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Principles of Science > Principles of Clinical Practice > Flashcards

Principles of Clinical Practice Flashcards

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1
Q

In what 3 cases does pattern recognition work best?

A
  1. Clinical pattern is unique for a disorder2. Only a few possibilities that are easily remembered or can easily be ruled in or out by routine tests3. Vet has extensive experience, is well read and up to date, reviews all diagnoses critically and has excellent memory
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2
Q

What are the advantages of pattern recognition?

A

Quick, cost effective and vet looks good and is happy - when correct!

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3
Q

What is pattern recognition very dependent on?

A

Experience, knowledge, memory and whether the clincial signs have been matched correctly to previous diagnosis

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4
Q

What can be the risk of pattern recognising?

A

Tunnel vision - excluding all data that doesn’t “fit” and focusing on one’s hunch

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5
Q

What can pattern-based tunnel vision investigations possibly result in?

A

Wasted time, money and patient endangerment

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6
Q

Give examples of organs where significant pathology can occur without biochemical or haematological changes

A

Gastrointestinal TractNeuromuscularCardiorespiratorySpleenBrainLiver - especially catsPancreas - especially cats

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7
Q

Why can reliance on blood tests to confirm diagnoses be problematic?

A

Results don’t clearly confirm a diagnosis so time is wasted ans well as clients money without direction towards actual problem

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8
Q

Describe problem-based clinical reasoning

A

Each significant clinical problem is assessed in a structured manner beforebeing related to the other problems

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9
Q

What are the 5 essential steps in problem-based clinical reasoning?

A
  1. Construct a problem list2. Define the problem3. Define the system (How may it be inolved)4. Define the location with the system5. Define the lesion
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10
Q

How does a problem list benefit the vetenarian?

A

Helps make explicit clinical signsTransforms vague to more specificPrevents overlooking less obvious but crucial signsClarifies obvious differences in chronology of clinical signs or clues that suggest more than one disorder

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11
Q

What is the first question to ask when defining and refining a problem?

A

Is there another clinical sign that this problem could be confused with?

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12
Q

What is the main difference between vomiting and regurgitation?

A

Vomiting is an active process while regurgitation is passive

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13
Q

When the owner says their pet has diarrhoea, what else could this possibly be?

A

Discharge from the genital tract or anal sacs

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14
Q

What is the most important question to ask when presented with weight loss?

A

Is the animals appetite normal or reduced?

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15
Q

What can differ between problems that present similarly and why is it important then to define and refine the problem?

A

Range of diagnoses to consider, diagnostic tools and treatment or management optionsImportant as can waste time and money delaying treatment, prolonging disease and suffering and potentially endanger patient’s life

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16
Q

What is the different between primary and secondary involvement of a system in diagnosing?

A

Primary is a structural problem within the system that must be involvedSecondary is a functional problem within the system caused by a pathology outside the system

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17
Q

How does investigation of primary and secondary problems differ?

A

Primary usually involves imaging system or biopsySecondary haematology and biochemistry are often more important

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18
Q

What alternative question could be asked for problems instead of system based?

A

Is the problem local or systemic?

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19
Q

Why is identifying the location within a system usually important?

A

Will allow selection of most appropriate method to move onto the next step

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20
Q

What are the 8 types of pathology that can occur?

A

DevelopmentalDegenerationInfectionInflammationNeoplasiaNutritionalTraumaToxic

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21
Q

What does the type of pathology depend on when defining lesions?

A

Body system/organ involvedSignalment of the patiantGeographic locationWhat’s common within the population

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22
Q

What diagnostic tool is most useful for determing whether an animal is vomiting or regurgitating?

A

Radiographs - useless for vomiting but vital for regurgitation

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23
Q

What 6 things can maximise success in small animal examinations?

A

ThoroughnessGood rapport with ownerGood rapport with patientKnowing what’s normal for the speciesKnowing what’s normal for the breedKnowing the patient

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24
Q

What should you do when an owner enters the examination room?

A

Introduce yourselfGreet the animalMake sure you get gender and name right

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25
What should you do before starting the physical aspect of the examination?
Look from a distance - locomotor and skin problemsListen as well - respiratory problems
26
What 5 things should you look for abnormalities in when in contact with the animal
SymmetryShapeSizeTexturePatient Response
27
Aside from the physical condition of an animal what else can suggest a problem?
The patient's demeanour
28
What is the normal temperature range for dogs and cats?
37.5-38.5 degrees Celcius
29
What are the normal pulse rates for dogs and cats in consults?
Dogs - 60-120 bpmCats - 180-200 bpm
30
What is the normal respiratory rate for dogs and cats in consult?
12-30 breaths pm
31
What is body condition scoring?
A system used to determine quantitively whether an animal is too fat or too thin
32
What should be looked for in the ears during a physical examination of a small animal?
Hair or wax blocking ear canalSigns of infection
33
What things should the eyes be checked for in the physical exam of a small animal?
Signs of painIncreased blinking (Blepharospasm)Retraction of the eye (Enophthalmos)Excessive tearing (Lacrimation)Photophobia
34
What things should be assessed when examining the mucous membranes?
Colour - can be breed dependentCapillary refill time (1-2 seconds)Hydration - dry or moist
35
How can the hydration status of an animal be assessed during the physical exam?
Skin turgor - pinch and it doesn't return to normal (not an accurate test of hydration)Eye positionMucous membranes
36
What should the submandibular lymph nodes feel like?
Peanuts that you can get your fingers all the way around
37
Describe how you would listen to the heart during a small animal physical exam
Listen on both sides of the thorax in the 3-5th intercostal spaces
38
Describe the process of lung auscultation during a small animal physical examination
Noughts and crosses - evaluate all lung fieldsCompare sidesCompare dorsal to ventralAll lung fields should have breath noises
39
Describe the process of abdominal palpation and what you would feel during a small animal physical examination
Systematic thorough approach starting slowlyCranial - Liver, spleen, stomach and kidneysMiddle - Intestinal loopsCaudal - Bladder, prostate and colon
40
What are the two pulses that should be checked and which can give an indication of circulation problems?
Femoral artery and metatarsal arteryMetatarsal pulse disappears faster than femoral pulse so if absent can be sign of problems
41
Describe the process of a reproductive examination of small animals
Look at external genitalia - protrude the penisRectal examination - feel for the prostate, uterus, urethra, pelvis, sublumbar lymph nodes, faeces, anal sacs and foreign material
42
How can the orthopaedic system be assessed in clinical exams of small animals?
Assess to begin when animal walks in - usually owner will be concernedCan feel joints and bones for pain or swelling
43
What two systems really only need to be assessed when there is evidence of abnormalities already present?
Neurological and dermatological
44
How does the physical exam of the cat differ from that of the dog?
Generally quieter in the clinicMucous membranes are paler and more difficult to assessMust palpate thyroid glands in every catParasternal auscultation importantCan palpate kidneys
45
How would you find the thyroid gland in the cat?
Pinch thumb and fingers around larynx and move towards thoracic inlet
46
What constitutes an emergency?
Any illness or injury where the owner thinks urgent veterinary attention is required - may not be life-threatening and can be trivial
47
What should be the first step when assessing an emergency?
A - Airways - is there a patent airwayB - Breathing - is the animal making useful breathingC - Circulation - is there a heart beat with pulses
48
What should be included in a capsule history?
Age, breed and sexPrimary/chief complaintDuration of problemAppetite, water intake and activity levelVaccination statusCurrent medications - both prescribed and not
49
What are the three major body systems that should be assessed during an emergency?
CardiovascularNeurologicalRespiratory
50
What 5 things are used to evaluate the cardiovascular system?
PulsesMucous membranesHeart rateCapillary refill timeCardiac auscultation
51
What can poor perfusion lead to?
Shock
52
What factors can complicate pulse evaluation?
Femoral fracturesIrritable animalsObesityHeavy muscling
53
How does mucous membrane colour and refill time differ with blood volume?
Hypovolaemic - paler with longer refill timeHypervolaemic - pinker with quicker refill time
54
What happens the more hypovolaemic you become?
Heart rate increases (tachycardia)Mucous membranes become palerCapillary refill time increasesPulse amplitude decreasesPulse duration decreases
55
What are the most common conditions that change clinical haemodynamic parameters?
HypovolaemiaAnaemiaSepsis/inflammatory response syndromeAbnormal cardiac function
56
How can a normovolaemic animal's pulse profile vary and why?
When stressed or in pain pulse profiles are slightly higher and narrower than resting animals
57
What do heart rates in excess of 220 bpm raise suspicions of?
Primary arrhythmias
58
What three things should be done when evaluating the respiratory system?
Watch the patient from afar - assess respiratory pattern and degree of effortListen without stethoscope - audible noiseListen with stethoscope - localise abnormal noises
59
What five parts of the respiratory system must be evaluated?
Upper airwaysSmall airwaysPulmonary parenchymaPleural spaceChest wall and diaphragm
60
Describe the postural manifestations of dyspnoea (shortness of breath)
Extended neckAbducted elbowsOpen-mouth breathingAnxious facial expressionIncreased abdominal movementParadoxical abdominal movement
61
What happens to lung sounds with increased effort?
Get louder
62
Describe the respiratory pattern and auscultation with upper airway pathology
Increased inspiratory effort in respiratory patternLoud referred airway noise
63
Describe the respiratory pattern and auscultation with lower airway pathology
Increased expiratory effort with the respiratory patternWheezes during auscultation
64
Describe the respiratory pattern and auscultation with pulmonary pathology
Some increased inspiratory effort but with mixed patternsHarsh sounds or crackles upon auscultation
65
Describe the respiratory pattern and auscultation with pleural space pathology
Shallow breathing respiratory patternDull and distant lung and heart sounds upon auscultation
66
Describe the respiratory pattern and auscultation with neurological pathology
Irregular and often slow respiratory patternQuiet auscultation due to reduced gas movement
67
What are the four classifications of mentation?
Alert and normally responsiveObtunded - depressed/mentally dull but rousableStuporous - rousable only by painful stimuliComatose
68
When defining the problem of weight loss, what 3 things must be considered?
Muscle atrophy - severe muscle wasting can result in loss of body weightCaloric intake - is the animal eating enough for its age and activity levelsPalatability - has the diet changed causing uninterest in food
69
What two possibilities are there when refining weight loss?
Weight loss associated with decreased appetite - appetite becomes problemWeight loss associated with normal or increased appetite - weight loss is the pathological condition
70
What two groups can weight loss due to decreased appetite be grouped into?
Can't eat Won't eat
71
What is the feeding-satiety centre in the hypothalamus influenced by and how can they cause anorexia?
Blood glucose levels - low causes hungerBody temperature - both high and low cause hungerMetabolic products - liver and kidney failureNeural input from GIT - inflammation and infection causing distensionSubstances released by neoplasia - cytokines and inflammatory mediatorsPsychic factors - seperation anxiety (Chihuahuas especially)Direct CNS pathology - tumours, inflammation and infection
72
What must we define when faced with anorexia?
Whether it is a primary CNS or secondary CNS caused by other factors (far more common)
73
What other signs of disease should we find with an anorexic patient most of the time?
PyrexiaMasses - abdominal tumours/lymph nodesSevere constipationSevere heart diseaseAnaemia - check mucous membranesIcterus - mucous membranes yellow
74
What are 8 causes of anorexia?
Endogenous toxins - inside body (liver/kidney)Exogenous toxins - outside bodyPyrexia - infection, inflammation etc.Electrolyte disturbance - Ca, Na and K out of reference rangeHepatic diseaseNeoplasia - cytokinesPsychic factorsPrimary CNS disease
75
What two things should be ruled out before refining weight loss with normal/increased appetite?
Extra exerciseChange in diet
76
What 3 things should we consider when faced with weight loss with normal/increased appetite?
Maldigestion - normal digestion impairedMalabsorption - normal digestion but cannot be absorbedMalutilisation - nutirents digested and absorbed but can't be used properly within the body
77
What are the 4 ways that maldigestion can occur?
Exocrine pancreatic insufficiencySecondary enzyme deficiencyBile acid deficiencyLoss of brush border enzymes
78
What is the most common cause of maldigestion and how does it occur?
Exocrine pancreatic insufficiencyPancreas not producing enough digestive enzymes meaning that digestion cannot occur effectively
79
Describe how bile acid deficiency can cause maldigestion
Bile acid is important to help break up and emulsify food (especially fats) Liver disease can cause blockage of the bile duct and thus causing deficiencyNo bile means fat broken down less effectively
80
What are the two ways that malabsorption can be refined further?
Structural disease of GI (primary) - most commonMetabolic disease making absorption more difficult (secondary GI disease)
81
What are 5 primary GI diseases that can cause malabsorption?
Inflammatory Bowel Disease (IBD)LymphangiectasiaGastrointestinal lymphomaSmall intestinal bacterial growthDry feline infectious peritonitis
82
What is inflammatory bowel disease?
Gut reacting to the immune system
83
What is lymphangiectasia and what is more commonly secondary to?
Dilation of lymph vesselsSecondary to IBD most commonly
84
What are 3 clinical signsof malabsorption?
Weight loss - despite normal/increased appetite but can be fussy eating with decreased appetiteDiarrhoea - unusual not to have this with malabsorptionCoprophagia - sometimes eating faeces as nutrients in food (more common with maldigestion)
85
What are 3 causes of malabsorption due to a secondary GI disease?
Hepatic disease - bile acids important for digestion and absorptionRight sided cardiac disease - tension on portal veinHyperthyroidism - gut transit time increased and less time for absorption also due to increased metabolic rate
86
What are the 2 things that can occur with malutilisation?
Failure to use nutrients appropriatelyLoss of nutrients after absoprtion
87
What should assist in narrowing the focus of a malutilisation case and what is usually not a significant feature?
History and physical examinationDiarrhoea not usually significant except in hyperthyroidism
88
What are 7 diseases where malutilisation occurs?
Diabetes mellitusCongestive heart failureDirofilariasis - heart wormNeoplasiaHyperthyroidismLiver disease - usually appetite decreased thoughRenal disease - protein losing nephropathy
89
Which 2 diseases causing malutilisation usually present with an increased appetite?
Diabetes mellitusHyperthyroidism
90
What is the formula for calculating the normal caloric requirement for a normally active dog or cat?
[(30xweight in kg)+70]x1.2
91
What is a rough guideline for the caloric contents of pet food?
1 cup of standard dry food = 400kcal400g wet food = 360kcal
92
What is usually the first indication to an owner that something is wrong with their pet?
Loss of appetite as owner aware of amount of food their pet eats
93
What can occur in cats particularly that could be a cause of anorexia?
Loss of smell
94
What are prehension and mastication difficulties most often associated with?
Disorders of the mouth and pharynx
95
What are some examples of local disorders of the mouth?
InflammationUlcerationForeign bodiesDental diseaseNeoplasms
96
What is dysphagia indicated by?
Excessive, forceful attempts to swallowRegurgitation of food from mouth or nostrils
97
What 4 things can dysphagia be due to?
Local disorders of tongue or phaynxPalatine abnormalitiesNeurological disorders with glossopharyngeal, vagus or hypoglossal nerves - rareCricopharyngeal achlasia - rare
98
What is a key question when inflammation is noted?
Is the cause due to local disease or systemic disease?
99
What systemic disorders can cause inflammation?
Uraemia due to renal failureViral infections in catsAutoimmune disordersNeutropenia - drug or bone marrow failure
100
What are some examples of local disorders that can cause inflammation?
IrritantsForeign bodiesDental diseaseEosinophilic complex of catsLymphocytic/plasmacytic stomatitis (inflammation of the mouth)Neoplasms
101
What is the most appropriate approach with an animal that hasn't eaten for 24-48 hours but is in good condition and what is it important to determine?
Wait and see approach - if serious will develop other clinical signsDetermine whether diet changed or environmental changes
102
What will animals with maldigestion usually present with?
Grossly abnormal gaeces and significant weight loss despite a normal or greatly increased appetite

Principles of Science (9 decks)

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