Week 1 Flashcards by S B

commonest benign bone tumour

osteochondroma

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what do osteochondroma consist of

bony outgrowth on the external surface with a cartilaginous cap

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sign/symptoms of osteochondroma

local pain

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what is an enchondroma

intramedullary and usually metaphyseal cartilaginous tumour caused by failure of normal enchondral ossification at the growth plate.

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how does an enchondroma appear

lesion usually lucent
can undergo mineralisation with a patchy sclerotic appearance
weaken the bone resulting in fracture

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features of enchondroma

many are indcidental findings

can occur on femur, humerus, tibia and small bones of hand and feet

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what is a simple bony cyst

single cavity benign fluid filled cyst in bone

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where a simple bony cysts seen

in long bones and in talus or calcaneus

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features of simple bony cyst

asymptomatic
incidental finding
weakness can lead to fracture

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how are simple bony cysts and enchondroma treated

curettage

bone grafting

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what is an aneurysmal bone cyst

lots of chambers which are filled with blood or serum

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where can aneurysmal bony cysts occurs

metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies

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signs/symptoms of aneurysmal bony cysts

locally aggressive causing cortical expansion and destruction
painful

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where do giant cell tumours affect

epiphysis and can extend to the subchondral bone

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where are GCTs commonly found

knee
distal radius
pelvis
spine

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signs/symptoms of GCT

painful
can cause pathological fracture
consists of multi-nucleate giant cells
x-ray ‘soap bubble’ sign

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what is fibrous dysplasia

disease of bone where a genetic mutation results in lesions of fibrous tissue and immature bone.

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features of fibrous dysplasia

can be mono or polyostotic
causes angular deformities
affected bone is wider with thinner cortices
stress fractures can occur

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what does Extensive involvement of the proximal femur in fibrous dysplasia cause

shepherd’s crook deformity

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what is an osteoid osteoma

small nidus of immature bone surrounded by an intense sclerotic halo.
occur in teens

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where do osteoid osteoma occur

proximal femur, the diaphysis of long bones and the vertebrae

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symptoms/signs of osteoid osteoma

intense constant pain, worse at night due to the intense inflammatory response

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what is the most common malignant bone tumour, who and where does it most commonly affect

osteosarcoma
younger age groups
knee

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what can prolonged survival in osteosarcomas

radiotherapy then chemotherapy

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what is a chondrosarcoma

cartilage producing primary bone tumour | tends to occur in older age groups

features of chondrosarcoma

very large, slow to metastasise | found in pelvis or proximal femur

what is Ewing's sarcoma

tumour of primative cells in the marrow poorest prognosis occur between 10-20 y/o

what is Ewing's sarcoma associated with and what is it sensitive to

associated with fever, raised inflammatory markers and a warm swelling radio and chemo sensitive

treatment of ES

surgery to remove the tumour and surrounding tissue to reduce the risk of recurrence amputations common

what do breast cancer mets appear as

blastic (sclerotic) or lytic

what do prostate cancer mets appear as

sclerotic

what do lung cancer mets appear as

lytic bony metastases

what do renal cancer mets appear as

large and very vascular lytic “blow out” bony metastases

what are features that suggest benign soft tissue neoplasm

smaller size, fluctuation in size (malignant tumours don’t regress in size), cystic lesions, well‐defined lesions, fluid filled lesions and soft / fatty lesions

what are features that suggest malignant soft tissue neoplasm

larger lesions (>5cm), rapid growth in size, a solid lesion, an ill‐defined lesion, an irregular surface, associated lymphadenopathy and systemic upset (weight loss, loss of apetite, fatigue).

first line investigation for suspicious swelling

MRI

what is the commonest benign soft tissue swelling

lipoma - neoplastic proliferation of fat | large but may not be well defines

where do ganglion cysts occur

around a synovial joint or a synovial tendon sheath | may form as a result of herniation or out‐pouching of a weak portion of joint capsule or tendon sheath

features of ganglion cysts

well‐defined, may be quite firm and readily transilluminate | can be excised but don't need to be

what is bursitis

inflammation of bursa around a joint

what causes bursitis

repeated pressure or trauma | may present as a soft tissue swelling

what causes a burial abscess

bacterial infection

what is AVN

ischaemic necrosis of bone

what are causes of AVN

``` idiopathic alcohol/steroid abuse thrombophilia sickle cell disease antiphospholipid deficiency in SLE ```

AVN can cause secondary osteoarthritis - true or false

true

what is osteoporosis characterised by

reduced bone mineral density and increased porosity | i.e. bone is of normal quality there is just not enough of it

what does WHO define osteoporosis as

bone mineral density less than 2.5 standard deviations below the mean peak value of young adults of the same race and sex

what is osteopenia

intermediate stage where bone mineral density is between 1 to 2.5 standard deviations below mean peak value

risk factors for osteoporosis

``` menopause smoking alcohol abuse lack of exercise poor diet ```

how is bone disease diagnosed

DEXA scan

what are the serum calcium and phosphate levels in osteoporosis

normal

Tx for osteoporosis

Calcium and vitamin D supplements Bisphosphonates HRT - last line

what is osteomalacia

abnormal softening of the bone due to deficient mineralization of osteoid (immature bone) secondary to inadequate amounts of calcium and phosphorus

what is osteomalacia called in children

Rickets

what is the two primary causes of osteomalacia/rickets (biochemistry)

1 - insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of or resistance to the action of vitamin D 2 - or phosphate deficiency caused by increased renal losses.

what are diseases/conditions that cause osteomalacia/rickets

``` malnutrition malabsorption lack of sunlight exposure hypophosphateamia (alcohol abuse) CKD ```

Sx of osteomalacia/rickets

Bone pain Deformities of soft bones Sustain fractures easily Sx of hypocalcaemia (e.g. paraesthesiae, muscle cramps, irritability, fatigue, seizures, brittle nails)

what is seen on x-rays of osteomalacia

pseudofractures e.g. Looser's zones

biochemistry results of osteomalacia

low calcium low serum phosphate high serum alkaline phosphatase.

Tx of osteomalacia

vitamin D therapy with calcium and phosphate supplementation

biochemistry of primary hyperparathyroidism

Serum PTH is usually elevated Calcium is high. | Phosphate is normal or low

what is secondary hyperparathyroidism

overproduction of PTH secondary to hypocalcaemia usually caused by vitamin D deficiency or CKD