Musculoskeletal

Question 1

Define CMS.

Answer 1

Circulation, motion, sensation; neurovascular check

Question 2

Which physiologic changes normally occur with age?

Answer 2

Muscle atrophy, decreased bone density, muscle weakness, decreased synovial fluid, decreased tissue over bony prominences, slower nerve reaction time

Question 3

Define osteoporosis.

Answer 3

Chronic metabolic disease characterized by decreased bone density.

Question 4

Where does hematopoeisis take place?

Answer 4

In the red marrow

Question 5

Which part of the bone stores fat cells?

Answer 5

Yellow marrow

Question 6

What is one major life-threatening complication caused by a break in a bone?

Answer 6

Fat embolism syndrome (FES); can occur when the yellow marrow is exposed

Question 7

Define osteoclasts.

Answer 7

Bone-destroying cells

Question 8

Define osteoblasts.

Answer 8

Bone-forming cells

Question 9

Define kyphosis.

Answer 9

Curvature of the thoracic (upper) vertebrae

Question 10

Define lordosis.

Answer 10

Curvature of the lumbar (lower) vertebrae

Question 11

Define scoliosis.

Answer 11

A lateral (S-shaped) curve of the vertebrae

Question 12

By what age is peak bone mass usually achieved?

Answer 12

30

Question 13

Where is the most common site for musculoskeletal injury?

Answer 13

Joints with synovial fluid

Question 14

In Gordon’s Functional Health Patterns, what does a level 0 represent?

Answer 14

Patient is able to provide full self-care

Question 15

In Gordon’s Functional Health Patterns, what does a level 4 represent?

Answer 15

Patient is dependent and does not participate in self-care

Question 16

In Lovett’s muscle scale, what does a level 0 represent?

Answer 16

No joint motion with no evidence of muscle contractility

Question 17

In Lovett’s muscle scale, what does a level 5 represent?

Answer 17

ROM is unimpaired against gravity with full resistance

Question 18

For a patient with osteoporosis, which lab value abnormalities would you expect to see?

Answer 18

Decreased calcium

Question 19

For a patient with osteomalacia, which lab value abnormalities would you expect to see?

Answer 19

Decreased calcium, decreased vitamin D, decreased phosphorus, elevated alkaline phosphatase (ALP)

Question 20

For a patient with paget’s disease, which lab value abnormalities would you expect to see?

Answer 20

Elevated alkaline phosphatase (ALP)

Question 21

For a patient with muscular dystrophy, which lab value abnormalities would you expect to see?

Answer 21

Elevated creatine kinase (CK), elevated aspartate aminotransferase (AST), elevated lactic dehydrogenase (LDH), elevated aldolase (ALD)

Question 22

For a patient with bone cancer, which lab value abnormalities would you expect to see?

Answer 22

Elevated calcium, elevated alkaline phosphatase (ALP)

Question 23

For a patient with bone fractures in the healing stage, which lab value abnormalities would you expect to see?

Answer 23

Elevated calcium, elevated phosphorus

Question 24

For a patient with muscle trauma, which lab value abnormalities would you expect to see?

Answer 24

Elevated creatine kinase (CK), elevated aspartate aminotransferase (AST)

Question 25

Why would a CT or MRI with contrast be contraindicated?

Answer 25

If the patient has an allergy to shellfish or iodine

Question 26

Why would an MRI be contraindicated?

Answer 26

If the patient has any irremovable metal in the body(eg. pacemaker, metal hip implant)

Question 27

Define osteoporosis.

Answer 27

Loss of bone density

Question 28

Define osteomalacia.

Answer 28

Demineralized bone

Question 29

Which blood markers may indicate osteoporosis?

Answer 29

N-teleopeptide (NTX) and C-teleopeptide (CTX)

Question 30

What is the single most effective exercise for osteoporosis prevention?

Answer 30

Walking for 30 minutes 3-5 times per week

Question 31

What types of foods containing calcium and vitamin D can you recommend to a person who is lactose intolerant?

Answer 31

Soy and fortified rice products

Question 32

What type of supplement is oscal?

Answer 32

Calcium supplement

Question 33

What type of patient teaching is essential for a patient taking oscal?

Answer 33

Drink lots of water (to prevent kidney damage)

Question 34

Why would a patient be prescribed a bisphosphonate such as Fosamax, Boniva or Actonel?

Answer 34

For prevention and treatment of osteoporosis

Question 35

What type of patient teaching is necessary for a patient taking a bisphosphonate?

Answer 35

Drink lots of water (to prevent kidney damage), take early in morning, sit up for 30-60 minutes after taking (to prevent esophageal irritation)

Question 36

What serious complications are related to Aredia and Reclast?

Answer 36

Osteonecrosis (jaw bone death)

Question 37

What contraindication is applied to selective estrogen receptor modulators (SERMs)?

Answer 37

Hx of thromboembolism

Question 38

What is Forteo and what is it indicated for?

Answer 38

Bone-building agent for treatment of osteoporosis of post-menopausal women with high risk of fracture

Question 39

What is calcitonin?

Answer 39

A thyroid hormone that inhibits osteoclastic activity

Question 40

What foods type of foods are good sources of vitamin D?

Answer 40

Eggs, chicken, liver, dairy

Question 41

What is ergocalciferol?

Answer 41

Vitamin D supplement

Question 42

Define exogenous osteomyelitis.

Answer 42

Infection of the bone from an outside source (eg. from stab wound)

Question 43

Define endogenous osteomyelitis.

Answer 43

Infection of the bone from an inside source (eg. from uti)

Question 44

Define contiguous osteomyelitis.

Answer 44

Infection of the bone from an adjacent tissue

Question 45

Which lab value abnormalities would you expect to see in a patient with osteomyelitis?

Answer 45

Elevated ESR, elevated WBC, elevated CRP

Question 46

In which populations might you see a muted reaction to osteomyelitis?

Answer 46

Immune compromised (HIV, RA), elderly

Question 47

How is osteomyelitis treated?

Answer 47

With antibiotics or hyperbaric oxygen (for special cases only)

Question 48

Which symptoms would you expect to see in a patient with osteosarcoma?

Answer 48

Leukocytosis, fever, anemia

Question 49

Which serious complication can be seen in crush syndrome?

Answer 49

Kidney failure; rhabdomyolosis (release of myoglobin from muscles to circulation) can occlude distal renal tubules and cause kidney failure

Question 50

Which symptoms are seen in a patient with fat embolism syndrome (FES)?

Answer 50

Altered mental status (earliest symptom), followed by respiratory distress and petechiae on the upper body (late symptom)

Question 51

Which lab value abnormalities would you expect to see in a patient with rheumatoid arthritis?

Answer 51

Positive ANA, positive rheumatoid factor

Question 52

What is the earliest sign of infection in elderly patients?

Answer 52

Change in mentation

Question 53

What effect does immunesuppressive agents (eg. methotrexate) have on the body?

Answer 53

They suppress bone marrow to reduce the immune response

Question 54

What effect do corticosteroids (eg. prednisone) have on the body?

Answer 54

They decrease inflammatory and immune responses by decreasing the WBC count