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Prepurchase Exam & Dentistry

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sihirlifil's version from 2018-03-15 13:57

PPE

Question Answer
PPEs are...FACT FINDING MISSIONS
Who is the veterinarian employed by?Potential buyer
Clear communication btw the 2 are paramount importance
The _________ determines whether to buy or notClient... lol
What is a standard PPE like?Does not exist! Each is custom tailored
The actual PPE is dependent on (5)The client
The intended use of the horse
TIme constraints
Training/behavior of the animal
Location of the exam
What does the PPE tell you about future soundness?NOTHING! Exam only describes what is seen on THAT DAY
PPE step 1: buyer comes up with (6)Realistic goals, define reason for purchase
Discuss faults/vices with owner/rider
Breed suitability/conformation
Hx & performance
Vax/deworming
Financial constraints, purchase price
Important question to ask the buyer before the exam?Does the buyer know the horse? If so, do they like the horse? (...would hope so)
PPE step 2: Selection of veterinarian involves (4)Conflict of interest if it's your patient (unless medical records made available to buyer)
Suitability for the disciplne, e.g. equine reproduction specialist for breeding animal
Member of national organization e.g. AAEP
TRUSTED individual!
PPE step 3: Honest & open communication. what do you discuss?What does the buyer want from the animal?
What is the buyer willing to spend on PPE? (Cost of animal may dictate how far to go)
T/F PPEs are a pass/fail
False
PPE step 4: to perform the actual exam you need?Safe/adequate facilities & handler (often more suitable at your clinic)
Visual exam includes (4)Accurate identification
BCS, general coat condition
Attitude/temperament
Obvious signs of trauma/surgical lesions
PPE step 5: hands-on includesGood PE! Note any abnormalities, suggest further workup
What do you do for the ophthalmology exam?
Full evaluation in field rarely possible (facilities/specialty)
Basic evaluation of sight
Assess eyelids, cornea, pupil, conjunctiva, ocular pressure
Check for presence of 3rd eyelid
What do you do to evaluate dentition?
(Extent of exam depends on horse/handler/age & available equipment/expertise)
Discuss teeth health management with seller
Confirm reported age
What do you do to evaluate skin?
Educated guess vs biopsy... skin scraping?
Relies on hx from seller
Scars vs. lesions/growths
Heart & lung auscultation:+/- Re-breathing exam
Pulse pressure
GI tract auscultation:Ventral auscultation in sandy soils!
Observe manure +/- fecal float
Things to check with the feet? (5)
Well maintained?
Shod?
Temperature of hoof capsules/coronary band
Look for evidence of palmar/plantar neurectomy
What are you palpating for musculoskeletal?
Legs: tendons, ligaments, splints, joints (flex & rotate)
Back & musculature: discuss areas of interest
What do you do for the neurological evaluation?Any obvious neurological deficits
Vax against neurological disease?
In who is CVM/Wobbler syndrome more of a risk?Young horses, esp. TB/WB
What to keep in mind about possible neuro abnormalities?Age-related
If in full competition, less likely a possibility
How do you perform the lameness exam?
Examination during walking, trotting, lunging, & turning/backing on hard level ground
Under tack
Flexion tests
(Limitations if not in work, broken in, or unshod)
BLOODWORK: (3)General profile
Drug screening
Coggin's test
What extra procedures might you want to do? (6)Radiographs (put into perspective of clinical findings!)
Endoscopy
Ultrasonography
Electrocardiography
Treadmill- exercise testing
MRI
**Conclusion: PPE is...Just part of the decision-making process
**Conclusion: Final report/discussion withThe vet
**Conclusion: findings give you?Reasonable expectations
**Conclusion: what kind of exam?NOT PASS/FAIL!
**Conclusion: PPE only applicable forThe point in time the exam was performed!
memorize

Dentistry

Question Answer
Normal dental anatomy of maxilla (pic)
Normal dental anatomy of mandible (pic)
Triadan numbering
How do you age with incisor table surface? (pic)E = enamel, C = cement, P = pulp cavity, D = dentin
Aging 0-5 years: Eruption of central incisors (101,201)2-2.5 years
Aging 0-5 years: Eruption of middle incisors (102, 202)3-3.5 years
Aging 0-5 years: Eruption of corner incisors (103,203)4-4.5 years
Aging 5-10 years: All upper adult incisors in wear at5 years
Aging 5-10 years: Upper corner incisor wider than tall5-6 years
Aging 5-10 years: Upper corner incisor square9-10 years
Aging 5-10 years: Cups present on table surface of all lower incisors<6 years
Aging 5-10 years: When are cups gone from 301 & 401?6 years
Aging 5-10 years: When are cups gone from 302 & 402?7 years
Aging 5-10 years: When are cups gone from 303 & 403?8-9 years
Aging 5-10 years: what do the lower central incisors look like?Oval from side to side
Aging 10-15 years: Upper corner adult incisors square at9-10 years
Aging 10-15 years: Upper corner incisors taller than wide at12-14 years
Aging 10-15 years: Galvayne's groove starts on upper corner incisor at9-10 years
Aging 10-15 years: Gavayne's groove is midway down the tooth at15 years
Aging 10-15 years: what do the lower central incisors look like?Round to triangular
Aging 15-20 years: Upper corner incisor looks?Much taller than wide
Aging 15-20 years: Galvayne's groove is all the way down at19-20 years
Aging 15-20 years: Central lower incisors 301, 401 are _________ than the middle ones (302 & 402)Smaller
Aging 15-20 years: what do the lower central incisors look like?Oval from front to back
Roughly how old? 1 year
Roughly how old? 5 years
Roughly how old? 10 years
Roughly how old? 21 years
Routine care: how often should the teeth be floated?Every 6-12 months depending on age & particular problems
Oral exam annually with vaccines
Thorough oral exam involves:Sedation
Full mouth speculum
Headlamp/light source
Dental mirror
Dentalpick
+/- radiographs
What's the sedation protocol?Different protocols exist depending on experience of veterinarian, temperament of horse
Combo Detomidine + butorphanol OR Xylazine + butorphanol (e.g. 200mg xylazine + 5mg butorphanol for adult)
Some tools & stuffHand vs. power (carbite heads usually)
What's wrong?
Sharp enamel points & ulcers in cheek
What's wrong?
Wave mouth
What are wolf teeth?Erupt at 6-18 months. Can have between 1-4
Remove wolf teeth? how would you do it?Don't remove unless causing a problem
Sedation required, block (1.5mL Mepivicaine HCl) medial aspect of next premolar, between gum & hard palate
Elevators & forceps required
Approach to dental exam (3)Complete PE- percuss sinuses, assess airflow, use sense of smell!!!
Complete oral examination w/ speculum, light source, mirror etc.
Skull radiographs
Diagnostic radiographs: what kind of machines? plates?Portable x-ra machines, standard plates. Larger plates are more useful
Diagnostic radiographs: Greater _________ capabilities are useful for denser sturcturesmA
Diagnostic radiographs: How do you prepare the horse? yourself?Sedation recommended! Use a rope halter (no metal artifacts)
Standard safety equipment: lead gowns/gloves, thyroid shilds, dosimeters, long plate handles
Standard views for nasal cavity, maxillary cheek teeth, paranasal sinuses (4)Lateral
DV
Right dorso 60* lateral - left ventrolateral oblique (RD60-LVO)
Left dorso 60* lateral - right ventrolateral oblique (LD60-RVO)
Where is the marker for the RD60-LVO?L marker on top of plate
Where is the marker for the LD60-RVO?R marker on top of plate
Additional views for nasal cavity, maxillary cheek teeth, paranasal sinuses (2)? what do they highlight?Right dorsal 15* lateral-left ventrolateral oblique (RD15-LVO)
Left dorso 15* lateral-rigt ventrolateral oblique (LD15-RVO)
Highlight the maxillary sinus & cheek teeth
What's the difference between A & B?
A = normal tooth root
B = Infected tooth root with draining tract
Tooth root abscess
(sinusitis?)
memorize

At LARF

Question Answer
SHERA (10 y.o. chestnut mare): CS of dental dz?Several years duration of unilateral nasal d/c (L)
Facial swelling over left maxillary sinus
Pungent odor from L nostril/mouth
Enlarged L submandibular LN
memorize

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