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195 Cards in this Set
- Front
- Back
In the ECG, what is the refractory period?
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Time during which the SA node cannot fire again
|
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Which adrenergic receptors are in the heart muscle?
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Beta
|
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Cadiac output is equal to what?
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CO= SV x HR
|
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Mean arterial pressure is equal to what?
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MAP = CO x SVR
|
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Fluid movement is based on what law?
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Starling's law
|
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What is preload?
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Volume of blood returning to the heart
|
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What is afterload?
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The resistance the blood has to force through to get out
|
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What are the priorities of the heart?
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-maintain normal systemic arterial pressure
-maintain normal tissue blood flow -maintain normal systemic and pulmonary capillary pressure |
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What is the heart's response to an increase in preload?
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A change in the force of contraction and stroke volume
|
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What effects of the CO are seen with heart disease and failure?
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-volume overload
-pressure overload -pump failure -electrical abnormalities |
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What is an example of volume overload?
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Mitral or tricuspid endocardiosis
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What is an example of pressure overload?
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Aortic stenosis (increased afterload)
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What heart disease condition is an example of pump failure?
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Dilated cardiomyopathy (thin floppy valve)
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In which dog breed is cardiomyopathy due to an abnormality of the electrical system seen?
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Boxers
|
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What are some of the clinical signs of heart failure?
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-syncope
-exercise intolerance -cough -dyspnea -abdominal distension -cyanosis |
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What additional clinical signs might you, as a vet, find with a cardiac failure patient?
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-pulse abnormalities
-murmurs -arrhythmias -jugular pulses |
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Jugular pulses can indicate what disease condition?
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Heartworms
|
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What other information should you gather for the Hx of a cardiac patient?
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-vacc status
-travel hx -diets, changes in H2O -indoor/outdoor -activity level -coughing...when? -vomiting/gagging -urinary habits -fainting/weakness -MM changes/cyanosis? -medications |
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What body posture will a dog assume if he is having breathing difficulties?
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Broad stance
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What are the general signs of backwards cardiac failure?
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Respiratory signs, ascites
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What are the signs of low cardiac output-- forward failure?
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Usually late onset
-exercise intolerance -syncope -pre-renal azotemia -cyanosis |
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Left sided, backwards heart failure will have what effect on the lungs in the dog?
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Pulmonary edema
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In cats, left or right sided backwards cardiac failure will have what effect on the lungs?
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Pleural effusion
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What clinical sign, in a cat, would lead you to suspect pleural effusion?
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Dyspnic, open-mouth breathing
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What are the causes of cardiac arrhythmias?
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-structural pathophysiologic remodeling
-genetic factors -environmental stress -ischemia -modulated by endocrine factors |
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At which cardiac phase are the coronary arteries supplied with blood?
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Diastole
|
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What is the clinical appearance of a dog with an arrhythmia?
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-anxious
-open-mouth breathing -orthopnea and elbows abducted -tachypnea -hyperpnea -inspiration vs expiration |
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What are the signs of syncope?
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-exertion or excitement
-rear limb weakness -sudden collapse -lateral recumbency -opisthotonos -micturation -vocalization -hypoxia |
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What are the causes of coughing in a patient with cardiac disease?
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-CHF
-mainstem bronchi compression -pneumonitis & vascular disease secondary to HWD (non cardiac dz = airway dz, parenchymal dz, pleural space dz) |
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Why should you pay close attention to the MM and CRT on potential cardiac patient?
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For signs of anemia, hypotension, poor perfusion, differential cyanosis
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On abdominal palpation of a cardiac patient, what might you feel? (think right sided failure)
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Fluid wave
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Why should you palpate the chest during PE on a cardiac patient?
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Sometimes can feel a murmur
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Aside from checking the arterial pulse of a cardiac patient, what else should you do?
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Check pulse pressure differences along with auscultation
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In which condition would you find a difference between pulse pressure?
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PDA
|
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Why do you examine the eyes of a cardiac patient?
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To look for hemorrhages or detached retina
|
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Jugular pulses are a result of increased venous pressure from what type of heart failure?
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Right sided
(or pericardial dz, volume overload, cranial mediastinal masses) |
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What are the causes of right sided failure?
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-tricuspid disease
-pulmonary hypertension -caval syndrome |
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What are you listening for when auscultating the chest?
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-heart sounds
-heart rhythm and rate -lungs -increased respiratory noise/purring |
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What is the general cause of a heart murmur?
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Turbulance
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What clin path diagnostics would you perform when working up a cardiac patient?
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-thyroid function (cat)
-heartworm test -CBC -Chem/UA -blood culture -rads -U/S -areterial blood pressure -ECG -neuro exam -holter monitoring -event monitoring |
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What information can echocardiography give you? (ultrasound)
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-it's non-invasive
-images the heart (chambers, vessels, valves) -measurements -Doppler; evaluate flow and pressure, valves |
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What 2 modes are used to image the heart?
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-2 D
-M mode |
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When would you consider performing a cardiac catheterization?
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-for diagnosing a complicated congenital abnormality
-evaluating pressures -therapeutic measures (ballooning, stenting) -research |
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What is the most common type and cause of hypertension?
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Secondary, concurrent with clinical disease of drug administration
|
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What is the effect of hypertension on the kidneys?
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Progression of CKD
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What are the effects of hypertension on the eyes?
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Retinopathy- acute blindness, detachment, vessel toruosity etc
|
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Hypertension can have what effects on the brain?
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Encephalopaty or stroke
|
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What effects of hypertension can be seen in the heart?
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Left ventricular hypertrophy or cardiac failure
|
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What effects does pulmonary hypertension have?
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-increased pulmonary bloodflow
-increased blood viscosity -increased pulmonary vascular resistance -luminal narrowing |
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Depolariaztion of the ventricles is seen in which segment of the ecg?
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QRS
|
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When examining a mean electrical axis from an ecg, what does a Right axis deviation mean?
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The Right ventricle is getting bigger
|
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When evaluating an ecg, what 5 questions do you ask?
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-rate
-rhythm -P/QRS, QRS/P -QRS morphology -measurements |
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On ecg paper, each horizontal line represents what value?
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.5 mv
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On ecg paper, what does each vertical line represent?
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.02 secs (at 50mm/sec)
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On which ecg speed are mesurements performed?
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50 mm/sec
|
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What are the causes of bradycardia?
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-Sinus node
-enhanced parasympathetic tone -hypothyroid -hypothermia -hyperkalemia -hypoglycemia -drug therapy -Av block |
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What are the causes of tachycardia?
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-pain
-fever -anemia -reduced cardiac output -hyperthyroidism -excitement |
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An increase in the amplitude or duration of the P wave indicates what?
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R or L atrial enlargement
|
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An increase in the R indicated what?
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-increase in amplitude = Left Vent enlargement
increase in duration = Left bundle branch block |
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What does an increased S indicate?
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-increase in amplitude = Right Vent enlargement
-increase in duration = Right bundle branch block |
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What information does a vector analysis provide?
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Measure of the net area under QRS
|
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INTRO TO CLINICAL NEURO
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INTRO TO CLINICAL NEURO
|
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What types of injuries cause neuronal tissue damage?
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-hypoxic
-chemical/toxic -mechanical |
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What changes in the axons can be seen with neuronal degeneration?
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-swollen axons
-degraded axonal material |
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What is Wallerian degeneration?
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Myelin loss
|
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Head pressing and circling are indicative of a lesion where in the brain?
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Forebrain
|
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Tetraparesis and ataxia of all 4 limbs is indicative of a brain lesion where?
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Brainstem
|
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What signs might you see in a patient with a cerebellar lesion?
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-wide base stance
-tremors -ataxia w/o paresis |
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A lesion cranial to the pons will produce signs where in the body?
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On the contralateral side
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Central and peripheral vestibular disease will both cause head tilt. How do you then distinguish one from the other?
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central: tetraparesis
periperhal: ataxia w/ no paresis |
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What is a potential cause of peripheral vestibular dz?
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Otitis media
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A transection of the Thoraco-lumbar spine can cause what clinical sign?
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Schiff-sherrington
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What are the clinical signs of a peripeheral nerve lesion?
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-flaccid paralysis to affected limb/area
-decreased muscle tone -rapid atrophy -decreased spinal reflexes |
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What signs would you see in NMJ disorders?
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-flaccid paralysis to all limbs
-decreased muscle tone/spinal reflexes (ie MG) |
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What signs would you look for in muscle weakness?
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-paresis, worse after exercise
muscle atrophy, +- pain |
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During a neuro exam, why do you evaluate the posture and gait?
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To check for paresis, ataxia, lameness
|
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What are some examples of postural reactions?
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-CP
-hopping -placing -hemiwalking -wheelbarrowing |
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The neuro exam also consists of checking which spinal reflexes?
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-withdrawl
-patellar, sciatic, cranial tibial -biceps, triceps, ecr -perinel/anal tone -bulbourethral -cutaneous trunci |
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What are the steps in performing the neuro exam?
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-describe the abnormalities
-localize the lesion -describe concurrent non neuro dz -characterize onset and progression -general rule out list -dx testing |
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What conditions can serology hep rule in or out?
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-toxoplasma
-neospora -ANA - lupus -2M antibodies- masticatory myositis -Mg AChR antibodies -distemper -thyroid |
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What are the risk of performing a myelogram?
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-inflammation
-seizures -can worsen condition |
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EMG is an electrodiagnostic test of what?
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Nerve conduction (destruction, severance, demyelination)
|
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What is the definition of a seizure?
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Excessive or hypersynchronus abnormal electrical activity in the cerebral cortex
|
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What are the phases of a seizure?
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-prodrome
-aura -ical -post ictal |
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Intracranial seizure can be caused by what structural changes?
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-vascular
-neoplasia -granuloma -encephalitis/meningitis -trauma -anomalous- hydrocephalus -strorage disorders |
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What is the cause of functional intracranial seizures?
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Epilepsy (idiopathic)
|
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What are some of the extracranial causes of seizure?
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-Metabolic (endocrine, hypoxia, hyperthermia, hypoglycemia, electrolytes, liver/renal dz)
-Toxic |
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What paroxysmal disorders can be confused with seizures?
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-syncope
-episodic paresis -MG -vestibular dz (rolling) -movement disorders -sleep disorders -OCD |
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Which dog breed is predisposed to Hansen Type I disc disease?
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Chondrodytsrophic
(explosive disc) |
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What is a Hansen Type II disc?
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Occurs in any breed, usually older, compressive
|
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INTRO TO FLUID THERAPY
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INTRO TO FLUID THERAPY
|
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Why do patients need fluid therapy?
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-loss of body water
-loss of electrolytes -excessive intake of electrolytes -systemic disease |
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The power to move water is related to what?
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Effective osmols
|
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What is the role of plasma proteins in osmolarity?
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Plasma proteins create oncotic pressure to hold water within vascular space
|
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What are insensible water losses?
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-evaporation
-fecal water loss -renal water loss |
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Movement of water from the ICF to the ECF is based on concentrations of what?
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Electrolytes
|
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What are the daily water intake requirements for a horse? A dog?
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Horse: 50 ml /kg/day
Dog: 60 ml/kg/say |
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Failure to replace insensible losses can lead to what condition?
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Dehydration
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Failure to replace isotonic fluid loss leads to what?
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Hypovolemia
|
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What is the definition of dehydration?
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Loss of body water
|
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Which compartment is responsible for loss of water?
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ICF
|
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What is the general cause of dehydration?
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Loss of body water and failure to replenish the ICF deficit (changes tonicity of compartments)
|
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What electrolyte sign is the hallmark of dehydration?
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Hypernatremia
|
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What is the definition of hypovolemia?
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Volume depletion refers to a reduction in ECF volumes (intravascular space)
-loss of water and electrolytes -loss of isotonic fluid (no change in tonicity) |
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What condtions result in hypovolemia?
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- blood loss
-diarrhea -vomiting |
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Which water compartment is affected by hypovolemia?
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ECF (vascular and interstitial spaces)
|
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Why is it important to distinguish dehydration from hypovolemia?
|
-pathophysiologic processes are different
-clinical signs are different -treatments are different |
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How does the body respond to dehydration?
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-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) |
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How does the body respond to volume depleation?
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-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 |
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What information is needed to recognize that a patient needs fluid therapy?
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-PE
-labs -history |
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What are the clinical signs of dehydration?
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-tachycardia
-tacky MM -prolonged skin tent -sunken eyes -increased urine SG |
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What are the clinical signs of hypovolemia?
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-tachydcardia
-decreased pulse pressure -reduced jugular fill -tachypnea -cold extremities -decreased urine output -depressed mentation |
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Is the assessment and level of hydration status sensitive to dehydration/hypovolemia?
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No, insensitive
|
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What is the threshold for clinical signs of dehydration?
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3-5% loss of body water
|
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What la test help in your diagnoses of hydration status?
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-PCV
-TS -USG -Serum creatinine -lactate -body mass (weigh) |
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After giving crystalloids, how much remains in the intravascular space?
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25% after 30 mins
|
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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 |
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Is hypertonic saline a maintenance fluid?
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NO- for resuscitation
|
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When giving a horse hypertonic saline, what else should you give?
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For every 1 liter of hypertonic saline, give 10 liters of crystalloids
|
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Why are colloids called "glue"?
|
The remain in the vascular space
|
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Colliods contain molecules that do what?
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Exert oncotic pressure, remain in the vascular space, draw water from the interstitium into the vasc space
|
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When are collids used?
|
Patient with hypoproteinemia
|
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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
|
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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
|
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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
|
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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 |