1.

Which of the following bone tumors commonly occurs in patients with

closed physes between 20 and 50 years of age:

a) Osteoid osteoma
b) Chondromyxoid fibroma
c) Solitary bone cyst
d) Giant cell tumor
e) Non-ossifying fibroma

2. Which of the following bone tumors arises exclusively in the epiphysis:

a) Osteoid osteoma
b) Chondromyxoid fibroma
c) Giant cell tumor
d) Chondroblastoma
e) Non-ossifying fibroma

3. Which of the following bone tumors commonly arises from the surface of

the posterior cortex of the distal femur:

a) Ewing’s tumor
b) Periosteal osteosarcoma
c) Parosteal osteosarcoma \\\\\\
d) Giant cell tumor
e) Periosteal chondroma

4. Which of the following patterns of bone destruction suggests a benign

process:

a) Permeative
b) Moth-eaten
c) Geographic with a sclerotic rim ////////
d) Cortical erosion with cortical thickening
e) Large lytic focus with ill-defined margin

5. The most common location of adamantinoma of bone is the:

a) Radius
b) Ulna
c) Femur
d) Tibia///////
e) Fibula

6. The most common location of osteofibrous dysplasia is the:

a) Femur
b) Tibia///////
c) Fibula
d) Radius
e) Ulna

7. The most common soft tissue sarcoma of the foot and ankle is:

a) Primitive neuroectodermal tumor

b) Malignant fibrous histiocytoma
c) Liposarcoma
d) Epithelioid sarcoma
e) Synovial sarcoma///////////

8. The most common soft tissue sarcoma of the upper extremity is:

a) Primitive neuroectodermal tumor

b) Malignant fibrous histiocytoma
c) Liposarcoma
d) Epithelioid sarcoma//////////
e) Synovial sarcoma

9. Which of the following describes the signal sequences on T1 and T2

weighted imaging of a soft tissue sarcoma:

a) Moderate(T1) / Low(T2)
b) Low(T1) / Low(T2)
c) High(T1) / High(T2)
d) Low(T1) / High(T2) /////////////////
e) High(T1) / Moderate(T2)

10. Which of the following describes the signal sequences on T1 and T2

weighted images of a lipoma:

a) Moderate(T1) / Low(T2)
b) Low(T1) / Low(T2)
c) High(T1) / High(T2)
d) Low(T1) / High(T2)
e) High(T1) / Moderate(T2)/////////////

11. Which of the following describes the signal sequences on T1 and T2

weighted images of a ganglion cyst:

a) Moderate(T1) / Low(T2)
b) Low(T1) / Low(T2)
c) High(T1) / High(T2)
d) Low(T1) / High(T2) //////////////
e) High(T1) / Moderate(T2)

12. Pigmented villonodular synovitis occurs most commonly in which of the

following joints:

a) Hip
b) Knee////////////////
c) Shoulder
d) Elbow
e) Ankle

13. To which of the following organs do soft tissue sarcomas most commonly

metastasize:

a) Brain
b) Lungs ////////////
c) Adrenals
d) Other bones
e) Kidneys
 14. In the adult, the notochord forms which of the following structures:

a) Vertebral body
b) Vertebral pedicles
c) Vertebral lamina
d) Vertebral spinous processes
e) Nucleus pulposus of the intervertebral discs /////////////

15. The most common location of a chordoma is:

a) Cervical vertebra
b) Thoracic vertebra
c) Lumbar vertebra
d) Sacrococcygeal region ///////////////////
e) Spheno-occipital region

16. At higher rates of loading, the failure pattern of a ligament will

tend to occur at:

a) Proximal insertion site

b) Distal insertion site
c) Equally at the proximal and distal insertion sites
d) Mid-substance//////////////////
e) Failure patterns have no relationship to site of failure

17. Ligaments have several important properties. Which of the following

proteins stores energy as a ligament lengthens and returns the ligament to

its original length after the load is removed:

a) Type I collagen
b) Type III collagen
c) Aggregan
d) Elastin////////////////
e) Platelet derived growth factor

18. The major biochemical component of a ligament is:

a) Water /////////////////
b) Collagen
c) Proteoglycan
d) Elastin
e) Link protein

19. Which of the following cells is responsible for maintaining the

extracellular matrix of a ligament:

a) Chondrocyte
b) Osteoblast
c) Fibroblast //////////////////////
d) Histiocyte
e) Synovial lining cells

20. Which of the following statements concerning the medial and lateral

menisci is correct:

a) The medial meniscus is more mobile than the lateral meniscus

b) The posterior horn of the lateral meniscus is the most mobile
c) The menisci transmit 50% of the joint forces with the knee in extension /////////
d) The lateral meniscus is important to restrain anterior translation
e) The menisci transmit 50% of the joint forces with the knee in flexion

21. In regard to the vascularity of the menisci, which of the following

statements are correct:

a) The capillary plexus penetrates the peripheral 30% of the medial

meniscus.////////////////
b) The capillary plexus penetrates the peripheral 50% of the medial meniscus.
c) The capillary plexus penetrates the peripheral 70% of the medial meniscus.
d) The capillary plexus penetrates the peripheral 90% of the medial meniscus.
e) The entire width of the medial meniscus has excellent vascularity.

22. Meniscal fibrocartilage is principally composed of which of the

following types of collagen:

a) Type I////////////
b) Type II
c) Type VI
d) Type IX
e) Type X
23. Bone bruises, or occult osteochondral injury, occur in up to 80% of

patients with an anterior cruciate ligament rupture. The most common

location of this articular injury is:

a) Medial femoral condyle ///////////////

b) Medial tibial plateau
c) Medial patellar facet
d) Lateral femoral condyle
e) Lateral patellar facet

24. Which of the following occurs when a joint is immobilized:

a) Slow decrease in collagen concentration

b) Rapid decrease in collagen concentration
c) Slow decrease in proteoglycan concentration
d) Rapid decrease in proteoglycan concentration //////////
e) No change in either collagen or proteoglycan concentration

25. Articular cartilage exhibits viscoelastic behavior (time dependent

behavior). When a constant load is applied, the deformation of the

articular cartilage will increase. This process is called:

a) Relaxation
b) Creep ///////////////////
c) Stretching
d) Corrosion
e) Fretting

26. Articular cartilage is composed of 4 zones. The chondrocytes of which

of the following zones produce a high concentration of collagen and a low

concentration of proteoglycan:

a) Superficial tangential zone //////////////////

b) Middle zone
c) Deep zone
d) Calcified zone
e) Tidemark zone
27. Which of the following types of collagen is the most common type in

articular cartilage:

a) Type I
b) Type II //////////////////////
c) Type IV
d) Type IX
e) Type X

28. A 12-year-old boy has multiple exostoses (osteochondromas). What is

the most likely pattern of inheritance in this condition:

a) Autosomal recessive
b) Autosomal dominant ////////////////
c) X-linked recessive
d) X-linked dominant
e) Almost always a spontaneous mutation

29. Which of the following describes the microscopic features of a bone

island:

a) Interlacing network of bone trabeculae in a loose, vascular, stromal connective

tissue dd
b) Compact cortical bone///////////////
c) Scattered giant cells in a mononuclear cell background with chicken-wire
calcification
d) Pleomorphic spindle cells with osteoid production
e) Prominent mature bone formation and low-grade malignant spindle cell tumor

30. Which tendon transfer results in the greatest recovery of thumb-index

finger pinch function?

a) Flexor digitorum superficials of ring finger

b) Extensor indicis proprius
c) Extensor digitorum communis
d) Extensor carpi radialis brevus///////////////////
e) Flexor digitorum superficialis
31. Which of the following collagen macromolecules found in articular

cartilage confers the major amount of tensile strength and resistance to

shear stress?

a) Type II collagen /////////////////

b) Type IX collagen
c) Type XI collagen
d) Type VI collagen
e) Type X collagen

32. Which of the following clinical findings are associated with

hyperparathyroidism?

a) Bone pain
b) Brown tumors
c) Pathologic fractures
d) Renal stones
e) All of the above ///////////////

33. During fracture repair systemic as well as local factors come into

play. Which of the following is considered a systemic factor in fracture

healing?

a) degree of vascular injury

b) degree of bone loss
c) age /////////////////
d) type of bone affected
e) degree of immobilization

34. Endochondral ossification is responsible for which of the following

conditions?

a) Callus formation during fracture healing

b) Heterotopic bone formation
c) Cartilage degeneration in osteoarthritis
d) Embryonic long bone development
e) All of the above //////////////////////
35. Which of the following wear mechanisms is the worst possible

situation?

a) Adhesive wear
b) Fatigue
c) Third body////////////////
d) Corrosive wear
e) Fretting

36. Which of the following statements inaccurately describes human bone as

a biomaterial?

a) Bone is isotropic//////////////////////
b) Bone is viscoelastic
c) Bone's strength and elastic modulus are approximately proportional to the square of
its density
d) Bone is a composite
e) Bone remodels its structure to maintain overall resistance to loading while the
material itself weakens

37. Of the four phases of fracture repair when fixation of any variety is

used, which phase occurs rapidly and crosses gaps?

a) Primary response
b) Extramedullary callus formation//////////////////
c) Intramedullary callus formation
d) Primal osteonal response
e) All of the above

38. Which of the following individuals has the highest dietary calcium

requirement?

a) A healthy growing child

b) A healthy pregnant 23-year-old woman
c) A healthy 60-year-old post-menopausal woman
d) A healthy adolescent
e) A healthy 29-year-old post-partum lactating mother///////////////////////
39. Which of the following is not a facilitator of calcium absorption?

a) 1,25 dihydroxy Vitamin D

b) Gastric pH
c) Ca:P ratio of 1:1 or 1:2
d) Achlorhydria/////////////////
e) Hyperkalaemia

40. Laboratory findings found in rickets and/or osteomalacia, include the

following except:

a) Normal serum calcium

b) Decreased serum phosphorous
c) Increased parathyroid hormone
d) Decreased alkaline phosphatase//////////////
e) Decreased serum calcium

41. Which of the following terms is used to describe a localized

conduction block in a peripheral nerve in which the nerve is intact and

full recovery is expected:

a) First-degree injury (neuropraxia) /////////////////////

b) Second-degree (axonotmesis)
c) Third-degree
d) Fourth-degree
e) None of the above

42. Which of the following describes the sequence in which motor and

sensory nerves fail in response to an injury:

a) Motor, proprioceptor, touch, temperature, and pain /////////////

b) Pain, proprioceptor, touch, temperature, and motor
c) Touch, proprioceptor, temperature, pain, and motor
d) Temperature, touch, temperature, motor, and pain
e) Proprioceptor, touch, temperature, pain, and motor

43. Following a traumatic nerve injury, in which time period would a

physician find denervation activity with fibrillation and positive sharp

waves in the affected muscles:

a) Immediately following the injury

b) 7 to 10 days following injury
c) 2 to 5 weeks following injury //////////////////////
d) 6 to 8 weeks following injury
e) 12 weeks following injury

44. Following a traumatic nerve injury, in which time period would a

physician find re-innervation of the affected muscles:

a) Immediately following the injury

b) 7 to 10 days following injury
c) 2 to 5 weeks following injury
d) 6 to 8 weeks following injury ////////////////////
e) 12 weeks following injury

45. Which of the following collagen types accounts for 10% to 20% of the

wet weight of articular cartilage:

a) Type I
b) Type II /////////////////
c) Type V
d) Type IX
e) Type XI

46. The affinity of articular cartilage for water is most related to which

of the following tissues:

a) Type II collagen
b) Type I collagen
c) Hydrophilic nature of the proteoglycans ///////////////
d) Link protein
e) Fibronectin

47. In which of the following articular cartilage zones is the collagen

fiber oriented perpendicularly:

a) Superficial tangential zone

b) Middle zone
c) Deep zone ///////////////
d) Calcified zone
e) Tidemark

48. The tidemark in articular cartilage separates which of the following

two zones:

a) The superficial tangential zone and the middle zone

b) The middle zone and the deep zone
c) The superficial zone and the deep zone
d) The deep zone and the calcified zone ///////////////////
e) The calcified cartilage zone and the subchondral bone zone

49. In which of the following articular cartilage zones is the highest

water content:

a) Superficial tangential zone //////////////////////

b) Middle zone
c) Deep zone
d) Calcified zone
e) Tidemark

50. Which of the following collagens acts as a nuclei for deposition of

type II collagen in articular cartilage:

a) Type I
b) Type III
c) Type IX
d) Type XI ///////////////////
e) Type XII

51. Which of the following is the most prevalent glycosaminoglycan in

articular cartilage:

a) Keratan sulfate
b) Chondroitin sulfate /////////////////////////
c) Hyaluronate
d) Dermatan sulfate
e) Fibromodulin

52. Adult articular cartilage receives its nutrition through which of the

following mechanisms:

a) Fine capillary network from the synovial tissues

b) Fine capillary network through the subchondral bone
c) Fine capillary network from the perichondral ring
d) Diffusion from the synovial fluid through large pores
e) Diffusion from the synovial fluid through small pores/////////

53. Which of the following statements is true concerning the changes seen

in human articular cartilage as a person ages (normal cartilage):

a) Progressive increase in chondroitin 4-sulfate

b) Progressive decrease in chondroitin 6-sulfate
c) Progressive decrease in collagen concentration
d) Progressive increase in collagen concentration
e) Progressive increase in keratan sulfate concentration//////////

54. Which of the following two components account for the biphasic

behavior of cartilage:

a) Chondroitin 4-sulfate and chondroitin 6-sulfate

b) Chondroitin 6-sulfate and keratan sulfate
c) Collagen and proteoglycans
d) Water and the solid matrix of cartilage (collagen and proteoglycans)
e) Collagen and fibronectin

55. A genetic mutation accounts for the manifestations of osteogenesis

imperfecta. Which of the following factors has a genetic mutation that has

been linked to osteogenesis imperfecta:

a) Fibroblast growth factor (FGF) receptor 3
b) Type I collagen //////////////////
c) Cartilage oligomeric matrix protein (COMP)
d) Fibrillin
e) Type II collagen

56. Haversian bone is composed of vascular channels surrounded

circumferentially by lamellar bone. Which of the following terms is used

to describe the unit of bone composed of a neurovascular channel

surrounded by a cell-permeated layer of bone matrix:

a) Bone remodeling unit

b) Plexiform bone
c) Osteon ///////////////////////
d) Volkman unit
e) Canaliculi

57. The normal porosity of cortical bone is:

a) 5%
b) 10% /////////////////////////
c) 20%
d) 25%
e) 30%

58. The normal porosity of trabecular bone is:

a) 10%
b) 20%
c) 30%
d) 40%
e) 50% to 90%////////////////////

59. Which of the following cells produce osteocalcin and bone

sialoprotein:

a) Osteocytes
b) Osteoblasts //////////////////////
c) Mast cells
d) Osteoclasts
e) Fibroblasts

60. Osteoblasts predominantly form which of the following types of

collagen:

a) Type I ////////////////////////
b) Type II
c) Type VI
d) Type IX
e) Type X

61. Osteocytes differ from osteoblasts because osteocytes:

a) Have a higher nucleus to cytoplasm ratio/////////////////

b) Have a larger number of organelles
c) Line the bone surfaces
d) Are isolated individually from other bone cells
e) Have alkaline phosphatase that is distributed over the outer surface of the cell

62. Osteoclasts bind to the bone surface through which of the following

proteins:

a) Osteocalcin (bone Gla protein)

b) Integrins//////////////////////
c) Osteopontin (bone sialoprotein 1)
d) Fibromodulin
e) Bone sialoprotein 2

63. Which of the following cells receive the majority of systemic

endocrine-based signals for control of bone metabolism:

a) Osteocytes
b) Osteoblasts//////////////////
c) Osteoclasts
d) Mast cells
e) Platelets
64. Which of the following cells have receptors for the hormone estrogen:

a) Osteoclasts
b) Osteocytes
c) Lymphocytes
d) Osteoblasts/////////////////
e) Mast cells

65. Water comprises what percentage of bone composition:

a) 5% to 8% /////////////////////
b) 20%
c) 30%
d) 40%
e) 50%

66. Which of the connective tissue collagens may facilitate calcification

in the holes and pores of bone collagen fibrils:

a) Type I ////////////////
b) Type I and II
c) Type I, II, VI, and XI
d) Type IX and X
e) Type X

67. Cortical bone remodeling per year in a healthy older adult is typically:

a) 2% to 5% ////////////////
b) 10%
c) 20%
d) 305
e) 50%

68. The periosteal vessels supply what portion of the cortical bone blood

circulation:

a) 5% to 10% of the inner endosteal surface

b) 10% to 20% of the inner endosteal surface
c) 1% to 5% of the outer periosteal surface
d) 15% to 20% of the outer periosteal surface///////////////
e) 30% to 50% of the outer periosteal surface

69. Human calcium absorption occurs in the

a) Stomach
b) Small intestine///////////////////
c) Large intestine
d) Liver
e) Parathyroid glands

70. Approximately how many hours of sunlight are necessary to produce the

daily requirement of 400 units of vitamin D in white people:

a) 1 hour ////////////////////
b) 2 hour
c) 4 hour
d) 6 hour
e) 81 hour

71. Hydroxylation of vitamin D to 25-hydroxyvitamin D occurs in the:

a) Liver ////////////////////////
b) Kidney
c) Thyroid
d) Parathyroid hormone
e) Small intestine

72. Which of the following serum levels is the best indicator of body

stores of vitamin D3:

a) 7-dehydrocholesterol
b) 1,25 dihydroxyvitamin D
c) 25 hydroxyvitamin D3 //////////////////////
d) 21,25 dihydroxyvitamin D
e) Parathyroid hormone levels
73. At which of the following sites is 25 hydroxyvitamin D3 converted

into the active hormone 1,25 dihydroxyvitamin D3:

a) Skin
b) Liver
c) Kidney//////////////
d) Parathyroid hormone
e) Small intestine

74. In which of the following osteonecrotic conditions does the marrow

cavity become packed with abnormal cells:

a) Caisson disease
b) Gaucher disease //////////////////
c) Renal transplantation
d) Pancreatitis
e) Chronic corticosteroid administration

75. Which of the following cells die in osteonecrosis:

a) Osteocytes only
b) Osteoblasts and osteocytes only
c) Osteoblasts, osteocytes, hematopoietic cells, capillary endothelial cells, and
lipocytes ///////////////
d) Osteoblasts and osteoclasts only
e) Osteoblasts only

76. The increased radiographic bone density in osteonecrosis is most

likely secondary to:

a) Calcification of the necrotic bone marrow

b) Insoluble soap from released calcium and free fatty acids
c) Creeping substitution on the dead trabeculae ///////////////
d) Resorption of the Haversian canal bone
e) Necrotic cortical bone

77. A 4-year-old child injures his elbow and presents with swelling and

limitation of voluntary movement. The radiographs show no obvious

fracture, but it does show a Baumann angle of 71° and an elevation of the

posterior fat pad. You tell the parents that this most likely represents:

a) A congenital anomaly with a valgus deformity of the elbow

b) A medial epicondyle fracture
c) A Salter I physeal separation
d) An occult supracondylar fracture //////////////
e) A variation of normal

78. The tibialis anterior muscle is principally innervated by which of

the following nerve roots:

a) L1
b) L2
c) L3
d) L4 /////////////
e) L5

79. The patellar tendon reflex is primarily transmitted through which of

the following nerve roots:

a) L1
b) L2
c) L3
d) L4///////////////////////
e) L5

80. The skin on the medial aspect of the leg and great toe is innervated

by which of the following nerve roots:

a) L2
b) L3
c) L4 ///////////////////////
d) L5
e) S1

81. The extensor hallucis longus muscle is innervated by which of the

following nerve roots:

a) L1
b) L2
c) L3
d) L4
e) L5 /////////////////

82. The extensor digitorum longus and brevis muscles are primarily

innervated by which of the following nerve roots:

a) L1
b) L2
c) L3
d) L4
e) L5 /////////////////

83. The gluteus medius muscle is principally innervated by which of the

following nerve roots:

a) L1
b) L2
c) L3
d) L4
e) L5 ///////////////

84. Testing of the L5 nerve root is accomplished through the:

a) Patellar tendon reflex

b) Achilles tendon reflex
c) Tibialis posterior reflex /////////////
d) Superficial anal reflex
e) Beevor sign

85. The skin on the lateral aspect of the leg and the dorsum of the foot

between the second and fourth toes is innervated by which of the following

nerve roots:

a) L1
b) L2
c) L3
d) L4
e) L5 ////////////////////////////

86. The peroneus longus and brevis muscles are innervated by which of the

following nerve roots:

a) L3
b) L4
c) L5
d) S1///////////////
e) S2

87. The Achilles tendon reflex (ankle reflex) is transmitted through

which of the following nerve roots:

a) L4
b) L5
c) S1////////////////////
d) S2
e) S3

88. Which of the following groups of nerve roots innervate the intrinsic

muscles of the foot:

a) L2, L3, and L4

b) L4 and L5
c) L4, L5, and S1
d) L5, S1, and S2
e) S2 and S3 //////////////

89. Perianal sensation is derived from which of the following nerve

roots:

a) L2, L3, and L4

b) L3, L4, and L5
c) L5, S1, and S2
d) S1, S2, and S3
e) S2, S3, S4, and S5 ////////////////

90. Which of the following sensory segmental levels corresponds with the

nipple line:

a) T2
b) T4////////////////
c) T7
d) T10
e) T12

91. Which of the following sensory segmental levels corresponds to

sensation at the xiphoid process:

a) T2
b) T4
c) T7 ////////////////////
d) T10
e) T12

92. The skin over the umbilicus is innervated by which of the following

sensory segmental levels:

a) T2
b) T4
c) T7
d) T10 ////////////////////
e) T12

93. The skin over the groin is innervated by which of the following

sensory segmental levels:

a) T2
b) T4
c) T7
d) T10
e) T12//////////////////////
94. In which of the following groups of patients should fluoroquinolones

such as ciprofloxacin not be used because of significant adverse effects:

a) Young women
b) Children ///////////////////////
c) Diabetic patients
d) Elderly patients
e) Patients with sickle cell anemia

95. Which of the following musculoskeletal complications may occur in

patients taking fluoroquinolones, such as ciprofloxacin:

a) Osteomalacia

b) Osteoporosis
c) Joint laxity
d) Tendon ruptures /////////////////
e) Parethesias

96. The human genome is comprised of approximately what number of genes:

a) 1,000
b) 5,000
c) 10,000
d) 30,000 //////////////
e) 10,0000

97. Which of the following occurs in Paget’s disease:

a) Inadequate mineralization of newly formed bone//////////

b) Low bone mass and microarchitectural deterioration of bone
c) Normal osteoclastic activity with decreased osteoblastic activity
d) Increased osteoclastic activity and normal osteoblastic activity
e) Increased osteoclastic activity and increased bone formation

98. Which of the following laboratory studies evaluates amounts of bone

resorption:
a) Serum alkaline phosphatase
b) Aspartate aminotransferase and alanine aminotransferase
c) Gamma-glutamyl transpeptidase
d) Osteocalcin
e) Urine N-telopeptide, pyridinoline, and deoxypyridinoline//////////

99. Paget’s disease is common in all of the following bones except:

a) Humerus
b) Spine
c) Femur
d) Hands and feet///////////
e) Pelvis

100. After oophorectomy or menopause, bone loss per year is estimated to

be:

a) 0.3% to 0.5%
b) 2% to 3% //////////////////////
c) 5% to 10%
d) 10% to 15%
e) 15% to 20%

101. Corticosteroids decrease bone mass through which of the following

mechanisms:

a) Inhibiting calcium absorption in the intestines /////////////

b) Decreasing calcium excretion in the kidneys
c) Increasing calcium binding proteins
d) Increasing overall protein synthesis
e) Increasing calcium bone absorption at high doses
102. Which of the following defines osteoporosis according to the World

Health Organization:

a) A 2.5 to 5.0 SD below age-matched controls

b) A 0.5 to 1.0 standard deviation (SD) below age-matched controls
c) A 1.0 to 2.0 SD below age-matched controls
d) A 1.0 to 2.5 SD below age-matched controls
e) More than 2.5 SD below age-matched controls///////////////

103. Which of the following features is associated with type 1

osteoporosis:

a) Primarily occurs in patients older than 75 years of age

b) Female to male ratio is 2:1
c) Cortical and trabecular bone are affected
d) Low turnover osteoporosis
e) Related to estrogen deficiency rather than calcium intake///////

104. Which of the following features is associated with type 2

osteoporosis:

a) High turnover osteoporosis

b) Female to male ratio is 6:1
c) Loss of cortical and trabecular bone///////////////
d) Related to estrogen deficiency
e) Primarly occur in patients less than 75 years of age