Miscellaneous Flashcards by N V

Define: diaphysis, epiphysis, metaphysis

Diaphysis: tubular shaft
Epiphysis: expanded end area
Metaphysis: connects diaphysis and epiphysis

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Describe the vascular supply of mature bone.

Has 3 major sets of blood vessels

- nutrient artery and vein, metaphyseal vessels, periosteal vessels

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Describe the neural innervation of bone.

Sensory nerves innervate the endosteum

Vasomotor nerves innervate the bone cavity and epiphysis

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What is intramembranous ossification and what type of bones are formed?

Osteoblasts differentiate within a mesenchymal or fibrous connective tissue

Form ‘dermal bones’ such as flat bones of the skull, the mandible and clavicle

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What is endochondral ossification?

Bones form from hyaline cartilage

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Name 3 benign and 1 malignant bone-forming tumour

Benign: Osteoma, otseoid osteoma, osteoblastoma
Malignant: Osteosarcoma

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Name 3 benign and 1 malignant cartilage-forming tumour

Benign: Chondroma, osteochondroma, chondroblastoma
Malignant: Chondrosarcoma

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List 2 malignant marrow tumours

Ewing’s

Myeloma

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List 3 benign and 3 malignant connective tissue tumours

Benign: Fibroma, fibrous histiocytoma, lipoma
Malignant: Fibrosarcoma, malignant fibrous histiocytoma, liposarcoma

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In staging tumours, what do the terms ‘low-grade’ and ‘high-grade’ mean?

Low-grade - moderately aggressive + take a long time to metastasise

High-grade - usually very aggressive and metastasise early

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How are malignant bone tumours staged?

Stage I: all low-grade sarcomas
Stage II: histologically high-grade lesions
Stage III: sarcomas which have metastasised

Can be further divided into Type A (intracompartmental) or Type B (extracompartmental)

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In describing benign MSK tumours, what does ‘latent’ mean? (3)

Well-defined margin. Grows slowly and then stops. Remains static/heals spontaneously

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In describing benign MSK tumours, what does ‘active’ mean? (3)

Progressive growth limited by natural barriers. Not self-limiting. Tendency to recur

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In describing benign MSK tumours, what does ‘aggressive’ mean?

Growth not limited by natural barriers

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What is a brown tumour?

Bone lesion that arises in setting of excess osteoclast activity e.g. hyperparathyroidism, and which is radiolucent on X-ray. Mainly affects phalanges of fingers, long bones

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In which age groups is osteosarcoma most frequently diagnosed?

2nd decade or 10-30

Describe 3 radiographic findings found in osteosarcoma

Codman’s triangle - manifestation of periosteal reaction - partial ossified periosteum lifted off cortex by neoplastic tissue
Sunburst - manifestation of periosteal reaction - tumour extension into periosteum
Destructive lesion in metaphysis, may cross epiphyseal plate

What is Ewing’s Sarcoma?

Tumour believed to arise from endothelial cells in bone marrow, usu. in tubular bone e.g. fibula/tibia/clavicle. Occurs in those 5 - 20 years old

In which age group does multiple myeloma usually occur?

90% occur in people over than 40 years, M:F = 2:1

How should multiple myeloma be investigated? (3)

Bloodwork - FBC (anaemia), increased ESR, urea and creatinine, and increased calcium
Serum and urine electrophoresis - IgG or IgA sometimes seen in latter, Bence Jones protein sometimes in former
X-rays: lytic, ‘punched-out’ lesions. CT/MRI may be used to detect lesions not seen on XR

What are the diagnostic criteria for multiple myeloma? (4)

Monoclonal protein band in serum or urine electrophoresis
Plasma cells increased on marrow biopsy
Evidence of end-organ damage: hypercalcaemia, renal insufficiency, anaemia
Bone lesions - skeletal survey - X-ray of chest, all of spine, skull

What are the signs of hypercalcaemia?

“Bones, stones, moans and psychic groans”

Bones: bone pain
Stones: renal
Moans: abdominal pain (also vomiting, constipation)
Groans: depression, confusion

List the 5 common tumours that metastasise to bone

Breast
Lung
Thyroid
Kidney
Prostate

Occurrence of osteolytic vs osteoblastic lesions in bone metastases

Bone metastases usually lytic - pathological fractures are therefore very common.

Prostate cancer occasionally osteoblastic

What are the common sites of bone metastases? (4)

1. Vertebrae 2. Pelvis 3. Proximal half of femur 4. Humerus

Describe Mirel's Criteria for Impending Fracture Risk and prophylactic internal fixation

4 variables: site, pain, lesion, size Site 1 - upper arm, 2 - lower extremity, 3- trochanter Pain 1 - mild, 2 - moderate, 3 - severe Lesion 1 - blastic, 2- mixed, 3 - lytic Size 1 - less than 1/3, 2 - 1/3 to 2/3 diameter, 3 - more than 2/3 diameter A score greater than 8 suggests prophylactic nailing

How does a bone scan work? (Lay explanation) (3)

1. Bone scans use radionuclides to detect areas of the bone which are growing or being repaired. A radionuclide (sometimes called a radioisotope or isotope) is a chemical which emits a type of radioactivity called gamma rays. A tiny amount of radionuclide is put into the body, usually by an injection into a vein. (Sometimes it is breathed in or swallowed, depending on the test.) 2. Cells which are most 'active' in the target tissue or organ will take up more of the radionuclide. So, active parts of the tissue will emit more gamma rays than less active or inactive parts. 3. The gamma rays which are emitted from inside the body are detected by the gamma camera. The rays are then converted into an electrical signal and sent to a computer. The computer builds a picture by converting the differing intensities of radioactivity emitted into different colours or shades of grey.

Which organisms can cause septic arthritis?

Most commonly caused by Staph aureus in adults Consider gonorrhoea in sexually active adults

How should septic arthritis be investigated? (3)

1. Blood: FBE, ESR, CRP, blood cultures 2. X-ray: to rule out fracture, tumour, metabolic bone disease 3. Joint aspirate

How is septic arthritis treated?

1. IV antibiotics - usu. fluclox (empiric therapy for S. aureus) 2. For small joints - needle aspiration is therapeutic 3. For major joints: urgent decompression and surgical drainage

What is the most common organism in osteomyelitis?

S. aureus

How is osteomyelitis classified?

Acute (less than 14 days) vs chronic Children vs adults Bones affected

Which bones are commonly affected in children vs adults in osteomyelitis?

Children: long bones Adults: Vertebrae

How is osteomyelitis investigated? (3)

1. Blood: FBE, ESR/CRP, blood culture 2. +/- biopsy 3. Imaging: X-ray +/- bone scan +/- MRI

What are the X-ray findings seen in osteomyelitis? (3)

1. Soft tissue swelling 2. Lytic bone destruction - generally not seen on plain films until 10-12d after onset of infection 3. Periosteal reaction (formation of new bone, esp. in response to #)

How is osteomyelitis managed? (2)

1. IV AB therapy:empiric - in long bones: fluclox, in vertebral: ceftriaxone. Adjust after results of blood cultures, serial CRP can be used to monitor response to therapy 2. Surgical debridement

What are the X-ray findings in a septic joint?(early vs late)

Early (0-3d): usu. normal. May show soft-tissue swelling or joint space widening from localised oedema Late (4-6d): joint space narrowing and destruction of cartilage