10. Pathology and Oncology MCQs

A 45-year-old male presents with vague sacral pain and bowel dysfunction. MRI reveals a large, destructive midline sacral mass. A CT-guided biopsy confirms a chordoma. Which of the following statements best characterizes the optimal treatment strategy for this pathology?

A 55-year-old female with metastatic renal cell carcinoma to the T8 vertebral body presents with severe back pain and progressive bilateral leg weakness. MRI shows high-grade epidural spinal cord compression. Based on the NOMS framework, what is the optimal management strategy?

An 80-year-old female presents with severe, worsening back pain 3 months after a minor fall. Initial radiographs at the time of the fall were reported as normal. Current radiographs demonstrate severe vertebral body collapse at T12 with an intravertebral vacuum cleft. What is the most likely diagnosis?

A 14-year-old boy presents with a destructive diaphyseal lesion of the femur. Biopsy reveals small round blue cells. Molecular testing demonstrates a t(11;22)(q24;q12) chromosomal translocation. This specific genetic aberration results in the formation of which fusion gene?

A 12-year-old boy presents with an aggressive diaphyseal bone tumor. Cytogenetic analysis of the biopsy specimen reveals a t(11;22)(q24;q12) chromosomal translocation. Which of the following fusion proteins is characteristically produced as a result of this translocation?

A 45-year-old female presents with a painless, slowly enlarging, firm, lobulated mass on the volar aspect of her index finger. X-rays show soft tissue swelling with no bone involvement.

Histological examination following excision is most likely to show:

A 45-year-old female complains of severe, paroxysmal pain in her thumbnail bed, exacerbated by cold temperatures. Exquisite point tenderness is noted on physical exam. What is the most likely diagnosis?

A 28-year-old industrial painter accidentally injects his left index finger with a high-pressure paint gun. He presents to the ED 2 hours later with a small, seemingly benign puncture wound on the volar tip of the finger, but complains of intense, throbbing pain. What is the single most important prognostic factor determining the likelihood of eventual amputation in this injury?

A 40-year-old female presents with severe, pinpoint pain under the nail of her left ring finger. The pain is exacerbated by cold weather. On examination, there is a bluish discoloration beneath the nail plate. Love's pin test is positive. The pathology underlying this condition originates from which of the following cell types?

A 30-year-old female presents with exquisite pinpoint pain in the pulp of her index finger, which worsens significantly upon exposure to cold water. Examination reveals pinpoint tenderness (positive Love's test), and her pain is relieved when a tourniquet is applied to the base of the digit (positive Hildreth's sign). The lesion responsible for these symptoms arises from which of the following cellular origins?

A 42-year-old woman presents with severe, excruciating pain at the tip of her left index finger, which worsens in cold weather. There is point tenderness over the nail bed (Love's pin test), and the pain is relieved when a tourniquet is applied to the base of the finger (Hildreth's sign). What is the most likely diagnosis?

A 40-year-old woman presents with severe pain in her right middle finger, exacerbated by cold weather. Examination reveals pinpoint tenderness beneath the nail plate. Pain is relieved when a tourniquet is applied to the base of the finger. What is the most likely diagnosis?

During a complicated resection of a palmar tumor, the vascular supply of the hand is meticulously dissected. The deep palmar arch is primarily formed by the terminal continuation of which artery?

A 65-year-old female with a history of breast cancer presents with right thigh pain. Radiographs reveal a 2 cm lytic lesion in the peritrochanteric region of the proximal femur. It is moderately painful with weight-bearing but does not involve the cortex circumferentially. Based on Mirels' criteria, what is her calculated score, and what is the recommendation for prophylactic fixation?

An 8-year-old boy presents with mild right arm pain after throwing a ball. Radiographs reveal a central, lytic, well-circumscribed lesion in the proximal humeral metaphysis with a "fallen leaf" sign. Assuming the fracture has healed and the lesion remains asymptomatic, what is the most appropriate natural history expectation and management?

A 10-year-old girl undergoes a knee radiograph for a minor contusion. An incidental eccentric, bubbly, multiloculated lucent lesion with a sclerotic rim is noted in the posteromedial metaphysis of the distal femur. What is the most common natural history of this lesion?

A 55-year-old woman with a history of breast cancer presents with severe, progressive midthoracic back pain. Neurological exam reveals 4/5 strength in the bilateral iliopsoas and hyperreflexia at the knees. MRI shows a destructive lesion at T8 with epidural extension compressing the spinal cord. She has an estimated life expectancy of 18 months. What is the most appropriate management?

A 16-year-old male presents with a 6-month history of well-localized mid-back pain that is worse at night and dramatically improves with ibuprofen. Imaging reveals a 1.2 cm sclerotic lesion with a central lucent nidus in the left lamina of T8. What is the most appropriate definitive management if conservative measures are poorly tolerated?

Within the Neurologic, Oncologic, Mechanical, and Systemic (NOMS) framework for evaluating metastatic spine tumors, which of the following tumor histologies is considered highly radioresistant, often prompting separation surgery followed by stereotactic radiosurgery (SRS) when causing epidural spinal cord compression?

A 60-year-old man presents with severe back pain and a solitary L2 vertebral body metastasis secondary to renal cell carcinoma. He has impending cord compression, and his estimated life expectancy is 18 months. What is the most appropriate surgical treatment strategy?