Dental OSCE (Objective Structured Clinical Examination) Practice Exam

What condition is characterized by punched-out radiolucencies in the skull?

1. Osteosarcoma

2. Multiple myeloma

3. Craniofacial fibrous dysplasia

4. Paget's disease

The correct answer is: Multiple myeloma

The condition characterized by punched-out radiolucencies in the skull is indeed multiple myeloma. This hematological malignancy is known for causing distinct radiographic findings, particularly in the bones. The “punched-out” lesions refer to areas where the bone has been destroyed, giving the x-ray appearance of holes or voids. These lesions occur because multiple myeloma results in the overproduction of abnormal plasma cells, which can infiltrate the bone marrow, leading to local bone resorption. These radiolucent lesions are often found in the skull, vertebrae, and other areas, further supporting the diagnosis. In contrast, while osteosarcoma and Paget's disease may present with bone lesions, they have different radiographic features and do not typically show the specific punched-out appearance associated with multiple myeloma. Craniofacial fibrous dysplasia, also known for its impact on bone structure, presents differently on x-rays and mainly shows ground-glass or hazy radiopacity rather than distinct punched-out lesions.