Bone Tumors MCQs

A 12-year-old boy presents with mild knee pain and swelling after a minor twist. Radiographs reveal an eccentric, expansile, lytic metaphyseal lesion in the proximal tibia. MRI demonstrates multiple fluid-fluid levels within the lesion. A biopsy confirms the diagnosis of a primary aneurysmal bone cyst (ABC). Which of the following genetic alterations is most specific to the pathogenesis of this lesion?

A 68-year-old man presents with generalized fatigue, severe lower back pain, and a recent laboratory finding of hypercalcemia. Radiographs show multiple punched-out lytic lesions in his skull and pelvis. Routine laboratory tests reveal a mild normocytic anemia and elevated serum creatinine. Which of the following tests is the most appropriate initial diagnostic step to confirm the suspected underlying malignancy?

A 19-year-old man presents with a 6-month history of right thigh pain that is worse at night and relieved significantly by ibuprofen. A CT scan of the femur is shown below.

It reveals a 7-mm radiolucent nidus surrounded by dense sclerotic bone in the femoral diaphysis. If a molecular analysis of the resected tissue were performed, the lesion would most likely demonstrate high levels of which of the following?

A 19-year-old male presents with dull, aching thigh pain that worsens at night and is completely relieved by ibuprofen. Radiographs and a CT scan reveal a 1 cm radiolucent nidus surrounded by dense sclerotic bone in the femoral diaphysis. What is the primary underlying biochemical mechanism for the characteristic pain pattern associated with this lesion?

Fibrous dysplasia is a benign fibro-osseous bone lesion that can present as a solitary lesion or as part of a more complex syndrome. This condition is fundamentally caused by a somatic activating mutation in which of the following genes?

A 65-year-old woman presents with diffuse skeletal pain and a pathological fracture of the proximal femur. Laboratories reveal anemia, hypercalcemia, and an elevated M-spike on serum protein electrophoresis. Which of the following radiographic findings is most characteristic of her condition?

A 19-year-old man complains of localized right tibial pain that is worse at night and dramatically relieved by NSAIDs.

Imaging reveals a small radiolucent nidus surrounded by dense reactive sclerosis. The dramatic pain relief provided by NSAIDs in this condition is due to the local inhibition of which of the following?

A 9-year-old boy sustains a pathologic fracture through a centrally located, lytic bone lesion in the proximal humerus. The lesion exhibits the 'fallen leaf sign' on radiographs. After the fracture heals, the lesion persists. What is the best initial surgical management?

An 18-year-old male presents with a painful clunking and grating sensation beneath his right scapula with overhead movement. Physical therapy and injections have failed to provide relief. A CT scan of the chest and shoulder reveals a bony exostosis arising from the ventral surface of the scapula. What is the most likely underlying diagnosis?

A 10-year-old girl is evaluated for a Shepherd's crook deformity of the proximal femur. Radiographs show a ground-glass appearance of the medullary canal. This condition is associated with a postzygotic somatic mutation in which of the following genes?

A 12-year-old girl has an expansile, eccentric lytic lesion in the proximal tibia. MRI reveals multiple fluid-fluid levels. Primary aneurysmal bone cysts are genetically characterized by a rearrangement involving which of the following genes?

A 22-year-old male presents with severe nocturnal anterior thigh pain that is reliably relieved by oral ibuprofen. Radiographs demonstrate a 1-cm radiolucent nidus surrounded by thick cortical sclerosis in the proximal femoral diaphysis. What is the most appropriate definitive management for this lesion?

A 10-year-old girl is evaluated for a leg length discrepancy and a "shepherd's crook" deformity of her proximal femur. Radiographs reveal an intramedullary lesion with a hazy, "ground-glass" matrix. This disorder is driven by a somatic postzygotic mutation in which of the following genes?

A 16-year-old boy presents with knee pain. Radiographs reveal an expansile, eccentric lytic lesion in the proximal tibial metaphysis. MRI demonstrates multiple fluid-fluid levels. Genetic analysis of this lesion would most likely reveal an abnormality involving which of the following genes?

A 12-year-old boy presents with severe, unrelenting mid-shaft thigh pain that is worse at night and relieved by NSAIDs. Radiographs show a small radiolucent nidus with surrounding dense reactive sclerosis. What is the primary mediator responsible for the nocturnal pain?

A 12-year-old girl complains of mild localized pain in her proximal humerus. Radiographs demonstrate an expansile, eccentric, multiloculated lucent lesion in the metaphysis. MRI shows multiple fluid-fluid levels. Primary aneurysmal bone cysts are most commonly associated with a rearrangement of which gene?

A 19-year-old man presents with nocturnal leg pain that is dramatically relieved by NSAIDs. A radiograph and CT scan demonstrate a small intracortical lucency with surrounding sclerosis in the tibial diaphysis.

What is the mechanism of action of the most appropriate minimally invasive treatment for this condition?

A 12-year-old girl presents with a rapidly expanding, painful mass in her proximal humerus. Radiographs show an expansile, multiloculated radiolucent lesion.

Genetic analysis of the tissue would most likely reveal an upregulation of which of the following?