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7- Surgery > Musculoskeletal Swellings > Flashcards

Musculoskeletal Swellings Flashcards

1
Q

Are musculoskeletal swellings mostly symptomatic or asymptomatic

A

Asymptomatic

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2
Q

Main sites of bone tumors

A

Long bones of lower limb 60%
Pelvis, coccyx, sacrum 18%
Upper limbs 13%

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3
Q

Are there obvious cause to musculoskeletal swelling

A

No

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4
Q

Predisposing factors

A 
Ionizing radiation 
Pagets dx
Fibrous dysplasia
Retinoblastoma 
Positive family hx
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5
Q

Classification

A

Benign
Intermediate
Malignant

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6
Q

Common benign tumor

A

Osteochondroma
Osteid osteoma
Chondroma

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7
Q

Malignant tumors

A

Multiple myeloma
Chondrosarcoma
Giant cell tumor
Ewing’s sarcoma

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8
Q

Enneking classification

A 
I low grade 
II high grade 
III metastases 
A Intracompartmental 
B extracompartmental
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9
Q

history

A

Soft tissue mass
Produce pain or disability
Night pain and sweats not relieved by analgesics ? => malignancy
Age => 5y likely infection/ eosinophilic granuloma. Late teen likely giant cell tumor/ osteoblastoma

Race => black likely Ewing sarcoma

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10
Q

Examination

A

Look for Mass or pain
Look for asymmetry , deformity , swelling
Palpate for mass and it’s composition
Malignant tumor => firm, non tender, inflammation signs

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11
Q

Investigations

A

Plain x rays => large zone of transition ? Periostal rxn ?

Scan

Biopsy

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12
Q

Main tumors of the ribs

A

Mets
Enchondroma
Chondrosarcoma
Ewing

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13
Q

Main tumors of the spine

A 
Mets
Myeloma 
Osteoblastoma 
Chordoma
Hemangioma 
ABC
Osteoid ostema
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14
Q

Main tumors of the pelvis

A 
Osteosarcoma 
Chondrosarcoma 
SBC
Lymphoma 
Ewing 
EG
Chordoma
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15
Q

Main tumors of hands

A

Endhondroma

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16
Q

Main tumors of proximal femur

A 
SBC
FD
Enchondroma 
Ewing 
EG
17
Q

Tumors of around the knee

A

AII , osteosarcoma

Ewing

18
Q

Epiphysis tumors types

A

Chondroblastoma

19
Q

Metaphysis tumors type

A

Osteosarcoma
MFH
Enchondroma

20
Q

Diaphysis tumors types

A

Adamantinoma
Osteoid osteoma
Chondromyxoid fibroma

21
Q

If you see sunray appearance / codmans triangle, most likely diagnosis ?

A

Osteosarcoma

Malignant lesion

22
Q

If you see onion peel appearance , most likely diagnosis ?

A

Ewing sarcoma
Malignant lesion
Chronic osteomyelitis

23
Q

If you see soap bubble appearance, most likely diagnosis ?

A

Osteoclastoma

Adamantinoma

24
Q

If you see ground glass appearance, most likely diagnosis ?

A

Fibrous dysplasia

25
Q

If you see patchy calcification , most likely diagnosis ?

A

Chondrogenic tumors

26
Q

If you homogenous calcification, most likely diagnosis ?

A

Osteogenic tumors like osteosarcoma

27
Q

Lab for diagnosis

A

FBC (leukemia ?)
C reactive protein (inflammation ?)
ESR (ewing sarcoma ? Leukemia? Eosinophilic granuloma ? Infection ?)
Alkaline phosphatase (osteosarcoma? Ewing sarcoma? Lymphoma ? Metastatic bone tumor ?)

28
Q

How to exclude the diagnosis of prostate cancer

A

PSA

29
Q

How to exclude the diagnosis of MYELOMA

A

Serum electrophoresis

Urinary bence jones proteins

30
Q

Types of biopsies possible

A

Needle (most common )
Incisional
Excisional

31
Q

Commonest benign bone tumor

A

Osteochondroma

32
Q

Population at risk Osteochondroma

A

10-20y

33
Q

Main sites Osteochondroma

A 
Distal femur 
Prox tibia 
Prox humerus 
Pelvis 
Scapula
34
Q

Clnical features Osteochondroma

A

Asymptomatic unless fracture of stalk or pressure on surrounding tissue causing pain

35
Q

X-ray Osteochondroma

A

Eccentric protrusion

36
Q

Osteochondroma histo

A

Pedunculated

Cauliflower or sessile

37
Q

Treatment Osteochondroma

A

None

Excision if pain

38
Q

Chances of malignant pain in Osteochondroma

A

1-5%

7- Surgery (13 decks)

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