MOD Exam I Material Flashcards
What must be added to replacement fluids to use them as maintenance fluids?
Potassium!
Keep in mind that it is not ideal to use replacement fluids as maintenance fluids
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?
Crystalloid Replacement Fluid
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))
Colloids: hetastarch
What size gap must a fracture be to heal by direct gap healing?
< 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)
In which zone of epiphysis will bone growth be affected?
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
What type of graft is considered the “gold standard” of bone grafts?
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
Which type of bone graft is considered to be the most osteoconductive?
Cortical Bone Grafts
What are the major electrolytes present in extracellular fluid (ECF)?
Na+, Cl-, and HCO3-
What are the major electrolytes present in intracellular fluid (ECF)?
K+, Mg2+, Phosphates, Protein
If water loss is greater than electrolyte loss, the patient is said to have what type of dehydration?
Hypertonic Dehydration
If water loss is equal to electrolyte loss, the patient is said to have* what type of dehydration*?
Isotonic Dehydration
If electrolyte loss is greater than water loss, the patient is said to have what type of dehydration?
Hypotonic Dehydration
In a patient with Johne’s disease, what should we expect to happen to serum Na+ and Cl-?
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.
Active Cl- secretion and inhibition of active absorption of Na+ and Cl- cause what kind of diarrhea?
Secretory diarrhea
Which type of diarrhea is associated with steatorrhea?
Osmotic [malabsorptive] diarrhea
What are the ‘classic’ fluids used in cardiac patients?
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!
What is KMAX?
Kmax = 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.
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
False
The Sliding Scale of Scott (SSS) deals with the amount of K that can be added, _not_ how fast it can be added.
What fluid rate should you use for a dog in hypovolemic shock?
90 mL/kg/hour
The shock rate is the same as one circulating blood volume
What fluid rate should you use for a cat in hypovolemic shock?
45 mL/kg/hour
The shock rate is the same as one circulating blood volume
Describe the proper fluid therapy for animals with head trauma or lung injuries:
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
What is the name/type of blood supply associated with fractures?
Extraosseous blood supply
Name the 3 phases of indirect bone healing:
Inflammation, Repair, Remodeling
Which phase of indirect bone healing is the most time consuming?
Remodeling
This can take up to 70% of the total healing time (can last up to 6-9 years in humans)
What is the maximum interfragmentary strain possible to allow for direct healing?
No more than 2%
Which form of direct bone healing will lay down new bone in the same/longitudinal direction of the original bone?
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.
In which type of direct bone healing are bony union and remodeling separate steps?
Gap healing
In contact healing they occur at the same time
Which bone fracture is more stable:
cortical bone fracture -or- cancellous bone fracture
cancellous bone fracture
A fracture of which epiphyseal zone will lead to endochondrial ossification?
Zone of proliferation
Endochondrial ossification can cause premature closure of the physis, resulting in bone abnormalities (lack of bone growth)
Casts and splints are associated with which type of bone healing?
Indirect healing
T/F: Cerclage wires and external fixator pins greatly affect vascularization of bone
False
Which two types of bone grafts can you mix to increase volume?
Cancellous autograft and allograft
Which bones can be used for cortical autografts?
Ribs, ulna, fibula, wing of ileum
Which type of graft will have osteoinductive properties and provide immediate mechanical support?
Cortical-cancellous
Which type of diarrhea is most commonly seen clinically?
Hypotonic diarrhea
What is the best test to identify increased serum D-lactate in calves presenting with ETEC diarrhea?
Loss of palpebral reflex
What tube type is best used for measurement of lactate?
Grey top
T/F: Handheld devices can measure levels of D-lactate
False
Handheld devices can measure levels of L-lactate. To measure D-lactate, a sample must be sent off to the lab
Which of the following are reasons for using a problem oriented approach?
- Assists in organization of information known about patient
- Ensures that each of the problems are looked into, diagnosed and managed in the most logical way
- Creates a systematic collection of information that is uniform across patients
- All of the above
All of the above
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.
False
An allograft is bone from another individual of the same species as the patient, but there is no osteogenesis with an allograft
What does **SOAP **stand for?
Subjective - Objective - Assessment - Plan
Which type of bone healing heals by callus formation?
Indirect bone healing
T/F: Cancellous autographs lack osteogenic properties
False
Cancellous autographs have superior osteogenic properties. Cancellous allographs lack osteogenic properties
What is the most common cause of secretory diarrhea?
Infection
Secretory diarrhea is usually caused by infectious agents (bacteria, viruses)
Body weight is approximately ___% water
Body weight is approximately 60% water
T/F: Extracellular space contains approximately 2/3 of the total body water
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)
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?
40 to 60 mL/kg/day
T/F: Maintenance fluids, such as Normosol M, are designed to replace daily Na+ losses without Na+ overload and should not be given rapidly
True
What is the most frequently used replacement fluid?
LRS
What is the most commonly used synthetic colloid in veterinary medicine?
Hetastarch
T/F: Colloids may be used to replace dehydration deficits
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
T/F: Hypertonic saline is ideal for cases of hypovolemic shock associated with dehydration
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
What is the difference between dehydration and shock?
**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
How do you calculate a dehydration deficit?
Fluid deficit in (liters) = % dehydrated x body weight (kg)
Example: 10% dehydrated x 10 kg = 1 liter needed
In dehydration cases, we often replace 1/2 (or more) of the dehydration deficit within the first _____ hours
In dehydration cases, we often replace 1/2 (or more) of the dehydration deficit within the first 4-6 hours
What are the ‘shock organs’ in a dog?
GI and liver
When SIRS is due to infection, it is called:
sepsis
however, often infectious and non-infectious SIRS are indistinguishable clinically because the pathophysiology is the same with the exception of the initiating insult
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 _____________
tissue factor
Tissue factor initiates coagulation through the extrinsic pathway of coagulation, which is then amplified by excessive thrombin generation
T/F: Hypochloremia is always associated with a metabolic alkalosis
True
↓Cl- = ↑pH
Rhodococcus equi-induced enterocolitis in foals produces what type of diarrhea?
Exudative diarrhea/increased permeability
There is a loss of normal epithelial lining (tight junctions) and a subsequent ↑ permeability leading to passive loss of fluid
