Neoplasia I & II Flashcards by Jojo Barnes-Jones

Electrophoresis of serum proteins is 80-90% accurate to predict the diagnosis of multiple myeloma. In decreasing frequency, which immunoglobulins are the most commonly elevated in plasma cell myeloma?

A. IgD > IgA > IgG > IgM > IgE

B. IgM > IgA > IgD > IgG > IgE

C. IgG > IgA > IgD > IgE > IgM

D. Iga > IgG > IgD > IgM > IgE

E. IgE > IgA > IgD > IgM > IgG

C. IgG > IgA > IgD > IgE > IgM

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95% of patients afflicted with Ewing’s sarcoma are under the age of 30. What is the peak age of onset for patients with this disease?

A. 5-10

B. 10-15

C. 15-20

D. 20-25

E. 25-30

B. 10-15

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What is the most common primary source of skeletal metastases in females?

A. Carcinoma of the prostate

B. Carcinoma of the lung

C. Carcinoma of the breast

D. Carcinoma of the uterus

E. Carcinoma of the kidney

C. Carcinoma of the breast

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Which one of the following is a reliable factor in making the diagnosis of a giant cell tumor?

A. The radiographic combination of a narrow zone of transition and no sclerotic margins

B. Anatomic location

C. Periosteal reaction

D. Fluid levels seen on CT

A. The radiographic combination of a narrow zone of transition and no sclerotic margins

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Which of the following differential diagnoses of a solitary osteolytic lesion of the skull that demonstrates a spiculated/reticular pattern or “spoke wheel” appearance?

A. Epidermoid tumor

B. Hemangioma

C. Eosinophilic granuloma

B. Hemangioma

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Which of the following primary sources of skeletal metastases is the leading cause of pathologic fracture?

A. Breast

B. Lung

C. Prostate

D. Thyroid

E. Kidney

A. Breast

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Which of the following carpal bones is most commonly affected by an osteoid osteoma?

A. Scaphoid

B. Lunate

C. Capitate

D. Trapezium

E. Pisiform

A. Scaphoid

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Which one of the following is false regarding multiple myeloma?

A. Most common primary malignant bone tumor

B. 10-15% of multiple myeloma cases are associated with amyloidosis

C. Lesions are greater than 5cm

D. Typically has a small soft tissue mass

C. Lesions are greater than 5cm

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Because the histologic differentiation between a low grade, well-differentiated chondrosarcoma and an enchondroma is often difficult, what is the best way to differentiate these two tumors?

A. Calcification visualized on the radiograph

B. Anatomic location of the tumor

C. Age of the patient

D. Degree of endosteal scalloping

C. Age of the patient

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Which of the following tumors of bone is described as a benign lesion consisting of a central core of vascular osteoid tissue surrounded by a peripheral zone of sclerotic bone?

A. Enostoma

B. Osteoma

C. Osteoid Osteoma

D. Osteochondroma

E. Enchondroma

C. Osteoid Osteoma

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What percentage of Ewing’s sarcoma has a propensity to metastasize?

A. <5%

B. 15-30%

C. 40-60%

D. 70-85%

E. > 95%

B. 15-30%

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Which one of the following processes may not produce (degenerate) into a fibrosarcoma?

A. Paget’s disease

B. Differentiated chondrosarcoma

C. Radiation therapy of bone

D. All the above may produce fibrosarcoma

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Which of following radiographic findings for Hodgkins lymphoma carries the poorest prognosis?

A.Pure osteolytic lesions.

B. Mixed osteolytic and osteosclerotic lesions.

C. Pure osteosclerotic lesions.

D. All of the above carry the same prognosis.

C. Pure osteolytic lesions

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Which one of the following is not a complication of a solitary osteochondroma?

A. Fracture

B. Vascular injury

C. Bursa formation

D. Disappearance of the cartilaginous cap

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What percentage of carcinomas of the breast will metastasize to bone?

A. 10%

B. 30%

C. 50%

D. 70%

E. 90%

D. 70%

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Which one of the following does not represent the radiographic findings of an enchondroma in the hand?

A. Matrix calcification

B. Cortical expansion

C. Soft tissue swelling

D. Endosteal scalloping

C. Soft tissue swelling

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What percent of all sacral tumors are chordomas?

A. 20%

B. 40%

C. 60%

D. 80%

B. 40%

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Which of the following sites represents the most common location of skeletal metastasis?

A. Spine

B. Long tubular bones

C. Small bones of the hands and feet

D. Skull

A. Spine

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Which one of the following does not represent plain film evidence of osteosarcoma demonstrating a favorable response to chemotherapy?

A. Decrease in the size of the soft tissue mass

B. Increase in the periosteal reaction

C. Tumor necrosis

D. Medullary sclerosis

C. Tumor necrosis

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Which one of the following statements is false?

A. The radiographic findings in fibrosarcoma of bone are not specific

B. Those fibrosarcomas that are in the tubular bones, eccentric, geographic, and involve only a portion of the cortex have a worse prognosis

C. Involves men and women with equal frequency

D. Intraosseous fibrosarcomas have a worse prognosis in comparison with their soft tissue cousins

B. Those fibrosarcomas that are in the tubular bones, eccentric, geographic, and involve only a portion of the cortex have a worse prognosis

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Which of the following statements is false in reference to the radiographic appearance of chondromyxoid fibromas?

A. It is primarily a metaphyseal lesion.

B. It is primarily eccentrically located and osteolytic.

C. Extensive calcific foci are visible within its matrix.

D. The lesion may range from 2-10 cm. E. Endosteal sclerosis is common.

C. Extensive calcific foci are visible within its matrix

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Metastases and multiple myeloma can have a similar appearance. Which of the following is NOT true when trying to differentiate metastases from multiple myeloma?

A. Multiple myeloma in the skull presents with discrete lesions of uniform size.

B. Multiple myeloma in the mandible is found less commonly than metastases.

C. Multiple myeloma in the spine will present without osseous extension in the posterior elements.

D. Multiple myeloma in the appendicular skeleton likes the olecranon process of the ulna.

B. Multiple myeloma in the mandible is found less commonly than metastases.

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According to Resnick, what is considered the “gold standard” for the diagnosis of conventional osteosarcoma?

A. Radiography

B. Scintigraphy

C. Angiography

D. Computed tomography

E. Magnetic resonance imaging

A. Radiography

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The periosteal reaction(s) frequently observed with a conventional osteosarcoma is what?

A. Solid

B. Sunburst

C. Codman’s triangle

D. Both B and C

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Which of the following tumors produces a blastic pattern of metastatic disease?

A. Liver

B. Kidney

C. Adrenal

D. Bladder

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A 54-year-old male presents with knee pain. Radiographs reveal a large eccentric osteolytic area with cortical disruption of the distal femur. What must be ruled out?

A. Nonossifying fibroma

B. Desmoplastic fibroma

C. Fibrosarcoma

D. Spindle cell sarcoma

C. Fibrosarcoma

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What is the most common region of a long bone to see an osteoid osteoma?

A. Epiphysis

B. Physis

C. Diaphysis

D. Metaphysis

E. Apophysis

C. Diaphysis

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Which of the following statements about imaging is true with respect to chondroblastomas?

A. The radiographic appearance is that of an eccentric or centrally located osteolytic lesion less than 5-6 cm with cortical thinning and flocculant areas of calcific foci within its matrix.

B. Scintigraphy will demonstrate an increase in radionuclide uptake of the lesion.

C. CT examination will demonstrate areas of calcific foci within its matrix.

D. MRI evaluation demonstrates low signal on TIWI and variable signal intensity on T2WI. E. All of the above are true.

E. All of the above are true

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In decreasing frequency, what is the most common site for conventional osteosarcoma of long bones?

A. Epiphysis > Diaphysis > Metaphysis

B. Diaphysis > Metaphysis > Epiphysis

C. Metaphysis > Diaphysis > Epiphysis

D. They are affected equally.

C. Metaphysis > Diaphysis > Epiphysis

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Which one of the following statements is false regarding malignant giant cell tumors?

A. There is no reliable way to radiographically differentiate a benign GCT from a malignant one.

B. 10 to 15% of giant cell tumors treated with radiation undergo malignant transformation

C. All giant cell tumors of the distal radius are malignant

D. Both A and C are false statements

C. All giant cell tumors of the distal radius are malignant

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The most common presentation of conventional osteosarcoma is what?

A. Purely lytic

B. Purely blastic

C. Mixed

D. Soft tissue mass only

C. Mixed

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What is the most common digit to be affected by an enchondroma?

A. 1st

B. 2nd

C. 3rd

D. 4th

E. 5th

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How often do chondroblastomas demonstrate calcific foci within the lesion?

A. 5%

B. 15%

C. 45%

D. 75%

C. 45%

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What is the most common location of a chordoma?

A. Sacrococcygeal region

B. Spheno-occipital region

C. Cervical spine

D. Thoracic spine

A. Sacrococcygeal region

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A simple or unicameral bone cyst is common in young children and located in the metaphysics but may migrate to the diaphysis as it matures. What percentage of simple bone cysts occur in the proximal humerus?

A. 25%

B: 50%

C. 75%

D. 100%

B. 50%

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Enchondromatosis is a rare, hereditary disorder of multiple, asymmetric foci of intraosseous and subperiosteal cartilage deposition, which usually involves one side of the body.

A. true

B false

B. false

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Which one of the following is false regarding multiple myeloma?

A. Pedicles involved late in the course of the disease

B. Periosteal new bone formation is rare

C. About 30% of the cases have a normal MRI

D. In comparison to metastatic disease, MM rarely affects the mandible

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What is the most common skeletal location of a simple bone cyst?

A. Humerus

B. Femur

C. Tibia

D. Fibula

A. Humerus

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In the femur, intraosseous lipoma has an unusual presentation. Which of the following best describes this?

A. a lytic lesion with a thin, well-defined sclerotic margin

B. a lytic area with a sclerotic margin and a central calcified or ossified nidus

C. a well-defined lytic area with marked ossification of a large part of the lesion’s margin

D. a highly sclerotic lesion with marked periostitis

C. a well-defined lytic area with marked ossification of a large part of the lesion’s margin

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In order of decreasing frequency, what are the most common locations for multiple myeloma to occur?

A. Vertebrae, ribs, skull, pelvis, femur

B. Femur, pelvis, vertebrae, ribs, skull

C. Skull, ribs, vertebrae, pelvis, femur

D. Pelvis, vertebrae, skull, ribs, femur

E. Ribs, vertebrae, skull, femur, pelvis

A. Vertebrae, ribs, skull, pelvis, femur

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Which statement below is true regarding the radiographic appearance of an osteoblastoma occurring in the long tubular bones?

A Periosteal reaction may resemble a malignant neoplasm.

B. Pathologic fractures are common

C. Multifocal lesions are frequently present with the conventional type

D. An epiphyseal location is common in the lower extremities.

A. Periosteal reaction may resemble a malignant neoplasm

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How often is a periosteal reaction evident adjacent to a chondroblastoma?

A. 5%

B. 15%

C. 45%

D. 75%

C. 45%

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The classic presentation of multiple myeloma is focal or diffuse areas of osteolysis demonstrating a permeative or punched out appearance of bone destruction, however an osteoblastic appearance may occur. What percentage of cases demonstrate an osteoblastic appearance?

A. 3%

B. 19%

C. 37%

D. 61%

E. 84%

A. 3%

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Which one of the following is the most important in allowing a precise radiographic diagnosis of chondrosarcoma?

A. Large soft tissue mass

B. Type of periosteal reaction

C. Tumor calcification

D. Soft tissue mass

C. Tumor calcification

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What is the most common bone of the hand to produce an enchondroma?

A. Proximal phalanges

B. Middle phlanges

C. Distal phalanges

D. Metacarpals

A. Proximal phalanges

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Which of the following statement is NOT true with regards to an osteoid osteoma?

A. Age of onset is usually between 7-25 years old.

B. It has a 3:1 male to female predilection.

C. It presents with bone pain at night that is relieved with salicylates.

D. Its site of predilection is the posterior elements of the vertebrae.

E. All of the above are true with regards to osteoid osteomas.

D. It’s site of predilection is the posterior elements of the vertebrae

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Malignant transformation of an enchondroma is most likely to occur in what skeletal location?

A. Foot

B. Hand

C. Femur

D. Rib

C. Femur

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What is the most common site of predilection for Ewing’s sarcoma?

A. Femur

B. llium

C. Tibia

D. Humerus

E. Sacrum

A. Femur

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Which of the following statements is NOT true regarding enchondromas of the long bones?

A. 25% of enchondromas affect the long bones.

B. The lower extremity is affected more than the upper extremity.

C. The humerus is most commonly affected.

D. The femur is the most commonly affected long bone of the lower extremity.

E. They are generally centrally located in the metaphysis.

B. The lower extremity is affected more than the upper extremity

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What is the most common site of involvement of conventional osteosarcoma?

A. Proximal femur

B. Distal femur

C. Proximal tibia

D. Distal tibia

E. Proximal humerus

B. Distal femur

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Aneurysmal bone cysts (ABC) are highly vascular lesions thought to be brought about by either trauma of a precursor lesion. Which one(s) of the following are thought to be those pre-existing lesions? (Select all that apply).

A. Chondrosarcoma

B. Chondroblastoma

C. Giant Cell Tumor

D. Ossifying fibroma

E. Non-ossifying fibroma

A. Chondroblastoma C. Giant Cell Tumor E. Non-ossifying fibroma

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Which of the following statements is false regarding solitary enchondroma?

A. it is a tumor composed of lobules of hyaline cartilage found in the medullary cavity

B. its distribution is similar to that of chondrosarcoma

C. it is usually an asymptomatic lesion

D. the distal phalanges of the hands are an unusual location

B. its distribution is similar to that of chondrosarcoma

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Which one of the following statements is true?

A. Humeral involvement is common in patients with chondroblastomas and infrequent in cases of chondromyxoid fibroma.

B. Chondromyxoid fibroma is more frequent in the femur, whereas chondroblastomas prefer the tibia.

C. Both chondromyxoid fibroma and chondroblastomas have a proclivity for the epiphyseal portion of bone.

D. Both A and C are true

A. Humeral involvement is common in patients with chondroblastomas and infrequent in cases of chondromyxoid

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Which of the following statements is true regarding conventional osteosarcoma?

A. the least typical sites of involvement are the femur, tibia and humerus

B. 50 to 75% of cases develop about the knee

C. osteosarcoma occurs frequently in the proximal femur and distal humerus and tibia

D. a diaphyseal location predominates in the long tubular bones

B. 50 to 75% of cases develop about the knee

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Which of the following primary tumors will most commonly involve the appendicular skeleton?

A. Renal cell carcinoma

B. Hepatocellular carcinoma

C. Medullary thyroid carcinoma

D. Bronchogenic carcinoma

E. Pro static carcinoma

D. Bronchogenic carcinoma

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Which of the following statements is false in reference to chondromyxoid fibromas?

A. It is the most common benign cartilage forming tumors.

B. Onset is generally less than 30 years of age.

C. It has an affinity for the tibial tuberosity.

D. Excision is the treatment of choice with a good prognosis.

E. All of the above are false

A.It is the most common benign cartilage forming tumors

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An osteoid osteoma occurring in the spine creates a painful scoliosis. Which one of the following is true regarding the location of the tumor?

A Lesion is on the concave aspect of the scoliotic curve, near the apex.

B. Lesion is on the convex aspect of the scoliotic curve, near the apex.

C. Lesion is on the concave aspect of the scoliotic curve, near the top of the curve.

D. Lesion is on the convex aspect of the scoliotic curve, near the bottom of the curve.

A. Lesion is on the concave aspect of the scoliotic curve, near the apex.

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Which one of the following is not true regarding giant cell tumor metastasis?

A. More common in giant cell tumors involving the distal radius

B. More common in recurrent giant cell tumors

C. Typically occurs 2 to 5 years after surgical removal of a giant cell tumor

D. More common in giant cell tumors that demonstrate soft tissue extension

D.More common in giant cell tumors that demonstrate soft tissue extension

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Which of the following conditions presents with multiple enchondromas and soft tissue vascular lesions?

A. Fong’s syndrome

B. Multiple hereditary exostoses

C. Maffucci’s syndrome

D. Ollier’s disease

E. Osteopoikilosis

C. Maffucci’s syndrome

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Which one of the following is NOT a factor in estimating the risk of malignant transformation of an osteochondroma?

A. Size of the cartilaginous cap

B. Pain

C. Solitary lesions versus multiple lesions

D. Location

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A patient presents to your office in RifRaf Seneca Falls, NY with a strange complaint of pain in his ring finger. The patient explains that he is a seasonal worker “carpenter” and has not worked in a few months. He spends most of his time relaxing and ice fishing at his favorite spot. The patient explains, as of recently he does not enjoy catching fish anymore, every time he reaches into the water to retrieve his catch he is completely incapacitated from the pain. Which one of the following is the most likely diagnosis?

A. Epidermoid inclusion cyst

B. Aneurysmal bone cyst

C. Glomus Tumor

D. Giant Cell Tumor

E. Enchondroma

C. Glomus Tumor

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When a child presents with unexplained diffuse osteopenia, your primary diagnosis should be until proven otherwise?

A. Osteoporosis

B. Multiple myeloma

C. Leukemia

D. Lymphoma

E. Metastases

C. Leukemia

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Which of the following statements is true with regards to chondroblastoma?

A. The age of onset is the 2nd and 3rd decades, most commonly between the ages of 5-25.

B. They have a male to female ratio of 2:1.

C. They present with local pain, swelling, and tenderness for a duration of months.

D. They primarily affect the epiphyseal and apophyseal regions of bone.

E. All of the above statements are true.

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Which of the following statements is NOT true about these imaging findings for conventional osteosarcoma?

A. The most common radiographic presentation is that of mixed osteolysis and osteosclerosis with a “Codman’s” triangle and soft tissue extension.

B. Scintigraphy demonstrates an increased uptake of the primary lesion and less uptake of secondary metastases,

C. Angiography demonstrates displacement or invasion of blood supply to the lesion.

D. CT demonstrates the extent of the lesion with little specificity

E. MRI demonstrates a high signal on T1, low signal on T2, and gadolinium enhancement of the lesion.

E. MRI demonstrates a high signal on T1, low signal on T2, and gadolineum enhancement of the lesion.

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Which of the following bone lesions appears radiographically as a solitary intraosseous sclerotic lesion aligned with the long axis of bone and spicules radiating from its center?

A. Enostoma

B. Osteoma

C. Enchondroma

D. Osteochondroma

E. Myositis ossificans

A. Enostoma

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Which of the following locations is the most common site for an osteoma?

A. Frontal sinus

B. Ethmoid sinus

C. Sphenoid sinus

D. Maxillary sinus

A. Frontal sinus

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What is the ratio of metastatic disease to bone vs. primary bone neoplasms?

A. 5:1

B. 15:1

C. 25:1

D. 35:1

E. 45:1

C. 25:1

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Which of the following statement is NOT true about enchondromas?

A. It is a tumor of the medullary cavity that contains lobules of hyaline cartilage.

B. Age of onset is between the 3rd and 4th decades of life and affects males and females equally.

C. It is the most common benign tumor of the hand.

D. The greater percent of enchondromas affect the long bones.

E. All of the above are true.

D. The greater percent of enchondromas affect the long bones

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Multiple osteomas occurring in the mandible, calvarium, or tubular bones accompanies what disorder?

A. Jaffe-Campanacci syndrome

B. Osteopoikilosis

C. Gardner’s syndrome

D. Parosteal osteomatosis

C. Gardner’s syndrome

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Fibrosarcoma may occur both in bone and in soft tissue. Why specifically is it important to differentially diagnose the two?

A. because of the much higher metastatic potential of soft tissue fibrosarcoma

B. because the prognosis of intraosseous fibrosarcoma is much poorer than that of its soft tissue counterpart

C. because soft tissue fibrosarcomas are much easier to surgically separate, by virtue of a pseudoencapsulation

D. None of the above

B. because the prognosis of intraosseous fibrosarcoma is much poorer than that of its soft tissue counterpart

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In order of decreasing frequency, what are the most common sites to develop skeletal metastases?

A. Sacrum, sternum, ribs

B. Ribs, sternum, spine

C. Spine, pelvis, ribs

D. Skull, sacrum, sternum

E. Pelvis, femur, humerus

C. Spine, pelvis, ribs

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What is the most common primary malignant tumor of the chest wall?

A. Metastatic disease

B. Multiple Myeloma

C. Osteosarcoma

D. Chondrosarcoma

E. Angiosarcoma

D. Chondrosarcoma

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Which of the following statements is NOT true regarding conventional osteosarcoma?

A. It presents in the 2nd and 3rd decades of life.

B. It has 2:1 male to female predilection.

C. It presents clinically with pain, swelling, decrease range of motion, warmth, and pyrexia.

D. 80% of primary lesions occur in the spine.

E. All of the above are true.

D. 80% of primary lesions occur in the spine

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Where is the most common location of osteoblastoma?

A. Long tubular bones

B. Small bones of the hands and feet

C. Vertebrae

D. Ribs

C. Vertebrae

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Which of the following sources of skeletal metastases is NOT common in children?

A. Medulloblastoma

B. Ewing’s sarcoma

C. Osteosarcoma

D. Plasmacytoma

E. Retinoblastoma

D. Plasmacytoma

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Which of the following statements is FALSE with regards to chondroblastoma?

A. The femur is affected in 33% of cases.

B. The humerus is affected in 20% of cases with the distal humerus affected most common.

C. Ther tibia is affected in 18% of cases with the proximal tibia affected most common.

D. Only 10% of chondroblastomas present in the bones of the hand and feet.

E. Lesions involving the innominate bones present in a para-acetabular distribution.

B. The humerus is affected in 20% of cases with the distal humerus affected most common

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The term “headless” bone scan is associated with which one of the following conditions?

A. Pagets disease

B. Multiple myeloma

C. Prostate metastasis

D. Acromegaly

C. Prostate metastasis

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Which of the following lesions is NOT associated with aneurysmal bone cysts?

A. Chondroblastoma

B. Fibrous dysplasia

C. Osteoblastoma

D. Osteoma

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According to Poirier, Ewing’s sarcoma is the most common primary malignant tumor of bone to metastasize to bone. Aside from bone, what is the most common site to see metastases from Ewing’s sarcoma?

A. Pelvic soft tissues

B. Kidney

C. Liver

D. Lung

E. Brain

D. Lung

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Which one of the following radiographic findings virtually ensures a diagnosis of a simple bone cyst?

A. Soap bubble appearance

B. Cortical thinning

C. Fallen fragment sign

D. Truncation

C. Fallen fragment sign

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Which of the following statements is TRUE regarding Hodgkin’s lymphoma?

A. Only 15-25% cases demonstrate radiographic findings.

B. Bone involvement is greater in adults than in children.

C. The spine, pelvis, ribs, femur, and sternum are the most common sites of involvement.

D. Hematogenous spread carries a poor prognosis.

E. All of the above are true.

E. All of the above are true

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What is the imaging study of choice to evaluate a solitary osteochondroma for potential malignant transformation?

A. Plain films

B. CT

C. MRI

D. Bone scan

C. MRI

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The most common MRI appearance of a benign hemangioma of the spine is what?

A. Low signal on T1-weighted and high signal on T2-weighted images

B. Low signal on T1-weighted and low signal on T2-weighted images

C. High signal on T1-weighted and Low signal on T2-weighted images

D. High signal on T1-weighted and High signal on T2-weighted images

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What percentage of carcinomas of the prostate will metastasize to bone?

A. 20%

B. 40%

C. 60%

D. 80%

E. 100%

C. 60%

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When in the diaphysis of long tubular bones, osteoid osteomas are typically found where?

A. in the medullary cavity

B. in the cortex

C. in a subperiosteal location

D. none of the above

B. in the cortex

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What is the term used to describe the radiographic appearance of a hemangioma within a vertebral body?

A. Corduroy cloth appearance

B. Cascading trabecular sign

C. Cartwheel configuration

D. Chambray cloth appearance

A. Corduroy cloth appearance

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Which one of the following mechanisms of metastatic spread is the most common?

A. Direct spread

B. Lymphatic spread

C. Hematogenous spread

D. Intraspinal spread

C. Hematogenous spread

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Which of the following differential diagnoses of skeletal metastases to the skull classically presents with a beveled margin?

A. Epidermoid cyst

B. Hemangioma

C. Eosinophilic granuloma

D. Fibrous dysplasia

E. “Doughnut” lesion

C. Eosinophilic granuloma

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Which of the following primary tumors does NOT present with both lytic and expansile metastases?

A Carcinoid tumors

B. Thyroid carcinoma

C. Renal cell carcinoma

D. Melanoma

E. Meningioma

A. Carcinoid tumors

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Which of the following statements is FALSE?

A. Patients with peripheral chondrosarcomas tend to be slightly younger than those with central chondrosarcomas.

B. Chondrosarcomas that occur in children has a greater frequency of involvement of the facial bones

C. Conventional chondrosarcomas arise de novo on the surface of a bone

D. Chondrosarcoma is the most frequent neoplasm of the scapula

C. Conventional chondrosarcomas arise de novo on the surface of a bone

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What percentage of sacrococcygeal chordomas demonstrates tumoral calcification on plain films?

A. 5%

B. 30%

C. 60%

D. 90%

C. 60

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Which one of the following is the least common benign neoplasm of cartilage?

A. Chondroblastoma

B. Enchondroma

C. Chondromyxoid fibroma

D. Desmoplastic fibroma

C. Chondromyxoid fibroma

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Which of the following statements is true regarding a conventional osteoblastoma?

A. It can be seen as an osteolytic, osteoblastic, or a mixed lesion.

B. It can be expansile with cortical thinning.

C. It is most commonly a diaphyseal lesion in long bones.

D. Differential diagnosis in the posterior element of the spine includes osteoid osteoma, aneurysmal bone cyst, eosinophilic granuloma, enchondroma, and fibrous dysplasia.

E. All of the above are true.

E. All of the above are true

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Which of the following differential diagnoses should NOT be considered for an enchondroma?

A. Bone infarct

B. Chondrosarcoma

C. Chondroblastoma

D. Osteochondroma

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Which one of the following statements is false?

A. A virus may be the etiologic agent of a giant cell tumor

B. Giant cell tumors are more common in females

C. Pathologic fracture is the most common initial presentation of a giant cell tumor

D. The sacrum is the most common spinal site

C. Pathologic fracture is the most common initial presentation of a giant cell tumor

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Of the following, which one is the most common location within a bone for a chondroblastoma to occur?

A. Apophysis

B. Metaphysis

C. Diaphysis

D. All the above

A. Apophysis

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What two bones account for about 57% of the total cases of osteoid osteomas?

A. Radius and tibia

B. Tibia and fibula

C. Femur and tibia

D. llium and spine

C. Femur and tibia

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What is the solid variant of aneurysmal bone cyst called?

A. Extragnathic giant cell reparative granuloma

B. Intraosseous clastoma

C. Bone zit

D. Expansive osseous cementoma

A. Extragnathic giant cell reparative granuloma

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What is the most common location enchondromas occur?

A. Ribs

B. Phalanges

C. Femur

D. Humerus

B. Phalanges

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Which of the following primary sources of skeletal metastases is NOT common in the adult patient?

A. Prostatic cancer

B. Breast cancer

C. Renal cell carcinoma

D. Lung cancer

E. Rhabdomyosarcoma

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Acute childhood leukemia represents the most common form of childhood malignancy. What is the age of onset?

A. <5

B. 5-10

C. 10-15

D. 15-20

A. <5

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The skeletal distribution of chondroblastoma does not include which of the following?

A. epiphyseal/ apophyseal location

B. in the feet, a particular predilection for the talus and calcaneus

C. a para-acetabular distribution in the innominate bone

D. in the skull, common involvement of the frontal bone

E. extremely rare occurrence of multilocular lesions

D. in the skull, common involvement of the frontal bone

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Which of the following malignant small round cell tumors of bone is most commonly found in white patients (95% of cases) and is a rarity in blacks?

A. Lymphoma

B. Neuroblastoma

C. Ewing’s sarcoma

D. Kaposi’s sarcoma

C. Ewing’s sarcoma

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What is the most common primary source of skeletal metastases in males?

A. Carcinoma of the prostate

B. Carcinoma of the lung

C. Carcinoma of the bladder

D. Carcinoma of the testes

E. Carcinoma of the uterus

A. Carcinoma of the prostate

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What is the most common cause for an “extrapleural signs of the chest (Yochum and Rowe)?

A. Fibrous dysplasia of a rib

B. Metastatic disease to the ribs

C. Chondrosarcoma of the sternum

D. Sliding esophageal hernia

B. Metastatic disease to the ribs

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What is the most common site to visualize osteosclerotic lesions in patients with acute lymphoblastic leukemia?

A. Skull

B. Mandible

C. Vertebra

D. Pelvis

E. Long bones

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Eosinophilic granuloma represents what percentage of Langerhans Cell Histiocytosis (Histiocytosis X)?

A. 20%

B. 50%

C. 70%

D. 90%

C. 70%

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In patients with acute childhood leukemia, the least likely finding on the radiographic examination will be

A. Diffuse osteopenia

B. Metaphyseal banding

C. Osteolytic lesions

D. Osteosclerotic lesions

E. Periostitis

D. osteosclerotic lesions

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Hypercalcemia is seen in patients with malignant tumors without metastasis. Which of these is correct?

A. The parathyroid is suspected to be the primary site

B. This condition has been termed pseudohyperparathyroidism C. Hypercalcemia only occurs in osteoblastic metastasis

D. The kidney is suspected to be the primary site

E. A preexisting vitamin D metabolism defect is the most likely explanation

B. This condition has been termed pseudohyperparathyroidism

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A 15-year-old male presents with a painless mass occurring in the proximal humerus. Plain film radiographs of the area reveals an osseous protuberance arising from the external surface of the humerus. The spongiosa and cortex of this protuberance are continuous with the parent bone. Which one of the following is true about the MRI of this lesion?

A. The cartilaginous tissue in the cap of this lesion is of low signal intensity on T2-weighted sequences

B. The use of gadolinium compounds allows differentiation from this lesion and a peripheral chondrosarcoma

C. The cartilaginous cap enhances with gadolinium

D. MRI is not useful in measuring the size of the cartilaginous cap

B. The use of gadolinium compounds allows differentiation from this lesion and a peripheral chondrosarcoma

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Which of the following statements is true?

A. Simple bone cysts located in the diaphyseal portion of a bone are considered “active”

B. 75% of simple bone cysts reoccur, regardless of the surgical method used.

C. Simple bone cysts and cementomas are related entities

D. Malignant transformation of simple bone cysts is unfortunately a common occurrence

C. Simple bone cysts and cementomas are related entities

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In a child or an adolescent, an eccentric, well-defined radiolucent lesion arising in the metaphysis of a long tubular bone, near the physis, describes

A. simple bone cyst

B. NOF/ fibrous cortical defect

C. osteoblastoma

D. osteosarcoma

B. NOF/ fibrous cortical defect

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Which one of the following statements is false regarding Nonossifying fibromas?

A. Muscle pull during weight-bearing is the most likely pathogenesis

B. Long tubular bones are affected most commonly

C. Multicentric nonossifying fibromas may occur without skin and café-au-lait spots

D. Nonossifying fibromas are common in the upper extremities

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Which magnetic resonance feature of osteochondroma allows precise identification of this lesion?

A. since cartilage demonstrates a signal void on MRI, the appearance of such a void around an exostosis is characteristic

B. the cartilage cap is of high signal intensity on T2WI, and the perichondrium covering the cap is of low signal intensity on T2, allowing measurement of its thickness

C. osteochondroma, like all tumors, is of low Sl on TIWI and high Sl one T2WI, and therefore MRI is not particularly helpful

D. the presence of the “solar eclipse sign”

B. the cartilage cap is of high signal intensity on T2WI, and the perichondrium covering the cap is of low signal intensity on T2, allowing measurement of its thickness

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Which of the following locations has the highest incidence of osteomas?

A.Frontal sinus

B. Ethmoid sinus

C. Sphenoid sinus

D. Maxillary sinus

A. Frontal sinus

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Which of the following is the most common site to develop skeletal metastases?

A. Cervical

B. Thoracic

C. Lumbar

D. Sacrum

E. Coccyx

C. Lumbar

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Which of the following is the least likely differential diagnoses for a chondroblastoma?

A. Giant cell tumor

B. Clear cell chondrosarcoma

C. Aneurysmal bone cyst

D. Osteochondroma

E. Enchondroma

D. Osteochondroma

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Which of the following primary sources of skeletal metastases is most likely to present as a solitary lesion on conventional radiographic examination?

A. Kidney

B. Lung

C. Prostate

D. Uterus

E. Bladder

A. Kidney

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Which one of the following represents the best description of a “collision” tumor?

A. Spontaneous degeneration of a benign tumor to a malignant one

B. Traumatically induced malignant transformation of a benign tumor

C. A malignant tumor engulfing a benign tumor

D. A tumor with a negative traumatic determination coefficient

C. A malignant tumor engulfing a benign tumor

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Which one of the following statements is FALSE?

A. The precise location of chondrosarcoma within a particular bone is not related to patient survival

B. Central chondrosarcoma demonstrates a more favorable 5 year survival rate when compared to peripheral chondrosarcomas

C. Pathologic fracture is the most common clinical presentation of a chondrosarcoma

D. All the above statements are false

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Which one of the following is NOT a DDX for an osteoblastoma?

A. Osteoid osteoma

B. Aneurysmal bone cyst

C. Eosinophilic granuloma

D Gorham’s disease

D. Gorham’s disease

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Which of the following is NOT a clinical finding associated with acute lymphoblastic leukemia?

A. Joint pain

B. Bone pain

C. Neuropathy

D. Lymphadenopathy

E. Splenomegaly

C. Neuropathy

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The most common initial presenting symptom of a giant cell tumor is:

A. local swelling

B. limitation of motion of the adjacent joint

C. pain

D. pathologic fracture

C. pain

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What percent of primary malignant osseous tumors does primary lymphoma of bone account?

A. 5%

B. 15%

C. 25%

D. 35%

E. 45%

A. 5%

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Which of the following primary tumors of bone is described as a diffuse endothelioma of bone and has recently been postulated that it has a neuroectodermal origin?

A. Ewing’s sarcoma

B. Multiple myeloma

C. Leukemia

D. Lymphoma

A. Ewing’s sarcoma

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Which one of the following statements is true regarding the differential diagnosis between spinal metastasis and Multiple myeloma?

A. Pedicle involvement is more common in metastatic disease

B. Multiple myeloma frequently has a paraspinal mass associated with it

C. A “fish” vertebrae is more common in metastatic disease

D. Multiple myeloma occurs in younger patients

A. Pedicle involvement is more common in metastatic disease

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In opposition to osteoid osteoma, osteoblastoma is most commonly found in which location?

A. tubular bones

B. flat bones

C. vertebrae

D. cranium

E. two of the above

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Which of the following statements describe ossifying fibromas?

A. It is a lesion closely related to fibrous dysplasia.

B. They most commonly affect the maxilla and mandible.

C. They predominate in women who are in there second, third, and fourth decades of life.

D. The tibia and fibula are the most common sites of tubular bone involvement.

E. All of the above

Because the histologic differentiation between a low grade, well-differentiated chondrosarcoma, and an enchondroma is often difficult, what is the best way to differentiate these two tumors?

A. Calcification visualized on the radiograph

B. Anatomic location of the tumor

C. Age of the patient

D. Degree of endosteal scalloping

C. Age of the patient

Classically, neurilemomas are composed of compact cellular areas in combination with loosely arranged hypocellular regions, this biphasic pattern is most commonly seen in the soft tissue tumors and less clearly present in the intraosseous type. What is the term used to name these distinct areas?

A. Bartoni A and B

B. Antoni A and B

C. Neuroni A and B

D. Verocay A and B

B. Antoni A and B

Hemangiomas are benign tumors of vascular origin. These tumors are most commonly seen in vertebrae and skull. Estimations of 10% of spines that are examined at time of autopsy have hemangiomas. What type of vascular channels composes this tumor seen within the spine?

A. Corduroy cloth

B. Capillary

C. Venous

D. Cavernous

B. Capillary

Which of the following imaging techniques is best utilized for the diagnosis of an osteoid osteoma?

A. Conventional radiographs

B. Scintigraphy

C. Ultrasound

D. Magnetic resonance imaging

A. Conventional radiographs

Which one of the following represents an osteosarcoma that features large cystic cavities filled with fresh and clotted blood?

A. Conventional osteosarcoma

B. Gnathic osteosarcoma

C. Small cell osteosarcoma

D. Telangiectatic osteosarcoma

Which of the following statements describe primary bone involvement from non-Hodgkins lymphoma?

A. It affects males more that females of any age.

B. It has a propensity for the appendicular skeleton.

C. It presents with a pathological fracture and a soft tissue mass.

D. A sequestrum is evident in 10% of cases.

E. All of the above.

Microscopically, synovial sarcomas usually have a biphasic histologic appearance. Occasionally, one cell type will predominate giving the tumor a monophasic appearance. Which of the cell types, when dominant, results in a worse prognosis?

A. Pseudoglandular

B. Fibrosarcoma

C. Endothelioid

D. Lipomatous

C. Endothelioid

In decreasing frequency, what is the most common site for conventional osteosarcoma of long bones?

A. Epiphysis > Diaphysis > Metaphysis

B. Diaphysis > Metaphysis > Epiphysis

C. Metaphysis > Diaphysis > Epiphysis

D. They are affected equally.

C. Metaphysis > Diaphysis > Epiphysis

What is the percentage of osteosarcomas that contain areas of tumor that are separate from the main neoplasm, or “skip” lesions?

A. 2%

B. 25%

C. 75%

D. 90%

B. 25%

The most common location of an ossifying fibroma is where?

A. Facial bones

B. Long tubular bones

C. Spine

D. Pelvis

A. Facial bones

Which of the following is the least reasonable differential diagnosis for malignant fibrous histiocytoma?

A. metastasis

B. plasmacytoma

C. lymphoma

D. lytic osteosarcoma

E. fibrosarcoma

D. lytic osteosarcoma

How many types of chondrosarcoma are there?

A. 10

B. 13

C. 2

D. 6

Giant cell reparative granulomas are both radiographically and histologically indistinguishable from which lesion?

A. giant cell tumor

B. aneurysmal bone cyst

C. brown tumor

D. fibrous dysplasia

C. brown tumor

Which of the following processes are thought to represent an ossifying, subperiosteal hematoma?

A. subungual exostosis

B. turret exostosis

C. reactive bone excrescence

D. Nora’s lesion

B. turret exostosis

Which of the following benign bone lesions would be included as a differential diagnosis for an intraosseous low-grade osteosarcoma?

A. Fibrous dysplasia

B. Non-ossifying fibroma

C. Chondromyxoid fibroma

D. All of these should be considered

D. All of these shoud be considered

Which one of the following disorders does Ewing’s sarcoma histologically resemble?

A. Neuroblastoma

B. Osteogenic sarcoma

C. Clear cell chondroblastoma

D. Chordoma

A. Neuroblastoma

Which of the following is not associated with myelofibrosis?

A. Extramedullary hematopoiesis

B. Bone marrow fibrosis

C. Anemia

D. Splenomegaly

E. All are associated with myelofibrosis

Which of the following statements best represents a gnathic osteosarcoma?

A. The mean age of onset is approximately 30 years old.

B. They present with greater affinity to the mandible versus the maxilla.

C. Radiographic appearance is that of a small radiodense lesion with permeation of the cortex, periostitis, and a soft tissue mass.

D. They are less like to metastasize, therefore 40% of patients have a 5yr survival rate. E. All of the above describe gnathic osteosarcomas.

E. All of the above describe gnathic osteosarcomas.

Which of the following statements is true about the imaging findings for telangiectatic osteosarcoma.

A. Radiography demonstrates a large, multiloculated and expansile lesion of osteolysis with extensive periosteal reaction.

B. A homogenous increase of radionuclide uptake on scintigraphy.

C. Areas of increase signal intensity on TIWI, fluid-fluid levels, and heterogeneous enhancement of gadolinium on MRI.

D. All of the above

C. Areas of increase signal intensity on TIWI, fluid-fluid levels, and hetergenous enhancement of gadolinium on MRI.

The ten-year survival rate for most chondrosarcomas is 30 to 70%. Which one of the following represents a factor that is an exception to this survival rate?

A. Spinal chondrosarcomas

B. Peripheral chondrosarcomas

C. Arcal chondrosarcomas

D. Pelvic chondrosarcomas

A. Spinal chondrosarcomas

A 13 year old male patient fracures his tibia. Upon radiographic examination, you discover a lesion in the diaphysis demonstrating a permeative to moth-eaten pattern of bone destruction, onion skined periostitis, and saucerization of the external cortex. Which of the following primary tumors of bone is the least likely differential.

A. Adamantinoma

B. Lymphoma

C. Infection

D. Osteosarcoma

E. Ewing’s sarcoma

A. Adamantinoma

Which one of the following is false regarding the radiographic presentation of osteofibrous dysplasia involving the long tubular bones?

A. Lesions may be purely blastic

B. A ground glass matrix calcification is common

C. Osseous deformity may be accentuated by pathologic fractures

D. Involvement of the distal segment of the humerus is typical

In what region of the spine do osteoid osteomas most commonly occur?

A. Cervical spine

B. Thoracic spine

C. Lumbar spine

D. Sacrum

C. Lumbar spine

What percent of Multiple Myeloma patients are under the age of 40 years?

A. >5%

B. >12%

C. >30%

D. 50%

A. >5%

Which one of the following is the least common benign neoplasm of cartilage?

A. Chondroblastoma

B. Enchondroma

C. Chondromyxoid fibroma

D. Desmoplastic fibroma

C. Chondromyxoid fibroma

Which of the following best describes hemangiopericytoma?

A. Benign

B. Malignant

C. Locally aggressive

D. All of the above

What percentage of multiple myeloma cases present with generalized osteopenia being the only radiographic finding?

A. 15%

B. 35%

C. 55%

D. 75%

A. 15%

Which of the following metastatic tumors most closely resembles liposarcoma?

A. breast

B. lung

C. renal cell

D. thyroid

C. renal cell

Chondromyxoid fibroma is found most commonly in which of the following locations?

A. innominate bone

B. small bones of the feet

C. tibia and femur

D. radius

C. tibia and femur

Which of the following statements is NOT true about Burkitt’s lymphoma?

A. It is the most common malignant disease of children in tropical Africa.

B. It is a stem cell lymphoma in children.

C. It has a high association with the Epstein-Barr virus.

D. It has a propensity for the facial bones.

E. It is common in the long bones.

Which two bones are affected in almost 70% of cases of periosteal chondroma?

A. humerus and tibia

B. humerus and femur

C. tibia and femur

D. tibia and fibula

B. humerus and femur

Systemic mastocytosis has recognized clinical manifestation resembling lymphoma or leukemia. However, it is the cutaneous involvement that is most common and characteristic. Which of the following disorders most closely resembles the cutaneous manifestations seen in mastocytosis?

A. Neurofibromatosis

B. Fibrous Dysplasia

C. Urticaria Pigmentosa

D. Gaucher’s Disease

C. Urticaria Pigmentosa

Which of the following lesions is defined as originating within the outer layer of periosteum?

A. Periosteal

B. Parosteal

C. Subperiosteal

D. Juxtacortical

E. Paraosseous

B. Parosteal

Neurogenic Sarcoma (Malignant Schwannoma) is an unusual lesion that has a variable histologic appearance (perhaps related to the versatility of the Schwann cell. Through metaplasia what tissue types can this tumor produce?

A. Cartilage

B. Bone

C. Fat

D. Muscle

E. All of the above

F. None of the above

E. All of the above

A 30-year-old male presents with a painful mass within the posterior aspect of his knee. Radiographs demonstrate a large radiodense and irregular mass at the posterior aspect of the distal femur. This mass is attached in a sessile fashion to the external cortex and a thin radiolucent line separates the remaining portion of the mass from the underlying bone. Which one of the following is the most likely diagnosis?

A. Parosteal osteosarcoma

B. Periosteal osteosarcoma

C. Surface high grade osteosarcoma

D. Conventional osteosarcoma

A. Parosteal osteosarcoma

What percentage of Ewing’s sarcoma represents a large cell (atypical) type?

A. <5%

B. 5-15%

C. 20-30%

D. 35-45%

E. > 50%

B. 5-15%

An ossifying fibroma is closely related radiographically and pathologically to what other disorder?

A. Fibrogenesis imperfecta ossium

B. Desmoplastic fibroma

C. Cementoma

D. Fibrous dysplasia

A 20 YOM presents with pain, soft tissue swelling, joint effusion, and restricted ROM of the left elbow. Radiographs reveal a positive sail sign, osteopenia, and uniform narrowing of the elbow joint space. Which one of the following is not a reasonable diagnosis?

A. Rheumatoid arthritis

B. Intracapsular desmoplasitic fibroma

C. Osteoid osteoma

D. Idiopathic synovitis

B. Intracapsular desmoplasitic fibroma

A 55-year-old female presents with a painful knee after a fall. The patient states that the knee has been swollen for some time, but because it wasn’t painful she didn’t seek attention for it. Radiographs of the distal femur to include the knee demonstrate a large lytic area within the distal femur accompanied by a periosteal reaction and a pathologic fracture. Further physical examination reveals several enlarged lymph nodes within the inguinal area that are painful on palpation and have a “rubbery’ feel. What is the most likely diagnosis?

A. Goltz syndrome

B. Non-Hodgkin’s lymphoma of bone

C. Mycosis fungoides

D. HOOD syndrome

B. Non-Hodgkin’s lymphoma of bone

Which one of the following is NOT a factor in estimating the risk of malignant transformation of an osteochondroma?

A. Size of the cartilaginous cap

B. Pain

C. Solitary lesions versus multiple lesions

D. Location

A 15-year-old male presents with a painless mass occurring in the proximal humerus. Plain film radiographs of the area reveals an osseous protuberance arising from the external surface of the humerus. The spongiosa and cortex of this protuberance is continuous with the parent bone. Which one of the following is true about the MRI of this lesion?

A. The cartilaginous tissue in the cap of this lesion is of low signal intensity on T2-weighted sequences

B. The use of gadolinium compounds allows differentiation from this lesion and a peripheral chondrosarcoma

C. The cartilaginous cap enhances with gadolinium

D. MRI is not useful in measuring the size of the cartilaginous cap

B. The use of gadolinium compounds allows differentiation from this lesion and a peripheral chondrosarcoma

Which of the following lesions commonly affect the great toe? Mark all that apply.

A. subungual exostosis

B. reactive bone excrescence

C. turret exostosis

D. Nora’s lesion

A. subungual exostosis

B. reactive bone excrescence

Which of the following statements is NOT true regarding an osteoid osteoma when found in the spine?

A. Pain associated with an osteoid osteoma is commonly radicular.

B. Scoliosis is commonly seen with the lesion on the concave aspect of the curve.

C. It is commonly seen as an osteosclerotic lesion of a pedicle.

D. All of the above are true.

Excluding osteoma cutis, what is the most common location for a soft tissue osteoma?

A. Plantar fascia

B. Posterior wall of the oral pharynx

C. Soft palate

D. Posterior portion of the tongue

Which of the following is not a reasonable differential diagnosis for a desmoplastic fibroma?

A. non-ossifying fibroma

B. chondromyxoid fibroma

C. giant cell tumor

D. simple bone cyst

E. fibrous dysplasia

D. simple bone cyst

According to Resnick which of the following is an AKA for Hemangioendothelioma?

A. Hemangiopericytoma

B. Lymphangiomatosis

C. Angiosacroma

D. Cystic Angiomatosis

C. Angiosacroma

Which of the following conditions presents with multiple enchondromas and soft tissue vascular lesions?

A. Fong’s syndrome

B. Multiple hereditary exostoses

C. Maffucci’s syndrome

D. Ollier’s disease

E. Osteopoikilosis

C. Maffucci’s syndrome

What percentage of aggressive osteoblastomas reoccur?

A. 10%

B. 50%

C. 75%

D. 90%

B. 50%

Which one of the following is false regarding Ewings sarcoma?

A. Rare in blacks

B. Demonstrates a large soft tissue mass

C. Flat bones represent the most common site of involvement

D. Demonstrates a positive PAS reaction for glycogen

C. Flat bones represent the most common site of involvement

Which of the following features best distinguishes ossifying fibroma of the facial bones from fibrous dysplasia?

A. ossifying fibromas are painful lesions of the tooth-bearing portion of the mandible

B. ossifying fibromas expand the bone in the AP dimension

C. ossifying fibromas usually smaller than 1 cm in diameter

D. ossifying fibromas are ill-defined, unilocular lesions with very little calcification

B. ossifying fibromas exapand the bone in the AP dimension

Which of the following is false regarding juxtacortical desmoid tumors?

A. almost exclusively found in the posteromedial cortex of the distal femur

B. represents a fibroblastic proliferation of the periosteum

C. the cause is most likely idiopathic

D. the cortex develops a saucer-like defect with adjacent sclerosis and periostitis and soft tissue swelling

C. the cause is most likely idiopathic

Originating from cranial, peripheral and sympathetic nerves, a solitary neurofibroma is exceedingly uncommon. However, when seen these tumors are found most commonly (approximately 66% of the time) in what bone?

A. Maxilla

B. Mandible

C. Tibia

D. Fibula

E. Humerus

B. Mandible

What is the most common age of onset of patients with primary lymphoma of bone?

A. <5

B. 10

C. 20

D. 30

E. > 40

According to Resnick, what is considered the “gold standard” for the diagnosis of conventional osteosarcoma?

A. Radiography

B. Scintigraphy

C. Angiography

D. Computed tomography

E. Magnetic resonance imaging

A. Radiography

What is the most likely region of a long bone to be affected by Ewing’s sarcoma?

A. Epiphysis

B. Metaphysis

C. Metadiaphysis

D. Diaphysis

E. Physis

C. Metadiaphysis

Ewing’s sarcoma is regarded as a highly aggressive tumor most commonly affecting persons between the ages of 5 and 30 years. Immunohistochemical and cytogenic studies as well as clinical and radiographic features are suggestive of this tumor origin. Although there is no definitive proof what is thought to be the cellular origin of this tumor?

A. Neuroectodermal

B. Sarcosanguinous

C. Lymphatic

D. Fibrohistocytic

A. Neuroectodermal

One theory for the origin of an intraosseous leiomyosarcoma is that the point of neoplastic departure is from the media of an intraosseous blood vessel. What is the cellular origin of the media of an intraosseous blood vessel?

A. Leiomyoma cells

B. Smooth muscle cells

C. Lymphatic cells

D. Epidermal cells

B. Smooth muscle cells

Regarding dysplasia ephysialis hemimelica, the term “hemimelica” refers to …

A. involvement of one side of an epiphysis

B. involvement of one side of an extremity

C. involvement of one side of the body

D. None of the above

B. involvement of one side of an extremity

Which one of the following represents an osteosarcoma whose component cells resemble those of Ewings sarcoma?

A. Fibrohistiocytic conventional osteosarcoma

B. Intraosseous low grade osteosarcoma

C. Small cell osteosarcoma

D. Telangiectatic osteosarcoma

C. Small cell osteosarcoma

Which of following primary tumors of bone carries the poorest prognosis with < 1yr survival rate?

A. Conventional osteosarcoma

B. Gnathic osteosarcoma

C. Telangiectatic osteosarcoma

D. Small cell osteosaroma

E. Intraosseous low-grade osteosarcoma

D. Small cell osteosaroma

Which of the following types of osteosarcomas is the least common?

A. Conventional

B. Telangiectatic

C. Gnathic

D. Small cell

E. Intracortical

What percentages of chondrosarcomas dedifferentiate?

A. 10%

B. 25%

C. 50%

D. 75%

A. 10%

Which of following radiographic findings for Hodgkins lymphoma carries the poorest prognosis?

A. Pure osteolytic lesions.

B. Mixed osteolytic and osteosclerotic lesions.

C. Pure osteosclerotic lesions.

D. All of the above carry the same prognosis.

A. Pure osteolytic lesions.

Which one of the following statements is FALSE?

A. MRI is less useful than CT in the evaluation of osteoid osteomas

B. Angiography is the imaging gold standard for identifying the osteoid osteoma nidus.

C. The “double density” sign is an abnormality may be seen in bone scintigraphy of osteoid osteomas.

D. Ultrasonography may be used successfully for the detection of osteoid osteomas in the femoral neck.

B. Angiography is the imaging gold standard for identifying the osteoid osteoma nidus.

In what percentage of fibrosarcoma cases is a pathologic fracture present at the initial work-up?

A. 10%

B. 30%

C. 50%

D. 70%

B. 30%

Osteolytic lesions are encountered in 30-50% of cases of acute childhood leukemia. Which of the following is characteristic of an osteolytic lesion for this disease?

A. Destruction of the proximal clavicle at the sternoclavicular joint.

B. Destruction of the posterior elements of the spine.

C. Destruction of the occipital bone near the foramen magnum.

D. Destruction of the medial cortex of the proximal humerus.

E. Destruction of the lateral cortex of the proximal femur.

D. Destruction of the medial cortex of the proximal humerus.

A 44-year-old male presents with a painful knee. Radiographs reveal a solitary geographic radiolucency within the distal femoral epiphysis. No periosteal reaction is present. Which one of the following represents the most likely diagnosis?

A. Chondroblastoma

B. Osteoid osteoma

C. Clear cell chondrosarcoma

D. Metastatic desmoplastic fibroma

C. Clear cell chondrosarcoma

First described by Starker in 1918, Hemophilic Pseudotumors of bone and soft tissue occurs at what frequency in patients with hemophilia?

A. < 2%

B. 20%

C. 60%

D. > 90%

A. < 2%

What percentage of patients with conventional osteosarcoma present with primary lesions of the femur?

A. 20%

B. 40%

C. 60%

D. 80%

E. 100%

B. 40%

What is the most common location for the locally aggressive (or malignant), angioblastoma (AKA. Adamantinoma)?

A. Femur

B. Pelvis

C. Tibia

D. Fibula

C. Tibia

The prognosis for small cell osteosarcoma is…

A. much better than for any other variety of osteosarcoma

B. similar to conventional osteosarcoma

C. poor, most patients die within a year of diagnosis

D. the poorest of all bone tumors overall

C. poor, most patients die within a year of diagnosis

Where is the most common location for a gnathic osteosarcoma to occur?

A. Mandible

B. Maxilla

C. Zygoma

D. Hard palate

A. Mandible

Which of the following statements is TRUE regarding Hodgkin’s lymphoma?

A. Only 15-25% cases demonstrate radiographic findings.

B. Bone involvement is greater in adults than in children.

C. The spine, pelvis, ribs, femur, and sternum are the most common sites of involvement.

D. Hematogenous spread carries a poor prognosis.

E. All of the above are true

Which of the following statements is false in reference to chondromyxoid fibromas?

A. It is the most common benign cartilage forming tumors.

B. Onset is generally less than 30 years of age.

C. It has an affinity for the tibial tuberosity.

D. Excision is the treatment of choice with a good prognosis.

E. All of the above are false.

A. It is the most common benign cartilage forming tumors.

Which one of the following disorders is not associated with giant cell tumors?

A. Paget’s disease

B. Goltz syndrome

C. Oncogenic osteomalcia

D. Neurofibromatosis

Which of the following lesions is defined as originating withing the inner layer of periosteum?

A. Periosteal

B. Parosteal

C. Subperiosteal

D. Juxtacortical

E. Paraosseous

A. Periosteal

Which of the following is NOT a common radiographic appearance for secondary bone involvement of non-Hodgkins lymphoma?

A. Multiple osteolytic lesions with a moth eaten to permeative pattern of bone destruction.

B. Endosteal scalloping.

C. Cortical destruction adjacent soft tissue involvement.

D. Periostitis.

E. Osteosclerotic lesions.

Which of the following statements is false in reference to the radiographic appearance of chondromyxoid fibromas?

A. It is primarily a metaphyseal lesion.

B. It is primarily eccentrically located and osteolytic.

C. Extensive calcific foci are visible within its matrix.

D. The lesion may range from 2-10 cm.

E. Endosteal sclerosis is common.

C. Extensive calcific foci are visible within its matrix.

Which one of the five major histologic types of ameloblastoma is most capable of metastasizing?

A. Follicular

B. Plexiform

C. Basal Cell

D. Acanthomatous

E. Granular Cell

Which one of the following is another term for Brown Tumor of Hyperparathyroid.

A. Pseudotumor

B. Osteoclastoma

C. Osteitis Fibrosa Cystica

D. Endothelioma

B. Osteoclastoma

What is the “gold standard” imaging technique for the specific diagnosis of conventional osteosarcoma?

A. Plain film

B. MRI

C. CT

D. Bone scan

A. Plain film

Which of the following is NOT a common radiographic finding for primary bone involvement of non-Hodgkins lymphoma in the appendicular skeleton?

A. Long bones of the lower extremity are most commonly involved.

B. Has a predilection for the posterior elements of vertebrae

C. Has a predilection for the metaphysis of long bones.

D. Osteolytic lesions with a poor zone of transition.

E. All of the above are common radiographic findings.

B. Has a predilection for the posterior elements of vertebrae

Which of the following lesions has a classic radiographic appearance of a centrally located, round radiolucency of cortical bone measuring less than a centimeter surrounded by a zone of uniform bone sclerosis?

A. Enostoma

B. Osteoma

C. Osteoblastoma

D. Osteoid osteoma

E. Osteosarcoma

D. Osteoid osteoma

Which of the following conditions presents with asymmetric and unilateral multiple enchondromas with shortening of the affected extremity and a palpable mass?

A. Fong’s syndrome

B. Multiple hereditary exostoses

C. Maffucci’s syndrome

D. Ollier’s disease

E. Osteopoikilosis

D. Ollier’s disease

The most common presentation of telangiectatic osteosarcoma is what?

A. Purely lytic

B. Purely blastic

C. Mixed

D. Soft tissue mass only

A. Purely lytic

Which of the following osteosclerotic lesions is a result of direct invasion from Hodgkin’s lymphoma of breast lymph nodes?

A. Sternum

B. Ribs

C. Vertebrae

D. Sacrum

A. Sternum

A patient presents to your office with complaints of frequent nosebleeds and blood in their stool. Labs reveal an increase in iron-binding capacity but are otherwise negative. On physical examination, you notice small red and violet lesions on the face, lips, oral and nasal mucosa, and the tips of the fingers and toes. Which of the following is associated with this patient’s condition?

A. Ulcerative Colitis

B. Gorham’s disease

C. Hemangiomatosis

D. Hemangioma

C. Hemangiomatosis

What is the most likely diagnosis of a lesion involving the distal metaphysis of the femur that is purely osteolytic, multilocular, and expansile with little or no evidence or periosteal reaction?

A. Conventional osteosarcoma

B. Gnathic osteosarcoma

C. Telangiectatic osteosarcoma

D. Small cell osteosarcoma

E. Surface high-grade osteosarcoma

C. Telangiectatic osteosarcoma

What percent of primary malignant osseous tumors does primary lymphoma of bone account?

A. 5%

B. 15%

C. 25%

D. 35%

E. 45%

A. 5%

What percentage of patients with Ewings sarcoma also has metastatic disease at presentation?

A. 30%

B. 60%

C. 80%

D. 100%

A. 30%

Which of the following sinuses represents the most common location for an osteoma?

Ethmoid
Frontal
Maxillary
Paranasal
Sphenoid

B. Frontal

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4850.

A 10 year old male patient presents with worsening pain at the ulnar aspect of his right hand. Radiographs yield the presence of an eccentric lucent lesion measuring 9mm circumferentially with surrounding sclerosis and a solid periosteal reaction present in the 5th metacarpal diaphysis. Which of the following is the most likely diagnosis?

Aneurysmal bone cyst
Enchondroma
Osteoblastoma
Osteoid osteoma
Osteosarcoma

D. Osteoid osteoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3786.

The most common vertebral region affected by giant cell tumors is?

Cervical
Coccygeal
Lumbar
Sacrum
Thoracic

D. Sacrum

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3940.

A female, 30 years of age, presents with knee pain. Radiographs yield the presence of a well defined lucent lesion that has multiple septations, is expansile, thins the cortex and has no evidence of periosteal reaction. An MRI yields the presence of fluid-fluid levels with a focus of low signal on all sequences. What does the focus of low signal most likely represent?

Cortical bone
Flow void
Hemosiderin
Intraosseous extension of meniscus
Necrosis

C. Hemosiderin

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3942.

A 21 year old male presents with shoulder pain. Radiographic examination yields the presence of a lucent lesion in the humeral head with periostitis in the adjacent metaphysis and diaphysis. What is the most likely diagnosis?

Acute osteomyelitis
Aneurysmal bone cyst
Brodie abscess
Chondroblastoma
Osteoid osteoma

D. Chondroblastoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3850, 3858.

A channel-like lucency is seen in the distal radial metaphysis and another is seen in the proximal humerus, without evidence of calcification, periosteal reaction, or involvement of the bones of the hands. Which of the following is most likely?

Gaucher disease
Jaffe-Campanacci syndrome
Maffucci syndrome
Neurofibromatosis type I
Ollier disease

E. Ollier disease

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3835.

A mandibular lesion is discovered containing small amounts of bone growth and cemental tissues, but mostly spheroidal calcifications are evident. Which of the following is the most appropriate term to use for diagnosis? Select all that are most appropriate.

Cementifying fibroma
Cemento-ossifying fibroma
Ossifying fibroma
Osteofibrous dysplasia
Psammomatous ossifying fibroma

A. Cementifying fibroma

E. Psammomatous ossifying fibroma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3796.

Osteofibrous dysplasia is most likely to occur in which of the following bones?

Fibula
Mandible
Radius
Tibia
Ulna

D. Tibia

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3797.

Epiphyseal osteosarcoma is most likely to arise within which of the following?

Tibial plateau
Femoral condyles
Humeral head
Femoral head
Calcaneus

B. Femoral condyles

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3801.

Radiographic examination of a 37 year old male with persistent mild pain at the knee yields an eccentrically located lucent lesion at the tibial tuberosity measuring 6cm circumferentially with coarse trabeculation, expansion of the bone, thinning of the cortex, and sclerosis of the medullary aspect of the lesion. Which of the following is the most appropriate diagnosis?

Brodie abscess
Chondroblastoma
Chondromyxoid fibroma
Desmoplastic fibroma
Giant cell tumor

C. Chondromyxoid fibroma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3867.

Osteochondroma affects the small bones of the hands and feet in what percent of cases?

C. 10

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3873.

Vascular injury from the presence of an osteochondroma is particularly common in which of the following regions?

Medial aspect of the hip
Posterior aspect of the knee
Ventral aspect of the shoulder
Ventral aspect of the wrist
Ventral aspect of the elbow

B. Posterior aspect of the knee

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3881.

What percent of all conventional chondrosarcoma affects the femur?

D. 25

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3899.

A 43 year old male presents with hip pain. Radiographic examination yields a poorly defined focus of osteolysis in the proximal femoral metaphysis. The lesion also demonstrates periosteal bone formation, endosteal scalloping, and stippled calcification. Which of the following is the most likely conclusion?

Chondromyxoid fibroma
Chondrosarcoma
Enchondroma
Fibrosarcoma
Osteosarcoma

B. Chondrosarcoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3900.

In regards to a non-ossifying fibroma affecting long tubular bones (excluding the fibula), what percent of the width of a section of bone must be involved to elevate the likelihood of fracture?

C. 50

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3925.

Pathologic fractures are seen at initial radiographic examination in what percent of cases?

C. 33

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3935.

A 27 year old male presents with mild persistent pain localized to the iliac region. Radiographic examination yields the presence of a solitary, eccentrically located, geographic, bubbly, lucent lesion in the ilium with well defined borders, multiple septations, expansion of the bone, and thinning of the cortex. Which of the following is the most accurate conclusion?

Chondroblastoma
Fibrous cortical defect
Fibroxanthoma
Non-ossifying fibroma
Osteoblastoma

C. Fibroxanthoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3937.

Intraosseous lipoma most commonly occurs in the _____, and when bilateral lesions are present they most commonly affect the ______?

Calcaneus, calcaneus
Calcaneus, fibula
Fibula, calcaneus
Fibula, femur
Fibula, fibula

C. Fibula, calcaneus

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3966.

A 31 year old male presents with worsening pain in the distal second digit with no prior history of trauma. Radiographic examination yields a solitary lucent lesion at the dorsal aspect of the terminal phalanx of the second digit. The lesion is purely lucent with a sclerotic margin on the medullary aspect of the lesion. Which of the following is the most accurate conclusion?

Epidermoid inclusion cyst
Felon
Glomus tumor
Intra-osseous ganglion
Paronychia

C. Glomus tumor

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3998.

A 42 year old female presents with jaw pain. Radiographic examination reveals an erosive defect seen at the posterior aspect of the mandible without periostitis. Which of the following is the most likely diagnosis?

Cementifying fibroma
Eosinophilic granuloma
Giant cell reparative granuloma
Ossifying fibroma
Solitary neurofibroma

E. Solitary neurofibroma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4011.

A 43 year old male presents with pain local to the upper thoracic spine. Radiographic examination reveals the presence of a lytic lesion with trace amounts of sclerosis of the T4 vertebral body with a calcific mass seen anteriorly creating a posterior mediastinal mass. The most likely diagnosis is which of the following?

Chordoma
Hodgkin lymphoma
Osteoblastoma
Osteosarcoma
Plasmacytoma

A. Chordoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4017.

Simple bone cysts of the metaphyses of the humerus, femur and those occupying _____% of the transverse diameter of a bone are vulnerable to fracture.

E. 85

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4024.

A 15 year old male presents with headaches and worsening pain on the surface of the skull and a palpable bump. Radiographs reveal the presence of a soap bubbly, lucent, well defined lesion demonstrating osseous expansion involving both the inner and outer tables of the skull. CT of the skull was subsequently performed, which yielded the presence of fluid levels within the lesion. Which of the following is the likely diagnosis?

Aneurysmal bone cyst
Eosinophilic granuloma
Epidermoid inclusion cyst
Giant cell tumor
Hemangioma

A. Aneurysmal bone cyst

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4045.

The presence of abnormal lambda light chain proteins is most suspicious of which of the following conditions?

Burkitt lymphoma
Classic myeloma
Hodgkin lymphoma
Large B cell lymphoma
POEMS syndrome

E. POEMS syndrome

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2210.

Radiolucent metaphyseal bands are characteristic of chronic childhood illnesses. After which age are these bands more characteristic of leukemia than any other condition?

0.5 years
1 year
2 years
4 years
8 years

C. 2 years

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p2292.

The tumor most similar radiographically to a malignant osteoblastoma is a/an _________. (Pg. 1130)

a. chondrosarcoma
b. osteosarcoma
c. malignant fibrous histiocytoma
d. lymphangioma

b. osteosarcoma

The most common location for an ossifying fibroma is _________. (Pg. 1130)

a. tibia
b. femur
c. facial bones
d. small bones of hands and feet

c. facial bones

What percentage of conventional osteosarcomas occur in the diaphysis? (Pg. 1131)

a. 5%
b. 10%
c. 20%
d. 25-30%

b. 10%

Purely lytic lesions are characteristic of which type of osteosarcoma? (Pg. 1132)

a. Conventional
b. Telangiectatic
c. Small cell
d. Parosteal

b. Telangiectatic

Which of the following is NOT a typical CT finding in gnathic osteosarcoma? (Pg. 1134)

a. Exuberant periosteal response
b. Tumor calcification
c. Involvement of the cortex
d. Soft tissue extension

a. Exuberant periosteal response

Small cell osteosarcoma is most similar histologically to what other neoplasm? (Pg. 1135)

a. Ewing sarcoma
b. Nephroblastoma
c. Lymphoma
d. Wilm tumor

a. Ewing sarcoma

Periosteal chondromas are composed of _________ and are located _________ the periosteal membrane. (Pg. 1143)

a. fibrocartilage, underneath
b. fibrocartilage, above
c. hyaline cartilage, underneath
d. hyaline cartilage, above

c. hyaline cartilage, underneath

What is the least common benign neoplasm of cartilage? (Pg. 1145)

a. Chondroblastoma
b. Chondromyxoid fibroma
c. Periosteal chondroma
d. Enchondroma

b. Chondromyxoid fibroma

T or F: Chondromyxoid fibroma is most common in the long tubular bones of the lower extremity. (Pg. 1145)

True

Which part of a long bone is typically involved with Trevor disease? (Pg. 1153)

a. Lateral aspect of metaphysis
b. Medial aspect of metaphysis
c. Lateral aspect of epiphysis
d. Medial aspect of epiphysis

d. Medial aspect of epiphysis

T or F: The great toe is the most common location for a subungual exostosis. (Pg. 1154)

True

The most important radiographic finding of chondrosarcoma to differentiate it from other tumors is _________. (Pg. 1154)

a. Degree of cortical violation
b. Amount of periostitis
c. Degree of tumor calcification
d. Involved bone

c. Degree of tumor calcification

Which indicator of malignancy is frequently absent in juxtacortical chondrosarcoma? (Pg. 1157)

a. Soft tissue invasion
b. Long zone of transition
c. Periosteal reaction
d. Cortical violation

c. Periosteal reaction

A clear cell chondrosarcoma is radiographically most similar to which other neoplasm? (Pg. 1157)

a. Enchondroma
b. Osteochondroma
c. Osteosarcoma
d. Chondroblastoma

d. Chondroblastoma

Which type of chondrosarcoma has the poorest prognosis? (Pg. 1159)

a. Dedifferentiated
b. Mesenchymal
c. Periosteal
d. Clear cell

a. Dedifferentiated

Which of the following signs and symptoms is NOT associated with Jaffe-Campanacci Syndrome? (Pg. 1161)

a. Multiple nonossifying fibromas
b. Hepatomegaly
c. Café au lait spots
d. Cryptorchidism

b. Hepatomegaly

Almost all cases of periosteal desmoid are located the ________ cortex of the distal end of the ________. (Pg. 1162)

a. posteromedial, tibia
b. posteromedial, femur
c. anterolateral, tibia
d. anterolateral, femur

b. posteromedial, femur

A fibrous histiocytoma is histologically identical to which other fibrous neoplasm? (Pg. 1163-4)

a. Fibrous dysplasia
b. Malignant fibrous histiocytoma
c. Nonossifying fibroma
d. Desmoplastic fibroma

c. Nonossifying fibroma

T or F: A giant cell reparative granuloma is histologically identical to a giant cell tumor. (Pg. 1168)

False

Hemangiomas are most common in _________ adults and are more common in _________. (Pg. 1172)

a. middle-aged, women
b. young, women
c. middle-aged, men
d. young, men

a. middle-aged, women

Which of the following is NOT another name for cystic angiomatosis? (Pg. 1174)

a. Diffuse angiomatosis
b. Hemangiomatosis
c. Hemangiolymphangiomatosis
d. All of the above are other names for cystic angiomatosis.

d. All of the above are other names for cystic angiomatosis.

Lymphangiomas are associated with which other disease process? (Pg. 1175)

a. Jaffe-Campanacci syndrome
b. Goltz syndrome
c. Gorham disease
d. Dercum disease

c. Gorham disease

The finding of _________ is a rare accompaniment to the presence of hemangiopericytoma. (Pg. 1177)

a. Hypophosphatemic osteomalacia
b. Soft tissue invasion
c. Exuberant subchondral sclerosis
d. Erlenmeyer flask deformity

a. Hypophosphatemic osteomalacia

Which of the following bones is NOT a typical location for a neurilemoma? (Pg. 1179)

a. Tibia
b. Femur
c. Maxilla
d. Sacrum

a. Tibia

T or F: Approximately 10% of chordomas at the base of the skull are chondroid in nature. (Pg. 1182)

False

The most common route of dissemination for metastatic emboli is: (Pg. 1138)

a. Direct extension
b. Lymphatic channels
c. Via arterial supply
d. Via venous supply

d. Via venous supply

Batson’s venous plexus creates an easy path for the metastatic spread of what tissue’s primary malignancy? (Pg. 1138-9)

a. Lung
b. Breast
c. Prostate
d. Liver

c. Prostate

Which of the following is NOT high on the DDx list of an ivory vertebra? (Pg. 1153-4)

a. Hodgkin lymphoma
b. Paget disease
c. Blastic metastasis
d. Osteoblastoma

d. Osteoblastoma

Which of the following is NOT a typical characteristic of the plain film finding of extrapleural sign? (Pg. 1159)

a. Sharp borders concave to the lung field
b. Most commonly seen with rib metastasis
c. Peripheral margins gradually taper to the chest wall
d. All of the above are characteristic of an extrapleural sign

a. Sharp borders concave to the lung field

A soft tissue mass extending from the calvarium with an accompanying sunburst spiculation of the skull tables is considered pathognomonic for what malignancy? (Pg. 1165)

a. Wilms tumor
b. Leukemia
c. Sympathicoblastoma
d. Osteoblastoma

c. Sympathicoblastoma

High serum levels of osteoclast activating factor is typical of what neoplasm? (Pg. 1170)

a. Osteosarcoma
b. Multiple myeloma
c. Chondrosarcoma
d. Leukemia

b. Multiple myeloma

The only consistent laboratory finding in osteosarcoma is elevation of: (Pg. 1185)

a. Acid phosphatase
b. Creatinine
c. Alkaline phosphatase
d. Osteoclast activating factor

c. Alkaline phosphatase

According to Yochum & Rowe, what percentage of osteosarcoma tumors present in the spine? (Pg. 1190)

a. 2.0 – 3.5
b. 3.5 – 7.0
c. 10.0 – 20.0
d. 25.0 – 35.0

b. 3.5 – 7.0

The most common sites for chondrosarcoma are ___________ and ___________. (Pg. 1195)

a. pelvis, proximal femur
b. proximal femur, proximal humerus
c. pelvis, ribs
d. pelvis, proximal humerus

a. pelvis, proximal femur

Malignant degeneration to chondrosarcoma is most common with which neoplasm? (Pg. 1197)

a. Paget disease
b. Fibrous dysplasia
c. Ollier disease
d. Hereditary multiple exostosis

c. Ollier disease

According to Yochum & Rowe, Ewing sarcoma presents in the long bones ______ of the time and in the flat bones ______ of the time. (Pg. 1201)

a. 30%, 60%
b. 40%, 50%
c. 50%, 40%
d. 60%, 30%

c. 50%, 40%

Metastatic skip lesions are most common with which malignancy? (Pg. 1204)

a. Multiple myeloma
b. Osteosarcoma
c. Chondrosarcoma
d. Ewing sarcoma

d. Ewing sarcoma

What is the most common location for fibrosarcoma? (Pg. 1205)

a. The shoulder
b. The elbow
c. The pelvis
d. The knee

d. The knee

What is the most likely primary neoplasm diagnosis when presented with involvement of multiple contiguous vertebral bodies and destruction of the intervertebral disc? (Pg. 1210)

a. Chordoma
b. Osteoblastoma
c. Metastasis
d. Hodgkin lymphoma

a. Chordoma

Which of the following is NOT a presenting sign or symptom of Non-Hodgkin lymphoma? (Pg. 1214)

a. Localized pain of an intermittent nature
b. General well-being of patient
c. Dull, achy pain that is relieved by rest
d. Palpable mass or soft tissue swelling

c. Dull, achy pain that is relieved by rest

In which location for giant cell tumor is the likelihood of malignant degeneration increased? (Pg. 1221)

a. Distal femur
b. Proximal tibia
c. Proximal humerus
d. Distal radius

d. Distal radius

Which of the following is NOT a characteristic of osteochondroma? (Pg. 1227)

a. Usually has a fibrocartilaginous cap
b. Can occur in any bone preformed in cartilage
c. When widespread with a familial history is known as hereditary multiple exostosis
d. Most are asymptomatic and the true incidence may be understated

a. Usually has a fibrocartilaginous cap

The likelihood of malignant degeneration for a solitary osteochondroma is ____% but the likelihood is ____% for the widespread form of the disease. (Pg. 1228)

a. 5, 10
b. 1, 20
c. 10, 20
d. 20, 50

b. 1, 20

T or F: Extension of a vertebral hemangioma into the neural arch occurs in 30-50% of cases.

False

Which of the following is true about Paget disease? (Pg. 1303-4)

a. The onset is insidious and up to 90% of patients are asymptomatic
b. Enlargement of affected bone is rare
c. It is rare after the age of 40 years
d. There is strong evidence that it is a metabolic or endocrine disorder

a. The onset is insidious and up to 90% of patients are asymptomatic

In which condition are pseudo-fractures common? (Pg. 1306)

a. Paget disease
b. Osteomalacia
c. Wilson disease
d. More than one answer is correct

d. More than one answer is correct

T or F: Neurofibromatosis typically has “coast of California” café au lait spots and fibrous dysplasia has “coast of Maine” spots. (Pg. 1333)

True

Which cutaneous abnormality represents the most frequent and best diagnostic feature of neurofibromatosis? (Pg. 1346)

a. Café au lait spots
b. Fibroma molluscum
c. Elephantiasis neuromatosa
d. Irregular patches of hair

b. Fibroma molluscum

Aneurysmal bone cyst occurs in what age group 75% of the time? (Pg. 1295)

a. over 70 years
b. 40 – 60 years
c. 20 – 40 years
d. 5 – 20 years

d. 5 – 20 years

T or F: Most simple bone cysts are asymptomatic until a pathologic fracture occurs.

True

Which of the following sections of bone does aggressive osteoblastoma most frequently affect?

a. Apophysis
b. Diaphysis
c. Epiphysis
d. Metaphysis
e. Physis

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3794.

d. Metaphysis

A 22 years of age female presents with painless enlargement at the left mandibular body. A computed tomography scan of the face demonstrates a 4cm osteolytic, septated, expansile lesion in the mandible. The lesion demonstrates expansion in the anterior to posterior dimension with moderate cortical thinning. Multiple subcentimeter foci of calcification are noted within. There is mild displacement of adjacent teeth. Which of the following is the most likely diagnosis?

a. Aneurysmal bone cyst
b. Eosinophilic granuloma
c. Fibrous dysplasia
d. Giant cell granuloma
e. Ossifying fibroma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3796-7.

e. Ossifying fibroma

A 15 years of age female presents with mild shin pain and anterior prominence. Radiographs yield the presence of a cortically based osteolytic lesion in the anterior aspect of the tibial diaphysis with expansion into the medullary portion of the tibia. There is false anterior tibial bowing present. Which of the following is the most appropriate conclusion?

a. Adimantinoma
b. Osteofibrous dysplasia
c. Medial tibial stress syndrome
d. Osgood-Schlatter disease
e. Syphilitic osteomyelitis

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3797.

b. Osteofibrous dysplasia

Which of the following forms of osteosarcoma tends to demonstrate fluid-fluid levels on magnetic resonance imaging?

a. Conventional
b. Gnathic
c. Parosteal
d. Small cell
e. Telangiectatic

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3818.

e. Telangiectatic

Which of the following forms of osteosarcoma most frequently affect the diaphysis?

a. Intracortical
b. Intraosseous
c. Parosteal
d. Small cell
e. Telangiectatic

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3822.

a. Intracortical

A 16 years of age male presents with moderate shoulder pain that has been mild in the past and intermittent. Radiographs of the shoulder demonstrate an osteolytic lesion in the subperiosteal portion of the medial aspect of the proximal humeral metaphysis. There is periosteal buttressing proximal and distal to the lesion. The lesion measures 2cm in greatest dimension and is well defined. Which of the following is the most likely diagnosis?

a. Aneurysmal bone cyst
b. Chondromyxoid fibroma
c. Enchondroma
d. Intracortical osteosarcoma
e. Juxtacortical chondroma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3848.

e. Juxtacortical chondroma

A 51 years of age female presents with forefoot pain. Radiographs of the foot demonstrate a bony excrescence arising from the medial aspect of the distal phalangeal base of the 1st digit. The excrescence points toward the ungual tuft. Which of the following is the most appropriate designation?

a. Bizarre parosteal osteochondromatous proliferation
b. Florid reactive periostitis
c. Reactive bone excrescence
d. Subungual exostosis
e. Turret exostosis

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3895.

c. Reactive bone excrescence

A 3 years of age male has begun demonstrating occasional refusal to ambulate with progressive prominence at the medial ankle. Radiographs demonstrate enlargement of the epiphysis distal tibial epiphysis and talus. Normal bone density was present. The other ankle was radiographed for comparison which was normal. Which of the following is the most likely diagnosis?

a. Dysplasia epiphysealis hemimelica
b. Hemophilia
c. Multiple epiphyseal dysplasia
d. Neurofibromatosis
e. Sickle cell disease

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3888.

a. Dysplasia epiphysealis hemimelica

Which of the following forms of chondrosarcoma typically affect the epiphysis?

a. Clear cell
b. Conventional
c. Dedifferentiated
d. Juxtacortical
e. Mesenchymal

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3912.

a. Clear cell

A 4 years of age male presents with progressive deformity about the knees and deficiency in relation to the growth curve. Radiographs of the knees demonstrate multiple non-ossifying fibromas. Radiographs of the cervical spine demonstrate platyspondyly, dental anomaly, and also reveal maxillary hypoplasia with relative prognathism. Which of the following is the most accurate conclusion?

a. Dysspondylochondromatosis
b. Jaffe-Campanacci syndrome
c. Neurofibromatosis
d. Ollier disease
e. Osteoglophonic dysplasia

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3928.

e. Osteoglophonic dysplasia

Which of the following lesions has an association with Goltz syndrome?

a. Adimantinoma
b. Ameloblastoma
c. Aneurysmal bone cyst
d. Chondroblastoma
e. Giant cell tumor

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3956.

e. Giant cell tumor

Which of the following lesions has an association with Gorlin syndrome?

a. Adimantinoma
b. Ameloblastoma
c. Aneurysmal bone cyst
d. Chondroblastoma
e. Giant cell tumor

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4683.

b. Ameloblastoma

The solid version of which tumor is thought to be a giant cell reparative granuloma?

a. Adimantinoma
b. Ameloblastoma
c. Aneurysmal bone cyst
d. Chondroblastoma
e. Giant cell tumor

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3961.

c. Aneurysmal bone cyst

Which of the following lesions is associated with Hardcastle syndrome?

a. Giant cell tumor of the tendon sheath
b. Liposarcoma
c. Malignant fibrous histiocytoma
d. Malignant peripheral nerve sheath tumor
e. Myelofibromatosis

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3963.

c. Malignant fibrous histiocytoma

Cementoma formation most frequently occurs in simple bone cysts in which anatomic location?

a. Calcaneus
b. Distal femur
c. Distal humerus
d. Proximal femur
e. Proximal humerus

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4034.

d. Proximal femur

Fibrolipomatous hamartoma is a tumor that is also referred to as a neural fibrolipoma. Which of the following conditions does this tumor most frequently cause?

a. Carpal tunnel syndrome
b. Cubital tunnel syndrome
c. Paraneoplastic syndrome
d. Saturday night palsy
e. Tunnel of Guyon syndrome

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p3048.

a. Carpal tunnel syndrome

A 13 years of age male presents with thigh pain. Radiographs demonstrate a non-calcified soft tissue mass at the proximal thigh without adjacent osseous findings. Magnetic resonance imaging reveals the soft tissue mass to demonstrate T1 signal isointense to that of skeletal muscle and high T2 signal compared also to skeletal muscle. Which of the following is the most likely diagnosis?

a. Leiomyosarcoma
b. Liposarcoma
c. Malignant peripheral nerve sheath tumor
d. Rhabdomyosarcoma
e. Synovial sarcoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4173.

d. Rhabdomyosarcoma

A 51 years of age female presents with flank pain. Radiographs of the lumbar spine demonstrates a non-specific soft tissue mass in the retroperitoneum and mild generalized osteopenia. Magnetic resonance imaging yields a retroperitoneal mass that demonstrates a spokewheel appearance with regions of signal voids within. Which of the following is likely responsible?

a. Angiosarcoma
b. Cystic hygroma
c. Hemangiopericytoma
d. Liposarcoma
e. Lymphangioma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4000.

c. Hemangiopericytoma

A patient develops a lymphangiosarcoma following a radical mastectomy for the treatment of breast carcinoma. Which of the following designations is most appropriate?

a. Dabsaka tumor
b. Kasabach-Merritt syndrome
c. Klippel-Trenaunay-Weber syndrome
d. Rendu-Osler-Weber syndrome
e. Stewart-Treves syndrome

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4202.

e. Stewart-Treves syndrome

A 30 years of age female presents with jaw pain. Magnetic resonance imaging yields the presence of a soft tissue lesion that demonstrates a rim of fat on T1, consistent with the split fat sign, and ring-like structures with peripheral high T2 signal that is consistent with fascicular sign. Which of the following is the likely conclusion?

a. Epithelioid hemangioendothelioma
b. Hemangiopericytoma
c. Lipoma
d. Liposarcoma
e. Schwannoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4222.

e. Schwannoma

Chondroid chordoma is a tumor that most frequently affects which of the following regions?

a. Cervical spine
b. Lumbar spine
c. Thoracic spine
d. Sacrococcygeal
e. Spheno-occipital

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4023.

e. Spheno-occipital

Which type of ameloblastoma occurs most frequently in the maxilla?

a. Acanthomatous
b. Basal cell
c. Follicular
d. Granular cell
e. Plexiform

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4083.

e. Plexiform

A 26 years of age male presents with knee pain, progressive swelling, and decreased range of motion. Radiographs demonstrate a partially calcified soft tissue mass that is eroding into the posterior tibial cortex at the knee. Magnetic resonance imaging reveals low T1 signal compared to marrow and high T2 signal compared to marrow. Which of the following is the most likely diagnosis?

a. Liposarcoma
b. Malignant peripheral nerve sheath tumor
c. Parosteal osteosarcoma
d. Pseudomalignant osseous tumor of soft tissue
e. Synovial sarcoma

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4215-6.

e.Synovial sarcoma

A patient presents with general musculoskeletal pain in the lower extremities. Clinical evaluation reveals a history of lung cancer. Radiographs demonstrate bilateral periostitis of the proximal tibial metaphyses and diaphyses. Which of the following named scintigraphy signs would be expected?

a. Bullhead
b. Double density
c. Double stripe
d. Drumstick
e. Honda

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4881.

c. Double stripe

Primary hypertrophic osteoarthropathy is typically distinguishable from the secondary form via epiphyseal involvement which is typically seen in primary. Which of the following causes of secondary hypertrophic osteoarthropathy can cause epiphyseal involvement thus complicating this differential?

a. Biliary cirrhosis
b. Congenital cyanotic heart conditions
c. Crohn disease
d. Pancreatic adenocarcinoma
e. Wilson disease

Resnick, Donald. Diagnosis of Bone and Joint Disorders. 4th ed. p4876.

b. Congenital cyanotic heart conditions

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