Question 1

Which sign or symptom is a very late indication of developmental dysplasia of the hip?

Accepted Answer

Pain is a very late sign of developmental dysplasia of the hip. Earlier signs include asymmetry of gluteal or thigh folds, leg-length discrepancy, and waddling gait.

Question 2

A healthcare professional is educating an expectant parent class. Which skeletal deformity does the professional tell them is normal at birth but generally disappears b  y years of age?

Accepted Answer

Genu varum (bowleg) generally resolves itself by 11ea6373_1609_5371_8970_b9a4b0099ced_TB6683_11 years of age, whereas genu valgum (knock knee) maximizes by 5 to 6 years of age. This statement is not true of either equinovarus or pes planus.

Question 3

A child has Duchenne muscular dystrophy and the parents want to know how this occurred. Which statement by the healthcare professional is most accurate?

Accepted Answer

A deletion of a segment of DNA or a single-gene defect on the short arm of the X chromosome is believed to be the cause of the X-linked inherited type of Duchenne muscular dystrophy. Spinal muscular atrophy is a common recessive genetic disorder due to an abnormality in the SMN1 gene. Facioscapulohumeral muscular dystrophy is a mild progressive type of muscular dystrophy that is inherited in an autosomal dominant pattern. Limb girdle muscular dystrophy may be a recessive disorder but is not well defined.

Question 4

What diagnosis is given to parents when their infant's hip maintains contact with the acetabulum but is not well seated within the hip joint?

Accepted Answer

Subluxated hip is the only option used to identify the condition when the hip maintains contact with the acetabulum but is not well seated within the hip joint. The dislocatable hip is sometimes located properly but can dislocate easily. A dislocated hip is out of its socket. "Subluxable" is often used interchangeably with subluxated.

Question 5

An insufficient dietary intake of which vitamin can lead to rickets in children?

Accepted Answer

Rickets results from either insufficient vitamin D, insensitivity to vitamin D, wasting of vitamin D by the kidney, or inability to absorb vitamin D and calcium in the gut. Vitamin D is the only vitamin associated with rickets.

Question 6

In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis. What factor makes this route the easiest for bacteria to gain access to this area?

Accepted Answer

The subperiosteal space in the metaphysis is the path of least resistance for bacterial invasion because the cortex of the bone in this area is porous or mazelike, and the inflammatory response blocks spread within the bone. Bacterial access to the subperiosteal space is not related to compromised blood supply, actions of macrophages and lymphocytes, or spread down the medullary cavity.

Question 7

A child has Duchenne muscular dystrophy. What complication does the healthcare professional teach the parents is most important to control?

Accepted Answer

Although the life expectancy of boys with Duchenne continues to rise, death usually occurs from respiratory infection and a compromised respiratory system. The healthcare professional would educate the parents about the importance of maintaining good pulmonary hygiene and functioning. While other complications may occur, respiratory infections are the most worrisome.

Question 8

An adolescent has been diagnosed with osteochondrosis. How does the healthcare professional describe the pathophysiology to the teen?

Accepted Answer

Vascular impairment and trauma to bone, coupled with an underlying developmental or genetic predisposition, have been identified as probable causes of osteochondrosis. Often this is due to trauma and/or overuse. It does not involve hormonal imbalances, deficiency of minerals, or a bacterial infection.

Question 9

What does the student learn about the pain experienced with Legg-Calvé-Perthes disease?

Accepted Answer

The child with Legg-Calvé-Perthes disease often complains of a limp or pain for several months. The pain is usually referred to the knee, inner thigh, and groin and aggravated by activity and relieved by rest. This selection is the only option that accurately describes the pain associated with Legg-Calvé-Perthes disease.

Question 10

A child has scoliosis with a 40-degree curvature of the spine, and the parent is worried about pulmonary involvement. What statement by the healthcare professional is most appropriate?

Accepted Answer

The professional should inform the parent that in scoliosis, curves in the thoracic spine greater than 80 degrees result in decreased pulmonary function. The other statements are inaccurate and should not be used to educate the parent.

Question 11

At birth, the diagnosis of cerebral palsy (CP) may be made based on what factor?

Accepted Answer

The diagnosis of CP is often made when gross motor milestones are not met by predicted ages. In some infants, diagnosis is made at birth because the child has an underlying diagnosis, such as a major brain malformation that is known to be associated with CP. None of the other options are known triggers for CP.

Question 12

The healthcare professional directs a student to assess a teen who has Osgood-Schlatter disease. What assessment finding does the student anticipate for this disorder?

Accepted Answer

Tendinitis of the anterior patellar tendon, within which the patella (kneecap) is embedded, and associated osteochondrosis of the tubercle of the tibia are characteristics of Osgood-Schlatter disease. The upper extremities are not involved.

Question 13

To assess for osteogenesis imperfecta, which laboratory result would the healthcare professional expect to find?

Accepted Answer

Serum alkaline phosphatase is elevated in all forms of osteogenesis imperfecta.

Question 14

Which protein, absent in muscle cells of Duchenne muscular dystrophy, mediates the anchoring of skeletal muscle fibers to the basement membrane?

Accepted Answer

Dystrophin is present in normal muscle cells and absent in Duchenne muscular dystrophy. Dystrophin mediates anchorage of the actin cytoskeleton of skeletal muscle fibers to the basement membrane through a membrane glycoprotein complex. Syntrophin is a family of dystrophin-associated proteins. Laminin is an abundant glycoprotein. Troponin is a marker of muscle injury or death, particularly in the heart.

Question 15

The student wants to know how the clinical manifestations and onset of juvenile idiopathic arthritis (JIA) differ from those of rheumatoid arthritis (RA) in adults. What answer by the healthcare professional is best?

Accepted Answer

The onset of JIA is less gradual than it is in adult RA. JIA also differs from the adult form in that predominantly the large joints are affected in JIA. Pain is not as severe as in the adult type which often is first noticed as generalized aches.

Question 16

A healthcare professional wants to estimate the total mass of muscle in a patient's body. What serum laboratory test should the professional evaluate?

Accepted Answer

The total mass of muscle in the body can be estimated from the amount of creatinine excreted in the urine, because the conversion of creatine to creatinine only takes place in muscle.

Question 17

A healthcare professional working with children learns that which is the most common congenital skeletal defect of the upper extremity?

Accepted Answer

The most common congenital skeletal defect of the upper extremity is syndactyly, or webbing of the fingers.

Question 18

Which bones are affected in Legg-Calvé-Perthes disease?

Accepted Answer

A recurrent interruption of the blood supply to the femoral heads presumably produces Legg-Calvé-Perthes disease, which is a self-limited disease of the hip.

Question 19

A child has a disorder that resulted in the failure of bones to ossify, resulting in soft bones and skeletal deformity. What treatment plan does the healthcare professional discuss with the parents?

Accepted Answer

This description characterizes rickets. Growing bone fails to mineralize because of a problem with vitamin D intake, absorption, or excretion. Treatment includes supplemental vitamin D. Extremely careful handling would be appropriate for osteogenesis imperfecta. Revascularization procedures would benefit a child with osteochondrosis. Containment and motion are the principles of treating Legg-Calvé-Perthes disease.

Question 20

Until the skeleton matures and adult stature is reached, where does growth in the length of bone occur?

Accepted Answer

Until the skeleton matures and adult stature is reached, growth in the length of bone occurs only at the physeal plate through endochondral ossification.

Quiz 46: Alterations of Musculoskeletal Function in Children