Boards Study Flashcards
(105 cards)
1
Q
Endothelin 1 has a role in:
A
osteoblastic tumor mets
2
Q
genetic mutation in McCune Albright
A
G alpha subunit
3
Q
Occult lytic bone mets with no known primary are typically:
A
lung
4
Q
do radiation and chemo work for chondrosarcomas?
A
no
- EXCEPT for Dedifferentiated Chondrosarcoma
5
Q
most likely site of mets?
A
spine
6
Q
most like site of pathologic fracture
A
proximal femur
7
Q
when you nail a pathologic fracture of the hip, which zones get radiation
A
the entire femur, because you spread the metastatic disease through the entire canal
8
Q
depth-related resection guidelines for acral lentiginous melanoma
A
> 4mm depth is full ray amputation
<0.76mm is disarticulation
9
Q
treatment of enchondromas of the digits?
A
can be treated with curettage and bone grafting
10
Q
E-cadherin and Integrins in tumor cells:
A
E-cadherin decreases and allow migration from tumor of origin
Integrins increase and establish foci of metastasis
11
Q
Maffucci syndrome
A
multiple enchondromas and hemangiomas
12
Q
surgery for lymphomas typically involves:
A
intramedullary stabilization. that’s basically all.
13
Q
chondroblastoma metastatic potential
A
can met to lungs in 2%
14
Q
Survival rates of localized osteosarcoma
A
65-70%
15
Q
most common axial site of a giant cell tumor
A
sacrum
16
Q
most common sites of metastatic osteosarcoma
A
- lung (get CT chest)
- bone
17
Q
Treatment of osteosarcoma
A
chemotherapy and wide resection
18
Q
Treatment of chondrosarcoma
A
wide resection alone
19
Q
All soft tissue sarcomas show this on MRI:
A
low T1 signal
high T2 signal
20
Q
CD99+ immunohistochemistry means:
A
tumor is Ewing’s sarcoma
21
Q
Enneking / MSK Tumor Society Classification
A
I = low grade II = high grade III = metastatic
A = intra-compartmental B = extra-compartmental
22
Q
Low grade sarcomas: (all stage I tumors)
A
- parosteal osteosarcoma
- well differentiated intramedullary osteosarcoma
- intramedullary chondrosarcoma
- chordoma
- adamantinoma
- secondary chondrosarcomas (MHE, Ollier’s)
Treat with wide resection alone
23
Q
High grade sarcomas (all stage II tumors)
A
- conventional osteosarcoma
- Ewing’s
- Dedifferentiated chondrosarcoma
- Malignant fibrous histiocytoma
- Secondary sarcomas (Paget’s, Irradiation, Bone infarc)
Treat with chemo and wide resection
24
Q
Lesions in the tibia
A
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.
