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Chapter 45: Alterations of Musculoskeletal Function

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Pathophysiology: The Biologic Basis for Disease in Adults and Children 8th Edition
Emily Doyle
Quiz by Emily Doyle, updated more than 1 year ago
Emily Doyle
Created by Emily Doyle about 5 years ago
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Question 1

Question
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?
Answer
  • 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.

Question 2

Question
A health care professional is providing education to a group of seasonal athletes. What type of fracture does the professional warn them to avoid?
Answer
  • Stress
  • Greenstick
  • Insufficiency
  • Pathologic

Question 3

Question
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?
Answer
  • Internal fixation
  • Reduction and immobilization
  • Calcium phosphate cement
  • Low-density ultrasound

Question 4

Question
Improper reduction or immobilization of a fractured femur can result in which outcome after cast removal?
Answer
  • 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.

Question 5

Question
Which structure attaches skeletal muscle to bone?
Answer
  • Tendon
  • Ligament
  • Bursa
  • Mesentery

Question 6

Question
What is the tear in a ligament referred to as?
Answer
  • Fracture
  • Strain
  • Disunion
  • Sprain

Question 7

Question
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?
Answer
  • Lateral epicondylopathy
  • Medial epicondylopathy
  • Bursitis
  • Lateral tendinitis

Question 8

Question
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?
Answer
  • 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

Question 9

Question
A student asks for an explanation of rhabdomyolysis. What response by the professor is best?
Answer
  • 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

Question 10

Question
Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression?
Answer
  • Muscle ischemia
  • Myoglobinuria
  • Volkmann contracture
  • Neural injury

Question 11

Question
By the time osteoporosis is visible on an x-ray examination, up to what percent of bone has been lost?
Answer
  • 30%
  • 40%
  • 50%
  • 60%

Question 12

Question
A patient has a bone density T score of -2.8. What diagnosis does the health care professional educate the patient on?
Answer
  • Osteoplasia
  • Osteoporosis
  • Osteopenia
  • Osteomalacia

Question 13

Question
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?
Answer
  • Iatrogenic
  • Regional
  • Idiopathic
  • Osteoblastic

Question 14

Question
In osteoporosis, the receptor activator of nuclear factor κB (RANK) activates what?
Answer
  • Osteoclast apoptosis
  • Osteoblast survival
  • Osteoprotegerin
  • Osteoclast survival

Question 15

Question
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?
Answer
  • Increased oxidative stress and increased intracellular reactive oxygen species
  • Hypoparathyroidism
  • Increased body weight
  • Decreased formation and short life span of osteoclasts

Question 16

Question
Which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts?
Answer
  • Parathyroid hormone
  • Glucocorticoid
  • Growth hormone
  • Estrogen

Question 17

Question
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?
Answer
  • 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

Question 18

Question
The health care professional teaches a group of seniors that the most common clinical manifestation of osteoporosis is which of these?
Answer
  • Bone deformity
  • Bone pain
  • Pathologic fracture
  • Muscle strain

Question 19

Question
A patient has been diagnosed with Paget disease. What explanation of the disease does the health care professional provide the patient?
Answer
  • “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.”

Question 20

Question
A health care professional determines that the student needs more education when the student makes which statement about treating bone infection?
Answer
  • 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.

Question 21

Question
Bone death as a result of osteomyelitis is due to what?
Answer
  • 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

Question 22

Question
A student studying osteomyelitis and asks for an explanation of the term “sequestrum.” What response by the professor is best?
Answer
  • 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

Question 23

Question
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?
Answer
  • Limb-salvaging surgery
  • Amputation
  • Oral bisphosphonates
  • Calcium and vitamin D supplements

Question 24

Question
Which statement accurately describes a characteristic of osteosarcoma?
Answer
  • 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

Question 25

Question
A professor has taught the class about giant cell bone tumors. Which statement by a student would require the professor to review the material?
Answer
  • 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.

Question 26

Question
Which patient finding would lead the health care professional to assess the patient for inflammatory joint disease?
Answer
  • Unilateral joint involvement
  • Normal joint synovial fluid
  • Absence of synovial membrane inflammation
  • Systemic symptoms of inflammation

Question 27

Question
What is a primary defect in osteoarthritis?
Answer
  • Stromelysin and acid metalloproteinase breakdown articular cartilage.
  • Immunoglobulin G (IgG) destroys the synovial membrane
  • Synovial membranes become inflamed.
  • Cartilage-coated osteophytes create bone spurs.

Question 28

Question
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?
Answer
  • Ways to decrease serum uric acid
  • Administration of oral methotrexate
  • Exercise and weight reduction
  • Rapid intravenous hydration

Question 29

Question
A patient has ankylosing spondylitis. Which description of this condition by the health care professional is most accurate?
Answer
  • 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

Question 30

Question
What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)?
Answer
  • Inflammation of the bursa
  • Inflammation of the long bones
  • Inflammation of fibrocartilaginous joints of the vertebrae
  • Inflammation of the small hand and feet bones

Question 31

Question
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?
Answer
  • Drinking plenty of water
  • Splinting affected joints
  • Eating more protein
  • Avoiding hot weather

Question 32

Question
What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis?
Answer
  • Reduced excretion of purines
  • Overproduction of uric acid
  • Increase in the glycosaminoglycan levels
  • Overproduction of proteoglycans

Question 33

Question
The pathophysiologic presentation of gout is closely linked to the metabolism of which chemical?
Answer
  • Purine
  • Pyrimidine
  • Vitamin E
  • Amino acid

Question 34

Question
A patient in the clinic is worried about having fibromyalgia. For which symptoms should the health care professional assess the patient for?
Answer
  • 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

Question 35

Question
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?
Answer
  • 15 years
  • 20 years
  • 30 years
  • 35 years

Question 36

Question
What event is associated with the beginning of bone loss in women?
Answer
  • Puberty
  • Sexual activity
  • Childbirth
  • Menopause

Question 37

Question
A patient in the clinic has calcium crystals that are associated with chronic gout. How does the professional document this finding?
Answer
  • Stones
  • Spurs
  • Tophi
  • Nodes

Question 38

Question
What are the primary sources of bacterial infections that lead to hematogenous bone infection? (Select all that apply.)
Answer
  • Sinus
  • Ear
  • Dental
  • Cutaneous
  • Throat

Question 39

Question
Which structures are most often affected by Paget disease? (Select all that apply.)
Answer
  • Vertebrae
  • Skull
  • Sternum
  • Metacarpals
  • Pelvis

Question 40

Question
Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.)
Answer
  • Subcutaneous tissue crystals
  • Anorexia
  • Painful, stiffening of joints
  • Edema of the wrists
  • Fever
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