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THRALL - Thom > 18. Orthopaedic Diseases of Young and Growing Dogs and Cats > Flashcards

18. Orthopaedic Diseases of Young and Growing Dogs and Cats Flashcards

1
Q

Pathophysiology of osteochondrosis / dissecans?

A
  • Young (6-9Mo), rapidly growing, large breeds
  • Epiphyseal cartilage necrosis -> Failure of endochondral ossification (may resume if vasculature can resuppy)
  • Divots within subchondral bone, progressive chondromalacia
  • Dissecans: flap, chondral or osteochondral fragment formation

=> ST, so not visualised radiographically

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2
Q

List 5 common sites of OCD

A
  • Caudal aspect of proximal humerus
  • Distomedial aspect of humeral trochlea
  • Lateral and medial femoralcondyles
  • Femoral trochlea
  • Lateral and medial talar ridges
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3
Q

What is a kissing lesion?

A
  • Subchondral defect that involves articular surface opposite primary (OCD) lesion
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4
Q

Rx features of OCD?

A
  • Flattening or concavity of affected subchondral bone
  • Irregularity or widening of joint
  • Sclerosis
  • Joint effusion
  • Capsular thickening
  • Mineralised flap / joint mouse

=> may become vascularised / enlarge over time

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5
Q

What causes the vacuum phenomenon in joints?

A

Traction -> accumulation of nitrogen gas.

=> Seen in shoulders with OCD

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6
Q

What views of the talus may aid identification of lateral talar ridge OCD?

A
  • Flexed dorsoplantar
  • Dorsolateral - plantaromedial oblique
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7
Q

What projections may aid in identification of shoulder OCD?

A

SUPINATED projections

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8
Q

What normal structure may be mistaken for lateral femoral condyle OCD?

A

Extensor fossa - origin of long digital extensor

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9
Q

Which contrast agents should be used for arthrographic evaluation of OCD?

A
  • Non-ionic low osmolar -> Avoids dilution due to water-influx.
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10
Q

List the 3 primary lesions (triad) involved in elbow dysplasia

A
  • Ununited anconeal process
  • Medial coronoid process fragmentation
  • OCD of distomedialaspect of humeral trochlea
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11
Q

Which 5 breeds have a seperate centre of ossification at the anconeal process?

A
  • GSD
  • Greyhounds
  • Pit bull
  • Lab
  • G. Ret
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12
Q

At what age should the anconeal process be fused?

A

150 days

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13
Q

Which 4 breeds are at risk of UAP?

A
  • Bernese
  • Rotti
  • Mastiffs
  • St Bernards

*OTHER LARGE BREEDS*

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14
Q

Which radiograph should be performed for suspected UAP?

A

Flexed lateral

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15
Q

What is the most common developmental disorder involving canine elbow?

A

Fragmented MCP

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16
Q

Clinical features of frag. MCP?

A
  • Medium and large breeds
  • >4-6months
  • Rx:usually cannot visualise directly. Inferance from OA
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17
Q

Which view can be used to highlight the medial coronoid process?

A

Cranial 25-deg lateral / caudomedial view

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18
Q

Rx signs of Frag MCP?

A
  • Abnormal countour / poor definition
  • Medial margin blunted / rounded
  • Seperate osseus body
  • Joint incongruity / sublux
  • Osteophytes (prox margin of anconeal process -> early sign)
  • Subchondral bone sclerosis adjacent to trochlear notch / prox radioulnar articulation
  • Large osteophyte from medial coronoid margin on CrCa
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19
Q

Features of congenital radial head luxation?

A
  • Breeds: Bouvier des flandres, Shi Tzy, bulldog, Afghan
  • CAUDOLATERAL luxation
  • Radial epiphysis may be convex (failure of normal ariticulation)
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20
Q

Features of aseptic necrosis of the femoral head?

A
  • Young small and toy breeds
  • Path: Compromise blood supply - necrosis of subchondral bone, with ongoing cartilage growth. Decreased opacity of femoral head, misshapen.
  • Rx: Time dependent

Early: Normal

Later: Linear lucencies in subchondral bone, decreased opacity of femoral epiphysis and metaphysis, flattening / irreg, joint space widening / sublux, PATH FRACT!

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21
Q

Features of spontaneous capital physeal fracture of cats

A
  • Non-traumatic, delayed physeal closure
  • Males, early neutered, approx 2yo
  • Rx:
    Malalignment of epiphysis and metaphysis

Head / neck osteolysis, sclerosis, resorption

CHECK BILATERALLY -> look for delayed closure

22
Q

What is the most common form of polymelia? Which animals / breeds?

A
  • Supernumerary limbs / parts of limbs!

=> Polydactly most common! Cats, and Great Pyrenees

23
Q

Features of nutritional secondary hyperparathyroidism

A
  • Calcium deficient or Ca:Phos imbalanced diets -> increased paraT

=> Bone resorption / osteomalacia

  • Rx:
    Osteopaenia, thin cortices, loss of dental lamina, spinal deformity and FOLDING FRACTURES
24
Q

Features of osteogenesis imperfecta?

A
  • RARE, generalised, multisystemic heritable disease

=> structural defect in TYPE 1 collagen

  • CS: Stunted growth, muscle atrophy, weakness, pink teeth, PATHOLOGICAL FRACTURES!

Rx: osteopaenia, thin cortices, path fractures, excessively opaque callus, medullary sclerosis

**MAY BE CONFUSED WITH HYPERPARA**

25
Q

List 4 generalised bone disorders

A
  • Nutritional secondary hyperparaT
  • Osteogenesis imperfecta
  • Panosteitis
  • Osteopetrosis
26
Q

Features of panosteitis?

A
  • Self limiting, young large breeds
  • MALES 4x more likely
  • Breeds: Bassett, GSD, shar pei, giant schnauzer, great pyrenees, mastiff
  • 5-12 months, although GSDs as young as 2 mo and old as years!
  • NOT INFLAMMATORY strictly
  • DIAPHYSEAL, near nutrient foramen
  • Rx:

Early: Blurring / accentuation of trabeculae; Nodular opacities within medulla similar to cortical bone -> Become more diffuse/ homogeneous

Smooth periosteal reaction (33-50% ish)

Late: Opacities resolve -> coarse thickened bone

  • If not responding, consider follow up to rule out other abnormalities
27
Q

What lesion has been described that should not be confused with panosteitis?

A
  • 46% ASYMPTOMATIC NEWFIES
  • Metaphyseal lucencies with coarse trabecular bone in distal radius / ulna
28
Q

Features of osteopetrosis? Osteosclerosis?

A
  • RARE inherited metabolic bone disease -> Abnormal osteoclasts
  • Increased bone, specifically in medulla -> myelophthisic anaemia
  • OSTEOSCLEROSIS: Rx identifcal -> can be seen with nonregen anaemia due to FeLV, possibly paraneoplastic too

Rx: Increased bone opacity, medullary cavities particularly.

Differs from panosteitis -> not large breed dogs, generalised / involvment of axial skeleton

29
Q

Features of congenital hypoT?

A
  • Rare developmental condition -> Thyroid aplasia / hypoplasia
  • Breeds: cats, boxers, deerhounds, g.schnau, affenpinschers, G.Danes
  • DISPROPORTIONATE DWARFISM -> short limbed, bow legged, long necks and trunks

Rx: EPIPHYSEAL DYSPLASIA - reudced / delayed oss of epiphyses -> prox tib, humeral and fem condyles; cuboid bone oss. in carpus and tarsus delayed, Short vert bodies and skull.

30
Q

Features of mucopolysaccharidosis?

A
  • Recessive, inherited -> Defect of glycosaminoglycan catabolism. Multiple types (10+)

=> Chronic, progressive, systemic disease -> MS, ocular, neuro, hepat, CV

  • Often lame with visual deficits and disproportionate dwarfism / facial dysmorphia

=> Broad maxilla, widespread eyes, flat nose, short ears, distal joint laxity

Rx: AXIAL AND APPENDICULAR SKELELTON

  • Epiphyseal dysplasia -> Delayed / incomplete epiphyseal ossification. Epiphyses smaller than normal, granular.
  • Maxilla short and flattened
  • Vert bodies cuboid and short
  • Frontal sinuses small / absent
  • DJD
  • Coxofemoral sublux / lux if femoral head epiphysis affected
31
Q

List 3 examples of epiphyseal dysplasias?

A
  • Congenital hypoT
  • Mucopolysaccharoidosis
  • Multiple Epiphyseal dysplasia of beagles
32
Q

Features of multiple epiphyseal dysplasia of beagles?

A
  • Rare inherited disorder -> Failure of normal epiphyseal ossification
  • Pseudoachondroplasia of miniature poodles thought to be similar

=> DELAYED GROWTH, never reach full size

Rx:

  • Stippling / irregularity of epiphyses by 3 weeks old
  • Most pronounced changes in humeral condyles at 1-3mo
  • Also, femur, metacarlap and metatarsal bones, occasionally vertebrae
  • EPIPHYSES EVENTUALLY MINERALISE, but deformed
  • Hip dysplasia associated
33
Q

List 9 diseases promarily affecting the metaphysis and physis (4 are osteochondral dysplasias!!!)

A

Osteochondral dysplasias:

  • Chondrodysplasia of alaskan malamutes
  • Chondrodysplasia of Norwegian Elkhounds
  • Osteochondrodysplasia of Scottish Fold Cats
  • Ocular chondrodysplasia of Labs

Rickets

Hypertrophic osteodystrophy

Multiple Cartilagenous Exostosis

Retained cartilage core

Incomplete ossification of humeral condyle

34
Q

What are osteochondral dysplasias??

A
  • MULTIPLE, complex. Only a few summarised in text

=> histologically and biochemically heterogeneous group

  • Marked alternations in chondrocyte morphologic characteristcs and cartilage architecture
  • Inherited, but variable expression => varying severity of CS
  • Important to distinguish chondrodystrophoid dogs that have been bred, and sporadic chondrodysplastic dwarfs
35
Q

Features of chondrodysplasia of alaskan Malamutes?

A
  • Autosomal recessive
  • Accompanied by MACROCYTIC HAEMOLYTIC ANAEMIA
  • CS: Limb shortening, cranial and lateral deviation of forelimbs and enlarged carpi
  • Limited to long and cuboidal bones. SKULL AND SPINE SPARED
  • Rx:

Most onbvious in sistal ulnar physis and metaphysis

Flaring of distal radial metaphysis

Angular limb deformities due to asynchronous antebrachial growth

  • Changes as early as 7 days, more definitive at 5-12 weeks
36
Q

Features of chondrodysplasia of Norwegian Elkhounds?

A
  • Autosomal recessive
  • As with other forms of chondrodysp -> disproportionate dwarfism
  • FRONT LIMBS > HINDLIMBS
  • ALSO EFFECTS AXIAL SKELETON

Rx:

Similar long bone changes as per alaskan malamutes

=> forelimb curvature by 5 weeks

Spinal changes: Lipping and pleating of ventral vert body, delayed union of endplates

Costochondral junctions flared and cupped

Skull UNAFFECTED

37
Q

Features of osteochondrodysplasi of Scottish Folds?

A
  • Simple autosomal dominant
  • WITH FOLDING OF THE PINNA!
  • CS: Short, difficulty supporting weight, gait abnormalities, thick tail base
  • Rx: Evident by. 7weeks

Metaphyses of metatarsals / carpals distorted and physes widened

May effect phalanges too

Punctate lucenceis in carpal and tarsal bones

Caudal vert reduced in length

DJD -> Ankylosis of carpal or tarsal joints

38
Q

Features of Ocular chondrodysplasia of Labs?

A
  • Autosomal recessive
  • Typical skeletal changes + OCULAR MANIFESTATIONS: cataracts, retinal dysplasia, retinal detachment

Rx:

  • Long bone shortening, specifically: Ulna and radius
  • Delayed growth of anconeal and coronoid processes of ulna, and medial epicondyle of humerus
  • Reduced cortical opacity / thickness
  • Retained cartilage core (distal ulna)
  • Flaring of ulnar metaphysis, widening of growth plate
  • Asynchronous Ulna / Radial growth -> Radius Curvus
  • Cuboidal bones and epiphyses misshapen and larger than normal
  • Ribs wider than normal -> flaring at costochondral junction
  • Hip dysplasia common
  • SKULL AND SPINE SPARED
39
Q

What are the two different forms of hereditary rickets?

A

Type 1: deficiency of enzyme that converts to active form

Type 2: Anomaly of receptor in target organ

40
Q

Pathophys of Rickets?

A
  • HYPOVITAMINOSIS D
  • Inherited or nutritional deficiency

=> Carnivores derive from diet only (not in skin)

  • Insufficient GI absorption of Ca and Phos
  • Can lead to secondary hyperparaT as due to lack of Ca -> mobilisation from skeleton
  • CS: Hypocalcaemia, alopecia, lameness (meyaphyseal thickening, bowing / angular limb)
41
Q

Rx features of rickets?

A
  • Widening / flaring of physes
  • Cuppining of adjacent epiphyses and metaphyses
  • Flared osteochondral junctions of ribs => Rachitic rosary
  • Diffuse osteopaenia, thin cortices
  • FOLDING FRACTURES
42
Q

Pathophys of hypertrophic osteodystrophy?

A
  • Large breeds, young (2-7mo)
  • Boxers, G.Danes, Irish setters, Weimaraners…
  • Unknown cause: oversupplementation minerals, hypovit C, supparative inflamm without infectious agent, distemper
  • CS: pyrexia, d+, footpadd hyperkeratosis, leukocytosis, anaemia, pneumonia…
  • Bilaterally symmetric bone lesions, typically distal radius / ulna/ tibia

=> may effect chostocondral junctions, metacarp/tars, CRANIOMANDIBULAR (?link with CMO)

  • Usually self limiting, although -> possible premature physeal closure and deformity thereafter
43
Q

Rx hypertrophic osteodystrophy

A
  • Double physis sign: lucent zone in metaphysis
  • Sclerotic metaphyseal margin - collapse of trabecular bone
  • Irregular periosteal new bone around metaphysis
  • Soft tissue swelling
  • Widening / concavity and increased opacity of distal rib ends

=> AGGRESSIVE, cannot distinuish from osteomyelitis. Consider follow up + cultures if not improving

44
Q

Features of multiple cartilagenous exostosis?

A
  • Benign proliferative disease (although malig transformation reported)
  • Thought to be hereditary
  • ANY BONE THAT UNDERGOES ENDOCHONDRAL OSSIFICATION
  • OFTEN MULTIPLE BONES
  • Usually stop growing once mature, although in cats seems more progressive
  • Rx:

Amorpohoous irreegular rib masses

Long bone / vertebral masses more organised

+- absence of cortical bone

Bone may be deformed

45
Q

Features of retained cartilage core?

A
  • Distal ULNAR metaphyses of large dogs. Sometimes lateral femoral condyle
  • Disruption of endochondral ossification with retention of hypertrophied cartilage

=> Angular limb, or seen in normal dogs

Rx:

Cone shaped radiolucency in distal ulnar metaphysis / lateral femoral condyle

Sclerosis around

Angular limb

DJD

46
Q

At what age should the humeral condylar ossification centres fuse?

A

84 days

47
Q

In IOHC, what is the incidence of Y/T fractures, lateral and medial condylar fracture?

A

Y/T: 50%

Lateral: 35%

Medial: 15%

48
Q

Pathophys of IOHC

A
  • Spaniel breeds -> hertitable
  • Males
  • Condylar fractue with normal exercise
  • Bilateral disease freq.
  • Incomplete ossification -> fissure
49
Q

Rx IOHC

A
  • Vertical line midcondylar region
  • Craniocaudal or 15 deg oblique
  • Smooth periosteal reaction at caudal and lateral aspect
  • Path fracture

+- FRAGMENTED MEDIAL CORONOID !

50
Q

Features of flexor enthesopathy / medial epicondylitis

A
  • enthesopathy of flexor tendons -. FLEXOR CARPI ULNARIS
  • Close association with ulnar nerve
  • CS: none, pain on pronation, chronic mild lameness
  • Only evidence of inflammation in acute phase
  • Seen +- elbow dysplasia

Rx:

Osseus body adjacent to medial jumeral epicondyle, spur of new bone extending caudally

DJD

+- Elbow dysplasia

51
Q

What is the prevalence of flexor enthesopathy as a primary disease and concomitantly with elbow dysplasia?

A

Primary: 6%

ED: 34%

THRALL - Thom (40 decks)

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