FNP II Question and answers rated A+

FNP II - MSK
What is rheumatoid arthritis? Describe the overview, etiology, and
pathophysiology - correct answer ✔· Overview
o Systemic, multisystem inflammatory disorder
o Affects synovial membrane of joints
o Periods of exacerbation & remission
o Immune response in genetically




· Etiology
o Theories:
§ Autoimmune
§ Infectious trigger
o Genetics
§ Family hx of RA
o Stress
§ Exacerbation of sx sometimes prescribe antidepressants to reduce


· Pathophysiology
o Rheumatoid factor develops in synovium
o Antibody/antigen complexes --> inflammation in joints
o Synovitis develops
o Hypertrophied synovium (lining) thickens & invades surrounding tissue
o Granulation formus (pannus)
§ Pannus

,· Erodes & destroys articular cartilage
· Affects tendons & ligaments
§ Laxity, subluxation & contracture
§ Nodules, ankylosing joints


Describe the presentation and clinical sx of rheumatoid arthritis - correct
answer ✔· Presentation
o Uniform joint space narrowing
o Marginal erosion of bare areas where synovium lies on bone
o Joint subluxation
o Muscle atrophy
o Inflammation of tendon
o Extra-articular manifestations


· Clinical sx
o Pain, swelling in hands & feet
o Morning stiffness, stiffness after rest
o Less of ROM
o Generalized fatigue
§ Severe during flare up
o Rheumatoid nodules
o Flares & remissions


Describe the tx for rheumatoid arthritis - correct answer ✔o Drug therapy
pyramid
§ NSAIDs
§ Biologic response modifiers (BRMs)

,· Non-TNF-abatacept, rituximab, tocilizumab
· Anti-TNF- adalimumab, etanercept, infliximab, certolizumab pegol,
golimumab
§ Steroids
§ Disease modifying anti-rheumatics (DMARDs)
· Hydroxychloroquine, leflunomide, MTX, minocycline, sulfasalazine
· Therapeutic effect may take weeks
o PT/OT
§ ROM exercises
§ Strength/endurance exercises
§ Splints
§ Fxnl abilities
o Therapeutic use of heat/cold
o Surgery - joint replacement


What are the complications of RA? - correct answer ✔o Flexion contractures
o Joint instability
o Tendon rupture
o Septic arthritis
o Cord compression
o Sensory/motor loss


Given an overview and epidemiology of Sjogren's syndrome - correct answer
✔· Chronic inflammatory autoimmune disorder r/t exocrine dysfxn
· Dryness of lacrimal, salivary glands
· May also affect skin, lungs, kidneys, heart
· Possibly affects hematopoietic system --> lymphoma

, · Epidemiology
o 4:100,000 ppl worldwide affected
o Primary or secondary
o Affects women 9x more often than men
o Age 40-60 yrs
o Typically accompanies underlying rheumatic diseases (RA, SLE, systemic
sclerosis)


Describe the pathophysiology of Sjrogen's syndrome - correct answer ✔o
Lymphocytic infiltration in all affected organs is hallmark of SS
o Pooling of lymphocytes, plasma cells in lacrimal & parotid glands
o Characteristics "dry eye" conjunctivitis (keratoconjunctivitis sicca)
o Parotid enlargement, diminished salivary excretions
o Hyperplasia of ductal epithelium in salivary glands produces characteristics
dry mouth ("xerostomia")
§ T-lymphocytes (CD4 + T-helper subset) w/TCRab receptors
§ Genetic predisposition
§ Importance of autoantibodies (Acetylcholine receptors) in salivary glands
may impair secretion of saliva
o Infection by viruses:
§ EBV
§ Retroviruses (human T-cell lymphatic virus)
§ HepC
§ Coxsackievirus
§ Disorders of estrogen: postmenopausal and estrogen tx (circumstantial
evidence)