year.

Answer 25

4

Question 26

True or False:

Tylenol is used first line for mild to moderate osteoarthritis.

Answer 26

True

per discussion board

Question 27

For severe osteoarthritis, what med is superior for treatment (if not contraindications)?

Answer 27

NSAIDs for severe

Question 28

Should you stop Allopurinol when starting colchicine for a gout flare?

Answer 28

YES!

You do NOT keep the chronic (suppressive) medication while treating the acute.

((per discussion board)

Question 29

Can intra-articular injections be used in the hands?

Answer 29

No. Not recommended. Too much risk for septic joint