Block 10 Metabolic Infx Traumatic Bone Dz MCQ's
- 1.A 30 year old woman developed severe pain over the mid anterior aspect of the lower leg. An infection was suspected but, because she was on vacation in an isolated area, she treated with an inadequate course of antibiotics. She subsequently observed sinus tracts on the skin surface over the affected area exuding granular material, identified by her surgeon as sequestrum. The latter is best described as:
- A.
Healthy bone growing around an area of infection
- B.
An abscess associated with bone infection
- C.
Periosteal response to underlying infection
- D.
Dead bone resulting from infection
- E.
Squamous cell carcinoma formed in sinus tracts
- 2.A 50-year-old woman who has lost 30 pounds over the past 3 months now presents with low back pain and is discovered to have several discrete lytic lesions in the lumbar back and pelvis. Serum alkaline phosphatase is elevated. Serum calcium, serum protein and peripheral blood smears are normal. Aspiration biopsy of a pelvic lesion is most likely to show:
- A.
Neoplastic plasma cells
- B.
Metastatic carcinoma
- C.
Osteoporosis
- D.
Leukemia
- E.
Hodgkins Disease
- 3.A 12 year old boy develops acute swelling, pain and redness of his right knee. On examination the right knee is painful even with the slightest movement. A CBC is performed and reveals a WBC of 12,000 with 80% neutrophils. Arthrocentesis is performed. The results are: Appearance: pale yellow, cloudy No crystals present Gram stain: Gram positive cocci in clusters String test: no string formed WBCs: 120,OOOjmm3 , 85% neutrophils Culture: pending Which of the following statements about th is patient's problem is most correct?
- A.
Treatment must be postponed until culture results are available to insure appropriate antibiotic coverage for the infection
- B.
A negative string test on the synovial fluid is specific for a diagnosis of infection
- C.
A knee xray will show evidence of subchondral sclerosis
- D.
The patient's age makes gout and rheumatoid arthritis more likely causes of his joint pain than infection
- E.
Methicillin resistant staphylococcus aureus is an increasingly common pathogen in this infection.
- 4.A 41 year-old woman presents with a 3 month history of increasing pain and tenderness of the wrist joints, metacarpophalangeal joints, and proximal interphalangeal joints of both hands. There is a stiffness of the joints for several hours after waking. As the day progresses, the joints are less bothersome. She has no other joint involvement or other major complaints. Based on this clinical picture, you would expect the primary (initial) pathology to involve which of the following structures?
- A.
Articular cartilage
- B.
Periarticular connective tissue
- C.
Subchondral bone
- D.
Synovial membranes
- E.
Tendons
- 5.A 55 year-old man presents with increasingly severe right hip pain . Radiographs show marked "joint space" narrowing, osteophyte formation and round rad iolucent cystic zones in the subchondral bone of the femoral head . The best diagnosis for the joint condition in this patient is
- A.
Ankylosing spondylitis
- B.
Infectious arthritis
- C.
Osteoarthritis
- D.
Psoriatic arthritis
- E.
Rheumatoid arthritis
- 6.19 year old male develops a painful knee that is swollen and red on examination. His physician decides to perform an arthrocentesis. The results follow: White Cell Count : 150,OOO!mm3 Differential: 85% polys Gram Stain : gram positive cocci in clusters Culture: pending Crystals: None String test: No string formed Which of the following is most true about arthrocentesis?
- A.
If rheumatoid arthritis is a possibility, arthrocentesis should not be performed
- B.
Arthrocentesis may be used diagnostically and therapeutically
- C.
If inflammation is present, the glucose in synovial fluid decreases, interfering with string formation.
- D.
An elevated white count occurs only in infected synovial fluid.
- E.
If only one test can be performed on a synovial fluid sample, it should be a cell count
- 7.A 15-year-old boy complains of pain that appears to be coming from the middle of his right thigh . X-ray studies confirm the presence of a lytic lesion measuring 0.8 cm. On further questioning, the boy says that the pain is relieved by aspirin. His mother is very anxious and fears that the lesion is malignant. However you assure her it is likely to be benign. You are thinking of:
- A.
Osteoid osteoma
- B.
Potts disease
- C.
Fibrous cortical defect
- D.
Ewings sarcoma
- E.
Chronic osteomyelitis
- 8.A 19-year-old man has been observing increasing swelling of the right knee and then suddenly fractures the distal right femur while jogging. An x-ray suggests a mass arising from the femur and the radiologist thinks he sees a "Codman's" triangle. Even before you know the results of the biopsy, you strongly suspect:
- A.
Chondrosarcoma
- B.
Osteosarcoma
- C.
Fibrous dysplasia
- D.
Paget disease
- E.
Non-ossifying fibroma
- 9.A 15 year old boy complains of pain that appears to be coming from the middle of his right thigh . X-ray studies confirm the presence of a lytic lesion measuring 0.8 cm. surrounded by a rim of denser bone. On further questioning, the boy says that the pain is relieved by aspirin. His mother is very anxious and fears that the lesion is malignant. However you assure her it is likely to be benign. You are thinking of:
- A.
Pott disease
- B.
Fibrous cortical defect
- C.
Ewings sarcoma
- D.
Osteoid osteoma
- E.
Chronic osteomyelitis
- 10.A 69 year-old woman presents with complaints of chronic back pain and x-rays reveals a compression fracture of the vertebral body of T2. She also says that she appears to be getting shorter. She is 20 years post-menopausal. Histologic examination of the vertebral bone would most likely reveal:
- A.
Malignant osteoid deposition
- B.
Periosteal new bone formation
- C.
Subperiosteal resorption
- D.
Widened osteoid seams
- E.
Thinned bony trabeculae
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