System Block 3 Final 3

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Haczar
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263252
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System Block 3 Final 3
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2014-02-22 18:56:16
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Musculoskeletal Bone Joints
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SB3 Final
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  1. A 33-year-old woman presents with a spontaneous fracture of her femoral head. She has suffered from Crohn disease for 20 years. Multiple surgical procedures have resulted in the removal of much of her small bowel. She has had profound weight loss over the last 10 years. The bone is pinned. Histologically, the resected femoral had shows bony trabeculated that are covered by a thicker–than–normal layer of osteoid (shown in the image). In this section, the osteoid is stained red, and mineralized bone is stained black. Which of the following best describes the pathogenesis of this lesion?



    A. Subperiosteal bone resorption
    B. Impaired mineralization of osteoid
    C. Inflammatory synovium with pannus formation
    D. Enhanced osteoblast activity
    E. Degenerative changes in the subchondral bone
    B. Impaired mineralization of osteoid (osteomalacia)
    (this multiple choice question has been scrambled)
  2. An 18-year-old man presents with bone pain about his need that has had for six weeks. Radiologic studies lytic lesion of the distal end of the femur, which arises in the metaphysis, extends into the proximal diaphysis, and elevates the periosteum. Serum levels of alkaline phosphatase on markedly elevated. The lesion is removed, and the cut surface of the surgical specimen as shown in the image. Molecular studies of this tumor but most likely reveal of mutation and gene encoding which of the following proteins?



    A. Cyclin A
    B. Rb tumor suppressor protein
    C. Cyclin D
    D. Stimulatory guanine nucleotide-binding protein
    E. Fibroblast growth factor receptor
    B. Rb tumor suppressor protein (osteosarcoma)
    (this multiple choice question has been scrambled)
  3. A 10-year-old boy complains of increasing pain in his left hip. He began limping shortly after playing a baseball game at school. He is afebrile. An x-ray of the formal head shows a fracture and irregular densities of the cancellous bone. You make a diagnosis of Legg-Calve-Perthes disease. Which of the following best describes the pathologic findings in this patient?

    A. Avascular osteonecrosis
    B. Osteitis fibrosa cystica
    C. Chondroma
    D. Osteopetrosis
    E. Fibrous dysplasia
    A. Avascular osteonecrosis
    (this multiple choice question has been scrambled)
  4. A 50-year-old man presents with today history of left leg pain. His temperature is 38.7°C. He has a harsh systolic murmur and echocardiograph evidence of bacterial endocarditis. If this patient has developed a hematogenous osteomyelitis, his bone infection would most likely be fun which of the following anatomic locations?

    A. epiphysis of a long bone
    B. body of a flat bone
    C. periosteum of a long bone
    D. metaphysis of a long bone
    E. diaphysis of a long bone
    B. Avascular osteonecrosis (osteomyelitis)
    (this multiple choice question has been scrambled)
  5. He 74-year-old, obese woman (BMI equals 33 kg/m2) complains of chronic pain and have back, knees, and fingers. The pain typically subsides at rest. On physical examination, the distal interphalangeal joints are enlarged and tender. Which of the following best describes the pathogenesis of joint pain in this patient?

    A. reduction of the volume of synovial fluid
    B. degenerative changes of cortical bone
    C. inflammatory synovium with pannus formation
    D. acute inflammation of the ligaments
    E. degeneration of articular cartilage
    E. degeneration of articular cartilage (osteoarthritis)
    (this multiple choice question has been scrambled)
  6. A 60-year-old woman with arthritis suffers a massive stroke and expires. At autopsy, the proximal phalangeal joint tissue shows pannus, synovial cell hyperplasia, and lymphoid follicles. Which of the following best describes the pathogenesis of pannus formation in this patient?

    A. calcification of the synovium
    B. chronic inflammation of synovium
    C. degeneration of cartilage
    D. dislocation of a portion of bone
    E. necrosis of fibroadipose tissue
    B. chronic inflammation of synovium (Rheumatoid arthritis)
    (this multiple choice question has been scrambled)
  7. Before-year-old woman complains of morning stiffness in her hands. On physical examination, her finger joints are painful, swollen, and warm. X-ray examination of the hands show narrowing of the joint spaces and erosion of joint surfaces of the metacarpal/phalangeal joints. The adjacent bones show osteoporosis. He synovial biopsy reveals prominent and lymphoid follicles, synovial hyperplasia, and villous folds (shown in the image). Laboratory studies conducted on a blood sample from this patient will most likely show polyclonal antibodies directed against which of the following proteins?



    A. Fab2 portion of IgM
    B. Double-stranded DNA
    C. Topoisomerase I
    D. Fc portion of IgG
    E. Ribonucleoprotein
    D. Fc portion of IgG (rheumatoid arthritis)
    (this multiple choice question has been scrambled)
  8. A 55-year-old man presents with pain in the left arm. Laboratory so use show elevated serum levels of calcium and parathyroid hormone. An x-ray of the left arm reveals multiple small bone cysts and pathologic fractures. Biopsy of the affected bone discloses numerous giant cells in a cellular and fibrous stroma. The patient undergoes removal of a parathyroid adenoma. Which of the following best describes the pathogenesis of bone pain and pathologic fractures in this patient?

    A. Enhanced osteoblastic activity
    B. Impaired mineralization of osteoid
    C. Increased bone resorption
    D. Increased mineralization of bone
    E. Osteoporosis
    • C. Increased bone resorption
    • (hyperparathryoidism)
  9. A 67-year-old man from England develops bow-legs and leg pain over the last 5 years. He also complains of progressive hearing loss over the last 2 years. A bone biopsy shows a mosaic pattern with prominent cement lines and increased osteoblastic and osteoclastic activity. Serum electrolyte levels are normal. This patient is at increased risk for developing which the following diseases?

    A. Pulmonary embolism
    B. Renal Failure
    C. Amyloidosis
    D. Multiple myeloma
    E. Osteogenic sarcoma
    E. Osteogenic sarcoma (Paget's Disease)
    (this multiple choice question has been scrambled)
  10. A 60-year-old man with a history of gout presents with multiple rubbery nodules on his hands (shown in the image). Which of the following best explains the pathogenesis of this patient's underlying condition?



    A. Autoimmune relapsing polychondritis
    B. High dietary intake of purine-rich foods
    C. Hypercalcemia and chondrocalcinosis
    D. Impaired renal excretion of uric acid
    E. Increased calcium hydroxyapatite deposition
    • D. Impaired renal excretion of uric acid
    • Gout
  11. 23-year-old man complains of stiffness and pain in his lower back that causes him to awaken at night. He first noticed morning stiffness in his lower back during his college years. He also describes occasional pain in his right eye and sensitivity to light. An x-ray of the sacroiliac region shows fusion of the small joint spaces in the posterior spine and ossification of the intervertebral discs. Serologic test for rheumatoid factor and antinuclear antibodies are negative. This patient most likely expresses which of the following human leukocyte antigen (HLA) haplotypes?

    A. B27
    B. B31
    C. B15
    D. B19
    E. B9
    A. B27 (Ankylosing Spondylitis)
    (this multiple choice question has been scrambled)
  12. A 20-year-old man complains of burning pain on urination, as well as pain in his fingers and left thigh. He also relates a recent episode of best ciliary diarrhea contracted during a visit to Mexico. Physical examination confirms arthritis and conjunctivitis. The patient responds well to treatment with NSAIDs. Which of the following is the most likely diagnosis?

    A. Reiter syndrome
    B. Ankylosing spondylitis
    C. Infectious arthritis
    D. Osteomyelitis
    E. Rheumatoid arthritis
    A. Reiter syndrome
    (this multiple choice question has been scrambled)
  13. 85-year-old man presents for three-week history of painful swelling of his right knee. Aspirational joint fluid returns numerous neutrophils and crystals, which I described as rhomboid and "coffin-like." Chemical analysis shows that these crystals are composed of calcium pyrophosphate. Which of the following is the most likely diagnosis?

    A. Ankylosing spondylitis
    B. Gout
    C. Infectious arthritis
    D. Pseudogout
    E. Rheumatoid arthritis
    • D. Pseudogout ( Calcium pyrophosphate
    • dihydrate (CPPD) )
  14. A 10-year old boy complains of pain in his hands and feet. His temperature is 38 C. Physical examination reveals a faint pericardial friction rub. His spleen, liver, and axillary lymph nodes are enlarged. Which of the following is most likely diagnosis?

    A. Reiter syndrome
    B. Gout
    C. Juvenile arthritis
    D. Gaucher disease
    E. Psoriatic arthritis

    A. Gaucher disease
    B. Gout
    C. Juvenile arthritis
    D. Psoriatic arthritis
    E. Reiter syndrome
    C. Juvenile arthritis
    (this multiple choice question has been scrambled)
  15. A 58-year-old woman fractious her hip after sliding on an icy sidewalk. An x-ray shows generalized osteopenia. A bone biopsy reveals attenuated phone trabeculate and the normal ratio of mineral-to-matrix. Serum calcium and phosphorous levels are normal. Which of the following best explains the pathogenesis of osteopenia in this post menopausal woman?

    A. Mosaic bone formation
    B. Increased osteoclast activity
    C. Increased mineralization of bone
    D. Impaired minerlization of osteoid
    E. Increased osteoblast activity
    B. Increased osteoclast activity (osteoporosis, osteopenia)
    (this multiple choice question has been scrambled)
  16. A two-year-old boy presents with a rash. On physical examination, he has a crusty, red skin lesion at the red hairline and on the extensor surfaces of his extremities and abdomen. Exophthalmos is noted. And x-ray film of the head shows multiple, radiolucent lesions in the skull. A biopsy of one of the skull lesions shows large, plump cells with pale, eosinophilic, foamy cytoplasm and convoluted nuclei (shown in the image). What is the most likely diagnosis?



    A. Multiple myeloma
    B. Giant Cell tumor of bone
    C. Large B-Cell Lymphoma
    D. Ewing Sarcoma
    E. Hand-Schuller-Christian disease
    E. Hand-Schuller-Christian disease
    (this multiple choice question has been scrambled)
  17. 17-year-old boy fractures his left tibia on a skiing accident. One year later, an x-ray of the leg discloses reactive bone formation in the calf muscle at the site of injury. Which of the following is the most likely diagnosis?

    A. Fibrous dysplasia
    B. Myositis ossificans
    C. Nodular fasciitis
    D. Malignant fibrous histiocytoma
    E. Synovial sarcoma
    B. Myositis ossificans
    (this multiple choice question has been scrambled)
  18. A 16-year-old boy presents with a two-week history of pain in his right leg. He says he has been taking aspirin to relieve the pain. An x-ray of the leg shows a 1 cm sharply demarcated, radiolucent lesion in the diaphysis of the tibia surrounded by dense, sclerotic bone. LeBron is surgically removed, and the girl specimen as shown in the image. Microscopically, the tumor shows a regular trabeculae of woven bone surrounded by osteoblasts, osteoclasts, and fibrovascular marrow. What is the appropriate diagnosis?



    A. Osteoid Osteoma
    B. Giant cell tumor of bone
    C. Osteoblastoma
    D. Solitary Chondroma
    E. Chondroblastoma
    A. Osteoid Osteoma
    (this multiple choice question has been scrambled)
  19. A 68-year-old woman presents with a lump in the soft tissue of her neck. Physical examination reveals a 0.5 cm subcutaneous tumor. Biopsy of the mass shows a benign neoplasm. The patient is told that she has the most common soft tissue tumor. What is the appropriate diagnosis?

    A. Leiomyoma
    B. Pleomorphic adenoma
    C. Fibroma
    D. Rhadomyosarcoma
    E. Lipoma
    E. Lipoma
    (this multiple choice question has been scrambled)
  20. A 56-year-old woman receives high dose radiation therapy for thyroid carcinoma. One year later, the patient presents with subcutaneous mass at the site of irradiation. A photomicrograph of the biopsy is showing the image. Which of the following is the most likely diagnosis?



    A. Leiomyosarcoma
    B. Synovial sarcoma
    C. Malignant fibrous hisiocytoma
    D. Rhadomyosarcoma
    E. Hodgkin lymphoma
    C. Malignant fibrous hisiocytoma
    (this multiple choice question has been scrambled)
  21. A 40-year-old woman presents with pain and swelling in her left elbow that had lasted six months. Physical examination reveals a 0.5 cm soft tissue mass. Biopsy of the mass discloses a biphasic histologic pattern consisting of cuboidal epithelial and spindle-shaped mesenchymal cells. Which of the following is most likely diagnosis?

    A. Nodular fasciitis
    B. Malignant fibrous histiocytoma
    C. Synovial sarcoma
    D. Liposarcoma
    E. Rhabdomyosarcoma
    C. Synovial sarcoma
    (this multiple choice question has been scrambled)
  22. A 50-year-old man complains of fever and severe pain in his great toe of 24 hours in duration. The pain developed in the morning and became so severe that he could not walk. Laboratory findings include leukocytosis, hyperuricemia, and hyperlipidemia. An x-ray of the affected joint reveals punched out lesions in the juxta-articular bone. An aspirate of joint fluid returns urate crystals and neutrophils. Which of the following would be the most likely pathologic finding within the periarticular soft tissue of this patient?

    A. Tophus
    B. Reactive bone
    C. Osteophyte
    D. Rheumatoid nodule
    E. Pannus
    A. Tophus
    (this multiple choice question has been scrambled)
  23. It 35 year-old woman has multiple cartilaginous lesions in her long and short bones. A radiograph of the hand (showing the image) reveals bulbous swellings. A biopsy shows abnormally arranged hyaline cartilage, with scattered zones of proliferation. This patient is at risk for which of the following bone diseases?



    A. Osteosarcoma
    B. Histocytic lymphoma
    C. Giant cell tumor of bone
    D. Synovial sarcoma
    E. Chondrosarcoma
    E. Chondrosarcoma (enchondromatosis)
    (this multiple choice question has been scrambled)
  24. 24-year-old man on chronic corticosteroid therapy for severe asthma present this with a 6-month history of increasing hip pain. This patient most likely exhibit symptoms of which of the following metabolic bone diseases?

    A. Osteomalacia
    B. Paget disease
    C. Gaucher disease
    D. Osteoporosis
    E. Osteopetrosis
    D. Osteoporosis
    (this multiple choice question has been scrambled)
  25. Excluding multiple myeloma, each of the following statements regarding primary bone neoplasms is correct EXCEPT:

    A  Less than half are malignant.
    B  Most occur about the knee.
    C  Most occur in older persons.
    D  Osteosarcomas are more frequent than chondrosarcomas.
    E  Males are more frequently affected than females.
    C  Most occur in older persons.

    Most primary bone tumors occur in younger persons.
  26. An 80-year-old woman falls out of bed and breaks her hip. Radiographs show not only a fracture of the left femoral head, but also a compressed fracture of T10. She probably has:

    A  Vitamin D deficiency
    B  A pyogenic infection
    C  Osteogenesis imperfecta
    D  Decreased bone mass
    E  Polyostotic fibrous dysplasia
    D  Decreased bone mass (osteoporosis)
  27. Chondrosarcoma is:

    A  The most frequent primary tumor of bone
    B  Usually seen in distal skeletal bones
    C  More common in females
    D  Sometimes seen to arise in benign cartilagenous tumors
    E  Associated with Paget's disease of bone
    D  Sometimes seen to arise in benign cartilagenous tumors
  28. You perform a sternal bone marrow aspirate on a 62 year old male and get a dark red jelly-like material in the syringe. The patient's total protein is 8.5 gm/dl with an albumin of 4.1 gm/dl. The smear of the aspirate will show which of the following as a prominent feature:

    A  Giant cells
    B  Fibroblasts
    C  Osteoblasts
    D  Metastatic renal cell carcinoma
    E  Plasma cells
    E  Plasma cells (Multiple Myeloma)
  29. A 66-year-old female with incresing difficulty in performing activities of daily living because of osteoarthritis is LEAST likely to have:

    A  Monoarticular involvement
    B  Knee involvement
    C  Bony ankylosis
    D  Morning stiffness
    E  Heberden's nodes
    C  Bony ankylosis
  30. A 13-year-old boy with pain in his left leg is found to have a neoplasm of the femur that radiologically is diaphyseal in location and on biopsy is seen microscopically to be composed of numerous small round blue cells. He also has fever. The probable diagnosis is:

    A  Ewing's sarcoma
    B  Medulloblastoma
    C  Neuroblastoma
    D  Chondroblastoma
    E  Osteoblastoma
    A  Ewing's sarcoma
  31. A 14 year old African male with sickle cell anemia (Hgb SS) is most prone to develop osteomyelitis with:

    A  Staphylococcus aureus
    B  Pseudomonas aeruginosa
    C  Salmonella
    D  E. coli
    E  Candida
    C  Salmonella
  32. A 70 year old male has noted increasing back and leg pain for years. Radiographs reveal bony sclerosis of the sacroiliac, lower vertebral, and upper tibial regions with cortical thickening, but without mass effect or bony destruction. If that weren't enough trouble, he says his hats don't even fit anymore. The major laboratory finding is an elevated serum alkaline phosphatase. The best diagnosis is:

    A  Adenocarcinoma of prostate with metastases
    B  Paget's disease of bone
    C  Renal failure with renal osteodystrophy
    D  OsteoporosisE  Osteomalacia
    B  Paget's disease of bone
  33. An expansile, eccentric lesion that radiographically is seen to be surrounded by a rim of reactive bone in the metaphysis of the distal femur in an 18-year-old female is most consistent with:

    A  Fibrous dysplasia
    B  Ewing's sarcoma
    C  Chondrosarcoma
    D  Osteosarcoma
    E  Aneurysmal bone cyst
    E  Aneurysmal bone cyst
  34. The finding of osteoblastic metastases of the vertebral column is most consistent with which of the following primary neoplasms:

    A  Infiltrating ductal carcinoma of breast
    B  Endometrial adenocarcinoma
    C  Adenocarcinoma of prostate
    D  Mucinous cystadenocarcinoma of ovary
    E  Renal cell carcinoma
    C  Adenocarcinoma of prostate
  35. Which statement regarding osteosarcoma of bone is INCORRECT:

    A  There is a male predominance.
    B  Bone trauma is a predisposing factor.
    C  Some cases are associated with radiation exposure.
    D  Femur and tibia adjacent to the knee are common sites.
    E  Metastases are usually hematogenous.
    B  Bone trauma is a predisposing factor.
  36. True statements concerning gouty arthritis include all of the following EXCEPT:

    A  Most patients with hyperuricemia will develop it.
    B  The first metatarsal-phalangeal joint is usually involved.
    C  Sodium urate crystals can be seen in synovial fluid.
    D  Tophi can erode bone and cartilage.
    E  Males are affected more than females.
    A  Most patients with hyperuricemia will develop it.
  37. A 5 year old boy has very short arms and legs, such that his height is less than the 5th percentile for age. However, his trunk and head appear normally proportioned for age. The most likely diagnosis is:

    A  Fibrous dysplasia
    B  Osteogenesis imperfecta
    C  Ollier's disease
    D  Alport's syndrome
    E  Achondroplasia
    E  Achondroplasia
  38. A 38 year old female has been on long-term corticosteroid therapy for treatment of systemic lupus erythematosus. The bone disease most commonly complicating this therapy is:

    A  Paget's disease of bone
    B  Rickets
    C  Osteochondritis
    D  Osteoporosis
    E  Osteomalacia
    D  Osteoporosis
  39. A 15-year-old girl is noted to have an abnormal lateral curvature of the spine. This is probably due to:
    A  Asymmetric cartilage growth of vertebral body end plates
    B  Multiple osteochondromas of the vertebral bodies
    C  Vitamin D deficiency with rickets
    D  A disorder of procollagen synthesis with multiple compressed fractures
    E  Trauma
    A  Asymmetric cartilage growth of vertebral body end plates
  40. A lateral projection from the metaphysis of the lower femur that is composed of a 3 cm stalk of bony cortex capped by cartilage is probably a(an):

    A  Osteochondroma
    B  Giant cell tumor
    C  Aneurysmal bone cyst
    D  Osteoid osteoma
    E  Enchondroma
    A  Osteochondroma
  41. All of the following statements regarding Paget's disease of bone are true EXCEPT:

    A  There is an increased risk for osteosarcoma.
    B  Most cases have polyostotic (multiple bone) involvement.
    C  Patients may develop congestive heart failure.
    D  Paramyxovirus infection has been implicated as an etiology.
    E  It is usually seen in young males.
    E  It is usually seen in young males.

    usually in older white males
  42. An elderly woman who has fractured her hip most likely has:

    A  A dietary lack of vitamin D
    B  Osteoclastic resorbtion coupled with some slowing of bone formation
    C  An abnormality of type 1 collagen synthesis
    D  A decrease in the osteoid matrix of bone
    E  Primary hyperparathyroidism from a parathyroid adenoma
    B  Osteoclastic resorbtion coupled with some slowing of bone formation
  43. Of the following bone lesions, the one that is most frequently associated with hyperparathyroidism is:

    A  Osteochondroma
    B  Giant cell tumor
    C  Paget's disease of bone
    D  Osteitis fibrosa cystica
    E  Fibrous dysplasia
    D  Osteitis fibrosa cystica
  44. A man in his 20's begins to note persistent lower back pain and stiffness that diminishes with activity. In his 30's he also develops hip and shoulder arthritis, and in his 40's he is bothered by decreased lumbar spine mobility. These findings are most typical for:

    A  Rheumatoid arthritis
    B  Ankylosing spondylitis
    C  Osteoarthritis
    D  Lyme disease
    E  Calcium pyrophosphate dihydrate deposition disease
    B  Ankylosing spondylitis
  45. Of the following bone diseases, which has a female predominance:

    A  Aneurysmal bone cyst
    B  Osteosarcoma
    C  Chondrosarcoma
    D  Ewing's sarcoma
    E  Osteochondroma
    A  Aneurysmal bone cyst
  46. A 21-year-old male college student has noted increasing pain and soreness in his left shoulder after a summer working on the ranch and bucking bales of hay while at a ranch up in the Cache Valley. He can hardly raise his left arm. Clear fluid is aspirated from the subacromial region. He probably has:

    A  Tenosynovitis
    B  Costochondritis
    C  Bursitis
    D  Ganglion cyst
    E  Pseudogout
    C  Bursitis
  47. An acute pyogenic arthritis is LEAST likely to:

    A  Complicate gonorrheal infection
    B  Complicate septicemia
    C  Involve large joints
    D  Lead to ankylosis with chronicity
    E  Occur with Lyme disease
    E  Occur with Lyme disease
  48. A social worker refers a 2-year-old child to you because of suspected child abuse. You find multiple recent and healing long bone fractures, blue sclerae, hearing loss, and misshapen teeth. Your diagnosis is:

    A  Extensive trauma ("shaken baby syndrome")
    B  Osteogenesis imperfecta
    C  Achondroplasia
    D  Rickets
    E  Osteopetrosis
    B  Osteogenesis imperfecta
  49. Which of the following statements regarding the development of an osteosarcoma of bone is TRUE:

    A  The majority of cases arise in Paget's disease of bone.
    B  About 10% arise from osteoid osteomas.
    C  Most arise in the bones of the arm.
    D  Most occur following radiation therapy.
    E  Patients with retinoblastoma are at risk.
    E  Patients with retinoblastoma are at risk.
  50. A 41-year-old male has had backache with muscle spasms, weakness, and pain in the right hip all the way to his toes for months. Physical exam reveals that the circumference of this leg is smaller than the left, and he has paresthesias in an L5 distribution. These findings are most likely due to:

    A  Spondylolisthesis
    B  Spina bifida
    C  Herniated nucleus pulposus
    D  Osteoporosis
    E  Paget's disease of bone
    C  Herniated nucleus pulposus
  51. A solitary destructive bony lesion of the skull that is composed histologically of histiocytes, eosinophils, plasma cells, and lymphocytes in a 5-year-old male is most likely:

    A  Osteoid osteoma
    B  Letterer-Siwe syndrome
    C  Eosinophilic granuloma
    D  Osteitis fibrosa cystica
    E  Tuberculosis
    C  Eosinophilic granuloma
  52. Which of the following statements regarding rheumatoid arthritis (RA) is INCORRECT:

    A  Pannus in joints contains numerous lymphocytes and plasma cells.
    B  Small joints are affected more than large joints.
    C  Joint involvement is typically symmetric.
    D  Males are affected more than females.
    E  Joint ankylosis is a long-term complication.
    D  Males are affected more than females.
  53. A young girl has pain in the region of the right upper thigh which is relieved by aspirin. A radiograph reveals a small lucent area in the femur surrounded by sclerotic bone. The most likely diagnosis is:

    A  Enchondroma
    B  Multiple myeloma
    C  Eosinophilic granuloma
    D  Osteoid osteoma
    E  Osteochondroma
    D  Osteoid osteoma
  54. All of the following are likely sources for metastatic lesions to bone EXCEPT:

    A  Adenocarcinoma of colon
    B  Oat cell carcinoma of lung
    C  Infiltrating ductal carcinoma of breast
    D  Renal cell carcinoma
    E  Adenocarcinoma of prostate
    A  Adenocarcinoma of colon
  55. A 49-year-old female has noted that she cannot completely extend the middle finger of her left hand. In the palm of her hand at the base of this finger there is an ill-defined mass that is very firm to palpation. What histologic appearance will this mass most likely demonstrate:

    A  Fibromatosis
    B  Rhabdomyosarcoma
    C  Granulomatous inflammation
    D  Dystrophic calcification
    E  Giant cell tumor of tendon sheath
    A  Fibromatosis (Dupuytren's contracture)
  56. A 45-year-old female notices that she develops tingling and numbness over the palmar surface of her thumb, index, and middle fingers after several hours at her computer workstation doing word processing. Pain in the same area often occurs at night as well. Which of the following pathologic findings accounts for her symptoms:

    A  Toxic peripheral neuropathy
    B  Rheumatoid arthritis
    C  Gout
    D  Hypertrophic osteoarthropathy
    E  Localized tenosynovitis
    E  Localized tenosynovitis
  57. A 45-year-old male has pain in his right knee. As he moves about during the day, the pain decreases. The underlying disease process is probably:

    A  Osteoporosis
    B  Osteochondroma
    C  Osteomalacia
    D  Osteoarthritis
    E  Osteopetrosis
    D  Osteoarthritis
  58. As he continues to age, a 50 year old male is bothered by decreasing mobility of his spine at the hips, and he has a "hunched over" appearance of the upper back. These problems have been slowly progressive. This man is LEAST likely to have:
    A  A similarly affected relative
    B  Involvement of the peripheral joints
    C  Sacroiliac ankylosis
    D  Onset of his disease in the 20's
    E  HLA-B27
    B  Involvement of the peripheral joints (Ankylosing spondylitis)
  59. A form of arthritis that affects young persons, often has a febrile onset, involves only a few joints (usually knees or ankles), and is accompanied by generalized lymphadenopathy is:

    A  Gonococcal arthritis
    B  Ankylosing spondylitis
    C  Juvenile rheumatoid arthritis
    D  Tuberculous arthritis
    E  Gout
    C  Juvenile rheumatoid arthritis
  60. The majority of cases of arthritis have clinical symptoms that are a result of:

    A  Loss of articular hyaline cartilage
    B  Synovitis
    C  Underlying osteomyelitis of bone
    D  Bone marrow fibrosis
    E  Crystal deposition
    A  Loss of articular hyaline cartilage
  61. Of the following mass lesions of bone, the one that is most likely to be present in an older adult, rather than in a child or young adult, is:

    A  Osteosarcoma
    B  Chondrosarcoma
    C  Ewing's sarcoma
    D  Giant cell tumor
    E  Osteoid osteoma
    B  Chondrosarcoma
  62. Multiple firm white irregular mass lesions are scattered throughout the vertebrae in a 71 year old male. He was known to have a markedly elevated serum alkaline phosphatase along with hypercalcemia. Which of the following explanations is most likely for these findings:

    A  Metastatic carcinoma of prostate
    B  Osteochondromatosis
    C  Ewing's sarcoma
    D  Fibrous dysplasia of bone
    E  Osteomalacia
    A  Metastatic carcinoma of prostate
  63. A 30 year old male has pain about his left knee that he has noted worsening for weeks. A radiograph reveals a 6 cm lytic lesion involving the epiphyseal region of the distal femur with a "soap bubble" appearance. The lesion is curretted, and histologically there are numerous giant cells in a stroma with plump to spindle shaped mononuclear cells. The most probable diagnosis is:

    A  Osteosarcoma
    B  Chondrosarcoma
    C  Malignant fibrous histiocytoma
    D  Giant cell tumor of bone
    E  Tuberculosis
    D  Giant cell tumor of bone
  64. Following a humeral fracture in a 16 year old boy suffered while he was going down a series of steps on in-line skates, the fracture is set. The fracture callus the forms during the first month while the arm is in the cast is not as strong as the surrounding bone because callus:

    A  Is mainly formed from type IV collagen
    B  Contains woven, rather than lamellar, bone
    C  Consists mostly of acute inflammatory cells
    D  Lacks osteoblasts
    E  Is formed primarily of bone marrow
    B  Contains woven, rather than lamellar, bone
  65. The appearance of irregularly thickened bone showing a mosaic of both osteolysis and osteogenesis in multiple sites in vertebrae, pelvis, and humerus is most often seen as a condition involving bone in a patient with which of the following histories:

    A  76 year old male with congestive heart failure
    B  11 year old female with precocious puberty
    C  5 year old girl with multiple long bone fractures and blue sclerae
    D  85 year old female with fracture of femoral neck
    E  Stillborn with multiple long bone fractures
    A  76 year old male with congestive heart failure
  66. A 61 year old male is found to have a mass in the proximal humerus. This mass is slow-growing. Metastases are not present. After resection, the mass is found to be firm and have a bluish-white appearance on sectioning. The histologic feature that is most likely to be characteristic of this mass is:

    A  Small round blue cells
    B  Osteoid
    C  Atypical chondrocytes
    D  Giant cells
    E  Plasma cells
    C  Atypical chondrocytes
  67. A former center for the Oakland Raiders football team retired in his 30's after a career of more than a decade. He now finds that he has a lot of stiffness in his right knee in the morning which soon abates, but by the end of the day he is taking non-steroidal anti-inflammatory medications for pain. These findings are most typical for:

    A  Rheumatoid arthritis
    B  Ankylosing spondylitis
    C  Osteoarthritis
    D  Lyme disease
    E  Osteomyelitis
    C  Osteoarthritis
  68. Along the extensor surface of the forearm of a 42 year old woman can be felt a firm, non tender, 1 cm rounded subcutaneous mass. Microscopically, the nodule shows an area of central necrosis surrounded by palisading epithelioid cells. Which of the following laboratory findings is most likely to accompany this lesion:

    A  Positive rheumatoid factor
    B  Elevated antinuclear antibody
    C  Monoclonal gammopathy
    D  Anti-Jo-1 (anti-histidyl-tRNA synthetase)
    E  Acetylcholine receptor antibody
    A  Positive rheumatoid factor
  69. Slow, progressive erosion of articular cartilage, followed by subchondral sclerosis and formation of osteophytes, has occurred in the joints of the hands as well as the vertebrae of a 69 year old male. There is pain, but no swelling. Ankylosis of the joints has not occurred. The most likely explanation for this is:

    A  Lyme disease
    B  Osteoarthritis
    C  Rheumatoid arthritis
    D  Remote fractures
    E  Osteoporosis
    B  Osteoarthritis
  70. A stillborn male is 37 weeks gestation at birth. Skeletal abnormalities had been seen on ultrasonography at 20 weeks gestation and consisted of long bone shortening. At birth, the extremities are malformed and shortened and a postmortem radiograph reveals multiple long bone fractures. The underlying disorder is most likely to be:

    A  Achondroplasia
    B  Fibrous dysplasia
    C  Rickets
    D  Congenital syphilis
    E  Osteogenesis imperfecta
    E  Osteogenesis imperfecta
  71. An elderly Caucasian male is at risk for all of the following complications of polyostotic Paget's disease of bone EXCEPT:

    A  Sarcoma of bone
    B  Fractures
    C  Osteomyelitis
    D  Congestive heart failure
    E  Facial droop from nerve palsy
    C  Osteomyelitis
  72. Multiple "hot spots" with increased uptake appear on bone scan of a 56 year old male. He has had pain in the right arm, left leg, and back, and there has been a fracture of the right humerus. The most likely explanation for these findings is:

    A  Metastatic carcinoma
    B  Aneurysmal bone cysts
    C  Osteomalacia
    D  Osteoid osteomas
    E  Osteomyelitis
    A  Metastatic carcinoma
  73. A soft tissue mass is present in an older male in association with bony destruction of the knee joint, along with local pain and swelling. This has progressively worsened for several years.

    A  Borrelia burgdorferi
    B  Neisseria gonorrheae
    C  Staphylococcus aureus
    D  Treponema pallidum
    E  No infectious etiology
    D  Treponema pallidum
  74. A ring-like rash is noted on the skin of the left lower thigh by a 35 year old woman. This is followed a couple of months later by an arthritis that involves several joints in succession, including right hip, left knee, and left elbow. She is otherwise healthy.

    A  Borrelia burgdorferi
    B  Neisseria gonorrheae
    C  Staphylococcus aureus
    D  Treponema pallidum
    E  No infectious etiology
    A  Borrelia burgdorferi
  75. A 45 year old female has deformities of her hands, with ulnar deviation, as a consequence of pannus in proximal interphalangeal joints.

    A  Systemic lupus erythematosus
    B  Lyme disease
    C  Osteoarthritis
    D  Gouty arthritis
    E  Rheumatoid arthritis
    E  Rheumatoid arthritis
  76. Acute inflammation of first metatarsal-phalangeal joint is noted in a 45 year old male.

    A  Systemic lupus erythematosus
    B  Lyme disease
    C  Osteoarthritis
    D  Gouty arthritis
    E  Rheumatoid arthritis
    D  Gouty arthritis
  77. Pseudogout involves the knees of a 55-year-old male.

    A Monosodium urate crystals
    B  Cholesterol crystals
    C  Plasma cells and lymphocytes
    D  Calcium pyrophosphate crystals
    E  White blood cells
    D  Calcium pyrophosphate crystals
  78. Synovium in a patient with rheumatoid arthritis.

    A  Monosodium urate crystals
    B  Cholesterol crystals
    C  Plasma cells and lymphocytes
    D  Calcium pyrophosphate crystals
    E  White blood cells
    C  Plasma cells and lymphocytes
  79. Malignant spindle cells making osteoid are observed in a lesion of the tibial metaphysis in a 15 year old male.

    A  Fibrous dysplasia
    B  Chondrosarcoma
    C  Osteoid osteoma
    D  Osteosarcoma
    E  Ewing's sarcoma
    D  Osteosarcoma
  80. A firm 7 cm mass with a bluish-white cut surface is removed from the left iliac wing of a 60-year-old male.

    A  Fibrous dysplasia
    B  Chondrosarcoma
    C  Osteoid osteoma
    D  Osteosarcoma
    E  Ewing's sarcoma
    B  Chondrosarcoma
  81. Ultrasound at 20 weeks gestation reveals that the male fetus has long bones measuring at less than the 5th percentile for age, but there are no fractures. Normal numbers of fingers and toes are present. The internal organs including the heart, lungs, liver, kidneys, and brain appear to be normal in size. The most likey explanation among the following is:

    A  Maternal vitamin D deficiency
    B  Achondroplasia
    C  Fibrous dysplasia
    D  Paget's disease of bone
    E  Congenital cytomegalovirus infection
    B  Achondroplasia
  82. Myasthenia gravis is associated with which of the following:

    A  Antibody to smooth muscle
    B  Symmetric lower limb muscle atrophy
    C  Muscular fasciculations
    D  Acetylcholine receptor degradation
    E  Inflammation of skeletal muscle
    D  Acetylcholine receptor degradation
  83. An 8-year-old male gets tired easily and can be outrun by his 5-year-old brother, even though his legs appear well-developed. He is probably:

    A  The victim of an X-linked recessive disorder
    B  A wimp
    C  the victim of myotonic dystrophy
    D  The victim of an autoimmune disease
    E  Homozygous for an autosomal recessive disorder
    A  The victim of an X-linked recessive disorder (duchenne muscular dystrophy)
  84. Polymyositis is characterized by each of the following statements EXCEPT:

    A  It is untreatable.
    B  Creatine kinase is elevated in blood.
    C  An inflammatory infiltrate is seen on muscle biopsy.
    D  There is degeneration and regeneration of muscle fibers.
    E  It is more frequently seen in women.
    A  It is untreatable.
  85. Which of the following is NOT associated with Duchenne's muscular dystrophy:

    A  An X-linked recessive pattern of inheritance
    B  Hypertrophied calves
    C  Striking early muscle fibrosis
    D  Lack of the muscle membrane protein dystrophin
    E  Marked increase in glycogen content of muscle fibers
    E  Marked increase in glycogen content of muscle fibers
  86. Polymyositis may demonstrate all of the following EXCEPT:

    A  Jo-1 antibody (antibody to transfer RNA synthetase)
    B  A significant association with HLA-DR3
    C  Eosinophilic infiltrate in muscle biopsy
    D  Symmetric muscle involvement
    E  An associated skin rash
    C  Eosinophilic infiltrate in muscle biopsy
  87. A section of skeletal muscle in a patient dying with an esophageal carcinoma would show which of the following histologic features most prominently:

    A  Degeneration and regeneration
    B  Necrosis
    C  Inflammation
    D  Metastasis
    E  Atrophy
    E  Atrophy
  88. Severe myalgia with fever and eosinophilia were present in a 28-year-old male several weeks after he returned from a camping trip to Alaska.
    A muscle biopsy would probably show:

    A  Grouped atrophy
    B  Encysted larvae
    C  Degeneration
    D  Neutrophilic infiltrates
    E  Fibrosis
    B  Encysted larvae
  89. A muscle biopsy that was taken from a patient with a neurogenic cause for muscular weakness will show which of the following:

    A  Inflammation
    B  Small angular and atrophic muscle fibers
    C  Grouped atrophy of muscle fibers
    D  Fibrosis
    E  Degeneration and regeneration of muscle fibers
    C  Grouped atrophy of muscle fibers
  90. A 4-year-old boy has slowly progressive muscle weakness, but his calves appear larger than normal. He has difficulty getting up off the floor. He has a serum creatine kinase of 1550 U/L. He probably has:

    A  Dermatomyositis
    B  Duchenne's muscular dystrophy
    C  Werdnig-Hoffman disease
    D  Amyotrophic lateral sclerosis
    E  Trichinosis
    B  Duchenne's muscular dystrophy
  91. A congenital myopathy is characterized by all of the following statements EXCEPT:

    A  Presence at birth
    B  Non-progressive muscular weakness
    C  Floppy infants
    D  Inflammation of muscle fibers
    E  Abnormalities of the muscle fibers
    D  Inflammation of muscle fibers
  92. Myasthenia gravis is characterized by which of the following:

    A  Lack of acetylcholine receptor antibodies
    B  Association with parathyroid hyperplasia
    C  Acute inflammation of muscle fibers
    D  Asymmetrical muscular weakness
    E  Association with thymoma
    E  Association with thymoma
  93. A 15-year-old male experiences severe muscle cramping and pain after only a few laps around the track in his high school physical education class. If he rests briefly, he can continue for a few more laps. One day, the coach makes him continue much longer, and he develops myoglobinuria. These findings are most consistent with:

    A  Acid maltase deficiency
    B  Lower motor neuron disease
    C  Muscular dystrophy
    D  Myophosphorylase deficiency
    E  A congenital myopathy (central core disease)
    • D  Myophosphorylase deficiency
    • (McArdle's disease)
  94. A 35-year-old female had a diagnosis of polymyositis made with a muscle biopsy. Following a course of corticosteroid therapy, she continues to have muscular weakness, particular in proximal muscles. The serum creatine kinase (CK) is only 41 U/L, and an electromyogram demonstrates no myopathic changes. These findings most strongly suggest:

    A  Treatment failure
    B  Upper motor neuron disease
    C  Corticosteroid-induced myopathy
    D  McArdle's disease
    E  Duchenne muscular dystrophy
    C  Corticosteroid-induced myopathy
  95. Which one of the following histologic findings on muscle biopsy would be most indicative of an active polymyositis:

    A  Marked fiber hypertrophy
    B  Many fibers undergoing degeneration and regeneration
    C  Grouping of atrophic fibers
    D  Extensive endomysial and perimysial fibrosis
    E  Subsarcolemmal glycogen deposition
    B  Many fibers undergoing degeneration and regeneration
  96. Duchenne's muscular dystrophy is characterized by all of the following findings EXCEPT:

    A  Early fibrosis in skeletal muscle
    B  X-linked pattern of inheritance
    C  Begins with proximal muscle weakness
    D  Often fatal in the second decade
    E  Grouped atrophy of muscle fibers
    E  Grouped atrophy of muscle fibers
  97. For several years, a 55 year old male has fatigued easily as the day progresses, but after a night's rest feels better in the morning. At first, he noted that his eyelids drooped, but now he has difficulty chewing food, particularly meat. Physical examination reveals reduced strength in both right and left extremities. Deep tendon reflexes are normal. A biopsy of muscle reveals no major histologic abnormalities. He is most likely to have:

    A  Myasthenia gravis
    B  Duchenne muscular dystrophy
    C  Trichinosis
    D  Werdnig-Hoffman disease
    E  Amyotrophic lateral sclerosis
    A  Myasthenia gravis
  98. Progressive, symmetrical muscular weakness in a 50-year-old male.

    A Atrophy of muscle fibers with fibrosis
    B  Grouped atrophy of muscle fibers
    C  Cachexia
    D  Positive antinuclear antibody test
    E  Botulinum perfringens toxin
    B  Grouped atrophy of muscle fibers
  99. Widespread, chronic myalgias in a 25-year-old female.

    A  Atrophy of muscle fibers with fibrosis
    B  Grouped atrophy of muscle fibers
    C  Cachexia
    D  Positive antinuclear antibody test
    E  Botulinum perfringens toxin
    • D  Positive antinuclear antibody test
    • (SLE)
  100. Neutrophils with destruction of individual muscle fibers on muscle biopsy in a 22-year-old female with a lilac-colored eyelid rash.

    A  Myasthenia gravis
    B  Polymyositis
    C  Werdnig-Hoffman disease
    D  McArdle's disease
    E  Amyotrophic lateral sclerosis
    Polymyositis
  101. Acetylcholine receptor antibody is found in a 34-year-old female who is easily fatigued by repetitive tasks such as typing.

    A  Myasthenia gravis
    B  Polymyositis
    C  Werdnig-Hoffman disease
    D  McArdle's disease
    E  Amyotrophic lateral sclerosis
    A  Myasthenia gravis
  102. A 3 year old girl has increasing weakness involving all of her extremities so that she has difficulty moving about. Her parents indicate that she has had no major illnesses. She was a term birth without complications. She has no fever. Laboratory findings, including a CBC, chemistry panel, and urinalysis, are unremarkable. Muscle biopsy reveals grouped atrophy of muscle fibers. The most likely diagnosis is:

    A  Myasthenia gravis
    B  Werdnig-Hoffman disease
    C  Duchenne muscular dystrophy
    D  Polymyositis
    E  Pompe's disease
    B  Werdnig-Hoffman disease
  103. A young male comes to the emergency room because of the onset over a couple of weeks of worsening fever, weakness, malaise, and tender aching muscular pain "all over". Laboratory findings include an elevated serum creatine kinase and an elevated white blood cell count with prominent eosinophilia with differential count. The best diagnosis is:

    A  Trichinella spiralis infection
    B  Werdnig-Hoffman disease
    C  Becker muscular dystrophy
    D  Mitochondrial myopathy
    E  Polymyositis-dermatomyositis
    A  Trichinella spiralis infection
  104. A family has their young children taken away and the parents are prosecuted for child abuse after an emergency room doctor reports that their 2-year-old child had experienced multiple fractures of the legs. The family had claimed that these occurred "when the dog knocked him over." However, 2 years later, it is noted that the child continues to have new fractures while in protective custody. Which of the following diseases would most likely present in this manner?

    A.Osteogenesis imperfecta
    B.Osteomyelitis
    C.Osteitis deformans
    D.Osteomalacia
    E.Osteopetrosis
    A.Osteogenesis imperfecta
    (this multiple choice question has been scrambled)
  105. One member of a medical school class is 1.07 m (3 feet 6 inches) tall, with a normal-sized skull and spine that appear large when compared to the abnormally short long bones of her limbs. Sexual development is normal. Which of the following is the pathologic basis of this relatively common autosomal dominant condition?

    A.Abnormal type I collagen
    B.Failure of matrix to mineralize
    C.Inhibition of cartilage synthesis
    D.Failure of kidney to convert vitamin D to 1,25-dihydroxy D
    E.Patchy bone resorption followed by disordered new bone matrix formation
    • C.Inhibition of cartilage synthesis 
    • (Achondroplasia)
  106. A radiology report notes that a femur shows an "Erlenmeyer flask"–shaped deformity. This finding suggests which of the following underlying diseases?

    A.Paget disease
    B.Osteoporosis
    C.Achondroplasia
    D.Osteogenesis imperfecta
    E.Osteopetrosis
    E.Osteopetrosis
    (this multiple choice question has been scrambled)
  107. A 50-year-old man undergoes sinus radiologic studies because he has been having chronic headaches. The radiologist notes that several of the bones of his face are enlarged and have lytic and sclerotic areas. Follow-up physical examination demonstrates pain on palpation of some of these areas, and questioning reveals that the patient has noticed decreased hearing over the last 2 years. Additional radiologic studies show similar lesions in the pelvis, femur, and vertebrae. Laboratory studies reveal marked elevations of serum alkaline phosphatase and increased levels of urinary hydroxyproline. Biopsy of one of the lesions would be most likely to show which of the following?

    A.Homer Wright pseudorosettes
    B.Sheets of undifferentiated small, round, blue cells
    C.Mosaic pattern of lamellar bone
    D.Anaplastic cells producing osteoid and bone
    E.Atypical chondrocytes and chondroblasts
    C.Mosaic pattern of lamellar bone
    (this multiple choice question has been scrambled)
  108. The earliest stage in Paget disease is characterized by which of the following?

    A.Osteoblastic activity predominates
    B.Rare resorption pits
    C.Prominent new bone formation
    D.Osteosclerosis
    E.Osteoclastic activity predominates
    E.Osteoclastic activity predominates
    (this multiple choice question has been scrambled)
  109. Bone biopsy demonstrates a haphazard arrangement of cement lines that creates a "mosaic pattern" of lamellar bone. This finding suggests which of the following?

    A.Osteopetrosis
    B.Osteogenesis imperfecta
    C.Osteomalacia
    D.Osteitis deformans
    E.Osteoporosis
    D.Osteitis deformans
    (this multiple choice question has been scrambled)
  110. A 72-year-old woman consults a physician because of chronic back pain that has recently become more severe. When she walks into the examination room, she is noted to be walking with a very stooped stance, so that she is mostly staring at her feet. Chest x-ray (obtained with difficulty because she cannot reach a fully erect posture) shows multiple compression fractures of the vertebrae. Which of the following is the most likely underlying cause of the compression fractures?

    A.Enchondroma
    B.Paget disease
    C.Chondrosarcoma
    D.Osteoporosis
    E.Osteopetrosis
    D.Osteoporosis
    (this multiple choice question has been scrambled)
  111. A patient with osteoporosis falls and experiences a Colles fracture. What bone was broken?

    A.Proximal tibia
    B.Proximal humerus
    C.Distal radius
    D.Distal fibula
    E.Distal femur
    C.Distal radius
    (this multiple choice question has been scrambled)
  112. A radiologist notes that a patient has a generalized radiolucency of bone. This finding suggests which of the following?

    A.Achondroplasia
    B.Osteomyelitis
    C.Paget disease
    D.Osteoporosis
    E.Albers-Schönberg disease
    D.Osteoporosis
    (this multiple choice question has been scrambled)
  113. A child is brought into the doctor’s office for evaluation. He was recently adopted from overseas. The child is attentive and interactive with the physician. On physical examination, the child has frontal bossing of his head, outward bowing of the sternum, lumbar lordosis, and bowing of the legs. Examination of the skin reveals no significant findings. What is the most likely explanation for the findings?

    A.Vitamin C deficiency
    B.Lead toxicity
    C.Vitamin D deficiency
    D.Physical abuse
    E.Congenital syphilis
    C.Vitamin D deficiency
    (this multiple choice question has been scrambled)
  114. An adult who presented with bone pain and fractures has low serum calcium, low serum phosphorus, and high alkaline phosphatase. This patient would most likely be treated with which of the following?
    A.Vitamin B12
    B.Vitamin B6
    C.Vitamin C
    D.Vitamin D
    E.Vitamin K
    D.Vitamin D
    (this multiple choice question has been scrambled)
  115. The underlying defect in osteomalacia is which of the following?

    A.Altered bone remodeling
    B.Decreased osteoclast function
    C.Impaired mineralization of osteoid
    D.Paraneoplastic syndrome
    E.Nonneoplastic replacement of marrow by fibrosis
    F.Estrogen deficiency
    G.Excessive parathyroid hormone
    H.Microbial infection
    I.Activation of FGFR3
    C.Impaired mineralization of osteoid
    (this multiple choice question has been scrambled)
  116. A 17-year-old boy with sickle-cell anemia develops pain around his knee. Physical examination demonstrates marked erythema and swelling of the knee, and tenderness to palpation of the distal part of the femur. The patient is suspected of having a bacterial infection of his femur. In this clinical setting, which of the following organisms would most likely be the cause?

    A.Haemophilus influenzae
    B.Pseudomonas
    C.Neisseria gonorrhoeae
    D.Escherichia coli
    E.Salmonella
    E.Salmonella
    (this multiple choice question has been scrambled)
  117. When discussing a patient with osteomyelitis of the femur, a physician mentions to a medical student that the patient has a sequestrum. What is a sequestrum?

    A.Fragment of necrotic bone
    B.Nodule of amyloidosis
    C.New bone formation
    D.Intraosseous abscess
    E.Cartilage spur
    A.Fragment of necrotic bone
    (this multiple choice question has been scrambled)
  118. A patient has tuberculous osteomyelitis of the thoracic and lumbar vertebrae. This condition is sometimes called which of the following?

    A.Pott disease
    B.Osgood-Schlatter disease
    C.Von Recklinghausen disease
    D.Ollier disease
    E.Gardner syndrome
    A.Pott disease
    (this multiple choice question has been scrambled)
  119. A 24-year-old man goes to an emergency room after falling on his hand. X-ray of the hand demonstrates a small lytic expansile lesion in the medullary cavity at the distal end of the fifth metatarsal, through which a small fracture is present. A few fuzzy calcifications are seen in the lesion, which is mostly radiolucent. The cortex over the lesion is thinned and slightly scalloped. Which of the following is the most likely cause of the mass?

    A.Osteosarcoma
    B.Osteochondroma
    C.Giant cell tumor of bone
    D.Enchondroma
    E.Osteoid osteoma
    D.Enchondroma
    (this multiple choice question has been scrambled)
  120. A patient has had bone pain, bony deformities, and pathologic fractures. Biopsy of a cystic enlargement of one bone demonstrates fibrosis and organized hemorrhage. Increased osteoclasts are noted. This patient should be evaluated for a tumor of which of the following?

    A.Thyroid gland
    B.Pituitary
    C.Parathyroid glands
    D.Endocrine pancreas
    E.Adrenal gland
    C.Parathyroid glands
    (this multiple choice question has been scrambled)
  121. Which of the following is the most common cause of avascular necrosis?

    A.Sickle cell anemia
    B.Steroids
    C.Gaucher disease
    D.Caisson disease
    E.Trauma
    E.Trauma
    (this multiple choice question has been scrambled)
  122. Digital clubbing due to periosteal new bone formation can be seen as a paraneoplastic syndrome. Cancer of which of the following would be most likely to cause it?

    A.Esophagus
    B.Stomach
    C.Ovary
    D.Pancreas
    E.Lung
    E.Lung
    (this multiple choice question has been scrambled)
  123. A child presents with multiple café-au-lait spots and precocious sexual development. If the child has a familial syndrome, which of the following bony abnormalities would most likely be present?

    A.Fibrous dysplasia
    B.Osteoclastoma
    C.Paget disease
    D.Osteoid osteomas
    E.Osteochondroma
    A.Fibrous dysplasia
    (this multiple choice question has been scrambled)
  124. A woman has multiple enchondromas and soft tissue hemangiomas. In which of the following sites is she at the greatest increased risk of developing a tumor?

    A.Uterus
    B.Colon
    C.Pancreas
    D.Ovary
    E.Stomach
    D.Ovary
    (this multiple choice question has been scrambled)
  125. Which of the following is a distinctive feature of osteoid osteoma?

    A.Brodie abscess
    B.Erlenmeyer flask–shaped deformity
    C.Colles fracture
    D.Soap-bubble appearance
    E.Thin sclera with a blue hue
    F.Mosaic pattern
    G.Central nidus
    H.Involucrum
    I."Burnout stage"
    G.Central nidus
    (this multiple choice question has been scrambled)
  126. A patient who has multiple benign bony growths capped with cartilage would be most likely to have which of the following?

    A.Gardner syndrome
    B.Von Recklinghausen disease of bone
    C.Maffucci syndrome
    D.Ollier disease
    E.Osteochondromatosis
    E.Osteochondromatosis
    (this multiple choice question has been scrambled)
  127. A 50-year-old man develops enlargement of one knee. X-ray studies show a noncalcifying mass of the very distal end of the femur. Open biopsy of the mass demonstrates poorly organized neoplastic cartilage containing abnormal chondrocytes with hyperchromatic, irregular nuclei. Many lacunae contain more than one chondrocyte, and a few abnormal mitotic figures are seen. Which of the following is the most likely diagnosis?

    A.Chondromyxoid fibroma
    B.Chondroma
    C.Chondrosarcoma
    D.Chondroblastoma
    E.Enchondromatosis
    C.Chondrosarcoma
    (this multiple choice question has been scrambled)
  128. A radiologist who notes the presence of Codman triangle would be specifically suspicious that a patient has which of the following?

    A.Metastasis to bone from breast
    B.Chondrosarcoma
    C.Ewing sarcoma
    D.Osteosarcoma
    E.Metastasis to bone from prostate
    D.Osteosarcoma
    (this multiple choice question has been scrambled)
  129. Patients with which of the following genetic diseases would be most likely to have an increased risk of osteosarcoma?

    A.Xeroderma pigmentosa
    B.Fanconi anemia
    C.Neurofibromatosis 2
    D.Neurofibromatosis 1
    E.Familial retinoblastoma
    E.Familial retinoblastoma
    (this multiple choice question has been scrambled)
  130. Tumors of which of the following sites would be most likely to cause an osteoblastic metastasis to bone?

    A.Kidney
    B.Thyroid
    C.Lung
    D.Breast
    E.Prostate
    E.Prostate
    (this multiple choice question has been scrambled)
  131. A 62-year-old man with known arthritis develops osteophytes at the distal interphalangeal joints of his hands. These lesions are also known as which of the following?

    A.Heberden nodes
    B.Rheumatoid nodules
    C.Bouchard nodes
    D.Swan neck deformity
    E.Boutonniere deformity
    A.Heberden nodes
    (this multiple choice question has been scrambled)
  132. An older patient complains to her doctor that "there is something in my knee joint." Physical examination of the joint demonstrates an intermittent blocking of joint mobility. Arthroscopy reveals small, free, cartilage fragments within the joint space. These findings are most likely to be associated with which of the following?

    A.Osteoarthritis
    B.Suppurative arthritis
    C.Gout
    D.Reiter syndrome
    E.Rheumatoid arthritis
    A.Osteoarthritis
    (this multiple choice question has been scrambled)
  133. A 44-year-old woman has a 10-year history of joint pain in her hands. On physical examination, she is noted to have radial deviation of her wrists and ulnar deviation of her fingers. The antibody associated with 80% of cases of her disease is usually which of the following?

    A.IgD antibody directed against the Fab fragment of IgM
    B.IgG antibody directed against the Fab fragment of IgM
    C.IgE antibody directed against the Fc fragment of IgA
    D.IgM antibody directed against the Fc fragment of IgG
    E.IgA antibody directed against the Fab fragment of IgG
    D.IgM antibody directed against the Fc fragment of IgG
    (this multiple choice question has been scrambled)
  134. A 27-year-old man presents with asymmetric joint pain that began in one wrist about a week ago and now also involves a knee and ankle. Additionally, he has a burning sensation in his eyes, which have red conjunctiva and are tearing frequently. When asked about other symptoms, he reports having had some dysuria during the last week. About which of the following should he be specifically asked as well?

    A.Recent sexual activity
    B.Recent intense exercise
    C.Recent ear infections
    D.Recent exposure to high altitudes
    E.Recent viral colds
    A.Recent sexual activity
    (this multiple choice question has been scrambled)
  135. For which of the following diseases would a patient with HLA B27 have the greatest relative risk when compared with patients without that HLA allele?

    A.Sjögren syndrome
    B.Ankylosing spondylitis
    C.Pemphigus vulgaris
    D.Celiac disease
    E.Chronic active hepatitis
    B.Ankylosing spondylitis
    (this multiple choice question has been scrambled)
  136. A patient with psoriasis who develops arthritis related to his/her skin disease would most likely have joint disease most similar to which of the following?

    A.Osteoarthritis
    B.Ankylosing spondylitis
    C.Rheumatoid arthritis
    D.Chondrocalcinosis
    E.Gout
    C.Rheumatoid arthritis
    (this multiple choice question has been scrambled)
  137. A 55-year-old woman with longstanding diabetes mellitus develops fever, chills, malaise, and a markedly erythematous, swollen, painful left knee joint. Diagnostic arthrocentesis would most likely show which of the following?

    A.Negatively birefringent, needle shaped crystals
    B.Marked thickening of the synovium with pannus formation
    C.Weakly positively birefringent, rhomboid-shaped crystals
    D.Baker cysts
    E.Joint mice
    C.Weakly positively birefringent, rhomboid-shaped crystals
    (this multiple choice question has been scrambled)
  138. A 5-year-old mentally retarded child with muscle spasticity and self-mutilating behaviors is found to have a deficiency of hypoxanthine-guanine phosphoribosyltransferase. This child would be most likely to develop which of the following forms of joint disease?

    A.Infectious arthritis
    B.Osteoarthritis
    C.Gout
    D.Rheumatoid arthritis
    E.Pseudogout
    C.Gout
    (this multiple choice question has been scrambled)
  139. An overweight, 40-year-old man presents to the emergency room with an acutely inflamed, bright-red, and swollen knee. The emergency room physician aspirates the joint, withdrawing 20 mL of cloudy fluid which, on microscopy, shows many neutrophils and needle-shaped birefringent microcrystals. Which of the following is the most likely composition of these crystals?

    A.Cystine
    B.Magnesium ammonium phosphate
    C.Urate
    D.Calcium oxalate
    E.Hydroxyapatite
    C.Urate
    (this multiple choice question has been scrambled)
  140. A 32-year-old woman removed two ticks from the back of her neck during a camping trip into the woods. Several days later, she experienced flu-like symptoms and an expanding skin rash at the site of the tick bite. The rash lasted several weeks and then cleared spontaneously. About a year later, she developed a migratory arthritis involving the knees, shoulders, and elbows. Which of the following would be most likely implicated in her problems?

    A.Borrelia
    B.Haemophilus
    C.Staphylococcus
    D.Streptococcus
    E.Chlamydia
    A.Borrelia
    (this multiple choice question has been scrambled)
  141. A 33-year-old woman who develops a hot, painful knee after a sexual encounter on a ski trip would be most likely to have infectious arthritis due to which of the following?

    A.Staphylococcus
    B.Haemophilus
    C.Streptococcus
    D.Neisseria
    E.Escherichia
    D.Neisseria
    (this multiple choice question has been scrambled)
  142. Which of the following organisms causes a migratory arthritis that develops following a tick bite?

    A.Treponema pallidum
    B.Plasmodium falciparum
    C.Neisseria gonorrhoeae
    D.Borrelia burgdorferi
    E.Haemophilus influenza
    D.Borrelia burgdorferi
    (this multiple choice question has been scrambled)
  143. An attending physician asks a medical student to demonstrate that a child has a positive Gower sign. What should the medical student ask the child to do?

    A.Touch his nose rapidly with alternating hands
    B.Stand on one foot with his eyes closed and arms extended horizontally forward
    C.Rise to a standing position from being on hands and knees on the ground
    D.Move his eyes systematically in a rotating pattern to cover all quadrants in sequence
    E.Hold his arms extended level with his shoulders and pointing sideways until he fatigues
    C.Rise to a standing position from being on hands and knees on the ground
    (this multiple choice question has been scrambled)
  144. A 7-year-old boy has a 2-year history of proximal muscular weakness. He is now having difficulty standing. This patient would be most likely to have an abnormality of which of the following?

    A.Acetylcholinesterase
    B.Dystrophin
    C.Nerve conduction
    D.Acetylcholine receptor
    E.Calcium channel
    B.Dystrophin
    (this multiple choice question has been scrambled)
  145. A patient with positive Gower sign would be most likely to have an abnormality of which of the following?

    A.Peripheral nerve myelin
    B.Neuromuscular junction
    C.Endomysium
    D.Acetylcholine receptor
    E.Dystrophin
    E.Dystrophin
    (this multiple choice question has been scrambled)
  146. A grape-like mass protruding from the penis of a 6-month-old boy would most likely be which of the following?

    A.Leiomyoma
    B.Rhabdomyosarcoma
    C.Leiomyosarcoma
    D.Neurofibrosarcoma
    E.Dermatofibroma
    B.Rhabdomyosarcoma
    (this multiple choice question has been scrambled)
  147. Biopsy of a 6-cm retroperitoneal mass demonstrates fibrous tissue with abundant spindle cells that initially look malignant, but the pathologist concludes the mass is benign. This lesion is most likely which of the following?

    A.Malignant fibrous histiocytoma
    B.Dermatofibroma
    C.Fibrosarcoma
    D.Rhabdomyoma
    E.Fibromatosis
    E.Fibromatosis
    (this multiple choice question has been scrambled)
  148. Which of the following would be the most likely site for a malignant fibrous histiocytoma to arise?
    A.Deep tissues of the neck
    B.Mediastinum
    C.Periorbital space
    D.Forearm
    E.Retroperitoneum
    E.Retroperitoneum
    (this multiple choice question has been scrambled)
  149. A baby is found to have a benign striated muscle tumor of the heart. The baby should also be evaluated for which of the following diseases?

    A.Von Hippel-Lindau disease
    B.Rhabdomyosarcoma of the vagina
    C.Ewing sarcoma
    D.Tuberous sclerosis
    E.Retinoblastoma
    D.Tuberous sclerosis
    (this multiple choice question has been scrambled)
  150. Which of the following is the most common sarcoma of the gastrointestinal tract?

    A.Leiomyosarcoma
    B.Malignant fibrous histiocytoma
    C.Liposarcoma
    D.Rhabdomyosarcoma
    E.Osteosarcoma
    A.Leiomyosarcoma
    (this multiple choice question has been scrambled)
  151. Which of the following characteristically has both glands and spindle cells?

    A.Synovial sarcoma
    B.Embryonal rhabdomyosarcoma
    C.Rhabdomyoma
    D.Malignant fibrosis histiocytoma
    E.Dermatofibroma
    F.Leiomyoma
    G.Lipoma
    H.Liposarcoma
    I.Neurofibrosarcoma
    A.Synovial sarcoma
    (this multiple choice question has been scrambled)
  152. PIP flexion + DIP hyperextension
    Boutonniere deformity = rheumatoid arthritis
  153. DIP flexion + PIP hyperextension
    Swan neck deformity = rheumatoid arthritis

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