Test 3 Flashcards
Syncope is
transient diffuse brain malfunction with spontaneous recovery (loss of consciousness and postural tone)
Breeds- narcolepsy
poodle, lab, dobie
Syncope vs seizure
Sync- sudden, during activity, shorter duration; seizure- pre-ictal, starts at rest,
Radiation pattern of pulmonic stenosis
Radiates dorsally
Where is a murmur from PDA heard best
Left side, very cranial under triceps mm.
Where is a VSD murmur heard
Sternally
Radiation pattern of aortic stenosis
Cranially up neck
Murmur heard at apex is likely which valve(s)
Mitral
Murmur heard at base is like which valve(s)
Aortic or pulmonic
Px of idiopathic syncope
Good unless Boxer/Dobie/Dane
Syncope ddx for respiratory- hypoxia (3)
LarPar, obstruction, pleural space dz
Syncope ddx for respiratory- pulmonary hypertension (2)
HWD, MVD
Syncope- respiratory ddx categories (5)
Hypoxia, pulmonary hypertension, parasites, cough, hyperventilation, (humans: hyperventilation)
Pathophys of cough-induced syncope
Increased thoracic pressure reduces venous return
Ddx syncope parasite
Oslerus osleri
Peripheral vascular dysfunction ddx for syncope (3)
Neurocardiogenic syncope, carotid sinus syncope, postural hypertension
Name a type of neurocardiogenic syncope and describe its pathophys
vasovagal syncope (esp in Boxers): adrenergic surge during exercise/strong ventricular contractions leads to increased BP, resulting in reflex bradycardia or vasodilation
Hematological ddx for syncope (3)
anemia, polycythemia, myeloproliferative dz (esp myeloma)
Endocrine causes of syncope (4)
Hypo/er-adrenocorticism, DM, insulinoma(CKCS)/hyperinsulinemia, pheochromocytoma
Neuro ddx for syncope
emboli/thrombi, space-occupying lesions, atherosclerosis (2* to hypoT4 increased fat), seizures, brain/vestib dz, narcolepsy, trauma
Iatrogenic syncope causes
Digoxin, vasodilators (phenothiazines, acepromazine, Ca channel blockers, beta blockers, rare ACEi), quinidine, class 3 heart agents
Phys of class 3 heart drugs and syncope, examples
sotalol, K-channel blockers- prolonged Q-T (repolarization)
What drug beside class three heart Rx causes prolonged Q-T which can cause iatrogenic syncope
Cisapride
What two shunts can cause cyanosis
VSD and R to L PDA, +/- PS (with pulmonary hypertension)
Which AV valve dysplasia has worse Px
Ao worse than pulm
Pericardial effusion can cause syncope by
Diastolic collapse of RA
Four bradyarrhythmic ddx of syncope
Sinus bradycardia, sick sinus syndrome (CKCS sudden death), AV blocks, persistent atrial standstill
Describe 2nd* AV block ECG
Fixed PR interval with occasional pauses
Describe 3rd* AV block ECG
No P-R association, slow rate, ventricular escape
SYNCOPE CONTINUED
SYNCOPE CONTINUED
Decreased production ddx- hypoproteinemia
liver dysfunction, mal-dig/abs and starvation, inflam dz (mild bc acute phase)
Increased loss ddx- hypoproteinemia
renal, intestinal, third space, burn
Main ddx categories for hypoproteinemia in young dogs
Congenital, infectious
Main ddx categories for hypoproteinemia in older dogs
inflammatory, neoplasia, metabolic
Most common cause of hypoglobulinemia
PLE
Dx test to eval liver in hypoprot
Start with chem,+/- bile acids, CT angiography for PSS, Bx
5 major concerns with hypoproteinemic patient
lower anesthetic drug requirement, more susceptible to fluid overload (LOOK UP), wound dehiscence, thromboemboli from lost antithrombin, hemorrhage from hepatic failure/clotting factors
What should be higher in fluid than serum in abd’centesis to be chyle
Triglycerides
When would you not want to do bile acid testing in hypoproteinemia
panhypoprot, other liver fxn markers WNL
When is bile acid testing indicated in hypoprot
low alb/norm glob; low BUN, low chem fxn tests
What breed is overrepresented in lymphangiectasia
Yorkie
Tx lymphangiectasia (hypoprot lecture)
Low fat diet +/- course of steroids
Causes of lymphangiectasia
IBD, neo, congenital
Where does thermoregulation take place in the brain
Anterior hypothalamus
Two metabolic ways of increased heat production by thermoregulatory center in brain
catecholamine and thyroxine release
Any elevation in core body temp due to production >loss is
Hyperthermia
Define pyrogenic hyperthermia
FEVER! Change in regulatory set point
Three non-pyrogenic types of hyperthermia
Inadequate loss, exercise induced, pathologic/pharmacologic
Name four exogenous pyrogens
Infectious agents (and LPS), immune complexes, inflammation, drugs (tetracyclone)
T/F exogenous proteins can directly cause hyperthermia
False- they stimulate endogenous pyrogen release
What are the four main endogenous pyrogens
IL-1, IL-6, TNF, IFN
Describe endogenous pyrogen pathway
Monocytes release cytokines which bind to vasc. endothelial cells in ant. hypothal, producing PGE1 and 2, and set point is altered
Criteria for FUO
Temp elevated, no spontaneous resolution, no determined cause on full initial workups
Top three ddx categories for FUO
Infection, imm-med’d, neoplasia
Negative prognostic indicators in parvo (5+)
NEURO signs, C-reactive protein (not sen/spec); CS: V, leth, hypoALb, lymphopenia (2 more days hops), low cholesterol, poor maintenance of WBC count
Tx in CPV (7)
Replacement fluids, 1/4 shock dose; unasyn + aminoglycosides; anti-emetics; PPI/H2-blocker; +/- analgesia
Tx CPV outpatient (4)
IV resuscitation, one cefovecin SQ, maropitant SID q 5d, SQ fluids prn
Avg water requirement, adjustment factors (4)
1 (-2) mL/kcal; 1.8 mL if overweight, hot; ) 0.5 mL/kcal for very cold; 2x as much bc poor concentrating ability until 11wks
IV Maintenance fluid rate for parvo patient -adlut, puppy
1 mL/kcal at 1 mL/lb/hour - adult (2x that for puppy +deficit%)
Shortcut math - 1/4 deficit
10 mL/lb bolus, then 2-5 mL/lb/h (or more with losses) per hour to replace rest of deficit
Disinfectant for parvo, shedding info
Bleach (1:30 >10min), trifectant, steam (shedding for weeks, survives for ~5 months on fomites)
Distemper disinfectant
Any disinfectant, shedding two weeks
Convalescent titers-
Need 4 fold increase
Lepto titers, high certainty start-point
800
Main CS lepto
vasculitis/edema/SIRS/fever; kidney, liver, LPHS (pulmonary hemorrhage syndrome); meningitis/uveitis/pancreatitis
CSF fluid in FIP
Very high protein (>200), high WBC (neut»_space;L, M); risk of herniation during collection
Strength of RT PCR testing in FIP
Good for detecting FCoV shedding in feces (cant tell benign from fulminant-form), presence of ORF or org out of GI doesnt indicate risk
Histo dx of FIP
Corona virus found with immunohistochem in pyogranulomatous lesions
Best dx for FIP besides histo
Rivalta test (> FCoV Ab, A:G ratio, IgG)
Why is FIP-IN vax not effective
labeled for 16+wks and exposure likely earlier- wont work after exposure
Breeds- FIP
Persian/Birman
Chance of 2nd cat in home getting infected with FIP
All will be seropositive, but no more risk due to exposure (unless genetic)
Syncope- tx vtach
IV lidocaine 2 mg/kg up to 4 times, may give K; esmolol (short B-bl) or sotalol (class 3) may also help
Which escape rhythm is supraventricular
Junctional
Ddx right axis shift
PS, HWD, pulm hypertension, VSD, TofF
What dx for 3* AV block
borelia titer, echo for MVDz, infectious dz PCR
Ddx afib
ANY cause of LAE- DCM, HCM, MVD, idiopathic
Ddx electrical alternans
Pericardial eff, pleural eff, SVT/AFib
Most dogs with Afib respond to what Tx
Digoxin and diltiazem (NO B-blockers in CHF!)
Define v-tach
> 3 VPCs
Differentiate VTach and ventricular escape
If escape control of SA node,
Ventricular vs junctional escape
Junctional (40-60), ventricular (20-40)
No p wave- ddx
Atrial standstill > sinus arrest
Why would a junctional escape be a slower rate than expected?
Conduction issue compounding- such as RBBB
Atrial standstill ddx
Hyperkalemia, myocarditis (lyme, trypan, rickett, bartonella), cardiomyopathy (EngSprSp), doxorubicin
When should VTach be treated
CS of dec. CO, R on T, multifocal,
Define neonate time periods
Neonatal: birth-2w; transitional: 2-4w; socialization: 4-12w; juvenile: 12w-puberty
When do dog eyelids open
5-14 d
When do ear canals open
6-14 d
When can puppies walk/U/BM spontaneously
14-21 d (extensor dominance at 5 days)
When is PCR like adult
8w
When is renal function like adults
8 w
When is liver function like adults
4-5 m
Normal temps for neonates
96-97F for weeks 1-2; 100F at 4w
Appropriate puppy weight gain
Double body weight in 10 d (5-10%/d); (Toy 100-200g, large 400-500g, giant 700g)
Appropriate kitten weight
100g at birth, double in 2 weeks (10-15g/day); 1 lb/month for 4 months (Slower in formula fed)
When should neonates be weighed?
12 h after birth, then daily for 2 weeks
Ddx categories for failure for neonate to grow
genetic, insuff nutrient, excessive nutrient loss, metabolic abnormalities
Neonate water turnover
2-3x adult
Dx dehydration in neonate
Dryness of oral/ocular MM or USG
Menace develops at
2-3m (starts developing at 3w)
Eval PLR in neonates at
21 days
When can you do otoscopic exam on young
> 4w
When should large breed puppy have ortho exam
Regularly from 2-6 months
Circulatory differences in neonates
Less BP, SC, PVR; Greater HR, CO, CVP
Normal neonate HR/RR
220 bpm with 15-35RR for first 4 weeks
Parameters for physio murmur in young; when to assess
Gr 1-3, early left basilar systolic; assess if present at 3m
What would indicate lung pathology in young
Absence or asymmetry of lung sounds
Three most common neonate issues
Hypothermia, hypoglycemia, sepsis
What is the critical neonate group
Lost >10% birth weight at 24 hours- needs feeding/fluids/nursing
Best way to assess neonate hearing
BAER at >6w
When do neonate teeth erupt
3-4 weeks
Testicles should be present by
16 w
When are all postural reactions present
6-8 weeks
Parameters of viability scoring
2 pts each: Activity/mm. tone, pulse/HR, stress reflexes, MM color, RR
Viability scoring
0-3 weak, 4-6 moderate, 7-10 normal
When are lab tests similar to adults
4 m
Neonate PCV
higher than puppy or adult (42%)
Neonate rads differences-
patially mineralized bones, soft tissue thin, 75% water- decreased kvp to half of adult at same thickness
When: solid food? wean?
Solid: 3w, wean 6-8w
Causes of sepsis in neonate
Gram -ve to blood via GI, resp, UT, skin infxn
Dx neonate sepsis
Hx/PE- umbilicus pucture wounds; MDB; bands in buffy coat, UA, cultures
When should client call vet
crying for 20 min when not alone, refusing nursing
Breeds- neonate renal dysplasia
Dogs> cats (lhasa, shih, wheaten, poodle)
Renal dysplasia- neonate causes
in utero panleuk, herpesvirus
Origin of DI in neonate
Hypothalamus or nephrogenic
CS appearance of PSS in young
Puppies- 6-8w; kittens by 6 months; variable CS, ascites/icterus rare
Kitten breeds for PSS
Himalayan, persian, mixed
Most consistent kitten signs of PSS
Hypersalivation, seizure, ataxia, tremor, depression; 2/3 will be small/thin/unkempt;
(less: blindness, mydriasis, V/D/Anorex, non-specific)
Kitten ddx for PSS
ARF, UTdz, hypoglycemia, electrolytes
Most reliable way to dx PSS in neonate
Fasted pre/post bile acids
Causes of pancreatitis in <6m
Trauma, parvo, FIP
Dog deciduous formula
I 3/3, C 1/1, P3/3
Dog permanent formula
I 3/3, C 1/1, P 4/4, M 2/3 (Gain P1/1, M 2/3)
Kitten deciduous formula
I 3/3, C 1/1, P 3/2
Kitten permanent formula
I 3/3, C 1/1, P 3/2, M 1/1 (gain M 1/1)
Where are caries most commonly found
Maxillary molars
What is wear from occluding tooth
Attrition (vs abrasion from external source)
When to extract discolored teeth
If on rads: lg pulp chmber, resportion into oral cavity, apical lucency (if no dz, recheck 6m-1yr)
Cat- first tooth involved in resorption
mandibular 3rd premolar
What is resorption in cats
Odontoclast resorption of cementum (alv bone fused to cementum, no periodontal ligament)
When can crown amputation be done in cat resorption (when can’t it?)
Ankylosis and no stomatitis, no visible periodontal ligament- Type 2; Cant in type 1, when periodontal ligament is in place)
Cause of resorption in dogs
Trauma, malocclusion, orthodontic force, inflammation
When can dog crown amp be done in resorption
If root indistinct (ankylosis)
Dog- patterns of resorption
Internal - starts in root canal, +/- tooth turns pink; External- starts apically (common in premolars); odontoclastic- like cats, least common, less important
6 indications for Abx in periodontal dz
Ulceration, severe +/- osteomyelitis, systemic dz, additional sx, bone implants, pulp capping/root canal (for 5-7d)
Dx testing values affected by oral dz
ALT, ALP, AST (1.5-2x normal), TP (glob), BUN
Tx cat stomatitis
Prophylaxis, Abx, pain rx, anti-inflam, extractions (distal to canines), home care +/- antiinflam or laster tx to remove proliferative tissue
Weaned kitten feeding recommendation
TID, no supplementation
What Abx in neonate sepsis
B-lactams (penicillin, cephalosporins)
What Rx causes abnormal teeth/bone development in young animals
Tetracyclines
What rx causes arthropathy, anemia, skin rxn, KCS in young animals
TMS
Why shouldnt gentamycin be used in young
Nephrotoxicity
When are dogs most sensitive to enrofloxacin
Up to 28 weeks (7m)
Why are beta lactams the antimicrobial of choice
prolonged half life, large therapeutic index
Neonatal isoerythrolysis- clinical course
Sudden death in first day w/o CS; stop nursing in first 3 days (red urine, icterus, anemia, fading to death in first week); tail tip necrosis in survivors
What are the main viruses in young
parvo, corona, herpes, adeno, calici, retro, morbilli
Normal gingival sulcus depths- dog and cat
Dog: 1-3mm, Cat: 0.5-1mm
2 most common periodontal dz anaerobes
Peptostreptococcus, porphyromonas
Most likely oral pathogens
Strep, staph, pasteurella, candida, spirochetes
Name three Abx for periodontal infection
Clavamox, clindamycin, doxycycline
If you found white plaque-like lesions on the tongue/mucosa, what would you likely diagnose
Mycotic stomatitis
Cause of mycotic stomatitis
Candida albicans overgrowth
Lepto Abx and course duration for oral ulcers
For two weeks:
‘cillins (peni, amoxi, ampi) and ‘cyclines (doxy, tetra); For 1 week: azithromycin
Granulomatous, yellow white lesions on tongue or mm- dx
blastomyces dermatidis
Tx oral blasto
Itraconazole for 2 months
CS of renal uremia in mouth
Pressure point ulcerations
Most severe poisoning affecting oral health; CS
Thallium- malaise, facial/oral erythema, severe pain
What is Plant awns from the hair coat causing oral trauma
phytogranulomatosis
Main CS from oral trauma
pawing, ineffectual swallowing
What type of stomatitis requires early, aggressive tx
Abyss/Pers/Siam/MCoon cats without cause for periodontal dz (plaque, teething)
Primary goal of feline severe stomatitis tx
reduce inflammation through plaque control (dental prophy)
Hallmarks of heatstroke
severe CNS disturbance with multiple organ dysfunction; temp >105.8
Four mechanisms of protecting from heat stroke
Thermoregulation, acclimatization, acute phase response, heat shock protein production
What accounts for 70% heat loss in pets
Radiation and convection
Define sensible response-
< 89.6F; conduction/convection/radiation
Define insensible response
> 89.6F, via evaporation via panting (pons), mm v’dilation; partial air system: in nose, out mouth to max SA
6 predisposing factors for heat stroke
Obesity, lar par, prev heat stroke, CNS dz, CV dz, exercise
Hypothalamus response to increased body heat- describe
Increased symp tone- inc HR, CO, mm. blood supply, cutaneous vasodilation; decreased splanchnic circ (kidney, GI, etc), –> sensible heat loss; panting to increase minute ventilation- evaporative heat loss
3 causes of evap cooling fail
env temp> body, dehydration, humidity >80%
Timing of dog acclimatization
partial 10-20d; full 60d
7 steps of acclimatization
- conserve water via aldo/adh 2. RAAS activation 3. Na-sparing 4. increased GFR 5. plasma vol expansion 6. increased HR and CO 7. increased ability to resist rhabdomyolysis
Consequence of failed adaptive mechanisms (4)
hypovolemia/dehy –> v’constrict’n and dec. CO –> hypoxia/dec perfusion –> hemorrhagic D, DIC, arrhythmias, renal failure
Define acute phase response
Coordinated response btwn endo cells, leukocytes, epith cells to protect from injury and promote tissue repair via cytokines, esp IL-6
What stressors can cause production of heatshock proteins; how
Heat, O and N reactive molecules, endotoxemia, ischemia; via increased transcription rate
Effect of HSPs
increased levels allow transient state of tolerance that would normally kill cells
5 mechanisms of HSPs
prevent protein breakdown/refold to correct; protect epith barriers to prevent endotoxin leakage, block apoptosis and interfere with oxidative stress; maintenance of arterial pressures to decreased cerebral ischemia; regulate bararecept reflex (to stop hypotension, bradycardia)
Pathophys of heat stroke- 7 key features
CV collapse, endothelial damage (global), coag alterations, CNS dysfxn, GI integrity loss, acid/base, sepsis/shock
Pathophys of CV collapse in HS
V’dilation in skin/mm in response to increased core temp –> decreased splanch BF –> generation of ROS/RNS –> splanchnic arteriolar dilation, organ dilation –> dec. CVP and CO –> circulatory shock
HS respiratory CS and 2 inciting factors; sequellae
CS: alv hemorrhage, pulm edema, congestion; from direct thermal injury to epith and increased pulmonary vasculature resistance from inflammation cytokines; DIC, ARDS
HS renal dmg model- 3 causes
direct thermal OR indirect via hypoxia from shunting or microthrombi in DIC OR muscle breakdown causing myoglobin nephrotoxicity
What portion of the liver has the most damage in HS
Centrilobular necrosis d/t highest function
Rx for GI HS signs
(-cidals) ampicillin and metro; metoclop and cerenia
Parvo organisms
CPV2, 2a, 2b, 2c
Ddx parvo
CPV1 (<8w puppy), cornoa, rota, circo, clostridial enteritis, HGE, distemper, helminth, salmonellosis
