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Basic Science Flashcards

1
Q

Benign bone tumour, bony outgrowth which cartilaginous cap

A

Osteochondroma

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2
Q

Where do osteochondromas typically occur?

A

Epiphysis of long bones, esp around the knee

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3
Q

Benign bone tumour, intramedullary metaphyseal cartilaginous tumour

A

Enchondroma

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4
Q

Symptoms of enchondroma

A

Asymptomatic

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5
Q

Appearance of bone in enchondroma

A

Usually lucent but may be patchy sclerotic

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6
Q

Where does enchondroma occur?

A

Tubular bones of hands and feet typically

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7
Q

How is an encondroma treated?

A

Scraped out

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8
Q

Benign bone tumour, solitary unicystic fluid filled neoplasm

A

Simple bone cyst

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9
Q

What causes a simple bone cyst?

A

Growth defect from physis

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10
Q

Where do simple bone cysts occur?

A

Metaphysis of long bones - usually proximal femur and humerus

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11
Q

Symptoms of simple bone cysts

A

Asymptomatic

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12
Q

Treatment of simple bone cyst

A

Curettage with bone graft +/- stabilisation

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13
Q

Benign bone tumour, locally aggressive, painful

A

Giant cell tumour

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14
Q

Where do giant cell tumours commonly occur?

A

Distal radius, knee, pevlix and spine

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15
Q

Which mutation is a/w a giant cell tumour?

A

Translocation between chromosome 1 and 2

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16
Q

How does a giant cell tumour appear on x-ray?

A

“soap bubble appearance”

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17
Q

Where may giant cell tumour metastasise to ?

A

Lung

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18
Q

How is a giant cell tumour treated?

A

Excision with phenol/bone cement/liquid nitrogen

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19
Q

Disease of the bone in adolescence, causes shepherd’s crook deformitiy

A

Fibrous dysplasia

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20
Q

What is the mutation in fibrous dysplasia?

A

Genetic mutation in G protein signalling

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21
Q

Where does fibrous dysplasia commonly affect?

A

Head and neck

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22
Q

What is polystotic fibrous dysplasia a/w?

A

Endocrine disorders

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23
Q

How is fibrous dysplasia treated?

A

Bisphosphonates for pain, stabilised fractures with internal fixation and cortical bone grafts

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24
Q

Why is intralesional excision not performed in fibrous dysplasia?

A

High recurrence rate

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25
Q

Benign bone tumour, small nidus of immature bone surrounded by a sclerotic halo, occurs in adolescence

A

Ostoid osteoma

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26
Q

Where is an osteoid osteoma common?

A

Proximal femur, diaphysis of long bones and vertebrae

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27
Q

Describe the pain in ostoid osteoma

A

Intense, constant, worse at night and relieved by NSAIDs

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28
Q

Describe the pain of an ostechondroma

A

Local pain

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29
Q

Describe the pain level of a giant cell tumour?

A

Painful

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30
Q

How is osteoid osteoma investigated?

A

X-Ray and CT

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31
Q

How is osteoid osteoma treated?

A

May spontaneously resolve

May need CT guided radiofrequency ablation

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32
Q

Which tumour is a/w hyperparathyroidism?

A

Brown tumour

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33
Q

Most common malignant bone tumour

A

Osteosarcoma

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34
Q

What mutation is a/w osteosarcoma?

A

Mutation in tumour suppressor retinoblastoma gene

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35
Q

Where are osteosarcomas commonly found?

A

Knee, proximal femur and pelvis

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36
Q

Where does an osterosarcoma metastasise to?

A

Blood, not lymph

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37
Q

Cartilage producing primary malignant bone tumour

A

Chondrosarcoma

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38
Q

What is the mean age to present with a chondrosarcoma

A

45

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39
Q

Where is a chondrosarcoma often found?

A

Pelvix or proximal femur

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40
Q

What is an issue in treating chondrosarcoma

A

Not radiosensitive or responsive to chemotherapy

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41
Q

Who gets Ewing’s sarcoma?

A

Teenagers

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42
Q

Where do Ewing’s sarcomas usually occur?

A

Long bones, femur

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43
Q

Malignant bone tumour, small round blue cell tumour

A

Ewing’s sarcoma

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44
Q

What mutation is a/w Ewing’s sarcoma?

A

t11;22 translocation on EWS gene on chromosome 22

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45
Q

How does Ewing’s sarcoma present?

A

Fever, raised inflammatory markers and warm swelling

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46
Q

When bone tumours are excised what margin around them is taken ?

A

3-4cm

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47
Q

Malignant cancer of round cells of the lymphocytic system and macrophages

A

Lymphoma

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48
Q

How is lymphoma treated?

A

Surgical resection

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49
Q

What is the mean survival with lymphoma?

A

<2 years

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50
Q

Malignant tumour from bone marrow

A

Myeloma

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51
Q

What is a solitary myeloma lesion called?

A

Plasmacytoma

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52
Q

What does a myeloma do?

A

Produce abnormal proteins which deposit in organ sites (amyloidosis)

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53
Q

Which age group gets myeloma?

A

45-65

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54
Q

How does myeloma present?

A

Weakness, back pain, bone pain, fatigue, weight loss and marrow suppression

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55
Q

How is myeloma diagnosed?

A

Plasma protein electrophoresis showing high paraprotein

Early morning urine for protein assay

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56
Q

How is myeloma treated?

A

Solitary - radiotherapy

Mulitple - chemotherapy

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57
Q

Which cancers commonly metastasise to bone?

A

Breast, prostate, lung, renal and thyroid

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58
Q

What are the mets like from breast cancer?

A

Blastic or lytics

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59
Q

Mean survival of breast cancer with bone mets?

A

24-26 months

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60
Q

Mean survival of lung cancer with bone mets

A

6 months

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61
Q

Mean survival of renal cell cancer with multiple mets?

A

12-18 months

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62
Q

How is fracture risk reduced in prostate cancer with bone mets?

A

Radiotherapy and hormone manipulation

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63
Q

What makes a soft tissue swelling more likely to be benign?

A

Small, fluctuation in size, cystic, well defined and soft

64
Q

What makes a soft tissue swelling more likely to be malignant ?

A

Large (>5cm), rapidly growing, ill defined, solid

65
Q

What is a lipoma?

A

Benign tumour in fat

66
Q

What is a leiomyoma?

A

Benign tumour in smooth muscle

67
Q

What is a chondroma?

A

Benign tumour in cartilage

68
Q

What is a rhabdomyoma?

A

Benign tumour in skeletal muscle

69
Q

What is a neuroma?

A

Benign tumour in nerve cells

70
Q

Benign tumour in haemangioma?

A

Benign tumour in blood vessels

71
Q

Small firm swelling on the flexor tendon sheath

A

Giant cell tumour of the tendon sheath

72
Q

What is a complication of a giant cell tumour of the tendon sheath?

A

May erode bone

73
Q

What does a giant cell tumour of the tendon sheath contain?

A

Multinucleated giant cells and haemosiderin

74
Q

Which is excision not carried out?

A

High recurrence rate

75
Q

What is pigmented villonodular synovitis?

A

Giant cell tumour in a joint

76
Q

What is a sarcoma?

A

Malignant soft tissue tumour

77
Q

What is an angiosarcoma?

A

Malignant tumour from blood vessels

78
Q

What is cause of angiosarcoma?

A

Complication of previous radiotherapy

79
Q

What is a liposarcoma?

A

Malignant tumour of fatty tissue

80
Q

Where does a liposarcoma occur?

A

In deep fatty tissue

81
Q

What is a rhabdomyosarcoma?

A

Malignant tumour of skeletal muscle

82
Q

Where are synovial sarcomas common?

A

Around the knee

83
Q

What are the two phases of a synovial sarcoma?

A

Sacromatous and epithelial

84
Q

Swelling around a synovial joint or tendon sheath

A

Ganglion cyst

85
Q

Why do ganglion cysts occur?

A

From weakened parts of the sheath or capsule, leading to out-pouching/herniation

86
Q

How does a ganglion cyst appear?

A

Well defined, firm, transiluminate

87
Q

Why is a ganglion cyst not really cystic?

A

Does not have an epithelial lining, only a fibrous wall

88
Q

Swelling of the bursa following repeated pressure or trauma

A

Bursitis

89
Q

Where is bursitis common?

A

Pre-patellar, olecranon, bunions

90
Q

What can cause bursitis other than trauma?

A

Infection, gout

91
Q

How is bursitis treated?

A

Inflammation spontaneously resolves, thickened bursal sac may remain and require excision

92
Q

Painless, epidermal inclusion cysts

A

Sebaceous cysts

93
Q

What lined an epidermal inclusion cyst?

A

Epithelium producing keratin

94
Q

Swelling which is a collection of neutrophils, infective and cellular debris +/- infecting organisms

A

Abscess

95
Q

How is an abscess treated?

A

Incision and drainage

96
Q

What is a psuedotumour?

A

Swellings which mimic tumours but are actually reactive/inflammatory

97
Q

Which process occurs in a pseudotumour?

A

Myositis ossificans

98
Q

What is myositis ossificans

A

Unusual reaction to injury causing progressive ossification of a site

99
Q

What is nodular fasciitis?

A

Rapid growth of lesion after trauma

100
Q

What groups are at risk for AVN?

A

Alcohol and steroid abusers

101
Q

What ratio does alcohol metabolism increase?

A

NADH : NAD

102
Q

How does AVN appear?

A

Large wedge shaped area of discolouration, no osteocytes

103
Q

What is creeping substitution?

A

Dead bone is slowly encircled by new, viable bone

104
Q

What can cause AVN?

A

Primary hyperlipidaemia
Increased coagulation
Caisson’s disease

105
Q

What is Caisson’s disease?

A

When nitrogen gas bubbles form in the body after too rapid a depressurisation in deep sea diving

106
Q

How is AVN treated?

A

Early: drilling under fluoroscopy
Surface collapse: joint replacement
Fusion in foot/ankle

107
Q

What does drilling under fluoroscopy do?

A

Compress the bone, prevent necrosis and encourage healing

108
Q

What is osteochondritis?

A

Developmental derangement of normal bone growth with inflammation

109
Q

What causes osetchondritis?

A

Increased physical activity and repetitive stress, FH important

110
Q

What is the pathogenesis of osteochondritis?

A

Impact/traction injuries cause bleeding and oedema in bone
Capillary compression
Necrosis
There is fragmentation and separation of the bone

111
Q

What is osteochondritis dissecans?

A

Osteochondritis which results in separation of the bone

112
Q

Where is osteochondritis dissecans common?

A

Lateral part of medial condyle in the knee
Anteromedial talar dome
Superomedial femoral head
Humeral capitellum

113
Q

What is Freiburg’s disease?

A

Osteochondritis in 2nd metatarsal head

114
Q

What is Kohler’s disease?

A

Osteochondritis in navicular bone

115
Q

What is Kienbock’s disease?

A

Osteochondritis in lunate or carpal bone

116
Q

What is Scheuermann’s disease

A

Osteochondritis in the capitellum of the elbow

117
Q

What is Osgood Schlatter disease?

A

Traction Osteochondritis at the tibial tubercle

118
Q

What is Sever’s disease?

A

Osteochondritis at the calcaneus?

119
Q

How it Osteochondritis dissecans treated?

A

Surgical realignment of the bone, OC dissecans pin or removal of unstable fragments

120
Q

What is osteoporosis?

A

Reduced bone mineral density and increased pores causing increased fragility and fracture risk

121
Q

What is the definition of osteoporosis?

A

Bone density 2.5 standard deviations below the mean of a young adult of the same race and gender

122
Q

What is the definition of osteopenia?

A

Bone density 1-2.5 standard deviations below the mean of a young adult of the same race and gender

123
Q

What is type 1 osteoporosis?

A

Post-menopausal

124
Q

What are risk factors for type 1 osteoporosis?

A

Caucasian, smoking, alcohol, lack of exercise and poor diet

125
Q

What is type 2 osteoporosis?

A

Osteoporosis of old age where bone density decreases by further than expected

126
Q

What are the risk factors for type 2 osteoporosis?

A

Caucasian, smoking, alcohol, lack of exercise, poor diet, reduced sunlight/vit D and chronic disease

127
Q

Which fractures are common with osteoporosis?

A

Femoral neck and vertebral

128
Q

Which drugs can cause osteoporosis?

A

Corticosteroid

129
Q

How is osteoporosis diagnosed?

A

DEXA scan

130
Q

How is osteoporosis treated?

A

Vit D, calcium, bisphosphonates, desunomab, strontium

131
Q

Which is intranasal calcitonin not used?

A

No benefit over other treatments and a risk of cancer

132
Q

What are the risks of HRT and raloxifene?

A

HRT - breath and endometrial cancer as well as DVT

Raloxifene - DVT

133
Q

What is osteomalacia?

A

Qualitative defect in bone resulting in abnormal softening due to deficient mineralisation of immature bone

134
Q

What is Rickett’s?

A

Osteomalacia in kids

135
Q

What are the two main causes of osteomalacia?

A

Insufficiet calcium absorption or vit D resistance

Phosphate deficiency due to renal losses

136
Q

Which medications are a/w osteomalacia?

A

Anti-convulsants

137
Q

What are the genetic causes of osteomalacia/Rickett’s?

A

X-Linked hypophosphataemia

Vit D resistant Rickett’s

138
Q

How does osteomalacia present? (9)

A

Bone pain, deformity, fracture, paraesthesia, muscle cramp, irritability, seizures, brittle nails, faitgue

139
Q

What are Looser’s zones?

A

Psuedofractures

140
Q

Where are Looser’s zones found in osteomalacia?

A

Pubic rami, proximal femur, ulna and ribs

141
Q

What are the biochemical findings of osteomalacia?

A

Low calcium, low serum phosphate, high serum alkaline phosphatase

142
Q

How is osteomalacia treated?

A

Vit D therapy and supplementation

143
Q

What is hyperparathyroidism?

A

Overactivity of the thyroid glands, producing lots of PTH

144
Q

What can cause hyperparathyroidism?

A

Benign adenoma, hyperplasia or malignant neoplasia

145
Q

How does hypercalcaemia present? (9)

A

Fatigue, depression, bone pain, myalgia, nausea, thirst, polyuria, renal stones, osteoporosis

146
Q

What are the biochemical findings of hyperparathyroidism?

A

Serum PTH and calcium igh, phosphate normal or low

147
Q

What is secondary hyperparathyroidism?

A

Overproduction of PTH in response to hypocalcaemia from vit D deficiency or CKD

148
Q

What is tertiary hyperparathyroidism?

A

When adenomas develop in secondary HPT

149
Q

How does hyperparathyroidism affect the bones?

A

Cause fragility fractures or lytic lesions

150
Q

How is hyperparathyroidism treated?

A

Remove adenoma or give supplements - obvs based on underlying cause

151
Q

How is very high serum calcium treated?

A

IV fluids, bisphosphonates and calcitonin

152
Q

What is renal dystrophy?

A

Bone changes due to CKD

153
Q

What affect does Paget’s disease have on the bones?

A

Chronic thickened, brittle and misshapen bones

154
Q

How common is Paget’s disease

A

5% over 55

10% over 80

155
Q

Which viruses is Paget’s disease a/w?

A

Paramyxoviruses, incl parainfluenza and mumps

156
Q

What is the pathogenesis of Paget’s disease?

A

Exaggerated vit D response causes increased osteoclast activity
Osteoblasts try to keep up but make shit bone basically

157
Q

How is Paget’s disease treated?

A

Bisphosphonates or calcitonin given if there is extensive lytic disease
Joint replacement
Stabilise fractures with intramedullary nails or plates

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