Final Exam Flashcards
(293 cards)
1
Q
A
Reptiles
2
Q
CRI that is used in Equine Acute Abdominal Distress that Increases Heart Contractility
A
Dobutamine
3
Q
Patients with _____ get increased Drug penetration into the CNS because the BBB becomes more Permeable
A
Azotemia
*Need to Decrease our Drug dosages in patients with Azotemia because more drug will cross the BBB into the CNS
4
Q
In Patients with Renal Disease, we want to Maintain MAP > ____mmHg
A
80
5
Q
Maintenance drugs used in Avian Patients
A
Isoflurane or Sevoflurane
6
Q
In Patients with Renal Disease, during Anesthesia we want to AVOID ______
A
STRESS
*Minimize stress to Avoid Catecholamine Release
7
Q
Concept when the Half Life of your Agonist Drug is Longer than that of the Antagonist (Reversal) Drug, where the animal will Recover but then become Sedate/Anesthetized again once Reversal Agent wears off
A
Renarcotization
*Try to have your Reversal Agent have a Similar or Longer Duration of Action compared to Anesthetic Drug
8
Q
Local Anesthesia Technique that is commonly used in Conjunction with General Anesthesia on Pregnant Animals
A
Lumbosacral Epidural
*Epidural Blood Volume is decreased by 1/3rd in Pregnant Patients
9
Q
____ Complete Cycles of Inspiration and Expiration are needed to exchange Inhaled gas in Birds
A
Two
10
Q
12 Year Old Warmblood Mare, 695 kg
History: Rolling in Stall, Watching Flank
Presenting Complaint: Colic
Physical Exam: Tachycardia, Dehydration, Abdominal Pain
What Preansthetic Medication should be used?
A
Xylazine
*Alpha 2 Agonists must be used in these Cases!!
11
Q
In Patients with Diabetes Mellitus, Severe Hypoglycemia can lead to ____ that is not apparent until after Anesthesia
A
Brain Damage
12
Q
Inspiration and Expiration are BOTH ACTIVE processes in which Species?
A
Reptiles
13
Q
Review of this Chart:
On Gas Anesthesia, The Cerebral Blood Flow increases even Higher in Response to Increased PaCO2. You’re not going to need as High of Levels of PaCO2 to Increase Cerebral Bloow Flow
Even with Normal Ventilation PaCO2 (40mmHg), Cerebral Blood Flow is going to Increase Significantly under Inhalant
We are going to Midly Hyperventilate patients with CNS Disease under Inhalant Anesthesia, because with Inhalants normal Levels of CO2 will still Increase Intracranial Pressure
A
14
Q
For Anesthetic Managment in Patients with Diabetes Mellitus your goal is to Prevent ______ at all times, prevent Prolonged Hyperglycemia and Maintain a Normal Fluid and Electrolyte Balance
A
Hypoglycemia
15
Q
Crocodiles have _______ (Dive Response) where Blood Bypasses the Lungs
A
Right-Left Shunting
*How do you get them to sleep if Inhalants will Bypass the Lungs? We don’t use Inhalants exclusively in Crocodiles because if they shunt they will wake up
16
Q
Preanesthetic Medication used on this Patient
A
Morphine
17
Q
In Patients with Insulinomas, prior to Surgery they have MInimal Fasting (4-6 Hours) and the goal is to maintain a Blood Glucose above ____ mg/dL during Surgery
A
40
18
Q
In Pregnant Patients under Anesthesia the Cardiac Ouput _____ by 30-50%
A
Increases
*Cardiac Output increases to meet the Oxygen Demands of the Fetus
19
Q
Three Antagonists used to reverse the High Potency Opioids
A
Naltrexone (Preferred)
Naloxone
Diprenorphine- Etorphine Reversal
*Naltrexone has a long duration of action and prevents lRenarcotization
20
Q
Reptiles Rely on External or Environmental Heat Sources for Thermoregulation. It is Crucial to maintain each species at Optimum Preferred Temperature between _____
A
25-35 Degrees Celsius
(77-95 Degrees Farenheit)
21
Q
During Anesthesia in Hyperthyroid Patients, _____ are used to Slow Heart Rate and Decrease Myocardial Oxygen Consumption
A
Opioids
22
Q
_____ Lung is Vestigial in Snakes
A
Left
*Vestigial- degenerate, rudimentary, or atrophied, having become functionless in the course of evolution.
23
Q
If a Wildlife patient receives a Dart Injury, such as a Hematoma, the wound should be clipped, scrubbed, and flushed and long-term _____ administered
A
Antibiotic (Ex. Penicillin)
24
Q
Best Preanesthetic Medication for Patients with CNS Disease
A
Benzodiazepenes + Opioids
*Anticonvulsant Activity and Minimal Cardiovascular effects
Wait to give Opioids until Ventilation is Controlled!! Opioids lead to Hypoventilation and Increased PaCO2 that can Increase Intracranial Pressure- Wait to give Opioids until the patient is on a Ventilator
25
True/False: In Patients with **Diabetes Insipidus**, prior to Anesthesia, Oral Water should be Withheld
**False**
**\***DO NOT Withold Water from patients with **Diabetes Insipidus**
26
The Goals of Anesthesia in patients with **CNS Disease** is to Keep Inhalant Low, and Avoid _____ and \_\_\_\_\_\_
**Hypoxemia**
**Hypercapnia**
27
Two Drugs that should not be used in Anesthesia in Patients with **Endocrine Disease**
**Etomidate**
**Alpha 2 Agonists**
**\***Patients with Endocrine Disease have _Decreased Stress Response - We want to Avoid Drugs that Block the Stress Response Completely such as Etomidate and Alpha 2 Agonists_
28
Electrolyte Abnormalities common in patients with **Addisons Disease**
**Hyperkalemia**
**Hyponatremia**
**\***Check for Electrolyte Abnormalities
29
Best Induction agent in patients with **Renal Disease**
**Propofol or Etomidate**
**\***Never Box or Mask patients with Renal disease because it is too Stressful
30
In Patients with **Liver Disease** you want to check your ______ Profile prior to Surgery (PT, PTT)
**Coagulation**
**\***Patients with Liver Disease that go into surgery with Abnormal Coagulation Factors have the Potential for _Thromboembolic Complications_
**\***Picture- Laboratory Findings in someone with Liver Disease- _Monitor Hydration, Blood Glucose, and Plasma Protein Concentrations_
31
Stabilization Plan for **Equine Acute Abdominal Distress**
**FLUIDS**
_**\***Hypertonic Saline with a Lot of Balanced Electrolyte Solution (LRS)- 25-35 Liters of LRS_
32
CO2 Diffuses ____ Times **More Rapidly** than Oxygen
**20x's**
33
Endocrine Disease characterized as **Insulin Deficiency**
**Diabetes Mellitus**
34
Treatment for **Hypoxemia**
**Resolve any Airway Obstruction**
**Position in Sternal**
**PEEP**
Consider Bronchodilator, especially in Large Animals
35
In Patients with **Diabetes Insipidus** you want to Monitor Serum ____ Concentrations and _keep below 160 mEq/L_
**Sodium**
**\***If Patient is Hypernatremic, the Correction not be made too Rapidly, but rather should be make over 72 Hours
36
Condition resulting from Blood Entering Arterial System without going through Ventilated Area of Lung that can result in **Hypoxemia**
**Right-Left Shunt**
37
**Pregnancy**, due to Progesterone, _____ the Dose Requirement of _Local Anesthetics_
**Decreases**
**\***Pregnant Patients are more sensitive to Local Anesthetics
38
True/False: ALL Anesthetics are likely to affect **Renal Blood Flow**
**True**
39
Best Maintenance for Patients with **Liver Disease**
**Isoflurane**
\*AVOID Halothane because it decreases Hepatic Blood Flow and is 20% metabolized by the Liver
40
Anesthetic Managment plan in a Patient with **Diabetes Mellitus** that has been Fasted Overnight and has a **Blood Glucose \< 99 mg/dL**
**No Insulin and Start 2.5% Dextrose Infusion**
41
Best _Premedication_ in Patients with **Cardiac Disease**
**Just Opioid or Opiod with a Benzodiazapine**
_\*DO NOT use Alpha 2 Agonists in Patients with Cardiac Disease_
42
What is the **Cushings Triad** seen in Patients with _CNS Disease_ under Anesthesia
**Increased Arterial Blood Pressure**
**Irregular Breathing**
**Bradycardia (Reflex)**
_**\***What Drug would you want to avoid that may cause Cushings Response in CNS Patients going to Anesthesia? Dexmetatomadine (Alpha 2 Agonist)_
43
No IV access before Induction
_How will we Induce this Patient?_
**Mask Administration with Sevoflurane or Isoflurane**
_**\***Then use Uncuffed Endotracheal Tube_
44
True/False: NSAIDs are NOT recommended for use during **Pregnancy**
**True**
45
\_\_\_\_\_ have a Three Chambered Heart that Functions as a Five Chamber Heart, leading to **Mixing of Oxygenated and Deoxygenated Blood**
**Reptiles**
_**\***Lizard, Snake and Turtles_
46
Review of this Chart:
_In a normal animal, Cerebral Blood Flow will be normal between 60-140 MAP. If the MAP is above or below that Interval there will not be Normal Cerebral Blood Flow_
_The Cerebral Blood Flow begins to Increase when the PaO2 Drops below 50- Flow will Increase to try to get more Oxygenation to Tissues_
_PaCO2 has a Linear Relationship with Cerebral Blood Flow (CBF). As PaCO2 Increases, so does Cerebral Blood Flow_
47
How would you Handle this Patient?
**Bunny Burrito**
**\***Helps to Avoid Kicking and Fractures
48
Treatment Indicated for Patients in **Chronic Pain** where Increased Temperature leads to Vasodilation and Increased Blood Flow that helps with Connective Tissue extensibility and Muscle Relaxation
**Thermotherapy**
**\***_Contraindicated during Acute Inflammation_
49
In Patients with **Mitral Valve Insufficiency**, Preoperative Preparation is aimed at Reducing the Regurgitant Fraction and Controlling \_\_\_\_\_\_
**Pulmonary Edema**
**\***Low Sodium Diets are Important
50
Case: 7 Year Old Male Canine Great Date 45kg
History: Non Productive Retching, Drooling, Abdominal Distention when owner came home from work
Physical Exam: HR= 160 bpm, RR= Panting, T= 99.3
CRT= 3 Seconds, mm = Pale Pink, Poor Pulses
**What Induction Agent would you use in this Patient?**
**Propofol**
**\***Small Dose just to get the patient Intubated
51
Best Sedatives to use in **Geriatric Patients**
**Benzodiazepines**
52
Preferred Place on Patients body to hit with a **Dart**
**Large Muscles on Hindlimb**
53
12 Year Old Warmblood Mare, 695 kg
History: Rolling in Stall, Watching Flank
Presenting Complaint: Colic
Physical Exam: Tachycardia, Dehydration, Abdominal Pain
**What Drugs are used for Induction?**
**5% GG + Ketamine**
**\***Do Not Titrate Induction agent in large animals, push all the drug at once
54
True/False: Anticholinergics are recommeneded for Routine Premedication in **Geriatric Patients**
**False**
55
Expect a _____ Mean Arterial Blood Pressure in **Neonates** under Anesthesia
**Lower**
56
\_\_\_\_\_\_ are generally NOT recommended for Anesthesia in **Pregnant Small Animals**
**Sedatives**
(Ex. Acepromazine, Benzodiazepines or Alpha 2 Agonists). _Most Sedatives will lead to Fetal Depression_
57
Patients with **Gastric DIlation-Volvulus** should be Maintained with ___ Levels of Inhalant
**Low**
**\***Sicker the Patient the less Inhalant you need
_\*Add CRI to Keep Inhalant Low- Fentanyl or Morphine CRI_
58
True/False: **Reptiles** commonly have _Prolonged Recovery_
**True**
**\***Want to use short acting and reversible drugs to help decrease the time of Recovery. _Turn off Inhalant 15 Minutes before Procedure ends_
59
**Avians and Reptiles** do NOT have \_\_\_\_\_, where both Inspiration and Expiration are Active
**Diaphrams**
60
How will we Preoxygenate Patients with **Gastric Dilation Volvulus?**
**Face Mask**
**\***Well Fitted with High Oxygen Flow Rate for 3-5 Minutes
_\*Must Preoxygenate all the way through to Intubation- Do NOT stop Preoxygenation during Induction_
61
True/False: Opioids are a good choice for Analgesia in **Geriatric Patients**
**True**
62
True/False: A **Failing Heart** May Not tolerate an Increased Fluid Load due to a Change in the Frank Starling Curve
**True**
**\***_Increased Preload Does NOT Equal Increased Cardiac Output in Patients with a Failing Heart_
_\*Increasing Pre-Load in a Failing Heart can lead to Congestion_
63
Two Distinct Functional Compartments of the **Avian** Respiratory System
**1. Ventilation- Trachea and Air Sacs**
**2. Gas Exchange- Parabronchial Lung** (Nonexpandable)
\*Trachea- Forms complete Cartilagenous Rings_- Do not use Cuffed Tubes in Birds_
_\*Airsacs Everywhere- be very Careful with Restraint!!!_
64
True/False: **Neonates** have a Higher Daily Fluid Requirement and are more tolerant to Fluid Overload
**False**
_**\***Less Tolerant to Fluid Overload_
65
Which **High Potency Opioid Antagonist** has Opioid Agonist Properties as well?
**Diprenorphine**
66
Which of the Following can Perform **Physical Rehabilitation:**
A. Licensed Veterinarian
B. Certified Veterinary Technician Trained in Physical Rehab
C. Licensed Physical Therapist educated in Veterinary Antaomy
**All of the Above**
67
What Pre-anesthetic Medication can be used?
**Sedative + Opioid** (Ex. Midazolam + Butorphanol)
_\*Rabbits Sedate really well with Midazolam._
_Give Prior to Removal from own Cage_
68
In Patients with **Addisons Disease**, Exogenous ____ Therapy is Required to Prevent Adrenal Crisis and Circulatory Collapse
**Glucocorticoid**
**\***Most commonly _Dexamethasone_
69
What **Fluid Therapy** should be used in this Patient?
**Balance Electrolyte Solution (LRS)**
**10-20 mL/kg/h IV**
70
True/False: **Birds** Loose Heat Fast under General Anesthesia and a Forced Air Warmer must be used
**True**
**\***Core Temperature is best measured by an Esophageal Probe
_\*Monitor Temperature Carefully in Birds- Gain and Loose Heat very quickly. Caution to Prevent Overheating- Birds can NOT dissociate Heat through their skin_
71
NSAID that can be given for Analgesia post Delivery in **Pregnant Canine Patients**, but should be _AVOIDED in cats_
**Acetaminophen**
72
**High PaCO2 (\> 40mmHg)** that will Result in Hypoxemia if Breathing Room Air
**Hypoventilation**
_**\***Generally will not result in Hypoxemia if breathing 100% O2- For the Most part under Anesthesia, Hypoventilation is not a cause of Hypoxemia_
73
Which Species can be **Ventilated** during Anesthesia by _Extension and Flexion of the Hind Legs_
**Chelonians (Turtles)**
**\***IPPV in Chelonians- Leg Extension and Flexion
74
Treatment that helps with the **_Acute Inflammatory phase_** that reduces Inflammation, Edema and Pain by using Cold Therapy, such as Crused Ice, Frozen Peas or Cold Immersion Baths
**Cryotherapy**
75
\_\_\_\_\_\_ Regulation is Important in **Small Mammals** because they have an Increased Surface Area to Body Weight Ratio
**Temperature**
**\***Small Mammals can be Cooled down rapidly but also Heated up Rapidly
76
**Ferrets** have a Deficient Glucuronidation Pathway, therefore Caution is taken when Administering _____ because it can cause Toxicity
**NSAIDs**
77
Application of High Energy, High Amplitude Acoustic Pressure Waves to Tissue that stimulates Healing
**Extracorporeal Shock Wave Therapy**
_**\***Can be Uncomfortable and makes a loud noise so heavy Sedation or Anesthesia is required_
78
Best Drug for Induction in a Cat with **Hypertrophic Cardiomyopathy**
**Etomidate**
79
In _____ Patients Following Anesthesia, Slow Recovery with _Hypothermia_ can occur, you should provide Active Warming Sources
**Hypothyroid**
80
_As PaCO2 Increases_, Cerebral Blood Flow (CBF)\_\_\_\_\_\_ and Intracranial Pressure \_\_\_\_\_\_\_
**Increases**
_**\***PaCO2 and CBF have a Linear Relationship- as CO2 Increases, the Cerebral Blood Flow increases. If the tissue senses high levels of CO2 the vessels will Vasodilate to increase perfusion and try to get the extra CO2 out of there_
_\*The More CO2, the more Cerebral Blood Flow, The More Intracranial Pressure- BAD. We want to keep the CO2 LOW_
81
Three Drug Delivery Methods used in **Wildlife**
**Pole Syringe** (3-4 Meters)
**Blowgun** (15 Meters)
**Dart Projectors** (up to 50 Meters)
82
Case: 7 Year Old Male Canine Great Date 45kg
History: Non Productive Retching, Drooling, Abdominal Distention when owner came home from work
Physical Exam: HR= 160 bpm, RR= Panting, T= 99.3
CRT= 3 Seconds, mm = Pale Pink, Poor Pulses
**What Maintenance would you use in this Patient?**
**Isoflurane in 100% O2**
\*Only about 0.5-1%
_\*Keep Inhalant Low- CRIs of Fentanyl and Lidocaine Help_
83
In a Canine Patient with **Gastric Dilation Volvulus**, what is our Fluid Plan?
**Shock Rate Dose (LRS) at 90mL/kg**
84
Hearing an **S4 Gallop Rythym** in a **Cat** is a sign of \_\_\_\_\_
**Hypertrophic Cardiomyopathy**
85
Preferred Induction Agent in many **Small Reptiles**
**Propofol**
**\***Tail Vessels often used
86
\_\_\_\_\_\_ Patients have:
**_Decreased MAC_**
_Decreased Muscle Mass_
_Decreased Plasma Volume_
_Decreased Metabolic Rate_
**Geriatric**
87
**Pregnancy** _____ MAC during Anesthesia and Pregnant Patients have an Increased Sensitivity to Local Anesthetics
**Decreases**
_**\***Pregnancy Decreases MAC- KNOW THIS_
88
Daily Fluid Maintenance used in **Avian Species**
**40-60 mL/kg/day**
89
Premedication Recommended in **Small Mammals**
**Sedative + Opioid**
**\***_Administer Preanesthetic Medication BEFORE Removal from Home Cage or Pen- Small Animals are more comfortable in thier Pens_
90
In what Two Species is Inspiration and Expiration BOTH Active Processes
**Reptiles**
**Birds**
91
Case: 7 Year Old Male Canine Great Date 45kg
History: Non Productive Retching, Drooling, Abdominal Distention when owner came home from work
Physical Exam: HR= 160 bpm, RR= Panting, T= 99.3
CRT= 3 Seconds, mm = Pale Pink, Poor Pulses
**What Fluid Therapy should be Given to this Patient?**
**90mL/kg Bolus (Shock Dose)**
**\***Gastric Dilation-Volvulus
92
**Foals** may be Induced with Iso/Sevo via \_\_\_\_\_
**Nasotracheal Tube**
**\***Smooth Induction and Minimal Environmental Contamination
93
**Hyperkalemia**
94
Injectable Premedications used as Sedatives in **Reptiles**
**Alpha 2 Agonists**
**Benzodiazepines**
_**\***Reversibility is a Benefit_
95
Best Drug used for Maintenance in a Patient with **Renal Disease**
**Isoflurane**
96
True/False: When Using **Acupuncture** as an Adjunct Treatment, **Western** Diagnosis and Medicine is a MUST
**True**
97
Range of Motion in Joints in Flexion and Extension are Measured using a _____ during **Physical Rehabilitation**
**Goniometer**
98
Anesthetic Managment plan in a Patient with **Diabetes Mellitus** that has been Fasted Overnight and has a **Blood Glucose 100-200 mg/dL**
**1/4 Usual Insulin Dose and Begin 2.5% Dextrose Infusion**
99
In Patients with a \_\_\_\_\_\_,
Increased Ventilation will Decrease PaCO2 Linearly
BUT _Increased Ventilation only MINIMALLY Increases O2_
**V/Q Mismatch**
_**\***CO2 diffuses much more Rapidly than O2_
100
Normal Fluid Therapy Volume used in Patients with **CNS Disease**
**3-5 mL/kg/h**
**\***Don't want to give too high of a volume, because that will Increase Intracranial Pressure
101
Goals of \_\_\_\_\_:
_Improve Muscle Strength and Reduce Atrophy_
_Increase Rate of TIssue Healing_
_Remodeling of Scar Tissue_
_Decrease Pain, swelling, and Muscle Spasm_
**Physical Rehabilitation**
102
Best Preanesthetic Medication in patients with **Renal Disease**
**Opioid + Benzodiazepine**
_**\***Avoid- Acepromazine_ because these patients cannot tolerate Hypotension
_\*Avoid Alpha 2 Agonists_ because Decreased Renal Perfusion
103
In **Neonates** a _____ is commonly given with Premedication because Neonates are _dependent on Heart Rate for Cardiac Output_
**Anticholinergics**
104
Delivery of an Electrical Current to the skin by Surface Electrodes placed over the Painful Region that provides analgesia by activating non-noxious large myelinated Nerve Fibers
**Transcutaneous Electrical Nerve Stimulation (TENS)**
105
True/False: Avoid Needling Tumors, Infected Skin and Wounds during **Acupuncture**
**True**
106
How would we **Induce** this Patient?
**Isoflurane by Mask**
**\***Than Place uncuffed ETT
107
Anesthetic concerns in patients with **Gastric Dilation-Volvulus** include Cardiac \_\_\_\_\_\_
**Arrhythmias**
_**\***Ventricular Premature Contractions are the most common_
108
True/False: **V/Q** varies throughout Different Areas of the Lung
**True**
**\***_V/Q is NOT the same in all parts of the Lung_. Overall it decreases from the Top to the Bottom of the Lung
109
Best _Induction_ Agents in Patients with **Cardiac Disease**
**Etomidate +** _Diazepam_
_\*_Start with Lower than Normal dose Initially and give it at a Slower Rate
110
Two Dissociative Anesthetics that are commonly used in **Zoo and Wildlife Animals** for Induction
**Ketamine**
**Tiletamine**
111
\_\_\_\_\_\_ Needles are commonly placed in **Reptiles** (Except Snakes) for administration of Drugs and Fluids
**Intraosseous**
_**\***Humerus, Femur or Tibia_
112
Sedatives Recommended for **Neonates**
**Benzodiazepines (Midazolam)**
**\***Avoid Alpha 2 Agonists and Phenothiazines- Significant Cardiovascular effects
113
True/False: MAC is Higher during **Pregnancy**
**False**
_**\***MAC is Lower during Pregnancy_
114
**Reflex that is a Mechanism to Match V/Q,** that is Decreased by Anesthetic Drugs, especially Inhalants
**Hypoxic Pulmonary Vasoconstriction**
**\***I_n cases of Alveolar Hypoxia, this reflex leads to Vasoconstriction of Small Pulmonary Arteries. However, Under anesthesia this Reflex is Decreased leading to V/Q Mismatching_
115
Drugs used during Anesthesia to Increase Heart Contractility in Patients with **Dilated Cardiomyopathy**
**Dopamine or Dobutamine**
**\***Patients may benefit from Increased Heart Rate in order to Maintain Cardiac Output
116
Anticholinergic that May be Added into **Rabbit** Premedication because Rabbits have an Inherently High Heart Rate
**Glycopyrrolate**
117
In Patients with **Hyperthyroid**, we should treat with _____ for 6-12 weeks to Reduce total Thyroxine to reference Range before Thyroidectomy, which Significantly reduces Perioperative Mortality
**Methimazole**
118
True/False: We want to AVOID Elevated Intracranial Pressure (ICP) in Patients with CNS Disease
**True**
**\***We want to avoid anything that is going to occulude the Neck- _No Neck Leashes or Jugular Catheters in Patients with CNS Disease_
119
What should be done for **Induction**
**Mask with Isoflurane then Intubate with Nasotracheal Tube**
**\***Always use a Capnograph to help us during Intubation
120
\_\_\_\_\_ Patients have these Pathologies:
_Limited Ability to Increase Heart Rate_
_Decreased Atrial/Myocardial Compliance_
_Decreased Function of Lungs_
_Decreased Thoracic Compliance_
_Decreased Liver/Renal Mass_
**Geriatric**
_**\***Decreased Liver and Renal Mass- Decreased Drug Clearance and Decreased GFR = Prolonged Duration of Action of the Drugs_
121
In Patients with **Mitral Valve Insufficiency** we can produce Mild Reductions in SVR and _Promote Forward Flow_ by using Low-Dose ______ Plus and Opioid
**Acepromazine**
**\***Can be used to Reduce Regrugitation in Patients with Mitral Valve Insufficiency
122
Ideally for an Elective Procedure, Stabilize a **Hypothyroid** Patient with _____ for 1-2 Weeks prior to Surgery
**Thyroxine**
123
If _____ is Present the Patient should **NOT** be Anesthetized unless the Condition requiring Therapy/Surgery is Life Threatening
**Pulmonary Edema**
**\***You want to Postpone Anesthesia in this Patient or else Complications can Arise
124
Do NOT Fast **Avian** Patients that are
**200**
_**\***Fast Birds that are \> 200g for 2-4 Hours prior to Anethesia to avoid Regurgitation_
125
Common Vein used for IV Access in **Snakes and Turtles**
**Jugular Vein**
_**\***In Turtles can also use: Dorsal Coccygeal Vein_
126
Best Induction agents used in **Neonates**
**Propofol or Alphaxalone**
127
**Reptiles** can Tolerate Severe _____ and \_\_\_\_\_\_
**Hypoxemia**
**Hypothermia**
128
Maintenance used in **Neonates**
**Sevoflurane or Isoflurane**
129
Review Diagram on V/Q
**Normal Alveolus- V/Q of 0.8**
**Shunt- V/Q = 0** (Perfusion without Ventilation)
**Dead Space- V/Q = Infinity** (Ventilation without Perfusion)
130
Single Wavelength Light that leads to Photochemical Reaction in the Cells that is useful for managing Chronic and Minor Pain
**Low Level Laser Therapy**
_**\***Protective Eye gear must be worn_
131
2 Regions of the Lungs in **Reptiles**
**Vascular Lung**- Gas Exchange
**Air Sac-** Regulates Air Flow
\*Air Sacs are not Involved in Gas Exchange
132
Induction agents used in **Pregnant Large Animals**
**Ketamine + Benzodiazepine**
133
Which Premedications should not be used in small animal patients with **CNS Disease** because it looks similar to _Cushings Response_?
**Alpha 2 Agonists (Dexmetatomadine)**
**\***Alpha 2 Agonists are still used as a premedication in Large Animals with CNS Disease
134
In Patients with **Equine Acute Abdominal Distress** we use all the monitoring equipment we have available, include _Arterial Blood Pressure._ What is the MAP in Equines?
**MAP \> 70mmHg**
135
Pressure Maintained in Airway to Prevent Alveolar Collapse
**Peep**
_**\***Positive End-Expiratory Pressure_
136
What Fluid Type should be Avoided in **Reptiles**
**Lactated Ringers**
**\***Potential Prolonged Half-Life of Lactate in Reptiles
_\*Best to use Normosol R in Reptiles_
137
Three _High Potency Opioids_ that are used for **Wildlife**
**Etorphine**
**Thiafentanil**
**Carfentanil-** Most Potent (8,000x Morphine)
\*Commonly used for Large Mammals- Elephants, Rhinos ect.
138
Which Sedatives are Routinely Used in **Pregnant Large Animals (Ex. Mares)**
**Alpha-2 Agonists** (Detomidine or Xylazine)
139
Compared to Mammals, which Species has:
**Avian**
140
What kind of **Breathing System** will you use?
**Nonrebreathing System**
_**\***Patient_
141
5 Causes of **Hypoxemia**
**Hypoventilation**
**Anatomic R to L Shunt**
**Low Inspired O2 (FiO2)**
**Diffusion Impairment**
**Ventilation-Perfusion (V/Q) Mismatch**
142
Horse _____ is a True Emergency, because Foals normally do not survive past 90 Minutes after Membrane Rupture
**Dystocia**
143
True/False: **Rabbits and Rodents** Vomit
**False**
**\***_Rabbits and Rodents DO NOT Vomit- Food and Water Not Witheld_
144
_Preanesthetic Medications_ used in in **Avian Patients**
**Midazolam + Butorphanol** (Sedative + Opioid)
_\*Birds Sedate very well with Midazolam_
_\*Avoid Alpha 2 Agonists in Avian Patients- Decreases Heart Rate by 50% and causes severe Bradycardia_
145
Three Anesthetic Concerns with **Equine Acute Abdominal Distress**
**Decreased Ventilation**
**Decreased Cardiovascular Function**
**Metabolic Acidosis**
146
Two ways to Assess **Oxygenation Ability**
**Alveolar-Arterial O2 Gradient**
**PaO2:FiO2**
147
The Kidneys recieve 25% of total Cardiac Output. **Renal Blood Flow** is Autoregulated within a Mean Arterial Pressure (MAP) Range of \_\_\_\_\_\_\_mmHg
**80-180mmHg**
_**\***Any patient with Renal Disease needs a MAP of at least 80mmHg_
148
Most Reliable Vein for IV access in **Lizards**
**VENTRAL Coccygeal Vein**
149
**E. Atrial Standstill and Junctional Rhythm**
**\***Cannot be Sinus Bradycardia because there are NO P Waves
\*If there are _No P Waves = Atrial Standstill. Ventricle Contracts on its own- Junctional Rhythym_
150
In order to Prevent ______ in Wildlife:
_Limit Chase to 2 Minutes_
_Wait 1 Day between Failed Attempts_
_Limit Stress after Capture_
_No handling or Stress for 6 weeks Post Capture_
**Capture Myopathy**
151
True/False: In Patients with **Renal Disease**, we want to Correct _Hydration Status_ Prior to Anesthesia episode and Maintain immediately Post
**True**
152
Drugs that Have _____ Respiratory Depression:
_Benzodiazepines_
_Phenothiazines_
_Opioids_
**Minimal**
153
True/False: _Hyperthermia and Hypothermia_ can be Life-threatening in **Wildlife** Anesthesia and Capture should be based on weather, time of day and season
**True**
154
The ____ Rate of a Gas is **Proportional** to:
Tissue Area
Partial Pressure Difference
Solubility of Gas in the Tissue
**Diffusion**
## Footnote
The Larger the Tissue area, the faster the Diffusion Rate
The Greater the Partial Pressure Difference, the Faster the Diffusion Rate
The Greater the Solubility of the Gas, the Faster the Diffusion Rate
155
How many **Acupuncture** points should be used?
Resuscitation- GV26
156
In Patients with **Hyperthyroidism** we Manage Tachycardia and Arrhythmias with \_\_\_\_\_\_, given 3-5 Days prior to Surgery
**Atenolol**
157
Type of **Acupunture** where an Electric Current is Applied to Acupuncture Needles
**Electroacupuncture**
**\***Enhances Treatment and most patients Tolerate it well
_\*High Frequency = Short Term Analgesia_
_Low Frequency = Long Term Analgesia_
158
Sodium (Na+) Channel Blocker that is used to Treat Malignant **Ventricular Arrhythmias**
**Lidocaine**
159
\_\_\_\_\_ is common in Anesthetized Large **Wildlife Animals** and Supplemental Oxygen is strongly recommended
**Hypoxemia**
160
Use of Needles applied to Stimulate Certain Points in the body in order to:
_Treat Disease_
_Relieve Pain_
_Return Homeostatis_
**Acupuncture**
161
Condition caused by **Prolonged Muscle Exertion** common in Hoofstock that causes:
_Hyperthermia_
_Lactic and Metabolic Acidosis_
_Myocyte Death and Rupture_
_Release of Potassium and Myoglobin_
**Exertional (Capture) Myopathy**
**\***Hyperkalemia- Cardiac Arrhythmias and Death
\*Myoglobinemia- Acute Renal Failure
162
In what Bones could we place and **Intraosseous Catheter**?
**Tibia**
**Ulna**
163
**Pregnant Patients** under Anesthesia have _____ Oxygen Consumption and _____ PaCO2
**Increased**
**Decreased**
164
Autoregulation of Cerebral Blood Flow is very Effective when Systemic Mean Arterial Pressure (MAP) is between _____ mmHg
**60-140mmHg**
**\***You want to maintain pressures Minimally above 60mmHg
\*_Between 60-140 MAP you are going to have Normal Cerebral Blood Flow_
165
**Neonates** have a High Metabolism and Minimal Hepatic Glycogen, making them Susceptible to \_\_\_\_\_. Neonates also have Higher Permeability of Blood-Brain Barrier leading to more Profound drug Effects
**Hypoglycemia**
166
What Two Induction Agents should be avoided in Patients with **Gastric Dilation-Volvulus** who have _Cardiac Arrhythmias_
**Thiopental**
**Ketamine**
167
**Atrial Fibrillation**
**\***No P Waves and the Baseline is Fibrillating
\*Irregularly Irregular- QRS Complexes are at a Random Distance
168
**Birds** have _____ Bones that must be avoided when Placing an Interosseous Needle
**Pneumatic**
**\***Pneumatic Bones are connected directly to the air sacs. Do NOT want to place an interosseous Needle in any of these bones because Fluids will be delivered to the Airsacs
169
Normal Ratio for **Ventilation-Perfusion**
**0.8-1**
_\*V is Equal to Q_
As Ventilation Decreases and Perfusion Increases the V/Q Mismatch goes to Zero
As Ventilation Increases and Perfusion Decreases the V/Q Mismatch goes to Infinity
170
Contraindications to which form of **Acupuncture?**
**Electroacupuncture**
171
**R-on-T phenomenon**
**\***If you see the R-on-T Phenomenon you should be concerned because the Patient will probably go into Fibrillations soon
172
Best Maintenance for Patients with **CNS Disease**
**Isoflurane/Sevoflurane**
**\***Try to use a Balanced Protocol in order to keep Inhalant levels low
173
Normal Oxygenation with **PaO2:FiO2** is \_\_\_\_
**500**
_\*_
174
Three common Lab Abnormalities found in Patients with **Renal Disease**
**Hyperkalemia**
**Azotemia**
**Acidemia**
175
Side Effects of \_\_\_\_\_\_:
_Excitation- Running, Pacing_
_Regurgitation_
_Respiration Depression- Hypoxemia_
_Muscle Rigidity_
**High Potency Opioids**
**\***Hard to Control these side effects out on the Field
176
What **Maintenance** was used in this Patient
**Isoflurane or Sevoflurane**
177
Most Patients needing **Rehabilitation** are \_\_\_\_, so this must be addressed or the therapy will not be Optimal
**Pain**
**\***Multimodal Approach to Treating Pain is Ideal
178
12 Year Old Warmblood Mare, 695 kg
History: Rolling in Stall, Watching Flank
Presenting Complaint: Colic
Physical Exam: Tachycardia, Dehydration, Abdominal Pain
**What Drug can be given during surgery to Decrease the Effects of Endotoxin Release?**
**Flunixin Meglumine**
179
Two Bones where Interosseous Cathethers for Fluid and Drug Administration can be placed in **Avian Species**
**Tibia**
**Ulna**
**_\*Avoid the Humerus and Femur- Pneumatic Bones_**
_\*Interosseous Catheters for Fluid Aministration is MORE stable than IV in Avian Species_
180
Preferred Induction Agent in **Pregnant Small Animals**
**Propofol**
_**\***Propofol can be used as a CRI during C-Section_
\*Alphaxalone can also be used
181
12 Year Old Warmblood Mare, 695 kg
History: Rolling in Stall, Watching Flank
Presenting Complaint: Colic
Physical Exam: Tachycardia, Dehydration, Abdominal Pain
**What Maintenance drugs would be Best?**
**Isoflurane + IPPV**
**LRS Fluids**
**Dobutamine- Increase Heart Contractility**
182
_Mice, Rats, Guinea Pigs and Chinchillas_ are considered \_\_\_\_\_
**Rodents**
183
Drugs of Choice for Analgesia in **Neonates**
**Opioids** (Pure mu Agonist- Ex. Morphine, Butorphanol)
\*Opioids are a good choice for Analgesia in Neonates because they are REVERSIBLE
184
Contraindication in Cases of **Esophageal Foreign Bodies**
**Inducing Emesis**
185
True/False: _Thiobarbiturates_ are the best Induction agents for patients with **Liver Disease**
**False**
_**\***Avoid Thiobarbiturates in Patients with Liver Disease because Thiobarbiturates are extrememly dependent on Liver Metabolism_
186
Anesthetic Managment plan in a Patient with **Diabetes Mellitus** that has been Fasted Overnight and has a **Blood Glucose \>200 mg/dL**
**1/2 usual Insulin Dose**
**\***No Dextrose Infusion until Blood Glucose falls below 150 mg/dL
187
In Patients with **Insulinomas**, during Anesthesia we want to measure Arterial Blood Pressure and Blood Gases to Avoid \_\_\_\_\_
**Hypotension**
_**\***Prolonged Periods of Hypotension can lead to Pancreatitis_
188
What **Premedications** are used in this Patient?
**Midazolam + Butorphanol**
189
Commonly used Alpha 2 Agonist that is combined with High Potency Opioids for Sedation in **Wildlife Animals**
**Xylazine**
190
How are **Avian** Species MOST commonly _Induced_
**Mask**
**\***Rare that we get a good enough Premedication effect in birds to get a good enough IV Catheter in place for Induction Drugs
191
For Patients with **CNS Disease**, Avoid Increased ______ via Head Positioning, Jugular Occlusion or Vomiting
**Intracranial Pressure**
192
Very _____ Patients have:
_Minimal Ability to Increase Contractility_
_Increased Extrcellular Fluid Volume_
_Higher Metabolic Rate_
_High Resting Respiratory Rate/Minute Ventilation_
_Hypoalbuminemia_
_Deficient in Heptic Microsomal Enzymes_
**Young (**
_**\***Neonates are Hypoalbuminemic, Deficient in Microsomal Enzymes, and Decreased GFR = Prolonged Effects of Drugs Extreted in Urine and Drugs that are Highly Protein Bound_
193
**Hyperthyroidism** can mask \_\_\_\_\_
**Renal Insufficiency**
194
**Geriatric Patients** have a Limited Ability to Increase Heart Rate because their _____ Receptors are LESS Responsive
**Beta**
195
What is the **Cushings Response** in Patients with **CNS Disease** under Anesthesia?
**Rapid Decompensation under Anesthesia**
\*An Increase in Systemic Blood Pressure leading to an Increase in Intracranial Pressure because the Body is attempting to maintain adequate Cerebral Perfusion Pressure
196
Which Drugs are Essential for the Managment of **Equine Acute Abdominal Distress**
**Alpha 2 Agonists (Xylazine)**
**\***Alpha 2 Agnoists can provide some Analgesia and decrease the amount of Inhalant that is needed
\*Use in Horses despite the Cardiovascular depression
197
**Idioventricular Rhythm**
**\***Ventricular- Wide Bizzare QRS Complexes
198
During Anesthesia and Recovery of **Wildlife,** it is best to have patients in _____ Recumbancy
**Sternal**
**\***Exception- Elephants are put in Lateral
199
Recommended Induction Agents for Patients with **Gastric Dilation Volvulus**
**Propofol or Alphaxalone** at Low Doses
200
During **Pacemaker Implantation**, the Patient may be Unresponsive to Anticholinergic, so a Temoprary _____ should be placed prior to Anesthesia
**Transvenous Pacemaker**
201
Goal of **Actupuncture** for both Eastern and Western Approaches
**Restore Homeostasis**
202
Which Species has **Complete Tracheal Rings** where we do NOT Inflate the Cuff on Endotracheal Tubes
**Avian**
203
True/False: **Acupuncture** is Complementary to Western Medicine, NOT a Replacement
**True**
204
Major Determinant of **Content of Oxygen** in Blood (CaO2)
**Hemoglobin**
**\***An Anemic Patient may have Normal PaO2 but marked Tissue Hypoxia. Not Resolved by Increasing PaO2 but rather by Increasing Hemoglobin
205
True/False: Fast Nursing Animals prior to Anesthesia
**False**
**\***NO FASTING for Nursing Animals- Concern for Hypoglycemia
206
Muscle Relaxation is Helpful in Cases of **Esophageal Foreign Bodies** (Ex. Swalloed a Bone). What drugs can be given for Muscle Relaxation
**Benzodiazepines and Neuromuscular Blocking Agents**
_\*Guafenisin- Large Animals_
207
Match These Terms with The Definition
1. Tidal Volume
2. Functional Residual Capacity
3. Vital Capaticy
4. Residual Volume
A. Remaining Gas in Lung after Max Expiration
B. Max Expiratory Volume after Max Inspiration
C. Remaining Gas in Lung after Normal Expiration
D. Normal Breath Volume
208
How many Channels are there in **Acupuncture**?
**14**
209
Which Two Drugs are AVOIDED as Premedications in Patients with **Liver Disease**?
**Acepromazine**
**Alpha 2 Agonists**
**\***Acepromazine- Causes Hypotension and we don't want to decrease hepatic blood flow. Inhibition of Platelet Aggregation- Patients with Liver disease already have Coagulation Factor issues and we don't want to add a platelet problem on top of it
\*Alpha 2 Agonists decrease Hepatic Blood Flow
210
In which **Small Mammals** do we NOT Intubate?
**Rodents**
_**\***Rats, Mice, Chinchillas and Guinea Pigs_
211
What Sedatives should be avoided in Patients with **Gastric Dilation Volvulus**
**Acepromazine**
**Alpha 2 Agonists**
212
During Anesthesia of **Pregnant Animals** we want to Maintain Fetal _____ Delivery and we want to Avoid \_\_\_\_\_, which will decrease Fetal Perfusion
**Oxygenation**
**Uterine Contraction/Vasoconstriction**
213
Vein used for IV access in **Rats**
**Lateral Tail Vein**
214
Condition in **Dogs** with **S3 Gallop Rhythyms** Characterized by Marked Ventricular Dilation and Poor Ventricular Performance
**Dilated Cardiomyopathy**
215
Best Drug for Induction in patients with **Pericardial Tamponade**
**Etomidate**
216
Normal Oxygenation with **Alveolar-Arterial O2 Gradient** should be \_\_\_\_\_\_mmHg
**5-10mmHg**
_**\***If \> 10mmHg, then there is an Oxygenation Problem_
217
**Induction Agents** used in Avian Species
**Ketamine + Benzodiazepine** (Need Benzo for Muscle Relaxation)
or
**Propofol** (Marked Respiratory Depression- Provide IPPV)
218
During Anesthesia in Patients with **Mitral Valve Insufficiency** we want to Produce a Modest Increased Heart Rate, to Avoid Bradycardia and Hypertension. What Drug can be used as a CRI To keep the _Cardiac Contractility_ Up?
**Dobutamine**
219
Animals with **Pleural Effusion** or **Pneumothorax** should have _____ ASAP
**Thoracocentesis**
220
True/False: Start Medical Managment for Hepatic Encephalopathy PRIOR to Surgery
**True**
221
Anesthetized patients with **Insulinoma** can be at risk for \_\_\_\_\_, leading to Cerebral Damage
**Hypoglycemia**
222
Recommended Premedication for Patients with **Gastric Dilation Volvulus**
**Benzodiazepine and Pure Mu Agonist Opioid IV**
**\***Safest choice with Unstable Cardiovascular Function
223
When Monitoring Patients with **CNS Disease** under Anesthesia we want to know the End-Tidal CO2. What **End-Tidal CO2** is best for these patients under anesthesia?
**30-35mmHg**
_\*PaCO2 should be around 35mmHg_
224
In Patients with **Diabetes Mellitus** we Avoid _____ because they cause _Transient Hypoinsulinemia and Hyperglycemia_
**Alpha 2 Agonists**
225
During Post Operative Care in Patients with **Renal Disease**, we want to AVOID _____ drugs such as _NSAIDs and Aminoglycosides_
**Nephrotoxic**
226
True/False: Most **Anesthetic Drugs** easily Diffuse across Placenta to the Fetus
**True**
227
Patients with Issues in their **Oral Cavity and Pharynx** have what Contraindication?
**Inducing Emesis**
**\***If the Patient has trouble opening its mouth and it vomits- Huge Aspiration Concern
_\*Want to avoid- Alpha 2 Agonists in these Patients. Wait to give Opioids until the patient is intubated or give opioid IV because it lowers the Risk of Vomiting_
228
True/False: There is a _Predominance of mu Receptors_ in **Reptiles**, so Pure mu Agonists, such as Morphine, should provide good Analgesia
**True**
229
**Birds** are MORE Sensitive to _____ Anesthetic Toxicity
**Local**
**\***Use small doses of Local Anesthetics in Avian Patients- Max dose of 2 mg/kg of Lidocaine
230
Three veins that can be used for Fluid Support (Catheter) in **Avian Species**
**Basilic (Ulnar) Vein**
**Median Metatarsal Vein**
**Right Jugular Vein**
231
Common Electrolyte Abnormality in patients with **Renal Disease** that we should Treat prior to Anesthesia
**Hyperkalemia**
232
True/False: **IPPV** can lead to Decreases in Cardiac Output and Blood Pressure
**True**
_**\***I:E Ratio should be 1:3 or Less_
233
**Pregnant Patients** under Anesthesia have:
\_\_\_\_\_\_ Functional Residual Capacity
\_\_\_\_\_ Pulmonary Resistance
\_\_\_\_\_ Gastric Emptying
**Decreased** Functional Residual Capacity
**Decreased** Pulmonary Resistance
**Delayed** Gastric Emptying
\*_Delayed Gastric Emptying and Decreased Lower Esophageal Spincter Tone leaves Pregnant Patients at a higher risk for Regurgitation and Aspiration_
234
In Patients with What **Endocrine Disease** should we Plan for Procedures to go First in the Morning
**Diabetes Mellitus**
235
True/False: In Patients having an **Emergency C-Section**, you want to correct Underyling Problems FIRST
**True**
236
Condition in **Cats** with **S4 Gallop Rhythyms** characterized by Ventricular Hypertrophy, Decreased Ventricular Filling, and Reduced Cardiac Output
**Hypertrophic Cardiomyopathy**
237
True/False: Must be VERY Careful with Restraint and Body Positioning in **Birds** due to their numerous Air Sacs
**True**
_**\***Always providing IPPV to Birds under Anesthesia_
238
\_\_\_\_\_\_ has the Greatest effect on Kinetic Energy and Potential for **Dart Injury**. We _use the Lowest ____ Possible for reach and Accuracy_
**Velocity**
239
**Rabbits** are given a Post Procedural ____ as soon as they are able to hold their heads up
**Snack**
_**\***Rabbits have High Metabolsim and can become Hypoglycemic if Food is Witheld_
240
Which **Two Species** have _NO Epligottis_, where there is Easy Visualization of the Glottis at the base of the Tongue
**Reptiles**
**Avian**
241
Primary Consideration when Anesthetizing **Wildlife**
**Safety**
_**\***Personnel Safety comes first!!_
242
What Veins can be used for _Venous Access_ of Fluid and Drug Administration
**Ulnaris Vein**
**Right Jugular Vein**
**Dorsal Metatarsal Vein**
243
In Patients with a **Patent Ductus Arteriosus**, during Ligation you will see an _Increased Blood Pressure followed by a Reflex Bradycardia_ known as ____ Sign
**Branham's Sign**
244
During **Acupuncture** we insert a Needle into tissue that causes \_\_\_\_\_, leading to Inflammation which will stimulate Repair, Anti-Inflammation, Pain Modulation and Continued Tissue Healing
**Microtrauma**
_\*Causing Microtrauma that will Release Factors to Promote Healing_
245
_AVOID Premedication_ with _____ in Patients with **CNS Disease** because it is long acting, non reversible, and causes Hypotension
**Acepromazine**
**\***Do not use Acepromazine as a Premed in patients with CNS Disease
246
Anesthesia with ____ quickly Reverses Life-Threatening Hypoxemia secondary to Hypoventilation
**IPPV**
247
Common **Endocrinopathy** typically seen in older Dogs that Causes these Clinical Signs:
**Hypothyroidism**
248
True/False: Loudness of **Heart Murmur** = Degree of Pathology
**False**
249
Which of the Following are Part of the Initial Evaluation for **Physical Rehabilitation:**
A. Physical Examination
B. Posture/Gait Assessment
C. Range of Motion in Hip, Stifle, Hock ect.
D. Palpation of limbs and Spine
**All of the Above**
250
Best Induction agent for Patients with **Liver DIsease**
**Propofol**
**\***Etomidate can be a good Induction agent as well
251
Ideal Induction Agent in Patients with **Mitral Valve Insufficiency**
**Etomidate**
252
True/False: It is the Responsibility of the Individual Practicing **Veterinary Physical Therapy** to know the Legal Issues related to both Veterinary and Physical Therapy Practice acts in their Respective State
**True**
253
\_\_\_\_\_ is Indicated in **Dyspneic Animals** because it will Decrease Anxiety and Work of Breathing
**Sedation** (Butorphanol)
254
In which **Species** is there often NO IV access before Induction
**Avian**
255
Cats with **Hypertrophic Cardiomyopathy** should be Treated with a _______ 1-2 Weeks Prior to Anesthesia in order to Control Arrhythmias and Decrease Stress on the Myocardium
**Beta-Blocker or Calcium Channel Blocker**
**\***Want to Slow the Heart Down in these Patients- Aim to Maintain a normal Heart Rate and DO NOT Increase Contractility as this will cause dynamic outflow obstruction from the Heart
256
Best Induction agents to use in **Geriatric Patients**
**Propofol or Alfaxalone**
257
In Patients with **Pericaridal Tamponade** (Fluid within the Pericardium), _____ is Recommended Prior to Anesthesia
**Pericardiocentesis**
**\***To Remove the Fluid around the heart prior to Anesthesia
258
Which of the following Induction agents causes Minimal Changes in Cardiopulmonary Function therefore making it a safe choice for a patient with **Cardiovascular Disease**
**Etomidate**
259
For Patients with **CNS Disease**, during Anesthesia you need to make sure to Maintain MAP \>/= \_\_\_\_\_\_mmHg for Cerebral Blood Flow Autoregulation
**60**
260
**Electrical Alternans**
**\***Height Difference between some of these
261
During Endotracheal Intubation in **Avian Species** you want to Prevent _____ Membrane Formation
**Trans-Tracheal Membrane Formation**
**\***In Avian Species we DO NOT inflate the cuff on endotracheal tubes. We want to Minimize Head and Neck movement during procedure to prevent the endotracheal tube from banging against and damaging the Trachea
\*Trans-tracheal Membrane Formation- A month after Intubation the Bird will return in respiratory distress because there is now scarring where the tube was batting against the mucosa and causes a stricture
262
\_\_\_\_\_ Occurs in 15-82% of Cats following Bilateral Thyroidectomy, so Calcium should be monitored daily for 5 days postop and treatment only needed if Clinical Signs Develop
**Hypocalcemia**
**\***Due to Accidently removing the Parathyroid gland as well, which regulates Calcium
263
_Inability to Eructate Rumen Gases_, which leads to Decreased Venous Return and Cardiac Output
**Bloat** (Rumen Tympany)
\*Place patients in Sternal Recumbancy
264
What **Induction Agent** was used in this Patient?
**Propofol**
**\***Administered in _Coccygeal Tail Vein_
265
Fluids should not be administered ______ in **Avian Patients** because Subcutaneous Fluids will burn with the Heating Elements
**Subcutaneous**
**\***During anesthesia we provide external heat for these patients and pockets of fluid subutaneously will Burn and Slough the skin
_\*Isotonic, nonirritating fluids ONLY_
266
Case: 7 Year Old Male Canine Great Date 45kg
History: Non Productive Retching, Drooling, Abdominal Distention when owner came home from work
Physical Exam: HR= 160 bpm, RR= Panting, T= 99.3
CRT= 3 Seconds, mm = Pale Pink, Poor Pulses
**How would you correct the Hypokalemia in this Patient?**
**Maximum of 0.5 mEq/kg/hr of Potassium "Spiked" Fluids**
\*Correct Hypokalemia as soon as Possible
267
Best Induction Agent for Patients with **CNS Disease**
**Propofol**
268
Best Preanesthetic Medication to use in Patients with **Liver Disease**
**Benzodiazepine (Diazepam or Midazolam) + Opioid**
**\***Avoid Morphine (Opioid)- Can cause Histamine release leading to Hypotension that decreases Hepatic Blood Flow
269
_During Inhalant Anesthesia_, We ______ Patients with **CNS Disease** in order to Reduce Cerebral Blood Flow and Decrease Intracranial Pressure
**Hyperventilate**
_**\***Under Inhalants we know that even at normal ventilation Cerebral Blood Flow is Increased. We want the PaCO2 levels to be very low so we Hyperventilate patients with CNS Disease under Inhalant Anesthesia_
_\*You want yor PaCO2 to be about 35mmHg, so your Capnograph is going to read between 30-35 mmHg_
270
In Patients with **Liver Disease,** Hypotension and Bradycardia may occur with Biliary Tree Manipulation. Consider _____ in the Anesthetic Plan
**Anticholinergic (Atropine)**
271
Alternative to Endotracheal Intubation in **Avian Patients** where a Cannula is inserted into and Air Sac for Induction and maintenance using Inhalant
**Air Sac Cannulation**
_**\***Use the LEFT Caudal Thoracic or Abdominal Air Sac_
_\*Useful for Beak Fractures and Upper Airway obstruction ect._
272
Clinical Signs relevant to Anesthesia with what **Endocrine Disease**
**Cushings Syndrome**
273
True/False: During **Physical Rehabilitation**, have the owner keep a log or journal of the patients daily activities so it can be reviewed at regular intervals by the veterinary team
**True**
274
Anesthetic Concerns of which **Gastrointestinal Disease**
**Gastric Dilation Volvulus**
**\***Decreased Ventilation- Stomach pushes Cranially and Compresses the Lungs
\*Decreased Cardiovascular Function- Stomach Pushes up and Compresses the Caudal Vena Cava and Aorta
275
Patients with _____ are Extremely **Poor** Anesthetic Candidates for the Following Reasons:
**Diabetic Ketoacidosis**
**\***Want to Stabilize this Patient before performing Anesthesia- _Don't want to Take patients with Diabetic Ketoacidosis to Surgery._
276
During Procedures in **Pregnant Patients** you want to Carefully Position the Patient to avoid _____ Compression
**Aortocaval**
**\***_Best not to put the animal is straight Dorsal, shifting them one way or the other to make sure the weight of the urterus is not on the great vessels_
277
True/False: Avoid Elective Anesthesia in Patients with **Pulmonary Disease**
**True**
**\***Fix Underlying Disease before putting under Anesthesia
278
True/False: Physical Trauma, Dart Injury, Hypoxemia, Regurgitation and Capture Myopathy are Possible Complications of **Zoo/Wildlife** Anesthesia
**True**
279
**Sustained Supraventricular Tachycardia**
**\***Ventricular Tachycardia- the complexes would be Wide and Bizarre
_\*Supraventricular- The Complexes look Normal_
\*Paroxysmal- Tachycardia that Stops and Starts
280
Providing an Epidural with _____ can provide up to 24 hours of Analgesia in **Pregnant Small Animals**
**Morphine**
281
In Patients with **Pericardial Tamponade,** we Pretreat with ____ to Ensure Optimal Venous Return
**Fluids**
282
Definition of **Hypoxemia** is a PaO2
**80-100**
283
Pathology in the ____ and _____ can lead to:
_Difficult Intubation_
_Difficulty Maintaining Patent Airway_
_Aspiration_
**Oral Cavity and Pharynx**
284
The **Pulmonary System** is a _Low Resistance system,_ where the Pressure in the Pulmonary Artery is \_\_\_\_\_
**15mmHg**
**\***Pulmonary System = Low Pressure System
285
Best Inhalant Anesthetics used in **Reptiles**
**Isoflurane and Sevoflurane**
**\***Decrease MAC with Decreased Body Temperature
286
Which two Drugs should be Avoided during Anesthesia of **Hyperthyroid** Patients
**Atropine**
**Ketamine**
_**\***Best Induction agent for patients with Hyperthyroidism- Alfaxalone or Propofol_
287
Rehibilitation Technique that provides Pain Relief, Relaxation, and Promotes Circulation that is used Post-Exercise to Reduce muscle Soreness
**Massage**
**\***Contraindications- Open Wounds, Unstable Fractures, Severe Pain
288
**Endocrine disease** characterized by Secretion of Excess Amounts of Glucocorticoids by the Adrenal Cortex
**Cushings Syndrome (Hyperadrenocroticism)**
289
No IV access Before Induction
_What Premedications will we use for this Patient?_
**Midazolam + Butorphanol**
**\***Give Opioid that is a _Kappa Receptor Agonist_- Butorphanol
290
What should be Given for **General Anesthesia**
**Isoflurane or Sevoflurane**
291
In Patients with **Diabetes Mellitus** we measure Blood Glucose every ___ Minutes during Anesthesia and once in Recovery
**30**
_**\***We want to maintain Blood Glucose between 150-250 mg/dL_
292
During Surgery in Patients with **Insulinomas** we are Checking the Blood Glucose every ___ Minutes
**15-30 Minutes**
293
True/False: **Nutritional Plan** should be included as part of Rehabilitation Therapy
**True**
