Computer test - ECG, US, endoscopy,BP measurement

Question 1

Central venous pressure measurement

Answer 1

Direct (catheterization or accurate invasive fluid replacement)
Indirect (examination of peripheral veins OR in DOGS : lateral recumbence collapse of v. saphena about 5cm aboce zero point)

Question 2

Systemic arterial pressure indications in small animal practice ?

Answer 2

To reveal secondary hypertension in case of known predisposing factors, diseases
To find the cause of ocular, central nervous or cardiac alterations, signs
In case of using ACE-inhibitors or hypertensive drugs
In case of severe diseases, shock
Anaesthesia monitoring Thrombosus
To reveal essential hypertension

Question 3

Blood pressure formula ?

Answer 3

Cardiac output x peripheral resistance Peripheral resistance depends on vessel diameter, wall elasticity, blood viscosity
From 120/80 mmHg in Aorta to 2-5 in vena cava.
Systolic/diastolic value
Pulse pressure = systolic minus diastolic pressure
Arterial mmean pressure : diastolic pressure + (pulse pressure / 3)

Question 4

Causes of hypertension ?

Answer 4

Renal diseases (50% of cases) 
Endocrine diseases (Cushing, Hypo-/hyperthyroidism, diabetes mellitus) 
Pheochromocytoma 
Obesitas 
Essential 
Acromegaly

Question 5

Consequences of hypertension ?

Answer 5

Ocular
Central nervous
Cardiac
Renal

Question 6

Arterial BP measurement different methods ?

Answer 6

Direct (arterial puncture by inserting pressure KT) = accurate but invasive & painful

Indirect :
Automatic (oscillometric method) → systolic, diastolic, arterial mean pressure measurement
Doppler method → systolic, (diastolic) pressure
Dog, cat: a. sacralis mediana, a. radialis

Question 7

Arterial BP measurement by Doppler method ?

Answer 7

Forelimb behind the paw, tail, (hind limb behind the paw) → aa. digitales palmares communes, a. caudalis mediana
Only systolic value
At any animal size
Needs training (technically more difficult than oscillometry)

Question 8

Arterial BP measurement by oscillometric method ?

Answer 8

Systolic, diastolic (mean) blood pressures
Dog: Forelimb (a. radialis), tail (a. caud. med.), hind limb (a. saphena)
Cat: Forelimb (a.radialis)
Automatic
Technically simpler but easily produces false measurements
Not reliable in animals smaller than 8kg

Question 9

Principles and parts of ECG

Answer 9

Measures amplitude and time of potential differences of electric current generated trhough depolarization and repolarization of cardiac structures’
Can be recorded intracardially, epicardially or on surface of body

Question 10

Small animals electrical conduction system ?

Answer 10

Sub-endocardial (fibres superficial on muscles)

Question 11

Large animals electrical conduction system ?

Answer 11

Sub-epicardial (fibres deep in muscles)

Question 12

P wave and correspondance in the cardiac cycle ?

Answer 12

Start of Atrial depolarization – diastole

Question 13

PQ phase and correspondance in the cardiac cycle ?

Answer 13

Total atrial depolarization – every cell ‘isoelectric’

Question 14

QRS complex and correspondance in the cardiac cycle ?

Answer 14

Start of ventricular depolarization – systole starts – o Atria repolarise but not detectable

Question 15

Q wave and correspondance in the cardiac cycle ?

Answer 15

Signal runs to apex of heart

Question 16

R wave and correspondance in the cardiac cycle ?

Answer 16

point of max ventricular depolarization

Question 17

S wave and correspondance in the cardiac cycle ?

Answer 17

Depolarization of right ventricle

Question 18

ST phase and correspondance in the cardiac cycle ?

Answer 18

Ventricles totally depolarized – ‘isoelectric line’

Question 19

T wave and correspondance in the cardiac cycle ?

Answer 19

Start of ventricular repolarization
o Small animals – down
o Large animals – up

Question 20

TP phase and correspondance in the cardiac cycle ?

Answer 20

Resting phase after repolarization – ‘isoelectric line’

Question 21

Diagnostic value of ECG

Answer 21

Only a part of systemic clinical examination, which is to us by proper indivation and in experienced hands
Exact diagnosis and evaluation of cardiac arrhythmias – best method
Detects enlarged cardiac chambers – but echocardiography better
Shows cardiac disturbances of electrolytes and systemic diseases – Ca2+. K+
Aids some cardiac disease diagnosis/prognosis
Monitors anaesthesia & surgery → deepness of narcosis, hypoxia, arrhythmias, danger of cardiac arrest
Evaluates effectiveness of cardiac drugs (Digitalis glycosides , antiarrhythmic medication, electrolyte substitution, pericardial puncture, etc.)

Question 22

Calculate HR on ECG ?

Answer 22

R/R interval, average of 3-4 beats

Question 23

ECG leads systems ?

Answer 23

• Einthoven - bipolar = difference of potential between two points
  First vector right to left forelimb,
  2nd vector left forelimb to left hindlimb,
  3rd vector left hindlimb to righ forelimb
  1st electrode = Right forelimb = Red / 2nd = Left forelimb = Yellow / 3rd = Left Hindlimb = Green
• Goldberger - unipolar (same as Einthoven but higher voltage)
• Wilson’s - unipolar precordial

Question 24

Position for ECG ?

Answer 24

Right lateral recumbency
Sternal recumbency 
Standing 
Attaching the leads (wetting, alligator clips) :
 Red = Right Foreleg, 
Yellow = Left Foreleg, 
Green = Left Hindleg, 
Black = Right Hindleg

Question 25

Standard speed of ECG ?

Answer 25

Paper speed – 25mm/sec (or 50 mm/sec) 25mm/sec – each square is 0.04 sec 50mm/sec – each square is 0.02/sec

Question 26

Different cardiac arrhytmias ?

Answer 26

* Normotop : impulse formation dist. o Sinus node - Sinus tachycardia or bradycardia - Sinus arrhythmia ``` * Heterotop : sick sinus syndrome o Atrium - Atrial extra systole (premature escape) - Atrial tachycardia - Atrial fluttern - Atrial fibrillation ``` o AV node - Nodal extra systole (premature escape) - Nodal tachycardia o Supra-ventricular - Ventricular extra systole (premature escape) F o Ventricle - Ventricular tachycardia - Ventricular fluttern - Ventricular fibrillation

Question 27

Impulse formation disturbances ?

Answer 27

* Normotop - Sinustachycardia - Respiratory (sinus) arrhythmia) - Ectopic beats : 1. escape beats, 2. premature beats, supraventricular extrasystole, premature ventricular contraction, ventricular extrasystole * Heterotrop - ventricular premature beats/extrasystoles, bigeminal rhythm - atrial fibrillation - paroxysmal ventricular tachycardia, - ventricular fluttern

Question 28

Impulse conduction disturbances ?

Answer 28

µ Normotrop - SA block - I, II, III degree AV block - Complete block of the bundle of His - Right bundle branch blockage - Left bundle branch block - Sinus arrest - Wandering pacemaker * Heterotop - 1stdegree AV block → Prolonged AV conduction time (PQ interval longer than usual) - 2nd degree AV block → P waves but no ventricular complex (QRS) - 3rd degree AV block → Isolated P waves and ventricular complexes (QRS) - His bundle → Complete block → Right block → Left block

Question 29

Signs of enlarged cardiac chambers ?

Answer 29

* Left Atrium – wide, notched P – P mitrale * Right Atrium – tall, peaked P – P pulmonale, atrial T * LA + RA – P biatriale * Left Ventricle – wide, tall QRS, ST changes, left axis shift of vector * Right Ventricle – S1, S2, S3, right axis shift of vector * Both ventricles – wide tall QRS, deep Q wave, P changes, normal axis of vector * Example – LA and LV enlargement – e.g. in DCM

Question 30

ECG changes in case of hyperkaliemia ?

Answer 30

``` Tall, peaked T Flattened P Bradycardia Prolonged P-R and Q-T Wide QRS Atrial standstill Sino-ventricular rhythm 3rd degree AV block Cardiac arrest ```

Question 31

ECG changes in case of hypoK ?

Answer 31

Prolonged Q-T Small biphasic T Bradycardia

Question 32

ECG changes in case of Hyper Ca ?

Answer 32

Elevated S-T Bradycardia Altered T Short S-T

Question 33

ECG changes in case of hypo Ca ?

Answer 33

Prolonged Q-T | Tachycardia

Question 34

ECG changes in case of myocardial hypoxia ?

Answer 34

Changing HR – decrease then increase Abnormally large T – may shift polarity (up/down) ST elevation or depression Cardiac arrhythmias

Question 35

Technique of echocardiography ?

Answer 35

Only sector transducers can be used Numbers of echocardiographic windows are limited Examination planes, transducer orientations and nomenclature differ from those of abdominal ultrasonography

Question 36

Diagnostic possibilites of echocardiography ?

Answer 36

Examination of cardiac chambers (wall, cavity) Recognition of valvular disorders Detection of shunts with contrast echocardiography (septal defects, PDA) Quantitative and functional examination: e.g. fractional shortening Detection of blood flow disorders (Doppler echocardiography) Detection of pericardial fluid : free fluid (even 15 mL), pericardial mass, paradoxical wall movement, collapsed “right heart”

Question 37

Echocardiography M mode ?

Answer 37

Unidirectional M-mode echocardiography (M: motion) or “duplex” mode → used for measurements of the left ventricle One-directional ultrasonography: the moving cardiac structures are depicted only along one ultrasound line emitted from the probe. Depth is plotted on the vertical and time on the horizontal axis

Question 38

Echocardiography B-mode ?

Answer 38

Two-dimensional B-mode echocardiography DCM: dilated cardiac myopathy HCM: hypertrophic cardiac myopathy

Question 39

Left ventricle dimension evaluation ?

Answer 39

Bi-dimensional mode | La = max 17 mm in cats

Question 40

Transducer used in abdominal US ?

Answer 40

1.12 MHz Transducers For large animals we have to use low frequency transducers. These produce higher waves which have a poorer resolution (old technique) nowadays they are better.

Question 41

Indications for Abdominal US ?

Answer 41

Palpable alterations in the abdomen Laboratory alterations (haematological changes, inflammation, etc.) Clinical signs without palpable or laboratory alterations Screening exam (congenital diseases, elderly patients) Only after a proper clinical examination to answer questions about morphology

Question 42

US of abdominal cavity - visible things ?

Answer 42

``` Fluid accumulation (black) → bladder, close to it there’s usually some free abdominal fluid Abdominal mass Free air ``` Enlarged lymph nodes (lymphoma) Hypoechoid because filled with a lot of blood Especially seen when enlarged due to some cancer US of the kidney Normal Diffuse kidney changes in a young dog Pyometra in dog - Fluid filled uterus Intestinal invagination Younger dogs with diarrhoea, elderly dogs Stones

Question 43

For which examination are rigid endoscopes used ?

Answer 43

Rhinoscopy (pharynx, larynx, trachea)

Question 44

For which examination are felxible endoscopes used ?

Answer 44

Oesophagoscopy, gastroscopy (Diameter: 5mm) | Bronchoscope only up/down movements possible

Question 45

Dimensions of flexible endoscope ?

Answer 45

Diameter: 6-10 mm, (5mm for oesophago/gastroscopy) length: 103-140 cm

Question 46

Avantages of endoscopy ?

Answer 46

``` Diagnostic imaging Culture and biopsy sample collection Semi-invasive diagnostic method Cheaper than diagnostic laparotomy Sometimes the only option / Possibility Therapeutic application ```

Question 47

Indications for rhinoscopy ?

Answer 47

``` Sneezing, reverse sneezing Epistaxis Facial or nasal pain/sensitivity Knowledge of foreign body Nasal discharge Difficult or noisy breathing Facial swelling or distorsion Ulceration of the rhinarium ```

Question 48

Indications for laryngo/pharyngoscopy ?

Answer 48

``` sLaryngeal dysfunction (Exercise intolerance, respiratory distress, increased respiratory effort, prolonged inspiratory time, voice change, cyanosis, coughing after feeding or drinking, inspiratory noise / Stridor) Difficulty in swallowing Regurgitation ```

Question 49

Indications for tracehobronchoscopy ?

Answer 49

Acute cough if an inhaled body is suspected Chronic cough (unknown cause or does not respond to therapy) Unexplained abnormal breathing pattern/lung infiltrate Removal of mucoid obstruction in atelectatic lung lobes Tracheal collapse (confirmation and staging) Chronic bronchitis (staging and sample collection) Stridor (not explained by laryngoscopy evaluation)

Question 50

Indications for oesophagoscopy ?

Answer 50

Dysphagia Retrieval of oesophageal foreign bodies Regurgitation Balloon catheter dilation of oesophageal structures

Question 51

Indications for gastroscopy ?

Answer 51

``` Evaluation of dysphagia Regurgitation Chronic vomiting Hematemesis, melena Gastric foreign bodies Placement of percutaneous gastronomy (PEG) tubes ```

Question 52

Indications for duodenoscopy ?

Answer 52

Chronic vomiting Chronic diarrhoea Melena Haematosis

Question 53

Indications for colonoscopy ?

Answer 53

``` Large bowel diarrhoea Tenesmus Haematochezia (blood in faeces) Increased faecal mucous Dyschezia (pain during defecation) Palpable rectal masse ```

Question 54

Diseases diagnosed by rhinoscopy ?

Answer 54

Rhinitis (viral, bacterial, fungal, Polyp, neurogenic, allergic) Foreign body Neoplasia (Adenocarcinoma, squamous cell

Question 55

Diseases diagnosed by laryngo/pharyngoscopy ?

Answer 55

``` Foreign bodies (bones) Elongated soft palate Tonsillitis, laryngitis Laryngeal paralysis/collapse Neoplasm, polype Nasopharyngeal stenosis ```

Question 56

Diseases diagnosed by tracheobronchoscopy ?

Answer 56

Tracheal collapse/hypoplasia/segmental stenosis Tracheobronchitis (viral, bacterial, fungal) Obstructive tracheal mass Trauma Neoplasia Canine chronic bronchitis Eosinophilic bronchitis Pulmonary parasites Feline asthma Foreign body Bronchopneumonia (Distemper, Bordetella bronchiseptica, etc.)

Question 57

Diseases diagnosed by oesophagoscopy ?

Answer 57

``` Megaoesphagus Foreign bodies Persistent right aortic arch Hiatus hernia Oesophagitis Oesophageal stricture Spirocercosis/Neoplasia ```

Question 58

Diseases diagnosed by gastroscopy ?

Answer 58

``` Chronic gastritis Ulcers Neoplasia Gastric motility disorder Foreign bodies Hiatal hernia Pyloric obstruction ```

Question 59

Diseases diagnosed by duodenoscopy ?

Answer 59

Inflammatory bowel disease (eosinophilic enteritis, lymphocytic-plasmacytic enteritis) Lymphangiectasia Duoedenal ulcer Lymphoma

Question 60

Diseases diagnosed by colonoscopy ?

Answer 60

``` Colitis (Inflammatory bowel d.; Hitiocytic ulcerative colitis, trichuris vulpis, bacterial colitis) Lymphoma Cecal inversion Adenocarcinoma Ileocolic intussusception ```