MSK Flashcards

Question

elbow dysplasia - pathopahysiology

Answer 1

osteochondrosis of humeral condyle - failure of endochondrial ossification ununited anconeal process - failure of fusion of growth plate allows anconeal process to detach fragmented coronoid process - medial coronoid fragments due to fissuring under the surface radio-ulnar incongruity - step between radius and ulna instead of smooth gap can have any of these concurrently - complicated joint

Answer 2

lameness choppy forelimb gait effusion pain crepitus reduced range of motion

Answer 3

wedge recession block recession abrasion tibial tubercule transposition distal femoral osteotomy - dramatic

Answer 4

vargus - limb bending inwards valgus - limb bending outwards limbs turned in, knees out happens as they grow mild deformities - stall confinement more dramatic - may need surgery - perioteal stripping or transphyseal bridging corrective foot trimming prognosis affected by - age at intervention, degree of deformity, joint affected and time that growth plate usually fuses, what the horse needs to eventually do

Answer 5

P1 - long pstern - 2-3 months MC3 - cannon bone - 6-9 months distal radius - 9-12 months

Answer 6

2 types - osteochondrosis dessicans (OCD) - non loaded margin of high impact joints sub chondral bone cysts (SBC) - high load margins, cysts develop within the joint usually genetic with environmental factors circulation not getting to cartilage as well as it should in rapidly growing young animals cartilage doesn't develop how it should

Answer 7

cause - intrinsic or extrinsic open or closed - is skin breached extent of damage number of fractures position direction of fracture lines location forces acting on the fracture - affects stability after fixed involvement of other tissues - trapped nerves, vessels, soft tissues, puncture of organs age of fracture fracture geometry transverse - straight across oblique - line of break offset from right angle comminuted - multiple peices segmental - large segment blown out

Answer 8

most common small animal appendicular fracture access for surgery lateral - less vessels

Answer 9

usually distal of mid diaphyseal usually just repair radius little dogs jumping off things can sometimes just use external fixator if sides of fracture well opposed

Answer 10

high velocity injury access for surgery from medial side - tension side, skin tighter over bone, less muscles to go through external fixator may work if comminuted and open

Answer 11

physeal (growth plate) fractures S - straight across A - above (along plate then up) L - lower (along plate then down) T - through (cutting down through plate) ER - erasure of plate (crush) always damage to growth plate avoid putting in devices that compress or restrict bone lengthening - smooth k wires preferred

Answer 12

usually young dogs (3-10 months) and cats fracture across growth plate operate early, delayed action worsens prognosis

Answer 13

main growth plate is a complression plate but also a tension plate at tibial tuberosity (attachment for patellar ligament) need a tension wire so tibial tuberosity doesn't just pull off

Answer 14

common in cats wire it shut - occlude sides but don't overtighten and crush tissues take wire out after about 6 weeks can use heavy gauge PDS instead of wire so will absorb check no other jaw fractures before fixing

Answer 15

referral needs a significant impact, not easy to break multiple fractures check spine, bladder, sciatic nerve

Answer 16

primary - osteosarcoma - most common - make bone myeloma, lymphoma, chrondrosarcoma - don't make bone secondary - metastasis to bone - squamous cell cancinoma, lung-digit - more common than primary

Answer 17

agreesive osteoblast tumour large and giant breeds more in male than female middle aged to older usually appendicular poor prognosis needs amputation and chemo - amputation alone not enough 90% have micro mets at time of diagnosis

Answer 18

used in cases of untreatable fractures, chronic pain from degenerative joint disease, chronic luxation fuse the joint outcome dependent on joint

Answer 19

not too serious - can sever whole way and still go back to work usually from wound on front of leg unable to extend joint usually common digital and long digital extensor tendon robert jone bandage if knuckling forwards standard wound care good prognosis

Answer 20

potentially life threatening - major support structure for distal limb over reach injury severe lameness weight bearing can give indication which tendon risk of synovial sepsis Ultrasound to see which tendon SDFT - fetlock drops on weight bearing DDFT - toe off ground when weightbearing SDFT, DDFT and SL - toe off ground and fetlock drop treatment - immobilise limb debride wound treat synovial sepsis suture tendon ends - repair prognosis good for life but bad for function complete laceration - very poor prognosis synovial sepsis - very poor prognosis

Answer 21

foreign body insufficient drainage sequestrum keratoma laminitis quittor3

Answer 22

persistently draining tract at coronary band radiograph - classic sequestrum appearance (dead bone, black bit where there should be bone surround by involcrum) can lead to infection in pedal bone remove inciting cause for antibiotics to work

Answer 23

benign tumour - in keratinised tissue in hoof wall noticable circular structure (keratinisation) in white line on base of foot radiograph - circular radiolucent in P3 needs surgical removal good prognosis but can reoccur

Answer 24

mostly draught breeds draining above coronary band non healing wound infection of collateral cartilages --> necrosis needs surgical debridment antibiotics will hold it but if stop taking them draining will start again

Answer 25

sometimes pus separation of horn sections quite lame crumbling of hoof wall multifactorial - environmental, nutritional (biotin, calcium, vitamin A), mechanical (hoof maintenance), infection can usually diagnose from separation of white line aggressive debridement of hoof wall - remove enough but keep stable manage triggering factors

Answer 26

hobby breeds moist environment - predisposes to anaerobic bacterial infection (so bacterial but management related) hypertrophy of dermis of horn of foot shite soft moist tissue around heel and frog usually smells bad aggressive debridement needed will bleed a lot - needs lots of packing topical metronidazole astringents - dry out tissue address management issues - otherwise will reoccur

Answer 27

foot balance hoof wall joint collateral ligament digital cushion DDFT navicular bursa distal sesamoid ligament

Answer 28

lameness - chronic and intermittent inconsistent performance loss of suppleness - not moving as usual tripping or stumbling unwillingness to go forwards - more likely to canter than trot temporary improvement with rest

Answer 29

worse on hard surfaces worse when circling mild to moderate usually one limb worse decreased cranial stride

Answer 30

minimal external signs insidious or acute onset usually no digital pulse or swelling improves with rest then gets worse when back to work

Answer 31

usually a contributing factor address before looking to other ddx foot trimming

Answer 32

associated with navicular bone, bursa and soft tissues in that region middle aged competition horses bilateral shortened stride worse on hard surface resolves on rest then comes back insidious onset risk factors - upright conformation jumping working on hard surfaces radiograph - once signs visible usually quite advanced - abnormal synovial fossae, cysts in bone, osteophytes, decreased cortical meduallry definition

Answer 33

change foot balance - decrease heel pressure, maximise surface area for weight NSAIDs steroids into bursa stem cells - repair DDFT damage polyacrimide hydrogel - support and cushioning for navicular bone bisphosphonates surgery - remove section of palmar digital nerve so can't feel foot progressive, not curable manage pain and progression

Answer 34

unilateral forelimb lameness acute onset often can block with palmar digital nerve block usually only shows on radiograph if very chronic tear MRI best for diagnosis

Answer 35

DIP and PIP joints mild lameness loss of performance reluctance to move forwards nerve blocks to diagnose acute joint damage --> synovitis (rapid) --> osteoarthritis (ongoing damage)

Answer 36

worse when cicrcling will block with abaxial sesamoid nerve block usually acute MRI to diagnose

Answer 37

ossification of collateral cartilages --> extra bone formation at side of foot rarely causes lameness unless fracture causing inflammation or concurrent cause of lameness cob type horses

Answer 38

NSAIDs - chronic lameness only effective if inflammation bute - cheap, effective for synovitis, possible renal and GI side effects flunixin meglumine - most effective for visceral pain, anti endotoxic, not usually first line for orthopedic pain fibrocoxib - osteoarthritis, more expensive than bute but less side effects paracetamol - human kind, analgesia for laminitis bisphosphonates - stop bone breakdown, alleviate pain and reduce lameness good for some arthritis significant side effects - renal, not with NSAIDs, colic (then can't give flunixin with it) tested for in doping - 30 day detection intra-articular steroids - reduced local inflammation short acting or long acting shorter acting - tramcinolone - high motion joints longer acting - methyprednisolone - low motion joints hyaluronic acid - improved viscosity of synovial fluid anti-inflammatory polyacrimide hydrogel - improved joint lubrication and cellular growth high motion joints - more space to fit gel in regenerative therapies - stem cells - made from horse or off the shelp reduction of mild to moderate degenerative joint disease grow new cartilage

Answer 39

intrinsic - strain extrinsic - injury displacement

Answer 40

tendon matrix degeneration - cumulative, associated with aging fibrillar spillage - crosslinks breakage fibril rupture complete rupture most common injury of event horses acute overload or degenerative

Answer 41

previous inflammation uneven surfaces muscular exhaustion foot imbalance long sloping pasterns reduced blood supply to mid SDFT region

Answer 42

swelling lameness thickening of tendon pain on palpation oedema heat sinking fetlock stance ultrasound - oedema, varying echogenicity, fibre allignment (scar tissue)

Answer 43

acute phase - days after injury - limit inflammation cold hosing icing NSAIDs steroids bandage - reduce oedema supportive bandage, box rest - prevent further damage subacute phase - reparative stage, some reduction in lameness and swelling box rest stem cells - promote angiogenesis, and quality repair platelet rich plasma - promote quality repair physio - therapeutic ultrasound, low level laser, hydrotherapy - reduce oedema and inflammation chronic phase - remodelling (months) controlled exercise programme - small amounts of hand walking then progressive increase rescanning before and after changes in exercise level

Answer 44

expensive and time consuming - have to harvest and grow them off the shelf probably will be available eventually autologous stem cells for tendon injuries form tendon tissue instead of scar tissue reduced re injury rate - better quality repair

Answer 45

cheaper than stem cells increased speed of healing ultrasound guided injection lacking long term studies around rate of reinjury

Answer 46

common - forelimb swelling in proximal 1/3 metacarpal ultrasound - enlargement, focal abnormalities, fibre pattern disruption, concurrent SDFT tendonitis on margins treatment - acute - box rest, NSAIDs, cold hosing, bandaging chronic - controlled exercise, NSAIDs, corrective foot trimming

Answer 47

proximal, body or branch types proximal forelimb - just below knee, some pain on deep palpation, some enlargement treat with controlled exercise, box rest, stem cells prognosis good hindlimb - more chronic, bilateral, poor perofrmance associated with striaght hindlimbs, worse on soft surface and with exercise radiography - sclerosis, avulsion fracture US - fibrosis, loss of striation, new bone laid down - US hard on hindlimbs body older event horses variable lameness further down leg associated with the new bone laid down on splint bone after injury diagnose on palpation treat - controlled exercise, shockwave branch any limb poor-fair prognosis

Answer 48

inflammation of tendon sheaths mild to moderate lameness minimal response to rest intrasynovial analgesia to confirm radiography - with contrast can see manica flexoria

Answer 49

tendon ring that hold SDFT in place marginal tears can drive chronic cases of tenosynovitis tears caused by compression of tendon in overextension

Answer 50

synovial fluid in cacaneal bursa (point of hock) cosmetic not usually lame

Answer 51

fetlock or tendon sheath distension with or without lameness

Answer 52

synovial distension of tarsal sheath cosmetic

Answer 53

acute - rule out sepsis rest ice/cold hosing NSAIDs intrathecal steroids hyaluronic acid tenoscopy - if lack of response to conservative treatment chronic - tenoscopy - early exercise post surgery to reduce post op adhesions rest and controlled exercise address underlying issues palmar annular ligament desmotomy - cut ligament to reduce constriction, good prognosis if desmitis has been controlled

Answer 54

tenosynovitis of carpal sheath (carpal tunnel) secondary to tendonitis of SDFT and DDFT, or fracture in that region, or osteochondroma need to remove the osseous impingment

Answer 55

actinobacillus lignaressi - gram -ve, oral commensal, gains entry through breaks in buccal mucosa sudden onset salivation dysphagia protrusion of tongue firm, swollen, painful tongue - not moving as much as usual enlarged lymph nodes submandibular swelling diagnosis - exam and bacterial c&s

Answer 56

stomatitis lumpy jaw dental disease oral foreign body pharyngeal trauma

Answer 57

isolate animal - makes sure get enough food an water ensure adequate food and water antibiotics oral potassium iodide or IV sodium iodide - not licensed in UK food animals

Answer 58

actinomycosis pyogranulomatous osteitis seen when young cattle teething - entry through mucosa when teeth erupting infects bone usually bright seeming enlargement of horizontal ramus of jaw soft tissue swelling irregular swelling and bone remodelling tooth displacement fractures discharging sinus tracts pain and inability to eat --> weight loss diagnosis - exam, impression smear from discharging tracts, radiography (extent of bone remodelling, doesn't change treatment options)

Answer 59

tooth root abscess fracture of mandible neoplasia foreign body feed impaction

Answer 60

food and water to reduce weight loss antibiotics

Answer 61

usually due to trauma - kick, hit by tractor, dystocia dysphagia weight loss excess salivation swelling at fracture site protruding tongue diagnosis - palpate misalignment at site, radiography management - slight displacement - will heal over time wire external fixator euthanasia/emergency slaughter (if don't have time for aftercare then just euthanise) ramus in calf will heal better than mandibular symphysis

Answer 62

not commonly reported leads to inefficient chewing --> decreased intake --> decreased productivity tooth root abscess - from infection from periodontal disease or penetration of crown of tooth by commensal bacteria jaw swelling salivation halitosis discharging sinus tracts inappetence weight loss diagnosis - inside mouth exam (use a gag), external palpation, radiography

Answer 63

remove infected tooth (could flush or suture after but hard to get it clean enough will cause overgrowth or malocclusion of opposing tooth antibiotics - long term if bone infection, can have negative effects on gut microflora NSAIDs dietary change - high energy concentrate that doesn't need as much chewing

Answer 64

oesophageal obstruction can be proximal cervical, at thoracic inlet or in thoracic oesophagus usually due to access to large lumps of root vegetables distress extended neck and lowered head salivation regularly trying to swallow lower obstruction - large amounts of clear viscous saliva over time - rumen bloat from not being able to ruminate may be able to feel or see blockage if very cranial pass stomach tube - won't go down if blocked

Answer 65

frothy bloat gassy bloat tetanus

Answer 66

relieve bloat - trocar or needle hyoscine - relaxes oesophagus massage obstruction further cranial manually remove if very cranial pass form stomach tube to push block into reumen probang - device that dislodges or slices obstruction if not too distressed can just leave it until it degrades a bit and can be swallowed

Answer 67

parapoxvirus zoonotic usually calves under 1yo papules in mouth anorexia salivation mild pyrexia lesions most severe - raised lesions ddx - foot and mouth BVD vesicular stomatitis bovine herpes blue tongue

Answer 68

picornavirus notifiable very contagious lesions in mouth and on feet anorexia depression pyrexia salivation milk drop vesicles on tongue and dental pad and hard palate - rupture to leave shallow ulcers lesions on coronary band later - pathopneumonic

Answer 69

fusobacterium necrophorum necrosis in mouth young calves - see outbreaks associated with poor hygiene lesions caused by trauma to mucosa wet lower jaw - excess saliva firm swellings in cheeks necrosis in mouth mucosa halitosis swelling in submandibular lymph nodes pyrexia if infection in larynx - anorexia, pyrexia, coughing inspiratory stridor (roaring), dyspnoea death - due to asphyxiation/respiratory distress treatment - penicillin steroids if in respiratory distress NSAIDs tracheotomy - if really struggling to breathe

Answer 70

texel throat (sheep) unable to breath properly more in tups infection of mucosal abrasions --> abscess in larynx --> exacerbates existing issue with larynx in predisposed breeds acute respiratory distress inspiratory effort and stertor - snoring sound neck extended, head lowered, nostril flare open mouth breathing diagnose by signs and breed predisposition

Answer 71

steroids - reduce swelling NSAIDs - more long term antibiotics - long term, prevent abscessation euthanasia tracheotomy - in severe cases usually doesn't fully resolve and often recurs

Answer 72

loss of smooth muscle tone recumbant s shaped neck

Answer 73

calcium sub cut - takes a few hours to work because impaired peripheral circulation calcium borogluconate (with magnesium) - into jugular slow calcium if heart irregularities don't give too much calcium - spike thick bedding with lots of grip food and water in easy reach remove calf for 24 hours lift and turn every 6 hours if recumbent - so not laying on muscle groups too long bloods - test if need also magnesium or phosphorus may need further calcium - bolus, electrolyte fluid, oral gels prevention - high calcium concentrate at calving assess forage component in diet prophylactic calcium for at risk coews - 3rd lactation on, twins keep in calving box for an extra day remove calf not milk for first few days hand feed colostrum and don't milk out whole udder D3 injection before calving control BCS calcium restriction last 3 weeks of gestation magnesium supplementation calcium binding products last 2 weeks gestation diet cation:anion balance manipulation - low sodium and potassium, high chloride and sulphates - monirot using urine pH straw or maize silage better low calcium

Answer 74

late pregnancy/early lactation older sheep associated with stress passive reflux of ruminal contents down nose when lying down blood sample pre treatment - calcium under 1mmol/litre treatment - slow IC calcium borogluconate prevention - feed adequate but not excessive calcium (5-10g/day), avoid stressful conditions/events

Answer 75

majority magnesium locked in bone, can only use the part from rumen and omasum (or intestines in calf) needed for milk and tissue production spring and autumn lactating cows without enough supplementation types - peracute acute subclinical chronic calf milk tetany

Answer 76

nervous and aggressive hyperaesthesia convulsions death

Answer 77

emergency - treat ASAP calm - surprises can cause convulsions keep in lateral while treating then move to sternal calcium borogluconate - has magnesium in, IV in tail vein control seizures - xylazine, ACP, pentobarbitone food and water nearby food with magnesium ongoing clinical cases usually tip of iceberg, check herd for subclinical lick blocks bolus magnesium concentrated magnesium in water spray pasture check soil magnesium levels good grasses that translate magnesium to their leaves ensure good daily dry matter intake reduce stress

Answer 78

first 6 weeks after lambing ewes with multiple lambs convulsion and sudden death ddx - acute mastitis (also presents as sudden death) treatment - IV calcium borogluconate, reduced stress (provide shelter)

Answer 79

down cows high production cows in periparturient period or if reduced feed intake around calving decreased GI motility young cows - slow growth, rickets adult - lethargy, weight loss, anorexia, muscle weakness, muscle and bone pain, rhabdomyolysis, intravascular hemolysis later stages - pica usually seen with milk fever diagnosis - blood sample for phosphorus, watch reaction to calcium treatment (try and get up but just shuffle about) oral or injectable phosphorus