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136 Cards in this Set
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How are immune mediated/infective arthritis DDX from OA
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joint tap
elevated WBC mainly of neutrophils in synovial fluid |
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If only 1 joint is affected, what DDX should be #1 |
infective/septic |
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What virus has been isolated from the synovia of dogs with immune-mediated arthritis |
distemper |
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What is an important DDX for FUO? |
immune mediated polyarthopathies |
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C/S of immune mediated polyarhtropathies |
lameness generalized stiffness - MC sudden onset with multiple swollen joints painful |
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C/S of bacterial joint infections |
acute onset swollen and painful +/- heat |
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What bacteria cause septic arthritis
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streptococci
staphlococci E.coli Pasturella |
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MC cause of septic joints Cats Dogs |
MC bite wound in cats MC hematogenous in dogs
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Why can you get more than one joint involved with septic arthritis (dogs)?
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occurs secondary to a severe systemic bacterial infection such as endocarditis
generally have lesions in other body parts cardiac murmur |
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What are radiographic changes with septic arthritis? |
early - ST swelling periosteal reaction calcification of the joint capsule |
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DX of septic arthritis
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culture of organism from synovial fluid
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TX for septic arthritis?
Aerobic/anerobic TX How long to TX? |
AB - braod spectrum - ampicillin, clavamox, cephalosporins
If anerobic is suspected - metronidazole (add in) 4-6 weeks (2 weeks past clinical signs) Rest +/- support bandaging NSAIDS - painful |
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What tick born disease has common presentation of acutre lameness associated with a migratory monoarhtiris or a pauciarhtiris |
lyme disease Borrelia burgodorferi |
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DX of Lyme arthritis |
difficult difficult to culture serological testing - can be suggestive |
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These two special bacterial are uncommon but can cause arthritis |
L form Mycoplasma |
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L form bacteria have ____ cell wall |
no |
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TX for L form arthritis |
tetracyclines |
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This bacteria occur in debilitated or immunocomprimised patients |
Mycoplasmal arthritis |
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How old on average are animals with mycoplasmal arthritis |
18 months |
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C/S of mycoplasmal arthritis What happens to the articular cartiladge |
insidious onset of clinical signs severe destruction of articular cartiladge |
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TX for mycoplasmal arthritis
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tylosin
gentamicin erythromycin |
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What are some protozoal causes of arthritis |
Leishmaniasis Toxoplasma gondii Hepatozoon canis Babesia |
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What virus can cause a true arthritis |
Calicivirus in cats |
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What occurs radiographically in rheumatoid arhtiris |
erosive based arthritis subcondral bone destruction "punched out" mineralizations of the epiphysis synovial effusion calcification of soft tissues |
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What autoantibodies cause rheumatoid arhtritis
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circulating autoantibodies against immunoglobulin G
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What species is rheumatoid arthritis more common in? |
dog |
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Periosteal proliferative polyarthritis is a _____ immune based arthritis |
erosive |
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Periosteal proliferative polyarthritis is more common in this species |
cat
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What locations are affected by periosteal proliferative polyarthritis
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hocks carpi
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What radiographs changes are noted with periosteal proliferative polyarthritis?
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marked periosteal new bone formation oftern extending beyond the confines of the joint.
bony destruction and proliferation can occur at the attachment n of ligaments and tendons |
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enthesiopathies
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bony destruction and proliferation at the attachement of ligaments and tendons
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What sex appears to be more affected with periosteal proliferative polyarthritis |
young male cats |
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This disease is a nonerosive immune based arthritis that is more common in spaniel breeds |
polyarthritis/polymyositis syndrome |
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Dogs with this disease have marked stiffness, poor excercise tolerance and crouched stance. wide spread muscle atrophy
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polyarthritis/polymyositis syndrome
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These animals present with pyrexia, stiffness, and neck pain +/- nervous signs |
polyarthritis/meningitis syndrome |
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This is a syndrome in humans with KCS, dry mouth and polyarthritis |
Sjogren syndrome |
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This breed of dog can be affected with a non-errosive arthritis and are generally less than 1 year of age.
Prognosis |
Akita
poor |
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What drugs have been reported to cause a drug induced arthritis.
Breed of dog most susceptible |
sulfa lincomycin erythromycin cephalosporins penicillins
Dobies |
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How can a diagnosis of Drug induced arthritis be made? |
worsening clinical signs while dog is on meds, and drast improvment in 2-7 days once meds are stopped. |
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What animals have had an immune based polyarthritis develope after VX
when is it seen and how long does it last |
kittens after first injection (Calicivirus)
occurs 7 days after VX and lasts for 1-2 days |
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What is the most common polyarthritis in both the dog and cat |
idiopathic polyarthritis |
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What is the TX in general for immune based arthropathies |
immune suppression with corticosteriods improvement should be seen in a few days, but therapy needs to go on for 4-8 weeks |
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Prognosis for polyarthropathies
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guarded
relapses common. Erosive and multi systemic have poorer prognosis |
Erosive
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Alternative TX for immune mediated arthropathies |
cyclophosphamide azathioprine Levamisole gold injections Auranofin (oral gold) |
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How is a bone biopsy performed |
Jamshidi bone biopsy needle biopsy is obtained from the center of the lesion (to avoid dense reactive bone) |
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When should a Jamshidi bone biopsy not be used? |
for biopsy of small bones lesions associated with fractures cystic and fluid filled lesions |
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How should cystic and fluid filled bone lesions be biopsied? |
incisional wedge biopsy |
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How can a biopsy of growth or px with endochondral ossification be performed?
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Percutaneous via Jamshidi needle of the greater tubercle to get physis biopsies
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If metabolic bone diseases are suspected, how can a bone biopsy be obtained
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Generally need larger specimen than a Jamshidi needle, use a Michele trephine from the iliac crest or excision of a segment of rib or distal ulnar diaphysis.
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How accurate are cultures of pus from draining tracts from bone? |
50% accurate in diagnosing the pathogens b/c they become colonized by skin organisms and gram-negative bacteria |
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What should be cultured for osteomyelitis? |
fluid via sterile aspiration pus/necrotic tissue/sequestra collected during surgical debridement |
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60% of osteomyelitits is caused by _______ bacteria |
anerobic |
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THis is absent of all or part of a distal limb |
hemimelia |
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What is the term for absent limb |
amelia |
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This is the most common paraxial (longitudinal) hemimelia in dogs and cats
occurance? Unilateral/bilateral |
radial agenesis
unilateral sporatic occurance |
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TX for radial agenesis |
reconstructive SX - dosen't work amputation |
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This appears like rudimentary digits are attached to the trunk like a seal flipper
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phocomelia - intercalary segment of limb missing
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This is two or more digitis fused in a bony or soft tissue union |
syndactyly |
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This is often called split hand or lobster claw deformity |
ectrodactyly |
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What digit is most commonly affected with ectrodactyly |
third metacarpal bone and digit are missing |
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This is a group of heritable diseases caracterized by osteopenia, excessive bone fragility and higher likelyhood to fracture |
osteogenesis imperfecta |
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Before a diagnosis of osteogenesis imprefecta is made, what more common diseases should be ruled out first. |
renal and nutritional secondary hyperparathyroidism |
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Dogs and cats with this disease will present at a young age with small head, ears, flattened face, corneal clouding, pectus excavatum, growth retardation, skeletal deformit y and bone leisons |
mucopolysaccharidosis (lysosomal storage disease) |
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What is osteochondrodysplasia |
disproportionate dwarfism reduced limb length relative to the trunk |
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What occurs at the metaphysis with chondrodysplasia? |
physeal cartilage is widened and adjacent metaphyseal bone is roughened and irregular. |
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Animals with this disease grow slowly but retain their normal body proportions |
pituitary dwarfism |
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Animals with this disease have soft puppy fur but symmetric alopecia and hyperpigmentation develope |
pituitary dwarfism |
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What occurs radiographicially with pituitary dwarfism? |
limb bones are shortened with delayed closure of growth plates.
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Prognosis for pituitary dwarfism |
poor |
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Aniamsl with this disease are disproportionate dwarfs with short limbs and spinke, block like trunks and broad short skulls. |
congenital hypothryoidsim |
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Radiographic findings with congenital hypothroidism |
epiphyseal dysgenesis and delayed skeletal maturation |
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Besides skeletal defects, what other clinical signs are apperant for congenital hypothyroidism? |
delayed dental eruption macroglossia mental dullness persistent puppy coat to thinning alopecia hyper cholesterolenmia |
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TX for congenital hypothyroidism? |
thyroxine can reverse many abnormalities and TX should be continued for life. |
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In large and giant breeds, ___ can be found in the metaphysis of the distal ulna.
Unilateral or bilateral |
cartilage cores
bilateral |
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What occurs physically with retained cartilage cores? |
retared ulnar growth results in: shortening of the ulna valgus and rotation of the paw elbow subluxation |
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What causes retianed cartilage cores? |
unknown 3x calcium dietary supplementation caused it in Great Danes |
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This occurs mainly in terrier breeds and is inherited but also occurs sporadicly and possibly related to K9 distemper |
craniomandibular osteopathy |
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What signs do puppies with craniomandibular osteopathy show?
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mandibular swelling
drooling prehension difficulties pain on opening the mouth |
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Radiographic signs of this disease include asymmetric irregular bony prolieration ivolving the tympanic bulla-petrous temporal bone and mandibule. |
craniomandibular osteopathy |
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TX of craniomandibular osteopathy |
self limiting slows and becomes static ~1yr of age
NSAIDs to help with pain |
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Prognosis for craniomandibular osteopathy |
guarded with excessive changes ankylois and adhesions can develope and SX can be used for salvage procedures |
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This causes lameness in medium, large, and giant breed dogs. 65% are male with acute lameness intermittent in one or more limbs |
panosteitis |
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panosteitis aka |
enostosis |
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How long can each panostitis episode last?
How long may symptoms last? |
2-3 weeks
2-9 months |
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What is the prognosis for panosteitis? TX? |
self limiting by 18 months
NSAIDs to help with pain
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How old are dogs when they start developing hypertrophic osteodystrophy
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3-4m
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What are C/S associated with hypertrophic osteodystrophy
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metaphyseal swelling
pain depression inappetence +/- pyrexia |
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How long does hypertropic osteodystrophy last? |
can recover in a few days others can last weeks |
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What radiographic changes occur with hypertropic osterodystrophy - bones affected |
metaphysis of limb bones - bilateral radiolucent zone in the metaphysis seperated from the normal appearing growth plate
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Cause of hypertrophic osteodystrophy |
unknown Distemper has been isolated, and dogs with HOD re-infected nieve dogs, but the rads and histopathology were different |
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TX for hypertrophic osteodystrophy? |
No TX NSAID
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HOw often is avascular necrosis of the femoral head bilateral |
15-20% |
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What causes avascular necrosis of the femoral head? |
unknown |
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avascular necrosis occurs in this type of dog |
small breed dogs |
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What type of conservative TX can be used for ANFH?
How well does it work? SX? |
short walks multiple times a day swimming NSAIDs
up to 30%
SX if necessary if clinical improvment is not seen in 4 weeks |
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Percent of results with SX for ANFH?
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up to 85%
some might still have intermittent lameness |
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What is hypertrophic osteopathy |
firm nonedematurous swelling of all 4 legs secondary to intrathoracic disease (neoplasia).
Firm warm and painful |
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Which comes first with secondary hypertrophic osteopathy - lung or limb lesion? |
limb changes often precede signs of thoracic disease, but can occur simutaneously or afterwards. |
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Where do lesions of secondary hypertrophic osteopathy occur and spread to |
start distally and spread proximally |
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TX for hypertrophic osteopathy |
SX correction of thoracic disease - even debulking will improve skeletal signs
bone abnormalities will regress over several months. |
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These do not cause clinical signs in dogs and are usually found in conjunction with osteosarcoma |
meduallary bone infarction |
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This is rather uncommon but is found in young large breeds. GSD and Doberman pinschers are over-represented
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bone cyst
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Where do bone cysts occur? |
in metaphysses and adjacent diapheyses of long gones.
Distal radius and ulna are affected most often |
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What do bone cysts look like radiographically |
lytic and expansible with thinned cortex with little to no periosteal reaction |
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TX of bone cysts |
some have spontaneously healed - fxr high risk SX draining/curettage and grafting |
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This is a non-neoplasitc lesion that results in considerable bone destruction. Rare
Possibly related to trauma |
aneurysmal bone cyst |
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How is it proposed that trauma causes aneurysmal bone cysts? |
trauma induced hemorrhage causes venous obstruction or arteriovenous shunts in the bone marrow |
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TX for aneurysmal bone cysts |
uncomplicated lesions can be SX removed |
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What is Codman's triangle |
periosteal new bone forms at the junction between lesion and noraml diaphyseal bone |
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These non-neoplastic leison affects the tooth bearing regions of the maxilla/mandibule of young dogs. Possibly secondary to trauma.
TX |
central giant cell granulomas
TX: SX remove |
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This disease is caused by diets with excessive phosphate, insufficient calcium or both |
nutritional secondary hyperthyroidism fed mainly meat, organ tissue |
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What age does nutritional hyperparathyroidism occur? |
young but can occur in adults |
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C/S for nutritional secondary hyperparathyroidism |
lameness reluctance to stand or walk skeletal pain |
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How can nutritional secondary hyperparathyroidism be diagnosed? Chemistry? Rads?
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no biochemical test
Ca is generally WNL ALKP and Phosp might be elevated Rads: mushroom shaped metaphysis thin cortices and decreased bone density |
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TX for nutritional secondary hyperparathyroidism |
confined for a few weeks good quality balanced diet calcium carbonate should be added to produce a calcium/phosp ratio 2:1 for 2-3 m +/- NSAID |
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What is rickets? |
insuffiencent calcium, phsopherous or both |
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What is the adult form of rickets? |
osteomalacia |
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What is the most likely cause of rickets in dogs and cats? |
hypovitaminosis D due to dietary deficiency inborn error in Vit D metabolism |
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What radiographic changes are evident with rickets?
What limb is more severely affected? |
axial and radial thickeining of growth plates and cupping of adjacent metaphysies
The distal ulnar growth plates are more severely affected |
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TX for rickets? |
regular diet with adequate and not excessive amounts of calcium, phospherous, and vit D |
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What TX can be added to the diet if a inborn error in vit D metabolism was suspected?
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dihydrotachysterol (synthetic Vit D)
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If dogs have renal osteodystrophy with secondary hyperparathyroidism, what other clinical signs should be shown
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Generally present with renal failure
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Prolonged intake of excessive ____ which is contained in mostly liver diets can cause osteopathy |
vit A supplements |
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Radiographically Lesions with hypervitaminosis A
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extensive enthesophytes involving the cervical and cranial thoracic vertebrae
enthesiophytes around limb joints, shoulder/elbow ankylosis |
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Prognosis from hypervitaminosis A |
Mature cats will clinically improve, but ankylosis will probably remain |
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This type of chondrodysplasia occurs in Alaskan Malamutes and other northern breeds |
Zinc responsive chondrodysplasia |
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What bacteria are common with osteomyelitis? |
Staph Anerobes - esp. in bite wound |
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What are the components of a sequestrum |
sequestra - avascular fragment involucrum - surrounds the sequestra cloaca - draining tract |
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Where are animals affected for acute hematogenous osteomyelitis? |
metaphyses of long bones |
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What type of changes can be seen with acute osteomyelitis |
soft tissue swelling, but may not see readiographic changes |
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What radiographic changes can be seen with chronic osteomyelitis? |
periosteal bone formation - extensive spiculated and radially orientated |
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This is diagnostic of osteomyelitis |
sequestra |
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TX for acute osteomyelitis (list AB) and for how long
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most AB penetrate bone well
penicillins/cephalosporins tetracyclines aminoglycosides 4-6 weeks |
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If have chronic osteomyelitis, what are TX options |
Have to SX debride necrotic tissue and AB |
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Mycoplasma have this type of cell wall
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Lack of
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How old are animals with rheumatoid arthritis
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Adult (5-6 years)
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