<![CDATA[Mock19 Pathological Fracture]]>Stem
A young female was cycling when she suddenly developed pain in her thigh as soon as she put her foot on the ground. X-ray showed fracture shaft femur with hypodense shadow.

What's the type of this fracture?

Pathological fracture

What's a pathological fracture?

Bone fracture which occurs without adequate trauma and is caused by a pre-existent pathological bone lesion.

What are the causes of a pathological fractures?

  1. Neoplastic: malignant tumours

Primary (multiple myeloma)
Metastatic

  1. Non-neoplastic:

Osteoporosis
Osteomyelitis
Osteomalacia
Osteogenesis imperfecta
Paget's disease
Bone cyst
Radiotherapy

What are the most common primary sources for bone metastasis?

Breast
Prostate
Lung
Thyroid
Kidney

What's the name of brain tumour causing sclerotic metastasis?

Medulloblastoma

Fracture was treated with internal fixation, how to check for malignancy?

Bone biopsy

Pathology results showed a typical bland appearance (follicular cells), what's the probable location of the primary?

Thyroid gland

A thyroid nodule was detected and FNA was done; however, it has not been able to rule out or confirm cancer, why?

In follicular thyroid neoplasm, malignancy is determined by capsular and vascular invasion which need histology rather than a cytology to confirm

What are the other sites of ectopic thyroid tissue other than head, neck and mediastinum?

Ovarian and testicular teratoma

Which investigation can be done to confirm thyroid metastasis?

Radioactive iodine scan

Which type of thyroid cancer that will show no response to iodine uptake?

Medullary thyroid cancer as its origin is from parafollicular C cells so it is not of a follicular origin

Tumour marker for Medullary thyroid cancer?

Calcitonin

The patient needed blood transfusion during surgery, what needs to be tested before a transfusion?

ABO
RH group cross matching

If the patient's blood group is known, would you still need cross matching? Why?

Yes, to determine if the recipient has pre-formed antibodies against any antigens on the donor's cells.

What are the complications of incompatible blood transfusion?

Acute haemolytic reactions
Febrile non-haemolytic transfusion reaction
Delayed haemolytic transfusion reactions
Transfusion related acute lung injury

Define haemolysis?

Rupture (lysis) of RBCs and release of their contents (cytoplasm) in the surrounding fluid (blood, plasma)

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