Chapter 12: Musculoskeletal Flashcards
1
Q
Where is osteoarthritis most common?
A
hips, knees, hands
2
Q
What is osteoarthritis?
A
Localized joint disease - deterioration of articulating cartilage and underlying bone degenerative joint disease, inflamed synovial lining, weakened muscles, bone erosion
Loss of proteoglycans ( provides structural support to the extracellular matrix as well as surrounding tissues and organs. Their affinity to water also provides cushion, protection, and a source of hydration)
3
Q
The APRN is providing education to patient who was recently diagnosed with Osteoarthritis? Which statement by the APRN is correct?
A. Osteoarthritis is commonly seen in thin, small-built females
B. Osteoarthritis is a result of joint inflammation
C. Osteoarthritis occurs due to erosion of cartilage in the joints
D. Osteoarthritis is a metabolic bone disease
A
C. Osteoarthritis occurs due to erosion of cartilage in the joints.
4
Q
complications of a femur fracture
A
fat embolism, compartment syndrome
5
Q
complication of displaced fracture
A
osteonecrosis
6
Q
complication of open fracture
A
osteomyelitis
7
Q
. Which of the following is a symptom of carpal tunnel syndrome?
sweaty palms
pain that is worse during the daytime
numbness in fingers
finger stiffness
A
numbness in fingers
8
Q
True or False:
A patient with carpal tunnel syndrome will likely experience pain when trying to make a fist.
A
false; patients with carpal tunnel will have numbness/tingling/pain at night and when flexing/extending the wrist or raising the arm
9
Q
thickening and contracture of palmar fascia d/t fibroblast proliferation and abnormal collagen deposition
A
DUPUYTREN CONTRACTURE (a.k.a. Palmar Fibromatosis)
painless nodule and thickening over affected area, starting at metacarpophalangeal joint, but can progress to proximal interphalangeal joint
limited flexion
10
Q
abnormal thickening of flexor (palmar) tendon at the metacarpophalangeal joint
affected finger locks during flexion
A
TRIGGER FINGER (a.k.a. Stenosing Flexor Tenosynovitis)
11
Q
inflammation and swelling of wrist tendons on radial side, can compress nerves
moving affected wrist/thumb or making a fist (Finkelstein maneuver) causes pain.
A
de Quervain Tendinopathy (a.k.a. Stenosing Tenosynovitis)
12
Q
compression of the median nerve as it travels into the carpal tunnel space in the wrist.
Cause is unclear but seems to be related to anatomy or inflammation, and it eventually leads to nerve ischemia.
A
Carpal tunnel syndrome
13
Q
Progressive loss of bone strength due to low bone mass and quality, leading to increase risk of fractures
secondary is less common (caused by endocrine disorders e. diabetes and thyroid disorders)
A
osteoporosis
aging increase osteocyte apoptosis resulting spongy bone becoming more fragile
14
Q
Intervertebral disk issues
A
disks begin to degenerate
15
Q
Spondylosis
A
narrow disk space seen on imaging
16
Q
Why would a patient with muscular dystrophy appear to have increased muscle mass?
A
muscular dystrophy is characterized by muscle weakness and atrophy, but pseudohypertrophy can occur d/t fat and connective tissue deposits in place of muscle
17
Q
- Characteristics of a patient that is at high risk for falling and fracturing a hip include:
A) obesity and short stature.
B) excessive sugar intake.
C) hearing impairment.
D) chronic osteoporosis.
A
D) chronic osteoporosis.
18
Q
- A pathologic stress fracture occurs in bones subjected to:
A) sudden direct force.
B) weakening by disease.
C) repeated excessive use.
D) massive muscle contraction.
A
B) weakening by disease.
19
Q
- Shortly after a closed fracture has occurred, early manifestations include localized:
A) tetany.
B) deformity.
C) necrosis.
D) numbness.
A
D) numbness.
20
Q
- In order to initiate the cellular events essential to bone healing, there must be
formation at the fracture site.
A) callous
B) hematoma
C) ossification
D) fibrin meshwork
A
B) hematoma
21
Q
- In contrast to structural scoliosis, postural scoliosis:
A) compresses vertebrae.
B) corrects with bending.
C) is apparent at birth.
D) becomes painful.
A
B) corrects with bending.
22
Q
- Factors that may adversely affect bone healing include of the bone.
A) immobilization
B) weight bearing
C) delayed union
D) tight alignment
A
C) delayed union
23
Q
- The distinguishing characteristic of chronic osteomyelitis is the presence of:
A) sequestrum bone.
B) abscess formation.
C) severe bone pain.
D) external drainage.
A
A) sequestrum bone.
sequestrum is a piece of dead bone that has separated from healthy bone
24
Q
- Developmental dysplasia of the hip (DDH), formerly known as congenital hip dislocation, is suspected when an infant has:
A) gluteal fold asymmetry.
B) lengthening of the thigh.
C) joint capsule tightness.
D) delay of knee crawling.
A
A) gluteal fold asymmetry.
25
9. Osteonecrosis is most often caused by:
A) stress fractures.
B) bacterial infection.
C) synovial inflammation.
D) bone marrow ischemia.
D) bone marrow ischemia.
26
10 The patient has a fractured tibia. After the cast is applied he is at high risk
. for compartment syndrome caused by:
A) inflammation.
B) joint immobility.
C) muscle atrophy.
D) extremity elevation.
A) inflammation.
27
11 A college baseball player has seen his season cut short by a rotator cuff
. injury. Rotator cuff injuries are frequent because of:
A) the inherent instability of the shoulder.
B) the absence of ligaments at the glenohumeral joint.
C) the vulnerability of the shoulder menisci.
D) the large mass of the humeral head.
A) the inherent instability of the shoulder.
28
12 A patients clavicular fracture has healed in the weeks following a bicycle
. accident. Which of the following events takes place in the remodelling stage of bone healing?
A) Formation of granulation tissue
B) Development of fibrocartilage that resembles the appearance of the original bone
C) Deposition of mineral salts into the callus
D) Reduction in the size of the callus
D) Reduction in the size of the callus
29
13 A child has been hospitalized for the treatment of hematogenous
. osteomyelitis. The defining characteristic of this type of osteomyelitis is:
A) the presence of dead bone tissue.
B) introduction of microorganisms from the bloodstream.
C) bacterial proliferation in the absence of the classic signs of infection.
D) destruction of the vascular network in the endosteum.
B) introduction of microorganisms from the bloodstream.
30
14 Following a lengthy series of diagnostic tests, a patients chronic hip pain has
. been attributed to advanced osteonecrosis. What treatment is this patient most likely to require?
A) Joint replacement surgery
B) Intravenous antibiotics
C) Injections of corticosteroids into the synovial space
D) Transfusion of packed red blood cells
A) Joint replacement surgery
31
15 Which of the following neoplasms of the skeletal system is likely to require
. the most timely and aggressive treatment?
A) Exostosis
B) Osteochondroma
C) Endochondroma
D) Osteosarcoma
D) Osteosarcoma
32
16 A patient with a diagnosis of small cell lung carcinoma has developed bone
. metastases, a finding that has prompted a series of new interventions. What are the primary goals of the treatment regimen for this patients bone cancer?
A) Prevention of brain metastasis and early identification of osteonecrosis
B) Promotion of bone remodeling at tumor sites through calcium and vitamin D supplements
C) Prevention of pathologic fractures and maximization of function
D) Pain management and prevention of osteomyelitis
C) Prevention of pathologic fractures and maximization of function
33
17 Metastatic bone disease is most closely associated with:
.
A) cervical cancer and ovarian cancer.
B) acute myelogenous leukemia (AML) and malignant melanoma.
C) non-Hodgkin lymphoma and bladder cancer.
D) breast cancer and prostate cancer.
D) breast cancer and prostate cancer.
34
18 A couple has just learned that their newborn infant has been diagnosed with
. osteogenesis imperfecta, and they have responded by seeking out as much information as possible about their childs diagnosis. What should the clinician teach the couple about their childs health problem?
A) This is something that your child may have inherited from one or both or you.
B) This might have been caused by something you were exposed to during the early part of your pregnancy.
C) Youll have to be vigilant of your childs safety for the next few years, but the disease often resolves spontaneously.
D) With aggressive treatment, most children with osteogenesis imperfecta are cured within several months.
A) This is something that your child may have inherited from one or both or you.
OI is passed on through the genes. The different types are passed on in different ways. The gene may be inherited from one or both parents. Or the gene can be passed on from an unexplained change (spontaneous mutation) of a gene.
Most babies with OI have a defect of one of two genes. These genes help in forming collagen. Collagen is a main part of connective tissue that connects and supports the whole body, including the bones. Because of the defect, there is not enough collagen. Or the collagen is abnormal.
Type I. Mildest and most common type. About 50% of all affected children have this type. There are few fractures and deformities
Type II. Most severe type. A baby has very short arms and legs, a small chest, and soft skull. He or she may be born with fractured bones. He or she may also have a low birth weight and lungs that are not well developed. A baby with type II OI usually dies within weeks of birth
Type III. Most severe type in babies who don’t die as newborns. At birth, a baby may have slightly shorter arms and legs than normal and arm, leg, and rib fractures. A baby may also have a larger than normal head, a triangle-shaped face, a deformed chest and spine, and breathing and swallowing problems. These symptoms are different in each baby.
35
19 A child with a diagnosis of Legg-Calv-Perthes disease will exhibit:
.
A) defective synthesis of type I collagen.
B) congenital dislocation of the acetabulofemoral joint.
C) necrosis of the proximal femoral head.
D) intoeing due to metatarsus adductus.
C) necrosis of the proximal femoral head.
36
20 Assessment of a newborn infant reveals the presence of developmental
. dysplasia of the hip (DDH) that is currently demonstrated by subluxation of the babys hip joint and a general laxity in the babys ligaments. What measures should be emphasized in this infants treatment?
A) Corticosteroid therapy
B) Close observation
C) Open reduction
D) Joint reconstruction
B) Close observation
37
1. Disorders that affect cortical bone typically result in:
A) fractures of long bones.
B) impaired collagen synthesis.
C) infection.
D) vertebral fractures.
A) fractures of long bones.
38
2. The condition that contributes to the pathology of all metabolic bone diseases is:
A) impaired vitamin D synthesis.
B) osteosarcoma.
C) infection.
D) osteopenia.
D) osteopenia.
39
3. In contrast to osteoporosis, osteomalacia causes without the loss of bone matrix.
A) stress fractures
B) calcium excretion
C) bone cortex thinning
D) defective mineralization
D) defective mineralization
40
4. Rheumatoid arthritis is a systemic inflammatory disease with joint manifestations described as:
A) dysplasia.
B) polyarticular.
C) asymmetrical.
D) osteophytes.
B) polyarticular.
41
5. A feature of rheumatoid arthritis that differentiates it from other forms of inflammatory arthritis is the development of:
A) pannus tissue.
B) tophi deposits.
C) subluxations.
D) autoantibodies.
A) pannus tissue.
an abnormal layer of inflammatory tissue that grows within the joints, causing damage to the cartilage and bone by essentially "eating away" at the joint lining, leading to pain, swelling, and joint destruction
42
6. HLA-B27 antigen may be linked to other genes that determine the pathologic autoimmune phenomenon in:
A) gout syndrome.
B) rheumatoid arthritis.
C) osteoarthritis syndrome.
D) ankylosing spondylitis.
D) ankylosing spondylitis.
43
7. Osteoarthritis is a degenerative form of joint disease that is often evidenced by:
A) spongy joints.
B) cartilage hypertrophy.
C) crepitus and grinding.
D) systemic inflammation.
C) crepitus and grinding.
44
8. Systemic sclerosis (scleroderma) is an autoimmune disease of connective tissue characterized by:
A) fibrosis.
B) thin fragile skin.
C) collagen deficiency.
D) avascular necrosis.
A) fibrosis.
45
9. The most commonly occurring early symptoms of systemic lupus erythematosus (SLE) include:
A) arthralgia.
B) tendon rupture.
C) facial hair growth.
D) pyelonephritis.
A) arthralgia.
46
10 Premature osteoporosis is being seen increasingly in female athletes because
. of an increased prevalence of:
A) amenorrhea.
B) high protein intake.
C) abnormal body fat.
D) osteoarthritis.
A) amenorrhea.
47
11 For many patients, the first indication that they have osteoporosis is:
.
A) bone pain that is not alleviated by rest.
B) a bone fracture.
C) craving high-calcium foods.
D) decreased range of motion in the hip and knee joints.
B) a bone fracture.
48
12 Which of the following measures should a public health nurse recommend to
. middle-aged women to reduce their chances of developing osteoporosis later in life?
A) Weight-control and daily use of low-dose corticosteroids
B) Genetic testing and range of motion exercises
C) Calcium supplementation and regular physical activity
D) Increased fluid intake and use of vitamin D supplements
C) Calcium supplementation and regular physical activity
49
13 A 77-year-old woman has been admitted to the geriatric medical unit of the
. hospital for the treatment of pneumonia. The nurse providing care for the patient notes the presence of nasal calcitonin, vitamin D, and calcium chloride on the patients medication administration record. The nurse should conclude that this patient likely has a history of:
A) scleroderma.
B) osteoarthritis.
C) rheumatoid arthritis.
D) osteoporosis.
D) osteoporosis.
50
14 An elderly resident of an assisted-living facility has had his mobility and
. independence significantly impaired by the progression of his rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this patients decline in health?
A) A mismatch between bone resorption and remodeling
B) Immunologically mediated joint inflammation
C) Excessive collagen production and deposition
D) Cytokine release following mechanical joint injury
B) Immunologically mediated joint inflammation
51
15 Which of the following signs and symptoms should prompt a 29-year-old
. womans primary care provider to assess for systemic lupus erythematosus (SLE)?
A) Chronic nausea and vomiting that is unresponsive to antiemetics
B) Joint pain and increased creatinine and blood urea nitrogen
C) A history of thromboembolic events and varicose veins
D) Dysmenorrhea and recent spontaneous abortion
B) Joint pain and increased creatinine and blood urea nitrogen
52
16 A 26-year-old woman has sought care for increasing pain at the back of her
. ankle and the bottom of her foot over the past 2 weeks. The patient states that she is generally in good health, although she completed a course of antibiotics for a chlamydial infection 6 weeks earlier. This patients recent history suggests the possibility of:
A) systemic sclerosis.
B) ankylosing spondylitis.
C) osteoarthritis.
D) reactive arthritis.
D) reactive arthritis.
53
17 A 55-year-old male patient has reported joint pain in his feet. Which of the
. following blood work results should prompt further testing to rule out primary gout?
A) Increased C-reactive protein (CRP)
B) Increased serum uric acid
C) Increased polymorphonuclear leukocytes
D) Increased serum cortisol
B) Increased serum uric acid
54
18 Despite differences in onset, involvement, and symptomatology, all of the
. spondyloarthropathies involve:
A) sacroiliitis.
B) calcinosis.
C) excessive bone turnover.
D) autoimmune etiology.
A) sacroiliitis.
S acroiliitis
Inflammation of the sacroiliac (SI) joint, which connects the base of the spine to the pelvis. Sacroiliitis is a hallmark of seronegative spondyloarthropathies and is often the first sign of more complex spondyloarthropathies.
Spondyloarthropathies
A group of conditions that can include axial spondyloarthritis, psoriatic arthritis, reactive arthritis, and arthritis related to inflammatory bowel diseases
55
19 The clinical course of osteoarthritis (OA) culminates in:
.
A) osteonecrosis and loss of synovial fluid.
B) formation of tophi in the synovial space.
C) osteophyte formation and erosion of cartilage.
D) separation of the epiphyseal plate.
C) osteophyte formation and erosion of cartilage.
56
20 Which of the following disorders of the skeletal system occurs exclusively in
. older adults?
A) Polymyalgia rheumatica
B) Psoriatic arthritis
C) Reiter syndrome
D) Ankylosing spondylitis
A) Polymyalgia rheumatica
57
What is a fibrosarcoma?
a tumor of collagen tissue
58
What is a myelogenic tumor?
▪ Giant cell tumor of bone marrow
and Ewing’s sarcoma (rare bone/soft tissue cancer affecting children and young adults)
59
myeloid sarcoma
Myeloid sarcoma is a rare, cancerous tumor that forms in soft tissues outside of the bone marrow:
What it is: A solid tumor made up of immature white blood cells called myeloblasts
60
What is an osteosarcoma?
a rare, aggressive, cancerous bone tumor that develops from bone-forming cells
61
what is a chrondrogenic tumor?
Chondrogenic tumors, also known as cartilaginous tumors, are a common type of bone tumor that form a cartilaginous matrix. They are classified as benign, intermediate, or malignant based on the risk of metastasis
62
34yo patient presents to the clinic with complaints of increasing back pains. She is also 31weeks pregnant and severely overweight. What spinal deviation do you suspect based on the given information?
A. Scoliosis
B. Lordosis
C. Kyphosis
D. Low back pain
B. Lordosis
63
Which of the following individuals are at greatest risk for developing gout?
A. African American male that is a vegetarian
B. White male who is pescatarian and eats lots of seafood
C. Pacific islander who is vegan
D. African American who eats lots of organ meats
D. African American who eats lots of organ meats
64
A 60-year-old man comes into the clinic complaining of a “few months” of intermittent lower back pain that has recently migrated up to his middle back. He is an active walker and has increased his walking recently because it alleviates this middle/lower back pain. At rest he states his pain has become excruciating especially at night. However, once he gets up in the morning, he feels a lot better. Lab tests showed a positive HLA-B27 gene test. What is the diagnosis?
a. ALS
b. Parkinson’s Disease
c. Fibromyalgia
d. Ankylosing spondylitis
d. Ankylosing spondylitis
65
When educating a young patient on the difference between a strain and a sprain, what would you include?
a. Sprains are an injury to a tendon or muscle and strains are an injury to a ligament.
b. Sprains are an injury to a ligament and strains are an injury to a tendon or muscle.
c. Sprains are associated with tendinitis while strains are not.
d. The sites most affected by strains are ankle, earlobe, and knee while sprains are lower back, hamstring, and skull.
b. Sprains are an injury to a ligament and strains are an injury to a tendon or muscle.
66
When skeletal muscles contract, the following processes occur: ____________ filaments pull on ____________ filaments and __________ is released from inside the muscle fibers and binds to _________.
A. myosin, actin, calcium, troponin
B. actin, myosin, calcium, troponin
C. myosin, actin, troponin, calcium
D. actin, myosin, troponin, calcium
A. myosin, actin, calcium, troponin
67
A risk factor for developmental hip displasia is:
A. Male gender, as males are more likely to experience DHD than females
B. Breech position in the third trimester
C. Not swaddling a newborn’s hips snugly after delivery
D. A mutation in collagen type I (COLIA1) or type II (COLIA2) acid chain genes
B. Breech position in the third trimester
68
What type of medication can put you at risk for gout?
thiazide diuretic d/t increased reabsorption of uric acid
69
what is the genetic component of rheumatoid arthritis?
mutation of MHC II alleles
70
What is a non-spine related symptom of ankylosing spondylitis? and why
Uveitis is a common ocular manifestation of HLA-B27-associated disease, which is present in 88% of patients with ankylosing spondylitis. The typical age of onset is in the second through fourth decades of life. Episodes are usually recurrent, with 1-4 limited episodes occurring in a year
71
what is spondylolisthesis?
forward shift of the vertebral body due to instability from a fracture
72
what is a spondylolysis?
fracture of the pars interarticularis, a thin portion of vertebrae that connects upper and lower facet joints. often in L5
73
what is radiculopathy
"pinched nerve"
74
in what subset of low back pain is calf pain when ambulating, but resolving when sitting/leaning forward, common?
spinal stenosis
symptom is called pseudoclaudication/neurogenic claudication
75
What subset of low back pain would result in a positive straight leg test?
herniated disc
76
What is Osgood-Schlatter disease?
Osgood-Schlatter disease is an osteochondritis of the tibial tubercle that occurs in adolescents
who have undergone a rapid growth spurt. In this disorder, there is a tendinitis of the patellar
tendon and avascular necrosis (osteochondrosis) of the tibial tubercle. With the disorder (also
known as tibial tubercle avulsion), the proximal anterior patellar tendon insertion eventually
separates from the tibial tubercle. The separation is a result of an overuse injury caused by
repetitive strain and chronic avulsion
