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195 Cards in this Set

  • Front
  • Back
In the ECG, what is the refractory period?
Time during which the SA node cannot fire again
Which adrenergic receptors are in the heart muscle?
Beta
Cadiac output is equal to what?
CO= SV x HR
Mean arterial pressure is equal to what?
MAP = CO x SVR
Fluid movement is based on what law?
Starling's law
What is preload?
Volume of blood returning to the heart
What is afterload?
The resistance the blood has to force through to get out
What are the priorities of the heart?
-maintain normal systemic arterial pressure
-maintain normal tissue blood flow
-maintain normal systemic and pulmonary capillary pressure
What is the heart's response to an increase in preload?
A change in the force of contraction and stroke volume
What effects of the CO are seen with heart disease and failure?
-volume overload
-pressure overload
-pump failure
-electrical abnormalities
What is an example of volume overload?
Mitral or tricuspid endocardiosis
What is an example of pressure overload?
Aortic stenosis (increased afterload)
What heart disease condition is an example of pump failure?
Dilated cardiomyopathy (thin floppy valve)
In which dog breed is cardiomyopathy due to an abnormality of the electrical system seen?
Boxers
What are some of the clinical signs of heart failure?
-syncope
-exercise intolerance
-cough
-dyspnea
-abdominal distension
-cyanosis
What additional clinical signs might you, as a vet, find with a cardiac failure patient?
-pulse abnormalities
-murmurs
-arrhythmias
-jugular pulses
Jugular pulses can indicate what disease condition?
Heartworms
What other information should you gather for the Hx of a cardiac patient?
-vacc status
-travel hx
-diets, changes in H2O
-indoor/outdoor
-activity level
-coughing...when?
-vomiting/gagging
-urinary habits
-fainting/weakness
-MM changes/cyanosis?
-medications
What body posture will a dog assume if he is having breathing difficulties?
Broad stance
What are the general signs of backwards cardiac failure?
Respiratory signs, ascites
What are the signs of low cardiac output-- forward failure?
Usually late onset
-exercise intolerance
-syncope
-pre-renal azotemia
-cyanosis
Left sided, backwards heart failure will have what effect on the lungs in the dog?
Pulmonary edema
In cats, left or right sided backwards cardiac failure will have what effect on the lungs?
Pleural effusion
What clinical sign, in a cat, would lead you to suspect pleural effusion?
Dyspnic, open-mouth breathing
What are the causes of cardiac arrhythmias?
-structural pathophysiologic remodeling
-genetic factors
-environmental stress
-ischemia
-modulated by endocrine factors
At which cardiac phase are the coronary arteries supplied with blood?
Diastole
What is the clinical appearance of a dog with an arrhythmia?
-anxious
-open-mouth breathing
-orthopnea and elbows abducted
-tachypnea
-hyperpnea
-inspiration vs expiration
What are the signs of syncope?
-exertion or excitement
-rear limb weakness
-sudden collapse
-lateral recumbency
-opisthotonos
-micturation
-vocalization
-hypoxia
What are the causes of coughing in a patient with cardiac disease?
-CHF
-mainstem bronchi compression
-pneumonitis & vascular disease secondary to HWD

(non cardiac dz = airway dz, parenchymal dz, pleural space dz)
Why should you pay close attention to the MM and CRT on potential cardiac patient?
For signs of anemia, hypotension, poor perfusion, differential cyanosis
On abdominal palpation of a cardiac patient, what might you feel? (think right sided failure)
Fluid wave
Why should you palpate the chest during PE on a cardiac patient?
Sometimes can feel a murmur
Aside from checking the arterial pulse of a cardiac patient, what else should you do?
Check pulse pressure differences along with auscultation
In which condition would you find a difference between pulse pressure?
PDA
Why do you examine the eyes of a cardiac patient?
To look for hemorrhages or detached retina
Jugular pulses are a result of increased venous pressure from what type of heart failure?
Right sided

(or pericardial dz, volume overload, cranial mediastinal masses)
What are the causes of right sided failure?
-tricuspid disease
-pulmonary hypertension
-caval syndrome
What are you listening for when auscultating the chest?
-heart sounds
-heart rhythm and rate
-lungs
-increased respiratory noise/purring
What is the general cause of a heart murmur?
Turbulance
What clin path diagnostics would you perform when working up a cardiac patient?
-thyroid function (cat)
-heartworm test
-CBC
-Chem/UA
-blood culture
-rads
-U/S
-areterial blood pressure
-ECG
-neuro exam
-holter monitoring
-event monitoring
What information can echocardiography give you? (ultrasound)
-it's non-invasive
-images the heart (chambers, vessels, valves)
-measurements
-Doppler; evaluate flow and pressure, valves
What 2 modes are used to image the heart?
-2 D
-M mode
When would you consider performing a cardiac catheterization?
-for diagnosing a complicated congenital abnormality
-evaluating pressures
-therapeutic measures (ballooning, stenting)
-research
What is the most common type and cause of hypertension?
Secondary, concurrent with clinical disease of drug administration
What is the effect of hypertension on the kidneys?
Progression of CKD
What are the effects of hypertension on the eyes?
Retinopathy- acute blindness, detachment, vessel toruosity etc
Hypertension can have what effects on the brain?
Encephalopaty or stroke
What effects of hypertension can be seen in the heart?
Left ventricular hypertrophy or cardiac failure
What effects does pulmonary hypertension have?
-increased pulmonary bloodflow
-increased blood viscosity
-increased pulmonary vascular resistance
-luminal narrowing
Depolariaztion of the ventricles is seen in which segment of the ecg?
QRS
When examining a mean electrical axis from an ecg, what does a Right axis deviation mean?
The Right ventricle is getting bigger
When evaluating an ecg, what 5 questions do you ask?
-rate
-rhythm
-P/QRS, QRS/P
-QRS morphology
-measurements
On ecg paper, each horizontal line represents what value?
.5 mv
On ecg paper, what does each vertical line represent?
.02 secs (at 50mm/sec)
On which ecg speed are mesurements performed?
50 mm/sec
What are the causes of bradycardia?
-Sinus node
-enhanced parasympathetic tone
-hypothyroid
-hypothermia
-hyperkalemia
-hypoglycemia
-drug therapy
-Av block
What are the causes of tachycardia?
-pain
-fever
-anemia
-reduced cardiac output
-hyperthyroidism
-excitement
An increase in the amplitude or duration of the P wave indicates what?
R or L atrial enlargement
An increase in the R indicated what?
-increase in amplitude = Left Vent enlargement

increase in duration = Left bundle branch block
What does an increased S indicate?
-increase in amplitude = Right Vent enlargement

-increase in duration = Right bundle branch block
What information does a vector analysis provide?
Measure of the net area under QRS
INTRO TO CLINICAL NEURO
INTRO TO CLINICAL NEURO
What types of injuries cause neuronal tissue damage?
-hypoxic
-chemical/toxic
-mechanical
What changes in the axons can be seen with neuronal degeneration?
-swollen axons
-degraded axonal material
What is Wallerian degeneration?
Myelin loss
Head pressing and circling are indicative of a lesion where in the brain?
Forebrain
Tetraparesis and ataxia of all 4 limbs is indicative of a brain lesion where?
Brainstem
What signs might you see in a patient with a cerebellar lesion?
-wide base stance
-tremors
-ataxia w/o paresis
A lesion cranial to the pons will produce signs where in the body?
On the contralateral side
Central and peripheral vestibular disease will both cause head tilt. How do you then distinguish one from the other?
central: tetraparesis

periperhal: ataxia w/ no paresis
What is a potential cause of peripheral vestibular dz?
Otitis media
A transection of the Thoraco-lumbar spine can cause what clinical sign?
Schiff-sherrington
What are the clinical signs of a peripeheral nerve lesion?
-flaccid paralysis to affected limb/area
-decreased muscle tone
-rapid atrophy
-decreased spinal reflexes
What signs would you see in NMJ disorders?
-flaccid paralysis to all limbs
-decreased muscle tone/spinal reflexes
(ie MG)
What signs would you look for in muscle weakness?
-paresis, worse after exercise
muscle atrophy, +- pain
During a neuro exam, why do you evaluate the posture and gait?
To check for paresis, ataxia, lameness
What are some examples of postural reactions?
-CP
-hopping
-placing
-hemiwalking
-wheelbarrowing
The neuro exam also consists of checking which spinal reflexes?
-withdrawl
-patellar, sciatic, cranial tibial
-biceps, triceps, ecr
-perinel/anal tone
-bulbourethral
-cutaneous trunci
What are the steps in performing the neuro exam?
-describe the abnormalities
-localize the lesion
-describe concurrent non neuro dz
-characterize onset and progression
-general rule out list
-dx testing
What conditions can serology hep rule in or out?
-toxoplasma
-neospora
-ANA - lupus
-2M antibodies- masticatory myositis
-Mg AChR antibodies
-distemper
-thyroid
What are the risk of performing a myelogram?
-inflammation
-seizures
-can worsen condition
EMG is an electrodiagnostic test of what?
Nerve conduction (destruction, severance, demyelination)
What is the definition of a seizure?
Excessive or hypersynchronus abnormal electrical activity in the cerebral cortex
What are the phases of a seizure?
-prodrome
-aura
-ical
-post ictal
Intracranial seizure can be caused by what structural changes?
-vascular
-neoplasia
-granuloma
-encephalitis/meningitis
-trauma
-anomalous- hydrocephalus
-strorage disorders
What is the cause of functional intracranial seizures?
Epilepsy (idiopathic)
What are some of the extracranial causes of seizure?
-Metabolic (endocrine, hypoxia, hyperthermia, hypoglycemia, electrolytes, liver/renal dz)

-Toxic
What paroxysmal disorders can be confused with seizures?
-syncope
-episodic paresis
-MG
-vestibular dz (rolling)
-movement disorders
-sleep disorders
-OCD
Which dog breed is predisposed to Hansen Type I disc disease?
Chondrodytsrophic
(explosive disc)
What is a Hansen Type II disc?
Occurs in any breed, usually older, compressive
INTRO TO FLUID THERAPY
INTRO TO FLUID THERAPY
Why do patients need fluid therapy?
-loss of body water
-loss of electrolytes
-excessive intake of electrolytes
-systemic disease
The power to move water is related to what?
Effective osmols
What is the role of plasma proteins in osmolarity?
Plasma proteins create oncotic pressure to hold water within vascular space
What are insensible water losses?
-evaporation
-fecal water loss
-renal water loss
Movement of water from the ICF to the ECF is based on concentrations of what?
Electrolytes
What are the daily water intake requirements for a horse? A dog?
Horse: 50 ml /kg/day

Dog: 60 ml/kg/say
Failure to replace insensible losses can lead to what condition?
Dehydration
Failure to replace isotonic fluid loss leads to what?
Hypovolemia
What is the definition of dehydration?
Loss of body water
Which compartment is responsible for loss of water?
ICF
What is the general cause of dehydration?
Loss of body water and failure to replenish the ICF deficit (changes tonicity of compartments)
What electrolyte sign is the hallmark of dehydration?
Hypernatremia
What is the definition of hypovolemia?
Volume depletion refers to a reduction in ECF volumes (intravascular space)

-loss of water and electrolytes
-loss of isotonic fluid
(no change in tonicity)
What condtions result in hypovolemia?
- blood loss
-diarrhea
-vomiting
Which water compartment is affected by hypovolemia?
ECF (vascular and interstitial spaces)
Why is it important to distinguish dehydration from hypovolemia?
-pathophysiologic processes are different
-clinical signs are different
-treatments are different
How does the body respond to dehydration?
-occurs over time
-response trigger is a change in tonicity (incr in plasma osmolality)
-pure water loss increases the tonicity of ICF
-leads to systemic hypernatremia
-increased serum Na trigers central osmoreceptors (thirst center, release of ADH)
How does the body respond to volume depleation?
-decreased ECF volumes leads to decreased venous return to RA and decreased CO
-decrease in CO activates many homeostatic mechanisms to improvce circulating volume (RAAS/AVP)
-exhaustion of homeostatic mechanisms leads to hypovolemic shock
What information is needed to recognize that a patient needs fluid therapy?
-PE
-labs
-history
What are the clinical signs of dehydration?
-tachycardia
-tacky MM
-prolonged skin tent
-sunken eyes
-increased urine SG
What are the clinical signs of hypovolemia?
-tachydcardia
-decreased pulse pressure
-reduced jugular fill
-tachypnea
-cold extremities
-decreased urine output
-depressed mentation
Is the assessment and level of hydration status sensitive to dehydration/hypovolemia?
No, insensitive
What is the threshold for clinical signs of dehydration?
3-5% loss of body water
What la test help in your diagnoses of hydration status?
-PCV
-TS
-USG
-Serum creatinine
-lactate
-body mass (weigh)
After giving crystalloids, how much remains in the intravascular space?
25% after 30 mins
What are the benefits to using hypertonic saline (7% NaCl)
-provides immediate expansion of vascular volume
-creates hypertonicity of ECF, redistributes fluid from ICF
-volume expansion is 2-3X volume infused
Is hypertonic saline a maintenance fluid?
NO- for resuscitation
When giving a horse hypertonic saline, what else should you give?
For every 1 liter of hypertonic saline, give 10 liters of crystalloids
Why are colloids called "glue"?
The remain in the vascular space
Colliods contain molecules that do what?
Exert oncotic pressure, remain in the vascular space, draw water from the interstitium into the vasc space
When are collids used?
Patient with hypoproteinemia
What are the advantages to using frozen plasma?
-excellent source of albumin (anti endotoxemic, clotting factors)

-easy to read o refractometer
What are the disadvantages to using frozen plasma?
-slow admin
-transfusion reactions
-requires time to thaw
-crossmatch
-blood admin set
-expensive
What colloid is a synthetic product that will increase vascular volume
Hetastarch
What are the disadvantages to hetastarch?
-cannot measure on refractometer
-has been associated with prolonged bleeding times at higher doses
When is whole blood used?
for blood or platelet loss
What is oxyglobin?
Polymerized bovine hemoglobin product
How long do the effects of oxyglobin last?
18 hours

long shelf life too
What are the routes that are used for fluid therapy?
-oral
-enteral
-subcuatneous
-IV
How is enteral fluid Tx given to a horse?
NGtube
-small intestinal resoprtion
What is the contraindication to using enteral fluids replacement?
Nasogastric reflux due to obstruction (must use IV for fluid replacement)
Is subcutaneous fluid replacement sued for horses?
No- small animals
what site is used for subcutaneous fluid therapy?
Interscapular space
The IV route is the most direct route to which fluid compartment?
ECF
When is the IV route for fluid therapy used?
Emergency resuscitation

requires critical monitoring of clinical signs and electrolytes
Why is the diameter of the catheter important in IV fluid therapy?
The bigger the radius the more flow (Poiseuille's law)
What are the site for IV catheter placement for fluid therapy?
-jugular vein
-cephalic vein
-saphenous vein
What catheter material is for long term use?
Polyurethane
What things should be kept in mind when placing/using an IV catheter?
-aseptic technique
-suture in place
-monitor site for inflammation
-flush 4x day with hep saline
How do you know if your fluid therapy worked?
Monitor your patient's response
Where do horse get their daily water?
Pre-prandial drinking
A horses diet affects their water intake, what type of diet increases water consumption?
High fiber, high protein/calcium
From where do horses get their potassium?
From diet- hay/baled forages are high in K+
Why is calcium important to a horse?
Minimal GI regulation, Ca is dietary dependent
Horse with anorexia are K and Ca deficient.. why is this important?
With decreased appetite horses will drink less, leads to clinical dehydration and e-lyte imbalances
What happens to a horses heart rate with increasing dehydration?
HR increases
How do you calculate the correction for the amount of dehydration?
% dehydration x body wieght (kg)
Water replacement for dehydration should be given over what time period?
12-24 hours
In the case of hypovolemia, a shock dose of fluids is given. How much is a shock dose?
Shock does = 1 blood volume = 8% of body weight
How much of the shock dose is given before reassessment?
1/4
What are the primary e-lytes in crystalloid fluids?
Na+ and Cl-
Crystalloids are designed to leak from where to where?
Form the vascular space to the interstitium
How much of the volume administered cyrstalloids remain in the vascular space 30 minutes after administration?
1/4
What is an isotonic solution? What is the tonicity of plasma?
isotonic: tonicity equal to plasma (280 mOsm/L)
What e-lytes are needed in an equine isotonic fluid?
K+, Ca+, Na+ Cl-, glucose
What human fluid products are used in equine med?
LRS
Normosol R
Once you've intitiated you fluid Tx plan, what do you do next?
-re-evaluate the patient
-monitor amount of fluid given
-monitor bloodwork
How can you encourage a horse to drink more water?
-add salt to diet
-change water source
-change water temp
How much enteral fluid can be given to a horse?
depends on stomach size, can safely give 10 L/ hours
If a second dose of enteral fluid is needed, it should be of what tonicity?
isotonic
CLINICAL MANIFESTATION OF RESPIRATORY DISEASE
CLINICAL MANIFESTATION OF RESPIRATORY DISEASE
What are some of the presenting signs of an animal with respiratory disease?
-dyspnea
-open mouth breathing
-ADR
-lethargy
-tachypnea
-anorexia
-vomiting/gagging
-etc
What approach do you take with a cat that arrives open mouth and panting?
O2 cage and leave alone
What should your primary response be when an animal arrives in distress?
Keep calm!
When ausculating the chest, increased heart sounds can mean what?
Effusion (sound travels through water)
What should you suspect with muffled heart sounds?
Pericardial effusion
Crackels, on auscultation, are heard from where?
Alveoli
What are the presenting signs of an animal with a nasal/paranasal disorder?
-nasal discharge
-serous
-mucopurulent +- blood
-epistaxsis
-sneezing
-stertor
-facial deformity
+- systemic illness signs
Why is recent travel a concern in a case o nasal disease?
Fungus
The PE for nasal disease should include a full exam of what?
Full oral exam
Epistaxis could point to a fungal infection or what other serious condition?
Clotting disorder- rodenticide
Initial diagnostics for any nasal disorder should include what?
-hx
-PE
-funduscopic exam
-thoracic rads
Why would you perform rhinoscopy?
To collect a bx, cytology, perform a culture, flushes
What are the signs of pharyngeal disease?
-stertor
-reverse sneezing
-gagging
-retching
-dysphagia
-airway obstruction
What is the cause of respiratory distress and change in vocalization?
Progressive airway obstruction
What systemic disease could cause laryngeal disease?
Aspiration pneumonia
Radiographs of an animal with laryngeal disease are evaluated for what?
-f.b.
-masses
-soft palate abnormalities
-larynx, caudal nasopharynx, cr trachea
What is the most common clinical sign of lower respiratory disease?
Cough
Why might you expect CHF in a patient with a cough?
Left atrium presses on Left main stem bronchus
A goose honk cough is indicative of what disease?
Kennel cough
A productive cough with hemoptysis can be an indicator of what disease conditions?
-heartworm
-pulmonary neoplasia
-fungal
-f.b.
-CHF
What diseases should you be on your DDX's for the trachea and bronchi?
-canine infect tracheobronchitis
-canine chronic bronchitis
-collapsing trachea
-feline bronchitis/asthma
-bacterial and mycplasmal infection
-oslerus osleri
-neoplasia
-trauma, tracheal tears
What diseases can affect the pulmonary parenchyma ?
-infectious
-pneumonias
-eosinophilic lung disease
-neoplasia
-contusions
50% of pneumonias will have what CBC results?
Neutrophilia and a left shift
What pulmonary diseases would you be looking for with serology?
-heartworm
-histoplasmosis
-blastomycosis
-toxo
etc
What is indicxated by a right shift of the oxygen hemoglobin dissociation curve?
RBCs can;t hold O2 with Hbg
What information would an arterial blood gas give you when working up a pulmonary patient?
V/Q and V/Q mismatch
What disease conditions will give you a bronchial pattern on a radiograph?
Bronchitis
Asthma
What disease conditions will give you a interstitial pattern on a radiograph?
-infections
-neoplasia
-eosinophilic lung disease
What type of pattern would you see on a radiograph of a patient with pulmonary edema, severe inflammatory disease or hemorrhage?
Alveolar pattern
In what condition of the respiratory system would fluoroscopy be helpful?
Dynamic tracheal collapse
Placement of stents
Through which procedures would you collect pulmonary samples?
-transtracheal /endotracheal wash
-bx
-bronchoscopy
What should your approach be in the case of pleural effusion?
Tap Tap Tap it!
What disease conditions can lead to a pure or modified transudate effusion?
-right sided heart failure
-pericardial dz
-hypoalbuminemia
-neoplasia
-diaphragmatic hernia