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Learn this stuff! > Sticking points (things I don't know well) > Flashcards

Sticking points (things I don't know well) Flashcards

1
Q

What causes extracellular edema?

A

Anything that can cause abnormal leakage of fluid into the interstitium from capillaries or blocks lymphatic return (lymphedema).

Specifically: SIRS

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2
Q

What is the innervation to the distal rectum:
- Internal anal sphincter?
- External anal sphincter?

A

Internal: Parasympathetic (poop) -> pelvic n. Sympathetic (store) ->hypogastric

External: Pudendal (somatic/conscious control)
Caudal rectal branch of Pudendal = motor
Perineal branch = Sensory

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3
Q

What happens to PaCO2 in respiratory acidosis?
To bicarb?

A

PaCO2 is elevated (because resp acidosis is hypoventilation/hypercapnia)
Bicarb also goes up to compensate. For every 1mmHg PaCO2 bicarb goes up 0.15mEq (acute) and 0.35mEq (chronic)

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4
Q

What is the rule of 4s in acid/base?

A

Normals are 4s:
pH = 7.4
Bicarb = 24mEq
Base Excess = +/- 4
CO2 = 40mmHg

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5
Q

Which band of the CrCL is taught in both flexion and extension?

A

The smaller craniomedial band
(The larger, caudolateral is lax in flexion)

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6
Q

What are menisci made of?

A

Fibrocartilage

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7
Q

What are the size cutoffs for T1, T2, T3 in the TNM scale?

What does N1 mean?

What stage must anything be if there is a distant met?

A

T1 <3 cm in diameter; superficial
T2 3–5 cm in diameter or with minimal invasion despite size
T3 >5 cm in diameter or with invasion of subcutis despite size

N1 Movable enlarged lymph nodes on same side of body

ANYTHING with an M1 is stage 4

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8
Q

If a patient has a skin tumor 6cm in diameter, a metastasis to an ipsilateral node, and a met to lung, what is the WHO TNM classification?

A

T3 N1b M1 = Stage 4

(the b means the node was metastatic, an (a) is enlarged but not mets)

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9
Q

What cranial nerves are involved in the oral phase of swallowing?

The pharyngeal/pharyngoesophageal phase?

A

5, 7, and 12

Pharyngeal is 9 and 10

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10
Q

What are the three classes of wounds?

A

Class 1: 0-6 hours old with minimal contamination
Class 2: 6-12 hours old (bact have replicated, but may still be ok)
Class 3: older than 12 hours

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11
Q

What wounds should you close with primary closure?
Delayed primary?
Secondary closure (3rd intention)?
2nd intention (no closure)?

A

Primary: Class 1 or class 2
Delayed primary: Class 2
Secondary closure: Class 3
Second intention: Class 3

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12
Q

What dressings are appropriate for wounds in the inflammatory and early repair phases?

A

Any hyperosmotics, debridement (maggots, enzymes), hydrophilics, antimicrobials

Goal is debride, provide moisture

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13
Q

What dressings are appropriate for wounds in the repair phase?

A

Hydrophilics, bioscaffolds, chitosan, and growth factor impregnated dressings

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14
Q

What dressing should you put over a wound in the maturation phase?
What is unique about this phase?

A

Non-adherent semi-occlusive such as Telfa, Adaptic

Maturation phase wounds are not open - they have a fragile epidermis that needs protecting.

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15
Q

What is LPS?

A

LPS (lipopolysaccharide) is found in the cell membrane of gram negative organisms.
- It is a PAMP, recognized by TLRs which initiate inflammation upon encountering it.
- It is the MAJOR component of endotoxin, and when gram negative bacteria are lysed, it is released even more

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16
Q

What is an antibiogram?

A

A summary of local/hospital flora and their susceptibility.
It allows you to make an informed empiric antibiotic choice.

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17
Q

Do you use the MIC90 when you don’t have any data on your resistant bug?

A

Yes
MIC90 is population data/MIC statistics on a specific bacterial species - what concentration the isolates were susceptible to.

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18
Q

How much does pH change if alveolar ventilation is increased 2x?

A

If you double ventilation, PaCO2 goes from 40 to 20mmHg really quick. That causes the pH to shift from 7.4 to 7.7
Doubling resp rate for just one minute will increase your pH by 0.2!

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19
Q

What are indications for a left thoracotomy?

For a right?

A

Left only: PDA/PRAA, feline thoracic duct

Right only: Middle lung lobe access, dog thoracic duct

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20
Q

What intercostal space should you use for a “cranial” thing?
For the heart/pericardium?
For lungs?
The caudal esophagus?
The thoracic duct?

A

Anything “cranial” is 4th ICS
Anything Heart is also 4th ICS (PDA, PRAA, Pericardium)
Lungs = 5th ICS
Caudal esophagus = 7,8,9
Thoracic duct = 10th

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21
Q

What are the muscles that cross the shoulder joint?

A

Triceps (long head)
Coracobrachialis
Teres major
Teres minor
Subscapularis
Supraspinatus
Infraspinatus
Deltoideus

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22
Q

What are the bones of the carpus?

A

Top row: (medial) Intermedioradiocarpal : ulnar carpal (Lateral) + ACB
Bottom row: Carpal 1, 2, 3, 4 (only 4 interacts with ulnar carpal, they get bigger as you move lateral).

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23
Q

What are the muscles that extend the carpus?

That Flex the carpus?

A

Extend: Common and lateral digital extensors, extensor carpi radialis and ulnaris
- All are Radial nerve

Flex: Flexor carpi radialis and SDF, DDF - Median nerve
Flexor carpi ulnaris and ulnar head of DDF - Ulnar nerve

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24
Q

How quickly does endogenous histamine take effect?

A

Peak effect is 15-20 min

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25
Q

What are 4 things to know about bloodflow to the kidneys?

A
  1. The kidneys get 25% of cardiac output (4mL/kg/gram of tissue)
  2. 10% of animals will have multiple renal arteries, the left is more common
  3. Most of the bloodflow is to the cortex
  4. There is an “arterial circle” formed by small capsular arteries (off the phrenicoabdominal or adrenal arteries) that invade into the capsule and anastomose with renal vessels. This is more pronounced in diseased kidneys
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26
Q

Describe the RAAS pathway:

A

Decreased renal perfusion -> renin produced by the JG cells in the kidney -> renin cleaves angiotensinogen into angiotensin 1 -> this travels to the lungs where ACE cleaves it into Angiotensin 2, which has 3 effects:
- Retention of sodium
- Vasoconstriction
- Aldosterone production -> sodium absorption

All three effects cause increased arterial pressure and vascular remodeling to boost renal perfusion.

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27
Q

Describe the mechanism of injury to cartilage:

What does articular cartilage get replaced by (if anything)?

A

Cartilage damage -> activated host proteases such as aggrecanases (ADAMTS-4 and -5) and matrix metalloproteinases (MMP-13); this results in cartilage degradation.
It fights to keep up (phase 2) but eventually loses (phase 3/eburnation).

Replaced by fibrocartilage.

28
Q

What causes pain in OA?

A

Synovitis -> activation of latent C fibers

29
Q

Cheyne-Stokes respiration is defined by what pattern?
Kussmaul?
Apneustic?

A

Cheyne-stokes = increasing/decreasing depth and rate, separated by pauses
Kussmaul = regular, deep breaths
Apneustic = gasping with short/insufficient expiration

30
Q

In basic terms what is cardiogenic shock?

A

The inability of the heart to propel blood through circulation.
Systolic failures = anything that interferes with ability to PUMP
Diastolic failures = anything that interferes with ability to FILL

31
Q

What are four causes of diastolic dysfunction?

A

HCM (less space to fill)
Cardiac tamponade (external pressures)
Pericardial fibrosis (external pressures)
Tension pneumothorax (external pressures)

32
Q

What is the benefit of having a serosa in GI healing?

A

It forms a fibrin clot/seal almost immediately over any wounds/incisions.

33
Q

In the tarsus, what ligaments are taught in flexion?
Which ligament do cat’s not have?
Which are the two that are substantial/need to be repaired?

A

Tibiotalar (MCL) and TaLofibular (LCL)
Cat’s don’t have any long portions.
Tibiotalar (MCL) and Calcaneofibular (LCL)

34
Q

What vessels supply the tarsus?
What veins drain it?
What nerves innervate it?

A

Cranial tibial a. and plantar branch of the Saphenous a.
Medial and lateral Saphenous vv.
Tibial n. Common peroneal n. and saphenous n.

35
Q

Are NSAIDs antipyretic?

A

Yes

36
Q

What innervates all muscles of the larynx except cricothyroideus?

A

The caudal laryngeal nerve - the terminal segment of the recurrent laryngeal, from the vagus.

37
Q

What lymph nodes drain the larynx?

A

The medial retropharyngeal nodes

38
Q

What nerve supplies sensation to the laryngeal mucosa and is the efferent limb of the cough reflex?

A

The cranial laryngeal n.

39
Q

How long does fascia rely on sutures for?

A

14-21 days

40
Q

List the lipophilicity of opioids from low to high:

A

Low = morphine (1)
Hydromorphone (?)
Pethidine (28)
Buprenex (?)
Remifentanyl (50)/Alfentanil (90)
Fentanyl (580)

41
Q

What cells are sources of TGF?

A

Platelets (have lots premade)
Lymphocytes, macrophages, fibroblasts, endothelial cells

42
Q

At 2 weeks, what is the strength of Vicryl (polyglactin 910)?
Of Monocryl (poliglecaprone 25)?

A

Vicryl = 50%
Monocryl = 20-30% (has lost 70-80%)

43
Q

When does chromic gut lose nearly 100% strength?

A

by 7 days

44
Q

What % of extracellular fluid is intravascular?

A

25%

45
Q

What are the concentration dependent antibiotics?

A

Focus And Martial Arts:

Fluoroquinolones
Aminoglycosides
Metronidazole
Azithromycin

46
Q

Lasers (light amplification by stimulated emission of radiation):
- which is UV?
-which is blue/green?
-which is for lithotripsy and arthroscopy?
-which is for endoscopy and laparoscopy?
- which one is for cutting bone?
-what do you use diode for?
- what size vessel can CO2 coagulate?

A

UV = Excimer (least penetration too)
Blue/green = Argon (absorbed by hemoglobin)
Litho/arthroscopy = Ho:YAG
Endoscopy/Laparoscopy = Nd:YAG (deepest penetration)
Bone = Er:YAG (absorbed by hydroxyapatite) - low penetration
Diode is for declaws /dermal (better hemostasis than CO2)
CO2 can coag a vessel <0.6mm

47
Q

What are the zones of articular cartilage?

A

“Mothers use Tide to Remove Those Stains” from deep to superficial
Mature (calcified)
[Tide mark]
Radiate (30% thickness, collagen fibrils in a radial disposition, does MOST resistance to compression)
Transitional (40-60% thickness, proteoglycans, first compression)
Superficial (10-20% thickness, in contact with synovial fluid, a barrier, gives cartilage it’s tensile properties)

48
Q

Stomach vasculature:
Greater curvature?
Pylorus/antrum?
Fundus?
Lesser curvature?
Caudal esophagus?

A

Greater curve: Left gastroepiploic off splenic a. and right gastroepiploic off right gastric from hepatic a.
Pyloric antrum: right gastric off hepatic a.
Fundus: Left gastric off celiac a.
Lesser curvature: Left gastric (celiac) and right gastric (hepatic)
Caudal esophagus: Left gastric a.

49
Q

What two breeds get congenital laryngeal paralysis?

A

Huskies and Dalmatians

50
Q

Wobblers Disease (cervical spondylomyelopathy):
Most common site?
Breed for disc associated?
What is abnormal in Disc?
What is abnormal in Osseous?

A

C6-C7 most common
Dobermans get discs
Disc = bigger discs that protrude, high torsion area, canal stenosis worsens with age
Osseous = vertebral malformation and osteoarthritic changes at the level of the zygapophyseal joint.+/- ligamentous degeneration

51
Q

More Wobbler’s Disease:
What % present with non-ambulatory tetraparesis?
What% have adjacent segment /Domino effect?
What % improve with medical management?
With surgery?

A

15% present non-ambulatory tetraparetic
20% have adjacent segment syndrome (Domino)
50% improve with medical management
80% improve with surgery

52
Q

What metastatic neoplasm is most common in the spleen?

A

Lymphoma

53
Q

What is normal intracranial pressure?
When should you consider treating elevated pressure?
What are the two ways to herniate?
Which is better, craniotomy or craniotomy + durotomy?

A

Normal = 8-15mmHg
Consider treating when it is > 15-20mmHg
Transtentorial and Foramen Magnum herniation
Craniotomy + durotomy (65% reduction in pressure vs 15% for craniotomy alone)

54
Q

What is a 0 on the Frankel Scale?
What is a 1?
What is a 2?
Etc?

A

0: Plegic, pain negative
1: Plegic, has deep but no superficial pain
2: Plegic with intact nociception
3: Nonambulatory paresis
4: Ambulatory paresis with GP ataxia
5: Spinal hyperesthesia only

55
Q

What cell type kills via phagocytosis and superoxide radicals?

A

Neutrophils

56
Q

How many days does it take for a cat to fully granulate a wound bed?
A dog?

A

Cat: 19 days
Dog: 7.5 days

57
Q

What can MSCs turn into?

Where are they harvested from?

A

They have “tri-lineage” differentiation and are “Multipotent”
- Osteoblasts
- Adipocytes
- Chondrocytes

Harvest from bone marrow or digest of adipose tissue

58
Q

What does cartilage get it’s cushion from?

A

Water and proteoglycans
- the transitional and radial zones provide most compression

59
Q

What does increased PaCO2 do to cardiac output?

To pulmonary vasculature (in an awake patient)?

A

Increases CVP -> increases SV -> increased cardiac output

Causes local hypoxic pulmonary vasoconstriction (a compensation for V/Q mismatch)

60
Q

What happens in a left to right shunt that leads to failure?

A

Excess volume in the right (from pressure in left pushing it accross shunt) -> irreversible pulmonary hypertension -> eventual reversal of right to left flow (Eisenmenger syndrome) -> left atrial dilation -> left sided failure

61
Q

Describe the ligaments of the atlas as related to AA luxation:

A

There is a single dorsal ligament from C2 spinous process to C1 dorsal arch that supports the AA joint.
Usually in AA dogs, there is a failure of the ventral ligament or of the dens, and over time, the dorsal ligament weakens until signs are seen.

62
Q

A 2-0 barbed PDS suture has equivalent breaking strength to what?

Should you use barbed suture in tendons?

A

3-0 normal PDS

No, don’t use barbed in a tendon

63
Q

Benzodiazepines:
MOA?
Heart effects?
GI motility effect?
Liver effect?

A

MOA: Enhance GABA (inhibitory neurotransmitter)
Heart: No major effects (means good in ill patients)
GI: Increases motility/clearance
Liver: Diaz has an active metabolite so use midazolam in patients with issues.

64
Q

How many mL are in a blood-soaked:
Woven 4x4 ?
Non-woven 4x4?
Pre-moistened 12x12 lap sponge?

A

Woven =5-12.5mL
Non-Woven = 10-18 mL
Lap Sponge = 50 mL

**you can also weigh the sponge - each 1g is 1mL (the weight of the sponge is negligible)

65
Q

Transfusions:
What is the trigger volume loss / what PCV should a critical patient be kept above?
How much do you give of pRBC?
Whole blood?
What is the most common transfusion reaction?

A

Trigger is 20% of total volume in an acute loss (dogs are 90mL/kg, cats 50mL/kg total vol)
A critical patient should have PCV>24%
pRBC @10-15 mL/kg
Whole blood 20-25 mL/kg
Most common reaction is pyretic (>1C elevation in temp within 30-60 min of transfusion start, lasts up to 20hr)

66
Q

What is TACO?
What is TRALI?

A

TACO = Transfusion associated circulatory overload - common, morbidity varies but mortality low
TRALI = Transfusion related acute lung injury - rare acute respiratory distress <24hr post transfusion with no other obvious cause. Most common with plasma transfusions, higher mortality.

67
Q

What are the clinical levels of dehydration?

A

<5% - nothing detectable
5-8% - decreased skin turgor, dry/tacky membranes
8-10% - decreased turgor, dry membranes + sunken eyes/ slight CRT delay
10-12% - severe skin tent, dry membranes, sunken eyes, prolonged CRT +/- shock
>12% - all of the above + shock, life threatening

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