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cortext > MSK basic sciences (pathology, biochemistry and histology) > Flashcards

MSK basic sciences (pathology, biochemistry and histology) Flashcards

1
Q

what is the commonest benign tumour of bone

A

osteochondroma

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2
Q

what is an osteochondroma

A

a bony outgrowth on the external surface of bone, covered with a cartilaginous cap

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3
Q

where do osteochondromas typically occur

A

around the epiphysis of long bones

especially around the knee

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4
Q

symptoms associated with osteochondroma

A

usually asymptomatic but may cause localised pain

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5
Q

what is an enchondroma

A

an intramedullary and usually metaphyseal cartilaginous tumour

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6
Q

enchondroma may undergo mineralisation and become patchy and sclerotic in appearance

true/false

A

true

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7
Q

complications of enchondroma

A

may weaken the bone causing pathologic fracture

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8
Q

where do enchondromas calssically occur

A

small tubular bones of the hands and feet

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9
Q

what is a simple bone cyst

A

solitary unicystic fluid-filled neoplasm located in a bone

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10
Q

most common locations of simple bone cysts

A

metaphyses of long bones (esp proximal femur and humerus)

talus/calcanues also

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11
Q

complication of simple bone cyst

A

weakness of bone leading to pathologic fracture

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12
Q

treatment of simple bone cyst

A

curettage and bone grafting +/- stabilisation

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13
Q

what is an aneurysmal bone cyst

A

a cyst with many chambers which are filled with blood or serum

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14
Q

where do aneurysmal bone cysts occur

A

metaphyses of long bones, flat bones and vertebral bodies

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15
Q

symptoms of aneurysmal bone cyst

A

pain

locally aggressive causing cortical expansion and destruction

risk of pathological fracture

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16
Q

treatment of aneurysmal bone cyst

A

curettage and grafting or bone cement

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17
Q

what is fibrous dysplasia

A

diseaseof a bone usually occurring in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone

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18
Q

monostotic vs polyostotic

A

monostotic affects one bone

polyostotic affect multiple bones

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19
Q

the most frequent sites of fibrous dysplasia

A

head and neck

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20
Q

what genetic cause is responsible for fibrous dysplasia

A

a mutation causing an abnormality in G protein signalling

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21
Q

fibrous dysplasia is often associated with endocrine disorders

true/false

A

true

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22
Q

effect of fibrous dysplasia on bones

A

angular growth deformity

wider bone with thinned cortices

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23
Q

what deformity is produced by excessive involvement of the proximal femur in fibrous dysplasia

A

shepherd’s crook deformity

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24
Q

how does fibrous dysplasia appear on a bone scan

A

intense increase in uptake during development but the lesion usually becomes inactive

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25
Q

treatment of fibrous dysplasia

A

bisphosphonates may reduce pain

patholigc fractures should be stabilised with internal fixation and cortical bone grafts

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26
Q

which part of bones do giant cell tumours tend to occur

A

metaphyseal region (can involve the epiphysis)

can extend to the subchondral bone adjacent to the joint

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27
Q

which bones/joints does giant cell tumour tend to affect

A

around the knee

distal radius

(other long bones, pelvis and spine)

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28
Q

giant cell tumours are completely benign

true/false

A

false

they tend to be locally aggressive and destroy the adjacent cortex

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29
Q

giant cell tumour presenation

A

pain

pathologic fracture

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30
Q

how do giant cell tumours appear on xray

A

‘soap bubble’

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31
Q

where can giant cell tumours metastasize to

A

lung

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32
Q

treatment of giant cell tumour

A

intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material and reduce risk of recurrence

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33
Q

what is an osteoid osteoma

A

a small nidus of immature bone surrounded by an intense sclerotic halo

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34
Q

common sites of osteoid osteoma

A

proximal femur

diaphysis of long bones

vertebrae

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35
Q

symptoms of osteoid osteoma

A

intense constant pain, worse at night

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36
Q

management of osteoid osteoma

A

NSAIDs

may resolve spontaneously

may require CT guided radiofrequenct ablation

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37
Q

diagnosis of osteiod osteoma

A

bone scan (intense local uptake)

CT

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38
Q

malignant bony lesions are cnot uncommon in older age groups but are normally a result of

A

metastases

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39
Q

red flags for bone cancer

A

constant pain that’s worse at night

systemic symptoms

unexplained skeletal pain

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40
Q

primary bone malignancy is more likely to occur in which age group

A

young people

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41
Q

a substantial ill-defined bony swelling may be

A

primary bone cancer - INVESTIGATE

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42
Q

signs of primary bone tumour on xray

A

cortical destruction

periosteal reaction

new bone formation (sclerosis/lysis)

extension into surrounding soft tissue

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43
Q

the most common primary bone tumour is

A

osteosarcoma

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44
Q

which gene is most commonly associated with osteosarcoma

A

tumour suppressor retinoblastoma gene

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45
Q

osteosarcoma most commonly affects bones surrounding which joint

A

the knee

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46
Q

common sites of osteosarcoma

A

knee

proximal femur

proximal humerus

pelvis

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47
Q

which type of metastasis is common in osteosarcoma

A

blood metastases

NOT LYMPH

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48
Q

treatment of osteosarcoma

A

adujavant chemotherapy to prolong survival

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49
Q

what is chondrosarcoma

A

cartilage producing primary bone tumour

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50
Q

characteristics of chondrosarcoma

(aggressive? age group? mets?)

A

less aggressive than osteosarcoma

mean age 45

slow to metastasise

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51
Q

where does chondrosarcoma affect

A

pelvis

proximal femur

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52
Q

treatment of chondrosarcoma

A

surgery

not radiosensitive or responsive to chemo

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53
Q

what is ewing’s sarcoma

A

primary bone tumour

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54
Q

which bones does ewing’s sarcoma tend to affect

A

long bones (esp femur)

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55
Q

how are ewing’s sarcomas radiologically described

A

onion skin pattern

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56
Q

signs of ewing’s sarcoma

A

fever

raised inflammatory markers

warm swelling

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57
Q

staging investigations of primary bone cancer

A

bonce scan

CT

(MRI for involvement of vessels, muscles and nerves)

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58
Q

what margin is reccomended when removing a bone tumour

A

3-4 cm

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59
Q

how to joint replacements after bone malignancy surgery differ from regular joint replacements

A

tend to be much bigger to make up for the loss of bone

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60
Q

metastatic bone tumours commonly spread from which types of cancer

A

breast carcinoma

prostate carcinoma

lung carcinoma

renal cell carcinoma

thyroid carcinoma

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61
Q

breast cancer bony metastases can be blastic (sclerotic) or lytic

true/false

A

true

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62
Q

prostate cancer produces lytic mets

true/false

A

false

sclerotic mets

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63
Q

lung cancer usually gives rise to lytic mets

true/false

A

true

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64
Q

why are renal cell carcinoma mets described as ‘blow out’ lesions

A

they can bleed tremendously with biopsy or surgery

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65
Q

bones most frequently invovled with mets are

A

vertebra

pelvis

ribs

skull

humerus

long bones of the lower limb

66
Q

patients with bony mets may present with

A

pathological fracture

67
Q

if a bony lesion is found on xray, how can a primary bone tumour be excluded?

A

bone scan

occasionally MRI

68
Q

which blood tests can be done when trying to detect a primary tumour after a bony met has been found?

A

serum calcium (hypercalcaemia)

LFTs (liver involvement)

plasma protein electrophoresis (myeloma)

FBC

U&Es

69
Q

what sort of bone lesions are at greater risk of pathologic fracture?

A

very painful

lesions occupying >50% of the diameter of the bone

cortical thinning

‘at risk’ areas (eg subtrochanteric area of the femur)

70
Q

managment of bony lesions at risk of patholgical fracture

A

skeletal stabilisation

joint replacement

71
Q

bony lesions not at risk of pathologic fracture can be treated with

A

bisphosphonates and radiotherapy

72
Q

causes of local soft tissue swelling

A

inflammatory (bursitis, rheumatoid nodules)

infection (abscess)

cystic lesions (ganglion, meniscal cyst, Baker’s cyst)

benign/malignant neoplasms

73
Q

what to ask when taking a history of a soft tissue swelling

A

how long the lump has been present

pain

growing/fluctuating size

solitary or multiple

74
Q

examination findings of soft tissue swelling

A

site

size

definition (well-defined, ill-defined)

consistency (cystic, solid, soft, hard)

surface (smooth, irregular)

mobility/fixity

temperature (abscess)

transilluminable

pulsatility

overlying skin changes

local lymphadenopathy

75
Q

what features would suggest a benign soft tissue neoplasm

A

smaller size

fluctuation in size

cystic lesions

well-defined lesions

fluid filled lesions

soft/fatty lesions

76
Q

features that suggest a malignant soft tissue neoplasm

A

larger lesions (>5 cm)

rapid growth

solid lesions

ill-defined lesions

irregular surface

assocaited lymphadenopathy

systemic upset

77
Q

extremely rapid growth of a soft tissue neoplasm is suggestive of benign/malignant neoplasm

A

benign

extremely fast growth is assocaited with a reactive pseudotumour

78
Q

what structures can benign soft tissue tumours affect

A

non-bony connective tissues

nerves

vessels

79
Q

what is a lipoma made of

A

fat

80
Q

what is a leiomyoma made of

A

smooth muscle

81
Q

what is a chondroma made of

A

cartilage

82
Q

what is a rhabdomyoma made of

A

skeletal muscle

83
Q

what are neuromas/schwannomas made of

A

nerves

84
Q

what are haemangiomas made of

A

blood vessels

85
Q

what is the most common type of soft tissue tumour

A

leiomyoma

they occur as fibroids in the uterus

86
Q

what is the commonest soft tissue tumour encountered in orthopaedics

A

lipoma

87
Q

what is giant cell tumour of tendon sheath

A

a small firm swelling usually found on the flexor tendon sheath of a finger

88
Q

what is the macroscopic and microscopic appearance of a giant cell tumour of tendon sheath

A

macroscopic - pigmented lesion

microscopic - multinucleated giant cells and haemosiderin

89
Q

what are malignant soft tissue tumours arising from the connective tissues known as?

A

sarcomas

90
Q

what is an angiosarcoma

A

malignant tumour arising from blood vessels

91
Q

most common cause of angiosarcoma

A

complication of previous radiotherapy

92
Q

what is a fibrosarcoma

A

rare tumour of unknown origin

93
Q

what is a liposarcoma

A

malignant tumour arising from fat

94
Q

where do liposarcomas occur

A

deep fatty tissue, most often within the abdomen

95
Q

what is a rhabdomyosarcoma

A

malignant tumour of skeletal muscle

96
Q

what age do sarcomas most commonly present

A

50-70

97
Q

where are ganglion cysts found

A

around synovial joints or synovial tendon sheaths

98
Q

why are ganglion cysts not truly cysts

A

they do not have an epithelial lining

99
Q

what is a bursa

A

a small fluid filled sac lined by synovium around a joint which prevents friction between tendons, bones, muscle and skin

100
Q

which bursae are often affected by bursitis

A

pre-patellar

olecranon

1st metatarsal head (bunion)

101
Q

bursitis can be caused by

A

infection

gout

repeated pressure

trauma

102
Q

characteristics of sebaceous cysts

A

squamous epithelium lining that produces abundant keratin

103
Q

what is released from a ruptured sebaceous cyst

A

degenerate keratn (cheesy substance)

104
Q

what does an abscess consist of

A

neutrophils

infective and cellular debris

(infection organism)

105
Q

what can cause an abscess

A

cellulitis

bursitis

penetrting wound

infected sebaceous cysts

106
Q

treatment of abscess

A

incision and drainage

107
Q

what is a pseudotumour

A

a tumour that mimics a neoplasm but is a reactive/inflammatory lesion

108
Q

what is myositis ossificans

A

progressive ossification at a site of injury

109
Q

what is the most common site of AVN

A

femoral head

110
Q

AVN is most common in which group of people

A

chronic alcoholics

111
Q

what is creeping substitution associated with

A

AVN

112
Q

what age group is affected by osteochondritis

A

children and young adults

113
Q

what is AVN

A

ischaemic necrosis of bone

114
Q

what sites are most prone to AVN

A

femoral head

femoral condyles

head of humerus

capitellum

proximal pole of scaphoid

proximal talus

115
Q

how can AVN be caused by fracture

A

fracture disrupts the blood supply to a portion of bone

116
Q

causes of AVN

A

fracture

idiopathic

alcoholism

steroids

hyperlipidaemia

increased coagulability

117
Q

what type of imaging can detect early changes in AVN

A

MRI

118
Q

what type of bone defect is osteoporosis

A

a quantitave defect

119
Q

what are the characteristics of osteoporosis

A

reduced bone mineral density and increased porosity

(normal bone quality, just not enough of it)

120
Q

complications of osteoporosis

A

increased risk of fracture

121
Q

what is the WHO definition of osteoporosis

A

bone mineral density less than 2.5 standard deviations below the mean peak value of young adults of the same race and sex

122
Q

what is osteopaenia

A

an intermediate stagoe of osteoprosis where bone mineral density is 1-2.5 standard deviation below mean peak value

123
Q

loss of bone density in osteoporosis is due to

A

gradual slow down of osteoblastic activity

124
Q

why do females tend to lose more bone density after the menopause

A

increase in osteoclastic bone resorption with the loss of protective effects of oestrogen

125
Q

what is type 1 osteoporosis

A

post menopausal osteoporosis

126
Q

risk factors for type 1 osteoporosis

A

smoking

alcohol abuse

lack of exercise

poor diet

127
Q

what is type 2 osteoporosis

A

osteoporosis of old age

128
Q

risk factors for type 2 osteoporosis

A

chronic disease

inactivity

reduced sunlight exposure

smoking/alcohol

poor diet

129
Q

what fractures are most common in ype 1 osteoporosis

A

colles fracture

vertebral insufficiency fractures

130
Q

fractures associated with type 2 osteoporosis

A

femoral neck fractures

vertebral fractures

131
Q

secondary osteoporosis can be caused by

A

steroid use

alcohol abuse

malnutrition

chronic disease (CKD, malignancy, RA)

endocrine disorders (cushing’s, hyperthyroidism, hyperparathyroidism)

132
Q

diagnosis of osteoporosis

A

DEXA scan (measures bone mineral density)

133
Q

serum calcium and phosphate levels in osteoporosis

A

normal

134
Q

treatments for osteoporosis

A

calcium and vit D supplements

bisphosphonates (reduce osteoclastic resorption)

Desunomab (monoclonal antibody which reduces osteoclast activty)

strontium (increase osteoblast replication and reduces resorption)

135
Q

risks of HRT for treatment of osteoporosis

A

increased risk of breast and endometrial cancer and DVT

136
Q
A
137
Q

what sort of defect is osteomalacia

A

qualitative

138
Q

what is osteomalacia

A

abnormal softening of the bone due to deficient mineralisation of osteoid (immature bone) secondary to inadequate amounts of calcium and phosphorus

139
Q

what is the difference between osteomalacia and ricketts

A

ricketts affects children

140
Q

what are the principal causes of osteomalacia

A

insufficient clacium absorption from the intestine (lack of dietary calcium or a deficiency o or resistance to the action of vitamin D)

phosphate deficiency due to increased renal losses

141
Q

specific causes of osteomalacia

A

malnutrition

malabsorption

lack of sunlight

hypophosphataemia

long term anticonvulsant use

CKD

142
Q

presentation of osteomalacia

A

bone pain (pelvis, spine, femora)

deformities from soft bones (more ricketts)

pathological fractures

hypocalcaemia (paraesthesiae, muscle cramps, irritability, fatigue, seizures, brittle nails)

143
Q

serum calcium, phosphate and ALP in osteomalacia

A

low Ca

low PO4

high ALP

144
Q

treatment of osteomalacia

A

vitamin D therapy

phosphate supplementation

145
Q
A
146
Q

what causes primary hyperparathyroidism

A

benign adenoma

hyperplasia

malignant neoplasia (rare)

147
Q

what does overproduction of PTH result in

A

hypercalcaemia

148
Q

symptoms of hyperparathyroidism

A

fatigue, depression, bone pain, myalgia, nausea, thirst, polyuria, renal stones, osteoporosis

149
Q

serum calcium and phosphate in hyperpara

A

Ca high

PO4 normal/low

150
Q

what is secondary hyperpara

A

physiological overproduction of PTH secondary to hypocalcaemia usually casued by vitamin D deficiency or CKD

151
Q

what are brown tumours

A

lytic bone lesion caused by hyperpara

152
Q

treatment of hyperpara

A

removal of the adenomatous gland

treatment of underlying cause (vit D supplementation)

153
Q

what is paget’s disease

A

a chronic disorder which results in thickened, brittle and mis-shapen bones

154
Q

paget’s disease affects the whole skeleton

true/false

A

false

it normally affects one or a few bones

155
Q

what causes the increased bone turnover in paget’s disease

A

increased osteoclast activity

156
Q

paget’s pathophysiology

A

increased osteoclast activity leads to increased bone turnover

osteoblasts become more active to correct excessive resorption

new bone is formed, but fails to remodel sufficiently and the resulting bone is brittle despite its increased thickness and density

157
Q
A
158
Q

which bones are commonly affected by paget’s disease

A

pelvis

femur

skull

tibia

ear ossicles (conductive deafness)

159
Q

presentation of paget’s disease

A

asymptomatic (incidental finding)

arthritis

pathologic fracture

deformity

pain

high output cardiac failure (increased blood flow through pagetic bone)

160
Q

xray appearance of paget’s disease

A

enlarged bone with thickened cortices and coarse, thickened trabeculae with mixed areas of lysis and sclerosis

161
Q

what do bone scans show in paget’s disease

A

increased uptake in the affected bone(s)

162
Q

treatment of paget’s disease

A

bisphosphonates (inhibit osteoclasts)

calcitonin (in extensive lytic disease)

joint replacment

cortext (6 decks)

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