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Flashcards in Small animal MSK disease 3 Deck (100)
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In an emergency case, what are the main body systems/areas that need to be assessed?

- Cardiovascular
- Respiratory
- Neurological
- Abdominal (urinary, spleen etc.)
- Musculoskeletal


What do the letters in A CRASH PLAN stand for?

A: airway
C: circulation
R: respiratory
A: abdomen
S: spine
H: head
P: pelvis
L: limbs
A: arteries and veins
N: nerves


In ACRASHPLAN, how are airways evaluated?

- Look for blockages
- Secure/establish airway immediately using ET tube
- Respiratory pattern
- Airway patency


In ACRASHPLAN, how is circulation evaluateed?

- Peripheral pulses incl. femoral and dorsal metatarsal, CRT, MM, blood pressure


In ACRASHPLAN, how is the respiratory system evaluated?

- Rate and effort
- Respiratory sounds
- Bruising
- External wounds to the chest


In ACRASHPLAN, how is the abdomen evaluated?

- Palpation, auscultation, imaging
- Bruising
- External wounds
- FAST ultrasound for free fluid and bladder integrity


Outline the ultrasonographic evaulation in an emergency situation

- 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


In ACRASHPLAN, how is the spine evaluated?

- Panniculus, reflexes, assess for deep pain
- Imaging
- Gait and posture, pain sensation, crepitus


In ACRASHPLAN, how is the head evaluated?

- 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


In ACRASHPLAN, how is the pelvis evaluated?

- Palpation
- Imaging
- Pelvic limb reflexes
- Wounds, bruising, pain, crepitus, perineum, external genitalia


In ACRASHPLAN, outline the limb evaluation

- Palpation, reflexes, imaging
- Deformities, fractures, pain, bruising, wounds, weight bearing vs not


In ACRASHPLAN, outline the evaluation of the arteries and veins

- CRT, MM colour, peripheral pulses, BP
- All accessible superficial arteries pulse and pressure


In ACRASHPLAN, outline the evaluation of the nerves

- Neurological exam
- Mentation, cranial nerves, conscious proprioception, postural reflexes, peripheral spinal reflexes, withdrawal reflexes, deep pain, cutaneous trunci reflex, anal tone


Outline the thoracic evaluation in an emergency trauma case

- Full thoracic examination, visual and palpation for broken ribs etc.
- Radiography to assess potential for rib fracture, diaphragmatic hernia etc.


Outline the initial advise that should be given to an owner over the phone in an trauma emergency situation

- 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


Outline the telephone advice that should be given to a farmer in the case of difficult lambings/calvings

Leave animal quietly and do not attempt further intervention


Outline the telephone advice that should be given to a farmer in the case of a uterine prolapse

- 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


Outline the telephone advice that should be given to a farmer in the case of a ruptured uterine artery

- 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


Outline the telephone advice to a farmer in the case of an emergency call regarding milk fever

If in lateral, prop into sternal using straw bale to prevent bloat


Outline the telephone advice to a farmer in the case of an emergency call regarding grass staggers

- Advice farmer not to touch/stimulate animal, may provoke fitting
- Stay clear of animal during fitting


Outline the telephone advice to a farmer in case of an emergency call for a cut/distal limb fracture

- Ask farmer to describe injury
- Isolate animal into a small pen to limit further injury by reducing space to walk in


What are the 3 main underlying causes of orthopaedic infection in animals?

- Haematogenous spread
- Direct contamination from trauma/puncture wound
- Post-operative infection, usually associated with an implant


What is the most common cause of orthopaedic infection in neonates of all species?

Haematogenous spread from umbilical infection


What are the most common infectious agent causing osteomyelitis in all species?

- Foals: enteric G-ve organisms
- Small animals: Streptococcus spp.


What is the most common cause of orthopaedic infection in dogs and cats?

Bites, trauma


What are the most common infectious agents causing osteomyelitis in dogs and cats?

Trauma: Staph, Strep
Bite: Pasteurella


What is the most common cause of orthopaedic infection in farm animals (sheep and cows)?

External and internal traumatic events to joints and bones


What is the most common infectious agent causing osteomyelitis in farm animals?

Actinomyces pyogenes (may or may not be combined with anaerobes)


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


What are the most common infectious agents causing osteomyelitis in adult horses?

- Injection: Staph
- Trauma: mixed, Enterobacteriaceae,
- Implant: mixed Enterobacteriaceae, Staph, Strep


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


What are the most common infectious agents causing osteomyelitis in birds?

- Coagulase positive Staphylococci
- Mycoplasma synoviae
- E. cecorum


What pathogens are involved in turkey osteomyelitis complex?

E. coli, Staph aureus, S. hyicus


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


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


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


Briefly describe the radiographic appearance of late/advanced osteomyelitis

- Bone lysis and demineralisation
- Periosteal proliferation
- Areas of sequestration
- Remodelling of cortex and endosteum


What other problems/complicating factors may be present in a case with osteomyelitis?

- Implant involvement
- Articular surface destruction/joint involvement


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


How would you identify fungal osteomyelitis and where does this usually occur?

- Coccidiomycosis: diagnosis using Sabourauds medium at room temp, culture from granulomatous lesion
- Blastomycosis


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


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


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.


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


Which antibiotics are commonly used for the treatment of osteomyelitis in birds?

- Cephalosporins
- Fluoroquinolones
- Lincomycin + clindamycin
- Metronidazole
- Amoxy-clav


Identify the antibiotics that should be avoided in neonates

- Chloramphenicol
- Tetracyclines
- Aminoglycocides
- Fluoroquinolones


List the indications for surgical intervention in cases with osteomyelitis

- Fracture
- Periosteal stripping
- Sequestrum


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


What are the common indications for tail amputation in mature dogs?

- Traumatic skin loss
- Ischaemia
- Denervation


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


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


List the main causes of lameness originating in the bones of the metacarpus/tarsus of small animals

- Hypertrophic osteopathy
- Osteoarthritis
- Luxations (single/multiple)
- Sesamoid disease -


Identify sesamoid diseases in small animals

- Fractured sesamoids
- Sesamoid disease of young dogd
- Bipartitie/tripartite sesamoids


What commonly occurs concurrently with luxations of the metacarpal/tarsal bones?

Multiple sesamoid ligament failures


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


Outline the management of metacarpal/tarsal shaft fractures

- Surgical
- If not surgical, manage in splinted bandage
- Monitor radiographically


What is the main consequence of metacarpal/tarsal distal condylar fractures?

Leads to instability of MCP/MTP joint, as collateral ligament attaachments are affected


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


What is the normal degree of flexion of the MCP/MTP joint?



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


Outline the diagnosis of sesamoid disease of young dogs

- Exclusion of other problems
- +/- nerve blocks


Outline the treatment of sesamoid disease in young dogs

- Neutraceuticals
- Conservative management i.e. physiotherapy


Outline the presentation and treatment of bipartite/tripartite sesamoids in dogs

- Loss of flexion, swelling but no pain
- Incidental finding
- No treatment


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


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


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


What treatment is recommended for fractures of P3 in dogs?

Distal P2 amputation unless simple fracture of ungual process


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


List potential causes of lameness originating in the bones of the digits of small animals

- Fractures
- Luxations/subluxations
- Osteoarthritis
- Osteomyelitis
- Neoplasia
- Trauma
- Digital amputation


What are the indications for digit amputation in small animals?

- Neoplasia e.g. SCC
- Chronic infection
- Osteomyelitis
- Severe trauma
- Biopsy of P3


When does digit amputation lead to lameness in small animals?

- When >2 digits removed
- Either of the central 2 digits amputated


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)


How should gangrene of the digits be treated in small animals?

- Debridement/amputation
- Antibiotics if secondary infection


Compare the presentation of acute vs. chronic tenosynovitis of the DDFT in small animals

- Acute: 100% lame
- Chronic: mild lameness


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


Outline the treatment of incomplete rupture of the DDFT

Exercise with NSAIDs may allow faster resolution


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


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


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


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


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


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


What are the causes of interdigital draining sinus tracts?

- Interdigital foreign bodies
- Deep pyoderma
- Demodiscosis
- Sterile pyogranulomata


Which breeds are predisposed to interdigital draining sinus tracts?

- Brachycephalics
- Heavy breeds e.g. bulldogs


Which breeds are predisposed to sterile pyogranulomata in the interdigital space?

- Bulldogs
- Great Danes
- Boxers


Explain the cause of interdigital sterile pyogranulomata

- Reaction to intradermal keratin
- Associated with walking on haired skin due to poor conformation, licking feet


How is sterile pyogranulomata diagnosed?

- Biopsy supportive but not definitively diagnostic
- Rule out parasites and infection (repeatedly negative tissue culture)


Outline the treatment of sterile pyogranulomata

- Careful use of glucocorticoids or ciclosporin
- Fusion podoplasty as last resort


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


Which parasitic infections may affect the haired skin of the paws of dogs?

- Demodicosis
- Harvet mite
- Hookworm


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


List the neoplasias that most commonly occur on the paws of dogs

- Melanoma
- Fibrosarcoma


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


Where does claw growth occur from?

Claws grow out from corium at ungual crest, very close to epidermis


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


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


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


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


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


What does paronychia mean?

Inflammation of claw fold and claw bed