Clin Med Final

moonlup's version from 2017-05-12 10:42

Section 1

Question Answer
Q**What do you see in a physiologic leukocytosis? Who do you think of? czd by?SCARED CAT! You'll see neutrophilia & a lymphocytosis (both go up). It is czd by catecholamines
Q**What do you see in a stress/corticosteroid leukogram? Who do you think of? czd by?Think "sick dog" w/ this one. Mature neutrophilia, monocytosis & lymphopenia (can also sometimes cz an eosinopenia). Czd by stress/corticosteroids
Tell me where AST, ALT & ALP are locatedAST: Mitochondria (think that the S looks like the inside of a mito) ALT: Cytoplasm (ALTernative to the intracellular AST, is the intracellular ALT) ALP: Membrane bound to bile caniculi
Know PTH & calcitonin's fxnsPTH= ↑ blood Ca++. Calcitonin= de ("tone" it down!)
WHAT CZS HYPERCALCEMIA?????DRAGONSHIT D -Hypervitminosis D R -Renal Dz A - Addision’s G - Granulomatous dz O - Osteopathy N - Neoplasia (lympsarc, anal sac, mult myel) S - Spurious H - Hyperparathy I - Idiopathic - cats T - Temp rare in cats
WHAT CZS HYPOCALCEMIA??HERPES! Hypoparathyroidism Eclampsia Renal dz PPancreatitis (imbalance/nutritional) OR Phosphorus (addition/enemas) Ethylene Glycol, Spurious
What are the values for hyposthenuria?<1.008 (less conc than the plasma). Kidneys STILL WORKING bc they can dilute
What are the values for isosthenuria?1.008-1.012 (same conc as plasma) kidneys NOT WORKING....IF azotemia, bc this could just be dilute urine
What are the values for hypersthenuria for a cat? A dog?1.030 for a dog, 1.035 for a cat (horse is like 1.025 but this wasnt on the slide, she mentioned it)
What's the factor we care about in the extrinsic path?7! (3 is tissue factor so shes not really too concerned)
Whats the factors we care about in the intrinsic path?Think gas station analogy: "it's not 12 dollars, it's 11 98" thats for the intrinsic path. So: 12, 11, 9, 8
Whats the factors we care about in the common path?2, 5, 10
One Step Prothrombin Time is aka? & tests for what?Aka OSPT or PT, it's testing the EXTRINSIC & common paths (extrinsic=extrovert, O=outgoing)
***CRP = Corrected Reticulocyte %. What is this & How do you calculate it?More accurate for describing a regeneration. it's the ~retic % times the (pt PCV/normal PCV) (if dogs >1.5%, indicates regen. Cats >1% is regen)

Section 2

Question Answer
Don’t forget starling’s forces. Why not forget?([capillary hydrostatic pressure - interstitial hydrostatic] - [capillary oncotic-interstitial oncotic]) → how do you think the glom filters? Based on this principal
How to differentiate pre vs renal azotemia?USG (if conc, its pre)
What’s prerenal azotemia?Dehydration
NORMAL protein:creatinine ratio for DOGS? CATS?DOGS: <0.5 is normal CATS: <0.4 is normal
****POLYURIA IS CONSIDERED HOW MUCH? (#)> 50 ml/kg/day

Section 3

Question Answer
*****What is the maintenance dose for dogs & cats?? *KNOW THE UNITS40-60mL/Kg/day (CATS USE LOWER END)
*****What is the maintenance dose for horses? *KNOW THE UNITS50mL/Kg/day
A shock dose is how much compared to body weight? How much is it compared to blood volume? What is the actual dose, in ml/kg?A shock dose is 8-9% of the body weight (think about a PTx that is 8% dehydrated) & it is essentially 1 blood volume. The dose is 80-90ml/kg (CATS ARE MUCH LESS THO)
What is the math equation for sensitivity?The (TRUE POSITIVES) / (TRUE POSITIVES + FALSE NEGATIVES)
What is the math equation for specificity?The (TRUE NEGATIVES) / (TRUE NEGATIVES + FALSE POSITIVES)
High sensitivity/specificity means...few false negatives/positives
Your total body water (TBW) is 60% of your body weight. Of that, what percent is in the ICF (intracellular fluid)? ECF?ICF=66% of TBW ECF= 33% TBW
How much of the TBW (total body water) is intravascular?Blood vol is 8% TBW
↓ BP & vol lead to triggering which type of receptors? To lead to what 2 mechanisms? Which czs? (SEE SLIDE 14 FOR CHART)Baroreceptors (neural mechanism) leads to ↑ CO, as well as peripheral vasoconstriction leading to ↑ BP & ↓ venous reserve. There is also the endocrine mechanism, to release hormones (like angiotensin) which ↑ blood volume. The overall affect is homeostasis of ECF restored!
Is dehydration isotonic, hypertonic, or hypotonic? How about hypovolemia?DEHYDRATION: hypertonic-only water loss HYPOVOLEMA: isotonic-loss of water & electrolytes
Breakdown of horse body water60% of BW is water. 40% of body weight is ICF, 20% is ECF (of that 75% is interstitial)
What are the 3 places which encompass the extracellular fluid?Intravascular, interstitial & transcellular
What is normal central venous pressure in adult horses?7-12 mm HG is normal in adults
Hypertonic Saline Solution (HSS) → What is the amount of bolus you'd want to give for HSS? What is the effect on the blood volume/ body?2-4 ml/kg bolus (1-2L per 500kg). This czs an immediate vascular expansion at about 2-3xs the amount infused. It alters the ECF & leads to a shift in the ICF
Potassium rate<0.5 mEq/kg/hr
Which 2 commercial crystalloid fluids CONTAIN POTASSIUM? How much?Plasma-Lyte 56 & Normosol-M. Na+= 40mEq/L, K+= 13mEq/L in both
Homemade fluids → IV → how would you make a fluid to treat ACIDOSIS?Use a 5:4:1 formula! This is 1L distilled water, 5g NaCl, 4g NaHCO3, 1g KCl (Supplies 48mEq/L HCO3)
Homemade fluids → IV → how would you make an isotonic bicarbonate solution?1L distilled water, 13g NaHCO3 (Baking soda) (Supplies 156 mEq/L bicarb)
Homemade fluids → IV → how would you make a fluid to treat ALKALOSIS? ( 2 types-saline or ringers. explain both)(1) Saline (0.9%): I gallon of distilled water, 36g NaCl (Supplies 154mEq/L) (2) Ringers solution: 5 gal distilled water, 170g NaCl, 6g KCl, 6.5g CaCl2
Homemade fluids → IV → how would you make a Isotonic Dextrose (5%) fluid?200g Dextrose to 4L distilled water
Homemade fluids → IV → how would you make an Isotonic Potassium Chloride Solution?40g KCl added to 1gallon distilled water... (Supplies 556 mEq K+ /gallon)
If you have a diarrheic calves (<8days old), your fluid should contain AT LEAST how much of ____ or ____?AT LEAST 60mmol/L of acetate OR bicarbonate
What is the rate for MAINTENANCE per day in adult cattle? Neonates?(1) Adults: 50ml/kg/day (2) Neonates: 80ml/kg/day
What is the RULE OF THUMB of maintenance rate per hour for cattle?2ml/kg/hr
How do you calculate the bicarb deficiency? (W/ base deficit)Bicarbonate (mmol) = Body weight (Kg) x Base deficit (mmol/L) x (0.5) ← 0.6 in neonates, 0.3 in adults
How do you calculate the bicarb deficiency? (w/ CO2 levels)Bicarbonate (mmol) = Body weight (Kg) x (30 – TCO2) x (0.6) ← this factor again-depends on animal (see other card)
The volume of fluid you should be giving in the 2nd hour of your cattle fluid plan is...? 3rd hour?The 2nd hour is the same as in the 1st hour (¼ deficit + maintenance/hr + on going losses/hr) but the volume in the 3rd hour is different bc the remainder of the deficit is divided over ~ 12-24 hours.
***A 1.3% NaHCO3-solution has how many mmol/L in it?Supplies 156 mEq/L(or mmol/L)

Section 4

Question Answer
Na level in hypo/hypernatremia<120meQ/L, >160mEq/l
****Amazingly helpful way to remember how to figure out if it is respiratory or metabolic acid base imbalance?R.O.M.E. Resp = Opposite (pH & PCO2 going in opposite directions, ↑ or ↓) Metabolic = Equal (pH & PCO2 moving in same direction, ↑ or ↓)
How does hypoadrenocortisism affect sodium levels? ExplainCzs HYPOnatremia! This is bc there are ↓ levels of aldosterone (the Na saving hormone) so there is ↓ sodium retention (ie more loss) & it also triggers ↑ water intake & retention of water to defend extracellular volume loss
**So, in which metabolic acidosis does the anion gap remain normal & in which does it ↑?In a LOSS OF HCO3-, Cl-compensates, NORMAL GAP. In an EXCESS OF ACID, the gap will ↑!! (bc compensation will result in accumulation of anion the excess acid was initial attached to)

Section 5

Question Answer
**What are the 3 substances which turn ON the acid receptor in the stomach?Gastrin ACh Histamine
Which cells secrete HCl?Parietal cells
What are CS for pancreatitis like in cats & what are they?In cats the signs are generally LESS specific The major 1 is Triaditis which is Pancreatitis, Cholangiohepatitis, IBD all at once (Inflamed pancreas, liver & duodenum) Additionally, in cats you might see Hepatic Lipidosis, Diabetes mellitus, Thromboembolism & Toxoplasmosis
What are 2 advanced tests you can use to test for pancreatitis & which is the better/more preferred one?There is TLI (Trypsin-like immunoreactivity) & PLI (pancreatic lipase immunoreactivity). PLI is the preferred choice
What are the 4 mechanisms of diarrhea? (Technically 5th too)(1) OSMOTIC (2) SECRETORY (3) DYSMOTILITY (4) EXUDATIVE (5) Mixed - which is any combo of the 1st 4)
Cobalamin and FolateCobalamin decreased in malabsorptive, folate increased in bacteria overgrowth
Name the parts of the horse large colon in order, starting w/ the cecum (incld flexures)Cecum → R ventral colon-(sternal flexure) → L ventral colon-(pelvic flexure) → L dorsal colon-(Diaphragmatic flexure) → R dorsal colon, Transverse and small
WHICH PLACES IN THE HORSE GI ARE ACTUALLY ATTACHED TO THE BODY WALL?Duodenum, cecum, R dorsal colon, transverse colon

Section 6

Question Answer
What is normal Resting Ammonia Concentration for DOGS? CATS?DOGS: <100 mg/dL CATS: <90 mg/dL cats
What do AST & ALP tell you & what should you know about them?They are LESS SPECIFIC than SDH & GGT.....however, AST will indicate hepatocellular damage & ALP will indicate cholestatic damage

Section 7

Question Answer
What is Diascopy, what is it used for & how to you perform it?Diascopy is a way to determine if a reddened area is a macule (local inflammation) or ecchymosis/petechia (bleeding problems). You take a glass side & you press it against the lesion. If it blanches, it is bc they BVs are just engorged from inflammation & you were able to push the blood out. If it doesnt blanch, it's bc the blood is extravascular, which indicates a bleeding disorder. So diascopy is a test of BLANCHABILILTY
What are 3 dzs which might cz there to be Comedos?Demodex Cushing’s 1° Schnauzer Comedo Syndrome
What is the type of Staph which animals get?Staph pseudintermedius (NOT aureus, that more for ppl)
What are the 3 major dermatophytes we will be looking at?Trichophyton mentagrophytes, Microsporum canis (>6), Microsporum gypseum (<6)

Section 8

Question Answer
How can you determine where the lesion on the SC is, using LMN & UMN signs & sensory ability?You will see LMN deficits AT the level of the lesion & you will see UMN signs CAUDAL to the lesion. you will also see Sensory deficits at the level of & caudal to the lesion
If there is a deficit in the brainstem, are the signs contra-(opposite) or ipsi-(same side)-lateral?IPSILATERAL
If there is brainstem damage, what kinda reflexes will you see in the body?UMN reflexes
Does Horner’s Syndrome have to do w/ parasympathetic or sympathetic innervation to the eye?Sympathetic dysfxn
What are the CS of Horner’s Syndrome?Ptosis Miosis Enophthalmos & elevated
What are 5 symptoms of cerebellar syndrome?Cerebellar ataxia (inability to coordinate balance, gait, extremity & eye movements) Intention tremors Decerebellate rigidity (extension of the thoracic limbs & flexion of the pelvic limbs) ↑ muscle tone Abnormal postural rxns
What will postural rxns be like in cerebellar syndrome?They will be delayed & followed by an exaggerated response
Vestibular proprioception/ataxia can be aka?Special proprioception/ataxia
Peripheral Vestibular SyndromeNo postural rxn deficits, head tilt towards lesion, fast phase away, ventral strabismus
Head tilt & fast phase nystagmus in.... PERIPHERAL vestibular syndrome? CENTRAL " " ? PARADOXICAL " " ?PERIPHERAL: Head tilt TOWARD, fast phase AWAY, no post. rxns, Horner's CENTRAL: Same as peripheral but nystagmus is positional/vertical, yes post. rxns PARADOXICAL: Head tilt AWAY, fast phase TOWARD, yes post. rxns on same side as lesion
Forebrain lesionAbnormal behavior, circle towards lesion, contralateral sensory, seizures, maybe low post. rxns
Cerebellum Lesionmaybe anisocoria, cerebellar ataxia in all limbs, maybe increased reflexes/tone in all limbs, intention tremors, contralateral
Brainstem lesionAbnormal Mentation, CNs affected, UMN in all limbs, proprioceptive ataxia in all limbs, decreased/absent post. rxns
C1-C5 lesionLike brainstem but normal mentation and CNs
C6-T2 lesionThoracis LMN, Pelvic UMN, Proprioceptive ataxia in all limbs, post. reflexes decreased
T3-L3 lesionPelvic UMN, proprioceptive ataxia pelvic, post. rxns decreased in pelvic,

Section 9

Question Answer
*CRACKLES & WHEEZES-which is bronchial & which is vesicular?Bronchial = Wheeze, Vesicular = Crackles
Stridor & Sturdor → which localizes where?STRIDOR = laryngeal (stride on your throat so you can't breath) STURDOR = paryngeal/nasal (your nasal cavity is more sturdy than your soft throat)
What does a bronchiolar pattern on rads look like?If bronchioles get enlarged, thats tramlines & doughnuts
What 3 things can cz an alveolar pattern on rads?Pulmonary Edema, Severe Inflammatory dz, Hemorrhage
*****Brachycephalic Airway Syndrome HAS WHAT 3 COMPONENTS? (what 2 other things may be present?)(1)Stenotic nares (2) Elongated soft palate (3) Everted laryngeal saccules There might also be (+/-) hypoplastic trachea, +/-end stage laryngeal collapse

Section 10

Question Answer
What is the Frank-Starling Mechanism?The ability of the heart to change its force of contraction & therefore stroke volume, in response to changes in venous return (↑ volume-stretch receptors in heart stretched-tell heart to contract harder)
Explain Tachypnea vs Hyperpnea & when you see theseTACHY = Short & shallow, usually associated w/ pulmonary edema HYPER = ↑ DEPTH, usually associated w/ hypoxia, hypercarbia
What's a "cowboy sign" & when do you see it?(VD view) The left atrium is pushing the bronchi up & apart, the bronchi look like they are straddling the L atrium. Means enlarged L atrium
When is the only time you don't do chest rads 1st?Arrhythmia - do ECG 1st
*Most common heart dz of dogs? What does it look like on imaging?Mitral endocardiosis  Big L atrium
*Most common heart dz in cats? What does it look like on imaging? (Common sequale?)Hypertrophic cardiomyopathy → L ventricle gets big, then pressure pushed through even a good mitral valve. & then pools in L atrium → clot → saddle thrombus