Rheumatic Disease (midterm)

Question 1

A patient with rheumatoid arthritis comes to you for treatment w swollen, painful joints. Which stage of the inflammatory disease process are they in?

A. Acute
B. Subacute
C. Chronic

Answer 1

Answer: A. Acute – these are cardinal signs

B. Subacute – would be getting better: pain and swelling went down, ROM improves
C. Chronic – disease would be active yet stable; symptoms would be managed

Question 2

T/F: Not all rheumatic diseases are systemic and symmetrical

Answer 2

Answer: TRUE; all rheumatic diseases are SYSTEMIC, however, disease like ankylosing spondylitis are ASYMMETRICAL. Some, like psoriatic arthritis can even be both

Question 3

The next patient on your schedule has osteoarthritis. You would expect to see all but which of the following?

A. Cartilage or ligament degeneration
B. Limited ROM
C. Swelling or inflammation
D. Weakness around affected joints

Answer 3

Answer: C. Swelling or inflammation – inflammation CAN happen but nor primary (definitely shouldn’t see swelling)

Question 4

The most common place for osteoarthritis deformity to occur is the:

A. Feet
B. Knee
C. Shoulders
D. Hands

Answer 4

Answer: D. Hands

Question 5

You’re seeing a patient with volar subluxation this afternoon. You expect to see:

A. The ECU slip volarly, acting as a flexor force
B. The hand & distal carpals radially deviate while the metacarpals ulnarly deviate
C. Decreased wrist extension and forearm supination
D. Ulnar drift of the MCPs

Answer 5

Answer: A. ECU slip volarly, acting as a flexor force

B. – this is ulnar subluxation/radial deviation
C. – this is DRUJ subluxation
D. – this is ulnar drift

Question 6

Match condition to location of chronic synovitis:

__ Swan Neck Deformity
__ Boutonniere Deformity
__ Mallet Finger
__ Zig Zag Deformity

A. DIP
B. PIP
C. MCP
D. CMC

Answer 6

C. MCP
B. PIP
A. DIP
D. CMC

Question 7

If your patient has RA and has more pain w/ compression, you would know they were in more of a/an _____ stage of their illness/

A. acute
B. subacute
C. chronic

Answer 7

Answer: C. chronic

A. – you would see pain and swelling
B. – you would see pain with movement

Question 8

T/F: Osteophytes are only indicative of osteoarthritis.

Answer 8

Answer: True – osteophytes are bony outgrowth associated with bony degeneration

Question 9

Which two tests would you use to elevate the CMC joint of the thumb?

A. Pinch test
B. Crepitus
C. Grind test
D. Finkelstein’s test

Answer 9

Answer: B (cracking during ranging = positive) and C (painful = positive)

A. – tests pinch strength
B. – tests for Dequervains

Question 10

Patient complains of tightness in hand. Patient is asked to extend their wrist and straighten their fingers. They are unable to in extension or neutral. Cause of the tightness is:

A. Extrinsic tightness of the flexors
B. Extrinsic tightness of the extensors
C. A joint issue
D. Intrinsic tightness

Answer 10

Answer: C. A joint issue

A. – laxity didn’t improve the outcome
B. – you aren’t testing these
D. – you would see MP, PIP, and DIP flexion

Question 11

Which of the following would not be appropriate for tightness in the hand?

A. Theraputty
B. Lever door handles
C. Using a rubberband around cups for easy grasp
D. Adaptive jar openers

Answer 11

Answer: A. Theraputty (don’t want to do biomechanical/strength)

Question 12

Which of the following are not goals of acute stage of rheumatic disease?

A. Pain reduction
B. Rest
C. Heat
D. Ice
E. ROM
F. Activity modification
G. Strength
H. Posture/Immobilization

Answer 12

Answer: C. Heat ( subacute/ chronic ) ; E. ROM ( chronic ) ; G. Strength ( chronic )

Question 13

Resting wrist hand orthosis (WHO) immobilizes…

A. Wrist
B. Wrist and MPs
C. Wrist, MPs, and PIPs
D. Wrist, MPs, PIPs, and DIPs

Answer 13

Answer: D. – it rests WHOle wrist and hand

Question 14

In a resting wrist hand orthosis, the wrist is ____ and the digits are ____.

A. Flexion; ~ 10 degrees of flexion
B. Neutral; ~ 30 degrees flexion
C. Extension; ~ 30 degrees flexion
D. Extension; ~ 10 degrees extension

Answer 14

Answer: B. ~ 30 degrees flexion of the digits mimics the natural “resting” posture

A. – typically wrist is extended or neutral, and you don’t hyperextend digits
C. – extension of the wrist isn’t resting posture
D. – you don’t hyper extend digits!

Question 15

A volar wrist orthosis (for volar subluxation) leaves what aspects of the hand free function?

A. CMC, MCP, PIP, DIP, thumb
B. MCP, PIP, DIP
C. MCP, PIP, DIP, thumb
D. PIP, DIP

Answer 15

Answer: C. – only the wrist needs to be immobile

Question 16

T/F: The thumb is not free in an ulnar drift orthosis

Answer 16

Answer: FALSE – ulnar drift affects the MCPs of digits 2 + 5 only

Question 17

A CMC stabilizer splint for DeQuervain’s

A. Immobilizes the forearm through the wrist
B. Immobilizes the radial aspect of the forearm, wrist, CMC, and MP of the thumb
C. Immobilizes the radial aspect of the forearm, wrist, CMC and MPs of digits
D. Immobilizes the CMC and MCP of the thumb

Answer 17

Answer: B – recall finkelstein’s test, then imagine why B is correct

Question 18

Which of the following is not recommended for improving ROM?

A. Active ROM
B. Passive Stretching
C. Active assistive techniques
D. Isometrics

Answer 18

Answer: D – for maintaining/improving strength

Question 19

An oval 8 can be used for… (SATA)

A. Swan neck deformity
B. Mallet finger
C. Boutonniere deformity
D. Zig zag deformity

Answer 19

Answer: A, B, and C (and trigger finger)