Bone Tumors (Benign and Malignant) MCQs

Orthopedics · 58 free questions with answers & explanations.

1. A 15-year-old boy presents with pain and a firm swelling around the knee for 3 months. X-ray shows a dense sunburst pattern of periosteal new bone with soft tissue extension and lifting of the periosteum forming a Codman's triangle. The most likely diagnosis is:
2. A 10-year-old girl presents with fever, anaemia, leukocytosis, and a painful swelling of the mid-shaft of the femur. X-ray shows an onion-skin periosteal reaction. Biopsy shows small round blue cells with little cytoplasm in sheets. The diagnosis is:
3. A 30-year-old woman has a lytic expansile lesion in the epiphysis of the distal femur with a soap-bubble appearance on X-ray. She has local pain and swelling. The lesion abuts the articular surface. Biopsy shows spindle cells and multinucleated giant cells. The most likely diagnosis is:
4. A 50-year-old man has pain in the back and multiple osteolytic lesions of the skull, spine, and ribs. Serum calcium is 12.5 mg/dL, serum protein is elevated, and urine shows Bence Jones proteins. The most likely diagnosis is:
5. A 15-year-old presents with a painful swelling around the knee for 3 months. X-ray shows a sunburst pattern with Codman's triangle at the distal femur metaphysis. MRI shows soft tissue extension. Bone biopsy confirms osteosarcoma. The current standard neoadjuvant treatment protocol before surgery is:
6. A 20-year-old presents with a painful mid-diaphyseal femur lesion. X-ray shows a permeative lytic lesion with 'onion skin' periosteal reaction. Biopsy shows small round blue cells forming rosettes. The chromosomal translocation most characteristic of this tumor is:
7. A 25-year-old presents with a painless swelling at the distal femur metaphysis. X-ray shows a bony projection (exostosis) with cortical and medullary continuity with the host bone, pointing away from the joint. MRI shows a cartilage cap <1 cm thick. The diagnosis is osteochondroma. Which finding on imaging would raise concern for malignant transformation to chondrosarcoma?
8. A 35-year-old presents with a lytic lesion at the distal femur epiphysis. X-ray shows a well-defined 'soap bubble' lytic lesion extending to the subchondral bone without crossing the joint. Biopsy shows giant cells scattered uniformly in a mononuclear stromal background. Campanacci grading Grade III giant cell tumor (GCT) is best managed by:
9. A 50-year-old woman with known breast carcinoma presents with severe back pain. X-ray shows collapse of D9 vertebra with a lytic lesion. Nuclear bone scan shows multiple 'hot spots.' This is consistent with metastatic bone disease. Compared to multiple myeloma, metastatic carcinoma typically produces which type of bone lesion most commonly?
10. In the Enneking staging system for primary bone sarcomas, a Stage IIB tumour is defined as:
11. Giant Cell Tumour (GCT) of bone is graded by the Campanacci radiological grading. A Grade III GCT with cortical destruction and soft tissue extension is best treated by:
12. The translocation t(11;22)(q24;q12) resulting in EWS-FLI1 fusion gene is pathognomonic of:
13. An osteoid osteoma is characterised by a central nidus (<2 cm) that produces prostaglandin E2 causing pain. The drug that MOST effectively relieves pain by directly targeting this mechanism is:
14. A 15-year-old boy presents with pain and swelling of the proximal tibia. X-ray shows a poorly defined lytic lesion in the metaphysis with a 'sunburst' periosteal reaction and Codman's triangle. Serum alkaline phosphatase (ALP) is markedly elevated. The most likely diagnosis is:
15. In the Enneking staging of musculoskeletal tumors, a Stage IIB lesion is defined as:
16. A 28-year-old woman presents with a painless, slowly enlarging mass on the posterior distal femur. X-ray shows a pedunculated bony outgrowth with a cartilage cap pointing away from the joint. The medullary cavity of the lesion is continuous with the host bone medullary cavity. The most likely diagnosis and its malignant transformation rate is:
17. A 40-year-old man has a lytic lesion in the epiphysis of the distal femur extending to the subchondral plate. MRI shows a well-circumscribed lesion with 'soap-bubble' appearance. Biopsy reveals osteoclast-like multinucleated giant cells on a mononuclear stromal background. The most appropriate initial treatment for this locally aggressive (Campanacci Grade 3) lesion is:
18. Which of the following is the hallmark translocation associated with Ewing's sarcoma, and what is its functional consequence?
19. A 14-year-old boy presents with progressive knee pain and a warm, tender swelling above the medial femoral condyle. X-ray shows a poorly defined lytic-sclerotic lesion in the metaphysis with periosteal reaction. Biopsy reveals malignant spindle cells in an osteoid matrix. Chest CT shows two pulmonary nodules. TNM staging (AJCC 8th edition) would classify this tumour as:
20. A 20-year-old man has an epiphyseal lytic lesion of the distal femur with a thin sclerotic rim, extending to the articular surface. Histology shows oval to polygonal cells with clear or eosinophilic cytoplasm and occasional nuclear grooves; there is no osteoid production. Which is the MOST likely diagnosis?
21. A 16-year-old male presents with fever, weight loss, and an aggressive lytic lesion of the femoral diaphysis with a classic 'onion peel' periosteal reaction. Biopsy shows small round blue cells arranged in sheets with PAS-positive glycogen granules. Which chromosomal translocation is pathognomonic?
22. A 60-year-old woman has a pathological fracture through a lytic lesion of the proximal femur. MRI shows multiple lesions in the pelvis, spine, and ribs as well. Serum alkaline phosphatase is normal but serum calcium is elevated and serum protein electrophoresis shows an M-spike. The bone lesion is most consistent with:
23. A 17-year-old boy has a distal femoral metaphyseal mass. X-ray shows a destructive lesion with a Codman's triangle and sunburst pattern. Biopsy confirms conventional osteosarcoma. According to the Enneking staging system, a high-grade intracompartmental tumor without metastasis is classified as:
24. Giant cell tumor (GCT) of bone is most commonly located in which region of the bone, and what is the WHO grade assigned to classic GCT?
25. A 55-year-old woman presents with a lytic lesion in the proximal femur with a 'soap bubble' appearance and cortical expansion. Biopsy shows large mononuclear stromal cells, abundant osteoclast-like giant cells, and haemosiderin deposits. She is commenced on denosumab. What is the mechanism of action of denosumab in this context?
26. A 14-year-old boy has a painful mid-shaft tibial lesion. X-ray shows an 'onion skin' periosteal reaction. Biopsy reveals sheets of small round blue cells with nuclear moulding around vascular channels ('pseudo-rosettes'). The specific chromosomal translocation most commonly underlying this tumor is:
27. An 18-year-old male presents with a distal femur lesion showing an aggressive periosteal reaction with 'sunray spicules' on X-ray, soft tissue extension, and serum alkaline phosphatase of 450 IU/L. Staging workup reveals pulmonary nodules. The MOST appropriate initial treatment is:
28. On X-ray of the knee, a soap-bubble lytic lesion eccentrically placed in the epiphysis and extending to the subchondral bone of the distal femur is seen in a 25-year-old. MRI shows fluid-fluid levels. The MOST likely diagnosis is:
29. The Enneking surgical staging system for musculoskeletal tumors classifies a low-grade malignant tumor confined within a natural compartment barrier (intracompartmental) as:
30. A 14-year-old with Ewing sarcoma of the proximal humerus is being staged. Which chromosome translocation is characteristically associated with Ewing sarcoma?
31. A 52-year-old woman presents with a 3 cm lytic lesion in the trochanteric region of the femur. Biopsy shows nests of epithelial cells with clear cytoplasm. PET scan shows an avid right renal mass. This is MOST likely:
32. A 15-year-old presents with nocturnal knee pain relieved by aspirin. X-ray shows a 10 mm radiolucent nidus surrounded by dense reactive bone sclerosis in the proximal tibial cortex. CT confirms a central mineralised nidus. What is the best minimally invasive treatment?
33. A 20-year-old male has a lytic expansile lesion at the proximal tibia epiphysis. X-ray shows a soap-bubble appearance with cortical thinning. Histology shows osteoclast-like multinucleated giant cells evenly distributed in a mononuclear stromal background. Which is the MOST accurate characterisation of this lesion?
34. Ewing sarcoma of bone shares a chromosomal translocation with peripheral PNET. Which translocation and resultant fusion oncogene drives this tumour?
35. A 16-year-old presents with distal femoral pain and swelling. X-ray shows a mixed lytic-sclerotic lesion arising from the metaphysis with a 'sunburst' periosteal reaction and Codman's triangle. Staging CT shows no metastases. What is the standard treatment protocol?
36. A 45-year-old woman has multiple pigmented villonodular synovitis (PVNS) nodules confirmed on MRI of the knee. The RANKL pathway drives osteoclast-mediated bone erosion in PVNS. Which targeted therapy is approved for unresectable or recurrent PVNS/tenosynovial giant cell tumour?
37. A 20-year-old presents with nocturnal bone pain in the proximal femur that is dramatically relieved by aspirin/NSAIDs. Plain X-ray shows a 1.5 cm lucent nidus surrounded by dense sclerotic bone. This classic presentation is diagnostic of:
38. Chondrosarcoma is the most common primary malignant bone tumor in adults over 50 years. Compared to osteosarcoma, a critical difference in its management is:
39. A 35-year-old presents with a locally aggressive lytic tumor of the distal radius, extending to the subchondral bone but confined within the cortex with no soft tissue extension. Giant cell tumor (GCT) of bone is suspected. The Campanacci grade that guides the choice between intralesional curettage and resection is:
40. Ewing's sarcoma characteristically presents in which decade of life, and the chromosomal translocation considered pathognomonic is:
41. A 22-year-old man has a painful lesion in the posterior cortex of the femoral diaphysis. X-ray shows a small radiolucent nidus (<1.5 cm) surrounded by dense cortical sclerosis. Night pain relieved by aspirin is the predominant symptom. What is the diagnosis and most important histological constituent of the nidus?
42. A 55-year-old man presents with a lytic lesion of the proximal femoral shaft, a soft tissue mass, and pathological fracture. Histology shows anaplastic spindle cells producing lace-like osteoid. The most likely diagnosis and characteristic cytogenetic abnormality are:
43. Giant cell tumour of bone most commonly affects which anatomical site and histological cell type defines its classification as a distinct entity?
44. A 15-year-old boy has a 3 cm painful swelling of the proximal tibia with night pain relieved by aspirin. X-ray shows a small radiolucent nidus (<2 cm) surrounded by dense reactive sclerosis. The diagnosis is:
45. A 55-year-old woman presents with pathological fracture through a lytic lesion in the proximal femur. Biopsy shows sheets of plasma cells. Serum protein electrophoresis shows an M-spike. Skeletal survey reveals multiple 'punched-out' lesions. This bone tumour is classified as:
46. The most common benign bone tumour is:
47. A 25-year-old woman presents with a 3-year history of night pain in the right femoral neck relieved completely by aspirin/NSAIDs. Thin-cut CT scan shows a small (<2 cm) lucent nidus with surrounding cortical sclerosis. The most appropriate treatment is:
48. A 35-year-old presents with a lytic lesion at the distal femoral epiphysis. X-ray shows a 'soap bubble' appearance with a transphyseal extension into the metaphysis and a thin sclerotic rim without periosteal reaction. Biopsy shows giant cells and mononuclear stromal cells. The Campanacci grade 3 (aggressive) giant cell tumor is treated with:
49. A 45-year-old man presents with a lobulated medullary lesion at the proximal humerus with ring-and-arc calcification on X-ray (stippled chondroid matrix). There is no cortical destruction. Biopsy shows hyaline cartilage lobules with mild nuclear atypia. This is most consistent with:
50. A 20-year-old male presents with a painful scoliosis and nocturnal back pain relieved by aspirin. CT scan shows a nidus of <1 cm with surrounding sclerosis in the posterior element of L3. The most likely diagnosis and preferred treatment is:
51. Chordoma, a malignant tumor arising from notochordal remnants, MOST commonly occurs at which anatomical location?
52. A 20-year-old woman has a 4 cm, well-defined, expansile lesion in the proximal tibia with 'soap bubble' appearance and cortical thinning on X-ray. On MRI the lesion extends to the articular surface. Biopsy reveals osteoclast-like giant cells on a mononuclear stromal background. Codman's triangle is absent. This is MOST likely:
53. A 40-year-old woman with known polyostotic fibrous dysplasia presents with café-au-lait spots with irregular ('Coast of Maine') borders and precocious puberty in her daughter. The syndrome combining polyostotic fibrous dysplasia, endocrine hyperfunction, and café-au-lait macules is called:
54. A 20-year-old man has a solitary osteochondroma (osteocartilaginous exostosis) of the distal femur that has been stable for years. On routine MRI, the cartilage cap thickness is measured at 3.2 cm. The significance of this finding is:
55. A 65-year-old man with known multiple myeloma presents with sudden onset severe back pain. Whole-spine MRI shows multiple vertebral lesions with a fresh T10 compression fracture causing moderate canal compromise but no neurological deficit. Bone biopsy of an accessible lesion confirms plasma cell myeloma. The most appropriate intervention for the T10 vertebral fracture is:
56. A 35-year-old presents with a giant cell tumour (GCT) of the distal radius, Campanacci Grade III (extensive cortical expansion and soft-tissue breach). The most appropriate surgical treatment is:
57. A 35-year-old presents with a well-defined lytic lesion at the distal femoral epiphysis extending to the subchondral bone. MRI shows a lobulated mass with fluid-fluid levels internally, the fluid levels representing blood products of different ages. The most likely diagnosis is:
58. In giant cell tumor (GCT) of bone, a Campanacci grade III lesion (extra-compartmental extension with soft tissue mass) at the distal radius is best managed by: