Quiz 1 Flashcards by Gabe Reardon

Categories of bone disease

Acronym

CATBITES

Congenital
Arthritis
Tumor
Blood
Infection
Trauma
Endocrine
Soft tissues

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Preliminary analysis to perform on patient’s radiograph

AS:R Highness

Age
Sex
Race
History
Number of lesions
Symmetry of lesions
Systems involved

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__ _ ___ bone loss to be seen on film

30-50%

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CT is useful in what scenarios?

Detect subtle osseous changes (lytic destruction, cortical integrity)
Detect subtle periosteal response
Detects subtle calcification

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T1 weighted CT images see

Brighter marrow fat

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T2 weighted CT images see

Brighter cell fluid and edema

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MRI is a good modality to view

Marrow
Extent of lesion
Matrix
Soft tissue mass
Impact on surrounding structures

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Bone scan benefits

Increased metabolic activity known as “hot spots”
View whole skeleton at once
Very sensitive to bone loss (3-5% loss may be a hot spot)

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ABC’s of radiographs

Alignment
Bone
Cartilage
Soft tissues

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Lesions to refer to internist

Metastasis

Multiple Myeloma

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Lesions to refer to orthopedic surgeon

Primary malignancies
Painful benign lesions
Lesions with risk of complications (pathological fx, effect on growth, malignant transformation)
Infection

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Lesions to document and not refer

Asymptomatic, benign lesions without significant risk o f complications

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Most mets begin in patients ___

> 40

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Most primary benign in patients ___

<30

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Red flags to know

Weight loss, fatigue, malaise, recurrent infection, pain pattern

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Neoplasms that are not solitary

Mets
Multiple myeloma
Some hereditary conditions (HME, Ollier’s, neurofibromatosis)

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DDx for expansile lesion of posterior/neural arch

Aneurysmal bone cyst
Osteoblastoma
Osteoid osteoma (appear sclerotic)

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Examples of epiphyseal-metaphyseal lesions

Aneurysmal bone cyst

Giant cell tumor

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Examples of metaphyseal - diaphyseal lesions

Chondrosarcoma
Osteosarcoma
Multiple myeloma
Osteoid osteoma
Non-ossifying fibroma
Chondromyxoid fibroma

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Examples of diaphyseal lesions

Marrow related or round cells

Multiple myeloma
Ewing sarcoma
Non-Hodgkin lymphoma

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“long lesion in a long bone”

Benign

fibrous dysplasia

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enostoma

Thorny border of bone island

can be helpful in identifying lesions

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Behavior of osteolytic lesions

Geographic
Moth-eaten
Permeative

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Behavior of osteoblastic

new bone formation
Reactive sclerosis
Overlying density of periosteal response
Sequestrum (necrotic bone)

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Presentation of geographic lesions

Well defined margins | Short zone of transition

Composition of osseous tumor

identify by cloud-like, cotton candy calcification of mass

Compostition of cartilage tumor

Pop-corn, stippled, punctuated

Composition of fibrous tumor

May appear hazy or like ground glass

More aggressive findings for lesions

Codman triangle Laminated Spiculated Sunburst

Less aggressiving findings for lesions

single layer thick/thin | cortical buttressing

Benign characteristics

``` Pt <30 lesion under 6 cm Monostotic lesion no destruction of cortex Solid periosteal response Geographic lytic destruction Sharp margination No soft tissue mass ```

Primary malignancy characteristics

``` Any age Lesions over 6 cm Monostotic (MM is an exception Cortical destruction Spiculated periosteal response Moth-eaten or permeative lytic lesion Indistinct margins Soft tissue mass ```

Metastatic characteristics

``` >40 years old Polyostotic lesions Cortical destruction Usually no periosteal response Moth-eaten or permative lytic lesions Indistinct margins (mb well-defined) Occasional soft tissue mass ```

Most common primary sites for metastasis are

Lungs, breast, renal, prostate

Target sites for metastasis

Axial skeleton Skull Proximal extremities Rare distal to knee or elbow

Skeletal metastasis may be as common as metastasis to ___ __ ___

liver or lung | 20-30% of all patients with maliganacies

Acral metastasis

Disappearance of a distal phalanx

80% of skeletal metastasis are primaries of what

Lung, breast, GI tract, prostate

breast is primary in ___ of women and prostate is primary in ___ of men

70%, 60%

Lung is primary site of metastasis in

25%

Bone lesion under 5

neuroblastoma

Bone lesion 10-20

Ewing sarcoma or osteosarcoma (MC)

Bone lesion 20-35

Hodgkin lymphoma

Bone pain presents in ___ and is ___ ___ ___

insidious, perisistent, nocturnal

Non-skeletal clues for pathologic fracture

weight loss, cachexia, anemia, advanced fever

Patients with suspected metastasis should be evaluated with

ESR, CBC, chem screen and UA

Serum calcium is elevated in what type of pathology?

lytic

alkaline phosphatase is elevated in what type of pathology?

blastic

Characteristics of primary malignancy

``` Expansion of bone Periosteal response Solitary response Lesion over 10cm Soft tissue mass ```

Characteristics of metastasis

70% of malignancy 2-4cm multiple lesion

What regions are most common for mets to appear

Thoracic and lumbar most common

Most common cause of a missing pedicle is ___ ___

osteolytic mets | "winking owl, one-eyed pedicle, blind vertebrae"

3 most common causes of Ivory Vertebra

osteoblastic metastasis paget's disease lymphoma

Key clue for Paget disease

cortical thickening, expansion

Key clue for lymphoma

anterior body scalloping

``` Skeletal metastasis: ___ to ribs and sternum ___ to pelvis ___ to skull ___ to long tubular bones ```

28% 12% 10% 10%

Management for oain and bone loss

Pain: steroids, NSAIDs | Bisphosphonates may be used to manage osteoclastic activity

4 most common primary malignancies of bone

Multiple myeloma Osteosarcoma Chondrosarcoma Ewing's sarcoma

Signs and symptoms if Multiple myeloma

Bone pain worse with activity and weight bearing, path. fx Anemia (normo/normo) Proteinuria Renal disease Weight loss Osteoporosis Amyloidosis Bacterial infection

Lab changes with multiple myeloma

normo/normo anemia Thrombcytopenia Elevated ESR hyperuricemia/hypercalcemia Elevated serum proteins (elevated G in a/g ratio) Bence-Jones protein in urine Increased number of bone marrow plasma cells

Diagnostic lab changes for multiple myeloma

serum protein electrophoresis | M spike = monoclonal globulin proteins

Plain film findings of multiple myeloma

Multiple well-defined round "punched out" defects Severe generalized osteopenia Some scalloping

Advanced Imaging for multiple myeloma

MRI very sensitive to marrow changes

Treatment for multiple myeloma

Targeted drug therapy Chemotherapy Bone marrow transplant

Complications for multiple myeloma

Pathologic fracture Renal failure Respiratory infection

Solitary Plasmacytoma characteristics

Localized plasma cell neoplasm | Geographic, lytic, highly expansile, "Soapy bubble"

Solitary plasmacytoma progresses to what?

multiple myeloma within 5 years

Osteosarcoma characteristics

Malignant noeplasm which forms osteoids

Subtypes of osteosarcoma

Intramedullary Surface/juxtacortical Extra-skeletal

Characteristics of primary osteosarcoma

75% of osteosarcoma | Occurs in patients 10-20 years old

Characteristics of secondary osteosarcoma

Occur in older patients | Due to malignant degenration of a benign lesion or Paget disease

Signs and symptoms of osteosarcoma

Painful swelling at site Pain often increases with activity Onset of symptoms to diagnosis is >6 months

Plain film findings of osteosarcoma

``` 75% in long bones 50% sclerotic "cumulus" cloud appearance Cortical destruction, agressive periosteal response, soft tissue mass ```

Advanced imaging for osteosarcoma

MRI for treatment planning Chest CT Bone scan

Treatment of osteosarcoma

Metastasis to lungs Surgical resection/amputation Radiation therapy Chemotherapy

Parosteal Sarcoma Age

30-50 years old

Characteristics of Parosteal Sarcoma

Dense, juxtacortical mass with stalk to cortex Not common overall, but accounts for 5% of osteosarcomas Slower growing

Parosteal Sarcoma vs. Myositis Ossificans

P: Stalk towards bone, dense central portion, Grows over time M: Seperate from bone, less dense centrally, smaller over time

Causes of secondary osteosarcoma

Degenration of a benign lesion Paget disease, Fibrous dysplasia, Osteochondroma, Enchondroma Ionizing radiation

Quiz 1 Flashcards

(79 cards)