1. Orthopaedic Diseases
OITE 2006

2. Eosinophilic granuloma Dysplasia epiphysealis hemimelica
A 12-year-old patient has an epiphyseal lesion. What is the most likely diagnosis?
Giant cell tumor
Aneurysmal bone cyst
Eosinophilic granuloma
Dysplasia epiphysealis hemimelica
Chondroblastoma #7

3. Eosinophilic granuloma Dysplasia epiphysealis hemimelica
A 12-year-old patient has an epiphyseal lesion. What is the most likely diagnosis?
Giant cell tumor
Aneurysmal bone cyst
Eosinophilic granuloma
Dysplasia epiphysealis hemimelica
Chondroblastoma #7

4. An 80-year-old woman reports the sudden development of pain in the left distal thigh. She denies any history of trauma. Figures 9a through 9d show radiographs, a bone scan, and a biopsy specimen. What is the most likely diagnosis?
Enchondroma
Osteosarcoma
Dedifferentiated chondrosarcoma
Metastatic breast carcinoma
Paget’s disease
#23

5. An 80-year-old woman reports the sudden development of pain in the left distal thigh. She denies any history of trauma. Figures 9a through 9d show radiographs, a bone scan, and a biopsy specimen. What is the most likely diagnosis?
Enchondroma
Osteosarcoma
Dedifferentiated chondrosarcoma
Metastatic breast carcinoma
Paget’s disease
#23

6. A 75-year-old woman reports an enlarging mass around her right thigh
A 75-year-old woman reports an enlarging mass around her right thigh. Figures 15a through 15d show radiographs and biopsy specimens. What is the most likely diagnosis?
Metastatic breast carcinoma
Multiple myeloma
Myositis ossificans
Chondrosarcoma
Osteosarcoma
#47

7. A 75-year-old woman reports an enlarging mass around her right thigh
A 75-year-old woman reports an enlarging mass around her right thigh. Figures 15a through 15d show radiographs and biopsy specimens. What is the most likely diagnosis?
Metastatic breast carcinoma
Multiple myeloma
Myositis ossificans
Chondrosarcoma
Osteosarcoma
#47

8. For which of the following skeletal tumors is radiation therapy routinely used for definitive local control?
Osteogenic sarcoma
Ewing’s sarcoma
Chondrosarcoma
Pleomorphic sarcoma
Paget’s sarcoma
#65

9. For which of the following skeletal tumors is radiation therapy routinely used for definitive local control?
Osteogenic sarcoma
Ewing’s sarcoma
Chondrosarcoma
Pleomorphic sarcoma
Paget’s sarcoma
#65

10. A 14-year-old girl reports right hip discomfort with activities
A 14-year-old girl reports right hip discomfort with activities. An AP radiograph is shown in Figure 24a, and coronal T1-weighted and axial T2-weighted MRI scans are shown in Figures 24b and 24c, respectively. A biopsy specimen is shown in Figure 24d. What is the treatment of choice for this tumor?
Surgery only
Surgery and chemotherapy
Surgery and radiation therapy
Chemotherapy only
Chemotherapy and radiation therapy
#78

11. A 14-year-old girl reports right hip discomfort with activities
A 14-year-old girl reports right hip discomfort with activities. An AP radiograph is shown in Figure 24a, and coronal T1-weighted and axial T2-weighted MRI scans are shown in Figures 24b and 24c, respectively. A biopsy specimen is shown in Figure 24d. What is the treatment of choice for this tumor?
Surgery only
Surgery and chemotherapy
Surgery and radiation therapy
Chemotherapy only
Chemotherapy and radiation therapy
#78

12. A 25-year-old man reports progressive wrist pain and swelling
A 25-year-old man reports progressive wrist pain and swelling. An AP radiograph and biopsy specimen are shown in Figures 25a and 25b. Management should consist of
below-elbow amputation.
bisphosphonate treatment.
nonsteroidal anti-inflammatory drugs.
chemotherapy followed by wide surgical resection.
intralesional resection and reconstruction
#79

13. A 25-year-old man reports progressive wrist pain and swelling
A 25-year-old man reports progressive wrist pain and swelling. An AP radiograph and biopsy specimen are shown in Figures 25a and 25b. Management should consist of
below-elbow amputation.
bisphosphonate treatment.
nonsteroidal anti-inflammatory drugs.
chemotherapy followed by wide surgical resection.
intralesional resection and reconstruction
#79

14. A 57-year-old man was diagnosed with localized prostate carcinoma 3 years ago, with negative margins and negative lymph nodes. He now reports a 3-week history of severe right hip pain that is worse with weight bearing. Radiographs are shown in Figures 26a and 26b. CT scans of the chest, abdomen, and pelvis, as well as whole body scan, are negative for other lesions.What is the next most appropriate step in treatment?
Right hip hemiarthroplasty
Locked intramedullary rod placement in the right femur
Biopsy of the right femur
Hip disarticulation
Curettage, cementation, and plate fixation
#84

15. A 57-year-old man was diagnosed with localized prostate carcinoma 3 years ago, with negative margins and negative lymph nodes. He now reports a 3-week history of severe right hip pain that is worse with weight bearing. Radiographs are shown in Figures 26a and 26b. CT scans of the chest, abdomen, and pelvis, as well as whole body scan, are negative for other lesions.What is the next most appropriate step in treatment?
Right hip hemiarthroplasty
Locked intramedullary rod placement in the right femur
Biopsy of the right femur
Hip disarticulation
Curettage, cementation, and plate fixation
#84

16. A 12-year-old boy sustained a knee injury in a fall off his bike
A 12-year-old boy sustained a knee injury in a fall off his bike. The patient reports that his knee pain improved the day after injury. Radiographs shown in Figures 30a and 30b reveal a lesion in the distal femur. Management should consist of
open biopsy and intralesional excision.
CT-guided needle biopsy and antimicrobial therapy.
curettage and autogenous iliac crest bone grafting.
anti-inflammatory drugs as needed.
observation and follow-up.
#96

17. A 12-year-old boy sustained a knee injury in a fall off his bike
A 12-year-old boy sustained a knee injury in a fall off his bike. The patient reports that his knee pain improved the day after injury. Radiographs shown in Figures 30a and 30b reveal a lesion in the distal femur. Management should consist of
open biopsy and intralesional excision.
CT-guided needle biopsy and antimicrobial therapy.
curettage and autogenous iliac crest bone grafting.
anti-inflammatory drugs as needed.
observation and follow-up.
#96

18. A 72-year-old man with a history of smoking 40 packs of cigarettes per year underwent successful left total hip arthroplasty 10 years ago. He now reports a 2-month history of progressive right hip pain. An AP pelvic radiograph and CT scan are shown in Figures 35a and 35b. What is the next most appropriate step in management?
Immediate cemented right total hip arthroplasty
Open reduction and internal fixation of the acetabular fracture
Activity modification, IV bisphosphonates, and follow-up in 6 weeks
Technetium Tc 99m scan and CT of the chest, abdomen, and pelvis
Radiation therapy
#109

19. A 72-year-old man with a history of smoking 40 packs of cigarettes per year underwent successful left total hip arthroplasty 10 years ago. He now reports a 2-month history of progressive right hip pain. An AP pelvic radiograph and CT scan are shown in Figures 35a and 35b. What is the next most appropriate step in management?
Immediate cemented right total hip arthroplasty
Open reduction and internal fixation of the acetabular fracture
Activity modification, IV bisphosphonates, and follow-up in 6 weeks
Technetium Tc 99m scan and CT of the chest, abdomen, and pelvis
Radiation therapy
#109

20. Which of the following tumors has the greatest potential to metastasize to the lung?
Osteoblastoma
Enostosis
Desmoplastic fibroma
Giant cell tumor
Enchondroma
#114

21. Which of the following tumors has the greatest potential to metastasize to the lung?
Osteoblastoma
Enostosis
Desmoplastic fibroma
Giant cell tumor
Enchondroma
#114

22. A 25-year-old man has had intermittent swelling in the left thenar eminence of the past few months. He describes the onset of a dull ache associated with the swelling. An AP radiograph is shown in Figure 39. What is the most likely diagnosis?
Lipoma
Hemangioma
Synovial sarcoma
Ewing’s family of tumor
Giant cell tumor of the tendon sheath
#119

23. A 25-year-old man has had intermittent swelling in the left thenar eminence of the past few months. He describes the onset of a dull ache associated with the swelling. An AP radiograph is shown in Figure 39. What is the most likely diagnosis?
Lipoma
Hemangioma
Synovial sarcoma
Ewing’s family of tumor
Giant cell tumor of the tendon sheath
#119

24. Which of the following diseases of bone (when nonmetastatic at diagnosis) carries the worst prognosis for 5-year survival?
Lymphoma
Osteosarcoma
Ewing’s sarcoma
Paget’s sarcoma
Conventional chondrosarcoma
#137

25. Which of the following diseases of bone (when nonmetastatic at diagnosis) carries the worst prognosis for 5-year survival?
Lymphoma
Osteosarcoma
Ewing’s sarcoma
Paget’s sarcoma
Conventional chondrosarcoma
#137

26. A 2-year-old boy has a limp and anterior bowing of the leg
A 2-year-old boy has a limp and anterior bowing of the leg. A lateral radiograph is shown in Figure 52. What is the most likely diagnosis?
Unicameral bone cyst
Osteofibrous dysplasia
Adamantinoma
Ewing’s sarcoma
Metastatic neuroblastoma
#147

27. A 2-year-old boy has a limp and anterior bowing of the leg
A 2-year-old boy has a limp and anterior bowing of the leg. A lateral radiograph is shown in Figure 52. What is the most likely diagnosis?
Unicameral bone cyst
Osteofibrous dysplasia
Adamantinoma
Ewing’s sarcoma
Metastatic neuroblastoma
#147

28. A 16-year-old girl has had vague right hip pain for the past 2 months
A 16-year-old girl has had vague right hip pain for the past 2 months. An AP radiograph of the pelvis and a T1-weighted fat suppression, gadolinium-enhanced MRI scan are shown in Figures 62a and 62b. A biopsy specimen is shown in Figure 62c. What characteristic genetic translocation is associated with this disease?
t(X;18)
t(2;13)
t(9;22)
t(11;22)
t(12;16)
#161

29. A 16-year-old girl has had vague right hip pain for the past 2 months
A 16-year-old girl has had vague right hip pain for the past 2 months. An AP radiograph of the pelvis and a T1-weighted fat suppression, gadolinium-enhanced MRI scan are shown in Figures 62a and 62b. A biopsy specimen is shown in Figure 62c. What characteristic genetic translocation is associated with this disease?
t(X;18)
t(2;13)
t(9;22)
t(11;22)
t(12;16)
#161

30. #167 chemotherapy and wide resection. ray amputation.
A 2-year-old girl has a mass and erythema in her right hand. She has no recent history of fever, chills, or sore throat. Examination reveals no lymphadenopathy. Figures 64a through 64f show a radiograph, MRI scans, clinical photograph, and a biopsy specimen. Treatment should consist of
chemotherapy and wide resection.
ray amputation.
curettage and allogenic bone grafting.
curettage and antimicrobial treatment.
bone marrow injection.
#167

31. #167 chemotherapy and wide resection. ray amputation.
A 2-year-old girl has a mass and erythema in her right hand. She has no recent history of fever, chills, or sore throat. Examination reveals no lymphadenopathy. Figures 64a through 64f show a radiograph, MRI scans, clinical photograph, and a biopsy specimen. Treatment should consist of
chemotherapy and wide resection.
ray amputation.
curettage and allogenic bone grafting.
curettage and antimicrobial treatment.
bone marrow injection.
#167

32. Which of the following diseases is most likely to develop in a patient with hereditary retinoblastoma?
Squamous cell carcinoma
Colon carcinoma
Transitional cell carcinoma
Chondrosarcoma
Osteogenic sarcoma
#190

33. Which of the following diseases is most likely to develop in a patient with hereditary retinoblastoma?
Squamous cell carcinoma
Colon carcinoma
Transitional cell carcinoma
Chondrosarcoma
Osteogenic sarcoma
#190

34. With current chemotherapy regimens, what is a typical 5-year survival rate for patients with nonmetastatic high-grade osteogenic sarcoma?
Less than 5%
20%
50%
70%
90%
#197

35. With current chemotherapy regimens, what is a typical 5-year survival rate for patients with nonmetastatic high-grade osteogenic sarcoma?
Less than 5%
20%
50%
70%
90%
#197

36. A 67-year-old woman has a painless lump in the adductor compartment of the thigh. Axial T1- and T2-weighted MRI scans are shown in Figures 82a and 82b. A biopsy specimen is shown in Figure 82c. What is the most likely diagnosis?
Liposarcoma
Lipoma
Neurofibroma
Malignant peripheral nerve sheath tumor
Pleomorphic sarcoma
#207

37. A 67-year-old woman has a painless lump in the adductor compartment of the thigh. Axial T1- and T2-weighted MRI scans are shown in Figures 82a and 82b. A biopsy specimen is shown in Figure 82c. What is the most likely diagnosis?
Liposarcoma
Lipoma
Neurofibroma
Malignant peripheral nerve sheath tumor
Pleomorphic sarcoma
#207

38. Figures 85a and 85b show the radiographs of a 17-year-old boy who has had ankle pain for the past 2 months. A biopsy specimen is shown in Figure 85c. CD99 immunohistochemistry staining of the tumor is positive. After staging, what is the next most appropriate step in management?
Chemotherapy
Curettage, culture, and antibiotics
Curettage and cementation
Wide resection
Radiation therapy
#214

39. Figures 85a and 85b show the radiographs of a 17-year-old boy who has had ankle pain for the past 2 months. A biopsy specimen is shown in Figure 85c. CD99 immunohistochemistry staining of the tumor is positive. After staging, what is the next most appropriate step in management?
Chemotherapy
Curettage, culture, and antibiotics
Curettage and cementation
Wide resection
Radiation therapy
#214

40. A low-grade, soft-tissue sarcoma of the thigh is completely excised
A low-grade, soft-tissue sarcoma of the thigh is completely excised. What is the first most common location for recurrence?
Thigh
Lymph nodes
Skeleton
Liver
Lung
#225

41. A low-grade, soft-tissue sarcoma of the thigh is completely excised
A low-grade, soft-tissue sarcoma of the thigh is completely excised. What is the first most common location for recurrence?
Thigh
Lymph nodes
Skeleton
Liver
Lung
#225

42. A bone marrow biopsy is a routine part of the staging work-up for what type of sarcoma?
Osteosarcoma
Synovial sarcoma
Ewing’s sarcoma
Fibrosarcoma
Chondrosarcoma
#239

43. A bone marrow biopsy is a routine part of the staging work-up for what type of sarcoma?
Osteosarcoma
Synovial sarcoma
Ewing’s sarcoma
Fibrosarcoma
Chondrosarcoma
#239

44. Osteosarcoma most commonly metastasizes to the lung
Osteosarcoma most commonly metastasizes to the lung. What is the second most common site of metastasis?
Lymph node
Brain
Bone
Spleen
Liver
#243

45. Osteosarcoma most commonly metastasizes to the lung
Osteosarcoma most commonly metastasizes to the lung. What is the second most common site of metastasis?
Lymph node
Brain
Bone
Spleen
Liver
#243

46. A 46-year-old woman has a 3-cm soft-tissue mass in the subcutaneous forearm. With the expectation that the patient has a lipoma, a marginal excision of the lesion is performed. The pathology report shows it to be a high-grade sarcoma. Staging studies confirm no evidence of metastases, and a postexcision MRI with contrast shows no evidence of residual tumor. What is the next most appropriate step in management?
Amputation
Wide surgical re-excision
Radiation therapy without additional surgery
Observation with follow-up MRI studies, followed by re-excision and radiation therapy if there is a recurrence
Chemotherapy
#249

47. A 46-year-old woman has a 3-cm soft-tissue mass in the subcutaneous forearm. With the expectation that the patient has a lipoma, a marginal excision of the lesion is performed. The pathology report shows it to be a high-grade sarcoma. Staging studies confirm no evidence of metastases, and a postexcision MRI with contrast shows no evidence of residual tumor. What is the next most appropriate step in management?
Amputation
Wide surgical re-excision
Radiation therapy without additional surgery
Observation with follow-up MRI studies, followed by re-excision and radiation therapy if there is a recurrence
Chemotherapy
#249

48. Examination of a 52-year-old man with a 4-week history of hip pain reveals a destructive, lytic proximal femoral lesion. He has no history of malignancy. What is the most likely diagnosis?
Lymphoma
Metastatic carcinoma
Chondrosarcoma
Osteosarcoma
Paget’s sarcoma of bone
#260

49. Examination of a 52-year-old man with a 4-week history of hip pain reveals a destructive, lytic proximal femoral lesion. He has no history of malignancy. What is the most likely diagnosis?
Lymphoma
Metastatic carcinoma
Chondrosarcoma
Osteosarcoma
Paget’s sarcoma of bone
#260

50. Orthopaedic Diseases
OITE 2006