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MSK > Basic Science - Pathology > Flashcards

Basic Science - Pathology Flashcards

1
Q

What is the commonest benign bone tumour?

A

Osteochondroma

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2
Q

What is an osteochondroma and what is the treatment of a growing or painful lesion?

A

Bony outgrowth externally with cartilagenous cap

Excisional biopsy

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3
Q

What is the cause of multiple osteochondroma?

A

Autosomal dominant hereditary disorder

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4
Q

Where do enchondroma occur?

A

Within - intramedullary and at metaphysis

Anatomically - Femur, humerus, tibia and small bones of hand and feet

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5
Q

What are the consequences of an enchondroma?

A

Can weaken bone and result in pathologic fracture

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6
Q

What is the treatment for a enchondroma if there has been a fracture or risk of one?

A

Curretage and bone graft

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7
Q

What is a simple bone cyst?

A

Single fluid filled cyst in bone = Growth defect from the physis, therefore metaphyseal in long bones

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8
Q

What is an aneurysmal bone cyst?

A

Multiple chambered filled with blood = arteriovenous malformation. Lesion locally agressive and causes cortical destruction and pain

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9
Q

Where do aneurysmal bone cysts occur?

A

Metaphyses of long bones, flat bones and vertebral bodies

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10
Q

What is a giant cell tumour of the bone?

A

‘Soap bubble’ X ray appearance, locally aggressive/ destructive tumours of multi nucleated giant cells arising in metaphyseal region normally. Can also involve epiphysis ans subchondral bone

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11
Q

What is the treatment of a GCT of bone?

A

Intralesional excision with phenol, bone cement or liquid nitrogen used to reduce recurrence

Cortical destruction can = joint replacement

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12
Q

What is a complication of GCT?

A

Metastases to lung causing benign pulmonary GCT

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13
Q

What is fibrous dysplasia?

A

Lesions of fibrous tissue and immature bone caused by genetic mutation.

In adolescence

Can cause defective mineralisation = angular deformities. Bone is also wider with thinner cortices

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14
Q

What is the consequences of fibrous dysplasia?

A

Shepherds crook deformity of proximal femur if involved

Stress fracture

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15
Q

Treatment of fibrous dysplasia?

A

Bisphosphonates for pain

Internal fixation stabilising and cortical bone graft for pathological fracture

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16
Q

What is osteoid osteoma?

A

A site of immature bone surrounded by intense sclerotic halo

Adolescence

Occurring at proximal femur, diaphysis of long bones and vertebrae

Causes intense pain, worse at night due to inflammation

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17
Q

Treatment of osteoid osteoma?

A

NSAIDS for pain

Some require CT guided radioablation or en bloc excision

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18
Q

What is a Brodies abscess?

A

Lytic bone lesion caused by subacute osteomyelitis

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19
Q

What is a Brown tumour?

A

Lytic bone lesion caused by hyperparathyroidism

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20
Q

What is the cause of enchondroma?

A

Failure of normal enchondral ossification

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21
Q

What are the RED FLAGS of any metastatic bone tumour?

A

Constant pain, ?severe and worse at night

Systemic - weigh loss, fatigue and loss of appetite

Be aware of older and younger patients

22
Q

What is the investigation done initially if suspicious of bone malignancy ?

A

X Ray

23
Q

In whom are primary bone tumours likely to occur?

A

Under 25’s

24
Q

What feature would mandate urgent referral ?

A

Substantial, ill defined bony swelling

25
Q

What would a primary bone tumour show on X ray?

A

Cortical destruction, periosteal reaction, new bone formation combined with lysis from destruction and extension into surrounding tissue

26
Q

What is the commonest primary bone cancer?

A

Osteosarcoma

27
Q

Site of osteosarcoma?

A

60% involve bones around knee

Other sites = proximal femur and humerus + pelvis

28
Q

What is the method of spread of osteosarcoma?

A

Haematogenous + lymphatic in some cases

29
Q

What adjuvant treatment can be used for osteosarcoma?

A

Chemotherapy, NOT radiotherapy

30
Q

Where will patients with osteosarcoma often have mets?

A

Pulmonary

31
Q

What is Ewings Sarcoma?

A

Malignant tumour of primative cells in marrow

Is radio and chemo sensitive

32
Q

What can be a presentation of Ewings sarcoma?

A

Much like osteomyelitis

Fever, raised inflammatory markers and warm swelling

33
Q

What is the definitive treatment of primary bone cancer?

A

Surgery for removal - margin of 3-4 cm + cuff of muscle

Staging through CT and MRI and biopsy

Often limb salvage afterwards involving joint reconstruction with large replacements to counteract bone loss

34
Q

What cancers will tend to metastasise to bone?

A

Breast, prostate, lung, renal cell and thyroid adenocarcinoma

35
Q

Features of breast cancer bone mets?

A

Can be lytic ( black on x ray) or sclerotic/ blastic ( white on X ray)

36
Q

Feature of prostate cancer bone mets?

A

Sclerotic lesions

Radiotherapy and hormone treatment can reduce fracture risk

Osteoblastic activity means fractures more likely to heal

37
Q

Features of lung cancer bone mets?

A

Lytic lesions

38
Q

Features of renal cell carcinoma bone mets?

A

Large, very vascular lytic lesions

Single bone met + resectable primary tumour can = cure by surgery

39
Q

How can a primary bone tumour be excluded if lesion found on X ray?

A

By bone scan or ?MRI

40
Q

What would indicate impending pathological fracture and therefore intervention?

A

Pain on weight bearing especially

Over 50% bone diameter

Cortical thinning

At risk area

41
Q

What is skeletal stabilisation?

A

Insertion of long rods/ intramedullary nails or joint replacement if destruction of joint

Any surgery = HIGH risk DVT so prophylaxis must be taken

42
Q

How can spinal cord compression be treated?

A

Usually in advanced spinal mets

By radiotherapy or anterior or posterior surgical decompression

43
Q

What is a ganglion cyst?

A

Cyst around synovial joint or the synovial tendon sheath caused by herniation of weak portion of joint capsule

44
Q

What are types of ganglion cyst?

A

Developmental - i.e. juvenile Bakers’s cyst

Resulting from joint damage or arthritis - i.e. Adult Baker’s cyst, mucous cyst of DIP joint, wrist ganglion

45
Q

What are the features of a ganglion cyst?

A

Well defined, quite firm and transilluminate

46
Q

What is a bursitis?

A

Inflamed bursae occurring due to repeated pressure and trauma. Can also be caused by gout and a bursal abscess can be caused by bacterial infection.

Thickened bursal sack can be left after inflammation subsides

47
Q

What sites are prone to avascular necrosis (AVN)?

A 
Femoral head
Femoral chondyles
Head of humerus
Capitellum  
Proximal pole of scaphoid
Proximal part of talus
48
Q

Causes of AVN

A 
Fracture
Alcoholism and steroid use or abuse
Primary hyperlipidaemia
Thrombophilia 
Sickle cell disease
Antiphospholipid in SLE
Caisson's disease
49
Q

How does lipid accumulation cause AVN

A

Increased fat in circulation = increased marrow fat content compressing venous outflow from bone

50
Q

What is sequelae of AVN?

A 
Necrosis
Patchy sclerosis 
Subchondral collapse
Irregularity of articular surface 
Secondary osteoarthritis
51
Q

Treatment of osteoarthritis?

A

If no articular collapse in an amenable site - drilling under fluroscopy to decompress bone

Articular collapse = joint replacement

Fusion? in wrist or ankle and foot

MSK (3 decks)

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