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MSK2 > Small animal MSK disease 3 > Flashcards

Small animal MSK disease 3 Flashcards

Triage

1
Q

In an emergency case, what are the main body systems/areas that need to be assessed?

A
  • Cardiovascular
  • Respiratory
  • Neurological
  • Abdominal (urinary, spleen etc.)
  • Musculoskeletal
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2
Q

What do the letters in A CRASH PLAN stand for?

A 
A: airway 
C: circulation
R: respiratory 
A: abdomen 
S: spine
H: head 
P: pelvis
L: limbs
A: arteries and veins 
N: nerves
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3
Q

In ACRASHPLAN, how are airways evaluated?

A
  • Look for blockages
  • Secure/establish airway immediately using ET tube
  • Respiratory pattern
  • Airway patency
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4
Q

In ACRASHPLAN, how is circulation evaluateed?

A
  • Peripheral pulses incl. femoral and dorsal metatarsal, CRT, MM, blood pressure
  • ECG
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5
Q

In ACRASHPLAN, how is the respiratory system evaluated?

A
  • Rate and effort
  • Respiratory sounds
  • Bruising
  • External wounds to the chest
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6
Q

In ACRASHPLAN, how is the abdomen evaluated?

A
  • Palpation, auscultation, imaging
  • Bruising
  • External wounds
  • FAST ultrasound for free fluid and bladder integrity
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7
Q

Outline the ultrasonographic evaulation in an emergency situation

A
  • 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
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8
Q

In ACRASHPLAN, how is the spine evaluated?

A
  • Panniculus, reflexes, assess for deep pain
  • Imaging
  • Gait and posture, pain sensation, crepitus
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9
Q

In ACRASHPLAN, how is the head evaluated?

A
  • 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
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10
Q

In ACRASHPLAN, how is the pelvis evaluated?

A
  • Palpation
  • Imaging
  • Pelvic limb reflexes
  • Wounds, bruising, pain, crepitus, perineum, external genitalia
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11
Q

In ACRASHPLAN, outline the limb evaluation

A
  • Palpation, reflexes, imaging

- Deformities, fractures, pain, bruising, wounds, weight bearing vs not

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12
Q

In ACRASHPLAN, outline the evaluation of the arteries and veins

A
  • CRT, MM colour, peripheral pulses, BP

- All accessible superficial arteries pulse and pressure

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13
Q

In ACRASHPLAN, outline the evaluation of the nerves

A
  • Neurological exam
  • Mentation, cranial nerves, conscious proprioception, postural reflexes, peripheral spinal reflexes, withdrawal reflexes, deep pain, cutaneous trunci reflex, anal tone
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14
Q

Outline the thoracic evaluation in an emergency trauma case

A
  • Full thoracic examination, visual and palpation for broken ribs etc.
  • Radiography to assess potential for rib fracture, diaphragmatic hernia etc.
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15
Q

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

A
  • 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
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16
Q

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

A

Leave animal quietly and do not attempt further intervention

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17
Q

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

A
  • 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

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18
Q

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

A
  • 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
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19
Q

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

A

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

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20
Q

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

A
  • Advice farmer not to touch/stimulate animal, may provoke fitting
  • Stay clear of animal during fitting
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21
Q

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

A
  • Ask farmer to describe injury

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

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22
Q

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

A
  • Haematogenous spread
  • Direct contamination from trauma/puncture wound
  • Post-operative infection, usually associated with an implant
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23
Q

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

A

Haematogenous spread from umbilical infection

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24
Q

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

A
  • Foals: enteric G-ve organisms

- Small animals: Streptococcus spp.

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25
Q

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

A

Bites, trauma

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26
Q

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

A

Trauma: Staph, Strep
Bite: Pasteurella

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27
Q

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

A

External and internal traumatic events to joints and bones

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28
Q

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

A

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

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29
Q

What are the most common causes of orthopaedic infection in adult horses

A
  • Septic arthritis secondary to injection
  • Septic arthritis and osteomyelitis secondary to trauma
  • Osteomyelitis due to implant infection
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30
Q

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

A
  • Injection: Staph
  • Trauma: mixed, Enterobacteriaceae,
  • Implant: mixed Enterobacteriaceae, Staph, Strep
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31
Q

What are the most common causes of orthopaedic infection in birds?

A
  • Femoral head necrosis in birds >22days old
  • Viral infection (immunosuppressive e.g. IBD)
  • Coccidiosis
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32
Q

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

A
  • Coagulase positive Staphylococci
  • Mycoplasma synoviae
  • E. cecorum
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33
Q

What pathogens are involved in turkey osteomyelitis complex?

A

E. coli, Staph aureus, S. hyicus

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34
Q

Outline the importance of E. cecorum in osteomyelitis in birds

A
  • Commensal enteric bacterium

- can cause epidemics of osteomyelitis, arthritis and spondylitis in broilers and broiler breeders

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35
Q

Outline the management of a fracture fixed with implants, that develops a post-operative infection

A

Leave in and treat with antibiotics for 4-6 weeks, then remove once infection cleared

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36
Q

Briefly describe the radiographic appearance of early (<2 weeks) osteomyelitis

A
  • 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
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37
Q

Briefly describe the radiographic appearance of late/advanced osteomyelitis

A
  • Bone lysis and demineralisation
  • Periosteal proliferation
  • Areas of sequestration
  • Remodelling of cortex and endosteum
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38
Q

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

A
  • Implant involvement

- Articular surface destruction/joint involvement

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39
Q

What is a bony sequestrum? Outline the treatment for this

A
  • Dead, avascular bone within living tissue
  • May resolve without treatment
  • Treatment is surgical removal of sequestrum
  • Antibiotics - clindamycin has good pone penetration
  • Analgesia
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40
Q

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

A

USA

  • Coccidiomycosis: diagnosis using Sabourauds medium at room temp, culture from granulomatous lesion
  • Blastomycosis
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41
Q

What are three key underlying problems that could cause recurrent/resistant infection within the bone?

A
  • 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
42
Q

Outline the antibiotic treatment of osteomyelitis in dogs and cats

A
  • 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
43
Q

Outline the antibiotic treatment of osteomyelitis in farm animals

A

Long term injectables possible, but more likely to opt for euthanasia due to withdrawal periods etc.

44
Q

Outline the antibiotic treatment of osteomyelitis in horses

A
  • 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
45
Q

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

A
  • Cephalosporins
  • Fluoroquinolones
  • Lincomycin + clindamycin
  • Metronidazole
  • Amoxy-clav
46
Q

Identify the antibiotics that should be avoided in neonates

A
  • Chloramphenicol
  • Tetracyclines
  • Aminoglycocides
  • Fluoroquinolones
47
Q

List the indications for surgical intervention in cases with osteomyelitis

A
  • Fracture
  • Periosteal stripping
  • Sequestrum
48
Q

What are the basic principles of surgical treatment in cases of osteomyelitis? i.e. aims

A
  • Stabilisation
  • Remove sequestrum
  • Remove focus of infection, sterilisation
  • Improve chance of bone healing
49
Q

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

A
  • Traumatic skin loss
  • Ischaemia
  • Denervation
50
Q

Outline the pre-operative management for tail amputation

A
  • 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
51
Q

What are the most common indications for lateral surgical approach to the stifle joint?

A
  • Repair of medial patellar luxation
  • Exploratory arthrotomy
  • Rupture of cranial cruciate ligament
52
Q

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

A
  • Fractures
  • Hypertrophic osteopathy
  • Osteoarthritis
  • Luxations (single/multiple)
  • Sesamoid disease -
53
Q

Identify sesamoid diseases in small animals

A
  • Fractured sesamoids
  • Sesamoid disease of young dogd
  • Bipartitie/tripartite sesamoids
54
Q

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

A

Multiple sesamoid ligament failures

55
Q

What are the indications for surgical treatment of metacarpal/tarsal shaft fractures?

A
  • Pronounced displacement, esp. dorsally
  • More than 2 metacarpal/tarsal fractures
  • Greyhounds more commonly treated surgically
56
Q

Outline the management of metacarpal/tarsal shaft fractures

A
  • Surgical
  • If not surgical, manage in splinted bandage
  • Monitor radiographically
57
Q

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

A

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

58
Q

Outline the treatment of metacarpal/tarsal distal condylar fractures

A
  • 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
59
Q

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

A

90degrees

60
Q

Outline the presentation of sesamoid disease of young dogs

A
  • Usually Rottweilers
  • Acute, becomes chronic
  • Loss of flexion of joint, pain, effusion
  • Usually sesamoids II or VII
61
Q

Outline the diagnosis of sesamoid disease of young dogs

A
  • Exclusion of other problems

- +/- nerve blocks

62
Q

Outline the treatment of sesamoid disease in young dogs

A
  • NSAIDs
  • Neutraceuticals
  • Conservative management i.e. physiotherapy
63
Q

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

A
  • Loss of flexion, swelling but no pain
  • Incidental finding
  • No treatment
64
Q

Discuss the consequences of a palmar metacarpal/plantar metarasal wound

A
  • 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
65
Q

What treatment is recommended for fractures of the shaft of P1/2 in dogs?

A
  • Closed reduction and external support, unless performance animal
  • Moulded plastic splint for 3-6 weeks
66
Q

What treatment is recommended for fractures of the head/base of phalanges in dogs?

A
  • Lots of instability therefore internal fixation and external support best
  • If fragments too small to reconstruct, consider amputation
67
Q

What treatment is recommended for fractures of P3 in dogs?

A

Distal P2 amputation unless simple fracture of ungual process

68
Q

Discuss the occurence and treatment of luxaations/subluxations of digits in dogs

A
  • P1/2, or more commonly P2/3
  • Usually racing greyhounds
  • Intricate surgical repair required, difficult
69
Q

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

A
  • Fractures
  • Luxations/subluxations
  • Osteoarthritis
  • Osteomyelitis
  • Neoplasia
  • Trauma
  • Digital amputation
70
Q

What are the indications for digit amputation in small animals?

A
  • Neoplasia e.g. SCC
  • Chronic infection
  • Osteomyelitis
  • Severe trauma
  • Biopsy of P3
71
Q

When does digit amputation lead to lameness in small animals?

A
  • When >2 digits removed

- Either of the central 2 digits amputated

72
Q

List the differentials for soft tissue damage in the digits of small animals

A
  • Cellulitis (most common, esp. cat bite abscess)
  • Tendon damage e.g. DDFT/SDFT
  • Ligament damage
  • Gangrene (ischaemia, necrosis)
73
Q

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

A
  • Debridement/amputation

- Antibiotics if secondary infection

74
Q

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

A
  • Acute: 100% lame

- Chronic: mild lameness

75
Q

Describe the presentation of damage to the DDFT in small animals

A
  • 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
76
Q

Outline the treatment of incomplete rupture of the DDFT

A

Exercise with NSAIDs may allow faster resolution

77
Q

Outline the presentation and treatment of damage to the SDFT

A
  • Rupture/avulsion leads to dropped toe, parallel to ground

- Rarely any clinical significance, often incidental finding

78
Q

Outline the treatment of superficial pad loss

A
  • Secondary intention healing
  • Keep clean, provide support
  • Bandage, splint, rest until early keratinisation
  • Do not exercise too early
79
Q

Outline the treatment of pad lacerations

A
  • 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
80
Q

List possible causes of lameness originating from the pads of small animals

A
  • Cut pads
  • Foreign bodies
  • Excessive wear
  • Burns (thermal/caustic)
  • Corns
  • Hyperkeratosis
  • plasma cell pododermatitis
  • Autoimmune disease
  • Nutrition related e.g. NME, zinc responsive dermatoses
81
Q

Outline the diagnosis of foreign bodies in the pads of small animals

A
  • 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
82
Q

List the possible causes of lameness originating from the haired skin of the paws of small animals

A
  • Interdigital sinus tracts
  • Interdigital foreign bodies
  • Parasitic infestation
  • Trauma
  • Hypersensitivity
  • Infection
  • Contact irritant
  • Neoplasia
83
Q

What are the causes of interdigital draining sinus tracts?

A
  • Interdigital foreign bodies
  • Deep pyoderma
  • Demodiscosis
  • Sterile pyogranulomata
84
Q

Which breeds are predisposed to interdigital draining sinus tracts?

A
  • Brachycephalics

- Heavy breeds e.g. bulldogs

85
Q

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

A
  • Bulldogs
  • Great Danes
  • Boxers
86
Q

Explain the cause of interdigital sterile pyogranulomata

A
  • Reaction to intradermal keratin

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

87
Q

How is sterile pyogranulomata diagnosed?

A
  • Biopsy supportive but not definitively diagnostic

- Rule out parasites and infection (repeatedly negative tissue culture)

88
Q

Outline the treatment of sterile pyogranulomata

A
  • Careful use of glucocorticoids or ciclosporin

- Fusion podoplasty as last resort

89
Q

Outline the treatment of interdigital foreign bodies

A
  • Poultice/bath to draw out salt water bathing, epsom salts), then explore cavity under GA with alligator forceps
  • Avoid antibiotics until explored
90
Q

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

A
  • Demodicosis
  • Harvet mite
  • Hookworm
91
Q

Discuss the treatment of trauma to the haired skin of the paws of dogs

A
  • Wound closure difficult due to limited free skin, high risk of vascular damage
  • May require amputation or multiple surgeries if severe
92
Q

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

A
  • SCC
  • Melanoma
  • Fibrosarcoma
93
Q

Describe feline lung-digit syndrome

A
  • 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
94
Q

Where does claw growth occur from?

A

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

95
Q

What is the legislation regarding dew claw removal?

A

Anyone 18+ can remove dew claws of a dog before its eyes are open, once eyes are open anaesthesia is mandatory

96
Q

Discuss the justification for the removal of the hind dew claws

A
  • 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
97
Q

Discuss the justification for the removal of the front dew claws

A
  • 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

98
Q

Outline the procedure of the removal of dew claws in a puppy <5 days old

A
  • 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
99
Q

Outline the procedure for dew claw removal in an older dog (>3months old)

A
  • 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
100
Q

What does paronychia mean?

A

Inflammation of claw fold and claw bed

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