How many Salter Harris fracture types are there? List them and why they involve.
Type 1: involves just the physisType 2: physis and through the metaphysisType 3: physis and epiphysis (articular)Type 4: through joint and across the physisType 5: compression fracture of the physis
Why do type 3 and 4 physeal fractures have poorer prognosis than 1 and 2?
Articular surfaces are involved, must be aligned anatomically or DJD (degenerative joint disease)
How are compression and traction physeal fractures treated?
Compression: immobilizationTraction: immobilize and counteract pull of the attached muscle
When the majority of the physes of the limbs closed? What are the exceptions?
By 1 years except the iliac crest (1-2.5 yrs.) and the pelvic symphysis (5-6 yrs) and possibly the head of the humerus.
What are the last physes of the shoulder and stifle to close?
Head of the humerus (13 months) and the tibial tuberosity
When does the physis of the anconeal process close?
4-6 months (considered ununited if open at 6 months
Why is the median nerve more in danger in the cat than dog if the humerus is fractured?
It is in the supracondylar canal
What is the landmark for locating the heart valves during ascultation?
Olecranon/point of the elbow in the 5th intercostal space
What is failure of the anconeal process to fuse with the ulna by six months of age?
Ununited anconeal process
What improper development commonly leads to arthritis of the elbow?
Fragmented medial coronoid process
What small sesamoid bone on the medial side of the carpus may be mistaken for a chip fracture when seen in radiographs?
Sesamoid bone of the oblique carpal extensor (abductor pollicus longus) tendon
What must be removed when declawing to prevent regrowth?
Dorsal part of the ungual crest
Name the following fractures:1. Bone twisted apart2. What fractures do and do not penetrate through the skin?3. Fracture where bone of the skull is pushed inward4. What is the name for the separation of a small fragments of bone where a ligament or tendon attaches?5. Fracture that is a small piece of bone chipped off a bone6. Flat piece of bone separates, common in horse carpal bones7. Fracture that splinters into many fragments8. Fracture where the broken ends of the bone are driven into each other
What is an infection in a joint (s) with bacteria, virus and/or fungus that causes cartilage damage?
Septic (infectious, bacterial) arthritis
DJD stands for what?
Degenerative joint disease
List a few radiographic signs of hip dysplasia
Shallow acetabulum, flattened femoral head < half of the femoral head inside the acetabulum
When can dogs can be certified hip dysplasia free?
After 2 years of age
What causes patellar luxation?
A shallow patellar (trochlear groove)
What other lesions may accompany a ruptured cranial cruciate ligament?
Medial collateral and medial meniscus. tears
How is patellar luxation commonly treated?
Surgically deepening the patellar groove
How is cranial cruciate rupture physically diagnosed?
Cranial drawer sign
What is an osseous (bony) outgrowth seen radiographically?
What is the term for an increase in the density of a bone?
What is immobility and consolidation of a joint due to disease, injury, or surgical procedure?
What is destruction of a bone, seen as reduced density (i.e. blacker)?
What is a luxation or dislocation?
Complete loss of contact between the articular surface of the joint
Define a subluxation.
Partial loss of contact between articular surfaces of a joint
What is the most common direction of hip (coxofemoral) luxation?
Why are articular fractures difficult to treat?
Must achieve anatomical reduction and rigid skeletal fixation to perfectly align the cartilage surface (no step defect) or it will rapidly lead to DJD.
What is a possible sequela to Salter type 5 fracture (compression)?
Angular limb deformity (valgus and varus deviation of bones from the axis of the limb past the joint)
What is valgus and varus? How do you remember which is which?
VaLgus: lateral deviation of bones past the jointVarus: medial deviation of bones past the joint
What results from twisting or overstretching a joint, causing a ligament to tear or separate form its bony attachment?
What is inflammation of a bursae?
What muscles must be transected to remove the entire forelimb, including the scapula?
All the extrinsic muscles of the forelimb
What is atrophy of supraspinatus and infraspinatus muscles causing a prominent scapular spine called and what causes it?
Sweeney, suproscapular nerve damage
What results from radial nerve paralysis of the extensors to the thoracic limb?
Inability to stand (the triceps can't extend the elbow), knuckling over the digits
What is the most important layer that must be opposed when closing a paramedian midline incision?
External rectus sheath
What is the most important structure to close in a midline incision?
How would you locate the trachea for an emergency tracheostomy?
Skin incision in the ventral neck, separate the strap muscles
What muscle and nerve must be functional to bear weight on the pelvic limb?
Quadriceps m, femoral nerve
What muscles are paralyzed with obturator nerve damage, resulting in lateral slipping on a slick surface?
Why does an animal knuckle over on the pelvic limb with fibular (peroneal) nerve damage?
Paralysis of the extensors of the digits
What is the only laryngeal muscle which opens the glottic cleft?
Cricoarytenoideus dorsalis muscle
What muscles do the facial nerve innervate? Which is of clinical significance?
Muscles of facial expression, orbicularis oculi muscle
What muscles are innervated by the madibular division of the trigeminal nerve?
Muscles of mastication
What do the 3rd, 4th, and 6th cranial nerves (oculomotor, trochlear, and abducens) innervate?
Extrinsic muscles of the eye
What does the hypoglossal nerve innervate?
Motor to the muscles of the tongue
What muscles are innervated by both cranial nerves 9 and 10 (glossopharyngeal and vagus)?
Muscles of the pharynx
What is the injection of a substance into a muscle? How is it done?
Intramuscular (IM) injection; always draw back on (aspirate) the syringe before injecting to make sure the needle is not in a vessel (see blood in the hub if in vessel)
Why can a broken neck result in respiratory paralysis?
Phrenic nerve to the diaphragm arises from the cervical and brachial plexuses
What is the panniculus (cutaneous trunci) response
Contraction of the cutaneous trunci muscle in respone to a pin prick to the trunk.
What is the reflex arc for the panniculus response?
Sensation from the skin of the trunk over the thoracic and lumbar spinal nerves to the spinal cord, up the cord to the lateral thoracic nerve, out to the cutaneous trunci muscle
Clinically, what is the panniculus response used to evaluate?
Level of the thoracic spinal cord damage
Where is the spinal cord damage if the panniculus response is absent caudal to the level of the 12th thoracic vertebrae?
Level of T10
For standing large animal flank surgeries, what must be blocked?
Both the dorsal and ventral branches of the abdominal nerves as the dorsal branches are sensory to the top of the flank
What nerve must be considered when removing the anal glands? Why?
Caudal rectal nerve; Damage can result in paralysis of the external anal sphincter, thus, fecal incontinence (likely leading to an early demise).
Define clonus/clonic muscular spasms?
Rapidly alternating involuntary muscular contraction and relaxation
How does a tetanic animal present?
Pump handle tail, saw horse stance, lockjaw, and sardonic grin
How does coonhound paralysis present?
Ascending flaccid paralysis (the pelvic limbs first then the front limbs)
Describe the pathophysiology of tick paralysis?
Blocks neuromuscular junctions resulting in a flaccid paralysis that ascends the spinal cord
How does tick paralysis present?
Flaccid paralysis that ascends the spinal cord
Describe the pathophysiology of a roarer/recurrent laryngeal nerve damage
Paralysis of the cricoarytenoideus dorsalis muscle, (open glottic cleft), resulting in a roaring sound when breathing
What is a common serious injury of all the nerves of the forelimb?
Complete avulsion (tearing) of the brachial plexus associated with HBC (hit by car).
What are the signs of complete avulsion of the brachial plexus?
Complete paralysis, extended flaccid limb, unable to support weight and dragging dorsum of paw
What is Sweeney?
Damage to the suprascapular nerve, resulting in paralysis of the supraspinatus and infraspinatus muscles acutely, thus, lateral instability of the shoulder joint. With time muscle atrophy corrects the instability, but results in a prominent scapular spine most common in horses).
What is the most common clinically significant nerve problem of the forelimb?
What are the two types of radial nerve injury?
High and low radial nerve injury
What are signs of high radial nerve paralysis?Signs of low radial nerve damage?
Inability to bear weight on the limb, dropped elbow and knuckling over on the digits-knuckling over on digits
What sensory loss is diagnostic for radial nerve injury?
Injury to which nerve causes lateral slipping on a slick surface?
What are the signs of fibular (peroneal) nerve damage?
Knuckling over, analgesia of the dorsal pes
How does an animal compensate for peroneal nerve damage?
By flipping the paw as advanced
What is peroneal (fibular) nerve paralysis similar to in the thoracic limb?
Low radial nerve paralysis, knuckling over
What is an iatrogenic cause of ischiatic nerve damage, what does it result in?
IM injection in the rear limb, resulting in paresis/paralysis of the rear limb.
What is the definition of proproception?
Sensing movements and position of the body parts
What tests are used to evaluate proprioception? Give an example.
Postural reactions (e.g., proprioceptive placing reaction: placing the animals weight on its dorsal paw should result in immediate adjustment to normal placement).
What does loss of proprioception tell you clinically?
Doesn't localize the lesion, but a sensitive indication of a neurological problem (anywhere along the proprioceptive pathway: peripheral nerves, spinal cord, brain stem, cerebrum, or cerebellum)
Complete loss of motor activity
Weakness, partial loss of voluntary motor activity
What are the suffixes -paresis and -plegia used to describe?
Paresis and paralysis, respectively
Differentiate flaccid and spastic paresis or paralysis?
Flaccid: decreased or no tone in musclesSpastic: increased tone/hypertonicity
Lack of coordinated movements with or without spasticity or paresis
What can cause ataxia?
Lesions of the entire nervous system may cause ataxia. Although not specific, it shows up frequently and is indicative or a nervous problem.
Define intention tremor and what it indicates.
A tremor (small, rapid, alternating movements at rest) that becomes worse with initiation of a movement and dissapears at rest; indicates: cerebellar disease
Involuntary movement of the eyes in either a rotatory, vertical, or horizontal direction
How does nystagmus at rest appear and what does it indicate?
Eyes move to the side of the lesion and snap back. Abnormally, usually indicates vestibular dysfunction
Define dysmetria and what it indicates.
Improper measuring of distance in muscular activity, too short or too long (e.g. goose stepping), Cerebellar disease
How do you screen for neurological problems?
Observing:1. Mental attitude/consciousness2. Stance and head position3. gait and strength4. proprioceptive positioning
Why is mental attitude/consciousness, behavior, seizures observed in a neuroscreening test?
Screen for cerebrum and brain stem problems
What does observation of stance and head position of a neuroscreening test check?
What abnormal stance and head position indicate neurological problems (cerebellum/vestibular system)?
Head tilt, wide based stance; head tremor/bobbing
What does gait and strength observation evaluate?
Entire nervous system
What is gait checked for during a neurological screening test?
Proprioceptive deficits, paresis, circling, ataxia, and dysmetria, scuffing, knuckling or atrophy
What does abnormalities in gait indicate in a neurological screening?
Nervous system problem (cerebrum, cerebellum, brain stem, spinal cord, peripheral nerves, or vestibular lesions.)
Do gait abnormalities localize a neurological lesion?
No, just a neurological problem that can be anywhere: cerebrum, cerebellum, brain stem, spinal cord, peripheral nerves, or vestibular system
How is strength tested during a neurological exam?
Push down on the standing animal
What does weakness indicate during a neurological screening?
Nervous problem somewhere other than the cerebellum, or peripheral vestibular system (cerebrum, brain stem or spinal cord injuries, peripheral nerves).
What is the only part of the nervous system that will not result in weakness?
Cerebellum (and peripheral vestibular system).
What is the most common postural reaction used to screen for neurological problems?
Proprioceptive positioning (knuckling)
What is a neuro screening test to indicate there is a neurological problem but doesn't localize where the problem is?
Proprioceptive positioning (knuckling), postural reaction, (also gait and strength observation)
For what does proprioceptive positioning (knuckling) test?
Conscious perception of the location of the limbs
What does loss of proprioception tell you clinically?
Doens't localize the lesion, but is a sensitive indication of a neurological problem (anywhere along the proprioceptive pathway: peripheral nerve, spinal cord, brain stem, cerebrum, cerebellum)
What is done once screening indicates a neurological problem?
Other procedures done to localize the lesion to a specific part of the nervous system.
What is the CSF tap and where is it done?
Removal of cerebrospinal fluid from the subarachnoid space in the cisterna magna or lumbar cistern
What is the epidural anesthesia, where is it commonly given?
Anesthetize the spinal nerves in the area, through the lumbosacral opening (L7-S1) into the epidural space
What is the affect of UMNs damage on LMNs?
LMNs increase their activity
To where do LMN signs localize the lesion?
Peripheral nerves, spinal cord, or segment of brain stem the LMN arises from
Define flaccid paresis or paralysis.
Decreased or no tone with paresis or paralysis due to lesions of LMNs
Define spastic paresis or paralysis.
Extra tone (hypertonicity) with paresis or paralysis due to lesions of UMNs
What does pointing your thumb down in LMN damage indicate?
Everything decreased or disappears
List 4 LMN disease signs (thumb down).
Decreased or absent tone (hypotonia to atonia)Decreased to absent reflexes (hypo- to areflexia)Flaccid paralysisRapid atrophy (neurogenic atrophy) 1 week
List 4 UMN disease signs (thumb up).
Normal to increased muscle toneNormal to increased reflexes (hyperflexia)Spastic paresis to paralysisSlow (disuse) atrophy
List how the reflexes are checked for the limbs?
How is a withdrawal reflex performed?
Pinch (pain) the toe; normal response = withdrawal of the limb
How is tone evaluated?
Palpate the muscles of the limbs
Localize the lesions: flaccid paralysis, absent reflexes and tone, and rapid atrophy to the pelvic limbs with normal thoracic limb
L4-S1 spinal cord lesion (area 4) (LMN signs to pelvic limbs, normal thoracic limbs)
Localize the lesion: spastic paresis, increased reflexes and tone to the left pelvic limb and flaccid paralysis, decreased reflexes and tone to the left thoracic limb.
Unilateral C6-T1 (area 2) on the left (LMN: left thoracic and UMN: lateral pelvic limb
Localize the lesion: spastic paresis, increased reflexes and increased tone to all limbs
Lesion cranial to C6 (area 1)
Localize the lesion: spastic paresis, increased reflexes and tone to the pelvic limbs, and normal thoracic limbs.
T3-L3 (area 3)(UMN: P limbs; Normal +/- Shiff-Sherington)
List presenting signs to transection of the spinal cord:1. C1-5 spinal cord2. Cervical enlargement, C6-T23. T3-L34. L4-S1
1. All 4 limbs: UMN (thumbs up) (no LMN signs to any limb)2. Pelvic limb: UMN (thumbs up) Thoracic limb: LMN (thumbs down)3. Pelvic limb: UMN (thumbs up) Thoracic limb: No effect (+/- Shiff-Sherington)4. Pelvic limb: LMN (thumbs down) Thoracic limb: no effect on
What causes a coma?
Complete disconnection of the reticular activation system from the cerebral cortex, usually due to a severe brain stem lesion.
List 3 primary deficits that may be seen with lesions to the cerebrum?
List 3 primary deficits that may be seen with lesions to the cerebrum?SeizuresBehavior and mentation abnormalitiesDepressionAbnormal posture with normal gaitBlind with normal pupillary reflexesComplusive pacing, head pressingProprioception deficits
Unilateral cerebral lesions will cause __________ signs?
Contralateral (opposite side)
How is the brain stem disease characterized?
Abnormal gait + abnormal posture and cranial nerve deficits, decreased mental states, proprioception deficits and weakness
What is the range of decreased levels of consciousness due to brainstem lesions?
Depression to coma
What is the best evidence of brainstem lesions?
Multiple dysfunction of cranial nerves 3-12
When should brain stem disease be suspected?
If cranial nerves abnormalities + UMN paresis, or decreased consciousness.
How does a cerebellar lesion present?
Uncoordinated without paresis (no weakness), proprioceptive deficits, vestibular signs
What do vestibular system lesions affect?
The ability to control posture in relationship to gravity and eye movements in relationship to head movements
What are signs of vestibular disease?
Head tilt, nystagmus, asymmetric ataxia with possibly circling
What is the primary diagnostic concern with vestibular disease?
Differentiating peripheral (no pareses or depression) from central (paresis and depression) vestibular disease
What is the first deficit to show with a neurological deficity?
What does BAR stand for?
Bright, alert, and responisive
What does multiple dysfunction of cranial nerves indicate?
Brain stem lesion
What would cause a dropped jaw?
Paralysis of trigeminal nerve (CrN 5)
Why is paralysis of the orbicularis oculi and loss of lacrimation the most vital results of facial nerve paralysis?
Drying of eye; animals are not vain (facial paralysis)
How is the auriculopalpebral nerve manipulated clinically? In what species?
Blocked to paralyze eyelids for eye procedures; large animals
How is the facial nerve commonly injured in the horse?
Lying on a halter buckle during surgery (buccal on buckle)
What cranial nerve is associated with blindness?
What cranial nerve is associated with anisocoria (unequal sized pupils)?
Sympathetic, parasympathetic (3)
What cranial nerve is associated with strabismus (uncontrolled deviation of the eye)?
Oculomotor (3), trochlear (4), abducent (6)
What cranial nerve is associated with dropped jaw and head atrophy?
What cranial nerve is associated with increased or decreased facial sensation
What cranial nerve is associated with facial paralysis?
What cranial nerve is associated with deafness and or loss of balance?
Vestibulocochlear (8) damage
What cranial nerve is associated with dysphagia (difficult swallowing)?
Glossopharyngeal (9), vagus (10)
What cranial nerve is associated with megaesophagus?
What cranial nerve is associated with laryngeal paralysis?
Vagus (10), recurrent laryngeal nerve
What cranial nerve is associated with paralysis of the tongue?
Paralysis of which nerve results in a weak tongue?
How is the facial/trigeminal reflex arc checked?
Prick the face, pulling away indicates intact trigeminal nerve, twitch of face muscles indicated intact facial nerve
What cranial nerve problem can be seen with middle ear infections?
Paralysis of the facial nerve and resulting dry eye
What procedure can be used to facilitate the exam of the eye? How?
Auriculopalpebral nerve (facial branch) block, eliminates blinking and closing of the eye (rare in the dog, common in horses)
What are signs of damage to the recurrent laryngeal nerve?
Laryngeal paralysis/ hemiplega: failure of the glottic cleft to open. Seen in horses (roarers) and dogs. High pitched, whistling on inspiration and exercise intolerance occur.
Discuss the clinical significance of the accessory nerve (11).
Little clinical significance
Describe the pupillary light reflex and what structures it involves.
Shining light in the eye, noting if the pupil constricts in that eye and then the other eye; checks both cranial nerves II and III (optic and oculomotor)
Describe the signs of facial nerve (7) damage.
Paralysis of the muscles of facial expression resulting in a distorted face, paralysis of the orbicularis oris muscle and if proximal enough, the ANS fibers to the lacrimal gland, thus, can result in dry eye (rare, but bad!)
What is a dysfunction of the sympathetic fibers to the eye?
List the cardinal signs of Horner's syndrome
Miosis (small pupil)enophthalmos (small eyes)ptosis (drooping eyelid)protrusion of the 3rd eyelid
What results in swelling or draining (pus) below the carnivore's eye?
Carnassial tooth abscess (upper P4)
How is aging of dog by their teeth used practically in dogs?
Baby teeth in by 6 weeks: vaccination timeAdult in by 6 months: spay/neuter time
Which dog teeth have three roots?
Last 3 on top
Which cat permanent teeth has 3 roots?
Upper PM4 (carnassial)
How is a nasogastric tube placed?
Through the nostril and the ventral nasal meatus or it will break the ethmoid turbinates, resulting in nasal bleeding (epistaxis)
A laryngotomy to open the larynx goes through which paired muscles to expose the larynx?
Sternohyoid muscles, middle strap muscle
The esophagus is accessible to surgery in the _______ half of the neck region on the _____ side.
What surgical landmark indicates the ventral midline of the larynx?
Cricoarytenoideus or bow tie muscle
Paralysis of what muscle results in "roarers" in horses?
Cricoarytenoideus dorsalis muscle
How is a tranquilized dog intubated?
Gently pull the tongue rostrally, push the soft palate up with the endotracheal tube, hold the epiglottis down with the tube, direct the tube between the vocal folds into the trachea
What causes laryngeal paralysis (dog and horses)?
Damage to the recurrent laryngeal nerve resulting in paralysis of the cricoarytenoideus dorsalis muscle, the only muscle to open the glottic cleft, producing a roaring sound when breathing
What is a roarer?
Dog or horse with laryngeal paralysis due to the recurrent laryngeal nerve damage and resulting paralysis of the cricoarytenoideus dorsalis muscle
Which is the most important layer that must be opposed when closing a paramedian midline incision?
External rectus sheath
What is the most important structure to close in the midline incision?
What is an incision opening the abdomen called?
Laparotomy or celiotomy incision
Name the structures that can be visualized through a xiphoid to pubic laparotomy incision without manipulation, and give their locations?
Cranial: falciform ligamentMiddle: greater omentum, +/- tail of spleenCaudal: bladder
What abdominal structures can be used to orient abdominal organ locations in your mind during surgery?
Descending duodenum: right side: mindCecum: surgery, find (blind ended), then locate other parts of the intestine in relationship to it
How are the abdominal gutters visualized?
Pull the duodenum and mesoduodenum or colon and mesocolon medially, packing off the rest of the viscera, to see the right or left gutters
How would you locate a bleeding ovarian stump during a spay?
Pull the descending duodenum or descending colon and their respective mesentery medially and look in the abdominal gutter caudal to the kidney.