Quiz 45: Alterations of Musculoskeletal Function in Children
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1. Until the skeleton matures and adult stature is reached, where does growth in the length of bone occur?
a. Epiphyseal line c. Epiphyseal cartilage
b. Physeal plate d. Metaphyseal plate
2. Which skeletal deformity is normal at birth but generally disappears by 21/2 years of age?
a. Genu varum (bowleg) c. Equinovarus (clubfoot)
b. Genu valgum (knock knee) d. Pes planus (flat feet)
3. The total mass of muscle in the body can be estimated from which serum laboratory test value?
a. Albumin c. Creatinine
b. Blood urea nitrogen d. Creatine
4. What is the most common congenital skeletal defect of the upper extremity?
a. Vestigial tabs c. Rickets
b. Paget disease d. Syndactyly
5. What diagnosis is given when the infant’s hip maintains contact with the acetabulum but is not well seated within the hip joint?
a. Dislocatable hip c. Dislocated hip
b. Subluxated hip d. Subluxable hip
6. Which sign or symptom is a very late indication of developmental dysplasia of the hip?
a. Asymmetry of the gluteal or thigh folds
b. Leg-length discrepancy
c. Waddling gait
7. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta?
a. Phosphorus c. Alkaline phosphatase
b. Calcium d. Total protein
8. The failure of bones to ossify, resulting in soft bones and skeletal deformity, characterizes which disorder?
a. Osteogenesis imperfecta c. Osteochondrosis
b. Rickets d. Legg-Calvé-Perthes disease
9. An insufficient dietary intake of which vitamin can lead to rickets in children?
a. C c. B6
b. B12 d. D
10. In scoliosis, curves in the thoracic spine greater than how many degrees result in decreased pulmonary function?
a. 40 c. 60
b. 50 d. 80
11. In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis, which is considered the path of least resistance. What factor makes this route for bacteria the path of least resistance?
a. Cortex of the bone in this area is porous or mazelike.
b. Blood supply to the metaphysis is easily compromised.
c. Macrophages and lymphocytes have limited access to the subperiosteal space.
d. Bacteria usually spread down the medullary cavity of the bone.
12. How do the clinical manifestations and onset of juvenile rheumatoid arthritis (JRA) differ from those of rheumatoid arthritis (RA) in adults?
a. JRA begins insidiously with systemic signs of inflammation.
b. JRA predominantly affects large joints.
c. JRA has more severe joint pain than adult RA.
d. JRA has a rapid onset of generalized aches as the first symptom.
13. What is the cause of osteochondrosis?
a. Imbalance between calcitonin and parathyroid hormone
b. Nutritional deficiency of calcium and phosphorus
c. Bacterial infection of the bone
d. Vascular impairment and trauma to bone
14. Which bones are affected in Legg-Calvé-Perthes disease?
a. Heads of the femur c. Heads of the humerus
b. Distal femurs d. Distal tibias
15. Which statement is true regarding the pain experienced with Legg-Calvé-Perthes disease?
a. Pain experienced with Legg-Calvé-Perthes disease in the elbows and upper and lower arms is aggravated by activity and relieved by rest.
b. Pain experienced with Legg-Calvé-Perthes disease in the knees, inner thighs, and groin is described as a continuous ache and relieved by antiinflammatory drugs.
c. Pain experienced with Legg-Calvé-Perthes disease in the knees, inner thighs, and groin is aggravated by activity and relieved by rest.
d. Pain experienced with Legg-Calvé-Perthes disease in the elbows and upper and lower arms is described as a continuous ache and relieved by antiinflammatory drugs.
16. Which assessment finding characterizes Osgood-Schlatter disease?
a. Lateral epicondylitis of the elbow
b. Inflammation of the anterior cruciate ligament
c. Bursitis of the subscapular bursa in the glenohumeral joint
d. Tendinitis of the anterior patellar tendon
17. At birth, the diagnosis of cerebral palsy (CP) may be made based on what factor?
a. Brain trauma during birth c. Major brain malformation
b. Prematurity d. Genetic defect
18. Which muscular dystrophy syndrome develops from an X-linked recessive mode of inheritance?
a. Duchenne c. Myotonic
b. Facioscapulohumeral d. Limb girdle
19. Which protein, absent in muscle cells of Duchenne muscular dystrophy, mediates the anchoring of skeletal muscle fibers to the basement membrane?
a. Syntrophin c. Dystrophin
b. Laminin d. Troponin
20. What pulmonary complication in children with Duchenne muscular dystrophy contributes to their death?
a. Infection c. Impaired formation of alveoli
b. Kyphoscoliosis d. Cancer
21. Generally, what is the first symptom of facioscapulohumeral muscular dystrophy?
a. Inability to open the eyes completely c. Drooping shoulders
b. Difficulty standing d. Facial pain
22. What is the most common malignant bone tumor diagnosed during childhood?
a. Chondrosarcoma c. Ewing Sarcoma
b. Fibrosarcoma d. Osteosarcoma
23. Molecular analysis has demonstrated that osteosarcoma is associated with which gene?
a. TP53 c. myc
b. src d. TSC2
24. Osteosarcoma usually metastasizes to the:
a. Pancreas c. Lungs
b. Liver d. Brain
25. A Ewing sarcoma arises from the:
a. Bone marrow c. Metadiaphysis of long bones
b. Bone-producing mesenchymal cells d. Embryonal osteocytes
26. Rhabdomyosarcoma can develop in which type of muscle?
a. Cardiac c. Involuntary
b. Smooth d. Striated
27. Which organism is the primary cause of osteomyelitis in a newborn?
a. Staphylococcus aureus c. Group B streptococcus
b. Escherichia coli d. Bacillus anthracis
28. What is the cause of structural scoliosis?
a. Poor posture c. Poor calcium absorption
b. Vertebral rotation d. Intrauterine trauma
29. Which statements are true regarding bone growth before adulthood? (Select all that apply.)
a. Growth in the length of bone occurs at the physeal plate.
b. Growth occurs through endochondral ossification.
c. Bone growth takes place under hormonal control.
d. Cartilage cells at the epiphyseal side of the physeal plate multiply and enlarge.
e. Cartilage cells at the metaphyseal side of the plate are replaced by bone.
30. The anatomic makeup of which bone structures make them susceptible locations for osteomyelitis in children? (Select all that apply.)
a. Hip joint
b. Distal femur
c. Proximal humerus
d. Distal radius
e. Lateral ankle
Match the type of muscular dystrophy with its description. Types may be used more than once.
______ A. Duchenne muscular dystrophy
______ B. Facioscapulohumeral muscular dystrophy
______ C. Myotonic dystrophy
______ D. Becker muscular dystrophy
31. Onset occurs at approximately 3 years of age with rapid progression and frequently mental retardation.
32. The face is expressionless, and pouting of the lips makes whistling impossible.
33. Shares the X-linked inheritance pattern but produces milder symptoms.
34. Is an autosomal dominant condition with a slow rate of progression and frequently mental retardation.