Bone Tumors MCQs

A 72-year-old woman presents with severe back pain. Laboratory testing shows anemia, hypercalcemia, and renal insufficiency. Radiographs reveal multiple punched-out lytic lesions in her skull and pelvis. Which of the following laboratory findings is most specific for confirming her likely diagnosis?

An 8-year-old boy incidentally undergoes radiography of the humerus, revealing a centrally located, well-circumscribed, radiolucent lesion in the proximal metaphysis with a cortical fragment resting at the dependent aspect of the cyst ('fallen leaf' sign). If aspirated, what is the most likely composition of the fluid contained within this lesion?

A 16-year-old male complains of severe mid-tibial pain that is characteristically worse at night and awakens him from sleep. The pain dramatically resolves within 30 minutes of taking ibuprofen. Radiographs demonstrate a 7 mm radiolucent nidus surrounded by intense reactive cortical sclerosis. The profound pain relief provided by NSAIDs is primarily mediated by the inhibition of which substance highly produced by the nidus?

A 15-year-old girl complains of severe, progressively worsening back pain that is predominantly nocturnal and relieved dramatically by non-steroidal anti-inflammatory drugs. Examination reveals a painful structural scoliotic curve. Imaging demonstrates a small radiolucent nidus with surrounding sclerosis in the posterior elements of L3. Which of the following statements is true regarding her scoliosis?

A 9-year-old boy falls and fractures his proximal humerus. Radiographs reveal a central, purely lytic lesion in the metaphysis with a piece of cortical bone resting dependently within the cavity ('fallen leaf' sign). If aspirated, the fluid within this cyst is most likely to contain high levels of which substance?

An 8-year-old boy presents with a symptomatic unicameral bone cyst (UBC) in the proximal humerus. Radiographs show a 'fallen leaf' sign. What is the most widely accepted initial invasive treatment for an active, symptomatic UBC?

A 19-year-old male presents with progressive back pain that is worse at night and poorly relieved by NSAIDs. Imaging reveals a 2.5 cm radiolucent nidus with surrounding sclerosis in the posterior elements of L4. What is the most likely diagnosis?

A 30-year-old female presents with a painless mass on the posterior aspect of her distal thigh. Radiographs show a dense, heavily ossified mass attached to the posterior cortex of the distal femur with a 'string sign'. What is the most likely diagnosis?

A 62-year-old man presents with generalized bone pain, fatigue, and renal impairment. Radiographs show multiple 'punched-out' lytic lesions in the skull and pelvis. Which of the following laboratory findings is most specific for confirming the diagnosis?

A 25-year-old female presents with a painless bowing deformity of her proximal femur. Radiographs reveal a ground-glass intramedullary lesion with cortical thinning and a 'shepherd's crook' deformity. The underlying pathophysiology involves a mutation in which of the following?

An 18-year-old male presents with a painful swelling over the anterior tibia. Radiographs show a radiolucent surface lesion in the diaphysis with crater-like scalloping of the underlying cortex and perpendicular bone spicules ('hair-on-end'). MRI confirms no medullary involvement. Histology shows predominantly intermediate-grade chondroblastic matrix. What is the diagnosis?

An 18-year-old male is undergoing treatment with the MAP protocol (High-dose Methotrexate, Adriamycin/Doxorubicin, and Cisplatin) for high-grade conventional osteosarcoma of the distal femur. Six months into treatment, he presents with progressive dyspnea on exertion, orthopnea, and lower extremity edema. Echocardiography reveals a significantly reduced left ventricular ejection fraction. Which chemotherapeutic agent is most likely responsible?

A 45-year-old female with known polyostotic fibrous dysplasia presents with a newly noticed, painless soft tissue mass in her right anterior thigh. MRI shows a well-circumscribed, T2-hyperintense intramuscular lesion. Biopsy reveals hypocellular, abundant myxoid stroma with rare bland spindle cells and no lipoblasts. The combination of these findings characterizes which of the following syndromes?

A 40-year-old male presents with shoulder pain. Radiographs show a lytic lesion in the proximal humeral epiphysis with central calcifications. Histological examination reveals tumor cells with abundant clear cytoplasm, distinct cell membranes, and scattered areas of conventional chondrosarcoma. What is the most likely diagnosis?

In a patient diagnosed with multiple myeloma, which of the following laboratory markers is considered the most powerful independent prognostic indicator of survival and is incorporated into the International Staging System (ISS)?

A 9-year-old boy is scheduled to undergo a Van Nes rotationplasty for an osteosarcoma of the distal femur. For this procedure to be mechanically successful and functional, which of the following anatomical structures must be preserved and fully functional?

A 16-year-old male is receiving neoadjuvant chemotherapy for osteosarcoma using the standard MAP regimen (Methotrexate, Doxorubicin, Cisplatin). He subsequently develops irreversible congestive heart failure. Which of the chemotherapeutic agents is most likely responsible for this specific toxicity?

A patient diagnosed with polyostotic fibrous dysplasia presents with a newly discovered, painless, deep soft tissue mass in the thigh. Excisional biopsy of the mass reveals a well-circumscribed lesion composed of bland spindle cells in an abundant myxoid stroma with decreased vascularity. The presence of this soft tissue lesion in conjunction with fibrous dysplasia is known as:

An 18-year-old female presents with a rapidly expanding, painful lytic lesion in her distal fibula. MRI shows an expansile lesion with multiple fluid-fluid levels. Genetic analysis reveals a characteristic rearrangement. Which gene is primarily involved?

A 68-year-old female complains of generalized bone pain and fatigue. Radiographs show multiple "punched-out" lytic lesions in her skull and pelvis. A bone scan shows no increased uptake in these areas. Which of the following laboratory findings is most likely to confirm the diagnosis?