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. What is the isokinetic contraction?

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?

Which of the following fractures is typically seen in pediatric patients and often resembles a "bent branch" on X-ray?

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?

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

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

A 75 year-old widow complains of generalised 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 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 then normal. His physician suspected possibly he had a problem in neurotransmitter such as in mystenia gravis disease. What is the name of neurotransmitter in skeletal neuromuscular junction?

Each typical vertebra has how many processes?

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

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

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?

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

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 20 year old woman came to the hospital with a fractured upper right tibia. X-ray showed well circumscribed lesion, partly cystic. Curretage 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 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 episode 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 and revealed Gram (+) cocci. How is the boy getting this illness?

50 years old male, has brief left knee stiffness in the morning, he also felt knee pain after prolong 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?

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

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?

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 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?

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?

Each typical vertebra has how many processes?

Which of the following is a radiographic sign of bone healing seen on X-ray after a fracture?

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

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 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 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:

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?

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?

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 15-year-old girl complained of severe pain in his left knee after vigarous 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 man 58 years old felt his right arm muscle became easy to fatigue and weak after recovary from right arm bone fractur. His physician said he got muscular atrophy and his connection between nerve and muscular was good. What is the muscular disuse atrophy?

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

35 years old man come with complaint of backpain 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 20-year-old man was crashed by motorcycle and cannot walk, then was bring to hospital by his friend. The photo radiograph showed fracture of the proximal femur. What structure is most likely injured?

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 base on microscopic appearance?

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 40-yr-old man was admitted to hospital 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?

What distinguishes cartilage from most other connective tissue?

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 test can set the definitive diagnosis?

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

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. What is the most likely diagnosis base on microscopic appearance?

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 young woman is diagnosed with RA. Which of the following statements about pathogenic

mechanisms in autoimmunity is CORRECT:

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?

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

52. 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?

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

54. When helping a baby delivery, a midwife noticed that there’s assymetric number of thigh skinfolds, uneven knee levels and limitation of hip

abduction. What diagnosis should be checked on the newborn?

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 then normal. What is the definition of muscle tone?

56. 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?

57. 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?

The major lubricant for diarthrotic joints is synthesized by

59. 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?

60. 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 you examining?

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 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?

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 child , 6 years old, present 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 work up should be done?

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?

68. 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 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?

Which of the following most accurately describes compact bone?

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 2nd, left 2nd 3rd metacarpophalangeal joints (MCPs), and the right 2nd, left 3rd and 4th 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 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?

73. 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. Radiograph examination reveals compression fracture on level L3-4 What is the most likely diagnosis?

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?

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 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 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 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?

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 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 epitheloid macrophages. The best diagnostic is

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

A 68-year-old man reports pain on his knees and difficulty walking. He can walk in the flat areas, but the pain come 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 became atrophy?

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?

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 week 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 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 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 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 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 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 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 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 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?

65 years old woman come to orthopaedic 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?

What is the neurotransmitter in neuromuscular skeletal muscle junction?

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 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 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 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 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?

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

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?

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

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

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

Mr. Budi, 54 years old was felt down when he was hit by the truck. The radiograph demonstrated the fracture of fibula. Which nerve of the leg wraps around the neck of fibula?

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 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?

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?

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

A 30-year-old man brought to your clinic after falling from 2 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 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?

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

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

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 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 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?

What is the neuro muscular junction?

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?

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?

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

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 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 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?

141.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?

What will happen in the forcible over stretch muscle?

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/μL (5000-10000), plt 300000/μl, serum uric acid: 11,3 mg/dL. Which of the following is the most appropriate treatment for the case above?

142.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 3 weeks. What would you probably see on the plain xray of the

forarm?

143.An overweight female 60 years old presented with bilateral knee pain during activity, bowleg, and knee joint osteophyte on x-ray. What is the

most appropriate treatment for this condition?

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?

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?

What is an appropriate characteristic for type 1 skeletal muscle?

144. A male 70 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 rst line of pharmaceutical management in this patient?

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?

145. A 20 year old man worked as a clerk for 5 years, since last month he has loss of sensation in his palmar and the 3 rd digit. Some of the exor

muscles has no strength to move. The doctor diagnosed with Carpal Tunnel Syndrome. What nerve is most likely compressed?

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?

146 .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?

147. What will happen in the forcible over stretch muscle?

148.A female, 60 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 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?

150. 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 3rd stages of knee osteoarthritis. What pathology in the knees that is the main cause that the knees become stiff?

149. A female, 60 years old, complained about swelling on the right knee. No inflammation sign was found, and uid is detected on suprapatellar

space—no other joint involvement. What type of immune system is reflect the predominance cell in the case above?

151. 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 base on microscopic appearance?

152. 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 uid analysis is taken on the above

case. The result is:

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?

154. 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 150. 155.involvement of the medullary cavity. The gross appearance shown in the gure. What is the most likely diagnosis?

157. A female, 60 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?

156. A radiographic lm 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?

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?

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?

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 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?Select one:

Female, 60 years old, complaint about pain and stiffness of her left knee. The doctor finds cartilage softening during knee arthroscopy. Which area in cartilage is relatively proteoglycan-rich and collagen-poor? Select one:

A postmenopausal 62-year-old woman was brought by her son to the hospital. She fell down in the bath room wh en she took shower, she felt very pain around her hip joint, then she couldn’t stand and flex her thigh. The radiograph showed fracture of her right collum femoris. What nerve is possibly injured?

A 20 yrs old tennis champion complains a problem when the forearm is extended. The examination of X-ray shows fracture of distalhumerus and the inferior fragment of humerus directed to the posterior part of the arm. What signs of nerve injured by the fracture above?

A 25 year old man of football player was injured of his knee joint. He complained of severe pain in his left knee. Later, the knee joint has been swollen. The doctor showed a radiograph with fracture patella and a torn of patellar ligament. What movement of the leg is impaired?

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 3rd stages of knee osteoarthritis. On physical examination, which muscles that most probable to became atrophy?

Select one:

A 3 yrs old boy fell down from the tree, he cries when abduct and flex his arm. The doctor diagnoses him as brachial plexus injury with Inability to flex the arm and forearm. Which muscle is most likely affected?

Select one:

What is the all or none law in skeletal muscle?

Select one:

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 possible condition?

A 20 yrs old tennis champion complains a problem when the forearm is extended. The examination of X-ray shows fracture of distal humerus and the inferior fragment of humerus directed to the posterior part of the arm. What signs of nerve injured by the fracture above?

Select one:

A 25 year old man of football player was injured of his knee joint. He complained of severe pain in his left knee. Later, the knee joint has been swollen. The doctor showed a radiograph with fracture patella and a torn of patellar ligament. What movement of the leg is impaired?

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 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 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 base on microscopic appearance?

A contraction in which the tension remains constant as the muscle shortens is said as: