Lab Final Review Flashcards
You begin seeing patients at a local substance abuse rehab 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 in his 30s. You learn that he is a diabetic and is a little overweight. He reports pain in his lower back, but says that it has increased in severity recently. As he gets up to leave, you notice that he has a pronounced stomping (slappage) 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 injuries, but has reduced sensation in his foot.
What is the likely diagnosis?
Neuropathic arthropathy
A 5-year-old presents with upper right thigh pain. The parents explain that the child has been experiencing pain for the past several months. You don’t notice any abnormalities in your physical exam and the parents explain that none of the child’s previous exams had produced abnormal findings either. A radiograph is taken and shows a small radiolucent area surrounded by a sclerotic border. Given the lesion’s size and appearance, you and your colleagues suggest that the patient be given a regimen of NSAIDs (aspirin) and this helps relieve the patient’s pain.
Which of the following best describes why NSAIDs relieve the patient’s pain?
- NSAIDs stop the accumulation of serous fluid causing expansion of this lesion, which relieves the patient’s pain
- Lesion contains an overproliferation of vasculature. Elevated PGE2 levels cause vasodilation which results in increased pain. NSAIDs affect the COX pathyway causing vasoconstriction and pain relief
- NSAIDs stop osteogenesis controlling the growth of the lesion
- The lesion is caused by the proliferation of abnormal plasma cells. NSAIDs reduce inflammation leading to necrosis of the plama cells
Lesion contains an overproliferation of vasculature. Elevated PGE2 levels cause vasodilation which results in increased pain. NSAIDs affect the COX pathyway causing vasoconstriction and pain relief
osteoid osteoma
Name the six Ds used to describe the impacts on bone observed in this radiograph
- Debris
- Disorganized
- Distension
- Density
- Destruction
- Dislocation
Which of the following applies to neuropathic arthropathy?
- Non-inflammatory
- Inflammatory
- Parasitic
- Infectious
Non-inflammatory
You are in clinic and a new patient arrives. Sam is a 36-year-old with swelling in his 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. You ask how long he has been experiencing these symptoms and he says that it has been several months, but things have gotten worse over 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 on the case presentation, what is the most likely diagnosis for this patient?
Rheumatoid arthritis
You are in clinic and a new patient arrives. Sam is a 36-year-old with swelling in his 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. You ask how long he has been experiencing these symptoms and he says that it has been several months, but things have gotten worse over 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.
What radiographic finding would best support your diagnosis?
- Osseous ankylosis of the interphalangeal and metacarpalphalangeal joints
- Juxta-articular osteoporosis at the interphalangeal and metacarpalphalangeal joint margins
- Reversible subluxations in the interphalangeal and metacarpalphalangeal joints
- Osteophyte formation at the interphalangeal and metacarpalphalangeal joint margins
Juxta-articular osteoporosis at the interphalangeal and metacarpalphalangeal joint margins
rheumatoid arthritis
You are in clinic and a new patient arrives. Sam is a 36-year-old with swelling in his 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. You ask how long he has been experiencing these symptoms and he says that it has been several months, but things have gotten worse over 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?
RA factor positive
rheumatoid arthritis
This radiograph demonstrates which type of deformity?
Boutonniere deformity
rheumatoid arthritis
What cellular events would produce this deformity?
- Synovium becomes inflamed due to autoimmune response, thickens, and becomes hyperplastic, forms panus
- Panus continues to thicken and eventually starts to produce extra protease b enzymes
- Erosion of the bone, lose ligament attachment sites causing subluxations, dislocations, and deformities
- Over time, fibrous bands form around the joint (fibrous ankylosis)
rheumatoid arthritis
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 it’s related to the additional hours at the restaurant. In the past few weeks, he has really had difficulty managing the business. You notice that he has lost about 15lbs since you last saw him. He says he’s actually eating more. Bloodwork shows that he is slightly anemic and radiographs of his skull, pelvis, and vertebra show multiple small punched out osteolytic lesions.
What diagnosis fits this patient presentation?
Multiple myeloma
A 57-year-old male named John has been receiving regular adjustments once a month for several years. You haven’t seen him i 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 it’s related to the additional hours at the restaurant. In the past few weeks, he has really had difficulty managing the business. You notice that he has lost about 15lbs since you last saw him. He says he’s actually eating more. Bloodwork shows that he is slightly anemic and radiographs of his skull, pelvis, and vertebra show multiple small punched out osteolytic lesions.
What lab findings would provide greatest evidence to help confirm your diagnosis?
Bence Jones protein
multiple myeloma
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 it’s related to the additional hours at the restaurant. In the past few weeks, he has really had difficulty managing the business. You notice that he has lost about 15lbs since you last saw him. He says he’s actually eating more. Bloodwork shows that he is slightly anemic and radiographs of his skull, pelvis, and vertebra show multiple small punched out osteolytic lesions.
What is the most probable sequella for this patient’s condition?
Renal failure
multiple myeloma
What is a probable sequela for this patient’s condition?
Renal failure
multiple myeloma
Which of the following observations is the most diagnostically relevant characteristic in this radiogaph?
- Soap bubble appearance
- Location of the lesion extending into the epiphyseal region
- Intact cortex
- Radiolucent lesions
Location of the lesion extending into the epiphyseal region
giant cell tumor
You start seeing a new patient, Andy, who is a 30-year-old male. He never had medical insurance and hasn’t seen a physician since he was a child. As he walks into your office, you notice his spine has a pronounced kyphosis in the thoracic region. Andy says that he has been experiencing stiffness and pain in his back for years. He finally decided to seek a doctor’s advice because he noticed less flexibility in his spine, which 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.
What is the most likely diagnosis?
Ankylosing spondylolitis
You start seeing a new patient, Andy, who is a 30-year-old male. He never had medical insurance and hasn’t seen a physician since he was a child. As he walks into your office, you notice his spine has a pronounced kyphosis in the thoracic region. Andy says that he has been experiencing stiffness and pain in his back for years. He finally decided to seek a doctor’s advice because he noticed less flexibility in his spine, which 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.
What lab result would help confirm your diagnosis for this patient?
HLA B27 positive
ankylosing spondylolitis
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 reports using NSAIDs, but they don’t seem to be helping long term. When you ask if he has had any recent injuries he says no.
What is the most likely diagnosis for this patient?
Osteosarcoma
Name 2 (or more) pathologies that typically produce the type of ankylosis seen in this radiograph
- Ankylosing Spondylitis
- Enteropathic Spondylitis
- Psoriatic arthritis
- Reiter’s syndrome
swan neck deformity
What is the name for the radiolucent lesions visible on the humeral head in the radiograph below showing a case of noniflammatory joint disease?
Geode
(aka subchondral cyst)
osteophyte circled in purple
Describe the cellular events leading to this degenerative joint disease
- Chondrocyte death is faster than production
- Synovial fluid fills spaces
- Fibrocartilage plug forms
- Cracks in fibrocartilage plug
- More synovial fluid fills in the cracks
- Cysts form around areas of synovial fluid
- Cysts can be capped by a fibrocartilage plug
subchondral cyst
What non-pharmacological treatments would you recommend for the patient with this radiograph showing degenerative joint disease?
Chiropractic care with soft tissue work
subchondral cyst
Is this lesion eccentric or eucentric?
Eucentric
Name three conditions you should include on your differential diagnosis based on this image
- Multiple myeloma
- Infection
- Mestastatic disease
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?
Systemic Lupus Erythematosus
(Lupus)
This radiograph depicts osteolytic lesions in the foot due to gout.
What causes the osteolytic response observed in this condition?
Uric crystal deposits
gout
This radiograph 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?
Periarticular erosions
gout
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
True or False:
The corduroy cloth appearance observed in cases of hemangioma can occur in more than one vertebrae, but never all vertebral bodies
True
In the image below, the green arrow indicates the fusion of intervertebral joints in the thoracolumbar spine due to the formation of ___, which are ossified or calcified annular intervertebral disk fibers.
Syndesmophytes
You have a patient who suffers from degenerative joint disease.
Which of the following would most likely describe this patient’s pain?
- Constant deep achy pain
- Sharp anterior knee pain
- Deep achy pain that may be worse with activity
- No pain but obvious joint destruction present on a physical exam or radiograph
Deep achy pain that may be worse with activity
During the pathogenesis of degenerative joint disease bony projections growing off the bone are called ___. These typically start developing ___
- osteophytes; at the joint margins
- syndesmophytes; at the joint margins
- osteophytes; on the articular cartilage
- syndesmophytes; on the subchondral bone
osteophytes; at the joint margins
Which of the following best describes the pathology depicted in the gross specimen in the image below?
- Benign
- Malignant
- Cyst
- Non-inflammatory
Malignant
Ewing sarcoma
A primary osteosarcoma is a primarily ___ growth, which will appear ___ on radiographs.
- Osteoblastic; radiopaque
- Osteoblastic; radiolucent
- Osteolytic; radiopaque
- Osteolytic; radiolucent
Osteoblastic; radiopaque
Which of the following terms best describes the appearance of an aneurysmal bone cyst on a radiograph?
- Multilocular
- Unilocular
- Non-expansile
- Eucentric
Multilocular
Which of the following will present as a primarily radiolucent lesion?
- Primary osteosarcoma
- Osteoma
- Osteophyte
- Enchondroma
Enchondroma
Which term best describes the neoplastic growth depicted in the image below near the distal femur metaphysis?
- Pedunculated
- Sessile
- Tuberous
- Malignant
- Eucentric
Pedunculated
Type I muscle fiber types will have more ___ compared to Type II muscle fiber types.
- numerous mitochondria
- fast conduction motor neurons
- SR pumping capacity
- contraction speed
numerous mitochondria
Becker Dystrophy is most likely to effect ___ (fibers).
extrafusal fibers
Your patient Gina mentions that her son, who is 3-years-old is demonstrating difficulty standing, walking, and sometimes even crawling. She states that his limbs have always looked a little thin compared to other children his age but didn’t think that was too abnormal until his recent difficulties. You suggest ordering blood work for the child and it returns with elevated levels of creatine kinase but normal c-reactive protein. A histological tissue section also demonstrates that multiple muscles in the body show progressive necrosis and fibrosis, primarily involving Type I muscle fibers.
What is the most likely etiology of the child’s condition?
Gene mutation causing decreased dystrophin production
Duchenne muscular dystrophy
What type of tissue is indicated by the purple arrow in this histological tissue section of an osteochondroma?
cartilage
osteochondroma
You are handed a file in clinic with no associated information for the case. Immediately you notice that the radiograph shows a mixed osteolytic and osteoblastic response in both os coxae and the left femur. You also notice increased cortical thickness and coarsening of the trabeculae in the left femur with no evidence for periosteal or soft tissue involvement.
Which pathology is most likely?
Paget’s disease
You have a 35-year-old female patient who you suspect is suffering from lupus. She frequently experiences a rash on the palms of her hands and face, under her eyes and over the bridge of her nose. Her symptoms and rash are often worse after UV exposure.
Which of the following is most likely the cause of this patient’s rash?
- Necrotizing vasculitis
- Keratin overproduction
- Dermatomyositis
- Keratoderma blennorrhagica
Necrotizing vasculitis
DDx: dermatomyositis
pick both if “select all that apply”
What skeletal muscle structure comprising a bundle of muscle fibers is indicated by #5 in this image?
Fascicle
What skeletal muscle structure comprising a bundle of muscle fibers is indciated by #4 in this image?
Muscle fiber
You see a 63-year old female patient for back pain. While taking her history, you learn that she was diagnosed with rheumatoid arthritis approximately 30 years previously and has been managing her condition well with disease modifying drug therapy and lifetyles changes. You note for her appointment states that she is experiencing back pain but does not give any additional details.
Which region of the spine/pelvis is most likely to be affected by her existing diagnosis?
Cervical region
You have a 65-year old male patient named Jim that you have been treating for the past 3 years. Recently, Jim has asked to see you more frequently as he states that he doesn’t receive as much relief from his adjustments. You tell Jim that you would like to take a new set of images just to verify that there haven’t been any changes to the area you are treating. On the radiograph, you notice that L3, L4, and L5 all have portions of the vertebral bodies that are not visualized. Intervetebral disk height is maintained for all lumbar vertebrae. L3, L4, and L5 all have lytic areas with cortical disruption.
Which of the following terms best describes this presentation?
- Osteosarcoma
- Benign
- Non-aggressive
- Aggressive
Aggressive
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.
Which of the following would you most likely observe on a radiograph of this patient’s right knee?
- Short Zone of Transition
- Long Zone of Transition
- Intact cortex
- Unremarkable findings
Long zone of transition
osteosarcoma
Which of the following is a true statement about osteochondromas?
- They will grow toward the joint
- They will grow away from the joint
- There are two forms pedicled and surreal
- They will generally elicit pain
- More than 3 is consistent with the multiple hereditary exostosis
They will grow away from the joint
What pathology is generally associated with the type of ankylosis shown in the radiograph below?
Rheumatoid arthritis
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 of the following best describes the pathogenesis of the disease associated with this patient’s condition?
- Damage to articular cartilage leading to inflammation in the joint
- Immune complexes directed at joint tissues lead to pannus formation and the erosion of joint structures
- Crystals accumulating in the joints are being broken down by neutrophils and macrophages resulting in inflammation and the
erosion of joint structures - A bacterial infection in the joint prompts synovitis and erosion of the joint structures
Immune complexes directed at joint tissues lead to pannus formation and the erosion of joint structures
rheumatoid arthritis
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.
What is the etiology of the pathology depicted in this radiograph?
Biomechanical stress with peripheral nerve damage
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.
Using the characteristic terminology specific for this disease process, name 2 radiographic observations that could be used to describe the impacts to bone observed in the radiograph.
- Decreased joint space
- Osteoclastic activity [Destruction, Dislocation, Debri, Distension, Disorganization, Density (subchondral sclerosing)]
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.
Using the characteristic terminology specific for this disease process, name 2 radiographic observations that could be used to describe the impacts to bone observed in the radiograph.
- Decreased joint space
- Osteoclastic activity [Destruction, Dislocation, Debri, Distension, Disorganization, Density (subchondral sclerosing)]
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 of the following is a potential sequela for Sam’s condition?
- Tenosynovitis
- Renal failure
- CPPD
- Chondrosarcoma
Tenosynovitis
rheumatoid arthritis
A new patient, Jim, presents with low back pain. Jim is a 25-year-old male states that his pain started several months ago and has been getting progressively worse. Lately, he is noticing less flexibility in his low back and more recently, he has been experiencing pain in his right knee. When asked about his medical history he reports a recent urinary tract infection, a humerus fracture that occurred 10 months ago, and a severe gastrointestinal infection several months ago. He reports that all of these issues have since been resolved.
Which of the following is the most likely potential sequela of Jim’s condition?
- Tenosynovitis
- Rhemuatoid arthritis
- Systemic Lupus Eyrathematosus
- Renal failure
- Conjuntivitis
Conjunctivitis
Reiter’s syndrome
A new patient, Jim, presents with low back pain. Jim is a 25-year-old male states that his pain started several months ago and has been getting progressively worse. Lately, he is noticing less flexibility in his low back and more recently, he has been experiencing pain in his right knee. When asked about his medical history he reports a recent urinary tract infection, a humerus fracture that occurred 10 months ago, and a severe gastrointestinal infection several months ago. He reports that all of these issues have since been resolved.
What is the most likely diagnosis for Jim?
Reiter’s syndrome
The osteoblastic activity indicated by the arrow is indicative of changes associated with which pathology?
- Chondromalacia patella
- Degenerative joint disease
- Ankylosing spondylitis
- Osteosarcoma
- Acute osteomyelitis
- Osteoma
Degenerative joint disease
A 65-year-old man diagnosed with Paget’s disease presents with an increased amount of Type I collagen biproducts and elevated alkaline phosphatase in his blood.
What does this indicate about the patient’s case (stage)?
The patient is in stage 2 of the disease process
Which of the following is used as a common route for hematogenous metastatic spread?
- Vertebral arteries
- Saphenous system
- Lymphatic spread
- Batson’s Venus Plexus
Batson’s Venus Plexus
Which pathology best fits this radiograph, which shows evidence of marginal lytic erosion and a periosteal response?
Psoriatic arthritis
What type of deformity is demonstrated in the second digit in this radiograph?
Swan neck deformity
