Week 4

Question 1

Bone forming vs cartilage forming tumours?

Answer 1

Osteoma
Chondroma

Question 2

Primary bone cancer risks

Answer 2

Previous radiotherapy
Predisposing conditions:
* Pagets / fibrous dysplasia / multiple enchondromas
Genetic
* p53, RBI

Question 3

Primary bone cancer presenting features

Answer 3

Persistent, increasing pain!!!!!!!!!
* not assoc w movement/worse at night
Swelling & erythema over joint
Palpable mass
Pathological fracture

Question 4

Primary bone cancer investigations

Answer 4

Imaging - x-ray, CT, MRI, bone scan
(x-ray not as effective)

Question 5

Primary bone cancer treatment

Answer 5

Neoadjuvant (pre-surgery)
* Chemo / radiotherapy / hormone
Surgery: reconstruction / amputation
Adjuvant
* Chemo / radiotherapy

Question 6

Describe osteosarcoma

Answer 6

Primary tumour affecting mostly young people
Distal femur/proximal tibia
Pulmonary mets
75% long-term survival
Treat: chemo/limb salvage

Question 7

Describe Ewing’s sarcoma

Answer 7

Young people, 2nd most common
Diaphysis of long bones, also DF and PT
Mixed survival
Treat: chemo/limb salvage/radiation

Question 8

Describe chondrosarcoma

Answer 8

Malignancy of chondrocytes, cortical thickening
* Majority arise de novo, few beingin
* Older patients 40-75y
* Commonest in pelvis, proximal and distal femur
* May be slow-growing /aggressive – this correlates with survival

Question 9

Describe osteoid osteoma

Answer 9

Painful, benign tumour of long bones
* Young people aged 5-25 years
* Central nodule of woven bone with
osteoblastic rim
* Pain worse at night, relieved by aspirin
* Usually resolve spontaneously
* treat with radiofrequency ablation

Question 10

Describe osteochondroma

Answer 10

Most common benign bone tumour!!!
* Benign lesion formed from abnormal cartilage
* Solitary or multiple (hereditary multiple exostoses, HME)
* Common in adolescents / young adults
* Can be caused by trauma
* <1% progress to chondrosarcoma (pelvic lesions)

Question 11

Describe endochondroma

Answer 11

Benign intramedullary cartilage lesion
* 2nd most common benign bone tumour
* Commonest in 20-50 year olds
* Usually asymptomatic, usually presents as incidental
finding
* Conservative treatment, curettage & bone grafting if
symptomatic

Question 12

How can we remember 6 most common bone mets?

Answer 12

BLT with a Kosher Pickle
(breast/lung/thyroid/kidney/prostate)

Question 13

Define lyctic and sclerotic

Answer 13

Lyctic - loss of bone
Sclerotic - gain of bone

Question 14

7 radiographic features of bone tumours

Answer 14

1. Location / nature
2. Neocortex
3. Cortical involvement
4. Zone of transition
5. Matrix

Question 15

What is Mirel’s score?

Answer 15

Used to assess likelihood of sustaining a pathological fracture

Question 16

Most common problems assoc with GP knee pain presentation

Answer 16

LIGAMENT STRAIN OFTEN MEDIAL COLLATERAL

BURSITIS

OSGOOD-SCHLATTER’S

OSTEOARTHRITIS (PATELLO-FEMORAL>KNEE)

Question 17

Less common GP knee pain presentations

Answer 17

CHONDROMALACIA PATELLAE

MENISCUS INJURY

CRUCIATE DAMAGE

GOUT

RHEUMATOID ARTHRITIS

PATELLAR SUBLUXATION/DISLOCATION