Ortho Oncology

Question 1

what is the most common reason for destructive bone lesions in adults?

Answer 1

metastatic cancer

Question 2

which carcinomas most commonly spread to bone?

Answer 2

Breast
Lung
Thyroid
Kidney
Prostate

“BLT and a Kosher Pickle”

Question 3

what is the most common site of bony metastasis?

Answer 3

thoracic spine

Question 4

what is the most common site of fracture secondary to metastasis?

Answer 4

proximal femur

Question 5

what are the 3 symptoms of bone metastasis?

Answer 5

pain in affected limb with movement/load

pain that awakens pt at night

metastatic hypercalcemia

Question 6

what is the full workup for a patient who presents without a known primary cancer? (3)

Answer 6

plain xray
CT chest/abdomen/pelvis
CT guided core biopsy

Question 7

what is the tumor marker for bones?

Answer 7

alkaline phosphatase

Question 8

what lab finding is more common in lytic lesions?

Answer 8

hypercalcemia

Question 9

what is the goal of treatment in metastatic bone lesions? (2)

Answer 9

pain control
maintain patient independence

Question 10

what is the non-op treatment for metastatic bone lesions? (2)

Answer 10

radiation
bisphosphonates (IV pamidronate)

Question 11

what do all patients with metastatic bone lesions require?

Answer 11

postop radiation to stabilize bone

Question 12

benign tumor located in the soft tissues

Answer 12

lipoma

Question 13

a patient presents with a mobile, painless, and palpable mass. Dx? Tx?

Answer 13

lipoma
non-op (unless symptomatic or rapidly growing)

Question 14

malignant tumor that arises from transformed cells of mesenchymal origin (connective tissue)

Answer 14

sarcoma

Question 15

what part of the body does sarcoma most commonly metastasize to?

Answer 15

lungs

Question 16

a patient presents with a painless rapidly growing mass. Dx?

Answer 16

sarcoma

Question 17

what imaging must be done for a possible sarcoma?

Answer 17

MRI w/ contrast

Question 18

what is the treatment for a sarcoma? (2)

Answer 18

careful wide excision
radiation

Question 19

neoplastic proliferation of plasma cells that result in osteoclastic stimulation, most common primary bone malignancy in adults

Answer 19

multiple myeloma

Question 20

how is multiple myeloma frequently discovered?

Answer 20

through fracture

Question 21

labs show pancytopenia, hypercalcemia, renal failure, and Bence-Jones Proteins on UPEP. Dx?

Answer 21

multiple myeloma

Question 22

what would an xray show in multiple myeloma?

Answer 22

punched out lesions

Question 23

what is the treatment for multiple myeloma?

Answer 23

chemo

Question 24

most common malignant bone tumor in kids that typically arises as solitary lesions within the fastest growing areas of the long bones

Answer 24

osteosarcoma

Question 25

what are the 2 most common sites of osteosarcoma?

Answer 25

distal femur proximal tibia

Question 26

what is the most common site of metastasis of osteosarcoma?

Answer 26

lungs

Question 27

what is the diagnostic for osteosarcoma?

Answer 27

core needle biopsy

Question 28

what is the treatment for osteosarcoma? (3)

Answer 28

preop + postop chemo wide resection limb salvage/amputation

Question 29

second most common malignant bone tumor in children

Answer 29

ewing's sarcoma

Question 30

where does ewing's sarcoma most commonly occur? (3)

Answer 30

pelvis distal femur proximal tibia

Question 31

an xray shows a large destructive lesion in the diaphysis or metaphysis with a moth-eaten appearance lesion. Dx?

Answer 31

ewing's sarcoma

Question 32

what must we get to diagnose ewing's sarcoma?

Answer 32

core needle biopsy

Question 33

what is required as a workup of Ewing's sarcoma?

Answer 33

bone marrow biopsy to r/o mets to marrow

Question 34

what is the treatment for ewing's sarcoma? (3)

Answer 34

pre-op and post-op chemo wide dissection limb salvage/amputation

Question 35

which one of the kid's carcinoma DOES respond to radiation?

Answer 35

ewing's sarcoma

Question 36

most common benign bone tumor in childhood

Answer 36

non-ossifying fibroma

Question 37

where do most non-ossifying fibromas occur?

Answer 37

lower extremity

Question 38

an xray shows a bubbly lytic lesion. Dx?

Answer 38

non-ossifying fibroma

Question 39

what is the treatment for non-ossifying fibroma?

Answer 39

resolves spontaneously

Question 40

self-limited benign bone lesion that presents with pain unrelated to activity; occurs in the diaphysis or metaphysis

Answer 40

osteoid osteoma

Question 41

what is the most common location of osteoid osteomas?

Answer 41

proximal femur

Question 42

what is important to note about pain d/t osteoid osteoma?

Answer 42

relieved by NSAIDs

Question 43

an xray shows an intensely reactive bone around a radiolucent nidus. Dx?

Answer 43

osteoid osteoma

Question 44

what is the study of choice for a osteoid osteoma?

Answer 44

CT

Question 45

what is the first line treatment for osteoid osteoma?

Answer 45

NSAIDs

Question 46

when does pain from osteoid osteoma usually resolve? when does the lesion spontaneously resolve?

Answer 46

after 3 yrs 5-7 yrs