Infection I & II Flashcards by Jojo Barnes-Jones

Osteomyelitis on MR T1-weighted spin-echo image intensity produces a:

a. low signal
b. high signal
c. variable signal
d. intermediate signal

a. low signal

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Which of the following vascular anatomic description is characteristic for children over 1 year old?

a. There is no vascular connection between the epiphysis and the metaphysis.
b. A vascular connection between the metaphysis and epiphysis exists.
c. The vascular supply of the epiphysis originates in the metaphysis.
d. The vascular supply of the epiphysis originates in the growth plate.

a. There is no vascular connection between the epiphysis and the metaphysis.

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Radiolucent linear or netlike collections seen on radiographs within the subcutaneous or muscular tissues should warrant further investigation for…

a. Tuberculosis
b. Syphilis
c. Gas gangrene
d. Pasteurella infections

c. Gas gangrene

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The presence of pustulosis palmaris, sternoclavicular hyperostosis and recurrent osteomyelitis in a child should warrant further investigation to rule out…

a. Chronic granulomatous disease
b. SAPHO syndrome
c. Sacoidosis
d. Carinoid tumor

b. SAPHO syndrome

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Osteomyelitis leading to destruction of the distal tuft and diaphysis of the terminal phylanx with relative sparing of the phalangeal base is a possible complication seen with…

a. a melon
b. a pelon
c. a felon
d. belon

c. a felon

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The direction of contamination in hematogenous osteomyelitis is

a. from the soft tissue inward toward the bone
b. from the bone outward into soft tissue
c. from the growth plate into the diaphysis
d. from the spinal canal to the bone

b. from the bone outward into soft tissue

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The term sinus tract refers to:

a. An opening in the involucrum, through which pus may be discharged outside the bone
b. An opening between the skin surface and the bone
c. An opening between an infected epiphysis and an adjacent synovial joint.
d. A segment of necrotic bone that is separated from living bone by granulation tissue

b. an opening between the skin surface and the bone

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Which of the following clinical presentation of hematogenously spread osteomyelitis is true?

a. Childhood osteomyelitis is always associated with sudden onset of high fever, a toxic state, and local signs of inflammation.
b. As many 50% of children with osteomyelitis have vague complaints, including local pain of 1 to 3 months’ duration with minimal if any temperature elevation.
c. In the infant, hematogenous osteomyelitis often leads to very dramatic findings, including pain, swelling, high-grade fever, nausea, unwillingness to move the affected bones and loss of consciousness.
d. The adult form of hematogenous osteomyelitis usually has a rapid onset with a relatively short period between the appearance of symptoms and signs and accurate diagnosis.

b. As many 50% of children with osteomyelitis have vague complaints, including local pain of 1 to 3 months’ duration with minimal if any temperature elevation.

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The breakdown of soft tissue that occurs in debilitated persons who maintain a single position for long periods is referred to as a

a. callus
b. pelvic sequestrum
c. decubitus ulcer
d. none of the above

b. pelvic sequestrum

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In the young patient population (infants and children), hematogenous osteomyelitis more commonly affects which of the following bones?

a. skull
b. spine
c. long bones of the extremities
d. short tubular of the extremities

c. long bones of the extremities

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A slowly progressive vertebral destruction with preservation of intervertebral discs, subligamentous spread of infection with erosion of anterior vertebral margins, large and calcified soft tissue abscesses, and the absence of severe bony eburnation are the radiographic signs associated with:

a. pyogenic spondylitis
b. suppurative spondylitis
c. tuberculous spondylitis
d. staphylococcal spondylitis

c. tuberculous spondylitis

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The term osteomyelitis refers to:

a. infection of the cortical bone
b. infection of the marrow
c. infection of the bone and marrow
d. infection of the bone and adjacent soft tissues

c. infection of the bone and marrow

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Spontaneous atlantoaxial subluxation that accompanies inflammation of neighboring soft tissues (rhinopharyngitis) seen mainly in children is termed?

a. Grisel’s syndrome
b. Jones’ syndrome
c. McGreggor’s syndrome
d. Julius’ syndrome

a. Grisel’s syndrome

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Staphylococcus aureus, group B streptococcus, and Escherichia coli are the bone isolates recovered most frequently in osteomyelitis affecting which of the following age group?

a. Neonate or infant
b. Children over the age of 1 year and less than 4 years
c. Children older than 4 years
d. Teenagers

a. Neonate or infant

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Human infection with animal exposure, bites, or scratches is associated with:

a. Brucella
b. Yersinia
c. Pasteurella
d. Klesiella

c. Pasteurella

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Brodie’s abscess are found more commonly in children, typically in boys and particularly in the

a. femur
b. tibia
c. radius
d. humerus

b. tibia

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Which of the following is true regarding childhood discitis?

a. Hematogenous contamination of the discal tissue is possible.
b. When positive, blood or bone biopsy culture most typically reveals Mycobacterium tuberculosis.
c. Radiographic changes are the most frequent in the cervical spine.
d. Intervertebral disc space narrowing is seen radiographically after the erosion of the subchondral bone plate and osseous eburnation.

a. Hematogenous contamination of the discal tissue is possible.

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A sharply delineated focus of active/subacute infection usually surrounded by eburnated bone is termed?

a. Sclerosing osteomyelitis of Garre
b. Chronic recurrent ostemyelitis
c. Bone abscess (Brodie’s abscess)
d. Acute infective hyperostosis

c. Bone abscess (Brodie’s abscess)

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Because of the anatomic arrangement of the ___ joint, osteomyelitis localized to the metaphysis can enter the joint by extending laterally without violating the growth plate.

a. ankle
b. knee
c. hip
d. elbow

c. hip

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Pott’s puffy tumor refers to…

a. An indolent soft tissue swelling of the scalp that is due to osteoyelitis of frontal bone
b. An osteomyelitis of the maxillary bone resulting from maxillary sinusitis
c. An expansile focus of tuberculous osteomyelitis of the spine
d. Both a and b are correct

a. An indolent soft tissue swelling of the scalp that is due to osteomyelitis of frontal bone

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The radiographic latent period for spinal osteomyelitis/spondylodiscitis is approximately

a. 3 days
b. 3 weeks
c. 3 months
d. 3 years

b. 3 weeks

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The term infective (suppurative) osteitis refers to:

a. infection of the cortical bone
b. infection of the marrow
c. infection of the bone and marrow
d. infection of the bone and adjacent soft tissues

a. infection of the cortical bone

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The most common joints affected by septic arthritis in infants, children and adults are…

a. knee and hip
b. ankle and knee
c. hip and shoulder
d. knee and shoulder

a. knee and hip

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Sequential contamination of the tendon sheath of the fifth finger, ulnar bursa, radial bursa, and first finger produces…

a. The devil sign
b. The U or V sign of Pimenti
c. The horseshoe abscess
d. The common flexor sign

c. The horseshoe abscess

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**The presence of gas in the soft tissues of the foot can be due any of the following agents but one. Which of the following agent does not produce gas as an end result of its metabolic activity?** a. Clostridium perfringens b. Escherichia coli c. Staphylococcus aureus d. Klebsiella pneumoniae

**c. Staphylococcus aureus**

**Subperiosteal abscess formation, extensive periostitis, and involucrum formation are relatively usual manifestations of osteomyelitis in which of the following age group?** a. Infants b. Children c. Adults d. People over 200 years old

**c. Adults**

**Radiographic signs of activity in chronic osteomyelitis:** a. thin, linear periostitis b. sequestration c. poorly defined areas of osteolysis d. all of the above

**d. all of the above**

**In patients with sickle cell disease, what organism is seen with higher incidence over the general populace?** a. Klebsiella b. Salmonella c. Shigella d. Pseudomonas

**b. Salmonella**

**The term involucrum refers to:** a. A fractured bony fragment displaced away from its parent bone caused by osteomyelitis. b. A layer of living bone that has formed around the dead bone. c. An opening between the skin surface and the bone. d. A segment of necrotic bone that is separated from living bone by granulation tissue.

**b. A layer of living bone that has formed around the dead bone.**

**The clinical presentation of vascular insufficiency, neurologic deficit, soft tissue swelling and mottled osteolysis of the foot should warrant an investigation to rule out...** a. Hypertrophic osteoarthropathy b. Acral metastasis c. Diabetes mellitus d. Psoriatic arthritis

**c. Diabetes mellitus**

**Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae are responsible for most cases of hematogenous osteomyelitis in which of the following age group?** a. Neonate or infant b. Children over the age of 1 year old and less than 4 years c. Children older than 4 years d. Teenagers

**b. Children over the age of 1 year old and less than 4 years**

**Which of the following is not commonly seen in tuberculous arthritis?** a. soft tissue swelling b. osteoporosis c. fast progression d. late joint space loss

**c. fast progression**

**An increase in the medial joint space of the hip by over 2 mm compared with the contralateral side and/or a joint space measuring more than 11 mm is known radiographically as...** a. Turret's sign b. Obturator sign c. Waldenstrom's sign d. Gluteus medius sign

**c. Waldenstrom's sign**

**Muscle enlargement, abscesses, subcutaneous edema and hard, "woody" induration of the overlying skin are characteristic of...** a. pyomyositis b. necrotizing fasciitis c. cellulitis d. tenosynovitis

**a. pyomyositis**

**A sclerotic non-purulent form of osteomyelitis characterized by intense proliferation of the periosteum leading to bony deposition is termed?** a. sclerosing osteomyelitis of Garre b. chronic recurrent non-suppurative osteomyelitis c. bone abscess (Brodie's abscess) d. acute non-infective hyperostosis

**a. sclerosing osteomyelitis of Garre**

**The combination of rapid loss of intervertebral disc height and adjacent lysis of bone is most suggestive of...** a. metastatic disease b. multiple myeloma c. infective spondylitis d. osteoporosis

**c. infective spondylitis**

**Cutaneous, sinus, and dental infections are three important sources for which of the following contamination route?** a. hematogenous b. spread from a contiguous source c. occasional contamination d. direct implantation

**b. spread from a contiguous source**

**A metaphyseal infection of the proximal portion of the humerus spreading through the adjacent cortex can contaminate the glenohumeral joint by extending along the tendon of the...** a. Supraspinatus b. Infraspinatus c. Subscapularis d. Long head of the biceps

**d. Long head of the biceps**

**Septic arthritis is more commonly...** a. a polyarticular condition b. a monoarticular condition c. a sexually transmitted condition d. a disease of the sexually inactive

**b. a monoarticular condition**

**Expansile tuberculous dactylitis has also been termed...** a. hand-foot syndrome b. sausage digit c. spina ventosa d. scrofula

**c. spina ventosa**

**Sacroiliac joint infections are usually...** a. bilateral and symmetric b. bilateral and asymmetric c. unilateral d. Both a and b are correct

**c. unilateral**

**Hematogenous ostemyelitis of children over 1 year old is encountered more frequently in which of the following portion of a bone?** a. epiphysis b. metaphysis c. diaphysis d. both a and b are equal in frequency

**b. metaphysis**

**During a magnetic resonance imaging scan with gadolinium contrast performed on a patient suspected to have ostemyelitis, the presence of a ring enhancing lesion of high signal intensity on T1-weighted images with a low signal center most likely represents a/an...** a. sequestrum b. involucrum c. cloaca d. abscess

**d. abscess**

**Acute inflammatory process of the deeper subcutaneous tissues resulting generally from a streptococcal or, less commonly, a staphylococcal infection, leading to pain or tenderness, redness, swelling, warmth, and mild to moderate fever is known as...** a. pyomyositis b. necrotizing fasciitis c. cellulitis d. tenosynovitis

**c. cellulitis**

**Septic spondylitis most typically involves the** a. cervical spine b. thoracic spine c. lumbar spine d. sacroiliac joints

**c. lumbar spine**

**When septic arthritis is considered in a differential diagonsis, which following diagnostic procedure should be recommended?** a. joint aspiration with subsequent culture b. bone scintigraphy c. conventional tomography d. computerized tomography

**a. joint aspiration with subsequent culture**

**Paronychia is...** a. an infection of the hair bed b. a loculated abscess of the dermal portion of the skin c. a subcuticular abscess of the nail fold d. an inflected mole

**c. subcuticular abscesses of the nail fold**

**When performing a scintigraphic evaluation for the presence of osteomyelitis, the advantage of the agent 67 Ga-citrate over 99 mm Tc-methylene diphosphonate is** a. It is sensitive to osteoblastic activity b. It binds with leukocytes c. It is dependent on the increased localized blood flow d. It is cheaper to use

**b. It binds with leukocytes**

**The term cloaca refers to:** a. an opening in the involucrum, through which pus may discharged outside the bone b. an opening between the skin surface and the bone c. an opening between an infected epiphysis and an adjacent synovial joint d. a layer of living bone that has formed around the dead bone

**a. an opening in the involucrum, through which pus may discharged outside the bone**

**The term sequestrum refers to:** a. A fractured bony fragment displaced away its parent bone caused by osteomyelitis b. A layer of living bone that has formed around the dead bone c. A connection between two infected organs d. A segment of necrotic bone that is separated from living by granulation tissue

**d. A segment of necrotic bone that is separated from living by granulation tissue**

**The presence periarticular osteoporosis, marginal joint erosions and slow progressive joint space loss is know as...** a. Ritter's triad b. Phemister's triad c. Webster's triad d. Foley's triad

**b. Phemister's triad**

**Which of the following does not represent a contamination route for osteomyelitis?** a. Hematogenous b. Spread from a continguous source c. Occasional contamination d. Direct implantation

**c. Occasional contamination**

**Which of the following is false about septic arthritis?** a. Rapid destruction of bone and cartilage is characteristic of bacterial arthritis b. In tuberculous arthritis, marginal osseous erosions with preservation of joint space and periarticular osteoporosis can be prominent. c. Osseous erosions at the edges of the joint related to the effects of diseased synovium on bone, lead to marginal defects that are similar in appearance and location to those of rheumatoid arthritis. d. Bony ankylosis of the joint is not characteristic of late-stage chronic pyogenic arthritis.

**d. Bony ankylosis of the joint is not characteristic of late-stage chronic pyogenic arthritis.**

**Which of the following choices does not represent a possible complication of osteomyelitis?** a. Growth disturbances b. Neoplasms c. Amyloidosis d. All of the above are possible complications

**d. All of the above are possible complications**

**The ulcerative channel and malignant transformation found with chronic osteomyelitis is referred to as a(n)** a. Phemisters pathway b. cloaca c. Marjolin's ulcer d. sinus tract

**c. Marjolin's ulcer**

**Which of the following joints is less likely to be affected by septic arthritis in the drug abuser?** a. sacroiliac b. sternoclavicular c. acromioclavicular d. ankle

**a. ankle**

**A cortical abscess can be radiographically visualized as a lucent lesion with surrounding sclerosis and periostitis. This appearance can stimulate which of the following conditions?** a. Osteoid osteoma b. Stress fracture c. non-ossifying fibroma d. Both a and b are correct

**d. Both a and b are correct**

**Vascular patterns of hematogenous infection in tubular bones of a child typically involve(s) the** a. epiphysis and metaphysis b. epiphysis c. diaphysis and metaphysis d. none of the above

**c. diaphysis and metaphysis**

**The sudden onset of lower limb paraplegia in spinal tuberculosis is referred to as** a. Pott's paraplegia b. Saunder's paraplegia c. Phemister's paraplegia d. Waldenstrom's paraplegia

**a. Pott's paraplegia**

**The most common joints affected by skeletal tuberculosis are...** a. The spine, ankle, shoulder b. The spine, hip, knee c. The shoulder, ankle, knee d. The wrist, hip, knee

**b. The spine, hip, knee**

**A 9 year old afebrile male presents to a clinic with right leg pain of 2 months duration with no prior history of trauma. Conventional radiographs demonstrated a radiolucent metaphyseal focus of the right distal femur, associated soft tissue swelling and no periosteal reaction. Which diagnosis does this presentation suggest?** A. Brodie’s abscess B. Hematogenous osteomyelitis C. Osteosarcoma D. Ewing sarcoma E. Lymphoma Bone and Joint Imaging (3rd ed.) Donald Resnick and Mark Kransdorf. (pg. 716-717)

**B. Hematogenous osteomyelitis**

**A 9-year-old afebrile male presents with right leg pain of 2 months duration with no prior history of trauma. Conventional radiographs demonstrated a radiolucent metaphyseal focus of the right distal femur, associated soft tissue swelling, and no periosteal reaction. What advanced imaging modality is recommended for further evaluation of this region?** A. MRI B. Computed tomography C. Ultrasound D. Bone Scan E. MRA

**A. MRI**

**A 9-year-old afebrile male presents to a clinic with right leg pain of 2 months duration with no prior history of trauma. Conventional radiographs demonstrated a radiolucent metaphyseal focus of the right distal femur, associated soft tissue swelling, and no periosteal reaction. What is the most common organism associated with this presentation?** A. Mycobacterium tuberculosis B. Escherichia coli C. Pseudomonas D. Haemophilus influenzae E. Staphylococcus aureus Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1373)

**E. Staphylococcus aureus**

**An 11-year-old male presented with intermittent right leg pain and prior history of antibiotic treatment. Previous radiographs demonstrated a radiolucent metaphyseal focus of the right proximal tibia. Follow up studies revealed an increased area of sclerosis surrounding the lesion. These combination of findings are highly suggestive of** A. Brodie’s abscess. B. Hematogenous osteomyelitis. C. Osteosarcoma. D. Ewing sarcoma. E. Lymphoma. Bone and Joint Imaging (3rd ed.) By Donald Resnick and Mark Kransdorf. (pg. 720)

**A. Brodie’s abscess**

**An 11-year-old male presented with intermittent right leg pain and prior history of antibiotic treatment. Previous radiographs demonstrated a radiolucent metaphyseal focus of the right proximal tibia. Follow up studies revealed an increased area of sclerosis surrounding the lesion. Which diagnosis is this diagnosis suggestive of?** A. Brodie’s abscess B. Hematogenous osteomyelitis C. Osteosarcoma D. Ewing sarcoma E. Lymphoma Bone and Joint Imaging (3rd ed.) By Donald Resnick and Mark Kransdorf. (pg. 720)

**A. Brodie’s abscess**

**A patient presents to a clinic with tenderness, pain, fusiform swelling, with his second digit in a semiflexed position. The patient history revealed a puncture wound located in the flexor crease of 2nd proximal interphalangeal joint. This presentation is highly characteristic and suggestive of** A. stenosing tenosynovitis B. septic arthritis C. infective digital tenosynovitis D. volkman contracture E. floor fasciitis Bone and Joint Imaging (3rd ed.) Donald Resnick and Mark Kransdorf. (pg. 720)

**C. infective digital tenosynovitis**

**A conventional radiographic study of a 55-year-old diabetic female’s right foot demonstrates a loss of soft tissue over the great toe, radiolucent shadows of the surrounding soft tissues, and mottled osteolysis of the underlying phalanx. These findings are most commonly associated with which route of contamination?** A. Hematogenous spread B. Spread from a contiguous source C. Direct implantation D. Postoperative infection E. Indirect spread Bone and Joint Imaging (3rd ed.) Donald Resnick and Mark Kransdorf. (pg. 721)

**C. Direct implantation**

**A conventional radiographic study of a 55-year-old diabetic female right foot demonstrates loss of soft tissue over the great toe, mottled radiolucent shadows in the surrounding soft tissues, and mottled osteolysis of the underlying phalanx. These findings are most frequently associated with which causative agent?** A. Klebsiella B. Mycobacterium tuberculosis C. Streptococcus Pyogenes D. MRSA E. Pseudomonas aeroginosa Bone and Joint Imaging (3rd ed.) Donald Resnick and Mark Kransdorf. (pg. 724) (pg. 721)

**E. Pseudomonas aeroginosa**

**The most common cause of human bite injury is** A. a fist blow to the mouth B. an animal bite C. a seizure D. self-inflicted E. an insect bite Bone and Joint Imaging (3rd ed.) Donald Resnick and Mark Kransdorf. (pg. 724)

**A. a fist blow to the mouth**

**Approximately 5% of dog bites and 20-50% of cat bites become infected. The infecting organisms vary, however the most common implicating agent is** A. staph aureus B. klebsiella C. mycobacterium tuberculosis D. pasteurella multocida E. streptococcus pyogenes Bone and Joint Imaging (3rd ed.) By Donald Resnick and Mark Kransdorf. (pg. 724)

**D. pasteurella multocida**

**A 26 year old male presented to a chiropractic office complaining of right knee pain. Physical examination findings revealed a decrease in range of motion, erythema, an altered gait and an elevated temperature. The chiropractor orders radiographs of the involved area which demonstrated a loss of the subchondral cortical bone. This finding is commonly associated as the earliest radiographic manifestation of** A. Tom Smith arthritis B. septic arthritis C. osteoarthritis D. septic tenosynovitis E. tuberculosis Yochum TR, Rowe LJ. Yochum and Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams Wilkins. 3rd ed. 2004. (pg. 1398)

**B. septic arthritis**

**A 26-year-old patient presents to a chiropractic office complaining of right knee pain. Physical examination findings revealed a decrease in range of motion, erythema, an altered gait and an elevated temperature. The chiropractor orders radiographs of the involved area which demonstrated a loss of the subchondral cortical bone. Laboratory investigation will most likely show** A. an increase of leukocytes. B. a decrease in leukocytes. C. a decrease in ESR. D. a decrease in CRP. E. an increase in rheumatoid factor. Yochum TR, Rowe LJ. Yochum and Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams Wilkins. 3rd ed. 2004. (pg. 1392)

**A. an increase of leukocytes.**

**A 32-year-old patient presents to the emergency department with severe low back pain. The patient was unable to provide any clinical history. The attending emergency personnel reported methadone tablets were found on the patient. Radiographs of the lumbar spine revealed loss of the L1/L2 intervertebral disc height, endplate sclerosis, and endplate irregularities. These findings most likely represent what diagnosis?** A. Infectious Spondylodiscitis B. Modic type I degernative changes C. Eosinophilic granuloma D. Schmorl nodes E. Pott’s disease Yochum TR, Rowe LJ. Yochum and Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams and Wilkins. 3rd ed. 2004.

**A. Infectious Spondylodiscitis**

**What specific advanced imaging protocol is recommended for the further evaluation of septic arthritis?** A. T1 weighted MRI B. T2 weighted MRI with contrast C. T1 weighted MRI with contrast, with or without fat suppression D. CT E. DEXA Diagnosis and Bone and Joint Disorders (4th ed.) by Donald Resnick or Bone and Joint Imaging (3rd ed.) By Donald Resnick and Mark Kransdorf. (pg. 741, Table 53-8)

**C. T1 weighted MRI with contrast, with or without fat suppression**

**Muscle spasm, ligament laxity, and synovial effusion are proposed causes related to spontaneous atlantoaxial subluxation in children most likely represents** A. Martucci Syndrome B. Down Syndrome C. Raynaud Syndrome D. Grisel Syndrome E. Klippel feil syndrome Bone and Joint Imaging (3rd ed.) Donald Resnick and Mark Kransdorf. (pg. 743 and Fig 54-2)

**D. Grisel Syndrome**

**A conventional radiographic study of the lumbar spine was performed on a 40-year-old male that presented with chronic low back pain. The images revealed sclerosis, vertebral body height loss and a radiolucent defect in the mid-portion of the L2 vertebrae’s inferior endplate. Advanced imaging revealed a well defined lytic process with embedded calcification and sub ligamentous involvement. These findings most likely suggest what diagnosis?** A. Infectious Spondylodiscitis B. Modic type I degenerative changes C. Eosinophilic granuloma D. Schmorl nodes E. Tuberculous spondylodiscitis Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1399)

**E. Tuberculous spondylodiscitis**

**A 14-year-old male with prior puncture wound to his leg presented to a clinic. Radiographs revealed a geographic lytic lesion of the right tibial diaphysis, a narrow zone of transition accompanied by severe sclerosis expanding the tibial diaphysis. Substantial muscle atrophy and leg length discrepancy were also noted during physical examination. The combination of these findings suggest a(n)** A. acute process. B. non-infectious process. C. cloaca. D. chronic process. E. normal therapeutic response. Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1390)

**D. chronic process.**

**Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) are well known associations of** A. an acute process. B. a non-infectious process. C. cloaca. D. chronic osteomyelitis E. a normal therapeutic response to corticosteroids. Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1390)

**D. chronic osteomyelitis**

**The most common pathogen cultured in cases of childhood inflammatory discitis is** A. klebsiella B. mycobacterium tuberculosis C. streptococcus Pyogenes D. staph aureus E. pseudomonas aeroginosa Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1391)

**D. staph aureus**

**What modality is recommended when further diagnostic evaluation is warranted in the proper visualization of sequestra, cortical erosions, and bony fragmentation?** A. PET scan B. CT C. CXR D. MRI E. DEXA Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1391)

**B. CT**

**End-stage suppurative septic arthritis is characterized on radiographs by** A. fibrous ankylosis. B. bony ankylosis. C. cloaca. D. joint effusion. E. distention of fat pads. Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1392)

**B. bony ankylosis.**

**A conventional radiographic study of a patient’s right hip demonstrates multiple radiolucent streaks in the myofascial planes about the hip and thigh. What is the most common pathogen implicated in this presentation?** A. Clostridium perfinges B. Actinomycosis C. Streptococcus Pyogenes D. Salmonella E. Pseudomonas aeroginosa Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1392)

**A. Clostridium perfinges**

**A conventional radiographic study of a patient’s right hip demonstrates multiple radiolucent streaks within the myofascial planes of the adjacent soft tissue. What is the most common cause of this presentation near a joint?** A. Thorocentesis B. Non-communicating wound C. Arthrocentesis D. Sternal biopsy E. Immobilization Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004.

**C. Arthrocentesis**

**Prognosis of septic arthritis is generally excellent with early detection and intervention. What is an optional recommended treatment of choice in these cases?** A. Bony debridement B. Bone chips C. Cloaca. D. Joint decompression E. St. John’s root Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1392)

**D. Joint decompression**

**A chiropractor has completed the examination of a 29-year-old male patient that presented with an altered gait. There is a clinical suspicion of septic arthritis. The initial plain film was normal. What modality would be recommended considering the latent period associated with radiographic findings of this nature?** A. MR arthrogram B. CT C. MRA D. PET scan E. Gallium-67 scan Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1392)

**E. Gallium-67 scan**

**Progressive and slow joint space narrowing, juxta-articular osteoporosis, and peripheral erosive defects of articular surfaces are highly concerning for a diagnosis of?** A. Septic arthritis B. Gouty arthritis C. Tuberculous arthritis D. Osteoarthritis E. Tuberculous bursitis Yochum TR, Rowe LJ. Yochum & Rowe’s Essentials of Skeletal Radiology. Lippincott, Williams & Wilkins. 3rd ed. 2004. (pg. 1408)

**C. Tuberculous arthritis Phemister's Triad Progressive and slow joint space narrowing, juxta-articular osteoporosis, and peripheral erosions**

**"Kissing sequestrum" are seen with...** A. Syphilis B. Tuberculosis C. Nocardiosis D. Coccidioidomycosis

**B. Tuberculosis**

**The most common joints affected by septic arthritis in infants, children and adults are...** A. Knee and hip B. Ankle and knee C. Hip and shoulder D. Knee and shoulder

**A. Knee and hip**

**The presence periarticular osteoporosis, marginal joint erosions and slow progressive joint space loss is known as...** A. Ritter's triad B. Phemister's triad C. Webster's triad D. Foley's triad

**B. Phemister's triad**

**Where is hematogenous osteomyelitis encountered more frequently in adults?** A. Skull B. Spine C. Long bones of the extremities D. Short tubular bones of the extremities

**B. Spine**

**In addition to Staphylococcus aureus, which of the following agent is more likely to be involved in septic arthritis of the sternoclavicular joint in the parenteral drug abusers?** A. Haemophilus influenzae B. Pseudomonas aeruginosa C. Escherichia coli D. Mycobacterium tuberculosis

**B. Pseudomonas aeruginosa**

**Tuberculosis in long tubular bones usually originates in the?** A. Epiphysis B. Metaphysis C. Diaphysis D. Two of the above

**A. Epiphysis**

**Cellulitis...** A. Affects intravenous drug addicts B. Is an acute inflammatory process of the epidermal cells C. Never affects the thorax D. Antibiotic therapy rarely improves the condition

**A. Affects intravenous drug addicts**

**Which of the following is false concerning cystic tuberculosis?** A. It is encountered much more frequently in children than in adults. B. These lesions usually affect the peripheral skeleton. C. The metaphyseal region of tubular bones is favored. D. The lesions are generally accompanied by sclerosis.

**D. The lesions are generally accompanied by sclerosis.**

**The breakdown of soft tissue that occurs in debilitated persons who maintain a single position for long periods is referred to as a** A. Callus B. Pelvic sequestrum C. Decubitus ulcer D. None of the above

**C. Decubitus ulcer**

**Infection of the symphysis pubis can radiographically simulate...** A. CPPD B. Osteitis pubis C. OCI D. Paget's disease

**B. Osteitis pubis**

**The visualization of a metaphyseal defect connected with the growth plate by a radiolucent tract ensures the diagnosis of...** A. Fracture B. Pyogenic infection C. Non-pyogenic infection D. Aneurysmal bone cyst

**B. Pyogenic infection**

**A sclerotic non-purulent form of osteomyelitis characterized by intense proliferation of the periosteum leading to bony deposition is termed?** A. Sclerosing osteomyelitis of Garré. B. Chronic recurrent non-suppurative osteomyelitis. C. Bone abscess (Brodie's abscess). D. Acute non-infective hyperostosis.

**A. Sclerosing osteomyelitis of Garré.**

**Septic arthritis is more commonly...** A. A polyarticular condition B. A monoarticular condition C. A sexually transmitted condition D. A disease of the sexually inactive

**B. A monoarticular condition**

**An unusual presentation of tuberculous erosions of the humeral head** A. Weaver's bottom B. Caries sicca C. Gouge defect D. Caries humerus

**B. Caries sicca**

**In older syphilitic children, bilateral painless effusions, especially of the knee, have been termed\_ joints.** A. Brown's B. Poncet's C. Clutton's D. Tom Smith's

**C. Clutton's**

**In which of the following age group does hematogenous osteomyelitis have a higher complication rate of growth arrest or asymmetrical growth maturation?** A. Infants B. Children C. Adults D. Both b and c are correct

**A. Infants**

**A large parrot-beak-like osteophyte has been reported as a characteristic feature of which of the following spinal infection?** A. Meningococcemia B. Brucella C. Klebsiella D. Salmonella

**B. Brucella**

**Undercooked pork or pork sushi results in infections with which organism?** A. Cysticercosis B. Tuberculosis C. Staph aureus D. Pseudomonas

**A. Cysticercosis**

**This syndrome, usually transmitted as an X-linked recessive trait, is characterized by purulent granulomatous and eczematoid skin lesions, granulomatous lymphadenitis with suppuration, hepatosplenomegaly, recurrent and persistent pneumonias, and chronic osteomyelitis; it frequently is fatal. It is know as...** A. Chronic granulomatous disease B. SAPHO syndrome C. Sarcoidosis D. Carcinoid tumor

**A. Chronic granulomatous disease**

**A cortical abscess can be radiographically visualized as a lucent lesion with surrounding sclerosis and periostitis. This appearance can simulate which of the following conditions?** A. Osteoid osteoma B. Stress fracture C. Non-ossifying fibroma D. Both a and b are correct

**D. Both a and b are correct**

**What is the primary infectious route for coccidiodomycosis?** A. Respiratory B. Implantation C. Gastrointestinal D. Genitourinary

**A. Respiratory**

**The most common neoplasm encountered in osteomyelitis is..** A. epidermoid carcinoma B. Basal cell carcinoma C. Plasmacytoma D. Angiosarcoma

**A. epidermoid carcinoma**

**Paronychia is...** A. An infection of the hair bed. B. A loculated abscess of the dermal portion of the skin. C. Subcuticular abscesses of the nail fol D. An infected mole

**C. A subcuticular abscesses of the nail fol**

**Which of the following is not a complication of septic arthritis?** A. Overgrowth of the epiphyses and apophyses B. Epiphyseal displacement C. Myositis ossificans surrounding the involved joint D. Degenerative joint disease

**C. Myositis ossificans surrounding the involved joint**

**Brodie's abscess are found more commonly in children, typically in boys and particularly in the...** A. Femur B. Tibia C. Radius D. Humerus

**B. Tibia**

**Sacroiliac joint infections are usually...** A. Bilateral and symmetric B. Bilateral and asymmetric C. Unilateral D. Both a and b are correct

**C. Unilateral**

**The four cardinal signs of Kanavel are used to diagnose clinically...** A. Tenosynovitis of the tendon sheath of the fingers. B. Septic arthritis of the midcarpal compartment. C. Septic arthritis of the metacarpophalangeal joints of the fingers. D. Septic arthritis of the proximal interphalangeal joints of the fingers

**A. Tenosynovitis of the tendon sheath of the fingers**

**What type of tumor occurs within the sinus tract in patients with long term chronic osteomyelitis?** A. Giant cell tumor B. Osteosarcoma C. Chondrosarcoma D. Squamous cell carcinoma

**D. Squamous cell carcinoma**

**What is the most common fungal infection of the skeleton worldwide?** A. Maduromycosis B. Tuberculosis C. Coccidiodomycosis D. Candidiasis

**A. Maduromycosis**

**What is the most commonly encountered skeletal involvement in actinomycosis?** A. Mandible B. Tibial tuberosity C. Femoral diaphysis D. Spine

**A. Mandible**

**Which of the following joints is less likely to be affected by septic arthritis in the drug abuser?** A. Sacroiliac B. Sternoclavicular C. Acromioclavicular D. Ankle

**D. Ankle**

**Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenza are responsible for most cases of hematogenous osteomyelitis in which of the following age group?** A. Neonate or infant. B. Children over the age of 1 year and less than 4 years. C. Children older than 4 years. D. Teenagers.

**B. Children over the age of 1 year and less than 4 years.**

**The presence of pustulosis palmaris, sternoclavicular hyperostosis and recurrent osteomyelitis in a child should warrant further investigation to rule out...** A. Chronic granulomatous disease B. SAPHO syndrome C. Sarcoidosis D. Carcinoid tumor

**B. SAPHO syndrome**

**Gonococcal arthritis closely resembles both radiographically and clinically which of the following conditions?** A. Rheumatoid arthritis B. Gout C. Psoriatic arthritis D. Reiter's syndrome

**D. Reiter's syndrome**

**Wimberger's sign is associated with** A. congenital syphilis B. Tuberculosis C. Leprosy D. Coccidioidomycosis

**A. congenital syphilis**

**Where are spinal epidural abscesses more commonly seen?** A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacro-coccygeal region

**B. Thoracic spine**

**Which of the following choices is not associated with osteomyelitis of the hand from direct implantation?** A. Human bites. B. Animal bites. C. Open fractures and dislocations. D. All of the above would cause osteomyelitis by direct implantation.

**D. All of the above would cause osteomyelitis by direct implantation.**

**Which of the following plantar muscle compartment provides a pathway by which an infection can spread from the plantar aspect of the foot into the lower leg?** A. Medial B. Intermediate C. Lateral D. None of the above

**B. Intermediate**

**The radiographic latent period for spinal osteomyelitis / spondylodiscitis is approximately** A. 3 days B. 3 weeks C. 3 months D. 3 years

**B. 3 weeks**

**Which of the following clinical presentation of hematogenously spread osteomyelitis is true?** A. Childhood osteomyelitis is always associated with a sudden onset of high fever, a toxic state, and local signs of inflammation. B. As many as 50 % of children with osteomyelitis have vague complaints, including local pain of 1 to 3 months' duration with minimal if any temperature elevation. C. In the infant, hematogenous osteomyelitis often leads to very dramatic findings, including pain, swelling, high-grade fever, nausea, an unwillingness to move the affected bones and loss of consciousness. D. The adult form of hematogenous osteomyelitis usually has a rapid onset with a relatively short period between the appearance of symptoms and signs and accurate diagnosis.

**B. As many as 50 % of children with osteomyelitis have vague complaints, including local pain of 1 to 3 months' duration with minimal if any temperature elevation.**

**Osteomyelitis leading to the destruction of the distal tuft and diaphysis of the terminal phalanx with relative sparing of the phalangeal base is a possible complication seen with...** A. A melon B. A pelon C. A felon D. A belon

**C. A felon**

**Expansile tuberculous dactylitis has also been termed...** A. Hand-foot syndrome B. Sausage digit C. Spina ventosa D. Scrofula

**C. Spina ventosa**

**Subperiosteal abscess formation, extensive periostitis, and involucrum formation are relatively unusual manifestations of osteomyelitis in which of the following age group?** A. Infants B. Children C. Adults D. People over 200 years old

**C. Adults**

**44. Spontaneous atlantoaxial subluxation that accompanies inflammation of neighboring soft tissues (rhinopharyngitis) seen mainly in children is termed?** A. Grisel's syndrome B. Jones' syndrome C. McGreggor's syndrome D. Julius' syndrome

**A. Grisel's syndrome**

**Which of the following is false about septic arthritis?** A. Rapid destruction of bone and cartilage is characteristic of bacterial arthritis. B. In tuberculous arthritis, marginal osseous erosions with preservation of joint space and periarticular osteoporosis can be prominent. C. Osseous erosions at the edges of the joint, related to the effects of diseased synovium on bone, lead to marginal defects that are similar in appearance and location to those of rheumatoid arthritis. D. Bony ankylosis of the joint is not characteristic of late-stage chronic pyogenic arthritis.

**D. Bony ankylosis of the joint is not characteristic of late-stage chronic pyogenic arthritis.**

**The presence of small elongated fragments of low signal intensity on all MRI sequences associated with hypertrophied synovium in a patient afflicted with tuberculous arthritis are called...** A. Green peas B. Mustard synovium C. Rice bodies D. Pepper flakes

**C. Rice bodies**

**Acute inflammatory process of the deeper subcutaneous tissues resulting generally from a streptococcal or, less commonly, a staphylococcal infection, leading to pain or tenderness, redness, swelling, warmth, and mild to moderate fever is known as...** A. Pyomyositis B. Necrotizing fasciitis C. Cellulitis D. Tenosynovitis

**C. Cellulitis**

**Maduromycosis most commonly involves which region?** A. Tarsometatarsal B. Carpometacarpal C. Glenohumeral D. Femorotibial

**A. Tarsometatarsal**

**Infectious ischial tuberosity bursitis is also know as...** A. Rider's bone B. Weaver's bottom C. Chronic repetitive sitting friction syndrome D. Drop the soap syndrome

**B. Weaver's bottom**

**The most common joints affected by skeletal tuberculosis are...** A. The spine, ankle, shoulder B. The spine, hip, knee C. The shoulder, ankle, knee D. The wrist, hip, knee

**B. The spine, hip, knee**

**The presence and extent of soft tissue infection is not commonly evaluated with** A. Magnetic resonance imaging B. Computed tomography C. Biopsy D. Scintigraphy

C. Biopsy

**Which of the following is not characteristic of "puffy hand syndrome"** A. Infrequent in drug addicts B. May follow local injections with contaminated needles C. Related to lymphedema from lymphatic destruction and fibrosis of subcutaneous tissue D. Bilateral swelling of the dorsum of the hand

A. Infrequent in drug addicts

**The earliest radiographic sign of acute hematogenous osteomyelitis in children is...** A. Displacement of the adjacent fat planes. B. Obliteration of the adjacent fat planes. C. Cortical destruction. D. Localized periosteal reaction.

A. Displacement of the adiacent fat planes.

**Which of the following is not seen in the clinical presentation of a patient with congenital syphilis?** A. Saddle nose B. Hutchinson's teeth C. Saber shin deformity D. Valgus deformity of the knees

D. Valgus deformity of the knees

**Guinea worm disease is also known as:** A. Dracunculiasis B. Loiasis C. Moya moya D. Cryptococcosis

A. Dracunculiasis

**Which of the following is not commonly seen in tuberculous arthritis:** A. Soft tissue swelling B. Osteoporosis C. Fast progression D. Late joint space loss

C. Fast progression

**Septic spondylitis most typically involves the** A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacroiliac joints

C. Lumbar spine

**An increase in the medial joint space of the hip by over 2 mm compared with the contralateral side and/or a joint space measuring more than 11 mm is known radiographically as...** A. Turret's sign B. Obturator sign C. Waldenstrom's sign D. Gluteus medius sign

C. Waldenstrom's sign

**A metaphyseal infection of the proximal portion of the humerus spreading through the adjacent cortex can contaminate the glenohumeral joint by extending along the tendon of the...** A. Supraspinatus B. Infraspinatus C. Subscapularis D. Long head of the biceps

D. Long head of the biceps

**In infants, group B streptococcus typically involves a single bone, particularly the...** A. Tibia B. Femur C. Humerus D. Radius

C. Humerus

**Which of the following types of calcific deposits is seen in tuberculous psoas abcesses?** A. Psammomatous calcification B. Conduit-wall calcification C. Teardrop-shaped calcification D. Cyst-wall calcification

C. Teardrop-shaped calcification

**A slowly progressive vertebral destruction with preservation of intervertebral discs, subligamentous spread of infection with erosion of anterior vertebral margins, large and calcified soft tissue abscesses, and the absence of severe bony eburnation are the radiographic signs associated with...** A. Pyogenic spondylitis B. Suppurative spondylitis C. Tuberculous spondylitis D. Staphylococcal spondylitis

C. Tuberculous spondylitis

**Sequential contamination of the tendon sheath of the fifth finger, ulnar bursa, radial bursa, and first finger produces...** A. The devil sign B. The U or V sign of Pimenti C. The horseshoe abscess D. The common flexor sign

C. The horseshoe abscess

**Acute kyphosis of Pott's disease is sometimes associated with the presence of...** A. Square vertebra B. Long vertebra C. Barrel-shaped vertebra D. Picture frame vertebra

B. Long vertebra

**Localized premature fusion of the central aspect of the physes, in a bilateral and relatively symmetric distribution, resulting in a cupped or cone-shaped metaphysis with epiphyseal disintegration, bowing and angular deformities especially in the legs and limb shortening are possible complications of which of the following infection in children?** A. Meningococcemia B. Brucella C. Klebsiella D. Salmonella

A. Meningococcemia

**In cases of direct implantation coccidioidomycosis, which structure is most commonly affected?** A. Tibial tuberosity B. Pisiform C. Olecranon D. Calcaneus

A. Tibial tuberosity

**The sudden onset of lower limb paraplegia in spinal tuberculosis is referred to as** A. Pott's paraplegia B. Saunder's paraplegia C. Phemister's paraplegia D. Waldenstrom's paraplegia

A. Pott's paraplegia

**The "rind" sign in computed tomographic images is described as a(n)** A. Ovoid mass of increased tissue attenuation that enhances after intravenous administration B. Ovoid mass of decreased tissue attenuation that enhances after intravenous administration C. Rim of increased tissue attenuation that enhances after intravenous administration of contrast material D. Rim of decreased tissue attenuation that enhances after intravenous administration of contrast material

C. Rim of increased tissue attenuation that enhances after intravenous administration of contrast material

**Which of the following agent is frequently involved in osteomyelitis or septic arthritis of the foot seen in patients walking barefoot on nails, glass and other sharp objects? This agent has a propensity for infecting cartilage.** A. Streptococcus pyogenes B. Haemophilus influenzae C. Pseudomonas aeruginosa D. Salmonella

C. Pseudomonas aeruginosa

**Because of the anatomic arrangement of the joint, osteomyelitis localized to the metaphysis can enter the joint by extending laterally without violating the growth plate.** A. Ankle B. Knee С. Hip D. Elbow

С. Hip

**Osteomylelitis on a MR T1-weighted spin echo image intensity produces a** A. low signal B. high signal C. variable signal D. intermediate signal

A. low signal

**Radiolucent linear or netlike collections seen on radiographs within the subcutaneous or muscular tissues should warrant further investigation for...** A. Tuberculosis B. Syphilis C. Gas gangrene D. Pasteurella infections

C. Gas gangrene

**When performing a scintigraphic evaluation for the presence of osteomyelitis, the advantage of the agent 67 Ga-citrate over 99m Tc-methylene diphosphonate is...** A. It is sensitive to osteoblastic activity B. It binds with leukocytes C. It is dependant on the increased localized blood flow D. It is cheaper to use

B. It binds with leukocytes

**Rice grain calcifications of the soft tissues are characteristic of what disease?** A. Cysticercosis B. Echinococcosis C. Rubella D. Toxoplasmosis

A. Cysticercosis

**Which of the following is true regarding childhood discitis?** A. Hematogenous contamination of the discal tissue is possible. B. When positive, blood or bone biopsy culture most typically reveals Mycobacterium tuberculosis. C. Radiographic changes are most frequent in the cervical spine. D. Intervertebral disc space narrowing is seen radiographically after the erosion of the subchondral bone plate and osseous eburnation.

A. Hematogenous contamination of the discal tissue is possible.

**Which of the following area of the foot is not a common location to observe a contamination of the skin and subcutaneous tissue at pressure points, leading to infective osteitis, osteomyelitis, and septic arthritis of adjacent bones and joints in a patient with diabetes mellitus?** A. Calcaneus B. Metatarsophalangeal joint C. Terminal phalanges D. Longitudinal arch of the foot

D. Longitudinal arch of the foot

**Which of the following are NOT included in the fungal diseases affecting bone?** A. Coccidiodomycosis B. Histoplasmosis C. Candidiasis D. Echinococcus

D. Echinococcus

**Which of the following vascular anatomic description is characteristic for children over 1 year old?** A. There is no vascular connection between the epiphysis and the metaphysis. B. A vascular connection between the metaphysis and epiphysis exists. C. The vascular supply of the epiphysis originates in the metaphysis. D. The vascular supply of the epiphysis originates in the growth plate.

A. There is no vascular connection between the epiphysis and the metaphysis.

**The direction of contamination in hematogenous osteomyelitis is** A. From the soft tissue inward toward the bone B. From the bone outward into the soft tissue C. From the growth plate into the diaphysis D. From the spinal canal to the bone

B. From the bone outward into the soft tissue

**In the young patient population (infants and children), hematogenous osteomyelitis more commonly affects which of the following bones?** A. Skull B. Spine C. Long bones of the extremities D. Short tubular bones of the extremities

C. Long bones of the extremities

**The term osteomyelitis refers to:** A. Infection of the cortical bone B. Infection of the marrow C. Infection of the bone and marrow D. Infection of the bone and adjacent soft tissues

C. Infection of the bone and marrow

**Human infection with animal exposure, bites or scratches is associated with** A. Brucella B. Yersinia C. Pasteurella D. Klebsiella

C. Pasteurella

**Which of the following is not a radiographic sign of congenital syphilis?** A. osteochondritis B. diaphyseal osteitis C. Campagnacci's sign D. periostitis

C. Campagnacci's sign

**Muscle enlargement, abscesses, subcutaneous edema and hard, "woody" induration of the overlying skin are characteristic of...** A. Pyomyositis B. Necrotizing fasciitis C. Cellulitis D. Tenosynovitis

A. Pyomyositis

**When septic arthritis is considered in a differential diagnosis, which of the following diagnostic procedure should be recommended?** A. Joint aspiration with subsequent culture. B. Bone scintigraphy. C. Conventional tomography. D. Computerized tomography.

A. Joint aspiration with subsequent culture.

**Resorption of cortical bone due to the inflammatory reaction about a gumma frequently is termed...** A. caries sicca B. caries necrotica C. caries sequestra D. caries osteoma

A. caries sicca

**Metaphyseal lesions in long bones characterized by symmetry, linear areas of radiolucency ,and increased bone density, producing a longitudinally oriented striated pattern (celery stalk appearance) is seen with which of the following conditions?** A. Rubella B. Syphilis C. Varicella D. Variola

A. Rubella

**Profuse involucrum formation is characteristic of osteomyelitis in the...** A. Infants B. Children C. Adults D. Both a and care correct

A. Infants

**Subligamentous extension of an abscess associated with mild contour irregularity (gouge defects) and sparing of the intervertebral discs is classically associated with...** A. Tuberculosis B. Syphilis C. Pyogenic spondylitis D. Coccidioidomycosis

A. Tuberculosis

**Which of the following differential diagnosis is unlikely in a 5 year old male with ill-defined metaphyseal moth eaten pattern of bone destruction with associated aggressive periosteal reaction?** A. Osteomyelitis B. Ewing's sarcoma C. Chondroblastoma D. Osteosarcoma

C. Chondroblastoma

**The combination of rapid loss of intervertebral disc height and adjacent lysis of bone is most suggestive of...** A. Metastatic disease B. Multiple myeloma C. Infective spondylitis D. Osteoporosis

C. Infective spondylitis

**The presence of gas in the soft tissues of the foot can be due any of the following agents but one. Which of the following agent does not produce gas as an end result of its metabolic activity?** A. Clostridium perfringens B. Escherichia coli C. Staphylococcus aureus D. Klebsiella pneumoniae

C. Staphylococcus aureus

**During a magnetic resonance imaging scan with gadolinium contrast performed on a patient suspected to have osteomyelitis, the presence of a ring-enhancing lesion of high signal intensity on T1-weighted images with a low signal center most likely represents a...** A. Sequestrum B. Involucrum C. Cloaca D. Abscess

D. Abscess

**The term infective (suppurative) osteitis refers to:** A. Infection of the cortical bone B. Infection of the marrow C. Infection of the bone and marrow D. Infection of the bone and adjacent soft tissues

A. Infection of the cortical bone

**In patients at age 6 months to 5 years\_\_\_\_\_\_\_\_ is a common cause of septic arthritis.** A. H. influenzae B. S. aureus C. P. aeruginosa D. E. coli

A. H. influenzae

**Linear calcification of nerves with a radiographic presentation of "licked candy-stick" appearance in the feet of a patient should warrant further investigation for...** A. Syphilis B. Diabetes mellitus C. Hansen's disease D. Tuberculosis

C. Hansen's disease

**The term involucrum refers to:** A. A fractured bony fragment displaced away from its parent bone caused by osteomyelitis. B. A layer of living bone that has formed around the dead bone. C. An opening between the skin surface and the bone. D. A segment of necrotic bone that is separated from living bone by granulation tissue

B. A layer of living bone that has formed around the dead bone.

**The term cloaca refers to:** A. An opening in the involucrum, through which pus may be discharged outside the bone. B. An opening between the skin surface and the bone. C. An opening between an infected epiphysis and an adjacent synovial joint. D. A layer of living bone that has formed around the dead bone

A. An opening in the involucrum, through which pus may be discharged outside the bone.

**The clinical presentation of vascular insufficiency, neurologic deficit, soft tissue swelling and mottled osteolysis of the foot should warrant an investigation to rule out...** A. Hypertrophic osteoarthropathy B. Acral metastasis C. Diabetes mellitus D. Psoriatic arthritis

C. Diabetes mellitus

**The hutchinsonian triad associated with congenital syphilis does not include** A. Hutchinson's teeth B. Dry mouth C. Interstitial keratitis D. Nerve deafness

B. Dry mouth

**Hematogenous osteomyelitis of children over 1 year old is encountered more frequently in which of the following portion of a bone?** A. Epiphysis B. Metaphysis C. Diaphysis D. Both a and b are equal in frequency

B. Metaphysis

**Hutchinson’s triad consists of Hutchinson’s teeth, interstitial keratitis and which of the following? Pg. 2552** A. Rhagades **B. Nerve deafness** C. Saddle nose D. Perforation of the palate

**B. Nerve deafness**

**The combination of severe bony eburnation of ribs, cutaneous sinus tracts and pleuritis is most suggestive of? Pg. 2563-4** A. Syphilis B. Tuberculosis C. Actinomycosis D. Cryptococcus

**C. Actinomycosis**

**Desert rheumatism is a complication most characteristically seen with which infective organism? Pg. 2569** A. Coccidioides immitis B. Histoplasma capsulatum C. Monosporium apiospermum D. Dracunculus medinensis

**A. Coccidioides immitis**

**Which of the following is the MOST COMMON location of joint involvement caused by coccidiomycosis? Pg. 2571** A. Ankle B. Foot C. Wrist D. Elbow

**A. Ankle**

**In cases of coccidioides osteomyelitis, diaphyseal involvement is usually seen where? Pg. 2569** A. Small tubular bones of the hands/feet B. Radius C. Tibia D. Humerus

**A. Small tubular bones of the hands/feet**

**The MOST COMMON systemic fungal infection in the US is? Pg. 2575** A. Blastomycosis B. Candidiasis C. Histoplasmosis D. Coccidiomycosis

**C. Histoplasmosis**

**Which of the following is FALSE regarding musculoskeletal histoplasmosis? Pg. 2575** A. MSK abnormalities are more common in cases of H. duboisii than H. capsulatum B. Up to 80% of cases will show ulcerating and popular lesions of the skin associated with osseous and articular changes C. The long bones are most commonly affected D. Noncaseating granulomas are seen in the bone marrow on histologic exam

**C. The long bones are most commonly affected**

**Systemic candidiasis in heroin addicts has a characteristic MSK location. Where is it? 2580** A. SI joints B. Costochondral junctions C. Knees D. Discovertebral joints

**B. Costochondral junctions**

**A pattern of intraarticular osseus fusion with a “melting snow appearance” is most characteristic of? Pg. 2581** A. Maduromycosis B. Histoplasmosis C. Actinomycosis D. Cryptococcosis

**A. Maduromycosis**

**Viral organisms with a known predilection for transplacental spread are commonly recognized by the acronym “TORCH.” Identify the correct list of known TORCH viruses. Pg.** A. Toxoplasmosis, rubella, cytomegalovirus, herpes simplex B. Toxoplasmosis, rubeola, cytomegalovirus, herpes simplex C. Toxoplasmosis, rubella, cytomegalovirus, hepatitis B D. Toxoplasmosis, rubeola, coronavirus, herpes simplex

**A. Toxoplasmosis, rubella, cytomegalovirus, herpes simplex**

**Catcher’s crouch syndrome is classically associated with which infection? Pg. 2582** A. Toxoplasmosis B. Cytomegalovirus C. Rubella D. Herpes simplex

**C. Rubella**

**Acute rubella arthroapthy typically occurs in which patient demographic? Pg. 2282** A. Children with transplacental infection B. Children who receive live, attenuated rubella vaccine C. Adults who receive live, attenuated vaccine D. Pregnant mothers with reactivation of latent rubella infection

**B. Children who receive live, attenuated rubella vaccin**e

**While the “celery stalk appearance” of longitudinally oriented metaphyseal striations of increased density may arise from a number of infectious etiologies, which of the following is TYPICALLY associated with this appearance? Pg. 2583** A. Cytomegalovirus B. Rubella C. Syphilis D. Toxoplasmosis

**B. Rubella**

**Osteomyelitis variolosa is a term applied to osteomyelitis occurring with which infection? Pg. 2588** A. Candidiasis B. Smallpox C. Tuberculosis D. Mumps

**B. Smallpox**

**Osteomyelitis variolosa usully involves which osseous structure? Pg. 2589** A. Vertebral bodies B. Metaphyses and epiphyses of small tubular bones C. Diaphyses of long tubular bones D. Irregular bones of the wrist and foot

**C. Diaphyses of long tubular bones**

**True or false: nonsuppurative septic arthritis caused by smallpox virus is often bilateral and symmetric? Pg. 2588-9** A. True B. False

**A. True**

**Osteomyelitis variolosa has an unusual affinity for which area? Pg. 2588** A. Ankle B. Spine C. Elbow D. Wrist

**C. Elbow**

**Reactive arthritis seen associated with cases of HIV infection often demonstrates an atypical presentation. What about this presentation is atypical compared to the classic presentation of reactive arthritis? Pg. 2591** A. The classic clinical triad is often incomplete as conjunctivitis is usually absent B. It affects the upper extremities more prominently than the lower extremities C. Axial spine involvement is more typical and more severe than appendicular involvement D. It affects women more than men

**A. The classic clinical triad is often incomplete as conjunctivitis is usually absent**

**Periostitis with skin lesion in an AIDS patient is strong evidence of? Pg. 2594** A. Kaposi sarcoma B. Pyomyositis C. Bacillary angiomatosis-bacillary peliosis D. Polymyositis

**C. Bacillary angiomatosis-bacillary peliosis**

**Calabar swellings are seen with which parasitic infection? Pg. 2598** A. Dracunculiasis B. Loiasis C. Cysticercosis D. Echinococcosis

**B. Loiasis**

**A patient presents with a localized pruritic rash on the outer aspect of their forearm. A review of the patient’s health records reveals radiographs of the same extremity taken two weeks’ prior to rule out fracture. No fracture or osseous irregularity is seen, but multiple fine, coiled, lacelike and filamentous calcifications are seen in the soft tissues. No other significant findings are seen. The patient further reports that they spent significant time in West Africa approximately 6 months ago. What diagnosis do you suspect? Pg. 2598** A. Loiasis B. Dracunculiasis C. Polymyositis D. Muscle infarction

**A. Loiasis**

**Dracunculiasis may show a particular increased incidence of which malignancy? Pg. 2599** A. Osteosarcoma B. Pleomorphic undifferentiated sarcoma C. Rhabdomyosarcoma D. Bladder carcinoma

**D. Bladder carcinoma**

**In which stage of development is a direct epiphyseal blood supply not present? (Pg. 2382)** a. Infant b. Child c. Adult d. A direct epiphyseal blood supply is present at all ages.

**b. Child**

**In which bone is sclerosing osteomyelitis most common? (Pg. 2396)** a. Tibia b. Femur c. Mandible d. Maxilla

**c. Mandible**

**Which of the following organisms is not a common cause of Potts puffy tumor? (Pg. 2396)** a. Staphylococcus aureus b. Pneumocystis carinii c. Streptococcus pneumoniae d. Haemophilus influenzae

**b. Pneumocystis carinii**

**Which tissue is infected in the lesion known as a felon? (Pg. 2401)** a. Nail fold b. Terminal pulp space c. Distal phalanx d. Synovial sheath

**b. Terminal pulp space**

**What is the most common infective organism that causes infection of the plantar aspect of the foot? (Pg. 2403)** a. Pseudomonas aeruginosa b. Staphylococcus aureus c. Streptococcus pneumoniae d. Haemophilus infuenzae

**a. Pseudomonas aeruginosa**

**Which neoplasm can arise in a focus of chronic osteomyelitis? (Pg. 2415)** a. Epidermoid carcinoma b. Dermoid carcinoma c. Squamous cell carcinoma d. Lymphangitis carcinomatosa

**a. Epidermoid carcinoma**

**In which age group is infection with *Haemophilus influenzae* most common? (Pg. 2421)** a. Adults b. Children over 5 years old c. Children under 5 years old d. It is very uncommon in all age groups.

**c. Children under 5 years old**

**Which joint is involved in Smith’s arthritis? (Pg. 2427)** a. Knee b. Hip c. Shoulder d. Elbow

**b. Hip**

T or F: **Prior arthrocentesis is the most common cause of gas collections in an infected joint. (Pg. 2424)**

**True**

**Tenosynovitis is a common complication of which disease? (Pg. 2438)** a. Scleroderma b. Reactive arthritis c. Ankylosing synovitis d. Rheumatoid arthritis

**d. Rheumatoid arthritis**

T or F: **Muscular and cutaneous infection are absent in cellulitis. (Pg. 2439)**

**True**

**Which virus is responsible for Bornholm disease? (Pg. 2440)** a. Poliovirus b. Rhinovirus c. Coxsackievirus d. Herpes simplex

**c. Coxsackievirus**

**Chronic recurrent multifocal osteomyelitis is associated with which syndrome? (Pg. 2445)** a. Reynaud b. Myelodysplastic c. SAPHO d. CREST

**c. SAPHO**

**Infection with which fungus is common in heroin addicts? (Pg. 2450)** a. Cryptococcus b. Aspergillis c. Pneumocystis pneumonia d. Candida

**d. Candida**

**Which nucleotide is most sensitive to bone infection? (Pg. 2456)** a. Gallium-67 b. 99Tc-MDP c. 99Tc-HMDP d. 111Indium

**a. Gallium-67**

**Which joint is involved in Grisel syndrome? (Pg. 2486)** a. Sacroiliac b. Atlantoaxial c. Atlantooccipital d. Sacrococcygeal

**b. Atlantoaxial**

**The _______ is the most commonly infected flat bone of the body. (Pg. 2500)** a. mandible b. ilium c. scapula d. ischium

**b. ilium**

**Which is the most common group of streptococci to cause osteomyelitis? (Pg. 2512)** a. Pneumococci b. Viridans c. Beta-hemolytic d. Alpha-hemolytic

**c. Beta-hemolytic**

T or F: **Sacroiliac joint infection is almost always unilateral in distribution. (Pg. 2501)**

**True**

**Sickle cell anemia predisposes a patient to infection with which organism? (Pg. 2514)** a. Streptococcus pneumoniae b. Haemophilus influenzae c. Staphylococcus aureus d. Pneumocystis carinii

**a. Streptococcus pneumoniae**

**Which radiographic finding helps identify gonococcus as the cause of osteomyelitis? (Pg. 2517)** a. Presence of felons and/or paronychiae b. Joint space narrowing c. Tenosynovitis d. Excessive eburnation

**c. Tenosynovitis**

**Approximately what percentage of skeletal infections are caused by gram-negative bacilli? (Pg. 2517)** a. Less than 3% b. 10% c. 25% d. 40%

**c. 25%**

**Pseudomonas infection is more common in which group of patients? (Pg. 2518)** a. Intravenous drug users b. Gay men c. Pregnant women d. Bald men named Chad

**a. Intravenous drug users**

**The HLA-B27 antigen predisposes patients to infection with which organism? (Pg. 2520)** a. Yersinia enterocolitica b. Haemophilus influenzae c. Staphylococcus aureus d. Pneumocystis carinii

**a. Yersinia enterocolitica**

T or F: **“Undulent fever” is another term for infection with Serratia marcescens. (Pg. 2521)**

**False**

**An 11 years of age male presents with a recent history of cellulitis, painful swelling at the anterior aspect of the knee, and mild fever. Radiographs demonstrate focal swelling at the anterior aspect of the patella and mild osteopenia of the patella. Which of the following is the likely diagnosis?** a. Infectious myositis b. Lymphadenitis c. Necrotizing fasciitis d. Septic prepatellar bursitis e. Septic tenosynovitis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2438.

**d. Septic prepatellar bursitis**

**A 34 years of age female presents with wrist and hand pain and swelling. Radiographs yield the presence of a lace like trabecular pattern in the 2nd proximal phalanx and a globular, sparsely calcified soft tissue mass over the posterior aspect of the distal carpal row. Which of the following is the likely explanation?** a. Gaucher disease b. Giant cell tumor of a tendon sheath c. Sarcoidosis tenosynovitis d. Sickle cell disease related osteomyelitis e. Thalassemia Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2438.

**c. Sarcoidosis tenosynovitis**

**A 47 years of age male presents with hip and foot pain and swelling. He reports recently traveling to the south pacific. Clinical evaluation determines the presence of a fever, posterior thigh swelling, enlarged femoral lymph nodes, and pyoderma of the foot. Radiographs only supported the presence of soft tissue swelling. An MRI yielded the presence of intramuscular abscess at the posterior thigh. Which of the following entities is likely present?** a. Cellulitis b. Infectious myositis c. Lymphadenitis d. Necrotizing fasciitis e. Non-infectious myositis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2441.

**b. Infectious myositis**

**Which of the following is often the result of an X-linked recessive condition that is related to deficient acidification of the phagocytic vacuole and results in extensive osteolysis of the hands and feet?** a. Chronic granulomatous disease b. Chronic recurrent multifocal osteomyelitis c. Lofgren syndrome d. Milroy disease e. SAPHO syndrome Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2444-5.

**a. Chronic granulomatous disease**

**On Scintigraphy evaluation the bullhead sign is noted. Which of the following is this sign associated with?** a. Chronic recurrent multifocal osteomyelitis b. Friedrich disease c. Osteitis condensans clavicle d. Sternocostoclavicular hyperostosis e. Weissmann-Netter-Stuhl syndrome Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4907.

**d. Sternocostoclavicular hyperostosis**

**Which of the following represents the most common location of musculoskeletal candidiasis in heroin users?** a. Costochondral junctions b. Knees c. Sacroiliac joints d. Spine e. Wrists Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2450.

**a. Costochondral junctions**

**Which of the following represents primary hereditary lymphedema?** a. Kenny-Caffey syndrome b. Mainliner syndrome c. Milroy disease d. Mucha-Habermann disease e. Waterhouse-Friderichsen syndrome Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2451.

**c. Milroy disease**

**Meningococcal infection most commonly produces septic arthritis in which of the following locations?** a. Cervical spine b. Hip c. Knee d. Lumbar spine e. Wrist Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2514.

**c. Knee**

**Which of the following groups of streptococcal infection can create myositis which closely resembles that of clostridial myonecrosis?** a. A b. B c. C d. F e. G Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2513.

**a. A**

**A 28 years of age female presents with worsening dorsal wrist pain and swelling. When asked about use of medications, she reports recently ceasing antibiotic therapy for a pelvic related infection. Radiographs of the affected extremity reveal soft tissue swelling in the regions of the extensor tendons with periostitis of the metacarpals. Which of the following infections creates this pattern in 70% of its cases of musculoskeletal manifestation?** a. Clostridial b. Gonococcal c. Salmonella d. Staphylococcal e. Streptococcal Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2515.

**b. Gonococcal**

**A patient presents with pain at the thoracolumbar junction. The patient reports having recently found a few days work in rice fields which had been flooded. Radiographic evaluation reveals loss of intervertebral disc height at L1/L2 and hazy indistinction of the vertebral endplates on either side of the intervertebral disc at this level. Which of the following is the likely agent?** a. Proteus Mirabilis b. Pseudomonas pseudomallei c. Mycobacterium leprae d. Corynebacterium diphtheriae e. Brucella melitensis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2518.

**b. Pseudomonas pseudomallei**

**A 55 years of age male farmer presents with persistent low back pain that began 3 months ago. Radiographs yield the presence of loss of intervertebral disc height at L2/L3 with an adjacent paravertebral abscess. Also noted are sclerosis of the L2 and L3 vertebral bodies and parrot-beak osteophytes. Which of the following is the likely etiologic agent?** a. Aeromonas hydrophilia b. Brucella abortus c. Corynebacterium diphtheriae d. Mycobacterium leprae e. Pasturella multocida Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2521-22.

**b. Brucella abortus**

**Iatrogenic infection can occur via the bacille Calmette-Guerin vaccination which is used to prevent which of the following infections?** a. Brucella melitensis b. Mycobacterium leprae c. Mycobacterium terrae d. Mycobacterium tuberculosis e. Variola Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2545.

**d.Mycobacterium tuberculosis**

**Which of the following human leukocyte antigen (HLA) is associated with an elevated incidence of antibiotic therapy failure in those with Lyme disease?** a. B27 b. Bw38 c. DR2 d. DR4 e. Dw2 Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2563.

**d. DR4**

**In the case of Yaws, which of the following is the term related to the proliferative exostoses of the maxillary bones?** a. Crab yaws b. Gangosa c. Goundou d. Gummas e. Mother yaws Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2559.

**c. Goundou**

**Which of the following is not associated with pseudoparalysis of Parrot?** a. Decreased range of motion of affected extremities b. Fever c. Pain d. Periostitis e. Syphilis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2554.

**b. Fever**

**Which of the following infectious agents provides a differential consideration for pigmented villonodular synovitis when it produces septic arthritis, given its skeletal sites of predilection and pattern of destruction?** a. Aspergillosis b. Cryptococcosis c. Histoplasmosis d. South American Blastomycosis e. Sporotrichosis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2578.

**e. Sporotrichosis**

**A 50 years of age male presents with pain above the eyebrows that he believes is a tension headache. Evaluation determines that the pain is arising from the sinuses. Computed tomography scan demonstrates destruction of the walls of the ethmoid sinuses. Which of the following is the etiologic organism that its primary site of involvement is the sinuses?** a. Aspergillosis b. Candidiasis c. Chromomycosis d. Maduromycosis e. Mucormycosis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2580.

**e. Mucormycosis**

**Which of the following is the most common etiologic agent for pyomyositis in patients with human immunodeficiency virus?** a. Pseudomonas aeruginosa b. Staphylococcus aureus c. Staphylococcus epidermidis d. Streptococcus pneumoniae e. Streptococcus pyogenes Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2592.

**b. Staphylococcus aureus**

**Which of the following is associated with reactivation of Epstein-Barr virus?** a. Kenny-Caffey syndrome b. Mainliner syndrome c. Milroy disease d. Mucha-Habermann disease e. Waterhouse-Friderichsen syndrome Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p1104.

**d. Mucha-Habermann disease**

**An 18 years of age female presents with elbow pain and epitrochlear lymph node enlargement. Magnetic resonance imaging study of the elbow demonstrates high T2 signal in the epitrochlear lymph node. Which of the following organisms most commonly causes this condition?** a. Afipia Felia b. Cytomegalovirus c. Rickettsia Rickettsii d. Rochalimea Henselae e. Trichinella Spiralis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2595.

**d. Rochalimea Henselae**

**A 27 years of age female presents with right hypochondriac region pain. Radiographs demonstrate permeative osteolysis of the 9th lateral rib angle. Computed tomography demonstrates a hypoattenuating focus in the liver adjacent to the rib lesion. Which of the following etiologic agents is likely responsible for this scenario of direct extension?** a. Amebiasis b. Dracunculiasis c. Leishmaniasis d. Loiasis e. Trichinosis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2597.

**a. Amebiasis**

**A 60 years of age male presents with right lower quadrant pain. An Echinococcal cyst is seen in the spleen that demonstrates daughter cysts on computed tomography of the abdomen without calcification. The cyst demonstrates rupture that is contained within the spleen. Which of the following classifications does this represent?** a. Type I cyst with type 1 rupture b. Type I cyst with type 2 rupture c. Type II cyst with type 1 rupture d. Type II cyst with type 2 rupture e. Type III cyst with type 1 rupture Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2602.

**c. Type II cyst with type 1 rupture**

**A 58 years of age male presents with anterior lower pelvic pain localized near the pubic symphysis. Radiographs of the pelvis demonstrate the presence of bladder wall calcification and urethral calcification. Which organism is most suspected?** a. Cysticercosis b. Dracunculiasis c. Echinococcus multilocularis d. Schistosoma haematobium e. Strongyloides stercoralis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2604.

**d. Schistosoma haematobium**

**Which of the following has a predilection for causing bony resorption at the medial aspect of the distal portion of the 5th proximal phalanx with the absence of periostitis?** a. Ainhum b. Chromomycosis c. Maduromycosis d. Mucormycosis e. Sporotrichosis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2604.

**a. Ainhum**

**A radiograph shows a thick sheath of periosteum that has detached from the cortex of the tibia which demonstrates a circular opening. The circular lucency is referred to as a(n):** a. Cloaca b. Involucrum c. Sequestrum d. Sinus tract e. Subacute abscess Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2379.

**a. Cloaca**

**Haemophilus influenzae osteomyelitis decreases after the age of:** a. 1 b. 2 c. 4 d. 5 e. 6 Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2380.

**c. 4**

The incidence of escherichia coli osteomyelitis decreases beyond the age of: a. 1 b. 2 c. 4 d. 5 e. 6 Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2380.

**a. 1**

**The most common etiologic organism of osteomyelitis in sickle cell disease is?** a. Clostridium perfringens b. Pseudomonas aeruginosa c. Salmonella paratyphi d. Staphylococcus Aureus e. Streptococcus pyogenes Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2155.

**c. Salmonella paratyphi**

**The portion of bone that is most often affected in adults with osteomyelitis is:** a. Apophysis b. Diaphysis c. Enthesis d. Epiphysis e. Metaphysis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2382.

**d. Epiphysis**

**A 3 year old male with knee pain for 1 week undergoes radiographic examination, which yields a 1.2cm lucent lesion in the proximal tibial metaphysis with surrounding sclerosis. MRI with contrast shows a homogeneous low signal intensity with a surrounding rim of enhancement. Which of the following is most likely?** a. Brodie abcess b. Chronic recurrent multifocal osteomyelitis c. Fatigue fracture d. Osteoid osteoma e. Tom Smith arthritis Resnick, Donald. Diagnosis of Bone and Joint disorders. 4th ed. p2392.

**a. Brodie abcess**

**A patient that presents with worsening distal finger pain and swelling for 2 weeks. Radiographs yield osseous destruction of the terminal phalanx at the tuft and diaphysis, as well as severe soft tissue swelling adjacent. The phalangeal base is spared. Which of the following is the most likely explanation?** a. Enchondroma b. Felon c. Glomus tumor d. Paronychia e. Phlegmon Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2401.

**b. Felon**

**The swelling of soft tissues specific to the dorsum of the hands in a drug addict is referred to as?** a. Hand-foot syndrome b. Mainliner syndrome c. Pott’s puffy tumor d. Puffy hand syndrome e. Shoulder-hand syndrome Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2401.

**d. Puffy hand syndrome**

**Which of the following has a predilection for affecting cartilage at an early stage of infection, thus having a predilection for affecting feet, sternoclavicular joints, intervertebral discs, and ears?** a. Clostridium perfringens b. Pseudomonas aeruginosa c. Salmonella paratyphi d. Staphylococcus Aureus e. Streptococcus pyogenes Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2403.

**b. Pseudomonas aeruginosa**

**Swan Ganz catheterization that results in osteomyelitis often affects which of the following bones?** a. Clavicles b. Humerus c. Radius d. Third metacarpal e. Ulna Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2407.

**a. Clavicles**

**Septic arthritis that results from skin puncture during a fist fight most commonly affects which of the following metacarpal phalangeal joints?** a. 1st b. 2nd c. 3rd d. 4th e. 5th Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2411.

**c. 3rd**

**Which of the following infective organisms is commonly implicated in cat bites that result in septic arthritis and osteomyelitis?** a. Pasteurella Multocida b. Pseudomonas aeruginosa c. Salmonella paratyphi d. Staphylococcus Aureus e. Staphylococcus Epidermidis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2411.

**a. Pasteurella Multocida**

**Following a surgical internal fixation of fractures, which represents the most common etiologic organism for osteomyelitis and septic arthritis?** a. Pasteurella Multocida b. Pseudomonas aeruginosa c. Salmonella paratyphi d. Staphylococcus Aureus e. Staphylococcus Epidermidis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2414.

**d. Staphylococcus Aureus**

**In neonates, which of the following locations is most commonly affected by septic arthritis?** a. Hip b. Knee c. Sacroiliac d. Shoulder e. Spine Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2427.

**a. Hip**

**MRI evaluation demonstrates high signal intensity on fluid sensitive sequences within the superficial and deep soft tissues, with fluid collections within the deep fascia. Which of the following is the best explanation?** a. Cellulitis b. Infective bursitis c. Infective tenosynovitis d. Necrotizing fasciitis e. Pyomyositis Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2439-2440.

**d. Necrotizing fasciitis**

**Malignant transformation of tissue lining a sinus tract is referred to as which of the following?** a. Felon b. Mainliner syndrome c. Marjolin ulcer d. Paronychia e. Pott’s puffy tumor Yochum, Terry. Essentials of Skeletal Radiology. 3rd ed. p1375.

**c. Marjolin ulcer**

**Which of the following bones is the most common affected by suppurative osteomyelitis?** a. Femur b. Humerus c. Radius d. Tibia e. Ulna Yochum, Terry. Essentials of Skeletal Radiology. 3rd ed. p1374.

**a. Femur**

**Which of the following radionuclide agents is most useful in evaluating for osteomyelitis?** a. Gallium-67 b. Indium-111 c. Technetium-99HMDP d. Technetium-99m e. Technetium-99MDP Marchiori, Dennis. Clinical Imaging. 3rd ed. p807

**a. Gallium-67**

**Tom Smith arthritis is characterized by rupture of the cortex of the ______ which results in the spread of the infectious organism into the joint capsule which results in septic arthritis.** a. Apophysis b. Diaphysis c. Enthesis d. Epiphysis e. Metaphysis Yochum, Terry. Essentials of Skeletal Radiology. 3rd ed. p1398.

**e. Metaphysis**

**Septic arthritis resulting from undulant fever will most commonly affect which of the following locations?** a. Hip b. Knee c. Sacroiliac d. Shoulder e. Spine Yochum, Terry. Essentials of Skeletal Radiology. 3rd ed. p1378.

**c. Sacroiliac**

**Which of the following is most useful in evaluating for infection of bone in the foot of a diabetic patient?** a. Gallium-67 b. Indium-111 c. Technetium-99HMDP d. Technetium-99m e. Technetium-99MDP Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2466.

**b. Indium-111**

**Infections of the head and neck that lead to atlantoaxial subluxation yields which of the following as a diagnosis?** a. Cocked Robin appearance b. Garre Sclerosing osteomyelitis c. Goltz syndrome d. Grisel syndrome e. Stevens-Johnson syndrome Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2486.

**d. Grisel syndrome**

**Which of the following vertebral segments is most commonly infected by mycobacterium tuberculosis?** a. T11 b. T12 c. L1 d. L2 e. L3 Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2527.

**c. L1**

**A cyst-like expansion of the third metacarpal is note upon radiographic examination. Biopsy and culture elucidates mycobacterium tuberculosis. The metacarpal finding is referred to as:** a. Phemister triad b. Pott’s puffy tumor c. Puffy hand syndrome d. Scrofula e. Spina ventosa Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2538-2539.

**e. Spina ventosa**

Infection I & II Flashcards

(284 cards)