Ch 21 Musculoskeletal System PDF

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Ch 21 Multiple Choice Identify the choice that best completes the statement or answers the question. ____ a. b. c. d. e.

1.

Fluid that lubricates articular cavities is called blood. synovial fluid. mucus. cerumen. marrow.

____ a. b. c. d. e.

2.

Bones around a joint are held together by synovial membranes. ligaments. muscles. cartilage. tendons.

____ a. b. c. d. e.

3.

Bones are attached to muscles by synovial membranes. ligaments. muscles. cartilage. tendons.

4. The elbow joint that allows for flexion and extension in one plane represents a type of _____ joint. a. articulated b. ball and socket c. hinge d. pivot condyloid e. saddle

____

____ a. b. c. d. e.

5.

Spinal vertebrae are separated from each other by bursae. tendons. disks ligaments. synovial fluid.

____ a. b. c. d.

6.

The glenohumeral joint is the other name for the elbow. hip. wrist. scapula.

shoulder.

e. ____ a. b. c. d. e.

7.

The joint where the humerus, radius, and ulna articulate is the wrist. elbow. shoulder. sternum. clavicle.

____ a. b. c. d. e.

8.

The articulation of the radius and carpal bones is the wrist. elbow. shoulder. clavicle. digits.

____ a. b. c. d. e.

9.

The cruciate ligaments within the knee provide for anterior and posterior stability. medial and lateral stability. movement on one plane. pivoting and rotation. shock absorption.

____ a. b. c. d. e.

10.

Medial and lateral surfaces of the tibiotalar joint are protected by bursae. tendons. muscles. ligaments. synovial fluid.

____ 11. The suprapatellar bursa separates the patella, quadriceps tendon, and muscle from the a. talus. b. fibula. c. femur. d. pelvis. e. tibia. ____ a. b. c. d. e.

12.

The tibia, fibula, and talus articulate to form the ankle. knee. hip. pelvis. forefoot.

____ a.

13.

Long bones in children have growth plates known as epiphyses.

epicondyles. synovium. fossae. diastasis.

b. c. d. e. ____ a. b. c. d. e.

14.

Ligaments are stronger than bone until birth. infancy. adolescence. middle adulthood. old age.

Injuries to long bones and joints are more likely to result in fractures than in sprains until a. preschool age. b. school age. c. adolescence. d. early adulthood. e. middle adulthood.

____

15.

16. The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are caused by a. decreased mineral deposition. b. increased hormone secretion. c. uterine enlargement. d. gait changes. e. increased mineral resorption.

____

____ a. b. c. d. e.

17.

Skeletal changes in older adults are the result of increased bone deposition. increased bone resorption. tendons becoming more elastic. decreased bone deposition. decreased bone resorption.

____ a. b. c. d. e.

18.

The usual number of vertebrae is 23. 24. 25. 26. 27.

19. The family history for a patient with joint pain should include information about siblings with a. trauma to the skeletal system. b. chronic atopic dermatitis. c. genetic disorders.

____

obesity. poor physical conditioning.

d. e. ____ a. b. c. d. e.

20.

Risk factors for sports-related injuries include competing in colder climates. previous fractures. history of recent weight loss. failure to warm up before activity. light body frame.

____ a. b. c. d. e.

21.

Light skin and thin body habitus are risk factors for rheumatoid arthritis. osteoarthritis. congenital bony defects. osteoporosis. sports-related injuries.

____ 22. Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of a. adolescents. b. infants. c. older adults. d. middle adulthood. e. children. ____ a.

23.

The musculoskeletal examination should begin when the patient enters the examination room. during the collection of subjective data. when height is measured. when joint mobility is assessed. the remainder of the physical examination is completed.

24.

Pain, disease of the muscle, and damage to the motor neuron may

b. c. d. e.

____

all cause bony hypertrophy. muscle crepitus. muscle hypertrophy. muscle wasting. claudication.

a. b. c. d. e. ____ a. b. c.

25.

An increase in muscle tone is known as crepitus. effusion. tenosynovitis.

atrophy. spasticity.

d. e. ____ a. b. c. d. e.

26.

Fasciculation occurs after injury to a muscle’s venous return. motor neuron. strength. tendon. fascia.

27. The physical assessment technique most frequently used to assess joint symmetry is a. inspection. b. palpation. c. percussion. d. the use of joint calipers. e. auscultation.

____

____ a. b. c. d. e.

28.

A goniometer is used to assess bone maturity. joint proportions. range of motion. muscle strength. body fat.

____ a. b.

29.

When palpating joints, crepitus may be caused when irregular bony surfaces rub together. supporting muscles are excessively spastic. joints are excessively lax. there is excess fluid within the synovial membrane. there is muscle wasting.

30.

The temporomandibular joint is palpated under the mandible anterior to the sternocleidomastoid muscle. from inside the mouth. anterior to the tragus. at the mastoid process. above the mandible at midline.

31.

Temporalis and masseter muscles are evaluated by having the patient frown. having the patient clench his or her teeth.

c. d. e. ____ a. b. c. d. e. ____ a. b.

asking patient to fully extend his or her neck. passively opening the patient’s jaw. having the patient shrug his or her shoulders.

c. d. e.

____

32.

The strength of the trapezius muscle is evaluated by having the

patient clench his or her teeth during muscle palpation. push his or her head against the examiner’s hand. straighten his or her leg with examiner opposition. uncross his or her legs with examiner resistance. adduct the arm.

a. b. c. d. e. ____

33.

Expected normal findings during inspection of spinal alignment

include asymmetrical skinfolds at the neck. slight right-sided scapular elevation. convex lumbar curve. head positioned superiorly to the gluteal cleft. convex cervical curve.

a. b. c. d. e. ____ a. b. c. d. e.

34.

A common finding in markedly obese and pregnant women is kyphosis. lordosis. paraphimosis. scoliosis. phimosis.

____ 35. When the patient flexes forward at the waist, what spinal observation would lead you to suspect scoliosis? a. A prominent lumbar hump b. A prominent cervical concave curve c. Lateral curvature of the spine d. Restricted ability to flex at the hips e. A gibbus ____ 36. When the shoulder contour is asymmetrical and one shoulder has hollows in the rounding contour, you would suspect a. a dislocated elbow. b. a fractured scapula. c. a dislocated shoulder.

muscle wasting. kyphosis.

d. e. ____ a. b. c. d. e.

37.

Ulnar deviation and boutonniere deformities are characteristic of winged scapula. osteoarthritis. osteoporosis. congenital defects. rheumatoid arthritis.

____ a. b. c. d. e.

38.

A finding that is indicative of osteoarthritis is swan neck deformities. Bouchard nodes. ganglion cysts Heberden nodes. spindle-shaped fingers.

____ 39. A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign. a. Phalen b. Gower c. Homan d. Tinel e. Allis ____ a. b. c. d. e.

40.

Classic carpal tunnel syndrome would result in pain in the fourth and fifth digits. a negative Phalen test. reduced abduction of the thumb. palm tingling. a negative Tinel sign.

____

41.

Excessive hyperextension of the knee with weight bearing may

indicate advanced joint degeneration. early signs of gout. rotation of the Achilles tendon. a meniscal tear. weakness of the quadriceps muscle.

a. b. c. d. e. ____ a. b. c. d.

42.

Arm length is measured from the acromion process through the olecranon joint to carpal thumb hinge. olecranon process to distal ulnar prominence. proximal radial prominence to distal joint. proximal ulnar joint to middle fingertip.

olecranon process to the second fingertip.

e.

____ a. b. c. d. e.

43.

A positive straight leg raise test usually indicates leg length discrepancy. knee instability. lumbar nerve root irritation. hip bursitis. improperly conditioned muscles.

____ a. b. c. d. e.

44.

The Thomas test is used to detect hip dislocation. unstable sacroiliac joints. knee instability. flexion contractures of the hip. asymmetry in the level of the iliac crests.

____

45.

Which one of the following techniques is used to detect a torn

meniscus? Phalen test McMurray test Thomas test Trendelenburg test Drawer test

a. b. c. d. e.

46. When performing the drawer test, the examiner would place the patient in a supine position and flex the knee 45 to 90 degrees, placing the foot flat on the table, and then a. grasp and evert the foot and extend the knee. b. grasp and invert the foot and rotate the knee. c. grasp the lower leg with both hands and draw the tibia forward and then backward. d. apply varus stress with the foot planted. e. apply valgus stress after the leg is extended.

____

____ a. b. c. d. e.

47.

Anterior cruciate ligament integrity is assessed via the _____ test. Lachman straight leg raise valgus stress Homan Thomas

____ 48. During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the _____ test. a. varus stress b. valgus stress c. Apley d. Lachman e. drawer ____ a. b. c. d. e.

49.

Term infants normally resist ankle dorsiflexion. McMurray test. forefoot adduction. knee extension. elbow flexion.

What technique is performed at every infant examination during the first year of life to detect hip dislocation? a. Ballottement maneuvers b. Barlow-Ortolani maneuvers c. Range of motion d. Thomas McMurray assessment e. Trendelenburg test

____

50.

____ 51. You note that a child has a positive Gower sign. You know that this indicates generalized a. arthropathy. b. muscle weakness. c. bursitis. d. muscle hypertrophy. e. scoliosis. ____ 52. A 3-year-old boy is brought to the clinic complaining of a painful right elbow. He is holding the right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of a. radial head subluxation. b. femoral anteversion. c. carpal tunnel syndrome. d. Osgood-Schlatter disease. e. osteomyelitis.

What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention? a. Carpal tunnel syndrome ____

53.

Osteitis deformans Radial head subluxation Talipes equinovarus Legg-Calvé-Perthes disease

b. c. d. e. ____

54.

A red, hot swollen joint in a 40-year-old man should lead you to

suspect trauma. bursitis. gout. cellulitis. tenosynovitis.

a. b. c. d. e. ____ a. b. c. d. e.

55.

An adult with bowed tibias and a shortened thorax may have ankylosing spondylitis. Paget disease. rheumatoid arthritis. Dupuytren contracture. Sprengel deformity.

56. In differentiating osteoarthritis from rheumatoid arthritis (RA), the patient with osteoarthritis typically exhibits a. metatarsus adductus. b. depression. c. sudden onset. d. less weakness and fatigue. e. pain most pronounced after periods of rest.

____

____ 57. A 45-year-old laborer presents with low back pain, stating that the pain comes from the right buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression? a. Positive straight leg raise result b. Positive Trendelenburg sign c. Negative Romberg test result d. Contralateral straight leg raise result e. Positive drawer test result

Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would perform a a. startle reflex. b. Barlow-Ortolani maneuver. c. Trendelenburg test. d. tibial torsion test. e. Lachman test. ____

58.

____ 59. A 7-year-old child who begins to limp and complains of persistent hip pain may have a. myelomeningocele. b. Dupuytren contracture. c. Legg-Calvé-Perthes disease. d. osteoarthritis. e. congenital hip dislocation. ____ a. b. c. d. e.

60.

Dupuytren contracture affects the hip flexor muscle. plantar fascia. carpal tunnel. palmar fascia. rotator cuff.

____ a. b. c. d. e.

61.

A dowager hump is the hallmark of osteoporosis. pathognomic of scoliosis. indicative of tendonitis. characteristic of rickets. indicative of muscular dystrophy.

Ch 21 Answer Section MULTIPLE CHOICE 1.

ANS: B

Articular cavities are lined with synovial membrane, which secretes synovial fluid that provides lubrication for the joint to move. PTS: 1 REF: p. 501 MSC: Organ System: Musculoskeletal 2. ANS: B

TOP: Discipline: Physiology

Bones are held together within a joint by ligaments. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Tendons attach muscle to bone, bones are not held together by muscles, and cartilage forms most of the joints in the adult skeleton and merely acts as a shock absorber. PTS: 1 REF: p. 501 MSC: Organ System: Musculoskeletal 3. ANS: E

TOP: Discipline: Gross Anatomy

Tendons attach muscle to bone. Synovial membranes secrete synovial fluids, which provide lubrication to the joints. Ligaments attach bone to bone. Muscles are not bound together by other muscles, and cartilage helps in the production of new bone and acts as an insulator for bones in joints.

PTS: 1 REF: p. 501 MSC: Organ System: Musculoskeletal 4. ANS: C

TOP: Discipline: Gross Anatomy

A hinge joint allows for flexion and extension in one plane. A condyloid joint allows flexion and extension in two planes. A ball and socket joint allows movement in all planes. An articulated joint means simply that the joint allows movement. A saddle joint allows motion in two planes at right angles to each other but no axial rotation. PTS: 1 REF: p. 505 MSC: Organ System: Musculoskeletal 5. ANS: C

TOP: Discipline: Gross Anatomy

Except for sacral vertebrae, the spinal vertebrae are separated from one another by fibrocartilaginous disks. PTS: 1 REF: p. 505 MSC: Organ System: Musculoskeletal 6. ANS: E

TOP: Discipline: Gross Anatomy

The shoulder joint, also called the glenohumeral joint, consists of the union between the humerus and the scapula. PTS: 1 REF: p. 505 MSC: Organ System: Musculoskeletal 7. ANS: B

TOP: Discipline: Gross Anatomy

The elbow is the site where the humerus, radius, and ulna meet. The shoulder is made up of the humerus and scapula. The wrist is made up of the radius and the carpal bones of the hand. The sternum connects to the clavicles and ribs. The clavicle connects to the scapula but not the humerus. PTS: 1 REF: p. 505 MSC: Organ System: Musculoskeletal 8. ANS: A

TOP: Discipline: Gross Anatomy

The joint composing the radius and carpal bones is called the wrist. PTS: 1 REF: p. 505 MSC: Organ System: Musculoskeletal 9. ANS: A

TOP: Discipline: Gross Anatomy

The cruciate ligaments within the knee are positioned so as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane. Cartilage is the structure that provides shock absorption. PTS: 1 REF: p. 507 MSC: Organ System: Musculoskeletal 10. ANS: D

TOP: Discipline: Gross Anatomy

The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides. Bursae, tendons, muscles, and synovial fluid do not offer stabilization protection to the ankle.

PTS: 1 REF: p. 507 MSC: Organ System: Musculoskeletal 11. ANS: C

TOP: Discipline: Gross Anatomy

The suprapatellar bursa separates the knee, the quadriceps, and muscle from the femur. PTS: 1 REF: p. 507 MSC: Organ System: Musculoskeletal 12. ANS: A

TOP: Discipline: Gross Anatomy

The tibia, fibula, and talus, or heel, join to form the ankle. PTS: 1 REF: p. 507 MSC: Organ System: Musculoskeletal 13. ANS: A

TOP: Discipline: Gross Anatomy

Epiphyses are the growth plates found in long bones in children. PTS: 1 REF: p. 508 MSC: Organ System: Musculoskeletal 14. ANS: C

TOP: Discipline: Gross Anatomy

Ligaments are stronger than bone during birth and infancy. It is not until adolescence that bone becomes stronger. PTS: 1 REF: p. 508 MSC: Organ System: Musculoskeletal 15. ANS: C

TOP: Discipline: Physiology

Fractures to long bones and joints are more common during growth years. During childhood and early adolescence, the epiphyseal growth plates are more easily injured than are the tougher ligaments. Growth is completed with the closure of the epiphyseal growth plates at about 20 years of age. PTS: 1 REF: p. 508 MSC: Organ System: Musculoskeletal 16. ANS: B

TOP: Discipline: Physiology

Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus. PTS: 1 REF: p. 508 MSC: Organ System: Musculoskeletal 17. ANS: B

TOP: Discipline: Physiology

As a person ages, the skeletal system undergoes several changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition. Tendons become less elastic in older adults. PTS: 1 REF: p. 508 MSC: Organ System: Musculoskeletal 18. ANS: B

TOP: Discipline: Physiology

The number of vertebrae that is most common is 24; as few as 11% of persons

have 23, and almost 5% have 26. PTS: 1 REF: p. 504 MSC: Organ System: Musculoskeletal 19. ANS: C

TOP: Discipline: Gross Anatomy

An important history to obtain for a patient with joint pain would be family history of genetic disorders such as osteogenesis imperfecta, dwarfing syndrome, rickets, hypophosphatemia, or hypercalciuria. PTS: 1 REF: p. 509 MSC: Organ System: Musculoskeletal 20. ANS: D

TOP: Discipline: Physiology

Failure to warm up before exercise is one risk factor for sports-related injuries. Climate, previous fractures, and weight loss are not as strong risk factors for sports-re...