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FPP-MSS > September 9 Bone Path > Flashcards

September 9 Bone Path Flashcards

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1
Q

What is the most common soft tissue tumor in adults?

A

Lipoma

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2
Q

What is the most common soft tissue tumor in adults?

A

Lipoma

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3
Q

What is the most common sarcoma in adults?

A

Liposarcoma

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4
Q

What is Rhabdomyosarcoma common in?

A

Kids

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5
Q

Lipoma

A

12q14-12q15 aberations -most common soft tissue tumor adults -solitary (unless rare hereditary) -painless and unmoving (unless angiolipoma) -soft yellow encapsulated masses -histo looks normal

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6
Q

Liposarcoma

A

-most common sarcoma in adults -deep soft tissues proximal extremities/retroperitoneum -histo=lipoblasts (scalloped vacuoles) WELL DIFFERENTIATED: supernumery ring chromosomes (12q14-q15 w/ MDM2 amplification) MYOXOID/ROUND LPS: t(12;16)(q 13;p11) = FUS CHOP gene PLEOMORPHIC: most agressive

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7
Q

Lipoblastoma

A

Kids Lipoblasts PLAG1

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8
Q

Hibernoma

A

Kids, brown fat tumor

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9
Q

Fibromatoses

A

SUPERFICIAL: palmar (Dupuytren contracture), plantar=on tendon sheaths -penile (Peyronie disease)=curvature penis Stabilize, could resolve DEEP SEATED/DESMOID: between benign fibrous tumors and fibrosarcoma Reoccur Teens-30s Gardner sx APC/B catenin mutations

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10
Q

Fibrosarcoma

A

Malignant, fibroblasts Adults Deep in thigh, knee, retroperitoneum Agressive Vimentin=marker?

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11
Q

What is the most common neoplasm in women?

A

Uterine leiomyomas

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12
Q

Leiomyosarcoma

A

10-20% soft tissue sarcomas F>M sin, deep soft tissues extremities/retroperitoneum Usually good if superficial

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13
Q

Rhabdomyosarcoma

A

Most common soft tissue disease in kids Head, neck, genitourinary TYPES: Embryonal, alveolar, pleomorphic

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14
Q

Embryonal Rhabdomyosarcoma

A

49% rhabdomyosarcoma

Head, neck (orbital and parameningeal), GU track

DEEP extremities, pelvis, retroperitoneum

Loss of 11p15, extra 8, 12, 13 and/or 20

Botryoids in female girl vaginas

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15
Q

Alveolar Rhabdomyosarcoma

A

31% rhabdomyosarcoma; 10-25 yo Deep soft tissues and EXTREMITIES!!!! PAX gene translocation -t(2;13)/PAX3-FKHR -t(1;13)/PAX 7-FKHR Alveolar growth pattern

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16
Q

Synovial Sarcoma

A

5-10% of soft tissue tumors Young adults, males 80% in deep soft tissue extremities around KNEE t(x;18)(p11;q11) w/ SYT SSX1 or SSX2 On MRI see calcifications, mass behind knee Treat with limb sparing surgery, chemo Metastasis lung, bone, lymph nodes 20% live >10 years

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17
Q

Pseudosarcomatous Proliferation

A

Idiopathic/trauma induced non neoplastic lesions that mimic sarcoma Nodular fascitis –> tumor after trauma on extremities; clonal chromosomal changes/big nuclei Myositis ossificans –> proximal extremities in young adults; trauma >50% cases *metaplastic bone that ostifies and gets filled w/ marrow

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18
Q

What is the most common sarcoma in adults?

A

Liposarcoma

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19
Q

What is Rhabdomyosarcoma common in?

A

Kids

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20
Q

Lipoma

A

12q14-12q15 aberations -most common soft tissue tumor adults -solitary (unless rare hereditary) -painless and unmoving (unless angiolipoma) -soft yellow encapsulated masses -histo looks normal

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21
Q

Liposarcoma

A

-most common sarcoma in adults -deep soft tissues proximal extremities/retroperitoneum -histo=lipoblasts (scalloped vacuoles) WELL DIFFERENTIATED: supernumery ring chromosomes (12q14-q15 w/ MDM2 amplification) MYOXOID/ROUND LPS: t(12;16)(q 13;p11) = FUS CHOP gene PLEOMORPHIC: most agressive

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22
Q

Lipoblastoma

A

Kids Lipoblasts PLAG1

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23
Q

Hibernoma

A

Kids, brown fat tumor

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24
Q

Fibromatoses

A

SUPERFICIAL: palmar (Dupuytren contracture), plantar=on tendon sheaths -penile (Peyronie disease)=curvature penis Stabilize, could resolve DEEP SEATED/DESMOID: between benign fibrous tumors and fibrosarcoma Reoccur Teens-30s Gardner sx APC/B catenin mutations

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25
Fibrosarcoma
Malignant, fibroblasts Adults Deep in thigh, knee, retroperitoneum Agressive Vimentin=marker?
26
Smooth muscle tumor characteristics
27
What is the most common neoplasm in women?
Uterine leiomyomas
28
Leiomyosarcoma
10-20% soft tissue sarcomas F\>M sin, deep soft tissues extremities/retroperitoneum Usually good if superficial
29
Rhabdomyosarcoma
Most common soft tissue disease in kids Head, neck, genitourinary TYPES: Embryonal, alveolar, pleomorphic
30
Embryonal Rhabdomyosarcoma
49% rhabdomyosarcoma;
31
Alveolar Rhabdomyosarcoma
31% rhabdomyosarcoma; 10-25 yo Deep soft tissues and EXTREMITIES!!!! PAX gene translocation -t(2;13)/PAX3-FKHR -t(1;13)/PAX 7-FKHR Alveolar growth pattern
32
Synovial Sarcoma
5-10% of soft tissue tumors Young adults, males 80% in deep soft tissue extremities around KNEE t(x;18)(p11;q11) w/ SYT SSX1 or SSX2 On MRI see calcifications, mass behind knee Treat with limb sparing surgery, chemo Metastasis lung, bone, lymph nodes 20% live \>10 years
33
Pseudosarcomatous Proliferation
Idiopathic/trauma induced non neoplastic lesions that mimic sarcoma Nodular fascitis --\> tumor after trauma on extremities; clonal chromosomal changes/big nuclei Myositis ossificans --\> proximal extremities in young adults; trauma \>50% cases \*metaplastic bone that ostifies and gets filled w/ marrow
34
Four categories of osteomyelitis?
Hematogenous: bacteria in bone bc previous infection (kids) Direct implantation: penetrating injury Continguous: spread of bacteria from ulcer/wound (adults) Inf of prosthetic device: bacteria in bone from inf of prosthetics (adults)
35
Hematogenous Osteomyelitis
Bone becomes "loose"; can occur in spine Staph aureus, strep sp., gram -, mycobacterium tuberculosis, salmonella in sickle cell pts
36
Direct implantation Osteomyelitis
Occurs from pseudomonas and other organisms
37
Contiguous osteomyelitis
S. Aureus, gram -, strep sp., anaerobes, Candida Bacteria in bone different than in ulcer!
38
Prosthetic Joint Infection Osteomyelitis
Coagulase - staph, S. aureus, gram -, strep sp. (hard to treat!)
39
General characteristics of osteomyelitis
Chronic infections lead to no fever Sequestrum=dead bone Involucrum=new bone Brodie's abscesses=abcesses in bone due to bacteria
40
Biofilms
Aggregations of microorganisms to surface of something Embedded in matrix of "slime", glycocalyx (tubes) More resistant to antibiotics/different properties than normal bacteria Coagulase - good at!
41
Treatment for Osteomyelitis
Rifampin= RNA inhibitor (good for biofilms and S. aureus) Antibiotics only helpful if tissue still there (oral for joint infections)
42
What is this?
Gout Urates on the articular surface, destroy cartilage Fuzzy crystals under microscope
43
What is the inflmmatory response of gout
The inflammasome eats/detects the MSU IL1B is activated Inflammatory cascade with neutrophils occurs
44
What are the categories of treatment for gout?
NSAIDS (NO ASPIRIN; indomethacin, naproxen) Corticosteroids (short term if can't take NSAIDS) Colchicine, allopurinal, febuxostat, pegloticase, probenecid
45
Colchicine
**Used for gout** No effect on uric acid excretion but antimiotic --bind to tublin in neutrophils and inhibit; less pain --oral, rapid absorption/good distribution --activated by CYP450 and eliminated via P glycoprotein --GI side effects --Contraindictations --\> elderly, hepatic/renal disease, CYP3A4/PgP inhibitors
46
What are some non-pharm ways of prophylaxis for treatment of gout?
Abstain from alcohol Wt loss No aspirin/thiazide
47
Allopurinol
**Prevent gout flare up** Inhibit last steps in uric acid biosynthesis via blocking xanthine oxidase Metabolized by aldehyde oxidoreductase oxypurinol (longer 1/2 life) Can cause hypersensitivity OR gout by mobilizing uric acid
48
Febuxostat
**Prevent gout flare up** Non-purine xanthine oxidase inhibitor Vs allopurinol, it's more potent, effective if you have impaired renal function BUT more adverse/CV effects
49
Pegloticase
**Used for gout** Sends PEGylated uricase to humans Makes uric acid to allantoin (H2O soluble) Need to be given by IV Can cause gout flare or immune response against PEG
50
Probenecid
**Used for gout** Uricosuric agent; increases rate of excretion of uric acid Compete with OAT so less uric acid reabsorbed GI effets, bad if kidney issues/stones Bad for use with drugs that need transporter (penicillin)
51
What is this?
Rheumatoid arthritis Microscopic picture of papillary synovitis (pannus) with lymphoid infiltrates at the center
52
What is this?
Rheumatoid arthritis Synovium hyperplasia with lymphocytes
53
What is this?
Rheumatoid nodule showing the central geographic fibrinoid necrosis and the surrounding palisaded chronic inflammatory cells
54
What are the general properties of DMARDs against rheumatoid arthritis?
Parental inj Extracellular, does not cross BBB Long half life, infreq. administration Safe but immunogenicity against; increase risk for inf
55
Etanercept
**Used for RA, all stages** Block TNFalpha by inhibiting ability to bind to receptor (only soluble) Recombo fusion protein
56
Adalimumab
**All stages RA** IgG human monoclonal Ab; binds to all forms TNFalpha to prevent binding
57
Tocilizumab
**Anti RA;** not first line humanized ab that binds to soluble/membrane form IL6 Alterations lipid profile
58
Tofacitinib
**Moderate-severe RA** Inhibitor of JAK (transcription factor that transcribes pro inflammatory genes) Alters lipid profile Oral
59
Rituximab
**Mod/severe RA** Depletes B cells by binding to CD20 (eitehr CDC or ADCC)
60
Abatacept
**Mod-severe RA** Inhibit binding to CD28 and activation of T cells by APC contains CTLA4 fusion protein
61
Anakinra
**RA mod/severe** Recombo protein that is a competitive antagonist of IL 1
62
What is this?
Early OA Superficial layers of cartilage crack Limited new matrix formed
63
What is this?
Subchondral cyst (geode) from late OA
64
What are the main treatment options for OA?
**Main**=wt loss, exercise, physical therapy (first line) **Corticosteroids/hyaluronans**=injected; high placebo--last line before therapy **Topical:** capsaicin, salicylates, menthol **Systemic:** acetaminophen, duloxetine, NSAIDS Opiods=NOT GOOD
65
Duloxetine
Used for OA Oral, centrally acting Causes inhibition of 5-HT/NE reuptake See analgesic effect earlier than antidepression, and minor side effects only
66
Capsaicin
**Used for OA** Topical, releases substance P, pain inhibiting effect; adverse=pain/erythema/site reactions/depletes sub P eventually
67
Glucosamine/Chondroitin
Dietary supplement for OA Glucosamine=maintain cartilage integrity Chondroitin=maintain joint viscosity and stimulate repair
68
Hyaluronic acid
Used for OA Injection, endogenous, inhibit degregation of cartilage apparently but no good data
69

FPP-MSS (6 decks)

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