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Small Animal Internal Medicine > SAM Mid-Term > Flashcards

SAM Mid-Term Flashcards

1
Q

What is the most common presentation of a uremic crisis?

A

Complication or exacerbation of CKD

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2
Q

What are the common findings with CKD?

A

Dehydration, anorexia, vomiting, weakness, and lethargy

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3
Q

What should you assess if you suspect a uremic crisis related to CKD?

A

Azotemia, Anemia, and Possible investigation of secondary problems

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4
Q

How would you treat a patient with CKD that is in a uremic crisis?

A

Correct the dehydration, treat the symptoms, and address comorbidities as needed

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5
Q

This is when the kidneys filter more than normal fluid

A

Diuresis

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6
Q

When is diuresis appropriate and inappropriate?

A
  • Appropriate = In cases of volume overload
  • Inappropriate = In cases of CKD
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7
Q

What does forced diuresis consist of?

A

Giving fluids and diuretics

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8
Q

What should be corrected aggressively in patients with CKD?

A

Dehydration

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9
Q

This is the only type of azotemia that resolves with fluid therapy

A

Pre-renal azotemia (as long as you rehydrate quickly!)

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10
Q

What type of fluids should be used to rehydrate and maintain a CKD patient?

A

Balanced electrolyte (LRS) for rehydration and Low sodium maintenance fluid

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11
Q

What are some at-home management strategies for CKD?

A
  • Hydration
  • Renal diets
  • Phosphate binders
  • Potassium supplementation
  • Blood pressure management
  • Anemia management
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12
Q

Regarding hydration in CKD, when voluntary intake is insufficient, what are the two options?

A
  • Intermittent SQ fluid administration or feeding tube placement
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13
Q

What are some pros and cons of SQ fluid administration?

A

Pros
- can be started immediately
- no procedures needed
Cons
- high salt fluids
- needles
- pets & clients may not tolerate well
- cost of supplies

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14
Q

What are some pros and cons of E-tube placement?

A

Pros
- Physiologic (can just give water)
- No needs/pain free
- Well tolerated
- May be cheaper in long term
- Can give most PO meds
Cons
- Increased up front costs
- Requires anesthesia
- Tube can be inadvertently removed
- Possible esophageal stricture

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15
Q

What specific type of disease is the leading cause of renal disease in dogs?

A

Glomerular diseases

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16
Q

What are signs of recurrent LUT issues?

A
  • Hematuria (macroscopic and microscopic)
  • Stranguria
  • Pollakuria
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17
Q

What are some characteristics of a complicated UTI?

A
  • Presence of anatomic or functional abnormality (urinary or repro tract abnormalities)
  • Presence of comorbidities that predispose to persistent infections
  • Recurrence
  • Intact male dog
  • Cats
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18
Q

What are some characteristics of an uncomplicated UTI?

A
  • Sporadic bacterial infection
  • Otherwise healthy animal
  • Normal urinary tract and fxn
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19
Q

What are some predisposing factors to recurrent LUT signs?

A
  • Degenerative diseases (CKD)
  • Anatomical features (obesity, hooded vulva, female)
  • Metabolic disorders (diabetes)
  • Neoplasia (TCC)
  • Inflammatory/infectious/immune (polyps, immunosuppression)
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20
Q

What two structures make up the upper urinary tract?

A

Kidneys and ureters

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21
Q

What two structures make up the lower urinary tract?

A

Bladder and urethra

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22
Q

Endotracheal washes are performed in what animals?

A

Cats and Small dogs

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23
Q

What is the purpose of an endotracheal and transtracheal wash?

A

Collect airway fluid samples for cytology and culture

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24
Q

When are endotracheal washes contraindicated?

A

If the patient is not a good anesthetic candidate

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25
Q

Why are transtracheal washes contraindicated in small dogs and cats?

A

It can cause iatrogenic SQ emphysema and tracheal laceration

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26
Q

What ligament do you palpate and “pop” through during a transtracheal wash?

A

Cricothyroid ligament

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27
Q

What is in indication for an NE/NG tube?

A

Short term (< 7 days) enteral nutritional support in critically ill patients

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28
Q

What are contraindications of a NE/NG tube?

A

Nasal cavity disease, coagulopathy, vomiting

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29
Q

How do you confirm proper placement of an NE/NG and esophagostomy tube?

A

With radiographs

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30
Q

What are indications for an esophagostomy tube?

A

Long term enteral nutritional support in anorexic patients or patients with oral disease, trauma, or surgery limiting their ability to eat

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31
Q

Esophagostomy tubes are placed in what animals?

A

Cats, Small dogs, +/- medium sized dogs

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32
Q

What are contraindications of esophagostomy?

A

Esophageal disease and coagulopathy

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33
Q

When developing a nutritional plan for feeding patients through a tube, the diet choice is dictated by what 3 things?

A

Tube size, patient needs, and energy density of diet

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34
Q

What is the typical interval of RER that you start with when feeding tubed patients?

A

1/3-1/4 RER

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35
Q

What are some indications for a bone marrow aspirate?

A
  • Unexplained thrombocytopenia, non-regenerative anemia, neutropenia, or pancytopenia
  • Investigation of atypical cells observed in peripheral blood
  • Dx or staging of neoplasia
  • Evaluation of iron stores
  • Aid in dx of infectious dz
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36
Q

(T/F) There are many contraindications for a bone marrow aspirate

A

FALSE, there are none

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37
Q

What are the 3 bone marrow sampling sites?

A
  • Greater tubercle of the humerus
  • Trochanteric fossa of the femur
  • Iliac crest of the pelvis
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38
Q

What is the purpose of a bone marrow biopsy?

A

To provide information about bone marrow architecture

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39
Q

What are indications for a thoracocentesis?

A
  • To collect pleural effusion for cytologic and/or microbiologic analysis
  • To relieve clinical signs of dyspnea caused by pleural effusion
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40
Q

What is a contraindication for thoracocentesis and abdominocentesis?

A

Coagulopathy (unless its hemothorax preventing ventilation)

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41
Q

Which intercostal space do you approach for a thoracocentesis?

A

7th-9th intercostal space

42
Q

What are indications for an abdominocentesis?

A
  • To collect abdominal effusion for cytologic and/or microbiologic analysis
  • To relieve clinical signs of dyspnea or discomfort associated with severe abdominal effusion
43
Q

What are some indications for arthrocentesis?

A
  • Joint swelling or pain in one or more multiple joints
  • Shifting leg lameness
  • Fever of unknown origin (polyarthritis)
44
Q

What are contraindications for arthrocentesis?

A
  • Significant coagulopathy
  • Pyoderma overlying arthrocentesis site
45
Q

What are the common arthrocentesis sites?

A
  • Carpus
  • Stifle
  • Tarsus
46
Q

What are some common causes of hypercalcemia?

A
  • Lymphosarcoma
  • Anal sac adenocarcinoma
  • Other neoplasia
  • Renal failure
47
Q

Name the 3 forms of calcium

A
  • Ionized calcium (free)
  • Protein bound calcium (albumin)
  • Complexed calcium
48
Q

Plasma is primarily composed of which type of calcium?

A

Ionized (50%) followed by protein bound (40%)

49
Q

What are some effects of calcium on the kidney?

A
  • Induces nephogenic diabetes insipidus
  • Increased medullary blood flow
  • Renal arteriolar vasoconstriction
  • Renal mineralization
50
Q

Why does PU/PD occur from hypercalcemia?

A
  • Increased water consumption
  • Reduced tubular function
  • Deficiency or impaired response to ADH
51
Q

What are clinical signs of hypercalcemia?

A
  • PU/PD
  • Anorexia/hyporexia
  • Lethargy
  • Weakness
  • Cardiac arrhythmias
  • Seizures/muscle twitching
52
Q

What are some aggressive therapy options for hypercalcemia?

A
  • IV 0.9% NaCl
  • Furosemide
  • Biphosphate injection
  • AVOID thiazides!
53
Q

What are some maintenance therapy options for hypercalcemia?

A

Oral corticosteroids or oral alendronate

54
Q

Describe diabetes mellitus

A
  • A problem with insulin (lack of production and response)
  • Characterized by hypERglycemia
55
Q

This type of diabetes is the lack of insulin production by beta cells

A

Type I

56
Q

This type of diabetes is the resistance to the effects of insulin

A

Type II

57
Q

Without insulin (or its substrate - glucose), these are converted into ketone bodies causing ketosis in diabetic patients

A

Fatty acids

58
Q

How can you diagnose diabetic ketoacidosis?

A

Diabetes mellitus + acidemia (that is NOT caused by something else

59
Q

What is the treatment for diabetic ketoacidosis?

A
  • Reverse the ketoacidosis by giving insulin
  • ID and treat the underlying cause
60
Q

What are two reasons why patients develop DKA?

A
  • Unmanaged or poorly managed diabetes mellitus
  • Previously well-managed diabetics that develop a co-morbidity
61
Q

When do you start insulin therapy in DKA?

A

Early, ideally within 1-4 hours

62
Q

What is the goal of insulin therapy in DKA vs DM?

A

DKA = get rid of the ketones
DM = regulate blood glucose

63
Q

Which enzymes are associated with hepatocellular injury?

A

ALT and AST

64
Q

Which enzymes are associated with cholestasis/enzyme induction?

A

ALP and GGT

65
Q

Which values are associated with indicating impaired liver function? Which of these values is exclusively made in the liver?

A
  • Bilirubin, albumin, glucose, cholesterol, and BUN
  • Albumin
66
Q

What is the most sensitive liver function test that is readily available for use in small animals?

A

Bile acids

67
Q

What are indications for a bile acids test?

A

Screening for loss of hepatic function or PSS

68
Q

The most common cause of abnormal liver enzymes is _______ to non-hepatic disease

A

secondary

69
Q

What are common symptoms associated with increased liver enzymes?

A
  • PU/PD
  • hyperactivity
  • Excessive panting, hair loss
  • Vomiting, diarrhea, inappetence
  • Cough or difficulty breathing
70
Q

Name some reasons to investigate further when liver enzymes are increased

A
  • ALT greater than twice normal over several months
  • Unexplained liver enzyme elevation persisting over 6-8 weeks
  • Non-hepatic causes have been ruled out
71
Q

How do you diagnose pancreatitis?

A
  • Hx/CS
  • Bloodwork
  • Imaging
  • Cytology/biopsy
  • Pancreatic lipase immunoreactivity (PLI)
72
Q

What bloodwork findings support pancreatitis diagnosis?

A
  • Inflammation
  • Liver enzyme elevation
  • Hyperbilirubinemia
73
Q

What does supportive care look like for pancreatitis patients?

A
  • Fluid therapy
  • Pain management
  • Anti-emetics
74
Q

What is essential in treating acute pancreatitis?

A

Pain management

75
Q

Name 3 causes of pre-hepatic (AKA hemolysis)

A
  • Immune-mediated
  • Toxic
  • Post-transfusion
76
Q

Name some causes of hepatic (AKA liver failure)

A
  • Toxicity
  • Hepatitis (infectious)
  • Cirrhosis (rare)
  • PSS (end-stage)
  • Microvascular dysplasia
  • Secondary injury (hepatic lipidosis)
  • Congenital deficiencies
77
Q

Name 4 causes of post-hepatic (AKA biliary obstruction)

A
  • Gall bladder mucocele
  • Cholelithiasis
  • Pancreatitis
  • Tumors
78
Q

What are findings supportive or pre-hepatic, hepatic, and post-hepatic?

A

Pre-hepatic: MM color, anemic, recent transfusion
Hepatic: liver enzyme elevation, hx of liver dz/injury
Post-hepatic: belly pain, liver enzyme elevation (cholestatic enzymes)

79
Q

Name some immunosuppressive therapies

A
  • Glucocorticoids (prednisolone, dexamethasone)
  • Azathioprine
  • Cyclosporine
  • Chlorambucil
  • Leflunomide
  • Mycophenolate mofetil
80
Q

Name some adjunctive therapies

A
  • Human IVIG
  • Vincristine
  • Melatonin
  • Supportive (blood products and antiplatelet therapy)
81
Q

What factors into the selection of immunosuppressive therapies?

A
  • Expected course and prognosis of disease
  • Concurrent diseases
  • Safety and efficacy
  • Ease of administration and monitoring (client compliance)
  • Cost
82
Q

What is a first line immunosuppressive therapy?

A

Glucocorticoids

83
Q

What immunosuppressive therapy has the following side effects:
- PU/PD, panting, polyphagia
- muscle atrophy and weakness
- iatrogenic hyperadrenocorticism
- vacuolar hepatopathy
- infection, sepsis
- GI ulceration
- hypercoagulability

A

Glucorticoids

84
Q

What are the contraindications of glucocorticoids?

A
  • Diabetes mellitus
  • infections
  • hyperadrenocorticism
  • NSAID therapy (washout)
85
Q

When should you consider other therapies?

A
  • No or poor response
  • Excessive side effects
  • Long duration of therapy anticipated
  • Corticosteroids contraindicated
86
Q

What is the MOA of azathioprine?

A
  • Inhibits purine synthesis –> disrupts lymphocyte proliferation
  • Blocks T-cell activation and promotes T-cell apoptosis
  • Decreases antibody synthesis
87
Q

You should limit the use of the azathioprine in which species?

A

Cats

88
Q

What immunosuppressive therapy has the following side effects:
- cytopenias
- hepatotoxicity
- chronic subclinical anemia
- GI signs (mild and self-limiting)

A

Azathioprine

89
Q

What is the MOA of cyclosporine?

A
  • Calcineurin inhibitor
  • Impairs function of T-cells and blunts immune response
90
Q

What immunosuppressive therapy has the following side effects:
- Primarily GI
- Hepatotoxicity, nephrotoxicity
- Gingival hyperplasia, hypertrichosis
- Platelet activation
* NOT myelosuppressive *

A

Cyclosporine

91
Q

Cyclophosphamide is used for dogs with what condition?

A

IMHA

92
Q

What immunosuppressive therapy has the following characteristics:
- alkylating agent antineoplastic
- immunosuppressive properties (targets B cells)
- slow onset of action (2 weeks)

A

Chlorambucil

93
Q

What immunosuppressive therapy has the following side effects:
- GI
- myelosuppression
- alopecia, poor hair growth
- neurological signs in cats

A

Chlorambucil

94
Q

What is the MOA of leflunomide?

A
  • Inhibits de novo pyrimidine synthesis
  • inhibits B and T cells function and proliferation
  • suppresses antibody production
95
Q

What immunosuppressive therapy has the following side effects:
- well tolerated
- GI effects
- myelosuppression
- cutaneous drug reactions
- hepatotoxicity

A

Leflunomide

96
Q

What is the MOA of mycophenolate mofetil?

A
  • Reversible inhibitor of inosine monophosphate dehydrogenase
  • inhibits de novo purine synthesis
  • inhibits lymphocyte proliferation and antibody production
97
Q

What immunosuppressive therapy has the following side effects:
- GI common (diarrhea, vomiting, poor appetite)
- Myelosuppression

A

Mycophenolate mofetil

98
Q

Describe an immunosuppression monitoring response?

A
  • Improvement in clinical signs and clinicopathologic abnormalities
  • Initiate prednisone taper by 25% q 2-4 weeks
  • Acceptable maintenance dose or discontinue
  • Treatment for at least 3 months
  • 2nd line drug tapered in a similar manner
99
Q

If there is a relapse, what is the next step?

A

Prednisone + second line therapy drug
- Long term therapy (low dose glucocorticoid or second line drug)

100
Q

This immunosuppressive therapy has been used to treat IMHA and ITP

A

Human IVIG

101
Q

What is the MOA of Vincristine?

A
  • Disruption of intracellular microtubles
  • Cell cycle specific cytotoxic agent
102
Q
A

Small Animal Internal Medicine (20 decks)

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