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Everything Else Flashcards

1
Q

What causes hypoalbuminemia?

A

Liver failure
Protein-losing enteropathy or nephropathy
Malnutrition
Systemic inflammation

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2
Q

What are the consequences for hypoalbuminemia?

A

Altered pharmacokinetics
Delayed wound healing
Decreased oncotic pressure

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3
Q

What causes hyperalbuminemia?

A

Dehydration

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4
Q

How is vascular resistance related to vessel diameter?

A

Resistance is inversely proportional to the radius of the vessel to the 4th power

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5
Q

What should you monitor in a patient that may have a coagulopathy?

A

Platelet count

Clotting times (PT, PTT)

Antithrombin

Fibrin degradation products/D-dimers

Thromboelastography

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6
Q

What is the most accurate way to monitor fluid balance?

A

Serial, consistent body weight measurements

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7
Q

What heart rate is concerning in dogs? Cats?

A

Dogs: tachycardia (>140 bpm)

Cats: bradycardia (<160 bpm)

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8
Q

What can cause a decrease in heart contractility?

A

Sepsis
SIRS
Primary heart disease

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9
Q

More than what percent of blood oxygen is carried by hemoglobin?

A

98%

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10
Q

Under normal conditions, what is the concentration of oxygen in the blood?

A

20 mL O2/dL

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11
Q

What is the difference between hyperthermia and fever?

A

Hyperthermia: increase in temp caused by external source

Fever: temp elevated from within (stimulation of pyrogens, elevated set point in hypothalamus)

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12
Q

What is the “Rule of 4”?

A

Normal values for Na, K, and pH

Na: 140
K: 4
pH: 7.4

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13
Q

What are the normal Na/K ratios for extracellular fluid? Intracellular?

A

Extracellular: High Na, low K

Intracellular: Low Na, high K

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14
Q

What molecule is the biggest determinant of water balance?

A

Na+

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15
Q

What are the two types of fluid loss and how quickly can they be replaced?

A
  1. Dehydration = interstitial/intracellular fluid loss. Replace slowly.
  2. Hypovolemia = intravascular fluid loss. Replace rapidly!
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16
Q

What are clinical signs of hypovolemia?

A 
Tachycardia
Prolonged CRT
Hypotension
Hypothermia, cool extremities
Weak pulses
Weakness, lethargy
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17
Q

How do you initially address hypovolemia?

A

Give fluid boluses of 10-20 mL/kg isotonic fluids and then reassess.

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18
Q

What type of fluid should be avoided in patients with liver disease?

A

Lactate-buffered solutions

Thought to mess with acid/base

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19
Q

Why should plain water never be given IV?

A

It causes a rapid shift of water intracellularly, causing blood cell swelling and death

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20
Q

What are the differences in Na/K ratios in maintenance fluids vs replacement fluids?

A

Maintenance: Low Na/Cl, high K (hypotonic)

Replacement: High Na/Cl, low K (isotonic)

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21
Q

What are hypertonic fluid used for?

A

Rapid volume expansion or reduction of intracranial pressure

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22
Q

What are contraindications of hypertonic fluids?

A

Severe dehydration

Hypernatremia

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23
Q

What is hypertonic saline?

A

Usually 7.2 - 7.5% saline (2400 mOsm)

Expands blood volume 3-2.5 the amount administered

4ml/kg IV over 5 min

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24
Q

What are the proposed benefits of hypertonic saline?

A

Rapud intravascular volume expansion

Decreases cerebral edema

Increased cardiac contractility

Immunomodulatory effects

Improved microcirculatory perfusion due to arteriolar vasodilation

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25
Q

What are the adverse effects of hypertonic saline?

A

Hypernatremia

Bradycardia

Hypotension

Bronchoconstriction

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26
Q

What do you need to remember about mannitol?

A

Must be kept warm to prevent crystallization

Should be administered through a filter

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27
Q

When do you discontinue fluid therapy?

A

Rehydration is complete

Patient is eating and drinking sufficiently

On-going losses are under control

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28
Q

What are colloids?

A

Fluids that contain large, insoluble molecules that do not freely cross a semi-permeable membrane

Act to hold water within vascular space for a longer duration than crystalloids

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29
Q

Which starling force explains why a hypoproteinemic animal can have pitting edema but no pulmonary edema?

A

Hydrostatic pressure

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30
Q

What is the main contributor to intravascular volume?

A

Albumin

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31
Q

What is colloid osmotic pressure?

A

Pressure exerted by large molecules the water it pulls across membranes

Measured using a colloid osmometer

Albumin generates 80% COP

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32
Q

What are the proposed effects of colloids?

A

Longer intravascular effects

Smaller volume requirements for intravascular expansion

Less dilutional coagulopathies

Decreased tissue edema formation

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33
Q

What characteristic of a molecule most influences serum osmolality?

A

CHARGE

Size doesn’t matter

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34
Q

What is the Gibbs-Donnan Effect?

A

Because electroneutrality must be maintained, Large negative proteins (such as albumin) draw positive ions (Na+) and water across semi-permeable membranes

Increases the COP 7-8mmHg

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35
Q

What are examples of natural colloids?

A

Albumin

Blood products (NOT packed RBCs)

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36
Q

Why should you never administer human albumin to a healthy patient or a patient that has received human albumin in the past?

A

Severe anaphylaxis

Delayed hypersensitivity reactions

Death

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37
Q

How do you calculate the albumin deficit?

A

Alb Dft = 10 x [Ab (desired) - Ab(patient)] x BW x 0.3

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38
Q

What is the primary synthetic colloid used in vet med? What are the potential adverse effects?

A

Hydroxyethyl Startch (Hetastarch, Pentastarch, Tetrastarch)

Acute renal failure

Anaphylaxis

Immunosuppression

Volume overload

Coagulopathy

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39
Q

What characteristic of a solution is most correlated with decreased coagulation?

A

Higher degree of substitution

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40
Q

What effect will colloid administration have on urine SG?

A

Increase it

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41
Q

What are non-cardiac causes of elevated heart rate?

A

Poor perfusion
Anemia
Pain/anxiety

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42
Q

What is the “shock triad” in cats?

A

Bradycardia
Hypothermia
Hypotension

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43
Q

Fluids with osmolalities >600mOsm should only be administered through what?

A

Central line

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44
Q

What will causes the biggest decrease in flow through a catheter?

A

Halving the diameter of the catheter

Poiseuille’s Law: Flow is proportional to diameter ^ 4

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45
Q

What are the most common sites for placing a central line?

A

Jugular v

Medial and lateral saphenous v

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46
Q

What are possible complications of catheterization?

A

Phlebitis

Thrombosis

Catheter embolism

SQ fluid infiltration to surrounding vein

Infection

Hemorrhage

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47
Q

What is the seldinger technique?

A

Use of a smaller introducing catheter or trochar + guide wire to gain access to vessels or hollow organs

May also be used to replace an existing catheter in the same location

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48
Q

What is the biggest disadvantage to IO catheterization?

A

Patient discomfort

Limited to 29mL/min

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49
Q

What complications are associated with IO catheterization?

A

Fat embolism

Infection

Extravasation of fluids

Compartment syndrome

Bone fractures

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50
Q

What is the difference between the thoracic and cardiac pump techniques for CPR?

A

Thoracic pump: pump at highest point on chest (large dogs)

Cardiac pump: pump above heart (small dogs, cats)

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51
Q

What is an ideal compression:ventilation ratio for CPR?

A

30:2

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52
Q

What are the shockable cardiac rhythms?

A

V fib

Pulseless V tach

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53
Q

When is open chest CPR indicated?

A

Tension pneumothorax

Pericardial/pleural effusion

Thoracic wall trauma

Diaphragmatic hernia

Prolonged closed chested CPR

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54
Q

What are the 4 cardiac rhythms associated with arrest?

A

Asystole
Pulseless electrical activity
Pulseless V tach
V fib

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55
Q

What is post-cardiac arrest syndrome?

A

Multiorgan failure

Cardiogenic shock

Anoxic brain injury

Sequela or pre-existing diseases

56
Q

What antibiotic is associated with neuro signs at high does?

A

Metronidazole

57
Q

Which antibiotics are known to be nephrotoxic?

A

Aminoglycosides

58
Q

What patient risk factors are associated with antibiotic resistance?

A

Prior antibiotic use (within the last 90 days)

Hospital acquired infection

Long-standing infection

Surgical implants

59
Q

What antibiotic would you use to treat puppy pneumonia?

A

Healthy, outpatient: doxy

Sick, outpatients: potentiated penicillins

Sick, inpatient: Potentiated penicillins + fluoroquinolone or chloramphenicol

60
Q

What antibiotic would you use to treat adult pneumonia?

A

Community-acquired: potentiated penicillins + fluoroquinolones

Hospital -acquired: potentiated penicillins + aminoglycoside OR carbapenems

61
Q

What antibiotic would you use to treat septic peritonitits?

A

Community-acquired: penicillins + fluoroqionolone or 3rd gen ceph

Hospital-acquired: penicillins + aminoglycoside + metronidazole OR imipenem

62
Q

What antibiotics would you give to treat an animal bite?

A

penicillins or potentiated penicillins

63
Q

What antibiotic would you use to treat a UTI?

A

1st gen ceph

Penicillins

64
Q

What are the 4 types of coagulation abnormalities in snake bit envenomations and which is the most common?

A
  1. Combined fibrinogenolysis amd thromocytopenia most common
  2. Fibrinogenolysis
  3. Thrombocytopenia
  4. DIC
65
Q

What is the Snake Bite Severity Score?

A

Used to classify severity and dose of antivenom

0-20 (20 is worst)

66
Q

How do you treat a snake envenomation?

A

IV crystalloid

Antivenom

Glucocorticoids/antihistamines for hypersensitivities only

67
Q

Why should you avoid NSAIDs with snake envenomations?

A

NSAIDs prevent platelet aggregation

68
Q

When is the optimum time to give antivenom?

A

Within first 4 hours of bite

69
Q

Which type of antivenom is associated with the least amount of hypersensitivity reactions?

A

Fab1

70
Q

What should you know about hemolytic anemia associated with elapid bites?

A

Hemolysis occurs in dogs but not in cats

71
Q

What are the components of bee venom and what are their actions?

A
  1. Melitin: hydrolyzes cell membranes, histamine release
  2. peptide 401: mast cell degranulation
  3. Phospholipase A: major Ag that causes hemolysis
  4. Hyaluronidase: spreading factor
72
Q

What causes the intense paid in vespid envenomations?

A

Serotonin, kinins, acetylcholine

73
Q

What are the active components of hymenoptera envenomation?

A

Vasoactive amines, acetylcholine, kinins

74
Q

Urticaria, angioedema, laryngeal edema, circulatory collapse, shock are all signs of what?

A

Anaphylaxis

75
Q

What are predisposing factors for having severe reactions to bee stings?

A

Beta blockers

ACE inhibitors

76
Q

What do you give for an animal in anaphylaxis?

A

Epi 0.01mg/kg IM

Stabilizes mast cells

77
Q

A pustule is indicative of what kind of envenomation?

A

Fire Ant

78
Q

What is the main component of black widow venom and what does it do?

A

Alpha-lactrotoxin

Induces massive neurotransmitter release

Cats are VERY PAINFUL

79
Q

How do you treat black widow envenomation?

A

Antivenom

Narcotic analgesics

Antihypertensives

Benzodiazapines

80
Q

What is the best sedative for an animal in respiratory distress?

A

Butorphanol

81
Q

What are the 3 most important things to do for an animal in respiratory distress?

A
  1. Hands off
  2. Oxygen
  3. Sedation
82
Q

What are the landmarks for thoracocentesis?

A

8th/9th intercostal space

83
Q

What can you give to increase strength of contractions? Frequency of contractions?

A

Strength - calcium

Frequency - oxytocin

84
Q

What are the indications for surgical intervention in a dystocia?

A

Obstructed

Fetuses stressed or dead

Oversize

Sick queen or bitch

Failed medical tx

85
Q

What are surgical emergencies in a dystocia?

A

Uterine torsion

Uterine rupture

86
Q

What is the main clinical sign associated with penile trauma?

A

Hematuria at the end or urination

87
Q

What disease should you be concerned with in patient with testicular abscess?

A

Brucella

88
Q

What is the difference between paraphimosis, priapism, and phimosis?

A

Paraphimosis: protrusion of nonerect penis without ability to retract

Priapism: persistent erection without sexual stimulation

Phimosis: inability to extrude penis from prepuce

89
Q

What is the expected weight gain of neonatal puppies and kittens?

A

Puppies: 1g per lb of adult weight

Kittens: 7-10 grams per day

90
Q

In neonates, bradycardia and hypotension are usually due to what?

A

Hypoxemia

HR <150bpm

91
Q

What 3 reflexes can asses neurologic function in neonates?

A

Righting reflex

Rooting relfex

Suckle reflex

92
Q

What is the fluid requirement for neonates?

A

80-100ml/kg/day

93
Q

What is a normal PCV for a neonate?

A

Around 30

Any higher-> dehydration

94
Q

What antibiotics can you use safely in neonates?

A

Metronidazole

B lactams

95
Q

What is neonatal isoerythrolysis?

A

Immune-mediated destruction of kitten’s erythrocytes by queen’s antibodies

Kittens with A or AB blood nursing from type B queen

Queen passes anti-A IgG Ab in colostrum

96
Q

What causes a high anion gap?

A

“DUEL”

Diabetic ketoacidosis

Uremic acids

Ethylene glycol

Lactate

97
Q

What causes a metabolic acidosis?

A

High AG, normoCl-: shock/high lactate, DKA, renal failure, toxins

Normal AG, hyperCl-: diarrhea

98
Q

What causes a metabolic alkalosis?

A

Upper GI obstruction, vomiting, loop diuretics, liver failure, Cushings

99
Q

What causes respiratory alkalosis? Acidosis?

A

Alkalosis: hyperventilation

Acidosis: hypoventilation

100
Q

What are the classifications of shock?

A

Hypovolemic: decrease in circulating blood volume

Cardiogenic: decrease in forward flow

Distributive: decrease or increase in SVR or maldistribution of blood

101
Q

What are the different types of hyperlactatemia?

A

A: increased oxygen demand, struggling

B1: associated with underlying disease

B2: drugs or toxins

B3: inborn errors of metabolism

102
Q

The hyperdynamic phase of sepsis is characterized by what?

A 
Bounding pulses
Injected mucous membranes
Fever
tachycardia
tachypnea
103
Q

How can you determine septic peritonitis from ab tap?

A

Lactate difference >2 mmol/L

Glucose difference >20 mg/dL

104
Q

What is the MOA of isotonic crystalloids in lower urinary blockage?

A

Dilution

105
Q

What is the MOA of albuterol or theophylline in lower urinary blockage?

A

Activates Na/K pump to push K intracellularly

106
Q

How can you diagnose uroabdomen from ab tap?

A

Creatinine 2:1

Potassium 1.4:1

107
Q

What are lung crackles suggestive of? Dull lung sounds?

A

Pulmonary contusions

Pleural space disease

108
Q

What does Schiff Sherringotn posture suggest?

A

Thoracolumbar spinal injury

109
Q

What tests are part of the minimum emergency database?

A

PCV and TP
Glucose
BUN/creatinine
Lactate

110
Q

A TS less than what value is indicative or hemorrhage?

A

<6

111
Q

What are common sources of internal bleeding at may not initially be apparent?

A

Femoral fracture
Pelvic fracture
Hemoabdomen

112
Q

What injury may contribute to hyperglycemia? Hypoglycemia?

A

Hyper: traumatic brain injury
Hypo: bite wounds, sepsis

113
Q

Analysis of abdominal effusions

A

PCV/TS close to blood = hemorrhage

Creatinine and K higher than blood = uroabdomen

Glucose and lactate low = sepsis

Bilirubin higher than blood = bile

114
Q

What toxic compound is acetaminophen converted to and why is it so toxic to cats?

A

NAPQI via CP450

Glucoronidation is limited in cats

115
Q

What is a common clinical sign of acetaminophen toxicity?

A

Chocolate brown MM

Vasculitis/puffy face in cats

116
Q

Why will pulse ox be inaccurate in patients with acetaminophen toxicity?

A

Methemoglobinemia distorts SPO2

117
Q

What is the best treatment for acetaminophen toxicity?

A

N-acetylcisteine

Increases availability of glutathione and coverts NAPQI to non-toxic conjugates

118
Q

What is serotonin syndrome? How do you treat it?

A

Certain drugs can increase serotonin levels ( antidepressants, opioids)

Leads to excessive serotonin in CNS

Leads to altered mentation, autonomic signs, neuromuscular weakness

Tx with cyproheptadine and decontamination

119
Q

What is the main concern with phenylpropanolamine (proin) overdose?

A

Severe hypertension

120
Q

What are the negative effects associated with albuterol overdose?

A

Thermal burns in mouth

Tachycardia

Severe temporary hypokalemia

121
Q

How do you treat the muscarinic and nicotinic signs of anticholinesterase toxicity?

A

Muscarinic: atropine

Nicotinic: 2 PAM

122
Q

What are the two clinical syndromes of xylitol toxicity?

A

Hypoglycemia (early)

Liver failure (delayed)

(Activated charcoal not helpful)

123
Q

What is the treatment of choice for tremors in mold toxicity?

A

Methocarbamol

124
Q

How is bread/pizza dough toxic and when is it okay to decontaminate?

A

Yeast produce ethanol, which interferes with NMDA receptors

Okay to decontaminate if patient isn’t drunk yet

125
Q

What is the MOA of garlic/onion toxicity?

A

Oxidative damage to hemoglobin (heinz bodied, eccentrocytes, hemolysis)

126
Q

What are the toxic metabolites of ethylene glycol?

A

Glycoaldehyde

Glycoxylic acid

127
Q

What is the test of choice to assess anticoagulant rodenticide toxicity?

A

Prothrombin (PT)

Factor 7 depletes earliest

128
Q

How do you treat hypercalcemia associated with Vit D3 toxicity?

A

0.9% NaCl diuresis
Furosemide
Corticosteroids

129
Q

How do you treat sago palm toxicity?

A

Cholestyramine
Hepatoprotectants
Supportive care

130
Q

What are the two main toxicities seen with mushroom toxicity?

A

Hepatotoxicity

Muscarinic signs

131
Q

Which genus of lillies are toxic?

A

Lilium or Hemerocallis

Tiger, Day, Easter, Stargazer

132
Q

How is fluid resuscitation with isotonic crystalloids associated with coagulopathy?

A

Dilution of clotting factors

Acidemia

Hypothermia

133
Q

Why do citrate-containing transfusions worsen coagulopathy?

A

Makes Ca drop

Citrate toxicity

134
Q

What are the 4 injuries to rule out in roll-over injuries?

A

Bldder rupture

Pelvic fractures

Body wall rupture

Diaphragmatic hernia

135
Q

What is the definition of AKI?

A

Inc creatinine by >0.3 mg/dL within 48 hrs

Inc creatinine > 1.5 times baseline

Urine production < 0.5 ml/kg/hr (normal is 1-2)

ECC (2 decks)

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