Oncology - MCQ

  1. 3- All of these are commonly found in the posterior elements of the spine, except?

  2. List 4 tumors in the posterior elements of the spine
    • ABC
    • Osteoid osteoma
    • Ostoblastoma (40% in spine)
    • Osteochondroma
  3. All those genetic associations are true except?

  4. Blurry picture of what looks like fibrous dysplasia of the humerus (or Pagets?). What is it the least likely to transform into?

  5. What is true regarding atypical lipomatous tumors/well differentiated liposarcomas?

  6. What is true about PVNS?


    • Most common 30-40
    • Most common knee
  7. What is the treatment plan of MFH?

  8. Classic description of osteoid osteoma of the fibula. Patient had to stop NSAIDs due to GI upset. What next?

  9. Which is a possible donor-site complication of vascularized fibular bone graft?

  10. What is true about fibrous dysplasia?


    caused by failure of production of normal lamellar bone

    Usually asymptomatic

    Monostotic is most common

    If cafe au lait spots > mcCune-Albright syndrome
  11. Patient comes to clinic with complaint of thigh pain x 3 weeks (Sherbrooke 3 months). Over this time he has noted an enlarging mass in posterolateral thigh. He also has café au lait spots and multiple cutaneous lesions. Patient has foot drop. What is the most likely diagnosis?

  12. What is true about bone cysts?

  13. What is true regarding atypical lipomatous tumors/well differentiated liposarcomas? REPEAT


    • Recurrence rate <10%
    • Have risk dediffrentiation
    • Myxoid liposarcoma: translocation 12;16
  14. Patient has multiple intraosseous lesions in his hands that are lytic with stippled calcifications. He wants to know if his kids will be affected. (Repeat)


    Olliers or mafucci both are sporadic
  15. 15 year old kid has a Ewing sarcoma in the distal femur. For some reason this was not amenable to limb salvage so patient and family were consented for amputation. The parents agree to go ahead, but the patient does not want to get amputated. He explains that he understands that the cancer may spread but he does not want an amputation. What should you do?

  16. When working up a bone tumor, what is false about tru-cut biopsy?

  17. What is true regarding GCT? REPEAT

  18. 60M has a history of a previous desmoid tumor that was excised 3 months ago. He is in your clinic and is found to have an basal skull ENT lesion (osteoma) seen on CT-Head. What is next step in management/investigation?


    Gardner syndrome: desmoid yumor + osteomas
  19. You are shown an x-ray (very fuzzy) of a tibia. There is a lesion in the cortex of tibial shaft. X-Ray provided of a large aggressive lesion in the proximal tibia, calcifications, popcorn-like matrix. They ask how you would like to treat?


    Its a chondrosarcoma

    Only can be used for mesenchymal chondrosarcoma
  20. Which of the following is an immunohistochemical marker for Ewing’s sarcoma?


    Histology is small round blue cells
  21. Name the immunohistochemical stain for:
    • CDA1 + S100
    • +CD20
    • +CD99
    • Keratin + S100
    • CD 138
    • Keratin
  22. A 25yo female with (a few months?) of leg pain twists and feels a crack in her hip. X-rays (described, not given) show a sclerotic lesion with an ossified soft tissue mass. MRI shows a small hematoma. Biopsy showed osteoid. What is the most appropriate treatment?


    This is an osteosarcoma > neoadjuvant chemo > restage > wide resection > adjuvant chemo
  23. What is the most common primary malignant tumor in the hand?

  24. Most common sarcoma foot
  25. Most common benign bone tumor
  26. An 80yo female with a history of breast cancer treated with mastectomy, lymph node dissection, and radiation with no recurrence 20 years ago presents with a humeral lesion which is sclerotic, and associated with an ossified soft tissue mass. Most likely diagnosis is?


    They are saying this is secondary sarcoma:from radiotherapy

    Breast usually lytic with no sclerosis
  27. All of the following are associated with osteosarcoma EXCEPT?


    Paget: complication is development of malignant tumor
  28. Li fraumeni syndrome: mutation
    p53: can lead to osteosarcoma
  29. Li fraumeni 3 diagnostic criteria
    • Sarcoma age <45
    • First degree relative with any cancer at age <45
    • Another first degree relative or a second degree with cancer <45...or sarcoma at any age
  30. Lady has soft tissue Sarcoma.  Worried about her kids getting it.  What you tell her?


    Most common sporadic

    if familial..li fraumeni syndrome
  31. Guy presents with pathologic fx of femur.  CT Chest, abdo, pelvis is clean.  Lesion of femur has extension into soft tissues with another lesion in the femur.  What is next step?

  32. Kid has ABC in forearm.  Which of the following is true except?


    • GCT age range 20-40 years
    • ABC 12-13
    • ABC recurrence 20%
  33. Lady with Breast mets, now with R hip pain.  Shown AP of pelvis- huge osteolytic lesion involving ilium. Also spine looked blastic to me so threw me off a bit but lesion to acetabulum more important.  What to do?

  34. Guy with open wound distal tibia- you are given picture.  Had open fx years ago and was infected.  Never really healed- multiple debridements.  Recently has gotten much larger and has draining sinus.  Likely problem? Xray seen was osteoperotic and had large lytic lesion and pic of lesion shown was totally gross!


    Marjolain ulcer = scc
  35. Guy with Malignant Fibrous Histiocytoma of Femur.  What is best treatment?


    radiation if >5cm

    need neoadjuvant and adjuvant chemo
  36. Guy with chordoma.  What is best treatment?


    Radiation is experimental: good for inoperative tumors

    No role for chemo
  37. GCT of the forearm- What is true?

  38. What is true regarding unicameral bone cysts?

  39. 8 yo boy with pathologic fracture of proximal phalanx. Lytic with stippled calcifications. What is the best treatment at this point?
    a) Cast
    b) Biopsy and K wire
    c) ORIF with curettage
    d) ORIF with phenol

    In small bones enchondroma treatment is immobilization until healing followed by curetage and bone grafting
  40. Predisposition to developing chondrosarcoma is associated with all of the following except?


    mafucci is enchondroma + angiomas
  41. Ewing sarcoma translocation
    T 11:22
  42. Multiple hereditary exostoses gene mutation
    EXT 1 or 2
  43. All of the following associations are correct except?

    • B)
    • but NF 1 can be associated with pilocytic astrocytoma
  44. 50 year old man with history of bowel cancer 2 years ago, treated with resection and no adjuvant therapy. Xray shows midshaft femur pathologic #. Staging investigations are negative. Bone scan only lights up at fracture site. What is the best management at this point?
    a) Biopsy before definitive treatment
    b) Femoral nailing and send reamings to pathology
  45. 60 yo man with cancer, 6 months life expectancy, debilitating pain R thigh, avulsion of LT. What is the best management?


    LT implies pathologic process of femoral neck
  46. Man with multiple lytic lesions in pelvis, hypercalcemia, M spike on SPEP, what is your next investigation?


    skeletal survey vs biopsy
  47. Lady with non-pathologic fracture 2 cm distal to LT, what is the best treatment?

  48. What is a feature of NOF?

  49. All of the following lesions are seen in the anterior elements of the spine except?

  50. 8 y.o. kid with fx of proximal phalanx through a lytic lesion with striations. Which is best treatment?
    a) Splint
    b) ORIF with curettage
    c) ORIF with phenol applied to lesiond.
    d) Resection of lesion

    curetage once bone lesion is healed
  51. Location enchondroma in the hand
    proximal phalanx
  52. All of the following are true with multiple enchondromas EXCEPT:

    • C)
    • enchondroma goes to low grade chondrosarc
  53. All of the following are true regarding poor prognosis with percutaneous steroid injection for UBC EXCEPT:


    Poor prognosis

    • Large size
    • Multiloculated
    • Radiographically active
    • Calcaneal location
  54. Fibrosarcoma of Bone.  What is the treatment?


    Fibrosarcoma of bone is same as MFH
  55. Child with lytic lesion in D5 with stippled calcification + fracture.  What is treatment?

  56. Stippled calcification: Dx
    • Chondroblastoma
    • Exteded intralesional curetage
  57. Soft tissue sarcoma most important prognosis

  58. 4 poor prognostic factors is soft tissue tumors
    • High grade
    • Size >5 cm
    • Deep to fascia
    • Presence mets
  59. What to do parosteal osteosarcoma.


    treatment for paraosteal osteosarc is wide local surgical excision
  60. Chemotherapy is used in the treatment of all of the following EXCEPT:


    angiosarcoma does not respond to chemo

    The rest do
  61. All are indications to prophylactically nail a pathologic lesion except;


    depends on location of multiple lytic lesions
  62. Parosteal osteosarcoma what is true?a)Never in the central canal
    (never communicates with medullary canal)
    b) Usually found in lower limbs
    c) Usually poorly differentiated, “de-differentiated”

    common site distal femur proximal tibia and proximal humerus

    Marrow invasion occurs in 25%

    Usually low grade well differentiated
  63. Lady with breast ca, multiple bone mets, comes in hypercalcemic, lethargic, ecg changes (qt changes)- obtunded. What is best treatment?


    calcitonin since neuro symptoms

    diuretics: loop diuretics
  64. 22-year-old female with neck pain.  No neurology. Systemically well. Xrays show an expansile lytic lesion in the anterior vertebral body extending into the pedicle.  This is most likely (Dalhousie has shorter question- benign vertebral lesion in 22 yo female spine?)


    ABC most common in posterior elements

    Hemangioma: vertical striation
  65. Most common presentation benign tumor in a 10 year old

  66. Which tumor is most likely to be found in the posterior elements

  67. Spine tumors all are true except”. I think this is the question!

  68. What is the classic triad McCune-Albright syndrome:


    key is polyostic fibrous dysplasia
  69. Where is the glomus tumor most likely found
    A. Pulp
    B. Nail bed
    C. Distal phalanx
    D. Hyponychial area
    E. Paronychium

    • rare benign tumor 
    • In subungual region
  70. 35-male patient with neck pain, exam negative, neck no masses.  What is the most likely diagnosis based on the images—(XR c-spine AP, oblique, CT, and bone scan given.  The oblique showed lytic lesion in the body of C5, bone scan increase uptake, CT some septation 2-3 in lytic lesion and slight expansion of the cortex.)
    a) Osteoblastoma
    b) Metastatic thyroid carcinoma
    c) Hemangioma
    Need to look at images
  71. Osteosarcoma versus Ewing sarcoma—what will most likely aid diagnosis?


    translocation T11:22
  72. An elderly gentleman presents with bone pain and lytic lesion in mid shaft of humerus extending to epiphysis. He also has punched out lesions of the skull. His Ca was normal and his ESR is elevated. Which test will help confirm?

    d) Serum creatinine
    An elderly gentleman presents with bone pain and lytic lesion in mid shaft of humerus extending to epiphysis. He also has punched out lesions of the skull. His Ca was normal and his ESR is elevated. Which test will help confirm?Serum protein electrophoresisBone scanPSATSHSerum creatinine

    Punch out lesions in the skull is pathomnemonic
  73. Glomus tumor, true except:


    Usually shelled out lesion phalanx

    Location is dermal reticular layer of the skin

    Classic presentation: blue red subungual lesion + cold insensitivity + paroxysmal
  74. 32yo man with 20 year history of mass in hip/buttock area. Now pain worsening for 1 year, noticed it has grown recently. On exam and xrays (not given) there were other bony prominences and bowing of the forearm bones. What is the likely treatment?


    This is NF1 because of bowing of forearm
  75. Which soft tissue tumor will not only be metastasized to lung?


    myxoid liposarcoma have a tendency to metastatize to different areas like retroperitoneum
  76. All need bone marrow Bx for staging except?

  77. Liposarcoma in somebody’s popliteus that is NV intact distally, option? Ottawa: a female with rapidly enlarging popliteal mass which is solid and firm. NV completely intact. MRI shows increase signal in T2 and diagnosis of Liposarcoma (low grade?). Rx:


    • Liposarcomas are the 2nd most common soft tissue sarcoma in adults.  
    • Treatment options include marginal resection without radiotherapy for well-differentiated liposarcomas and wide surgical resection with adjuvant radiotherapy for higher grade tumors)

    liposarcoma always in deep compartments
  78. Long story on dude with MHE and father who had it, maternal grandfather who had it, and wants to know if kids will get it, what combo?


    autosomal dominant
  79. Pain and crepitus around the shoulder is usually? Ottawa: Painful scapulothoracic crepitus. What is the most common etiology?


    Snapping scapula syndrome: osteochondroma, elastofibroma,
  80. With regards to eosinophilic granuloma, all are true EXCEPT


    big mimicker
  81. Little kid with lesion in cortex that is well circumscribed and focal appearing like OO (Osteoid Osteoma) and NSAIDs with full night pain relief, Tx caused tummy bleed, had to stop, next:

  82. Osteosarcoma, all for staging EXCEPT? Ottawa: Teenager with distal femoral lesion with sclerosis, periosteal reaction, sunburst appearance, large ST mass. Asked which of the following are not indicated in the work-up?


    increase ALP is sign of poor prognosis
  83. Dude with parosteal osteosarcoma on Bx, tx?


    Paraosteal osteosarcoma treatment is wide resection if low grade

    if high grade then chemo followed by resection
  84. Girl with epiphyseal lesion, no periosteal reaction, no soft tissue mass, well corticated, tx? Ottawa: 12yo with knee pain 2cm well circumscribed lytic lesion in proximal lateral tibial epiphysis, no periosteal new bone, no breech of cortex. MRI shows that it enhances on T2 image with surrounding edema (Bright on T2 with lots of edema).  (it was a chondroblastoma), no ST mass:



    typical location: epiphyseal

    2% can metastasize to lungs

    Rx: after end of growth
  85. Simple bone cysts in adults, what is true?

  86. A 68 male who has lost 25 pounds in 6 months and has LBP. Radiographs showed a radiolucent lesion on the left side. What is the diagnosis:

  87. A 33 male presents with wrist pain. The MRI shows breakthrough through the volar cortex into PQ. Biopsy reveals GCT. What is the best treatment?


    Good option in campanacci 3( through cortex) of the distal radius
  88. What is the most common soft tissue malignancy in the foot?


    second most common melanoma
  89. The most important determinant of survival after resection of sacral chordoma is


    no role for chemo

    Radio for unopperable tumors
  90. The function of a patient with polyostotic fibrous dysplasia is most affected by

    • B)
    • (from an article)
  91. Enchondroma

  92. Best treatment for chondrosarcoma of forearm

  93. Young guy with high grade soft tissue sarcoma in medial thigh, does not extend proximal to inguinal ligament, does not involved N/V structures, what is the best treatment

  94. Indication to fix a pathologic lesion. ?All except


    historically >2,5 cm have higgher risk
  95. Fibrous dysplasia, what kind of graft would you use post corrective osteotomy?


    the rest have higher chance to be resolved
  96. Chondrosarc in 35 year old pt. Worse prognosis associated with what feature?
    a) Age
    b) Pelvic location
    c) Hypocellularity with abundant matrix
    d) Diploid on flow cytometry
  97. Osteogenic sarcoma
    a) Highest incidence in 3rd decade
    b) Regional lymph nodes commonly involved
    c) Others
    No answer provided
  98. Chemo and osteosarc – all are true EXCEPT


    increased margin after chemo
  99. 10 year history of chronic osteomyelitis + draining ulcer, recently much worse. Picture shown of nasty leg ulcer looking like dog ass. Why sudden worsening?


    Marjolain ulcer
  100. Chronic infected tibia with swab of draining sinus showing Proteus, enterococcus, pseudomonas. Which conclusions can be drawn from the swab?


    Organisms isolated from sinus tract drainage typically do not accurately reflect the organisms present deep within the wound and within bone
  101. What of the following predisposes to Adamantinoma?

  102. Soft tissue sarcoma metastasizes to:


    lung mets via hematogenous spread
  103. 4 poor prognostic factors soft tissue sarcoma
    • >5cm
    • deep to fascia
    • High grade (>2)
    • Radio resistant tumor
  104. Young girl with bone tumour large soft-tissue mass and round blue cell (basically tells you it’s Ewing’s) that is potentially salvageable.  Initial management should be:

  105. 70 yo male with 3 month hx progressive thigh pain, now with severe increase pain.  Past hx of prostate cancer resection, radiation treatment 10 yrs ago.  Xray, MRI and bone scan show isolated lytic intertrochanteric lesion with expansion of the hematoma throughout the compartments and surrounding the neurovascular bundle.  Rx:


    Always do biopsy
  106. Glomus tumour best verified with:


    glomus: Modified smooth muscle cells called glomus cells

    Most common location is distal extremities
  107. 80 yo female hx of breast ca with mastectomy, node resection, radiation 20 yrs ago with painful mass humerus.  Told on xray it’s destructive, periosteal rxn, soft tissue expansion with osteoid matrix.  Dx:


    because of osteoid
  108. Which of the following will likely result in secondary chondrosarcoma:


    hans schuller christian: Exophthalmos, DI, Skull defects
  109. The most important determinant of survival after resection of sacral Chordoma is

  110. Some guy has a proximal femoral resection for a tumour and is fixed with an allograft-prosthetic composite.  No problems for 6 yrs but then he comes back with pain and an X-ray which shows loosening of the stem mainly in the distal bone (host femur), non-union of the allograft with the host femur, and what looks like a fracture of the allograft.  What is the most common cause of failure?

  111. 20 yr-old with neck pain and weakness in C6 distribution.  Shown axial CT cuts of a lytic lesion with cortical expansion in the posterior elements of C6.  What is the LEAST likely diagnosis?


    GCT usually anterior elements
  112. Soft tissue sarcoma treatment. All are true EXCEPT


    pre op rads 2x complication vs post op

    Chemo is for mets!!!1
  113. Incisional biopsy principles, EXCEPT?

  114. 75 yo Male with sclerotic IT lesion. Biopsy reveals carcinoma. What test will give the Dx?
    a) PSA
    b) CXR
  115. 20 yr-old with neck pain and weakness in C6 distribution.  Shown axial CT cuts of a lytic lesion with cortical expansion in the posterior elements of C6.  What is the LEAST likely diagnosis?

  116. Chondroblastoma. All are true EXCEPT

    • C)
    • usually epiphyseal
  117. Cement in GCT. All are true EXCEPT


    No difference in local recurrence
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Oncology - MCQ
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