Ortho 1

Question 1

what is the definition of primary osteoarthritis in cats? what is the most important risk factor?

Answer 1

caused by age, obesity (systemic factors), genetic predisposition.

age most important

Question 2

what is the most common type of osteoarthritis in cats, primary or secondary?

Answer 2

primary

Question 3

what is the definition of secondary OA in cats?

Answer 3

due to biomechanics factors affecting the joint (trauma, development abnormalities, instability, mechanical overload)

Question 4

define primary OA in dogs.

Answer 4

due to genetics, age, systemic factors (obesity)

Question 5

define secondary OA in dogs.

Answer 5

secondary to primary inciting cause.. a treatment needs to address primary cause

following injury or insult to affected joints (CCL rupture, articular fx or OC initiates biochemical cascade leading to arthritis)

Question 6

which is more common in dogs, primary or secondary OA?

Answer 6

secondary

Question 7

what are the most common C/S of OA in a dog?

Answer 7

lameness, reluctance to exercise, inactivity stiffness, pain, joint effusion, muscle atrophy, joint thickening, altered ROM, altered gait, altered behaviour

Question 8

what are the most common C/S of OA in a cat?

Answer 8

most cats don’t show C/S recognized by owners!!!

more behaviour changes than clinical ones

changes in mobility, activity level, increased time spent resting, changes in social behaviour, increased vocalization, objection to being handled, changes in play and hunting, overall posture, pain on flexion and extension, crepitus upon manipulation of joint, muscle atrophy, joint thickening

Question 9

client-based questionnaires or checklists regarding OA have been used in both research and clinical settings. What utility do these tools have?

Answer 9

provide a summative score that can assess severity of disease at outset and response to treatment

Question 10

what PE findings are expected in a cat with OA?

Answer 10

gait changes (walking, jumping), pain on flexion and extension, joint effusion, crepitus, decreased ROM/ROM asymmetry, periarticular thickening/fibrosis, muscle atrophy

Question 11

what PE findings are expected in a dog with OA?

Answer 11

gait abnormalities/changes, lameness, pain on flexion and extension, joint effusion, muscle atrophy, joint thickening, altered ROM

Question 12

what are the radiographic signs of OA?

Answer 12

often nonspecific!

• osteophytosis/periarticular new bone formation
• enthesophytes
• subchondral bone sclerosis
• joint effusion
• ST swelling/thickening
• intra-articular mineralization/narrowed joint space
• cysts
• capsular or extra-articular mineralization

Question 13

what are osteophytes?

Answer 13

outgrowth of bone at the margin of an articular surface

Question 14

what are enthesophytes?

Answer 14

bone spurs forming at ligament or tendon insertion into bone; growing in natural direction of pull of ligament/tendon

Question 15

what is the most valuable and cost-effective means to assess joint?

Answer 15

arthroscopy

Question 16

do radiographic signs and C/S of OA always correlated? if no, then how do we interpret our findings?

Answer 16

no

complete systemic assessment is needed to rule out other metabolic abnormalities and provide a baseline before NSAID therapy

Question 17

in cats with OA, treatment is often aimed at _______. why?

Answer 17

alleviating chronic pain

because arthritis is not dx in many cats until it’s advanced :(

Question 18

tell me about the multimodal treatment options for feline OA

Answer 18

Pain relief:
- NSAIDs
- gabapentin, tramadol
- WEIGHT MGMT!!!

Joint supplements:
- essential fatty acids (DHA and EPA)

Chondroprotective agents:
- glucosamine and chrondroitin sulphate

Controlled exercise
Environmental mods
Rehab

Polysulfated glycosaminoglycans (PSGAG)

monoclonal antibodies (emerging)

surgery as a salvage procedure when medical mgmt doesn’t work

Question 19

tell me about the multimodal medical treatment options for canine OA

Answer 19

WEIGHT LOSS!!!!

Exercise (low-impact)

nutrition (essential fatty acids = omega 3)

drugs:
- NSAIDs
- paracetamol/codeine (short term)
- oral opiates/tramadol (short term)
- gabapentin +amantadine
- corticosteroids

Question 20

what is the most important therapy that all small animal owners can (and should!) offer their pets, regardless of financial situations, for OA?

Answer 20

WEIGHT MANAGEMENT!!!!!!!!!!

Question 21

when is surgery considered in a dog with OA?

Answer 21

it is prolonged as long as possible until weight loss is maximized

Question 22

what surgery do you do for a dog with OA?

Answer 22

total joint replacement

Question 23

what is the typical signalment of panosteitis?

Answer 23

usually 5-12 mo, large breed dogs, males > females

possible <5mo to 5 years, possible in small dog breeds

Question 24

how do you diagnose panosteitis?

Answer 24

PE: shifting leg lameness, pain on palpation of long bones

rads (diagnostic): circumscribed opacities in medullary canal (patchy opacities, “thumb prints”)

Question 25

how do you treat panosteitis? what is the prognosis?

Answer 25

treatment does not influence outcome pain mgmt (NSAIDs) and rest feed complete and balanced diet (not too high in protein) good to excellent

Question 26

what is the typical signalment for hypertrophic osteodystrophy? (HOD)

Answer 26

2-6mo old, young rapidly growing Dogs, male>female, mostly large/giant breeds (but all can get it)

Question 27

how do you diagnose HOD (hypertrophic osteodystrophy)? PE and diagnostic tests

Answer 27

PE: painful swelling of metaphysical long bones, often see systematic illness (fever, lethargy, inappetence, d+) rads (diagnostic): Lucent line in metaphysial region parallel to physis = double physis - periostea or endosteal reaction in physis region - subperiosteal hemorrhage --> new bone formation, usually palisading along periosteum or bridging the physis

Question 28

how do you differentiate between HOD and HO?

Answer 28

HO has deposition of periosteal new bone in distal extremities and long bones

Question 29

how do you treat mild and severe cases of hypertrophic osteodystrophy (HOD)?

Answer 29

mild: supportive care + NSAIDs severe: hospital, supportive care, opioids basically, symptomatic therapy typically improve in 7-10 days, bony changes improve over months

Question 30

what is avascular necrosis of the femoral head? what is the typical signalment?

Answer 30

noninflammatory aseptic necrosis of the femoral head and neck in small breed dogs (toy breeds and terriers), 4-11mo cause not well understood

Question 31

how do you diagnose avascular necrosis of the femoral head? PE and tests

Answer 31

pe: mild to severe non-weight bearing lameness in pelvic limbs; mild cases may be subclinical; acute pelvic limb lameness in a small breed dog rads (diagnostic): - progressive radiopacity of lateral epiphyseal area of femoral head - followed by lysis of femoral head (moth eaten, apple core appearance) - flattening and lucency of the head

Question 32

how do you treat avascular necrosis of the femoral head ?

Answer 32

this is a surgical disease... can help lameness with rest + NSAIDs, but ultimately they have to go to sx femoral head and neck ostectomy or total hip arthroplasty (replacement)

Question 33

what is the difference between multiple cartilaginous exostosis in cats and dogs?

Answer 33

dogs: young growing patients - exostosis appears + enlarges BEFORE skeleton matures (giant breed dogs) cats: assoc w/ FeLV - exostosis appears AFTER skeleton matures

Question 34

how do you diagnose multiple cartilaginous exostosis? PE and testing

Answer 34

PE: pain present if exostosis assoc with tendon, ligament, vessel, or spinal cord compression rads (used as monitoring tool): single or multiple bony masses within cortex, medullary cavity confluent with host bone with distinct trabecular pattern

Question 35

how do you treat multiple cartilaginous exostosis?

Answer 35

depends on size and location of lesions and C/S non-sx: rest and NSAIDs sx: indicated for single or large exostosis (esp w spinal cord compression)

Question 36

what is the typical signalment for slipped capital femoral epiphysis?

Answer 36

cats > dogs 4.5-42 mo maine coon, siamese overweight neutered males

Question 37

how do you diagnose slipped capital femoral epiphysis? PE and testing

Answer 37

PE: acute or chronic pelvic limb lameness, painful coxofemoral joint upon manipulation, inability to jump, 1/4 cases are bilateral rads: - widening and lateral displacement of capital femoral growth plate with progressive resorption and sclerosis of femoral neck acute pelvic limb lameness in a cat

Question 38

how do you treat slipped capital femoral epiphysis?

Answer 38

sx: - if early: reduction with internal fixation - if chronic: femoral head and neck ostectomy or total hip replacement medical: rehab after hip replacement, sublingual buprenorphine or oral tramadol

Question 39

what is osteochondrosis and what are the different types?

Answer 39

disorder of the ordered process of endochondral ossification. avascular necrosis of the developing epiphyseal cartilage OC latens: early microscopic lesion OC manifesta: subclinical lesions radiographically and clinically apparent OC dissecans (OCD): if attached or loose cartilage flaps are present and typically causing C/S

Question 40

what is the typical signalment of osteochondrosis dissecans? OCD

Answer 40

4-8 mo males>females large/giant breed dogs can occur in small dogs and cats but not as common

Question 41

how do you diagnose OCD? PE and testing

Answer 41

PE: consider in any young large/giant breed dog with lameness and swollen painful joints! Always look at contralateral joint bc often bilateral rads (diagnostic): - defects in subchondral bone - flattening of contour - sclerotic margins - ± mineralization of cartilage flap mainly at humeral head

Question 42

how do you manage OCD non-surgically?

Answer 42

lean BCS, NSAIDs, exercise restriction, dietary supplements

Question 43

how do you surgically manage OCD?

Answer 43

arthrotomy or arthroscopy flap excision and joint mouse retrieval palliative techniques: curettage, abrasion arthroplasty, Forage, micro fracture restorative techniques: fragment reattachment, osteochondral translates (autografts)

Question 44

what is the OCD prognosis based on location?

Answer 44

from best to worst: shoulder stifle, medial humeral condyle talus

Question 45

What is hypertrophic osteopathy? HO

Answer 45

periostea reaction of distal extremities can be any bone and can be bilaterally symmetric most often associated with primary or metastatic neoplasia