Multiple Choice Questions


Please use the comments section at the bottom of the page if you have any query or feedback about any of the questions.

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

Correct Answer: D

The term osteochondrosis refers to symptomatic disorders involving cartilage growth. Cartilage affected by osteochondrosis may be epiphyseal, physeal, or apophyseal. Gorham’s disease is not an example of osteochondrosis. Gorham’s disease is a lymphatic disorder known as disappearing bone disease.

Author: Fouad Chaudery


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

B) EXT 1 
C) Fibroblast growth factor receptor protein
E) COL1A1 

Correct Answer: A

Fibrous dysplasia is due to a postzygotic mutation in the GNAS1 gene. By contrast, EXT 1 mutations can cause multiple exostoses, and fibroblast growth factor receptor protein mutations cause achondroplasia, among other disorders. CFBA1 mutations are responsible for cleidocranial dysplasia. COL1A1 mutations are responsible for osteogenesis imperfecta.

Author: Fouad Chaudery


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. 

Correct Answer: D

Multiple hereditary exostosis (MHE) is inherited as an autosomal dominant condition. There are three genes known to be involved: EXT 1, 2, and 3. EXT 1 and 2 encode glycosyltransferases needed for biosynthesis of heparan sulfate. Fibroblast growth factor receptor is abnormal in achondroplasia.

Author: Fouad Chaudery


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

Correct Answer: E

Enchondral bone formation or ossification is bone formation on a cartilage module. Enchondral bone formation occurs in each of the following scenarios: embryonic long bone development, epiphyseal secondary center of ossification formation, callus formation during fracture healing, degenerating cartilage of osteoarthritis, calcifying cartilage tumors, and bone formed with use of demineralized bone matrix.

Author: Fouad Chaudhry


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

Corect answer: D

From the data provided in the question, this lesion has the following features:
• High-grade: Stage II
• Extra-compartmental: Add suffix B
• No evidence of metastases: Patient is not Stage III 

The Surgical Staging System of the Musculoskeletal Tumor Society is a useful system to both predict prognosis and plan treatment. The system for malignant lesions has three different stages:
Stage IA Low-grade intracompartmental lesions (the tumor remains confined to the medullary cavity)
Stage IB Low-grade extra compartmental (the tumor has penetrated the cortex and entered the soft tissues)
Stage IIA High-grade intracompartmental (the tumor remains confined to the medullary cavity)
Stage IIB High-grade extra compartmental (the tumor has penetrated the cortex and entered the soft tissues)
Stage III The presence of metastases in addition to the primary lesion, such as pulmonary metastases or other bone lesions

In order to use this system, one must know the grade of the tumor:
Low-Grade (Stage I) High-Grade (Stage II)
Parosteal osteosarcoma High-grade intramedullary osteosarcoma
Well differentiated intramedullary osteosarcoma Periosteal osteosarcoma
Grade I chondrosarcoma High-grade surface osteosarcoma
Grade I hemangioendothelioma Dedifferentiated chondrosarcoma
Grade I MFH Grade 2, 3, 4 MFH
Chondrosarcoma in Ollier's disease
Chondrosarcoma in Maffucci's syndrome

Author: Rajesh Lakhey


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

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

Correct answer: D

Adamantinomas almost exclusively occur in the tibia alone or in the tibia and fibula. Occasionally, this rare tumor occurs in the femur, radius, or ulna (very rare).

Radiographically, this lesion is based in the diaphysis; there is usually one dominant lesion with surrounding sclerosis and other smaller lesions, again with areas of sclerosis.

Author : Rajesh Lakhey




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

Best answer: C


Regional LN should be examined, as it tends to spread through it.

Author: Ahmed Eltanboly



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

Best answer: A


Better to be treated by wide resection or amputation.

Author: Ahmed Eltanboly


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                                                                                                                                         
) Chemotherapy is usually given both pre and post operatively and has radically improved survival rates.                                   
C) Limb salvage options might include rotationplasty.                                                                                                                                                      
) In this case wide local excision and a distal femoral lengthening endoprosthesis could be used.                                                     
) Limb salvage surgery is not possible in the majority of distal femur osteosarcoma cases

Answer : E

Limb salvage surgery should be attempted wherever possible in osteosarcoma, in this case rotationplasty could be considered. Bone and lung metastases are the commonest locations and initial staging should include CT chest and bone scan.

Author:Firas Arnaout

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