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MSK > Infectious Disease and Neoplasms > Flashcards

Infectious Disease and Neoplasms Flashcards

1
Q

What is the pathology of Osteopetrosis?

A
  • Bones are abnormally dense and prone to breakage
  • Osteoclasts fail to resorb bone
  • Bones become sclerotic and thick but brittle
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2
Q

What is the etiology of Osteopetrosis?

A

heredity disease (uncommon), infantile form often fatal

  • Adult onset autosomal dominant
  • Infantile and intermediate onset: autosomal recessive
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3
Q

What is the S/Sxs of Osteopetrosis?

A

Vary depending on type

  • Bone fx
  • Low blood cell levels
  • Impaired vision and hearing
  • Dental problems related to infections
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4
Q

What is the workup for Osteopetrosis?

A

XR- bones w/ chalky white appearing, unusually dense

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5
Q

What is the treatment for Osteopetrosis?

A
  • Bone marrow transplants
  • Interferon gamma 1b: delays disease progression
  • Prednisone
  • Calcitriol
  • Symptomatic care
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6
Q

What is the pathology of Osteomalacia?

A

Occurs in adults after epiphyseal closure

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7
Q

What is the pathology of Rickets?

A

Softening and weakening of bones in infants and children

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8
Q

What is the etiology of Osteomalacia and Rickets?

A
  • Abnormal calcium, phosphorus or Vit D metabolism = accumulation of osteoid before epiphyseal closure (or after) = decrease bone stability.
  • Inadequate dairy intake
  • VDRR, hereditary hypophosphatemia rickets
  • Chronic renal failure = renal osteodystrophy = renal rickets
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9
Q

What is the MC cause of Osteomalacia and Rickets?

A

Vitamin D deficiency

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10
Q

What is the risks of Osteomalacia and Rickets?

A
  • kids <2
  • Northern latitudes
  • Darker skin
  • Anticonvulsants
  • Solely breast feeing
  • CKD
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11
Q

What are the S/Sxs of Osteomalacia and Rickets?

A
  • Muscle weakness
  • Protuberant abdomen
  • Delayed growth
  • Abnormalities of skull and teeth
  • Bowing of lower extremities (femur and tibia)
  • SCFE common with renal rickets
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12
Q

What is the workup for Osteomalacia and Rickets?

A

XR

- Rickets: milk man and looser lines

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13
Q

What is the treatment for Osteomalacia and Rickets?

A
  • Tx underlying cause

- Referral to endo and ortho

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14
Q

What is the pathology of Osteopenia?

A
  • Early stages of osteoporosis

- 1/3 men vs 3/5 women

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15
Q

What is the greatest and earliest loss of Osteopenia?

A

Trabecular bone in thoracic/lumbar vertebrae and femoral neck

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16
Q

What is the etiology of Osteopenia?

A
  • Deficiency of some kind- estrogen, Vit D. Calcium
  • Osteoclast bone resorption increases
  • Decrease in bone formation (osteoblasts)
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17
Q

What is the S/Sx of Osteopenia?

A

No S/Sxs unless fracture occurs

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18
Q

What is the workup for Osteopenia?

A
  • DEXA
  • BMD: 1 to 2.5
  • T score: -1 to -2.5
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19
Q

What is tx for Osteopenia?

A
  • Prevention is key
  • Exercise and nutrient- calcium and Vit D
  • Estrogen not appropriate
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20
Q

What is the pathology of Osteoporosis?

A

W>M

- more bone loss compared to osteopenia

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21
Q

What is the etiology of Osteoporosis?

A
  • Deficiency of some kind- estrogen, Vit D. Calcium
  • Osteoclast bone resorption increases
  • Decrease in bone formation (osteoblasts)
  • 1st two yrs of menopause is when you’ll see the most bone changes
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22
Q

What are S/Sxs of Osteoporosis?

A
  • Usually none
  • Progressive dorsal kyphosis
  • Skeletal pain - often d/t fx
  • Insufficient fractures
  • Spontaneous or minimal trauma
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23
Q

What are the risks for Osteoporosis?

A
  • Older age
  • Female
  • Low BMI
  • Not using estrogen replacement
  • Smoking
  • Caucasian
  • Limited weight bearing activity
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24
Q

What is the workup for Osteoporosis?

A 
DEXA (1st line)
- All women >65 and men >70
- Start at 60 if increased risk
- Post menopausal women 
XR
Labs: BMP, CBC, TSH, Vit D
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25
Q

What is the treatment for Osteoporosis?

A
  • Estrogen replacement therapy
  • Bisphosphates ( 5 yrs max)
  • SERMs
  • Calcium 1500 Mg/day
  • Vitamin D 800U/day
  • Repeat screening annually or biannually
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26
Q

What is the pathology of Pagets disease?

A

Middle to older age, familial risk

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27
Q

What is the etiology of Pagets disease?

A

Chaotic bone remodeling-increased osteoblastic and osteoclastic activity = disorganized woven and lamellar bone
- Enlarger, hypervascular bone

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28
Q

What are the S/Sxs of Pagets disease?

A
  • Discovery often incidental and asymptotic
  • Often affecting the pelvis, spine, sacrum, femur, skull, tibia, humerus, scapula
  • Gradual progression of disease
  • Bone pain and pathologic features
  • May notice deformity
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29
Q

What is the workup for Pagets disease?

A
  • XRs: Well demarcated areas of decalcification early
  • New bone-increased density, expansion of bone and coarse trabeculation
  • Sclerosis, enlargement and increase bone density
  • Increase serum alk phos or bone specific
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30
Q

What is the treatment for Pagets disease?

A
  • If asymptotic = no therapy
  • Optimal calcium and vitamin D intake
  • Bisphosphonates
  • NSAIDs for pain
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31
Q

What are some mechanisms that cause septic joint?

A
  • Hematogenous (MC) - blood from bacterial/viral illness
  • Contiguous spread
  • Direct introduction (rusty nail)
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32
Q

What are the S/Sxs of septic joint?

A
  • Painful, swollen, red and warm joint
  • Fever
  • Inability or pain with weight bearing
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33
Q

What is the workup for septic joint?

A
  • Labs: increases WBC, ESR, CRP

- Joint aspiration: WBC > 50,000 bacteria

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34
Q

What is the treatment for septic joint?

A
  • IV antibiotics guided by aspiration followed by oral

- Surgery

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35
Q

What is Tenosynovitis?

A
  • Inflammation of the abductor pollicis longus and extensor pollicis brevis
  • Radial aspect of wrist
  • MC form of tendonitis at the wrist
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36
Q

What is the cause of Tenosynovitis?

A

Overuse, repetitive activities, often chronic

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37
Q

What are the S/Sxs of Tenosynovitis?

A
  • Radial sided wrist pain
  • Increase pain w/ activities
  • Swelling
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38
Q

What is the workup for Tenosynovitis?

A
  • TTP first dorsal compartment

- Positive Finkelstein’s test

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39
Q

What is the treatment for Tenosynovitis?

A
  • Avoid activities
  • Thumb spica splint
  • NSAIDs
  • Rest, Ice
40
Q

What is Osteonecrosis/Avascular necrosis?

A

Death of bone tissue d/t lack of blood supply

- Ischemic pathophysiology

41
Q

What causes Osteonecrosis/Avascular necrosis?

A
  • Trauma
  • EtOH
  • Corticosteroid use
42
Q

What is the workup for Osteonecrosis/Avascular necrosis?

A
  • XRs: wedge-shapes areas of increased density and segmental collapse, eventual loss of normal bone shape
43
Q

What is the treatment for Osteonecrosis/Avascular necrosis?

A
  • Early- NSAIDs, rest, PT

- Late- surgery, osteotomy, and joint replacement

44
Q

What is Pyogenic osteomyelitis?

A

Infections of bone caused by microorganisms

45
Q

What are some pathways that cause Pyogenic osteomyelitis in both kids and adults?

A
  • Kids: Hematogenous
  • Adults: contiguous and trauma
  • Implantation of foreign device
  • Contiguous focus of infection
46
Q

What are the S/Sxs of ACUTE Pyogenic osteomyelitis?

A
  • Local S/S infection
  • Systemic illness
  • Tenderness
  • Pain in involved area
  • Decreased ROM
47
Q

What are the S/Sxs of CHRONIC Pyogenic osteomyelitis?

A
  • prolonged infection = necrotic bone
  • Open injury
  • Bone pain
  • Erythema
  • Drainage (sinus tracts)
48
Q

What is the workup for Pyogenic osteomyelitis?

A
  • Elevated: ESR, CRP. WBC
  • XR: osteolysis, periosteal reaction, and sequestra
  • MRI
  • Blood cultures for acute hematogenous- MC staph aureus
  • Chronic: different variety (ie DM pt w/ open sores)
49
Q

What is the treatment for Pyogenic osteomyelitis?

A
  • Team approach
  • IV antibiotics (initial tx - 6 wks) (vanco)
  • Surgery
50
Q

What pts usually have Tuberculosis osteomyelitis?

A

AKA Potts disease

  • seen in older immigrants
  • More common in HIV/AIDs
51
Q

What are the S/Sxs of Tuberculosis osteomyelitis?

A
  • Back pain: vertebral MC involved d/t TB in the lungs

- Slow and indolent w/ more propensity for abscess formation.

52
Q

What are the treatment for Tuberculosis osteomyelitis?

A

Double-Drug antituberculotic therapy (isoniazid and rifampin)

53
Q

What are Osteomas?

A
  • Benign tumor, slow growing

- New piece of bone usually growing on another piece of bone

54
Q

What is the MC location for Osteomas?

A

Skull (frontal bone)

55
Q

What are the S/Sxs of Osteomas?

A
  • Vary on location
  • Cranial nerve or visual/hearing issues (if growth is on inside of skull)
  • Round, hard smooth mass
  • Can be painful
56
Q

What is the treatment for Osteomas?

A

Disappear on their own or surgery if painful or cosmetic reason

57
Q

What are Osteoblastomas?

A
  • Benign, can become aggressive and malignant
  • M > F
  • 2nd-3rd decades of life (10-29)
58
Q

Where are Osteoblastomas usually located?

A

Diaphysis of long bones

59
Q

What are the S/Sxs of Osteoblastomas?

A
  • Painful, night pain

- Swelling and tenderness

60
Q

What is the workup for Osteoblastomas?

A
  • XR: lucent defect w/ various degrees of density

- Well circumscribed

61
Q

What is the treatment for Osteoblastomas?

A

Surgical curettage

62
Q

What are Osteosarcomas?

A
  • MC malignant tumor, most high grade
  • MC in children and adolescent
  • M > F (1.5-2x)
63
Q

Where are Osteosarcomas usually located?

A

Metaphysis of long bones (distal femur, proximal tibia, proximal humerus)

64
Q

What are the S/Sx of Osteosarcomas?

A

Pain and swelling of affected area (usually upper arm or around knee)

65
Q

What is the workup for Osteosarcomas?

A

XR:

  • Destructive lesion
  • Moth eaten appearance
  • Sunburst appearance
  • Cuff of new periosteal
  • New bone formation (Codmans triangle)
66
Q

What is the treatment for Osteosarcomas?

A
  • Core-needle bx or open bx
  • Chemo (pre and post op)
  • Limb sparing surgery
  • NO role for radiation therapy
67
Q

What are Osteochondromas?

A
  • MC benign bone tumor, slow growing
  • Outgrowth of growth plate
  • Grows with child, as they grow then it usually stops
  • 1st-3rd decades of life (0-29)
68
Q

Where are Osteochondromas usually located?

A
  • Metaphysis of long bones

- Sometimes in small hand and foot bones

69
Q

What are the S/Sx of Osteochondromas?

A

Nonpainful

70
Q

What is the workup for Osteochondromas?

A

XR: bony prominence usually growing away from closest joint

71
Q

What is the treatment for Osteochondromas?

A

Usually none required

72
Q

What are Chondromas?

A
  • Benign cartilage tumor: made up of mature cartilage
73
Q

Where are Chondromas usually located?

A

Small bones of hands and feet, humerus, and femur

74
Q

What are the S/Sxs of Chondromas?

A
  • Asymptomatic
  • Pain (dull)
  • Swelling
  • Can be endochondromas (going into the bone)
75
Q

What can endochondromas cause?

A
  • Fractures

- Causes thinning and takes away stability

76
Q

What is the treatment for Chondromas?

A

Surgical removal

77
Q

What are Chondroblastomas?

A
  • Rare and benign

- Males younger than 25

78
Q

Where are Chondroblastomas usually located?

A
  • Epiphysis of long bones (femur and humerus)

- MC: around knee and shoulder

79
Q

What are the S/Sxs of Chondroblastomas?

A
  • Joint pain
  • Joint stiffness
  • Muscle atrophy (d/t no using joint/extremity)
  • Limp
80
Q

What is the treatment for Chondroblastomas?

A
  • Curettage, bone graft and packing

- Resection

81
Q

What is an Ewing Sarcoma?

A
  • Malignant and very aggressive
  • Lesions below elbow and below mid calf w/ no mets = 80% 5 yr survival rate w/ tx
  • Adolescent, 2nd decade of life (10-19)
82
Q

Where are Ewing Sarcoma usually located?

A

Diaphyseal region of long bone and flat bones

83
Q

What are the S/Sx of Ewing Sarcoma?

A
  • Pain and palpable mass (d/t soft tissue rxn)
  • Pathologic fx
  • Fever and weight loss
84
Q

What is the workup for Ewing Sarcoma?

A

XR: onion peel periosteal rxn and soft tissue mass

85
Q

What is the treatment for Ewing Sarcoma?

A
  • Chemo-systemic = mainstay

- Surgery- local resection, limb salvage

86
Q

What is a Giant Cell tumor?

A
  • Benign, aggressive-connective tissue, stromal cells and giant cells
  • F > M
  • Adults
87
Q

Where are Giant cell tumors usually located?

A

Lower extremities - epiphyseal regions of long bones

88
Q

What are the S/Sx of Giant cell tumors?

A

Pain and swelling at lesion site

89
Q

What is the workup for Giant cell tumors?

A

XR:

  • Expansive lesions, osteolytic (destroying the bone)
  • Extend into subchondral bone
  • Cortical thinning
90
Q

What is the treatment for Giant cell tumors?

A
  • Surgery: most effective
  • Curettage and graft (cement)
  • Radiation: usually only if surgery is not an option
91
Q

What are the MC sites of origin for bone metastases?

A
  • Prostate
  • Breast
  • Lung
  • Kidney
  • Bladder
  • Thyroid
92
Q

What are the MC bones involved for bone metastases?

A
  • Vertebrae
  • Proximal femur
  • Pelvis
  • Ribs
  • Sternum
  • Proximal humerus
  • Skull
93
Q

What are some common characteristic of a spinal tumor?

A
  • Neck or back pain
  • Pain worsens at night and with physical activity
  • Numbness/tingling/weakness in extremities
  • On imaging you are able to see tumor compressing of the spinal cord
94
Q

What radiographic features are seen with bone cysts?

A
  • Lucid lesions with a narrow zone of transition,mostly seen in skeletally immature pt
  • Centrally located well demarcated
  • They sometimes expand the bone with thinning without breach of the cortex unless there is a pathologic fracture.
95
Q

What radiographic features are seen with benign tumors?

A
  • Geographic bone destruction
  • Slow growing, well defined margins
  • Thicker sclerotic margins (better encapsulated)
96
Q

What radiographic features are seen with cancerous tumors?

A
  • Moth eaten pattern
  • Permeative bone destruction w/ poorly defined margins
  • Rapidly growing

MSK (11 decks)

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