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FNP Question and answer verified to pass
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FNP Question and answer verified to pass OA - correct answer Exacerbated by activity, relieved by rest. AM stiffness resolves in 30 min. Tx: exercise is considered first line! Acet and NSAIDS (GI and CV issues). -Most common joint: DIP. Most problematic: hip/knee. -Deformity of PIP is Boucha...

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  • August 18, 2024
  • 5
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • fnp
  • fnp question and answer verified to pass

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  • Musculoskeletal
  • Musculoskeletal

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FNP: Musculoskeletal
OA - correct answer ✔Exacerbated by activity, relieved by rest. AM stiffness
resolves in 30 min.
Tx: exercise is considered first line! Acet and NSAIDS (GI and CV issues).
-Most common joint: DIP. Most problematic: hip/knee.
-Deformity of PIP is Bouchard nodes
-Labs: typically ESR and CRP are normal. SLE and ANA's normal.
-Glucosamine can be first-line (in Europe). Can cause bronchospasm.
Condroitin is often used with (synergistic) but has anticoagulant effect.


RA - correct answer ✔often bilateral, symmetric, peripheral.
(Remember, lupus and scleroderma often have polyarthritis)
-Peak age of onset: 20-40. More common in women/those with autoimmune.
-Most common: hands (not DIP- OA), wrists, ankles, toes.
-Labs: ESR, CRP, Rehumatoid factor (+ in 90%), hemogram can show ACD,
ANA (in 95% for SLE but in 30-50% of RA).
Tx: NSAIDS (symptom control but don't change process- still backbone of tx).
DMARDS- start as soon as dx is known. Steroid injection.
-Sjogrens syndrome common in those with RA. Decreased oral/ocular
secretions with ESR elevated in 90%.


Gout - correct answer ✔Risks: high purine (red meats, fish, gravies, spinach,
asparagus, yeast) diets, diuretic use, ASA use (inhibits ability to excrete UA),
low fluid intake, ETOH, DM, obesity, niacin and aspirin
-100x more common than acutely infected joint!
Attacks: NSAIDS (indomethacin, Naproxen), steroids (via needle), colchicine
with probenecid

, If on HCTZ, stop and start something else!
-With first episode, can obtain uric acid levels, but may be reduced during this
phase. Analysis of joint aspirate is dx, ESR usually high.
-After acute phase, 24h uric acid collection determines uric acid overproducer
or undersecreter. Undersecreters benefit from probenecid, overproducers
from allopurinol.


Epicondylitis - correct answer ✔-presents with decreased hand grip strength
-Tennis elbow: lateral
-Golfers elbow: medial
-Conservative tx in first 3-4 wks includes rest, aplints, NSAIDS. If persist, can
use short-arm cast. Local steroid injection can be helpful if s/s last > 6-8 wks.


Cox 1-2 - correct answer ✔Cox 1: maintains protective gastric mucosal layer
Cox 2: helps with inflammatory response, pain transmission, and renal
arteriole constriction


Meniscal tear - correct answer ✔-shock absorber. With large tear, pt c/o
knee locks, pops, gives out. Effusion is common- tightness and stiffness. With
certain positions there is a sudden-onset, sharp, localized pain (usually in
median aspect of knee). Pt will have inability to kneel.
-Pts with partial, horizontal and anterior tears may have normal exam.
McMurray test (palpable pop on joint line) is specific but poorly sensitive for
meniscal tear. Apley grinding test similar.
-May need rest, elevation, ice, analgesia and possibly crutch walking and
aspiration.


Carpal Tunnel Syndrome - correct answer ✔-burning, aching, tingling pain
radiating to forearm in median nerve. Classic finding is acroparesthesia
(awakening at night with NT pain in fingers). PE shows + Tinels and Phalens

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