Chapter 43: Structure and Function of the Musculoskeletal System

MULTIPLE CHOICE
1. Which bone cells produce osteocalcin when stimulated by 1,25-dihydroxyvitamin D and

synthesize osteoid?
a. Osteoclasts
b. Osteocytes

c. Fibrocytes
d. Osteoblasts

ANS: D

Osteoblasts are cells derived from mesenchymal stem cells and produce several substances,
including osteocalcin, transforming growth factorbeta (TGF-) (a growth inhibitor for many
cells), macrophage colonystimulating factor, receptor activator of nuclear factor kappa-B
ligand, osteoprotegerin (OPG), and bone matrix when stimulated by 1,25-dihydroxyvitamin
D. This statement is not true of the other options.
PTS: 1

REF: Page 1514

2. What happens to the original bone during the second phase of bone remodeling?
a. The original bone is replaced.
c. The original bone is resorbed.
b. It hardens.
d. It is synthesized.
ANS: C

The distribution of these apoptotic osteocytes provides osteoclasts with information about
where to begin resorbing damaged bone. In the second phase of remodeling (resorption), the
osteoclasts form a cutting cone that gradually resorbs bone, leaving behind an elongated
cavity termed a resorption cavity. This selection is the only option that accurately describes
what happens when bone is resorbed.
PTS: 1

REF: Pages 1519-1520

3. Which cells function to maintain bone matrix?

a. Osteoclasts
c. Osteoblasts
b. Osteocytes
d. Osteophytes
ANS: B

Osteocytes help synthesize and replace needed elements of the matrix by signaling osteoclasts
and osteoblasts to resorb and form new bone. This selection is the only option that performs
that function.
PTS: 1

REF: Pages 1514-1515

4. Which bone cells are large and multinucleated and contain lysosomes filled with hydrolytic

enzymes?
a. Osteoblasts
b. Osteoclasts

c. Osteocytes
d. Fibrocytes

ANS: B

Osteoclasts are the major resorptive cells of bone. They are large multinucleated cells with a
short life span and contain lysosomes (digestive vacuoles) filled with hydrolytic enzymes.
This selection is the only option that is described in this manner.

PTS: 1

REF: Page 1515

5. Which bone cell secretes hydrochloric acid to help dissolve bone minerals and collagenase,

thus aiding in the digestion of collagen?

a. Osteocytes
b. Osteoblasts

c. Osteoclasts
d. Osteophytes

ANS: C

Only osteoclasts bind to the bone surface of cell attachment proteins called integrins. They
bring about resorption of bone by secreting hydrochloric acid and cathepsin K (a protease
enzyme) that help dissolve bone minerals and collagenase, which aids in digesting collagen,
along with the action of cytokines.
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REF: Page 1515

6. Which glucoprotein is believed to inhibit calcium phosphate precipitation and play a part in

bone resorption by recruiting osteoclasts?

a. Osteocalcin
b. Osteonectin

c. Laminin
d. Osteopontin

ANS: A

The roles of osteocalcin may be to inhibit calcium phosphate precipitation and play a part in
bone resorption by recruiting osteoclasts. This statement is not true of any other option.
PTS: 1

REF: Page 1516

7. Which glucoprotein is thought to transport essential elements such as hormones, ions, and

other metabolites to and from the bone cells?

a. Osteocalcin
b. Osteonectin

c. Laminin
d. Bone albumin

ANS: D

Researchers believe bone albumin transports essential elements such as hormones, ions, and
other metabolites to and from the bone cells and maintain the osmotic pressure of bone fluid
(fluid surrounding mineral crystals and osteoblasts). This statement is not true of any other
option.
PTS: 1

REF: Page 1516

8. How is the work function of a muscle usually calculated?

a. Muscle type
c. Foot pounds
b. Calculating force distance
d. Kilograms
ANS: B

The ultimate function of muscle is to accomplish work. Although expressed in such measures
as foot-pounds or kilogram-meters, work refers to the amount of energy liberated or the
amount of force exerted over a distance (work force distance). Muscle type is not relevant.
PTS: 1

REF: Page 1533

9. What is the basic structural unit in compact bone?

a. Small channels called canaliculi

b. Osteocytes within the lacunae

c. Tiny spaces within the lacunae

d. Haversian system

ANS: D

The basic structural unit in compact bone is the haversian system (see Figure 43-4). This
selection is the only option that accurately identifies the basic structure of compact bone.
PTS: 1

REF: Page 1517

10. Which part of an injured joint becomes insensitive to pain and regenerates slowly and

minimally?
a. Synovium
b. Articular cartilage

c. Bursa
d. Tendon

ANS: B

Articular cartilage has no blood vessels, lymph vessels, or nerves. Therefore it is insensitive to
pain and regenerates slowly and minimally after injury. These statements are not true of the
other options.
PTS: 1

REF: Page 1525

11. The outer layer of the periosteum contains blood vessels and nerves that penetrate the inner

structures of the bone by way of which structure?

c. Sharpey canals
d. Trabeculae

a. Volkmann canals
b. Canaliculi
ANS: A

All bones are covered with a double-layered connective tissue called the periosteum. The
outer layer of the periosteum contains blood vessels and nerves, some of which penetrate to
the inner structures of the bone only through channels called Volkmann canals (see Figure 434).
PTS: 1

REF: Page 1517

12. What is the function of Sharpey fibers?

a. To anchor the outer layer of the periosteum to the inner layer
b. To contain blood vessels and nerves on the outer layer of the periosteum
c. To help attach tendons and ligaments to the periosteum
d. To attach muscles to the periosteum
ANS: C

Collagenous fibers (Sharpey fibers) that penetrate the bone anchor the inner layer of the
periosteum to the bone. Sharpey fibers help hold or attach tendons and ligaments, not muscle,
but to the periosteum of bones.
PTS: 1

REF: Page 1517

13. After puberty, the epiphyseal plate calcifies, and the epiphysis merges with the __________.
a. Epiphyseal line
c. Metaphysis
b. Epiphyseal plate
d. Articular cartilage
ANS: C

After puberty, the epiphyseal plate calcifies and the epiphysis merges only with the
metaphysis.
PTS: 1

REF: Page 1518

14. The stage of healing in the bone that involves procallus formation entails which process?
a. Formation of a hematoma that allows the development of a fibrin network
b. Production of granulation tissue by fibroblasts, capillary buds, and osteoblasts
c. Development of a primitive bone matrix termed woven bone
d. Remodeling of the periosteal and endosteal bone surfaces
ANS: B

Fibroblasts, capillary buds, and osteoblasts move into the wound to produce granulation tissue
called a procallus. None of the other options are associated with this process.
PTS: 1

REF: Page 1520

15. Which term describes a freely movable joint?

a. Synarthrosis
c. Biarthrosis
b. Amphiarthrosis
d. Diarthrosis
ANS: D

Based on movement, a joint is classified as a synarthrosis (immovable joint), an

amphiarthrosis (slightly movable joint), or a diarthrosis (freely movable joint). Biarthrosis is
not a term used to describe a freely movable joint.
PTS: 1

REF: Page 1520

16. Which type of joint holds teeth in the maxilla or mandible?

a. Amphiarthrosis
c. Synarthrosis
b. Diarthrosis
d. Gomphosis
ANS: D

A gomphosis is a special type of fibrous joint in which a conical projection fits into a
complementary socket and is held in place by a ligament. Gomphosis is the only term used to
identify the joint that holds teeth in the maxilla or mandible.
PTS: 1

REF: Page 1520

17. The hyaline cartilage joints between the ribs and sternum are examples of which type of joint?
a. Synchondrosis
c. Gomphosis
b. Symphysis
d. Syndesmosis
ANS: A

A synchondrosis is the only type of joint in which hyaline cartilage, rather than fibrocartilage,
connects the two bones. The joints between the ribs and the sternum are synchondroses and
are not examples of any of the other types.
PTS: 1

REF: Page 1520

18. The joint that contains a synovial membrane that lines the inner joint capsule is an example of

which type of joint?

a. Amphiarthrosis
b. Diarthrosis

c. Synarthrosis
d. Biarthrosis

ANS: B

The joint that contains a synovial membrane that lines the inner joint capsule is a diarthrosis.
A synovial joint consists of the following parts: (1) fibrous joint capsule (articular capsule),
(2) synovial membrane that lines the inner surface of the joint capsule, (3) joint cavity
(synovial cavity or space formed by the capsule), (4) synovial fluid, which fills the joint cavity
and lubricates the joint surface, and (5) articular cartilage, which covers and pads the
articulating bony surfaces.
PTS: 1

REF: Page 1522

19. What is the function of the synovial membranes type A cells within the intima?
a. To release mast cells, initiating the inflammatory process after joint injury
b. To ingest and remove bacteria and debris by phagocytosis in the joint cavity
c. To secrete hyaluronate, a binding agent that gives synovial fluid its viscous quality
d. To store fat cells and glycogen, providing adenosine triphosphate for joint activity
ANS: B

The intima contains two types of synovial cells: A and B. Type A synovial cells ingest and
remove bacteria and particles of debris by phagocytosis in the joint cavity. None of the
remaining options accurately describes the function of the synovial membranes type A cells.
PTS: 1

REF: Page 1522

20. Which statement does not present accurate information concerning synovial fluid?
a. Synovial fluid contains protein polysaccharides to repair the synovial membrane

after injury.
b. It lubricates the joint surfaces.
c. Synovial fluid nourishes the pad of the articular cartilage.
d. It contains leukocytes to phagocytize joint debris and microorganisms.
ANS: A

Synovial fluid lubricates the joint surfaces, nourishes the pad of the articular cartilage that
covers the ends of the bones, and contains free-floating synovial cells and various leukocytes
that phagocytose joint debris and microorganisms. The other options provide accurate
information about synovial fluid.
PTS: 1

REF: Page 1522

21. What anchors articular cartilage to the underlying bone?

a. Sharpey fibers
c. Glycoproteins
b. Collagen fibers
d. Elastin fibers
ANS: B

Collagen fibers are important components of the cartilage matrix because they anchor the
cartilage securely to underlying bone. This statement is not true of the other options.
PTS: 1

REF: Pages 1524-1525

22. What controls the movement of synovial fluid through cartilage?

a. Cartiloregulins
b. Hyaluronate

c. Proteoglycans
d. Chondroitin

ANS: C

Only proteoglycans give articular cartilage its stiff quality and regulate the movement of
synovial fluid through the cartilage.
PTS: 1

REF: Page 1525

23. Which statement is false about muscles?

a. Muscle comprises 50% of an adults body weight and 40% of a childs body

weight.
b. Muscle is 75% water, 20% protein, and 5% organic and inorganic compounds.
c. Muscle contains 32% of all protein stores for energy and metabolism.
d. Muscles are encased in fascia.
ANS: A

Muscle constitutes 40% of an adults body weight and 50% of a childs body weight. The
other options are true statements regarding muscles.
PTS: 1

REF: Pages 1526-1527

24. Which characteristic is true of type II (white fast-motor) muscle fibers?

a. Slow contraction speed
c. Profuse capillary supply
b. Fast conduction velocities
d. Oxidative metabolism
ANS: B

Type II fibers, also called white fast-motor fibers, are innervated by relatively large type II
alpha motor neurons with fast conduction velocities. This selection is the only correct option
provided.
PTS: 1

REF: Page 1529

25. As the innervation ratio of a particular organ increases, what other property also increases?
a. Control
c. Coordination
b. Movement
d. Endurance
ANS: D

The greater the innervation ratio of a particular organ, the greater is its endurance. Lowinnervation ratios promote control and coordination, whereas high ratios promote strength and
endurance. An increase in the innervations ratio does not result in an increase in movement.
PTS: 1

REF: Page 1528

26. Which statement describes a neuroregulin?

a. Chemical mediator that initiates signals from the anterior horn cell of the spinal

card to the axon of motor nerve branches of groups of muscle fibers

b. Neurotransmitter that provides a means of reporting changes in length, tension,

velocity, and tone in muscles

c. Proteoglycan secreted by neurons, which increases acetylcholine receptors
d. Mechanoreceptor that lies parallel to muscle fibers and responds to muscle

stretching

ANS: C

Motor and sensory neurons secrete a proteoglycan called neuroregulin that increases
acetylcholine receptors and helps in the formation of muscle spindle fibers. This selection is
the only option that accurately describes a neuroregulin.
PTS: 1

REF: Pages 1528-1529

27. Which four-step process correctly describes muscle contraction?

a. Coupling, contraction, relaxation, excitation
b. Contraction, relaxation, excitation, coupling
c. Relaxation, excitation, coupling, contraction
d. Excitation, coupling, contraction, relaxation
ANS: D

Muscle contraction is a four-step process: excitation, coupling, contraction, and relaxation.

PTS: 1

REF: Page 1533

28. Which type of ion directly controls the contraction of muscles?

a. Sodium
c. Calcium
b. Potassium
d. Magnesium
ANS: C

Contraction begins as the calcium ions combine with troponin, a reaction that overcomes the
inhibitory function of the troponin-tropomyosin system. This selection is the only option that
has such a direct association with muscle contraction.
PTS: 1

REF: Page 1533

29. In which type of contraction does the muscle maintain a constant tension as it moves?
a. Isotonic
c. Hypertonic
b. Isometric
d. Hypotonic
ANS: A

Only during an isotonic contraction does the muscle maintain a constant tension as it moves.
PTS: 1

REF: Page 1535

30. Which term is used to identify a functional muscle contraction in which the muscle contracts

but the limb does not move?

a. Isotonic
b. Isometric

c. Eccentric
d. Concentric

ANS: B

Only during an isometric contraction (static or holding contraction) does the muscle maintain
a constant length as tension is increased. Isometric contraction occurs, for example, when the
arm or leg is pushed against an immovable object. The muscle contracts, but the limb does not
move.
PTS: 1

REF: Page 1535

31. Which statement is false about aging and the musculoskeletal system?

a. Haversian system erodes, the canals nearest the marrow cavity widened, and the

endosteal cortex converts to spongy bone.

b. The remodeling cycle increases because of a decreased ability of the basic

multicellular units to resorb and deposit bone.

c. Cartilaginous rigidity increases because of decreasing water content and decreasing

concentrations of glycosaminoglycans.
d. Muscle ribonucleic acid (RNA) synthesis declines, although the regenerative

function of muscle tissue is reportedly normal in older adults.

ANS: A

Aging does not typically have an effect on the haversian system as described. The remaining
options are accurate statements regarding the effects of aging.
PTS: 1

REF: Page 1536

32. Which component is found in synovial fluid?

a. Protein polysaccharides
c. Leukocytes
b. Water
d. Chondrocytes
ANS: C

Synovial fluid lubricates the joint surfaces, nourishes the pad of the articular cartilage that
covers the ends of the bones, and contains only free-floating synovial cells and various
leukocytes that phagocytose joint debris and microorganisms. None of the remaining options
are found in synovial fluid.
PTS: 1

REF: Page 1522

33. What term is used to identify an interlacing bundle of dense, white fibrous tissue that is richly

supplied with nerves, blood vessels, and lymphatic vessels?

c. Hematoma
d. Elastin fibers

a. Procallus
b. Joint capsule
ANS: B

The joint capsule is made up of parallel, interlacing bundles of dense, white fibrous tissue. It
is richly supplied with nerves, blood vessels, and lymphatic vessels. None of the other options
are associated with this structure.
PTS: 1

REF: Page 1522

MULTIPLE RESPONSE
34. In adults, hematopoiesis takes place in which bone marrow cavities? (Select all that apply.)
a. Skull
b. Shoulders
c. Sternum
d. Long bones
e. Pelvis
ANS: A, B, C, E

The marrow cavities within certain bones serve as sites of blood cell formation. In adults,
blood cells exclusively originate in the marrow cavities of only the skull, vertebrae, ribs,
sternum, shoulders, and pelvis.
PTS: 1

REF: Page 1510

35. Which statements are true regarding osteocytes? (Select all that apply.)
a. An osteocyte is a transformed osteoblast.
b. An osteocyte obtains nutrients from capillaries in the canaliculi.
c. The functioning of an osteocyte is well understood.
d. Osteocytes signal osteoclasts and osteoblasts to form new bone.
e. An osteocyte helps maintain levels of calcium and phosphorus in blood plasma.
ANS: A, B, D, E

An osteocyte is a transformed osteoblast. Osteocytes communicate with each other and help
concentrate nutrients in the matrix. They obtain nutrients from capillaries in the canaliculi,
which contain nutrient-rich fluids and also help synthesize and replace needed elements of the
matrix by signaling osteoclasts and osteoblasts to resorb and form new bone. Through
exchanges among these cells, hormone catalysts, minerals, and optimal levels of calcium,
phosphorus, and other minerals are maintained in blood plasma.
PTS: 1

REF: Pages 1514-1515

36. Which minerals are stored in bones? (Select all that apply.)
a. Carbonate
b. Phosphate
c. Selenium
d. Magnesium
e. Calcium
ANS: A, B, D, E

Bones have a crucial role in mineral homeostasis and in storing and releasing minerals (e.g.,
calcium, phosphate, carbonate, magnesium) that are essential for the proper working of many
delicate cellular mechanisms. Selenium is not stored in the bones.
PTS: 1

REF: Page 1510

37. Which factors influence the rate of protein synthesis of skeletal muscles? (Select all that

apply.)
a. Insulin
b. Cortisol
c. Parathyroid hormone
d. Growth hormone
e. Amino acid substrates
ANS: A, E

The rate of protein synthesis is related to insulin levels amino acid substrates and to overall
nutritional status.
PTS: 1

REF: Page 1533

MATCHING

Match the stages of wound healing of a bone with the description of each. Stages may be used
more than once.
______ A. Callus replacement
______ B. Hematoma formation
______ C. Remodeling
______ D. Procallus formation
______ E. Callus formation
38. Fibroblasts, capillary buds, and osteoblasts move into the wound to produce granulation
39.
40.
41.
42.

tissue.
Periosteal and endosteal surfaces of the bone are formed to the size and shape of the bone
before an injury.
Osteoblasts form membranous or woven bone. Enzymes increase the phosphate content and
permit the phosphate to join with calcium to be deposited.
Fibrin and platelets form a meshwork within the initial framework for healing.
Osteoblasts continue to restore callus with lamellar bone or trabecular bone.

38. ANS: D
PTS: 1
REF: Page 1520
MSC: Fibroblasts, capillary buds, and osteoblasts move into the wound to produce granulation tissue
called procallus.
39. ANS: C
PTS: 1
REF: Page 1520
MSC: Remodeling occurs as the periosteal and endosteal surfaces of the bone are remodeled to the
size and shape of the bone before injury.
40. ANS: E
PTS: 1
REF: Page 1520
MSC: Callus formation occurs as osteoblasts in the procallus form membranous or woven bone
(callus). Enzymes increase the phosphate content and permit the phosphate to join with calcium to be
deposited as mineral to harden the callus.
41. ANS: B
PTS: 1
REF: Page 1520
MSC: Hematoma formation occurs if vessels have been damaged, causing hemorrhage. Fibrin and
platelets within the hematoma form a meshwork that is the initial framework for healing with the help
of hematopoietic growth factors such as platelet-derived growth factor and transforming growth factorbeta (TGF-b).
42. ANS: A
PTS: 1
REF: Page 1520
MSC: Callus replacement occurs as osteoblasts continue to replace the callus with lamellar bone or
trabecular bone.