Exam (elaborations)
NURP 532-Rheum Exam Questions And Correct Answers
- Course
- Institution
NURP 532-Rheum Exam Questions And Correct Answers ...
[Show more]
Content preview
NURP 532-Rheum ExamQuestions And Correct Answers
stages of gout progression - Answer stage 1-high uric acid levels: uric acid builds up in
blood, crystallization in joints
stage 2-acute gout: symptoms start, pain in affected areas
stage 3-intercritical gout:remission between attacks
stage 4-chronic gout: pain is frequent and tophi form in joints
Gout S/S - Answer Rapid onset (pain peaks in 1 day)
Hot, red, swollen joint (usually 1 joint only)
Pain worse at night/rest "bedsheet pain"
PE=Most common locations:
-First metatarsophalangeal joint
-Followed by midtarsal joints, ankles, knees, fingers
Red, hot, exquisitely tender joint
Absence of fever
Tophi in chronic disease
Gout risk factors - Answer -Use of loop or thiazide diuretics
-Men or postmenopausal women (female sex hormones increase excretion of uric acid)
-Increased age
-Black
-Obesity
-Diet: EtOH intake, organ meat, shellfish, sugary food/drinks
dif dx for gout - Answer Septic joint arthritis (fever, elevated WBC; need to get
arthrocentesis if thinking this)
Cellulitis (possible fever/elevated WBC, usually located more over soft tissue)
,Bursitis (profound swelling d/t enlarged bursa)
Lyme (+titres, systemic sx)
Pseudogout (normal serum uric acid levels but +crystals)
Trauma (elicited on history)
Osteoarthritis (chronic onset)
Rheumatoid arthritis (polyarticular, often symmetrical)
diagnosing gout - Answer JOINT FLUID ASPIRATION- Gold standard for Diagnosis
-(AKA Arthrocentesis) Presence of intracellular monosodium urate crystals in synovial
fluid
SERUM URIC ACID- elevated
-Commonly checked but NOT diagnostic of gout
-May be normal or even low during an active flare;
most gout patients will have elevations in between flares
-Therefore, best measured in between flares to monitor response to uric acid
lowering/preventative treatments
Imaging (U/S, MRI, CT) not usually needed unless there is trauma/diagnostic uncertainty
American College of Rheumatology Diagnostic Criteria- Gout - Answer Presence of
characteristic urate crystals in the joint fluid
or
Presence of a tophus proven to contain urate crystals by chemical means or polarized
light microscopy
or
Presence of six or more of the following clinical, laboratory, or radiologic findings:
-Asymmetric swelling within a joint on radiography
-Attack of monoarticular arthritis
-Culture of joint fluid negative for microorganisms during attack of joint inflammation
-Development of maximal inflammation within one day
-Hyperuricemia
-Joint redness
, -More than one attack of acute arthritis
-Pain or redness in the first metatarsophalangeal joint
-Subcortical cyst without erosions on radiography
-Suspected tophus
-Unilateral attack involving first metatarsophalangeal joint
-Unilateral attack involving tarsal joint
Gout tx - Answer acute=NSAIDS, Colchicine, Corticosteroids
prophylactic=Allopurinol, Colchicine, Probenecid
-Initiate if: tophi, hx of kidney stones, 2+ gout flares per year, (1+ flares per year if CKD
stage 2 or higher)
-Goal is to bring uric acid level <6 mg per dL
-Continue 3-6 mons after active flare, indefinitely if there are tophi and/or ongoing sx
-DO NOT start Allopurinol during active gout flare!
non-pharm mgmt of Gout - Answer -encourage weight loss if overweight/obese
-limit sugary foods/ HFCS intake
-avoid ETOH
-limit high purine organ meats (beef, lamb, pork, shellfish)
-inc low fat dairy and vegetables
Juvenile Idiopathic Arthritis (JIA) - Answer assess for=
-Joint redness
-Family history
-Limping/limited movement (can be secondary to pain AND/OR joint contractures)
-Rash (non-pruritic, erythematous, trunk and proximal extremities)
diagnostic criteria for JIA - Answer 1) Onset before age 16 years
2) Arthritis involving one or more joints or at least two of the following findings:
Limitation in range of motion (ROM)
Tenderness or pain with joint movement
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Flat. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
72964 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now