Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 45: Alterations of Musculoskeletal FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. 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.ANS: CA pathologic fracture is a break at the site of a preexisting abnormality, usually by force that would not fracture a normal bone. A greenstick fracture is one in which the outer surface is disrupted but the inside in intact. The stable fracture with a bent but not broken cortex is a torus fracture. Cumulative stress results in stress fractures.PTS: 1 DIF: Cognitive Level: Understanding 2. 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. Stressb. Greenstickc. Insufficiencyd. PathologicANS: AA stress fracture occurs in normal or abnormal bone that is subjected to repeated stress, such as repetitive and strenuous activities that occur during athletics. A greenstick fracture is one in which the outer surface of the bone is disrupted but the interior is intact. Insufficiency fractures are seen in osteoporosis and osteomalacia. A pathologic fracture is one that occurs from force that would not usually break a bone. There is usually an underlying lesion or abnormality at the site of the fracture.PTS: 1 DIF: Cognitive Level: Understanding 3. 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 fixationb. Reduction and immobilizationc. Calcium phosphate cementd. Low-density ultrasoundANS: BThis patient has manifestations of a subluxation. Treatment would include reduction followed by immobilization, followed by physical therapy. Internal fixation would be appropriate for some fractures. Calcium phosphate cement can be used to fill a large defect in bone such as seen in nonunion. Low-density ultrasound is another option to promote new bone growth in nonunion.PTS: 1 DIF: Cognitive Level: Applying 4. 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.ANS: DImproper reduction or immobilization of a fractured bone may result in nonunion, delayed union, or malunion. Malunion is the healing of a bone in a nonanatomic position that could result in the bone not being straight. The other options are normal occurrences.PTS: 1 DIF: Cognitive Level: Remembering 5. Which structure attaches skeletal muscle to bone?a. Tendonb. Ligamentc. Bursad. MesenteryANS: AA tendon is fibrous connective tissue that attaches skeletal muscle to bone. A ligament attaches bones together where they meet at a joint. A bursa is a small sac lined with synovial membrane and filled with synovial fluid; bursae are located between tendons, muscles, and bony prominences. Their primary function is to separate, lubricate, and cushion these structures. The mesentery is a fold of the peritoneum that attaches internal abdominal organs to the posterior wall of the abdomen.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. What is the tear in a ligament referred to as?a. Fractureb. Strainc. Disuniond. SprainANS: DLigament tears are commonly known as sprains. A fracture is a break in a bone. A strain is an injury to a tendon or muscle. Disunion is when bones do not heal together properly after a fracture.PTS: 1 DIF: Cognitive Level: Remembering 7. 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 epicondylopathyb. Medial epicondylopathyc. Bursitisd. Lateral tendinitisANS: ALateral epicondylopathy, commonly called tennis elbow, is the result of tissue degeneration or irritation of the extensor carpi radialis brevis tendon at its origin. Medial tendinitis or medial epicondylitis, referred to as golfer’s elbow, is a degenerative process of the pronator teres, flexor carpi radialis, and palmaris longus tendons at the medial humeral condyle. Bursitis is inflammation of the bursae. Tendinitis is a general term for inflammation of a tendon.PTS: 1 DIF: Cognitive Level: Remembering 8. 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 ligamentb. Sharp and localized, persisting over the distribution of the tendon or ligamentc. Pins-and-needle sensations that occur distal to the injury with movementd. Intermittent and aching, occurring over the distribution of the tendon or ligamentANS: BThe pain resulting from tendon and ligament injuries is usually described as being sharp and localized, persisting over the distribution of the tendon or ligament. This selection is the only option that accurately describes this type of pain.PTS: 1 DIF: Cognitive Level: Remembering 9. 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 supplyb. Smooth muscle degeneration, resulting from ischemiac. Lysis of skeletal muscle cells through the initiation of the complement cascaded. Release of myoglobin from damaged striated muscle cellsANS: DRhabdomyolysis involves the release of myoglobin when muscle cells are damaged. It is not due to muscle paralysis, muscle degeneration, or from the complement cascade.PTS: 1 DIF: Cognitive Level: Remembering 10. Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression?a. Muscle ischemiab. Myoglobinuriac.
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