Patho Ch. 39 Alterations of Musculoskeletal Function 5th edition

A 35-year-old female presents with impaired motor function and visual disturbances. The diagnosis is Paget disease. What additional symptoms would be expected? (Select all that apply.) a. Skull thickness b. Dementia c. Deafness d. Headache e. Hypertension

ANS: A, B, C, D a. Skull thickness b. Dementia c. Deafness d. Headache In Paget disease, the skull thickens and assumes an asymmetric shape. Thickened segments of the skull may compress areas of the brain, producing altered mentality and dementia. Impingement of new bone on cranial nerves causes deafness. Headache is commonly noted. Hypertension does not occur.

A 60-year-old male presents with swelling and pain in the knee. CT reveals a tumor of spongy bone. His diagnosis would be: a. Chondrosarcoma b. Rhabdomyoma c. Rhabdomyosarcoma d. Fibrosarcoma

a. Chondrosarcoma A chondrosarcoma is an ill-defined malignant tumor that infiltrates trabeculae in spongy bone. Rhabdomyoma is an extremely rare benign tumor of muscle that generally occurs in the tongue. The malignant tumor of striated muscle is called rhabdomyosarcoma. A fibrosarcoma is a solitary tumor that most often affects the metaphyseal region of the femur or tibia.

Which of the following people is at highest risk for the development of gout? a. Men aged 40 to 50 years b. Premenopausal women c. Male adolescents d. Female children

a. Men aged 40 to 50 years People at highest risk for gout are men aged 40 to 50 years of age. People at highest risk for gout are men aged 40 to 50 years of age, not premenopausal women. People at highest risk for gout are men aged 40 to 50 years of age, not male adolescents. People at highest risk for gout are men aged 40 to 50 years of age, not female children.

An 80-year-old male presents with skeletal pain and tenderness, especially in the hips. He is diagnosed with osteomalacia caused by: a. Collagen breakdown in the bone matrix b. Excessive bone resorption c. Crowding of bone marrow by excessive bone growth d. Inadequate bone mineralization

d. Inadequate bone mineralization Osteomalacia is a metabolic disease characterized by inadequate and delayed mineralization of osteoid in mature compact and spongy bone. Idiopathic osteoarthritis leads to collagen breakdown. Giant cell tumors promote excessive bone resorption. Abnormal remodeling causes crowding of bone marrow.

A 70-year-old female presents with a hip fracture. She is diagnosed with osteoporosis. One factor that most likely contributed to her condition is: a. Increased androgen levels b. Decreased estrogen levels c. Strenuous exercise d. Excessive dietary calcium

b. Decreased estrogen levels Osteoporosis can be attributed to decreased estrogen levels. Osteoporosis can be attributed to decreased estrogen levels, not increased androgen levels. Osteoporosis can be attributed to decreased estrogen levels, not strenuous exercise. Osteoporosis can be attributed to decreased estrogen levels, not excessive dietary calcium.

The most common cause of toxic myopathy is: a. Infection b. A tumor c. Alcoholism d. Osteoporosis

c. Alcoholism Alcohol remains the most common cause of toxic myopathy. Alcohol, not infection, remains the most common cause of toxic myopathy. Alcohol, not a tumor, remains the most common cause of toxic myopathy. Alcohol, not osteoporosis, remains the most common cause of myopathy.

A 32-year-old male was injured in a motor vehicle accident and confined to bed for 3 weeks. During this time, the size and strength of muscle fibers decreased, a condition referred to as: a. Myodysplasia b. Ischemic atrophy c. Disuse atrophy d. Deconditioning hypoplasia

c. Disuse atrophy The term disuse atrophy describes the pathologic reduction in normal size of muscle fibers after prolonged inactivity from bed rest. The patient is experiencing disuse atrophy, not myodysplasia. The patient is experiencing disuse atrophy, not ischemic, which would be due to decreased blood flow. The patient is experiencing disuse atrophy, not hypoplasia.

A 32-year-old obese male begins a jogging routine. A week after beginning, he fractures his leg. This is referred to as a what type of fracture? a. Comminuted b. Greenstick c. Fatigue d. Compound

c. Fatigue A fatigue fracture is caused by abnormal stress or torque applied to a bone that usually occurs in individuals who engage in a new activity that is both strenuous and repetitive. A comminuted fracture is one in which a bone breaks into two or more fragments. A greenstick fracture perforates one cortex and splinters the spongy bone. An open fracture is a complete and incomplete fracture that breaks through the skin.

A 54-year-old male was recently diagnosed with rheumatoid arthritis (RA). Which of the following is the expected treatment of choice? a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Gold salts c. Methotrexate d. Hydroxychloroquine

c. Methotrexate Methotrexate remains the first line of treatment for RA. Methotrexate, not NSAIDs, remains the first line of treatment for RA. Methotrexate, not gold salts, remains the first line of treatment for RA. Methotrexate, not hydroxychloroquine, remains the first line of treatment for RA.

A 76-year-old female was diagnosed with osteoporosis by radiologic exam. She is at high risk for: a. Bone infections b. Joint injuries c. Pathologic bone fractures d. Osteomalacia

c. Pathologic bone fractures The patient will be at risk for pathologic bone fractures due to bone fragility. The patient will not be at increased risk for infection. The patient could be at risk for joint injury, but will be at greatest risk for fracture. The patient is not at risk for osteomalacia.

A 70-year-old female with osteoporosis fractures her leg at a location of preexisting abnormality. She reports that the fracture occurred following a minor fall. Which of the following best describes the fracture? a. Fatigue fracture b. Stress fracture c. Pathologic fracture d. Greenstick fracture

c. Pathologic fracture A pathologic fracture is a break at the site of a preexisting abnormality, usually by force that would not fracture a normal bone. A fatigue fracture is caused by abnormal stress or torque applied to a bone with normal ability to deform and recover. Stress fractures occur in normal or abnormal bone that is subjected to repeated stress, such as occurs during athletics. A greenstick fracture perforates one cortex and splinters the spongy bone.

A 46-year-old male presents with severe pain, redness, and tenderness in the right big toe. He was diagnosed with gouty arthritis. He is at risk for developing: a. Cholelithiasis b. Myocarditis c. Renal stones d. Liver failure

c. Renal stones Renal stones are 1000 times more prevalent in individuals with primary gout than in the general population. Renal stones, not cholelithiasis, are a risk factor in gout. Renal stones, not myocarditis, are a risk factor in gout. Renal stones, not liver failure, are a risk factor in gout.

A 70-year-old female presents with a hip fracture secondary to osteoporosis. This condition is caused by an increase in bone: a. Density b. Formation c. Resorption d. Mineralization

c. Resorption Osteoporosis is due to an increase in bone resorption. Osteoporosis is due to an increase in bone resorption; density would be decreased, not increased. Osteoporosis is due to an increase in bone resorption, not formation. Osteoporosis is due to an increase in bone resorption, not mineralization.

A malignant tumor of striated muscle tissue origin is called: a. Myelogenic tumor b. Giant cell tumor c. Rhabdomyosarcoma d. Rhabdomyoma

c. Rhabdomyosarcoma The malignant tumor of striated muscle is called rhabdomyosarcoma. Myelogenic tumors originate from various bone marrow cells. Giant cell tumor is the sixth most common of the primary bone tumors. A rhabdomyoma is an extremely rare benign tumor of muscle that generally occurs in the tongue.

A 46-year-old male presents with severe pain, redness, and tenderness in the right big toe. He was diagnosed with gouty arthritis. The symptoms he experienced are caused by the crystallization of _____ within the synovial fluid. a. Purines b. Pyrimidines c. Uric acid d. Acetic acid

c. Uric acid Gout is caused by an increase in uric acid. Gout is caused by an increase of uric acid. Uric acid is a result of purine metabolism, but purine is not present in the joint. Gout is caused by an increase in uric acid, not pyrimidines. Gout is caused by an increase in uric acid, not acetic acid.

A 13-year-old female is admitted to the hospital for evaluation and treatment of an osteosarcoma in her left distal femur. Which statement best describes osteosarcoma? a. Myelogenic, develops in red bone marrow only b. Benign, develops in spongy bone tissue c. Collagenic, originates in the periosteum d. Osteogenic, most often develops in the bone marrow

d. Osteogenic, most often develops in the bone marrow Osteosarcomas are osteogenic tumors. Osteosarcomas are osteogenic tumors, not myelogenic. Osteosarcomas are osteogenic tumors, not benign. Osteosarcomas are osteogenic tumors, not collagenic.

Transchondral fractures are most prevalent in: a. Adolescents b. Older adults c. Infants d. Premenopausal females

a. Adolescents Transchondral fractures are most prevalent in adolescents. Transchondral fractures are most prevalent in adolescent, not older adults. Transchondral fractures are most prevalent in adolescents, not infants. Transchondral fractures are most prevalent in adolescents, not premenopausal females.

Myotonia is characterized by: a. Prolonged depolarization of muscle cell membranes b. Absence of adenosine triphosphate (ATP) for muscle contraction c. Delayed muscle contraction d. Hyperactive reflexes

a. Prolonged depolarization of muscle cell membranes Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane. Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane, not due to absence of ATP for muscle contraction. Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane, not delayed muscle contraction. Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane, not hyperactive reflexes.

A 21-year-old female presents with low back pain and stiffness that is alleviated by physical activity. She was diagnosed with ankylosing spondylitis (AS). The first joint to be affected would be the: a. Sacroiliac b. Carpal c. Shoulder d. Knee

a. Sacroiliac The sacroiliac joint is affected first, usually before any damage can be radiographically detected. The sacroiliac joint, not the carpal joint, is affected first, usually before any damage can be radiographically detected. The sacroiliac joint, not the shoulder, is affected first, usually before any damage can be radiographically detected. The sacroiliac joint, not the knee, is affected first, usually before any damage can be radiographically detected.

A 12-year-old female hurts her ankle while playing basketball. Tests reveal that she tore a ligament. This condition is known as a: a. Sprain b. Strain c. Disunion d. Subluxation

a. Sprain A torn ligament is also called a sprain. Tearing or stretching of a muscle or tendon is commonly known as a strain. Disunion occurs when fracture ends fail to heal. Subluxation occurs when contact between the opposing joint surfaces of a fracture are partially lost.

To make a diagnosis of fibromyalgia, tenderness must be present in ____ of the 18 points necessary for diagnosis.

ANS: 11 Tenderness in 11 of these 18 points is necessary for diagnosis along with a history of diffuse pain.

The pattern of bone destruction indicative of an aggressive malignant tumor is known as J_____ pattern. (Select all that apply.) a. Moth-eaten b. Permeative c. Geographic d. Radial e. Selective

ANS: A, B, C a. Moth-eaten b. Permeative c. Geographic Three patterns of bone destruction by bone tumors have been identified: (1) the geographic pattern, (2) the moth-eaten pattern, and (3) the permeative pattern. Radial and selective are not considered patterns of malignancy.

A 29-year-old male was recently diagnosed with AS. He is interested in obtaining more information about his disease. Patient teaching would include which of the following? (Select all that apply.) a. A diagnosis is made from history, physical examination, x-rays, and genetic analysis. b. Inflammation of the fibrocartilage in cartilaginous joints results in the erosion of bone structure, scar tissue formation, and joint fusion. c. The more common signs and symptoms of early disease include restricted joint movement and increased pain after physical activity. d. The usual treatment includes anti-inflammatory and analgesic medications, exercises, and physical therapy. e. The spine becomes bent forward as the normal convex curve of the lower spine diminishes.

ANS: A, B, D, E a. A diagnosis is made from history, physical examination, x-rays, and genetic analysis. b. Inflammation of the fibrocartilage in cartilaginous joints results in the erosion of bone structure, scar tissue formation, and joint fusion. d. The usual treatment includes anti-inflammatory and analgesic medications, exercises, and physical therapy. e. The spine becomes bent forward as the normal convex curve of the lower spine diminishes. The most common signs and symptoms of early AS are low back pain and stiffness. Typically, the individual with primary disease develops low back pain during the early 20s. The pain is at first insidious but progressively becomes persistent. It is often worse after prolonged rest and is alleviated by physical activity. The normal convex curve of the lower spine (lumbar lordosis) diminishes and concavity of the upper spine (kyphosis) increases. NSAIDs will often provide temporary symptom relief within 48 hours. Analgesic medications are prescribed to suppress some of the pain and stiffness and to facilitate exercise.

Signs and symptoms of subluxation include (select all that apply): a. Pain b. Swelling c. Hemorrhage d. Limitation of movement e. Joint deformity

ANS: A, B, D, E a. Pain b. Swelling d. Limitation of movement e. Joint deformity Signs and symptoms of dislocations or subluxations include pain, swelling, limitation of motion, and joint deformity.

A 70-year-old male presents with back pain, fever, and weight loss. He reports that he had a recent respiratory infection from which he thought he recovered. Tests revealed increased white blood cell count, and a diagnosis of endogenous osteomyelitis was made. The primary organism causing this condition is: a. Staphylococcus aureus b. Salmonella c. Mycobacterium d. Haemophilus influenza

a. Staphylococcus aureus Staphylococcus aureus remains the primary microorganism responsible for osteomyelitis. Staphylococcus aureus, not Salmonella, remains the primary microorganism responsible for osteomyelitis. Staphylococcus aureus, not Mycobacterium, remains the primary microorganism responsible for osteomyelitis. Staphylococcus aureus, not Haemophilus influenza, remains the primary microorganism responsible for osteomyelitis.

A 34-year-old female was recently diagnosed with RA. Physical examination revealed that inflammation started in the: a. Synovial membrane b. Articular cartilage c. Subchondral bone d. Surrounding ligaments

a. Synovial membrane Inflammation of RA starts in the synovial membrane. Inflammation of RA starts in the synovial membrane, not the articular cartilage. Inflammation of RA starts in the synovial membrane, not the subchondral bone. Inflammation of RA starts in the synovial membrane, not the surrounding ligaments.

A 51-year-old male experienced severe acute gouty arthritis. Which of the following is the most common trigger for the symptoms? a. Trauma b. Anemia c. High-fat foods d. Lack of exercise

a. Trauma Trauma is the most common trigger for gout symptoms. Trauma is the most common trigger for gout symptoms. Gout is not manifested by anemia. Trauma is the most common trigger for gout symptoms. Gout is not caused by high-fat foods, but high purine. Trauma, not lack of exercise, is the most common trigger for gout symptoms.

Researchers now believe that RA is: a. Curable with antiviral agents b. An autoimmune disease c. A complication of rheumatic fever d. Related superficial joint injury

b. An autoimmune disease RA is now thought to be an autoimmune disease. RA is an incurable disease. RA is not a complication of rheumatic fever. RA is not due to joint injury.

A 54-year-old female was recently diagnosed with degenerative joint disease. This condition is characterized by loss of: a. The epiphyses b. Articular cartilage c. Synovial fluid d. The joint capsule

b. Articular cartilage Degenerative joint disease is caused by loss of the articular cartilage. Degenerative joint disease is caused by loss of the articular cartilage, not the epiphyses. Degenerative joint disease is caused by loss of the articular cartilage, not the synovial fluid. Degenerative joint disease is caused by loss of the articular cartilage, not the joint capsule.

Which of the following clinical findings would be expected in the patient with rhabdomyolysis? a. Sweating b. Dark urine c. Yellow color to the skin d. Lower extremity swelling

b. Dark urine A classic triad of muscle pain, weakness, and dark urine is considered typical of rhabdomyolysis. Dark urine, not sweating, is a classic sign of rhabdomyolysis. Dark urine, not yellow skin, is a classic sign of rhabdomyolysis. Dark urine, not lower extremity swelling, is a classic sign of rhabdomyolysis.

A disorder similar to osteomalacia that occurs in growing bones of children is termed: a. Paget disease b. Rickets c. Osteomyelitis d. Osteosarcoma

b. Rickets Abnormal bone growth in children is termed rickets. Paget disease is a state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling, both resorption and formation. Osteomyelitis is a bone infection. Osteosarcoma is a form of bone cancer.

A 35-year-old female suffers a broken clavicle following a motor vehicle accident. X-ray reveals that the bone surfaces in the joint partially lost contact with each other. This condition is called: a. Dislocation b. Subluxation c. Distortion d. Nonunion

b. Subluxation Subluxation occurs when contact between the opposing joint surfaces of a fracture are partially lost. Dislocation is the displacement of one or more bones in a joint in which the opposing joint surfaces lose contact entirely. Distortion is not a term applicable to fracture healing. Nonunion is failure of the bone ends to grow together.

A 65-year-old Hispanic female is admitted to the hospital with a pathologic, compound, transverse fracture of the femur. Which of the following statements best describes this type of fracture? a. The fracture line is parallel to the bone. b. The fracture line is straight across the bone. c. The fracture line is perpendicular to the bone. d. The fracture line is vertical to the shaft of the bone.

b. The fracture line is straight across the bone. A transverse fracture occurs straight across the bone. A linear fracture runs parallel to the long axis of the bone. A transverse fracture runs straight across the bone, not perpendicular. A transverse fracture runs straight across the bone, not vertically.

The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called: a. Monarticular arthritis b. Tophaceous gout c. Asymptomatic hyperuricemia d. Complicated gout

b. Tophaceous gout Tophaceous gout is a progressive inability to excrete uric acid, which expands the urate pool. Until urate crystal deposits (tophi) appear in cartilage, synovial membranes, tendons, and soft tissue. Tophaceous gout, not monarticular arthritis gout, is characterized by crystalline deposits. Asymptomatic hyperuricemia would not lead to crystalline deposits. Tophaceous gout, not complicated gout, is characterized by crystalline deposits.

The cause of Paget disease is: a. Fluoride deficiency b. Unknown at present c. Excess vitamin A d. Osteogenic sarcoma

b. Unknown at present The cause of Paget disease is unknown. The cause of Paget disease is unknown; it is not due to fluoride deficiency. The cause of Paget disease is unknown; it is not due to excess vitamin A. The cause of Paget disease is unknown; it is not due to osteosarcoma.

A 56-year-old male was admitted to the hospital with a diagnosis of osteomalacia. History reveals that he takes anticonvulsants, underwent small bowel resection 3 years earlier, and suffers from chronic pancreatitis. What is the common link between these three factors and the development of osteomalacia? a. Impaired phosphate absorption b. Increased calcium excretion c. Vitamin D deficiency d. Impaired vitamin C metabolism

c. Vitamin D deficiency Disorders of the small bowel, hepatobiliary system, and pancreas are causes of vitamin D deficiency in the United States. Vitamin D deficiency is the most important factor in osteomalacia. Vitamin D deficiency, not impaired phosphate absorption, is the common cause of osteomalacia. Vitamin D deficiency, not increased calcium excretion, is the common cause of osteomalacia. Vitamin D deficiency, not impaired vitamin C metabolism, is the common cause of osteomalacia.

An important and useful clinical measure in the diagnosis of rhabdomyolysis is measurement of which laboratory value? a. White blood cell count b. Antinuclear antibodies c. Aspartate aminotransferase d. Creatine kinase (CK)

d. Creatine kinase (CK) The most important and clinically useful measurement in rhabdomyolysis is serum CK. A level five times the upper limit of normal (about 1000 units/liter) is used to identify rhabdomyolysis. White blood cell count may be measured, but it is not more important than the CK. Antinuclear antibodies may be measured, but it is not more important than the CK. Aspartate aminotransferase may be measured, but it is not more important than the CK.

Fibromyalgia is a chronic musculoskeletal disorder characterized by: a. Pain resulting from joint and muscle inflammation b. Muscle pain in the back and gastrointestinal symptoms c. Neurologic pain in the skeletal muscles d. Diffuse pain, fatigue, and tender points

d. Diffuse pain, fatigue, and tender points Fibromyalgia is characterized by diffuse pain, fatigue, and point tenderness. Fibromyalgia is not related to joint and muscle inflammation. Fibromyalgia is not related to specific back pain and is not manifested by gastrointestinal upset. Fibromyalgia is not related to neurologic pain in muscles.

A 36-year-old male complains of pain and weakness in the elbow. He reports that he is a warehouse worker and lifts boxes daily. MRI reveals inflammation of the tendon where it attaches to bone. This condition is called: a. Periostitis b. Muscle strain c. Bursitis d. Epicondylopathy

d. Epicondylopathy When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known epicondylopathy. When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known epicondylopathy, not periostitis. Muscle strain is local muscle damage that occurs when the muscle is stretched beyond capacity. Bursitis is inflammation of the bursae.

The incidence of fractures of the pelvis is highest in: a. Preadolescent boys b. Adolescent boys c. Adolescent girls d. Older adults

d. Older adults The incidence of fractures of the upper femur, upper humerus, vertebrae, and pelvis is highest in older adults and is often associated with osteoporosis. Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons. Fracture of the pelvis is highest in older adults. Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons. Fracture of the pelvis is highest in older adults. Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons. Fracture of the pelvis is highest in older adults.