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E - MSK > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

Most common primary bone tumour in young

A

Osteosarcoma

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2
Q

Most common primary bone tumour in older

A

Myeloma

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3
Q

Difference between pain in bone tumours and benign tumours

A

Bone

  • Pain is activity related
  • progressive pain at night and rest

Benign

  • may be activity related if large enough to weaken bone
  • Osteoid osteoma pain - dull pain that escalates to severe pain at night
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4
Q

other than pain how else can bone tumours present

A

swelling
pathological fracture
mass
incidental abnormal x-ray

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5
Q

how to exam for suspected bone tumour

A 
general health 
measure mass
location, shape, consistency, mobility, tenderness of mass
local temperature 
neuro-vascular deficits
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6
Q

Investigations for suspected bone tumour

A

X-ray - most useful
CT - for assessing ossification and calcification, staging
MRI - accurate for limits of disease
Isotope bone scan - staging for skeletal mets
Angiography -
PET - response to chemo

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7
Q

difference in x-rays for inactive and active tumours

A

Inactive

  • clear margins
  • surrounding rim of reactive bone
  • cortical expansion possible in aggressive benign lesions

Active

  • less well defined zone of transition between lesion and normal bone
  • Cortical destruction (means malignancy)
  • New bone formation (occurs when the lesion destroys the cortex)
  • Codman’s triangle
  • Onion skinning
  • Sunburst pattern
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8
Q

What work-up needs to be done prior to biopsy of bone tumour

A 
Bloods
X-ray of affected limb and chest
MRI of lesion 
Bone scan 
CT chest, abdo, pelvis
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9
Q

Cardinal features of malignant primary bone tumour

A 
Increasing and unexplained pain 
Deep-seated boring nature 
Night pain 
Difficulty weight bearing
Deep swelling
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10
Q

Examples of malignant primary bone tumours

A

Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma

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11
Q

Typical presentation of primary and secondary osteosarcoma

A

Adolescents arising in metaphases of long bone esp. around the knee
Secondary OS common in bone affected by Paget’s disease or irradiation

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12
Q

Clinical Features of Osteosarcoma

A

Pain - increasing, analgesics become ineffective, unexplained, deep boring ache, NIGHT
Loss of Function - limp, reduced joint movement, stiff back
Swelling - diffuse, near end of long bone, rapid enlargement, warm, venous congestion, pressure effects
Pathological Fracture
Joint Effusion
Deformity
Neurovascular Effects
Systemic Effects of Neoplasia

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13
Q

Investigation of choice for osteosarcoma

A

MRI - shows bone destruction and new bone formation and determines resection margins

Good for showing

  • interosseous and extraosseus extent of tumour
  • skip mets
  • joint involvement
  • epiphyseal extension
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14
Q

Treatment of osteosarcoma

A

Resection + Chemotherapy

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15
Q

What is Ewing’s sarcoma and what is its typical presentation

A

Malignant round cell tumour of long bones (typically diaphysis) and limb girdles
Usually in adolescents
t11:22 chromosomal translocation common

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16
Q

Radiographic findings in ewings sarcoma

A

(MRI helpful)

  • Bone destruction
  • Concentric layers of new bone formation (onion skin)
  • A soft tissue mass
17
Q

Treatment of ES

A

Chemo + resection and limb salvage therapy

or RT

18
Q

Prognosis of ES

A

22% 5 year recurrence rate if mets at diagnosis

55% 5 year recurrence rate if no mets at diagnosis

19
Q

Typical presentation of chondrosarcoma

A

Benign but aggressive tumour
Associated with pain or a lump
Presents in the axial skeleton of the middle aged

20
Q

Investigations for chondrosarcoma

A

Radiograph - popcorn calcification

CT/MRI - define tumour extent

21
Q

Treatment of chondrosarcoma

A

Excision (chemo nor RT work)

22
Q

Suspicious signs of a soft tissue tumour

A

Tumours deeper than deep fascia
Subcutaneous tumours >5cm
Rapid growth
Hard, craggy, fixed, no distinct margins
Non-tender to palpation but deep ache, worse at night
BUT may be painless
Recurrence after previous excision

23
Q

Most common sites of secondary bone tumours (most - least)

A 
Vertebrae
Proximal Femur
Pelvis 
Ribs
Sternum 
Skull
24
Q

7 commonest primary cancers which metastasise to bone

A
  1. Lung (smoker, CXR, sputum cytology)
  2. Breast
  3. Prostate (osteosclerotic 2o), PR, PSA
  4. Kidney (solitary, vascular)
  5. Thyroid (esp. follicular ca)
  6. GI tract (FOB, endoscopy, markers)
  7. Melanoma
25
Q

Prognosis after pathological fracture

A

~50% survive >6m
~30% survive >1y
Breast + soft tissue mets ~1-2y survival

26
Q

Prevention of pathological fracture

A

Early chemo or Deep X-ray therapy
Prophylactic Internal Fixation (if lytic lesion + increasing pain and/or:
- >2.5cm diameter
- >50% cortical destruction
Bone cement
Embolisation - esp. renal or thyroid (wait 48h before surgery)

27
Q

What system is used for fracture risk assessment

A

Mirel’s Scoring System

  • Maximum score = 12
  • Score >8 prophylactic fixation is recommended prior to RT
28
Q

difference between osteolytic and osteoblastic lesions

A

OL = tumour causes bone breakdown / thinning, calcium released from bone into bloodstream, lucencies, common in multiple myeloma

OB = increased bone production, thickening, rigid, inflexible bone formed, common in prostate cancer

29
Q

What scores 1 in Mirel’s

A

Site - UL
Pain - mild
Lesion - blastic
Size - <1/3

30
Q

What scores 2 in Mirel’s

A

Site - LL
Pain - moderate
Lesion - mixed
Size - 1/3-2/3

31
Q

What scores 3 in Mirel’s

A

Site - Peritrochanter
Pain - Functional
Lesion - lytic
Size >2/3

32
Q

Commonest soft tissue tumour

A

lipoma

33
Q

Presentation of lipoma

A

Painless lump which increases in size
Deep to deep fascia
Mass >5cm
Can become painful in malignancy

34
Q

Investigation of soft tissue tumour

A

MRI followed by needle biopsy

35
Q

Treatment of STTs

A

Excision with wide margins followed by RT

chemo generally insensitive in adult STTs

36
Q

most common metastasise in STTs

A

to Lungs (haematogenous spread)

E - MSK (29 decks)

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