Question 1

A patient in the clinic had a femur x-ray that was read as having a "moth-eaten" appearance. What treatment option does the health care professional discuss with the patient?
A)Limb-salvaging surgery
B)Amputation
C)Oral bisphosphonates
D)Calcium and vitamin D supplements

Accepted Answer

A moth-eaten appearance of a bone signifies osteosarcoma, a malignant bone-forming cancer. The preferred treatments are chemotherapy and limb-salvaging surgery. Oral bisphosphonates and calcium and vitamin D supplements would be treatments for osteoporosis.

Question 2

Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.)
A)Subcutaneous tissue crystals
B)Anorexia
C)Painful, stiffening of joints
D)Edema of the wrists
E)Fever

Accepted Answer

Rheumatoid arthritis begins with general systemic manifestations of inflammation, including fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness. Local manifestations also gradually appear over weeks or months. Typically, the joints become painful, tender, and stiff. Neither tissue crystals nor edema is associated with rheumatoid arthritis.

Question 3

A patient in the clinic is worried about having fibromyalgia. For which symptoms should the health care professional assess the patient for?
A)Hot, tender, and edematous muscle groups bilaterally
B)Fasciculations of the upper and lower extremity muscles
C)Exercise intolerance and painful muscle cramps
D)Sensitivity at tender points and profound fatigue

Accepted Answer

Widespread joint and muscle pain, fatigue, and tender points are characteristics of fibromyalgia, a chronic musculoskeletal syndrome. Increased sensitivity to touch (i.e., tender points), the absence of systemic or localized inflammation, and fatigue and sleep disturbances are common. Fatigue is profound. Hot, tender and edematous muscle groups; muscle fasciculations; and exercise intolerance are not generally associated with fibromyalgia.

Question 4

Which structures are most often affected by Paget disease? (Select all that apply.)
A)Vertebrae
B)Skull
C)Sternum
D)Metacarpals
E)Pelvis

Accepted Answer

Paget disease most often affects the axial skeleton, especially the vertebrae, skull, sacrum, sternum, and pelvis. The metacarpals are not associated with the axial skeleton or Paget disease.

Question 5

A patient in the clinic has calcium crystals that are associated with chronic gout. How does the professional document this finding?
A)Stones
B)Spurs
C)Tophi
D)Nodes

Accepted Answer

With time, crystal deposition in subcutaneous tissues causes the formation of small white nodules, or tophi, that are visible through the skin. Crystal aggregates deposited in the kidneys can form urate renal stones and lead to renal failure. Stones are precipitates that accumulate in liquid, such as kidney stones. Spurs are outgrowths of bone. Nodes are a central connecting point for some bodily structures.

Question 6

What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)?
A)Inflammation of the bursa
B)Inflammation of the long bones
C)Inflammation of fibrocartilaginous joints of the vertebrae
D)Inflammation of the small hand and feet bones

Accepted Answer

AS involves inflammation of fibrocartilage in cartilaginous joints, primarily in the spine and sacroiliac joints. AS does not include inflammation of bursa, long bones, of small bones in the hands and feet.

Question 7

Bone death as a result of osteomyelitis is due to what?
A)Formation of immune complexes at the site of infection
B)Localized ischemia
C)Tumor necrosis factor-alpha (TNF-a) and interleukin 1 (IL-1)
D)Impaired nerve innervation at the site of infection

Accepted Answer

Vessel damage causes local thrombosis (blockage) of the small vessels, which leads to ischemic necrosis (death) of bone. Bone death is not due to the formation of immune complexes, tumor necrosis factor and interleukins, or impaired nerve innervation.

Question 8

What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis?
A)Reduced excretion of purines
B)Overproduction of uric acid
C)Increase in the glycosaminoglycan levels
D)Overproduction of proteoglycans

Accepted Answer

When the uric acid reaches a certain concentration in fluids, it crystallizes, forming insoluble precipitates that are deposited in connective tissues throughout the body. Crystallization in synovial fluid causes acute, painful inflammation of the joint, a condition known as gouty arthritis. This selection is the only option that accurately identifies the cause of crystallization in synovial fluid associated with gouty arthritis.

Question 9

Which statement accurately describes a characteristic of osteosarcoma?
A)Slow-growing tumor that begins in the bone marrow and infiltrates the trabeculae
B)Solitary tumor that most often affects the metaphyseal region of the femur or tibia
C)Aggressive tumor most often found in the bone marrow of long bones
D)Tumor that infiltrates the trabeculae in spongy bone and implants in surrounding tissue by seeding

Accepted Answer

An osteosarcoma is a malignant bone-forming tumor. It is aggressive and most often found in bone marrow; it has a moth-eaten pattern of bone destruction. A fibrosarcoma begins in the bone marrow and infiltrates the trabeculae. It tends to be a solitary tumor that affects the metaphyseal region of the femur or tibia. A chondrosarcoma spreads by seeding.

Question 10

A patient has ankylosing spondylitis. Which description of this condition by the health care professional is most accurate?
A)Chronic inflammatory disease with stiffening and fusion of the spine and sacroiliac joints
B)Chronic systemic inflammatory disease that affects many tissues and organs
C)State of abnormal and excessive bone resorption and formation
D)Wide-spread and deep chronic muscle pain, fatigue, and tender points

Accepted Answer

Ankylosing spondylitis (spondyloarthritis) is a chronic, inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac joints. Rheumatoid arthritis is a chronic systemic inflammatory disease that affects multiple tissues and organs. Paget disease is characterized by abnormal and excessive bone resorption and formation. Fibromyalgia manifests with wide-spread, deep chronic muscle pain, fatigue, and tender points.

Question 11

What are the primary sources of bacterial infections that lead to hematogenous bone infection? (Select all that apply.)
A)Sinus
B)Ear
C)Dental
D)Cutaneous
E)Throat

Accepted Answer

Cutaneous, sinus, ear, and dental infections are all primary sources of bacteria in hematogenous bone infections. Throat infections are not generally associated with bone infections.

Question 12

What event is associated with the beginning of bone loss in women?
A)Puberty
B)Sexual activity
C)Childbirth
D)Menopause

Accepted Answer

Bone loss in women is associated with menopause. Bone loss is most rapid in the first years after menopause but persists throughout the postmenopausal years. The other options are not relevant as triggers for bone loss.

Question 13

The pathophysiologic presentation of gout is closely linked to the metabolism of which chemical?
A)Purine
B)Pyrimidine
C)Vitamin E
D)Amino acid

Accepted Answer

The pathophysiologic presentation of gout is closely linked only to purine metabolism (or cellular metabolism of purines) and kidney function.

Question 14

A professor has taught the class about giant cell bone tumors. Which statement by a student would require the professor to review the material?
A)Giant cell tumors are an overexpression of genes including osteoprotegerin ligand (OPGL).
B)The tumors are malignant, solitary, and irregularly shaped.
C)Giant cell tumors are typically located in the epiphysis in the femur, tibia, radius, and humerus.
D)They are slow-growing tumors that extend over the articular cartilage.

Accepted Answer

The giant cell tumor is generally a benign, solitary, circumscribed tumor that causes extensive bone resorption because of its osteoclastic origin. This statement would cause the professor to review the material. The other options are true statements concerning giant cell tumors.

Question 15

A student studying osteomyelitis and asks for an explanation of the term "sequestrum." What response by the professor is best?
A)An area of devascularized and devitalized bone
B)An enzyme that phagocytizes necrotic bone
C)A subperiosteal abscess
D)A layer of new bone surrounding the infected bone

Accepted Answer

Lifting of the periosteum disrupts blood vessels that enter bone through the periosteum, which deprives the underlying bone of its blood supply. This deprivation leads to necrosis and death of the area of infected bone, producing sequestrum, an area of devitalized bone. None of the other available options accurately identify the term "sequestrum".

Question 16

A person in the health care clinic has gout. In order to prevent a common complication, what self-care measure does the health care professional teach the person about?
A)Drinking plenty of water
B)Splinting affected joints
C)Eating more protein
D)Avoiding hot weather

Accepted Answer

Renal stones are 1000 times more prevalent in individuals with primary gout than they are in the general population. One self-care measure to prevent stones and to prevent uric acid remaining in the kidney is a large fluid intake. Splinting joints would be difficult in gout; 50% of the time the affected joint is in the big toe. The other 50% involve the heel, ankle, and instep of the foot; knee; wrist; or elbow. More protein is not related to preventing complications. Avoiding hot weather is also not a preventative measure for complications of gout.

Question 17

What is a primary defect in osteoarthritis?
A)Stromelysin and acid metalloproteinase breakdown articular cartilage.
B)Immunoglobulin G (IgG) destroys the synovial membrane.
C)Synovial membranes become inflamed.
D)Cartilage-coated osteophytes create bone spurs.

Accepted Answer

The primary defect in osteoarthritis is the loss of articular cartilage. IgG-mediated synovial membrane destruction is seen in rheumatoid arthritis as are inflamed synovial membranes. Osteophytes are seen in osteoarthritis.

Question 18

Which patient finding would lead the health care professional to assess the patient for inflammatory joint disease?
A)Unilateral joint involvement
B)Normal joint synovial fluid
C)Absence of synovial membrane inflammation
D)Systemic symptoms of inflammation

Accepted Answer

Inflammatory joint disease is characterized by systemic signs of inflammation (fever, leukocytosis, malaise, anorexia, hyperfibrinogenemia) and inflammatory damage or destruction in the synovial membrane or articular cartilage. Joint swelling tends to be symmetric. Joint synovial fluid will demonstrate hemorrhage, coagulation, and fibrin deposition. The synovial membranes are inflamed.

Question 19

A patient reports joint stiffness with movement and joint pain in weightbearing joints that is usually relieved by rest. What treatment option does the health care professional discuss with the patient?
A)Ways to decrease serum uric acid
B)Administration of oral methotrexate
C)Exercise and weight reduction
D)Rapid intravenous hydration

Accepted Answer

Pain and stiffness in one or more joints, usually weightbearing or load-bearing joints, are the first symptoms of osteoarthritis. The joint pain is usually relieved by rest. The standard treatment approach begins with weigh reduction and an exercise regime. Decreasing serum uric acid would be beneficial in gout. Oral methotrexate is one drug used in rheumatoid arthritis. Rapid intravenous hydrations would be appropriate for rhabdomyolysis.

Question 20

A health care professional is teaching a group of college women about increasing calcium in the diet to prevent osteoporosis. A participant asks at what age is peak bone mass is reached in women. What response is best?
A)15 years
B)20 years
C)30 years
D)35 years

Accepted Answer

Bone formation continues at a pace faster than resorption until peak bone mass-or maximum bone density and strength-is reached at approximately 30 years of age, after which bone resorption slowly exceeds bone formation.

Quiz 45: Alterations of Musculoskeletal Function

A patient in the clinic had a femur x-ray that was read as having a "moth-eaten" appearance. What treatment option does the health care professional discuss with the patient?

Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.)

A patient in the clinic is worried about having fibromyalgia. For which symptoms should the health care professional assess the patient for?

Which structures are most often affected by Paget disease? (Select all that apply.)

A patient in the clinic has calcium crystals that are associated with chronic gout. How does the professional document this finding?

What is the primary pathologic alteration resulting from ankylosing spondylitis (AS) ?

Bone death as a result of osteomyelitis is due to what?

What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis?

Which statement accurately describes a characteristic of osteosarcoma?

A patient has ankylosing spondylitis. Which description of this condition by the health care professional is most accurate?

What are the primary sources of bacterial infections that lead to hematogenous bone infection? (Select all that apply.)

What event is associated with the beginning of bone loss in women?

The pathophysiologic presentation of gout is closely linked to the metabolism of which chemical?

A professor has taught the class about giant cell bone tumors. Which statement by a student would require the professor to review the material?

A student studying osteomyelitis and asks for an explanation of the term "sequestrum." What response by the professor is best?

A person in the health care clinic has gout. In order to prevent a common complication, what self-care measure does the health care professional teach the person about?

What is a primary defect in osteoarthritis?

Which patient finding would lead the health care professional to assess the patient for inflammatory joint disease?

A patient reports joint stiffness with movement and joint pain in weightbearing joints that is usually relieved by rest. What treatment option does the health care professional discuss with the patient?

A health care professional is teaching a group of college women about increasing calcium in the diet to prevent osteoporosis. A participant asks at what age is peak bone mass is reached in women. What response is best?