Quiz 44: Alterations of Musculoskeletal Function
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1. 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 c. Pathologic
b. Incomplete d. Greenstick
2. Which type of fracture usually occurs in an individual who engages in a new activity that is strenuous and repetitive?
a. Stress c. Insufficiency
b. Greenstick d. Pathologic
3. Which term is used to identify the temporary displacement of two bones causing the bone surfaces to partially lose contact?
a. Dislocation c. Malunion
b. Subluxation d. Nonunion
4. 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.
5. Which structure attaches skeletal muscle to bone?
a. Tendon c. Bursa
b. Ligament d. Mesentery
6. The tear in a ligament is referred to as a:
a. Fracture c. Disunion
b. Strain d. Sprain
7. Which medical diagnosis is characterized by tissue degeneration or irritation of the extensor carpi radialis brevis tendon?
a. Lateral epicondylitis c. Bursitis
b. Medial tendinitis d. Lateral tendinitis
8. 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
9. 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
10. Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression?
a. Muscle ischemia c. Volkmann contracture
b. Myoglobinuria d. Neural injury
11. By the time osteoporosis is visible on an x-ray examination, up to what percent of bone has been lost?
a. 30% c. 50%
b. 40% d. 60%
12. A bone density of 645 mg/cm2 would support which diagnosis?
a. Osteoplasia c. Osteopenia
b. Osteoporosis d. Osteomalacia
13. 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 c. Idiopathic
b. Regional d. Osteoblastic
14. Considering the pathophysiologic process of osteoporosis, after being activated by receptor activator of nuclear factor B ligand (RANKL), receptor activator of nuclear factor B (RANK) activates which of the following?
a. Osteoclast apoptosis c. Osteoprotegerin
b. Osteoblast survival d. Osteoclast survival
15. 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
c. Increased body weight
d. Decreased formation and short life span of osteoclasts
16. Considering the pathophysiologic process of osteoporosis, which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts?
a. Parathyroid hormone c. Growth hormone
b. Glucocorticoid d. Estrogen
17. Considering the pathophysiologic process of osteoporosis, what are the effects of extracellular signal-regulated kinases (ERKs) and receptor activator of nuclear factor B 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.
18. What is the most common clinical manifestation of osteoporosis?
a. Bone deformity c. Pathologic fracture
b. Bone pain d. Muscle strain
19. Which disorder is characterized by the formation of abnormal new bone at an accelerated rate beginning with excessive resorption of spongy bone?
a. Osteomalacia c. Osteoporosis
b. Paget disease d. Osteosarcoma
20. 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.
21. 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-) and interleukin 1 (IL-1)
d. Impaired nerve innervation at the site of infection
22. 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
23. What pattern of bone destruction is described as not well-defined and not easily separated from normal bone?
a. Moth-eaten c. Geographic
b. Permeative d. Porous
24. 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
25. 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.
26. 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
27. 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.
28. 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.
29. 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 c. Osteoarthritis
b. Rheumatoid arthritis d. Suppurative arthritis
30. 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 c. Paget disease
b. Rheumatoid arthritis d. Fibromyalgia
31. 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
32. In ankylosing spondylitis, the CD8+ T cells are presented with which antigen?
a. Synovium c. Tendons
b. Cartilage d. Ligaments
33. People with gout are at high risk for which co-morbid condition?
a. Renal calculi c. Anemia
b. Joint trauma d. Hearing loss
34. 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
35. The pathophysiologic presentation of gout is closely linked to the metabolism of which chemical?
a. Purine c. Vitamin E
b. Pyrimidine d. Amino acid
36. 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
37. At what age is peak bone mass and strength reached in women?
a. 15 years c. 30 years
b. 20 years d. 35 years
38. What event is associated with the beginning of bone loss in women?
a. Puberty c. Childbirth
b. Sexual activity d. Menopause
39. What term is used to identify the calcium crystals that are associated with chronic gout?
a. Stones c. Tophi
b. Spurs d. Nodes
40. What are the primary sources of bacterial infections that lead to hematogenous bone infection? (Select all that apply.)
41. Which structures are most often affected by Paget disease? (Select all that apply.)
42. Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.)
a. Subcutaneous tissue crystals
c. Painful, stiffening of joints
d. Edema of the wrists
Match the phrases with the corresponding characteristics.
______ 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
43. McArdle disease
44. Myoadenylate deaminase deficiency