Tumor and Metabolic Diseases Flashcards
Musculoskeletal tumors come from what tissue
mesodermal
what is mesodermal tissue
connective tissue like bone, fat, muscles
what are Musculoskeletal called
sarcomas
Sarcomas metastasize where
lung
what are 4 types of Musculoskeletal tumors
benign bone
malignant bone
benign soft tissue
malignant soft tissue
histories of what other cancers are important for Musculoskeletal tumors
prostate, lung, breast, thyroid, renal
chest x-ray: CXR
lung
mammogram
breast
PSA
prostate
UA
renal
TSH/Thyroid US
thyroid
SPEP/ UPEP
myeloma
ESR/CRP
infection
CBC diff, CMP
anemia, alk phos
CT chest/ abdomen/ pelvis
look for primary or mets to lung
MRI
asses soft tissue of anatomy
bone scan
bony activity, skip lesions
X-ray of limbs
bony destruction
above what age are bone tumors most likely metastatic
40
growing soft tissue masses are most likely what
malignant
how do you treat soft tissue >5cm or deep
excision
how do you treat malignant soft tissue
resection
how do you treat benign bone
excision if aggressive
how do you treat malignant bone
chemo
resection
reconstruction
radiation ( not first line)
what is the translocation of Ewing
11,22,
what part of the bone does osteomyelitis occur
metaphysis
osteomyelitis: most common bacteria involvied
- staph aureus
- hemolytic strep
others: TB, syphillis, fungus and virus
most common spread for osteomyelitis? other avenues
hematogenously
- direct inoculation with open fractures
someone with osteomyelitis will have a history of what
achy, unrelenting night pain
fever
what will the exam show for osteomylitis
tenderness in bone
ROM of joints ok
swelling, warmth, redness, draining sinus
Osteomyelitis: CBC with diff
elevated WBC with left shift
Osteomyelitis: ESR/CRP
elevated inflammatory markers
Osteomyelitis: X-ray of limb
may show Brodie’s abscess
Osteomyelitis: blood culture
may grow bug from hematogenous spread
Osteomyelitis: bone culture
gold standard for diagnsosis
Osteomyelitis: MRI/bone scan
very helpful to asses abscess and extent
Osteomyelitis: treatment
empiric: Vanc
clear abscess or no improvement: surgical washout
chronic: multiple treatments
what is osteoprosis
low bone mass leading to micro-architectural deterioration, causing increase fragility of bone
Describe the different types of primary osteoprosis
type I: postmenopausal, caused by hormone changes
Type II: senile, altered calcium metabolism
what is secondary osteoporosis
long term steroid use
- hyperparathyroidsm
- hyperthyroidsim
- long term immobilization
what are 3 things the physical exam will show for osteoporosis
loss of height
- thoracic kyphosis
- loss of menstruation
what is a common test used for osteoporosis
DEXA scan of spine, hip, or femur
T score: compare to 25 yr old
Z score: compare to matched age
for DEXA scan how much below SD means they have osteoporosis
what does NTx measure
bone collagen
osteoporosis: CBC
anemia
osteoporosis: TSH/PTH
hyperthyroid
hyperPTHism
osteoporosis: SPEP/UPEP
Multiple myeloma
osteoporosis: Ca/P/Alk Phos/Vit D
osteomalacia
BUN/Cr/ LFT indicates what
renal/liver causes
how does one prevent osteoporosis
maximize Ca/Vit D
weight bearing exercises
minimize smoking, caffeine, meds
treatment for osteoporosis
bisphosphates
Calcitonin
Pulsed PTH
SERMS ( not recommended)
what does the doctor need to pay attention to with Biphophates
can only use for about 5 years
- disrupts ruffled border of osteoclasts
what are the 5 most common primary carcinomas that metastasize to the bone
prostate, lung, breast, thyroid, renal
what is the common bacteria that causes oestomyelitis
staph aureus
what is the difference between T and Z score in DEXA scan
T- compare with 25 yr old
Z- compare with your age
what is the most common metastatic site for sarcomas
lung
why does osteomyelitis most commenly happen in the metaphysis of bone
blood vessels
name one common medicine that with long term use can cause secondary osteoprorsis
Steroid use
