Internal-Medicine
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
188 9: Muscles and Joints<br />
71. Most common form of eye involvement<br />
(SELECT ONE)<br />
72. Associated with increased frequency of infections<br />
(SELECT ONE)<br />
73. Found in association with occupational lung<br />
disease (SELECT ONE)<br />
74. Commonly involves Achillis tendon (SELECT<br />
ONE)<br />
DIRECTIONS (Questions 75 through 83): Each of<br />
the numbered items in this section is followed by<br />
answers. Select the ONE lettered answer that is<br />
BEST in each case.<br />
75. A 67-year-old woman develops symptoms of<br />
cough and sputum production after an upper<br />
respiratory tract infection. A CXR does not<br />
show any signs of pneumonia but the report<br />
mentions a “pseudofracture” sign (Looser<br />
zones) seen in the left scapula compatible with<br />
osteomalacia. She has no pain in the scapula.<br />
Which of the following best differentiates rickets<br />
and osteomalacia?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
the mineralization defect is less severe<br />
in osteomalacia<br />
osteomalacia is only produced by vitamin<br />
D deficiency, unlike rickets<br />
the skeleton is at a different stage when<br />
affected<br />
parathyroid hormone levels are only<br />
routinely elevated in rickets<br />
rickets always is characterized by<br />
hypocalcemia<br />
76. A 72-year-old man is recently found to have<br />
hypocalcemia and osteomalacia is suspected<br />
based on the decrease in the cortical bone thickness<br />
and osteopenia is seen on x-rays. Which of<br />
the following is the most likely mechanism of<br />
the resistance to the effects of vitamin D?<br />
(A) excess parathyroid hormone secretion<br />
(B) insufficient parathyroid hormone<br />
secretion<br />
(C) defective receptors for 25(OH)<br />
vitamin D<br />
(D)<br />
(E)<br />
defective receptors for 1,25(OH)2<br />
vitamin D<br />
mineralocorticoid excess<br />
77. A 66-year-old woman complains of pain in her<br />
left hip when walking. Three days ago, she<br />
tripped and fell in her apartment. On examination,<br />
there is decreased range of motion in the<br />
hip, no leg length discrepancy. X-rays of the hip<br />
reveal osteopenia. Which of the following is the<br />
primary defect in vitamin D metabolism that<br />
causes osteopenia associated with aging?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
impaired intestinal absorption of<br />
vitamin D<br />
impaired liver hydroxylation of<br />
vitamin D<br />
impaired renal hydroxylation of 1(OH)<br />
vitamin D<br />
low parathyroid hormone levels<br />
low phosphate levels<br />
78. Which of the following clinical findings is characteristic<br />
of both osteomalacia and rickets?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
frontal bossing in the skull<br />
muscle weakness<br />
prominent costochondral junctions<br />
defects in tooth enamel<br />
knock-knees<br />
79. An 84-year-old man, previously well except for<br />
chronic osteoarthritis, develops a hot, red,<br />
painful knee. Physical examination reveals an<br />
exquisitely tender, swollen knee. Which of the<br />
following is the most likely finding on synovial<br />
fluid analysis?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
staphylococcal infection<br />
gonococcal infection<br />
calcium hydroxyapatite crystals<br />
calcium pyrophosphate crystal deposition<br />
calcium oxalate<br />
80. A 74-year-old man has recurrent attacks of<br />
pain, swelling, and redness in his left knee. He<br />
has background osteoarthritis of both knees,<br />
which require him to take acetaminophen on a<br />
regular basis. Joint fluid was removed during<br />
one acute episode of knee pain, and synovial
Change language