A nurse is caring for an old lady with osteoarthritis and all the following facts are true regarding osteoarthritis except?

Appeared in: NCL (MP) Nursing Officer - 2019

Explanation

Tophi are not a feature of osteoarthritis.
They are pathognomonic for chronic tophaceous gout, a different type of arthritis.
Tophi are composed of hard, chalky deposits of monosodium urate crystals that accumulate in and around the joints.
Common sites for tophi include the helix of the ear, fingers, toes, and the olecranon bursa (elbow).

Option A: Crepitus, a palpable or audible grating or crackling sensation, is a very common clinical sign in osteoarthritis.
Option C: This option is incorrect because the characteristic nodules of osteoarthritis are bony (osteophytes), not soft subcutaneous nodules. Soft subcutaneous nodules are a hallmark of rheumatoid arthritis.
Option D: Pain on moving the joint is a cardinal symptom of osteoarthritis. The pain is typically mechanical in nature, worsening with activity or weight-bearing and improving with rest.

Clinical Relevance

Nursing practice connection: Knowing Clinical manifestations of osteoarthritis and its differential diagnosis from other forms of arthritis like gout and rheumatoid arthritis helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Accurately differentiating between types of arthritis is crucial for nurses as the management, medication, and patient education strategies vary significantly.
For a patient with OA, nursing interventions focus on pain management, joint protection, exercise, and weight control. For gout, management involves medications to lower uric acid and dietary modifications.
A nurse's assessment skills are vital in identifying key signs like crepitus, bony nodules (Heberden's/Bouchard's), and differentiating them from signs of other conditions like the soft nodules of RA or the tophi of gout.

How to Approach the Question

First, identify the core concept: the clinical features of osteoarthritis.
Note the negative lead-in keyword 'except'. This means you are looking for the option that is FALSE or not associated with osteoarthritis.
Evaluate each option against your knowledge of osteoarthritis.
Option A (Crepitus): Is this seen in OA? Yes, it's common.
Option B (Tophi): Are these seen in OA? No, they are specific to gout.
Option C (Subcutaneous nodules): Are these seen in OA? No, OA has bony nodules. Soft subcutaneous nodules are seen in RA.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of osteoarthritis and its differential diagnosis from other forms of arthritis like gout and rheumatoid arthritis.
Stem keywords: osteoarthritis, old lady, facts, except
Lead-in keywords: except
Clinical cues: The patient's age ('old lady') is a common demographic for osteoarthritis.
Clinical cues: The image showing Heberden's nodes is a classic sign of osteoarthritis.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 109-111

E6 Medicine Davidson Principles Practice 24e p. 1029-1031

Practise the full NCL (MP) Nursing Officer - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.