Bone Tumors Practice Questions

Q: Which of the following anatomical locations is least commonly the site of a metastatic tumor?

Small bone of the lower limb. **Explanation:** The distribution of skeletal metastases is primarily determined by the presence of **red bone marrow**. Metastatic cells travel via the bloodstream and tend to deposit in highly vascularized areas. In adults, red marrow is concentrated in the **axial skeleton** (vertebrae, pelvis, ribs, skull) and the proximal ends of the femur and humerus. **1. Why "Small bones of the lower limb" is correct:** The small bones of the hands and feet (acrometastasis) contain very little to no red marrow in adults, as it has been replaced by fatty yellow marrow. Consequently, these sites are the **least common** for metastatic deposits. When acrometastasis does occur, the most common primary source is often the lung. **2. Analysis of incorrect options:** * **Vertebra (Option D):** This is the **most common** site for skeletal metastasis due to the rich venous plexus (Batson’s plexus) and high red marrow content. * **Pelvis (Option A) and Ribs (Option B):** These are part of the axial skeleton and are frequently involved in metastatic disease, following the spine in order of prevalence. **NEET-PG High-Yield Pearls:** * **Most common bone tumor overall:** Metastatic bone disease (Secondary). * **Most common primary bone tumor:** Multiple Myeloma (if excluded, then Osteosarcoma). * **Common Primaries:** In males, Prostate cancer; in females, Breast cancer. Lung cancer is the most common primary to metastasize to the bone in both sexes combined. * **Batson’s Plexus:** A valveless venous system that allows retrograde spread of cancer cells (especially from the prostate) to the spine without passing through the lungs.

Q: Jaffe's syndrome is defined as which of the following?

Fibrous dysplasia with cafe au lait spots.. ### Explanation **Fibrous Dysplasia** is a benign bone condition where normal bone is replaced by fibrous connective tissue and haphazardly arranged bony trabeculae. It presents in three distinct clinical patterns, and distinguishing between them is high-yield for NEET-PG. **1. Why Option B is Correct:** **Jaffe’s Syndrome** (also known as Jaffe-Lichtenstein Syndrome) is a specific subtype of polyostotic fibrous dysplasia. It is defined by the clinical dyad of: * **Polyostotic Fibrous Dysplasia:** Involvement of multiple bones. * **Café-au-lait spots:** Hyperpigmented skin lesions, typically with irregular "Coast of Maine" borders. **2. Why the Other Options are Incorrect:** * **Option A:** Fibrous dysplasia alone can be **monostotic** (single bone, 70% of cases) or **polyostotic** (multiple bones). Jaffe’s syndrome specifically requires the presence of cutaneous pigmentation. * **Option C:** This describes **McCune-Albright Syndrome**. It is characterized by the triad of polyostotic fibrous dysplasia, café-au-lait spots, and **hyperfunctioning endocrinopathies** (most commonly precocious puberty in girls). While Jaffe’s and McCune-Albright are related, the presence of endocrine dysfunction is the differentiating factor. **3. High-Yield Clinical Pearls for NEET-PG:** * **Genetic Mutation:** Both Jaffe’s and McCune-Albright are caused by a post-zygotic mutation in the **GNAS1 gene**. * **Radiology:** Look for the characteristic **"Ground-glass appearance"** and "Shepherd’s crook deformity" of the femur. * **Histology:** Features "Chinese letter" patterns of trabeculae without osteoblastic rimming. * **Mazabraud Syndrome:** A rare association of fibrous dysplasia with soft tissue myxomas.

Q: A swelling over the distal end of the femur with secondary deposits in the lungs is diagnosed as:

Osteogenic sarcoma. **Explanation:** **Osteogenic Sarcoma (Osteosarcoma)** is the most common primary malignant bone tumor in children and young adults. It typically arises in the **metaphysis** of long bones, with the **distal femur** being the most frequent site (around 40% of cases). A hallmark of Osteosarcoma is its high propensity for **early hematogenous spread**, specifically to the **lungs**. The presence of "skip lesions" and pulmonary metastases at the time of diagnosis is a classic clinical presentation for this malignancy. **Why other options are incorrect:** * **Giant Cell Tumor (GCT) / Osteoclastoma:** These terms refer to the same entity. GCT is a "locally aggressive" tumor but is typically benign. It occurs in the **epiphysis** (after physeal closure) and rarely metastasizes to the lungs (only in <2% of cases, known as "benign pulmonary implants"). * **Ewing’s Sarcoma:** While it is a highly malignant tumor that metastasizes to the lungs, it typically involves the **diaphysis** (shaft) of long bones and presents with systemic symptoms like fever and an "onion-peel" periosteal reaction. **NEET-PG High-Yield Pearls:** * **Radiology:** Look for the "Sunray appearance" or "Sunburst appearance" and "Codman’s triangle" (periosteal elevation). * **Enzyme Marker:** Serum **Alkaline Phosphatase (ALP)** is often elevated and serves as a marker for prognosis and treatment response. * **Age Group:** Bimodal distribution (10–20 years and >60 years associated with Paget’s disease). * **Treatment:** Neoadjuvant chemotherapy → Limb salvage surgery → Adjuvant chemotherapy.

Q: Which of the following is not a common cause of osteolytic lesions?

Prostate cancer. **Explanation:** The key to answering this question lies in distinguishing between **osteolytic** (bone-destroying) and **osteoblastic** (bone-forming) lesions. **1. Why Prostate Cancer is the Correct Answer:** Prostate cancer is the classic example of a malignancy that produces **osteoblastic (sclerotic) metastases**. This occurs because prostate cancer cells secrete factors like Bone Morphogenetic Proteins (BMPs) and TGF-β, which stimulate osteoblast activity, leading to increased bone density on X-rays. While it can occasionally have mixed features, it is the least likely among the options to present as a purely osteolytic lesion. **2. Analysis of Incorrect Options (Common Causes of Osteolytic Lesions):** * **Breast Cancer:** Typically presents as **mixed** lesions (both lytic and blastic), but osteolytic lesions are very common due to the secretion of PTHrP, which activates osteoclasts. * **Thyroid Cancer:** Characteristically produces **purely osteolytic**, highly vascular, and "expansile" (blow-out) lesions. * **Bronchogenic Carcinoma (Lung):** Primarily produces **osteolytic** lesions. Lung cancer is also the most common primary to metastasize to the bones of the hand and feet (acrometastasis). **3. NEET-PG High-Yield Pearls:** * **Mnemonic for Osteolytic Metastases:** "Lead Kettle" (**Li**ve, **K**idney, **E**sophagus, **T**hyroid, **T**estis, **L**ung, **E**nteric). * **Most common source of bone metastasis in males:** Prostate cancer. * **Most common source of bone metastasis in females:** Breast cancer. * **Purely Lytic Lesions:** Kidney (RCC) and Thyroid (often present with "pulsatile" bone secondary). * **Investigation of Choice:** **MRI** is the most sensitive for detecting early marrow involvement, while a **Bone Scan** (Technetium-99m) is used for screening (Note: Bone scans may be "cold" in purely lytic lesions like Multiple Myeloma).

Q: Which of the following is NOT true about osteoid osteoma?

Pain is not relieved by salicylates.. **Explanation:** Osteoid osteoma is a common benign, bone-forming tumor characterized by a small radiolucent core called a **nidus** (less than 2 cm) surrounded by a zone of reactive bone formation (sclerosis). **1. Why Option B is the correct answer (The False Statement):** The hallmark clinical feature of osteoid osteoma is **nocturnal pain** that is **exquisitely relieved by salicylates (Aspirin) or NSAIDs**. This occurs because the nidus contains high concentrations of prostaglandins (PGE2 and PGI2). Since the question asks for the statement that is *NOT* true, Option B is the correct choice because pain *is* relieved by these medications. **2. Analysis of Incorrect Options:** * **Option A:** It is indeed a **benign** tumor, typically affecting children and young adults (10–25 years). * **Option C:** Bone scans are highly sensitive for osteoid osteoma. They show a **"double density sign"** (intense uptake in the nidus surrounded by a less intense area of uptake in the reactive bone), making it useful for localization. * **Option D:** On X-ray, the lesion appears as a **dense, sclerotic area** of bone. The central radiolucent nidus may sometimes be obscured by this intense surrounding sclerosis, requiring a CT scan for better visualization. **NEET-PG High-Yield Pearls:** * **Most common site:** Femur (specifically the neck) and Tibia. * **Gold Standard Investigation:** Thin-cut **CT Scan** (best to visualize the nidus). * **Histology:** Shows a nidus of haphazardly arranged osteoid trabeculae with prominent osteoblasts. * **Management:** Medical management with NSAIDs is the first line. If refractory, **Radiofrequency Ablation (RFA)** is the treatment of choice. * **Differential Diagnosis:** Osteoblastoma (nidus >2 cm, pain not relieved by aspirin).

Q: A 25-year-old man presents with severe pain in the left femur. The pain is relieved by aspirin. On plain film, a 0.5-cm lucent lesion, which is surrounded by marked reactive sclerosis, is seen. What type of bone lesion is most likely associated with these findings?

Osteoid osteoma. **Explanation:** The clinical presentation is classic for **Osteoid Osteoma**, a benign bone-forming tumor. The diagnosis is based on three hallmark features: 1. **Clinical:** Severe nocturnal pain that is characteristically relieved by **NSAIDs/Aspirin**. This occurs because the tumor produces high levels of prostaglandins. 2. **Radiological:** A small radiolucent zone called a **nidus** (typically <1.5–2 cm). 3. **Reactive Changes:** The nidus is surrounded by a significant zone of **perifocal reactive sclerosis** (dense bone formation). **Analysis of Incorrect Options:** * **A. Osteoma:** These are slow-growing, dense ivory-like bony masses, most commonly found in the skull and paranasal sinuses. They are asymptomatic and do not present with a radiolucent nidus. * **C. Osteoblastoma:** Often called "giant osteoid osteoma," it has a nidus >2 cm. Crucially, the pain is **not** relieved by aspirin, and there is much less reactive sclerosis compared to osteoid osteoma. It most commonly affects the posterior elements of the spine. * **D. Osteosarcoma:** A highly malignant tumor typically seen in the metaphyseal region of long bones. It presents with systemic symptoms, a large soft tissue mass, and aggressive radiological features like Sunburst appearance or Codman’s triangle, rather than a small, sclerotic-rimmed nidus. **High-Yield Pearls for NEET-PG:** * **Most common site:** Proximal Femur (neck). * **Gold Standard Investigation:** Contrast-enhanced CT scan (best to visualize the nidus). * **Pathology:** The nidus consists of interlacing osteoid trabeculae. * **Management:** Medical management with NSAIDs; if refractory, **Radiofrequency Ablation (RFA)** is the treatment of choice.

Q: Bone metastases is common in which of the following?

Renal Cell Carcinoma (RCC). **Explanation:** **Bone Metastases in Renal Cell Carcinoma (RCC)** Renal Cell Carcinoma (RCC) is one of the most common primary malignancies that metastasize to the bone. The underlying medical concept is that RCC typically produces **purely osteolytic lesions**. These metastases are characteristically highly vascular (pulsatile) and often present with pathological fractures. In adults, the most common primaries spreading to bone follow the mnemonic **PB-KTL** (Prostate, Breast, Kidney, Thyroid, Lung). **Analysis of Options:** * **Renal Cell Carcinoma (RCC):** Correct. It is a classic cause of lytic bone metastasis in adults. * **Nephroblastoma (Wilms Tumor):** Incorrect. While it is the most common renal tumor in children, it rarely metastasizes to the bone; it primarily spreads to the lungs. * **Neuroblastoma:** Incorrect. Although Neuroblastoma *does* frequently metastasize to the bone (especially the skull and orbit), in the context of standard orthopedic and surgical teaching for exams like NEET-PG, RCC is the classic "high-yield" answer for renal-origin bone metastasis. * **Clear Cell Sarcoma of the Kidney (CCSK):** This is known as the "Bone Seeking Tumor of the Kidney" in children. However, it is a rare variant compared to the high prevalence of RCC in the general population. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of bone metastasis:** Spine (followed by femur and pelvis). * **Osteoblastic (Sclerotic) Metastasis:** Most common in Prostate cancer. * **Osteolytic Metastasis:** Most common in RCC, Lung, and Thyroid cancer. * **Mixed Lesions:** Most common in Breast cancer. * **Pulsatile Bone Secondary:** Think RCC or Follicular Carcinoma of the Thyroid. * **Investigation of choice:** Bone Scan (Technetium-99m) is highly sensitive, but for RCC (which is purely lytic), a bone scan may occasionally be "cold"; hence, X-rays or MRI are vital.

Q: Which bone tumor commonly arises from the metaphysis?

Osteogenic sarcoma. **Explanation:** The location of a bone tumor is a critical diagnostic clue in orthopaedics. Bone tumors are typically classified based on their site of origin: **Epiphysis, Metaphysis, or Diaphysis.** **1. Why Osteogenic Sarcoma (Osteosarcoma) is correct:** Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. It characteristically arises in the **metaphysis** of long bones (most commonly the distal femur and proximal tibia). This is because the metaphysis is the site of most active bone turnover and growth plate activity, where mesenchymal stem cells are prone to malignant transformation. **2. Analysis of Incorrect Options:** * **Ewing Sarcoma:** This tumor typically arises from the **diaphysis** (shaft) of long bones. It is characterized by a "small round blue cell" appearance and an "onion-skin" periosteal reaction. * **Osteoclastoma (Giant Cell Tumor):** This is a classic **epiphyseal** tumor (occurring after growth plate closure). It is known for its "soap bubble" appearance on X-ray and its tendency to extend to the articular surface. * **Osteoid Osteoma:** While it can occur in the metaphysis, it is more frequently found in the **cortex of the diaphysis**. It is clinically distinguished by nocturnal pain relieved by aspirin. **NEET-PG High-Yield Pearls:** * **Metaphyseal tumors:** Osteosarcoma, Osteochondroma, Enchondroma, and Aneurysmal Bone Cyst (ABC). * **Epiphyseal tumors:** Giant Cell Tumor (GCT) and Chondroblastoma (the only one in children). * **Diaphyseal tumors:** Ewing Sarcoma, Adamantinoma, and Osteoid Osteoma. * **Radiological Sign for Osteosarcoma:** Sunburst appearance and Codman’s triangle.

Q: Vertebra plana occurs in which of the following conditions?

Eosinophilic granuloma. **Vertebra Plana** refers to the complete symmetrical collapse of a vertebral body, resulting in a thin, flat, "coin-on-edge" appearance on lateral radiographs, while the adjacent intervertebral discs remain preserved. ### **Why Eosinophilic Granuloma is Correct** **Eosinophilic Granuloma (EG)**, the localized form of Langerhans Cell Histiocytosis (LCH), is the most common cause of vertebra plana in children. The disease involves an abnormal proliferation of histiocytes which causes focal bone destruction. In the spine, this leads to a pathological fracture and rapid collapse of the vertebral body. Because the intervertebral discs are resistant to the histiocytic process, they remain intact, creating the classic radiographic appearance. ### **Why Other Options are Incorrect** * **B, C, and D (Chondrosarcoma, Osteosarcoma, Fibrosarcoma):** These are aggressive primary malignant bone tumors. While they can cause vertebral destruction and pathological fractures, they typically present with asymmetrical collapse, significant soft tissue masses, and destruction of posterior elements. They rarely result in the uniform, pancake-like flattening characteristic of vertebra plana. ### **NEET-PG High-Yield Pearls** * **Classic Sign:** "Calvé’s disease" was the historical term for vertebra plana, now known to be caused primarily by EG. * **Age Group:** Most commonly seen in children aged 2–10 years. * **Differential Diagnosis (Mnemonic: FETID):** * **F**racture (Trauma) * **E**osinophilic Granuloma (Most common) * **T**uberculosis (though TB usually destroys the disc space first) * **I**nfection/Inflammation * **D**iffuse Malignancy (Leukemia/Metastasis) * **Prognosis:** In EG, the collapsed vertebra often shows significant "re-expansion" or partial height recovery over time after the disease resolves.

Question 1

Which of the following anatomical locations is least commonly the site of a metastatic tumor?

Accepted Answer

Small bone of the lower limb

Answer

Pelvis

Answer

Ribs

Answer

Vertebra

Question 2

Jaffe's syndrome is defined as which of the following?

Accepted Answer

Fibrous dysplasia with cafe au lait spots.

Answer

Fibrous dysplasia.

Answer

Fibrous dysplasia with cafe au lait spots and endocrinal abnormalities.

Answer

None of the above.

Question 3

A swelling over the distal end of the femur with secondary deposits in the lungs is diagnosed as:

Accepted Answer

Osteogenic sarcoma

Answer

Giant cell tumor

Answer

Osteoclastoma

Answer

Ewing's sarcoma

Question 4

Which of the following is not a common cause of osteolytic lesions?

Accepted Answer

Prostate cancer

Answer

Breast cancer

Answer

Thyroid cancer

Answer

Bronchogenic carcinoma

Question 5

Which of the following is NOT true about osteoid osteoma?

Accepted Answer

Pain is not relieved by salicylates.

Answer

It is a benign bone tumor.

Answer

Bone scan shows increased uptake in the lesion.

Answer

X-ray shows a dense lesion.

Question 6

A 25-year-old man presents with severe pain in the left femur. The pain is relieved by aspirin. On plain film, a 0.5-cm lucent lesion, which is surrounded by marked reactive sclerosis, is seen. What type of bone lesion is most likely associated with these findings?

Accepted Answer

Osteoid osteoma

Answer

Osteoma

Answer

Osteoblastoma

Answer

Osteosarcoma

Question 7

A 7-year-old boy with a history of trauma 2 months ago now presents with fever and acute pain over the thigh. X-ray of the femoral shaft shows lesions with multiple laminated periosteal reactions. What is the next line of management?

Accepted Answer

MRI

Answer

CRP measurement

Answer

Core biopsy

Answer

Tc99 MDP scan

Question 8

Bone metastases is common in which of the following?

Accepted Answer

Renal Cell Carcinoma (RCC)

Answer

Nephroblastoma

Answer

Neuroblastoma

Answer

Clear cell sarcoma

Question 9

Which bone tumor commonly arises from the metaphysis?

Accepted Answer

Osteogenic sarcoma

Answer

Ewing sarcoma

Answer

Osteoclastoma

Answer

Osteoid osteoma

Question 10

Vertebra plana occurs in which of the following conditions?

Accepted Answer

Eosinophilic granuloma

Answer

Chondrosarcoma

Answer

Osteosarcoma

Answer

Fibrosarcoma

Bone Tumors — MCQs

Bone Tumors — MCQs

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