Musculoskeletal Swellings

Question 1

Are musculoskeletal swellings mostly symptomatic or asymptomatic

Answer 1

Asymptomatic

Question 2

Main sites of bone tumors

Answer 2

Long bones of lower limb 60%
Pelvis, coccyx, sacrum 18%
Upper limbs 13%

Question 3

Are there obvious cause to musculoskeletal swelling

Answer 3

No

Question 4

Predisposing factors

Answer 4

Ionizing radiation 
Pagets dx
Fibrous dysplasia
Retinoblastoma 
Positive family hx

Question 5

Classification

Answer 5

Benign
Intermediate
Malignant

Question 6

Common benign tumor

Answer 6

Osteochondroma
Osteid osteoma
Chondroma

Question 7

Malignant tumors

Answer 7

Multiple myeloma
Chondrosarcoma
Giant cell tumor
Ewing’s sarcoma

Question 8

Enneking classification

Answer 8

I low grade 
II high grade 
III metastases 
A Intracompartmental 
B extracompartmental

Question 9

history

Answer 9

Soft tissue mass
Produce pain or disability
Night pain and sweats not relieved by analgesics ? => malignancy
Age => 5y likely infection/ eosinophilic granuloma. Late teen likely giant cell tumor/ osteoblastoma

Race => black likely Ewing sarcoma

Question 10

Examination

Answer 10

Look for Mass or pain
Look for asymmetry , deformity , swelling
Palpate for mass and it’s composition
Malignant tumor => firm, non tender, inflammation signs

Question 11

Investigations

Answer 11

Plain x rays => large zone of transition ? Periostal rxn ?

Scan

Biopsy

Question 12

Main tumors of the ribs

Answer 12

Mets
Enchondroma
Chondrosarcoma
Ewing

Question 13

Main tumors of the spine

Answer 13

Mets
Myeloma 
Osteoblastoma 
Chordoma
Hemangioma 
ABC
Osteoid ostema

Question 14

Main tumors of the pelvis

Answer 14

Osteosarcoma 
Chondrosarcoma 
SBC
Lymphoma 
Ewing 
EG
Chordoma

Question 15

Main tumors of hands

Answer 15

Endhondroma

Question 16

Main tumors of proximal femur

Answer 16

SBC
FD
Enchondroma 
Ewing 
EG

Question 17

Tumors of around the knee

Answer 17

AII , osteosarcoma

Ewing

Question 18

Epiphysis tumors types

Answer 18

Chondroblastoma

Question 19

Metaphysis tumors type

Answer 19

Osteosarcoma
MFH
Enchondroma

Question 20

Diaphysis tumors types

Answer 20

Adamantinoma
Osteoid osteoma
Chondromyxoid fibroma

Question 21

If you see sunray appearance / codmans triangle, most likely diagnosis ?

Answer 21

Osteosarcoma

Malignant lesion

Question 22

If you see onion peel appearance , most likely diagnosis ?

Answer 22

Ewing sarcoma
Malignant lesion
Chronic osteomyelitis

Question 23

If you see soap bubble appearance, most likely diagnosis ?

Answer 23

Osteoclastoma

Adamantinoma

Question 24

If you see ground glass appearance, most likely diagnosis ?

Answer 24

Fibrous dysplasia

Question 25

If you see patchy calcification , most likely diagnosis ?

Answer 25

Chondrogenic tumors

Question 26

If you homogenous calcification, most likely diagnosis ?

Answer 26

Osteogenic tumors like osteosarcoma

Question 27

Lab for diagnosis

Answer 27

FBC (leukemia ?) C reactive protein (inflammation ?) ESR (ewing sarcoma ? Leukemia? Eosinophilic granuloma ? Infection ?) Alkaline phosphatase (osteosarcoma? Ewing sarcoma? Lymphoma ? Metastatic bone tumor ?)

Question 28

How to exclude the diagnosis of prostate cancer

Answer 28

PSA

Question 29

How to exclude the diagnosis of MYELOMA

Answer 29

Serum electrophoresis | Urinary bence jones proteins

Question 30

Types of biopsies possible

Answer 30

Needle (most common ) Incisional Excisional

Question 31

Commonest benign bone tumor

Answer 31

Osteochondroma

Question 32

Population at risk Osteochondroma

Answer 32

10-20y

Question 33

Main sites Osteochondroma

Answer 33

``` Distal femur Prox tibia Prox humerus Pelvis Scapula ```

Question 34

Clnical features Osteochondroma

Answer 34

Asymptomatic unless fracture of stalk or pressure on surrounding tissue causing pain

Question 35

X-ray Osteochondroma

Answer 35

Eccentric protrusion

Question 36

Osteochondroma histo

Answer 36

Pedunculated | Cauliflower or sessile

Question 37

Treatment Osteochondroma

Answer 37

None | Excision if pain

Question 38

Chances of malignant pain in Osteochondroma

Answer 38

1-5%