Bone is composed of osteogenic cells, organic matrix, and mineral.

Osteogenic cells: osteoblasts, osteocytes, and osteoclasts, derived from mesenchymal cells

Matrix (⅓ mass): collagen and proteoglycans

Mineral (⅔ mass): calcium phosphate crystals deposited as hydroxyapatite.


Osteoblast lining cells form a polarized layer and depoit osteoid. Osteocytes live within canaliculi of the mineralized bone matrix. Together osteoblasts and osteocytes regulate the flow of mineral ions from extracellular fluid to the mineralized bone matrix. Osteoclasts are found in sites of bone remodeling.


There are two types of bone matrix: hard compact cortical bone, which surrounds marrow cavities within the shafts of long bone, and spongy cancellous bone forming trabeculae cavities that enclose hematopoietic marrow and fatty marrow.

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rads

Radiography • differerential absorption is necessary to create an image. the image represents a lack of absorption; darker areas are where x rays were not absorbed, in contrast to bright shadows cast by structures with great absorption. In order to be visualized, a stucture must be surrounded by a substance of differing radiopacity.

  • radiographic opacities

  • geometry of magnification

  • distortion (object and receiver planes are not parallel)

  • “the unfamiliar image concept”

  • loss of depth perception

  • superimposition opacities (small structures surrounded by air cast disproportionately opaque superimposition opacities)

  • summation sign

  • silhouette sign/border effacement

Sonography • differential reflection. B-mode images are a collection of dots that correspond to the amplitude of strength of the returning echo. These dots are displayed on a black background. Increasing the power (V) leads to a uniform increase in image echogenicity. Keeping the power low helps improve image resolution and prevent artifacts. “subtle parenchymal echotexture”

Artifacts have the potential to enhance evaluation of structures by providing insight to their composition. Sonographic imaging of a fluid-filled structure is characterized by enhancement of soft tissues distal to it, where a hypoechoic tissue mass looks similar but does not show distal enhancement.

  • echogenicity (the ability to generate echoes)

  • attenuation

  • acoustic shadows (soft tissue-bone and soft tissue-gas interfaces; renal, cystic, or cholecystic calculi)

  • spatial compounding?

  • acoustic enhancement

  • reverberation artifacts

  • mirror-image artifacts (when the liver is imaged with the diaphragm/lung interface acting as a highly reflective structure)

  • slice thickness artifact (in the urinary and gallbladder, mimic the presence of sludge or sediment)

  • refraction (displays organs to the side of their actual location, appear wider than normal)

  • edge-shadowing artifact (refraction artifact created by a curved surface, with anechoic regions distal to the curved surface; seen with kidneys, urinary and gall bladder)

sigla


PAM “positive allosteric modulator” – binds to a receptor and amplifies the agonists’ effect. eg, the BZD (and other induction agents) at GABA receptors.

vesicant a blister agent, a chemical compound that causes severe burns (cantharidin)

urticant a nettle agent, causing corrosive tissue injury upon contact, resulting in erythema, urticaria, intense itching, and a hive-like rash.

nerve agents a class of organophosphates, producing sympathetic signs and death by respiratory paralysis.

corrosive strong acid/oxidative

caustic alkaloid

hemiplegia refers to spasticity restricted to one side of the body

diplegia when used singularly, refers to paralysis affecting symmetrical parts of the body.

hemorrheology the study of blood flow in the vascular system

rheology the study of the flow of matter

The term was inspired by the aphorism of Simplicius, panta rhei, “everything flows”.

An aphorism is an original thought, spoken or written in a laconic (concise) and memorable form Aphorism literally means a “distinction” or “definition”.

In rhetoric, chiasmus (from the Greek: χιάζω, chiázō, “to shape like the letter Χ”) is the figure of speech in which two or more clauses are related to each other through a reversal of structures in order to make a larger point; that is, the clauses display inverted parallelism.


facsimile (‘fac simile’ make alike) an exact copy or reproduction



crisis (hippocrates)


Distemper:: Disturbed condition of the body or mind; ill health, illness; a mental or physical disorder; a disease or ailment.


Drachms (literally an eighth)

A unit of weight originally equal to the weight of a drachma; an apothecaries’ weight of 1/8 ounce (60 grains).


Dropsy

A condition of excess watery fluid in the tissues or cavities of the body; congestive heart failure from whatever cause.


dyscrasia

sicks, disease, pathology, morbidity


eucracia: health, balance, homeostasis


Fatuity

Used here in the older sense meaning imbecility, dementia.


Fecula

[Latin faecula, dim. of faex meaning dregs, sediment] 1 Sediment. 2 Faecal matter of insects or other invertebrates.


fundus: a collective term describing all the structures in the posterior portion of the globe that can be viewed with the ophthalmoscope.


Glareous

[from glarieux, French] Consisting of viscous transparent matter, like the white of an egg.


Griped

With respect to the bowels: afflicted with spasmodic pain as if by contraction or constriction.


Little’s Disease Spastic diplegia.

Diplegia, when used singularly, refers to paralysis affecting symmetrical parts of the body. This should not be confused with hemiplegia which refers to spasticity restricted to one side of the body, or quadriplegia which requires the involvement of all four limbs but not necessarily symmetrical


Meteorism

Flatulent distension of the abdomen with gas in the alimentary canal.


Morbid = pathologic (“morbid obsesity”)


Mortification

Used in the medical sense: gangrene, necrosis.


Phthisic, phthisis

[From Greek phthisikos through Latin and Old French] 1 Pulmonary tuberculosis. 2 Any of various lung or throat affections; a severe cough; asthma.

Phthisis is a Greek word for consumption, an old term for pulmonary tuberculosis; around 460 BC, Hippocrates identified phthisis as the most widespread disease of the times. It was said to involve fever and the coughing up of blood, which was almost always fatal.

phthisicky

Having phthisis, or some symptom of it, as difficulty in breathing. Asthmatic, wheezy.


physik

[From Latin physica and Greek phusike] 1 Natural science. 2 The art or practice of healing. Medical people collectively. 3 Medical treatment; fig. a healthy practice or habit; a mental, moral, or spiritual remedy. 4 Medicine; specifically, a cathartic. 5 Medical science; the physician’s art.


physis

“vis medicatrix naturae” in Latin

the belief that the body can heal itself


Saginate

Fatten an animal for food.


Sapid

[ L. sapidus ] 1 Of food etc.: having a distinct (esp. pleasant) taste or flavour, savoury, palatable. 2 Of talk, writing, etc.: agreeable, mentally stimulating.


scirrhous

A large, hard, and painless swelling.


spotted fever

Rickettsial fever; typhus.


St. Anthony’s Fire

Erysipelas, or inflammation of the skin due to ergot poisoning.


typhoid

enteric fever caused by salmonella enterica sepsis, feat. delirium reminiscent of typhos, epistaxis, and rose spots.


typhus: any of several diseases caused by rickettsia bacteria.

  • typhos (τῦφος) meaning smoky or hazy, describing the state of mind of those affected with typhus.


Vitriol

As used here probably refers to sulphuric acid; also used for any of the various sulphates of metallic elements.

 

Radiology_Exam_II

Radiology Exam II

Axial Skeleton Lecture

  1. What type of radiographs would one take in order to confirm otitis media?

    1. Bulla Series confirms diagnosis of otitis media

    2. However, negative study does not rule out this diagnosis

    3. Severity depends on structures involved

  2. What type of radiographs would be helpful in diagnosing otits intima?

    1. None, at least not bulla

  3. What are the common views taken in a bulla series? (3)

    1. VD/DV

    2. Lateral Oblique

    3. Frontal Open Mouth or Frontal Closed Mouth (Cat)

      1. Also called Rostroventral Caudodorsal

  4. What does one need to evaluate in a VD Bulla Radiograph?

    1. Symmetry, External Ear Canals, Soft Tissues, Bullae

  5. What is a rostro 10 ventro-caududorsal oblique?

    1. Special bulla projection in cat in order to see bullae without superimposition

  6. What are the radiographic signs of Chronic Otitis Media? Acute?

    1. Chronic

      1. Sclerosis: increased opacity

      2. Typanic bulla thickened, irregular, destructive

    2. Acute – None

    3. +/- otitis externa  soft tissue opacity in external ear canals (may indicate)

  7. What indications might prompt one to radiograph a nasal series?

    1. Chronic Nasal Discharge

    2. Presence of Mass

    3. Deformation of Nose

  8. What are the common views of nasal series?

    1. Lateral – use closed mouth

    2. VD/DV and lateral closed mouth – view for seeing frontal sinuses

    3. VD open mouth or intraoral techniques –beam 30 to 45 into mouth, or cassette in mouth

    4. Frontal (rostro-dorsal) – see frontal sinuses

  9. What are the two main general types of spinal radiography?

    1. Survey and Contrast Studies

  10. What are the techniques of spinal radiography?

    1. Sedation or anesthesia  quality/radiation protection

    2. High detail film – screen combinations

    3. Grid/bucky >10

    4. Minimum of 2 orthogonal views

    5. Collimate image is equal or less than 30 cm

    6. Rad each vertebral segment separately

  11. What are the exceptions for using sedation in spinal rads?

    1. If patient has experienced recent trauma, or is physiologically unstable

  12. Why should the spine be radiographed in sections?

    1. Divergence of the x-ray beam in whole images creates projection artifacts that alter the width of disc spaces, making them look narrow as they are farther from central beam.

  13. What type of views should one strive for in spinal radiographs?

    1. Straight lateral views with superimposition of the transverse processes and ribs

  14. Where should dorsal spinous processes be located in an optimal VD views?

    1. Should be located centrally

  15. When evaluating the spine, one should consider what?

    1. Number of Vertebrae, their shape, opacity, alignment, and canal diameter

    2. Disc spaces and intervertebral foramen

  16. What is the relevant anatomy to consider in a lateral projection of the spine?

    1. Large transverse process – C6

    2. Size of spinous process

    3. Intervertebral disc space T10 – T122 (aticlinal v.)

    4. Large l7 – S1 space

    5. Ventral border of Ls and L4 are insertion of diaphragm

  17. Why is it important to consider vertebral number, axis, and shape?

    1. Differentiate species

    2. Find luxations, congential defects, disease

  18. What soft tissue structures may be present in spinal rads? What soft tissue cannot be seen?

    1. Soft tissue tumors, abscesses may communicate with vertebral canal through intervertebral foramen

    2. Sublumbar LN

    3. Paralumbar swellings, if sufficiently large

    4. Spinal trauma often associated with trauma of thorax/abdomen

    5. Nervous cannot be visualized

  19. What might opacity of bony structures indicate in spinal radiographs?

    1. Sclerosis, lysis

      1. Mineralization of disc due to degeneration

      2. Discospondylitis (infection of spinal cord)

  20. Why would one choose to use alternate spinal imaging?

    1. Allows not only bony structure but also nervous tissue to be analyzed

  21. What is Myelography and its protocol? What is it used to detect?

    1. Filling of subarachnoidal space with positive contrast medium

    2. Used to detect spinal cord compression in animals

  22. What is CT? What is its use and advantage over Rad?

    1. Allows axial imaging of the spine and skull in all animals and has excellent tissue contrast compared to radiography. Soft tissue vs fluid can be differentiated?

  23. What is MRI and what is it used to visualize?

    1. MRI allows imaging in transverse, sagittal, and dorsal planes and has the best soft tissue contrast for examining the brain and musculoskeletal system.

  24. In horses, what are MRIs used and not used for?

    1. Examination is limited to skull and cranial portion of cervical spine (as in CT – in notes, not explained earlier???)

  25. What are additional ways to diagnostically study spine?

    1. Nuclear Medicine and Ultrasound – but they are more limited

    2. Ex, in presence of open fontanelles, brain can be examined with ultrasound

  26. What are the proper views one must pursue in radiographing the equine skull?

    1. Lateral Standing Views – multiple necessary to see incisors, sinuses, guttural pouches

    2. Oblique Standing Views – Right and Left

      1. Teeth roots, upper and lower

      2. Sinuses, left and right

    3. DV

    4. Intraoral for incisors

  27. What views would one take for diagnosing TMJ?

    1. DV, Sagittal Oblique

  28. What positioning of spine needs to happen with cats?

    1. Usually none

Thoracic Lecture

  1. How many views should be taken in thoracic imaging?

    1. Minimum of 2 orthogonal views – a lateral and VD/DV

  2. What consideration to inspiration or expiration be given in thoracic imaging and why?

    1. Inspiratory and expiratory can be made to assess airway dynamics

    2. Inspiratory allows visualization of lungs and is preferred in thoracic imaging

    3. Inspiration maximizes constrast of lung

  3. In lateral recumbency, how does dependency influence imaging of the lungs?

    1. Dependent side is the side animal is laying on, the non-dependent side is imaged

    2. Dependent lung is not aerated, non-dependent lung has more air

  4. What are the four common, basic views in thoracic radiology?

    1. Left Lateral – left recumbent (beam direction R  L)

    2. Right Lateral –right recumbent (beam L  R)

    3. Ventrodorsal –Dorsal recumbency (beam Ventral  Dorsal)

    4. Dorsoventral – Sternal Recumbency

  5. What are pertinent exposure factors to consider in thoracic radiology?

    1. High Kilovolt peak (kVp) – penetrate ribs, maximize latitude of contrast (long scale)

    2. Low milliampere-second (mAs) – as fast as possible (1/30, 1/60,1/120)

      1. Eliminate motion unsharpness

    3. Fast film-screen combinations

    4. Grid if size of 15 cm (10 cm if obese)

  6. What is the technique to consider when making thoracic radiology?

    1. Forelimbs cranial prevents superimposition with brachial muscles

    2. Sternum lifted up with foam wedge prevents rotation

    3. Inspiration maximizes lung contrast

    4. Center at heart behind shoulder blades

  7. How much of the lung does lateral view show?

    1. 60 – 70% are visible

  8. What are the absolute indications for thoracic radiographs?

    1. Severe, acute and chronic respiratory disease, thoracic trauma, severe trauma to other areas of body, CV disease, thoracic operative metastatic check, shock, dysphagia, esophageal obstruction, thoracic wall defects

  9. What are other indications that may encourage thoracic radiographs?

    1. Status of older patients (pre-operative check), metabolic diseases, post-op follow-up on thoracic sx or drain placement, therapeutic monitoring.

  10. What may expiratory views be indicated for?

    1. Lower airway obstruction, emphysema, suspicion of small volume pneumothorax or collapsing stem bronchi

  11. Where is the crura of the diaphragm in inspiration? In Expiration.

    1. T12 – T13 in lateral view and cupola is caudal to T8. Here you can distinguish three crura in dogs. At Expiration, the crura is cranial to T12. In DV, you can see 3 crura, but all appear as dome in VD.

  12. Why must one be wary of sedation in thoracic radiography? Why else might it be bad?

    1. Radiolography is stressful, and patients with heart or pulmonary disease may suffer severe consequence of stress.

    2. Sedation can change appearance of the lung and cardiovascular system: small lung volume, dilation of esophagus, atelectasis, and collapse of dependent lung lobe.

  13. How many views of lungs should be taken if mass or lesion is suspected?

    1. More than 2. AS far as lateral, only 70 percent of lung is visible, and this is mostly non-dependent. Thus, it is imperative to consider taking two laterals as well as DV.

  14. What occurs to the cardiac silhouette in expiration?

    1. The cardiac silhouette width to thorax width is larger than during inspiration. The diaphragm is higher and more dome-shaped and the rib-diaphragm angle is smaller.

  15. What is optimal positioning in thoracic radiographs?

    1. Patient should NOT be rotated around long axis of body.

    2. Rib arches and costochondral junctions of R and L should be superimposed.

    3. Forelimbs pulled forward so as not to overlap lungs

    4. In VD, sternum should not be superimposed with vertebral column

    5. Thoracic inlet, cranial abdomen, thoracic spine, and sternum should be included in view

  16. What exposure factors should play a role in thoracic radiographs?

    1. High kVp and low mAs (using highest possible mA and lowest time) to maximize latitude.

    2. Combination allows penetration of ribs and prevents motion unsharpness due to breathing.

  17. Do cats require grids in thoracic radiography?

    1. No

  18. What are components of a thorough analysis of a film?

    1. Recognition of normal anatomy

    2. Recognition of artifacts and variations of anatomy

    3. Species and breed specific variations

  19. When will normal, healthy pleura show up on a radiograph?

    1. If beam is projected tangentially to crura, they will show up as fine line

  20. When will crura show up apart from the aforementioned occurrence?

    1. Widened pleural fissures are visible is there is pleura fluid.

  21. How will pneumothorax manifest radiographically?

    1. Pneumothorax (air in pleural space, collapsed lung) increases lucency of thorax

    2. Causes retraction of lung lobes

    3. Elevation of heart from sternum

    4. Pulmonary vasculature cannot be followed to thoracic wall

    5. Lucent, vessel-free space can be seen in periphery of the thorax

  22. What are mediastinal structures? Which are visible radiographically (normally)?

    1. Esophagus, trachea, heart, large vessels, nerves, thymus

    2. Trachea, heart

  23. When will esophagus become visible radiographically?

    1. If it has air or fluid in it

    2. Small amount of air in excited dogs may be normal

  24. Mediastinal structures become visible when what occurs in mediastinum?

    1. When air is in mediastinum

    2. Tracheal, bronchiole, esophageal rupture can cause this

  25. What is the cardiac silhouette comprised of?

    1. Myocardium, vessels, blood, pericardium.

  26. How would one visualize the internal structures of the heart?

    1. Echocardiogram

  27. Technicalities of the cardiac silhouette are as follows:

    1. In dog, diameter is 2.5 to 3.5 intercostal spaces

    2. Trachea makes 15 degree angle with vertebral column in deep chested dog, 10 degree in shallow chested

  28. IN VD view, cardiac silhouette should NOT be more than ____ of the width of the thorax.

    1. 2/3

  29. What is Vertebral Heart Score?

    1. Length and Width of heart on lateral view measured into comparison to vertebral column starting at T4.

      1. Dogs: 8.5 – 10.5

      2. Cats: less than 8

    2. Assesses size of heart

  30. Which lung lobes contact heart?

    1. Right Cranial

    2. Right Middle

    3. Accessory

    4. Caudal part of Left Cranial

  31. What structures of pulmonary parenchyma are visible radiographically?

    1. Airways (bronchi) up to level of secondary bronchi

    2. Pulmonary arteries and veins

    3. Interstitium

  32. How do pulmonary vessels usually appear?

    1. Air in lungs and fluid in vessels creates sharp contrast in healthy patients

  33. What do end-on vessels appear as?

    1. Smoothly marginated round soft tissue opacities resembling small nodules or rings

  34. What is the interstitium of the lung? How should it appear normally?

    1. Scaffolding of lung that contains vessels, bronchi, lymphatics, connective tissue.

    2. Should appear relatively lucent

  35. When reading a radiograph, what should one consider?

    1. Breed and age variations

    2. Young dogs – thymus

    3. Young dogs and cats – larger cardiac silhouette compared to thorax

    4. Older age – lung may appear more opque

    5. What do you see?

      1. Be systematic – look from outside in

      2. Consider soft tissue changes, mineralization, organ position, skeletal structures…

      3. DO NOT IGNORE PERIPHERY AND OUTLYING ORGANS/STRUCTURES

    6. Consider these findings in conjunction with!!!!!!!!!!

      1. Signalment and Clinical Presentation

      2. Other diagnostics

    7. REPEAT

  36. What happens last after thoroughly evaluating radiograph

    1. Diagnosis, Differential Diagnosis, Further Diagnostics…

  37. Compare the cardiac silhouette in left and right lateral views

    1. R: Oval

    2. L: Rounded , apex elevated

  38. Compare crura of diaphragm in left and right laterals

    1. R: crura parallel, right crus more cranial, vena cac confluent with right crus

    2. L: crura diverge, L crus more cranial

  39. Gas in fundus can be seen in which lateral view?

    1. Left Lateral

  40. Compare the crura in VD and DV

    1. VD: crura convexamd superimposed oer convex cupola

    2. DV: dome shape

  41. Compare cardiac silhouette in VD and DV

    1. VD: Elongated silhouette

    2. DV: Round silhouette

  42. How does the accessory lung lobe appear in VD and DV

    1. VD: more aerated

    2. DV: less aerated

  43. Letters on radiographs should

    1. Be on lateral side and tell you which extremity or side of animal is seen

  44. What can cause pseudo-pleural-effusion?

    1. Obesity

  45. What are the thoracic boundaries?

    1. Sternum

    2. Vertebral bodies

    3. Ribs and intercostals soft tissues

    4. Soft tissue at thoracic inlet

    5. Diaphragm

  46. What is the significance of the diaphragm in orientation in thoracic rads?

    1. Caudal limit of thoracic cavity

    2. Shaped and position influenced by:

      1. Phase of respiration

      2. Intraabdominal contents

      3. Species and breed

      4. Body condition

      5. Radiographic projection and positioning

      6. Age

  47. When are pleural fissure lines seen in healthy animals?

    1. Thickened in older patients

    2. Projected exactly tangentially to beam

  48. How does pneumothorax appear on a radiograph?

    1. Radiolucent zone between lung and thoracic wall

    2. Lung borders retracted, opacity increased

    3. Dorsal elevation of cardiac silhouette

  49. Hypovascular lung appears more _________

    1. radiolucent

  50. Hypervascular lung appears more_________

    1. Radiopaque, more opacity

  51. Intersitial disease is normally manifested as what type of pattern on a radiograph?

    1. generalized

  52. Alveolar increased opacity appears as and is caused by what?

    1. More opaque, save spares aerate lucent bronchi, even more opaque than interstitial disease

    2. Fluid filled cells – arteries and veins nearly invisible

    3. Hallmark of alveolar disease—-patchy like clouds

  53. What are reflections of parietal pleura?

    1. Reflections ventral to vertebrae form the mediastinal pleura

    2. Confluent with thoracic wall and diaphragm

  54. What are reflections of mediastinum?

    1. Cranioventral

      1. Thymus, LN

    2. Caudoventral

      1. Lateral extent of accessory lung love

    3. Caval reflection

  55. What mediastinal structures can be seen?

    1. Aorta, cadual vena cava, heart, some bronchi

    2. Esophagus is aerated or fluid filled

    3. Enlarged ln

    4. Thymus in young animals –“sail sign”

  56. What is pneumomediastinum?

    1. Cervical subcutaneous emphysema

    2. More mediastinal structures visible (outer tracheal wall, vessels)

    3. Can lead to pneumothorax

    4. Tracheal walls more visible – tracheal stripe sign

  57. Cardiac silhouette is contains what

    1. Pericardium, Great vessels (aorta, aortic arch, pul. A.) heart and blood, fat

  58. What is an angiogram?

    1. Injected in order to contrast vessels and blood flow in heart

  59. What is the size of heart in cats and its shape?

    1. 2 intercostal spaces (veterbal heart scale is less than 8)

    2. Oval

  60. What do vessels and circulations give clues to in thoracic radiography?

    1. Presence of heart disease, shunting, decompenstaion

    2. Must asses aorta/cadual vena cava

    3. Lungs and pulmonary vessels

    4. Abdomen and pleura

  61. Hearts appear smaller in dogs with _____ chest

    1. Deep

  62. Hearts appear large in dogs with _____ chest

    1. Smaller, or flatter

  63. Label the pulmonary artery, bronhcus, and vein in caudl lung lobe in VD thorax rad – just see notes

  64. What is osteochondrosis?

    1. Calcification of cartilage

  65. What are extrathoracic soft tissue structures?

    1. Soft tissues of cervical region

    2. Thoracic wall and abdomen: presences of gas, nipples, liver size, cervical trachea

    3. Obesity (could be cushings if fat is in thorax)

    4. Cachexia sign or metabolic or metastatic disease

  66. What can cause cranial displacement of diaphragm?

    1. Lung fibrosis, pain, obesity, space occupying lesion in abdomen, diaphragmatic paralysis

  67. What can cause caudal displacement of diaphragm?

    1. Deep inspiration, acidsosis, dypsnea, asthma, intrathoracic space-occupying lesion, pneumothorax, pleural fluid

  68. What lung lobes can be seen in VD?

    1. R Cr, R Cd, Acc, L Cr, L Cd

  69. What lung lobes can be seen in DV?

    1. R Cr, R Mid, R Cd

    2. L cr (cr, cd), L cd

Equine Clusterfuck

  1. What are general considerations necessary in planning equine radiographs?

    1. Brush hair to remove debris

    2. Remove splint, bandage

    3. May need grid for stifles

    4. May need sedation

    5. Cassette holder with handle

  2. What are the standard equine carpal views?

    1. DP, LM, DLPMO, DMPLO, Flexed LM

  3. What are special equine carpal views?

    1. Skyline – DPr-DdiO

      1. Distal Radius: D80Pr-DDiO

      2. Proximal row: D55PR-DDiO

      3. Distal row: D30Pr-DDiO

  4. Dorsal Proximal View is used to visualize what?

    1. Joints, Soft Tissue, Bone Margins, Physeal Scar

    2. Conformation: beam parallele to ground and centered mid-carpus

    3. Marker always lateral

  5. LM allows visualization of what views?

    1. Soft tissues, joints, bones margins

    2. There is also a fat pad on the dorsal surface of carpus

    3. Confromation: beam is parallel to ground and directed just distal and dorsal to prominence of accessory carpal

  6. What is a D60L-PMO used to see?

    1. Dorsomedial aspect of Radius, Radial and 3rd carpal

    2. Palmarolateral aspect of ulnar and 4th

    3. Accessory carpal bone –seen as walnut

  7. What is D60M-PLO used to see?

    1. Dorsolateral aspect of radius, intermediate and 3rd carpals

    2. Palmaromedial aspect of radial and 2nd carpals

      1. 2nd carpal articulates only with MTII

      2. May see 1st 30 percent of time

  8. What is flexed LM used to see?

    1. Evaluate distal radius

    2. Proximal aspect of intermediate carpal bone

    3. Distal aspect of radial carpal bone

    4. Proximal aspect of 3rd carpal

    5. ¾ flexion of carpus and hold foot at level of opposite carpus

  9. What is a D80Pr-DDiO used to see?

    1. Distal radius – 2 grooves

    2. Medial: extensor carpi radilais

    3. Lateral: common digital extensor tendon

    4. Intertendinous eminence: common fracture sites

    5. Protocol: place MC parallel to ground, radius perpendicular to ground, direct beam downward.

  10. What is a D55Pr-DDiO used to view?

    1. Proximal row of carpal bones

    2. Procedure: flex carpus, keep slightly cranial to opposite carpus, keep MC parallel to gound.

  11. What is D30Pr-DDiO used to view?

    1. Distal row of carpals, mainly the third

    2. Procedure: position carpus cranial and proximal to opposite.

  12. What is the antebrachiocarpal joint?

    1. Distal Radius and proximal row of carpal bones

  13. What is the Middle carpal joint?

    1. Between proximal and distal rows of carpal bones

  14. What is Carpometacarpal joint?

    1. Between Distal Carpals and MCs

  15. What are the two centers of ossification?

    1. Radial Epiphysis (24 – 36 m)

    2. Lateral styloid process (ulna)

      1. Fuses with epiphysis less than one year

      2. Lucency in caudodistal lateral radius

  16. What are the distal joints?

    1. Metacarpo-metarsophalangeal (fetlock) – High motion joint

    2. Proximal internphalngeal (Pastern) – Low motion joint

    3. Distal interphalangeal (CoffIn) – Widest joint

  17. What are the standard views for studying the fetlock?

    1. LM

      1. Evaluate Soft tissue, bone margins, sesamoid bones, joint spaces, conformation

    2. DP (D30Pr-PaDiO)

      1. See soft tissue, bone margins, joints, conformation

      2. Sesamoids: Lateral (thin, tall) Medial (wider)

    3. DMPLO (C30Pr60M – PaDiLO)

      1. DL and PM aspect of limb

      2. Marker: cranial on medial side to indicate M view

    4. DLPMO (D30Pr60L – PaDiMO)

      1. DM aspect and PL aspect of limb

      2. Need marker to distinguish sesamoids – placed palmar in lateral oblique

    5. Flexed LM

      1. Assess sagittal ridge and palmar aspect of distal MC3

      2. Flex fetlock as much as possible and direct beam at the joint, keeping it parallel to ground

  18. What are the standard pastern views?

    1. D45P-PaDiO

    2. LM

    3. D45P30L-PaDiMO

    4. D45P30M-PaDiLO

  19. What are the standard foot views?

    1. LM

    2. D45PR-PADiO (45DP)

    3. D65PR-PaDiO (65 cone down)

    4. D65Pr-PaDiO (P3)

    5. Pa45Pr-PaDiO (Flexor)

  20. LM of Foot

    1. Corticomedullary distinction

    2. Proximal and distal borders

    3. Horizontal beam direction centered on coronary band above heel bulbs

  21. 65 DP of Foot (P3)

    1. Evaluate P3

    2. Foot on cassette, angle 65 degree beam above coronary band

  22. 65 DP of foot (Cone down)

    1. Evaluate body and distal border

      1. No coffin joint superimposition

    2. Place 65 degree cone down beam above coronary band

  23. Foot: 45 DP

    1. See proximal border and body

    2. Distal border overlaps coffin

    3. Place 45 degree just above coronary band

  24. Foot: Flexor

    1. See flexor cortex and corticomedullary distinction

    2. Midsagittal ridge lucency normal

    3. Center beam between bulbs of heel

  25. What is the anatomy of equine stifle relevant to DI?

    1. Distal femur

      1. Cr – trochlear ridges

      2. Cd – femoral condyles

    2. Proximal Tibia

    3. Fibula: multiplpe ossification centers

    4. Patella

  26. What are the standard views of a stifle?

    1. Caudocranial (CC)

    2. LM

    3. Caudo 30 Lateral – Craniomedial Oblique (LMO)

  27. Stifle LM

    1. Medial Femoral trochlea is larger, proximal and cranial

    2. Slight flattening of both trochlea

    3. Evaluate patella

  28. Caudocranial

    1. Medial intercondylar eminence large and sharp

    2. Margins of femur and tibia

    3. Patella slightly lateral

    4. Lateral femorotibial joint normally narrower

    5. Center beam on soft tissue indention caudal to joint

  29. Stifle: LMO

    1. Good view of lateral trochlear ridge and medial femoral condyle

    2. Medial condyle is caudal

  30. Foal Stifle

    1. Irregular trochlear ridges and patella

      1. Require 6-9 m for ossification

    2. Tibial apophysis

      1. Rad other limb

  31. Tarsus Anatomy is

    1. Talus: medial and lateral trochlear ridges

    2. Calcaneus (Lat)

    3. Tarsals (1/2, 3, 4, Central)

    4. Proximal MT

    5. Tibiotarsal (tibia and talus)

    6. Proximal intertarsal (talus and prox row of tarsals)

    7. Distal intertarsal (proximal and distal rows)

    8. Tarsometatarsal: distal row and MTs

  32. What are standard views of the tarsus?

    1. DP, LM, D45L – PMO, D45M – PLO

  33. Tarsus DP

    1. Medial and lateral malleolus

    2. Joints, talus ridges

  34. Tarsus LM

    1. Joint spaces, soft tissue

  35. Tarsus D45L – PMO (DLO)

    1. DM aspect of joint

    2. Medial mallelus

    3. Planterolateral aspects of joint

  36. Tarsus D45M – PLO (DMO)

    1. Separates trochlear ridges

    2. Lateral trochlear ridge – large notch

    3. See DL bones and joint

    4. See PM bones and joint

  37. What are Carpal disorders?

    1. Adult

      1. Carpal fractures (chip, slap)

      2. DJD

    2. Young

      1. Angular limb deformity

      2. Incomplete ossification

      3. Septic arthritis

  38. What is best view to see carpal bone fractures?

    1. Flexed LM

    2. Most common sites to see

      1. Distal Radius

      2. Radial and intermediate

      3. 3rd

  39. What are fetlock disorders?

    1. DJD, Osteochondrosis, Chip fractures of proximal phalanx

  40. Osteochondrosis is best seen in what view

    1. Sagittal ridge, seen best on flexed LM

  41. What are pastern disorders?

    1. High ringbone = DJD between P1 and P2

    2. Fractures, Osteochondrosis

  42. What are foot disorders?

    1. Subsolar abcess, Laminitis, Navicular disorder, DJD – low ringbone, osteochondrosis

    2. Laminitis is seen best in LM

  43. What are stifle disorders?

    1. Osteochondrosis, Osseous cyst-like lesions, DJD, Trauma (Fractue, CCL, Meniscal tear)

  44. Where does osteochondrosis occur in the equine stifle?

    1. Lateral and Medial trochlear ridges

    2. Patella

nerve gas

Nerve gas (Sarin, VX) is chemically similar to some commercial pesticides in use here. It causes overstimulation of the parasympathetic nervous system whose effects can be summarized by the cholinergic toxidrome of SLUDGE: Salivation, Lacrimation(tears), Urination, Defecation, GI symptoms, and Emesis. Pt’s will eventually seize and become apnic (stop breathing). Treatment will include the common drug Atropine, and 2-PAM. Different gases will give you different times for treatment options.