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Mechanism of Disease (Elise) > Exam 2 MOD > Flashcards

Exam 2 MOD Flashcards

1
Q

Glomerulonephritis is a group of condition in which ________ are deposited in the glomeruli

A

immune-complexes

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2
Q

Which lung lobe is anatomically predisposed to atelectasis?

A

Right middle lung lobe

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2
Q

What pro-kinetics can you use in non-obstructive vomitting?

A

Metoclopramide (CRI best)
Cisaparide

Ranitidine

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3
Q

The a-a gradient in ventilation perfusion mismatch is ____(normal, high, low)

A

high, >30 mmHg

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3
Q

Pylmonary Fibrosis, decreased RBC transit time through alveolar capillaries (pulmonary hypertension) and thickening of blood- gas interface (smoke, pneumonia) are all cause what?

A

Diffusion Impairment

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3
Q

How does high oxygen Anesthesia cause atelectasis?

A

High FiO2 causes the loss of nitrogen which normally creates a nitrogen skeleton to keep the alveoli open

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3
Q

what is syncope?

A

fainting due to lack of oxygen delivery to brain

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4
Q

What causes depression in acute renal failure?

A

Uremic encephalopathy

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5
Q

________Ventilation is the total amount of NEW air moved into the respiratory passage each minute

A

Minute Ventilation

——————

Vm= RR x Vt

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6
Q

Due to the increased airway resistance in upper airway disease, there is an increased intra-pulmonary pressure which leads to a ______mismatch

A

V/Q

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6
Q

All vomiting stimuli converge at the _______center

A

emetic/vomiting

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6
Q

T/F: Proteinuria indicates a decrease in kidney function

A

FALSE - if may involves the glomerulus and GFR may be maintained, thus there is no azotemia.. although with time the increase protein can cause interstitial nephritis

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7
Q

What are 3 secondary changes of brachycephalic airway disease?

A
  1. Laryngeal collapse
  2. Soft Tissue inflammation and edema
  3. Everted tonsils
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8
Q

If blood is red in vomit, where is it coming from? what if it is dark/black colored?

A

red blood= esophagus or URT

dark blood= stomach or jejunum

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9
Q

_______ Volume is the volume of air inspired/expired with a normal breath (10 ml/kg)

A

Tidal Volume (Vt)

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9
Q

In which situation would your proteinuria be greater; PCT damage or Glomerular disease

A

Glomerular disease

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9
Q

How does the healing time and strength vary between the bladder, stomach, colon and skin?

A
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10
Q

What anti-acids/gastroprotectants can you use in vomitting cases?

A

Histamine blockers (cimetidine, ranitidine,famotidine)

Proton pump inhibitors (omeprazole)

Sucralfate

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12
Q

_______ is abnormally low partial pressure of O2 in the tissue caused by low O2 delivery (ie anemia, poor circulation)

A

Hypoxia

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12
Q

UMN or LMN?

Hindlimb ataxia, Small bladder that is difficult to express

A

UMN - thoracolumbar region

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13
Q

In what wound healing phase is the weak type III collagen replaced by type I collagen?

A

Maturation Phase

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13
Q

At three months a skin wound has acheived _____% of normal stength. This is the maximal strength it will ever acheive

A

80%

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14
Q

Which of the following is false about the pathophysiology of vomitting:

  1. Prodromal signs include hypersalivation
  2. Relaxation of oesophageal sphincter
  3. Intestinal motor activity and retching
  4. Inputs to the vomiting centre come from the blood
A

4!

Inputs to the vomitting center come from the abdominal viscera, , hypogastric nerve (reflex), vestibular apparatus, cerebral and CTZ (blood)

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15
Q

Wounds NOT closed heal by _______ _____ healing

A

secondary intention

——

Indicated for wound that are HIGHLY contaminated and devitalized and will require open wound management for several days to weeks

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16
Q

Which dog breed is most likely to get a hypoplastic trachea?

A

English Bulldogs

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17
Q

________ mixes with fluid lining of alveoli to increase stability/decreases surface tension

A

Surfactant

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18
Q

Chronic Kidney Disease leads to _______damage & loss

A

nephron

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18
Q

Collagen synthesis is ________ proportional to tension on the wound

A

inversely

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19
Q

Why would you test gastrin levels in a vomitting patient?

A

Test used in cases of chronic gastric ulcers when concerned about Gastrinoma. Gastrin levels can be high if on chronic leprazol therapy or if there is a mast cell tumor

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20
Q

What would be a possible diagnosis for a dog that is vomitting 6-8 hours after food?

How will the etiology change if the dog is a young bull dog? vs a lab? vs a geriatric patient white dog?

A

gastro-pyloric obstruction

young Bull dog= congenital pyloric stenosis

young lab = infectious

geriatric = acquired antral hypertrophy

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20
Q

What drugs can you use as anti-emetics?

A

NK1 pathway inhibitors (maropitant)

Anti-dopaminergics (Metoclopramide)

Serotonin antagonists (Ondansetron)

Phenothiazines (chlorpromazine)

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21
Q

What is the VD/VT of Horses and Cows? Dogs?

A

Cow/Horse= 50%

Dogs = 30%

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22
Q

Epitheliazation of the bladder starts within _____ days and is complete withing ____ days

A

2 & 30

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23
Q

What are 4 main causes of hypoventilation?

A
  1. Decreased RR
  2. Decreased Tidal Volume (damage to chest, pain, paralyisi, resistance)
  3. Increased metabolic rate (more CO2)
  4. Hyperthermia
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23
Q

What is the “praying positon” indicate in an animal with vomitting?

A

Abdominal pain/Right cranial quadrant disease = pancreatitis

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23
Q

the esophagus lacks a ____layer

A

serosal

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24
Q

Volume overload—> ________ hypertrophy –> increased ___load

Pressure overload —> ________ hypertrophy–> increased ___load

A

Volume overload—> eccentric hypertrophy –> increase afterload

Pressure overload —> concentric hypertrophy –>increase preload

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24
Q

Which of the following is NOT a feature of nephrotic syndrome/end stage PLN?

  1. Hypoalbuminemia
  2. Hypercholesterolemia
  3. Proteinuria
  4. PU/PD
A

PU/PD is not a feature alone by nephrotic syndrome

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25
Q

What commonly happens in dogs & horses when you have damage to the recurrent laryngels nerve? and what is the pathophysiology?

A

Laryngeal Paralysis –> loss of function of the arytenoideus m. –> lack of laryngal abduction on inspiration –> increase upper airway resistance –> increased inspiratory effort –> dyspnea, syncope, hypoxia –> death

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27
Q

Volume of alveoli air replaced with each breath is ~______ of total alveolar air

A

1/7th

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29
Q

***5 main reasons for hypoxia?****

WILL BE ON EXAM

A
  1. Hypovetilation
  2. Ventilation-Perfusion Mismatch
  3. Anatomic Shunt
  4. Diffusion Impairment
  5. Low FiO2
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30
Q

Systemic causes of vomitting usually stimulate the emetic center through the ______

A

CTZ

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30
Q

What is normal urine production? What is considered oliguric?

A

Normal: 1-2 ml/kg/hr

Oliguria:

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30
Q

What are the 3 major players of the inflammatory stage? What is each of their roles?

A
  1. Platelets- immediate- hemostasis, release cytokines (attract fibroblast)
  2. Neutrophils- w/in 24-48 hours- kill bacteria, break down clot, release cytokines
  3. Monocytes-w/in 48-96 hours- debridement and release cytokines to recruit cells for the repair phase
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31
Q

What are the parasympathetic, sympathetic and somatic innervations to the bladder?

A
  • Parasympathetic- pelvic N (S1-3) - involved in urine voiding
  • Sympathetic- hypogastric (L1-4/L2-5)- urine storage
  • Somatic - pudendal n. (S1-3) -external urethral sphincter
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32
Q

What does the RAS system do to bradykinin?

A

inactivates

bradykinin is a chemokine that causes vasodilation

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33
Q

What is the appearance of regurgitation vs vomit?

A

regurgitation- tubular, mucous covered, undigested

vomit- “puddle”, digested (may be bile stained)

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34
Q

What do you call an intense inspiratory sounds associated with narrowing of upper airways?

A

Stridor

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35
Q

T/F: In Anatomical shunts, PaO2 will not increase with delivery of 100% FiO2

A

True

35
Q

What type of tissue is layed down 3-5 days post wound and is rich in capillar beds, fibroblast, macrophages, collagen, fibronectin and hyaluronic acid?

A

Granulation Tissue

35
Q

The strength of a wound is only _% that of normal tissue at 1 week and ___% at 3 weeks post wounding

A

3%= 1 week

30%=3 weeks

36
Q

ilius is a common sequela to ________ of the intestines in cats and dogs

A

inflammation

37
Q

What type of tissue has a 0-4 day lag phase for healing?

A

GI tract

Due to the fibrin seal on the serosal layer within the first 12-24 hours that then has to undergo fibrinolysis and collagen deposition

38
Q

As heart rate increases, the heart perfusion during diastole _____(increase/decrease)

A

decreases

heart will be working harder with less delivery of nutrients

39
Q

Which part of the kidney is most metabolically acitve and most sensitive to changes in O2 and toxic injury?

A

PCT

40
Q

In GI tract healing, normal strength is reacheived in about _____ days

A

10-17 days

the stomache heals quickly (14 days)

Esophagus has high rate of incisional dehiscence

Colon heals slower than the SI

41
Q

If a vomitting animal is obtunded or comatose on PE, what are 3 DDxs?

A

Hypoglycemia, hepatic encephalopathy, systemic toxicosis

41
Q

How can salivary glands give you clues on what is going on in the esophagus?

A

Severe esophageal distention with a foreign body or granuloma can trigger temperol lobe epilepsy that causes severe hypertrophy and pain of salivary glands –> pain and dysphagia

41
Q

In Delayed Primary Closure, Appositional closure occus within 3-5 days after wounding but ______ granulation tissue is present?

A

BEFORE

Indicated for midly contaminated wound that require cleaning, debridement and open wound management for a couple days in order to decrease microbial contamination and improve tissue health for closure

42
Q

________ is low partial pressure O2 in arterial blood (

A

Hypoxemia

43
Q

What must you rule out before giving a prokinetic?

A

Foreign body or intussusception

45
Q

How do you develop a right to left shunt?

A

VSD/PDA –> increase pressure in RV and PA –> Pulmonary hypertention –> R ventricular thickening –> RV or PA pressure becomes greater than LV or aorta pressure –> R to L shunt –> severe hypoxia

46
Q

What does optimal intestinal healing depend on?

A
  1. Blood supply
  2. Accurate mucosal apposition
  3. Minimal surgical trauma
  4. Submucosa holding layer
47
Q

What are the two main etiologies of regurgitation?

A

Obstruction & Weakness

(both can be either congenital or acquired)

49
Q

Congestion and edema of nasal passages causes post-operative airway obstruction in what species?

A

Horses

higher risk when dorsal recumbency for >1-2 hours and/or with nose below level of heart

May lead to non-cardiogenic edema

51
Q

Diffusion rate is inversely proportional to (2 things)?

A

Tissue Thickness

Molecular Weight

52
Q

What part of the PCT cells are lost first during cell damage?

A

brush border

53
Q

What are the two main airway defenses? where are they located?

A
  1. Mucocillary Elevator - conducting airways to epiglottis
  2. Alveolar Macrophages- alveoli
55
Q

What do you call a harsh snoring, sound mostly on inspiration, associated with obstruction of the larynx?

A

Stertor

56
Q

In which organ is the collagen synthesis speak at 5 days and 100% of the original strength is reached in 21 days?

A

Bladder!

57
Q

In the GI tract, what is the holding layer?

A

submucosa!!

59
Q

The A-a gradient in hypoventilation is _______(normal/raised/low)

A

Low,

60
Q

What type of healing is indicated for wounds that are HIGHLY contaminated and devitalized and will require open wound management for several days to weeks?

A

Secondary Intention Healing

62
Q

nasal discharge, sneezing, reverse sneezing, epistaxis, gaggind, stertor and stridor are all clinical signs of what type of disease?

A

Upper Airway Disease

64
Q

________ Law of resistance says that with laminar flow, resistance to flow is inversely proportional to the radius to the fourth power

A

Poiseullie’s

65
Q

What endocrine response to heart failure increases venous return/preload? What hormone increases circulatory volume?

A

Angiotensin II- increase preload

Aldosterone - increase volume

67
Q

What percent regurge must be present to have enough decrease in CO to be considered heart failure?

A

70%

69
Q

Hypoventilation results in hyper____

A

hypercarbia (increased PaCO2, >45 mmHg)

hypoxia occurs due to inadequate ventilation for gas exchange

70
Q

What are the Major players of the proliferation stage?

A
  1. Fibroblast
  2. Endothelial cells
  3. Epithelial cells
71
Q

What occurs when there is an imbalance between natural defenses and infectious agents in the respiratory system?

A

Pneumonia!

72
Q

Which species has a slower first intention healing and slower/less abundant granulation tissue formation: dog or cat?

A

CAT– so you may want to keep stiches in for longer and keep the cone on longer

74
Q

T/F: The CTZ center is protected by the BBB

A

False- thus it is bathed in toxins and can stimulate the vomiting center in the medulla

75
Q

In Ventilation Perfusion Mismatch_____ exchange is impaired but can be corrected with increased ventilation due to it being 20x more soluable than O2

A

CO2

77
Q

What are clinical signs of Lower Airway disease?

A
  • Dyspnea
  • Coughing
  • Wheezing
  • Orthopnea
  • (clinical signs associated with primary disease process)
79
Q

What is the inspiratory reserve volume?

A

Increased air beyond the normal volume

81
Q

Why does atelectasis typically occur?

A

as a result of increased surface tenison

  1. Decrease transpulmonary pressure
  2. Loss of structural support of parenchyma
  3. Decreased surfactant
82
Q

What are the 4 stages of Acute Kidney Injury?

A
  1. Induciton
    • Insult occurs
    • No clinical signs- may find tubular cell in sediment
  2. Exstension
    • insult still present
    • clinical sign present
  3. Maintenance
    • etiology gone- now left with damage
    • may recover, enter CRF or worsen into anuric renal failure
  4. Recovery
    • may slowly improve if damage to cells is sublethal
    • kidney function slowly improves
84
Q

Low partial pressure of insipred oxygen most commonly occurs at ______ _____

A

high altitudes

85
Q

What enables stomach wounds to heal so quickly?

A

Fibrinogen is layed down by both fibroblast and smooth muscle cells

86
Q

Why is there a poorer prognosis as blood levels of catecholamines increases?

A

high catecholamines –> vasospasm, toxic effects, arrhythmias

88
Q

higher negative pressue to overcome obstruction –> soft tissue changes (edema, hyperplasia, collapse, respiratory muscle failure) –> decrease air flow —- is the pathophysiology to what disease?

A

Brachycephalic Airway Disease

89
Q

What happens if there is a DECREASE in functional residual volume

A

Hypoxia

90
Q

In the GI tract, Dehiscence (seperating of wound layers) occurs ____ days after surgery, during the ____phase

A

3-5 days, during the LAG phase

92
Q

What causes hypoxia in pneumonia?

A
93
Q

What are Lab findings of CRF?

A

Azotemia & Unable to concentrate urine

94
Q

UMN or LMN?

Hindlimb paraplegia, urinary incontinance, large bladder, easy to express

A

LMN- Sacral damage

95
Q

What is the pathophysiology of CRF?

A
  1. Failure of excretion of nitrogenous waste –>uremia
  2. Failure of urine concentration ->PU/PD
  3. Failure of synthesis of calcitriol (Vit D3) –> hypocalcemia & renal secondary hyperparathyroidism –> rubber jaw
  4. Failure of erythropoietin synthesis –>anemia
  5. Failure to catabolise peptide hormones (e.g. gastrin) –> uremic gastritis & decreas pH–> stomach ulceration/erosion
  6. systemic hypertension –> hypertensive retinopathy & glomular hypertension
  7. defective hemostasis
  8. mineral imbalance
  9. proteinuria
  10. renal fibrosis
96
Q

Secondary closure/Third intention healthing is when closure of a wound occurs 3-5 days after wound healing, ______ granulation tissue has formed in the wound bed

A

AFTER

wound is closed over the granulation tissue (+/- debridement)

97
Q

2 causes of damage to alveoli capillaries that results in leakage of RBC and plasma into alveoli

A

Pulonary overinflation

Pulmonary hypertension

99
Q

Hypotension and Pulmonary edema are signs of ____-sided congested heart failure

A

Left

—-

Hypertrophy = increased CRT, increased HR, decrease pulse, weakness, syncome, azotemia

Pulmonary edema = dyspnea, coughing, orthopnea, tachypnea, ex intoerance, cynosis

100
Q

What cells recruit fibroblasts? and what are fibroblasts main role?

A

Recruited by platelets and M0

Role= synthesize collagens & become myofibroblasts (form adhesions that provide mechanical leverage to cause wound contraction)

101
Q

Is hypoxemia more severe with R ot L or L to R shunts?

A

R to L

102
Q

What are three differentials for an animal with azotemia and high potassium?

A
  1. Urethral blockage (more in cats)
  2. Addisons (check resting cortisol and stress leukogram)
  3. Acute Renal Failure
103
Q

In intestinal obstruction there is a severe hypo_____

A

chloremia

104
Q

What is the most common heart disease seen in small dogs?

A

Myxomatous atrioventricular valve disease (endocardiosis)

105
Q

How does pyometra cause pu/pd?

A

Endotoxins interfere with the ADH receptor

106
Q

What creates diastolic pressure?

A

the force of the elastic recoil of the aorta

106
Q

What electrolyte is important for GI motility, but is commonly lost in cases/causes of vomitting?

A

K

107
Q

What type of wound closure is indicated for midly contaminated wound that require cleaning, debridement and open wound management for a couple days in order to decrease microbial contamination and improve tissue health for closure?

A

Delayed Primary Closure

109
Q

Define Heart Failure

A

Cardiac output insufficent to meet body needs

110
Q

Chronic wounds usually do not progross beyond what stage of wound healing?

A

inflammatory phase

111
Q

What exacerbates heart failure?

A

compensatory mechanism (sympathetic nervous system, Aldosterone, Angiotensin II, baroreceptors)

113
Q

What type of healing is through appositional wound healing acheived by fixing the wound edges together? When would you use this healing?

A

Primary Wound Closure/First Intention healing

Used for surgical wounds, clean wounds, and wounds with no tension

114
Q

What drugs can you use to treat heart failure compensation effects?

A

B Blockers- decrease sympathetic

ACE inhibitos- interfere with RAAS

Furosimide- stop Na reabsorption

115
Q

In anatimical shunts, there is an extreme ________ mismatch due to normal ventilation and no perfusion

A

V/Q

116
Q

What are clinical signs of RIGHT CHF?

A

Ascities

pleural effusion

Hypotension

Distendion of jugular vein

Hepto-splenomegally

117
Q

What is the leading cause of vomitting in dogs and cats?

A

diet

118
Q

T/F: The effects of cardiac cachexia are hard to reverse

A

True =(

Even if you reverse the heart disease, the animal may still remain thin

119
Q

What are the three primiary components of brachycephalic airway disease?

A
  1. Elongated soft palate (most common)
  2. Stenotic nares
  3. Stage I laryngeal collapse/Everted laryngeal saccules
120
Q

Are increase salivation, nausea and heaving (abdominal contractions) associated with vomitting or regurgitation?

A

vomitting

121
Q

In skin wound healing, Net collagen synthesis is complete by ____ weeks

A

4-5

collagen maturation may continue for 12-18 months

122
Q

How does the diagnostic plan differ from acute vomitting vs chronic vomitting?

A

Acute (less than 5 days) - requires hospitalization & emergency therapy/monitoring, self limiting, treated symptomatically

Chronic (>5-7 days and not responding to symptomatic therapy) - in-depth investigation

Mechanism of Disease (Elise) (3 decks)

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