Management of Disease Flashcards
1
Q
Why is the jugular vein preferred when taking blood?
A
Biggest palpable vein-better flow
Less risk of venous damage
Less compromise to venous access
Sampling process takes less time ‘
2
Q
What gauge size of needle should you use when drawing blood?
A
Dog=21g (green)
Cat=23g (blue)
3
Q
What are the 3 contraindications when taking blood from the jugular vein?
A
Aggressive/very scared patients
Risk of increasing intracranial pressure (patients with trauma) or cervical instability
Pyoderma over the site
4
Q
How do you raise the jugular vein?
A
Extend the head and move it slightly laterally
Use your thumb to apply pressure in the jugular groove
5
Q
Why, after drawing blood and placing it into the appropriate tubes, do you gently invert the tubes?
A
To prevent clot formation
6
Q
What does EDTA prevent?
A
Coagulation
7
Q
What is meant by haematuria?
A
Blood in urine
8
Q
What is meant by pollakiuria?
A
Frequent small urinations
9
Q
What is meant by dysuria?
A
Painful urination
10
Q
What is meant by stranguria?
A
Painful urination with vocalisation
11
Q
How do you differentiate between Hb and myoglobin as the cause of red urine?
A
Check CK (creatine kinase) levels-will be high in cases of muscle damage
12
Q
What is the normal pH for dogs and cats?
A
5-7.5
13
Q
What form of bilirubin appears in urine?
A
Conjugated
14
Q
What is the most common cause of pyuria (WBCs in urine)?
A
UTI
15
Q
Small numbers of squamous and transitional epithelial cells are a normal finding in urine, but may be increased under which 3 circumstances?
A
UTI
Irritation
Neoplasia
16
Q
Casts found in urine originate from where?
A
Renal origin:
Ascending Loop of Henle
Distal tubule
17
Q
Why should you only check for crystals in fresh urine and not stored urine?
A
Crystals can precipitate in stored urine
18
Q
Do struvite crystals form in acidic or alkaline urine?
A
Akaline
19
Q
What is the definition of effusion?
A
Any accumulation of fluid in a body cavity
20
Q
What is the definition of ascites?
A
Abdominal effusion
21
Q
What is the definition of transudate?
A
Usually due to mechanical factors (hydrostatic, oncotic)
22
Q
What is the definition of exudate?
A
Usually due to increased vascular permeability due to inflammation
23
Q
What kind of tube would you use for culture?
A
Plain sterile
24
Q
What kind of tube would you use for cytology, TP and cell count samples?
A
EDTA
25
What are the 6 types of effusion?
Transudation (high or low-protein)
Exudation
Haemorrhage
Lymphorrhage (chylous or non chylous lymphatic)
Rupture of hollow organ (urine, bile, GI)
Mixed
26
What is chyle? What does it look like?
Chylomicron-rich lymph fluid
| Milky fluid
27
What are the main veins used for blood sampling?
Jugular, cephalic, lateral saphenous, medial saphenous, ear veins, sublingual
28
Which value for triglyceride count indicates that a substance is chyle?
Over 1.13 mmol/L
29
Why is chyle opaque?
Due to the prescence of chylomicrons, which are big
30
What are the 4 main causes of chylothorax?
Heart disease
Trauma/surgery
Neoplasia
Idiopathic
31
What are the 3 main causes of chyloabdomen?
Trauma/surgery
Neoplasia
Idiopathic
32
Which sided heart failure causes high-protein ascites?
Right-sided
33
What is the appearance of normal synovial fluid?
Clear, pale yellow
| Very viscous
34
How are beta-lactams eliminated?
Mainly via kidneys
35
When taking a radiograph, what is the shape and size of the primary beam controlled by?
Lead collimators
36
How does a radiograph appear if it is under-exposed?
Too white
37
How does a radiograph appear if it is over-exposed?
Too black
38
What are the 5 basic radiographic opacities?
```
Air
Fat
Soft tissue/fluid
Mineral (bone)
Metallic
```
39
In a radiograph, apparent opacity of a tissue depends on what?
```
Atomic number (black=lowest, white=highest)
Physical density (thickness)
```
40
What is meant by the microbiome?
The genetic material of all the microbes (bacteria, fungi, protozoa, viruses) that live on and inside an animal
41
What is the mechanism of action of beta-lactams?
Interfere with bacterial cell wall production, causing cell lysis
42
Which antimicrobial would be your first choice when treating Streptococcal infection in horses?
Beta-lactams
43
What is the mechanism of action of chloramphenicol?
Binds to 50S ribosomal subunit, inhibits protein synthesis
| Bacteriostatic
44
Potentiated sulphonamides are a combination of which 2 things?
Sulphonamide and diaminopyrimidine
45
Why is rifampin usually given in combination with another drug?
Resistance develop rapidly
46
What is the advantage of a drug being lipophilic?
Good penetration into cells
47
Penicillins mainly affect which: gram negative or gram positive bacteria?
Gram positive
48
Around how much of an animal's total body weight is blood?
10%
49
What is the difference between serum and plasma?
Serum is plasma with the coagulation proteins removed
50
At rest, approximately 1/3 of a horse's RBCs are located where?
Spleen
51
What is the most common cause of hyperglobulinaemia?
Chronic inflammation
52
What is the most common cause of panhyperproteinaemia?
| high TP due to increased albumin and globulin
Dehydration
53
What is the definition of oedema?
Abnormal accumulations of fluid in the interstitial spaces
54
What percentage of liver mass has to be lost before function is affected?
80%
55
Which 3 drugs are used as appetite stimulants?
Diazepam
Mirtazapine (best)
Cyproheptadine
56
Naso-oesophageal tubes are for which length of time?
Which kind of food are they used for and why?
Is sedation required to insert them?
Where does the tip of the tube end?
What are the contra-indications?
Short to medium term (2 weeks)
Liquid foods, due to the small diameter of the tube
No
Distal oesophagus
Vomiting, no gag reflex, disease of nose or pharynx, damage to face
57
Oesophagostomy tubes are for which length of time?
Is sedation or general anaesthetic required to insert them?
Where does the tube enter the oesophagus?
What are the contra-indications?
Medium to long term support (number of months)
GA
Laterally
Diseases of oesophagus and below
58
Gastrostomy tubes are for which length of time?
| Is sedation or GA required to insert them?
Long term support (minimum 7 days)
| GA
59
What are the % MERs of:
Entire male
Neutered male/entire female
Neutered female
Entire male= 65% MER
Neutered male/entire female= 60% MER
Neutered female= 55% MER
60
What are the only 3 indications for the use of parenteral feeding over enteral feeding?
Malabsorption syndromes, acute severe pancreatitis, severe persistent vomiting
61
Metzenbaum and mayo scissors are used for what?
```
Metzenbaum = fine dissecting
Mayo = dissecting connective tissue and fascia
```
62
What is the difference between synthetic and natural sutures?
Synthetic: made from lab-produced chemical polymers. Broken down by hydrolysis. Cause minimal tissue reaction.
Natural: made from animal or plant material. Provoke more tissue reaction as they provoke a foreign body response. Broken down by enzymatic degradation.
63
What is the critical amino acid for wound repair?
Methionine
64
Most greyhounds are what blood type?
CEA 1.1 negative
65
What is the difference between major and minor cross matches?
Major cross match: detects antibodies in recipient plasma against donor red cells
Minor cross match: detects antibodies in the donor against recipient red cells
66
Which blood group is most common in cats?
Type A
67
Which blood group is mostly used for donors in dogs?
CEA 1.1 negative
68
What channels do local anaesthetics block?
Sodium
69
Glutamate and aspartate act on which receptors?
NMDA receptors
AMPA receptors
Kainate receptors
70
Substance P and neurokinin A act on which receptors?
Neurokinin receptors (G-protein coupled)
71
What 3 properties of alpha 2 agonists make them useful as premedication agents?
All cause:
Analgesia
Sedation
Muscle relaxation
72
Which is the only inhalation agent that has analgesic properties?
Nitrous oxide
73
Where are leukocytes produced and released from?
Bone marrow
74
Leukocyte release and egression into peripheral tissues is stimulated by what?
Inflammatory cytokines from injured/infected areas
75
Neutrophil production is regulated by what?
Cytokines and growth factors
76
Maturation time of neutrophils in the bone marrow is how long?
When might it be shorter?
7 days
(from blast to segmented neutrophil)
2-3 days with inflammation
77
Where are neutrophils stored?
Bone marrow
78
What is the average blood transit time for neutrophils?
6-10 hours
79
On exit from circulation, how are neutrophils lost?
Across mucosal surfaces or are removed by macrophages in liver/spleen
80
Left shift is usually seen with which kind of inflammation?
Acute
81
What leucocyte alteration often happens in young excited cats?
Lymphocytosis
82
What leucocyte alteration is most suggestive of acute inflammation?
Neutrophilia with left shift
83
What are the boundaries for leucocytosis and leucopenia when looking at a blood smear?
45 WBC in a single LPF10x field = leucocytosis
84
Which factor does vWf adhere to?
Factor VIII (prolongs it's half life)
85
Von Willebrand factor is synthesised and stored where?
Endothelial cells
86
Haemophilia A is a deficiency in which clotting factor?
Factor VIII
87
Haemophilia B is a deficiency in which clotting factor?
Factor IX
88
What clinical signs are seen with acute DIC?
```
Presentation with thrombotic disease and/or bleeding diatheses
Haemorrhage
Thrombosis
Multiorgan failure
Metabolic acidosis
```
89
Which drug can be used to reverse all alpha 2 agonists, particularly medetomidine?
Atipamezole
90
Chronic blood loss is defined as bleeding that has happened for how long?
Over 2 weeks
91
How long do feline aggregate reticulocytes last?
24 hours
92
How long do feline punctate reticulocytes last?
Up to 10 days
93
What RBC shape abnormality is strongly supportive of IMHA?
Spherocyte
94
Which red blood cell types are typical of microangiopathic anaemia?
Schistocytes and acanthocytes
95
How long does osteoid take to mineralise?
80-90 days
96
How long does it take for osteoclasts to resorb bone?
3-4 weeks at 40μm/day
97
What is meant by a fracture?
Disruption in the cortical continuity of a bone
Can be complete or incomplete
Can be secondary to direct or indirect trauma
98
What are the 3 grades of fracture classification?
Grade I-Bone ends have pierced skin and retracted
Grade II- Fracture ends exposed
Grade III-Major soft tissue loss and trauma
99
Of the time it takes for a fracture to heal, what % is spent in the:
Inflammation phase
Reparative phase
Remodelling phase
Inflammation phase: 10%
Reparative phase: 40%
Remodelling phase: 70%
(The phases overlap)
100
What is the normal sequence of events regarding healing of an indirect fracture?
```
Haematoma (localised collection of blood outside the blood vessels)
Granulation tissue
Connective tissue
Fibrocartilage
Bone formation-callus
Callus remodelling
```
101
What are the uses of positional bone screws?
To maintain relative position of two bone fragments
To fasten plate to bone
To anchor wire or suture to bone
To lock an interlocking nail
102
How should you position lag screws?
| What do they create?
Perpendicular to the fracture line
| Used to create compression
103
When might you use an external fixator during fracture healing?
```
Long bone fractures
Highly comminuted fractures
Adjunct to other fixation, e.g. IM pin
Open/infected fractures
Immobilising joints to protect soft tissue repairs or arthrodeses
Delayed unions caused by instability
Corrective osteotomies
```
104
What are the advantages of using external fixators?
Rigid fixation with minimal invasion of injured area
Allows access to open wounds during fracture repair
Can maintain limb length, if bone defects exist, while secondary bone healing occurs
Allows for gradually increasing loads to be applied to the healing bone
Minimal complication rate if rules of fixation are applied
Materials are inexpensive
105
What are arthritides?
Conditions causing pain and dysfunction related to joints
106
What is a diarthrodial joint?
A specialised joint consisting of a synovial cavity allowing articulation between two or more bones
107
What is synovial fluid made of?
Ultrafiltrate of plasma plus protein (hyaluronic acid)
108
Extracellular matrix within articular cartilage mainly consists of what?
Collagens (80-90% type II)
Proteoglycans (glycosaminoglycans such as aggrecan and HA)
Water (approx 70%)
Collagens confer shear resistance, whereas hydrated proteoglycans provide compression
109
Osteoarthritis is thought of as a disease of what?
Articular cartilage
110
What are the radiographic signs of osteoarthritis?
```
Soft tissue swelling
Osteophytosis (presence of osteophytes-bony growths)
Enthesophytosis
Subchondral bone sclerosis (hardening)
Intra-articular mineralisation (e.g. meniscus)
Fragmentation/joint mice
Collapsed joint space
Subchondral bone cysts
```
111
What is the function of biphosphonates?
Inhibit bone resorption by inhibition of osteoclasts
Compete with ATP resulting in apoptosis of osteoclasts
Alters “rough” border attachments
Reduced recruitment of osteoblasts to osteoclasts
112
What are the symptoms of immune-mediated polyarthritis?
```
Multiple limb joint pain/swelling
Generalised stiffness
Shifting lameness
Neck pain
Lethargy
PUO (pyrexia of unknown origin)
```
113
Describe normal synovial fluid
Pale yellow, high viscosity
| WBC
114
Describe septic synovial fluid
Serosanguinous/turbid/reduced viscosity
WBC>10-20x109/l
Total protein >30-40g/l
>90% neutrophils
115
How can hyperparathyroidism lead to intrinsic fractures?
Increased PTH. PTH stimulates osteoclasts to resorb bone, which results in calcium loss from bone into blood.
116
PTH1 receptors are present in high levels where?
Bone and kidney
117
Which 6 things should you mention when classifying a fracture?
Open or closed fracture?
Which bone?
Position of fracture (eg articular, epiphyseal)
Type of fracture line (eg transverse, oblique)
Degree of displacement
Reconstructable?
118
What occurs during the reparative phase of fracture healing?
Cartilage callus formation
| Lamellar bone deposition
119
Normal blood supply to the bone is via which arteries?
Nutrient, periosteal, and distal/proximal metaphyseal arteries
120
Fractured bones receive additional blood supply from which arteries?
Extraosseous arteries surrounding tissues (can be disturbed by fixation method)
121
In which type of bone healing is there formation of a callus/intermediate cartilage stage?
Indirect bone healing
122
With which fractures does direct bone healing occur?
Accurately anatomically reduced and compressed fractures only
123
Why might complications occur with fracture healing?
Infection
Instability (unsuitable fixation)
Implant failure
124
What are the advantages of using IM pins when treating fractures?
Good at resisting bending (strength in bending proportional to (radius)4)
In neutral axis of bone (no stresses or strains eg compression)
Often relatively inexpensive
May be used with other fixation devices (eg ESF, plate)
125
What are the disadvantages of using IM pins?
Poor at resisting rotation
Poor at resisting shear
Interferes with medullary blood supply
Difficult in chondrodystrophic dogs
126
What should the width of an IM pin be?
As wide as possible
| 30% bone diameter if combining with plate or ESF
127
Cerclage wires are used in combination with IM pins with which kind of fracture?
Long oblique fractures
128
What are the uses of positional screws?
To maintain relative position of two bone fragments
To fasten plate to bone
To anchor wire or suture to bone
To lock an interlocking nail
129
How long should a positional screw be?
2mm longer than measured depth (unless blind-ending hole)
130
What do lag screws create?
Compression
131
How do you insert a lag screw?
```
Overdrill cis cortex
Place drill insert and drill trans cortex
Measure depth
Tap (trans cortex only)
Insert screw
```
132
What may plates be used for?
Compression
Neutralisation
Bridging (buttress)
133
What are the indications for using ESFs (external fixators)?
```
long bone fractures
highly comminuted fractures
adjunct to other fixation, e.g. IM pin
open/infected fractures
immobilising joints to protect soft tissue repairs or arthrodeses
delayed unions caused by instability
corrective osteotomies
```
134
What are the advantages of using ESF? (external fixators)
Rigid fixation
Minimal invasion of injured area
Allows access to open wounds during fracture repair
Can maintain limb length, if bone defects exist, while secondary bone healing occurs
Allows for gradually increasing loads to be applied to the healing bone
Minimal complication rate
Materials are inexpensive
135
What impact does lameness have on reproductive performance?
Ovarian cysts
3.5 x greater odds of delayed cyclicity
Lower oestrus intensity
Prolonged calving intervals, less likely to conceive
50% of lame cows did not ovulate/express oestrus (in a study)
136
How does the Dairy Co mobility score sheet describe 'good mobility'?
Walks with even weight-bearing and rhythm on all 4 feet, with a flat back. Long, fluid strides.
137
Briefly describe the Dutch method for trimming cows' claws
Start with medial hind claw
Trim dorsal wall length to 7.5-8cm
Reduce sole depth at the toe to approx. 5-7mm
Spare the heel
Correct for other claw
Dish out
Deeper and wider modelling of the lateral hind/medial fore claw
138
Of the lesions which cause lameness in cattle, which are infectious and which are non-infectious?
```
Infectious:
Digital dermatitis
Interdigital dermatitis
Foul in the foot
Heel horn erosion
```
Non-infectious:
Sole ulcers
White line lesions
Sole haemorrhage/bruising
139
What rate should crystalloids be administered at?
| What about colloids?
60-90ml/kg/hour
| 3-4ml/kg/hr (max 20ml/kg)
140
Explain the pathophysiology of DIC
Disseminated Intravascular Coagulation
In a healthy animal, there are always tiny breaks in blood vessels. Coagulation factors produce fibrin to form a seal over the break; platelets also plug the hole. Once the vessel has healed, the clots are broken down by the body.
In DIC, because of the damage to the blood vessels, the blood clotting system gets activated and starts to form multiple small clots throughout the body. As many are formed, coagulation factors are used up. The clots that usually repair damaged vessels are rapidly broken down before the vessel has a chance to repair itself.
2 problems:
1) Blood clots throughout the body
2) Inability of clots to form and remain where they should, resulting in bleeding
141
Give the indications for blood transfusions
```
Non-regenerative anaemias
Blood loss
Haemolytic anaemias
Severe thrombocytopenia
DIC
Clinical compromise
Weakness, ataxia
Tachypnoea, dyspnoea
Marked tachycardia
Signs of hypoxia
```
142
Why must you always cross-match before giving a cat a blood transfusion, but you can give a dog its first blood transfusion without cross-matching?
Cats have naturally occurring antibodies against red cell antigens
Dogs do not have naturally occurring antibodies to major red cell antigens (antibodies are raised after first transfusion)
143
What are blood groups defined by?
Inherited antigens on the surface of RBCs
144
Which properties do you look for in a blood donor dog?
```
Never been abroad
Nulliparous
8 years old or less
Ideally over 28kg
Friendly, healthy, good condition
Vaccinated over 14 days ago
Ideally CEA 1.1, 1.2, 3, 5 or 7 negative
```
145
When might cross-matching be impossible or inaccurate?
Inaccurate if on immunosuppressive therapy
| Can't be carried out if auto agglutinating
146
When taking blood from a dog for a blood transfusion, where should you collect it from?
Jugular vein
147
When taking blood from a dog for blood transfusion, what should be added to it?
What should then be given to the donor?
CPDA-1 anticoagulant
2-3 x volume of blood collected in crystalloids
148
What are the blood types in cats?
| Which is most and least common?
A, B, AB
A most common in DSH
AB are rare
149
What is the minimal interval between blood donations in dogs and why?
What about cats?
Dogs: 28 days, to prevent iron deficiency developing
Cats: 28-42 days
150
Which properties do you look for in a blood donor cat?
```
Friendly, healthy, good condition, preferably indoors
8-10 yrs old or less
Never been abroad
Nulliparous
Vaccinated over 14 days ago
Ideally >4kg (lean weight)
FeLV, FIV, M.haemofelis negative
PCV >35%
```
151
How should whole blood and packed red cells be stored?
For up to 4 weeks at 4-5oC
152
Why should whole blood not be given to a patient with thrombocytopenia?
Whole blood does not contain platelets or coagulation factors
153
Stored red cells have reduced what?
Oxygen-carrying capacity
154
In which ways can you administer blood when doing a blood transfusion?
IV: jugular, cephalic, saphenous
Bone marrow cavity of proximal femur
Intra-peritoneal administration is poor: slow uptake, only 40% of RBCs absorbed
155
Why is hypocalcaemia a transfusion reaction?
Citrate anticoagulant chelates calcium
156
What is a possible consequence of circulatory overload during a blood transfusion?
Pulmonary oedema
Frusemide (loop diuretic; inhibits resorption of Na, Cl and water in loop of Henle, resulting in loss of Na, Cl and water into urine)
157
Give some advantages and disadvantages of using oxyglobin
```
Advantages:
Long shelf life
No donor required
Can be given via standard giving sets
No need to cross match
Improved O2 carrying capacity
```
```
Disadvantages:
Shorter duration of effect
Free Hb is vasoactive (potentially decreasing O2 delivery to tissues)
Risk of volume overload
Not licensed in cats
```
158
When is the use of oxyglobin contra-indicated?
Congestive heart failure
Renal impairment
Impaired cardiac function
159
Why may a regenerative anaemia first appear non-regenerative?
Reticulocytes only increase within 2-3 days of onset of anaemia, and peak at 4-7 days
160
Describe the stages of reticulocytes from nucleated RBC to mature RBC in cats
Nucleated RBC
Aggregated reticulocytes (last 24 hours)
Punctate reticulocytes (last up to 10 days)
Mature RBC
161
What clinical signs are seen with hypovolaemic shock?
```
Pallor
Tachycardia
Weak peripheral pulses
Poor peripheral perfusion
-increased Capillary Refill Time
-cold extremities
-increased lactate
```
162
Which kind of blood loss is seen with acute haemorrhage?
Proportional loss of all blood components
Interstitial fluid moves into the vascular space
-blood ‘dilution’ -> PCV and TP fall
163
How does chronic blood loss influence anaemia?
May lead to consumption of iron stores and iron deficiency anaemia (IDA)
Less iron -> less Hb -> smaller and hypochromic RBCs
May be regenerative or non-regenerative
164
What is the most common cause of iron deficiency anaemia?
Chronic GI haemorrhage
165
Name some causes of chronic GI haemorrhage
```
IBD
Neoplasia
Parasitism
NSAIDs
Corticosteroids
Chronic renal failure
Idiopathic GI ulceration
```
166
What kind of red blood cells are seen with iron deficiency anaemia?
Microcytic (smaller cells, due to an extra cellular division)
Hypochromic (less Hb due to less iron)
167
Which drugs can you use to treat GI haemorrhage?
Sucralfate
H2 receptor antagonists (eg ranitidine)
Proton pump inhibitors (omeprazole)
Prostaglandin E analogues
168
How can you treat iron-deficiency anaemia?
```
Blood/packed red cell transfusion (if unstable, hypoxic, prior to surgery)
Iron supplementation (oral ferrous sulphate, intramuscular iron dextran)
```
169
What RBC shape abnormality is strongly supportive of IMHA and why?
Spherocyte
Macrophages 'pit' the membrane portion of the RBC with the antigen-antibody complex -> decreased RBC surface -> loss of discoid shape -> spherocyte
170
What is the difference between agglutination and rouleaux formation?
Agglutination= Antibody-mediated clumping; may be temperature dependent. Strongly supportive of IMHA.
Rouleaux formation= Stacking of RBCs due to increased plasma proteins coating RBCs. Caused by inflammation, cancer. Normal in horses and cats at some degree
171
What is the total blood volume of a dog or cat?
Cat/sheep/cattle: 6-7% of body mass, or 60-70ml/kg
| Dog/horse: 8-9% of body mass, or 80-90ml/kg
172
Can an animal be hypovolaemic without being dehydrated?
Yes: with acute haemorrhage, only blood from the intravascular compartment is affected, so before inter-compartmental fluid shift occurs (which takes a few hours), the animal will not be dehydrated.
If an animal is dehydrated it is always hypovolaemic.
173
Which fluid would you give to a patient with pure water loss?
Hypotonic fluids. Watery, low (Na)+ crystalloid.
| eg 5% glucose, or 4% glucose with 0.18% saline
174
Which fluid would you give to a patient with ECF-like fluid loss? (water and electrolytes)
Isotonic fluids. Salty, ECF-like crystalloids.
eg Hartmanns, or normal 0.9% saline.
Or colloids suspended in ECF-like fluids.
175
Which fluid would you give to a patient with proteinaceous ECF-like fluid loss?
Colloids suspended in ECF-like fluids
176
Which fluid would you give to a patient with blood loss?
Blood/ HBOC
Colloids
Isotonic crystalloids eg Hartmanns
177
Give some clinical signs of intravascular hypovolaemia
Tachycardia
Tachypnoea
Pale mucous membranes, increased CRT
Weak peripheral pulses (cold extremities)
Decreased urine output (increased specific gravity)
Altered mentation (depression, recumbency, inactive)
178
What is the bolus rate of fluid administration for treatment of shock?
10ml/kg over 15-30 mins
179
What does the Coombs test test for?
Anti-erythrocyte antibodies and complement, ie agglutination
| Supports a suspicion of IMHA
180
What is seen with azotaemia?
Increased urea and creatinine
181
Which kind of drugs would you give to treat IMHA and why?
Corticosteroids, eg Prednisolone
Reduce Fc receptor mediated RBC destruction
Inhibit complement
182
What type of drugs are azathioprine and cyclophosphamide?
Cytotoxic
183
How does human immunoglobulin work as a treatment for IMHA?
Blocks Fc receptors on macrophages so inhibits phagocytosis
184
Cell ghosts are evident of what?
Direct membrane damage by complement
185
Oxidative injury results in which kinds of RBCs?
Eccentrocytes and Heinz body formation
186
Give the chain of events that cause anaesthetic overdose to lead to death
Chemical CNS depression -> unconsciousness -> respiratory arrest -> hypoxaemia -> cardiac arrest (via myocardial hypoxia) -> cessation of circulation -> worsening CNS depression -> death
187
Where would you inject when doing an intra-cardiac euthanasia?
Ribspace 3, base of heart
188
What drug should you use for euthanasia via anaesthetic overdose?
Quinalbarbital
189
If dyspnoea is heard with an airway noise (stridor or stertor), is there an upper or lower airway problem?
Upper
190
What are the clinical signs of forward heart failure?
Heart is failing as a pump
Lethargy, exercise intolerance
Weak femoral pulses, unable to detect distal pulses (metatarsal)
Pale mucous membranes, slow CRT
Cold extremities
Possible hypothermia
Cardiogenic shock (decreased BP and organ failure)
Heart sounds quiet or distant on auscultation
Poor cardiac output
191
Left sided congestive heart failure causes what?
Pulmonary oedema
192
What are the clinical signs of left-sided congestive (backwards) heart failure?
Tachypnoea (inspiratory and expiratory, restrictive breathing pattern)
Cough in dogs due to left atrial enlargement
+/- soft inspiratory crackles on auscultation
(Pulmonary oedema)
193
What are the clinical signs of right-sided congestive (backwards) heart failure?
```
Ascites (positive fluid wave on ballotment)
Distended jugular veins
Positive hepatojugular reflux
+/- pleural effusion
Rarely sub-cutaneous oedema in SA
Hepatic congestion
```
194
What is the normal heart rate in dogs and cats?
Dogs: 80-140
Cats: 120-200
195
Describe the 6 grades of heart murmurs
I: very quiet, only detected in optimal conditions
II: less loud than the heart sounds
III: as loud as the heart sounds
IV: louder than the heart sounds
V: loud heart murmur with a precordial thrill
VI: very loud murmur with a precordial thrill that can still be detected after lifting the stethoscope off the chest wall
196
When are the heart sounds S3 and S4 heard?
S4 is detected in animals which depend on atrial contraction to achieve ventricular filling – e.g. with abnormal left ventricular relaxation, in feline HCM.
S3 is heard when early diastolic filling is abruptly decelerated in a stiff, poorly compliant left ventricle, and filling pressures are high (e.g. DCM)
197
What does it mean if you hear crackles or wheezes when listening to the lungs?
Crackles (inspiratory): smaller airways are opening
| Wheezes (expiratory): narrowed airways
198
Is an increase in heart rate symbolic of cardiac disease or respiratory disease?
```
Increase= cardiac
Decrease= respiratory
```
199
Describe the classifications of severity of heart disease/ heart failure
Class 1 Heart disease present, no clinical signs
Class 2 Heart disease, signs only after strenuous activity
Class 3 Comfortable at rest, signs on modest exertion
Class 4 Severe clinical signs even at rest: life- threatening, requires urgent treatment.
200
What are the functions of the kidneys?
Excretion of waste
Control of body fluid balance (volume and composition) (electrolyte disturbances, hypertension)
Endocrine organ (renin, EPO, 1,25-didroxyvitamin D)
201
Give some indications for cystotomy
- removal of cystic calculi (commonest indication)
- investigation of haematuria
- repair of ruptured bladder
- bladder biopsy
- surgical treatment of bladder neoplasia
202
What is the difference between relative and absolute polycytaemia?
Relative is caused by a 'relative' increase of the red cell mass caused by decreased plasma volume due to fluid shift or dehydration, or by RBC distribution
Absolute is cause by an actual increase in red cell mass
203
How does the caudal maxillary sinus communicate with the frontal sinus? (horse)
Via the frontomaxillary sinus
204
Where do the Rostral and caudal maxillary sinus' drain?
Middle meatus
205
What is cachexia?
Loss of weight, muscle atrophy, fatigue, weakness, loss of appetite
206
What is the difference between hypoplasia and atrophy?
```
Hypoplasia= organ never reaches full size
Atrophy= organ reaches full size then gets smaller
```
207
What are Sarcoids thought to be caused by?
Bovine papilloma virus type 1
208
What is ehrlichia?
Intracellular, gram-negative bacteria
209
What is ehrlichia transmitted by?
Ticks
210
What are the 3 main species of Ehrlichia?
Ehrlichia canis
Ehrlichia ewingii
Ehrlichia chaffeensis
211
What is Ehrlichia canis transmitted by?
The brown dog tick Rhipicephalus sanguineous
212
Which dog breed is more susceptible to Ehrlichia canis?
German shepherds
213
When do clinical signs of Ehrlichia canis appear?
8-20 days after infection (acute disease)
214
What are the 3 phases of disease regarding Ehrlichia canis?
Acute, subclinical, chronic
215
Describe the acute phase of Ehrlichia canis
Lethargy, weight loss, splenomegaly, lymphadenomegaly, uveitis, retinal haemorrhage, cutaneous petechial and ecchymotic haemorrhages, epistaxis, polyarthritis, neurological signs due to meningitis and/or haemorrhage
216
Describe the chronic phase of Ehrlichia canis
Develops in only some infected dogs (sequestration of organism within spleen, evades host immune system)
Pancytopenia (hypoplasia of bone marrow cells)
Secondary infections (immunosuppression)
Granular lymphocytosis
Bone marrow plasmacytosis
Immune-complex glomerulonephritis causing protein-losing nephropathy
217
How can you diagnose Ehrlichia?
Complete blood count:
- Mild non-regenerative anaemia
- Thrombocytopenia
- Mild leukopenia
- Pancytopenia in chronic cases
- In some dogs, can see morulae in circulating macrophages
Biochemistry:
- High globulins, low albumin
- High ALT and ALP
Urinalysis:
- Proteinuria
- Pyuria (pus in urine), haematuria, cylindruria (casts in urine)
Coagulation profile:
-Thrombocytopenia, decreased platelet aggregation, prolonged buccal mucosal bleeding time, prolonged aPTT
CSF analysis:
-Increased CSF protein concentration, lymphocytic pleocytosis (abnormal increase in amount of lymphocytes)
Bone marrow analysis:
-Chronic ehrlichiosis: hypoplasia of all bone marrow elements, decreased iron stores, marrow plasmacytosis (large amount of plasma cells)
218
Which diagnostic assays are available for diagnosing Ehrlichia?
```
Cell culture (whole blood)
Morula detection (whole blood, buffy coat smears, body fluids,, tissue aspirates)
IFA serology (serum)
ELISA serology (serum)
PCR (whole blood, spleen, LN, BM, buffy coat)
```
219
How can you treat Ehrlichiosis?
Doxycycline (10mg/kg SID or 5mg/kg BID PO) (per os-oral)
| Oxytetracycline (7.5-10 mg/kg BID IV; change to oral doxycycline as soon as possible)
220
Treatment for Ehrlichiosis should be based on what?
Resolution of platelet counts and improvement of hyperglobulinaemia
221
How can you prevent Ehrlichiosis?
Tick prevention: synthetic pyrethroids, permethrin, or deltamethrin
Low dose doxycycline ?
Early removal of ticks (24-48hr delay between attachment and feeding)
222
Which strain of Ehrlichia causes 'Canine Monocytic Ehrlichiosis'?
E.canis
223
What do you call a castrated bull?
Steer/bullock
224
What do you call a castrated ram?
Wether
225
When does a bull become fertile?
| What is its scrotal circumference?
7 months old
| Scrotal circumference= 28 cm
226
When is a ram likely to become fertile?
```
4-6 months
1st Autumn (mostly seasonal breeders)
```
227
Why might you castrate a bull/ram?
Safer to handle and manage
Prevent accidental pregnancies
Better carcass quality (increased fat deposition, avoid taint. Decreased chance of dark cutting meat)
Tradition
228
Why might you not castrate a bull/ram?
Welfare- pain, stress, haemorrhage
Reduced growth rates
Growth setback at time of castration
229
When are bulls slaughtered for beef?
12-15 months
230
When can you castrate calves and lambs with rubber rings?
First 7 days (no local required)
231
How is a calf or lamb castrated if it is older than 7 days old?
Calf:
0-2 months: trained lay person aged 16 or over, no analgesia
Over 2 months: veterinary surgeon, local anaesthetic
Lamb:
0-3 months: trained lay person aged 16 or over, no analgesia
Over 3 months: veterinary surgeon, local anaesthetic
232
What are the advantages and disadvantages of castrating lambs/calves when they are young vs older?
Younger: less stress, easier, safer, less risk to animal, less setback to growth, easier in some management systems eg indoor lambing
Older: more stressful, increased danger to operator, increased risk to animal, better carcass quality? Loner period of high growth rate, easier in some management systems eg suckler calves
233
Give some methods of castration in lambs and calves
```
Rubber rings
Open castration (knife)
Bloodless castration ('burdizzo'-clamps break the blood vessels supplying the testes. Spermatic cords are crushed one at a time, leaving a space in the muddle to maintain blood flow to scrotum)
```
234
Which local anaesthetic is usually used when castrating calves?
Procaine 5% with adrenaline
10-15 min onset, lasts 45-90 mins
Can also use epidural anaesthesia but risk of recumbency and 20 min time delay
235
Where is local anaesthetic injected when castrating a calf?
Spermatic cord +/- SC into scrotum +/- into testes
236
Give some risks associated with open castration of bulls/calves (knife)
```
Haemorrhage- ensure haemostasis
Herniation
Infection at wound site
Tetanus (vaccinate with covexin 8)
Gut tie- associated with recoil of spermatic cord into abdomen
```
237
What are the methods of open (surgical) castration in calves?
Traction (up to 4 months old)
Twist and pull (entire cord or vascular portion only)
Emasculators (open-incise vaginal tunic. Closed- incise skin only)
238
Which antibiotics can you give following surgical castration on a calf?
Long acting penicillin or Oxytetracyclines
239
Give some complications of surgical calf castration and state how you would resolve them
Haemorrhage (pack with cotton wool, ligate spermatic cord)
Abscessation (establish drainage)
Gross infection and swelling (antibiotics and NSAIDS)
Gut tie (laparotomy or slaughter)
240
Where should anaesthetic be injected when dehorning calves?
| How much local anaesthetic should you use?
Cornual branch of trigeminal nerve
3-10ml of local anaesthetic
Could also inject into branches of cervical nerve at back of horn
241
Which sedative should you use when dehorning large calves?
Xylazine
| 0.5-1.2ml im
242
What kind of aftercare should you give to a calf after dehorning?
Analgesia- NSAIDS eg Metacam
| Check for haemorrhage in older animals and sinusitis
243
How do you treat sinusitis in a cow?
Tilt head to drain
Hosepipe in hole to flush out
Antibiotic?- penicillin, pen/strep
244
Which areas are common sites for biting in pigs?
Flanks, ears, tails and vulva
245
What is liver cyrrhosis?
Chronic inflammation
| Fibrous material impairs blood flow to cells
246
What is the function of the middle ear (Eustachian tube)?
Drains fluid from middle ear and equalises air pressure either side of the tympanic membrane
247
Explain the ear canal's self-cleaning mechanism
Cerumen (secreted by sebaceous and ceruminous glands) catches foreign material, desquamated keratinocytes and microbes. It contains antimicrobial peptides and Igs
Epithelial migration: living keratinocytes carry cerumen and contents out of ear canal
248
What is osteomyelitis?
Inflammation of bone or bone marrow, usually due to infection
249
What are anal sacs?
Paired diverticula of rectal wall
250
Where are anal glands located?
Between internal and external sphincters of anus
| 4 and 8 o clock
251
Describe the epithelium of anal glands
Dogs: secretory epithelium containing modified sweat and sebaceous glands
Cats: only sebaceous glands
252
When are anal sacs emptied?
Defaecation
| Also involved in social interactions between animals and marking territory
253
Which problems can occur with anal sacs?
Impaction (most common)
Infection
Abscess (result of infection; can rupture -> cellulitis, fistula)
Neoplasia (rare)
Dogs, rare in cats
254
What causes impaction of anal sacs?
Over-secretion, change in character of secretion, change in muscle tone or faecal form
May be secondary to obesity or intestinal disorders eg diarrhoea
255
How do you treat impaction of anal sacs?
Manual expression
| Correct underlying cause
256
What causes anal sac infections?
Recurrent or chronic impaction
Incomplete emptying
Faecal contamination
Obesity
257
Which microorgansims can be isolated from infected anal sacs?
```
E.coli
Streptococcus faecalis
Clostridium welchii
Proteus
(all found in intestinal tract)
```
Staphylococcus spp
Malassezia
(found in moist mucocutaneous junctions)
258
What are the clinical signs of anal sac disease?
```
"Scooting"
Licking/chewing anal area
Tenesmus
Perianal discomfort, irritation, pain
Smelly discharge from perianal area
Self-trauma to flanks and tail base
```
259
How do you treat anal sac infections?
```
Express anal sac contents
Irrigate sacs with antiseptic
Instill antibacterials
Lance and drain abscesses
Systemic antibacterials
Abscess has ruptured: anal sac removal
```
260
Give some signs of anal sac neoplasia
Tenesmumus
PU and PD (hypercalcaemia)
Constipation
Swelling of perianal area
Adenocarcinoma most common
261
What causes shock?
| What are the clinical signs?
Low blood perfusion to tissues
Low blood pressure, rapid heart rate, signs of poor organ perfusion eg low urine output, confusion, loss of consciousness
262
Give some causes of atelectasis
Pleural effusion
Blockage/narrowing of bronchial tubes (eg plug of mucous, tumour, foreign object within bronchus)
Diaphragmatic hernia -> compression of lungs
263
What types of colloids are there?
Natural: plasma, albumin
Synthetic: gelatin, dextrans, hydroxyethyl-starches
264
Give some indications for taking a chest X-ray
```
Coughing
Dyspnoea
Regurgitation
Cardiac disease
Tumour hunt
Trauma
Weight loss
Chest wall abnormalities
```
265
If the lung lobes appear separate on a chest xray, what is the diagnosis?
Pleural effusion; fluid between the lobes
266
If the following are seen on a chest X-ray, what is the diagnosis:
Retraction of lungs from thoracic margins
Collapse of lungs -> increased opacity
Elevation of cardiac silhouette from sternum
Pneumothorax (air within pleural space)
267
What is the difference between primary, predisposing and perpetuating factors with regards to a disease?
Primary: underlying cause of disease
Predisposing: factors making the disease more likely to occur in an individual
Perpetuating: factors preventing resolution of disease
268
What is the function of cerumen?
Catches foreign material, desquamated keratinocytes and microbes
Contains antimicrobial peptides and antibodies
269
What is the function of the middle ear?
Drains fluid from the middle ear and equalises air pressure either side of the tympanic membrane
270
Give the primary factors that can cause otitis in dogs and cats
```
Parasites
Allergic skin disease
Immune-mediated
Neoplasms and polyps
Foreign bodies
Rare/miscellaneous
Epithelialisation defects
Endocrinopathies
(PAIN FREE)
```
271
Give some factors that may predispose an animal to otitis externa
```
Hairy/narrow/pendulous/waxy ears
Swimming
High temp and humidity
Overzealous cleaning
Inappropriate cleaning agents
```
272
Which anti-inflammatory drugs can be used to resolve progressive pathological changes in otitis externa?
```
Not NSAIDs (poor at resolving inflammatory skin disorders)
Not cyclosporin (slow-acting)
Corticosteroids eg prednisolone; topical or systemic
```
273
What is the primary factor causing otitis in dogs and cats?
Dogs: atopic dermatitis
Cats: polyps, neoplasia
274
What can you give to an AB cat if you have no AB blood available?
Washed red cells
275
What kind of blood should be transfused to a patient with coagulopathies or hypoalbuminaemia?
Plasma
276
What kind of blood should be transfused to a patient with thrombocytopenia?
Platelet-rich plasma
277
What is the problem with stored whole blood when it comes to blood transfusions?
It has no platelets or coagulation factors
278
What is the definition of pyrexia?
An increase in temperature of 1oC or more
279
Where is the eustachian tube located?
| What does it do?
From the pharynx to the middle ear cavity
| Equalises pressure on each side of the eardrum and drains fluid from middle ear
280
Why is enteral nutrition preferred over parenteral?
Easier
Fewer complications
More economical
More physiological
281
Enterostomy tubes are indicated when?
| When are they contra-indicated?
Indicated: pancreatitis
| Contra-indicated: diffuse intestinal disease
282
Describe naso-oesophageal tube placement
Pour topical local anaesthetic solution into nostril
Measure tube from nose to 9-10th rib
Pass tube into nose in ventromedial direction (first push nose dorsally then flex head ventrally)
Secure tube with tape, suture tape to skin (tie first suture as close to nares as possible)
Elizabethan collar
283
Describe oesophagostomy tube placement
Placed in lateral neck (usually LHS)
Measure length of Carmalt forceps against neck
Insert forceps though mouth and push out laterally through the muscle, then incise the skin over it
Grab tube with forceps and pull until most of tube is pulled out of animal's mouth
Reverse the tube and push it as far down oesophagus as possible
Secure tube to skin with fingertrap pattern
284
Describe gastrotomy tube placement
Clip left side of stomach
Insert hypodermic needle into stomach and thread wire through
Grab wire with endoscope and pull up through mouth
Thread wire into tube, pull tube through mouth into stomach then through body wall
Remove wire
