1. A 65 years old woman comes to her physician because she had lower back pain for 1 month.

On
physical examination, there is pain on deep palpation and motion of the lumbosacral, but no
mass. One year ago she was treated for cervical cancer with pelvic irradiation and
chemotherapy, but she never visited doctor for follow up. Recent MRI shows lytic mass and
destruction at the Lumbal Vertebrae I-III .
Which of the following lesion is most likely to be found in the patient ’s lumbal ?
a. Osteoporosis
b. Osteoarthritis
c. Metastatic of cervical cancer
d. Undifferentiated High Grade Pleomorphic Sarcoma
e. Giant Cell Tumor of Bone
2. A 40 years old woman has experienced malaise, fatigue, and joint pain at her hands and feet
for the past 3 months. On physical examination , the joint involvement is symmetric, look
swollen and warm to the touch. Microscopic view of the excised joint capsule tissue is chronic
proliferative synovitis.
Which of the following laboratory findings is most likely to be reported in this patient ?
a. Positive acid fast stain of joint tissue
b. Serum positive for rheumatoid factor
c. Hyperuricemia
d. Uric acid crystals in joint space
e. Positive pyogenic bacteria in synovial fluid
3. A 45 years old man had dull ,constant pain in the mid section of the right thigh for the past 3
months . On physical examination , there is large, ill defined mass , pain on palpation and
movement. Skin surface shows shining , hyperemia , and venaectasia. Blood examination shows
normal leucocyte, normal ESR. MRI shows a 15 cm solid mass with necrotic area , deep to the
quadriceps but it doesn’t involve the femur.
Which of the following is the most likely diagnosis ?
a. Intramuscular Abscess
b. Osteosarcoma
c. Giant Cell Tumor of the bone
d. Lipoma
e. Rhabdomyosarcoma
4. A 60 years old man experienced acing pain in the right knee, over the past 2 years. He noticed
that the joint feel a bit stiff in the morning. On physical examination there is no joint swelling,
warmth or deformity. Laboratory studies show normal levels of serum calcium, phosphorus,
alkaline phosphatase, and uric acid. X ray shows narrowed joint space.
Which of the following is the most likely diagnosis ?
a. Gout arthritis
b. Chronic Osteomyelitis
c. Multiple myeloma
d. Osteoarthritis
e. Rheumatoid arthritis
5. A 56 years old man has experienced pain in his lower back, hip, and shoulder for the past 3
months . He also feels malaise and fatigue. Since 1 month a go his right shoulder look bigger
than his left shoulder and the pain is worse. On physical examination there is ill defined mass at
his right shoulder which feel pain on movement. Bone survey X ray shows multiple lytic
punched out lesion at the proximal right humerus, lumbal I-IV , ilium, costae and skull .Serum
electrophoresa protein examination show hypergammaglobulinemia.
What is the diagnosis of the patient ?
a. Osteosarcoma
b. Metastatic of carcinoma
c. Multiple myeloma
d. Malignant lymphoma
e. Chondrosarcoma
6. (From case number 5 ) What will you find in the urine examination of the patient ?
a. Malignant cells
b. Bence Jones Protein
c. Rheumatoid factors
d. Amyloid deposite
e. Inflammatory cells
7. A 17 year old girl experienced mass and pain in her left knee for more than 2 years . on
physical examination there is tumor mass with hard consistency below her left knee. X ray
shows solid mass like mushroom with central calcification at metaphyse proximal tibia, there
is no periosteal reaction. Microscopic features of this tumor are?
a. Mononuclear cells and multinucleated giant cells
b. Malignant osteoblast with osteoid matrix
c. Malignant chondrocyte within lacunae
d. Fibrous cap, hyaline cartilage, bone trabeculae
e. Benign chondrocyte within lacunae
8. A 25 year old man suffered from low back pain for 2 months. Physical examination found
tenderness on palpation at the lumbal vertebrae . Spinal X ray showed destruction of corpus
vertebrae at the lumbal I-II . The patient had history of thyroidectomy I year a go and chronic
cough since 6 months a go. Sputum examination showed acid fast bacilli. How is microscopic
features from the vertebral biopsy of the patient ?
a. Thyroid carcinoma cells
b. Epitheloid granuloma and caseous necrotic
c. Granulation tissue and caseous necrotic
d. Malignant osteoblast and osteoid matrix
e. Proliferation of plasma cells
9. A 40 years old man experienced episodes intense local pain involving his left toe especially at
night since 5 months ago. Now he also feels pain at his knee. On physical examination the toe
looks edema and hyperemia, and there is 1 cm painless nodules at the dorsum pedis and left
auricle. What is laboratory finding of this patient ?
a. Hyperuricemia
 b. Positive Rheumatoid factor
c. Hypocalcemia
d. Hyperphosphatemia
e. Anemia
10. A 35 years old woman complained about painful bulging wrist since last 6 months. On physical
examination, there is tumor at distal radius which has 8 cm in diameter. X ray represents lytic
lesion with cortex depletion at epimetaphyse of radius. FNAB exhibits group of monotonous oval
cell stroma and osteoclast type of datia cell. What is diagnose of this patient?
a. Osteosarcoma
b. Ewing’s sarcoma
c. Giant cell tumor
d. Chondrosarcoma
e. Chondroma
11. A 11 years old boy suffered from fever since 10 days ago. He also complained about right knee
swelling. Axillar temperatur shows 39oC. There are right knee edema and hyperemia on its skin
surface. X ray represents sclerotic type of lytic lesion with intact bone’s cortex. What kind of
examination to establish the etiology of this case?
a. Culture of tissue biopsy
b. FNAB
c. MRI
d. Complete blood count
e. USG
12. A 65 years old woman complained of a lump in her right gluteus since 4 months ago. Physical
examination indicates tumor mass which has 10 cm in diameter with venaectasia on its skin
surface. X ray rontgen exhibits soft tissue tumor without bony involvement.Biopsy examination
represents fibroblast proliferation which forms Herring bone structures. What is diagnose of
this patient?
a. Chondrosarcoma
b. Liposarcoma
c. Undifferentiated high grade sarcoma
d. Fibrosarcoma
e. Fibromatosis
13. A 60 years old man with liposarcoma in his right femur. Prognose of this patient is influenced
by?
a. Tumor location
b. Tumor grading and staging
c. Patient age
d. Trauma history
e. Concomitant disease
14. A 56 years old woman collided with motorcycle and had open fracture on her tibia. She had
been operated since 6 months ago. The former incision wound discharges pus continuously until
 nowadays and the skin around the scar looked hiperemic. X ray shows sclerotic type of bone’s
lytic lesion. What is diagnose of this patient?
a. Acute osteomyelitis
b. Chronic osteomyelitis
c. Osteosarcoma
d. Metastatic carcinoma
e. Osteoporosis with secondary infection
15. A 40 years old woman has experienced forefinger swelling since 8 months ago. She also felt
numbness in her forefinger. On physical examination exhibits solid mass on 2 nd digiti dextra
which has 3 cm in diameter. X ray represents lytic lesion with clear boundaries at phalanx manus
dextra. Diagnose of this patient is chondroma. How is microscopic appearance from operated
tissue of this patient?
a. Benign proliferative osteoblast
b. Layers of hyaline cartilage and bone trabeculae
c. Proliferation of osteoclast type of datia cells
d. Proliferation of chondrocyte binucleated
e. Hyaline cartilage which composed of benign chondrocyte
16. A 15 years old boy complained of a painful lump on his right knee since last 3 months which is
getting bigger. What kind of clinical data would be required to establish appropriate diagnosis to
this patient?
a. Age, location, radiology, pathology examination
b. Age, job, address, radiology, FNAB examination
c. Marital status, location, age, and tumor size
d. Age, location, trauma history, and tumor size
e. Radiology examination, vries coupe, age, and location
17. A 10 years old boy comes to orthopaedic clinic because of swelling on his right thigh since last 6
months. X ray examinaton indicates permeative tumor lesion on femur dextra diaphyse, which is
accompanied by onion skin periosteal reaction. FNAB reported some malignant small round cell
tumor. What is diagnosis of this patient?
a. Osteosarcoma
b. Chondrosarcoma
c. Plasmacytoma
d. Ewing’s sarcoma
e. Lymphoma maligna
18. (From clinical case no. 17 above) where is the frequent metastatic site of tumor in case above?
a. Lung
b. Inguinal lymphnodes
c. Colli (neck) lymphnodes
d. Vesica urinaria
e. Ren
19. A 45 years old woman has lump on her back for last 2 years. Lump has soft-solid consistency,
which has 8 cm in diameter. Tumor doesnt involve bone structures. What kind of examination to
check cell component before operative treatment?
a. USG
b. CT Scan
c. FNAB
d. Frozen section
e. Histopathologic open biopsy
20. (From clinical case no.19 above) according to operative histopathologic examination toward
patient above, there are multiple lobulus which composed of mature adipocyte cells. What is
diagnosis to this patient?
a. Liposarcoma
b. Fibroma
c. Fibrosarcoma
d. Lipoma
e. Lipoblastoma