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56 Cards in this Set

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List the 5 steps outlined for a complete and systematic orthopedic exam in the dog or cat.
S-Signalment, History, & PE
O-Observation of ambulation, grade & characterize gait
A-Awake patient ortho examination (localize areas of pain)
R-Restrained ortho exam (chemical restraint/general anesthesia)
R-Radiographic evaluation
Know the 3 historical aspects of the chief complaint vital to a complete patient history.
1. Manner of onset
2. Signs seen by owner
3. Duration of signs
Know the four grades characterizing a lameness
Grade I- barely perceptible
Grade II- noticeable lameness, but weightbearing most of the time
Grade III- only occasionally weightbearing, usually to catch balance
Grade IV- non-weightbearing lameness
Know the four listed aspects of the local examination of the affected limb in the specific orthopedic exam.
1. Careful palpation- don’t forget to inspect the skin, as well as bones, muscles & joints
2. Symmetric evaluation
3. Palpate all bones and joint in affect extremity- paw → up
4. Neurologic exam
Know the hallmark of a complete orthopedic exam (localize the lameness to a specific part of a specific limb).
Judged by the animals reaction on awake exam. Goal of exam, in order to establish differential.
Know the five listed purposes of the radiograph exam in a complete orthopedic exam.
-Dx localized lameness
-Confirm ortho exam Dx
-Make prognosis from radiograph of ortho disease
-R/O diseases considered in differential Dx
-Evaluate unrelated/ sign. problems that may influence the Tx of the orthopedic disease
List the 3 most common long bone tumors in the dog in the order of frequency of occurrence.
1. Osteosarcoma
2. Chondrosarcoma
3. Fibrosarcoma
List the breed size and two most common locations for long bone osteosarcomas.
Large and giant breed dogs tend to get osteosarcomas in the distal radius and proximal humerus (Away from the elbow, towards the knee)
Describe the general biologic behavior of long bone osteosarcomas in the dog
Osteosacromas in the dog are usually productive, more likely to metastasize (esp. to lungs)
Arise from the metaphyseal region, but don’t cross joints.
Describe the general biologic behavior of long bone osteosarcomas in the cat
Osteosacromas in the cat are usually lytic=more pathologic fractures, & less metastasis, amputation can cure.
Occur in the hind limb more often than the fore limb
Know the 3 most common sites for chondrosarcoma in the dog.
Ribs, Nasal Cavity, Pelvis
Know the 5 most common nonosseous tumors directly invasive to bone.
Squamous cell carcinoma***- oral cavity & digits
Malignant melanoma**- oral cavity & sublingual
Acanthomatous Epulis
Oral Fibrosarcoma
Synovial Sarcoma
Know the 3 most frequent secondary bone tumors in the dog (metastatic dissemination from a primary neoplasm elsewhere in the body).
Mammary carcinoma
Primary lung carcinoma
Prostatic carcinoma
Thyroid carcinoma
hemangiosarcoma
Know the appropriate diagnostic steps in evaluating bony lesions suspected of neoplasia
Physical exam, radiographic exam of the affected part, thoracic evaluation for metastasis, biopsy
Describe the technical aspects of a proper bone biopsy of a suspected neoplastic lesion.
Michelle trephine/Jamshidi needles
Must completely penetrate the cortex, through the medulla, to cortex on other side
Need to take multiple samples from center of lesion
Use stab incision & biopsy in different planes- minimize fracture to bone
Know the typical breed and signalment
Young, growing (5-13 month) large & giant breed dogs
Know the typical breed and signalment for Craniomandibular Osteopathy
3-8 month old (terriers)
Know the typical clinical signs (including history)
sudden onset lameness, chronic leg shifting lameness, localized pain on digital pressure
Know the most common bones affected
NEAR the elbow, distal humerus, proximal ulna & radius
Know the typical treatment for Panosteitis
Restricted activity & NSAIDs/corticosteroids for pain
Know the typical breed and signalment for Hypertrophic Osteodystrophy.
young (3-7 months), rapidly growing large & giant breed dogs
Know the typical clinical presentation for Hypertrophic Osteodystrophy.
, painful swellings of metaphyseal regions of long bones (distal radius, ulna, tibia)
Know the typical location of radiographic presentation for Hypertrophic Osteodystrophy.
Early: radiolucent bands w/in the metaphysis parallel to the growth plates
Late: ossified cuff around metaphysis
Know the prognosis for Hypertrophic Osteodystrophy.
Guarded, can spontaneously recover or cause permanent bony changes & deformities
Know the etiologic controversy regarding hypovitaminosis C for Hypertrophic Osteodystrophy.
Vitamin C deficiency-Scurvy in people
Overnutrition/mineral imbalance
Know the typical treatment Hypertrophic Osteodystrophy.
Correct nutritional imbalances, analgesics, supportive therapy
Know Treatment for Hypertrophic Osteopathy.
treat infections/remove tumors=signs will regress, bones will heal
Know disease description for Hypertrophic Osteopathy.
Quadrilateral disease of the extremities of periosteal bone proliferation, most common in old dogs
Know most common etiology for Hypertrophic Osteopathy.
primary or metastatic pulmonary neoplasms, also associated with infections
Rapid increases in BF to extremities-vascular tissue & periosteal bone formation- possibly mediated (caused) by vagal stimulus
Know clinical signs for Hypertrophic Osteopathy.
lameness in all four limbs; warm, painful, swollen limbs; no edema, stiff, stilted gait
Radiographic signs: Periosteal proliferation, new bone formation, soft tissue swelling parallel to the bones
Know the 4 most common sites of OCD development.
Shoulder-most common caudocentral
Elbow- usually w/ FCP medial humeral condyle
Stifle- lateral femoral condyle
Talus- proximal medial ridge
Understand the pathogenesis of OCD.
Failure of norm endochondral osteogenesis of articular cartilage=increased thickness & separation from bone. Flap-allows synovial fluid to contact epiphyseal bone. Can be partial (flaps)/complete (joint mice)=pain & lameness, communic. of subchondral fracture w/ articular surface
Know the typical signalment of a dog likely to develop OCD.
Young (4-8 months), large and giant breed dogs
Bilateral in many, other joint problems commonly develop (hip dysplasia)
the 2 major objectives in surgical treatment of OCD
Remove the cartilage flap
Stimulate cartilage bed (by scraping or forage)
Rank the prognosis based on the joint involved.
Best in the shoulder
Worst in the hock
Intermediate prognosis in the elbow & stifle
Know the common direction & frequency of directions in luxation
Traumatic luxation- medial or lateral, usually larger dogs, causes a leg carrying lameness
Congenital luxation- usually medial (generally small breeds)
Know the muscles torn in traumatic luxations in either direction
Medial/lateral glenohumeral ligaments usually torn in trauma
Supraspinatus-cranial
Teres minor-caudal
Infraspinatus- lateral
Subscapularis- medial
the 4 major muscles of support to the scapulohumeral joint
Supraspinatus-cranial
Teres minor-caudal
Infraspinatus- lateral
Subscapularis- medial
the recommended repair by biceps tendon transposition (IV 2a&b)
Medial luxation=medial transposition
Lateral luxation=lateral transposition
Six diseases of the elbow
UAP
FCP
OCD
Traumatic luxation
Congenital luxation
Subluxation
-Radius curvus
-Asynchronous growth of radius & ulna
Know the disease description of UAP
Failure of the 4th ossification center to unite w/ the unla by 16-18 weeks
Know the clinical signs of UAP
Instability of the elbow, decreased flexion/extension of the elbow, secondary DJD
Know the time of definitive radiographic diagnosis of UAP
Cannot be done definitively before 20 weeks (takes that long to fuse in normal animal)
Know the surgical treatment of UAP
Proximal ulna osteotomy*
Surgical removal of loose UAP-still have instability, just not lame, leads to DJD
Screw fixation- piece too small to fix effectively w/ screws
Know the lesion site of FCP
Medial coronoid process of humerus
Know the clinical signs of FCP
Young (6-10 month old), large/giant breeds
Uni/bi-lateral disease, causes weightbearing lameness
Pain on flexion & extension, but no joint distension
Know the diagnosis of FCP
Difficult to see on radiographs due to superimposition/deterioration of the joint w/ OCD
Suspect in all large, young dogs with elbow DJD w/o arthritis or UAP
Know the surgical treatment of FCP
Surgical removal
Arthroscopic removal
Know the site of elbow OCD
Medial humeral condyle of young, large/giant breed dogs
Know the surgical treatment of elbow OCD
Surgical removal via medial approach, check for FCP
Scrap/forage the subchondral bed to stimulate new cartilage growth
Know the prognosis for elbow OCD
Good if surgery before DJD starts, but not as good as OCD in other joints
Know the 2 types of elbow luxation
Congenital-lateral, think bulldog
Traumatic-usually caudolateral
Know the therapeutic indications for traumatic elbow luxation
Closed reduction-
Open reduction-
Know the etiologies of ligamentous Carpus/tarsus injury
Trauma
Immune-mediated joint disease
Know the clinical findings of ligamentous Carpus/tarsus injury
Joint pain and swelling
Gait and stance abnormalities (palmo-, plantigrade)
Increased laxity/instability/ hyperextension
Know the main categories of treatment optionsof ligamentous Carpus/tarsus injury
Repair the ligaments
Conservative= coaptation (splinting) in flexion
Arthrodesis + coaptation (partial or complete)