5. Which of the following agents has a significant possibility of allergic reaction?

A. Etoposide
B. Methotrexate
C. Cisplatin
D. L-Asparaginase
E. Vinblastine

6. Which of the following cancers is more common in school-age children?

A. Hodgkin lymphoma
B. Neuroblastoma
C. Retinoblastoma
D. Wilms tumor
E. Hepatoblastoma

7. Which of the following lymphadenopathies, region-wise, are highly suggestive

of malignancy?
A. Anterior upper cervical
B. Post auricular
C. Supraclavicular
D. Axillary
E. Inguinal

8. A “new-onset asthma” symptoms during adolescence may be a presentation

of
A. acute lymphoblastic leukemia
B. lymphoma
C. neuroblastoma
D. askin tumor
E. brain tumor

9. PET scan as a part of workup in staging of pediatric cancers is indicated in

which of the following malignancies?
A. CNS tumor
B. Neuroblastoma
C. Retinoblastoma
D. Hodgkin lymphoma
E. Hepatoblastoma

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10. CSF analysis as a part of work up in staging of pediatric cancers is indicated
in which of the following malignancies?
A. Hodgkin lymphoma
B. Wilms tumor
C. Bladder rhabdomyosarcoma
D. Non-Hodgkin lymphoma
E. Osteosarcoma

11. Which of the following chromosomal translocations is associated with acute

promyelocytic leukemia?
A. t(9;22)
B. t(1;19)
C. t(15;17)
D. t(2;13)
E. t(11;22)

12. A 6-year-old boy under current treatment of acute lymphoblastic leukemia

has exposed to a brother with active chicken pox.
Of the following, the MOST appropriate management is
A. oral acyclovir
B. intravenous acyclovir
C. varicella-zoster immunoglobulin
D. close observation for any skin lesions
E. close observation for any temperature rise

13. Among all the aspects of palliative care, the most serious cause of suffering
of a cancer child is
A. hair loss
B. psychological trauma
C. pain
D. fear of death
E. fear of loss of function

14. Which of the following agents has been associated with neurocognitive
deficits as late effects of cancer treatment?
A. Cyclophosphamide
B. Etoposide
C. Vincristine
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 D. Daunomycin
E. Methotrexate

15. Which of the following agents has been associated with hearing loss as late
effects of cancer treatment?
A. cyclophosphamide
B. carboplatin
C. etoposide
D. vincristine
E. daunomycin

16. Which of the following matches is TRUE regarding late effects of cancer
therapy and uses of chemotherapies?
A. Renal insufficiency and daunomycin
B. Cardiomyopathy and busulfan
C. Pulmonary fibrosis and melphalan
D. Gonadal dysfunction and procarbazine
E. Peripheral neuropathy and carboplatin

17. Which of the following matches is TRUE regarding oncological emergencies

and cancers?
A. Hyperkalemia and medulloblastoma
B. Hyponatremia and rhabdomyosarcoma
C. Disseminated intravascular coagulation and lymphoma
D. Spinal cord compression and neuroblastoma
E. Superior vena cava syndrome and hepatoblastoma

18. Which of the following agents has the LEAST myelosuppressive effect?
A- Dactinomycin
B- Daunomycin
C- Methotrexate
D- Vincristine
E- Carmustine

19. What is the MOST common primary modality of treatment of childhood

cancer?
A. Chemotherapy
B. Surgery
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 C. Radiotherapy
D. Biologic agent therapy
E. Laser therapy

20. Which of the following tissue cells is MORE susceptible to effects of

chemotherapy?
A. Neurons
B. Muscle cells
C. Connective tissue
D. Epidermis
E. Bone

21. What is the most common adverse effect of radiation therapy in children?
A. Dermatitis
B. Mucositis
C. Somnolence
D. Alopecia
E. Nausea and diarrhea

22. Which of the following agents is used as prophylaxis in patients with cancer
to prevent infection with Pneumocystis jiroveci?
A. Amoxiclavulanic acid
B. Trimethoprim-sulfamethoxazole
C. Fluconazole
D. Ciprofloxacin
E. Acyclovir

23. Patients receiving immunosuppressive therapy should receive irradiated

blood products to prevent
A- graft-versus-host disease
B- transfusion-associated reactions
C- infections
D- febrile neutropenia
E- thrombocytopenia

24. Which of the following presenting features is common in acute

lymphoblastic leukemia as compared to acute myeloid leukemia?
A. Subcutaneous nodules
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 B. Disseminated intravascular coagulation
C. Granulocytic sarcoma
D. Mediastinal mass
E. Gingival hypertrophy

25. Which of the following features of acute myeloid leukemia is specific for
infants?
A. Blueberry muffin lesions
B. Disseminated intravascular coagulation
C. Chloroma
D. Splenomegaly
E. Gingival hypertrophy

26. Which of the following features is MORE common in acute promyelocytic

leukemia rather than other types of acute myeloid leukemia?
A. Subcutaneous nodules
B. Disseminated intravascular coagulation
C. Granulocytic sarcoma
D. Splenomegaly
E. Gingival hypertrophy

27. Which of the following features of acute myeloid leukemia is associated with
t(8;21)?
A. Subcutaneous nodules
B. Disseminated intravascular coagulation
C. Chloroma
D. Gingival hypertrophy
E. Huge splenomegaly

28. Which of the following chromosomal abnormalities is usually seen in acute

promyelocytic leukemia?
A. t(8;21)
B. inv(16)
C. t(15;17)
D. 11q23 abnormalities
E. del(7q), −7

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29. Which of the following agents has improved the survival of acute
promyelocytic leukemia dramatically and deferred the need for bone marrow
transplantation?
A. All-trans-retinoic acid
B. Arsenic trioxide
C. Cytarabine
D. Anthracycline
E. Etoposide

30. A 3-day-old boy with Down syndrome is noted by a family pediatrician as

having enlarged liver and spleen during the first checkup visit. The mother
states that he is active and good feeder, with no obvious features of sickness.
General physical and regional examination was normal apart from
hepatosplenomegaly. An initial complete blood count showed Hb 12.0 gm/dl,
WBC 55,000/cmm with many blast cells, and platelets 70,000/cmm. BMA
showed acute leukemia.
Which of the following facts discussed during counseling is inadmissible?
A. Ten percent of neonates with Down syndrome develop a transient
leukemia.
B. These features usually resolve within the first three months of life
C. At time being, less intensive chemotherapy should be instituted to
induce remission
D. After resolution, 20-30% will develop acute leukemia in the next 3 years
E. Later on, such cases will develop acute megakaryocytic leukemia

31. Ninety-nine percent of chronic myeloid leukemia cases are characterized by

which of the following specific translocation?
A. t(1;19)
B. t(4;11)
C. t(9;22)
D. t(12;21)
E. t(10;14)

32. A 6-year-old boy is referred to the pediatric clinic from a general physician
for fever, fatigue and weight loss for the last few weeks. The patient experience
pain in the abdomen below the left side of the chest. During examination, he is
pale, febrile 38.3 C, no lymphadenopathy, but frank abdominal distension.
Abdominal examination shows a huge spleen reaching umbilicus, slightly tender
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on palpation. Cardiovascular and neurological examination are normal.
Complete blood count shows Hb 9.5 gm/dl, WBC 53,000/cmm, platelets
560,000/cmm. The peripheral blood demonstrated normocytic, normochromic
anemia, with leukocytosis, 5% blasts, 17% myelocytes, 5% metamyelocytes, 10%
lymphocytes, 2% monocytes, 5% eosinophils and 3% basophils and
thrombocytosis. The bone marrow is characteristically hypercellular, with
expansion of the myeloid cell line and its progenitor cells. Megakaryocytes are
increased.
Of the following, the MOST likely diagnosis is
A. Acute lymphoblastic leukemia
B. Toxoplasmosis
C. Acute promyelocytic leukemia
D. Chronic myeloid leukemia
E. Kala-azar

33. Which of the following genetic syndromes has a predilection for juvenile
myelomonocytic leukemia?
A. Edward syndrome
B. Noonan syndrome
C. Turner syndrome
D. Klinefelter syndrome
E. Angelman syndrome

34. Which of the following factors is stratified as high risk in treatment of acute
lymphoblastic leukemia?
A. Age at diagnosis of 9 years
B. WBC at diagnosis of 33,000/cmm
C. Pre-B-cell detected by flowcytometry
D. Philadelphia chromosome detected by cytogenetic study
E. Rapid response to therapy

35. Which of the following agents is added to the higher risk patient during
induction therapy of acute lymphoblastic leukemia?
A. Prednisolone
B. Daunomycin
C. Asparaginase
D. Vincristine
E. Intrathecal methotrexate
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36. Which of the following infectious agents requires prophylactic treatment
during chemotherapy for acute lymphoblastic leukemia?
A. Pneumocystis jiroveci
B. Streptococcus viridans
C. Leishmania donovani
D. Escherichia coli
E. Pseudomonas auroginosa

37. Which of the following clinical presentations is more frequently

encountered in T-cell rather than B-cell acute lymphoblastic leukemia?
A- Hepatosplenomegaly
B- Respiratory distress
C- Bone pain
D- Pallor
E- Fever

38. Which of the following is a B-symptom in Hodgkin lymphoma?

A. Pruritus
B. Anorexia
C. Painful limbs
D. Lethargy
E. Drenching night sweating

39. Which of the following is the typical presentation of Hodgkin lymphoma?

A. Left cervical progressive swelling for 3 months in a six-year old boy; no
other constitutional symptoms; active daily living is perfect.
B. A nine-month old boy with shortness of breath due to rapidly
progressing mediastinal mass.
C. A twelve-year old girl with fever for 4 months and abdominal distension;
examination showed generalized lymphadenopathy and
hepatosplenomegaly.
D. Chronic abdominal pain in a ten-year old boy with appearance of
jaundice in the last few weeks, sonogram showed big lymph node at the
porta hepatis
E. An axillary swelling of few months in a nine-years old girl, with fever and
weight loss; history of contact with tuberculosis patient.

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40. A 10-year-old boy is recently diagnosed with Hodgkin lymphoma. He has
right sided cervical and axillary lymph nodes involvement. No history of fever in
the last weeks, with remarkable weight loss about 15% in the last 4 months.
Work up and staging have failed to identify more involved lymph nodes groups.
What is the correct stage of the disease for this patient?
A. IB
B. IIA
C. IIB
D. IIIA
E. IIIB

41. A newly diagnosed Hodgkin disease in a thirteen-year old girl with bilateral
cervical lymph nodes involvement. The family reported one episode of high
fever (40.0C) in the last days, but without weight loss or sweating. Work up
showed liver multiple hypoechoic lesion by sonography with high metabolic
activity by PET scan suggestive of liver involvement.
What is the correct stage of the disease for this patient?
A. IIB
B. IIIB
C. IIIA
D. IVA
E. IVB

42. What is the cutoff time to use standard treatment rather than myeloablative
autologous stem cell transplantation in children with relapsed Hodgkin
lymphoma?
A. 6 months
B. 12 months
C. 18 months
D. 24 months
E. 30 months

43. In the perspectives of International Pediatric Non-Hodgkin Lymphoma

Staging System, which of the following matches is CORRECT?
A. Mediastinal tumor is stratified as stage II.
B. A primary completely resected gastrointestinal tumor is stratified as
stage I
C. Any paraspinal tumor is stratified as stage II
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 D. Two or more nodal sites on the same site of the diaphragm is stratified
as stage III
E. A single bone lesion with regional lymph node involvement is stratified
as stage II

44. A 6-year-old boy presents with irritant coughing that progressed to

shortness of breath for the last week with low grade fever and night sweating.
The mother noted that his face had become swollen and slightly dusky in color.
On examination, he is febrile (38.5C), no pallor, and no skin bleeding, in
moderate respiratory distress, with puffy face and engorged neck vessels; there
are dilated superficial veins on the upper chest. Lymph node examination
revealed enlarged left supraclavicular lymph nodes. Abdominal examination
shows normal soft abdomen with no palpable masses or organomegaly. Initial
radiological evaluation shows big mediastinal mass; Complete blood count and
bone marrow aspiration are normal, liver and renal function are normal, lactate
dehydrogenase is high.
Of the following, the MOST likely diagnosis is
A. acute lymphoblastic leukemia
B. neuroblastoma
C. germ cell tumor
D. sarcoma
E. lymphoblastic lymphoma

45. Which of the following types of lymphoma is treated with the same
therapeutic approach of childhood acute lymphoblastic leukemia?
A. Burkitt lymphoma
B. Germinal center B-cell like lymphoma
C. Anaplastic large cell lymphoma
D. Lymphoblastic lymphoma
E. Diffuse large B-cell lymphoma

46. Which of the following scenarios of newly diagnosed pediatric non-Hodgkin

lymphoma is indicated for radiotherapy as part of treatment?
A. A six-year old girl with huge jaw mass causing difficult breathing and
swallowing, diagnosed as Burkitt lymphoma
B. A three-year old boy with big abdominal mass causing pressure effect on
the ureters and consequent hydronephrosis diagnosed as diffuse large
B-cell lymphoma
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 C. A two-year boy with intestinal mass with bilateral facial palsies,
diagnosed as Burkitt lymphoma
D. A ten-year old boy with acute superior mediastinal syndrome, diagnosed
as lymphoblastic lymphoma
E. A six-year-old boy with disseminated anaplastic large cell lymphoma
including liver, spleen, and lungs.

47. Which of the following is a recognized complication seen in newly diagnosed

patient with bulky Burkitt lymphoma after starting treatment?
A. Disseminated intravascular coagulopathy
B. Septicemia
C. Tumor lysis syndrome
D. CNS encephalopathy
E. Hemorrhagic pancreatitis

48. A 6-year-old boy is recently diagnosed with Burkitt lymphoma. Treatment is

started with intravenous fluid hydration and chemotherapy. Three day later, the
boy develops tremulousness and unusual spasm of both hands. Review of his
charts shows reduced urine output for the last 12 hours with slightly elevated
blood pressure. The body weight is increased by 500 gm comparing to that at
time of admission. These findings are consistent with:
A. acute renal failure due to chemotherapy
B. tumor lysis syndrome
C. postrenal urinary tract obstruction by the tumor
D. renal failure from lymphomatous infiltration
E. acute renal injury from dehydration

49. What is the most common malignancy below age of 19 years?

A. Leukemia
B. CNS tumor
C. Renal Tumors
D. Lymphoma
E. Sarcomas

50. Lhermitte-Duclos disease (Dysplastic gangliocytoma of the cerebellum) is

seen in which of the following familial syndromes?
A. Tuberous sclerosis
B. Von Hippel-Lindau syndrome
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 C. Li-Fraumeni syndrome
D. Cowden syndrome
E. Turcot syndrome

51. Which of the following familial syndromes’ defects is located on

Chromosome 17?
A. Neurofibromatosis type 1
B. Neurofibromatosis type 2
C. Tuberous sclerosis
D. Cowden syndrome
E. Von Hippel-Lindau syndrome

52. What is the most common primary brain tumor in children (0-14) year old?
A. Pilocytic astrocytoma
B. Glioblastoma
C. Ependymal tumors
D. Meningioma
E. Pituitary tumors

53. What are the most common congenital and neonatal brain tumors?
A. Teratomas (mature and immature)
B. Embryonal tumors
C. Astrocytic tumors
D. Neuronal tumors
E. Mixed neuronal-glial tumors

54. In young children, the diagnosis of brain tumor may be delayed because
A. the tumor increases in size very slowly due to low proliferation rate
B. the symptoms are similar to common illnesses in this age group such as
vomiting
C. there is a good space for these tumors to grow in before producing
symptoms
D. the symptoms are usually neglected by the family of the child
E. the diagnosis for brain tumors is difficult in this age group

55. Which of the following features is more frequently seen in supratentorial

tumor as compared to infratentorial tumor?
A. Headache
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 B. Vomiting
C. Focal motor weakness
D. Nausea
E. Torticollis

56. What is the standard neuroimaging modality for diagnosis of primary brain
tumors?
A. CT scan
B. MRI
C. PET scan
D. MRA
E. Sonography

57. In addition to the routine evaluation of brain tumors, special consideration

should be taken in tumor of Pituitary, suprasellar and optic chiasmal region to
look for
A. metabolic assessment
B. respiratory function evaluation
C. endocrine function
D. hematological evaluation
E. cardiac function

58. What is the preferential site for CNS germ cell tumors?
A. Suprasellar
B. Pontine
C. Cerebral cortex
D. Cerebellum
E. Medulla

59. Which of the following statements regarding ependymomas in children is

TRUE?
A. The median age of presentation is 10 years
B. The majority occur in the supratentorial location
C. Radiologically, it appears like a well-circumscribed lesion with variable
enhancement.
D. Tumor in the posterior fossa is associated with better outcome
E. Surgery alone is usually curative

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60. What is the MOST common CNS embryonal tumor?
A. Medulloblastoma
B. Supratentorial PNET
C. Ependymoblastoma
D. Medulloepithelioblastoma
E. Atypical teratoid/rhabdoid tumor

61. Which of the following malignancies is associated with Chloroma?

A. Acute lymphoblastic leukemia
B. Acute myeloid leukemia
C. Non-Hodgkin lymphoma
D. Neuroblastoma
E. Medulloblastoma

62. What is the most common extracranial solid tumor in children?

A. Wilms tumor
B. Neuroblastoma
C. Non-Hodgkin lymphoma
D. Hodgkin Lymphoma
E. Rhabdomyosarcoma

63. What is the most commonly diagnosed malignancy in infants?

A. Wilms tumor
B. Neuroblastoma
C. Non-Hodgkin lymphoma
D. Hodgkin Lymphoma
E. Rhabdomyosarcoma

64. A 4-year-old boy is brought by his mother complaining of bone pain and
limping with fever for the last three weeks. The mother notice that he lost
weight during this period and his skin color became lighter with significant loss
of his usual activity. Also, she noticed that he has been developed a bluish
discoloration around both eyes. On examination, he is ill, febrile, pale, with
bilateral periorbital ecchymoses, no Lymph node enlargement and no other skin
discoloration. Abdominal examination is notable for upper right sided deep-
seated abdominal mass that is below the liver. Liver is 2 cm below costal margin
and spleen is not palpable.
Of the following, the MOST likely diagnosis is
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 A. Wilms tumor
B. non-Hodgkin lymphoma
C. neuroblastoma
D. leukemia
E. systematic lupus erythematosus

65. The syndrome of Neuroblastoma with massive liver involvement is called

A. Pepper syndrome
B. Horner syndrome
C. Hutchinson syndrome
D. Kerner-Morrison syndrome
E. Neurocristopathy syndrome

66. Limping and irritability in young child with neuroblastoma associated with
bone and bone marrow metastasis referred to as
A. Pepper syndrome
B. Horner syndrome
C. Hutchinson syndrome
D. Kerner-Morrison syndrome
E. Neurocristopathy syndrome

67. An 18-month-old boy who is referred to the pediatric hospital for evaluation
of chronic diarrhea and failure to thrive for the past few months with no
response to any medical therapy or therapeutic formulas. All diarrhea-related
lab tests are negative. The accompanied sonography shows a small right sided
adrenal gland mass, which is confirmed by CT scan.
Of the following, the MOST likely cause of diarrhea is
A. food allergy
B. vasoactive intestinal peptides
C. associated celiac disease
D. small intestinal bacterial overgrowth
E. pancreatic insufficiency

68. Spontaneous regression of neuroblastoma is reported in which of the

following clinical scenarios?
A. A three-year old boy with large suprarenal tumor invading the adjacent
vessels with isolated bone marrow metastasis.

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 B. A five-year old girl with small suprarenal mass and diffuse bone marrow
involvement.
C. A sixteen-month boy with small suprarenal tumor and widespread
subcutaneous tumor nodules, massive liver involvement without bone
involvement.
D. A four-month old girl with small mediastinal tumor and Horner
syndrome
E. A six-year old girl with paraspinal tumor causing acute paralysis from
spinal cord compression

69. What is the MOST common metastatic site of Wilms tumor?

A. Lung
B. Bone marrow
C. Brain
D. Spleen
E. Bone

70. A 9-month-old boy develops abdominal distension noticed by the mother

for the last few weeks. Past history reveals a birth weight of 5.5 kg and neonatal
surgical correction of omphalocele. On examination; he has large tongue,
abdominal distention, and asymmetrical appearance of the lower limbs giving
an impression of larger left lower limb than the right side. Ultrasonography
shows large liver and pancreas.
Of the following, the MOST likely diagnosis is
A. WAGR syndrome
B. Denys-Drash syndrome
C. Beckwith-Wiedemann syndrome
D. Perlman syndrome
E. Trisomy 18

71. Features of (Male pseudohermaphroditism with female external genitalia,

focal segmental glomerulosclerosis and gonadoblastoma) are linked to Wilms
tumor. These features are suggestive of
A. Perlman syndrome
B. Denys-Drash syndrome
C. Frasier syndrome
D. Schimke syndrome
E. Galloway-Mowat syndrome
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72. A 10-year-old girl is referred to the hematology/oncology unit after initial
diagnosis of Wilms, tumor based on imaging studies. On examination, she has
short stature, microcephaly, and multiple café-au-lait spots distributed on the
trunk.
Of the following, the MOST likely diagnosis is
A. Diamond-Blackfan Anemia
B. Dyskeratosis Congenita
C. Shwachman-Diamond syndrome
D. Cartilage hair hypoplasia
E. Fanconi anemia

73. A 3-year-old boy is referred after initial diagnosis of Wilms tumor based on
the imaging studies. He has a history of early onset renal failure and renal
mesangial sclerosis and pseudohermaphrodism.
Of the following, the MOST likely diagnosis is
A. WAGR syndrome
B. Denys-Drash syndrome
C. Beckwith-Wiedemann Syndrome
D. Frasier Syndrome
E. Perlman Syndrome

74. The clinical characteristics of Polyhydramnios, macrosomia, distinctive facial

features, renal dysplasia, nephroblastomatosis, and multiple congenital
anomalies is indicative of
A. Simpson-Golabi-Behmel syndrome
B. Costello syndrome
C. Perlman syndrome
D. Sotos syndrome
E. Beckwith-Wiedemann syndrome

75. What is the MOST common initial clinical presentation of Wilms tumor?
A. Abdominal pain
B. Abdominal mass
C. Hematuria
D. Hypertension
E. Fever

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76. Which one of the following conditions is stratified as stage V disease of
Wilms tumor?
A. Bilateral renal involvement
B. Lung metastasis
C. A tumor thrombus extended into the inferior cava
D. Liver metastasis
E. Lymph node metastasis outside the abdominopelvic region

77. What is the MOST common solid renal tumor identified in the neonatal
period?
A. Mesoblastic nephroma
B. Wilms tumor
C. Clear cell sarcoma
D. Rhabdoid tumor of the kidney
E. Renal cell carcinoma

78. What is the MOST common anatomic site affected by Rhabdomyosarcoma?

A. Head and Neck
B. Orbit
C. Hepatobiliary
D. Extremities
E. Retroperitoneal

79. Sarcoma botryoides is a grape like mass of Rhabdomyosarcoma locat in the

A. Vagina
B. Rectum
C. Neck
D. Orbit
E. Cheek

80. Which of the following is a benchmark to differentiate between Ewing and

osteogenic sarcomas
A. Age of onsent is the second decades for Ewing, but the third decade for
osteogenic
B. Females gender predominates in Ewing while male do so in osteogenic
sarcoma
C. Site of predilection is diaphysis of long bones in Ewing while metaphysis
of the long bones in osteogenic
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 D. Fever is rare in Ewing while it is common in osteogenic
E. Lung and bones are common metastatic sites in Ewing while liver and
bone marrow in osteogenic sarcoma

81. Rothmund-Thomson syndrome is a rare condition associated with which of

the following group of manifestations?
A. Short stature, skin telangiectasia, small hands, and hypoplasticity of the
thumbs
B. Short stature, skin melanoma, large hands and feet, and absence of the
kidneys
C. Tall stature, skin telangiectasia, large feet, and hypoplasticity of the
thumbs
D. Short stature, skin telangiectasia, small hands and feet, and extra-
thumbs
E. Tall stature, skin rash, large hands and feet, and hypoplasticity of the
thumbs

82. A 13-year-old boy presents with 3-month history of left lower thigh pain and
swelling that grew up slowly. He has no history of trauma or injury to the site
and no fever or other constitutional features. Activity is normal except for the
last few weeks where he started to feel aches and movement restriction. Initial
CBC and other biochemical tests were normal but elevated alkaline
phosphatase. X-ray of the left thigh shows a lytic lesion in the lower left femur
with the classical sunburst pattern.
Of the following, the MOST likely diagnosis is
A. Ewing Sarcoma
B. Osteosarcoma
C. Non-Hodgkin lymphoma
D. Simple bone cyst
E. Histiocytosis

83. What is the MOST important prognostic factor in osteosarcoma?

A. Age
B. Gender
C. High LDH level
D. Histologic response to chemotherapy
E. Primary site of tumor

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84. Why patients with bone tumors may have delay in diagnosis?
A. The pathological differentiation of bone tumors is rather difficult
B. Patients are usually adolescent and reluctant to further diagnostic work
up
C. Clinical features are usually nonspecific of the disease itself
D. Symptoms are likely to be attributed to a sport injury
E. Apart from biopsy, no specific diagnostic test is available

85. A 12-year-old boy presented with 2-week history of fever, mild lower back
pain, and troublesome standing and walking with fever at day and night. This
progressed to complete inability to move his lower limbs that ensued suddenly
within the last 24 hours. There was no antecedent history of trauma. On
examination, there was bilateral spastic paraplegia with only a flicker of
movement at the right ankle joint. Sensory examination revealed mild
hypoesthesia to all sensations below the level of D10 dermatome. Tendon
reflexes of his lower extremities were exaggerated and Babinski response was
extensor bilaterally. Magnetic resonance imaging revealed a lesion in the D9
vertebra compressing the spinal cord.
Of the following, the MOST likely diagnosis is
A. Ewing sarcoma
B. rhabdomyosarcoma
C. osteogenic sarcoma
D. leukemia
E. Burkitt Lymphoma

86. What is the characteristic radiographic sign of Ewing sarcoma?

A. Moth-eaten appearance
B. Codman triangles
C. Onion skin appearance of periosteum
D. Sunburst appearance of bone lesions
E. Popcorn calcifications

87. Which of the following malignancies is radioresistant?

A. Ewing Sarcoma
B. Lymphoma
C. Neuroblastoma
D. Osteosarcoma
E. Wilms’ tumor
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88. Which of the following benign bone lesions can be diagnosed by radiographs
only?
A. Langerhans cell histiocytosis
B. Fibrous dysplasia
C. Osteomyelitis
D. Osteochondroma
E. Osteoblastoma

89. A 6-year-old boy presents with right lower thigh swelling that has been
noticed for the last few months. Initial radiograph shows lesion in the right
femur.
Which of the following symptoms is suggestive of malignant nature of the
lesion?
A. Night sweatig
B. Night pain
C. Poor appetite
D. Local erythema
E. Impaired daily activities

90. Which of the following benign bone lesions can be treated by observation
only?
A. Osteoblastoma
B. Chondroblastoma
C. Aneurysmal bone cyst
D. Chondromyxoid fibroma
E. Osteochondroma

91. You are the physician responsible for counselling with a family of a 10-year-
old boy who is recently diagnosed as having Osteochondroma by radiographic
suggestion.
Which one of the following statements regarding his condition is TRUE?
A. Surgery is not performed unless the lesion is symptomatic
B. The diagnosis requires core needle biopsy
C. Malignant degeneration is a possible squeal in childhood
D. It is not common during childhood
E. Usually arise from vertebrae and pelvic bone

517
92. Which of the following conditions has features closely resemble bone
infection?
A. Osteochondroma
B. Osteoid osteoma
C. Eosinophilic granuloma
D. Angiosarcoma
E. Aneurysmal bone cyst

93. Maffucci syndrome refers to a condition of angiomas of the soft tissue with
multiple
A. Osteochondroma
B. Enchondroma
C. Chondroblastoma
D. Chondromyxoid fibroma
E. Osteoid osteoma

94. What is the classical presenting feature of retinoblastoma?

A. Pain
B. Decreased vision
C. Strabismus
D. Leukocoria
E. Pupil irregularity
95. The diagnosis of retinoblastoma is essentially established by
A. ophthalmological examination
B. MRI brain
C. CT scan brain
D. local Sonography
E. biopsy

96. A common differential diagnosis of retinoblastoma is

A. glaucoma
B. endophthalmitis for toxoplasma gondi
C. idiopathic retinopathy
D. raised intraocular pressure
E. hyperplastic primary vitreous

97. Which of the following conditions is associated with an increased risk for
mediastinal germ cell tumors?
518