10. Pathology and Oncology MCQs

A 60-year-old patient requires prophylactic intramedullary nailing for an impending pathologic fracture of the femur. Preoperative staging reveals the primary tumor is a renal cell carcinoma. What is the most critical preoperative intervention to minimize intraoperative complications?

A 12-year-old boy presents with a permeative lytic lesion in the diaphysis of his femur and an associated large soft tissue mass. Biopsy demonstrates sheets of small round blue cells. Which chromosomal translocation is most characteristic of this pathology?

A 15-year-old boy presents with severe thigh pain and swelling. Radiographs reveal a permeative lytic lesion in the femoral diaphysis with an "onion skin" periosteal reaction. Biopsy reveals uniform small round blue cells. What is the most common chromosomal translocation associated with this tumor?

A 16-year-old boy presents with worsening distal thigh pain. Radiographs reveal a mixed lytic and blastic metaphyseal lesion with a 'sunburst' periosteal reaction. Biopsy confirms a conventional high-grade intramedullary osteosarcoma. What is the most appropriate management sequence?

An 18-year-old male presents with a painful, enlarging mass about the right knee. Radiographs reveal a mixed lytic and sclerotic lesion in the distal femoral metaphysis with a Codman triangle. If a biopsy is planned to confirm the suspected diagnosis of osteosarcoma, what is the most critical principle of the biopsy technique?

A 15-year-old boy presents with knee pain and a destructive lesion in the distal femoral metaphysis exhibiting a "sunburst" periosteal reaction. Biopsy confirms high-grade osteosarcoma. What is the standard sequence of treatment?

A 15-year-old boy presents with progressive knee pain and a palpable mass in the distal femur. Radiographs show a destructive metaphyseal lesion with a 'sunburst' periosteal reaction. Biopsy confirms classic high-grade intramedullary osteosarcoma. What is the defining histological hallmark of this tumor?

A 65-year-old man with a history of lung cancer presents with progressively worsening right thigh pain. Radiographs reveal a large destructive lytic lesion in the proximal femur with a Mirels' score of 10. What is the most appropriate next step in management?

A 15-year-old boy presents with worsening knee pain and swelling. Radiographs of the distal femur show a mixed lytic and blastic lesion with a "sunburst" periosteal reaction and Codman's triangle. If distant metastasis is present, what is the most likely location?

A 12-year-old boy presents with localized thigh pain, low-grade fever, and an elevated ESR. Radiographs demonstrate a diaphyseal lytic lesion of the femur with an "onion-skin" periosteal reaction. Cytogenetic testing of the biopsy will most likely show which translocation?

A 32-year-old female presents with progressive knee pain. Radiographs reveal an eccentric, purely lytic lesion in the distal femoral epiphysis extending to the subchondral bone with no sclerotic border. What is the most appropriate definitive surgical management?

A 35-year-old immigrant presents with progressive back pain, night sweats, and lower extremity weakness. MRI reveals a destructive lesion of the T8-T9 vertebral bodies with relative sparing of the disc space and a large paraspinal abscess. What is the most appropriate next step in management?

A 65-year-old male with a 40-pack-year smoking history presents with bilateral knee and ankle pain. Radiographs reveal symmetric, solid periosteal new bone formation along the diaphyses and metaphyses of the tibiae and fibulae. Which of the following is the most likely underlying diagnosis?

A 58-year-old female with known breast cancer presents with thigh pain. Radiographs show a 3.5 cm lytic lesion in the peritrochanteric region of the proximal femur. She complains of severe pain with weight-bearing. What does her Mirels' score dictate regarding management?

A 7-year-old boy presents with a painful, solitary lytic lesion in the skull and a mild chronic cough. Biopsy of the skull lesion demonstrates cells with grooved nuclei expressing CD1a and S-100. Electron microscopy reveals Birbeck granules. Which of the following organs should also be carefully evaluated?

A 30-year-old female undergoes curettage and cementing of a giant cell tumor of the distal femur. Two years later, routine follow-up imaging reveals multiple asymptomatic, small, peripheral lung nodules. Biopsy of a lung nodule confirms histopathology identical to the primary tumor. What is the standard management for this pulmonary condition?

A 15-year-old male is undergoing chemotherapy for conventional osteosarcoma of the proximal tibia. He presents to the emergency department with sudden onset pleuritic chest pain and shortness of breath. Chest radiograph shows a spontaneous pneumothorax. What is the most likely underlying cause?

An 11-year-old boy presents with a 2-month history of thigh pain and low-grade fever. Radiographs show a permeative diaphyseal lesion in the femur with a prominent "onion-skin" periosteal reaction. Which of the following cytogenetic abnormalities is most diagnostic for this tumor?

A 65-year-old man presents with severe mid-back pain. Laboratory tests reveal anemia, hypercalcemia, and elevated serum creatinine. Serum protein electrophoresis shows a monoclonal spike. Which test is most appropriate to evaluate the full extent of skeletal involvement?