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Bone Tumors MCQs

Practice Set 23 of 52

This practice set contains high-yield board review questions covering key concepts in Bone Tumors. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 441

Topic: Bone Tumors

A 55-year-old male undergoes wide surgical resection for a conventional Grade II chondrosarcoma of the proximal femur. Which of the following best describes the role of adjuvant therapy for this condition?

. Standard multi-agent chemotherapy should be administered postoperatively
. Postoperative external beam radiation is required for local control
. Adjuvant therapy is generally ineffective; wide surgical margins are the mainstay of treatment
. Targeted therapy with denosumab is indicated to prevent recurrence
. Intralesional radiofrequency ablation should follow the resection

Correct Answer & Explanation

. Adjuvant therapy is generally ineffective; wide surgical margins are the mainstay of treatment

Explanation

Conventional chondrosarcomas are notably resistant to both chemotherapy and radiotherapy. The mainstay of curative treatment relies solely on achieving wide surgical resection margins.

Question 442

Topic: Bone Tumors

A 16-year-old male complains of severe back pain, especially at night. Imaging reveals a 2.5 cm lytic lesion with central calcification in the posterior elements of L4. What is the most likely diagnosis?

. Osteoid osteoma
. Osteoblastoma
. Aneurysmal bone cyst
. Ewing sarcoma
. Multiple myeloma

Correct Answer & Explanation

. Osteoblastoma

Explanation

While both osteoid osteoma and osteoblastoma have similar histology, an osteoblastoma is distinguished by a nidus size greater than 2 cm and a predilection for the posterior elements of the spine. Osteoblastomas are also less predictably relieved by NSAIDs compared to osteoid osteomas.

Question 443

Topic: Bone Tumors

Which of the following radiographic findings is the hallmark of Dysplasia Epiphysealis Hemimelica?

. Symmetrical epiphyseal enlargement with a single central ossification center
. Asymmetric epiphyseal enlargement with multiple ossification centers
. Metaphyseal flaring with a pedunculated bony exostosis
. Diaphyseal cortical thickening with a radiolucent nidus

Correct Answer & Explanation

. Asymmetric epiphyseal enlargement with multiple ossification centers

Explanation

Correct Answer: Asymmetric epiphyseal enlargement with multiple ossification centersCharacteristically, DEH lesions show on radiographs as asymmetric epiphyseal enlargement with multiple ossification centers, reflecting the hemimelic (one-sided) nature of the epiphyseal involvement.

Question 444

Topic: Bone Tumors

While Dysplasia Epiphysealis Hemimelica (DEH) shares histological similarities with osteochondroma, it is primarily distinguished by its site of origin. From which specific anatomical region of the bone does DEH arise?

. Diaphysis
. Metaphysis
. Epiphysis
. Physis (growth plate) exclusively

Correct Answer & Explanation

. Epiphysis

Explanation

Correct Answer: EpiphysisDEH is a developmental disorder affecting the epiphyses in young children. This is a key distinguishing factor from osteochondromas, which arise from the metaphysis or diaphysis.

Question 445

Topic: Bone Tumors

A 6-year-old boy presents with the clinical appearance shown below. Palpation reveals a bone-hard mass. Based on the most likely diagnosis, what is the expected histological appearance of this lesion?


. Identical to an osteoid osteoma
. Identical to an osteochondroma
. Identical to an enchondroma
. Identical to a chondroblastoma
. Identical to an osteosarcoma

Correct Answer & Explanation

. Identical to an osteochondroma

Explanation

Correct Answer: Identical to an osteochondromaThe clinical image demonstrates a moderate, painless, bone-hard swelling at the lateral side of the ankle, characteristic of Dysplasia Epiphysealis Hemimelica (DEH). Histologically, DEH lesions are similar to osteochondromas. However, they are distinguished by their origin: DEH arises from the epiphysis, whereas osteochondromas arise from the metaphysis or diaphysis.

Question 446

Topic: Bone Tumors

A 12-year-old boy presents with limited range of motion in his knee. Imaging is provided below. The mass protrudes from the distal femoral epiphysis into the popliteal fossa. How does this condition primarily differ from an osteochondroma?


. It has a completely different histological appearance
. It arises from the epiphysis rather than the metaphysis or diaphysis
. It predominantly affects the upper limbs
. It is more common in females
. It typically presents in adulthood

Correct Answer & Explanation

. It arises from the epiphysis rather than the metaphysis or diaphysis

Explanation

Correct Answer: It arises from the epiphysis rather than the metaphysis or diaphysisThe imaging demonstrates Dysplasia Epiphysealis Hemimelica (DEH) of the distal femur. While histologically similar to an osteochondroma, DEH is uniquely characterized by its origin from the epiphysis. Osteochondromas classically arise from the metaphysis or diaphysis.

Question 447

Topic: Bone Tumors

When evaluating plain radiographs of a patient with Dysplasia Epiphysealis Hemimelica (DEH), what is the classic radiographic hallmark of the lesion?

. Symmetrical enlargement of the entire epiphysis with a single central lucency
. Asymmetric epiphyseal enlargement with multiple ossification centers
. A purely lytic epiphyseal lesion with a sclerotic margin
. Sunburst periosteal reaction extending from the metaphysis

Correct Answer & Explanation

. Asymmetric epiphyseal enlargement with multiple ossification centers

Explanation

Correct Answer: Asymmetric epiphyseal enlargement with multiple ossification centersOn radiographs, DEH lesions characteristically show asymmetric epiphyseal enlargement (due to the hemimelic nature of the disease) accompanied by multiple ossification centers.

Question 448

Topic: Bone Tumors

The imaging below demonstrates a protruding bone mass in a 10-year-old patient. Unlike a standard exostosis, this specific lesion originates from which anatomical region?




. Diaphysis
. Metaphysis
. Physis
. Epiphysis
. Apophysis

Correct Answer & Explanation

. Epiphysis

Explanation

Correct Answer: EpiphysisThe provided radiograph and MRI show a protruding bone mass extending into the popliteal fossa. This is a classic presentation of Dysplasia Epiphysealis Hemimelica (DEH). While histologically identical to an osteochondroma, DEH is defined by its origin from the epiphysis, whereas true osteochondromas arise from the metaphysis or diaphysis.

Question 449

Topic: Bone Tumors

A 5-year-old boy undergoes excision of a bony mass causing a deformity at the medial aspect of the distal tibia. Histological examination reveals a cartilage-capped bony outgrowth. Which of the following features definitively distinguishes Dysplasia Epiphysealis Hemimelica from a solitary osteochondroma in this patient?

. The presence of a hyaline cartilage cap
. The continuity of the medullary cavity with the host bone
. The origin of the lesion from the epiphysis
. The presence of endochondral ossification
. The age of the patient

Correct Answer & Explanation

. The origin of the lesion from the epiphysis

Explanation

Correct Answer: The origin of the lesion from the epiphysisHistologically, DEH is indistinguishable from an osteochondroma. The definitive distinguishing feature is the anatomical site of origin: DEH arises from the epiphysis, whereas osteochondromas arise from the metaphysis or diaphysis.

Question 450

Topic: Bone Tumors

A 6-year-old child is evaluated for a suspected skeletal developmental disorder affecting the epiphyses. Which of the following constellations of symptoms is most classically associated with the presentation of Dysplasia Epiphysealis Hemimelica?

. Painless hypermobility and recurrent dislocations
. Bone-hard mass, deformity, aching pains, and limited range of motion
. Night pain relieved by NSAIDs and a radiolucent nidus
. Rapidly growing soft tissue mass with overlying skin erythema
. Symmetrical polyarticular joint swelling and morning stiffness

Correct Answer & Explanation

. Bone-hard mass, deformity, aching pains, and limited range of motion

Explanation

Correct Answer: Bone-hard mass, deformity, aching pains, and limited range of motionThe most common presenting symptoms of Dysplasia Epiphysealis Hemimelica (DEH) include the presence of a mass with the consistency of bone, visible deformity, aching pains, and a limited range of motion in the affected joint.

Question 451

Topic: Bone Tumors

Both Dysplasia Epiphysealis Hemimelica (DEH) and osteochondroma share similar histological features. Which of the following characteristics best differentiates DEH from a typical osteochondroma?

. DEH lacks a cartilage cap.
. DEH arises from the epiphysis, whereas osteochondroma arises from the metaphysis or diaphysis.
. DEH is typically a malignant precursor.
. Osteochondroma presents with multiple ossification centers within the joint space.
. DEH exclusively affects the upper limbs.

Correct Answer & Explanation

. DEH arises from the epiphysis, whereas osteochondroma arises from the metaphysis or diaphysis.

Explanation

Correct Answer: DEH arises from the epiphysis, whereas osteochondroma arises from the metaphysis or diaphysis.Histologically, DEH is similar to an osteochondroma (both have a cartilage cap and underlying trabecular bone). However, osteochondromas arise from the metaphysis or diaphysis, whereas DEH uniquely arises from the epiphysis, leading to intra-articular pathology and joint deformity.

Question 452

Topic: Bone Tumors

A 4-year-old child presents with irregular, multi-centric radiopaque foci adjacent to the medial aspect of the distal tibial epiphysis on plain radiographs. Over the next two years, these foci are expected to:

. Migrate into the metaphysis
. Resorb completely without intervention
. Enlarge and merge with the main epiphyseal ossification center
. Penetrate the articular cartilage and cause a hemarthrosis
. Induce an adjacent osteosarcoma

Correct Answer & Explanation

. Enlarge and merge with the main epiphyseal ossification center

Explanation

Early radiographic findings of DEH include multiple irregular ossification centers adjacent to the epiphysis. Over time, these foci enlarge and coalesce into a single mass that merges with the native epiphysis.

Question 453

Topic: Bone Tumors

Which of the following best describes the fundamental pathogenesis of Dysplasia Epiphysealis Hemimelica (Trevor disease)?

. Failure of primary spongiosa resorption
. Autosomal dominant mutation in EXT1
. Avascular necrosis of the secondary ossification center
. Proliferation of an epiphyseal osteochondroma
. Metaphyseal fibrous defect

Correct Answer & Explanation

. Proliferation of an epiphyseal osteochondroma

Explanation

Dysplasia Epiphysealis Hemimelica (DEH), or Trevor disease, is essentially an osteochondroma arising from the epiphysis. It results from an asymmetrical, hamartomatous proliferation of the epiphyseal cartilage.

Question 454

Topic: Bone Tumors

Which of the following MRI findings is most characteristic of Dysplasia Epiphysealis Hemimelica and helps confirm the diagnosis preoperatively?

. High T1 signal indicating fatty marrow replacement
. Double-line sign pathognomonic for osteonecrosis
. A cartilage cap contiguous with the normal epiphyseal cartilage
. Disruption of the physis with a fibrous tether
. Intramedullary cystic lesion with fluid-fluid levels

Correct Answer & Explanation

. A cartilage cap contiguous with the normal epiphyseal cartilage

Explanation

MRI is crucial for evaluating DEH, demonstrating a hyperintense cartilage cap on T2-weighted images that is continuous with the normal articular cartilage of the epiphysis. This confirms its epiphyseal origin.

Question 455

Topic: Bone Tumors

A 5-year-old boy presents with an asymmetric valgus deformity of the right knee. MRI is performed to evaluate an irregular ossific mass adjacent to the medial condyle. What is the most characteristic MRI finding of this lesion?

. A fluid-filled cyst with a thick sclerotic rim
. An epiphyseal osteocartilaginous mass showing corticomedullary continuity with the underlying bone
. A diaphyseal intramedullary lesion with multiple fluid-fluid levels
. A hyperintense metaphyseal mass with punctate popcorn calcifications
. Subperiosteal reactive bone formation with a sunburst periosteal reaction

Correct Answer & Explanation

. An epiphyseal osteocartilaginous mass showing corticomedullary continuity with the underlying bone

Explanation

On MRI, DEH typically appears as an epiphyseal mass that demonstrates corticomedullary continuity with the host bone. This appearance mimics an osteochondroma, but it uniquely originates from the epiphysis.

Question 456

Topic: Bone Tumors

A 14-year-old male is diagnosed with high-grade conventional osteosarcoma of the distal femur. What is the standard first-line neoadjuvant chemotherapy regimen?

. Doxorubicin, Cisplatin, and High-dose Methotrexate
. Vincristine, Doxorubicin, and Cyclophosphamide
. Ifosfamide and Etoposide
. Imatinib and Sunitinib
. Denosumab and Zoledronic acid

Correct Answer & Explanation

. Doxorubicin, Cisplatin, and High-dose Methotrexate

Explanation

The standard first-line neoadjuvant chemotherapy regimen for conventional osteosarcoma is the MAP regimen. This includes Methotrexate (high-dose), Adriamycin (Doxorubicin), and Platinol (Cisplatin).

Question 457

Topic: Bone Tumors

A 16-year-old male with a history of bilateral retinoblastoma develops a conventional osteosarcoma of the distal femur. This patient is most likely to harbor a germline mutation in which of the following genes?

. TP53
. RB1
. EXT1
. GNAS
. NF1

Correct Answer & Explanation

. RB1

Explanation

Germline mutations in the RB1 gene are responsible for hereditary retinoblastoma and significantly increase the risk of secondary malignancies, particularly osteosarcoma. TP53 mutations are associated with Li-Fraumeni syndrome, which also predisposes to osteosarcoma.

Question 458

Topic: Bone Tumors

Multiple Hereditary Exostoses (MHE) is inherited in an autosomal dominant pattern. Mutations in EXT1 and EXT2 genes disrupt the synthesis of which of the following?

. Chondroitin sulfate
. Heparan sulfate
. Type II collagen
. Fibroblast growth factor receptor 3
. Aggrecan

Correct Answer & Explanation

. Heparan sulfate

Explanation

EXT1 and EXT2 mutations in MHE lead to a defect in heparan sulfate synthesis. This disruption causes abnormal chondrocyte proliferation and the formation of multiple osteochondromas.

Question 459

Topic: Bone Tumors
A 12-year-old girl presents with a "shepherd's crook" deformity of the proximal femur, precocious puberty, and large café-au-lait spots with irregular borders. This syndrome is caused by a somatic mutation affecting which signaling pathway?
. Wnt/beta-catenin pathway
. G-protein coupled cAMP pathway
. Ras/MAPK pathway
. PI3K/AKT pathway
. TGF-beta pathway

Correct Answer & Explanation

. G-protein coupled cAMP pathway

Explanation

McCune-Albright syndrome consists of polyostotic fibrous dysplasia, endocrine abnormalities, and "coast of Maine" café-au-lait spots. It is caused by a post-zygotic somatic activating mutation in the GNAS gene, which upregulates the cAMP signaling pathway.

Question 460

Topic: Bone Tumors

A 22-year-old male presents with chronic back pain that is poorly relieved by NSAIDs. Imaging reveals a 2.5 cm lytic lesion with central ossification in the posterior elements of L4. What is the most likely diagnosis?

. Osteoid osteoma
. Osteoblastoma
. Aneurysmal bone cyst
. Giant cell tumor
. Chondromyxoid fibroma

Correct Answer & Explanation

. Osteoblastoma

Explanation

Osteoblastomas are histologically similar to osteoid osteomas but are larger (>1.5 to 2.0 cm). They frequently occur in the posterior elements of the spine and present with dull pain that is characteristically less responsive to NSAIDs.

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