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Ortho OITE study 2020 > Ginger Holt Video > Flashcards

Ginger Holt Video Flashcards

1
Q

Sarcomas are tumors of?

A

connective tissue

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2
Q

sarcomas typically mets vis

A

hematogenous spread and not nodal spread, mets to chest and lungs

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3
Q

age less than 5 benign

A

Osteomyelitis

Osteofibrous Dysplasia

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4
Q

age < 5 malignant

A

LCH (Letter-Siwe)
LCH (hand schuller)
Metastatic Neuroblastoma

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5
Q

age < 30 malignant

A

ewings

osteosarcoma

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6
Q

age < 30 benign

A 
Osteoid Osteoma
Osteoblastoma
Chrondroblastoma
ABC
LCH
Osteofibrous Displasia
Non-Ossifying Fibroma
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7
Q

> 30 malignant

A 
Chondrosarcoma
Mets
Lymphoma
Myeloma
Chordoma
Adamantinoma
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8
Q

Age > 30 benign

A

GCT

Paget’s DZ

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9
Q

DX? Diurnal pain, relief with NSAIDS (aspirin non selective)

A

Osteoid Osteoma

*soft tissue sarcomas are deceptively painless

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10
Q

11,22

A

Ewings

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11
Q

X-18

A

Synovial Sarcoma

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12
Q

SSX1-SYT

A

Synovial Sarcoma

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13
Q

RB and p53

A

Osteosarcoma

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14
Q

EXR/CRP

A

Ewings and Infection

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15
Q

SPEP/UPEP

A

Myeloma

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16
Q

PSA

A

Prostate

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17
Q

p53 is on chromosome ?

A

17

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18
Q

retinoblastoma gene is on chromosome

A

13

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19
Q

Limb salavage surgery/Wide excision

(not necessarily amputation is tx for what?

A 
Chondrosarcoma
Adamantinoma
Chordoma
PARosteal Osteosarcoma
Soft tissue sarcoma
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20
Q

ORIF + radiation for which processes

A

Mets (Prostate, Breast, Lung Kidney, Thyroid)
Lymphoma
Myeloma

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21
Q

RFA

A

Osteoid Osteoma

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22
Q

Intra-lesional resection is ok for which tumors…

A

GCT
ABC
NOF
LCH

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23
Q

Doxorubicin toxicity and mech of ACTION

A

Cardiac toxicity
anthracycline antibiotic
Cytostatic agent

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24
Q

after doxorubicin tx of bone sarcoma patient needs what study

A

echocardiogram

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25
Q

Preop radiation dose for soft tissue sarcoma

A

50 Gy

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26
Q

Postop radiation dose for soft tissue sarcoma

A

60-66 Gy

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27
Q

radiation dose for mets

A

25-30 Gy

*whole bone/surgical field needs radiation

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28
Q

Downside to preop radiation therapy

A

periop wound healing complications

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29
Q

Downside to postop radiation therapy

A

LARGER FIELD, long term fibrosis, and bone fractures, higher rate of radiation induced sarcomas

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30
Q

Heterotopic bone ppx dosage

A

5GY single dose, 4 hours before or within 72 hours after

ortho bullets says < 550cGY not effecting and says dose i 700cGy

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31
Q

ADVANTAGE OF preop radiation

A

lower dose and smaller field

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32
Q

remove tumor but don’t have wide cuff of tissue=

A

marginal resection

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33
Q

marginal resection is OK for which sarcoma

A

Liposarcoma

Schwannoma

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34
Q

most common type of sarcoma resection, takes normal cuff of tissue

A

wide resection

*limb salvage surgery

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35
Q

removal of entire compartment as a form of tumor resection

A

radical or amputation

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36
Q

In order most common sites for metastatic disease spread

A

Lung
Liver
Bone

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37
Q

In order most common sites of spread for bone mets

A

Spine
Proximal Femur- most comon site of fracture
Humerus-second most common site of fracture

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38
Q

most common carcinomas that metastasize to bone

A 
BLT with a Kosher Pickle
breast
lung
thyroid
kidney
prostate
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39
Q

order of tumor workup

A 
History
Local staging- Xray, CT scan
MRI, 
systemic staging
biopsy
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40
Q

ap xray of every bone in the body

A

Skeletal Survey

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41
Q

next step in DIAGNOSIS of myeloma

A

SPEP/UPEP

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42
Q

next step in STAGING of myeloma

A

Skeletal Survey

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43
Q

next step in staging of presumed metastatic lytic lesion of bone

A

CT of Chest, Abdomen and Pelvis

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44
Q

for OSA, CSA, EWS, STST you need ct of what only

A

CT chest, not CAP

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45
Q

whole body bone scan needed for staging in which cases

A

OSA
EWS
METS

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46
Q

Bone marrow biopsy needed for staging in what cases

A

mYeloma with mets, and EWINGS

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47
Q

Smooth muscle actin +

A

Leiomyosarcoma

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48
Q

Desmin + (skeletal muscle)

A

Rhabdomyosarcoma

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49
Q

S-100 + (neural)

A

Schwannoma, MPNST

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50
Q

CD34/CD31 + (endothelial cells, vascular tumors)

A

Hemangioma

Angiosarcoma

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51
Q

Beta Catenin+ (Wnt signaling)

A

fibromatosis, extra-abdominal desmoid

52
Q

CD99+

A

ewings/PNET

53
Q

IHC: Keratin+

A

Epithelial sarcoma
Synovial Sarcoma
Carcinoma

54
Q

IHC: EMA (epihelioid membrane antigen)

A

Epithelioid Sarcoma and Synovial Sarcoma

55
Q

IHC: MYo-D1, Myogenin+

A

rhabdomyosarcoma

56
Q

IHC: Vimentin +

A

Soft tissue sarcoma

57
Q

osteosarcoma translocation

A

unknown

58
Q

11,22

A

ewings

59
Q

ews-FL1

A

ewings

60
Q

12,16

q13, p11

A

myxoid liposarcoma

61
Q

TLS CHOP

A

Myxoid liposarcoma

62
Q

2,13

A

alveolar rhabdomyosarcoma

63
Q

pax3-FKHR

A

alveolar rhabdomyosarcoma

64
Q

12,22

A

clear cell sarcoma

65
Q

EWS, ATF1

A

clear cell sarcoma

66
Q

x,18

A

synovial sarcoma

67
Q

SSX1-SYT

A

synovial sarcoma

68
Q

9,22

A

myxoid chrondrosarcoma

69
Q

ews-CHN

A

myxoid chondrosarcoma

70
Q

gene in McCune Albright syndrome

A

GNAS

71
Q

tumor of mcune albright

A

polyostotic fibrous dysplasia and precocious puberty

72
Q

gene of li-fraumeni

A

p53

73
Q

tumor of li fraumeni

A

osteosarcoma and rhabdomyosarcoma

74
Q

Fibrous displasia + soft tissue myxomas

A

Mazabraud syndrome

GNAS 1

75
Q

multiple non ossifying fibromas, giant cell granulomas of the jaw, with cafe au lait spots

A

Jaffe campanacci

76
Q

RECQL4 gene, sun sensitive rash with prominent poikiloderma and telengectasias, osteosarcomas

A

Rothmund-Thompson

77
Q

Multiple enchondromas- PTHR1 gene, chonrdrosarcomas

A

Ollier’s dz

78
Q

multiple enchondromas, angiomas, CNS, pancreatic, and ovarian malignancies

A

Maffucci’s

79
Q 
kids less than 5
Langerhans cell histiocystosis
exopthalmos
diabetes insipidus
lytic skull lesions
A

Hand-Schuller-Christensen

80
Q

FATAL LCH in infants

A

Letterer Siwe

LCH plut visceral and bone disease

81
Q

Benign Enneking uses what numerus

A

Arabic numerals

1,2,3

82
Q

Enneking malignant system uses what numerals

A

ROman Numerals

I, II, III

83
Q

Most common stage of enneking when they present with a primary bone cancer

A

IIB

High grade = II
Extracompartmental -T2 and thus T1= Intra-compartmental
Mets=0, M1 is with mets

84
Q

What makes something grade III enneking?

A

mets, distal or regional

85
Q

AJCC key size for bone tumor

A

> 8cm

86
Q

AJCC key size for soft tissue tumor

A

> 5cm
*ANY LESION > 5CM OR (1.5CM IN HANDS/FEET) NEEDS 3D IMAGING
BEFORE FNA/BIOPSY

87
Q

NF1 PREDISPOSES TO WHICH STS

A

MPNST

88
Q

Gardner’s familial polyposis PREDISPOSES TO WHICH STS

A

Low grade fibrosarcoma

89
Q

radiation therapy PREDISPOSES TO WHICH STS

A

high grade sts

90
Q

Stewart treves PREDISPOSES TO WHICH STS

A

Lympedema and /angiosarcoma

91
Q

Dioxin (agent orange) PREDISPOSES TO WHICH STS

A

high grade sts

92
Q

can have fluid degeneration sts

A

Synovial sarcoma

93
Q

Biphasic cell population, epithelioid nests forming lumina and containing mucin with contrasting spindle cells running in fascicles

A

synovial sarcoma

94
Q

fat with immature liboblasts, MDM2+, ring chromosomes

A

liposarcoma

marginal excision + radiation

95
Q

fat juxtaposed to high grade elements

A

de-differentiated lisosarcoma

wide excision + radiation

96
Q

herringbone pattern

A

fibrosarcoma

*gardner’s familial polyposis

97
Q

Spindle cells in a whirling, storiform pattern, crop circles, S100+

A

MPNST- NF1

radiation + surgery

98
Q

lymph node mets

A 
ESARC or RACES
epithelioid
Synovial
Angio
Rhabdomyo
clear cell
99
Q

Most common pediatric STS

Very responsive to chemo

A

Rhabdomyosarcoma

100
Q

epithelioid nests
spindle cells
rudimentary vascular channels
CD34+

A

Angiosarcoma

101
Q

small round blue cells, desmin +, chromosome 2,13, PAX, FKHR

A

rhabdomysocarc

102
Q

treatment of rhabdomyosarcooma

A

chemo
wide excision
+/_ radiation for + margins

103
Q

MC sarcoma of hand

A

epithelioid

WIDE ESCISION

104
Q

INVASIVE tumor, affecting multiple compartments, spindle cells in collagenous stroma, invades muscle, BETA CATENIN +, ESTROGEN RECEPTOR

A

FIBROMATOSIS, EXTRA ABDOMINAL DESMOID TUMOR

wide resection _ rdiation

105
Q

egg on a string

A

schwannoma

along the nerve, follow the nerve

106
Q

nuclear palisading, verocay bodies, antoni A/antoni B

A

Schwannoma

107
Q

phleboliths

A

vascular malformation

sclerotherapy if small

108
Q

Due to neoplastic mononuclear phagocyte
CSF1 gene
1p13

A

PVNS
nodular-complete excision
diffuse- complete synovectomy (typically arthroscopic, then open from back and resect if needed

109
Q

rice bodies

A

synovial chondromatosis

excise nodules, complete synovectomy

110
Q

most common sts of foot

A

clear cell sarcoma

synovial sarcoma

111
Q

Prostaglandin that causes pain in osteioid osteoma

A

PGE2

112
Q

continuation of osteioid osteoma, Age < 30, not relieved by NSAIDS

A

Osteoblastoma

Not self limiting in growth

113
Q

> 2 cm in size
mixed lytic blastic
diaphyseal lesion
woven bone with NON MALIGNANT RIMMING OSTEOBLASTS

A

OSTEOBLASTOMA

114
Q

TX OF OSTEOBLASTOMA

A

INTRALESIONAL EXCISION/CURETTAGE

115
Q

MIRELS CRITERIA (4)

*8 or greater, ppx fixation required

A

Site (pertrochanteric=3)
Pain (functional pain=3)
Character/type Blastic=1, mixed=2, lytic =3
Size = >2/3 bone diameter

116
Q

Low grade surface osteosarcoma with good outcomes

A

PAR osteal

par=stuck on bone

117
Q

high grade surface osteosarcoma with intermediate outcomes

A

PERI osteal

118
Q

treatment of parosteal osteosarcoma

A

wide excision

119
Q

worst outcomes to best in order for the 3 types of osteosarcoma

A

Conventional Intramedlluary Osteosarcoma (worst)

Periosteal osteosarcoma

Parosteal osteosarcoma (best)

120
Q

DIFFERNCE BETWEEN TELANGIECTATIC OSTEOSARCOMA VS ANEURYSMAL BONE CYST?

A

ABC DOES NOT EXPAN PAST THE PHYIS

TELANGIECTATIC CAN HAVE GIANT CELLS

121
Q

IHC common in skeletal mets

A

Keratin
CK7 (breast and lung cancer)
TTF1 (lung cancer)

122
Q

benefits of bisphosphonate therapy in mets tx

A

reduces rate of skeletal events (but denosumad is superior at this)
reduces lysis and associated hypercalcemia

123
Q

worst heal rate of path fracture

A

lung-0% heal rate

124
Q

Can do metastatectomy

A

thyroid, kidney

125
Q

preoperative embolization necessary

A

renal cell and thyroid

Ortho OITE study 2020 (7 decks)

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