Musculoskeletal System (1-14) Flashcards
(371 cards)
1
Q
What 3 topics should be discussed when taking an orthopedic history
A
- presenting complaint
- general history
- problem history
2
Q
for forelimb lameness, the head nod goes down on the good or bad side?
A
good side
3
Q
A dog with a head nod down on the left side has lameness on which limb?
A
right forelimb
4
Q
list the anatomy of the paw
A
- phalanges
- metacarpal/metatarsal bones
- flexor tendons
5
Q
what 5 areas of the paw should be examined/palpated during a clinical exam
A
- digital pad/nail
- central pad
- interdigital webs
- distal and proximal interphalangeal joints
- metacarpal/tarsal phalangeal joint
6
Q
List the anatomy of the carpus
A
- antebrachiocarpal joint
- middle carpal joint
- carpometacarpal joint
7
Q
what 2 areas of the carpus should be palpated/examined during a clinical exam
A
- styloid processes
- accessory carpal bone
8
Q
to what degree can a normal carpus be flexed
A
150
9
Q
to what degree can a normal carpus be extended
A
10-20
10
Q
to what degree can a normal carpus be valgused
A
10-15
11
Q
what does applying valgus and varus stress to the carpus check for
A
collateral ligaments integrity
12
Q
list the anatomy of the elbow
A
- medial part of humeral condyle
- anconeus
- collateral ligaments
- annular ligament
13
Q
what 3 areas of the elbow should be palpated/examined during a clinical exam
A
- ulna and radius
- medial/lateral epicondyles
- olecranon (and triceps tendon)
14
Q
to what degree can a normal elbow be extended
A
150
15
Q
to what degree can a normal elbow be flexed
A
20
16
Q
what degree should the elbow be fixed at in order to rotate the paw to test supination and pronation
A
90
17
Q
name the 3 areas of the shoulder that should be examined/palpated during a clinical exam
A
- deltoid tuberosity
- greater tubercle of the humerus
- acromion of the scapula
18
Q
to what degree can a normal shoulder be flexed
A
60
19
Q
to what degree can a normal shoulder be extensed
A
160
20
Q
to what degree can a normal shoulder be abducted
A
35
21
Q
list the anatomy of the hock
A
- tarsal bones
- short and long collateral ligaments
- plantar fibrocartilage
22
Q
what two areas of the hock should be palpated/examined during a clinical exam
A
- medial and lateral malleoli
- calcaneous/achilles tendon
23
Q
to what degree can a normal talocrural (hock) joint be flexed
A
20
24
Q
to what degree can a normal talocrural (hock) joint be extended
A
180
25
how can you check the long and short collateral ligaments of the hock?
valgus and varus stress in flexion/extension
26
list the anatomy of the stifle
1. complex hinge joint
2. collateral ligaments
3. cranial and caudal cruciate
4. medial and lateral menisci
5. joint capsule/muscle
27
what two areas of the stifle should be palpated/examined during a clinical exam
1. tibial tuberosity, fibular head
2. patella, fabella
28
to what degree can a normal stifle be flexed
40
29
to what degree can a normal stifle be extended
160-170
30
to what degree can a normal stifle be rotated internally
5
31
list the anatomy of the hip
1. femoral head
2. acetabulum
3. joint capsule
4. Teres ligament
5. surrounding muscles
32
what two areas of the hip should be palpated/examined during a clinical exam
1. greater trochanter
2. ilial wing, ischium
33
to what degree can a normal hip be flexed
50
34
to what degree can a normal hip be extended
160
35
to what degree can a normal hip be abducted
40
36
what kind of tube should be used for Arthrocentesis
EDTA tube
37
list 5 properties of synovial fluid
1. clear, colorless or pale yellow
2. viscous
3. small volume
4. low cell count
5. mononuclear cytology
38
what position should the elbow be in for arthrocentesis
neutral position
39
what position should the antebrachiocarpal joint be in for arthrocentesis
flexed maximally
40
what position should the stifle be in for arthrocentesis
slight flexion
41
name 6 clinical signs of fracture
1. loss of function (lame)
2. swelling
3. change in limb length, alignment or orientation
4. abnormal ROM
5. pain
6. crepitus
42
what 3 things does fracture healing need
1. adequate reduction and stability of the fracture site
2. absence of complicating factors
3. sufficient time
43
name 4 goals of fracture management
1. reduce discomfort
2. eliminate ongoing trauma
3. support healing
4. restore function
44
what two things does primary bone union require
1. complete stability
2. no or small fracture gap
45
# name the type of primary bone healing
1. direct apposition of the fracture ends with no movement permits direct remodelling
2. new cutting cones are initiated in the region of the fracture
3. reduced radiographic density at bone ends adjacent to fracture site
contact healing
46
# name the type of primary bone healing
1. small gaps between the fracture end
2. minimal movement
3. lamellar bone forms directly in the fracture gap
4. intracortical remodelling throuhg the fracture gap then restores bone integrity
gap healing
47
# name the neutralising force
causes lengthening
tension
48
# name the neutralising force
causes shortening
compression
49
# name the neutralising force
combines tension and compression: tension on convex surface, compression on concave surface - neutral axis results
bending
50
# name the type of fracture
bone fracture secondary to an underlying pathologucal process that weakens the structure (infection, neoplasia, nutritional disease)
-normal loading results in fracture
pathological fracture
51
# name the fracture classification
occurs in the central/middle part of a bone
diaphyseal
52
# name the fracture classification
occurs in the wider part of the bone near the growth plate.
metaphyseal
(occurs in metaphysis)
53
# name the fracture classification
type of bone fracture that affects the growing part of a skeletally immature animal, potential for growth plate damage
-likely articular involvement
epiphyseal fracture
54
# name the fracture classification
when a bone breaks inside or around a joint;
must achieve accurate anatomical reduction and rigid fixation for best results;
'no compromise' fractures
articular fractures
55
# name the type of incomplete fracture
skeletally immature animals where bone incompletely mineralized, so less brittle than fully mineralized adult bone;
secondary to skeletal demineralization
Greenstick
56
# name the type of incomplete fracture
crack through a bone without alteration in its alignment and in which the periosteum is not broken;
undisplaced ones are often seen running along the cortex from a major fracture line
fissure
57
# name the type of complete fracture
bone is broken perpendicular to its length in a straight line
transverse
58
# name the type of complete fracture
bone is broken at an angle, straight line that's angled across the width of your bone
oblique
59
# name the type of complete fracture
bone is broken in at least two places, leaving a piece of bone totally separated by the breaks
segmental
60
# name the type of complete fracture
when bone is broken with twisting motion;
fracture line that wraps around the bone and looks like a corkscrew
spiral
61
# name the type of complete fracture
A fracture with more than one fracture line so that there are one or more intermediate fragments
multifragmentary
62
this is when a bone fragment is distracted by muscle pull or ligament attachment
(tibial tuberosity, olecranon, elective osteotomy)
avulsion
63
where does avulsion occur in skeletally immature animals?
along physis
64
where does avulsion occur in skeletally mature animals
at muscular/ligament insertions
65
this is when fracture ends are driven together;
often stable and can be managed conservatively
impacted
66
# name the type of fracture
broken bone that causes an open wound or break in the skin;
previously known as a 'compound' fracture;
graded 1-3 on the severity of soft tissue injury
open fracture
67
what is the immediate first aid of open fractures
1. cover open wounds
2. control hemorrhage
68
name 3 clinical function signs of fracture healing
1. progressive improvement in function
2. consistent weight bearing
3. minimal muscular atrophy
69
name 2 radiographic signs of fracture healing
1. bridging callus
2. loss of fracture lines
70
what 4 things should be done ASAP to treat an open fracture
1. clip widely
2. lavage copiously
3. debride all dead tissue
4. start open wound management
71
what 3 types of factors play a role in the fracture patient assessment score to identify 'risky' patients
1. clinical factors
2. mechanical factors
3. biological factors
72
the higher the fracture patient assessment score, the (lower or higher?) the risk in fracture healing?
lower
73
# which mechanical aspect of a fracture has a higher risk?
bridge fracture, contact fracture, or compression fracture?
bridge fracture
74
# which mechanical aspect of a fracture has a higher risk?
multiple limb injury OR single limb
multiple limb injury
75
# which mechanical aspect of a fracture has a higher risk?
toy breed, large breed, or giant breed?
giant breed
76
# which biological aspect of a fracture has a higher risk?
juvenile, yong adult, adult, geriatric?
geriatric
77
# which biological aspect of a fracture has a higher risk?
poor health or excellent health?
poor health
78
# which biological aspect of a fracture has a higher risk?
good soft tissue or poor soft tissue?
poor soft tissue
79
# which biological aspect of a fracture has a higher risk?
cortical bone or cancellous bone?
cortical bone
80
# which biological aspect of a fracture has a higher risk?
low enery or high energy?
high energy
81
name 2 clinical aspects that can make fracture healing more risky
poor client and patient compliance
82
name one conservative method of fracture repair
cage rest
83
name two external methods of fracture repair
1. Coaptation
2. ESF
84
name 3 coaptation methods of fracture repair
1. splint
2. cast
3. dressing
85
name 3 External Skeletal Fixation (ESF) methods of fracture repair
1. linear
2. circular
3. hybrid
86
name 5 internal methods of fracture repair
1. internal fixators
2. plates and screws
3. screws alone
4. wires
5. pins
87
name 1 salvage method of fracture repair
amputation
88
what is the emergency support for lower limb fractures
Robert-Jones Dressing
89
name 4 advantages of external coaptation for fracture management
1. ultimate biological fixation
2. quick
3. don't need much inventory
4. MIGHT be cheap
90
name 3 disadvantages of external coaptation for fracture management
1. heavy maintenance
2. cast associated soft tissue injury
3. fracture disease
91
# name the external method of fracture management
short-term/adjunctive support;
OK for radius and ulna;
apply over cast padding and conforming bandage;
spoon part at bottom
splint
92
# name the external method of fracture management
thermoplastic materials;
stronger and lighter than Plaster of Paris;
need to be quite hot before they are moldable;
can be awkward to use
anatomical molded splints
93
# name the external method of fracture management
cheap;
easy to apply;
conform well;
take 8+ h to dry fully;
heavy to wear;
radiodense
Plaster of Paris (cast)
94
# name the external method of fracture management
light and strong;
don't soften when wet;
conform well;
set rapidly;
radiolucent;
need an oscillating saw for removal
Fiberglass/Resin (cast)
95
how often should a cast be checked by a vet
weekly
96
name 5 signs of cast complications to explain to owners to watch for
1. rubbing/chewing at cast
2. swollen foot pads
3. bad smell
4. stops weight bearing
5. becomes ill
97
name 4 possible cast complications
1. soft tissue complications (pressure sores, ischemia)
2. fracture disease (muscle wasting, stiffness, osteoporosis, tissue adhesion)
3. malunion
4. delayed union
98
# name the external method of fracture management
a series of percutaneous pins that pass into or through the bone and are connected externally by clamps and rods, acrylic bars and epoxy putty
external skeletal fixation (ESF)
99
name 3 advantages of external skeletal fixation (ESF) for fracture management
1. versatile
2. easy to apply
3. compatible with principles of 'biological osteosynthesis'
100
this aims to take full advantage of biological healing potential to maximize rate of fracture healing (maintain limb length and orientation & avoid creating further surgical trauma);
goal is to provide an optimal biological and mechanical environment for fracture repair
biological osteosynthesis
101
what type of pins does unilateral frame for external skeletal fixation (ESF) use
half pins
102
what type of pins does bilateral frame for external skeletal fixation (ESF) use?
full pins
103
# which type of external skeletal fixation (ESF)?
unilateral, uniplanar
type 1
104
# which type of external skeletal fixation (ESF)?
bilateral, uniplanar
type 2
105
# which type of external skeletal fixation (ESF)?
bilateral, biplanar
type 3
106
# which type of external skeletal fixation (ESF)?
ring fixator, cESF
Ilizarov
107
# which type of fixation pin for external skeletal fixation (ESF)?
holds fracture together by friction only
smooth pin
108
# which type of fixation pin for external skeletal fixation (ESF)?
good bone purchase;
weak point must be protected
negative profile thread pin
109
# which type of fixation pin for external skeletal fixation (ESF)?
excellent bone purchase;
no weak point;
must pre-drill a pilot hole
positive profile thread pin
110
what should the width of the pins used for external skeletal fixation (ESF) be?
20-25% of cortical width
111
how many pins should you aim for per fragment in external skeletal fixation (ESF)?
3 pins per fragment
112
what can external skeletal fixation (ESF) be used for besides just fracture management?
protection of ligament repairs
113
# name the internal method of fracture repair
holds fragments in alignment;
resists bending but NOT rotation, shear or axial shortening
intramedullary (IM) pins
114
what should the diameter of IM pins be?
aim to fill the medullary canal at narowest point
115
# name the method of placing an IM pin
1. introduce pin away from fracture site
2. reduce fracture
3. advance pin across fracture
may be able to do this closed
normograde pinning
116
# name the method of placing an IM pin
1. introduce pin at fracture site
2. push/pull pin through bone to allow fracture reduction
3. reduce fracture and drive pin across fracture line
retrograde pinning
117
what bone can you NOT use intramedullary (IM) pinning in?
radius
118
# name the internal method of fracture repair
an IM pin perforated to accept bone screws;
neutralizes all forces very effectively;
requires specialized instrumentation;
can be technically challenging
interlocking (IL) nail
119
# name the internal method of fracture repair?
used to repair fractures or osteotomies which are subjected to distractive forces (olecranon osteotomy, tibial tuberosity avulsion, malleolar fracture);
figure 8 wire anchored in a transverse bone tunnel and passed around the ends of the pin(s);
anchored by twisting ;
converts distractive forces to compression at the fracture line
tension band wiring
120
# name the type of bone screw
cut their own thread in the bone;
cutting tip
self tapping
121
# name the type of bone screw
thread must be cut in the bone;
thread conforms exactly to screw profile;
maximises metal-bone contact and holding power
tapped
122
name the 5 steps of bone screw placement
1. drill pilot hole
2. measure depth of hole (and add 2mm)
3. Countersink
4. tap
5. place screw and tighten
123
# name the type of bone screw
when the screw crosses a fracture line that can be compressed;
provides interfragmentary compression
Lag Screw
124
# name the type of bone screw
when the screw crosses a fracture line that cannot be compressed;
when near fragment is too small to take a gliding hole
position screw
125
what 3 ways can a bone plate be applied
1. compression plate
2. neutralisation plate
3. buttress plate
126
127
# name the type of bone plate
bone is anatomically reconstructed and load sharing;
promotes primary bone union;
uses tension band principle
compression plate
128
# name the type of bone plate
applied to protect a lag screw reconstruction; cannot take significant loads without failure;
load sharing between plate and bone
neutralisation plate
129
# name the type of bone plate
fracture cannot be anatomically restructured;
no load sharing between bone and plate;
plate transmits the full force of loading across the fracture gap
buttress plate
130
this is inflammation/infection of the bone and associated bone marrow
osteomyelitis
131
what is the most common source of infection causing osteomyelitis?
post-surgery
(open fracture, open reduction of closed fracture)
132
name 4 sources of infection causing osteomyelitis
1. post-surgery
2. penetrating injury
3. local extension
4. haematogenous spread (rare)
133
what 3 things does the establishment of infection in the bones/bone marrow require?
1. sufficient numbers of pathogenic bacteria
2. avascular cortical bone
3. favorable environment for colonization and multiplication
134
name 5 clinical signs associated with acute osteomyelitis (ex: following extension of a deep surgical site infection)
1. localized pain
2. swelling
3. pyrexia
4. anorexia
5. lethargy
135
name 4 clinical signs associated with chronic osteomyelitis
1. lameness
2. bone pain
3. swelling
4. heat
136
name 5 radiographic signs of osteomyelitis
1. bone destruction
2. periosteal new bone formation
3. soft tissue swelling
4. sequestrum formation
5. delayed or non-union
137
this is failure of bone healing and is usually iatrogenic; i.e. YOUR FAULT
non-union
138
# name the type of non-union
usually arise due to inadequate stability of the fracture site or inadequate reduction;
should heal following adequate stabilization
viable non-union
139
# name the type of non-union
highly vascular fracture site;
significant callus;
need to work out what is wrong and put it right (remove loose implants and stabilize fragments);
don't usually require bone graft
hypertrophic non-union
140
name 4 types of non-viable non-union
1. dystrophic
2. necrotic
3. defect
4. atrophic
141
# name the type of non-union
blood supply inadequate
dystrophic (non-viable non-union)
142
# name the type of non-union
necrotic tissue in fracture site
necrotic (non-viable non-union)
143
# name the type of non-union
bone defect at fracture gap
defect (non-viable non-union)
144
# name the type of non-union
biologically inactive;
no evidence of attempt to heal;
bone ends sclerotic and atrophied;
medullary cavity may seal over;
fracture gap fills with fibrous tissue;
pseudoarthrosis formation
atrophic (non-viable non-union)
145
what is the treatment for atrophic non-union of a fracture
1. aggressive treatment (open approach, debride fracture ends to viable bone, open medullary cavity)
2. rigid stabilization
3. bone graft
146
this is when the quadriceps muscle becomes adherent to fracture site;
progressive decrease in range of stifle joint mobility;
stifle and hock overextend
quadriceps contracture
147
what is the treatment for quadriceps contracture?
1. surgical release of adhesions
2. muscle/tendon lengthening if necessary
3. passive and active physiotherapy
4. 90-90 bandage postoperatively
148
# what is the classification of bone graft?
donor and recipient is same individual
autograft
149
# what is the classification of bone graft?
donor and recipient are different animals of the same species
allograft
150
# what is the classification of bone graft?
demineralized bone matrix
biomaterials
151
# what is the classification of bone graft?
ex: ceramics, bioglass
synthetic bone substitutes
152
name 4 properties of an ideal bone graft
1. osteogenic
2. osteoinductive
3. osteoconductive
4. non-immunogenic
153
this property of an ideal bone graft means it is a source of osteoblasts to fracture site
osteogenic
154
this property of an ideal bone graft means it induces migration and differentiation of mesenchymal stem cells from remote site
osteoinductive
155
this property of an ideal bone graft means it is a scaffold in which bone can develop
osteoconductive
156
what are 2 uses for bone grafts
1. filling defects
2. to encourage healing
157
name 4 places you can collect a cancellous autograft from
1. lateral tuberosity of humerus
2. medial proximal tibia
3. greater trochanter of femur
4. wing of ileum
158
name 3 advantages of cancellous autograft
1. no immune response
2. greatest osteogenic effect (high cellularity)
3. no risk of cross infection
159
name 2 disadvantages of cancellous autograft
1. extra operating sites must be prepped and accessed
2. large quantities can be difficult to obtain
160
name 3 advantages of cortical allograft
1. can be banked
2. convenient
3. unlimited quantity
161
name 3 disadvantages of cortical allograft
1. immunogenic
2. slow incorporation into host bone
3. risk of cross infection
162
where do primary tumors of the musculoskeletal system originate from?
mesenchymal cells
| (sarcoma)
163
what does an osteosarcoma originate from
bone
164
what does a soft tissue sarcoma, fibrosarcoma, myxosarcoma originate from
connective tissue
165
what does a haemangiosarcoma originate from
blood vessels
166
what do rhabdomyosarcomas originate from
striated muscle
167
what do leiomyosarcomas originate from
smooth muscle
168
what do liposarcomas originate from
fat
169
what do chondrosarcomas & synovial cell sarcomas originate from
cartilage
170
name 3 musculoskeletal sarcomas with a higher risk of metastasis (>90%)
1. osteosarcoma
2. haemangiosarcoma
3. histiocytic sarcoma elsewhere (NOT around the joint)
171
name 5 musculoskeletal tumors with a lower risk of metastasis (<40%)
1. peripheral nerve sheath tumor (PNST)
2. Fibrosarcoma (FSA) / soft tissue sarcoma (STS)
3. Histiocytic sarcoma around the joint
4. chondrosarcoma
5. feline injection site sarcoma
172
# Stage vs. Grade
This is the extent of the tumour: how far has it got?
clinical assessment of current disease burden
Stage
173
# Stage vs. Grade
This is based on the histological features of the tumor;
mitotic activity, vascularity, invasion, necrosis, differentiation
Grade
174
name 1 pro and 1 con of using incisional biopsy and histology to diagnose a primary sarcoma in the musculoskeletal system
Pro: large sample so better chance of diagnosis and accurate grade
Con: requires GA
175
name 1 pro and 1 con of using tru-cut biopsy to diagnose a primary sarcoma in the musculoskeletal system
Pro: may be possible under sedation
Con: small sample so chance of non-representative sample - diagnosis or grade
176
what is the preferred type of imaging for musculoskeletal primary tumors
MRI or CT
| (radiograph is rel. insensitive)
177
all sarcomas have a predilection for metastasis to what organ?
lungs
178
name 2 clinical signs of an osteosarcoma
1. pain and lameness
2. swelling/mass at primary site
179
name 5 differentials for bone tumors
1. osteosarcoma!
2. chondrosarcoma
3. histiocytic sarcoma
4. other (fibrosarcoma, haemangiosarcoma, etc)
5. benign tumors/cysts
180
name 4 primary treatment options for an osteosarcoma
(to prevent pain, stop or delay progression of tumor)
1. amputation!
2. limb sparing (high risk of infection and failure)
3. radiotherapy
4. analgesia only
181
what is the best chemotherapy protocol to slow development of metastatic disease from an osteosarcoma?
carboplatin
182
what is the median survival for a dog with an osteosarcoma after amputation alone?
5 months
183
what is the median survival for a dog with an osteosarcoma after amputation and platinum chemotherapy?
9-12 months
184
name 4 possible toxicities caused by Carboplatin
1. GI toxicity
2. Myelosuppression
3. nephrotoxicity
4. mild GIT side effects
185
name 3 prognostic factors for osteosarcoma
1. location
2. presence of metastatic disease
3. total alkaline phosphatase
186
where is an osteosarcoma most likely to occur in dogs
front limbs
| (appendicular skeleton - metaphysis of long bones)
187
what are the ideal surgical margins for soft tissue sarcomas
3 cm lateral and 1 fascial plane beyond extent of tumour
188
name 3 methods of sample preparation for margin assessment of soft tissue sarcomas
1. cardinal (most common)
2. bread loafing
3. shaved margins
189
# name the sample prep method for margin assess. of soft tissue sarcomas
3 sections;
relies on mass being spheroid (not always true)
cardinal
190
metronomic chemo to treat microscopic residual disease from a soft tissue sarcoma is well tolerated but what is the main risk?
sterile haemorrhagic cystits
191
name 4 prognostic factors of soft tissue sarcomas
1. tumour grade and mitotic rate
2. tumour size
3. tumour location
4. achieving local control of tumour
192
what organ is most commonly affected by haemangiosarcomas
spleen
193
name 3 clinical signs of a haemangiosarcoma
1. shock, collapse, haemoabdomen
2. palpable mass or fluid thrill on spleen
3. intramuscular bruising
194
name 2 poor prognostic factors of a haemangiosarcoma
1. tumour rupture and bleeding into abdomen
2. metastases
195
what is the typical survival for splenic tumors with metastasis
4-6 weeks
196
what category of chemodrug is Doxorubicin and Epirubicin
antitumour antibiotic
197
name 8 toxicities that may be caused by Doxorubicin and Epirubicin
1. SEVERE perivascular irritant
2. anaphylaxis (premed w chlorpheniramine)
3. acute/cumulative cardiotoxicity
4. nausea
5. GI effects
6. Myelosuppression
7. nephrotoxicity
8. alopecia
198
when should an echocardiogram be performed when giving Doxorubicin or Epirubicin to a patient
prior to first & third or fourth treatment
199
what type of haemangiosarcomas have an excellent outcome and mean survival time (MST) of 1000 days
dermal HSA
200
how are the best outcomes achieved for a histiocytic sarcoma
multi-modal therapy
(surgery, radiation, & lomustine/anthracycline chemo)
201
the synonym of this is Degenerative joint disease;
it affects the diarthrodial joints
osteoarthritis (OA)
202
what 3 things is osteoarthritis (OA) charcterized by?
1. degeneration of cartilage
2. periarticular new bone and fibrosis
3. low grade inflammation
203
what are 2 possible pathogeneses for osteoarthritis (OA)
1. abnormal motion on normal cartilage
2. normal motion on abnormal cartilage
204
name 5 clinical findings/signs of ostearthritis (OA)
1. lameness
2. pain
3. reduction in normal movement
4. effusion
5. crepitus
205
name three signs of osteoarthritis (OA) seen on radiographic imaging
1. osteophytosis
2. sclerosis
3. effusion
206
name 4 signs of osteoarthritis seen arthrocentesis investigations
1. incr. or decr. volume
2. reduced viscosity
3. incr. white blood cells
4. pred. mononuclear
207
what nutritional supplement can be given to treat osteoarthritis (OA) with unequivocal evidence of efficacy
Omega-3 Fatty Acids
208
40% of older cats with osteoarthritis (OA) also have this disease
kidney disease
209
what two options are there for surgical management of osteoarthritis (OA)?
1. arthroplasty
2. arthrodesis (NOT hip)
210
what is a synonym for bacterial infective arthritis
septic arthritis
211
name 5 signs of bacterial infective arthritis seen with arthrocentesis investigations
1. large volume
2. abnormal appearance
3. incr. cell count
4. neutrophilia
5. culture
212
what is Lyme disease caused by?
Borrelia burgdorferi,
transmitted by Ixodes ticks
213
what is the treatment for Lyme disease?
Tetracyclines
214
SKIPPING 8
**COME BACK TO IT**
215
name 5 differential diagnoses for multiple limb lameness in immature dogs/cats
1. craniomandibular osteopathy
2. nutritional secondary hyperparathyroidism
3. panosteitis
4. metaphyseal osteopathy
5. vaccine reactions
216
name 5 differential diagnoses for multiple limb lameness in adult dogs/cats
1. immune mediated joint disease
2. drug induced polyarthritis
3. renal secondary hyperparathyroidism
4. hypervitaminosis A
5. hypertrophic osteopathy
217
name the pathogenesis of craniomandibular osteopathy
1. lamellar bone production
2. occipital bones/tympanic bullae/mandible
3. +/- long bones
218
what is the clinical sign of craniomandibular osteopathy
| (young dogs - 5-7 months)
pain on opening mouth +/- limb swelling
219
excess of this mineral impairs endochondral ossification
calcium
220
puppies and kittens fed this type of diet are more prone to nutritional secondary hyperparathyroidism
all meat diets
221
name 4 features of nutritional secondary hyperparathyroidism
1. low calcium:phosphate ratio
2. increased parathyroid hormone
3. calcium resorbed from skeleton
4. osteopenia (pathological fractures)
222
what breeds are more prone to panosteitis?
large breeds (GSD)
| (rare in cats)
223
what sex is panosteitis more common in
males
224
name 3 clinical signs of panosteitis
1. waxing and waning lameness
2. can be non-weight bearing
3. pain on bone palpation
225
name 3 radiographic signs of panosteitis
1. medullary opacity
2. occassional periosteal bone
3. weeks to develop
226
what is teh treatment for panosteitis
1. analgesia
2. self resolves in adulthood
227
what is metaphyseal osteopathy characterized by
severe metaphyseal inflammation
228
what age, breed, and sex is metaphyseal osteopathy more common in?
(can occur in both dogs and. cats and any breed though)
young (4-6 month),
giant breeds,
male
229
name 4 clinical signs of metaphyseal osteopathy
1. very painful
2. pyrexic
3. shifting lameness
4. gross metaphyseal swelling
230
name 2 radiographic findings with metaphyseal osteopathy
1. metaphyseal radiolucency, parallel to physis
2. periosteal mineralization
231
metaphyseal osteopathy usually resolves in 7-10, but what is the exception to this?
hip in cats
232
name 2 clinical signs seen with vaccination reactions
1. pyrexia
2. stiff, panful, swollen joints
233
how long after primary vaccination course are vaccination reactions usually seen
2-7 days
234
what are 2 sub-classifications of immune mediated joint disease
1. erosive
2. non-erosive
235
what is the pathogenesis of immune mediated joint disease
1. inappropriate immune response in synovium
2. pain and lameness
236
name 2 genetic risks for immune mediate joint disease
1. major histocompatability complex genes
2. terrier breeds
237
name 4 signs of immune mediated joint disease found on clinical examination
1. joint effusion, distal joints
2. multiple joints affected
3. symmetrical joint swelling
4. overt joint pain
238
what changes will be seen in synovial fluid analysis for immune mediated joint disease
1. increased volume
2. reduced viscosity
3. turbid (raised cell count)
4. neutrophilic cytology
239
what is the treatment for immune mediated joint disease?
Prednisolone (immunosuppression)
240
what 3 immunosuppressive drugs can be used to treat immune mediated joint disease if the animal does not respond to Prednisolone?
1. Chlorambulcil
2. Azathioprine (NEVER IN CATS)
3. Leflunomide/Ciclosporin
241
what is a common example of an erosive form of immune mediated joint disease
Rheumatoid arthritis (rare)
242
what is the most common form of immune mediated joint disease
idiopathic immune mediated polyarthritis (IMPA)
| (non-erosive)
243
name 4 subgroups of idiopathic immune-mediated polyarthritis (IMPA)
1. no association
2. reactive - infection
3. enteropathic
4. neoplastic
244
what 3 drugs most commonly cause drug-induced polyarthritis
1. Cephalosporins
2. Penicillins
3. Sulphadiazine-trimethoprim (Dobermans)
245
name 5 clinical features of renal secondary hyperparathyroidism
(chronic renal insufficiency)
1. reduced glomerular filtration rate
2. reduced renal excretion of phosphorus
3. reduced calcitriol
4. increased parathyroid hormone
5. osteopenia - pathological fractures
246
what is "rubber jaw" caused by?
renal secondary hyperparathyroidism
247
what is the treatment for renal secondary hyperparathyroidism
1. reduced phosphate diet
2. oral phosphate binder
3. vitamin D
248
cats fed liver rich diets can develop this disease causing limb lameness
hypervitaminosis A
249
name 3 clinical signs of hypervitaminosis A
1. stiff, lame, unkempt appearance
2. neurological defecs
3. excessive spinal new bone, even fusion
250
name 3 synonyms for hypertrophic osteopathy
1. hypertrophic pulmonary osteoarthropathy
2. hypertrophic pulmonary osteopathy
3. Marie's disease
251
what is the radiographic sign of hypertrophic osteopathy
periosteal new bone
(any limb bone)
252
what is the main cause of hypertrophic osteopathy
thoracic mass neoplasia
253
name 5 differential diagnoses for forelimb lameness in the immature dog and cat
1. carpal laxities
2. elbow dysplasia
3. incomplete ossification of the humeral condyle (IOHC)
4. developmental luxation
5. osteochondritis dissecans
254
what are 3 causes of carpal laxity in puppies and kittens
1. period of rest
2. casting
3. poor nutrition
255
what is the treatment for carpal laxity
exercise / balanced diet
(spontaneously resolves)
256
what causes flexural deformity of the carpus?
contracture flexor carpi ulnaris
257
Elbow dysplasia is a group of what 3 developmental conditions of dogs?
1. fragmented coronoid process (FCP)
2. Osteochondritis dissecans of the medial part of humeral condyle (OCD)
3. ununited anconeal process (UAP)
258
what sex is predisposed to fragmented coronoid process (FCP) - (elbow dysplasia)
males
259
what is a grade 0 elbow dysplasia
no osteophytosis
260
what is a grade 1 elbow dysplasia
osteophytes < 2mm
261
what is grade 2 elbow dysplasia
osteophytes 2-5mm or lesion
262
what is grade 3 elbow dysplasia
osteophytes >5mm or lesion with osteophytes
263
how old mus t a dog be in order to have elbow dysplasia scored
1 year
264
what is the most common form of elbow dysplasia
fragmented coronoid process (FCP)
265
what signs will be seen on clinical examination for fragmented coronoid process (FCP)
pain on extension and flexion/supination
266
fragmented coronoid process (FCP) is frequently bilateral or unilateral?
bilateral
267
what 3 surgical treatments can be done for fragmented coronoid process (FCP)
1. arthrotomy or arthroscopy
2. fragment removal
3. ulna/humeral osteotomy
268
this is the failure of endochondral ossification
osteochondrosis
269
name 3 aetiologies of osteochondritis dissecans (OCD) of the medial part of the humeral condyle
1. genetics
2. "over nutrition"
3. ischemia
270
how to diagnose osteochondritis dissecans (OCD) of the medial part of the humeral condyle
radiography
271
what is the treatment for osteochondritis dissecans (OCD) of the medial part of the humeral condyle
surgical removal of the flap
272
name 4 signs seen on clinical examination with ununited anconeal process
1. crepitus
2. marked effusion
3. pain on extension
4. 25% bilateral disease
273
how to diagnose ununited anconeal process?
radiography
(flexed mediolateral view)
274
how to treat ununited anconeal process ?
1. osteoarthritis management
2. surgical removal
3. surgical fixation
275
what is the treatment for incomplete ossification of the humeral condyle?
transcondylar position screw
276
name two ways to diagnose shoulder osteochondrosis
1. radiography (radiolucent deficit)
2. positive contrast arthrogram
277
what is the surgical treatment for shoulder osteochondrosis
flap removal / abrade surface
278
name 6 differential diagnoses for hind limb lameness
1. osteochondritis dissecans of the talus
2. medial patellar luxation
3. lateral patella luxation
4. Avascular necrosis
5. hip dysplasia
6. panosteitis
279
what 2 presenting signs will a dog with osteochondritis dissecans of the talus
1. marked hind limb lameness
2. marked effusion/swelling
280
what 3 things can be done to diagnose osteochondritis dissecans of the talus
1. radiography
2. CT
3. arthrocentesis (degenerative cytology)
281
what radiographic sign will be seen with osteochondritis dissecans of the talus
medial trochlear ridge appears absent
282
what is the treatment for osteochondritis dissecans of the talus
1. fragment removal
(arthrotomy/arthroscopy technically challenging)
283
what is the prognosis for osteochondritis dissecans of the talus
guarded
(some require arthrodesis)
284
name 3 causes of medial patella luxation
1. developmental
2. complication of cruciate rupture
3. trauma
285
# name the grade of medial patella luxation
in sulcus, and spontaneously returns in sulcus when manually luxated
grade 1
286
# name the grade of medial patella luxation
when in sulcus, stays in;
when out of sulcus, stays out
grade 2
287
# name the grade of medial patella luxation
when out of sulcus, can be returned in, but spontaneously luxates out
grade 3
288
# name the grade of medial patella luxation
out of sulcus all the time, can't be put in
grade 4
289
what is the treatment for an asymptomatic dog with medial patella luxation
no treatment
290
what is the treatment for a symptomatic dog with medial patella luxation
surgical treatment
(realign patella mechanism)
291
name 4 possible surgical methods to treat medial patella luxation and realign patella mechanism
1. lateral tibial tuberosity transposition
2. trochlear wedge/block recession sulcoplasty
3. medial desmotomy
4. lateral capsular overlap
292
what is the prognosis for dogs with grade 1-3 medial patella luxation
excellent
293
what is the prognosis for dogs with grade 4 medial patella luxation
guarded
(may require corrective osteotomy)
294
what breeds is lateral patella luxation more common in
large breeds
(flat coat retrievers )
295
what breeds is medial patella luxation more common in
small/toy breeds
296
what are the two surgical treatments for lateral patella luxation
1. medial tibial crest transposition
2. trochlear wedge/block sulcoplasty
297
this disease is ischaemic necrosis of the femoral head
Legg-Calve-Perthe's disease
298
what breeds is Legg-Calve-Perthe's disease more common in
small, toy breeds
(dogs)
299
what will the clinical history of a dog with Legg-Calve-Perthe's disease be?
1. progressively deteriorating lameness
2. marked hip pain
| (3-12 months of age)
300
what 2 signs of Legg-Calve-Perthe's disease can be seen on radiography for diagnosis
1. lysis/mottling femoral head/neck
2. femoral head collapse
301
2 ways to surgically treat Legg-Calve-Perthe's disease
1. femoral head + neck ostectomy
2. mini total hip replacement
302
what is the prognosis for Legg-Calve-Perthe's disease
good outcome with surgery
303
what sex is metaphyseal osteopathy of cats more common in
male
(< 2 years old)
304
what radiographic sign will be seen to diagnose metaphyseal osteopathy of cats
radiolucent line across femoral meaphysis
| (fracture in 50% cases)
305
name 2 surgical treatments for metaphyseal osteopathy of cats
1. femoral head and neck excision
2. total hip replacement
306
what is the prognosis for metaphyseal osteopathy of cats treated surgically
excellent
307
what two things make up the temporomandibular joint
1. mandibular condyles
2. temporal bone
308
what are the two treatment options for luxation of the temporomandibular joint
1. closed reduction
2. open reduction and loose muzzle (4 weeks)
309
how will a dog with luxation of the temporomandibular joint present
unable to close mouth
310
name 5 common differential diagnoses for forelimb lamness in mature cat/dog
1. luxation/subluxation injury of carpus
2. collateral ligament injury
3. incomplete ossification of humeral condyle
4. fragmented medial coronoid process
5. traumatic luxation of elbow
311
name 3 causes of carpal luxation or subluxation
1. trauma (common)
2. chronic immune mediated polyarthritis (rare)
3. chronic degeneration (rare)
312
what are the 2 presenting signs of carpal luxation or subluxation
1. palmargrade stance (hyperextended)
2. mild-moderate lameness
313
how to diagnose carpal luxation or subluxation
radiography / stress radiography
(identify joint)
314
how to treat carpal luxation or subluxation in puppies
medically!
should spontaneously resolve, no surgery
315
how to treat carpal luxation or subluxation in an adult
surgical management
(pancarpal arthrodesis)
316
name the 4 principles/steps of arthrodesis to treat carpal luxation or subluxation
1. remove all articular cartilage
2. cancellous bone graft
3. rigid internal fixation (plate)
4. coaptation (splint/cast) (not always used)
317
what is the prognosis for an adult with carpal luxation or subluxation that has had pancarpal arthrodesis
excellent (80%)
318
what are 2 possible complications of treating carpal luxation or subluxation with pancarpal arthrodesis
1. failure of arthrodesis
2. metacarpal fracture
319
what is the presenting sign for adult animals with carpal collateral ligament injury
normal stance with slight valgus
320
how to diagnose carpal collateral ligament injury
1. palpation
2. stress radiography
321
name 2 surgical treatment options for carpal collateral ligament injury
1. APL transposition
2. prosthetic - screw/bone tunnels
322
what breed of dog is predisposed to incomplete ossification of the humeral condyle (IOHC)
spaniels
323
what is a synonym for incomplete ossification of the humeral condyle (IOHC)
Humeral Intercondylar Fissure (HIF)
324
name the 3 possible fractures that dogs with incomplete ossification of the humeral condyle (IOHC) are predisposed to
1. lateral part of condyle
2. medial part of condyle
3. di-condylar ('Y' or 'T')
325
how to treat an adult dog with incomplete ossification of the humeral condyle (IOHC) alone
position screw
326
how to treat an adult dog with incomplete ossification of the humeral condyle (IOHC) AND a lateral OR medial condyle fracture
lag screw and plate fixation
327
how to treat an adult dog with incomplete ossification of the humeral condyle (IOHC) AND a dicondylar fracture
lag screw and double plate fixation
328
what is the prognosis for a dog treated for incomplete ossification of the humeral condyle (IOHC)
good (for return to normal function)
WILL develop elbow osteoarthritis
329
what to look for on diagnostic imaging when diagnosing traumatic elbow luxation
avulsion fragments
330
how to medically manage traumatic elbow luxation
1. closed reduction
2. check collaterals
3. dressing 2 weeks
331
Pronation checks (medial or lateral?) collaterals
medial
332
Supination checks (medial or lateral?) collaterals
lateral
333
how to surgically treat traumatic elbow luxation
1. open reduction
2. re-attach avulsion
3. replace ligaments
334
name 2 elbow salvage procedures
1. elbow arthrodesis
2. total elbow replacement
335
what angle should the elbow be fused at in elbow arthrodesis
110 degrees with a caudal plate
336
this disease is rare in dogs and very rare in cats;
there will be pain on biceps test (palpation on hsoulder flexion);
diagnosed on ultrasound
biceps tendon disease
| (tenosynovitis or traumatic rupture)
337
name 8 differential diagnoses for hindlimb lameness in the adult dog/cat
1. ligament injuries
2. shear injuries
3. Achilles tendon injuries
4. cranial cruciate ligament disease
5. collateral ligament rupture
6. patella tendon rupture
7. coxofemoral luxation
8. hip dysplasia
| (many more)
338
how to manage ligament injuries of the hock in a mature dog/cat?
1. treat wounds appropriately
2. external skeletal fixation
3. pins and tension band
339
what is the prognosis for managed ligament injuries of the hock in a mature dog/cat?
good;
development of osteoarthritis
340
what 3 Achilles Tendon injuries can a mature dog/cat have?
1. tendinosis
2. partial rupture
3. complete rupture (trauma)
341
thickening, but no lengthening would indicate this Achilles tendon injury in a mature dog/cat
tendinosis
342
lengthening & flexed ('clenched') digits would indicate this Achilles tendon injury in a mature dog/cat
partial rupture
343
plantigrade stance would indicate this Achilles tendon injury in a mature dog/cat
complete rupture (trauma)
344
how to treat Achilles tendon tendinosis (no lengthening) in a mature dog/cat
medical management
345
how to treat partial rupture of Achilles tendon (lengthening) in a mature dog/cat
temporary immobilization/repair or salvage
346
how to treat complete rupture of Achilles tendon in a mature dog/cat
primary repaire (surgery)
347
name 2 instances where pantarsal arthrodesis is used as treatment in a mature dog/cat
1. end-stage talocrural joint osteoarthritis
2. failed Achilles mechanism injury
348
name 5 functions of the cranial cruciate ligament
1. limit cranial translation
2. limit internal rotation
3. limit valgus/varus motion
4. limit stifle extension
5. proprioception
349
what 4 clinical signs will be seen on clinical examination in a mature dog/cat with cranial cruciate ligament rupture
1. stifle effusion
2. stifle thickening (medially)
3. muscle atrophy (bilateral)
4. pain on full extension
350
name 2 radiographic signs of cranial cruciate ligament rupture
1. effusion
2. osteophytosis
351
describe extracapsular stabilization (lateral fabella-tibial suture LTFS) for a cranial cruciate ligament rupture
1. tibial tunnel
2. under patella ligament
3. around lateral fabella
352
name 3 tibial osteotomies for dunamic stabilization of a cranial cruciate ligament rupture
1. tibial plateau levelling osteotomy (TPLO)
2. tibial wedge osteotomy (TWO)
3. Tibial tuberosity advancement (TTA)
353
which technique of stabilization is preferred for cranial cruciate ligament rupture
TPLO
(tibial plateau leveling osteotomy)
354
name 2 issues with dynamic stabilization for cranial cruciate ligament rupture
1. costs increased
2. complications challenging
355
what is the most important orthopaedic condition?
cruciate ligament disease
356
name 3 steps to diagnos a collateral ligament injury
1. varus and valgus stress test
2. confirm with stress radiographs
3. check integrity of cruciate ligaments
357
what is the treatment for collateral ligament injury in a mature dog/cat
1. primary repair (if possible)
2. supplement - screws and suture
358
name 5 ligaments that may be involved in a multiple ligamentous injury (often all are injured)
1. medial collateral ligament
2. lateral collateral ligament
3. cranial cruciate ligament
4. caudal cruciate ligament
5. menisci
359
what is the treatment for multiple ligamentous injury in a mature dog/cat
1. repair/replace individual components
2. transarticular external skeletal fixation
360
what is the prognosis for isolated collateral injuries
excellent
361
what is the prognosis for multiple ligament injuries
moderate
(expect lameness, DJD progresses)
362
how is the patella displaced in a patella ligament rupture?
proximally displaced
(from forced flexion - quad muscles)
363
what 3 places should you palpate to diagnose hip luxation in a mature dog/cat
1. ilial wing
2. trochanter
3. tuber ischia
364
name 3 medical treatments for hip luxation in a mature dog/cat
1. closed reduction
2. cage rest
3. support (Ehmer sling, hobbles)
365
what support can be used for a cradiodorsal hip luxation that has had closed reduction
Ehmer sling
366
what support can be used for a caduoventral hip luxation that has had closed reduction
hobbles
367
name the surgical treatment of choice for hip luxation
iliofemoral suture
| (base of trochanter to iliopubic eminence)
368
how to diagnose hip dysplasia in a mature dog/cat?
1. Ortolani test (angle of reduction - young only)
2. Radiographs (hip laxity in young; hip osteoarthritis in old)
369
how to medically manage a mature dog/cat with hip dysplasia
osteoarthritis management
(weight, analgesia, acitivty control, etc)
370
2 ways to surgically manage hip dysplasia in a juvenile dog
1. Juvenile pubic symphysiodesis (<5mo)
2. pelvic osteotomy (<12mo)
371
name 2 ways to sugically manage hip dysplasia in an adult dog
1. femoral head and neck ostectomy (juvenile and adult)
2. total hip replacement (adult)
