Patho Ch. 44: Alterations of Musculoskeletal Function

A 35-year-old 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.

ANS: 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. REF: p. 994

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.

ANS: D diffuse pain, fatigue, and tender points Fibromyalgia is characterized by diffuse pain, fatigue, and point tenderness and the absence of systemic or localized inflammation. Fibromyalgia is not related to specific back pain and is not manifested by gastrointestinal upset. Nor is it related to neurologic pain in muscles. REF: p. 1022

A patient states, "I have tennis elbow." Which condition best describes this injury? a. Lateral epicondylitis b. Medial epicondylitis c. Chronic bursitis d. Tendinopathy

a. Lateral epicondylitis Lateral epicondylitis is tennis elbow. Golfer's elbow is medial epicondylitis. Epicondylitis is inflammation of a tendon where it attaches to a bone. Chronic bursitis can result from repeated trauma and occurs between tendons and muscles. Tendinopathy involves pain over the entire tendon.

Which bone tumor is the most aggressive and demonstrates a moth-eaten pattern of bone destruction? a. Osteosarcoma b. Chondrosarcoma c. Endochondroma d. Fibrosarcoma

a. Osteosarcoma Osteosarcoma has a moth-eaten pattern and is the most aggressive type of bone tumor. Chrondrosarcoma is the second most common primary malignant bone tumor and infiltrates the trabeculae of spongy bone. A secondary chondrosarcoma is derived from an endochondroma. Fibrosarcoma is a solitary tumor that most frequently affects the metaphyseal region of the femur.

A deficiency of which substances have been associated with osteoporosis? (select all that apply) Select all that apply. a. Iron b. Estrogen c. Calcium d. Vitamin D e. Magnesium

b,c,d,e Osteoporosis is linked to a decreased of inadequate dietary calcium intake and lack of vitamin D, as well as possibly decreased magnesium. It can occur in middle-aged and older women because of estrogen deficiency, as well as estrogen-independent age-related mechanisms. Iron levels have not been linked to this disorder.

At what age does age-related bone loss begin? a. 20-30 b. 30-40 c. 40-50 d. 50-60

b. 30-40 After age 30, bone resorption slowly exceeds bone formation. Age-related bone loss begins in the third to fourth decade.

Which is a clinical manifestation of Paget disease? a. Increased lacrimation b. Increased sympathetic nervous system discharge c. Decreased density of skull d. Impaired motor function

d. Impaired motor function There may be cranial nerve dysfunction with impaired motor function. In Paget disease, bone remodeling occurs and is first evident in the thickening of the frontal and occipital regions of the skull. Deafness, atrophy of the optic nerve, and obstruction of the lacrimal duct may occur. The sympathetic nervous system is not directly affected.

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. Colchicine

ANS: C Methotrexate Methotrexate remains the first line of treatment for RA. Neither NSAIDs, gold salts, nor colchicine is a treatment of choice for RA. REF: p. 1015

A 56-year-old male was admitted to the hospital with a diagnosis of osteomalacia. History reveals that he underwent bariatric surgery 3 years earlier. What is the common link between the surgery and the development of osteomalacia? a. Impaired phosphate absorption b. Increased calcium excretion c. Vitamin D deficiency d. Impaired vitamin C metabolism

ANS: C Vitamin D deficiency Impaired nutrient absorption from bariatric surgery can result in vitamin D deficiency. Vitamin D deficiency is the most important factor in the development of osteomalacia. Neither impaired phosphate absorption, increased calcium excretion, nor impaired vitamin C metabolism is a cause of osteomalacia. REF: p. 1006

The most common cause of toxic myopathy is: a. infection. b. a tumor. c. alcoholism. d. osteoporosis.

ANS: C alcoholism Alcohol remains the most common cause of toxic myopathy. REF: p. 1026

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. myelodysplasia. b. ischemic atrophy. c. disuse atrophy. d. fibromyalgia.

ANS: C disuse atrophy The term disuse atrophy describes the pathologic reduction in normal size of muscle fibers after prolonged inactivity from bed rest, trauma (casting), or local nerve damage as can be seen with spinal cord trauma or polio. Ischemic atrophy is due to decreased blood flow. Such an experience would not result in either myelodysplasia or fibromyalgia. REF: p. 1021

The inflammatory symptoms of classic gouty arthritis are caused by the crystallization of _____ within the synovial fluid. a. purines b. pyrimidines c. monosodium urate d. acetic acid

ANS: C monosodium urate In classic gouty arthritis, monosodium urate crystals form and are deposited in joints and their surrounding tissues, initiating a powerful inflammatory response. Uric acid is a result of purine metabolism, but purine is not present in the joint. Gout is not caused by an increase in pyrimidines or acetic acid. REF: p. 1018

A 46-year-old male diagnosed with gouty arthritis is at high risk for developing: a. cholelithiasis. b. myocarditis. c. renal stones. d. liver failure.

ANS: C renal stones Renal stones are 1000 times more prevalent in individuals with primary gout than in the general population. Gouty arthritis does not appear to increase the risk for the development of cholelithiasis, myocarditis, or liver failure. REF: p. 1019

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.

ANS: C resorption. In osteoporosis, old bone is being resorbed faster than new bone is being made, causing the bones to lose density, becoming thinner, and more porous. Mineralization is not increased by osteoporosis. REF: p. 1001

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

ANS: A Men aged 40-50 years People at highest risk for gout are men aged 40-50 years of age. Gout is rare in children, adolescent males, and premenopausal women. REF: p. 1018

A malignant tumor of striated muscle tissue origin commonly found on the neck is called a: a. myelogenic tumor. b. giant cell tumor. c. rhabdomyosarcoma. d. rhabdomyoma.

ANS: C rhabdomyosarcoma The malignant tumor of striated muscle is called rhabdomyosarcoma. They are located in the muscle tissue of the head, neck, and genitourinary tract in 75% of cases. 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. REF: p. 1031

Osteomalacia is a result of: a. collagen breakdown in the bone matrix. b. excessive bone resorption. c. crowding of bone marrow by excessive bone growth. d. inadequate bone mineralization.

ANS: D 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. REF: p. 1006

The diagnosis of rhabdomyolysis is based on the measurement of which laboratory value? a. White blood cell count (WBC) b. Antinuclear antibodies c. Aspartate aminotransferase d. Creatine kinase (CK)

ANS: 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 per liter) is used to identify rhabdomyolysis. While the other options may be measured, they are not used as diagnostic criteria. REF: p. 998

Which term is used to describe a bone fracture that results in two or more fragments? a. Complete b. Open c. Comminuted d. Oblique

c. Comminuted A comminuted fracture is one in which the bone breaks into two or more fragments. An oblique fracture is one that is slanted in relation to the shaft of the bone. An open fracture is when the skin is broken. A complete fracture is one in which the bone is broken all the way through.

A client is admitted to the hospital with a transverse fracture of the femur. Which statement 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. Such a fracture would not occur either perpendicularly or vertically in relationship to the bone. A linear fracture runs parallel to the long axis of the bone. REF: p. 991

Which organism is the most common cause of hematogenous osteomyelitis in sickle cell patients? a. Haemophilus influenzae b. Staphylococcus aureus c. Group B streptococci d. Salmonella

d. Salmonella The most common cause in a sickle cell patient is Salmonella. The most common hematogenous cause overall is Staphylococcus aureus. Group B streptococci and H. influenzae tend to affect young children.

A transchondral fracture: a. occurs in normal or abnormal bone that is subjected to repeated stress or trauma. b. runs parallel to the long axis of the rib bones and has a complex healing process. c. damages the bone, but it is still in one piece as in an incomplete fracture. d. results in fragmentation and separation of a portion of the articular cartilage.

d. results in fragmentation and separation of a portion of the articular cartilage. A transchondral fracture consists of a fragmentation and separation of a portion of the articular cartilage that covers the end of a bone or joint. Stress fractures occur in normal or abnormal bone that is subjected to repeated stress. An incomplete fracture occurs when the bone is damaged but is still in one piece. A linear fracture runs parallel to the long axis of the bone.

A 32-year-old obese male begins a jogging routine. A week after beginning, he fractures his leg. This is referred to as 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. A compound fracture is a complete and incomplete fracture that breaks through the skin. REF: p. 993

A patient experiences trauma and repetitive stress on his knee joint resulting in inflammation and microtears in the tendon. Which of the following are associated with these symptoms? (select all that apply) Select all that apply. a. Epicondylopathy b. Tendinopathy c. Bursitis d. Osteomyelitis e. Ankylosing spondylitis (AS)

a Epicondylopathy b Tendinopathy c Bursitis Correct Feedback: Tendinopathy and bursitis are inflammatory responses that may be seen after trauma and repetitive stress. They cause degradation of collagen fibers (tendinosis), inflammation of tendons (tendinitis), and inflammation of the bursal sacs (bursitis). A bony prominence at the end of a bone where tendons or ligaments attach is termed an epicondyle. When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known as tendinopathy or epicondylopathy. Microtears in the tendon, the presence of disorganized collagen fibers, and neovascularization are indicative of incomplete tissue repair. Initial inflammatory changes cause thickening of the tendon sheath, limiting movements, and causing pain. Osteomyelitis is a bone infection most often caused by bacteria. AS is a chronic, inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac joints. Incorrect Feedback: Tendinopathy and bursitis are inflammatory responses that may be seen after trauma and repetitive stress. They cause degradation of collagen fibers (tendinosis), inflammation of tendons (tendinitis), and inflammation of the bursal sacs (bursitis). A bony prominence at the end of a bone where tendons or ligaments attach is termed an epicondyle. When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known as tendinopathy or epicondylopathy. Microtears in the tendon, the presence of disorganized collagen fibers, and neovascularization are indicative of incomplete tissue repair. Initial inflammatory changes cause thickening of the tendon sheath, limiting movements, and causing pain. Osteomyelitis is a bone infection most often caused by bacteria. AS is a chronic, inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac joints.

A patient is diagnosed with gout following pain in the big toe. Which would be the symptoms or signs of the disease? (select all that apply) Select all that apply. a. Hyperuricemia b. Inflammation of a single joint c. Formation of renal stones d. Tophi formations e. Increased blood clotting

a,b,c,d Gout is manifested by an increase in serum urate concentration (hyperuricemia), recurrent attacks of monoarticular arthritis (inflammation of a single joint), deposits of monosodium urate monohydrate (tophi) in and around the joints, and the formation of renal stones. Increased coagulation is not associated with this disorder.

Which are complications of rhabdomyolysis? (select all that apply) Select all that apply. a. Metabolic acidosis b. Hyperkalemia c. Muscle pain d. Renal failure e. Disseminated intravascular coagulation

a,b,d,e The complications of rhabdomyolysis are renal failure, hyperkalemia, metabolic and respiratory acidosis, and disseminated intravascular coagulation. Muscle pain is not a complication of rhabdomyolysis.

What is the term for the failure of the bone ends to grow together? a. Nonunion b. Delayed union c. Malunion d. Dislocation

a. Nonunion Nonunion is when the bone ends do not grow together. A delayed union is a union that takes 8-9 months to heal. A malunion is the healing of a bone in a nonanatomic position. Dislocation is the displacement of one or more bones in a joint in which the opposing joint surfaces lose contact entirely.

Inadequate and delayed mineralization of osteoid in mature compact bone describes which disease? a. Osteomalacia b. Osteoporosis c. Paget disease d. Osteomyelitis

a. Osteomalacia Osteomalacia is the inadequate and delayed mineralization in mature compact and spongy bone. Osteoporosis is a disease in which bone tissue is normally mineralized but the mass density of the bone is decreased. Osteomyelitis is an infection of the bone. Paget disease is a state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling.

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. Such fractures are not associated with older adults, infants, or premenopausal females. REF: p. 993

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. REF: p. 1022

What is the term used to identify a pattern of bone destruction indicative of an aggressive malignant tumor? (select all that apply) a. Moth-eaten b. Permeative c. Geographic d. Radial e. Selective

ANS: 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. REF: p. 1028

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 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. REF: p. 994

A 60-year-old male presents with swelling and pain in the knee. CT reveals a tumor has developed from a pre-existing benign bone lesion. This supports which diagnosis? a. Secondary chondrosarcoma b. Rhabdomyoma c. Rhabdomyosarcoma d. Fibrosarcoma

ANS: A Secondary chondrosarcoma Chondrosarcoma is the second most common primary malignant bone tumor and is a tumor of middle-aged and older adults. Chondrosarcomas that develop from a pre-existing benign bone lesion are known as secondary chondrosarcomas. 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. REF: p. 1030

What term is used to describe a torn ligament? a. Sprain b. Strain c. Disunion d. Subluxation

ANS: 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. REF: p. 995

What is the primary organism responsible for osteomyelitis? a. Staphylococcus aureus b. Salmonella c. Mycobacterium d. Haemophilus influenza

ANS: A Staphylococcus aureus Staphylococcus aureus remains the primary microorganism responsible for osteomyelitis. While the other options are possible causes, they are not as predominant as is Staphylococcus aureus. REF: p. 1008

What is the most common aggravating trigger of gouty arthritis attacks? a. Trauma b. Anemia c. High-fat foods d. Lack of exercise

ANS: A Trauma Trauma is the most common aggravating factor of an acute gouty exacerbation. Gout is not triggered by anemia or lack of exercise. Gout is not caused by high-fat foods, but rather high-purine foods. REF: p. 1019

A 21-year-old is diagnosed with ankylosing spondylitis (AS). The most likely joint to be affected would be the: a. sacroiliac. b. carpal. c. shoulder. d. knee.

ANS: A sacroiliac AS is a chronic, inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac joints. AS is not associated initially with the carpal joints, the shoulder, or the knees. REF: p. 1017

A 34-year-old female was recently diagnosed with rheumatoid arthritis (RA). Physical examination revealed that inflammation is noted in various: a. synovial membranes. b. short bones. c. subchondral bones. d. bursae sacs.

ANS: A synovial membranes Inflammation of RA starts in the synovial membrane. The inflammation is not associated with short bones, subchondral bones, or bursae sacs. REF: p. 1012

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

ANS: B Dark urine A classic triad of muscle pain, weakness, and dark urine is considered typical of rhabdomyolysis. Neither sweating, yellow skin, nor lower extremity swelling is associated with rhabdomyolysis. REF: p. 997

The chronic stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called: a. monoarticular arthritis. b. tophaceous gout. c. asymptomatic hyperuricemia. d. complicated gout.

ANS: B Tophaceous gout Tophaceous gout is the third and chronic stage of the disease. It is characterized by a progressive inability to excrete uric acid, which expands the urate pool. This causes urate crystal deposits (tophi) to appear in cartilage, synovial membranes, tendons, and soft tissue. The characteristic crystalline deposits are not associated with monarticular or complicated gout. Asymptomatic hyperuricemia would not lead to crystalline deposits. REF: p. 1019

Researchers now believe that rheumatoid arthritis (RA) is a result of: a. an ineffective antiviral agent. b. an autoimmune disease. c. a complication of rheumatic fever. d. a superficial joint injury.

ANS: B an autoimmune disease RA is now thought to be an autoimmune disease. There is no proof that RA is associated with ineffective antiviral therapy, rheumatic fever, or joint injuries. REF: p. 1012

Osteoarthritis, a degenerative joint disease, is characterized by loss of: a. the epiphyses. b. articular cartilage. c. synovial fluid. d. the joint capsule.

ANS: B articular cartilage Osteoarthritis is caused by loss of the articular cartilage. It is not associated with the epiphyses of bones, synovial fluid, or the joint capsule. REF: p. 1009

When 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.

ANS: B decreased estrogen levels. Osteoporosis can be attributed to decreased estrogen levels. Osteoporosis is not attributed to increased androgen levels, excessive exercise, or excessive dietary calcium. REF: p. 1002

A disorder similar to osteomalacia that occurs in growing bones of children is termed: a. Paget disease. b. rickets. c. osteomyelitis. d. osteosarcoma.

ANS: 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 while osteosarcoma is a form of bone cancer. REF: p. 1006

The cause of Paget disease is: a. fluoride deficiency. b. unknown at present. c. excess vitamin A. d. osteogenic sarcoma.

ANS: B unknown at present The cause of Paget disease is unknown, but studies have implicated both genetic and environmental factors. There is no known association between Paget disease and fluoride deficiency, excess vitamin A, or osteosarcoma. REF: p. 1007

A 70-year-old diagnosed with osteoporosis fell and fractures the left leg at a location of pre-existing abnormality. Which term describes the fracture? a. Fatigue b. Stress c. Pathologic d. Greenstick

C) Pathologic A pathologic fracture is a break at the site of a pre-existing abnormality, usually by force such as a fall 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. REF: p. 992

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 and without gender preference. REF: p. 991

A 36-year-old reports pain and weakness in the elbow. MRI reveals inflammation of the tendon and the presence of microtears 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 as epicondylopathy. Such an injury is not referred to as periostitis which involves the presence of inflammation. Muscle strain is local muscle damage that occurs when the muscle is stretched beyond capacity. Bursitis is inflammation of the bursae. REF: p. 995

Which age-group has the highest incidence of bone tumors? a. Children b. Adolescents c. Adults between ages 30 and 35 years d. Adults between ages 30 and 50 years

b. Adolescents Children younger than 15 years have few bone tumors. Adolescents have the highest incidence. Adults between the ages of 30 and 35 have the lowest incidence. After age 35, incidence increases slowly until at age 60, when it is equal to that of adolescents.

What is the term for a chronic inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints? a. Gout b. Ankylosing spondylitis c. Rheumatoid arthritis d. Osteoarthritis

b. Ankylosing spondylitis AS is a chronic, inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints. Osteoarthritis is a common age-related disorder of synovial joints. Rheumatoid arthritis is a systemic inflammatory autoimmune disease associated with swelling and pain in multiple joints. Gout is a syndrome caused by an inflammatory response to uric acid production.

Which of the following is TRUE regarding the clinical manifestations of rhabdomyolysis? a. The myoglobin makes the urine almost clear in color. b. Creatine kinase (CK) levels are often five times greater than normal. c. There are decreased levels of serum potassium. d. Hypercalcemia is seen early in the course of rhabdomyolysis.

b. Creatine kinase (CK) levels are often five times greater than normal. The urine takes on a reddish brown pigmentation, almost the color of tea. The CK level five times greater than normal is used to identify rhabdomyolysis. There are increased levels of potassium. Serum hypocalcemia occurs early, and hypercalcemia occurs late.

A patient presents with skin rash, calcinosis, and eyelid edema. These signs support which diagnosis? a. Rheumatoid arthritis b. Dermatomyositis c. Toxic myopathy d. Rhabdomyosarcoma

b. Dermatomyositis Dermatomyositis is inflammation of the connective tissue and muscle fibers. This results in extensive necrosis and destruction of muscle fibers. The presence of skin rash, calcinosis, and eyelid edema most often suggests dermatomyositis. Rheumatoid arthritis is a systemic inflammatory disease associated with joint pain. Toxic myopathy is associated with alcohol abuse. It is often manifested by muscle weakness and pain. Rhabdomyosarcoma is a malignant tumor of the striated muscle.

A patient has total displacement of a bone from its normal position. Which of the following terms describes this injury? a. Fracture b. Dislocation c. Subluxation d. Nonunion

b. Dislocation This injury is describing a dislocation. The patient has temporary displacement of a bone from its normal position. If the contact is only partially lost between the two surfaces, it is called a subluxation. A fracture is a complete break in the bone, and nonunion is the failure of bone ends to grow together after a fracture.

A middle-aged female presents with painful, tender joints. Laboratory testing reveals elevated IgM and IgG. Which of the following is the most likely diagnosis? a. Inflammatory joint disease b. Rheumatoid arthritis c. Caplan syndrome d. Ankylosing spondylitis

b. Rheumatoid arthritis Rheumatoid arthritis is characterized by the presence of rheumatoid factors, typically IgM and IgG. Inflammatory joint disease is arthritis and is due to inflammatory damage or destruction of the synovial membrane or articular cartilage. Caplan syndrome occurs with the presence of pulmonary nodules and pneumoconiosis in rheumatoid patients. Ankylosing spondylitis is a chronic, inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints.

A patient is brought to the hospital after twisting an ankle. The ligaments appear to have sustained tears. Which is the best term to describe this injury? a. Strain b. Sprain c. Avulsion d. Reduction

b. Sprain Sprains involve tears of the ligaments; strains are tears in tendons. An avulsion is a complete separation of a tendon from its bony attachment site. Treatment of a displaced fracture involves realigning the bone fragments (reduction) close to their normal or anatomic position and holding the fragments in place.

A patient reports right thigh pain that began after an injury to that area a few weeks earlier. A diagnosis of myositis ossificans is made. Myositis ossificans: a. has a well-known etiology. b. occurs only in the thigh. c. can also occur with burns. d. is a late complication of a stress fracture.

c. can also occur with burns. The condition is myositis ossificans. The patient had a previous localized muscle injury, and scar tissue calcifies. While rare, the condition is associated with burns. The etiology is not well understood, and it is a complication of any muscle injury.

Diffuse pain, fatigue, and tender joints without inflammation describe which diagnosis? a. Disuse atrophy b. Contracture c. Stress-induced muscle tension d. Fibromyalgia

d. Fibromyalgia Fibromyalgia is a chronic musculoskeletal syndrome that is often misdiagnosed due to the vague symptoms, such as diffuse pain, fatigue, and tender points, associated with it. The cause is not yet known. Disuse atrophy is a reduction in normal size of muscle fibers after prolonged inactivity or local nerve damage. Contracture is a contraction of muscle fibers caused by phenomena secondary to the muscle and sometimes without a muscle action potential. Stress-induced muscle tension is caused by chronic anxiety and includes neck stiffness, back pain, and headache.