Huether, Ch. 41 Alterations of Musculoskeletal Function

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 Inflammation of RA starts in the synovial membrane. The inflammation is not associated with short bones, subchondral bones, or bursae sacs.

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, B, C 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 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 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.

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

ANS: C 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.

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 remains the first line of treatment for RA. Neither NSAIDs, gold salts, nor colchicine is a treatment of choice for RA.

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 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.

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 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.

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

ANS: A 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.

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 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.

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 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.

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 People at highest risk for gout are men aged 40-50 years of age. Gout is rare in children, adolescent males, and premenopausal women.

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

ANS: A 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.

Transchondral fractures are most prevalent in: a. adolescents. b. older adults. c. infants. d. premenopausal females.

ANS: A Transchondral fractures are most prevalent in adolescents. Such fractures are not associated with older adults, infants, or premenopausal females.

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 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.

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 Osteoporosis can be attributed to decreased estrogen levels. Osteoporosis is not attributed to increased androgen levels, excessive exercise, or excessive dietary calcium.

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 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.

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 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.

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

ANS: B 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.

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 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.

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.

The incidence of fractures of the pelvis is highest in: a. preadolescent boys. b. adolescent boys. c. adolescent girls. d. older adults.

ANS: D 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.

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 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.

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.

ANS: D 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.

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

ANS: 11

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 Signs and symptoms of dislocations or subluxations include pain, swelling, limitation of motion, and joint deformity.

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 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.

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.

ANS: B 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.

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 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.

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

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

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 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.

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

ANS: C 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.

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

ANS: C Alcohol remains the most common cause of toxic myopathy.

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 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.

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 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.

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 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.