10. Pathology and Oncology MCQs

A 15-year-old boy presents with severe, dull aching pain in his proximal thigh that worsens at night and is dramatically relieved by ibuprofen. Imaging shows an 8mm intracortical radiolucent nidus with dense surrounding sclerosis. What is the standard of care for definitive, minimally invasive treatment?

A 25-year-old male with Multiple Hereditary Exostoses (MHE) presents with a rapidly enlarging and increasingly painful osteochondroma on his proximal tibia. Which of the following is the most critical complication to rule out?

The mnemonic 'CRAB' is used to recall the hallmark end-organ damage manifestations of Multiple Myeloma. Which of the following accurately represents the CRAB criteria?

A 65-year-old male presents with new-onset back pain, fatigue, and hypercalcemia. Radiographs show multiple punched-out lytic lesions in the axial skeleton, as seen in the provided image. Which laboratory finding is most specific for confirming the diagnosis of this pathology?

A 60-year-old male with multiple myeloma presents with severe thigh pain on weight-bearing. Radiographs show a 4 cm lytic lesion in the subtrochanteric region with 50% cortical destruction. What is the most appropriate management?

A 32-year-old female presents with a purely lytic, eccentric lesion in the distal femoral epiphysis. Biopsy reveals multinucleated giant cells in a background of mononuclear cells. The true neoplastic cells in this tumor express high levels of which marker?

A 14-year-old boy presents with a permeative lytic lesion in the femoral diaphysis with an "onion skin" periosteal reaction. A biopsy shows small round blue cells. Molecular analysis is most likely to reveal which of the following translocations?

An 11-year-old boy presents with a painful, swollen mid-thigh. Radiographs demonstrate a destructive diaphyseal lesion with an 'onion skin' periosteal reaction. Histology shows sheets of small, round, blue cells. Which chromosomal translocation is most classically associated with this malignancy?

A 62-year-old man presents with an impending pathologic fracture of the proximal femur secondary to a biopsy-proven metastatic renal cell carcinoma lesion. Prophylactic intramedullary nailing is planned. What is the most critical step in management immediately prior to surgical fixation?

A 32-year-old man presents with recurrent, spontaneous hemarthroses of the knee. MRI demonstrates a nodular synovial mass with prominent 'blooming artifact' on gradient-echo sequences. The pathophysiology of this condition involves the overexpression of which of the following factors?

A 70-year-old man presents with severe back pain and anemia. Radiographs demonstrate multiple lytic skull lesions.

Serum electrophoresis shows an M-spike. Which of the following is the most likely finding on bone marrow biopsy?

A 14-year-old boy has a permeative, destructive lesion in the distal femur with a "sunburst" periosteal reaction. Biopsy confirms high-grade intramedullary osteosarcoma. What is the single most important prognostic factor for his long-term survival?

A 12-year-old boy presents with thigh pain and fever. Radiographs show a diaphyseal lytic lesion of the femur with an "onion-skin" periosteal reaction. Biopsy shows small blue round cells. Which chromosomal translocation is most characteristically associated with this tumor?

A 65-year-old man presents with chronic hip pain. Radiographs show a large destructive lesion in the ilium with "rings and arcs" calcification. Biopsy confirms a grade II conventional chondrosarcoma. What is the most appropriate primary treatment?

A 45-year-old woman undergoes an MRI for knee pain, which reveals a 4 cm cartilage tumor in the distal femur. Which of the following features is the most reliable indicator of a grade I chondrosarcoma rather than a benign enchondroma?

A 16-year-old boy presents with a 6-month history of right thigh pain that is worse at night and completely relieved by ibuprofen. Radiographs show a 1 cm radiolucent nidus surrounded by dense sclerotic bone. The profound pain relief from NSAIDs is due to inhibition of which substance produced by the nidus?

A 15-year-old male presents with enlarging bumps around his knees and ankles. Radiographs demonstrate multiple sessile and pedunculated osteochondromas. He carries a mutation in the EXT1 gene. What is the approximate lifetime risk of malignant transformation to chondrosarcoma in this condition?

A 68-year-old male presents with fatigue, diffuse bone pain, and hypercalcemia. A representative radiograph is shown.

Serum protein electrophoresis confirms a monoclonal gammopathy. When evaluating the extent of this patient's skeletal disease, which of the following imaging modalities is most likely to yield false-negative results due to the underlying pathophysiology of the bone lesions?