Rad 3 Lecture MT Study guide

A low grade Chondrosarcoma may be impossible to differentiate from?

a. chordoma

b. osteochondroma

c. enostoma

d. enchondroma

d. enchondroma

The first noticeable radiographic feature of MM is:

a. moth eaten pattern of destruction

b. vertebral plana fracture

c. multiple punched out lesions

d. diminished bone density

d. diminished bone density

Numerous uniform lytic lesions are observed in the skull and a compression fracture with anterior and posterior vertebral body collapse is seen in the thoracic spine of a 50 yo male. Most likely diagnosis is:

a. chordoma

b. hodgkin lymphoma

c. multiple myeloma

d. chondrosarcoma

c. multiple myeloma

What is the most common benign tumor of the axial skeleton?

a. osteoma

b. hemangioma

c. chordoma

d. osteochondroma

b. hemangioma

Chondroblastoma has a preference for:

a. epiphysis

b. diaphysis

c. metadiaphysis

d. metaphysis

a. epiphysis

Osteosarcoma classically involves which part of a long tubular bone?

a. epiphysis

b. diaphysis

c. apophysis

d. metaphysis

d. metaphysis

"If a lesion is noted about the knee and suggests a primary malignant bone tumor, not any one in particular, then think of _______." This rule is know as what and is associated with which tumor?

a. Lichenstein, osteosarcoma

b. Lichenstein, fibrosarcoma

c. Lithuania, fibrous dysplasia

d. Lithuania, fibrous dysplasia

b. Lichenstein, fibrosarcoma

A 4 yo female presents with fever, loss of appetite and severely lethargic. X-rays of her bilateral knees demonstrates bands of radiolucency at the visualized metaphysis. Best diagnosis?

a. leukemia

b. ewing sarcoma

c. osteoid osteoma

d. osteosarcoma

a. leukemia

A large, expansile lytic lesion with cortical destruction with amorphous calcification observed within the sacrum of a 32 year old male. They complain of chronic sacral pain. Best diagnosis?

a. plasmacytoma

b. enchondroma

c. chordoma

d. giant cell tumor

c. chordoma

T/F: The majority of hemangiomas are safe to adjust.

T

The most common cause of blastic metastasis in a male patient is:

a. bronchogenic carcinoma

b. renal cell carcinoma

c. prostatic carcinoma

d. breast carcinoma

c. prostatic carcinoma

All of the following are expansile except:

a. non-ossifying fibroma

b. aneurysmal bone cyst

c. osteoid osteoma

d. osteoblastoma

c. osteoid osteoma

Which of the following is not a lab finding associated with MM?

a. M-spike electrophoresis

b. reversal of albumin to globulin ratio

c. Bence Jones proteinuria

d. elevated acid phosphatase

d. elevated acid phosphatase

Chondrosarcoma is most commonly seen in patients age _______.

a. 1-15

b. 20-40

c. 10-25

d. 40-60

d. 40-60

All of the following are findings associated with primary benign neoplasm except:

a. geographic pattern of destruction

b. cortical destruction

c. permeative pattern of destruction

d. solid periosteal reaction

c. permeative pattern of destruction

A 49 year old male presents with hip pain. X-rays reveal a lesion in the proximal femur that is lytic with ill-defined margins. Significant punctuate calcifications are present. Subtle cortical destruction is observed. Best diagnosis?

a. osteosarcoma

b. chondrosarcoma

c. enchondroma

d. fibrosarcoma

b. chondrosarcoma

The most common contrast agent utilized with MRI is ____ and the most common radioisotope used with scintigraphy is _____.

a. technetium-99; gadolinium

b. gadolinium; technetium-99

c. houndsfield; technetium-99

d. gadolinium; houndsfield

b. gadolinium; technetium-99

Typically, normal vertebral marrow demonstrates a ______ signal on T1 relative to CSF fluid. However, with metastatic disease, as normal marrow is replaced, the lesion will appear ______ on T1 and ______ T2.

a. high/bright; low; high

b. low; low; high

c. high; low; low

a. high/bright; low; high

What is the name sign associated with multiple sarcomatous metastatic lesions seen scattered throughout the lungs?

a. multiple snowball appearance

b. cookie bite erosion

c. cannonball metastasis

d. extrapleural sign

c. cannonball metastasis

What is the most common malignant tumor of the skeleton?

a. metastasis

b. osteosarcoma

c. multiple myeloma

d. chondrosarcoma

a. metastasis

Skeletal metastasis in young children may arise from a primary...

a. cholesteatoma

b. lipoma

c. neuroblastoma

d. hemangioblastoma

c. neuroblastoma

What is the most common benign neoplasma to affect the hand?

a. osteochondroma

b. enchondroma

c. chondrosarcoma

d. enostoma

b. enchondroma

Most cases of metastasis are _____ and spread via ____.

a. lytic, lymphatic channels

b. lytic, hematogenous dissemination

c. blastic, direct extension

d. blastic, hematogenous dissemination

b. lytic, hematogenous dissemination

Which of the following should raise concern for pathological fracture due to malignancy?

a. distal radial impaction

b. lesser trochanter avulsion

c. femoral condyle impaction

d. spinous process avulsion

b. lesser trochanter avulsion

The presence of Reed-Sternberg cells and pain following consumption of alcohol should raise suspicion of:

a. fibrosarcoma

b. hodgkin lymphoma

c. synovial sarcoma

d. multiple myeloma

b. hodgkin lymphoma

A 13 year old male presents with ankle pain following a skateboarding accident. No complaints reported prior to the injury. An eccentric well defined lytic expansile lesion is observed in the metadiaphysis of the tibia. No cortical destruction or periosteal reaction is observed.

a. chondroblastoma

b. osteoid osteoma

c. non-ossifying fibroma

d. aneurysmal bone cyst

c. non-ossifying fibroma

The triad of findings including digital clubbing, bilateral symmetric periostitis and arthritis is most commonly seen with _____.

a. hereditary multiple exostosis

b. mafucci syndrome

c. hypertrophic osteoarthropathy

d. gardner syndrome

c. hypertrophic osteoarthropathy

What is the most common benign neoplasm of the paranasal sinuses?

a. hemangioma

b. osteochondroma

c. enostoma

d. osteoma

d. osteoma

Osteoblastoma most commonly affects the ____

a. paranasal sinus

b. clavicle

c. neural arch

d. greater trochanter

c. neural arch

What is the most likely diagnosis for a 15 year old with increasing severe back pain, and scoliosis and sclerotic pedicle?

a. aneurysmal bone cyst

b. osteoblastoma

c. chordoma

d. osteoid osteoma

d. osteoid osteoma

Patients with chordoma have symptoms arising from:

a. fatigue from marrow replacement

b. pain due to cortical destruction

c. pain due to pathological fracture

d. discomfort attributed to mass effect

d. discomfort attributed to mass effect

Scintigraphy has very high ____ but low _____.

a. sensitivity; specificity

b. specificity; sensitivity

a. sensitivity; specificity

Which lesion characteristically begins are metaphyseal lesion but extends to the subchondral/subarticular bone?

a. giant cell tumor

b. osteoblastoma

c. plasmacytoma

d. simple bone cyst

a. giant cell tumor

Multiple expanded lucent bone lesions are appreciated in the metacarpals, phalanges and distal radius. Several of the lucent lesions demonstrate a pattern. No tissue calcifications are seen. Best diagnosis?

a. Ollier's disease

b. Maffucci syndrome

c. hereditary multiple exostosis

d. gardner syndrome

a. Ollier's disease

Diffuse whitening of the vertebral body with anterior body scalloping is most likely due to:

a. hodgkin lymphoma

b. paget's disase

c. hemangioma

d. osteoblastic metastasis

a. hodgkin lymphoma

The "cumulus cloud" appearance is:

a. spiculated periostitis seen in aggressive malignancies

b. lobulated soft tissue mass associated with chondrosarcoma

c. dense, ivory lesion with rough lobulated margins in osteosarcoma

d. reactive sclerosis response to host bone seen in ewing sarcoma

c. dense, ivory lesion with rough lobulated margins in osteosarcoma

What 2 malignancies should be considered for a 57 yo male with multiple lytic lesions in the ilium, sacrum, and proximal femur? (PATA)

a. osteosarcoma

b. chordoma

c. metastasis

d. multiple myeloma

c. metastasis

d. multiple myeloma

A 52 year old male presents with pelvic pain. X-rays reveal 8 cm ill-defined lytic expansile lesion with cortical destruction. Choose 2 possible diagnosis.

a. ewing sarcoma

b. blow out metastasis

c. giant cell tumor

d. plasmacytoma

b. blow out metastasis

d. plasmacytoma

The most common primary malignancy to cause metastasis in female patients is:

a. renal carcinoma

b. lung carcinoma

c. breast carcinoma

d. bladder carcinoma

c. breast carcinoma

Non-traumatic loss of the posterior vertebral body height most often indicates:

a. burst fracture

b. previous injury

c. congenital anomaly

d. pathologic fracture

d. pathologic fracture

A painless small 2 cm cortically based lesion with a hazy matrix is discovered in the distal femur:

a. fibrous cortical defect

b. simple bone cyst

c. chondroblastoma

d. osteoid osteoma

a. fibrous cortical defect

The "blind vertebra" indicates:

a. Spots of radiolucency in the vertebral body from a hemangioma

b. unilateral pedicle agenesis with contralateral hypertrophy

c. bilateral pedicle destruction from metastasis

d. neural arch expansion from a large aneurysmal bone cyst

c. bilateral pedicle destruction from metastasis

Which 2 lesions should be considered in a 10 year old male with a 7cm lytic lesion which demonstrated marled cortical destruction and aggressive periostitis. (Select 2)

a. fibrosarcoma

b. ewing sarcoma

c. chondrosarcoma

d. metastasis

e. osteosarcoma

b. ewing sarcoma

e. osteosarcoma

What is the gold standard for evaluating the entire skeleton for multiple lesions?

a. X-ray

b. MRI

c. Scintigraphy

d. CT

c. Scintigraphy

What is the most common benign tumor of the appendicular skeleton?

a. hemangioma

b. enchondroma

c. osteochondroma

d. enostoma

c. osteochondroma

The most common primary osseous malignancy of childhood is:

a. chondrosarcoma

b. ewing sarcoma

c. metastasis

d. osteosarcoma

d. osteosarcoma

Which of the following is least likely to be hot on a bone scan?

a. multiple myeloma

b. paget's disease

c. hypertrophic pulmonary osteoarthropathy

d. infection

a. multiple myeloma

What are the top 3 most common causes for an ivory vertebra?

a. hodgkin's lymphoma

b. hemangioma

c. paget's disease

d. multiple myeloma

e. blastic metastasis

f. lytic metastasis

a. hodgkin's lymphoma

c. paget's disease

e. blastic metastasis

The triad of abnormal growth seen in almost half of the cases of Gardner syndrome consists of:

a. colonic polyps, soft tissue fibromas, cafe au lait spots

b. soft tissue fibromas, multiple osteomas, and colonic polyps

c. multiple osteomas, colonic polyps, cafe au lait spots

d. cafe au lait spots, soft tissue fibromas, multiple osteomas

b. soft tissue fibromas, multiple osteomas, and colonic polyps

Several blastic lesions throughout the pelvis may suggest which name sign?

a. cookie bite erosions

b. cannonball metastasis

c. multiple snowball appearance

d. cumulous clouds

c. multiple snowball appearance