MSK

Question 1

what nerve root is the biceps reflex?

Answer 1

C5-C6

Question 2

what nerve root is the triceps reflex?

Answer 2

C7-C8

Question 3

what nerve root is the knee reflex?

Answer 3

L3-L4

Question 4

what nerve root is the ankle reflex?

Answer 4

S1-S2

Question 5

what nerve is the deltoid muscle innervated by?

Answer 5

C5

Question 6

what nerve is the triceps muscle innervated by?

Answer 6

C7

Question 7

what nerve is the quadriceps muscle innervated by?

Answer 7

L3

Question 8

what nerve are the long flexors innervated by?

Answer 8

L8

Question 9

what nerve is the gastrocnemius innervated by?

Answer 9

S1

Question 10

Lateral epicondylitis:
-AKA
-what illicits pain?
-how long do episodes last for?

Answer 10

tennis elbow
• Pain and tenderness localized to the lateral epicondyle
• Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended also there is pain on middle finger extension
• Episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks

Question 11

Medial epicondylitis:
-AKA
-what illicits pain
-where can numbness/tingling be felt?

Answer 11

Golfers elbow
Features
• Pain and tenderness localized to the medial epicondyle
• Pain is aggravated by wrist flexion and pronation
• Symptoms may be accompanied by numbness / tingling in the 4th and
5th finger due to ulnar nerve involvement

Question 12

Radial tunnel syndrome
-what is this most commonly due to?
-where is the pain
-what movements worsen pain?

Answer 12

Most commonly due to compression of the posterior interosseous branch of the radial nerve. It is thought to be a result of overuse.
Features
• Symptoms are similar to lateral epicondylitis making it difficult to diagnose
• However, the pain tends to be around 4-5 cm distal to the lateral epicondyle
• Symptoms may be worsened by extending the elbow and pronating the forearm, not like tennis elbow where supinating is the problem

Question 13

what is cubital tunnel syndrome?
-where is tingling felt
-what may worsen symptoms

Answer 13

Due to the compression of the ulnar nerve.
Features
• Initially intermittent tingling in the 4th and 5th finger
• May be worse when the elbow is resting on a firm surface or flexed for extended periods
• Later numbness in the 4th and 5th finger with associated weakness

Question 14

what is olecranon bursitis?

Answer 14

Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.

Question 15

what is de-quervains tenosynovitis?
-who does this typically affect?

Answer 15

De Quervain’s Tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old

Question 16

what are the features of de-quervains tenosynovitis?
-where is pain? where is tender?
-what movement is particularly painful?
-what is finkelstein’s test?

Answer 16

Features
• Pain on the radial side of the wrist
• Tenderness over the radial styloid process
• Abduction of the thumb against resistance is painful
• Finkelstein’s test: with the thumb is flexed across the palm of the hand, pain is reproduced by
movement of the wrist into flexion and ulnar deviation

Question 17

what is the management of de-quervains tenosynovitis?

Answer 17

Management
• Analgesia
• Steroid injection
• Immobilization with a thumb splint (SPICA) may be effective
• Surgical treatment is sometimes required

Question 18

lateral epicondylitis: what activities typically cause this? who does it most commonly affect? which arm?

Answer 18

Lateral Epicondylitis typically follows unaccustomed activity such as house painting or playing tennis (‘tennis elbow’). It is most common in people aged 45-55 years and typically affects the dominant arm.

Question 19

what is the management of lateral epicondylitis?

Answer 19

Management options
• Advice on avoiding muscle overload
• Simple analgesia
• Steroid injection
• Physiotherapy

Question 20

what is carpal tunnel syndrome caused by?

Answer 20

Carpal Tunnel Syndrome is caused by compression of MEDIAN NERVE in the carpal tunnel

Question 21

what is the typical history of carpal tunnel syndrome?

Answer 21

History
• Pain/pins and needles in thumb, index, middle finger e.g. At night
• Patient flicks hand to obtain relief

Question 22

what is found on examination in carpal tunnel syndrome?

Answer 22

Examination
• Weakness of thumb abduction
• Wasting of thenar eminence (NOT
HYPOTHENAR)
• Tinel’s sign: tapping causes paraesthesia
• Phalen’s sign: flexion of wrist causes symptoms

Question 23

what are the causes of carpal tunnel syndrome?

Answer 23

Causes: pregnancy, premenstrual, edema (CCF), lunate fracture, RA

Question 24

what is seen on electrophysiology studies in carpal tunnel syndrome?

Answer 24

Electrophysiology
• Motor + sensory: prolongation of the action potential

Question 25

what is the treatment of carpal tunnel syndrome?

Answer 25

Treatment
• Carpal injection
• Wrist splints at night
• Surgical decompression (flexor retinaculum division)

Question 26

what is the role of the median nerve in the upper arm?

Answer 26

Arm: The median nerve has no voluntary motor or cutaneous function in the (upper) arm. It gives vascular branches to the wall of the brachial artery. These vascular branches carry sympathetic fibers.

Question 27

what is the role of the median nerve in the forearm?

Answer 27

Forearm: It innervates all of the flexors in the forearm except flexor carpi ulnaris and that part of flexor digitorum profundus that supplies the medial two digits. The latter two muscles are supplied by the ulnar nerve (specifically the Muscular branches of ulnar nerve).

Question 28

what does the main portion of the median nerve supply in the forearm?

Answer 28

The main portion of the median nerve supplies the following muscles:
Superficial group:
o Pronator teres
o Flexor carpi radialis
o Palmaris longus
Intermediate group:
o Flexor digitorum superficialis muscle

Question 29

what does the interosseus branch of the median nerve supply?

Answer 29

The anterior interosseus branch of the median nerve supplies the following muscles: Deep group:
o Flexor digitorum profundus (only the lateral half)
o Flexor pollicis longus
o Pronator quadratus

Question 30

what is the motor supply of the median nerve in the hand?

Answer 30

The muscles of the hand supplied by the median nerve can be remembered using the mnemonic, “LOAF” for Lumbricals 1 & 2, Opponens pollicis, Abductor pollicis brevis and Flexor pollicis brevis.

Question 31

what is the sensory innervation of the median nerve in the hand?

Answer 31

The median nerve innervates the skin of the palmar side of the thumb, the index and middle finger, half the ring finger, and the nail bed of these fingers.
The lateral part of the palm is supplied by the palmar cutaneous branch of the median nerve, which leaves the nerve proximal to the wrist creases. This palmar cutaneous branch travels in a separate fascial groove adjacent to the flexor carpi radialis and then superficial to the flexor retinaculum. It is therefore spared in carpal tunnel syndrome.

Question 32

what does median nerve injury at a level above the elbow cause?

Answer 32

• Injury of this nerve at a level above the elbow results in loss of pronation and a reduction in flexion of the hand at the wrist.

Question 33

what syndrome could cause entrapment of the median nerve at the level of the elbow or proximal forearm?

Answer 33

Entrapment at the level of the elbow or the proximal forearm could be due to the pronator teres
syndrome.

Question 34

what causes anterior interosseous syndrome?

Answer 34

Injury to the anterior interosseous branch in the forearm causes the anterior interosseous
syndrome.

Question 35

what does severing the median nerve cause?

Answer 35

• Severing the median nerve causes median claw hand
In the hand, thenar muscles are paralyzed and will atrophy over time. Opposition and flexion of
the thumb are lost. The thumb and index finger are arrested in adduction and hyperextension. This appearance of the hand is collectively referred as ‘ape hand deformity’..

Question 36

anterior interosseous nerve:
-what is this?
-where does this arise?

Answer 36

Anterior Interosseous Nerve: is the largest branch of the median nerve arising distal to the lateral epicondyl. It is a favorite nerve in MRCP-I. It accounts for < 1% of all compression palsies in the upper limb.

Question 37

what does anterior interosseous nerve supply?

Answer 37

It supplies:
• Flexor pollicis longus
• Felxer digtorium profundus to the index and sometimes middle finger
• Pronator quadrates

Question 38

what are the symptoms of anterior interosseous nerve damage?

Answer 38

The typical symptoms:
• Inability to oppose the thumb and index finger
• Inability to flex the thumb IP joint
• Inability to flex the distal IP joint of the index
• Pronator quadrates paralyzed

Question 39

where does the radial nerve arise from?

Answer 39

Radial Nerve: arises from the posterior cord of the brachial plexus (C5-8)

Question 40

what is the motor innervation of the radial nerve?

Answer 40

Motor to
• Extensor muscles (forearm, wrist, fingers, thumb)

Question 41

what is the sensory innervation of the radial nerve?

Answer 41

Sensory to
• Dorsal aspect of lateral 3 1/2 fingers
• However, only small area between the dorsal aspect of the 1st and 2nd metacarpals is
exclusively by the radial nerve

Question 42

what is seen in radial nerve damage?
-what if there is axillary damage?

Answer 42

Patterns of damage
• Wrist drop
• Sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals

Axillary damage
• As above
• Paralysis of triceps

Question 43

what does the ulnar nerve arise from?

Answer 43

Ulnar Nerve: arises from medial cord of brachial plexus (C8, T1)

Question 44

what is the motor innervations of the ulnar nerve?

Answer 44

Motor to
• Medial two lumbricals
• ADductor pollicis
• Interossei
• Hypothenar muscles: ABductor digiti minimi, flexor digiti minimi • Flexor carpi ulnaris

Question 45

what is the sensory innervation of the ulnar nerve?

Answer 45

Sensory to
• Medial 1 1/2 fingers (palmar and dorsal aspects)

Question 46

what is seen on radial nerve damage at the wrist?
-what if the damage is at the elbow?

Answer 46

Damage at wrist
• ‘Claw hand’
• Wasting and paralysis of intrinsic hand muscles (except lateral two lumbricals)
• Wasting and paralysis of hypothenar muscles
• Sensory loss to the medial 1 1/2 fingers (palmar and dorsal aspects)

Damage at elbow
• As above
• Radial deviation of
wrist

Question 47

Adhesive capsulitis:
-what condition is this assoc with?
-what are the phases of illness?
-how long does the episode last for?

Answer 47

Adhesive Capsulitis (frozen shoulder) has a known association with diabetes. Patients typically
have a painful freezing phase, an adhesive phase and a recovery phase. The episode typically lasts 2-3
years.

Question 48

what is diabetic amyotrophy?
-what happens?
-where is affected?
-who does this occur in?

Answer 48

Diabetic Amyotrophy: or proximal diabetic neuropathy or lumbosacral radiculoplexus
neuropathy, is a diabetic neuropathy characterized by painful muscle wasting and weakness. It affects
the lower limbs and is typically asymmetric. Proximal diabetic neuropathy typically occurs in aged
type 2 diabetic males, though it may occur in younger diabetic patients and females.

Question 49

what are red flags for back pain?

Answer 49

Red flags for lower back pain
• Age<20yearsor>50years
• History of previous malignancy
• Night pain
• History of trauma
• Systemically unwell e.g. Weight loss, fever

Question 50

Describe low back pain of facet joints?

Answer 50

May be acute or chronic
Pain worse in the morning and on standing
On examination there may be pain over the facets. The pain is typically worse on extension of the back

Question 51

describe what is seen in spinal stenosis:
-what is the onset?
-where is the pain?
-what relieves the pain?
-what is seen on examination
-what is required for diagnosis?

Answer 51

Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnosis

Question 52

ankylosing spondylitis:
-who does this most typically affect??
-describe the symptoms?

Answer 52

Typically a young man who presents with lower back pain and stiffness Stiffness is usually worse in morning and improves with activity Peripheral arthritis (25%, more common if ♀)

Question 53

Describe the pain in peripheral artery disease?
-what may be seen on examination?
-what may be in the past medical history?

Answer 53

Pain on walking, relieved by rest
Absent or weak foot pulses and other signs of limb ischemia Past history may include smoking and other vascular diseases

Question 54

In lumbar disc prolapse:
-what does this normally produce?
-what pain is found?
-when is the pain worse?

Answer 54

Prolapsed lumbar disc usually produces clear dermatomal leg pain associated with neurological deficits.
Features
• Leg pain usually worse than back
• Pain often worse when sitting

Question 55

Spinal cord compression:
-who is this more common in?

Answer 55

Spinal Cord Compression is an oncological emergency and affects up to 5% of cancer patients. It is more common in patients with lung, breast and prostate cancer

Question 56

what are the features of spinal cord compression
-describe the back pain
-describe the neurological signs seen

Answer 56

Features
• Back pain: may be worse on lying down and coughing
• Neurological signs depend on the level of the lesion. Tendon reflexes tend to be increased
below the level of the lesion and absent at the level of the lesion

Question 57

Describe the symptoms from an L3 nerve root compression?

Answer 57

Sensory loss from anterior thigh to medial aspect of lower leg
Weak quadriceps
↓ knee reflex
Positive femoral stretch test

Question 58

Describe the symptoms from an L4 nerve root compression?

Answer 58

Sensory loss anterior aspect of knee
Weak quadriceps
↓ knee reflex
Positive femoral stretch test

Question 59

Describe the symptoms from an L5 nerve root compression?

Answer 59

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Question 60

Describe the symptoms from an S1 nerve root compression?

Answer 60

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
↓ ankle reflex
Positive sciatic nerve stretch test

Question 61

what is the management of nerve root compression?

Answer 61

Management
• Similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises
• If symptoms persist then referral for consideration of MRI is appropriate

Question 62

what is a bakers cyst?
-what is the lining of this?
-what is the investigation of choice?
-what is the most common complication of a bakers cyst?

Answer 62

Baker Cyst (Popliteal Cyst)
• Most common mass in the popliteal fossa
• Since the cyst is an extension from the knee joint, it is lined by synovium.
• Ultrasound is the investigation of choice in the evaluation of a popliteal mass.
• Complication: most common is rupture or dissection of fluid into the adjacent proximal
gastrocnemius muscle belly which results in a syndrome mimicking the symptoms of a deep vein thrombosis. Doppler ultrasound will, however, show the vascular lumen to be compressible (the lumen is not compressible in DVT due to the presence of the thrombus).

Question 63

what are the ottowa rules for ankle injury?

Answer 63

Ankle x-ray is required only if there is any pain in the malleolar zone and + 1 of the following findings:
• Bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the
lower 6 cm of posterior border of the fibular)
• Bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower
6 cm of the posterior border of the tibia)
• Inability to walk four weight bearing steps immediately after the injury and in the emergency
department

Question 64

The low calcium and phosphate combined with the raised alkaline phosphatase point towards what?

Answer 64

osteomalacia

Question 65

what i osteomalacia?

Answer 65

Basics
• Normal bony tissue but ↓ mineral content
• Rickets if when growing
• Osteomalacia if after epiphysis fusion

Question 66

what are the different types of osteomalacia?

Answer 66

Types
• Vitamin D deficiency e.g. Malabsorption, lack of sunlight, diet
• Renal failure
• Drug induced e.g. Anticonvulsants
• Vitamin D resistant; inherited
• Liver disease, e.g. Cirrhosis

Question 67

what are the features of osteomalacia/rickets?

Answer 67

Features
• Rickets: knock-knee, bow leg, features of hypocalcemia
• Osteomalacia: bone pain, fractures, muscle tenderness, proximal myopathy

Question 68

what are the investigations for osteomalacia?

Answer 68

Investigation
• Low Ca2, PO34-, 25(OH) vitamin D
• Raised ALP
• X-ray: children - cupped, ragged metaphyseal surfaces; adults - translucent bands (Looser’s
zones or pseudofractures)

Question 69

what is the treatment of osteomalacia?

Answer 69

Treatment
• Calcium with vitamin D tablets

Question 70

♂ with osteoporosis without significant Hx → check ?

Answer 70

testosterone

Question 71

what is the treatment of osteoporosis?
-when is this indicated?

Answer 71

• Treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis (a T-score of – 2.5 SD or below). In women aged 75 years or older, a DEXA scan may not be required ‘if the responsible clinician considers it to be clinically inappropriate or unfeasible’
• Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
• Alendronate is first-line
• Around 25% of patients cannot tolerate
alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate.
• Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates . Raloxifene may actually decrease the risk of breast cancer.

Question 72

bisphosphonates:
-name 4
-what fractures do these prevent?

Answer 72

Bisphosphonates
• Alendronate, risedronate and etidronate are all licensed for the prevention and treatment of post- menopausal and glucocorticoid-induced osteoporosis
• All three have been shown to ↓ the risk of both vertebral and non-vertebral fractures although alendronate, risedronate may be superior to etidronate in preventing hip fractures
• Ibandronate is a once-monthly oral bisphosphonate

Question 73

does vitamin D and calcium therapy decrease fracture rates?

Answer 73

Vitamin D and calcium
• Poor evidence base to suggest ↓ fracture rates in the general population at risk of osteoporotic fractures - may ↓ rates in frail, housebound patients

Question 74

what is raloxifene?
-what fractures does this prevent?
-what does this increase the risk of?

Answer 74

Raloxifene - selective estrogen receptor modulator (SERM)
• Has been shown to prevent bone loss and to ↓ the risk of vertebral fractures, but has not yet
been shown to ↓ the risk of non-vertebral fractures
• Has been shown to ↑ bone density in the spine and proximal femur
• May worsen menopausal symptoms
• ↑ risk of thromboembolic events
• May ↓ risk of breast cancer

Question 75

what is strontium ranelate?
-how does this work?
-what does this increase the risk of?

Answer 75

Strontium ranelate
• ‘Dual action bone agent’ - ↑ deposition of new bone by osteoblasts and ↓ the resorption of bone by osteoclasts
• Strong evidence base, may be second-line treatment in near future
• increased risk of cardiovascular events: any history of cardiovascular disease or significant risk of cardiovascular disease is a contraindication
• increased risk of thromboembolic events: a Drug Safety Update in 2012 recommended it is not used in patients with a history of venous thromboembolism
• may cause serious skin reactions such as Stevens Johnson syndrome

Question 76

what is teriparatide?

Answer 76

T eriparatide
• Recombinant form of parathyroid hormone
• Very effective at increasing bone mineral density but role in the management of osteoporosis
yet to be clearly defined

Question 77

HRT:
-what does this decrease the risk of?
-when should this be used?

Answer 77

Hormone replacement therapy
• Has been shown to ↓ the incidence of vertebral fracture and non-vertebral fractures
• Due to concerns about ↑ rates of cardiovascular disease and breast cancer it is no longer recommended for primary or secondary prevention of osteoporosis unless the woman is
suffering from vasomotor symptoms

Question 78

Hip protectors:
-who is this used in?

Answer 78

Hip protectors
• Evidence to suggest significantly ↓ hip fractures in nursing home patients
• Compliance is a problem

Question 79

patients who take which drug should be assessed for osteoporosis prophylaxis?
-what does this assessment involve?

Answer 79

Patients who take the equivalent of prednisolone 7.5 mg or more each day for 3 months or longer
should be assessed and where necessary given osteoporosis prophylactic treatment

Assessment for treatment - patients taking the equivalent of prednisolone 7.5 mg or more each day for 3 months, and one of the following
• Are over the age of 65 years
• Have a history of a fragility fracture
• Have a T-score less than - 1.5 SD

Question 80

what is the treatment given to patients who need osteoporosis prophylaxis due to prednisolone use?

Answer 80

Treatment
• First-line: oral bisphosphonate
• Second-line: alfacalcidol or calcitriol

Question 81

what is pagets disease?

Answer 81

Paget’s Disease is a disease of ↑ but uncontrolled bone turnover. It is thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by ↑ osteoblastic activity. Paget’s disease is common (UK prevalence 5%) and symptomatic in only 5%.

Question 82

what are the predisposing factors to pagets disease?

Answer 82

Predisposing factors
• Increasing age
• ♂sex
• Northern latitude
• Family history

Question 83

what are the clinical features of pagets disease?

Answer 83

Clinical features - only 5% of patients are symptomatic
Normal calcium and phosphate combined with a raised alkaline phosphate
• Bone pain (e.g. Pelvis, lumbar spine, femur)
• Classical, untreated features: bowing of tibia, bossing of skull
• Raised alkaline phosphatase (ALP) - calcium and phosphate are typically normal
(calcium can be raised)
• Skull x-ray: thickened vault, osteoporosis circumscripta

Question 84

what are the indications for treatment of pagets disease?
-what is used?

Answer 84

Indications for treatment include bone pain, skull or long bone deformity, fracture, periarticular Paget’s
• Bisphosphonate (either oral risedronate or IV zoledronate)
• Calcitonin is less commonly used now

Question 85

what are the complications of pagets disease?

Answer 85

Complications
• Deafness (cranial nerve entrapment)
• Bone sarcoma (1% if affected for > 10 years)
• Fractures
• Skull thickening
• High-output cardiac failure

Question 86

what is osteopetriosis?
-what can be used for treatment?

Answer 86

• AKA marble bone disease
• Rare disorder of defective osteoclast
function resulting in failure of normal
bone resorption
• Stem cell transplant and interferon-gamma
have been used for treatment

Question 87

what is osteogenesis imperfecta?
-what is the most common form?

Answer 87

Osteogenesis Imperfecta (more commonly known as brittle bone disease) is a group of disorders of collagen metabolism resulting in bone fragility and fractures. The most common, and milder, form of osteogenesis imperfecta is type 1

Question 88

how is osteogenesis imperfecta inherited?
-what is the pathogenesis?

Answer 88

Overview
• Autosomal dominant
• Abnormality in type 1 collagen due to ↓ synthesis of pro-α 1 or pro-α 2 collagen polypeptides

Question 89

what are the features of osteogenesis imperfecta?

Answer 89

Features
• Presents in childhood
• Fractures
• Blue sclera
• Deafness secondary to otosclerosis

Question 90

what are the features of rhabdomyolysis?

Answer 90

• Acute renal failure with disproportionately raised creatinine
• Elevated CK
• Myoglobinuria
• Hypocalcemia (myoglobin binds calcium)
• Elevated phosphate (released from myocytes)

Question 91

what are causes of rhabdomyolysis?

Answer 91

• Seizure
• Collapse/coma (e.g. Elderly patients collapses at home, found 8 hours later)
• Ecstasy
• Crush injury
• Mcardle’s syndrome
• Drugs: statins

Question 92

what is the management of rhabdomyolysis?

Answer 92

Management
• IV fluids to maintain good urine output
• Urinary alkalinization is sometimes used

Question 93

why is there hypercalcaemia in myeloma?

Answer 93

Hypercalcemia in myeloma
• Due primarily to ↑ osteoclastic bone resorption caused by local cytokines released by the myeloma cells
• Other contributing factors include impaired renal function, ↑ renal tubular calcium reabsorption and elevated PTH-rP levels

Question 94

what is the diagnosis of myeloma?

Answer 94

• Monoclonal proteins in the serum and urine (Bence Jones proteins)
• ↑ plasma cells in the bone marrow
• Bone lesions on the skeletal survey
• Other findings on investigations:
o Rouleaux formation of RBCs on blood film

Question 95

what is a useful marker of prognosis in myeloma?

Answer 95

B2-microglobulin is a useful marker of prognosis - raised levels imply poor prognosis. Low levels of albumin are also associated with a poor prognosis

StageCriteriaMedian survival (months)
I B2 microglobulin < 3.5 mg/l Albumin > 35 g/l 62
II Not I or III 45
III B2 microglobulin > 5.5 mg/l 29

Question 96

what is ewings sarcoma?
-who is this commonly found in?
-male or female preponderance?

Answer 96

Ewing’s Sarcoma is the most lethal malignant primary bone tumor derived from the red bone marrow. It is most common in children and adolescents and rare after the age of 30 years. It has a ♂:♀= 3:2.

Question 97

what is the presentation of ewings sarcoma?

Answer 97

Presentation: earliest symptom is pain, which is usually intermittent but becomes increasingly intense. Delay in the diagnosis can occur due to the fact that the clinical picture may be similar to that of acute or chronic osteomyelitis. However, eventually most patients have a large palpable rapidly growing mass, which is tense and tender.

Question 98

what are poor prognostic features of ewings sarcoma?

Answer 98

•♂
• Age > 12 years
• ↑LDH
• Anemia
• Poor response to chemotherapy.