Final Flashcards
(104 cards)
0
Q
What is the most common primary malignancy of bone
A
Multiple myeloma
1
Q
What is the most common malignancy of bone
A
Metastasis
2
Q
What is the most common primary malignancy of bone in a child?
A
Osteosarcoma
3
Q
What is the 2nd 3rd AND 4th most common primary malignancies of bone?
A
Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma
4
Q
Rain drop skull
A
Multiple myeloma
5
Q
Saucerization
A
Ewings sarcoma
6
Q
Protein electrophoresis with M spike in what percent of which patients?
A
80-90% of multiple Myeloma patients.
7
Q
Multiple myeloma findings on film lead to what actions?
A
Confirm Dx and medical consult. Biochemical profile, protein electrophoresis, skeletal survey and MR of abnormal areas and bone marrow biopsy.
8
Q
This tumor is subarticular
A
Giant cell tumor
9
Q
Grossly expansive lesson in the distal metaphyseal region of the distal femur that does not extend into the sub articular region.
A
Aneurysmal bone cyst (ABC)
10
Q
The most likely primary bone malignancy to metastitize to bone?
A
Ewing’s sarcoma
11
Q
Tumor in proximal tibia that is lyric, eccentric, metaphyseal and expansile
A
Aneurysmal bone cyst
12
Q
Periosteal buttress aka
A
Codmans triangle often see with ABC
13
Q
Ground glass
A
Fibrous dysplasia
14
Q
Cumulus cloud-like density noted in he distal femoral metaphysis
A
Osteopenia sarcoma
15
Q
Thickened density in the proximal humerus, thickened vortices, and accentuated disorganized trabeculation
A
Paget’s disease
16
Q
What is the most common benign tumor of the spine?
A
Hemangioma, MC age +40
17
Q
Coarsened accentuated vertical trabeculation
A
Benign hemangioma
18
Q
Rind of sclerosis (very short zone of transition, well marginated with shtick sclerotic rim)
A
Monostotic Fibrous Dysplasia (benign)
19
Q
Fallen fragment sign is caused by?
A
A piece of cortex has fallen into the cyst - a sign of pathological fracture
20
Q
Non ossifying fibroma location?
A
Distal tibia
21
Q
Simple bone cyst location?
A
Proximal humerus
22
Q
Enchondroma location?
A
Hand
23
Q
Monostotic Fibrous dysplasia location?
A
Proximal femur
24
Saber shin description?
Anterior bowing of tibia
25
Candle flame, blade of grass, or v shaped appearance to the leading edge of a lytic tumor in bone marrow can indicate what?
Pagets disease
26
Ivory vertebra indicates (3 conditions)
Blastic metastasis, pagets or lymphoma.
27
A flat plateau stalk-like bony protuberance/broad based exostosis.
Sessile osteochondroma (sessile=bush ie no "trunk")
28
Which tumor likes the diaphyseal region?
Ewing's sarcoma
29
Elongated bony exostosis in the distal metaphyseal region of the femur pointing away from the joint. Give name and MC age
Pedunculated osteochondroma, under 20 yro
30
Picture frame appearance (thickened endplates, increased width)
Paget's disease
31
Eccentric, geographic lytic lesion with very thin cortex in metaphyseal region which does not extend beneath the joint surface
Aneurysmal bone cyst
32
Eccentric geographic slightly expansive subarticular lytic lesion
Giant cell tumor 20-40 yro
33
Eccentric, geographic, slightly expansive lytic lesion that extends to the end of the bone
Giant cell tumor
34
Eccentric, geographic, expansile, lytic lesion in the metaphyseal region
Aneurysmal bone cyst
35
Central, geographic, truncated lytic lesion in the metaphyseal region
Simple bone cyst
36
Multiple sessile like osteochondromas, metaphyseal widening.
Hereditary Multiple Exostosis (HME) aka diaphyseal achalasia
37
Subtitle permeation lytic destructive changes, "solid layer"Periosteal reaction in the distal diametaphysieal region of the femur.
Could be osteosarcoma or Ewings sarcoma
38
Ewings - diaphysis or metaphysis?
Diaphysis
39
Osteosarcoma - diaphysis or metaphysis?
Metaphysis
40
Well defined eccentric geographic lytic lesion in the proximal tibial epiphysis
Chondroblastoma (before growth plate closure)
41
Lytic eccentric geographic subarticular lesion in the proximal tibia
Giant cell tumor
42
What is multiple myeloma?
Malignant proliferation of plasma cells- a hematologic malignancy.
43
Soap bubble appearance aka
Septations
44
Multiple amorphous "pop corn" like calcifications in the soft tissue and lytic destructive changes in the superior portion of the pelvis.
Chondrosarcoma
45
One eyed pedicle sign or winking owl causes (4)
Congenital, lytic mets(MC), primary tumor, infection
46
T/F multiple myeloma tends to spare the pedicle (no winking owl)
True, most of the time.
47
Nidus (nest) description and what tumor does it indicate?
Well defined round (oval) radio lucena lesion with surrounding radio dense zone. Osteoid osteoma.
Intense pain especially at night relieved by asprin.
48
4th most common primary malignant tumor
Ewings
49
2nd most common primary malignant tumor in children?
Ewings
50
Tumors that are round cell tumors (3)
Multiple myeloma, Ewings, non-Hodgkin's lymphoma (and all like the diaphysis)
51
What is the MC benign tumor of the hand?
Enchondroma
52
Rain drop skull tumor and age
Multiple myeloma, 50-70yro
53
In multiple myeloma what cells malignantly proliferate?
Plasma cells (>10%)
54
What test is most diagnostic for tumors?
Biopsy.
55
Large geographic radiolucency noted in the frontal bone region. What is the name for the condition and what is the name for the underlying disease causing the condition?
Osteoporosis circumscripta.
| Lytic phase of Paget's disease involving the outer table of the skull.
56
Geographic eccentric lytic lesion in an epiphysis or apophysis of a child
Chondroblastoma
57
Tumors with fibrous matrix (6)
```
Fibrous dysplasia
Desktop lasted fibroma
Non ossifying fibroma
Fibrous cortical defect
Ossifying fibroma
Fibrosarcoma
```
58
Maffuccis syndrome signs
Phleboliths and enchondromas
59
Considerable expansile, soap bubbly, with cortical thinning
Blow out lytic mets
60
What likely would destroy a single pedicle? (4 categories)
Lytic mets
Primary bone tumor,
Soft tissue tumor,
Infection
61
Osteoid osteoma points to remember (4)
Nidus with surrounding sclerosis
10-25 yro
Painful, relieved by asprin
Do bone scan or CT to confirm
62
Pathological collapse of vertebrae -possible causes (6)
```
Lytic metastatic carcinoma -most likely
Multiple myeloma -most likely
Osteoporosis (w or w/out trauma) -most likely
Eosinophilic granuloma (child)
Paget's disease
Infection
```
63
Accentuated disorganized trabeculation and cortical thickening with bone softening deformity (anterior bowing) of the right tibia the “Saber Shin” deformity
Pagets Disease
64
Ill-defined lytic destructive change of the cortex and medullary region of the distal femoral shaft with an associated pathological fracture.
(45 year old female)
Lytic mets possibility in a female is most likely from a primary breast tumor until proven otherwise
65
Geographic “not well defined”
Giant Cell Tumor
66
Geographic “well defined”
Fibrous Dysplasia
67
Soap bubbly highly expansile lytic destructive change in the proximal aspect of the radius
Thyroid or renal mets most likely
68
Diaphyseal location in a child with laminated periosteal reaction and lytic changes. What diagnosis? What age is most likely?
Ewing’s sarcoma is likely
| 10-25 yro, peak at 15
69
Broad wide femoral metaphyseal regions and multiple sessile bony outgrowths in the proximal femora and deformity and expanded pubic bones
Hereditary Multiple Exostosis (HME)
| aka Diaphyseal Achalasia
70
Ivory Vertebra list of differential diagnoses (3). What labs are used to determine each?
Lymphoma: A CBC, BCP, and an ESR for starting
Blastic Mets: a BCP to include alkaline and acid phosphatase and PSA
Paget's: A baseline BCP for alkaline phosphatase
71
“One eyed pedicle sign” or “Winking owl sign” with contralateral hypertrophy
congenitaly missing pedicle
72
spiculated (sunburst) periosteal reaction and lytic destructive changes in the distal femoral metaphysis with areas of sclerosis (14yro boy)
osteosarcoma
73
Sunburst/spiculated periosteal Rx, Codman’s triangle, sclerotic change in the distal metaphyseal region, large soft issue mass with osteoid matrix
osteosarcoma of distal femur with large soft tissue mass exhibiting osteoid matrix
74
What is the most common age and location for an osteosarcoma?
10 to 25 years of age and metaphyseal location most commonly around the knee
75
Osteosarcoma
Sclerotic ?%
Lytic ?%
Mixed ?%
Sclerotic 50%
Lytic 25%
Mixed 25%
76
Very dense proximal tibia
Osteosarcoma is a must to consider
77
Collapsed disc could be (4 DDx)
Osteoporosis
Lytic Mets
Multiple myeloma
EG (child)
78
What is the most common benign tumor of bone?
osteochondroma
79
What is the most common benign tumor of the spine?
Hemangioma
80
55year old male with shoulder pain, Fluffy, stippled, cotton wool like calcifications noted in the diametaphyseal region
Possibly Chondrosarcoma
| 40-60 age is MC and usually over 50
81
Permeative to moth eaten destruction, wide zone of transition, aggressive periostitis, and soft-tissue extension noted in the diaphyseal region extending into the metaphyseal region of the mid to distal femur. (12yro girl)
Ewing’s Sarcoma or possibly an osteosarcoma
82
Somewhat geographic lytic destruction, punctate calcification in the matrix, long zone of transition and periosteal reaction indicating a host response.
Chondrosarcoma
83
Multiple broad based plateau like bumps causing a widened asymmetrical appearance with several broad based exostoses seen on face as a cortical outline
Multiple Sessile Osteochondromas
84
What is the MC cause of ivory vertebra in a 20-40 age range?
Lymphoma
85
Differential diagnosis for ivory vertebra (3)
Paget’s disease, Blastic Metastasis or Lymphoma
86
Ollier’s Disease aka?
Multiple Enchondromas. (-which usually develop in childhood. The growth of these endochondromas usually stops after skeletal maturation.)
87
When Blastic mets is found on film what tests confirm it?
BCP to include alkaline and acid phosphatase levels as well as a PSA and digital rectal exam as needed would be appropriate
88
fibroxanthoma aka
nonossifying fibroma
89
Multiple enchondromas and multiple soft tissue hemangiomas (phleboliths)
Maffucci’s Syndrome
90
Maffucci’s Syndrome rate of malignancy transformation
up to 25% malignant degeneration rate (high)
91
what does “corduroy cloth” look like? What disease is it found in?
Accentuated vertical trabeculation found in hemangioma
92
What is the possibility of malignant transformation of Hereditary Multiple Exostosis (HME)?
Approx 5-20%
93
Why is a “subarticular” eccentric lytic lesion in a 12 year old not a Giant Cell Tumor?
Because GCT’s occur in the 20-40 year age range after growth plate closure
94
Expansile lobulated lytic destructive lesion with a very thin cortex in the neural arch and extending into the body
Aneurysmal Bone Cyst or osteoblastoma - both like neural arch and both are expansile
95
What malignancy does Hereditary Multiple Exostosis (HME) typically transform into?
chondrosarcoma
96
What is a Mnemonic for remembering a list of differential diagnoses concerning a “solitary lytic” bone lesion?
```
FOGMACHINES
F = Fibrous Dysplasia
O = Osteoblastoma
G = Giant Cell Tumor
M = Metastasis / Myeloma
A = Aneurysmal Bone Cyst
C = Chondroblastoma
H = Hyperparathyroidism (brown tumors)/ Hemangioma
I = Infection
N = Non-ossifying Fibroma
E = Eosinophilic Granuloma / Enchondroma
S = Solitary Bone Cyst
```
97
Once Paget’s Disease is suspected on film, what do you do next
A base line alkaline phosphatase level for future comparison, a bone scan for other possible areas of involvement and considering the extensive involvement an orthopedic consult and perhaps an orthopedic/endocrinologist consult would help
98
What is the typical age and typical location for Simple Bone Cyst?
3-14 years of age, central, metaphyseal and MC in the proximal humerus
99
What is Madelung’s deformity?
Retarded bone growth, short ulna, bowing of radius and subluxation of the radioulnar joint
100
What age is MC and what location does osteoblastoma like?
10-15 and loves the neural arch region of the spine
101
Is Osteoblastoma painful?
Yes, dull and not relieved by asprin
102
Enchondroma most likely age?
10-30
103
Ovoid radioluceny with a small central density and surrounding sclerosis.
Ankle Pain for months. Aspirin relieves the pain and the family thinks it must be arthritis, but this is a adolescent patient.
What is the Dx?
Osteoid Osteoma
