1. Most primary bone tumors arise in the

A.   diaphysis
B.   diencephalon
C.   epiphysis
D.   metaphysis (*)
E.   sub-periosteum

2.   Which bone tumor usually arises in the cortex of the facial
skull bones?

A.   enchondroma
B.   osteoblastoma
C.   osteochondroma
D.   osteoid osteoma
E.   osteoma (*)

3.   Which is most likely to be particularly painful at the time
of discovery?

A.   aneurysmal bone cyst
B.   enchondroma
C.   exostosis
D.   fibrous dysplasia
E.   osteoid osteoma (*)

4.   Mutation in the receptor for fibroblast growth factor 3?

A.   achondroplasia (*)
B.   Ollier's
C.   osteogenesis imperfecta
D.   osteopetrosis  
E.   rheumatoid arthritis

5.   Which usually produces an exudate rather than a transudate?

A.   blocked lymphatics
B.   congestive heart failure
C.   inflammation (*)
D.   kidney failure
E.   liver failure

6.   During the active phase of Lyme disease, examining a joint
would probably show all EXCEPT

A.   eosinophils  (*)
B.   fibroblast proliferation
C.   fibrin
D.   neutrophils
E.   plasma cells



7.   Rheumatoid factor is

A.   a crystal
B.   a cytokine produced by T-cells
C.   a neutrophil product
D.   a hypothetical substance perhaps a small bacterium
E.   an antibody against other antibodies (*)

8.   Which microbe is most likely to grow from a single inflamed
joint in an otherwise-healthy 21 
year old man?

A.   chlamydia
B.   enterococcus
C.   gonococcus (*)
D.   salmonella
E.   staphylococcus

9.   Which is most likely to give a cloudy solution when a bit of
synovial fluid is dropped into 
vinegar?

A.   fracture
B.   gonorrhea (*)
C.   hemophilia flare-up
D.   osteoarthritis
E.   Reiter's syndrome

10.  Where do you find Heberden's nodes in osteoarthritis?

A.   cardiac valves
B.   coronary arteries
C.   distal finger joints (*)
D.   hips
E.   knees

11.  ONE KODACHROME.  Muscle biopsy.  What is it?

A.   denervation-reinnervation (*)
B.   mitochondrial myopathy
C.   muscular dystrophy, perhaps Duchenne's
D.   myotonic dystrophy
E.   nemaline myopathy

12.  ONE KODACHROME.  Bone lesion.  Your best diagnosis?

A.   chondrosarcoma
B.   fibrous dysplasia
C.   healing callus / procallus
D.   metastatic adenocarcinoma (*)
E.   Paget's osteitis deformans



13.  THREE KODACHROMES.  Bone lesion.  What is it?

A.   chondrosarcoma
B.   healing fracture
C.   osteoclastoma
D.   osteomyelitis
E.   osteosarcoma  (*)

14.  ONE KODACHROME.  From the knee.  What is you best diagnosis?

A.   chondrosarcoma
B.   gout
C.   pigmented villinodular synovitis (*)
D.   rheumatoid arthritis
E.   suppurative arthritis

15.  ONE KODACHROME.  Trichome stain of muscle.  What is wrong?

A.   muscular dystrophy, perhaps Duchenne's
B.   myasthenia gravis
C.   nerve injury (*)
D.   polymyositis / dermatomyositis
E.   trichinosis

16.  ONE KODACHROME.  Soft tissue lesion.  What is your best
diagnosis?

A.   gouty tophus
B.   myositis ossificans
C.   rheumatoid nodule
D.   polymyositis
E.   synoviosarcoma (*)

17.  ONE KODACHROME.  Muscle biopsy.  What is your impression?

A.   clostridial myonecrosis
B.   denervation-reinnervation
C.   mitochondrial myopathy
D.   muscular dystrophy (*)
E.   trichinosis

18.  ONE KODACHROME.  What is the most likely diagnosis?

A.   metastatic prostate cancer (*)
B.   osteoarthritis
C.   osteogenesis imperfecta
D.   osteoporosis
E.   parathyroid bone disease



19.  TWO KODACHROMES.  Patient photo and bone specimen.  What is
the diagnosis?

A.   Ollier's
B.   osteogenesis imperfecta
C.   Paget's osteitis deformans (*)
D.   rheumatoid arthritis
E.   rickets

20.  ONE KODACHROME.  Muscle biopsy.  What is wrong?

A.   denervation-reinnervation 
B.   mitochondrial myopathy
C.   muscular dystrophy, consistent with Duchenne's
D.   polymyositis
E.   type II fiber atrophy (*)

21.  TWO KODACHROMES.  Bone lesion.  What is it?

A.   ankylosing spondylitis
B.   liposarcoma
C.   metastatic cancer
D.   osteoporosis (*)
E.   Paget's osteitis deformans

22.  TWO KODACHROMES.  Muscle biopsy.  What's the disease?

A.   mitochondrial myopathy (*)
B.   muscular dystrophy, consistent with Duchenne's
C.   polymyositis-dermatomyositis
D.   trichinosis
E.   vasculitis

23.  THREE KODACHROMES.  Your best diagnosis, please.

A.   bacterial infection
B.   fibrosarcoma
C.   osteomyelitis
D.   osteosarcoma
E.   squamous cell carcinoma (*)

24.  TWO KODACHROMES.  Your thoughts on this muscle biopsy?

A.   mitochondrial myopathy
B.   muscular dystrophy
C.   neuropathy (*)
D.   trichinosis
E.   no pathology



25.  ONE KODACHROME.  What is this?

A.   ante-mortem thrombus
B.   cholesterol needles (*)
C.   fat embolus from a fractured calcaneus
D.   myocardial tissue that has undergone necrosis
E.   pus

26.  ONE KODACHROME.  Childhood illness.  What is it?

A.   dermatomyositis
B.   Duchenne's muscular dystrophy
C.   mitochondrial myopathy
D.   periodic paralysis
E.   Werdnig-Hoffman spinal atrophy (*)

27.  ONE KODACHROME.  The most abundant cell here? 

A.   adenocarcinoma cell
B.   eosinophil
C.   epithelioid macrophage
D.   fibroblast
E.   plasma cell (*)

28.  TWO KODACHROMES.  Lung.  What is the diagnosis?

A.   abscess
B.   adenocarcinoma
C.   infarct (*)
D.   metastatic osteosarcoma
E.   squamous cell carcinoma

29.  ONE KODACHROME.  Soft tissue lesion.  What is it?

A.   clostridial myonecrosis
B.   gouty tophus
C.   liposarcoma (*)
D.   necrotic fat
E.   rheumatoid nodule

30.  TWO KODACHROMES.  What is this?

A.   gangrene
B.   gout (*)
C.   Ollier's enchondromatosis
D.   osteoarthritis
E.   rheumatoid arthritis




31.  THREE KODACHROMES.  Patient photo and two photomicrographs.
What's your diagnosis?

A.   fibrous dysplasia (*)
B.   metastatic melanoma
C.   osteopetrosis
D.   osteosarcoma
E.   parathyroid bone disease

32.  TWO KODACHROMES.  Bone lesion.  What is it?

A.   Ewing's sarcoma (*)
B.   healing fracture with lymphocytes
C.   osteomyelitis
D.   osteosarcoma
E.   Paget's osteitis deformans

33.  ONE KODACHROME.  What do you see on this muscle biopsy?

A.   muscular dystrophy, possibly Duchenne's
B.   myotonic dystrophy
C.   myasthenia gravis (*)
     D.   polymyositis / dermatomyositis
E.   trichinosis

34.  TWO KODACHROMES.  Soft tissue lesion

A.   desmoid
B.   gout
C.   malignant fibrous histiocytoma (*)
D.   myositis ossificans
E.   rheumatoid nodule

35.  ONE KODACHROME.  What is this?

A.   cholesterol deposit
B.   fat embolus from a fractured long bone
C.   fibrinoid necrosis of an artery
D.   lymphatic carcinomatosis
E.   thrombus (*)

36.  TWO KODACHROME.  Diagnosis, please.

A.   Duchenne's muscular dystrophy
B.   mitochondrial myopathy
C.   myasthenia gravis
D.   myotonic dystrophy (*)
E.   nemaline myopathy



BONUS ITEMS

37.  TWO KODACHROMES.  Suggest a diagnosis.

[Ehlers-Danlos]



38.  TWO KODACHROMES.  Spine.  What is wrong?

[ankylosing spondylitis]




39.  TWO KODACHROMES.  Your best diagnosis please?

[osteogenesis imperfecta]




40.  What do we mean by a "greenstick fracture"?

[cracked but not 2 pieces; accept "incomplete"]



41.  What's the eponymous name we give to an area of
osteomyelitis that has been walled-off and 
is now a sanctuary for bacteria?

[Brodie's]



42.  What do we mean by a "paradoxical embolus"?

[systemic veins to systemic arteries] 





43.  What's a "cardiac vegetation"?

[I need a thrombus on the valves]





44.  Why do lines of Zahn not form in a post-mortem thrombus?

[d-oh! The blood is not flowing OR happen suddenly]



45.  What's a schistocyte?

[fragmented red cell]



46.  What is a "joint mouse?"

[detached fragment of bone/cartilage in a joint]



47.  Briefly explain why recent venipuncture sites re-bleed when
you develop disseminated 
intravascular coagulation?

[plasmin activated]




48.  What's the eponym for the painful bumps on the front of the
shins, just below knees, especially 
in members of the men's track team?

[Osgood-Schlatter's, either is sufficient]


49.  Which cytokine is bound by the new "breakthrough" molecules
now being administered for 
rheumatoid arthritis?

[tumor necrosis factor]



50.  And why do you see testicular atrophy and loss of
spermatogenesis in anabolic steroid users?  
Please be clear.

[suppresses pituitary hormone production]




YOUR NAME: _________________________
36 points

Who's sitting near you?


UHS PATHOLOGY
Musculoskeletal Unit
2002-2003

INSTRUCTIONS:

We have tried to write a fair test.  If you have a concern with
one of the items, please ask Dr. 
Friedlander during the exam.  Don't phonate.

The exam key will be posted immediately following the test. Write
your challenges on the key.  We 
will deal with them immediately.  Of course, you may also follow
the official procedure, but why wait?  

When every student has taken the exam, you will get your own exam
back to keep.  In the meantime, 
you are on your honor not to discuss the exam with anybody who
may not yet have taken it. 

Usually we have your exams hand-scored within 24 hours, and you
are welcome to look at your 
papers once we've announced that they're finished.

This exam is rather heavy on bonus items.  We are especially
concerned that you do well.  If you 
seem to be having a problem with pathology, please come and talk
with us.

GOOD LUCK!