Principles Of Surgery Final Flashcards
(116 cards)
1
Q
Name the step involved in working up an orthopedic case?
A
- Signalmen and Anamnesis
- Physical Exam
- Neuro Exam
- Orthopedic Exam
- Localize lesion
- List differentials
- Run Diagnostic test
2
Q
Circumspection
A
Difficulty flexing the joint
3
Q
What signs may you see in an animal suffering from forelimb lameness?
A
Head bob: head goes up when painful leg hits the ground
4
Q
What signs may you see in an animal suffering from hind limb lameness?
A
- Hip elevation as painful limb touches ground
- Lowering head/leaning forward when painful limb hits ground
- Forelimbs shifted under body to take weight off the hind limb
5
Q
What are signs of a diseased joint?
A
- Effusion: feels like thick water balloon
- Crepitus
- Pain
- Decreased or increased range of motion
6
Q
How would you isolate a joint of interest to test?
A
Hold bone below or above joint
7
Q
What are some causes of plantigrade stance?
A
- Talocrural joint luxation/fractures
- Intertarsal joint luxations/fractures
- Tarsometatarsal joint luxations/fractures
- Rupture of gastrocnemius
- Rupture of calcaneal tendon
- Fractures of all metatarsals
- Sciatic neuropathy/palsy/weakness
- Polyneuropathy secondary to diabetes or endocrinopathy
- Collagen synthesis disorders
8
Q
If you notice a plantigrade stance with flexed toes, what is going on?
A
Gastrocnemius allusion with superficial digital flexor intact
9
Q
What are the palpating landmarks for the hock joint?
A
- Medial and lateral melleoli
- Calcaneus
- Common Calcanean tendon
- Talocrural joint space
10
Q
How do you palpate the patella laterally?
A
- Partially flex the stifle
- Rotate toes laterally
- Puts patella laterally
11
Q
How do you luxate the patella medially?
A
- Extend the stifle
- Rotate the toes medially
- Push the patella medially
12
Q
When palpating long bones, what are you typically looking for?
A
- Panosteitis
- Bone neoplasia
- Osteomyelitis
- Fractures
13
Q
What is the problem with palpating long bones over nerves and muscle?
A
It can give you false positive results
14
Q
When palpating long bones, you want your knuckles to turn white; therefore, palpating __________.
A
Firmly
15
Q
What are causes of forelimb lameness in growing dogs?
A
- OCD of the humeral head
- Elbow incongruity/dysplasia
- Panosteitis
- Hypertrophic osteodystrophy
- Physical injury/fractures
- Puppy carpal laxity syndrome
- Angular limb deformity
- Other Congenital deformities
16
Q
What are some causes of forelimb lameness in adult dogs?
A
- Toe trauma
- Osteoarthritis (secondary)
- Fractures
- Traumatic joint luxations
- Autoimmune polyarthropathy
- Biceps tenosynovitis
- Supraspinatus tendinopathy
- Infraspinatus contracture
- Medial shoulder instability
- Carpal hyper extension/palmar fibrocartilage rupture
- Epicondylitis/uninitiated medial epicondyle
- Fragmented sesamoids
- Neoplasia
- Panosteitis
- Referred neuropathic pain from intervertebral disk disease or wobbler’s
17
Q
What are the palpating landmarks of the shoulder?
A
- Acromion process of the scapular spine (joint)
- Greater tubercle of the humerus (joint)
- Acromial and scapular head of the deltoid mm.
- Supraspinatus mm.
18
Q
What are the passive stabilizers of the shoulder joint?
A
- Joint capsule
- Medial/lateral glenohumeral ligaments
- Biceps brachii tendon
- Joint congruity of glenoid fossa and humeral head
- Joint fluid cohesion
19
Q
Where are the active stabilizers of the shoulder joint?
A
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
20
Q
If there is resistance to shoulder extension during palpating, what may this indicate?
A
- OCD of the humeral head
2. Supraspinatus tendinopathy
21
Q
During palpation, if there is resistance to shoulder flexion, what may be going on?
A
Biceps tenosynovitis
22
Q
What is the biceps tenosynovitis test?
A
You flex the shoulder, extend the elbow and palpate the biceps tendon medial to the greater tubercle of the humerus
23
Q
What is the shoulder abduction test used for?
A
Test the integrity of the medial shoulder joint stabilizers like the glenohumeral ligaments, biceps brachii tendon, and the subscapularis mm.
24
Q
Where is it best to palpate the brachium/humerus?
A
Distal or medial; less chance you will accidentally squeeze muscle and nerves
25
If a dog is experiencing elbow pain, what could you see?
1. Slightly abducted elbows with paw externally rotated to reduce loading on the medial side of joint
2. Keeps elbows in extension when laying down
3. Skinny forearms
26
What are the palpation landmarks for the elbow?
1. Olecranon
2. Medial/lateral epicondyles
3. Joint
27
How would you palpate for elbow joint effusion?
Palpate the valley between the epicondlyles and the olecranon, there will be thickening or water balloon effect.
28
What muscle in the elbow can be confused for joint effusion?
Anconeus
29
If there is resistance to flexion when you flex the elbow, what may be going on?
Elbow arthritis caused by elbow dysplasia
30
Where on the antebrachium is it ideal to palpate for panosteitis?
Proximally on the ulna
31
Where is it common to palpate pain/swelling indicative of an osteosarcoma in the antebranchium?
Distal radius
32
What defect does Dr. Warnocks dog have?
Intercalated radial hemimelia with congenital caudomedial shoulder luxation and limb hypoplasia
33
What are the palpation landmarks for the carpus?
1. Medial/lateral styloid processes
2. Accessory carpal bone
3. Antebrachiocarpal joint
34
How would you palpate the carpus?
1. Strong flexion and on cranial portion
| 2. Dimple distal to radius is the antebrachialcarpal joint space and won’t feel if there is joint effusion or thickening
35
What part of the body in small animals is the most common source of lameness?
Paws
36
What are causes of lameness stemming from the paws?
1. Split nails
2. Nail bed tumors
3. Foxtails/foreign bodies
4. Fractures
5. Fragmented sesamoids
6. Pad lacerations
7. Arthritis
37
If you see a dropped toe, what is happening?
Torn superficial digital flexor tendon
38
If you see a knocked up toe, what is happening?
Torn deep digital flexor tendon
39
What are some causes of hindlimb lameness in growing dogs?
1. Hip dysplasia
2. Panosteitis
3. HOD
4. Leg Calves Perthes disease
5. OCD-stifle or hock
6. Physical fractures/trauma
7. ALD
8. Long digital extensor tendon avulsion
9. Cranial cruciate ligament avulsion
10. Epipphysiolysis
40
What are some causes of hindlimb lameness in adult dogs?
1. Toe Trauma
2. Osteoarthritis
3. Fractures
4. Traumatic joint luxations
5. Cranial cruciate ligament disease
6. Medial patellar luxation
7. Calcaneal tendon tears/degeneration
8. Superficial digital tendon luxation
9. Fibrotic contracture and myopathies
10. Contracture and myopathies
11. Illiosoas tendinitis/groin sprain
12. Autoimmune polyarthopathy
13. Fractured sesamoids
14. Neoplasia
15. Hypertrophic osteopathy
16. Panosteitis
17. Referred neuropathic pain from intervertebral disk disease or lumbosacral instability
41
What are the palpation landmarks for the hip?
1. Iliac crest
2. Ischiatic tuberosity
3. Greater trochanter of the femur
42
If the palpation landmarks of the hip become a line, what is occurring?
Crandiodorsal hip luxation
43
If there is pain on extension of the hip, what could be the problem?
1. Hip dysplasia
2. Hip osteoarthritis
3. Femoral head and neck fractures
4. Lumbosacral disease
5. Illiopsoas tendiopathy
44
How can you test for hip laxity?
1. Ortolani’s test
| 2. Barlow test
45
What is gracilis and semitendinosus fibrotic myopathy?
It is an autoimmune disease that tends to occur in german shepherd dogs characterized my muscle necrosis.
46
What is the signs of a cranial crucial ligament rupture in a dog?
1. Medial buttress, a thickening on the proximal medial side of the tibia.
2. Positive sits test
47
What are the stifle joint palpation landmarks?
1. Patella
2. Patellar ligament
3. Joint space
4. Tibial tuberosity
5. Fabellae
6. Fibular head
48
What are some tests you can do to determine a cranial cruciate ligament tear?
1. Cranial drawer test (do sedated)
| 2. Cranial tibial thrust (do sedated)
49
How would you palpate for patellar location medially and laterally?
```
Medial:
1. Flex stifle
2. Rotate toes laterally
3. Puth patella laterally
Lateral:
1. Extend stifle
2. Rotate toes medially
3. Push patella medially
```
50
What does TLC stand for?
T: Tumor
L: Location
C: Condition and client
51
One of the most important aspects of patient management is to _______________.
Know what the disease is
52
What types of tumors is a FNA most useful for diagnosing?
Readily exfoliating tumors like carcinomas, mast cell tumors, lymphoma, TVT, melanoma, and histiocytomas
53
What types of tumors is a FNA not useful for?
Most sarcomas
54
How could you maximize diagnostic yield with an FNA?
Image guided with ultrasound or CT/MRI
55
When should you not do a pre-treatment biopsy?
When the biopsy is nearly as difficult or dangerous as definitive surgery.
Examples:
1. Lung, splenic, and adrenal mass
56
How would you decide between taking an incisional or excisional biopsy?
Ask the question, will the excisional biopsy compromise chance for a cure if a need to perform a more aggressive surgery in even that this is a malignancy? If the answer is NO, do an excisional.
57
What plane would you want to incise along when taking a biopsy on the tail or leg?
Longitudinal
58
What plane would you want to incise along when taking a biopsy on the body?
Transverse
59
When should electrocautery be used when taking a biopsy?
After collection of the biopsy as it may distort cells
60
Why would you want to change instruments for closing a biopsy site?
Lower risk of seeding tumor cells into adjacent tissues
61
What is the ideal tissue:formalin ratio for storing a biopsy sample?
1:10
62
In what type of biopsy would you want to mark margins?
Excisional
63
What are some different types of instruments that can be used to obtain a bone biopsy?
1. Jamshidi
| 2. Trephine
64
What are some special biopsy techniques available beside incisional/excisional, punch, and needle core?
1. Endoscopy
2. Laparoscopy
3. Thoracoscopy
4. Image guided with CT or MRI
65
What is usually included on a histological report of a biopsy you send in to the pathologist?
1. Neoplastic or not
2. Benign or not
3. Histologic type
4. Histologic grade
5. Status of margins (distance, composition)
66
What characteristics of the dressing do you want to think about when dressing a wound?
1. Does it adhere to skin?
2. Does it absorb?
3. Does it debride?
4. Does it occlude"
5. Is is biologic?
67
If you are dealing with a heavily contaminated wound or one with lots of tissue trauma, what is the best dressing do use?
Debriding and absorbent dressings like gauze sponges, hypertonic saline dressing, and hydrophilic dressings.
68
If you are dealing with a healthy granulating wound that needs to epithelialize, what is the best dressing to use?
Want it to provide a moist environment and be occlusive or semi-occlusive, like hydrogels, tells, and polyurethane foam.
69
If you are dealing with a persistent and resistant microbial infection on a wound, what is the best dressing do use?
One with effective antibiosis, so iodine containing, antimicrobial cause dressing, silver impregnanted dressings, and honey (may sure its medical grade).
70
How would you secure the contact/primary layer of a dressing?
1. Conforming gauze
2. Cast padding
3. Elasticon
71
What is a dressing?
The contact/primary layer of a bandage.
72
What is the purpose of a secondary/intermediate layer of a bandage?
1. Absorbent
| 2. Padding via roll or sheet cotton or cast padding
73
What is the purpose of the outer/tertiary layer of a bandage?
1. Holds layers in place
2. Provides mechanical protection
3. Provides immobilization
74
Roll and conforming gauze, vet wrap/coflex, and elastikon are all considered what type of layer in a bandage?
Outer/tertiary
75
What is a stent/tie-over/bolster bandage?
Its used in difficult to bandage areas, where there are stand stutters places, and contains a construct dressing with a secondary layer secured with umbilical tape.
76
What is a robert jones/extremity bandage?
Used to immobilize, protect and aid in treatment of injuries/wounds distal to the elbow or stifle
77
What is a modified robert jones bandage?
Same but less bulk, so would use cast padding instead of cotton in small animals and just use less layers in large animals.
78
An dog has a luxation of the elbow joint, what kind of bandage will you employ?
A robert jones common limb bandage.
79
What is difference in bulky limb bandage between small and large animals?
In large animals, the tertiary layer will be repeated until the bandage is 3x the circumference of the limb
80
What are the principles of a robert jones bandage?
1. Immobilize joints above/below injury
2. Leave 2 toes out in small animals to monitor excessive pressure
3. Use stirrups or adhesive tape to prevent slipping
81
How should a robert jones bandage be applied in small animals?
Distal to proximal, place stirrups, avoid wrinkles, and the tertiary layer should not be too tight.
82
How should a robert jones bandage be applied in large animals?
Same as a small animals except no stirrups and make the tertiary layer tight.
83
Why would we use a ehmer sling?
It maintains pelvic limb in flexion in small animals preventing weight bearing. Great for maintaining reduction of craniodorsal coxofemoral joint luxation
84
When would we NOT use an ehmer sling?
Ventral or caudal coxofemoral luxations in small animals
85
Why would you use a belly band with an ehmer sling?
It provides limb abduction and pronation of the coxofemoral joint which forces the femoral head into the acetabulum and maintain it beneath the acetabular rim
86
What is a robinson sling?
Used on small animals to prevent weight bearing on the pelvic limb, but does not flex the limb.
87
A dog has a tibial fracture, what kind of sling will you use and why?
A robinson sling as it can be maintained for awhile due to less flexion of pelvic limb, prevents weight bearing and limited range of motion, and slow downs an overactive patient.
88
This sling maintains the thoracic limb in flexion preventing weight bearing and is used to immobilize the shoulder joint after luxation and in scapular fractures. (only used in small animals )
Valpeau sling
89
Explain the differences in using thoracic/abdominal bandages on large and small animals?
Bandages can tighter on large animals, but its easier to incorporate the shoulder to prevent slippage in small animals...need to use elastikon in large animals to prevent slippage.
90
What are the rules to using a head bandage on a small animals?
1. Not too tight
2. MUST NOT SLIP (choking)
3. Need to eat, move and breath
4. Monitor constantly
5. Mark where ears are so you don't cut them off when removing
91
What the rules to using a head bandage on large animals?
1. Same as small animals
| 2. Can use stockinette
92
What are examples of pre-made splints?
1. Kimzey leg saver for horses
| 2. Schroeder-tomas splint
93
What can splints be made out of?
1. Wood boards
| 2. PVC pipe
94
Why would you use a splint in a small animals?
Immobilize the hip or shoulder joint without flexion
95
What is a spica splint?
Used after injury of proximal limb in small animals, it must extend over the contralateral side dorsally and has similar rules as thoracic/abdominal bandages.
96
What is the most important principles of casts?
Immobilize the joint above and below
97
Where should a cast always be ended? WHY?
Proximal most aspect of a long bone.
Top of cast is stress rise and can cause fracture if ending in middle/distal of bone
98
What is the difference between a full leg cast and half cast on small animals?
Full leg is from the toes to the axilla/groin and immobilizes bone up the the elbow/stifle. Half cast is from the toes to the elbow/stifle and use for fractures of the metatarsus/metacarpus
99
Whta is the difference between a full limb cast and half limb cast and foot cast in large animals?
The full limb goes from the hoof to the elbow/stifle and immobilizes joints up the carpus/hock. The half limb is from the hoof to the carpus/hock and used for fractures of the phalanges 1 & 2, proximal sesamoid bones, suspensory apparatus breakdown and flexor tendon transections. The foot cast is from the foot to the fetlock and is used for heel bulb lacerations and coffin bone fractures.
100
What is a tube cast?
Used in large animals from the fetlock to the elbow/stifle to immobile the carpus/tarsus, correct angular limb deformities, and protect incompletely ossified cuboidal bones in carpus/tarsus in foals.
101
What type of cast incorporates transcortical pins in large animals?
Transfixation cast
102
What is a bandage cast?
Placed over a robert jones bandage and bivalved to allow for wound care. For immobilization, not stabilization.
103
How often should you check small animals toes for swelling, heat, cold, pain or discoloration?
Every 8-12 hours
104
What type of cast incorporates u-shaped metal bar to prevent direct weight bearing on toes in small animals?
Walking bar casts
105
What can you used to remove a cast?
1. Obstetric wires(Gigli wire)
| 2. Cast cutter (oscillating saw)
106
Name the steps you need to take before you discharge an animal with a bandage/cast to protect you ASSets?
1. Informed consent
2. Risk/complications
3. Intructions for monitoring
4. Give explicit actions when certain signs seen use ASAP to these actions
5. State time/date for recheck
6. Get in writing that if owner changes bandage, it is against your medical advice
107
What are the complications of bandages/casts?
1. Slippage
2. Pressure sores
3. Rub sores
4. Skin irritation
5. Devitalization of tissues
6. Joint/tendon contracture
7. Joint/tendon laxity
8. Nerve damage
9. Cast/splint breaks
10. Patient destroy bandage/cast
108
If a joint/tendon contracts when using a bandage, what happened?
It was on too long
109
```
Fill in the criteria for the classification of lameness in large animals:
Grade 1:
Grade 2:
Grade 3:
Grade 4:
Grade 5:
```
1. Difficult to observe/not consistent
2. Difficult to observe in straight line/ consistent under certain conditions
3. Consistent at trot in all circumstances
4. Lameness, marked nodding, biting or shortened stride
5. Minimal weight bearing/can't move
110
What are the 7 most common cause of large animals lameness?
1. Osteoarthritis
2. Septic arthritis
3. Lacerations
4. Tendon/ligament ruptures
5. Osteochondrosis
6. Fractures
7. Foot abscesses
111
What are the components to the lameness exam in large animals?
1. Visual inspection with conformation
2. Palpation of limbs standing versus unweighted
3. Note swellings, sensitivity, and asymmetry
4. Hoof tests
5. Hammer hoofs
6. Examine during motion
7. Flexion tests
8. Nerve blocks
9. Diagnostic imaging (radiographs 1st, u/s for soft tissue)
112
What are clinical signs of front limb lameness in large animals?
1. Head/neck elevate when lame limb supports weight
| 2. Head down when sound limb supports weight
113
What are clinical signs of hind limb lameness in large animals?
1. Hip excursion
2. Asymmetry of pelvis and bony prominence
3. May have head nod when lame leg supports weight
4. Shortened stride
5. Dragging toe and not tracking up
6. Decreased extension of fetlocks
114
What is a flexion test?
You hold the animals limb in flexion at a joint for 30-90 seconds and then watch the animal walk around on it to determine lameness.
115
What are the types of flexion tests that can be done on large animals?
1. Lower limb flexion (fetlock)
2. Carpal flexion
3. Shoulder/elbow flexions and extension
4. Hock/stifle flexion (spavin test)
5. Wedge test
116
Name the lameness exam blocks in large animals from least amount of the leg blocked to the most.
1. Palmer/plantar digital nerve block
2. Basilar/abaxial sesamoid block
3. Low 4-point point block
4. High 4-point block
5. Intra-articular joint block
