The health care professional is caring for a person who has a pathologic fracture. The patient asks the professional to explain the condition. What response by the professional is best?
The outer surface of the bone is disrupted, but the inside is intact
A stable fracture where the cortex of the bone bends but doesn’t break
A fracture that happens at the site of an abnormality already in that bone.
It was caused by the cumulative effects of stress on the bone over time.
A health care professional is providing education to a group of seasonal athletes. What type of fracture does the professional warn them to avoid?
Stress
Greenstick
Insufficiency
Pathologic
A patient has a temporary displacement of two bones causing the bone surfaces to partially lose contact with each other. What treatment does the health care professional prepare the patient for?
Internal fixation
Reduction and immobilization
Calcium phosphate cement
Low-density ultrasound
Improper reduction or immobilization of a fractured femur can result in which outcome after cast removal?
The muscles around the fracture site are weak.
The fracture requires 6 to 8 weeks of physical therapy.
The skin under the cast is dry and flaky.
The bone is not straight.
Which structure attaches skeletal muscle to bone?
Tendon
Ligament
Bursa
Mesentery
What is the tear in a ligament referred to as?
Fracture
Strain
Disunion
Sprain
A patient seen in the clinic has tissue degeneration or irritation of the extensor carpi radialis brevis tendon. What diagnosis does the health care professional document?
Lateral epicondylopathy
Medial epicondylopathy
Bursitis
Lateral tendinitis
A patient in the Emergency Department has either a tendon or ligament injury. What pain description from the patient would the health care professional associate with these injuries?
Dull and diffuse, persisting over the distribution of the tendon or ligament
. Sharp and localized, persisting over the distribution of the tendon or ligament
Pins-and-needle sensations that occur distal to the injury with movement
Intermittent and aching, occurring over the distribution of the tendon or ligament
A student asks for an explanation of rhabdomyolysis. What response by the professor is best?
Paralysis of skeletal muscles, resulting from an impaired nerve supply
Smooth muscle degeneration, resulting from ischemia
Lysis of skeletal muscle cells through the initiation of the complement cascade
Release of myoglobin from damaged striated muscle cells
Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression?
Muscle ischemia
Myoglobinuria
Volkmann contracture
Neural injury
By the time osteoporosis is visible on an x-ray examination, up to what percent of bone has been lost?
30%
40%
50%
60%
A patient has a bone density T score of -2.8. What diagnosis does the health care professional educate the patient on?
Osteoplasia
Osteoporosis
Osteopenia
Osteomalacia
Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat fracture of the tibia and fibula?
Iatrogenic
Regional
Idiopathic
Osteoblastic
In osteoporosis, the receptor activator of nuclear factor κB (RANK) activates what?
Osteoclast apoptosis
Osteoblast survival
Osteoprotegerin
Osteoclast survival
A health care professional who works with older women understands that which changes are believed to play a significant role in the development of age-related bone loss?
Increased oxidative stress and increased intracellular reactive oxygen species
Hypoparathyroidism
Increased body weight
Decreased formation and short life span of osteoclasts
Which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts?
Parathyroid hormone
Glucocorticoid
Growth hormone
Estrogen
A patient is brought to the Emergency Department after being found by neighbors. The patient says she has been lying on the floor in the house for 3 days. What action by the health care professional is best?
Order a serum creatine kinase (CK) level
Obtain an x-ray of the patient’s hips
Arrange for the patient to have a DXA scan
Perform the Fracture Risk Assessment
The health care professional teaches a group of seniors that the most common clinical manifestation of osteoporosis is which of these?
Bone deformity
Bone pain
Pathologic fracture
Muscle strain
A patient has been diagnosed with Paget disease. What explanation of the disease does the health care professional provide the patient?
“It is a severe infection in your bones.”
“It is a problem with bone resorption and formation.”
“It is a condition in which your bones become soft.”
“It’s a disorder of altered energy production in muscle.”
A health care professional determines that the student needs more education when the student makes which statement about treating bone infection?
Bone contains multiple microscopic channels that are impermeable to the cells and biochemicals of the body’s natural defenses.
Microcirculation of bone is highly vulnerable to damage and destruction by bacterial toxins, leading to ischemic necrosis of bone.
Bone cells have a limited capacity to replace bone destroyed by infections.
Bacteria are walled off by macrophages and T lymphocytes; consequently, the antibiotics cannot penetrate the infected area.
Bone death as a result of osteomyelitis is due to what?
Formation of immune complexes at the site of infection
Localized ischemia
Tumor necrosis factor-alpha (TNF-α) and interleukin 1 (IL-1)
Impaired nerve innervation at the site of infection
A student studying osteomyelitis and asks for an explanation of the term “sequestrum.” What response by the professor is best?
An area of devascularized and devitalized bone
An enzyme that phagocytizes necrotic bone
A subperiosteal abscess
A layer of new bone surrounding the infected bone
A patient in the clinic had a femur x-ray that was read as having a “moth-eaten” appearance. What treatment option does the health care professional discuss with the patient?
Limb-salvaging surgery
Amputation
Oral bisphosphonates
Calcium and vitamin D supplements
Which statement accurately describes a characteristic of osteosarcoma?
Slow-growing tumor that begins in the bone marrow and infiltrates the trabeculae
Solitary tumor that most often affects the metaphyseal region of the femur or tibia
Aggressive tumor most often found in the bone marrow of long bones
Tumor that infiltrates the trabeculae in spongy bone and implants in surrounding tissue by seeding
A professor has taught the class about giant cell bone tumors. Which statement by a student would require the professor to review the material?
Giant cell tumors are an overexpression of genes including osteoprotegerin ligand (OPGL).
The tumors are malignant, solitary, and irregularly shaped.
Giant cell tumors are typically located in the epiphysis in the femur, tibia, radius, and humerus.
They are slow-growing tumors that extend over the articular cartilage.
Which patient finding would lead the health care professional to assess the patient for inflammatory joint disease?
Unilateral joint involvement
Normal joint synovial fluid
Absence of synovial membrane inflammation
Systemic symptoms of inflammation
What is a primary defect in osteoarthritis?
Stromelysin and acid metalloproteinase breakdown articular cartilage.
Immunoglobulin G (IgG) destroys the synovial membrane
Synovial membranes become inflamed.
Cartilage-coated osteophytes create bone spurs.
A patient reports joint stiffness with movement and joint pain in weightbearing joints that is usually relieved by rest. What treatment option does the health care professional discuss with the patient?
Ways to decrease serum uric acid
Administration of oral methotrexate
Exercise and weight reduction
Rapid intravenous hydration
A patient has ankylosing spondylitis. Which description of this condition by the health care professional is most accurate?
Chronic inflammatory disease with stiffening and fusion of the spine and sacroiliac joints
Chronic systemic inflammatory disease that affects many tissues and organs
State of abnormal and excessive bone resorption and formation
Wide-spread and deep chronic muscle pain, fatigue, and tender points
What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)?
Inflammation of the bursa
Inflammation of the long bones
Inflammation of fibrocartilaginous joints of the vertebrae
Inflammation of the small hand and feet bones
A person in the health care clinic has gout. In order to prevent a common complication, what self-care measure does the health care professional teach the person about?
Drinking plenty of water
Splinting affected joints
Eating more protein
Avoiding hot weather
What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis?
Reduced excretion of purines
Overproduction of uric acid
Increase in the glycosaminoglycan levels
Overproduction of proteoglycans
The pathophysiologic presentation of gout is closely linked to the metabolism of which chemical?
Purine
Pyrimidine
Vitamin E
Amino acid
A patient in the clinic is worried about having fibromyalgia. For which symptoms should the health care professional assess the patient for?
Hot, tender, and edematous muscle groups bilaterally
Fasciculations of the upper and lower extremity muscles
Exercise intolerance and painful muscle cramps
Sensitivity at tender points and profound fatigue
A health care professional is teaching a group of college women about increasing calcium in the diet to prevent osteoporosis. A participant asks at what age is peak bone mass is reached in women. What response is best?
15 years
20 years
30 years
35 years
What event is associated with the beginning of bone loss in women?
Puberty
Sexual activity
Childbirth
Menopause
A patient in the clinic has calcium crystals that are associated with chronic gout. How does the professional document this finding?
Stones
Spurs
Tophi
Nodes
What are the primary sources of bacterial infections that lead to hematogenous bone infection? (Select all that apply.)
Sinus
Ear
Dental
Cutaneous
Throat
Which structures are most often affected by Paget disease? (Select all that apply.)
Vertebrae
Skull
Sternum
Metacarpals
Pelvis
Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.)
Subcutaneous tissue crystals
Anorexia
Painful, stiffening of joints
Edema of the wrists
Fever
