Chapter 22

Question 1

Fluid that lubricates articular cavities is called?

a) blood
b) synovial fluid
c) mucus
d) cerumen
e) marrow

Answer 1

B
Articular cavities are lined with synovial membrane, which secretes synovial fluid that provides lubrication for the joint to move.

Question 2

Bones around a joint are held together by

a) synovial membranes
b) ligaments
c) muscles
d) cartilage
e) tendons

Answer 2

B)
Bones are held together within a joint by ligaments. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Tendons attach muscle to bone, bones are not held together by muscles, and cartilage forms most of the joints in the adult skeleton and merely acts
as a shock absorber.

Question 3

Bones are attached to muscle by

a) synovial membranes
b) ligaments
c) muscles
d) cartilage
e) tendons.

Answer 3

E

Tendons attach muscle to bone. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Ligaments attach bone to bone. Muscles are not bound together by other muscles, and cartilage helps in the production of new bone and acts as an insulator for bones in joints.

Question 4

The elbow joint that allows for flexion and extension in one plane represents a type of _______ joint

a) articulated
b) ball and socket
c) hinge
d) pivot condyloid
e) saddle

Answer 4

C

A hinge joint allows for flexion and extension in one plane. A condyloid joint allows flexion and
extension in two planes. A ball and socket joint allows movement in all planes. An articulated
joint means simply that the joint allows movement. A saddle joint allows motion in two planes at
right angles to each other but no axial rotation.

Question 5

Spinal vertebrae are separated from each other by

a) bursae
b) tendons
c) disks
d) ligaments
e) synovial fluid

Answer 5

ANS: C

Except for sacral vertebrae, the spinal vertebrae are separated from one another by fibrocartilaginous disks.

Question 6

The glenohumeral joint is the other name for the?

a) elbow
b) hip
c) wrist
d) scapula
e) shoulder

Answer 6

ANS: E

The shoulder joint, also called the glenohumeral joint, consists of the union between the humerus and the scapula.

Question 7

The joint where the humerus, radius, and ulna articulate is the

a) wrist
b) elbow
c) shoulder
d) sternum
e) clavicle

Answer 7

ANS B

The elbow is the site where the humerus, radius, and the ulna meet. The shoulder is made up of the humerus and the scapula. The wrist is made up of the radius and the carpal bones of the hand. The sternum connects to the clavicles and ribs. The clavicle connects to the scapula but not the humerus.

Question 8

The articulation of the radius and the carpal bones is the?

a) wrist
b) elbow
c) shoulder
d) clavicle
e) digits

Answer 8

ANS: A

The joint comprising the radius and the carpal bones is the wrist.

Question 9

The cruciate ligaments within the knee provide for?

a) anterior and posterior stability
b) medial and lateral stability
c) movement on one plane
d) pivoting and rotation
e) shock absorption

Answer 9

ANS A

The cruciate ligaments within the knee are positioned so as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane. Cartilage is the structure that provides shock absorption.

Question 10

Medial and lateral surfaces of the tibiotalar joint are protected by?

a) bursae
b) tendons
c) muscles
d) ligaments
e) synovial fluid

Answer 10

ANS D

The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides. Bursae, tendons, muscles, and synovial fluid do not offer stabilization protection to the ankle.

Question 11

The suprapatellar bursa separates the patella, quadriceps tendons and muscle from the

a) talus
b) fibula
c) femur
d) pelvis
e) tibia.

Answer 11

ANS C

The suprapatellar bursa separates the knee, the quadriceps, and muscle from the femur.

Question 12

The tibia, fibula, and talus articulate to form the

a) ankle
b) knee
c) hip
d) pelvis
e) forefoot

Answer 12

ANS A

The tibia, fibula, and talus or heel, join to form the ankle

Question 13

Long bones in children have growth plates known as?

a) epiphyses
b) epicondyles
c) synovium
d) foassae
e) diastasis

Answer 13

ANS A

Epiphyses are the growth plates found in long bones in children.

Question 14

Ligaments are stronger than bone until

a) birth
b) infancy
c) adolescence
d) middle adulthood
e) old age

Answer 14

ANS C

Ligaments are stronger than bone during birth and infancy. It is not until adolescence that bone becomes stronger.

Question 15

Injuries to long bones and joints are more likely to result in fractures than in sprains until

a) preschool age
b) school age
c) adolescence
d) early adulthood
e) middle adulthood

Answer 15

ANS C

Fractures to long bones and joints are more common during growth years. During childhood and early adolescence, the epiphyseal growth plates are more easily injured than are the tougher ligaments. Growth is completed with the closure of the epiphyseal growth plates at about 20
years of age.

Question 16

The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are caused by?

a) decreased mineral deposition
b) increased hormone secretion
c) uterine enlargement
d) gait changes
e) increased mineral resorption

Answer 16

ANS B

Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus.

Question 17

Skeletal changes in older adults are the result of

a) increased bone deposition
b) increased bone resorption
c) tendons becoming more elastic
d) decreased bone deposition
e) decreased bone resorption

Answer 17

ANS B

As a person ages, the skeletal system undergoes several changes. One of the dramatic changes in the skeletal equilibrium is that bone resorption dominates bone deposition. Tendons become less elastic in older adults.

Question 18

The usual number of vertebrae is

a. 23.
b. 24.
c. 25.
d. 26.
e. 27.

Answer 18

ANS: B

The number of vertebrae that is most common is 24; as few as 11% of persons have 23, and almost 5% have 26.

Question 19

The family history for a patient with joint pain should include information about siblings with

a. trauma to the skeletal system.
b. chronic atopic dermatitis.
c. genetic disorders.
d. obesity.
e. poor physical conditioning.

Answer 19

ANS: C

An important history to obtain for a patient with joint pain would be family history of genetic
disorders such as osteogenesis imperfecta, dwarfing syndrome, rickets, hypophosphatemia, or
hypercalciuria.

Question 20

Risk factors for sports-related injuries include

a. competing in colder climates.
b. previous fractures.
c. history of recent weight loss.
d. failure to warm up before activity.
e. light body frame.

Answer 20

ANS: D
Failure to warm up before exercise is one risk factor for sports-related injuries. Climate, previous
fractures, and weight loss are not as strong risk factors for sports-related injuries. A light body
frame is a risk factor for osteoporosis, not sports-related injuries.

Question 21

Light skin and thin body habitus are risk factors for

a. rheumatoid arthritis.
b. osteoarthritis.
c. congenital bony defects.
d. osteoporosis.
e. sports-related injuries.

Answer 21

ANS: D
People with light skin and a thin body frame are at greater risk for developing osteoporosis.
Rheumatoid arthritis, osteoarthritis, bony defects, and sports-related injuries are not found to
have a correlation with light skin and a small frame.

Question 22

Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of

a. adolescents.
b. infants.
c. older adults.
d. middle adulthood.
e. children.

Answer 22

ANS: C
History taking of older adults should consist of symptoms of nocturnal muscle spasms. Pregnant women and older adults commonly experience nocturnal leg cramps resulting from imbalances of fluids, hormones, minerals or electrolytes, or dehydration. A particular concern with the older adults is that this may be a sign of intermittent claudication.

Question 23

The musculoskeletal examination should begin when

a. the patient enters the examination room.
b. during the collection of subjective data.
c. when height is measured.
d. when joint mobility is assessed.
e. the remainder of the physical examination is completed.

Answer 23

ANS: A
When the patient first walks in the room, the examiner should observe the gait and posture as part of the musculoskeletal examination.

Question 24

Pain, disease of the muscle, and damage to the motor neuron may all cause

a. bony hypertrophy.
b. muscle crepitus.
c. muscle hypertrophy.
d. muscle wasting.
e. claudication.

Answer 24

ANS: D

Muscle wasting is a consequence of pain from injury, pathology of the muscle, and injury to the motor neuron.

Question 25

An increase in muscle tone is known as

a. crepitus.
b. effusion.
c. tenosynovitis.
d. atrophy.
e. spasticity.

Answer 25

ANS: E
An increase in muscle tone is referred to as spasticity. Crepitus, effusion, and tenosynovitis do not relate to muscle, and atrophy is wasting or a decrease in muscle mass.

Question 26

Fasciculation occurs after injury to a muscle’s

a. venous return.
b. motor neuron.
c. strength.
d. tendon.
e. fascia.

Answer 26

ANS: B
Fasciculations can often be visualized as muscle twitching or dimpling under the skin, but they usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of motor neuron disease or peripheral nervous system diseases.

Question 27

The physical assessment technique most frequently used to assess joint symmetry is

a. inspection.
b. palpation.
c. percussion.
d. the use of joint calipers.
e. auscultation.

Answer 27

ANS: A
The assessment technique most commonly used to assess joint symmetry is inspection.
Palpation, percussion, auscultation, and the use of joint calipers are not commonly used for this
purpose.

Question 28

A goniometer is used to assess

a. bone maturity.
b. joint proportions.
c. range of motion.
d. muscle strength.
e. body fat.

Answer 28

ANS: C
The angle of a joint can be accurately measured using a goniometer. This is used when the joint range of motion is beyond the normal limits. Muscle strength, bone maturity, body fat, and joint proportions are not measured by a goniometer.

Question 29

When palpating joints, crepitus may be caused when

a. irregular bony surfaces rub together.
b. supporting muscles are excessively spastic.
c. joints are excessively lax.
d. there is excess fluid within the synovial membrane.
e. there is muscle wasting.

Answer 29

ANS: A
Crepitus is felt or heard when irregular bony surfaces rub together. Spastic muscles, muscle
wasting, lax joints, and excess synovial fluid do not produce this grating sound upon palpation.

Question 30

The temporomandibular joint is palpated

a. under the mandible anterior to the sternocleidomastoid muscle.
b. from inside the mouth.
c. anterior to the tragus.
d. at the mastoid process.
e. above the mandible at midline.

Answer 30

ANS: C
The temporomandibular joint is palpated just anterior to the tragus of the ear; the fingertips are placed inside the joint space as the patient opens and closes the mouth. Under the mandible, above the mandible, and at the mastoid process do not describe the location of the temporomandibular joint.

Question 31

Temporalis and masseter muscles are evaluated by

a. having the patient frown.
b. having the patient clench his or her teeth.
c. asking patient to fully extend his or her neck.
d. passively opening the patient’s jaw.
e. having the patient shrug his or her shoulders.

Answer 31

ANS: B
Having the patient bite down and clench his or her teeth is the method to examine the strength of
the temporalis and masseter muscles. Cranial nerve V is tested with this same maneuver.

Question 32

The strength of the trapezius muscle is evaluated by having the patient

a. clench his or her teeth during muscle palpation.
b. push his or her head against the examiner’s hand.
c. straighten his or her leg with examiner opposition.
d. uncross his or her legs with examiner resistance.
e. adduct the arm.

Answer 32

ANS: B
Having the patient apply opposite force with differing head motions, against the examiner’s
hand, assesses the sternocleidomastoid and trapezius muscles.

Question 33

Expected normal findings during inspection of spinal alignment include

a. asymmetrical skinfolds at the neck.
b. slight right-sided scapular elevation.
c. convex lumbar curve.
d. head positioned superiorly to the gluteal cleft.
e. convex cervical curve.

Answer 33

ANS: D
Spinal alignment is considered within normal limits when the patient’s head is positioned directly over the gluteal cleft. The skin folds should be symmetrical, the scapulae are at even heights, and both the cervical and lumbar curves are concave.

Question 34

A common finding in markedly obese and pregnant women is

a. kyphosis.
b. lordosis.
c. paraphimosis.
d. scoliosis.
e. phimosis.

Answer 34

ANS: B
Bowing of the back, or lordosis, is more commonly found in pregnant women and obese patients because of an altered center of gravity. Kyphosis is more commonly seen in older adults, and scoliosis is more commonly seen in teenagers. Phimosis and paraphimosis are penile conditions.

Question 35

When the patient flexes forward at the waist, what spinal observation would lead you to suspect scoliosis?

a. A prominent lumbar hump
b. A prominent cervical concave curve
c. Lateral curvature of the spine
d. Restricted ability to flex at the hips
e. A gibbus

Answer 35

ANS: C

Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist.

Question 36

When the shoulder contour is asymmetrical and one shoulder has hollows in the rounding contour, you would suspect

a. a dislocated elbow.
b. a fractured scapula.
c. a dislocated shoulder.
d. muscle wasting.
e. kyphosis.

Answer 36

ANS: C

Asymmetrical contours to the shoulder with a hollowing in the socket are symptoms of a shoulder dislocation. Kyphosis is a condition of the back; muscle wasting, a dislocated elbow, and a scapula fracture do not present with these symptoms.

Question 37

Ulnar deviation and boutonniere deformities are characteristic of

a. winged scapula.
b. osteoarthritis.
c. osteoporosis.
d. congenital defects.
e. rheumatoid arthritis.

Answer 37

ANS: E
Deviation of the fingers toward the ulnar side and boutonniere deformities are classic symptoms
of rheumatoid arthritis. Winged scapula, osteoarthritis, congenital defects, and osteoporosis do
not present with these symptoms.

Question 38

A finding that is indicative of osteoarthritis is

a. swan neck deformities.
b. Bouchard nodes.
c. ganglion cysts
d. Heberden nodes.
e. spindle-shaped fingers.

Answer 38

ANS: D
Heberden nodes are bony overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint, they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities and spindle-shaped fingers; ganglion cysts are not associated with osteoarthritis.

Question 39

A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign.

a. Phalen
b. Gower
c. Homan
d. Tinel
e. Allis

Answer 39

ANS: D
The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers.

Question 40

Classic carpal tunnel syndrome would result in

a. pain in the fourth and fifth digits.
b. a negative Phalen test.
c. reduced abduction of the thumb.
d. palm tingling.
e. a negative Tinel sign.

Answer 40

ANS: C
Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, a positive Phalen sign, reduced abduction of the thumb, and sparing of palm tingling. The median half of the fourth digit and entire fifth digit are asymptomatic.

Question 41

Excessive hyperextension of the knee with weight bearing may indicate

a. advanced joint degeneration.
b. early signs of gout.
c. rotation of the Achilles tendon.
d. a meniscal tear.
e. weakness of the quadriceps muscle.

Answer 41

ANS: E
Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness. Gout, joint degeneration, Achilles tendon rotation, and meniscal tears do not cause
hyperextension of the knee.

Question 42

Arm length is measured from the acromion process through the

a. olecranon joint to carpal thumb hinge.
b. olecranon process to distal ulnar prominence.
c. proximal radial prominence to distal joint.
d. proximal ulnar joint to middle fingertip.
e. olecranon process to the second fingertip.

Answer 42

ANS: B
Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow (olecranon process) joint to the wrist (distal ulnar prominence).

Question 43

A positive straight leg raise test usually indicates

a. leg length discrepancy.
b. knee instability.
c. lumbar nerve root irritation.
d. hip bursitis.
e. improperly conditioned muscles.

Answer 43

ANS: C
Lumbar nerve root irritation at the L4, L5, and S1 levels can be assessed by asking the patient to lie supine with the neck flexed and to raise one leg. If pain is felt, it is a positive straight leg raise
result. The straight leg raise test does not assess leg length, knee stability, hip bursitis, or muscle condition.

Question 44

The Thomas test is used to detect

a. hip dislocation.
b. unstable sacroiliac joints.
c. knee instability.
d. flexion contractures of the hip.
e. asymmetry in the level of the iliac crests.

Answer 44

ANS: D
The Thomas test requires the patient to lie supine with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture. The Thomas test does not assess hip dislocation, sacroiliac joints, knee instability, or asymmetry of the iliac crests.

Question 45

Which one of the following techniques is used to detect a torn meniscus?

a. Phalen test
b. McMurray test
c. Thomas test
d. Trendelenburg test
e. Drawer test

Answer 45

ANS: B
The McMurray test points to a meniscus tear. The Phalen test detects carpal tunnel syndrome. The drawer test detects an anterior cruciate ligament tear, the Thomas test detects hip contraction, and the Trendelenburg test detects weak hip abductor muscles.

Question 46

When performing the drawer test, the examiner would place the patient in a supine position and flex the knee 45 to 90 degrees, placing the foot flat on the table, and then

a. grasp and evert the foot and extend the knee.
b. grasp and invert the foot and rotate the knee.
c. grasp the lower leg with both hands and draw the tibia forward and then backward.
d. apply varus stress with the foot planted.
e. apply valgus stress after the leg is extended.

Answer 46

ANS: C
The next step is to place both hands on the lower leg with the thumbs on the ridge of the anterior tibia just distal to the tibial tuberosity. Draw the tibia forward, forcing the tibia to slide forward of the femur. Then push the tibia backward. Anterior or posterior movement of the knee greater
than 5 mm in either direction is an unexpected finding.

Question 47

Anterior cruciate ligament integrity is assessed via the _____ test.

a. Lachman
b. straight leg raise
c. valgus stress
d. Homan
e. Thomas

Answer 47

ANS: A
The Lachman test evaluates anterior cruciate ligament integrity. The straight leg raise test assesses nerve root damage, the valgus stress test assesses instability of the lateral and medial
collateral ligaments, the Homan test assesses for blood clots in the legs, and the Thomas test is used to detect flexion contractures of the hips.

Question 48

During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the _____ test.

a. varus stress
b. valgus stress
c. Apley
d. Lachman
e. drawer

Answer 48

ANS: B

The injury described will most likely result in a medial meniscus or medial collateral ligament
damage. Your initial assessment would be to apply the valgus stress test to assess the medial
meniscus.

Question 49

Term infants normally resist

a. ankle dorsiflexion.
b. McMurray test.
c. forefoot adduction.
d. knee extension.
e. elbow flexion.

Answer 49

ANS: D

Along with elbows and hips, newborns tend to resist extension of the knee; however, movements should be symmetrical.

Question 50

What technique is performed at every infant examination during the first year of life to detect hip dislocation?

a. Ballottement maneuvers
b. Barlow-Ortolani maneuvers
c. Range of motion
d. Thomas McMurray assessment
e. Trendelenburg test

Answer 50

ANS: B
At every examination during an infant’s first year of life, the Barlow-Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation and is signified by a clicking noise with the maneuver.

Question 51

You note that a child has a positive Gower sign. You know that this indicates generalized

a. arthropathy.
b. muscle weakness.
c. bursitis.
d. muscle hypertrophy.
e. scoliosis.

Answer 51

ANS: B
Gower sign is generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee, pushing down on the thighs while trying to pull up the trunk. It is often associated with muscular dystrophy.

Question 52

A 3-year-old boy is brought to the clinic complaining of a painful right elbow. He is holding the right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of

a. radial head subluxation.
b. femoral anteversion.
c. carpal tunnel syndrome.
d. Osgood-Schlatter disease.
e. osteomyelitis.

Answer 52

ANS: A
The symptoms this child is experiencing are indicative of a radial head subluxation, or nursemaid’s elbow. The symptoms are not consistent with femoral anteversion, carpal tunnel syndrome, Osgood-Schlatter disease, or osteomyelitis.

Question 53

What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention?

a. Carpal tunnel syndrome
b. Osteitis deformans
c. Radial head subluxation
d. Talipes equinovarus
e. Legg-Calvé-Perthes disease

Answer 53

ANS: A
Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms of the syndrome.

Question 54

A red, hot swollen joint in a 40-year-old man should lead you to suspect

a. trauma.
b. bursitis.
c. gout.
d. cellulitis.
e. tenosynovitis.

Answer 54

ANS: C
Gout is characterized as red, hot swollen joints, especially the great toe. Gout is commonly linked to men older than 40 years.

Question 55

An adult with bowed tibias and a shortened thorax may have

a. ankylosing spondylitis.
b. Paget disease.
c. rheumatoid arthritis.
d. Dupuytren contracture.
e. Sprengel deformity.

Answer 55

ANS: B

Paget disease is characterized by bowed tibias, asymmetric skull, shortened chest, and susceptibility to fractures.

Question 56

In differentiating osteoarthritis from rheumatoid arthritis (RA), the patient with osteoarthritis typically exhibits

a. metatarsus adductus.
b. depression.
c. sudden onset.
d. less weakness and fatigue.
e. pain most pronounced after periods of rest.

Answer 56

ANS: D
One of the key differences between the symptoms of osteoarthritis and those of RA is that fatigue is uncommon in osteoarthritis patients. The joints of patients with RA are stiff after rest.

Question 57

A 45-year-old laborer presents with low back pain, stating that the pain comes from the right buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression?

a. Positive straight leg raise result
b. Positive Trendelenburg sign
c. Negative Romberg test result
d. Contralateral straight leg raise result
e. Positive drawer test result

Answer 57

ANS: D
This patient, according to the pattern of radiculopathy, has an L3–L4 injury to the right side. The most alarming finding would be crossover pain to the affected leg while raising the unaffected leg because this finding is more suggestive of herniation.

Question 58

Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would perform a

a. startle reflex.
b. Barlow-Ortolani maneuver.
c. Trendelenburg test.
d. tibial torsion test.
e. Lachman test.

Answer 58

ANS: B
The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm results for hip dislocation.

Question 59

A 7-year-old child who begins to limp and complains of persistent hip pain may have

a. myelomeningocele.
b. Dupuytren contracture.
c. Legg-Calvé-Perthes disease.
d. osteoarthritis.
e. congenital hip dislocation.

Answer 59

ANS: C
Constant hip pain with a limp in a young child is indicative of Legg-Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by inadequate blood supply.
Myelomeningocele, Dupuytren contracture, osteoarthritis, and congenital hip dislocation are not
characterized by age group and these symptoms.

Question 60

Dupuytren contracture affects the

a. hip flexor muscle.
b. plantar fascia.
c. carpal tunnel.
d. palmar fascia.
e. rotator cuff.

Answer 60

ANS: D

A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture.

Question 61

A dowager hump is

a. the hallmark of osteoporosis.
b. pathognomic of scoliosis.
c. indicative of tendonitis.
d. characteristic of rickets.
e. indicative of muscular dystrophy.

Answer 61

ANS: A
Osteoporosis leads to vertebral compression and kyphotic bowing of the spine known as
dowager’s hump.