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Bone Pathology II > Quiz 1 > Flashcards

Quiz 1 Flashcards

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1
Q

Categories of bone disease

Acronym

A

CATBITES

Congenital
Arthritis
Tumor
Blood
Infection
Trauma
Endocrine
Soft tissues
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2
Q

Preliminary analysis to perform on patient’s radiograph

A

AS:R Highness

Age
Sex
Race
History
Number of lesions
Symmetry of lesions
Systems involved
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3
Q

__ _ ___ bone loss to be seen on film

A

30-50%

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4
Q

CT is useful in what scenarios?

A

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

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5
Q

T1 weighted CT images see

A

Brighter marrow fat

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6
Q

T2 weighted CT images see

A

Brighter cell fluid and edema

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7
Q

MRI is a good modality to view

A 
Marrow
Extent of lesion
Matrix
Soft tissue mass
Impact on surrounding structures
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8
Q

Bone scan benefits

A

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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9
Q

ABC’s of radiographs

A

Alignment
Bone
Cartilage
Soft tissues

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10
Q

Lesions to refer to internist

A

Metastasis

Multiple Myeloma

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11
Q

Lesions to refer to orthopedic surgeon

A

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

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12
Q

Lesions to document and not refer

A

Asymptomatic, benign lesions without significant risk o f complications

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13
Q

Most mets begin in patients ___

A

> 40

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14
Q

Most primary benign in patients ___

A

<30

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15
Q

Red flags to know

A

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

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16
Q

Neoplasms that are not solitary

A

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

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17
Q

DDx for expansile lesion of posterior/neural arch

A

Aneurysmal bone cyst
Osteoblastoma
Osteoid osteoma (appear sclerotic)

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18
Q

Examples of epiphyseal-metaphyseal lesions

A

Aneurysmal bone cyst

Giant cell tumor

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19
Q

Examples of metaphyseal - diaphyseal lesions

A 
Chondrosarcoma
Osteosarcoma
Multiple myeloma
Osteoid osteoma
Non-ossifying fibroma
Chondromyxoid fibroma
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20
Q

Examples of diaphyseal lesions

A

Marrow related or round cells

Multiple myeloma
Ewing sarcoma
Non-Hodgkin lymphoma

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21
Q

“long lesion in a long bone”

Benign

A

fibrous dysplasia

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22
Q

enostoma

A

Thorny border of bone island

can be helpful in identifying lesions

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23
Q

Behavior of osteolytic lesions

A

Geographic
Moth-eaten
Permeative

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24
Q

Behavior of osteoblastic

A

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

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25
Presentation of geographic lesions
Well defined margins | Short zone of transition
26
Composition of osseous tumor
identify by cloud-like, cotton candy calcification of mass
27
Compostition of cartilage tumor
Pop-corn, stippled, punctuated
28
Composition of fibrous tumor
May appear hazy or like ground glass
29
More aggressive findings for lesions
Codman triangle Laminated Spiculated Sunburst
30
Less aggressiving findings for lesions
single layer thick/thin | cortical buttressing
31
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 ```
32
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 ```
33
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 ```
34
Most common primary sites for metastasis are
Lungs, breast, renal, prostate
35
Target sites for metastasis
Axial skeleton Skull Proximal extremities Rare distal to knee or elbow
36
Skeletal metastasis may be as common as metastasis to ___ __ ___
liver or lung | 20-30% of all patients with maliganacies
37
Acral metastasis
Disappearance of a distal phalanx
38
80% of skeletal metastasis are primaries of what
Lung, breast, GI tract, prostate
39
breast is primary in ___ of women and prostate is primary in ___ of men
70%, 60%
40
Lung is primary site of metastasis in
25%
41
Bone lesion under 5
neuroblastoma
42
Bone lesion 10-20
Ewing sarcoma or osteosarcoma (MC)
43
Bone lesion 20-35
Hodgkin lymphoma
44
Bone pain presents in ___ and is ___ ___ ___
insidious, perisistent, nocturnal
45
Non-skeletal clues for pathologic fracture
weight loss, cachexia, anemia, advanced fever
46
Patients with suspected metastasis should be evaluated with
ESR, CBC, chem screen and UA
47
Serum calcium is elevated in what type of pathology?
lytic
48
alkaline phosphatase is elevated in what type of pathology?
blastic
49
Characteristics of primary malignancy
``` Expansion of bone Periosteal response Solitary response Lesion over 10cm Soft tissue mass ```
50
Characteristics of metastasis
70% of malignancy 2-4cm multiple lesion
51
What regions are most common for mets to appear
Thoracic and lumbar most common
52
Most common cause of a missing pedicle is ___ ___
osteolytic mets | "winking owl, one-eyed pedicle, blind vertebrae"
53
3 most common causes of Ivory Vertebra
osteoblastic metastasis paget's disease lymphoma
54
Key clue for Paget disease
cortical thickening, expansion
55
Key clue for lymphoma
anterior body scalloping
56
``` Skeletal metastasis: ___ to ribs and sternum ___ to pelvis ___ to skull ___ to long tubular bones ```
28% 12% 10% 10%
57
Management for oain and bone loss
Pain: steroids, NSAIDs | Bisphosphonates may be used to manage osteoclastic activity
58
4 most common primary malignancies of bone
Multiple myeloma Osteosarcoma Chondrosarcoma Ewing's sarcoma
59
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
60
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
61
Diagnostic lab changes for multiple myeloma
serum protein electrophoresis | M spike = monoclonal globulin proteins
62
Plain film findings of multiple myeloma
Multiple well-defined round "punched out" defects Severe generalized osteopenia Some scalloping
63
Advanced Imaging for multiple myeloma
MRI very sensitive to marrow changes
64
Treatment for multiple myeloma
Targeted drug therapy Chemotherapy Bone marrow transplant
65
Complications for multiple myeloma
Pathologic fracture Renal failure Respiratory infection
66
Solitary Plasmacytoma characteristics
Localized plasma cell neoplasm | Geographic, lytic, highly expansile, "Soapy bubble"
67
Solitary plasmacytoma progresses to what?
multiple myeloma within 5 years
68
Osteosarcoma characteristics
Malignant noeplasm which forms osteoids
69
Subtypes of osteosarcoma
Intramedullary Surface/juxtacortical Extra-skeletal
70
Characteristics of primary osteosarcoma
75% of osteosarcoma | Occurs in patients 10-20 years old
71
Characteristics of secondary osteosarcoma
Occur in older patients | Due to malignant degenration of a benign lesion or Paget disease
72
Signs and symptoms of osteosarcoma
Painful swelling at site Pain often increases with activity Onset of symptoms to diagnosis is >6 months
73
Plain film findings of osteosarcoma
``` 75% in long bones 50% sclerotic "cumulus" cloud appearance Cortical destruction, agressive periosteal response, soft tissue mass ```
74
Advanced imaging for osteosarcoma
MRI for treatment planning Chest CT Bone scan
75
Treatment of osteosarcoma
Metastasis to lungs Surgical resection/amputation Radiation therapy Chemotherapy
76
Parosteal Sarcoma Age
30-50 years old
77
Characteristics of Parosteal Sarcoma
Dense, juxtacortical mass with stalk to cortex Not common overall, but accounts for 5% of osteosarcomas Slower growing
78
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
79
Causes of secondary osteosarcoma
Degenration of a benign lesion Paget disease, Fibrous dysplasia, Osteochondroma, Enchondroma Ionizing radiation

Bone Pathology II (3 decks)

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