Tumor questions on the OITE conform to a number of predictable patterns, and recognition of these patterns, plus a systematic approach to eliminating the incorrect "distraction" answers will lead to a higher probability of success.
How to Approach a Tumor Question on the OITE:
The following is a suggestion only - ultimately you must determine you own best exam strategy. Remember that age and location are extremely important. Both bone and soft tissue tumors tend to occur in certain body sites in certain age groups, so bear these important facts in mind at all times. Age and location will steer you towards the right answer every time. Naturally, to make use of these facts you will need to have memorized which tumors happen where and when! Fortunately, that information can be found in this app.
Parse the Question:
Read the question carefully and extract the key facts being presented. In particular, note the age and body site, and take note of the chronicity of the presentation. Did the problem develop over days, weeks, months, or longer? Symptoms that develop in hours or days point to infection or inflammatory lesions, since tumors do not grow that fast. Symptoms that develop over weeks or months point to neoplasms. Symptoms that come and go may point to hemangioma, which can grow or shrink, and symptoms that go back for years, especially in multiple sites, point to hereditary and metabolic lesions, such as osteochondromatosis and Paget's.
For Bone Tumor Questions:
The overall approach for bone tumor diagnosis questions, and bone tumor "next best step in management" questions: To answer correctly, you need to pick the right tumor. Carefully read and parse the question and the answers. Formulate a short differential based on the text of the question ONLY, then look at the XRAY only. Do not look at the MRI or pathology until you have used the question and the xray to eliminate one, two or even three of the five answers. Once you have done this, use the MRI and pathology to work towards the most likely correct answer. DO NOT look at the pathology and images right away and work back, hoping that one of the five answers will "jump out" at you as the right one. This method will get you confused more often than not.
For Soft Tissue Tumor Questions:
You will need to know which soft tissue tumors occur in what sites at what ages, just as in bone tumors. Note which which soft tissue tumors have notable features on plain xray (synovial sarcoma, hemangoima). In addition, the MRI images will be much more important in questions on soft tissue tumors. You will need to memorize the basic MRI appearance of malignant sarcoma, lipoma, hemangioma, heterotopic ossification, infection, and perhaps others, on MRI.
The Pathology
You will need to know how to recognize certain tissues on histopathology images, such as bone, cartilage, bone marrow, muscle, tendon. You should study how to differentiate a malignant tumor from a benign tumor. In the setting of the OITE exam, there will only be 5 possible answers, and if you read the question carefully and considered the age and location of the tumor, you will hopefully be able to eliminate at least one or two of the five.
Therefore, you will be called on to use the pathology images to make a call between the two or three likely possibilities. Often, these last remaning tumors are very dissimilar on pathology, such as hemangioma and Ewing sarcoma, so you should only need to remember the basic histological features of the tumors in order to pick the correct answer. It is very unlikely you will be asked to make subtle distinctions between pathologic tissues, such as splitting malignant fibrous histiosarcoma from leiomyosarcoma. Look at images of the frequently tested tumors in the list above and note the common features for each. There is one frequently tested tumor you should definitely know well: Synovial sarcoma has a very distinctive histological appearance, which you should spend time memorizing.
