check your understanding 44, 45, 47, 51, 52

The complication which is not likely to result from a compound, transverse fracture of the tibia and fibula is a. air embolus. b. fat emboli. c. compartment syndrome. d. bone infection.

a. air embolus. Air embolus is not likely to occur secondary to this fracture. Bone infection is likely, because it is an open fracture. Fat emboli are likely because the fracture is in a long bone. Compartment syndrome is likely because of the extent of soft-tissue injury

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. an autoimmune process. b. an infective process. c. caused by bacterial infection. d. because of an enzymatic defect.

a. an autoimmune process. 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

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

a. autoimmune mechanisms. 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

A compound, transverse fracture is best described as a bone that is a. broken and protruding through the skin. b. broken along the long axis. c. broken in two or more pieces. d. cracked but not completely separated.

a. broken and protruding through the skin. The type of fracture described is broken and protruding through the skin. A comminuted fracture is one that is broken in two or more pieces. An incomplete fracture is cracked but not completely separated. A longitudinal fracture is broken along the long axis.

It is true that epidural bleeding is a. characterized by a lucid interval immediately after injury. b. located between the arachnoid and the dura mater. c. associated with widespread vascular disruption. d. usually because of venous leakage.

a. characterized by a lucid interval immediately after injury. The source of bleeding in most epidural hematomas is arterial. The patient may suffer only a brief period of disturbed consciousness followed by a period of normal cognition (lucid interval). Then consciousness rapidly deteriorates as the epidural hematoma expands and compresses brain structures. As the epidural hematoma expands, pressure is placed on the brain structures. The bleeding associated with an epidural hematoma occurs between the inner surface of the skull and the dura mater. The source of bleeding in most epidural hematomas is arterial.

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

a. immune cells accumulating in pannus and destroying articular cartilage. 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.

The stroke etiology with the highest morbidity and mortality is a. intracranial hemorrhage. b. intracranial thrombosis. c. intracranial embolization. d. cardiac arrest.

a. intracranial hemorrhage. Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. It carries a 38% mortality, with death usually occurring within minutes to hours. Ischemic strokes are the most common and include thrombotic and embolic types. Embolic and ischemic strokes are the most common type. Stroke is the third leading cause of death in the United States. Cardiac arrest is not the stroke etiology with the highest morbidity and mortality

The initial treatment of an individual experiencing a seizure is concentrated on a. maintaining an airway. b. administering anticonvulsant medication. c. documenting the seizure pattern. d. obtaining an EEG.

a. maintaining an airway. Treatment of an individual experiencing a seizure is concentrated on maintaining an airway and protecting the individual from injury. If the seizures are because of irreversible or unidentifiable factors, anticonvulsant medications specific to the type of seizure are the best management. Recording the course of the seizure episode is useful, but is not the initial focus of care. EEG studies may be useful in determining abnormalities which elicit the pathologic mechanism

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

a. polyarthritis. 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.

Compartment syndrome occurs secondary to a. soft-tissue damage. b. muscle necrosis. c. bone infarction. d. breakdown of RBCs.

a. soft-tissue damage. Compartment syndrome occurs because of severe soft-tissue damage. Bone infarction and the breakdown of RBCs do not cause compartment syndrome. Muscle necrosis does not cause compartment syndrome, but can result from it

Intracranial pressure normally ranges from ______ mm Hg. a. 15 to 25 b. 0 to 15 c. 10 to 20 d. 20 to 30

b. 0 to 15 ICP is the pressure exerted by the contents of the cranium, and it normally ranges from 0 to 15 mm Hg. Normal ICP ranges from 0 to 15 mm Hg. Fifteen to 25 mm Hg is considered to be high. Elevated ICP may occur in most types of acute brain injury. ICP of 20 to 30 mm Hg is high and is associated with impaired neurologic function because of compression of brain structures.

A tool used to assess levels of consciousness is a. intracranial pressure (ICP) monitoring. b. Glasgow Coma Scale (GCS). c. central perfusion pressure (CPP). d. magnetic resonance imaging (MRI).

b. Glasgow Coma Scale (GCS). The Glasgow Coma Scale (GCS) is a standardized tool developed for the purpose of assessing the level of consciousness in acutely brain-injured patients. An MRI is useful in evaluating a patient with an increase in ICP or change in mental status. ICP monitoring is useful in monitoring and treating patients with head trauma or other sources of excessive CSF. Central perfusion pressure is a useful tool in guiding therapy along with ICP.

The physiologic change most likely to lead to an increase in intracranial pressure is a. respiratory hyperventilation. b. cerebral vasodilation. c. REM sleep. d. hypernatremia.

b. cerebral vasodilation. Cerebral edema starts a cyclic process whereby fluid collection in the brain leads to compression of vessels, which results in inadequate blood and oxygen perfusion into the cells. This results in ischemia, which triggers vasodilation, increased capillary pressure, and increased edema. An increase in intracranial pressure is not associated with hypernatremia nor caused by respiratory hyperventilation. The physiologic change most likely to lead to increased intracranial pressure is not related to sleep.

Pain in fibromyalgia involves a. autoimmune destruction of muscle tissue. b. changes in pain transmission in the spinal cord. c. muscle inflammation. d. nerve inflammation.

b. changes in pain transmission in the spinal cord. Pain in fibromyalgia involves changes in pain transmission in the spinal cord that are called central sensitization. Muscle inflammation, nerve inflammation, and autoimmune destruction of muscle tissue do not cause the pain in fibromyalgia.

Pain that waxes and wanes and is exacerbated by physical exertion is likely related to a. neuralgia. b. fibromyalgia syndrome. c. intermittent claudication. d. neuropathy.

b. fibromyalgia syndrome. Patients complain of pain that waxes and wanes and that does not follow a dermatomal pattern in fibromyalgia syndrome. The pain tends to be exacerbated by physical exertion. Trigeminal neuralgia is a form of neuropathic pain that can be quite disabling for patients. It is sudden, momentary, but excruciating pains along the second and third divisions of the trigeminal nerve. In the early stages, intermittent claudication is associated with physical activity and alleviated with rest and has a cramping quality. In severe cases, ischemic neuropathy may ensue and cause a more consistent burning, shooting pain in the leg or foot. In pain related to neuropathy, patients complain of burning pain in the distal bilateral lower extremities that is frequently worse at night.

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

b. inadequate renal excretion of uric acid. 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

Dopamine precursors and anticholinergics are all used in the management of Parkinson disease, because they a. prevent progression of the disease. b. increase dopamine activity in the basal ganglia. c. produce excitation of basal ganglia structures. d. induce regeneration of neurons in the basal ganglia.

b. increase dopamine activity in the basal ganglia. The mainstay of Parkinson therapy has been aimed at increasing the level of dopamine in the CNS. Anticholinergics and dopamine precursors are not related to regeneration of neurons. Preventing the progression of Parkinson disease is not the mechanism of action in medications used to treat the disease. Excitation of basal ganglia structures is not produced with dopamine precursors and anticholinergics.

It is useful to conceptualize pain physiology according to the four stages because each stage provides an opportunity for a. education. b. intervention. c. documentation. d. stimulation.

b. intervention. It is clinically useful to conceptualize pain physiology according to these four processes, because each stage provides an opportunity for intervention in the pain experience. It is more useful to provide intervention for the patient experiencing pain. Stimulation may actually increase the pain level for the patient. Documentation of findings is appropriate, but taking measures to reduce or stop the pain is more advantageous

The most important determinant for prescribing therapy for acute stroke is a. age of the patient. b. ischemic versus hemorrhagic cause. c. location of ischemia. d. thrombotic versus embolic cause.

b. ischemic versus hemorrhagic cause. Treatment pathways differ between ischemic and hemorrhagic stroke. The goals of therapy for ischemic stroke are to minimize infarct size and preserve neurologic function. Secondary prevention for thrombotic stroke includes lifestyle modification to address risk factors. It is critical to prevent further hypoxia or ischemia after ischemic stroke regardless of the age of the patient

Healing of a fractured bone with a poor alignment is called a. disunion. b. malunion. c. nonunion. d. delayed union.

b. malunion. Malunion is a complication that occurs when the bone fails to align correctly during the healing process. Nonunion and delayed union are different complications of bone healing. Disunion is not the term used for fracture healing with poor alignment

Bone healing may be impaired by a. excessive vitamin C. b. nicotine use. c. immobilization. d. a high-protein diet.

b. nicotine use. Nicotine can delay bone healing. Vitamin C, protein, and immobilization are necessary for bone healing.

The displacement of two bones in which the articular surfaces partially lose contact with each other is called a. subjugation b. subluxation. c. dislocation. d. sublimation.

b. subluxation. Subluxation is partial dislocation of a joint. Subjugation, sublimation, and dislocation are not the terms for partial loss of contact of articular surfaces.

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

b. systemic manifestations of inflammation. 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 ________ is the level of painful stimulation required to be perceived. a. tolerance b. threshold c. perception d. expression

b. threshold Pain threshold is the level of painful stimulation required to be perceived and is remarkably similar from one individual to another. Perception includes an awareness and interpretation of the meaning of the sensation. Pain perception is influenced by attention, distraction, anxiety, fear, fatigue, and previous experience and expectations. Pain tolerance is the degree of pain that one is willing to bear before seeking relief. Pain tolerance varies widely among individuals and within the same individual under differing conditions. Pain expression is the way in which the pain experience is communicated to others. Pacing, writhing, jaw clenching, facial grimacing, muscle guarding, crying, moaning, groaning, and verbal descriptions may be used to express pain.

Ascending paralysis with no loss of sensation is characteristic of a. myasthenia gravis. b. amyotrophic lateral sclerosis. c. Guillain-Barré syndrome. d. multiple sclerosis.

c. Guillain-Barré syndrome. Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis. It usually begins in the legs, spreading often to the arms and face. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Ascending paralysis is not characteristic of myasthenia gravis. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs.

Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency? a. Osteopenia b. Osteomyelitis c. Osteomalacia d. Osteoporosis

c. Osteomalacia Osteomalacia is inadequate mineralization of bone tissue, most commonly caused by vitamin D deficiency, and it usually causes skeletal pain. Osteopenia, osteomyelitis, and osteoporosis are not caused by vitamin D deficiency.

Most muscle strains are caused by a. bleeding into the muscle. b. muscle asymmetry. c. abnormal muscle contraction. d. a tear in an adjoining tendon.

c. abnormal muscle contraction. Most muscle strains are caused by abnormal muscle contraction. A muscle strain can be caused by a tear in the muscle. A tendon strain can be as a result of a tear in the tendon. Muscle asymmetry is not the cause of muscle strains. Muscle strains are not caused by bleeding into the muscle

Upper extremity weakness in association with degeneration of CNS neurons is characteristic of a. multiple sclerosis. b. myasthenia gravis. c. amyotrophic lateral sclerosis. d. Guillain-Barré syndrome.

c. amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis that usually begins in the legs. Upper extremity weakness associated with degeneration of CNS neurons is not characteristic of myasthenia gravis.

Clinical manifestations of a stroke within the right cerebral hemisphere include a. cortical blindness. b. right visual field blindness. c. left-sided muscle weakness and neglect. d. expressive and receptive aphasia.

c. left-sided muscle weakness and neglect. Manifestations of ischemic stroke are related to the cerebral vasculature involved and the area of brain tissue the vessel supplies. Contralateral hemiplegia is a usual finding. Contralateral hemiplegia , hemisensory loss, and contralateral visual field blindness are usual manifestations of stroke. Left visual blindness would be more indicative of a stroke affecting the right cerebral hemisphere. Aphasia is an integrative language disorder that occurs with brain damage to the dominant cerebral hemisphere (usually left) and involves all language modalities

Risk factors for hemorrhagic stroke include a. sedentary lifestyle. b. atherosclerosis. c. dysrhythmias. d. acute hypertension.

d. acute hypertension. Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. Risk factors for stroke are similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a risk factor for hemorrhagic stroke.

A risk factor for osteoporosis is a. late menopause. b. ovarian cysts. c. endometriosis. d. early menopause.

d. early menopause. Early menopause and late menarche are risk factors for osteoporosis. Endometriosis, late menopause, and ovarian cysts are not risk factors for osteoporosis.

Paget's disease is characterized by a. inflammatory disorder resulting in fusion of spine joints. b. overactivity of osteoblasts leading to multiple bone tumors. c. failure of resorption by osteoclasts resulting in hard bones. d. excessive bone resorption followed by excessive formation of fragile bone.

d. excessive bone resorption followed by excessive formation of fragile bone. Paget's disease is characterized by excessive bone resorption followed by excessive formation of fragile bone. Overactivity of osteoblasts that lead to multiple bone tumors is not the cause of Paget's disease. Paget's disease is not characterized by the fusion of spine joints. Fragile bone, not hard bone, is a characteristic of Paget's disease.

The pathophysiology of osteomalacia involves a. crowding of cells in the osteoid. b. increased osteoclast activity. c. collagen breakdown in the bone matrix. d. inadequate mineralization in the osteoid.

d. inadequate mineralization in the osteoid. Osteomalacia is characterized by inadequate or delayed mineralization in the osteoid. Osteomalacia does not involve increased osteoclast activity, collagen breakdown in the bone matrix, or crowding of cells in the osteoid.

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

d. intervertebral joint fusion. 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

Anticholinesterase inhibitors may be used to manage a. fibromyalgia. b. muscular dystrophy. c. rheumatoid arthritis. d. myasthenia gravis.

d. myasthenia gravis. Anticholinesterase inhibitors may be used to manage myasthenia gravis. Anticholinesterase agents are not used to manage muscular dystrophy, fibromyalgia, or rheumatoid arthritis.

Pain with passive stretching of a muscle is indicative of a. vascular insufficiency. b. skeletal muscle damage. c. contractile tissue injury. d. noncontractile tissue injury.

d. noncontractile tissue injury. Pain with passive stretching of a muscle is indicative of noncontractile tissue injury. Pain with passive stretching of a muscle is not an indication of a contractile tissue injury, vascular insufficiency, or skeletal muscle damage

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

d. rheumatoid arthritis. 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.

The first indication of brain compression from increasing intracranial pressure (ICP) may be a. absence of verbalization. b. Glasgow Coma Scale score of 13. c. decorticate posturing. d. sluggish pupil response to light.

d. sluggish pupil response to light. Careful monitoring of the pupillary response to light during the acute phase is critical, as a failing response may be the first indication of brain compression from increasing ICP. Mild dilation of a pupil with sluggish or absent light response is ominous. Decorticate posturing is related to a deteriorating motor status. Absence of verbalization is not the first indication of brain compression. A GCS score of 13 is not the first indication of brain compression. Although, acute changes in level of consciousness should be further investigated

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

d. systemic aching in the musculoskeletal system. 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

A unique characteristic feature of fibromyalgia is the presence of a. head pain. b. muscle atrophy. c. contractures. d. tender point pain.

d. tender point pain. Tender point pain is a unique characteristic feature of fibromyalgia. Headache, contractures, and muscle atrophy are not unique characteristic features of fibromyalgia.