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Neurology > Dermatology & Ortho > Flashcards

Dermatology & Ortho Flashcards

1
Q

Canine atopic dermatitis (CAD)

A

Genetically predisposed inflammatory and pruritis skin Dz
Ass with IgE
Common allergens
-dust mites, pollen, mould spores, food
Dx Env/ food induced
No detectable allergens
-Atopic like dermatitis

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2
Q

CAD pathogenesis

A

Cutaneous inflammation and pruritus
Defective skin barrier function
Microbial colonisation
- more staph
Other flares

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3
Q

Type 1 hypersensitivity

A

IgE bound to Mast cells
Allergen bound by IgE causes mast cell degranulation
This causes inflammation
-histamine, PG, IL

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4
Q

T IV hypersensitivity

A

Allergen peptides presented to T cells by langerhan cells
Induce clonal expansion
Tcells make pro-inflammatory cytokines (IL4, 13, 31)
B cells produce IgE

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5
Q

CAD Dx

A

Compatible hx
CS
Exclusion of Ddx
No pathognomonic signs

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6
Q

CAD CS

A

Pruritus
1° lesion- erythema and papules
2° lesion- otitis, lesions due to pruritus, alopecia, saliva staining, lichenification

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7
Q

Favrot criteria

A

Onset of CS <3y/o
Dog outdoors alot of the time
Responds to glucocorticoids
Pruritus sine materia
Affects front feet/ pinna
Non affected ear margins
non affected dorso lumbar area

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8
Q

Pruritus Ddx

A

Ectoparasites-
-Sarcoptes, cheyletiellosis, fleas
Allergic skin Dz-
-CAD, contact dermatitis
Microbial infection-
-Bac pyoderma, Malasezzia
Other
-Pemiphigus foliaceus, epithuliotropic lymphoma

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9
Q

Food allergy terminology

A

AD- Atopic dermatitis (sensu strictu)
NFIAD- Non-food induced AD
>+ve Ag specific IgE tests (AD)
>-ve Ag specific IgE tests (Atopic like dermatitis)
FIAD- Food induced AD
> Immune mediated food allergy
>Non-immune medicated food intolerance

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10
Q

FIAD

A

Maltese-beagle X, Westie, Boxer
Dx- elimination diet, no seasoanlity
-IgE X reactions
Hydrolysed protein diets-
-Assumes T I Hyper sensitivity

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11
Q

Food trials

A

Minimum 6 weeks
Challenge in face of improvement
Use diary
Steroids initially to lower 2° inflammation

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12
Q

AD summary

A

Compatible history and clinical signs
Favrot’s criteria (use as a check)
Exclude all differential diagnoses
-Ectoparasites, other allergies (food, fleas) and secondary
- infections (pyoderma, yeast)
Serology or intradermal tests if ASIT an option for management

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13
Q

Tx of CAD

A

Improve skin barrier
Allergen avoidance and AIT
Control inflammation and pruritus
Control flare factors

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14
Q

Improve skin barrier function

A

Reduce transepidermal water loss
Reduce exposure to environmental allergens and irritants
Reduce microbial colonisation and inflammation
Tx-
Non irritating shampoos
Topical moistures and emollients
Supplementation with oral/ topical EFA (essential fatty acids)

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15
Q

Allergen avoidance and allergen immunotherapy

A

Preventative therapy
Desensitisation to environmental allergens via induction of tolerant state in peripheral T cells
Allergens- Dust mites, mould spores, pollen (seasonal)
AIT-
Administration of gradually increasing quantity of allergen
Ameliorate CS
Allergen intradermal testing to ID specific allergens
Trial over 12m

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15
Q
A
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15
Q

Anti inflammatory and pruritics

A

Restoration of normal skin environment
Glucocorticoids- Sys-Preds, Top-betamethasone
-Avoid sole therapy (Sys)
Calcineurin inhibitors- inhibit T lymphocytes

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16
Q

Imaging indications ortho

A

Ac/ Chr lameness
Joint/ skeletal pain
F# suspicion/ characterisation
Bone swelling
Evaluate systemic Dz

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17
Q

Imaging examination

A

Correct region - CE, Hx, ortho exam
Best modality - Xray, US, CT, MRI, gamma scintigraphy
Technically competent - orthogonal 2 views 90° apart
Accurate interpretation

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18
Q

Radiography limitations

A

Geometric distortion (not parallel to cassette)
Oblique projection - artefactual lesion
Poor soft tissue resolution

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19
Q

Serial radiography

A

Monitor progression of Dz
Assess dynamic progression of Dz

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20
Q

Imaging exam basics

A

Deviation from normal appearance
Lesions accurately described in systematic fashion
Pertinent aspects of lesions appreciated from description
Ddx formulation
Contralateral comparison

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21
Q

Radiographic description

A

Number
size
Shape
Location
Opacity
(Roentgen signs)

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22
Q

Specific musculoskeletal assessment

A

Soft tissue (swelling/ loss)
Bones
-align, shape, periosteal reaction, physes, medulla
Joint- subchondral, swelling

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23
Soft tissue imaging
Reduced size -Atrophy focal -Weight loss general Increased size -Focal - trauma, abscess, neo, granuloma -Diffuse - oedema, cellulitis, neo
24
Periosteal reaction (bone surface)
Benign -> aggresive Smooth Rough Palisading Spicular Sunburst Amorphus
25
Aggressive lesions
Transition zone - long periosteal reaction - active Cortical integrity - destruction/ expand Soft tissue swelling
26
Category of skeletal lesion distribution
Monostotic Polyostotic (multi bones) Focal Generalised Sym Asym
27
Joints images
Soft tissue swelling Joint space width Subchondral bone opacity Osteophytes Periarticular mineralisation
28
Predilecation sites of ortho lesions
Osteochondrosis -Cd Humeral head, Md humeral condyle -Lt femoral condyle, Md trochlear ridge Osteosarcoma -Prox humerus, distal radius/ ulna -Distal femur, prox. tibia
29
CE stifle
Cranial drawer Tibial compression test Dx- Hx, CS, xray, arthrocentesis
30
Stifle problems
Dev- osteochondrosis, patella lux Trauma - Ruptured lig, F#, avulsion Acq - OA, Neo, cruciate Dz
31
CCL
Most common HL lameness -role in stifle joint stability 2 fct bands -Cr medial (ext, flex) -Cd lateral (ext) Partial rx then CM band goes CS- leg carried flex, stifle effusion, medial buttress, tibial compression test/ Cr drawer Dx- CE, Hx, radiography Tx- Cons-<15kg, restrict exercise (6wks) Sx- TPLO/ TTA (periarticular), intracapsular (OTT) Aftercare - re ex at 6/12wks
32
Meniscal injury
Medial more common Sx removal if persistent lameness
33
Patella luxation
Medial more common than lateral Grade 1-4 dogs (toy/ large) Intermittent/ frequent/ permanent/ permanent+no reduction Dx- Hx, CS, radiography Tx cons. -G2, less exercise and NSAIDs Sx- recurrent CS -reinforce lateral retianculum (STS) -deepen trochlear groove
34
Osteochondrosis
Uncommon (male labs) Femoral condyle Joint mouse/flap -> osteochondrosis dissecans CS- lame >5m, bilateral crouch, joint effusion Dx- Hx, CS, radiography
35
Elbow dysplasia
Elbow incongruity Fragmentation of medial coronoid OCD of medial humeral condyle Ununited anconeal process
36
Elbow incongruity
Short radius- premature closure of GP Short ulna- premature closure distal ulna physis Bone lengthening - osteotomies
37
Medial coronoid Dz
Multifactorial- genes, nutrition, males Disturbance endochondral ossification Mechanical overload -joint incongruity, high tensile force, shear stress Tx- analgesia and weight control Sx- fragment removal
38
Osteochondrosis/ itis
5-8m old CS- lame + joint effusion Dx - radiography Disturbance of endochondral ossification Tx- cartilage flap removal and debridement
39
Ununited anconeal process
Male Basset, GSD, 5-12m Joint incongruency - short ulna CE- FL lame, large effusion Dx- flexed mediolateral view Sx- remove anconeal process
40
Incomplete ossification of the humeral condyle (IOHC) or Humeral Intracondylar Fissure
Humeral condyle formed from two separate centres of ossification: *Fusion typically occurs @ ~12 weeks of age *Adult onset of clinical signs * Median 3 – 4.5 years (Ranges 5m to 9 years) * ?stress fracture aetiology *Spaniel breeds overrepresented *Up to 50% of French Bulldog LCF have HIF in contralateral limb IOHC VS HIF Sx- lateral screw placement (less SSI risk)
41
Common instabilities
Hip luxation Carpal hyperextension Tarsal instability Digit luxation Bicep tendinopathy
42
Carpal hyperextension
High rise fall, degeneration (border collies) Dx- CE, radiographs Tx- Sx
43
Gastrocnemius enthesopathy
Large breed Thick achilles Plantigrade stance Sx don't bandage
44
Digit luxations
Common at each level Stable - reduce and splint to secure Unstable - Sx Amputation of digit Ungunal crest ostectomy
45
Hip conditions
Dev- Hip dysplasia, Legg-Perthe's Dz Trauma- F#, coxofemoral luxation Acq- OA, Neo, Imm mediated arthropathy
46
Hip dysplasia
Lax and unstable hip joint (poor soft tissue cover) Large breed dog and Devon Rex cat Present - young, adult w/ 2° OA +ve Ortolani test Dx- Hx, CS, xray Early changes- note for triple pelvic osteotomy (TPO) Progressive- Morgan line on femoral neck Cons.- less exercise and weight, analgesia Sx- no response to cons. Tx -D/TPO young -juve pubic symphisoidesis -femoral head and neck excision adults -total hip replacement (ideal but ££££)
47
Legg Calve Perthe's Dz
Small breeds (WHWT) Ischaemia of femoral head bone -> deforms -> collapse Immature ~ 5m unilaterally lame Dx- pain and crepitus on hip manipulation -xray (frog leg and VD extended) Tx- Sx best - FHNE/ THR -rehab important
48
Coxofemoral luxation
Most common luxation Trauma in >1yr V. lame - leg flex (stifle out, hock in) Greater trochanter prominent Tx- closed reduction initially -re-lux - open reduction and stabilisation
49
F# forces
Bending Torsion Compression High energy Bending and axial compression
50
Implants
Plates and screws External skeletal fixators Pins and wires
51
Plates and screws
Dynamic compression plates, locking, specialised DCP- neutral, buttress, compression Non locking - bone plate friction for stability Lock - fixed angle, stability through screw and plate Adv- poor quality bone -Improved vascularity -Monocortical more stable Dis- no lag screw through plate Lag- static inergragmental compression, efficient compression
52
IM pin
Med-long simple oblique F# Use in combination Direct pin - normograde Indirect - retrograde As large as possible Adv- Good bend resistance Neutral bone axis Cheap Con be used in combination with other methods Dis- Poor rotation and shear resistance Interferes with medullary blood supply Hard in chondrodystrophic dogs
53
F# repair assessment
Apparatus Alignment Apposition Activity
54
Articular F#
Always Sx Need rigid internal fixation
55
Diaphyseal F#
Cast (below elbow/ stifle) Robert Jones bandage (short term)
56
Femoral head and neck F#
Capital and Capital physeal Femoral neck Greater trochanter
57
Pelvic F#
Parts - SI junction, weight bear axis, acetabulum Cd to acetabulum ignore
58
Distal humeral condylar F#
young may be weight bearing Trauma may be mild Any crepitus -> radiograph Sx normally indicated (articular F#)
59
Distal radial F#
Blood supply poor in toy breeds Plate best solution Takes 6m to heal (other implants won't last that long)
60
Mandibular symphyseal separation
Cats after falling Mandibular canines misaligned Dx- Radiographs +/- CT Tx- Muzzle, wire
61
Foot main conditions
F# Luxations pad injuries FB Nail injuries Sesamoid Dz
62
Corn
Focal hyper keratosis Thickening of hard pad, excess keratin Tx- hulling out -often recur
63
Superficial digital flexor tendonectomy
Removal of >1cm of tendon Originally done when adjacent digit had FT/ missing
64
Foot F# MT/ MC
Single- Tx w/ external coaption Multiple- internal fixation Check viability (soft tissue injuries
65
Toe amputation
Single digit well tolerated Ind- severe luxation, neo, F#
66
Bone Dz
Paraneoplastic -Marie's (hypertrophic osteopathy) Dev -Panosteitis -metaphyseal osteopathy -Craniomandibular osteopathy Nutrition -Nutrition 2° Hyper ParaThy -Renal 2° Hyper ParaThy
67
Panosteitis
CS- shifting lameness Ac onset, FL predominantly (U&R) Dx- radiography Tx- self limiting, analgesia
68
Metaphyseal osteopathy
Young and rapid growth (6m-2y) Inh Imm Def (weimeaaner) Varied severity Dx- Sig, CS, Radiograph Tx- self limiting, analgesia
69
Craniomandibular osteopathy
Non infl., non neoplastic proliferative bone Dz <1yr WHWT, scottie CS- mandibular swelling, can't Prehend Dx- Sig. CE, radiography Tx- support, self limiting
70
Marie's Disease
Hypertrophic osteopathy Sig- older (9yr) dogs and cats Aet- paraneoplastic Cs- lameness (over months), firm swelling Dx- radiography (new bone formation) Tx- symptomatic, remove 1° cause
71
Nutritional 2° hyperparathyroidism
Aet- high P:Ca diet young CS- lameness, skeletal pain, swollen metaphysis Dx- Hx, radiography (warped skeleton) Tx- correct diet, Ca supplementation, NSAID
72
Ligament injuries
1st°- minimal tearing -NSAIDs 2nd°- partial rupture, haemorrhage and oedema -support bandages 1m 3rd°-complete rupture/ avulsion -Sx repair (monofilament)
73

Neurology (25 decks)

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