MCQ Revision PDF

An 11-year-old boy has pain in his left leg that has persisted for 3 weeks. On physical examination his temperature is 37.9°C. A radiograph of the leg reveals a mass in the diaphyseal region of the left femur with overlying cortical erosion and soft tissue extension. A bone biopsy is per...

An 11-year-old boy has pain in his left leg that has persisted for 3 weeks. On physical examination his temperature is 37.9°C. A radiograph of the leg reveals a mass in the diaphyseal region of the left femur with overlying cortical erosion and soft tissue extension. A bone biopsy is performed and the lesion on microscopic examination shows numerous small round blue cells arranged in rosettes. Karyotypic analysis of these cells shows t(11;22). Which of the following neoplasms is he most likely to have? A Ewing sarcoma B Medulloblastoma C Neuroblastoma D Chondroblastoma E Osteoblastoma A 16-year-old boy has noted pain in his left knee after each hockey practice session for the past month. On examination there is tenderness to palpation of his left knee, with reduced range of motion. A plain film radiograph of the left leg reveals a mass of the proximal tibial metaphysis that erodes bone cortex, lifting up the periosteum where reactive new bone is apparent. The mass does not extend into the epiphyseal region. A bone biopsy is performed and microscopic examination shows atypical, elongated cells with hyperchromatic nuclei in an osteoid stroma. Which of the following neoplasms is he most likely to have? A Ewing sarcoma B Osteosarcoma C Chondrosarcoma D Multiple myeloma E Metastatic seminoma A 56-year-old woman has a 27 year history of poorly controlled diabetes mellitus. She develops an ulceration on the ball of her foot that does not heal for 2 months. Which of the following complications involving bone is she most likely to develop? A Chondrocalcinosis B Osteomyelitis C Squamous cell carcinoma  D Osteosarcoma E Osteopetrosis An otherwise healthy 44-year-old man with no prior medical history has had increasing back pain and right hip pain for the past decade. The pain is worse at the end of the day. On physical examination he has bony enlargement of the distal interphalangeal joints. A radiograph of the spine reveals the presence of prominent osteophytes involving the vertebral bodies. There is sclerosis with narrowing of the joint space at the right acetabulum seen on a radiograph of the pelvis. Which of the following diseases is he most likely to have? A Gout B Rheumatoid arthritis C Osteoarthritis D Osteomyelitis A 51-year-old man has noted constant, dull right hip pain for the past 3 months. On physical examination he has diminished range of motion of the right hip. A radiograph reveals a 10 x 13 cm mass involving the right ischium of the pelvis. The mass has irregular borders and there are extensive areas of bony destruction along with some scattered calcifications. The lesion is resected, and grossly the mass has a bluish-white cut surface. Which of the following is the most likely diagnosis? A Osteosarcoma B Enchondroma C Osteoblastoma D Chondrosarcoma E Paget sarcoma A 69-year-old man has noted increasing back and leg pain for 3 years. He has greater difficulty hearing on the left. On physical examination he has decreased range of motion at the hips. Radiographs reveal bony sclerosis of the sacroiliac, lower vertebral, and upper tibial regions. His hats don't even fit him anymore. Laboratory studies show a serum alkaline phosphatase of 264 U/L. Which of the following conditions is he most likely to have? A Metastatic adenocarcinoma  B Paget disease of bone C Renal failure with renal osteodystrophy D Osteoporosis E Vitamin D deficiency A 5-year-old boy measures at the 5th percentile in height for age. On physical examination most of his decreased height is due to very short legs. However, his trunk and head appear normally proportioned for age. He is of above average intelligence and becomes an orthopedic surgeon. Which of the following is the most likely diagnosis? A Fibrous dysplasia B Osteogenesis imperfecta C Ollier disease D Achondroplasia A 38-year-old woman has severe systemic lupus erythematosus with renal complications. She is treated with long-term corticosteroid therapy. Which of the following bone diseases is she most likely to develop? A Paget disease of bone B Rickets C Osteochondritis D Osteoporosis E Osteomalacia which of the following features represent the most common complication of Basal cell carcinoma of skin? Select one: a. secondary infection b. local recurrence c. lymphatic spread d. blood spread  A 60 years old male was presented to his surgeon by mass on his cheek which was rapidly growing for the past 2 months. on examination the mass had ulcerating surface with raised everted edges and necrotic floor. Incisional biopsy revealed infiltration of the dermis by cell nests with central keratinization. what is your provisional diagnosis? Select one: a. Basal cell carcinoma b. malignant melanoma c. squamous cell carcinoma d. melanocytic nevus All of the following features are present in genital warts EXCEPT Select one: a. papillomatosis b. acanthosis c. hyperkeratosis d. Moro microbscess which of the following factors determine the (T stage) in assessment of malignant melanoma? Select one: a. tumor size b. degree of local spread c. vertical spread (depth of invasion) d. degree of horizontal (superficial) spread A 23 years male was presented by severe pain in his left knee joint. He had high grade fever, increased ESR. X ray revealed a well defined cystic lesion containing a piece of necrotic bone. His doctor described for him a strong course of antibiotics and recommended surgical removal and debridement of the necrotic bone. What is the definition of necrotic bone in this case? Select one: a. sinus b. cloaca c. involucrum d. sequestrum a 60 years male was presented to the ER by pathological fracture in his left femur. X ray revealed an ill defined mass at epiphysis of femur with soap pubble appearance. what the expected microscopic features of this lesion Select one: a. biphasic tumor composed of giant cells and mononuclear stromal cells b. sheets of malignant chondrocytes with more than 2/ lacuna c. rosettes of small rounded cells d. atypical osteoblasts with lace like osteoid A 60 years male was presented to the ER by pathological fracture of his left ribs. x ray chest and skull revealed multiple osteolytic lesions in the skull. Bone marrow biopsy revealed sheets of malignant plasma cells. Which of the following clinical presentations are common in this case? Select one: a. dystrophic calcification b. Normal protein electrophoresis c. hypocalcemia d. primary amyloidosis Post menopausal women are liable to which of the following metabolic bone disorders secondary to lack of estrogen hormone production? Select one: a. osteopetrosis b. osteomalacia c. paget disease of bone d. osteoporosis Which of the following structures are presented in soft callus during the process of healing bone fractures? Select one: a. calcified osteoid b. non calcified osteoid c. granulation tissue d. inflammatory reaction a 10 years old male was presented by severe pain in his left lower limb. X ray revealed a bony process from cortex of metaphysis of the lower tibia with MUSHROOm appearance. Microscopic examination revealed bone trabeaculea covered by cartilagenous cap. what is your diagnosis? Select one: a. osteoblastoma b. chondroma c. osteoid osteoma 1- An 80-year-old woman has had no major medical problems, but she has never been physically active for most of her life. One day she falls out of bed and immediately notes a sharp pain in her left hip. She is subsequently unable to ambulate without severe pain. Radiographs show not only a fracture of the left femoral head, but also a compressed fracture of T10. Which of the following conditions is she most likely to have? A Vitamin D deficiency B Acute osteomyelitis C Osteogenesis imperfecta D Osteoporosis E Metastatic breast carcinoma 2- A 16-year-old boy has noted pain in his left knee after each hockey practice session for the past month. On examination there is tenderness to palpation of his left knee, with reduced range of motion. A plain film radiograph of the left leg reveals a mass of the proximal tibial metaphysis that erodes bone cortex, lifting up the periosteum where reactive new bone is apparent. The mass does not extend into the epiphyseal region. A bone biopsy is performed and microscopic examination shows atypical, elongated cells with hyperchromatic nuclei in an osteoid stroma. Which of the following neoplasms is he most likely to have? A Ewing sarcoma B Osteosarcoma  C Chondrosarcoma D Multiple myeloma 3- A 5-year-old boy measures at the 5th percentile in height for age. On physical examination most of his decreased height is due to very short legs. However, his trunk and head appear normally proportioned for age. He is of above average intelligence and becomes an orthopedic surgeon. Which of the following is the most likely diagnosis? A Fibrous dysplasia B Osteogenesis imperfecta C Ollier disease D Achondroplasia 4- A social worker refers a 2-year-old child to the physician because of suspected child abuse with multiple bone fractures. On physical examination, the child has blue sclerae, diminished hearing in both ears, and misshapen teeth. There are no external contusions or lacerations of the skin. Radiographs of the child's extremities show recent and healing long bone fractures. Which of the following is the most likely diagnosis? A Trauma ('shaken child syndrome') B Osteogenesis imperfecta C Achondroplasia D Rickets E Osteopetrosis 5- A 50-year-old man has experienced pain in his right knee for the past 4 years. The pain is worse when walking for longer distances. On physical examination there is no joint swelling, warmth, or erythema, but he does have decreased range of motion. Which of the following conditions is he most likely to have? A Osteoporosis C Osteomalacia D Osteoarthritis E Osteopetrosis  1) bone tumour is associated with lifting of periosteum off bone producing the Codman triangle and a sunburst appearance on X-ray? A Osteosarcoma B Osteoma C Ewing sarcoma D Chondroma 2) A 51-year-old man has noted constant, dull right hip pain for the past 3 months. A radiograph reveals a 10 x 13 cm mass involving the right ischium of the pelvis. The mass has irregular borders along with some scattered calcifications. Grossly the mass has a bluish-white cut surface. Which of the following is the most likely diagnosis? A Osteosarcoma B Enchondroma C Osteoblastoma D Chondrosarcoma E Paget sarcoma 3) Osteogenesis imperfecta results from: A. Decrease peak bone mass with ageing B. Defect in Type I Collagen protein C. Vitamin D deficiency. Accelerated rate of bone remodeling 4) Vitamin D deficiency in children results in: A. Early closure of skull fontanelles B. Increased intestinal absorption for calcium C. Genu varum due to inadequate bone mineralization D. Lion-shaped bones of face 1) A 51-year-old man has noted constant, dull right hip pain for the past 3 months. On physical examination he has diminished range of motion of the right hip. A radiograph reveals a 10 x 13 cm mass involving the right ischium of the pelvis. The mass has irregular borders and there are extensive areas of bony destruction along with some scattered calcifications. The lesion is resected, and grossly the mass has a bluish-white cut surface. Which of the following is the most likely diagnosis? A Osteosarcoma B Enchondroma  C Osteoblastoma D Chondrosarcoma E Paget sarcoma 2) A 70 year old with long standing hypertension and increasing shoe size and cap size comes into your office. Her condition has progressed a tumor. Radiological examination reveals sunburst effect and Codman's triangle. What is the most common location of her tumor? A. Metaphysis B. Diaphysis C. Epiphysis D. Metaphysis and Diaphysis E. Diaphysis and Epiphysis 3) A 45-year-old man has experienced pain in the area of the left hip and upper thigh for the past 7 months. On physical examination, there is tenderness on deep palpation of the left side of the groin. There is a reduction in range of motion at the left hip. There is no swelling or warmth to the touch. Pelvic and left leg radiographs show an upper femoral mass lesion arising in the metaphyseal region and eroding the surrounding bone cortex. The proximal femur is excised and on sectioning has of bale blue gross appearance. Which of the following cell types is most likely to be proliferating in this mass? (A) Osteoblasts (B) Chondroblasts (C) Osteoclasts (D) Primitive neuroectodermal cells (E) Plasma cells 4) An 18-year-old man sees the physician because he has had pain around the right knee for the past 3 months. There are no physical findings except for local pain over the area of the distal right femur. A radiograph of the right leg shows an ill- defined mass involving the metaphyseal area of the distal right femur, and there is elevation of the adjacent periosteum. A bone biopsy specimen shows large, hyperchromatic, pleomorphic spindle cells forming an osteoid matrix. What is the most likely diagnosis? A. Ewing sarcoma B. Chondrosarcoma C. Giant-cell tumor of bone D. Fibrous dysplasia E. Osteosarcoma 5) A 12-year-old girl has complained of sudden onset of severe pain in her left knee that has awakened her from sleep on several occasions during the past 6 weeks. For each episode, her mother has given her acetylsalicylic acid (aspirin), and the pain has been relieved. On physical examination, there are no remarkable findings. A radiograph of the left knee shows a well-defined, 1-cm lucent area surrounded by a thin rim of bony sclerosis located in the proximal tibial cortex. The patient undergoes curettage of the lesion, and the pain does not recur. What is the most likely diagnosis of this lesion? A. Osteosarcoma B. Enchondroma C. Osteoid osteoma D. Chondrosarcoma E. Giant cell tumors 6) A 15-year-old boy experiences severe pain in the right leg after performing a gymnastic floor exercise. On physical examination, there is marked pain on palpation of the right lower thigh just above the knee. Radiographs show a pathologic fracture across a discrete, 3-cm lower femoral diaphyseal lesion that has central lucency with a thin sclerotic rim. The lesion is completely intramedullary and well circumscribed. A bone biopsy specimen of the affected region shows trabeculae of woven bone scattered in a background of fibroblastic proliferation. What is the most likely diagnosis? A. Osteoid osteoma B. Ewing sarcoma C. Fibrous dysplasia D. Osteosarcoma E. Enchondroma 7) A 30-year-old man has experienced pain in the area of the left knee for more than 1 month. On physical examination, there is tenderness to palpation of the distal left thigh and knee. The area is firm, but there is no erythema or warmth. A radiograph of the left leg shows a 7-cm mass in the distal femoral epiphyseal area, with a “soap bubble” appearance. Microscopic examination of a biopsy specimen of the lesion shows multinucleated cells in a stroma predominantly composed of spindle-shaped mononuclear cells. What is the most likely diagnosis? (A) Ewing sarcoma (B) Osteoblastoma (C) Enchondroma (D) Osteitis fibrosa cystica (E) Giant-cell tumor 8) Osteoid osteoma originates from: a. Periosteum. b. Cortex.  c. Medullary cavity. d. All of the above 9) bone secondaries commonly arise from cancer of: a. Breast. b. Lung. c. Prostate. d. Adrenal. 10) Ewing's tumor affecting the humerus a. it is a metastasis from carcinoma of the thyroid b. should be treated by immediate amputation c. looks like a cut onion on x-ray d. has a soap-bubble appearance on x-ray e. displays sun-ray spicules on x-ray 11) bone tumour is associated with lifting of periosteum off bone producing the Codman triangle and a sunburst appearance on X-ray? A Osteosarcoma B Osteoma C Ewing sarcoma D Chondroma