Pathophysiology: Questions and Answers. Exam Revision

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Questions and Answers PART X · QUESTIONS 1. Changes associated with aging that can contribute to low back pain include all the following except a. Muscle spasm b. Narrowing of disc spaces c. Dec... reased water content of intervertebral discs d. Decreased flexibility of lumbar curve View Answer 2. Mrs. L., your neighbor, is 62 years old, 5′ 3″ tall, and weighs approximately 160 lbs. She is complaining of low back pain. She cannot identify any precipitating factor but she reports having had “back problems” off and on for years. It ordinarily goes away on its own if she “takes it easy.” She reports sometimes taking acetaminophen or ibuprofen, which helps. This time, however, she says her back has been bothering her for the last 2 months and is present most of the time, although it gets worse when she’s been more active. She mentions that she just took a week off and “stayed in bed the entire time.” When she returned to her normal activity yesterday, her back pain came right back and may even be a little worse. What is the most appropriate response? a. “You probably have a slipped disc. You should make an appointment to be seen by your primary care provider to have some tests done.” b. “Back pain is commonly associated with aging. You could try one of the nutritional supplements from the health food store.” c. “Lots of times exercises and weight loss help back problems. I’d recommend that you join a gym and try to lose 25 to 30 lbs.” d. “Staying in bed for a week may have caused your muscles to become weaker. You should see your primary care provider to check your back and suggest some exercises and other things that can help you.” View Answer 3. Most low back pain is due to which of the following? a. Vertebral fractures b. Herniated intervertebral discs c. Muscle sprain/strain d. Obesity View Answer 4. Degenerative disc disease commonly occurs in whom? a. Those with a poor dietary calcium intake b. Those with a narrowing of the spinal canal c. People as they age d. In athletes, particularly African-American males View Answer 5. What is the basic pathophysiology underlying osteoporosis? a. An imbalance between osteoclastic and osteoblastic activity b. An increase in osteoblastic activity c. A decrease in osteoclastic activity d. Impaired calcium absorption that leads to a decrease in osteoclastic activity View Answer 6. Which of the following is an appropriate response for you to make to a 40-year-old woman who is interested in learning what she can do to decrease her risk for osteoporosis? a. “You should take hormones to replace estrogen once you reach menopause.” b. “If you do not have risk factors in your history, you probably don’t need to do anything special.” c. “Weight-bearing exercises and an adequate intake of calcium and vitamin D are important factors in preventing osteoporosis.” d. “Osteoporosis is inevitable, so there’s nothing much you can do to prevent it.” View Answer 7. Which of the following medications may contribute to iatrogenic osteoporosis? a. Steroids b. Thyroid hormones c. Heparin d. NSAIDs View Answer 8. Which of the following statements about osteoporosis in men is true? a. Osteoporosis is less significant in men because their bones are more dense. b. Demineralization in men begins in the late 70s or early 80s. c. Men do not get osteoporosis because it is an estrogendependent disorder. d. Men have fewer vertebral compression fractures than women because they have less trabecular bone. View Answer 9. What provides tensile strength? a. Compact bone b. Trabecular bone c. Periosteum d. Haversian system View Answer 10. What portion of the bone contains pain receptors? a. Endosteum b. Marrow c. Haversian system d. Periosteum View Answer 11. The matrix of bone is made of which of the following? a. Bone marrow b. Collagen c. Calcium d. Cartilage View Answer 12. Callus formation at the site of a fracture takes 2 to 6 weeks. Which of the following statements about bone healing is true? a. The most important vitamin in bone healing is vitamin B. b. Callus is strong and stable. c. The palpable bump at the site of a fracture gradually disappears as ossification takes place. d. Bone remodeling takes 6 to 8 weeks, during which time it is important for the patient to avoid stress to the fracture site. View Answer 13. Which of the following statements best reflects the pathophysiology of osteoarthritis? a. It is characterized by thinning of the articular cartilage, commonly affects weight-bearing joints, and has an asymmetrical distribution. b. It is a systemic inflammatory disease that affects many joint structures in a symmetrical fashion and can also involve other body systems. c. It is a systemic disease with several phases and is accompanied by hyperuricemia with deposition of urate crystals in joints and other tissues. d. It is a disease of aging that ultimately results in profound disability. It commonly contributes to pathological fractures due to increased excretion of calcium and protein by the kidneys. View Answer 14. Mrs. T. has rheumatoid arthritis and has been told that she needs to exercise regularly and that a plan will be worked out with her the next day. Which of the following statements indicates that she understands the rationale for exercise with this disease? a. “I know I have to do lots of exercises now so the inflammation in my joints will go away.” b. “I understand that exercise of my joints is important to help prevent loss of motion.” c. “Because exercise is so important, I plan to do as much as I can, regardless of whether it hurts or not—‘no pain, no gain’.” d. “They told me I needed to do regular exercise. I think they mean just for my hips and shoulders, because my knees and hands hurt too much.” View Answer 15. Which of the following classifications of medications is commonly used with osteoarthritis, rheumatoid arthritis, and gout? a. Narcotics b. Steroids c. Uricosurics d. NSAIDs View Answer 16. What is involved in the pathophysiology of gout? a. A reduction of uric acid, which allows calcium to precipitate b. Inflammation resulting from intraarticular deposition of urate crystals c. Thinning of the articular cartilage, leading to splitting and fragmentation d. Formation of tophi in the kidneys, which impairs excretion of uric acid View Answer 17. _________ initiates the release of serum calcium. a. Phosphate b. Vitamin D c. Calcitonin d. Parathyroid hormone (PTH) View Answer 18. The most common fracture site of type II osteoporosis is a. Ankle b. Proximal humerus c. Wrist d. Vertebrae View Answer 19. Monoarticular joint pain is a common finding of a. Gouty arthritis b. Rheumatoid arthritis c. Osteoarthritis d. None of the above View Answer PART X · ANSWERS 1. The correct answer is a. Muscle spasm is usually a consequence of strain, overuse, or injury. 2. The correct answer is d. Postural muscles lose strength at approximately 3% per day with bed rest. A referral is indicated for appropriate diagnosis and treatment. The other options contain inappropriate suggestions or incorrect information. 3. The correct answer is c. This is the most common cause, usually due to deconditioning or overuse. Answers a and b are less common sources of back pain; d is sometimes a contributing factor. 4. The correct answer is c. Degenerative disc disease results from fibrosis and thinning of the nucleus pulposus associated with aging. 5. The correct answer is a. It is a disturbance in the balance between osteoclastic and osteoblastic activity, from a variety of causes, and results in osteoporosis. The other choices are incorrect or incomplete. 6. The correct answer is c. Weight bearing helps increase osteoblastic activity. Vitamin D is needed for calcium absorption, which is necessary for new bone formation. The other choices are incorrect because estrogen replacement is not recommended for all women, and all older women are at some degree of risk and should modify their lifestyle and/or diet as indicated. 7. The correct answer is a. Long-term use of glucocorticoid hormones can commonly cause osteoporosis; the others do not. 8. The correct answer is a. Bones in men are denser and thicker than those of women. The other choices are incorrect because demineralization in men begins in the late 60s, and men do get osteoporosis and vertebral compression fractures. 9. The correct answer is b. The mesh-like network provides tensile strength. The other options include parts of bone structure but do not provide tensile strength. 10. The correct answer is d. Because this is the only bone tissue that contains pain receptors, any process that disrupts or results in pressure on the periosteum causes pain. 11. The correct answer is b. The matrix is collagen tissue. Minerals deposit on this tissue. 12. The correct answer is c. Vitamins D and C are the most important for bone healing. The callus is unstable and not as strong as bone tissue, and bone remodeling can take as much as a year, depending on a number of factors. 13. The correct answer is a. Osteoarthritis is caused by wear and tear and trauma and can occur in middle age and in the elderly. The other options describe other forms of arthritis. 14. The correct answer is b. Individualized exercise plans are important to maintain as much joint function as possible, while at the same time preventing additional joint damage. (This is the rationale for why choice d is incorrect.) Choices a and c are incorrect because arthritis does not go away and exercise should not be done to the point of pain. 15. The correct answer is c. These are antiinflammatory medications used with all these conditions. The other choices are incorrect because narcotics are not used for long-term treatment of arthritis; under certain circumstances, steroids are sometimes used with rheumatoid arthritis; and NSAIDs are used with gout. 16. The correct answer is b. This is the only option that describes the pathology of gout. 17. The correct answer is d. PTH regulates blood calcium levels and phosphate while promoting formation of osteoclasts. 18. The correct answer is b. The proximal humerus is among the most common sites for type II osteoporotic fractures. The other sites include the femoral neck and proximal tibia. 19. The correct answer is a. Monoarticular joint pain, especially of the great toe, is a hallmark of gout. [Show More]

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