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Bone Pathology II > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Categories of bone disease

Acronym

A

CATBITES

Congenital
Arthritis
Tumor
Blood
Infection
Trauma
Endocrine
Soft tissues
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2
Q

Preliminary analysis to perform on patient’s radiograph

A

AS:R Highness

Age
Sex
Race
History
Number of lesions
Symmetry of lesions
Systems involved
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3
Q

__ _ ___ bone loss to be seen on film

A

30-50%

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4
Q

CT is useful in what scenarios?

A

Detect subtle osseous changes (lytic destruction, cortical integrity)
Detect subtle periosteal response
Detects subtle calcification

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5
Q

T1 weighted CT images see

A

Brighter marrow fat

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6
Q

T2 weighted CT images see

A

Brighter cell fluid and edema

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7
Q

MRI is a good modality to view

A 
Marrow
Extent of lesion
Matrix
Soft tissue mass
Impact on surrounding structures
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8
Q

Bone scan benefits

A

Increased metabolic activity known as “hot spots”
View whole skeleton at once
Very sensitive to bone loss (3-5% loss may be a hot spot)

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9
Q

ABC’s of radiographs

A

Alignment
Bone
Cartilage
Soft tissues

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10
Q

Lesions to refer to internist

A

Metastasis

Multiple Myeloma

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11
Q

Lesions to refer to orthopedic surgeon

A

Primary malignancies
Painful benign lesions
Lesions with risk of complications (pathological fx, effect on growth, malignant transformation)
Infection

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12
Q

Lesions to document and not refer

A

Asymptomatic, benign lesions without significant risk o f complications

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13
Q

Most mets begin in patients ___

A

> 40

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14
Q

Most primary benign in patients ___

A

<30

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15
Q

Red flags to know

A

Weight loss, fatigue, malaise, recurrent infection, pain pattern

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16
Q

Neoplasms that are not solitary

A

Mets
Multiple myeloma
Some hereditary conditions (HME, Ollier’s, neurofibromatosis)

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17
Q

DDx for expansile lesion of posterior/neural arch

A

Aneurysmal bone cyst
Osteoblastoma
Osteoid osteoma (appear sclerotic)

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18
Q

Examples of epiphyseal-metaphyseal lesions

A

Aneurysmal bone cyst

Giant cell tumor

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19
Q

Examples of metaphyseal - diaphyseal lesions

A 
Chondrosarcoma
Osteosarcoma
Multiple myeloma
Osteoid osteoma
Non-ossifying fibroma
Chondromyxoid fibroma
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20
Q

Examples of diaphyseal lesions

A

Marrow related or round cells

Multiple myeloma
Ewing sarcoma
Non-Hodgkin lymphoma

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21
Q

“long lesion in a long bone”

Benign

A

fibrous dysplasia

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22
Q

enostoma

A

Thorny border of bone island

can be helpful in identifying lesions

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23
Q

Behavior of osteolytic lesions

A

Geographic
Moth-eaten
Permeative

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24
Q

Behavior of osteoblastic

A

new bone formation
Reactive sclerosis
Overlying density of periosteal response
Sequestrum (necrotic bone)

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25
Q

Presentation of geographic lesions

A

Well defined margins

Short zone of transition

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26
Q

Composition of osseous tumor

A

identify by cloud-like, cotton candy calcification of mass

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27
Q

Compostition of cartilage tumor

A

Pop-corn, stippled, punctuated

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28
Q

Composition of fibrous tumor

A

May appear hazy or like ground glass

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29
Q

More aggressive findings for lesions

A

Codman triangle
Laminated
Spiculated
Sunburst

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30
Q

Less aggressiving findings for lesions

A

single layer thick/thin

cortical buttressing

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31
Q

Benign characteristics

A 
Pt <30
lesion under 6 cm
Monostotic lesion
no destruction of cortex
Solid periosteal response
Geographic lytic destruction
Sharp margination
No soft tissue mass
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32
Q

Primary malignancy characteristics

A 
Any age
Lesions over 6 cm
Monostotic (MM is an exception
Cortical destruction
Spiculated periosteal response 
Moth-eaten or permeative lytic lesion
Indistinct margins
Soft tissue mass
33
Q

Metastatic characteristics

A 
>40 years old
Polyostotic lesions
Cortical destruction
Usually no periosteal response
Moth-eaten or permative lytic lesions
Indistinct margins (mb well-defined)
Occasional soft tissue mass
34
Q

Most common primary sites for metastasis are

A

Lungs, breast, renal, prostate

35
Q

Target sites for metastasis

A

Axial skeleton
Skull
Proximal extremities
Rare distal to knee or elbow

36
Q

Skeletal metastasis may be as common as metastasis to ___ __ ___

A

liver or lung

20-30% of all patients with maliganacies

37
Q

Acral metastasis

A

Disappearance of a distal phalanx

38
Q

80% of skeletal metastasis are primaries of what

A

Lung, breast, GI tract, prostate

39
Q

breast is primary in ___ of women and prostate is primary in ___ of men

A

70%, 60%

40
Q

Lung is primary site of metastasis in

A

25%

41
Q

Bone lesion under 5

A

neuroblastoma

42
Q

Bone lesion 10-20

A

Ewing sarcoma or osteosarcoma (MC)

43
Q

Bone lesion 20-35

A

Hodgkin lymphoma

44
Q

Bone pain presents in ___ and is ___ ___ ___

A

insidious, perisistent, nocturnal

45
Q

Non-skeletal clues for pathologic fracture

A

weight loss, cachexia, anemia, advanced fever

46
Q

Patients with suspected metastasis should be evaluated with

A

ESR, CBC, chem screen and UA

47
Q

Serum calcium is elevated in what type of pathology?

A

lytic

48
Q

alkaline phosphatase is elevated in what type of pathology?

A

blastic

49
Q

Characteristics of primary malignancy

A 
Expansion of bone
Periosteal response
Solitary response
Lesion over 10cm
Soft tissue mass
50
Q

Characteristics of metastasis

A

70% of malignancy
2-4cm
multiple lesion

51
Q

What regions are most common for mets to appear

A

Thoracic and lumbar most common

52
Q

Most common cause of a missing pedicle is ___ ___

A

osteolytic mets

“winking owl, one-eyed pedicle, blind vertebrae”

53
Q

3 most common causes of Ivory Vertebra

A

osteoblastic metastasis
paget’s disease
lymphoma

54
Q

Key clue for Paget disease

A

cortical thickening, expansion

55
Q

Key clue for lymphoma

A

anterior body scalloping

56
Q 
Skeletal metastasis:
\_\_\_ to ribs and sternum
\_\_\_ to pelvis
\_\_\_ to skull
\_\_\_ to long tubular bones
A

28%
12%
10%
10%

57
Q

Management for oain and bone loss

A

Pain: steroids, NSAIDs

Bisphosphonates may be used to manage osteoclastic activity

58
Q

4 most common primary malignancies of bone

A

Multiple myeloma
Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma

59
Q

Signs and symptoms if Multiple myeloma

A

Bone pain worse with activity and weight bearing, path. fx
Anemia (normo/normo)
Proteinuria
Renal disease

Weight loss
Osteoporosis
Amyloidosis
Bacterial infection

60
Q

Lab changes with multiple myeloma

A

normo/normo anemia
Thrombcytopenia
Elevated ESR
hyperuricemia/hypercalcemia
Elevated serum proteins (elevated G in a/g ratio)
Bence-Jones protein in urine
Increased number of bone marrow plasma cells

61
Q

Diagnostic lab changes for multiple myeloma

A

serum protein electrophoresis

M spike = monoclonal globulin proteins

62
Q

Plain film findings of multiple myeloma

A

Multiple well-defined round “punched out” defects
Severe generalized osteopenia
Some scalloping

63
Q

Advanced Imaging for multiple myeloma

A

MRI very sensitive to marrow changes

64
Q

Treatment for multiple myeloma

A

Targeted drug therapy
Chemotherapy
Bone marrow transplant

65
Q

Complications for multiple myeloma

A

Pathologic fracture
Renal failure
Respiratory infection

66
Q

Solitary Plasmacytoma characteristics

A

Localized plasma cell neoplasm

Geographic, lytic, highly expansile, “Soapy bubble”

67
Q

Solitary plasmacytoma progresses to what?

A

multiple myeloma within 5 years

68
Q

Osteosarcoma characteristics

A

Malignant noeplasm which forms osteoids

69
Q

Subtypes of osteosarcoma

A

Intramedullary
Surface/juxtacortical
Extra-skeletal

70
Q

Characteristics of primary osteosarcoma

A

75% of osteosarcoma

Occurs in patients 10-20 years old

71
Q

Characteristics of secondary osteosarcoma

A

Occur in older patients

Due to malignant degenration of a benign lesion or Paget disease

72
Q

Signs and symptoms of osteosarcoma

A

Painful swelling at site
Pain often increases with activity
Onset of symptoms to diagnosis is >6 months

73
Q

Plain film findings of osteosarcoma

A 
75% in long bones
50% sclerotic
"cumulus" cloud appearance
Cortical destruction, agressive periosteal response,
soft tissue mass
74
Q

Advanced imaging for osteosarcoma

A

MRI for treatment planning
Chest CT
Bone scan

75
Q

Treatment of osteosarcoma

A

Metastasis to lungs
Surgical resection/amputation
Radiation therapy
Chemotherapy

76
Q

Parosteal Sarcoma Age

A

30-50 years old

77
Q

Characteristics of Parosteal Sarcoma

A

Dense, juxtacortical mass with stalk to cortex
Not common overall, but accounts for 5% of
osteosarcomas
Slower growing

78
Q

Parosteal Sarcoma vs. Myositis Ossificans

A

P: Stalk towards bone, dense central portion, Grows over time
M: Seperate from bone, less dense centrally, smaller over time

79
Q

Causes of secondary osteosarcoma

A

Degenration of a benign lesion
Paget disease, Fibrous dysplasia, Osteochondroma, Enchondroma
Ionizing radiation

Bone Pathology II (3 decks)

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