3.9 of 53 Ratings
You are following a 62-year-old patient with metastatic disease. His most recent clinical radiograph is shown in Figure A. A previous biopsy specimen is displayed in Figure B. The patient was debating over the risks and benefits of prophylactic fixation of the right hip for progressively worsening functional groin pain. However two days after the visit, the patient presents to the emergency room where you see and diagnose him with a complete pathologic fracture of the right femoral neck. Which of the following is accurate of the pathology in this vignette?
A femoral prosthesis with a full-length press-fit stem is most appropriate to protect the entire bone
Lesions are poorly radiation or chemotherapy-sensitive
Pathologic fractures have a low chance of healing
Prophylactic fixation was indicated prior to fracture to avoid delay systemic therapy
Radionuclide bone scan is ideal for detection
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A 61-year-old male has a 6 month history of low back pain with increasing left sciatic leg pain for 5 weeks. On examination, he has bone tenderness in the lumbar and thoracic spine. Neurological examination shows 4/5 weakness in the L5 distribution in the left leg. MRI images of the thoracic and lumbar spine are shown in Figures A. Follow-up laboratory studies show anemia associated with the presence of a serum monoclonal protein. What would be the next most appropriate investigation in the diagnostic work-up of this patient?
CT scan of head
Lower extremity electromyelography
Bone marrow aspiration and biopsy
Lytic bone lesions, commonly seen in metastatic bone disease or multiple myeloma, are due to which of the following mechanisms?
RANK ligand action on neoplastic cells
RANK action on neoplastic cells
Osteoprotegrin action on osteoclastic cells
RANK ligand action on osteoclastic cells
RANK action on osteoclastic cells
A 55-year-old male with chronic low grade back pain, intermittent fevers, and anemia underwent a bone biopsy for a lytic lesion in the spine. The biopsy is seen in Figure A. A urine protein electrophoresis is likely to show which of the following?
Polyclonal heavy chain immunoglobins
Polyclonal light chain immunoglobins
Monoclonal heavy chain immunoglobin
Monoclonal light chain immunoglobin
Decreased urine albumin
A 55-year-old male has chronic thoracic back pain and undergoes a biopsy of a suspicious lesion in the T6 vertebral body seen in Figure A. The asterisk in Figure B represents what type of cell seen by the pathologist?