[Ex4] - C41 - AP

Question 1

41-1. The incidence of fractures of the pelvis is highest in:

a. preadolescent boys.
b. adolescent boys.
c. adolescent girls.
d. older adults.

Answer 1

ANS: D

The incidence of fractures of the upper femur, upper humerus, vertebrae, and pelvis is highest
in older adults and is often associated with osteoporosis. Fractures of healthy bones,
particularly the tibia, clavicle, and lower humerus, tend to occur in young persons and without
gender preference.

Question 2

41-2. A client is admitted to the hospital with a transverse fracture of the femur. Which statement
best describes this type of fracture?

a. The fracture line is parallel to the bone.
b. The fracture line is straight across the bone.
c. The fracture line is perpendicular to the bone.
d. The fracture line is vertical to the shaft of the bone.

Answer 2

ANS: B

A transverse fracture occurs straight across the bone. Such a fracture would not occur either
perpendicularly or vertically in relationship to the bone. A linear fracture runs parallel to the
long axis of the bone.

Question 3

41-3. A 70 year old diagnosed with osteoporosis fell and fractures the left leg at a location of
preexisting abnormality. Which term describes the fracture?

a. Fatigue
b. Stress
c. Pathologic
d. Greenstick

Answer 3

ANS: C

A pathologic fracture is a break at the site of a preexisting abnormality, usually by force such
as a fall that would not fracture a normal bone. A fatigue fracture is caused by abnormal stress
or torque applied to a bone with normal ability to deform and recover. Stress fractures occur
in normal or abnormal bone that is subjected to repeated stress, such as occurs during
athletics. A greenstick fracture perforates one cortex and splinters the spongy bone.

Question 4

41-4. A 32-year-old obese male begins a jogging routine. A week after beginning, he fractures his
leg. This is referred to as a what type of fracture?

a. Comminuted
b. Greenstick
c. Fatigue
d. Compound

Answer 4

ANS: C

A fatigue fracture is caused by abnormal stress or torque applied to a bone that usually occurs
in individuals who engage in a new activity, that is, both strenuous and repetitive. A
comminuted fracture is one in which a bone breaks into two or more fragments. A greenstick
fracture perforates one cortex and splinters the spongy bone. A compound fracture is a
complete and incomplete fracture that breaks through the skin.

Question 5

41-5. Transchondral fractures are most prevalent in:

a. adolescents.
b. older adults.
c. infants.
d. premenopausal females.

Answer 5

ANS: A

Transchondral fractures are most prevalent in adolescents. Such fractures are not associated
with older adults, infants, or premenopausal females.

Question 6

41-6. A 35 year old suffers a broken clavicle following a motor vehicle accident. X-ray reveals that
the bone surfaces in the joint partially lost contact with each other. This condition is called:

a. dislocation.
b. subluxation.
c. distortion.
d. nonunion.

Answer 6

ANS: B

Subluxation occurs when contact between the opposing joint surfaces of a fracture are
partially lost. Dislocation is the displacement of one or more bones in a joint in which the
opposing joint surfaces lose contact entirely. Distortion is not a term applicable to fracture
healing. Nonunion is failure of the bone ends to grow together.

Question 7

41-7. What term is used to describe a torn ligament?

a. Sprain
b. Strain
c. Disunion
d. Subluxation

Answer 7

ANS: A

A torn ligament is also called a sprain. Tearing or stretching of a muscle or tendon is
commonly known as a strain. Disunion occurs when fracture ends fail to heal. Subluxation
occurs when contact between the opposing joint surfaces of a fracture are partially lost.

Question 8

41-8. A 36 year old reports pain and weakness in the elbow. MRI reveals inflammation of the
tendon and the presence of microtears where it attaches to bone. This condition is called:

a. periostitis.
b. muscle strain.
c. bursitis.
d. epicondylopathy.

Answer 8

ANS: D

When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known
as epicondylopathy. Such an injury is not referred to as periostitis which involves the presence
of inflammation. Muscle strain is local muscle damage that occurs when the muscle is
stretched beyond capacity. Bursitis is inflammation of the bursae.

Question 9

41-9. Which clinical finding would be expected in the patient with rhabdomyolysis?

a. Sweating
b. Dark urine
c. Yellow color to the skin
d. Lower extremity swelling

Answer 9

ANS: B

A classic triad of muscle pain, weakness, and dark urine is considered typical of
rhabdomyolysis. Neither sweating, yellow skin, nor lower extremity swelling is associated
with rhabdomyolysis.

Question 10

41-10. The diagnosis of rhabdomyolysis is based on the measurement of which laboratory value?

a. White blood cell count (WBC)
b. Antinuclear antibodies
c. Aspartate aminotransferase
d. Creatine kinase (CK)

Answer 10

ANS: D

The most important and clinically useful measurement in rhabdomyolysis is serum CK. A
level five times the upper limit of normal (about 1000 units per liter) is used to identify
rhabdomyolysis. While the other options may be measured, they are not used as diagnostic
criteria.

Question 11

41-11. A 70-year-old female presents with a hip fracture secondary to osteoporosis. This condition is
caused by an increase in bone:

a. density.
b. formation.
c. resorption.
d. mineralization.

Answer 11

ANS: C

In osteoporosis, old bone is being resorbed faster than new bone is being made, causing the
bones to lose density, becoming thinner, and more porous. Mineralization is not increased by
osteoporosis.

Question 12

41-12. When a 70-year-old female presents with a hip fracture, she is diagnosed with osteoporosis.
One factor that most likely contributed to her condition is:

a. increased androgen levels.
b. decreased estrogen levels.
c. strenuous exercise.
d. excessive dietary calcium.

Answer 12

ANS: B

Osteoporosis can be attributed to decreased estrogen levels. Osteoporosis is not attributed to
increased androgen levels, excessive exercise, or excessive dietary calcium.

Question 13

41-13. Osteomalacia is a result of:

a. collagen breakdown in the bone matrix.
b. excessive bone resorption.
c. crowding of bone marrow by excessive bone growth.
d. inadequate bone mineralization.

Answer 13

ANS: D

Osteomalacia is a metabolic disease characterized by inadequate and delayed bone
mineralization of osteoid in mature compact and spongy bone. Idiopathic osteoarthritis leads
to collagen breakdown. Giant cell tumors promote excessive bone resorption. Abnormal
remodeling causes crowding of bone marrow.

Question 14

41-14. A 56-year-old male was admitted to the hospital with a diagnosis of osteomalacia. History
reveals that he underwent bariatric surgery 3 years earlier. What is the common link between
the surgery and the development of osteomalacia?

a. Impaired phosphate absorption
b. Increased calcium excretion
c. Vitamin D deficiency
d. Impaired vitamin C metabolism

Answer 14

ANS: C

Impaired nutrient absorption from bariatric surgery can result in vitamin D deficiency.
Vitamin D deficiency is the most important factor in the development of osteomalacia.
Neither impaired phosphate absorption, increased calcium excretion, nor impaired vitamin C
metabolism is a cause of osteomalacia.

Question 15

41-15. A disorder similar to osteomalacia that occurs in growing bones of children is termed:

a. Paget disease.
b. rickets.
c. osteomyelitis.
d. osteosarcoma.

Answer 15

ANS: B

Abnormal bone growth in children is termed rickets. Paget disease is a state of increased
metabolic activity in bone characterized by abnormal and excessive bone remodeling, both
resorption and formation. Osteomyelitis is a bone infection while osteosarcoma is a form of
bone cancer.

Question 16

41-16. The cause of Paget disease is:

a. fluoride deficiency.
b. unknown at present.
c. excess vitamin A.
d. osteogenic sarcoma.

Answer 16

ANS: B

The cause of Paget disease is unknown, but studies have implicated both genetic and
environmental factors. There is no known association between Paget disease and fluoride
deficiency, excess vitamin A, or osteosarcoma.

Question 17

41-17. What is the primary organism responsible for osteomyelitis?

a. Staphylococcus aureus
b. Salmonella
c. Mycobacterium
d. Haemophilus influenza

Answer 17

ANS: A

Staphylococcus aureus remains the primary microorganism responsible for osteomyelitis.
While the other options are possible causes, they are not as predominant as is S. aureus.

Question 18

41-18. Osteoarthritis, a degenerative joint disease, is characterized by loss of:

a. the epiphyses.
b. articular cartilage.
c. synovial fluid.
d. the joint capsule.

Answer 18

ANS: B

Osteoarthritis is caused by loss of the articular cartilage. It is not associated with the epiphyses
of bones, synovial fluid, or the joint capsule.

Question 19

41-19. Researchers now believe that rheumatoid arthritis (RA) is a result of:

a. an ineffective antiviral agent.
b. an autoimmune disease.
c. a complication of rheumatic fever.
d. a superficial joint injury.

Answer 19

ANS: B

RA is now thought to be an autoimmune disease. There is no proof that RA is associated with
ineffective antiviral therapy, rheumatic fever, or joint injuries.

Question 20

41-20. A 34-year-old female was recently diagnosed with rheumatoid arthritis (RA). Physical
examination revealed that inflammation is noted in various:

a. synovial membranes.
b. short bones.
c. subchondral bones.
d. bursae sacs.

Answer 20

ANS: A

Inflammation of RA starts in the synovial membrane. The inflammation is not associated with
short bones, subchondral bones, or bursae sacs.

Question 21

41-21. A 54-year-old male was recently diagnosed with rheumatoid arthritis (RA). Which of the
following is the expected treatment of choice?

a. Nonsteroidal anti-inflammatory drugs (NSAIDs)
b. Gold salts
c. Methotrexate
d. Colchicine

Answer 21

ANS: C

Methotrexate remains the first line of treatment for RA. Neither NSAIDs, gold salts, nor
colchicine is a treatment of choice for RA.

Question 22

41-22. A 21 year old is diagnosed with ankylosing spondylitis (AS). The most likely joint to be
affected would be the:

a. sacroiliac.
b. carpal.
c. shoulder.
d. knee.

Answer 22

ANS: A

AS is a chronic, inflammatory joint disease characterized by stiffening and fusion (ankylosis)
of the spine and sacroiliac joints. AS is not associated initially with the carpal joints, the
shoulder, or the knees.

Question 23

41-23. Which of the following people is at highest risk for the development of gout?

a. Men aged 40–50 years
b. Premenopausal women
c. Male adolescents
d. Female children

Answer 23

ANS: A

People at highest risk for gout are men aged 40–50 years of age. Gout is rare in children,
adolescent males, and premenopausal women.

Question 24

41-24. The inflammatory symptoms of classic gouty arthritis are caused by the crystallization of
_____ within the synovial fluid.

a. purines
b. pyrimidines
c. monosodium urate
d. acetic acid

Answer 24

ANS: C

In classic gouty arthritis, monosodium urate crystals form and are deposited in joints and their
surrounding tissues, initiating a powerful inflammatory response. Uric acid is a result of
purine metabolism, but purine is not present in the joint. Gout is not caused by an increase in
pyrimidines or acetic acid.

Question 25

41-25. A 46-year-old male diagnosed with gouty arthritis is at high risk for developing:

a. cholelithiasis.
b. myocarditis.
c. renal stones.
d. liver failure.

Answer 25

ANS: C

Renal stones are 1000 times more prevalent in individuals with primary gout than in the
general population. Gouty arthritis does not appear to increase the risk for the development of
cholelithiasis, myocarditis, or liver failure.

Question 26

41-26. What is the most common aggravating trigger of gouty arthritis attacks?

a. Trauma
b. Anemia
c. High-fat foods
d. Lack of exercise

Answer 26

ANS: A

Trauma is the most common aggravating factor of an acute gouty exacerbation. Gout is not
triggered by anemia or lack of exercise. Gout is not caused by high-fat foods, but rather
high-purine foods.

Question 27

41-27. The chronic stage of gout, characterized by crystalline deposits in cartilage, synovial
membranes, and soft tissue, is called:

a. monoarticular arthritis.
b. tophaceous gout.
c. asymptomatic hyperuricemia.
d. complicated gout.

Answer 27

ANS: B

Tophaceous gout is the third and chronic stage of the disease. It is characterized by a
progressive inability to excrete uric acid, which expands the urate pool. This causes urate
crystal deposits (tophi) to appear in cartilage, synovial membranes, tendons, and soft tissue.
The characteristic crystalline deposits are not associated with monarticular or complicated
gout. Asymptomatic hyperuricemia would not lead to crystalline deposits.

Question 28

41-28. A 32-year-old male was injured in a motor vehicle accident and confined to bed for 3 weeks.
During this time, the size and strength of muscle fibers decreased, a condition referred to as:

a. myelodysplasia.
b. ischemic atrophy.
c. disuse atrophy.
d. fibromyalgia.

Answer 28

ANS: C

The term disuse atrophy describes the pathologic reduction in normal size of muscle fibers
after prolonged inactivity from bed rest, trauma (casting), or local nerve damage as can be
seen with spinal cord trauma or polio. Ischemic atrophy is due to decreased blood flow. Such
an experience would not result in either myelodysplasia or fibromyalgia.

Question 29

41-29. Fibromyalgia is a chronic musculoskeletal disorder characterized by:

a. pain resulting from joint and muscle inflammation.
b. muscle pain in the back and gastrointestinal symptoms.
c. neurologic pain in the skeletal muscles.
d. diffuse pain, fatigue, and tender points.

Answer 29

ANS: D

Fibromyalgia is characterized by diffuse pain, fatigue, and point tenderness and the absence of
systemic or localized inflammation. Fibromyalgia is not related to specific back pain and is
not manifested by gastrointestinal upset. Nor is it related to neurologic pain in muscles.

Question 30

41-30. The most common cause of toxic myopathy is:

a. infection.
b. a tumor.
c. alcoholism.
d. osteoporosis.

Answer 30

ANS: C

Alcohol remains the most common cause of toxic myopathy.

Question 31

41-31. A malignant tumor of striated muscle tissue origin commonly found on the neck is called a:

a. myelogenic tumor.
b. giant cell tumor.
c. rhabdomyosarcoma.
d. rhabdomyoma.

Answer 31

ANS: C

The malignant tumor of striated muscle is called rhabdomyosarcoma. They are located in the
muscle tissue of the head, neck, and genitourinary tract in 75% of cases. Myelogenic tumors
originate from various bone marrow cells. Giant cell tumor is the sixth most common of the
primary bone tumors. A rhabdomyoma is an extremely rare benign tumor of muscle that
generally occurs in the tongue.

Question 32

41-32. A 60-year-old male presents with swelling and pain in the knee. CT reveals a tumor has
developed from a preexisting benign bone lesion. This supports which diagnosis?

a. Secondary chondrosarcoma
b. Rhabdomyoma
c. Rhabdomyosarcoma
d. Fibrosarcoma

Answer 32

ANS: A

Chondrosarcoma is the second most common primary malignant bone tumor and is a tumor of
middle-aged and older adults. Chondrosarcomas that develop from a preexisting benign bone
lesion are known as secondary chondrosarcomas. Rhabdomyoma is an extremely rare benign
tumor of muscle that generally occurs in the tongue. The malignant tumor of striated muscle is
called rhabdomyosarcoma. A fibrosarcoma is a solitary tumor that most often affects the
metaphyseal region of the femur or tibia.