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SA Final exam > Internal medicine > Flashcards

Internal medicine Flashcards

1
Q

Types of Jaundice

A
  1. Pre-hepatic: release of Hg due to RBC lysis
  2. Hepatic: dysfunction of hepatocytes or intrahepatic biliary tree
  3. Post-hepatic: obstruction or rupture of biliary tree, with impairment of excretion of conjugated Br into SI
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2
Q

Prehepatic Jaundice DD

A
  • Immune-mediated hemolytic anemia
  • Toxic: snake, onion/garlic, paracetamol, zink
  • Transfusion reaction
  • Erythrocyte parasites
  • Cats: Mycoplasma haemofelis, FeLV-anemia,
 FIP, FIV, Hypophosphatemia-induced hemolytic anemia,
 Acetaminophen toxicity
, Neonatal isoerythrolysis
  • Dogs: Heartworm (caval syndrome) , Leptospira
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3
Q

Hepatic Jaundice DD

A

-Toxic hepatopathy: plants, mycotoxin
-Inflammatory: hepatitis, cholangiohepatitis, lipidososis
-Neoplasia (primary or metastatic)

-Hepatic amyloidosis
Cats:
-Suppurative or lymphocytic cholangiohepatitis
-Idiopathic hepatic lipidosis
-FeLV-associated diseases (esp. lymphosarcoma)
-Feline infectious peritonitis
-Toxoplasmosis
-Acetaminophen toxicity
Dogs:
-Chronic hepatitis
-Copper storage diseases

-Leptospirosis

-Infectious canine hepatitis

-Hepatic fibrosis/cirrhosis

-Thiacetarsamide

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4
Q

Posthepatic Jaundice 
DD

A

Biliary tract obstruction: biliary stones or mucocele
-Pancreatitis (acute or chronic) with compression of the bile duct 

-Neoplasia (intestinal, pancreatic or hepatic) with bile duct compression

-Cholelithiasis or inspissated bile
-Duodenal FB (blocking duodenal pappillae)
Biliary Rupture:
-Traumatic rupture of bile duct or gall bladder

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5
Q

Azotaemia and types

A

Elevated conc. of BUN or Crea

  • Pre-renal: no direct parenchymal damage
  • Renal: direct parenchymal damage
  • Post-renal: failure to remove urine from the body
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6
Q

Uraemia

A

Comb. of presence of azotaemia and CS of illness

-CS: lethargy, inappetence, weight loss, vomiting, diarrhoea, stomatitis

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7
Q

Pre-renal azotaemia DD

A
  • Due to reduced renal perfusion: hypovolaemia (shock, dehydration, hemorrhage), cardiogenic
  • Due to increased protein catabolism: necrosis, starvation, infection, fever
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8
Q

Renal azotaemia DD

A
  • Tubular disease: toxins (NSAID´s, Ace-inhib., Lilium spp., antifungals, Gentamicin, Ethylene Glycol, grapes, pigmenturia, hypercalcaemia), renal ischemia (hypovolaemia, hypotension, heart disease)
  • Interstitial disease: pyelonephritis (e.g. Lepto)
  • Glomerular disease: immune complex deposition due to infections, immune-mediated disease or severe inflam.
  • Hereditary disease
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9
Q

Post-renal azotaemia DD

A

-Rupture or obstruction of ureters, bladder or urethra

+/- Large painful bladder, inability to urinate, abdominal pain, uroabdomen

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10
Q

Chronic kidney disease DD

A
  • Glomerulonephritis
  • Secondary to AKD
  • Infectious: bacterial, viral (e.g. FIP), fungal, rickettsial
  • Metabolic kidney disease: hypercalcaemia, amyloidosis, drugs and toxins (grapes, NSAIDs, anti-freeze)
  • Tubular disease
  • Neoplasia
  • Polycystic kidneys, renal dysplasia and other inherited diseases
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11
Q

Acute VS Chronic kidney disease

A
  • Acute should not have: non-regen. anaemia, history of loss of condition and PU/PD
  • AKD: acute onset anorexia and lethargy +/- vomiting, +/- painful kidneys, reduced water intake, good body condition, oliguria
  • CKD: chronic anorexia, lethargy, vomiting, +/- small, irregular kidneys, poor body condition, chronic weight loss, PU, PD, +/- anaemia (non-regen.)
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12
Q

Diagnosing jaundice

A
  • Pre-hepatic: anaemia - PCV, TP, icteric serum, spherocytes, autoagglutination
  • Hepatic: Incr. Br, ALT +/- incr. ALP, GGT, AST, US: liver pathology
  • Post-hepatic: Incr. Br, ALP, GGT +/- ALT, US: biliary tract congestion, biliary stones, mucocele, pancreatitis
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13
Q

SI acute diarrhoea DD

A
  • Diet: indiscretion, diet change
  • Parasites: hookworms, roundworms, Giardia, Coccidia
  • Virus: parvo, corona, rota
  • Bacterial: Campylobacter, E.coli, Salmonella, Clostridia
  • Toxic: NSAIDs, Organophosphates
  • HGE
  • Structural obstructions: FB, intussusception, torsions
  • Extraintestinal: pancreatitis, liver/kidney, Addisons, ischaemic (e.g. heat stroke)
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14
Q

LI acute diarrhoea DD

A
  • Diet: intolerance, hypersensitivity
  • Parasites: Giardia, roundworms, hookworms, Coccidia
  • Bacterial: ABE/SIBO, Campylobacter, Clostridia, Salmonella
  • Fungal: Histoplasmosis, Pythiosis
  • Infiltrative: IBE, lymphangiectasia, neoplasia
  • Breed-related enteropathy (GS, Basenjis)
  • Structural obstructions: FB/intussusception
  • Extraintestinal: pancreatitis, EPI, liver/kidney disease, Addisons, structural obstructions (FB, intussusceptions, volvulus), Addison´s, hyperthyroidism (cats)
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15
Q

Haematochezia DD

A
  • Inflammatory: IBD, Histocytic ulcerative colitis (Boxers), polyps
  • Parasites: hookworm, whipworm, Giardia
  • Bacterial: Clostridia
  • Virus: Parvo
  • HGE
  • Trauma and coagulopathy
  • Neoplasia: lymphoma, adenocarcinoma
  • Anal gland disorders
  • FB
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16
Q

Seizsure DD

A
  • Intracranial: inflam. (meningoencephalitis, granulomatous/steroid responsive), Distemper, Metabolic (storage disease), Neoplasia, Coagulopathy, Hypertension, Idiopathic epilepsi, hydrocephalus, trauma
  • Extracranial: Hepatic Encephalopathy (liver failure, PSS), Toxic (plants, lead, anti-parasitic (pyrethroids, organophosphates, carbamate) metaldehyde, rodenticide, strychnine, chocolate, caffeine, ethylene glycol
17
Q

Common DD of seizures in dogs

A

< 1 y/old: PSS, Inflammatory, Distemper, Hydrocephalus/Storage disease, Toxins
1-5 y/old: Epilepsy, Cerebral Neoplasia, Toxins, Inflammatory
> 5 y/old: Cerebral neoplasia, Toxins, Inflammatory, Metabolic, Epilepsi, Vascular

18
Q

Common DD of seizures in cats

A

(not as common as dogs)

Neoplasia, FIP, FIV, FelV, Cryptococcus, Toxoplasma, Toxins, Traumatic

19
Q

Treatment of seizures

A
  • Status epilepticus: O2 tx., IV catheter, Diazepam 0,5-1mg/kg (x3) -> Midazolam -> Propofol -> Phenobarbitone
  • Chronic tx.: Phenobarbital, Potassium Bromide, Levetiracetem, Zonisamide, Imepitoin
  • At home: Diazepam (rectal+oral+intranasal), Clonazepam, Levetiracetem
20
Q

DD of pruritus in dogs

A

Dog: FAD and Atopic dermatitis (90%)

  • Allergy: Flee (FAD), Atopic dermatitis, Food AD, Mosquito bite hypersensitivity, Contact dermatitis
  • Parasitic: Flee (FAD), Demodicosis, Sarcoptic mange (scabies)
  • Bacterial: Surface pyoderma (hot spot, skin fold), Superficial pyoderma, Deep pyoderma (Furunculosis), Abscess/Cellulitis, Atypical (GS pyoderma cellulitis)
  • Fungi: Malassezia dermatitis, Ringworm (Dermatophytosis)
21
Q

DD of alopecia

A

Either pruritic, or non-pruritic:

  • Hormonal: Hypothyroidism, Cushing´s, Hyperestrogenism (cystic ovaries, Sertoli cell tumour, Granulosa cell tumor)
  • Neoplasia: Sertoli cell tumour, Granulosa cell tumor
  • Immunological (rare): Drug eruptions, Juvenile cellulitis, Pemphigus foliaceous, Lupus erhytematosus
22
Q

Dermatology diagnosing

A
  • Flee comb
  • Skin swab
  • Skin scrape: supf. (scabies, other supf. mites), deep (Demodex)
  • Sticky tape impression and smear (bacteria, yeast, ring worm)
  • Hair pluck/Trichogram: microscope (ring worm, Demodex), fungal culture (ring worm)
  • Wood lamp (ring worm)
  • Biopsy (punch/wedge)
  • Blood: T4, baseline hormones
  • Food trial
  • Allergy testing (IgE serological, intradermal skin test)
23
Q

Dermatology tx.

A
  • Cephalexin + clorhexidine shampoo: bacterial (except deep), 2nd bacterial infections: FAD, atopic dermatitis, contact allergy, food allergy, fungal, parasitic
  • Prednisolon (anti-inflam. + immunosup.)
  • Miconazole shampoo: fungal (ringworm systemic: Griseofulvin, Itraconazole) (malassezia systemic: Ketoconazole dog, Itraconazole cat)
  • Cyclosporin (immunosup.)
  • Apoquel: Oclanitib
  • Cytopoint: Lokivetmab
  • Isoxazoline parasiticide, Amitraz wash: Demodex, Sarcoptes
24
Q

DD of pruritus in cats

A

Cat:

  • FAD (60%)
  • Food Allergy dermatitis - fish protein allergy (30%)
  • Atopy, feline eso. granuloma complex, mites (10%)
25
Q

DD of alopecia in cat

A

Clinical presentations:

  • Bilat. symmetrical alopecia: FAD, food allergy, feline atropy, mosquito bite hypersensitivity, ringworm, psychogenic alopecia
  • Head and neck pruritus (mild alopecia): same + Notoedric mange, Otodectic mange, Demodecosis, autoimmune (Pemphigus foliaceus)
  • Feline miliary dermatitis: FAD, food allergy, feline atropy, mosquito bite hypersensitivity, parasites (Notoedric mange, Otodectic mange, Demodecosis), ringworm, pyoderma, nutritional disorders (FA def.), idiopathic, neoplasia (MCT)
26
Q

DD of hyposthenuria

A

< 1.008 (actively diluting)

  • Cushing´s
  • HyperCa
  • Hyperthyroidism
  • Pyelonephritis
  • DI
  • Pyometra
  • Liver disease
  • Psychogenic PD
  • Diuretics
  • IV fluids
  • Normal
27
Q

DD of isosthenuria

A
  1. 008-1.013

- Same as hypo + kidney disease

28
Q

DD of hypersthenuria

A
  1. 014-1.029: min. conc.
    - Cushing´s + Addisons
    - Kidney disease
    - Liver disease
    - DM, renal glycosuria
    - Normal
  2. 030-1.045: max. conc.
    - Dehydration
    - Normal
    - Acute kidney injuiry
29
Q

DD of proteinuria

A
  • Hemorrhage: trauma, inflam., neoplasia, urolithiasis, FLUTD, coagulopathy
  • Inflam. in UT: inflam., neoplasia, infection
  • Kidney disease: primary glomerular disease (Amyloidosis, GN), primary tubular diseas
  • Pre-renal proteinuria: fever, cardiac disease, shock, muscular exertion, seizures
30
Q

DD of urinary incontinence

A
  • Consider first: 2nd. to PU/PD, submissive/cognitive behaviour, can´t walk
  • Urethral sphincter mechanism incompetence
  • Paradoxical urinary incontinence: prostatic dis., neoplasia, uroliths, FLUTD
  • Ectopic ureter
  • Inflammation: bacterias, uroliths, FLUTD, neoplasia, prostatitis
  • Neurological dysfunction: UMN (large, distended), LMN (soft), Detrusor atony
31
Q

DD of liver diseases

A
  • Acute hepatopathy/hepatitis
  • Chronic hepatopathy/hepatitis
  • Cholangiohepatitis
  • Feline hepatic lipidosis
  • Feline inflam. liver disease/Cholangitis
  • Hepatic Encephalopathy
32
Q

3 endocrine diseases causing hyperglycemia

A
  • DM
  • Cushings
  • Hypothyroidism
33
Q

Cause of smaller liver

A
  • Fibrosis/Cirrhosis
  • CPSS
  • HMD
34
Q

Tx of liver disease

A
  • Supportive: IV fluids, electrolytes, Maropitant, Omeprazole, Sucralfate, Famotidine
  • Coagulopathy: serum + vit.K inj.
  • NS: reduce NH3 -> lactulose/psyllium, AB (Metronidazole), diet (low P, high BV, high carb., mod. fiber content, small meals freq.)
  • Immunosup.: Prednisolon +/-Azathioprine
  • If bact. inf: AB (Metronidazole, Ampicillin)
  • Anti-fibrotic: Colchine
  • Antioxidants: Vit.E+C, SAMe, NAC-N-acetylcysteine
  • Cu-chelation: D-penicillamine, Zink acetate
  • Choleretic: UDCA (Ø bile obst.)
  • Ascites: Spirolactone, +/-Furosemide, abd.centesis
  • Cat lipidosis: NE/G-tube! High P. Gradually incr.
35
Q

DD of coughing

A
  • Laryngeal: paralysis, collapse, laryngitis, FB
  • Brachycephalic Airway Syndrome
  • Infectious tracheobronchitis - Kennel Cough (harsh hacking)
  • Tracheal collapse (goose honk)
  • Ca chronic bronchitis (hacking)
  • Fe bronchial disease (chronic cough)
  • Pneumonia (soft, rarely in cats)
  • Pulm. oedema (non-cardiogenic) (soft)
36
Q

Types of resp. sounds

A
  • Crackling: fine/coarse (pneum., chronic bronchitis, heart failure, asthma, COPD)
  • Wheeze: narrowing airways (asthma, COPD, heart failure)
  • Rhonchi: obstr. trachea, bronchitis, pneum.)
  • Pleural friction rub: pleural inflam., pericarditis
37
Q

DD of dyspnoea

A

= shortness of breath

  • Nasal cavity: tumors
  • Tracheal: collapse, hypoplasia, parasites
  • W/Ø resp. origin (Kussmaul): mets, gastric dilation, metabolic acidosis
  • Ca chronic bronchitis (obst. exp.)
  • Fe bronchial disease/asthma (obst. exp.)
  • Pneumonia
  • Pulm. oedema, neoplasia
  • Lung lobe torsion
  • Mediastinitis
  • Pleural effusion
  • Pneumothorax
  • Diaphragmatic hernia
  • Congenital cardiac disease
  • AV-valve dysplasia
  • Pericardial effusion
  • Heart worm disease
  • Oesophagitis, FB, spirocercosis,
  • Hypoxia due to inhal. of toxic gases, severe anaemia
  • Pancreatitis, acute hepatitis, goitre, acromegaly, HSA, hyperthermia, tetanus
38
Q

Tx. of resp. diseases

A
  • Acute: SpO2 and O2 therapy, sedation, +/-intubation, active cooling if required,
  • Anti-inflam.: Dexamethasone, Prednisolone, inhalers: Fluticasone puffers, budesonide nebuliser
  • BCAS: Rest, cool environment, surgery (Ø for tr. hypoplasia)
  • Bacterias: Doxycycline/Amoxiclav
  • Antitussives: Codeine, Tramadol (Ø syst. ill)
  • Nebulization, coupage
  • Bronchodilator: Terbutaline, Salbutamol inhaler

SA Final exam (4 decks)

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