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5. OITE > Oncology 2013 > Flashcards

Oncology 2013 Flashcards

1
Q
  1. A 60-year-old woman has had a high-grade pleomorphic undifferentiated sarcoma of the thigh. Which figure supports this pathologic diagnosis?
  2. Figure 4a
  3. Figure 4b
  4. Figure 4c
  5. Figure 4d
  6. Figure 4e
A
  1. Figure 4d

RECOMMENDED READINGS

Randall RL. Malignant soft-tissue tumors. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:277-287.

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2
Q
  1. Which soft-tissue sarcoma is most likely to develop lymphatic metastasis?
  2. Liposarcoma
  3. Leiomyosarcoma
  4. Synovial sarcoma
  5. Myxoid liposarcoma
  6. Pleomorphic sarcoma
A
  1. Synovial sarcoma

RACE MS

Rhabdomyosarcoma

Angiosarcoma

Clear Cell Sarcoma

Epithelial Sarcoma

Malignant Histiosarcoma

Synovial Sarcoma

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3
Q
  1. Figures 25a through 25c are the axial T1 and postcontrast MRI scans and biopsy specimen of a 35-yearold man with a painless right thigh mass. He noticed the mass about 2 weeks ago and is unsure if it has changed in size. Which translocation most commonly is associated with this type of tumor?
  2. t(2;13)(q35;q14)
  3. t(12;22)(q13;q12)
  4. t(12;16)(q13;p11)
  5. t(X;18)(p11;q11)
  6. t(17;22)(q22;q13)
A
  1. t(12;16)(q13;p11)

(Myxoid Liposarcoma)

RECOMMENDED READINGS

Krishnan B, Khanna G, Clohisy D. Gene translocations in musculoskeletal neoplasms. Clin Orthop Relat Res. 2008 Sep;466(9):2131-46. Epub 2008 Jun 20. Review. PubMed PMID: 18566876.

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4
Q
  1. Figures 34a through 34d are the radiographs and biopsy specimen of a 68-year-old woman with an 8-month history of a slowly enlarging, painful distal left thigh mass. What is the recommended treatment?
  2. Surgery alone
  3. Radiotherapy alone
  4. Radiotherapy and surgery
  5. Neoadjuvant chemotherapy and surgery
  6. Neoadjuvant chemotherapy, radiotherapy, and surgery
A
  1. Surgery alone

(Chondrosarc)

RECOMMENDED READINGS

Seo SW, Remotti F, Lee FYI. Chondrosarcoma of bone. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:185-195.

Greenspan A, Jundt G, Remagen W, eds. Differential Diagnosis in Orthopaedic Oncology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:158-256.

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5
Q
  1. Figures 47a through 47d are the plain radiographs, axial MRI scan, and biopsy specimen of an 8-yearold boy with progressive right elbow pain that awakens him from sleep. Examination reveals soft-tissue fullness around his elbow and pain with active or passive motion. What is the most likely diagnosis?
  2. Lymphoma
  3. Osteomyelitis
  4. Osteogenic sarcoma
  5. Ewing sarcoma
  6. Langerhans cell histiocytosis
A
  1. Langerhans cell histiocytosis

RECOMMENDED READINGS

Hoover KB, Rosenthal DI, Mankin H. Langerhans cell histiocytosis. Skeletal Radiol. 2007 Feb;36(2):95- 104. Epub 2006 Oct 7. Review. PubMed PMID: 17028900.

Lichtenstein L, Jeffe HL. Eosinophilic granuloma of bone: With report of a case. Am J Pathol 1940 Sep;16(5):595-604.3. PubMed PMID: 19970524.

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6
Q

60.

Figures 60a through 60e are the radiographs, MRI scan, and biopsy specimen of a 17-year-old boy with a 3-month history of left thigh pain that is constatn and not relieved by anti-inflammatory medication. What is the most likely diagnosis?

  1. Enchondroma
  2. Ewing sarcoma
  3. Osteoblastoma
  4. Chondrosarcoma
  5. Chondroblastoma
A
  1. Chondroblastoma

RECOMMENDED READINGS

Sailhan F, Chotel F, Parot R, SOFOP. Chondroblastoma of bone in a pediatric population. J Bone Joint Surg Am. 2009 Sep;91(9):2159-68. PubMed PMID: 19723993.

Weber KL, O’Connor MI. Benign cartilage tumors. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:103-120.

Greenspan A, Jundt G, Remagen W, eds. Differential Diagnosis in Orthopaedic Oncology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:158-256.

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7
Q
  1. What is the treatment recommendation for an American Joint Committee on Cancer stage IIB (Enneking stage IIB) malignant fibrous histiocytoma of the bone?􀁖􀁗􀁄􀁊􀁈􀀃􀀬􀀬􀀥􀀌􀀃􀁐􀁄􀁏􀁌􀁊􀁑􀁄􀁑􀁗􀀃􀂿􀁅􀁕􀁒􀁘􀁖􀀃􀁋􀁌􀁖􀁗􀁌􀁒􀁆􀁜􀁗􀁒􀁐􀁄􀀃􀁒􀁉􀀃􀁅􀁒􀁑􀁈􀀢
  2. Wide excision alone
  3. Radiotherapy and wide excision
  4. Chemotherapy and radiation
  5. Chemotherapy and wide excision
  6. Chemotherapy, wide excision, and radiotherapy
A
  1. Chemotherapy and wide excision

RECOMMENDED READINGS

Wittig JC, Villalobos CE. Other skeletal sarcomas. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:197-204.

Jeon DG, Song WS, Kong CB, Kim JR, Lee SY. MFH of bone and osteosarcoma show similar survival and chemosensitivity. Clin Orthop Relat Res. 2011 Feb;469(2):584-90. Epub 2010 Jun 18. PubMed PMID: 20559764.

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8
Q
  1. Figures 79a through 79d are the plain radiographs and axial CT scans of an 80-year-old woman with severe dementia and a newly noted thigh mass. Examination reveals a large, nonmobile anterior thigh mass that is minimally tender. What is the best next treatment step?
  2. Biopsy
  3. Chest CT scan
  4. Observation
  5. Wide resection
  6. Marginal resection
A
  1. Observation

RECOMMENDED READINGS

Beiner JM, Jokl P. Muscle contusion injuries: current treatment options. J Am Acad Orthop Surg. 2001J ul-Aug;9(4):227-37. Review. PubMed PMID: 11476532.

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9
Q
  1. Figures 86a through 86c are the radiographs and biopsy specimen of a 14-year-old boy who has had left knee pain for 4 weeks. What is the most likely diagnosis?
  2. Chondroblastoma
  3. Chondrosarcoma
  4. Parosteal osteosarcoma
  5. Osteoblastoma
  6. Osteosarcoma
A
  1. Osteosarcoma

RECOMMENDED READINGS

􀀰􀁈􀁖􀁖􀁈􀁕􀁖􀁆􀁋􀁐􀁌􀁗􀁗􀀃􀀳􀀭􀀏􀀃􀀪􀁄􀁕􀁆􀁌􀁄􀀃􀀵􀀰􀀏􀀃􀀤􀁅􀁇􀁘􀁏􀀐􀀮􀁄􀁕􀁌􀁐􀀃􀀩􀀺􀀏􀀃􀀪􀁕􀁈􀁈􀁑􀂿􀁈􀁏􀁇􀀃􀀨􀀰􀀏􀀃􀀪􀁈􀁗􀁗􀁜􀀃􀀳􀀭􀀑􀀃􀀲􀁖􀁗􀁈􀁒􀁖􀁄􀁕􀁆􀁒􀁐􀁄􀀑􀀃􀀭􀀃􀀤􀁐􀀃􀀤􀁆􀁄􀁇􀀃Hornicek FJ. Osteosarcoma of bone. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:163-174.

Greenspan A, Jundt G, Remagen W, eds. Differential Diagnosis in Orthopaedic Oncology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:40-157.

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10
Q
  1. Figures 109a through 109d are the plain radiographs and axial T2-weighted MRI scans of a 30-year-old woman who has had right hip pain for the past moth. Examination reveals an antalgic gait and a firm, fixed proximal femoral mass. What is the best next treatment step?
  2. Biopsy
  3. Observation
  4. Chemotherapy
  5. Internal Fixation􀀃 􀀗􀀑􀀃􀀃􀀃􀀃􀀬􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑
  6. Radiation therapy
A
  1. Biopsy

RECOMMENDED READINGS

Gibbs CP Jr, Weber K, Scarborough MT. Malignant bone tumors. Instr Course Lect 2002:51;413-28. PubMed PMID: 12064130.

􀀰􀁈􀁖􀁖􀁈􀁕􀁖􀁆􀁋􀁐􀁌􀁗􀁗􀀃􀀳􀀭􀀏􀀃􀀪􀁄􀁕􀁆􀁌􀁄􀀃􀀵􀀰􀀏􀀃􀀤􀁅􀁇􀁘􀁏􀀐􀀮􀁄􀁕􀁌􀁐􀀃􀀩􀀺􀀏􀀃􀀪􀁕􀁈􀁈􀁑􀂿􀁈􀁏􀁇􀀃􀀨􀀰􀀏􀀃􀀪􀁈􀁗􀁗􀁜􀀃􀀳􀀭􀀑􀀃􀀲􀁖􀁗􀁈􀁒􀁖􀁄􀁕􀁆􀁒􀁐􀁄􀀑􀀃􀀭􀀃􀀤􀁐􀀃􀀤􀁆􀁄􀁇􀀃

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11
Q
  1. Figures 127a through 127c are the femur radiographs of a 76-year-old man who is a community ambulator. This man, who has biopsy-proven metastatic prostate cancer, has been experiencing left hip and thigh pain while walking for 3 weeks. What is the best next treatment step?
  2. Total hip arthroplasty
  3. Long cephalomedullary fixation
  4. Long cephalomedullary fixation and radiotherapy
  5. Plate and screw hip fixation
  6. Plate and screw hip fixation and radiotherapy􀀃 􀀕􀀑􀀃􀀃􀀃􀀃􀀯􀁒􀁑􀁊􀀃􀁆􀁈􀁓􀁋􀁄􀁏􀁒􀁐􀁈􀁇􀁘􀁏􀁏􀁄􀁕􀁜􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

􀀃 􀀖􀀑􀀃􀀃􀀃􀀃􀀯􀁒􀁑􀁊􀀃􀁆􀁈􀁓􀁋􀁄􀁏􀁒􀁐􀁈􀁇􀁘􀁏􀁏􀁄􀁕􀁜􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁕􀁄􀁇􀁌􀁒􀁗􀁋􀁈􀁕􀁄􀁓􀁜

􀀃 􀀗􀀑􀀃􀀃􀀃􀀃􀀳􀁏􀁄􀁗􀁈􀀃􀁄􀁑􀁇􀀃􀁖􀁆􀁕􀁈􀁚􀀃􀁋􀁌􀁓􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

􀀃 􀀘􀀑􀀃􀀃􀀃􀀃􀀳􀁏􀁄􀁗􀁈􀀃􀁄􀁑􀁇􀀃􀁖􀁆􀁕􀁈􀁚􀀃􀁋􀁌􀁓􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁕􀁄􀁇􀁌􀁒􀁗􀁋􀁈􀁕􀁄􀁓􀁜

A
  1. Long cephalomedullary fixation and radiotherapy

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. Review. PubMed PMID: 19487532.

Damron TA. Treatment principles and prediction of the impending pathologic fracture. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:369-374.

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12
Q
  1. A 70-year-old woman with multiple myeloma is scheduled to begin intravenous bisphosphonate treatment and has concerns about the side effects of this medication. In addition to reviewing the common side

effects, the following is advised before therapy initiation

  1. an echocardiogram.
  2. a chest radiograph.
  3. a complete blood count.
  4. a gastric swallowing study.
  5. completion of invasive dental work.
A
  1. completion of invasive dental work.

RECOMMENDED READINGS

Pazianas M, Abrahamsen B. Safety of bisphosphonates. Bone. 2011Jul;49(1):103-10. Epub 2011 Jan 12. Review. PubMed PMID: 21236370.

Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007 Aug;29(8):1548-58. Review. PubMed PMID: 17919538.

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13
Q
  1. Figures 155a and 155b are the plain radiographs of a 17-year-old boy who recently noted painless swelling in his distal thigh. Examination reveals a firm, fixed, deep distal thigh mass. There is no asssociated tenderness. What is the best next treatment step?
  2. Biopsy
  3. Resection
  4. A CT scan
  5. An MRI scan
  6. Observation
A
  1. Observation

RECOMMENDED READINGS

Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol. 2012 Jun 17. PubMed PMID: 22707094.

Wilkins RM. Treatment of benign bone tumors. In: Menendez LR, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2002:79-85.

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14
Q
  1. Figures 170a through 170c are the plain radiographs and coronal short inversion time inversion recovery (STIR) MRI scan of a 44-year-old woman with metastatic thyroid carcinoma and right shoulder pain. She reports no history of trauma. Examination reveals no masses and considerable tenderness of the proximal
    humerus. What is the best next treatment step?
  2. Observation
  3. Physical therapy
  4. Radiation therapy
  5. Prophylactic internal fixation􀀃 􀀗􀀑􀀃􀀃􀀃􀀃􀀳􀁕􀁒􀁓􀁋􀁜􀁏􀁄􀁆􀁗􀁌􀁆􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑
  6. Proximal humeral replacement
A
  1. Radiation therapy

RECOMMENDED READINGS

Evans AR, Bottros J, Grant W, Chen BY, Damron TA. Mirels’ rating for humerus lesions is both reproducible and valid. Clin Orthop Relat Res. 2008 Jun;466(6):1279-84. Epub 2008 Mar 21. PubMed PMID: 18357496.

Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989 Dec;(249):256-64. PubMed PMID: 2684463.

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15
Q
  1. Figures 180a through 180f are the plain radiographs, coronal short inversion time inversion recovery MRI scans, and biopsy specimen of a 27-year-old woman with an enlarging painless calf-mass. She first noticed the area several months ago and is unsure if the mass has increased in size. What is the most likely diagnosis?
  2. Desmoids
  3. Liposarcoma
  4. Schwannoma
  5. Synovial sarcoma
  6. Pleomorphic sarcoma
A
  1. Synovial sarcoma

RECOMMENDED READINGS

Bakri A, Shinagare AB, Krajewski KM, Howard SA, Jagannathan JP, Hornick JL, Ramaiya NH. Synovial sarcoma: imaging features of common and uncommon primary sites, metastatic patterns, and treatment response. AJR Am J Roentgenol. 2012 Aug;199(2):W208-15. PubMed PMID: 22826423.

Kilpatrick SE. Diagnostic Musculoskeletal Surgical Pathology. Philadelphia, PA: Saunders; 2004.

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16
Q
  1. Figures 210a and 210b are the axial T1 and postgadolinium MRI scans of a 67-year-old woman with a right thigh mass that has grown in size and has become increasingly symptomatic for 6 months. What is the best next treatment step?
  2. Observation
  3. Core biopsy
  4. Wide resection
  5. Marginal resection
  6. Radiation therapy
A
  1. Marginal resection

RECOMMENDED READINGS

Damron TA. What to do with deep lipomatous tumors. Instr Course Lect. 2004;53:651-5. Review. PubMed PMID: 15116655.

Rougraff BT, Durbin M, Lawerence J, Buckwalter K. Histologic correlation with magnetic resonance imaging for benign and malignant lipomatous masses. Sarcoma. 1997;1(3-4):175-9. PubMed PMID: 18521221.

17
Q
  1. Figures 220a through 220c are the radiograph, MRI scan, and biopsy specimen of a 5-year-old boy with a 4-week history of right hip pain, limp, and a low-grade fever. He also has diabetes insipidus,

exopthalmus, and multiple lesions in the skull. What is the most likely diagnosis?

  1. Ollier disease
  2. Gorham disease
  3. Hand-Schuller-Christian disease
  4. Mazabraud syndrome
  5. McCune-Albright syndrome
A
  1. Hand-Schuller-Christian disease

RECOMMENDED READINGS\

Velez-Yanguas MC, Warrier RP. Langerhans’ cell histiocytosis. Orthop Clin North Am. 1996 Jul;27(3):615-23. Review. PubMed PMID: 8649742.

Islinger RB, Kuklo TR, Owens BD, Horan PJ, Choma TJ, Murphey MD, Temple HT. Langerhans’ cell histiocytosis in patients older than 21 years. Clin Orthop Relat Res. 2000 Oct;(379):231-5. PubMed PMID: 11039811.

18
Q
  1. Figures 233a through 233c are the radiographs and biopsy specimen of a 32-year-old woman who has had progressive ankle pain for 6 months. What is the most appropriate treatment option?
  2. Radiotherapy alone
  3. Intralesional curettage
  4. Intralesional curettage with adjuvants
  5. Wide surgical resection and radiotherapy
  6. Neoadjuvant chemotherapy and wide resection
A
  1. Intralesional curettage with adjuvants

RECOMMENDED READINGS

McDonald DJ, Weber KL. Giant cell tumor of bone. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:133-140.

Arbeitsgemeinschaft Knochentumoren, Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am. 2008 May;90(5):1060-7. PubMed PMID: 18451399.

19
Q
  1. Figure 242 is the anteroposterior radiograph of a 28-year-old man who underwent resection and reconstruction for an Ewing sarcoma. What is the common functional deficit encountered during rehabilitation
  2. Hip instability
  3. Abductor weakness
  4. Adductor weakness
  5. Quadriceps weakness
  6. Leg-length discrepancy
A
  1. Abductor weakness

RECOMMENDED READINGS

Parvizi J, Sim FH. Proximal femoral replacements with megaprostheses. Clin Orthop Relat Res 2004; 420: 169-75. PubMed PMID: 15057093.

Zehr RJ, Enneking WF, Scarborough MT. Allograft-prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop Relat Res 1996; 322:207-23. PubMed PMID: 8542698.

20
Q
  1. Figures 258a and 258b are the radiographs of a 48-year-old woman who had knee pain after falling from a standing height. Her pain subsequently resolved. She was treated 2 years ago for invasive ductal breast carcinoma. What is the best next step in management?
  2. An MRI scan
  3. Biopsy
  4. Bone scan
  5. Observation
  6. Prophylactic Fixation􀀃 􀀘􀀑􀀃􀀃􀀃􀀃􀀳􀁕􀁒􀁓􀁋􀁜􀁏􀁄􀁆􀁗􀁌􀁆􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑
A
  1. Observation

RECOMMENDED READINGS

Marco RA, Gitelis S, Brebach GT, Healey JH. Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg 2000; 8: 292-304. PubMed PMID: 11029557.

Unni KK, Inwards CY, eds. Dahlin’s Bone Tumors: General Aspects and Data on 10,165 Cases. Philadelphia, PA: Lippincott Williams & Wilkins, 2010.

21
Q
  1. Figures 267a through 267c are the radiographs and biopsy specimen of a 10-year-old boy who is experiencing lateral ankle pain during sports and recreational activities. What is the best next treatment step?
  2. Wide resection
  3. Curettage and bone graft
  4. Aspiration and steroid injection
  5. Chemotherapy and wide resection
  6. Observation and activity restriction
A
  1. Curettage and bone graft

RECOMMENDED READINGS

Weber KL, Heck RK Jr. Cystic and benign bone lesions. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:87-102.

Greenspan A, Jundt G, Remagen W, eds. Differential Diagnosis In Orthopaedic Oncology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:387-457.

Steffner RJ, Liao C, Stacy G, Atanda A, Attar S, Avedian R, Peabody TD. Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? J Bone Joint Surg Am. 2011 Nov 2;93(21):e1221-9. PubMed PMID: 22048101.

22
Q
A

5. OITE (41 decks)

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