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10. Pathology and Oncology MCQs

Practice Set 26 of 351

This practice set contains high-yield board review questions covering key concepts in 10. Pathology and Oncology. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 501

Topic: 10. Pathology and Oncology

A 30-year-old black woman presents with complaints of pain in the tip of her right index finger. The pain started approximately 6 months ago and becomes intense in cold weather. She also states that her nail on the index finger does not look as good as the others despite regular manicures. You notice a bluish discoloration and ridging of the nail. The nail is not split, but it appears clubbed. The patient does not have a history of respiratory or hemodynamic disease and appears healthy. The nail is exquisitely tender on pressure, but no mass is palpable. Two-point discrimination is intact and capillary refill is good. Radiographs do not reveal bony destruction, but you notice pressure indentation over the distal phalanx. The joint space is preserved, and the patient has full range of motion. The next step in management includes:

. Ordering a magnetic resonance image
. Ordering a bone scan
. Ordering a computed tomography scan
. Performing an excisional biopsy
. Injecting the distal phalanx medullary canal with corticosteroid

Correct Answer & Explanation

. Performing an excisional biopsy

Explanation

This is a classic case of a glomus tumor with cold intolerance and nail deformity. Imaging studies often are inconclusive, although computed tomography scans may show cortical reaction. This patient is symptomatic and should receive definitive treatment. It should be noted that magnetic resonance imaging is increasingly helpful for nonclassical presentations of finger pain.

Question 502

Topic: 10. Pathology and Oncology

A 30-year-old black woman presents with complaints of pain in the tip of her right index finger. The pain started approximately 6 months ago and becomes intense in cold weather. She also states that her nail on the index finger does not look as good as the others despite regular manicures. You notice a bluish discoloration and ridging of the nail. The nail is not split, but it appears clubbed. The patient does not have a history of respiratory or hemodynamic disease and appears healthy. The nail is exquisitely tender on pressure, but no mass is palpable. Two-point discrimination is intact and capillary refill is good. Radiographs do not reveal bony destruction, but you notice pressure indentation over the distal phalanx. The joint space is preserved, and the patient has full range of motion. Based on your clinical diagnoses, the histological findings will include which of the following:

. Well-formed vascular channels with nonmyelinated nerve endings
. Mucous islands with blood vessels
. Giant cells filled with inflammatory cells in the interstitium
. Negatively birefringent cystals
. Amorphous calcium in pseudocapsule

Correct Answer & Explanation

. Well-formed vascular channels with nonmyelinated nerve endings

Explanation

Glomus tumors consist of well-formed vascular channels with nonmyelinated nerve endings. Glomus tumors are not associated with mucous islands or giant cells. Negatively birefringent crystals are found in patients with gout. The presentation of this patient does not suggest gout. Amorphous calcium in a pseudocapsule is diagnostic of calcinosis. C alcinosis occurs intracutaneoulsy or subcutaneously. These deposits can be tender but are not effected by changes in weather, as are glomus tumors.

Question 503

Topic: 10. Pathology and Oncology

Glomus tumors are characterized by all of the following except:

. Three-quarters of glomus tumors occur in the hand.
. Pain, point tenderness, and cold sensitivity are clinically present.
. Glomera are neuromyoarterial apparatuses that regulate sympathetic outflow.
. Persistence of symptoms for more than 3 months after excision is suggestive of recurrence.
. None of the above

Correct Answer & Explanation

. None of the above

Explanation

Glomera are neuromyoarterial apparatuses that regulate temperature.

Question 504

Topic: 10. Pathology and Oncology

Neurofibromas are characterized by all of the following except:

. Cafa-au-lait spots
. Axillary freckles
. Dumbbell tumors
. Ease of surgical excision
. C haracteristic oval avascular tumor in continuity with nerve trunk

Correct Answer & Explanation

. Ease of surgical excision

Explanation

Neurofibromas are benign tumors of neural origin that are transmitted as an autosomal dominant trait with variable penetrance. Neurofibromas are associated with cutaneous manifestations like cafe-au-lait spots and axillary freckles. They may be dumbbell shaped and can be identified with magnetic resonance imaging, which is especially helpful for deeper multiple lesions. They are infiltrative, making excision with preservation of peripheral nerve function difficult thus requiring bridge grafting for significant motor or sensory funtional requirements.

Question 505

Topic: 10. Pathology and Oncology
Recklinghausen's disease is associated with all of the following except:
. Diffuse neurofibromatosis
. Schwannoma
. High potential for malignant degeneration
. Plexiform growth
. None of the above

Correct Answer & Explanation

. None of the above

Explanation

Diffuse neurofibromatosis is a separate clinical presentation and is not associated with Recklinghausen's disease.

Question 506

Topic: Soft Tissue Tumors & Metastasis

Schwannomas are differentiated from neurofibromas by all of the following except:

. Ease of excision
. Eccentric location on the nerve
. Absence of fascicles
. Presence of schwann cells
. None of the above

Correct Answer & Explanation

. Presence of schwann cells

Explanation

Schwann cells contribute to schwannoma and neurofibroma.

Question 507

Topic: 10. Pathology and Oncology

All of the following are true for infantile digital fibroma except:

. 80% of infantile digital fibroma cases appear by 1 year of age
. Infantile digital fibroma is exclusive to fingers and toes
. Intracytoplasmic inclusion bodies are present
. Wide local excision is curative
. Recurrent disease never implies malignant transformation

Correct Answer & Explanation

. Intracytoplasmic inclusion bodies are present

Explanation

Eighty percent of infantile digital fibromata appear before a child's first birthday. They are exclusive to the fingers and toes and are usually painless. Infantile digital fibromata are often small and the same color as the skin. On histological examination, intracytoplasmic inclusion bodies are present. Although benign, the fibromata are locally aggressive. They do not metastaaize, but recurrences after wide local excision are common. Surgery is indicated when deformity or contracture is imminent.

Question 508

Topic: 10. Pathology and Oncology

Marjolins ulcers are risk factors for which of the following tumors:

. Squamous cell carcinoma
. Basal cell carcinoma
. Melanoma
. Synovial sarcoma
. Osteosarcoma

Correct Answer & Explanation

. Squamous cell carcinoma

Explanation

Marjolins ulcers are malignant degenerations in chronic skin ulcers, sinuses, and burn scars and are risk factors for squamous cell carcinoma. Any patient with chronic, nonhealing ulcers should undergo biopsy for malignant degeneration. Basal cell carcinoma, malignant melanoma, synovial sarcoma, and osteosarcoma are not commonly associated with Marjolin's ulcer.

Question 509

Topic: 10. Pathology and Oncology

Which of the following tumors rarely metastasizes:

. Malignant melanoma
. Synovial sarcoma
. C lear cell carcinoma
. Dermatofibrosarcoma protuberans
. Squamous cell carcinoma

Correct Answer & Explanation

. Dermatofibrosarcoma protuberans

Explanation

Dermatofibrosarcoma protuberans presents as a variably colored, slow- growing nodule involving the subcutaneous tissue. This tumor has a low incidence of metastasis; however, the recurrence rate is high even with wide local excision.

Question 510

Topic: 10. Pathology and Oncology

Lymph node involvement is common in all of the following tumors except:

. Sweat gland tumors
. Squamous cell carcinoma
. Melanoma
. Basal cell carcinoma
. Merkel's cell carcinoma

Correct Answer & Explanation

. Squamous cell carcinoma

Explanation

Basal cell carcinomas rarely metastasize. Malignant sweat gland tumors, malignant melanoma, and Merkel's cell carcinoma are aggressive. Treatment usually includes regional lymphadenectomy. Squamous cell carcinoma is one of the most common hand malignancies and has the capacity to metastasize via the lymphatics.

Question 511

Topic: 10. Pathology and Oncology

Nevi at greatest risk for malignant degeneration are:

. Giant congenital hair variety
. Blue nevi
. Junctional nevi
. Compound nevi
. Nevus sebaceous

Correct Answer & Explanation

. Nevus sebaceous

Explanation

Giant congenital hairy nevi, dysplastic nevi, senile lentigo, and congenital melanocytic nevi have significant risk for malignant degeneration. Nevus sebaceous is present at birth in the head and neck region and has a 10% incidence of malignant transformation. Blue nevi, junctional nevi, and compound nevi have lower risks for transformation.

Question 512

Topic: 10. Pathology and Oncology

All of the following are risk factors for malignant melanoma except:

. Sunlight
. Genetic predisposition
. C opper-based tanning lotions
. Atypical nevi
. Immunosuppressive state

Correct Answer & Explanation

. Sunlight

Explanation

Sun exposure is the most important risk factor for melanoma. Family history, atypical nevi, and an immunosuppressive state increases an individual's risk for developing melanoma. It is unknown if tanning lotions cause malignant melanomas.

Question 513

Topic: 10. Pathology and Oncology

Which of the following statements is true regarding soft tissue sarcomas:

. Soft tissue sarcomas frequently metastasize to bone.
. Patients with soft tissue sarcomas of the hand have worse prognosis than patients with similar tumors in other extremities.
. Soft tissue sarcomas present as a painful mass in the hand.
. Overall prognosis is better with radical resection than wide excision.
. Soft tissue sarcomas can be "shelled out".

Correct Answer & Explanation

. Patients with soft tissue sarcomas of the hand have worse prognosis than patients with similar tumors in other extremities.

Explanation

Soft tissue sarcomas in the hand present as painless lesions, do not metastasize to bone, and although local control is better with radical resection, there is no improvement in overall survival when compared to wide excision. Soft tissue sarcomas should not be "shelled out."C orrect Answer: Patients with soft tissue sarcomas of the hand have worse prognosis than patients with similar tumors in other extremities.

Question 514

Topic: 10. Pathology and Oncology

Which of the following tumor metastasizes to lungs:

. Squamous cell carcinoma
. Basal cell carcinoma
. Soft tissue sarcoma
. Schwannoma
. Actinic keratosis

Correct Answer & Explanation

. Soft tissue sarcoma

Explanation

Squamous cell carcinoma and basal cell carcinoma do not commonly metastasize to the lungs. Actinic keratoses are premalignant lesions that progress into squamous cell carcinomas. Schwannomas are common benign nerve tumors.

Question 515

Topic: 10. Pathology and Oncology

Which of the following is not a characteristic of synovial sarcomas:

. Synovial sarcomas are poorly differentiated masses located close to joints, tendon, or bursa.
. Spindle and epithelial-type cells with monophasic or biphasic cells are present on histology.
. Lymphatic spread is common.
. Wide or radical excision with radiation or chemotherapy prevents metastases.
. High grade malignant soft tissue sarcoma

Correct Answer & Explanation

. High grade malignant soft tissue sarcoma

Explanation

Synovial sarcomas are high grade malignant soft tissue sarcomas, in which metastases can occur years after surgery. Long term followup is necessary. They arise close to joints, tendons or bursa and lymphatic spred is common. Histology reveals spindle and epithelial type cells with menophasic or biphasic pattern. Treatment includes wide resection and radiation, chemotherapy is not usually used.

Question 516

Topic: 10. Pathology and Oncology

C haracteristic histological features of malignant schwannoma are best described as:

. Fusiform cells with neoplastic schwann cells and nerve fascicles
. Spindle and epithelial-type cell mix with monphasic or biphasic cells
. Round or fusiform cells with clear cytoplasm and nerve fascicles
. Pleomorphic spindle histiocytes and giant cells in a storiform pattern
. None of the above

Correct Answer & Explanation

. Fusiform cells with neoplastic schwann cells and nerve fascicles

Explanation

The histological features of malignant schwannoma have characteristic fusiform cells with neoplastic schwann cells and nerve fascicles.

Question 517

Topic: 10. Pathology and Oncology

A 16-year-old male is diagnosed with high-grade intramedullary osteosarcoma of the distal femur. He undergoes neoadjuvant chemotherapy followed by limb-salvage surgery. What is the most important histologic prognostic factor for long-term survival in this patient?

. Percentage of tumor necrosis map on the resected specimen
. Presence of giant cells
. Mitotic index prior to chemotherapy
. Degree of vascularity in the tumor
. Amount of osteoid matrix produced

Correct Answer & Explanation

. Percentage of tumor necrosis map on the resected specimen

Explanation

The percentage of tumor necrosis in the surgical specimen following neoadjuvant chemotherapy is the single most important prognostic factor in osteosarcoma. Greater than 90% necrosis indicates an excellent response and better overall survival.

Question 518

Topic: 10. Pathology and Oncology

A 45-year-old female presents with severe paroxysmal pain in her right ring finger, which is severely exacerbated by cold temperatures. Point tenderness is noted over the nail bed, and the nail plate shows a faint bluish discoloration. What is the most characteristic histological finding of this lesion?

. Biphasic pattern with spindle cells and epithelial cells
. Sheets of uniform cells with eosinophilic cytoplasm surrounding blood vessels
. Multinucleated giant cells with background mononuclear cells
. Myxoid stroma with stellate cells
. Mature adipocytes separated by fibrous septae

Correct Answer & Explanation

. Sheets of uniform cells with eosinophilic cytoplasm surrounding blood vessels

Explanation

The clinical presentation is classic for a glomus tumor, a painful, cold-sensitive hamartoma of the glomus body. Histologically, they feature solid sheets of uniform, round-to-oval cells (glomus cells) surrounding capillary vessels.

Question 519

Topic: Bone Tumors

A 55-year-old male presents with deep, aching shoulder pain. Radiographs reveal a large, lytic lesion in the proximal humerus with intralesional 'popcorn' calcifications and endosteal scalloping. What is the most appropriate definitive management for a conventional high-grade lesion of this type?

. Extended intralesional curettage with adjuvant
. Neoadjuvant chemotherapy followed by wide resection
. Wide surgical resection alone
. Definitive external beam radiation therapy
. Radiofrequency ablation

Correct Answer & Explanation

. Wide surgical resection alone

Explanation

The presentation describes a conventional chondrosarcoma. Unlike osteosarcoma or Ewing sarcoma, conventional chondrosarcomas are generally resistant to chemotherapy and radiation, making wide surgical resection the primary treatment.

Question 520

Topic: 10. Pathology and Oncology

Optimal treatment for a symptomatic ganglion is:

. Observation
. Closed rupture
. Aspiration
. Surgical excision
. Corticosteroid injection

Correct Answer & Explanation

. Surgical excision

Explanation

Surgical excision of a symptomatic ganglion, with removal of the entire ganglion stalk and a portion of the joint capsule at its base, reliably relieves pain and has a low recurrence rate (approximately 5%). C losed rupture, while potentially effective, has a recurrence rate of approximately 50%. Ganglions are prone to recur after aspiration, although 3 serial aspirations of a ganglion have been shown to reduce the recurrence rate to about 15%. The addition of corticosteroids to aspiration treatment has not been shown to provide any additional benefit. While observation of painless ganglions is certainly acceptable treatment given their benign prognosis, it is not considered the optimal course for a symptomatic lesion.

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