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5. OITE > Oncology 2014 > Flashcards

Oncology 2014 Flashcards

1
Q

Question 4

A 62-year-old otherwise healthy man underwent resection of a mass in his anterior thigh. The 8-cm superficial mass was a high-grade pleomorphic sarcoma, but no margins could be determined. The surgeon thought the mass was a lipoma, but stated taht adequate margins were identified intrasurgically. He did not send frozen section margins. Which treatment would best improve local control?

  1. Observation
  2. Radiation to the surgical bed
  3. Wide re-resection of the surgical bed and radiation
  4. Chemotherapy and re-resection of the surgical bed
  5. Wide re-resection of the surgical bed
A
  1. Wide re-resection of the surgical bed

RECOMMENDED READINGS

Venkatesan M, Richards CJ, McCulloch TA, Perks AG, Raurell A, Ashford RU; East Midlands Sarcoma Service. Inadvertent surgical resection of soft tissue sarcomas. Eur J Surg Oncol. 2012 Apr;38(4):346-51. doi: 10.1016/j.ejso.2011.12.011. Epub 2012 Jan 20. PubMed PMID: 22264775.

Noria S, Davis A, Kandel R, Levesque J, O’Sullivan B, Wunder J, Bell R. Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg Am. 1996 May;78(5):650-5. PubMed PMID: 8642020.

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2
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Question 17

Figures 17a through 17d are the anteroposterior and lateral radiographs and low- and high-power biopsy specimens of a 67-year-old woman who has progressive left hip pain. She describes pain at rest that is exacerbated with weight bearing. What is the best next step?

  1. Observation
  2. Wide resection
  3. Internal fixation
  4. Chemotherapy
  5. Radiation therapy
A
  1. Internal fixation

RECOMMENDED READINGS

Peabody T. The rodded metastasis is a sarcoma: strategies to preventinadvertent surgical procedures on primary bone malignancies. Instr Course Lect. 2004;53:657-61. Review. PubMed PMID: 15116656.

Quinn RH, Randall RL, Benevenia J, Berven SH, Raskin KA. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners. J Bone Joint Surg Am. 2013 Oct 16;95(20):1887-95. Review. PubMed PMID: 24288805.

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3
Q

Question 25

Figures 25a through 25d are the radiographs and biopsy specimens of a 20-year-old man who has ambulatory pain in his right heel. What is the most likely diagnosis?

  1. Chondroblastoma
  2. Intraosseous lipoma
  3. Unicameral bone cyst
  4. Aneurysmal bone cyst
  5. Giant-cell tumor of bone
A
  1. Unicameral bone cyst

RECOMMENDED READINGS

Kilgore WB, Parrish WM. Calcaneal tumors and tumor-like conditions. Foot Ankle Clin. 2005 Sep;10(3):541-65, vii. Review. PubMed PMID: 16081020.

Weber KL, Heck RK: 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.

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4
Q

Question 37

Figures 37a through 37f are the plain radiographs, coronal and axial postcontrast MR images, and biopsy specimens of a 14-year-old boy who has progressive knee pain and swelling after falling from a bicycle several months ago. He now notes constant pain and has a limp. Examination reveals a deep, nonmobile distal thigh mass. What is the best next step?

  1. Curettage
  2. Embolization
  3. Wide resection
  4. Chemotherapy
  5. Radiation therapy
A
  1. Chemotherapy

Luetke A, Meyers PA, Lewis I, Juergens H. Osteosarcoma treatment - where do we stand? A state of the art review. Cancer Treat Rev. 2014 May;40(4):523-32. doi: 10.1016/j.ctrv.2013.11.006. Epub 2013 Nov 27. Review. PubMed PMID: 24345772.

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.

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5
Q

Question 47

Figures 47a through 47c are the radiographs of a 65-year-old man with a history of lung adenocarcinoma. He has thigh pain with weight bearing. His bone scan findings reveal no other osseus lesion. What is the most appropriate next step?

  1. Biopsy
  2. Radiotherapy
  3. Total femur replacement
  4. Intramedullary nail and radiotherapy
  5. Wide resection and intercalary reconstruction
A
  1. Biopsy

RECOMMENDED READINGS

Weber KL, Randall RL, Grossman S, Parvizi J. Management of lower-extremity bone metastasis. J Bone Joint Surg Am. 2006 Dec;88 Suppl 4:11-9. PubMed PMID:17142431.

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.

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6
Q

Question 60

Figures 60a through 60c are the axial T1, T2, and postcontrast MR images of a 57-year-old man who has a painless enlarging anterior thigh mass. What is the next appropriate step?

  1. Biopsy
  2. Chest CT
  3. Resection
  4. Observation
  5. Radiation therapy
A
  1. Biopsy

RECOMMENDED READINGS

Scarborough MT. The biopsy. Instr Course Lect. 2004;53:639-44. Review. PubMed PMID: 15116653.

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.

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7
Q

Question 71

Figures 71a and 71b are the T2-weighted MR image and histology of a 27-year-old man who had a painful lump in his right ankle for several months. Marginal resection was performed. Further treatment should include

  1. amputation.
  2. observation.
  3. chemotherapy and wide re-resection
  4. wide re-resection, radiation, and chemotherapy.
  5. wide re-resection of the area and radiation.
A
  1. observation.

RECOMMENDED READINGS

Lai CS, Chen IC, Lan HC, Lu CT, Yen JH, Song DY, Tang YW. Management of extremity neurilemmomas: clinical series and literature review. Ann Plast Surg. 2013 Dec;71 Suppl 1:S37-42. doi: 10.1097/SAP.0000000000000042. PubMed PMID: 24284739.

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8
Q

Question 79

Figures 79a through 79d are the plain radiographs and biopsy specimens of a 14-year-old boy who has sudden-onset calf pain after stepping awkwardly off a curb. His family notes that he has sustained fractures in the past. What is the most likely diagnosis?

  1. Adamantimona
  2. Fibrous dysplasia
  3. Nonossifying fibroma
  4. Osteofibrous dysplasia
  5. Osteogenesis imperfecta
A
  1. Adamantimona
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9
Q

Question 90

Figures 90a through 90c are the radiographs and pathology of a 20-year-old man who has knee pain and swelling 1 year after undergoing curetting of a benign bone tumor of the proximal tibia. What is the most likely diagnosis?

  1. Osteomyelitis
  2. Chondroblastoma
  3. Aneurysmal bone cyst
  4. Giant-cell tumor of bone
  5. Malignant giant-cell tumor
A
  1. Giant-cell tumor of bone
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10
Q

Question 109

Figures 109a and 109b are the radiographs of a 66-year-old woman with metastatic breast cancer who has a 3- to 4-week history of progressively worsening pain in her left leg and an inability to bear weight on her left lower extremity. Her estimated survival time is longer than 6 months. What is the appropriate next step?

  1. Biopsy of the area
  2. Intramedullary nail fixation
  3. Consultation with hospice care
  4. Consultation with a radiation oncologist
  5. Consultation with a chemotherapy oncologist
A
  1. Intramedullary nail fixation

RECOMMENDED READINGS

Biermann JS, Holt GE, Lewis VO, Schwartz HS, Yaszemski MJ. Metastatic bone disease: diagnosis, evaluation, and treatment. J Bone Joint Surg Am. 2009 Jun;91(6):1518-30. Review. PubMed PMID: 19487533.

Coleman RE. Skeletal complications of malignancy. Cancer. 1997 Oct 15;80(8 Suppl):1588-94. Review. PubMed PMID: 9362426.

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11
Q

Question 127

Figures 127a through 127c are the axial T1, coronal short tau inversion recovery, and axial postcontrast MR images of a 49-year-old woman who has an enlarging, increasingly symptomatic posterior arm mass. She is not sure how long the mass has been present. What is the most likely diagnosis?

  1. Lipoma
  2. Myxoma
  3. Hemangioma
  4. Atypical lipoma
  5. Soft-tissue sarcoma
A
  1. Lipoma

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.

Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 2004 Mar;182(3):733-9. PubMed PMID: 14975977.

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12
Q

Question 156

Figures 156a and 156b are the plain radiograph and biopsy specimen of a 14-year-old boy who has a 6-week history of right leg pain. The most appropriate next diagnostic steps should include

  1. a bone scan, MR of the femur, and CT of the chest.
  2. a bone scan; MR of the femur; and CT of the chest, abdomen, and pelvis.
  3. a bone marrow aspirate; CT of the chest, abdomen, and pelvis; and a bone scan.
  4. a bone marrow biopsy; CT of the chest, abdomen, and pelvis; MR of the femur; and a bone scan.
  5. nothing further; a biopsy should be adequate to stage this disease.
A
  1. a bone scan, MR of the femur, and CT of the chest.

RECOMMENDED READINGS

Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am. 2011 Jul;49(4):749-65, vi-vii. Doi: 10.1016/j.rcl.2011.05.006. Epub 2011 Jun 16. Review. PubMed PMID: 21807172.

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13
Q

Question 172

Figures 172a and 172b are the left humerus radiographs of a 78-year-old woman with multiple myeloma and multifocal osseous disease who has progressive left arm pain at rest and with activity. Comprehensive care of this patient’s osseous disease should include

  1. radiation to the left humerus and bisphosphonates.
  2. surgical stabilization and radiation to the left humerus.
  3. surgical stabilization and radiation to the left humerus and bisphosphonates.
  4. surgical stabilization and radiation to the left humerus, bisphosphonates, and hormone therapy.
  5. surgical stabilization and bisphosphonates.
A
  1. surgical stabilization and radiation to the left humerus and bisphosphonates.

RECOMMENDED READINGS

Scharschmidt TJ, Lindsey JD, Becker PS, Conrad EU. Multiple myeloma: diagnosis and orthopaedic implications. J Am Acad Orthop Surg. 2011 Jul;19(7):410-9. Review. PubMed PMID: 21724920.

Yeh HS, Berenson JR. Treatment for myeloma bone disease. Clin Cancer Res. 2006 Oct 15;12(20 Pt 2):6279s-6284s. Review. PubMed PMID: 17062714.

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14
Q

Question 187

Figures 187a through 187f are the plain radiographs, coronal short tau inversion recovery and axial T1 MR images, and biopsy specimens of a 9-year-old boy who has had a limp for 4 months. He has intermittent right hip pain and mild irritability around the hip. What is the most likely diagnosis?

  1. Fibrous dysplasia
  2. Osteofibrous dysplasia
  3. Unicameral bone cyst
  4. Aneurysmal bone cyst
  5. Eosinophilic granuloma
A
  1. Unicameral bone cyst

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;2007:89-92.

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15
Q

Question 217

Figures 217a through 217e are the plain radiographs, coronal and axial T2-weighted MR images, and biopsy specimen of a 16-year-old boy who has severe activity-related knee pain. He has a firm, fixed, deep distal thigh mass. What is the most likely diagnosis?

  1. Osteosarcoma
  2. Osteoblastoma
  3. Chondrosarcoma
  4. Osteochondroma
  5. Nonossifying fibroma
A
  1. Osteochondroma

RECOMMENDED READINGS

Stieber JR, Dormans JP. Manifestations of hereditary multiple exostoses. J Am Acad Orthop Surg. 2005 Mar-Apr;13(2):110-20. Review. PubMed PMID: 15850368.

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16
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Question 241

Figures 241a and 241b are the MR images of the right hip and the bone scan of a 50-year-old man who has progressively worsening right hip pain and difficulty ambulating. What is the best next step?

  1. Consultation with a medical oncologist
  2. Consultation with a radiation oncologist
  3. Surgical stabilization or hemiarthroplasty of the area
  4. Biopsy and surgical stabilization of the area while in the operating room
  5. CT scans of the chest, abdomen, and pelvis followed by biopsy
A
  1. CT scans of the chest, abdomen, and pelvis followed by biopsy

RECOMMENDED READINGS

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

Rougraff BT, Kneisl JS, Simon MA. Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. J Bone Joint Surg Am. 1993 Sep;75(9):1276-81. PubMed PMID: 8408149.

17
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Question 254

Figures 254a and 254b are the MR image and plain radiograph of a 32-year-old man with a several-year history of right knee pain that includes intermittent swelling and warmth in the knee region. An open biopsy hematoxylin and eosin stain is shown in Figure 254. What is the best next step?

  1. Wide resection alone
  2. Intravenous antibiotic therapy and curretage
  3. Chemotherapy and wide resection
  4. Chemotherapy, radiation, and wide resection
  5. Surgical stabilization with an intramedullary nail
A
  1. Intravenous antibiotic therapy and curretage

RECOMMENDED READINGS

Kanoun ML, Khorbi A, Khmiri C, Tebourbi A, Hadded N, Boughzala W, Ben Maitig M, Chebil M, Hachem A, Essadem H. Diagnosis and treatment of Brodie’s abcess in adults: about twenty cases. Tunis Med. 2007 Oct;85(10):857-61. French. PMID: 18236808.

Blickman JG, van Die CE, de Rooy JW. Current imaging concepts in pediatric osteomyelitis. Eur Radiol. 2004 Mar;14 Suppl 4:L55-64. Review. PubMed PMID: 14752569.Dormans JP, Drummond DS. Pediatric Hematogenous Osteomyelitis: New Trends in Presentation, Diagnosis, and Treatment. J Am Acad Orthop Surg. 1994 Nov;2(6):333-341. PubMed PMID: 10709026.

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Question 257

Figures 257a through 257e are the MR images and biopsy specimens of a 75-year-old woman who has an enlarging posterior thigh mass. She developed the mass after a fall several months ago. Examination reveals she has a firm, fixed, deep mass. What is the most likely diagnosis?

  1. Myxoma
  2. Hematoma
  3. Fibromatosis
  4. Neurofibroma
  5. Soft-tissue sarcoma
A
  1. Soft-tissue sarcoma

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.

Randall RL. Malignant soft-tissue tumors. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons;2007: 277-288.

19
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Question 262

Figures 262a through 262e are the plain radiographs, axial T2-weighted MR image, and low- and highpower biopsy specimens of a 17-year-old boy who has had progressive ankle pain following a baseball injury. Examination reveals diffuse tenderness around the medial hindfoot. What is the most likely diagnosis?

  1. Giant-cell tumor
  2. Fibrous dysplasia
  3. Chondroblastoma
  4. Unicameral bone cyst
  5. Eosinophilic granuloma
A
  1. Chondroblastoma

RECOMMENDED READINGS

Srinivasan R, Parvin SD, Lambert D. Spontaneously ruptured middle colic artery aneurysm in a patient with Marfan’s syndrome. Eur J Vasc Surg. 1990 Jun;4(3):317-8. PubMed PMID: 2354728.

Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol. 2012 Sep;41(10):1195-212. doi:10.1007/s00256-012-1427-0. Epub 2012 Jun 17. Review. PubMed PMID: 22707094.

20
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Question 266

Figures 266a through 266d are the plain radiographs and biopsy specimens of a 48-year-old woman who has a progressive wrist sprain and swelling. She has had considerable activity-related pain, and now has pain that awakens her from sleep. What is the most likely diagnosis?

  1. Brown tumor
  2. Osteosarcoma
  3. Giant-cell tumor
  4. Chondroblastoma
  5. Metastatic carcinoma
A
  1. Giant-cell tumor

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.

21
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Question 270

Figures 270a and 270b are the plain radiographs of a 47-year-old woman who has had progressive right knee pain for several months. Examination reveals no mass but diffuse tenderness around the proximal tibia. In addition to discussing surgery, it also is appropriate to discuss nonsurgical treatment with

  1. denosumab.
  2. bisphosphonates.
  3. teriparitide (Forteo).
  4. external beam radiation.
  5. radiofrequency ablation.
A
  1. denosumab.

RECOMMENDED READINGS

Lewin J, Thomas D. Denosumab: a new treatment option for giant cell tumor of bone. Drugs Today (Barc). 2013 Nov;49(11):693-700. doi:10.1358/dot.2013.49.11.2064725. Review. PubMed PMID: 24308016.

Xu SF, Adams B, Yu XC, Xu M. Denosumab and giant cell tumour of bone-a review and future management considerations. Curr Oncol. 2013 Oct;20(5):e442-7. doi: 10.3747/co.20.1497. Review. PubMed PMID: 24155640; PubMed Central PMCID:PMC3805412.

22
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Question 273

Figure 273 is the anteroposterior radiograph of the distal tibia of a 12-year-old girl who sustained a recent injury while playing basketball. She is tender over the involved area. What is the most appropriate next step?

  1. MR images
  2. Open biopsy
  3. Chest CT scans
  4. Cast placement
  5. Internal fixation
A
  1. Cast placement

RECOMMENDED READINGS

Ortiz EJ, Isler MH, Navia JE, Canosa R. Pathologic fractures in children. Clin Orthop Relat Res. 2005 Mar;(432):116-26. PubMed PMID: 15738811.

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