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NUR 524 Exam 4 Questions And Correct Answers
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NUR 524 Exam 4 Questions And Correct Answers 2024-2025Erythrocyte Sedimentation Rate (ESR) - Timed test answer that quantifies the rate at
which red blood cells settle through a volume of plasma
Non Specific marker of inflammation (Clumping from inflammation causes RBCs to sink
faster)
Rheumatoid Factor (RF) - Answer An immunoglobulin IgM antibodydirected against IgG
Usually present in RA, but can be present with other disorders
Presence of RF in RA usually signifies more severe disease
ANTI-Nuclear Antibody (ANA)-Answer Pathogenic autoantibodies
Present in 95% of SLE patients; Also present in 25-30% normal patints
HLA-B27 - Answer immunogenetic marker associated with spondyloarthropathies:
present in 95% of pts with ankylosingspondylitis
50-80% of patients with spondyloarthropathy of inflammatory bowel disease, Reiter's
syndrome or psoriasis
Ankylosing Spondylitis - Answer chronic, progressive arthritis with stiffening of joints,
primarily of the spine; Seronegative spondyloarthropathies: group of inflammatory
arthritides with many shared features
Anklosing spondylitis
Reactive arthritis & Reiter's syndrome
psoriatic arthritis
Arthritis associated with inflammatory bowel disease(IBD)
,These diseases are characterized by: sacroiliitis, peripheral joint inflammation & eye
inflammation and
Ankylosing Spondylitis Patho and Presentation - Answer Inflammation of bony insertions
of ligaments & tendons -> new bone formation
Ligamentous inflammatory granulation tissue is gradually replaced by fibrocartilage &
then ossifies
Insidious onset of low back pain, exacerbation and periods of remission. Pain is diffuse,
poorly localised, described as a deep ache, nagging discomfort in the low back below
waist, buttocks or in hips, improves with exercise, worsens with rest
Ankylosing Spondylitis S/S - Answer Asymmetric joint involvement, often large joints•
Extra articular manifestations: low-grade fever, fatigue and wt. loss• acute anterior
uveitis: painful, red eye, up to 30% of pts.• Cardiac involvement: aortic valve
insufficiency, mild or severe
PE: Loss of normal lumbar lordosis
Often palpable muscle spasm Para spinal muscles
Decreased spine mobility
Ankylosing Spondylitis Diagnostics - Answer Rheumatology has 3 clinical criteria for
diagnosis:
low back pain & stiffness >3 months, improving with exercise, not relieved by rest• 2.
limited ROM of lumbar spine• 3. Limited chest expansion
Presence of sacroiliitis on radiologic exam + 1 clinical criterion is diagnostic
Ankylosing Spondylitis Management - Answer Should be co-managed with
rheumatology, & refer to PT, ortho & ophthalmology
First line: NSAIDs: particularly indomethacin, tolmetin & sulindac. Other NSAIDs such as
ibuprofen & naproxen are variably effective.
,High dose ASA not effective
TNF's: tumor necrosis factor agents are effective but are costly.
Pain management very important to minimize spinal deformity and allow pts.to exercise
Variety of neurological issues: 1. cord compression 2° to spinal fx of fusedspine, 2.
Atlantoaxial subluxation from chronic cervical involvement, 3.Cauda equina syndrome
Reactive Arthritis & Reiter's Syndrome - Answer Reactive arthritis = acute sterile
inflammatory arthropathy after an infection & no microbial invasion of the synoviumor or
joint space & prior infection is remote from joint
Reiter's syndrome: an example of reactive arthritis defined by classic triad of
conjunctivitis, urethritis &arthritis
Reactive arthritis is the preferred term as many patients are first seen with an
incomplete syndrome without all 3 criteria
Reactive Arthritis: seen post Stds and GI infections: common causative agent:
salmonella, shigella, Yersinia, campylobacter & chlamydia
Reactive Arthiritis and Reiter's Incidence - Answer One study 260 individuals with
Salmonella infection 19 or 7% developed reactive arthritis.
Peak incidence of RA/RS is in 3rd decade of life
Postveneral Reiter's syndrome affects men more than women ranging from 9:1 to 5:1
Reactive Arthiritis and Reiter's Presentation - Answer When there is a documented
infection: arthritic s/s occur 10-20days later.
Less than 40% of pts. Present with the classic triad
Arthropathy of RS is distinctive: lower extremity, asymmetric joint involvement,
"sausage digits", heel pain, Achilles tendinitis, plantarfasciitis & sacroiliitis.
, Dactylitis: "sausage digit" result of inflammation of insertions of ligaments/tendons:
characteristic of Reiter's & psoriatic arthritis
Course of disease is variable: initial episode 2-3 mos., may have recurrent acute
attacks, 1/3 of pts. Have sustained disease activity/chronicity
Less than 20% of patients have chronic/destructive/debilitating disease
Reactive Arthiritis and Reiter's Diagnostics - Answer Labs are non-specific, ESR & CRP
will be elevated, leukocytosis with thrombocytosis & often mild anemia.
X-ray shows sausage digits, Achilles tendinitis/plantarfasciitis & periosteal rxn of new
bone formation.
Periarticular demineralization/osteopenia notably absent in RS vs. RA
Reactive Arthiritis and Reiter's Management - Answer same as ankylosing spondylitis
Also sulfasalazine, methotrexate, abx?, ? TNF
Psoriatic Arthritis: Incidence/Pathophysiology - Answer Inflammatory arthritis assoc.
with the dermatologic dx of psoriasis.
6% of patients with mild-moderate psoriasis develop inflammatory arthritis
Severe psoriasis = 30-40% joint disease, men & women are equally affected
Common age of onset: 30-40 years
> extensive spinal involvement in men + HLA-B27
Psoriatic Arthritis Presentation - Answer Occurs before, with or after onset of the skin
disease
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