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FPP-MSS > September 9 Bone Path > Flashcards

September 9 Bone Path Flashcards

1
Q

What is the most common soft tissue tumor in adults?

A

Lipoma

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2
Q

What is the most common soft tissue tumor in adults?

A

Lipoma

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3
Q

What is the most common sarcoma in adults?

A

Liposarcoma

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4
Q

What is Rhabdomyosarcoma common in?

A

Kids

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5
Q

Lipoma

A

12q14-12q15 aberations -most common soft tissue tumor adults -solitary (unless rare hereditary) -painless and unmoving (unless angiolipoma) -soft yellow encapsulated masses -histo looks normal

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6
Q

Liposarcoma

A

-most common sarcoma in adults -deep soft tissues proximal extremities/retroperitoneum -histo=lipoblasts (scalloped vacuoles) WELL DIFFERENTIATED: supernumery ring chromosomes (12q14-q15 w/ MDM2 amplification) MYOXOID/ROUND LPS: t(12;16)(q 13;p11) = FUS CHOP gene PLEOMORPHIC: most agressive

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7
Q

Lipoblastoma

A

Kids Lipoblasts PLAG1

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8
Q

Hibernoma

A

Kids, brown fat tumor

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9
Q

Fibromatoses

A

SUPERFICIAL: palmar (Dupuytren contracture), plantar=on tendon sheaths -penile (Peyronie disease)=curvature penis Stabilize, could resolve DEEP SEATED/DESMOID: between benign fibrous tumors and fibrosarcoma Reoccur Teens-30s Gardner sx APC/B catenin mutations

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10
Q

Fibrosarcoma

A

Malignant, fibroblasts Adults Deep in thigh, knee, retroperitoneum Agressive Vimentin=marker?

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11
Q

What is the most common neoplasm in women?

A

Uterine leiomyomas

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12
Q

Leiomyosarcoma

A

10-20% soft tissue sarcomas F>M sin, deep soft tissues extremities/retroperitoneum Usually good if superficial

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13
Q

Rhabdomyosarcoma

A

Most common soft tissue disease in kids Head, neck, genitourinary TYPES: Embryonal, alveolar, pleomorphic

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14
Q

Embryonal Rhabdomyosarcoma

A

49% rhabdomyosarcoma

Head, neck (orbital and parameningeal), GU track

DEEP extremities, pelvis, retroperitoneum

Loss of 11p15, extra 8, 12, 13 and/or 20

Botryoids in female girl vaginas

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15
Q

Alveolar Rhabdomyosarcoma

A

31% rhabdomyosarcoma; 10-25 yo Deep soft tissues and EXTREMITIES!!!! PAX gene translocation -t(2;13)/PAX3-FKHR -t(1;13)/PAX 7-FKHR Alveolar growth pattern

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16
Q

Synovial Sarcoma

A

5-10% of soft tissue tumors Young adults, males 80% in deep soft tissue extremities around KNEE t(x;18)(p11;q11) w/ SYT SSX1 or SSX2 On MRI see calcifications, mass behind knee Treat with limb sparing surgery, chemo Metastasis lung, bone, lymph nodes 20% live >10 years

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17
Q

Pseudosarcomatous Proliferation

A

Idiopathic/trauma induced non neoplastic lesions that mimic sarcoma Nodular fascitis –> tumor after trauma on extremities; clonal chromosomal changes/big nuclei Myositis ossificans –> proximal extremities in young adults; trauma >50% cases *metaplastic bone that ostifies and gets filled w/ marrow

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18
Q

What is the most common sarcoma in adults?

A

Liposarcoma

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19
Q

What is Rhabdomyosarcoma common in?

A

Kids

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20
Q

Lipoma

A

12q14-12q15 aberations -most common soft tissue tumor adults -solitary (unless rare hereditary) -painless and unmoving (unless angiolipoma) -soft yellow encapsulated masses -histo looks normal

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21
Q

Liposarcoma

A

-most common sarcoma in adults -deep soft tissues proximal extremities/retroperitoneum -histo=lipoblasts (scalloped vacuoles) WELL DIFFERENTIATED: supernumery ring chromosomes (12q14-q15 w/ MDM2 amplification) MYOXOID/ROUND LPS: t(12;16)(q 13;p11) = FUS CHOP gene PLEOMORPHIC: most agressive

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22
Q

Lipoblastoma

A

Kids Lipoblasts PLAG1

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23
Q

Hibernoma

A

Kids, brown fat tumor

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24
Q

Fibromatoses

A

SUPERFICIAL: palmar (Dupuytren contracture), plantar=on tendon sheaths -penile (Peyronie disease)=curvature penis Stabilize, could resolve DEEP SEATED/DESMOID: between benign fibrous tumors and fibrosarcoma Reoccur Teens-30s Gardner sx APC/B catenin mutations

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25
Q

Fibrosarcoma

A

Malignant, fibroblasts Adults Deep in thigh, knee, retroperitoneum Agressive Vimentin=marker?

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26
Q

Smooth muscle tumor characteristics

A
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27
Q

What is the most common neoplasm in women?

A

Uterine leiomyomas

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28
Q

Leiomyosarcoma

A

10-20% soft tissue sarcomas F>M sin, deep soft tissues extremities/retroperitoneum Usually good if superficial

29
Q

Rhabdomyosarcoma

A

Most common soft tissue disease in kids Head, neck, genitourinary TYPES: Embryonal, alveolar, pleomorphic

30
Q

Embryonal Rhabdomyosarcoma

A

49% rhabdomyosarcoma;

31
Q

Alveolar Rhabdomyosarcoma

A

31% rhabdomyosarcoma; 10-25 yo Deep soft tissues and EXTREMITIES!!!! PAX gene translocation -t(2;13)/PAX3-FKHR -t(1;13)/PAX 7-FKHR Alveolar growth pattern

32
Q

Synovial Sarcoma

A

5-10% of soft tissue tumors Young adults, males 80% in deep soft tissue extremities around KNEE t(x;18)(p11;q11) w/ SYT SSX1 or SSX2 On MRI see calcifications, mass behind knee Treat with limb sparing surgery, chemo Metastasis lung, bone, lymph nodes 20% live >10 years

33
Q

Pseudosarcomatous Proliferation

A

Idiopathic/trauma induced non neoplastic lesions that mimic sarcoma Nodular fascitis –> tumor after trauma on extremities; clonal chromosomal changes/big nuclei Myositis ossificans –> proximal extremities in young adults; trauma >50% cases *metaplastic bone that ostifies and gets filled w/ marrow

34
Q

Four categories of osteomyelitis?

A

Hematogenous: bacteria in bone bc previous infection (kids) Direct implantation: penetrating injury Continguous: spread of bacteria from ulcer/wound (adults) Inf of prosthetic device: bacteria in bone from inf of prosthetics (adults)

35
Q

Hematogenous Osteomyelitis

A

Bone becomes “loose”; can occur in spine Staph aureus, strep sp., gram -, mycobacterium tuberculosis, salmonella in sickle cell pts

36
Q

Direct implantation Osteomyelitis

A

Occurs from pseudomonas and other organisms

37
Q

Contiguous osteomyelitis

A

S. Aureus, gram -, strep sp., anaerobes, Candida Bacteria in bone different than in ulcer!

38
Q

Prosthetic Joint Infection Osteomyelitis

A

Coagulase - staph, S. aureus, gram -, strep sp. (hard to treat!)

39
Q

General characteristics of osteomyelitis

A

Chronic infections lead to no fever Sequestrum=dead bone Involucrum=new bone Brodie’s abscesses=abcesses in bone due to bacteria

40
Q

Biofilms

A

Aggregations of microorganisms to surface of something Embedded in matrix of “slime”, glycocalyx (tubes) More resistant to antibiotics/different properties than normal bacteria Coagulase - good at!

41
Q

Treatment for Osteomyelitis

A

Rifampin= RNA inhibitor (good for biofilms and S. aureus) Antibiotics only helpful if tissue still there (oral for joint infections)

42
Q

What is this?

A

Gout

Urates on the articular surface, destroy cartilage

Fuzzy crystals under microscope

43
Q

What is the inflmmatory response of gout

A

The inflammasome eats/detects the MSU

IL1B is activated

Inflammatory cascade with neutrophils occurs

44
Q

What are the categories of treatment for gout?

A

NSAIDS (NO ASPIRIN; indomethacin, naproxen)

Corticosteroids (short term if can’t take NSAIDS)

Colchicine, allopurinal, febuxostat, pegloticase, probenecid

45
Q

Colchicine

A

Used for gout

No effect on uric acid excretion but antimiotic

–bind to tublin in neutrophils and inhibit; less pain

–oral, rapid absorption/good distribution

–activated by CYP450 and eliminated via P glycoprotein

–GI side effects

–Contraindictations –> elderly, hepatic/renal disease, CYP3A4/PgP inhibitors

46
Q

What are some non-pharm ways of prophylaxis for treatment of gout?

A

Abstain from alcohol

Wt loss

No aspirin/thiazide

47
Q

Allopurinol

A

Prevent gout flare up

Inhibit last steps in uric acid biosynthesis via blocking xanthine oxidase

Metabolized by aldehyde oxidoreductase oxypurinol (longer 1/2 life)

Can cause hypersensitivity OR gout by mobilizing uric acid

48
Q

Febuxostat

A

Prevent gout flare up

Non-purine xanthine oxidase inhibitor

Vs allopurinol, it’s more potent, effective if you have impaired renal function BUT more adverse/CV effects

49
Q

Pegloticase

A

Used for gout

Sends PEGylated uricase to humans

Makes uric acid to allantoin (H2O soluble)

Need to be given by IV

Can cause gout flare or immune response against PEG

50
Q

Probenecid

A

Used for gout

Uricosuric agent; increases rate of excretion of uric acid

Compete with OAT so less uric acid reabsorbed

GI effets, bad if kidney issues/stones

Bad for use with drugs that need transporter (penicillin)

51
Q

What is this?

A

Rheumatoid arthritis

Microscopic picture of papillary synovitis (pannus) with lymphoid infiltrates at the center

52
Q

What is this?

A

Rheumatoid arthritis

Synovium hyperplasia with lymphocytes

53
Q

What is this?

A

Rheumatoid nodule showing the central geographic

fibrinoid necrosis and the surrounding palisaded chronic

inflammatory cells

54
Q

What are the general properties of DMARDs against rheumatoid arthritis?

A

Parental inj

Extracellular, does not cross BBB

Long half life, infreq. administration

Safe but immunogenicity against; increase risk for inf

55
Q

Etanercept

A

Used for RA, all stages

Block TNFalpha by inhibiting ability to bind to receptor (only soluble)

Recombo fusion protein

56
Q

Adalimumab

A

All stages RA

IgG human monoclonal Ab; binds to all forms TNFalpha to prevent binding

57
Q

Tocilizumab

A

Anti RA; not first line

humanized ab that binds to soluble/membrane form IL6

Alterations lipid profile

58
Q

Tofacitinib

A

Moderate-severe RA

Inhibitor of JAK (transcription factor that transcribes pro inflammatory genes)

Alters lipid profile

Oral

59
Q

Rituximab

A

Mod/severe RA

Depletes B cells by binding to CD20 (eitehr CDC or ADCC)

60
Q

Abatacept

A

Mod-severe RA

Inhibit binding to CD28 and activation of T cells by APC

contains CTLA4

fusion protein

61
Q

Anakinra

A

RA mod/severe

Recombo protein that is a competitive antagonist of IL 1

62
Q

What is this?

A

Early OA

Superficial layers of cartilage crack

Limited new matrix formed

63
Q

What is this?

A

Subchondral cyst (geode) from late OA

64
Q

What are the main treatment options for OA?

A

Main=wt loss, exercise, physical therapy (first line)

Corticosteroids/hyaluronans=injected; high placebo–last line before therapy

Topical: capsaicin, salicylates, menthol

Systemic: acetaminophen, duloxetine, NSAIDS

Opiods=NOT GOOD

65
Q

Duloxetine

A

Used for OA

Oral, centrally acting

Causes inhibition of 5-HT/NE reuptake

See analgesic effect earlier than antidepression, and minor side effects only

66
Q

Capsaicin

A

Used for OA

Topical, releases substance P, pain inhibiting effect; adverse=pain/erythema/site reactions/depletes sub P eventually

67
Q

Glucosamine/Chondroitin

A

Dietary supplement for OA

Glucosamine=maintain cartilage integrity

Chondroitin=maintain joint viscosity and stimulate repair

68
Q

Hyaluronic acid

A

Used for OA

Injection, endogenous, inhibit degregation of cartilage apparently but no good data

69
Q
A

FPP-MSS (6 decks)

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