Tutoring Session Flashcards
what are characteristics of benign vs malignant lesions
benign - single, geographic, short zone, respecting borders, well defined, no pain**
malignant - mutliple, long zone, moth eaten, permeative, periosteal reaction, destroying borders, ill defined, pain**
** pain is subjective but most commonly benign are not painful and malignant are painful
what tumor causes cachexia and pain
multiple myeloma
cachexia - wasting of the body
what tumor occurs in and affects the red marrow of bone causing osteopenia
multiple myeloma
what is needed to confirm diagnosis of multiple myeloma
aspiration and biopsy of bone marrow
sternum and ilium
what are rare sclerotic lesions of multiple myeloma called
POEMS
what malignant tumor spares the pedicles
multiple myeloma
what are risk factors for multiple myeloma
farmers, exposure to wood dust, nuclear exposure
what is the mnemonic for lytic lesions
fog machines
feg nomashic
fibrous dysplasia
enchondroma
giant cell tumor
non ossifying fibroma osteoblastoma myeloma ABC simple bone cyst hyperPTH infection chondroblastoma
what is the most common sclerotic lesion tumor
central osteosarcoma
central osteosarcoma typically results in what issues in the limbs
asymmetry or taller limb
what part of the bones does central osteosarcoma affect
metaphysis
where will central osteosarcoma not spread to
physis - limits spread of tumor
what tumor will metastasize to the lungs via the blood
central osteosarcoma
“cannonball mets”
what tumor can cause a pneumothorax
central osteosarcoma - mets to lungs via blood “cannonball mets”
what tumor can cause skip lesions in the spine via mets
central osteosarcoma
condmans triangle and spiculated cortex describes what type of tumor
central osteosarcoma
what does central osteosarcoma look like on MRI sequences T1, T2, STIR
t1 - low
t2 - high
stir - high
high due to edema
secondary osteosarcoma arises from what
what is the most common
benign bone tumor
pagets bone 44%
what lab value can help monitor if pagets bone has gone malignant
alkaline phosphatase
what is the process of thinking to know what a tumor is
benign or malignant
matrix - bone, fibrous, cartilage
location
unique features
what is advantage of conventional radiography
non invasive
what percent of bone needs to be diminished in order to observe it on xray
30-50%
how long may it take to visualize osteomyelitis in peripheral bone in xray
10-14 days
occult fracture - 7-10 days
spinal osteomyelitis - 21 days
aggressive tumors - 4-6 weeks
what agent is used for radionucleotide bone scan
technetium methylene disphosphate
what is the difference between enchondral, intramembranous, and appositional bone formation
enchondral - develops from cartilage, requires cartilaginous template, forms the physis or growth plate, forms most of skeleton, controls bone lengthening
intramembranous - develops from mesenchyme/connective tissue, no cartilage stage, forms the flat bones, mandible. skull, clavicle
appositional - controls width of the bone via periosteal activity
what are characteristics of different layers of bone
periosteum - surrounds bone except at ends, not seen on imaging unless inflamed or pathology present
epiphysis - located at ends of long bones, preformed cartilage slowly ossifies, supports joints
apophysis - sites of muscle attachment
physis - growth plate, area of maturing cartilage that develops into bone, trauma alters growth
zone of provisional calcification - radiopaque band on either side of physis, calcification to mature bone, disease may alter and arrest growth forming harris growth arrest lines
metaphysis - most metabolic active portion of bone, most common area for tumors and infection, contains trabeculae that bears stress and weight
diaphysis - shaft of bone, thick cortex with decreased medullary cavity
what diseases affect the metaphysis
mutiple myeloma ewings sarcoma NHL adamantinoma infection
most common location for tumor inside a bone
metaphysis
metabolically active
diaphyseal tumors indicates what kind of disease
bone marrow disease
what is difference between wide and narrow zone of transition
what does each indicate
wide - little or no sclerosis around it - indicates malignancy
narrow - sharp sclerotic rings around it - indicates benign
what is difference between moth eaten and permeative
moth eaten is larger multiple irregular holes in bone - 2-5 cm
permeative is tiny multiple pinholes in bone - very aggressiv and rapidlly forming
describe geographic lesions
circumscribed
solitary and uniform
sharp margin - narrow zone of transition
soap bubbly or septated
what tumors contain permeative lesions
what tumors contain moth eaten lesions
ewings sarcoma
NHL
MM
MM
mets
what tumors contain osteoblastic lesions
blastic mets - MC - have history of cancer (prostate)
osteosarcoma
pagets disease
how long does it take before a periosteal reaction will show up in imaging after stimulus
10-21 days
what are examples of periosteal reactions
solid - benign
laminated - called onion skin appearance, alternating lucent and opaque areas, slow and aggressive tumors
spiculated - aka sunburst reaction, perpendicular brushed whiskers, highly aggressive tumor
laminated periosteal reaction is seen in what tumor
ewings sarcoma
onion skin
how is codmans triangle formed
subperisoteal extension of the lesion
what are the following lab tests for
CBC ESR CRP serum calcium serum phosphorus alkaline phosphatase acid phosphatase total protein
CBC - infection
ESR - inflammation
CRP - inflammation - better
serum calcium - indicates lytic bone destruction or PTH dysfunction
serum phosphorus - indicates lytic bone destruction
alkaline phosphatase - indicates osteoblast activity
acid phosphatase - prostate - increased with gauchers and mets
total protein - mets or MM - IgG spike and BJ proteins in urine
alkaline phosphatase helps indicate what 3 diseases
pagets
mets
lymphoma
what is endosteal scalloping
thinning of cortex along endosteal surface of bone
slow growing medullary lesions
what are the radiographic densities to dark to light
dark- lucent - air fat water bone metal - light - opaque
what imaging should always be performed first
what views
xray
2 perpendicular views
how big does the lesion have to be before it is seen on xray
1-5 cm
when is special imaging indicated
when patient isnt 50% better after 2 weeks
what imaging uses iodinated contrast
discography
inject into IVD to recreate pain to determine level causing pain
bone scan is good for detecting what
what cant it detect
mets tumors infection arthritis fractures AVN
cant detect MM - no osteoblast activity
bone scans are __ but not __
sensitive
but not specific
bone scans can detect __ % of bone destruction
how many times more sensitive than xray
3-5%
10x
what are the advantages and disadvantages of ultrasound
advantages - good for msk, abdomen, vascular, cyst, guided biopsy
disadvantage - operator dependent and long learning curve
what imaging uses mutiplanar reconstruction of images
CT
what are advantages and disadvantages of CT
advantages - bone detail and very quick
disadvantage - high radiation
what are advantages and disadvantages of MRI
advantages - soft tissue, no radiation, sensitive to marrow, good for spinal disease and discs
disadvantage - claustrophobia, noisy, metallic clips or implants, expensive
what is high intensity and what is low intensity on t1 and t2 MRI
t1
- high - bone marrow/fat
- low - csf, edema, infection
t2
- high - csf, edema, infection
- low - bone marrow/fat
what tumors occur in the epiphysis
what tumors occur in the diaphysis
epiphysis - chondroblastoma, giant cell, CMF
diaphysis - ewings sarcoma, EG, lymphoma
