Tumors and Infections

Question 1

What are the 5 most common primary sites of cancer that metastasize to bone?

Answer 1

Breast
Lung
Kidney
Thyroid
Prostate

Question 2

Most Common Malignancy of Bone

Answer 2

Metastases

Question 3

Most common Primary Malignancy of Bone

Answer 3

Myeloma

Question 4

Most Common Primary Sarcoma of Bone

Answer 4

Osteosarcoma

Question 5

Benign tumor that involves the cortex and expands into the medullary cavity. Lytic with well-defined and lobulated margins.

Answer 5

Nonossyfying Fibroma

Question 6

Where are Nonossyfying Fibromas most commonly found?

Answer 6

Femur
Tibia

Question 7

Benign tumor that is sclerotic and presents with a small < 1cm Lucent nidus
- best seen on CT

Answer 7

Osteoid Osteoma

Question 8

Signs and Symptoms of Osteoid Osteoma

Answer 8

Night Pain
- responsive to NSAIDs

Question 9

Where are Osteoid Osteomas most commonly found?

Answer 9

Long Bones
Posterior Spine

Question 10

Treatment for Osteoid Osteoma

Answer 10

Self-limited
Non-surgical

Question 11

Benign and progressive tumor that may be lytic, sclerotic, or mixed.

Radiolucent nidus > 2cm

Big Brother to Osteoid Osteoma

Answer 11

Osteoblastoma

Question 12

Osteoblastoma Signs and Symptoms

Answer 12

Dull ache
- not relieved by NSAIDs

Question 13

Osteoblastoma Treatment

Answer 13

Surgery

Question 14

Bone arising from stalk (pedunculated) or “bump” on bone that is benign. Occurs on the metaphysis of long bones usually in childhood and young adults.

Answer 14

Osteochondroma

Question 15

Benign lytic bone expansion. Can occur on any bone and has a ground glass appearance on X-Ray.

Answer 15

Fibrous Dysplasia

Question 16

Radiolucent, well-defined, confined to the cortex with a sclerotic border. Benign.

Answer 16

Fibrous Cortical Defect

Question 17

Where are Fibrous Cortical Defects most commonly found?

Answer 17

Distal Femur
Tibia

Question 18

Benign lytic lesion that may erode beyond the cortex. Can metastasize to the lungs, even though it is benign.

Answer 18

Giant Cell Tumor

Question 19

Where are Giant Cell Tumors most commonly found?

Answer 19

Distal Femur
Proximal Tibia
Distal Radius
Proximal Humerus
Pelvis
Sacrum

Question 20

A benign vascular tumor of bone.

Honey-comb appearance
Jail Bar Appearance

Answer 20

Hemangioma

Question 21

Most common primary bone malignancy. Usually has localized bone pain (ribs or spine) or pathologic fractures.

X-Rays show “Punched Out” Lesions

Answer 21

Multiple Myeloma

Question 22

Who does Multiple Myeloma most Commonly Effect?

Answer 22

Males > 40
African Americans

Question 23

What are 2 significant findings of Multiple Myeloma?

Answer 23

Bence Jones Proteins
- proteinuria

Hypercalcemia
- due to bone destruction

Question 24

Malignancy that causes callous formations.

Answer 24

Osteosarcoma

Question 25

What is the most common site of Metastasis of Osteosarcoma?

Answer 25

Lungs

Question 26

How is osteosarcoma treated?

Answer 26

Multi-Agent Chemotherapy + Limb Salvage Resection

Question 27

What pathogen is the primary cause of Osteomyelitis?

Answer 27

Staph. aureus - 60% of cases

Question 28

What are common causes that allow for Osteomyelitis?

Answer 28

Open Fracture Surgery Open Wound Hematogenous Spread

Question 29

Signs of an Epidural Abscess with Vertebral Osteomyelitis

Answer 29

Fever Severe Back or Neck Pain Radicular Symptoms Incontinence

Question 30

What are the most common locations of Osteomyelitis?

Answer 30

Long Bones Vertebrae

Question 31

If a patient is an IV drug abuser, what are the most likely sites of Osteomyelitis?

Answer 31

1. SPINE But also: 2. Sternoclavicular Joint 3. Sacroiliac Joint

Question 32

Signs and Symptoms of Hematogenous Osteomyelitis

Answer 32

Sudden Onset of Fever Chills Pain Tenderness

Question 33

Causes of Contiguous Osteomyelitis

Answer 33

Prosthetic Joint Orthopedic Surgery

Question 34

Causes of Vascular Insufficiency Osteomyelitis

Answer 34

Diabetes - foot and ankle are most common

Question 35

What are 2 clues of Osteomyelitis in Ulcers?

Answer 35

Easily able to advance probe to the Bone Ulcer area > 2cm

Question 36

If testing for Osteomyelitis, why should you get the cultures from the bone or blood and not from the overlying wounds or ulcers?

Answer 36

Wounds or ulcers are unreliable due to contamination with skin flora.

Question 37

Osteomyelitis Treatment

Answer 37

IV ABX (4 - 6 weeks) - MRSA → Vancomycin - MSSA → Cefazolin. Oxacillin. Nafcillin.

Question 38

When does Osteomyelitis require Surgery?

Answer 38

1. Epidural Abscess 2. Extensive Disease 3. Recurrent or Persistent Infection

Question 39

Acute onset of inflammatory monoarticular arthritis, most often in large weight-bearing joints and wrists.

Answer 39

Septic Arthritis (Non-gonococcal acute bacterial arthritis)

Question 40

What is the most common pathogen to cause of Septic Arthritis?

Answer 40

Staph. aureus

Question 41

What are the most common causes of Septic Arthritis in IV Drug Abusers?

Answer 41

E. coli Pseudomonas

Question 42

Joints are usually in what position with Septic Arthritis due to effusion?

Answer 42

Flexion Abduction

Question 43

What are the hallmarks of Septic Arthritis?

Answer 43

Joint Tenderness Effusion Erythema Marked Limitation of Passive Motion

Question 44

What tests should be performed on a patient with Septic Arthritis?

Answer 44

Labs Ultrasound Joint Fluid Aspiration Cultures Gonococcal → Throat, Cervical, and Urethral Cultures

Question 45

What might a AP/Lateral X-Ray show in a patient with Septic Arthritis?

Answer 45

Usually Normal - maybe soft tissue swelling with widened joint space

Question 46

What would an Ultrasound show in a patient with Septic Arthritis?

Answer 46

Joint Effusion

Question 47

Why should you perform an MRI with Septic Arthritis?

Answer 47

Rule Out Osteomyelitis

Question 48

Septic Arthritis Treatment

Answer 48

Vancomycin + Ceftriaxone until cultures return Emergent Surgical Decompression and Lavage - Cornerstone of Treatment

Question 49

Arthritis that is common is MSM → higher incidence of asymptomatic gonococcal pharyngitis and proctitis predisposes them to disseminated infection. Women 2-3x > men - especially during menses and pregnancy Typically occurs in healthy persons.

Answer 49

Gonococcal Arthritis

Question 50

Signs and Symptoms of Gonococcal Arthritis

Answer 50

1 - 4 days of migratory polyarthralgias 1. Tenosynovitis (60%) 2. Purulent Monoarthritis (40%) Most have asymptomatic skin lesions

Question 51

Best Test for Gonococcal Arthritis

Answer 51

Urinary NAAT

Question 52

Gonococcal Arthritis Treatment

Answer 52

Ceftriaxone (1g IV or IM) - change to oral agent with 7 day course - Responds DRAMATICALLY to ABX