Multiple Choice Questions

Muskuloskeletal Tumours

Test your knowledge , learn more and get ready for your orthopaedic exam

 

52. Regarding osteosarcoma, which of the following statements is correct?

A) Affects the epiphyses of long bones
B) Can result in pulmonary metastases via haematogenous spread
C) Is exclusively a disease of adolescence and early adult life
D) Is most commonly seen around the hip
E) On x ray shows a ‘sunburst’ appearance due to bony involvement

 

51. When compared with postoperative external beam radiation therapy for the treatment of soft-tissue sarcomas. Preoperative radiation therapy is associated with which of the following?

A) Higher wound complications
B) Higher doses of radiation
C) Larger volumes of tissue irradiated
D) Worse overall survival
E) Worse functional results

 

50. Acral bone metastases (to the hands and feet) are most likely the result of a primary solid organ tumour in which of the followings structures?

A) DLiver
B) Lung
C) Breast
D) Thyroid
E) Prostate

 

49. What is the primary problem in rickets osteomalacia?

A) Defect in the zone of proliferation within the physis
B) Defect in type I collagen
C) Defect in the ext-1 gene
D) Low level of calcium
E) Production of dysplastic fibrous bone

 

48. What syndrome is characterized by polyostotic fibrous dysplasia, cafe-au-lait spots with serrated borders, endocrine abnormalities, and unilaterality?

A) Jaffe-Campanacci syndrome
B) Hunter’s syndrome
C) Maffucci’s syndrome
D) Multiple hereditary exostoses
E) McCune-Albright syndrome

 

47. A 68-year-old woman has had progressive pain in the right thigh for the past several months. She has a history of hypertension, treated with hydrochlorothiazide and osteoporosis treated with alendronate for 10 years. At this point, she is virtually wheelchair bound. 

Radiographs are shown . Additional studies show no signs of systemic disease. 

What is the most likely etiology of her condition

A) Prolonged use of bisphosphonates
B) Use of calcium-wasting diuretics
C) Occult metastatic cancer
D) Vitamin D-resistant rickets
E) Disuse osteopenia

 

46. An otherwise healthy 12-year-old boy has ankle pain after being kicked while playing soccer. Radiographs are shown in Figures.Examination reveals tenderness to palpation, but not with weight bearing. He had no pain preceding the incident. What is the next most appropriate step in management?

A) Observation
B) Curettage and grafting
C) Wide surgical resection
D) Whole body bone scan
E) Chemotherapy

 

45. A 20-year-old collegiate field hockey player has had diminished knee flexion for the past 3 years. Lately she has noted right knee pain that requires her to stop playing. Radiographs are shown in Figures. 

What is the next best step in management?

A) Radiation therapy
B) Surgical biopsy
C) Chemotherapy
D) Knee arthroscopy
E) Bisphosphonates

 

44-year-old woman with a history of breast cancer and a recent diagnosis of lung carcinoma with multiple painful biopsy-proven skeletal metastasis now reports progressive weight-bearing pain in her left thigh. 

Current treatment consists of chemotherapy for the lung mass and radiation therapy. 

An AP radiograph of the left femur is shown . What is the best option for treatment of her thigh pain?

A) Bisphosphonate therapy
B) Resection and megaprosthetic reconstruction
C) Prophylactic nailing
D) Radiation therapy
E) Chemotherapy

 

43. A 23-year-old woman who noted 1 day of thigh pain after jogging now reports persistent thigh swelling and can feel a mass. The radiograph, CT scan, and MRI scans are shown in Figures. 

What is the most likely diagnosis?

A) Soft-tissue sarcoma
B) Pseudoaneurysm
C) Abscess
D) Osteosarcoma
E) Myositis ossificans

 

42. Figures show the radiographs of an otherwise healthy 64-year-old man who has had right groin pain for the past 3 months. 

What is the next most appropriate step in management?

A) Biopsy
B) Observation
C) Radiation therapy
D) Prophylactic fixation of the femur
E) Bone scan, CT scan of the chest/abdomen/pelvis, laboratory studies

41. Figures show the radiographs of a 30-year-old-man who had Ewing’s sarcoma at the age of 10 treated with radiation therapy for local control. 

What is the most likely diagnosis?

A) Recurrent Ewing’s sarcoma
B) Osteomyelitis
C) Radiation-induced sarcoma
D) Metastatic adenocarcinoma
E) Bone infarct

 

40. Figure  shows the AP and lateral radiographs of a 12-year-old boy with knee pain after a fall. Previous to the fall he denies any history of pain. What is the most likely diagnosis?

A) Unicameral bone cyst
B) Chondroblastoma
C) Fibrous dysplasia
D) Nonossifying fibroma
E) Osteosarcoma

 

39. The diagnosis of gout can be made either by the presence of tophaceous deposits in the skin or bursae of the extremities or by the presence of which of the following?

A) Elevated urine pH
B) Elevated serum uric acid
C) Calcium pyrophosphate crystals in the synovial fluid
D) Monosodium urate crystals in the synovial fluid
E) Elevated serum phosphate

 

38. Giant cell tumour of the tendon sheath is histologically most closely related to which of the following?

A) Desmoplastic fibroma
B) Dermatofibroma
C) Pigmented villonodular synovitis (PVNS)
D) Myositis ossificans
E) Epithelial inclusion cyst

 

37. A 57-year-old woman has a right proximal humerus lesion that was originally discovered when a chest radiograph was obtained. The right shoulder is asymptomatic. An AP radiograph of the right shoulder is seen in Figure. 

What is the next step in management?

A) MRI
B) CT
C) Bone scan
D) Biopsy
E) Observation

 

36. Radiographs of the right knee of a 21-year-old man are seen in Figures . 

What is the inheritance pattern of this disorder?

A) Sporadic
B) Autosomal dominant
C) Autosomal recessive
D) X-linked dominant
E) X-linked recessive

 

35. A 63-year-old man has had increasing left leg pain over the last several months. History reveals that he has had recurring cyclic pain in the leg for the past several years. Radiographs show an enlarged, sclerotic tibia, with thickened coarse trabeculae and varus bowing. 

What is the most appropriate management for this patient?

A) Vitamin D
B) Calcium supplement
C) Methotrexate
D) Nonsteroidal antiinflammatory drugs (NSAIDs)
E) Bisphosphonate therapy

 

34. Which of the following is the most common soft-tissue sarcoma of the hand?

A) Chondrosarcoma
B) Rhabdomyosarcoma
C) Epithelioid sarcoma
D) Myxoid liposarcoma
E) Hemangiopericytoma

 

33. A 55-year-old woman with a history of lung cancer who underwent resection 1 year ago now reports thigh pain. Radiographs are shown in Figures. A CT scan of the chest, abdomen, and pelvis and a bone scan show no other lesions. 

What is the most appropriate next step in management?

 

A) Chemotherapy
B) External fixation
C) Reamed intramedullary nail with reamings sent to pathology
D) Biopsy
E) External beam radiation followed by placement of an intramedullary nail

 

32.A 15-year-old girl is referred for evaluation of a tibial lesion noted on radiographs performed after a twisting injury of the left knee. She was asymptomatic prior to the injury that occurred 3 weeks ago. The pain from the injury has now resolved. 

Radiographs of the left knee are seen in Figures. 

What is the next step in management of this patient?

A) CT
B) MRI
C) Bone scan
D) Needle biopsy
E) Observatione

 

31.A 13-year-old girl injured her left shoulder playing volleyball. The shoulder was previously asymptomatic. She was referred for evaluation of a left humeral lesion noted on radiographs obtained after the injury. Currently she has returned to playing volleyball and is asymptomatic again. 

AP and lateral radiographs of the shoulder are seen in Figures .

What is the next most appropriate step in management of this patient?

A) MRI
B) CT
C) Bone scan
D) Needle biopsy
E) Observation

 

30.What syndrome is associated with the presence of enchondromas and hemangiomas? 

A) Maffucci’s syndrome
B) Hunter’s syndrome
C) Multiple hereditary exostoses
D) Ollier’s disease
E) Trevor’s disease

 

29.7-year-old boy has multiple firm, fixed masses about his knees and extremities. Occasionally he has pain when he bumps his knee or around his proximal legs when he is playing soccer. 

Radiographs and CT scan are shown in Figures. 

What is the next most appropriate step in management?

A) Observation
B) Biopsy of the largest lesions
C) Whole body PET scan
D) Removal of all lesions about the knee
E) Bisphosphonate therapy

 

28.Tumoural calcinosis is a hereditary disease that involves which of the following?

A) Calcium metabolism
B) Phosphate metabolism
C) Oxalate metabolism
D) Chloride metabolism
E) Renal tubular insufficiency

 

27. An otherwise healthy 15-year-old boy is seen in the emergency department for an injury sustained while playing dodge ball. 

A radiograph is shown in Figure .

What is the most appropriate treatment for this patient?

 

A) Aspiration and injection
B) Resection and reconstruction
C) Sling and pain medication
D) Curettage and bone grafting
E) Intramedullary nail fixation

 

26.  Figures show the AP radiograph and axial CT scan of an 18-year-old woman who has proximal thigh pain. 

What is the most appropriate treatment?

 

A) Observation
B) Curettage and grafting
C) Radiofrequency ablation
D)Wide resection
E)Wide resection and chemotherapy

 

25. An 11 year-old boy presents to fracture clinic having sustained a fall the day before and knee pain. 

Which of the following statements describes this condition?

A) A malignant primary bone tumour ; wide excision and attempted limb salvage is the main treatment
B) Locally aggressive condition which requires curettage and adjuvant treatment to halt local progression and recurrence
C) A malignant primary bone tumour, commoner in childhood; chemotherapy is the mainstay of treatment
D)A benign condition of childhood that is treated with curettage
E) A benign condition of childhood that almost always spontaneously disappears in adulthood

 

24. A 45-year-old woman has a painless thigh mass that is larger than 5 cm. 

What is the best next step?

A) Percutaneous biopsy
B) Positron emission tomography (PET)/CT scan
C) Excisional biopsy
D) MRI of the thigh with gadolinium
E) Simple analgesia and discharge

 

23.A 31 year-old woman has a 2 month history of dull, aching pain in her shoulder after fall.

Her radiograph is presented.

 

 Which of the following is the most appropriate treatment?

A) Wide resection with preoperative chemotherapy
B) Wide resection with perioperative radiation
C) Wide resection alone
D) Forequarter amputation
E) Marginal resection followed by joint reconstruction

 

22.The figuers anteroposterior and lateral radiographs, CT scan, and technetium
bone scan of a 12-year-old boy who has experienced 7 months of pain in his lower leg. The pain
limits his ability to participate in sports and he is having difficulty sleeping. 

He is afebrile, and laboratory study findings including an erythrocyte sedimentation rate, C-reactive protein, and
complete blood count are within normal limits.

What is the most likely diagnosis?

A) Osteomyelitis
B) Osteoid osteoma
C) Stress fracture
D) Adamantinoma                                                                                                                                                                                                                                         E) Fibrous Dysplasia

 

21. A 35 year old man was being evaluated for chronic thigh pain. Xray attached. 

What is your diagnosis?

A) Osteopetrosis
B) Osteopokilosis
C) Osteopathia striata
D) Melorrheostosis 
E) Osteoporosis

 

20. Most common malignancy of bones is:

A) Osteosarcoma
B) Ewings saroma
C) Metastasis
D) Lymphoma
E) Chondrosarcoma

 

19. Epiphyseal osteochondroma is also known as:

(A) Mafucci’s syndrome
(B) Freiberg’s fracture
(C) Larsen-Johansson disease
(D) Trevor’s disease
(E) Iselin’s disease

 

18. The most common location of a chordoma is: 

A) Cervical vertebra
B) Thoracic vertebra
C) Lumbar vertebra
D) Sacrococcygeal region
E) Spheno-occipital region 

 

17. Which of the following tumors is considered to be a benign primary spine tumor:

A) Osteosarcoma
B) Chordoma
C) Multiple myeloma
D) Osteoblastoma
E) Lymphoma

 

16. Which of the following diagnostic modalities is used most often to evaluate suspected malignant astrocytomas of the spinal cord:

A) History and physical examination is often sufficient to make the diagnosis
B) Imaging characteristics of malignant astrocytomas on MRI are specific enough to make the diagnosis
C) Malignant astrocytoma of the spinal cord is a clinical diagnosis and only confirmed after post-mortem tissue evaluation
D) An open biopsy with tissue evaluation is the only way to make the diagnosis
E) Computed tomography with a myelogram

 

15. A 57-year-old man with known lung cancer and metastatic disease complains of increasing low back pain. How often is the lumbar spine involved when a patient has known spinal metastasis:

A) 5%
B) 15%
C) 50%
D) 85%
E) 99%

 

14. Pain is the most common complaint in patients presenting with a primary spine tumor and is present in which percentage of patients:

A) 55%
B) 65%
C) 75%
D) 85%
E) 95%

 

13. What percentage of osteoblastomas occur in the spine:

A) 20% to 30%
B) 30% to 40%
C) 40% to 50%
D) 50% to 60%
E) 60% to 70%

 

12. Which of the following methods is the standard in diagnosing vertebral metastatic disease:

A) Plain radiography demonstrating lytic lesion
B) Computed tomography with bony destruction respecting adjacent vertebral levels
C) Magnetic resonance imaging with typical destructive lesion characteristics
D) Tissue biopsy
E) There is no standard of care in diagnosing vertebral metastasis.

 

11. The most effective treatment for malignant intramedullary tumors of the spinal cord is:

A) Surgical excision
B) Radiation therapy
C) Chemotherapy
D) Surgical excision followed by a combination of chemotherapy and radiation therapy.
E) Neither a single treatment modality nor a combination of treatment modalities has proven effective in significantly improving mortality

 

10. This slide is a computed tomogram of the dominant shoulder of a 45-year-old male tennis player. 

The most likely diagnosis is:

A) Osteosarcoma
B) Synovial osteochondromatosis
C) Anterior glenoid fracture
D) Synovial cell sarcoma
E) Rotator cuff tear arthropathy


9. All of the disorders listed below are examples of osteochondrosis except:

A) Legg-Calvé-Perthes disease
B) Scheuermann’s disease 
C) Osgood Schlatter disorder 
D) Gorham’s disease
E) Blount disease

 

8. Polyostotic fibrous dysplasia is caused by a mutation in which of the following genes:

A) GNAS 1
B) EXT 1 
C) Fibroblast growth factor receptor protein
D) CFBA1
E) COL1A1 

 

7. Which of the following is known about the genetics of multiple hereditary exostosis (MHE):

A) There is no genetic pattern for this condition.
B) MHE follows an x-linked inheritance pattern. 
C) MHE follows an autosomal recessive pattern. 
D) MHE involves a defect in biosynthesis of heparan sulfate. 
E) MHE involves a defect in fibroblast growth factor. 

 

6. Enchondral ossification is responsible for mineralization in all of the following conditions except: 

A) Callus formation during fracture healing
B) Heterotopic bone formation
C) Cartilage degeneration is osteoarthritis
D) Embryonic long bone development
E) Perichondrial bone formation

 

5. A 15-year-old boy has a destructive lesion in the distal femur with soft tissue extension. Needle biopsy shows a high-grade osteosarcoma. CT scan of the chest is normal and the technetium bone scan shows involvement of only the distal femur. 

What is the surgical stage according to the system of the Musculoskeletal Tumor Society:

A) Stage 1
B) Stage 2
C) Stage IIA
D) Stage IIB
E) Stage III

 

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

A) Radius
B) Ulna
C) Femur
D) Tibia
E) Fibula

 

3. The most common malignant tumor of the hand is?

A) Chondrosarcoma
B) Epithelioid sarcoma
C) Squamous cell carcinoma
D) Basal cell carcinoma
E) Osteosarcoma

 

2. The most common soft tissue sarcoma of the hand is:

A) Epithelioid sarcoma
B) Malignant fibrous histiocytoma
C) Soft tissue osteosarcoma
D) Synovial sarcoma
E) Alveolar rhabdomyosarcoma


1. A 10 year-old boy presents with worsening pain in the femur. MRI scan and biopsy shows features consistent with a high grade osteosarcoma. 

Which one of the following statements does NOT apply to his treatment?

A) A CT chest is required to look for pulmonary metastases                                                                                                                                         
B
) Chemotherapy is usually given both pre and post operatively and has radically improved survival rates.                                   
C) Limb salvage options might include rotationplasty.                                                                                                                                                      
D
) In this case wide local excision and a distal femoral lengthening endoprosthesis could be used.                                                     
E
) Limb salvage surgery is not possible in the majority of distal femur osteosarcoma cases

 

5. A 68-year-old woman has had progressive pain in the right thigh for the past several months. She has a history of hypertension, treated with hydrochlorothiazide and osteoporosis treated with alendronate for 10 years. At this point, she is virtually wheelchair bound. 

Radiographs are shown . Additional studies show no signs of systemic disease. 

What is the most likely etiology of her condition ?

A) Prolonged use of bisphosphonates
B) Use of calcium-wasting diuretics
C) Occult metastatic cancer
D) Vitamin D-resistant rickets
E) Disuse osteopenia

 

4. An otherwise healthy 12-year-old boy has ankle pain after being kicked while playing soccer. Radiographs are shown in Figures.Examination reveals tenderness to palpation, but not with weight bearing. He had no pain preceding the incident. What is the next most appropriate step in management?

A) Observation
B) Curettage and grafting
C) Wide surgical resection
D) Whole body bone scan
E) Chemotherapy

 

3. A 20-year-old collegiate field hockey player has had diminished knee flexion for the past 3 years. Lately she has noted right knee pain that requires her to stop playing. Radiographs are shown in Figures. 

What is the next best step in management?

A) Radiation therapy
B) Surgical biopsy
C) Chemotherapy
D) Knee arthroscopy
E) Bisphosphonates

 

2-year-old woman with a history of breast cancer and a recent diagnosis of lung carcinoma with multiple painful biopsy-proven skeletal metastasis now reports progressive weight-bearing pain in her left thigh. 

Current treatment consists of chemotherapy for the lung mass and radiation therapy. 

An AP radiograph of the left femur is shown . What is the best option for treatment of her thigh pain?

A) Bisphosphonate therapy
B) Resection and megaprosthetic reconstruction
C) Prophylactic nailing
D) Radiation therapy
E) Chemotherapy

 

1. A 23-year-old woman who noted 1 day of thigh pain after jogging now reports persistent thigh swelling and can feel a mass. The radiograph, CT scan, and MRI scans are shown in Figures. 

What is the most likely diagnosis?

A) Soft-tissue sarcoma
B) Pseudoaneurysm
C) Abscess
D) Osteosarcoma
E) Myositis ossificans

Test your knowledge , learn more and get ready for your orthopaedic exam

2 thoughts on “Oncology”

Leave a Reply

Your email address will not be published. Required fields are marked *