Deck 44: Alterations of Musculoskeletal Function

Question 1

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; consequently, the antibiotics cannot penetrate the infected area.

Answer 1

Bacteria are walled off by macrophages and T lymphocytes; consequently, the antibiotics cannot penetrate the infected area.

Question 2

The pain resulting from tendon and ligament injuries is usually described as:

A) Dull and diffuse, persisting over the distribution of the tendon or ligament
B) Sharp and localized, persisting over the distribution of the tendon or ligament
C) Pins-and-needle sensations that occur distal to the injury with movement
D) Intermittent and aching, occurring over the distribution of the tendon or ligament

Answer 2

Sharp and localized, persisting over the distribution of the tendon or ligament

Question 3

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

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

Answer 3

Estrogen

Question 4

Which medical diagnosis is characterized by tissue degeneration or irritation of the extensor carpi radialis brevis tendon?

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

Question 5

How is rhabdomyolysis characterized?

A) Paralysis of skeletal muscles, resulting from an 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 6

Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression?

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

Question 7

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 8

Which term is used to identify the temporary displacement of two bones causing the bone surfaces to partially lose contact?

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

Question 9

By the time osteoporosis is visible on an x-ray examination,up to what percent of bone has been lost?

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

Question 10

Which type of fracture usually occurs in an individual who engages in a new activity that is strenuous and repetitive?

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

Question 11

What type of fracture occurs at a site of a preexisting bone abnormality and is a result of a force that would not normally cause a fracture?

A) Idiopathic
B) Incomplete
C) Pathologic
D) Greenstick

Question 12

Improper reduction or immobilization of a fractured femur can result in which outcome 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.

Question 13

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 14

Which structure attaches skeletal muscle to bone?

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

Question 15

Considering the pathophysiologic process of osteoporosis,after being activated by receptor activator of nuclear factor kB ligand (RANKL),receptor activator of nuclear factor kB (RANK)activates which of the following?

A) Osteoclast apoptosis
B) Osteoblast survival
C) Osteoprotegerin
D) Osteoclast survival

Question 16

The tear in a ligament is referred to as a:

A) Fracture
B) Strain
C) Disunion
D) Sprain

Question 17

Considering the pathophysiologic process of postmenopausal osteoporosis,which changes are believed to play a significant role in the development of age-related bone loss?

A) Increased oxidative stress and increased intracellular reactive oxygen species
B) Hypoparathyroidism
C) Increased body weight
D) Decreased formation and short life span of osteoclasts

Question 18

Considering the pathophysiologic process of osteoporosis,what are the effects of extracellular signal-regulated kinases (ERKs)and receptor activator of nuclear factor kB ligand (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 19

What is the most common clinical manifestation of osteoporosis?

A) Bone deformity
B) Bone pain
C) Pathologic fracture
D) Muscle strain

Question 20

A bone density of 645 mg/cm² would support which diagnosis?

A) Osteoplasia
B) Osteoporosis
C) Osteopenia
D) Osteomalacia

Question 21

What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)?

A) Inflammation of the sacroiliac joint
B) Inflammation of the long bones
C) Inflammation of fibrocartilaginous joints of the vertebrae
D) Inflammation of the small hand and feet bones

Question 22

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 23

Which is a characteristic of inflammatory joint disease?

A) Unilateral joint involvement
B) Normal joint synovial fluid
C) Absence of synovial membrane inflammation
D) Systemic symptoms of inflammation

Question 24

Which clinical manifestations are associated with fibromyalgia?

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) Sensitivity at tender points and profound fatigue

Question 25

In ankylosing spondylitis,the CD8+ T cells are presented with which antigen?

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

Question 26

What term is used to identify the calcium crystals that are associated with chronic gout?

A) Stones
B) Spurs
C) Tophi
D) Nodes

Question 27

What event is associated with the beginning of bone loss in women?

A) Puberty
B) Sexual activity
C) Childbirth
D) Menopause

Question 28

People with gout are at high risk for which co-morbid condition?

A) Renal calculi
B) Joint trauma
C) Anemia
D) Hearing loss

Question 29

Which medical diagnosis is described as 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 30

At what age is peak bone mass and strength reached in women?

A) 15 years
B) 20 years
C) 30 years
D) 35 years

Question 31

What are the primary sources of bacterial infections that lead to hematogenous bone infection? (Select all that apply.)

A) Sinus
B) Ear
C) Dental
D) Cutaneous
E) Throat

Question 32

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

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

Question 33

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

A) Formation of immune complexes at the site of infection
B) Localized ischemia
C) Tumor necrosis factor-alpha (TNF-a) and interleukin 1 (IL-1)
D) Impaired nerve innervation at the site of infection

Question 34

What is a primary defect in osteoarthritis?

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

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 and nitric oxide, 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 weight bearing.

Question 36

Which statement is false concerning giant cell tumors?

A) Giant cell tumors are an overexpression of genes including osteoprotegerin ligand (OPGL).
B) The tumors are malignant, solitary, and irregularly shaped.
C) Giant cell tumors 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 37

Which statement accurately describes 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) Aggressive tumor most often found in the bone marrow of long bones
D) Tumor that infiltrates the trabeculae in spongy bone and implants in surrounding tissue by seeding

Question 38

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 39

The pathophysiologic presentation of gout is closely linked to the metabolism of which chemical?

A) Purine
B) Pyrimidine
C) Vitamin E
D) Amino acid

Question 40

When considering osteomyelitis,sequestrum is identified as what?

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

Question 41

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)Impairment of the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 42

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)Impairment of the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 43

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)Impairment of the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 44

Which structures are most often affected by Paget disease? (Select all that apply.)

A) Vertebrae
B) Skull
C) Sternum
D) Metacarpals
E) Pelvis

Question 45

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)Impairment of the breakdown of glycogen and production of lactic acid
E)Autoimmune disease

Question 46

Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.)

A) Subcutaneous tissue crystals
B) Anorexia
C) Painful, stiffening of joints
D) Edema of the wrists
E) Fever

Question 47

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)Impairment of the breakdown of glycogen and production of lactic acid
E)Autoimmune disease