Deck 55: Understanding Bone Growth, Development, and Disorders: Exploring Diagnosis, Treatment, and Pathogenesis

Question 1

Which of the following is an aspect of the bone growth and development that occurs during the first two decades of life?

A) Most bone abnormalities can be traced to anomalies in the embryonic stage of development.
B) The physiological effects of in utero positioning normally remain into late adolescence.
C) Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells.
D) Bone length increases through childhood, while bone diameter remains static.

Answer 1

Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells.

Question 2

A female toddler has been diagnosed with toeing-in (metatarsus adductus). What teaching should the pediatrician provide to the parents of the child about her diagnosis?

A) "She will likely walk later than most children, but it will resolve itself with time."
B) "We'll likely need to start putting the first of a series of casts on her legs quite soon."
C) "The best time to perform the surgery that's needed will be at age 3 or 4."
D) "While there's no effective treatment for her toeing-in, most children learn to accommodate the problem and walk independently."

Answer 2

"We'll likely need to start putting the first of a series of casts on her legs quite soon."

Question 3

When a 4-year-old boy stands erect with his medial malleoli touching, the distance between his knees is 2 inches. What is the child's most likely diagnosis and treatment?

A) Genu varum, which can be treated by bracing
B) Flatfoot, which will require orthopedic shoes
C) Genu valgum necessitating a series of surgeries
D) Femoral torsion, which will spontaneously resolve before puberty

Answer 3

Genu varum, which can be treated by bracing

Question 4

Following genetic testing and a thorough history from the child's mother and father, a 5-month-old boy has been diagnosed with osteogenesis imperfecta. What teaching point should the care team provide to the mother and father?

A) "His skeleton is prone to breakage, and we'll begin hormone therapy to treat this."
B) "His hips are extremely susceptible to dislocation, so rough play is out of the question."
C) "You'll need to commit to calcium supplementation for the duration of his development."
D) "You'll need to be very careful to avoid causing fractures to his fragile bones."

Question 5

Which of the following newborn infants demonstrates the highest risk of presenting with developmental dysplasia of the hip (DDH)?

A) A girl who was born with toeing-in and who was in a breech presentation
B) A twin girl who required resuscitation after delivery
C) A boy who was born by caesarian section to a 44-year-old first-time mother
D) A boy with Down syndrome who was exposed to cocaine in utero

Question 6

While an infant is in the supine position with both knees flexed, the clinician applies gentle downward pressure to both knees, and the knee and thigh are abducted as an upward and medial pressure is applied to the proximal thigh. This examination technique, used to screen for a reducible dislocation, is called

A) Galeazzi test.
B) Ortolani maneuver.
C) clubfoot test.
D) Trendelenburg test.

Question 7

The parents of a newborn who has been diagnosed with developmental dysplasia of the hip ask the nurse about the reason this harness has to be on their child. The nurse responds,

A) "This harness allows your baby some mobility as it slowly brings the leg back into abduction."
B) "The harness is meant to help the baby be moved without increasing his pain."
C) "The harness will keep the leg immobile and force the femoral head back into the cup-shaped socket of the hip bone."
D) "Infants with dysplasia of the hip need to keep the leg still, and this harness will provide the immobility needed for healing postsurgery."

Question 8

Following bone density scanning and diagnostic imaging, a 4-year-old boy has been diagnosed with Legg-Calvé-Perthes disease. Which of the following findings, signs, and symptoms would lead clinicians to this conclusion? Select all that apply.

A) The boy has significant difficulty in walking.
B) The boy's feet toe-in when standing upright.
C) The child has limited abduction of the affected hip.
D) His femoral head region is noted to be necrotic
E) There are numerous microfractures where his patellar tendon and tibia articulate.

Question 9

Child/parents are coming into the physician's office to get the results of some diagnostic testing relating to his knee pain and unusual stiffness and fatigue. The physician suspects the child may have slipped capital femoral epiphysis. The nurse should anticipate that the treatment will involve: Select all that apply.

A) no weight bearing on the femur.
B) bed rest.
C) traction.
D) injection of steroids into the joint.
E) high dose of calcium supplements.

Question 10

A public health nurse has learned that a colleague has been screening for scoliosis during visits made to schools even though such screening is not mandated. How should the nurse best respond to the colleague?

A) "The potentially harmful outcomes of screening have been shown to outweigh the benefits."
B) "Screening for scoliosis has been proven to be inaccurate."
C) "Screening is unnecessary now that we know scoliosis is a benign condition."
D) "The low prevalence and incidence of scoliosis have made screening unnecessary."

Question 11

While measuring the height of a 12-year-old girl during an office visit, the primary care physician noted a deviation of the girl's spine. This was subsequently quantified as being a right curve scoliosis of approximately 10-degree deviation. Which of the following treatment options is most clearly indicated?

A) Use of a Milwaukee brace during waking hours
B) Surgical correction of the girl's spine
C) Observation and no active treatment
D) Use of external rods to correct the deviation

Question 12

When explaining to a class of nursing students the effects of dysregulation of the RANKL/RANK/OPG pathway, the instructor emphasizes that this plays a prominent role in the pathogenesis of: Select all that apply.

A) osteomalacia.
B) neoplasia of the bone.
C) osteoporosis.
D) genu varum.
E) bone necrosis.

Question 13

Which of the following clients is most likely to have low bone density?

A) A 70-year-old woman with increased numbers of osteoblasts.
B) A 78-year-old female whose osteoclast function is inhibited.
C) A 65-year-old male who is noted to have osteopenia.
D) A 68-year-old male who takes vitamin D supplements.

Question 14

A 74-year-old female has been diagnosed with osteoporosis after her bone density scan indicated osteopenia. Which of the following factors would her care team be most likely to rule out as contributors to her health problem?

A) The woman is an African American and was exposed to asbestos in her work.
B) She has been a heavy drinker for her whole adult life and has diabetes mellitus.
C) The client takes corticosteroids for treatment of her long-standing osteoarthritis.
D) The woman has an estrogen deficiency and has never undergone hormone therapy.

Question 15

A nurse is teaching a wellness group among a group of older adult women. One of the women has asked for advice about preventing osteoporosis, which affects many of her friends. What is the nurse's best response to the woman's query?

A) "Osteoporosis has been shown to have a strong genetic basis, so there is little you can do to prevent it."
B) "Weight-bearing exercise is helpful, as are calcium supplements."
C) "If possible, scaling back your hormone replacement therapy will reduce your osteoporosis risk."
D) "There are drugs called glucocorticoids that both prevent osteoporosis and treat it if you do develop it."

Question 16

The osteoporosis patient asks the nurse to explain what a bisphosphonate medication does. The nurse will respond,

A) "This medication helps prevent bone resorption, which will help prevent fractures."
B) "These drugs increase your phosphorus levels and thereby help with your calcium levels as well."
C) "This medication stimulates your parathyroid gland to increase osteoclastic activity."
D) "This medication plays an important role in bone remodeling."

Question 17

The infant of a family that has recently immigrated to the United States from South Asia has been diagnosed with rickets. Bone density scanning would yield which of the following characterizations of the infant's bones?

A) The child's bones are far softer than those of healthy children.
B) The infant has bones that are brittle and susceptible to breakage.
C) The child's bones lack bone matrix and prevent weight bearing.
D) The child's bones are oversized due to insufficient osteoclasts.

Question 18

A patient is suspected to have osteomalacia based on his clinical manifestations and lab/diagnostic workup (low calcium levels, transverse lines on x-ray). The nurse would expect the patient to have which of the following clinical manifestations? Select all that apply.

A) Nerve palsy in upper extremities.
B) Calcification of aortic valve.
C) Bone pain.
D) Muscle weakness.
E) Cold limb with absent pulses.

Question 19

A 16-month-old boy has a normal weight for his age but a height far below the normal range. His list of symptoms includes a protruding abdomen, lethargy, bow legs, muscle weakness, and irritability. His teeth have not yet developed, and he has difficulty standing. What is the child's most likely diagnosis?

A) Rickets
B) Rachitic rosary
C) Paget disease
D) Developmental dysplasia of the hip

Question 20

A patient comes into the orthopedic clinic complaining of severe pain in his hip that was not caused by a fall. On inspection, the femur and tibia are bowed. There is also a reduced angle of the femoral neck, which gives the patient a "waddling gait" appearance. The doctor suspects Paget disease. The patient asks how he got that. The nurse will respond,

A) "It's because you don't eat enough calcium-rich foods in your diet."
B) "When you were a child you probably broke you hip, and since it wasn't displaced, you continued to walk on it."
C) "It might be related to a thyroid condition. We will need to run some more blood work."
D) "It's most likely a genetic predisposition. Do you know if anyone else in your family has this problem?"