Exam 1 Flashcards

Question

Diagnostic - Imaging

Answer 1

Radiograph -For initial diagnosis -Two views minimum -Only one joint clinically affected or crepitation, instability or restricted range of motion -Abnormalities of joints, DJD, chronic septic arthritis, and erosive immune mediated arthritis **If presumed IMPA, NOT recommended if the response to treatment is rapid and complete. Abnormalities seen are mild joint capsule distention and soft tissue swelling** -Radiographs of infectious polyarthritis typically only demonstrate soft tissue swelling and effusion. CT MRI Ultrasound

Answer 2

CT Imaging

Answer 3

Arthrocentesis/synovial joint fluid analysis -Minimal risk **High diagnostic yield** -Sedation for dogs, general anesthesia for cats -If Polyarthritis is suspected, fluid should be analyzed from at least 3-4 joints, including at least one carpus, one hock, one stifle. -Sterile procedure -Only very small amount of joint fluid (1-3 drops) is needed for determining viscosity, estimated cell count, differential WBC count, and culture -Larger volumes are required for a cell count **Always aseptically prepare and wear gloves** Synovial Smears -Should be prepared immediately: one drop of synovial fluid is placed onto each slide, a second is used to make a smear -Additional drops of synovial fluid should be submitted for culture and sensitivity Normal synovial fluid -Thick, viscous fluid secreted by synovium -Clear to slightly yellow in color -High content of hyaluronic acid and additional molecules such as LUBRICIN -Primary function is to lubricate articular surfaces and facilitate movement with the joint **No more than three WBC per high-dry power field (40x)** -Mixture of large and small mononuclear cells ** <10% neutrophils** -Blood contamination = 1 neutrophil/500 RBC

Answer 4

Synovial Fluid cytology chart

Answer 5

-Radiographs - chest, abdomen -Bloodwork - tick-borne disease panels, immune panels (ANA, LE, RF) -Cultures - Blood, urine, bone

Answer 6

-Developmental -Degenerative joint disease (DJD) - most common -Cytology: macrophages, mononcytes

Answer 7

-Infectious: treated with antibiotics -Immune mediated - non-erosive most common 1. Primary idiopathic 2. Reactive polyarthritis: secondary to something else going on

Answer 8

Dog -Distemper -Bacterial (Gram negative) Staphylococcus, Streptococcus (most common) -Mycoplasma, bacterial L-forms (Tetracyclines Tx) -Borrelia burgdorferi -Leishmania -Tick-borne: Ehrlichia spp, Rocky Mountain spotted fever, Anaplasma spp. Cat -Calicivirus (polyarthritis, oral ulcers) -Feline syncytium-forming virus -Feline infectious peritonitis -Bacteria Pateurella multicocida, other (anaerobes) -Mycoplasma, bacterial L-forms

Answer 9

-Chronic progressive disorder of joints -Articular cartilage damage and degenerative proliferative changes in the periarticular tissues -Any breed (C/F), any size and age can be affected **Joint instability, trauma and developmental orthopedic diseases are the most commonly identified underlying causes** -Estimated 20% of canine population are affected. Periarticular elbows and hips -Behavioral changes: can't jump anymore Clinical Signs -NO SYSTEMIC signs -Insidious onset of signs confined to the musculoskeletal system -Low grade lameness, stiffness, sometimes only after exertion, muscle atrophy Prevention and Treatment **Think Multi-modal** -Weight management: overweight/obese BCS associated with joint incongruity, negatively affects normal movement. Chronic pain and dysfunction. -Exercise and physical fitness -Pharmaceuticals -Physical rehabilitation: water therapy -Complementary therapies: dietary supplements, Omega3

Answer 10

Arachiodonic Acid

Answer 11

Firocoxib Robenacoxib - Cats Deracoxib Carprofen Meloxicam Etodolac Ketoprofen Tepoxalin (off the market now)

Answer 12

-Grapiprant (Non-Cox) : PGE2 EP4 receptor antagonist -All NSAIDs have the potential to cause GI side effects ranging from gastric ulceration to erosion -Cox-1 sparing NSAIDs are associated with 50% less GI ulceration in humans and animal studies Use NSAIDs Judiciously -Dehydrated -Hypotensive -Geriatrics with comorbidities

Answer 13

-Roebenacoxib -Meloxicam -Use judiciously as part of multimodal therapy

Answer 14

-For Acute pain -Not long term -Butorphanol (mild to moderate pain) -Methadone -Hydromorphone -Buprenorphine -Morphine -Tramadol -Fentanyl **Cerenia prior to opioid to prevent emesis**

Answer 15

-Ketamine CRI - NMDA receptor inhibitor -Amantadine - NMDA antagonist -Amitriptyline - TCA with pain modulating **Gabapentin - associated with NMDA receptors** -Lidocaine (transdermal patches or liposomal encapsulated lidocaine cream)

Answer 16

-Stem cell therapy -Platelet rich plasma (PRP), autologous conditioned serum -Hyaluronic acid -Corticosteroids **Not great long term results**

Answer 17

-Uses radio-synovi-orthesis to break the cycle of pain and inflammation for chronic OA patients -Novel radioisotope (tin-117m) is injected into the joint, engulfed by macrophages and synoviocytes, which causes apoptosis **92% success** -Can last 1 year!

Answer 18

-Newest OA drug -MOA: anti-NGF monoclonal antibody once monthly injection -Anti-nerve-growth factor

Answer 19

Route of Infection -Hematogenous **Direct inoculation: penetrating joint wounds are common, often resulting in single joint infection** -Spread from local, adjacent tissue -More common in large breed male dogs **Staphylococcus spp., Streptococcus spp., and Colifrom organisms are most common in dog** **Pasteurela multicocida most common in cats** Diagnosis -Radiographs of affected joint -Aerobic and anaerobic cultures of joint fluid -Arthrocentesis with joint fluid analysis -Additional tests as dictated by case - thoracic/abdominal imaging, UA with culture, blood cultures Treatment -Goal is to rapidly resolve infection, decrease inflammatory compounds in joint (enzymes, fibrin) -Start antibiotics as soon as cultures are collected -Initial choice: BROAD SPECTRUM, beta-lactamase resistent antibiotics (e.g., cephalosporin, clavamox). Treatment -Medical management with caution -Chronic infections, foreign bodies, immature animals with open growth plates should have immidiate surgical management

Answer 20

-Borrelia burgdorferi -Spirochete related to Leptospira and Treponema bacteria -Worldwide distribution -90% of Lyme disease northeastern US -Most dogs are asymptomatic -No breed, sex, age predilection **Lameness and/or myalgia most common signs in dogs** -Acute onset with lethargy, inappetance, +/- fever, lymphadenopathy **Joint inflammation in one or more joints, painful on palpation** -Affected joints characterized by marked FIBRIN effusion, NEUTROPHILIC infiltration, thickened synovial membranes -Lymphocytes and plasma cells replace neutrophils in chronically infected joints Treatment -History: recent exposure in endemic region -Clinical signs -Positive serology -Prompt response to antibiotic therapy -Dogs may respond within 24-48hrs of antibiotic therapy Acute infections -Tetracyclines (e.g., doxycycline, 10 mg/kg, q24 hrs) -Lactams (e.g., amoxicillin, 20 mg/kg, q8 hr) Chronic/refractory cases -Azithromycin (5mg/kg, q12 hrs) -3rd generation Cephalosporins (e.g., Cefriaxone, 20mg/kg, q12 hrs) Steroid Therapy -Should be used with caution -Low dose anti-inflammatory doses only -Immunosuppressive doses exacerbate infection NSAIDs -May be used for pain relief from arthritic complications, with the usual cautions of monitoring for GI and renal side effects

Answer 21

-Rocky Mountain Spotted Fever -Ehrlichia canis -Ehrlichia ewingii -Anaplasma phagocytophilum **Polyarthritis largely due to immune complex deposition in synovial membranes** **Vasculitis, systemic disease association possible** -CBC abnormalitites, thrombocytopenia Dx -ELISA test -PCR to confirm -Response to therapy -Fourfold rising IgG titer over 2-3 weeks -Joint taps with cytology may be useful, especially during acute phase when serology is still negative Treatment -Tetracyclines (e.g., Doxycycline) for 3 or more weeks -Concurrent glucocorticoid therapy (PREDNISONE, 0.5-2mg/kg PO q24hrs) if antimicrobial therapy alone does not eliminate the fever, lameness, and joint swelling.

Answer 22

**Mycoplasma gatae and Mycoplasma felis** -Bacterial L-form secondary to bite wounds -Septic arthritis secondary to foreign bodies or bite wounds -Transient polyarthropathy associated with Calicivirus following vaccination of kittens **Always rule out FeLV/FIV

Answer 23

**Reactive polyarthritis accounts for 25% of all non-erosive immune-mediated polyarthritis cases** -Chronic bacterial, fungal, or Rickettsial infections -Neoplasia -Drug induced (e.g., Trimethoprim-sulfa, Phenobarbital, Penicillin) -Numerous systemic diseases (e.g., endocarditis, heartworm disease, pyelonephritis)

Answer 24

**Diagnosed ONLY by Ruling out other causes of polyarthritis and it's the most common form of polyarthritis in the dog.. NOT CATS** Clinical Signs -Cyclic fever -Stiffness and lameness -Multiple joints affected IMPA Diagnosis -Synovial fluid analysis -Failure to ID other infectious causes Treatment -Empirical treatment with Doxycycline while awaiting the results of synovial fluid cultures **Rapid and complete response to antibiotics makes it unlikely IMPA** **Cornerstone of therapy: PREDNISONE 2mg/kg q12 hrs for 3-4 days, 2mg/kg for 14 days if improving decrease dose by half every 4 weeks -Additional immunosuppressants such as Azothioprine might need to be added

Answer 25

Developmental Orthopedic Diseases

Answer 26

1. Hip dysplasia 2. Elbow dysplasia 3. Medial Patellar luxation 4. Shoulder Osteochondritis Dissicans 5. Panosteitis

Answer 27

Profile -Multifactoral disease with genetic and environmental factors -Factors can be coxofemoral joint laxity in affected dog, which leads to long term osteoarthritic changes within the joints Pathophysiology Proposed Causes 1. Primary joint laxity due to abnormal collagen type or fibers development in the joint capsule and ligament of the femoral head 2. Abnormal endochondral ossification of the acetabulum resulting in joint incongruency, joint effusion, and secondary subluxation and laxity PennHip Distraction Index (Gold Standard) OFA extended Hip view Treatment Medical -Weight control - maintain lean body -Exercise, low impact, strengthening and proprioception -Surgery - TPO (triple pelvic osteotomy); Total Hip Replacement, FHO (femoral head osteotomy) -Manage osteoarthritis Prevention -Selective breeding -Promote slow, steady growth rate in puppies to achieve lean body condition

Answer 28

-Ununited Anconeal Process (UAP) -Medial Coronoid Disease or Fragmented Coronoid Process (MCP or FCP) -Osteochondrosis of the Humerus (OCD) of medial humeral condyle -Most patient are affected by only 1 or 2 of these conditions at the same time Causes -Multifactorial: genetic and environmental -Dogs present with unilateral or bilateral lameness or stifness of the forelimbs with effusion, pain, and decreased range of motion of the elbow Pathophysiology 1. OC/OCD: disturbance in endochondral ossification, leading to a region of abnormally thickened cartilage, resulting in ischemic necrosis, flap formation (e.g., OCD). 2. MCD (FCP) may be caused by abnormal load distribution across the elbow joint, caused by various joint incongruities, which lead to pathologic lesions affecting load-bearing joint surfaces. 3. UAP hereditary abnormality in the growth plate leading to incomplete fusion of the anconeal process of the ulna -Subsequent instability in the elbow may lead to fracture of the UAP and secondary arthritic changes Treatment Medical Management -Weight control - maintain lean body mass -Exercise - low impact, strengthening and proprioception -Surgery - arthroscopy, arthrotomy -Manage osteoarthritis Prevention -Selective breeding -Promote slow, steady growth in puppies to achieve lean body condition

Answer 29

-Abnormal angular limb structure and forces result in medial displacement of the quadriceps mechanism -This muscular displacement results in abnormal forces that predispose the patella to luxate medially -Small breeds are predisposed, although it does affect some large breeds **Akita, Sharpei, Great Pyrenees** Pathophysiology **Coxa vara** (e.g., decreased angle of inclination of the femoral head) and diminished **anteversion angle** (e.g., less cranially oriented) of the femoral head, results in medial displacement of the quadriceps mechanism -Patellar luxation is graded from 1 to 4, depending on the frequency of luxation and difficulty of manual reduction Complex skeletal abnormalities affecting the overall alignment of the limb, including: -Abnormal conformation of the hip joint, such as hip dysplasia -Malformation of the femur, with abnormal angulation and torsion malformation of the tibia -Deviation of the tibial crest -Tightness/atrophy of the quadriceps muscles, acting as a bowstring -A patellar ligament that may be too long Treatment Medical management -Weight control - maintain lean body -Exercise - low impact, strengthening, and proprioception -Surgical correction -Manage osteoarthritis Prevention -Select breeding -Selected exercises for Grade 1-2?

Answer 30

-Multifactorial, genetics, environmental factors (e.g., high protein diets, calories, calcium) -Large breeds are most commonly affected, usually presenting with unilateral or bilateral forelimb lameness between 4-8 mts of age.

Answer 31

-Self-limiting inflammation of the bone marrow in long bones -Large breed dogs, particularly German shepherd dogs are commonly affected, although smaller breeds can also be affected. **Males** seem to be affected more frequently than females -Most patients are between 5-12mts of age -Range 2mts to 5 yrs of age Pathophysiology -Etiology unknown **Involves the diaphyseal and metaphyseal regions of long bones** -Lesions include medullary fibrosis, and endosteal and subperiosteal bones deposition.

Answer 32

Medical Management -NSAIDs for pain management -Allow patient to self-limit exercise but encourage low impact movement -Generally, resolves in 3-5 days -May recur in different leg at a later time **Shifting leg lameness**

Exam 1 Flashcards

(59 cards)