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Year 3 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Which nerves and blood vessels does articular cartilage contain?

A

NONE

also relatively hypoxic

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2
Q

What effect do NSAIDs have on the COX pathway?

A

Inhibit it, therefore preventing the conversion of arachidonic acid to prostaglandin precursors (thus preventing pain)

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3
Q

In which 2 ways can be NSAIDs be administered?

A

Oral and systemic

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4
Q

How do corticosteroids prevent pain?

A

Inhibit IL-1, TNF-α, and prostaglandins

Alter signalling pathways and gene expression

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5
Q

What are the equine doses for MPA and TA (corticosteroids)?

A

MPA: 40-120mg/joint (total horses dose 160mg)
TA: 6-12mg/joint (total horses dose 18-20mg)

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6
Q

Which cytokine is involved with osteoarthritis?

A

IL-1

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7
Q

How do bisphosphates work?

A

Inhibit bone resorption (hence prevent loss of bone mass) by inhibiting osteoclasts:
- Competes with ATP, resulting in apoptosis
- Alters ‘rough’ border attachments
- Reduced recruitment of osteoblasts to osteoclasts
May also inhibit NO and IL-1 induced collagenase release in chondrocytes/synovial cells

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8
Q

What are the symptoms of immune-mediated joint disease?

A

Multiple limb joint pain/swelling, generalised stiffness, shifting lameness, neck pain, lethargy, PUO (pyrexia of unknown origin)
Secondary OA/ joint deformities in chronic cases

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9
Q

How might you diagnose immune-mediated joint disease?

A

Synoviocentesis
Full clinical exam
Anaemia, proteinuria, leucopenia, low albumin
Radiograph

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10
Q

How would you treat immune-mediated joint disease?

A

Corticosteroids

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11
Q

Explain the pathophysiology of infective arthritis (synovial sepsis)

A

Marked inflammatory response:
-Vasodilation and influx of neutrophils
-Release of IL-1 and TNF-a
Fibrin clots trap bacteria (protect bacteria, reduces synovial nutrient exchange)
Cartilage destruction and extension to subchondral bone

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12
Q

What are the clinical signs of infective arthritis?

A

Acute onset, severe lameness
Stiffness, lying down, pyrexia
Wound near/over joint
Pain on palpation/articular swelling

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13
Q

What is the difference between tendons and ligaments?

A

Tendons:
Passively transfer force generated by muscle to bony attachments, leading to movement
Support joints
Store energy

Ligaments:
Attach/stabilise bones/joints
Protect tendons
Proprioception

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14
Q

What is the difference in content of collagen type in tendons and ligaments?

A 
Tendon= 95% collagen type I, 1-5% type III
Ligament= 90% type 1, 10% type III
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15
Q

What are the causes of intrinsic and extrinsic tendon/ligament injuries?

A

Intrinsic: overload/degenerative
Extrinsic: external trauma

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16
Q

If a flexor tendon is damaged, what % of original function can be restored?

A

50% at best

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17
Q

What is PRP therapy?

A

Platelet-rich plasma therapy
Uses platelets from patient’s own blood to rebuild a damaged tendon or cartilage
Relieves pain and jump-starts healing process

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18
Q

How can we limit inflammation in horses with SDFT tendonitis?

A

Cold hosing

NSAIDs

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19
Q

Which cells proliferate/migrate during muscle repair?

A

Satellite/precursor

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20
Q

White muscle disease is caused by a deficiency in what?

A

Selenium/vitamin E

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21
Q

Which enzymes may be elevated with muscle disease?

What might you see in the urine?

A

AST/ CK

Myoglobinuria

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22
Q

Give a brief description of polysaccharide storage myopathy

A

Increased muscle uptake of glucose and synthesis of glycogen
Muscle stiffness, reluctance to exercise, poor performance
Avoid high-energy feeds (give low-carb, high fibre diets)

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23
Q

Which bacteria causes non-exertional rhabdomyolysis?

A

Clostridium

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24
Q

The fetlock joint is between which bones?

A

3rd metacarpal/metatarsal bone and P1

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25
Q

What is the white line of a cow’s hoof?

A

Junction between wall horn and sole horn

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26
Q

How does the pedal bone stay attached to the dermal lamellae?
This may be compromised by what?

A

Via collagen fibres

Increased activity of MMPs

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27
Q

What is the function of osteoblasts?

What do they develop into?

A

Form bone matrix

Osteocytes (maintain bone tissue)

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28
Q

What is the function of osteoclasts?

A

Bone resorption (breakdown of bone matrix)

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29
Q

What are the differences between woven and lamellar bone? (3)

A

Woven:
Fibrils 0.1-3um diameter (smaller)
Random arrangement
Highly mineralised

Lamellar:
Fibrils 2-3um (larger)
Arranged into sheets
Less highly mineralised

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30
Q

What are the functions of bones?

A 
Skeletal support (movement, muscle attachment)
Protection
Haematopoesis 
Regulation of mineral homeostasis 
Fat storage
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31
Q

What is an osteon (Haversian system)?

A

Functional unit of bone. Cylindrical structure containing a central (Haversian) canal which contains a blood vessel. Osteocytes exist within their own lacunae. They make contact with each other via canaliculi (small canals) to participate in exchange of nutrients and metabolic waste.

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32
Q

What stimulates bone growth?

A

Genetic template
Hormones
Load

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33
Q

What stimulates bone adaptation?

A

Increase in load
Decrease in load
Repetitive load
Plastic deformation

34
Q

What is meant by the word ‘physis’?

A

Growth plate

35
Q

Adaptive response of bone depends on which 3 things?

A

Strain, magnitude, frequency

36
Q

What are the advantages of bone remodelling?

A

Allows bones to change shape in response to compressive forces (increases ability to resist fracture)
Replacement of damaged bone
Prevents accumulation of fatigue damage (repairs micro-cracks)
Contributes to mineral homeostasis

37
Q

How long does osteoid take to mineralise?

A

80-90 days

38
Q

How long does bone resorption by osteoclasts take?

A

3-4 weeks at 40um/day

39
Q

In which part of the bone do microcracks form?

A

Cortical bone

40
Q

What is the difference between elastic and plastic deformation?

A

With elastic deformation, the bone deforms and returns to the original shape. With plastic deformation it does not, but remodelling is stimulated.

41
Q

How does modelling of trabecular bone result in stronger bones?

A

Increased thickness of trabeculae

Increase in bridging between trabeculae

42
Q

What impact does cyclic repetitive strain have on trabecular bone?

A

Microcracks in trabeculae
Resorption of trabecular bone:
Increased porosity and decreased strength
Collapse of subchondral bone under articular cartilage
Predisposition to fracture

43
Q

What impact does exercise have on the third carpal bone?

A

Increased bone density
Increased density of trabecular bone
Increased microdamage and remodelling
Increased risk of fracture

44
Q

What adaptations do bones have to racing? (horses and dogs)

A

Increase in bone mineral density

Increase in cortical thickness

45
Q

How is a greyhound’s central tarsal bone adapted to racing?

A

Right central tarsal bone has a greater bone mineral density vs left (undergoes compression and rotation)
Dorsal aspect of bone undergoes adaptive remodelling-thickened and compacted trabeculae

46
Q

Where is calcitonin released from?

A

Thyroid

47
Q

In which 3 ways does calcitonin decrease blood calcium levels?

A

Increases calcium deposition in bones
Decreases calcium uptake in intestines
Decreases calcium resorption from urine

48
Q

Give some examples of complications that may occur following a fracture

A

Contamination/infection
Damaged blood/nerve supply
Contralateral limb problems
Implant failure

49
Q

What are the 5 zones of the physeal anatomy?

A 
Resting cartilage
Zone of proliferation
Zone of hypertrophy
Zone of calcification of cartilage
Matrix resorption and ossification/secondary spongiosa
50
Q

What does OCD stand for?

A

Osteochondrosis dessicans

Cartilaginous or osteochondral flap

51
Q

What is meant by osteochondrosis?

A

Family of orthopaedic diseases
Abnormal endochondral ossification
Interruption of blood supply to bone -> bony necrosis -> regrowth of the bone

52
Q

Abnormalities leading to OCD can occur at which different stages?

A

Disruption of blood supply
Abnormal chondrocyte maturation
Defective matrix production
Persistence of hypertrophic chondrocytes

53
Q

How may hormones influence OCD?

A

Testosterone and growth hormones
Transient hyperinsulinaemia
Transient hypothyroidism (thyroid hormone influences chondrocyte maturation)
Growth factors (TGF-b, IGF-1, IGF-2: alter chondrocyte metabolism)

54
Q

How may nutrition influence OCD?

A

Excess energy and protein
Imbalance of Ca:P (excess phosphorus is more influential)
Imbalance of Cu:Zn (Cu deficiency; Cu is involved in collagen cross-linking)

55
Q

Which radiographic abnormalities might you see with OCD?

A

Irregular subchondral bone
Osseous densities:
-mineralised cartilage
-osteochondral fragments

56
Q

What is physitis?

What are the clinical signs?

A

Enlargement of the physis (inflammation or disrupted endochondral ossification)

Lameness, stiff gait, self-limiting

57
Q

Hypertrophic osteodystrophy typically affects which kinds of dogs?

A

Large breeds, 2-8 months old

58
Q

Briefly describe the pathogenesis of hypertrophic osteodystophy

A

Necrosis of the capillary loops of the cartilage of the metaphyseal physis
Cuff of metaplastic cartilage and bone

59
Q

What are the clinical signs of hypertrophic osteodystrophy?

A

Lameness, fever, lethary, painful bone
Primarily long bones – distal aspect
Bilateral and symmetric

60
Q

Describe the radiographic abnormalities seen with hypertrophic osteodystrophy

A

Abnormal bone on diaphyseal side of physis
Decreased radiodensity parallel to physis
Irregular widening of the physis
Sub and extra-periosteal new bone

61
Q

Panosteitis typically affects which kinds of dogs?

What is it?

A

Large breeds, 5-18 months old, male

Fibrosis of bone tissue

62
Q

Which radiographic abnormalities are associated with panosteitis?

A

Increased opacity of medullary cavity
Indistinct trabecular pattern
Increased endosteal opacity (darker appearance)

63
Q

Describe the pathogenesis of Legg-Calve-Perthes Disease

A

Avascular necrosis of the femoral head
Bone remains mechanically stable initially
When SCB loses mechanical strength – collapse of articular surface

64
Q

Legg-Calve-Perthes Disease affects which kinds of dogs?

A

Toy breeds, 4-11 months

65
Q

What is the treatment for Legg-Calve-Perthes Disease?

A

Surgical, due to severity of arthritis

Femoral head and neck excision

66
Q

Which 2 terms are used to describe deviation of a limb from the normal axis in angular limb deformities?

A

Valgus – lateral deviation distally

Varus – medial deviation distally

67
Q

How do angular limb deformities occur?

A

Asynchronous growth of a pair of bones
ie radius and ulna
Differential growth between bones, after damage to one (trauma to growth plate)
Shorter (affected) bone acts to create bowing of longer bone

68
Q

Angular limb deformities affect which kinds of dogs?

A

Small breeds, eg Shi-tzu

69
Q

How do flexural limb deformities occur in cows and horses?

A

Disproportionate growth

Bone is functionally longer than muscle-tendon unit

70
Q

Which 4 things should you assess when doing an initial static evaluation of an equine orthopaedic exam?

A

(1) Posture
(2) Balance
(3) Muscling/symmetry
(4) Conformation of the limbs

71
Q

How can you determine whether swelling is located around the carpal joint or tendon sheath?

A

Joint effusion is generally horizontal, whereas tendon sheath is vertical

72
Q

The common calcanean tendon is made up of what?
Where does it insert?
Where does the calcanean bursa lie?

A

Gastrocnemius, semitendinosus, biceps femoris
Inserts on calcaneus underneath SDFT
Bursa lies between SDFT and calcanean tuberosity

73
Q

What happens to the SDFT as it inserts on the calcaneus?

A

Widens

74
Q

What is ‘curb’ in horses?

A

Swelling of the distal plantar aspect of the hock, common in highly active horses

75
Q

How do you determine which forelimb a horse is lame on?

A

Head/neck RISE as the lame leg bears weight (or just before)

76
Q

How do you determine which hindlimb a horse is lame on?

A

Asymmetrical movement of the pelvis
There is increased overall vertical movement of the tuber coxae/hindquarters of the lame leg (compared to the non-lame leg)

77
Q

What might it mean if a horse lands its feet toe first?

A

Palmar foot pain

78
Q

What might it mean if a horse lands its feet heel first?

A

Abscesses/laminitis

79
Q

When lunging a horse, which kinds of injury may be worse on the inside and outside?

A

Inside: foot/joint lameness
Outside: soft tissue injury

80
Q

Briefly describe how you can manipulate the upper limb

A

Shoulder and elbow region
Limb pulled caudally will extend elbow and flex shoulder
Limb extended cranially will extend shoulder and flex elbow

Year 3 (28 decks)

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