Bone Tumors MCQs

Multiple Hereditary Exostoses (MHE) is an autosomal dominant condition characterized by multiple osteochondromas. This disorder is most commonly associated with a loss-of-function mutation in genes responsible for the synthesis of:

A 65-year-old male presents with a painful, destructive lytic lesion in his proximal humerus. Laboratory evaluation reveals hypercalcemia and an elevated total serum protein. Which test is most definitive for confirming the underlying diagnosis?

A 15-year-old boy presents with progressive knee pain. Radiographs reveal an ill-defined metaphyseal lytic lesion in the distal femur with periosteal elevation forming an acute angle with the cortex. What is this radiographic sign called, and what does it typically indicate?

A 70-year-old female presents with severe, atraumatic back pain. Radiographs reveal multiple 'punched-out' lytic lesions in the skull and a compression fracture of L2. Serum protein electrophoresis shows a monoclonal spike. Which of the following laboratory findings is also most characteristically associated with this patient's underlying disease?

A 16-year-old boy presents with aching pain in his proximal tibia that is significantly worse at night and is dramatically relieved by taking ibuprofen. Radiographs reveal a cortical sclerosis surrounding a small radiolucent nidus. The pathophysiology of this lesion's pain mechanism is primarily driven by high levels of which substance?

A 15-year-old boy presents with progressive knee pain and swelling. Radiographs show a destructive metaphyseal lesion in the distal femur with a sunburst periosteal reaction and Codman's triangle. Biopsy confirms high-grade osteosarcoma. What is the most appropriate treatment algorithm?

A 25-year-old woman complains of night pain in her tibia that is dramatically relieved by NSAIDs. Radiographs show a small radiolucent nidus surrounded by dense reactive sclerosis. Which of the following substances is produced in abnormally high amounts by the nidus?

A 19-year-old male complains of severe, aching pain in his right thigh that is worse at night and dramatically relieved by ibuprofen. Radiographs demonstrate a sclerotic area with a 5 mm radiolucent nidus in the femoral cortex. Which of the following is the predominant cell type responsible for producing the prostaglandin E2 (PGE2) in this lesion?

A 15-year-old male presents with night pain in his femur that is dramatically relieved by NSAIDs. A CT scan shows a small radiolucent nidus surrounded by dense reactive sclerosis. What is the primary mediator secreted by this lesion that causes the characteristic pain?

A 15-year-old boy presents with severe night pain in his proximal femur that is dramatically relieved by oral ibuprofen. Imaging confirms a cortically based lesion with a small radiolucent nidus. The symptomatic relief provided by NSAIDs is directly related to the inhibition of which of the following?

A 19-year-old male reports persistent nocturnal diaphyseal tibial pain that is dramatically relieved by aspirin. Radiographs reveal a cortically based sclerotic lesion with a central radiolucent nidus measuring 8 mm. What is the primary biochemical mediator produced in high quantities by the nidus responsible for the patient's specific pain pattern?

A 19-year-old male complains of severe, aching pain in his proximal femur that is notably worse at night and dramatically relieved by ibuprofen. Radiographs demonstrate a 1-cm radiolucent nidus surrounded by dense reactive sclerosis. What is the most appropriate initial management?

A 14-year-old boy presents with severe, progressive right groin pain that is distinctly worse at night and dramatically relieved by NSAIDs. Imaging shows a 1cm radiolucent nidus surrounded by reactive sclerosis in the femoral neck. If this untreated lesion is located within the hip joint capsule, which of the following complications is most likely?

A 65-year-old male presents with a pathologic fracture of the proximal humerus. Subsequent systemic workup reveals hypercalcemia, normocytic anemia, and Bence-Jones proteinuria. What is the characteristic radiographic appearance of the skeletal lesions associated with this pathology?

A 68-year-old man presents with severe back pain. Plain radiographs reveal multiple "punched-out" lytic lesions in his skull and spine. If a technetium-99m bone scan is performed, what is the most likely expected finding for these specific lesions?

A 60-year-old female with back pain has punched-out lytic skull lesions and a monoclonal protein spike. What is the most appropriate imaging modality to evaluate the extent of her skeletal involvement?

A 15-year-old boy presents with aching knee pain that is noticeably worse at night and dramatically relieved by ibuprofen. Radiographs show a small radiolucent nidus with surrounding sclerosis in the proximal tibia. What is the primary molecular driver of his pain?

A 10-year-old boy is evaluated for multiple bony bumps around his knees and ankles. Radiographs show multiple pedunculated and sessile osteochondromas pointing away from the joint spaces. He is diagnosed with Multiple Hereditary Exostoses (MHE). The mutated genes (EXT1 and EXT2) in this condition are normally responsible for the synthesis of:

A 65-year-old male is diagnosed with a conventional grade II chondrosarcoma of the proximal humerus. What is the most appropriate definitive management strategy for this lesion?