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Flashcards in Boards Study Deck (105):
1

Endothelin 1 has a role in:

osteoblastic tumor mets

2

genetic mutation in McCune Albright

G alpha subunit

3

Occult lytic bone mets with no known primary are typically:

lung

4

do radiation and chemo work for chondrosarcomas?

no
- EXCEPT for Dedifferentiated Chondrosarcoma

5

most likely site of mets?

spine

6

most like site of pathologic fracture

proximal femur

7

when you nail a pathologic fracture of the hip, which zones get radiation

the entire femur, because you spread the metastatic disease through the entire canal

8

depth-related resection guidelines for acral lentiginous melanoma

>4mm depth is full ray amputation
<0.76mm is disarticulation

9

treatment of enchondromas of the digits?

can be treated with curettage and bone grafting

10

E-cadherin and Integrins in tumor cells:

E-cadherin decreases and allow migration from tumor of origin

Integrins increase and establish foci of metastasis

11

Maffucci syndrome

multiple enchondromas and hemangiomas

12

surgery for lymphomas typically involves:

intramedullary stabilization. that's basically all.

13

chondroblastoma metastatic potential

can met to lungs in 2%

14

Survival rates of localized osteosarcoma

65-70%

15

most common axial site of a giant cell tumor

sacrum

16

most common sites of metastatic osteosarcoma

- lung (get CT chest)
- bone

17

Treatment of osteosarcoma

chemotherapy and wide resection

18

Treatment of chondrosarcoma

wide resection alone

19

All soft tissue sarcomas show this on MRI:

low T1 signal
high T2 signal

20

CD99+ immunohistochemistry means:

tumor is Ewing's sarcoma

21

Enneking / MSK Tumor Society Classification

I = low grade
II = high grade
III = metastatic

A = intra-compartmental
B = extra-compartmental

22

Low grade sarcomas: (all stage I tumors)

- parosteal osteosarcoma
- well differentiated intramedullary osteosarcoma
- intramedullary chondrosarcoma
- chordoma
- adamantinoma
- secondary chondrosarcomas (MHE, Ollier's)

Treat with wide resection alone

23

High grade sarcomas (all stage II tumors)

- conventional osteosarcoma
- Ewing's
- Dedifferentiated chondrosarcoma
- Malignant fibrous histiocytoma
- Secondary sarcomas (Paget's, Irradiation, Bone infarc)

Treat with chemo and wide resection

24

Lesions in the tibia

adamantinoma
osteofibrous dysplasia
fibrous dysplasia
osteomyelitis

25

S100, CD1A immunostains

Langerhans cell histiocytosis (eosinophilic gran)

26

Keratin immunostain

Metastatic cancer
Adamantinoma

27

CD20 (b cell) immunostain

lymphoma

28

CD99 immunostain

Ewing's

29

Keratin, S100 immunostain

Chordoma

30

CD138 immunostain

Myeloma

31

Only tumors you aspirate and inject cortisone

EOG
UBC

32

Tumors you curettage

- giant cell tumor
- ABC
- NOF
- chondroblastoma

33

Tumors that get Chemo

- high grade osteosarcoma
- Ewing's tumor
- Mets

any high grade tumor

34

Mechanisms of Radiation therapy

production of free radicals
direct genetic damage

35

Tumors treated with Bisphosphonates

- Metastatic bone disease
- Myeloma
- Paget's disease
- Polyostotic fibrous dysplasia

36

When do you give a bisphosphonate holiday?

after 5-8 years

37

If mets distal to elbow or distal to knee we should think:

lung carcinoma

38

Everything malignant in bone is (MRI findings):

Low T1 signal
HIgh T2 signal

39

IF Hgb low and ESR high, think:

myeloma

40

Criteria for internal fixation of an osseous lesion

>50% cortical destruction
high stress site
purely lytic pattern
weight bearing pain
pain following irradiation

41

after you prophylactically fix a metastatic lesion, you must:

GIVE RADIATION
- every single patient

also give denosumab or bisphosphonate

42

Bence jones proteins

light chains (kappa or lambda) release into the urine in multiple myeloma

43

systemic complications of myeloma:

- hypercalcemia
- nephropathy
- anemia

44

If Hgb <12 and ESR >50, think:

multiple myeloma

45

Characteristic xray findings of lymphoma:

long lesions
- can involve over 50% of bone length in the appendicular skeleton

46

when there is hyaline cartilage in the medullary cavity, ti is either:

enchondroma (not growing)
chondrosarcoma (growing)

47

Common secondary sarcomas:

- paget's
- post irradiation
- sarcoma in a bone infarct

48

Geographic pattern of Paget's disease:

caucasians of Anglo-saxon descent
- europe
- north america
- australia
- new zealand

49

bone disease caused by Paramyxovirus infection:

Paget's disease
- long subclinical course
- disease localized to single organ system
- intranuclear virus capsid-like structures

Nuclear inclusion within the osteoclasts

50

Viruses implicated in Paget's

- RSV
- Paramyxovirus
- Canine virus (?)

51

Lab findings in Paget's

- elevated serum alk phos
- elevated urine collagen breakdown products
--- N-telopeptide
--- Hydroxyproline

52

most common types of post-radiation sarcomas:

- MFH
- osteosarcomas

53

Enchondroma on MRI

Low T1
High T2

54

Bone islands on MRI

Low T1
Low T2

55

Osteopoikilosis

multiple areas of bone islands

56

Most frequently presenting stage of osteosarcoma:

Enneking II B

57

poor prognostic factors for treatment of osteosarcoma:

- mets at presentation
- skip lesions in single bone
- post-treatment necrosis of <90%

58

IF you see a young person with malignant appearing tumor with chondroid appearance on histo, think:

osteosarcoma
- periosteal
- parosteal
standard subtype

59

Ewing's Treatment:

chemo sandwich

60

poor prognostic factor for Ewing's?

post chemo necrosis of <95%

61

Where will you see UBC?

proximal humerus
proximal femur

nowhere else

62

Treatment of UBC in proximal humerus

injection of methylprednisolone

63

Treatment of UBC in proximal femur

curettage, bone graft, internal fixation

64

Histology of Osteoblastoma:

loose fibrovascular connective tissue with OSTEOBLASTIC RIMMING

65

Most common benign tumor to go to the lungs

Giant cell tumor (2%)

66

Recurrence rates of curettage of a UBC:

High - around 70% in some series

67

What is responsible for low T1 and T2 signal in PVNS?

Hemosiderin

68

When you see periarticular erosions on both sides of a jont, you should think:

primary synovial process
- PVNS
- RA
- infection

69

Rheumatoid nodules show up on:

extensor surfaces

70

Gout crystals:

negatively birefringent
needle shaped

71

Lymph nodes soft tissue mets:

CARES
- clear cell
- angiosarc
- rhabdomyosarc
- epithelioid sarc
- synovial sarc

72

Epithelioid sarcoma stains with:

Keratin!!!! Strongly Keratin +

73

Denosumab

- RANK-L monocloncal Ab
- give for myeloma or metastatic disease or osteoporosis

74

Osteoblast markers

Vitamin D
Osteocalcin
RANKL
Alkaline phosphatase
TGF-b
BMPs

75

Osteoclast Markers

RANK receptor
Acid phosophatase
Cathepsin K
Calcitonin
A/B integrin receptor

76

Istotropic nature of woven bone

mechanical characteristics are independent of direction of loading

77

In children, woven bone allows for:

resistance to fracture

78

What kind of bone is seen in fibrous dysplasia

GNAS mutation
- inability to form mature bone
- ALL Woven Bone

79

By age 2, most bone is:

Lamellar bone

80

Anisotropic nature of lamellar bone

mechanical properties of bone are dependent upon directionality of loading

81

Gene mutation for Melorrheostosis

LEMD3

82

Role of TGFb and BMPS in bone formation

osteoclasts eliminate bone and releases TGFb and BMP
- TGFb recruits mesenchymal stem cells
- BMPs turn these into osteoblasts

83

What are the coupling factors for bone resroption and bone creation:

TGF-b and BMP

84

Fibro-osseous Dysplasia

ACVR1
shoulder contractures
shortened first rays
Mineralization of the soft tissues

DO NOT OPERATE - they turn to stone

85

Overactivity of TGFb is:

Camarati Engelman Disease
- thicknening of the diaphyses (diaphyseal dysplasia)

86

RUNX2

Master regulator of the osteoblast
- mutation here = Cleidocranial Dysplasi

87

SOX9

transcription factor for cartilage

88

PPAR gamma

transcription factor for fat

89

Transcription factors for bone:

RUNX2
Osterix

90

Sclerostin

secreted by osteocytes
inhibits bone formation

91

high mechanical stresses will do waht to sclerostin levels?

will DROP sclerostin levels
- will increase if you cast someone, or otherwise unload the bones

92

TRAP does what:

helps acidify the matrix to resorb it

93

These chemical signals tell a bone to resorb:

- PTH
- Vitamin D
- Prostaglandin E

94

Bone chemical composition:

Ca10 P4 (6) - OH2

95

What is the only collagen which mineralizes?

Type I

96

What osteoblast secretion factor controls insulin secretionin the pancreas?

Osteocalcin

97

Recommmndation of daily calcium/D supplements

- 1200 mg caclcium
-800mg D

98

Female athlete triad:

Decreased available energy
Disturbed Menses
Decreased bone mineral density

Treatment is: make the girls eat

99

3 Gene defects for osteoporisis

- Vitamin D receptor
- LDRP5
- COL1 gene

100

Inflammatory phase of fx healing: Growth Factors

- PDGF
- TGFB
- IL1, 6
- PGE2

101

Soft Callus Phase of Fx healing: Growth Factors

SOX9 --> COL2
Indian Hedgehog

102

Hard Callus Phase of Fx Healing: Growth Factors

Type X Collagen
RUNX2 --> Osteocalcin (osteoblasts)
Osteopontin

103

Characteristics of secondary chondrosarcoma following an osteochondroma:

low grade
curable with resection alone
<1% of the time

104

Workup of a bone sarcoma should include:

chest CT
- rarely need Abdomen or Pelvis due to extremely rare mets to viscera

105

A marginal resection is defined as

Through the margin and reactive zone of the tumor. Or through the pseudo capsule. Microscopic disease may be found here.