Large Animal Surgery Exam I Flashcards Preview

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Flashcards in Large Animal Surgery Exam I Deck (187):
1

Best tool for diagnosis tendonitis

Ultrasound

Use 7.5-12mHz linear transducer

2

Consists of Curasalt/20% hypertonic saline on kerlix. Used for exudative or necrotic wounds. Change every 24-48 hours and switch dressing when necrotic tissue/infection resolves

Hypertonic saline dressing

3

Nerve block for low 4 point block. Blocks between MCIII and MC II above the fetlock and between Suspensory ligament DDF tendons. Needle placed in two spots. 

Lat/Med palmar nerves- between SL and DDF. DF tendon sheath across back of fetlock is goal. Being blocked by proximal and palmar needles. 

Lat/Med palmar metacarpal nerves- blocks distal to button of splint (Distal and Dorsal)

4

Minimum stall rest for fracture thats fasted

12 weeks

5

If less than 1/3rd of eyelid margin is missing close using

Direct apposition

6

Phase of wound healing with hemostasis and fibrin deposition, then inflammation with activated platelets and other white blood cells

Inflammation/Lag Phase

7

Healing with granulation tissue, would contracture and epithelialization

Second intention healing

8

Increases support in the heel and leg. Used to help hold heel together and stop excessive movement. 

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Bar shoe

9

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Plain emasculator

10

Used for radial and tibial fracture stabilization, and gastroc rupture in farm animals. Large ring placed around axilla or groin and two rods extend down. Rods attach to metal foot plate and limb is in cast. Maintains limb in extension

Thomas schroeder splint

11

Type of skin graft that is completely separated form blood supply.

Free graft (Island grafts, sheet graft)

12

In the horse an inguinal cryptochid is most common on the ____ side

Right

13

Olecranon fracture stabilization consists of

Stack bandage with palmar splint, extend from heels to top of elbow

14

How long is a flexion test held for on a forelimb and hindlimb?

30 sec

15

When placing bandage place ____ layer without tension and always

Primary, always push flexor tendons medially (right limb-clockwise, left limb- counterclockwise)

16

Modality of choice for imaging bone. Used with radiographs

CT

17

This shit?

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Fibrotic myopathy

18

Blocked below carpus in the groove betweent the suspensory and DDF. 4 needles total, numb from carpus down

High 4 point block

19

Bandage sutured over a wound or incision site. Create suture loops with umbilical tape to hold down

Stent bandage

20

Starts immediately after wounding. Need wound contraction to assist which begins 2nd week of injury.

Epithelialization

21

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Reimer emasulator

22

Immediate wound closure. Clean and clean contaminated wounds

Primary closure (healing)

23

Histology of retained testes contains

Atrophic seminiferous tubules

24

Castrated horses will still be fertile for

Up to three weeks

25

Used to decrease edema, usually use Nitrofurazone ointment, DMSO, and Epsom salts. Use saran wrap to support bandage. Remove and wash limb at least daily

Sweat bandage

26

If going well change a cast

6 weeks in adults and 7-14 days in neonate, if swelling when 1st placed then change at 3-5 days

27

Most common tears within the synovial cavity on which tendon

DDF in forelimb and Manica flexoria in hindlimb

28

Paralysis of the suprascapular nerve caused by trauma

Sweeny

29

Grade III lameness

Consistently observable at a trot under all circumstances

30

Treatment for thrush

Removal of all loose horn, caustic agents like copper sulfate

31

Cryosurgery causes tissue destruction by 

Direct cellular damage and/or anorexia to the microvasculature, this causes cellular dehydration causing changes to macromolecules, lipids, and pH and formation of intracellular ice crystals. Also causes cell membrane damage and thermal shock

32

Tendon consists of

70% water, 30% collagen and shit (type I collagen)

33

Most important for survival of a free graft

Prep the recipient site. Topical antibiotics 24-48hr before graft, and granulation tissue flush with the skin

34

Used in horses with navicular. Extends beyond the heel. 

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Egg bar shoe

35

Only modality providing real time evaluation of both soft tissue and some bone

Ultrasouns

36

Clinical parameters of OA

Effusion, Decreased viscosity of synovial fluid, Increased TP

37

Surrounds the tendon but is not in a sheath

Paratendon

38

Fractures distal to the fetlock require what kind of support

Dorsal splint

39

Used in post surgical lavage. Contains HA, Chondroition sulfate, and N-acetyl D-glucosamine.

Polygon

40

In wound healing initiated by decreased O2 tension, high lactate, and low pH in the wound

Angiogenesis

41

Abnormal keratinization in response to chronic injury. Signs include lameness, fistulous tract at coronary band and deviation at the white line

Keratoma

42

Nerve block for Abaxial (basi-sesamoid). Anesthesizes foot, P2, distal SDF and DDF and annular ligaments

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Palmar digital

43

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White modified emasculator

44

Dressing using Kerlix AMD (active ingredient is PHMB), microbes unable to become resistant, change every 3-7 days or sooner.

Antimicrobial dressing

45

Grade IV lameness

Obvious lameness with marked head nod, hitching, and shortened stride

46

Tendon laceration locations in forlimb and hindlimb

Forelimb: Severance between fetlock and carpus

Hindlimb: Severance below hock

47

Closure greater than 5 days after injury. Contaminated and infected wounds

Secondary closure

48

What is the appropriate hoof pastern axis for front and back limbs

Front-50o

Back -55o

 

49

Removal of the ductus deferents for male infertility

Vasectomy

50

Part of the tendon that contains intrinsic blood supply, nerves, and growth factors

Endotendon

51

Inexpensive cast material but no longer practical. Takes 24 hours to set and messy

Plaster of Paris

52

Not used for diagnostics of lameness. Lasts 5-6 hours and can be used for shoeing and therapeutics

0.5% Bupivacaine

53

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Serra Emasculator

54

True or false, Double ligate during an open castration

False. Increases risk of infection

55

Cast application steps

Drill hole in toe of hoof wall- pass Gigli wire Stockinette 2.5x the length of cast Extra padding around proximal aspect and coronary band No finger prints of wrinkles Overlap cast padding and tape 50% Elastikon on top

56

Sudden and involuntary exaggerasted flexion of one or both hind limbs. Cause unknown

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Stringhalt

57

Mechanism unknown. Inhibits degenerative enzymes and counteracts effects of IL-1 and reduction of synovial effusion. 

Polysulfated Glycosaminoglycans (PSGAGs)

58

Tendons most prone to injury

SDF and Suspensory ligament

Due to load during heel strike

59

Where does the hoof grow from

Perioplic corium

60

Examples of non entry teaser surgery

Penis and prepuce deviation

61

Where does distal limb bandages extend to

Below the carpus/tarsus and below the coronary band

62

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White emasculator

63

Used on full limb for large wounds, cellulitis, swelling, and fracture stabilization. Use two layers of secondary cotton.

Stack bandage

64

The trot is a 

2 beat diaganol gate

65

Objectively detects and quantifies body movement irrgularity. Uses wireless tablets and shit. Data transmitted to tablet

Equinosis Q

66

Allows for stretch of tendon. Lost when load is applied

Crimp pattern

67

Graft failure happens from

Hemorrhage, motion, and infection

68

Unbranched non sulfated GAG that comes from type B synoviocytes. Provides viscoelasticity, boundary lubrication, scavages free radicals, and decreased aggrecan degeneration. Can be condroprotective IA and provides analgesia

Sodium hyaluronate/Hyaluronan/Hyaluronic acid/HA

69

Shoes used for angular limb deformaties 

Dalmer shoes

70

Skin graft harvested under mane or abdomen. Recipient holds are made smaller than the graft and made first to allow hemostasis

Punch graft

71

Inserts on P3

DDF

72

In horses abdominal cryptochrid is most common on the ____ side

Left

73

Nerve block for palmar digital block. Approach in groove between flexors and ergot. Effect in 5 minutes

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Palmar digital nerve

74

Indication for castration in horses

Behavior change. 1-1 1/2 years

75

Indication for Burdizzo emasculation 

Teat amputation, Tail docking, Bloodless castration

76

Spavin test

Flexion test on proximal hind limb. Hold in flexion for 90 seconds. Not hock specific

77

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Serra Modified emasculator

78

Phase of healing initiated by macrophage release of tissue growth factors, then angiogenesis, collagen deposition, and wound contraction

Proliferative Phase

79

Removal of the tail of the epididymis

Epididymectomy

80

Produces spermatozoa

Testis

81

Complications of immobilization with casting

Articulate cartilage degeneration, Loss of bone density, Decreased muscle strength

82

Healing 2-5 days after injury and before granulation tissue production. Contaminated wounds and questionable viability, edema/tension

Delayed primary closure

83

Layer of synovial membrane with blood supply and innervation

Subintimal

84

Radial fracture stabilization consists of

Robert jones bandage, palmar splint from heel to elbow, and lateral splint from hoof to withers

85

Grade II lameness

Difficult to observe in straight line but consistently apparent under circling, hard surface, etc

86

Grand V lameness

Minimal weight bearing or not at all, inability to move

87

Complication from castration with fluid from vaginal tunic creating a swelling. Remove vaginal tunic to fix. 

Hydrocele

88

Current recommended treatment with HA

20mg/joint for lameness. Use 20mg weekly for 3 weeks. 

89

Why is it important to incorporate the hoof into the cast for large animas

To ensure maximum diversion of weight from the limb and ground forces away from the limb to the cast

90

Lots of layers of cotton used, expensive, heavy. Preserves blood supply and supports fractures. Should be 2x the size of the limb. Can incorporate a splint to add rigidity

Robert Jones Bandage

91

Phase of wound healing that begins 2nd week and can last 1-2 years. Final scar is weaker than original.

Remodeling phase

92

Complication of castration. Can be caused by strep. Correct with surgical removal

Scirrhous cord 

93

Shock absorber. More deformable than cortical bone. Sclerosis contributes to OA progression

Subchondral bone

94

Indication for castration in farm animals

Increase growth rate, castrate at 10-14 days and there is less complications, less pain, and better meat in the boar.

95

Fractures proximal to carpus/tarsus require what kind of support

Robert jones with extended lateral splint

96

Approach to coffin joint arthrocentesis

Dorsal parallel just proximal to coronary band, dorsal perpendicular and lateral.

97

Hormonal assay to test for retained testical

Human chorionic gonadotropin increases synthesis and secretion of testosterone. 

 

Test testosterone. If >100pg/mL after 2 hours of injection then cryptorchid

98

Part of tendon that is contiguous with endotenon, surrounds tendon

Epitenon

99

Originates from proximal MC/MT III, branches and inserts on sesamoid bones

Suspensory ligament

100

Minimum amount of xray views for lameness evaluation

4 (2 oblique, 1 lateral, 1 DP)

101

Proteoglycan in articular cartilage. Form aggregates with HA and protects collagens from damage

Aggrecan

102

How does proud flesh develop

Inefficient and protracted inflammatory phase resulting in excessive proliferative phase. Fibroblasts maintain synthetic role and dont differentiate and PMNs stay higher for longer.

103

Which two bandage layers are secured with conforming rolled gauze?

Primary and secondary layers Just primary secured with regular rolled gauze

104

Necrosis of the collateral cartilage. Caused by subcoronary abscess or interfering. Signs include lameness, localized pain, suppurative sinus tracts

Quittor

105

Which shoe facilitates break over

Rocker toe

106

Fractures distal to carpus/tarsus require what kind of support

Robert jones with caudal/plantar and lateral splint

107

Three phases of wound healing

Inflammation/Lag, Proliferative, Remodeling

108

Which wounds heal faster body or limbs?

Body (1mm/day)

109

Type of skin graft that remains connected to the donor site

Pedicle graft

110

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Hausmann emasculator

111

Resin impregnated fiberglass type cast material. Light weight. Fully sets in 5-7 minutes and easy to apply.

Fiberglass cast material

112

Collagen production begins ______ after wounding and consists initially of mostly type III collagen

2-3 days

113

Used to support the frog and in horses with laminitis and founder

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Heart bar shoe

114

Instrument used for blunt castration

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Pincer emasculatome

115

Whats up here?

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Peroneus tertius rupture. 

116

Approach to fetlock joint arthrocentesis

Collateral sesamoidean ligament approach. Support joint in flexed position, palpate palmar M3, dorsal border of suspensory ligament, distal border of MC4. Proximal lateral sesamoid bone

117

Divides at P1 and inserts on P2

SDF

118

Does up regulation of GAGs and collagen synthesis. Decreases inflammatory mediators and improves synovial membrane. Can cause infection. 

Adequan

119

Single most important factor in success of wound repair

Debridement

120

Blocks origin of the suspensory ligament. Weighbearing and done in mediolateral direction

Lateral palmar nerve block

121

Layer of synovial membrane with synoviocytes, macrophage type A and Fibroblast type B

Intimal

122

Can be diagnostic and therapeutic

Arthroscopy

123

Corrective surgery for navicular disease, fracture, or chronic hoof pain

Palmar digital neurectomy

124

Can be combined with HA when given IA, chondroprotective and potent anti-inflammatory

Triamcinolone

125

If greater than 1/3rd of the eyelid margin is missing close

Must use grafting technique to achieve functional closure

126

Treatments for proud flesh

Resection and bandage, delayed secondary closure, skin grafts

127

When treating a stifle with injections best to

Use lateral approach and treat all compartments

128

Signs of graft acceptance

Adherence, Serum imbibition, revascularization (48hr- ino, 4-5 days neo) and organization

129

Grade 1 lameness

Difficult to observe, incosistent

130

Used to define the health of a joint. Creates the joint surface and made of specialized matrix. Composed of PGs, HA and Collagens

Articular cartilage

131

Salter Harris fractures easy to reduce in foals

Type 1 and 2

132

Used if lameness cannot be determined or localized by not detectable on xray or u/s. Uses technetium-99 and gamma radiation

Nuclear scintigraphy

133

Corrective surgery for stringhalt

Lateral digital extensor tenotomy

134

Makes the non collagenous matrix of tendons

Tenocytes

135

Largest compartment in the stifle, most likely to communicate. Cranial and lateral approach

Femoropatellar joint

136

Back bone of cartilaginous matrix. Creates polarized charge

Hyaluronic acid

137

What the what is this

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Upward fixated patella

138

Contains sertoli cells (nourish spermatozoa) and Leydig cells (androgens)

Epididymidis

139

Gross appearance of fibroblastic sarcoid can resemble

Exuberant granulation tissue, fibrosarcoma, cutaneous habronemiasis, SCC, melanoma, and fibroma

140

Histologically sarcoids resemble

Fibrosarcomas, fibromas, schwannomas, neurofibrosarcomas.

141

These type of sarcoids appear horny, dry and wartlike and are usually 6cm or less in diameter

Verrucous sarcoids

142

These type of sarcoids are large and resemble granulation tissue grossly

Fibroblastic sarcoids

143

The distinguishing histological features of equine sarcoids are

Hyperplastic and hyperjeratotic epidermis

Marked rete-peg formation

Dermal component of irregular arranged fibroblasts and bundle formation

No invasion of muscle

144

Equine sarcoids are caused by

Bovine Papilloma virus

145

Differential diagnosis for verrucous sarcoids

Dermatophytosis

146

Chemotherapy agent proven to be 96% successful at improving sarcoid treatment

Cisplatin

147

Non surgical treatment for tendonitis

Cold therapy- 20 min hydrotherapy

Compression and coaptation- reduces edema

NSAIDs- Bute

148

Non surgical treatment for tendonitis, Performed under u/s guidance, use PRP, stem cells, and bone marrow

Intralesional Injections

 

149

Used as intralesional injection for tendonitis. Contains growth factors, mesenchymal stem cell growth, and ACP

Platelet rich plasma

150

Intralesional injection for tendonitis. Thought to heal with less fibrosis and more normal tissue. Reduces inflammation and regenerates tissue

Stem cell therapy.

Bone marrow derived. 3 week turnaround time from lab. Taken from tubercoxae or sternum with Jamshidi

Fat derived- get in 48 hours or same day inhouse. Allogeneic. 

Mixed with PRP is best if can be afforded.

151

Treatment for tendonitis. Increases vascularization and growth factors in the area. Decreases pain and may reduce convalescent time. Goal is a more organized scar at end of healing

Shock wave therapy

152

Most important component of tendonitis treatment

Rehabilitation

153

Most common cause of tendonitis 

Strain induced (overstrain) from repetative microtrauma. Phase of molecular degeneration progressively weakens the tendon

154

Cause of tendonitis caused by over reaching, wire, kicking, and usually while the tendon is under load

Percutaneous trauma. 

Most serious with trauma to palmar aspect of pastern or metacarpus. Extensor tendon lacerations are bad. 

155

Pathogenesis of septic arthritis

Decreased HA synthesis, Loss of PC, joint effusion, Pain, compromise to synovial blood flow. 

156

Type of septic arthritis in foal. Occurs in <1 week of age. Multiple joints common- Larger usually (Stifle or tibiotarsal).

Causes acute severe lameness and effusion

S type

157

Type of foal septic arthritis. Occurs in bone adjacent to articular cartilage. Expanding epiphysis. Happens in weeks old foals. History of disease. Multiple joints but usually femur, talus, tibia, radius. 

Mild intermittent lameness, fever, then acute lameness/effusion

E type 

158

Type of septic foal arthritis. Occurs in physis of long bones. Age is weeks to months. Seemingly healthy. Occurs in one site, usually distal physis of MC III or MT III, radius, tibia.

Premonitory lameness then acute sever lameness and swelling. Periarticular swelling without effusion

P type

Do not debride. Diagnose with radiographs and aspirate

159

Septic arthritis in adults is usually

Iatrogenic. and caused by Staphylococcus

An open joint is an infected joint

160

Clinical signs of septic arthritis in adults

No bone involvement usually. Acute severe lameness. Synovial effusion. Per-articular heat and swelling. Maybe a fever

161

Gold standard for diagnosis of septic arthritis

Microbiology of joint fluid

162

Abnormal synovial cytology results- might be septic

Serosanguinous

Turbid

Thousands of WBC, 90% neutrophils

TP- >3.5 g/dL

163

To be successful in treating septic arthrits

Have rapid recognition of disease and immediate aggressive treatment

164

Mainstay of treatment for septic arthritis

Lavage

Arthroscopic is ideal, but through needle can be fine. Place needle in all compartments

165

Collagen is synthesized as

Procollagen molecules with an alpha helical chain and amino terminal and carboxyterminal extensions

166

Function of tendon unit is dependent upon

Crosslinking and collagen fibril organization

Crosslinking is dependent on COMP

167

Tenocytes

Spindle shaped nuclei, inactive forms of type II

Type I cells

168

Tenocytes

Oval nuclei, abundant in young growing tendon

Type II

169

Tenocyte

Round nuclei. More like chondrocytes better for areas of compression. 

Type III cells

170

Seperates fascicles and carries blood supply and nerves as well as mesenchymal stem cells in the tendon. Has higher levels of growth factors like TGF beta 

Endotenon

171

How do tendons get their blood supply

From muscular origin and osseous insertion and from accessory ligaments, paratenon, and mesotenon

172

Part of the tendon where changes with age and exercise can be seen long term

Non collagenous components (GAG and COMP)

173

First phase of tendonopathy

Degeneration

174

Characteristics of SDF tendon injury

Usually centerally location (core lesion) and most severe just below mid metacarpal

175

Characteristics of check ligament desmitis

Either isolated or in combo with injury to SDF. Usually mild lameness and swelling restricted to proximal 1/2 of the palmar metacarpus. Most common in ponies

176

Characteristics of suspensory ligament tendon injury

Can fail at any site. Usally injured at proximal region near metacarpus/tarsus. Joint effusion and lameness

177

Characteristics of DDF tendon injury

Usually injured in the digital sheath. Can be injured in substance of tendon or on medial or lateral borders. Difficult to see on u/s if doesnt extend out of sheath

178

Charactersitcs of extensor injury

May stumble on the dorsal aspect of the MCT/MTP

179

When can you do intralesional injections for tendonitis

Wait 3 days after injury. Usually 7-45 days. 

180

When is annular ligament desmotomy indicated

If annular ligament is impeding the normal gliding function of the flexor tendons

181

What is this shit

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Kimzey splint

182

What is this 

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Cast spreaders

183

What is this

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Thomas schroeder splint

184

Surgical technique used here for melanoma

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Sliding flap technique

185

What are these triangles called in the sliding flap technique

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Burows triangles

186

When using sliding flap dont

Undermine > 4 cm (2 inches)

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187

In sliding flaps length of burows triangles should be 

1/2 the length of the excised area