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5. OITE > Oncology 2015 > Flashcards

Oncology 2015 Flashcards

1
Q

4.

A 16-year-old boy has had progressive leg pain for 6 weeks. Radiographs and a gadolinium-enhanced MR image are shown in Figures 4a through 4c. Figures 4d and 4e reveal low- and high-power pathology. What is the best next step?

  1. Wide resection
  2. Wide resection and radiotherapy
  3. Neoadjuvant chemotherapy, wide resection, and radiotherapy
  4. Neoadjuvant chemotherapy, wide resection, and adjuvant chemotherapy
  5. Curetting and bone grafting
A
  1. Neoadjuvant chemotherapy, wide resection, and adjuvant chemotherapy

RECOMMENDED READINGS

Chou AJ, Malek F. Osteosarcoma of bone. In: Biermann JS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 159-170.

Messerschmitt PJ, Garcia RM, Abdul-Karim FW, Greenfield EM, Getty PJ. Osteosarcoma. J Am Acad Orthop Surg. 2009 Aug;17(8):515-27. Review. PubMed PMID: 19652033.

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Q
  1. A 35-year-old man has had a painless mass for 4 months. A radiograph and T1-weighted, T2-weighted, and contrast-enhanced axial MR images are shown in Figures 17a through 17d. Histopathology is shown in Figure 17e. Treatment recommendations should include
  2. clinical and radiologic surveillance.
  3. marginal excision.
  4. wide excision.
  5. wide excision and radiotherapy.
  6. radiotherapy.
A
  1. wide excision and radiotherapy.

RECOMMENDED READINGS

Esther RJ. Soft-tissue sarcomas. In: Biermann JS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 295-306.

Bird JE. Surgical management of soft-tissue sarcomas. In: Biermann JS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 307-315.

Gilbert NF, Cannon CP, Lin PP, Lewis VO. Soft-tissue sarcoma. J Am Acad Orthop Surg. 2009 Jan;17(1):40-7. Review. PubMed PMID: 19136426.

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3
Q
  1. Figures 25a through 25c are the anteroposterior and lateral radiographs and high-power histopathology of a 26-year-old man who has had a progressive growth on his nondominant wrist for 3 months. Which additional study should be recommended in the evaluation of this patient?
  2. Positron emission tomography (PET) scan
  3. Whole-body bone scan
  4. Thin-cut (2-mm) CT scan
  5. Chest radiograph
  6. CT of the chest, abdomen, and pelvis
A
  1. Chest radiograph

RECOMMENDED READINGS

Cheong D, Letson GD. Giant cell tumor of bone. In: Biermann JS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 133-146.

Raskin KA, Schwab JH, Mankin HJ, Springfield DS, Hornicek FJ. Giant cell tumor of bone. J Am Acad Orthop Surg. 2013 Feb;21(2):118-26. doi: 10.5435/JAAOS-21-02-118. Review. PubMed PMID: 23378375.

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4
Q
  1. Figures 37a through 37c are the MR images of an enlarged thigh and high-power pathology of a 55-year-old woman who noted asymmetry of her thighs. A positive result for which additional pathologic study will help to determine the definitive pathologic diagnosis?
  2. t(X; 18)
  3. t(11;22)
  4. HMB-45
  5. MDM2 amplification
  6. Mutation in the neurofibromin 2 (NF2) gene
A
  1. MDM2 amplification

RECOMMENDED READINGS

McGarry SV. Lipoma and other benign lipomatous tumors. In: Biermann JS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 257-261.

Weiss SW, Golsblum JR. Enzinger and Weiss’s Soft Tissue Tumors. 5th ed. Philadelphia, PA: Elsevier; 2008.

Jones KB. The molecular biology of musculoskeletal neoplasia. In: Biermann JS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 31-38.

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5
Q
  1. (Deleted)

Figures 47a and 47b are the MR images of a 50-year-old man who has a slow-growing mass in his right thigh that was removed in a piecemeal manner and subsequently diagnosed as an intermediate-grade liposarcoma. The figures show the mass prior to surgical excision. A CT scan of his chest, abdomen, and pelvis reveals no evidence of metastatic disease. What is the best next step?

  1. Clinical and radiologic surveillance every 3 months
  2. MR imaging of the extremity
  3. Tumor bed excision
  4. Transfemoral amputation
  5. Radiation
A
  1. MR imaging of the extremity

RECOMMENDED READINGS

Umer HM, Umer M, Qadir I, Abbasi N, Masood N. Impact of unplanned excision on prognosis of patients with extremity soft tissue sarcoma. Sarcoma. 2013;2013:498604. doi: 10.1155/2013/498604. Epub 2013 Apr 30. PubMed PMID: 23737702; PubMed Central PMCID: PMC3659434.

Potter BK, Adams SC, Pitcher JD Jr, Temple HT. Local recurrence of disease after unplanned excisions of high-grade soft tissue sarcomas. Clin Orthop Relat Res. 2008 Dec;466(12):3093-100. doi: 10.1007/ s11999-008-0529-4. Epub 2008 Sep 26. PubMed PMID: 18818981; PubMed Central PMCID: PMC2628223.

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6
Q
  1. Radiographs, MR imaging, and needle biopsy of the right distal femur were used to diagnose a high-grade osteosarcoma in a 12-year-old girl. In addition to a chest CT scan, comprehensive staging and initial treatment should include a
  2. whole-body bone scan and referral to pediatric oncology.
  3. whole-body bone scan and referral to pediatric oncology and radiation oncology.
  4. whole-body bone scan, bone marrow biopsy, and referral to pediatric oncology and radiation oncology.
  5. CT scan of the abdomen and pelvis, whole-body bone scan, and referral to pediatric oncology.
  6. CT scan of the abdomen and pelvis, whole-body bone scan, bone marrow biopsy, and referral to pediatric oncology.
A
  1. whole-body bone scan and referral to pediatric oncology.

RECOMMENDED READINGS

Messerschmitt PJ, Garcia RM, Abdul-Karim FW, Greenfield EM, Getty PJ. Osteosarcoma. J Am Acad Orthop Surg. 2009 Aug;17(8):515-27. Review. PubMed PMID: 19652033.

Chou AJ, Malek F. Osteosarcoma of bone. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:159-170.

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7
Q
  1. Figures 71a and 71b are the radiographs of a 73-year-old woman with a history of nonmetastatic breast cancer and ambulatory thigh pain for 1 month. A whole-body bone scan reveals radiotracer uptake localized to the proximal femur. A needle biopsy confirms metastatic breast carcinoma. What is the most appropriate treatment strategy?
  2. Radiation
  3. Prophylactic internal fixation
  4. Prophylactic internal fixation and radiation
  5. Proximal femur resection
  6. Proximal femur resection and radiation
A
  1. Prophylactic internal fixation and radiation

RECOMMENDED READINGS

Bickels J, Dadia S, Lidar Z. Surgical management of metastatic bone disease. J Bone Joint Surg Am. 2009 Jun;91(6):1503-16. doi: 10.2106/JBJS.H.00175. Review. PubMed PMID: 19487532.

Beebe KS: Prediction of impending pathologic fractures and treatment considerations in patients with metastatic bone disease. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:331-338.

Goodman HJ, Patterson FR. Surgical management of lower extremity metastatic disease. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:345-353.

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8
Q
  1. A 70-year-old woman with a history of breast cancer has left groin pain with ambulation. Radiographs reveal a destructive lesion in her left proximal femur without fracture. A bone scan reveals a solitary lesion in the left femoral neck. Following a thorough history and examination, the best next step is
  2. referral to radiation oncology for radiotherapy.
  3. surgical prophylaxis.
  4. surgical prophylaxis followed by radiotherapy.
  5. laboratory evaluation (complete blood count [CBC], chemistry panel, urinalysis) followed by surgical prophylaxis.
  6. laboratory evaluation (CBC, chemistry panel, and urinalysis); CT scan of the chest, abdomen, and pelvis; and biopsy of the femoral lesion.
A
  1. laboratory evaluation (CBC, chemistry panel, and urinalysis); CT scan of the chest, abdomen, and pelvis; and biopsy of the femoral lesion.

RECOMMENDED READINGS

Weber KL. Evaluation of the adult patient (aged >40 years) with a destructivebone lesion. J Am Acad Orthop Surg. 2010 Mar;18(3):169-79. Review. PubMedPMID: 20190107.

Rougraff BT. Evaluation of the patient with carcinoma of unknown originmetastatic to bone. Clin Orthop Relat Res. 2003 Oct;(415 Suppl):S105-9.Review. PubMed PMID: 14600599.

Beebe KS: Prediction of impending pathologic fractures and treatment considerations in patients with metastatic bone disease. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:331-338.

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9
Q
  1. Figure 90 is the biopsy specimen of a 30-year-old man who has a 4-month history of a painless, slow-growing mass in his medial thigh. Local imaging (orthogonal radiographs and MR images with intravenous gadolinium) reveals a 6- x 5- x 7-cm heterogeneous mass in the adductor magnus muscle. Additional analysis confirms the presence of translocation t(X; 18). What are the appropriate staging steps to establish a diagnosis?
  2. Chest CT scan and whole-body bone scan
  3. Chest radiographs and chest CT scan
  4. Chest radiographs, chest CT scan, and whole-body bone scan
  5. Chest radiographs, chest CT scan, and examination of locoregional lymph nodes
  6. Chest radiographs, chest CT scan, whole-body bone scan, and examination of locoregional lymph nodes
A
  1. Chest radiographs, chest CT scan, and examination of locoregional lymph nodes

RECOMMENDED READINGS

Gilbert NF, Cannon CP, Lin PP, Lewis VO. Soft-tissue sarcoma. J Am Acad Orthop Surg. 2009 Jan;17(1):40-7. Review. PubMed PMID: 19136426.

Esther RJ. Soft tissue sarcomas. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:295-306.

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10
Q
  1. Figure 109 is the postsurgical radiograph of a 60-year-old woman who sustained a right pertrochanteric fracture through a solitary osseous metastasis of renal cell cancer origin. She is a community ambulatory who fell as the result of an episode of dizziness that has been attributed to multiple small-brain metastases. She was treated with proximal femoral resection and the reconstruction shown in the figure through a posterolateral approach. What is the most appropriate immediate rehabilitation plan?
  2. Nonweight-bearing activity with walker assistance and posterior hip precautions
  3. Toe-touch weight bearing with cane assistance and posterior hip precautions
  4. Toe-touch weight bearing with cane assistance and posterior and anterior hip precautions
  5. Full weight bearing with walker assistance and posterior hip precautions
  6. Full weight bearing with cane assistance and anterior and posterior hip precautions
A
  1. Full weight bearing with walker assistance and posterior hip precautions

RECOMMENDED READINGS

Faruqui SR, Jaeblon T. Ambulatory assistive devices in orthopaedics: uses and modifications. J Am Acad Orthop Surg. 1 2010 Jan;18(1):41-50. Review. PubMed PMID: 20044491.

Goodman HJ, Patterson FR: Surgical management of lower extremity metastatic disease. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:345-353.

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11
Q

119.

A 65-year-old woman sustained a pathologic hip fracture through a femoral neck lesion. She has breast cancer and multifocal metastatic bone disease. In addition to estrogen receptor status, which other pathologic order(s) will assist your medical oncologist in planning this patient’s treatment?

  1. Human epidermal growth factor receptor 2 (HER2)/neu receptor status only
  2. HER2/neu and vascular endothelial growth factor (VEGF) receptors
  3. Progesterone receptor status only
  4. Progesterone and HER2/neu receptors
  5. Progesterone, VEGF, and HER2/neu receptor
A
  1. Progesterone and HER2/neu receptors

RECOMMENDED READINGS

Quinn RH, Rajani R. Disease-specific considerations in metastatic bone disease. In: Biermann JS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014: 365-369.

Buzdar AU. Role of biologic therapy and chemotherapy in hormone receptor- and HER2-positive breast cancer. Ann Oncol. 2009 Jun;20(6):993-9. doi: 10.1093/annonc/mdn739. Epub 2009 Jan 15. Review. PubMed PMID: 19150946.

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12
Q
  1. Several cancers directly produce receptor activator of nuclear factor kappa beta ligand (RANKL), an important molecule in
  2. osteoclastogenesis.
  3. osteoblastogenesis.
  4. stem cell differentiation.
  5. interstitial macrophages.
  6. osteopontin production.
A
  1. osteoclastogenesis.

RECOMMENDED READINGS

Fitzhugh VA. The pathophysiology of bone metastasis. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:319-329.

Lynch CC. Matrix metalloproteinases as master regulators of the vicious cycle of bone metastasis. Bone. 2011 Jan;48(1):44-53. doi: 10.1016/j.bone.2010.06.007. Epub 2010 Jun 16. Review. PubMed PMID: 20601294.

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13
Q
  1. Figures 151a and 151b are the short tau inversion recovery and postcontrast MR images of a 27-year-old man who has mild, progressive pain and swelling overlying his upper thoracic spine. What is the best next step?
  2. Biopsy
  3. Wide resection
  4. Marginal resection
  5. Radiation therapy
  6. Repeat imaging in 3 months
A
  1. Biopsy

RECOMMENDED READINGS

Damron TA, Beauchamp CP, Rougraff BT, Ward WG Sr. Soft-tissue lumps and bumps. Instr Course Lect. 2004;53:625-37. Review. PubMed PMID: 15116652.

Escobar C, Munker R, Thomas JO, Li BD, Burton GV. Update on desmoid tumors. Ann Oncol. 2012 Mar;23(3):562-9. doi: 10.1093/annonc/mdr386. Epub 2011 Aug 22.

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14
Q
  1. Radiotherapy and chemotherapy may be used as part of definitive treatment for
  2. osteosarcoma.
  3. Ewing sarcoma.
  4. chondrosarcoma.
  5. adamantinoma.
  6. schwannoma.
A
  1. Ewing sarcoma.

RECOMMENDED READINGS

Baldini EH. Radiation therapy. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:77-84.

Wright J. Chemotherapy. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:53-63.

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15
Q
  1. Painful symptoms caused by osteoid osteomas are mediated by
  2. Cyclooxygenase-2 (COX-2).
  3. endorphins.
  4. prostaglandin E2.
  5. prostaglandin H2.
  6. prostaglandin I2.
A
  1. prostaglandin E2.

RECOMMENDED READINGS

Henshaw RM, Carmody Soni EE. Benign bone-forming tumors. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:107-121.

Makley JT, Dunn MJ. Prostaglandin synthesis by osteoid osteoma. Lancet. 1982 Jul 3;2(8288):42. PubMed PMID: 6123769.

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16
Q
  1. Osteogenesis imperfecta is a metabolic bone disease characterized by which inheritance pattern(s)?
  2. Autosomal dominant and autosomal recessive
  3. X-linked recessive
  4. Autosomal recessive and X-linked recessive
  5. Autosomal dominant
  6. Autosomal dominant and X-linked recessive
A
  1. Autosomal dominant and autosomal recessive

RECOMMENDED READINGS

Burnei G, Vlad C, Georgescu I, Gavriliu TS, Dan D. Osteogenesis imperfecta:diagnosis and treatment. J Am Acad Orthop Surg. 2008 Jun;16(6):356-66.Review. PubMed PMID: 18524987.

Krakow D. Skeletal dysplasias. Clin Perinatol. 2015 Jun;42(2):301-19, viii. doi: 10.1016/j. clp.2015.03.003. Epub 2015 Apr 8. Review. PubMed PMID: 26042906; PubMed Central PMCID: PMC4456691.

Harrington J, Sochett E, Howard A. Update on the evaluation and treatment of osteogenesis imperfecta. Pediatr Clin North Am. 2014 Dec;61(6):1243-57. doi: 10.1016/j.pcl.2014.08.010. Epub 2014 Sep 22. Review. PubMed PMID: 25439022.

17
Q
  1. A bone tumor staged as IIA is defined by the Enneking Surgical Staging System as
  2. low-grade intracompartmental.
  3. low-grade extracompartmental.
  4. high-grade intracompartmental.
  5. high-grade extracompartmental.
  6. high-grade regional or distant metastasis
A
  1. high-grade intracompartmental.
18
Q
  1. Giant-cell tumor of bone (GCTB) is most commonly seen in which structure?
  2. Distal femur
  3. Distal radius
  4. Proximal tibia
  5. Proximal femur
  6. Proximal humerus
A
  1. Distal femur

RECOMMENDED READINGS

Cheong D, Letson GD. Giant cell tumor of bone. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:133-146.

McDonald DJ, Weber KL. Giant cell tumor of bone. In: Schwartz HS, ed. Orthopaedic Knowledge Update 2: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:134-135.

19
Q
  1. Local recurrence of primary malignant bone tumors is directly related to
  2. tumor size.
  3. surgical margin.
  4. histologic grade.
  5. anatomic location.
  6. neoadjuvant therapy.
A
  1. surgical margin.

RECOMMENDED READINGS

Kawaguchi S, Lewis VO. Surgical management of malignant primary bone tumors. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:219-230.

Enneking WF. Surgical procedures. In: Enneking WF, ed. Musculoskeletal Tumor Surgery. New York, NY: Churchill Livingstone; 1983:99.

20
Q
  1. Figures 257a and 257b are the radiographs of a 23-year-old man who has multiple bony masses that are intermittently symptomatic. Which gene is most likely associated with his condition?
  2. NF1
  3. SYT
  4. EWS
  5. EXT1
  6. COL1A
A
  1. EXT1 ( Multiple Hereditary Exostosis)

(Fibrous Dysplasia, Maffucci Syndrome, Multiple Hereditary Exostosis, Ollier Disease, Paget Disease)

RECOMMENDED READINGS

Muthusamy S, Conway SA, Temple HT. Five polyostotic conditions that general orthopedic surgeons should recognize (or should not miss). Orthop Clin North Am. 2014 Jul;45(3):417-29. doi: 10.1016/j. ocl.2014.04.004. Review. PubMed PMID: 24975767.

Steffner R. Benign bone tumors. Cancer Treat Res. 2014;162:31-63. doi: 10.1007/978-3-319-07323-1_3. Review. PubMed PMID: 25070230.

21
Q
  1. Figures 262a through 262d are the radiographs and MR images of a 10-year-old girl who has activity-related bilateral knee pain. Examination reveals diffuse anterior knee tenderness. What is the best next step in treatment of this lesion?
  2. Biopsy
  3. Observation
  4. CT scan of the chest
  5. Curettage and grafting
  6. Radiofrequency ablation
A
  1. Observation

RECOMMENDED READINGS

Steffner R. Benign bone tumors. Cancer Treat Res. 2014;162:31-63. doi: 10.1007/978-3-319-07323-1_3. Review. PubMed PMID: 25070230.

Smith SE, Kransdorf MJ. Primary musculoskeletal tumors of fibrous origin. Semin Musculoskelet Radiol. 2000;4(1):73-88. Review. PubMed PMID: 11061693.

22
Q
  1. Figures 270a through 270e are the radiographs, MR image, and CT scans of a 19-year-old woman who has had progressive right hip pain for 1 year. She denies any antecedent trauma or inciting event. Examination reveals diffuse tenderness around the hip and pain with attempted range of motion. What is the best next step?
  2. Biopsy
  3. CT scan of the chest
  4. Antibiotic treatment
  5. Radiofrequency ablation
  6. Protected weight bearing
A
  1. Radiofrequency ablation

RECOMMENDED READINGS

Gibbs CP, Lewis VO, Peabody T. Beyond bone grafting: techniques in the surgical management of benign bone tumors. Instr Course Lect. 2005;54:497-503. Review. PubMed PMID: 15948474

Bourgault C, Vervoort T, Szymanski C, Chastanet P, Maynou C. Percutaneous CT-guided radiofrequency thermocoagulation in the treatment of osteoid osteoma: a 87 patient series. Orthop Traumatol Surg Res. 2014 May;100(3):323-7. doi: 10.1016/j.otsr.2014.02.001. Epub 2014 Mar 25. PubMed PMID: 24679368.

23
Q
  1. Figures 273a through 273f are the radiographs, MR images, and low- and high-power biopsy specimens of a 15-year-old girl who has progressive knee pain and a limp. The pain began insidiously and has progressed to pain at night. Examination reveals diffuse tenderness around the knee but no mass. What is the best next step?
  2. Embolization
  3. Chemotherapy
  4. Wide resection
  5. Radiation therapy
  6. Curettage and grafting
A
  1. Chemotherapy

RECOMMENDED READINGS

Lewis VO, Morris CD, Parsons TW 3rd. Malignant and benign bone tumors that you are likely to see. Instr Course Lect. 2013;62:535-49. PubMed PMID: 23395056.

Weber K, Damron TA, Frassica FJ, Sim FH. Malignant bone tumors. Instr Course Lect. 2008;57:673-88. Review. PubMed PMID: 18399615.

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