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Medical Nursing And. Anaesthesia > Medicine > Flashcards

Medicine Flashcards

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1
Q

What are the two main causes of regenerative anaemia ?

A

Blood loss (haemorrhage) and haemolysis

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2
Q

Why are feline reticulocytes different to canine reticulocytes? Why is this relevant to diagnosing anaemia?

A

Maturation is different, cats have both Aggregate and Punctate reticulocytes. Dogs just have aggregate, no further maturation to Punctate.
Fining Punctate reticulocytes is not indicative of anaemia, common in healthy cats. Finding aggregate reticulocytes in cats is far more indicative of anaemia.

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3
Q

What is the range of PCV values that cover mild to severe anaemia in cats and dogs?

A 
Cats = 24-10%
Dogs = 37-13%
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4
Q

Which clinical sign of anaemia is most difficult to spot in a cat compared to a dog?

A

Lethargy, weakness and exercise intolerance, as they are not walked.

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5
Q

How would PMR be altered in an anaemic patient?

A 
Pulse = increased (compensate for reduced RBCs) and hyper dynamic. 
MM = pale, white pale is most indicative as some cats have pale pink membranes naturally 
RR= increased to ventilate lungs faster, more oxygen

Extra = murmurs in the heart on auscultation. Less viscous blood, more turbulence in the heart.

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6
Q

How would anaemia be investigated if suspected?

A 
Physical examination (PMR) 
Haematology (PCV, MCV, Reticulocyte count, Blood smear (looking for evidence of regeneration to determine type))
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7
Q

Doxycycline is given to cats with FIA, why must it be followed with food? What kind of drug is it?

A

Very acidic tablet, can cause inflammation and oesophageal stricture if not followed by food. It’s an antibiotic

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8
Q

How does neonatal isoerythrolysis occur in cats?

A

Queen with type B blood giving birth to kittens with type A blood. Type A has ineffective antibodies to B, type B has very efficacious antibodies to A. Colostrum contains effective antibodies to kittens type A RBCs. Intravascular haemolysis.

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9
Q

What is a Primary haemostatic platelet plug?

A

An aggregate of platelets, connected by von willebrands factors, that plugs a hole in the vessel wall upon injury.

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10
Q

Define Primary Haemostasis

A

The reflex contraction of a blood vessel following injury, and the formation of the platelet plug.

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11
Q

Which breed of dog most commonly presents with Von Willebrand’s disease ?

A

Dobermans

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12
Q

What is cholestasis? How would it contribute to a bleeding disorder?

A

Obstruction of the bile duct, vitamin K deficiency. Just like rodenticide poisoning, clotting factors in the liver cannot be produced and so Haemostasis is dysfunctional.

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13
Q

Describe the differences in clinical signs between primary and secondary bleeding disorders

A

Primary: petechial bleeds (small), ecchymotic bleeds (large), prolonged bleeding on venepuncture, surface bleeding, prolonged bleeding from cuts, multiple sights
Secondary: deep cavity bleeds, haematomas, venepuncture ok, localised site of bleeding, delayed/re bleeding from cuts (starts to slow and clot, but then bleeds again)

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14
Q

What does an activated clotting time test in terms of clotting pathways? Can it be conducted in house?

A

Intrinsic and common pathways. Can be completed in house

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15
Q

Why would a Prothrombin Time (PT) be more effective than an Activated Partial Thromboplastin Time (APTT), at assessing if rodenticide has left the body?

A

Factor VII is vitamin K dependent clotting factor and has the shortest half life of all vitamin K dependent clotting factors. If rodenticide has gone, testing the extrinsic pathway (where factor VII works), will be the most sensitive. PT will be prolonged if factor VII is absent. Therefore, testing PT (and the extrinsic pathway) will prove the return of the factors sooner than a APTT (as this tests the intrinsic pathway)

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16
Q

How many platelets per high power field is considered normal when assessing a blood smear for thrombocytopenia ?

A

11-25 platelets

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17
Q

Which clotting factor is absent in patients with haemophilia A?

A

VIII

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18
Q

What is associated with RBCs that are hypochromic and microcytic ? What do these terms describe?

A

Hypochromic, pale. Microcytic, small. Associated with iron deficiency

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19
Q

What is hydronephrosis ? What would it be a result of?

A

Water retention in the kidneys, distending renal pelvis and calcyes. As a result of blocked ureta or urethra.

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20
Q

At which value of a patients urine specific gravity would indicate chronic renal insufficiency, in the presence of azotaemia ?

A

Dogs SG < 1.035

Cats SG < 1.045

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21
Q

Name 5 qualities of a diet designed for patients with CKD

A

Low in phosphorus, sodium, protein. High in energy (fat), palatable. Omega 3 PUFAs. Increased potassium and B vitamins. Increased ferment able fibre.

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22
Q

What are the 4 treatment goals of a patient with CKD?

A

Treat underlying disease, correct and maintain fluid balance, manage clinical signs and complications, delay progression of CKD (situations that could cause lasting damage)

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23
Q

Name the 10 clinical signs and complication that must be managed for a patient with CKD

A

Food, vomiting and nausea, inppetance anorexia, constipation, hyperphosphataemia, systemic hypertension, UTIs, Anaemia, secondary hyperparathyroidism, proteinuria

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24
Q

Why does CKD cause secondary hyperparathyroidism?

A

Increased phosphorus leads to increased parathyroid hormone being produced. This would normally increase phosphorus excretion, but in patients with CKD this does not happen due to insufficient no of functional nephrons. Phosphorus binds to calcium in the body, removing ca2+ from circulation. To compensate for decreased ca2+, bone is resorbed to release ca2+. Negative cycle, more PTH released. Treat by managing renal dx.

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25
Q

Discuss the advantages and disadvantages of a fibre optic endoscope (fibre optic image)

A 
Advs= portable, cheaper than video, wide range of sizes, satisfactory image 
Dis= honeycomb image, fragile, requires separate camera for video, difficult to rotate, smaller scopes have worse resolution.
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26
Q

Discuss the advantages and disadvantages of a video-image scope?

A

Adv=excellent image, integrated video cycling via chip in end, eyepiece so vet away from patient, easier to rotate.

Dis = more expensive, not portable, smaller diameters not available

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27
Q

How would you distinguish between non-repeatable and repeatable episodes of dietary sensitivity?

A

Non-repeatable are due to one off situations that can’t be replicated. Eg scavenging or food poisoning.

Repeatable is a food intolerance or a food allergy. Same reaction reliably after consumption.

28
Q

What is the difference between a food intolerance and a food allergy?

A

Food intolerance has no immunological component. Caused by individuals own flora, enzyme activity, intestinal permeability, mast cell stability, genetic susceptibility. Present first time animal eats food, dose dependant (little may be ok), avoidance of antigenically similar foods is unnecessary,

Food allergy has an immunological component. Animal needs to be sensitised so will not be first time animal eats food. Related antigenic foods cannot be eaten.

29
Q

How would a food allergy be diagnosed?

A

Diet trial is the only reliable method. Exclusion phase, challenge phase, rescue and provocation phase, maintenance diets

30
Q

Describe the stages of a diet trial, to diagnose and treat a food allergy

A

Exclusion: relieve animal of symptoms by feeding novel diet or hydrolysed diet. 3 weeks minimum
Challenge phase: original diet reintroduced for 2 weeks.
Rescue and provocation phase: exclusion diet to rescue patient from clinical symptoms. 25% replaced with protein, see if relapse occurs, if it does then rescue with exclusion diet. Should build list of ok foodstuffs
Maintenance diet: exclusion diet if owners refuse to re-challenge, or combo of ok foods found in provocation phase

31
Q

How is inflammatory bowel disease (IBD) diagnosed ?

A

Biopsy (won’t tell you cause of inflammation, just type of inflammation and severity)

32
Q

What are the clinical signs of IBD? How would you know it is this causing the symptoms, and not other GI conditions?

A

Vomiting, Haemetemesis, SI D+ (large volume, watery, melaena), LI D+ (mucoid, haematechezia, increased frequency, tenesmus), a do discomfort and pain, borborygmi, flatus, weight loss(SI), altered appetite, hypoproteinaemia (protein lost at broken intestinal barrier, fluid follows as reduced colloid osmotic pressure, leads to ascites).

Non-descript symptoms, therefore other causes must be eliminated before IBD diagnosed.

33
Q

Why would a folate and cobalamin be sent off for a patient with suspected inflammation of the bowels? What are these b vitamins used for?

A

Cobalamin is B12, and is used in conjunction with Folate (B9) to make RBCs and contribute to immune function. B12 needed to produce RNA, DNA.
Folate is absorbed in small intestine, cobalamin absorbed in large intestine, sending these off for analysis can tell you what part of the gut is inflamed.

34
Q

What is the primary course of treatment for IBD, ideally?

A

Ideally diet trial on a strict exclusion diet (highly digestible, restricted fat, hydrolysed as intestine inflamed?). If animal too sick however, steroids (usually pred) will be used as well to stimulate appetite and reduce inflammation

35
Q

Name the four categories of drug that can be used to help treat a patient with IBD

A

Corticosteroids, Azathioprine (steroid sparing, used with steroids, cytotoxic), cyclosporine, 5-ASA derivatives (only for colitis).

36
Q

Define tumour, cancer, neoplasia and benign.

A

Tumour: a swelling
Cancer: malignant tumour
Neoplasia: new growth
Benign: neoplasm that forms a solid cohesive tumour and does not metastasise

37
Q

Describe these types of cancer in terms of tissue origin and benign /Malignant.
A) fibrosarcoma
B)lymphoma
C) osteoma

A

Fibrous tissue, malignant
lymph, malignant
Bone, benign

38
Q

When would a benign tumour be life threatening?

A

If it was in a location that disrupted normal physiology. Eg brain tumour

39
Q

Why are replication inhibiting drugs not very efficacious in the majority of tumour?

A

Curve of replication, by the time the tumour is detectable the rate of proliferation is so much reduced that the time where the tumour is most susceptible to treatment has passed.

40
Q

What are the four aspects of cancer diagnosis that will dictate the prognosis of the patient?

A

Metastatic ability, tumour grade (mitotic rate, cellular and nuclear characteristics), paraneoplastic effects, hyperhistaminaemia,

41
Q

Discuss the haematological complications that arise with cancers.

A

Neoplastic infiltration of the bone marrow (non-regenerative anaemia).
Sertoli and granulosa tumours (testes) produce oestrogen which is toxic to the bone marrow (non-regen),
blood loss at tumour site,
blood loss as a result of products of tumour cells eg mast cell tumours releasing histamine (gastric ulcers, blood loss),
destruction of RBCs (2ndary immune mediated haemolytic anaemia, antibodies cross linking to RBCs, microscopic destruction by passing through necrotic tumours, sheering of RBCs [schistocytes])

42
Q

How could you prepare for a surgical patient having treatment for a mast cell tumour?

A

Pre-med with H1 antagonist, reduce chance of anaphylactic shock.
H2 antagonists in the run up to prevent formation of gastric ulcers
Clotting aids? Heparin produced by mast cells.

43
Q

How is cancer diagnosed ? How are they graded ?

A

Histological diagnosis from FNA or biopsy. TNM system. Tumour (T0-4), Nodes (N0-4), Metastasis (M0-2)

44
Q

What are the aims 3 of cancer treatment, depending on the patients grading?

A

Cure (all cancerous cells gone), Remission (all clinical evidence gone but some cancerous cells remain and may grow another tumour), Palliation (cannot achieve remission or cure, make QoL as good as possible in meantime, improve wellbeing and physiological function of the animal)

45
Q

How can cancer be treated?

A

Surgical excision, radiation, cytotoxic drugs (combination of them)

46
Q

What is the normal HR ranges for dogs, cats and horses?

A

Dogs- 60-180
Cats - 110-180
Horses - 32-44

47
Q

What is the normal blood pressure ranges for dogs and cats ?

A

Systolic : 90-120mmHg
Diastolic: 55-90mmHg
Mean: 60-85mmHg

48
Q

List the 20 aspects of patient care incorporated by ‘The Rule of 20’

A

1)Fluid balance, 2) oncotic pull, 3) glucose, 4)electrolytes and acid base, 5)oxygenation and ventilation, 6) level of consciousness and mentation, 7) blood pressure,,8) heart rate rhythm and contractibility, 9) temperature, 10) coagulation, 11) RBCs, 12) renal function, 13) immune status AB choice WBC count, 14) GI motility, 15)drug doses and metabolism, 16) nutrition, 17) pain control, 18) patient mobilisation and nursing care, 19) wound care, 20) TLC.

49
Q

Cite the two equations for working out RER. Why would you not use one of them over the other?

A

(30 x BW) + 70

70 (BW) ^0.75

Linear one can only be used for patients who are between 2-30kgs. Non-linear is more accurate.

50
Q

What is the name of the graph used in Quality Control to plot control samples daily, so as to know if results from patient samples can be deemed reliable

A

Levy-Jennings graph

51
Q

List three cytological indications of malignant neoplasia, from a smear.

A

Large cells, haphazard arrangement of layered cells, cells in the wrong location, variation in cell size, loss of cellular cohesion

52
Q

What is a normal result from a schirmer tear test?

A

15-25mm over 1 minute

53
Q

What might be the cause of gradually increasing ETCO2, whilst returning to baseline between breaths.

A

Respiratory: hypoventilation
Physiological: increased cardiac output, increased production of CO2 by increased metabolism or increased temperature.

54
Q

Give an example of a mineralocorticoid and a glucocorticoid. Where are they produced?

A

Glucocorticoid: cortisol
Mineralocorticoids: aldosterone
Both produced in the adrenal cortex

55
Q

What is the difference between a low dose dexamethasone suppression test and an ACTH stim?

A

Low dose dex puts glucocorticoids into circulation. ACTH should reduce.

ACTH stim puts ACTH into circulation. Cortisol examined before and after inj.

56
Q

What kind of ocular discharge is epiphoric?

A

Excessive watering

57
Q

What is the word given to pupils of different sizes?

A

Anisocoria

58
Q

What properties must a topical drop have to penetrate the cornea ?

A

Lipophilic, hydrophilic

59
Q

Describe the properties a solution drop has, compared with an ointment drop for eyes

A

Solutions are more aqueous, less irritant, need to be applied more frequently, quick elimination.
Ointments are longer lasting, reducing frequency,

60
Q

Name 5 common conditions of the eye

A

Oversized eyelids, globe proptosis, exophthalmos, enophthalmos, ectropian, entropian, conjunctivitis, ocular discharge, strabismus, cataract, corneal colour change, macropalpebral fissure, blephrospasm, blood in anterior chamber.

61
Q

When cats get very stressed they can be hyperglycaemic. What test would distinguish high glucose usually (e.g. Diabetes) from stress high glucose?

A

Fructosamine

62
Q

List 5 causes of haemolytic anaemia

A 
FeLV infection 
Feline infectious anaemia (haemoplasma infection) 
1st degree (not common) 2nd degree immune mediated haemolytic anaemia (to infection/neoplasia) 
Heinz body anaemia 
Severe hypophosphataemia 
Incompatible blood transfusions 
Neonatal erythrolysis 
Inherited defects in some breeds
63
Q

Name the two mycoplasmas responsible for causing feline infectious anaemia

A

Mycoplasma haemofelis

Candidatus mycoplasma haemominutum

64
Q

Describe the pathophysiolofy of Heinz body anaemias

A

Irreversibly denatured oxidised Hb. High numbers seen in patients with issues relating to oxidative damage (onion toxicity, lymphoma, paracetamol toxicity, diabetic ketoacidosis). These RBCs are destroyed prematurely causing haemolytic anaemia.

65
Q

List 7 systemic disorders that cause non-regenerative anaemia

A

Neoplasia,FeLV, FIV, bacterial infection, chronic kidney disease and chronic inflammation

Medical Nursing And. Anaesthesia (2 decks)

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