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Large Animal Surgery > Large Animal Surgery Exam I > Flashcards

Large Animal Surgery Exam I Flashcards

1
Q

Best tool for diagnosis tendonitis

A

Ultrasound

Use 7.5-12mHz linear transducer

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2
Q

Consists of Curasalt/20% hypertonic saline on kerlix. Used for exudative or necrotic wounds. Change every 24-48 hours and switch dressing when necrotic tissue/infection resolves

A

Hypertonic saline dressing

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3
Q

Nerve block for low 4 point block. Blocks between MCIII and MC II above the fetlock and between Suspensory ligament DDF tendons. Needle placed in two spots.

A

Lat/Med palmar nerves- between SL and DDF. DF tendon sheath across back of fetlock is goal. Being blocked by proximal and palmar needles.

Lat/Med palmar metacarpal nerves- blocks distal to button of splint (Distal and Dorsal)

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4
Q

Minimum stall rest for fracture thats fasted

A

12 weeks

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5
Q

If less than 1/3rd of eyelid margin is missing close using

A

Direct apposition

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6
Q

Phase of wound healing with hemostasis and fibrin deposition, then inflammation with activated platelets and other white blood cells

A

Inflammation/Lag Phase

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7
Q

Healing with granulation tissue, would contracture and epithelialization

A

Second intention healing

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8
Q

Increases support in the heel and leg. Used to help hold heel together and stop excessive movement.

A

Bar shoe

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9
Q
A

Plain emasculator

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10
Q

Used for radial and tibial fracture stabilization, and gastroc rupture in farm animals. Large ring placed around axilla or groin and two rods extend down. Rods attach to metal foot plate and limb is in cast. Maintains limb in extension

A

Thomas schroeder splint

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11
Q

Type of skin graft that is completely separated form blood supply.

A

Free graft (Island grafts, sheet graft)

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12
Q

In the horse an inguinal cryptochid is most common on the ____ side

A

Right

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13
Q

Olecranon fracture stabilization consists of

A

Stack bandage with palmar splint, extend from heels to top of elbow

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14
Q

How long is a flexion test held for on a forelimb and hindlimb?

A

30 sec

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15
Q

When placing bandage place ____ layer without tension and always

A

Primary, always push flexor tendons medially (right limb-clockwise, left limb- counterclockwise)

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16
Q

Modality of choice for imaging bone. Used with radiographs

A

CT

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17
Q

This shit?

A

Fibrotic myopathy

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18
Q

Blocked below carpus in the groove betweent the suspensory and DDF. 4 needles total, numb from carpus down

A

High 4 point block

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19
Q

Bandage sutured over a wound or incision site. Create suture loops with umbilical tape to hold down

A

Stent bandage

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20
Q

Starts immediately after wounding. Need wound contraction to assist which begins 2nd week of injury.

A

Epithelialization

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21
Q
A

Reimer emasulator

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22
Q

Immediate wound closure. Clean and clean contaminated wounds

A

Primary closure (healing)

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23
Q

Histology of retained testes contains

A

Atrophic seminiferous tubules

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24
Q

Castrated horses will still be fertile for

A

Up to three weeks

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25
Q

Used to decrease edema, usually use Nitrofurazone ointment, DMSO, and Epsom salts. Use saran wrap to support bandage. Remove and wash limb at least daily

A

Sweat bandage

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26
Q

If going well change a cast

A

6 weeks in adults and 7-14 days in neonate, if swelling when 1st placed then change at 3-5 days

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27
Q

Most common tears within the synovial cavity on which tendon

A

DDF in forelimb and Manica flexoria in hindlimb

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28
Q

Paralysis of the suprascapular nerve caused by trauma

A

Sweeny

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29
Q

Grade III lameness

A

Consistently observable at a trot under all circumstances

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30
Q

Treatment for thrush

A

Removal of all loose horn, caustic agents like copper sulfate

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31
Q

Cryosurgery causes tissue destruction by

A

Direct cellular damage and/or anorexia to the microvasculature, this causes cellular dehydration causing changes to macromolecules, lipids, and pH and formation of intracellular ice crystals. Also causes cell membrane damage and thermal shock

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32
Q

Tendon consists of

A

70% water, 30% collagen and shit (type I collagen)

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33
Q

Most important for survival of a free graft

A

Prep the recipient site. Topical antibiotics 24-48hr before graft, and granulation tissue flush with the skin

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34
Q

Used in horses with navicular. Extends beyond the heel.

A

Egg bar shoe

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35
Q

Only modality providing real time evaluation of both soft tissue and some bone

A

Ultrasouns

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36
Q

Clinical parameters of OA

A

Effusion, Decreased viscosity of synovial fluid, Increased TP

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37
Q

Surrounds the tendon but is not in a sheath

A

Paratendon

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38
Q

Fractures distal to the fetlock require what kind of support

A

Dorsal splint

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39
Q

Used in post surgical lavage. Contains HA, Chondroition sulfate, and N-acetyl D-glucosamine.

A

Polygon

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40
Q

In wound healing initiated by decreased O2 tension, high lactate, and low pH in the wound

A

Angiogenesis

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41
Q

Abnormal keratinization in response to chronic injury. Signs include lameness, fistulous tract at coronary band and deviation at the white line

A

Keratoma

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42
Q

Nerve block for Abaxial (basi-sesamoid). Anesthesizes foot, P2, distal SDF and DDF and annular ligaments

A

Palmar digital

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43
Q
A

White modified emasculator

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44
Q

Dressing using Kerlix AMD (active ingredient is PHMB), microbes unable to become resistant, change every 3-7 days or sooner.

A

Antimicrobial dressing

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45
Q

Grade IV lameness

A

Obvious lameness with marked head nod, hitching, and shortened stride

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46
Q

Tendon laceration locations in forlimb and hindlimb

A

Forelimb: Severance between fetlock and carpus

Hindlimb: Severance below hock

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47
Q

Closure greater than 5 days after injury. Contaminated and infected wounds

A

Secondary closure

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48
Q

What is the appropriate hoof pastern axis for front and back limbs

A

Front-50o

Back -55o

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49
Q

Removal of the ductus deferents for male infertility

A

Vasectomy

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50
Q

Part of the tendon that contains intrinsic blood supply, nerves, and growth factors

A

Endotendon

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51
Q

Inexpensive cast material but no longer practical. Takes 24 hours to set and messy

A

Plaster of Paris

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52
Q

Not used for diagnostics of lameness. Lasts 5-6 hours and can be used for shoeing and therapeutics

A

0.5% Bupivacaine

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53
Q
A

Serra Emasculator

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54
Q

True or false, Double ligate during an open castration

A

False. Increases risk of infection

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55
Q

Cast application steps

A

Drill hole in toe of hoof wall- pass Gigli wire Stockinette 2.5x the length of cast Extra padding around proximal aspect and coronary band No finger prints of wrinkles Overlap cast padding and tape 50% Elastikon on top

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56
Q

Sudden and involuntary exaggerasted flexion of one or both hind limbs. Cause unknown

A

Stringhalt

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57
Q

Mechanism unknown. Inhibits degenerative enzymes and counteracts effects of IL-1 and reduction of synovial effusion.

A

Polysulfated Glycosaminoglycans (PSGAGs)

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58
Q

Tendons most prone to injury

A

SDF and Suspensory ligament

Due to load during heel strike

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59
Q

Where does the hoof grow from

A

Perioplic corium

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60
Q

Examples of non entry teaser surgery

A

Penis and prepuce deviation

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61
Q

Where does distal limb bandages extend to

A

Below the carpus/tarsus and below the coronary band

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62
Q
A

White emasculator

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63
Q

Used on full limb for large wounds, cellulitis, swelling, and fracture stabilization. Use two layers of secondary cotton.

A

Stack bandage

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64
Q

The trot is a

A

2 beat diaganol gate

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65
Q

Objectively detects and quantifies body movement irrgularity. Uses wireless tablets and shit. Data transmitted to tablet

A

Equinosis Q

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66
Q

Allows for stretch of tendon. Lost when load is applied

A

Crimp pattern

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67
Q

Graft failure happens from

A

Hemorrhage, motion, and infection

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68
Q

Unbranched non sulfated GAG that comes from type B synoviocytes. Provides viscoelasticity, boundary lubrication, scavages free radicals, and decreased aggrecan degeneration. Can be condroprotective IA and provides analgesia

A

Sodium hyaluronate/Hyaluronan/Hyaluronic acid/HA

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69
Q

Shoes used for angular limb deformaties

A

Dalmer shoes

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70
Q

Skin graft harvested under mane or abdomen. Recipient holds are made smaller than the graft and made first to allow hemostasis

A

Punch graft

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71
Q

Inserts on P3

A

DDF

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72
Q

In horses abdominal cryptochrid is most common on the ____ side

A

Left

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73
Q

Nerve block for palmar digital block. Approach in groove between flexors and ergot. Effect in 5 minutes

A

Palmar digital nerve

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74
Q

Indication for castration in horses

A

Behavior change. 1-1 1/2 years

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75
Q

Indication for Burdizzo emasculation

A

Teat amputation, Tail docking, Bloodless castration

76
Q

Spavin test

A

Flexion test on proximal hind limb. Hold in flexion for 90 seconds. Not hock specific

77
Q
A

Serra Modified emasculator

78
Q

Phase of healing initiated by macrophage release of tissue growth factors, then angiogenesis, collagen deposition, and wound contraction

A

Proliferative Phase

79
Q

Removal of the tail of the epididymis

A

Epididymectomy

80
Q

Produces spermatozoa

81
Q

Complications of immobilization with casting

A

Articulate cartilage degeneration, Loss of bone density, Decreased muscle strength

82
Q

Healing 2-5 days after injury and before granulation tissue production. Contaminated wounds and questionable viability, edema/tension

A

Delayed primary closure

83
Q

Layer of synovial membrane with blood supply and innervation

A

Subintimal

84
Q

Radial fracture stabilization consists of

A

Robert jones bandage, palmar splint from heel to elbow, and lateral splint from hoof to withers

85
Q

Grade II lameness

A

Difficult to observe in straight line but consistently apparent under circling, hard surface, etc

86
Q

Grand V lameness

A

Minimal weight bearing or not at all, inability to move

87
Q

Complication from castration with fluid from vaginal tunic creating a swelling. Remove vaginal tunic to fix.

88
Q

Current recommended treatment with HA

A

20mg/joint for lameness. Use 20mg weekly for 3 weeks.

89
Q

Why is it important to incorporate the hoof into the cast for large animas

A

To ensure maximum diversion of weight from the limb and ground forces away from the limb to the cast

90
Q

Lots of layers of cotton used, expensive, heavy. Preserves blood supply and supports fractures. Should be 2x the size of the limb. Can incorporate a splint to add rigidity

A

Robert Jones Bandage

91
Q

Phase of wound healing that begins 2nd week and can last 1-2 years. Final scar is weaker than original.

A

Remodeling phase

92
Q

Complication of castration. Can be caused by strep. Correct with surgical removal

A

Scirrhous cord

93
Q

Shock absorber. More deformable than cortical bone. Sclerosis contributes to OA progression

A

Subchondral bone

94
Q

Indication for castration in farm animals

A

Increase growth rate, castrate at 10-14 days and there is less complications, less pain, and better meat in the boar.

95
Q

Fractures proximal to carpus/tarsus require what kind of support

A

Robert jones with extended lateral splint

96
Q

Approach to coffin joint arthrocentesis

A

Dorsal parallel just proximal to coronary band, dorsal perpendicular and lateral.

97
Q

Hormonal assay to test for retained testical

A

Human chorionic gonadotropin increases synthesis and secretion of testosterone.

Test testosterone. If >100pg/mL after 2 hours of injection then cryptorchid

98
Q

Part of tendon that is contiguous with endotenon, surrounds tendon

99
Q

Originates from proximal MC/MT III, branches and inserts on sesamoid bones

A

Suspensory ligament

100
Q

Minimum amount of xray views for lameness evaluation

A

4 (2 oblique, 1 lateral, 1 DP)

101
Q

Proteoglycan in articular cartilage. Form aggregates with HA and protects collagens from damage

102
Q

How does proud flesh develop

A

Inefficient and protracted inflammatory phase resulting in excessive proliferative phase. Fibroblasts maintain synthetic role and dont differentiate and PMNs stay higher for longer.

103
Q

Which two bandage layers are secured with conforming rolled gauze?

A

Primary and secondary layers Just primary secured with regular rolled gauze

104
Q

Necrosis of the collateral cartilage. Caused by subcoronary abscess or interfering. Signs include lameness, localized pain, suppurative sinus tracts

105
Q

Which shoe facilitates break over

A

Rocker toe

106
Q

Fractures distal to carpus/tarsus require what kind of support

A

Robert jones with caudal/plantar and lateral splint

107
Q

Three phases of wound healing

A

Inflammation/Lag, Proliferative, Remodeling

108
Q

Which wounds heal faster body or limbs?

A

Body (1mm/day)

109
Q

Type of skin graft that remains connected to the donor site

A

Pedicle graft

110
Q
A

Hausmann emasculator

111
Q

Resin impregnated fiberglass type cast material. Light weight. Fully sets in 5-7 minutes and easy to apply.

A

Fiberglass cast material

112
Q

Collagen production begins ______ after wounding and consists initially of mostly type III collagen

113
Q

Used to support the frog and in horses with laminitis and founder

A

Heart bar shoe

114
Q

Instrument used for blunt castration

A

Pincer emasculatome

115
Q

Whats up here?

A

Peroneus tertius rupture.

116
Q

Approach to fetlock joint arthrocentesis

A

Collateral sesamoidean ligament approach. Support joint in flexed position, palpate palmar M3, dorsal border of suspensory ligament, distal border of MC4. Proximal lateral sesamoid bone

117
Q

Divides at P1 and inserts on P2

118
Q

Does up regulation of GAGs and collagen synthesis. Decreases inflammatory mediators and improves synovial membrane. Can cause infection.

119
Q

Single most important factor in success of wound repair

A

Debridement

120
Q

Blocks origin of the suspensory ligament. Weighbearing and done in mediolateral direction

A

Lateral palmar nerve block

121
Q

Layer of synovial membrane with synoviocytes, macrophage type A and Fibroblast type B

122
Q

Can be diagnostic and therapeutic

A

Arthroscopy

123
Q

Corrective surgery for navicular disease, fracture, or chronic hoof pain

A

Palmar digital neurectomy

124
Q

Can be combined with HA when given IA, chondroprotective and potent anti-inflammatory

A

Triamcinolone

125
Q

If greater than 1/3rd of the eyelid margin is missing close

A

Must use grafting technique to achieve functional closure

126
Q

Treatments for proud flesh

A

Resection and bandage, delayed secondary closure, skin grafts

127
Q

When treating a stifle with injections best to

A

Use lateral approach and treat all compartments

128
Q

Signs of graft acceptance

A

Adherence, Serum imbibition, revascularization (48hr- ino, 4-5 days neo) and organization

129
Q

Grade 1 lameness

A

Difficult to observe, incosistent

130
Q

Used to define the health of a joint. Creates the joint surface and made of specialized matrix. Composed of PGs, HA and Collagens

A

Articular cartilage

131
Q

Salter Harris fractures easy to reduce in foals

A

Type 1 and 2

132
Q

Used if lameness cannot be determined or localized by not detectable on xray or u/s. Uses technetium-99 and gamma radiation

A

Nuclear scintigraphy

133
Q

Corrective surgery for stringhalt

A

Lateral digital extensor tenotomy

134
Q

Makes the non collagenous matrix of tendons

135
Q

Largest compartment in the stifle, most likely to communicate. Cranial and lateral approach

A

Femoropatellar joint

136
Q

Back bone of cartilaginous matrix. Creates polarized charge

A

Hyaluronic acid

137
Q

What the what is this

A

Upward fixated patella

138
Q

Contains sertoli cells (nourish spermatozoa) and Leydig cells (androgens)

A

Epididymidis

139
Q

Gross appearance of fibroblastic sarcoid can resemble

A

Exuberant granulation tissue, fibrosarcoma, cutaneous habronemiasis, SCC, melanoma, and fibroma

140
Q

Histologically sarcoids resemble

A

Fibrosarcomas, fibromas, schwannomas, neurofibrosarcomas.

141
Q

These type of sarcoids appear horny, dry and wartlike and are usually 6cm or less in diameter

A

Verrucous sarcoids

142
Q

These type of sarcoids are large and resemble granulation tissue grossly

A

Fibroblastic sarcoids

143
Q

The distinguishing histological features of equine sarcoids are

A

Hyperplastic and hyperjeratotic epidermis

Marked rete-peg formation

Dermal component of irregular arranged fibroblasts and bundle formation

No invasion of muscle

144
Q

Equine sarcoids are caused by

A

Bovine Papilloma virus

145
Q

Differential diagnosis for verrucous sarcoids

A

Dermatophytosis

146
Q

Chemotherapy agent proven to be 96% successful at improving sarcoid treatment

147
Q

Non surgical treatment for tendonitis

A

Cold therapy- 20 min hydrotherapy

Compression and coaptation- reduces edema

NSAIDs- Bute

148
Q

Non surgical treatment for tendonitis, Performed under u/s guidance, use PRP, stem cells, and bone marrow

A

Intralesional Injections

149
Q

Used as intralesional injection for tendonitis. Contains growth factors, mesenchymal stem cell growth, and ACP

A

Platelet rich plasma

150
Q

Intralesional injection for tendonitis. Thought to heal with less fibrosis and more normal tissue. Reduces inflammation and regenerates tissue

A

Stem cell therapy.

Bone marrow derived. 3 week turnaround time from lab. Taken from tubercoxae or sternum with Jamshidi

Fat derived- get in 48 hours or same day inhouse. Allogeneic.

Mixed with PRP is best if can be afforded.

151
Q

Treatment for tendonitis. Increases vascularization and growth factors in the area. Decreases pain and may reduce convalescent time. Goal is a more organized scar at end of healing

A

Shock wave therapy

152
Q

Most important component of tendonitis treatment

A

Rehabilitation

153
Q

Most common cause of tendonitis

A

Strain induced (overstrain) from repetative microtrauma. Phase of molecular degeneration progressively weakens the tendon

154
Q

Cause of tendonitis caused by over reaching, wire, kicking, and usually while the tendon is under load

A

Percutaneous trauma.

Most serious with trauma to palmar aspect of pastern or metacarpus. Extensor tendon lacerations are bad.

155
Q

Pathogenesis of septic arthritis

A

Decreased HA synthesis, Loss of PC, joint effusion, Pain, compromise to synovial blood flow.

156
Q

Type of septic arthritis in foal. Occurs in <1 week of age. Multiple joints common- Larger usually (Stifle or tibiotarsal).

Causes acute severe lameness and effusion

157
Q

Type of foal septic arthritis. Occurs in bone adjacent to articular cartilage. Expanding epiphysis. Happens in weeks old foals. History of disease. Multiple joints but usually femur, talus, tibia, radius.

Mild intermittent lameness, fever, then acute lameness/effusion

158
Q

Type of septic foal arthritis. Occurs in physis of long bones. Age is weeks to months. Seemingly healthy. Occurs in one site, usually distal physis of MC III or MT III, radius, tibia.

Premonitory lameness then acute sever lameness and swelling. Periarticular swelling without effusion

A

P type

Do not debride. Diagnose with radiographs and aspirate

159
Q

Septic arthritis in adults is usually

A

Iatrogenic. and caused by Staphylococcus

An open joint is an infected joint

160
Q

Clinical signs of septic arthritis in adults

A

No bone involvement usually. Acute severe lameness. Synovial effusion. Per-articular heat and swelling. Maybe a fever

161
Q

Gold standard for diagnosis of septic arthritis

A

Microbiology of joint fluid

162
Q

Abnormal synovial cytology results- might be septic

A

Serosanguinous

Turbid

Thousands of WBC, 90% neutrophils

TP- >3.5 g/dL

163
Q

To be successful in treating septic arthrits

A

Have rapid recognition of disease and immediate aggressive treatment

164
Q

Mainstay of treatment for septic arthritis

A

Lavage

Arthroscopic is ideal, but through needle can be fine. Place needle in all compartments

165
Q

Collagen is synthesized as

A

Procollagen molecules with an alpha helical chain and amino terminal and carboxyterminal extensions

166
Q

Function of tendon unit is dependent upon

A

Crosslinking and collagen fibril organization

Crosslinking is dependent on COMP

167
Q

Tenocytes

Spindle shaped nuclei, inactive forms of type II

A

Type I cells

168
Q

Tenocytes

Oval nuclei, abundant in young growing tendon

169
Q

Tenocyte

Round nuclei. More like chondrocytes better for areas of compression.

A

Type III cells

170
Q

Seperates fascicles and carries blood supply and nerves as well as mesenchymal stem cells in the tendon. Has higher levels of growth factors like TGF beta

171
Q

How do tendons get their blood supply

A

From muscular origin and osseous insertion and from accessory ligaments, paratenon, and mesotenon

172
Q

Part of the tendon where changes with age and exercise can be seen long term

A

Non collagenous components (GAG and COMP)

173
Q

First phase of tendonopathy

A

Degeneration

174
Q

Characteristics of SDF tendon injury

A

Usually centerally location (core lesion) and most severe just below mid metacarpal

175
Q

Characteristics of check ligament desmitis

A

Either isolated or in combo with injury to SDF. Usually mild lameness and swelling restricted to proximal 1/2 of the palmar metacarpus. Most common in ponies

176
Q

Characteristics of suspensory ligament tendon injury

A

Can fail at any site. Usally injured at proximal region near metacarpus/tarsus. Joint effusion and lameness

177
Q

Characteristics of DDF tendon injury

A

Usually injured in the digital sheath. Can be injured in substance of tendon or on medial or lateral borders. Difficult to see on u/s if doesnt extend out of sheath

178
Q

Charactersitcs of extensor injury

A

May stumble on the dorsal aspect of the MCT/MTP

179
Q

When can you do intralesional injections for tendonitis

A

Wait 3 days after injury. Usually 7-45 days.

180
Q

When is annular ligament desmotomy indicated

A

If annular ligament is impeding the normal gliding function of the flexor tendons

181
Q

What is this shit

A

Kimzey splint

182
Q

What is this

A

Cast spreaders

183
Q

What is this

A

Thomas schroeder splint

184
Q

Surgical technique used here for melanoma

A

Sliding flap technique

185
Q

What are these triangles called in the sliding flap technique

A

Burows triangles

186
Q

When using sliding flap dont

A

Undermine > 4 cm (2 inches)

187
Q

In sliding flaps length of burows triangles should be

A

1/2 the length of the excised area

Large Animal Surgery (2 decks)

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