Chapter 22: Musculoskeletal System

Question 1

The type of joint that has the widest range of motion in all planes is the
a. ball-and-socket.
b. condyloid.
c. gliding.
d. saddle.

Answer 1

ANS: A
The ball-and-socket joint is the joint that has the widest range of motion (e.g., the hip joint). A
condyloid joint may only move in two planes. A gliding joint is only able to glide. A saddle
joint has no axial rotation.

Question 2

Spinal vertebrae are separated from each other by
a. bursae.
b. tendons.
c. disks.
d. ligaments.

Answer 2

ANS: C
Except for sacral vertebrae, the spinal vertebrae are separated from one another by disks.
Spinal movement is achieved by paraspinous muscles, tendons, and ligaments. Bursae are
located in the knee, elbow, shoulder, and hip.

Question 3

The joint where the humerus, radius, and ulna articulate is the
a. wrist.
b. elbow.
c. shoulder.
d. clavicle.

Answer 3

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

Question 4

The articulation of the radius and carpal bones is the
a. wrist.
b. elbow.
c. shoulder.
d. clavicle.

Answer 4

ANS: A
The joint comprising the radius and carpal bones is called the wrist.

Question 5

The tibia, fibula, and talus articulate to form the
a. ankle.
b. knee.
c. hip.
d. pelvis.

Answer 5

ANS: A
The tibia, fibula, and talus (or heel) join to form the ankle.

Question 6

Long bones in children have growth plates known as
a. epiphyses.
b. epicondyles.
c. synovium.
d. fossae.

Answer 6

ANS: A
Epiphyses are the growth plates found in long bones in children

Question 7

The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are the result
of
a. decreased mineral deposition.
b. increased hormone secretion.
c. uterine enlargement.
d. gait changes.

Answer 7

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 8

Skeletal changes in older adults are the result of
a. increased bone deposition.
b. increased bone resorption.
c. decreased bone deposition.
d. decreased bone resorption.

Answer 8

ANS: B
With age, the skeletal system changes. One of the dramatic changes in skeletal equilibrium is
that bone resorption dominates bone deposition

Question 9

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.

Answer 9

ANS: C
An important history to obtain for a patient with joint pain would be family history of genetic
disorders, such as ost

Question 10

Risk factors for sports-related injuries include
a. competing in colder climates.
b. previous fracture.
c. history of recent weight loss.
d. failure to warm up before activity.

Answer 10

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.

Question 11

Light skin and thin body habitus are risk factors for
a. rheumatoid arthritis.
b. osteoarthritis.
c. congenital bony defects.
d. osteoporosis.

Answer 11

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

Question 12

Inquiry about nocturnal muscle spasms would be most significant when taking the
musculoskeletal history of
a. adolescents.
b. infants.
c. older adults.
d. middle-age adults.

Answer 12

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 13

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.

Answer 13

ANS: A
When the patient first walks in the room, the examiner should be observing his or her gait and
posture as part of the musculoskeletal examination.

Question 14

Fasciculation occurs after injury to a muscle’s
a. venous return.
b. motor neuron.
c. strength.
d. tendon.

Answer 14

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 15

The physical assessment technique most frequently used to assess joint symmetry is
a. inspection.
b. palpation.
c. percussion.
d. the use of joint calipers.

Answer 15

ANS: A
The assessment technique most commonly used to assess joint symmetry is inspection.

Question 16

A goniometer is used to assess
a. bone maturity.
b. joint proportions.
c. range of motion.
d. muscle strength.

Answer 16

ANS: C
The angle of a joint can be accurately measured by using a goniometer. A goniometer is used
when the joint range of motion is beyond normal limits.

Question 17

When palpating joints, crepitus may occur 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.

Answer 17

ANS: A
Crepitus is felt or heard when irregular bony surfaces rub together.

Question 18

The temporomandibular joint is palpated
a. under the mandible, anterior to the sternocleidomastoid muscle.
b. above the mandible at midline.
c. anterior to the tragus.
d. at the mastoid process.

Answer 18

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

Question 19

The temporalis and masseter muscles are evaluated by
a. having the patient shrug his or her shoulders.
b. having the patient clench his or her teeth.
c. asking the patient to fully extend his or her neck.
d. passively opening the patient’s jaw.

Answer 19

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

Question 20

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.

Answer 20

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

Question 21

Expected normal findings during the inspection of spinal alignment include
a. asymmetric skin folds at the neck.
b. slight right-sided scapular elevation.
c. concave lumbar curve.
d. the head positioned superiorly to the gluteal cleft.

Answer 21

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 symmetric, the scapulae are at even
heights, and both the cervical and lumbar curves are convex.

Question 22

A common finding in markedly obese patients and pregnant women is
a. kyphosis.
b. lordosis.
c. paraphimosis.
d. scoliosis.

Answer 22

ANS: B
Bowing of the back, or lordosis, is more commonly found in pregnant women or obese
patients because of an altered center of gravity. Kyphosis is more commonly seen in older
adults. Paraphimosis is a penile condition. Scoliosis is more commonly seen in teenagers.

Question 23

A wheelchair-dependent older woman would most likely develop skin breakdown at
a. C7.
b. the iliac crests.
c. L4.
d. the gibbus.

Answer 23

ANS: D
This older woman, most likely kyphotic from osteoporosis, would have the greatest friction
point at the gibbus. The gibbus results from collapsed vertebrae, resulting in a sharp, pointy
deformity of the back. C7 and L4 remain as concave curves, with less friction. The iliac crests
would not protrude as far as the gibbus.

Question 24

When the patient flexes forward at the waist, which spinal observation would lead you to
suspect scoliosis?
a. Prominent lumbar hump
b. Prominent cervical concave curve
c. Lateral curvature of the spine
d. Restricted ability to flex at the hips

Answer 24

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 25

When a patient abducts an arm and the ipsilateral scapula becomes more prominent (winged),
this usually means that
a. there has been an injury to the nerve of the anterior serratus muscle.
b. one of the clavicles has been fractured.
c. there is a unilateral trapezius muscle separation.
d. one shoulder is dislocated.

Answer 25

ANS: A
If the long thoracic nerve is damaged or bruised, it can cause paralysis of the serratus anterior muscle and winging of the scapula, or shoulder blade. This is not a symptom of a fractured
clavicle or trapezius muscle separation. A dislocated shoulder would result in a hollowing
effect.

Question 26

When the shoulder contour is asymmetric and one shoulder has hollows in the rounding
contour, you would suspect
a. kyphosis.
b. fractured scapula.
c. a dislocated shoulder.
d. muscle wasting.

Answer 26

ANS: C
Asymmetric 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 and a scapular
fracture do not present with these symptoms.

Question 27

Ulnar deviation and swan neck deformities are characteristics of
a. rheumatoid arthritis.
b. osteoarthritis.
c. osteoporosis.
d. congenital defects.

Answer 27

ANS: A
Deviation of the fingers toward the ulnar side and swan neck deformities are classic
symptoms of rheumatoid arthritis. Osteoarthritis, congenital defects, and osteoporosis do not
present with these symptoms.

Question 28

A finding that is indicative of osteoarthritis is (are)
a. swan neck deformities.
b. Bouchard nodes.
c. ganglions.
d. Heberden nodes.

Answer 28

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; ganglions are present in nerve conditions.

Question 29

Carpal tunnel syndrome would result in
a. a negative Tinel sign.
b. a negative Phalen test.
c. reduced abduction of the thumb.
d. palm tingling.

Answer 29

ANS: C
Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign,
positive Phalen test, reduced abduction of the thumb, and sparing of palm tingling

Question 30

Cardinal signs for rheumatoid disorders include which of the following? (Select all that
apply.)
a. Gradual onset
b. Weakness that is usually localized and not severe
c. Coarse crepitus on motion
d. Joint tenderness
e. Sleep disturbance

Answer 30

ANS: A, D, E
Hallmark signs of rheumatoid arthritis are gradual onset of stiffness for 1 hour after rising,
sleep disturbance, joint tenderness, and medium to fine crepitus.

Question 31

The wrist moves in (Select all that apply.)
a. eversion and inversion.
b. proximal radius and ulna articulation.
c. flexion and extension.
d. adduction and abduction.

Answer 31

ANS: C, D
The wrist movement is in two planes, flexion and extension or radial and ulnar rotation.
Adduction and abduction are for shoulder and hip joints, and eversion and inversion are for
ankle movement.