Deck 42: Alterations of Musculoskeletal Function

Question 1

The pain associated with tendon and ligament injuries is usually described as being:

A)dull and diffuse and persists over the distribution of the tendon or ligament.
B)sharp and localized and persists over the distribution of the tendon or ligament.
C)pins-and-needle sensations distal to injury on movement.
D)intermittent and aching over the distribution of the tendon or ligament.

Answer 1

sharp and localized and persists over the distribution of the tendon or ligament.

Question 2

Improper reduction or immobilization of a fractured femur results in which of the following after cast removal?

A)The muscles around the fracture site are weak.
B)The fracture requires 6 to 8 weeks of physical therapy.
C)The skin under the cast is dry and flaky.
D)The bone is not straight.

Answer 2

The bone is not straight.

Question 3

Osteomyelitis is a bone infection caused only by bacteria.

Answer 3

False

Question 4

Paget disease can occur in any bone, but it most often affects the appendicular skeleton.

Question 5

Compartment syndromes are a localized form of crush syndromes.

Question 6

A tear in a ligament is known as a:

A)fracture.
B)strain.
C)disunion.
D)sprain.

Question 7

_____ fractures usually occur in individuals who engage in a new activity that is strenuous and repetitive.

A)Stress
B)Greenstick
C)Insufficiency
D)Pathologic

Question 8

A fracture in which the bone breaks into two or more fragments is a comminuted fracture.

Question 9

Alcohol abuse is the most common cause of toxic myopathy.

Question 10

A(n) _____ fracture is a fracture at a site of a preexisting bone abnormality, usually by a force that would not normally cause a fracture.

A)idiopathic
B)incomplete
C)pathologic
D)greenstick

Question 11

Cutaneous, sinus, ear, and dental infections are primary sources of bacteria in hematogenous bone infections.

Question 12

Bone is unique among body tissue because after a fracture that destroys bone, a new bone is formed, but there is no scar tissue.

Question 13

_____ is the temporary displacement of two bones in which the bone surfaces partially lose contact.

A)Dislocation
B)Subluxation
C)Malunion
D)Nonunion

Question 14

It is possible for a healthy young woman to gain bone mass up to and through the second decade of life.

Question 15

What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon?

A)Lateral epicondylitis
B)Medial tendinitis
C)Bursitis
D)Lateral tendinitis

Question 16

Receptor activator of nuclear factor kb ligand (RANKL) expression is inversely correlated with serum level of 17 b-estradiol (i.e., with estradiol deficiency, RANKL is increased).

Question 17

The calcium crystals that appear in the cartilage, synovial membranes, tendons, and soft tissue of people with chronic gout are called tophi.

Question 18

Which of the following attaches skeletal muscle to bone?

A)Tendon
B)Ligament
C)Bursa
D)Mesentery

Question 19

In osteomalacia the remodeling cycle proceeds normally through osteoid formation, but mineral calcification and deposition do not occur.

Question 20

A balance between receptor activator of nuclear RANKL and osteoprotegerin (OPG) is necessary to prevent osteoporosis.

Question 21

A characteristic of inflammatory joint disease is:

A)unilateral joint involvement.
B)normal joint synovial fluid.
C)absence of synovial membrane inflammation.
D)systemic symptoms of inflammation.

Question 22

By the time osteoporosis is visible on x-ray, up to ____% of bone has been lost.

A)30
B)40
C)50
D)60

Question 23

Which statement is false about giant cell tumors?

A)They are an overexpression of genes including osteoprotegerin ligand (OPGL).
B)They are malignant, solitary, irregularly shaped tumors.
C)They are typically located in the epiphysis in the femur, tibia, radius, and humerus.
D)They are slow-growing tumors that extend over the articular cartilage.

Question 24

When considering osteomyelitis, sequestrum is a(n):

A)area of devascularized and devitalized bone.
B)enzyme that phagocytizes necrotic bone.
C)subperiosteal abscess.
D)layer of new bone surrounding the infected bone.

Question 25

A woman with a bone density of 675 mg/cm² would be described as having:

A)osteoplasia.
B)osteoporosis.
C)osteopenia.
D)osteomalacia.

Question 26

Considering the pathophysiology of osteoporosis, after being activated by receptor activator of nuclear RANKL, RANK activates:

A)osteoclast apoptosis.
B)and prolongs osteoblast survival.
C)osteoprotegerin.
D)and prolongs osteoclast survival.

Question 27

Considering the pathophysiology of osteoporosis, which cytokines and hormones decrease receptor activator of RANKL expression?

A)IL-4 and transforming growth factor-beta (TGF-ß)
B)IL-1 and tumor necrosis factor-alpha (TNF-a)
C)IL-11 and glucocorticoids
D)IL-17 and parathyroid hormone (PTH)

Question 28

What pattern of bone destruction is described as not well defined and not easily separated from normal bone?

A)Moth-eaten
B)Permeative
C)Geographic
D)Porous

Question 29

Bone death as a result of osteomyelitis is due to:

A)formation of immune complexes at the site of infection.
B)localized ischemia.
C)TNF-a and IL-1.
D)impaired nerve innervation at the site of infection.

Question 30

Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts?

A)ERKs increase the life span of osteoclasts and RANKL decreases the life span of osteoblasts.
B)ERKs and RANKL increase the life span of osteoclasts and decrease the life span of osteoblasts.
C)ERKs and RANKL increase the life span of osteoblasts and decrease the life span of osteoclasts.
D)ERKs increase the life span of osteoblasts and RANKL decreases the life span of osteoclasts.

Question 31

Considering the pathophysiology of osteoporosis, which hormone exerts antiapoptotic effects on osteoblasts, but proapoptotic effects on osteoclasts?

A)Parathyroid hormone
B)Glucocorticoid
C)Growth hormone
D)Estrogen

Question 32

Which statement is false about factors that contribute to the difficulty in treating bone infections?

A)Bone contains multiple microscopic channels that are impermeable to the cells and biochemicals of the body's natural defenses.
B)Microcirculation of bone is highly vulnerable to damage and destruction by bacterial toxins, leading to ischemic necrosis of bone.
C)Bone cells have a limited capacity to replace bone destroyed by infections.
D)Bacteria are walled off by macrophages and T lymphocytes so that the antibiotics cannot penetrate the infected area.

Question 33

After prolonged muscle compression, which pathophysiologic alteration precedes crush syndrome?

A)Muscle ischemia
B)Myoglobinuria
C)Volkmann contracture
D)Neural injury

Question 34

Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula?

A)Iatrogenic
B)Regional
C)Idiopathic
D)Osteoblastic

Question 35

In osteoarthritis, what is the effect of the disruption of the pumping action of proteoglycans?

A)Pump malfunction stimulates the induction of nitric oxide synthase (iNOS) and nitric oxide (NO), which degrades the cartilage.
B)Cartilage is damaged by proteolytic enzymes because they cannot be pumped out of the joint.
C)Cartilage becomes dry, brittle, and wears away because fluid cannot be pumped into the cartilage.
D)Cartilage takes in too much fluid and is unable to withstand the stresses of weightbearing.

Question 36

Which of the following is a characteristic of osteosarcoma?

A)Slow-growing tumor that begins in the bone marrow and infiltrates the trabeculae
B)Solitary tumor that most often affects the metaphyseal region of the femur or tibia
C)An aggressive tumor most often found in the bone marrow of long bones
D)A tumor that infiltrates the trabeculae in spongy bone and implants in surrounding tissue by seeding

Question 37

The most common clinical manifestation of osteoporosis is:

A)bone deformity.
B)bone pain.
C)pathologic fracture.
D)muscle strain.

Question 38

Which disorder is characterized by the formation of abnormal new bone at an accelerated rate beginning with excessive resorption of spongy bone?

A)Osteomalacia
B)Paget disease
C)Osteoporosis
D)Osteosarcoma

Question 39

Rhabdomyolysis is characterized by:

A)paralysis of skeletal muscles resulting from impaired nerve supply.
B)smooth muscle degeneration resulting from ischemia.
C)lysis of skeletal muscle cells through the initiation of the complement cascade.
D)release of myoglobin from damaged striated muscle cells.

Question 40

What is a primary defect in osteoarthritis (OA)?

A)Stromelysin and acid metalloproteinase break down articular cartilage.
B)IgG destroys the synovial membrane.
C)Synovial membranes become inflamed.
D)Cartilage-coated osteophytes create bone spurs.

Question 41

Clinical manifestations of fibromyalgia include:

A)hot, tender, and edematous muscle groups bilaterally.
B)fasciculations of the upper and lower extremity muscles.
C)exercise intolerance and painful muscle cramps.
D)burning or gnawing pain at tender points and profound fatigue.

Question 42

Match the phrases with the corresponding characteristics.
Polymyositis

A)Caused by sedatives and narcotics, particularly street heroin
B)Caused by viruses, bacteria, and parasites
C)Exercise intolerance with normal production of lactic acid
D)Impairs the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 43

In ankylosing spondylitis, the CD8⁺ T cells are presented with which of the following antigens?

A)Synovium
B)Cartilage
C)Tendons
D)Ligaments

Question 44

Match the phrases with the corresponding characteristics.
McArdle disease

A)Caused by sedatives and narcotics, particularly street heroin
B)Caused by viruses, bacteria, and parasites
C)Exercise intolerance with normal production of lactic acid
D)Impairs the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 45

Match the phrases with the corresponding characteristics.
Rhabdomyolysis

A)Caused by sedatives and narcotics, particularly street heroin
B)Caused by viruses, bacteria, and parasites
C)Exercise intolerance with normal production of lactic acid
D)Impairs the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 46

Acute alcoholic myopathy, McArdle disease, and disorders of lipid metabolism in muscles:

A)are autoimmune diseases.
B)are capable of depositing immune complexes in muscles.
C)are causes of myoglobinuria.
D)result in progressive muscle weakness.

Question 47

Match the phrases with the corresponding characteristics.
Myositis

A)Caused by sedatives and narcotics, particularly street heroin
B)Caused by viruses, bacteria, and parasites
C)Exercise intolerance with normal production of lactic acid
D)Impairs the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 48

The primary pathologic alteration in the sacroiliac joint resulting from ankylosing spondylitis (AS) is:

A)inflammation of the enthesis.
B)inflammation of the synovium.
C)synovitis and bone marrow inflammation.
D)diskitis and nucleus pulposus inflammation.

Question 49

People with gout are at high risk for:

A)renal calculi.
B)joint trauma.
C)anemia.
D)hearing loss.

Question 50

Match the phrases with the corresponding characteristics.
Myoadenylate deaminase deficiency

A)Caused by sedatives and narcotics, particularly street heroin
B)Caused by viruses, bacteria, and parasites
C)Exercise intolerance with normal production of lactic acid
D)Impairs the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 51

Clinical manifestations of rheumatoid arthritis (RA) include:

A)collection of crystals in subcutaneous tissue of extremities.
B)fatigue, fever, and weakness.
C)pain in one or more weight-bearing joints.
D)edema of the wrists and distal joints of the fingers.

Question 52

Which joint disease is characterized by joint stiffness on movement and joint pain of weight-bearing joints that usually is relieved by rest?

A)Gouty arthritis
B)Rheumatoid arthritis
C)Osteoarthritis
D)Suppurative arthritis

Question 53

_____ is a chronic inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints.

A)Ankylosing spondylitis
B)Rheumatoid arthritis
C)Paget disease
D)Fibromyalgia

Question 54

What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis?

A)Reduced excretion of purines
B)Overproduction of uric acid
C)Increase in the glycosaminoglycan levels
D)Overproduction of proteoglycans

Question 55

The pathophysiology of gout is closely linked to the metabolism of:

A)purine.
B)pyrimidine.
C)vitamin E.
D)amino acid.