CORTEXT Pathology

Question 1

are malignant neoplasms of bone common or uncommon?

Answer 1

uncommon

Question 2

commonest benign tumour of bone

Answer 2

osteochondroma

Question 3

where do osteochondromas typically form?

Answer 3

epiphysis of long bones, particularly around the KNEE

Question 4

do osteochondromas typically metastasise

Answer 4

no

Question 5

associated symptoms with osteochondromas?

Answer 5

just local pain

Question 6

where do enchondromas typically form?

Answer 6

small tubular bones of hands and feet

Question 7

are enchondromas benign or malignant

Answer 7

benign

Question 8

common sites of bone cysts?

Answer 8

talus
calcaneus
proximal humerus
femur

Question 9

how are benign tumours usually treated

Answer 9

curettage
bone grafting
excisional biopsy

Question 10

how does an aneursysmal bone cyst differ from a typical bone cyst?

Answer 10

contains chambers filled with blood and serum

Question 11

name 2 locally aggressive benign tumours

Answer 11

giant cell tumour

aneurysmal bone cyst

Question 12

where do giant cell tumours commonly arise?

Answer 12

knee

distal radius

Question 13

which benign tumour commonly shows a “soap bubble” on x ray

Answer 13

giant cell tumour

Question 14

which of the benign tumours involves a genetic mutation?

Answer 14

fibrous dysplasia

Question 15

what does the genetic mutation cause in fibrous dysplasia?

Answer 15

lesions of fibrous tissue and immature bone

Question 16

which is the most frequent site of fibrous dysplasia?

Answer 16

bones of head and neck

Question 17

which benign tumour is common in adolescents and commonly appears on the proximal femur, long bones and vertebrae

Answer 17

osteoid osteoma

Question 18

predominant clinical feature of osteoid osteoma

Answer 18

intense pain that is worse at night

Question 19

what treatment would relieve the pain in osteoid osteoma

Answer 19

NSAIDs

Question 20

what is a myeloma

Answer 20

tumour of plasma cells

Question 21

clinical red flags of bone mets?

Answer 21

constant severe pain that is worse at night, weight loss, fatigue, loss of appetite

Question 22

x ray features of malignant primary bone tumours

Answer 22

cortical destruction
periosteal reaction
new bone formation
extension into soft tissue

Question 23

what is a periosteal reaction

Answer 23

raised periosteum producing bone

Question 24

most common form of primary malignant bone tumour

Answer 24

osteosarcoma

Question 25

what pathological process usually causes osteosarcomas?

Answer 25

mutations in retinoblastoma gene (tumour suppressor)

Question 26

most common areas where osteosarcomas arise?

Answer 26

MAINLY knee proximal femur proximal humerus pelvis

Question 27

which is the more common place to metastasise to in osteosarcoma?

Answer 27

blood not bone

Question 28

who tends to get chondrosarcoma?

Answer 28

older age group -> 45 year olds

Question 29

where are chondrosarcomas typically found?

Answer 29

pelvis | proximal femur

Question 30

who gets ewings sarcoma?

Answer 30

teenagers

Question 31

associated symptoms of ewings sarcoma

Answer 31

fever raised inflam markers warm swelling

Question 32

staging investigations for bone tumours

Answer 32

bone scan CT chest MRI

Question 33

common tumours that metastasise to bone

Answer 33

``` thyroid breast lung renal cell prostate ```

Question 34

which of the common tumours causing bone mets has the lowest survival? what is the prognosis?

Answer 34

lung, 6 months

Question 35

which primary tumours are most likely to cause sclerotic mets?

Answer 35

prostate | breast

Question 36

most common bones involved with mets

Answer 36

``` vertebra pelvis ribs skull humerus long bones of lower limb ```

Question 37

common blood tests used in diagnosing bone cancer and why they are used

Answer 37

``` serum calcium (hypercalcaemia), LFTs (liver mets), plasma proteins (myeloma), FBC, U+E ```

Question 38

common diffuse soft tissue swellings?

Answer 38

oedema | synovitis

Question 39

common local soft tissue swellings

Answer 39

inflammatory eg bursitis abscess baker's cyst benign/malignant neoplasms

Question 40

4 S's of lump examination

Answer 40

site size surface skin changes

Question 41

other things to look for on examination of a lump

Answer 41

consistency (fluid?, hard?) temperature (abscess?) lymphadenopathy

Question 42

would extremely rapid neoplastic growth (1 week) be worrying?

Answer 42

no, its probably a pseudotumour

Question 43

what examination features would suggest a benign soft tissue neoplasm

Answer 43

small, solid and well defined neoplasm that fluctuates in size, usually cysty/soft

Question 44

what examination features would suggest a malignant soft tissue neoplasm?

Answer 44

large, solid, ill defined neoplasm with an irregular surface and systemic symptoms

Question 45

what would be described as a larger lump?

Answer 45

>5cm

Question 46

what is a benign soft tissue tumour of smooth muscle called?

Answer 46

leiomyoma

Question 47

what is a benign soft tissue tumour of cartilage called?

Answer 47

chonromas

Question 48

what is a benign soft tissue tumour of blood vessels called?

Answer 48

haemangiomas

Question 49

which kind of joint does a ganglion cyst typically form on?

Answer 49

synovial

Question 50

what is a bursa?

Answer 50

small, fluid filled sac lined by synovium that prevents friction between bones etc

Question 51

common causes of bursitis

Answer 51

bacterial infection | gout

Question 52

most common site of avascular necrosis?

Answer 52

femoral head

Question 53

who typically gets avascular necrosis and why

Answer 53

chronic alcoholics steroid users both cause hypercoaguable blood

Question 54

what is avascular necrosis

Answer 54

ischaemic necrosis of bone

Question 55

treatment of avascular necrosis?

Answer 55

drilling under fluoroscopy (if articular surface hasnt collapsed), joint replacement (if artciular surface HAS collapsed)