Cortext Week 1 Flashcards
What is the commonest benign bone tumour?
Osteochondroma - produces bony outgrowth on the external surface with cartilagenous cap. They can cause local pain.
What benign bone tumour is an intramedullary tumour and usually a metaphyseal cartilagious tumour caused by failure of normal enchondral ossification at the growth plate? The lesion is usually lucent but can produce a patchy sclerotic appearance. Many are incidental findings and the lesions are usually asymptomatic but can cause pathological fractures.
Enchondroma
Where are simple bone cysts usually found?
Metaphyseal in long bones such as proximal femur and humerus although can occur in the talus or calcaneous. Usually incidental findings in children and young adults.
What type of bone cyst is painful, locally aggressive and found in long bones, flat bones and vertebral bodies?
Aneurysmal bone cyst
What benign bone tumour commonly occurs around the knee and distal radius but can also occur in the pelvis and spine? They are painful.
Giant cell tumour
Give the name of the disease of a bone usually occurring in adolescence where there are lesions of fibrous tissue and immature bone. Defective mineralisation may result in angular deformities and the affected bone could be wider with thinned cortices. Extensive involvement of the proximal femur can produce a Shepherd’s crook deformity.
Fibrous dysplasia. Bisphosphonates may reduce pain.
Give the term for a small nidus of immature bone surrounded by an intense sclerotic halo. They commonly occur in adolescence and common sites include the proximal femur, diaphysis of long bones and vertebrae. Clinical features include intense constant pain worse at night, the pain is relieved with NSAIDs.
Osteoid osteoma
A Brodies abscess (subacute osteomyelitis) and hyperparathyroidism (Brown tumours) can also present with a lytic lesion of bone - true or false.
True
What type of tumours show aggressive and destructive signs on x-ray including cortical destruction, raised periosteum producing bone, new bone formation and extension into the surrounding tissue?
Malignant primary bone tumours
What is the most common malignant bone tumour?
Osteosarcoma. Seen in adolescence and early adulthood with 60% involving bones around the knee.
What is the cartilage producing bone tumour that is less common and less aggressive than an osteosarcoma? It tends to occur in older age groups (45) and are large but slow to metastasise.
Chondrosarcoma - tend to be found in pelvis or proximal femur
What kind of malignant tumour is fibrous and tend to occur in abnormal bone (bone infarct, fibrous dysplasia, post irradiation, Paget’s)? They usually affect adolescents or young adults.
Fibrosarcoma
What tumour is a malignant tumour of primitive cells in the marrow? It is the second most common and has the worst prognosis. Most cases occur between ages 10 and 20. It is associated with fever, raised inflammatory markers and a warm swelling - it is radio and chemo sensitive.
Ewing’s sarcoma
What is a maligant B cell proliferation arising from the marrow and can present as solitary or multiple lesions?
Myeloma - patients are usually 45 - 65, can present with weakness, backpain, bone pain, fatigue, weight loss, anaemia and recurrent infection. Diagnosis is with plasma protein electrophoresis and early morning urine collection for Bence Jones protein assay. Solitary lesions are treated with radiotherapy and multiple ones with chemotherapy
Name the five metastatic bone tumours?
Breast, prostate, lung, renal and thyroid
What cancer usually gives large and vascular lytic blow out bony metastases which can bleed a lot?
Renal
What is the commonest benign soft tissue tumour?
Lipoma
What soft tissue swelling occurs around a synovial joint or tendon sheath? It may form as a result of herniation or outpouching of a weak portion of joint capsule or tendon sheath or as a result of underlying joint damage/arthritis.
A gangliion cyst
What tends to occur in children and may be due to increased physical activity with repetitive stress?
Osteochondritis. Common sites include 2nd metatarsal head (Freiburg’s disease), navicular bone (Kohler’s disease), lunate of the carpus (Kienbock’s disease) and capitellum of elbow (Panner’s disease). Vertebral compression can also occur (Scheuermann’s disease).
Give two examples of traction osteochondritis which occurs at bony tubercles where tendons attach?
Tibial tubercle - Osgood Schlatter disease
Calcaneus - Sever’s disease
What is the term for fragmentation with seperation of the bone and cartilage within a joint?
Osteochondritis dissecans - common sites include lateral part of medial femoral condyle in the knee, anteromedial talar, superomedial femoral head and humeral capitellum.
Name the sites which are particularly prone to AVN.
- Femoral head
- Femoral condyles
- Head of humerus
- Capitellum
- Proximal pole of scaphoid (waist of scaphoid fracture)
- Proximal part of talus
Name two causes of AVN?
Steroid abuse and alcohol
Thrombophilia, sickle cell disease, antiphospholipid deficiency in SLE - all increase coaguability
What profession is at risk of Caisson’s disease which causes AVN?
Deep sea diving
