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Dag 2 Flashcards

1
Q

Bony swelling of the proximal humerus in a young patient. The most likely diagnosis is:

  1. chondrosarcoma
  2. chondroblastoma
  3. fibrous dysplasia
  4. broad-based osteochondroma
  5. eosinophilic granuloma
A
  1. broad-based osteochondroma
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2
Q

A 57-year-old male presents with neck pain and headache. Facial nerve palsy is found on physical examination. Sagittal T1-weighted MR showed a hypointense masse measuring 5x4x4.5 cm centered in the clivus. A transoral biops was performed and showed a tumor with lobulated architecture and abundant extracellular matrix. The tumor cells show abundant, vacuolated cytoplasm. Immunohistochemistry for keratin and brachyury is positive. These findings ars most typical for

  1. Chondrosarcoma
  2. Enchondroma
  3. Benign notochordal cell tumor
  4. Chordoma
  5. Chondroblastoma
A
  1. Chordoma
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3
Q

20-year old patient with complaints of proximal humerus. Plain radiograph and axial T2-weighted (water sensitive) MR image representing a lesion. Which of the following statements is right?

  1. based on the age and radiographic appearance chondrosarcoma is the most likely diagnosis
  2. based on location, age of the patient and radiographic appearance osteosarcoma is the most likely diagnosis
  3. the radiographic appearance and surrounding edema on MRI (high on T2) is consistent with osteomyelitis
  4. the radiographic appearance and surrounding edema is consistent with chondroblastoma
  5. this is certainly a benign lesion because there is no soft tissue extension
A
  1. the radiographic appearance and surrounding edema is consistent with chondroblastoma
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4
Q

Adult patient with condroid lesion of the middle phalanx and fracture. Plain radiographs in AP and lateral direction. Which of the following statements is not valid?

  1. without cortical destruction and soft tissue swelling, low-grade chondrosarcoma in a phalanx is not a likely diagnosis
  2. enchondroma is the most commonly encountered bone tumor in a phalanx
  3. enchondromas in phalanges may present as lucent lesions without any calcifications
  4. a fracture after a minor trauma is a common presentation of an enchondroma of the hand
  5. MR imaging should always be performed in patients with chondroid lesions of the phalanges
A
  1. MR imaging should always be performed in patients with chondroid lesions of the phalanges
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5
Q

32-year old patient with pain of the left knee. Plain radiographs and axial T2-weighted MR image are shown. Which answer is right?

  1. based on the location and age of the patient chondroblastoma is the most likely diagnosis
  2. based on the location and age of the patient giant cell tumor is the most likely diagnosis
  3. the low signal intensity on T2 and surrounding edema (high signal) makes a diagnosis of chondroblastoma or giant cell tumor unlikely
  4. based on the radiographic appearance, age and MRI aneurysmal bone cyst is most likely diagnosis
  5. based on the radiographic lesional margins, this is certainly a malignant bone tumor
A
  1. based on the location and age of the patient giant cell tumor is the most likely diagnosis
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6
Q

Conventional osteosarcoma is characteristically defined as

  1. A malignant, bone-forming neoplasm that arises on the surface of bone
  2. A low-grade malignant bone-forming tumor that arises within the medullary cavity of bone
  3. A malignant neoplasm in which the neoplastic cells produce bone
  4. A malignant hyaline cartilage neoplasm
  5. A bone-forming neoplasm that produces woven bone spicules, which are bordered by prominent osteoblasts
A
  1. A malignant neoplasm in which the neoplastic cells produce bone
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7
Q

A 21 year old man presented with a painful increasing swelling of the lower leg. Images and histology are shown below. What is the most likely diagnoses?

  1. Unicameral Bone Cyste
  2. Osteosarcoma
  3. Ewing Sarcoma
  4. Aneurysmal Bone Cyste
  5. High grade Chondrosarcoma
A
  1. Aneurysmal Bone Cyste
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8
Q

Classic adamantinoma of long bone occurs in the diaphysis of long bones. Histologically, this lesion is characteristcally composed of

  1. Epithelial cells embedded in a cellular fibrous proliferation
  2. Osteoblasts depositing mature lamellar bone admixed with osteoclasts
  3. Osteoclast-like giant cells in a background of mononuclear cells
  4. Small round cells with a diffuse growth pattern
  5. Spindle-shaped cells depositing woven bone
A
  1. Epithelial cells embedded in a cellular fibrous proliferation
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9
Q

12 year old girl with pain on the posteromedial side right knee. No fever, no trauma, severe nightpain. X-ray, MRI and histology are shown. What is the most likely diagnoses

  1. Unicameral Bone Cyste
  2. Osteomylitis
  3. Fibrous dysplasia
  4. Chondroblastoma +/- Aneurysmal Bone Cyste
  5. Chondrosarcoma
A
  1. Chondroblastoma +/- Aneurysmal Bone Cyste
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10
Q

34 year old man with mild pain in the right thigh, no fever no swelling, no night pain. X-ray, MRI, and Histology are shown. What is the most likely diagnoses?

  1. Chondroblastoma
  2. Osteomyelitis
  3. Osteosarcoma
  4. Enchondroma
  5. High grade Chondrosarcoma
A
  1. Enchondroma
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11
Q

Which of the following tumors is associated with IDH1 or IDH2 mutations?

  1. Osteochondromas
  2. Enchondromas
  3. Osteoid osteoma
  4. Osteoblastoma
  5. Chondroblastoma
A
  1. Enchondromas
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12
Q

You work in a sarcoma center. This 13 yr old boy has pain in his left hip. What is true about this lesion:

  1. You must get a “, it might be malignant and you should order an MRI
  2. It looks benign, a “no-touch” lesion and you should not do anything
  3. It may be an osteoid and you first order a CT
  4. It may be an osteoid osteoma and you first order an MRI
  5. It may be a metastasis and you order a chest x-ray and do bloodtests
A
  1. It may be an osteoid and you first order a CT
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13
Q

What is the preferred route of biopsy?

  1. 1
  2. 2
  3. 3
  4. 4
  5. 5
A
  1. 3
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14
Q

What biopsy route can be used?

  1. 1
  2. 2
  3. 3
  4. 4
  5. 1 and 3 can both be used
A
  1. 1 and 3 can both be used
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15
Q

A 56 year old man has spontaneous pain in his roght hip, no trauma. Past medical history is unremarkable except for prostatitis. He had fysiotherapy, but the pain got worse. X ray shows a lucency right proximal femur. You ordered an MRI, but before it was done, he presents with a fracture.

  1. You do an MRI, blood tests and plan a biopsy or consult a collegue.
  2. It is probably a metastasis, he is in pain, so you take him to theatre to do a biopsy and put in a femoral nail
  3. You first ask the medical oncologist to screen him for a primary lesion, and plan him already for biopsy and femoral nailing in 2 days so he does not have to wait too long
  4. You do a biopsy and wait for the result before you do anything else
  5. Because of his age and the lytic nature of the lesion, it is very likely multiple myeloma and he needs chemotherapie and radiation directly
A
  1. You do an MRI, blood tests and plan a biopsy or consult a collegue.
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16
Q

A 3 year old boy has vague pain in his left lower tibia. The x ray is shown. What should you do?

  1. biopsy because it can be malignant
  2. MRI, to rule out malignancy
  3. nothing, tell the parents it is a solitary bone cyst
  4. follow up with x ray after 6 weeks
  5. its excentric localisation is indicative for non-ossifying fibroma, no further treatment or follow up is needed
A
  1. follow up with x ray after 6 weeks
17
Q

A 45 old man devolps a painless swelling on his medial malleolus of which the images are shown below. What is the preferred choice of diagnostics

  1. X ray + MRI + Needle biopsy + Chest CT
  2. X ray + Needle biopsy + MRI + Chest CT
  3. X ray + Excisional biopsy
  4. X ray + Incisional biopsy
  5. X ray + MRI + Incisional biopsy + PET-CT
A
  1. X ray + MRI + Needle biopsy + Chest CT
18
Q

After MRI and biopsy the patient returns for a diagnosis. What is the most likely diagnoses

  1. Low grade Liposarcoma
  2. Osteosarcoma
  3. Chondrosarcoma
  4. Mixoidfibrosarcoma
  5. Synoviosarcoma
A
  1. Mixoidfibrosarcoma
19
Q

What should be considered the Optimal treatment plan (Mixoidfibrosarcoma)

  1. (Neo)adjuvant radiation therapy + resection
  2. (Neo)adjuvant Chemotherapy + resection
  3. (Neo)adjuvant radiotion therapy + resection + free flap
  4. Below knee amputation
  5. Palliative chemotherapie
A
  1. (Neo)adjuvant radiotion therapy + resection + free flap
20
Q

20 year old male comes to see you after a whoops procedure. Histology and postoperative scar are shown. What is the most likely diagnosis

  1. Volar ganglion
  2. Liposarcoma
  3. Osteosarcoma
  4. Synoviosarcoma
  5. Ewing Sarcoma
A
  1. Synoviosarcoma
21
Q

A 18 year old female has a swelling of the right lower leg dorsal aspect. What is the diagnosis?

  1. Parosteal osteosarcoma
  2. High grade chondrosarcoma
  3. Myositis ossificans
  4. Osteochondroma
  5. Chondrosarcoma
A
  1. Osteochondroma
22
Q

What is the treatment?

  1. Never operate
  2. Biopsy obligatory
  3. Only resect if complains
  4. Resection obligatory
  5. Curretage + adjuvans
A
  1. Only resect if complains
23
Q

15 year old girl, pain right groin since 4 months, got worse after skiing. Which is the most plausible DD?

  1. Chondrosarcoma, osteosarcoma
  2. Sports injury, Eosinophilic granuloma
  3. Aneurysmal bone cyst, Giant cell tumor
  4. Classical osteosarcoma, Ewing’s sarcoma
  5. Ewing’s sarcoma, Aneurysmal bone cyste
A
  1. Ewing’s sarcoma, Aneurysmal bone cyste
24
Q

Biopsy: what is the diagnose, what can confirm that?

  1. Metastatic lung carcinoma, 11-12 translocation
  2. Osteosarcoma, rosette pattern of cells
  3. Ewing’s sarcoma, translocation 11-12 product
  4. Chondrosarcoma, wagon wheel nuclei
  5. Ewing’s sarcoma, rosette pattern of cells
A
  1. Ewing’s sarcoma, translocation 11-12 product
25
Q

15 year old girl, Ewing’s sarcoma. Which treatment gives the best chance of survival?

  1. Chemotherapy, resection and radiotherapy
  2. Chemotherapy and radiotherapy
  3. Chemotherapy and resection or RT equally
  4. Wide resection only
  5. No cur possible, palliative treatment only
A
  1. Chemotherapy, resection and radiotherapy
26
Q

A 10 year old boy has a painfull swelling of the left upper leg/knee. X-rays and MRI are shown above. What is the most likely diagnosis?

  1. Osteochondroma
  2. Chondrosarcoma
  3. Aneurysmal bone cyst
  4. Classical osteosarcoma
  5. Ewing’s sarcoma
A
  1. Classical osteosarcoma
27
Q

Osteosarcomas most often metastasize to

  1. liver
  2. bone
  3. regional lymf nodes
  4. lungs
  5. brains
28
Q

26 year old woman, pain left shoulder since 1 year, no improvement with fysiotherapy. How would you value the findings on MRI?

  1. Certainly benign
  2. Probably benign
  3. Certainly malignant
  4. Probably malignant
  5. An inactive, inert lesion
A
  1. Probably benign
29
Q

26 year old woman with chondroblastoma of left shoulder. What is the therapy?

  1. Radiation therapy
  2. Wide resection, reconstrucion
  3. Marginal excision, reconstruction
  4. Curettage, adjuvant, bone grafting
  5. Chemotherapy and wide excision
A
  1. Curettage, adjuvant, bone grafting
30
Q

A 64 year old male has progressive pain of his left lower leg since 2 months. On the basis of the images above, what is the most likely diagnosis?

  1. High grade chondrosarcoma
  2. Lymfoma
  3. Enchondroma
  4. Osteosarcoma
  5. Aneurysmal Bone Cyst
A
  1. High grade chondrosarcoma
31
Q

If a biopsy would show chondrosarcoma graad 2, what would the correct treatment advise be?

  1. Curettage
  2. Radiotherapy
  3. Chemotherapy, followed by resection
  4. Radiotherapy first, then resection
  5. Wide resection
A
  1. Wide resection
32
Q

Betreffende wee delen tumoren van het steun- en bewegingsapparaat stelt de “richtlijn weke delen tumoren” (2004) het volgende:

  1. Een zwelling kan, zonder nadere diagnostiek vooraf, worden geexcideerd als deze kleiner is dan 3 centimeter, oppervlakkig van de fascie is gelokaliseerd en er geen andere alarmsignalen zijn
  2. Alle weke delen zwellingen die oppervlakkig liggen kunnen, zonder nadere diagnostiek vooraf, worden geexcideerd. Voorwaarde is wel dar er pathologisch onderzoek van de gereseceerde afwijking plaatsvindt zodat zo nodig aanvullende therapie kan worden ingezet
  3. Bij alle weke delen zwellingen dient te worden verwezen naar een gespecialiseerd centrum of overleg hiermee plaats te vinden
  4. Bij alle weke delen zwellingen dienst, voor excisie, radiologische en pathologische diagnostiek te worden verricht
  5. Van geexcideerde tumoren, kleiner dan 5 cm en oppervlakkig gelegen, hoeft geen pathologisch onderzoek te worden verricht
A
  1. Een zwelling kan, zonder nadere diagnostiek vooraf, worden geexcideerd als deze kleiner is dan 3 centimeter, oppervlakkig van de fascie is gelokaliseerd en er geen andere alarmsignalen zijn
33
Q

Bij vrijwel alle hooggradige weke delen sarcomen van het steun- en bewegingsapparaat is het belangrijkste onderdeel van de behandeling:

  1. Chemotherapie
  2. Resectie met een marge van gezond weefsel
  3. Radiotherapie
  4. Combinatie van chemotherapie, radiotherapie en resectie
  5. Radiotherapie en chemotherapie
A
  1. Resectie met een marge van gezond weefsel
34
Q

The most important risk factor in metastic disease of the bone is?

  1. Size of the bone metastasis
  2. Number of bone metastasis
  3. Functional status
  4. Previous chemotherapy
  5. Primary tumor
A
  1. Primary tumor
35
Q

Analysing the fracture risk and optimal preoperative screening in a 66-year-old patient with an impending pathological fracture of a unknown primary tumor at the proximal femur shown on a MRI scan of the femur following steps should be at least performed:

  1. X ray proximal femur, Tech 99 scan, CT chest
  2. X ray complete femur, Tech 99 scan, CT chest
  3. X ray complete femur, Tech 99 scan, biopsy, x thorax
  4. X ray complete femur, Tech 99 scan, biopsy, CT chest
  5. X ray complete femur, Tech 99 scan, biopsy, CT chest and abdomen
A
  1. X ray complete femur, Tech 99 scan, biopsy, CT chest and abdomen
36
Q

A 46-year-old man has had persistent pain of the left knee for the past 2 months after a minor trauma. A radiograph and coronal T1-weighted and T2-weighted MRI scans are shown. What is the most likely diagnosis?

  1. Metastatic prostate cancer
  2. Enchondroma
  3. Atypical cartilaginous tumour (ACT)
  4. Bone infraction
  5. Osteomyelitis
A
  1. Bone infraction
37
Q

A 49-year-old man reports a painless mass at the proximal part of the left fibula that appeared 3 years ago and has slowly increased size. Examination reveals a firm, well-defined non-tender mass at the proximal fibula. Plain radiographs and T2 weighted MRI scans are shown. What is the most likely treatment?

  1. Observation
  2. Primary enbloc resection
  3. Curettage with adjuvants
  4. Curettage
  5. Chemotherapy
A
  1. Primary enbloc resection
38
Q

A 63-year-old male has right humeral pain with arm activity and in rest at night. In the history none malignancy’s are reported. Ct chest and Tech 99 are unremarkable accept for known humeral lesion. Plain radiograph is shown, T1- and T2 weighted and with gadolinium. What is the most likely diagnosis?

  1. Metastatic prostatic cancer
  2. Low grade chondrosarcoma (ACT)
  3. High grade chondrosarcoma
  4. Giant cell tumour
  5. Lymphoma
A
  1. High grade chondrosarcoma
39
Q

26-year-old boy has a painful slowly-growing mass of the right knee for the past 9 months. He reports a painless mass at this site for at least 10 years. Examination reveals a firm, well-defined non-tender mass at the posterior proximal fibula-tibia. Plain radiographs and T2-weighted MRI scans are shown. What is the most likely treatment?

  1. Through knee exarticulation
  2. Intralesional excision
  3. Curettage
  4. Primary enbloc resection
  5. Radiotherapy
A
  1. Primary enbloc resection

CCOC III (6 decks)

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