Memmlers The Human Body in Health and Disease, 12th edition Barbara Janson Cohen – Test Bank
Chapter 6. Musculoskeletal System: Consideration and Interventions for Specific Pediatric Pathologies
Identify the choice that best completes the statement or answers the question.
____ 1. Select the most accurate statement about exercise and children.
A. Children with Duchenne muscular dystrophy should participate in intense regular exercise to improve muscle bulk and slow the progression of the disease.
B. Children with juvenile idiopathic arthritis should only perform non–weight-bearing exercises to avoid increasing joint pain.
C. Children with cerebral palsy typically have poor aerobic and muscular endurance.
D. Children with Ehler’s Danlos syndrome should not participate in sports due to risk of joint damage.
____ 2. Select the correct statement(s) regarding Duchenne muscular dystrophy (DMD). Children with DMD
A. develop hypertrophy of the gastrocnemius as a method to compensate for progressive weakness.
B. should avoid resistive activities and eccentric contractions as this can cause further muscle breakdown.
C. require use of ankle foot orthoses to maintain walking past 12 years of age.
D. will not get muscle contractures if parents perform passive stretches weekly.
____ 3. A unilateral limitation in hip abduction could be an indication of
A. developmental hip dysplasia.
B. slipped capital femoral epiphysis.
C. Legg-Calvé-Perthes disease.
D. osteomyelitis of the hip.
E. All of the above
____ 4. Children with cerebral palsy
A. commonly retain neonatal levels of hip retroversion.
B. have atypical muscle composition so strengthening is not advocated.
C. have a higher incidence of scoliosis than the general population.
D. characteristically have intellectual disabilities.
____ 5. Select the correct statement regarding congenital muscular torticollis.
A. It can be associated with developmental dysplasia of the hip.
B. The muscle tightness will spontaneously resolve by 12 months of age.
C. It is characterized by tightness of the sternocleidomastoid muscle resulting in decreased lateral flexion and rotation to the same side.
D. Torticollis is caused by prematurity.
____ 6. Arthrogryposis
A. is characterized by an asymmetrical pattern of contractures and joint involvement.
B. typically has associated cognitive impairments.
C. may be related to a lack of fetal movement.
D. is a progressive disorder.
____ 7. Which following disorder can cause fractures early in life, and children younger than 3 are typically investigated for child abuse?
A. Osteogenesis imperfecta
B. Cerebral palsy
D. Juvenile idiopathic arthritis
____ 8. Children with juvenile idiopathic arthritis in their hips
A. exacerbate (cause to flare up) their symptoms with exercise.
B. should lie in prone every day.
C. have lifelong joint inflammation.
D. should use a wheelchair as their main means of mobility.
____ 9. Which of the following is an unlikely cause of a leg length discrepancy?
A. Inflammatory hyperemia
C. Joint contracture
D. Stress fracture of bone diaphysis
____ 10. Wayne Stuberg and colleagues demonstrated that a standing program could facilitate hip development in children with developmental disabilities. The program recommended was:
A. 30 min, 2 days per wk.
B. 30 min, 5 days per wk.
C. 60 min, 1 day per wk.
D. 60 min, 3 days per wk.
____ 11. Which of the following conditions can present as toe-walking?
A. Cerebral palsy
B. Duchenne muscular dystrophy
C. Idiopathic toe walking
D. All of the above
____ 12. Moderate exercise for children with juvenile idiopathic arthritis usually leads to
A. increased joint pain.
B. increased joint inflammation.
C. improved fitness.
D. increased joint bleeds.
____ 13. Children with Duchenne muscular dystrophy
A. will have increased base of support, lateral trunk sway, and toe-walking during the late ambulatory stage.
B. will have loss of upper extremity function, scoliosis, and contractures during the late nonambulatory stage.
C. will have increased lumbar lordosis and weakness in the hip extensors and ankle dorisflexors
D. All of the above
____ 14. Why should children with arthrogryposis be evaluated for an early intervention program?
A. Arthrogryposis is generally associated with intellectual impairment.
B. Arthrogryposis is a progressive, debilitating condition.
C. Weakness and contractures at birth may delay motor milestone acquisition and lead to disuse weakness.
D. Physical therapy intervention can correct the deformities.
____ 15. Young boys having Duchenne muscular dystrophy tend to use the Gower maneuver to rise from the floor because of weakness in
A. knee extensors and flexors.
B. hip extensors and flexors.
C. distal leg musculature.
D. upper extremity musculature.
____ 16. Pseudohypertrophy is commonly seen in children with
A. Duchenne muscular dystrophy.
B. Ehlers-Danlos syndrome.
C. juvenile idiopathic arthritis.
D. Blout disease.
____ 17. Methods to promote bone mineralization include
A. impact exercise.
B. weight-bearing exercise.
C. upright standing frames.
E. All of the above
1. Name two pediatric diagnoses where limitation in range of motion is a common characteristic.
2. Name two diagnoses where heightened reaction to trauma is common.
3. Which type of juvenile idiopathic arthritis involves the most joints and is the most debilitating?
Chapter 6. Musculoskeletal System: Consideration and Interventions for Specific Pediatric Pathologies
1. ANS: C
Rationale: Well-planned, regular exercise is beneficial for children with DMD and JIA working within the guidelines listed in the chapter. Children with EDS can participate in sporting activities; however, the therapist should work with the family to determine the sports that meet the child’s interest and prevent joint damage. Contact sports should be avoided. Children with CP typically move much less than able-bodied peers and therefore have poor endurance.
2. ANS: B
Rationale: Resistive activities and eccentric contractions require increased muscle power and cause increased muscle damage.
3. ANS: E
Rationale: Asymmetrical abduction is a common finding in all of the diseases.
4. ANS: C
Rationale: Weak musculature and atypical/asymmetrical movement patterns are believed to be responsible for the higher incidence of scoliosis.
5. ANS: A
Rationale: Torticollis is associated with developmental dysplasia of the hip as well as plagiocephaly.
6. ANS: C
Rationale: The joint restrictions seen in arthrogryposis are believed to be due to a fetal muscular problem that decreases the amount of fetal movement. The lack of movement doesn’t break down the mesenchyme for joint formation. Arthrogryposis is a nonprogressive disorder, associated with a symmetrical pattern of muscle contractures and joint involvement. Cognitive impairments are not typically associated with this disorder.
7. ANS: A
Rationale: OI is a genetic collagen mutation that results in fragile bones. More severe forms of OI present with multiple fractures as a result of the birthing process, whereas more mild forms may result in frequent fractures as a result of mild, seemingly insignificant injuries.
8. ANS: B
Rationale: Hip extension range of motion is commonly lost in children with JIA. Prone lying encourages hip extension range of motion. Although some children may have lifelong degenerative changes, the inflammation associated with JIA will most likely go into remission.
9. ANS: D
Rationale: Inflammatory hyperemia can cause bone overgrowth or early physeal closure. Hemimelia describes the congenital absence or shortening of a bone, which can cause bone or limb shortening. Joint contractures are one possible cause of apparent leg length discrepancy. A stress fracture of the diaphysis should not influence leg length, as it does not involve bone displacement.
10. ANS: D
Rationale: 60 min of standing are needed 3 or more days a wk; 30 min has been found to be insufficient.
11. ANS: D
Rationale: Children with cerebral palsy, Duchenne muscular dystrophy, or idiopathic toe walking can all present to the clinic with the report of consistent or intermittent toe walking.
12. ANS: C
Rationale: Community-based exercise programs have been shown to improve endurance and decrease joint symptoms (Klepper, 1999). Eighty percent of the children with polyarticular JIA who participated in an 8-week program of low-impact aerobics, strengthening, and flexibility exercises reported a significant improvement in joint pain and all had improved endurance. There were no reports of increased joint pain or inflammation. Children with JIA do not have joint bleeds.
13. ANS: D
Rationale: All of listed problems occur in children with DMD.
14. ANS: C
Rationale: Arthrogryposis is not associated with intellectual impairment, nor is it progressively debilitating. However, the weakness and contractures present at birth can delay milestone acquisition and lead to weakness. Physical therapy might help reduce or delay deformities, but physical therapy by itself will not correct the deformities.
15. ANS: B
Rationale: Proximal weakness is greater than distal weakness in children with DMD.
16. ANS: A
Rationale: Pseudohypertrophy (enlargement without increased strength) of the calf muscles is commonly seen in those with Duchenne muscular dystrophy.
17. ANS: E
Rationale: Impact exercise, such as running and jumping, can increase bone mineral density (Hind & Burrows, 2007; Vicente-Rodriguez et al., 2007; McKay et al., 2005). Improvements in bone mineralization were not seen in children who participated in non–weight-bearing exercise such as swimming (Grimston, Willows, & Hanley, 1993). Weight-bearing and intermittent weight-bearing programs also improve bone mineral density. Intermittent weight bearing with movement can be accomplished by partial weight-bearing ambulation through a use of a treadmill or gait trainer. Also, an upright standing frame that allows some weight shifting is beneficial.
Arthrogryposis, osteogenesis imperfecta, congenital muscular torticollis, hemophilia, JIA, late-stage DMD, etc.
2. ANS: 1. Cardiac and skeletal muscle contain visible bands that are called __________.
2. The muscular layer of the intestine is composed of visceral, or ____________, muscle.
3. The ability of a muscle to transmit electrical current is termed __________.
4. The ability of a muscle to shorten is termed ____________.
5. Binding sites on the actin molecules are covered by troponin and _________________ when the muscle is at rest.
6. The larger of the two filaments forming a cross-bridge is made of a protein called _______________.
7. The neurotransmitter released at the neuromuscular junction is called ____________.
8. The compound that causes the myosin head to detach from actin is called ______________.
9. Muscles operating anaerobically are said to be in a state of _____________.
10. The polysaccharide in muscles containing multiple glucose molecules is named _____________.
11. The energy-storing compound that is similar to ATP is called ______________.
12. The increase in muscle size resulting from resistance training is termed ______________.
13. A contraction that shortens the muscle but does not increase muscle tension is called _______________.
14. Mr. M’s arm muscle is contracted because he is carrying a heavy box. This contraction, which is associated with an increase in muscle tension, is termed _______________.
15. A muscle that produces a given movement is called the _________________.
16. The muscle that opposes a given action is called the ________________.
17. The more movable attachment point of a muscle is called the ___________.
18. The pivot point of a lever system is called the _________________.
19. Raising a beer glass by flexing the arm at the elbow is an example of a __________-class lever system.
20. A term referring to a muscle that decreases the angle at a joint is ______________.
21. An adjective describing muscle fibers running in a straight line is _______________.
22. The dome-shaped muscle used in breathing is the _______________.
23. The large triangular muscle across the back of the neck and shoulders is the _______________.
24. The muscle with four origins that covers the front and sides of the thigh bone is the ______________.
25. The prime mover in plantar flexion is the _____________.
26. The innermost muscle of the abdomen is the _______________.
27. The triceps brachii _____________ the arm at the elbow.
28. The _______________ tendon is attached to the heel.
29. The cheek muscle used in whistling is the _____________.
30. The muscles located between the ribs are called the _______________.
31. Aging is associated with a gradual decrease in the number of muscle cells, or ______________.
32. Inflammation of a tendon is called __________________.
33. Inflammation of a fluid-filled sac near a joint results in _________________.
34. The medical term for muscle pain is _______________.
35. The scientific name for wryneck is__________________.
36. A sudden involuntary muscle contraction is a(n) _______________.
37. The word part sarc/o means _____________.
38. The specialized membranes that permit electric impulses to pass between cardiac muscle cells are called
B) intercalated disks
39. A bundle of muscle fibers is called a(n)
40. The membrane surrounding individual muscle fibers is the
B) deep fascia
41. Which of the following is NOT a function of the muscular system?
A) skeletal movement
B) heat generation
D) body cooling through evaporation
42. A single neuron and all the muscle fibers it stimulates comprise a(n)
A) neuromuscular junction
B) motor end plate
C) motor unit
43. The two filaments that form cross-bridges are
A) actin and troponin
B) tropomyosin and myosin
C) actin and myosin
D) troponin and tropomyosin
44. Which of the following events occurs during muscle relaxation?
A) Calcium is pumped into the sarcoplasmic reticulum.
B) Acetylcholine is released into the synaptic cleft.
C) The actin binding sites are exposed.
D) The action potential travels to the sarcoplasmic reticulum.
45. The ion that binds the troponin/tropomyosin complex is
46. The compound that binds myosin and provides the energy for the power stroke is
A) creatine phosphate
47. A substance produced during oxygen debt is
A) lactic acid
B) calcium phosphate
48. The compound that stores oxygen in muscle cells is
C) creatine phosphate
49. Exercise results in
A) dilation of blood vessels
B) a decrease in the number of mitochondria
C) muscle atrophy
D) an increase in the resting heart rate
50. The partial contraction observed in resting muscle is called
A) muscle tone
B) isometric contraction
C) isotonic contraction
51. Pushing the feet against the floor is an example of a(n)
A) isometric contraction
B) muscle tone
C) isotonic contraction
D) isometric and isotonic contraction
52. A muscle that steadies body parts during a movement is called a(n)
C) prime mover
D) extrinsic muscle
53. In anatomic lever systems, the fulcrum is the
54. A term referring to a ring-shaped muscle is
55. A muscle that raises a body part is a(n)
56. In naming muscles, the suffix –ceps means
B) attachment points
D) direction of fibers
57. Which of the following is NOT a muscle of the head?
58. Which of the following is NOT a muscle of the abdomen?
A) internal oblique
B) transversus abdominis
D) rectus abdominis
59. A muscle that moves the head is the
C) serratus anterior
D) rotator cuff
60. The levator ani is found in the
61. A muscle located at the angle of the jaw used for chewing is the
62. The muscle that closes the lips is the
A) orbicularis oris
B) orbicularis oculi
63. An antagonist to the adductor group of the thigh is the
A) gluteus maximus
B) gluteus medius
D) peroneus longus
64. An antagonist to the gastrocnemius is the
D) tibialis anterior
65. The hamstring muscles act to
A) extend the leg
B) flex the leg
C) flex the thigh
D) adduct the thigh
66. A sudden and painful involuntary contraction of a muscle is called a
67. Student’s elbow and housemaid’s knee are examples of
D) carpal tunnel syndrome
68. Inflammation of connective tissues is called
69. Carpal tunnel syndrome involves the tendons of the
C) upper arm
70. A spasm of visceral muscle is called (a)
71. Any word containing the part brachi/o probably refers to the
72. The main flexor of the forearm is the
D) triceps brachii
73. Compare the location and function of the three types of muscle tissue.
74. A new drug blocks the release of acetylcholine from neuron endings. The mad scientist Dr. C takes the drug and then tries to move her arm. What will happen? Discuss the role of acetylcholine in muscle contraction in your answer.
75. JL is sitting in a chair wearing very heavy boots. She slowly straightens her leg, raising her boot. A. Is this an isotonic or isometric contraction? B. Name the prime mover and antagonist participating in this action. C. Discuss the mechanics of this action, naming the class of lever and the names and relative positions of the fulcrum, resistance, and effort.
76. Ms. V was riding her bike down a steep hill when her brakes seized. She flew over the handlebars and landed on her shoulder, tearing a number of ligaments that hold the shoulder joint in place. Name the type of injury. Should she apply ice or heat to the injured area, and why?
77. Based on your knowledge of word parts, what is the definition of brachialgia?
9. oxygen debt
11. creatine phosphate
15. prime mover
24. quadriceps femoris
26. transversus abdominis
73. Smooth muscle makes up the walls of the hollow body organs, the blood vessels, and the respiratory passageways. It moves involuntarily, producing the wavelike motions of peristalsis that move substances through a system. Cardiac muscle makes up the wall of the heart. It moves involuntarily to pump blood out of the heart. Skeletal muscle is usually attached to bones and moves the skeleton. It is controlled voluntarily.
74. Dr. C will not be able to move her arm because acetylcholine will not be released. Normally, acetylcholine is released subsequent to an action potential in the motor neuron. It binds receptors in the motor end plate of the muscle, initiating an action potential that initiates a muscular contraction.
75. A. isotonic B. The quadriceps femoris is the prime mover, the hamstring group is the antagonist. C. This action is an example of a third-class lever. The weight of the boot is the resistance, the knee joint is the fulcrum, and the effort is generated in the front of the thigh (quadriceps femoris). The effort is exerted between the resistance and the fulcrum.
76. Ms. V has suffered a shoulder sprain. She should apply ice to constrict the small blood vessels in the region and minimize internal bleeding.
77. Pain (–algia) in the arm (brachi/o).
Ehlers-Danlos syndrome, hemophilia, and osteogenesis imperfecta.
Systemic JIA is generally the most painful form of the disease (Adams & Lehman, 2005). The high number of joints involved, long duration of disease, and resulting orthopedic changes make this type of JIA one of the most debilitating.