Fundamentals of clinical practice Flashcards

Question

What is the primary objective of aseptic surgery?

Answer 1

Reducing infections

Answer 2

Age Physical condition Nutritional status Diagnostic procedures Concurrent metabolic disorders Current medication

Answer 3

Principles of aseptic technique Sterilisation Disinfection Anaesthesia Atraumatic technique

Answer 4

Patient prep (clipping, scrubbing, draping) Surgeon prep (scrubbing, gowning, gloving, hats and masks) Theatre behavior (etiquette, talking , flow etc)

Answer 5

Surgery exceeding 90 mins Prosthesis implantation Patients with existing prostheses undergoing certain surgical procedures Severly infected or traumatised wounds Rational selection of antibiotics for prophylactic use | Traumatic surg, long surg, prothesis prescence

Answer 6

high tensile strength Easy to use and tie Uniform tensile strength = finer suture material can be used Inhibit tissue reactions and wicking Non toxic Non carcinogenic Non allergic Easily sterilised Minimal bacterial adhesion Standardisable characteeristics Sufficient length of properties Inexpensive | uniform tensile strength, easy, non toxic or carginogenic, sterilised

Answer 7

Raw materials from naturally occurring sources Cat gut/ silk

Answer 8

Raw material produced in an industrial process Nylon etc

Answer 9

Materials that are fully degraded and absorbed by the body once placed

Answer 10

Materials that stay in place for an indefinite period (60 days without changing in anyway

Answer 11

Monofilament suture - single filament Multifilament - multiple strands that are braided to create a thicker thread of the desired diameter

Answer 12

Breaking strength per unit area

Answer 13

Tendency to retain original configuration

Answer 14

Lack of smoothness or presence of friction whilst passing through tissue

Answer 15

Tissues respond to the implantation of sutures as they do to other foreign material and can provoke an inflammatory response

Answer 16

Suture material is foreign body Tissue reaction Amount of material Presence of infection

Answer 17

Absorption characteristics Natural or synthetic Phagocytosis vs hydrolysis

Answer 18

2-0 is bigger than 3-0 0 is bigger then 00=2-0

Answer 19

Attached to the suture material

Answer 20

Threading the needle causes a double strand of suture material Multiple uses causes bluntness Increases tissue trauma

Answer 21

Minimal trauma Single use Optimal penetration properties (more expensive)

Answer 22

The point The body The eye or the swage

Answer 23

The tip of the swage to the needle point

Answer 24

Curvature is measured in relation to a circle. Deeper the wound the more curved the needle

Answer 25

Blunt - circular elliptic Sharp (polygonal) Compound (tapercut, short cutting point etc)

Answer 26

Made from stainless alloys Sufficiently rigid to resist forces applied to them during handling Sufficiently flexible to bend before breaking

Answer 27

Needles are flexible and therefore bend before breaking This is important as it warns the surgeon that the forces placed on the needle are too great

Answer 28

Stainless steel- strong and resistant to corrosion Chromium plated carbon steel- cheaper but prone to corrosion and pitting Titanium - light weight and used to handle delicate tissues. Reduced glare from operating light | stainless steel, chromium plated, titanium

Answer 29

Tungsten carbide implants which are particularly strong and used as blades or for gripping Generally have gold handles for identification | tungston carbide makes stronger- identified by gold handle

Answer 30

Cutting skin Baird parker no 3 is the most commonly used blade Various blades can be used

Answer 31

No 10 is most commonly used - large convex surface No 11 = stab incisions into hollow viscera such as bladder or stomach no 15 = more delicate with smaller convex cutting edge (precise cuts such as urethrostomies)

Answer 32

Power grip allows for thicker and tougher tissues to be cut Pencil grip allows for delicate precise use

Answer 33

Scissors held with the thumb in one ring and fourth finger in the other Index finger is placed over the joint for increased stability

Answer 34

Scissors held for cutting towards the dominant hand

Answer 35

Ringed instrument with a ratchet mechanism allowing the surgical needle to be held by the needle holder

Answer 36

Mayo hegar Olsen Hegar Gillie

Answer 37

Heavy duty with a single tooth interdigitating with two on the opposing tip Can be traumatic to tissues

Answer 38

Applying dressings Have no rat teeth and are particularly traumatic to tissues as pressure is needed if used for this purpose

Answer 39

Fine forceps with a small rat tooth grip

Answer 40

LEAST TRAUMATIC These have longitudinal and transverse serrations originally used for vascular use as they are the least traumatic

Answer 41

Penhold or chopstick grip

Answer 42

Designed to occlude blood vessels and prevent haemorrhage Wide variety all have rings with a ratched mechanism Straight ot curved and come in variety of sizes with different interdigitations commonly used = Halsted mosquito, Spencer wells and Carmalt

Answer 43

Varied in their form but can be divided into self retaining and handheld Improve visibility or exposure for easier and more accurate surgery placing tissue under tension reduces bleeding and allows easier cutting and dissection

Answer 44

Left - abdominal retractor (balfour- 3 point retractor which prevents rotation) Right - thoracic retractor with ratchet mechanism which can gradually retract ribs (2 point retractor)

Answer 45

Haemostasis and inflammation (platelet aggregation and WBC) Proliferation/ Fibroplasia (angiogenesis, granulation) Maturation (remodelling of collagen 1->3) contraction of the wound

Answer 46

Tissue damage Blood leakage from vessels Activation of clotting cascade by damage to endothelium ( intrinsic and extrinsic) Platelet aggregation and release of cytokines Stabilisation of platelet plug by fibrin formation

Answer 47

Overlaps with haemostasis First 72 hours of injury Vasodilation following transient vasoconstriction Cytokines in fibrin clot will attract WBCs (neutrophils then macrophages) Destruction of cells by phagocytosis cleans up bacteria and devitalised tissue

Answer 48

Overlaps inflammatory phase Formation of granulation tissue - formed of macrophages, firboblasts and new blood vessels Fibroblasts proliferate and produce new extracellular matrix, elastin and collagen = strength More resistant to infection

Answer 49

Formation of new epithelial tissue (pale pink tissue) Shrinking grows across wound Myofibroblasts cause wound contraction Contact inhibition- contact of epithelial cells stops growth = smoothness which is normal Measure wound regularly for deficit shrinking

Answer 50

Remodelling Type 3 collagen is replaced by type 1 collagen Cross-linking of collagen Components of extra cellular matrix change Increase in tensile strength Can take weeks to months

Answer 51

Patient factors - age and comorbidities Wound factors - infection and location Concurrent treatment - corticosteroids(delay healing) Radiation (tissue fibrosis and vasc scarring)

Answer 52

Age Comorbidities (HAC and diabetes) Nutrition status (hypoproteinaemia- will slow wound healing)

Answer 53

Infection Location (tension, movement, local blood supply)

Answer 54

Corticosteroids- delay all stages of wound healing Radiation - Tissue fibrosis and vascular scarring

Answer 55

Abrasion Avulsion Incision laceration Puncture

Answer 56

Abrasion Loss of epidermis and some dermis (blunt trauma/ shearing)

Answer 57

Avulsion - tearing of tissues from attachments on limbs it's a degloving injury

Answer 58

Incision - created by a sharp object Minimal trauma (neat)

Answer 59

laceration - tearing type wound causes irregular defect Usually jagged

Answer 60

Puncture Penetrating wound Superficial damage may be minimal Deep damage may be substantial

Answer 61

Epidermis Dermis Hypodermis Subdermal plexus Terminal branched of direct cutaneous arteries Within the panniculus and subcutis protect subdermal plexus in mobilisation

Answer 62

Assessment of patient other injuries Life threatening complications Stabilise Examine with sedation

Answer 63

Degree of tissue damage Depth of wound VItal structures such as bones joints nerves and tendons (especially important in puncture wounds)

Answer 64

Golden period is 6-8hrs Contaminated or infected History from the owner Has the bacteria started dividing

Answer 65

Foreign material devitalised tissue Bacterial innoculum (bit vs clean glass etc) Takes into account the age and nature of the wound

Answer 66

Gross contamination- tap water Copious lactated ringers or hartmanns 35-60 ml18G needle = higher pressure 7-8psi Debridement - dressings, surgical etc

Answer 67

Primary intention closure Secondary intention healing Third intention closure

Answer 68

6-12 hrs Bacteria divide >12hr bacterial invasion

Answer 69

Blood supply reduced ability to fight infection Divitalised tissue ()inc bac growth) FB (red ability to fight infection) Type of contamination (soil better than organic debris, clean glass vs bite wound) Type of bacteria

Answer 70

Promote healing Convert contaminated into clean Control infection

Answer 71

Surgical Mechanical Autolytic Enzymatic - rare Biological- rare

Answer 72

Remove dead necrotic contaminated particulate matter and bacteria from the wound Ready for wound closure and healing

Answer 73

debrided with sharp surgery to remove dead tissue preserve vital structures can carry out scraping to remove chronic granulation tissue wound lavage and dressing

Answer 74

Lactated ringers solution due to pH and its compatability with tissue 0.9% saline is often used Fluid at body temp 35ml with syringe and 18G needle = 7-8psi high vol on newly presented wounds

Answer 75

Chronic granulation bed to healthy granulation bed Sterile swabs soaked in isotonic crystalloids such as Hartmanns Placed on chronic granulation bed Dry swabs on top of the bed to bandage Changed every 24 hrs

Answer 76

A mechanical pump attached to the wound reduces air pressure drawing off exudate and reducing oedema

Answer 77

Reduces bacterial colonisation Promotes granulation tissue development Increases rate of mitosis Spurs the migration of epithelial cells within the wound

Answer 78

Topical negative pressure wound therapy

Answer 79

Creating an airtight water tight seal

Answer 80

Negative pressure wound therapy?

Answer 81

Antibacterial effect - reduction of bacteria Healing stimulating properties Debriding effect Antiinflammatory effect Odour reducing capacity Reducing in wound pain

Answer 82

Osmotic effect Low pH Both help to draw fluid from the wound area

Answer 83

Hydrogen peroxide (glucose oxidase) Antioxidant (flavinoids) High sugar content (osmotic effect) Acidic (pH 3.2-4.5) Methylglyoxal found in manuka honey (nectar from manuka plant 15+ at least)

Answer 84

Medical grade maggots Hard to keep in wound Unable to identify healthy tissue from necrotic tissue

Answer 85

Speed to effect and expense to cost Scraping with scalpel often seen as the best Wet to dry is second best

Answer 86

Aid to healing of wound, surgical site Stabilise wound and prevent disruption to healing process Prevent self trauma and trauma to wound Prevent debris entering wound Migrating bacteria Helps with local pain relief Aid clotting and prevent further contamination

Answer 87

Dry sterile swab dressing - normally for wet-dry or dry-dry debridement Impregnated dressings - coated with petroleum jelly or antibiotics Semi occlusive dressing- central absorptive core with non stick layer to absorb exudate (post op) Absorbent dressings - for large exudating wounds Alginates - naturally occuring fibres from seaweeds- moistened and packed into to encourage wound inflammatory factors (dry out eventually and need to be changed)

Answer 88

Alginate gels - encourage new tissue growth on stalled wound Contact cream- flamazine (siver sulfadine) for burns Dermasol- antibioitc for small wounds Aluminium liquid spray- large animals covers wounds for protection

Answer 89

Primary layer - dressing (most important) Secondary layer - padding material 2 components Tertiary layer- vet wrap etc

Answer 90

Supportive padding dressing - cotton roll (placed for comfort and absorbs exudate that makes it through the dressing, holds away from clean wound) thick enough to prevent strikethrough Open weave conforming gauze- allows light pressure to be applied can be absorbent (can cause restriction and compression= discomfort and can cause tissue death)W

Answer 91

Protection from the outside environment More important for limb and paw Usually cohesive layer so sticks to itself Adhesive layer can be used - stronger and thicker but don't stick directly to patient (paws normally)

Answer 92

Robert jones bandage- multiple species in long bone fractures post op protection Gutter splints - fractures below the carpus (small dogs and cats) Plaster of paris on a roll - needs to be wetted and applied over the secondary layer Fibreglass impregnated with resin-

Answer 93

Applied 1 joint above and 1 joint below to immobilise the bone to its maximum splinting stability

Answer 94

Swelling - distal limb not included Tissue necrosis - bandage too tight Decupital ulcers - over bony prominences Patient interference due to uncomfortable bandage

Answer 95

Ring dressings over the elbows and hock etc to prevent rubbing of the bandage It comes with its own issue( removes pressure from bony prominence but can apply pressure to the sides of the wound)

Answer 96

Alginate based dressings - Seaweed stimulates the release of inflammatory factors for wound healign

Answer 97

Classify the wound How and why it occurred What structures are involved How much contamination of the wound is there? Clean -> contaminated Location is key for determining wound healing

Answer 98

History, clinical assessment and sedation considerations Lameness level (suggests catastrophic injury through tendons etc) Assess gait

Answer 99

High blood loss is a contraindication Regional anaesthesia might be required

Answer 100

DDflexor tendon Superficial digital flexor tendon

Answer 101

Brachial plexus Penetration of the thoracic cavity

Answer 102

Synovial structure (calcaneal bursa) suggest a poor outcome Would cause lameness Synovial fluid samples and cellularity can assess inflammation etc

Answer 103

Synovial fluid assessment Sterile solution into calcaneal bursa allows for indication of bacteria presence in the wound Imaging of wound for fractures

Answer 104

Bones (sequestrian - bone that acts as foreign body) Acoustic shadow suggest foreign body Soft tissue damage Fractures

Answer 105

Superficial or deep Structures involved joints etc Closing the wound options

Answer 106

Primary intention healing is when the wound edges are brought and kept together by sutures or staples. The healing occurs with wound epithelisation and connective tissue deposition.

Answer 107

Tension Matress suture patterns combats tension Stents and quills distribute tension over the surface of the skin Pressure on the skin is then reduced

Answer 108

WBCs are encouraged to be attracted to the wounds - Several days/ weeks To speed this up debridement can be carried out (surgically or wet-dry swabs) Speeds up route to proliferation

Answer 109

Allow natural debridement of the body The primary closure after assessmetn for necrotic tissue

Answer 110

Route for fluid and inflammatory exudate to exit the wound Speeds up debridement of the wound

Answer 111

Latex penrose drain in two separate incisions at wound bed Active drains can be used sometimes

Answer 112

Primary closure The deep pocket suggested use of Penrose drain to allow exudate to exit Quils and stents reduce skin tension Mattress sutures also decrease skin tension Wound can heal faster due to primary intention wound healing

Answer 113

Granulation tissue and fibroblasts stops epithelial migration Has little nerve supply but very good blood supply This tissue can be trimmed back using a scalpel blade below the skin surface for epithelial migration to occur

Answer 114

Punch grafting - cores of skin are applied Pinch grafting - small sections of skin can be embedded into granulation tissue Apply epithelial cells into the centre of the wound so that epithelial granulation can occur

Answer 115

Simple bandage A figure of 8 bandage Robert jones bandage

Answer 116

Covers for carpus and tarsus to go around the hock avoids pressure points

Answer 117

Treatment modality Support At least 3 layers

Answer 118

Protective material Padding Conforming Outer layer Finishing

Answer 119

Condense the padding to provide extra support

Answer 120

Unstable fractures Unstable tendon injuries There is a variety of methods ranging from commercially available options and homemade materials

Answer 121

1- alignments of dorsal cortices, splint placed dorsally 2. Splint placed laterally and caudally 3- splint placed laterally and medially 4- forelimb - stabilise carpus

Answer 122

1- alignments of dorsal cortices, splint placed dorsally 2. Splint placed laterally and caudally 3- splint placed laterally and medially

Answer 123

Inflammatory Restorative Remodelling

Answer 124

Inflamatory response with fracture Lysis of osteocytes liberates inflammatory mediators IMs call in macrophages and inflammatory cells to clear wound and debris

Answer 125

The blood clot is formed at the fracture site w/in 2 hrs (blood clot plays a role in neovascularisation) Phagocytes called to the location

Answer 126

Inflammatory phase

Answer 127

Soft callus formation Hard callus formation

Answer 128

The first callus is similar to hypercellular fibrocartilaginous tissue Callus plays a role in stabilisation of the fracture site Process takes 4 days to 3 weeks

Answer 129

Blood supply is restored by soft callus support This means cartilage formed can be substituted by bone tissue (endochondral ossification) this results in the formation of a hard callus begins 2 weeks after fracture and ends between 6th and 12th week

Answer 130

Ends of the bones are enveloped by fusiform mass called a callus Remodelling occurs involving osteoclasts Slow process that can take years

Answer 131

First intention (minimal bone callus formation) Second intention (most common natural type of healing)

Answer 132

Characterised by direct bone formation on the fracture line Occurs when the fracture is stabilised with a good blood supply and reducible fracture compression on fracture site

Answer 133

Interfragmentary compression This can be caused by: - Patients' weight - application of osteosynthesis systems that compress the fracture lines - placement of osteosynthesis systems that redistribute the weight

Answer 134

First intention healing through the use of a dynamic bone plate Bony formation with minimum formation of callus

Answer 135

ensure that the blood supply is not excessively damages (particularly the intraosseous supply) Ossification by first intention takes place much faster the second intenteion

Answer 136

At first, direct osteonal union is not as stable as primary healing with separation

Answer 137

Late treatment Deficient reduction of the fracture or loss of fragments Poor blood supply Infection Absence of forces of compression

Answer 138

Within the restorative phase there is poor blood supply, anatomical reduction hasn't occurred and there are few compressive forces This means that second intention healing (soft callus formation followed by excessive hard callus formation) Right xray shows remodelling of hard callus bone

Answer 139

Stabilise animal Orthogonal radiographs Fracture score and assess what forces are applied to the fracture and how these can be managed Make sure expertise and equipment is available

Answer 140

Orthogonal radiographs Mediolateral view and craniocaudal view

Answer 141

Fracture scoring gives an indication of severity and biological nature of the fracture as well as non biological factors such as financing and surgeons abilities Higher score= more demanding to repair and therefore greater chance of complications

Answer 142

Patient factors Fracture Owner factors Surgeon

Answer 143

Weight of animal Age Boisterousness Concurrent illnesses

Answer 144

Type of fracture - does it allow compression plating or req external fixator Open or closed Associated soft tissue injuries Single or one of several fractures

Answer 145

Will they comply with post op instructions Finances

Answer 146

Are they able to manage the fracture Is the equipment available

Answer 147

Degree of displacement/ comminution

Answer 148

Young dog vs old dog Soft tissue components Osteosarcoma = Pathological fracture = wont heal Contamination if open fracture

Answer 149

Bending- when leg placed at angle to ground or asymmetrical muscle contraction Torsion - when body changes direction with leg planted on ground Tension Axial compression

Answer 150

determined by fracture type and forces that will be applied

Answer 151

Shear force will be generated

Answer 152

1. axial compression 2. tension 3. bending 4. torsion

Answer 153

Diaphyseal bones are asymmetrically loaded when weight-bearing mandible is asymmetrically loaded during mastication

Answer 154

Asymmetrical forces are applied to the bone and result in internally generated forces This produces tension or compression a plate should be applied to the tension side as it will not be broken by tensile forces but would be by successive compressions

Answer 155

Femur- lateral aspect Tibia- medial aspect Radius- craniomedial aspect Humerus - laterocranial aspect Mandible - dorsal aspect

Answer 156

Axial compression is good when transverse if not then this will cause the fracture to collapse or shear Tension causes the fracture to be distracted (lag screwing or tension bands) Torsion results in rotation of the fracture ( plates or external fixator) Bending due to asymmetrical nature can be corrected with pin in the medullary cavity

Answer 157

Intimate contact of the bone ends under compression Through application of bone plate and extensive dissection and manipulation of soft tissues

Answer 158

Doesn't require reduction of fracture Adopting look but do not touch approach or minimally invasive plate os (MIPO when a plate is placed through the subcut tunnels)

Answer 159

Strain that tissues will tolerate as the fracture heals Some fractures naturally have movement Younger the animal the fracture may only require that the animal be cage rested Cage rest can cause pressure sores and joint stiffness

Answer 160

Strain is the change in length over the original length of the fracture Small gap and much movement then the strain is high ad the fracture fails to heal as the tissue rupture

Answer 161

Resorption of fragment ends increases the fracture gap and therefore creates greater stability and reduced movement at the fracture site and the strain decreases

Answer 162

Plating of a tibial fracture Accurate reduction of the fracture Not under compression as the fracture is oblique No callus should form and there will be bone to bone union

Answer 163

External fixator with a LBDT approach Results in secondary healing and callus formation

Answer 164

Radiographs are used to assess - alignment of the fracture - Positioning of implants - encroachment of implants into joints or soft tissues or the bridging of growth plates in young animals

Answer 165

Prior to the removal of implants If the progression is not as anticipated There is evidence of sepsis

Answer 166

Intramedullary pin and cercalge wire Plating (w or wo compression Intramedullary nail External Fixator Pin and tension band Various combinations of these

Answer 167

Counteracts bending forces as it lies in the centre of the bone Poor at axial compression using this pin means that the bone column is reformed with the aid of cerclage wire

Answer 168

Cerclage wires draw fragments to their normal position and then fix them relying on the circular cross section of the bone to produce stability

Answer 169

if the fracture is transverse then rotation is possible To prevent this rotation a plate can be used in addition to the pin

Answer 170

Normograde This is when the pin is placed from proximal end of the proximal fragment Small skin incision is made and pin is seated into the bone. This pin is advanced proximal to the fracture site The pin is then pushed into the distal fragment More difficult that retrograde pinning but allows accurate placement of the pin proximally avoiding the sciatic nerve

Answer 171

The pin enters the proximal fragment distally Leaves the proximal bone fragment and a small wound is made in the skin for the pin to be pushed through The pin is grasped by the Jacobs chick pulled proximally until it is positioned proximal to the fracture site Fracture is reduced and pin driven into the distal fragment

Answer 172

Pinning in retrograde suffers from loss of control to where the proximal part of the pin lies In cat this could lead to damage of the sciatic nerve

Answer 173

Normograde placement of an IM pin

Answer 174

IM pin and cerclage wires

Answer 175

IM pin and external fixator The EF prevents rotation as well as offering resistance to axial compression both of which the IM achieves poorly

Answer 176

Requires special jigs to ensure the screws enters the nail Strong and excellent at preventing rotation and bending Only be used in straight bones (tibia and femur) Infrequently used in vet med

Answer 177

Intramedullary interlocking nail

Answer 178

Series of pins placed through the skin connected to a connecting bar Pins are attached to the bar with clamps or epoxyresin Pins may be threaded or the triagulation of pins prevents them pulling out Very versatile and counteracts all the forces applied to a fracture (esp with IM pin) Good for open fractures

Answer 179

External fixator to radioulnar fracture Placement can be uniplanar, biplanar, unilateral or bilateral Bilateral are stronger can be used to augment IM pin fixation

Answer 180

pins prone to infection Prone to discharge where pins pass through muscle masses Req freq exams and reap of loose pins req staging down (removal of pins to change load bearing from fixator to the bone)

Answer 181

Lots of diff types Allow for reconstruction of comminuted fractures Protect against axial and rotational forces Not as good at preventing bending as they are not positioned along the central axis of the bone- worse when plate is exposed to cyclical loading

Answer 182

Non locking are older and req plate to adhere to screws by friction - applies to plate and bone Locking plate there is a thread where the screw engages as well as in the bone - diameters of the screw that engages in the plate is greater than that which engages in bone Special guides needed for locking Can be considered a internal external fixator Locking means limited ability to angle screws

Answer 183

Buttress plate = strong central section that bridges comminuted section of fracture Neutralisation plate allows reconstruction of fracture by taking some of the load Compression plate compresses the fracture by making use of eccentrically placed screws in an oval screw hole.

Answer 184

Screw starts its flight at the top of the slope and when tightened it moves down the slop and shifts one fragment towards the fracture therefore compressing it Using this way means the bone takes all of the load

Answer 185

1. Simple transverse fracture repaired with compression plate 2. Comminuted but reconstructable fracture repaired with neutralisation plate 3. Comminuted fracture treated with buttress plate

Answer 186

the trans cortex is incomplete in this image and radius is compounded by the force strain section of the ulna This results in the plate being exposed to cyclical loading and failure In the humerus, femur and tibi this bending tendency can be managed with an IM in, a rod plate

Answer 187

Special set of fractures that are produced by distractive forces generated internally As a result they are exposed to distractive forces during healing larger fragments can be repaired by screw placement and compression by lagging technique Distractive forces can be converted into compressive using a tension band

Answer 188

Allow for compression to be applied to the fracture The near hole is over drilled to have the same diameter as the thread so it doesnt grip When the screw is tightened it pulls the far fragment against the near Used to produce rigid fixation and will counteract the distractive forces

Answer 189

Fracture is reduced and then 2 pins are used to fix it in position A figure 8 of wire is applied opposite to the distractive foce and the two arms are tightened With the wire tightened and pulling in the opp direction the end result is compressive force applied to the fracture

Answer 190

Pneumatised bone with periosteal blood supply needs to be preserved Avian bone is brittle and prone to splintering Avian bone heals primarily from the endosteum Rapid healing Anatomical abnormalities due to flight adaptation Fractures involving joint or w/in 10cm = poor prog IM pins and external fixators used for thin and brittle bones

Answer 191

Humeral fracture in a kestrel repaired with an IM pin tied to a uniplanar external fixatory Clamps are replaced with epoxyresin to reduce the weight of the device

Answer 192

Comminuted fractures - esp of pastern region compound fractures of long bone complete fractures of long bone and proximal long bone fracture of pelvis where the animal is recumbent PONY UNDER 300KG - potentially fixable issues

Answer 193

- Gentle tissue handling - strict asepsis Haemostasis preservation of blood supply no tension on tissues Good approximation of tissues Obliteration of dead space

Answer 194

Age Nutrition Comorbidities Medications

Answer 195

coeliotomy Performed with the objective of obtaining information that is not available via clinical diagnostic methods once underlying pathology has been determined the procedure can continue as a therapeutic procedure

Answer 196

Abdominal cavity is divided into 5 regions - Cranial abdomen GI tract Right paravertebral region Left paravertebral region Caudal abdomen

Answer 197

Peritoneal fluid to do this Excision of the falciform ligament Examination of the righ and paravertebral gutters

Answer 198

Liver Gall bladder and bile ducts Hepatic hilus Epiploic foramen Spleen

Answer 199

Stomach Intestinal tract Pancreas Regional lymph nodes

Answer 200

Hepatic portal vein Caudal vena cava Coelic artery Hepatic lymph nodes Right adrenal gland Right kidney and proximal ureter Right ovary and uterine horn

Answer 201

Aorta Left adrenal gland Left kindey and proximal ureter Left ovary and uterine horn

Answer 202

Bladder and distal ureters proximal urethra Prostate gland and ductus deferens Uterine body and proximal vagina Regional lymph nodes

Answer 203

Diaphragm Oesophageal hiatus Aortic and caval hiatus Greater and lesser omentum Internal inguinal rings

Answer 204

Make a diagnosis Grading and staging the condition - histologic degree of malignancy - metastatic spread - paraneoplastic syndrome Use this to determine how the tumour will behave

Answer 205

Prophylactic surgery Diagnosis and staging Definitive excision palliative surgery Cytoreduction - follow up w chemo Management of oncological emergencies Surgery for supportive therapy Treatment of metastatic disease

Answer 206

Ovariectomy/ ovariohysteractomy and mammary neoplasia Reduces the risk of mammary neoplasia with and incidence of 0.5% if before neutered before the first oestrus 8% before second and 26% after 2 cycles No effect after 2.5 years

Answer 207

Bleeding splenic haemangiosarcoma

Answer 208

Cytology (FNA and impression smear) Histology

Answer 209

core biopsy Punch biopsy Incisional biopsy Excisional biopsy

Answer 210

Looking for metastatic tumours

Answer 211

How much surgery Debulking/cytoreduction Marginal resection Wide resection Radical resection

Answer 212

Pseudocapsule Reactive Zone Tumour Skip metastases Satellite metastases

Answer 213

Leaves macroscopic volumes of tumour. Will recur unless given adjuvant therapy (which is less effective if gross vs microscopic tumour remains)n

Answer 214

local excision That is, tumour removal with minimal amount of surrounding normal tissue Can result in microscopic or macroscopic presence of residual tumour

Answer 215

Removal of the tumour with complete margins of normal tissue in all directions Local recurrence is unlikeley

Answer 216

Fascial planes are the best border to a margin (especially over fat) Deep margins are much more difficult to achieve

Answer 217

Removal of an entire anatomical structure or compartment containing the tumour Local recurrence unlikely This often applies for sarcomas which can extend along fascial planes rather than through them

Answer 218

Suture holding is most important in the submucosal layer

Answer 219

Making a hole in the stomach For the removal of gastric foreign body

Answer 220

Stay sutures Sterile swabs Operate outside of the peritoneal cavity Closure Absorbable monofilament and atraumatic needle 3/0 cats 3/0 or 2/0 in dogs Pattern Continuous - simple cont- contin invertinfg Two layer - sub mucosal / mucosal and then seromuscular layer Omentalise

Answer 221

Improved vascular supply Improved lymphatic drainage Rich source of inflammaotry and immunogenic cells (neut, t and b lymphs and macrophages) Neovascularisation (angiogenic factors

Answer 222

Omentalization, the placement of omentum around organs or within cavities to improve vascularization or drainage,

Answer 223

Intussusception (in-tuh-suh-SEP-shun) is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This telescoping action often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected.

Answer 224

invagination of a proximal portion of intestine (intussusceptum) into a more distal portion (intussuscipiens)

Answer 225

14 days post suturing Wound strength will have reached nearly normal levels Urinary bladder takes 21-28 days post surgical repair

Answer 226

Breakdown of the intestine and the urinary bladder usually occurs within 72-96 hrs post op Occurs during the lag phase of healign during this time all support and strength of the wound comes from the sutures

Answer 227

Integrity of the repair Check for bleeding lavage and suction Count swabs Change gloves Change instruments

Answer 228

Wound infection peritonitis Uroabdomen check clinical signs Radiography Abd US Abd Tap

Answer 229

Enterectomy dehiscence

Answer 230

Presence of peritoneal fluid

Answer 231

Toxic neutrophils in high numbere Bacterial presence

Answer 232

Would expect the animal to be hyperkalaemic Urethrogram is leaking from bladder repair into the peritoneal space Peritonitis was also present on Exp Lap

Answer 233

External rectal sheath is most important? reconstruct the original anatomy Rectus muscle has no wound holding strength

Answer 234

External and internal leaf

Answer 235

The process by which veterinary surgeons integrate clinical and contextual factors to make decisions about the diagnoses, treatment options and prognoses of their patients

Answer 236

Pattern recognition, illness scripts Problem based clinical reasoning Often dual process reasoning used

Answer 237

Pattern - No memory reliance Fast unconscious and intuitive Pattern recognition mode or heuristics (experience) Cognitive biases and emotional influences are sources of error

Answer 238

Relies on working memory Slow analytical and abstract Modes are inductive and hypothetico-deductive reasoning working cognitive overload and knowledge base can be a source of error

Answer 239

What is the problem Which body system is involved and how Where in the body system is the problem located What is the lesion

Answer 240

Identify and clarify problems vomiting vs regurgitation Prioritise the most specific problems Jaundice vs lethargy Focus diagnostic or therapeutic plans on these Don't forget the other problems Body system responsible and how is it involved? primary (structural) or secondary (functional)

Answer 241

History and clinical exam Further testing Vomiting animal- mass in abdomen or haemotology may show secondary Knowing between the two saves clients time and money

Answer 242

History and clinical exam Further testing such as imaging Endoscopy etc

Answer 243

Degenerative, Anomalous, Metabolic, Neoplastic, Nutritional, Inflammatory, Idiopathic, Toxic, Traumatic, Vascular

Answer 244

Graphical representation of changes in pathology over time

Answer 245

Pharmacodynamics Pharmacokinetics

Answer 246

The action of the dryg What does it target and what is the responseW

Answer 247

Movement of the drug in the body Where does it go Consider therapeutic plasma concentration

Answer 248

Right drug Right dose RIght onset and duration of action Supervision and surveillance Modification and refinement Do no harm

Answer 249

Underlying disease factors Drug data Owner needs Patient factors Practice Compliance

Answer 250

Receptors Ion channels Structural proteins Enzymes Carrier molecules DNA

Answer 251

Agonistic drug

Answer 252

Partial - acts on a receptor and elicits a 50% response or a smaller response Full agonist- acts on a receptor and elicits a full response

Answer 253

The amount of drug req to produce a 50% of its maximal effects ED50

Answer 254

The maximum therapeutic response that a drug can produce

Answer 255

Capacity of a drug to cause a particular action in an population

Answer 256

Relates to the drugs ability to target only a selective population ie cell/tissue/signalling pathway In preference to others

Answer 257

Either bind to a different receptor site or block "post binding" chain of events Ie act downstream of the receptor

Answer 258

Shifts the agonist dose-response curve to the right in parallel

Answer 259

Bind to catalytic site Inhibits normal reaction therefore decreased production of undesired product

Answer 260

The effect of a drug can decrease when given continuously or repeatedly

Answer 261

Change in receptors Loss of receptor number Exhaustion of mediators Increased metabolic degradation of the drug Physiological adaptation (crosstalk between body systems, one takes over) Drug transporters (active extrusion of the drug)

Answer 262

Amount/volume of medication taken at one time

Answer 263

1g of powder dissolved in 100ml Or equivalent

Answer 264

Surface area Metabolic rate

Answer 265

Risk based decision tree Legal and professional req Suitable and authorised medicine for the condition and species you are treating Where there is no suitable drug we are required to move through the drugs that may work to avoid suffering

Answer 266

A suitable vet med authorised in NI with import certificate

Answer 267

Veterinary medicine with marketing authorisation valid in GB or NI wide for a diff species or condition Import certificate required

Answer 268

Human medicine UK with marketing authorisation or authorised medicine from outside the UK Medicine for livestock must be approved for food production in the country it is coming from

Answer 269

Extemporaneous preparation create a product to use for animals - purity and concentration needs be controlled bought in This could include mixing drugs

Answer 270

Human medicines authorised outside of the UK

Answer 271

prescription

Answer 272

Adverse event

Answer 273

Adverse reaction

Answer 274

Suspected adverse reaction

Answer 275

Suitably qualified problem

Answer 276

Registered Qualified person

Answer 277

Veterinary medicines directorate

Answer 278

National office of animal health

Answer 279

RCVS code of professional conduct

Answer 280

Controlled drugs

Answer 281

Prescription only medicine veterinary

Answer 282

Prescription only medicine veterinarian/pharmacist/SQP

Answer 283

Non food animals VPS

Answer 284

Authorised veterinary medicine general sale list

Answer 285

POM-V POM-VPS POM-V medicines must have a prescription from a veterinary surgeon

Answer 286

RQP Clinical assessment of the animals does not have to be carried out when prescribing POM-VPS medicines and the animal does not have to be under the RQPs care but the RQP requires sufficient info

Answer 287

CD in schedules 1-4 have a pres validity of up to 28 days Prescriptions for schedule 5 CDs have a validity of up to 6 months

Answer 288

Schedules 2 and 3

Answer 289

When the total quantity of the prescription is to be dispensed in instalments, the written prescription needs to state the dates for the instalments and the amount or quantity to be dispensed First instalment must be dispensed within the 28 day validity period

Answer 290

for schedule 2,3 and 4 CDs the instalments do not need to be dispensed in the first 28 days

Answer 291

A VS cannot usually have an animal under their care if there has been no physical examination, therfore a VS should not treat an animal or prescribe POM-V medicines via the internet alone

Answer 292

A clinical assessment is any assessment which provides the VS with enough information to diagnose and prescribe safely and effectively May include a physical examination byt not always

Answer 293

Name and amount dosage Admin instructions Any accessory warnings

Answer 294

Alteration to an existing prescription or prescription fraud can be reported to the veterinary medicines directorate via The RCVS considers reporting Px misuse in public interest and in most cases a report to the VMD will be a justified breach of client confidentiality

Answer 295

Any observation in animals whether or not considered to be product-related that is unfavourable and unintended and that occurs after any use of a veterinary medicine Included are events related to a suspected lack of expected efficacy or noxious reactions in humans after being exposed to a Vet medicien

Answer 296

Lack of expected efficacy Unexpected AE (event that is not described in SPC) Serious AE= death or life threatening clinical signs, disability or incapacity, birth defects Non serious = AE all other adverse reactions of lack of efficacy following treatment w VM are non serious

Answer 297

Suspected lack of expected efficacy

Answer 298

A reaction to veterinary medicine which is harmful and unintended and which occurs at doses normally used in animals for the prophylaxis, diagnosis or treatment of disease or to restore, correct or modify a physiological function

Answer 299

After using an authorised VM Following off label use Using a human product in animals After using a compounded preparation Using an imported product

Answer 300

Record what happened in as much detail as possible Report the event electronically to the VMD within 15 calendar days

Answer 301

Periodic safety update report

Answer 302

imposing a complete ban on the possession, supply, manufacture, import and export of controlled drugs except as allowed by regulations or by licence from the Secretary of State.

Answer 303

The Misuse of Drugs Regulations 2001 allow for the lawful possession and supply of controlled (illegal) drugs for legitimate purposes. They cover prescribing, administering, safe custody, dispensing, record keeping, destruction and disposal of controlled drugs to prevent diversion for misuse

Answer 304

1 - no current therapeutic use 2- have therapeutic use but are highly addictive (highly restricted) 3- therapeutic use but misuse may lead to moderate or low physical dependence or high psychological dependence (subject to restrictions and Px 4- Therapeutic use but misuse may lead to limited physical dependence or psychological dependence 5- contain small quantities of substances that might cause dependence but potential for abuse is very low

Answer 305

Details of drugs requested and supplier RCVS number

Answer 306

Locked cabinet Recorded register lock box in the car - secured to vehicle and not left unattended Some schedule 3 drugs should also be kept in locked cabinet

Answer 307

Made irretrievable before disposal Denaturing kits Soap for tablets Cat litter Destruction of schedule 2 drugs should be witnessed by VMR inspector CDLO Independence MRCVS Recorded in CDR

Answer 308

Data assessment and authorisation in GB via the VMD or centralised application to the European medicine agency (EMA) Prescribing dispensing and supply of veterinary medicines Testing, inspection and investigation Post-marketing authorisation

Answer 309

Prescription-only medication - vet Medicined must only be prescribed by a VS following a clinical assessment of the animal or group of animals which must be under their care

Answer 310

Stict limitation on its use specifice safety reasons Specialised knowledge for use and application Narrow safety margin Government policy to demand control at a high level

Answer 311

clinical exam is not required

Answer 312

only for non food animals limits the effect of endemic diseases

Answer 313

medicines for pet species the active ingredient of which has been declared by the secretary of stat as not req veterinary control Exempt from the requirement for marketing authorisation These are over the counter medications

Answer 314

Any prescription for a veterinary medicinal product issued by a professional person qualified to do so in accordance with applicable national law

Answer 315

Activity and toxicity Pharmacokinetics Clinical factors Other factors - dosage form, route of administration

Answer 316

Dose - potency and efficacy Onset - absorption and distribution Loading dose - Vd Maintenance dose - clearance Time to steady state- Half life

Answer 317

The potency of the drug - partial agonist vs full agonist Bioavailability and first-pass metabolism Absorption- drug needs to cross the membrane Distribution

Answer 318

Lipophilic

Answer 319

Time to reach the maximum (Tmax) Route of administration Chemical structure and formulation - pH of location Clinical situations

Answer 320

Polypharmacy Gut content Splanchnic blood flow

Answer 321

Pathology Tissue blood perfusion Changes in pH States of shock

Answer 322

Administration Absorption and distribution Elimination

Answer 323

Enables therapeutic concentrations to be reached sooner Principally determined by Vd

Answer 324

Principally determined by clearance

Answer 325

Within 5 half lives

Answer 326

Ideal situation is constant IV infusion Increasing dose frequency minimises the peaks and troughs so the drug will approach Css Owner and patient compliance is reduced with multiple daily dosign Need for balanced approach and considerations if dose is missed

Answer 327

1, Normal kinetics 2, saturation kinetics

Answer 328

Plasma concentration increase proportionally with dose

Answer 329

If dose is increased then disproportionate increase in steady-state concentrations Necessitates smaller dose increments

Answer 330

Bound and free fractions in equilibrium Only the free drug is active Free drug can be distributed, metabolised or excreted saturable binding could lead to non linear relation between dose and free concentration by the effective concentration range is below that at which this would be important in most scenarios Extensive protein binding slows drug elimination

Answer 331

Related to the drug - High for lipid-soluble drug -Low for molecular size -Decreases for high degree of ionisation - Formulation can improve absorption Related to the body - increases with SA and absorptive surface pH will affect the extent of ionisation GI motility (slow =inc fast = dec) The integrity of absorptive surfaces Diseases

Answer 332

Inc adipose tissue increases Vd for lipid soluble drugs High water body content increases vd for water soluble drugs

Answer 333

polymorphic forms of a drug differ in the physicochemical properties like dissolution and solubility, chemical and physical stability, flowability and hygroscopicity. These forms also differ in various important drug outcomes like drug efficacy, bioavailability, and even toxicity.

Answer 334

Absorption is variable as there is altered gastric emptying and rapid topic absorption Distribution inc for non lipid Distribution dec for lipid drugs Metabolism is dec as there is dec hepatic function Excretion - GFR is normal but drug tubular secretion in the nephron is longer for weak acid or basic drugs

Answer 335

Absorption is variable Plasma level affected therefore alterations to dose and dose frequency Possible lower metabolic clearance Possible lower excretion clearance

Answer 336

Absorption reduced Body mass inc so lower water inc fat content Metabolism changes are minimal so decreased plasma albumin Excretion has decreases renal elimination as decreased renal mass and GFR (similar to animals with chronic renal disease)

Answer 337

Reduced bioavailability lowers Cmax Later Tmax Affects plasma level- dose and dosing frequency Little change in metabolic clearance Lower excretion clearance

Answer 338

decreased metnation- inc effects of sedatives Decreased blood flow = lower clearance for highly cleared drugs eg anaesthetics

Answer 339

Associated with most profound changes in PK A gradual loss of urine concentrated ability and ability to acidify Also altered drug distribution patterns Change in acid base balance Uraemia - chronic acidosis, red albumin binding of drug and less hepatic metabolism

Answer 340

Content and activity of phase 1/II reactions is decreased Little effect on drug metabolism untile 80% functional loss no adequate functional tests Most antimicrobials are well tolerated

Answer 341

Altered serum pH and protein binding

Answer 342

Urine feaces Milk and sweat Expired air

Answer 343

we want drugs to be above the minimal effect concentration but below toxic levels This window is the therapeutic window a we want this to stay in the therapeutic window until the issue is resolved

Answer 344

The time taken for the drug to become effective

Answer 345

The concentration max which is the peak concentration This needs to be below the toxic levels

Answer 346

IV bolus = instant Infusion= zero order Oral or IM= inc slowly and then decline

Answer 347

When elimination of drug brings concentration below the minimal effective concentration

Answer 348

The amount of parent drug eliminated from the body per unit of time

Answer 349

Metabolites then excreted Direct excretion via the kidneys Hepatobiliary system

Answer 350

Enzymatic conversion of drug to a metabolite Lipid soluble to water soluble is the aim Lipid soluble -> catabolic phase-> drug derivative -> Anabolic phase -> Water soluble drug

Answer 351

Cytochrome P450 (CYP) is a hemeprotein that plays a key role in the metabolism of drugs and other xenobiotics

Answer 352

Passive filtration of small drugs (effected by GFR and plasma protein binding) Secretion (affinity for transporters, lipophilicity and polarity effect) Reabsorption (effected by lipophilicity, polarity and urine pH) If remain in the nephron then excretion via the urine

Answer 353

OATs and OCTs

Answer 354

Lipophilic drugs will be reabsorbed

Answer 355

Measure the efficiency of drug elimination The volume of blood/plasma cleared of a parent drug per unit time

Answer 356

Measure of extent of absorption from administration site to measurement site

Answer 357

The volume into which a drug appears to be distrubted with a concentration equal to that in the plasma Vd is a reversible process

Answer 358

The magnitude of Vd for a drug is influenced by its reversible affinity for tissue proteins vs plasma proteins. It is expressed in units of volume per Kg body weight

Answer 359

The time taken for the plasma concentration of the drug to halve

Answer 360

Pharmaceutical - interaction prior to administration Pharmacokinetic - tissue/plasma levels of one drug altered by another one Pharmacodynamic- action of one drug is altered by another one

Answer 361

Altered pharmacological response to one drug caused by the presence of a second drug

Answer 362

Enhanced, inhibited or has new effects or no change at all Summation Potentiation Synergism

Answer 363

The combined effect of two drugs produced a result that equals the sum of the individual effects of each agent

Answer 364

When a drug on its own does not have an effect but may affect/be affected in combination with another drug

Answer 365

Drug combinations produce a therapeutic or toxic effect greater than the sum of each drug's action

Answer 366

Physical - incompatibility interaction (binding to plastic or insolubility in some solutions) Chemical - Stability of drugs is often pH dependent, oxidation and reduction reactions, complex formation , inactivated by certain vehicles

Answer 367

Additive Synergistic Negation

Answer 368

Unintended or noxious response to a drug that occurs within a reasonable time frame following administration

Answer 369

Results form the interplay of facilitatory and inhibitory pathways throughout the peripheral and central nervous systems

Answer 370

Represents malfunction of neurological transmission and serves no physiological purposehat

Answer 371

Altering behaviour to avoid damage or minimise further damage

Answer 372

TPR & pain assessment Treat pain and reassess

Answer 373

Clinical Biochemical Behavioural

Answer 374

Physiological measurements SDS, NRS, VAS DIVAS Composite scales Pain faces Acute vs Chronic pain QoL scales Analgesiometry and accelerometers Gait analysis Pressure sensitive walkways

Answer 375

Difficult, subjective and other drugs can affect evaluation Environment and owner can affect the animal Species variation Interspecies variation Domestication, hierarchy, feeding, aggression The pain scale must reflect or accomodate these differences

Answer 376

Follow an established psychometric approach Validity is the most fundamental attribute of the questionnaire Validity in the criteria, content and construct Utiity - quick and easy to us

Answer 377

. Ear Changes : fold, curl and angle forwards or outwards, pointed shape 2. Orbital Tightening: narrowing of the orbital area, partial or complete eye closure or squeezing 3. Nose/Cheek Flattening: with eventual absence of the crease between the cheek and whisker pads 4. Whisker Change: move forward away from face

Answer 378

Ear position (held backwards= pain )

Answer 379

The distance between the ear canal becomes larger and the ears fall down to the side and turn outwards. move in diff directions or positioned asymmetrically

Answer 380

Muscles around eye are stretched gives upper eyelide a distinctive angled appearance Sclera is more evident in the medial canthus Stare is withdrawn and intense during the induction of pain

Answer 381

Nostrils are dilated laterally and change from a normal elongated shape to a square with more marked edges noticeable in the medial part of the nostrils, where they are drawn more sharply towards the medial plane

Answer 382

Jaw muscles on the side of the horses face become mroe stressed and marked Especially m. Zyomaticus and m. Caninus, but also m.Masseter may be tense

Answer 383

Increased tonus of the lips and tension of the chin during pain stimuli results in a more edges shape of the muzzle

Answer 384

Asymmetrical/low ears or ears held stiffly backwards Angled eye/tension above the eye area and orbital tightening Withdrawn and tense stareNostrils – square-like/strainedTension of the muzzle/strained mouth and pronounced chin Tension of the mimic muscles/chewing muscles

Answer 385

Opioids, NSAIDs, local anaesthetics Ketamine and alpha 2 agonists Cold therapy Tissue handling Nursing care (bandages, massage, IV lines, monitoring, ROM, ensuring sleep) Other therapies (limited evidence) e.g. Laser, TRPV1 agonists, pulsed EMF

Answer 386

The COX enzymes are the targets for NSAIDs. NSAIDs also target descending pain pathways PAG+ NRM

Answer 387

Phenylbutazone Flunixin meglumine Meloxicam

Answer 388

Meloxicam Ketoprofen Cattle and small ruminants should receive NSAIDs for castration, disbudding and assisted calving

Answer 389

Renal or hepatic insufficiency (how bad?) Hypovolaemia Congestive heart failure & pulmonary disease Coagulopathies, active haemorrhage Spinal injuries Gastric ulceration Concurrent use of steroids Shock, trauma Pregnancy

Answer 390

An new class of piprant NSAID that doesn't block COX It works lower down the inflammatory pathway by blocking some activity of specific prostaglandin

Answer 391

Used to be classified as a NSAID (blocks central & peripheral COX) CB1 & TRPV1 actions & antipyretic Used IV in dogs & horses (no licence) Pardale-V (paracetamol & codeine) has licence in dogs Licensed in pigs NEVER USE IN CATS

Answer 392

Use in pre-emptive, multimodal and preventive analgesia Controlled drugs Full agonist, partial agonists and agonist-antagonists and antagonist exist 4 key receptors mu, delta, kappa & orphanin Morphine, methadone, pethidine, fentanyl, buprenorphine, butorphanol, tramadol

Answer 393

Local anaesthetics are amides or esters Esters hydrolysed by plasma cholinesterases, amides by the liver Narrow therapeutic index (easy to overdose, care with dosing) Overdose? Use 20% intralipid IV Lidocaine can also be given IV as CRI for analgesia (dogs & horses) Mechanism of action – ionized charged form interacts with Rc

Answer 394

one spray delivers 2-4mg of lidocaine. Lidocaine jelly (2% 20mg/ml) for catheterising the urethra Somatic tissue can be infiltrated, reliable & safe Lidocaine is most often used (0.5-2.0%) Anaesthesia is produced by multiple intradermal (or subcut) injections The local is slowly injected as needle is advanced along the proposed surgical site Best performed in sedated/anaesthetised animals Place the needle in the 1st desensitized area & make injections at the periphery of advancing wheal Don’t use xylocaine spray (reactions)

Answer 395

Bind to alpha 2 receptors Analgesic & other actions (sedation, ↓HR) Sedation for all spp Premedication, rescue analgesia Short lived approx. 1 hr analgesia Can antagonise with atipamezole

Answer 396

Sedation (A) Decrease MAC Analgesia (somatic & visceral) (A & B) Hyper (B) then hypotension (A) Decreased CO & HR, increased SVR Respiratory depression Increased urine production Decreased GI motility Decreased surgical stress response Hyperglycaemia, GH enhanced, Thermoregulation affected Sweating

Answer 397

Uses of ketamine: induction agent (dissociative anaesthesia), perioperative analgesic, restraint of fractious cats (sprayed in mouth) Combined with other drugs for sedation (IM or IV) Very versatile, useful for zoo and exotic animals NMDA receptor antagonism (but also interacts at many other Rc) Memantine

Answer 398

Triggers glutamate release in the brain through blocking NMDA receptors on inhibitory neurones Neurones release NT that keep other neurones from firing and releasing glutamate stores when glutamate gets released it triggers synaptic formation and strengthening in the brain

Answer 399

is multifactorial (posture, mood, movement - scales reflect this)

Answer 400

Helsinki Chronic Pain Index GuvQuest Canine Brief Pain Inventory (CBPI) (OA & bone cancer pain) Liverpool osteoarthritis in Dogs (LOAD e) CSOM (client specific outcome measures)

Answer 401

Hydrotherapy & physiotherapy Chondroprotectives Exercise management Weight control & diet Joint replacement/salvage Anti NGF Ab (Librela, Solensia) Irap Accupuncture Other drugs: garlic & fenugreek, sodium hyaluronate (Hyonate), prednoleucotropin (PLT), steroids, paracetamol (not cats) Stem cell therapies (MCS)

Answer 402

The effects of MSCs are exerted primarily through their secreted factors, including extracellular vesicles and bioactive molecules such as chemokines, cytokines and growth factors These paracrine factors have a range of immunomodulatory, anti-inflammatory, angiogenic and anti-apoptotic properties - rename “Medicinal Signalling Cells” Adipose tissue-derived MSCs (ADSCs)

Answer 403

Potential efficacy as analgesics in patients with chronic pain Cannabinoids act on peripheral, spinal & supra-spinal sites to exert antinociceptive and antihyperalgesic effects Clinical trials investigating the use of CBD oil in dogs with OA have had mixed results No licence in the UK, and vets must be aware of the legal position regarding prescribing

Answer 404

Hurt Hunger Hydration Hygiene Happiness Mobility More good days than bad Each category score out of 10. 0 = unacceptable, 10=excellent, >35 acceptable QoL

Answer 405

Have a narrow therapeutic index Ionised charge form interacts with the receptors The receptor for LAs are located within the port of the Na channel close to the cytoplasm and on the ionised charged form the LA can interact with the receptor

Answer 406

LAs are amides or esters Amide versions will be broken down by liver Esters will be broken down by plasma cholinesterases

Answer 407

Procaine- cattle Lidocaine - all species Proparacaine - eyedrops

Answer 408

Bupivacaine- SA Mepivacaine- Equine

Answer 409

Slow onset LAs are often more potent and more toxic

Answer 410

Preinscional block

Answer 411

Intra testicular block

Answer 412

Direct infilitration of the mesovarium ligament (splash block on ovaries also works)

Answer 413

Retro bulbar anaesthesia

Answer 414

Infiltration of LA following enucleation and suture closure

Answer 415

Lumbosacral and sacrococcygeal epidurals

Answer 416

: Canine and feline tail amputations, perineal urethrostomies, anal sacculectomies, catheterisation for relief of urethral obstruction, perineal relaxation for delivery of puppies/kittens, and other surgeries of the penis or perineal region.

Answer 417

Rostral maxillary dental block Infraorbital Provides analgesia to soft tissue of rostral maxillaru

Answer 418

Caudal maxillary Extra oral Needle inserted below the cranioventral border of the zygomatic arch, between caudal border of maxilla and cranial border of mandibular ramus Needle advanced parallel to the plane of the hard palate and 1cm caudal to the lateral canthus of the eye The needle is advanced until bone is felt, aspirate! ++ risk of venepuncture

Answer 419

Mandibular block The (green) inferior alveolar nerve (IAN) is a branch of the mandibular nerve Individual alveolar nerves branch dorsally through short section of bone to each individual tooth to innervate the tooth structures and adjacent bone Nerves exit mental foramina to innervate soft tissue of rostral lower lip

Answer 420

Rostral mandibular block The (green) inferior alveolar nerve (IAN) is a branch of the mandibular nerve Individual alveolar nerves branch dorsally through short section of bone to each individual tooth to innervate the tooth structures and adjacent bone Nerves exit mental foramina to innervate soft tissue of rostral lower lip

Answer 421

Bier block in cattle

Answer 422

This technique provides safe, short-term anaesthesia of the extremity. To perform IVRA or a Bier block, place a catheter distally in an appropriate vein (cephalic or saphenous) in the limb requiring analgesia. De-sanguinate the limb by placing an Esmarch bandage, and then place a tourniquet proximally and tighten it. Remove the Esmarch bandage and inject lidocaine into the cannula, remove cannula and prep leg for surgery. Bier block used in cattle.

Answer 423

Femoral and sciatic nerve block PNBs offer and alternative to epidural with reduced risk of urine retentiona and reduced postoperative opoid consumption

Answer 424

Femoral artery (arrow) and femoral nerve (solid arrow).

Answer 425

The intravenous route - CRI Only use pure lidocaine IV (no adrenaline!) More benefit in soft tissue pain?? Can be used in both dogs and equines (colics) as an infusion (is it prokinetic?) Decreases MAC, reduces opioid dose Contributes to balanced anaesthesia Post op can be useful Best avoided in cats

Answer 426

Overdose with local anaesthetic can occur occasionally Support patient (airway, seizures, arrhythmias, can also administer intralipid) Prevent by carefully calculating dose and always aspirate before injecting The risk of toxicity is small if care is taken

Answer 427

Intramuscular Intravenous Subcutaneous Inhalation Across the mucous membrane

Answer 428

Anaesthetics are pharmacological agents that target specific central nervous system receptors. Once they bind to their brain receptors, anaesthetics modulate remote brain areas and end up interfering with global neuronal networks, leading to a controlled and reversible loss of consciousness.

Answer 429

Rapid onset of action, rapid uptake by CNS, 5-8 mins unconsciousness Milky alkyl phenol Respiratory and cardiovascular depression Rapid and smooth recovery Suitable for ‘top ups’ or TIVA, only given IV, licensed for dogs and cats No analgesia Works at GABA

Answer 430

Pharmacokinetics of propofol: Absorption (minimal oral bioavailability) Solubility (minimally soluble in water) Distribution (98% protein bound) Metabolism (liver, glucuronidation) Elimination (renal) GABAA beta subunit (inward directed Cl current hyperpolarizes the postsynaptic membrane and inhibits neuronal depolarization)

Answer 431

Rapid onset of action, rapid uptake by CNS Respiratory and cardiovascular depression Rapid and smooth recovery (if premedicated) Clear, colourless neuroactive steroid Suitable for ‘top ups’ or TIVA, and can be give IM for sedation No analgesia Works at GABA Licensed for dogs, cats, rabbits

Answer 432

Pharmacokinetics Absorption (good bioavailability) Solubility (soluble in water) Distribution (30-50% protein bound) Metabolism (liver, rapid, also lungs, kidney) Elimination (renal, and small % bile) GABAA allosteric modulator

Answer 433

Dissociative anaesthesia’ & analgesia Clear colourless solution, IV or IM (can sting) Licensed for cats, dogs, ruminants, rodents, rabbits, primates, horses Poor muscle relaxation, therefore combined with other drugs (BZD, alpha 2) Schedule 2 drug Component of the feline ‘triple’ or ‘’quad’ IM protocols Mechanism of action is primarily due to antagonism at NMDA receptor

Answer 434

Occasionally these drugs can be used for induction (their main use is maintenance) A mask/induction chamber is used Often used in birds, rodents, & very compromised animals But stress is involved with restraint/breathing the agent (isoflurane > sevoflurane) Deliver via precision vaporiser, in oxygen, slowly increase % until animal unconscious Mechanism of action (GABA, 2PK)

Answer 435

At the spinal cord level, inhalation anaesthetics decrease transmission of noxious afferent information ascending from the spinal cord to the cerebral cortex via the thalamus, thereby decreasing supraspinal arousal. There is also inhibition of spinal efferent neuronal activity reducing movement response to pain. Hypnosis and amnesia, on the other hand, are mediated at the supraspinal level. Inhalation agents globally depress cerebral blood flow and glucose metabolism. Tomographic assessment of regional uptake of glucose in anaesthetized volunteers indicates that the thalamus and midbrain reticular formations are more depressed than other regions. Electroencephalographic changes including generalized slowing, increased amplitude, and uncoupling of coherent anteroposterior and interhemispherical activity occur during anaesthetic-induced unconsciousness.

Answer 436

Zoletil’ (zolazepam & tiletamine) MS-222 Thiopentone ‘Ketofol’ (ketamine + propofol) Etomidate

Answer 437

Confidential enquiry into perioperative small animal facilities

Answer 438

60% of the fatalities occurred within the recovery period with half of these dying within 3 hours of disconnection Greater vigilance is required regarding monitoring the recovering patient

Answer 439

ASA category Breed Age Weight Length of anaesthesia Type of surgery Drugs given Temperature Species Vigilance/ experience of staff Available equipment

Answer 440

Staff always present consider the logistics Separate species to red stress Good ventilation to eliminate exhaled gases Open fronted kennels and cages Warming equipment Protective clothing and gloves should be worn Emergency equipment

Answer 441

Anaesthetic machine Breathing systems Anaesthetic induction drugs and anagesics Equipment for IVFT Endotracheal tubes and laryngoscope Suction apparatus Monitoring equipment Emergency drugs (crash box) Defibrillator (if poss)

Answer 442

Separate to anaesthetic monitoring sheet Need all information from the anaesthetic (hand-over) TPR every 5 mins initially, reduce to every 10 as recovery progresses Remember ABC on recovery

Answer 443

Surgery/procedure ends Vaporiser is switched off (do NOT turn down early) If using nitrous oxide, switch off and increase oxygen to deliver adequate FGF and minimise diffusion hypoxia (leave on 100% O2 for 10 mins if N2O was used) ‘Dump’ the reservoir bag on the breathing system (with valve open) and fill with fresh gas- oxygen by increasing the flowmeter

Answer 444

Disconnect the patient from the breathing system Switch off oxygen Move patient to recovery area Do not deflate cuffs until apt Cuff may not be fully deflated following dental or oral procedures to prevent inhalation of blood and debris Check oropharynx with laryngoscope in these cases

Answer 445

gag-reflex returns; indicated by swallowing, tongue flicking (same in most species i.e. horses, ruminants, pigs etc.)

Answer 446

approximately 15 seconds before swallowing, try checking for palpebral reflexes, provoked ear twitches, but it’s hard to judge. Don’t delay as can cause laryngospasm

Answer 447

BOAS Extubate on inspiration

Answer 448

patients head and neck should be extended ant the tongue gently pulled forward to maintain patent airway

Answer 449

Level of consciousness, activity and recovery of physiological reflexes Body temp Oxygenation Ventilation and airway patency Circulation (HR, pulse quality, MM colour, CRT) Postoperative analgesia

Answer 450

They are alert, lifting head and swallowing Showing normal ocular reflexes. Jaw tone indicates good muscle strength They are not shivering, and body temp is above shivering threshold (>35°C) MM are pink while breathing room air (if in doubt, use pulse oximeter) They are breathing well without ETT in place. No signs of upper airway obstruction present Effective analgesia has been provided and is likely to last until the next assessment is due.

Answer 451

Loss of pharyngeal muscle tone Regurgitation or vomiting Laryngospasm or laryngeal oedema

Answer 452

Increase resp noise or effort Abdominal effort, nares flaring Air hunger posture (head and neck extended) Cyanosis (late sign)n Agitation and restlessness Agonal breathing (terminal sign)

Answer 453

Call for help Open mount use laryngoscope Pull tongue forward and suction blood/mucous Reintubate if possible Always have induction agent ready just in case

Answer 454

Monitor pulse rate & quality every 5 minutes in first stage of recovery Where will you palpate the pulse? Can also monitor blood pressure, mucous membrane colour & CRT, ECG & temp ICU cases will have further monitoring

Answer 455

Very important to keep animal normothermic during anaesthesia and continue in recovery Ambient temp Breathing system (circle vs non re-breathing) & HME Prep solution/alcohol kept to min Bubble wrap/socks/space blankets Warm IV fluids and flushing solution Hot air blankets

Answer 456

Is the patient comfortable? Is the animal restless/vocalising because it is… In pain Dysphoric Emerging from the anaesthesia Uncomfortable (bladder full/ needs to defecate) If in doubt , give an analgesic & re-assess Pain scales

Answer 457

Don’t underestimate the importance Utilise the nurses, they are experts in this Talk to owners before reuniting with pet Home with sufficient analgesia Owners aware of how to spot problems Owners aware of what to do/who to call? Instruction sheets/specific surgery/condition Buster collars Cage rest/sufficient advice given? Post op/check-up appointment booked?

Answer 458

1% in elective cases 2% in non colic emergency cases 5.4% in emergency colic surgery cases

Answer 459

Fractures in recovery (highest mortality) Post anaesthetic myopathy Neuropathies and spinal cord malacia Intraoperative cardiac arrest Respiratory obstruction

Answer 460

Increasing ASA grade Increasing age and foals Surgery type and position Duration Time of day, OOH provision Agents used (premed/TIVA) Recovery quality

Answer 461

Some surgical procedures can be performed with the horse standing e.g. castration, sarcoid removal Sedatives and analgesics and local anaesthetic combinations can be used Cases where used: sedated with romifidine and butorphanol IV, and then had two intratesticular injections of lidocaine, and IV NSAID received an infusion of detomidine, and increments of butorphanol IV, and local anaesthetic infiltration at the surgical site, plus a NSAID. ODSP (kissing spine) surgery

Answer 462

Admit the night before Complete physical exam - murmurs? Blood samle Starve Remove shoes Ensure horse is clean

Answer 463

IV cannula always Flush out mouth Tail bandage/plait Clip if possible Weigh Make anaesthetic plan Pre medicate the horse

Answer 464

Prepare monitoring equipment Prime anaesthetic circuit with isoflurane Select ET tube Change soda lime Label and prepare drugs Leak test anaesthetic machine and ventialor nad set Tidal volume Prepare fluids and dobutamine Prep tabel

Answer 465

Rebreathing circuit- CIRCLE Fresh gas flow rate? Start 6-8L/min After 15min reduce to 3-4L/min

Answer 466

Acepromazine

Answer 467

Anxiolytic Reduces catecholamines (dec cardiac arrest) Reduced anaesthetic gase requirement Improves recoveries Improved tissue perfusion through vasodilation

Answer 468

Penile prolapse Hypovalaemia

Answer 469

IM 40 mins before sedation IV 20 mins before sedation

Answer 470

Alpha 2 agonists Opiods

Answer 471

Sedation for induction Analgesia Vasoconstriction and bradycardia

Answer 472

Analgesia Improved sedation quality Respiratory depression?

Answer 473

ASA 1 & 2 With or without Acepromazine Wait 20-40 mins Add alpha 2 agonist with or without opioid Remember with NSAID and then potentially antibiotic

Answer 474

Head down, wide based stance Horses are insensible to surroundings

Answer 475

IV ketamine A benzodiazepene (midazolam can be combined with the ketamine) Occasionally guaifenesin IV can be used instead of an alpha 2 agonist

Answer 476

Intubate (ET tubes, cuffs checked, gag, lubricant) Attach hobbles and move horse Place on table and connect to anaesthetic machine Maintain horse in dorsal or lateral recumbency on oxygen in isoflurane Monitor as usual, place arterial line for ABP, ECG, Et CO2 Catheterise Connect IV fluids

Answer 477

Can supplement anaesthesia with injectables for maintaining plane of anaesthesia (PIVA) e.g. lidocaine

Answer 478

Maintenance of anaesthesia

Answer 479

Isoflurane or sevoflurane (only iso is licensed)

Answer 480

Hypotension Need lowest dose that ensures anaesthesia

Answer 481

Palpating pulses Reflexes and eye signs Muscle tone Machine Multiparameter Pulse oximeter Blood gases

Answer 482

Total intravenous anaesthesia (alternative to volatile agent)

Answer 483

Top up bolus injections( ketamine 0.5mg/kg) Continuous rate infusions (triple drip in equine anaesthesia - useful for field work)

Answer 484

Produces a lower anaesthesia stress response compared with inhalation agents and is therefore physiologically superior method

Answer 485

Partial intravenous anaesthesia

Answer 486

Reduces amount of inhalant gas required

Answer 487

Problems we see Hypotension Hypoxaemia Hypercapnia Bradycardia Tachycardia Neuropathy Eye problems

Answer 488

Use positive inotrope Reduce isoflurane Use PIVA Increase fluids <70mmHg using invasive arterial monitoring

Answer 489

Becomes apparent in recovery period Fatal Cause is potentially hypotension Usually heavy bred horses and yound More common in dorsal recumbency Not related to duration of anaesthesia

Answer 490

Myelomalacia, or “soft cord,” is characterized by an absence of confluent spinal cord cysts. Histologically, myelomalacia is characterized by microcysts, reactive astrocytosis, and thickening of the pia arachnoid.

Answer 491

Low O2 tension in blood - Shown by low stats on SPO2% and low SaO2 on blood gases PaO2 <60mmHg Occurs due to O2 failure or V/Q mismatch The animal is turned on its back, RR is reduced (by drugs), CO is reduced (by drugs) = low O2 delivery

Answer 492

Check the SPO2% reading - some pulse oximeter probes don’t work well on horse tongues, so check it first Take blood gas - if PaO2 is much lower than it should be (remember is should be 4-5 x FIO2%) – act Switch down the isoflurane/sevoflurane Ventilate/IPPV… increase resp/tidal volume Ensure adequate circulating blood volume (IVFT) Tilt table (head up) slightly if possible Give beta agonist (down the ETT) eg salbutamol

Answer 493

High CO2 – seen on capnograph and blood gas Why does it happen? The animal is turned on its back, RR is reduced (by drugs and position), so CO2 rises in the body We tolerate a bit of hypercapnia Spontaneous breathing in recovery Increased oxygen dissociation in tissues

Answer 494

Reduce the volatile agent (isoflurane) Instigate ventilation

Answer 495

Breed/fitness of horse and their HR prior to anaesthesia If blood pressure or oxygen delivery is compromised too - you need to act

Answer 496

Consider the cause and address those Then if HR is still low use drug - Hyoschine N butykbromide (buscopan) Other drugs include atropine or glycopyrrolate

Answer 497

Volatile agednt Vagal tone Opiod Alpha 2 agonist Toxaemia Hypoxia

Answer 498

Breed/fitness of horse and their HR prior to anaesthesia Evaluate ABP and reflexes too, especially nystagmus and palpebral reflex, may need to act fast if horse moves

Answer 499

Consider the causes… sympathetic stimulation (nociception is most likely), but can be CO2, acid base disturbance, drug reaction, cardiac issue, hypotension… Depth not adequate… Administer ketamine bolus IV and consider the % volatile agent – may need to increase too (increase FGF too to speed this rate of change up) More analgesia? Check arterial blood gas… hypercapnia? BP Low…. Treat as for hypotension

Answer 500

Sympathetic stimulation (nociception is likely) CO2 acid base disturbance Drug reaction Cardiac issue Hypotension

Answer 501

Evident when horse wakes up, may cause poor recovery Can resemble myopathy Not usually as painful as myopathy Radial nerve, facial nerve (headcollar left on during sx)

Answer 502

Usually when a horse has been in lateral recumbency Must protect lowermost eye with padding Lubrication for eye

Answer 503

Volatile agent switched off Reconnected to hoist Head supported Positioned in RLR in recovery box (if dorsal or RLR on table), LLR if LLR on table Pull dependent limb forwards (why?) Demand valve can be used to stimulate breathing Nasal tubes (obligate nasal breather) Extubate when swallowing or just before Exit recovery box, watch, can recover with ropes outside

Answer 504

Quiet Dark Empty bladder Analgesia Allow time for anaesthetic drug elimination Sedation Lateral: 30 minutes Sternal: 10-15minutes Standing: 15 minutes then taken back to stable

Answer 505

Sedation  low dose alpha 2 agonists. Given once in recovery and breathing spontaneously (romifidine) or once signs of reduced anaesthestic depth occur (xylazine)

Answer 506

Upper airway obstruction Laryngeal obstruction Nasal oedema

Answer 507

Stridor or stertor following tracheal extubation Nostril flaring on inspiration Abdominal respiratory effort Exaggerated thoracic excursion Absence of airflow at the nostrils Obstruction tends to occur within the nasal passages or at the level of the larynx

Answer 508

Select appropriate ET tube size and insert gently Dorsal displacement of soft palate Epiglottic retroversion Following laryngeal surgery may leave ET tube in place for recovery (secured) If obstruction occurs be prepared to reintubate (may need more drugs) Emergency tracheostomy

Answer 509

Common usually resolves as horse stands Use nasopharyngeal tubes, or phenylephrine or both Can recover horse to standing with ET tube in place

Answer 510

Consider what is the normal for that animal first (do you have pre-op results?) Next – ask yourself if it is actually causing a problem with perfusion & oxygen delivery Check SPO2% and the ABP to decide Consider what might be causing it Drugs (volatile, alpha 2 agonist, induction agent, opioid) Toxaemia (endogenous/exogenous) Vagus Heart problem (e.g. sick sinus) Hypoxia Hypothermia

Answer 511

Approach to treatment: Is output being compromised? (ABP & SPO2%) – if yes – need to intervene Why is it happening? Check depth of anaesthesia, vagal tone causes, hypoxia, toxaemia Treat cause first if possible, for alpha 2 induced bradycardia – use atipamezole (alpha 2 antagonist) Otherwise consider anticholinergics 2 options: atropine or glycopyrrolate

Answer 512

Consider what is the normal for that animal first (do you have pre-op results?) Next – ask yourself if it is actually causing a problem with perfusion & oxygen delivery Check SPO2% and the ABP to decide Consider what might be causing it Sympathetic stimulation, too ’light’ PaCO2, PaO2, pH abnormalities CNS disturbances Low ABP, or cardiac disease Drugs e.g. anticholinergics

Answer 513

Approach to treatment: Is output being compromised? (ABP & SPO2%) Why is it happening? Check depth of anaesthesia, CO2 etc, then consider an IV opioid, or lidocaine or propranolol/esmolol Vaporiser setting can be increased in addition to opioid

Answer 514

Ask yourself if it is actually causing a problem with perfusion & oxygen delivery Commonest causes of ectopic beats Circulating catecholamines (stress) Hypoxia or hypercapnia Hypovolaemia or hypotension Anaesthetic drugs Myocardial inflammation or stimulation Trauma CHF or HCM Major organ dz e.g. intracranial dz Detected via ECG

Answer 515

Is output being compromised? (ABP & SPO2%) Is there a danger of ventricular fibrillation? Are the VPCs multiform, in sequence or paroxysms? Why is it happening? Check depth of anaesthesia, CO2 etc, then consider an IV opioid, lidocaine or propranolol/esmolol Vaporiser setting can be increased in addition to opioid

Answer 516

Check equipment (cuff size, cuff position, transducer, patency of cannula, fluid line) Urine production?? i.e. other crude indicators of output Commonest causes of hypotension: Anaesthetic drugs Hypovolaemia and haemorrhage Cardiac insufficiency Check patient and attempt to determine cause Reduce volatile/inhalant agent (TIVA/PIVA) Increase IVFT (intravenous fluid therapy) Check urine output if possible Re-check ABP Consider use of inotrope (dobutamine) Consider use of vasopressor (norepinephrine)

Answer 517

Increased CO2 depth of anaesthesia hypoventilation pyrexia rebreathing fresh gas flow rates too low exhaustion of soda lime changes in dead space

Answer 518

Low CO2 Disconnection (check breathing system) Mis-intubation ??

Answer 519

Cats on non-rebreathing systems (T piece or mini Lack) Often lower ET CO2 readings

Answer 520

Obstruction Hyperventilation Circulatory failure Hypotension Cardiac arrest

Answer 521

Failing ET CO2 values In this case due to partial airway obstruction but could be Circ failure, hypervent, hypotens. CA

Answer 522

Cardiogenic oscillations

Answer 523

Palpate a pulse Check O2 is connected/ animal is not disconnected Check the pulse ox to verify the SPO2% Reconnect breathing system if disconnected Re-intubate if extubated or tube is blocked Replace the pulse oximeter probe Reduce the volatile agent Improve perfusion (IVFT) & inotropes (e.g. dobutamine in equine) Ventilate the animal if there is hypoventilation/obesity (tilt table) In equine GA s verify with arterial blood gas (other interventions will then be tried) e.g. beta agonist, recruitment (> D1C) Investigate other causes (haemorrhage, pneumothorax)

Answer 524

Dysphoria and prolonged recovery are common Discern if dysphoria is pain or hypoxia or emergence/confusion Provide analgesia IV, oxygen or sedation (microdoses) as necessary Delayed recovery is often hypothermia, can antagonize other drugs and also check glucose

Answer 525

Rapid onset of action, rapid uptake by CNS, 5-8 mins unconsciousness Milky alkyl phenol Respiratory and cardiovascular depression Rapid and smooth recovery Suitable for ‘top ups’ or TIVA, only given IV, licensed for dogs and cats No analgesia Works at GABA

Answer 526

Pharmacokinetics of propofol: Absorption (minimal oral bioavailability) Solubility (minimally soluble in water) Distribution (98% protein bound) Metabolism (liver, glucuronidation) Elimination (renal) GABAA beta subunit (inward directed Cl current hyperpolarizes the postsynaptic membrane and inhibits neuronal depolarization)

Answer 527

Pharmacodynamics Anaesthesia, respiratory depression, decreased CMRO2, depressed cardiovascular reflexes Haemodynamic effects are largely result of sympathetic depression - Stable cardiac output- Decreased heart rate (blunted baroreceptor reflex)- Decreased MAP, SVR, CVP

Answer 528

Rapid onset of action, rapid uptake by CNS Respiratory and cardiovascular depression Rapid and smooth recovery (if premedicated) Clear, colourless neuroactive steroid Suitable for ‘top ups’ or TIVA, and can be give IM for sedation No analgesia Works at GABA Licensed for dogs, cats, rabbits

Answer 529

Pharmacodynamics of alfaxalone: Anaesthesia, decreased CMRO2, Haemodynamic effects minimal - Stable cardiac output- Stable heart rate- Stable MAP, SVR, CVP

Answer 530

Absorption (good bioavailability) Solubility (soluble in water) Distribution (30-50% protein bound) Metabolism (liver, rapid, also lungs, kidney) Elimination (renal, and small % bile) GABAA allosteric modulator

Answer 531

Choose the drug (how?) Calculate the dose Look at the data sheet dose suggestions Dose is reduced is animals that have been premedicated Dose is reduced in unhealthy animals (ASA II-V) Draw up slightly more drug than you anticipate using Inject either drug slowly to effect over 60 seconds (you might not need all the drug) Animal will become sedated and then unconscious

Answer 532

Volatile anesthetics (VA) are gases that are used to induce and maintain general anesthesia, with benefits of relatively rapid onset and recovery with acceptable effects on peripheral organs in most patients.

Answer 533

The presence of an appropriately trained and experienced anaesthetist is the main determinant of patient safety during anaesthesia The associated of anaesthetists of GB and Ireland 2007

Answer 534

I - healthy pet no disease II- mild systemic disease of localised disease III- moderate systemic disease limiting activity but not life-threatening IV- Severe systemic disease incapacitating and life-threatening not expected to live without surgery V- Moribund, not expected to liver >24 hours with or without surgery

Answer 535

Efforts must be directed towards thorough preoperative patient evaluation and improvement of the patients clinical state if possible The identification of risk factors before anaesthesia should lead to increased levels of anaesthetic surveillance performed ideally by well trained staff | use benzodiazapiense not Acepromazine maleate

Answer 536

Clinical evaluation & recent history Previous GA history Current medications Current comorbidities Temperament/anxiety Pain Hydration status Oxygenation Plan (know the surgery/diagnostics and position and possible complications), use a checklist

Answer 537

Pre-operative blood tests & diagnostics are indicated! IVFT resuscitation Anti anxiety medication may be indicated Continue medications during peri-op period Pre-place IV access Pre-oxygenate (mask, flow by, cage, nasal prongs) Drain chest/abdomen or decompress

Answer 538

ASA III-V Avoid the alpha 2 agonists in compromised animals V low doses of alpha 2 agonist may be used if animal very distressed Opioid alone may be sufficient to sedate patient (but patients are often quiet/compromised) e.g. methadone or butorphanol Fentanyl and midazolam (IV) useful Ketamine and midazolam (IM or IV) cats (not in HCM) Alfaxalone and opioid is an option (NB volume of injectate is disadvantage), can add BZD too if necessary

Answer 539

Dont leave unsupervised after premed Continue to provide oxygen IV admin of premed often followed soon by induction drugs Titrate induction drugs slowly to effect in small animals Palpate pulse during induction Observe MM Be ready to intubate and secure airway swiftly to provide O2 Consider attaching monitoring equipment before induction

Answer 540

Comprehensive and continual monitoring Avoid a deep plane of anaesthesia PIVA & TIVA can reduce reliance on volatile agents IVFT – goal directed Analgesia, local blocks Have emergency drugs ready/calculated Encourage efficiency and discourage slow/time wasting Keep patient warm from the outset

Answer 541

IVFT before induction (?hypertonic saline) PCV, TP, lactate, glucose (minimum), belly tap, NG tube Often omit acepromazine Still use standard dose of alpha 2 agonist followed by ketamine & NSAIDs Often have had additional alpha 2 during work up Careful positioning Comprehensive monitoring, often are ventilated (IPPV) IVFT during GA v important PIVA is recommended to reduce volatile agent Regular blood gases recommended

Answer 542

Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy and route of administration Suitable selection of antibiotics

Answer 543

Work with clients to avoid the need for antimicrobials Avoid inappropriate use Choose the right drug Monitor antimicrobial sensitivity Minimise use Record and justify deviations from the protocol Report suspected treatment failure to the VMD

Answer 544

Inform owners about the benefits of regular pet health checks Use symptomatic relief or topical preparations where appt Integrated disease control programmes Animal health and welfare planning Isolate infected animals wherever possible

Answer 545

For uncomplicated viral infectiosn Restrict use to ill or at risk animals Advise clients on correct administrates and storage of products and completion of course Avoid underdosing

Answer 546

Where cytology and or culture is positive

Answer 547

Identify likely target organisms and predict their susceptibility Create practice based protocols for common infections based on clinical judgement and up to date knowledge Know how antimicrobials woerk and their pharmacodynamic properties Use narrow spectrum anitmicrobials where possible

Answer 548

While clinical diagnosis is often the initial basis for treatment, bacterial culture and sensitivity must be determined whenever possible so that a change of treatment can be implemented if necessary Monitor bacterial culture and sensitivity trends

Answer 549

Use only when necessaru and evidence that usage reduces morbidity and or mortality Regularly assess antimicrobial use and develop written protocols Use alongise strict aseptic techniques

Answer 550

Be able to justify your choice of antimicrobial and dose Keep an accurate record of treatement and the outcome to help evaluate therapeutic regimens

Answer 551

Report through the suspected adverse reaction surveillance scheme (SARSS) This may be the first indication of resistance

Answer 552

Suspected adverse reaction Surveillance Scheme

Answer 553

Practice policy based on what is expected and then what is sensible to use and what the practice will use

Answer 554

Narrow spectrum or Broad spectrum

Answer 555

Targets a narrow group of bacteria (either gram pos or neg

Answer 556

Targets the Gram pos and gram neg bacteria

Answer 557

Kills the organism Penecillins Cepahlosporins

Answer 558

Drugs that temporarily inhibit the growth of an organism (reversible if removed) Examples are tetracyclines and chloramphenicol

Answer 559

Peptidoglycan wall is unique to bacteria ABs target the wall Lysozyme produced by host breaks the bonds in polysacs Beta-Lactam ABs inhibit transpeptidase PBP so peptide cross-links cannot be formed Glycopeptides - bind to peptide chains so peptide cross-links cannot form

Answer 560

Penicillins Cephalosporins

Answer 561

Target the ribosome so that proteins cannot be formed

Answer 562

Topical application interact with membranes and disrupt Product licensed for dermatology Lipids/charge properties of host vs bacterial membrane allow for distinction

Answer 563

Aerobic or anaerobic drugs

Answer 564

Unjustified therapy poor selection Wrong dose Suppressed host response Resistance

Answer 565

Culture and antibiotic sensitivity testing

Answer 566

Disc diffusion - antibiotic gradient from disc (inhibition zone) MIC determination using liquid cultures in wells

Answer 567

Minimum inhibitory concentration

Answer 568

Clinical breakpoint values There are interpretive criteria with clinical breakpoints for MIC values for diff bacteria

Answer 569

Break point is determined and then anything above is resistant and everything below is sensitive

Answer 570

Above MIC the resistant bacteria will be left and Below the MIC the sensitive bacteria will survive but grow slowly while resistant bacteria will proliferate quickly and overgrow

Answer 571

An innate ability to resist activity of a particular antimicrobial agent through inherent structural or functional characteristics which allow tolerance of the drug

Answer 572

Lacks the target or altered target

Answer 573

When a microorganism obtains the ability to resist the activity of a drug. Can be a mutation or new gene acquisition

Answer 574

Alteration drug Alteration of target bypass mechanism Efflux systems

Answer 575

Gram negative bacteria as the AB cannot penetrate the outer membrane of the bacteria

Answer 576

Enterococci as the AB has a low affinity for penicillin binding proteins

Answer 577

Mycoplasmas lack a cell wall so a cell wall targeting AB will not work

Answer 578

Gene mutations - change binding site Gene acquistiion Coresistance

Answer 579

Mechanism transfer, Conjugations of plasmids or other routes Risks transfer between potential pathogens and commensals

Answer 580

Where genes physically linked on the same mobile elements. The are found together once established BInd the same or very close sites One change effects binding of multiples or modification of site

Answer 581

The drug is pumped out of the bacteria maintaining very low concentrations reducing the efficacy

Answer 582

Degrades the AB most common with B-lactamases

Answer 583

Tetracyclines

Answer 584

acetylation of aminoglycosides

Answer 585

AB works by bingin to PBP affecting the peptide cell wall cross linking = weakened cell wall Beta lactamase (enz) breaks down the Beta lactam Methicillin then has resistance Alternate PBPs called MecA now increase resistance to Beta lactams

Answer 586

Underdosing Length of selective level Presence of resistant bacteria to select

Answer 587

Minimum selective concentration

Answer 588

Minimum inhibitory concentration

Answer 589

Multi drug resistance strains Non susceptible to > agent in >3 clinical antimicrobial categories

Answer 590

Extensive drug resistance Non susceptible to >1 agent in all but >2 clinical Ab categories

Answer 591

Pandrug resistance Non susceptible to all antimicrobial agents listed

Answer 592

Stopping infectious agents coming onto site Management movement of animals and materials into hospitals, farms, clinics

Answer 593

Reduce infection Spread on surfaces and fomites Effective management of infective material Effective cleaning

Answer 594

Generalised action Therefore damaging so self harm or patient harm Some toxic so tainting a risk Hypersensitivity

Answer 595

Alcohols Alkalis Aldehydes Oxidising agents Phenols QACs

Answer 596

- door closed - white coats removed - Full-body apron - Gloves Masks and visor - Double bag waste -Dispose of bedding - cleaning using Trigene advance high level disinfectant

Answer 597

Highly contagious - acute GI disease Persistent as non enveloped virus Expelled contaminated material (organic matter

Answer 598

Passing of heat over a contaminated item - sterilisation via hot air oven 150degrees over 30 minutes to kill microorganisms Not effective against spore creating bacteria Takes a long time Certain items can go in (metal and glass) Risk of fire

Answer 599

Effective against spores Heat form Chemical form It is best to use heat steam and pressure (autoclave) Boils water to produce steam = pressure pushes steam into packaging some forms do not remove air which can inhibit sterilisation

Answer 600

gravity displacement autoclave and the high-speed prevacuum sterilizer.

Answer 601

Vacuum assisted sterilisation system

Answer 602

Ethylene oxide in large scale practice (endoscopes etc) Inactivates DNA cells - strict COSHH controls Req specialist training and takes a relatively long time without interruption

Answer 603

Clean and check Pack Sterilise Monitor sterilisation Check out of date supplies

Answer 604

Treatment of mixed bacterial infections in which one drug is not effective To achieve synergistic antimicrobial activity against particularly resistant strains To reduce the risk of or overcome AB resistance

Answer 605

Where the activity is greater than either of the 2 individually

Answer 606

Where there is a benefit for treatment but there is no increase of individual acitivity

Answer 607

Bacteriostatic

Answer 608

Bacteriocidal

Answer 609

Several bactericidal antibiotics are substantially impaired by simultaneous use of bacteriostatic drugs (most are ribosomal inhibitors) This is an example of antagonism

Answer 610

Sulphonamide Act on different targets making them more effective - synergistic result

Answer 611

Amoxycillin Amoxycalv Breaks down penicillins by breaking fown Beta lactamase inhibitors

Answer 612

Bacteriostatic drugs

Answer 613

Procain is metabolised to paraaminobenzoic acid which can reduce effectiveness of SULPHONAMIDE treatment

Answer 614

Reduces efficacy as they compete for the target site

Answer 615

Mixed infection

Answer 616

Combination therapy Mixed infection where the use of 1 antibiotic will not be effective The empirical selection must be made. Penicillins kill the anaerobic bacteria Aminoglycosides treat gram-negative bacteria Presentation of a strict anaerobe means that metronidazole is added

Answer 617

Sometimes there may be combination treatment but cultures will confirm the need

Answer 618

Staph aureus- beta lactam R Strep uberis - beta lactam sen E coli - gram neg

Answer 619

A drug used to treat cancer by causing cell death and stopping cells from dividing

Answer 620

Oral By injection IV infusion Topical

Answer 621

Chemo drugs only Chemotherapeutic drugs as part of a treatment plan eg with radiotherapy

Answer 622

Cytotoxic drugs such as Vincristine Doxorubicin Chlroambucil Cylophosphamide

Answer 623

Inhibit mitosis and /or damage DNA Kill rapidly dividing cells Neoplastic cells GI tract epithelium Bone marrow cells

Answer 624

Tyrosine kinase inhibitors Monoclonal antibodies

Answer 625

Receptors Signalling pathways Antigens

Answer 626

For mast cell tumours in dogs Masitinib Toceranib

Answer 627

Monoclonal antibodies against specific tumour antigens

Answer 628

Palliative not curavtive Toxicity limits dose or freq of dose

Answer 629

Highest dose with the acceptable side effects

Answer 630

Aims: delay or slow disease progression/ not kill cancer cells Inhibits angiogenesis Modulates immune response to cancer cells

Answer 631

Cell cycle non specific drugs act through all phases of the cell cycle Cell cycle phase specific drugs kill a limited number of cells with any single dose

Answer 632

Vincristine Vinblasine Cytrabine

Answer 633

Doxorubicin Cyclophosphamide Lomustine Chlorambucil

Answer 634

Alkyl group binds to and cross links DNA

Answer 635

Bind to tubulin in cells and disrupt mitotic spindle

Answer 636

Inhibit use of cell metabolites used in growth and cell division

Answer 637

Inhibit topoisomerase -II causing the breakage of DNA and cell death Forms free radicals

Answer 638

Bind platinum to DNA causing cross linkage and cell death

Answer 639

Inhibit various TK receptors eg KIT or VEGFR

Answer 640

Maximising the benefits Minimising harm

Answer 641

Without sensation General anaesthesia is total lack of sensations Local anaesthesia relates to lack of sensation in a localised part of the body

Answer 642

Lack of awareness of painful inputs is caused

Answer 643

Achieving the desired effects of an anaesthetic by using multiple drugs, allowing a more conservative dose for each drug thereby reducing the side effects An additional factor involved in reduced drug dose is reducing patient stress

Answer 644

Unconsciousness Narcosis Tranquilisation Hypnosis Analgesia Muscle relaxation Immobilisation Amnesia Sedation

Answer 645

Induction Maintenance Emergence/ recovery

Answer 646

Confidential enquiry into perioperative small animal fatalities

Answer 647

Normal physiology Minimal loss of temperature Minimal pain GOod organ function BP maintained Less cardiovascular depression Less cerebral hypoxia Less dysrhythmias

Answer 648

Patient Drug pose minimal risk Procedure Staff Emergency or planned Facilities and equipment

Answer 649

AVA and RECOVER

Answer 650

quality improvement process that seeks to improve patient care and outcomes through systematic review of care against expicit criteria and the implementation of change

Answer 651

NO FASTING

Answer 652

Different body systems can be affected by helminths, protozoa and maggots of some flies Control of these endoparasites is difficult

Answer 653

kill External parasites

Answer 654

Kill internal parasites

Answer 655

Kill internal and external parasits

Answer 656

Used to treat infections of animals with parasitic worms Flat worms eg Fluke (trematodes) Tapeworms (cestodes) Round worms (nematodes)

Answer 657

Organophosphates Benzimidazoles Salicylanilides Pyrazinoisoquinolones Sulphonamides Tetrahydropyrimidines Imidazothiazoles Hexahydropyrazine Macrocyclic lactones

Answer 658

Betatubulin Nicotinergic acetylcholine receptor GABA receptor and glutamate gated chloride channel

Answer 659

Bind to Beta tubulin Inhibit/blockage of polymerisation causing abnormal microtubule formation and disruption intracellular homeostasis and energy metabolism

Answer 660

Excitatory ACh containing neurones Inhibitory GABA containing neurones

Answer 661

Flaccid paralysis of the worms through increasing GABA and therefore increasing the relaxation Pip acts on GABA Macro acts on glutamate

Answer 662

Act on ACh to increase contraction and therefore cause spastic paralysis of the worms

Answer 663

Cyclic octadepsinpeptide Aminoacetonitrile derivatives Spiroindole

Answer 664

Acts on specific classes of transmembrane G protein couples receptors latrophilin receptor class This causes flaccid paralysis of the pharynx

Answer 665

MPTL -1 receptors , a unique kind of Ach receptor that causes spastic paralysis

Answer 666

Acetylcholine antagonist causing flaccid paralysis and expulsion of parasites

Answer 667

Animal welfare Economic loss Vectors of disease Source of zoonotic infection

Answer 668

Chemical and non chemical Work in conjunction with each other

Answer 669

Depends on life stage (normally adlt) Sometimes ineffective in killing the adult so target another stage May intervene at multiple stages Which animals require treatment (contagious or species specific)

Answer 670

Avoid contact with parasite (barriers, most useful where only part of the lifecycle is on the host) Create conditions that are unsuitable for the parasite to live Change host env (dagging tails) Change off host env (dung management)

Answer 671

Ticks Babesiosis

Answer 672

Drug action required Spectrum of activity Speed of onset required Duration of action/frequency of reapplication Contraindications Safety Development of resistance

Answer 673

Neurotoxins Insect growth factors Others (repellants, desiccants and mechanical agents)

Answer 674

Species Age restrictions (lower age for many products) Suitable mode of application Meat/milk withdrawal periods

Answer 675

Know which parasites you are looking for based on host species, history and clinical signs Select apt test Carry out test correctly and take adequate samples from representative areas Examine the sample systematically to find the parasite Identify the parasite

Answer 676

Sheep scab Detects host antibodies to recombinant mite antigen Can detect sheep scab infestation within 2 weeks of contact- potentially prior to the appearance of clinical signs Potential for false positives from previous resolved infection

Answer 677

Canine NB potential for Fals pos - takes 1 months to seroconvert False negatives- occasional cross reaction with antihousedust mite antibodies in environmental atopics

Answer 678

Detects flea allergy or hypersensitivity not infestation Detects Type I hypersensitivity but not Type IV

Answer 679

Psoroptes Take superficial at leading edge of the lesions

Answer 680

50% Treatment trial oftern req to thoroughly rule out fleas sarcoptes and cheyletiella

Answer 681

Top = psoroptes jpinted pedicel and funnel shaped sucker Other surface mites= unjointed pedical and cup shape sucker

Answer 682

Th e study of basic responses of cells and tissues to insults and injuries irrespective of the organs, systems or species of animal involved

Answer 683

Pathology of organ systems The study of alterations in specialised organs and tissues

Answer 684

Examination of tissues taken during life (biopsy) or after death (necropsy) Examines nature and extent of disease process

Answer 685

Examination of blood and other body fluids as well as cells (cytology) during life

Answer 686

The study of the structural, biochemical and functional changes in cells, tissues and organs that underlie disease → An understanding of pathology is fundamental to understandinghow disease occurs and, consequently, how disease can be diagnosed, treated, and prevented

Answer 687

mechanisms of disease development

Answer 688

Functional consequences of molecular and morphologic changes

Answer 689

Aging Immunologic defects Genetic defects

Answer 690

Agents- physical, chemical or biological Deficiencies - nutritional, environmental deficits

Answer 691

Biochemical alterations in cells or tissues that alter the function

Answer 692

Structural alterations in cells or tissues

Answer 693

Vascular and interstitial tissue changes that develop in response to tissue injury and that are designed to sequester, dilute and destroy the causal agent

Answer 694

INteraction of the blood coagulation system and platelets to form within a vascular lumen an aggregate of fibrin and platelets

Answer 695

Intrinsic mutations in somatic cells that underlie abnormal mechanisms for control of mitosis, differentiation and cell to cell interactions Lead to uncontrolled replication of cells that impinges on adjacent normal tissue

Answer 696

Abnormalitied or imbalances of carbohydrate, fat and protein metabolism in the cell lead to accumulation of glycogen, lipid or protein as well as complexes of abnormally folded protein derivateves

Answer 697

Death of cells and tissues in the living aniaml

Answer 698

Removal and examination of a tissue dample from a living animla body for diagnostic purposes

Answer 699

Methodical examination of the dead animal

Answer 700

Conclusion concerning the nature, cause of name of a disease

Answer 701

Abnormal structural and functional changes that occur in the body

Answer 702

Based on data obtained from the case history, clinical signs and physical examination

Answer 703

Based on changes observed in the chemistry of fluids and the haemotology, structure and function of cells collected from the living patient

Answer 704

Also known as lesion diagnosis Based on the predominant macroscopic and microscopic lesions

Answer 705

Names the specific cause of the disease

Answer 706

Stated the common name of the disease

Answer 707

Morphology, molecular biology, microbiology, immunology, genetics, informatics… Morphology is cornerstone of pathology

Answer 708

Macroscopic examination Microscopic examination Observation by the unaided eye LIght microscopy and electron microscopu

Answer 709

Polymerase chain reaction (PCR) In situ hybridization (ISH) Genomics (DNA sequencing, DNA microarrays) Transcriptomics (RNA sequencing) Proteomics Metabolomics…. Immunological approaches

Answer 710

Colour and texture changes, gas production, and odours that are caused by post-mortem bacterial metabolism and dissolution of host tissues (post-mortem decomposition)

Answer 711

Rigor mortis Algor mortis Livor mortis (hypostatic congestion) Post-mortem clotting Haemoglobin imbibition, bile imbibition Pseudomelanosis Bloating Softening Lens opacity

Answer 712

Contraction of muscles occuring after death Due to depletion of ATP and glycogen, commences 1-6 hours after death and persists for 1-2 days

Answer 713

GRadual cooling of the cadaver

Answer 714

Gravitational pooling of blood down the side of the animal

Answer 715

Occurs mainly in the heart and blood vessels

Answer 716

Haemoglobin imbibition:Red staining of tissue (Once the integrity of blood vessel walls is lost, haemoglobin released by lysed erythrocytes penetrates the vessel wall)

Answer 717

Bile imbibition:Bile in the gallbladder penetrates its wall and stains adjacent tissue yellowish/greenish/brown

Answer 718

Blue-green discoloration of the tissue by iron sulphide (FeS)(formed by the reaction of hydrogen sulphide (H2S) generated by putrefactive bacteria and the iron from haemoglobin released from lysed erythrocytes)

Answer 719

Result of post-mortem bacterial gas formation in the lumen of the gastrointestinal tract

Answer 720

Softening of tissue results from autolysis of cells and connective tissue often aided by putrefactive bacteria

Answer 721

Occurs when the carcass is very old or frozen Reversible on warming

Answer 722

Need to distinguish the normal from the abnormal Need to distinguish lesions from post mortem change

Answer 723

Location Number/extent Demarcation Distribution Colour Size Shape Consistency and texture

Answer 724

Severity, duration, distribution, location and the disease process Macroscopic

Answer 725

On the 1. forelimb, there was a clipped area measuring 10 x 5 cm. Within the clipped area is 2. a 3.well-demarcated, 4. focal, 5. pink to dark red, 6. 3 cm in diameter x 2 cm height 7. round, raised, 8. firm, hairless mass.

Answer 726

The 1. stomach was 4. diffusely distended, 8. gas-filled and 5. diffusely dark red

Answer 727

Affecting 20% of the right kidney, within the renal cortex and extending into the medulla, was a focal, well-demarcated, 3 x 2 cm, light tan to dark red, wedge-shaped lesion.

Answer 728

Affecting 30% of the tongue, on the left underside and extending to the lingual surface, there was a focal, moderately well demarcated, pink to red, 5 x 2 x 1 cm, oval, multinodular, firm mass

Answer 729

Focally extensively, effacing the perineum and base of the tail, was a well-demarcated, black to red, approximately 1 meter by 50 cm x 10 cm, ulcerated, multinodular mass.

Answer 730

Adhered to the viscera and mesentery of the ileum and paired caeca, were numerous, well demarcated, multifocal, up to 2 cm in diameter, pink to tan, round firm masses.

Answer 731

Affecting up to 90% of the mammary gland, there was multifocal to coalescing, poorly demarcated areas of grey to light pink, friable tissue, admixed with haemorrhage and abundant light pink purulent exudate (pus).

Answer 732

Causes Oxygen deprivation Physical agents Chemical agents and drugs Infectious agents Immunologic reactions Genetic derangements Nutritional imbalances

Answer 733

Causes of hypoxia (= oxygen deficiency): Reduced blood flow (= ischaemia) Inadequate oxygenation of the blood (cardiorespiratory failure) Decreased oxygen-carrying capacity of the blood(anaemia, carbon monoxide poisoning, blood loss)

Answer 734

Mechanical trauma Extremes of temperature Radiation Electric shock

Answer 735

Hypertonic concentrations (glucose, salt…) Poisons (arsenic, cyanide…) Environmental pollutants Insecticides, herbicides Therapeutic drugs

Answer 736

Viruses (and prions) Bacteria Fungi Parasites

Answer 737

Immune reactions to external agents (microbes) and environmental substances Immune reactions to endogenous self-antigens(autoimmune diseases)

Answer 738

Deficiency of functional (e.g. enzymes) or structural proteins → errors of metabolism, accumulation of damaged DNA or misfolded proteins Influence the susceptibility of cells to injury by chemicals and other environmental insults

Answer 739

Nutritional excess Nutritional deficiency

Answer 740

Key points:Depletion of cellular energy stores(adenosine triphosphate ATP) Cellular swelling / fatty change Alterations of intracellular organelles → In early stages or mild forms of cell injury, the functional and morphologic changes are reversible if the damaging stimulus is removed

Answer 741

Always pathologic Cell membranes are damaged Often with inflammation

Answer 742

May be physiologic or pathologic Cell membranes are intact No inflammation Cell suicide or programmed death Once the cells DNA or proteins are damaged beyond repair

Answer 743

Morphologic changes Increase eosinophilia Cytoplasmic vacuolation

Answer 744

Patterns of tissue necrosis: Coagulative necrosis Liquefactive necrosis Gangrenous necrosis Caseous necrosis Fat necrosis

Answer 745

Localised area of coagulative necrosis caused by ischaemia due to vascular obstructio

Answer 746

Pus collection of necrotic neutrophils and tissue debris (encapsulated pus= abscess)

Answer 747

Variant of coagulative necrosis Usually applied to a limb that has lost its blood supply(also tail, ears, udder) 3 types of gangrene:dry, moist or gas

Answer 748

Fat necrosis Focal areas of fat destruction Fat appears white, firm chalky resembling flecks of soap Typically resulting from release of pancreatic lipases

Answer 749

Cell shrinkage Chromatic condensation Cytoplasmic blebs and apoptotic bodies phagocytosis of apoptotic cells or cell bodies

Answer 750

Reversible functional and structural responses to more severe physiologic stresses and some pathologic stimuli, allowing the cell to survive and continue to function→ changes in size, number, phenotype, metabolic activity or function of cells → cell injury once the limits of adaptive responses are exceeded

Answer 751

Increase in the size of cells (by producing more organelles), resulting in an increase in the size of the organPhysiologic compared with pathologic Stimuli:Increased functional demand (e.g. muscle) or by stimulation by hormones (e.g. uterus during pregnancy) or growth factors (or even some viruses)

Answer 752

Increase in the number of cells in an organ or tissue = inc mass and size Physiologic compared with pathologic Stimuli = same as hypertrophy Hypertrophy and hyperplasia often occur together and have the same gross appearance

Answer 753

Physiologic, pathologic

Answer 754

During embryonal, fetal development, uterus atrophy after parturition

Answer 755

Decreased workload Loss of innervation Diminished blood supply INadequate nutrition Loss of endocrine stimulation Pressure

Answer 756

Potentially reversible change in which one differentiated cell type is replaced by another Most common - columnar to squamous epithelial Causes are chronic irritation, deficiencies, result of cell/tissue injury, oestrogen toxicity

Answer 757

Agenesis – never developed Aplasia – started development but stopped early Atresia – absence of an orifice Hypoplasia – incomplete development Dysplasia – disordered growth Neoplasia

Answer 758

Heat Redness Swelling Pain Loss of function

Answer 759

Acute Inflammation is a redundant, complex, adaptative and protective response of vessels, resident cells and leucocytes to noxious stimuli. Inflammation brings cells and molecules of host defense from the circulation to the sites where they are needed, in order to eliminate the offending agents and repair the tissues. It lasts hours to days

Answer 760

Infections (bacterial, viral, fungal, parasitic) and microbial toxins Tissue necrosis; ischemia; trauma, physical and chemical injury; irradiation Foreign bodies (splinters, dirt, sutures); endogenous substances urate crystals (in gout), cholesterol crystals (in atherosclerosis), and lipids Immune reactions (hypersensitivity)

Answer 761

The morphologic hallmarks of acute inflammatory reactions are: dilation of blood vessels, activation and recruitment of leukocytes and active exudation of fluid in the extravascular tissues.

Answer 762

Recognition of the injurious agent Reaction of blood vessels Recruitment of leukocytes Removal/clearance of the agent Regulation (control) of the response Repair (resolution)

Answer 763

Vasoactive Amines (Histamine, Serotonine) Released/Produced by mast cells, basophils, platelets Inflammatory Lipids (Prostaglandins, Leukotrienes) Produced by mast cells, leukocytes Complement (C5a, C3a) Plasma (produced in liver) Cytokines (IL-1, TNF, IL-6) Produced by macrophages, endothelial cells, mast cells Others: Kinins, Chemokines, Nitric Oxide, Coagulation Cascade, PAF,….

Answer 764

Vasodilation Increased vascular permeablility Leukocyte recruitment and activation Pain Tissue damage

Answer 765

1- Complete resolution Clearance of the offending agent and regeneration. 2-Scarring, or fibrosis Connective tissue growth into the area of damage or exudate, this occurs after substantial tissue destruction. 2-Progression to chronic inflammation Unresolved inflammatory process due to either the persistence of the injurious agent or some interference with the normal process of healing.

Answer 766

The acute phase response is characterized by different systemic effects of acute inflammation (and other conditions) including pyrexia, leucocytosis, metabolic changes. The response also includes changes in the concentrations of plasma proteins, called acute phase proteins (APPs).

Answer 767

Biomarker: a biological molecule that is objectively measured and is an indicator of a normal or abnormal process, or of a condition or disease.

Answer 768

Transudate: Extravascular filtrate of protein and cell poor fluid. It is due to increased hydrostatic pressure or to decreased colloido-osmotic pressure, or combination of both. It is accumulated in body cavities and extracellular compartments. The fluid appears grossly clear and watery.

Answer 769

Exudate: extravascular fluid that has a high protein concentration and can contain leucocytes. Its presence implies the existence of an inflammatory process that has increased the permeability of blood vessels.

Answer 770

Serous FIbrinous Purulent Haemorrhagic

Answer 771

Inflammation with exudation of fluid with a low concentration of plasma protein and no to low numbers of leukocytes.

Answer 772

Inflammation with exudation of fibrinogen and fluid, and formation of thick friable, loosely adherent fibrin

Answer 773

Inflammation with the production of pus, viscous to creamy liquid, an exudate consisting of degenerated and necrotic neutrophils, debris and fluid. It is typically associated to bacterial infections

Answer 774

Haemorrhagic inflammation Inflammation with vascular damage, loss of integrity of endothelium and/or extensive tissue necrosis, with leakage of red blood cells. This type of acute inflammation reflects a severe inciting stimulus.

Answer 775

Normally 24-72 hours after acute inflammation Persists for weeks months or years

Answer 776

Macrophages M1 cells or M2 cells M1 Arginine to nitric oxide Highly toxic to phagocytosed organisms M2 Non-inflammatory Arginine to Orthinine Orthinine = proline in Extra-cellular fluid Proline = precursor for collagen synthesis.

Answer 777

Systemic illness comes with tissue inflammation Pro-inflammatory cytokines E.g Interleukin 1, Interleukin 6 Pyrexia Lethargy Weight loss? Stimulate Acute phase proteins E.g C reactive proteins = immunosuppressive? Indicators of chronic inflammation in blood

Answer 778

Persistent Stimulus Inert irritant (suture material?) Granuloma formation: Necrotic Centre Foreign material + Neutrophils Macrophages (Giant cells) Infectious granuloma? Lymphocytes

Answer 779

Wound Healing (See Surgery week) Inflammation Proliferation Maturation M2 Macrophages Proline TGF – B Promotes collagen deposition

Answer 780

Atopic Dermatitis Inflammatory bowel disease Toxic agent Inflammatory Bowel disease Year 2 (GI) - allergic response, a chronic inflammatory state remains due to cytokines and immune cells

Answer 781

Parasitic Fungal Neoplastic

Answer 782

Chronic inflammatory lesion Characterised by predominance of macrophages and neutrophils Large Granuloma Examples: Feline Infectious Peritonitis Johnes Disease in cattle Slow growth despite aggressive clinical signs T cell : Macrophage interactions important

Answer 783

Johnes disease Granulomatous lesions in the lymph node of a johnes cow

Answer 784

H&E image shows a circular mass of cells caused by a granulomatous lesion Johnes disease

Answer 785

Caseous granuloma Chronic granulomatous disease

Answer 786

Affects organ function Breakdown could lead to excessive bacterial dissemination throughout the body

Answer 787

Inherited disorder Phagocytes dont work properly Increased susceptibility to repeated bacterial or fungal infections

Answer 788

Chronic pyelonephritis in a dog’s kidney Pyogenic granulomas are small raised red bumps Hydronephrosis Kidneys have become swollen and stretched

Answer 789

Actinobacillosis Bacterial cause. Rarely be an outbreak of this (an individual cow condition) Present with increased salivation and difficulty chewing? Typically acute in its presentation Proliferative and ulcerative chronic-active inflammatory lesions Contains neutrophils mixed with mononuclear inflammatory cells (lymphocytes, macrophages, plasma cells). Fibrous tissue present in the tongue.

Answer 790

Cross section Chronic inflammation= loss of muscle of the tongue Replaced by fibrous tissue during healing White interwoven bands of fibrous tissue called arrowheads Granulomatous inflammation in the centre of the image

Answer 791

Chronic inflammation (mastitis) caused by tuberculosis Biosecurity Economic implications Zoonotic risk

Answer 792

Immune mediated arteritis Inflammation occurs in the blood vessels Swelling of the heart muscle not often any main clinical signs until severe stage

Answer 793

Chronic hepatitis Acute hepatitis = infectious, toxic or idiopathic Etiology of chronic hepatitis is not known Acute hepatic failure can progress to chronic active hepatitis. Clinically, this might be seen as weight loss, lethargy and depression within the animal. Think about liver disease and impact on protein breakdown (with liver disease, branched chain amino acids are not catbolised correctly)

Answer 794

Lung pyogranuloma Granulomas and pyogranulomas in the lung of a dog. Grey nodules which vary in size throughout the lung parachyma. nodules would be composed of granulomatous inflammatory lung lobes would fail to collapse.

Answer 795

Granulomatous inflammatory lesion Activated and giant multinucleate cells Internal intracellular organisms within the giant macrophage cells Lymphocytes and plasma cells

Answer 796

Chronic interstitial nephritis Kidney disorder and inflammation of the kidney. Acute interstitial nephritis = uncommon in cats Chronic progressive interstitial nephritis = common and more commonly referred to as chronic kidney disease. Cause = infectious agents? infectious disease?

Answer 797

Chronic nephritis in the cat Granulomatous vasculitis Development of renal interstitial pyogranuloma. Multiple, large, irregular, and pale grey subcapsular cortical foci

Answer 798

chronic interstitial nephritis Diffuse interstitial fibrosis Fine pitting of the capsular cortical surface Stippled red Bands of greay fibrous tissue surrounding islands of renal cortex

Answer 799

Healing bone

Answer 800

Abnormal mass of tissue occuring due to abnormal cell proliferation

Answer 801

Benign Premalignanat Malignant

Answer 802

Process of gradual steps toward tumour development

Answer 803

Through histology Organisation of tissue structure Degree of cellularity Nuclear to cytoplasmic ratio Nuclear morphology Necrosis Mitotic index Individualisation of cells Invasiveness of cells

Answer 804

Benign= non invasive Malignant= invades surrounding tissue

Answer 805

Slow growing masses Good demarcation from surrounding tussue Minimal necrosis

Answer 806

Can grow rapidly Invasiveness to surrounding tissue Can spread to other sites in the body (metastasis) Increased necrosis

Answer 807

Malignant tumour

Answer 808

pleomorphism anisokaryosis- variation in nuclear size Prominent nucleoli Macrocytosis Macrokaryosis Macronuclei Asinonucleoliosis - varied nucleolar size Multiple nuclei Increased N:C ratio Coarse chromatin nuclear molding Abnormal mitotixc figures

Answer 809

Promote proliferation

Answer 810

Suppress proliferation in induce cell death

Answer 811

Oncoproteins

Answer 812

Proteins that promote cell growth in the absence fo normal growth promotion signals and despite normal check point controls

Answer 813

Neoplasia is a multi-factorial process (not a single cause) Genetic factors Epigenetic factors Environmental factors Multiple hit hypothesis One mutation (genetic or epigenetic) usually not enough to cause neoplasia on its own

Answer 814

Sustaining proliferative signalling Evading growth suppressors Resisting cell death Inducing angiogenesis Activation invasion and metastasis Enabling replicative immortality

Answer 815

Starts with mutagenesis or carcinogenesis These are the initiating factors that cause genetic change This change makes cells more likely to divide in an uncontrolled way in the right conditions

Answer 816

An agent that damages DNA

Answer 817

A mutagen that causes neoplasia

Answer 818

Intrinsic factors Normal by-products of cell metabolism that cause DNA damage e.g. reactive oxygen species (ROS) AKA free radicals Extrinsic factors Environmental agents Chemical Physical Oncogenic viruses

Answer 819

Direct acting= effective in the form in which they enter the body Indirect acting = require activation by enzymes in the body in order to act as carcinogens (Cytochrome P450)

Answer 820

All types of radiation are complete carcinogens Initiators of oncogenesis Also promoters of oncogenesis through continued exposure Ionising radiation => Direct DNA damage => ROS generation Can result in G to T transversion UV radiation (sunlight) => Pyrimidine dimer formation (can cause cause misreading during transcription or replication)=> ROS generation

Answer 821

Dominant oncogene mechanismMutation in viral gene causes host cells to produce oncoprotein => neoplasia e.g. Feline leukaemia virus, canine papilloma virus Insertional mechanismNo oncogene in virusInsertion of viral DNA into host cells activates proto-oncogenes > oncogenes => neoplasia e.g. Avian leukosis virus

Answer 822

Suppress host immune system DIrectly stimulate host cell proliferation

Answer 823

Neoplasia is a disease characterised by abnormal cell growth It is the result of an imbalance in the mechanisms that regulate cell proliferation Both genetic and epigenetic alterations of somatic cell DNA contribute to neoplastic growth Cancer grows progressively from normal tissue and multiple alterations are required for the onset of malignancy Gain of function in genes that promote cell proliferation (oncogenes) promote cancer Loss of function in genes that oppose cell proliferation (tumour suppressor genes) promote cancer

Answer 824

Pain Visible lump(s) Reduced appetite Vomiting Weight loss Increased drinking Change in toileting Change in breathing/cough Off legs/reluctance to walk Seizures/neurological changes

Answer 825

Can be direct or indirect Direct being compression, obstruction, pain, bleeding Indirect= paraneoplastic syndromes

Answer 826

Caused by products of the tumour cells not the tumour mass

Answer 827

Can be life threatening May help diagnose the primary tumour Can affect response to treatment Affect the QoL

Answer 828

Effusions infection Paraneoplastic syndromes

Answer 829

Endocrine Haematological Gastrointestinal Dermatological Neuromuscular Other

Answer 830

Hypercalcaemia Hypoglycaemia

Answer 831

Associated with lymphoma and anal sac carcinoma Commonly presents as inappetence, polydipsia, vomiting

Answer 832

Associated with insulinoma Commonly presents as weakness, ataxia and seizures

Answer 833

Cancer is the most common cause of hypercalcaemia in dogs and top 3 in cats Caused by parathyroid hormone related protein produced directly from the tumour cells Acts on bones and kidneys to stimulate calcium release into blood

Answer 834

Anaemia Thromocytopenia Coagulopathies

Answer 835

Can be common across cancer types Associated with Lymphoma GI tumours Mast cell tumours

Answer 836

Can be common across all cancer types Mechanisms include Increased consumption Increased sequestration Immune mediated distruction

Answer 837

Common across all cancer types Hypercoagulability Disseminated intravascular coagulation

Answer 838

Ulceration Associated with mast cell tumours Commonly presents as Melaena Haematemesis

Answer 839

Increase histamine relaease Increased gastric acid secretion Ulceration

Answer 840

Epidermal necrosis Alopecia Nodular deramtofibrosis Exfoliative dermatitis

Answer 841

Associated with Pancreatic and hepatic tumours

Answer 842

Associated with sertoli cell tumours in dogs Pancreatic carcinomas in cats

Answer 843

Associated with renal adenocarcinoma (usually in GSDsP

Answer 844

Associated with thyoma in cats

Answer 845

Myasthenia gravis Peripheral neuropathy

Answer 846

Associated with thymoma, osteosarcoma, bile duct carcinoma Commonly presents as muscle weakness and dysphagia

Answer 847

Associated wth multiple cancer types Commonly presents as Weakness -Progressive paraparesis/tetraparesis

Answer 848

Cachexia Pyrexia Hypertrophic osteopathy

Answer 849

Associated with: -Multiple cancer types (Complex mix of cytokines and prostaglandins alter protein, carbohydrate and lipid metabolism) Commonly presents as: -Loss of muscle mass and fat despite adequate nutrition

Answer 850

Pyrexia Associated with: -Multiple cancer types Commonly presents as: -Fever

Answer 851

Hypertrophic osteopathy Associated with: -Lung tumours (primary and metastatic) -Less commonly liver, kidney, bladder tumours Commonly presents as: -Swollen/painful distal limbs -Lameness

Answer 852

rapid periosteal new bone growth affecting distal limbs. Most commonly associated with lung tumours (primary or metastatic)

Answer 853

Only malignant neoplasms (cancer) spread to other parts of body Once cancer has spread, it affects treatment options and prognosis Primary tumours only account for 10% of cancer deaths 90% of cancer deaths are due to cancerous growths at sites in the body distant from the primary tumour

Answer 854

Movement of cancer cells from one tissue or organ to another

Answer 855

Metastases aka ‘mets’ –new cancerous growths at distant body sites Cancer cells break away from primary tumour and usually travel through blood and lymphatic vessels to new tissues/organs Can take years for metastasis to become apparent

Answer 856

Haematogenous Lymphatic Transcoelomic

Answer 857

Most common route for sarcomas Tend to invade thinner-walled veins rather than arteries Ultimately enter lungs and liver

Answer 858

Lymph node(s) closest to the tumour are colonised first These first lymph nodes develop the largest tumour masses E.g. Intestinal adenocarcinoma metastasises first to the mesenteric lymph nodes

Answer 859

Transcoelomic Cancer cells spread across the surface of abdominal and thoracic structures E.g. Mesotheliomas, ovarian adenocarcinomas

Answer 860

Intravasation Extravasation Colonisation

Answer 861

Dependent on the ability of tumour cells to adapt to the microenvironment of distant tissues And the layout of the circulation

Answer 862

Cancer cells reach the bone thrugh the vessels of the marrow They adhere to the specialised stromal cells coating the bone facing the marrow They are attracted by growth factors contained in the ECM Cancer cells activated osteoclasts and osteoblasts at different extents resulting in osteolytic and osteoblastic metastasis

Answer 863

Osteosarcoma Haemangiosarcoma Melanoma Mammary tumours Others (thyroid, tonsillar, pancreatic)

Answer 864

Mast cell tumours Haemangiosarcoma

Answer 865

Mammary tumours Prostatic adenocarcinoma Urinary bladder tumours

Answer 866

Fine needle aspirate and surgical biopsy?

Answer 867

For cytology Examination of cells that have exfoliated from mass

Answer 868

For histopathology Examination of tissue architecture of mass

Answer 869

Incisional best for planning surgery afterwards so can determine margins etc. Excisional best when tumour type is highly suspected and pre-op biopsy will not affect outcome e.g. bleeding splenic mass

Answer 870

Pros Gives an idea of cell type involved and presence of any malignant features Good for external masses where the suspected cell type exfoliates easily (e.g. MCTs) Easy, quick, cheap (usually) Often a good starter to rule ddx in or out

Answer 871

Cons Unlikely to obtain any results for poorly exfoliative tumours (e.g. fibrosarcoma) Cannot grade disease Does not give a prediction of how the tumour will behave biologically or a prognosis Does not allow formulation of a targeted treatment plan

Answer 872

Pros Allows definitive diagnosis Allows grading of disease Contributes to formulation of a targeted treatment plan Gives detail as to margins required at surgical removal Contributes to a prognosis

Answer 873

Grade describes the appearance of the cancer cells and the surrounding tissue Low grade tumours contain organised cells and look more like relatively normal tissue High grade tumour tissue is disorganised and cells look very abnormal

Answer 874

Cranioventral

Answer 875

Fibrino suppurative inflammation

Answer 876

Liver, severe chronic multifocal to coalescing granulomatous hepatitis

Answer 877

Haired skin, severe, subacute multifocal to coalescing dermal infarctions

Answer 878

Brain, sever diffuse acute to subacute suppurative meningitis

Answer 879

Heart, severe diffuse subacute fibrino- suppurative pericarditis

Answer 880

Lung, cranioventral peracute mild agonal blood inhalation

Answer 881

Haired skin, papillomas

Answer 882

anaesthetic complications severe trauma severe electrolyte disturbances hypovolemia vagal stimulation cardiac arrhythmias cardiorespiratory disorders debilitating or end-stage diseases Myocardial hypoxia Drugs and toxins pH abnormalities Electrolyte disturbances Temperature problems

Answer 883

Lack of oxygen delivery to tissues (DO2) Unconsciousness and systemic cellular death Cerebral hypoxia brain death within 4 to 6 minutes

Answer 884

Loss of consciousness Apnoea or agonal gasping No corneal reflex or palpebral reflex No heart sounds No palpable pulse Central eye position Pupils fixed and dilated Bleeding stops at surgical site Mucous membrane grey/blue/white CRT altered (can be normal!) Dry cornea General muscle flaccidity ECG arrhythmias (VF, VT, Asystole, PEA/EMD)

Answer 885

BLS = chest compressions and ventilation

Answer 886

Need LOTS of people EXHAUSTING Need to swop in every 2 minutes AIM highest compression rate you can Throw whole body onto caudo-dorsal lung field Horse needs to be in lateral recumbency on solid surface Success reported in the literature limited

Answer 887

Airway: May need to clear this manually or with suction. Orotracheal intubation with ET tube. Or Emergency Tracheostomy 3-5cm midline incision and blunt dissection. Trachea entered 2-4cm caudal to larynx, ET tube placed between rings. Takes time…. Large Guage Needle with a syringe and ET tube connector for instant access.

Answer 888

Positive Pressure Ventilation (PPV) is required: ET tube connected to AMBU Bag, Anaesthetic machine or a demand valve (Large Animal). Or Mouth-to-snout/nose/mask ventilation. Be careful – you are in full control of the lungs! Tidal volume – approx. 10ml/kg Iatrogenic barotrauma, pulmonary haemorrhage or pneumothorax is easy to do. Ventilation rate – 10 breaths per minute or less Potential for oxygen toxicity considering low cardiac output

Answer 889

Monitoring Obtain vascular access Administer reversals

Answer 890

Capnography – ETCO2 Measures perfusion; movement of carbon dioxide from the tissues to the lungs >15-20mmHg = Good compressions. ECG Allows rhythm assessment – is it a shockable rhythm or not – VF/pulselessVT Does NOT tell you about perfusion/cardiac output Other methods include SPO2% - not very reliable (movement error) Blood gas analysis Venous blood gas samples preferred Blood pressure – not very reliable (movement error) Doppler monitoring of arterial blood flow or direct monitoring

Answer 891

Clinical changes: Pulses – difficult to palpate! Mucous membrane colour Eye position changes (central  ventromedial) Pupil changes size Palpebral, corneal, gag reflex may be noticed Breathing or chest movements (twitches) resume Lacrimation Animal regains consciousness

Answer 892

Cephalic, sephaenous or jugular IV Intraosseous route IO Intratracheal IT

Answer 893

Route of choice for drugs & fluids Tricky during CPCR because of the movement Jugular venous canula is ideal for administration but risk of thrombophlebitis, other veins not as effective but you can ‘flush’ the drug centrally

Answer 894

As rapid as peripheral veins Useful in small animals, very collapsed animals and birds Sites used include the greater tubercle of the humerus, tibial crest or trochanteric fossa of the femur In neonates can be achieved with a needle, however, in older patients with a mature cortex, a drill is often needed.

Answer 895

Dilute and use urinary catheter inserted beyond carina Chest inflations will distribute the drugs Higher doses are needed

Answer 896

Antagonists: Atipamezole – Alpha-2’s e.g. medetomidine Naloxone – Opiods e.g. methadone Flumazenil – Benzodiazepines e.g. midazolam These are primarily drugs used in sedation/premedication or analgesia.

Answer 897

Asystole = flat line. Pulseless Electrical Activity = can look normal – don’t get caught out. More responsive to CPR -> drug therapy to augment this. Adrenaline/Epinephrine Adrenergic agonist – α and β receptors. Positive inotrope and chrono trope. Increases myocardial oxygen demand. α adrenergic effects include peripheral vasoconstriction ‘Shunts’ blood from the periphery to the heart, brain and lungs. Low dose adrenaline is recommended.

Answer 898

Adrenaline Vasopressin Atropine

Answer 899

Causes peripheral vasoconstriction without deleterious effects on myocardial oxygen demand Similar efficacy to adrenaline in dogs (small studies) Meta-analyses in humans have failed to demonstrate an advantage Expensive

Answer 900

Parasympatholytic Evidence does not show a clear benefit Theoretically good for patients with high vagal tone – common in veterinary patients Rabbits can have atropinase as a naturally occurring enzyme so not recommended.

Answer 901

Adrenergic agonist – α and β receptors. Positive inotrope and chrono trope. Increases myocardial oxygen demand. α adrenergic effects include peripheral vasoconstriction ‘Shunts’ blood from the periphery to the heart, brain and lungs. Low dose adrenaline is recommended.

Answer 902

Increased myocardial oxygen demand Increased rate of ROSC No increase in survival rates Can be considered in prolonged arrest - >10 minutes

Answer 903

Administration to euvolaemic patients is associated with reduced coronary perfusion. Only considered in patients with known hypovolaemia

Answer 904

Metabolic acidosis is a common occurrence in CPA Mixed results in experimental studies so considered only in prolonged CPA

Answer 905

More effective than external compressions Requires significant resources both during and especially in recovery Can be considered for intra-thoracic pathology e.g. tension pneumothorax, or if already in surgery

Answer 906

Return of Spontaneous Circulation (ROSC) Capnography – sudden increases in ETCO2 are associated with ROSC ECG – Return of a normal rhythm is not necessarily supportive – PEA Return of consciousness/movement/reflexes

Answer 907

Many patients re-arrest Respiratory optimisation Supportive oxygen +/- ventilation if required Target PaO2 80-100mmHg or SpO2 94-98% Beware hyperoxia and oxidative damage with reperfusion Cardiovascular optimisation If hypotensive – beware fluid overload, so use of vasopressor therapy is sensible Hypothermia Can be beneficial to cardiac and neurologic outcomes – re-warm slowly 0.5oC/h

Answer 908

The practice of pathology as it pertains to the care of patients The subspeciality in pathology concerned with the theoretical and technical aspects of lab tech that pertain to the diagnosis and prevention of disease

Answer 909

Surgical pathology (biopsy) Necropsy

Answer 910

Haematology Clinical chemistry Glucose Haemostasis/ coagulation

Answer 911

Choos ept gauge needle Never dispense blood sample through needle Increases in plasma/serum values of some compounds/ enzymes due to their higher concentration in the RBC Interferes determinations by colorimetry or interference in chemical interactions

Answer 912

Increases or decreases values of some compounds due presence of extra lipid fractions Turbidity caused by the lipids interfering in light detection methods Main changes are Incr in total lipid triglycerides and cholesterol Many determinations either cannot be carried out or results are sig affected

Answer 913

Pre analytical - patient prep, sample prep, shipping Analytical - apt equ and reagents, still working Post analytical- results match patient, apt intervention, diagnostic sensitivity and specificity

Answer 914

Validation of the techniques used Quality control performed before and/or during analysis Only know the equipment was working when the last QC was checked

Answer 915

Precision Repeatability/reproducibility Accuracy Measuring the right thing correctly Specificity (analytical) Different from « diagnostic specificity » Sensitivity (analytical) and range (linearity) When do we need to dilute a sample Others

Answer 916

A control material (known composition) which is treated/ measured as a specimen to check the analytical process is still working correctly. Quality control is performed before or during the analysis to ensure the validity of the result. Should be performed regularly Your analysis is only as good as the last passed QC How many cases do you want to recall/reavaluate? Internal QC: with patient samples External QC (EQA): not contemporaneous

Answer 917

Spot equipment errors Find things the machines cant Bands, metamyelocytes, toxic change nRBC’s, inclusions, parasites Red cell morphology (spherocytes, acanthocytes) Early red cell regeneration (polychromatophils)

Answer 918

Low/Medium power (x10, x20 obj) Orientation, identify 3 zones Feathered edge Platelet clumps, big cells, big parasites Body Rouleaux, agglutination Monolayer RBC density, WBC numbers, Estimated differential

Answer 919

Medium/High power (x40 and x100 (oil) obj) - monolayer Platelet numbers and morphology RBC morphology (small parasites) WBC morphology WBC differential count 3 cell series (RBC, WBC and Platelets) Up to 3 magnifications (x10, x40, x100)

Answer 920

Platelet clumps Big cells Heart worm

Answer 921

Closer look at: Anisocytosis Polychromasia Poikilocytosis Inclusions

Answer 922

Neutrophils Left-shift (bands) Young cells inflammation Distinguish from high neutrophils due to stress Right shift Hypermature Toxic change Vacuolation Blue cytoplasm “Dohle” bodies High demand/septicaemias etc

Answer 923

Remember all 3 series (e.g. do platelets first so don’t forget) Once found monolayer, use battlement approach to ensue aren’t going over the same area again and again Try to stay within monolayer (if dog, should be able to see central pallor)

Answer 924

Small intestine: Enteritis, necrohaemorrhagic, segmental, acute, severe

Answer 925

No this is livor mortis

Answer 926

t is a hemangiosarcoma.

Answer 927

There are multifocal, round, red hairless massess on haired skin.

Answer 928

Left ventricular hypertrophy, diffuse, severes and chronic

Answer 929

Lungs , haemorrhage multifocal to coalescing sever and acute

Answer 930

severe mucopurulent discharge coming from the eyes and nares.

Answer 931

Cerebrum meningioma

Answer 932

Pseudomelanosis

Answer 933

mandible and a melanoma.

Answer 934

it is not a lesion. What we see is oedema.

Answer 935

This is bone, with physis. We see a fracture which is focally extensive, severe and acute.

Answer 936

Haired skin, sarcoma

Answer 937

urinary bladder, there are multiple white gritty crystals.

Answer 938

diaphragm. We see a hernia, focal, severe, acute, with visceral displacement.

Answer 939

duodenum is a focal perforating ulcer with a 1.5cm diameter.

Answer 940

haired skin, on the chin of the cat. We see folliculitis which is multifocal, moderate and chronic.

Answer 941

Thryoid, §Adenomatous hyperplasia, bilateral, sever and chroni

Answer 942

perianal gland. Here we see an adenoma.

Answer 943

Carcinoma Cutaneous histiocytoma Follicular cyst Lipoma or subcut adipose Lymphoma Mast cell tumour Mixed inflammation Neutrophilic inflammation with sepsis Lymph node reactive hyperplasia Sebaceous adenoma Sarcome

Answer 944

The study of cell numebr and type in a tissue mass or fluid accumulation to investigate its cause §

Answer 945

Common cytological specimens include: Fine needle samples Capillary action sample Aspirate Touch imprints Body fluids Lavages

Answer 946

Cytological examination may allow: Differentiation of inflammation from tissue growth (hyperplasia/neoplasia) Differentiation of types of inflammation Detect neoplasia [Malignant vs benign] [Should indicate general type of neoplasm e.g., sarcoma vs carcinoma] [May identify the specific neoplasm] Differentiation of different fluids (exudates, transudates etc)

Answer 947

Sampling is quick, safe and inexpensive: Cells can often be safely retrieved from lesions near vulnerable structures in conscious animals, making anaesthesia & surgical biopsy unnecessary. Sampling demands little equipment or skill(?)* Results can be quickly available

Answer 948

In the detection of neoplasia there are: False negatives: Poor exfoliation of a neoplasm Failure to sample tumour tissue Extensive necrosis/inflammation present (also, a neoplasm may not be well-differentiated enough to allow an accurate diagnosis) False positives: Dysplasia (which can mimic neoplasia) may occur in inflammatory diseases Histopathology provides information on tissue architecture, adequacy of excision, invasion etc and is often the next diagnostic procedure.

Answer 949

FNS Minimal patient prep and restraint Dry, stain, dry in minutes Microscopic review <5mins “bricks” rather than buildings Architecture seldom preserved – cells come through a hypodermic needle Not always conclusive Biopsy More patient prep, restraint anaesthesia as more invasive (Tru-cut, incisional, excisional) Fix in formalin (overnight?) Trim, process (dehydrate) embed in wax, slice, stain, coverslip (minimum 1 day) Architecture preserved (even if obtained by biopsy needle (e.g. Tru-cut) More often conclusive

Answer 950

Inflammation- neutrophilic, eosinophilic, granulomatous Cystic- epidermal, sialcoele, seroma, haematoma Neoplastic- epithelial, round, mesenchymal

Answer 951

Epithelial cells High yield, cells associated with one another, rafts, sheets, acini, cuboidal or culmnar

Answer 952

Spindle/ mesenchymal Low yield, spindle shaped cells, usually single but may be in association/sheets, may be matrix

Answer 953

Round cells High yield, discrete round cells that are non adherent

Answer 954

Neutrophilic inflammation (suppurative acute) - This includes abscesses Pyogranulomatous inflammation Granulomatous (macrophagic, chronic) inflammation Eosinophilic inflammation

Answer 955

histiocytoma Lipoma Adenoma

Answer 956

Trichoblastoma (basal cell tumour) Trichoepithelioma (hair follicle tumour) Squamous cell carcinoma Sebaceous cell tumours (adenoma, carcinoma, epithelioma) Anal sac apocrine adenocarcinoma Perianal gland (hepatoid) adenoma

Answer 957

Arise from connective tissue, muscle, bone & cartilage, nerve, endothelial cells Cells in non-cohesive aggregates or individually Cell borders are variably defined and often indistinct Embedded in matrix Spindle shaped cells with cytoplasmic tails common Cells can be oval or plump

Answer 958

Mesenchymal skin tumour

Answer 959

Adipocytes with small nucleus and abundant (single vacuole/globule) cytoplasm Free fatty droplets NB cells may fall off slides during staining / fixation Avoid methanol fixation (Soln. A) – use soln’s B & C only Consider drop rather than dip Subcutaneous fat appears identical!

Answer 960

Plasmacytoma

Answer 961

Discrete cells Eccentric nuclei Chromatin clumping Perinuclear clear zones Golgi, Ig production

Answer 962

Cytology very useful in evaluation of skin tumours Don’t make assumptions – aspirate all masses Be prepared to take biopsies where results are inconclusive Always interpret in context of clinical history Take lots of smears to increase likelihood of diagnostic smear Don’t be tempted to make a diagnosis from poorly cellular samples

Answer 963

Lymphoma x. The smear has poor stain penetration and colour differentiation. The sample is highly cellular consisting of round cells on a pale basophilic background including RBC's, disrupted cell nuclei and cytoplasmic blebs (lymphoglandular bodies). The rounds cells are lymphoid in appearance (round nuclei with thin rim of cytoplasm). Small lymphocytes are in the minority. Most cells (>50%) are relatively monomorphic large lymphocytes (>2 cell diameters). Poor stain penetration makes nuclear morphology difficult to discern but there may be irregular nuclear borders and conspicuous nucleoli. A disorderly mitotic figure is observed. Rare neutrophils and eosinophils are present.

Answer 964

Lymph node reactive hyperplasia The smear has low cellularity on a clear background of occasional RBC's, disrupted cell nuclei and cytoplasmic blebs (lymphoglandular bodies). The cells are lymphoid in appearance (round nuclei with little or no discernible cytoplasm). There is variation in lymphocyte size but the large majority (>75%) are small lymphocytes with the remainder being intermediate and large lymphocytes.

Answer 965

Follicular (epidermal inclusion) cyst There sample is almost acellular on a background of RBC's and non-degenerate neutrophils (?iatrogenic sampling haemorrhage). There are ill defined basophilic patches reminiscent of keratin content but not intact squames. A large cholesterol crystal is observed.

Answer 966

Sebaceous adenoma viii. The smear contains clusters of adherent cells on a clear background with RBC's. The cells have a roundish monomorphic appearance, eccentric nuclei and abundant foamy cytoplasm. No nuclear atypia nor evidence of inflammation is observed.

Answer 967

Follicular (epidermal inclusion) cyst The smear contains few if any nucleated cells but does have an abundance of anuclear blue staining structures with irregular variably defined angular borders. The morphology is most consistent with keratin/squames. No evidence of inflammation is observed.

Answer 968

Mixed pyogranulomatous inflammation xii. The smear has low cellularity on a lightly proteinaceous background including RBC's. The observed cells are a mixture of mostly degenerate neutrophils, non-degenerate neutrophils and vacuolated foamy macrophages with occasional keratin squames. Infectious agents are not observed.

Answer 969

Mast cell tumour A moderately cellular sample on a background of RBC's and scattered metachromatic granules. Nuclear staining is poor. Cells are all of the same round type, in seemingly non-adherent clusters. Pale staining eccentric nuclei are surrounded by intensely metachromatic granular cytoplasm. The nuclear staining quality prevents further evaluation of nuclear characteristics.

Answer 970

Lymphoma The smear has low cellularity on a lightly staining background with numerous RBC's, cytoplasmic blebs (lymphoglandular bodies) and disrupted cell nuclei. Occasional neutrophils are observed consistent with the degree of background haemorrhage. The cells are morphologically lymphoid, (round with small amount of cytoplasm). Of the intact cells, the majority are intermediate or large in size. Small lymphocytes are in the minority. Irregular nuclear borders and variably conspicuous nucleoli are observed.

Answer 971

Lipoma or subcutaneous adipose iii. Clusters of swollen, rounded cells with abundant pale/colourless cytoplasm; nuclei are compressed to one edge of the swollen cells

Answer 972

Mixed pyogranulomatous inflammation v. The smear is moderately cellular with a pale staining background including debris, erythrocytes and occasional disrupted cells. Cells include degenerate neutrophils and macrophages with foamy/vacuolated cytoplasm.

Answer 973

cutaneous histiocytoma The smear contains scattered small groups of medium-sized, round cells with variably small amounts of pale basophilic cytoplasm. Nuclei are round or oval and either centrally or slightly eccentrically placed. There is moderate anisokaryosis (variation in nuclear size). Rare examples of binucleation and nuclear moulding are observed.

Answer 974

Sarcoma vii. The smear is moderately cellular on a haemorrhagic background. There scattered small groups of individual and loosely associated medium-sized, elongated polyhedral or 'spindle shaped' cells with indistinct cytoplasmic borders. Nuclei are round or oval; contain single nucleoli and there is moderate anisocytosis (2-3x).

Answer 975

Carcinoma The sample is highly cellular with a moderately staining background of debris. Inflammatory cells are not a feature. The cellular population is pleomorphic marked anisocytosis, anisokaryosis, and highly variable N:C ratio. There are occasional examples of cellular adherence but in the main, cells are loosely associated. Bi- and multi-nucleate cells are observed

Answer 976

Carcinoma A moderately cellular sample on a variably staining proteinaceous background including debris and occasional RBC's. Cells are tightly adherent in clusters with often take the form of attempts to create ducts and acini. There is moderately anisocytosis and anisokaryosis and variable but often high N:C ratio. Multinucleation may be present. Inflammatory cells are not a feature.

Answer 977

Neutrophilic inflammation with sepsis The sample is moderately cellular on a background of variably staining debris and some nuclear disruption and nuclear streaming. The cells are exclusively degenerate neutrophils. Coccoid bacteria are observed commonly in pairs or quartets