Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
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Chapter 59- Disorders of Musculoskeletal Function
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | A 68-year-old woman has had her mobility and quality of life severely affected by rheumatoid arthritis (RA). Place the following pathophysiological events involved in her health problem in the correct order that they most likely occurred. Use all the options.
A) Inflammatory response B) Interaction between rheumatoid factor (RF) and IgG C) T-cell–mediated immune response D) Pannus invasion E) Destruction of articular cartilage |
|
| Ans: | C, B, A, D, E | |
| Feedback: | ||
| RA is thought to begin with a T-cell–mediated immune response that precipitates interaction between IgG and RF that constitutes an immune response. Pannus invasion is one consequence of this interaction, the ultimate result of which is destruction of cartilage. | ||
| 2. | Following a progressive onset of fatigue, aching, and joint stiffness over the last 2 years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which of the following teaching points should his primary care physician include during the office visit in which this diagnosis is communicated to the client? | |
| A) | “The symptoms you’ve been experiencing are the result of damage inside your joints, but I’ll start you medications that will reverse this damage.” | |
| B) | “It’s important that you maximize your level of activity, since decreasing your mobility will worsen the disease.” | |
| C) | “The best treatment plan is to try all other available treatments before resorting to using medications.” | |
| D) | “Steroids and anti-inflammatory drugs that I’ll prescribe will likely bring some relief to your symptoms.” | |
| Ans: | D | |
| Feedback: | ||
| Current treatment guidelines for RA involve early and aggressive pharmacological treatment, including NSAIDs and corticosteroids. Damage cannot be reversed, and while therapeutic exercise plays a role in treatment, rest is also important. | ||
| 3. | The physician is considering prescribing an anti-tumor necrosis factor (TNF) like infliximab for a rheumatoid arthritis patient. Which of the following statements is accurate about the advantages of using a TNF inhibitor? | |
| A) | “Since TNF inhibitors have few side effects, these drugs will fit well into your regimen.” | |
| B) | “Your disease-modifying antirheumatic drug (DMARD) methotrexate has more cardiovascular side effects than TNF inhibitors.” | |
| C) | “TNF inhibitors help slow the disease progression and improve your ability to perform routine ADL functions.” | |
| D) | “Not only do TNF inhibitors control your disease better but they also will interrupt the inflammatory cascade at several levels.” | |
| Ans: | C | |
| Feedback: | ||
| Second-line antirheumatic drugs include anti-TNF drugs such as etanercept, infliximab, and adalimumab. These drugs are biologic response–modifying agents or TNF inhibitors that block TNF-a, one of the key proinflammatory cytokines in RA. Anti-TNF-a agents have shown significant efficacy although they do have some potential adverse side effects. Evidence indicates that CV side effects are not different for TNF inhibitors than for DMARDs. The TNF inhibitor agents also have been shown to inhibit radiologic disease progression and improve functional outcomes. | ||
| 4. | A physician is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which of the following aspects of the physician’s assessment and the client’s history would be considered potentially indicative of SLE? Select all that apply. | |
| A) | The client has a “butterfly rash” on her nose and cheeks. | |
| B) | She complains of intermittent joint pain. | |
| C) | The woman states that she has numerous environmental allergies. | |
| D) | The client has been hospitalized twice in the past for pleural effusions. | |
| E) | Blood work indicates low red cells, white cells, and platelets. | |
| Ans: | A, B, D, E | |
| Feedback: | ||
| A butterfly rash, joint pain, pleural effusion, and low levels of blood cellular components are all associated with SLE. Environmental allergies are not noted to be risk factors or associated symptoms of the disease. | ||
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