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Bone Questions

Bone Questions

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Published by Robert Yeung

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Published by: Robert Yeung on Jul 03, 2012
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Bone, Joint & Soft Tissue (1-60)
Question 1Excluding multiple myeloma, each of the following statements regarding primary boneneoplasms is correctEXCEPT: 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.Question 2An 80-year-old woman falls out of bed and breaks her hip. Radiographs show not only afracture of the left femoral head, but also acompressed fracture of T10.She probably has:A Vitamin D deficiencyB A pyogenic infectionC Osteogenesis imperfecta*D Decreased bone mass/osteoporosis E Polyostotic fibrous dysplasiaQuestion 3Chondrosarcoma is:
This is a chondrosarcoma, which has a predilection for involvement of metaphysis or diaphysis.
1
 
This high power microscopic appearance of achondrosarcoma demonstrates ** pleomorphic chondrocytes that are piled together in ahaphazard arrangement. In general, **chondrosarcomas occur over a wider age range thanosteosarcomas, including older adults
A The most frequent primary tumor of boneB Usually seen in distal skeletal bonesC More common in females*D Sometimes seen to arise in benign cartilagenous tumorsE Associated with Paget's disease of boneQuestion 4You 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'stotal protein is 8.5 gm/dlwith analbumin of  4.1 gm/dl. The smear of the aspirate will show which of the following as a prominentfeature:A Giant cellsB FibroblastsC OsteoblastsD Metastatic renal cell carcinoma*E Plasma cellsQuestion 5A 66-year-old female with increasing difficulty in performing activities of daily living because
of osteoarthritis
isLEASTlikely to have:A Monoarticular involvement an oesteophytesOA is more felt than an outward deformity. Mornining stiffness in hands that gets better with use2
 
B Knee involvementxxCBony ankylosis / xtic of Rh Arthritis
The prominent ulnar deviation of the hands and "swan neck"deformity of the fingers is due to rheumatoid arthritis (RA). This autoimmunedisease leads to synovial proliferation with inflammation and joint destruction,typically in asymmetrical pattern involving small joints of hands and feet,followed bywrists, ankles,elbows, and knees. Rheumatoid factor can be identified serologically in most 80%, but not all, RA patients.
 
Sometimes persons with rheumatoid arthritis (RA) haverheumatoid nodulesform in subcutaneous locations at pressure points, such asthe elbow shown here. Rheumatoid nodules may also appear viscerally, such ason the pleura of the lung.
 
This is the synovium in rheumatoid arthritis. There ischronicinflammation with lymphocytes and plasma cellsthat produce the blue areas beneath the nodular proliferations. This"pannus" is destructive and produceserosion of the articular cartilage, eventually destroying the joint.
D Morning stiffness and gets worse with useE Heberden's nodes and crepitus and wt bearing jtsQuestion 6A 13-year-old boywith pain in his left leg is found to have aneoplasm of the femur ( + Pelvis)that radiologicallyis diaphysealin location and on biopsy is seen microscopically to becomposed of numerous small round blue cells. He also has fever. The probable diagnosisis:zzA Ewing's sarcoma ( Homer Wright rosette)3

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