Cheung Part 1 Flashcards
what are the 5 most common primary bone tumors that metastasize to bone
"BLT with a Kosher Pickle" Breast Lung Thyroid Kidney Prostate
what is the difference between the T and Z score
Z score is age matched
T score is compared to 25 yo female
musculoskeletal tumors come from what tissue
mesodermal (connective tissue like bone, fat, muscles)
musculoskeletal tumors are likely to metastasize to
the lung
what shows up radio opaque on an X-ray
bones
some soft tissue
hardware
what shows up radio-lucent on X-ray
air
sutures
ligaments
oblique X-ray of foot is at what angle
15 degrees
what type of break takes the lowest amount of energy to create
spiral
what type of break takes the most amount of energy to create
comminuted
what type of break goes straight across the bone
transverse
what type of break goes across the bone at an angle
oblique
over the age of 40 bone tumors are most likely what
metastatic
growing soft tissue masses re most likely what
malignant
excision is recommended for a benign bone tumor when
if it is aggressive
a benign soft tissue tumor grater than 5cm or is deep what is the recommended treatment
excision
in osteomyelitis the infection of the bone itself prefers what location
metaphysis
what is the most common and second most common causes of osteomyelitis
staph aureus (#1) hemolytic strep
what are the physical exam results for osteomyelitis
tenderness in bone
ROM of joints is OK (unlike septic arthritis)
swelling, warmth, redness, draining sinus
patients with osteomyelitis typically have what history
fever
achy, unrelenting night pain
what is seen in a CBS with diff for osteomyelitis
elevated WBC with left shift
what is seen on x-raty of the limb with osteomyelitis
may show Brodie’s Abscess
Brodie’s Abscess is seen in what
osteomyelitis
what is the gold standard of diagnosis for osteomyelitis
bone scan
how is osteomyelitis treated
empire treatment with antibiotic (vanc) while waiting for Cx
surgical washout if no improvement in 2 days or if there is a clear abscess
chronic (eg diabetes) may need multiple treatments
what is osteoporosis
low bone mass leading to micro architectural deterioration, causing increase fragility of bone
what bones are commonly affected by osteoporosis
hip, spine, wrist, shoulder fractures
what is the mortality rate at 1 year for all hip fractures
25%
type 1 primary osteoporosis is due to what
postmenopausal osteoporosis caused by hormonal changes leading to bone loss
type II primary osteoporosis is due to what
senile osteoporosis
caused by altered metabolism leading to bone loss
secondary osteoporosis is due to what
long term steroid use hyperparathyoridism hyperthyroidsm renal failure cancers
what is seen in physical exam
loss of height
thoracic kyphosis
loss of menstruation
what test and what score signifies osteoporosis
DEXA scan of spine, hip or femur
T or Z score less than -2.5 SD below mean
what does NTx measure
bone collagen
how is osteoporosis treated
bisphosphonates
calcitonin
pulsed PTH
SERMS
how do bisphosphonates work
disrupting ruffled border of osteoclasts
how does one prevent osteoporosis
maximize Ca/Vit D and WV exercise
minimize smoking, caffeine, meds
osteosarcoma presents at what age
1st decade
osteosarcoma has what clinical signs
swelling, night pain
osteosarcoma like what bones and what part of the bone
metaphysis
knee, hip, pelvis
what does osteosarcoma do to the bone
both plastic and lytic
how is osteosarcoma treated
micromets neoadjuvent chemo resection reconstruction chemo NO RADIATION
Ewings/PNET presents when
2nd decade of life
what clinical signs are associated with ewings/pnet
swelling, night pain
where and in what bones do Ewings/PNET affect
diaphyseal to metaphyseal
femur
pelvis
what do Ewings/PNED to do to the bone
lytic
what is the translocation and marker associated with ewings
t(11;22)
CD99+
small found blue cells
how is Ewings/PNET treated
neoadjuvent chemo
resection
chemo
can treat with radiation alone
what age is chondrosarcoma seen in
50s+
what clinical symptoms are seen in chondrosarcoma
tooth-achy pain
where can one find chondrosarcoma
metaphyseal
shoulder
hip
knee
what does chondrosarcoma do to the bone
lyric among stippled calcification
how is chondrosarcoma treated
Grade I- currettage
grade other- wide resection and reconstruction
NOT radio or chemo sensitive
metastatic disease does what to the bone
lytic, blastic, and mixed
how is metastatic treated
radiation vs currettage and nailing
what is the math of metastatic disease
cuboidal cells, rosettes, and or an image of the kidney tumor
