46.

A 85-year-old female was admitted due to pain of the deformed right thigh with
swelling due to a fall from her resident's CR. Patient claimed that her height
became decreased & she noted severe kyphosis. The following laboratory results
to be:

Total calcium = normal

Inorganic phosphate = normal
Alkaline Phosphatase = normal

What is the pathologic diagnosis?

a. Osteopetrosis

b. Osteoporosis

c. Osteitis Deformans

d. Osteomalacia

e. Osteonecrosis

47. A 25-year-old male sought consult to the clinic for a periodic health
examination. Physically, the patient was noted to have short stature & described
himself as being a "dwarf & weird". He had very short & plump bilateral upper &
lower extremities however his head was large. Other than his physical appearance,
other physical examination findings were unremarkable. What is the pathologic
process involved?

a. Qualitative or quantitative abnormal synthesis of Type 1 Collagen

b. Mutation in Fibroblast Growth Factor Receptor 3 (FGFR3)

c. Reduction in bone mass owing to small but incremental loses incurred in the
constant tumover of bone.

d. Hereditary defect in osteoclast function resulting in reduced bone resorption &

enhanced net bone overgrowth

48. A 50-year-old male came in to clinic for consult due to frequent enlargement of
the head which occurred every month. He appeared to have a lionlike facies. He
claimed that the usual hat that he wear could not fit to his head & he had force to
change the hat size. Punch biopsy of the skull bone revealed a chaotic picture of
trabecular bone ("mosaic" pattern), rather than the normal linear lamellar pattern.
What is the pathologic diagnosis?

a. Osteopetrosis
b. Osteonecrosis

c. Leprosy

d. Osteitis Deformans

49. A 4-year-old girl was brought by her parents to the clinic due to bowing of both
legs, & deformities of ribs, skulls & other bone. Father claimed that his monthly
income is inadequate to sustain the nutrition of his 8 children. Total Ca-6 mg/dl
(Normal value: 9-11 mg/dl.), Inorganic Phosphate-1.5 mg/dl (Normal value: 3-4.5
mg/dL) Alkaline Phosphatase-900 U/L (Normal value: 191-435 U/L). What is the
impression?

a. Osteomalacia

b. Rickets

c. Osteopetrosis

d. None of the above

50. X-ray of the knee is extremely helpful in diagnosing Gouty Arthritis because the
deposition crystal can be visualized via Plain Radiography. True or False

a. True

b. False

51. Accumulating evidence that estrogen replacement therapy coupled with calcium
supplementation, when begun during or soon after the onset of the menopause,
can slow or prevent the abnormal loss of bone. True or False

a. True

b. False

52. There is no known way of preventing or arresting Osteoarthritis. True or False

a. True
b. False

53. Enteropathic Arthritis appears in 10% to 20% of patients with inflammatory

bowel disease as a non-migratory oligoarthritis of the large joints & spine. True or
False

a. True

b. False

54. A 77-year-old male sought consult due a mass on the left popliteal area of the
knee which was movable, well-circumscribed in margin & painless. What is the
impression?

a. Ganglion Cyst

b. Baker's Cyst

c. All of the above

d. None of the above

55. A 23-year-old male, medical student, decided to be admitted for excision of a 1

cm in diameter, firm, movable, non-painful, well-circumscribed, round mass at the
dorsal portion of the left wrist for cosmetic purpose. Patient claimed the mass was
present since his childhood & does not disturb his daily living. What is the
impression?

a. Baker's Cyst

b. Giant Cell Tumor

c. Ganglion Cyst

d. None of the above

56. A 30-year-old well-nourished male was brought by her wife to ER due to

inability to bend forward after his awakening from bed associated with severe pain
(PS-10/10). Patient cried in agony while placed in the ER bed. Her wife claimed the
patient was like a "bamboo" looking very stiff. Patient claimed to have severe neck
pain & fatigue as well. No deformities of any kind was noted. What is the
impression?

a. Osteoarthritis

b. Rheumatoid Arthritis
c. Ankylosing Spondylitis

d. None of the above

57. A 21-year-old sexually active male was brought by his family to ER due to high
grade fever (T=40°C) & chills associated with severe pain (PS-10/10) on his left
knee joint with surrounding swelling & erythema for 4 days. The wound swells with
surrounding erythema & tenderness on his left knee on palpation. What is the
etiologic agent?

a. Gonococcus

b. Heamophilus Influenza

c. Staphylococcus aureus

d. None of the above

58. A 15-year-old African boy was admitted due to multiple physical deformities &
pain of the deformed body areas (PS-8/10). Physically, the patient was noted to
have deformities on both upper extremities & both lower extremities after patient
had a fall from climbing a tall tree. He was also noted to have blue sclerae. X-ray of
the right arm revealed a linear fracture at the shaft of the humerus. Which type is
uniformly fatal in perinatal period?

a. I

b. ll

c. III

d. IV

59. A 7-year-old boy was brought to the ER due to painful joints, self-mutilation,
seizures, & mood changes. Blood Uric Acid was taken which revealed a 4-fold
increased in the result as compared to the normal value. All other laboratory results
were of normal results. Based on this important laboratory findings, the literature of
the patient was noted to have total lack of HGPRT. What is the impression?

a. von Gierke's Disease

b. Lesch-Nyhan Syndrome
c. All of the above

d. None of the above

60. A 4-year-old girl was brought by her parents to the clinic due to bowing of both
legs, & deformities of ribs, skulls & other bone. Father claimed that his monthly
income is inadequate to sustain the nutrition of his 8 children. Total Ca-6 mg/dl
(Normal value: 9-11 mg/dL), Inorganic Phosphate-1.5 mg/dl (Normal value: 3-4.5
mg/dL) Alkaline Phosphatase-900 U/L (Normal value: 191-435 U/L). What vitamin
is deficient with this patient?

a. A

b. D

c. E

d. K

61. A dwarf walked in to your clinic for wellness check-up. The following findings
could be a suspect for Achondroplasia except:

a. Shortening of the proximal limbs

b. Small head with prominent forehead frontal bossing

c. Spinal kyphosis or lordosis

d. Short fingers and toes with trident hands

62. Punch biopsy of a bone fragment of a 30-year-old female complaining of right

knee pain revealed needle-shaped crystals surrounded by lymphoplasmacytic cells.
What is the pathologic diagnosis?

a. Chondrocalcinosis

b. Gouty Arthritis

c. Lyme Arthritis

d. None of the above

63. A 34-year-old male sought consult to a clinic due to painful left knee initially
then later transfer to the right knee 3 days after. The patient claimed that something
bite him from the back. On physical examination on which this therapeutic
management was done revealed a small bug sticking in the skin in the "bullseye" of
the "target-like lesion". What is the etiologic agent responsible for the shown
pathology?

a. Mycobacterium tuberculosis

b. Staphylococcus aureus

c. Borrelia burgdorferi

d. Neisseria gonorrheae

64. A 34-year-old male sought consult due to sudden onset, unexplained swelling
and pain (PS-9/10) at the dorsal surface of the left wrist. Patient claimed the pain
worsened at rest & relieved by writing. The mass was 2 cm, movable, well-
circumscribed, slightly tender & warm to touch Punch biopsy revealed multiple
hemosiderin-laden macrophages. What is the pathologic diagnosis?

a. Nodular Tenosynovitis

b. Pigmented Villonodular Synovitis

c. All of the above

d. None of the above

65. A 78-year-old female was admitted due to pain of the deformed right thigh (PS-
10/10) with swelling due to a fall from her resident area. Patient had a fall 4 days
from her admitted date. Tenderness was felt upon palpation of the right thigh with
crepitus & swelling. No signs of lacerations nor abrasions were noted. X-ray of the
right femur, APL view revealed Avascular Necrosis. What is the most common
etiology?

a. Vascular interruption

b. Thrombosis & Embolism

c. Venous hypertension

d. Steroid-induced

66. A research study of a 23-year-old male who complained of right knee pain
revealed a deficiency of C5, C6, or C7. What is the pathologic diagnosis?

a. Tuberculous Arthritis

b. Lyme Arthritis
 c. Gonococcal Arthritis

d. None of the above

67. Physical examination of a left hand of a 34-year-old male who complained of

pain in the left wrist and left fingers revealed thick scales of plaque-like skin lesions
which are of equal sensation when doing the pinprick from the skin lesion to the
normal skin. What is the associated co-morbidity of the patient?

a. Inflammatory Bowel Diseases

b. Psoriasis

c. Sexually Transmitted Diseases

d. Hyperuricemia

68. A 80 years old female sought consult to clinic due to kyphosis & decreased
height from her previous height. Patient had also experienced some generalized
bone discomfort. Based on this clinical information, the following could precipitate
the patient to have this pathology:

a. Increased physical activity

b. Estrogen replacement therapy coupled with calcium supplementation

c. Malnutrition

d. None of the above

69. A 28-year-old male was admitted due to pain of the deformed right thigh
(PS=10/10) with swelling due to a Motor Vehicular Accident. Tenderness was felt
upon palpation of the right thigh with crepitus. No signs of lacerations nor abrasions
were noted. X-ray of the right femur, APL view revealed a linear fracture. The
following are causes for imperfect repair of fracture bone:

a. Infection

c. Communition

b. Malalignment

e. All of the above

70. Autopsy of a 27-year-old female who died of respiratory distress revealed

Langhan's multinucleated giant cells and caseation necrosis in a bone parenchyma.
What is the pathologic diagnosis?

a. Pyogenic Osteomyelitis

b. Pott's Disease

c. Lyme Arthritis

d. None of the above