Pathological Fractures

Question 1

What is a pathological fracture?

1 - a fracture that is due to infection
2 - a low impact fracture in a both with existing abnormality
3 - malignant bones

Answer 1

2 - a low impact fracture in a both with existing abnormality

Question 2

Which of the following is NOT a common cause of a pathological bone fracture?

1 - malignancy
2 - osteoporosis
3 - osteomyelitis
4 - osteoarthritis
5 - osteomalacia

Answer 2

4 - osteoarthritis

Question 3

Are primary malignant bone tumours common?

Answer 3

• no
• generally secondary from other sites
• most common include breast, lung, renal, thyroid and prostate

Question 4

All of the following are common causes of secondary bone metastasis, EXCEPT which
one?

1 - breast
2 - lung
3 - colon
4 - thyroid
5 - renal
6 - prostate

Answer 4

3 - colon

Question 5

Which 2 of the following are common causes of haematological bone cancers?

1 - myeloma
2 - leukemia
3 - lymphoma
4 - myelodysplastic Syndromes

Answer 5

1 - myeloma
3 - lymphoma

Question 6

All of the following are common sites where secondary metastatic cancer can spread to, EXCEPT which one?

1 - spine (vertebral body)
2 - proximal Femur (subtrochanteric region)
3 - humerus (head, neck and shaft)
4 - pelvis (pubic rami)

Answer 6

4 - pelvis (pubic rami)

Question 7

All of the following are benign bone cancers, EXCEPT which one?

1 - Osteosarcoma
2 - Osteochondroma
3 - Enchondroma
4 - Osteoid osteoma
5 - Giant cell tumours
6 - Aneurysmal bone cyst
7 - Fibrous cortical defect

Answer 7

1 - Osteosarcoma

• benign tumours generally remain localised to the bone

Question 8

All of the following are benign bone cancers. Which is most common?

1 - Osteochondroma
2 - Enchondroma
3 - Osteoid osteoma
4 - Giant cell tumours
5 - Aneurysmal bone cyst
6 - Fibrous cortical defect

Answer 8

1 - Osteochondroma

• presents as a painless mass
• though to arise form abnormal growth at the growth plates

Question 9

At what age do benign bone cancers generally occur?

1 - 1-3 y/o
2 - 5-15 y/o
3 - 10-30 y/o
4 - >35 y/o

Answer 9

3 - 10-30 y/o

Question 10

How are benign bone tumours generally diagnosed?

1 - blood results
2 - bone tumour marker
3 - plain film X-ray
4 - biopsy

Answer 10

3 - plain film X-ray

• often random finding

Question 11

The second most common benign tumour is an enchondroma. What do these generally form from?

1 - articular cartilage
2 - periosteum
3 - hyaline cartilage
4 - blood vessels

Answer 11

3 - hyaline cartilage

• typically located in medullary of bone

Question 12

The second most common benign tumour is an enchondroma that form from hyaline cartilage and are located in the medullary. Where in the body are these tumours most common?

1 - feet
2 - hands
3 - hips
4 - spine

Answer 12

2 - hands

• normally a single tumour, but multiple tumours is called Ollier’s disease

Question 13

Are all benign tumours surgically operated on?

Answer 13

• no
• only if painful, impinging nerves or range of motion at a joint

Question 14

Three of the following are malignant bone tumours, which one is NOT malignant?

1 - Ewings
2 - Osteosarcoma
3 - Osteochondroma
4 - Chondrosarcoma

Answer 14

3 - Osteochondroma

Question 15

Which of the following is the most common malignant bone tumour?

1 - Ewings
2 - Osteosarcoma
3 - Chondrosarcoma

Answer 15

2 - osteosarcoma

• can be intramedullary (most common), periosteal or parosteal

Question 16

Osteosarcoma are the most common malignant bone tumours. They are aggressive osteogenic tumours (bone forming cells) and can spread to other tissues. What is the most common site in the body for Osteosarcoma?

1 - distal humerus or tibia
2 - proximal tibia or distal femur
3 - proximal femur or humerus

Answer 16

2 - proximal tibia or distal femur

Question 17

Osteosarcoma are the most common malignant bone tumours. They are aggressive osteogenic tumours (bone forming cells) and can spread to other tissues. Are these types of tumours painful?

Answer 17

• yes
• cause lots of pain and swelling

Question 18

Osteosarcoma are the most common malignant bone tumours. They are aggressive osteogenic tumours (bone forming cells) and can spread to other tissues. Do these generally occur in children and young adults or older adults?

Answer 18

• children and young adults
• likely due to still having high bone turnover when compared with older people

Question 19

How are Osteosarcoma tumours generally treated?

1 - palliative care as prognosis is poor
2 - radiotherapy
3 - radiotherapy and chemotherapy
4 - chemotherapy and resections of bone

Answer 19

4 - chemotherapy and resections of bone

• poor prognosis 77% 5 year survival if localised and 26% if metastatic

Question 20

Ewings sarcoma is a malignant bone tumour that has been linked with a 11:22 chromosomal translocation. Does this generally occur in younger or older patients?

Answer 20

• younger patients
• <25 y/o

Question 21

Ewings sarcoma is a malignant bone tumour that has been linked with a 11:22 chromosomal translocation that generally occurs in younger patients. Where in the bone do these tumours generally occur?

1 - medullary
2 - epiphysis
3 - diaphysis
4 - metaphysis

Answer 21

3 - diaphysis

• generally in long bones
• causes pain, fever and swelling

Question 22

How are Ewings sarcoma tumours generally treated?

1 - palliative care as prognosis is poor
2 - radiotherapy
3 - radiotherapy and chemotherapy
4 - chemotherapy, radiotherapy and resections of bone

Answer 22

4 - chemotherapy, radiotherapy and resections of bone

Question 23

Chondrosarcoma are malignant bone tumours and as the name indicates these originate from chondrocytes (cartilage forming cells). Are these tumours always malignant and aggressive?

Answer 23

• no
• they have varying degree of malignancy

Question 24

Chondrosarcoma are malignant bone tumours and as the name indicates these originate from chondrocytes (cartilage forming cells). What 2 locations do these generally occur in?

1 - humerus and pelvis
2 - proximal femur and pelvis
3 - proximal tibia and femur
4 - distal femur and humerus

Answer 24

2 - proximal femur and pelvis

• generally present as a progressively painful mass
• biopsy will show characteristic “blue-balls

Question 25

Chondrosarcoma are malignant bone tumours and as the name indicates these originate from chondrocytes (cartilage forming cells). Do these tumours generally occur in older or younger patients?

Answer 25

- older patients - around 40 y/o

Question 26

Chondrosarcoma are malignant bone tumours and as the name indicates these originate from chondrocytes (cartilage forming cells). How are these tumours generally treated? 1 - wide surgical resection 2 - radiotherapy 3 - radiotherapy and chemotherapy 4 - chemotherapy, radiotherapy and resections of bone

Answer 26

1 - wide surgical resection - 60-70% 5 year survival overall

Question 27

Secondary bone tumours are when primary tumours from other locations have spread to the bones. When trying to diagnose a patient with secondary bone tumours, why do we need the joint above and below tumour? 1 - identify if tumour has spread 2 - identify if the tumour is malignant 3 - identify resection required

Answer 27

1 - identify if tumour has spread - also helps with biopsy to identify the primary cause of the tumour

Question 28

What % of pathological fractures occur due to metastasis? 1 - 3% 2 - 13% 3 - 30% 4 - 60%

Answer 28

3 - 30% - 50% in femoral neck

Question 29

Surgery is one option for patients with secondary metastasis. Which 2 of the following are the preferred option if surgery is required? 1 - stabilise the fracture and radiotherapy 2 - amputation as limits risk of reoccurrence 3 - fix the fracture

Answer 29

1 - stabilise the fracture and radiotherapy 3 - fix the fracture

Question 30

Bisphosphonates are one non-surgical treatment options for patients with secondary metastasis tumours. What is the mechanism of action of Bisphosphonates? 1 - inhibit osteopblasts 2 - inhibit osteoclasts 3 - bind with hydroxyapatite 4 - bind with RANK-L

Answer 30

3 - bind with hydroxyapatite - hydroxyapatite, which is the mineralized form of calcium found in bones - osteoclasts break down bones, they also take in the bisphosphonates, essentially kills the osteoclasts from within

Question 31

Denosumab is one non-surgical treatment options for patients with secondary metastasis tumours. What is the mechanism of action of Denosumab? 1 - inhibit osteopblasts 2 - inhibit osteoclasts 3 - bind with hydroxyapatite 4 - bind and inhibits RANK-L

Answer 31

4 - bind and inhibits RANK-L - RANK-L normally stimulates monocytes to form osteoclast cells that then reabsorb bone