Metastatic Disease of Extremity

(OBQ20.198) A 67-year-old female presents to the ED with right hip pain after standing up from a chair and feeling a pop in her hip. She states she fell to the ground and was unable to bear weight after. Radiographs are shown in Figure A. She has a past medical history of hypertension, coronary artery disease and breast cancer, which was treated with lumpectomy 3 years prior. The fracture is deemed pathologic by the radiologist. What role do matrix metalloproteases play in this type of fracture?

(OBQ20.21) Figure A is the AP radiograph of a 51-year-old male who presents to the ED after sustaining a fall in which he landed on his right shoulder. Given the appearance of the proximal humerus, a biopsy was obtained as demonstrated in Figure B. Which of the following is the most appropriate implant to treat this patient’s injury?

(OBQ19.25) A 48-year-old male is referred to your clinic for progressive left hip and thigh pain for the past three weeks. His pain is causing him to walk with a significant limp and he is no longer able to do his job as a carpenter. Two months ago, he found a lump in his neck, however, he never saw his doctor due to concerns about missing work. A radiograph obtained in your office is shown in Figure A. A biopsy slide obtained from the lesion is shown in Figure B. What is this patient's Mirel's score, and what would be the next best step in treatment?

(SBQ18SP.71) A 65-year-old man presents to your clinic as a referral for consideration of prophylactic treatment for an impending pathologic hip fracture. He was diagnosed with metastatic prostate cancer one month ago and most recently had his first course of chemotherapy. Which of the following is associated with this diagnosis as compared to other metastatic carcinomas?

(OBQ18.163) A 65-year-old man with a 20-pack-year tobacco history and a remote history of small cell lung carcinoma presents with thigh pain and radiographs demonstrated in Figure A. He undergoes a full femur MRI and a CT chest, abdomen, and pelvis, both of which reveal no other areas of disease. What is the next best step in management?

(OBQ18.61) A 78-year-old man presents to your office with new onset right knee pain 3 years after total knee replacement. The pain is worse with weightbearing and he now has to use a cane. Ibuprofen initially gave him pain relief, but he now reports constant pain. Figure A and B represent his 1-year and 3-year (current) radiographs, respectively. ESR is 14, CRP 2.3, and an aspirate reveals 900 nucleated cells with a negative gram stain and negative leukocyte esterase. What is the best next step in management?

(OBQ18.161) A 70-year-old man is scheduled to undergo a procedure to address a symptomatic left proximal femur solitary lesion. Plain radiographs are depicted in Figure A and histopathology in Figure B. Which of the following procedures is associated with improved survivorship in this patient?

(SBQ18SP.72) A 72-year-old 2-pack-per-day smoker presents to your office with increasingly severe right hip pain that is now exacerbated by any weight-bearing. Physical exam is significant an antalgic gait but otherwise a full painless range of motion, good strength, and an absence of neurologic symptoms. A radiograph is shown in Figure A. Metastatic work-up reveals a primary source. The histopathology is shown in Figure B. Which of the following is LEAST associated with the diagnosis?

(OBQ15.109) A 59-year-old women with known metastatic lung cancer presents with acute left hip pain with ambulation, as shown in Figure A. She previously underwent a right lung lobectomy 2 years ago, which has been complicated by chronic chest pain. Her oncologist predicts an estimated life expectancy of 12-18 months. She currently lives independently and walks for 2 hours per day. What would be the most appropriate treatment and rehabilitation plan?

(OBQ13.127) 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?

(SBQ11PA.100.1) A 54-year-old male presents to the emergency department after a sudden onset of pain and inability to use his right arm after pushing himself up from a chair. X-rays are obtained and demonstrated in Figures A & B. The patient denies other medical problems. He is subsequently admitted for continued workup including a CT chest/abdomen/pelvis, which does not demonstrate any relevant abnormalities. What would be the next best step of the options below?

(OBQ11.202) 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, however, the initial diagnostic workup over a year ago did not show any metastatic disease. What is the next most appropriate step in management of this patient?

(SBQ11OS.121.1) You are consulted to see a 67-year-old female with a new-onset inability to ambulate due to severe right hip pain. Her past medical history is significant for metastatic breast cancer. Radiographs demonstrate a peritrochanteric lytic lesion involving 40% of the cortical circumferential circumference. She has no radiographic evidence of osteoarthritis, acetabular involvement, or skip lesions. The oncology team feels her life expectancy is > 6 months. Which of the following is the recommended management correctly paired with her Mirel's score?

(OBQ11.210) All of the following are known steps in the development of a malignant tumor with the ability to metastasize EXCEPT?

(OBQ11.171) Endothelin 1 is known to be involved in which of the following disease processes?

(OBQ10.120) 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?

(OBQ08.214) 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?

(OBQ08.162) Metastatic bony lesions that occur distal to the elbows or knees are most likely to originate from which one of the following primary organs?

(OBQ07.208) 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?

(OBQ07.172) 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?

(OBQ06.260) What is the most common cause for an aggressive lytic bone lesion in a patient above 40-years-old?

(OBQ06.40) All of the following are necessary steps in bony metastasis of a malignant cell EXCEPT?

(OBQ06.84) 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?

(OBQ06.109) 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?

(OBQ05.244) 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?

(OBQ05.186) 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?

(OBQ05.65) 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?

(OBQ04.150) 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?