Pathology EMQ template.

Name:

Candidate number:

Theme: Metabolic bone histopathology

 

OPTION LIST

 

A	Familial hypocalciuric hypercalcaemia	I	Paget’s disease
B	Hypocalcaemia	J	Renal osteodystrophy
C	Multiple Endocrine Neoplasia Type 1	K	Rickets
D	Multiple Endocrine Neoplasia Type 2a	L	Sarcoidosis
E	Multiple Myeloma	M	Secondary hyperparathyroidism
F	Osteomalacia	N	Vitamin D toxicity
G	Osteoporosis	O
H	Primary hyperparathyroidism	P

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 74-year-old man presents with bone pain. Microscopic examination of a bone biopsy elicits woven bone mixed with lamellar bone in a mosaic pattern.

 

 

2. A bone biopsy of a 40-year-old lady shows cystic spaces filled with fibrous tissue and haemosiderin-pigmented macrophages. Laboratory tests reveal a serum ionised calcium concentration of 1.5 mmol/L.

 

 

3. A 63-year-old lady complains of generalised bone pain and a subsequent bone densitometry study revealed significant loss of cortical bone. Microscopic examination of a parathyroid nodule biopsy revealed uniform, polygonal chief cells and larger oxyphil cells.

 

4. A 5-year-old boy is brought to clinic by his parents. He complains of bone pain and tenderness. Microscopically, a significant increase in bone osteoid content is noted.

 

 

5. A 58-year-old man presents with generalised bone pain. Laboratory investigations reveal increased serum PTH and phosphate levels. Microscopic examination of a parathyroid gland biopsy shows hyperplasia of chief cells.

 

 

 

ANSWERS

1. I

2. H

3. H

4. K

5. M