a) w/c 16-Sept-13 / PRINCIPLES

Question 1

What are the 4 main steps involved in Problem Based Clinical Reasoning?

Answer 1

1) Define the problem
2) Define the system
3) Define the location in the syste
4) Define the lesion

Question 2

Four examples of where it is vital to define the problem?

Answer 2

Vomiting or Regurgitating?
Straining; colitis or constipation?
Red Urine; blood haemoglobin or myoglobin?
Abdominal pain or back pain?

Question 3

For every clinical sign there is a system that MUST be involved. e.g. for vomiting the ____ must be involved

Answer 3

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

Question 4

The system affected can either be affected in a ___ or ___ way

Answer 4

Primary way i.e. structural (nerve damage)

Secondary way i.e. functional (collapse- hypoglycemia)

Question 5

Defining the system: Pale mucous membranes

Answer 5

Anemia or poor peripheral perfusion

Question 6

What is the abbreviation DINT used for?

Answer 6

Developmental, Degeneration, Infection, Inflammation, Neoplasm, Nutritional, Trauma, Toxic DDIINNTT

Question 7

Increased inspiratory effort would be indicative of respiratory disease in the _______ airway

Answer 7

Upper Respiratory disease (also with loud, referred noise) remember UI

Question 8

From watching the respiratory pattern (from afar) and ausculating a patient with lower respiratory disease you would expect…

Answer 8

LOWER: Increased expiratory effort (watch from afar) and WHEEZING noise on ausculatation

Question 9

Auscultation reveals ‘Crackling’ noise; this is indicative of _____ disease

Answer 9

Pulmonary disease

Question 10

4 types of Mentation when assessing the emergency patient are

Answer 10

1. Alert and Responsive
2. Obtunded
3. Stuperous
4. Commatosed

Question 11

4 types of shock are:

Answer 11

Hypovolemic, Maldistributive, Cardiogenic, Obstructive

Question 12

Proptosis is

Answer 12

Forward displacement of the eyeball

Question 13

What is the term given to the spasm of the orbicularis oculi muscle of the eyelids?

Answer 13

Blepharospasm

Question 14

What does TRP stand for?

Answer 14

Temperature (37.5 to 38.5), Pulse, Resp Rate

Question 15

What systems do you assess in the emergency patient

Answer 15

Cardiorespiratory, Neurological

Question 16

What is paradoxical abdominal movement?

Answer 16

Serious form of dyspnoa where the chest movements are the opposite of normal

Question 17

What is tomography

Answer 17

Making images that represent a section through the body

Question 18

If a dog and cat both present with dyspnoa in lateral recumbancy; which one do you prioritise?

Answer 18

Cat; dyspnoa in lateral recumbancy = death

Dog; still serious

Question 19

What is dysphagia

Answer 19

WL with decreased appetitite; DIFFICULTY SWALLOWING

Question 20

Define true anorexia and the one rare cause that is often overlooked

Answer 20

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

Question 21

Most common causes of Anorexia

Answer 21

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

Question 22

Normal physiology of digestion

Answer 22

Ingestion, Digestion, Absorption, Utilisation. Therefore 3 MALS

Question 23

Most common form of Maldigestion in DOGS

Answer 23

Exocrine Pancreatic Insufficiency
can also be caused by a deficiency of bile acid.
Loss of brush border enzymes

Question 24

Primary and secondary causes of malabsorption

Answer 24

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

Question 25

How do the clinical signs differ between dogs and cats with IBD (primary malabsorption gut disease)

Answer 25

DOGS: Diarhaea
CATS: Vomiting

Question 26

Which of the 3 MALS does not have diarrhoea as a common clinical sign

Answer 26

Malutilisation e.g. diabeties, dirofilariasis, heart failure, renal disease, (liver disease normally decreased)

Question 27

Common causes of

Malutilisation with INCREASED appetite

Answer 27

Diabeties or Hypothyroidism

Question 28

What would an appropriate energy intake be for a small dog who has normal activity levels?

Answer 28

60kcal/kg - SMALL DOG
50kcal/kg - AVERAGE
40kcal/kg - LARGE DOG
ADJUST DEPENDING ON ACTIVITY LEVELS

Question 29

What is the normal PCV for a dogs haematocrit

Answer 29

30- 35 %

Question 30

Main problem associated with NSAIDs e.g. meloxicam

Answer 30

Gastric ulcers

Question 31

What is the concept where vagal tone decreased HR known as? Is this a pathogenic or non-pathogenic process?

Answer 31

Sinus arrhythmia. This is normal

Question 32

What would be the first clinical sign you would observe in a dog with suspected congestive heart failure?

Answer 32

Monitor Resp Rate in Waiting room (i.e. from a distance).
In CHF = increased from normal
Normal: 25-30bpm

Question 33

When is it preferable to have a high mA value?

Answer 33

To stop motion blur (mAs= mA x time)

Question 34

Increasing the kVp affects which 2 values?

Answer 34

Increased number AND energy of x-rays (i.e. penetrating power)

Question 35

What happens to low energy electrons?

Answer 35

They are removed as they would provide a useless radiation dose

Question 36

When would you increase kVp

Answer 36

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

Question 37

What is the maximum permisable dose for workers?

Answer 37

The MPD is 20mSv

Natural dose for normal people = 2.3 mSv