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Year 3 Trauma And Orthopaedics > Spine pathology + bone tumours > Flashcards

Spine pathology + bone tumours Flashcards

1
Q

L5 radiculopathy

A

Weakness of hip abduction
Weakness in foot and big toe dorsiflexion - foot drop
Sensory loss of dorsum of foot
+ve sciatic nerve stretch test

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2
Q

Sciatic neuropathy

A

Loss of ankle jerk and plantar response

Loss of knee flexion and power below knee

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3
Q

L3 root compression

A

Sensory loss over anterior thigh

Weak quadriceps - Reduced knee extension
Weak hip flexion and hip adduction

Absent knee jerk test

Positive femoral stretch test

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4
Q

L4 nerve root compression

A

Sensory loss of anterior aspect of knee

Weak quads - Reduced knee extension

Absent knee reflex

Positive femoral stretch test

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5
Q

S1 nerve root compression

A

Sensory loss of posterolateral aspect of leg and lateral foot and sole of foot

Weak plantar flexion
Reduced ankle reflex
+ve sciatic nerve stretch test

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6
Q

RF for primary bone cancers

A

RB1 and p53 mutation - osteosarcoma in children

TSC1/2 mutation - chondroma during childhood

Exposure to alkylating agents in chemotherapy and radiotherpay

Pagets disease and fibrous dysplasia

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7
Q

Which bone tumours show soap bubble appearance on Xray

A

Giant cell tumours

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8
Q

Bone tumour causing Codman’s triangle or sunburst pattern on Xray

A

Osteosarcoma

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9
Q

Bone tumour causing onion skin pattern on Xray

A

Ewing’s sarcoma

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10
Q

Bone tumour causing lytic lesions with calcification, endosteal scalloping and cortical remodelling on Xray

A

Chondrosarcoma

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11
Q

Pott’s disease

A

Vertebral TB
Back pain and neurological features
Low grade fever
MRI gold standard

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12
Q

L4 sciatica distribution of pain

A

Anterior thigh
Anterior knee
Medial leg

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13
Q

L5 sciatica distribution of pain

A

Lateral thigh
Lateral leg
Dorsum of foot

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14
Q

S1 sciatica

A

Posterior thigh
Posterior leg
Heel
Sole of foot

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15
Q

Sciatic nerve roots

A

L4 - S3

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16
Q

Femoral nerve roots

A

L2 - L4

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17
Q

Obturator nerve roots

A

L2 - L4 anterior divisions

18
Q

Common bone metastasis

A 
Prostate 
Breast 
Kidney 
Thyroid 
Lung
19
Q

Symptoms of bone tumours

A

Pain not associated with movement
Worse at night
Pathological fractures - without trauma

20
Q

Osteoid osteoma summary, age, presentation, Mx

A 
Benign 
Arise from osteoblasts 
10 - 20 yrs old 
Males > females 
Metaphysis of long bones

Symptoms:

  • progressive localised pain
  • worse at night
  • Better with NSAIDs
  • can have localised swelling, tenderness and limping

Mx:

  • serial X-ray - every 4 - 6 months
  • surgical resection - if severe pain
21
Q

Osteochondroma summary, age, presentation, Mx

A

Benign
Outgrowth from metaphysis covered with a cartilaginous cap
10 - 20 yrs old

Normally asymptomatic and slow growing
Can cause deformity of impinge on nerves if large

Ix:
- X-ray - pedunculated growth on metaphysis

Mx:

  • conservative management with serial X-ray - 4 - 6 months
  • if symptomatic and large - surgical resection
22
Q

Chondroma summary, age, presentation, Mx

A

Benign
Arise from chondroblasts - within medulla

20-50 years old

Affecting the long bones of the hands, femur, and humerus

Symptomatic
Pathological fractures

Ix:
Xray - well circumscribed oval lucency with intact cortex

Mx:
- conservative - observation if asymptomatic and small

  • large or symptomatic chondromas may require removal with curettage and bone grafting
23
Q

Giant Cell Tumour summary, age, presentation, Mx

A

Benign
Arise from the multinucleated giant cells and stromal cells - affects epiphysis of long bones
20-30 years old

Symptoms:

  • pain
  • swelling
  • limitation of joint movement

Ix:
Xray - eccentric lytic area, giving a “soap bubble” appearance

Mx:
Surgical resection - may require bone grafting or reconstruction

24
Q

Most common malignant primary bone tumour

A

Osteosarcoma

25
Q

Osteosarcoma

A

Malignant
Found in metaphysis of the distal femur or proximal tibia

Either at 10-14 years or in those >65yrs

RF: Paget’s disease

Symptoms:
- localised constant pain and a tender soft tissue mass may be palpable

Ix:

  • Xray - medullary and cortical bone destruction + periosteal reactions- Codman’s triangle” or as a “sunburst pattern”
  • Tissue biopsy

Mx:
- aggressive surgical resection with systemic chemotherapy

26
Q

Where does osteosarcoma metastasis to

A

Lung and bone

27
Q

Ewing’s Sarcoma

A

Paediatric malignancy
M>F
Arise from primitive poorly differentiated neuroectodermal cells - commonly affect the diaphysis of long bones

Symptoms:
- painful and enlarging mass - tenderness and warmth

Ix:
Xray - lytic lesion with periosteal reactions -producing layers of reactive bone - “onion skin” appearance

Mx:

  • neoadjuvant chemotherapy followed by surgical excision
  • radiotherapy if unresectable
28
Q

Chondrosarcoma

A

Malignant tumours of the cartilage

Onset is 40-60 yo
Affects axial skeleton - especially pelvis, shoulder, and ribs

Symptoms:

  • painful and enlarging mass

Ix:
Xray - lytic lesions with calcification, cortical remodelling, and endosteal scalloping

Mx:
Low grade lesions- intralesional curettage

Intermediate- and high-grade lesions -wide en-bloc local excision

29
Q

Radiological Features of Bone Tumours

A

Benign - sharp and well-defined, lacking soft tissue involvement and no cortical destruction

Malignant - poorly defined with rough borders, involving soft tissues and have cortical destruction

30
Q

Radiculopathy

A

Conduction block in the axons of a spinal nerve or its roots

  • motor axons - weakness
  • sensory axons - paraesthesia
31
Q

Radicular pain

A

pain from damage or irritation of the spinal nerve tissue, particularly the dorsal root ganglion

32
Q

Causes of radiculopathy

A

Compression due to:

  • Intervertebral disc prolapse
  • Degenerative diseases of the spine
  • Fracture
  • Malignancy
  • Infection - Extradural abscess, osteomyelitis, Pott’s disease (TB) or herpes zoster
33
Q

Mx of radiculopathy

A

Amitriptyline
Pregabalin and gabapentin as alternatives.

Muscle spasms -benzodiazepines (often diazepam) or baclofen

Physio

34
Q

Lasègue Test

A

Straight leg raise - assess for disc herniation

With the patient lying down on their back, the examiner lifts the patient’s leg while the knee is straight. The ankle can be dorsiflexed and / or the cervical spine flexed for further assessment.

35
Q

Degenerative disc disease mx

A

Pain relief - NDAIDs or co - codamol

Activity - encouraging motility

Physiotherapy - strengthening the core

36
Q

Jefferson Fracture

A

Atlas C1 burst fracture

Due to axial loading of cervical spine

37
Q

Hangman’s Fracture

A

Fracture through the pars interarticularis of C2 (axis) bilaterally

Due to cervical hyperextension and distraction

38
Q

Odontoid Peg Fractures

A

Most common in older patients

Low-impact injuries and neck pain

Can be fatal, especially with significant displacement of the odontoid; those who survive can have no neurology

39
Q

Investigations for cervical fractures

A

CT scan

MRI scan - for children

40
Q

Management of cervical spine fractures

A

ATLS
3 point C spine immobilisation
Analgesia and admit

Stable:
- rigid color and halo vests

Unstable:

  • Posterior fixation - pedicle scres and rods
  • Fusion - across the injured segment of the spine to the uninjured segments above and below, with or without decompression of the vertebral canal.

Year 3 Trauma And Orthopaedics (25 decks)

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