prep for clinical practice spot exam Flashcards

Question 1

Q

Total body water =

Answer

A

2/3 body weight

Question 2

Q

Aims of fluid therapy

Answer

A

Maintenance of normal physiology – e.g. during anaesthesia
Improvement of organ function e.g. kidney, heart, liver
The correction of electrolyte disturbances
The correction of hypovolaemia
The correction of acid base disturbances
(Total parenteral nutrition (TPN) - usually partial parenteral nutrition (PPN) used in animals)

Question 3

Q

what is the fluid defecit of a patient with tacky muscous membranes

Question 4

Q

what is the fluid defecit of a patient with skin tenting and shrunked eyes

Question 5

Q

what is the fluid defecit of a patient with increased pulse rate and colde peripheries

Question 6

Q

what is the fluid defecit of a patient with weak pulses

Question 7

Q

what is the fluid defecit of a patient with collapse

Question 8

Q

What is the daily maintenance rate for an animal?

Answer

A

≈2.5ml/kg/hour
≈60ml/kg/day
{Or (30 x Kg) + 70 ???}

Question 9

Q

Types of fluid

Answer

A

Crystalloids (hypotonic, isotonic, hypertonic)

Colloids

Blood products
HBOCS (hemoglobin-based oxygen carrying solutions) –££ & problems….

Question 10

Q

Crystalloids- Isotonic-Lactated Ringer’s solution (LRS) aka Hartmann’s

Answer

A

If in doubt, choose Hartmann’s!

Inadequate potassium for long term therapy
Good for shock, diuresis, during anesthesia & can use for maintenance (can add other things to it)

Only 25% remains in vascular space after 12 minutes

Na+ 130 mEq/l , Cl– 109mEq/l
Buffered, contains lactate as a bicarbonate precursor

Question 11

Q

Crystalloids- Hypotonic

Answer

A

0.18% NaCl
0.18% NaCl + 5% glucose

Do you really want to use this ???

Hypotonic losses occur when the type of fluid being lost has a higher concentration of water than plasma, such as with diabetes insipidus and panting.

Hypotonic crystalloids are useful for treating patients with hypotonic fluid losses that result in hypernatremia or patients that have renal disease and cannot excrete the salt load of balanced isotonic solution

Question 12

Q

Crystalloids- Hypertonic saline

Answer

A

Draws water from interstitial space
Transient effect (10-15 mins)
Rapid restoration of MAP, increased myocardial contractility, CO & oxygen delivery
2ml/kg over 10 min, can repeat once but must follow with isotonic fluids
More commonly used in large animals (e.g. prior to colic surgery) but can be used in dogs and cats (carefully)
Also used in severe life-threatening raised ICP

used during resuscitation in hypovolemic shock and to decrease intracranial pressure.

Question 13

Q

colloids

Answer

A

Colloid solutions contain large molecules (>10,000 Da) and tend to remain in the intravascular space longer than crystalloids

Support circulating blood volume
e.g. severe hypovolaemia, haemorrhage, hypoproteinaemia

Exert a colloid osmotic pressure
More rapid initial re-expansion of volume
Only 1/4 of crystalloid administered remains in circulation in 40 mins

Support circulation longer than crystalloids
Types

HES solutions are thought to be most effective in treating hypovolemia because the colloid should theoretically remain in the intravascular space

includes-
artificial -gelatins, dextrans, starches, HBOCs
Oxypolygelatin
Dextran 40
Pentastarch
Hetastarch
Albumin
Whole blood
Plasma

artificial -gelatins, dextrans, starches, HBOCs
natural colloids e.g. albumin, plasma

However, no evidence of clinical superiority
over crystalloids

Question 14

Q

Colloids – Gelatins (ntk)

Answer

A

Oxypolygelatins
Plasma half life 2-4 hours (manufacturer data)
Weight average 30,000 D -pulls an equivalent volume of water from interstitial space
No need for concurrent crystalloid but often do give both
Produces osmotic diuresis
No direct coagulation effects
15 ml/kg total

Question 15

Q

Colloids – starches (ntk)

Answer

A

Plasma half life 25 hours (hetastarch) - due to molar substitution
Initial elimination by tissue uptake
Excretion by metabolism - serum amylase rises
Volume expanded by volume given
Reversal of microvascular permeability
?anti inflammatory effect ?
Direct coagulation effects
Increased APT in dogs (factor VIII precipitation)
Anaphylaxis in 0.0005-0.085% human patients
Nausea and vomiting in cats - slow administration
Up to 40 ml/kg/day

Question 16

Q

blood products

Answer

A

Natural’ colloids
Chosen according to clinical requirement
Whole blood
pRBCs
Ffp
Cryoprecipitate

Match the fluid to the loss

Question 17

Q

Oxyglobin Solution

Answer

A

Oxyglobin is a solution for infusion (drip into a vein). What is Oxyglobin used for? Oxyglobin is used to increase the oxygen content of the blood in dogs with anaemia (low red-blood-cell count). Oxyglobin should be used for at least 24 hours.

0 ml per kilogram body weight, administered at a rate of up to 10 ml/kg per hour. The most appropriate dose depends on the severity of the anaemia and how long the dog has been anaemic, as well as the desired duration of the medicine’s effect. Oxyglobin is intended for a single use only. Oxyglobin does not need to be matched to the dog’s blood type

Question 18

Q

Intravenous access for fluid therapy

Answer

A

Commonest route used
Relatively simple to master
Consider the different veins that can be used e.g. cephalic, saphenous, jugular, auricular, lateral thoracic
Select large bore cannula (flow α r 4)

Complications can & do occur:
Extravasation
Thrombosis
Thrombophlebitis
Infection
Emboli
Exsanguination

Question 19

Q

burette

Answer

A

will deliver 60 drops per ml (more accuratethan giving set) for fluid therapy

Question 20

Q

giving set

Answer

A

it will deliver 15 or 20 drops per ml (check on the packet)
for fluid therapy
less accurate than burrette

Question 21

Q

how to calculate Volume and rate of fluid therapy

Answer

A

Calculate total deficit (% fluid deficit + losses )
Add on maintenance fluids
Acute (replace ½ total deficit over first 1-2 hours) then consider rate thereafter (over 24 or 48 hours) – keep monitoring ins and outs
In cases of shock can give 60-90ml/kg/hr (<1hr though, and MUCH less in cats)
Chronic losses – replace over 3-4 days

OR BASE RESPONSE ON CLINICAL SIGNS!!

Question 22

Q

Why Give Fluids during anesthesia?

Answer

A

maintain circulating volume to ensure adequate perfusion and oxygen delivery to organs

Allows an ‘open vein’
Ancillary drugs/PIVA
Emergency situations

Fluid deficits caused by peri-operative fasting
Vasodilatory effects of anaesthetic drugs leading to a relative hypovolaemia
Acepromazine, isoflurane
Losses from the respiratory tract (worsened by endotracheal intubation)
Use HME’s, low flow anaesthesia if appropriate

Question 23

Q

Stranguria

Answer

A

difficulty/straining to urinate

Generally disorders of:
The lower urinary tract (bladder or urethra)
The genital tract (prostate, vagina)
Both

Two processes have potential to cause stranguria:
Non-obstructive stranguria
Mucosal irritation/inflammation of lower urinary/genital tract
Obstructive stranguria
Obstruction or narrowing of the urethra/bladder neck

Stranguria + large bladder may be obstructed = emergency!

Question 24

Q

Dysuria

Answer

A

difficult +/or painful urination

Question 25

Q

Pollakiuria

Answer

A

abnormally frequent urination (little & often)

Question 26

Q

Haematuria

Answer

A

present of blood in urine

Haematuria causes:
Iatrogenic haematuria
Pathological haematuria
Genital sources (if voided)

Do they have clinical signs associated with LUTD?
Has bleeding been noticed from other sites?
Trauma?
Rodenticides?
Blood in faeces?
Pattern to urine pigmentation?

Look for haemorrhage at other sites
Abdomen, thorax, mucosae (especially mouth, axillae, groin)
Palpate and assess kidneys for size, symmetry, discomfort
Examine the external genitalia

Gross “pigmenturia”
red, brown or black urine

Urinalysis: positive haem

3 possible causes:
Haematuria
Haemoglobinuria
Myoglobinuria

Gross haematuria:
>150 RBCs/hpf

Occult haematuria:
Positive Hb on dipstick
>5 RBCs/hpf but not visibly pink
Care re: interpretation if catheterised/cysto

Both can be accompanied by clinical signs (stranguria, dysuria, pollakiuria)

Question 27

Q

Periuria

Answer

A

urination at inappropriate sites

Question 28

Q

Anuria

Answer

A

failure of urine production by the kidneys

Question 29

Q

Oliguria

Answer

A

reduction in urine production

Question 30

Q

Polyuria

Answer

A

Increase urine production

Question 31

Q

Pigmenturia

Answer

A

The presence of a component that imparts an abnormal colour to urine.

Haemoglobinuria
pink-red urine
Intravascular lysis of RBCs
Lysis of RBCs within the urinary excretory pathway e.g. USG <1.008, pH>7

Myoglobinuria
rare in dogs and cats (seen more in horses)
Extensive skeletal muscle damage/myopathies
Creatinine Kinase

Question 32

Q

tests for the function of the distile tubule and loop of henle

Answer

A

Urine Specific Gravity

Question 33

Q

tests for the function of the proximal tubes

Question 34

Q

tests for the function of the Glomerular function

Answer

A

Biochemistry
Dipstick

Question 35

Q

dog urine specific gravity

Answer

A

1.015 to 1.045

Question 36

Q

cat urine specific gravity

Answer

A

1.035 to 1.060

Question 37

Q

what does a dipstick test for

Answer

A

Protein
pH
Blood/Haem
Ketone
Bilirubin
Glucose

also measures Leucocytes
Nitrite
Urobilinogen
USG
but these should not be used

Question 38

Q

Renal Tubular Casts

Answer

A

Proteinaceous plugs of dense, mesh-like mucoprotein +/- cells accumulate in distal portion of nephron
Low number (<2/HPF) can be normal
Increased number relates to tubular disease
Try to identify associated cells, e.g. epithelial, WBC, RBC

Question 39

Q

pyuria

Answer

A

pus in your pee

Leucocytes
Cystocentesis sample - <3/HPF
<8/HPF catheter/voided
High counts = pyuria

+/- bacteria

Question 40

Q

Magnesium ammonium phosphate
struvite

Answer

A

Most commonly seen in dogs and cats
Neutral-alkaline urine
UTI’s
Diet

thin long, pyramidal

Question 41

Q

Cystine

Answer

A

Hexagonal
Acidic Urine
Abnormal finding
Inherited defect in proximal renal tubular transport of AA’s
Concentrated, acidic urine
Radiolucent

Question 42

Q

Calcium oxalate dihydrate

Answer

A

Cross-striations, “envelope”
Acidic urine
Can be seen in clinically normal animals or storage artefact
Or urolithiasis, hypercalcuria, hyperoxaluria..

Question 43

Q

Calcium oxalate monohydrate

Answer

A

Picket fence
Abnormal in cats/dogs
Ethylene glycol ingestion
Not 100% sensitive
Can be seen in normal horse

Question 44

Q

Calcium Carbonate

Answer

A

Alkaline Urine
Yellow-brown or colourless
Common in equine
Not seen in dogs and cats

Question 45

Q

Bilirubin in the urine

Answer

A

Orange-reddish brown
Low number routinely observed in dogs

Question 46

Q

Ammonium biurate Crystals

Answer

A

Acidic urine
Abnormal finding in most breeds
Routine finding in Dalmations

Question 47

Q

Amorphous Crystals

Answer

A

Aggregates/no defining shape
Urates - acidic
Phosphates – alkaline
Xanthene

Question 48

Q

Urolith

Answer

A

A calculus (stone) in the urinary tract
Single or multiple
Cystolith, ureterolith, nephrolith…

Remember – Crystals do NOT = Urolith
Recognised in all species
Common urolith types vary with species
Calcium carbonate – horses, rabbits
Magnesium ammonium sulphate, calcium oxolate – dogs, cats

One mineral normally predominates

Renomegaly – uni/bilateral +/- pain
Renal failure if bilateral
“big kidney-little kidney” cats

Question 49

Q

Nephroliths

Answer

A

Kidney stones
Asymptomatic
Incidental finding on x-rays
Associated with pyelonephritis
Pain, pyuria, pyrexia

Question 50

Q

Eupnoea

Answer

A

Normal respiration

Question 51

Q

Tachypnoea

Answer

A

Increased respiratory rate (not necessarily depth)

Primary cardiac disease
Neurological disease- Damage to respiratory control centre
Pain
Stress
Hyperthermia- Cooling mechanism
Metabolic disease
Acidosis/alkalosis
Increased PaCO2
Abdominal discomfort
Restricted movement of diaphragm
Primary respiratory disease

Question 52

Q

Apnoea

Answer

A

Absence of respiration

Question 53

Q

Hypoventilation and Hyperventilation are both…

Answer

A

Alterations in ventilation at the alveolar level

Question 54

Q

Hypercarbia

Answer

A

Increased CO2 in blood

Hypoventilation
Inc prodn of CO2

Primary drive for respiration

Question 55

Q

Hypoxaemia

Answer

A

Decreased O2 in blood

Poor O2 intake
Hypoventilation
Increased O2 consumption
Decreased O2 carrying capacity

Question 56

Q

STRIDOR

Answer

A

noisy breathing that occurs due to obstructed air flow through a narrowed airway.
as compared to stertor, which sounds like a snore, stridor is a high-pitched sound that results from rigid tissue vibrations. It is typically associated with laryngeal or tracheal disease. Laryngeal paralysis and tracheal collapse are two common presentations in companion animal practice.

Question 57

Q

STERTOR

Answer

A

This term implies a noise created in the nose or the back of the throat. It is typically low-pitched and most closely sounds like nasal congestion you might experience with a cold, or like the sound made with snoring

Question 58

Q

Upper RT Obstruction respiritory pattern

Answer

A

Causes marked inspiratory effort
Dynamic collapse of soft tissues due negative pressure associated with inspiration
Inspiratory STRIDOR or STERTOR

Question 59

Q

Lower RT Obstruction

Answer

A

Thickening, inflammation and mucus
Causes increased expiratory effort
Small airways held open during inspiration
Early collapse during expiration

Question 60

Q

Restrictive Respiratory Pattern

Answer

A

Expansion of the thorax restricted

Decreased tidal volume
Tachypnoea / short-shallow breaths

Hypoventilation

Question 61

Q

Paradoxical Respiratory Pattern

Answer

A

Paradoxical movement of the chest wall
Trauma – “Flail” chest
Terminal respiratory failure – fatigue of muscles

Question 62

Q

serous nasal discharge

Answer

A

Inc. nasal secretions
Allergic rhinitis
Acute Inflammation
Viral infection

Question 63

Q

mucoid nasal discharge

Answer

A

Inc. mucus prodn
Chronic disease

Question 64

Q

puralent nasal discharge

Answer

A

Bacterial infection
1o or opportunistic
pathogen

Answer 59

A

Trauma
Clotting disorder
Vascular disease

Answer 60

A

Nasal cavity
Paranasal sinuses
Guttural Pouch (horses)- sometimes bilateral
Nasopharyngeal- sometoimes bilateral

Answer 61

A

URT Origins-
Guttural Pouch (horses)
Nasopharyngeal
Trachea

LRT Origins-
Bronchoalveolar space
Oedema, Pneumonia
Pulmonary vasculature
Haemorrhage

Answer 62

A

a disease that affects the upper airway in horses. It causes a decrease in airflow to the lungs and can cause exercise intolerance. Horses with the disease are called “roarers” because they make a characteristic respiratory noise that sounds like “roaring” when exercised
Common cause of poor performance in race horses
Also occurs in dogs, in association with hypothyroidism

Answer 63

A

Interstitium is the space between the alveoli and capillaries
Interstitium becomes more prominent
Air still present in alveoli and normal vessels seen

Diffuse (unstructured) - e.g. oedema/ diffuse lymphoma

Nodular – e.g. soft tissue mass ie neoplasia/abscess

Underexposure, expiration or obesity can look similar – often misdiagnosed

Answer 64

A

Thickened bronchi
Infiltration/mineralisation of bronchial walls or due to peribronchial changes
thickning/ mineralisation of the brochial walls or peribrochial changes result in Classical ‘donuts’ or ‘tramlines’
Bronchi may be more obvious in the periphery of the lungs where normally wouldn’t be seen

Answer 65

A

Consolidation or collapse of alveoli
Air in alveoli is replaced by fluid (oedema/haemorrhage) or cells
Air bronchogram is commonly seen
Can be focal or diffuse

Examples; bronchopneumonia, aspiration pneumonia, oedema, haemorrhage, neoplasia, lung lobe collapse or torsion

Answer 66

A

Any changes to the size, course or opacity of the pulmonary vessels
Vessels may be larger or smaller than normal or may be tortuous
Commonly seen associated with cardiac disease
Tortuous vessels seen with heartworm
Differentials depend on vessels affected

Answer 67

A

Fluid in the pleural space
Transudate, exudate, haemorrhage, chyle

lung edges to move away from the thoracic wall

Answer 68

A

Air in the pleural space

Answer 69

A

Sampling of tracheal mucus
Trans-endoscopic
Trans-tracheal

Representative of tracheal secretions and ascending lower airway secretions
Cytology + Culture

Answer 70

A

Sampling of bronchoalveolar space
Trans-endoscopic
Blind
Cytology on

Answer 71

A

Neurocardiogenic

Cardiogenic

Answer 72

A

Bradyarrhythmia and vasodilation
- Vasovagal- occurs when you faint because your body overreacts to certain triggers,
- Tussive- known also as laryngeal vertigo or laryngeal epilepsy, is a. syndrome in which fainting and vertigo with or without convulsions follows. a paroxysm of coughing
- Situational- when a patient faints in response to a specific trigger, or a specific situation. Some triggers can include: Swallowing. Coughing. Prolonged periods of straining

Answer 73

A

Hypotension-inducing arrhythmias
- Sinus arrest
- V Tach
- AV block

Combination of structural heart disease & less hypotensive inducing arrhythmias +/- excitement/ exertion

Intermittent, profound hypotension resulting in marked reduction in blood flow to brain
Estimated blood pressure fall ≤50%
Arrhythmia
Asystole – sinus arrest or ventricular standstill
Marked reduction in cardiac output – rapid V Tach
Duration 10-30 seconds
Activity level and presence/ absence structural heart disease
Pulmonary hypertension
Most common cause bradyarrhythmias
Might be intermittent

Answer 74

A

Intermittent, profound hypotension resulting in reduction in blood flow to brain
BUT lesser degree of hypotension cf. syncope
Arrhythmia
Less rapid v tach
SVT
Less profound bradyarrhythmias
Structural heart disease and pulmonary hypertension may exacerbate
Excitement/ exertion

Answer 75

A

Disorder of impulse formation and conduction systems of the heart
Dogs <60bpm and cats <100bpm
Bradycardias to consider:
Advanced AV block (High grade 2nd degree and 3rd degree)
Sinus arrest
Atrial standstill due to hyperkalaemia
Persistent atrial standstill
Can be drug induced
ACP
Opioids
Alpha2-agonists
B-blockers, calcium channel antagonists and potassium channel blockers are all c/i in sinus bradycardia, SSS and AVB greater than 1st degree
Sinus bradycardia usually high vagal tone and does not result in syncope

Answer 76

A

Supraventricular and ventricular tachycardias
Dogs >160bpm and cats >200bpm
Supraventricular tachycardia
Most common is atrial fibrillation (AF)
New onset – weakness, collapse or syncope
SVT is an umbrella term
AF, accessory pathways, atrial flutter…
Regular SVT less common cause of syncope
Ventricular tachycardia
Boxers and Dobermanns
Can drop CO dramatically
Sudden death – more so when abnormal function of LV

Answer 77

A

Blue or grey skin or lips (cyanosis) happens when there’s not enough oxygen in your blood,

Answer 78

A

displays the right ventricular outflow tract which is usually a third of the normal left ventricle.

Answer 79

A

e define several short-axis views, each cutting the heart at a different level between the base and the apex. The entire heart can be scanned using these short-axis views

Answer 80

A

FS (%) = (Left ventricular internal diameter during diastole – Left ventricular internal diameter during systole)/ LVDd

calculated by measuring the percentage change in left ventricular diameter during systole. It is measured in parasternal long axis view (PLAX) using M-mode. The end-systolic and end-diastolic left ventricular diameters are measured.

if there are no abnomalities fractional shortening correlates with ejection fraction- the amount of blood that the heart pumps each time it beats

FS% is affected by many external factors therefore has its limitations

Answer 81

A

Left ventricular internal diameter during diastole
cm/Body Weightˆ0.294

For those dogs which are cross breeds are pure bred dogs with no published reference ranges available, then the “Cornell method” scales the LVDd (cm) to bodyweight (kg

Answer 82

A

Using Echocardiography, the mitral Valve E-Point to Septal Separation (EPSS) is a straightforward approach that roughly corresponds to the status of left ventricular (LV) function, but its use has been limited to echocardiography and without solid quantitative correlation to left ventricular ejection fraction (LVEF)

he minimal distance between the anterior leaflet of the mitral valve and the septal endocardium over several cardiac cycles.

Answer 83

A

Mannheimia haemolytica

Pasturella multocida

Histophilus somnus

Mycoplasma spp.

Others

Answer 84

A

Parasitic bronchitis, commonly known as husk, is caused by lungworm, Dictyocaulus vivaparus, invasion. Unlike most respiratory disease, which tends to be seen in winter months, this disease is only seen from late spring until early autumn. Like other parasitic diseases, its aetiology is dictated by its lifecycle. Once infection occurs by ingestion the infective larvae penetrates the gut wall, migrating through the body to the lung where it reaches adulthood and begins egg laying. The eggs are coughed up, swallowed and pass out through faeces

Answer 85

A

Trypthophan toxicity
respiritory disease in cattle
Fog fever is seen rarely in cattle grazing lush pasture. It is due to an excess of tryptophan in the diet which the animal can’t process quickly enough resulting in toxic damage to the lungs.

Answer 86

A

an allergic reaction to the inhalation of fungal spores usually from mouldy silage

Answer 87

A

Enzootic calf pneumonia
Pneumonic pasteurellosis (shipping fever)
Mycoplasma bovis
IBR
RSV
PI3
Verminous pneumonia
Fog Fever
Farmers lung
Aspiration pneumonia
Embolic pneumonia (vena caval abcess)
?Stridor - Calf diptheria (Fusobacterium necrophorum)
?Tachypnoea - Septicaemia (eg salmonella Dublin)

Answer 88

A

Heart disease is any condition affecting the cardiovascular system
- chronic in nature e.g. cardiomyopathy
- acute in nature e.g. myocarditis
- may or may not have clinical signs associated with it e.g. syncope, exercise intolerance
- abnormalities on physical examination usually present e.g. heart murmur
Heart failure is a syndrome where the heart can no longer meet the metabolic demand of the body
- Usually acute onset
- Clinical signs present e.g. exercise intolerance, syncope, lethargy, anorexia etc.
- Physical examination abnormalities present e.g. fluid thrill, dyspnoea, crackles, jugular pulsation etc.

Answer 89

A

audible s3 and s4 sounds

Normally heard in dogs and cats;
Occur during systole
S1
‘lub’
Closure of AV valves
S2
‘dub’
Closure of semilunar valves

Not normally heard in dogs and cats
Gallop sounds (occur in diastole)
S3
Early diastolic filling
Not heard in compliant ventricle
Systolic dysfunction
S4
Atrial contraction
Forceful atrial ejection into a noncompliant ventricle
Hypertrophic/ restrictive cardiomyopathy

Answer 90

A

1 – barely audible, need quiet room
2 – audible but quieter than heart sounds
3 – clearly audible and as loud as heart sounds
4 - louder than heart sounds
5 – THRILL (PALPATION) present
6 – Audible with stethoscope lifted off chest
Mild/ moderate/ loud/ thrilling (Ljungvall 2014)

Answer 91

A

Mitral regurgitation-
Grade can correlate with severity (MMVD not DCM)
Pansystolic worse (MMVD)
Can be musical/ whooping
Often radiates to right
a type of heart valve disease in which the valve between the left heart chambers doesn’t close completely, allowing blood to leak backward across the valve.

Tricuspid regurgitation-
Difficult to distinguish from radiating left sided murmurs
Vary with respiration
Tricuspid valve dysplasia
Pulmonary hypertension
Degeneration of valve
occurs when the valve’s flaps (cusps or leaflets) do not close properly.

Answer 92

A

Harsh sounding
Radiate widely to thoracic inlet
Low grade are difficult to distinguish from physiologic/ innocent
(Cats – HOCM dynamic)

The valve between the lower left heart chamber and the body’s main artery (aorta) is narrowed and doesn’t open fully.

Pulmonic stenosis
Left heart base
Radiate dorsally
he narrowing of the pulmonary valve, which controls the flow of blood from the heart’s right ventricle into the pulmonary artery

Answer 93

A

Innocent-
Puppies and kittens
No structural heart disease
Grade 1-3
Systolic
Left heart base
Don’t radiate widely

Functional-
Associated with disease process
Anaemia
Hyperthyroidism
Fever
Hypertension
Pregnancy
No structural heart disease
Grade 1-3
Systolic
Left heart base
Don’t radiate widely

Answer 94

A

Usually left to right
Smaller defect louder murmur
Right sternal border
Increased right side pressure
Quieter
Bi-directional
Right to left
Absent

Answer 95

A

Murmur not directly related to ASD
Only large defects
Increased blood flow
Relative pulmonic stenosis
Left heart base

Answer 96

A

Respiratory disease – cyanosis, dyspnoea/ tachypnoea, muffled heart sounds, crackles, dull percussion, cough, syncope
Neoplasia – ascites, muffled heart sounds, dyspnoea/tachypnoea, dull percussion, weakness
Hypoproteinaemia – ascites, muffled heart sounds
Neurological disease – paresis, paralysis, weakness, syncope
Metabolic disease – syncope, weakness, tachypnoea

Answer 97

A

Heart murmur (dog vs cats)
Arrhythmia (dogs vs cats)
Gallop sound
Cat with cold hindlimbs
Cyanosis
Presence of goitre
Retinal detachment
Some neurological signs

Answer 98

A

Dyspnoea/ tachypnoea
Crackles in lungs
Ascites (fluid thrill)
Jugular distension
Significant jugular pulsation
Muffled heart or lung sounds
Positive hepatojugular reflux
Pulsus alternans/ paradoxus
Peripheral oedema
Plus usually signs of heart disease

Answer 99

A

CARDIAC DISEASE-
Cardiomegaly causing left
mainstem bronchus compression
Congestive heart failure (fulminant
pulmonary oedema)

RESPIRATORY DISEASE
Upper airway dz (laryngeal
paralysis, BUAS, tracheal collapse)
Lower airway dz (infectious/
inflammatory/ neoplastic)

Answer 100

A

Chronic Myxomatous
Mitral Valve Dz/CMVD
- Dilated
Cardiomyopathy/DCM
- Hypertrophic
Cardiomyopathy/HCM
- Pericardial Effusion/PE
- Restrictive
Cardiomyopathy/RCM

Patent Ductus
Arteriosus
* Mitral Valve Dysplasia
* Tricuspid Valve
Dysplasia
* Pulmonic Stenosis

Answer 101

A

horacic rads with echo are the gold standard
Echocardiography will also diagnose the underlying disease, provide
chamber size (prognosis) and identify any effusions

Answer 102

A

vertebral heart scale measured on VD and DV radiographs

a method for measuring heart size in thoracic radiograph

8.5 – 10.5 in dog

7.5 in cat

Answer 103

A

diagnostic test for heart failure and its management. It has a very high diagnostic sensitivity for HF

Non-cardiac causes of rraised NT-proBN-
 Systemic hypertension
 Hyperthyroidism
 Renal failure

Answer 104

A

the most commonly used method to evaluate left atrial (LA) size in dogs
Normal LA dimension was defined as an LA/Ao ratio <1.6

Answer 105

A

Diaphragm often appears as 3 ‘humps’
Distance between diaphragm & heart is greater than for DV
Better visualisation of accessory lobe
Gas should be in the pylorus
Right and ventral

Answer 106

A

Normal width (DV)
○ < 2/3 width of thorax
* Normal width (lateral)
○ 2.5 – 3.5 intercostal spaces wide  Significant breed variation
* Normal height (lateral – 5th rib)
○ 2/3 height of thorax

Answer 107

A

Cat - Normal width (DV)
< 2/3 width of thorax
Normal short axis (lateral)
= cranial 5th rib to caudal 7th rib
Normal long axis (lateral)
2/3 height of thorax

Answer 108

A

O’Clock:
Aortic Arch = 11-1
Right Atrium = 9-11
Main PA = 1-2
Left aurical = 2-3
Left ventricle = 2-5
Right Ventricle = 5-9

Answer 109

A

Assess technical quality
Good technique is essential to obtain diagnostic radiographs
Positioning
Centring
Collimation
Exposure factors
Labelling
Artefacts

Answer 110

A

A minimum of 2 orthogonal views
Beyond that – case dependent!
Routine (inc cardiac) cases – RL and DV
Screening for metastases RL + LL + VD/DV
Specific lung pathology – RL + LL + VD
Appearance unclear on one lateral and DV/VD – take the other lateral

Answer 111

A

Cardiac silhouette position more consistent
Diaphragm obstructs less lung field
More lung between cardiac silhouette and thoracic wall

Position:
Right lateral recumbency
legs secured cranially, neck extended
foam wedge to prevent rotation

Lateral view:
Centre beam slightly caudal to caudal border of scapula
Collimate to thoracic inlet, thoracic spine, sternum and diaphragm (cranial abdomen)

Answer 112

A

Heart rotates to one side and distorts shadow
May produce better pulmonary detail
Can see more of the lung fields

centring/collimation
Ensure symmetrical positioning with spine and sternum superimposed (to avoid axial rotation)
Centre beam in midline, at level of caudal border of scapula
Collimate to thoracic inlet, diaphragm and body wall (skin edges) – unless investigation requires otherwise.

Answer 113

A

Safer in dyspnoeic patient
Heart lies in anatomically correct position – easier to interpret cardiac silhouette

centring/collimation
Ensure symmetrical positioning with spine and sternum superimposed (to avoid axial rotation)
Centre beam in midline, at level of caudal border of scapula
Collimate to thoracic inlet, diaphragm and body wall (skin edges) – unless investigation requires otherwise

Answer 114

A

Aim to produce a horse ‘sedated enough’ for ketamine induction
Healthy horses often receive ACP I/M
Associated with improved outcome and better oxygenation
Place IV cannula

Alpha-2 agonist IV
Xylazine shortest acting and can ‘top up’ - ? Good choice with colics
Detomidine intermediate action (45 minutes), small volumes
Romifidine longest acting (up to 90 minutes) and ? Less ataxia – standing sx?

Less common technique – infuse GGE until ‘knuckling’ then induce
Centrally acting muscle relaxant
Infused immediately prior to induction until horse is ataxic & as part of TIVA often called ‘Triple Drip’
Currently licensed and produced by Dechra
Best to use to 5% or 10% solution
Can substitute benzodiazepines (BZD) midazolam, diazepam (zolazepam)
Used in combination with induction agents to improve relaxation
Good in foals alone, don’t use in adults alone

Answer 115

A

Centrally acting muscle relaxant
Infused immediately prior to induction until horse is ataxic & as part of TIVA often called ‘Triple Drip’
Currently licensed and produced by Dechra
Best to use to 5% or 10% solution
Can substitute benzodiazepines (BZD) midazolam, diazepam (zolazepam)
Used in combination with induction agents to improve relaxation
Good in foals alone, don’t use in adults alone

Answer 116

A

Ketamine - Dissociative anaesthetic
Excellent anaesthesia combined with other drugs
Must not be used alone (seizures)
Eyes remain open and central, less cumulative than thiopentone
Can be used as ‘top ups’ (don’t exceed induction dose)
Takes up to 2 minutes to ‘go down’

Used in combination with acepromazine, alpha 2 agonists, BZDs or guaifenesin (GGE)

Answer 117

A

Acepromazine im, wait approx 30-45 minutes

Detomidine iv, wait 5 minutes, HR>20 bpm, adequate sedation must be apparent

Diazepam/ketamine iv for induction (can use ketamine alone)

Ketamine iv top ups q 8-15 mins (0.1-0.2mg/kg) OR ‘triple drip’ (GGE, ketamine, alpha-2)

Add ¼ dose detomidine after 4/5 doses if using ketamine alone

DO NOT leave until horse standing
Field recoveries usually smoother than hospital
Advice to owner and arrange follow up
Flies
Bleeding
Swelling

Answer 118

A

Acepromazine im, wait approx 30-45 minutes
Detomidine iv, wait 5 minutes, HR>20 bpm, adequate sedation must be apparent
Diazepam/ketamine iv for induction (can use ketamine alone)
Intubate, maintain on isoflurane in oxygen
Monitor depth, keep ABP > 70mmHg, and PCO2 <60mmHg IPPV if necessary. Sedate for recovery

Answer 119

A

LEGAL ASPECTS – check licenced drugs
Many procedures done standing
Induction of anaesthesia usually achieved iv (calves can be masked induced)
Some cows may drink chloral hydrate…

Answer 120

A

Can be achieved with drugs given im (deep), iv or via mask with inhalant
Ketamine, alfaxalone, propofol
Ketamine combinations
Malignant hyperthermia (rare condition of pigs will manifest itself soon after exposure to inhalant usually), rapidly fatal, can be treated with dantrolene

Answer 121

A

Hypotension-
Reduce IAA, fluid boluses, pressors/anticholinergics

Inadequate anaesthesia and poor recovery-
Is usually inadequate analgesia and premedication!

Anaesthetic overdose-
Use of alpha-2s, adding CRIs and not reducing vaporiser

Equipment/monitor issues-
Check first!

Hypothermia – delayed recovery and arrhythmias
Maintain body temp (warming devices)
Low glucose

Cardiac dysrhythmias-
Bradycardia: Alpha-2s, hypothermia, anaesthetic overdose
Tachycardia: Nociception, hypovolaemia, drugs

Answer 122

A

Increased intra-thoracic pressure
Gas flow from flowmeters has nowhere to escape
Increased intra-thoracic pressure as lungs inflate

Increased alveolar pressure causes:
Compression (collapse) of pulmonary capillaries (reduced preload)
Compression of heart chambers (decreased filling)
Compression of aorta (increased afterload)
=> Dramatic reduction in cardiac output
Circulatory arrest 
Alveolar damage / rupture

Answer 123

A

air becoming trapped in tissues beneath the skin. The condition is rare, but it can occur as a result of trauma, injury, infection, or certain medical procedures. Doctors sometimes refer to subcutaneous emphysema as crepitus, tissue emphysema, or subcutaneous air.
can result from ruptured trachea caused by et tube

Answer 124

A

can cause cardiovascular arrest

Start CPR
Specific treatment for local anaesthetic overdose-
Lipid infusion: Intralipid 20%
Bolus 1 ml/kg over 1 min Q 3-5mins
Total dose 3-4 ml/kg
CRI: 0.25 ml/kg/min “until haemodynamic recovery”
Initial research in dogs
Expt overdose of bupivacaine 10 mg/kg i/v
Cardiac massage unsuccessful for 10 mins
6/6 lipid treated dogs survived; 0/6 untreated dogs survived
Normal sinus rhythm returned w/in 5 mins of lipid infusion

Answer 125

A

Older/sick patients
Multiple underlying conditions

Cardiovascular depression
Vasoactive drugs (which?), inhaled anaesthetic agents (effects?)
Hypothermia
Fluid loss

Overstimulation
Nociception

Answer 126

A

What is the rate

What is the overall rhythm

Is there a P for every QRS

Is there a QRS for every P

Are there aberrant (usually ventricular) complexes

What do the monitors tell you about the patient?

Answer 127

A

seen as longer streaches between each PQRST complex

Perfectly normal rhythm

Often seen in fit anaesthetised patients

Sign of high vagal tone
Be careful of procedures that stimulate vagus such as ocular surgery

Answer 128

A

multiple p waves without a PQRS complex

Can be caused by vagal stimulation or very ‘deep’ anaesthesia

Can be idiopathic

Commonly as a result of alpha-2 agonists
Very rarely HIGH dose opioids

Treatment?

If necessary, antagonise the alpha-2 agonist (or administer naloxone?)

Decrease anaesthetic depth

If still no response and reduced cardiac output?
Consider atropine/glycopyrrolate

Answer 129

A

very strange p waves
very deep s waves
large t waves

Treatment – Stop further deterioration, ensure all other parameters are normal

Answer 130

A

ocational very deep s waves coupled with large t waves

Stop further deterioration, ensure all other parameters are normal
Recover asap, ?amiodarone
Then cardiology
Rate control if there is underlying heart disease – medical mx
Electrical DC cardioversion may be an option

Answer 131

A

occasional very large qrs waves with pause after

Check physiology – often due to hypoxia or hypercapnia. Sometimes low blood pressure
Add analgesia – may be due to nociception
Possible lidocaine if becoming frequent

Answer 132

A

very squshed look of whole line
no visibel p waves with frequent qrs complexes and strange t waves

Causes?

Anything that causes tachycardia!
Nociception, hypotension, hypercapnia, hypoxia, hypokalaemia, drugs – which?

Treatment?

Underlying cause
Lidocaine/magnesium/amiodarone

Answer 133

A

small pqr
very deep s wave and large t wave
Often a deterioration of SVT – treat underlying cause
Often as a result of sepsis or a major underlying condition

May deteriorate into ventricular fibrillation (often fatal)

Treatment = underlying cause, lidocaine, amiodarone, magnesium
Ensure all other parameters normal

Answer 134

A

qrs without p wave with large qrs complex

Would you treat this?
Possible due to alpha-2 agonists or high dose opioids?

What would you do?
Treat cause otherwise ensure all other physiology is normal

Answer 135

A

upperlip, roof of nose, skin rostral to canal

Transbuccal
Transdermal
Place needle into canal

Answer 136

A

maxilla, upper teeth, nose, upper lip

Transorbital approach
Transdermal approach
Ventral to notch in zygomatic arch
Transmucosal – cannula into infra-orbital canal

Answer 137

A

akinesia of globe, desens, eye and orbit

Auriculopalpebral
Supraorbital
3 point
Petersen block
Retrobulbar

Answer 138

A

lower lip, insisors

Mandibular nn
Mental foramen

Answer 139

A

mandible, teeth,skin mucosa

Medial mandible
Just rostqral to angular process
Or transmucosal – medial aspect mandible

Answer 140

A

Displays percentage oxygen saturation of haemoglobin
Accuracy is affected by
poor circulation (common in critical patients)
ambient light
movement of the probe
chow-chows
Useful post-op
saturating on room air?

Limitations-
High/low heart rates
Probe design

How is the haemoglobin saturation SPO2% (reading from pulse oximeter) related to PaO2 (partial pressure of oxygen in the blood)?

Oxygen content is dependent on both SaO2 and PaO2

Oxygen content
= (1.39 x Hb x SPO2%) + (0.003 x PaO2)

Hb of 15g/dL (PCV 45%)
Cyanosis may start to manifest at SpO285% - no other signs

Haemoglobin of 9 g/dL (PCV 27%)
The threshold SaO2 level for cyanosis is lowered to about 73% (PaO2 38 mm Hg), the patient would certainly have other signs

Remember, >95% saturation tells us nothing about blood oxygen content- could be anamic

Answer 141

A

Capnography (carbon dioxide measurement) conveys information relating to both respiratory and cardiac function
The end tidal carbon dioxide concentration is measured from the alveolar plateau and should remain constant with unchanged ventilation and cardiac output

Main-stream and side-stream machines are available

Normal ET CO2 = 35–45 mm Hg
Hyperventilation – Decreased ETCO2
Hypoventilation - Increased ETCO2

Cardiovascular status
CVS depression / arrest
Reduced delivery CO2 to lungs

can also show airway obstruction and rebreathing

Other indicators
Oesophageal intubation
Leak at cuff/Patient disconnection
Adequacy of resuscitation

Answer 142

A

The alveolar concentration (at 1 atm) producing immobility in 50% of patients in response to a noxious stimulus
i.e. Potency

MAC is for healthy, un-premedicated patients

MAC affected by
Age, N2O, hypotension, hypoxia, anaemia, opioids, sedatives, LAs, pregnancy

MAC not affected by
Stimulation, duration, species, sex, CO2, NSAIDs

Isoflurane 1.28 (dog) 1.63 (cat)
Halothane 0.87 (dog) 1.14 (cat)
Sevoflurane 2.2 (dog) 2.58 (cat)
Desflurane 10.3 (dog) 9.8 (cat)

Nitrous oxide 188-297 (dog) 255 (cat)

Answer 143

A

total intravenous anaesthesia

Can be used for short procedures in small animals/aggressive patients
E.g. ‘quad’ anaesthesia for cat neuters

Routinely used for field procedures in horses
E.g. ‘GGE, ketamine, alpha-2 agonist – so called triple drip
Various ‘recipes’

GGE (Guaifenesin, a centrally acting skeletal muscle relaxant with little or no analgesic properties)
Supplied as 5% guaifenesin in 5% dextrose and infused to effect until signs of ataxia are seen, at which time IV bolus of ketamine is given

Maintained with infusion given to effect

Answer 144

A

partial intravenous anaesthesia

Goals of PIVA
Reduce MAC
Reduce cardiopulmonary depression
Provide additional analgesia
Improve environmental impact

ideal drugs-
MAC reduction
Analgesic
Minimal toxicity
Minimal effects on the body
Short context sensitive half life
Compatible with other drugs
NO single drug meets these requirements
Hence the need for combinations

Answer 145

A

Seen in sheep continuously exposed to wet pasture – often lambs but can be seen in housed ewes when straw becomes wet and warm
Fusebacterium Necrophorum – can be zoonotic – human wounds have been swabbed and F. Necrophorum found – wear gloves when examining lame sheep!
Mild and transient lameness, rapidly resolves with treatment
Dermatitis involving some or all of the skin between the claws of the feet – skin between claws appears red and inflamed with white discharge
V common, less important than footrot/CODD, but associated with pathogenesis of foot abscesses and foot rot

Answer 146

A

Footrot – 90% of lameness in the national flock
Dichelobacter Nodusus (Bacteroides) BUT needs F. necorphorum to facilitate epidermal invasion
D.nodosus – obligate parasite, can’t survive in the environment for more than 1 week
Also requires devitalised skin – chronic exposure to wet conditions and faecal contamination
Fly strike can occur in affected feet

Characterised by lameness which can be severe, often recumbent leading to reduced feeding time, weight loss, poor wool quality

Very effective vaccine against footrot.
Acts as treatment and prevention.
Timing is important
A second injection can be needed 4-6 weeks
One injection will last 6 months.
Diagnosis is essential

Answer 147

A

Contagious Ovine Digital Dermatitis
Relatively ‘new’ disease – ongoing research
Bacteria – treponeme species. Some association with cattle with Bovine Digital Dermatitis
Link between CODD and footrot
Usually SEVERE lameness with one claw of one foot affected
Initially ulcers develop on the coronary band which then under-run the hoof, can lead to whole hoof avulsion
Graded 1-5
Can lead to permanent hoof growth problems
Often needs systemic treatment with antibiotic and NSAIDs

Answer 148

A

Often individual rather than ‘whole flock’ issue
Unknown aetiology – walking on stony ground, nutritional imbalance?
‘Shelley Hoof’
Separation of the hoof wall from the underlying tissues
Lameness caused by dirt packing into space created
Can lead to abscess formation

Answer 149

A

Painful red swellings caused by:
Over-trimming
Chronic untreated lesions
Chemical irritation

Answer 150

A

viral disease usually seen around mouth of ewes/lambs – causes proliferative lesions around coronary band

Answer 151

A

– ongoing research into aetiology – can appear similar to orf lesions

Answer 152

A

lame in all 4 feet, often after grain gorging or over-fat rams, can lead to longer term hoof deformation
Broken leg bottom left

Answer 153

A

spinal abscess as a result of any systemic bacterial infection can initially present as lameness before progressing to ataxia

Answer 154

A

Most common = septic arthritis ‘Joint-ill;
Streptococcus Dysgalactiae
Transmission still unknown – cord/tagging/tailing/castrating/oral/vaginal canal?
Swollen joints, ill thrift, death
1-2% of flocks, can be up to 50% of lambs in severe outbreaks

control-
Lamb outdoors!- Reduces bacterial load for newborn lambs
Wear long gloves for each assisted lambing
Maintain clean dry lambing shed and pens
Consider if tailing/castration necessary for the particular system
Check colostrum intake

Research evidence suggests that wearing long disposable gloves for lambing will be the most effective method to reduce the prevalence within a flock

Answer 155

A

Disruption to horn growth due to pressure on the corium underneath P3

Risk Factors:
Standing time
Surfaces
Foot trimming
Fat mobilisation
Inflammation

Remove pressure
Block
Trim loose horn
NSAID

Prevention:
Cow comfort – minimise standing times
Maximise transition health
Ensure cows aren’t lame in dry yards
Prompt ID and treatment
Foot trimming technique and strategy

Answer 156

A

Multifactorial
Strong bacterial component
Treponeme spp
Genetic susceptibility
Hoof hygiene!

Answer 157

A

Bacterial infection of interdigital tissue
F. Necrophorum et al
Painful, swollen ID space
Characteristic fragrance

Treatment
Systemic antimicrobials
NSAID
Local treatments

Prevention
Similar to DD
Minimise risk of interdigital trauma

Answer 158

A

Prevention:
Hygiene and trimming of loose heel horn

v shaped lesions

Answer 159

A

3-4x/week
Not too strong/acidic (below pH3)
No more than 200 cows
Effective design required
Commonest ingredients – formalin, CuSO4

Answer 160

A

using oxygen to wash out the nitrogen contained in lungs after breathing room air, resulting in a larger alveolar oxygen reservoir.

With any rebreathing system where carrier gas is oxygen
Use higher flows for ~10 minutes
Risk of alveolar hypoxia
N.B also after short disconnections – movement between theatres etc

Answer 161

A

High gas flow requirements
Loss of heat and moisture
Cheap to purchase, expensive to run
Low resistance to respiration
Suitable for very small patients

Rebreathing circuits use a carbon dioxide absorber to trap and remove CO2 so the patient can breathe gases that have been recycled through the machine. Non-rebreathing circuits use high gas flows to washout expired CO2 from the circuit before the patient takes its next breath.

t piece
bain
lack
mcgill

Answer 162

A

Based on multiples of minute volume, where minute volume is;

                Respiratory rate x Tidal volume

				OR

              	  	200 ml per kg

Answer 163

A

non-rebreathing

Reservoir bag at fresh gas inlet
Awkward to use
circute factor of 1
1 x Vm (Vm = Vt x RR) or (Vm =200ml/kg)

resivour bag is attached to one limbs
>5kg
not sutible fopr ippv

Answer 164

A

Co-axial Magill
circut factor is 1
1 x minute volume (tvxrr)
Damage to inner limb results in rebreathing

resivour bag is attached to two limbs

> 10 to <25-30kg
not sutible for ippv

Answer 165

A

Alternative to T-piece for patients under 10 kg
Bodyweight range 1-10kg
1 x minute volume
No bag twist hazard
Very low resistance
Easy to clean smooth bore tubing

Answer 166

A

Suitable for very small patients, < 8 kg
2-3 x Vm
circute factor is 2-3

Suitable for IPPV

resouvouir back further from gass inlet than lack, attached to one limb, with another limb coming form gass outlet

Answer 167

A

Co-axial T-piece
Suitable for 7 – 10 kg
circute factor of 2-3
2- 3 X Vm
Beware – damage to inner tube

like magil but with inner tube

Answer 168

A

versitile circle unit
has sodalime

can be converted form circle to lack to t- piece

lever upright (lack)
- lever down (T-piece)
- circle

Versatile, suitable for 4 kg - >20 kg

Pros
Compact
Well designed
Scavenge at machine end
Straightforward conversion to IPPV (Nb increase flow)
Applies PEEP
Increases FRC
Prevents microatalectasis
Lowers work of breathing in human infants

Cons
Cost
Very heavy – strain on common gas outlet
Flows of 50ml/kg/min in lever up (lack) not substantiated in animals
Relies on 3 human references

Answer 169

A

Inspect system
Connect to common gas outlet
Test system for leaks
Check unidirectional valves on circle
Specific tests to check integrity of
co-axial lack and co-axial Bain

Answer 170

A

Pneumatic
Medullary

Answer 171

A

Ventral tail vein
Care with species that perform autotomy
Jugular vein
Can be considered for leopard geckos

Answer 172

A

Ventral tail vein
Recommended site
Care not to insert needle into hemipenes or cloacal musk glands
Cardiocentesis
CARE  risks of laceration to ventricle and risk of pericardial haemorrhage

Answer 173

A

Venepuncture sites
Right jugular vein
Can obtain large volumes
Gentle pressure to achieve haemostasis

Basilic (ulnar/brachial vein)
Extend wing and visualise vein
Vein runs over the elbow area
Care as haematoma formation is common

Medial metatarsal vein
Vein is very short in psittacines

Answer 174

A

back bar- Horizontal part of the anaesthetic machine circuit between the rotameter block and the common gas outlet
Vaporisers are mounted on the back bar, enabling volatile agents to be added to the fresh gases. The pressure in the back bar is approximately 1 kPa at the outlet end, and may be 7–10 kPa at the rotameter end
Contains a ‘blow off’ or pressure relief valve at the outlet end plus safety features to only allow one vaporiser in use

Oxygen failure warning device
If fitted (Ritchie whistle or electronic)

Vaporiser-
Expensive and need servicing
See maintenance lecture

Common gas outlet-
Anaesthetic mixture attaches to breathing system
Non-return valve

Oxygen flush -
Bypass vaporiser
35l/min
CARE with breathing system valves – expiratory = open

Answer 175

A

uses a mechanical respirator to deliver a controlled pressure of a gas to assist in ventilation or expansion of the lungs, thereby providing an increased tidal volume for patients with a variety of pulmonary conditions.
Intermittent manual – ‘sighing’. A good habit! Close valve + short inspiration up to 20cm water. Chest supra-maximal. OPEN VALVE AGAIN.
Continuous manual. Repeated sighing. Can be tiring. Will allow breathing control but turn down vaporiser.
Mechanical. Ventilator. TV – 10-20ml/kg. Use large TV with slow rates. Various types. Frees anaesthetist and regular rhythm.

Answer 176

A

Visual check
Leak test; If pop-off valve, close and inflate with thumb over end until no balloon creases
Bain – occlude end with syringe with oxygen at 2l/min – flow should drop
With no IAA – BREATH into circle to check valves (or use 2 bag method)

Answer 177

A

used to absorb carbon dioxide
USA – baralime.
90% = calcium hydroxide;
Ca(OH)2 +CO2 -> CaCO3 + H2O + Heat. Therefore gas warmed and humidified.
Colour change – usually to purple but NOT permanent so change if needed at end of anaesthetic.
Dust. Tracking of gas. Dead space. Resistance. Hyperthermia.
Exhaustion – colour change, no heat, increased heart/resp rate and bp, wound ooze, red mms.

Answer 178

A

Recommended in adult dogs/cats 3-6 hours, water until premed
<3 = food present. >6 = stomach pH drops so reflux is damaging
Neonates = from 0.5 to 3 hours – monitor glucose

Horses withdraw concentrate overnight (gas distension) – controversial

Ruminants withdraw 6 hours and reduce concentrates 12-24 hours

Small exotics/furries – shorter times depending on species

Answer 179

A

Various types available
Most are cuffed with a visible pilot balloon
Inflate to ~25mmHg – use manometer if possible
Murphy, Magill or Cole

Use of laryngoscope advisable

Flow = ∆𝑃𝜋𝑟4/8∩𝐿
Go as large as possible
What size shall I place?
Selection based on nasal septal width = 21% accurate
Selection based on tracheal palpation = 46% accurate
Best technique = visualise larynx using laryngoscope
Spray lidocaine (cats, why not dogs?) and WAIT
Try largest but have a range available
Cut to length – minimise dead space
Not possible with armoured tubes

Red rubber in common use
Crack over time + non-repairable
Prone to kinking
Irritant
Not possible to visualise blockages
Low volume high pressure cuff
Can lead to tracheal trauma but good seal

Difficult to recommend

More popular
Disposable but reused, silicone tubes repairable
Less prone to kinking compared to rubber
Non-irritant
Allows visualisation of blockages
Usually high volume low pressure cuff
Less risk of tracheal trauma but relatively good seal

Answer 180

A

Designed for emergency use in paediatric anaesthesia
The shoulder of the tube should impact in the larynx to provide a gas-tight seal
However movement or IPPV tends to dislodge the tube
Still quite useful for exotic animal anaesthesia

Answer 181

A

veterinary specific (rabbits and cats)
2 species where ETT placement can be challenging

Designed to anatomical standards

Answer 182

A

High pressure/low volume (red rubber and some silicone ETT) exert pressure on a small part of the tracheal mucosa.

May see tracheitis or pressure necrosis
This can lead to tracheal strictures

Extreme cases may see tracheal rupture
Post-op subcutaneous emphysema in cats – but still recommended to use a cuff

ALWAYS disconnect from breathing system when changing position whenever a change in recumbency is needed
Especially with dental cases where head and neck movement is common

Always inflate carefully preferably with manometer
Or listen for leaks

Answer 183

A

Sedation and anxiolysis facilitating handling of the animal
Reduction of the stress for the animal
Reduction the amount of other anaesthetic agents
Provision of a balanced anaesthesia technique
Provision of analgesia
Counter the effects of other anaesthetic agents to be administered during the anaesthesia procedure e.g. atropine to prevent an opioid mediated bradycardia
Contribute to a smooth, quiet recovery after anaesthesia

Answer 184

A

Potent sedative and analgesic drugs
Xylazine was the first 2 agonist to be used in veterinary practice
Superseded by medetomidine & dexmedetomidine (cats & dogs), both lasting about 45 minutes
Xylazine (30minutes), detomidine (45 minutes)and romifidine (60 minutes, less ataxia) used in horses
Xylazine and detomidine used in cattle
The superior selectivity of dexmedetomidine makes it the theoretical 2 agonist of choice for use in small animals

can be injectable or oral gel

Sedation is profound & dose related
Alpha 2 agonists provide good analgesia through an agonist effect at spinal cord 2 receptors
The duration of analgesia provided by a 10 µg/kg dose of dexmedetomidine is approximately 1 hour
Intra-op analgesia improved
The dose of induction and maintenance agents required after alpha 2 agonists are dramatically reduced in small animals
Intravenous induction agents must be given slowly and to effect (vein to brain circulation time is slowed)

Alpha 2 agonists produces a biphasic effect on blood pressure (initial increase followed by a return to normal or slightly below normal values)
Heart rate is decreased throughout the period of 2 agonist administration HR 45-60bpm dogs and 100-120 bpm cats

Alpha2agonists cause a reduction in cardiac output & in healthy animals.
Urine production is increased due to a reduction in vasopressin and renin secretion

Endogenous insulin secretion is reduced leading to a transient hyperglycaemia
Both liver blood flow and the rate of metabolism of other drugs by the liver are reduced
Peripheral vasoconstriction tends to reduce peripheral heat loss
As a consequence it can be easier to maintain normothermia during the peri-operative period compared to animals given acepromazine
Small ruminants are quite sensitive to alpha 2 agonists
#reversable- atipamezole

Answer 185

A

Alpha 2 sedation and analgesia is rapidly antagonised by the administration of atipamezole, a specific alpha2 adrenergic receptor antagonist
Reversal is advantageous because the recovery period is noted to be a high risk time for anaesthetic complications
IM atipamezole produces smooth and good quality recoveries
IV atipamezole produces a very rapid, excitable recovery from anaesthesia and this route of administration is not recommended
It is important to ensure that analgesia is supplemented with different classes of drugs
Atipamazole rarely used in horses and cattle

Answer 186

A

Acepromazine commonest/only licensed one
Sedation and anxiolysis that is initially dose dependent
With larger doses the duration of action is more prolonged
The quality and reliability of sedation can be improved by combination with an opioid (neuroleptanalgesia)
Addition of an opioid also provides analgesia, advantageous since acepromazine itself is not analgesic
To maximise sedation the animal should be left undisturbed for 30-40 minutes after administration
Less reliable sedation cf dexmedetomidine

Acepromazine (ACP) is an antagonist of 1 adrenoreceptors and can cause peripheral vasodilation and a fall in arterial blood pressure
Avoid in animals with marked cvs disease or animals in shock
Acepromazine is long lasting & non-reversible so avoid in hypotensive animals
Acepromazine has anti-arrhythmic properties which may be advantageous during anaesthesia
Reduction in body temperature occurs due to a resetting of thermoregulatory mechanisms combined with increased heat loss due to peripheral vasodilation

No evidence to suggest that acepromazine alters seizure threshold
Giant breeds of dog may be “more sensitive” to the effects of acepromazine
Some boxer dogs are sensitive to even small doses of acepromazine, which has been attributed to acepromazine induced orthostatic hypotension or vasovagal syncope in this breed
Although acepromazine is not contraindicated in boxers, it is not the premedicant of choice in this breed - a very low dose (≤0.01 mg/kg) is recommended and animals should be monitored carefully after administration
Acepromazine is a dopamine antagonist
Anti-emetic
Contraindicated in breeding stallions

Acepromazine gel (horses) & tablets

Answer 187

A

Midazolam or diazepam (MA coming for midazolam, diazepam has MA in France)
Benzodiazepines alone produce minimal or no sedation in healthy cats and dogs
May even cause excitation due to loss of learned “inhibitory” behaviour
Benzodiazepines are therefore given in combination with other sedatives
In dogs benzodiazepines often combined with opioids because both classes of drugs are cardiovascularly stable and the combination can provide reliable sedation
In cats benzodiazepine and opioid is not very sedative, so benzodiazepine is most commonly combined with ketamine

These drugs have minor effects on cardiorespiratory systems
Therefore these drugs tend to be used as premedicants in animals with cardiovascular compromise.
Benzodiazepines are commonly used to manage convulsions, particularly as a first line intervention for animals presenting in status epilepticus

Answer 188

A

Acepromazine + opioid
Alpha 2 agonist + opioid
Alpha 2 agonist + BZD
Alpha 2 agonist + Ketamine
BZD + Ketamine
Opioid + BZD
Alpha 2 agonist + BZD + opioid

How to choose….
Reason for anaesthesia or sedation
Duration of sedation required
Procedure to be carried out
Degree of pain expected from the procedure
Species and breed of the patient
Age of the patient
ASA classification of the patient

Answer 189

A

Injectable Induction Agent
Quick recovery with no hangover
Apnoea if given too quickly

Most commonly used anaesthetic in UK (dogs and cats)
Alkyl phenol, white emulsion 10mg/ml
Soyabean oil, glycerol, egg lecithin, no preservative, NaOH (changes pH)
Supports bacteria and endotoxin
Use within 24 hours
A multi-dose vial with preservative was available (‘Propoflo Plus’ – Zoetis) 28d shelf

Rapid onset of action -rapid uptake by CNS
Short period of unconsciousness (5-8 mins)
Large volume of distribution (lipophilic)
Rapid smooth emergence due to redistribution & efficient metabolism (hepatic and extra hepatic) metabolites inactive

Respiratory depression (apnoea) - IPPV - Speed of injection?
Cardiovascular depression
Rapid and smooth recovery
Suitable for top ups or TIVA
Muscle relaxation usually ok
Anticonvulsant ??
Not irritant, pain reported
Analgesia ?? probably not
↓ ICP (patients with raised and normal ICP)

Rigidity, twitching
Apnoea
Profound bradycardia
Care in hypoproteinaemia
Heinz body anaemia in cats
??? Use for patients with pancreatitis / hyperlipoproteinaemia or diabetic hyperlipidaemia
Pain on injection ?
Local reaction (clear formulation, discontinued)

Answer 190

A

Injectable Induction Agent
Predictable
Single use vials
Apnoea
Rough recoveries

Answer 191

A

Injectable Induction Agent
IM or IV
Long recovery?
Can be rough recovery
Controlled drug

Answer 192

A

Ultra short acting

However difficult (impossible) to source
Use currently in horses to ‘top up’

Prolonged recovery in sighthounds - metabolism and body fat
Massive skin sloughing if injected extra-vascularly

Answer 193

A

Steroid Anaesthetics – ‘Saffan’ – no longer available in UK in this form
Alphaxalone(6mg/ml)/alphadolone(3mg/ml)
Alphaxalone more potent
Solubilised by Cremaphor EL
Didn’t give it to dogs
Used in ruminants & pigs

Formulation without Cremaphor (instead a 2-hydroxypropyl-beta-cyclodextrin (HPBCD))
Alfaxan  (Alfaxalone)
Is suitable for cats and dogs (& other spp)
Alfaxalone is a clear colourless neuroactive steroid
Causes anaesthesia by activating the GABA (inhibitory) receptor

Alfaxalone has a short plasma elimination half life and is cleared from the body relatively quickly
Alfaxalone can be give as repeated boluses or as TIVA to maintain anaesthesia
Premedication is preferable
Anaesthesia induction is smooth, and the injection is given slowly over 60 seconds.

Occasional apnoea is seen and IPPV may be necessary (more than propofol)

The drug has good cardiovascular stability, causes no histamine release and produces good muscle relaxation

Animals should not be disturbed during recovery as excitement can occur

Answer 194

A

Ketamine (also Tiletamine in Europe/USA)
Weak organic base pH 3.5
Racemic 10% solution (100mg/ml)
IV, IM, SC, IP, PO, epidural
Dissociative state
Used in many species for induction and analgesia

Dissociative anaesthesia = detached from surroundings
Patient may have their eyes open and make reflex movements during surgery

In recovery the patient may be agitated
Hallucinations are associated with human ketamine anaesthesia
Can be reduced by premedication with benzodiazepines

Ketamine increases the intracranial pressure

Can be combined with BZD, alpha 2 agonists, acepromazine, opioids
Versatile induction agent and wide safety margin
Invariably needs to be combined with something

Rapid induction
Respiratory effects are mixed – bronchodilation and RR usually preserved but my stop!
GOOD ANALGESIA
CVS effects depend on dose
Muscle tone ↑ and jerky movements
Salivation and lacrimation ↑
Ketamine can be diluted with sterile water or physiological saline

Stormy recovery if disturbed or not adequately premedicated
Depth assessment is different (eyes open)
Corneal drying - use ‘Lacrilube’ or similar tears
Vomiting common with alpha 2 combinations avoid in patients with GI obstruction
Avoid in patients with ↑ ICP, ocular surgery, fever, hyperthyroidism
Schedule 2 CD

Answer 195

A

Smooth muscle spasm-
Inflammation

Colitis / Ulceration-
Distension
Impaction

Gas accumulation-
Obstruction
Impaction

Tension on the mesentery-
Displacement

Tissue congestion/infarction/necrosis-
Torsion/volvulus
Strangulation

Answer 196

A

Mild signs – Restless, Pawing, Flank watching
Gas build up / inflammation of GIT / Smooth muscle spasms

Moderate signs - Lying down flat out, groaning-
Impaction or other simple obstruction

Very fractious, violent rolling-
Acute, severe strangulation

Dull, unresponsive-
End-stage – Severe illness due to colic

Inappetence
Reduced faecal output
Vocalising/grunting
Agitation
Pawing at the ground
Lip curling
Flank Watching
Lying down
For long periods
Repeatedly

Stretching to urinate
Rolling / Thrashing
Sweating excessively
Straining

Answer 197

A

Any non-gastrointestinal source of abdominal pain
Liver disease / hepatomegaly
Urinary disease-
Renal pain
Bladder Dz (urolithiasis)

Peritonitis
Intra-abdominal abscess
Intra-abdominal neoplasia
Reproductive disorders

Other
Non-abdominal, pain mistaken for colic
Oesophageal obstruction
Rhabdomyolosis (tying-up)
Laminitis
Pleuroneumonia

Answer 198

A

Auscultation - GIT borborygmi of the ascending colon (caecum & LC)

Auscultation of GIT has some degree of specificity but low degree of sensitivity.
Hypermotility: Increased smooth muscle activity - ‘spasm’ colic
Local hypomotility: Localised stasis of GIT
General absence: GIT ileus – common finding in most colics

Very useful for monitoring cases – e.g. progressive loss of motility

Answer 199

A

Nasogastric reflux
Fluid/ingesta reflux from the stomach
>2 Litres of fluid is abnormal
Usually indicative of small intestinal obstruction (physical or functional)
Can occur due to LC displacement (pressure on duodenum)

Presence of gastric reflux has significant diagnostic value
Majority of cases with reflux need referring to hospital
Relieving reflux is also very therapeutic
>8L will stretch stomach and be a significant source of pain

Answer 200

A

ventral band of cecum
great vessels
caudal pole of left kidney
caudodorsal aspect of spleen
nephrosplenic space and ligament
fecal balls in small colon
inguanal rings in stallion
bladder when distended

Abnormalities: - Impaction
- Distension (Gas accumulation)
- Displacement
- Masses

Answer 201

A

Assess for presence of changes in peritoneal fluid

Serosanguineous colour change/ Increased protein concentration- Serosal compromise – leakage of blood components

Increased Lactate concentration- Anaerobic tissue metabolism

Presence of ingesta- Rupture of GIT tract
High WBC count- Peritonitis

Answer 202

A

Analgesia
Imperative to provide some form of analgesia to a colic case

NSAIDs
The most common form of analgesics used to treat colic
Slow onset and long duration of activity
Flunixin meglumine (Finadyne Solution)
1.1 mg/kg iv
Potent visceral analgesic
Can masks deterioration in CVS status

Ketaprofen (Ketofen)
1.1 - 2.2mg/kg iv

Phenylbutazone (Equipalazone Injection)
4.4mg/kg iv

Alpha-2 agonists-
Potent analgesics with rapid onset and short duration of action
Allow rapid re-assessment of case progression

Xylazine (Rompun, Virbaxyl)
Dose rate: 0.2-1.1mg/ml
Analgesia for 15-20min

Detomidine (Domosedan)
Dose rate: 0.01-0.02mg/kg
Analgesia for 1-2 hours

Romifidine (Sedivet)
Dose rate: 0.04-0.08mg/kg
Analgesia for 1-3 hours

Opiods-
Not first line analgesic
Usually reserved for higher degree of pain

Butorphanol (Torbugesic)
0.05-0.075mg/kg iv
Potent analgesic; 1 hour duration

Spasmolytics (Anticholinergics)

N-Butylscopolamine (Buscopan Injectable )
Smooth muscle relaxant
Rapid onset and short duration of activity
Good for;
Treating hypermotile/spasm type colic
‘Gas’ colic
Relaxing rectum prior to rectal examination

General Rules
For first-line treatment, or where diagnosis is uncertain, use short acting analgesic agents
Assessing progression, rapid recurrence of pain or deteriorating CV status is vital in the decision to refer

Beware the potent anti-inflammatory effects of flunixin, which can significantly ‘mask’ the early signs of endotoxaemia.
Only administer NSAIDs after the diagnosis or CV status have been established

Answer 203

A

Enteric fluids-
Indicated in the vast majority of colic cases
Most cases will have a degree of dehydration
Contraindicated if NG reflux is present, or suspect small intestinal lesion

Excellent way to rehydrate the colonic content (impactions)
Bolus(es) of isotonic fluids (tap water + NaCl + KCl)
5-8L can be given q2hrs

Purgatives
Liquid Paraffin; Magnesium Sulphate (Epsom Salts)

Answer 204

A

Essentially, any indicators that the case won’t resolve with simple conservative therapy (analgesics & enteric fluids)

Non-response to analgesia
Significant CV compromise
Rapid deterioration despite therapy
Complex abnormalities on rectal exam
Presence of NG reflux
Recurrent/chronic cases with unclear Dx

82.9% survival rate for 1st opinion cases

Answer 205

A

A loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose
A loading dose is most useful for drugs that are eliminated from the body relatively slowly, i.e. have a long systemic half-life
Without an initial higher dose, it would take a long time for the concentration of these drugs to reach therapeutic levels
Examples include ketamine and fentanyl

Answer 206

A

Effect of drug on the body

Drugs are chemicals and as such interact chemically with biological/cellular molecules – most often proteins
Enzymes (e.g. ACE inhibitors, aspirin, neostigmine)
Carrier Molecules (e.g. flavonoid – Pgp antagonist, digoxin)
Ion channels (e.g. verapamil - L-type calcium channel antagonist)
Receptors (e.g. benzodiazepine – GABA receptor agonist, adrenoceptor agonists and antagonists )
Structural proteins (e.g. Taxol – Tubulin “agonist”)
DNA (e.g. anti cancer agents like Doxorubicin)

Answer 207

A

the theory of anaesthetic action which proposes that the potency of an anaesthetic agent is related to its lipid solubility. Potency is described by the minimum alveolar concentration (MAC) of an agent and lipid solubility by the oil:gas solubility coefficient.

Answer 208

A

a compound naturally produced by the body which binds to and activates that receptor. For example, the primary endogenous agonist for serotonin receptors is serotonin, and the primary endogenous agonist for dopamine receptors is dopamine.

Answer 209

A

the maximum therapeutic response that a drug can produce (example: morphine vs buprenorphine)

Answer 210

A

Drug Target Interaction
If the activation is 100%, namely each time a drug interacts with its
target there is a response then the agonist is said to be a “full agonist”
If the activation is <100%, the agonist is said “partial agonist”. Partial
agonists have lower efficacy than full agonists – even with maximal occupancy of receptors.

An agonist has affinity and efficacy – therefore elicits a biological response

Agonist: molecule/drug that binds and activates the receptor
Affinity: the tendency of a drug to bind to the receptor
Efficacy: the tendency of a drug to activate the receptor once bound

Answer 211

A

the tendency of a drug to bind to the receptor

Answer 212

A

the tendency of a drug to activate the receptor once bound

Answer 213

A

Drug Target Interaction

Antagonist: molecule/drug that binds a receptor without activation

Antagonist have affinity but zero efficacy (as they block the target activity)

Main types of antagonism:
* Competitive
* Non-competitive
* Irreversible

Answer 214

A

Competitive agonists compete with agonists for the receptor binding site.
The chemical structure of the agonist and competitive antagonist are often similar (lock and key hypothesis).
Antagonist binds to receptor in such a way as to prevent agonist binding
Competitive antagonism is surmountable – additional agonist can overcome the receptor blockade.

Addition of a competitive antagonist shifts the dose response curve of the agonist to the right (e.g. methadone/naloxone)

Answer 215

A

Non-competitive antagonists either bind to a different receptor site

OR

Block the chain of events “post” binding - acting “downstream” of the receptor.

shift the efficacy of the agonist down

Answer 216

A

Antagonist dissociates from the receptor only very slowly or not at all.
The antagonist forms covalent bonds with the receptor.
Irreversible antagonism is insurmountable – additional agonist cannot overcome the receptor blockade.
Often used in drug discovery, rarely in practice – why?
BUT……Some irreversible enzyme inhibitors are used in practice – e.g. aspirin, omeprazole

Answer 217

A

Inverse agonist: drug that reduces the activation of a receptor with constitutive activity (example: GABAA receptor)
Can be regarded as drugs with negative efficacy.

Answer 218

A

Effective concentration. The dose required for an individual to experience 50% of the maximal effect.

Answer 219

A

Effective dose. The dose for 50% of the population to obtain the therapeutic effect.

Answer 220

A

toxic dose (or LD50) ÷ effective dose (or ED50)
Large TI is safer!

Answer 221

A

Ion channel cell surface transmembrane receptor

Ligand regulated enzyme
E.g. insulin receptor

G-protein coupled receptors

Protein synthesis regulating receptor

Answer 222

A

(“rapid protection”).
Reduction in drug tolerance which develops after a short period of repeated dosing. Not common. Often due to a lack of a co-factor

Answer 223

A

When a drug becomes antagonistic to its own effects

Answer 224

A

Change in receptors
become resistant to drug stimulation/conformational changes

Loss of receptors
endocytosis

Exhaustion of mediators
degradation/low re-expression level

Increased metabolic degradation
higher concentration of drugs are needed

Physiological adaptation
crosstalk between body systems, one takes over

Drug transporters
drug removed from receptor sites

Answer 225

A

The Veterinary Medicines Directorate (VMD), which is an executive agency, sponsored by the Department for Environment, Food & Rural Affairs

VMD is responsible for;
monitoring and taking action on reports of adverse events from veterinary medicines
testing for residues of veterinary medicines or illegal substances in animals and animal products
assessing applications for and authorising companies to sell veterinary medicines
controlling how veterinary medicines are made and distributed
advising government ministers on developing veterinary medicines policy and putting it into action
making, updating and enforcing UK legislation on veterinary medicines

Answer 226

A

Prescription-only Medicine – Veterinarian

must be prescribed by a veterinary surgeon, who must first carry out a clinical assessment of the animal under his or her care.

Answer 227

A

Prescription-only Medicine – Veterinarian, Pharmacist, Suitably Qualified Person

medicines may be prescribed in circumstances where a veterinary surgeon has carried out a clinical assessment and has the animals under his or her care. However, the Veterinary Medicines Regulations provide that POM-VPS may be prescribed in circumstances where the veterinary surgeon, pharmacist or SQP has made no clinical assessment of the animals and the animals are not under the prescriber’s care.

Answer 228

A

Non-Food Animal – Veterinarian, Pharmacist, Suitably Qualified Person

medicines may be supplied in circumstances where the veterinary surgeon or SQP is satisfied that the person who will use the product is competent to do so safely, and intends to use it for the purpose for which it is authorised.

Answer 229

A

Authorised Veterinary Medicine – General Sales List

Answer 230

A

The cascade is a risk-based decision tree to aid prescribing on a case-by-case basis.
Initially a VS should prescribe a medicine authorised in the jurisdiction where they are practising, for use in the target species, for the condition being treated, and used at the manufacturer’s recommended dosage.
If no such product exists, follow the cascade.
Nb. There is separate guidance on the Cascade for veterinary surgeons practising in England/Wales/Scotland, and for those in Northern Ireland. Please refer to VMD website

The treatment in any particular case is restricted to animals on a single holding
Any medicine imported from another country must be authorised for use in a food-producing species in that country
The pharmacologically active substances contained in the medicine must be listed either
for use in NI – in table 1 of the Annex to Regulation (EU) No. 37/2010 (this table replaces Annexes I, II or III of Council Regulation (EEC) 2377/90);
for use in GB – in the GB MRL Register as part of the VMD’s Product Information Database.
The veterinary surgeon responsible for prescribing the medicine must specify an appropriate withdrawal period
The veterinary surgeon responsible for prescribing the medicine must keep specified records

Answer 231

A

Controlled drugs (CDs) are listed in Schedules 1 to 5 of the Misuse of Drugs Regulations 2001

Veterinary medicines only contain CDs in Schedules 2, 3, 4 and 5

Schedule 1 drugs include drugs such as cannabis or LSD – highly addictive, no therapeutic value

Schedule 2 CDs have therapeutic value but are highly addictive
Licenced examples;
Methadone
Fentanyl
Pethidine
Ketamine

Schedule 3 includes buprenorphine, barbiturates and some benzodiazepines which are also subject to special prescription writing requirements. Some are also subject to special storage requirements

Schedule 4 and schedule 5 drugs have no additional special controls
Ketamine WAS Schedule 4
Since November 2015 reclassified as Schedule 2
Now subject to full schedule 2 legal requirements

Schedule 2s: Obtained from wholesalers providing a signed prescription has been issued by the requesting veterinary surgeon
Must keep requisition records for at least 2 years

Schedule 2 or 3 CDs ; written prescription must be signed by the person issuing it which may be hand-written, typed in a computerised form or computer generated.

This prescription is only valid for 28 days.

Repeat dispenses on the same prescription are not allowed with schedule 2 or 3 drugs

Recommended that you keep a copy of a CD requisition to assist in complying with the law on wholesale supply

RCVS considers that a veterinary nurse may draw up and administer a CD

Provided the veterinary surgeon
Prescribed the drug to a specific animal
Decided on the dose
Authorised that it be drawn up and is confident that the veterinary nurse is competent to draw up and administer the prescribed dose
A veterinary surgeon does not need to be present when the drugs are drawn up or administered
but the legal responsibility for the supply of the CDs remains with the veterinary surgeon

Recommended to have a standard operating procedure
Veterinary nurses may administer CDs out of hours when there is no vet on the premises
A veterinary nurse is not able to decide to give a CD or change the dose (i.e. make prescribing decisions) without the instructions of a veterinary surgeon

Answer 232

A

Complete records of Schedule 2 CDs must be kept in a Controlled Drugs Register (CDR)

CDR = either a computerised system or a bound book separated into each class of drug with a separate page for each strength and form of that drug at the top of each page.

Loose leaf registers or card index systems are not allowed

CDR entries must be
In chronological order, made in ink or in a computerised form in which every entry can be audited, and made on the day of the transaction
The book must be kept at the premises to which it relates and be available for inspection at any time
It must be kept for a minimum of two years after the date of the last entry

The CDR must record for all CD purchased and supplied
The date supply received, name and address of supplier and quantity received

The CDR must record for all CDs administered or supplied
The date supplied, name and address of person supplied, details of the authority to possess (prescriber or licence holder’s details) and the quantity supplied

Answer 233

A

Schedule 2 and Schedule 3 CDs containing buprenorphine must be kept in a locked container which is constructed and maintained to prevent unauthorised access to the drugs and can only be opened by a veterinary surgeon or other authorised person

The room housing this container should be lockable and tidy to avoid drugs being misplaced

CD container keys should not be kept with keys to other parts of the building

The room should not normally be accessible to clients

Any returned CDs should not be re-used and should be destroyed according to regulations.

Answer 234

A

Analgesics may act at different sites
They may act at the site of injury and decrease the pain associated with an inflammatory reaction (e.g. NSAIDs)
They may alter nerve conduction (e.g. local anaesthetics)
They may modify transmission in the dorsal horn (e.g. opioids & some antidepressants)
They may affect the central component and the emotional aspects of pain (e.g. opioids & antidepressants)

Answer 235

A

Natural (opiate) and synthetic (opioid) drugs
Endogenous opiates
Opioid receptors identified; mu, delta, kappa, nociceptin
Effect depends on dose, route, species, stimulus etc
CVS effects, pruritis, urinary retention, ileus, pancreatic duct, temperature, miosis, mydraisis, vomiting & nausea, mania & respiratory depression?
MOSTLY IN PEOPLE

Answer 236

A

The most efficacious opioid at relieving pain

It is a full agonist at mu, delta and kappa receptors

Not licensed. (CD II)

Nevertheless still used widely
CRIs and epidurals plus horses

Answer 237

A

A synthetic mu agonist (full) & affinity for NMDA receptor
Has effects as a norepinephrine and serotonin reuptake inhibitor
Following IV - duration of action is approximately 4 hours (can be longer with sc)
Vomiting – not usually
Use as premed, for sedation, intra op (v slow IV), on recovery, and as CRI
Poor oral availability
Licensed for dogs and cats. CD II

Answer 238

A

Synthetic agonist at the mu receptor
Also shown to block sodium channels
Agonist at alpha 2 B subtypes
Negative inotropic effects but tends to increase heart rate
NOT IV- Can induce histamine release
Pethidine should not be administered to dogs receiving selegiline - Monoamine oxidase inhibitor + pethidine ≡ serotonin syndrome
CD II (licensed for dogs, cats, horses)
Spasmodic colic
DOA ≈ 90 minutes

Answer 239

A

Fentanyl is a highly lipid soluble short acting mu opioid agonist. CD II

Uses:
Intraoperatively as bolus, with peak analgesic effects occurring in 3-5 minutes
At induction with a benzodiazepine
For compromised patients, fentanyl + benzodiazepine may be sufficient for intubation
CRIs are very effective
Transdermal fentanyl patches

Respiration slows or may cease following a bolus -
Bradycardia can be significant
Fentanyl ‘spot on’ licensed for dogs (Recuvyra)

Answer 240

A

has been used in dogs (often with paracetamol) for mild to moderate pain (post op)

Answer 241

A

antagonism of pure mu opioids

Answer 242

A

Tramadol is popular! But there is a lack of data in dogs, better in cats
It is commonly prescribed to humans – now licensed in dogs
It is a synthetic analogue of codeine; it is a low potency mu selective partial agonist PRODRUG with LIMITED metabolism in dogs
It has an alpha 2 adrenergic effect and inhibits 5HT reuptake
CDIII
Very limited value in dogs but useful in cats

Answer 243

A

a partial agonist with a strong affinity for mu receptors (mild kappa antagonist)
Highly potent but not as efficacious as pure opioids
Peak effect IV admin 45-60mins
Mild to moderate pain, good sedation, long duration of action, preservative in multi dose vials
Licensed for dogs and cats and horses
OTM route works v well (cats>dogs)

Answer 244

A

is a kappa opioid agonist and mu antagonist (short-medium duration)
Its actions differ to that of the other opioids
Available as oral form (Torbutrol)
Useful in combination with acepromazine for sedation e.g. cardiac patients
Licensed for dogs, cats & horses
Antitussive- suppress coughing
LIMITED ANALGESIA

Answer 245

A

Lidocaine
Prilocaine (+lidocaine)
Bupivicaine
Mepivicaine
Ropivicaine
Etidocaine
Amethocaine
Proparacaine
Cocaine

Answer 246

A

Lidocaine
Prilocaine (+lidocaine)
Bupivicaine
Mepivicaine
Ropivicaine
Etidocaine
Amethocaine
Proparacaine
Cocaine

LAs are weak bases and largely ionised at physiological pH.
?Problem in inflamed tissue

Their speed of onset is inversely related to their degree of ionization.
?Longer to start working in inflamed tissue

Their duration of effect is directly related to their degree of protein-binding.

Their potency is related to their lipid solubility.

Answer 247

A

Inhibit prostaglandin production by interfering with cyclo-oxygenase (COX)
COX 1, 2
Now thought also to have a spinal action
Synergistic with other drugs
iv, im, sc, poSome licensed for pre-operative use
Carprofen and meloxicam have revolutionized perioperative pain management in UK in last 3 decades

Carprofen
Firocoxib
Meloxicam
Deracoxib
Etodolac –
Ketoprofen
Cimicoxib
Mavacoxib
Robenacoxib
Grapiprant
Paracetamol ? and codeine (opioid)
Phenylbutazone
Tolfenamic acid
Tepoxalin*
Vedaprofen
Keterolac
Aspirin

Licensed NSAIDs for horses-
Phenylbutazone
Suxibuzone
Firocoxib
Meloxicam
Flunixin meglumine
Vedaprofen
Carprofen

Traditional NSAIDs are contraindicated in patients with:
Renal or hepatic insufficiency
Hypovolaemia
Congestive heart failure & pulmonary disease
Coagulopathies, active haemorrhage
Spinal injuries
Gastric ulceration
Concurrent use of steroids
Shock, trauma (esp head trauma)
Pregnancy

Answer 248

A

Prostaglandin (PG) synthesis attributable to COX 1 along length of GIT
PGs play a role in regulating renal blood flow, reducing vascular resistance & enhance organ perfusion
COX 1 is found in neurones and in the foetus, amniotic & uterine tissue
Blood platelets contain COX 1

Answer 249

A

Piprant class NSAID
Non-cyclooxygenase inhibiting non-steroidal anti-inflammatory drug

Licenced for treatment of mild to moderate osteoarthritis pain and inflammation in dogs

Has been called ‘next step’ when ‘traditional’ NSAIDs are not tolerated

Approved for use in dogs from 9 months of age and favourable safety profile

Once daily administration (chewable tablet) – 2mg/kg

Adverse events include vomiting, diarrhoea, decreased appetite and tiredness.
Often dogs will adjust but washout between NSAIDs essential

Not for use in cats

Answer 250

A

antagonism of pure mu opioids

Answer 251

A

Paracetamol: 10-15 mg/kg PO two to three times daily. Is it a NSAID?
Analgesic & antipyretic
Mechanism of action unknown!
Thought to inhibit COX-3(??) but recent data suggest there may be another site

Answer 252

A

bind to alpha 2 receptors

Receptors widespread

Drugs have other actions (sedation, ↓HR etc)

Systemic, epidural, peripherally

Synergism with LA’s

Dogs/cats-
Medetomidine (45 minutes)
Dexmedetomidine (45 minutes)

Horses
Xylazine (30 minutes)
Detomidine (45 minutes)
Romifidine (60-70 minutes)

Cattle -
Xylazine
Detomidine

Very useful drugs
Sedative action
Analgesic (& reduce MAC)
Compatible with other drugs & potential to antagonise (atipamezole), IV, IM, epidurally, buccally (detomidine)
Small volume

Alpha 2 receptors
3 subtypes (4) A,B,C
Diverse sites: CNS & PNS

Hyper (B) then normo/hypotension (A)
Decreased CO & HR, increased SVR
Respiratory depression
Increased urine production
Decreased GI motility
Decreased surgical stress response
Hyperglycaemia, GH enhanced
Thermoregulation affected
Sweating

Sedation including standing sedation for equine/large animal

Premedication

PIVA/TIVA

Epidural

Rescue analgesia

One of the few classes of drugs with an antagonist- atipamazole

Answer 253

A

As induction agents
As analgesics peri op
Ketamine for fractious cats (sprayed in mouth)
Very versatile
Will improve the patient’s post op comfort
It has been shown that at low doses ketamine can prevent the ’wind up’ and sensitisation of dorsal horn cells
0.5mg/kg after induction
Can be used in the pre-med
CRI e.g. Add 60mg ketamine to 1L LRS and administer at 10ml/kg/hr to dogs intra op (10mcg/kg/min)

Answer 254

A

inhibits cell wall synthesis and gram positive bacteria

Answer 255

A

inhibits cell wall cynthesis
broad spectrum

Answer 256

A

inhibits cell wall synthesis
skin ointment for gram positive bacteria

Answer 257

A

inhibits cell wall synthesis
broad spectrum

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