1. JH is a 75-year-old female with hand and finger pain. Her past medical history includes CHF, HTN, Dyslipidemia, and OA. Her allergies include oxycodone and sulfa (anaphylaxis) and she is currently taking aspirin every day. What is the best option(s) for therapy for JH? (select all that apply)
a. Voltaren gel
b. Tramadol
c. Celebrex
d. Capsaicin
e. Naproxen

2. True or False: Voltaren gel has a black box warning for CV and GI adverse events.
a. True
b. False

3. Which of the following statements is TRUE?
a. A solid (nonsynovial) joint provides excellent structural integrity and allows for a wide range of movement because it lacks a joint space.
b. Fibrous joints consist of two bones united by fibrous connective tissue, have no joint cavity, and exhibit little to no movement.
c. Cartilaginous joints consist of two bones united by hyaline or fibrocartilage and allow for a wide range of motion.
d. Synovial joints have a joint space (or cavity) that does not allow for a wide range of motion.

4. Which of the following medications could lead to serotonin syndrome if administered concomitantly with Sertraline?
a. Acetaminophen
b. Tramadol
c. Oxycodone
d. Ibuprofen

5. Acetaminophen taken at higher concentrations is primarily metabolized by:
a. Sulfation and glucuronidation
b. Oxidation to toxic NAPQI metabolite
c. Oxidation and glucuronidation
d. Sulfation to toxic NAPQI metabolite

6. The Km for acetaminophen for the oxidation pathway is ________ than the Km for the sulfation and glucuronidation pathway.
a. Higher
b. Lower
c. The same
d. Could be either higher or lower

7. Which of the following is FALSE regarding the epidemiology of OA? (select all that apply)
a. OA affects more than 50% of all individuals 65 years of age or older.
b. OA occurs more frequently in men than women.
c. OA is usually symmetric compared to rheumatoid arthritis that is usually asymmetric.
d. The most commonly affected joints are the knees

8. _________ is the type of cartilage found on the articular surface of synovial joints.
a. Hyaline cartilage
b. Fibrocartilage
c. Elastic cartilage
d. Synovial cartilage

9. Which of the following statements regarding chondrocytes is FALSE?
a. Chondrocytes are specialized cartilage cells that secrete the extracellular matrix.
b. Chondrocytes are specialized cartilage cells that are surrounded by the extracellular matrix.
c. Chondrocytes occur only in groups.
d. All of the above statements are true.

10. True or False: The principal glycosaminoglycans of cartilage are chondroitin sulfate and keratin sulfate.
a. True
b. False

11. ___________ work to build bone, while __________ degrade bone.
a. Osteoclasts; osteoblasts
b. Osteoblasts; osteoclasts
c. Osteoclasts; fibroblasts
d. Fibroblasts; osteoclasts

12. ______________ is a connective tissue inner lining of the joint space.
a. Synovial fluid
b. Synovial cartilage
c. Synovial membrane
d. Synovial meniscus

13. The pathophysiology of OA is all of the following EXCEPT:
a. Is multifactorial and involves the complex network of extracellular and intracellular mediators that regulate chondrocyte activity.
b. Involves proteolytic degradation of cartilage components.
c. Can occur in any synovial joint in the body.
d. The course of OA is usually slow and reversible.

14. Which is the correct order of events in OA?
a. Damage of the articular cartilage; chondrocyte proliferation and inflammation; chondrocyte death; articular cartilage erodes
b. Chondrocyte proliferation and inflammation; damage of the articular cartilage; articular cartilage erodes; chondrocyte death
c. Damage of the articular cartilage; articular cartilage erodes; chondrocyte proliferation and inflammation; chondrocyte death
d. Chondrocyte proliferation and inflammation; damage of the articular cartilage; articular cartilage erodes; chondrocyte death

15. Which of the following joints is affected in secondary OA?
a. Knees
b. Hips
c. Elbows
d. Cervicolumbar spine

16. True or False: Secondary OA occurs when there is no known cause and is the most common type of OA.
a. True
b. False

17. Localized OA involves less than _____ joints and generalized involves over ______ joints.
a. 3; 4
b. 4; 5
c. 2; 4
d. 2; 3

18. Most commonly, OA affects the following joints (select all that apply):
a. Hand
b. Knees
c. Hips
d. Wrists
e. Ankles

19. Which of the following drug classes are NOT used in the treatment of OA?
a. NSAIDS
b. DMARDS
c. Corticosteroids
d. Opioids

20. True or False: Acetaminophen is only effective when COX-2 concentrations are low and lacks anti-inflammatory activity.
a. True
b. False

21. An OTC choice for the treatment of OA is:
a. Diclofenac
b. Ketorolac
c. Meloxicam
d. Naproxen

22. Which of the following NSAIDS has the lowest CV risk?
a. Sulindac
b. Celebrex
c. Naproxen
d. Meloxicam

23. True or False: You cannot (should not) take Naproxen while taking Prednisone.
a. True
b. False

24. Ketorolac has a black box warning of:
a. Hypersensitivity reactions
b. Cardiovascular events
c. Gastrointestinal events
d. All of the above

25. Glucocorticoids do all of the following except:
a. Stimulates lipocortin
b. Stimulates prostaglandin synthesis
c. Inhibits phospholipase A2
d. Inhibits the release of arachidonic acid

26. Which of the following statements about Tramadol is FALSE?
a. It is synthesized as a racemic mixture.
b. The (+) isomer has u opioid agonist activity of about 1/3800 times the strength of morphine.
c. The (-) isomer of tramadol possesses only 1/20 of the opioid activity of the (+) isomer.
d. The (-) isomer is an effective inhibitor of norepinephrine and epinephrine reuptake. (norepinephrine and serotonin)

27. __________ is a synthetic prostaglandin E1 analog that has been shown to protect against NSAID induced GI adverse effects.
a. Omeprazole
b. Benztropine
c. Misoprostol
d. Acetaminophen

28. Which of the following are generally NOT recommended in a patient with hand OA?
a. Intraarticular injection therapies
b. Topical Capsaicin
c. Tramadol
d. Oral NSAIDS
e. Topical NSAIDS

29. Which of the following are recommended treatments in hip and knee OA? (select all that apply)
a. Acetaminophen
b. Tramadol
c. Opioids (first-line)
d. Oral NSAIDS
e. Topical NSAIDS (knee only)
f. Intraarticular corticosteroid injections
g. Topical capsaicin (knee only)

30. How long should you use topical capsaicin before you begin to experience the maximum benefit?
a. 1-2 weeks
b. 3-4 weeks
c. 5-7 days
d. 3-5 days

31. True or False: If a patient wants to take glucosamine for their OA, you want to tell them to take glucosamine hydrochloride and not glucosamine sulfate.
a. True
b. False