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Year 2 > CORTEX pathology > Flashcards

CORTEX pathology Flashcards

1
Q

List the possible causes of a benign bone tumour

A 
Neoplastic
Developmental 
Traumatic 
Infectious
Inflammatory
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2
Q

Which is more common primary bone cancer or metastatic disease?

A

Metastatic disease by far

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3
Q

What is the most common benign bone tumour? Describe this tumour

A

Osteochondroma

Bone outgrowth with cartilaginous cap

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4
Q

How do osteochrondromas present?

A

Asymptomatic

Local pain

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5
Q

Osteochondromas, while benign, carry a high malignant transformation risk. T/F

A

False - risk of malignant transformation low

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6
Q

When might multiple osteochondromas occur?

A

Autosomal dominant hereditary disorder

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7
Q

Describe an enchondroma. Why do they occur?

A

Intramedullary, metaphyseal cartilaginous tumour

Failure of normal endochondral ossification

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8
Q

How do enchondromas appear radiologically?

A

Lucent radiologically +/- sclerotic areas

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9
Q

How do enchondromas present?

A

Asymptomatic

Pathological fractures

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10
Q

Which bones do enchondromas occur within?

A

Femur
Humerus
Tibia
Hand & feet (phalynx)

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11
Q

How can enchondromas be treated?

A

Curattege of lesion

Filling with bone graft

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12
Q

What are simple bone cysts sometimes called?

A

Unicameral bone cysts

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13
Q

Describe a simple bone cyst. What causes them?

A

Single cavity fluid filled cyst in bone (metaphysis in long bones)
Defect in the physis

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14
Q

Which bones do simple bone cysts occur within?

A

Long bones (femur, humerus)
Talus
Calcanus

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15
Q

How do simple bone cysts present?

A

Asymptomatic

Pathological fracture

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16
Q

How can simple bone cysts be treated?

A

Curattege of lesion
Filling with bone graft
+/- stabilisation

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17
Q

Which age group is usually diagnosed with simple bone cysts? How are they diagnosed?

A

Young adults/children

Incidentally on x-ray

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18
Q

Describe an aneurysmal bone cyst

A

Multichambered cyst filled with blood or serum occuring in metaphyses

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19
Q

What causes aneurysmal bone cysts?

A

Arteriovenous malformation

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20
Q

Which bones do aneurysmal bone cysts usually occur within?

A

Long bones
Flat bones (skull, ribs)
Vertebral bodies

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21
Q

How do aneurysmal bone cysts present?

A

Locally aggressive –> pain

Pathological fracture

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22
Q

How are aneurysmal bone cysts treated?

A

Curettege

Filling with bone graft

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23
Q

Describe a giant cell tumour of the bone

A

Radiolucent lesion affecting metaphyseal, epiphyseal or even subchondral bone near joints

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24
Q

Which bones do giant cell tumours usually occur within?

A

Knee
Distal radius

Long bones
Pelvis
Spine

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25
Q

How do giant cell tumours characteristically appear on x-ray?

A

Soap bubble appearance

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26
Q

How do giant cell tumours present?

A

Locally destructive –> pain
Pathological fracture
Metastases to lung (benign GCT)

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27
Q

How are giant cell tumours treated?

A

Intralesional excision + phenol/bone cement/liquid nitrogen to destroy residual tumour (& prevent reoccurrence)
Joint replacement in aggressive lesions

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28
Q

In which age group does fibrous dysplasia occur?

A

Adolescents

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29
Q

Why does fibrous dysplasia occur?

A

Genetic mutation causing lesions of fibrous tissue & immature bone

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30
Q

Does fibrous dysplasia affect one bone or many?

A

Either - monostotic or polystotic

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31
Q

How do bones affected by fibrous dysplasia appear?

A

Angular deformities

Wide bone with thin cortices

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32
Q

How does fibrous dysplasia present?

A

Pain

Stress fractures

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33
Q

What type of deformity can occur in fibrous dysplasia and what bone does this involved?

A

Proximal femur - shepherd’s crook

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34
Q

Describe the typical bone scan result in fibrous dysplasia

A

Increased uptake during development followed by inactivity

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35
Q

How can fibrous dysplasia be managed?

A

Biphosphonates (pain reduction)
Fixation of stress fractures
Cortical bone grafts (improves strength)

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36
Q

Why is intralesional excision NOT used in fibrous dysplasia?

A

Reoccurrence rate high

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37
Q

How does an osteoid osteoma present?

A

Small nidus of immature bone surrounded by sclerotic halo

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38
Q

Which age group gets osteoid osteomas?

A

Adolescents

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39
Q

Which bones do osteoid osteomas commonly occur within?

A

Proximal femur
Diaphysis of long bones
Vertebrae

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40
Q

How do osteoid osteomas present?

A 
Intense constant pain
Night pain (inflammatory response)
Pain relieved by NSAIDs
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41
Q

How are osteoid osteomas investigated?

A

X-ray (not diagnostic)
Bone scan
CT

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42
Q

How are osteoid osteomas managed?

A

Self resolving
CT guided radiofrequency ablation
En bloc excision

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43
Q

What is a brodie’s abscess?

A

Subacute osteomyelitis which shows up as lytic bone lesion

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44
Q

What is a brown tumour?

A

Lytic bone lesion associated with hyperparathyroidism

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45
Q

How do bony metastases present?

A 
Intense constant pain 
Worse at night 
Systemic symptoms (weight loss, anaemia, loss of apetite)
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46
Q

In which age groups would unexplained bone pain be most concerning?

A

> 60

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47
Q

Are bony swellings a cause for concern?

A

When paired with red flags or constant bony pain

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48
Q

How do cancer affecting the bone appear on x-ray?

A 
Cortical destruction
Periosteal retraction (raised & producing new bone)
Sclerosis
Lysis
Extension into soft tissues
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49
Q

What is the most common form of primary bone cancer?

A

Osteosarcoma

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50
Q

Who gets osteosarcoma?

A

Young adults

51
Q

Which bones does osteosarcoma most commonly affect

A

Knee

Proximal humerus
Proximal femus
Pelvis

52
Q

How does osteosarcoma typically spread?

A

Haematogenous (can spread lymphatically but less common)

53
Q

Where does osteosarcoma commonly metastasis to?

A

Lungs

54
Q

Osteosarcomas are sensitive to which treatment?

A

Excision
Chemotherapy (as adjuvant - not curative)

NOT radiotherapy

55
Q

What is chondrosarcoma?

A

Cartilage producing primary bone tumour

56
Q

Which age group commonly gets chondrosarcoma?

A

Adults (median age 45)

57
Q

Chondrosarcomas are typically small and fast spreading. T/F

A

False - large and slow spreading

58
Q

Where are chondrosarcomas most commonly found?

A

Pelvis

Proximal femur

59
Q

How are chondrosarcomas treated?

A

NOT radio OR chemotherapy

Excision

60
Q

Which two fibrous primary bone tumours tend to occur in pathological bone? List conditions associated with pathological bones

A

Fibrosarcoma
Malignant fibrous histiocytoma

Paget’s
Fibrous dysplasia
Post irradiation
Bone infarct

61
Q

Which age group is affected by fibrosarcoma?

A

Adolescents and young adults

62
Q

What is Ewing’s sarcoma? How common is it? What is it’s prognosis?

A

Malignant tumour of primitive cells in bone marrow
Second most common
Really shitty

63
Q

Which age group tends to get Ewing’s sarcoma?

A

10-20 y/o

64
Q

How does ewing’s sarcoma present? What is it commonly misdiagnosed as?

A

Bone pain
Fever
Raised inflammatory markers
Warm swelling

Osteomyelitis

65
Q

How is ewing’s sarcoma treated?

A

Excision

Radio and chemotherapy

66
Q

How are primary bone tumours staged?

A

Bone scan
CT chest
MRI/CT (local spread)
Biopsy

67
Q

What is lymphoma?

A

Cancer of round cells/macrophages

68
Q

How does lymphoma affect the bone? Which bones does it tend to affect?

A

Primary bone tumour (non-hodkins)
Metastatic

Pelvis
Femur

69
Q

How is lymphoma of the bone treated?

A

Excision

Chemo/radiotherapy for metastatic

70
Q

What is myeloma?

A

Malignant B cell proliferation & antibody production

71
Q

What are the two forms of myeloma? How do they differ?

A

Plasmacytoma - solitary lesion

Multiple myeloma - multiple osteolytic lesions

72
Q

Which age group is typically affected by myeloma?

A

45-65

73
Q

How does multiple myeloma present?

A 
Weakness
Back pain
Bone pain
Fatigue
Weight loss
Marrow suppression (anaemia & recurrent infection)
Pathological fracture
74
Q

How is multiple myeloma diagnosed?

A

Plasma protein electrophoresis (high paraprotein)

Early morning urine collection (Bence Jones proteins - overflow proteinuria)

75
Q

Metastases are not always detected on bone scan of multiple myeloma. Why? How is this overcome?

A

Normal osteoblastic response to bone lysis is not present

Skeletal survey

76
Q

How is myeloma treated?

A

Plasmacytoma - radiotherapy

Multiple myeloma - chemotherapy

77
Q

Which cancers commonly metastases to bone? State whether they are lytic or sclerotis

A 
Breast - either 
Prostate - sclerotic 
Lung - lytic
Renal cell - lytic 
Thyroid adenocarcinoma
78
Q

How are renal cell bony mets different from other mets?

A

Large and vascular - can bleed profusely on biopsy/surgery

79
Q

Which bones are frequently metastasised?

A 
Vertebrae
Pelvis
Ribs
Skull
Humerus
Long bones of lower limb
80
Q

Bone pain with any red flag symptom should be investigated how?

A

X-ray

81
Q

How should bony lesions be investigated?

A 
Bone scan (occasionally MRI)
Blood tests (serum calcium - raised ; LFTs - mets ; plasma protein electrophoresis - myeloma ; FBC ; U&E)
82
Q

Skeletal stabilisation and/or joint replacement is often indicated for pre-emptive treatment of pathological fractures. T/F

A

True - if high risk

83
Q

When might soft tissue swellings be diffuse?

A

Synovitis (around joint)

Oedema

84
Q

When might soft tissue swellings be local?

A 
Bursitis
Rheumatoid nodules
Abscess
Cystic lesions (ganglion, meniscal, baker's)
Benign or malignant neoplasm
85
Q

What should be looked for on examination of soft tissue swellings?

A 
Site(s)
Size 
Border
Consistency 
Surface
Mobility
Temperature (infection)
Transilluminable 
Pulsatility 
Skin changes
Lymphadenopathy
86
Q

Which features suggest benign soft tissue swelling?

A 
Small
Fluctuation in size
Cystic lesions
Well defined 
Fluid filled
Soft/fatty
87
Q

Which features suggest malignant soft tissue swelling?

A 
Large (>5cm)
Rapid growth
Solid
Ill defined
Irregular 
Lymphadenopathy
Systemic symptoms
88
Q

How may soft tissue swellings be investigated?

A

MRI
USS (if suspected cystic)
Biopsy

ONLY if cause unknown with unclear clinical picture

89
Q

What is the commonest benign soft tissue swelling? What is this?

A

Lipoma

Neoplasm of fat tissue

90
Q

Where do lipomas occur?

A

Subcutaneous fat

Rarely within muscle

91
Q

What is a giant cell tumour of the tendon sheath? How does it present?

A

Exactly what it says on the tin
Swelling found on flexor tendon sheath of finger
Painful
+/- bone erosion

92
Q

How are giant cell tumours of the tendon sheath treated?

A

Excision has high reoccurrence rate

Not malignant so leave them alone

93
Q

What are giant cell tumours of the tendon sheath known as when they involve a synovial joint? How do they present?

A

Pigmented Villonodular Synovitis

Pain +/- effusion in knee

94
Q

Malignant tumours arising from the connective tissues are called what?

A

Sarcomas

95
Q

Which age group most commonly gets sarcomas?

A

50-70 but can occur at any age

96
Q

What is a ganglion cyst? Where are they most commonly found?

A

Herniation of weak portion of joint capsule/tendon sheath occuring around synovial joints
Wrist

97
Q

What causes ganglions?

A 
Congenital weakness (juvenile Baker's cyst)
Underlying joint damage (arthritis --> adult Baker's cyst, mucous cyst of DIP, wrist ganglion)
98
Q

Describe a ganglion

A

Well circumscribed
Transilluminate
Firm

99
Q

Are ganglions excised?

A

It can be done but will reoccur so try to avoid this

100
Q

What is buristis?

A

Inflammation of bursa

101
Q

What is a bursa?

A

Small fluid filled sac lined with synovium preventing friction at a joint

102
Q

What are the common areas for bursitis? Why does it occur?

A

Pre-patellar
Olecranon
Bunion (medial 1st metatarsal head)

Repeated pressure/trauma
Bacterial infection (abscess)
Gout

103
Q

How are sebaceous cysts managed?

A

Excision +/- biopsy

104
Q

What are the causes of abscesses on a limb? How are the managed?

A

Cellulitis
Bursitis
Penetrating wound
Infected sebaceous cyst

Must incise and drain pus

105
Q

What is the end result of osteochondritis and AVN? Why does this occur?

A

Necrosis

Disrupted blood supply to the area –> ischaemia

106
Q

Who gets osteochondritis? Why?

A

Young adults & children
Physical activity with repeated stress
Familial
Coagulopathy

107
Q

How might repeated impaction or traction injuries cause osteochondritis?

A

Bleeding and oedema within bone –>
Capillary compression –>
Reduced blood supply –>
Necrosis

108
Q

What is the result of necrosis in osteochondritis?

A

Compression/fragmentation/separation of bone +/- overlying cartilage –>
Irregular joint surface –>
Osteoarthritis at a young age

109
Q

What are the common sites of compression osteochondritis?

A 
Second metatarsal head (Freiburg's)
Navicular bone (Kohler's)
Lunate (Kienbock's)
Capitellum (Panners)
Vertebral (Scheuermann's disease)
110
Q

What is traction osteochondritis and at which sites does it commonly occur?

A

Osteochondritis occuring at apophysis

Tibial tubercule (Osgood Schlatters)
Calcaneus (Sever's disease)
111
Q

Define osteochondritis dissecans. Where does it commonly occur?

A

Fragmentation with separation of bone and cartilage within a joint

Lateral part of medial femoral condyle of knee
Anteriomedial talar done
Superomedial femoral head
Humeral capitulum

112
Q

How does osteochondritis dissecans present?

A

Pain
Locking
Effusions
Giving way of joints

113
Q

How is traction osteochondritis treated?

A

Settles with test

114
Q

How can osteochondritis and osteochondritis dissecans be treated respectively?

A

Osteotomy (joint damage)

Pinning of fragments +/- excision of detached parts

115
Q

What is avascular necrosis (AVN) and in which age group does it occur?

A

Ischaemic necrosis of bone

Adults

116
Q

Which sites are prone to AVN?

A 
Femoral head
Femoral condyles
Head of humerus
Capitulum 
Proximal pole of scaphoid 
Proximal part of talus
117
Q

Which pathologies can AVN be secondary to?

A

Femoral neck fracture
Proximal humerus fracture
Waist of scaphoid fracture
Talar neck fracture

118
Q

Is AVN ever idiopathic?

A

Yep

119
Q

How can alcoholism, primary hyperlipidaemia and steroids cause AVN?

A

Mobilise fats into circulations where they get lodged in small vessels & increased fat content of bone can compress venous outflow

120
Q

Which causes of increased coagulation are linked to AVN?

A

Thrombophilia
Sickle cell disease
Antiphospholipid deficiency in SLE

121
Q

What is a rare cause of AVN?

A

Decompression sickness after deep sea diving (due to nitrogen bubbles)

122
Q

How does AVN progress?

A 
Necrosis -->
Patchy sclerosis -->
Subchondral collapse -->
Irregularity of articular surface -->
Secondary OA
123
Q

How is AVN managed?

A

If not yet collapsed and in amenable site (e.g femoral head) drilling under fluroscopy can relieve pressure
Joint replacement or fusion if collapse

Year 2 (72 decks)

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