Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACVECC Boards study > Seminal articles > Flashcards

Seminal articles Flashcards

1
Q

Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome - what was impact on mortality? Complications on interventions group?

A

The use of NMB + heavy sedation protocol vs light sedation protocol and usual care approach did not result in a lower mortality. Interventions group - less physically active and more adverse CV effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pulmonary hypertension secondary to respiratory disease and/or hypoxia in dogs: Clinical features, diagnostic testing and survival - what was cut off pulmonary arterial pressure assoc with non survival? What was sole independent predictor of survival in multivariable analysis? MST?

A

Cut off systolic PAP was (=/>) 47
Administration of a phosphodiesterase 5 inhibitor was sole independent predictor of survival
Median survival days 276

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Oxygen exposure resulting in arterial oxygen tensions above the protocol goal was associated with worse clinical outcomes in acute respiratory distress syndrome - what was the average cumulative above goal O2 exposure in days? what was the main finding?

A

0.24 +/- 0.41 FiO2 days
Patients with above goal O2 exposure more likely to die, have fewer vent free days and hosp free days
dose response relationship between cumulative above goal exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Oxygen exposure resulting in arterial oxygen tensions above the protocol goal was associated with worse clinical outcomes in acute respiratory distress syndrome
- what was the goal exposure exposure defined?

A

Difference between FiO2 and 0.5 whenever FiO2 was above 0.5, and when PaO2 > 80 mmhg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Respiratory effects of low vs high tidal volume with or without PEEP in anaesthetised dogs with healthy lungs - what was the best combination of settings that improved lung compliance?

A

tidal volume 15 ml/kg and PEEP of 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Respiratory effects of low vs high tidal volume with or without PEEP in anaesthetised dogs with healthy lungs - was CO2 higher in high or low TV groups? How about airwya pressures? How about oxygenation?

A

CO2 - higher in low TV group
Airway pressure higher in the PEEP group
Oxygenation - similar in all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is first line option for treatment of URI in cats? if acute or chronic

A

acute - doxycycline or amoxicillin PO
chronic - same but base choice on C&S, doxy or amoxiclav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Canine infectious resp diease complex - first line?

A

Doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pneumonia in animals with no systemic manifestations - first line?

A

Doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pneumonia with sepsis?

A

FQ and penicillin or clindamycin initially, base oral drug choices on C&S and clinical response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pyothorax

A

Parenteral adm of FQ and penicillin/clindamycin with therapeutic lavage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In paper looking at comparison of LidCO and pulseCO in 15 dogs with SIRS, was there good agreement?

A

No - percentage error for the overall diff in CI values was 122%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In the paper comparing peritoneal fluid and peripheral glucose concentrations in the diagnosis of septic peritonitis, what was the sensitivity and specificity of whole blood vs peritoneal fluid, plasma vs peritoneal fluid and plasma vs peritoneal fluid supernatant?

A

WB-F - sensitivvity 41%, specificity 100%; P-PF = 88.2% and 80%, P-PFS = 82.4% and specificty 77.8% using a cut off of > 20 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In the peritoneal fluid vs peripheral glucose concentration for septic peritonitis paper what did the cut off have to be to improve the PPV, specificity and accuracy of P-PF and P-PFS?

A

=/>
38%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In the 2018 surviving sepsis update what is the main change from 2016 guidelines?

A

3 hour and 6 hour bundles have been combined into a single 1 hour bundle:
1. measure lactate and remeasure if initial lactate is > 2
2. obtain blood cultures prior to adm
3. adm BS abx
4. begin rapid adm of 30ml/kg crystallod for hypotension of lactate > 3 mmol/L
apply vasopressors if patient is hypotensive during/after fluid resusc to maintain MAP =/> 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the percentage of dogs with abdominal sepsis acquired AKI?

A

12%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What properties should an antimicrobail possess to allow it to adequately cross the blood prostate barrier?

A

Lipid soluble, weakly alkaline, high pKa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the prevalence of bacteriuria in catheterised dogs and cats?

A

10-55%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In a study looking at GFR, UOP and FE in AKI in dogs, what was the main diff in survivors/non survivors?

A

GFR increased signficantly in survivors, FE of NA decreased sig over time. The excretion ratio and fractional excretion were highly correlated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What was the conclusion of the GFR/UOP FE paper in AKI dogs?

A

That excretion ratio could be used as a surrogate marker to follow trends in solute excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Does fluid type have outcome on blocked cats?

A

No impact on outcome but quicker resolution of acid base abnormalities

22
Q

Post obstructive diuresis: how common is it and what is linked to it?

A

Baseline acidemia is linked to it. Seen in 46% of patients by 6 hours.

23
Q

Type of urinary cathter in blocked cats - which are preferred as indwelling and what size (5 vs 3.5 Fr) had a higher chance of reobstruction?

A

the polytetrafluoroethylene and polyurethane ones - firmer at room temp, softer when at body temp. 5Fr had moe chance of reobstruction

24
Q

What is the incidence of UTI after urinary cath placement in blocked cats?

A

33%

25
Q

What is the mechanism of epithelial dysfunction in AKI in sepsis?

A

Activation of tubuloglomerular feedbaack -> tubular dysfuntion leads to decreased reabsorption, and higher Na/Cl delivery to th emacula densa and vasoconstriction of the afferent arteriole/vasodilation of the efferent arteriole-> drop in GFR

26
Q

What are the 3 types of AKI grading systems in veterinary medicine? What was increasing grade assoc with?

A

RIFLE (like) criteria, AKIN, IRIS. Higher mortality.

27
Q

What are the drawbacks of RIFLE/VAKI?

A

Need patient’s baseline creatinine, may limit use to just hosp acquired AKI

28
Q

What biomarkers are potentially useful in the early detection of AKI?

A

URINARY NGAL, urinary cystatin C, NAG, retinol binding protein, tissue injhibitor of metalloproteinases 2, insulin like growth factor binding protien 7

29
Q

what type of fluids assoc with development of AKI in people?

A

adminisdtration of HES (septic patients - higher incidence of RRT needed), fluids containing supraphysiologic chloride -> affferent arteriole vasoconstriction via the macula densa

30
Q

What is the proposed pathphysiology behind HES related AKI?

A

Osmotic nephrosis from uptake of HES by tubular cells, accumulation of intracellular water, cytoplasmic swelling

31
Q

Retrospective study of non azotemic cats treated with HES vs cats that were not -> what was AKI defined as?

A

VAKI - > 150% increase or > 26 umol/L increase in serum creatinine from baseline

32
Q

Retrospective study of non azotemic cats treated with HES vs cats that were not - what as the median dose of HES given? What was the main finding?

A

20 ml/kg/day. SHort term change in serum creatinine and development of AKI were not significantly different between cohorts

33
Q

What are clinical signs associated with Leptospirosis infection?

A

Renal, hepatic failure, uveitis, pulmonary hemorrhage acute febrile illness, abortion, bleeding tendencies, vasculitis, acquired nephrogenic DI

34
Q

What are the clinpath abmnormalities assoc witjh Lepto?

A

Elevated kdiney values, increased liver values (ALP, TBIL > ALT), thrombocytopenia, increased CK, coagulation parameter changes (PT/APTT prolongations)

35
Q

Is MAT for Lepto accurate and how should it be interpreted?

A

Not really - frequently see negative MAT in first week of illness, reccomend convalescent titres 2-4 weeks after acute diagnosis. Recommend testing 7-14 days between titres, 4 fold increase supports infection. Titres can still be v high after vaccination. Sensitivity for single MAT titre > 800 was 67%

36
Q

How should PCR testing for Lepto be carried out?

A

Within first 7 days - Blood sample of choice, after 10 days get. highest conc in urine. If timeline unknown, test both. Sensitivity on whole blood was 90% in first 5 days of illness. Culture not for acute testing.

37
Q

How to treat Lepto?

A

Recommend doxycyline 5 mg/kg PO or IV q 12 for 2 weeks or if not eating etc then ampicillin 20 mg/kg IV q 6 hours, follow up with 2 week course of doxy to eliminate from renal tubules

38
Q

How is sporadic bacterial cystitis defined?

A

Traditionally described animals with no comorbidties that hav ehad < 3 episodes of cystitis in prio 12 months but animals with urinary tract abnormalities can also develop sporadic cystitis and not be at risk of complications/recurrence

39
Q

How to diagnose sporadic bacterial cystitis?

A

Presence of LUT signs with concurrent evidence supporting cystitis like hematuria, pyuria, bugs on cytology, C&S. Culture is preferred for all animals but empirical therapy alone can be justified in dogs but not in cats.

40
Q

How should sporadic bact infection be treated?

A

Empirically in dogs ok - can start while awaiting culture as well. In cats it is ok to withhold abs pending culture. Analgesia isreasonable. and may be as important as abx - starting this first then abx 3-4 days later if not resolving
Empirical abx - amoxicillin for 3-5 days (or amoxyclav)
do not recommend repeat culture if clinical response

41
Q

Recurrent UTI - what is reinfection vs relapse vs refractory

A

Recurrence of UTI within 6 months with a new organism
Relapse: recurrence within 6 months after apparently successful teratment, indistinguishable organism from prior
refractory - persistent positive results wit no period of elmiination

42
Q

What is a recurrent bacterial cystitis?

A

diagnosis of 3 or more episodes of clinical bacterial cystitis in prev 12 months OR 2 or more episodes in preceding 6 months

43
Q

How long should a recurrent infection be treated? Follow up?

A

3-5 days for reinfection. 7-14 for persistent potentially relapsing infection. If longer treatment done, then culture after a week can be considered - whether or not clinical cure documented?

44
Q

Pyelonephritis - what is major causative bug? What is treatment? WHat should be indicated on pathology form (for urine culture) and why?

A

Enterobacteriaceae. Fluoroquinolone first line usually, or cefpodoxime. ANtibiotic breakpoints for serum rather than urine drug concentrations iomportant because pyelo involves infection of the tissues and not the urine

45
Q

What bacteria are implicated in bacterial prostatitis? What empirical antibiotic is best? How long to treat for?

A

Gram negs (E coli, Klebsiella, Pseudomonas, Pasteurella), Gram pos (STaph, Strep), Brucella. Fluoroquinolone - best penetration of the blood prostate barrier. 4 weeks for acute, 4-6 if chronic

46
Q

WHat is subclinical bacteriuria defined as? What is the incidence of this reported in healthy dogs?

A

Presence of bacteria in urine determined by culture from cystocentesis in the absence of clinical evidence of ifnectious urinary tract dz. up to 12%.

47
Q

When to treat subclinical bacteriuria?

A

Hardly. Can be considered if clinical signs are due to cysttiis. or if there is concern for high risk of ascending/systemic infection or that bladder is a focus of extra urinary infection. plaque forming organisms like corynebacterium, urease producing staph

48
Q

If signs of cystitis are present and a ucath is in place (fever) - how to manage?

A

Remove, cysto and culture - replace cath if required, or sample can be taken through new catheter. Culture should not be performed on urine in bag etc. Remove catheter ASAP when possible. Do not routinely replace ucath.

49
Q

What should be done prior to urinary tract endoscopy/sx?

A

Bacterial culture performed prior to procedures - take a eek before. If bacteriuria identified, treatment for 3-5 days immed before procedure to decrease bacterial counts. Perioperative prophylaxis should be considered for stone manipulation and/or if pre-culture yields bacteria. if needed, 1/2 gen cephalosporin should be given IV < 60 mins prior to procedure, redosed intra op after 2 half lives. not given beyond 24 hours if no complications/infection. may consider longer course )(3-5 days) if bacteriuria pre procedure

50
Q

Based on results of a study by Kulendra et al in JSAP 2020, what was the MST in cats managed with SUB based on IRIS AKI?

A

IRIS stage 1-3 >900 days, IRIS stage 4-5 < 600 days

ACVECC Boards study (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions