Bone tumours: malignant: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Bone tumours: malignant

Sample item

A 60-year-old has back pain, anaemia and a high ESR, and radiographs show punched-out skull lesions. A bone scan is cold. Which test is the most useful next?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Serum protein electrophoresis with urine Bence Jones protein

Punched-out lytic lesions with anaemia and a high ESR suggest multiple myeloma, which gives a cold bone scan because there is little osteoblastic activity. Electrophoresis shows an M band, and urine shows light chains.

Option by option

  • A. Urinary VMA

    Urinary VMA is used for neuroblastoma and phaeochromocytoma.

  • B. Serum PSA

    PSA indicates prostate cancer, which gives sclerotic metastases.

  • C. Serum protein electrophoresis with urine Bence Jones protein (correct)

    Correct. Demonstrating a paraprotein confirms myeloma.

  • D. Serum alpha-fetoprotein

    Alpha-fetoprotein is a marker for hepatocellular and germ cell tumours.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Orthopaedics questions

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Serum protein electrophoresis with urine Bence Jones protein. Punched-out lytic lesions with anaemia and a high ESR suggest multiple myeloma, which gives a cold bone scan because there is little osteoblastic activity.

Why is "Urinary VMA" not the answer?

Urinary VMA is used for neuroblastoma and phaeochromocytoma.

Why is "Serum PSA" not the answer?

PSA indicates prostate cancer, which gives sclerotic metastases.

Why is "Serum alpha-fetoprotein" not the answer?

Alpha-fetoprotein is a marker for hepatocellular and germ cell tumours.

What concept does this question test?

It tests Bone tumours: malignant in Orthopaedics. Electrophoresis shows an M band, and urine shows light chains.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Bone tumours: malignant?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.