Lab Final Practice Questions Flashcards
What pathology best fits the radiograph below, which shows evidence of marginal lytic erosions and a periosteal response?
A: Psoriatic arthritis
B: Lyme disease
C: Rheumatoid arthritis
D: Systemic lupus erythematosus
Psoriatic arthritis
A 26-year-old male presents to your office with pain in his knees. He is trying to get in shape after gaining weight during his graduate school program where he says he was largely inactive because of his rigorous work and school schedules. In the past few months he has started jogging regularly and following a mediterranean diet. He says that both knees feel achy and stiff all day and in the past week he stopped jogging due to the pain. You take radiographs of both knees but don’t see any relevant changes to bone or alignment. Based upon the case presentation, which of the following is the most likely diagnosis for this patient?
A: Degenerative joint disease
B: Chondromalacia patella
C: Rheumatoid arthritis
D: Osteosarcoma
E: Septic arthritis
F: Neuropathic arthropathy
Chondromalacia Patella
You begin seeing patients at a local substance abuse rehabilitation clinic. Your first patient is a 56-year-old male with a history of opioid abuse due to a back injury he sustained at work when he was 35. You learn that he is a little overweight and was diagnosed with diabetes 5-years ago, although he has not been managing his condition well for at least the past year. He reports pain in his lower back, but says that it hasn’t increased in severity recently. As he gets up to leave you notice that he has a pronounced stomping gait when he walks and his foot is slightly everted. You ask your patient if he has noticed any new injuries or pain in his foot, but he says no. When you examine his foot you notice that he doesn’t have any sores or open epidermal lesions. Which of the following diagnoses best fits this patient’s presentation?
A: Neuropathic arthropathy
B: Chondromalacia patella
C: Degenerative joint disease
D: Gout
E: Septic arthritis
F: Acute osteomyelitis
Neuropathic arthropathy
A 46-year old female patient presents with altered gait and swelling in their right knee. An examination reveals that the patient demonstrates a lack of sensation when the affected area is stimulated. Which of the following best describes the etiology of the pathology depicted in the radiograph below?
A: Biomechanical stress with peripheral nerve damage
B: Biomechanical stress
C: Immune complexes directed at the joint produces pannus and tissue erosion
D: A bacterial infection which produces pus and bone erosion
E: A traumatic fracture complicated by infection
Biomechanical stress with peripheral nerve damage
- Part 1. A new patient arrives to the clinic. Sam is a 36-year-old male who presents with pain and swelling in both hands. He explains that the pain is fairly constant and he sometimes has difficulty performing tasks due to the pain and stiffness in his fingers. He also explains that he has been feeling extremely tired lately and is having difficulty staying focused at work. He states that the pain started several months ago but things have gotten progressively worse in the past month. When you take his temperature you notice a slight fever. You ask if he remembers seeing a rash or having any digestive issues and he says that he hasn’t noticed anything since his symptoms began. Based solely on the case presentation what is the most likely diagnosis for this patient?
A: Psoriatic arthritis
B: Rheumatoid arthritis
C: Degenerative joint disease
D: Enteropathic arthropathy
Rheumatoid arthritis
- Part 2. A new patient arrives to the clinic. Sam is a 36-year-old male who presents with pain and swelling in both hands. He explains that the pain is fairly constant and he sometimes has difficulty performing tasks due to the pain and stiffness in his fingers. He also explains that he has been feeling extremely tired lately and is having difficulty staying focused at work. He states that the pain started several months ago but things have gotten progressively worse in the past month. When you take his temperature you notice a slight fever. You ask if he remembers seeing a rash or having any digestive issues and he says that he hasn’t noticed anything since his symptoms began. Which blood result would best confirm your diagnosis?
A: RF-factor positive
B: HLA-B27 positive
C: ESR elevated
D: Hyperuricemia
RF-factor positive
What type of deformity is demonstrated in the second digit in the image below?
swan neck deformity
- Part 1. One of your patients, a 57-year-old male named John, has been receiving regular adjustments once a month for several years. You haven’t seen him in over a year due to COVID and the more recent increased workload he is experiencing at his restaurant due to staffing shortages. He reports back pain and states that he has been feeling exhausted lately, but assumes its related to the additional hours at the restaurant. In the past few weeks, though, he has really had difficulty managing the business. You notice that he has lost about 15 lbs. since you last saw him. When you ask him about it he says, “I know, I can’t figure it out. With all the stress, I am eating more lately if anything.” You gather bloodwork and radiographs. The blood work shows that he is slightly anemic. The radiographs of his skull, pelvis, and vertebrae show multiple small osteolytic lesions. What diagnosis best fits this patient presentation?
A: Osteoid osteoma
B: Multiple myeloma
C: Lyme disease
D: Giant cell carcinoma
E: Primary osteosarcoma
Mulitple myeloma
- Part 2. One of your patients, a 57-year-old male named John, has been receiving regular adjustments once a month for several years. You haven’t seen him in over a year due to COVID and the more recent increased workload he is experiencing at his restaurant due to staffing shortages. He reports back pain and states that he has been feeling exhausted lately, but assumes its related to the additional hours at the restaurant. In the past few weeks, though, he has really had difficulty managing the business. You notice that he has lost about 15 lbs. since you last saw him. When you ask him about it he says, “I know, I can’t figure it out. With all the stress, I am eating more lately if anything.” You gather bloodwork and radiographs. The blood work shows that he is slightly anemic. The radiographs of his skull, pelvis, and vertebrae show multiple small osteolytic lesions. Which of the following is the most probable sequella for this patient’s condition?
A: Degenerative joint disease
B: Renal failure
C: Diabetes
D: Rheumatoid arthritis
E: Becker muscular dystrophy
F: Aneurysmal bone cysts
Renal failure
Which of the following observations is the most diagnostically relevant characteristic in the radiograph?
A: Soap bubble appearance
B: Location of the lesion extending into the epiphyseal region
C: Intact cortex
D: Radiolucent lesions
Location of the lesion extending into the epiphyseal region
- Part 1. You start seeing a new patient, Andy, who is a 30-year-old male. Andy never had medical insurance and hasn’t seen a physician since he was a child. Andy says that he has been experiencing stiffness and pain in his back for years. He says the pain started in his lower back, but has been getting progressively worse. He finally decided to seek a doctor’s advice because he noticed less flexibility in his spine, which is starting to alter some of his activities of daily living. You notice that his He says the pain is fairly severe in the morning, but gets a bit better during the day. More recently, he has noticed pain in his feet as well. You ask if he has had a history of gastrointestinal issues and he reports that he has not. What is the most likely diagnosis for Andy?
A: Psoriatic arthritis
B: Rhemuatoid arthritis
C: Ankylosing spondylitis
D: Enteropathic arthritis
Ankylosing spondylitis
- Part 2. You start seeing a new patient, Andy, who is a 30-year-old male. Andy never had medical insurance and hasn’t seen a physician since he was a child. Andy says that he has been experiencing stiffness and pain in his back for years. He says the pain started in his lower back, but has been getting progressively worse. He finally decided to seek a doctor’s advice because he noticed less flexibility in his spine, which is starting to alter some of his activities of daily living. You notice that his He says the pain is fairly severe in the morning, but gets a bit better during the day. More recently, he has noticed pain in his feet as well. You ask if he has had a history of gastrointestinal issues and he reports that he has not. What lab result would help confirm your diagnosis for this patient?
HLA B27 positive
You are providing supportive care to a local high school soccer team. One of the players, a 17 year-old boy, reports pain and swelling in his right knee. He says he hasn’t been experiencing the pain that long, but its getting worse. He explains that it feels like its deep in his leg, just below the knee, and it is keeping him awake at night. He reported using NSAIDs, but they don’t seem to be helping long term. When you asked if he has had any recent injuries he says no. What is the most likely diagnosis for this patient?
A: Chondromalacia patella
B: Osteosarcoma
C: Osteochondroma
D: Enteropathic arthropathy
Osteosarcoma
This question is worth 2 points. Make sure to answer both parts of the question. Name 2 pathologies that typically produce the type of ankylosis seen in the radiograph below.
Psoriatic Arthritis
Ankylosing Spondylitis (also Enteropathic Spondylitis)
What is the name for the radiolucent lesions visible on the humeral head in the radiograph below showing a case of noniflammatory joint disease. __1__
Subchondral cyst
What non-pharmacological treatments would you recommend for the patient with the radiograph below showing degenerative joint disease?
Chiropractic care with soft tissue work.
A 25-year old female presents with pain and stiffness in both hands. Examination of her hands demonstrates subluxations of the metacarpal phalangeal and interphalangeal joints but the patient is able to extend these joints with normal joint alignment when they exert downward pressure. A radiograph also shows no lytic changes in the joints. Based solely on this information, what is the most likely diagnosis for this patient? __1__
Systemic Lupus Erythematosus
- Part 1. The radiograph below depicts osteolytic lesions in the foot due to gout. What causes the osteolytic response observed in this condition? __1__
uric crystal deposits
- Part 2. The radiograph below depicts an osteolytic lesion in the foot due to gout. What term would you use to describe the osteolytic lesion indicated by the blue arrow based on its location?
A: Periarticular erosion
B: Marginal erosions
C: Intraosseous erosions
D: Mouse ear deformity
Periarticular erosions
Your clinician hands you the radiograph below and asks you to examine the changes at the distal interphalangeal joint. What terminology would you use to describe the reactive bone formation surrounding the marginal erosion?
Fluffy periostitis OR mouse ear deformity (psoriatic arthritis)
