Bones, Joints and soft tissue tumors, vascular , heart

Which of the following features is characteristic of osteoarthritis?

Failure of osteoclasts to resorb bone thereby resulting in thickened sclerotic bones with reduced mechanical strength is a characteristic feature of

A couple brings their 2-year-old daughter to the clinic for the first time for a well-child check-up . Physical examination reveals short stature, a flat midface with a prominent forehead, and shortening of the limbs. The child's father exhibits similar physical features.

This seronegative spondyloarthropathy is a chronic inflammatory joint disease that typically affects the axial joints (especially the sacroiliac joints) of persons 20- 30 years of age, who also test positive for HLA-B27.

A 54-year-old male complains of right knee swelling and pain. Microscopic findings of synovial fluid aspiration are shown on the image below. Which of the following is the most likely cause of this patient's symptoms?

A 15-year-old boy notices a swelling around his left knee, which has been progressive over the past few months. The swelling is associated with pain, which becomes unbearable. He is brought by his parents to the emergency department. Radiographic analysis of his left knee reveals an elevation of the periosteum and an infiltrative mass in the distal femur.What is the most likely diagnosis?

A 13-year-old boy complains of pain persisting in his left leg for 3 weeks. On physical examination his temperature is 37.9 C. A radiograph of the leg reveals a mass in the diaphyseal region of the left femur with overlying cortical erosion and soft tissue extension. A bone biopsy is performed and the lesion on microscopic examination shows numerous small round blue cells. Which of the following neoplasms is he most likely to have?

An otherwise healthy 44-year-old man with no prior medical history has had increasing back pain and right hip pain for the past decade. The pain is worse at the end of the day. On physical examination he has bony enlargement of the distal interphalangeal joints (DIP). A radiograph of the spine reveals the presence of prominent osteophytes involving the vertebral bodies. There is sclerosis with narrowing of the joint space at the right acetabulum seen on a radiograph of the pelvis. Which of the following diseases is he most likely to have?

A 55-year-old obese male with history of HTN, diabetes, and lumbago presents with bilateral knee pain that has worsened slowly over the last 2 years. The knee pain is worse in the morning, lasts less than 30 minutes, and improves with activity. What physical exam finding would be present in patients?

A 37-year-old previously healthy male presents with difficulty walking due to severe pain, swelling, redness, and warmth of his right great toe over the last 24 hours after partying all night at a friend’s bachelor party. His hangover has subsided, but his big toe pain continues despite taking Tylenol. What finding is diagnostic?

Multiple enchondromas are a feature of:

A 42-year-old woman Paro presents with slowly progressive syndrome comprising of features like pain and tender ness in multiple joints, with joint stuffiness on rising in the morning. Joint involvement is symmetric, with the proximal interphalangeal and metacarpophalangeal joints especially involved. The physician finds presence of tenderness in all the inflamed joints. Which of the following laboratory abnormalities is most likely asso ciated in this patient?

A 37-year-old man presents with lower back pain. He complains of stiffness in his axial spine that usually improves over the course of the morning with activity. X-ray of the lumbar spine is normal, while x-ray of the sacroiliac joints shows bilateral abnormality including irregular joint space widening with bone erosions and subchondral sclerosis. HLA-B27 is positive. Which of the following is the most likely diagnosis?

A 47-year-old man presents to his primary doctor with 2 weeks of fever, headache, and muscle aches. He also has noted a nonpruritic erythematous rash in the right groin. The rash has been enlarging for the past week, with new areas of clearing resulting in concentric rings of erythema. The patient is a Boy Scout leader and recently returned from a camping trip in Connecticut. Which of the following is the most likely diagnosis?

In osteoarthritis

A 5-year-old girl presents to the pediatrician for evaluation of short stature. On physical exam she has multiple lower extremity bruises and bluish scleral discoloration. Dental exam reveals multiple cavities. Audiological evaluation reveals a conductive hearing loss. Radiographic skeletal survey reveals healed right seventh rib and right humerus fractures and a healing left midshaft clavicle fracture. The physician does not suspect child abuse. Which of the following is the most likely diagnosis?

A 24-year-old male presents with history of diarrhea 3 weeks ago and returns to the clinic with redness in the eyes, tearing, painful urination, mouth sores, and right knee pain. What is the diagnosis?

You encountered a 35-year old patient with necrotizing granulomas along the respiratory tract and the lungs. He eventually died of crescentic glomerulonephritis. Which of the following markers would turn out positive in this patient?

.Which of the following is most likely associated with the Philadelphia chromosome?

A 40 year old male suddenly experienced severe headache. Upon consultation, his BP is noted to be at 200/120. Past history shows normal BP on regular checkups. Anti hypertensive are immediately given. However, BP remains in the range of 200/120-180/100. Nicardipine drip is instituted. Two days later, the patient died becasue of intracerebral hemorrhage. Biopsy of the kidney revealed onion skin, concentric, laminated thickening of the walls of arterioles with progressive narrowing of the lumina consistent with what kind of arteriolosclerosis?

A 27-year-old man who is an IV drug user presents to the emergency department because of abdominal pain. He reports red discoloration of his urine. On examination, he is hypertensive and has no dyspnea, chest pain, or hemoptysis. After initial evaluation in the clinic, the patient is admitted to the hospital. A chest radiograph and radiographic imaging of the kidneys, bladder, and pelvis reveal no abnormalities. Laboratory studies reveal elevated levels of amylase and lipase and an elevated level of creatinine. The patient is positive for hepatitis B surface antigen. Which of the following is the most likely diagnosis?

A 70-year-old woman complains of a throbbing unilateral headache and vision problems. She reports weight loss and mandibular pain while eating. The patient also has a history of recurrent bouts of fever accompanied by malaise and muscle aches. Physical examination reveals nodular enlargement of the temporal artery with pain on palpation. A biopsy is obtained (shown in the image). What is the appropriate diagnosis?

A 19-year-old young woman who emigrated from Taiwan 8 years ago presents with fever, malaise, myalgias, and arthritis and “coldness” in her upper extremities. She has a weak radial pulse bilaterally, and a magnetic resonance angiogram demonstrates nearly 75% stenosis of the main arteries originating from the aorta. She likely has which of the following rheumatologic conditions?

A 45-year-old man is brought to the emergency room with rapid pulse and cold and clammy skin. Blood pressure is 90/50 mm Hg. An X-ray film of the chest demonstrates dilation of the ascending aorta. Cardiac auscultation reveals a diastolic murmur in the aortic region. Laboratory studies show that serum cholesterol is 160 mg/dL, hematocrit is 35%, and hemoglobin is 13.6 g/dL. The fluorescent Treponema antibody test is positive. The patient suddenly becomes hypotensive and dies. The luminal surface of the ascending aorta at autopsy is shown in the image. Which of the following was most likely involved in the pathogenesis of this aortic lesion?

A 45-year-old man presents with pain in the legs upon exercise and destruction of the tips of his fingers. He has an 80-packyear history of smoking. Laboratory values include hemoglobin of 16 g/dL, WBC of 8,500/μL, serum cholesterol of 220 mg/dL, fasting blood sugar of 90 mg/dL, and negative tests for antinuclear antibodies. Biopsy of the affected area (shown in the image) reveals intraluminal thrombi in medium-sized arteries and inflammation extending from arteries to neighboring veins and nerves. What is the appropriate diagnosis?

An 80-year-old man with long-standing diabetes and systemic hypertension dies of congestive heart failure. The luminal surface of the abdominal aorta is shown in the image. Which of the following pathologic changes would you expect to see on microscopic examination?

A 20-year-old woman complains of double vision, fainting spells, tingling of the fingers of her left hand, and numbness of the fingers of her right hand. Physical examination reveals absence of pulse in her right arm. Laboratory tests show elevated erythrocyte sedimentation rate and thrombocytosis. An aortogram demonstrates narrowing and occlusion of branching arteries, including the right subclavian artery. The patient subsequently develops heart failure and dies of massive pulmonary edema. At autopsy, the aorta has a thickened wall and shows vasculitis and fragmentation of elastic fibers. Which of the following is the most likely diagnosis?

A 20-year-old woman presents with increasing fatigue, muscle pain, and visual disturbances. Physical examination finds weak pulses in her upper extremities, and further evaluation finds thickening of the aortic arch and narrowing of the blood vessels that originate from the aortic arch. Which of the following is the most likely diagnosis?

During a routine checkup in the GP, a 34-year-old man had consistently high blood pressure of 149 mmHg systolic. Benign hypertension is characterized by:

A 70-year-old woman presents with recurrent headaches, blurred vision, and a 1- week history of joint pain and flu-like symptoms. Physical examination finds focal tenderness in her right temporal area, and laboratory examination reveals a markedly elevated erythrocyte sedimentation rate. A biopsy from her right temporal artery reveals granulomatous inflammation with giant cells in the inner tunica media of the vessel wall. Without treatment, what is the worst complication associated with this individual's disease?

Upon autoposy an incidental finding of atherosclerosis was made. Which of the following is true of atherosclerosis?

A 3-year-old boy comes to the pediatrician with fever, conjunctivitis, erythema in the oral mucosa, and cervical lymphadenopathy. The boy suddenly becomes hypotensive and goes into cardiac arrest and dies shortly thereafter. Autopsy shows aneurysmal dilations of the left circumflex and right coronary arteries. The boy’s disease is characterized as a self-limiting disease that most commonly affects the coronary arteries. Which of the following diseases is the correct diagnosis?

A 69-year-old woman has been bedridden while recuperating from a bout of viral pneumonia complicated by bacterial pneumonia for the past 2 weeks. Physical examination now shows some swelling and tenderness of the right leg, which worsens when she raises or moves the leg. Which of the following terms best describes the condition involving her right leg?

A Young scientist studies chronic vasculitis, involving small and medium-sized arteries. The etiology of this vasculitis is unknown, but in 30 % of cases, it is associated with Hepatitis B infection. This adult type vasculitis does not involve pulmonary arteries and does not cause glomerulonephritis. There is perivascular inflammation resulting in nodularity, mIcroaneurysms are seen in 50% of cases. Which of the following most likely represents this vasculitis?

A previously healthy 67-year-old man presents to the emergency room with numbness of his left leg. Temperature and blood pressure are normal. Physical examination shows pallor and a cool left leg with absence of distal pulse An ECG reveals no abnormalities. An arteriogram demonstrates a markedly dilated abdominal aorta and occlusion of the left popliteal artery. The blockage is removed surgically, and the patient recovers. Which of the following is the most likely source of the arterial thromboembolus in this patient?

A 52-year-old woman comes to the emergency department due to increasing dyspnea and chest tightness over the past 2 weeks. She has a history of stage 4 chronic kidney disease due to chronic glomerulonephritis. Temperature is 36.6 C (97.8 F), blood pressure is 106/82 mm Hg, and pulse is 98/min. Systolic blood pressure decreases by 12 mm Hg during inspiration. Physical examination shows distant heart sounds and clear lungs. Echocardiography in this patient is the most likely to reveal which the following findings?

An young athlete dies suddenly and unexpectedly. Autopsy reveals massive myocardial hypertrophy with disproportionate thickening of the ventricular septum. What is the most likely pathologic etiology of this condition?

A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged 550 gm heart with predominantly left ventricular hypertrophy. Her kidneys are small, about 80 gm each, with cortical scarring, and microscopically they demonstrate small renal arterioles that have luminal narrowing from concentric intimal thickening. Which of the following is the most likely condition associated with her findings?

A 17-year-old high school student dies suddenly while playing basketball. At autopsy, asymmetric hypertrophy of the interventricular septum is discovered. Histologic sections from this area reveal disorganization of the myofibers, which are thicker than normal and have hyperchromatic nuclei. What is the most likely diagnosis?

A 40-year-old woman presents with dyspnea, heart palpitations, and pitting edema. She was seen for fl u-like symptoms and prominent muscle pain 3 weeks ago. Physical examination shows tachycardia and irregular heart beats. A chest X-ray reveals cardiomegaly and pulmonary edema. The patient subsequently dies of cardiorespiratory failure. Histopathology of the heart muscle at autopsy is shown in the image. What is the appropriate diagnosis?

Endocarditis in IV drug users typically

Evidence of inflammation or myofiber disarray. Which of the following is the most likely diagnosis?

A 50-year-old woman presents with fatigue and shortness of breath. Physical examination shows clinical evidence of pulmonary edema, enlargement of the left atrium, and calcification of the mitral valve. A CT scan demonstrates a large mass in the left atrium. Before open heart surgery can be performed, the patient expires of an ischemic stroke. The heart at autopsy is shown in the image. Which of the following is the most likely diagnosis?

Which of the following is characteristic of stable angina pectoris?

A 56-year-old-man with a 25 pack-year smoking history sees his physician with complaints of dyspnea and weight gain. Chest x-ray shows pulmonary artery enlargement and echo shows right ventricular hypertrophy. Which of the following is the most likely diagnosis?

An 8-month-old girl with Turner syndrome is brought to the emergency room by her parents, who complain that their daughter is breathing rapidly and not eating. Physical examination reveals tachypnea, pallor, absent femoral pulses, and a murmur heard at the left axilla. There is hypertension in the upper extremities and low blood pressure in both legs. A chest x-ray shows notching or scalloping of the ribs. What is the appropriate diagnosis?

A 5-year-old boy comes to the ED with spots on the abdomen. His mother reports he has had a fever for a week. Physical exam reveals conjunctivitis, mucositis, and edema of the hands and feet (PIC 4). Which of the following is the most likely diagnosis?

A 55-year-old male with history of HTN, diabetes, hyperlipidemia, smoking, peripheral vascular disease s/p vascular bypass presents to your clinic complaining of fatigue and substernal chest discomfort for the last few weeks. He describes the chest pain as a band-like squeezing sensation that gradually comes on with exertion and is relieved with rest. On occasions the discomfort radiates down his left arm with crushing chest discomfort. The chest pain does not change with position or respiration. He came in today because the pain has not gone away for hours. What do you suspect?

A 2-week-old girl is found to have a harsh murmur along the left sternal border. The parents report that the baby gets “bluish” when she cries or drinks from her bottle. Echocardiogram reveals a congenital heart defect associated with pulmonary stenosis, ventricular septal defect, dextroposition of the aorta, and right ventricular hypertrophy. What is the appropriate diagnosis?

The following are features of right sided heart failure EXCEPT:

A 24-year-old man was found to have a ventricular septal defect upon echocardiogram. Which of the following is true of ventricular septal defect:

A 67-year-old man presents to the GP with breathlessness upon exertion, orthopnea and oedema of legs, feet and ankles. Which of the following of heart failure is true?

Pulmonary hypertension that results from the reversal of the direction of blood flow through a congenital heart defect that initially had produced a left-to-right shunt is a characteristic feature of which of the following disorders?

A 53-year-old man presents with recurrent chest pain that has gotten progressively worse over the last several weeks. He says that approximately a year ago the pain would occasionally occur when he was mowing his yard but now the pain sometimes occurs while he is sitting in a chair at night reading a book. The pain, which is localized over the sternum, lasts much longer now than it did a few months ago. What type of angina does this individual have at present?

A medical student working in the emergency department sees a female baby, born 2 weeks ago, who is brought in by her anxious mother. The mother tells the student that her baby seems “purple,” especially her fingers and toes, and looks extremely blue when crying. On physical examination the sleeping baby has mild cyanosis of the face and trunk, but moderate cyanosis of the extremities. What is the most common cause of cyanosis within the first few weeks of life?

An 11-month-old girl is noted to have blue lips and some fatigue after running around the room for 4 minutes. She was the product of a normal delivery. The family recently immigrated from Mexico, and she has not been evaluated by a doctor. Which of the following is the most likely diagnosis?

Which of the following type of infection, precedes by several weeks, the development of acute rheumatic fever?

A 68-year-old man has had progressive dyspnea for the past year. On physical examination, extensive rales are heard in all lung fields. An echocardiogram shows that the left ventricular wall is markedly hypertrophied. A chest radiograph shows pulmonary edema and a prominent left-sided heart shadow. Which of the following conditions has most likely produced these findings?