Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 46: Alterations of Musculoskeletal Function in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Until the skeleton matures and adult stature is reached, where does growth in the length of bone occur?a. Epiphyseal lineb. Physeal platec. Epiphyseal cartilaged. Metaphyseal plateANS: BUntil the skeleton matures and adult stature is reached, growth in the length of bone occurs only at the physeal plate through endochondral ossification.PTS: 1 DIF: Cognitive Level: Remembering 2. A healthcare professional is educating an expectant parent class. Which skeletal deformity does the professional tell them is normal at birth but generally disappears by 212 years of age?a. Genu varum (bowleg)b. Genu valgum (knock knee)c. Equinovarus (clubfoot)d. Pes planus (flat feet)ANS: AGenu varum (bowleg) generally resolves itself by 212 years of age, whereas genu valgum (knock knee) maximizes by 5 to 6 years of age. This statement is not true of either equinovarus or pes planus.PTS: 1 DIF: Cognitive Level: Remembering 3. A healthcare professional wants to estimate the total mass of muscle in a patient’s body. What serum laboratory test should the professional evaluate?a. Albuminb. Blood urea nitrogenc. Creatinined. CreatineANS: CThe total mass of muscle in the body can be estimated from the amount of creatinine excreted in the urine, because the conversion of creatine to creatinine only takes place in muscle.PTS: 1 DIF: Cognitive Level: Remembering 4. A healthcare professional working with children learns that which is the most common congenital skeletal defect of the upper extremity?a. Vestigial tabsb. Paget diseasec. Ricketsd. SyndactylyANS: DThe most common congenital skeletal defect of the upper extremity is syndactyly, or webbing of the fingers.PTS: 1 DIF: Cognitive Level: Remembering 5. What diagnosis is given to parents when their infant’s hip maintains contact with the acetabulum but is not well seated within the hip joint?a. Dislocatable hipb. Subluxated hipc. Dislocated hipd. Subluxable hipANS: BSubluxated hip is the only option used to identify the condition when the hip maintains contact with the acetabulum but is not well seated within the hip joint. The dislocatable hip is sometimes located properly but can dislocate easily. A dislocated hip is out of its socket. “Subluxable” is often used interchangeably with subluxated.PTS: 1 DIF: Cognitive Level: Understanding 6. Which sign or symptom is a very late indication of developmental dysplasia of the hip?a. Asymmetry of the gluteal or thigh foldsb. Leg-length discrepancyc. Waddling gaitd. PainANS: DPain is a very late sign of developmental dysplasia of the hip. Earlier signs include asymmetry of gluteal or thigh folds, leg-length discrepancy, and waddling gait.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. To assess for osteogenesis imperfecta, which laboratory result would the healthcare professional expect to find?a. Increased phosphorusb. Decreased calciumc. Increased alkaline phosphatased. Decreased total proteinANS: CSerum alkaline phosphatase is elevated in all forms of osteogenesis imperfecta.PTS: 1 DIF: Cognitive Level: Remembering 8. A child has a disorder that resulted in the failure of bones to ossify, resulting in soft bones and skeletal deformity. What treatment plan does the healthcare professional discuss with the parents?a. Extremely careful handlingb. Increasing vitamin D intakec. Revascularizationd. Containment and motion therapyANS: BThis description characterizes rickets. Growing bone fails to mineralize because of a problem with vitamin D intake, absorption, or excretion. Treatment includes supplemental vitamin D. Extremely careful handling would be appropriate for osteogenesis imperfecta. Revascularization procedures would benefit a child with osteochondrosis. Containment and motion are the principles of treating Legg-Calvé-Perthes disease.PTS: 1 DIF: Cognitive Level: Applying 9. An insufficient dietary intake of which vitamin can lead to rickets in children?a. Cb. B12c. B6d. DANS: DRickets results from either insufficient vitamin D, insensitivity to vitamin D, wasting of vitamin D by the kidney, or inability to absorb vitamin D and calcium in the gut. Vitamin D is the only vitamin associated with rickets.PTS: 1 DIF: Cognitive Level: Remembering 10. A child has scoliosis with a 40-degree curvature of the spine, and the parent is worried about pulmonary involvement. What statement by the healthcare professional is most appropriate?a. “Scoliosis is a bone disorder and does not affect the lungs.”b. “Yes, we should obtain pulmonary function studies soon.”c. “Scoliosis severe enough to involve the lungs would be fatal.”d. “The lungs aren’t affected until the curvature is over 80 degrees.”ANS: DThe professional should inform the parent that in scoliosis, curves in the thoracic spine greater than 80 degrees result in decreased pulmonary function. The other statements are inaccurate and should not be used to educate the parent.PTS: 1 DIF: Cognitive Level: Understanding 11. In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis. What factor makes this route the easiest for bacteria to gain access to this area?a. Cortex of the bone in this area is porous or mazelike.b. Blood supply to the metaphysis is easily compromised.c. Macrophages and lymphocytes have limited access to the subperiosteal space.d. Bacteria usually spread down the medullary cavity of the bone.ANS: AThe subperiosteal space in the metaphysis is the path of least resistance for bacterial invasion because the cortex of the bone in this area is porous or mazelike, and the inflammatory response blocks spread within the bone. Bacterial access to the subperiosteal space is not related to compromised blood supply, actions of macrophages and lymphocytes, or spread down the medullary cavity.PTS: 1 DIF: Cognitive Level: Remembering 12. The student wants to know how the clinical manifestations and onset of juvenile idiopathic arthritis (JIA) differ from those of rheumatoid arthritis (RA) in adults. What answer by the healthcare professional is best?a. JIA begins insidiously with systemic signs of inflammation.b. JIA predominantly affects large joints.c. JIA has more severe joint pain than adult
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