Basic Science Flashcards
(157 cards)
1
Q
Benign bone tumour, bony outgrowth which cartilaginous cap
A
Osteochondroma
2
Q
Where do osteochondromas typically occur?
A
Epiphysis of long bones, esp around the knee
3
Q
Benign bone tumour, intramedullary metaphyseal cartilaginous tumour
A
Enchondroma
4
Q
Symptoms of enchondroma
A
Asymptomatic
5
Q
Appearance of bone in enchondroma
A
Usually lucent but may be patchy sclerotic
6
Q
Where does enchondroma occur?
A
Tubular bones of hands and feet typically
7
Q
How is an encondroma treated?
A
Scraped out
8
Q
Benign bone tumour, solitary unicystic fluid filled neoplasm
A
Simple bone cyst
9
Q
What causes a simple bone cyst?
A
Growth defect from physis
10
Q
Where do simple bone cysts occur?
A
Metaphysis of long bones - usually proximal femur and humerus
11
Q
Symptoms of simple bone cysts
A
Asymptomatic
12
Q
Treatment of simple bone cyst
A
Curettage with bone graft +/- stabilisation
13
Q
Benign bone tumour, locally aggressive, painful
A
Giant cell tumour
14
Q
Where do giant cell tumours commonly occur?
A
Distal radius, knee, pevlix and spine
15
Q
Which mutation is a/w a giant cell tumour?
A
Translocation between chromosome 1 and 2
16
Q
How does a giant cell tumour appear on x-ray?
A
“soap bubble appearance”
17
Q
Where may giant cell tumour metastasise to ?
A
Lung
18
Q
How is a giant cell tumour treated?
A
Excision with phenol/bone cement/liquid nitrogen
19
Q
Disease of the bone in adolescence, causes shepherd’s crook deformitiy
A
Fibrous dysplasia
20
Q
What is the mutation in fibrous dysplasia?
A
Genetic mutation in G protein signalling
21
Q
Where does fibrous dysplasia commonly affect?
A
Head and neck
22
Q
What is polystotic fibrous dysplasia a/w?
A
Endocrine disorders
23
Q
How is fibrous dysplasia treated?
A
Bisphosphonates for pain, stabilised fractures with internal fixation and cortical bone grafts
24
Q
Why is intralesional excision not performed in fibrous dysplasia?
A
High recurrence rate
25
Benign bone tumour, small nidus of immature bone surrounded by a sclerotic halo, occurs in adolescence
Ostoid osteoma
26
Where is an osteoid osteoma common?
Proximal femur, diaphysis of long bones and vertebrae
27
Describe the pain in ostoid osteoma
Intense, constant, worse at night and relieved by NSAIDs
28
Describe the pain of an ostechondroma
Local pain
29
Describe the pain level of a giant cell tumour?
Painful
30
How is osteoid osteoma investigated?
X-Ray and CT
31
How is osteoid osteoma treated?
May spontaneously resolve
| May need CT guided radiofrequency ablation
32
Which tumour is a/w hyperparathyroidism?
Brown tumour
33
Most common malignant bone tumour
Osteosarcoma
34
What mutation is a/w osteosarcoma?
Mutation in tumour suppressor retinoblastoma gene
35
Where are osteosarcomas commonly found?
Knee, proximal femur and pelvis
36
Where does an osterosarcoma metastasise to?
Blood, not lymph
37
Cartilage producing primary malignant bone tumour
Chondrosarcoma
38
What is the mean age to present with a chondrosarcoma
45
39
Where is a chondrosarcoma often found?
Pelvix or proximal femur
40
What is an issue in treating chondrosarcoma
Not radiosensitive or responsive to chemotherapy
41
Who gets Ewing's sarcoma?
Teenagers
42
Where do Ewing's sarcomas usually occur?
Long bones, femur
43
Malignant bone tumour, small round blue cell tumour
Ewing's sarcoma
44
What mutation is a/w Ewing's sarcoma?
t11;22 translocation on EWS gene on chromosome 22
45
How does Ewing's sarcoma present?
Fever, raised inflammatory markers and warm swelling
46
When bone tumours are excised what margin around them is taken ?
3-4cm
47
Malignant cancer of round cells of the lymphocytic system and macrophages
Lymphoma
48
How is lymphoma treated?
Surgical resection
49
What is the mean survival with lymphoma?
<2 years
50
Malignant tumour from bone marrow
Myeloma
51
What is a solitary myeloma lesion called?
Plasmacytoma
52
What does a myeloma do?
Produce abnormal proteins which deposit in organ sites (amyloidosis)
53
Which age group gets myeloma?
45-65
54
How does myeloma present?
Weakness, back pain, bone pain, fatigue, weight loss and marrow suppression
55
How is myeloma diagnosed?
Plasma protein electrophoresis showing high paraprotein
| Early morning urine for protein assay
56
How is myeloma treated?
Solitary - radiotherapy
| Mulitple - chemotherapy
57
Which cancers commonly metastasise to bone?
Breast, prostate, lung, renal and thyroid
58
What are the mets like from breast cancer?
Blastic or lytics
59
Mean survival of breast cancer with bone mets?
24-26 months
60
Mean survival of lung cancer with bone mets
6 months
61
Mean survival of renal cell cancer with multiple mets?
12-18 months
62
How is fracture risk reduced in prostate cancer with bone mets?
Radiotherapy and hormone manipulation
63
What makes a soft tissue swelling more likely to be benign?
Small, fluctuation in size, cystic, well defined and soft
64
What makes a soft tissue swelling more likely to be malignant ?
Large (>5cm), rapidly growing, ill defined, solid
65
What is a lipoma?
Benign tumour in fat
66
What is a leiomyoma?
Benign tumour in smooth muscle
67
What is a chondroma?
Benign tumour in cartilage
68
What is a rhabdomyoma?
Benign tumour in skeletal muscle
69
What is a neuroma?
Benign tumour in nerve cells
70
Benign tumour in haemangioma?
Benign tumour in blood vessels
71
Small firm swelling on the flexor tendon sheath
Giant cell tumour of the tendon sheath
72
What is a complication of a giant cell tumour of the tendon sheath?
May erode bone
73
What does a giant cell tumour of the tendon sheath contain?
Multinucleated giant cells and haemosiderin
74
Which is excision not carried out?
High recurrence rate
75
What is pigmented villonodular synovitis?
Giant cell tumour in a joint
76
What is a sarcoma?
Malignant soft tissue tumour
77
What is an angiosarcoma?
Malignant tumour from blood vessels
78
What is cause of angiosarcoma?
Complication of previous radiotherapy
79
What is a liposarcoma?
Malignant tumour of fatty tissue
80
Where does a liposarcoma occur?
In deep fatty tissue
81
What is a rhabdomyosarcoma?
Malignant tumour of skeletal muscle
82
Where are synovial sarcomas common?
Around the knee
83
What are the two phases of a synovial sarcoma?
Sacromatous and epithelial
84
Swelling around a synovial joint or tendon sheath
Ganglion cyst
85
Why do ganglion cysts occur?
From weakened parts of the sheath or capsule, leading to out-pouching/herniation
86
How does a ganglion cyst appear?
Well defined, firm, transiluminate
87
Why is a ganglion cyst not really cystic?
Does not have an epithelial lining, only a fibrous wall
88
Swelling of the bursa following repeated pressure or trauma
Bursitis
89
Where is bursitis common?
Pre-patellar, olecranon, bunions
90
What can cause bursitis other than trauma?
Infection, gout
91
How is bursitis treated?
Inflammation spontaneously resolves, thickened bursal sac may remain and require excision
92
Painless, epidermal inclusion cysts
Sebaceous cysts
93
What lined an epidermal inclusion cyst?
Epithelium producing keratin
94
Swelling which is a collection of neutrophils, infective and cellular debris +/- infecting organisms
Abscess
95
How is an abscess treated?
Incision and drainage
96
What is a psuedotumour?
Swellings which mimic tumours but are actually reactive/inflammatory
97
Which process occurs in a pseudotumour?
Myositis ossificans
98
What is myositis ossificans
Unusual reaction to injury causing progressive ossification of a site
99
What is nodular fasciitis?
Rapid growth of lesion after trauma
100
What groups are at risk for AVN?
Alcohol and steroid abusers
101
What ratio does alcohol metabolism increase?
NADH : NAD
102
How does AVN appear?
Large wedge shaped area of discolouration, no osteocytes
103
What is creeping substitution?
Dead bone is slowly encircled by new, viable bone
104
What can cause AVN?
Primary hyperlipidaemia
Increased coagulation
Caisson's disease
105
What is Caisson's disease?
When nitrogen gas bubbles form in the body after too rapid a depressurisation in deep sea diving
106
How is AVN treated?
Early: drilling under fluoroscopy
Surface collapse: joint replacement
Fusion in foot/ankle
107
What does drilling under fluoroscopy do?
Compress the bone, prevent necrosis and encourage healing
108
What is osteochondritis?
Developmental derangement of normal bone growth with inflammation
109
What causes osetchondritis?
Increased physical activity and repetitive stress, FH important
110
What is the pathogenesis of osteochondritis?
Impact/traction injuries cause bleeding and oedema in bone
Capillary compression
Necrosis
There is fragmentation and separation of the bone
111
What is osteochondritis dissecans?
Osteochondritis which results in separation of the bone
112
Where is osteochondritis dissecans common?
Lateral part of medial condyle in the knee
Anteromedial talar dome
Superomedial femoral head
Humeral capitellum
113
What is Freiburg's disease?
Osteochondritis in 2nd metatarsal head
114
What is Kohler's disease?
Osteochondritis in navicular bone
115
What is Kienbock's disease?
Osteochondritis in lunate or carpal bone
116
What is Scheuermann's disease
Osteochondritis in the capitellum of the elbow
117
What is Osgood Schlatter disease?
Traction Osteochondritis at the tibial tubercle
118
What is Sever's disease?
Osteochondritis at the calcaneus?
119
How it Osteochondritis dissecans treated?
Surgical realignment of the bone, OC dissecans pin or removal of unstable fragments
120
What is osteoporosis?
Reduced bone mineral density and increased pores causing increased fragility and fracture risk
121
What is the definition of osteoporosis?
Bone density 2.5 standard deviations below the mean of a young adult of the same race and gender
122
What is the definition of osteopenia?
Bone density 1-2.5 standard deviations below the mean of a young adult of the same race and gender
123
What is type 1 osteoporosis?
Post-menopausal
124
What are risk factors for type 1 osteoporosis?
Caucasian, smoking, alcohol, lack of exercise and poor diet
125
What is type 2 osteoporosis?
Osteoporosis of old age where bone density decreases by further than expected
126
What are the risk factors for type 2 osteoporosis?
Caucasian, smoking, alcohol, lack of exercise, poor diet, reduced sunlight/vit D and chronic disease
127
Which fractures are common with osteoporosis?
Femoral neck and vertebral
128
Which drugs can cause osteoporosis?
Corticosteroid
129
How is osteoporosis diagnosed?
DEXA scan
130
How is osteoporosis treated?
Vit D, calcium, bisphosphonates, desunomab, strontium
131
Which is intranasal calcitonin not used?
No benefit over other treatments and a risk of cancer
132
What are the risks of HRT and raloxifene?
HRT - breath and endometrial cancer as well as DVT
| Raloxifene - DVT
133
What is osteomalacia?
Qualitative defect in bone resulting in abnormal softening due to deficient mineralisation of immature bone
134
What is Rickett's?
Osteomalacia in kids
135
What are the two main causes of osteomalacia?
Insufficiet calcium absorption or vit D resistance
| Phosphate deficiency due to renal losses
136
Which medications are a/w osteomalacia?
Anti-convulsants
137
What are the genetic causes of osteomalacia/Rickett's?
X-Linked hypophosphataemia
| Vit D resistant Rickett's
138
How does osteomalacia present? (9)
Bone pain, deformity, fracture, paraesthesia, muscle cramp, irritability, seizures, brittle nails, faitgue
139
What are Looser's zones?
Psuedofractures
140
Where are Looser's zones found in osteomalacia?
Pubic rami, proximal femur, ulna and ribs
141
What are the biochemical findings of osteomalacia?
Low calcium, low serum phosphate, high serum alkaline phosphatase
142
How is osteomalacia treated?
Vit D therapy and supplementation
143
What is hyperparathyroidism?
Overactivity of the thyroid glands, producing lots of PTH
144
What can cause hyperparathyroidism?
Benign adenoma, hyperplasia or malignant neoplasia
145
How does hypercalcaemia present? (9)
Fatigue, depression, bone pain, myalgia, nausea, thirst, polyuria, renal stones, osteoporosis
146
What are the biochemical findings of hyperparathyroidism?
Serum PTH and calcium igh, phosphate normal or low
147
What is secondary hyperparathyroidism?
Overproduction of PTH in response to hypocalcaemia from vit D deficiency or CKD
148
What is tertiary hyperparathyroidism?
When adenomas develop in secondary HPT
149
How does hyperparathyroidism affect the bones?
Cause fragility fractures or lytic lesions
150
How is hyperparathyroidism treated?
Remove adenoma or give supplements - obvs based on underlying cause
151
How is very high serum calcium treated?
IV fluids, bisphosphonates and calcitonin
152
What is renal dystrophy?
Bone changes due to CKD
153
What affect does Paget's disease have on the bones?
Chronic thickened, brittle and misshapen bones
154
How common is Paget's disease
5% over 55
| 10% over 80
155
Which viruses is Paget's disease a/w?
Paramyxoviruses, incl parainfluenza and mumps
156
What is the pathogenesis of Paget's disease?
Exaggerated vit D response causes increased osteoclast activity
Osteoblasts try to keep up but make shit bone basically
157
How is Paget's disease treated?
Bisphosphonates or calcitonin given if there is extensive lytic disease
Joint replacement
Stabilise fractures with intramedullary nails or plates
