Lab Final Practice Questions

Question 1

What pathology best fits the radiograph below, which shows evidence of marginal lytic erosions and a periosteal response?
A: Psoriatic arthritis
B: Lyme disease
C: Rheumatoid arthritis
D: Systemic lupus erythematosus

Answer 1

Psoriatic arthritis

Question 2

A 26-year-old male presents to your office with pain in his knees. He is trying to get in shape after gaining weight during his graduate school program where he says he was largely inactive because of his rigorous work and school schedules. In the past few months he has started jogging regularly and following a mediterranean diet. He says that both knees feel achy and stiff all day and in the past week he stopped jogging due to the pain. You take radiographs of both knees but don’t see any relevant changes to bone or alignment. Based upon the case presentation, which of the following is the most likely diagnosis for this patient?
A: Degenerative joint disease
B: Chondromalacia patella
C: Rheumatoid arthritis
D: Osteosarcoma
E: Septic arthritis
F: Neuropathic arthropathy

Answer 2

Chondromalacia Patella

Question 3

You begin seeing patients at a local substance abuse rehabilitation clinic. Your first patient is a 56-year-old male with a history of opioid abuse due to a back injury he sustained at work when he was 35. You learn that he is a little overweight and was diagnosed with diabetes 5-years ago, although he has not been managing his condition well for at least the past year. He reports pain in his lower back, but says that it hasn’t increased in severity recently. As he gets up to leave you notice that he has a pronounced stomping gait when he walks and his foot is slightly everted. You ask your patient if he has noticed any new injuries or pain in his foot, but he says no. When you examine his foot you notice that he doesn’t have any sores or open epidermal lesions. Which of the following diagnoses best fits this patient’s presentation?
A: Neuropathic arthropathy
B: Chondromalacia patella
C: Degenerative joint disease
D: Gout
E: Septic arthritis
F: Acute osteomyelitis

Answer 3

Neuropathic arthropathy

Question 4

A 46-year old female patient presents with altered gait and swelling in their right knee. An examination reveals that the patient demonstrates a lack of sensation when the affected area is stimulated. Which of the following best describes the etiology of the pathology depicted in the radiograph below?
A: Biomechanical stress with peripheral nerve damage
B: Biomechanical stress
C: Immune complexes directed at the joint produces pannus and tissue erosion
D: A bacterial infection which produces pus and bone erosion
E: A traumatic fracture complicated by infection

Answer 4

Biomechanical stress with peripheral nerve damage

Question 5

5. Part 1. A new patient arrives to the clinic. Sam is a 36-year-old male who presents with pain and swelling in both hands. He explains that the pain is fairly constant and he sometimes has difficulty performing tasks due to the pain and stiffness in his fingers. He also explains that he has been feeling extremely tired lately and is having difficulty staying focused at work. He states that the pain started several months ago but things have gotten progressively worse in the past month. When you take his temperature you notice a slight fever. You ask if he remembers seeing a rash or having any digestive issues and he says that he hasn’t noticed anything since his symptoms began. Based solely on the case presentation what is the most likely diagnosis for this patient?
   A: Psoriatic arthritis
   B: Rheumatoid arthritis
   C: Degenerative joint disease
   D: Enteropathic arthropathy

Answer 5

Rheumatoid arthritis

Question 6

6. Part 2. A new patient arrives to the clinic. Sam is a 36-year-old male who presents with pain and swelling in both hands. He explains that the pain is fairly constant and he sometimes has difficulty performing tasks due to the pain and stiffness in his fingers. He also explains that he has been feeling extremely tired lately and is having difficulty staying focused at work. He states that the pain started several months ago but things have gotten progressively worse in the past month. When you take his temperature you notice a slight fever. You ask if he remembers seeing a rash or having any digestive issues and he says that he hasn’t noticed anything since his symptoms began. Which blood result would best confirm your diagnosis?
   A: RF-factor positive
   B: HLA-B27 positive
   C: ESR elevated
   D: Hyperuricemia

Answer 6

RF-factor positive

Question 7

What type of deformity is demonstrated in the second digit in the image below?

Answer 7

swan neck deformity

Question 8

8. Part 1. One of your patients, a 57-year-old male named John, has been receiving regular adjustments once a month for several years. You haven’t seen him in over a year due to COVID and the more recent increased workload he is experiencing at his restaurant due to staffing shortages. He reports back pain and states that he has been feeling exhausted lately, but assumes its related to the additional hours at the restaurant. In the past few weeks, though, he has really had difficulty managing the business. You notice that he has lost about 15 lbs. since you last saw him. When you ask him about it he says, “I know, I can’t figure it out. With all the stress, I am eating more lately if anything.” You gather bloodwork and radiographs. The blood work shows that he is slightly anemic. The radiographs of his skull, pelvis, and vertebrae show multiple small osteolytic lesions. What diagnosis best fits this patient presentation?
   A: Osteoid osteoma
   B: Multiple myeloma
   C: Lyme disease
   D: Giant cell carcinoma
   E: Primary osteosarcoma

Answer 8

Mulitple myeloma

Question 9

9. Part 2. One of your patients, a 57-year-old male named John, has been receiving regular adjustments once a month for several years. You haven’t seen him in over a year due to COVID and the more recent increased workload he is experiencing at his restaurant due to staffing shortages. He reports back pain and states that he has been feeling exhausted lately, but assumes its related to the additional hours at the restaurant. In the past few weeks, though, he has really had difficulty managing the business. You notice that he has lost about 15 lbs. since you last saw him. When you ask him about it he says, “I know, I can’t figure it out. With all the stress, I am eating more lately if anything.” You gather bloodwork and radiographs. The blood work shows that he is slightly anemic. The radiographs of his skull, pelvis, and vertebrae show multiple small osteolytic lesions. Which of the following is the most probable sequella for this patient’s condition?
   A: Degenerative joint disease
   B: Renal failure
   C: Diabetes
   D: Rheumatoid arthritis
   E: Becker muscular dystrophy
   F: Aneurysmal bone cysts

Answer 9

Renal failure

Question 10

Which of the following observations is the most diagnostically relevant characteristic in the radiograph?
A: Soap bubble appearance
B: Location of the lesion extending into the epiphyseal region
C: Intact cortex
D: Radiolucent lesions

Answer 10

Location of the lesion extending into the epiphyseal region

Question 11

11. Part 1. You start seeing a new patient, Andy, who is a 30-year-old male. Andy never had medical insurance and hasn’t seen a physician since he was a child. Andy says that he has been experiencing stiffness and pain in his back for years. He says the pain started in his lower back, but has been getting progressively worse. He finally decided to seek a doctor’s advice because he noticed less flexibility in his spine, which is starting to alter some of his activities of daily living. You notice that his He says the pain is fairly severe in the morning, but gets a bit better during the day. More recently, he has noticed pain in his feet as well. You ask if he has had a history of gastrointestinal issues and he reports that he has not. What is the most likely diagnosis for Andy?
    A: Psoriatic arthritis
    B: Rhemuatoid arthritis
    C: Ankylosing spondylitis
    D: Enteropathic arthritis

Answer 11

Ankylosing spondylitis

Question 12

12. Part 2. You start seeing a new patient, Andy, who is a 30-year-old male. Andy never had medical insurance and hasn’t seen a physician since he was a child. Andy says that he has been experiencing stiffness and pain in his back for years. He says the pain started in his lower back, but has been getting progressively worse. He finally decided to seek a doctor’s advice because he noticed less flexibility in his spine, which is starting to alter some of his activities of daily living. You notice that his He says the pain is fairly severe in the morning, but gets a bit better during the day. More recently, he has noticed pain in his feet as well. You ask if he has had a history of gastrointestinal issues and he reports that he has not. What lab result would help confirm your diagnosis for this patient?

Answer 12

HLA B27 positive

Question 13

You are providing supportive care to a local high school soccer team. One of the players, a 17 year-old boy, reports pain and swelling in his right knee. He says he hasn’t been experiencing the pain that long, but its getting worse. He explains that it feels like its deep in his leg, just below the knee, and it is keeping him awake at night. He reported using NSAIDs, but they don’t seem to be helping long term. When you asked if he has had any recent injuries he says no. What is the most likely diagnosis for this patient?
A: Chondromalacia patella
B: Osteosarcoma
C: Osteochondroma
D: Enteropathic arthropathy

Answer 13

Osteosarcoma

Question 14

This question is worth 2 points. Make sure to answer both parts of the question. Name 2 pathologies that typically produce the type of ankylosis seen in the radiograph below.

Answer 14

Psoriatic Arthritis
Ankylosing Spondylitis (also Enteropathic Spondylitis)

Question 15

What is the name for the radiolucent lesions visible on the humeral head in the radiograph below showing a case of noniflammatory joint disease. __1__

Answer 15

Subchondral cyst

Question 16

What non-pharmacological treatments would you recommend for the patient with the radiograph below showing degenerative joint disease?

Answer 16

Chiropractic care with soft tissue work.

Question 17

A 25-year old female presents with pain and stiffness in both hands. Examination of her hands demonstrates subluxations of the metacarpal phalangeal and interphalangeal joints but the patient is able to extend these joints with normal joint alignment when they exert downward pressure. A radiograph also shows no lytic changes in the joints. Based solely on this information, what is the most likely diagnosis for this patient? __1__

Answer 17

Systemic Lupus Erythematosus

Question 18

18. Part 1. The radiograph below depicts osteolytic lesions in the foot due to gout. What causes the osteolytic response observed in this condition? __1__

Answer 18

uric crystal deposits

Question 19

19. Part 2. The radiograph below depicts an osteolytic lesion in the foot due to gout. What term would you use to describe the osteolytic lesion indicated by the blue arrow based on its location?
    A: Periarticular erosion
    B: Marginal erosions
    C: Intraosseous erosions
    D: Mouse ear deformity

Answer 19

Periarticular erosions

Question 20

Your clinician hands you the radiograph below and asks you to examine the changes at the distal interphalangeal joint. What terminology would you use to describe the reactive bone formation surrounding the marginal erosion?

Answer 20

Fluffy periostitis OR mouse ear deformity (psoriatic arthritis)

Question 21

In the image below, the green arrow indicates the fusion of intervertebral joints in the thoracolumbar spine due to the formation of ______________, which are ossified or calcified annular intervertebral disk fibers.
A: Syndesmophytes
B: Osteophytes
C: Periarticular ossifications
D: Annular fibrosis

Answer 21

Syndesmophytes

Question 22

You have a patient who suffers from degenerative joint disease. Which of the following would most likely describe this patient’s pain?
A: Constant deep achy pain
B: Sharp anterior knee pain
C: Deep achy pain that may be worse with activity
D: No pain but obvious joint destruction present on a physical exam or radiograph

Answer 22

Deep achy pain that may be worse with activity

Question 23

This questions has two blanks. Make sure you choose the answer choice below that answers both blanks correctly in the order presented in the answer choice. During the pathogenesis of degenerative joint disease bony projections growing off the bone are called ____________________. These typically start developing __________________.
A: osteophytes; at the joint margins
B: syndesmophytes; at the joint margins
C: osteophytes; on the articular cartilage
D: syndesmophytes; on the subchondral bone

Answer 23

osteophytes; at the joint margins

Question 24

Which of the following best describes the pathology depicted in the gross specimen in the image below?
A: Benign
B: Malignant
C: Cyst
D: Non-inflammatory

Answer 24

malignant

Question 25

Choose the answer that completes the sentence correctly. A primary osteosarcoma is a primarily ____________ growth, which will appear _______________ on radiographs. A: Osteoblastic; radiopaque B: Osteoblastic; radiolucent C: Osteolytic; radiopaque D: Osteolytic; radiolucent

Answer 25

osteoblastic; radiopaque

Question 26

Which of the following terms best describes the appearance of an aneurysmal bone cyst on a radiograph? A: Multilocular B: Unilocular C: Non-expansile D: Eucentric

Answer 26

multilocular

Question 27

Which of the following will present as a primarily radiolucent lesion? A: Primary osteosarcoma B: Osteoma C: Osteophyte D: Enchondroma

Answer 27

enchondroma

Question 28

Which term best describes the neoplastic growth depicted in the image below near the distal femur metaphysis? A: Pedunculated B: Sessile C: Tuberous D: Malignant E: Eucentric

Answer 28

pedunculated

Question 29

Type I muscle fiber types will have more ____________ compared to Type II muscle fiber types. A: Numerous mitochondria B: Fast conduction motor neurons C: SR pumping capacity D: Contraction speed

Answer 29

numerous mitochondria

Question 30

Becker Dystrophy is most likely to effect ___________. A: Intrafusal fibers B: Extrafusal fibers C: Type II fibers D: Permeative fibers

Answer 30

Extrafusal fibers

Question 31

Your patient Gina mentions that her son, who is 3-years-old is demonstrating difficulty standing, walking, and sometimes even crawling. She states that his limbs have always looked a little thin compared to other children his age but didn't think that was too abnormal until his recent difficulties. You suggest ordering blood work for the child and it returns with elevated levels of creatine kinase but normal c-reactive protein. A histological tissue section also demonstrates that multiple muscles in the body show progressive necrosis and fibrosis, primarily involving Type I muscle fibers. What is the most likely etiology of the child's condition? A: Autoimmnue disorder B: Tau inclusions in the cytoplasm of cells C: Denervation D: Gene mutation causing decreased dystrophin production

Answer 31

gene mutation causing decreased dystrophin production

Question 32

Which of the following terms best describes the appearance of the lesion in the image below? A: Eccentric B: Eucentric C: Metaphyseal D: Expansile

Answer 32

eucentric

Question 33

What type of tissue is indicated by the purple arrow in this histological tissue section of an osteochondroma? A: Cartilage B: Bone C: Fibrous tissue D: Fibrofatty infiltrate

Answer 33

cartilage

Question 34

You are handed a file in clinic with no associated information for the case. Immediately you notice that the radiograph shows a mixed osteolytic and osteoblastic response in both os coxae and the left femur. You also notice increased cortical thickness and coarsening of the trabeculae in the left femur with no evidence for periosteal or soft tissue involvement. Which of the following pathologies is most likely? A: Paget's Disease B: Primary Osteosarcoma C: Multiple myeloma D: Acute Osteomyelitis E: Monostotic Fibrous Dysplasia

Answer 34

Paget's disease

Question 35

You have a 35-year-old female patient who you suspect is suffering from lupus. She frequently experiences a rash on the palms of her hands and face, under her eyes and over the bridge of her nose. Her symptoms and rash are often worse after UV exposure. Which of the following is most likely the cause of this patient's rash? A: Necrotizing vasculitis B: Keratin overproduction C: Dermatomyositis D: Keratoderma blennorrhagica

Answer 35

necrotizing vasculitis OR dermatomyositis

Question 36

What skeletal muscle structure comprising a bundle of muscle fibers is indciated by #4 in the image below? A: Myofibril B: Fascicle C: Endomyseum D: Sarcolemma

Answer 36

fascicle

Question 37

You see a 63-year old female patient for back pain. While taking her history, you learn that she was diagnosed with rheumatoid arthritis approximately 30 years previously and has been managing her condition well with disease modifying drug therapy and lifetyles changes. You note for her appointment states that she is experiencing back pain but does not give any additional details. Which of the following regions is most likely to be affected by her existing diagnosis? A: Cervical region B: Sacroiliac region C: Lumbar region D: Thoracolumbar region

Answer 37

Cervical region

Question 38

You have a 65-year old male patient named Jim that you have been treating for the past 3 years. Recently, Jim has asked to see you more frequently as he states that he doesn't receive as much relief from his adjustments. You tell Jim that you would like to take a new set of images just to verify that there haven't been any changes to the area you are treating. On the radiograph, you notice that L3, L4, and L5 all have portions of the vertebral bodies that are not visualized. Intervetebral disk height is maintained for all lumbar vertebrae. L3, L4, and L5 all have lytic areas with cortical disruption. Which of the following terms best describes this presentation? A: Osteosarcoma B: Benign C: Non-aggressive D: Aggressive

Answer 38

aggressive

Question 39

You are providing supportive care to a local high school soccer team. One of the players, a 17 year-old boy, reports pain and swelling in his right knee. He says he hasn't been experiencing the pain that long, but its getting worse. He explains that it feels like its deep in his leg, just below the knee, and it is keeping him awake at night. He reported using NSAIDs, but they don't seem to be helping long term. When you asked if he has had any recent injuries he says no. Which of the following would you most likely observe on a radiograph of this patient's right knee? A: Short Zone of Transition B: Long Zone of Transition C: Intact cortex D: Unremarkable findings

Answer 39

Long zone of transition

Question 40

Which of the following is a true statement about Osteochondromas? A: They will grow toward the joint B: They will grow away from the joint C: There are two forms pedicled and surreal D: They will generally elicit pain E: More than 3 is consistent with the multiple hereditary exostosis

Answer 40

they will grow away from the joint

Question 41

What pathology is generally associated with the type of ankylosis shown in the radiograph below?

Answer 41

rheumatoid arthritis

Question 42

42. Part 1. A new patient arrives to the clinic. Sam is a 36-year-old male who presents with pain and swelling in both hands. He explains that the pain is fairly constant and he sometimes has difficulty performing tasks due to the pain and stiffness in his fingers. He also explains that he has been feeling extremely tired lately and is having difficulty staying focused at work. He states that the pain started several months ago but things have gotten progressively worse in the past month. When you take his temperature you notice a slight fever. You ask if he remembers seeing a rash or having any digestive issues and he says that he hasn't noticed anything since his symptoms began. Which of the following best describes the pathogenesis of the disease associated with this patient's condition? A: Damage to articular cartilage leading to inflammation in the joint B: Immune complexes directed at joint tissues lead to pannus formation and the erosion of joint structures C: Crystals accumulating in the joints are being broken down by neutrophils and macrophages resulting in inflammation and the erosion of joint structures D: A bacterial infection in the joint prompts synovitis and erosion of the joint structures

Answer 42

immune complexes directed at joint tissues lead to pannus formation and the erosion of joint structures

Question 43

43. Part 2. A new patient arrives to the clinic. Sam is a 36-year-old male who presents with pain and swelling in both hands. He explains that the pain is fairly constant and he sometimes has difficulty performing tasks due to the pain and stiffness in his fingers. He also explains that he has been feeling extremely tired lately and is having difficulty staying focused at work. He states that the pain started several months ago but things have gotten progressively worse in the past month. When you take his temperature you notice a slight fever. You ask if he remembers seeing a rash or having any digestive issues and he says that he hasn't noticed anything since his symptoms began. What radiographic finding would best support your diagnosis? A: Osseous ankylosis of the interphalangeal and metacarpalphalangeal joints B: Juxta-articular osteoporosis at the interphalangeal and metacarpalphalangeal joint margins C: Reversible subluxations in the interphalangeal and metacarpalphalangeal joints D: Osteophyte formation at the interphalangeal and metacarpalphalangeal joint margins

Answer 43

Juxta-articular osteoporosis at the intherphalangeal and metarcarpalphalangeal joint margins

Question 44

One of your patients, a 57-year-old male named John, has been receiving regular adjustments once a month for several years. You haven't seen him in over a year due to COVID and the more recent increased workload he is experiencing at his restaurant due to staffing shortages. He reports back pain and states that he has been feeling exhausted lately, but assumes its related to the additional hours at the restaurant. In the past few weeks, though, he has really had difficulty managing the business. You notice that he has lost about 15 lbs. since you last saw him. When you ask him about it he says, "I know, I can't figure it out. With all the stress, I am eating more lately if anything." You gather bloodwork and radiographs. The blood work shows that he is slightly anemic. The radiographs of his skull, pelvis, and vertebrae show multiple small osteolytic lesions. What additional laboratory finding would provide the greatest evidence to help confirm your diagnosis?

Answer 44

Bence Jones Protein

Question 45

This question is worth 2 points. Make sure to answer both questions. A 46-year old female patient presents with altered gait and swelling in their right knee. An examination reveals that the patient demonstrates a lack of sensation when the affected area is stimulated. Using the characteristic terminology specific for this disease process, name 2 radiographic observations that could be used to describe the impacts to bone observed in the radiograph below. __2__

Answer 45

decreased joint space; osteoclastic activity [Destruction, Dislocation, Debri, Distension, Disorganization, Density (subchondral sclerosing)]

Question 46

A new patient arrives to the clinic. Sam is a 36-year-old male who presents with pain and swelling in both hands. He explains that the pain is fairly constant and he sometimes has difficulty performing tasks due to the pain and stiffness in his fingers. He also explains that he has been feeling extremely tired lately and is having difficulty staying focused at work. He states that the pain started several months ago but things have gotten progressively worse in the past month. When you take his temperature you notice a slight fever. You ask if he remembers seeing a rash or having any digestive issues and he says that he hasn't noticed anything since his symptoms began. Which of the following is a potential sequela for Sam's condition? A: Tenosynovitis B: Renal failure C: CPPD D: Chondrosarcoma

Answer 46

tenosynovitis

Question 47

47. Part 1. A new patient, Jim, presents with low back pain. Jim is a 25-year-old male states that his pain started several months ago and has been getting progressively worse. Lately, he is noticing less flexibility in his low back and more recently, he has been experiencing pain in his right knee. When asked about his medical history he reports a recent urinary tract infection, a humerus fracture that occurred 10 months ago, and a severe gastrointestinal infection several months ago. He reports that all of these issues have since been resolved. Which of the following is the most likely potential sequela of Jim's condition? A: Tenosynovitis B: Rhemuatoid arthritis C: Systemic Lupus Eyrathematosus D: Renal failure E: Conjuntivitis

Answer 47

conjunctivitis

Question 48

48. Part 2. A new patient, Jim, presents with low back pain. Jim is a 25-year-old male states that his pain started several months ago and has been getting progressively worse. Lately, he is noticing less flexibility in his low back and more recently, he has been experiencing pain in his right knee. When asked about his medical history he reports a recent urinary tract infection, a humerus fracture that occurred 10 months ago, and a severe gastrointestinal infection several months ago. He reports that all of these issues have since been resolved. What is the most likely diagnosis for Jim? A: Psoriatic arthritis B: Rhemuatoid arthritis C: Ankylosing spondylitis D: Reiter's syndrome E: Enteropathic arthritis

Answer 48

Reiter's syndrome

Question 49

The osteoblastic activity indicated by the arrow is indicative of changes associated with which pathology? A: Chondromalacia patella B: Degenerative joint disease C: Ankylosing spondylitis D: Osteosarcoma E: Acute osteomyelitis F: Osteoma

Answer 49

degenerative joint disease

Question 50

A 65-year-old man diagnosed with Paget's disease presents with an increased amount of Type I collagen biproducts and elevated alkaline phosphatase in his blood. What does this indicate about the patient's case? A: The patient is in Stage 2 of the disease process B: The patient is in Stage 1 of the disease process C: The patient is in Stage 3 of the disease process D: The patient is in remission

Answer 50

the patient is in stage 2 of the disease process

Question 51

A 5-year-old presents with upper right thigh pain. The parents explain that the child has been experiencing pain for the past several months. You don't notice any abnormalities in your physical exam and the parents explain that none of the child's previous exams have produced abnormal findings either. A radiograph is taken and shows a radiolucent area measuring 1 cm in diameter that is surrounded by a sclerotic border. Given the lesion’s size and appearance, you and your colleagues suggest that the patient be given a regimen of NSAIDs (aspirin) and this helps relive the patient’s pain. Which of the following best describes why NSAIDs relive the patient's pain? A: The NSAIDs stop the accumulation of serous fluid causing expansion of this lesion, which relieves the patient's pain. B: The lesion contains an overproliferation of vasculature. Elevated PGE2 levels cause vasodilation which results in increased pain. The NSAIDs afftect the COX pathway causing vasoconstriction and pain relief. C: The NSAIDs stop osteogenesis controlling the growth of the lesion. D: The lesion is caused by the proliferation of abnormal plasma cells. The NSAIDs reduce inflammation leading to necrosis of the plasma cells.

Answer 51

The lesion contains an overproliferation of vasculature. Elevated PGE2 levels cause vasodilation which results in increased pain. The NSAIDs afftect the COX pathway causing vasoconstriction and pain relief.

Question 52

What is used as a common route for hematogenous metastatic spread? A: Vertebral arteries B: Saphenous system C: Lymphatic spread D: Batson's Venus Plexus

Answer 52

Batson's Venus Plexus