Clinical 2 Final Exam!!!!!

Front 1

For the MusculoskeletalSystem what do we Examine and Observe?

Back 1

•Examineposture

Look for Muscle atrophy–(decrease in size of muscle)

Caused by: Lack of nervesupply•Muscle disease•Disuse

•Observe Alllimbs/joints make sure the same size

•Stands withweight fully on all limbs

Front 2

How would you Observe the MusculoskeletalSystem/ Examination.

Back 2

•Watch animalwalk

•Hold up ordrag any leg

•Bear weightthe same on all legs

•Any headbobbing

Front 3

What are the grades of lameness and how many grades are there?

Back 3

Grades of lameness:

•Grade I – barely perceptible

•Grade II –noticeable but weight bearing

•Grade III – bearsweight occasionally for balance

•Grade IV –completely non-weight bearing

Front 4

What is a Grade 1 Lameness?

Back 4

Barely Perceptible

Front 5

What is a Grade 2 Lameness?

Back 5

Noticeble but weight bearing

Front 6

What is a Grade 3 Lameness?

Back 6

Bears weight occasionally for balance

Front 7

What is a Grade 4 lameness?

Back 7

Completely non-weight bearing

Front 8

How do you examine the musculature system through palpation?

Back 8

•Developroutine

•Palpate andexamine each leg from distal to proximal

•Flex andextend each joint individually

•Examine alllegs

•Examine skinbetween toes and pads

•Palpate theneck

Front 9

What are we looking for in Lameness?

Back 9

•Acute vsChronic

•Trauma?

•Signalment

•Unilateral vsbilateral

•Shifting leglameness

•Single limb (Often due tominor strain or sprain, resolves with rest in 1-3 days)

Front 10

How is Lameness Diagnosed?

Back 10

•Localizeeffected area by PE

•Radiographarea

•Further tests:

•Joint tap

•CT scan

•MRI

•Serologicaltesting

•Exploratorysurgery

Front 11

What is Panosteitis?

Back 11

•Self-limitingbenign bone disease

Front 12

Who is prone to getting Panosteitis?

Back 12

•Young largeand giant breed dogs, usually in first year of life (6-18 mo, rarely up to5 yrs)

•Esp. common inGerman shepherds

Front 13

How is Panosteitis diagnosed and treated?

Back 13

Diagnosis:

•Exam – palp.mid-shaft of long bones elicits pain•Radiographs (↑intramedullary densities and irregular endosteal surfaces of long bones)

Treatment:

–NSAIDS and time

Front 14

What is Osteochondrosis?

Back 14

•Degenerationor aseptic necrosis of bone and cartilage followed by reossification

•Defect ofendochondral ossification (defect in articular cartilage development)

•Hyalinecartilage does not mature into bone, thickens, can not receive nutrients, dies,detaches.

Front 15

What is Osteochondrosis Dissecans?

Back 15

•OCD = termused for disease when a flap forms as a result of progression of articularcartilage defect.

Front 16

Where is Osteochondrosis typically seen?

Back 16

•Lameness

•Seen instifle, hock, elbow; shoulder is most common

Front 17

What breeds and age typically gets Osteochondrosis?

Back 17

•Large breeds –Retrievers, Bernese Mt. Dogs, Rottweilers

•Young dogs(5-8 months)

Front 18

How do you diagnose and treat Osteochondrosis.

Back 18

Diagnosis:

•Exam –lameness, pain on flexion of joint•Radiographs –lesion visible•Joint mice –loose cartilage pieces

Treatment:

•Rest andweight control in early stages•Surgery(remove flap, curettage of lesion)

Front 19

What is Ununited Anconeal Process?

Back 19

•Failure of anconeal process tofuse with the olecranon

•May bebilateral

Front 20

What kind of animals/age, get Ununited Anconeal?

Back 20

•Large breeddogs – German Shepherds•Young dogs(7-8 months)

Front 21

How is Ununited Anconeal Diagnosed and Treated?

Back 21

Diagnosis:

•Exam –lameness, crepitus on flexion of elbow joint, joint swelling

•Radiographs

Treatment:

Surgicalremoval of anconeal process

Front 22

What is Fragmented Medial Coronoid Process?

Back 22

•Coronoidprocess is the cranial medial articular process of the ulna distal to thetrochlear notch•May bebilateral

Front 23

What type of animals get Fragmented Medial Coronoid Process.

Back 23

•Large breeddogs – German Shepherds

•Young dogs(4-12 months)

Front 24

How is Fragmented Medial Coronoid Process diagnosed and treated?

Back 24

Diagnosis:

•Exam –Lameness, pain on flexion of elbow and palpation of medial aspect of joint,joint swelling•Radiographs.

Treatment: – surgicalremoval of coronoid process.

Front 25

What is Aseptic (Avascular) Femoral Head Necrosis.

Back 25

Also called: Legg-Calve-Perthes Disease

•Loss of bloodsupply and subsequent degeneration of femoral head.

Front 26

What type of animals get Aseptic Femoral Head Necrosis?

Back 26

•Young (4 – 11months) miniature and toy breed dogs

•Unilateral orbilateral

Front 27

What are the clinical signs of Aseptic Femoral Head Necrosis?

Back 27

Clinicalsigns:

irritability and chewing of hip/flank, pain, atrophy of hip muscles,gradual lameness.

Front 28

How do you diagnose Aseptic Femoral Head Necrosis?

Back 28

Diagnosis:

Radiographs

Treatment:

Surgery (FHO), neuter due to probable heritable nature of disease.

Front 29

What is Hypertrophic Osteodystrophy (HOD) and who gets it?

Back 29

•Developmentaldisorder of metaphysis of long bones of large and giant breed puppies,

•Usually at 3 –4 months age (2 – 8 months).

Front 30

Is there a cause of Hypertrophic Osteodystrophy?

Back 30

•Cause unknown(diets high in calories, protein, and calcium ?; vit C def ?; CDV ?)

Front 31

Any signs or symptoms or sign of Hypertrophic Osteodystrophy?

Back 31

•Bilateral,symmetrical metaphyseal swelling, pain, and lameness

•Possiblefever, anorexia, depression

•Can be verydebilitating

Front 32

How is Hypertrophic Osteodystrophy diagnosed and treated?

Back 32

Diagnosis: –Radiography (metaphyseal lucency and periosteal bone formation)

Treatment:

-pain relief (NSAIDS), supportive care.

Front 33

What is Hip Dysplasia and who gets it?

Back 33

•Abnormaldevelopment or growth of the hip joint – usually bilateral

•Congenital,bilateral DJD or hip laxity

•Large breeddogs, younger (5-8 months) and older dogs

Front 34

What causes Hip Dysplasia?

Back 34

Causes:

•Geneticpredisposition

•Environmentand dietary factors

•Disparitybetween muscle mass and the developing skeletal system

Front 35

What are some Hip Dysplasia Clinical Signs?

Back 35

•Difficulty inrising

•Stiffness thatdecrease as the animal warms up on exercise

•Pain onpalpation of the dorsal pelvic area or over hip joint

•Older dogs –waddling gait, +/- of hip muscles•LamenessRestrictedrange of motion of joint

Front 36

How is Hip Dysplasia Diagnosed?

Back 36

•Radiographs•OrthopedicFoundation of Animals (OFA) and/or PennHIP positioning to quantitate hip joint laxity•Must be > 24 mo for OFAcertification; will perform preliminary evaluation at > 4 mo & < 24 months age•PennHIP - reliable at16 weeks (4 months) of age – reliability at 6 months of age is somewhatimproved over 4 months of age; reliability at 1 year of age is somewhatimproved over 6 months of age•Severity ofclinical signs may not correspond to degree of radiographic change

Front 37

How is hip dysplaisa treated conservatively?

Back 37

•Moderateexercise

•Weight control

•Antiinflammatory medication

•NSAIDs,Tramadol, Prednisone•Chondroprotective agentsAdequan, Cosequin

Front 38

How is hip dysplaisa treated with surgery?

Back 38

•severe pain

•TPO – triplepelvic osteotomy

•Total hipreplacement

•FHO – femoralhead and neck osteotomy

Front 39

What is Patellar Luxation and types?

Who gets it?

Back 39

MedialLuxation:

•Toy andminiature breeds

Lateralluxation: – less common

•Large andmedium breeds

•Consideredinherited – usually result of anatomic deformities

Front 40

What are clinical signs of Patellar Luxation?

Back 40

•Neonates andyoung puppies – abnormal hind limb fx

•Animal skipsor intermittently holds leg

Front 41

How is Patellar Luxation diagnosed and treated?

Back 41

Diagnosis:

•Palpation toluxate patella

•Radiographs

Treatment: –None, rest, surgery

Front 42

What is Osteoarthritis?

Back 42

•Degenerativejoint disease – DJD

•Slowlyprogressive cartilage degeneration

Front 43

What are signs and how diagnose Osteoarthritis?

Back 43

Signs:

•Pain, lameness•Stiffness –esp. on rising•Crepitus injoint

Diagnosis: •Radiographs

Front 44

How is Osteoarthritis treated?

Back 44

•Prevention

•Rest duringflare-ups only

•Diet

•Hill’s j/d Canine –omega-3 FA’s, glucosamines, chondroitinsulfate•Medication•Chrondroprotective agents (polysulfated glycosaminoglycans, glucosamines, chondroitinsulfate, hyaluronic acid)•NSAIDSTramadolC

Front 45

What are some Treatments for OA/DJD?

Back 45

NSAIDS:

•Carprofen - Rimadyl •Meloxicam -Metacam•Deracoxib - Deramaxx •Firocoxib - Previcox •Tepoxalin - Zubrin.

Nutraceuticals(cartilage building blocks):

•Glucosamineand chondroitin sulfate - Cosequin (PO)•Chondroprotective agents•HyaluronicAcid - Hyalovet (IA)•PolysulfatedGlycosaminoglycan - Adequan (IM)

Front 46

What is Osteosarcoma?

Who gets it?

Where is it found?

Is prognosis good?

How treated?

Back 46

•Neoplasticcondition of bones

•Often largeand giant breed dogs

•Older patients

•Metastasis tolungs common

Signs: Unilaterallimb lameness, firm painful swelling

Treatment: –amputation & chemotherapy -------Prognosis poor

Front 47

Fractures, how do they typically happen?

Clinical signs ?

Diagnosis?

Back 47

•75% due tomotor vehicle accidents•Violence, bonedisease, repeated stress

•Quickassessment of patient

•Supportbandages until patient stable.

Clinical signs:

•Hx of trauma•Pain,localized tenderness•Lameness,deformity of the bone

•Loss of fx

•Creptius, localizedswelling or bruising

Diagnosis:

•Radiographs –at least 2 views

Front 48

Where do Pediatric Fractures occur?

Back 48

•Most commonlyoccur through growth plate (metaphyseal growth plate = physis)

Front 49

What is a pediatric fracture classified as?

What is the best way to repair?

Back 49

•Classified as Type I –Type V based on involvement of adjacent epiphysis/articular surface and/oradjacent metaphysis.

•Repair bestvia external fixation

Front 50

What does Physeal damage mean for bone growth?

Back 50

•Physeal damage fromtrauma or repair before closure of growth plate can result in no furtherlongitudinal growth of bone.

Front 51

How are fractures repaired?

Back 51

•Externalfixation

•Casts

•Kirschner Apparatus

•Internal fixation

•IM Pins

•Cerclage Wires

•Lag Screws

•Plates

Front 52

What are Myopathies and what types are there?

Back 52

•Diseases thataffect muscle

•Many types

•Most common –inflammatory, immune-mediated, acquired

Front 53

What can cause Myopathies?

Back 53

•Electrolyteimbalances, endocrine, paraneoplastic, parasitic, viral, toxic, other

Front 54

What are clinical signs of myopathies?

Back 54

muscleweakness and/or pain – generalized or localized, swelling.

Front 55

How do you diagnose myopathies?

Back 55

clinicalsigns, muscle biopsy, serum chemistries

Front 56

What is Myasthenia gravis?

Back 56

It is a myopathy

•Autoantibodiesto nicotinic AChR’s on the postsynaptic membrane of the neuromuscular junction

•Can cause megaesophagus

Front 57

How is myasthenia gravis diagnosed?

Back 57

-Serum titerfor antibodies to muscle nicotinic

Front 58

What is a treatment for myasthenia gravis?

Back 58

Anticholinesterasedrugs

Front 59

What is Masticatory Muscle Myositis?

Back 59

•Focalinflammatory myopathy that selectively affects the muscles of mastication•Immune-mediated.

Front 60

What causes Masticatory Muscle Myositis?

Back 60

Immune-mediated.

Front 61

What is acute and chronic Masticatory Muscle Myositis.

Back 61

Acute: musclesswollen, painful

Chronic:muscles atrophy, fibrose can not open mouth fully.

Front 62

How is Masticatory Muscle Myositis diagnosed and treated?

Back 62

Diagnose: serumantibodies against masticatory muscle type 2M fibers; muscle biopsy

Treatment:glucocorticoids

Front 63

What is Polymyositis and who gets it?

Back 63

•Generalizedinflammatory myopathy; immune-mediated

•Middle-agedlarge breed dogs.

Front 64

What are clinical signs of Polymyositis?

Back 64

Clinicalsigns:

weakness worsens with exercise, hyperesthesia on palpation, fever,depression

Front 65

How is Polymyositis diagnosed and treated?

Back 65

Diagnose: serum creatine kinase (CK)levels often elevated; muscle biopsy is the test of choice

Treatment:glucocorticoids

Front 66

What are some other causes of myopathies?

Back 66

•Hypokalemia(cats)•Serum K+and/or Ca++ imbalances

•Hypothyroidism

•HyperadrenocorticismDiabetesmellitus (cats)

Front 67

Why is bandaging done for musculoskeletal injuries?

Back 67

•Protect wounds

•Hold clean orsterile dressings in place

•Secure splints

•Providesupport for the bony anatomy

•Support andstabilize soft tissue

•Restrictmotion to eliminate stress

•Prevent weightbearing

•Providecompression to control hemorrhage and tissue edema

•Discouragelicking and grooming

Front 68

What are some Principles ofBandage Application?

Back 68

•Prepare areasbefore bandage application•Protectivewound pads should be secured to the skin

•Do not bandagetoo tightly

•Instructowners on basic care of bandage

Front 69

what are Non-adherentdressings - Adaptic, Telfa any why used?

Back 69

•Permit flow ofexudate through dressing

•Easily removedfrom the wound

•Less painfulto patient

•Minimizesdisruption of healing tissue

•Kling, Conformor Stretch gauze

•Elastic gauze bandage

•Self adhering

•Conforms to bodycontours without slipping

Front 70

What is a Soft PaddedBandage and used for?

Back 70

•Most commonlimb bandage

•Coverabrasions or lacerations

•Light supportbandage - after injury or surgery•Can be adaptedinto a coaptation splint withthe addition of a metasplint

Front 71

What is the Robert JonesBandage and used for?

Back 71

•Immobilize andsupport injured soft and bony tissue

•Usedpreoperatively to stabilize a fracture of the distal limbs until internalfixation is completed

•Not forfractures of the proximal limbsa

Front 72

What are the Feline Blood Groups?

Back 72

•A, B, and AB

Front 73

Why can cats haveacute hemolytic reactions with first the incompatible transfusion?

Back 73

•Cats havenaturally occurring preformed antibody to the antigen they lack.

Front 74

What cat breeds are typically type B blood?

Back 74

•Persian, DevonRex, British Shorthair, Himalayan, Abyssinian, Birman, Scottish Fold, Somali

-have high prevalence Type B, up to 50%

Front 75

What cat breeds are typically type A?

Back 75

•Orientalbreeds (Siamese and Burmese tend to be type A (almost always)

Front 76

Which cat is a universal recipient?

Back 76

Type AB

Front 77

What are indications for blood transfusion?

Back 77

•Decreased RBCnumber to the extent that O2 carryingcapacity is insufficient to maintain adequate perfusion

•Decreasedplatelets resulting in hemorrhage•Decreasedclotting factors or von Willebrand’s Factorresulting in hemorrhage

Front 78

What are some RBC Transfusion Options?

Back 78

•Fresh wholeblood

•Stored wholeblood

•Packed RedBlood Cells (PRBC’s)

Front 79

What is Packed RedBlood Cells (PRBC’s) best used for?

Back 79

Treatment ofchoice for anemia

Front 80

What are some Anti-coagulants used?

(4 types)

Back 80

•Heparin: Mustuse in 24-48 hours

•Acid CitrateDextrose (ACD): Can store for 14 days

•CitratePhosphate Dextrose (CPD): Can store for 21 days

•CPD-Adenine(CPDA): Can store for 35 days•Administerthrough micropore filter toeliminate micro thrombi

Front 81

What is •Oxyglobin® (hemoglobin glutamer–200) used for?

Back 81

•Given instead ofblood for acute anemia

Front 82

How long is Oxyglobin stable for? how soon after opening does it last for?

Back 82

•Stable for 2years if unopened

•Use within 24 hours after opening

Front 83

what does plasma contain?

Back 83

•Contains allclotting factors, albumin, immunoglobulins

Front 84

Which type of blood is ok for rodentcide poisoning?

Back 84

Frozen Plasma

•Contains factors 2, 7,9, and 10 so OK for rodenticide toxicity

Front 85

What is Cryoprecipitate?

Back 85

•Concentratedsolution containing factor 8, factor 13, fibrinogen, and von Willebrand’s factorderived from FFP

Front 86

What is Cryoprecipitate a treatment for?

Back 86

•Treatment of choice forHemophilia A and von W Dz.

Front 87

What is the volume amount for RBC transfusion in dogs and cats?

Back 87

Blood Volume = 90 ml/kg for dogs

and 70 ml/kgfor cats

Front 88

What temperature should blood be at before transfusion?

Back 88

37° C toprevent hypothermia

Front 89

What is the rate of administration for blood transfusion? and when should it be done by?

Back 89

•Depends on patientcondition and specific component being transfused

•Typicallystart slowly and increase rate if no reaction

•Faster ifhypovolemic due to acute blood loss•Slower ifheart disease present

•Should be completedwithin 4 hours to prevent bacterial contamination

Front 90

What is the maximum rate of infusion of potassium chloride (KCL)?

Back 90

0.5 mEq/kg/hr

Front 91

What is the maintenance dose (ml) for cats?

Back 91

60ml/kg/d X BW

Front 92

What is the maintenance dose for cats if using the body mass method?

Back 92

80 X (BW in Kg to the 3/4 power)

Front 93

How do you assess percent dehydration and equation?

Back 93

Total ml for rehydration = %dehydration X BW in kg X 1000

Front 94

Once you have your percent dehydration how much do you give in the 1st 24hrs and the 2nd 24 hours?

Back 94

80% first 24hrs

20% second 24hrs