Exam 2 MOD Flashcards
1
Q
Glomerulonephritis is a group of condition in which ________ are deposited in the glomeruli
A
immune-complexes
2
Q
Which lung lobe is anatomically predisposed to atelectasis?
A
Right middle lung lobe
2
Q
What pro-kinetics can you use in non-obstructive vomitting?
A
Metoclopramide (CRI best)
Cisaparide
Ranitidine
3
Q
The a-a gradient in ventilation perfusion mismatch is ____(normal, high, low)
A
high, >30 mmHg
3
Q
Pylmonary Fibrosis, decreased RBC transit time through alveolar capillaries (pulmonary hypertension) and thickening of blood- gas interface (smoke, pneumonia) are all cause what?
A
Diffusion Impairment
3
Q
How does high oxygen Anesthesia cause atelectasis?
A
High FiO2 causes the loss of nitrogen which normally creates a nitrogen skeleton to keep the alveoli open
3
Q
what is syncope?
A
fainting due to lack of oxygen delivery to brain
4
Q
What causes depression in acute renal failure?
A
Uremic encephalopathy
5
Q
________Ventilation is the total amount of NEW air moved into the respiratory passage each minute
A
Minute Ventilation
——————
Vm= RR x Vt
6
Q
Due to the increased airway resistance in upper airway disease, there is an increased intra-pulmonary pressure which leads to a ______mismatch
A
V/Q
6
Q
All vomiting stimuli converge at the _______center
A
emetic/vomiting
6
Q
T/F: Proteinuria indicates a decrease in kidney function
A
FALSE - if may involves the glomerulus and GFR may be maintained, thus there is no azotemia.. although with time the increase protein can cause interstitial nephritis
7
Q
What are 3 secondary changes of brachycephalic airway disease?
A
- Laryngeal collapse
- Soft Tissue inflammation and edema
- Everted tonsils
8
Q
If blood is red in vomit, where is it coming from? what if it is dark/black colored?
A
red blood= esophagus or URT
dark blood= stomach or jejunum
9
Q
_______ Volume is the volume of air inspired/expired with a normal breath (10 ml/kg)
A
Tidal Volume (Vt)
9
Q
In which situation would your proteinuria be greater; PCT damage or Glomerular disease
A
Glomerular disease
9
Q
How does the healing time and strength vary between the bladder, stomach, colon and skin?
A
10
Q
What anti-acids/gastroprotectants can you use in vomitting cases?
A
Histamine blockers (cimetidine, ranitidine,famotidine)
Proton pump inhibitors (omeprazole)
Sucralfate
12
Q
_______ is abnormally low partial pressure of O2 in the tissue caused by low O2 delivery (ie anemia, poor circulation)
A
Hypoxia
12
Q
UMN or LMN?
Hindlimb ataxia, Small bladder that is difficult to express
A
UMN - thoracolumbar region
13
Q
In what wound healing phase is the weak type III collagen replaced by type I collagen?
A
Maturation Phase
13
Q
At three months a skin wound has acheived _____% of normal stength. This is the maximal strength it will ever acheive
A
80%
14
Q
Which of the following is false about the pathophysiology of vomitting:
- Prodromal signs include hypersalivation
- Relaxation of oesophageal sphincter
- Intestinal motor activity and retching
- Inputs to the vomiting centre come from the blood
A
4!
Inputs to the vomitting center come from the abdominal viscera, , hypogastric nerve (reflex), vestibular apparatus, cerebral and CTZ (blood)
15
Q
Wounds NOT closed heal by _______ _____ healing
A
secondary intention
——
Indicated for wound that are HIGHLY contaminated and devitalized and will require open wound management for several days to weeks
16
Which dog breed is most likely to get a hypoplastic trachea?
English Bulldogs
17
\_\_\_\_\_\_\_\_ mixes with fluid lining of alveoli to increase stability/decreases surface tension
Surfactant
18
Chronic Kidney Disease leads to \_\_\_\_\_\_\_damage & loss
nephron
18
Collagen synthesis is ________ proportional to tension on the wound
inversely
19
Why would you test gastrin levels in a vomitting patient?
Test used in cases of **chronic gastric ulcers** when concerned about **Gastrinoma**. Gastrin levels can be high if on chronic **leprazol** therapy or if there is a **mast cell tumor**
20
What would be a possible diagnosis for a dog that is vomitting 6-8 hours after food?
How will the etiology change if the dog is a young bull dog? vs a lab? vs a geriatric patient white dog?
**gastro-pyloric obstruction**
young Bull dog= congenital pyloric stenosis
young lab = infectious
geriatric = acquired antral hypertrophy
20
What drugs can you use as anti-emetics?
NK1 pathway inhibitors (maropitant)
**Anti-dopaminergics (Metoclopramide**)
Serotonin antagonists (Ondansetron)
Phenothiazines (chlorpromazine)
21
What is the VD/VT of Horses and Cows? Dogs?
Cow/Horse= 50%
Dogs = 30%
22
Epitheliazation of the bladder starts within _____ days and is complete withing ____ days
2 & 30
23
What are 4 main causes of hypoventilation?
1. **Decreased RR**
2. **Decreased Tidal Volume** (damage to chest, pain, paralyisi, resistance)
3. **Increased metabolic rate** (more CO2)
4. **Hyperthermia**
23
What is the "praying positon" indicate in an animal with vomitting?
Abdominal pain/**Right cranial quadrant disease = pancreatitis**
23
the esophagus lacks a \_\_\_\_layer
serosal
24
Volume overload---\> ________ hypertrophy --\> increased \_\_\_load
Pressure overload ---\> ________ hypertrophy--\> increased \_\_\_load
Volume overload---\> **eccentric** hypertrophy --\> increase **afterload**
Pressure overload ---\> **concentric** hypertrophy --\>increase **preload**
24
Which of the following is NOT a feature of nephrotic syndrome/end stage PLN?
1. Hypoalbuminemia
2. Hypercholesterolemia
3. Proteinuria
4. PU/PD
PU/PD is not a feature alone by nephrotic syndrome
25
What commonly happens in dogs & horses when you have damage to the recurrent laryngels nerve? and what is the pathophysiology?
**_Laryngeal Paralysis_** --\> loss of function of the **arytenoideus m.** --\> lack of laryngal **abduction** on inspiration --\> increase upper airway **resistanc**e --\> increased inspiratory effort --\> dyspnea, syncope, hypoxia --\> death
27
Volume of alveoli air replaced with each breath is ~\_\_\_\_\_\_ of total alveolar air
**1/7th**
29
\*\*\*5 main reasons for hypoxia?\*\*\*\*
WILL BE ON EXAM
1. **Hypovetilation**
2. **Ventilation-Perfusion Mismatch**
3. **Anatomic Shunt**
4. **Diffusion Impairment**
5. **Low FiO2**
30
Systemic causes of vomitting usually stimulate the emetic center through the \_\_\_\_\_\_
CTZ
30
What is normal urine production? What is considered oliguric?
Normal: 1-2 ml/kg/hr
Oliguria:
30
What are the 3 major players of the inflammatory stage? What is each of their roles?
1. **Platelets**- immediate- hemostasis, release cytokines (attract fibroblast)
2. **Neutrophils**- w/in 24-48 hours- kill bacteria, break down clot, release cytokines
3. **Monocytes**-w/in 48-96 hours- debridement and release cytokines to recruit cells for the repair phase
31
What are the parasympathetic, sympathetic and somatic innervations to the bladder?
* Parasympathetic- pelvic N (S1-3) - involved in urine voiding
* Sympathetic- hypogastric (L1-4/L2-5)- urine storage
* Somatic - pudendal n. (S1-3) -external urethral sphincter
32
What does the RAS system do to bradykinin?
inactivates
----
bradykinin is a chemokine that causes vasodilation
33
What is the appearance of regurgitation vs vomit?
regurgitation- tubular, mucous covered, undigested
vomit- "puddle", digested (may be bile stained)
34
What do you call an intense inspiratory sounds associated with narrowing of upper airways?
Stridor
35
T/F: In Anatomical shunts, PaO2 will not increase with delivery of 100% FiO2
True
35
What type of tissue is layed down 3-5 days post wound and is rich in capillar beds, fibroblast, macrophages, collagen, fibronectin and hyaluronic acid?
Granulation Tissue
35
The strength of a wound is only \_% that of normal tissue at 1 week and \_\_\_% at 3 weeks post wounding
3%= 1 week
30%=3 weeks
36
ilius is a common sequela to ________ of the intestines in cats and dogs
inflammation
37
What type of tissue has a 0-4 day lag phase for healing?
GI tract
---
Due to the fibrin seal on the serosal layer within the first 12-24 hours that then has to undergo fibrinolysis and collagen deposition
38
As heart rate increases, the heart perfusion during diastole _\_\_\_\_\_(increase/decrease)_
**decreases**
-----
heart will be working harder with less delivery of nutrients
39
Which part of the kidney is most metabolically acitve and most sensitive to changes in O2 and toxic injury?
PCT
40
In GI tract healing, normal strength is reacheived in about _____ days
10-17 days
----
the stomache heals quickly (14 days)
Esophagus has high rate of incisional dehiscence
Colon heals slower than the SI
41
If a vomitting animal is obtunded or comatose on PE, what are 3 DDxs?
Hypoglycemia, hepatic encephalopathy, systemic toxicosis
41
How can salivary glands give you clues on what is going on in the esophagus?
Severe esophageal distention with a foreign body or granuloma can trigger temperol lobe epilepsy that causes severe hypertrophy and pain of salivary glands --\> pain and dysphagia
41
In Delayed Primary Closure, Appositional closure occus within 3-5 days after wounding but ______ granulation tissue is present?
BEFORE
----
Indicated for midly contaminated wound that require cleaning, debridement and open wound management for a couple days in order to decrease microbial contamination and improve tissue health for closure
42
\_\_\_\_\_\_\_\_ is low partial pressure O2 in arterial blood (
Hypoxemia
43
What must you rule out before giving a prokinetic?
Foreign body or intussusception
45
How do you develop a right to left shunt?
VSD/PDA --\> increase pressure in RV and PA --\> Pulmonary hypertention --\> R ventricular thickening --\> RV or PA pressure becomes greater than LV or aorta pressure --\> R to L shunt --\> severe hypoxia
46
What does optimal intestinal healing depend on?
1. Blood supply
2. Accurate mucosal apposition
3. Minimal surgical trauma
4. Submucosa holding layer
47
What are the two main etiologies of regurgitation?
Obstruction & Weakness
(both can be either congenital or acquired)
49
Congestion and edema of nasal passages causes post-operative airway obstruction in what species?
**Horses**
------
higher risk when dorsal recumbency for \>1-2 hours and/or with nose below level of heart
May lead to non-cardiogenic edema
51
Diffusion rate is inversely proportional to (2 things)?
Tissue Thickness
Molecular Weight
52
What part of the PCT cells are lost first during cell damage?
brush border
53
What are the two main airway defenses? where are they located?
1. Mucocillary Elevator - conducting airways to epiglottis
2. Alveolar Macrophages- alveoli
55
What do you call a harsh snoring, sound mostly on inspiration, associated with obstruction of the larynx?
Stertor
56
In which organ is the collagen synthesis speak at 5 days and 100% of the original strength is reached in 21 days?
Bladder!
57
In the GI tract, what is the holding layer?
submucosa!!
59
The A-a gradient in hypoventilation is \_\_\_\_\_\_\_(normal/raised/low)
Low,
60
What type of healing is indicated for wounds that are HIGHLY contaminated and devitalized and will require open wound management for several days to weeks?
Secondary Intention Healing
62
nasal discharge, sneezing, reverse sneezing, epistaxis, gaggind, stertor and stridor are all clinical signs of what type of disease?
Upper Airway Disease
64
\_\_\_\_\_\_\_\_ Law of resistance says that with laminar flow, resistance to flow is inversely proportional to the radius to the fourth power
Poiseullie's
65
What endocrine response to heart failure increases venous return/preload? What hormone increases circulatory volume?
**Angiotensin II-** increase preload
**Aldosterone** - increase volume
67
What percent regurge must be present to have enough decrease in CO to be considered heart failure?
70%
69
Hypoventilation results in hyper\_\_\_\_
hyper**carbia** (increased PaCO2, \>45 mmHg)
-----------
hypoxia occurs due to inadequate ventilation for gas exchange
70
What are the Major players of the proliferation stage?
1. Fibroblast
2. Endothelial cells
3. Epithelial cells
71
What occurs when there is an imbalance between natural defenses and infectious agents in the respiratory system?
Pneumonia!
72
Which species has a slower first intention healing and slower/less abundant granulation tissue formation: dog or cat?
CAT-- so you may want to keep stiches in for longer and keep the cone on longer
74
T/F: The CTZ center is protected by the BBB
**False**- thus it is bathed in toxins and can stimulate the vomiting center in the medulla
75
In Ventilation Perfusion Mismatch\_\_\_\_\_ exchange is impaired but can be corrected with increased ventilation due to it being 20x more soluable than O2
**CO2**
77
What are clinical signs of Lower Airway disease?
* Dyspnea
* Coughing
* Wheezing
* Orthopnea
* (clinical signs associated with primary disease process)
79
What is the inspiratory reserve volume?
Increased air beyond the normal volume
81
Why does atelectasis typically occur?
as a result of increased surface tenison
-----------
1. Decrease transpulmonary pressure
2. Loss of structural support of parenchyma
3. Decreased surfactant
82
What are the 4 stages of Acute Kidney Injury?
1. **Induciton**
* Insult occurs
* No clinical signs- may find tubular cell in sediment
2. **Exstension**
* insult still present
* clinical sign present
3. **Maintenance**
* etiology gone- now left with damage
* may recover, enter CRF or worsen into anuric renal failure
4. **Recovery**
* may slowly improve if damage to cells is sublethal
* kidney function slowly improves
84
Low partial pressure of insipred oxygen most commonly occurs at ______ \_\_\_\_\_
high altitudes
85
What enables stomach wounds to heal so quickly?
Fibrinogen is layed down by both fibroblast and smooth muscle cells
86
Why is there a poorer prognosis as blood levels of catecholamines increases?
high catecholamines --\> vasospasm, toxic effects, arrhythmias
88
higher negative pressue to overcome obstruction --\> soft tissue changes (edema, hyperplasia, collapse, respiratory muscle failure) --\> decrease air flow ---- is the pathophysiology to what disease?
Brachycephalic Airway Disease
89
What happens if there is a DECREASE in functional residual volume
Hypoxia
90
In the GI tract, Dehiscence (seperating of wound layers) occurs ____ days after surgery, during the \_\_\_\_phase
3-5 days, during the LAG phase
92
What causes hypoxia in pneumonia?
93
What are Lab findings of CRF?
Azotemia & Unable to concentrate urine
94
UMN or LMN?
Hindlimb paraplegia, urinary incontinance, large bladder, easy to express
LMN- Sacral damage
95
What is the pathophysiology of CRF?
1. Failure of excretion of nitrogenous waste --\>**uremia**
2. Failure of urine concentration -\>**PU/PD**
3. Failure of synthesis of calcitriol (Vit D3) --\> **hypocalcemia & renal secondary hyperparathyroidism --\> rubber jaw**
4. Failure of erythropoietin synthesis --\>**anemia**
5. Failure to catabolise peptide hormones (e.g. gastrin) --\> **uremic gastritis** & decreas pH--\> **stomach ulceration/erosion**
6. systemic hypertension --\> hypertensive retinopathy & glomular hypertension
7. defective hemostasis
8. mineral imbalance
9. proteinuria
10. renal fibrosis
96
Secondary closure/Third intention healthing is when closure of a wound occurs 3-5 days after wound healing, ______ granulation tissue has formed in the wound bed
AFTER
-----
wound is closed over the granulation tissue (+/- debridement)
97
2 causes of damage to alveoli capillaries that results in leakage of RBC and plasma into alveoli
Pulonary overinflation
Pulmonary hypertension
99
Hypotension and Pulmonary edema are signs of \_\_\_\_-sided congested heart failure
**_Left_**
**----**
**Hypertrophy** = increased CRT, increased HR, decrease pulse, weakness, syncome, azotemia
**Pulmonary edema** = dyspnea, coughing, orthopnea, tachypnea, ex intoerance, cynosis
100
What cells recruit fibroblasts? and what are fibroblasts main role?
Recruited by **platelets** and **M0**
Role= synthesize **collagens & become myofibroblasts** (form adhesions that provide mechanical leverage to cause wound contraction)
101
Is hypoxemia more severe with R ot L or L to R shunts?
R to L
102
What are three differentials for an animal with azotemia and high potassium?
1. **Urethral blockage** (more in cats)
2. **Addisons** (check resting cortisol and stress leukogram)
3. **Acute Renal Failure**
103
In intestinal obstruction there is a severe hypo\_\_\_\_\_
chloremia
104
What is the most common heart disease seen in small dogs?
Myxomatous atrioventricular valve disease (endocardiosis)
105
How does pyometra cause pu/pd?
Endotoxins interfere with the ADH receptor
106
What creates diastolic pressure?
the force of the elastic recoil of the aorta
106
What electrolyte is important for GI motility, but is commonly lost in cases/causes of vomitting?
K
107
What type of wound closure is indicated for midly contaminated wound that require cleaning, debridement and open wound management for a couple days in order to decrease microbial contamination and improve tissue health for closure?
Delayed Primary Closure
109
Define Heart Failure
Cardiac output insufficent to meet body needs
110
Chronic wounds usually do not progross beyond what stage of wound healing?
inflammatory phase
111
What exacerbates heart failure?
compensatory mechanism (sympathetic nervous system, Aldosterone, Angiotensin II, baroreceptors)
113
What type of healing is through appositional wound healing acheived by fixing the wound edges together? When would you use this healing?
**Primary** Wound Closure/**First Intention** healing
Used for **surgical wounds, clean wounds, and wounds with no tension**
114
What drugs can you use to treat heart failure compensation effects?
B Blockers- decrease sympathetic
ACE inhibitos- interfere with RAAS
Furosimide- stop Na reabsorption
115
In anatimical shunts, there is an extreme ________ mismatch due to normal ventilation and no perfusion
V/Q
116
What are clinical signs of RIGHT CHF?
Ascities
pleural effusion
Hypotension
Distendion of jugular vein
Hepto-splenomegally
117
What is the leading cause of vomitting in dogs and cats?
diet
118
T/F: The effects of **cardiac cachexia** are hard to reverse
**True =(**
Even if you reverse the heart disease, the animal may still remain thin
119
What are the three primiary components of brachycephalic airway disease?
1. Elongated soft palate (most common)
2. Stenotic nares
3. Stage I laryngeal collapse/Everted laryngeal saccules
120
Are increase salivation, nausea and heaving (abdominal contractions) associated with vomitting or regurgitation?
vomitting
121
In skin wound healing, Net collagen synthesis is complete by ____ weeks
4-5
--------
collagen maturation may continue for 12-18 months
122
How does the diagnostic plan differ from acute vomitting vs chronic vomitting?
Acute (less than 5 days) - requires hospitalization & emergency therapy/monitoring, self limiting, treated symptomatically
Chronic (\>5-7 days and not responding to symptomatic therapy) - in-depth investigation
