PRACTICE QUESTIONS: MUSCULOSKELETAL SYSTEM

1. A 12-year-old boy is diagnosed with Lesch-Nyhan syndrome. At puberty, he develops

arthritis, and death from renal failure occurs at age 25. This patient's condition is due to
an enzyme deficiency in which of the following biochemical pathways?

A. Ganglioside metabolism
B. Monosaccharide metabolism
C. Purine metabolism
D. Pyrimidine metabolism
E. Tyrosine metabolism

2. A 24-year-old graduate student presents to a physician with complaints of severe

muscle cramps and weakness with even mild exercise. Muscle biopsy demonstrates
glycogen accumulation, but hepatic biopsy is unremarkable. Which of the following is
the most likely diagnosis?

A. Hartnup's disease
B. Krabbe's disease
C. McArdle's disease
D. Niemann-Pick disease
E. Von Gierke's disease

3. A 40-year-old man comes to the physician because of a 2-week history of a tingling

sensation in the 1st, 2nd, and 3rd digits of the right hand and loss of coordination
and strength of the right thumb. Which of the following nerves has most likely been
affected?

A. Anterior interosseous nerve

B. Median nerve
C. Musculocutaneous nerve
D. Radial nerve
E. Ulnar nerve

4. An x-ray of the arm of a 4-year-old boy shows radiolucent area between epiphysis
and the diaphysis. There is no history of trauma to his hand. This radiolucent area is
most likely which of the following?

A. Articular cartilage
B. Epiphyseal plate
C. Perichondrium
D. Primary ossification center
E. Secondary ossification center

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5. A 31-year-old man comes to the physician because of difficulty with fine motor control
in his hand. He had trauma to his right hand. Physical examination shows a deficit in
his ability to abduct and adduct his digits, and inability to oppose his thumb on his
right hand. Which of the following neural structures was most likely injured?

A. Lower trunk of the brachial plexus

B. Median nerve
C. Musculocutaneous nerve
D. Upper trunk of the brachial plexus
E. Ulnar nerve

6. A 26-year-old man is stabbed in the left chest during a bar brawl. Several days after
he is treated, he returns to the doctor complaining of decreased function in his left arm.
Physical examination shows a winged left scapula and an inability to raise his left arm
above the horizontal. Which of the following nerves is most likely affected?

A. Axillary nerve
B. Long thoracic nerve
C. Lower subscapular
D. Suprascapular nerve
E. Thoracodorsal nerve

7. A 5-year-old boy falls off his bike and fractures his humerus. He is taken to the
emergency room, and the bone is set by one of the emergency room physicians. Which
of the following is responsible for producing the majority of the new bone that will reunite
the two fragments?

A. Cancellous bone
B. Cartilage
C. Compact bone
D. Marrow
E. Periosteum

8. A 31-year-old man sustains a fracture of his right humerus following a car crash. He
is treated with fracture reduction and a cast around the fractured limb. A biopsy of the
healing area is most likely to show which of the following types of bones?

A. Cancellous
B. Compact
C. Spongy
D. Trabecular
E. Woven

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9. A 40-year-old woman is diagnosed with severe, disabling rheumatoid arthritis.
Rheumatoid factor is positive. What would a biopsy of the synovium of her knee most
likely reveal?

A. A nearly normal synovium with scattered inflammatory cells

B. A non-proliferative synovitis with abscess formation
C. A non-proliferative synovitis with many neutrophils
D. A proliferative synovitis with many eosinophils, neutrophils, and plasma cells
E. A proliferative synovitis with many lymphocytes, macrophages, and plasma cells

10. A young man presents for an employment physical. He is very tall, has long fingers,
and hyperflexible joints. He states that he has always been called "double jointed".
Which of the following disorders is associated with this syndrome?

A. Dissecting aortic aneurysm

B. Hepatosplenomegaly
C. Polycystic kidneys
D. Progressive neurologic dysfunction
E. Retinoblastoma

ANSWER KEY:
1. C
2. C
3. B
4. B
5. A
6. B
7. E
8. E
9. E
10. A.

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