Multiple Choice Questions

Muskuloskeletal Tumours

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

 

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

Correct Answer : D

Melorheostosis is a rare benign bone disease including dysostosis and sclerosis. 

Dripping candle wax presence is a common and typical sign of melorheostosis. This sign appears as irregular hyperostosis of the cortical bone which is likened to melted wax flowing down one side of a candle. 

It can sometimes cause pain, stiffness joint, or limitation of motion in the affected areas implicitly but mostly has no symptoms

Author :Firas Arnaout

 

20. Most common malignancy of bones is:

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

Correct Answer : B

Metastasis is most common malignancy of bone.

Author: S Kamat

 

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

Correct Answer : D

Epiphyseal osteochondroma is also known as Trevor’s disease. Epiphyseal osteochondroma is localized to a specific region of the body, unlike multiple osteochondroma, which affects the entire body. 

Epiphyseal osteochondroma and multiple osteochondroma are unrelated disorders.

Author: Rajesh Bahadur Lakhey

 

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 

Correct Answer: D

Over 50% of the time, chordomas commonly occur in the sacrococcygeal region. 

Cervical, thoracic, and lumbar vertebral chordomas account for approximately 10% of chordomas. The remaining chordomas occur in the spheno-occipital region.

Author: Fouad Chaudhry

 

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

Correct Answer: D

Author: Rajesh Bahadur Lakhey

 

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 magnetic resonance imaging (MRI) are specific enough to make the diagnosis.
C) Malignant astrocytoma of the spinal cord is a clinical diagnosis and is 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

Correct Answer: D

Clinically, early symptoms of intramedullary tumors are nonspecific. Almost all intramedullary tumors show contrast
uptake. Even though there are specific MRI characteristics to each tumor, enough variability and overlap exists in their
radiologic appearance that histological examination is still required for definitive diagnosis.

Author: Rajesh Bahadur Lakhey

 

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%

Correct Answer: D

In 85 % of patients with metastatic disease to the spine, the lumbar region vertebral body is
involved. If operable, the vertebral body lesion can be managed via an anterior approach with a
corpectomy, as opposed to a posterior approach with laminectomy and removal of all involved
posterior elements (if they are involved).

Author: Rajesh Bahadur Lakhey

 

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%

Correct Answer: D

Pain is the most common complaint in patients presenting with a primary spine tumor
A. Present in up to 85% of patients
B. Typically localized to the site of lesion but can be radicular
C. Characterized as:
     1. Progressive
     2. Gradual in onset
     3. Worse at night
     4. Non-mechanical
D. Loosely associated with trauma
Weakness can be seen in up to 42% of patients
Mass is evident in up to 16% of patients
Three percent of patients are asymptomatic
Other symptoms can include:
E. Sensory loss
F. Loss of sphincter control

Author: Rajesh Bahadur Lakhey

 

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%

Correct Answer: C

Osteoblastomas are:
* Osteoblastic bone-forming lesions measuring more than 2 cm in size characterized by marked growth potential
* Similar in histology and presentation to osteoid osteoma with the main difference being the size of the tumor
* Most common in the 2nd and 3rd decades of life
* Twice as common in men than in women
* Common in the spine:
* Spinal osteoblastomas account for 40% to 45% of all osteoblastomas .

Over half of spinal osteoblastomas occur in the lumbar spine

Author: Rajesh Bahadur Lakhey

 

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.

Correct Answer: D

The only definitive method of determining the presence and nature of metastatic tumor is vertebral biopsy. Computed
tomography-guided biopsy of the spine provides an accurate access to the lesion. Open biopsy is indicated when
image guided biopsy is not feasible or non-diagnostic. Differential diagnosis mainly involves spinal infections,
osteoporosis, disk disease, and multiple myeloma.

Author: Rajesh Bahadur Lakhey

 

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

Correct Answer: E

Despite treatment, a poor prognosis is given to patients with malignant intramedullary tumors. The median survival
time for patients with cervical tumors is 3 to 6 months. Surgical excision, radiation, and chemotherapy are not found to significantly improve survival. Treatment is generally supportive

Author: Rajesh Bahadur Lakhey

 

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

Correct Answer: B

Synovial osteochondromatosis is a rare condition typically affecting middle-aged men. The computed tomogram demonstrates the osteocartilaginous nodules. Early in the disease, arthroscopic removal of loose bodies and synovectomy usually results in an acceptable outcome. In cases of progressive disease resulting in secondary shoulder arthrosis, shoulder arthroplasty may be required.

Author: Rajesh Bahadur Lakhey


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:

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

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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