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VetMed Year 4- Term 1 > WEEK 4 LOCOMOTION- DJD > Flashcards

WEEK 4 LOCOMOTION- DJD Flashcards

1
Q

How does the function of Type A and Type B synvoicocytes differ?

A

Type A: Macrophages- phagocytic function Type B: formation of Synovial fluid

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2
Q

Bone changes with osteoarthritis

A

-New bone formation -Bone lysis

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3
Q

Where does Pain come from is DJD / Osteoarthritis

A

->No pain receptors in cartilage. ->Pain receptors in joint capsule. Synovitis/ Joint Distention. ->Exposure of subchondral bone

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4
Q

Mechanism of NSAIDs in treatment of OA

A

Inhibition of cyclooxygenase pathway/ prevent prostaglandin synthesis - Decrease synovitis - Reduce cartilage degradation Side effects: Nephritis/ GI ulceration Negative influence on cartiladge/ bone metabolism

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5
Q

Phenylbutazone routes of administration

A

IV/ PO

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6
Q

Why is intraarticular corticosteroids more effective than NSAIDs at treating osteoarthritis

A

Corticosteroids. Mechanism: Inhibit prostaglandin synthesis (block phospholipase a2/ cycloosygenase pathways) INHIBITS SYNTHESIS OF CARTILAGE-DEGRADING CYTOKINES (TNF-alpha) Inhibits cartilage - degreading enzymes (metalloprotinases)

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7
Q

Which drugs have a negative effect on cartilage healing and metabolism

A

NSAIDs/ Corticosteroids

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8
Q

How do Glycosaminoglycans work?

A

Horses Mechanism: 1. MMP inhibition (also inhibited by corticosteroids) 2. Stinulates HA production 3. Stimulates matrix synthesis

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9
Q

Cartrophen works via

A

Glycosaminoglycans (GAGs) 1. MMP inhibition 2. Stimulates HA production 3. Stimulates matrix synthesis

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10
Q

Surgical treatment of osteoarthritis

A

Athrodesis. Surgical formation of joint aka ankalosis

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11
Q

Synovial fluid from the right carpus of a 5 year old FN Weimaraner, one of several effused joints shows lots of neutrophils. Most likely Diagnosis

A

Weimaraners are one of the breeds in which polyarthritis-meningitis syndrome has been reported (although it may be seen in many breeds). Therefore neck pain may also be present. The CSF may also show neutrophilic inflammation. INFECTIOUS DISEASE MAY ALSO LEAD TO POLYARTHRITIS

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12
Q

Infectious diseases may also lead to polyarthritis, and may consider testing for these,

A

Erlichia and Borrelia. If considering Rhumatoid arthritis then ANA test (SLE)

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13
Q

Sites for Osteosarcoma

A

Proximal humerus, distal radius, distal femur and proximal and distal tibia in dogs. Cats have no preferential sites. Heads in horses and cattle. DOGS: LARGE/GIANT BREEDS ARE PREDISPOSED

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14
Q

Cranial cruciate rupture signs on radiograph

A

Positive Cranial Draw. Osteophyte formation in distal aspect of the patella, fabellas, proximal tibia and femoral trochlea. Joint effusion.

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15
Q

Flattening of the caudal aspect of the humeral head in a lame 7 month old Newfoundland is indicitive of

A

Osteochonrosis dessicans

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16
Q
A

Comminuted fracture

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17
Q
A

Avulsion fracture.

Differentiate between Oblique fracture and Spiral fracture

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18
Q

Which type of fractures are a) easy to neutralise with a cast b) difficult to neutralise witha cast

A

a) Easy to neutralise with cast: Bending/Rotational forces
b) Compression/Shear are difficult to neutralise.

Olecranon fractures/ Fractures of greater trochanter difficult to control with cast (use sling)

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19
Q

Distraction forces are caused by muscle _____ and poorly neutralised by external coaption. What is the best way to neutralise?

A

Olecreanon fractures/ Fractures of greater trochanter.

Sling to decrease weight bearing, reduce muscle tension, reduce tension forces.

Compression/Shear also difficult to neutralise with a cast

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20
Q

Basic guidelines for coaptation with regard to joints

A

Joints above and below have to be immobalised therefore can’t be used above stifle/ elbow

Spica splints to immobalise hip/shoulder

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21
Q

If using a cast to support internal fixation when should it be done?

A

3-5 days, less swelling reduce before place cast.

Immediately post surgery use robert jones swelling to decrease swelling

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22
Q

Number of neutrophils in a) normal joint b) degenerative joint disease in arthrocentesis

A

a) normal joint <5%
b) Degenerative joint disease <10%

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23
Q

Treatment of Septic arthritis in a) small animal b) horse

A

a) Small animal: Amoxicillin / Clavulanitc acid (6 weeks) 94% will resolve. Medical just as good as Surgery
b) Horse: ACUTE INFECT = EMERGENCY. Mostly caused by iatrogenic. Eliminate organisms from joint. Intra-articular- Penicillin and Gentamycin. Also oral AB. Resample every 48 hrs.

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24
Q

How does Aetiology of IMPA and IMPA (Erosive) differ?

A

IMPA:

Ag/ab complex [page21image1368] formation of inflammatory products

Host IgG and M bind to altered autologous IgG

Ag/Ab complex deposited on synovium neutrophil/macrophage chemotaxis

IMPA EROSIVE:

Cellular or humoral immunopathogenic factors

Release of chondrodestructive collagenases/proteases

Failure of self-tolerance or production of immunogenic immunoglobulins

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25
Immune mediated arthritis is what type of hypersensitivity reaction
Type III. Immune-complex formation
26
Synovial fluid analysis is negative for culture- what is the diagnosis?
Synovial fluid analysis can help distinguish septic arthritis (+ve culture) from immune-mediated HOWEVER NEGATIVE CULTURE does not mean sterile (50% will have -ve culture but septic arthritis) Degenerate neutrophils= septic Non-degenerate= immune mediated
27
Difference between Type I and Type IV hypersensitivity reactions
Type I: Immediate/ anaphylactin reaction. IgE--\> mast cells Type IV: Cell-mediated/ delayed type reaction . Type II: Ab-dependend (IgG or IgM against cell surface component)
28
Arthritis in 1 joint likely to be...
Septic arthritis,. Immune-mediated arthritis is more likely to be polyarticular i.e. 6+ joints. or pauciarticular (2-5) VERY RARELY MONOARTICULAR
29
4 types of Non-erosive polyarthritis
Type I: uncomplicated idiopathic 50% Type II: Associated with remote infections (reactive) e.g. endocarditis Type III: Associated with GI disease/ hepatic Type IV: Associated with remote neoplasia Signs often most severe in Type I, II and milder in III, IV Reactive polyarthrtisis = Type II, III, IV
30
4 other causes of non-erosive polyarthritis
1. Systemic Lupus Erythematous 2. Lyme Disease (Borrelia) 3. Doberbmanns + Sulphonamides 4. Calcivirus 5. Steroid responsive meningitis-arthritis 6. IBD 7. Immune-mediated
31
Pathogenesis of Erosive arthritis
On radiography = collapse of joint space. Chronic synovitis leads to production of proliferative granulation tissue = pannus Pannus invades articular cartilage and can erode sub-chondral bone. Pannus + inflamed synovium produce enzymes including proteases/collagenanses = further joint destruction. Similar changes to septic artheritis
32
Examples of erosive joint diseases
1. Rheumatoid arthritis 2. Periosteal proliferative polyarthritis in CATS 3. Polyarthritis of Greyhounds (Felty's Syndrome) 4. Felty's Syndrome (RA, splenomegaly and neutropenia)
33
Felty's Syndrome
Rhematoid arthritis Splenomegaly Neutropenia
34
A dog has raised RF, what test is used to differentiate between rhumatoid arthritis and SLE (both cause increase in RF)
Anti-nucelar antibody test (ANA) +VE in SLE Deposition of immune complexes in the skin Skin lesions Symmetric or focal skin lesions - redness, scaling, ulcers, depigmentation, and/or hair loss Ulceration of mucocutaneous junctions and oral mucosa may develop TYPE III immune complex formation
35
Disease-modifying antirheymatic drugs
lefunomide, methotrexate, gold therapy= treatment for Rheumatoid arthritis = erosive TYPE iii immune complex formation
36
Mainstay of treatment for polyarthritis (immune-mediated)
Prednisalone - taped dose. Initially 2-4mg/kg daily. +/- cytotoxic drugs (bone marrow suppression) cyclophosphamide (haemorrganic cystitis in cats) azothioprine (not cats)
37
Monitoring of treatment for im polyarthritis
Response often within 7 days. Substanial decrease in WBCs/ neutrophils is a good prognostic indicator 4 types: 1: uncomplicated idiopathic 2. associated with remote infections 3. associated with gi disease/ hepatic 4. associated with remote neoplasia
38
Crystal based arthritis treatment
Main Ddx for reptiles/ birds(lack enzyme) Tx: Fluid therapy, avoid meds that increase renal excretion
39
Indications for Femoral Head and Neck Excision (FHNE)
Hip dysplasia (juvenile pain) Intractable osteoarthrits / DJD Femoral head and neck fractures/ acetabular fractures Persistant luxation Legg-Calve0Perthes disease (avascular necrosis of the femoral head)
40
Best outcome post FHNE surgery is achieved in dogs \<
Dogs \<30kg = best prog. Some restriction in ROM will affect FULL athletic performance. Aftercare vital to outcome: early return to CONTROLELD exercise (analgesia, physio, hydro) GENERAL PRACTICE PROCEDURE,.
41
Surgical technique for FHNE
Want to remove removal neck as well. Leave LESSER TROCHANTER (as Ipsilosoas m. inserts here)
42
Ideal patient for total hip replacement
Skeletally mature, large breed dog (\>20kg) Sensible, well trained dog £4000 CAGE REST FOR 6 WEEKS POST-OP (c.f. FHNE exercise encouraged)
43
How does the aftercare vary between Total Hip replacement and FHNE surgery?
Hip replacement: 10% severe complications, CAGE REST FOR 6 WEEKS. FHNE: Low risk of minor Cx. Activity encouraged asap. Function: THR= EXCELLENT/ NORMAL (\>30kg) FHNE: Reduced but acceptable (\<20/30kg)
44
Mechanically it is better to loose a ____ limb
Better to loose a pelvic limb rather than thoracic limb. BEFORE AMPUTATION- CHECK CONTRALATERAL LIMB IS HEALTHY!! - Neoplasia - Trauma (ischemia) - paralysis (brachial plexus avulsion) - Unmanageable joint condition - Client finances
45
Why is it better to loose a pelvic limb than thoracic limb
Thoracic limb: 60% weight bearing Pelvic limb: 40% weight bearing Better to loose pelvic limb. Before amputation CHECK CONTRALTERAL LIMB IS HEALTHY
46
How does amputation site differ in cows from small animals
Cattle: Proximal interphalangeal joint with cartilage removal in cattlwe Digtal p1 or p2 in small animal.
47
Bog Spavin = Tx=
Laymans terms for osteoarthritis in horses Most common cause of HL lameness in horse ``` Tx: Intra articular corticosteroids (methylprednisalone acetate)- not cartilage friendly! Consider arthrodesis (ankalosis) x= ```
48
Presentation of common calcanean tendon injury. Which breeds are predisposed
Dobermans / German Shepherds are predisposed. Extended stifle and Hyperflexion of digits
49
Common calcaneal injurys Extension of stifle Hyperflexion of digits = pathopneumonic for common calcanean injury Dobermans / GSDs
50
How many patella ligaments do horses have
3. medial, middle and lateral
51
Dog with CrCL tear prognosis for contralateral limb
40-60% will develop tear in contralateral limb. Majority have concurrent medial meniscal damadeg
52
Treatment for CrCL damage
Do not try and fix ligament as already too damaged. Have to change biomechanisms of knee joint i.e. osteotomy (bone cut) techniques to affect quadricep mechanics. Tibial Plateau Leveling Osteotomy (TPLO) involves making a circular cut around the top of the tibia and rotating its contact surface (tibial plateau) until it attains a near level orientation (approximately 90 degrees) relative to the attachment of the quadriceps muscles (Figure 2). This renders the knee more stable, in the absence of the CrC
53
Two surgical techniques for CrCL damage
TPLO or Tibeal Tuberostity Advancement (TTA) or suture https://www.acvs.org/small-animal/cranial-cruciate-ligament-disease
54
Target for % lameness in cow herd
\<5% (but majority of farms ++++)
55
Most common foot lesion affecting cows feet
30% sole ulcers 22.5% white line disease Digital dermatitis
56
Score 0 dairy cow
Walks with even weight bearing and rhythm on all four feet, with a flat back. Long fluid strides C.F. Score 1: Steps uneven, shortened strides
57
Score 2 cow mobility
uneven weight bearing on a limb that is immediately identifiable and/or obviously shortened strides (usually with an arch to the centre of the back)
58
Cow walks swinging right hind leg through much quicker than left hind. Cow is probably lame on \_\_\_\_
Lame on contralateral limb to the one being swung through quickly. Cows moves limb through quickly to take weight off lame limb.
59
In score 2 cow the dew claws of the hind limb will sink low on the \_\_\_\_limb
Dew claws will sink lower when weight is placed on the healthy limb (more weight bearing) when compared to affected limb
60
Score 3 cows
Walk slower than walking speed. Can't keep up with herd.
61
90:90:90 rule
90% lameness hind , 90% feet, 90% lateral
62
Dutch 5 step foot trim
1. Create foot angle of 52 degrees 2. Create balance between claws 3. Transfer weight from sole onto wall, toe and heal 4. Remove weight from painful claw 5. Remove loose/ sharp horn
63
Step 1 of Dutch 5 step foot trimming technique is to create an angle of
52 degrees, Measure 7.5cm from cornary band (cut 1) Cut 2: Trim sole until white line just appears at tip of toe (5-7mm step at toe)
64
Which claw to start on for step 1 Dutch foot trim
Start at most normal claw. Inner hind claw Outer fore claw Cut 1: 7.5cm Cut 2: 5-7mm step at toe
65
Haemorrhage in horn is roughly ___ months historic
Hamorrhage in the horn is roughly 2 months historic.
66
When would systemic antibiotics be indicated for sole ulcers?
Normally just topic. If swelling above coronary band systemic antibiotics are indicated
67
What causes sole ulcers?
Laminitis is a controversial foot condition in cattle. Acidosis does not appear to directly cause claw horn lesions. Most claw horn disease STEMS FROM ENVIRONMENTAL CONDITIONS. Body condition score and claw horn growth rates may be important in sole ulcer pathogenesis. Biotin may improve claw horn quality
68
What two things are thought to decrease sole ulcers
1, Biotin 2. Feeding higher dry matter intake (much probably due to drier drug) i. e. ENVIRONMENTAL
69
Why are sole ulcers more likely around calving?
Decreased digital cushion (comprised of fat therefore decrease BCS = no digital cushion) Poor foot angle, trauma, more growth, less weear. Treponemes???
70
Exostoses
Caused by chronic injury/ damage Calcification on the surface of bone Potential aetiology of Sole ulcer (with loss of fat pad, loss of laminar suspetion around calving, poor foot angle)
71
Pathogenesis of White Line Disease
Soft claws during high rainfall? Loss of fat pad Thin soles Rough, stoney tracks Brusing from long standing times Sharp turns on concrete Sequalae: wall ulcers
72
White line disease. Biotin deficiency, soft claws during high rainfall,
73
Aetiology of Digital dermatitis
Three familys of Treponeme, gaining entry through hair follicles. Sequale: interdigital hyperplasia.
74
Digital dermatitis scoring
M1: Ulcerative (\<2cm) M2: Ulcerative (\>2cm) M3: Regressing M4:.1 Reactivating M4: Hyperkaratotic
75
DD treatment (M1,M2,M3,M4)
M1: Clean,dry, topical oxytet for 3 days M2: As above but debride and consider bandaging M4: Debulk/Debride under local, badage with antibacterial
76
Foul in the foot
An acute bacterial infection of the subcutaneous tissues characterised by symmetrical swelling, separation of the claws and interdigital skin necrosis yielding a pungent odour Fusobacterium necrophorum
77
Aetiological theories for Foul-in-foot
1. Fusobacterium necrophorum 2. Foreign body through skin. Sequale: interdigital hyperplasia
78
Procedure for cow claw amputation
Should be culled? Barren? Sound medial claw? Tornique Block (procaine/ antibiotics) 1. Incise into interdigital space 2-3cm 2. Embrotomy wire up and obliquly outwards 3. Melolin pressure bandage 4. Redress every 48 hours, 96 hours, 7 days then leave open 5. BLOCK UNAFFECTED DIGIT (NORMALLY MEDIAL UNAFFECTED)
79
Which local anaesthetic is licenced for a) cows b) horses
a) cows= procaine ((adrenocaine) b) horses= lidocaine
80
Claw amputation needs to be done proximal to \_\_\_
If can't find vein tornquie prox to hock = bigger veins Want to amputate prox to P2 otherwise will cut off blood supply and form a sequestrum
81
Causative agent of lameness in a) piglets b) growers
a) 2days to weaning = arthritis (dog sitting)- e coli, staph, strep) Bacteriology from PM - penicillin/ampicillin/lincomycin b) Growers: Osteochondrosis dessicans/ infectious (mycoplasma hyosynvovia, erisepothrax)
82
Sheep Scald
Interdigital hyperplasia. Red, wet interdigital space. Loss of hair in interdigital space. Primarily caused by Fusobacterium necrophroum (presence in faeces)
83
Foot rot requires what extra bacteria?
D. nodosus CODD is caused by treponemes Toe Granuloma normally iatrogenic (farmers + vets)
84
The risk of scald progressing to footrot is determined by...
Whether D.nodosus is on the farm The virulence and dose of the D.nodosus The susceptibility of the sheep Whether the sheep is treated promptly before separation of the hoof horn occurs ROUTINE TRIMMING NOT REQUIRED
85
Management of foot rot and scald
The most important action is the early treatment with parenteral antibiotics and a topical spray, with NO foot trimming
86
Treatment of Footrot
Oxytetracycline spray a clean foot Long acting parenteral antibiotic • Oxytetracycline • Amoxicillin Allow sheep to stand on clean concrete Clean up the area Ideally isolate the sheep 14 days Prognosis: 90% recover in 5 days
87
Treatment of Scald
Ewes: Treat as footrot Lambs: Oxytetracycline spray, stand in clean area and re spray5 days if nec
88
When to cull sheep with scald/ footrot
If still lame after 2 antibiotic treatments or if misshaped claws
89
Footbathing concentration for a) ZnSO4 b) Formalin c) CuSO4
a) ZnSO4: 10% \> 2 mins standing b) Formalin: 3% c) DON'T USE Stand sheep for 1 hr afterwards
90
Aetiotogy and Treatment of Contagious Ovine Digital Dermatitis
Same treponemes that cause bovine digital dermatitis. Use Tilmacosin (Mycotil) Footbath: Lincomycin / Tylocin
91
Where does the cranial cruciate ligament run?
The cranial cruciate (red) runs from proximal and lateral to distal and medial, the caudal cruciate runs in the opposite direction
92
How long for ligament damage to regain a) 50% of original strength b) 90% of strength
50%: 6 weeks 90%: 1 year
93
Post operative care for CCL repair
No hydrotherapy initially. Lead walks for 6-8 weeks. Cold packs
94
Vitiligo
Hypopigmentation c.f. Lentigo = hyperpigmentation
95

VetMed Year 4- Term 1 (12 decks)

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