Metastatic Bone Disease

Question 1

3 indications for surgical intervention

Answer 1

1. intractable pain
2. impending pathologic fracture
3. pathologic fracture

Question 2

Most common reason for bone mets in females

Answer 2

breast cancer

Question 3

What makes up posterior spinal column

Answer 3

spinous process, laminae, facets, ligamentum flavum

Question 4

3 main characteristics of metastatic disease that increases risk of pathologic fracture

Answer 4

Anaplastic, rapidly growing, osteolytic

Question 5

3 most common cancers that results in metastatic bone disease

Answer 5

lung, breast, prostate

Question 6

which bony mets have increased risk of fracture, lytic or blastic?

Answer 6

lytic

Question 7

Majority of symptomatic lesions to the femur come from what 4 cancers?

Answer 7

breast, prostate, renal, multiple myeloma

Question 8

Common symptoms of bone mets

Answer 8

bone pain severe at night

Question 9

What kind of exercises are done in bone cancer rehab

Answer 9

isometric and non-resistive isotonic exercises

Question 10

MC UE location for bony mets

Answer 10

humerus

Question 11

Skeletal survey reveals diffuse punched out lytic lesions with black sclerotic borders

Answer 11

multiple myeloma

Question 12

What makes up middle spinal column

Answer 12

PLL, posterior half of vertebral body, posterior annulus

Question 13

most common bones that osteosarcomas are found in

Answer 13

knee and proximal humers

Question 14

Most common reason for bone mets in males

Answer 14

prostate cancer

Question 15

most common site of pathologic fractures

Answer 15

proximal femur

Question 16

The most common primary malignant bone tumor in children

Answer 16

osteosarcoma

Question 17

median survival rate for breast cancer with metastatic cancer

Answer 17

24 months

Question 18

What precaution is taken if bony mets to a limb is suspected?

Answer 18

NWB

Question 19

spine is considered stable if…

Answer 19

one column is involved

Question 20

Surgical intervention is indicated if greater than how much of medullary cross-sectional diameter is involved

Answer 20

50-60%

Question 21

Bone scan sensitivity and specificity

Answer 21

It is highly sensitive, but low specificity for bony mets

Question 22

What kind of physical modalities are contraindicated in malignancy

Answer 22

deep heat modalities such as diathermy, microwave and ultrasound

Question 23

Pharmacologic treatment for multiple myeloma

Answer 23

bisphosphonates and high dose steroids

Question 24

specificity and sensitivity of PET scan vs bone scan

Answer 24

PET scan is more sensitive and more specific for bone mets

Question 25

Any complaint of bone pain in cancer patient warrants what 2 images?

Answer 25

x-ray and bone scan

Question 26

Majority of symptomatic lesions to the hip come from what 4 cancers?

Answer 26

prostate, breast, lung, lymphoma

Question 27

what would bone scan look like for multiple myeloma

Answer 27

normal

Question 28

what pharmacologic treatment is used for metastatic bone disease

Answer 28

biphosphonates or denosumab

Question 29

where is primary cancer if bony mets is blastic vs lytic

Answer 29

blastic lesions = prostatic cancer

lytic lesions = breast, lung, kidney

Question 30

If there is bone mets in the spine, what is relation of pain and position of patient

Answer 30

pain is worse with lying down and better with sitting

Question 31

In the upper extremity, the majority of symptomatic lesions come from what three cancers?

Answer 31

Breast cancer, multiple myeloma, renal cancer

Question 32

median survival rate for prostate cancer

Answer 32

40 months

Question 33

what would skeletal survey look like for multiple myeloma

Answer 33

diffuse punched out lytic lesions

Question 34

LE indication for surgical intervention (%age of cortex involved)

Answer 34

30-50%

Question 35

UE indication for surgical intervention (%age of cortex involved)

Answer 35

> 50%

Question 36

Osteoblastic vs osteolytic lesions in terms of strength and stiffness

Answer 36

osteolytic has decreased strength and stiffness

osteoblastic has decreased stiffness

Question 37

median survival rate for lung and kidney cancer with metastatic disease

Answer 37

6 months

Question 38

spine is considered unstable if…

Answer 38

2 columns are involved, only the middle column is involved, or there is >20 degree angulation

Question 39

what makes up the anterior spinal column

Answer 39

ALL, anterior annulus, anterior half of vertebral body