New NR509 study guide Revised.docx - NR509 Mid-Term Study...

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NR509 Mid-Term Study Guide Articular structures include joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments and juxta-articular bone o Articular disease involves: Swelling Tenderness of the joint Crepitus Instability “locking” Deformity Limits active and passive range of motion due to stiffness or pain Extra-articular structures include periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve and overlying skin o Extra-articular disease involves: “point of focal tenderness in regions adjacent to articular structures Limits active range of motion RARELY causes swelling, instability, joint deformity Know the sources of joint pain (pg. 627 algorithm) Nonarticular conditions : trauma/fracture, fibromyalgia, polymyalgia rheumatica, bursitis, tendinitis Intra-articular (acute, < 6 weeks) : acute arthritis o infectious arthritis o gout o pseudogout o Reiter syndrome Intra-articular (chronic, > 6 weeks) : chronic inflammatory arthritis vs chronic noninflammatory arthritis o Chronic inflammatory arthritis with 1-3 joints involved: Indolent infection Psoriatic arthritis Reiter syndrome Periarticular JA o Chronic inflammatory arthritis with >3 joints involved: Psoriatic arthritis or Reiter syndrome (no symmetry) rheumatoid arthritis if not RA then systemic lupus, scleroderma, polymyositis * Know what causes saddle numbness and urinary retention (pg. 678?) CES (cauda equina syndrome) most commonly results from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as a person ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
The following are other potential causes of CES: Spinal lesions and tumors Spinal infections or inflammation Lumbar spinal stenosis Violent injuries to the lower back (gunshots, falls, auto accidents) Birth abnormalities Spinal arteriovenous malformations (AVMs) Spinal hemorrhages (subarachnoid, subdural, epidural) Postoperative lumbar spine surgery complications Spinal anesthesia Know how retinal detachment presents (p.217) Sudden, painless vision loss that is unilateral Know what the word obtunded means (p. 769) The obtunded patient opens eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased. Know what cranial nerve you’re assessing when checking lateral gaze (p. 237) Cranial nerve VI: abducens Know what should be listed under adult illnesses in health history (pg. 10) Medical illnesses : such as diabetes, hypertension, hepatitis, asthma, and HIV. Also hospitalizations, number and gender of sexual partners, and risk-taking sexual practices Surgical : dates, indications, and types of operations Obstetric/Gynecologic : obstetric history, menstrual history, methods of contraception, and sexual function Psychiatric

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