Bone Tumors MCQs

A 24-year-old female presents with a painless, slow-growing mass on the posterior aspect of her distal femur. Radiographs reveal a heavily ossified, lobulated mass on the cortical surface with a radiolucent cleft separating the tumor from the underlying cortex. What is the most likely diagnosis?

A 14-year-old boy complains of right thigh pain that is worse at night and dramatically relieved by ibuprofen. CT scan shows a 7 mm radiolucent nidus surrounded by dense sclerosis in the femoral diaphysis. What is the primary mediator responsible for his specific pain pattern?

A 55-year-old man presents with an enlarging, painful mass in his proximal femur. Radiographs show a lytic lesion with 'popcorn' calcifications and endosteal scalloping. What is the standard of care for a conventional high-grade chondrosarcoma?

A 22-year-old male presents with dull, aching pain in his mid-back that is not significantly relieved by ibuprofen. Imaging shows a 3.5 cm lytic lesion with central mineralization in the posterior elements of T8. Histology demonstrates interlacing trabeculae of woven bone lined by prominent osteoblasts. What is the most likely diagnosis?

A 15-year-old male complains of right thigh pain that is significantly worse at night and dramatically improves 30 minutes after taking ibuprofen. Radiographs show a 1 cm radiolucent nidus surrounded by dense reactive sclerosis in the femoral diaphysis. What biochemical mediator is produced in excess by the central nidus, causing these classic symptoms?

A 19-year-old male complains of severe, aching pain in his right shin that is worse at night and relieved by ibuprofen. Radiographs show a dense cortical thickening with a small 6 mm radiolucent nidus. What is the primary pain-generating mechanism in this lesion?

A 65-year-old man presents with severe back pain and a solitary lytic lesion in the L3 vertebral body. Laboratory testing reveals an M spike on serum protein electrophoresis. What imaging modality is considered the standard of care for staging skeletal involvement in this disease?

A 19-year-old male complains of severe, progressively worsening right thigh pain that occurs primarily at night and is dramatically relieved by NSAIDs. Imaging shows a radiolucent nidus surrounded by dense reactive sclerosis. What is the most definitive, minimally invasive treatment?

An 18-year-old male presents with painful scoliosis. Imaging reveals a 2.5 cm radiolucent lesion with a mineralized matrix in the posterior elements of L3. The pain is persistent and is only partially relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). What is the most likely diagnosis?

A 65-year-old man presents with new-onset back pain, anemia, and an M-spike on serum protein electrophoresis. Radiographs show a compression fracture of T12 and punched-out lytic skull lesions. Which of the following imaging modalities is most sensitive for detecting additional early osseous lesions in this patient?

A 22-year-old male presents with dull, aching pain in his mid-back that is constant, night-predominant, and only partially relieved by ibuprofen. CT scan shows a 3.5 cm expansile lytic lesion in the posterior elements of T8 with a distinct radiolucent nidus and surrounding sclerosis. What is the most likely diagnosis?

A 16-year-old male complains of severe, aching thigh pain that is worse at night and dramatically relieved by NSAIDs. Radiographs demonstrate a 1-cm radiolucent nidus surrounded by dense sclerotic bone in the femoral diaphysis. What is the preferred definitive treatment if medical management fails?

An 8-year-old girl is evaluated for precocious puberty, irregular cafe-au-lait macules, and recurrent fractures. Radiographs reveal polyostotic expansile, radiolucent bone lesions with a ground-glass appearance. What is the underlying genetic mutation?

A 7-year-old female presents with precocious puberty, cafe-au-lait spots with irregular 'coast of Maine' borders, and an antalgic gait. Radiographs show a large, expansile lytic lesion in the proximal femur. This syndrome is caused by a somatic, post-zygotic activating mutation in which gene?

A 3-year-old child is diagnosed with congenital pseudarthrosis of the tibia (CPT). Radiographs show a sclerotic, atrophic non-union in the middle third of the tibia. He has a history of multiple casting attempts that have failed. What is the most critical factor influencing the high failure rate and difficult management of CPT?

A 7-year-old girl presents with a limp and a leg length discrepancy. Radiographs reveal a ground-glass appearance in the proximal femur with a shepherd's crook deformity. Physical examination shows large, irregular hyperpigmented skin macules with jagged borders. Which of the following endocrine abnormalities is most commonly associated with this patient's syndrome?

A 14-year-old boy with polyostotic fibrous dysplasia presents with a progressive shepherd's crook deformity of the proximal femur and increasing thigh pain. What is the most appropriate surgical management to prevent impending fracture and correct the deformity?

A 5-year-old boy presents with asymmetric shortening of his right leg and multiple hard, painless swellings on the fingers of his right hand. Radiographs show multiple radiolucent lesions in the metaphyses and diaphyses of the right femur, tibia, and phalanges, with endosteal scalloping. The left side is completely unaffected. What is the most likely diagnosis?