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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
Q

Soft tissue imaging

A

Reduced size
-Atrophy focal
-Weight loss general
Increased size
-Focal - trauma, abscess, neo, granuloma
-Diffuse - oedema, cellulitis, neo

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24
Q

Periosteal reaction (bone surface)

A

Benign -> aggresive
Smooth
Rough
Palisading
Spicular
Sunburst
Amorphus

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25
Q

Aggressive lesions

A

Transition zone - long
periosteal reaction - active
Cortical integrity - destruction/ expand
Soft tissue swelling

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26
Q

Category of skeletal lesion distribution

A

Monostotic
Polyostotic (multi bones)
Focal
Generalised
Sym
Asym

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27
Q

Joints images

A

Soft tissue swelling
Joint space width
Subchondral bone opacity
Osteophytes
Periarticular mineralisation

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28
Q

Predilecation sites of ortho lesions

A

Osteochondrosis
-Cd Humeral head, Md humeral condyle
-Lt femoral condyle, Md trochlear ridge
Osteosarcoma
-Prox humerus, distal radius/ ulna
-Distal femur, prox. tibia

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29
Q

CE stifle

A

Cranial drawer
Tibial compression test
Dx- Hx, CS, xray, arthrocentesis

30
Q

Stifle problems

A

Dev- osteochondrosis, patella lux
Trauma - Ruptured lig, F#, avulsion
Acq - OA, Neo, cruciate Dz

31
Q

CCL

A

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
Q

Meniscal injury

A

Medial more common
Sx removal if persistent lameness

33
Q

Patella luxation

A

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
Q

Osteochondrosis

A

Uncommon (male labs)
Femoral condyle
Joint mouse/flap -> osteochondrosis dissecans
CS- lame >5m, bilateral crouch, joint effusion
Dx- Hx, CS, radiography

35
Q

Elbow dysplasia

A

Elbow incongruity
Fragmentation of medial coronoid
OCD of medial humeral condyle
Ununited anconeal process

36
Q

Elbow incongruity

A

Short radius- premature closure of GP
Short ulna- premature closure distal ulna physis
Bone lengthening - osteotomies

37
Q

Medial coronoid Dz

A

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
Q

Osteochondrosis/ itis

A

5-8m old
CS- lame + joint effusion
Dx - radiography
Disturbance of endochondral ossification
Tx- cartilage flap removal and debridement

39
Q

Ununited anconeal process

A

Male Basset, GSD, 5-12m
Joint incongruency - short ulna
CE- FL lame, large effusion
Dx- flexed mediolateral view
Sx- remove anconeal process

40
Q

Incomplete ossification of the humeral condyle (IOHC) or Humeral Intracondylar Fissure

A

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
Q

Common instabilities

A

Hip luxation
Carpal hyperextension
Tarsal instability
Digit luxation
Bicep tendinopathy

42
Q

Carpal hyperextension

A

High rise fall, degeneration (border collies)
Dx- CE, radiographs
Tx- Sx

43
Q

Gastrocnemius enthesopathy

A

Large breed
Thick achilles
Plantigrade stance
Sx don’t bandage

44
Q

Digit luxations

A

Common at each level
Stable - reduce and splint to secure
Unstable - Sx
Amputation of digit
Ungunal crest ostectomy

45
Q

Hip conditions

A

Dev- Hip dysplasia, Legg-Perthe’s Dz
Trauma- F#, coxofemoral luxation
Acq- OA, Neo, Imm mediated arthropathy

46
Q

Hip dysplasia

A

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
Q

Legg Calve Perthe’s Dz

A

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
Q

Coxofemoral luxation

A

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
Q

F# forces

A

Bending
Torsion
Compression
High energy
Bending and axial compression

50
Q

Implants

A

Plates and screws
External skeletal fixators
Pins and wires

51
Q

Plates and screws

A

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
Q

IM pin

A

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
Q

F# repair assessment

A

Apparatus
Alignment
Apposition
Activity

54
Q

Articular F#

A

Always Sx
Need rigid internal fixation

55
Q

Diaphyseal F#

A

Cast (below elbow/ stifle)
Robert Jones bandage (short term)

56
Q

Femoral head and neck F#

A

Capital and Capital physeal
Femoral neck
Greater trochanter

57
Q

Pelvic F#

A

Parts - SI junction, weight bear axis, acetabulum
Cd to acetabulum ignore

58
Q

Distal humeral condylar F#

A

young may be weight bearing
Trauma may be mild
Any crepitus -> radiograph
Sx normally indicated (articular F#)

59
Q

Distal radial F#

A

Blood supply poor in toy breeds
Plate best solution
Takes 6m to heal (other implants won’t last that long)

60
Q

Mandibular symphyseal separation

A

Cats after falling
Mandibular canines misaligned
Dx- Radiographs +/- CT
Tx- Muzzle, wire

61
Q

Foot main conditions

A

F#
Luxations
pad injuries
FB
Nail injuries
Sesamoid Dz

62
Q

Corn

A

Focal hyper keratosis
Thickening of hard pad, excess keratin
Tx- hulling out
-often recur

63
Q

Superficial digital flexor tendonectomy

A

Removal of >1cm of tendon
Originally done when adjacent digit had FT/ missing

64
Q

Foot F# MT/ MC

A

Single- Tx w/ external coaption
Multiple- internal fixation
Check viability (soft tissue injuries

65
Q

Toe amputation

A

Single digit well tolerated
Ind- severe luxation, neo, F#

66
Q

Bone Dz

A

Paraneoplastic
-Marie’s (hypertrophic osteopathy)
Dev
-Panosteitis
-metaphyseal osteopathy
-Craniomandibular osteopathy
Nutrition
-Nutrition 2° Hyper ParaThy
-Renal 2° Hyper ParaThy

67
Q

Panosteitis

A

CS- shifting lameness
Ac onset, FL predominantly (U&R)
Dx- radiography
Tx- self limiting, analgesia

68
Q

Metaphyseal osteopathy

A

Young and rapid growth (6m-2y)
Inh Imm Def (weimeaaner)
Varied severity
Dx- Sig, CS, Radiograph
Tx- self limiting, analgesia

69
Q

Craniomandibular osteopathy

A

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
Q

Marie’s Disease

A

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
Q

Nutritional 2° hyperparathyroidism

A

Aet- high P:Ca diet young
CS- lameness, skeletal pain, swollen metaphysis
Dx- Hx, radiography (warped skeleton)
Tx- correct diet, Ca supplementation, NSAID

72
Q

Ligament injuries

A

1st°- minimal tearing
-NSAIDs
2nd°- partial rupture, haemorrhage and oedema
-support bandages 1m
3rd°-complete rupture/ avulsion
-Sx repair (monofilament)

73
Q
A

Neurology (25 decks)

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