UHPAB June 2025 Medicine DNE11

Degenerative & Endocrine Disorders - Nurses Revision Uganda

🏥 Nurses Revision Uganda

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Medicine UHPAB June 2025

SECTION A: Objective Questions (20 marks)

🔬 Clinical Focus: This paper covers degenerative diseases, endocrine disorders, and connective tissue conditions. Focus on pathophysiology and nursing priorities!

Which of the following is NOT a degenerative disorder?

a) Trigeminal neuralgia

b) Parkinson's disease

c) Gout arthritis

d) Bell's palsy

Gout is a metabolic inflammatory disorder, not degenerative. It's caused by uric acid crystal deposition in joints, triggering inflammation. Degenerative disorders involve progressive loss of structure/function over time (Parkinson's - neuronal degeneration). Trigeminal neuralgia involves nerve irritation, Bell's palsy is inflammatory (viral), but gout is the clearest non-degenerative answer.

(a) Trigeminal neuralgia: Can involve vascular compression and nerve damage, but has degenerative components.
(b) Parkinson's disease: Classic degenerative disorder with loss of dopaminergic neurons.
(d) Bell's palsy: Inflammatory (viral) neuropathy, but can have some degenerative features during recovery.

DEGENERATIVE DISORDERS: "PAD" - Parkinson's, Alzheimer's, Dementia, Osteoarthritis, Multiple sclerosis

Pain relief techniques for a patient suffering from trigeminal neuralgia exclude

a) Applying hot/cold compresses

b) Using a soft toothbrush

c) Administration of peripheral nerve blocks

d) Administration of muscle relaxants

(a) Applying hot/cold compresses

Trigeminal neuralgia is triggered by light touch and temperature changes. Hot or cold compresses applied to the face can trigger severe paroxysmal pain. The condition requires avoidance of triggers. Peripheral nerve blocks (c) are effective, soft toothbrushes (b) reduce trigger stimulation, and muscle relaxants (d) may help with jaw tension.

(b) Soft toothbrush: This IS appropriate - reduces mechanical trigger from oral care.
(c) Peripheral nerve blocks: This IS appropriate - effective interventional treatment (glycerol injection, radiofrequency).
(d) Muscle relaxants: This IS appropriate - may reduce associated jaw clenching that triggers pain.

⚡ TRIGGER WARNING: Trigeminal neuralgia is called "suicide disease" due to severity. Teach patients strict trigger avoidance: no hot/cold foods, gentle face washing, soft foods only!

Which of the following nursing actions is most appropriate for the care of a patient with pheochromocytoma?

a) Encouraging the patient to rest

b) Regulating patient's fluid intake

c) Maintaining fluid balance

d) Monitoring blood pressure

(d) Monitoring blood pressure

Pheochromocytoma is a catecholamine-secreting tumor causing life-threatening hypertensive crises. Blood pressure can spike to >200/120 mmHg within seconds. Continuous BP monitoring is the highest priority to detect paroxysms and guide alpha-blocker therapy. A BP spike can trigger stroke, MI, or arrhythmia. While other options are important, BP monitoring is life-saving.

(a) Encouraging rest: Important but secondary to BP monitoring; rest alone doesn't prevent crises.
(b) Regulating fluid intake: Not specifically critical; fluid balance is managed globally but not tumor-specific.
(c) Maintaining fluid balance: General nursing care, but BP monitoring is more specific and urgent for this condition.

PHEOCHROMOCYTOMA TRIAD: "PHE" - Palpitations, Headache, Hypertension + sweating

Which of the following conditions commonly occurs in patients with Cushing syndrome?

a) Depression

b) Anxiety

c) Psychosis

d) Panic attacks

(a) Depression

Depression occurs in 50-70% of Cushing's syndrome patients due to hypercortisolism's direct effects on brain neurochemistry (reduced serotonin, dopamine), hippocampal atrophy, and sleep disruption. Mood changes often precede physical manifestations. Psychosis (c) occurs in 3% (more in severe cases), anxiety (b) and panic (d) can occur but depression is most common and characteristic.

(b) Anxiety: Can occur but less common than depression; often secondary to physical changes.
(c) Psychosis: Rare (<5%); occurs in severe hypercortisolism with concentrations >1000 nmol/L.
(d) Panic attacks: Not characteristic; more likely generalized anxiety than discrete panic.

🧠 Neuropsychiatric First: In Cushing's, mood changes often present BEFORE physical signs. Always screen for depression when evaluating hypercortisolism symptoms.

Which of the following is NOT a risk factor for Hodgkin's lymphoma?

a) Alcoholism

b) Mononucleosis

c) Family history

d) Age

(a) Alcoholism

Alcoholism is NOT a recognized risk factor for Hodgkin's lymphoma. Risk factors include: EBV infection (mononucleosis) b-cell transformation, family history (genetic susceptibility), and age bimodal distribution (15-35 and >55). Alcohol is linked to other cancers (breast, liver, esophagus) but not specifically Hodgkin's lymphoma.

(b) Mononucleosis: IS a risk factor - EBV infects B-lymphocytes, causing malignant transformation in Hodgkin's.
(c) Family history: IS a risk factor - 3x increased risk with first-degree relative with Hodgkin's.
(d) Age: IS a risk factor - bimodal distribution peaks in young adulthood and elderly.

HODGKIN'S RISK: "EMF" - EBV/Mononucleosis, Male gender, First-degree relatives, Age bimodal

Which of the following is a common cause of generalised enlargement of lymph glands?

a) Lupus erythematosus

b) Hodgkin's lymphoma

c) Pheochromocytoma

d) Addison's disease

(b) Hodgkin's lymphoma

Hodgkin's lymphoma classically presents with painless, generalized lymphadenopathy - typically cervical, supraclavicular, and mediastinal nodes. Nodes are rubbery, non-tender, and may coalesce. Systemic "B symptoms" (fever, night sweats, weight loss) often accompany. Lupus causes localized not generalized lymphadenopathy; pheochromocytoma and Addison's are adrenal disorders without lymph node involvement.

(a) Lupus erythematosus: Causes localized cervical lymphadenopathy during flares, not generalized.
(c) Pheochromocytoma: Adrenal medulla tumor; no lymph node involvement; presents with hypertension.
(d) Addison's disease: Adrenal cortex insufficiency; no lymphadenopathy; presents with hypotension, hyperpigmentation.

🔍 Painless Lymphadenopathy = RED FLAG! Especially supraclavicular nodes. Always consider lymphoma until proven otherwise. Urgent biopsy needed!

Which of the following nursing interventions relieves pain in a patient with lymphadenitis?

a) Administration of antibiotics

b) Applying a warm compress

c) Applying a cold compress

d) Raising the affected part

(b) Applying a warm compress

Warm compresses (40-45°C) increase blood flow, promote drainage, and reduce lymph node congestion and pain. Applied for 15-20 minutes 3-4 times daily. Cold compresses would vasoconstrict and worsen stagnation. Antibiotics (a) treat infection but don't directly relieve pain. Elevation (d) is less effective for nodes than for extremity edema.

(a) Antibiotics: Treat underlying bacterial cause but take 24-48 hours to reduce pain; not immediate relief.
(c) Cold compress: Causes vasoconstriction, reduces perfusion, and may worsen lymphatic drainage.
(d) Raising the affected part: Only applicable if limb is involved; ineffective for cervical nodes (most common).

LYMPHADENITIS CARE: "WARM" - Warm compresses, Antibiotics, Rest, Monitor for abscess

Which of the following is NOT a complication of lymphangitis?

a) Necrosis

b) Bacteraemia

c) Cellulitis

d) Sepsis

(a) Necrosis

Necrosis is not a typical complication of lymphangitis (infection of lymphatic vessels). Lymphangitis causes red streaks from infection spread, leading to systemic complications: bacteremia (b), cellulitis (c), and sepsis (d). Necrosis indicates severe tissue death from ischemia or overwhelming infection, not characteristic of uncomplicated lymphangitis.

(b) Bacteraemia: IS a complication - bacteria enter bloodstream through lymphatics causing positive blood cultures.
(c) Cellulitis: IS a complication - infection spreads from lymphatics to surrounding soft tissue.
(d) Sepsis: IS a complication - systemic inflammatory response to bacteremia from lymphatic source.

🔴 Red Streak Alert! Lymphangitis requires IV antibiotics within 24 hours. If untreated, sepsis can develop rapidly. Monitor vitals closely!

Measures to manage lymphedema exclude

a) Gradual limb exercises

b) Restricting all forms of exercise

c) Compression bandaging

d) Meticulous skin care

(b) Restricting all forms of exercise

Exercise is ESSENTIAL for lymphedema management. Restricting all exercise worsens lymphatic stasis and increases swelling. Gradual, progressive muscle contractions promote lymph flow through the pumping mechanism. Exercise should be gentle, progressive, and combined with compression. Complete restriction leads to muscle atrophy and worsening edema.

(a) Gradual exercises: This IS included - muscle pump action enhances lymphatic drainage.
(c) Compression bandaging: This IS included - cornerstone of therapy, provides external support to move lymph.
(d) Meticulous skin care: This IS included - prevents infection (cellulitis) which worsens lymphedema.

LYMPHEDEMA MANAGEMENT: "C-E-L-L" - Compression, Exercise, Lymphatic massage, Lifestyle (weight control, skin care)

Which of the following interventions is appropriate for managing a patient with tendinitis?

a) Avoid high calorie and fat diet

b) Take plenty of fluids and fruits

c) Rest, ice compression and elevation

d) Keep on the sides with legs straight

Tendinitis is inflammation of a tendon, and RICE is the first-line treatment. Rest prevents further micro-tears, ice reduces inflammation and pain (applied 15-20 min every 2-3 hours for first 48 hours), compression limits swelling, and elevation reduces edema. This protocol reduces inflammatory mediators and promotes healing. Diet (a,b) and positioning (d) are not primary interventions.

(a) Avoid high calorie/fat: General health advice but doesn't address acute inflammation directly.
(b) Plenty of fluids/fruits: Good for general health but not specific treatment for tendinitis.
(d) Side-lying with legs straight: Irrelevant positioning unless specific lower extremity tendinitis.

ACUTE INFLAMMATION: "RICE" - Rest, Ice, Compression, Elevation (first 48-72 hours)

11
A patient with tendinitis is advised to avoid

a) Calcium intake

b) Alcohol intake

c) Anti inflammatories

d) Flexing affected joints

(b) Alcohol intake

Alcohol should be avoided in tendinitis as it increases inflammation and interferes with healing. Alcohol metabolites can worsen inflammatory responses and impede collagen synthesis. NSAIDs (c) are actually recommended. Calcium (a) is important for tendon health. Flexing (d) should be avoided only in acute phase, but alcohol avoidance is more critical throughout healing.

(a) Calcium intake: Should NOT be avoided - essential for tendon repair and bone attachment.
(c) Anti-inflammatories: Should NOT be avoided - first-line medication for pain and inflammation.
(d) Flexing affected joints: Should be avoided only in acute phase (first 48h), then gentle ROM is encouraged.

🍷 Alcohol Impairs Healing: Inhibits inflammatory response, dehydrates tissues, interferes with protein synthesis. Advise complete abstinence during acute tendinitis recovery (2-4 weeks).

12
Specific nursing interventions for managing a patient with gout exclude

a) Pain management

b) Lifestyle modification

c) Exercise of the affected joint

d) Administration of urate-lowering medications

(c) Exercise of the affected joint

During acute gouty arthritis, the affected joint should be rested, not exercised. Exercise increases inflammation and severe pain. The joint should be immobilized, elevated, and protected from pressure. Exercise is appropriate during intercritical periods (between attacks) to maintain function, but NEVER during acute flare. Pain management (a), lifestyle modification (b), and urate-lowering drugs (d) are all key interventions.

(a) Pain management: This IS included - NSAIDs, colchicine, steroids for severe acute pain.
(b) Lifestyle modification: This IS included - low-purine diet, weight loss, alcohol avoidance.
(d) Urate-lowering medications: This IS included - allopurinol, febuxostat for chronic management.

GOUT ACUTE PHASE: "R-E-S-T" - Rest, Elevate, Splint, Treat (NSAIDs/colchicine)

13
Which of the following is a symptom of acute pyelonephritis?

a) Urine retention

b) High blood pressure

c) Hypothermia

d) Flank pain

(d) Flank pain

Flank pain (costovertebral angle tenderness) is the hallmark symptom of pyelonephritis. It results from inflammation of the renal capsule and stretching of pain-sensitive structures. Pain is typically unilateral, severe, constant, and worsened by percussion over CVA. Urine retention (a) is rare; hypertension (b) is not characteristic; fever (not hypothermia c) is typical.

(a) Urine retention: Not typical - bladder involvement is rare; patients usually have normal or increased urine output.
(b) High blood pressure: Not characteristic - BP may be normal or low if sepsis develops.
(c) Hypothermia: Opposite of expected - fever >38°C is hallmark of acute infection.

PYELONEPHRITIS: "F-U-N" - Fever, Urinary symptoms (frequency, dysuria, urgency), Nausea/vomiting + Flank pain

14
Which of the following interventions does the nurse include in the plan of care for a patient with pyelonephritis?

a) Discontinue antibiotics

b) Restrict protein in the diet

c) Increase on the fluid intake

d) Encourage ambulation

(c) Increase on the fluid intake

Increased fluid intake (2-3 liters/day) is crucial to flush bacteria and reduce fever. Hydration helps dilute bacterial concentration, promote renal blood flow, and prevent complications from sepsis. IV fluids are often needed initially. Antibiotics (a) should be continued for 14 days, protein restriction (b) is unnecessary, and bed rest (not ambulation d) is preferred during acute febrile phase.

(a) Discontinue antibiotics: DANGEROUS - must complete full 14-day course to prevent relapse and resistant organisms.
(b) Restrict protein: Unnecessary - no renal failure present; protein needed for recovery.
(d) Encourage ambulation: Not priority - bed rest with bathroom privileges during febrile phase; ambulation can worsen flank pain.

💧 Flush Those Kidneys! Monitor urine output hourly (target >30 mL/hr). Dark, concentrated urine indicates inadequate hydration. IV bolus may be needed if nausea prevents oral intake.

15
Which of the following assessments does the nurse perform frequently for a patient admitted with Addison's crisis?

a) Urine gravity

b) Neck distension

c) Body weight

d) Blood pressure

(d) Blood pressure

Addison's crisis is acute adrenal insufficiency causing profound hypotension and shock. Cortisol is essential for vascular tone and catecholamine sensitivity. Without it, BP plummets (often <90 /60 mmHg). Continuous BP monitoring every 15-30 minutes guides IV hydrocortisone and fluid resuscitation. A falling BP signals impending cardiovascular collapse requiring immediate intervention. Other assessments are less critical in crisis.

(a) Urine gravity: Not immediate priority - BP and perfusion are life-threatening concerns first.
(b) Neck distension: Assesses fluid overload, but Addison's crisis needs aggressive fluid resuscitation, so not a concern.
(c) Body weight: Important for overall management but not as urgent as hemodynamic monitoring.

ADDISON'S CRISIS: "LOW-BC" - Low BP, Low Cortisol, Low Sodium, Low Glucose, Bradycardia, Confusion, Coma

16
Which of the following is an appropriate nursing care goal for a patient with Addison's disease?

a) Self-care management

b) Improving nutritional status

c) Promoting early ambulation

d) Managing fluid volume

(d) Managing fluid volume

Fluid volume management is critical in Addison's disease due to cortisol and aldosterone deficiency causing sodium/water loss. Goal is to maintain adequate circulating volume, prevent dehydration, and avoid hypovolemic shock. This involves daily weights, strict I/O, encouraging sodium intake, and ensuring adequate oral/IV fluids. While other goals are important, fluid balance is the most disease-specific and life-sustaining priority.

(a) Self-care management: Important but not immediate physiological priority; comes after stabilization.
(b) Nutritional status: Needed but secondary to fluid/electrolyte balance which is more urgent.
(c) Early ambulation: Contraindicated during acute phase due to weakness and risk of orthostatic hypotension.

⚖️ Daily Weights! Best indicator of fluid status in Addison's. Target stable weight ±0.5 kg/day. Sudden drop = dehydration crisis. Sudden gain = over-replacement.

17
Which of the following is the nurse's finding following an assessment on a patient with Cushing's syndrome?

a) Coarse skin

b) Hyperkalemia

c) Truncal obesity

d) Hypotension

(c) Truncal obesity

Truncal (central) obesity is the hallmark physical finding of Cushing's syndrome. Cortisol causes selective fat deposition in abdomen, back (buffalo hump), and face (moon face), with relative sparing of limbs. Skin is thin and fragile (not coarse a), hypokalemia (not hyperkalemia b) occurs from mineralocorticoid effect, and hypertension (not hypotension d) is classic feature.

CUSHINGOID FEATURES: "MT-Moon Buffalo Purple Striae" - Moon face, Truncal obesity, Buffalo hump, Purple striae, Thin skin, Hypertension, Hyperglycemia, Osteoporosis, Infections, mood Changes

18
A patient suffering from osteoporosis is NOT advised to:

a) Engage in weight-bearing exercises regularly

b) Consume adequate calcium and vitamin D

c) Adhere to prescribed medications

d) Participate in high-impact activities like jumping or running without proper guidance

d) Participate in high-impact activities like jumping or running without proper guidance

Explanation:

a) Engage in weight-bearing exercises regularly: This is highly advised for osteoporosis patients as it helps to strengthen bones and improve bone density.

b) Consume adequate calcium and vitamin D: These nutrients are crucial for bone health and are strongly advised for preventing and managing osteoporosis.

c) Adhere to prescribed medications: Medications such as bisphosphonates or denosumab are often prescribed to slow bone loss and are essential for treatment.

d) Participate in high-impact activities like jumping or running without proper guidance: High-impact activities can increase the risk of fractures in individuals with osteoporosis. While exercise is important, these activities should be approached with caution and ideally under the guidance of a healthcare professional to ensure safety and prevent injury. Therefore, patients are generally NOT advised to do these without proper guidance.

✅ Key takeaway: While exercise is vital for osteoporosis, certain high-impact activities can be detrimental. Always prioritize exercises that are safe and appropriate for the individual's bone density and fracture risk.

19
Which of the following instructions does the nurse include in the teaching of a patient with osteoarthritis?

a) Maintain balance between rest and exercise

b) Consume a high carbohydrate diet

c) Keep affected joint immobilised

d) Consume a high protein and fat diet

(a) Maintain balance between rest and exercise

Osteoarthritis requires balanced activity: too much worsens pain, too little causes stiffness and muscle atrophy. Teach pacing, joint protection techniques, and gentle ROM exercises. High carb (b) or high protein/fat (d) diets are not therapeutic. Complete immobilization (c) leads to contracture and weakness. Weight management through balanced diet and regular gentle exercise is key.

(b) High carbohydrate diet: Not specific - weight management is key, not macronutrient composition.
(c) Keep joint immobilized: Contraindicated - leads to stiffness, contracture, muscle wasting.
(d) High protein/fat diet: Not therapeutic - obesity worsens OA mechanically and metabolically.

20
Which of the following dietary instructions does the nurse share with a patient with osteoporosis?

a) Decrease fluid intake to reduce weight

b) Increase intake of foods rich in calcium

c) Increase intake of foods with phosphorus

d) Reduce the intake of foods with sodium

(b) Increase intake of foods rich in calcium

Calcium is the cornerstone mineral for bone formation and maintenance. Adult requirement is 1200-1500 mg/day. Sources: dairy, fortified foods, leafy greens, sardines. High sodium (d) increases renal calcium excretion, so reducing sodium is also good advice, but calcium increase is more directly therapeutic. Phosphorus (c) is usually adequate; excess can be harmful. Fluid restriction (a) is never indicated.

(a) Decrease fluid intake: DANGEROUS - dehydration increases stone risk and impairs overall health.
(c) Increase phosphorus: Unnecessary - usually adequate in diet; excess can bind calcium and reduce absorption.
(d) Reduce sodium: Good advice but secondary to calcium - high sodium increases calcium excretion, but calcium intake is primary intervention.

OSTEOPOROSIS PREVENTION: "C-V-D-Exercise" - Calcium, Vitamin D, Diet (low sodium), Weight-bearing exercise

SECTION B: Fill in the Blank Spaces (10 marks)

21
A condition characterised by inflammation of connective tissue between the muscles and bones is called ________________

Fascitis (or Myofascitis)

Fascitis is inflammation of the fascia, the connective tissue that surrounds muscles, tendons, and bones. Most common form is plantar fasciitis (heel pain). Other types include necrotizing fasciitis (life-threatening infection) and eosinophilic fasciitis. Presents with pain, stiffness, and swelling in affected areas.

22
An auto immune disease on the connective tissue affecting all organs is called________________

Systemic lupus erythematosus (SLE)

SLE is a chronic autoimmune disease where the immune system attacks connective tissues throughout the body. Affects skin, joints, kidneys, heart, lungs, brain. Characterized by autoantibodies (ANA, anti-dsDNA), malar rash, arthritis, serositis, renal involvement. More common in women (9:1). Severity ranges from mild to life-threatening.

23
Chemical substances synthesised and secreted by specific organs or glands are known as________________

Hormones

Hormones are chemical messengers secreted by endocrine glands (pituitary, thyroid, adrenal, pancreas, gonads) directly into bloodstream. They travel to target organs and regulate physiological processes like metabolism, growth, reproduction, and mood. Examples: insulin, cortisol, thyroxine, estrogen. Act via negative feedback loops.

24
A condition resulting from over production of the growth hormone by the pituitary gland is called________________

Acromegaly (in adults) or Gigantism (in children)

Acromegaly occurs in adults after epiphyseal closure, causing enlarged hands, feet, facial features (prognathism, macrognathia), and soft tissue swelling. Gigantism occurs in children before epiphyseal closure, causing proportional excessive height. Both caused by pituitary adenoma secreting excess GH. Diagnosed by elevated IGF-1 levels and glucose suppression test.

GROWTH HORMONE EXCESS: "Acromegaly = Adults, Gigantism = Growing kids"

📏 Physical Hallmark: Can't fit into wedding ring after age 30? Increasing shoe size? Deepening voice? Classic acromegaly! Screen with IGF-1 level.

25
A disorder characterised by cystic dilation of kidney tubules is known as________________

Polycystic kidney disease (PKD)

PKD is a genetic disorder causing multiple fluid-filled cysts in kidneys that enlarge and destroy normal renal tissue. Autosomal dominant PKD (ADPKD) is most common, presenting in adulthood with hypertension, hematuria, progressive renal failure. Autosomal recessive PKD (ARPKD) presents in infancy with enlarged kidneys and pulmonary hypoplasia. Can also affect liver and pancreas.

26
Involuntary movement associated with abnormal posturing of limbs is called________________

Dystonia

Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive movements and postures. Can be focal (torticollis, blepharospasm), segmental, or generalized. Caused by basal ganglia dysfunction. Treatment includes botulinum toxin injections, anticholinergics, dopaminergic agents, and deep brain stimulation in severe cases.

27
An acute viral infection characterised by painful cutaneous vesicles on the skin is called________________

Herpes zoster (Shingles)

Herpes zoster is reactivation of varicella-zoster virus (VZV) in sensory nerve ganglia, causing painful vesicular rash in dermatomal distribution. Presents with burning pain followed by grouped vesicles on erythematous base. Complications include post-herpetic neuralgia (chronic pain), ophthalmic involvement leading to blindness. Treatment: antivirals (acyclovir) within 72 hours, analgesics, and prevention via vaccine in elderly.

SHINGLES TREATMENT: "72-Hour Rule" - Antivirals MUST start within 72 hours of rash onset to be effective!

28
A chronic inflammatory skin disorder characterised by abnormal proliferation of epidermal cells is________________

Psoriasis

Psoriasis is autoimmune skin disease with hyperproliferation of keratinocytes causing thick, silvery-scaled plaques on erythematous base. Typically on extensor surfaces (elbows, knees), scalp, sacral area. Caused by T-cell mediated inflammation. Can be associated with psoriatic arthritis. Treatment: topical steroids, vitamin D analogs, phototherapy, systemic immunosuppressants (methotrexate, biologics).

29
A condition characterised by excessive secretion of aldosterone is known as________________

Hyperaldosteronism (Conn's syndrome when primary)

Hyperaldosteronism causes sodium retention, potassium excretion, and metabolic alkalosis. Primary (Conn's syndrome) caused by adrenal adenoma, presents with hypertension, hypokalemia, muscle weakness. Secondary caused by RAAS activation (CHF, cirrhosis, renal artery stenosis). Diagnosis: elevated aldosterone/renin ratio. Treatment: spironolactone (aldosterone antagonist), surgery for adenoma.

30
Inflammation of fluid filled sacs between the bone and tendon is known as________________

Bursitis

Bursitis is inflammation of the bursa, a small fluid-filled sac that cushions bones, tendons, and muscles near joints. Common sites: shoulder (subacromial bursitis), elbow (olecranon bursitis), hip (trochanteric bursitis), knee (prepatellar bursitis). Caused by repetitive motion, trauma, infection, gout. Treatment: rest, ice, NSAIDs, aspiration, antibiotics if infected, steroid injection for persistent cases.

SECTION B: Short Essay Questions (10 marks)

31
Outline five (5) risk factors for urinary tract infections. (5 marks)

Risk factors facilitate bacterial entry and colonization in urinary tract:

1. Female gender and anatomy: Shorter urethra (4 cm) allows easier bacterial ascent; proximity to anus and vagina increases contamination risk.

2. Urinary obstruction and stasis: BPH, stones, strictures, neurogenic bladder prevent complete emptying, allowing bacterial multiplication.

3. Catheterization and instrumentation: Indwelling catheters provide direct entry path; 3-7% per day develop bacterial infections.

4. Diabetes mellitus: Glycosuria provides bacterial growth medium; impaired immunity reduces bacterial clearance; autonomic neuropathy causes bladder dysfunction.

5. Immunosuppression: HIV/AIDS, chemotherapy, chronic steroids reduce host defenses. Also includes pregnancy (ureteral dilatation from progesterone) and post-menopausal estrogen deficiency (urethral mucosal atrophy).

UTI RISK FACTORS: "F-U-N-D-I" - Female, Urinary stasis, Neurogenic bladder, Diabetes, Immunosuppression, Instrumentation

💧 Prevention Key: Adequate hydration (2-3L/day), complete bladder emptying, proper perineal hygiene (front-to-back), and avoiding spermicides reduce UTI risk significantly!

32
Outline five (5) interventions nurses implement for a patient with a neurological disorder. (5 marks)

Neurological disorders require comprehensive nursing care to prevent complications and promote function:

1. Frequent neurological assessments: Monitor GCS, pupil size/reactivity, limb movement, and vital signs every 1-2 hours to detect early deterioration. Changes precede imaging findings.

2. Airway and aspiration precautions: Maintain patent airway, suction as needed, position side-lying if unconscious, perform swallow assessment before oral intake to prevent aspiration pneumonia.

3. Pressure injury prevention: Turn every 2 hours, use pressure-relieving mattresses, maintain skin integrity, and perform regular skin inspections - immobility is common in neurological conditions.

4. DVT prophylaxis: Apply compression stockings, administer LMWH if prescribed, perform passive/active limb exercises - paralysis increases clot risk 3-fold.

5. Bowel and bladder management: Establish regular toileting schedule, monitor I/O, prevent constipation with fluids/fiber, use condom catheters or intermittent catheterization to avoid indwelling catheters.

NEURO CARE: "A-B-C-D-E-F" - Airway, Breathing, Circulation, DVT prophylaxis, Eyes/Assessment, Fluids, GCS monitoring

SECTION C: Long Essay Questions (60 marks)

33
(a) State ten (10) signs and symptoms of hyper aldosteronism. (5 marks)
(b) Describe with rationale ten (10) specific nursing interventions implemented in the first 72 hours of admission for a patient with hyper aldosteronism. (10 marks)
(c) Outline five (5) complications of hyper aldosteronism. (5 marks)

(a) Signs and Symptoms of Hyperaldosteronism:

1. Hypertension: Resistant to usual antihypertensives, often severe (>180/110 mmHg) due to sodium retention and volume expansion.

2. Hypokalemia: Muscle weakness, cramps, paralysis, and fatigue from excessive renal potassium excretion.

3. Polyuria and nocturia: Hypokalemia causes nephrogenic diabetes insipidus with impaired urinary concentrating ability.

4. Headaches: Severe and persistent due to hypertension and cerebral vasoconstriction.

5. Metabolic alkalosis: Excess H+ secretion in kidneys causes high bicarbonate, low chloride, and muscle twitching.

6. Tetany and paresthesias: Hypokalemia and alkalosis increase neuromuscular excitability, causing numbness and tingling.

7. Visual disturbances: Papilledema and retinal changes from malignant hypertension.

8. Cardiac arrhythmias: Hypokalemia predisposes to ventricular ectopy, atrial fibrillation, and torsades de pointes.

9. Edema: Uncommon despite sodium retention due to "escape phenomenon," but may occur in severe cases.

10. Polydipsia: Excessive thirst compensating for polyuria and dry mouth from dehydration.

(b) 72-Hour Nursing Interventions for Hyperaldosteronism:

1. Continuous cardiac and blood pressure monitoring: Detects hypertensive crises and arrhythmias from hypokalemia, guides antihypertensive titration.

2. Strict intake and output with daily weights: Monitors fluid balance, detects diuresis from spironolactone therapy, and guides potassium replacement.

3. Frequent serum potassium monitoring (every 6-12 hours): Hypokalemia is life-threatening; guides IV/oral replacement and prevents overcorrection.

4. Administer spironolactone (aldosterone antagonist) as prescribed: Blocks aldosterone effects, promotes sodium/water excretion and potassium retention - primary treatment.

5. Seizure precautions: Severe hypokalemia and hypertension increase seizure risk; maintain airway and suction equipment at bedside.

6. Neurological checks every 4 hours: Detects worsening muscle weakness, paralysis, or altered mental status from electrolyte imbalance.

7. ECG monitoring for U waves and arrhythmias: Hypokalemia causes characteristic U waves and predisposes to fatal arrhythmias requiring immediate correction.

8. Maintain safe environment for weakness: Reduces fall risk from muscle weakness; assist with ambulation, provide call bell within reach.

9. Dietary modifications (high potassium, low sodium): Supports medical therapy; provides foods like bananas, oranges, spinach while limiting salt.

10. Patient education about medication compliance: Ensures understanding that spironolactone must be taken lifelong; non-compliance causes recurrence of symptoms.

(c) Complications of Hyperaldosteronism:

1. Cerebrovascular accident (stroke): Severe hypertension causes intracranial hemorrhage or ischemic stroke.

2. Myocardial infarction: Hypertension accelerates atherosclerosis and cardiac remodeling, increasing MI risk.

3. Cardiac arrhythmias and sudden death: Hypokalemia causes ventricular tachycardia, torsades de pointes, and cardiac arrest.

4. Chronic kidney disease: Long-standing hypertension damages renal arterioles and glomeruli.

5. Hypertensive retinopathy and blindness: Grade 3-4 retinal changes from malignant hypertension can cause permanent vision loss.

HYPERALDOSTERONISM COMPLICATIONS: "STROKE" - Stroke, Tachycardia/arrhythmias, Renal failure, Ophthalmic damage, Kidney disease, Endocrine crisis

34
(a) Describe five (5) stages of Parkinson's disease. (10 marks)
(b) Explain ten (10) coping measures the nurse teaches the family and a patient with Parkinson's disease. (10 marks)

(a) Stages of Parkinson's Disease (Hoehn & Yahr Scale):

Stage 1 (Unilateral involvement): Tremor, rigidity, and bradykinesia affecting one side only. Minimal functional impairment, often unnoticed by others. Presents with subtle hand tremor or reduced arm swing.

Stage 2 (Bilateral involvement without impairment of balance): Symptoms affect both sides, but posture and balance remain intact. Patients can live independently but activities are slower. Facial masking and speech changes emerge.

Stage 3 (Bilateral disease with mild to moderate postural instability): Significant bradykinesia and gait disturbance with impaired balance. Can still perform ADLs independently but requires caution with ambulation due to fall risk. Standing from chair becomes difficult.

Stage 4 (Severe disability but able to walk or stand unassisted): Rigidity and bradykinesia severely limit function. Cannot live alone - requires assistance with ADLs. May use walker but still mobile with aid. Tremor may be less prominent than earlier stages.

Stage 5 (Cachectic stage - wheelchair bound or bedridden): End-stage disease with severe motor and non-motor symptoms. Complete dependency for all ADLs. Frequent hospitalizations for aspiration pneumonia, pressure ulcers, falls. Cognitive decline often present.

(b) Coping Measures for Parkinson's Disease:

1. Establish medication timing routine: Take levodopa exactly on schedule with protein restriction to prevent "wearing off" fluctuations. Use pill organizer and alarms.

2. Fall prevention strategies: Remove rugs, install grab bars, ensure adequate lighting, use non-slip footwear, consider walker/cane to reduce fall risk from postural instability.

3. Swallowing precautions: Sit upright 90° during meals, take small bites/sips, tuck chin when swallowing, thicken liquids if needed to prevent aspiration.

4. Communication techniques: Speak slowly and loudly, use facial exercises to improve expression, consider speech therapy for voice amplification, use writing aids or computer for communication when handwriting becomes illegible.

5. Energy conservation and pacing: Schedule activities during "on" periods, break tasks into small steps, rest frequently, use assistive devices to reduce energy expenditure.

6. Emotional support and depression screening: Acknowledge grief and frustration, encourage support groups, watch for depression (common in 40-50% of patients), seek counseling if needed.

7. Exercise and physical therapy: Daily stretching to prevent contractures, tai chi for balance, swimming for mobility, walking program maintains function and reduces rigidity.

8. Caregiver respite and support: Teach family about disease progression, provide respite care resources, encourage caregiver support groups to prevent burnout from long-term care demands.

9. Adaptive equipment and home modifications: Use weighted utensils to reduce tremor, button hooks for dressing, raised toilet seats, shower chairs - maintains independence.

10. Advanced directive planning: Discuss future care preferences early while patient has decisional capacity, including feeding tube, resuscitation wishes, and long-term care options.

⏰ Medication Timing is Everything! Levodopa effect lasts 3-4 hours. "On-off" phenomenon is distressing. Teach patients to plan activities 30-60 minutes after dose when "on" period peaks.

35
(a) List ten (10) signs and symptoms of rheumatoid arthritis. (5 marks)
(b) Describe with rationale ten (10) nursing interventions that are performed on a patient with acute rheumatoid arthritis in the first 48 hours of admission. (10 marks)
(c) List five (5) complications of rheumatoid arthritis. (5 marks)

(a) Signs and Symptoms of Rheumatoid Arthritis:

1. Morning stiffness >30 minutes: Prolonged stiffness in affected joints, particularly severe upon waking and improving with movement.

2. Symmetrical polyarthritis: Pain, swelling, and warmth in same joints bilaterally (both hands, both knees), especially MCP and PIP joints.

3. Rheumatoid nodules: Subcutaneous nodules over pressure points (elbows, fingers) in 20-30% of patients indicating severe disease.

4. Systemic symptoms: Low-grade fever, fatigue, weight loss, malaise reflecting systemic inflammatory nature.

5. Deformities and joint instability: Ulnar deviation, swan-neck, boutonniere deformities, subluxation from chronic inflammation.

6. Limited range of motion: Reduced flexibility and function from pain, swelling, and joint damage.

7. Joint tenderness to palpation: Painful joints even with light touch from synovial inflammation.

8. Anemia of chronic disease: Normocytic anemia from chronic inflammation suppressing erythropoiesis.

9. Vasculitis signs: Nail fold infarcts, digital ulcers, gangrene in severe longstanding disease.

10. Ocular manifestations: Dry eyes (Sjögren's), scleritis, episcleritis from extra-articular involvement.

(b) 48-Hour Nursing Interventions for Acute Rheumatoid Arthritis:

1. Complete bed rest with joint splinting: Reduces pain and inflammation by minimizing stress on inflamed synovium; prevents deformity during acute flare.

2. Apply cold packs to affected joints: Cold reduces pain, swelling, and inflammatory mediators in acute phase (heat used only in chronic phase).

3. Administer DMARDs and steroids as prescribed: Methotrexate (DMARD) and prednisolone provide rapid anti-inflammatory effect and initiate disease control.

4. Pain assessment using standardized scale: Regular monitoring guides analgesic administration and evaluates treatment response.

5. Positioning and pressure area care: Maintains functional position, prevents contractures, and avoids pressure ulcers from immobility.

6. Assist with ADLs while preserving dignity: Severe pain limits self-care; provides help with feeding, hygiene while encouraging independence within limits.

7. Monitor for systemic complications: Check temperature, respiratory status (pleural effusion), cardiac symptoms (pericarditis) from extra-articular involvement.

8. Provide emotional support and validation: Acute flares cause significant distress and depression; therapeutic communication reduces anxiety and fear.

9. Educate about disease and medication side effects: Ensures understanding of lifelong DMARD therapy, need for compliance, and monitoring for toxicity (methotrexate requires liver function tests).

10. Initiate gentle passive ROM after acute pain subsides: Prevents joint stiffness and contractures while maintaining function; transitioned to active ROM as inflammation improves.

(c) Complications of Rheumatoid Arthritis:

1. Joint deformities and ankylosis: Permanent damage causing loss of function, disability, and need for joint replacement surgery.

2. Rheumatoid vasculitis: Inflammation of blood vessels causing ulcers, gangrene, neuropathy, and organ damage - life-threatening complication.

3. Cardiovascular disease: Increased risk of myocardial infarction and stroke from chronic inflammation accelerating atherosclerosis.

4. Pulmonary fibrosis and pleuritis: Interstitial lung disease from rheumatoid nodules and inflammation causing restrictive lung disease.

5. Felty syndrome: Triad of RA, splenomegaly, and neutropenia - increases infection risk and indicates severe disease.

RA COMPLICATIONS: "JOINT" - Joint deformities, Organ involvement (heart, lung), Infection risk, Neutropenia (Felty), Vasculitis, Tendon rupture

💊 Early DMARD Treatment is Critical! Starting DMARDs within 3 months of diagnosis prevents irreversible joint damage. Don't delay! Methotrexate is first-line for moderate-severe RA.

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