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220 Cards in this Set
- Front
- Back
What is the most commonly reported skin prob in llamas and alpacas?
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mites
|
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What are the 2 most impt mite species of relevance to llamas and alpacas?
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Sarcoptes
Choriptes |
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Describe how mite transmission occurs in camelids.
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horizontal spread by direct contact and fomites fr env
|
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Describe the symptoms of sarcoptic mange.
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alopecia
hyperkeratosis *severe pruritus 2ndary bact inf (pyoderma) can become more generalized if severe wt loss decr fiber prod death |
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What is a big difference bet. the symptoms of sarcoptic mange and that of chorioptic mange?
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sarcoptic mange is very itchy, chorioptic mange is NOT
|
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How do you diagnose sarcoptic mange?
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DEEP skin scrapings (negative ones don't rule it out)
histopath skin biopsy |
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Is sarcoptic or chorioptic mange a zoonotic risk?
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sarcoptic - YES
chorioptic - NO |
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How is sarcoptic mange treated?
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topical lime sulfur
topical + parenteral ivermectin |
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What is the organism that causes sarcoptic mange?
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Sarcoptes scabei
|
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What is the organsm that causes chorioptic mange?
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Chorioptes bovis
|
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What is the most common mite infestation of alpacas?
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chorioptes
|
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How do you diagnose chorioptic mange?
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SUPERFICIAL skin scraping (of dorsal interdigital area and axilla)
|
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Chorioptic mange: first lesions are seen where?
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distal limbs
|
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What are the clin signs of chorioptic mange?
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alopecia
erythema scaling/crust lichenification can become more generalized (less common) |
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Out of sarcoptic and chorioptic mange, which is more difficult to diagnose?
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sarcoptic - b/c mites are smaller and burrow deeper into the skin (deep skin scraping may be negative)
|
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How is chorioptic mange treated?
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topical application of 1% ivermectin in water with DMSO
lime sulfur Frontline spray ($$$) |
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What is the most common dental prob of camelids?
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tooth root abscess
|
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Which teeth are considered the 'fighting teeth' in camelids?
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I3 and upper and lower canines
|
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In camelids, which teeth are more likely to get tooth root abscesses?
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mandibular and cheek teeth more likely
|
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Which age range of camelids are most likely to be affected by tooth root abscesses?
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young mature (5-8 yrs old)
|
|
What is the most common isolate of tooth root abscesses?
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Trueperella pyogenes
|
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How do tooth root abscesses present in camelids?
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hard bony swelling over affected tooth
draining tract most eat normally and without pain |
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How are tooth root abscesses definitively diagnosed?
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CT or radiograph
|
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What is the prognosis of tooth root abscessses in camelids?
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if off-feed --> poor prog (high mortality rate)
|
|
How are tooth root abscesses treated in camelids?
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medical: Florfenicol, Penicillin, Ceftiofur
surgery: remove tooth/root |
|
What is the cause of most neuro dz's in llamas and alpacas?
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Parelaphostrongylus tenuis
|
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How are camelids infected w/ P. tenuis?
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ingestion of infective stage of worm from deer feces, in intermediate host (snail)
occurs in llamas/alpacas that share spaces w/ deer |
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What are the most common signs of P. tenuis inf?
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posterior paresis
paralysis inability to rise ataxia head tilt etc. |
|
How is a P. tenuis inf diagnosed?
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CSF: eosinophilic pleocytosis
hx, clin signs |
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How is P. tenuis inf treated?
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Fenbendazole, Ivermectin, Flunixin, oral vit E
|
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What is the prognosis of camelids inf'ed w/ P. tenuis?
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guarded if animal stays the same or gets worse in the first wk of tx
|
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Describe the symptoms of EHV-1 in llamas/alpacas.
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blindness
nystagmus head tilt paralysis eye lesions etc. |
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What species of tick is responsible for tick paralysis?
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Dermacentor --> flaccid paralysis
|
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What are some non-parasitic causes of paresis in alpacas?
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trauma - vert fractures, cervical luxations/subluxations
discospondylitis vert body abscesses cranial/brain dz's rye grass staggers, botulism |
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What are some causes of colic in the camelid?
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ulcers
forestomach/int obs c1 impaction peritonitis urogenital abnormalities - uterine torsion, dystocia, urolithiasis, UTI |
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What are some clin signs of heat stress in a camelid?
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hypophagia
weakness ataxia myopathy neuro signs |
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Which type of camelid is primarily affected by BVDV?
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alpacas
|
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What is the predominant source of inf of BVDV in an alpaca herd?
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PI animals
|
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How are animals screened for PI BVDV?
|
EDTA blood sample in juvenilles
can also screen herd via PCR |
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How long is normal gestation in llamas and alpacas?
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~340 days
|
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What is the normal TPR for a newborn cria?
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T: 100-102
P: 70-100 bpm R: 20-30 bpm |
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If the newborn cria isn't suckling w/in ___ hours, they become a high risk neonate.
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3 hrs
|
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How do you test for adequacy of passive transfer?
|
measure serum IgG - should be >800 mg/dL IgG
|
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Failure of passive transfer can lead to what serious illness in crias?
|
septicemia
|
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What are some signs of septicemia in crias?
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persistent tachycardia, tachypnea
hypothermic sicker than they look |
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What are some signs of prematurity/dysmaturity in crias?
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low birth wt
tendon laxity floppy ears incisors not erupted incr'ed need for intensive care in immediate neonatal period |
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What are the 3 most common congenital defects in llamas?
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skeletal
immune system reproductive |
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What are some clin signs of choanal atresia?
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distress
open-mouth breathing (beyond 1st few hrs of life) decr airflow thru one/both nostrils hypoxemia can't nurse and breath at same time --starvation --aspirate milk --> pneumonia, sepsis --aerophagia |
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What are some signs that a cria has a severe congenital heart defect?
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murmur loud on rt side (indicates VSD)
persistent tachycardia/tachypnea grade III-IV, lasts longer than 1st few days of life |
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What is the origin of a sequestrum?
|
localized trauma
|
|
What are the clin signs of a sequestrum?
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lameness (+/-)
swelling painful on palpation localization distal extremities |
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How do you diagnose sequestrum?
|
rads
|
|
How do you treat sequestrum?
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debridement and sequestrectomy
+/- cast |
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What is the prognosis of sequestrum?
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good to excellent
|
|
What is the most common site of a fracture in calves?
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matacarpus/metatarsus III/IV "cannon bone"
|
|
What are the fracture treatment options of cattle?
|
slaughter
stall confinement splints casts orthopedic implants |
|
How long should you keep a cast on a calf? An adult?
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calf - 4-6 wks (chg every 2-4 wks)
adult - 8-12/16 wks (chg every 4-6 wks) |
|
What are some cast complications of the injured limb?
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pressure sores
cast breakage open fracture inf malalignment non-union |
|
What are some cast complications of the contralateral limb?
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tendon/lig laxity
varus/valgus laminitis |
|
What is often the cause of metacarpal/metatarsal fractures in calves?
|
forced extraction during dystocia, or single loop on chain instead of double loop
|
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What should you do before you put a cast on a calf w/ a metacarpal/metatarsal fracture?
|
make sure distal limb is viable and not dead and crushed B4 YOU PUT CAST ON
|
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What is the treatment for metacarpal/metatarsal fractures?
|
reduction 50% in both planes
fiberglass cast for simple fractures transfixation pin cast for unstable fractures chg cast every 2-4 wks (calf) |
|
What is the prognosis for metacarpal/metatarsal fractures?
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good, heal in 4-6 wks
if avascular --> poor prog |
|
What is the 2nd most common type of fracture in cattle?
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tibial fracture
|
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What are the clin signs of a tibial fracture?
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soft tissue swelling, lameness
lateral deviation of limb usually highly comminuted and risk of opening on medial side |
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Describe the tx for a tibial fracture.
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depends on: fracture config, economy, and age of animal
transfixation pin cast internal fixation (plates, screws) Thomas-Schroeder splint |
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What types of physeal fractures are most common?
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Salter Harris types I and II
|
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Describe the causes of septic arthritis in adult cattle.
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primary - direct trauma leads to single joint inf
secondary - adjacent inf leads to single joint inf |
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Describe the causes of septic arthritis in calves.
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tertiary - systemic inf leads to mult joint inf
|
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What are the clin signs of septic arthritis?
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severe lameness
soft tissue swelling joint effusion wounds or other signs of trauma +/- fever (fever in calves when systemically inf'ed) |
|
When you see a swollen joint in a calf, what diagnosis should you jump to?
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septic arthritis til proven otherwise!
|
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How is septic arthritis diagnosed?
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rads (take 10-14 days for bony chg)--> need at least 2 views!
arthrocentesis, fluid analysis US |
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How is septic arthritis treated?
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*treat aggressively
treat w/ both systemic and local antimicrobials NSAIDs (ie meloxicam) joint lavage/drainage/debridement if neccessary (culture tissue also if you can) arthrodesis/ankylosis - must clear inf prior to this tx; try other tx's before this *may start treating before you see bony change on rads to get a head start |
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What is the prognosis of septic arthritis?
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generally good
|
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What are the 2 forms of tenosynovitis in cattle?
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aseptic
septic |
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What is the most common site of tenosynovitis in cattle?
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digital flexor tendon sheath
extensor carpi radialis tendon sheath |
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What are the clin signs of tenosynovitis?
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lameness
swelling |
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What is the treatment of tenosynovitis?
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similar to septic arthritis
digit amputation sometimes neccessary |
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What is the prognosis os tenosynovitis?
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guarded to poor
|
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What is usually the cause of coxofemoral luxation in adults?
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trauma
dystocia; falling/slipping |
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What is usually the cause of coxofemoral luxation in calves?
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forced extraction
|
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How does coxofemoral luxation often present in cattle?
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lame toe-touching
"dropped hip" appearance |
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How is coxofemoral luxation diagnosed?
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palpation
rads - most common craniodorsal |
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How is coxofemoral luxation treated?
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closed or open reduction
|
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What is the prognosis of a coxofemoral luxation?
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craniodorsal - good; ventral - poor
bad if animal doesn't stand before sx |
|
What are the 2 main sources for obtaining a herd SCC?
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bulk tank (BTSCC)
indiv cow samples taken each month by DHIA organization (Weighted SCC) |
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What is the target SCC?
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150,000/ml
|
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***What is the legal limit for BTSCC in the US?
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750,000/ml
|
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**There is pressure to drop the BTSCC limit to _______________ to improve European exports.
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400,000/ml
|
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Why is there an interest in BTSCC?
|
lower SCC for higher (longer) keeping quality of milk
|
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The indiv cow samples taken each month by DHIA are how specific and how sensitive?
|
80% specificity
80% sensitivity |
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Cows with a high SCC produce (more or less) milk.
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less
|
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SCC is generally (higher or lower) in the winter and (higher or lower) in the summer.
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lower in winter
higher in summer |
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What indicates a chronically inf'ed cow?
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200 or greater at previous test and 200 or greater at current test
|
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What indicates a new (lactating) inf'ed cow?
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>40 DIM and 200 or greater at the current test but were <200 at previous test
|
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What indicates a fresh cow (heifer) inf?
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5-40 DIM and 200 or greater at first test but uninf'ed at last test of previous lactation
|
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What is a clinical quarter case?
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1 quarter affected once
|
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What is a clinical cow case?
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1 cow with one or more quarters affected once
|
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Describe the relationship bet. SCC and mastitis.
|
weak relationship
|
|
Give the 4 factors of milk quality loss.
|
retentiion of high SCC cows in the herd
failure to capture SCC premiums too much clin mastitis culling too many chronic high SCC and mastitis cows |
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What is the legal limit for the plate count for Grade A milk in the US?
|
100,000/ml
|
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What is the target level for the plate count for Grade A milk in the US?
|
<5,000/ml
|
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What is the major source of coliforms?
|
manuer
|
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What is the major source of environmental Strep?
|
bedding
|
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What organism is responsible for 'pus' in bulk tank milk culture? What does it's presence indicate?
|
Trueperella pyogenes
it indicates chronic inf in the herd |
|
What are the 3 most common contagious pathogens?
|
Streptococcus agalactiae
Staphylococcus aureus Mycoplasma spp |
|
What steps were in the 5 point plan to control of contagious pathogens?
|
dry cow therapy
post-milking teat dripping regular milking machine maintenance treat clin cases cull chronically inf'ed cows |
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What was a downfall to the 5 point plan to control of contagious pathogens?
|
env pathogens weren't taken into account
|
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What are the most common environmental pathogens?
|
E. coli
Enterobacter Klebsiella Serratia Citrobacter environmental Streptococci and Enterococci |
|
Describe some culture strategies on farms.
|
all cows (all quarters)
CMT positive and trace quarters all clin mastitis cases some clin mastitis cases (pathogen profiling) chronically inf'ed cows |
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Clin mastitis in WI dairy herds is often due to what?
|
gram - bact
|
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______________ is essential for mastitis detection and for achieving good milk let down.
|
fore-milking
|
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What hormone stimulates milk ejection?
|
oxytocin
|
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When milking, what is a good unit on time? What is a good udder contact time?
|
1:30-2:30
20 secs |
|
Pre-dipping or post-dipping: which helps control env bact? contagious bact?
|
pre-dip for env bact
post-dip for contagious bact |
|
What are some of the chemicals used in teat dips?
|
disinfectant (ie iodine, chlorous acid, etc)
skin conditioner (ie glycerine, sorbitol, lactic acid) |
|
Inappropriate vacuum levels of the milking machine causes what?
|
congestion & edema of the teat end
|
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Too much massage by the milking machine causes what to the teat?
|
hyperkeratosis
|
|
The goal for peak flow claw vacuum is what?
|
40 kPa
|
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What is the major negative consequence of teat-end hyperkeratosis?
|
teat canal not good at closing after milking --> elevated risk for new inf
|
|
How do we influence hyperkeratosis?
|
choice of liner
mean peak flow vacuum duration and force of massage duration of unit on time teat dip choice (exfoliation) |
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What is most effective in the disinfection of milking units?
|
hot water + disinfectant
|
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What finding in a cow would cause a farmer to begin routine mastitis tx?
|
hot quarter
|
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What finding in a cow would cause a farmer to begin severe mastitis tx?
|
fever
|
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What factor is the biggest determinant of treatment success for mastitis?
|
prior hx of the cow
|
|
How do we set up the mastitis tx program for success?
|
allow milkers to record that a cow has abnormal milk, but don't make the milker treat it
examine the premast SCC and treatment record to determine duration of tx select appropriate label treatments use addition approach (see notes) |
|
With Gram negatives, udder texture will return to normal (slower or faster) than the milk
|
faster
|
|
Suspend mastitis therapy when the udder texture or the milk returns to normal after the min # of treatment days?
|
texture
|
|
Improved cure rates for which bact inf's have been demonstrated w/ prolonged courses of IMM tubes?
|
streptococci and s. aureus
|
|
Mastitis cow with a hot quarter. What might a farmer add on to tx?
|
anti-inflamm
|
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Mastitis cow with fever. What might a farmer add on to tx?
|
IV antibiotics
|
|
Mastitis cow that is sick and off-feed. What might a farmer add on to tx?
|
hypertonic saline
|
|
What are the choice anti-inflammatories for cows?
|
NSAIDS (Flunixin - IV, Aspirin - oral)
Corticosteroids |
|
Hypertonic saline does what for the cow?
|
raises CO and BP for a short period
|
|
What finding(s) is/are present in a severe 'toxic' cow?
|
see notes
|
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What is a popular way in which new inf's are prevented in uninf'ed cows?
|
internal sealants
|
|
What are the mechanisms of manure transfer to the udder?
|
direct transfer (lying in crap)
leg transfer splash transfer tail transfer |
|
Which type of bedding material is inert with an abrasive action for dairy cows?
|
sand
|
|
Which a's and v's are responsible for supplying the udder?
|
external pudendal a and v
|
|
Which udder v. is often used for med admin?
|
mammary v's
|
|
What is the Rosette of Furstenberg?
|
thickening of CT at teat cistern...keeps bact fr going up in there and causing inf
|
|
Describe the clinical exam process of the teats and udder.
|
visual exam and descriptive lesion
palpation gland and teat insertion rod or teat cannula milk bact culture and sens |
|
What type of medical imaging is used for the teat and udder?
|
US
rads theloscopy |
|
What are some guidelines for US exam of the teat/udder?
|
always compare to normal side
scan in both longitudinal and transverse plane |
|
How can a cow be adequately restrained for mammary sx?
|
standing or dorsal recumb
|
|
Describe the blood supply of the teat.
|
circular at base
longitudinal along wall |
|
What types of meds are given for mammary sx?
|
local antibiotics
systemic NSAIDs |
|
Describe the ideal method of closure of the teat.
|
3 layer closure...mucosa/submucosa, muscle layer, skin
|
|
What is the most common cause of reduced milk flow?
|
obstructive lesions of rosette of furstenburg
|
|
How is an obstructive lesion of rosette of furstenburg usually diagnosed?
|
US**
clin exam w/ probe |
|
What are the surgery options for obstructive lesions of rosette of furstenburg?
|
blind through streak canal
theloscopy/thelotomy rest teat for 3x3 days |
|
What are the diff types of obstructive lesions of the teat cistern?
|
I: <30% mucosa affected
II: >30% mucosa affected III: bet. teat and gland sinus IV: extent fr teat sinus into gland sinus |
|
How are the diff types of obstructive lesions of the teat cistern differentiated?
|
US
|
|
What is the preferred method for treating obstructive lesions of the teat cistern?
|
theloscopy
|
|
What are the pros and cons of blind surgical procedures thru streak canal?
|
pros: quick; no incision in teat
cons: no visualization; procedure may cause more damage; 2nd intention healing |
|
What are the pros and cons of theloscopy/thelotomy?
|
pros: visualization; less damage to tissue; diagnositic
cons: not quick; need equipment (can't do on farm); incision in teat (but it heals nicely) |
|
What types of traumatic injuries to the udder/teat tend to have a deceptive and poor prognosis?
|
crushing injuries
|
|
What factors determine prognosis of an udder/teat injury?
|
extent
chronicity orientation (longitudinal better than transverse) involvement of teat cistern involvement of distal end teat |
|
How would you treat an udder/teat injury that is up to 24-48 hrs old?
|
debride + primary closure
|
|
How would you treat an udder/teat injury that occured 48-96 hrs ago?
|
inf risk high
sx attempt high risk fistula formation |
|
How would you treat an udder/teat injury that is more than 96 hrs old?
|
sx not recommended
heal by 2nd intention |
|
What is the purpose of locomotion scoring?
|
to ID a cow that is lame so that she can be treated
to determine herd lameness prevalence for herd troubleshooting and tracking to determine herd lameness prevalence for welfare auditing |
|
Describe some changes that occur in the gait of lame cows.
|
asymmetric gait
wt transfer bet. limbs arched back joint flexion head bob see notes |
|
What expenses contribute to the cost of lameness?
|
3 lb milk loss per cow per day
0 to 50 extra days to conception increased delayed cyclicity post-partum culling risk 2-4x non-lame footbathing, trimming, treatments |
|
How does hoof-trimming prevent lameness?
|
restores a more upright foot angle
balances wt bet. inner and outer claw |
|
The benefits of restoring balance bet. the inner and outer claw last how long?
|
around 4 months
|
|
How often should cows be hoof-trimmed during lactation?
|
2x (@ dry-off and @ 80-150DIM)
|
|
How to corns form on the cow foot?
|
claws not trimmed FLAT...
then when they walk on concrete, the claws are pulled apart and the corns form |
|
What are the most common trimming issues?
|
trimmming toes too short
removal of too much sole and heal horn -->thin soles, white line dz, toe ulcers excessive removal of outer wall horn removal of the axial wall in the toe region poor tx of existing lesions |
|
The visual general term "laminitis" in cow dz is now more accurately called what?
|
claw horn lesion
ie... sole hemorrhage sole ulcer sole fracture toe ulcer white line dz |
|
What triggers loosening of the connection between the pedal bone and the horn capsule?
|
gelatinoproteases in the corium are triggered at parturition
subacute ruminal acidosis? |
|
What is another name for P3?
|
pedal bone
|
|
How long does it take for the sole to fully grow?
|
2 months
|
|
What is the central reason for the cause of sole hemorrhage and sole ulcer?
|
jxn bet. pedal bone and horn capsule is weakened/broken down, then
PRESSURE causes pedal bone to sink and cause hem, the basal cells are damaged, resulting in interrupted horn prod and eventual ulcer |
|
What is the digital cushion?
|
3 fat pads underneath the pedal bone that provide support to the pedal bone
|
|
How is digital cushion thickness affected by lactation?
|
high at calving, dips, then inc's at end of lactation
(fat in fat pad behaves like fat everywhere else in lactating cow's body) |
|
What is the significance of the white line?
|
jxn bet. sole and wall - it's a structural weak point where hemorrhage and damage can occur
|
|
Sole ulcers and white line dz peak in younger or older cows?
|
older
|
|
DD peaks in younger or older cows?
|
younger
|
|
What are the 3 main types of infectious lesions of the hoof?
|
DD (heel warts)
foot rot heel horn erosion |
|
What is foot rot?
|
acute or subacute inflamm of the skin and SQ tissues above ID space
starts from the inside...resulting in necrosis and sloughing |
|
What is the predominate isolate of foot rot?
|
F. necrophorum - a leucocidal and hemolytic endotoxin
|
|
How are beef cows treated for foot root?
|
long acting oxytetracycline
|
|
How are dairy cows treated for foot rot?
|
ceftiofur sodium - 3 days
|
|
What makes treatment of foot rot unique?
|
only cause of lameness in which 1st line of tx is a parenteral antibiotic
|
|
What is the most common infective lesion of a cow's foot?
|
DD
|
|
What M stage is considered acute and clinical?
|
M2
|
|
How would you treat an M2 lesion?
|
oxytet
|
|
What is the most impt M stage of DD?
|
M4 - chronic stage
|
|
What is a major cause of DD?
|
Treponemes (also campylobacter, bacteriodes, etc)
|
|
What type of cow housing env is most affected by DD?
|
freestall barns - more in contact w/ own manure causing maceration and low o2 tension
|
|
What can you do to reduce transition of M2 to M4?
|
early effective tx
|
|
What can you do to reduce transition of M4 to M2?
|
effective foot baths
|
|
Which type of chemical is most widely used in footbaths?
|
cu sulfate
|
|
What main factors contribute to the prevalance of DD on a farm?
|
not treating acute lesions early enough
poor footbath design, poor use of chemicals |
|
What is the the 'typical site' of a sole ulcer?
|
beneath the flexor tuberosity of the pedal bone, 2/3 back from toe, outer claw of rear foot
|
|
What is the most important thing to do when treating an ulcer?
|
trim claw to transfer wt off site of ulceration
apply hoof block to rest affected claw |
|
Which type of bedding material has the least prevalance of associated lameness?
|
sand - promotes normalized resting behavior
|
|
What is the challenge with manure solids bedding?
|
udder health challenge
|
|
How does milking frequency affect the production of lame cows?
|
no diff
|
|
When during the year is lameness at its peak?
|
late summer
|
|
What are some major factors influencing body temp of cows and barns?
|
fan capacity and soaking of holding area
parlor throughput pen stocking density fans over the resting area |
|
Where on the hoof does white line dz tend to occur?
|
outer claw, 2/3 of the way back fr the toe
|
|
White line dz refers to what 3 conditions?
|
hemorrhage
fissure abscess |
|
What is the best tx for white line dz?
|
trim all loose and dz'ed horn (trim as much as you need to)
block sound claw for 30 days |
|
What are some areas for rubber flooring priorities?
|
transfer lanes
holding areas parlor (pens) |
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What factors lead to toe ulcer?
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overtrimming
pedal bone sinkage trauma (rough floors, etc) |
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How do you treat a toe ulcer?
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remove sole around wall horn around ulcer and block other claw
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Where on the hoof do vertical fissures often occur?
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often front foot, abaxial claw
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How do you treat vertical fissures of the hoof?
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trim loose horn away fr corium and thin edges
remove bearing surface below crack and block sound claw |
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How do horizontal fissures occur?
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form due to a severe interruption to horn growth (ie mastitis)
the defect cracks when it reaches halfway down dorsal wall |
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How do you treat horizontal fissures of the hoof?
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remove loose horn, block least affected side
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What meds are often involved in bovine foot sx?
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apply local analgesia and block sound claw
give nsaids before procedure perform procedure consider parenteral antibiotics and continue w/ nsaids |
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How do corns (interdigital hyperplasia) result?
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irritation and inflamm of interdigital skin, possibly due to trimming w/ concavity (claws are pulled apart esp on concrete)
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How are corns (interdigital hyperplasia) treated?
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foot-trim and treat inf w/ local oxytet or cu sulfate
surgical removal cryotherapy *if infected but not sore, you may not need to remove |
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Describe deep digital sepsis.
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end-stage lameness
painful, non-wt bearing check for fever swelling usually off-center and encircles claw can get inf of: navicular bone, flexor tendon, P2/P3 joint |
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what factors lead to deep digital sepsis?
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severe sole ulceration
severe white line dz w/ abscessation super foot rot complications of routine hoof lesions that have gone untreated |
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What is the easiest tx for deep digital sepsis?
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remove affected tissue - digit amputation
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Ankylosis or arthrodesis are considered alternatives to what?
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amputation for deep digital sepsis
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What are the five freedoms? MUST STATE PERFECTLY!!!
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freedom from hunger and thirst
freedom from thermal and physical discomfort freedom from pain, injury and dz freedom to express normal patterns of behavior freedom from fear and stress |