| Terms |
Definitions |
|
On physical exam, a patient is found to have a right lower quadrant abdominal mass and positive fecal occult blood. Radiographic studies show a thickened terminal ileum, skip lesions, and areas of stricture. Diagnosis?
|
Crohn’s disease
|
|
What is the cause of the symptoms of hemochromatosis
|
Increased iron deposition
|
|
What is a child with pauciarticular RA at risk for
|
Iritis (do slit-lamp test)
|
|
Which hematologic disease is associated with avascular necrosis of the femoral head
|
Sickle cell anemia
|
|
A 50 year old white female presents with very dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). She reports that she has several dental caries filled recently. What is the most likely syndrome
|
Sjogren’s disease
|
|
What is podagra
|
Gout of the metatarsophalangeal joint of the big toe
|
|
What bones does tuberculous osteomyelitis affect
|
Spine
Hip
Long bones
Bones of the hands and feet
|
|
List the classic triad of Hand-Schuller-Christian disease
|
Skull lesions
Diabetes insipidus
Exophthalamos
|
|
What are the 2 most frequent locations of giant cell tumor
|
Distal femur
Proximal tibia
|
|
What is the central radiolucent area in an osteoid osteoma called
|
Nidus
|
|
Which vessels are usually affected in Wegener’s granulomatosis
|
Medium and small vessels of the respiratory tract and kidneys
|
|
What population is most commonly affected by osteoid osteoma
|
Males less than 25 year old
|
|
What is a localized bone infection surrounded by granulation tissue called
|
Brodie abscess
|
|
What are systemic symptoms of Crohn’s disease
|
Aphthous ulcers
Erythema nodosum
Uveitis
|
|
What are Herberden’s nodules
|
Palpable DIP joints with osteophytes
|
|
Previous exposure to which bacteria can precipitate Reiter disease
|
Chlamydiae
Shigella
Salmonella
Campylobacter
Yersinia species
|
|
Which antibody is sensitive but not specific for the diagnosis of SLE
|
Antinuclear antibody
|
|
Describe the clinical features of osteitis deformans
|
Pain, fracture, and skeletal deformities; deafness when skull is involved; short stature when spine is involved
|
|
What is the autoantibody that is most closely associated with scleroderma
|
Anti-DNA topoiosomerase I (anti-Scl-70)
|
|
What is the name of the rash on the eyelids found in dermatomyositis
|
Heliotrope rash
|
|
What diseases are associated with pseudogout
|
Hyperparathyroidism
Hemochromatosis
|
|
A 45 year old male smoker complains of cold sensitivity and pain in his fingers. Some fingers have signs of gangrene. What is he suffering from
|
Buerger’s disease (smoking and thromboangiitis obliterans)
|
|
What is the diagnostic test that confirms temporal arteritis
|
Temporal artery biopsy
|
|
What are the usual causative organisms (2) of pyogenic osteomyelitis in newborns
|
Group B β-hemolytic strep
E coli
|
|
A 5 year old child presents with complaints in two joints. Which disease is this
|
Pauciarticular juvenile RA
|
|
What population is most commonly affected by enchondroma
|
All age groups
|
|
What imaging test should be done to confirm Takayasu’s arteritis
|
Angiogram
|
|
How should a patient with fibromyalgia be treated
|
NSAIDs and antidepressants
|
|
What is the effect of PTH on bone
|
It stimulates the active phase of bone remodeling
|
|
A 20 year old black male presents with a 1 month history of worsening back pain that is worse in the morning and improves with exercise. What is the suspected diagnosis
|
Ankylosing spondylitis
|
|
What is the cause of Crohn’s disease
|
Idiopathic
Associated with HLA-B27
|
|
Name the 2 clinical signs of aneurysmal bone cysts
|
Pain
Soft tissue swelling
|
|
How are tuberculous organisms spread
|
Hematogenously
|
|
What do Birbeck granules look like
|
Tennis rackets
|
|
What are the characteristic eye findings in osteogenesis imperfecta
|
Blue sclerae
|
|
What is giant cell tumor
|
Benign tumor characterized by multinucleated giant cells and fibrous stroma
|
|
What is different about pediatric RA
|
It is often RF negative
|
|
What causes scurvy
|
Vitamin C deficiency
|
|
What genetic defect is present in Ewing sarcoma
|
11,22 translocation
|
|
How does vitamin C deficiency lead to impaired bone formation
|
Failure of praline and lysine hydroxylation required for collagen synthesis
|
|
What is the usual causative organism of pyogenic osteomyelitis in IV drug abusers
|
Pseudomonas organisms
|
|
What is the course of giant cell tumor
|
Although benign, it is locally aggressive
|
|
What is the course of Letterer-Siwe disease
|
Aggressive and fatal
|
|
In what 4 areas does Ewing sarcoma occur most often
|
Long bones, pelvis, scapula, ribs
|
|
Describe the difference between rickets and osteomalacia
|
Osteomalacia occurs in adults, rickets in children. Because bone growth is not complete in patients with rickets, skeletal deformities are common
|
|
In Takayasusu’s arteritis, what would an angiogram reveal
|
Thickening (granulomatous inflammation) of the aortic arch and proximal vessels
|
|
If a patient with secondary syphilis is not treated, what are some outcomes in the following years
|
One third of patients get tertiary syphilis (1-40 years after infection); Two thirds have no further symptoms
|
|
Give 2 histologic differential diagnoses of aneurysmal bone cysts
|
Giant cell tumor of bone
Telangiectatic osteosarcoma
|
|
What is the prognosis for chondrosarcoma
|
Chondrosarcoma is slow growing, but has a high tendency to recur; 10 year survival rate is 50-60%
|
|
A boy scout with Lyme disease recalls a strange bull’s eye rash that appeared and then disappeared before he could get an appointment. What is the rash called
|
Erythema chronicum migrans
|
|
A 4 year old Japanese female presents to the ER with a 5 day history of fever above 102, arthritis, bright red lips, swollen hands and feet, and swollen lymph nodes. Diagnosis
|
Kawasaki disease (mucocutaneous lymph node syndrome)
|
|
Describe the major histologic feature of fibrous dysplasia
|
Proliferation of fibroblasts, which produce a dense collagenous matrix
|
|
What is the usual causative organism of pyogenic osteomyelitis in sickle cell anemia patients
|
Salmonella organisms
|
|
What happens to bone affected by tuberculous osteomyelitis
|
Progressive destruction, with little ossification
|
|
Microscopically, how does osteitis deformans appear
|
Marked medullary fibrosis; disorganization of normal trabecular pattern
|
|
Describe the clinical symptoms of osteochondroma
|
Pain and compression of adjacent structures
|
|
A patient with syphilis describes two papular lesions on his penis that are gray-white. What are these lesions
|
Condylomata lata of the secondary stage of syphilis
|
|
What portion of bone is affected by unicameral bone cysts
|
Distal ends of long bones
|
|
Which neoplasm is associated with SLE and myasthenia gravis
|
Thymoma
|
|
What are treatment options for syphilis in primary and secondary stages
|
Penicillin G—intramuscular
|
|
How is the diagnosis of hypersensitivity angiitis made
|
Skin biopsy showing infiltration of dermal capillaries
|
|
A 55 year old white woman presents with 1 month history of proximal muscle weakness and pain, increasing fatigue, and malaise. What disease should be ruled out
|
Polymyositis
|
|
What lab values would be abnormal in polymyalgia rheumatica
|
Elevated ESR
|
|
How many types of osteogenesis imperfecta are there
|
4 (types I to IV)
|
|
What population is most commonly affected by osteoma
|
Males of any age
|
|
What is osteoporosis
|
A decrease in bone mass
|
|
What lab tests help to diagnose gout
|
Uric acid level
Joint fluid aspiration of needle-shaped crystals with negative birefringence
|
|
What clinical symptoms do patients with microscopic polyangiitis have
|
Hemoptysis; Hematuria; Abdominal pain/blood in stool; Skin findings (purpura)
|
|
An 18 year old man presents with migratory arthritis, currently in his ankle, a rash, and pain with urination. A Gram’s stain of urethral discharge shows gram-negative cocci. Diagnosis?
|
Gonococcal arthritis
|
|
Is fibrous dysplasia monostotic or polyostotic
|
80% monostotic; 20% polyostotic
|
|
Which vessels does Kawasaki disease typically affect
|
Large, medium, and small arteries
|
|
An 18 year old female patient presents with a 5 week history of arthritis, fever, 15lb weight loss, and diarrhea. What diseases should be considered
|
Inflammatory bowel disease—Crohn’s and ulcerative colitis
|
|
How is hyperparathyroidism treated
|
By removal of the parathyroid lesion
|
|
What is the causative organism of the sore throat in rheumatic fever
|
Group A β-hemolytic streptococci
|
|
What are the clinical features of osteoid osteoma
|
Increasing pain, worse at night, relieved by aspirin
|
|
Name the 2 most frequent locations of osteoblastoma
|
Vertebrae and long bones
|
|
A 22 year old Asian female presents to your office with arthritis, fevers, night sweats, change in vision, and skin nodules. On physical exam, she is found to have weak and uneven pulses in the upper extremities. What disease should be ruled out
|
Takayasu’s arteritis (pulselessness disease)
|
|
What autoantibodies are found in Kawasaki disease
|
Antiendothelial antibodies
|
|
What are the 2 most frequent locations for osteochondroma
|
Distal femur
Proximal tibia
|
|
With what disease is polymyalgia rheumatica associated
|
Temporal arteritis
|
|
What are some causes for chest pain in a patient with SLE
|
Pleuritis
Pericarditis
|
|
Which autoantibody groups are associated with Churg-Strauss
|
Antineutrophil cytoplasmic antibody (ANCA); Antimyeloperoxidase
|
|
What is the treatment for gout
|
Acute—Colchicine, NSAIDs
Maintenance—Allopurinol
|
|
What are the most frequent locations of osteoid osteoma
|
Ends of diaphysis of femur or tibia
|
|
What treatments are available for myasthenia gravis
|
Anticholinesterase drugs; Corticosteroids; Thymectomy; Plasmapheresis
|
|
What is the cause of hemochromatosis as a secondary disorder
|
Chronic blood transfusions
|
|
A 23 year old male, sexually active college student arrives at your clinic complaining of a swollen red knee and urethritis. What organism is the most likely
|
Neisseria gonorrhoeae
|
|
What is pyogenic osteomyelitis
|
Infection of the medullary and cortical portions of the bone, including the periosteum
|
|
What is the most common causative organism of septic joint
|
Staphylococcus aureus
|
|
A 33 year old white male complains of joint pain. He mentions that he has noticed an increase in pigmentation along with frequent urination and a strange tendency to set off metal detectors. Diagnosis?
|
Hemochromatosis
|
|
What is the treatment for chondrosarcoma
|
Total resection, if possible
|
|
What are the signs and symptoms of Buerger’s disease
|
Intermittent claudication of small vessels; Raynaud’s phenomenon; Nodular phlebitis
|
|
What disease is similar to RA (bilateral joint pain, fever) but is seen in children, along with rash and hepatosplenomegaly
|
Still’s disease (juvenile RA)
*Kids can’t sit Still when their joints hurt
|
|
Define osteochondroma
|
Bony growth covered by a cartilaginous cap
|
|
What are the 2 most frequent locations of an osteoma
|
Skull
Facial bones
|
|
What is the treatment for polyostotic bone lesions
|
Conservation (nonsurgical), because lesions stop growing after puberty
|
|
The early phase of Ewing sarcoma mimics what other disease
|
Acute osteomyelitis
|
|
How are aneurysmal bone cysts treated
|
Removal of entire lesion with insertion of bone chips
|
|
What is affected in Hand-Schuller-Christian disease
|
Bone
Liver
Spleen
Other tissues
|
|
How frequently do flare-ups occur with chronic osteomyelitis
|
It varies, with intervals of months to years
|
|
What population is affected by unicameral bone cysts
|
Young males
|
|
What are six clinical manifestations of rickets
|
Craniotabes—thickening and softening of occipital and parietal bones
Late closing of fontanelles
Rachitic rosary—costochondral swelling
Harrison groove—depression of insertion site of diaphragm into rib cage
Pigeon breast—protrusion of sternum
Short stature caused by spinal deformity
|
|
What is edrophonium
|
Anticholinesterase inhibitor
|
|
How are the manifestations of SLE in the kidney classified
|
Type I—appears normal by light microscopy
Type II—mesangial lupus glomerulonephritis
Type III—focal proliferative glomerulonephritis
Type IV—diffuse proliferative glomerulonephritis
Type V—membranous glomerulonephritis
|
|
What are some common organisms that are found uniquely in the joints of infants and young children
|
Group B streptococci
Haemophilus influenzae
|
|
Where does enchondroma most frequently occur
|
Hands and feet
|
|
What is characteristic of Letterer-Siwe disease
|
Widespread histiocyte proliferation
|
|
What causes osteopetrosis
|
Failure of osteoclastic cells by an unknown mechanism
|
|
What is classic sign of ankylosing spondylitis on radiographs
|
Bamboo spine
|
|
What causes osteosarcoma
|
The cause is unknown
|
|
Polyostotic lesions are part of what syndrome
|
Albright syndrome
|
|
What are some of the findings in tertiary syphilis
|
Iritis (Argyll Robertson pupil); Aortitis; Neurosyphilis (tabes dorsalis, paresis); Gummas
|
|
What is the only specific test that provides a definitive diagnosis of polymyositis
|
Muscle biopsy showing lymphoid inflammation
|
|
What is another name for unicameral bone cyst
|
Solitary bone cyst
|
|
Which vessels are affected in Churg-Strauss syndrome
|
Small and medium sized vessels
|
|
What skin findings are associated with sarcoidosis
|
Erythema nodosum; Lupus pernio
|
|
What autoantibody causes Graves disease
|
Thyroid-stimulating hormone (TSH)-receptor antibody
|
|
What is histiocytosis X
|
A group of disorders affecting other organs systems in addition to bone. It is characterized by proliferation of histiocyte cells
|
|
A 30 year old white male presents with new onset of SLE-like symptoms. Which drugs can cause these
|
Hydrazine
INH
Procainamide
Phenytoin
*You won’t be HIPP with drug-induced Lupus
|
|
Define osteitis deformans
|
Bone disease characterized by abnormal bony architecture with increases in osteoblastic and osteoclastic activity, and a “high turnover rate”
|
|
What disease is characterized by symptoms and lab values similar to polymyositis, but also has a lilac edematous rash on the eyelids
|
Dermatomyositis
|
|
What are the radiographic findings in osteogenesis imperfecta
|
Thin and osteopenic bones, often with many foci of fracture callus
|
|
What is the actual cause of rheumatic fever
|
Hypersensitivity—cross reaction antibodies against M protein of Streptococci
|
|
Besides increased iron supply, what are other important lab findings in hemochromatosis
|
Increased ferritin
Increased transferrin
Positive Prussin blue stain
|
|
What is osteoma
|
Benign tumor of mature bone
|
|
Which organism should be suspected in a sickle cell patient with osteomyelitis
|
Salmonella
|
|
Name three clinical features of chondrosarcoma
|
Pain, swelling, and presence of mass for several years
|
|
What are the clinical features of Ewing sarcoma
|
Pain, swelling, and presence of mass for several years
|
|
What would a biopsy of temporal arteritis show
|
Granulomatous arteritis
|
|
A patient with syphilis admits that initially he had a red, firm, painless sore on his penis 6 weeks ago, but it disappeared. What is the lesion called
|
Chancre—the primary stage of syphilis
|
|
What are treatment options for hemochromatosis
|
Phlembotomy; Deferoxamine
|
|
What findings would be expected histologically in Crohn’s disease
|
Transmural inflammation of bowel wall; Noncaseating granulomas; Mucosal damage; Ulceration
|
|
What are the clinical features of osteoblastoma
|
Usually none
|
|
What systemic illnesses do patients with ulcerative colitis exhibit
|
Toxic megacolon; Colon cancer; Primary sclerosing cholangitis; Pyoderma gangrenosum; Uveitis; Erythema nodosum
|
|
How is the diagnosis made in a patient with gonorrhea
|
Urethral swab
|
|
What bones are commonly affected by pyogenic osteomyelitis in children
|
Long bones
|
|
What causes osteitis deformans
|
Cause is unknown; an infectious nature is postulated
|
|
What is the prognosis with Ewing sarcoma
|
Poor. Malignant course with early metastases; the 5 year survival rate is 0-12%
|
|
Is osteitis deformans monostotic or polyostotic
|
Both
|
|
How does Ewing sarcoma appear on gross pathology
|
Hemorrhagic and necrotic destruction of medullary cavity
|
|
What causes osteomalacia
|
Vitamin D deficiency
|
|
What are the 2 genetic variants of osteopetrosis
|
AR and AD
|
|
A 40 year old black female present with increasing shortness of breath, polyarthritis, change in vision, fevers, and malaise. On chest x-ray, there is bilateral hilar lymphadenopathy. What is the most likely diagnosis
|
Sarcoidosis
|
|
What population is most commonly affected with Ewing sarcoma
|
Males less than 15 years
|
|
What are patients with Sjogren’s at risk for developing
|
Lymphoma
|
|
A 45 year old white female presents with a 3 month history of diarrhea, fatty white stools, and a rash that was diagnosed as dermatitis herpetiformis. What is her probable diagnosis
|
Celiac sprue
|
|
A 45 year old white woman presents with a 2 month history of decreased sleep and several (>11) very tender points on her anterior and posterior torso and neck that produce extreme pain with palpation. She has a history of anxiety disorder and depressio
|
Fibromyalgia
|
|
What other disease is strongly associated with temporal arteritis
|
Polymyalgia rheumatica
|
|
Which two antibodies are very specific for SLE
|
Anti-Smith
Antidouble-stranded DNA
|
|
Histiocyte cells are similar to what epidermal cells
|
Langerhans cells
|
|
What are some associated findings with ankylosing spondylitis
|
Positive family history; Uveitis; Anemia
|
|
What antibodies are most closely associated with CREST syndrome
|
Anticentromere antibody
|
|
What other symptoms are common with psoriasis
|
Nail pitting
Psoriatic arthritis with sausage digits
|
|
A 7 year old boy presents with arthritis, lower extremity palpable purpura, abdominal pain, and blood in the stool and urine. Diagnosis?
|
Henoch-Schonlein purpura
|
|
What is the classic reaction hours after treatment for syphilis that involves shaking chills, sore throat, myalgia, and malaise
|
Jarisch-Herxheimer reaction
|
|
What is another name for osteochondroma
|
Exostosis
|
|
What is the treatment for hypoparathyroidism
|
Administration of PTH or vitamin D
|
|
What is the treatment for dermatomyositis and polymyositis
|
High-dose steroids
|
|
A 28 year old African-American female presents to the clinic with new onset of fatigue, weight loss, joint pain, and Raynaud’s phenomenon. On exam, she is found to have a malar rash. Diagnosis?
|
SLE
|
|
What is seen on bone histologic examination in scurvy
|
Decreased trabecular bone mass and abnormal osteoblasts
|
|
What are the Jones criteria of rheumatic fever
|
Fever
Erythema marginatum
Verrucous valvular vegetations
Erythrocyte sedimentation rate increase
aRthritis
Subcutaneous nodules
Chorea (Sydenham’s)
Preceded by Streptococcus infection
*FEVERS and Chorea preceded by a Streptococcus infection
|
|
What are the clinical signs of hypoparathyroidism
|
Signs of hypocalcemia, including soft tissue ossification and calcification, abnormal dentition, and otoscleorosis
|
|
What is the more limited version of scleroderma
|
CREST syndrome
|
|
What is chondrosarcoma
|
Malignant cartilaginous neoplasm
|
|
Define osteosarcoma
|
Malignant osteoid and bone-producing neoplasm
|
|
How does giant cell tumor appear radiographically
|
Soap bubble appearance
|
|
How can you diagnose septic joint
|
Arthrocentesis with high white blood cells/ neutrophil count and Gram’s stain
|
|
What causes Lyme disease
|
Borrelia burgdorferi, which is transmitted by Ixodes tick bites
|
|
What are the clinical features of osteosarcoma
|
Pain, swelling, and pathologic fractures
|
|
What disease would be expected in a young woman that suffers with RA-like symptoms (polyarthritis), leukopenia, leg ulcers, and splenomegaly?
|
Felty’s syndrome
|
|
What lab finding support the diagnosis of polymyositis
|
Increased ESR; Increased CPK; Increased aldolase; Increase LDH; Antinuclear may be positive; Abnormal electromyography
|
|
What is osteogenesis imperfecta
|
A group of heritable diseases characterized by abnormal type I collagen
|
|
A 50 year old man presents with fever, arthralgias, and palpable purpura on the lower extremities after starting several new medications. What is the most likely diagnosis
|
Hypersensitivity angiitis
|
|
What is the treatment for osteitis deformans, and why?
|
Calcitonin or one of the diphosphonates. They decrease resorption, and thus decrease the high turnover rate
|
|
What is seen on bone histologic examination in hypothyroidism
|
Active osteoblasts and lack of osteoclasts
|
|
What are 2 common conditions associated with osteopetrosis
|
Anemia due to decreased marrow space
Blindness, deafness, and other cranial nerve involvement due to narrowing of neural foramina
|
|
Which serologic test detects syphilis the earliest, is the most specific, and stays positive even after treatment
|
Fluorescent treponemal antibody absorption test (FTA-ABS)
|
|
What bones are commonly affected by pyogenic osteomyelitis in adults
|
Vertebrae
|
|
What are the fibrous tissue lesions seen in resorbed bone called
|
Brown tumors
|
|
Does extraskeletal involvement occur in eosinophilic granuloma
|
Yes, commonly in the lung
|
|
What is the most common reason for hypoparathyroidism
|
Surgical removal of parathyroid glands
|
|
Which antibody is found in Wegener’s
|
Cytoplasmic-ANCA (c-ANCA), predominantly antiproteinase 3
|
|
A 35 year old white male presents with diffuse red/purple plaques with silver scale on extensor surfaces and scalp. What disease is suspected
|
Psoriasis
|
|
Name the 2 most frequent locations of osteosarcoma
|
Distal femur and proximal tibia
|
|
Describe the radiographic appearance of fibrous bone dysplasia
|
Well-defined zones of rarefaction surrounded by narrow rims of sclerotic bone
|
|
What HLA types are increased in patients with Buerger’s disease
|
HLA-A9 and HLA-B5
|
|
What is seen on radiography of aneurysmal bone cysts
|
Circumscribed zone of rarefaction, with extension into soft tissues
|
|
What are the official criteria for the diagnosis of SLE
|
Oral ulcers
Renal disorder
Photosensitivity
Hematologic (anemias, cytopenias)
Arthritis (nonerosive synovitis)
Neurologic (seizures, psychosis)
Serositis
Malar rash
Antinuclear antibody
Immunologic (anti-DNA, anti-Smith, false positive rapid plasma reagin/Venereal Disease research Laboratory [RPR/VDRL])
Discoid rash
*The ORPHAN’S MAID has Lupus
*Need 4/11 criteria for diagnosis
|
|
A patient presents with urethritis, conjunctivitis, arthritis, and happens to be HLA-B27 positive. Diagnosis?
|
Reiter disease
*Can’t pee, can’t see, can’t kick with your knee
|
|
What findings would be expected on gross examination of a biopsy taken for a small bowel with Crohn’s disease
|
Sharp demarcation of diseased bowel (skip lesions); Linear ulcers; Cobblestone mucosa; Sinus tract/fistula formation; Creeping fat around the bowel surface; *The old Crohn skips down the cobblestone tract
|
|
A black female with SLE delivered an infant with bradycardia, which is later found to have AV-block. What autoantibody could have caused this congenital heart block
|
Anti-Rho antibodies which cross the placenta
|
|
What cardiac complications are possible with Lyme disease
|
First-degree AV-block
|
|
What deformity is associated with Wegener’s
|
Saddle nose deformity
|
|
Give 3 possible causes of avascular necrosis
|
Emboli
Decompression syndrome (the bends)
Sickle cell anemia
|
|
How does chondrosarcoma appear on gross pathology
|
Lobulated white or gray mass, with mucoid material and calcification
|
|
Which antibody system is associated with drug-induced Lupus
|
Antihistone
|
|
A 42 year old male presents with chronic sinusitis, hemoptysis, necrotizing granulomas of the nose and palate, and a previous diagnosis of crescentic glomerulitis. Diagnosis?
|
Wegener’s granulomatosis
|
|
What does subperiosteal reactive new bone resemble
|
Onion skin
|
|
What are the clinical features of osteoma
|
It is asymptomatic, unless drainage of paranasal sinus is blocked
|
|
Radiographically, how does chondrosarcoma appear
|
Cortical destruction with occasional medullary involvement
|
|
Why are multiple fractures common in osteopetrosis
|
Although bone is hyperdense, it is intrinsically disorganized. Consequently, it is weaker
|
|
With what other conditions is avascular necrosis commonly associated
|
Alcoholism
Corticosteroid treatment
Hyperuricemia
SLE
Trauma
|
|
What is characteristic of Hand-Schuller-Christian disease
|
Histiocyte proliferation with inflammatory cells
|
|
Name the 4 most frequent locations of chondrosarcoma
|
Proximal femur, proximal humerus, pelvis, spine
|
|
What population is affected by aneurysmal bone cysts
|
Females in 2nd to 3rd decade of life
|
|
What is Ewing sarcoma
|
Undifferentiated round cell malignant tumor
|
|
What is the treatment for Buerger’s disease
|
Stop smoking
|
|
What is the best way to diagnose syphilis in the primary stage
|
Darkfield exam
|
|
Define rickets
|
Bone abnormality caused by defective calcification of osteoid matrix and increased thickness of epiphysial growth plates
|
|
What cardiac lesion is associated with SLE in the adult and consists of nonbacterial verrucous valvular vegetations
|
Libman-Sacks endocarditis
|
|
Where does Ewing sarcoma arise
|
Undifferentiated mesenchymal cells of the medullary cavity
|
|
What is tuberculous osteomyelitis
|
Bone infection due to spread of tuberculous organisms
|
|
What is osteomalacia
|
A bone abnormality caused by defective calcification of osteoid matrix
|
|
Does osteochondroma undergo transformation to a malignant tumor
|
Rarely
|
|
An 18 year old football player complains of joint pain, bruising, and somewhat limited range of motion. He reports that he has always been a free bleeder. Diagnosis?
|
Hemarthroses associated with hemophilia
|
|
Give another name for osteitis deformans
|
Paget disease of the bone
|
|
What is the treatment for polyarteritis nodosa
|
Steroids and cyclophosphamide
|
|
What is the major complication of temporal arteritis that prompts administration of steroids
|
Blindness
|
|
What are the calcium and phosphorus levels in the blood in patients with osteoporosis
|
Normal
|
|
What is the prognosis with aneurysmal bone cysts
|
Recurrences occur 20% to 30% of the time
|
|
Define scurvy
|
Bone abnormality characterized by impaired osteoid matrix formation
|
|
Describe the pathophysiology associated with osteoporosis of the elderly
|
A continuous loss of bone occurs at the trabecular and cortical layers due to increased resorption
|
|
What diseases are associated with myasthenia gravis
|
Thymoma; Thyrotoxicosis
|
|
What is the treatment for unicameral bone cysts
|
Curettage with insertion of bone chips
|
|
What causes osteoporosis
|
Impaired synthesis or increased resorption of bone matrix
|
|
What is the treatment for avascular necrosis
|
Hemiarthroplasty
|
|
What is the common clinical presentation of osteopetrosis
|
Multiple fractures
|
|
What type of cancer are patients with hemochromatosis at risk of
|
Hepatocellular cancer
|
|
Name the 4 factors predisposing to osteosarcoma
|
Paget disease
Ionizing radiation
Bone infarcts
Familial retinoblastoma
|
|
What is the genetic association of ankylosing spondylitis
|
AR, HLA-B27
|
|
What are some treatments of osteoarthritis
|
NSAIDs and weight reduction to reduce strain on joints
|
|
How do you treat gonorrhea
|
Ceftriaxone
|
|
What is the prognosis in Hand-Schuller-Christian disease
|
Better than Letterer-Siwe, worse than eosinophilic granuloma
|
|
What are the treatments for Lyme disease
|
Tetracycline; Doxycycline
|
|
What commonly prescribed drug induces osteopenia
|
Steroids
|
|
Which organism should be suspected in a patient with diabetes and osteomyelitis
|
Pseudomonas
|
|
What types of immune complexes are found in tissue biopsy of Henoch-Schonlein purpura
|
IgA dominant
|
|
What is the prognosis for osteoid osteoma
|
Excellent. Resection of nidus and sclerotic bone is curative
|
|
What are the two clinical features of hyperparathyroidism
|
Bone pain and hypercalcemia
|
|
Where does giant cell tumor originate
|
Epiphysis of long bones
|
|
What is the prognosis with unicameral bone cysts
|
Excellent, with few recurrences
|
|
What dietary recommendations should celiac sprue patients follow
|
Avoid all foods containing gliadin (gluten), including wheat and beer
|
|
What is the treatment for osteomalacia
|
Correct vitamin D deficiency
|
|
What causes rickets
|
Vitamin D deficiency
|
|
Which titers are elevated with rheumatic fever
|
Antistreptolysin O titer; ESR
|
|
How is the diagnosis of myasthenia gravis confirmed
|
Edrophonium challenge temporarily improves muscle strength
|
|
What does immunoflorescence of affected tissue in Goodpasture’s syndrome show
|
Linear deposits of IgG and C3 in the glomerular basement membrane
|
|
Name 2 clinical symptoms of pyogenic osteomyelitis
|
Fever, local bone pain
|
|
Which lab test should you order when you suspect RA
|
Rheumatoid factor
|
|
What is osteochondroma’s claim to fame
|
Most common benign tumor of bone
|
|
Besides bone, what else is affected in osteogenesis imperfecta
|
Teeth, skin, eyes
|
|
What is the treatment for osteoporosis
|
No cure. Calcium supplements, exercise, and estrogen therapy (in some patients) help reduce the risk, however
|
|
What are the significant laboratory values in hyperparathyroidism
|
Calcium >11.5 mg/dl; Phosphorus <2.0 mg/dl
|
|
Which serologic tests are used for presumptive diagnosis of syphilis
|
VDRL and RPR
|
|
After bone is resorbed, what replaces it
|
Fibrous tissue
|
|
A 55 year old white female complains of 3 months of neck stiffness, pelvic and pectoral girdle weakness, and pain, fatigue, and malaise. What is the most likely diagnosis
|
Polymyalgia rheumatica
|
|
Which joints are most commonly involved in RA
|
Wrists, PIP, and metacarpophalangeal
|
|
What population is most commonly affected with osteitis deformans
|
Elderly persons
|
|
What vessels does Takayasu's arteritis affect
|
Medium and large arteries
|
|
What treatment for osteoblastoma allows the best prognosis
|
Results are excellent when the lesion is removed by curettage
|
|
How does osteosarcoma appear on gross pathology
|
Large necrotic and hemorrhagic mass
|
|
A 34 year old abstinent Asian patient presents with a several year history of arthritis, recurrent genital and oral ulcers, and a painful rash over the pretibial areas. Diagnosis?
|
Behcet’s disease
|
|
A 43 year old male presents to your clinic with a history of falling on his knee two days ago. Since then, the knee has become red, swollen, and warm. Diagnosis?
|
Septic joint
|
|
What is the prognosis of osteoma
|
Excellent. Resection is curative
|
|
A 22 year old white female presents with a 2 week history of migratory polyarthritis, 15 lb weight loss, and grossly bloody mucoid diarrhea. Diagnosis?
|
Ulcerative colitis
|
|
What is the treatment for scurvy
|
Correction of vitamin C deficiency
|
|
A 4 year old boy presents with arthralgias, soft hyperextensible skin, corneal and scleral abnormalities, joint laxity, and easy bruising. Diagnosis?
|
Ehlers-Danlos syndrome
|
|
What population is affected by Letterer-Siwe disease
|
Infants
|
|
Why the name “marble bone” disease for osteopetrosis
|
Bones look short and block-like, and are radiodense, like marble
|
|
How does osteoid osteoma appear radiographically
|
Central radiolucent area surrounded by sclerotic bone
|
|
What is the microscopic appearance of osteosarcoma
|
Malignant stroma containing osteoid and bone
|
|
What are some laboratory findings of Churg-Strauss syndrome
|
Blood eosinophilia; Increased IgE
|
|
What clinical test for ankylosing spondylitis should be performed in the office
|
Schober test—decreased angle of anterior flexion of the back, eliciting pain
|
|
How is osteosarcoma treated
|
Surgical amputation of affected limb, and adjunctive chemotherapy
|
|
What is the gross pathology of aneurysmal bone cysts
|
Bone is greatly distorted with irregular outlines. It appears spongy, with cystic spaces of various sizes
|
|
What is the prognosis in eosinophilic granuloma
|
Best of all variants of histiocytosis X. Lesions sometimes heal without treatment
|
|
A young man presents with arthritis, asthma, allergy, weight loss, fever, and vasculitis. What disease is suspected
|
Churg-Strauss syndrome
|
|
What features are characteristics of ulcerative colitis
|
Continuous involvement beginning at rectum; Microabscesses; Pseudopolyps; Superficial ulceration
|
|
What are the major complications of Kawasaki disease
|
Myocardial infarction and coronary artery aneurysms
|
|
A 65 year old white male presents to clinic with a 2 hour history of sudden onset of extreme pain in his great toe. What disease should be suspected in this patient
|
Gout
|
|
What is the distinctive inflammatory heart lesion associated with rheumatic fever
|
Aschoff’s bodies
|
|
What is avascular necrosis
|
Necrosis of bone, usually the femoral head, caused by infarction
|
|
Which vessels are mainly affected in Henoch-Schonlein purpura
|
Small vessels (capillaries, venules, and arterioles)
|
|
Where does osteochondroma originate
|
In the metaphysis
|
|
What are the criteria for a diagnosis of Kawasaki disease
|
Fever >5 days; Lymphadenopathy; Bilateral conjunctival injection; Mucosal changes (fissuring, injection, strawberry tongue, erythema); Extremitiy changes (edema, erythema); Rash (truncal, may be desquamative); Arthritis (may be present)
|
|
What are characteristic markers of histiocytic cells
|
Birbeck granules
|
|
How does Ewing sarcoma appear radiographically
|
Destructive appearance
|
|
What is the prognosis of osteochondroma
|
Excellent. Resection is usually curative
|
|
What is the phenomenon that describes the development of a psoriatic plaque in an area of previous trauma
|
Koebner phenomenon
|
|
What pathology would be seen in biopsy of celiac sprue
|
Blunting of villi; Lymphocytes in the lamina propria
|
|
How do the causative bacteria of pyogenic osteomyelitis spread in the body
|
Hematogenously
|
|
What are some complications of Takayasu’s arteritis
|
Pulmonary hypertension; Stroke
|
|
How do tophi appear on x-ray
|
“Punched out” lesions
|
|
How is a Brodie abscess treated
|
Drain or debride the abscess
Administer antibiotics
|
|
A 32 year old female presents to your office complaining of morning stiffness for greater than 1 hour, pain in joints bilaterally, with fatigue and hand deformations over time. Diagnosis?
|
Rheumatoid arthritis
|
|
What are the two main causes of hyperparathyroidism
|
Parathyroid hyperplasia and parathyroid adenoma
|
|
What is used to treat psoriasis
|
Psoralen ultraviolet A (PUVA)
Retinoids
Methotrexate
Cyclosporin
|
|
Fibrous dysplasia most commonly affects what bones
|
Ribs, femur, tibia, maxilla
|
|
What are treatment options for Crohn’s disease
|
Sulfasalazine; Corticosteroids; Bowel rest; Surgery (fistulas, obstruction); B12 supplements for malabsorption
|
|
What should be done if Kawasaki disease is suspected
|
Treat with aspirin and IV immunoglobuliins
|
|
Radiographically, how does osteoblastoma appear
|
Well-circumscribed lesion surrounded by sclerotic bone
|
|
What is chondrosarcoma’s microscopic appearance
|
Poorly developed cartilage cells with anaplastic cells
|
|
What population is most commonly affected by chondrosarcoma
|
Males 30-60 years old
|
|
What are Bouchard’s nodules
|
Palpable PIP joints with osteophytes
|
|
What is the treatment for rickets
|
Correction of vitamin D deficiency
|
|
What is the nidus of osteoid osteoma, microscopically
|
Osteoblasts, calcification, and multinucleate giant cells
|
|
What are signs of osteoarthritis on x-ray
|
Joint space narrowing, osteophytes
|
|
A 65 year old female presents with increasing headache, vision changes, scalp pain, and jaw pain. She also complains of a few previous months of aching joints and muscles. What should immediately be suspected
|
Temporal (giant cell) arteritis
|
|
What commonly results from osteopenia
|
Fractures
|
|
What population is most commonly affected by giant cell tumor
|
Females 20 to 40 years old
|
|
Name three clinical characteristics of scurvy
|
Subperiosteal hemorrhage
Osteoporosis
Epiphysial cartilage not replaced by osteoid
|
|
What are significant laboratory test values in pyogenic osteomyelitis
|
Marked leukocytosis, fever, and increased sedimentation rate
|
|
What is the appearance of unicameral bone cysts on gross pathology
|
Multiloculated cavity
|
|
What is the name of the sign that occurs when a small amount of scale is removed from a psoriatic plaque, leaving small bleeding points behind
|
Auspitz sign
|
|
What is the antibody associated with Goodpasture’s syndrome
|
Antiglomerular basement membrane
|
|
How is a diagnosis of polyarteritis made
|
Tissue biopsy showing transmural necrotizing arteritis of medium-sized arteries
|
|
Radiographically, elevation of periosteum is called what
|
Codman triangle
|
|
Name the five most common locations of osteitis deformans
|
Spine, pelvis, skull, femur, and tibia
|
|
From what two preexisting cartilaginous tumors can chondrosarcoma arise
|
Multiple familial osteochondromatosis
Multiple enchondromatosis
|
|
In adults, what is the usual cause of pyogenic osteomyelitis
|
Complications from surgery and compound fractures
|
|
What is characteristic of eosinophilic granuloma
|
Histiocytic proliferation with inflammatory cells, including many eosinophils
|
|
How does hypoparathyroidism affect bone
|
It decreases the turnover rate
|
|
What are two common histories with Henoch-Schonlein purpura
|
Post-streptococcal infection or upper respiratory infection; History of insect bites
|
|
A 28 year old male presents with a 2 week history of joint pain, fever, malaise, as well as a new rash all over his body including his palms and soles. Diagnosis?
|
Secondary (disseminated) syphilis
|
|
What is rheumatoid factor
|
Immunoglobin M antibody to fragment crystallizable (Fc) portion of IgG
|
|
Why is Kawasaki disease one of the only indications for using aspirin in children
|
Reye’s syndrome limits the use of aspirin in children, except in the treatment for Kawasaki disease
|
|
A 12 year old presents with migratory polyarthritis, rash, fever, and general malaise. She recalls having a sore throat about 3 weeks ago but did not get treatment. Diagnosis?
|
Acute rheumatic fever
|
|
Which two HLA types is SLE linked to
|
HLA-DR2 and HLA-DR3
|
|
How is osteomalacia diagnosed
|
By bone biopsy
|
|
A 26 year old white male presents with malaise, fever, weight loss, hypertension, ab pain, and melena. He has a history of hepatitis B and drug use. What disease is suspected
|
Polyarteritis nodosa (PAN)
|
|
What population is most commonly affected by osteochondroma
|
Males under 25 years of age
|
|
What portion of the bone is most commonly involved initially in pyogenic osteomyelitis
|
Metaphysis
|
|
What HLA type is associated with psoriatic arthritis
|
HLA-B27
|
|
What disease is characterized by pain in weight-bearing joints, is worse after use, has crepitation with motion, no signs of inflammation, and is seen in the middle-aged population
|
Osteoarthritis, aka degenerative joint disease
|
|
What is the inheritance pattern of primary hemochromatosis
|
Autosomal recessive
|
|
What population is affected by Hand-Schuller-Christian disease
|
Children less than 5 years old
|
|
Why does subperiosteal hemorrhage occur with scurvy
|
Because of increased capillary fragility
|
|
What is seen on bone histologic examination in hyperparathyroidism
|
An increased number of osteoclasts
|
|
A 15 year old boy scout complains of a 2 week history of flu-like illness and joint pain which started in his left knee, and now is in his right knee. It all began after a camping trip in Connecticut. Diagnosis?
|
Lyme disease
|
|
What variant of osteopetrosis is most severe
|
The AR variant is fatal in infancy
|
|
What HLA type is associated with myasthenia gravis
|
HLA-DR3
|
|
When avascular necrosis occurs in the femoral head of children, what is it called
|
Legg-Calve’-Perthes disease
|
|
What is the treatment for monostotic bone lesions
|
Curettage or local resection
|
|
What abnormality is often seen in the fibrous tissue of resorbed bone
|
Hemosiderin pigment
|
|
Give another name for osteosarcoma
|
Osteogenic sarcoma
|
|
What autoantibodies are associated with Sjogren’s disease
|
Antinuclear antibody (ANA) (nonspecific) and antinucleoprotein antibodies (SS-A[Ro] and SS-B)
|
|
What are some common organisms associated with implantable devices and prosthetics
|
Staph aureus
Staphylococcus epidermidis
Gram-negative bacilli
|
|
What portion of bone is usually affected with aneurysmal bone cysts
|
Metaphysis of long bones
Vertebrae
|
|
What is the prognosis of giant cell tumor
|
Frequently recurs after local curettage
|
|
On biopsy of affected tissue, what is the classic finding in sarcoidosis
|
Noncaseating granulomas
|
|
What lab values should be evaluated in fibromyalgia
|
CBC—normal; ESR—normal
|
|
What is the disease that is a variation of polyarteritis nodosa, which affects smaller arterioles, capillaries, and venules rather than the larger vessels
|
Microscopic polyangiitis (leukocytoclastic vasculitis)
|
|
What are 5 clinical findings in Letterer-Siwe disease
|
Hepatosplenomegaly
Lymphadenopathy
Pancytopenia
Pulmonary involvement
Recurrent infections
|
|
Name 3 clinical signs of unicameral bone cysts
|
Pain
Soft tissue swelling
Occasional fractures
|
|
What is seen radiographically in patients with osteoporosis
|
Diffuse radiolucency of bone
|
|
What is the usual clinical presentation of osteogenesis imperfecta
|
Multiple fractures, often with minimal trauma
|
|
Which antibody is microscopic polyangiitis most closely associated with
|
p-ANCA
|
|
In which sex and race is SLE most common and severe
|
Black females
|
|
What is the size range of aneurysmal bone cysts
|
Up to 20 cm
|
|
What causes myasthenia gravis
|
Antiacetylcholine-receptor antibody
|
|
What are some GI symptoms commonly associated with Sjogren’s
|
Constipation and pancreatic insufficiency due to gland destruction
|
|
What are the major differences that separate UC from Crohn’s
|
No skip lesions, no granulomas, no fistulas/sinuses in ulcerative colitis
|
|
What other findings should be looked for in a patient with gout
|
Tophi, subcutaneous deposits of uric acid crystals
|
|
A 55 year old white female presents with polyarthritis, dysphagia and reflux esophagitis, pulmonary fibrosis, and hypertension. On exam, her face appears tight and masklike and she has swelling of the hands and thickening of the skin. What is the most lik
|
Scleroderma (systemic scleroderma)
|
|
A 23 year old white female presents with a 6 month history of weight loss, muscle weakness, palpitations, diarrhea, and fine tremor. Tachycardia and exophthalmos are present. What do you suspect
|
Graves’ disease (diffuse toxic goiter)
|
|
How is Ewing sarcoma treated
|
Amputation of limb; possibly chemotherapy
|
|
What is seen on radiography of unicameral bone cysts
|
Radiolucent area with smooth, thin cortex
|
|
What is enchondroma
|
Benign intramedullary cartilaginous neoplasm
|
|
What population is most commonly affected by osteosarcoma
|
Males 10-20 years old
|
|
What are wire-loop lesions in the kidney and what do they represent
|
Thickening of the capillary wall found in diffuse proliferative glomerulonephritis; indicate a poor prognosis with SLE
|
|
What are the significant laboratory values of osteosarcoma
|
A 2-3 fold increase in alkaline phosphatase levels
|
|
Name 3 reasons for persistent pyogenic osteomyelitis
|
Necrotic bone acting as a locus for persistent infection
Pyogenic exudate compressing vascular supply of bone
Inflammation in relatively avascular areas of bone
|
|
What is the prognosis for osteosarcoma
|
Poor; 5 year survival rate is 5% to 20%
|
|
Name 3 variants of histiocytosis X
|
Eosinophilic granuloma
Hand-Schuller-Christian disease
Letterer-Siwe disease
|
|
What can precipitate an outbreak of psoriasis
|
Infection
Stress
Sunburn
Drugs— β-blockers, lithium, and antimalarials
|
|
Name 5 states with which osteoporosis is associated
|
Postmenopause
Physical inactivity
Hypercorticism
Hyperthyroidism
Calcium deficiency
|
|
What are 2 other names for osteopetrosis
|
Marble bone disease
Alber-Schonberg disease
|
|
What population is most commonly affected by osteoblastoma
|
Males under 30
|
|
What bone complications occur in fibrous dysplasia
|
Deformity secondary to repeated fractures
|
|
What is the cause of unicameral bone cyst
|
Unknown
|
|
What should be done immediately when temporal (giant cell) arteritis is suspected
|
Start high-dose steroids
|
|
What is the clinical presentation of eosinophilic granuloma
|
Solitary bone lesion
|
|
What are some common findings with RA
|
Fever
Malaise
Pericarditis
Pleural effusions
Uveitis
Subcutaneous nodules
|
|
Which lab test is elevated in temporal arteritis
|
ESR
|
|
What are contributing factors for gout
|
Thiazide diuretics
Lesch-Nyhan syndrome
Diets with high protein and alcohol
|
|
Microscopically, what is seen with Ewing sarcoma
|
Undifferentiated small round cells in sheets or cords
|
|
What is the name for the chronic inflammation of cartilage found in RA
|
Pannus
|
|
What can osteomalacia mimic radiographically
|
Osteoporosis
|
|
What is the most common form of psoriatic arthritis
|
Asymmetric arthritis in fingers or toes
|
|
A 23 year old white female develops limb weakness, ptosis, diplopia, and difficulty chewing. Weakness improves after rest. Sensation and reflexes remain intact and normal. What disease is suspected
|
Myasthenia gravis
|
|
What is the usual causative organism of pyogenic osteomyelitis in children
|
Staph aureus
|
|
What are patients with dermatomyositis and polymyositis at an increased risk of developing
|
Ovarian cancer
|
|
Radiologically, what is seen with avascular necrosis
|
Reparative foci replacing necrotic bone
|
|
How is Sjogren’s disease diagnosed
|
Lip biopsy; Schirmer’s test (showing decreased lacrimation)
|
|
What is osteopetrosis
|
An inherited disorder characterized by abnormally dense bone
|
|
What are the symptoms for hemochromatosis
|
Bronze diabetes; Congestive heart failure; Micronodular cirrhosis
|
|
A patient with established ulcerative colitis presents to the ER with high fever and symptoms of shock and abdominal distention. What must be suspected
|
Toxic megacolon
|
|
Osteoma occurring as multiple lesions, with intestinal polyps and soft tissue tumors, is known by what name
|
Gardner syndrome
|
|
What causes celiac sprue
|
Antigliaden antibody (IgA antiendosomal)
|
|
What is osteoid osteoma
|
Neoplastic proliferation of osteoid and fibrous tissue
|
|
What electrolyte abnormality is common with sarcoidosis
|
Hypercalcemia
|
|
State osteosarcoma’s claim to fame
|
Osteosarcoma is the most common primary malignant tumor of bone
|
|
What is osteomalacia called when secondary to renal disease
|
Renal osteodystrophy
|
|
What is tuberculous osteomyelitis with spinal involvement called
|
Pott disease
|
|
What lab test is usually abnormal in Takayasu’s arteritis
|
ESR (elevated)
|
|
A 24 year old man recently diagnosed and treated for chlamydia complains of persistent joint pain with tender Achilles’ tendons and eye irritation. Diagnosis?
|
Reiter’s reactive arthritis
|
|
In what age group does osteomalacia typically occur
|
Adults
|
|
How does osteosarcoma spread
|
Hematogenously
|
|
Besides Wegener’s, what is the other disease that involves both the respiratory tract (hemoptysis) and kidney (renal failure)
|
Goodpasture’s syndrome
|
|
What are the characteristics of CREST syndrome
|
Calcinosis (subcutaneous); Raynaud phenomenon; Esophageal dysfunction; Sclerodactyly; Telangiectasia
|
