a) w/c 16-Sept-13 / PRINCIPLES Flashcards
What are the 4 main steps involved in Problem Based Clinical Reasoning?
1) Define the problem
2) Define the system
3) Define the location in the syste
4) Define the lesion
Four examples of where it is vital to define the problem?
Vomiting or Regurgitating?
Straining; colitis or constipation?
Red Urine; blood haemoglobin or myoglobin?
Abdominal pain or back pain?
For every clinical sign there is a system that MUST be involved. e.g. for vomiting the ____ must be involved
Gastrointestinal system.
In either a PRIMARY or SECONDARY role
Vomiting Primary: Structural disease of the gut
Secondary way: Functional systemic disease e.g. liver/kidney disease
The system affected can either be affected in a ___ or ___ way
Primary way i.e. structural (nerve damage)
Secondary way i.e. functional (collapse- hypoglycemia)
Defining the system: Pale mucous membranes
Anemia or poor peripheral perfusion
What is the abbreviation DINT used for?
Developmental, Degeneration, Infection, Inflammation, Neoplasm, Nutritional, Trauma, Toxic DDIINNTT
Increased inspiratory effort would be indicative of respiratory disease in the _______ airway
Upper Respiratory disease (also with loud, referred noise) remember UI
From watching the respiratory pattern (from afar) and ausculating a patient with lower respiratory disease you would expect…
LOWER: Increased expiratory effort (watch from afar) and WHEEZING noise on ausculatation
Auscultation reveals ‘Crackling’ noise; this is indicative of _____ disease
Pulmonary disease
4 types of Mentation when assessing the emergency patient are
- Alert and Responsive
- Obtunded
- Stuperous
- Commatosed
4 types of shock are:
Hypovolemic, Maldistributive, Cardiogenic, Obstructive
Proptosis is
Forward displacement of the eyeball
What is the term given to the spasm of the orbicularis oculi muscle of the eyelids?
Blepharospasm
What does TRP stand for?
Temperature (37.5 to 38.5), Pulse, Resp Rate
What systems do you assess in the emergency patient
Cardiorespiratory, Neurological
What is paradoxical abdominal movement?
Serious form of dyspnoa where the chest movements are the opposite of normal
What is tomography
Making images that represent a section through the body
If a dog and cat both present with dyspnoa in lateral recumbancy; which one do you prioritise?
Cat; dyspnoa in lateral recumbancy = death
Dog; still serious
What is dysphagia
WL with decreased appetitite; DIFFICULTY SWALLOWING
Define true anorexia and the one rare cause that is often overlooked
Anorexia: Appetite control in hypothalamus.
- Glucose levels, temperature, metabolic products, neural imput from GIT.
RARE but POSSIBLE: DIRECT CNS Pathology.
i.e. primary CNS vs other reasons = secondary CNS
Most common causes of Anorexia
Pyrexia = common in cats i.e. cat bite. TAKE TEMP
Severe constipation (c.f. with colitis simular CS)
Anaemia (pale MM)
Psychic factors e.g. stress
LOOK FOR MORE SPECIFIC SIGN E.G. toxins (endo/exogenous). electrolyte disturbances
Normal physiology of digestion
Ingestion, Digestion, Absorption, Utilisation. Therefore 3 MALS
Most common form of Maldigestion in DOGS
Exocrine Pancreatic Insufficiency
can also be caused by a deficiency of bile acid.
Loss of brush border enzymes
Primary and secondary causes of malabsorption
Impairment of absorption in small intestine following digestion.
Primary: Structural disease (COMMON). Lymphoma, IBD, bacterial overgrowth
Secondary: Metabolic: Hepatic disease (bile acids), Hypothyroidism; increased food transit time - metabolic rate
How do the clinical signs differ between dogs and cats with IBD (primary malabsorption gut disease)
DOGS: Diarhaea
CATS: Vomiting
Which of the 3 MALS does not have diarrhoea as a common clinical sign
Malutilisation e.g. diabeties, dirofilariasis, heart failure, renal disease, (liver disease normally decreased)
Common causes of
Malutilisation with INCREASED appetite
Diabeties or Hypothyroidism
What would an appropriate energy intake be for a small dog who has normal activity levels?
60kcal/kg - SMALL DOG
50kcal/kg - AVERAGE
40kcal/kg - LARGE DOG
ADJUST DEPENDING ON ACTIVITY LEVELS
What is the normal PCV for a dogs haematocrit
30- 35 %
Main problem associated with NSAIDs e.g. meloxicam
Gastric ulcers
What is the concept where vagal tone decreased HR known as? Is this a pathogenic or non-pathogenic process?
Sinus arrhythmia. This is normal
What would be the first clinical sign you would observe in a dog with suspected congestive heart failure?
Monitor Resp Rate in Waiting room (i.e. from a distance).
In CHF = increased from normal
Normal: 25-30bpm
When is it preferable to have a high mA value?
To stop motion blur (mAs= mA x time)
Increasing the kVp affects which 2 values?
Increased number AND energy of x-rays (i.e. penetrating power)
What happens to low energy electrons?
They are removed as they would provide a useless radiation dose
When would you increase kVp
If you needed increased penetrating power i.e. thicker patients. Can use x-ray grids. Allows focussing of primary beam; Grid factor= 2/3 x mAs
What is the maximum permisable dose for workers?
The MPD is 20mSv
Natural dose for normal people = 2.3 mSv
