Unit 6: Ch 49 (Porth's 5th Ed) - Disorders of Musculoskeletal Function: Developmental and Metabolism Disorders Flashcards
- Which of the following is an aspect of the bone growth and development that occurs
during the first two decades of life?
A) Most bone abnormalities can be traced to anomalies in the embryonic stage of
development.
B) The physiological effects of in utero positioning normally remain into late
adolescence.
C) Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells.
D) Bone length increases through childhood, while bone diameter remains static.
Ans: C
Feedback:
During development, the mature and enlarged cartilage cells at the metaphyseal end of
the plate become metabolically inactive and are replaced by bone cells. This process
allows bone growth to proceed without changing the shape of the bone or causing
disruption of the articular cartilage. Abnormalities linked to the embryonic stage of
development are uncommon, and the physiological effects of in utero positioning
resolve by 3 to 4 years. Both length and diameter of bones increase during development.
- A female toddler has been diagnosed with toeing-in (metatarsus adductus). What
teaching should the pediatrician provide to the parents of the child about her diagnosis?
A) “She will likely walk later than most children, but it will resolve itself with time.”
B) “We’ll likely need to start putting the first of a series of casts on her legs quite
soon.”
C) “The best time to perform surgery thats needed will be at age 3 or 4.”
D) “While there’s no effective treatment for her toeing-in, most children learn to
accommodate the problem and walk independently.”
Ans: B
Feedback:
Toeing-in, regardless of staging, requires some form of intervention, most commonly
braces or casts. Treatment is not noted to include surgery, and spontaneous resolution is
not common.
- When a 4-year-old boy stands erect with his medial malleoli touching, the distance
between his knees is 2 inches. What is the child’s most likely diagnosis and treatment?
A) Genu varum, which can be treated by bracing
B) Flatfoot, which will require orthopedic shoes
C) Genu valgum necessitating a series of surgeries
D) Femoral torsion, which will spontaneously resolve before puberty
Ans: A
Feedback:
Genu varum, or bowlegs, can be treated by bracing. The child’s stance is not indicative
of flatfoot, genu valgum, or femoral torsion.
- Following genetic testing and a thorough history from the child’s mother and father, a
5-month-old boy has been diagnosed with osteogenesis imperfecta. What teaching point
should the care team provide to the mother and father?
A) “His skeleton is prone to breakage, and we’ll begin hormone therapy to treat this.”
B) “His hips are extremely susceptible to dislocation, so rough play is out of the
question.”
C) “You’ll need to commit to calcium supplementation for the duration of his
development.”
D) “You’ll need to be very careful to avoid causing fractures to his fragile bones.”
Ans: D
Feedback:
There is no definitive treatment for correction of the defective collagen synthesis that is
characteristic of osteogenesis imperfecta, and prevention and treatment of fractures are
important. Hip dislocation is not a common manifestation, and neither hormone therapy
nor calcium supplements are useful in treatment
- Which of the following newborn infants demonstrates the highest risk of presenting with
developmental dysplasia of the hip (DDH)?
A) A girl who was born with toeing-in and who was in a breech presentation
B) A twin girl who required resuscitation after delivery
C) A boy who was born by caesarian section to a 44-year-old first-time mother
D) A boy with Down syndrome who was exposed to cocaine in utero
Ans: A
Feedback:
Female sex, a history of breech presentation, and congenital skeletal abnormalities are
all correlated with DDH. Respiratory emergencies, delivery by caesarian section,
advanced age of the mother, Down syndrome, and drug exposure are not noted risk
factors for DDH.
- While an infant is in the supine position with both knees flexed, the clinician applies
gentle downward pressure to both knees, and the knee and thigh are abducted as an
upward and medial pressure is applied to the proximal thigh. This examination
technique, used to screen for a reducible dislocation, is called
A) Galeazzi test.
B) Ortolani maneuver.
C) clubfoot test.
D) Trendelenburg test
Ans: B
Feedback:
The Ortolani maneuver is a described test for a reducible dislocation. The Galeazzi test
is a measurement of the length of the femurs that is done by comparing the height at the
knees while they are flexed at 90 degrees. Trendelenburg test is used for an older child
- The parents of a newborn who has been diagnosed with developmental dysplasia of the
hip ask the nurse about the reason this harness has to be on their child. The nurse
responds,
A) “This harness allows your baby some mobility as it slowly brings the leg back into
abduction.”
B) “The harness is meant to help the baby be moved without increasing his pain.”
C) “The harness will keep the leg immobile and force the femoral head back into the
cup-shaped socket of the hip bone.”
D) “Infants with dysplasia of the hip need to keep the leg still, and this harness will
provide the immobility needed for healing postsurgery.”
Ans: A
Feedback:
The Pavlik harness is used on newborns (up to 6 months) to maintain the femoral head
in the acetabulum. The harness allows the child more mobility as the leg is slowly and
gently brought into abduction.
- Following bone density scanning and diagnostic imaging, a 4-year-old boy has been
diagnosed with Legg-Calvé-Perthes disease. Which of the following findings, signs, and
symptoms would lead clinicians to this conclusion? Select all that apply.
A) The boy has significant difficulty in walking.
B) The boy’s feet toe-in when standing upright.
C) The child has limited abduction of the affected hip.
D) His femoral head region is noted to be necrotic
E) There are numerous microfractures where his patellar tendon and tibia articulate.
Ans: A, C, D
Feedback:
Pain and difficulty in walking commonly accompany Legg-Calvé-Perthes disease, in
which necrosis exists in the epiphyseal growth center of the femoral head. Toe-in would
not be an expected related finding, and microfractures where the patellar tendon and
tibia articulate are associated with Osgood-Schlatter disease.
- Child/parents are coming into the physician’s office to get the results of some diagnostic
testing relating to his knee pain and unusual stiffness and fatigue. The physician
suspects the child may have slipped capital femoral epiphysis. The nurse should
anticipate that the treatment will involve: Select all that apply.
A) no weight bearing on the femur.
B) bed rest.
C) traction.
D) injection of steroids into the joint.
E) high dose of calcium supplements
Ans: A, B, C
Feedback:
Early treatment is imperative to prevent lifelong crippling. In situ fixation is
recommended. Avoidance of weight bearing on the femur and bed rest are essential
parts of the treatment. Traction or gentle manipulation under anesthesia is used to
reduce the slip. Surgical insertion of pins to keep the femoral neck and head of the
femur aligned is a common method of treatment for children with moderate or severe
slips. High dose of calcium supplements will not correct this problem.
- A public health nurse has learned that a colleague has been screening for scoliosis
during visits made to schools even though such screening is not mandated. How should
the nurse best respond to the colleague?
A) “The potentially harmful outcomes of screening have been shown to outweigh the
benefits.”
B) “Screening for scoliosis has been proven to be inaccurate.”
C) “Screening is unnecessary now that we know scoliosis is a benign condition.”
D) “The low prevalence and incidence of scoliosis have made screening
unnecessary.”
Ans: A
Feedback:
The U.S. Preventative Services Task Force recommends against the routine screening of
asymptomatic adolescents for idiopathic scoliosis indicating that the potential harms
from screening include unnecessary follow-up visits and evaluations due to
false-positive results and psychological adverse effects, especially related to brace wear.
Screening is not necessarily inaccurate, and scoliosis is not necessarily benign. The
incidence and prevalence remain high.
- While measuring the height of a 12-year-old girl during an office visit, the primary care
physician noted a deviation of the girl’s spine. This was subsequently quantified as
being a right curve scoliosis of approximately 10-degree deviation. Which of the
following treatment options is most clearly indicated?
A) Use of a Milwaukee brace during waking hours
B) Surgical correction of the girl’s spine
C) Observation and no active treatment
D) Use of external rods to correct the deviation
Ans: C
Feedback:
For persons with lesser degrees of curvature (10 to 20 degrees), the trend has been away
from aggressive treatment of scoliosis and toward a “wait-and-see” approach, taking
advantage of the more sophisticated diagnostic methods that now are available. The use
of surgery or braces is not indicated with a 10-degree curvature.
- When explaining to a class of nursing students the effects of dysregulation of the
RANKL/RANK/OPG pathway, the instructor emphasizes that this plays a prominent
role in the pathogenesis of: Select all that apply.
A) osteomalacia.
B) neoplasia of the bone.
C) osteoporosis.
D) genu varum.
E) bone necrosis.
Ans: B, C
Feedback:
It is now believed that dysregulation of the RANKL/RANK/OPG pathway plays a
prominent role in the pathogenesis of bone diseases such as neoplasia and bone lesions
as well as osteoporosis. Avascular necrosis is known as bone necrosis (death) due to
interruption to the blood supply of the bone.
- Which of the following clients is most likely to have low bone density?
A) A 70-year-old woman with increased numbers of osteoblasts.
B) A 78-year-old female whose osteoclast function is inhibited.
C) A 65-year-old male who is noted to have osteopenia.
D) A 68-year-old male who takes vitamin D supplements.
Ans: C
Feedback:
Osteopenia is characterized by a reduction in bone mass greater than expected for age,
race, or sex that occurs because of a decrease in bone formation, inadequate bone
mineralization, or excessive bone deossification. Increases in osteoblasts, inhibition of
osteoclasts, and vitamin D supplementation would all be associated with high bone
density
- A 74-year-old female has been diagnosed with osteoporosis after her bone density scan
indicated osteopenia. Which of the following factors would her care team be most likely
to rule out as contributors to her health problem?
A) The woman is an African American and was exposed to asbestos in her work.
B) She has been a heavy drinker for her whole adult life and has diabetes mellitus.
C) The client takes corticosteroids for treatment of her long-standing osteoarthritis.
D) The woman has an estrogen deficiency and has never undergone hormone
therapy.
Ans: A
Feedback:
African American race is not a risk factor for the development of osteoporosis, and
African Americans tend to have higher bone density than Whites and Hispanics.
Asbestos exposure is not a noted risk factor for osteoporosis, while alcohol use,
diabetes, steroids, and estrogen deficiency are all risk factors.
- A nurse is teaching a wellness group among a group of older adult women. One of the
women has asked for advice about preventing osteoporosis, which affects many of her
friends. What is the nurse’s best response to the woman’s query?
A) “Osteoporosis has been shown to have a strong genetic basis, so there is little you
can do to prevent it.”
B) “Weight-bearing exercise is helpful, as are calcium supplements.”
C) “If possible, scaling back your hormone replacement therapy will reduce your
osteoporosis risk.”
D) “There are drugs called glucocorticoids that both prevent osteoporosis and treat it
if you do develop it.”
Ans: B
Feedback:
Exercise and calcium supplementation have been shown to reduce the incidence of
osteoporosis. Use of steroids is a risk factor, and estrogen deficiency would contribute
to, rather than preventing, osteoporosis. There is a genetic component to the disease, but
this does not preclude prevention efforts.
