Week 13 Rheumatology Flashcards
A patient who has osteoarthritis in the carpometacarpal joints of both thumbs asks about corticosteroid injections to treat symptoms. What will the nurse practitioner tell this patient about this therapy?
A Corticosteroid therapy reduces inflammation and improves joint mobility
B Injections may be administered as needed up to 6 times per year
C Intra-articular injections provide significant pain relief for 3–4 months
D This treatment may cause a temporary increase in pain, warmth, and redness
D This treatment may cause a temporary increase in pain, warmth, and redness
Intraarticular injections of corticosteroids are helpful in decreasing pain, but may cause a transient increase in pain, warmth, and redness. This therapy does not improve inflammation and joint mobility. Injections are not recommended more than 3 to 4 times per year. The duration of pain relief is variable.
A patient has swelling and tenderness in the small joints of both hands and reports several weeks of malaise and fatigue. A rheumatoid factor (RF) test is negative. What will the primary care nurse practitioner do next?
A Begin treatment with a biologic, disease-modifying anti-rheumatic (DMARD) drug
B Order radiographic tests, a CBC, and acute-phase reactant levels
C Reassure the patient that the likelihood of rheumatoid arthritis is low
D Refer the patient to an orthopedic specialist for evaluation and treatment
B Order radiographic tests, a CBC, and acute-phase reactant levels
The patient has signs of rheumatoid arthritis (RA); the RF test may be negative initially but will become positive in 70% to 80% of patients. The provider’s next step is to order tests to confirm the diagnosis and to provide a baseline to monitor disease progress and response to treatment. DMARDs may be ordered when the disease is confirmed. The PCP may treat in consultation with a rheumatologist who will order medications and will refer the patient for physical therapy, occupational therapy, and psychotherapy if needed.
A patient reports a history of recurrent lower back pain for 6 months. The patient describes the pain as a deep ache and stiffness that is worse upon awakening and improves after walking. Which findings will the nurse practitioner elicit to help make a clinical diagnosis of ankylosing spondylitis? Select all that apply.
A Assessment of the degree of lumbar lordosis
B Evaluation of lateral thoracic spine flexion
C Measurement of chest expansion
D Noting the degree of cervical kyphosis
E Observation for scapular asymmetry
A,B,C
Examination of the spine will show loss of the normal lumbar lordosis, decreased thoracic spine flexion, and diminished chest expansion. Cervical kyphosis is not assessed. Scapular asymmetry evaluates for scoliosis.
Which of the following statements about psoriatic arthritis is correct?
A It affects about 70% of patients who have psoriasis
B It’s asymmetric and involves the distal joints of the hands and feet
C It’s symmetric and usually involves the larger joints in the body
D The diagnosis is confirmed with a positive ANA and inflammatory markers
B.
Arthritis occurs in about 20-30% of patients with psoriasis. It is asymmetric and affects the distal joints of the hands and feet. There are no lab findings that confirm the diagnosis. The diagnosis is made clinically based on joint inflammation and absence of RF, and cutaneous findings/psoriasis. CASPAR criteria can be used.
A patient is diagnosed with ankylosing spondylitis and begins taking a COX-2 inhibitor with minimal pain and inflammation relief. What will the nurse practitioner do next to manage this patient’s symptoms?
A Prescribe a trial of sulfasalazine or methotrexate
B Refer to rheumatology to begin a biologic anti-tumor necrosis factor agent
C Switch the patient to a COX-1 inhibitor medication
D Start the patient on corticosteroid injections every 3 months
C.
NSAIDs have been shown to reduce pain and stiffness and reduce progression of structural damage if administered continuously. Patients should try at least two NSAIDs before other medications are attempted. Sulfasalazine and methotrexate have not been shown to be significantly effective for axial disease. Biologic anti-tumor necrosis factor medications are given only after failure of two NSAIDs. Corticosteroid injections are not indicated at this time.
The primary care pediatric nurse practitioner examines a child who has had stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for what form of juvenile idiopathic arthritis (JIA)?
A Systemic JIA
B Oligoarticular JIA
C Polyarticular JIA
D Enthesitis-related JIA
B Oligoarticular JIA
Oligoarticular JIA is characterized by mild, painless asymmetric joint involvement without systemic symptoms. Enthesitis-related JIA involves arthritis of the lower limbs, especially the hips, intertarsal joints, and sacroiliac joints, with swelling, tenderness, and warmth. Polyarticular JIA involves 5 or more joints. Systemic JIA presents with systemic symptoms, such as fever
The primary care pediatric nurse practitioner is managing care for a child who has been diagnosed with juvenile idiopathic arthritis (JIA) and has a positive antinuclear antibody (ANA). Which specialty referral is critical for this child?
A Pain management
B Ophthalmology
C Cardiology
D Orthopedics
B.
An ophthalmology consultation is critical for children with JIA who have a positive ANA. Uveitis occurs in up to 35% of children with JIA who have a positive ANA. Other specialists may be consulted for specific symptoms.
A 12-year-old child is brought to the clinic with joint pain, a 3-week history of low-grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An antinuclear antibody (ANA) test is positive. Which of the following tests has the highest sensitivity in confirming the diagnosis?
A Anti-Sm antibodies
B Anti-double-strand DNA antibodies
C Anti-Ro antibodies
D Anti-La antibodies
B.
Anti-double-strand DNA antibodies are present in most people with SLE and are generally exclusively seen in cases of SLE and not other diseases. Anti-SM antibodies are diagnostic of SLE but are only seen in 30% of patients with systemic lupus erythematous (SLE).
A patient who is taking prednisolone 20 mg daily to treat polymyalgia rheumatica reports blurred vision. What will the nurse practitioner do?
A Discontinue the medication
B Increase the prednisolone dose to 60 mg daily
C Prescribe NSAIDs to treat the inflammation
D Refer to a rheumatologist or the emergency room immediately
D.
Sudden vision loss, diplopia, and other visual disturbances may indicate giant cell arteritis (GCA) and requires immediate referral to rheumatology or the emergency department. The primary provider should not change the medication regimen without a consult.
The primary care pediatric nurse practitioner is reviewing the rheumatology plan of care for a child who is diagnosed with systemic lupus erythematosus (SLE). Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes?
A Have the child rest between activities
B Obtain regular ophthalmology exams
C Participate in low-impact exercises
D Use ultraviolet A (UVA) and ultraviolet B (UVB) sunscreen daily
Use ultraviolet A (UVA) and ultraviolet B (UVB) sunscreen daily
Which of these are symptoms associated with fibromyalgia? Select all that apply.
A Gastrointestinal complaints
B Hepatosplenomegaly
C Musculoskeletal pain
D Nonrestorative sleep
E Renal complications
A. C, C
A 60-year-old patient reports new onset of bilateral shoulder pain with morning stiffness, lasting approximately 1 hour. Which of these will be included in initial diagnostic testing for this patient? Select all that apply.
A Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
B Serum complement
C Liver function tests (LFTs)
D Protein electrophoresis
E Serum calcitonin
ACD
ESR, CRP, and protein electrophoresis are included in the initial diagnostic workup when polymyalgia rheumatica is suspected. Serum calcitonin and complement are not indicated.
Ankylosing Spondylitis
What
Where
Symptoms
What: long term inflammation initiates bone regrowth
Where: Spine & pelvis
Symptoms
- stiff neck & pack
- mobility problems over time
