Answers at the end of the paper 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. Decreased water content of intervertebral discs d. Decreased flexibility of lumbar curve Answers available at https://bit.ly/3ajUoIW 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.” Answers available at https://bit.ly/3ajUoIW 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 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 Answers available at https://bit.ly/3ajUoIW 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 Answers available at https://bit.ly/3ajUoIW 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.” 7. Which of the following medications may contribute to iatrogenic osteoporosis? a. Steroids b. Thyroid hormones c. Heparin d. NSAIDs Answers available at https://bit.ly/3ajUoIW 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. 9. What provides tensile strength? a. Compact bone b. Trabecular bone c. Periosteum d. Haversian system 10. What portion of the bone contains pain receptors? a. Endosteum b. Marrow c. Haversian system d. Periosteum Answers available at https://bit.ly/3ajUoIW 11. The matrix of bone is made of which of the following? a. Bone marrow b. Collagen c. Calcium d. Cartilage Answers available at https://bit.ly/3ajUoIW 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. Answers available at https://bit.ly/3ajUoIW 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. 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.” 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 Answers available at https://bit.ly/3ajUoIW 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 17. _________ initiates the release of serum calcium. a. Phosphate b. Vitamin D c. Calcitonin d. Parathyroid hormone (PTH) 18. The most common fracture site of type II osteoporosis is a. Ankle b. Proximal humerus c. Wrist d. Vertebrae Answers available at https://bit.ly/3ajUoIW 19. Monoarticular joint pain is a common finding of a. Gouty arthritis b. Rheumatoid arthritis c. Osteoarthritis d. None of the above Answers available at https://bit.ly/3ajUoIW
