Exam Revision.. Flashcards
Identify 5 causes of Dermatological disease
- Parasites
- Infection
- Allergy
- Neoplasia
- Hormonal imbalance
What is the Aetiology for Atopic Dermatitis?
- Genetic disposition to become sensitive to allergens
- Have abnormal skin barrier function
What is the Pathophysiology for Atopic Dermatitis?
- Allergens are proteins that when inhaled or absorbed through skin, resp or GI tract
- Causes allergen-specific IgE production
- IgE molecules affix to tissue mast cells or basophils
- When primed cells encounter specific allergen again
- Mast cell degranulation occurs
- Resulting in the release of proteolytic enzymes, histamines, bradykins + other vasoactive amines
- Leading to inflammation (erythema, oedema + pruritits)
What are the 7 Clinical signs for Atopic Dermatitis?
- Puritis +++
- Inflammation
- Lesions
- Alopecia
- Lichenification
- Erythema
- Papules
What is Lichenification?
- Thickened + leathery apperance of skin
- Looks elevated + like elephant skin
What is this?
Lichenification
What are the 10 Diagnosis for Atopic Dermatitis?
- Hx
- Clinical signs
- Exclusion of other causes (Parasites + Infections)
- Examination
- Microscopy (Tape, Skin scrape)
- Bacterial culture
- Fungal culture
- Biopsy
- Exclusion diet
- Intradermal testing
What are the breed dispositions for Atopic Dermatitis?
- Shar-Pei
- Fox Terrier
- Golden Retriever
- Labrador Retriever
- Dalmation
- Boxer
- Boston Terrier
- Lhasa Apso
- Scottish Terrier
- Shih Tzu
- WHWT
At what age are dogs most suspectible to get Atopic Dermatitis?
Between 6 months + 3 years old
What 6 areas of the body does Atopic Dermatitis affect?
- Feet
- Face
- Ears
- Flexural surfaces of front legs
- Axillae
- Abdomen
What Dermatological disease uses the Favrot’s Criteria?
Atopic Dermatitis
What is the Favrot’s criteria?
+
How many are there?
- Critera which a px has to have in order to be diagnosed with AD
- There is 8 criteria + they are:
1. Affected ear pinnae (not margins)
2. Affected front paws
3. Age of onsent of < 3 years
4. Chronic or recurrent Yeast infections
5. Corticosteriod-responsive pruritis
6. Mostly indoor lifestyle
7. Non-affected dorsolumbar area
8. Pruritis w/o skin lesion at onset
What are the treatment options for Atopic Dermatitis?
- Treat cause
- Systemic or topical tx
- Antibiotics
- Steroids
- Antifungals
- Antihistamines
- Parasiticides
Other:
1. Hormone treatment
2. Exclusion diet
3. Allergen removal
4. Vaccination
5. Immunosupressants
6. Monoclonal antibody therapy
What is Syncope?
Fainting
What is Paresis?
General limb weakness
True or False.
A seizure is a symptom not a disease.
True
What is a Seizure or Convulsion?
Violent irregular motion of the limbs, caused by Involuntary contraction of the muscles
What are the 2 Aetiology’s of seizures?
(What can they be split into)
- Intracranial
- Extracranial
What are potential 9 Intracranial causes of Seizures?
- Hydrocephalus
- Encephalitis
- Tumours
- Idiopathic epilepsy
- Head trauma
- RTA
- Infections
- Heatstroke
- Cerebral abscesses
What are potential Extracranial causes of Seizures?
- Liver disease
- Portosystemic shunts
- Clots
- Hypoxia
- Allergens
- Medications
- Metabolic imbalances :
* Hypocalcaemia
* Hypoglycaemia
* Hypokalaemia
* Hepatic + Renal failure
What is the Aetiology of Epilepsy?
- Neurological condition
- Arises from disruption of Forebrain function
- Often Idiopathic (most common)
- Suspected genetic link in a no. of breeds (Border collies etc)
What 3 breeds of dog are suspected to have a genetic link to Epilepsy?
- Border Collies
- Hungarian Vislas*
- Labradors*
* = Over-represented
What is the Pathophysiology of Epilepsy?
- Disordered electrical activity of the brain cells
- Imbalance in excitatory + inhibitory signals
- Can be partial (Cats) or generalised (Dogs)
- Has 3 phases:
* Pre-ictal
* Ictal
* Post-ictal - Prolonged seizures = Status Epliepticus (more than 5 mins)
What species is more susceptable to Partial Epilepsy?
Cats
What species is more susceptable to Generalised Epilepsy?
Dogs
What is a generalised seizure?
- Full blow seizure phase
- Equivalent of Grand Mal in humans
What are the 3 stages of Epileptic seizures?
- Pre-ictal
- Ictal
- Post-ictal
What are seizures called that last longer than 5 minutes + potentially lethal?
Status Epliepticus
True or False.
Px with Status Epilepticus can come out of these types of seizures by themselves with no veterinary intervention.
False.
They require immediate emergency veterinary care.
What common clinical sign can Status Epilepticus cause?
Hyperthermia
Why does Status Epilepticus cause Hyperthermia?
Because the seizuring activity of rapid muscle contractions causes the body to heat up
How does Status Epilepticus cause brain damage in px?
- Because the seizuring activity causes Hyperthermia, leading to overheating the brain
- Resulting in brain damage
If an Epilpetic seizure is caused by an Infection, what can potentially trigger it?
Loud noises
List the possible 8 clinical signs of Pre-ictal?
- Anxious
- Restless
- Altered behaviour
- Px feels uneasy
- Not aware of surroundings
- Head pressing
- Standing in corner of the room
- Disoriented
Some aren’t classed as clinical signs.. more signs associated
Period prior to seizure
List the possible 9 clinical signs of Ictal?
- Active episodes of fitting
- Collapse
- Unconciousness
- Jaw spasms
- Vocalisation
- Incontinence
- Clonic paddling spasms
- Tonic spasms
- Panting
Note - actions vary from animal to animal
Episode of fitting
What’s the difference between Clonic + Tonic spasms?
Clonic spasms =
* Involuntary rapid + rhythmic jerking or muscle contractions
Tonic spasms =
* Muscle contraction or stiffening that can last seconds > minutes
Despite Tonic + Clonic spasms, name 3 others
- Tonic-Clonic
- Myoclonic
- Atonic
If Clonic spasms are Involuntary rapid + rhythmic jerking or muscle contractions
+
Tonic spasms are muscle contraction or stiffening that can last seconds > minutes…
What is the difference between Tonic-Clonic, Myoclonic + Atonic seizures?
Tonic-Clonic
* Tonic phase immediately followed with Clonic phase
Myoclonic
* Sporadic jerks or movements typically on both sides of body
Atonic
* Drop attacks + non-convulsive seizures
* Sudden loss of muscle tone w/multiple or extended seizures
List the possible 5 clinical signs of Post-Ictal?
- Extreme tiredness
- Dazed
- Ataxia
- Hunger
- Unresponsive to owner
Recovery period
Why should you not bring a patient straight into the VP if the patient is in Post-ictal?
Because:
* They’re in the recovery period
* More stress will can trigger another seizure
What is the exception to bringing in a patient while they’re in Post-ictal?
If they are in Status Epilepticus
What are the 8 possible Diagnosis for Epilepsy?
- Hx
- Clinical signs
- Physical exam
- Neurological exam
- Bloods - Biochemistry + Haematology (Infection, toxicity, glucose + uraemia)
- MRI (look for tumours)
- CT
- CSF Tap (Check for meningitis)
Why 2 reasons may you perform a MRI or CT for a patient with Epilepsy?
To check for:
1. Tumours
1. Brain abnormalities
Why may you perform a CSF Tap for a patient with Epilepsy?
To rule out Meningitis
What are the 9 possible treatment options for Epilepsy?
- Tx started only when seizures are severe + occur more than 2x a year
- Identify + treat cause (if not idiopathic)
- Life-long tx
- Phenobarbitone
- Imepitoin
- Postassium Bromide (dogs only)
- Levetriacetam
- Monitor Liver function
- If severe + life-long = Euthansia
Trialed tx is most common
What 4 drugs are in the controlled drugs cabinet, used for the treatment of Epilepsy?
- Phenobarbitone
- Imepitoin
- Postassium Bromide (dogs only)
- Levetriacetam
What drug can you only give to dogs for the treatment of Epilepsy?
+
What side effects does this drug have?
- Postassium Bromide
- Clinical signs:
* Sedation
* Ataxia
* PU/PD
* Pancreatitis
How often should you take bloods for Epileptic patients?
Q3 - 6 months
How should you treat a patient who is Status Epilepticus?
- IV or rectal Diazepam
- Propofol
- Cool px
True or False.
Treatment for patients with Epilepsy does not address the Primary concern, but manages the symptoms
True
True or False.
Idiopathic Epilepsy is not a life-long condition
False, it is life-long
What are the 6 criteria for when you should you start treatment for Epilepsy?
- If severe
- Occurs more than 2x a year
- 1x seizure Q6 m/o
- Bad seizures + bad Post-ictal Csigns
- < 6 m/o at onset
- Owner finds them distressing
Whata are 2 considerations for clients when treating Epilepsy?
- Expensive, as therapeutic mointoring is required (MRI, Drugs, Regular liver function tests etc)
- QOL of pet
When should you stop treatment for Epilepsy?
Never!
13 …
What advice should you give to clients during seizures?
- Low lighting
- Keep children + other pets away
- Record: time, gaps + frequency of seizures
- Reduce noise
- Clear all areas
- Call VP + VS
- Don’t pull tongue out (bite)
- Don’t call name
- Pillow under head
- Stay with them
- Stay calm!
- Reassure owner pet isn’t in pain
- If over 5 minutes long - home vist or come into VP
What parameter can drop if seizuring for long periods of time?
Blood sugar
What is the most common treatment for Status Epilepticus?
Euthansia
What type of seizure is:
- Really alarming
- Dangerous
-
Lasts more than 2 minutes
or - 2 seizures without a break
- Can be given with IV propofol
Status Epliepticus
What rate infusion should Propofol be given to a patient in Status Epilepticus?
Constant rate infusion
What seizure starts again as soon as the previous one starts to wear off?
Status Epilepticus
What is a Cluster seizure?
- More than 1 seizure close together
- Px gains consciousness between seizures
What are the 10 possible Aetiologies of Chronic Renal Failure?
- Common in cats
- Kidneys no longer able to compensate
-
Idiopathic deterioration in geriatric cats (most common)
1.Hx of Acute Renal Damage (Injury, toxins) - Neoplasia
- Polycystic Kidney Disease (Persians)
- Chronic infection
- Pyelonephritis
- Golmerulonephritis
- DM
- Hypertension
What species is CKD/F most common in?
Cats
What is the Pathophysiology of Chronic Renal Failure?
- Uraemia (Kidney unable to filter nitrogenous waste from blood, Urea)
- pH + Electrolyte imbalance (Potassium + Phosphate, due to renal function)
- Reduced Erythropoietin production (reduced erythrocyte formation in bone marrow)
- Only when 75% of nephrons damaged/lost
What type of anaemia is caused by CRD/F?
Non-regenerative anaemia
8 dx tests..
How would you diagnose Non-regenerative anaemia in cats with CRD/F?
- Physical exam
- Haematology bloods
- CBC
- PCV
- Kidney palpatation (see if symmetrical)
- Bone marrow biopsy
- CT
- Ultrasound
What are the 16 possible Clinical signs of CRD/F?
- PU
- PD
- V+
- Dehydration
- Weight loss
- Inappetance
- Anorexia
- Depression
- Oral ulcers
- Hallitosis
- Seizures
- Non-regenerative anaemia
- Azotaemia
- Uraemia
- Hypokalaemia
- Anuric (End-stage)
What are the 10 possible Diagnosis for CRD/F?
- Hx
- Clinical signs
- Physical exam
- Urinalysis
- USG
- Bloods - Haematology + Biochemistry (BUN, Creatinine, SDMA + Electrolytes)
- BP
- Radiography
- Ultrasound
- Determine cause + extent of azotaemia
- Elevated levels of Urea
- Elevated levels of Creatinine
- SDMA testing - sensitive to early changes, used alongside Creatinine in IRIS staging
- Electrolyte levels - Phosphate for prognosis, to detect Hypokalaemia
What blood chemistry parameters are measured to asses kidney function?
- BUN
- Urea
- Creatinine
- Symmetrical Dimethylarginine (SDMA)
Why is SDMA testing performed for patients with CRF?
What level may rise before the other?
Urea or Creatinine?
Creatinine
What USG what potentially indicate CRF in Cats?
< 1.035
What is the normal USG for Cats?
1.035 - 1.060
Whats the normal USG for Dogs?
1.015 - 1.045
What does a declining USG + increasing urine protein levels in the blood raise suspicion of?
CRD/F
What 2 things should be ruled out when diagnosing CRF?
- Presence of blood
- Infection
Why would blood + urea testing diagnose renal disease?
Because impaired kidney functions leads to a build up of nitrogenous waste in the blood, so this will be indicative upon testing
4 reasons..
Why would you image the kidney for CRD?
Because it will show any:
1. Acromegaly
1. Abnormalities
1. Lack of symmetry
1. Stage the disease
What are the treatment options avaliable for CRF?
- IVFT
- Protein + Phosphorus restricted diet
- Kidney prescripion diet
- Antibiotics
- Phosphate binders
- Potassium supplements
- Hypertension
- Amlodipine
- Treat anaemia (Nandralone, Erythropoietin)
- Monitor urine infections
- Mangage anorexia + V+
What are the 2 possible Aeitologies for Diabetes Mellitus?
- Type 1
- Type 2
What is the Aeitology for Type 1 Diabetes Mellitus?
- B-cells are destroyed
- Can no longer synthesise Insulin adequately
- Immune-mediated
-
Breed dispositions
* WHWT
* Jack Russel Terriers - Pancreas damage (Inability to synthesise Insulin)
- Known as ‘Insulin dependent’
B-cells = gamma
What is Type 1 DM known as?
- Insulin dependent
- Absloute Insulin deficiency
- Cannot produce enough Insulin
What is Type 2 DM?
- Reduced ability to respond to Insulin
What is the Aeitology for Type 2 Diabetes Mellitus?
- Reduced ability to respond to Insulin
- Obesity (little fat dogs)
- Oestrus
- Cushing’s disease
- Steroids
- Acromeagaly (cats)
What is the Pathophysiology for Diabetes Mellitus?
- Absloute (Type 1) or relative ( Type 2)
- Reduced tissue utilisation of glucose
- Leads to hyperglycaemia in bloodstream
- Low glucose levels in cells (Due to ^)
- Renal threshold for glucose exceeded > Glycosuria
- Eventually fats break down as can’t access glucose
- Leads to Ketosis > Ketoacidosis
What type of DM is most common in veterinary px?
+
What is it?
- Type 2
- Reduced ability to respond to Insulin