Final Review Flashcards by Sarah Sabler

How do you calculate HR form a 25mm/sec ECG strip? 50mm/sec ECG strip?

25mm: 5 boxes = 1 second
50mm: 10 boxes = 1 second

Count complexes on strip
Determine time represented on strip
Divide complexes by seconds
Multiply by 60

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List the (4) main signs of UMN involvement

Paralysis (Paresis if partial)

Normal accentuated reflexes

Normal to increased muscle tone

Minimal muscle atrophy

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List the (4) main signs of LMN involvement

Paralysis (Paresis if partial)

Absent muscle tone (Decreased if partial)

Absent reflexes (Hyporeflexia if partial)

Severe muscle atrophy (Less severe if partial) - takes 7-10 days to see clinically

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UMNs have an _____ effect on LMNs.

Inhibitory

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What does FONS stand for? What is it the treatment for?

F: Furosemide
O: Oxygen
N: Nitroglycerine
S: Sedation (torb, ace) & Shock/effusion (dobutamine CRI)

Heart failure

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T/F: Cats are more sensitive to the diuretic effect of furosemide, so while it should be used aggressively to treat heart failure until the kitty is stable, it should then be tapered sharply.

True

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What are the treatments for LMN bladder?

PPA (sphincter)
Bethanecol (muscle)

Also Estrogen

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What are the treatments for UMN bladder?

Phenoxybenzamine
Prazosin
Tamulosin

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Where is the lesion when a LMN bladder is present?

Lesion caudal to L3

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Where is the lesion when a UMN bladder is present?

Lesion cranial to L3

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Where is the lesion when the panniculus reflex is lost?

C8-T11

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What cranial nerve-associated syndrome can occur with lesions from C1-T2?

Horner’s syndrome

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What are the 3 causes of ataxia?

CP deficits (no feedback to the limbs from the spine/brain)
Cerebellar (responsible for fine motor, tend to sway/shake persistently, intention tremor)
Vestibular (usually unilateral, fall toward the site of lesion)

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What nerve is affected when you see a dropped elbow?

Radial

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What nerve is affected when you see a plantigrade stance?

Sciatic

In cats can be associated w/diabetes

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You observe:
Knuckling
Dropped elbow
Neurogenic muscle atrophy of forelimb
Flaccid paralysis of forelimb
Loss of panniculus reflex
Horner’s (prolapse of 3rd eyelid, enophthalmus (sunken eye), droopy eye lids)

What are you thinking?

Brachial plexus avulsion

Lesion at C6-T2

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You observe:
Paraparesis or paraplegia of the hind limbs (ataxia, dragging)
Normal forelimb reflexes
Normal CN reflexes

If the hindlimb relfexes are increased (UMN), where is the lesion?
What if they are decreased or absent (LMN)?

Caudal to T2 for sure

T2-L3 = UMN,

Caudal to L3= LMN

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Where is the lesion if you have LMN sings in the front and UMN signs in the hindlimb?

C6-T2

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You observe: 
A Labrador, <3yo
Exercise induced collapse
Sporadic abnormal gait
LMN  signs in in hindlimb
Spontaneous recovery in 5-25min

What are you thinking?

Metabolic myopathy (DNM1/dynamin gene genetic disorder)

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What is the drug therapy for myesthenia gravis?

Pyridostigmine

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What’s the gold standard test for myethenia gravis?

AchR Antibody test (immune complex)

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You observe:
CP deficits on one side
Falling/head tilt/ circling to the other side

What are you thinking?

Cerebellar lesion

Paradoxical Vestibular Syndrome

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Where is the lesion with Schiff-Sherington?What are the signs?

Severe lesion T2 - L6/7

UMN in front (increased tone, tetanus-like, rigid extension)
Normal hindlimbs

What is it called when you see stiff front limbs, opisthotonus and flexed hindlimbs? Where is the lesion?

Decerebellate rigidity

Cerebellar lesion

What does the QRS complex represent?

Ventricular depolarization

What does a "peaky" (tall) P wave indicate?

Right atrial enlargement

What does a "lumpy" (mound, low) P wave indicate?

Left atrial enlargement | (p)Lump-Left

What does a tall R wave and wide QRS complex indicate?

Left ventricular enlargement | in cats, commonly HCM

What type of block do you have when the P-R interval is prolonged?

1st degree AV block | If R is far form P, you have a first degree

What type of block do you have when there is no conduction from the atria or ventricles, normal P waves and escape beats?

3rd degree AV block | If P's and Q's don't agree, then you have a third degree!

Which arrhythmia is common in dogs with DCM and is associated with atrial enlargement with multiple atrial foci that fire independently? The electrical activity on the ECG is rapid and chaotic, there is no P wave and there are uneven undulations of the baseline.

Atrial fibrillation

What stage of heartworm does phrophylactic use of Ivermectin, Milbemycin, DEC, or Moxidectin kill?

L3 and L4 up to 30 days of age

What type of block do you have when you have a progressively longer P-R interval, eventually resulting in no QRS following a P wave?

2nd degree AV block Mobitz Type I/Wendebach (Longer, longer, longer, drop! Then you have a Wenkebach!)

What can you use to control lung and heart-related clinical signs associated with heartworm disease in dogs?

For parenchymal lung disease: Prednisone (give until signs resolve usually 2-5d) ``` For CHF: Diuretics (furosemide) ACE Pimobendan Low sodium diet (Aspirin no longer recommended) ```

What type of block do you have when you get sudden dropped beats, one or multiple P waves without following QRS?

2nd degree AV block Mobitz Type II (If some P's don't get through, then you have a Mobitz Two!)

What are the 4 steps in treating heartworm in dogs?

1. Begin prophylaxis (to prevent further infection) 2. Manage signs of moderate or severe lung disease and heart failure 3. Kill microfilaria to stop the dog from being a source of infection) 4. Adulticide therapy.

What is the drug of choice for killing microfilaria?

Moxidectin | 2nd best: Ivermectin

What drug injected IM kills adult heartworm?

Melarsmine (Immiticide)

When treating canine heartworm when can you expect serious complications to occur (if they are going to occur)? How do you minimize the occurrence of these complications?

2-3 weeks after treatment Strict cage rest for at least 4-6 weeks

What does hemoptysis in a heartworm + dog indicate?

Severe pulmonary thromboembolic complications

Why should you be careful about giving fluids when treating heartworm in dogs?

They can exacerbate pulmonary edema and R-CHF.

How is definitive diagnose of heatworm made in dogs? What tests can you perform?

Identifying MF in the blood (appear 6-7 months post-infection) Modified Knott's test (centrifugation) DiFil Test Kit (uses a filter) 40% chance of false negatives To confirm: Antigen test

What radiographic changes are seen with heartworm? | Can these be seen early in the disease?

Right ventricular enlargement Prominent male pulmonary artery (at 1 o'clock causing inverted D) Enlarged lobar arteries (esp right caudal pulmonary A) which are pruned or truncated peripherally +/- Broncho-alveolar patterns in lung tissue surrounding affected As Yes they can be seen early, but can persist long after the worms have died.

What is the differential diagnosis for for MF in the blood?

Acanthocheilonema reconditum – head not tapered, hooked tail, mobile, adults in SQ tissues

What are your treatment options for sinus bradycardia? What will you check (via blood test) first and which test will you perform?

First check electrolytes and thyroid. Do Atropine Response Test (can also use glyco)- if HR increases, control the rate with TERTBUTALINE, ISOPROAMIDE, ISOPROTERENOL or PROBANTHENE

How can you treat sinus arrest?

If responds to atropine, then control the rate with TERTBUTALINE, ISOPROAMIDE, ISOPROTERENOL or PROBANTHENE. If not, pacemaker.

How can you treat hyperkalemia?

Sodium bicarb IV Glucose/Insulin Calcium gluconate (antagonize cardiotoxic effects of K to present fibrillation/asystole)

For what heart conditions is insertion of a pacemaker indicated?

Sinus bradycardia, Sinus arrest , that is not responding to drugs High-grade Second-degree AV block 3rd degree AV block (can use isoproterenol to stabilize first) Sick Sinus Syndrome Junctinal or Ventricular escape beats

What drugs can be used in cardiac emergencies to to increase ventricular response rates?

Isoproterenol Dopamine

Which dogs prolong AV conduction or prevent ventricular escape beats?

``` Digoxin B-blockers Procainamide Quinidine Lidocaine Phenothiazines ```

For which arrhythmias can vagal maneuvers be used?

Supraventricular premature depolariatzations (SPDs, SVTs) Atrial Tachycardia

Which calcium channel blocker is used to control heart rate (esp restoring sinus rhythm) to decrease the work load on the heart? It acts as a negative inotrope. What is the long acting formulation of this drug called?

Diltiazem Dilacor

What class of drugs are effective negative chronotropes and might have cardioprotective effects? Which ones are commonly used? What animals should these be used with great caution?

B- blockers Metoprolol, Carvediolol Those with decreased contractility.

``` What class of drugs slow the progression of heart failure, blunted pathological remodeling, enable an up to 50% reduction in furosemide dose, and prolong and improve the quality of life for dogs in heart failure? They are also vasodilators. What are the side effects? ```

ACE inhibitors Side effects: hypotension, azotemia

What drug that inhibits phosphodiesterase, causes arterio- and venodilator? It is also a calcium sensitizer with positive inotropic effects.

Pimobandan

Which short acting B-blocker lowers the ventricular response rate and should only be used in emergencies and if the contracility is normal?

Esmolol