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VM 611 > Musculoskeletal Midterm > Flashcards

Musculoskeletal Midterm Flashcards

1
Q

What are examples of group 2, semicritical, fractures?

A

articular fractures, physeal fxs, joint luxation

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2
Q

What time frame should group 2 fractures be treated?

A

2-5 days

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3
Q

What type of open fracture is when skin is penetrated from the inside out by sharp bone fragment?

A

type 1

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4
Q

What type of open fracture is when skin wound larger than 1 cm?

A

type 2

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5
Q

What type of open fracture is when bone is fragmented from high energy trauma?

A

type 3

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6
Q

What are the different subclassifications of type 3 open fractures?

A

a - no major reconstruction
b - reconstruction required
c - major arterial injury

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7
Q

What type of open fracture requires amputation?

A

type 4

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8
Q

What classification scheme is used for physeal fractures?

A 
salter-harris scheme
type 1 - just physis
type 2 - physis and metaphysis
type 3 - physis, epiphysis, articular
type 4 - physis, meta, epi and articular
type 5 - crushing injury
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9
Q

Term for fracture with three or more fragments whose lines interconnect.

A

comminuted fx

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10
Q

Term for fracture where 3 fragments do not interconnect

A

segmental fx

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11
Q

Term for insertion point of a tendon or ligament is fractured and distracted from rest of bone.

A

avulsion fx

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12
Q

Term for fracture line perpendicular to the long axis of the bone

A

transverse

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13
Q

Term for fracture line is at angle to the long axis of the bone

A

oblique

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14
Q

What are the 3 postoperative assessments of fracture repair?

A

alignment
apparatus
apposition - how pieces fit
activity - bone healing

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15
Q

Whats the difference between indirect bone healing and direct bone healing?

A

indirect - cartilage precursor

direct - no cartilage

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16
Q

What environment does indirect bone healing occur?

A

unstable mechanical environment (strain)

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17
Q

Does indirect bone healing increase or decrease fracture gap?

A

increases

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18
Q

What are the two types of direct bone healing?

A

contact - simulatneous union and remodeling

gap healing - small gaps fill with fibrous bone, haversian remodeling

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19
Q

How does direct bone healing look like on an xray?

A

fracture line increases in density, no bridging or callus

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20
Q

When does intramembranous bone healing occur?

A

strain of less than 5%, bridging of comminuted bone fragments occur, smaller callus

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21
Q

What does creatinine kinase measure?

A

myonecrosis, peaks at 6-12 hours

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22
Q

What does aspartate aminotransferase (AST) measure?

A

cell damage, not specific - skeletal, cardiac muscle, liver, RBC

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23
Q

Where is the place to take muscle biopsies for horses for most diseases?

A

semimembranosis (type 2 fibers)

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24
Q

What muscle should a biopsy be taken for equine motor neuron disease? (TQ)

A

sacrocaudalis medialis dorsalis (type 1 fibers)

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25
Q

What is the most common myopathy in horses?

A

exertional myopathies

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26
Q

What causes HYPP on cellular level?

A

failure in Na channel in muscle

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27
Q

What is the tx for mild HYPP?

A

mild exercise, feeding grain or corn syrup (insulin)

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28
Q

What is the Tx for severe HYPP?

A

calcium gluconate, IV dextrose, sodium bicarbonate

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29
Q

What breeds get recurrent exertional rhabdomyolysis?

A

thoroughbreds, standardbreds, arabians

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30
Q

What is the pathogenesis of RER?

A

defect in intracellular calcium regulation ->necrotic muscle

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31
Q

What are CS of RER?

A

tying up, pigmenturia, increased CK

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32
Q

How is RER treated?

A

prevent renal damage, correct acid-base, alleviate anxiety and muscle pain

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33
Q

What breeds get PSSM?

A

quarter horses and like-breeds

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34
Q

What is the pathology of PSSM?

A

increased muscle glycogen, enhanced insulin sensitivity

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35
Q

How is PSSM diagnosed?

A

serum CK persistently increased, submaximal exercise challenge test

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36
Q

How should PSSM be managed?

A

increase fat in diet, regular exercise

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37
Q

What 3 molecules are responsible for matrix breakdown in osteoarthritis?

A

aggrecanases, cathepsins, free O radicals

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38
Q

What cells produce the mediators that progress osteoarthritis?

A

chondrocytes, synovial cells, subchondral osteoblasts

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39
Q

What are the 3 differential diagnosis for aggressive bone disease?

A

osteosarcoma, osteomyelitis, blasto

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40
Q

Where are common areas of OCD in front limb?

A

shoulder - caudal humeral head
hock - medial trochlear ridge of talus
elbow - medial humeral condyle

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41
Q

What is OCD?

A

defect in cartilage

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42
Q

What are common areas of OCD in hind limb?

A

stifle - lateral femoral condyle

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43
Q

What causes metaphyseal osteopathy/hypertrophic osteodystrophy?

A

failure of endochondral ossification (young large breed dogs)

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44
Q

What is seen with metaphyseal osteopathy on radiographs?

A

double physis, periosteal proliferation, widened metaphyseal region

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45
Q

What will be seen on radiographs with panosteitis?

A

increased medullary opacity near nutrient foramen

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46
Q

What is osteochondromatosis?

A

benign proliferation of bone and cartilage

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47
Q

What age and species is osteochondromatosis seen?

A

older cats

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48
Q

What age and types of dogs do you see femoral head and neck necrosis?

A

small breed dogs

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49
Q

What are the radiographic signs of DJD?

A

narrowing joint space, subchondral bone lysis, osteophytes

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50
Q

What is the signalment for patients with masticatory muscle myosiits?

A

young to middle aged, german shepherds, retrievers, doberman

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51
Q

What antibodies are involved in masticatory muscle myositis?

A

type 2M fiber antibodies

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52
Q

What is the tx for masticatory muscle myositis?

A

immunosuppressive, azathioprine

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53
Q

What is the signalment for patients with extraoculuar myositis?

A

young large breed dogs

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54
Q

What is polymyositis?

A

diffuse inflammation of skeletal muscle, immune mediated

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55
Q

What is breed predilection for polymyositis?

A

large breed adult dogs - GSD

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56
Q

What is the treatment for extraocular myositis?

A

corticosteroids, will resolve

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57
Q

What are the CS of feline idiopathic polymyositis?

A

acute onset weakness, cervical ventroflexion

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58
Q

What is a primary cause of feline hypokalemic myopathy?

A

renal disease

also inherited in burmese cats

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59
Q

What is the pathogenesis of feline hypokalemic myopathy?

A

GI loss
translocation from EC to IC (alkalemia, insulin)
urinary loss (renal dz, diuretics)
insufficient intake (anorexia)

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60
Q

How is muscular dystrophy inherited?

A

x-linked recessive trait, variable expression

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61
Q

What breeds of dogs and cats get muscular dystrophy?

A

dogs - golden retriever, GSP, rottie

cats - DSH, siamese, maine coone

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62
Q

What are CS of muscular dystrophy?

A

weakness, muscle loss in first few weeks of age

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63
Q

What breed gets centronuclear myopathy?

A

labs

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64
Q

How is centronuclear myopathy inherited?

A

autosomal recessive (males and females affected)

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65
Q

What 2 inherited myopathies do labs get?

A

centronuclear myopathy, lab episodic/exercise induced collapse

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66
Q

What are CS of exercised induced collapse in labs?

A

youung adult, paresis, ataxia, recover within 30 mins

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67
Q

What dog breed gets fibrotic myopathy?

A

GSDs

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68
Q

What are CS of myotonia?

A

onset 2-6 months, muscle stiffness, neuro normal

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69
Q

What breed mostly gets myotonia?

A

mini schnauzer

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70
Q

What is the hallmark of osteoarthritis?

A

degeneration of cartilage

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71
Q

What are the drugs in the “disease modifying” group of anti arthritic drugs?

A

hyaluronic acid
PSGAGs - chondroiton sulfate/glucosamine
IRAPs - stem cells

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72
Q

What topical NSAID targets cox 2 for osteoarthritis?

A

diclofinec sodium

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73
Q

What is the MOA of corticosteroids?

A

inhibit phospholipase A

74
Q

What is the MOA of NSAIDs?

A

inhibit Cox 1 and 2 (want to inhibit cox 2 mostly)

75
Q

What is the best way to deliver corticosteroids in osteoarthritis?

A

intra-articularly

76
Q

How do corticosteroids produce chondroprotective effects?

A

inhibit MMPs

77
Q

What is the half life and target of hyaloronic acid?

A

12-24 hours

synovial lining

78
Q

What are the MOAs of PSGAGs with osteoarthritis?

A

inhibit degradation enzymes
inhibit PGE2 synthesis
stimulate matrix synthesis

79
Q

What are the side effects of PSGAGs?

A

potentiation of infectious arthritis

hemarthrosis

80
Q

How is IRAP made? (interleukin receptor antagonist)

A

WBCs of patient and chromium sulfate beads makes them produce antiinflammatory cytokines

81
Q

What drug binds to bone surfaces and poisons osteoclasts as they resorb bone?

A

bisphosphanates

82
Q

What is the MOA of platelet rich plasma therapy in osteoarthritis?

A

lysing platelets releases anabolic growth factors, no clinical studies

83
Q

What are stem cells indicated for in osteoarthritis?

A

intraarticular soft tissue injuries but not cartilage damage

84
Q

What are CS of rickettsial disease involvment with arthritis?

A

polyarthritis, lymphadenopathy, thrombocytopenia

85
Q

What type of infectious arthritis spreads to other joints locally?

A

lyme arthritis

86
Q

What type of arthritis results from systemic inflammation?

A

reactive polyarthritis (immune complexes)

87
Q

What is the most common form of polyarthritis in dogs?

A

idiopathic polyarthritis (immune mediated)

88
Q

WHat joints are more severely affected in idiopathic polyarthritis?

A

distal joints (hock, carpus)

89
Q

What are CS of shar pei fever?

A

episodes of fever, swelling around hock, young dogs

90
Q

What may be seen with joint tap in hock fever in sharpeis?

A

amyloidosis

91
Q

What disease results in subcutaneous abscesses and causes polyarthritis in cats?

A

L form-associated arthritis

92
Q

What are the “erosive” forms of joint disease in SA?

A

L-form arthritis, greyhound arthritis, rheumatoid arthritis, feline chronic progressive polyarthritis

93
Q

What happens in the joints with rheumatoid arthritis?

A

is like idiopathic polyarthritis but joints destroyed over a few weeks

94
Q

What type of reduction is indicated in articular fractures?

A

open reduction

95
Q

What type of reduction is indicated in comminuted nonreducible diaphyseal fractures of long bones?

A 
open reduction or 
closed reduction (external fixator)
96
Q

What type of reduction is indicated in greenstick or nondisplaced fractures of long bones below elbow and stifle?

A

closed reduction

97
Q

Term for ability of the material to induce migration and differentiation of mesenchymal stem cells into osteoblasts via presence of transforming growth factor beta superfamily.

A

osteoinduction

98
Q

Term for the ability of cells to survive transplantation and serve as source of osteoblasts

A

osteogenesis

99
Q

Term for ability of the material to provide a scaffold for host bone invasion

A

osteoconduction

100
Q

Term for the surface bonding between graft and host bone

A

osteointegration

101
Q

Where can cancellous bone autografts be harvested on a patient?

A

proximal humerus, proximal tibia, ilial wing (metaphysis)

102
Q

Where can cortical bone autografts be harvested on a patient?

A

ribs, ilial wing, distal ulna and fibula

103
Q

What type of lameness may be indicated if a horse is “on a right line”?

A

suspect right forelimb lamness

104
Q

What type of lameness is indicated if the horse is “on the right shaft”?

A

left hindlimb lamness

105
Q

What are the factors that increase stiffness in an ESF?

A 
increasing pin diameter (up to 25% of bone diameter
pin number (2-4)
pin location closer to fracture
clamp 1 cm from skin
connecting bar size and number
106
Q

What are the 4 different types of ESFs?

A

Type 1a - unilateral, uniplanar
Type 1b - unilateral, biplanar
Type 2 - bilateral, uniplanar
Type 3 - bilateral, biplanar

107
Q

Is loop cerclage wire or twisted cerclage better for tension?

A

loop

108
Q

How does cerclage wire affect blood supply to long bone?

A

no effect if placed correctly, if loose, will disrupt periosteal blood supply

109
Q

WHat is the advantage to IM pins?

A

very resistant to bending forces

110
Q

What is the disadvantage to IM pins?

A

do not counteract rotational forces (smooth pin)

111
Q

What is the most commonly used IM pin?

A

steinmann pins, trocar point

112
Q

How should IM pins be placed in the tibia?

A

always normograde

113
Q

What bone should IM pins not be placed?

A

radius

114
Q

What fractures are good for interlocking nail IM pins?

A

comminuted diaphyseal fractures

115
Q

What is the maximum size of an ESF pin?

A

no larger than 25% of bone

116
Q

What is the maximum size of a bone screw?

A

no larger than 40% of bone

117
Q

What are the differences between cortical and cancellous screws?

A

cortical - more threads per inch

cancellous - larger outer diameter

118
Q

What is the advantage of using locking head screws?

A

head of screw has threads, locks into plate to provide stability

119
Q

How are positional screws placed different than compression screws?

A

compression screw must be perpendicular to fracture line
cis cortex must have gliding hole
trans cortex must have threaded hole

120
Q

What are the three types of bone plates?

A

compression
neutralization
bridging

121
Q

What type of bone plate is best for fracture lines that are transverse or short oblique no greater than 45 degrees?

A

compression plate

122
Q

What type of bone plate is best for reducible comminuted fractures and oblique fractures greater than 45 degrees?

A

neutralization plate

123
Q

What type of bone plate is best for fragmented diaphyseal fractures where reduction is not possible?

A

bridging plate

124
Q

What are characteristics of a dynamic compression plate?

A

oblong holes

125
Q

Where must screws be placed on a DCP to get compression? neutralization?

A

neutralization - centrally

eccentrically - compression (loaded)

126
Q

What are characteristics of bridging plate?

A

no holes in the middle, stronger

127
Q

What is a LC-DCP plate?

A

bottom surface of plate is scalloped to decrease periosteal blood supply disruption
can compress in either direction

128
Q

Term for horse foot is thrown outward in flight but lands inside the normal track.

A

paddling

129
Q

Term for horse foot swings inward in flight but often lands outside normal track. Can result in interference.

A

winging

130
Q

Term for horse feet are placed directly in front of one another, associated with base narrow/toe out conformation.

A

plaiting

131
Q

Term for horse food striking a limb with the opposite limb.

A

interfering

132
Q

Term for horse hitting the sole of the forefoot with toe of ipsilateral hindfoot

A

forging

133
Q

Term for hitting the heels of the forefoot with ipsilateral hindfoot

A

overreaching

134
Q

How long should forelimb flexion tests last? Which one is the most specific?

A

distal limb - 30 s
carpus - 60 s, most specific
shoulder - 60 s
Elbow - 60 s

135
Q

What does a wedge test do?

A

exacerbates problems in the foot

136
Q

What is blocked by palmar/planter digital nerve block? (medial and lateral PD nerves)

A

blocks heel, caudal 1/3 of foot

137
Q

What does a PD block with a ring block desensitize?

A

whole foot

138
Q

What does an abaxial sesamoid block desensitize?

A

foot and pastern

139
Q

What is desensitized by the low palmar/planter block?

A

fetlock

140
Q

What are the 3 main proposed hypothesis of pathogenesis of laminitis?

A
  1. blood flow alterations –> cell death
  2. BM breakdown by endogenous enzymes stimulated by toxin
  3. systemic inflammatory response leading to inflammation in lamellae
141
Q

What phase of laminitis is the period between first signs of lamness to rotation or sinking?

A

acute

142
Q

What phase of laminitis is mild lamness without mechanical failure?

A

subacute

143
Q

What are the different types of the chronic stage of laminitis?

A

early chronic - first several months
chronic active - recurrence after improvement
chronic stable - stable coffin bone with improvement in hoof

144
Q

What drug can be used as a free radical scavenger in laminitis cases?

A

dimethyl sulfoxide

145
Q

What is the duration of analgesics for lameness diagnostics?

A

lidocaine - 1.5-3 hrs
mepivicaine - 2-3 hrs (most used, less irritating)
bupivicaine - 3-6 hrs

146
Q

What are the landmarks for palmar or plantar digital nerve block?

A

distal pastern just proximal to collateral cartilages

147
Q

What nerves are blocked by abaxial sesamoid nerve block?

A

medial and lateral palmar/planter nerves

148
Q

What is blocked by the abaxial sesamoid nerve block?

A

entire digit and pastern +/- partial fetlock

149
Q

What nerves are blocked by low palmar/plantar block in a horse?

A

medial and lateral palmer nerves, and medial and lateral palmar metacarpal nerves

150
Q

What structures are blocked by low palmar block?

A

fetlock, pastern, digit

151
Q

What nerves are blocked by high palmar block?

A

same nerves as low palmar block –> medial and lateral plamer nerves, and medial and lateral palmar metacarpal nerves

152
Q

What nerves does the high palmar block?

A

entire metacarpus

153
Q

What does the median, ulnar, and musculocutaneous nerve block in a horse?

A

mid to distal antebrachium and carpus

154
Q

What structures does the peroneal and tibial nerve block in a horse?

A

distal crus, tarsus, and metatarsus

155
Q

What nerve block blocks the fetlock joint?

A

metacarpophalangeal/metatarsophalangeal joint block

156
Q

What 2 joints are blocked by the tibiotarsal joint block?

A

tibiotarsal and proximal intertarsal joints

157
Q

What radiographic technique is better for determining laxity in hip dysplasia patients?

A

PennHIP

158
Q

At what age is pubic symphysiodesis for hip dysplasia done?

A

12-20 weeks

159
Q

What surgical procedure can be performed for hip dysplasia if patients are too old for pubic symphysiodesis?

A

triple pelvic osteotomy

160
Q

What types of puncture wounds of the sole of the horse are most severe?

A

around the frog - emergency if involves synovial structure

161
Q

Term for deviation of limb medially.

A

varus

162
Q

What is the most common angular limb deformity in foals?

A

carpus valgus

163
Q

What breeds are susceptible to periarticular laxity angular deformities?

A

“windswept” standardbreds and drafts

164
Q

Which angular limb deformities is restricted exercise indicated?

A

DOCBs - delayed ossification of cuboidal bones

165
Q

What surgical technique is used for growth acceleration in angular limb deformities?

A

periosteal elevation - releave tension on concave aspect

166
Q

What surgical technique is used for growth retardation in angular limb deformities?

A

transphyseal bridging

167
Q

What is the time frame for periosteal elevation/stripping correction in the fetlock?

A

less than 4 weeks

168
Q

What is the time frame for periosteal stripping/elevation correction in the carpus?

A

less than 6 months

169
Q

What type of cranial cruciate ligament rupture results from acute trauma?

A

failure of tibial attachment site

170
Q

What is the most commonly performed surgery for cranial cruciate rupture?

A

lateral fabellar-tibial suture (extracapsular)

171
Q

What is the difference between osteotomies and extracapsular techniques in repairing a cranial cruciate rupture?

A

osteotomies change biomechanics of joint (affects cranial tibial thrust)

172
Q

What is an alternative to TPLO for immature patients to avoid cutting into physis?

A

tibial wedge ostectomy

173
Q

When do acquired flexural limb deformities most commonly appear in horses?

A

4 weeks to 4 months of age or as yearlings

174
Q

What nutritional factors are involved in acquired flexural deformities in horses?

A

excessive intake, abrupt change, mineral imbalance

175
Q

What drug can be given IV to younger foals as part of conservative treatment of flexural limb deformities?

A

oxytetracycline - dramatic response but doesnt last

176
Q

What is the surgical treatment for an angular limb deformity in the DIP(coffin) joint?

A

inferior check ligament desmotomy, DDFT tenotomy

177
Q

Where are DDFT tenotomy usually performed?

A

level of pastern or at mid-metacarpus (more proximal is easier but can get blemish)

178
Q

What is the sx tx for flexural limb deformities at the MCP joint?

A

superior check ligament desmotomy +/- ICL desmotomy

179
Q

What is the sx tx for flexural limb deformities at the carpal joint?

A

ulnaris lateralis, flexor carpi ulnaris tenotomy

180
Q

What should be avoided in flexor tendon laxity in foals?

A

no splinting or bandaging!!!!!

181
Q

What are CS of ruptured common digital extensor tendon in foals?

A

swelling in tendon sheath at dorsolateral carpus, buckled knees

VM 611 (16 decks)

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