year old male patient presents with year history of

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					46 year old male patient presents with a 2 year history of increasing R sided neck pain
over the last year he has begun to loose the sensation to his Right thumb. He notes that
he is becoming clumsier with this hand.

1. Differential diagnosis in this patient may include which of the following
   A. Cervical radiculopathy
   B. Cervical spondylosis
   C. Herniated disc.
   D. Tumor
   E. All of the above

2. A cervical spine Xray has been done within the past week which was read as being
   ―normal‖ What evaluation might be most reasonable to carry out at this time?
   A. MRI
   B. Myelogram
   C. Cervical X-ray (AP/Lat/oblique)
   D. Bone scan
   E. Cardiolyte Scan.

3. If this patient has a C6 radiculopathy we may expect to find an abnormal muscle test
    A. Biceps (C5)
    B. Triceps (C7)
    C. Extensor carpi radialis longus
    D. Flexor digitorum profundus
    E. Abductor digiti minimi

4. If this patients X-ray in reality shows marked DJD at the level of C6-C7.Possible
    etiologies of his spondylitic changes include
    A. Age related degeneration
    B. HVLA thrust technique from last weeks visit
    C. Referred pain from his heart
    D. Acute infection
    E. Acute ―whiplash‖

5. Evaluation and treatment of somatic dysfunction would be absolutely contraindicated
   in this patient in which of the following situations
   A. Herniated disc
   B. Bone spur
   C. Muscle spasm
   D. Ligament strain
   E. Patient request to not “treat” their neck with OMT

Available diagnostic imaging modalities, select one for the following questions:
   A. Radiographs
   B. Nuclear Medicine bone scans
    C. CT scan
    D. MRI scan
6. Initial work-up of a patient who sustained trauma to the spine.--A. (radiographs)

7. Which is the cheapest examination in imaging of the spine?--A. (radiographs)

8. The best imaging examination to workup a cancer patient for possible bony metastasis
   is—B. (Nuclear Medicine bone scans)

9. The best imaging examination for persistent of lumbar pain is:--D. (MRI scan)

10. Which imaging modality does not involve radiation?—D. (MRI scan)

11. We can gain important information on the status of spondylolysis by combining what
    imaging modalities?
    A. a + c
    B. b + c
    C. c + d
    D. a + d

                  Questions 12,13,14




                          a                          b

Above is a study of a patient with back pain:
12. What is study (a)?—A. (I’m not sure where these choices are, but it’s a bone scan)

13. What is study (b)?—C. (???)

14. What is the diagnosis for this patient?
    A. Metastasis
    B. Spondylolysis, acute
   C. Herniated disc
   D. Normal

                         Question 15
  T2 sag. C-spine

                                                T2 axial Disc level


15. What is the structure labeled ―a‖ on the MR of C-spine?
    A. spinal cord
    B. cerebrospinal fluid
    C. disc
    D. lamina

16. Ankylosing spondylitis typically presents as
    A. sudden onset of sharp lower back pain
    B. pain relieved by rest
    C. insidious low back pain relieved by activity
    D. chronic pain in the elderly
    E. pain usually better in the morning

17. Defining features of ankylosing spondylitis include all of the following except
    A. low back pain
    B. restricted lumbar spinal motion
    C. decreased chest expansion
    D. radiographic evidence of sacroiliitis
    E. HLA-B27

18. The most common extra-articular manifestation of ankylosing spondylitis is
    A. anterior uveitis
    B. aortic valve disease
    C. back pain
    D. pulmonary fibrosis
    E. fever

19. Reactive arthritis is a reaction to
    A. rheumatoid arthritis
    B. over-activity
    C. sacroiliac joint inflammation
    D. infection outside the joint
    E. trauma

20. Enteropathic arthritis is related to
    A. bowel infection
    B. inflammatory bowel disease
    C. urethritis
    D. irritable bowel syndrome
    E. colon cancer

21. Which of the following is a disease of endochondral ossification?
    A. Blount’s disease (growth disorder of the tibia that causes the lower leg to angle
              inward, resembling a bowleg)
    B. Klippel-Feil syndrome (rare; characterized by the congenital fusion of any 2 of
              the 7 cervical vertebrae)
    C. congenital scoliosis (curvature of spine that’s a result of malformations of the
              vertebral elements).
    D. Scheuermann disease (form of juvenile osteochondrosis of the spine; found
              mostly in teens, and presents a significantly worse deformity than postural
              kyphosis (they can’t consciously correct their posture).
    E. idiopathic scoliosis (lateral curvature of spine; can occur in kids aged 10-maturity;
              the abnormal curve occurs for unknown reasons)

22. Choose the correct statement regarding Klippel-Feil Syndrome:
    A. males and females are affected equally
    B. it usually presents in adulthood
    C. five types of this syndrome exist
    D. laboratory tests make the final diagnosis
    E. osteopathic manual medicine is not indicated

23. A thirteen year old girl is brought to the office with a diagnosis of ―mild scoliosis‖
    from a school health screening. The information states that on a Scoliometer, the
    curve in her back was 10 degrees. What further evaluation would be needed?
    A. nothing at this time
    B. standing flexion test
    C. spinal x-rays alone
    D. a neurologic exam
    E. a CT scan of the spine
24. Choose the correct statement regarding diskitis.
    A. mild cases in children can resolve without antibiotics
    B. OMM should be used as the first line of therapy
    C. recurrence of symptoms is very frequent
    D. plain films of the spine are diagnostic
    E. it is always completely dehabilitating

25. Which of the following is true regarding infantile idiopathic scoliosis?
    A. immediate surgery is needed
    B. bracing is needed in infancy
    C. it has significant spontaneous resolution
    D. it is only seen in children older than six years
    E. only resolves with surgery

26. A 55 year old woman asks her doctor about osteoporosis and hormone replacement
    therapy. Her last menstral period was 4 years earlier. She had problems with hot
    flashes in the past but has not had any symptoms in the past year. She has no history
    of chronic medical problems or medications associated with decreased bone density.
    In order to help her decide, you order a DEXA of her hip and spine. The t-score at
    both sites is less than -3.5. Which of the following is the best next step in the care of
    this patient?
    A. start HRT
    B. start bisphosphonate
    C. evaluate the patient for secondary causes of osteoporosis
    D. obtain serum or urine markers of bone resorption
    E. nuclear bone scan

27. You are asked to see a patient in the hospital for medical management. He was
    admitted the previous night when he fell at the grocery store and suffered a hip
    fracture. He is a 60 year old man with no history of smoking, excessive alcohol use,
    or medications associated with osteoporosis. Which of the following tests would be
    least useful?
    A. Osteocalcin
    B. Testosterone
    C. Serum calcium
    D. Thyroid stimulating hormone
    E. DEXA scan of his spine and opposite hip

28. The main factor influencing peak bone mass is:
    A. body mass index
    B. calcium intake during childhood and adolescence
    C. genotype
    D. exercise
    E. protein-calorie nutritional status
29. Which of the following tests is best suited to determine short-term assessment of
    response to therapy with a bisphosphonate?
    A. Baseline DEXA scan with repeat DEXA in 6 months
    B. Osteocalcin levels 3 months after treatment is begun
    C. C-telopeptide of collagen 2 months after therapy is begin
    D. Urinary pridinoline at baseline with repeat value in 3 months

30. All of the following medications reduce the risk of fragility fracture by slowing bone
    resorption (osteoclastic activity) except:
    A. bisphosphonates
    B. hormone replacement therapy
    C. synthetic estrogen receptor modulator
    D. recombinant PTH
    E. miacalcin

31. Which of the following statements about Pagets disease is correct?
    A. Treatment with bisphosphonates only improves pain and does not alter the
       structure of the bone.
    B. Osteosarcoma is a benign bone tumor that can complicate the disease.
    C. Normal calcium, phosphorus and PTH (parathyroid hormone) are the rule in
       Paget’s disease.
    D. Bone scan is not sensitive in Pagets disease since the lesions typically seen are
    E. Pain is often due to the new bone formation being harder and more firmly

32. Cord compression is the most important complication of Skeletal TB (tuberculosis).
    However, patients with skeletal TB usually present with:
    A. Fever
    B. Weight loss
    C. Cough
    D. Progressive pain
    E. Joint erythema and warmth

33. A 52 year old presents with a markedly increased alkaline phosphatase of 850 with
    normal liver function tests, calcium, phosphorous, parathyroid hormone and
    creatitine. He has had B/L hip and knee pain since college. XR demonstrates cortical
    thickening with irregular trabeculae. Old records show an elevated AP for over 5
    years. The most likely diagnosis is:
    A. Skeletal TB
    B. Pagets
    C. Sarcoidosis
    D. Rickets
    E. Osteonecrosis
34. Which of the following statements about osteonecrosis, also known as avascular
    necrosis is correct?
    A. Results from compromise of bone vasculature leading to death of the bone
       and bone marrow.
    B. Patients most commonly present with fracture
    C. Bone scan is the most sensitive radiographic study.
    D. The goal of treatment is to restore normal blood flow to the arteries leading to the
    E. Steroids, sickle cell anemia and trauma are the only known causes

35. All of the following are known complication of Pagets disease EXCEPT:
    A. Deafness
    B. Iron deficiency anemia
    C. Osteosarcoma
    D. Fracture
    E. Conduction abnormalities of the heart

36. On your hospital rounds, you are seeing a 28 year old is suspected of having
osteomyelitis of his tibia. Your attending physician notes that certain medical conditions
are more closely associated with osteomyelitis caused by certain organisms. If this
patient had sickle cell disease, which organism is most associated with osteomyelitis?
    A. aspergillus
    B. M furfur
    C. P multocida
    D. Salmonella sp
    E. S aureus

37. A 17 year old has chronic osteomyelitis of his second toe. On his x-ray you see
    whitened open areas surrounding little pockets of normal bone. Which of the
    following BEST describes this finding?
    A. osteolysis
    B. periosteal thickening
    C. rarefaction
    D. sequestrum
    E. soft tissue swelling

38. You are seeing a 21 year old college student who complains of joint swelling. First it
    was in her knee and then her elbow and now she presents to you with a red warm
    right wrist and a rash on her hands. While you are awaiting cultures to return, which
    of the following is the BEST course of action?
    A. CBC and ESR
    B. IM ceftriaxone
    C. Joint aspiration
    D. Oral penicillin
    E. No treatment until cultures return
39. During your rounds with an attending, you see a previously well 38 year old male
    with a high fever and a red swollen knee joint. Which of the following MOST
    LIKELY determines the underlying etiology?
    A. Empiric antibiotics
    B. Joint aspiration
    C. Physical examination
    D. Radiographs
    E. Referral to orthopedics

40. During your rounds with an attending, you see a previously well 38 year old male
    with a high fever and a red swollen knee joint. Which of the following MOST
    SUGGESTS a septic arthritis as the underlying cause?
    A. Fever
    B. Synovial WBC 25000
    C. Synovial WBC 50000
    D. Synovial WBC 100,000
    E. WBC count of 12000

41. Spondylolysis is:
    A. A stress fracture of the pars interarticularis
    B. Tuberculosis of the spine.
    C. Malignancy of the spine.
    D. A post operative complication of lumbar discectomy.

42. When evaluating a young athlete with low back pain it is important to obtain oblique
    views of the lumbar spine in order to adequately visualize the:
    A. Vertebral body
    B. Transverse process
    C. Spinous process
    D. Pars Interarticularis

43. Atypical Scheuerman’s Disease is characterized by:
    A. Pain, vertebral body endplate changes and Schmorl’s nodes
    B. Pain and pars interarticularis fracture
    C. Pain and peripheral neuropathy
    D. Pain, hemi-vetebrae and scoliosis

44. Bonnet’s Test is a nerve root tension sign that helps to differentiate:
    A. Pott’s disease from meralgia paresthetica
    B. Herniated lumbar disc from piriformis syndrome
    C. Lumbago from multiple myeloma
    D. Degenerative disc disease from facet syndrome

45. Ligaments and fascia help to stabilize the spine and set motion limits. One of the
    primary functions of the thoracolumbar fascia is to:
    A. Serve as a force transfer link between the legs and the trunk
   B. Protect the kidneys
   C. Facilitate hamstring contraction
   D. Facilitate adductor contraction

46. Thoracic kyphosis is most commonly associated with what condition?
    A. Osteoporosis
    B. Rib Fracture
    C. Poor conditioning
    D. Vertebral fracture
    E. Pectus carinatum

47. A 46 yo male presents with back pain. Exam demonstrates poor flexion of the
    lumbar spine. X-rays show a spine which looks like ―bamboo‖. What is the most
    likely diagnosis?
    A. Osteoarthritis
    B. Ankylosing spondylitis
    C. Rheumatoid arthritis
    D. Kyphoscoliosis
    E. Lupus arthritis

48. A 68-year-old white woman, whose mother and maternal aunt had late-life hip
fractures, asks you about osteoporosis prevention. She is healthy and walks 4 or 5 days
each week. Her only medications are calcium and vitamin D supplements. At a health
fair, she had an ultrasonography of the heel, with a T score of –1.5. She is reluctant to
take additional drugs. Which of the following is most appropriate for this patient?
    A. Reassurance and continuation of the current regimen
    B. Quantitative computed tomography (QCT) of the spine
    C. Dual-energy x-ray absorptiometry (DEXA scan) of the spine and hip
    D. Alendronate
    E. Plain lumbar and hip films.

49. A 75-year-old white man has back pain after gardening and is found to have a T10
    vertebral compression fracture. The patient has no other symptoms and has always
    been in good health except for mild hypertension that is treated with a diuretic. He is
    very active and does weight-bearing exercise for 1-2 hours each day. He does not
    smoke cigarettes and drinks alcohol only occasionally. Which of the following is the
    most likely cause of the fracture?
    A. Osteoporosis
    B. Testosterone deficiency
    C. Longstanding corticosteroid use
    D. Chronic malabsorption
    E. Metastatic carcinoma

50. A 73 year old woman comes to your office with recent onset of low back pain that
    seems worse with activity. She is able to sit with no pain and sleeps pain free. The
    pain has, on occasion, seemed to radiate into both lower extremities. On
   examination, there are no tender areas in the back. Neurologic and vascular exams
   are normal. The most likely diagnosis is:
   A. Polymyalgia Rheumatica
   B. Vertebral compression fracture
   C. Spinal Stenosis
   D. Herniated disk
   E. Sever osteoporosis.

1. Which of the following is NOT considered in the differential diagnosis of acute
   monoarticular joint pain?
   A. Infection
   B. Gout
   C. Tumor
   D. Osteoporosis
   E. Hemarthrosis

2. What according to textbooks is considered to be the most common cause of acute non-
   traumatic monoarthritis?
   A. Staph
   B. Strep
   C. Gonococcus
   D. Gout
   E. Mycobacterium

3. A 57 yo male presents to the ER with a red, painful and swollen right knee. synovial
   fluid analysis reveals 4cc of opaque, yellow fluid with a WBC count of 120,000 with
   75% polys. Gram stain and culture are pendidng at this time. What is the appropriate
   A. Cefazolin 1gm IV q 8hours
   B. Ciprofloxacin 400mg IV q 12 hrs
   C. Ceftriaxone 1gm IV q 12 hrs
   D. Vancomycin 1 gm IV q 12 hrs
   E. Ibuprofen 800 mg q 4 hours prn

4. Choose the correct statement regarding the pathophysiology of the joint pain in JRA:
   A. extra synovial fluid and distention of the joint
   B. a positive rheumatoid factor
   C. a positive ANA
   D. bacteria in the joint
   E. redness over the joint

5. Joint destruction in JRA is due to which of the following factors?
    A. the presence of cytokines and proteases
    B. bacterial in the synovial fluid
    C. decreased synovial fluid
    D. increased lymphocytes
   E. hyperplasia of the synovium

6. Choose the correct statement regarding polyarticular JRA:
   A. only small joints are involved
   B. is always associated with high fever
   C. cervical spine pain may be present
   D. only involves large joints
   E. has a rash as a component

7. Which type of JRA can be associated with nodule formation?
   A. systemic onset JRA
   B. pauciarticular JRA
   C. rheumatoid factor negative JRA
   D. polyarticular JRA
   E. psoriatic arthritis

8. Osteopenia is commonly associated with which of the subtypes of JRA?
   A. systemic onset JRA
   B. polyarticular JRA
   C. pauciarticular JRA
   D. osteopenia is not associated with JRA
   E. psoriatic arthritis

9. Which of the following is associated with short stature?
   A. Poland syndrome (one-sided congenital malformations ; underdevelopment or
               absence of pectoralis muscles on one side of body as well as webbing of
               the fingers on the ipsilateral hand).
   B. Jeune syndrome (asphyxiating thoracic dysplasia; classic manifestations in
               infancy include dwarfism with short ribs, short limbs, and radiographic
               changes in ribs and pelvis)
   C. pectus excavatum
   D. pectus carinatum
   E. all are associated with short stature

10. Asphyxiating thoracic dystrophy is a synonym for which of the following?
    A. pectus carinatum
    B. pectus excavatum
    C. Jeune syndrome
    D. Poland syndrome
    E. nipple hypoplasia

11. A six year old child presents to the office with his parents, with a chief complaint of
    fatigue, and a chest wall deformity. The evaluation in the office reveals an abnormal
    heart sound, a click. Which of the following would you consider as a diagnosis?
    A. Jeune syndrome
    B. Poland syndrome
   C. pectus carinatum
   D. pectus excavatum
   E. asphyxiating thoracic syndrome

12. A twenty two year old woman comes to the office with a complaint of
    ―asymmetrical breast development‖. She has no other complaints, or symptoms.
    Which diagnosis would you consider with this information?
    A. Poland syndrome
    B. Jeune syndrome
    C. pectus carinatum
    D. pectus excavatum
    E. Marfan syndrome

13. Which of the following is the result of a vascular event early in gestation?
    A. Jeune syndrome
    B. Poland syndrome
    C. pectus carinatum
    D. pectus excavatum
    E. Marfan syndrome

14. Which of the following findings would be associated with a diagnosis of
    developmental dysplasia of the hip?
    A. unequal thigh creases
    B. increased adduction on the affected side
    C. decreased abduction on the opposite side
    D. no findings except a hip click
    E. pain on hip movement

15. The Scottish Rite Brace is associated with which of the following?
    A. slipped capital femoral epiphysis
    B. idiopathic scoliosis
    C. transient synovitis
    D. developmental dysplasia of the hip
    E. Legg-Calve-Perthes disease

16. The evaluation modality of choice for transient synovitis is which of the following?
    A. ultrasound alone
    B. AP and lateral frog leg x-rays
    C. bone scan alone
    D. magnetic resonance imaging alone
    E. physical examination alone

17. Choose the correct statement regarding transient synovitis of the hip:
    A. always requires antibiotic therapy
    B. does not need any therapy
    C. may require needle aspiration
   D. requires an Atlanta brace
   E. requires surgery

18. Avascular necrosis of the femoral head can occur in which of the following
    A. slipped capital femoral epiphysis
    B. congenital scoliosis
    C. transient synovitis
    D. Scheuermann disease
    E. developmental dysplasia of the hip

19. Choose the correct statement regarding sickle cell anemia:
    A. only the hip joint is affected
    B. males are more affected than females
    C. only children are affected until age six years
    D. this condition rarely needs antibiotics
    E. the most common painful joint sites are the humerus, tibia and femur

20. Which of the following is true regarding osteosarcoma?
    A. it is rare in very young children
    B. the incidence in African-Americans is lower
    C. females are affected more commonly
    D. is less common in adolescence
    E. is more common in the spine

21. Which is the true statement regarding the onset of osteosarcoma?
    A. it has a sudden onset
    B. it always presents with high fever
    C. does not present as a mass lesion
    D. symptoms may be present for weeks
    E. only occurs in the femur

22. Choose the correct statement regarding modalities for evaluating osteosarcoma:
    A. plain films are diagnostic
    B. a combination of modalities is needed
    C. only MRI is necessary
    D. imaging is not necessary
    E. a bone scan is always diagnostic

23. Which of the following organisms should be suspected in osteomyelitis in a person
    affected with sickle cell anemia?
    A. staphylococcus aureus
    B. Neisseria gonorrhea
    C. salmonella
    D. group B streptococcus
    E. no specific organism
24. A 13 year old soccer player kicks hard at a bouncing ball moving toward him. He
    immediately experiences pain and a ―popping‖ sensation in his anterior hip near the
    anterior superior iliac spine. On examination he is tender directly over the ASIS and
    x-ray reveals an avulsion injury there. Which muscle is most likely to be involved in
    this injury?
    A. adductor magnus
    B. iliopsoas
    C. piriformis
    D. rectus femoris
    E. sartorius

25. A 22 year old former collegiate soccer player from Mississippi moves to graduate
    school here in the new river valley. She presents with a 4 week history of anterior
    hip and thigh pain. The onset was gradual, shortly after moving here and starting to
    train for a marathon with her boyfriend. When questioned about distance, she states
    she’s been increasing only about 1 mile a week, except for about a month ago when
    she increased from 2 to 6 miles four times per week and began running hills. At first
    her pain was only after running, but now her pain is constant, even at night. Which
    diagnostic test will show the EARLIEST evidence of injury in her case?
    A. arthrogram
    B. bone scan
    C. CT scan
    D. electromyelogram
    E. MRI

26. A 39 year old mail carrier is driving when traffic suddenly stops in front of her. She
slams on the brakes but hits the car in front of her forcefully. She has immediate pain in
her right hip posteriorly. You diagnose a posterior hip dislocation. Of the following,
which is the MOST DEBILITATING complication associated with hip dislocation?
    A. avascular necrosis
    B. femoral neck fracture
    C. instability
    D. labral tear
    E. osteoarthritis

27. A positive fulcrum test suggests?
    A. anterior hip capsule laxity
    B. posterior instability of the knee
    C. posterior hip labral tear
    D. sacral-iliac dysfunction
    E. stress injury of the femur

28. A 79 year old grandmother presents with several weeks of right lateral thigh pain. It
    is deep, achy and ―just hurts all the time.‖ It is especially bad when she hits it on
    something or when she rolls over on it at night. Then, it wakes her up and is
   sometimes bad enough to make her cry. It is better with ice and ibuprofen. Which of
   the following is essential to diagnose her condition?
   A. decreased knee reflex
   B. MRI of lumbar spine
   C. MRI of right hip
   D. Palpation distal to right trochanter
   E. X-ray of right hip

29. A 22 year old has pain in his back and pain that radiates into the region of his inguinal
    ligament and across the base of his penis and into his inner thigh. As you assemble
    your differential diagnosis, which nerve root, does this distribution represent?
    A. T11
    B. T12
    C. L1
    D. L2
    E. L3

30. A 42 year old complains of pain in the lateral thigh and hip. She has been training for
    a 10K and complains of a ―snapping‖ in her left hip. It started a few weeks ago, at
    first it was just annoying, but now it hurts and it feels ―like my hip is coming out of
    joint‖ – She shows you. It gets worse when she runs or if she walks briskly. Which
    of the following is the most common cause of ―snapping hip‖?
    A. acetabular labral tear
    B. dislocation of hip
    C. illiopsoas friction over greater trochanter
    D. iliotibial band friction
    E. loose body in hip

31. A soccer player tries to field a ball with his inner thigh. His hip is in flexion and
external rotation when the ball hits his thigh just above the medial aspect of the knee. He
feels a pop and immediate pain in his groin and cannot continue playing. On palpation
you detect pain and a defect just lateral and inferior to pubic symphysis . There is no
change with coughing or sneezing. Which diagnosis of the following should be highest
on the differential diagnosis list for this scenario?
    A. Acetabular labral tear
    B. Adductor longus avulsion/tear
    C. Adductor magus avulsion/tear
    D. Inguinal hernia
    E. Ostiitis pubis

32. Which of the following is LEAST LIKELY to be a cause of posterior hip pain?
    A. Gluteus medius strain
    B. Gracilis tear
    C. Posterior acetabular labral tear
    D. Piriformis syndrome
    E. Sacroiliac dysfunction
33. A 78 year old complains of a 6 month history of progressively worsening left hip pain
    which is associated with a deep pain, and particularly worse at night and wakes him
    from sleep. He has a 50 pack year history of smoking and his review of systems is
    significant only for a 20 pound non-intentional weight loss over the past few weeks
    and difficulty starting and stopping his urine stream. Of the following, which exam
    or diagnostic test is MOST LIKELY to point to his diagnosis?
    A. Auscultation of lungs
    B. Exam of hip
    C. Lumbar spine examination
    D. Rectal examination
    E. X-ray of hip

In the lecture, the following imaging modalities were discussed:
    A. Radiographs
    B. MR imaging
    C. CT
    D. Scintigraphy[nuclear medicine bone scan]
Please identify the following images:

34.                                --D. (Scintigraphy)

35.—A. (Radiographs)
36.—B. (MRI)

37. Which of the following concerning Lupus and Rheumatoid Arthritis (RA) is correct?
    A. Lupus tends to be symmetric but RA is not
    B. Synovial Hypertrophy is common to both RA and Lupus
    C. Prednisone is the initial therapy of choice for both Lupus and RA
    D. Erosions are common in both RA and Lupus
    E. Myalgias are common in both Lupus and RA

38. Which of the following concerning Lupus and Rheumatoid Arthritis (RA) is correct?
    A. Morning stiffness is common with Lupus but not with RA
    B. Myositis is common with RA but rare with Lupus
    C. Osteoporosis is rare in both Lupus and RA
    D. Avascular necrosis is seen in up to 50% of Lupus patients and is uncommon
       in RA patients
    E. Deforming arthritis in uncommon in RA and common in Lupus
39. Which of the following concerning Lupus and Rheumatoid Arthritis (RA) is correct?
    A. The swan-neck deformity is seen commonly (>50%) in both Lupus and RA and is
       reducible in both
    B. Ulnar deviation is seen more commonly in Lupus than RA
    C. Subcutaneous nodules are seen commonly in Lupus and rarely in RA
    D. Synovial fluid is always exudative in Lupus and transudative in RA
    E. In Lupus, the PIP joint is involved more commonly than the wrist or the

40. A 32 year old female patient presents with a 2 month history of morning stiffness
    lasting 3-4 hrs, pain and swelling of both knees, her MCP and PIP joints. She also has
    a positive ANA and RF as well as an x-ray of her hands showing mild erosions of the
    PIP joints bilaterally. What course of therapy would be most beneficial for this
    A. Watchful waiting with prn acetaminophen
    B. Watchful waiting with prn NSAIDS
    C. Methotrexate 7.5mg po weekly
    D. Physical therapy with prn Ibuprophen 400mg QID prn
    E. Prednisone 40mg po BID

41. A 28 you woman presents with a malar rash of 6wks duration as well as a 3 month
    history of pain involving her right PIP and MCP joints as well as her left knee. She
    admits to occasional morning stiffness lasting only minutes and has no signs of
    deforming arthritis on physical exam. X-rays of her hands reveal no erosions. Blood
    work reveals a positive ANA, a negative RF and serology positive for Anti-double-
    stranded DNA and anti-Smith antibodies. You begin hydroxychloroquine which is
    particularly helpful for her skin manifestations as well as arthralgias. You see her in
    follow-up three weeks later and she is still complaining of arthralgias. What would
    you begin next?
    A. An NSAID such as Ibuprofen or Naproxen
    B. Azithromycin
    C. Chelation Therapy
    D. Immunoglobulin
    E. Thalidomide

42. Regarding knee imaging studies the diagnostic imaging study that best demonstrates
    ligamentous injuries is:
    A. Plain films
    B. CT Scan
    C. Bone Scan
    D. MRI Scan

43. You aspirate an acutely swollen knee that has been injured traumatically and note a
    bloody effusion. Your top differential diagnostic choice would be:
    A. ACL Tear
    B. Medial meniscus tear
   C. Gouty arthritis
   D. Patellar tendon rupture

44. The type of knee brace that would be most commonly prescribed for an ACL
    deficient knee would be: prophylactic brace, the functional brace and the
    rehabilitative brace.
    A. A prophylactic brace
    B. A functional brace
    C. A rehabilitative brace
    D. A valgus unloading brace

45. The most common mechanism of injury for acute anterior cruciate ligament tear is:
    A. Non-contact with coupled flexion, valgus load and torsional knee rotation.
    B. Contact with hyperextension and varus load with torsional knee rotation
    C. Direct contact on the anterior tibia with posterior translation of the tibia on the
    D. Contact with valgus load coupled with hyperflexion

46. A Segond fracture noted on plane films of the knee is pathoneumonic for:
    A. Torn posterior cruciate ligament
    B. Torn anterior cruciate ligament
    C. Torn medial collateral ligament
    D. Torn lateral collateral ligament

47. A 56 year old man presents with a 3 month history of weakness. He is no longer able
    to walk up steps and get tools from his upper shelf. He denies fever, weight loss. A
    CK is markedly elevated at 15,000. He is on no medications and his physical exam
    shows proximal muscle weakness. You suspect an inflammatory myopathy. What is
    the definitive test to diagnose polymyositis?
    A. EMG
    B. Elevated CK
    C. Biopsy
    D. MRI
    E. PET scan

48. During the physical exam of the above patient, you notice psoriaform plaques on the
    extensor surface of his elbows and the dorsal surface of his phalanges. EMG
    excludes a neuropathic cause and suggests myopathy. The most likely diagnosis is:
    A. Polymyositis
    B. Dermatomyositis
    C. Inclusion body myositis
    D. Fibromyalgia
    E. Psoriatic arthritis

49. Which of the following is the most appropriate initial treatment of the above patient?
    A. Methotrexate
   B.   Azathioprine
   C.   Cyclosporine
   D.   Intravenous immune globulin
   E.   Prednisone

50. A 26 year old woman presents with undiagnosed muscle pain for over 3 years. She
    complains of generalized muscle pain and weakness, unrefreshed sleep, chronic
    tension headaches and fatigue. Physical exam is normal. TSH, CK, CMP, CBC,
    ANA are normal. She has pain with palpation over her B/L medial epicondyles of the
    elbows, medial knee, greater trochanters, and sacroiliac joints. She has no pain on
    palpation of the anterior thigh. The most likely diagnosis is:
    A. Polymyositis
    B. Dermatomyositis
    C. Inclusion body myositis
    D. Fibromyalgia
    E. Amyopathic dermatomyositis

1. Which of the following is a common cause of genu varus?
   A. a chromosomal defect
   B. Blount disease (growth disorder of the tibia (shin bone) that causes the lower leg
              to angle inward, resembling a bowleg)
   C. excessive vitamin D intake
   D. amniotic bands
   E. Down syndrome

2. In tibial bowing, which of the following associated problems is the biggest concern?
    A. having an odd gait
    B. cosmetic appearance
    C. intoeing
    D. leg length difference
    E. knee pain

3. Which of the following causes knee pain in adolescents?
   A. metatarsus adductus
   B. tibial torsion
   C. genu valgum
   D. hip dysplasia
   E. Blount disease

4. Proximal femoral focal deficiency has a proven cause in which of the following?
   A. thalidomide exposure
   B. fluoride exposure
   C. acetaminophen exposure
   D. alcohol exposure
   E. aspirin exposure
5. The Van Ness procedure (surgical rotation) is associated with which of the following?
   A. Blount disease
   B. proximal femoral focal deficiency
   C. tibial torsion
   D. genu valgum
   E. scoliosis

6. A 21-year-old soccer player ―rolled her ankle‖ at the game. She presented to the
   emergency room complaining of lateral ankle pain. X-rays reveal an avulsion
   fracture off the medial maleolus. Which of the following is the best management of
   this injury?
   A. avoid running for 4 weeks
   B. casting non-weight bearing on crutches for 6 weeks
   C. casting with partial weight bearing on crutches for 6 weeks
   D. stirrup ankle sprain brace and weight bearing as tolerated
   E. surgical fixation of the fracture
               (An avulsion fracture is an injury to the bone in a place where a tendon or
               ligament attaches to the bone. When an avulsion fracture occurs, the
               tendon or ligament pulls off a piece of the bone)

7. A 48 year old complains of anterior and lateral leg pain. She states the pain started
   with a ―pop‖ that occurred while chasing her Great Dane who had broken its leash.
   She has very weak dorsiflexion of the foot, and her foot tends to invert when she
   dorsiflexes. Which diagnosis is MOST LIKELY?
   A. avulsion of the medial maleolus
   B. high ankle sprain
   C. rupture of posterior tibialis
   D. rupture of tibialis anterior
   E. tibial plateau fracture

8. A 23 year old female presents with posterior
   heel pain after a fall waterskiing. Of the following,
   which mechanism of injury is MOST COMMONLY
   associated with this mechanism of injury?
   A. Eversion
   B. Forceful dorsiflexion
   C. Forceful plantarflexion
   D. Inversion
   E. Landing after a jump

9. Which of the following treatments has been demonstrated to facilitate tendon healing
   in patients with achilles tendinosis?
   A. eccentric exercise
   B. electric stimulation
   C. ibuprofen
   D. massage
   E. steroid injection

10. Which of the following best describes Mulder’s sign?
    A. contralateral tightness of the iliopsoas & rectus with ipsilateral hip flexion
    B. lancinating pain improved with restoration of transverse arch
    C. neurologic symptoms with the hip in flexion and ADDuction
    D. pain on thigh compression in femoral stress fracture
    E. radicular pain reproduced on straight leg raise

11. You and your friends are playing football at the tailgate party. She lands awkwardly
    on her foot, bringing her full weight down axially on her toes. She has immediate
    pain over the dorsal aspect of her 1st metatarsal proximally and inability to bear
    weight on that side. You follow her to the emergency room and routine foot x-rays
    reveal no fracture. The diagnosis that most closely fits this scenario is?
    A. First metatarsal-phalangeal joint sprain
    B. First metatarsal stress fracture
    C. First metatarsal shaft fracture
    D. Lisfranc joint injury (fracture and dislocation of the joints in the midfoot, where
                a cluster of small bones forms an arch on top of the foot between the ankle
                and the toes)
    E. Navicular fracture

12. A 45 year old complains of posterior heel pain for the past 2 weeks. The pain started
    at the gym after doing particularly heavy ―squat‖ lifting. His pain is worse with
    raising up on his toes and worse when you palpate his heel cord and passively
    dorsiflex his leg. Which of the following is NOT a cause of posterior heel pain?
    A. achilles tendinosis
    B. Haglund’s deformity (bony enlargement on back of heel)
    C. plantar fasciitis
    D. retrocalcaneal bursitis (inflammation of the bursa at the back of heel)
    E. shepherd’s fracture (a fracture of the external tubercle (post. process) of the talus)

13. Which of the following is true of bunions?
    A. Associated with wide, flat shoes
    B. Due to high transverse arch
    C. Sesamoiditis contributes to joint changes
    D. Usually requires surgery for uncontrolled symptoms
    E. Varus deviation of the first metatarsal phalangeal joint

14. Osteophyte formation on the dorsal aspect of the first metatarsal-phalangeal joint that
    limits motion results in
    A. bunion
    B. hallux rigidus
    C. hallux valgus
    D. hallux varus
    E. turf toe
15. In the treatment of metatarsal stress fractures, the most important consideration for
    healing is?
    A. control of ankle motion
    B. control of pain
    C. control of hindfoot extension
    D. control of metatarsal phalangeal joint motion
    E. restoration of the longitudinal arch

16. In nursemaid elbow, which of the following clinical findings is common?
    A. redness and warmth are usually present
    B. the child will not move the arm at all
    C. circulation may be abnormal
    D. the child cannot feel the arm
    E. a fracture is always present

17. Which of the following best describes the clinical findings in Little League Elbow?
    A. microtrauma is a likely cause
    B. the wrist is always involved
    C. redness of the area is common
    D. decreased range of motions is common
    E. findings are the same in all ages

18. Choose the correct statement regarding Little League Elbow:
    A. decreased range of motion in the affected arm is common
    B. surgery is always required for this disorder
    C. most cases only need conservative treatment
    D. there is no prevention for this disorder
    E. medication is curative

19. Choose the correct statement regarding brachial plexus injuries:
    A. these injuries are always very severe and devastating
    B. surgery is required for all brachial plexus injuries
    C. there is no treatment for brachial plexus injuries
    D. these injuries can be prevented by monitoring fetal size
    E. these disorders are inherited

20. Which of the following statements is correct regarding distal radial fractures?
    A. these injuries are always the result of abuse
    B. there is only one type of distal radius fracture
    C. these fractures are more common in elderly persons
    D. these injuries are more common in Caucasians
    E. casting is the treatment of choice

21. You are evaluating a 15 month old child in the ED for a suspicion of child abuse. The
    grandmother states that the child has ―osteogenesis imperfecta type 2‖, and gives no
   further history. Since there are multiple fractures on the x-rays you obtain, how would
   you make the diagnosis?
   A. perform a bone biopsy
   B. send collagen synthesis analysis and chromosome marker
   C. look at the eyes for blue sclera
   D. send for a chromosome analysis and a CBC
   E. obtain a CT scan of the entire child

22. Enchondromas and hemangiomas can coexist in which of the following disorders?
    A. Maffucci syndrome
    B. metachondromatosis
    C. Ollier disease
    D. Hurler syndrome
    E. osteogenesis imperfecta

23. Choose the correct statement regarding the mucopolysaccharidoses:
    A. all MPS syndromes are fatal in child hood
    B. all MPS syndromes have the same enzymatic deficiency
    C. all MPS syndromes can be detected prenatally
    D. all MPS syndromes are transmitted by sex-linked recessive
    E. all MPS syndromes have a normal life span

24. Choose the correct statement regarding Hunter syndrome:
    A. is also called Sanfilippo syndrome
    B. is fatal in infancy
    C. is the same as Hurler syndrome
    D. has a severe and mild form
    E. all forms have mental retardation

25. Which is true of Sanfilippo syndrome?
    A. death occurs by age 10
    B. the most common problems are orthopedic
    C. it is inherited by the sex linked recessive transmission
    D. it is the same as Morquio syndrome
    E. it is the most common type of MPS

26. Which of the following dermatomes are found in the hand and wrist?
    A. T2, T1, and C7
    B. T1, T2, and C8
    C. C6, C7 and C8
    D. C4, C5, and C6
    E. C1, C2, and C3

27. Which of the following is true?
    A. Ganglion cyst are firm nodules that do not transilluminate
    B. Ganglion cyst are an early sign of malignancy involving the tendon sheath
   C. One should suspect a ganglion cyst after presentation of an acute fracture
   D. All ganglion cysts need to be removed surgically for permanent resolution
   E. Ganglion cyst commonly result from a tear in ligaments overlying the lining
      of tendons or joints

28. A patient presents complaining of pain in their R little finger at the DIP joint. They
    mention it is stuck in a flexed position and they cannot straighten it despite trying.
    The remember banging the tip of the finger while reaching for a door handle three
    days ago. You suspect which of the following?
    A. Trigger Finger
    B. Mallet Finger
    C. Thumb UCL Sprain
    D. Anterior Interosseous Syndrome
    E. Guyon’s Canal Syndrome

29. A 30 y/o construction worker doing a lot of jack hammering complains of L wrist
    pain with numbness in a nonspecific distribution. He has a negative Tinel’s sign and
    his grip strength is 5/5. You strongly suspect which of the following?
    A. Kienbock’s disease (breakdown of the lunate bone)
    B. Ulnar nerve entrapment
    C. Scapholunate Instability
    D. Ganglion cyst
    E. Cubital Tunnel Syndrome

30. 23 y/o R handed male presents c/o R wrist pain that has been present for several
   years. It will come and goes. He locates the pain to the middle of his wrist. He
   reports he was a cheerleader in college so he often had sore wrists and thought it was
   from overuse. X-rays are suspicious for Kienbock’s disease. Which of the following
   is true?
   A. If Kienbock’s disease is left untreated, it can lead to complete collapse of the
   B. Stage 1, Kienbock’s disease never requires surgery
   C. Kienbock’s disease is often a result of a traumatic hyperextension injury to the
        wrist with the thumb abducted
   D. A positive Watson Shift Test can indicate presence of avascular necrosis of the
   E. Kienbock’s disease is avascular necrosis of the scaphoid after fracturing the
        scaphoid bone

31. Avascular necrosis is most likely to occur in what type of hip fracture:
    A. Non-displaced fracture
    B. displaced intertrochanteric fracture
    C. displaced femoral neck fracture
    D. displaced subtrochanteric fracture

32. The most common treatment for a femoral shaft fracture is:
   A.   cast
   B.   plate and screws
   C.   intramedullary rod
   D.   amputation

33. When a fracture breeches the articular surface of a joint, a patient is at greatest risk
    A. pain when weather changes
    B. stiffness/loss of motion
    C. post traumatic arthrosis
    D. all of the above

34. Articular discontinuity of __________mm is considered a pre-arthritic state in medial
    tibial plateau fractures.
    A. 1mm
    B. 2mm
    C. 3mm
    D. 4mm

35. With a severe fracture to the lower leg or ankle, the most important initial concern is:
    A. location of fracture
    B. severity of fracture
    C. severity of soft tissue injury
    D. severity of pain

36. When rehabilitating a significantly injured knee, which type of rehabilitation should
    first be incorporated?
    A. Isometric
    B. Eccentric
    C. Isolytic
    D. Concentric
    E. Econcentric

37. A 20 year VT women’s basketball player comes into the sports medicine clinic
    complaining of anterior knee pain worse with jumping. You diagnose her with
    patellofemoral syndrome. Which radiological view is necessary to assess PF
    A. Lateral
    B. AP
    C. Oblique
    D. Merchant
    E. Tunnel

38. Which muscle is crucial in patellar stabilization and rehabilitation for patellofemoral
   A.   Rectus femoris
   B.   Vastus intermedius
   C.   Vastus lateralis
   D.   Vastus medialis obliquus
   E.   Shawnus maximus

39. A 19 year old VT football player has suffered from a recurring popliteal cyst and
    medial knee pain throughout the 2005 season. You are very anxious about traveling
    to a BCS bowl game next year and want to uncover the reason for the chronicity of
    his swelling ASAP. Which is the most likely culprit here?
    A. Medial meniscus pathology
    B. Anterior cruciate ligament tear
    C. Posterior cruciate ligament tear
    D. Quadricep strain
    E. Apophysitis of the tibial tuberosity

40. A tunnel view on plain xray is an important view in considering which of the
    following disorders?
    A. Patellofemoral Syndrome
    B. Osteochondritis dissecans
    C. Osgood Schlatter’s disease
    D. Baker’s cyst
    E. Sinding Larsen Johansson’s disease

41. Supracondylar Humerus Fractures in children
    A. Are a difficult fracture to treat because the area is hard to get to
    B. Are a frequent cause for medical liability claims
    C. Are the most common childhood fracture of all
    D. Are usually flexion type injuries
    E. Cause damage to one of the neighboring nerves in 70% of cases

42. If you see an otherwise normal elbow x-ray of a skeletally immature individual with a
    ―posterior fat pad sign,‖ then
    A. The fracture is a supracondylar humerus fracture
    B. There is a 75% chance of an occult fracture being present
    C. This injury is likely to cause a growth disturbance
    D. This patient will likely need a surgical repair
    E. You will never see an anterior fat pad sign at the same time

43. There are _____ growth centers around a normal elbow which appear and fuse at
    different stages of development.
    A. 1
    B. 2
    C. 3
    D. 4 or less
    E. 5 or more
44. All of the following statements concerning complications following a pediatric
    supracondylar humerus fracture are correct except:
    A. Iatrogenic injury to the ulnar nerve can occur during surgery while placing the
    B. Malunion is most often due to growth disturbance rather than malreduction
        as was once thought.
    C. Most nerve injuries that do occur resolve spontaneously in 3-6 months.
    D. Neurologic injury occurs in 10-20% of displaced, extension type supracondylar
        humerus fractures in children.
    E. The anterior interosseus nerve is the one commonly injured.

45. A ―Monteggia Fracture‖ is
    A. A simple problem to treat, which seldom requires surgery
    B. Dislocation of the proximal ulna with fracture of the radial head
    C. Dislocation of the radial head with fracture of the proximal ulna
    D. The most common adult elbow fracture
    E. The most common pediatric elbow fracture

46. 40 y/o male patient presents w/ medial elbow pain. Relates he is a weekend tennis
    player. States that he has been playing for years without problems. Only new change
    is a new racquet. What is his most likely diagnosis based on his history?
    A. Lateral epicondylitis
    B. Tennis elbow
    C. Golfer’s elbow
    D. Olecranon bursitis
    E. Wrist somatic dysfunction

47. 20 y/o patient presents with pain and numbness in the first 3 fingers of his left hand.
    Also has noticed weakness in the hand. Upon exam, you notice weakness at the DIP
    joint of his thumb and index finger. What is the most likely nerve that is being
    impinged upon to give him the pain and numbness described?
    A. Radial nerve
    B. Ulnar nerve
    C. Median nerve
    D. Vagus nerve
    E. Phrenic nerve

                                  CCC Exam 1 – Block 8

-- but they were about Mohs micrographic surgery, tumor advancement by direct extension into
surrounding tissue, lesions that are considered precursors to squamous cell carcinomas, growths
that are known to spontaneously involute, and a lesion whose histology reveals atypical cells
involving epidermal appendages.
6. This acquired hypertrichotic patch (Image)
        a. arises from abnormal nevomelanocytes
        b. needs to be biopsied as its malignant potnential is high
        c. is know as a café au lait patch
        d. is an acquired large congential hairy nevus
        e. is a developed hamartomatous anomaly
7. Atypcial nevi (image)
        a.are not typically present at birth
        b. are most often found on the lower extremities of men
        c. decline in frequency around the age of 40
        d. are most often smaller than common benign nevi
        e. occurring in one family member, puts all first degree relatives at risk for

8. Breslow depth
        a. is an anatomic measure of tumor invasion
        b. is the most important histological determinant of prognosis in patients with
        c. is measure from the dermoepidermal junction to the deepest part of the tumor
        d. is prognostically less important than histologically proven angiolymphatic
        e. is reported in cm.

9. Malignant melanoma
       a. is responsible for 25% of skin cancer deaths in the US
       b. is more common in Hispanic person than in whites
       c. is the most common cancer in women aged 25-29
       d. incidence is unchanged by chronic exposure to UVA radiation from tanning
       e. should most commonly be diagnosed by performing a shave biopsy

10. This pigmented tumor (image)
       a. accounts for 70% of all malignant melanomas
       b. most often arises from a precursor lesion called lentigo maligna
       c. is a traumatic blood-filled lesion known as talon noir
       d. is the most frequent melanoma type in African Americans and Asians
       e. histologically reveals a radial growth phase only

11. A patient presents with a lesion on her ankle. The lesion started as from a poorly
fitting shoe that rubbed her heel. The lesion is now noted to be erythematous with
crusting and exudates and additional lesions forming adjacent to the lesion. There are no
vesicles and no erythema noted in the lower foot below the lesion or on the leg. The
diagnosis is most likely:
         a. Bullous Impetigo
       b. Non-bullous Impetigo (Correct)
       c. Ecthyma (Also Correct)
       d. Cellulitis
       e. Scalded Skin Syndrome

12. An infant presents with a fluent rash to the trunk and extremities. The skin is peeling
in large sheets and the child is very irritable and crying. The child has a low grade fever.
The child developed an upper respiratory infection noted with yellow green nasal
discharge. This spread rapidly and the child developed a fine rash over the remainer of
the body. This was followed by vesicular eruptions.
        a. Bullous Impetigo
        b. Non-bullous Impetigo
        c. Ecthyma
        d. Cellulitis
        e. Scalded Skin Syndrome

13. The organism that is most likely to cause the illness in question 12?
       a. Staph Aureus
       b. Step Pyogenes
       c. Psuedomonas
       d. Vibrio Vulnificus
       e. MRSA

14. An elderly patient in the skilled nursing unit of a nursing home has recently been
discharged from the hospital where she had a stroke. The pt. is on IV assisted feeding and
has recently had a urinary catheter removed. Today the patient presents with vesicular
lesions on the trunk and thighs. The lesions are hemorrhagic, dark in color, and mildly
inflamed. There is regional lymphadenopathy and fever of 101 is present. The most likely
diagnosis is:
        a. Bullous Impetigo
        b. Ecthyma
        c. Ecthyma Gangrenosum
        d. Cellulitis
        e. Scalded Skin Syndrome

15. The most likely organism to cause this illness in question 14 is:
       a. Staph Aureus
       b. Strep Pyogenes
       c. Psuedomonas
       d. Vibio Vulnificus
       e. MRSA

22. – 26. Match the organism from the following
        a. Necrotizing Fasciitis from Steptococcal infection
        b. Vibrio Vulnificus
        c. S. Aureus
        d. Ecthyma from Strep Pyogenes (Ecthyma is a skin infection similar to
           impetigo. It is often called "deep impetigo" because it occurs deep inside the
        e. Pseudomonas
To the infections described in 22 through 26 below.

22. Bacterial infection with green purulent discharge that may be seen with a nail
puncture to the bottom of the foot through old tennis shoes. E

23. Infection seen from dirty seawater after a flood or hurricane, causing severe blistering
lesions and ulcerations. - B

24. infection seen on the buttocks of a child with deep ulceration, fever, and
lymphadenopathy. - D

25. Common secondary infection that occurs in patients with the chronic tinea pedis.- C

26. Servere infection that may follow surgery spreads rapidly and causes tissue death – A

27. Choose the correct statement regarding nodules:
       a. groups pf nodules are known as plaques
       b. nodules cantain clear fluid
       c. pityriasis rosea is an example of a nodule
       d. nodules are palpable subcutaneous lesions
       e. nodules are the same as bullae

28. – 32. Match the following lesions with their examples:
28. papules – B (Lichen striatus)
29. vesicles – A (Varicella)
30. nodules – C (Hemangioma)
31. bullae – E (Blistering dactylitis)
32. plaques – D (Psoriasis)

a.   varicella
b.   lichen striatus
c.   hemangioma
d.   psoriasis
e.   blistering dactylitis
        Questions Remembered from CCC Heme Nov 2006
                            ******Use at your own Risk*****
                       Excuse errors, faulty memories and confusion

   1. T/F Deaths due to CML are less than 1/1000/yr (true)

   2.    Cells under microscope for MMF = teardrops

   3. Cells under microscope for CML = basophils

   4. Cells under microscope for CLL = lymphocytes granular

   5. Burkitts lymphoma cause = EBV

   6. Stage of NHL; cervical + medistinal masses = Stage II

   7. Which test result would show worse prognosis for NHL = LDH; increased

   8. B12 deficiency = atrophic glossitis

    9. Folate deficiency = normal Methylmalonic and homocysteine
                  elevated (this is correct but on the test we think it gave an option of
                  elevated MMA and normal homocysteine so be sure to read what it
   10. Cytotoxic aplastic anemia = benzene

   11. Idiosyncratic aplastic anemia = chemo

   12. T/F ALL presents significantly different in Adults than children = True

   13. Which one is a B symptom = episodic fever

   14. Which one causes neural degeneration = Copper

   15. Which is true about Pernicious Anemia = Was named so b/c it was fatal before
                                               treatment became available

   16. All have low hct, wbc, with reticulocytosis except = aplastic anemia

   17. Serum Ferritin Test distinguishes between = iron deficiency anemia vs anemia of
                                                   chronic disease

18. Which is not associated with ? = gluten insensitivity

19. Medi…man with low MCV > the options were assume thallassemia b/c he is from
                             the Med, Transfuse and GI colonoscopy or give iron
                                     supplements ( Many of us chose give iron
                                     supplements b/c he appeared iron deficient)

20. Age range for NHL = > 60

21. Motrin for ankle with identical twin brother > options were take off motrin, schedule
                                                   Transfusion, take off all meds (many
                                                    of us chose take off all meds)

22. 2 classifications of MDS = WHO and FAB true

23. These are all seen in the 9 subtypes/categories of MDS except > the options were
                                                                    Pelger Huet
                                                                     maybe gums
                                                                     (the answer was
                                                                      all three we think)

24. Treatment for ANLL would be Induction, consolidation but if the question was
    Treatment for ALL then you would need Induction, consolidation and CNS

25. APL which one is true = present with DIC or the question may have been what is the
    most common cause of DIC > options obstetric complications, liver disease, ???
    (many of us chose obstetric complications????)

26. MDS Staging by total body mass disease = False

27. Leukostasis?

28. ALL presents with wide range chromosomal abnormalities and ploidy = true

29. MDS presents w/???

30. Which method is not used to detect …> answer was go to Philadelphia

31. Markers for ??? options > were T cell CD4, B23 - who knows?????

32. Tyrosine Kinase > blocks phosphorylation

33. Which is not indicative of P Vera = Increased RBC test

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