Chapter 45 Flashcards
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.
c. A fracture that happens at the site of an abnormality already in that bone.
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
a. Stress
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
b. Reduction and immobilization
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.
d. The bone is not straight.
Which structure attaches skeletal muscle to bone?
a. Tendon
b. Ligament
c. Bursa
d. Mesentery
a. Tendon
What is the tear in a ligament referred to as?
a. Fracture
b. Strain
c. Disunion
d. Sprain
d. Sprain
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
a. Lateral epicondylopathy
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
b. Sharp and localized, persisting over the distribution of the tendon or ligament
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
d. Release of myoglobin from damaged striated muscle cells
Which pathophysiologic alteration precedes crush syndrome after prolonged muscle
compression?
a. Muscle ischemia
b. Myoglobinuria
c. Volkmann contracture
d. Neural injury
b. Myoglobinuria
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%
a. 30%
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
b. Osteoporosis
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
b. Regional
In osteoporosis, the receptor activator of nuclear factor B (RANK) activates what?
a. Osteoclast apoptosis
b. Osteoblast survival
c. Osteoprotegerin
d. Osteoclast survival
d. Osteoclast survival
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
a. Increased oxidative stress and increased intracellular reactive oxygen species
Which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on
osteoclasts?
a. Parathyroid hormone
b. Glucocorticoid
c. Growth hormone
d. Estrogen
d. Estrogen
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
a. Order a serum creatine kinase (CK) level
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
a. Bone deformity
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.”
b. “It is a problem with bone resorption and formation.”
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.
d. Bacteria are walled off by macrophages and T lymphocytes; consequently, the
antibiotics cannot penetrate the infected area.
Bone death as a result of osteomyelitis is due to what?
a. Formation of immune complexes at the site of infection
b. Localized ischemia
c. Tumor necrosis factor-alpha (TNF-) and interleukin 1 (IL-1)
d. Impaired nerve innervation at the site of infection
b. Localized ischemia
A student studying osteomyelitis and asks for an explanation of the term “sequestrum.” What
response by the professor is best?
a. An area of devascularized and devitalized bone
b. An enzyme that phagocytizes necrotic bone
c. A subperiosteal abscess
d. A layer of new bone surrounding the infected bone
a. An area of devascularized and devitalized bone
A patient in the clinic had a femur x-ray that was read as having a “moth-eaten” appearance.
What treatment option does the health care professional discuss with the patient?
a. Limb-salvaging surgery
b. Amputation
c. Oral bisphosphonates
d. Calcium and vitamin D supplements
a. Limb-salvaging surgery
Which statement accurately describes a characteristic of osteosarcoma?
a. Slow-growing tumor that begins in the bone marrow and infiltrates the trabeculae
b. Solitary tumor that most often affects the metaphyseal region of the femur or tibia
c. Aggressive tumor most often found in the bone marrow of long bones
d. Tumor that infiltrates the trabeculae in spongy bone and implants in surrounding
tissue by seeding
c. Aggressive tumor most often found in the bone marrow of long bones
A professor has taught the class about giant cell bone tumors. Which statement by a student
would require the professor to review the material?
a. Giant cell tumors are an overexpression of genes including osteoprotegerin ligand
(OPGL).
b. The tumors are malignant, solitary, and irregularly shaped.
c. Giant cell tumors are typically located in the epiphysis in the femur, tibia, radius,
and humerus.
d. They are slow-growing tumors that extend over the articular cartilage.
b. The tumors are malignant, solitary, and irregularly shaped.
Which patient finding would lead the health care professional to assess the patient for
inflammatory joint disease?
a. Unilateral joint involvement
b. Normal joint synovial fluid
c. Absence of synovial membrane inflammation
d. Systemic symptoms of inflammation
d. Systemic symptoms of inflammation
What is a primary defect in osteoarthritis?
a. Stromelysin and acid metalloproteinase breakdown articular cartilage.
b. Immunoglobulin G (IgG) destroys the synovial membrane.
c. Synovial membranes become inflamed.
d. Cartilage-coated osteophytes create bone spurs.
a. Stromelysin and acid metalloproteinase breakdown articular cartilage.
A patient reports joint stiffness with movement and joint pain in weightbearing joints that is
usually relieved by rest. What treatment option does the health care professional discuss with the
patient?
a. Ways to decrease serum uric acid
b. Administration of oral methotrexate
c. Exercise and weight reduction
d. Rapid intravenous hydration
c. Exercise and weight reduction
A patient has ankylosing spondylitis. Which description of this condition by the health care
professional is most accurate?
a. Chronic inflammatory disease with stiffening and fusion of the spine and sacroiliac
joints
b. Chronic systemic inflammatory disease that affects many tissues and organs
c. State of abnormal and excessive bone resorption and formation
d. Wide-spread and deep chronic muscle pain, fatigue, and tender points
a. Chronic inflammatory disease with stiffening and fusion of the spine and sacroiliac
joints
What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)?
a. Inflammation of the bursa
b. Inflammation of the long bones
c. Inflammation of fibrocartilaginous joints of the vertebrae
d. Inflammation of the small hand and feet bones
c. Inflammation of fibrocartilaginous joints of the vertebrae
A person in the health care clinic has gout. In order to prevent a common complication, what
self-care measure does the health care professional teach the person about?
a. Drinking plenty of water
b. Splinting affected joints
c. Eating more protein
d. Avoiding hot weather
a. Drinking plenty of water
What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis?
a. Reduced excretion of purines
b. Overproduction of uric acid
c. Increase in the glycosaminoglycan levels
d. Overproduction of proteoglycans
b. Overproduction of uric acid
The pathophysiologic presentation of gout is closely linked to the metabolism of which
chemical?
a. Purine
b. Pyrimidine
c. Vitamin E
d. Amino acid
a. Purine
A patient in the clinic is worried about having fibromyalgia. For which symptoms should the
health care professional assess the patient for?
a. Hot, tender, and edematous muscle groups bilaterally
b. Fasciculations of the upper and lower extremity muscles
c. Exercise intolerance and painful muscle cramps
d. Sensitivity at tender points and profound fatigue
d. Sensitivity at tender points and profound fatigue
A health care professional is teaching a group of college women about increasing calcium in the
diet to prevent osteoporosis. A participant asks at what age is peak bone mass is reached in
women. What response is best?
a. 15 years
b. 20 years
c. 30 years
d. 35 years
c. 30 years
What event is associated with the beginning of bone loss in women?
a. Puberty
b. Sexual activity
c. Childbirth
d. Menopause
d. Menopause
A patient in the clinic has calcium crystals that are associated with chronic gout. How does the
professional document this finding?
a. Stones
b. Spurs
c. Tophi
d. Nodes
c. Tophi
