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Phase 1 > Ch. 68, 70, 71, 73, 74 Last of Musculoskeletal > Flashcards

Ch. 68, 70, 71, 73, 74 Last of Musculoskeletal Flashcards

1
Q

What are the aggrecanases?

A

examples are ADAMTS 4 and ADAMTS 5
cleaves the aggrecan protein core in the interglobular domain between G1 and G2
ADAMTS 5 is upregulated in murine OA models
aggrecan is degraded and this disrupts the collagen network

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2
Q

what enzymes degrade the type II collagen triple helix?

A

MMP 1 and MMP 13

Maybe also MMP8 and MMP4

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3
Q

what is the most abundant non collagenous protein of articular cartialge?

A

cartilage oligomeric matrix protein

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4
Q

what cells are thought to be the precursors of osteophytes?

A

mesenchymal stem cells

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5
Q

what cytokine plays a crucial role in the induction of osteophytosis?

A

TGF beta

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6
Q

what are the validated owner completed questionaires for dogs and cats?

A

for dogs, the Canine Orthopedic Index (COI) and for cats, there is none

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7
Q

what are the radiologic features of OA?

A 
osteophytosis
enthesophytosis
effusion
soft tissue swelling
subchondral sclerosis
intra artciular mineralization
subchondral cyst
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8
Q

what are two weight loss pharmaceuticals approved for use in dogs?

A

Mitratapide and Dirlotapide are microsomal triglyceride transfer protein inhibitors that can suppress appetite in dogs

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9
Q

how does acetaminophen have analgesic effect?

A
  • May work on CNS but indirectly activate the cannabinoid (CBI) receptors
  • acetaminophen –> deacetylation to p-aminophenol will conjugate with AA to form N-arachidonoylphenolamine, an endogenous cannabinoid
  • May play central inhibitory action on COX1 splice variant
  • May stimulate inhibitory pain pathway that is mediated by serotonin by activating serotonin receptors
  • Has no produced renal or gastric injury in dogs when given at recommended dosages
  • Not licensed for use in dogs in most countries
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10
Q

characteristics of carprofen

A
  • propionic acid derived NSAID
  • COX 2 selective with COX1:COX2 of 17
  • stimulatory effect on sulfated glycosaminoglycans but inhibitory at higher doses
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11
Q

characteristics of Deracoxib

A
  • coxib

- metabolism is primarily in the liver with elimination half life of 3 hours

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12
Q

characteristics of etodolac

A
  • indole acetic acid derivative that inhibits both COX1 and COX2
  • may inhibit COX1 preferentially
  • affects macrophage chemotaxis
  • removed from body primarily through biliary excretion but it does under enterohepatic recirculation –> a long half life
  • not approved in patients less than 12 months old
  • may cause KCS
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13
Q

characteristics of firocoxib

A
  • a pyridylsulfone

- COX 1: COX2 ratio is 342-430 therefore strongly cox 2 specific

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14
Q

characteristics of ketoprofen

A
  • propionic acid

- recommended treatment of up to thirty days

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15
Q

characteristics of mavacoxib

A

COX1:COX2 OF 21 –> Prefers to inhibit cox 2
very long administration - may only have to dose once a month
may do a treatment cycle every 2 months
only labeled for use in Europe

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16
Q

characteristics of meloxicam

A
  • cox 2 selective with a ratio of 3
  • long half life so give once a day
  • currently the only NSAID that is licensed in Europe, Australia, and New zealand for long term treatment of cats with OA
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17
Q

characteristics of phenylbutazone

A
  • licensed in Europe only
  • COX1:COX2 ratio of 2.64 - slightly more cox 2 selective
  • toxicity can manifest as hemorrhage, biliary stasis, hepatitis, renal failure, blood dyscrasias
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18
Q

characteristics of robenacoxib

A
  • COX1:COX2 of 140 so highly COX2 selective
  • extensively metabolized by the liver and has a half life in blood of 1.2 hours
  • excretely primarily in the biliary system and some by kidneys
  • recommended that liver enzymes are assayed before and after starting liver enzymes
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19
Q

characteristics of tepoxalin

A
  • only labeled in Europe
  • inhibits COX (nonselective) and 5-lipoxygenase
  • 10% GI adverse event rate
  • may ameliorate the degradation of collagen in a canine in vitro model of cartilage catabolism
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20
Q

characteristitcs of tolfenamic acid

A
  • recommended dosage is 4 mg/kg SID for three days and then repeat every 7 days - so give 3 days of meds and then 4 days off and repeat
  • not super practical
  • labeled in Europe
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21
Q

charactersitics of amantadine for OA pain

A
  • NMDA antagonist

- also used as drug for Parkinson’s –> may act on dopaminergic system too

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22
Q

characteristics of gabapentin for OA pain

A
  • gamma aminobutyric acid (GABA)
  • originally developed for the treatment of epilepsy
  • not licensed for dogs or cats
  • may involve voltage gated N type calcium ion channels
  • excreted by the kidneys and so patients with renal insufficiency may require less dosing
  • avoid abruptly stopping the drug because that may lead to rebound pain
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23
Q

characteristics of codeine

A
  • codeine, aka methymorphine - natural alkaloid found in opium poppy
  • approx 5-10% is converted to morphine
  • the remaining free amount may be conjugated to form codeine-6-gluconuride (70%), norcodeine (10%), and hydromorphone (1%)
  • schedule II controlled substance
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24
Q

How can intra articular steroids be detrimental to the joint?

A

repeated use can lead to suppression of the cartilage matrix synthesis
recommend no more than 3-4 injections per year

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25
Q

how do polysulfated glycosaminoglycans aid in OA pain management?

A
  • direct injection may maintain chondrocyte viability
  • IM administration may lead to inhibited cartilage oligomeric matrix protein degradation and decreases in serum cartilage oligomeric matrix protein concentrations
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26
Q

how does pentosan polysulfate aid in OA treatment

A
  • semisynthetic GAG prepared from beech hemiscellulose and is structurally similar to heparin
  • may retard cartilage degrafation and stimulate syntehtsis of hyaluronan by synovial cells and proteoglycan by chondrocytes
  • acts as a fibrinolytic and thrombolytic agent
  • approved in Europe, Australia and New Zealand, and canada
27
Q

How are n-3 essential fatty acids thought to be involved in the OA process?

A
  • reduce mRNa levels for ADAMTS-4 and 5 and MMP-3 and MMP-13 (proteinases that degrade cartilage
  • reduce mRNA for COX2 (but not COX1)
  • reduce mRNA for TNF alpha, IL-1
28
Q

what are key factors related to human rheumatoid arthritis

A
  1. a genetic link with human leukocyte antigen (HLA)-DR4
  2. a dramatic response to blockade of TNF alpha suggests that TNFalpha plays big role
  3. similar response to depletion of B lymphocytes but not T lymphocytes
  4. presence of autoantibodies to the Fc region of immunoglobulin G (known as rheumatoid factors) and to citrullinated peptides (ACPAs)
  5. link with tobacco smoking
29
Q

what is pannus?

A

In erosive forms of immune mediated polyarthritis like canine rheumatoid arthritis, granulation tissue called pannus will proliferate and invade the margins of articular cartilage and subchondral bone

30
Q

What is the significance of DLA class II genes?

A

DLA class II is a highly significant genetic risk factor for antinuclear antibody positive immune mediated polyarthritis

31
Q

what are rheumatoid factors?

A

anti-immunoglobulin antibodies for IgM and IgA against the Fc portion
the rheumatoid factor will form a complex with the immunoglobulin
not specific for canine rheumatoid arthritis

32
Q

type I IMPA

A

this is a non erosive idiopathic IMPA
most dogs with IMPA will respond to initial immunosuppression but 31% of dogs relapsed, required further treatment, or both

33
Q

type II IMPA

A

non erosive
compared ot Reiter’s syndrome in people or called reactive arthritis
may be secondary to infection from Salmonella, Shigella, Yersinia, Campylobacter, Chlamydia
treating the underlying infection can resolve the IMPA but you may have recurrent or chronic IMPA still

34
Q

type III IMPA

A

non erosive
most common GI signs are vomiting and diarrhea
may be a source of bacterial and food antigens that can trigger an immune complex disease

35
Q

type IV IMPA

A

non erosive

paraneoplastic IMPA - no direct invasion of the neoplasm

36
Q

Drug induced IMPA - which is the most commonly implicated drug?

A

sulfonamide

usually withdrawal of the drug results in improvement within 1-3 days

37
Q

what is polyclonal activation?

A

non specific reactivation of memory b lymphocytes - may show high levels of many antibodies, which can make it confusing to diagnose what type of IMPA the patient has

38
Q

feline chronic progressive polyarthritis or periosteal proliferative polyarthritis

A

erosive and non erosive forms but seems like mostly erosive
may see ankylosis of the joins - tarsi and carpi most commonly affected
marked proliferation of periosteal new bone
negative for rheumoatoid factor
entehesopathies
usually positive for feline syncytial forming virus (FeSV) and FeLV

39
Q

what are infliximab and adalimumab

A

TNF alpha antibody treatments for rheumatoid arthritis

40
Q

what are the typical causes of bacterial polyarthritis in puppies and kittens?

A

usually secondary to omphalophlebitis, streococcal pharyngitis, or uterine/mammary infection

41
Q

what are the three criteria for bacterial infective arthritis?

A
  1. typical history and clinical signs
  2. synovial fluid cytology consistent with bacterial infective arthritis
  3. positive bacteriologic culture
42
Q

how does Borrelia burgdorferi induce IMPA

A

induce and activate host proteases such as aggrecanases ADAMTS and matrix metalloproteinases –> cartilage degradation

43
Q

what is the recommended serodiagnostic test for borrelia burgdorferi

A

C6 and IR6 peptides that bind to the VlsE protein
the organism is found in low levels in the blood and is difficult to culture
can check PCR but it might be high with only exposure not so much a serologic response

44
Q

what are bacterial L forms?

A

cell wall deficient bacteria that revert to their parent cell wall state in culture
an L form of Nocardia was seen in a dog with IMPA

45
Q

what stains will show mycoplasma organisms?

A

Giemsa, Wright, or Leishmann

46
Q

what are the diameters of arthroscopes used in small animal med?

A

1.9, 2.3, 2.4, 2.7
usually 1.9 for carpi and tarsi
2.7 for shoulders and stifles
1.9 or 2.3/2.4 for elbows

47
Q

what length is typical for arthroscopes?

A

short - 8.5 cm

long - 13 cm

48
Q

what is a direct coupling for an arthroscope?

A

also called glass on glass, the arthroscope is coupled to the camera using a threaded interface

49
Q

what is the commonly recommended starting pressure for arthroscopy fluid?

A

60 mm Hg

50
Q

what size surgical curette is typically used for arhtroscopy?

A

size 5-0

51
Q

what is the typical size of arthroscopic cannulas?

A

inner diameters of 2.3 to 3.5 and a length of 4-5cm

52
Q

where are the accepted common locations of OCD in the dog?

A

humeral head
medial aspect of the humeral condyle
lateral or medial femoral condyle
medial or lateral trochlear ridge of the talus

53
Q

when does the tibial tuberosity fuse?

A

6-8 months to the condule

6-12 months to the shaft

54
Q

saltation and stasis

A

saltation - short periods of growth
stasis - no growth

growth is not a continuous process, goes back and forth between these states

55
Q

what is the Hueter Volkmann law?

A

growth is retarded by increased mechanical compression and accelerated by reduced loading in comparison with normal values - growth usually is occurring during recumbency and not while standing and moving

56
Q

what are the two main differences between the epiphyseal inner layer and the growth plate?

A
  1. inner layer is visually disorganized and does not have the ordered zonal and columnar arrangement of the growth plate
  2. unlike the proliferative, hypertrophic, and mineralization zones in the [hysis, the chondro-epiphysis has a lot of vasculature
57
Q

what is kinetic vs kinematic gait analysis

A

kinetic is the study of forces generated during movement

kinematic is the study of motion irrespective of masses or forces

58
Q

what are the symmetrical gaits?

A

trot
walk
pace

59
Q

what are the components measured with each time a foot makes contact with a measurement device?

A

force vector - described the direction of force
spatial components - describe the location of the force vector
three orthogonal movements

60
Q

what shape is Fz (vertical force) during the trot and walk?

A

trot is a bell shape and walk is an M shape

61
Q

Braking vs propulsion

A

both are measurements of the craniocaudal force
braking is deceleration and is positive
propulsion is acceleration and is negative

62
Q

what is a symmetry index?

A

using an animal’s own limb to serve as an internal control for comparison

63
Q

what is parallax error

A

occurs as the subject moves away from the optical axis of the camera

64
Q

what is perspective error?

A

occurs when the subject moves out of the calibrated plane of motion

Phase 1 (35 decks)

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