Week 1 & 2 Intensive Flashcards

Question

Answer 1

Miller's knot- type of simple (circumferential) ligature that is particularly useful for ligating a vascular pedicle-- binds itself as it tightens

Answer 2

\* Smaller patients (surface area to volume ratio)

Answer 3

\* composite of a number of SDS-- relating to particular aspects of behaviour associated with pain (pictorial... behaviour/demeanor) \* May also have a physiological component

Answer 4

Femoral/pelvic fractures Fractious animals obesity, heavy muscling, jack russels

Answer 5

\* Supraspinal - loss of consciousness - amnesia - analgesia - attenuation of autonomic responses \* Spinal - muscle relaxation - analgesia - attenuation of autonomic responses

Answer 6

\* Haematocrit= RBC count x RBC volume- calculated in the analyzer \* Packed Cell Volume- spin the tube down and measure how much red cells make up the total volume of plasma

Answer 7

\* Sensitizes the myocardium to catecholamine \* emesis (more frequent than romifidine or medetomidine)

Answer 8

\* Neuro: decreases cerebral metabolic consumption, dialtes cerebral vasculature, can increase ICP \* Resp: decreases minute volume, increase PaCO2, airway irritant (coughing and laryngospasm), effective bronchodilator, apnoea occurs when anaesthetic depth is excessive \* CV: decreased CO, reflex increase in HR, decrease in cardiac contractility and SV, decreased BP, large decrease in vascular resistance, profound hypotension when anaesthetic depth is excessive \* Good muscle relaxation \* No significant analgesia

Answer 9

\*DO NOT drop Na+ by \> 0.5-1 mmol/hr or \> 12 mmol/24 hours

Answer 10

\* Urea synthesis, cholesterol synthesis, albumin synthesis, glucose synthesis, bilirubin conjugation, bile acids uptake and excretion, ammonia uptake and metabolism

Answer 11

\* Multimodal, limit development of peripheral sensitisation and central sensitisation, block neuroendocrine response, reduce major complications, improves outcome

Answer 12

Tumour type, grade and stage

Answer 13

\* high therapeutic index \* lack of cumulation in the body (ideal for CRI) \* rapid, complete recovery of consciousness \* lack of irritant effects and activity when given peri-venously (IM/ SC)

Answer 14

Conjugated means it has been processed through the liver. Unconjugated is the form straight from haemoglobin \*\* not terribly helpful, but it can help if elevated bilirubin and almost entirely unconjugated that's when you think pre-hepatic... by the time we diagnose, it is usually a mix of the two

Answer 15

\* Excellent agents for sedation in the "poor risk" patient, alone or with opioid drugs BUT unreliable in "healthy adult" patients \* increase muscle relaxation during anaesthesia \* offset muscle hypertonicity caused by ketamine \* stimulate appetite in anorexic patients \* treatment of seizures \* decrease dose of induction agent

Answer 16

\* Describes intensity of pain \* No pain, mild, moderate, severe \* Not very sensitive

Answer 17

\* Signs of severe shock \* Weak pulse, not breathing \* Dilated pupils \* Reflexes are absent \* lost control of sphincter tones

Answer 18

\* secretions of large volumes of saliva e.g. 50 L of saliva in 24 hours.... consequence: potential airway obstruction or aspiration \* Regurgitation- possible aspiration of ruminal contents \* positioning: compression of the diaphragm-- lateral or dorsal recumbency... consequences: decrease in ventilation, increase ventilation- perfusion mismatch, hypoxaemia and hypercapnia \* Compression of the major abdominal vessels: dorsal recumbency, abdominal viscera, decrease venous return, decrease CO, decrease BP \* Tympany: due to impaired eructation-- gas produced through continuous fermentation of ingesta accumulates in the rumen-- caused by lateral or dorsal recumbency, heavy sedation and anaesthesia.. consequences: respiratory distress, decreased CV function

Answer 19

\* dissociative anaesthesia \* amnesia/ hallucinations in recovery \* analgesia (somatic \> visceral) \* immobility \* GABA and NMDA receptors \* increased ICP \* may cause seizures \* CV: direct negative inotropic effect in vitro, increased sympathetic tone in vivo, increased HR, contractility, CO, and arterial BP, increased myocardial oxygen demands \* Resp: apnoea, bronchodilation, apneustic breathing \* increased muscle tone \* Pain on injection

Answer 20

\* Anaerobic infections \* Particularly mouths, osteomyelitis, peritonitis \* Can use as a flush \* Flagyl- often use human brands

Answer 21

Ribbon malleable retractors

Answer 22

\* Rigorous training \* Full PPE- mask, gowns, hood \* Closed system- minimum aerosolization when administered

Answer 23

1. Diagnosis- cell of origin 2. Grade (invasion, Mitotic Index (MI)) 3. Assessment of adequacy of margins

Answer 24

Hypertonic ECF \* Hypertonic dehydration

Answer 25

Measures of solubility in blood and tissues at a given temperature (37C) \* The ratio of inhalation anaesthetic concentration in two compartments or tissues (blood:gas)

Answer 26

\* plasma concentration decreases rapidly as a result of both distribution out of the vascular space and elimination \* Recovery depends upon distribution and elimination of half lives

Answer 27

\* Pre-existing respiratory depression \* head trauma \* pancreatitis

Answer 28

\* Prednisolone, Dexamethasone \* Reduces inflammation \* Significant systemic side effects: delayed wound healing, abortion in the last trimester, laminitis \* Long duration of action (12-24 hours)

Answer 29

\* Signalment: patient, wider system (e.g. farm) \* History: disease distribution? time & space; are there associations with events, places, things that suggest RISK FACTORS \* Clinical exam of: Animal (are there other cases? Environment; Management (e.g. examin records) \* Further tests and special examinations: rule ddx in or out (during process or to finalize it); use response to treatment

Answer 30

\* temperatures similar to field conditions with temperature variation allowing the animal to choose its thermal environment (thermoregulate)

Answer 31

\* A collection of component changes in behavior and perception \* Components of the anaesthetic state including loss of consciousness, amnesia, analgesia, muscle relaxation, and attenuation of autonomic responses

Answer 32

\* LRS, Normosol- R, Plasmalyte-148 (all are balanced isotonic) \* all contain buffers (lactate, acetate, gluconate) and have lower chloride concentrations \* ideal initial fluid therapy while test results pending as the vast majority of illnesses result in metabolic acidosis e.g. uremic acidosis, ketoacidosis, lactic acidosis

Answer 33

Stypics e.g. silver nitrate (only use on nails as causes pain and burns tissue), potassium permanganate \* Porcine gelatin sponges-- swells and causes tamponade \* Oxidized regenerated cellulose- forms gelatinous clot on contact with blood, creating mechanical tamponade and barrier to bleeding, bactericidal, absorbed over 2-6 weeks \* Bone wax- sterile beeswax with softening agents, creates mechanical barrier to bleeding (difficult to adhere to bleeding bone), often used in spinal surgery... inhibits bone healing-- do not use on fractures or sternotomies \* Bovine collagen- mechanical tamponade plus enhances platelet aggregation \* Polysaccharide spheres- swelling provides tamponade/ mechanical barrier \*

Answer 34

I know what that is and exactly what causes it

Answer 35

Is it pre-hepatic, hepatic, or post-hepatic?

Answer 36

\* Medullary hypotonicity or impaired ADH action can mimic renal failure - Hypochloridemia due to upper GIT obstruction - HypoA - HyperA

Answer 37

\* Treatment- known infection \* Prophylaxis- not currently ill with a particular disease, but at high risk of acquiring an infection \* Metaphylaxis- mass medication of a group of animals, in advance of an expected outbreak of disease Minimise resistance by: \* appropriate antibiotic choice \* Appropriate antibiotic use \* Minimizing use

Answer 38

\* Food at least 8 hours \* Water for at least 2 hours

Answer 39

\* Lymphoma \* Mast cell tumours \* Multiple myeloma \* Nasal tumours \* Transitional cell carcinoma (bladder/urethra) \* Haemangiosarcoma \* Osteosarcoma \* Other solid tumours as adjunctive therapy

Answer 40

If relatively acute in onset, can replace first half of deficit over 6-8 hours and remainder over 16-18 hours. \* if relatively chronic (days) or acute can also replace at a consistent rate over 24 hours (or more if necessary) \* cardiac dysfunction, oliguric/anuric renal failure, other forms of fluid intolerance e.g. vascular leak

Answer 41

\* Normal RR= 15-25 bpm \* Normal respiratory pattern: - diaphragmatic contraction 70-80% of a resting inspiration - diaphragmatic contraction results in passive abdominal movement - on inspiration chest and abdomen move out together

Answer 42

\* Neuro: decreases cerebral vasculature, can increase ICP \* Resp: decreases minute volume (ventilation), increase in PaCO2, effective bronchodilator, apnoea occurs when depth is excessive \* CV: decreases CO, decrease in myocardial contractility and SV, CO is lower than iso, decrease in BP mainly due to decrease in CO, BP is higher than iso \* Good muscle relaxation \* no significant analgesic

Answer 43

\* Proto-oncogenes: Tumour cell growth is mediated by proto-oncogenes that can arise spontaneously or during the development of the tumour. Effects that increase growth of cells to avoid apoptosis. May alter the function of cells that develop during cancer. \* Tumour suppressor genes: Proto-oncogenes counter acted by tumour suppressor genes that discourage growth-- so there is a balance.

Answer 44

70-80% of normal tissue

Answer 45

An inflammatory leukogram (no left shift, but toxic change)

Answer 46

\* legally prescribing and dispensing an appropriate active ingredient that gets to the site of infection at levels above the MIC for an appropriate period, taking into account: \* prudent use of antibiotics \* cost \* Compliance \* Drug interactions

Answer 47

\* Diagnosis: biopsy \* Tumour staging- LN, distant organ biopsy \* Curative surgery- local tumour control \* Palliation- advanced diseaes for quality of life (splenectomy for haemangiosarcoma, life expectancy is 3 months... amputation for pathological fracture) \* Prevention- OHE to prevent mammary cancer \* Cytoreduction as part of multimodal therapy- radiation/ chemotherapy/immunotherapy

Answer 48

\* Acepromazine: sedation, no muscle relaxation or analgesia, significant CV side- effects: vasodilation and hypotension, use with caution in stressed or hypovolemic horses, long duration of action: half-life: 3 hr \* Diazepam: reliable sedation in foals, unreliable sedation in adults, excellent muscle relaxation, no analgesia, few CV side effects, poor IM absorption, long duration of action half-life 9.7 hours

Answer 49

\* Amount of drug per unit time \* Can be increased by increasing dosage at particular administration \* Can be increased by shortening time interval \* Optomising dose intensity improves outcome

Answer 50

\* Physiological pain (or adaptive pain)- warning for potentially harmful stimulus, localized and transient \* Pathological pain- tissue damage has occurred, ongoing pain... acute (pancreatitis) or chronic (inflammation of a joint)

Answer 51

\* \> 90% cornified cells marks beginning of "cytological oestrus"; superficial and anuclear squamous cells (anuclear, largest vaginal epithelial cells, resemble "cornflakes") \* bacteria can be present \* BUT no neutrophils should be present

Answer 52

\* Butorphanol: kappa agonist, mu antagonist, analgesia (visceral), no sedation or muscle relaxation, CV side effects, limited effect on GI motility and transit time, short duration of action (1-2 hours) \* morphine: mu, kappa, delta agonist, analgesia (somatic), no sedation or muscle relaxation, significant behavioral and CV side effects at higher doses, effect on GI motility and transit time, short duration of action (2-4 hours)

Answer 53

(Anatomy: testicles L3 and L4; scrotum S2, S3, S4, S5) \* Intratesticular: Lidocaine 2-4 mL/100 kg/site \* Spermatic cord: Lidocaine 1-2 mL/100 kg/ site \* Scrotum: Lidocaine 1-2 mL/100 kg

Answer 54

\* Platelet clumping can show low on the analyzer \* Lipaemia- can falsely inscrease total solids, Hb, MCH, and MCHC

Answer 55

\* use of suture material and surgical knots to occlude blood vessels-- vascular strangulation \* Simple (circumferential)- after applying haemostat, elevate it away from the tissue to place ligature around clamped vessel-- strangulation used with a simple knot and safety against slippage is ensured by the double knot \* Transfixation- usually used on pedicles, sometimes in combination with simple (circumferential) ligatures

Answer 56

\* Bladder and ureters \* Prostate or uterus/ ovaries \* Open omental bursa to visualize L limb pancreas

Answer 57

\* Use the least potent/ effective drug first \* If you use the best drugs first and there are cells resistant to that drug then you only have the worst drug to use against those tough cells

Answer 58

Inactivated by organic material \* Chlorhexidine gluconate- works in the presence of organic materials & alcohol works but reduced efficacy in the presence of organic materials

Answer 59

\* Induction and arousal from anesthesia depends largely on redistribution not from metabolism \* hepatic metabolism 5% total dose is metabolised per hour

Answer 60

Greater tissue drag, increased tendency for bacterial colonization due to interstices between strands-- should be avoided in contaminated environments

Answer 61

\* HR from ECG (normal QRS complexes, Is there a P wave in front of every QRS?, Is there a QRS after every P wave?), pulse oximeter, stethoscope \* BP related to CO and to vasomotor tone

Answer 62

Hendra virus is an enveloped RNA virus that is classed as a Category A and is sensitive to soaps/detergents and many disinfectants

Answer 63

Liver function is okay... we know there is liver damage though, so it has to be hepatic.

Answer 64

Mayo-hegar needle holder

Answer 65

4% Chlorhexidine Gluconate \* Broad spectrum gram positive, lesser extent gram negative \* Not sporicidal, some viruses \* acts by altering the bacterial cell wall and precipitates intracellular contents \* Immediate action with ongoing residual action by binding to keratin \* Active in the presence of organic matter

Answer 66

\* solute is lost in excess of water \* results in hypotonicity of the ECF (hypotonic dehydration) \* hyponatremia, hypoosmolality\*\* neurons do not like to be swollen so they pump out molecules \* e.g. severe burn injury, hyperadrenocorticism, iatrogenic \* CNS effects: chronic hyponatraemia--\> decrease in neuron idiogenic osmoles to match ECF tonicity - rapid correction of ECF hypoosmolality--\> neuron shrinkage!! Causes demyelination known as central pontine myelinolysis or osmotic demyelination syndrome

Answer 67

Similar loss of solute and water \* No change in ECF osmolality and no fluid shifting \* Na+ and osmolality remain within normal limits e.g. haemorrhage, vomiting, diarrhoea

Answer 68

1. Penicillins 2. Cephalosporins 3. Macrolides 4. Aminoglycosides 5. Tetracyclines 6. Sulfonamides

Answer 69

\* control the speed at which the anaesthetic concentration can be changed

Answer 70

\* sepsis: presence of pathogens (or their toxins) in tissues \* aspepsis: the absence of microorganisms in living tissue \* antisepsis: prevention of sepsis by the destruction or inhibition of microorganisms \* antiseptic: a chemical agent that either kills pathogenic microorganisms or inhibits their growth

Answer 71

\* contact with intact skin \* exam tables, BP cuffs \* clean as necessary with detergent and water

Answer 72

\* Body surface area \* Metabolic basis, presuming smaller animals have faster excretion etc.

Answer 73

\* bathe the patient pre-op with 4% chlorhexidine scrub solution 1. Pre-wash- 0.5 % chlorhexidine gluconate 2. Removal of detergent- 70% alcohol spray 3. Application of an approved surgical skin antiseptic product- 0.5% chlorhexidine tincture (CHG) spray OR providone iodine and alcohol

Answer 74

\* Severe haemorrhage leads to hypotensive shock \* Bleeding obscures the operative field \* Blood within the operative field irritates tissue, prevents tissue apposition, delays healing and potentiates infection \* Blood on instruments, drapes and tissues is an ideal medium for bacterial

Answer 75

Identify the main problem - identify body system associated with signs - identify lesion in the body system - identify aetiology/agent likely to cause lesion

Answer 76

\* too small staple- won't incorporate all layers and may cause ischaemia to wound edges \* too large they may not achieve adequate tissue apposition or haemostasis

Answer 77

Epidural Anaesthesia: (Anatomy: Spinal cord ends below S1 or S2, epidural space, subarachnoid space) \* Intercoccygeal epidural (C1-C2): Lidocaine: 1 mL/100 kg \*Complications severe ataxia and excitement if pelvic plexus nerve roots blocked (L5- S2) Epidural Analgesia: (Anatomy: spinal cord ends below S1 or S2, epidural space, subarachnoid space) \* Intercoccygeal epidural (C1-C2) \* Strict aseptic technique \* Morphine: 0.1 mg/kg diluted in saline (4-6 mL/100 kg)

Answer 78

\* Treatment should begin when tumour cell population is smallest \* Multi-drug protocols minimize likelihood of resistance \* Drugs should be administered at the maximum tolerated dose

Answer 79

\* Ketamine: NMDA receptor antagonist, dissociative anaesthetic, analgesia at subanaesthetic doses, poor muscle relaxation, limited CV side effects, very short duration of action (20 minutes)

Answer 80

Look at albumin when interpreting Calcium. Most of total calcium is albumin bound. \* Think about the balance- absorbed from the GIT, deposited in bone or resorption depending on need, renal excretion, leakage from cells (phosphate) \* Consider hormones PTH, vitamine D, PTHrP

Answer 81

\* CBC: anaemia, inflamm \* Biochem: colloid oncotic pressure (albumin), hepatic function (SDH, GGT, bile acids), renal function (BUN, creatinine), Muscle enzyme abnormalities (CK, AST), Electrolyte abnormalities (Na, K, Ca, Cl), Tissue perfusion (Lactate) \* Urinalysis (renal function- specific gravity) \* Diagnostic imaging

Answer 82

Synthetic, monofilament, non-absorbable or synthetic absorbable (long acting)

Answer 83

Yankauer suction- large volumes from abdominal cavity or thorax-- not fine dissection Frazier Ferguson- can place index finger over hole and varies the suction Poole- multiple opening at its tip which reduces plugging problems encountered with omentum and removal of fluid from abdominal cavity (disposable available)

Answer 84

Dog \> 20 kg= '0' suture gauge Small dog/ cat- 3/0--\> 2/0

Answer 85

\* Respiratory rate \* Respiratory effort \* Auscultation

Answer 86

\* Round cell tumours: Prednisolone \* Carcinoma/sarcoma: Piroxicam or meloxicam

Answer 87

Sedation and muscle relaxant: \* Diazepam or midazolam Analgesia: \* Butorphanol \* Buprenorphine (longer duration of action)

Answer 88

Stainless steel, titanium (reduced CT/MRI artifact), absorbable

Answer 89

100% eliminated unchanged by the lungs \* Vitamin B12 deficiency with prolonged exposure (megaloblastic anaemia, polyneuropathy)

Answer 90

\* Selective Serotonin Reuptake Inhibitors (SSRI) \* Tricyclic Anti-Depressants (TCAs) \* Clomipramine \* Tazodone (SARI- Serotonin 2 A Antagonist Re-uptake Inhibitor) \* Beta blockers- propranolol- blocks adrenergic activity-- useful in combination with an SSRI or TCA \* Noise phobias: Benzodiazepines or Trazodone (SARI)- best used prior to the noise event

Answer 91

\* Weight loss despite adequate nutritional intake because glucose is the main substrate for tumours (tumours can't use lipids) - high energy conversion to lactate and back - protein (muscle mass) broken down to supply amino acids \*\* Poor prognostic indicator

Answer 92

\* Dogs 80-120 bpm \* Cats 160- 220 bpm \* \> 220- 240 is usually an arrhythmia \* Heart sounds are quiet with hypovolaemia

Answer 93

\* Controls the maximum anaesthetic concentration that can be reached

Answer 94

\* Synergistic effects \* Produces reliable "safe" sedation \* Reduces dose of induction and maintenance agent \* Pre-emptive analgesia

Answer 95

\* heart disease, pulmonary disease, sodium derangements, hypoalbuminaemia, severe anemia, oligoanuric renal failure, TBI, vascular permeability, underlying disease (Addison's, DKA, FUO)

Answer 96

\* Cornual branches of the zygomaticotemporal and infratrochlear nerve in goats \* GA may be preferred in young animals to avoid toxicity and in adults with large horns

Answer 97

1. Regenerative or non-regenerative? - loss (haemorrhage, haemolysis) - decreased production 2. Is the protein level low, normal or high? 3. Are there clues on the blood film?

Answer 98

\* hepatic metabolism and redistribution \* extra-hepative metabolism-- lung, kidney, blood?? \* slower in cats than in dogs (phenol compound)

Answer 99

\* GI disorders- FBs, torsion, rupture \* Urogenital abnormalities unresponsive to medical treatment \* Abdominal disorders of unknown origin \* Penetrating trauma \* Acute abdomen \* Generalized peritonitis \* Diagnosis and treatment of portosystemic shunts \* Splenic abnormalities \* Uncontrolled abdominal haemorrhage

Answer 100

\* Indirect consequence of tissue trauma and inflammation \* constant activation of peripheral receptor - Glutamate, asparate, substance P are released (constant activation of AMPA and neuropeptide receptors on dorsal horn; increased response to both nociceptive (hyperalgesia) and non-nociceptive (allodynia) stimuli)

Answer 101

\* Isoflurane: 1.4 @ 37C \* Sevoflurane: 0.7 @ 37C

Answer 102

\* Hepatic metabolism in dogs and horses \* Mainly excreted unchanged via the kidney in cats \* rapid recovery in most species due to redistribution from CNS to body tissues

Answer 103

\* Halothane \* Induction of anaesthesia is slower \* Changes in depth are slower during maintenance of anaesthesia (less control of depth) \* Recovery of anaesthesia is slower

Answer 104

\* IV only (skin slough- treatment saline and lidocaine), thin dogs, hypovolaemia, liver dysfunction, age, obesity, hypoproteinaemia-acidosis

Answer 105

1. 0 MAC = light surgical plane 1. 5 MAC = moderate surgical plane 2 MAC = deep surgical plane 3 MAC = mostly dead

Answer 106

\* Abdominal cryptorchid testes \* Ovariectomy/ ovariohysterectomy \* Liver biopsy \* Lap- assisted gastropexy \* Lap- assisted cystotomy

Answer 107

\* Isoflurane: - Cat 1.6% - Dog 1.4% - Horse 1.4 % \* Sevoflurane - Cat 2.6% - Dog 2.3% - Horse 2.3%

Answer 108

\* the first surgery is the best chance to effect a local cure \* Excise biopsy tracts \* Early vascular (venous) ligation to reduce tumour embolic spread \* Gentle tissue handling to reduce tumour embolic spread & to reduce seeding into the wound bed, thoracic or abdominal cavities \* Lavage excision bed \* Change gloves and close wound with separate set of instruments \* Submit all resected tissue for histopathology (NOT a choice, if it is worth removing, it is worth submitting) \* Ink margins \* Submit as whole specimen

Answer 109

\* Induction: 3% \* Maintenance: 1-2% \* Faster induction, recovery, changes in depth during maintenance

Answer 110

Kern and Lane bone-holding forceps-- available with or without ratchets \* Lowman bone clamp- long bone use \* Richards bone-holding forceps- tubular bones \* Verbrugge bone clamp- rapid fixation of fragments (large dogs) \* Reduction forceps with speed lock- hold fragments in place rapidly, with point maintain fracture fragments in reduction during fixation

Answer 111

next to T13, L1 and L2 \* 23 gauge, 8.9 cm spinal needle \* Inserted 2.5-3 cm lateral to the dorsal midline \* 2 mL for ventral branch, 1 mL for dorsal branch

Answer 112

\* event related not time related \* published guidelines: 96 weeks for plastic/ paper wrapped items post steam sterilisation

Answer 113

Advantages: reduced surgical time, ease of application, if used correctly, integrity/security of closure is equivalent to hand sutured Disadvantages: cost

Answer 114

History and Examination Assessment, Problem List (each problem has ddx) Plan (each problem has a plan) Communication

Answer 115

\* Observe strict aseptic technique \* Thorough knowledge of anatomy and technique \* Control haemorrhage meticulously \* Gentle tissue handling- every damaged cell places additional demands on the body's recovery mechanisms; appropriate location of incisions and adequate incision length \* Preserve blood supply to tissues \* Accurate tissue apposition with minimal tension \* Eliminate dead space

Answer 116

\* Non-cornified cells - mainly small, round parabasal cells and intermediate cells (larger than parabasal cells, higher cytoplasm: nuclear ratio) \* Neutrophils can be present \* Bacteria can be present

Answer 117

CK and AST \* CK more specific \* AST is from red cells and liver \* But look at both (ALT and LDH) \* We see myoglobinuria in the urine if there is muscle damage

Answer 118

\* emulsion lipid based (white) \* support bacterial growth and must be discared within 6 hours after opening \* do not keep in fridge \* CV depression \* resp depression \* pain on injection

Answer 119

\* Dehydration--\> concentrated urine - often greater increase in Urea than Creatinine - other clinical evidence \* GIT protein absorption or bleeding - incrased urea only unless concurrent dehydration

Answer 120

\* Airway: is there a patient airway? \* Breathing: is the animal making useful breathing efforts? \* Circulation: is there a heart beat with pulses?

Answer 121

P2 (N95) respirator mask

Answer 122

\* The use of ionising radiation to cause cell death via application of energy to DNA-- proliferating cells are radiation sensitive (neoplasms and renewing cell populations) \* surrounding normal structures e.g. skin, eyes, brain, GIT, bone, lungs

Answer 123

\* Intake (post prandial increase) \* GIT absorption (pancreatic function) \* Hepatic synthesis (corticosteroids, insulin, thyroid hormone, lipase)-- if you have a bile blockage, you often have an increase in cholesterol \* Tissue metabolism (corticosteroids, insulin, thyroid hormone, lipase) \* Loss (lymphangiectasia- pathological inflammation of lymph vessels esp in the small intestines, can be congenital, secondary can be caused by granulomas, cancer, or increased central venous pressure causing abnormal lymph drainage secondary to pericarditis or right sided heart failure)

Answer 124

Gram positive drugs used for respiratory, mastitis and prostates and as in-feed medication in large animals \* Erythromycin, Tylosin, Tulathromycin, Oleandomycin \* Some topical forms in small animals - especially ears (e.g. Tilmycosin)

Answer 125

\* Full (pure mu) agonists: morphine, methadone, meperidine, hydromorphone, fentanyl, alfentanil, remifentanil \* Partial mu agonists: buprenorphine \* Kappa agonist- mu antagonists: butorphanol, nalbuphine

Answer 126

\* Pain pathways are long and complicated and different drug classes act at different sites \* Multi-modal approach improves efficacy and reduces side effects

Answer 127

hand-held Meyerding retractor - retracting large muscle during long bone or pelvic fracture repair

Answer 128

1. Acute resuscitative-- correction of intravascular deficit. Rapid IV fluid therapy targeting restoration to perfusion. e.g. 15 ml/kg over 15 minutes 2. Rehydration therapy-- correction of interstitial or intracellular deficit-- gradual restoration over 24 hours, for example (intracellular hydration care re: cerebral oedema) 3. Maintenance requirements- volume of fluid needed to maintain zero fluid balance-- considers sensible and insensible (evaporative- cutaneous, respiratory, faeces, saliva) + ongoing losses

Answer 129

Gelpi pernineal retractor

Answer 130

\* Xylazine: alpha 2 agonist, sedation, analgesia, muscle relaxation, significant CV side effects: peripheral phase: initial increase in BP reflex decrease in HR, central phase: decrease in BP and HR, Decreased GI motility, short duration of action (30 minutes) \* Romifidine: alpha 2 agonist, sedation, analgesia, muscle relaxation, CV effects, decreased GI motility, long duration of action (60 minute) \* Detomidine: alpha 2 agonist, sedation, analgesia, muscle relaxation, CV effects, decreased GI motility, long duration of action (60 minutes) \*Medetomidine: alpha 2 agonist, sedation, analgesia, muscle relaxation, CV side effects, decreased GI motility, short duration of action (30 minutes)

Answer 131

Deficit (ml) = Estimated deficit (%) x body weight (kg) x 1000 ml/ 1 L e.g. 10 kg dog, 5% deficit: 0.5 x 10 x 1000= 500 ml

Answer 132

\* Used for large blood vessels or vascular pedicles when increased security is required e.g. closed castration, vessels in amputation \* Typically placed after and distal to a simple ligature

Answer 133

Campylobacter foetal liver

Answer 134

Condition score aim for 3 at mating and lambing \*\* Short-term increased protein intake pre-mating For Merinos: Extra 1 CS (7-10 kg bodyweight)= extra 10-20% lambs born

Answer 135

Gosset- ideal for smaller patients

Answer 136

2-3 cm lateral margins (5 cm for high grade soft tissue sarcoma (STS)) OR one fascial plane deeper than compartment of origin

Answer 137

\* Isoflurane: (240 mmHg/ 760 mmHg) \* 100 = 32% \* Sevoflurane (160 mmHg/ 760 mmHg)\* 100 = 21%

Answer 138

During anaesthesia deglutination reflexes are lost and endotracheal intubation is necessary to secure the airway. It also allows for the delivery of inhalant anaesthesia and mechanical ventilation.

Answer 139

\* Speed up GIT emptying \* Useful for solid poisons \* Examples: Sorbitol, Epson Salts (MgSO4), Paraffin Oil

Answer 140

\* Demeanour, posture, vocalisation, attention to wound, mobility, interaction with people, response to handling \* HR RR and pupil dilation

Answer 141

\* Barbiturates (thiopental, pentobarbital, phenobarbital) \* Dissociative agents (ketamine) \* Imidazole derivative (etomidate) \* Steroids (alfaxalone) \* Phenol derivatives (propofol)

Answer 142

Cause hypotension and hypothermia which both reduce/mast the amount of bleeding

Answer 143

\* 80% eliminated unchanged by lungs \* 20% metabolized by liver and eliminated in urine

Answer 144

\* Tissue trauma (inflammatory mediators from damaged cells- H+, K+, PG, plasma (bradykinin), plateletes (serotonin), mast cells (histamine), macrophages (cytokines)) \* Inflammation- sensitising soup of chemical mediators \* Purpose: promote healing by enhancing perception of pain, protect against future damage

Answer 145

\* Examination of draining lymph nodes-- palpation/ FNA/biopsy \* Imaging +/- cytology/ biopsy of distant organs-- lungs, abdominal organs, LN, liver \* Haematology, Biochem, Urinalysis-- looking for othe organ involvement, incurrent disease and/or paraneoplastic syndromes

Answer 146

\* Silk, polypropylene, Nylon, polyester

Answer 147

Dehydration

Answer 148

\* age, breed sex \* Primary complaint \* Duration of the problem \* Appetite, water intake and activity \* Vaccination status \* Any current medication

Answer 149

\* between days 7 and 14 after injury corresponding to the rapid accumulation of collagen in the wound. By 21 days, the collagen content is at its maximum-- but wound strength is only about 20% of its final strength

Answer 150

History: Dyspnoea \* Less air in the lungs \* bacterial aspiration pneumonia Test: broncho alveolar lavage

Answer 151

1. Penicillins (Amoxycillin, Betamox, Clavulox, Clavubactin S) 2. Cephalosporins (Cephalexin, KefVet) 3. Tetracyclines (Vibravet) 4. Sulfonamides 5. Fluoroquinolones (Tribrissen) 6. Metronidazole

Answer 152

1- a normal healthy patient to 6- A declared brain-dead patient whose organs are being removed for donor purposes

Answer 153

\* Muscle relaxation \* Anxiolytic \* Appetite stimulation \* Minimal CV and resp effects \* Anti-convulsant \* Potential for complete reversal (flumazenil) \* Anti-arrhythmic

Answer 154

Group of cells that have continued to proliferate, lack ability to die... ignore the signals for apoptosis

Answer 155

\* GA \* Oxygenation failure: low PaO2 even with O2 therapy \* Ventilation failure: High CO2 \* Post cardio-pulmonary resuscitation

Answer 156

Natural sutures e.g. catgut-- enzymatic absorption \* Synthetic sutures-- absorbed via hydrolysis (reaction with water)-- more rapid in urine \* Glyconate (Monosyn)- 50% strength at 2-3 weeks, absorbed completely in 60-90 days \* Polyglycolic acid (Dexon) \* Polyglactin 910 (Vicryl)- braided

Answer 157

- ABCs: airway, breathing, circulation - capsule history: important points from the owner - major body system assessment - prioritised problem list: What's going to kill it first? stabilize most life threatening problem first

Answer 158

\* Tumour type (what is it?) \* Tumour grade (how bad is it?) \* Tumour stage (Where is it?) \*\* Results of biopsy and clinical staging tests provide information on expected biological behaviour and therefore prognosis, which helps us select optimal treatment options \* Knowledge of tumour type, grade, and stage dictates "surgical dose"

Answer 159

\* Stabilize vital signs \* history and evaluation \* stop ongoing absorption \* give antidote if available \* increase toxin clearance \* supportive care

Answer 160

Neutrophils- shortest of the lifespan (Red cells are not as impacted) \* Neutrophils can help us adjust dose-- if too high a dose at risk of secondary infection \* Check full CBC 1 week after giving chemotherapy and before each treatment \*\* If severe neutropenia then drop the next dose by 25%, PO aerobic antibiotics, if severe neutropenia + pyrexia--\> IV antibiotics... some oncologists recommend 10 days prophylactic antibiotics with each new chemotherapy regime/ drug

Answer 161

\* contact with intact non-sterile mucosa or non-intact skin \* e.g. endoscopes, anaesthetic equipment \* sterilisation is preferable, otherwise high level disinfection required

Answer 162

Supra-spinal \* Opioids \* Alpha 2 agonists \* Centrally acting NSAIDs \* Tramadol (weak opioid, serotoninergic, NMDA) \* Tricyclic Anti-depressants

Answer 163

\* Avoid bleeding by knowledge of relevant anatomy and careful dissection \* Digital pressure/ tamponade (allows clot to form 30 seconds for soft clot then 2-3 minutes for cross linking of fibrin-- definitive haemostasis can be applied for 4 minutes) \* Haemostats \* Ligatures (best haemostatic security- simple or double) \* Vessel sealant devices \* Topical local haemostatic agents

Answer 164

Central vessels

Answer 165

\* Low residual activity (unlike chlorhexidine) \* Inactivated by organic material \* contraindicated in neonates and is noted as having a high incidence of skin reaction

Answer 166

Cause hypotension and hypothermia

Answer 167

\* Steam sterilisers \* Time required: - 121 degrees for 15 minutes at 101 Kpa - 132 degrees for 4 minutes at 203 Kpa \* Autoclave cycle times: 4 minute sterilisation time + 2 minutes safety margin + 16 minutes penetration + 25 minute drying time = 47 minute total cycle

Answer 168

\* The volume of fluid needed to maintain zero fluid balance \* sensible losses- urine: varies with disease, generally 1-2 ml/kg/hr in health \* insensible (cutaneous, respiratory), faeces, saliva-- expect 0.5-0.8 ml/kg/hr when healthy and resting-- much higher when exercising, hyperthermia, etc.

Answer 169

\* Minimum Alveolar Concentration \* Minimum alveolar concentration (partial pressure) of an anaesthetic that produces immobility in 50% of subjects exposed to supramaximal noxious stimulus (skin incision or tail clamp) \* Measure of potency (ED50) that allows us to compare inhalation anaesthetics across species

Answer 170

\* Behavioural changes: depression, sleep disturbance, irritability/aggression, social withdrawal, decrease in appetite, decrease interest in exercise, loss of playfulness \* reduced mobility (stiffness, lameness) \* lick granuloma etc. \* Helsinki Pain Index

Answer 171

Czerny retractor- deep or shallow

Answer 172

Phlebitis, extravasation (leakage of fluid/cells out of vasculature), thombosis (especially with central lines), catheter related infections/ sepsis, embolism (catheter, air), risk of volume overload, exsanguination

Answer 173

\* Inflammatory response - neutrophilia and/or monocytosis - left shift or toxic change \* Stress response - lymphopenia - mature neutrophilia +/- monocytosis (dog) \* Physiological leukocytosis - neutrophilia and lymphocytosis in a young animal

Answer 174

Synthetic absorbable or non-absorbable sutures, Nylong and polypropylene cardiac muscle

Answer 175

Problems most likely due to x and I'll examine, test, etc. to verify

Answer 176

\* absence of theatre contamination \* rapid, smooth induction \* seamless transition from induction to maintenance \* easy to deepen anaesthesia \* rapid, predictable recovery of better quality \* Safer for patients with MH (malignant hyperthermia- severe reaction to anaesthetic drugs, genetic), asthma and other allergic conditions \* less stress response to surgery \* absence of nausea and vomiting/ appetite stimulation (propofol)

Answer 177

\* History of vomiting, diarrhoea, anorexia \* Clinical signs: - Increased Hct/RBC/Hb (assuming no blood loss0 - Increased albumin (assuming no protein loss) - Increased Na and Cl (assuming no electrolyte loss) - Increased Urea with normal creatinine

Answer 178

\* Cardiovascular: pulses, mucous membranes, CRT, HR, cardiac auscultation \* Respiratory: RR, RE, pulmonary auscultation \* Neurological: gait, mentation \* Abdominal palpation \* Body temperature

Answer 179

\* Emesis \* gastric lavage \* Enema \* Cathartics & adsorbents \* Washing skin or eyes

Answer 180

\* Ovulation occurs: 2-3 days \* oocytes mature: 4-6 days \* Cervix closes day 7 \* D1 in relation to d0 is day 8

Answer 181

Plasticity- degree to which suture will deform under load but then will go back to its original shape/ length when load is ceased Pliability- ability of suture to change shape, related to ease of handling Suture pull out value- load required to pull a suture loop out of tissue. relates mainly to tissue strength: fat

Answer 182

\* dose-dependent sedation/hypnosis \* analgesia \* muscle relaxation

Answer 183

\* rate and rhythm \* pulse profile: strength/ height, duration/ width, variability \* synchronicity with heart beat \* more difficult in cats

Answer 184

\* Intermittent bolus-- okay for cases \< 5 minutes, simple, no special equipment required but large total drug dose and slow recovery \* Constant rate infusion (CRI)- smoother anaesthesia, deeper with time, risk of awareness of side effects (rate) \* Variable rate infusion (VRI)- smoother, lower total drug dose, faster recovery, frequent adjustment needed \* Target controlled infusion- computer, set of PK parameters for a given population, syringe driver-- achieves stable plasma concentration, simple to use, easy to change in response to clinical effect

Answer 185

\* Polydioxanone (monoplus, PDS)- 50% strength lost at 6 weeks \* Polyglyconate (Maxon) \* Glycomer 631 (Biosyn)- 50% strength at 2-3 weeks, but takes 90-110 days to be completely removed

Answer 186

Pattern recognition Hypothetic deductive reasoning Problem-oriented approach Key abnormality method

Answer 187

\* be placed in sternal recumbency \* Endotracheal tube left in place \* Keep cuff inflated until swallowing

Answer 188

\* Use multi-drug protocols that target different stages of the cell cycles, different modes of action, shouldn't interfere with each other's actions, not have overlapping toxicities

Answer 189

Hohmann retractor- large blades used in pelvic and long bone fractures. mini-Hohmann-- used for exposure of the meniscus in the stifle joint and other fine work

Answer 190

\* Neuro: decreases cerebral metabolic consumption, increases cerebral blood flow therefore ICP \* Resp: decreases minute volume (ventilation), small increase in RR, increase in PaCO2, effective bronchodilator, apnoea occurs when anaesthetic depth is excessive \* CV: decreases CO due to decrease in myocardial contractility and SV, decreases BP du to decrease in CO, sensitizes heart to catecholamine induced arrhythmias \* poor muscle relaxation \* no significant analgesic effect \* Trigger for malignant hyperthermia

Answer 191

More than 97% eliminated unchanged by lungs \* less than 3% metabolized by liver and eliminated in urine \* Hepatic blood flow and oxygen delivery are better maintained than with halothane \*reacts with older formulations of soda lime and one of the breakdown products in potentially nephrotoxic

Answer 192

Within 1-2 hours of ingestion

Answer 193

\* Shift from parabasal and intermediate cells to superficial cells (pyknotic nuclei, angular shape to the cytoplasm) \* Numerous red blood cells \* Neutrophils commonly observed \* Bacteria commonly observed

Answer 194

Cat: 250, Dog: 200, Horse: 200 PC: blood/gas: 0.5

Answer 195

Ratio between toxic and therapeutic dose \* In chemotherapy, it really is the maximum drug tolerated-- highest dose that can be given without unacceptable side effects

Answer 196

\* Off label okay- use in a different way to label, in SA need consent from client and to be able to justify use e.g. to vet board and in food producing animals- single animal treatment only, need appropriate withholding periods \*\* Against label is counter to what the label says

Answer 197

(Anatomy: sensory (V)) \* Mental: Lidocaine: 2-3 mL

Answer 198

Knot- knot security is defined as the knot holding capacity expressed as a percentage of the original tensile strength of the suture material

Answer 199

Expert Advisory Group on Antimicrobial Resistance \* High- essential antibiotics for treatment of human infections where there are few or no alternative for many serious bacterial infections e.g. 3rd generation Cephalosporins and Fluoroquinolones \* Medium- there are other alternatives but less than those for those classified as low e.g. Anti-staph penicillins (Cloxacillins), amoxicillin- clavulanate, Trimethoprim-sulphonamides \* Low- reasonable number of alternative agents in different classes available to treat most infections even if antibiotic resistance develops e.g. narrow spectrum penicillins, amoxicillin, tetracycline, neomycin, streptomycin, erythromycin

Answer 200

Falciform ligament, suction peritoneal fluid

Answer 201

\* tranquillization \* anti-arrythmic \* anti-emetic \* spasmolytic \* antihistamine \* alpha 1 receptor blockade

Answer 202

\* Stainless steel- susceptible to cyclic stress and biofilm formation but is malleable and corrosion resistant, scratch resistant.... \* Titanium- lighter than stainless steel for same strength, elasticity/ stiffness closer to bone, improved cyclic loading, improved osseointegration (surface to which bone can grow), less artifact for CT and MRI, more expensive \* Polymethylmethacrylate (PMMA, bone cement)- functions for fixation and load distribution with orthopaedic implants e.g. total hip replacement, pelvic or spinal fractures (composite repairs)... functions by interlocking with bone-- cement-- filler not a glue..... disadvantages: porous so infection impossible to eliminate once established \* Tantalum- modulus of elasticity is close to subchondral bone, texture and porosity is similar to cancellous bone so encourages osseointegration/ biological fixation.

Answer 203

\* Seroma (pocket of clear serous fluid) \* Hypothermia (esp. young and small) \* Dehiscence and evisceration (wound ruptures along a surgical incision) \* foreign materials left in abdomen \* adhesions- restrictive or non-restrictive \* Peritonitis \* Infection \* Self trauma- suture knots too tight \* Skin irritation from clippers

Answer 204

\* GI protectant (sucralfate, ranitidine, omeprazole/pantoprazole, misoprostal) \* Antiemetics (metoclopramide, maropitant) \* Analgesics

Answer 205

Elecated amylase and lipase, cholestasis (Total bilirubin, conjugated bilirubin), elevated glucose Other findings with pancreatitis \* Inflammatory leukogram \* Lipaemia \* Hyperglycaemia

Answer 206

\* Diazepam \* Midazolam (not licensed in animals)

Answer 207

\* induction \* GA for short procedures \* onset of GA after IV injection: 15-30 seconds \* duration of GA: 10-20 minutes

Answer 208

Reticulocytosis

Answer 209

\* Vessel diameter should be between 1/3- 2/3 of clip length

Answer 210

Palpebral and corneal reflex, eye position, jaw tone \*\* also monitoring mucous membrane colour, CRT, sublingual pulse, chest movement, skin temperature

Answer 211

Identify all the problems. Think of differentials for every problem. Test and examine to rule each in or out.

Answer 212

Albumin + globulins \* Synthesis (liver function, inflammation) or loss (renal, GIT, third space, exudation) \* Hydration status \* Colostrum absorption in neonates

Answer 213

Neuro: Increases ICP \* Resp: does not change minute volume, effective bronchodilator, apnoea if excessive anaesthesia \* CV effects: symp nervous system, increases CO, increases BP \* No muscle relaxation \* Significant analgesic effect (NMDA)

Answer 214

\* widespread distribution throughout the body - sympathetic nervous system - vascular endothelium - CNS (spinal and supra-spinal) - platelets - uterus - gut

Answer 215

Immobilisation, control of swelling/ oedema, check regularly (dry, comfortable), regular observation, monitoring urine output (ensuring bladder is emptied regularly), frequent turning, offer food, minimize stress \* Cryotherapy, thermotherapy (muscle relaxation) \* Active and passive exercise programs \* Transcutaneous electrical nerve stimulation (TENS)- joint mobility, decreased oedema, minimize disuse atrophy, muscle strengthening, sensory awareness, decrease pain \* Physical therapy \* Massage

Answer 216

\* Ventral midline (most common) \* Paracostal (extension for increased exposure- liver) \* Flank (ovariohysterectomy, grid gastropexy) \* Retroperitoneal (adrenal neoplasia)

Answer 217

\* used for large blood vessels or pedicles when increased security is needed \* Halsted, modified transfixation and figure of eight techniques described

Answer 218

Allis tissue forceps- interlocking teeth Babcock intestinal forceps \* Doyen intestinal forceps- delicate atraumatic grip- resection or anastamoses of stomach or intestinal

Answer 219

60:40:20:15:5 total body water: intracellular fluid: extracellular fluid: interstitial fluid: intravascular fluid

Answer 220

MAC (%) \* Cat 1.2 \* Dog 0.9 \* Horse 0.9 Partition coefficient @ 37C Blood/gas: 2.4

Answer 221

\* Poorly concentrated urine despite dehydration - cats USG \< 1.035 Dogs USG \< 1.030 Horses and cattle USG \< 1.025 \* Acute renal insufficiency - history - hyperkalaemia - oliguria or anuria \* Chronic renal insufficiency - history - polyuria - often hypokalaemic

Answer 222

\* Not for epileptic patients \* Not in cat with kidney dysfunction \* Not in glaucoma or "brain" patient \*\* use with muscle relaxant

Answer 223

\* Poor libido \* Balanoposthitis (knob rot) \* Musculoskeletal problems \* 5 T's: Teeth, torso, toes, tossle, testes \* Poor sperm output (not enough testis- size) \* Poor semen quality (heat: fever, scrotal mange; orchitis)

Answer 224

Classic muscle damage pattern | (not liver- ALT is hardly increased)

Answer 225

Cardiovascular forceps e.g. Debakey forceps allow occlusion of only a portion of the vessel

Answer 226

\* Diaphragm \* Liver and gall bladder \* Stomach

Answer 227

\* If FNA cytology non-diagnostic or equivocal \* If type of treatment would be altered \* If extent of treatment would be altered \* owners willingness to treat would change \* malignant neoplasia- to grade and plan \* goal is diagnosis for prognostic purposes

Answer 228

Induction: 3% Maintenance: 1-2% \*\* Slower induciton and recovery than Iso and sevo \* slower changes in depth during maintenance

Answer 229

\* Partial pressure-- the blood, brain and other tissue compartments must fill up with anaesthetic before the partial pressure in the alveoli equilibrates with the partial pressure in the brain \* at equilibrium, the partial pressure is the same in each compartment but the concentration of anaesthetic in each compartment is dependent on solubility (partition coeffecient)

Answer 230

\* Imidazole derivative (IV anaesthetic agent) \* Kept away from light \* No CVS effect \* Mild respiratory depression

Answer 231

Measures the saturation of oxygen with haemoglobin (SpO2) & HR \* arterial oxygen tension of 60 mmHg -- oxygen saturation \> 90% \* SpO2 can be normal in hypoventilating patients when the inspired oxygen fraction is increased (which normally should be the case during anaesthesia)

Answer 232

[(BW x 30) + 70 ml/kg/day] / 24 hours e.g. 4.79 ml/hr for a 1.5 kg animal

Answer 233

\* Tachycardia, hypotension, poor peripheral perfusion/ peripheral vasoconstriction, weak pulses (decreased pulse amplitude), pale mucous membranes, slow CRT, mental depression, delayed recovery from anaesthetic

Answer 234

Weirlaner retractor-- pointed or blunt-- grip lock mechanisms

Answer 235

Brucella ovis-- mainly male infertility... epididymis & testicular granulomas, ewe abortions rare \* Homosexual spread mechanical between male to male \*Lifelong infection, need to eradicate-- cull and replace from accredited flock OR test and slaughter-- serology 2-3 weeks apart

Answer 236

\* The anaesthetic concentration changes very quickly

Answer 237

\* Nervous system, CV and resp health? \* Medical history? \* Vaccinations (tetanus)? \*Allergies (penicillin) \* Genetic conditions (exertional rhabdo, hyperkalemic periodic paralysis)

Answer 238

UVB- blocked by plastic and glass \* many reptiles use UVB to synthesize vitamin D3 and calcium metabolism

Answer 239

(Anatomy: Sensory (V), Motor (III, IV, VI, VII)) \* Supraorbital: Lidocaine: 1 mL \* Auriculopalpebral: Lidocaine: 2-3 mL

Answer 240

Advantages: rapid application, application non painful (do not need GA), cheap Disadvantages: low strength c/w sutures, shouldn't be used on their own

Answer 241

Nylon and stainless steel, polydioxanone, polyglyconate \*\* prolonged tensile strength)

Answer 242

ECF osmolality (mOsm/kg) = 2 ([Na+] + [K+]) + Glucose + BUN Normal in dogs = 300 mOsm/kg; cats= 310 mOsm/kg Tonicity= Effective osmolality= 2 ([Na+] + [K+]) + Glucose

Answer 243

"Liver Trauma"-- Also AST \* Cholestasis- ALP, GGT

Answer 244

monogastric- 12 hours, no water withdrawal ruminant- 12-36 hours (depending on size), 12 hour water withdrawal small mammals, birds, neonates- short to no fast due to risk of hypoglycemia, no water withdrawal

Answer 245

Atipamezole (Antisedan)-- will reverse Xylazine, medetomidine, and dexmedetomidine \* will not fully reverse CV depression

Answer 246

\* Hydration status \* Loss (renal (Aldosterone), GIT, third space, exudation) \* Transcellular shift \* Na and Cl usually shift together \* Selective Cl loss occurs with vomiting and abomasal disorders

Answer 247

Adrenaline- injected up the nose to control epistaxis or onto bleeding gastric ulcers \* Diluted 1:1000 to 1:10000 U/ml \* Disadvantage: systemic effects on CVS, profound local vasoconstriction leading to ischaemia

Answer 248

\* High fat diets (theoretically cancer cannot use lipids for energy), calorie dense, increase protein content if renal function is acceptable, omega-3 supplementation \* Avoid high anti-oxidant diets because may interfere with chemotherapeutic agents BUT if appetite is poor- get them to eat whatever they will

Answer 249

Stress leukogram

Answer 250

\* 1st day with \<50% keratinized epithelial cells marks D1 \* increase in parabasal and intermediate cells \* Many neutrophils observed \* "meoestral cells": neutrophils found in cytoplasm \* copious amounts of vaginal discharge sometimes observed--\> "Dioestral dumping"

Answer 251

\* Incisional: - diagnosis: cell origin, grade (invasion/mitotic index) - complete removal not possible - diffuse organ change (e.g. liver) - include normal tissue - multiple biopsies - for cores, at least 5mm long \* Excisional: Definitive surgery & diagnosis - surgical dose not altered by knowledge of tumour type (e.g. splenectomy for splenic mass) - benign tumor based on cytology (lipoma) - lymph node (staging) - provides grade information

Answer 252

\* isotonic- balanced (composition resembles ECF): LRS, unbalanced: 0.9% NaCl, 2.5% dextrose in 0.45% NaCl \* hypotonic- water for injection, 0.45% NaCl \* hypertonic- 7.5% dextrose in LRS, 50% dextrose

Answer 253

\* Severe haemorrhage--\> hypotensive shock \* Blood obscures visualization in the operative field, irritates tissue, prevents tissue apposition, delays healing, potentiates infection \* Blood on instruments, drapes and tissues is an ideal medium for bacterial growth

Answer 254

\* Neuro: opioid are more widely distributed: brain and spinal cord, autonomic NS, opioids= release of dopamine therefore changes in behavior and locomotor, inhalation anaesthetics cause a dramatic prolonged excitement phase during recovery from anaesthesia \* Resp: obligate nasal breathers, prolonged recumbency and nasal oedema can cause significant airway obstruction, dead space/ tidal volume ratio is relatively large, small changes in tidal volume can cause dramatic changes in alveolar ventilation and gas exchange, susceptible to compression atelectasis of the lungs when placed in dorsal recumbency \* CV system: horses very sensitive to the CV effects, alpha 2 agonists produce dramatic decrease in HR and CO, decreases in CO and BP associated with inhalant anaesthesia (2x other species), size and weight predisposed to poor muscle perfusion, ischemia, myopathy

Answer 255

\* Within 3-4 hours of ingestion \* Only if animal is stable \* only if animal is ambulatory \* not if poison is corrosive or volatile \*Washing soda- NaCO3, apomorphine, xylazine

Answer 256

Monofilament nylon and polypropylene

Answer 257

\*Local anaesthetic and other lipophilic drug toxicoses \* Bupivicaine, mepivacaine, ropivacaine, lidocaine, haloperidol, clomipramine, verapamil, carvedilol, amlodipine, propanolol, moxidectin, thiopentone \* Anecdotal reports in vet medicine: baclofen, permethrin, loperamide, bupropion, sertraline

Answer 258

The number of actively dividing cells is decreased, sensitivity to chemotherapy and radiation therapy is reduced. Primary treatment is usually surgery and chemotherapy can be adjunctive

Answer 259

Straight- placed by hand in skin Curved- used in deep or small surgical fields with needle holders where working space is limited \* Eyed needles- reusable

Answer 260

\* Reduce tissue drag, improve pliability and improve tying characteristics, reduce risk of infection (triclosan inhibits bacterial fatty acid synthesis)

Answer 261

Campylobacter abortion placentitis

Answer 262

\* Repetitive, low dose chemotherapy \* Higher frequency doses than standard protocols \* Drugs target stroma/blood supply and perhaps act immunologically against the tumour itself \* Usually low dose cyclophosphamide + piroxicam \* post operative management of sarcomas, inoperative tumours, following multi agent protocols

Answer 263

\* CBC/ biochemistry (minimum PCV, TS, BUN, BG) \* Heartworm \* Thyroid function \* Coagulation \* Radiology \* Echo

Answer 264

\* Lignocaine over 2 minutes (decreases laryngeal reflex- IV or spray over larynx) \* Thiopental IV OR propofol or Alfaxan IV

Answer 265

Why campylobacter is transmitted through ewe or doe mob

Answer 266

\* More than 99% eliminated unchanged by lungs \* Less than 1% metabolized by liver and eliminated in urine \* No hepatic or renal toxicity associated with metabolites \* Hepatic blood flow and oxygen delivery are better maintained than with halothane

Answer 267

\* controlled air conditioning with low turbulence \* minimal traffic \* dry, with low humidity 35-70% \* temp \< 23 degrees \* free from direct sunlight, dust, dampness, insects, vermin, and constant handling \* smooth washable surfaces \* positive pressure airflow with four air exchanges/hr \* storage in cabinets ideal- away from floor, wall, and ceiling \* no food, drink, non sterile goods \* kept away from water pipes \* Cardboard boxes not recommended- wire racks ideal

Answer 268

\* Urinary obstruction/ uroabdomen \* Hyperkalaemia \* Variable USG depending on hydration status

Answer 269

1. What is it? Neoplastic or non-neoplastic, tumor type/ cell of origin (round cell, epithelial, or mesenchymal) 2. How bad is it? B or M. Grade? 3. Where is it? Clinical stage (spread/extent of cancer), TNM system

Answer 270

\* history, PE esp cardiac, pulmonary function, temp, hydration status, food witholding, body weight obtained, blood work performed, jugular catheter placed and secured to allow for admin of anaesthetic drugs and IV fluids

Answer 271

Regenerative- elevated reticulocyte count. Increased RBC loss- haemorrhage or haemolysis Non-regenerative- normal or low reticulocyte count. Reduced rbc production- chronic disease/ inflammation, marrow disease, iron deficiency (\*\* remember, is it pre-regenerative or true non-regenerative)

Answer 272

\* Extended neck \* abducted elbows \* open mouth breathing \* anxious facial expression \* increased abdominal movement \* paradoxical abdominal movement \* cyanosis \* lateral recumbency \* beware of rapidly changing body position and pupillary dilation in cats

Answer 273

\* gait--\> recumbency, single or multiple limb lameness, ataxia, paresis or paralysis \* mentation--\> depressed, stuporous, comatose, hyperexcitable, dysphoric, hyesterical

Answer 274

\* Alfaxan CD- rapid clearance and minimal cumulation \* Propofol: rapid clearance, predictable metabolism, minimal cumulation

Answer 275

\* Absorption- if there is primary GI disease, absorption of oral cytotoxic drugs may be affected \* Distribution- when drugs are highly protein bound, hypoalbuminaemia-- issue with distribution \* Excretion- chronic kidney disease affecting renal clearance, more side effects \* Metabolism- decreased hepatic clearance of drugs

Answer 276

Balfour self-retaining abdominal retractor

Answer 277

\* collapse/ loss of consciousness \* seizures \* bleeding \* large or penetrating wounds \* choking or difficulty breathing \* protracted or severe vomiting \* difficulty urinating \* toxin ingestion \* previous life-threatening problems

Answer 278

\* By only treating with AMs when necessary \* By treating with appropriate AM regimes \* By ensuring owner compliance with treatment \* By performing C&S testing \* By not over-prescribing \* By preventing bacterial disease

Answer 279

\* Mare: day 14 \* Cow: day 28 \* Sheep: day 75

Answer 280

No residual action Acts by denaturing proteins

Answer 281

Presence of organic matter

Answer 282

\* respiratory depression (mild) \* initial period of hypertension resulting in reflex bradycardia--\> decrease in blood pressure back to normal or below due to centrally mediated decreased sympathetic tone \* bradycardia \* cardiac arrythmias (A-V blocks 1 and 2) \* hyperglycaemia \* diuresis (problem in horses) \* decreased intestinal motility \* vomiting (mainly Xylazine in SA)

Answer 283

History Clinical examination Clinical pathology Producton analysis

Answer 284

\* expansile growth \* Destruction of host tissues & function \* Infiltration and metastasis \* Necrosis, ulceration and haemorrhage \* Cachexia \* hormone production (e.g. hyperCa) \* Reduced quality of life and reduced life span

Answer 285

60-90 minutes for lower limb surgery Lignocaine 2 mg/kg only

Answer 286

\*\* look at the cells by either. Using BOTH is the best interpretation: 1. FNA for cytology (aspirational or non-aspirational technique) \* splattered onto a slide so lose the architecture \* looks at the individual cell detail 2. Surgical biopsy for histopathology (incisional or excisional) \* patterns and structure of the tissue

Answer 287

\* Qualitative-- quality of the tissue e.g. fascia is an effective barrier to neoplastic cells while fat is a poor barrier

Answer 288

\* Returns to service: something impairs sperm fertilizing egg but doesn't disrupt normal oestrus cycle e.g. oestrogenic clover, mating young ewes \* Does not return to service: Pregnancy loss after maternal recognition of pregnancy, mating period coincides with beginning or end of normal breeding season, oestrus may cease if ewes are under severe nutritional stress

Answer 289

\* DO NOT increase Na+ by \> 0.5-1 mmol/hr or \> 12 mmol/24 hours

Answer 290

\* CO = SV x HR \* When SV increases, CO increases

Answer 291

3mm and 6mm in catgut \* 3 throws for multifilament, 4 for monofilament

Answer 292

\* Tachycardia, hypotension, poor peripheral perfusion/ peripheral vasoconstriction-- weak pulses (reduced pulse amplitude), pale mucous membranes, slow CRT, mental depression/ delayed recovery from anaesthesia

Answer 293

Nitrous oxide \* Induction of anaesthesia is faster \* Changes in depth are faster during maintenance of anaesthesia (more control of depth) \* Recovery from anaesthesia is faster

Answer 294

Polypropylene- least thrombogenic suture Polytetrafluoroethylene, nylon, coated polyester, polydioxanone

Answer 295

\* either times stronger than morphine \* better sedation than morphine \* emesis less likely \* no histamine release

Answer 296

\* Hyperthermia, ephedrine, opioids (horse)

Answer 297

Febrile with abnormal WBC count \* at least 3 weeks in horses with a recent history of respiratory disease

Answer 298

\* Causes vasoconstriction \* Helps reduce swelling and has analgesic properties \* e.g. cold packing nose for epistaxis or stifle following cruciate surgery

Answer 299

\* Crystalloids- solutions of water and solutes capable of entering all body fluid compartments \* Colloids- large molecular weight fluids restricted to the plasma compartment in patients with an intact endothelium

Answer 300

More than 1 breath per second

Answer 301

Pain that extends beyond the expected time of healing... no useful protective function, debilitating, poor QOL

Answer 302

\* Cat: 1.6 Dog: 1.4 Horse: 1.4 \* Partition coefficient: - blood/gas: 1.4

Answer 303

\* Spleen \* Rectum, colon, caecum \* Mesenteric root and LN \* Ileum \* Jejunum \*Mesocolon to retract viscera to expose left kidney and adrenal ( can see aorta)

Answer 304

Close defects e.g. chest wall reconstruction, perineal hernia \* augment/ buttress primary repairs of slow healing tissue e.g. tendon \* prosthetic replacement for tendons Complications: infection, viscercal adhesions, failure

Answer 305

\* A steer that is mounted by other steers \* Predisposing factors: - implanted with stilboestrol or oestrogen, high stocking density, mixed groups of steers, crowded conditions (especially in warm weather)

Answer 306

Effective for arteries up to 1 mm and vessels up to 2 mm \* Disadvantages: tissue damage and charring (do not use close to vital structures), can lead to longer healing times, rebleeding can occur due to the probe sticking to affected tissue, fire risk if used near flammable materials

Answer 307

\* Decreases cerebral metabolic requirements for oxygen, cerebral perfusion prssures and causes a corresponding decrease in ICP and intraocular pressure \* Do not use in maintenance of anaesthesia for caesarian sections because it crosses the placenta and may affecte neurological and cardiorespiratory variables in puppies and kittens

Answer 308

\* Carbohydrate intake \* Hormone balance- insulin, cortisol, glucagon \* Utilisation- exercise, sepsis

Answer 309

\* Haven't reach puberty yet either due to being too young or too lightweight \* Have reach puberty but too low bodyweight/CS \* Wrong time of year- short-day breeders (less seasonal breeders can be induced with ram effect) \* Some toxins affect reproductive hormones and suppress oestrus (e.g. coumestans from lucerne/ white clover)

Answer 310

\* Mucous membranes \* Capillary refill time \* Pulses \* Heart rate \* Cardiac auscultation

Answer 311

\* Expensive (Alfaxalone \> Propofol) \* Varying response to standard dose- age, sex, obesity, haemodynamic states \* no "self-regulation" of anaesthetic depth

Answer 312

\* Administered in oxygen \* Secure airway (endotracheal tube) \* Rapid induction of anaesthesia \* Better control of depth during maintenance of anaesthesia \* Rapid complete recovery from anaesthesia \* Rapid elimination with very little metabolism

Answer 313

Management, Modification, Medication

Answer 314

(Anatomy- sensory (V)) \*Infraorbital: Lidocaine 2-3 mL

Answer 315

\* Slow deep breaths-- patients have good alveolar ventilation and a fast rise in alveolar anaesthetic concentration (partial pressure), depth is easier to control, and recovery is faster \* Patients that take rapid shallow breaths-- have poor alveolar ventilation and a slow rise in alveolar anaesthetic concentration (partial pressure), depth is harder to control, and recovery is slower

Answer 316

\* Lavage abdomen with warmed 0.9% NaCl (warm to help correct hypothermia) \* Volume 20-50 ml/kg \* should be clear after repeated lavage otherwise may need to explore to bleeding, contamination

Answer 317

\* Signs: more older dry ewes, increased teat length, precocious lactation, enlarged genitalia in wethers and dry ewes, vaginal or uterine prolapse \* Caused by phytoestrogens-- impaired sperm transport or chronic uterine change \* Diagnosis: identify clover, wether teat length assay, uterine histopathology \* Treatment: avoid risk pastures near joining, cull at younger age, graze cattle, reduce stocking rate to increase grass and decrease clover, pasture renovation

Answer 318

Dissemination of neoplastic cells to discontinuous other sites to form a detectable (macroscopic) tumour

Answer 319

\* entry or penetration into sterile tissue, cavity or bloodstream \* Surgical instruments, surgical implants \* all items must be sterile

Answer 320

\* Acid fast- Mycobacteria (Nocardia)-- acid fast don't really matter because we don't treat them anyway

Answer 321

\* Oxygen toxicity (decreases pulmonary function, pulmonary oedema, species-specific) \* Barotrauma, cardiovascular depression, infection

Answer 322

\* Allows sealing of the airway to prevent aspiration and to provide positive-pressure ventilation without air leaking-- but over inflation can cause necrosis and stenosis of the tracheal mucosa \* Turn off O2 and pop off valve, and listen for a leak at the same time than someone else is giving a breath to your patient. If a leak is present, inject air into the cuff while listening until the leak has disappeared.

Answer 323

\* Nasal carcinomas, brain tumours, thyroid cancer, oral tumours (SCC, MM), incompletely excised MCT and STS

Answer 324

Lumbosacral space, approx 3 cm caudal to the line joining the anterior borders of the ilium \*Dose is 2/3 in pregnant or obese animal because epidural space volume is reduced either by vessel engorgement or fat deposition respectively

Answer 325

\* SA circuits have relatively small volumes and the anaesthetic concentration can be changed quickly \* LA circuits have relatively large volumes and the anaesthetic concentration cannot be changed quickly

Answer 326

\* General surgery packs and instruments \* Balfour self-retaining retractors \* Laparotomy sponges \* Suction (Poole, Yankauer, Frazier) \* Culture tubes or swabs \* Formalin and containers for biopsy samples \* Appropriate selection of suture material

Answer 327

Haemorrhagic cystitis (Diuresis with frusemide at time of treatment)

Answer 328

\* Duodenum \* Pancreas \* Portal vein and caudal vena cava \* Right kidney and adrenal

Answer 329

\* Synthetic absorbable sutures, surgical gut, monofilament non-absorbable \* do not use polyglycolic acid in the bladder may be absorbed in urine

Answer 330

Currettes- scraping tissue or material from cavity walls, obtain cancellous bone grafts, to debride and sample bone, remove nucleus pulposus during intervertebral disc fenestration Volkmann- double ended Spratt bone currette- round cup

Answer 331

\* Controlled use of freeze/thaw cycles to destroy tissues (-22C); 2-3 freeze/thaw cycles per treatment using Nitrous Oxide or Liquid Nitrogen... cheap can use with sedation, disadvantages: no tissue diagnosis if no pre treatment biopsy, lack of ability to assess tissue margins \* Small masses, eyelid/ear/nose tumours, SCC/histocytoma, animals not suited for anaesthesia/surgery

Answer 332

\* Nausea, vomiting, inappetance, diarrhoea

Answer 333

\* gauze swab with digital pressure ( definitive haemostasis-- 4 minutes) \* counterpressure bandage post abdominal surgery-- do not include ribcage \* packing the nasal cavity

Answer 334

\* "To effect" at induction \* Smooth, rapid recovery \* Lack of excitement at induction \* Lack of hangover in recovery \* Non-cumulative nature \* Ability to use as CRI \* Hepatic disease

Answer 335

\* Major organ disease- especially kidney disease (aminoglycosides, oxytetracycline) - liver disease- (rifampin) - neuromuscular disease (aminoglycosides) \* age of patient: adult horses (macrolides- due to AM associated colitis) - foals (enrofloxacin) \* Physiological state e.g. pregnancy \* Previous hypersensitivity reaction \* no good rationale for use

Answer 336

\* The anaesthetic concentration changes very slowly

Answer 337

\* schedule for first procedure of morning \* evening meal and insulin the night before \* ideally small meal in the middle of the night and 1/2 insulin \* no morning meal \* check glucose pre-op-- if normal and \< 500 g/dL- no AM insulin, if \>500 g/dL- 1/2 dose AM insulin (hyperosmolar concerns), if low- provide supplemental glucose

Answer 338

Thenar grip- no change in grip when releasing and re-grasping needle Tripod- allows precision when releasing needle, although slower Palmed- suturing tough tissue, less precise

Answer 339

Rapidly healing tissue like stomach or bladder, slow healing like fascia with poor blood supply long acting \*\* braided sutures should NOT be used in the GIT due to capillarity

Answer 340

\* Signalement, history \* General exam, esp. hereditary diseases \* special repro exam - digital palpation of vulva and vagina - vaginoscopy - cytology - microbiology?? waste of time and money \* B. canis test

Answer 341

\* Scrubbing, gowning, gloving, skin preparation of the patient, theatre etiquette/ protocols, standard precautions

Answer 342

Tensile strength- load at which the suture fails Capillarity- wicking of fluid along a suture Mechanical creep/ stress relaxation- tendency of suture to slowly and permanently deform under constant stress

Answer 343

Olsen-hegar needle holder (with scissors-- allow suture to be tied and cut)

Answer 344

Anaesthetics relax the lower oesophagus sphincter and decrease GI motility \* risk of regurgitation and aspiration \* risk of bloat \* risk of ileus (obstruction)--\> very uncomfortable post op \*\* emergency--\> exception!!!

Answer 345

Blood carbon dioxide levels (PaCO2) generally vary inversely with the minute volume, an animal with an increased minute volume e.g. due to hyperventilation should demonstrate a lower blood CO2 level

Answer 346

Onion grass poisoning can cause early abortion \* toxin from fungus growing on grass \* Can cause neurological signs as well (staggers) in adults

Answer 347

1-10 \* Better than SDS but not as sensitive as VAS (inter-observer reliability)

Answer 348

\* Sedatives, analgesics, injectable anaesthetics, hypothermia, pregnancy, extremes of age, severe hypercapnia, severe hypoxemia, severe anaemia

Answer 349

\* Water is lost in excess of solutes \* Results in hypertonicity of the ECF (hypertonic dehydration) \* Hypernatraemia, hyperosmolality \*\* important because neurons do not like to be dehdrated \* e.g. heat stroke, water deprivation, exercise (panting), vomiting, diarrhoea, polyuria, iatrogenic \* chronic hypernatraemia--\> increase in neuron idiogenic osmoles to match ECF tonicity (neurons make extra molecules-- amino acids to cause their intracellular osmolality to go up to bring more water in).... rapid correction of ECF hyperosmolality--\> cerebral oedema.

Answer 350

\* Flagging- lateral deviation of the tail \* winking- upward tipping of the vulva \* lordosis- standing firmly and arching her back \* note vaginal discharge

Answer 351

Cardiac toxicity

Answer 352

Entire female

Answer 353

\* 0.9% NaCl \* no buffer, relatively high chloride= acidifying effect \* ideal for hypochloremic metabolic alkalosis seen with high gastrointestinal obstruction OR perhaps a patient with lots of vomiting (losing HCl)

Answer 354

No. 10 \* No. 11 ideal for stab incisions into fluid- filled structures such as organs \* No. 15 smaller No. 10 Grips: fingertip grip, pencil grip (more precise movements) or palmed grip

Answer 355

\* during the induction period, the anaesthetic concentration (partial pressure) in the breathing circuit is higher than in the alveoli, blood, brain, and other tissues \* Anaesthetic moves down the concentration gradient (into the patient), and distributes between the alveoli, blood, brain, and other tissues until equilibrium is reached

Answer 356

\* in the pregnant bitch sharp drop off of progesterone about 62 days after LH peak

Answer 357

anaphylaxis, perivascular sloughing, slow regrowth of shaved areas, loss of whiskers, myelosuppression

Answer 358

\* provides info on the potential behaviour of tumours \* Degree of cellular differentiation (pleomorphism) \* number of mitotic figures (growth rate) \* degree of necrosis/ haemorrhage \* evidence of local invasion \* presence of metastasis (vascular and lymphatic) \* varies with type of tumour-- low v. high grade or numerical 1-3

Answer 359

Is it prerenal, renal or post renal?

Answer 360

Etomidate because it produces minimal cardiovascular changes

Answer 361

\* Non-seasonal breeders \* Spontaneous ovulation \* Puberty at time of first oestrus cycle 3.5 to 24 months (breed dependent) \* Interoestrus interval (IEI): average 7 months, range 5-12 months

Answer 362

\* PCV/TP \* Glucose & Calcium \* Electrolytes \* Urine

Answer 363

Cat: 2.6 Dog: 2.3 Horse: 2.3 \* Partition coefficient at 37C- blood/gas: 0.7

Answer 364

\* Lipid sink effect - lipid emulsion provides separate plasma compartment for lipophilic agents to partition into results in less free drug available to other tissues \* Side effects: allergic reaction, rare, anaphylactoid-like signs, fever, nausea, vomiting, dyspnoea, tachypnoea, cyanosis, arrhythmias, hypotension, CVS collapse, fat overload syndrome (when endogenous lipid clearance mechanisms overwhelmed), fat embolism, hyperlipidaemia, hepatomegaly, icterus, splenomegaly, thrombocytopenia, prolonged clotting times, haemolysis, hypertriglyceridaemia, mild increase in HR, transient decrease in pH, altered pulmonary function, hypercoagulability, fluid overload, interfere with lab tests, interaction with other drugs (e.g. anticonvulsants)

Answer 365

Listeria abortion

Answer 366

Senn-Miller and Mathieu retractors-- two kinds-- similar-- Retract skin and superficial muscle layers (no good for large muscle mass)

Answer 367

\* Isoflurane: - induction: 3% (2 MAC) - Maintenance: 1-2% (1 MAC) \* Sevoflurane: - Induction: 5% (2 MAC) - Maintenance: 2-3% (1 MAC)

Answer 368

The ducts open really close to each other-- if you have something going on with the liver or pancreas there can be damage to the duct.... especially if cholestasis always consider both the liver and the pancreas

Answer 369

\* Renal function: BP and urine output \* Temperature: hypothermia and rewarming or hyperthermia

Answer 370

\* Any losses in addition to usual metabolic losses e.g. vomiting, diarrhoea, polyuria, pleural or peritoneal effusion, blood loss, excess panting, wound effusion, haemorrhage \* difficult to quantify but should be estimated

Answer 371

\* Phenylbutazone, Flunixin, Ketoprofen \* reduces inflammation \* significant side effects: platelet function, renal blood flow, GI ulcers \* Long duration of action (12-24 hour)

Answer 372

\* Clean organs before clean-contaminated organs \* Liver/pancrease/spleen first \* GIT order: stomach, duodenum, jejunum, ileum \*adrenal: FNA preferred over biopsy due to significant bleeding and catecholamine release \* Kidney and colon not routinely biopsied

Answer 373

I. Disordered consciousness, voluntary movement II. Excitement (may be unnoticeable with heavy premedication or narcosis) III. Surgical anaesthesia (resembles natural sleep) IV. Overdose

Answer 374

\* High blood flow-- good alveolar perfusion and a slow rise in alveolar anaesthetic concentration (partial pressure), induction is slower, recovery is slower \* low blood flow-- poor alveolar perfusion and a fast rise in alveolar concentration (partial pressure), induction is fast, and recovery is faster

Answer 375

\* Lidocaine: few systemic side- effects, short duration of action (1-2 hours) \* Mepivacaine: few systemic side effects short duration of action (2-3 hours) \* Ropivacaine: few systemic side- effects, long duration of action (3-4 hours) \* Bupivacaine: few systemic side- effects, long duration of action (4-6 hours)

Answer 376

\* Twitching/ paddling in recovery is possible in cats \* Usually stop if stimulation ceases \* Dramatically reduced by premedication \* Respiratory depression at induction -- same with propofol \* Decrease in arterial BP (\< propofol)

Answer 377

\* Major mechanism of chemotherapy failure \* Failure at any point responsible for chemosensitivity \* Multidrug resistance- tumour cell express transporters that actively express drug from the cell

Answer 378

\* Maintain renal perfusion - IV fluids - urinary catheter - monitor urine output - monitor: urea, creatinine, electrolytes, PCV, TP

Answer 379

\* Starches, gelatins, albumin/ plasma, 20% mannitol

Answer 380

\* Regenerative \* Haemolysis

Answer 381

Toxoplasma focal cotyledon lesions

Answer 382

\* d0= day of the LH surge- first day serum progesterone doubles/ rises \> 2ng/ml \* days 1-7 = days of oestrus- in relation to LH surgey \* D1= first day of dioestrus- based on cytology (decrease of keratinised cells to \< 50%)

Answer 383

\* Hypovolaemia: decreased blood volume \* Maldistributive: inappropriate vasodilation \* Obstructive: block to cardiac filling \* Cardiogenic: pump failure

Answer 384

\* anaesthetic used: lipid solubility, molecular size, protein binding, ionization \* dose \* rate of administration \* route of administration \* animals level of consciousness \* acid-base, electrolyte, and serum protein status \* animal cardiac output

Answer 385

\* similar analgesic profile to morphine \* no vomiting \* NMDA (not morphine) \* long half-life in humans, so many cumulate with repeat doses \* duration - 4 hours in dogs and 6-8 hours in cats

Answer 386

\* Check anaesthetic depth \* Check HR \* Rapid fluid administration \* IV dobutamine administered to effect, dopamine administered to effect

Answer 387

Campylobacter fetus subsp fetus and C. jejuni

Answer 388

\* anaesthetic redistributes until a new equilibrium is reached \* Equilibrium is reached when the inspired anaesthetic concentration is equal to the alveolar or end-tidal concentration

Answer 389

\* Cyanosis: hypoxaemia, paracetamol, polycythaemia \* Icterus: blue to gree eyes \* Brown: paracetamol \* Cherry red: carbon monoxide poisoning

Answer 390

\* fixed day breeding- e.g. breed day 12 and 14 after onset of prooestrus \*based on behaviour- start breeding every other day during time when bitch stands for the male \*\* Accurately detect oestrus: \*\* start in prooestrus, sampling every 2 to 3 days (M, W, F) - serum progesterone levels (10-25 ng/ml at time of fertile period but variable... aim for breeding 15-20 ng/ml) - test for "breeding reflexes" - vaginoscopy - exfoliative cytology

Answer 391

\* Class of antibiotic e.g. penicillin, aminoglycoside \* Spectrum of activity: broad or narrow \* Effect on bacteria: bacteriostatic or bactericidal \* Mode of action: inhibit cell wall synthesis, membrane function protein synthesis, etc

Answer 392

Genetics, environment (internal and external), experience

Answer 393

\* hypotension- care with hypovolaemic patients \* collapse in some families of boxers \* decreased seizure threshold \* hypothermia

Answer 394

\* from caudal thorax to perineum and laterally 5-10 cm (xiphoid to pubis)

Answer 395

\* Acute renal insufficiency because bladder was small and soft (vs. if we couldn't detect it or if it was hard- obstruction), collected urine, poorly concentrated and hyperkalaemic (this cat actually ingested lilies)

Answer 396

Rochester- Carmalt forceps have longitudinal serrations-- larger crushing forceps used primarily for large tissue bundles such as ligation of vascular or tissue stumps and pedicles such as during an ovariohysterectomy. (a few cross striations to prevent tissue slippage)

Answer 397

Increased memory, less tissue drag \* but less pliable, poorer handling

Answer 398

\* If we don't kill a particular cell line with chemotherapy, we will engender them to resistance \* Survival of the fittest

Answer 399

\* the patient- skin or haematogenous \* surgical equipment and implanted biomaterials (sutures, plates, screws) \* surgical personnel \* operating environment- including airborne particles

Answer 400

volume of gas inhaled or exhaled per minute minute volum = tidal volume x respiratory rate

Answer 401

BP = peripheral vascular resistance (PVR)/ CO \* BP and HR are not reliable for CO sudden severe hypovolemic hypotension

Answer 402

\* heat (and light) \* hide \* humidity \* health \* hygiene \* healthy appetite \* habitat \* handling

Answer 403

\* Concurrent disease that contradicts chemotherapy options (GI disease) \* Systemic health \* Unable to cure or long-term remission \* Owners unable to afford or consider chemotherapy \* Age alone is not a reason

Answer 404

Carboplatin, renal toxicity (diuresis)

Answer 405

\* Blunt- friable tissue e.g. liver \* Taper fine point- delicate tissue e.g. GI tract, bladder, muscle \* Cutting- tough tissue skin, peritoneum, fascia

Answer 406

10 mL- hence counting the number of blood-soaked swabs and measuring the volume of blood collected in the suction bottle will give an indication of the amount of blood loss

Answer 407

oxidised regenerated cellulose or gelatin to cover the bleeding surface \* local compression can produce the same effect but is time consuming. Suction can disrupt clot formation

Answer 408

Stainless steel instruments: steam under pressure Flexible endoscopes: peracetic acidor high level disinfection OPA Cidex Packaged suture materials: gamma irradiation

Answer 409

Gross movement of the shank is translated to fine movement of the blades

Answer 410

Resistance

Answer 411

Dry saturated steam

Answer 412

Babcock tissue forceps

Answer 413

Antifungal property

Answer 414

High memory-- difficulty in handling and decreased knot security

Answer 415

1. Chlorhexidine scrub solution 2. 70% alcohol spray 3. Chlorhexidine in 70% ethyl alcohol

Answer 416

\* Scrub suits and face mask

Answer 417

Gentle scurbbing in a circular motion from the incision site towards the periphery-- vigorous scrubbing has two disadvantages: create abrasions on the skin and bring follicular bacteria to the surface which then infect the abrasions.

Answer 418

Square knot

Answer 419

Surgical gowns and surgical gloves are the sterile barriers Non-sterile: scrub suits, surgical head covers, face masks, shoe covers, skin scrub

Answer 420

There is a correlation between the number of people and their movements, and the number of airborne bacteria in the operating theatre. Therefore it is important to reduce the number and movement of people in and out, and within the surgical theatre. Only the front of the gown, from mid chest to waist, the sleeves and gloved hands are considered "sterile". The surgeon and assistant should always be conscious of the “sterile field” and take all precautions to prevent a breakdown in aseptic technique. Non-sterile personnel should not walk in front or in-between an open sterile trolley. The first rule of conversation in the operating room is silence! Noise, whether it is conversation, music or phones ringing are a distraction that interrupts patient care and potentially increases the risk of error. Any conversation should be kept to the task at hand unless the surgeon initiates conversation however this is not a green light to continue casual conversations. Personal mobile phones or other devices should not be taken into theatre.

Answer 421

1. History 2. Physical Examination 3. Diagnostic Techniques 4. Collecting and Organising Information 5. Surgical Planning Allows comparison of the patient prior to and following surgery, risk profile, etc.

Answer 422

\*\* Reducing SSI 1. Hair removal 2. Skin preparation 3. Patient Draping 4. The Sterile Field

Answer 423

Shaving produces small lacerations which has been shown to increase post-operative infection rate up to ten fold No. 40 clipper blade with a minimum of 15 cm on each side of the incision \* Clipping: - replace blunt clipper blade - clean clipper blade before each use or preferably after each use - use a coarser blade for denser coats (No. 10 vs. No. 40) - clip initially along hair growth pattern; against hair for a closer clip - replace blades with missing teeth-- apply flat on skin to reduce clipper lacerations - avoid excess heat production from continuous heavy usage to reduce clipper burns - skin over irregular areas can be effectively clipped by applying tension to the skin or sliding it over to an adjacent flat area - ensure edges are straight for owner acceptance and easier drape application

Answer 424

skin antisepsis: 0.5% Chlorhexidine + 70% alcohol open wounds: 0.05% Chlorhexidine solution using sterile water is recommended

Answer 425

inactivated in the presence of organic material, especially blood and has poor residual activity... inactivated by alcohol \* High incidence of skin reactions

Answer 426

Near, top, tail, and far

Answer 427

\* Rough tissue handling \* improper use of instruments \* Prolonged exposure

Answer 428

1. A knowledge of surgical anatomy 2. Careful dissection 3. Dissection under gentle traction 4. Tissue must be kept moist during dissection- dry tissues result in an inflammatory response and potentiates adhesions between tissues such as the intestine-warm sterile saline 5. Avoid transection of muscle bellies 6. Keep operative time to minimum 7. Close dead space 8. Reduce the amount of foreign bodies within the wound

Answer 429

\* Allis tissue forceps- hold the linea alba during an ovariohysterectomy or laparatomy \* Babcock tissue forceps- urinary bladder during cystotomy \* Doyen intesinal forceps- for intestinal anastamosis

Answer 430

\* S. aureus in orthopaedic procedures ( from the skin) \* Coliforms and anaerobes in lower GIT surgery \*\* Cephazolin, a first generation cephalosporin which has efficacy against coagulase positive staphylococci and E. coli, \*\* low toxicity, cost effective and prolonged duration of activity

Answer 431

\* excess bleeding obscures the operative field \* blood on cloth drapes allows passage of bacteria through the drapes into the surgical field \* Post operative haemorrhage or haematoma formation delays healing and encourages infection \* Protracted haemorrhage may result in anaemia, poor healing and haemorrhagic shock

Answer 432

\* Compression (digital pressure 2-3 minutes) \* Crushing- haemostatic forceps on severed blood vessels will stimulate vasoconstriction and clot formation (by the exposure of sub-endothelial collagen, a potent platelet activator) \* Torsion- also creates further damage to the vessel wall and exposes sub-endothelial collagen \* Ligation with SILK OR metal ligation clips \* Suturing with polypropylene \* Tourniquets e.g. lower limb surgery- esmarch's bandage used in the distal limb of horses \* Stypics: open wounds-- adrenaline, ferric chloride, silver nitrate \* Absorbable haemostatic agents-- sheet of material or powder-- e.g. liver-- gelatin sponge, oxidised cellulose, calcium alginate fibres, fibrin sealants and glues, topical thrombin, bone wax \* Systemic haemostatic agents (Tranexamic acid, delta aminocaproic acid)- delay fibrinolytic activity-- vitamin K for warfarin \* Surgical diathermy or electro-surgery- high frequency alternating current traveling between two electrodes to produce local heat in tissues because the electric current attempts to travel through the tissues, they act as a resistor and produce heat, which achieves tissue injury and protein coagulation (excess use of electrocautery has been shown to double infection rates)

Answer 433

1. Traumatic inflammation- 1st vasoconstriction for 5-10 minutes, then dehydration of fibrin strands and other blood proteins to form scab which allows epithelial cells to migrate and wound contraction 2. Destruction or debridement- about 6 hours in-- leukocytes migrate into the wound by diapedesis and breakdown cellular debris, bacteria and foreign material. Then nethrophils to remove extracellular material. Then macrophages-- which remove most of the debris and attract fibroblasts by releasing cytokines 3. Proliferation (repair)- fibroblast proliferation (after debris has been removed; 4-6 days after injury) and migration, capillary infiltration (4-6 days after injury) \*\* fibroblasts, glycoproteins, protein polysaccharides, and capillary loops form granulation tissue (more type III collagen-- eventually becomes type I-- which aids in increasing tensile strength of wound) 4. after 3 weeks there is no further increase in the amount of collagen in the wound-- in the maturation stage the collagen forms re-organize along lines of stress (strength of the wound remains 15-20% weaker than original tissue)...

Answer 434

\* Cushing's disease, uraemia, disseminated cancer, diabetes, old patients, chronic anaemia (hypoxic tissues), protein deficiency from parasitism, malnutrition, malabsorption, liver disease, drugs (anti-inflammatory drugs, cytotoxic drugs), trauma (surgical), motion, seroma (free fluid in the wound), infection, low temperatures, foreign bodies (can wall off inert materials such as carbon, lead shot but not organic materials such as grass seeds-- inflammatory ongoing reaction) \* decreased capacity for fibroplasia and an increased risk of infection, release of endogenous ACTH and cortisol from disease/stress (inhibit early and late phases of wound healing- inflamm, neovascularisation, fibroplasia, collagen formation, wound contraction) \* Heart failure-- or other diseases that interfere with peripheral circulation

Answer 435

Mayo scissors: Straight or curved, blunt-blunt scissors. Heavy duty scissors used for dissecting and cutting strong tissues such as fascia. Metzembaum scissors: Usually curved. Similar to mayo scissors but these scissors have shorter blades relative to the handles and a much more delicate action for dissection around delicate tissues. Iris scissors: Sharp-sharp scissors Blunt-Sharp scissors : These scissors are robust instruments designed for cutting materials such as excess suture material following suture placement. They are not a tissue scissor. Wire scissors: These are very strong scissor designed to cut surgical wire with a shearing action. Bandage scissors: These scissors usually have a protected end on the lower blade to protect the skin during bandage removal. Suture scissors: alternatively a #12 sterile disposable hook blade may be used. Curved scissors offer greater mobility and visibility while straight scissors provide greater mechanical advantage

Answer 436

\* The greater pressure required to hold smooth-tipped tissue forceps is more traumatic than using tissue forceps with small teeth (Adson) or fine serrations (Debakey)?

Answer 437

\* Bonney forceps: heavy robust instrument for tissues such as skin or the linea alba (1:2 or 2:3 teeth) \* Potts Smith forceps: Longer, more delicate for delicate tissues such as gut \* Adson forceps (1:2 teeth) or Brown Adson: multiple intermeshed fine teeth-- delicate tissue \* Russian forceps: wide tip and deep grooved gripping surface-- lung or atrial appendage \* Debakey- cardiovascular or urogenital surgery-- adventitia around a blood vessel to aid in dissection-- fine serrations or teeth that intermesh \* Dressing forceps: stronger and more robust than tissue forceps-- used to hold spnges or gauze -- not for tissue as causes injury due to using more pressure to attempt to hold the tissues

Answer 438

\* Allis tissue forceps- may crush tissue and should be used on connective tissue and fascial planes only; linea alba during an ovariohysterectomy or laparotomy \* Babcock intestinal forceps- less traumatic to the tissues than allis. Fine longitudinal striations. Urinary bladder during cystotomy. \* Noyes alligator forceps: long thin shaft- can enter small openings and are excellent for removing foreign bodies from structures such as the ear canal \* Doyen intestinal forceps: designed to hold intestines without crushing-- long thin bowed jaws with tips of the jaws meeting at the same time as the ratchets first teeth engage

Answer 439

\* Halsted mosquito haemostats \* Kelly and crile- more robust

Answer 440

Rochester Carmalt forceps- clamping vascular pedicles. The grooves run parallel with the long axis of the jaws. They are particularly useful in ligating ovarian and uterine pedicles.

Answer 441

\* Mathieu- needle holder operated by the palm of the hand and therefore suffers in precision and feel for the tissues \* Gillies pattern- large thumb grip set at an angle to the other for use over the thumb. Also has a scissor incorporated into the jaws but does not have a ratchet.

Answer 442

\* stainless steel instruments, drapes, gowns, swabs, most rubber articles, glassware and some heat stable plastics NO endoscopes, lenses and some plastics can be damaged

Answer 443

\* synthetic suture materials, plastic catheters and syringes \*\* NOT on endoscopes

Answer 444

\* medium to high level disinfection \* endoscopes-- or other lensed instruments

Answer 445

\* Rapidly absorbable: - Catgut (chromic catgut 30 days, catgut 15 days), Monocryl (Polyglecaprone) 7-10 days, Vicryl Rapide 5 days, Caprosyn (Polyglytone) \* Medium term: - Dexon (Polyglycolic acid 14 loss of 35% tensile strength, 21 days 65%), Vicryl (Polyglactin)- similar to Dexon, Polysorb (Braided Lactomer, similar to Vicryl and Dexon), Biosyn (monofilament Glycomer) similar to all of the above \* Longer-term: - PDS (50% loss of tensile strength in 28 days and 75% in 75 days), Maxon (Polyglyconate- 50% of tensile strength at 28 days, 75% in 42 days)

Answer 446

\* Silk (ligating large blood vessels) \* Linen (braided-- causes tissue reaction, GIT surgery) \* Polyester (multifilament braided... extremely strong, durable, pliable and easy to handle. Huge tissue reaction) \* Nylon (Polyamide)- monofilament-- significant memory makes handling and knot tying difficult \* Caprolactum- twisted multifilament coated material with good handling. Only used in skin. \* Polypropylene- monofilament, vascular surgery \* Polybutester- monofilament, not as stiff as nylon. Good knot security, little packet memory \* Stainless steel- multi or mono, highest tensile strength andg greatest knot security. Essentially inert but poor durability to repeated flexing and may break.

Answer 447

Tissue adhesives, cyanoacrylates, not as strong as sutures if used alone. Tissue toxicity and delayed wound healing. They polymerise in the moisture present in a wound with the release of heat.

Answer 448

\* Surgeons knot is used to place a suture in tissues in which the wound edges are under some tension and the first throw wants to slip \* Multifilamentous materials have better know security when compared with monofilaments. But this is significantly reduced by coating and 4-5 throws are frequently required to secure them. Also premature locking is also a problem associated with these sutures.

Answer 449

\* Initial strength- cannot be stronger than the tissue holding as will tear as well \* Durability- loss of suture strength of absorbable sutures should lag behind the gain of strength of a healing wound \* Tissue reaction \* Biomechanical properties

Answer 450

Temperature! Fans, soak in water, alcohol if not much hair, cool water enema

Answer 451

Increase BP and ICP--\> Could exacerbate CNS system issues SO DO NOT DO IF ANIMAL IS not ambulatory or unstable

Answer 452

Urine casts