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Orthopaedics and Trauma > Bone disease > Flashcards

Bone disease Flashcards

1
Q

Most common types of bone tumour

A

Metastatic: Breast, bronchus, Thyroid, Kidney, prostate

Haematopoietic: Lymphoma, leukaemia, myeloma

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2
Q

Presenting complaints for bone tumours

A

Incidental finding

Pathological fracture

Bony pain (Esp night pain)

Soft tissue swelling

Painless bony mass

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3
Q

Characteristic location of chondrosarcoma

A

Pelvis

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4
Q

Characteristic location of osteoblastoma

A

Posterior spine

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5
Q

Characteristic location of simple bone cyst

A

Proximal humerus

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6
Q

Characteristic location of adamantinoma

A

Tibia diaphysis

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7
Q

Tumours in patients <20

A

Osteosarcoma

Osteoid osteoma

Ewing’s

Simple cyst

Chondroblastoma

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8
Q

Tumours in patients >60

A

Mets, myeloma, Chondrosarcoma, malignant fibrous histiocytoma

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9
Q

Tumours in middle-aged patients (20-60)

A

Giant cell

Malignant fibrous histiocytoma

Lymphoma

Chondrosarcoma

Mets

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10
Q

Features of bone tumours to look for on X-ray

A

Periosteal reaction

Zone of transition

Cortical breach

Bone loss

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11
Q

Types of periosteal reaction to tumour

A

None

Solid

Lamellated

Spiculated/sunburst

Codman’s triangle

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12
Q

Radiology of zone of transition

A

Most reliable indicator of benign vs malignant

Can be narrow or wide

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13
Q

Patterns of bone destruction

A

Geographic

Moth-eaten

Permeative

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14
Q

Presentation of osteoid osteoma

A

Small solitary nodule

Cortical

Central nidus, lytic surroundings + sclerotic rim

Painful (night pain) but responds to NSAIDs

5-25y, M:F 3:1

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15
Q

Management of osteoid osteoma

A

Radioablation

Surgical excision

NSAIDs

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16
Q

Presentation of osteochondroma

A

90% isolated lesion due to abnormal growth of growth plate

Growth ceases with growth plate fusion

Painless lumps or pain from soft tissue impingement

Points away from affected joint w/ continuous cortex

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17
Q

Management of osteochondroma

A

Excise if large/suspicious

Small risk of malignant transformation (higher in hereditary multiple exostoses)

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18
Q

What is an enchondroma?

A

Intramedullary cartilage-forming lesion

Cortical thinning

no periosteal reaction

lytic/mottled appearance

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19
Q

Management of enchondroma

A

None necessary unless painful/enlarging

Small risk of malignant change (higher in Ollier’s or Marfucci’s)

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20
Q

Aggressive vs non-aggressive lesions

A
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21
Q

Presentation of chondroblastoma

A

Benign tumour

Epiphyseal, lower limb/prox humerus

Young patients (10-25)

Round, lytic, well-defined X-RAY lesion

22
Q

Presentation of fibrous cortical defect/non-ossifying fibroma

A

Young children

Arises from cortex –> thing sclerotic rim + oval-shaped lucent lesion

Distal femur/tibia

Benign, asymptomatic

23
Q

Fibrous dysplasia

A

Developmental abnormality, becomes evident in adolescence

Ribs, femur, prox tibia esp affected (shepherd’s crook appearance)

Multiple fractures, heal but remain deformed

Treat by strengthening + straightening bone

Intramedullary bulged cortex

24
Q

Simple bone cyst

A

Well-defined circular lucent lesion in centre (c.f. aneurysmal expansile + blood-filled)

Mainly in children (c.f. aneurysmal in teenagers)

25
Q

Giant cell tumours

A

Late teens, 3rd and 4th decades, F>M

Lytic lesions, mainly around knees

Metaphyseal

Sharp zone of transition

Benign

26
Q

Ewing’s sarcoma presentation

A

Young child

Most commonly in femur/tibia diaphysis

Pain/swelling of weeks-months + systemic upset

Periosteal reaction + lytic + destructive (radiolucent) lesion

27
Q

Endocrine causes of osteoporosis

A

Post-menopausal oestrogen deficiency (late menarche/early menopause)

Hyperparathyroidism, hyperthyroidism

Cushing’s, hypogonadism

Corticosteroid excess

28
Q

Investigations for osteoporosis

A

DEXA scan (<-2.5 is bad, <-1 osteopaenia)

TFTs, U&Es, LFTs

Bone profile (Ca, PTH)

Consider cortisol, testosterone, oestradiol, VitD

Multiple myeloma screen (ESR, serum IG + electrophoresis, urinary bence-jones)

29
Q

Treatment for osteoporosis

A

Ca and VitD

Bisphosphonate

Synthetic PTH (teriparatide)

Denozumab (RANK-L biologic)

HRT

Exercise, weight loss

Stop smoking

30
Q

Clinical features of osteomalacia

A

VitD deficiency

Bone pain/waddling gait

Polyarthralgia

Pathological fractures

Subperiosteal erosions/cortical compression fractures in Looser’s zone

Proximal myopathy w/ normal CK

31
Q

Clinical features of Paget’s

A

Bone tenderness

cortical thickening, sclerosis

Deafness from nerve compression

Headache

Pathological fractures

Osteoarthritis

Rarely: osteosarcoma, vascular steal

Often asymptomatic raised ALP

>50-80

32
Q

Sites commonly affected in Paget’s disease

A

Pelvis, spine, skull

33
Q

Genetics of Ewing sarcoma

A

Mutations chromosome 11 and 22

Neuro-ectodermal cell origin

34
Q

Syndromic associations of enchondromas

A

Ollier

Marfucci

35
Q

Locations of primaries in bone mets

A

Paired midline organs

Lung

Kidney

Thyroid

Prostate

Breast

36
Q

Radiographic features of malignant tumours

A

Codman’s triangle

Fuzzy zone of transition

Onion peel appearance

Sunburst

37
Q

What is an involucrum?

A

Complication of osteomyelitis

Thick periosteal sheath (new, ossified bone) surrounding sequestrum

38
Q

What is a sequestrum?

A

Necrosed bone separated from surrounding bone

Complication of osteomyelitis

39
Q

What are bisphosphonates?

A

E.g. alendronate

Bone protection with steroids, and in post-menopausal osteoporotic women

40
Q

MRI finding osteomyelitis

A

Loss of high T1 signal in bone marrow

41
Q

Management of osteomyelitis

A

Wound swab

Blood cultures

Bone biopsy

IV abx

Surgical debridement

42
Q

Complications of osteomyelitis

A

Bone destruction

Pathological fracture

Septic arthritis

Deformity/growth disturbance

Sepsis

43
Q

Most common XR abnormality in myeloma

A

Vertebral osteoporosis/osteopaenia

Punched-out Lytic bone lesions may be present

44
Q

Demographics of osteosarcoma

A

Most common bone sarcoma

Affects adolescents, mainly males

Paget’s disease in elderly

45
Q

Clinical features of osteosarcoma

A

Long bone metaphyses (dital femur > proximal tibia > distal humerus)

Mixed sclerotic/lytic lesion

Codman’s triangle

46
Q

Presentation of chondrosarcoma

A

Adults in 5th decade

10% arise from previous enchondroma

47
Q

Retinoblastoma tumour association

A

Osteosarcoma

48
Q

Hereditary multiple exostosis tumours

A

Osteochondroma

Chondrosarcoma

chromosome 8 and 11 muts

49
Q

Nutritional causes of osteoporosis

A

Anorexia nervosa

Malabsorption

VitD deficiency –> hyperPTH

Ca deficiency

Smoking/alcohol/caffeine

50
Q

Medical (non-endocrine) causes of osteoporosis

A

RA

Osteogenesis imperfecta

Multiple myeloma

Orthopaedics and Trauma (8 decks)

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