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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
Q

Immune mediated arthritis is what type of hypersensitivity reaction

A

Type III.

Immune-complex formation

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26
Q

Synovial fluid analysis is negative for culture- what is the diagnosis?

A

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

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27
Q

Difference between Type I and Type IV hypersensitivity reactions

A

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)

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28
Q

Arthritis in 1 joint likely to be…

A

Septic arthritis,.

Immune-mediated arthritis is more likely to be polyarticular i.e. 6+ joints. or pauciarticular (2-5) VERY RARELY MONOARTICULAR

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29
Q

4 types of Non-erosive polyarthritis

A

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

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30
Q

4 other causes of non-erosive polyarthritis

A
  1. Systemic Lupus Erythematous
  2. Lyme Disease (Borrelia)
  3. Doberbmanns + Sulphonamides
  4. Calcivirus
  5. Steroid responsive meningitis-arthritis
  6. IBD
  7. Immune-mediated
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31
Q

Pathogenesis of Erosive arthritis

A

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

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32
Q

Examples of erosive joint diseases

A
  1. Rheumatoid arthritis
  2. Periosteal proliferative polyarthritis in CATS
  3. Polyarthritis of Greyhounds (Felty’s Syndrome)
  4. Felty’s Syndrome (RA, splenomegaly and neutropenia)
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33
Q

Felty’s Syndrome

A

Rhematoid arthritis

Splenomegaly

Neutropenia

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34
Q

A dog has raised RF, what test is used to differentiate between rhumatoid arthritis and SLE (both cause increase in RF)

A

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

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35
Q

Disease-modifying antirheymatic drugs

A

lefunomide, methotrexate, gold therapy= treatment for Rheumatoid arthritis = erosive TYPE iii immune complex formation

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36
Q

Mainstay of treatment for polyarthritis (immune-mediated)

A

Prednisalone - taped dose. Initially 2-4mg/kg daily.

+/- cytotoxic drugs (bone marrow suppression)

cyclophosphamide (haemorrganic cystitis in cats)

azothioprine (not cats)

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37
Q

Monitoring of treatment for im polyarthritis

A

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

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38
Q

Crystal based arthritis treatment

A

Main Ddx for reptiles/ birds(lack enzyme)

Tx: Fluid therapy, avoid meds that increase renal excretion

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39
Q

Indications for Femoral Head and Neck Excision (FHNE)

A

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
Q

Best outcome post FHNE surgery is achieved in dogs <

A

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
Q

Surgical technique for FHNE

A

Want to remove removal neck as well.

Leave LESSER TROCHANTER (as Ipsilosoas m. inserts here)

42
Q

Ideal patient for total hip replacement

A

Skeletally mature, large breed dog (>20kg)

Sensible, well trained dog
£4000

CAGE REST FOR 6 WEEKS POST-OP (c.f. FHNE exercise encouraged)

43
Q

How does the aftercare vary between Total Hip replacement and FHNE surgery?

A

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
Q

Mechanically it is better to loose a ____ limb

A

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
Q

Why is it better to loose a pelvic limb than thoracic limb

A

Thoracic limb: 60% weight bearing

Pelvic limb: 40% weight bearing

Better to loose pelvic limb.

Before amputation CHECK CONTRALTERAL LIMB IS HEALTHY

46
Q

How does amputation site differ in cows from small animals

A

Cattle: Proximal interphalangeal joint with cartilage removal in cattlwe

Digtal p1 or p2 in small animal.

47
Q

Bog Spavin =

Tx=

A

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
Q

Presentation of common calcanean tendon injury. Which breeds are predisposed

A

Dobermans / German Shepherds are predisposed.

Extended stifle and Hyperflexion of digits

49
Q
A

Common calcaneal injurys

Extension of stifle

Hyperflexion of digits = pathopneumonic for common calcanean injury

Dobermans / GSDs

50
Q

How many patella ligaments do horses have

A

medial, middle and lateral

51
Q

Dog with CrCL tear prognosis for contralateral limb

A

40-60% will develop tear in contralateral limb.

Majority have concurrent medial meniscal damadeg

52
Q

Treatment for CrCL damage

A

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
Q

Two surgical techniques for CrCL damage

A

TPLO or Tibeal Tuberostity Advancement (TTA) or suture https://www.acvs.org/small-animal/cranial-cruciate-ligament-disease

54
Q

Target for % lameness in cow herd

A

<5% (but majority of farms ++++)

55
Q

Most common foot lesion affecting cows feet

A

30% sole ulcers

22.5% white line disease

Digital dermatitis

56
Q

Score 0 dairy cow

A

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
Q

Score 2 cow mobility

A

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
Q

Cow walks swinging right hind leg through much quicker than left hind. Cow is probably lame on ____

A

Lame on contralateral limb to the one being swung through quickly. Cows moves limb through quickly to take weight off lame limb.

59
Q

In score 2 cow the dew claws of the hind limb will sink low on the ____limb

A

Dew claws will sink lower when weight is placed on the healthy limb (more weight bearing) when compared to affected limb

60
Q

Score 3 cows

A

Walk slower than walking speed. Can’t keep up with herd.

61
Q

90:90:90 rule

A

90% lameness hind , 90% feet, 90% lateral

62
Q

Dutch 5 step foot trim

A
  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
Q

Step 1 of Dutch 5 step foot trimming technique is to create an angle of

A

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
Q

Which claw to start on for step 1 Dutch foot trim

A

Start at most normal claw.

Inner hind claw

Outer fore claw

Cut 1: 7.5cm

Cut 2: 5-7mm step at toe

65
Q

Haemorrhage in horn is roughly ___ months historic

A

Hamorrhage in the horn is roughly 2 months historic.

66
Q

When would systemic antibiotics be indicated for sole ulcers?

A

Normally just topic.

If swelling above coronary band systemic antibiotics are indicated

67
Q

What causes sole ulcers?

A

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
Q

What two things are thought to decrease sole ulcers

A

1, Biotin

  1. Feeding higher dry matter intake (much probably due to drier drug)
    i. e. ENVIRONMENTAL
69
Q

Why are sole ulcers more likely around calving?

A

Decreased digital cushion (comprised of fat therefore decrease BCS = no digital cushion)

Poor foot angle, trauma, more growth, less weear.

Treponemes???

70
Q

Exostoses

A

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
Q

Pathogenesis of White Line Disease

A

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
Q
A

White line disease.

Biotin deficiency, soft claws during high rainfall,

73
Q

Aetiology of Digital dermatitis

A

Three familys of Treponeme, gaining entry through hair follicles.

Sequale: interdigital hyperplasia.

74
Q

Digital dermatitis scoring

A

M1: Ulcerative (<2cm)

M2: Ulcerative (>2cm)

M3: Regressing

M4:.1 Reactivating

M4: Hyperkaratotic

75
Q

DD treatment (M1,M2,M3,M4)

A

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
Q

Foul in the foot

A

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
Q

Aetiological theories for Foul-in-foot

A
  1. Fusobacterium necrophorum
  2. Foreign body through skin.

Sequale: interdigital hyperplasia

78
Q

Procedure for cow claw amputation

A

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
Q

Which local anaesthetic is licenced for a) cows b) horses

A

a) cows= procaine ((adrenocaine)
b) horses= lidocaine

80
Q

Claw amputation needs to be done proximal to ___

A

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
Q

Causative agent of lameness in a) piglets b) growers

A

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
Q

Sheep Scald

A

Interdigital hyperplasia. Red, wet interdigital space. Loss of hair in interdigital space.

Primarily caused by Fusobacterium necrophroum (presence in faeces)

83
Q

Foot rot requires what extra bacteria?

A

D. nodosus

CODD is caused by treponemes

Toe Granuloma normally iatrogenic (farmers + vets)

84
Q

The risk of scald progressing to footrot is determined by…

A

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
Q

Management of foot rot and scald

A

The most important action is the early treatment with parenteral antibiotics and a topical spray, with NO foot trimming

86
Q

Treatment of Footrot

A

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
Q

Treatment of Scald

A

Ewes: Treat as footrot

Lambs: Oxytetracycline spray, stand in clean area and re spray5 days if nec

88
Q

When to cull sheep with scald/ footrot

A

If still lame after 2 antibiotic treatments or if misshaped claws

89
Q

Footbathing concentration for a) ZnSO4 b) Formalin c) CuSO4

A

a) ZnSO4: 10% > 2 mins standing
b) Formalin: 3%
c) DON’T USE

Stand sheep for 1 hr afterwards

90
Q

Aetiotogy and Treatment of Contagious Ovine Digital Dermatitis

A

Same treponemes that cause bovine digital dermatitis.

Use Tilmacosin (Mycotil)

Footbath: Lincomycin / Tylocin

91
Q

Where does the cranial cruciate ligament run?

A

The cranial cruciate (red) runs from proximal and lateral to distal and medial, the caudal cruciate runs in the opposite direction

92
Q

How long for ligament damage to regain a) 50% of original strength b) 90% of strength

A

50%: 6 weeks

90%: 1 year

93
Q

Post operative care for CCL repair

A

No hydrotherapy initially.

Lead walks for 6-8 weeks.

Cold packs

94
Q

Vitiligo

A

Hypopigmentation

c.f. Lentigo = hyperpigmentation

95
Q
A

VetMed Year 4- Term 1 (12 decks)

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