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A 65-year-old community-ambulatory patient complains of constant left hip pain that affects her activities of daily living. Staging studies confirm multi-focal disease. Biopsy results are shown in Figure A. Recent radiographs are shown in Figures B and C. Life expectancy is estimated at 1 year. What is the most appropriate treatment option?
Curettage, cemented dynamic hip screw fixation and radiotherapy.
Curettage, cancellous bone grafting, cephalomedullary fixation and radiotherapy.
Proximal femoral resection, replacement with allo-prosthetic composite and radiotherapy.
Cemented hemiarthroplasty and radiotherapy.
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You are seeing a 53-year-old female for 1 year of increasing knee pain. She is otherwise healthy. Based on the imaging studies below (Figures A-D), what is your diagnosis?
Giant cell tumor
Renal Cell Carcinoma
What is the most appropriate treatment for a 65-year-old female with a 100-pack-year tobacco history who presents with a new painful lytic lesion in her femoral diaphysis?
Antegrade femoral nailing with reamings sent to pathology for analysis
Antegrade femoral nailing with adjuvant radiotherapy to the lesion
Minimally invasive plating of the femur for stabilization and open cementation of the lesion
Referral to medical oncology for chemo-radiotherapy
Lesion biopsy with further treatment based on the results of the biopsy
A 56-year-old female is referred for a second opinion after placement of an intramedullary nail through a presumed metastatic lesion in her proximal femur. Final biopsy results from the lesion show a high-grade chondrosarcoma and staging studies show this to be an isolated site of disease. What treatment should be recommended?
Intramedullary nail removal and radiotherapy to the limb
Systemic chemotherapy and keep nail in place to prevent fracture
Wide proximal femoral resection and hemiarthroplasty followed by radiotherapy
Wide resection including hip disarticulation
What is the most common cause for an aggressive lytic bone lesion in a patient above 40-years-old?
Metastatic bone disease
A 65-year-old patient without a history of cancer presents with thigh pain and a lytic lesion in the left femur. A CT scan of the chest, abdomen, and pelvis as well as a bone scan show this to be an isolated tumor. Biopsy confirms adenocarcinoma. What is the most likely primary source of this patient's tumor?
A 51-year-old female with known metastatic breast cancer presents with acute right thigh pain and inability to bear weight. A radiograph is shown in Figure A. A biopsy is performed that confirms metastatic breast cancer. What is the next step in management?
Local radiation therapy
Intramedullary nailing only
Intramedullary nailing and chemotherapy
Intramedullary nailing, radiation therapy to the tumor site, and chemotherapy
Intramedullary nailing, radiation therapy to the entire femur, and chemotherapy
Which of the following correctly lists the life expectancy from least life expectancy to greatest life expectancy when a patient presents with metastatic carcinoma to bone?
Prostate < breast < thyroid < renal < lung
Renal < prostate < breast < thyroid < lung
Lung < renal < thyroid < breast < prostate
Thyroid < renal < lung < breast < prostate
Lung < renal < breast < prostate < thyroid
All of the following are necessary steps in bony metastasis of a malignant cell EXCEPT?
Avoidance of immune surveillance
Target tissue localization
Induction of angiogenesis
Direct stimulation of osteoclasts
Metastatic bony lesions that occur distal to the elbows or knees are most likely to originate from which one of the following primary organs?
A 62-year-old male with a 50-pack-year history of tobacco use presents with complaints of productive cough and increasing leg pain for the past 6 months. Proximal tibial radiographs are shown in Figures A and B, and are concerning for an impending pathologic fracture. CT of the chest, abdomen, and pelvis, and staging blood work are negative. MRI of the tibia shows a multi-focal cortically based lesion without significant soft tissue mass and whole body technetium bone scan shows this to be an isolated lesion. What is the next most appropriate step in management of this patient?
Intramedullary nailing of the tibia and send canal reamings to pathology
Radiotherapy for palliative pain control as the risk for pathological fracture is very small
Open incisional biopsy
Chemotherapy and surgical stabilization with intramedullary nailing of the tibia
Radiotherapy and surgical stabilization with intramedullary nailing of the tibia
A 65-year-old woman presents with elbow pain. Her radiograph is shown in the Figure A. The patient had a history of non-metastatic breast cancer 10 years ago which was treated successfully. Repeat mammogram, bone scan and CT scan of the chest, abdomen and pelvis demonstrate this to be an isolated lesion. What is the next most appropriate action in treatment?
Biopsy of lesion
Total elbow arthroplasty
Currettage and bone grafting
Percutaneous cement injection
A 70-year-old man with a history of esophageal cancer presents to the emergency department with pain in his right femur. His right hip xray is shown in Figure A and B. His medical oncologist has estimated he has a life expectancy of less than 6 months. His activities are limited to walking around his house. Which of the following management options is most appropriate?
Sliding hip screw
Proximal femoral locking plate
Proximal femoral replacement
A 70-year-old female has unrelenting lower back pain and severe left anterior thigh pain. She has hip flexion weakness on the left that is limiting her ambulation. A representative image from her abdominal CT is shown below as well as a sagittal MRI of her spine. Nonoperative management has failed. What is the next appropriate step before performing an anterior corpectomy and stabilization of the spine?
CT-guided biopsy of spinal lesion
External beam radiation
Arteriography and embolization of the spinal lesion
A 53-year-old woman with a history of Paget's disease and bilateral total hip arthroplasties presents with left hip pain and dysuria. An AP pelvic radiograph and CT scan are shown in Figure A and B. What is the next most appropriate step in management?
Revise the left hip total arthroplasty with a cemented stem
Open reduction and internal fixation of the acetabular fracture
Rest, IV bisphosphanates and follow-up in 6 weeks
Technetium Tc 99 and CT of the chest, abdomen and pelvis
All of the following are known steps in the development of a malignant tumor with the ability to metastasize EXCEPT?
Tumor cell intravasation
A 69-year-old man with known metastatic lung cancer presents with a pathological fracture after a fall from standing height (Figure A). Which of the following options is the best choice for treating this fracture?
Total hip arthroplasty
Dynamically locked cephalomedullary nail
Statically locked cephalomedullary nail
A 65-year-old male is seen for increasing thigh pain and a new femoral lesion seen by his oncologist. A current radiograph is shown in Figure A. He has a known diagnosis of lung carcinoma but no history of metastatic disease. What is the next most appropriate step in management of this patient?
Intramedullary stabilization and send femoral reamings as biopsy
Endothelin 1 is known to be involved in which of the following disease processes?
RANK ligand induced tumor lysis
Osteoblastic bone metastases
Physeal bar formation
A 61-year-old female presents with a 6 month history of pain in the left hip and thigh. A hip radiograph is shown in Figure A. Serum protein electrophoresis is normal, and a bone scan shows increased uptake in the left femur only. A biopsy is taken and shown in Figure B. What is the most likely diagnosis?
Primary lymphoma of bone