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Exam 2 Flashcards

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1
Q

Defintion of syncope

A

Sudden, transient loss or depression of consciousness and postural tone resulting from transient and diffuse cerebral malfunction with spontaneous recovery.

Often due to deprivation of energy substrates (glucose or oxygen)

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2
Q

Definition of pre-syncope

A

An incomplete form of syncope

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3
Q

Definition of seizure

A

Abnormal excessive paroxysmal synchronous discharge in a population of neurons

Dysfunction of grey matter, which may be primary in origin or secondary to a metabolic abnormality

Can be tonic clonic or psychomotor

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4
Q

Definition of narcolepsy and cataplexy

A

Narcolepsy - dog collapses into sleep

Cataplexy - sudden onset of muscle paralysis

Can be induced by excitement or eating

Dogs can usually be roused by stimulation

Inherited forms in poodles, labradors, dobermans

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5
Q

Characteristics of fit (seizure)

A 
Pre-ictal phase
Marked limb movement, urination, defecation
Completely unresponsive
Long duration (>3 min)
Gradual recovery
Behavior change
Evidence of other neurological disease
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6
Q

Characteristics of fainting (syncope)

A 
Sudden onset
Provoking event (vomiting, sudden change in level of activity)
Flaccid collapse 
Followed by opistotonus
Completely unresponsive
Short duration (< 1 min)
No limb movement
Generally rapid and complete recovery
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7
Q

Characteristics of “falling over”

A

Elderly dog with musculoskeletal disease

Usually multiple events at exercise prior to presentation

Gradual onset

Variable duration

Dog becomes recumbent but no loss of consciousness

No spontaneous limb movement, urination, or defecation

Quick, complete recovery

Evidence of pain on clinical exam

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8
Q

Physical exam findings associated with syncope

A 
Pale or cyanotic MM
Hypo or hyperkinetic pulses
Distention of jugular pulses
Neurological deficits
Gallop rhythm
Murmur
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9
Q

Cause of syncope in humans

A

46% non-cardiogenic
36% undiagnosed
16% arrhythmias
2.5% obstructive cardiac disease

(Probably similar in animals)

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10
Q

What kind of hematological disorders can cause syncope?

A

Anemia
Polycythemia
Myeloproliferative disease

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11
Q

Which endocrine disorders can result in syncope?

A 
Cushings, Addisons
DM, DKA
Hyperinsulinemia/insulinoma
Pheo
HypoT4
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12
Q

Which muscular disorders should be differentials for a patient presenting for syncope?

A 
Polymyositis
Muscular dystrophy
Myopathy secondary to hypoK+, steroids, myotonia
Labrador and retriever myopathy
Mitochondrial myopathy
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13
Q

Which neurological disorders should be differentials for a patient presenting for syncope?

A 
Thrombi
Hemorrhage
Space-occupying lesions
Atheroscleosis
Seizure
Vestibular or cerebellar disease
Spinal trauma
Narcolepsy/cataplexy
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14
Q

Which musculoskeletal disorders should be differentials for a patient presenting for syncope?

A 
DJD
Polyarthritis
Panosteitis
Hypertrophic osteodystrophy
Bilateral ACL rupture
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15
Q

Which neuromuscular disorders should be differentials for a patient presenting for syncope?

A

Myasthenia
Botulism
Peropheral polyneuopathies

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16
Q

Which drugs can cause iatrogenic syncope?

A

Digoxin

Vasodilators (phenothiazine derivatives, ACE inhibtors, beta blockers, CCB)

Quinidine

Class 3 agents (cisapride, sotalol)

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17
Q

What effects will class 3 agents have on a patient’s ECG?

A

Prolonged QT interval

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18
Q

Which congenital heart diseases can cause syncope?

A

Obstruction to outflow (AS and PS, tumors, endocarditis)

Tetralogy of Fallot

Shunts (VSD, PDA)

Severe AV valve dysplasia

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19
Q

What physical exam finding may indicate that a patient has a R->L PDA?

A

Cranial MM pink

Caudal MM cyanotic

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20
Q

What acquired cardiac disease can cause syncope?

A 
Severe AV valve disease
Systolic dysfunction (e.g. DCM)
Pericardial disease
Pulmonary hypertension
Arrhythmias
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21
Q

Which bradyarrhythmias can cause syncope?

A

Sinue bradycardia
Sick sinus syndrome
AV Block (2rd and 3rd degree)
Atrial standstill

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22
Q

Which tachyarrhytmias can cause syncope?

A

Afib
Atrial flutter
Supraventricular tachycardia
Ventricular tachycardia

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23
Q

Treatment for VPCs?

A

Lidocaine

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24
Q

Treatment of ventricular tachycardias?

A

Lidocaine, K+

Esmolol, sotalol

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25
Classes of anti-arrhythmic drugs
1: Na+ channel blockers 2: B blockers 3: K+ channel blockers 4: Ca+ channel blockers
26
If an animal is presenting with collapse and ECG shows multiple episodes of profound bradycardia, what is a likely diagnosis?
Vasovagal (neurally-mediated) syncope
27
What is the treatment for vasovagal (neurally-mediated syncope)?
None if infrequent If situational, avoid situation Sympathomimetics Beta blockers, mineralocorticoid supplementation Pacemaker
28
Two types of leads in pacemakers
Passive fixation | Active fixation
29
What ECG characteristics are representative of atrial fibrillation?
No P waves Supraventricular Irregular Fast
30
What are the goals of treatment for atrial fibrillation?
Slow HR Convert to NSR Provide inotropic support Control CHF
31
Treatment for atrial fibrillation?
``` Ca channel blocker (diltiazem) beta blockers (EXCEPT IF CHF PRESENT) ```
32
Treatment for pericardial effusion
Furosemide (high dose IV) Pimobendan Drainage Fluids (high dose IV)
33
How is blood pressure regulated?
Locally - NO and other metabolites mediate vasomotor tone Systemically - Baroreceptor reflexes/sympathetic nervous system, RAAS, renal blood volume control
34
What are the three causes of systemic hypertension?
1. White Coat Syndrome 2. Primary hypertension 3. Secondary hypertension
35
What is White Coat Syndrome?
Increase in BP due to measurement process or situation Usually sympathetic stimulation with stress/excitement Resolves when cause is eliminated No treatment necessary
36
What is primary hypertension?
"Essential" or "idiopathic" May be associated with subclinical renal disease Uncommon in dogs and cats
37
What can cause secondary hypertension?
Renal disease Adrenocortical disease (hyperadrenocorticism or hyperaldosteronism) Diabetes mellitus HyperT4 Pheo Polycythemia Acromegaly Diet Breed (sight hounds) Iatrogenic
38
What is the most common underlying cause of secondary hypertension?
renal disease
39
What percent of cats with renal disease have hypertension?
20-30%
40
What is the correlation between degree of azotemia and BP?
No correlation
41
How does diabetes mellitus cause hypertension?
Blood volume expansion with hyperglycemia Overproduction of renin
42
What percent of hyperthyroid cats have hypertension?
10-30%
43
How does hyperthyroidism cause hypertension?
Increased cardiac output
44
How does pheochromocytoma cause hypertension?
Increased cardiac output Peripheral vasoconstriction *May be episodic
45
How does polycythemia cause hypertension?
Increased blood viscosity increases peripheral vascular resistance
46
How does diet cause hypertension?
Salt intake Little effect on BP in dogs and cats unless massive or pre-existing secondary hypertension
47
What drugs can cause hypertension?
``` Corticosteroids Phenylpropanolamine Cyclosporin A Erythropoeiten NSAIDs Electrolyte solutions Adrenergic agonists ```
48
Main tissues affected by hypertension?
Heart Kidneys Eyes Brain
49
Effects of hypertension on the CV system
Concentric hypertrophy of LV (-> murmurs or gallops, CHF) Arteriosclerosis Hemorrhage
50
What is a prognostic indicator of effects of hypertension on kidneys?
Degree of proteinuria
51
What effects does hypertension have on the eye?
Tortuous retinal vessels Papilledema Retinal edema, hemorrhage, detachment, degeneration Secondary glaucoma
52
Effects of hypertension on CNS
Hypertensive encephalopathy Stroke Behavior alterations, depression, ataxia, seizures, stupor coma, death
53
Can hypertension be diagnosed based off of one BP measurement?
Rarely In cases where there are definite clinical signs or evidence of end-organ damage
54
How can you measure BP?
Direct - arterial catheter Indirect - doppler and oscillometric methods
55
Advantages and disadvantages of direct BP measurements
Advantages: accurate, objective, repeatable, ability to measure systolic/diastolic/mean BP Disadvantages: invasive, requires technical skills to place and maintain arterial access
56
Advantages and disadvantages of indirect BP measurement
Advantages: technically simple and non-invasive Disadvantages:less repeatable and inaccurate with movement or inconsistent technique
57
What is the most accurate and repeatable non-invasive technique to measure BP in cats?
Doppler sphygmomanometry
58
Normal BP
>150/95 | >160/100 considered abnormal
59
At what blood pressure should treatment be initiated?
Moderate risk 160-179/100-119
60
At what blood pressure is there severe risk of end-organ damage?
>180/120
61
Treatment of BP is based on
Clinical signs Risk of end-organ damage
62
Treatment of hypertension?
``` Avoid high salt intake ACE inhibitors Ca channel blockers Adrenergic blockers Hydralazine Nitroprusside Diuretics ```
63
How do ACE inhibitors treat hypertension?
Block conversion of angiotensin I to angiotensin II Vasodilation Reduced secretion of aldosterone and ADH -> inc Na and H20 excretion Dec sympathetic tone Reduced cardiac and vascular hypertrophy Reduces GFR and proteinuria
64
Adverse effects of ACE inhibitors in treatment of hypertension?
Decreased GFR and azotemia Hyperkalemia
65
How do calcium channel blockers (amlodipine, diltiazem) work to treat hypertension?
Decreased calcium influx into vascular smooth muscle -> vasodilation
66
How to adrenergic blockers work to treat hypertension?
Decrease HR and contractility to dec CO
67
Treatment of choice for hypertension caused by hyperthyroidism?
Beta blockers
68
Treatment of choice for hypertension caused by pheochromocytomas?
alpha blockers | phenoxybenzamine, prazosin
69
How does hydralazine work to treat hypertension?
we don't know causes vasodilation
70
After initiating therapy for hypertension, how long should you wait to recheck BP?
7-10 days
71
When hypertension is controlled, how often should you monitor BP?
1-4 months
72
Normal pulmonary arterial pressure
25/10 mmHg 15 mmHg mean
73
How does hypoxia affect pulmonary vasculature
Causes vasoconstriction | Opposite of systemic circulation
74
What agents cause vasodilation in pulmonary vasculature?
NO PGI2 O2
75
What agents cause vasoconstriction in pulmonary vasculature?
Thromboxane Endothelin 1 Angiotensin II Serotonin
76
Causes of pulmonary hypertension
Idiopathic ``` Increased PVR: Primary PHT HW disease Chronic pulmonary disease PTE High altitude Hypoventilation ``` Increased PBF: Congenital cardiac shunts Increased CO Increased PCWP: PA stenosis L-sided CHF
77
What is the most common cause of pulmonary hypertension in FL? Overall?
FL: HW disease Overall: L-sided CHF
78
Consequences of pulmonary hypertension
Reduced CO Hypoxemia Cor pulmonale
79
Clinical signs/physical exam findings associated with pulmonary hypertension
Clinical signs similar to other cardiopulmonary diseases ``` R-sided CHF Ascites Syncope Cyanosis Murmur ```
80
How can you diagnose pulmonary hypertension?
Measurement of pulmonary artery pressure Direct = cardiac catheterization *gold standard* Indirect = echo
81
What ECG findings are associated with pulmonary hypertension?
Deep S wave and right axis deviation (RV enlargement) Tall P waves (RA enlargement) Arrhythmias
82
Treatment for pulmonary hypertension
Treat underlying cause (EXCEPT R->L shunts) ``` Oxygen Diuretics ACEi NO Ca channel blockers Synthetic prostacyclins (cost prohibitive) ``` ET-1 receptor antagonists (cost prohibitive) Phosphodiesterase inhibitors (sildenafil - most common tx) Antithrombotics
83
Regulators of endothelial vascular tone
Vasodilators: NO and PGI2 Vasoconstrictor: ET-1
84
What is the pathophysiology of vascular remodeling in PHT?
Chronically elevated ET-1 ang Ag-II cause smooth muscle hypertrophy of vascular walls Eventually is irreversible
85
What might thoracic radiographs show for a patient with PHT?
``` Pleural fluid/pulomary edema Cardiomegaly Tortuous, blunted pulmonary arteries Bronchial or alveolar pattern Bronchiectasis ```
86
PAP estimate equation
PG = 4 x V^2 | Normal = 10-25
87
Prognosis for PHT
Poor-grave
88
What are the most common types of thyroid tumor?
Follicular cell adenoma | Adenomatous hyperplasia
89
What percent of thyroid tumors are malignant?
1-3% | Most of these are carcinomas
90
Clinical signs of hyperthyroidism
``` Weightloss Polyphagia Hyperactivity PU/PD Vomiting Diarrhea Anorexia ```
91
Common physical exam findings of hyperthyroid patients
Palpable thyroid nodule Tachycardia Murmur Muscle wasting
92
What is the T3 suppression test?
Used to dx hyperthyroidism Blood drawn for T3 and T4 T3 (cytomel) administered x 3 days Draw sample 2-4 hr post last pill for T3 and T4 Normal cat will have suppressed T4 Hyperthyroid cat ill not suppress Why measure T3? -> Assess client compliance
93
Treatment for hyperthyroidism?
Methimazole Diet (Hill's y/d) I 131 Surgery Not really recommended: Propylthiouracil Iopanoic acid
94
Most common type of hypothyroidism?
Acquired, primary (decreased T4)
95
Which breed is prone to secondary hypothyroidism due to pituitary malformation?
GSD
96
Breed predisposition for hypothyroididm?
Beagles, dobies, goldens
97
Clinical signs associated with hypothyroidism?
``` "Tragic expression" Corneal lipid deposits/lipemia retinalis Truncal alopecia Hyperpigmentation Hyperkeratosis Peripheral neuropathy Myxedema coma ```
98
Lab findings associated with hypothyroidism?
Hypercholesterolemia Hypertriglyceridemia Low T4
99
Treatment for hypothyrodism
Levothyroxine 0.02 mg/kg BID | Re-test in 6-8 weeks
100
Which breeds have an autosomal recessive gene for hypoadrenocorticism?
Standard poodle Portuguese water dog Nova Scotia duck tolling retriver
101
Physical exam findings with hypoadrenocorticism?
``` Hypothermia Pale MM, prolonged CRT Bradycardia Weak pulses Melena Depressed mentation ```
102
Lab findings associated with hypoadrenocorticism?
``` Lack of stress leukogram Eosinophilia Mild, non-regen anemia HyperK+ HypoNa+ HyperCa++ HyperP Azotemia Hypocholestrolemia Hypoalbuminemia ```
103
What to do for an unstable patient in which you suspect hypoadrenocorticism?
``` Start ATCH stim IV catheter Dex (0.25-0.5 mg/kg IV) Fluids (NaCl) Treat hyperK+ ```
104
Treatment for hypoadrenocorticism?
Oral pred DOCP Florinef
105
What is atypical addison's?
Similar history, presenting complaint, and PE to Addison's Normal Na+ and K+ ACTH stim still abnormal Don't need mineralocorticoids, just pred Rarely progresses to mineralocorticoid deficiency
106
Breed predisposition for hyperadrenocorticism
Dachshunds Terriers Boxers
107
Clinical signs of hyperadrenocorticism
``` PU/PD Alopecia Pendulous abdomen Polyphagia Panting Facial nerve paralysis ```
108
Physical exam findings with hyperadrenocorticism
``` Ptosis Lip droop Tachypnea Pendulous abdomen Hepatomegaly Muscle wasting Truncal alopecia Comedones Thin skin Calcinosis cutis Cushing's myopathy ```
109
Lab findings associated with hyperadrenocorticism
``` Stress leukogram Thrombocytosis ELE Hyperglycemia Hypercholesterolemia Proteinuria ```
110
Screening tests for hyperadrenocorticism
Urine cortisol:creatinine ratio ACTH stim LDDS
111
Discriminating tests for hyperadrenocorticism
LDDS HDDS Endogenous ACTH
112
Urine cortisol:creatinine test
Negative test -> HAC very unlikely | owner needs to collect first AM urine at home
113
ACTH stim
Doesn't discriminate between PDH and AT
114
LDDS
If suppresses at 4 hours but "escapes" at 8 hrs -> HAC 20% of patients with PDH won't suppress at all
115
HDDS
Lack of suppression -> AT | Suppression -> PDH
116
Endogenous ACTH test
Low -> AT | High -> PDH
117
Treatment of hyperadrenocorticism
Mitotane Trilostane Surgery (hypophysectomy or adrenalectomy) Radiation
118
Mitotane
Tx HAC Should not be administered to sick or anorexic animals Load with 50 mg/kg/day Repeat ACTH stim in 1 week Maintain with 50 mg/kg/week Goal: pre and post values in normal "pre" range
119
Possible side effects of mitotane
vomiting | addison's
120
Side effects of trilostane
Blocks 3B hydroxysteroid dehydrogenase which can lead to increases in precursor hormones, which can have similar effects as cortisol Addison's Adrenal enlargement
121
What is Atypical Cushing's?
Similar clinical signs and PE findings as Cushing's Normal pre/post cortisol levels Extended hormone panel to UTenn -> 2-3 hormones increased post-ACTH Treatment similar to typical Cushing's
122
Common presenting complaints/clinical signs with DM
``` PU/PD Bumping into things Vomiting Hyporexia Lethargy Hind-end weakness (cats) Weightloss ```
123
Lab findings with DM
Hyperglycemia Hypertriglyceridemia Inc ALP and ALT Glucosuria
124
Goals of treatment of DM
Resolve clinical signs | Avoid hypoglycemia
125
Long-term effects of DM
Eyes: cataracts, lens-induced uveitis, corneal ulceration, diabetic retinopathy Urinary: bacterial or fungal cystitis, proteinuria, diabetic nephropathy CNS: diabetic neuropathy (cats)
126
Canine dental formula
Deciduous: 2 ( I 3/3 C 1/1 P 3/3) = 28 Permanent: 2 (I 3/3 C 1/1 P 4/4 M 2/3) = 42
127
Feline dental formula
Deciduous: 2 (I 3/3 C 1/1 P3/2) = 26 Permanent: 2 (I 3/3 C 1/1 P 3/2 M 1/1) = 30
128
Eruption times of canine teeth
Deciduous: Incisors: 2-4 weeks Canines: 3 weeks Premolars: 4-12 weeks ``` Permanent: Incisors: 3-5 months Canines: 4-6 months Premolars: 4-6 months Molars: 5-7 months ```
129
Eruption times of feline teeth
Deciduous: Incisors: 2-3 weeks Canines: 3-4 weeks Premolars: 3-6 weeks ``` Permanent: Incisors: 3-4 months Canines: 4-5 months Premolars: 4-6 months Molars: 4-5 months ```
130
Characteristics of normal dental occlusion
Scissors bite - upper incisors in front of lower incisors Lower canine fits evenly between upper canine and 3rd incisor Premolars fit in a shearing fashion (interdigitate) Upper 4th premolar fits outside (lateral) to lower 1st molar
131
What is true dental prophylaxis?
*done on mouth FREE OF DISEASE* 1. Complete oral exam 2. Supragingival scaling 3. Subgingival curettage/root planing 4. Polish (with fluoride) 5. Flush 6. Repeat oral exam
132
What are dental caries?
Bacterial degeneration of the enamel Not common in pets Maxillary 1st molar most common due to incomplete enamel closure
133
What causes enamel abrasions?
Excessive grooming Toys Rocks
134
What is dental attrition?
Wear from other teeth Caused by malocclusion Causes increased risk of tooth fracture
135
What causes enamel hypoplasia/hypocalcification?
Reduced formation of enamel aka enamel dysplasia Hereditary Systemic infection causing high fever during tooth formation (e.g. distemper) Enamel organ damage during early extraction of deciduous teeth Other trauma during tooth formation
136
What causes enamel staining?
Intrinsic - tetracycline use during enamel development Extrinsic - metal from fence, cage, bowl, other objects
137
What causes discolored teeth?
Trauma that results in pulpal hemorrhage +/- tooth death or nonvital tooth Pink -> purple -> tan
138
What tooth most commonly undergoes resorption?
Mandibular 3rd premolar (80% of the time) Caused by periodontal disease or oral trauma
139
What is ankylosis?
Alveolar bone fused to cementum Can be caused by: Resorption/inflammation (no periodontal ligament is visible) Excessive masticatory forces Tx: crown amputation
140
Classes of dental malocclusion
0: normal or breed normal 1: jaw relationship normal, but one or more teeth is out of position 2: mandible is short (mandibular distoclusion) in relation to maxilla - brachygnathia (overbite) 3: Maxilla short in relation to mandible (mandibular mesioclusion)- prognathia (underbite)
141
T/F: class 2 and 3 dental malocclusion are more likely to be hereditary in origin
True
142
Cranial mandibular osteodystrophy
Inherited condition (West Highland White Terriers ) Non-cancerous bone formation at the TMJ and spreads to the mandible Results in pain, fever, resistance to eat or open jaw
143
TMJ Locking
Trauma leading to luxation of TMJ Can be secondary to dysplasia causing laxity Coronoid slips under zygomatic arch, then mouth cannot close Must reduce arch or coronoid to get mouth to move
144
Gingival enlargement
(Gingival hyperplasia) Boxers Can be secondary to chronic inflammation Pseudoenlarged gingival pocket formation
145
Neoplasia of odontogenic structures
Ameloblastoma Odontoma Acanthomatous or peripheral ameloblastoma Peripheral odontogenic fibroma
146
Neoplastic tumors of gingiva
Malignant melanoma SCC Fibrosarcoma Osteosarcoma
147
Most important single oral cavity problem
Periodontal disease
148
Is periodontal disease reversible?
No At the point where bone/supporting structures are lost, the damage is nor reversible. Gingivitis IS reversible
149
Why are smaller breeds predisposed to periodontal disease?
Smaller breeds have closer teeth that reduce the cleaning ability of saliva/teeth and thinner supporting bone
150
Stages of periodonatal disease
Stage 1: Gingivitis Stage 2: Early periodontitis (up to 25% attachment loss) Stage 3: Moderate periodontitis (25-50% attachment loss) Stage 4: Severe periodontitis (>50% attachment loss)
151
What is the only reversible stage of periodontal disease?
Gingivitis
152
Indication for the use of antibiotics to treat periodontal disease
Oral ulceration Severe periodontitis including purulent discharge Additional surgery being performed Bone implants Pulp capping (pulpotomy)
153
Most commonly used antibiotics in the treatment of periodontal disease
Clavamox Clindamycin Doxycycline
154
Chronic ulcerative stomatitis
Canine disease Halitosis, oral pain, inappetence, anorexia, ptyalism, periodontal disease Unknown cause, may be associated with fusiform bacilli and spirochetes Immunodeficient patients PE findings: Severe gingivitis, ulceration, necrosis of oral MM, chelitis, gingival recession, depression, fever, cachexia Tx: Anti-inflammaories, extractions, debridement, antibiotics, oxygenated mouth rinses, +/- tube feedings
155
Mycotic stomatitis
Caused by overgrowth of Candida albicans Associated with long-term antibiotic use, immunodeficiency, other diseases Causes chronic dysphagia, inappetence and/or anorexia, ptyalism, halitosis, white plaque-like lesions in mucocutaneous junction, glossitis Tx: eliminate underlying condition, anti-fungal medication (ketoconazole)
156
How does leptospirosis cause oral disease?
Oral signs associated with uremia and thrombocytopenia
157
Oral clinical signs associated with canine distemper virus
Hyperemia Ulceration of MM Ptyalism
158
Oral clinical signs associated with canine infectious hepatitis
Tonsilar enlargement Oral hemorrhage or petechiation Injected or hyperemic MM
159
Clinical sign associated with oral blastomycosis
Granulomatous, yellow-white, up to 1.5 cm lesions on tongues or MM (Little white dogs)
160
Oral clinical signs associated with hypothyroidism and diabetes mellitus
Severe generalized marginal gingivitis not associated with expected quantities of calculus Dysphagia Periodontal disease
161
Oral clinical signs associated with hypoparathyroidism
Oral ulcers Necrosis associated with oral ulcers Halitosis Ptyalism
162
How to differentiate whether bleeding in oral cavity is due to oral disease or coagulopathy?
Bleeding will only be in oral cavity if it’s oral disease...
163
Clinical signs associated with thallium toxicity
Oral inflammation and ulceration Malaise Generalized erythema Generalized severe pain
164
What causes phytogranulomatosis?
Oral trauma from plant awns from the hair coat
165
General oral clinical signs associated with oral trauma
``` Pawing at mouth Ineffectual swallowing Ptyalism Inappetence Anorexia Dysphagia ```
166
Is tonsillectomy indicated for tonsillitis?
No | Does not cure clinical signs
167
Causes of tonsillitis
Primary - idiopathic (CKCS, eosinophilic) Secondary - secondary to diseases causing chronic regurgitation, vomiting, coughing
168
Primary goal of treatment of severe feline stomatitis
Reduce inflammation through plaque control Dental prophylaxis is imperative no matter the etiology
169
Treatment of severe feline stomatitis includes
``` Antibiotics Analgesics Anti-inflammatories Extractions At-home care ``` After all therapies have failed, cyclosporine
170
Clinical signs seen in teething animals
Serous nasal discharge Metallic halitosis Enlarged mandibular lymph nodes
171
What is tight lip?
Condition in which the lip is too attached to the gingiva and can result in tooth impressions/trauma to gums Shar peis
172
What is a dentigerous cyst?
Fluid-filled structure that develops at the separation of the follicle of an unerupted tooth (destructive)
173
What is an odontoma? What are the two types?
Odontogenic tumor that contains both epithelial and mesenchymal cells Young animals during development of permanent teeth (except rats) Compound: tooth-like structures (denticles) present Complex: conglomerate of dental tissue
174
Feline Juvenile Gingivitis
Cats 8-18 months old Abysinnians, persians, siamese, maine coons Required early and aggressive treatment May be proliferative With proper therapy, will wane at 24 months
175
What causes tooth resorption?
There is no proven cause
176
Stages of tooth resorption
Stage 1 – Mild dental hard tissue loss, either cementum alone or cementum and enamel. In this stage of the disease, a defect in the tooth's enamel is all that is usually noted. There is little to no sensitivity because the resorption has not yet reached the dentin. Stage 2 – Moderate dental hard tissue loss including cementum or cementum and enamel, and loss of dentin that has not yet reached the pulp cavity. Stage 3 – Deep dental hard tissue loss including cementum or cementum and enamel, and loss of dentin that extends to the pulp chamber. At this third stage of disease, most of the tooth is still viable. Stage 4 – Extensive dental hard tissue loss and most of the tooth has lost its integrity. A significant amount of the tooth's hard structure has been destroyed. Stage 4 has three sub-categories: 4a (crown and root of tooth are equally affected), 4b (crown is more severely affected than the root), and 4c (root is more severely affected than the crown). Stage 5 – Only remnants of the tooth remain, covered by gum tissue. The majority of the tooth has been resorbed, leaving only a raised area on the gum.
177
3 primary patterns of canine tooth resorption
1. Internal resorption 2. Idiopathic bony replacement resorption (external) 3. Osteoclastic resorption (like cats, least common)
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Initiating causes of canine tooth resorption
Trauma Orthodontic treatment Malocclusion
179
What percent of discolored teeth are non-vital (dead) or dying?
92%
180
Only infectious disease that feline stomatitis is correlated with?
calicivirus
181
What is insulin "stacking"?
If more insulin is given at the peak effect of the last dose, the effect will "stack" and have more of an effect and last longer than intended Can cause hypoglycemia
182
Goals of therapy for feline diabetic?
Eliminate clinical signs Maintain good QOL for owner and cat Potential remission
183
Unlike all other insulins that need to be rolled, which needs to be shaken?
Vetsulin
184
How long does it usually take to achieve adequate glycemic control in diabetic patients?
1-3 months
185
What is the Somogyi effect?
Rebound hyperglycemia secondary to hypersecretion of counter regulatory hormones during hypoglycemia
186
Which insulins are short-acting, intermediate-acting, and long-acting?
Short: HUmulin R, Novolin R Intermediate: NPH (Humulin N, Novolin N), Lente, PZI Long: Glargine, Detemir
187
What is the max starting dose for insulin therapy for a cat?
2U/cat
188
What should the diet of a feline diabetic consist of?
Low card, high protein to minimize postpradial hyperglycemia
189
What is an appropriate amount of weight loss per week for a diabetic patient?
1-2% of body weight per week
190
Which concurrent illnesses or medications can contribute to insulin resistance?
Stomatitis UTI Glucocoritcoids
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Advantages and disadvantages of BGCs
Advantages: Nadir and peak time of effect Duration of effect Evaluate for Somogyi effect Disadvantages: Stress hyperglycemia Laborious Cost
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Why are fructosamine levels used to assess glycemic control?
Represent BG of previous 1-2 weeks Can be artifactually lowered by hyoproteinemia, hyperthyroidism, lean cats, newly diagnosed or mild DM
193
Renal glucose threshold
300 mg/dL
194
Why do patients with diabetes develop cataracts?
High levels of glucose overwhelm lead to higher levels of sorbitol and fructose in the eye (Aldose reductase activity decreases with age)
195
Is plantargrade stance in diabetic cats reversible?
rarely
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Pathophysiology of ketosis
Decreased amounts of insulin (diabetic patient) lead to decreased inhibition of lipolysis/FFA production result in ketogenesis
197
DKA almost always occurs as a result of
DM + a concurrent problem (commonly UTI or pancreatitis)
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Physical exam findings of patient in DKA
``` Hypothermic Tachycardic Tachypnea Tacky MM, inc CRT Weak pulses Muscle wasting Depressed/obtunded mentation ```
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How to treat hyponatremia in patient in DKA
for every 100 mg/dl BG increase above 100, add 1.6 mEq/L of Na
200
Osmolality equation
[2 (Na + K) + 0.05 (BG) + 0.33 (BUN)] = osmolality
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What are the most important things to avoid during treatment of patient with DKA
Fluid overload Rapid changes in osmolarity Hypokalemia Hypophosphatemia
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Pathophysiology of hypokalemia in DKA patient
K+ move from cells in to blood with decreased blood pH and insulin levels Lost through urine When fluid is replace and acidemia is fixed, K will move back intracellulary Results in hypokalemia
203
Best insulin choice for treatment of patient in DKA?
Regular insulin 0.2U/kg IM
204
Primary goals of treatment of patient in DKA
Stop ketogeneisis Rehydrate Correct electrolyte imbalances Avoid hypoglycemia (NOT regulation of BG)
205
Most common complication associated with treating DKA
Hypoglycemia
206
What is hyperosmolar nonketotic DM?
Severe hyperglycemia (BG > 600) Hyperosmolarity (> 350 mOsm/kg) Dehydration Absence of ketonuria
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Pathophysiology of hyperosmolar nonketotic DM
Glucosuria -> osmotic diuresis -> water loss Underlying disease -> dec fluid intake -> dehydration Dehydration -> dec GFR -> dec renal glucose excretion
208
Why is there no ketonuria in patients with hyperosmolar nonketotic DM?
May produce a small amount of insulin B-hydroxybutyrate not dectecatbe on urine dipstick
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Physical exam findings for patient with hyperosmolar nonketotic DM?
Profound dehydration Obtunded Hypotermia Prolonged CRT
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Lab findings for patieht with hyperosmolar nonketotic DM
Hyperglycemia HypoK Hyperosmolality Azotemia
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Treatment goals for patient with hyperosmolar nonketotic DM
Correct dehydration Restore electrolyte balance Correct osmolality GO SLOWLY
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Pathophysiology of idiogenic osmol formation
Fluid pulled from brain during severe dehydration Brain produces idiogenic osmols to pull fluid back into brain When insulin is given, brain glucose and osmolality are increased Idiogenic osmols cannot leave -> higher osmolality of brain when compared to ECF Fluid pulled back into brain causing cerebral edema Need to tx with mannitol +/- corticosteriods
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Maximum rate of Na decrease when treating hypernatremia
Decrease no more than 0.5 mEq/L/hr
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Diagnosis of DM is based on
Clinical signs Fasting hyperglycemia Glucosuria
215
Diagnosis of DKA is made by what clinical findings
Ketonuria | Metabolic acidosis
216
Extravascular hemolysis
Erythrophagocytosis by macrophages Produced spherocytes
217
Intravascular hemolysis
RBCs lysed via complement-mediated destruction Produced fragmented, ghost cells
218
Hallmarks of intravascular hemolysis
Hemoglobinuria | Hemoglobinemia
219
What toxins can cause hemolytic anemia
Acetaminophen Methylene blue Onions Zinc
220
What type of hemolysis does microhepatic hemolytic anemia cause?
Intravascular (causes physical trauma to cell)
221
How does hypophosphatemia cause hemolysis?
Severe hypophosphatemia causes inhibition of RBC ATP production -> oxidative stress -> hemolyis
222
What diseases are associated with hypophosphatemia that may lead to a hemolytic anemia?
DM Hepatic lipidosis After initiation of enteral feeding
223
Diseases associated with hereditary hemolytic anemia
Pyruvate kinase deficiency Pyruvate phosphofructokinase deficiency Stomatocytosis
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What drugs are associated with canine IMHA?
Sufla drugs Cephalosporins Penicillins
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What are the two most common infectious diseases to cause hemolysis and regenerative amemia?
Babesiosis | Feline Hemoplasmosis
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What kind of anemia does cytaux cause?
Hemolytic, NON-REGENRATIVE anemia
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What kind of hemolysis does babesia cause?
Intravascular
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Most common neoplasia associated with IMHA?
Lymphoma
229
What is the immune response composed of in IMHA?
Type II immune reaction: Ab +/- complement-mediated destruction IgG: macrophage erythrophagocytosis +/- completment-mediated destruction IgM: complement-mediated destruction only
230
Breeds with hereditary predisposition for IMHA
``` Cockers Schnauzer Bichon Min Pin English Springer Poodle Collie OES Finnish Spitz ```
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Lab findings with IMHA
``` Regen anemia Leukocytosis Thrombocytopenia Spherocytosis Heinz bodies Parasites ``` ELE, Tbili Azotemia Bilirubinuria Hemoglobinuria
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What three tests help diagnose IMHA?
Autoagglutination Direct Ab test (Coomb's) Flow cytometry for anti-RBC Ab
233
What causes autoagglutination?
IgM and IgG
234
What is the Coomb's test?
Patient RBCs washed to remove non-bound proteins Anti-IgG/IgM/complemenet Ab added Agglutination supportive of IMHA
235
Negative prognostic indicators associated with IMHA
``` Rapidity of onset Bilirubin > 10 Intravascular hemolysis Persisten agglutination Thromboembolic complications Marrow-directed disease ```
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Complications of IMHA
Thromboembolic complications (PTE) DIC
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Breed over-represented in feline IMHA
Himalayans
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What is the immune response composed of in ITP?
Type II immune reaction
239
Causes of secondary ITP
Drugs: cephalosporins and sulfonimides Infectious: anaplasma, babesia, lepto, leishmania Neoplasia: lymphoma, hemangiosarc, histiocytic sarc Inflammation: hepatitis, pancreatitis, SIRS
240
Lab findings with ITP
SEVERE thrombocytopenia (<30,000) Regenrative anemia Leukocytosis PT/PTT WNL (unless in DIC)
241
Diagnosis of ITP based on:
Exclusion of other disease processes Presence of severe thrombocytopenia Normal to increased megakaryopoeisis Platelet bound Ab
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How do glucocorticoids work in the treatment of IMHA/ITP?
Alter function of macrophage Fc receptor Inhibit the production of several cytokines Decrease immunoglobulin affinity Decrease immunoglobulin production
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How does cyclosporine work in the treatment of IMHA/ITP?
Inhibits T-cell mediated immunity Inhibits production of IL-2 by activated T cells
244
How does azathioprine work in the treatment of IMHA/ITP?
Antimetabolite (purine antagonist) that interferes with DNA and RNA synthesis, mitosis Inhibits cell-mediated and humoral immunity
245
How does leflumonide work in the treatment of IMHA/ITP?
Antimetabolite (inhibits pyrimidine synthesis) Inhibits cell-mediated and humoral immunity Reduced B-cell populations
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What should you warn owners of when treating with leflumonide?
teratogenic
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Which drug is most useful for the treatment of IMHA/ITP during the initial phases during hospitalization?
Vincristine
248
Defects of primary hemostasis that produce platelet abnormalities most commonly cause
reduced platelet numbers
249
What is glanzmann's thromboasthenia?
Spontaneous bleeding affects Great Pyrenese
250
Most common cause of petechia and ecchymoses in dog?
Thrombocytopenia
251
Causes of decreased plately production
Drugs (chemo, TMS) Infection (FIV/FeLV, Rickettsial, fungal) Myelophthisis Myelofibrosis Immune-mediated Neoplasia
252
What is congential macrothrombocytopenia?
Macrothrombcytopenia caused by single nucleotide change in gene encoding beta 1- tubulin, which likely affects microtubule stability resulting in altered platelet formation by megakaryocytes Affects Cairn, Norfolk terriers, Cavaliers NO BLEEDING TENDENCIES
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Most common cause of thrombocytopenia in dogs?
ITP
254
Inherited conditions that cause petechia and ecchymoses
vWBD | Glanzmann's thromboasthenia

SA Medicine (3 decks)

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