Misc Flashcards
3 phases of cardiac ischaemia
Electrical phase, circulatory phase, metabolic phase
What is the starting dose for a biphasic defibrillator and what is the maximum dose?
Start 2-4J/Kg
Maximum dose 10J/Kg
What 3 parts make up Virchow’s triad?
Altered blood flow
Endothelial damage
Hypercoagulability
What is the ratio to diagnose Chylothorax
Fluid >3:1 x blood triglycerides
> or equal to 100mg/dL
What troponin value make haemangiosarcoma more like!?
Check Chun 0.25ng/ml?
Name endogenous pyrogens involved in pyrexia?
Cachectin (TNF-alpha)
Lymphotoxin (TNF-beta)
IL-1alpha
IL-1 beta
Interferon alpha
Interferon beta
Interferon gamma
IL-6
Macrophage inflammatory protein 1 alpha
Macrophage inflammatory protein 1 beta
IL-8
Benefits of high flow nasal O2 as per SACCM 2023
Heated and humidified
Inspiratory flows demands
Functional reserve capacity
Lighter
Oxygen
Washout dead space
As per SACCM what are the recommended initial high flow nasal oxygen settings
Flow rate = patients minute volume= respiratory rate x tidal volume (10-15ml/kg)
Fi02 = 100%
Temperature= 32-37 degrees Celsius
Name the categorises of necrotising soft tissue infections
Type 1- polymicrobial
• mixed anaerobes and aerobes
• usually isolate four or more organisms
Type 2 - monomicrobial
• commonly beta-haemolytic streptococcus
Type 3- gram neg monomicrobials
• clostridia infections
• included marine organisms
Type IV- fungal
• Candida infections
What does snap 4dx plus snap test for?
Dirofilaria immitis
Ehrlichia canis
Ehrlichia ewingii
Ehrlichia Chaffeensis
Anaplasma phagocytophilum
Anaplasma platys
Borrelia burgdorferi
What receptor is involved with anaphylaxis?
FC epsilon R1
Transmembrane with alpha, beta and gamma subunits
What type of reaction is anaphylaxis?
Type 1 hypersensitivity reaction involving IgE, mast cells, basophils
What type of reaction is serum sickness?
Delayed reaction Type III hypersensitivity reaction
What May cause a high anion gap metabolic acidosis?
HAGMA
DUEL
D= diabetes
U= uremic
E= ethylene glycol
L= lactate
S= salicylates
What May cause a normal anion gap metabolic acidosis
NAGMA
A=Addisons
B= bicarbonate loss (GI or renal)
C= chloride excess
D= Diuretics (acetazolomide)
Anion gap equation
(Na+ K)- (bicarbonate + chloride)
What are the 5 phases of AKI?
5 phases
Insult
Initiation
Extension
Maintenance
Recovery
Half life of synthetic canabinoids
72-96 hours
Name the methods of heat loss
Convection
Conduction
Radiation
Evaporation
What type of hypersensitivity reaction is anaphylaxis?
Type I and IgE predominates
Name the 3 forms of dyshemoglobin
Methemoglobin
Carboxyhemoglobin
Sulfhemoglobin
How many sulfhydrl groups do cats have on their red blood cells and when damaged what do you see on cytology
8
This is why more likely to have oxidative damage and form Heinz bodies ( a few normal in cats)
What is the normal level of methemoglobin in the blood
<3%
Name three ways paracetamol/acetaminophen is metabolised
Glucuronidation (dogs)
Sulfation (cats)
Or
Oxidation by CYP2E1 and CYP1A2 to NAPQI which is toxic
What enzyme(s) is thiamine a cofactor for?
Pyruvate dehydrogenase
Alpha ketoglutarate dehydrogenase
Transkeletase
What does bradykinin cause and which enzyme breaks it down
Causes hypotension
Angiotensin converting enzyme (ACE)
Hypertension classification and TOD risk
Normal <140mmHg
Minimal risk of TOD
Prehypertensive 140-159mmHg
Low risk of TOD
Hypertensive 160-179mmHg
Moderate TOD risk
Severely hypertensive > or equal to 180mmHg
High risk of TOD
Which organs are at risk of TOD
Eyes
Kidneys
Brain
Heart
Define sepsis
Life-threatening organ dysfunction cause by dysregulated host response to infection
How many plasma volumes would be needed of TPE?
1-1.5 plasma volumes
Name some adverse reactions from TPE
Hypocalcaemia
Plasma reactions
Alkalosis secondary to citrate
AKI because of colloids
Blood loss because of circuit
Hypoproteinaemia
Haemorrhage
In humans what categories are there for TPE to help guide tx?
Category 1 -1st line (myasthenia gravis)
Category 2-2nd line tx (IMHA)
Category 3- limited trials (IMTP and sepsis)
Category 4- ineffective or harmful
For what toxins does TPE work best for?
Small volume of distribution and intravascular (<1L/kg)
E.g NSAIDs as highly protein bound
Sodium concentration in hartmanns
130mmol/L
Fractional excretion of Sodium
Urine sodium x serum creatinine divided by urine creatinine x serum sodium
Name 4 factors that determine diffusion rate (Ficks law) of a substance from blood to interstitium
Gradient concentration
Surface area for exchange
Diffusion distance
Permeability of capillary wall to the diffusing substance
Name 4 functions of the endothelial cell
- Enzymatic conversion of circulating hormones
- Production of substances that lead to blood clot formation
- Key roles in abiogenesis and remodelling of vasculature
- Production of vasoactive substances
What does an inotrope do?
Increases strength of heart beat
What does a chronotropic drug do?
Increases heart rate
What does a dromotropic drug do?
Increases speed of conduction
What would a high peak pressure mean?
Airway issue/resistance
E.g
ET tube blockage
Retained secretions
Mucous plug
What does a high plateau pressure mean?
Compliance issue
Pneumothorax
ARDS
What defines a massive transfusion?
Transfusion of Blood products totalling estimated blood volume in 24 hours
50% of blood volume in 3-4 hours
Admin 1.5ml/kg/min for 20mins
Cholinergic crisis signs
SLUDGE
MUDDLES
Salivation, lacrimation, urination, defecation, GI motility, emesis, miosis
Excess of acetylcholine
Drug side effect or toxin with organophosphate?
Naloxone
1. MOA
2. length of action
- Binds with great affinity to mu, kappa, delta opioid receptors, competitively displacing agonists with lesser affinity and so reversing actions of agonist agents
- Short acting whereas nalmefene and naltrexone are longer acting
What are the diagnostic criteria of syndrome of inappropriate anti diuretic hormone secretion
- Hypoosmolar hyponatremia
- Euvolemia
- Inappropriate concentrated urine-urine osmolarity >100mOsm/L
- Urine sodium concentration>30mmol/L
- Hypoadrenocorticism excluded
What are risk factors for acute pancreatitis increased morbidity and mortality
Older age, obesity, hypertriglyceridemia, biliary reflux, drug reactions, pancreatic trauma, recent Sx, concurrent endocrinopathies dogs, current GI dz and/or cholestatic disease
Pathophysiology of pancreatitis
Premature activation of proteases within pancreatic acinar cells
Abnormal fusion of lysosomes and zymogen granules leads to premature activation of trypsinogen to trypsin
Local cascade from trypsin activating other pro enzymes
Pancreatic secretory trypsin inhibitor overwhelmed
What two major enzymatic reactions are cobalamin needed for
Methionine synthase
Methylmalonyl-CoA-mutase
