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X-ray Dx Study Guide
for test 3 (Tumors)
1. Primary malignant tumor capable of producing a cannonball lesion
Osteosarcoma
2. Most common mets in children 5 years old and younger
Neuroblastoma
3. What is the process of lytic lesions?
pressure erosion
4. Which tumor could show an unremarkable bone scan?
Multiple Myeloma
5. Which primary Neoplasms will metastasize to the hand and foot?
Bronchogenic Carcinoma
6. Bone expansion
A) Primary malignancy
7. Effects joint spaces
B) Secondary malignancy
8. Soft tissue
C) Neither
9. Multiple lesions
10. >10 cm in length
11. Erodes bone in a few days
12. Periosteal response
13. Most common tumor that causes multiple levels of vertebral collapse
Multiple Myeloma
14. A 65 yr. old male presents with sciatica, LBP, and intermittent pain which is
becoming constant. Which is the most serious symptom?
Nocturnal pain? or Post exercise hematuria?
15. If the same pt has multiple myeloma what would be a finding?
Normochromic, normocytic anemia
16. What would be the confirmatory test for multiple myeloma?
Immuno-electrophorhesis
17. If x-ray of the skull showed lytic lesions and a spiculated response, what would be the
dx?
Neuroblastoma
18. Which of the following is least likely to calcify? Fibrous, Cartilaginous, Osteoid, or
they would all be the same?
Fibrous
19. Originates in the abdomen
A) Neuroblastoma
20. Shows "flocculent" pattern
B) Chondrosarcoma
21. Uniform holes in the skull
C) Multiple myeloma
22. Age 10-25, diaphysis
D) Ewing's Sarcoma
23. Cortical Saucerization
E) Osteosarcoma
24. Metaphysis of a 10-20 year old
25. Hot spots are a consequence of?
Osteoblastic activity
26. If you see an ill defined pedicle on a film...
Rule in lytic mets until proven otherwise
27. Heavy smoker presents with LBP what do you do first?
Physical exam
28. If you treat this patient and he seems to improve which is true?
 Spinal adjustments decrease pain in cancer
 Bone scan may be indicated
29. If you do a bone aspiration what will you find in secondary lesions?
Cells similar to those in the primary lesion
30. Which primary malignancy crosses the epiphyseal plate?
Chondroma
31.What is the most common tumor to metastasize to other bone?
Ewing's Sarcoma
32. Tumors don't spread readily though the lymph system because
There is a lack of lymph channels in bone
33. What is the most reliable way to distinguish between mets and infection?
Infection crosses the joint space
34. Blastic mets show?
Reactive sclerosis
35. Which is associated with chondrosarcoma?
A history of enchondroma
36. Which is least likely to show an increase in alkaline phosphatase?
multiple myeloma
37. Which is more closely related to a secondary lesion than a primary lesion?
No periosteal response??
38. If Benz-Jones proteins are present this is ?
inclusive of multiple myeloma
39.What is true of solitary plasmacytoma?
7 out of 10 develop multiple myeloma
40. Which is closely related to the knee and is found in the metaphysis?
Osteosarcoma
41. What is the most common malignancy of the hand?
Chondrosarcoma
42. Other than the mandible where is adamantioma found?
Tibia
43. A patient presents with hematogenous dysuria. Which indicates prostate?
acid phosphatase
ring sclerosis
Affects sinuses and vision
4th m/c primary malignant bone tumor
Affects children under two
fallen fragment sign
saber shin deformity
Primary that affects the ends of the axial
skeleton, sacrococcygeal & sphenooccipital
Fibrous dysplasia
Osteo____
Ewing's sarcoma
Neuroblastoma
unicameral bone cyst
Paget's
Chordoma
Generally affects Vertebral body
Generally affects posterior motor units
more
Coast of Calif. smooth cafe au lait spots
osteolysis, then repair
second m/c primary malignant bone tumor
Affects patients over 55 yrs of age
50% develop sharp kyphoscoliosis
Quasi-malignant
spoked wheel skull
Osteoporosis circumscripta
Corduroy cloth appearance
ground glass appearance
causes lytic mets
70% of malignancies of bone
shepherd's crook deformity
cotton wool
M/C primary bone malignancy
causes mixed mets
cardiomegaly
Many osteochondromas
m/c benign tumor of the spine &
(1% of all primary bone tumors)
pain worse @ night relieved by aspirin
Primary Malignancy
Secondary malignancy
mets is rare here
Aggressive process = malignant
soft tissue
more round
permeative
motheaten
imperceptable margins
Epiphysis
Neurofibromatosis
Paget's
Osteosarcoma
Paget's
Neurofibromatosis
Giant-cell tumor
hemangioma
Paget's
hemangioma
fibrous dysplasia
lung cancer
metastasis
fibrous dysplasia or Paget's
Chondroblastoma or Paget's
multiple myeloma
breast cancer
Paget's
hereditary multiple exostosis
hemangioma
(vertebra & skull)
osteoid osteoma <1cm &
(Brodies abscess >1cm)
below elbow or knee
non-aggressive process = benign
Chondroblastoma
Giant Cell after fusion of growth plate
Diaphysis
Bone island
Ewing's Sarcoma
m/c cause of missing pedicles
Round Cell tumors
uncommon cause of ivory vertebra
metaphysis (Classic)
Causes of ivory vertebra
Myeloma
Ewing's sarcoma (classic)
Non-Hodgkin's Lymphoma
Adamantinoma
enostoma
Diaphyseal lesion
onion skin
cortical saucerization
codman's triangle
sunray/whiskers effect
metastasizes early - to bone
Lytic mets
Ewing's sarcoma
multiple myeloma
Non-Hodgkin's Lymphoma
Multiple Myeloma
Osteosarcoma
Paget's
(55yrs cortical thickening, bone bigger)
Hodgkin's Lymphoma
(35 yrs)
Osteoblasic Metastasis
(55 yrs, regular outline, normal sized or
collapsed)