MOD Exam I Material

Question 1

What must be added to replacement fluids to use them as maintenance fluids?

Answer 1

Potassium!

Keep in mind that it is not ideal to use replacement fluids as maintenance fluids

Question 2

If you have an unknown diagnosis or you don’t have any lab results for a patient that needs fluids, which fluid type should be used?

Answer 2

Crystalloid Replacement Fluid

Question 3

What type of fluid would be used in cases that need oncotic support but don’t need clotting factors? (For example: cases with low albumin (vasculitis, PLN, PLE, liver failure, sepsis, etc))

Answer 3

Colloids: hetastarch

Question 4

What size gap must a fracture be to heal by direct gap healing?

Answer 4

< 1 mm & >0.01 mm

To heal by direct gap healing, the fracture gap must be less than 1 mm&greater than 0.01 mm (If the fracture gap is less than 0.01 mm, it would heal by contact healing)

Question 5

In which zone of epiphysis will bone growth be affected?

Answer 5

Zone of Proliferation

A fracture of the zone of proliferation will heal by endochondrial ossification, and can cause premature closure of the physis. This may be seen often in fractures of young patients and can lead to angular abnormalities

Question 6

What type of graft is considered the “gold standard” of bone grafts?

Answer 6

Cancellous Autogenous Bone Graft

This is the most common bone graft in small animal veterinary medicine. It is the only bone graft that promotes osteogenesis

Question 7

Which type of bone graft is considered to be the most osteoconductive?

Answer 7

Cortical Bone Grafts

Question 8

What are the major electrolytes present in extracellular fluid (ECF)?

Answer 8

Na⁺, Cl^-, and HCO₃^-

Question 9

What are the major electrolytes present in intracellular fluid (ECF)?

Answer 9

K⁺, Mg²⁺, Phosphates, Protein

Question 10

If water loss is greater than electrolyte loss, the patient is said to have what type of dehydration?

Answer 10

Hypertonic Dehydration

Question 11

If water loss is equal to electrolyte loss, the patient is said to have* what type of dehydration*?

Answer 11

Isotonic Dehydration

Question 12

If electrolyte loss is greater than water loss, the patient is said to have what type of dehydration?

Answer 12

Hypotonic Dehydration

Question 13

In a patient with Johne’s disease, what should we expect to happen to serum Na⁺ and Cl^-?

Answer 13

serum Na⁺ and Cl^- should increase

Johne’s disease is associated with hypertonic dehydration (water loss > electrolyte loss). In this type of dehydration, water moves from ICF to ECF to maintain volume, creating an osmotic gradient. As a result, we expect the major ECF electrolytes to increase.

Question 14

Active Cl^- secretion and inhibition of active absorption of Na⁺ and Cl^- cause what kind of diarrhea?

Answer 14

Secretory diarrhea

Question 15

Which type of diarrhea is associated with steatorrhea?

Answer 15

Osmotic [malabsorptive] diarrhea

Question 16

What are the ‘classic’ fluids used in cardiac patients?

Answer 16

0.45% NaCl

The ‘classic’ fluids for a cardiac patients are 0.45% NaCl (as opposed to 0.9%) and are made isotonic through the addition of dextrose.

A lower sodium fluid is used because a high sodium load can unmask pre-clinical CHF as water follows sodium, and can result in volume overload!

Question 17

What is K_MAX?

Answer 17

K_max = 0.5 mEq/kg/hr

This is the maximum amount of potassium you can give an animal. Never give more than 0.5 mEq/kg/hr because hyperkalemia is life-threatening and can easily result in death.

Question 18

Due to obligate renal K loss, patients who are not eating will become hypokalemic within days. For this reason, K is often added to fluids.

T/F: The Sliding Scale of Scott (SSS) is used to determine how quickly potassium can be added to a patient’s fluids

Answer 18

False

The Sliding Scale of Scott (SSS) deals with the amount of K that can be added, _not_ how fast it can be added.

Question 19

What fluid rate should you use for a dog in hypovolemic shock?

Answer 19

90 mL/kg/hour

The shock rate is the same as one circulating blood volume

Question 20

What fluid rate should you use for a cat in hypovolemic shock?

Answer 20

45 mL/kg/hour

The shock rate is the same as one circulating blood volume

Question 21

Describe the proper fluid therapy for animals with head trauma or lung injuries:

Answer 21

Hypertonic saline & colloids, then crystalloids

Hypertonic saline helps draw fluid from the interstitial space and into the intravascular space, resulting in a rapid (but transient) increase in circulating volume.

Concurrent **colloid **use allows hypertonic saline to stay in the intravascular space longer.

Followed with crystalloids at a maintenance rate

Question 22

What is the name/type of blood supply associated with fractures?

Answer 22

Extraosseous blood supply

Question 23

Name the 3 phases of indirect bone healing:

Answer 23

Inflammation, Repair, Remodeling

Question 24

Which phase of indirect bone healing is the most time consuming?

Answer 24

Remodeling

This can take up to 70% of the total healing time (can last up to 6-9 years in humans)

Question 25

What is the maximum interfragmentary strain possible to allow for direct healing?

Answer 25

No more than 2%

Question 26

Which form of direct bone healing will lay down new bone in the same/longitudinal direction of the original bone?

Answer 26

Contact Healing

Gap healing, on the other hand, will first lay down perpendicular, then remodeling will occur and lay it back down in the same orientation.

Question 27

In which type of direct bone healing are bony union and remodeling separate steps?

Answer 27

Gap healing

In contact healing they occur at the same time

Question 28

Which bone fracture is more stable:

cortical bone fracture -or- cancellous bone fracture

Answer 28

cancellous bone fracture

Question 29

A fracture of which epiphyseal zone will lead to endochondrial ossification?

Answer 29

Zone of proliferation

Endochondrial ossification can cause premature closure of the physis, resulting in bone abnormalities (lack of bone growth)

Question 30

Casts and splints are associated with which type of bone healing?

Answer 30

Indirect healing

Question 31

T/F: Cerclage wires and external fixator pins greatly affect vascularization of bone

Answer 31

False

Question 32

Which two types of bone grafts can you mix to increase volume?

Answer 32

Cancellous autograft and allograft

Question 33

Which bones can be used for cortical autografts?

Answer 33

Ribs, ulna, fibula, wing of ileum

Question 34

Which type of graft will have osteoinductive properties and provide immediate mechanical support?

Answer 34

Cortical-cancellous

Question 35

Which type of diarrhea is most commonly seen clinically?

Answer 35

Hypotonic diarrhea

Question 36

What is the best test to identify increased serum D-lactate in calves presenting with ETEC diarrhea?

Answer 36

Loss of palpebral reflex

Question 37

What tube type is best used for measurement of lactate?

Answer 37

Grey top

Question 38

T/F: Handheld devices can measure levels of D-lactate

Answer 38

False

Handheld devices can measure levels of L-lactate. To measure D-lactate, a sample must be sent off to the lab

Question 39

Which of the following are reasons for using a problem oriented approach?

1. Assists in organization of information known about patient
2. Ensures that each of the problems are looked into, diagnosed and managed in the most logical way
3. Creates a systematic collection of information that is uniform across patients
4. All of the above

Answer 39

All of the above

Question 40

T/F: An allograft is bone from another individual of the same species as the patient. Allografts promote a high degree of osteogenesis in the patient.

Answer 40

False

An allograft is bone from another individual of the same species as the patient, but there is no osteogenesis with an allograft

Question 41

What does **SOAP **stand for?

Answer 41

Subjective - Objective - Assessment - Plan

Question 42

Which type of bone healing heals by callus formation?

Answer 42

Indirect bone healing

Question 43

T/F: Cancellous autographs lack osteogenic properties

Answer 43

False

Cancellous autographs have superior osteogenic properties. Cancellous allographs lack osteogenic properties

Question 44

What is the most common cause of secretory diarrhea?

Answer 44

Infection

Secretory diarrhea is usually caused by infectious agents (bacteria, viruses)

Question 45

Body weight is approximately ___% water

Answer 45

Body weight is approximately 60% water

Question 46

T/F: Extracellular space contains approximately 2/3 of the total body water

Answer 46

False

Extracellular space contains approximately 1/3 of the total body water and contains fluid that is not in the cells

Intracellular space contains 2/3 of total body water (~40% of body weight)

Question 47

A maintenance dose of fluids is the required volume needed per day to keep the patient in balance with no change in total body water.

What is the default maintenance dose of fluids?

Answer 47

40 to 60 mL/kg/day

Question 48

T/F: Maintenance fluids, such as Normosol M, are designed to replace daily Na⁺ losses without Na⁺ overload and should not be given rapidly

Answer 48

True

Question 49

What is the most frequently used replacement fluid?

Answer 49

LRS

Question 50

What is the most commonly used synthetic colloid in veterinary medicine?

Answer 50

Hetastarch

Question 51

T/F: Colloids may be used to replace dehydration deficits

Answer 51

False

Colloids are helpful to keep fluids in intravascular space, but to replace dehydration deficits, you need crystalloids to get into interstitial and intracellular spaces

By combining both colloids and crystalloids, you decrease the amount of crystalloid you have to use and restore the fluid deficit of intravascular space more rapidly

Question 52

T/F: Hypertonic saline is ideal for cases of hypovolemic shock associated with dehydration

Answer 52

False

Hypertonic saline is contraindicated in cases of dehydration or hypernatremia.

It is indicated in cases of hypovolemic shock that do not have dehydration or hypernatremia

Question 53

What is the difference between dehydration and shock?

Answer 53

**Dehydration **is fluid loss from intracellular and/or interstitial space (sometimes vascular space if severe enough)

**Hypovolemic shock **is fluid loss from vascular space resulting in inadequate oxygen delivery to tissue

Question 54

How do you calculate a dehydration deficit?

Answer 54

Fluid deficit in (liters) = % dehydrated x body weight (kg)

Example: 10% dehydrated x 10 kg = 1 liter needed

Question 55

In dehydration cases, we often replace 1/2 (or more) of the dehydration deficit within the first _____ hours

Answer 55

In dehydration cases, we often replace 1/2 (or more) of the dehydration deficit within the first 4-6 hours

Question 56

What are the ‘shock organs’ in a dog?

Answer 56

GI and liver

Question 57

When SIRS is due to infection, it is called:

Answer 57

sepsis

however, often infectious and non-infectious SIRS are indistinguishable clinically because the pathophysiology is the same with the exception of the initiating insult

Question 58

While associated with many serious diseases and trauma, the main trigger for DIC in nearly all disease states is the pathologic exposure, expression, or release of _____________

Answer 58

tissue factor

Tissue factor initiates coagulation through the extrinsic pathway of coagulation, which is then amplified by excessive thrombin generation

Question 59

T/F: Hypochloremia is always associated with a metabolic alkalosis

Answer 59

True

↓Cl^- = ↑pH

Question 60

Rhodococcus equi-induced enterocolitis in foals produces what type of diarrhea?

Answer 60

Exudative diarrhea/increased permeability

There is a loss of normal epithelial lining (tight junctions) and a subsequent ↑ permeability leading to passive loss of fluid