Small animal MSK disease 3 Flashcards
Triage (100 cards)
1
Q
In an emergency case, what are the main body systems/areas that need to be assessed?
A
- Cardiovascular
- Respiratory
- Neurological
- Abdominal (urinary, spleen etc.)
- Musculoskeletal
2
Q
What do the letters in A CRASH PLAN stand for?
A
A: airway C: circulation R: respiratory A: abdomen S: spine H: head P: pelvis L: limbs A: arteries and veins N: nerves
3
Q
In ACRASHPLAN, how are airways evaluated?
A
- Look for blockages
- Secure/establish airway immediately using ET tube
- Respiratory pattern
- Airway patency
4
Q
In ACRASHPLAN, how is circulation evaluateed?
A
- Peripheral pulses incl. femoral and dorsal metatarsal, CRT, MM, blood pressure
- ECG
5
Q
In ACRASHPLAN, how is the respiratory system evaluated?
A
- Rate and effort
- Respiratory sounds
- Bruising
- External wounds to the chest
6
Q
In ACRASHPLAN, how is the abdomen evaluated?
A
- Palpation, auscultation, imaging
- Bruising
- External wounds
- FAST ultrasound for free fluid and bladder integrity
7
Q
Outline the ultrasonographic evaulation in an emergency situation
A
- Abdomen: AFAST, 4 sites: diaphragmatic-hepatic, splenorenal, cysto-colic, hepatorenal, and bladder integrity assessed
- Thorax: same time as abodminal, examine left and right sides, chest tube site, pericardial site, wet/dry/third space
8
Q
In ACRASHPLAN, how is the spine evaluated?
A
- Panniculus, reflexes, assess for deep pain
- Imaging
- Gait and posture, pain sensation, crepitus
9
Q
In ACRASHPLAN, how is the head evaluated?
A
- Visual, imaging, eyes, palpation
- Mentation cognitive function, cranial nerves, external wounds/bruising
- Eyes: symmetry, third eyelids, eye position, haemorrhage, detailed ophthalmological examination
- Ears and nose also
10
Q
In ACRASHPLAN, how is the pelvis evaluated?
A
- Palpation
- Imaging
- Pelvic limb reflexes
- Wounds, bruising, pain, crepitus, perineum, external genitalia
11
Q
In ACRASHPLAN, outline the limb evaluation
A
- Palpation, reflexes, imaging
- Deformities, fractures, pain, bruising, wounds, weight bearing vs not
12
Q
In ACRASHPLAN, outline the evaluation of the arteries and veins
A
- CRT, MM colour, peripheral pulses, BP
- All accessible superficial arteries pulse and pressure
13
Q
In ACRASHPLAN, outline the evaluation of the nerves
A
- Neurological exam
- Mentation, cranial nerves, conscious proprioception, postural reflexes, peripheral spinal reflexes, withdrawal reflexes, deep pain, cutaneous trunci reflex, anal tone
14
Q
Outline the thoracic evaluation in an emergency trauma case
A
- Full thoracic examination, visual and palpation for broken ribs etc.
- Radiography to assess potential for rib fracture, diaphragmatic hernia etc.
15
Q
Outline the initial advise that should be given to an owner over the phone in an trauma emergency situation
A
- Almost always best to bring in
- Advise careful approach
- If bleeding, apply pressure either with dressing from first aid kit, or clean towel
- Attempt to keep injured limbs still where possible
- Vets must attend to animal if animal cannot be brought into practice
16
Q
Outline the telephone advice that should be given to a farmer in the case of difficult lambings/calvings
A
Leave animal quietly and do not attempt further intervention
17
Q
Outline the telephone advice that should be given to a farmer in the case of a uterine prolapse
A
- Contain animal and keep as quiet as possible
- Wrap prolapse in clean, damp cloth e.g. old bed sheet to limit/prevent injury to uterus
18
Q
Outline the telephone advice that should be given to a farmer in the case of a ruptured uterine artery
A
- Place hand in vagina, identify rupture artery (high pulsing pressure), grasp and hold to prevent further blood loss
- If not possible, pack vagina with clean damp towels in an attempt to limit blood loss
19
Q
Outline the telephone advice to a farmer in the case of an emergency call regarding milk fever
A
If in lateral, prop into sternal using straw bale to prevent bloat
20
Q
Outline the telephone advice to a farmer in the case of an emergency call regarding grass staggers
A
- Advice farmer not to touch/stimulate animal, may provoke fitting
- Stay clear of animal during fitting
21
Q
Outline the telephone advice to a farmer in case of an emergency call for a cut/distal limb fracture
A
- Ask farmer to describe injury
- Isolate animal into a small pen to limit further injury by reducing space to walk in
22
Q
What are the 3 main underlying causes of orthopaedic infection in animals?
A
- Haematogenous spread
- Direct contamination from trauma/puncture wound
- Post-operative infection, usually associated with an implant
23
Q
What is the most common cause of orthopaedic infection in neonates of all species?
A
Haematogenous spread from umbilical infection
24
Q
What are the most common infectious agent causing osteomyelitis in all species?
A
- Foals: enteric G-ve organisms
- Small animals: Streptococcus spp.
25
What is the most common cause of orthopaedic infection in dogs and cats?
Bites, trauma
26
What are the most common infectious agents causing osteomyelitis in dogs and cats?
Trauma: Staph, Strep
Bite: Pasteurella
27
What is the most common cause of orthopaedic infection in farm animals (sheep and cows)?
External and internal traumatic events to joints and bones
28
What is the most common infectious agent causing osteomyelitis in farm animals?
Actinomyces pyogenes (may or may not be combined with anaerobes)
29
What are the most common causes of orthopaedic infection in adult horses
- Septic arthritis secondary to injection
- Septic arthritis and osteomyelitis secondary to trauma
- Osteomyelitis due to implant infection
30
What are the most common infectious agents causing osteomyelitis in adult horses?
- Injection: Staph
- Trauma: mixed, Enterobacteriaceae,
- Implant: mixed Enterobacteriaceae, Staph, Strep
31
What are the most common causes of orthopaedic infection in birds?
- Femoral head necrosis in birds >22days old
- Viral infection (immunosuppressive e.g. IBD)
- Coccidiosis
32
What are the most common infectious agents causing osteomyelitis in birds?
- Coagulase positive Staphylococci
- Mycoplasma synoviae
- E. cecorum
33
What pathogens are involved in turkey osteomyelitis complex?
E. coli, Staph aureus, S. hyicus
34
Outline the importance of E. cecorum in osteomyelitis in birds
- Commensal enteric bacterium
| - can cause epidemics of osteomyelitis, arthritis and spondylitis in broilers and broiler breeders
35
Outline the management of a fracture fixed with implants, that develops a post-operative infection
Leave in and treat with antibiotics for 4-6 weeks, then remove once infection cleared
36
Briefly describe the radiographic appearance of early (<2 weeks) osteomyelitis
- Insensitive to early disease
- Must have 50% of bone resorption to see bone lysis
- May take 21 days to be detected
- May see delayed periosteal proliferative appearance
37
Briefly describe the radiographic appearance of late/advanced osteomyelitis
- Bone lysis and demineralisation
- Periosteal proliferation
- Areas of sequestration
- Remodelling of cortex and endosteum
38
What other problems/complicating factors may be present in a case with osteomyelitis?
- Implant involvement
| - Articular surface destruction/joint involvement
39
What is a bony sequestrum? Outline the treatment for this
- Dead, avascular bone within living tissue
- May resolve without treatment
- Treatment is surgical removal of sequestrum
- Antibiotics - clindamycin has good pone penetration
- Analgesia
40
How would you identify fungal osteomyelitis and where does this usually occur?
USA
- Coccidiomycosis: diagnosis using Sabourauds medium at room temp, culture from granulomatous lesion
- Blastomycosis
41
What are three key underlying problems that could cause recurrent/resistant infection within the bone?
- Presence of abscess/protective wall preventing penetration of antibiotics
- Incorporation of infected bony sequestrum into remodelling callus and cortex
- Avascularity and scar formation so bone dies, fragments and becomes sequestrum
42
Outline the antibiotic treatment of osteomyelitis in dogs and cats
- Systemic bacteriocidal for 3-4 weeks following end of clinical signs
- Base on C+S, until result use cephalosporin, amoxycillin, or clindamycin+metronidazole - Gentamicin PMMA chains for local application also an option, extracted within 7-10 days or left in permanently in some cases
43
Outline the antibiotic treatment of osteomyelitis in farm animals
Long term injectables possible, but more likely to opt for euthanasia due to withdrawal periods etc.
44
Outline the antibiotic treatment of osteomyelitis in horses
- Systemic IV broad spec until C+S
- Commonly cephalosporin +amikacin, or penicillin + gentamycin
- 7-10 days initially, then continue min. 1 months depending on severity
- Local: gentamycin, or amikacin PMMA beads, or IV/IO limb perfusion with amikacin, ampicillin, penicillin, cephazoin
45
Which antibiotics are commonly used for the treatment of osteomyelitis in birds?
- Cephalosporins
- Fluoroquinolones
- Lincomycin + clindamycin
- Metronidazole
- Amoxy-clav
46
Identify the antibiotics that should be avoided in neonates
- Chloramphenicol
- Tetracyclines
- Aminoglycocides
- Fluoroquinolones
47
List the indications for surgical intervention in cases with osteomyelitis
- Fracture
- Periosteal stripping
- Sequestrum
48
What are the basic principles of surgical treatment in cases of osteomyelitis? i.e. aims
- Stabilisation
- Remove sequestrum
- Remove focus of infection, sterilisation
- Improve chance of bone healing
49
What are the common indications for tail amputation in mature dogs?
- Traumatic skin loss
- Ischaemia
- Denervation
50
Outline the pre-operative management for tail amputation
- Warn owner re. risk of post-op dehiscence due to trauma by dog, sdifficulty of protecting site
- Consider anal purse sting suture, and prophylactic antibiotics
- Consider epidural or local anaesthetic infiltration
- Tail clip at least 10cm around proposed site of incision, distal portion draped
- Place tourniquet several cm proximal to amputation site
51
What are the most common indications for lateral surgical approach to the stifle joint?
- Repair of medial patellar luxation
- Exploratory arthrotomy
- Rupture of cranial cruciate ligament
52
List the main causes of lameness originating in the bones of the metacarpus/tarsus of small animals
- Fractures
- Hypertrophic osteopathy
- Osteoarthritis
- Luxations (single/multiple)
- Sesamoid disease -
53
Identify sesamoid diseases in small animals
- Fractured sesamoids
- Sesamoid disease of young dogd
- Bipartitie/tripartite sesamoids
54
What commonly occurs concurrently with luxations of the metacarpal/tarsal bones?
Multiple sesamoid ligament failures
55
What are the indications for surgical treatment of metacarpal/tarsal shaft fractures?
- Pronounced displacement, esp. dorsally
- More than 2 metacarpal/tarsal fractures
- Greyhounds more commonly treated surgically
56
Outline the management of metacarpal/tarsal shaft fractures
- Surgical
- If not surgical, manage in splinted bandage
- Monitor radiographically
57
What is the main consequence of metacarpal/tarsal distal condylar fractures?
Leads to instability of MCP/MTP joint, as collateral ligament attaachments are affected
58
Outline the treatment of metacarpal/tarsal distal condylar fractures
- Ideally treat with internal fixation and external support
- Closed reduction and external casting often leads to instability or poor intra-articular alignment of fragments leading to DJD
59
What is the normal degree of flexion of the MCP/MTP joint?
90degrees
60
Outline the presentation of sesamoid disease of young dogs
- Usually Rottweilers
- Acute, becomes chronic
- Loss of flexion of joint, pain, effusion
- Usually sesamoids II or VII
61
Outline the diagnosis of sesamoid disease of young dogs
- Exclusion of other problems
| - +/- nerve blocks
62
Outline the treatment of sesamoid disease in young dogs
- NSAIDs
- Neutraceuticals
- Conservative management i.e. physiotherapy
63
Outline the presentation and treatment of bipartite/tripartite sesamoids in dogs
- Loss of flexion, swelling but no pain
- Incidental finding
- No treatment
64
Discuss the consequences of a palmar metacarpal/plantar metarasal wound
- Haemorrhage: blood vessels superficial, poorly protected
- Tendon damage: partial/full rupture (often clean laceration), repair if possible, bandage in slight flexion to reduce tension on repair
65
What treatment is recommended for fractures of the shaft of P1/2 in dogs?
- Closed reduction and external support, unless performance animal
- Moulded plastic splint for 3-6 weeks
66
What treatment is recommended for fractures of the head/base of phalanges in dogs?
- Lots of instability therefore internal fixation and external support best
- If fragments too small to reconstruct, consider amputation
67
What treatment is recommended for fractures of P3 in dogs?
Distal P2 amputation unless simple fracture of ungual process
68
Discuss the occurence and treatment of luxaations/subluxations of digits in dogs
- P1/2, or more commonly P2/3
- Usually racing greyhounds
- Intricate surgical repair required, difficult
69
List potential causes of lameness originating in the bones of the digits of small animals
- Fractures
- Luxations/subluxations
- Osteoarthritis
- Osteomyelitis
- Neoplasia
- Trauma
- Digital amputation
70
What are the indications for digit amputation in small animals?
- Neoplasia e.g. SCC
- Chronic infection
- Osteomyelitis
- Severe trauma
- Biopsy of P3
71
When does digit amputation lead to lameness in small animals?
- When >2 digits removed
| - Either of the central 2 digits amputated
72
List the differentials for soft tissue damage in the digits of small animals
- Cellulitis (most common, esp. cat bite abscess)
- Tendon damage e.g. DDFT/SDFT
- Ligament damage
- Gangrene (ischaemia, necrosis)
73
How should gangrene of the digits be treated in small animals?
- Debridement/amputation
| - Antibiotics if secondary infection
74
Compare the presentation of acute vs. chronic tenosynovitis of the DDFT in small animals
- Acute: 100% lame
| - Chronic: mild lameness
75
Describe the presentation of damage to the DDFT in small animals
- Leads to "knocked up" toe - distal part of toe sticks up due to tension on extensor tendon
- Can be chronic due to progressive weakness
- Complete rupture less painful than progressive injury
76
Outline the treatment of incomplete rupture of the DDFT
Exercise with NSAIDs may allow faster resolution
77
Outline the presentation and treatment of damage to the SDFT
- Rupture/avulsion leads to dropped toe, parallel to ground
| - Rarely any clinical significance, often incidental finding
78
Outline the treatment of superficial pad loss
- Secondary intention healing
- Keep clean, provide support
- Bandage, splint, rest until early keratinisation
- Do not exercise too early
79
Outline the treatment of pad lacerations
- Debride to bleeding edge
- Appose deep layers with buried simple interrupted absorbable sutures
- Appose epithelial edges with interrupted sutures
- Take bites several mm from wound edge
- If acute, thorough lavage, minimal debridement
- Old, contaminated/infected: hydrophilic bandages several days after closure
- Restrict exercise
80
List possible causes of lameness originating from the pads of small animals
- Cut pads
- Foreign bodies
- Excessive wear
- Burns (thermal/caustic)
- Corns
- Hyperkeratosis
- plasma cell pododermatitis
- Autoimmune disease
- Nutrition related e.g. NME, zinc responsive dermatoses
81
Outline the diagnosis of foreign bodies in the pads of small animals
- Can be difficult, pain on local pressure, very focal pain
- Probe hole with needle
- Radiography (contrast to outline tracts, esp. if chronic)
- Ultrasonography
- Watch for abscesses higher on leg, usually mid-metacarpal/tarsal region
82
List the possible causes of lameness originating from the haired skin of the paws of small animals
- Interdigital sinus tracts
- Interdigital foreign bodies
- Parasitic infestation
- Trauma
- Hypersensitivity
- Infection
- Contact irritant
- Neoplasia
83
What are the causes of interdigital draining sinus tracts?
- Interdigital foreign bodies
- Deep pyoderma
- Demodiscosis
- Sterile pyogranulomata
84
Which breeds are predisposed to interdigital draining sinus tracts?
- Brachycephalics
| - Heavy breeds e.g. bulldogs
85
Which breeds are predisposed to sterile pyogranulomata in the interdigital space?
- Bulldogs
- Great Danes
- Boxers
86
Explain the cause of interdigital sterile pyogranulomata
- Reaction to intradermal keratin
| - Associated with walking on haired skin due to poor conformation, licking feet
87
How is sterile pyogranulomata diagnosed?
- Biopsy supportive but not definitively diagnostic
| - Rule out parasites and infection (repeatedly negative tissue culture)
88
Outline the treatment of sterile pyogranulomata
- Careful use of glucocorticoids or ciclosporin
| - Fusion podoplasty as last resort
89
Outline the treatment of interdigital foreign bodies
- Poultice/bath to draw out salt water bathing, epsom salts), then explore cavity under GA with alligator forceps
- Avoid antibiotics until explored
90
Which parasitic infections may affect the haired skin of the paws of dogs?
- Demodicosis
- Harvet mite
- Hookworm
91
Discuss the treatment of trauma to the haired skin of the paws of dogs
- Wound closure difficult due to limited free skin, high risk of vascular damage
- May require amputation or multiple surgeries if severe
92
List the neoplasias that most commonly occur on the paws of dogs
- SCC
- Melanoma
- Fibrosarcoma
93
Describe feline lung-digit syndrome
- Rare
- Majority of digital carcinomas in cats are mets from primary pulmonary carcinomas, although rarely show pulmonary signs
- Radiograph thorax of all cats with suspect digital lesion
94
Where does claw growth occur from?
Claws grow out from corium at ungual crest, very close to epidermis
95
What is the legislation regarding dew claw removal?
Anyone 18+ can remove dew claws of a dog before its eyes are open, once eyes are open anaesthesia is mandatory
96
Discuss the justification for the removal of the hind dew claws
- Variable development, may have no skeletal articulation and so are easy to remove
- Commonly catch, can tear off, often remove before 5 days of age
97
Discuss the justification for the removal of the front dew claws
- Is a fully formed first digit with skeletal articulation
| - Only remove if justified based on particular anatomy/appearance inviting possible damage e.g. sticks out, working dog
98
Outline the procedure of the removal of dew claws in a puppy <5 days old
- Aseptically prepare skin
- Abduct dew claw, transect web of skin between dew claw and pad with mayo scissors
- Disarticulate MCP/MTP joint with scalpel blade/Mayo scissors
- Control haemorrhage with pressure/electrocautery
- Appose skin margins with single sutures/heal by secondary intention
99
Outline the procedure for dew claw removal in an older dog (>3months old)
- Clip, aseptically prepare skin
- Elliptical incision around base of digit and MCP/MTP joint
- Dissect SC tissue
- Ligate dorsal common and axial palmar arteries
- Disarticulate MCP/MTP joint or transect P1
- Appose SC tissues with simple continuous/interrupted absorbable sutures
- Appose skin with simple interrupted sutures
- Soft padded bandage 3-5 days
100
What does paronychia mean?
Inflammation of claw fold and claw bed
