Pre-midterm Flashcards
why take a history?
- part of examination
- establish relationship
- information
- avoid mistakes
- client expectation
- practice building
what are problems with history taking?
- completeness
- bias
- inexperience/misinterpretation
- guilt
- fear
- ownership issues
- management differences
- owner diagnosis
- owner treatment
- language
- herd problem?
- definition of disease
what are special physical examination cases (LA)
- prepurchase
- breeding soundness
- foal health check
- health certificate
- insurance exams
- export paper
what should be assessed on distance exam? (11)`
- attitude
- physical condition
- general body shape
- conformation
- hair coat
- stance
- posture
- environment
- resp rate
- evidence of defecation/urination
- behavior
what is the normal temp of a horse?
37.5-38.5
what is the normal temp of cow
38-39
What is the normal pulse of a horse
28-44
What is the normal pulse of a horse
28-44
What is the normal pulse of a cow?
60-80
What is the normal resp rate of a horse?
8-16
what is the normal resp rate of a cow?
10-30
What is Q, R and S in an ECG?
Q is depolarization of septum, R is deplarization of wall and S is depolarization of upper areas
What is Q, R and S in an ECG?
Q is depolarization of septum, R is depolarization of wall and S is depolarization of upper areas
What is pimobendan?
a postiive inotrope and a vasodilator
what are the main determinants of blood pressure?
CO and systemic vascular resistance
what are two diseases that can increase blood pressure?
- cushings (increased sensitivity to adrenergic hormones so vasoconstriction)
- hyperthyroidism (increased CO)
what is heart failure/cardiac insufficiency?
when the heart cannot meet the demands of the body
what is forward heart failure common in
dilated cardiomyopathy, sometimes in chronic heart failure
What are the signs of forward heart failure
- pulse poor
- hypothermic
- weak
4, hypotensive - prolonged CRT
6 may have syncope - progression to cardiogenic shock
what is the most common congestive heart failure?
left
what are the clinical signs of left sided congestive heart failure?
left atrial enlargement and pulmonary edema
What are the signs of right sided congestive heart failure?
- pleural effusion (cat)
2. ascites (dog)
What are three mechanisms of compensation in cardiovascular physiology?
- frank-starling mechanism
- ventricular hypertrophy
- neurohemoral mechanism
What is the RAAS sstem
Renin is released from the kidney and converts angiotensinogen to angiotensin I, that is converted by ACT to ATII. ATII causes aldosterone release, increased thirst, increased GFR, myocardial hypertrophy, vasoconstriction
What is the RAAS sstem
Renin is released from the kidney and converts angiotensinogen to angiotensin I, that is converted by ACT to ATII. ATII causes aldosterone release, increased thirst, increased GFR, myocardial hypertrophy, vasoconstriction
What are 4 neurohumoral mechanisms that work in compensation (heart)
- RAAS
- adrenergic nervous system
- ADH
- atrial naturetic peptide
Combatting what prolongs lifespan?
neurohumoral activation
what is spironolactone?
aldosterone antagonist
What does the adrenergic nervous system do to the heart?
increase HR, contactility, afterload (vasoconstriction), oxygen demand
What are three examples of diastolic dysfunction? Why is it an issue?
- hypertrophic cardiomyopathy, restrictive cardiomyopathy
- pericardial disease
- tachycardias
What is an issue with pimobendan?
only oral
What is an issue with pimobendan?
only oral
why is important to be thorough with a physical exam? (heart)
There may be something compromizing the ability to treat the heart (renal dz) or something may mimic cardio dz (resp dz)
Why can there be cachexia with heart disease?
underperfusion of the intestines can result in endotoxin, bacteremia, inflammation)–TNF alpha production–cachexia (omega 3 decreases TNF alpha and cachexia)
what on retinal exam can indicates cardio dz?
retinal detachment or hemorrhage (hypertension)
What can change apex beat?
- heart shift
- reduced with effusion
- pneumothorax
- obesity
- DCM
what is a pulse deficit?
a heart beat that was not accompanied by a pulse (premature beat or pulse wave not big)
what are physiologic murmurs?
anemia, athletes, young animals
What can only the ECG diagnose?
- rhythm/conduction defects
- adverse effects of anesthesia on impulse generation, conduction
- drug monitoring for drugs that influence rhythm, conduction
What can ECG HELP detect?
- cardiomegaly
- emergency test for hyperkalemia
- helpful for pericardial effusion–aspiration
What can the ECG not do
- give definitive diagnosis of heart size
- determine mechanical strength of contraction
- determine if congestive heart failure is present
what position is ECG done in?
right lateral recumbancy
what position is ECG done in?
right lateral recumbancy
what is nitroglycerin?
venodilator. blod to abdomen rather than lungs. good for emergency
What drugs decrease preload?
furosemide, spironolactone, thiazides, ACE inhibitors, nitroglycerin
what drugs reduce afterload and improve CO?
ACE inhibitors (decrease ATII so less vasoconstriction)–may negatively affect GFR
hydralazine–arterial dilator
amlodipine: calcium channel blocker used for hypertension in cat
what drugs can improve contractility?
dobutamine (CRI only)
dopamine cheaper, can cause arrhythmias, vasoconstriction
pimovendan–inodilateor (positive inotrope and dilation)
when does cyanosis occur?
when hemoglobin
what is stridor?
abnormal sound that can hear without stethoscope, usually URT
what is a horse resp rate?
12-20
what is a cow resp rate?
26-50
what is a dog resp rate?
18-34
what is a cat resp rate
16-40
what is a cat resp rate
16-40
what is the normal ratio of inspiration to expiration?
1.0:1.2
which is louder, inspiratory or edxpiratory sound?
inspiratory (if reversed dealing with resp dz)
what are vesicular sounds from?
segmental bronchi
what are vesicular sounds from?
segmental bronchi
what are crackles?
collapsed airwaas snapping open, esp end expiratory
what are wheezes
longer musical sounds due to vibration of airway walls before closing (expiration), usually due to bronchoconstriction
what occurs with upper resp tract disease?
inpiratory dyspnea and noisy inspiration heard from distance away
what occurs with lower resp tract dz?
expiratory dysnpean and noise best heard with stethoscope
what is a nasal swab for?
URT-bacterial/viral infection
what is nasal lavage for?
culture, immunoglobulins, foreign body, parasitic ova
what is tracheal lavage for?
–best one for pneumonia
for bacteria and cytology
what are the two types of tracheal lavage?
transtracheal wash, transendoscopic sampling
what is bronchoalveolar lavage used for?
- RAO, IAD, EIPH
a go
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a good bronchoalveolar lavage sample is what?
foamy because of surfactant
what is bronchoalveolar lavage not good for?
focal disease like neoplasia or pneumonia
what is the technique of choice for studying pleural space and pleural surface?
ultrasonography
where do you go for pleurocentesis/thoracocentesis
6-7 intercostal space, 10cm dorsal to olecanon, cranial border of rib
what are thoracocentesis samples submitted for?
- cytology
- bacterial culture
- sensitivity
What should you submit with a thoracocentesis sample?
TW sample to see if there is a common association with pleuritis and parenchymal disease
what should you submit pleural fluid in?
EDTA for cell count and protein determination
what serology samples should be submitted?
2 sampless 10-14 days apart
how should a bacteriology sample be submitted?
sterile culture swab on ice and get fast. have appropriate transport media for aerobic, anerobic
what should be collected for virology?
swabs early in disease during days 1-3 of pyrexia–nasopharyngeal swab good. DON’T freeze
What should be sent for blood gas?
only arterial
What is PaO2 an indicator of? what is PaCO2 an indicator of?
- gas exchange
2. ventilation
what can cause hypoxia?
ventilation perfusion mismatch
diffusion impairment
shunts
hypoventilation
what can cause hypoxia?
ventilation perfusion mismatch
diffusion impairment
shunts
hypoventilation
4 factors of pulmonary edema
endothelial permeability
alveolar epithelial permeability
hydrostatic pressure
colloid osmotic pressure
what is classic finding of pneumothorax?
pleura not moving–static
laryngeal paresis/paralysis causes what?
- inspiratory dyspnea
- exercise intolerance
- roaring
what is treatment for laryngeal paresis/paralysis?
prosthetic laryngoplasty
what does dorsal displacement of soft palate cause?
stridor-noise during exhalation
what is metoclopramide?
antiemetic (dopamine antagonist) and stimulates GI motility
what are phenothiazines, maropitant, metoclopramide?
antiemetics
what should use of gi protectants be restricted to?
pateints with ulers, potential for ulcer (although more use omeprazole)
what coudl you give dog with esophageitis?
sulcralfate
what is misoprostol?
synthetic prostaglandin
