Bone Path II Quiz 1

Question 1

DDX: Young Adult (<40) With Primary Malignant Tumor

Answer 1

Osteosarcoma (10-25)
Ewings Sarcoma (10-25)

Giants Cell Tumor (20-40)
Parosteal Osteosarcoma (30-50)
Non-Hodgkins Lympoma (20-50)

Question 2

Most Common Primary Bone Malignancies

Answer 2

Multiple Myeloma (most)
Osteosarcoma
Chondrosarcoma
Ewings Sarcoma

Question 3

DDX: >40 Lytic

Answer 3

METS!
Multiple Myeloma (multiple)

Question 4

Is osteosarcoma lytic or blastic?

Answer 4

50% Sclerotic
25% Lytic
25% Mixed

Question 5

What is the most aggressive form of osteosarcoma?

Answer 5

Lytic

Question 6

Primary Malignant bone tumors that like the Epiphysis

Answer 6

Giant Cell (metaphysis/diaphysis)
Clear Cell Chondrosarcoma
Fibrosarcoma

Question 7

Expansile/ Soap Bubbly Lesions

Answer 7

Solitary plasmacytoma
Fibrosarcoma
Giant Cell Tumor

Question 8

Pt with primary bone maligancy that is 10-25 years old. DDX

Answer 8

Osceosarcoma

Ewings Sarcoma

Question 9

Pt that is 25-35 DDX

Answer 9

Giant Cell Carcinoma

Hodgkin’s Lymphoma

Question 10

What is the most common cause of a missing pedicle?

Answer 10

Mets

Question 11

Where does Mets like to go in bone?

Answer 11

Spine (40%)
Axial skeleton
Skull
Proximal extremities

Question 12

What labs can you run to check for Mets?

Answer 12

ESR
Serum Ca (lytic)
Alk Phos (blastic)

Question 13

DDX for Ivory Vertebra

Answer 13

Osteoblastic Mets
Pagets
Hodgkins

Question 14

What would you treat with to inhibit osteoclast activity?

Answer 14

Biphosphates

Question 15

What is the most common symptom of MM?

Answer 15

Bone pain #1

Systemic Symptoms

Question 16

What is the age group for MM?

Answer 16

50-70

Question 17

How do you diagnose MM?

Answer 17

Elevated Serum Proteins= Reversed A/G Ratio (G>A)

Question 18

Where does MM like to go?

Answer 18

Humerus, Femur, Diaphysis, Spine, Skull (same as mets)

Question 19

What does MM look like on x-ray?

Answer 19

Multiple Punched out lytic lesions.

Question 20

If its looks like mets, but there is one one lesions, what do you suspect?

Answer 20

Solitary Plasmacytoma

Question 21

What do Solitary Plasmacytomas look like on x-ray?

Answer 21

Lytic
Expansile
Soap Bubbly

Question 22

What age group does Osteosarcoma affect?

Answer 22

10-25

Question 23

Where do you most often see Osteosarcoma in bones?

Answer 23

Metaphysis of long bones.

Question 24

What does osteosarcoma look like on x-ray?

Answer 24

Cortical disruption
Spiculated
ST mass
Cumulus Cloud
Lytic 25% (more aggro) 
Blastic 50%

Question 25

What ancillary study do you use to plan treatment in Osteosarcomas?

Answer 25

MRI

Question 26

What ancillary study do you use to scan for mets with Osteosarcoma?

Answer 26

CT/Bone Scan

Question 27

Can you use bone scan to look for MM?

Answer 27

No- doesnt show up

Question 28

Where is mets most common from Osteosarcoma?

Answer 28

Lung (Cannonball mets)

Question 29

Dense mass with stalk to cortex and no periosteal response. DDX

Answer 29

Parosteal Osteosarcoma Myositis ossificans (no stalk)

Question 30

What age group do Parosteal Osteosarcomas affect?

Answer 30

30-50

Question 31

What is the most common primary malignancy of hand, sternum, scapula?

Answer 31

Chondrosarcoma

Question 32

Where do you most commonly find Chondrosarcomas?

Answer 32

``` Pelvis Prox femur Prox humerus Ribs Scapula Knee Craniofascial bones. ```

Question 33

What do Chondrosarcomas look like on x-ray?

Answer 33

Large Lytic Popcorn stippled calcifications Can have large ST mass

Question 34

What age group are chondrosarcomas found in?

Answer 34

40-60

Question 35

Where is long bones do you find Chondrosarcomas?

Answer 35

Metaphysis (most) | Diaphysis (some)

Question 36

Where do you find Clear Cell Chondrosarcomas?

Answer 36

Epiphysis

Question 37

What age groups do Ewing Sarcomas affect?

Answer 37

10-25

Question 38

What are the symptoms Ewing Sarcomas?

Answer 38

Pain and swelling | Looks like an INFECTION

Question 39

In what part of bone do you most commonly find Ewing Sarcomas?

Answer 39

Diaphysis

Question 40

Are Ewing Sarcomas well defined?

Answer 40

No, wide zone of transition

Question 41

Does Ewing Sarcomas have a good prognosis?

Answer 41

No, often amputation if found

Question 42

Where do you most commonly find Fibrosarcomas?

Answer 42

Knee (50%)

Question 43

Do Fibrosarcomas have a periosteal response?

Answer 43

No, but they do have a large ST mass

Question 44

What is the treatment of choice for Fibrosarcomas?

Answer 44

Amputation

Question 45

Is the pronosis good for Fibrosarcomas?

Answer 45

No

Question 46

What is the msot common ST sarcoma in adjults?

Answer 46

Malignant Fibrous Histocytoma (MFH)

Question 47

What do Malignant Fibrous Histocytomas look similar to on x-ray?

Answer 47

Fibrosarcomas

Question 48

Where in the body are Chordomas most commonly found?

Answer 48

Sacrococcyggeal and Spheno-occipital regions.

Question 49

Is mets common with Chordomas?

Answer 49

No

Question 50

What are the symptoms in Chordomas most often from?

Answer 50

The mass of the tumor affecting surrounding tissues.

Question 51

Chodomas are lytic/blastic?

Answer 51

Lytic

Question 52

What age group does Non-Hodgkins Lympomas affect?

Answer 52

20-50

Question 53

Are Non-Hodgkin's Lympoma pts healthy?

Answer 53

Usually, Yes

Question 54

Where is Non-Hodgkins Lympomas usually found?

Answer 54

Femur, Tibia, Humerus

Question 55

What does Non-Hodgkins Lymphomas look like on x-ray

Answer 55

Permeative (moth eaten) Lytic Minimal Periosteal Response

Question 56

What is the most common symptom of Hodgkins Lympoma?

Answer 56

Pain

Question 57

Where is Hodgkins Lympomas most common?

Answer 57

Verteba

Question 58

What does Hodgkins looks like in vertebra?

Answer 58

Ivory Vertebra Poss exuberant peristeal response

Question 59

What age group does Synovial Sarcomas affect?

Answer 59

30-50

Question 60

Are Synovial Sarcomas painful?

Answer 60

Yes

Question 61

What do Synovial Sarcomas look like on x-ray?

Answer 61

Calcification in 1/3 | Speckled

Question 62

How do you treat Synovial Sarcomas?

Answer 62

Excitation (mod good prognosis)

Question 63

What ancillary study do you use to check Synovial Sarcomas?

Answer 63

MRI