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Medical Quiz on Joint Disorders

Total questions: 153

Worksheet time: 1hrs 17mins

Name
Class
Date
1.

The major lubricant for diarthrotic joints is synthesized by

a)

Synovial membrane

b)

Fibrous capsule

c)

Annulus fibrosus

d)

Articular cartilage

e)

Nucleus pulposus

2.

Which area in cartilage is relatively proteoglycan-rich and collagen-poor?

a)

Perichondrium

b)

Epiphyseal plate

c)

Interterritorial matrix

d)

Fibrocartilage

e)

Territorial matrix

3.

A 20 year-old man complains of sharp and almost constant pain in the region of the right knee. This pain has been present for two months and is associated with swelling of the knee. On admission to hospital a radiograph reported as follows: "Bulky, sclerotic lesion in the lower end of the femur. The lesion extends to the surrounding extra-osseous tissue with transverse 'sunray' streamers of radio-opacity". What is the most likely disorder of bone?

a)

Osteosarcoma

b)

Hyperparathyroidism

c)

Metastatic cancer

d)

Osteomyelitis

e)

Paget's disease

4.

50 years old male, has brief left knee stiffness in the morning, he also felt knee pain after prolonged walking. X-ray of the knee found that there is an osteophyte in the medial compartment of the knee. Where are the disease processes arising from?

a)

Cartilage

b)

Synovium

c)

Bone

d)

Intraarticular fat

e)

All of the above

5.

A 10 year-old boy developed high fever, chills, and worsening leg pain. His upper left leg started to hurt 3 to 4 days ago, and last night he began limping. His parent reports no history of trauma to the area. His only past medical history is two episodes of otitis media (infection in the ear) at age 2 and 7. There were localized tenderness and swelling over the left distal femur. WBC count is 11,500 cells/uL; normal differential count, but ESR is 58 mm/hour. The blood cultures obtained revealed Gram(+) cocci. How is the boy getting this illness?

a)

Direct spread

b)

Air-borne

c)

Lymphogenic

d)

Hematogenous

e)

Fecal-oral

6.

Female 68 years old, present with severe bow legs and pain in both knees during activities. Force change in this condition is?

a)

Increase adduction moment

b)

Increase abduction moment

c)

Decrease extension moment

d)

Decrease flexion moment

e)

None of all the above

7.

While examining a piece of tissue taken from the epiphyseal plate, you noticed large cells arranged in rows. Which of the following layers are you examining?

a)

Calcified zone

b)

Proliferative zone

c)

Hypertrophy zone

d)

Resting zone

8.

A 30-year-old woman was hit by a car and fell down at her arm. She cannot abduct her arm. The radiograph showed fracture of proximal humerus, then she cannot abduct her arm, what vessel is the most possible injured?

a)

A. ulnaris

b)

A. axillaris

c)

A. radialis

d)

A. brachialis

e)

A. profundabrachii

9.

Female 67 years old complaining of pain in the right hip in the last 2 years, the pain comes after walking in a long distance. She feels otherwise healthy. From the physical examination we found painful and limited hip internal rotation. Which is the most possible condition?

a)

Infection

b)

Osteoarthritis

c)

Rheumatoid arthritis

d)

Gout

e)

AVN

10.

A man 30 years old felt very tired after half marathon training. What is the nerve for maintaining a muscle tonus in sustained stretch?

a)

Static γ fiber tonuclear chain fiber of intrafusal skeletal muscle

b)

Dynamic γ fiber tonuclear chain fiber of intrafusal skeletal muscle

c)

Static γ fiber tonuclear bag fiber of intrafusal skeletal muscle

d)

Dynamic γ fiber tonuclear bag fiber of intrafusal skeletal muscle

e)

Static γ fiber tonuclear chain fiber of extrafusal skeletal muscle

11.

While moving into a new apartment a student lifting a heavy box of books experiences a sharp pain in his back, radiating down the anterior thigh and medial side of his leg. After several days of misery, he finally goes for treatment and is told that he has a herniated intervertebral disk at the L3 level which is compressing a spinal nerve where it exits the vertebral column. Where is the point of compression?

a)

Hiatus of the sacral canal

b)

Vertebral foramen

c)

Foramen magnum

d)

Central canal

e)

Intervertebral foramen

12.

While examining a piece of supportive tissue taken from the vertebral column, you noticed rows of cells, in lacunae, between collagen fibers. Which of the following supportive tissue are you examining?

a)

Hyaline cartilage

b)

Compact bone

c)

Elastic cartilage

d)

Fibrous cartilage

13.

A 70-year-old male came to hospital with chief complaint of sudden sharp pain on his back when he was gardening. On physical examination vital signs are normal, range of motion was limited, and there is pain on bending and twisting. Radiographic examination reveals compression fracture on level L3-4. What is the most likely diagnosis?

a)

Osteomalacia

b)

Osteoporosis

c)

Osteopetrosis

d)

Spondylitis

e)

Neoplasm

14.

When helping a baby delivery, a midwife noticed that there’s asymmetric number of thigh skin folds, uneven knee levels and limitation of hip abduction. What diagnosis should be checked on the newborn?

a)

Developmental dysplasia of the hip

b)

Blount disease

c)

Athrogryphosis

d)

Osteogenesis imperfecta

15.

A 15-year-old girl complained of severe pain in her left knee after vigorous exercise for 4 weeks. The knee joint has been swollen and red then she cannot extend her leg. The doctor diagnosed as stress fracture. The MRI showed tear of patella ligament, which structure of the bone is inserted by those ligament?

a)

Capitulum fibulae

b)

Malleolus lateralis

c)

Crista tibialis

d)

Tuberositas tibia

e)

Condyles medialis

16.

A 75 year-old widow complains of generalized aching in her bones, and a gradually increasing curvature of her upper spine. An X-ray shows osteopenia and vertebral changes. Serum calcium, phosphate, alkaline phosphatase and a blood screen, including ESR, are all normal. What is the most likely cause of this condition?

a)

Hyperparathyroidism

b)

Hyperthyroidism

c)

Multiple myeloma

d)

Osteoporosis

e)

Vitamin D deficiency

17.

A 50-year-old woman has experienced pain in lumbar joints for several months. Radiographic examinations shows Bamboo’s spine. Physical examination reveals several nodules in her small joints in the hands and feet. Histology of the nodule after biopsy shows a central fibrinoid necrosis, surrounding by palisading epithelioid macrophages. The best diagnostic is

a)

Rheumatoid arthritis

b)

Osteoid osteoma

c)

Gout diseases

d)

Chronic osteomyelitis

e)

Osteoarthritis

18.

A 40-yr-old man was admitted to hospitals suffering from tuberculosis. A pathologist discovered central caseous necrosis surrounded by epithelioid macrophages in an area affected by the bacterial infection. Which type of inflammation is most likely associated with this patient's infection?

a)

Ulcer

b)

Acute suppurative

c)

Granulomatous

d)

Chronic active

e)

Chronic suppurative

19.

A 25 year-old man comes to outpatient for follow up his tibia fracture started last month. Physical and radiologic examination reveals normal phase of bone remodeling. Which of the following cell is the most involved in process above?

a)

Osteoblast

b)

Osteocyte

c)

Osteoclast

d)

Osteon

e)

Osteoid

20.

A 20 year old woman came to the hospital with a fracture upper right tibia. X-ray showed well circumscribed lesion, partly cystic. Curettage biopsy is performed and histopathology shows well demarcated fibrous tissue containing small abnormal bone trabeculae. What is the most likely diagnosis based on microscopic appearance?

a)

Ganglion cyst

b)

Chondroblastoma

c)

Fibrous dysplasia of the bone

d)

Osteomyelitis chronic

e)

Osteomyelitis tuberculosa

21.

Female, 60 years old, complaint about pain and stiffness of her left knee. The doctor finds cartilage softening during knee arthroscopy. What is the earliest change that happened at the cartilage?

a)

Decrease proteoglycan

b)

Vascular invasion

c)

Chondroblast death

d)

Decrease collagen

22.

A 65-year-old woman complained of pain in his thigh after strenuous session at the gym. She cannot extend her leg. What muscle is probably impaired?

a)

M. tibialis anterior

b)

M. biceps femoris

c)

M. gastrocnemius

d)

M. quadriceps femoris

e)

M. semimembranosus

23.

A 10 years old girl, admitted to hospital due to draining sinus on the right leg for 2 years. She has chronic osteomyelitis that is multi-resistance to antibiotics. What is the most probable cause of multi-resistance?

a)

Abscess

b)

Septicemia

c)

Involucrum

d)

Sequestrum

e)

Cellulitis

24.

A man 58 years old felt his muscle became easy to fatigue and weak. His physician examined him and found his muscle tone and muscle strength is lesser than normal. His physician suspected possibly he had a problem in neurotransmitters such as in myasthenia gravis disease. What is the name of neurotransmitter in skeletal neuromuscular junction?

a)

Norepinephrine

b)

Epinephrine

c)

Acetylcholine

d)

Dopamine

e)

Serotonin

25.

A 68-year-old man reports pain on his knees and difficulty walking. He can walk in the flat areas, but the pain comes when he tries to go up and down the stairs and when standing from a sitting position. She also felt stiffness on both of her knees. On physical examination, which muscles that most probable to become atrophy?

a)

Hamstrings

b)

Anterior tibialis

c)

Quadriceps

d)

Gastrocnemius

26.

A man 38 years old had upper arm muscles sore after he exercised weight training. He went to the doctor and doctor suggested weight training with the multigym. What is the isokinetic contraction?

a)

The length of muscular remains constant during contraction

b)

The muscle lengthens as it contracts maintaining force and movement

c)

The maximal contraction at constant speed over the full range of movement

d)

Tension remains constant as the muscle shortens or lengthens

e)

The muscle shortens to produce force and movement

27.

A child, 6 years old, presents to emergency room with fever and pain over his left knee since yesterday. There is exquisite tenderness on left proximal tibia, and mild local swelling. No history of injury. What is the most appropriate laboratory workup should be done?

a)

Blood culture

b)

Electrolytes

c)

Rheumatoid factor

d)

ASTO

e)

Liver function

28.

12 year-old boy admitted to the hospital with the complaints of fever, chills, local swelling and pain at his left leg after an accident 3 weeks ago. An x-ray of his femur showed bone destruction, necrosis, and new bone formation. A clinical diagnosis of bone infection was made. What additional diagnostic information should be obtained before this boy received his first dose of antibiotic?

a)

Serum creatinine and blood urea nitrogen (BUN)

b)

Complete blood count

c)

MRI scan

d)

Culture of bone aspirate

e)

Procalcitonin level

29.

While examining a piece of bone tissue, you noticed a structure consisting of circular layers surrounding a tube in the center. Which of the following structures are you examining?

a)

Haversian canal

b)

Lamellae generals

c)

Lamellae interstitials

d)

System Havers

30.

A 75 year-old widow complains of generalized aching in her bones, and a gradually increasing curvature of her upper spine. An X-ray shows osteopenia and vertebral changes. Serum calcium, phosphate, alkaline phosphatase and a blood screen, including ESR, are all normal. What is the most likely cause of this condition?

a)

Hyperthyroidism

b)

Osteoporosis

c)

Vitamin D deficiency

d)

Hyperparathyroidism

e)

Multiple myeloma

31.

A 58 year-old woman was admitted to the hospital with a two-month history of pain, swelling and purulent discharge to her left lower leg. This occurred one year after sustaining a fracture to that area. Colonies grown from the purulent discharge on blood agar were convex and appeared golden yellow. What is the most likely diagnosis?

a)

Arthritis caused by Streptococcus pneumoniae

b)

Wound infection caused by Sporothrix schenckii

c)

Osteoarthritis caused by Neisseria gonorrhoeae

d)

Osteomyelitis caused by Staphylococcus aureus

e)

Osteomyelitis caused by Haemophilus influenzae

32.

A man 55 years old felt his muscle became easy to fatigue and weak. His physician examined him and found his muscle tone and muscle strength is lesser than normal. What is the definition of muscle tone?

a)

The minimum resistance of the unstretched muscle

b)

The maximum resistance of the moderate contraction muscle

c)

The maximum resistance of the overstretched muscle

d)

The minimum resistance of the overstretched muscle

e)

The resistance of the active or passive stretched muscle

33.

A patient was hit by a motorcycle from the side. She has pain on shoulder and x-ray fracture of the proximal humerus then she cannot abduct her arm and impairment of the muscle, what nerve is the most probably affected?

a)

N. Ulnaris

b)

N. Radialis

c)

N. Medianus

d)

N. Axillaris

e)

N. Musculocutaneus

34.

A 19 year-old medical student has a fractured radius. He is concerned that his healed fracture won't be strong enough for football. You tell him that he has particular cells that make osteoid and promote mineralisation in fracture healing leading to bone strength. Which cells are these?

a)

Osteocytes

b)

Chondroblasts

c)

Osteoblasts

d)

Osteoclasts

e)

Chondrocytes

35.

A 54-year-old nurse presents for evaluation of her arthritis. Her symptoms began several years ago with acute pain and swelling in the left ankle. This was followed 8 months later by pain and swelling in the left wrist and several joints of the fingers. Functional inquiry is otherwise completely negative. Physical examination reveals swelling and tenderness in the right 2, left 2-3 metacarpophalangeal joints (MCPs), and the right 2, left 3 and 4 proximal interphalangeal (PIP) joints. There is no swelling in the elbows, wrists, knees, or ankles. There are no cutaneous findings. Her general physical examination is normal. Which of the following tests will be most helpful in confirming diagnosis?

a)

Erythrocyte sedimentation rate (ESR)

b)

HLA-B27 antigen

c)

Serum uric acid

d)

Rheumatoid factor

e)

Check ANA

36.

A man 58 years old felt his right arm muscle became easy to fatigue and weak after recovery from right arm bone fracture. His physician said he got muscular atrophy and his connection between nerve and muscular was good. What is the muscular disuse atrophy?

a)

The reducing flow of nerve impulses to the inactive muscle because they are not used

b)

The reducing flow of nerve impulses to the inactive muscle because a muscle's nerve impulses cease

c)

The reducing flow of nerve impulses to the inactive muscle because the damage to the nerves that control them

d)

The progressive degradative action of enzymes that is generally associated with severe cellular trauma

e)

The muscles suffer a vital loss of protein, and muscle fibers are replaced gradually by fat and connective tissue

37.

28 years old woman have a chronic back pain and weak both lower legs, after series of examination the woman is diagnosed with tuberculous spondylitis. Which of the following tests can set the definitive diagnosis?

a)

Positive culture of mycobacterium in biopsy result

b)

Inhomogeneous appearance abscess in MRI

c)

Endplate destruction on vertebral x-ray

d)

Positive result on tuberculin skin test

38.

A 30-year-old man was crashed by motorcycle and fell down at his sacrum. The imaging showed fracture of his sacrum. Afterwards he has problem of pain in his buttock to the leg. Radiograph showed compression of Sciatic nerve. What muscle is most likely affected?

a)

M. gracilis

b)

M. adductor magnus

c)

M. rectus femoris

d)

M. sartorius

e)

M. gastrocnemius

39.

A 60-year-old woman came with complete left femoral neck fracture after fell from tricycle (becak). The bone mineral density examination showed it is less than -2.5. Microscopic examination showed that the bone cortex becomes thinner and the trabeculae have less complex branching. The most significant contributing factor for this fracture is:

a)

Senile osteoporosis

b)

Hyperthyroid

c)

Immobilization osteoporosis

d)

Vitamin D deficiency

e)

Multiple myeloma

40.

A 60 year old man complains about stiffness and pain in the back after activity. Radiographic examination reveals narrowing of L4-5, L5-S1 disc space. What is the most possible cause of the complaint?

a)

Loss of nucleus pulposus chondroitin sulfate

b)

Facet joint degeneration

c)

Annulus fibrosus tear

d)

Osteoporosis

e)

Increased disc water content

41.

65 years old woman come to orthopedic outpatient department after medical check-up, she brings the result of her knee x-ray. From the x-ray we can see that there is an osteophyte in the medial compartment of the knee and some minimal changes on the cartilage, physical examination of the knee is unremarkable. From the case above we can conclude that her knee is having the problem of?

a)

Normal knee

b)

Osteoarthritis

c)

Rheumatoid arthritis

d)

Aging

e)

Gout arthritis

42.

A 20-year-old man was crashed by motorcycle and cannot walk, then was bring to hospital by his friend. The photoradiograph showed fracture of the proximal femur. What structure is most likely injured?

a)

Condyles lateralis

b)

Epicondyles medialis

c)

Linea aspera

d)

Acetabulum

e)

Trochanter major

43.

35 years old man come with complaint of back pain and stiffness. The pain is chronic, not radiating and not changed with movement. On physical examination there’s only slight tenderness and gibbus. What the most probable diagnosis?

a)

Degenerative disc

b)

Spondylarthrosis

c)

Spondylolisthesis

d)

Spondylitis

44.

A 20-year-old girl had fractured her right humerus in a car accident 2 weeks ago. The fracture did not heal properly, and developed a purulent infection of the skin around the site of fracture. An X–ray revealed a focus bone loss near the lower end of the humerus. Curettage biopsy was performed. Microscopic appearance showed a sequestrum, inflammatory cells proliferation and granulation tissue. What is the most likely diagnosis based on microscopic appearance?

a)

Rheumatoid arthritis

b)

Acute Osteomyelitis

c)

Chronic specific osteomyelitis

d)

Chronic non-specific osteomyelitis

e)

Osteoarthritis

45.

A 55 year old male has a history of episodes of a painless nodule with overlying ulcerated skin at his big toe. Beneath the eroded skin is a chalky white deposit of soft material surrounded by erythematous soft tissue. Microscopic appears a collection of filamentous urate crystals. This nodule is most consistent with which of the following lesions?

a)

Osteophyte

b)

Granuloma

c)

Furuncle

d)

Tophus

e)

Pannus

46.

A 30-year-old woman was hit by a byccle and fell down at her arm. She cannot abduct her arm. What muscle is most likely affected?

a)

M. deltoideus

b)

M. biceps brachii

c)

M. supraspinatus

d)

M. subscapularis

e)

M. teres mayor

47.

Radiographic film from a 60-year old woman shows a complete right femoral neck fracture just only caused by a minor fall. In Examination serum calcium level is normal. Bone density examination shows T–score =-2.5. Which of the following condition factor is the most contributing factor for this fracture?

a)

Parathyroid adenoma

b)

Postmenopausal bone loss

c)

Aging

d)

Vitamin D deficiency

e)

Osteomyelitis chronic

48.

A 65-year-old woman reports pain on her knees and difficulty walking. She can walk in the grocery store, but the pain come when she tries to go up and down the stairs and when standing from a sitting position. She also felt stiffness on both of her knees. After seeing a doctor, she is diagnosed with 3 stages of knee osteoarthritis. What pathology in the knees that is the main cause that the knees become stiff?

a)

Capsular fibrosis

b)

Subchondral bone destruction

c)

Osteophyte formation

d)

Cartilage destruction

49.

On a regular checkup of a 6-week-old female infant you note positive Ortolani test on the left side. You suspect the patient is having DDH so you decided to refer the patient to orthopaedic spesialis. On consultation, you try to explain the parents the most probable initial treatment for this patient?

a)

Observation

b)

Closed reduction and internal fixation

c)

Open reduction and internal fixation

d)

Open reduction and cast

e)

Conservative protection with Pavlik harness

50.

Mr. Bachtiar, 75 years old, he suddenly could not walk because fell very pain in his right Leg. Which of these nerves make the basis of the lumbar plexus?

a)

L1-L5

b)

L2-L5

c)

L2-L4

d)

L1-L4

e)

L5-S1

51.

In a case of fracture at the neck of fibula, what nerve wraps around the neck of fibula?

a)

N. Femoral

b)

N. Superficial fibular

c)

N. Common fibular

d)

N. Tibial

e)

N. Deep fibular

52.

Which of the following most accurately describes compact bone?

a)

Also known as cancellous bone

b)

Forms the diploe in cranial bones

c)

Lines the medullary (marrow) cavity

d)

Predominant bone type in the epiphysis of adult long bones

e)

Characterized by the presence of osteons

53.

A 38-year-old woman has recent onset of cold fingers, joint pain, fever, weight loss, and a facial rash. Examination reveals a symmetrical inflammatory arthropathy, a rash over her face and neck, and lymphadenopathy. Investigations reveal thrombocytopenia, normal urine examination, and a strongly positive anti nuclear antibodies (ANA). What is the most likely diagnosis?

a)

Acute osteoarthritis

b)

Rheumatoid arthritis

c)

Septic arthritis

d)

Systemic lupus erythematosus

e)

Gout

54.

In the impairment of muscle inserted to the femur proximal, what movement of the thigh is the most probably disturbed?

a)

Medial rotation

b)

Lateral rotation

c)

Flexion

d)

Extension

e)

Abduction

55.

A man 38 years old had sore upper arm muscle after he helped to push a heavy cart to the side of street. He went to the doctor and doctor said possibly he had muscle strain. A muscle strain is caused by:

a)

Inflammation of ligament

b)

Inflammation of muscle fibers

c)

Overstretching ligament

d)

Excessive stretching or working of the muscle.

e)

Very forceful, repetitive muscular activity

56.

A 42-year-old woman came to the hospital with complains of sharp pain on the upper back in the last 5 months. She also said that 2 years ago she underwent bilateral ovarian cyst surgery. Physical exam reveals tenderness on the thoracic region, no swelling, and no redness. What is the most likely diagnosis in this case?

a)

Posterior rib fracture

b)

Muscle spasm

c)

Herniated nucleus pulposus

d)

Osteoporosis

e)

Spondylitis

57.

While examining a piece of supporting tissue taken from a knee joint, you noticed many cells located in lacunae, some of which are grouped into clusters of two or more cells. The matrix is homogenous. Which of the following supportive tissue are you examining?

a)

Compact bone

b)

Fibrous cartilage

c)

Elastic cartilage

d)

Hyaline cartilage

58.

While examining a “bony” tissue taken from the epiphyseal plate, you noticed several layers of cells. One of these layers consists of rows of flattened cells, arranged like a stack of coins. Which of the following layers are

a)

Proliferative zone

b)

Calcified zone

c)

Hypertrophied zone

d)

Reserve/resting zone

59.

A 25-year-old man of tennis player was injured of his elbow joint. He complained that he cannot extend his forearm. What muscle is probably impaired?

a)

M. supraspinatus

b)

M. subscapularis

c)

M. teres mayor

d)

M. triceps brachii

e)

M. deltoideus

60.

Mr Alan 48 years got infection and swelling at his hand. He went to the hospital and he was given the antibiotic. After 2 weeks his hand healed but he couldnot bend his finger normally. His doctor said his finger possibility suffered muscular necrosis and became contracture. What is the process in muscle contracture?

a)

The non-stretchy Fibrous tissue replace the connective tissue of the muscle fiber

b)

The fat gradually replace the muscle fibers and connective tissue

c)

The progressive degradative of muscle fiber

d)

The non-stretchy Fibrous tissue replace the normally stretchy (elastic) tissues

e)

The Progressive loss of myofibril

61.

Male 57 years old complaint of chronic right hip pain after sports activities. The doctor found osteophyte on hip x ray, and bone marrow lesion on MRI. Histologically, it contains vascular infiltration. What does the lesion on the case signifies?

a)

Effusion

b)

Injury

c)

Inflammation

d)

Instability

e)

Progression

62.

The major lubricant for diarthrotic joints is synthesized by?

a)

Synovial membrane

b)

Articular cartilage

c)

Annulus fibrosus

d)

Nucleus pulposus

e)

Fibrous capsule

63.

What is the preferred treatment for infant diagnosed with CTEV or clubfoot?

a)

Stretching and serial casting with Ponseti method

b)

Open reduction surgery

c)

Bone reconstruction

d)

Soft tissue surgery

e)

Physiotherapy and observation

64.

The most common sequelae of tuberculous spondylitis in an adolescent are?

a)

Pathological dislocation

b)

Bony ankylosis

c)

Chronic osteomyelitis

d)

Fibrous ankylosis

e)

Vertebral body fusion

65.

Quasimoto, the "Hunchback of Notre Dame," suffered from an abnormal thoracic curvature called kyphosis. In this condition the accentuated convexity of the curvature is:

a)

Anterior

b)

Medial

c)

Caudal

d)

Posterior

e)

Lateral

66.

In the injury of proximal femur, which one of the muscle is inserted to those structure?

a)

M. rectus femoris

b)

M. semitendinosus

c)

M. gluteus maximus

d)

M. vastus medialis

e)

M. biceps femoris

67.

A radiographic film from a 60-year old woman shows a complete right femoral neck fracture just only caused by a minor fall. In Examination serum calcium level is normal. Bone density examination shows T–score =-2.5. Which of the following condition factor is the most contributing factor for this fracture?

a)

Postmenopausal bone loss

b)

Vitamin D deficiency

c)

Calcium deficiency

d)

Parathyroid adenoma

e)

Osteomyelitis chronic

68.

A women 60 years old felt his muscle became easy to fatigue and weak. His physician examined him and found his muscle tone and muscle strength is lesser then normal. What will happen in the length tension relationship if the muscle is over stretch?

a)

The overstretched muscle will develop the little tension

b)

The overstretched muscle will produce a relatively maximum contraction

c)

The overstretched muscle will produce a relatively weak contraction

d)

The overstretched muscle will develop a Maximum tension

e)

The overstretched muscle will produce an optimal contraction

69.

An 85-year-old woman has been confined to a nursing home for the past 6 years. Bone density scans suggest that she has osteoporosis. Although the amount of calcium in her diet is adequate, she cannot absorb enough of it to maintain bone mineral density. One factor likely contributing to her condition is insufficient production of which substance in the dermis of her skin?

a)

Parathormone

b)

Melanin

c)

Vitamin A

d)

Calcitonin

e)

Vitamin D

70.

Mrs Ani is a 50 year-old woman, has painful, symmetrical swelling of her metacarpophalangeal (MCP) joints, and has recently found it difficult to wash clothes. She gained some relief from ibuprofen tablets, which she was able to buy in a small quantity from pharmacy. What is the mechanism of the drug given above?

a)

Inhibits cyclooxygenase enzymes

b)

Selectively inhibit COX-2

c)

Similar to anti-inflammatory corticosteroid

d)

Increases the local production of prostaglandins at sites of inflammation

71.

Before taking further treatment, the doctor gave her non-narcotic analgetic to reduce the inflammation and pain. It was also known that the patient is 6-month old pregnant. Which of the following is the most appropriate NSAID for this patient?

a)

Ibuprofen

b)

Acetaminophen

c)

Aspirin

d)

Mefenamic acid

e)

Methampyrone

72.

A 34 year old man came with pain in his left knee since 2 weeks especially in the morning more than 1.5 hours. He also felt pain in his achilles. 1 month before there was history of chronic diarrhea. The rheumatic factor was negative. What is the most probable diagnose for his problems?

a)

Osteonecrosis

b)

Osteoarthritis

c)

Reactive arthritis

d)

Gout arthritis

e)

Rheumatoid arthritis

73.

A 5-year-old girl is on skin traction after fractures her left femur 3 weeks ago. Now the physician removed the traction and found that the fracture fragment is not displaceable anymore but there is still some movement on fracture site with mild tenderness. What is the most likely phase of healing?

a)

Initial bleeding phase

b)

Hard callus phase

c)

Clinical union phase

d)

Soft callus phase

e)

Proliferation phase

74.

A 52 year old man has been taking aspirin for rheumatoid arthritis for 8 months. Exacerbations are becoming worse, and she asks her physician about drugs that might stop the progression of the disease. Which of the following is the most appropriate drug of choice?

a)

Cholchicine

b)

Methotrexate

c)

Prednisone

d)

Sodium diclofenac

e)

Celecoxib

75.

A 55-year-old female complaining of pain on her left knee, usually worse following activity since few months ago. There's also stiffness that worsen after sitting for prolonged periods of time. The findings from the conventional X-ray of left knee are narrowing of the joint-space, osteophytes formation, and subchondral sclerotic. What is the basic pathomechanism in the case above?

a)

Ligament weakening

b)

Cartilage degradation

c)

Meniscus tear

d)

Synovial membrane inflammation

e)

Porotic bone

76.

A 10-year-old boy was brought to a clinic because of back pain for around one month especially while bending. His mother also noted that her son’s left shoulder is slightly higher than the right. On physical exam the doctor found that Adam’s test was positive but no length discrepancy. What is the most appropriate examination do diagnose this patient?

a)

Spine MRI

b)

Spine CT-scan

c)

Left lateral decubitus X-ray

d)

Standing PA & lateral X-ray

e)

Supine lateral X-ray

77.

Female 60 years old complaint about swelling on the right knee. No inflammation sign found, and fluid is detected in suprapatellar space. No involvement of other joint. Synovium in this case is predominance by?

a)

Macrophage

b)

Lymphocyte B

c)

Leukocyte

d)

Neutrophil

e)

Lymphocyte T

78.

A 60 years old woman fell down then felt very pain in her muscle of medial thigh and could not adduct her thigh. Which nerve is probably injured?

a)

N. Obturator internus

b)

N. Tibialis

c)

N. Femoralis

d)

N. Peroneus superficialis

e)

N. Glutealis superior

79.

Agus, 7 years old boy present to ER because of pain in his left forearm after falling down.He couldn’t move his left forearm. The forearm looks swelling and deformed. X rays shows incomplete radius ulna fracture. The doctor plan to do closed reduction and cast immobilization. What are special features of fractures in children that support the treatment plan?

a)

Thick periosteum

b)

More frequent torn ligaments and dislocation

c)

Frequent joint stiffness

d)

Diagnostic problem due to secondary ossification of epiphyseal plate

80.

A 44-year-old man presents to your office with pain and swelling of the small joints in his hands and wrists. He reports stiffness in his both hands that occurs every morning and lasts for 2 hours. On examination, he has symmetrical involvement of both wrists and proximal interphalangeal joints. The involved joints are swollen and tender. Laboratory tests show high ESR, negative rheumatoid factor, and a positive anti-CCP antibody. X-ray of the wrist and hands reveal erosions in the proximal phalanges and ulnar styloid process. Which is the most appropriate drug to halt the disease progression?

a)

NSAID

b)

Prednisone

c)

Infliximab

d)

Hydroxychloroquine

e)

Methotrexate

81.

30 years old male has a chronic discharging sinus from his left leg. He had tibia fracture 1 year before and was taken care by traditional bone setter. He is able to walk with some bowing and shortening of the left leg, only sometimes he feels pain on the leg. What is the most probable finding on leg x ray?

a)

Fracture nonunion

b)

Involucrum

c)

Sunburst appearance

d)

Brodie’s lesion

e)

Abscess

82.

A 60 year-old female come to hospital with swelling and pain of the right knee. Rontgen photo shows joint space narrowing and macroscopic shows the articular surfaces eroded. Microscopic shows the synovial tissues are thickened with MN cells proliferation. What is the most likely diagnosis in her conditions?

a)

Gout disease

b)

Bursitis

c)

Osteoarthritis

d)

Rheumatoid arthritis

e)

Synovitis

83.

A 35 year old man came to physician with solid mass in his right parietal. Physical examination noted that the tumor is not mobile but solid and hard consistency. The X-ray imaged neither distortion nor destruction on that right parietal’s bone. Curettage biopsy was performed. What is the most likely diagnosis base on microscopic appearance?

a)

Osteoma

b)

Giant Cell tumor

c)

Fibrous dysplasia

d)

Chondroblastoma

e)

Chondroma

84.

A contraction in which the tension remains constant as the muscles shorten is said as:

a)

Concentric contraction

b)

Eccentric contraction

c)

Isometric contraction

d)

Isotonic contraction

e)

Isokinetic contraction

85.

A 55-year-old lady consults to her doctor for her pain and limitation of movement affecting in her interphalangeal joints each morning. Those symptoms have been exists for 10 years but have become disabling only in the recent one year. The physical examination found several nodules on her right 1-4 interphalangeal joints. An enucleation is then performed in one of her digital nodules. The microscopic showed the center of the nodule is generally necrotic, eosinophilic which is surrounded by a zone of epitheloid cells with lymphocyte and the plasma cells are interspersed. What is your diagnosis that fit most to her condition?

a)

Rheumatoid arthritis

b)

Multiple Myeloma

c)

Osteoarthritis

d)

Gout Arthritis

e)

Rheumatic fever

86.

Mrs Rani is 66 years old and has four adult children. She is on Hormone replacement therapy. She has always been a homemaker and a life-long non-smoker. She developed late onset asthma five years ago, requiring regular oral as well as inhaled steroid therapy. Asthma has limited her physical activity, although she was never someone who enjoyed exercise anyhow. Two weeks ago, she tripped over her cat and fractured her left hip. What is most likely to cause bone loss?

a)

Estrogen replacement therapy

b)

Regular exercise

c)

Large doses of glucocorticoids

d)

Excess osteoblastic activity

87.

6 months ago, 25 years old university student twisted her knee and heard a popping sound. Swelling developed within two-hours after the injury. Now, there is no more swelling but she feels her knee unstable. Which test would be most appropriate to use for examination of the cruciate ligaments of the knee?

a)

Plain radiograph

b)

Radio-isotope scan

c)

Computed tomography

d)

Ultrasound

e)

Magnetic resonance imaging

88.

A young woman is diagnosed with RA. Which of the following statements about pathogenic mechanisms in autoimmunity is CORRECT:

a)

Rheumatoid factors are DNA-anti-DNA immune-complexes found in arthritic joints

b)

In Graves' disease, an auto-antibody found commonly in patients binds to the TSH receptor and kills the thyroid cell

c)

In systemic lupus erythematosus, the various anti-nuclear antibodies produced in the patient are highly pathogenic because these

d)

Cytotoxic T cells do not play a major role in autoimmune diseases because the auto-antigens involved are either nucleic acids or carbohydrates

e)

Relief can be obtained in some autoimmune diseases by blocking the effects of the inflammatory cytokines produced

89.

Female 65 years old on Hormone replacement therapy. Complained of feeling shorter along the last few years. Which investigation is the most useful to diagnose this patient?

a)

Dual X-ray absorptiometry

b)

Femoral neck ultrasound

c)

Plain X-ray of the spine

d)

Multiple-site magnetic resonance imaging

90.

A 65 year-old woman presents with pain, stiffness and swelling of her knees. Physical examination reveals marked knee crepitus. Reconstructive surgery is performed and the resected bone reveals destruction of the articular cartilage. Which of the following BEST describes the etiology of this woman's disease?

a)

Wear and tear destruction of articular cartilage

b)

Deposition of short, rhomboid-shaped positively birefringent crystals

c)

Presence of anti-IgG autoantibodies

d)

Deposition of needle-shaped negatively birefringent crystals

e)

Deficient enzyme in the metabolic pathway involving tyrosine

91.

65 years old lady came to your office with complain if pain on her lower back. The pain especially felt after she plays with her 1 years old grandson. Low Back Pain is always associated with:

a)

Arthritis of facet joints

b)

Back muscle tightness or spasm

c)

Chronic stress to the lumbar spine

d)

Fever

e)

Prolapsed intervertebral disc

92.

65 years old lady came to your office with complain if pain on her lower back. The pain especially felt after she plays with her 1 years old grandson. Low Back Pain is always associated with:

a)

Arthritis of facet joints

b)

Back muscle tightness or spasm

c)

Chronic stress to the lumbar spine

d)

Fever

e)

Prolapsed intervertebral disc

93.

Herniated intervertebral disc characterized by radiating pain due to compression of spinal nerve. Part of the anatomical structure that compresses the spinal nerve at herniated intervertebral disc is:

a)

Vertebral body

b)

Intervertebral disc

c)

Nucleus pulposus

d)

Vertebral arch

e)

Annulus fibrosus

94.

A 65 year-old lady presented with left knee pain. Physical examination showed mild tenderness. X-ray showed reduced joint space and formation of osteophytes. Small amount of joint effusion was noted. What is the most likely clinical diagnosis?

a)

Traumatic arthritis

b)

Reactive arthritis

c)

Osteoarthritis

d)

Rheumatoid arthritis

e)

Pseudo-gout

95.

A 6 months old baby presents with fever, drowsy, irritable, and swelling of her left hip. She doesnt want to move her left extremity. X ray show metaphyseal proximal femoral bone destruction and hip joints swelling. The most common cause of this condition is

a)

Streptococcus group B

b)

Pseudomonas aeroginosa

c)

Staphylococcus aureus

d)

Gram negative bacilli

96.

A 60-year-old man has suffered a swelling in his right great toe after over eating blinjo crackers. He has a history of acute arthritis episodes affecting ankle and heels. The biopsy was then performed over him. The microscopic showed large collections of uric crystals and foreign body giant cells fill in the nodule. Your best diagnosis will be:

a)

Osteoarthritis

b)

Gout disease

c)

Rheumatoid arthritis

d)

Rheumatic fever

e)

Synovitis chronic

97.

A 76 year-old lady developed vertebral osteomyelitis. Her blood culture grew Gram-positive cocci arranged in clusters. What is the most likely etiological agent?

a)

Staphylococcus aureus

b)

Streptococcus pneumoniae

c)

Enterococcus faecalis

d)

Viridans streptococci

e)

Streptococcus pyogens

98.

A 20 yrs old waiters complains a unable to flexed his hand and the hand looks like “claw hand”. What nerve is the most likely injured?

a)

N. medianus

b)

N. musculocutaneus

c)

N. Radialis

d)

N. Axillaris

e)

N. Ulnaris

99.

5 years old boy presents to emergency department with intense pain on his left upper leg since yesterday. He has refused to walk since yesterday because of pain. No history of injury. He has some fever and sore throat since 3 days ago. On physical examination, point tenderness was found on proximal left tibia. No abnormality detected on cruris x ray. What is the most appropriate response to this condition?

a)

Hospital admission and IV antibiotic treatment

b)

Cold pack several times a day

c)

Outpatient follow up

d)

Order magnetic resonance imaging

e)

Pain management

100.

A 55 year-old man has noted pain in his right knee for several years. There is no joint swelling. As he moves during the day, the pain increases. If a biopsy of the joint is performed, this would show which of the following histological changes?

a)

Bone marrow fibrosis

b)

Loss of articular hyaline cartilage

c)

Underlying osteomyelitis of bone

d)

Needle shaped crystal deposition

e)

Papillary hyperplasia of the synovial

101.

What distinguishes cartilage from most other connective tissue?

a)

Its predominant cell type secretes both fibers and proteoglycans

b)

It functions in mechanical support

c)

Its extracellular matrix is rich in collagen

d)

Its predominant cell type is a mesenchymal derivative

e)

It lacks blood vessels

102.

A female, 60 years old, complained about swelling on the right knee. No inflammation sign was found, and fluid is detected on suprapatellar space-no other joint involvement. What type of immune system is reflect the predominance cell in the case above?

a)

Neutralizer

b)

Memory

c)

Killer

d)

Innate

103.

A 50-year-old male, presented with right painful tibial bone fracture since 3 month before. X rays show segmental fracture on tibia diaphyses with minimal callus. One month latter, the pain still persists. Another x-ray was taken, with atrophic changes of bone at the facture site. What is the most likely diagnosis?

a)

Delayed union

b)

Avascular necrosis

c)

Non-union

d)

Malunion

e)

Reflex simphatetic dystrophy

104.

A 20 yrs old tennis champion complains a paralyzed to extend his antebrachii and his hand. What nerve is the most likely injured?

a)

N. median

b)

N. radial

c)

N. musculocutaneous

d)

N. ulnar

e)

N. axillary

105.

Amin 15 years old boy felt down from the stairs then the radiograph showed that his joint between clavicle and scapula was fracture. What part of the scapula articulates with the clavicle?

a)

Acromion

b)

Infraspinous fossa

c)

Coracoid process

d)

Supraglenoid tubercle

e)

Spine process

106.

A 47 year-old male presents to the Emergency Department with acute onset of lower back pain radiating posteriorly down the right leg into the outer edge of the foot. On examination, plantar flexion of the ankle is weakened and ankle reflexes are absent on the right side. What is the most likely diagnosis?

a)

Spinal stenosis

b)

Vertebral fracture

c)

Mechanical back pain

d)

Vertebral osteomyelitis

e)

Acute disc prolapsed

107.

A 45 year-old man presented with acute pain of big toe and knee at night. Physical examination revealed inflammation of joints and a nodular lesion adjacent to the big toe. Joint fluid aspirate is performed. What fluid analysis test most likely establishes the diagnosis?

a)

Gross appearance with assessment of viscosity

b)

Total cell count and differential count

c)

Crystal identification by polarized microscopy

d)

Cytology for malignant celli

e)

Gram stain and bacterial culture

108.

What will happen in the forcible over stretch muscle?

a)

Muscle injury

b)

Muscle spasticity

c)

Muscle contracture

d)

Muscle atrophy

e)

Muscle dystrophy

109.

A 58-year-old woman had a history of myocardial infarction and at this time has no symptom. Her lab shows Hb 11 g/dL (10-12), Ht 40% (37-45), Leu 6000 cells/L (5000-10000), plt 300000/ul, serum uric acid: 11,3 mg/d L. Which of the following is the most appropriate treatment for the case above?

a)

Indomethacin

b)

Lifestyle modification

c)

Allopurinol

d)

Colchicine

e)

Sulfinpyrazone

110.

Mrs Rani is 66 years old and has four adult children. She is on Hormone replacement therapy. She has always been a homemaker and a life-long non-smoker. She developed late onset asthma five years ago, requiring regular oral as well as inhaled steroid therapy. Asthma has limited her physical activity, although she was never someone who enjoyed exercise anyhow. Two weeks ago, she tripped over her cat and fractured her left hip. Which investigation is the most useful to diagnose this patient?

a)

Multiple-site magnetic resonance imaging

b)

Plain X-ray of the spine

c)

Femoral neck ultrasound

d)

Dual X-ray absorptiometry

111.

An 80-year-old woman who lives independently at home presents with low back pain in the setting of a fall. She slipped on a wet floor in the kitchen. Blood tests reveal a haemoglobin of 10.5 g/dL (NR 12.0- 16.0 g/dL), a normal white blood cell count, but an elevated ESR. X-rays of the lumbosacral spine reveal a compression fracture of L4, and multiple lytic lesions of her thoracic spine are seen on chest X-ray. What is the most likely diagnosis?

a)

Metastatic carcinoma

b)

Ankylosing spondylitis

c)

Multiple myeloma

d)

Fibromyalgia

e)

Osteoarthritis

112.

A 15-year-old adolescent boy presented with a swelling of the distal femoral that was growing slowly during the 3-month period prior to presentation. The swelling became painful after a minimal injury caused by a fall. A firm, palpable mass was present on physical examination. The remainder of the findings from the examination were unremarkable. Radiography showed a heterogeneous mass measuring 8 cm in length on the distal femoral metaphysis. Magnetic resonance imaging demonstrated a well-defined periosteal lesion with a cortical lysis but without involvement of the medullary cavity. The gross appearance shown in the figure. What is the most likely diagnosis?

a)

Chondroma

b)

Leiomyosarcoma

c)

Enchondroma

d)

Fibrous dysplasia

e)

Osteosarcoma

113.

What is an appropriate characteristic for type 1 skeletal muscle?

a)

High glycolitic capacity

b)

Large diameter

c)

Low oxydative capacity

d)

Fast twitch glycolytic

e)

Rich vascularization

114.

A 8 year old boy came with pain on left hip and inability to walk. He was diagnosed with leg-calves and perthes disease. Which of the following happened on his left hip?

a)

A decrease in the amount of normal Type I collagen

b)

Dyschondrosis of medial physis of proximal femur

c)

Displacement of the capital femoral epiphysis from the metaphysis through the physis

d)

Avascular of capital epiphysis of the femur

115.

A 65-year-old man complaint about chronic right knee pain during activity. During arthroscopic examination, the physician found fibrillation and softening of tibial and femoral cartilage. What is the most probable substance that responsible for the cartilage condition?

a)

TNF

b)

Lipase

c)

VEGF

d)

Protease

e)

IL-1

116.

A 16 year-old has had a hard painless lump on the medial aspect of his knee for at least eight years. It caused no problems until he was kicked in the area of the lump during football game. What is the most likely diagnosis?

a)

Osteomalacia

b)

Osteosarcoma

c)

Osgood-Schlatter disease

d)

Osteochondroma

e)

Osteochondritis

117.

A male 60 years old complained of a sudden swelling of the left knee. The patient sometimes felt calf muscle spasms, otherwise healthy. He suffered several times left knee swelling before. There was a palpable bony enlargement of the knee. What is the least possible condition?

a)

Gout arthritis

b)

Neoplasms

c)

Knee osteoarthritis

d)

Rheumatoid arthritis

e)

Septic arthritis

118.

On first prenatal ultrasound exam, the fetus seems to have normal and complete limb, however when born the infant have only one hand. What error that most probably happen in growth and development?

a)

Disruption

b)

Dysplasia

c)

Malformation

d)

Deformation

119.

A 5 years old boy fall down when jumping on the bed. His mom brought him to ER few hour after the fall. The doctor diagnosed him with fracture of the forearm. Which fracture is common in children?

a)

Bennet's fracture

b)

Burst fracture

c)

Montegia fracture

d)

Green stick fracture

e)

Cole's fracture

120.

A 36-year-old woman has noted a nodule beneath the skin in her left groin since adolescence. On physical examination, the lesion has a 2-cm diameter and is nontender, soft, rubbery, and movable. Microscopic examination shows the findings in the figure. Which of the following cell types is most likely to comprise this lesion?

a)

Smooth muscle

b)

Fibroblast

c)

Endothelial cells

d)

Skeletal muscle

e)

Adipocyte

121.

A 45-year-old man has experienced pain in the area of the left hip and upper thigh for the past 7 months. On physical examination, there is tenderness on deep palpation of the left side of the groin. The range of motion at the left hip is decreased, but there is no swelling or warmth on palpation. Pelvic and left leg radiographs show an upper femoral metaphyseal mass lesion that erodes into the surrounding bone cortex. The proximal femur is excised and on sectioning has the gross appearance shown in the figure. Which of the following cell types is most likely to be proliferating in this mass?

a)

Primitive neuroectodermal cell

b)

Chrondrocyte

c)

Osteoclast

d)

Plasma cell

e)

Osteoblast

122.

A patient suffered a complete tear of biceps brachii muscle at its insertion site at the radial tuberosity. For proper treatment, you must identify the damaged tissue. Which of the following tissue was damaged at the tear site?

a)

Dense regular connective tissue

b)

Dense irregular connective tissue

c)

Reticular tissue

d)

Elastic tissue

e)

Loose areolar connective tissue

123.

A 19-year-old footballer was sidelined after falling in a game. You as a first aid team present found that his forearm is strangely angulated, no laceration on the skin, and neither paresthesia nor diminished distal pulse present. Which is the most appropriate FIRST step to help this patient?

a)

Immobilize the forearm with a splint

b)

Apply ice packs directly on the forearm

c)

Try to re-aligned the forearm

d)

Apply pressure to the forearm to stop swelling

124.

A 25-year-old woman presented with a firm mass in her left lateral pelvis. She felt pain in the area of the mass when lying on her side. Her past medical history was significant only for hypertension. Family history was negative for bone diseases.Physical exam revealed a bony mass that was immovable and attached to her left iliac wing. The mass was approximately 7 cm in greatest dimension. She felt mild pain with extremes of abduction and adduction of her left hip. A radiograph showed a mushroom-shaped bony excrescence joined to the iliac wing by a broad stalk. Computed tomography confirmed this and showed that the mass did not have a fibrous capsule. The patient underwent surgical removal of the suspicious bone lesion. Microscopic examination shows the findings in the figure. What is the most likely diagnosis?

a)

Osteochondroma

b)

Ewing sarcoma

c)

Osteomyelitis

d)

Chondroma

e)

Osteosarcoma

125.

A male, 65 years old, presented with pain in the right hip, especially during prolonged walking, since 3 years ago. She had painful and limited right hip internal rotation. What is the appropriate next step to confirm the diagnosis in this case?

a)

Hip ultrasound

b)

Rheumatoid factor and anti-CCP

c)

Hip X-ray

d)

CRP and ESR laboratory

126.

A male, 65 years old, presented with pain in the right hip, especially during prolonged walking, since 3 years ago. She had painful and limited right hip internal rotation. What is the most appropriate diagnosis in this case?

a)

Rheumatoid arthritis

b)

Osteoarthritis

c)

Gout

d)

Psoriasis

127.

A 19-year-old with hormonal imbalances came to hospital for upper right femur fractured. The X-ray showed well circumscribed lesion and a partly cystic. A curretage biopsy was performed and its microscopic showed fibrous tissue proliferated that containing "claw (U)-shape" configuration of bone trabeculas. What is the most likely diagnosis you may describe to him?

a)

Chondroblastoma

b)

Osteomyelitis tuberculosa

c)

Osteomyelitis chronic

d)

Fibrous dysplasia of the bone

e)

Ganglion cyst

128.

A 12-year-old boy comes to the Rheumatology Clinic with symmetrical painful swollen joints including: proximal interphalangeals, metacarpophalangeals, wrist and knee joints. This has been occurring for the last three months and upon further inquiry he indicates that this is the first time he has developed these symptoms. Laboratory findings reveal positive rheumatoid factor and ANA. Your choice for the first treatment in this case is:

a)

Glucocorticoids

b)

Cyclophosphamide

c)

Opioids

d)

NSAIDs

e)

Methotrexate

129.

A man 38 years old had upper arm muscle sore after he exercised weight training. He went to the doctor and doctor suggested weight training with the multigym and also aerobic training. What is the eccentric isotonic contraction?

a)

The muscle lengthens as it contracts maintaining force and movement

b)

The muscle shortens to produce force and movement

c)

Tension remains constant as the muscle shortens or lengthens

d)

The length of muscular remains constant during contraction

e)

The maximal contraction at constant speed over the full range of movement

130.

A 30-year-old boy had his right femur fractured by a car accident in the past 2 weeks. His fracture was not properly treated for which a purulent infection of the skin around the site of fracture has now been developing. A curettage biopsy is performed and its microscopic showed a sequestrum of the bone, inflammatory cells, and a granulating tissue but showed no specific giants. What is the most possible diagnosis?

a)

Bone tumor

b)

Osteomyelitis TB

c)

Bursitis

d)

Osteomyelitis pyogenic

e)

Synovitis

131.

A mother come to outpatient department because of concern that her 9 months old baby boy seems to have bow leg. When the boy starts to stand she noticed that both of his leg seems bowing on the knee. There's no history of trauma or other anomaly. What would probably be the problem?

a)

Unilateral blount disease

b)

Normal knee

c)

Post traumatic bow leg

d)

Infection

e)

Congenital femoral deficiency

132.

A male 60 years old complained of a sudden swelling of the left knee. The patient sometimes felt calf muscle spasms, otherwise healthy. He suffered several times left knee swelling before. There was a palpable bony enlargement of the knee. What is the appropriate next step to confirm the diagnosis in this case?

a)

CRP and ESR laboratory

b)

Rheumatoid factor and anti-CCP

c)

Joint aspiration and fluid analysis

d)

Knee ultrasound

133.

A 30-year-old man brought to your clinic after falling from 2nd floor balcony 15 minutes ago. He is drowsy and barely conscious. On examination you found an oddly angled right femur with blood oozing from a pin point wound. Which of the following category is best to describe this condition?

a)

Open fracture grade 3B

b)

Open fracture grade 1

c)

Open fracture grade 2

d)

Open fracture grade 3A

e)

Open fracture grade 3C

134.

A male 66 years old complained of a sudden swelling of the left knee. Synovial fluid analysis is taken and the result is The appearance of Calcium pyrophosphate dihydrate crystals. What is the possible condition?

a)

Infection

b)

Osteoarthritis

c)

Pseudogout

d)

Gout

e)

Rheumatoid

135.

A 19-year-old girl came to the clinic due to joint pain and swelling on both knee and left ankle with stiffness in the morning since 6 weeks ago. On physical examination, the involved joints were erythematous, warmth, slight tender on palpation, and limited active-passive motion. Laboratory findings showed hemoglobin 11 g/dL, leukocytes 11,500/mm3, platelets 400,000/mm, negative ANA, positive RF, elevated C3, ESR and CRP. Which cytokine is the major target of treatment in this case?

a)

IL-1

b)

IL-6

c)

Interferon y (gamma)

d)

TNF-a

e)

TGF-b

136.

A 30-year-old woman has experienced pain in the area of hands and feet. On physical examination, there is a mass and slowly growing, no erythema or warmth. A radiograph shows a 7-cm mass in the metaphyseal region of small tubular bones of the hands and feet. Microscopic examination shows the findings in the figure. What is the most likely diagnosis?

a)

Osteoblastoma

b)

Chondroma

c)

Plasmacytoma

d)

Giant cell tumor

e)

Osteitis fibrosa cystica

137.

What is the neuro muscular junction?

a)

The part of the sarcoplasmic of the muscle cell that is in closest proximity to the synaptic end bulb

b)

The meeting point of a nerve fibre and the muscle fibre that it supplies

c)

The the releasing place of the neurotransmitter acetylcholine (ACh) from post synaptic terminal

d)

The production place of the neurotransmitter acetylcholine (ACh) in post synaptic terminal

e)

The point of action potential traveling in the T tubules reaches the sarcoplasmic reticulum

138.

A 34-year-old man presented with sudden excruciating pain in right arm and an inability to move after attempting to lift a weight equal to his body weight above his head in the gym. On physical examination, the patient was unable to move right shoulder, and squaring of right shoulder contour, internal rotation of the right shoulder is limited. Radiographs showed the anterior and inferior positions of the humeral head relative to the glenoid fossa. What is the most likely diagnosis for this?

a)

Rotator Cuff Tear

b)

Impingement syndrome

c)

Shoulder bursitis

d)

Frozen shoulder

e)

Anterior shoulder dislocation

139.

A 5 years old boy fall down when jumping on the bed. His mom brought him to ER few hour after the fall. The doctor diagnosed him with fracture of the forearm. This boy was put on an arm cast for 4 weeks, on the 3rd weeks. What would you probably see on the plain xray of the forarm?

a)

Normal bone with periosteal thickening

b)

Clear fracture line

c)

Osseous callus

d)

Porotic bone on fracture site

e)

Undistinguised fracture site

140.

A male 68 years old presents with chronic left hip pain with osteophyte and joint space narrowing. The patient also has a history of peptic ulcers. What is the first line of pharmaceutical management in this patient?

a)

COX-2 inhibitor

b)

Tramadol

c)

Topical NSAID

d)

Hyaluronic acid injection

141.

Mr. Adi, 34 years old was felt down when he climbed the tree. The radiograph demonstrated the fracture of talus. What is the most appropriate reason that fractures of the talus have minimal displacement?

a)

It is a tiny bone

b)

It is a irregular bone

c)

It is place over the calcaneus

d)

Attached muscles pull the fragments apart

e)

Malleoli hold the fragments in place

142.

A 20 years old man worked a clerk for 5 years, since last month he has loss of sensation in his palmar and the 3 first digit. Some of the flexor muscles has no strength to move. The doctor diagnosed with Carpal Tunnel Syndrom. What nerve is most likey compressed?

a)

N. radialis

b)

N. medianus

c)

N. ulnaris

d)

N. musculocutaneus

e)

N. digitalis ventralis

143.

A 44-year-old man presents to your office with pain and swelling of the small joints in his hands and wrists. He reports stiffness in his both hands that occurs every morning and lasts for 2 hours. On examination, he has symmetrical involvement of both wrists and proximal interphalangeal joints. The involved joints are swollen and tender. Laboratory tests show high ESR, negative rheumatoid factor, and a positive anti-CCP antibody. X-ray of the wrist and hands reveal erosions in the proximal phalanges and ulnar styloid process. Which is the most appropriate drug to halt the disease progression?

a)

Prednisolone

b)

Hydroxychloroquine

c)

NSAID

d)

Infliximab

e)

Methotrexate

144.

A male 60 years old complained of a sudden swelling of the left knee. The patient sometimes felt calf muscle spasms, otherwise healthy. He suffered several times left knee swelling before. There was a palpable bony enlargement of the knee. Synovial fluid analysis is taken on the above case. The result is:

a)

The appearance of calcium pyrophosphate dihydrate crystals

b)

Increase red blood count

c)

Appearance of bacteria

d)

Increase white blood count

145.

An overweight female 60 years old presented with bilateral knee pain during activity, bowleg, and knee joint osteophyte on x-ray. What is the first-line treatment for this condition?

a)

Knee tapping

b)

weight loss

c)

Knee unloading brace

d)

steroid injection

146.

A patient, male 50 years old, presents to a clinic with briefly left knee stiffness in the morning and pain following prolonged walking. On x-ray examination, a knee osteophyte was found. The disease processes arise from all these tissue, except:

a)

Peripheral blood vessels

b)

Bone

c)

Intraarticular fat

d)

Cartilage

e)

Synovium

147.

A 5 years old boy fall down when jumping on the bed. His mom brought him to ER few hour after the fall. The doctor diagnosed him with fracture of the forearm. What is the phase of bone healing happening when this boy come to the ER?

a)

Remodelling

b)

Consolidation

c)

Consolidation

d)

Haematoma and inflamation

e)

Callus formation

148.

A man comes for treatment with complaints of not being able to rotate his head to the right. What muscle problem might there be?

a)

M. splenius colli sinistra

b)

M. iliocostalis sinistra

c)

M. trapezius sinistra

d)

M. serratus posterior superior

e)

M. semispinalis sinistra

149.

In pediatric X-ray imaging, which feature is characteristic of a growth plate (physis)?

a)

Radiolucent line between the epiphysis and metaphysis

b)

Thickened cortex

c)

Fracture line parallel to the diaphysis

d)

Sclerotic line across the diaphysis

e)

Displacement of the epiphysis

150.

Each typical vertebra has how many processes?

a)

6

b)

8

c)

4

d)

7

e)

5

151.

Which of the following conditions is characterised by the appearance of "sunburst" or "spiculated" patterns on a bone X-ray?

a)

Osteoarthritis

b)

Osteochondroma

c)

Paget's disease

d)

Osteomyelitis

e)

Osteosarcoma

152.

A forensic expert examines a vertebra found in the forest. It is suspected that these bones are thoracic vertebrae, but at these bones only 1 fovea costalis was found on each side of the vertebral body and a fovea costalis transversalis on each transversal process. Judging from this condition, the forensic expert is examining which thoracic vertebrae?

a)

VT IX

b)

VT VIII

c)

VT XI

d)

VT XII

e)

VT X

153.

Why is it important to obtain both an anterior-posterior (AP) and a lateral view in bone X-rays?

a)

To detect soft tissue abnormalities

b)

To minimize radiation exposure

c)

To better visualize the depth and alignment of fractures

d)

To avoid overexposure of the X-ray film

e)

To provide a complete 3D image