1  

Osteosarcoma occurs most commonly at which of the following sites?

A. Diaphysis
B. Epiphysis
C. Metaphysis
D. Growth plate
ANSWER:

2  Which of the following bone tumours diagnostically produce osteoid tissue?

A. Osteosarcoma
B. Ewing’s sarcoma
C. Osteoclastoma
D. Fibrous dysplasia of bone
ANSWER:

3  Which of the following tumours are benign but osteolytic in nature?

A. Ewing sarcoma
B. Osteoclastoma
C. Osteoma
D. Chondroma
ANSWER:

4  The following tumours appear mucoid and show glistening features of sectioning:

A. Osteosarcoma
B. Ewing’s sarcoma
C. Chondrosarcoma
D. Osteoclastoma.
ANSWER:

5  The P NET tumours occurring in children will show which of the following?

A. Giant cells.
B. PAS positive small round cells
C. CEA 125 positivity
D. Osteoid tissue
ANSWER:
6   A 15- year -old girl developed facial erythema on exposure to sunlight. She was diagnosed with
SLE. Which of the following auto- antibody tests will be diagnostic?

A. Anti-ds DNA.
B. Anti- RNA.
C. Anti-topoisomerase
D. Ant centromere.
ANSWER:

7   The CREST syndrome commonly is associated with systemic scleroderma. Which of the
following is representative of this acronym?

A. Collagen
B. Raynaud phenomenon
C. Endocarditis
D. Sinusitis.
ANSWER:

8  Females with osteoporosis are prone to develop fractures. Which of the following is the most
common cause?

A. Low oestrogen levels

B. Hypo-vitaminosis D
C. Corticosteroid therapy
D. Low calcium diet.
ANSWER:

9   A 32- year -old teacher was diagnosed with scleroderma. Which of the following sites will be
most commonly associated with this disease?

A. Liver
B. Skin
C. Sclera
D. Synovial tissue.
ANSWER:

10   Eburnation of the bone results in severe pain. This occurs in which of the following diseases?
 A. Rheumatoid arthritis.
B. Osteoarthritis.
C. Gouty arthritis.
D. Septic arthritis.
ANSWER:

11  In gout associated with hyperuricemia, the uric acid monosodium crystals most commonly affect
which of the following tissues?

A. Tendons.
B. Fascia.
C. Adipose tissue
D. Synovium.
ANSWER:

12  Patients with Albright syndrome will present with which of the following features?

A. Monostotic fibrous dysplasia.

B. Multiple endocrinopathy.
C. Skin tumours.
D. Delayed onset of puberty.
ANSWER:

13   Osteoarthritis will present with which of the following?

A.
Osteophytes.
B. Synovial atrophy.
C. Increased osteoblastic activity
D.
Codman’s triangle.
ANSWER:

14
 Pannus formation is most common in the following conditions:

A. Osteoarthritis
B. Rheumatoid arthritis.
C. Osteomalacia.
D. Gouty arthritis.
ANSWER:

15   Most bony tumours result in destruction and thinning of cortical bone leading to fractures. On
 x- ray, the ‘onion skin’ pattern of layering of new bone formation is seen in

A. Ewing sarcoma.
B. Osteosarcoma
C. Multiple myeloma.
D. Osteoclastoma..
ANSWER:

16.  A 58 -years -old female presented with pain and tenderness at the T7-T9 region of the
thoracic spine. X- ray showed a lytic lesion with narrowing of intervertebral joint spaces.
The urine showed proteinuria. These features are seen in which of the following?

A. Metastatic bone carcinoma.

B. TB Spine
C. Myeloma
D. Osteomyelitis
ANSWER:

17  A 68- year- old female was diagnosed as having rheumatoid arthritis affecting her hands.
Which of the following will best describe her condition?

A. Radial deviation of fingers.

B. Dysphagia.
C. Wrist joint pain.
D. Osteoporosis.
ANSWER:

18  A 44 -year old man complained of pain and swelling of left big toe. His serum uric acid
level was raised. This is seen in which of the following types of arthritis?

A. Acute rheumatoid
B. Tuberculous
C. Septic
D. Gouty
ANSWER:

19  A 74- year- old man complained of severe bone pains. He was diagnosed with multiple
myeloma. Which of the following laboratory tests will be diagnostic?

A. Peripheral blood smear

B. Urine for Bence- Jones proteins.
 C. Serum electrophoresis.
D. Erythrocyte sedimentation rate.
ANSWER:

20  A 68 –year- old male, was diagnosed having multiple myeloma and bone pains. Which of
the following are diagnostic features in the peripheral blood?

A. Rouleaux formation
B. Nucleated red blood cells.
C. Plasma cells.
D. Thrombocytopenia.
ANSWER:

Which of the following body structures is the most commonly affected in scleroderma?
TUTORIALS
A Lungs.
B Kidneys.
C Brain.
D Skin

A 35-year- old female presented with hypertension and generalized thickening of the
skin. A skin biopsy showed reduction of dermal appendages. She was diagnosed with
systemic scleroderma. Which of the following features will best describe her
condition?

A Over-production of dermal collagen.

B Bence -Jones proteinuria.
C Malar rash
 D Libmann -Sac endocarditis

A 38-year- old school teacher complained of arthralgia and intermittent pain on

walking. She developed reflux oesophagitis and dysphagia. She was diagnosed with
scleroderma. Which of the following features will be diagnostic?

A Increased production of collagen.

B Complicates as adenocarcinoma.
C Malar rash.
D Rheumatoid arthritis

A 15 –years- old male was diagnosed with osteosarcoma of the femur. Which of the
following features will be characteristic?

A Destruction of cortex.
B ‘Onion’ skin radiological appearance
C Keratin pearls on histology
D Plasma cells in the peripheral blood

A 34- year -old male presented with pain and swelling of the knee joint. X rays
revealed a mass arising from the distal end of the femur and diagnosed as
chondrosarcoma. Which of the following features will be diagnostic?

A Cartilaginous origin.
B Osteoid formation
C Predisposes to osteoclastoma.
D Large spindle shaped cells.

A 14 -year -old student presented with a swelling at the diaphyseal end of the femur.
He was diagnosed with Ewing sarcoma. Which of the following features will be
diagnostic?

A Mitotic activity
B Small blue cells.
C Homer-Wright pseudo rosettes.
D CD 99 positivity

The osteoclastoma occurring at the distal end of the femur will present with which of
the following diagnostic features?

A Mononuclear stromal cells.

B Thickening of cortical bone.
C Codman triangle on x-rays.
D Multinucleated giant cells.
MEQ:

A 68- year- old female slipped on a stair case and fell on her hip. She was
unable to get up unattended.
X- ray showed fracture at the femoral neck and rarefied cortex. A duel-
energy x-ray absorptiometry (DEXA) revealed a T- score of -2.5.  Her
fracture was due to osteoporosis.
Q1. Discuss the term osteoporosis.
Ans: Osteoporosis is a generalised skeletal disorder characterised by low bone mass and micro-
architectural deterioration of bone which leads to fragility and risk of fracture 
Reduced BMD may be caused by a range of factors such as endocrine disturbances, dietary
deficiencies, or side effects of pharmacological interventions.

Q2. Mention 3 causes leading to osteoporosis.

Ans: 1. General: Menopausal female.
Sedentary life style

Alcohol ( increases parathyroid hormone (PTH) and reducse concentrations of vitamin D

metabolites required for efficient calcium absorption)

Smoking
2. Drugs: Prolonged usage of corticosteroids.
Cytotoxic drugs
3. Endocrine: Hyperparathyroidism.
DM. type 1
Cushing’s syndrome
4. Diet:
Low calcium diet.
5. Others:
Chronic renal disease.
 Coeliac disease.
IBD

Q3. Briefly discuss the pathogenesis of osteoporosis.

Ans: Osteoporosis is a generalised skeletal disorder characterised by low peak bone mass and micro-
architectural deterioration of bone which leads to fragility and risk of fracture.

The World Health Organisation (WHO) criteria for osteoporosis occurs when bone mineral density
(BMD) falls at or below -2.5 . The fall in the peak bone mass is caused by:

i. Endocrine disturbances.

ii. Dietary deficiencies,

iii. Pharmacological interventions.

iv. Excessive alcohol

v. Hyperparathyroidism.
vi. Hyperthyroidism.
vii. Low calcium and vitamin D.

Q4. Discuss the term ‘T score’ in this case.

Ans: Patients with T- scores that are -1 and above have normal bone density,
A score between -1 and -2.5 indicates osteopenia.
A score -2.5, indicates osteoporosis.

Q5. Discuss the term: ‘Rarified cortex’?

Ans: Thinning of cortical bone.