Cheung Part 1

Question 1

what are the 5 most common primary bone tumors that metastasize to bone

Answer 1

"BLT with a Kosher Pickle"
Breast
Lung
Thyroid
Kidney
Prostate

Question 2

what is the difference between the T and Z score

Answer 2

Z score is age matched

T score is compared to 25 yo female

Question 3

musculoskeletal tumors come from what tissue

Answer 3

mesodermal (connective tissue like bone, fat, muscles)

Question 4

musculoskeletal tumors are likely to metastasize to

Answer 4

the lung

Question 5

what shows up radio opaque on an X-ray

Answer 5

bones
some soft tissue
hardware

Question 6

what shows up radio-lucent on X-ray

Answer 6

air
sutures
ligaments

Question 7

oblique X-ray of foot is at what angle

Answer 7

15 degrees

Question 8

what type of break takes the lowest amount of energy to create

Answer 8

spiral

Question 9

what type of break takes the most amount of energy to create

Answer 9

comminuted

Question 10

what type of break goes straight across the bone

Answer 10

transverse

Question 11

what type of break goes across the bone at an angle

Answer 11

oblique

Question 12

over the age of 40 bone tumors are most likely what

Answer 12

metastatic

Question 13

growing soft tissue masses re most likely what

Answer 13

malignant

Question 14

excision is recommended for a benign bone tumor when

Answer 14

if it is aggressive

Question 15

a benign soft tissue tumor grater than 5cm or is deep what is the recommended treatment

Answer 15

excision

Question 16

in osteomyelitis the infection of the bone itself prefers what location

Answer 16

metaphysis

Question 17

what is the most common and second most common causes of osteomyelitis

Answer 17

staph aureus (#1)
hemolytic strep

Question 18

what are the physical exam results for osteomyelitis

Answer 18

tenderness in bone
ROM of joints is OK (unlike septic arthritis)
swelling, warmth, redness, draining sinus

Question 19

patients with osteomyelitis typically have what history

Answer 19

fever

achy, unrelenting night pain

Question 20

what is seen in a CBS with diff for osteomyelitis

Answer 20

elevated WBC with left shift

Question 21

what is seen on x-raty of the limb with osteomyelitis

Answer 21

may show Brodie’s Abscess

Question 22

Brodie’s Abscess is seen in what

Answer 22

osteomyelitis

Question 23

what is the gold standard of diagnosis for osteomyelitis

Answer 23

bone scan

Question 24

how is osteomyelitis treated

Answer 24

empire treatment with antibiotic (vanc) while waiting for Cx
surgical washout if no improvement in 2 days or if there is a clear abscess
chronic (eg diabetes) may need multiple treatments

Question 25

what is osteoporosis

Answer 25

low bone mass leading to micro architectural deterioration, causing increase fragility of bone

Question 26

what bones are commonly affected by osteoporosis

Answer 26

hip, spine, wrist, shoulder fractures

Question 27

what is the mortality rate at 1 year for all hip fractures

Answer 27

25%

Question 28

type 1 primary osteoporosis is due to what

Answer 28

postmenopausal osteoporosis caused by hormonal changes leading to bone loss

Question 29

type II primary osteoporosis is due to what

Answer 29

senile osteoporosis | caused by altered metabolism leading to bone loss

Question 30

secondary osteoporosis is due to what

Answer 30

``` long term steroid use hyperparathyoridism hyperthyroidsm renal failure cancers ```

Question 31

what is seen in physical exam

Answer 31

loss of height thoracic kyphosis loss of menstruation

Question 32

what test and what score signifies osteoporosis

Answer 32

DEXA scan of spine, hip or femur | T or Z score less than -2.5 SD below mean

Question 33

what does NTx measure

Answer 33

bone collagen

Question 34

how is osteoporosis treated

Answer 34

bisphosphonates calcitonin pulsed PTH SERMS

Question 35

how do bisphosphonates work

Answer 35

disrupting ruffled border of osteoclasts

Question 36

how does one prevent osteoporosis

Answer 36

maximize Ca/Vit D and WV exercise | minimize smoking, caffeine, meds

Question 37

osteosarcoma presents at what age

Answer 37

1st decade

Question 38

osteosarcoma has what clinical signs

Answer 38

swelling, night pain

Question 39

osteosarcoma like what bones and what part of the bone

Answer 39

metaphysis | knee, hip, pelvis

Question 40

what does osteosarcoma do to the bone

Answer 40

both plastic and lytic

Question 41

how is osteosarcoma treated

Answer 41

``` micromets neoadjuvent chemo resection reconstruction chemo NO RADIATION ```

Question 42

Ewings/PNET presents when

Answer 42

2nd decade of life

Question 43

what clinical signs are associated with ewings/pnet

Answer 43

swelling, night pain

Question 44

where and in what bones do Ewings/PNET affect

Answer 44

diaphyseal to metaphyseal femur pelvis

Question 45

what do Ewings/PNED to do to the bone

Answer 45

lytic

Question 46

what is the translocation and marker associated with ewings

Answer 46

t(11;22) CD99+ small found blue cells

Question 47

how is Ewings/PNET treated

Answer 47

neoadjuvent chemo resection chemo can treat with radiation alone

Question 48

what age is chondrosarcoma seen in

Answer 48

50s+

Question 49

what clinical symptoms are seen in chondrosarcoma

Answer 49

tooth-achy pain

Question 50

where can one find chondrosarcoma

Answer 50

metaphyseal shoulder hip knee

Question 51

what does chondrosarcoma do to the bone

Answer 51

lyric among stippled calcification

Question 52

how is chondrosarcoma treated

Answer 52

Grade I- currettage grade other- wide resection and reconstruction NOT radio or chemo sensitive

Question 53

metastatic disease does what to the bone

Answer 53

lytic, blastic, and mixed

Question 54

how is metastatic treated

Answer 54

radiation vs currettage and nailing

Question 55

what is the math of metastatic disease

Answer 55

cuboidal cells, rosettes, and or an image of the kidney tumor