Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

14 Onco > Surgery MSK > Flashcards

Surgery MSK Flashcards

1
Q

t/f msk tumors are common

A

false, bone sarcoma 0.2% of all malignancies, soft tissue sarcomas are <1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

bone tumor evaluation process

A
  • history and pe
  • xray of lesion
  • lab assessments
  • local imaging and cxr
  • biopsy
  • staging + other exams
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

t/f age of patient is most important

A

true, certain bone tumors are more common in certain age groups

table 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

7 xray questions for bone tumor evaluation

A 
- location
aggressiveness
- how large (compared to bone)
- how extensive
- what is the lesion doing to the bone
- what is the bone doing in response
- is there a cortical lesion
- is there soft tissue mass
histology
- what is the matrix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

descriptions of bone

A
  • geographic: margins are sharp and zone of transition is narrow (non-aggressive)
  • moth eaten: multiple lytic lesions in bone (myeloma or metastatic ca)
  • permeative pattern: ill defined margin and wide zone of transition (osteogenic sarcoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 patterns of bone

A
  • marginal sclerosis
  • cortical thickening
  • periosteal new bone formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is marginal sclerosis

A
  • non-aggressive

- gct os more aggressive, does not show marginal sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is cortical thickening

A
  • high concentrations of pde2 = pain relieved by nsaids
  • pge2 = stimulates osteoblasts = bone thickening
  • osteofibrous dysplasia is seen in pedia pts, benign lesion involving anterior cortex of tibia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

4 sub patterns of periosteal new bone formation

A
  • bone remodeling and endosteal espansion
  • neocorticalization
  • poorly organized periosteal new bone formation
  • muti-level periosteal response or onion peel pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is bone remodeling and endosteal expansion

A
  • expansile remodeling and endosteal scalping
  • cortical thinning seen in enchondromas
  • seen in non-ossifying fibroma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is neocorticalization

A
  • non-aggressive tumor destroying original cortex
  • periosteum forms new layer of bone to contain the tumor
  • gct and enchondroma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is poorly organized periosteal new bone formation

A

more in aggressive (osteosarcoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is multi-level periosteal response and onion peel pattern

A
  • periosteum being lifted by tumor = onion peel patter
  • ewing’s sarcoma, osteosarcoma, osteomyelitis
  • condmans triangel: original cortex, lifted periosteum, tumor
  • more in aggresive tumos (osteosatcoma)
  • hair on head or sunburst pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is cortical erosion

A
  • points to aggressiveness

- seen in osteosarcoma and gct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are soft tissue masses

A
  • gct: locally aggressive, destroy cortex and extend tissue
  • osteosarcoma: very aggressive and penetrates through intact cortex and soft tissue
  • fibrous dysplasia: confined to bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 types of matrix

A
  • osteoid
  • chondroid
  • ground glass
  • lytic lesions or no matrix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is osteoid matrix

A
  • fluffy, cloudlike, amorphous calcifications

- osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is chondroid matrix

A
  • stippled, flocculent, or rings and arcs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is ground glass matrix

A
  • fibrous dysplasia
  • bone does not mature to lamellar bone but remains as woven bone interspersed within a fibrous background
  • when found on the hip = coxa vara or shepherd’s crook deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are lytic lesions or no matrix

A
  • gct, aneurysmal, and unicameral bone cysts and certain metastatic carcinoma (renal cell carcinoma or thyroid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

most useful to see the soft tissue and intramedullary extent of the tumor and to check involvement of major neurovascular structures

A

mri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

benign neoplasms

A

fibrous: fibrous cortical defect, non-ossifying fibroma, fibrous dysplasia
lytic: unicameral bone cyst, giant cell tumor
osseous lesions: osteoid osteoma
cartilaginous: osteochondroma, enchondroma

23
Q

what are fibrous cortical defects and non-ossifying fibromas

A
  • age: children and adolescents
  • site: metaphyseal cortical defect, long bones
  • fcd: <2-3 cm, nof >3 cm
  • geographic borders
  • sclerotic rim
  • dx: incidental on xray
  • tx :if symptomatic, needs surgery
24
Q

what are fibrous dysplasias

A
  • age: monoostotic any age, 5-20 yrs
  • age: polyostotic any age
  • ground glass matrix
  • due to failure of bone to mature to lamellar bone causing deformities
25
Q

what are unicameral bone cyst

A
  • age: 4-13
  • proximal humerus, femur, metaphyseal to disphyseal
  • central lytic lesion
  • geographic
  • no soft tissue component
  • fallen leaf sign!!! (broken bone cortex at bottom of cyst
  • resolves as skeleton matures
  • can have pathologic fractures
26
Q

what are giant cell tumors

A
  • skeletally mature 20-30
  • epimetaphyseal, around knee, distal radius
  • no matrix (lytic)
  • cortices thinned out, expanded, or deficient with soft tissue extension
  • can be locally aggressive
  • tx: medical and surgery
27
Q

what are osteoid osteoma

A
  • age 10-30
  • usually cortical
  • small, 1-2 cm lucent nidus with surrounding sclerotic reaction (thick bone)
  • high pge2 in nidus = pain and stimulates osteoblasts to produce bone
  • pain relieved by nsaids
  • tx: ablation of nidus
28
Q

what is an osteochondroma

A
  • 10 yo, <20
  • surface lesion, metaphyseal
  • sessile or pedunculated bony outgrowth with cartilaginous cap
  • +/- calcifications
  • due to abnormal growth of bone perpendicular to epiphysis
  • growth after maturity = metastasis
29
Q

what is enchondroma

A
  • 15-40 yo
  • within shafts of long tubular bones, hands, and feet
  • chondroid matrix, endosteal scalloping, no cortical break, no soft tissue extension
  • long bones
  • symptomatic: curettage and bone graft
  • long bone destruction - malignant degeneration
30
Q

malignant bone neoplasms

A

metastatic carcinoma
marrow and round cell tumors: mm, ewing’s sarcoma
osseous: osteosarcoma
cartilaginous: chondrosarcoma

31
Q

most common malignancy seen in bone

A

metastatic ca

- usually in axial skeleton and proximal appendicular skeleton

32
Q

what are acral metastasis

A
  • metastasis beyond elbow and knee
  • spread via arterial circulation
  • point to lung primary or lung metastasis
33
Q

connections of batson’s vertebral vein plexus

A
  • breast, lung, kidney prostate thyroid
  • vertebral bodies pelvis ribs skull proximal limb girdle
  • no venous valves
  • inc pressure in lungs and abdomen = bypass heart and lungs = flow into vertebral plexus of veins
34
Q

most common primary ca that metastasize to bone

A

breast, lung, kidney, prostate, thyroid, gi tract

35
Q

what is multiple myeloma

A
  • > 50 yo
  • primary bone marrow tumor from plasma cells
  • multiple lytic lesions on skeleton
  • punched out lesions, endosteal scalloping, pathologic fractures
  • tx: medical
36
Q

what is ewing’s sarcoma

A
  • usually children and young adults
  • on long bones and pelvis
  • round cell tumors
  • “moth eaten” appearance
  • destructive permeative lesions with soft tissue component
  • tx: chemo, radio, surgery
37
Q

what is osteogenic sarcoma

A
  • 10-25 yo
  • long bones
  • medullary, cortical destruction, permeative borders, aggressive periosteal reaction, osteoid matrix
  • lace like histology
  • tx: chemo and surgery
38
Q

most common primary malignancy of bone

A

osteosarcoma

39
Q

what is chondrosarcoma

A
  • 30-60 yo
  • usually long bones
  • lytic, intralesional calcifications, permeative, endosteal scalloping >2/3 of cortex
  • lobules of cartilage
  • tx:surgery
40
Q

types of closed biopsy

A

fnab and core needle

41
Q

incisional vs excisional biopsy

A

incisional: peripheral, more sampling errors and less representative
excisional: remove entire mass

42
Q

enneking surgical staging for msk tumors

A

table 21

43
Q

surgical margins for benign stages

A

table 22

44
Q

surgical margins for malignant stages

A

table 23

45
Q

osteosarcoma tx

A

1: both surgery and chemo
2: neoadjuvant, surgery, finish chemo (always stage)

46
Q

surgery in osteosarcoma

A
  • local tumor control: limb sparing resection or limb amputation
  • final pathologic evaluation
47
Q

oncologic surgical margins

A

read

48
Q

contraindications for limb salvage

A
  • surgical margins are inadequate
  • survival is not expected to exceed 3 mos
  • gross contamination with tumor (poorly performed biopsy, certain pathologic fractures, inadvertent surgery with unresectable positive margins)
49
Q

what is autograft - vascularized fibular graft

A
  • for long bone defects

- bone is fixed over bone defect and vessel are sutured to vessels of tumor bed

50
Q

what is recycled autograft - autoclaved

A

read

51
Q

what is deep freeze autograft - pedicles frozen recycled autograft

A

read

52
Q

what is large segment allograft

A
  • bone bank
53
Q

what is bone regenration - bone transport

A
  • external fixator

- astronomized

54
Q

tumor prosthesis and rotationplasty

A

read

14 Onco (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions