exam 1 Flashcards
(122 cards)
1
Q
What are the steps of collecting information?(9)
A
Signalment Owner's complaint History +TPR Physical exam Working problem list Differential Dx list Diagnostic plan for each DD Prognosis & Treatment Therapy and monitoring
2
Q
What do you look at during a physical?
A
gen. appearance
demeanor
gait & posture
3
Q
What does SOAP stand for?
A
subjective data, objective data, assessment, plan
4
Q
Of the 9 different steps, which is the most important thing to address?
A
The owners complain
5
Q
Of the nine different steps, what will give you 70% of your diagnosis?
A
Step three which is your history and TPR
6
Q
Of the 9 different steps, which is the most important with clinical skill?
A
Step 4the physical examination
7
Q
Give examples of step 7 (diagnostic plan for each DD)?
What is the reasoning behind this step?
A
CBC, biochem, imaging, astrology, PCR.
To rule in/rule out common conditions. Give a definitive diagnosis – master problem list.
8
Q
Why do you need to keep medical records?
A
It's the law. It allows you see recurring/pre-existing problems. Continuity. Finance. Research.
9
Q
What is the percentage of total body weight by water?
A
60%
10
Q
What percent of total body weight by water is contained in the intracellular space?
A
40%
11
Q
What percent of total body weight by water is contained in the extracellular space?
A
1/3 or 20%
12
Q
Separate the extracellular space into its three compartment.
A
Interstitial, intravascular, transcellular.
13
Q
What is the range of the dose in ml/kg/day? At which end of the range is cats and which is dogs?
A
40-60 ml/kg/day
40 is cats, and 60 is for dogs.
14
Q
What are the two basic types of fluids you can give?
A
crystalloids and
colloids
15
Q
If the diagnosis is unknown or there is no lab work results, what replacement fluid should you choose?
A
crystalloid
16
Q
Describe the difference between a crystalloid and colloid.
A
Crystalloid: The solute that can move freely around the fluid compartments. It ends up in the interstitial space.
Colloids: Has a larger molecular weight, and will remain in the intravascular space. It will keep fluids in the intravascular space with it.
17
Q
What is the use of the Crystalloid?(3)
A
– Correct dehydration
– expanded vascular space inshock
– correct electrolyte/acid-base imbalances
18
Q
How does a crystalloid work? What is the issue with this?
A
About a 1/3 of it stays within the intravascular space the other 2/3 enter interstitial space which can lead to peripheral edema.
19
Q
List a few examples of replacement fluid. Which is used most frequently?
A
Ringers, LRS, Normosol R, 0.9 % saline, PlasmaLyte.
LRS
20
Q
List of examples of maintenance fluid.
A
Normosol M, 0.45 % NaCl with 2.5 % dextrose, PlasmaLyte 56
21
Q
True or false: you can’t use replacement fluid as maintenance fluid.
A
False.
You can use replacement fluid, but it’s not ideal for maintenance you must add K and must monitor the serum sodium.
22
Q
What are the two types of colloids?
A
Natural and synthetic
23
Q
Give examples of natural colloids, and what is the point of using these?
A
Plasma or whole blood. purpose is to restore RBCs, clotting factors, AT III, and clotting factors needed.
24
Q
Give some examples of synthetic colloids, and its use.
A
Dextran and hetastarch.
Hetastarch is most commonly used synthetic colloids in vet med.
25
When would you use hetastarch?
In cases that need oncotic support but don't need clotting factors.
26
How should you dose hetastarch?
| Is there a contradiction for this?
Bolus: 5 – 10ml/kg over 5 – 10 min for hypovolemia.
CRI: 10 – 20ml/kg/day is the maximum daily dose.
Heart failure
27
What are the potential side effects of colloids (both natural and synthetic)?
– Fluid overloaded and pulmonary edema
–coagulopathy
– renal failure
*human albumin: could cause life-threatening allergic reaction in dogs.
28
What is an issue with the patient being on replacement fluid for several days?
It can and most likely will become mildly hypernatremia
29
Can I combine colloids and crystalloids in dehydration or shock cases?
yes
– Start replacement crystalloid to correct for dehydration
– Piggy-back a colloid (plasma would be good choice, but could use hetastarch if you didn’t have plasma). Once you calculate the mls of colloids you will be using, subtract that number from the calculated dehydration deficit.
– By using colloid, you decrease the amount of crystalloid you have to use.
30
What are the classic fluids for cardiac patients?
0.45% NaCl & are made isotonic through the addition of dextrose
31
Patients that are not eating but are being given fluids will become ________ within day.
How can this be prevented?
Hypokalemic
Add K to the fluids
32
What is the Kmax for adding/giving K to an animal? If you go over this what can happen?
0.5 mEq/kg/hr
Can cause hyperkalemia, which can result in death.
33
When is the ideal scenario to hypertonic saline?
With an animal with head trauma or cerebral edema.
34
What is the percentage that your hypertonic saline solution must be before you can administer it?
7.5%
35
What are the two solution concentrations for your hypertonic saline solution?
7% and 23%
36
What are the indications/scenarios you should use a hypertonic saline?
Cases of hypovolemic shock that do not have dehydration or hypernatremia.
Head trauma cases.
37
What are the contraindications for hypertonic saline?
Dehydration and hypernatremia
38
What are the side effects of hypertonic saline?
Administration may cause bronchoconstriction, bradycardia and hypertension.
39
Where the 4 ways to do fluid administration?Which is most appropriate for dehydration & shock?
```
– Enteral
– intraosseous
– IV
– subcutaneous
IV
```
40
What are the perfusion parameters you have to know when it comes to monitoring the patient on fluids? (6)
```
Heart rate
capillary refill time
MM
pulse pressure
temperature
blood pressure
```
41
How many milliliters is equal to 1 pound?
500 mL
42
What is the difference between dehydration and hypovolemia?
Dehydration:
– loss of total body water
– manifested by decreased skin turgor, tacky or dry MM, sunken eyes
– cause inadequate water intake or excessive fluid loss
Hypovolemia:
– decrease in circulating vascular volume
– manifested by tachycardia (or bradycardia in cats), prolonged CRT, poor peripheral pulses, decreased urine output.
– Can be a result of blood loss, severe dehydration, or redistribution of fluids with in the body.
43
What are your 4 levels of dehydration, and give the percentage associated with each.
– subclinical: < 5%
– mild: 7%
– moderate: 10%
– severe: 13%
44
What would you see with mild dehydration?
Subtle loss of skin elasticity, tacky mucous membranes.
45
What would you see with moderate dehydration?
Prolonged skin tent, tacky MM. Signs of volume depletion appear: prolonged capillary refill time (CRT> 2 sec)
46
What would you see with severe dehydration?
Skin tent stands in place, tacky MM, sunken eyes, > sec CRT, depressed. Proceed to overt signs of shock (tachycardia, poor pulses)
47
What are the three different types of shock?
| Describe each
– cardiogenic shock: failure of the pump
– distributive shock: failure of the tubing
– hypovolemic shock: failure of the fluid
48
What are the five classifications of circulatory shock?
```
– Hypovolemic
– cardiogenic
– vasodilatory or distributive
– obstructive
– combination of the above
```
49
What are the three types of hypovolemic shock?
Hemorrhagic
non-hemorrhagic
redistribution of fluid: edema
50
Give examples of when you would see obstructive circulatory shock. (4)
GDB, pericardialdiffusion, venous thrombosis, tension pneumothorax.
51
What can cause vasodilatory distributive shock?
–Caused by circulation of laboratory years associate with SIRS.
– maldistribution of blood from central circulation.
*This results in vasodilation which leads to hypoperfusion (despite the increase in blood volume and increasing cardiac output)
52
What can vasodilatory or distributive shock cause? (6)
Sepsis, endotoxemia, massive muscle trauma, emboli, thrombi, anaphylaxis.
53
What is sepsis?
Systemic infection
54
What type of bacteria is the main cause of septic shock? (Basic not exact name of bacteria)
Gram-negative bacteria. Some gram-positive are capable of causing this, but most won't.
55
What are the two phases of septic shock, and which is worse?
Hyperdynamic/warm and hypodynamic/cold.
Hypodynamic is worse than hyper hyperdynamic.
56
What is associated with hyperdynamic septic shock?
– high cardiac output
– low peripheral resistance because of vasodilation from chemicals
– capillaries more permeable = leakage, fluid shifts, third spacing
– rarely seen in's
–* increased heart rate, respiratory rate, temperature*
–*rapid CRT, red MM*
57
What is associated with hypodynamic/cold septic shock?
```
– low cardiac output
– increased peripheral resistance
– decreased BP
–*decreased heart rate, CVP, weak pulse*
–*cool extremities, low temperature*
–*pale to cyanotic and and and prolonged CRT*
– becomes MODS (multiple organ dysfunction)
– common in cats
```
58
What is the proper dose in ml/kg for a dog and cat in shock?
90ml/kg for a dog, and half of that for a cat (45ml/kg)
59
Give the shock organs for a dog, horse, cat, ruminants, and pigs.
Dog: GI and liver
Horse: G.I. and lung
Cat, ruminant, pig: lungs
60
What are the clinical signs of hypovolemic shock?
```
–Tachycardia and dogs, but often bradycardia in cats.
– Pale MM
– prolonged CRT
– cool limbs
–Weak pulse (MAP 70 mm Hg)
```
61
Where the clinical signs of cariogenic shock?
– signs overlap with hypovolemia
–*look for signs of heart failure: loud murmur, arrhythmia, history of heart disease*
– signs of low cardiac output: Pale MM, prolonged CRT, hypothermia, cool limbs.
62
What can cause hypertonic saline solution to stay in the intravascular space longer?
Concurrent colloid use.
63
How do you treat hypovolemia shock (hemorrhagic)?
Use a transfusion of whole blood/rbc's.
64
What is the universal donor for dog blood?
DEA 1.1
65
Is blood typing or cross matching recommended for cats and dogs?
Yes. Not often possible in acute blood loss cases.
66
What is an alternative to using blood products to treat hypovolemic shock (hemorrhagic)?
You can transfuse oxyglobin.
67
How do you treat septic shock?
Use fluid therapy is noted for hypovolemic shock. You can also use broad-spectrum antibiotics based on your suspected pathogen.
If it's peritonitis
you may want to do a surgical exploration/drainage.
68
If you find a G.I. ulceration what should you use and why?(drug)
Heparin, it will improve efficacy of antithrombin III in neutralizing activated coagulation factors.
69
When would you consider using a vasopressors in treating septic shock? (3)
What is your prognosis in this case?
What are the vasopressors that can be used?(2)
– jugular vein distended
– crackles are hard on auscultation
– CVP > 10 cm H2O
very guarded
dopamine, dobutamine
*intensive care needed
70
How do you treat cariogenic shock? (6)
– Oxygen
– minimal fluid therapy until cardiac function can be accurately determined
– congestive heart failure (CHF)= furosemide
– arrhythmias= manage appropriately
– vasodilators
– positive inotropes
71
When monitoring a patient with any type of shock what should you be looking for? (4)
Heart rate, pulse quality, respiration rate and effort, temperature.
72
Referring to blood pressure what MAP (mean arterial pressure) are you looking for?
>80 mm Hg
73
What does SIRS stand for?
Systemic inflammatory response syndrome
74
What is SIRS?
Imbalance of pro-inflammatory (excess) and anti-inflammatory mediators (not enough) on a systemic scale in response to an insult.
75
List your pro-inflammatory cytokines, and your anti-inflammatory cytokines.
Pro: TNF, IL -1, IL-6
| anti-: IL 4, IL 10, IL 13
76
What is SIRS a result of?
Inflammation when it is not contain.
77
Where do you find PRRs?
| What is the result of them?
Immune cells: monocytes, macrophages, neutrophils.
| Intracellular signaling cascade that releases pro-inflammatory cytokines.
78
What is SIRS called when it's due to infection?
Sepsis
79
What are the noninfectious causes of SIRS? (6)
Hypotension, trauma and hemorrhage, hypoxia and ischemia, pancreatitis, burn, neoplasia.
80
What is MODS?
Multiple organ dysfunction syndrome.
It is an altered function of one or more organs in an acutely ill patient such that homeostasis cannot be maintained without intervention.
81
What is the mortality rate of MODS?
50+ %
82
Define diarrhea.
Increased stool output, passage of abnormally fluid or unformed stools usually associated with increased frequency and/or volume of feces.
83
Which cells in the G.I. tract responsible primarily for absorption, and which are primarily responsible for secretion?
Absorption: enteric villi
secretion: intestinal crypts
84
What are the 4 pathophysiologic mechanisms of diarrhea?
1. Osmotic (malabsorption/maldigestion)
2. secretory
3. Increased permeability (exudative)
4. Alternative motility
85
How does Osmotic (malabsorption/maldigestion) diarrhea work?
Osmotic diarrhea may develop when a osmotically active molecules remained in the intestinal lumen (malabsorption). This promotes movement of water from the plasma to the intestinal lumen.
As a result, the absorptive capability of the small and large intestine are overwhelmed.
86
Give an example of a primary gastrointestinal disease.
Rhodococcus equi
*diarrhea or vomiting is a result of disease with in the G.I. tract
87
Give an example of the secondary gastrointestinal disease.
Exocrine pancreatic insufficiency, renal disease.
*Diarrhea or vomiting is a manifestation of the disease somewhere else in the body.
88
What is the difference between acute and chronic diarrhea?
Acute: self-limiting in many cases. Other cases may be associated with systemic illness requiring intensive care. Examples: dietary indiscretion, dietary intolerance, pancreatitis, parvovirus enteritis in dogs, panleukopenia in cats, salmonellosis.
Chronic: diagnosis often require a more extensive work. Examples: IBD (inflammatory bowel disease), gastrointestinal neoplasia, chronic parasitism/fungal infections.
89
What is the long bone blood supply in mature animals, immature animals, and a fractured bone?
```
Mature animals:
– principal nutrient artery
– metaphyseal arteries
– periosteal arteries
Immature animals:
– Epiphyseal & metaphyseal arteries
Fractured bone:
–development of extraosseous blood supply
```
90
Look at picture slides 3, 8, 10-14, 16-28, 33-38, 46-51, 53-55
of bone healing grafting slide set.
Has information I couldn't make into questions
91
What are the two types of bone healing?
```
Indirect healing (healing by intermediate callus formation)
Direct healing (primary osteona reconstruction)
```
92
What are the three stages of indirect healing?
Inflammation, repair, remodeling.
93
What are the two types of direct healing?
Contact healing, and gap healing
94
When do you use indirect bone healing? What do you see with the blood supply?
How far is the gap between fracture fragments?
With an unstable mechanical environment and motion between fracture fragments. You will see transient extraosseous blood supply develop.
Greater than 1 mm.
*You also see impaired blood supply or impaired revascularization.
95
In indirect bone healing when will the inflammatory stage begin, and how long does it last?
It begins immediately after the fracture, and lasts for 3 to 4 days.
96
What happens during the inflammatory stage of indirect bone healing?
You have the development of a clot at the fracture site. This will release osteoinductive growth factors that stimulate angiogenesis, which leads to bone formation. You also see abundant mast cells (vasoactive substances – new vessel formation) and extraosseous blood supply within hours.
97
What happens during the repair stage of indirect bone healing?
How long does this stage last?
The clot changes into granulation tissue by action of mononuclear cells and fibroblasts. Slight gain in mechanical strength is achieved with the formation of a soft callus. Mesenchymal cells become osteoblasts which form a medullary and external callus (fibrcartilage). Resorption and mineralization of the fibrocartilage forming a hard callus.
Bony union is achieve.
Approximately 2 months
98
What percent of total healing time is the remodeling stage?
How long can it last up to?
What does this stage do?
70% of total healing time.
6 to 9 years (humans)
Functions to provide optimal function and strength. Is a balance of osteoclast resorption and osteoblast deposition.
99
What law governs the remodeling stage of indirect bone healing?
Governed by Wolfe’s Law
- (Compression)-osteoblasts
- (Tension)-osteoclasts
100
List in order what you see when bone heals with indirect healing? (6)
1. Hematoma
2. Granulation tissue
3. Connective tissue
4. Cancellous bone
5. Bone
6. Haversion remodeling
101
What does direct bone healing referred to?
Direct filling of fracture site with bone without callus formation.
102
How does direct bone healing occur?
How long can this take?
It occurs by direct osteonal proliferation. It requires precise reduction and rigid fixation that minimize osteoprogenitor cells.
About 6 to 12 months for appropriate mechanical strength.
103
What's the space between fracture sites in contact healing (part of direct bone healing)?
Less than 0.01 mm
104
How far is the fracture gap in gap healing (part of direct bone healing)?
Less than 1 mm
105
Which is more stable, a cortical bone fracture or a cancellous bone fracture?
Cnacellous Bone fracture
106
Why physeal fracture occur?
Because an area is weaker than surrounding bone.
107
With a physeal fracture, how will a fracture of the zone of hypertrophy and the zone of proliferation heal?
The zone of hypertrophy will heal by continued growth of physeal cartilage.
The zone of proliferation will heal by endochondrial ossification. (Be careful with this fracture if it does not heal properly the bone may become warped. (Like your thumb))
108
What type of bone healing which you use if you have an absolutely stable fracture? Which would you use if it was an unstable fracture?
Stable: direct bone healing
unstable: indirect bone healing
109
What are the six factors that affect fracture healing?
- Location of fracture
- Stability
- Method of fixation
- Biological environment
- Blood supply
- Biomechanical vs. biological osteosynthesis
110
How does the biomechanics approach to fracture healing work?
It uses anatomical reduction, rigid fixation, and will compromise soft tissue to achieve healing.
111
How does the biological osteosynthesis approach to fracture healing work?
It emphasizes the role of soft tissue integrity, restores overall length, restores overall alignment, limit surgical approach, limit soft tissue disruption, emphasizes use of bone grafts. (Is look but don't touch approach)
112
```
Which of the below would be a good example of biological osteosynthesis?
A. Pins with wires
B. casts and splints
C. No fixation
D. Two of the above
E. All the above
```
D. (B and C)
113
What are the three origins of bone grafts?Describe each.
Which is the most commonly used.
Autograft: patients own bone
Allograft: bone from another individual of the same species as patient
Xenograft: bone from individual of another species
autograft
114
What are the three types of bone grafts?
Cancellous, cortical, and cortical-cancellous
115
What are the three functions of bone grafts?
Osteogenesis – laying down new bone by osteoblasts
Osteoinduction – recruitment of host mesenchymal cells to form new bone or osteogenesis
Osteoconduction-providing a scaffold for the growth of new bone
116
Why is autogenous cancellous bone grafts considered to be the gold standard of bone grafts?(3)
- Promotes osteogenesis:
- -Graft provides cells directly
- -Osteoinduction
- -Osteoconduction
- Readily available
- Avoids immune reactions
117
What are some drawbacks of autogenous cancellous bone grafts? (5)
- Mechanically weak
- Increased surgical time
- Limited storage time
- Pain at donor site
- Intraoperative blood loss
118
What are some of the positives of allograft cancellous bone grafts? (4)
Negatives? (2)
```
Positive:
-Available as frozen chips or powder
-Decreased surgical time
-Readily available
-No donor site problems
Negatives:
-Expensive
-Lack osteogenic properties
```
*Can mix with autograft to increase volume
119
What are the five phases of cancellous bone grafts? List times associated with each phase.
Phase I – inflammation(within hours)
Phase II – revascularization and osteoinduction(2 weeks)
Phase III – osteoconduction(3-4 weeks)
Phase IV – mechanical support(up to 12 weeks)
120
For the cortical bone grafts where are the autographs taken from? (Bones 4)c
Ribs, ulna, fibula, ilial wing
121
What are the phases of the cortical bone graft? (3)
- Osteoclasts move into graft and resorb bone
- Osteoblasts follow and lay down new bone
- Mechanical strength of graft maintained
122
Where are the bone grafts taken from for cancellous bone grafts? (3 bones)
proximal humerus, proximal tibia, wing of ilium
