Free Orthopedics Review | Dr Hutaif General Orthopedics -...
Updated: Feb 2026
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Key Medical Takeaway
This topic focuses on FREE Orthopedics MCQS 2022 1401-1450, Enchondroma is the most common primary bone tumor in the hand, often affecting the phalanges and metacarpals. This can involve joints like the metacarpophalangeal (MCP) joint and distal interphalangeal (DIP) joints. Additionally, ganglions frequently arise at DIP joints, termed mucous cysts. These represent prevalent pathologies within the hand’s complex joint structures.
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FREE Orthopedics MCQS 2022 1401-1450
QUESTION 1
Which of the following statements regarding ganglions is false:
1
Surgery can lead to a decrease in range of motion.
2
Ganglions are filled with mucinous fluid that does not transilluminate.
3
Needle aspiration is diagnostic and therapeutic, although the rate of recurrence is high after this procedure.
4
Volar ganglion may arise in relation to the radial artery.
5
Ganglions may be multilobulated.
Transillumination is a hallmark of ganglions. Because of the location from which ganglia arise and the dissection performed during resection, a decrease in range of motion can be seen postoperatively. Needle aspiration is diagnostic and can be therapeutic, however, recurrence rates as high as 95% have been reported. Volar ganglia can often be intimately associated with the radial artery. Ganglia may often be multilobulated.
QUESTION 2
Dorsal wrist ganglions originate from the:
1
Scapholunate ligament
2
Dorsal capsule
3
Extensor digitorum communis (EDC ) tendon
4
Dorsal carpal ligament
5
C apitolunate joint
Dorsal wrist ganglia do not arise from the dorsal capsule, EDC tendon, capitolunate joint, or dorsal intercarpal ligament. Dorsal wrist ganglia arise from the scapholunate ligament. Some surgeons advocate excising a small rim of the scapholunate ligament to avoid recurrence.
QUESTION 3
Ganglions of the distal interphalangeal (DIP) joints of the fingers are called:
1
Mucous cysts
2
Bouchard nodes
3
Heberden nodes
4
Inclusion cysts
5
Retinacular cysts
Ganglions arising at the DIP joints are called mucous cysts and ganglions from the flexor tendon in the palm are called retinacular cysts.
Bouchard nodes are osteophytes that develop at the proximal interphalangeal joint.
Heberden nodes are bony spurs at the dorsal aspect of the DIP joint and are present in osteoarthritis. Inclusion cysts are mobile, nonadherent to skin, and can occur anywhere on a hand.
QUESTION 4
Management of a mucous cyst entails:
1
Aspiration with injection of hyaluronidase
2
Aspiration only
3
Excision and resection of osteophytes
4
Aspiration with injection of steroids
5
Arthrodesis of the distal interphalangeal joint
Treatment of mucous cysts, which are ganglions of the distal interphalangeal joint associated with osteoarthritic changes, entails excision of the cyst and osteophyte resection of fusion.
Aspiration only or aspiration of the cyst with injection of hyaluronidase is not indicated or efficacious in the treatment of mucous cysts because the osteophyte must be addressed. Injection of steroids also fails to address the underlying cause of these cysts. Arthrodesis of the distal interphalangeal joint is not necessary in the treatment of typical mucous cysts.
QUESTION 5
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 most likely diagnosis is:
1
Glomus tumor
2
Acute perinychia
3
Paronychia
4
Giant cell tumor
5
Turret exostosis
This patient presents with the classic triad of glomus tumor: sharp lancinating pain, point tenderness, and cold sensitivity. Localized bluish discoloration is also strongly suggestive of a glomus tumor.
Giant cell tumors can be found on the fingertip, however, a presentation of a giant cell tumor with these symptoms would be unusual. Mucous cysts would be part of the differential but does not cause a bluish discoloration or cold insensitivity. An acute paronychia would be painful and erythematous is infectious. A mucous cyst is not infectious. This classic triad does not describe a turret exotosis.
QUESTION 6
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:
1
Ordering a magnetic resonance image
2
Ordering a bone scan
3
Ordering a computed tomography scan
4
Performing an excisional biopsy
5
Injecting the distal phalanx medullary canal with corticosteroid
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 7
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:
1
Well-formed vascular channels with nonmyelinated nerve endings
2
Mucous islands with blood vessels
3
Giant cells filled with inflammatory cells in the interstitium
4
Negatively birefringent cystals
5
Amorphous calcium in pseudocapsule
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 8
Glomus tumors are characterized by all of the following except:
1
Three-quarters of glomus tumors occur in the hand.
2
Pain, point tenderness, and cold sensitivity are clinically present.
3
Glomera are neuromyoarterial apparatuses that regulate sympathetic outflow.
4
Persistence of symptoms for more than 3 months after excision is suggestive of recurrence.
5
None of the above
Glomera are neuromyoarterial apparatuses that regulate temperature.
QUESTION 9
All of the following are characteristic of hemangiomas except:
1
70% of hemangiomas are visible by 4 weeks of age
2
70% of hemangiomas regress by 7 years of age
3
Hemangiomas are three times more common in woman than men
4
All cavernous hemangiomas regress by 12 years of age
5
None of the above
C avernous hemangiomas are noninvoluting hemangiomas and require surgical excision.
QUESTION 10
Pseudoaneurysms differ from true aneurysms in that:
1
Pseudoaneurysms are expansile.
2
Pseudoaneurysms occur secondary to trauma.
3
Pseudoaneurysms have a fibrous wall.
4
Pseudoaneurysms frequently occur in the ulnar artery.
Pseudoaneurysms occur secondary to penetrating trauma and have a fibrous wall, compared to true aneurysms that have all the elements of an arterial wall.
QUESTION 11
Neurofibromas are characterized by all of the following except:
C haracteristic oval avascular tumor in continuity with nerve trunk
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 12
Recklinghausenâs disease is associated with all of the following except:
1
Diffuse neurofibromatosis
2
Schwannoma
3
High potential for malignant degeneration
4
Plexiform growth
5
None of the above
Diffuse neurofibromatosis is a separate clinical presentation and is not associated with Recklinghausenâs disease.
QUESTION 13
Schwannomas are differentiated from neurofibromas by all of the following except:
1
Ease of excision
2
Eccentric location on the nerve
3
Absence of fascicles
4
Presence of schwann cells
5
None of the above
Schwann cells contribute to schwannoma and neurofibroma.
QUESTION 14
All of the following are true for infantile digital fibroma except:
1
80% of infantile digital fibroma cases appear by 1 year of age
2
Infantile digital fibroma is exclusive to fingers and toes
3
Intracytoplasmic inclusion bodies are present
4
Wide local excision is curative
5
Recurrent disease never implies malignant transformation
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 15
Felon complications include all of the following except:
1
Phalangeal osteomyelitis
2
Suppurative flexor tenosynovitis
3
C ollar button abscess
4
Distal interphalangeal joint septic arthritis
5
Nailbed deformity
Felons that are chronic or neglected may penetrate adjacent structures such as the distal phalanx, nailbed, or distal interphalangeal joint. They can also contribute to the formation of a pyogenic flexor tenosynovitis. C ollar button abscesses are localized to web space. They typically arise from direct inoculation, not from distant felons.
QUESTION 16
Which of the following is not a classic Kanavel sign of flexor tenosynovitis:
1
Pain on passive extension
2
Flexion attitude of the finger
3
Tenderness of flexor sheath
4
Anesthesia of the fingertip
5
Fusiform swelling of the entire finger
The cardinal signs of flexor tenosynovitis described by Kanavel include pain on passive extension, flexion attitude of the finger, tenderness of flexor sheath, and swollen finger.
QUESTION 17
Septic flexor tenosynovitis may involve all of the following areas except the:
1
Radial bursa
2
Thenar space
3
Paronaâs space
4
Snuffbox
5
Ulnar bursa
The radial and ulnar bursae are extensions of the tendon sheaths of the flexor pollicis longus and the flexor digitorum profundus of the small fingers. They can easily be involved in a case of pyogenic flexor tenosynovitis. Although not direct extensions of the flexor sheaths, the thenar space and Parona's space are adjacent to the flexor sheaths and can be involved in suppurative conditions. The snuffbox, however, does not have any contributions from the flexor system and is not usually involved in cases of pyogenic flexor tenosynovitis.
QUESTION 18
Regarding the management of web space abscess, which of the following statements is not true:
1
Transverse incisions should be used.
2
Wounds may be left open.
3
Drains are often used following evacuation.
4
Early motion must be encouraged.
5
Thorough debridement of the dead muscle is required.
Transverse incisions can lead to contractures that limit finger abduction. Leaving wounds open allow for continued drainage. If preferred, closed suction drains can be used after closure of the wound. All devitalized tissue must be debrided and all signs of infection removed and irrigated copiously. Early motion is encouraged to prevent stiffness.
QUESTION 19
Meleneyâs infection is a:
1
Spreading ulcer rimmed with gangrenous skin
2
Patchy gangrenous involvement of the hand
3
Dry gangrene with superimposed infection
4
Multiple infective ulcer of the forearm
5
C reates a sinus fistula to the midcarpal space
Found in necrotizing fasciitis, Meleneyâs infection is a spreading ulcer rimmed with gangrenous skin. The affected area must be debrided immediately. C ultures are taken at the time of surgery to tailor antibiotic coverage. Amputation is not unusual to control the spread of the gangrenous infection.
QUESTION 20
Meleneyâs infection is caused by:
1
Streptococcus viridans
2
Aerobic hemolytic staphylococci
3
Microaerophyllic non-hemolytic streptococci
4
B & C
5
Staphylococcus aureus
Aerobic hemolytic staphylococci and microaerophyllic non-hemolytic streptococci synergistically act to produce Meleneyâs infection. Meleney's infection is a gangrenous infection that often results after a small injury. The infection is characterized by significant, rapid swelling with gangrenous changes.
QUESTION 21
The most common pathogen for osteomyelitis of phalanges is:
1
Staphylococcus aureus
2
Streptococci
3
Haemophilus influenzae
4
Mix of gram-negative and gram-positive organisms
5
Pasturella multocida
Staphylococcus aureus is the most common pathogen that causes osteomyelitis in the hand. Most cases of osteomyelitis in the hand are due to direct extension. Other pathogens can be found if there is a contaminated injury that penetrates directly into the bone. H. infuenza , mixed pathogens, and Pasturella multocida are less likely causes of osteomyelitis and are often caused by direct inoculation injuries or bites.
QUESTION 22
The most common pathogen causing septic arthritis in the hand is:
1
Staphylococcus aureus
2
Streptococci
3
Haemophilus influenzae
4
Mix of gram-negative and gram-positive organisms
5
Atypical mycobacterium
Staphylococcus aureus is the most common pathogen that causes septic arthritis in the hand. The second most common pathogen is streptococcus species infections, which are often the result of trauma. Treatment includes incision and drainage with copius irrigation.
QUESTION 23
"C ollar button" abscess refers to:
1
Web space infection
2
Finger pulp infection
3
Extension of infection from mid-palmar space to Paronaâs space in the forearm
4
Eponychial infection
5
Septic joint with dorsal and palmar extension
C ollar button abscess is an infection of web space and is usually a result of penetrating trauma. Treatment of such abscesses requires incision and drainage through dorsal and palmar incisions. C are must be taken to avoid the neurovascular bundles. Finger pulp infections are known as felon. Infections involving Parona's space is typically involved in a horseshoe abscess. Eponychial infections are limited to the nail fold. C ollar button abscesses do not include joint involvement.
QUESTION 24
A 35-year-old woman is bitten on her left index finger by a snake in her backyard. Management of snake bites includes all of the following except:
1
Keeping the patient emotionally and physically still
2
Applying a tourniquet
3
Identifying the snake
4
Injecting antivenin locally based on recommended guidelines
5
C all immediately for help
There are different snake bite protocols depending on the species of snake. However, common steps in all snake bite protocols include keeping the patient emotionally and physically still, calling for help immediately, applying a moderately tight tourniquet proximally to prevent further spread of venom, and capture or identification of the snake. Local injection of the antivenin in the fingers or toes is contraindicated.
QUESTION 25
C ardinal signs of evenomation include all of the following except:
1
Fang marks
2
C yanosis
3
Pain
4
Swelling
5
Ascending lymphangitis
The cardinal signs of evenomation appear between 10 minutes and 4 hours after a person is bitten. The signs include fang marks, pain, swelling, and local necrosis. C yanosis is not considered a cardinal sign of evenomation.
QUESTION 26
All of the following nerves are involved in infection with Mycobacterium leprae except the:
1
Ulnar nerve at the elbow
2
Median nerve in the carpal tunnel
3
Supraorbital nerve
4
Vagus nerve
5
Spinal accessory nerve
Mycobacterium leprae causes skin, nerve, and tendon sheath infections. M leprae commonly affects the hands because it has a predilection for cool parts of the body. M leprae causes neuropathy, which frequently involves the ulnar nerve at the elbow and the median nerve at the wrist. The resulting limb deformities require various surgical procedures. C ranial nerves and autonomic nerves are not affected.
QUESTION 27
A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MC P joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal air in the joint but no joint
dislocation or fracture, and there is no neurovascular deficit. All of the following are appropriate steps in the management of this patient except:
1
Injection of tetanus toxoid
2
C losure of the wound
3
Exploration for air in the joint
4
Admitting the patient for observation and intravenous antibiotics
5
Splinting
Human bite wounds on the hand are typically found over the MP joint. The mechanism of injury is a clenched-fist blow to the mouth. Oral flora enters the wound, which often communicates with the joint. Eikenella corrodens is frequently cultured from human bite wounds, but the most common pathogen is staphylococcus aureus. Appropriate treatment includes the administration of tetanus toxoid, exploration if there is air in the joint or frank infection, observation, intravenous antibiotics, arm elevation, and splinting. All bites over joints should be assumed to penetrate and require formal incision and drainage.
QUESTION 28
A 24-year-old man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MC P joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. An important step in assessment of human bites is:
1
Evaluation for tendon injury in clenched-fist position
2
Bone scan to rule out osteomyelitis
3
Ultrasound to rule out septic arthritis
4
Monitoring finger girth to document progress
5
None of the above
Evaluation for tendon injury in a clenched-fist position is essential because tendons slide proximally in the open-hand position. Involvement of tendon or joint usually necessitates surgical debridement.
QUESTION 29
A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MC P joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. After cultures are taken, the next important step in treatment is:
1
Debridement in the emergency department and suture
2
Single dose intravenous (IV) antibiotics and discharge on oral antibiotics with follow-up instructions
3
Admit and administer IV antibiotics
4
Patient work up for human immunodeficiency virus
5
None of the above
A patient with a human bite must be admitted for IV antibiotics and observation. If left untreated, human bites are commonly infected by a mixed flora of organisms. Therefore, they must be treated diligently.
QUESTION 30
A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MC P joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. The most appropriate antibiotic treatment includes:
1
Imipenam and ciprofloxacin
2
C efotaxime and ciprofloxacin
3
Amoxicillin and ciprofloxacin
4
Amoxicillin and flocloxacillin
5
Bactrim and rifampin
Imipenam and ciprofloxacin provide treatment for gram-negative and gram-positive organisms.
QUESTION 31
Which of the following organisms is most likely found in a cat bite:
1
Eikenella corrodens
2
Pasteurella multocida
3
Micrococcus
4
Borrelia recurrentis
5
None of the above
Pasteurella multocida is the most common organism found in animal bites.
QUESTION 32
Which of the following is the atypical mycobacterium that infects a penetrating wound sustained in an aquatic environment:
1
Mycobacterium avium
2
Mycobacterium marinum
3
Mycobacterium aquaticum
4
Mycobacterium tuberculosis hominis
5
Mycobacterium chelorei
Tuberculosis is the most common chronic infection found in the hand. Mycobacterium marinum is the atypical mycobacterium that can infect a wound sustained in a marine environment, freshwater lake, or tropical fish tanks. It is also called swimming pool granuloma or fish tank granuloma.
QUESTION 33
Which of the following is not true for infections caused by Mycobacterium marinum:
1
Noncaseating granuloma is present.
2
Minocycline is the preferred treatment.
3
Lowenstein-Jensen media can be used for cultures.
4
Painful swelling of digit, palm, or wrist is present with redness, warmth, and tenderness.
5
It is also referred to as fish tank granuloma.
Tuberculous infections are chronic infections and do not produce acute signs of inflammation. Therefore, pain and tenderness are present in these infections but warmth and redness are absent. Abscesses produced in tuberculous infections are termed "cold abcesses."
QUESTION 34
Which of the following fascial structures does not contribute to the formation of the spiral cord:
1
Pretendinous band
2
Lateral digital sheet
3
Graysonâs ligament
4
C lelandâs ligament
5
Spiral band
The pretendinous band, spiral band, lateral digital sheet, and Grayson's ligament are all parts of the normal fascia that contribute to the formation of the spiral cord. C leland's ligament is not involved at all in the disease process.
QUESTION 35
Which of the following structures contribute to the formation of the spiral cord:
1
Pretendinous band, Graysonâs ligament, and C lelandâs ligament
2
Pretendinous band, lateral digital sheet, and Graysonâs ligam
3
Pretendinous band, Landsmeer ligament, and Graysonâs ligament
4
Pretendinous band, Landsmeer ligament, and natatory ligament
5
C leland's ligament and Grayson's ligament
The spiral cord is formed from the pretendinous band, spiral band, Grayson's ligament, and lateral digital sheet. C leland's ligament is not affected in Dupuytren's contracture. Remember that bands and ligaments give rise to cords, which are the diseased state.
QUESTION 36
Surgical release in Dupuytrenâs disease is indicated in which of the following:
1
A 15° metacarpophalangeal (MP) joint contracture and a 15° proximal interphalangeal (PIP) joint contracture
2
A 15° MP joint contracture and a 0° PIP joint contracture
3
Palpable spiral cord involving ring and small fingers
4
Palpable spiral cord involving ring and small fingers with multiple skin pits
5
Palpable spiral cord involving ring and small fingers in both of the hands
The indication for surgery in Dupuytrenâs disease is MP joint contracture larger than 30° and any degree of PIP joint deformity. The other answers are incorrect because they are subjective descriptions and do not necessarily indicate joint involvement.
QUESTION 37
Skin pits in Dupuytrenâs disease are caused by:
1
Vertical septae of Legueu and Juvara
2
Vertical fibers of palmar aponeurosis anchoring to the skin
3
Longitudinal fibers of palmar aponeurosis inserting into the skin
4
Longitudinal pretendinous bands
5
C ontractures of the natatory ligaments
The longitudinal fibers forming layer 1 of the palmar aponeurosis insert into the dermis and, when contracted, give rise to skin pits. The pretendinous bands give rise to the central cord. C ontractures of the natatory ligament give rise to the natatory cord. Vertical fibers and septae do not give rise to pits.
QUESTION 38
An otherwise healthy man has Dupuytrenâs disease, which involves his small finger with 40° proximal interphalangeal joint involvement. The preferred surgery in this patient is:
1
Partial fasciectomy
2
Arthrodesis
3
Arthroplasty
4
Osteotomy
5
Fasciotomy with skin grafting
A partial fasciectomy is the preferred surgery in this situation. It is recommended that involved fascial cords be resected rather than performing prophylactic fasciectomies. C are must be taken to preserve the neurovascular bundles. Arthrodesis, arthroplasty, and osteotomies are salvage procedures meant for recurrent disease. Fasciotomy has been recommended for elderly patients
who cannot tolerate a long operation.
QUESTION 39
Marjolinâs ulcers are risk factors for which of the following tumors:
1
Squamous cell carcinoma
2
Basal cell carcinoma
3
Melanoma
4
Synovial sarcoma
5
Osteosarcoma
Marjolinâs 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 40
Which of the following tumors rarely metastasizes:
1
Malignant melanoma
2
Synovial sarcoma
3
C lear cell carcinoma
4
Dermatofibrosarcoma protuberans
5
Squamous cell carcinoma
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 41
Lymph node involvement is common in all of the following tumors except:
1
Sweat gland tumors
2
Squamous cell carcinoma
3
Melanoma
4
Basal cell carcinoma
5
Merkel's cell carcinoma
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 42
Which of the following is not a characteristic of an acrolentiginous melanoma:
1
Involves palm and nail bed
2
Delays in diagnosis are common
3
Presents in older patients
4
Does not commonly metastasize
5
Develops rapidly
Acrolentiginous melanomas are usually flat, pigmented lesions. These melanomas often occur in older patients, affecting the palm and nail bed. At the time of presentation, acrolentiginous melanomas are frequently metastasized.
QUESTION 43
Nevi at greatest risk for malignant degeneration are:
1
Giant congenital hair variety
2
Blue nevi
3
Junctional nevi
4
C ompound nevi
5
Nevus sebaceous
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 44
All of the following are risk factors for malignant melanoma except:
1
Sunlight
2
Genetic predisposition
3
C opper-based tanning lotions
4
Atypical nevi
5
Immunosuppressive state
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 45
Which of the following statements is true regarding soft tissue sarcomas:
1
Soft tissue sarcomas frequently metastasize to bone.
2
Patients with soft tissue sarcomas of the hand have worse prognosis than patients with similar tumors in other extremities.
3
Soft tissue sarcomas present as a painful mass in the hand.
4
Overall prognosis is better with radical resection than wide excision.
5
Soft tissue sarcomas can be "shelled out".
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."
QUESTION 46
Which of the following tumor metastasizes to lungs:
1
Squamous cell carcinoma
2
Basal cell carcinoma
3
Soft tissue sarcoma
4
Schwannoma
5
Actinic keratosis
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 47
Which of the following is not a characteristic of synovial sarcomas:
1
Synovial sarcomas are poorly differentiated masses located close to joints, tendon, or bursa.
2
Spindle and epithelial-type cells with monophasic or biphasic cells are present on histology.
3
Lymphatic spread is common.
4
Wide or radical excision with radiation or chemotherapy prevents metastases.
5
High grade malignant soft tissue sarcoma
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 48
C haracteristic histological features of malignant schwannoma are best described as:
1
Fusiform cells with neoplastic schwann cells and nerve fascicles
2
Spindle and epithelial-type cell mix with monphasic or biphasic cells
3
Round or fusiform cells with clear cytoplasm and nerve fascicles
4
Pleomorphic spindle histiocytes and giant cells in a storiform pattern
5
None of the above
The histological features of malignant schwannoma have characteristic fusiform cells with neoplastic schwann cells and nerve fascicles.
