Bone Tumors MCQs

A 22-year-old male presents with chronic, dull back pain that is worsened at night. He reports the pain is poorly relieved by aspirin. Radiographs and CT scan reveal a 2.5 cm radiolucent lesion with a sclerotic margin located in the posterior elements of the L3 vertebra. What is the most likely diagnosis?

A 22-year-old male presents with dull, aching pain in his posterior thoracic spine that is not reliably relieved by NSAIDs. Radiographs and a CT scan reveal a 2.5 cm radiolucent nidus in the right lamina of T8 with surrounding sclerosis. What is the most likely diagnosis?

In evaluating a 16-year-old male with a newly diagnosed conventional high-grade osteosarcoma of the distal femur, appropriate staging studies are obtained. Among standard laboratory values, which of the following is considered an independent poor prognostic indicator for overall survival?

Which of the following clinical or radiographic features most reliably differentiates an osteoblastoma from an osteoid osteoma?

A 25-year-old female presents with a slowly enlarging mass on the posterior aspect of her distal femur. Plain radiographs show a heavily ossified, juxtacortical mass with a broad base on the surface of the bone, and a radiolucent cleft separating portions of the tumor from the underlying cortex. Medullary involvement is minimal. What is the most likely diagnosis?

A 16-year-old boy presents with progressive, nocturnal thigh pain that is rapidly and completely relieved by ibuprofen. Radiographs demonstrate a 7 mm radiolucent nidus in the femoral diaphysis surrounded by dense reactive cortical sclerosis. Which inflammatory mediator is found in extraordinarily high concentrations within this nidus, explaining the efficacy of NSAIDs?

A 19-year-old male presents with persistent dull back pain that is not relieved by ibuprofen. Radiographs and a CT scan reveal a 3.5 cm expansile, radiolucent lesion in the posterior elements of L3 with a thin sclerotic rim. Histologically, the lesion consists of interlacing trabeculae of woven bone lined by prominent osteoblasts. What is the most likely diagnosis?

A 27-year-old man has had pain in the right index finger for the past 9 months. The pain is completely relieved with ibuprofen. An AP radiograph and CT scan are shown in Figures 80a and 80b. What is the most likely diagnosis?

An otherwise healthy 16-year-old boy who has had thoracolumbar pain with an increasingly worse deformity for the past 2 years now reports that the pain is worse at night. He responded well to nonsteroidal anti-inflammatory drugs initially, but they have become less effective. He denies any neurologic or constitutional symptoms. Examination is consistent with a mild thoracolumbar scoliosis and is otherwise normal. Laboratory studies show a normal CBC, erythrocyte sedimentation rate, and C-reactive protein. Standing radiographs show a 20 degree left thoracolumbar scoliosis, and he has a Risser stage of 4. A bone scan shows increased uptake at L2; a CT scan through this level is shown in Figure 18. Management should now consist of

A 20-year-old college student complains of deep, aching anterior thigh pain that is notably worse at night. The pain is consistently and completely relieved within 30 minutes of taking ibuprofen.

A radiograph and subsequent CT scan reveal a 0.8 cm radiolucent nidus surrounded by dense reactive sclerosis in the femoral diaphysis. What is the most widely accepted definitive, minimally invasive treatment for this condition if medical management is intolerable?

A 14-year-old boy presents with multiple painless, hard bony protuberances around his knees, ankles, and shoulders that have been present since early childhood. Radiographs demonstrate multiple pedunculated and sessile bone lesions pointing away from the joints, showing continuity of the cortex and medullary cavity with the host bone. Mutations in which of the following genes are most commonly responsible for this condition, and what is their normal cellular function?

A 25-year-old woman presents with hip pain and an impending pathological fracture of the proximal femur. Radiographs reveal a classic 'shepherd's crook' deformity with a diaphyseal 'ground-glass' appearance. The patient's medical history includes precocious puberty and hyperthyroidism. Which of the following best describes the underlying cellular pathophysiology of her musculoskeletal and endocrine abnormalities?

A 12-year-old girl presents with pain and swelling over her left proximal humerus after a minor fall. Radiographs show an expansile, eccentric, radiolucent lesion in the metaphysis. MRI demonstrates multiple internal fluid-fluid levels. Biopsy reveals blood-filled cystic spaces separated by fibrous septa containing osteoclast-like giant cells. Which of the following genetic alterations is most characteristic of the primary form of this lesion?

A 10-year-old girl is evaluated for a leg length discrepancy and a limp. Radiographs of the left femur reveal a large medullary lesion with a 'ground-glass' appearance and a characteristic 'shepherd's crook' deformity of the proximal femur. She also has several large, irregular hyperpigmented macules on her back and signs of precocious puberty. Which of the following best describes the pathogenesis of her underlying condition?

A 10-year-old boy presents with multiple painless, hard bony bumps around his knees and ankles. Radiographs demonstrate multiple sessile and pedunculated osteochondromas pointing away from the adjacent joints. He is clinically diagnosed with multiple hereditary exostoses (MHE). Loss-of-function mutations in which of the following genes are responsible for this autosomal dominant condition?

A 9-year-old girl is evaluated for an antalgic gait and leg length discrepancy. Radiographs of her right femur reveal an expansive, 'ground-glass' intramedullary lesion with cortical thinning. On physical examination, she has large, irregularly bordered hyperpigmented macules ('coast of Maine') and signs of precocious puberty. This clinical syndrome is caused by a somatic, activating postzygotic mutation in which of the following genes?

A 14-year-old boy presents with pain and swelling in his left shoulder. Radiographs show an expansile, lytic lesion in the proximal humerus. Magnetic resonance imaging demonstrates multiple 'fluid-fluid levels'. A core needle biopsy confirms an aneurysmal bone cyst. Which of the following genetic abnormalities is considered the primary driver of this neoplastic lesion?

Distinguishing a low-grade chondrosarcoma from a benign enchondroma can be challenging on imaging and histology. Which of the following clinical or radiographic features is most suggestive of a low-grade chondrosarcoma rather than an enchondroma?

A 9-year-old boy undergoes evaluation for mild shoulder discomfort. A radiograph reveals a centrally located, purely lytic lesion in the proximal humerus diaphysis with thinning of the cortices. A 'fallen leaf' sign is noted.

Diagnostic aspiration yields clear, serous yellow fluid. Laboratory analysis of this fluid is most likely to show markedly elevated levels of which of the following compared to normal serum?

A 19-year-old man complains of localized pain in the proximal tibia that is significantly worse at night. He reports that over-the-counter ibuprofen provides dramatic relief within 30 minutes. Plain radiographs demonstrate an area of dense cortical thickening with a small 8-mm radiolucent central nidus.

The intense nocturnal pain characteristic of this lesion is mediated by a tremendously increased local concentration of which substance?