Question 1

The health care professional teaches a group of seniors that the most common clinical manifestation of osteoporosis is which of these?
A)Bone deformity
B)Bone pain
C)Pathologic fracture
D)Muscle strain

Accepted Answer

The most common clinical manifestation of osteoporosis is bone deformity. Pain does occur, but is often associated with fractures, which can be pathological in nature (occurring under normal stress). Muscle strain is not a component of osteoporosis.

Question 2

By the time osteoporosis is visible on an x-ray examination, up to what percent of bone has been lost?
A)30%
B)40%
C)50%
D)60%

Accepted Answer

Generally, osteoporosis is radiographically detected as increased radiolucency of bone. By the time abnormalities are detected by x-ray examination, as much as 25% to 30% of bone tissue may have been lost.

Question 3

Which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts?
A)Parathyroid hormone
B)Glucocorticoid
C)Growth hormone
D)Estrogen

Accepted Answer

Data reveal that sex steroids (e.g., estrogens) exert antiapoptotic effects on osteoblasts but exert proapoptotic effects on osteoclasts; in both scenarios, activating the extracellular signal-regulated kinases (ERKs) accomplishes these effects. This process is not true of any of the other options.

Question 4

A patient has a bone density T score of -2.8. What diagnosis does the health care professional educate the patient on?
A)Osteoplasia
B)Osteoporosis
C)Osteopenia
D)Osteomalacia

Accepted Answer

Bone density is based on the number of standard deviations that differ from the mean bone mineral density of a young-adult reference population (a T-score). A normal T score is >-1.0. A score between -1.0 and -2.5 signifies osteopenia. A score <-2.5 indicates osteoporosis.

Question 5

The health care professional is caring for a person who has a pathologic fracture. The patient asks the professional to explain the condition. What response by the professional is best?
A)The outer surface of the bone is disrupted, but the inside is intact.
B)A stable fracture where the cortex of the bone bends but doesn't break.
C)A fracture that happens at the site of an abnormality already in that bone.
D)It was caused by the cumulative effects of stress on the bone over time.

Accepted Answer

A pathologic fracture is a break at the site of a preexisting abnormality, usually by force that would not fracture a normal bone. A greenstick fracture is one in which the outer surface is disrupted but the inside in intact. The stable fracture with a bent but not broken cortex is a torus fracture. Cumulative stress results in stress fractures.

Question 6

A patient is brought to the Emergency Department after being found by neighbors. The patient says she has been lying on the floor in the house for 3 days. What action by the health care professional is best?
A)Order a serum creatine kinase (CK) level
B)Obtain an x-ray of the patient's hips
C)Arrange for the patient to have a DXA scan
D)Perform the Fracture Risk Assessment

Accepted Answer

This patient is at high risk of having rhabdomyolysis. The best diagnostic test for this disorder is a serum creatine kinase level. The patient may well have a hip fracture, but other bones may be broken as well and the patient may well have rhabdomyolysis. A DXA scan and Fracture Risk Assessment are useful tools for osteoporosis.

Question 7

In osteoporosis, the receptor activator of nuclear factor kB (RANK) activates what?
A)Osteoclast apoptosis
B)Osteoblast survival
C)Osteoprotegerin
D)Osteoclast survival

Accepted Answer

RANKL activates the receptor RANK, which is expressed on osteoclasts and their precursors and suppresses apoptosis, which leads to activation and the prolongation of osteoclast survival. Apoptosis, osteoblast survival, and osteoprotegerin are not affected.

Question 8

A student asks for an explanation of rhabdomyolysis. What response by the professor is best?
A)Paralysis of skeletal muscles, resulting from an impaired nerve supply
B)Smooth muscle degeneration, resulting from ischemia
C)Lysis of skeletal muscle cells through the initiation of the complement cascade
D)Release of myoglobin from damaged striated muscle cells

Accepted Answer

Rhabdomyolysis involves the release of myoglobin when muscle cells are damaged. It is not due to muscle paralysis, muscle degeneration, or from the complement cascade.

Question 9

A patient has a temporary displacement of two bones causing the bone surfaces to partially lose contact with each other. What treatment does the health care professional prepare the patient for?
A)Internal fixation
B)Reduction and immobilization
C)Calcium phosphate cement
D)Low-density ultrasound

Accepted Answer

This patient has manifestations of a subluxation. Treatment would include reduction followed by immobilization, followed by physical therapy. Internal fixation would be appropriate for some fractures. Calcium phosphate cement can be used to fill a large defect in bone such as seen in nonunion. Low-density ultrasound is another option to promote new bone growth in nonunion.

Question 10

Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression?
A)Muscle ischemia
B)Myoglobinuria
C)Volkmann contracture
D)Neural injury

Accepted Answer

Myoglobinuria is an excess of myoglobin (an intracellular muscle protein) in the urine. Muscle cell damage releases the myoglobin. The most severe form is often called crush syndrome. Less severe and more localized forms of muscle damage are called compartment syndromes. This selection is the only option that accurately identifies the pathophysiologic alteration that precedes crush syndrome.

Question 11

What is the tear in a ligament referred to as?
A)Fracture
B)Strain
C)Disunion
D)Sprain

Accepted Answer

Ligament tears are commonly known as sprains. A fracture is a break in a bone. A strain is an injury to a tendon or muscle. Disunion is when bones do not heal together properly after a fracture.

Question 12

Improper reduction or immobilization of a fractured femur can result in which outcome after cast removal?
A)The muscles around the fracture site are weak.
B)The fracture requires 6 to 8 weeks of physical therapy.
C)The skin under the cast is dry and flaky.
D)The bone is not straight.

Accepted Answer

Improper reduction or immobilization of a fractured bone may result in nonunion, delayed union, or malunion. Malunion is the healing of a bone in a nonanatomic position that could result in the bone not being straight. The other options are normal occurrences.

Question 13

A patient in the Emergency Department has either a tendon or ligament injury. What pain description from the patient would the health care professional associate with these injuries?
A)Dull and diffuse, persisting over the distribution of the tendon or ligament
B)Sharp and localized, persisting over the distribution of the tendon or ligament
C)Pins-and-needle sensations that occur distal to the injury with movement
D)Intermittent and aching, occurring over the distribution of the tendon or ligament

Accepted Answer

The pain resulting from tendon and ligament injuries is usually described as being sharp and localized, persisting over the distribution of the tendon or ligament. This selection is the only option that accurately describes this type of pain.

Question 14

A health care professional is providing education to a group of seasonal athletes. What type of fracture does the professional warn them to avoid?
A)Stress
B)Greenstick
C)Insufficiency
D)Pathologic

Accepted Answer

A stress fracture occurs in normal or abnormal bone that is subjected to repeated stress, such as repetitive and strenuous activities that occur during athletics. A greenstick fracture is one in which the outer surface of the bone is disrupted but the interior is intact. Insufficiency fractures are seen in osteoporosis and osteomalacia. A pathologic fracture is one that occurs from force that would not usually break a bone. There is usually an underlying lesion or abnormality at the site of the fracture.

Question 15

Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat fracture of the tibia and fibula?
A)Iatrogenic
B)Regional
C)Idiopathic
D)Osteoblastic

Accepted Answer

Classic regional osteoporosis is associated with disuse or immobilization of a limb because of fractures, motor paralysis, or bone or joint inflammation.

Question 16

A patient has been diagnosed with Paget disease. What explanation of the disease does the health care professional provide the patient?
A)"It is a severe infection in your bones."
B)"It is a problem with bone resorption and formation."
C)"It is a condition in which your bones become soft."
D)"It's a disorder of altered energy production in muscle."

Accepted Answer

Paget disease is a state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling. Osteomyelitis is a bone infection. Bones become soft in osteomalacia. Several metabolic disorders lead to altered energy production, such as McArdle disease.

Question 17

A health care professional who works with older women understands that which changes are believed to play a significant role in the development of age-related bone loss?
A)Increased oxidative stress and increased intracellular reactive oxygen species
B)Hypoparathyroidism
C)Increased body weight
D)Decreased formation and short life span of osteoclasts

Accepted Answer

Recent studies indicate that increased oxidative stress (OS) and increased intracellular reactive oxygen species (ROS) play significant roles in the development of age-related bone loss, as well as other age-related changes in the body.

Question 18

A patient seen in the clinic has tissue degeneration or irritation of the extensor carpi radialis brevis tendon. What diagnosis does the health care professional document?
A)Lateral epicondylopathy
B)Medial epicondylopathy
C)Bursitis
D)Lateral tendinitis

Accepted Answer

Lateral epicondylopathy, commonly called tennis elbow, is the result of tissue degeneration or irritation of the extensor carpi radialis brevis tendon at its origin. Medial tendinitis or medial epicondylitis, referred to as golfer's elbow, is a degenerative process of the pronator teres, flexor carpi radialis, and palmaris longus tendons at the medial humeral condyle. Bursitis is inflammation of the bursae. Tendinitis is a general term for inflammation of a tendon.

Question 19

A health care professional determines that the student needs more education when the student makes which statement about treating bone infection?
A)Bone contains multiple microscopic channels that are impermeable to the cells and biochemicals of the body's natural defenses.
B)Microcirculation of bone is highly vulnerable to damage and destruction by bacterial toxins, leading to ischemic necrosis of bone.
C)Bone cells have a limited capacity to replace bone destroyed by infections.
D)Bacteria are walled off by macrophages and T lymphocytes; consequently, the antibiotics cannot penetrate the infected area.

Accepted Answer

Bacteria are not walled off by macrophages and T lymphocytes, thus inhibiting the effects of antibiotics. This statement would cause the professional to review the material with the student. The other options are true statements regarding factors that contribute to the difficulty in treating bone infections.

Question 20

Which structure attaches skeletal muscle to bone?
A)Tendon
B)Ligament
C)Bursa
D)Mesentery

Accepted Answer

A tendon is fibrous connective tissue that attaches skeletal muscle to bone. A ligament attaches bones together where they meet at a joint. A bursa is a small sac lined with synovial membrane and filled with synovial fluid; bursae are located between tendons, muscles, and bony prominences. Their primary function is to separate, lubricate, and cushion these structures. The mesentery is a fold of the peritoneum that attaches internal abdominal organs to the posterior wall of the abdomen.

Quiz 45: Alterations of Musculoskeletal Function

The health care professional teaches a group of seniors that the most common clinical manifestation of osteoporosis is which of these?

By the time osteoporosis is visible on an x-ray examination, up to what percent of bone has been lost?

Which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts?

A patient has a bone density T score of -2.8. What diagnosis does the health care professional educate the patient on?

The health care professional is caring for a person who has a pathologic fracture. The patient asks the professional to explain the condition. What response by the professional is best?

A patient is brought to the Emergency Department after being found by neighbors. The patient says she has been lying on the floor in the house for 3 days. What action by the health care professional is best?

In osteoporosis, the receptor activator of nuclear factor kB (RANK) activates what?

A student asks for an explanation of rhabdomyolysis. What response by the professor is best?

A patient has a temporary displacement of two bones causing the bone surfaces to partially lose contact with each other. What treatment does the health care professional prepare the patient for?

Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression?

What is the tear in a ligament referred to as?

Improper reduction or immobilization of a fractured femur can result in which outcome after cast removal?

A patient in the Emergency Department has either a tendon or ligament injury. What pain description from the patient would the health care professional associate with these injuries?

A health care professional is providing education to a group of seasonal athletes. What type of fracture does the professional warn them to avoid?

Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat fracture of the tibia and fibula?

A patient has been diagnosed with Paget disease. What explanation of the disease does the health care professional provide the patient?

A health care professional who works with older women understands that which changes are believed to play a significant role in the development of age-related bone loss?

A patient seen in the clinic has tissue degeneration or irritation of the extensor carpi radialis brevis tendon. What diagnosis does the health care professional document?

A health care professional determines that the student needs more education when the student makes which statement about treating bone infection?

Which structure attaches skeletal muscle to bone?