LA Exam 4

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LA Exam 4
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  1. Signs of eye pain
    • squint
    • tear
    • pupil constricted
    • photophobia
    • periocular swelling
  2. most reliable eye reflex
    dazzle reflex
  3. eye exam in dark
    • dilate pupil for fundic exam
    • visulaize lens for clarirty
    • visualize vitrious, optic disk, retinal vessels, tapetum
  4. nerve block for ocular exam
    • auriculopalpebral nerve of facial nerve (VII)
    • frontal branch of trigeminal nerve (CN V)
  5. Menace response
    CN II, VII
  6. pupillary light reflex
    CN II, III
  7. dazzle reflex
    CN II, VII
  8. eyelid laceration
    • upper and lateral more common
    • always repair or get exposure keratitis
  9. periocular SCC
    • debulk
    • cryotherapy
    • hyperthermia
    • chemo
  10. Habronemiasis
    • hot, humid summer
    • vector- house and stable fly
    • adults- bots
    • larvae in feces
    • tx- topical insecticide, fly control, systemic ivermectin
    • looks like shallow, blood patch on face/sheath
  11. entropion
    • foals
    • loss of periorbital fat or dehydration
    • tx- temp stay sutures or inj
  12. ocular SCC
    • debulk
    • strontium-90 irradiation
    • 5-FU
    • om sclera or cornea
  13. periocular sarcoid
    • sx excision
    • 5-FU
    • cisplatin
    • hypertherm, cryo, radiation
    • raised blood lump
  14. exophthalmus
    • normal size globe that's pushed forward
    • neoplasia, cystic mass, inflammation
  15. cornael lateration
    • repair immediately
    • hole plugs with fibrin or iris
    • cover with conjunctival flap
    • do not use ointments prior to repair
    • reinflate anterior chamber (Na hyaluronate, sterile saline)
  16. globe rupture
    • acute or chronic
    • prompt sx
    • evaluate internal strucutres to see if need to enucleate
  17. corneal ulcer
    • painful
    • flourescein stain taken up by disrupted epithelium
    • descemeos membrane will not take up stain- see halo
    • bac, fungal, mixed
    • dx- scrape, culture
    • tx- AB (chloramphenicol), antifungal (miconazole), atropine, anticollagenase (stope melting from pseudomonas), banamine, sx
    • keep pupil dilated with stropine to reduce pain of ciliary muscle spasms and reduce chance of synechia
  18. bacterial keratitis
    • scrape
    • neovascularization in growth starts 3-5d and grows 1mm/d
  19. used to cover corneal damage
    • porcine submucosa patch
    • conjunctival flap
    • equine origin amnion
  20. fungal keratitis
    • fungus in eye naturally so need puncture
    • may not take up stain
    • inhibits neovascularization
    • usually to Descemet's membrane
    • #1 Aspergillis or Fusarium
  21. conjunctivitis
    • irritation
    • allergy
    • insect related
  22. corneal FB
    • seed
    • insect parts
    • plant marterial
  23. dermoids
    • congenital
    • raised mass on cornea adjacent to limbus
    • non-painful unless haired
    • tx-keratotomy
    • bilateral
    • ddx: SCC
  24. eosinophilic keratitis
    • proliferative or ulcerative or caseous
    • medial canthus
    • non-painful
    • eosinophils on corneal cytology
    • tx- topical steroids (even though it's an ulcer!)
  25. traumatic corneal edema
    • blunt force separation of endothelium and Descemet's membrane from stroma
    • permanent
    • tx- topical hyperosmotic 5% NaCl
  26. third eyelid SCC
    • folds under eye so may not see
    • thick, white drainage from eye
  27. scleral SCC
    tx- radiation
  28. acute anterior uveitis
    • inflammation of iris or ciliary body
    • painful
    • neovascularization, hypopion, constricted pupil
    • can lead to recurrent uveitis
  29. equine recurrent uveitis (ERU)
    • #1 reason for blindness in horse
    • immune mediated panuveitis
    • appaloosa and warmbloods
    • if no subsequent episodes for 2 or more yrs then risk reduced for more
    • separation of retina, cataract, glaucoma
    • Lepto most commonly implicated
    • tx- sustained cyclosproin implants suprachondral
  30. glaucoma
    • secondary to ERU
    • primary is rare
    • disorder of aqueous flow
    • normal 20-30 mmHg
    • linear band opacity
    • corneal edema
    • buphthalmoss- bigger eye
    • must dec prod of aqueous humor- beta blocker, carbanic anhydrase inhibitors
  31. cataract
    • most common congenital ocular anomaly
    • opacity of lens
    • acquired- ERU
    • don't confuse with lens suture lines
  32. luxated lens
    • from ERU
    • secondary to trauma
    • prognosis poor for sight
  33. detached retina
    • seconddary to ERU
    • fluid accumulated in retina
    • complete or incomplete
    • see best on ultrasound
    • tx- reduce inflammation
  34. Rocky Mountain Horse
    • congenital anterior and posterior segment abnormalities
    • associated with coat color- dark chocolate with white main and tail
  35. congenital stationary night blindness
    • appaloosas
    • reduced ability to see in low light conditions
    • reluctant to enter dark areas or move after dark
    • congenital and non-progressive
  36. infectious bovine keratoconjunctivitis
    • pinkeye
    • Moraxella bovis (gram -)
    • financial loss
    • concurrent with IBR
    • vector- face fly
    • summer
    • Herefords
    • unilateral
    • pain
    • central corneal lesion
    • neovascularization
    • cattle can see around scar, horse cannot
    • tx- oxytet, penicillin
  37. Infectious Keratoconjunctivitis of sheep and goats
    • chamydia, mycoplasma
    • same dz as in cattle
  38. periocular SCC in cattle
    • secondary to lymphosarcoma
    • older cattle with white around eye
    • tx- cryo, enucleation, usually just cull
  39. CN I
    • sensory
    • olfatory n
    • smell
    • damage= loss of smell
  40. CN II
    • sensory
    • optic n
    • vision
    • damage= loss of vision
  41. CN III
    • motor
    • oculomotor
    • medial/dorsal/ventral rectus
    • constrict pupil
    • damage= droopy eyelid, mydriasis, ventrolateral strabismus, absent PLR
  42. CN IV
    • motor
    • trochlear
    • dorsal oblique m
    • damage= eye rotation laterally
  43. CN V
    • both sensory and motor
    • trigeminal nerve
    • sensory to entire head
    • motor to mm of mastication
  44. CN VI
    • motor
    • abducens n
    • lateral rectus
    • damage= medial strabismus
  45. CN VII
    • both sensory and motor
    • facial n
    • motor to mm of facial expression
  46. CN VIII
    • sensory
    • vestibulocochlear n
    • hearing and balance
    • damage= deaf, nystagmus, ataxia, head tilt, positional strabismus
  47. CN IX
    • both sensory and motor
    • glossopharyngeal n
    • motor to pharynx
    • damage= difficulty swallowing, regurge of food
  48. CN X
    • both sensory and motor
    • vagus n
    • motor to pharynx, larynx, esophagus, trachea
    • parasym to esophagus, heart, lungs
    • damage= dysphagia, insp dyspnea
  49. CN XI
    • motor
    • accessory n
    • motor to trapezius
    • damage= atrophy
  50. CN XII
    • motor
    • hypoglossal n
    • motor to tongue
    • damage= dysphagia, lingual paralysis, atrophy
  51. palpebral reflex
    CN V, VI, VII
  52. menace response
    CN II, VII
  53. pupillary light reflex
    CN II, III
  54. cerebrum lesion signs
    • change in mentation
    • depression
    • blindness
    • circling
    • seizures
    • opisthotonus
    • head pressing
    • yawning
    • bellowing
  55. cerebellum lesion signs
    • ataxia without weakness
    • intension tremors
    • wide base stance
    • exaggerated reflexes
    • no proprioceptive deficits
    • opisthotonus
  56. vestibular lesion signs
    • peripheral- head tilt, fall to lesion side, circle to lesion side, ataxia, nystagmus with fast phase away form lesion
    • central- depression, loss of appetite, ataxia with wekness, nystagmus that's rotary/dorsoventral/changes with head position
  57. brain stem lesion signs
    • ataxia
    • paresis
    • depression
    • CN deficits
  58. spinal cord lesion causes
    • focal- vertebral body abscess, vertebral trauma/fx, lymphoma, malformation
    • multifocal- CAEV, parelophostrongylus tenuis
    • hypoderma bovis
    • fissuse- rabies, pseudorabies, OP tox, tetanus, copper tox
  59. C1-6 lesion
    • inc reflexes
    • ataxia/weakness in all limbs
    • recumbent- lesion side down
  60. C6-T2 lesion
    • hperactive rear limb relfexes
    • depressed fore reflexes
    • ataxia/weakness in fore and hind
  61. T2-L3 lesion
    • normal fore reflexes
    • hperactive hind reflexes
    • ataxia/weakness in hind
  62. L4-S2 lesion
    • normal fore reflexes
    • depressed hind reflexes
    • ataxia/weakness in hind
  63. S1-2 lesion
    • bladder distension
    • loss of anal tone
  64. Polioencephalomalacia
    • thiamine deficiency- from change in rumen flora, high conc and low roughage, dec activity of transketolase enzyme in RBC leading to dec utilization of glucose in brain, dec ATP leads to intracellular edema
    • high sulfates- high sulfur diet, bac release H2S gas, gas eructated and inhaled, inhibits cytochrome oxidase
    • tx- thiamine, remove sulfur diet, Vit B, transfaunation
  65. three stages of polio
    • uncoordinated movement/convulsions when excited
    • blind/opisthotonus/star gazing
    • lateral recumbency, sudden onset with cortical blindness (intact PLR), normal rumen function
    • dx- transketolase activity in blood
  66. lead tox pathology
    • lead stored in bone
    • binds to RBC and inc fragility
    • porphyrin build up
    • inhibits utilization of Fe
    • source- batteries
  67. acute lead tox clinical signs
    • seizures
    • champing of jaw
    • blind (intact PLR)
    • rumen atony, dead protozoa (opposite of polio)
    • ddx- tetanus, rabies
  68. subacute lead tox clinical signs
    • anorexia
    • dull
  69. chronic lead tox clinical signs
    normocytic normochromic anemia
  70. lead tox dx and tx
    • dx- whole blood lead (purple top) >0.35ppm
    • tx- magnesium sulfate, Ca EDTA, thiamine
  71. rabies
    • rhabdovirus
    • saliva in bite wound, CSF fluids in break in skin
    • migrates up neuron to CNS, replicates, goes to salivary glands
    • incubates 3wks- 3mth
    • fox, skunk, raccoon, bats
    • furious- tenesmus, bellow, hypersexuality
    • dumb- depressed, anorexic, salivate
    • paralytic- unexplained ataxia or shifting limb lameness, recumbency
    • dx- Negri bodies
  72. pseudorabies
    • contact with pigs
    • mad itch
    • excoriation
    • looks like rabies
    • nasal swabs
  73. water deprivation/salt
    • show pigs, frozen auto waterer, calves recetly weaned
    • Na accumulates in brain so when given water then get edema
    • blind, GI signs
    • dx- clinical signs, hx
    • tx- frequent small amt of water
  74. nervous coccidia
    • Eimeria
    • bloody diarrhea in weaning calves
    • intermittent with shorter and shorter episodes
    • paddling, mm tremors
    • dx- clinical signs
    • tx- albon.vit A, only tx once then put in quiet place
  75. urea toxicosis
    • not acclamated to urea in diet
    • excess NH3 produced, inc pH, NH4 converted to NH3, goes to liver that is overwhelmed, converted to urea and excess NH3 in blood
    • dx- smell of rumen, rumen pH >8
    • ddx- polio, lead
    • tx- 1/2 gal vinegar in cold water (sheep 1qt), rumenotomy
  76. bacterial meningitis
    • young calves, lambs, kids, pigs
    • associated with FPT
    • omphalitis, hypopion, swollen jts, dirrhea, blind with intact PLR
    • E. COLI- most common in young
    • Pseudomonas aeruginosa- adults
    • cloudy meninges/CSF
    • tx- Ab (ceftiofur), NSAIDs (banamine), IV fluids, colostrum, thiamine
  77. Thrombotic meingoenceohalitis (TEME)
    • Histophilus somni
    • vasculitis with thrombus formation
    • fever, blind, neuro signs, weak ataxia, swollen jts
    • dx- hemorrhages in retina
    • tx- oxytet, florfenicol, NSAIDs
  78. Listeria
    • asymmetrical CNS dz
    • lives in soil, spoiled silage, vegitation
    • enters via breaks in mucosa
    • migrates up CN V (trigeminal n.)
    • seen commonly during tooth eruption
    • microabscesses in brain
    • multifocal cranial signs with depression and acute onset
    • dx- mononuclear pleocytosi
    • tx- PPG, oxytet, thiamine
    • zoonotic
  79. BVD
    • cerebellar hypoplasia
    • present at birth- young
    • wide base stance, hypermetria, intension tremors
    • dx- virus isolation, ear notch, pre-suckle serology
    • ddx- stroage dz, grass staggers, locoweed
  80. grass staggers
    • dallas grass staggers- claviceps paspali
    • fungus attaches to grasses
    • ddx- cerebellar hypoplasia
    • head tremors, ataxia, hypermetria
    • tx- remove from offending pasture, mow grass head
    • adult cattle
  81. cerebellar disease differentials
    • cerebellar hypoplasia
    • cerebellar abiotrophy
    • storage dz
    • grass staggers
    • locoweed
    • hereditary disease
    • meningitis
  82. vertebral body abscess
    • Actinomyces pyogenes
    • animals over 2wks (FPT)
  83. epidural abscess
    • ascending myelitis from tail docking, epidural inj, trauma
    • febrile, inf leukogram
  84. Spinal cord parasites
    • Hypoderma bovis
    • Paralaphorastrongylus tenuis
    • white tailed deer nateral host
    • slugs/snails IH
    • larvae migrate to cord of deer but no clinical signs
    • asymmetric cord signs, recumbency
    • tx- ivermectin, dexamethasone, fenbendazole
  85. bovine lymphosarcoma
    • invades nodes near the spinal cord
    • asymmetric cord signs
    • lumbar area
    • recumbent, ataxia
    • older cows (3-6yrs)
    • positive for BLV
    • attacks sciatic n- dropped hocks
  86. tetanus
    • clostridium tetani
    • in soil
    • stiff, stilted gait, elevated third eyelid, retracted ears, bloat, hyperesthetic, pump handle tail
    • tx- PPG, keep in a quiet place
  87. Metabolic and nutritional neuro dz in goats and sheep
    • hypocalcemia
    • hypomagnesemia
    • polioencephalomalacia
    • enterotoxemia
    • copper deficiency
  88. infectious or inflammatory neuro dz in goats and sheep
    • Listeria
    • pseudorabies
    • bacterial meningoencephalomyelitis
    • necrotic encephalopathy
    • cerebral abscess
    • otitis media
  89. viral neuro dz in goats and sheep
    • scrapie
    • medi and visna
  90. parasitic neuro dz in goats and sheep
    • coenurus cerebralis- GID- taenia multiceps tapeworm passed by dog
    • oastrus ovis- nose bot
    • parelaphostrongylus tenuis
  91. scrapie
    • mostly black faced sheep
    • 1-5yr
    • ddx- parasites, bad teeth, Johne's, C. pseudotuberculosis, abscess, poor nutrition
    • hard to transmit
    • smacking of lips, tremors, loss of vision
    • dx- third eyelid prion test
    • reportable dz
  92. most common souce of lameness in horse
    foot
  93. ring bone/bone spavin
    lump medial hock jt
  94. digital pulse
    inc with inflammation
  95. hoof tester exam
    • pos with navicular dz over frog
    • pos with laminitis over toe
  96. moving exma in horse
    head up when bad leg hits the ground
  97. grades of lameness
    • grade 1- subtle, inconsistent at a trot
    • grade 2- consistent at a trot
    • grade 3- obvious at a trot, not seen at walk
    • grade 4- seen at walk and trot
    • grade 5- nonweight bearing
  98. flexion test
    • 0- no change
    • 1- mild, 2-3 bad steps
    • 2- mod, inc lameness half of circle
    • 3- severe, limps full circle
  99. distal limb flexion
    • not specific for fetlock pain
    • tendon, coffin, pastern, ankle jts, navicular pain
  100. carpal flexion
    specific for carpal lesions
  101. hock flexion/extension
    • hock
    • stifle
    • hip
    • proximal suspensory lig
  102. lidocaine for nerve blocks
    • used mostly in cattle
    • lasts 20 min
    • blocks Na channels thus preventing nerve depolarization
  103. carbocaine/mepivicaine
    • used in equine
    • 45-60 min
    • blocks Na channels thus preventing nerve depolarization
  104. marcaine/bupivicaine
    • used in equine
    • 4-6 hrs
    • blocks Na channels thus preventing nerve depolarization
  105. Posterior digital nerve block
    • navicular area
    • impar and CSL
    • distal DDFT
    • navicular burse
    • sole of foot to toe
    • palmar coffin jt
    • 80% of hoof
  106. etiology of horse needing posterior digital nerve block
    • big horse, small feet
    • poor hoof confirmation- poor heel support
    • poor shoeing
    • long toe, low heel
  107. PE of horse needing posterior digital nerve block
    • point foot during exam
    • contracted heels
    • atrophied frogmismatched feet
    • inc digital pulse
    • hoof tester pos on frog
    • usually bilateral
  108. rads after posterior nerve block
    • lateromedial- spurs, bone shape
    • dorsopalmar- synovial invaginations, spurs
    • flexor view- sclerosis, cortical erosion, DDFT
  109. tx navicular dz
    • corrective shoeing- inc heel angle by 2 degrees and takes 25% of pressure off navicular area
    • eggbar shoe- inc heel support
    • bute
    • Hyaluronic acid
    • coffin jt or navicular bursa inj (last resort)- corticosteroids, HA
    • neurectomy sx- very last resort, only lasts 2 yrs, use in older horses
  110. sheared heels
    • breakdown of heel bulbs
    • caused by overuse
    • one heel higher than the other- higher hits ground first so most painful
    • hoof tester sore at heels
    • PDN block
  111. tx sheared heel
    • straight or eggbar shoe
    • float heel
    • PDN block
  112. bruised heel/corn
    • btw bar and heel of hoof
    • overdue for shoes
    • shoe too small
    • pigeon-toed
    • long toe, low heel
    • common in front feet
    • PDN block
  113. abaxial block
    • block just below fetlock
    • entire foot and pastern desensitized
    • laminitis, hoof abscess, white line dz, keratoma, high and low ringbone
  114. laminitis
    • axial block
    • rotation of P3 bc DDFT
    • acute, severe lameness
    • endotoxemia
    • walking on egg shells
    • reluctant to move
    • hoof tester pos at toe
    • wider rings at heels
    • deformed feet
  115. tx laminitis
    • emergency
    • ice feet for 48hrs to stop MMPs
    • banamine
    • bute
    • DMSO
    • after 48hr then inc blood flow to area- ace
    • deep bedding
    • frog support to oppose DDFT
    • shorten toe
    • Heartbar shoe
    • deep flexor tenotomy- salvage, stops pull of DDFT
  116. sinker
    • laminae detaches all the way around hoof
    • P3 sinks vs rotating
    • grave prognosis
  117. hoof abscess
    • rainy, muddy weather
    • acute
    • 4/5 lame
    • lower limb may swell bc hoof cannot
    • unilateral
    • abaxial nerve block
  118. tx hoof abscess
    • scrape sole with hoof knife or walk to pop- establish drainage
    • flush tract- betadine
    • soak in Epsom salt
    • foot bandage
    • treatment plate
    • Ab
  119. white line dz
    • gravel, seedy toe
    • separation of laminae from hoof capsule
    • gas pocket seen on rads on hoof wall
    • abaxial block
  120. tx white line dz
    • remove undermined hoof wall
    • support entire foot
    • 1/4 inch per month
  121. keratoma
    • recurrent hoof abscess
    • benign hoof tumor
    • swirls of abnormal keratin
    • sx excision thru hoof capsule
    • abaxial block
  122. pedal osteitis
    abaxial block
  123. ringbone
    • abaxial block
    • low- coffin jt OA
    • high- pastern OA
    • secondary to trauma or OCD lesion
    • see bony exostosis at pastern
  124. tx ringbone
    • rounded toe show
    • bute
    • intra-articular inj with cortisone
    • sx only for high ringbone- arthrodesis
    • prognosis poor for low ringbone bc no sx option, high motion jt and cannot fuse
  125. low 4 point nerve block
    • fetlock jt
    • digital tendon sheath
    • suspensory branches
    • coffin jt
    • hoof
  126. synovitis of fetlock jt
    • low 4 point block
    • "osslets"
    • may not be lame
    • jt effusion seen at fetlock jt
    • tx- bute, rest, HA, intra-articular meds (HA, Ab
  127. hyperplastic synovial pad/proliferative synovitis
    • 4-point block
    • fat pad in front of distal MC3 cranially
    • due to chronic hyperextention of fetlock
    • fetlock effusion
    • rads- lysis of distal MC3
    • ultrasound- larger nodular pad
    • tx- arthroscopic sx, NSAIDs
  128. sesamoiditis
    • 4-point block
    • inflammation and bony lysis os sesamoid bones
    • inc fetlock effusion
    • rads- inc vascular channels or lysis
    • tx- rest, NSAIDs, intra-articular meds
  129. tendonitis/tenosynovitis
    • 4-point block
    • inflammation in digital tendon sheath
    • swelling above and below fetlock
    • ddx- windpuff
    • tx- rest, bute, intra-articular inj (HA), annular lig resection (sepsis a problme)
    • fair prognosis with tendon lesion
  130. windpuff
    • swelling above fetlock only
    • ddx- tendonitis
    • not lame
  131. fetlock chip fracture
    • inc jt effusion
    • may not be lame
    • rads- proximal P1 chip fx
    • tx- arthroscopic sx, intra-articular meds can stop pain but not problem
  132. proximal palmar metacarpal block
    • superfiacial and deep flexor tendonitis
    • suspensory lig desmitis
    • bucked shins
  133. superficial digital flexor tendonitis
    • proximal palmar metacarpal block
    • 3-4/5 lame
    • improves in 7-10d
    • swelling
    • ultrasound- type 1-4
  134. types of tendonitis
    • 1- diffuse lesion, <25% of CSA
    • 2- diffuse, 25-50% CSA
    • 3- localized, mostly anechoic
    • 4- core lesion, anechoic lesion
  135. tx tendonitis
    • ice 20 min for 7d
    • rest
    • NSAIDs
    • support bandage
    • inj HA and corticosteroids
    • tendon splitting
  136. suspensory ligament desmitis
    • proximal palmar metacarpal block
    • common in main wt bearing limb of working horse
    • 2-3/5 lame
    • acute
    • no swelling
    • rads- avulsion fx, sclerosis
    • tx- ice, support bandage, NSAIDs
  137. splints
    • proximal palmar metacarpal block
    • inf of interosseous lig attaching proximal splint to cannon bone
    • excessive training in young horse
    • bony exostosis over splint bone
    • lame initially
    • tx- ice, rest, NSAIDs, bandage, DMSO
    • sx removal if impinges on suspensory lig
  138. bucked shin complex
    • proximal palmar metacarpal block
    • 2 yr old race horse in training
    • overuse of MC3 that is still remodeling
    • forelimb
    • rads- thickening of dorsal cortex MC3
    • tx- ice, reduce training (short speed works, 1-3/wk at short distance)
    • can lead to saucer fx thru thickened cortex

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