Chapter 52: Alterations in musculoskeletal function- Rheumatic

Ankylosing spondylitis causes a. intervertebral joint fusion. b. instability of synovial joints. c. costal cartilage degeneration. d. temporomandibular joint degeneration.

ANS: A Ankylosing spondylitis causes joint fibrosis, ossification, and fusion, most commonly of the intervertebral and sacroiliac joints. Ankylosing spondylitis does not cause instability of synovial joints, degeneration of cartilage, or temporomandibular joint degeneration.

Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to a. wear and tear on weight-bearing joints. b. septic joint inflammation and necrosis. c. unknown etiologic factors. d. autoimmune mechanisms.

ANS: D Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to autoimmune mechanisms. Wear and tear on weight-bearing joints and septic joint inflammation and necrosis do not lead to SLE. SLE is known to be attributed to autoimmune mechanisms

Although skin manifestations may occur in numerous locations, the classic presentation of systemic lupus erythematosus (SLE) includes a. lesions affecting the palms of hands and the soles of feet. b. dry, scaly patches in the antecubital area and behind the knees. c. cracked, scaly areas in the webs of fingers. d. a butterfly pattern rash on the face across the bridge of the nose.

ANS: D The classic presentation of SLE includes a butterfly pattern rash on the face across the bridge of the nose. The classic presentation does not involve lesions affecting the palms of the hands and the soles of the feet; dry, scaly patches in the antecubital area and behind the knees; or cracked, scaly areas in the webs of the fingers.

Systemic disorders include a. adhesive capsulitis. b. verrucae. c. osteoarthritis. d. rheumatoid arthritis.

ANS: D Systemic manifestations of rheumatoid arthritis include fever, malaise, and lymphadenopathy. Adhesive capsulitis and osteoarthritis are not systemic diseases. Verrucae are warts, and they are not systemic.

Ankylosing spondylitis is characterized by a. inflammation, stiffness, and fusion of spinal joints. b. loss of articular cartilage in weight-bearing joints. c. excessive bone remodeling leading to soft bone. d. immune mechanisms leading to widespread joint inflammation.

ANS: A Ankylosing spondylitis is characterized by inflammation, stiffness, and fusion of spinal joints. Osteoarthritis involves loss of articular cartilage in weight-bearing joints. Paget's disease involves excessive bone remodeling leading to soft bone. RA involves immune mechanisms leading to widespread joint inflammation

Prosthetic joint infection is most often because of a. defective replacement material. b. injury to the joint. c. hematogenous transfer. d. arthritis.

ANS: C Prosthetic joint infection is often because of bacterial spread to the joint via the blood stream. Defective replacement material is not the cause of prosthetic joint infection. Injury to the joint may lead to the implementation of a prosthetic joint, but the injury itself is not the cause of prosthetic joint infection. Arthritis may lead to the need for a prosthetic joint, but arthritis is not the cause of prosthetic joint infection.

Rheumatoid arthritis involves joint inflammation caused by a. bacterial infection. b. trauma. c. autoimmune injury. d. congenital hypermobility.

ANS: C Rheumatoid arthritis is caused by autoimmune injury to synovial joints. Rheumatoid arthritis is not a joint infection, is not caused by trauma, and is not caused by congenital hypermobility

The pathophysiology of rheumatoid arthritis involves a. immune cells accumulating in pannus and destroying articular cartilage. b. free radicals attaching to the synovial membrane and tunneling into articular cartilage. c. excessive wear and tear and microtrauma that damage articular cartilage. d. cysts developing in subchondral bone and creating fissures in articular cartilage.

ANS: A In rheumatoid arthritis, immune cells accumulate in pannus and destroy articular cartilage. Free radicals do not attach to membranes; they damage them by removing electrons from them. Rheumatoid arthritis is not caused by excessive wear and tear. Subchondral cysts and fissures in articular cartilage are not characteristic of rheumatoid arthritis.

It is true that scleroderma involves a. inflammation and fibrosis of connective tissue. b. autoantibodies against acetylcholine receptors. c. infection by beta-hemolytic streptococcus. d. inflammation caused by antigenic fragments of dead organisms.

ANS: A Scleroderma involves fibrosis of connective tissue. Myasthenia gravis involves autoantibodies against acetylcholine receptors. Rheumatic fever involves infection by beta-hemolytic streptococcus. Lyme disease is thought to involve inflammation caused by antigenic fragments of dead organisms

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be a. systemic manifestations of inflammation. b. localized pain in weight-bearing joints. c. reduced excretion of uric acid by the kidney. d. firm, crystallized nodules or "tophi" at the affected joints.

ANS: A Systemic manifestations of inflammation are a clinical finding consistent with rheumatoid arthritis. The pain of rheumatoid arthritis is not localized to weight-bearing joint. Uric acid is not a causative factor in this disorder. Gout causes firm, crystallized nodules, or "tophi," at the affected joints

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

ANS: A The final chronic stage of gout is called tophaceous gout. Gouty arthritis and complicated gout are not the final stages. Asymptomatic hyperuricemia is the first stage of gout.

To avoid the progression of cutaneous lesions, a patient diagnosed with systemic lupus erythematosus (SLE) should a. avoid sun exposure. b. avoid excessive use of moisturizers. c. refrain from washing the affected areas. d. apply warm, wet compresses daily.

ANS: A To avoid the progression of cutaneous lesions, a patient with SLE should avoid sun exposure. Avoiding excessive use of moisturizers, refraining from washing the affected areas, and applying warm, wet compresses daily will not deter the progression of lesions

Characteristics of gout include (Select all that apply.) a. disturbed uric acid metabolism. b. crystalline deposits in bony and connective tissue. c. onset before menopause in women. d. cardiac involvement. e. renal involvement.

ANS: A, B, D, E Gout is caused by a disturbance in uric acid metabolism and leads to crystalline deposits in bony and connective tissue (tophi). Tophi can deposit in cardiac and renal tissue. In women the onset is post-menopause.

Manifestations of osteoarthritis include (Select all that apply.) a. nodules on joints of the hands. b. crepitus with joint movement. c. pain that is worse upon arising in the morning. d. stiffness that worsens with joint use. e. narrowing of joint spaces.

ANS: A, B, E Osteoarthritis results in nodules on the joints of hands (Heberden and Bouchard) and crepitus with joint movement. Radiologic examination demonstrates narrowing of joint spaces. The pain is worse with activity and is relieved with rest. Stiffness is relieved with joint use

Signs/symptoms of Lyme disease include (Select all that apply.) a. fever and chills. b. migratory rash. c. arthritic pain. d. headache. e. myalgia.

ANS: A, C, D, E Manifestations of Lyme disease include fever and chills, arthritic pain, headache, and myalgia. A migratory rash does not occur in Lyme disease. A single characteristic lesion at the site of the tick bite is annular in nature.

Enteropathic arthritis is associated with a. irritable bowel syndrome. b. inflammatory bowel disease. c. chronic constipation. d. chronic diarrhea.

ANS: B Enteropathic arthritis is associated with inflammatory bowel disease (Crohn disease and ulcerative colitis). Irritable bowel syndrome, chronic constipation, and chronic diarrhea are not symptoms of enteropathic arthritis

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be a. caused by bacterial infection. b. an autoimmune process. c. an infective process. d. because of an enzymatic defect.

ANS: B The presence of rheumatoid factor autoantibodies indicates that RA is an autoimmune process. The presence of rheumatoid factor autoantibodies does not indicate infection, an infective process, or an enzymatic defect

Tophi are a. renal calculi composed of uric acid. b. deposits of urate crystals in tissues. c. painful edematous joints. d. spots that coalesce in a malar rash.

ANS: B Tophi are deposits of urate crystals in tissues that occur in gout. Tophi are not renal calculi, painful edematous joints, or a type of rash

The most common presenting sign/symptom with rheumatic fever is a. cardiac murmur. b. polyarthritis. c. rash. d. painless nodules.

ANS: B Polyarthritis is the most common presenting symptom of RF. A cardiac murmur is only present if carditis ensues, and this is a late sign. The rash and the painless nodules of RF are not the earliest signs/symptoms.

A laboratory test result that helps confirm the diagnosis of systemic lupus erythematosus (SLE) is a. elevated serum calcium level. b. elevated monoclonal antibody titer. c. positive antinuclear antibodies. d. positive microsomal antibodies

ANS: C A positive antinuclear antibody test helps confirm the diagnosis of SLE. SLE is not confirmed by elevated serum calcium level, elevated monoclonal antibody titer, or positive microsomal antibodies

"Tell me again the name of that chemical that makes crystals when my gout flares up," asks the client. The nurse's best response is a. calcium phosphate. b. urea. c. uric acid. d. beta-hydroxybutyric acid.

ANS: C Gout occurs when uric acid crystals form in joints. Calcium phosphate and beta-hydroxybutyric acid do not lead to crystal formation in gout. Uric acid, not urea, leads to crystal formation in gout.

The chief pathologic features of osteoarthritis are a. stress fractures of the epiphysis, inflammation of the diaphysis, and accumulation of excessive synovial fluid. b. autoimmune damage to the synovium, destruction of articular cartilage by pannus, and thickening of synovial fluid. c. degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. d. thinning of the joint capsule, resorption of bone, excessive formation of new bone, and formation of bone spurs.

ANS: C The chief pathologic features of osteoarthritis are degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. Although osteoarthritis does involve formation of bone spurs, all the other answer choices listed do not occur with osteoarthritis.

Individuals diagnosed with systemic lupus erythematosus (SLE) are at risk for developing numerous complications of various organs because of a. excessive production of connective tissue. b. formation of osteophytes in tissues. c. immune injury to basement membranes. d. impaired tissue oxygen transport.

ANS: C The immune injury to basement membranes in SLE leads to numerous complications. SLE does not involve excessive production of connective tissue or formation of osteophytes in tissues. SLE does not impair oxygen transport

"Please explain the pathophysiology of osteoarthritis to me," says another nurse. "Is it just wear and tear so that the cartilage wears out?" Your best response is a. "Yes; repeated use just wears out the cartilage, until it becomes thin and denuded. That causes pain and will eventually cause joint inflammation." b. "Yes; with increasing age, the inflammation from repeated joint use accumulates and causes the cartilage to get thin and ragged until it disappears." c. "No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone." d. "No; autoimmune cells infiltrate the joint and collect on the cartilage in a mass called 'pannus' that eventually thins and destroys the cartilage."

ANS: C Osteoarthritis involves a complex interaction between osteoclasts, osteoblasts, chondrocytes, and synoviocytes that eventually destroy cartilage and damage subchondral bone. Repeated use of a joint and pannus are not the causes of osteoarthritis. Inflammatory mediators, not inflammation from repeated joint use, are the cause of osteoarthritis

Gouty arthritis is a complication of a. group A streptococcal infection. b. autoimmune destruction of joint collagen. c. excessive production of urea. d. inadequate renal excretion of uric acid.

ANS: D Gouty arthritis is a complication of inadequate renal excretion of uric acid. Rheumatic fever-related arthritis is related to group A streptococcal infection. Gout is not an autoimmune disorder. Gout is because of inadequate renal excretion of uric acid, not excessive production of urea

The pain of nonarticular rheumatism ("growing pain") is worse a. during activity. b. following strenuous exercise. c. upon awakening. d. during the night.

ANS: D Growing pains are worse at night in the calves, shins, and thighs. Growing pains are not worse during activity or following strenuous exercise. Growing pains are worse at night, not upon awakening

The earliest manifestation of scleroderma is a. thick, tight, shiny skin. b. skin hyper/hypopigmentation. c. renal impairment. d. Raynaud phenomenon.

ANS: D Raynaud phenomenon with blanching of the digits in response to cold is the earliest manifestation. Thick, tight, shiny skin and hyper/hypopigmentation are not the earliest manifestation. Renal impairment is a late manifestation.

In contrast to osteoarthritis, rheumatoid arthritis may be associated with a. debilitating joint pain and stiffness. b. improvement in symptoms with aspirin therapy. c. changes in activities of daily living. d. systemic aching in the musculoskeletal system.

ANS: D Rheumatoid arthritis is associated with systemic aching in the musculoskeletal system, but osteoarthritis is not. Osteoarthritis also causes debilitating joint pain and stiffness. Aspirin therapy will improve symptoms in both disorders. Both disorders can lead to changes in activities of daily living.