Questions

Just like the actual exam

Aligned with the American Association of Nurse Practitioner and American Nurses Credentialing Center format. Authored & peer-reviewed by Family NPs.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

  • Must address important content
  • Must be well structured

Question

A 75-year-old woman presents to the clinic complaining of joint pain. She states that, for the last month, she has had increasingly painful joints that are now more localized to both hands and both feet. She also complains of fatigue and weakness. Which of the following symptoms would the provider expect to find in the suspected diagnosis?

A Pain that is worse after activity
B Pain that is worse at night
C Pain that is worse in the morning
D Pain that is worse on palpation

Rheumatoid arthritis (RA), an autoimmune disease, is an inflammatory, symmetric form of arthritis that causes varying degrees of joint destruction, disability, deformity, and premature death. Some patients are genetically susceptible to RA, while others may have hormonal or environmental contributing factors. The chief target of inflammation is the synovial lining of diarthrodial joints. Early changes in the synovial membrane are observed in the capillaries. The synovial membrane encounters hyperplastic thickening due to the proliferation of fibroblasts and new blood vessel formation. Clinical manifestations of RA occur insidiously over several weeks to months, but sometimes, patients can have acute symptoms. Initial symptoms include generalized weakness, fatigue, weight loss, aching, and stiffness. Symptoms then become more localized with swollen, painful joints. Patients with RA usually have pain that is worse in the morning that lasts at least 30 minutes or all morning. Patients with osteoarthritis may also experience morning pain, but the pain typically does not last as long as it does in RA. Initially, the most commonly affected joints include the small joints of the hands, wrists, and small joints of the feet. Joint involvement will be bilateral and symmetric in RA and may also affect the knees, hips, shoulders, ankles, and cervical spine. On physical examination, the inflamed joint may feel tender and warm. The synovial membrane will feel boggy and thick on palpation. The skin over the joint may have a ruddy color and appear shiny and thin. A diagnosis of RA can be made based on history and physical examination. RA can affect many organs, including the heart and spleen. A baseline laboratory panel is recommended on initial diagnosis and periodically includes complete blood count, erythrocyte sedimentation rate, C-reactive protein, serum creatinine, liver function tests, urinalysis , rheumatoid factor, and anti-cyclic citrullinated peptide antibodies. Normocytic, normochromic anemia is common in patients with RA. Antirheumatic drugs can be nephrotoxic and hepatotoxic, which is why baseline kidney and liver function tests are necessary. Ultrasound and MRI can both be used to confirm an RA diagnosis. A hallmark sign of RA is bone marrow edema. Synovial fluid aspiration can also be used to confirm a diagnosis. Normally, synovial fluid is clear and viscous. In RA, the synovial fluid has poor viscosity and a high WBC count. Treatment may include a regimen of NSAIDs, glucocorticoids, and antirheumatic drugs. A referral to a rheumatologist is often indicated.

Pain that is worse after activity (A), at night (B), or on palpation (D) is not specific to rheumatoid arthritis.


Explanations

Written with a purpose

Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.

  • Created for optimal learning and recall
  • Help reinforce your knowledge
  • Focus on the essential information

Illustrations

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Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.

rheumatoid arthritis

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One Step Further

Taking your learning to the next level

After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Q: What nonpharmacological intervention may a patient with rheumatoid arthritis include in their morning routine to aid in morning joint pain?

REVEAL ANSWER

A: Warm showers.

Rheumatoid Arthritis

  • More common in women and those aged 40–50 years
  • Morning stiffness lasting > 30 minutes
  • PE will show symmetrical soft, red, tender swelling in joints (MCP, PIP)
  • Bilateral ulnar deviation at MCP, boutonnière deformity, and swan-neck deformity
  • Labs will show positive RF, anti-cyclic citrullinated peptide antibodies
  • Most commonly caused by autoimmune destruction of synovial joints
  • Treatment is DMARDs

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information
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