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A 56-year-old male with a history of prostate cancer presents to your clinic complaining of bilateral foot pain (right greater than left) that he relates to his chronic bunion and claw toe deformities. He denies new trauma, fevers, or weight loss. He says that he is able to ambulate but has had progressively increased pain in the great and lesser toes of both feet, with progressive difficulty in wearing shoes. During his radiographic evaluation a lesion is found in the right tibia which is shown in Figure A. What is the next most appropriate step in management of the tibial lesion?
Core needle biopsy of the right tibia
Excisional biopsy of the right tibia
MRI of the right tibia
Reassurance and repeat radiographs in 3-6 months
Staging with CT of the chest, abdomen, and pelvis, and referral to an orthopaedic oncologist
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A 30-year-old male presents with thumb swelling and pain of 6 months duration. He denies a history of trauma or previous problems with the thumb. Radiographs, MRI, and histology slide are shown in Figures A through D. What is the most appropriate treatment for this patient?
Curettage and bone grafting
Radiation and intralesional excision
A 55-year-old male with a history of diabetes mellitus presents with left leg pain localized to his posterior knee and calf. The pain is worse with prolonged walking and resolves when he rests and remains standing upright. He has a history of chronic low back pain, prior cardiac stenting, and smokes 1 pack of cigarettes daily for the last twenty years. Physical exam is remarkable for 1+ patellar reflexes and an ABI of 0.8. A radiograph of his lumbar spine is shown in Figure A. T2-weighted sagittal and axial MRI images are shown in Figure B and C respectively. A radiograph of his left knee is shown in Figure D. What is the most likely cause his leg pain?
Lumbar Disc Herniation
A 70-year-old woman falls and presents with pelvic pain. Physical exam shows she is able to walk without difficulty. Radiographs of the pelvis and hip are shown in Figure A, B, and C. A biopsy of the lesion in the proximal femur is shown in Figure D. What is the next best step in management of the femoral lesion?
Resection and internal fixation
Chemotherapy followed by wide resection
Which of the following diseases carries greater than 50% risk of developing a malignancy?
Multiple hereditary exostoses
This video demonstrates the histolopathology of Enchondroma / Ollier's Disease...
HPI - increasing pain and stiffness of the right index finger since over 6 months
curretage and bone grafting
HPI - Fall from bed and sustained fracture shaft femur left
Additional work up in this case
HPI - 57yo woman who had an XRays of her Left knee for the diagnosis of knee arthritis.
Incidental finding on the XRay was a tumor of the fibula head.
How would you manage this lesion?