Pathological Fracture

Question 1

Stem: A young female was cycling when she suddenly developed pain in her thigh as soon as she put her foot on the ground. X-ray showed fracture shaft femur with hypodense shadow.

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Q1: What’s the type of this fractur? What’s a pathological fracture?

Answer 1

Pathological
Bone fracture with inadequate trauma due to preexisting pathologic changes

Question 2

Q2: What are the causes of a pathological fracture?

Answer 2

Neoplastic; Multiple myloma, 2ry tumors
Non-neoplastic; bone cyst, paget dis., hyperparathyroidism, osteomyelitis, osteomalacia

Question 3

Q3: What are the most common primary sources for bone metastasis?

Answer 3

Lung, Prostate, breast, thyroid, kidney

Question 4

What’s the name of brain tumor causing sclerotic metastasis?

Answer 4

Medulloblastoma, Tuberous sclerosis

Question 5

Q4: Fracture was treated with internal fixation, how to check for malignancy?

Answer 5

By taking bone biopsy

Question 6

Q5: Pathology results showed a typical bland appearance (follicular cells). What’s the probable location of the primary?

Answer 6

Thyroid

Question 7

Q6: A thyroid nodule was detected and FNA was done; however, it has not been able to rule out or confirm cancer, why?

Answer 7

Malignancy is determined by capsular and vascular invasion which need histology rather than a cytology to confirm

Question 8

Q7: What are the other sites of ectopic thyroid tissue other than head, neck and mediastinum?

Answer 8

Ovarian and testicular teratomas

Question 9

Q8: Which investigation can be done to confirm thyroid metastasis? Which type of thyroid cancer that will show no response to iodine uptake?

Answer 9

Radioactive iodine scan
medullary Thy Ca as it’s originating from parafollicular C cells.

Question 10

Q9: The patient needed blood transfusion during surgery, what needs to be tested before a transfusion?

Answer 10

ABO, Rh Cross matching

Question 11

If the patient’s blood group is known, would you still need cross matching? Why?

Answer 11

Yes, to detect whether there’s recipient abs againt donor serum

Question 12

Q10: What are the complications of incompatible blood transfusion?

Answer 12

Immunrelated:- –Acute hemolytic transfusion reaction.
–Delayed hemolytic transfusion reaction
– Febrile non hemolytic transfusion reaction
–Transfusion related Acute Lung injury
Non-immune;- volume overlaod, electrolyte imbalances, infection, hypoCa

Question 13

Q11: Define hemolysis?

Answer 13

Rapture of RBCs with release of its conent of cytoplasm to the surroundings fluid