Hematopoietic, Endocrine, Metabolic, and Nutritional Disorders I & II Flashcards by Jojo Barnes-Jones

In a patient with eosinophilic granuloma, what does a radiodense focus within a lytic cranial lesion represent?

a. target lesion
b. button sequestrum
c. rain-drop skull
d. geographic skull

b. button sequestrum

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Periosteal new bone formation in thyroid acropachy is most commonly seen in which bones?

a. radius and ulna
b. tibia and fibula
c. metacarpals and metatarsals
d. femur and humerus

c. metacarpals and metatarsals

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A middle-aged man on long-term hemodialysis complains of moderate low-back pain, which began insidiously several months ago. Lumbar spine radiographs taken four weeks ago were essentially unremarkable, but a new set of radiographs demonstrates loss of the L2/3 and L3/4 disc spaces, with endplate destruction, reactive subchrondral sclerosis, and bony spurring and fragmentation. The patient’s white blood cell count and erythocyte sedimentation rate are within normal limits. These findings are consistent with?

a. infectious spondylitis due to hemodialysis
b. destructive spondyloarthropathy of hemodialysis
c. amyloidosis
d. Metastatic disease from an unknown primary tumor

b. destructive spondyloarthropathy of hemodialysis

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Although a certain degree of subperiosteal resorption may be seen with disease causing high bone turnover, when extensive, it is pathognomonic for which disorder?

a. osteoporosis
b. osteopenia
c. osteomalacia
d. osteoclastoma

b. osteopenia

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Which of the following disorders has a pathogensis similar to Osgood-Schlatter’s disease and may coexist with it?

a. Blount’s disease
b. osteoochodritis dissecans
c. Sinding-Larsen-Johnansson disease
d. spontaneous osteone of the knee (SONK)

c. Sinding-Larsen-Johnansson disease

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The radiographic finding of increased radiolucency of bone is best termed?

a. osteoporosis
b. osteopenia
c. osteomalacia
d. osteoclastoma

b. osteopenia

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Although a certain degree of subperiosteal resorption may be seen with disease causing high bone turnover, when extensive, it is pathognomonic for which disorder?

a. osteoporosis
b. hyperparathyroidism
c. reflex sympathetic dystrophy syndrome
d. osteogenesis imperfecta

b. hyperparathyroidism

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Which of the following best describes the distribution in individual bones of periosetal new bone formation in thyroid acropachy?

a. generally symmetric
b. diaphyses are most involved
c. more prominent on the ulnar aspect
d. the distribution is completely unpredictable

b. diaphyses are most involved

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Which of the following is a common finding in the spine in patients with acromegaly?

a. posterior osteophyte formation
b. disc calcification
c. marginal syndesmophytes, similar to those seen in ankylosing sponylitis
d. posterior scalloping

d. posterior scalloping

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The most common causes of generalized osteoporosis are senescent osteoporosis and…

a. hyperparathryoidism
b. osteogenesis imperfecta
c. postmenopausal osteoporosis
d. multiple myeloma

c. postmenopausal osteoporosis

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In osteomalacia, radiolucent areas oriented at right angles to the cortex, which incompletely span the diameter of the bone, represent what?

a. Fatigue fractures
b. Losers lines
c. Greenstick injuries
d. Harris lines

b. Losers lines

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In which location within bone is conversion of bone marrow from fatty to red marrow considered unusual, at any age after the first few months of life?

a. femoral neck
b. base of the skull
c. apophyses or epiphyses
d. vertebral bodies

c. apophyses or epiphyses

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Where is Thiemann’s osteochondrosis found?

a. fifth metatarsal base
b. ischiopubic sychondrosis
c. tarsal navicular
d. phalangeal bases

d. phalangeal bases

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In magnetic resonance imaging of osteonecrosis of the femoral head, which of the following is a specific indicator of ischemic necrosis of the femoral head?

a. double-line sign
b. snowcap appearance
c. cresent sign
d. sagging-rope sign

a. double-line sign

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Flattening and sclerosis of the 3rd metatasal head, with enlargement and irregularity of the base of the proximal phalanx, is an osteonecrosis most commonly seen in?

a. adolescent males
b. adult males
c. adolescent females
d. adult females

c. adolescent females

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What is the fundamental morphologic abnormality that leads to arthritic compliants in patients with acromegaly?

a. increased tendency of the subchondral bone to fracture
b. capsular laxity leading to joint instability
c. overgrowth of cartilage with a more fragile ground substance matrix
d. a marked tendency to calcuim pyrophosphate dihydrate crystal deposition (CPPD)

c. overgrowth of cartilage with a more fragile ground substance matrix

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In addition to vertebra plana, how may eosinophilic granuloma present in the spine?

a. ivory vertebra
b. band-like radiolucencies
c. soap-bubbly
d. diffuse osteopenia

c. soap-bubbly

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Which of the following neoplasms is most frequently found to lead to oncogenic osteomalacia, as determined by histological analysis?

a. non-ossifying fibroma
b. hemangiopericytoma
c. giant cell tumor
d. hemangioendothelioma

b. hemangiopericytoma

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Although any area of the skelton can be used when evaluating cortical bone loss in metabolic bone disease, which bones are usually investigated?

a. the proximal femur
b. the tubular bones of the hand
c. the lumbar spine
d. the calcaneus

b. the tubular bones of the hand

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What is the cause of Legg-Calve-Perthes disease?

a. osteonecrosis
b. epiphysis
c. dysplasia
d. physeal osteochondritis

a. osteonecrosis

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The ______ is a thin layer of connective tissue that lines the inside of the cortex and the surface of the medullary cavity.

a. Periosteum
b. Endosteum
c. Parenchyma
d. Mesenchyme

b. Endosteum

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Which type of thalassemia affects the fetus?

a. alpha-thalassemia
b. beta-thalassemia
c. thalassemia minor
d. thalassemia intermedia

a. alpha-thalassemia

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Which of the following findings hypervitaminosis D is characteristic of adults rather than children?

a. alternating dense and lucent metaphyseal bands
b. cortical thickening due to periosteal apposition
c. widespread osteosclerosis
d. massive soft tissue calcification

d. massive soft tissue calcification

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The radiographic finding of transverse radiolucent metaphyseal line (“scurvy line”) seen in scurvy corresponds to which of the following pathologic/structural abnormalities of the affected bone:

a. thickened zone of provisional calcification
b. Trummerfield zone
c. a fracture through the metaphyseal area
d. a region of osteoclast proliferation

b. Trummerfield zone

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Which of the following nuclear machine findings serves to rule out, or at least decrease the profitability of, post-traumatic osteonecrosis of the scapnoid? a. decreased radiotracker uptake at the distal scaphoid pole b. increased radiotracker uptake at the distal scaphoid pole c. decreased radiotracker uptake at the proximal scaphoid pole d. increased radiotracker uptake at the proximal scaphoid pole

d. increased radiotracker uptake at the proximal scaphoid pole

What is the pathologic basis for secondary hyperparathyroidism? a. parathyroid adenoma b. long-standing hypocalcemia leading to parathyroid hyperplasia c. autonomously hyperfunctioning parathyroid glands d. parathyroid carcinoma

b. long-standing hypocalcemia leading to parathyroid hyperplasia

What is the name of the radiographic sign given to the appearance created by enlargement and elongation of the mandible in acromegaly? a. rodent facies b. overbite c. leonine facies d. lantern jaw

d. lantern jaw

When a child presents with unexplained diffuse osteopenia and bilateral metaphyseal radiolucent bands, your primary diagnosis should be ________ until proven otherwise? a. Osteoporosis b. Multiple myeloma c. Leukemia d. Lymphoma

c. Leukemia

Which of the following allows differientiation between reflex sympathetic dystrophy and a primary articular disorder such as rheumatoid arthritis? a. absence of periarticular osteopenia in RSD b. the bilateral and symmetric nature in RSD c. absence of intra-articular erosions in rheumatoid arthritis d. preservation of joint space in RSD

d. preservation of joint space in RSD

What is the eponym for post-traumatic osteonecrosis of the vertebral bodies, leading to delayed collaspe and a painful kyposis? a. Scheuermann's disease b. Schmorl's disease c. Junghann's disease d. Kummel's disease

d. Kummel's disease

In addition to many other complications, patients with small bowel malabsorptive states such as sprue or regional enteritis, are at risk for which of the following deficiencies? a. scurvy b. hypovitaminosis D c. hypovitaminosis A d. iron deficiency anemia

b. hypovitaminosis D

In rickets, there is deficient mineralization of the zone of provisional calcification, which eventually becomes radiolucent and irregular with progression of the disease. This leads to which of the following radiographic findings? a. widening of the growth plate b. fraying of the metaphysis c. cupping of the metaphysis d. increased radiodensity of the metaphysis

b. fraying of the metaphysis

Subperiosteal resorption of cortical bone at the medial aspect of the proximal may be seen in hyperparathyroidism, as well as in another disease process, in which it is known as what sign? a. Frostberg's sign b. Waldenstrom's sign c. Wimberger's sign d. Hawken's sign

c. Wimberger's sign

Which of the following radiographic findings is suggestive ischemic necrosis of the vertebral body? a. patchy osteosclerosis b. a central depression at the vertebral linear endplates c. an irregular intravertebral linear radiolucency d. a completely flat compression of the vertebral body (vertebra plana)

c. an irregular intravertebral linear radiolucency

After what age does the gender difference in the frequency of osteoporosis disappear? a. after the female menopause b. after the male mid-life crisis c. after 50 years of age d. after 80 years of age

d. after 80 years of age

What distinguishes stress fractures seen with overuse of normal bone from pseudofractures of osteomalacia? a. bilateral and symmetric distribution b. presence of callus formation c. location within bone (perpendicular to cortex) d. parallel margins showing mild to moderate sclerosis

b. presence of callus formation

Which of the following is commonly associated with negative ulnar variance? a. Preiser's disease b. Panner's disease c. Keinbock's disease d. Iselin's disease

c. Keinbock's disease

The cortical thickening seen in hypervitaminosis A occur in which region of tubular bones? a. epiphysis b. metaphysis c. diaphysis d. apophyses

c. diaphysis

Which of the following classes of drugs are particularly known to lead to osteomalacia? a. non-steroidal anti-inflammatories b. hormone-replacement therapy c. anticonvulsants d. intravenous contrast agents

c. anticonvulsants

Which of the following disorders was first noted in women during the first trimester of pregnancy is now known to occur in either gender and all ages groups causes spontaneous and sometimes severe hip pain without history of trauma or inflection and generally resolves within 3 months to one year? a. regional migatory osteoporosis b. reflex sympathetic dystrophy c. transient osteoporosis of the hip d. partial transient osteoporosis

c. transient osteoporosis of the hip

What is the name of the radiographic sign in scurvy, created by an epiphyseal shell of increased density with a central lucency? a. Pelken's sign b. Waldenstrom's sign c. Wimberger's ring epiphysis d. Trummerfeld sign

c. Wimberger's ring epiphysis

In quantitative bone material analysis, why is trabecular (cancellous) bone preferred to cortical (compact) bone for accurate analysis? a. trabecular bone is more easily accessible for analysis b. the high rate of metabolic turnover trabecular bone makes it more responsive to metabolic stimuli c. the skeleton is mainly composed of tracecular bone which makes analysis more accurate d. quantitative bone mineral analysis is performed on cortical bone, not trabecular bone

b. the high rate of metabolic turnover trabecular bone makes it more responsive to metabolic stimuli

In which physeal layer does the cartilaginous column became calcified? a. zone of undifferentiated cartilage cells b. zone of proliferating cartilage c. zone of hypertrophic cells (maturation zone) d. zone of provisional calcification

d. zone of provisional calcification

How is the alignment alteration seen in Blout's disease best described? a. acute varus angulation of the femur with respect to the tibia b. acute inward angulation of the tabia just below c. acute valgus angulation of the tabia respect to the femur d. acute posterior angulation of the tabia just below the knee

b. acute inward angulation of the tabia just below

Which of the following terms best describes the condition that occurs when a decrease in bone mass is greater than that expected for a person of a given age, sex, and race, and which results in structural bone failure manifested by fractures? a. osteoporosis b. osteopenia c. osteomalacia d. osteoclastoma

a. osteoporosis

Where is the most frequent site of bone infarction in sickle cell anemia? a. proximal humerus b. distal femur c. proximal femur d. proximal tibia

c. proximal femur

Which of the following is the most common cause of endogenous Cushing's disease? a. adrenal adenoma b. anterior pituitary neoplasm c. adrenal hyperplasia d. ectopic adrenal tissue

c. adrenal hyperplasia

Name the best radiographic projection to identify scaphoid fractures. a. PA Wrist b. PA Hand c. Medial Oblique Wrist d. PA Wrist with ulnar deviation

d. PA Wrist with ulnar deviation

The squared configuration of the skull due to accumulation of osteoid in the frontal and parietal regions of the skull in rickets is known as... a. triphyllocephaly b. craniostenosis c. caput succedaneum d. craniotabes

d. craniotabes

Which of the following is a typical feature of Gaucher's disease? a. Arachnodactyly b. Scoliosis c. Aortic dissection d. Erlenmeyer flask deformity

d. Erlenmeyer flask deformity

The osteoporosis seen in Cushing's disease resembles which other form of osteoporosis? a. osteoporosis of immobilization b. postmenopausal or senile osteoporosis c. regional migratory osteoporosis d. reflex sympathetic distrophy

b. postmenopausal or senile osteoporosis

The "rachitic rosary" is most commonly seen at the costochondrial junctions of which ribs? a. the upper ribs b. the middle ribs c. the lower ribs d. at all costochondrial junctions

b. the middle ribs

Osteonecrosis due to pancreatitis most commonly involves the femoral head and which other area? a. small bones of the hands and feet b. humeral head c. talus d. vertebral bodies

b. humeral head

Wrist radiographs of a 20 year old male patient with hyperparathyroidism reveal a large lucent lesion with well-defined margins and internal septations, eccentrically located near the subarticular region of the distal radius. The most likely diagnosis is? a. giant cell tumor b. aneurysmal bone cyst c. osteoclastoma d. fibrous cortical defect

c. osteoclastoma

Patients with sickle cell anemia demonstrate an unusual propensity which of the following infections? a. Meningococcemia b. Brucella c. Klebsiella d. Salmonella

d. Salmonella

Which of the following findings is less commonly seen in Thalassemia? a. "hair-on-end" skull b. rodent facies c. H-vertebrae d. Erlenmeyer flask deformity

c. H-vertebrae

Which of the following radiographic manifestations is particularly helpful in the diagnosis of lead poisoning in children? a. multiple dense metaphyseal lines in a single bone b. vertical striations within the metaphysis c. overtubulation of the femora (long, gracile-appearing bones) d. dense metaphyseal lines at the proximal fibula

d. dense metaphyseal lines at the proximal fibula

What is a common feature of skull lesions in eosinophilic granuloma due to non-uniform growth of the lesion? a. surrounding sclerosis b. soft tissue mass c. beveled edges d. extension across sutures

c. beveled edges

Of the following articulations, which one is most frequently involved in hemophilia? a. knee b. cervical spine c. hip d. wrist

a. knee

Which of the following are common associated imaging findings in transient osteoporosis of the hip? a. loss of joint space b. joint effusions c. abnormal signal intensity in the acetabulum d. abnormal signal intensity in the ipsilateral knew

b. joint effusions

How is the general osseous pathology of thalassemia represented on radiographs? a. widespread osteosclerosis and obliteration of the marrow spaces b. osteoporosis, widened medullary spaces and coarsened trabecular pattern c. severe osteopenia and multiple fractures in various stages of healing d. short, bowed tubulkar bones and multiple vetrebral abnormalities

b. osteoporosis, widened medullary spaces and coarsened trabecular pattern

On magnetic resonance imaging, what is the appearance of post-traumatic osteonecrosis of the scaphoid? a. decreased signal intensity on T1, proton, and T2-weighted imaging sequences b. increased signal intensity on T1 and proton-density weighted sequences, decreased signal intensity on T2 c. increased signal intensity on T1 , proton, and T2-weighted imaging sequences d. decreased signal intensity on T1 and proton-density weighted sequences, decreased signal intensity on T2

d. decreased signal intensity on T1 and proton-density weighted sequences, decreased signal intensity on T2

Which of the following radiographic abnormalities is not an integral part but rather an associated finding in Scheuermann's disease? a. anterior vetrebral body wedging leading to kyphosis b. cartilaginous node formation c. loss of intervertebral disc height d. scoliotic curvature at the same level as the kyphosis

d. scoliotic curvature at the same level as the kyphosis

At which of the following joints is subchondral bone resorption seen most commonly with hyperparathyroidism? a. sacroiliac b. sternoclavicular c. acromioclavicular d. symphysis pubis

a. sacroiliac

What percentage of Langerhans Cell Histiocytosis is made up eosinophilic granuloma? a. 5% b. 20% c. 50% d. 70%

d. 70%

Step-like central depression of the vertebral endplates is a characteristic finding of Sickle cell anemia and A. Gaucher’s disease B. Osteogenesis Imperfecta C. Schuermann’s disease D. Thalassemia minor E. Osteoporosis (Resnick, pg. 1818 Vol.3)

D. Thalassemia minor

Osteonecrosis following renal transplantation commonly involves what anatomical structure? A. Metacarpal head B. Metatarsal head C. Femoral epiphysis D. Humeral epiphysis E. Lunate (Resnick, pg. 2096 Vol. 3)

C. Femoral epiphysis

The mother of a pediatric patient is concerned that her toddler has had an allergic reaction due to his hands swelling up a week ago. She does not understand how this could have occurred because he has not been outside due to the freezing temperatures. Radiographs revealed circumferential periosteal elevation, subperiosteal new bone formation, and multiple patchy radiolucent foci distributed throughout the shafts of the metacarpals. This combination of findings is highly suggestive of which diagnosis? A. Tuberculosis B. Hand-foot syndrome C. Yaws D. Small pox E. Leukemia (Resnick, pg. 2151 Vol 3)

B. Hand-foot syndrome

The mother of a pediatric patient is concerned that her toddler has had an allergic reaction due to his hands swelling up a week ago. She does not understand how this could have occurred because he has not been outside due to the freezing temperatures. Radiographs revealed circumferential periosteal elevation, subperiosteal new bone formation, and multiple patchy radiolucent foci distributed throughout the shafts of the metacarpals. What clinical information is relevant in determining the patient may most likely have sickle cell anemia? A. The patient is of Mediterranean heritage. B. The patient is of Jewish heritage. C. The patient is of African heritage. D. The patient is of Chinese heritage E. The patient is of Irish heritage. (Resnick, pg. 2151 Vol 3)

C. The patient is of African heritage.

According to Resnick, a serious and common complication of sickle cell anemia patients is A. prostration B. soft tissue swelling C. acute chest syndrome D. dactylitis E. fever (Resnick, pg. 2149 Vol 3)

C. acute chest syndrome

The only facial bone involved in sickle cell anemia is A. the ethmoid. B. the temporal bone. C. the inferior nasal concha. D. the sphenoid. E. the mandible. (Resnick, pg. 2150 Vol 3)

E. the mandible.

The snow-capped appearance in long tubular bones is most commonly seen in the A. the radius. B. the distal tibia. C. the distal humerus D. the proximal humerus. E. the distal ulna. (Resnick, pg. 2154 Vol 3)

D. the proximal humerus.

Extensive thickening of the cranial vault associated with marked diploic expansion and hair-on-end appearance is most commonly seen in A. hemoglobin-C disease. B. hemolytic Anemia C. spherocytosis D. thalassemia E. acromegaly (Resnick, pg. 2180 Vol 3)

D. thalassemia

A 4 year old male patient presents with diabetes insipidus and bilateral exophthalmos. Conventional radiographs of the skull reveal multiple lytic calvarial defects. What is the most likely diagnosis? A. Lymphoma B. Leukemia C. Letterer-Siwe Disease D. Eosinophilic Granuloma E. Han-Schuller-Christian Disease (Resnick, pg. 2264 Vol 3)

E. Han-Schuller-Christian Disease

A 3 year old male patient presents lymphadenopathy, fever, hepatosplenomegaly and purpuric skin lesions. Conventional radiographs of the skull reveal prominent lytic calvarial defects at the base of the skull and the mandible. What is the most likely diagnosis? A. Lymphoma B. Leukemia C. Letterer-Siwe Disease D. Eosinophilic Granuloma E. Hand-Schuller-Christian Disease (Resnick, pg. 2264 Vol 3)

C. Letterer-Siwe Disease

The hallmark finding commonly associated with spontaneous healing of patients with extraskeletal manifestations associated with Langerhan Histiocytosis is A. vertebral body remodeling B. sclerosis C. bony resorption D. density decrease E. undertubulation (Resnick, pg. 2264 Vol 3)

B. sclerosis

A conventional radiographic study of the bilateral hands of a 42 year old male demonstrates generalized osteopenia, digital clubbing and lytic destruction of the 2nd and 3rd metacarpals. He recently has been experiencing bouts of sternal pain and increasing tenderness. These findings are commonly seen in patients diagnosed with chronic leukemia. What is a well-known associated complication in such cases according to Resnick? A. Gouty arthritis B. Secondary gout C. CPPD D. SCM E. PVNS (Resnick, pg. 2294)

B. Secondary gout

The most common form of childhood malignancy is A. Hairy cell leukemia B. Osteosarcoma C. Lymphoma D. Acute Leukemia E. Cytomegalic inclusion disease (Resnick, pg. 2291 Vol 3)

D. Acute Leukemia

A 25 year old male presents with knee pain of 6 weeks duration. Radiographs demonstrated increased spacing of the intercondylar notch, bulbous enlargement of medial femoral condyle, periarticular osteopenia, and narrowing of the bilateral femorotibial joint spaces. This constellation of findings is concerning for which genetically linked pathology? A. Juvenile Idiopathic Arthritis B. Septic Arthritis C. Hemophilia Arthropathy D. Pigmented Nodular Villa Synov1itis E. Tuberculous Arthritis (Resnick, pg. 2351 Vol 3)

C. Hemophilia Arthropathy

Lunate malacia has an increased association with a shore ulna, which is also known as A. positive ulnar variance B. negative ulnar variance C. VISI D. DISI E. Tuberculous Arthritis (Resnick, pg. 3707 Volume 3)

B. negative ulnar variance

Which of the following conditions appears to share pathologic, clinical and radiologic features with Hand-Schuller-Christian disease, although it is uncommon disease process and the average patient is much older? A. Rosai-Dorfman disease B. Erdheim-Chester disaease C. Burkitt's lymphoma D. Malignant histiocytosis

B. Erdheim-Chester disease

Flattening and sclerosis of the 3rd metatarsal head, with enlargement and irregularity of the base of the phalanx, is an osteonecrosis most commonly seen in? A. Adolescent males B. Adult males C. Adolescent females D. Adult females

C. Adolescent females

Which of the following is common finding in children with thalassemia major? A. H-vertebrae B. Irregular vertical striations near the ends of the the long bones C. Multiple rib fractures D. Premature fusion of the epiphyses

D. Premature fusion of the epiphyses

What is the most common skeletal abnormality of hypoparathyroidism? A. Dense metaphyseal bands B. Osteoporosis C. Subcutaneous calcification D. Osteosclerosis

D. Osteosclerosis

Which bones are most commonly affected by osteomyelitis in sickle cell anemia? A. Facial bones B. Skull C. Long bones D. Vertebrae

C. Long bones

In addition to periostitis, what other radiographic findings are most often seen with chronic venous insufficiency? A. Soft tissue edema and ossification B. Lymphedema C. Osteoncrosis D. Osteomyelitis

A. Soft tissue edema and ossification

In acromegaly, what radiographic appearance may be created by the formation and approximation of osseous excrescences and enlargement of distal tufts and bases of the distal phalanges? A. Spade-like distal tufts B. Pseudoforamina C. Turret exostoses D. Bizarre parosteal osteochondromatous proliferation

B. Pseudoforamina

In myelofibrosis, fibrotic replacement of bone marrow is demonstrated by which of the following changes in signal intensity on standard spin echo magnetic resonance sequences? A. Increased T1 and decreased T2-weighted signal B. Decreased T1 and increased T2-weighted signal C. Increased T1 and T2-weighted signal D. Decreased T1 and T2-weighted signal

D. Decreased T1 and T2-weighted signal

Which of the following complications is surprisingly uncommon in Cushing's disease? A. Vertebral compression fractures B. Renal calculi C. Osteonecrosis D. Excessive callus formation

C. Osteonecrosis

Parathyroid hormone may have a direct effect on collagen or promote its enzymatic degradation, thus predisposing patients to capsular laxity and ligamentous instability. Which of the joints below are particularly vulnerable to this? A. PIP and DIP joints B. Glenohumeral joint C. Subtalar joint D. Acromioclavicular and sacroiliac joints

D. Acromioclavicular and sacroiliac joints

The "Salt and pepper skull" of hyperparathyroidsm is due to what pathologic process? A. Intracotical bone resorption B. Diploic bone resorption C. Bone marrow hyperplasia D. Trabecular bone resorption

D. Trabecular bone resorption

What is the pathologic basis of pseudohypoparathyroidism? A. Deficient secretion of parathyroid hormone B. Surgical removal of the parathyroid glands C. The presence of biologically ineffective parathyroid hormone D. Inability of end organs to respond to parathyroid hormone

D. Inability of end organs to respond to parathyroid hormone

Which disorder is described by the following paragraph: "osteolysis of the terminal phalanges of the hands with band-like radiolucencies across the waist of one or more terminal phalanges and tuftal resorption; affecting the thumb more frequently than other digits". A. post-traumatic acro-osteolysis B. Leprosy C. Multicentric reticulohistiocytosis D. Acro-osteolysis due to polyvinyl chloride toxicity

D. Acro-osteolysis due to polyvinyl chloride toxicity

Which facial bone is commonly involved in marrow hyperplasia in sickle cell anemia? A. Maxilla B. Mandible C. Occiput D. Zygoma

B. Mandible

The Erlenmeyer-flask deformity may be seen, among others, in Gaucher's disease, Pyle's disease, osteopetrosis, and which of the following: A. Hypophosphatasia B. Plumism C. Vitamin E toxicity D. Bismuth toxicity

B. Plumbism

Which of the following describes a hemolytic anemia with onset in late childhood or adolescence, featuring anemia, jaundice, and splenomegaly; with normal hemoglobin, but abnormal (inflexible) erythrocytes which get stuck in and are destroyed by the spleen? A. Aplastic anemia B. Fanconi's anemia C. Sickle cell anemia D. Hereditary spherocytosis

D. Hereditary spherocytosis

Which of the following skeletal manifestations may be seen in hypovitaminosis A occurring in infancy? A. Early closure of cranial sutures B. Widening of tubular bones C. Epiphyseal overgrowth D. Widening of cranial sutures due to increased intracranial pressure

D. Widening of cranial sustures due to increased intracranial pressure

Of the following articulations, which one is most frequently involved in hemophilia? A. Knee B. Cervical spine C. Hip D. Wrist

A. Knee

If adequately performed, hemodialysis generally leads to resolution of the bone changes seen in renal osteodystrophy. If,instead, these bone changes progress, what is now believed to be the primary cause? A. Excessive removal of phosphate during dialysis B. Osteomalacia due to aluminum intoxication C. Phosphate retention during dialysis D. Excessive removal of calcium during dialysis

B. Osteomalacia due to aluminum intoxication

In which of the following occupations would would the occurrence of band-like acro-osteolysis be most accurately be considered a form of stress fracture? A. Snake handler B. Polyvinyl chloride worker C. Guitar player D. Electrician

C. Guitar player

In a patient with eosinophilic granuloma, what does a radiodense focus within a lytic cranial lesion represent? A. Target lesion B. Button sequestrum C. Rain-drop skull D. Geographic skull

B. Button sequestrum

Which of the following processes results in thickening of the long bones in osteomalacia? A. Cortical remodeling B. Subperiosteal deposition of osteoid C. Endosteal thickening D. Appositional bone growth

B. Subperiosteal deposition of osteoid

At what age is sickle cell dactylitis or "hand-foot syndrome" most common? A. Adulthood B. Adolescence C. 2 to 10 years D. 6 months to 2 years

D. 6 months to 2 years

What skull abnormalities are commonly found in hypophosphatasia? A. Widened diploe B. Sclerotic skull base C. Craniosynostosis D. Basilar impression

C. Craniosynostosis

Bismuth toxicity in adults may demonstrate which of the following radiographic abnormalities? A. Dense transverse metaphyseal bands B. Erlenmeyer flask deformity C. Osteonecrosis D. Cortical hyperostosis

C. OSteonecrosis

Magnetic resonance imaging of the lumbar spine of a 15-year old female with sickle-cell anemia demonstrate a widespread decrease in signal intensity of vertebral bone marrow, on both T1, T2 and fat-suppressed sequences. This raises the concern for? A. Bone marrow ischemia/infarction B. Iron overload C. Osteomyelities D. Normal reconversion of bone marrow

B. Iron overload

In which location within bone is conversion of bone marrow from fatty to red marrow considered unusual, at any age after the first few months of life? A. Femoral neck B. Base of the skull C. Apophyses or epiphyses D. Vertebral bodies

C. Apophyses or epiphyses

Which of the following arthritic conditions may be seen in 18-40% of patients with primary hyperparathyroidism? A. Calcium pyrophosphate crystal deposition disease B. Oseoarthritis C. Ochronosis D. Gout

A. Calcium Pyrophosphate crystal deposition disease

Which of the following is a frequent extra-osseous complication of hemodialysis, which may be severe, and, according to a study quoted in Resnick, may affect up to 80% of patients? A. Carpal tunnel syndrome B. Septicemia C. Osteonecrosis D. Soft tissue and vascular calcification

D. Soft tissue and vascular calcification

The radiographic finding of increased radiolucency of bone is best termed? A. Osteoporosis B. Osteopenia C. Osteomalacia D. Osteoclastoma

B. Osteopenia

Subchondral bone loss may be seen within joints in osteoporosis. Which disease is mimicked by magical subchondral bone resorption? A. Septic arthritis B. Tuberculous arthritis C. Rheumatoid arthritis D. Psoriatic arthritis

C. Rheumatoid arthritis

Which of the following disorders represents a high-turnover osteoporosis characterized by urinary loss of calcium and phosphorus without a compensatory increase in intestinal calcium absorption? A. Hyperparathyroidism B. Osteoporosis of immobilization or disuse C. Paget's disease D. Idiopathic juvenile osteoporosis

B. Osteoporosis of immobilization or disuse

Which of the following compression neuropathies is particularly characteristic in acromegaly, occurring in 30% of patients, frequently bilaterally? A. Carpal tunnel syndrome B. Compartment syndrome C. Raynaud's syndrome D. Neural foraminal encroachment

A. Carpal tunnel syndrome

A radiodense or chalky appearance of bones throughout the thorax, vertebral column, and pelvis with relative sparing of the skull and appendicular skeleton suggest which of the following: A. Osteopetrosis B. Fluorosis C. Hypervitaminosis D D. Hypervitaminosis A

B. Fluorosis

Which of the following must be included in the differential diagnosis of gas within a vertebral body? A. Dissected air from pneumothorax B. Spinal infection C. Chemical fixer artifact D. Degenerative disc disease

B. Spinal infection

Which of the following spinal syndromes may represent a form of reflex sympathetic dystrophy? A. Kummel's disease B. Scheuermann's disease C. Idiopathic juvenile osteoporosis D. Idiopathic juvenile kyphosis

A. Kummel's disease

Ward's triangle in the neck of the femur is an area of comparative radiolucency bordered by four anatomic groups of trabeculae. With early trabecular resorption due to osteoporosis, which anatomic group of trabeculae becomes more accentuated? A. The principal compressive group B. The principal tensile group C. Both principal compressive and principal tensile groups D. The principal ad secondary compressive groups

C. Both principal compressive and principal tensile groups

Gradually developing biconcave deformities of the vertebral bodies are characteristic of disorders with diffuse weakening of bone, such as osteoporosis, osteomalacia, Paget's disease and hyperparathyroidism. These deformities are known as... A. H-vertebrae B. FIsh vertebrae C. Cartilaginous nodes D. Cupid's bow contour

B. Fish vertebrae

What is the most common radiographic finding in the skull in hypoparathyroidism? A. Calvarial thickening B. Enlargement of the frontal sinuses C. Osteosclerosis of the skull base D. Enlargement of the sella turcica

A. Calvarial thickening

What does the Hawkins sign represent? A. Osteosclerosis of the entire talus, signifying talar osteonecrosis B. Osteopenia of the entire talus, representing adequate blood supply to the talus after injury C. A subchondral radiolucency in the talar dome, representing adequate vascularity in the area D. Patchy radiolucency of the talar dome, signifying osteonecrosis

C. A subchondral radiolucency in the talar dome, representing adequate vascularity in the area

A frontal pelvis radiograph of an 18-year-old black male who complains of hip pain and limping demonstrates bilateral osteosclerosis and early subchondral collapse of the femoral epiphyses. A reasonable differential diagnosis includes which of the following? A. Legg-Calve-Perthes disease B. steroid-induced osteonecrosis C. Gaucher's disease D. sickle-cell anemia

D. Sickle-cell anemia

What is the term for the appearance of the skull in Hand-Schuller-Christian disease, where confluent areas of destruction may isolate islands of bone? A. Floating skull B. Osteoporosis eosinophilica C. Geographic skull D. Beveled skull

C. Geographic skull

Which of the following is a complication of osteonecrosis which may occur many years after, and may possibly be a result of the repair process? A. Pathologic fracture B. Sarcomatous degeneration C. Repeat infarction D. Septic arthritis

B. Sarcomatous degeneration

What percentage of Langerhans Cell Histiocytosis is made up by eosinophilic granuloma? A. 5% B. 20% C. 50 % D. 70%

D. 70%

Where is the most frequent site of bone infarction in sickle cell anemia? A. proximal humerus B. distal femur C. proximal femur D. proximal tibia

C. proximal femur

Of the following magnetic resonance imaging methods used in the diagnosis of transient osteoporosis of the hip, which is incompatible with the effective use of gadolinium-based contrast agent? A. chemical shift B. fat suppression C. STIR D. spin-echo

C. STIR

Which bone in the skull remains unaffected by the changes due to marrow hyperplasia in thalassemia? A. Frontal B. Parietal C. Temporal D. Occipital

D. Occipital

The development of osteoporosis eventually occurs due to an imbalance between bone resorption and bone formation. In which of the following conditions is there an increase in both bone resorption and bone formation, leading to osteoporosis? A. Hyperparathyroidism B. Osteoporosis due to steroid administration C. Osteoporosis due to alcoholism D. Osteoporosis due to heparin administration

A. Hyperparathyroidism

Which of the following conditions most resembles chronic hypervitaminosis A? A. Diffuse idiopathic skeletal hyperostosis B. Infantile cortical hyperostosis C. Diaphyseal dysplasia D. Metaphyseal chondrodysplasia

B. Infantile cortical hyperostosis

Which condition may be noted in manufacturers of illicit alcohol ("moonshine"), in which renal tubular injury leads to uric acid retention? A. Hemarthrosis, most prominently in the knees B. Blindness C. Saturnine gout D. Renal tubular acidosis

C. Saturnine gout

Which feature of thalassemia may also be seen in hereditary spherocytosis, although milder and much more rarely? A. Hair-on-end skull B. Rodent facies C. Diaphyseal infarction D. H-vertebrae

A. Hair-on-end skull

In the radiologic staging of osteonecrosis of the femoral head, which stage demonstrates the crescent sign? A. Stage 1 B. Stage II C. Stage III D. Stage IV

C. Stage III

Which of the following allows differentiation between reflex sympathetic dystrophy and a primary articular disorder such as rheumatoid arthritis? A. Absence of periarticular osteopenia in RSD B. The bilateral and symmetric nature of RSD C. Absence of intra-articular erosions in rheumatoid arthritis D. Preservation of joint space in RSD

D. Preservation of joint space in RSD

What is a common feature of skull lesions in eosinophilic granuloma, due to non-uniform growth of the lesion? A. Surrounding sclerosis B. Soft tissue mass C. Beveled edges D. Extension across sutures

C. Beveled edges

In a patient with hemolytic anemia, a paraspinal mass of low signal intensity on T1-weighted images, with a rim of higher signal intensity similar to fat, is consistent with? A. A paraspinal abscess due to Salmonella infection B. Superimposed diffuse idiopathic skeletal hyperostosis C. Extramedullary hematopoiesis D. Paraspinal hematoma due to pathologic vertebral fracture

C. Extramedullary hematopoiesis

What causes the coarsened trabecular pattern in osteomalacia? A. Loss of secondary trabeculae in spongy bone, leading to greater prominence of the remaining trabeculae B. The deposition of unmineralized osteoid which coats the trabeculae and lines haversian canals C. An overabundance of osteoid seams in the cortex D. This pattern is created by radiographic summation of multiple Looser's lines

A. Loss of secondary trabeculae in spongy bone, leading to greater prominence of the remaining trabeculae

On magnetic resonance imaging of osteochondritis dissecans, which of the following is an indicator of instability of the osteochondral fragment? A. High signal intensity on T2-weighted images, surrounding the fragment B. On T2-weighted images, low signal intensity interface between the fragment and parent bone C. With gadolinium, lack of enhancement of the interface between the fragment and the parent bone D. High signal intensity on T1-weighted images, surrounding the fragment

A. High signal intensity on T2-weighted images, surrounding the fragment

Which of the following crystal deposition diseases might be expected to occur in a patient with severe thalassemia? A. Hemochromatosis B. Wilson's disease C. Calcium hydroxyapatite crystal deposition disease D. Multicentric reticulohistiocytosis

A. Hemochromatosis

What substance is found in abnormal amounts in the blood and urine of patients with hypophosphatasia? A. Phosphoethanolamine B. Mike's Hard Lemonade C. Glucose D. Urinary hydroxyproline

A. Phosphoethanolamine

Which of the following is a synonym for familial idiopathic hyperphosphatasia, a rare disorder of bone occurring in children, which shares some of its skeletal characteristics with a common disorder of bone affecting older individuals? A. Juvenile rheumatoid arthritis B. Juvenile Paget's disease C. Hyperostosis frontalis interna D. Familial expansile osteolysis

B. Juvenile Paget's disease

In the metaphyses of growing long bones, bismuth toxicity may share which of the following radiographic manifestations with lead toxicity? A. Dense transverse metaphyseal bands B. Erlenmeyer flask deformity C. Osteonecrosis D. Cortical hyperostosis

A. Dense transverse metaphyseal bands

The major skeletal abnormality in hyperthyroidism is ? A. Osteomalacia B. Generalized osteoporosis C. Subperiosteal resorption D. Hypertrophic osteoarthropathy

B. Generalized osteoporosis

Vascular occlusion in sickle cell anemia may lead to extensive osteosclerosis and coarsening of the trabecular pattern in the pelvis, spine and long bones. Which of the following processes could safely be excluded in the differential diagnosis of this appearance? A. Paget's disease B. Gaucher's disease C. Myelofibrosis D. Blastic metastasis

B. Gaucher's disease

You are asked to evaluate radiographs of a child with a known autosomal-recessive congenital disorder. The history includes multiple fractures with resulting deformities and shortening of the extremities. There are significant blood enzyme abnormalities. The radiographs demonstrate general deossification with a coarsened trabecular pattern, bowing deformities and old fractures. The most striking radiographic abnormalities are noted at the growth plates, which exhibit rickets-like changes, but there are also irregular, quite prominent radiolucencies which extend deeply into the metaphysis. These findings suggest... A. Fanconi's syndrome B. Hypophosphatasia C. Hereditary vitamin D-dependent rickets D. Familial vitamin D-resistant rickets

B. Hypophosphatasia

Which of the following is commonly associated with polyvinyl chloride toxicity acro-osteolysis? A. Multiple sclerosis B. Chronic fatigue syndrome C. A disorder similar to Raynaud's phenomenon D. Aplastic anemia

C. A disorder similar to Raynaud's phenomenon

What is the pathologic basis, and generally the cause of death, in Letterer-Siwe disease? A. Marrow infiltration and replacement by histiocytes B. Cerebral invasion by histiocytes C. Histiocytic proliferation of multiple organ systems, leading to progressive anemia D. Histiocytic infiltration of the myocardium leading to heart failure

C. Histiocytic proliferation of multiple organ systems, leading to progressive anemia

What distinguishes Hand-Schuller-Christian disease from eosinophilic granuloma? A. Ethnicity of affected patients B. Multiplicity of lesions and organ involvement C. Lack of progression D. Presence of "floating teeth"

B. Multiplicity of lesions and organ involvement

Which of the following radiographic findings in bone is interpreted as a favorable prognostic sign in patients with histiocytosis? A. Enlargement of osseous lesions B. Patchy, diffuse, or ring-like sclerosis of or around bone lesions C. Cortical thickening D. Periosteal reaction

B. Patchy, diffuse, or ring-like sclerosis of or around bone lesions

What is responsible for enlargement of the thoracic cage in acromegaly? A. This is only seen when patients have coexisting emphysema B. Enlargement of the pulmonary parenchyma C. Elongation of the ribs D. The common coexistence of pectus carinatum and acromegaly

C. Elongation of the ribs

What best differentiates the radiographic findings in myelofibrosis from those seen in fluorosis? A. Absence of spinal osteophytosis and ligamentous calcification in myelofibrosis B. Sparing of the appendicular skeleton in myelofibrosis C. Absence of periosteal new bone formation in fluorosis D. The two disorders are indistinguishable without bone marrow biopsy

A. Absence of spinal osteophytosis and ligamentous calcification in myelofibrosis

When a child presents with unexplained diffuse osteopenia and bilateral metaphyseal radiolucent bands, your primary diagnosis should be until proven otherwise? A. Osteoporosis B. Multiple myeloma C. Leukemia D. Lymphoma

C. Leukemia

Fanconi's anemia and the TAR syndrome can resemble each other very closely. Which of the following best differentiates between the two? A. The osseous abnormalities in Fanconi's anemia are consistently the same and are bilateral B. In the TAR syndrome, the radius may be hypoplastic, dysplastic or absent C. There are always five digits present in the hand in the TAR syndrome D. The two syndromes are radiographically indistinguishable

C. There are always five digits present in the hand in the TAR syndrome

Which of the following is typical of osteochondritis dissecans of the knee (OCD), as opposed to spontaneous osteonecrosis of the knee (SONK)? A. OCD generally occurs in older patients B. OCD occurs in the non-weight-bearing portion of the knee C. OCD is more painful at night D. OCD can occur due to a multitude of causes

B. OCD occurs in the non-weight-bearing portion of the knee

What distinguishes pseudopseudohypoparathyroidism from pseudohypoparathyroidism? A. Normocalcemia B. Hypercalcemia C. Hyperphosphatemia D. Hypocalcemia

A. Normocalcemia

What is the most common intrathoracic cause of hypertrophic osteoarthropathy? A. Cyanotic congenital heart disease B. Bronchogenic carcinoma C. Hodgkin's disease D. Metastatic disease

B. Bronchogenic carcinoma

What is the most common estimated frequency of post-traumatic osteonecrosis of the scaphoid? A. 1 - 5% B. 10 - 15% C. 25% D. over 50%

B. 10 - 15%

At what age is Letterer-Siwe disease most common? A. Under 3 years B. Between 5 and 10 years C. Adolescence D. Early adulthood

A. Under 3 years

What is the most common cause of hypoparathyroidism? A. Accidental radiation damage to the parathyroid glands B. Congenital absence or atrophy of the parathyroid glands C. Excision of or damage to the parathyroid glands during thyroid surgery D. Damage to the parathyroid glands due to chemotherapy

C. Excision of or damage to the parathyroid glands during thyroid surgery

Where is the most typical and classic location of osteochondritis dissecans? A. Medial facet of the patella B. Capitulum of the humerus C. Medial aspect, lateral femoral condyle D. Lateral aspect, medial femoral condyle

D. Lateral aspect, medial femoral condyle

Which of the following is not part of the "classic triad" of Hand-Schuller-Christian disease? A. Diabetes insipidus B. Exophthalmos C. Destructive bone lesions D. Hepatosplenomegaly

D. Hepatosplenomegaly

In quantitative bone mineral analysis, why is trabecular (cancellous) bone preferred to cortical (compact) bone for accurate analysis? A. Trabecular bone is more easily accessible for analysis B. The high rate of metabolic turnover of trabecular bone makes it more responsive to metabolic stimuli C. The skeleton is mainly composed of trabecular bone, which makes analysis more accurate D. Quantitative bone mineral analysis is performed on cortical bone, not trabecular bone

B. The high rate of metabolic turnover of trabecular bone makes it more responsive to metabolic stimuli

What is the major skeletal abnormality in hypopituitarism? A. Osteoporosis B. Slipped capital femoral epiphysis C. Periostitis deformans D. Delayed skeletal maturation

D. Delayed skeletal maturation

In which of the following rare types of osteomalacia is the central skeleton of otherwise healthy males exclusively affected? A. Dialysis-related osteomalacia B. Hepatic osteodystrophy C. Osteomalacia related to vitamin D deficiency D. Atypical axial osteomalacia

D. Atypical axial osteomalacia

Which of the following conditions complicates myelofibrosis in 5 to 20% of cases? A. Hemarthrosis B. Gout C. Multiple myeloma D. Amyloidosis

B. Gout

What is the predominant radiographic feature of pachydermoperiostosis? A. Medullary sclerosis B. Coarsened trabecular pattern C. Cortical thinning D. Periostitis

D. Periostitis

In which of the following hematopoeitic bone marrow disorders are the facial bones involved in marrow hyperplasia, to the extent that the paranasal sinuses are obliterated and a very characteristic facial appearance results? A. Sickle cell anemia B. Iron deficiency anemia C. Hereditary spherocytosis D. Thalassemia

D. Thalassemia

Periostitis deformans is seen in toxicity of which of the following substances? A. Lead B. Bismuth C. Phosphorus D. Fluorine

D. Fluorine

Which of the following is not a cause of post-traumatic osteonecrosis of the femoral head? A. Femoral neck fracture B. Hip dislocation C. Slipped capital femoral epiphysis D. Femoral shaft fracture

D. Femoral shaft fracture

Subchondral bone resorption at the discovertebral junction may allow formation of which of the following radiographic findings? A. Limbus bones B. Schmorl's nodes C. Narrowing of the disc space D. Rugger-jersey spine

B. Schmorl's nodes

Which of the following radiographic manifestations is particularly helpful in the diagnosis of lead poisoning in children? A. Multiple dense metaphyseal lines in a single bone B. Vertical striations within the metaphysis C. Overtubulation of the femora (long, gracile-appearing bones) D. Dense metaphyseal lines at the proximal fibula

D. Dense metaphyseal lines at the proximal fibula

Patients with Sickle Cell Anemia are more at risk of osteomyelitis from which organism? 1. Salmonella 2. Brucella 3. Streptococcus 4. Pseudomonas

a. Salmonella Yochum 3^rd Ed. Pg. 1427

AVN of the femoral or humeral heads ocurs in what percentage of Sickle Cell disease cases? 1. \<5% 2. 10% 3. 25% 4. 50%

b. 10% Yochum 3^rd Ed. Pg. 1427

1. What pathogenesis leads to the sickle cell crisis? 1. Mesenteric vascular thrombosis 2. Papillary necrosis and renal failure 3. Secondary peritonitis 4. Cardiomegaly with heart failure

**a. Mesenteric vascular thrombosis** Yochum 3^rd Ed. Pg. 1427

The homozygous form of sickle cell disease (HbS-S) results from a defect in hemoglobin synthesis in which: 1. Valine is substituted for glutamic acid in the sixth position of the beta globulin chain 2. Glutamic acic is substituted for valine in the sixth position of the beta globulin chain 3. Lysine is substituted for glutamic acid in the sixth position of the beta globulin chain 4. Glutamic acid is substituted for lysine in the sixth position of the beta globulin chain

a. Valine is substituted for glutamic acid in the sixth position of the beta globulin chain Yochum 3^rd Ed. Pg. 1428

1. Which form of anemia tends to result in the MOST SEVERE form of marrow hyperplasia? 1. Sickle cell anemia 2. Cooley’s Anemia 3. Thalassemia minor 4. Pernicious anemia

b. Cooley’s Anemia Yochum 3^rd Ed. Pg. 1432

The extramedullary hematopoietic foci found in sickle cell anemia and thalassemia are USUALLY seen where? 1. Posterior mediastinum 2. anterior mediastinum 3. middle mediastinum 4. abdomen

a. Posterior mediastinum Yochum 3^rd Ed. Pg. 1432

State whether the following radiographic changes are MORE LIKELY to be seen with sickle cell disease or with thalassemia : 1. Hair-on-end skull 2. Erlenmyer flask deformity 3. H-shaped vertebral bodies 4. Medullary infarct 5. AVN of femoral heads 6. Mauskopf facies

1. Hair-on-end skull – **thalassemia** 2. Erlenmyer flask deformity – **thalassemia** 3. H-shaped vertebral bodies – **Sickle cell** 4. Medullary infarct – **sickle cell** 5. AVN of femoral heads – **sickle cell** 6. Mauskopf facies – **thalassemia** Yochum 3^rd Ed. Pg. 1434

1. What percentage of hemophiliacs may demonstrate evidence of hemophilic pseudotumors on radiographs 1. 1-2% 2. 10-12% 3. 20-25% 4. 45-50%

a. 1-2% Yochum 3^rd Ed. Pg. 1436

Hemophilic pseudotumors are MOST LIKELY to occur where? 1. Knee 2. Hand 3. Shoulder 4. Ankle

a. Knee Yochum 3^rd Ed. Pg. 1436

The MOST COMMON form of childhood leukemia is? 1. Acute Lymphocytic Leukemia 2. Acute Myelogenous Leukemia 3. Chronic Myelogenous Leukemia 4. Chronic Lymphocytic Leukemia

a. Acute Lymphocytic Leukemia Yochum 3^rd Ed. Pg. 1440

Which radiographic finding is most likely to be seen with childhood leukemia? Yochum 3^rd Ed. Pg. 1441 1. Generalized increase in bone density 2. Dense submetaphyseal bands 3. Blastic lesions 4. Periosteal response

d. Periosteal response Yochum 3^rd Ed. Pg. 1441

Which form of leukemia is MOST LIKELY to demonstrate osseous abnormalities on radiographs IN ADULTS? 1. Chronic Myelogenous Leukemia 2. Chronic Lymphocytic Leukemia 3. Acute Lymphocytic Leukemia 4. Acute Myelogenous Leukemia

b. Chronic Lymphocytic Leukemia Yochum 3^rd Ed. Pg. 1442

All of the following are predisposing factors to the development of AVN EXCEPT: 1. Alcoholism 2. Corticosteroids 3. Radiation 4. CPPD

d. CPPD Yochum 3^rd Ed. Pg. 1445

Which region of bone is most susceptible to AVN? 1. Diaphysis 2. Metaphysis 3. Apophysis 4. Epiphysis

d. Epiphysis Yochum 3^rd Ed. Pg. 1445

The SNOWCAP SIGN of AVN appears in which phase of the lesion? 1. Avascular phase 2. Revascularization 3. Repair and Remodeling 4. Deformity

b. Revascularization Yochum 3^rd Ed. Pg. 1445

In the context of AVN, Creeping Substitution refers to: 1. Deposition of new bone directly onto dead bone 2. Replacement of necrotic bone with fibrous and granulation tissue 3. Cessation of epiphyseal growth with continuation of articular cartilage growth 4. Remodeling of new bone in response to altered biomechanical stresses

a. Deposition of new bone directly onto dead bone Yochum 3^rd Ed. Pg. 1445-6

# Match the AVN eponym with its appropriate skeletal location. Yochum 3rd Ed. Pg. 1462 Kummel’s Disease 1. Vertebral body in an adult 2. Tarsal navicular 3. Medial tibial metaphysis 4. Humeral head

1. Vertebral body in an adult

# Match the AVN eponym with its appropriate skeletal location. Yochum 3rd Ed. Pg. 1462 Hass’ Disease 1. Humeral head 2. Capitellum 3. Lunate 4. Scaphoid

a. Humeral head

# . Match the AVN eponym with its appropriate skeletal location. Yochum 3rd Ed. Pg. 146 Freiberg’s Disease 1. Tarsal navicular 2. Lunate 3. Scaphoid 4. Metatarsal head

d. Metatarsal head

# . Match the AVN eponym with its appropriate skeletal location. Yochum 3rd Ed. Pg. 146 Preiser’s Disease 1. Scaphoid 2. Lunate 3. Metacarpal Head 4. Capitellum

a. Scaphoid

# . Match the AVN eponym with its appropriate skeletal location. Yochum 3rd Ed. Pg. 146 Panner’s Disease 1. Tarsal Navicular 2. Calcaneal Apophysis 3. Patella 4. Capitellum

d. Capitellum

# . Match the AVN eponym with its appropriate skeletal location. Yochum 3rd Ed. Pg. 146 Kohler’s disease 1. Medial Tibial Condyle 2. Talus 3. Lunate 4. Tarsal Navicular

d. Tarsal Navicular

Osteochondritis Dissecans is MOST LIKELY to occur where? 1. Medial aspect of the lateral femoral condyle 2. lateral aspect of the medial femoral condyle 3. inferior aspect of the medial femoral condyle 4. inferior aspect of the lateral femoral condyle

b. lateral aspect of the medial femoral condyle

Which radiographic projection is most sensitive in the detection of osteochondritis dissecans? 1. Lateral Knee 2. AP Knee 3. Sunrise View 4. Tunnel View

d. Tunnel View Yochum 3^rd Ed. Pg. 1479

True or false: Monckeberg’s medial sclerosis commonly causes narrowing of the affected artery. 1. True 2. False

b. False

Which of the following is FALSE regarding idiopathic juvenile osteoporosis? 1. It is uncommon and progressive 2. Typically arises in the years following puberty 3. The symptoms simulate those of arthritis 4. Transverse fractures of the appendicular skeleton may result

a. It is uncommon and progressive

Following immobilization, what is the average length of time it takes for osteoporosis to arise? Pg. 1796 1. 3-4 weeks 2. 2-3 months 3. 5-6 months 4. 6+ months

b. 2-3 months

What is the cause of 90% of cases of Complex Regional Pain Syndrome? Pg. 1798 1. Degeneration 2. Disc herniation 3. Postsurgical 4. Trauma

d. Trauma

Which of the following is NOT a feature of CRPS on three-phase bone scan? Pg. 1801-2 1. May involve entire limb on phase I 2. Prominent uptake in both bone and adjacent soft tissue 3. A predominantly segmental pattern, i.e. uptake at a single joint with sparing of the remainder of the limb 4. Scans at different times may reveal migration from one side of a joint to another

c. A predominantly segmental pattern, i.e. uptake at a single joint with sparing of the remainder of the limb

A 20 year old male presents with insidious onset of right hip pain of three weeks’ duration and walks into your office with a limp. He denies any history of trauma, but has a history of childhood asthma which was managed with an inhaler; He reports that he has not had an asthma attack in several years. A conventional radiographic series of the affected hip is unremarkable. An MRI of the hip is performed, revealing marked marrow edema in the femoral head and neck with a small joint effusion on fluid-sensitive sequences. The MRI is otherwise unremarkable. What is the MOST LIKELY diagnosis? Pg. 1804-8 1. Septic arthritis 2. Chandler disease 3. Transient Regional Osteoporosis 4. Chronic regional pain syndrome

c. Transient Regional Osteoporosis

Transient regional osteoporosis and regional migratory osteoporosis are similar pathologic processes with nonetheless distinct characteristics. Which of the following is TRUE regarding these two pathologies? Pg. 1804-16 1. Regional migratory osteoporosis most commonly occur in the hip 2. Transient regional osteoporosis occurs more often in women than in men while regional migratory osteoporosis occurs more often in men 3. Regional migratory osteoporosis typically arises in somewhat older individuals than does transient regional osteoporosis 4. Transient regional osteoporosis usually involves the left hip in men, but can occur in either hip in women

c. Regional migratory osteoporosis typically arises in somewhat older individuals than does transient regional osteoporosis

Which of the following disease is NOT commonly recognized as a potential cause of wormian bones? Chapman, 14.67 1. Hajdu-Cheney Syndrome 2. Hypophosphatasia 3. Down Syndrome 4. Hyperthyroidism

d. Hyperthyroidism

In Paget disease, osteolysis typically begins where? Pg. 1951 1. Metaphysis at the capsular insertion 2. Subchondral epiphysis 3. Mid-diaphysis 4. Simultaneously in the diaphysis, metaphyses and epiphyses

b. Subchondral epiphysis

Which of the following is FALSE regarding the distribution of Paget disease? Pg. 1954-5 1. Most cases are monostotic 2. Polyostotic cases are typically symmetrically distributed 3. Predominantly involves the axial skeleton 4. Rib involvement is uncommon

1. Most cases are monostotic

What is the SECOND most common malignant neoplasm to result from malignant degeneration of Paget disease? Pg. 1975 1. Chondrosarcoma 2. Osteosarcoma 3. Fibrosarcoma 4. Malignant fibrous histiocytoma

c. Fibrosarcoma

What proportion of Hypopituitarism cases are familial in etiology? Pg. 2022 1. 10% 2. 25% 3. 50% 4. 90%

a. 10%

Which of the following is included in the expected radiographic appearance of the periostitis associated with thyroid acropachy? Pg. 2030 1. Predominant involvement of long bones 2. Symmetric distribution 3. Periostitis extends to the metaphyses and epiphyses 4. More prominent on the radial aspect of affected bones

d. More prominent on the radial aspect of affected bones

Epiphyseal dysgenesis is an important radiographic clue seen most often in which endocrine disorder? Pg. 2034 1. Hyperthyroidism 2. Hypophosphatasia 3. Hypothyroidism 4. Rickets

c. Hypothyroidism

What disease syndrome is characterized by the combination of hypoadrenalism, chronic mucocutaneous candidiasis, dental hypoplasia and hypoparathyroidism, usually arising in childhood? Pg. 2097 1. Schmidt syndrome 2. Wermer syndrome 3. Whitaker syndrome 4. Sipple syndrome

c. Whitaker syndrome

The renal resistance to parathyroid hormone in _____________ occurs proximal to the generation of \_\_\_\_\_\_\_\_\_\_? Pg. 2099 1. pseudopseudohypoparathyroidism; ATP 2. pseudohypoparathyroidism; ATP 3. pseudohypoparathyroidism; cAMP 4. pseudopseudohypoparathyroidism; cAMP

c. pseudohypoparathyroidism; cAMP

Which of the following is FALSE regarding adhesive caspulitis seen with diabetes mellitus? Pg. 2118 1. It occurs in 10-20% of patients with diabetes mellitus 2. It is most common in men over 40 3. It typically involves the nondominant shoulder 4. MRI will demonstrate thickening of the inferior glenohumeral ligament \>4mm

b. It is most common in men over 40

What disease is characterized by the deficiency of spectrin, the largest and most abundant structural protein of the erythrocyte membrane? Pg. 2177 1. Aplastic anemia 2. Thalassemia 3. Hereditary spherocytosis 4. Fanconi anemia

c. Hereditary spherocytosis

In which disease do patients exhibit an impaired ability to incorporate iron into marrow erythroid precursors? Pg. 2178 1. Aplastic anemia 2. Hereditary spherocytosis 3. Iron deficiency anemia 4. Thalassemia

a. Aplastic anemia

Which form of Gaucher disease does NOT exhibit a particular ethnic distribution? Pg. 2234 1. Type I 2. Type II 3. Type IIIa 4. Type IIIb

b. Type II

The MOST COMMON musculoskeletal manifestation of Fabry disease is? Pg. 2246-8 1. Avascular necrosis 2. Periarticular swelling 3. Osteoporosis 4. Enthesopathy

a. Avascular necrosis

Fabry disease often demonstrates a characteristic skin lesion. What is it? Pg. 2247 1. Fibroma molluscum 2. Acanthosis nigricans 3. Angiokeratoma corporis diffusum 4. Urticaria pigmentosa

c. Angiokeratoma corporis diffusum

Typical onset of multicentric reticulohistiocytosis is usually around what age? Pg. 2249 1. Childhood 2. Young adult 3. Middle age 4. Senescence

c. Middle age

In the majority of cases, the initial manifestation of multicentric reticulohistiocytosis is? Pg. 2249 1. Polyarthritis 2. Nodular eruption of the skin 3. Lymphadenopathy 4. Mucosal papules about the lips, buccal membrane and tongue

a. Polyarthritis

True or false: the bone lesions seen in Histiocytosis X may be seen to cross open physeal plates. Pg. 2259 1. True 2. False

a. True

Bilateral knee radiographs are obtained on a 55 year old male with mild bilateral knee pain. Evaluation of the imaging reveals a bilateral and symmetric distribution of patchy medullary sclerosis, coarsened trabecular pattern and mild cortical thickening in the metaphyses and diaphyses of the tibiae and femora with complete sparing of the epiphyses. Assessment of the patient’s lumbar and cervical spine radiographs reveals only moderate degenerative changes and calcified atherosclerosis in the abdominal aorta and common carotid arteries. This pattern of findings is most characteristic of which disease? Pg. 2270-4 1. Paget disease 2. Myelofibrosis/mastocytosis 3. Erdheim-Chester disease 4. Chronic osteomyelitis

c. Erdheim-Chester disease

Which of the following is not a radiographic finding typically seen in rickets? (Pg. 1909) a. Bowing b. Pelken’s spurs c. Osteopenia d. All of the above are typical with rickets.

b. Pelken’s spurs

What is the most common cause of vitamin D deficiency in the United States? (Pg. 2396) a. Liver disease b. Kidney disease c. Intestinal malabsorption d. Inadequate sunlight

c. Intestinal malabsorption

Deficiency of which structural protein leads to hereditary spherocytosis? (Pg. 2177) a. Collagen b. Spectrin c. Fibrillin d. Sclerotin

b. Spectrin

Which type of Niemann-Pick disease is characterized as chronic without nervous system involvement? (Pg. 2246) a. Type A b. Type B c. Type C d. Type D

b. Type B

The radiographic findings of Niemann-Pick disease are virtually identical to which other lipid storage disease? (Pg. 2246) a. Gaucher disease b. Fabry disease c. Multicentric reticulohistiocytosis d. Niemann-Pick disease is a unique radiographic entity that is dissimilar to all other lipid storage diseases.

a. Gaucher disease

In which age group is multicentric reticulohistiocytosis most common? (Pg. 2249) a. 40-50 b. 10-30 c. 70-80 d. It is common at all ages.

a. 40-50

Which syndrome is associated with multicentric reticulohistiocytosis? (Pg. 2249) a. Maffucci b. Down c. Sjögren d. AIDS

c. Sjögren

Which of the Langerhans Cell Histiocytoses is considered by some researchers to be a malignant lymphoma? (Pg. 2257) a. Eosinophilic granuloma b. Letterer-Siwe disease c. Hand-Schüller-Christian disease d. Fabry disease

b. Letterer-Siwe disease

T or F: Langerhans cells are present in all three types of Histiocytosis X. (Pg. 2257)

TRUE

Erdheim-Chester disease is another name for which lipid storage disease? (Pg. 2270) a. Membranous lipodystrophy b. Fucosidosis c. Multicentric reticulohistiocytosis d. Lipid granulomatosis

d. Lipid granulomatosis

T or F: Radiolucent and radiodense metaphyseal bands are a nonspecific finding that most commonly indicates a nutritional deficit. (Pg. 2292)

TRUE

The radiographic findings of neuroblastoma are strikingly similar to which other disease? (Pg. 2295) a. Scurvy b. Rickets c. Acute leukemia d. Letterer-Siwe disease

c. Acute leukemia

Chronic lichenoid dermatitis is characteristic of which myeloproliferative disorder? (Pg. 2328) a. Ameloidosis b. Myelofibrosis c. Systemic mastocytosis d. Chronic lichenoid dermatitis is found with all of the myeloproliferative disorders.

c. Systemic mastocytosis

Which of the following is not characteristic of Klippel-Trenaunay syndrome? (Pg. 2366) a. Cutaneous hemangiomas b. Varicose veins c. Soft tissue and bony hypertrophy d. Synovial hemangiomas

d. Synovial hemangiomas

Which finding, when added to the triad of findings for Klippel-Trenaunay syndrome, changes the diagnosis to Parke-Weber syndrome? (Pg. 2366) a. Arteriovenous fistula b. Pronounced osteoporosis c. Hypercholesterolemia d. Atherosclerosis

a. Arteriovenous fistula

The Ficat staging system is used for osteonecrosis of which bone? (Pg. 3613) a. Humeral head b. Femoral head c. Talar dome d. Tibial plateau

b. Femoral head

Hawkins sign is indicative of osteonecrosis of which bone? (Pg. 3637) a. Femoral head b. Talus c. Humeral head d. Vertebral body

b. Talus

In which area of the spine is Kümmel disease most common? (Pg. 3647) a. Cervicothoracic b. Lumbosacral c. Thoracolumbar d. Sacrococcygeal

c. Thoracolumbar

T or F: Ahlbäck disease is found in the knees of adults. (Pg. 3661)

TRUE

Which hormone shows elevated levels in many Paget disease patients? (Pg. 1949) a. Parathormone b. Vitamin D c. Calcitonin d. Estradiol

a. Parathormone

Marked delays in skeletal maturation are characteristic of which disease? (Pg. 2022) a. Hyperpituitarism b. Hyperparathyroidism c. Hypopituitarism d. Hypovitaminosis D

c. Hypopituitarism

Werner syndrome is associated with hypersecretion of which hormone? (Pg. 2064) a. Thyroxine b. Thyronine c. Parathormone d. Calcitonin

c. Parathormone

Serum levels of which substance differentiate pseudohypoparathyroidism from pseudo-pseudohypoparathyroidism? (Pg. 2099) a. Calcium b. Potassium c. Magnesium d. Parathormone

a. Calcium

A “cheiroarthropathy” constellation of symptoms including joint contractures, thick skin and short stature can be seen with which disease? (Pg. 2118) a. Diabetes mellitus b. Cushing disease c. Addison disease d. Hypothyroidism

a. Diabetes mellitus

T or F: Serum alkaline phosphatase levels are typically elevated in milk-alkali syndrome. (Pg. 3441)

FALSE

Marrow hyperplasia affecting the maxilla is more commonly seen in? 1. Eosinophilic granuloma 2. Gaucher disease 3. Leukemia 4. Sickle cell anemia 5. Thalassemia

e. Thalassemia

Osteonecrosis occurring in Gaucher disease most commonly affects which body region? 1. Elbow 2. Hip 3. Knee 4. Shoulder 5. Spine

b. Hip

Another name for H shape vertebral body is: 1. Calve disease 2. Honda sign 3. Reynold’s phenomenon 4. Riggler’s notch 5. Sail sign

c. Reynold’s phenomenon

The most common etiologic organism of osteomyelitis in sickle cell disease is? 1. Clostridium perfringens 2. Pseudomonas aeruginosa 3. Salmonella paratyphi 4. Staphylococcus Aureus 5. Streptococcus pyogenes

c. Salmonella paratyphi

A bell shaped thoracic cage is characteristic in which condition? 1. Acromegaly 2. Hyperparathyroidism 3. Osteomalacia 4. Sickle cell anemia 5. Thalassemia

c. Osteomalacia

Which of the following conditions demonstrates a pale pink cytoplasm on periodic acid Schiff and crumpled tissue paper cytoplasm? 1. Eosinophilic granuloma 2. Gaucher disease 3. Leukemia 4. Sickle cell anemia 5. Thalassemia

b. Gaucher disease

The most commonly affected area in eosinophilic granuloma is? 1. Humerus 2. Mandible 3. Pelvis 4. Ribs 5. Skull

e. Skull

Granulocytic sarcoma, also referred to as chloroma, is most commonly associated with which of the following? 1. Acute lymphocytic leukemia 2. Acute myelogenous leukemia 3. Chronic lymphocytic leukemia 4. Chronic myelogenous leukemia 5. Hairy cell leukemia

b. Acute myelogenous leukemia

A 29 year old male presents with bilateral knee pain and swelling and Volkmann’s contractures, which is the most likely diagnosis? 1. Gaucher disease 2. Hemophilia 3. Leukemia 4. Sickle cell anemia 5. Thalassemia

b. Hemophilia

1. Radiographic examination of a 69 year old male demonstrates multiple circular lucent lesions of varying size within the ilia bilaterally, subchondral resorption at the sacroiliac joints and subchondral sclerosis of the lumbar vertebral endplates. The lucent lesions most likely represent? 1. Brown tumors 2. Enchondromas 3. Glomus tumors 4. Hemophilic pseudotumors 5. Osteomyelitis

a. Brown tumors

In regards to osteoporosis in the proximal femur, which of the following is the trabecular pattern that remains in the highest quantity? 1. Principle compressive 2. Principle tensile 3. Secondary compressive 4. Secondary tensile 5. Spongiosa

a. Principle compressive

Rachitic rosary affects which ribs? 1. Atypical 2. Floating 3. Lower 4. Middle 5. Upper

d. Middle

Dense periostitis with a feathery contour is demonstrated on the radial aspects of the metacarpals bilaterally asymmetric in distribution, in addition to pretibial myxedema. Which is the most likely diagnosis? 1. Hypervitaminosis A 2. Leukemic acropachy 3. Primary hypertrophic osteoarthropathy 4. Secondary hypertrophic osteoarthropathy 5. Thyroid acropachy

e. Thyroid acropachy

What type of bone formation occurs at the alveolar margins of the maxilla and mandible that results in the separation of teeth in those with acromegaly? 1. Endochondral 2. Subarticular 3. Subligamentous 4. Subperiosteal 5. Subchondral

d. Subperiosteal

Bulbous enlargement is demonstrated at the anterior costochondral junctions in a patient that has a chromophobic adenoma that is enlarging the sella turcica. What is the most likely diagnosis? 1. Acromegaly 2. Leukemia 3. Rickets 4. Scurvy 5. Thalassemia

a. Acromegaly

A patient presents with polyuria and polydypsia and pain in the shoulders. Dense, amorphous, clusters of calcification is demonstrated around the proximal humerus on the radiographs of the shoulder. Which is most likely? 1. Hypervitaminosis A 2. Hypervitaminosis C 3. Hypervitaminosis D 4. Hypovitaminosis C 5. Pseudohyperparathyroidism

c. Hypervitaminosis D

Radiographic examination of the knee in a child that presents with knee pain demonstrates solid periosteal new bone along the femoral diaphysis and fusion of the distal femoral physis. Which of the following is the most likely diagnosis? 1. Hypervitaminosis A 2. Hypervitaminosis C 3. Hypervitaminosis D 4. Leukemia 5. Pseudohyperparathyroidism

a. Hypervitaminosis A

Radiographic examination of a child yields sclerotic metaphyseal lines adjacent to the distal femoral physis with lateral bowing of the femoral diaphysis. Which of the following is the most likely explanation? 1. Healing rickets 2. Hypervitaminosis D 3. Hypovitaminosis C 4. Lead poisoning 5. Rickets

a. Healing rickets

Brown tumors are most commonly seen in: 1. Femur 2. Humerus 3. Mandible 4. Pelvis 5. Ribs

c. Mandible

Negative ulnar variance predisposes an individual to which of the following? 1. Freiberg infraction 2. Kienbock disease 3. Kummel disease 4. Preiser disease 5. Thiemann disease

b. Kienbock disease

A 14 year old, afebrile, male presents with painless swelling of the proximal interphalangeal joints of the third digit bilaterally. Radiographs yield sclerosis of the proximal phalangeal heads. What is the most likely diagnosis? 1. Acute osteomyelitis 2. Hand-foot syndrome 3. Mauclaire disease 4. Preiser disease 5. Thiemann disease

e. Thiemann disease

Reticuloendotheliosis is also referred to as: 1. Acute megakaryoblastic leukemia 2. Eosinophilic granuloma 3. Granulocytic sarcoma 4. Hairy cell leukemia 5. Polycythemia vera

d. Hairy cell leukemia

The incidence of osteomyelitis in sickle cell anemia is ____ times that of the general population. 1. 10 2. 25 3. 50 4. 75 5. 100

e. 100

Which of the following can present with ‘floating teeth’? 1. Acromegaly 2. Brown tumors 3. Eosinophilic granuloma 4. Gaucher disease 5. Osteitis fibrosa cystica

c. Eosinophilic granuloma

Which of the following is another name for yellow marrow? 1. Active 2. Cellular 3. Hematopoietic 4. Inactive 5. Myeloid

d. Inactive

Which of the following is the least appropriate differential consideration for hair on end appearance of the skull? 1. Hemophilia 2. Hereditary Spherocytosis 3. Iron deficiency anemia 4. Sickle cell disease 5. Thalassemia

a. Hemophilia

Expansion of the medullary cavity in regards to hereditary Spherocytosis occurs most notably in which of the following? 1. Distal humerus 2. Distal tibia 3. Proximal femur 4. Proximal fibula 5. Proximal tibia

c. Proximal femur

Which of the following locations is least likely to yield the presence of a chloroma? 1. Extra-osseous sites 2. Facial bones 3. Femur 4. Ribs 5. Sternum

c. Femur

An 8 years of age patient with a history of seizures presents with low back pain and chronic worsening fatigue, and resultantly laboratory investigation is performed which yields pancytopenia. Magnetic resonance imaging was performed and yielded the presence of diffuse homogeneous high T1 signal throughout all visualized marrow. Which of the following is the most likely diagnosis? 1. Aplastic anemia 2. Hereditary spherocytosis 3. Iron deficiency anemia 4. Kasabach-Merritt syndrome 5. Sickle cell disease

a. Aplastic anemia

A 13 years of age, Nova Scotian male, presents with radicular symptoms in the lower extremity. Clinical investigation yields mildly yellow sclerae which is reported to be very recent onset. Progressive worsening eyesight was also reported. An MRI of the lumbar spine was obtained and hepatosplenomegaly and lymphadenopathy were noted. Which of the following diagnoses is most suspect? 1. Niemann-Pick type D 2. Gaucher disease 3. Hereditary Spherocytosis 4. Fabry disease 5. Refsum disease

a. Niemann-Pick type D

A 24 years of age male presents with a long-standing history of polyarthralgia, multiple skin lesions predominately affecting the trunk and lower extremities, and radiographs that elucidated the presence of osteopenia localized to the thoracolumbar segments. Which of the following is the most appropriate conclusion? 1. Aluminum toxicity 2. Aplastic anemia from gold toxicity 3. Fabry disease 4. Gaucher disease 5. Niemann-Pick disease

c. Fabry disease

Malignant tumors occur in up to what percent of cases of multicentric reticulohistiocytosis? 1. 5 2. 15 3. 30 4. 60

c. 30

A 58 years of age female presents with low back pain and hip pain. Radiographs demonstrate the presence of a partially calcified retroperitoneal mass in addition to sclerosis of the proximal femoral metaphyses bilaterally with adjacent cortical thickening and sparing of the femoral heads. Which of the following is the most likely diagnosis? 1. Erdheim-Chester disease 2. Klippel-Trenaunay-Weber syndrome 3. Malignant myelofibrosis 4. Mazabraud syndrome 5. Pachydermoperiostosis

a. Erdheim-Chester disease

Which of the following can present with a lichen-like growth on the skin? 1. Amyloidosis 2. Fabry disease 3. Gaucher disease 4. Lipoid granulomatosis 5. Niemann-Pick disease

a. Amyloidosis

A 50 years of age male presents with diffuse worsening neck and low back pain. Upon clinical inspection, pigmented hives are noted. Radiographic evaluation yielded the presence of multiple lytic lesions at the visualized portion of the skull on the lateral cervical spine radiograph and multifocal Osteosclerotic foci within the ilia bilaterally. Laboratory evaluation yielded normal uric acid levels. Which of the following is the most appropriate explanation? 1. Erdheim-Chester disease 2. Hairy cell leukemia 3. Hand-Schuller-Christian disease 4. Myelofibrosis 5. Systemic mastocytosis

e. Systemic mastocytosis

A 61 years of age male presents with low back pain and bilateral foot pain that has be progressive recently. Laboratory evaluation yields elevated uric acid levels. Radiographs of the feet demonstrate erosion at the 1^st metatarsophalangeal joint, while radiographs of the lumbar spine demonstrate sandwich vertebrae. Which of the following is the most appropriate conclusion? 1. Addison disease 2. Erdheim-Chester disease 3. Myelofibrosis 4. Oxalosis 5. Systemic mastocytosis

c. Myelofibrosis

A patient presents with facial hemihypertrophy, port-wine stains, and cutaneous lymphangioms with the absence of arteriovenous malformations. Which of the following is the most appropriate conclusion? 1. Klippel-Trenaunay syndrome 2. Parke-Weber syndrome 3. Klippel-Trenaunay-Weber syndrome 4. Glanzmann thrombasthenia 5. Von Willebrand disease

a. Klippel-Trenaunay syndrome

Osteonecrosis of the capitate bone is most closely associated with which of the following scenarios? 1. Perilunate dislocation 2. Scapholunate advanced collapse 3. Trans-scaphoid, perilunate fracture dislocation 4. Trans-scaphoid, trans-capitate, perilunate fracture-dislocation 5. Volar intercalated segmental instability

d. Trans-scaphoid, trans-capitate, perilunate fracture-dislocation

A 37 years of age female presents with foot pain. Radiographs demonstrate medial collapse of the navicular bone with a resultant comma shape configuration. Which of the following eponyms represents this condition? 1. Brailsford disease 2. Dietrich disease 3. Friedrich disease 4. Iselin disease 5. Mueller-Weiss disease

e. Mueller-Weiss disease

Which of the following conditions is often mistaken for osteogenesis imperfecta due to radiographic evidence of bowing of the bones and clinical evidence of ligamentous laxity, but can be distinguished by the presence of deafness and the absence of blue sclerae and dental abnormalities? 1. Dysspondylochondromatosis 2. Familial idiopathic Hyperphosphatasia 3. Hereditary gnathodiaphyseal sclerosis 4. Osteoglophonic dysplasia 5. Osteoporosis pseudoglioma syndrome

e. Osteoporosis pseudoglioma syndrome

Which of the following is associated with the drumstick configuration of the metacarpals? 1. Frostbite 2. Myelofibrosis 3. Oxalosis 4. Radiation changes 5. Systemic mastocytosis

c. Oxalosis

In the case of long tubular bone involvement of Paget disease in the osteolytic phase, which of the following sections of bone almost invariably represents the site of origin? 1. Apophysis 2. Diaphysis 3. Epiphysis 4. Metaphysis 5. Physeal scar

c. Epiphysis

A 62 years of age female presents with right hip pain and foot pain with recent soft tissue swelling. Clinical history provides a history of chronic renal disease and a history of osteoporosis. Clinical evaluation yields a hard mass adjacent to the femoroacetabular joint. Radiographs of the foot demonstrate periosteal new bone formation at the metatarsals and periarticular calcification at the ankle. Which of the following is the most appropriate conclusion? 1. Aluminum toxicity from dialysate 2. Milk-alkali syndrome 3. Polyarteritis nodosa 4. Renal osteodystrophy 5. Thyroid acropachy

d. Renal osteodystrophy

A 16 years of age female presents with proximal wrist pain. She is approaching the diagnostic criteria but not meeting the criteria for dwarfism. Radiographs demonstrate fused physes, periarticular calcification about the wrist, a short curved 1^st metacarpal, a short 4^th metacarpal, and a poorly defined exostosis extending directly perpendicular from the lateral aspect of the distal radial metadiaphysis. Which of the following is the most appropriate conclusion? 1. Hyperthyroidism 2. Hypervitaminosis D 3. Hypoparathyroidism 4. Hypopituitarism 5. Pseudohypoparathyroidism

e. Pseudohypoparathyroidism

A 34 years of age female presents with rapidly worsening back pain near the thoracolumbar junction. Clinical evaluation yields the presence of hirsuitism, generalized obesity, short stature, and bruising on the hands and wrists are also noticed. Radiographs of the spine demonstrate severe generalized osteopenia, while T11 demonstrates partial loss of vertebral body height and an intra-vertebral vacuum cleft. Which of the following is the most appropriate conclusion? 1. Addison disease 2. Cushing disease 3. Hypoparathyroidism 4. Hypothyroidism 5. Pseudohypoparathyroidism

b. Cushing disease

A 12 years of age male presents progressive worsening mid back and low back pain. The patient also has had a mild intermittent cough that has been slowly progressive over the past 4 weeks. Clinically noted is the small stature of the patient and skin pigmentation. The patient has new imaging for review from their primary care physician. A chest CT was performed which upon review yields a small calcified granuloma, prominent costal cartilage calcification, and calcification of the adrenal glands which were included in the study. Which of the following is the likely conclusion? 1. Addison disease 2. Hypothyroidism 3. Primary Hemochromatosis 4. Pseudohypoparathyroidism 5. Whipple disease

a. Addison disease

A 13 years of age male presents with bilateral hip pain. Clinical evaluation yields the presence of overdeveloped muscles, accelerated maturation, and decreased subcutaneous fat. Also noted was an enlarged abdomen which upon palpation yielded hepatosplenomegaly. Which of the following is most likely? 1. Cerebral gigantism 2. Hyperthyroidism 3. Lipoatrophic diabetes 4. Pituitary gigantism 5. Proteus syndrome

c. Lipoatrophic diabetes

What percent of patients with caudal regression syndrome have a diabetic mother? 1. 1 2. 20 3. 45 4. 75 5. 90

b. 20

A 53 years of age male presents with a slowly growing, hard, shoulder mass. History reveals chronic high levels of serum calcium, normal urinary calcium levels, and self reported chronic indigestion that has been self managed with over the counter methods. Radiographs demonstrate large calcified periarticular mass and ligamentous calcification. Which of the following is the appropriate diagnosis? 1. Addison disease 2. Burnett syndrome 3. Cope syndrome 4. Fluorine toxicity 5. Toxemia

b. Burnett syndrome

Which of the following is least appropriate as a differential consideration for a band-like pattern of acro-osteolysis? 1. Epidermolysis bullosa 2. Hajdu-Cheney disease 3. Hyperparathyroidism 4. Polyvinyl chloride toxicity 5. Rothmund syndrome

a. Epidermolysis bullosa

Although there are some inconsistencies in the value of the heel-pad thickness measurement in acromegaly, if other causes of thickening are excluded, according to Resnick, what is the accepted measurement in men that suggests a diagnosis of acromegaly? a. 21.5 mm b. 23 mm c. 27 mm d. 30 mm

b. 23 mm

In a patient with eosinophilic granuloma, what does a radiodense focus within a lytic cranial lesion represent? a. target lesion b. button sequestrum c. rain-drop skull d. geographic skull

b. button sequestrum

Although any skeletal site may be involved with eosinophilic granuloma, which area is uncommonly affected? a. mandible b. ribs c. small bones of hands and feet d. long bones

c. small bones of hands and feet

What is a common feature of skull lesions in eosinophilic granuloma, due to non-uniform growth of the lesion? a. surrounding sclerosis b. soft tissue mass c. beveled edges d. extension across sutures

c. beveled edges

In long tubular bones, where is a rare location for lesions of eosinophilic granuloma to arise in? a. cortex b. epiphysis c. medullary cavity d. diaphysis

a. cortex

What percentage of patients with eosinophilic granuloma is thought to eventually develop multiple osseous and extra-osseous lesions? a. 10% b. 25% c. 50% d. 70%

a. 10%

Which of the following is not part of the "classic triad" of Hand-Schuller-Christian disease? a. diabetes insipidus b. exophthalmos c. destructive bone lesions d. hepatosplenomegaly

d. hepatosplenomegaly

In what approximate percentage of patients does the "classic triad" of Hand-Schuller-Christian disease actually occur? a. 1% b. 10% c. 20% d. 37.5%

b. 10%

In what percentage of patients is the skull involved in Hand-Schuller-Christian disease? a. 25% b. 50% c. 75% d. over 90%

d. over 90%

What is the term for the appearance of the skull in Hand-Schuller-Christian disease, where confluent areas of destruction may isolate islands of bone? a. floating skull b. osteoporosis eosinophilica c. geographic skull d. beveled skull

c. geographic skull

What distinguishes Hand-Schuller-Christian disease from eosinophilic granuloma? a. ethnicity of affected patients b. multiplicity of lesions and organ involvement c. lack of progression d. presence of "floating teeth"

b. multiplicity of lesions and organ involvement

With what substance are the histiocytes filled in Hand-Schuller-Christian disease? a. cholesterol b. hemosiderin c. albumin d. chocolate

a. cholesterol

At what age is Letterer-Siwe disease most common? a. under 3 years b. between 5 and 10 years c. adolescence d. early adulthood

a. under 3 years

Letterer-Siwe disease makes up what percentage of the histiocytoses? a. 10% b. 20% c. 30% d. 50%

a. 10%

What is the pathologic basis, and generally the cause of death, in Letterer-Siwe disease? a. marrow infiltration and replacement by histiocytes b. cerebral invasion by histiocytes c. histiocytic proliferation of multiple organ systems, leading to progressive anemia d. histiocytic infiltration of the myocardium leading to heart failure

c. histiocytic proliferation of multiple organ systems, leading to progressive anemia

Which of the following radiographic findings in bone is interpreted as a favorable prognostic sign in patients with histiocytosis? a. enlargement of osseous lesions b. patchy, diffuse, or ring-like sclerosis of or around bone lesions c. cortical thickening d. periosteal reaction

b. patchy, diffuse, or ring-like sclerosis of or around bone lesions

Which of the following findings tends to parallel recovery of vertebral body height in healing spinal lesions in patients with histiocytosis? a. recovery of the normal trabecular pattern b. resolution of sclerosis c. recovery of the disc space d. interbody fusion

c. recovery of the disc space

Which of the following injectable substances has recently become popular in the treatment of bone lesions due to histiocytosis? a. gold b. methotrexate c. ascorbic acid d. methylprednisolone

d. methylprednisolone

Which of the following conditions appears to share pathologic, clinical and radiologic features with Hand-Schuller-Christian disease, although it is an uncommon disease process and the average patient is much older? a. Rosai-Dorfman disease b. Erdheim-Chester disease c. Burkitt's lymphoma d. malignant histiocytosis

b. Erdheim-Chester disease

What percentage of patients with pleural mesothelioma may develop secondary hypertrophic osteoarthropathy? a. 5% b. 10% c. 50% d. 85%

c. 50%

What is the most common intrathoracic cause of hypertrophic osteoarthropathy? a. cyanotic congenital heart disease b. bronchogenic carcinoma c. Hodgkin's disease d. metastatic disease

b. bronchogenic carcinoma

Although any area of the skeleton can be used when evaluating cortical bone loss in metabolic bone disease, which bones are usually investigated? a. the proximal femur b. the tubular bones of the hand c. the lumbar spine d. the calcaneus

b. the tubular bones of the hand

Although a certain degree of subperiosteal resorption may be seen with any disease causing high bone turnover, when extensive, it is pathognomonic for which disorder? a. osteoporosis b. hyperparathyroidism c. reflex sympathetic dystrophy syndrome d. osteogenesis imperfecta

b. hyperparathyroidism

Subchondral bone loss may be seen within joints in osteoporosis. Which disease is mimicked by marginal subchondral bone resorption? a. septic arthritis b. tuberculous arthritis c. rheumatoid arthritis d. psoriatic arthritis

c. rheumatoid arthritis

When osteoporosis-related subchondral bone resorption occurs centrally within a joint, which of the following findings allows differentiation from osteonecrosis? a. lack of joint space narrowing b. absence of significant bony collapse c. absence of cortical thinning d. presence of subchondral sclerosis

b. absence of significant bony collapse

When using magnetic resonance imaging in the analysis of pelvic insufficiency fractures, the resulting altered signal intensity is similar to that seen in skeletal metastasis. Which of the following would tend towards an insufficiency fracture rather than an aggressive lesion? a. disruption and fragmentation of the cortex b. the absence of a discrete soft tissue mass c. the rarity of skeletal metastasis in the pelvis d. it is impossible to differentiate the two without a biopsy

b. the absence of a discrete soft tissue mass

b. long-standing hypocalcemia leading to parathyroid hyperplasia

Which of the following findings are rare in renal osteodystrophy, but not infrequent in primary hyperparathyroidism? a. brown tumors b. osteosclerosis c. chondrocalcinosis d. periostitis

c. chondrocalcinosis

What percentage of children with renal osteodystrophy demonstrate slipped epiphyses? a. 10% b. 25% c. 50% d. 75%

a. 10%

Which of the following arthritic conditions may develop secondary to the biochemical abnormalities of renal osteodystrophy? a. calcium hydroxyapatite crystal deposition disease b. Milwaukee shoulder c. Wilson's disease d. gouty arthritis

d. gouty arthritis

Name an additional finding in the skull and face in hypoparathyroidism. a. exophthalmos b. hypertelorism c. hypoplastic dentition d. widened mandibular angle

c. hypoplastic dentition

Which of the following findings of hypervitaminosis D is characteristic of adults rather than children? a. alternating dense and lucent metaphyseal bands b. cortical thickening due to periosteal apposition c. widespread osteosclerosis d. massive soft tissue calcification

d. massive soft tissue calcification

Which of the following patient groups are especially susceptible to hypervitaminosis D? a. hemophiliacs b. patients who experience limited exposure to sunlight c. patients with pre-existing renal or gastrointestinal disorders d. Trevor (patient with congenital/ acquired syphilis)

c. patients with pre-existing renal or gastrointestinal disorders

The most common skeletal manifestation of hypervitaminosis D in adults is? a. dense metaphyseal bands b. massive soft tissue calcification c. focal or generalized osteoporosis d. cortical thickening due to periosteal apposition

c. focal or generalized osteoporosis

Which of the following skeletal manifestations may be seen in hypovitaminosis A occurring in infancy? a. early closure of cranial sutures b. widening of tubular bones c. epiphyseal overgrowth d. widening of cranial sutures due to increased intracranial pressure

d. widening of cranial sutures due to increased intracranial pressure

In hypervitaminosis A, which tubular bones most commonly demonstrate hyperostosis? a. ulnae and metatarsal bones b. femora and metacarpals c. ribs d. maxilla and mandible

a. ulnae and metatarsal bones

Which of the following conditions most resembles chronic hypervitaminosis A? a. diffuse idiopathic skeletal hyperostosis b. infantile cortical hyperostosis c. diaphyseal dysplasia d. metaphyseal chondrodysplasia

b. infantile cortical hyperostosis

Scurvy in infants is generally detected at what age? a. under 4 months b. between 4 and 8 months c. between 8 and 14 months d. at any time after birth

c. between 8 and 14 months

In contrast to skeletal manifestations in children, which of the following findings may be seen with scurvy in adults? a. hemarthrosis b. subperiosteal hemorrhage c. petechial hemorrhages d. metaphyseal excrescences

a. hemarthrosis

In addition to Freiberg's infarction, what other disease may cause osteonecrosis of the metatarsal head? a. scleroderma b. systemic lupus erythematosus c. Sjogren's syndrome d. dysbaric osteonecrosis

b. systemic lupus erythematosus

Which of the following is commonly associated with negative ulnar variance? a. Preiser's disease b. Panner's disease c. Keinbock's disease d. Iselin's disease

c. Keinbock's disease

Which of the following is not a complication of lunatomalacia? a. scapholunate dissociation b. secondary degenerative joint disease of the wrist c. inferior prolapse of the capitate d. ulna minus variant

d. ulna minus variant

Which two of the following are thought to represent an alteration in the normal ossification sequence, rather than a true osteonecrosis? (Mark both choices.) a. Kohler's disease b. Legg-Calve-Perthes disease c. Thiemann's disease d. Panner's disease e. Chandler's disease

a. Kohler's disease d. Panner's disease

What percentage of Osgood-Schlatter's disease occurs bilaterally? a. 1 - 5% b. 5 - 10% c. 10 - 20% d. 25%

d. 25%

Which finding is fundamental to the radiographic diagnosis of Osgood-Schlatter's disease? a. soft tissue swelling b. fragmentation of the tibial apophysis c. complete avulsion of the tibial apophysis d. fragmentation of the inferior pole of the patella

a. soft tissue swelling

The pelvis may undergo osseous deformity in rickets, when the hip and the spine intrude into the soft pelvic bones. The resultant deformity is known as? a. champagne glass pelvis b. triradiate configuration c. Otto's pelvis d. pelvic outlet constriction

b. triradiate configuration

The "rachitic rosary" is most commonly seen at the costochondral junctions of which ribs? a. the upper ribs b. the middle ribs c. the lower ribs d. at all costochondral junctions

b. the middle ribs

There are four zones or areas of metabolic and growth activity within the normal bony growth plates of children. Which of these zones is grossly abnormal in rickets, resulting in widening of the growth plate? a. the reserve zone b. the hypertrophic zone and all its sub-zones c. the proliferating zone d. the zone of maturation

d. the zone of maturation

Concave impressions on the vertebral endplates may be seen in rickets, caused by expansion of the intervertebral discs. How may this be differentiated from osteoporosis? a. in rickets, most vertebral bodies are involved to a similar degree b. in rickets, only a few adjacent levels are involved c. in osteoporosis, these findings invariably lead to vertebral collapse d. differentiation is not possible with respect to this radiographic finding

a. in rickets, most vertebral bodies are involved to a similar degree

The osseous changes of rickets are most obvious in regions of most active growth in a skeletally immature individual. Which of the following skeletal areas would therefore show the best radiographic evidence of rickets? a. costochondral junctions of the middle ribs b. the distal part of the femur c. the proximal portion of the humerus d. the distal end of the ulna and radius

a. costochondral junctions of the middle ribs

With respect to the organ where hydroxylation of vitamin D3 at the carbon 25 position occurs, patients with which of the following diseases are particularly susceptible to osteomalacia? a. emphysema b. renal failure c. multiple myeloma d. primary biliary cirrhosis

d. primary biliary cirrhosis

c. anticonvulsants

What is the most common form of renal tubular rickets/ osteomalacia? a. X-linked hypophosphatemia b. vitamin-D resistant rickets c. hereditary vitamin-D dependent rickets d. Fanconi's anemia

a. X-linked hypophosphatemia

Which of the following neoplasms is most frequently found to lead to oncogenic osteomalacia, as determined by histological analysis? a. non-ossifying fibroma b. hemangiopericytoma c. giant cell tumor d. hemangioendothelioma

b. hemangiopericytoma

Which of the following benign bone tumors is most commonly associated with oncogenic osteomalacia? a. non-ossifying fibroma b. hemangiopericytoma c. giant cell tumor d. hemangioendothelioma

a. non-ossifying fibroma

The diseases named below all predispose patients to osteonecrosis. In which of these is the femoral head an uncommon location? a. renal transplantation b. chronic panreatitis c. alcoholism d. pregnancy

b. chronic panreatitis

In the staging of osteonecrosis of the femoral head, which stage demonstrates the crescent sign? a. Stage I b. Stage II c. Stage III d. Stage IV

c. Stage III

According to Resnick, how many osteoporosis-related fractures occur annually in the United States in women over 45? a. Half a million b. 1 million c. 5 million d. 10 million

b. 1 million

There is a normal difference in vertical height between the anterior and posterior aspect of the thoracic vertebral body, caused by a slight prominence of the vertebral body anterior to the superior rib facet. Taking this normal prominence into account, a true vertebral compression is considered to be present if this difference exceeds: a. 2 mm b. 4 mm c. 6 mm d. if the anterior and posterior vertebral body heights are equal

b. 4 mm

Although all of the following alterations in vertebral shape may be seen in osteoporosis, which of these actually indicates that a fracture of the vertebral body has occurred? a. wedge-shaped vertebral body b. fish vertebra c. cartilaginous node formation d. H vertebra

a. wedge-shaped vertebral body

Given that estrogen is known to inhibit bone resorption, which of the following congenital syndromes is likely to exhibit osteoporosis? a. Down's syndrome b. Klinefelter's syndrome c. Noonan's syndrome d. Turner's syndrome

d. Turner's syndrome

According to Resnick, which of the following clinical complications of senile or postmenopausal osteoporosis is unusual? a. neurologic complications b. bone pain c. abnormal laboratory values such as serum calcium or phosphorus d. transcervical and subtrochanteric femoral fractures

a. neurologic complications

Which of the following disorders represents a high-turnover osteoporosis characterized by urinary loss of calcium and phosphorus without a compensatory increase in intestinal calcium absorption? a. hyperparathyroidism b. osteoporosis of immobilization or disuse c. Paget's disease d. idiopathic juvenile osteoporosis

b. osteoporosis of immobilization or disuse

What percentage of all cases of hypertrophic osteoarthropathy is made up by primary HOA, also known as pachydermoperiostosis? a. 3-5% b. 10% c. 25% d. more than 50%

a. 3-5%

What is the most common age at onset, race and gender of patients with pachydermoperiostosis? a. adult white females b. adolescent white females c. adolescent black males d. adult black males

c. adolescent black males

What percentage of the disorder described in the following paragraph is caused by traumatic injuries: "a neural-based disorder, thought to be related to overactivity of the sympathetic nervous system, which characteristically affects the shoulder and hand; clinical findings include stiffness, pain, weakness, swelling, vasomotor changes and hyperesthesia; radiographic alterations include soft tissue swelling and regional osteoporosis". a. 5 % b. 50% c. 75% d. 95%

a. 5 %

In what percentage of patients is thyroid acropachy seen, after treatment for hyperthyroidism? a. 0.5 to 1% b. 20 to 40% c. 40 to 60% d. 80 to 100%

a. 0.5 to 1%

Which area is most commonly affected by periostitis due to chronic venous insufficiency? a. any bone may be involved b. any bone may be involved but it is most common in the lower extremity c. the lower extremity is affected almost exclusively d. the ankles and feet only

c. the lower extremity is affected almost exclusively

Name a common complication of chronic venous stasis? a. varicose veins b. skin ulceration c. pathologic fracture d. osteoporosis

b. skin ulceration

Hematopoietic, Endocrine, Metabolic, and Nutritional Disorders I & II Flashcards

(364 cards)