Pathophysiology Chapter 46 Alterations of Musculoskeletal Function in Children

Chapter 46: Alterations of Musculoskeletal Function in Children

MULTIPLE CHOICE

1.            Until the skeleton matures and adult stature is reached, where does growth in the length of bone occur?

a.            Epiphyseal line

b.            Physeal plate

c.             Epiphyseal cartilage

d.            Metaphyseal plate

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   years of age?

a.            Genu varum (bowleg)

b.            Genu valgum (knock knee)

c.             Equinovarus (clubfoot)

d.            Pes planus (flat feet)

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.            Albumin

b.            Blood urea nitrogen

c.             Creatinine

d.            Creatine

4.            A healthcare professional working with children learns that which is the most common congenital skeletal defect of the upper extremity?

 

 

a.            Vestigial tabs

b.            Paget disease

c.             Rickets

d.            Syndactyly

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 hip

b.            Subluxated hip

c.             Dislocated hip

d.            Subluxable hip

6.            Which sign or symptom is a very late indication of developmental dysplasia of the hip?

a.            Asymmetry of the gluteal or thigh folds

b.            Leg-length discrepancy

c.             Waddling gait

d.            Pain

7.            To assess for osteogenesis imperfecta, which laboratory result would the healthcare professional expect to find?

a.            Increased phosphorus

b.            Decreased calcium

c.             Increased alkaline phosphatase

d.            Decreased total protein

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 handling

b.            Increasing vitamin D intake

c.             Revascularization

d.            Containment and motion therapy

9.            An insufficient dietary intake of which vitamin can lead to rickets in children?

a.            C

b.            B12

c.             B6

d.            D

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.”

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.

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 RA.

d.            JIA has a rapid onset of generalized aches as the first symptom.

13.          An adolescent has been diagnosed with osteochondrosis. How does the healthcare professional describe the pathophysiology to the teen?

a.            Imbalance between calcitonin and parathyroid hormone

b.            Nutritional deficiency of calcium and phosphorus

c.             Bacterial infection of the bone

d.            Vascular impairment and trauma to bone

14.          Which bones are affected in Legg-Calvé-Perthes disease?

a.            Heads of the femur

b.            Distal femurs

c.             Heads of the humerus

d.            Distal tibias

15.          What does the student learn about the pain experienced with Legg-Calvé-Perthes disease?

a.            Elbow and upper and lower arm pain is aggravated by activity and relieved by rest.

b.            Knee, inner thigh, and groin pain is described as a continuous ache and relieved by antiinflammatory drugs.

c.             Knee, inner thigh, and groin pain is aggravated by activity and relieved by rest.

d.            Elbow and upper and lower arm pain is described as a continuous ache and relieved by antiinflammatory drugs.

16.          The healthcare professional directs a student to assess a teen who has Osgood-Schlatter disease. What assessment finding does the student anticipate for this disorder?

a.            Lateral epicondylitis of the elbow

b.            Inflammation of the anterior cruciate ligament

c.             Bursitis of the subscapular bursa in the glenohumeral joint

d.            Tendinitis of the anterior patellar tendon

17.          At birth, the diagnosis of cerebral palsy (CP) may be made based on what factor?

a.            Brain trauma

b.            Prematurity

c.             Major brain malformation

d.            Genetic defect

18.          A child has Duchenne muscular dystrophy and the parents want to know how this occurred. Which statement by the healthcare professional is most accurate?

a.            X-linked recessive inheritance

b.            Common SMN1 gene abnormality

c.             Autosomal dominant inheritance

d.            Inheritance is not well defined

19.          Which protein, absent in muscle cells of Duchenne muscular dystrophy, mediates the anchoring of skeletal muscle fibers to the basement membrane?

a.            Syntrophin

b.            Laminin

c.             Dystrophin

d.            Troponin

20.          A child has Duchenne muscular dystrophy. What complication does the healthcare professional teach the parents is most important to control?

a.            Respiratory infection

b.            Joint contractures

c.             Urinary tract infection

d.            Fractures from falling

21.          Generally, what is the first symptom of facioscapulohumeral muscular dystrophy?

a.            Inability to open the eyes completely

b.            Difficulty standing

c.             Drooping shoulders

d.            Facial pain

22.          What is the most common malignant bone tumor diagnosed during childhood?

a.            Chondrosarcoma

b.            Fibrosarcoma

c.             Ewing Sarcoma

d.            Osteosarcoma

23.          Molecular analysis has demonstrated that osteosarcoma is associated with which gene?

a.            TP53

b.            src

c.             myc

d.            TSC2

24.          A child has osteosarcoma and the healthcare team is assessing for metastases. What diagnostic study would be the priority?

a.            Pancreatic enzyme analysis

b.            Liver biopsy

c.             Chest x-ray or CT scan

d.            Brain MRI

25.          What does a Ewing sarcoma arise from?

a.            Bone marrow

b.            Bone-producing mesenchymal cells

c.             Metadiaphysis of long bones

d.            Embryonal osteocytes

26.          Rhabdomyosarcoma can develop in which type of muscle?

a.            Cardiac

b.            Smooth

c.             Involuntary

d.            Striated

27.          A newborn is diagnosed with osteomyelitis. What organism does the healthcare professional prepare to treat?

a.            Staphylococcus aureus

b.            Escherichia coli

c.             Group B streptococcus

d.            Bacillus anthracis

28.          A student asks what the cause of structural scoliosis is. What explanation by the professor is accurate?

a.            Poor posture

b.            Vertebral rotation

 c.            Poor calcium absorption

d.            Intrauterine trauma

MULTIPLE RESPONSE

1.            What does the student learn about bone growth before adulthood? (Select all that apply.)

a.            Growth in the length of bone occurs at the physeal plate.

b.            Growth occurs through endochondral ossification.

c.             Bone growth takes place under hormonal control.

d.            Cartilage cells at the epiphyseal side of the physeal plate multiply and enlarge.

e.            Cartilage cells at the metaphyseal side of the plate are replaced by bone.

2.            The anatomic makeup of which bone structures make them susceptible locations for osteomyelitis in children? (Select all that apply.)

a.            Hip joint

b.            Distal femur

c.             Proximal humerus

d.            Distal radius

e.            Lateral ankle