Comprehensive Exam: VET 195

the bell of the stethoscope is used with _________ contact and allows ________-frequency sounds to be heard

light, low

Lipemia

Serum appears cloudy because of excess fat. Associated w/ many diseases including pancreatitis, diabetes mellitus, hypothyroidism, and primary lipid disorder. Pt should be fasted and have the test repeated in 12hrs

Hemolyzed serum in a whole blood sample usually occurs because of bad sample collection techniques but can also be indicative of _____________ anemia

Hemolytic anemia (causes lysis of rbcs inside vessels)

What is the difference between PCT and HCT?

PCT is done by hand and HCT is calculated by the blood analyzer

What dog breeds have higher than normal PCV values?

Sighthound breeds, whippets

Mean Corpuscular Volume

volume of the average red blood cell

Hyperkalemia is usually associated with which cases?

urethral obstructions, acute renal failure, and Addison's dz

Hypocalcemia is often seen with:

eclampsia or Addison's dz

Severe hyponatremia indicates

electrolyte problems. when there's a rise in serum sodium levels its usually due to water loss

Azotemia

(excessive) BUN and urea in the blood. indicates kidney failure

PaO2

partial pressure of oxygen in the arterial blood. indicates how well blood is being oxygenated and how well the lungs/circulatory system is working

The ___________ of particles determines the colloid osmotic pressure (COP) value

Number

Colloid osmotic pressure

The measurement of pressure exerted on the capillary membrane by colloid particles in plasma. Fluid and colloids are attracted into moving into the side with the most colloids to balance the pressure on the membrane.

critical thinking

the ability to rationally make decisions on the basis of data gathered through investigation, analysis, and evaluation

culture of safety

a culture where errors are addressed respectfully and placing blame isn't the focus

SBAR stands for

Situation, Background, Assessment, Recommendation/Request

The diaphragm of a stethoscope is used to hear _______ frequency sounds easier

high

Bounding pulses may indicate

early shock

Weak/thready pulses are usually caused by

poor cardiac output, hypovolemia, and arrhythmias

dogs and cats should ideally have urine with a specific gravity of

1.030 g/dl (dog) 1.035 g/dl (cat)

Tanner's Clinical Judgement Model

Noticing, Interpreting, Responding, & Reflecting

What component of I-PASS is most important?

the summary/synthesis component

What does I-PASS stand for?

Illness Severity, Patient Summary, Action List

Situation Awareness and Contingency Planning, &

Synthesis by Receiver

deep yellow/orange colored plasma indicates

jaundice, liver disease, or hemolysis

What species has darker colored plasma than other species?

Horses

How much blood (per week) can you draw for diagnositcs on a critically ill patient?

No more than 5-7% of their total blood volume

Dehydration will cause an increase in

PCV and TS values

How do you tell the difference between agglutination and Rouleaux?

Rouleaux disperses with saline

Lactate concentration

indicator of hypoperfusion (poor blood flow). a high lactate level is indicative of hyperlactemia. Normal value is 2.5 mmol or less. Lactate tests can use venous or arterial blood

Blood Colloid Osmotic Pressure helps determine what?

If proteins are leaking through vasculature and into the compartment outside the vessel

What does von Willebrand factor do?

controls the "stickiness" of platelets and assists in forming a clot.

The metabolic component of blood gas is

HCO3 AKA Bicarbonate

What kind of proteins are the main source of osmotic pressure in capillaries?

Albumin proteins (from the liver)

One stage prothrombin time (PT)

This test evaluates the extrinsic and common coagulation pathways. Measures the amount of time it takes for a fibrin clot to form after adding calcium and a tissue activating factor to the sample

Activated partial thromboplastin time (aPTT or PTT)

Evaluates the intrinsic and common pathways. The PTT measures the time it takes for a fibrin clot to form after calcium and an activator are added to a blood sample

Common coagulation pathway

The final stage of the coagulation cascade. Starts by either the extrinsic (activated by tissue trauma) or intrinsic (activated by factors inside blood) pathways activating factor X (10)

buccal mucosal bleeding time (BMBT)

Measures the ability of platelets to form a platelet plug. Normal patients stop bleeding within 1-5 minutes. This test is reserved for patients with regular platelet counts but questionable platelet function

Which patients are at risk for hypoxemia?

Tachypneic/Dyspneic, critically ill, anesthetized, and deteriorating patients

Systolic arterial pressure (SAP)

Peak pressure in the arteries when the left ventricle is ejecting blood during systole

Distributive shock

maldistribution of blood flow/ inappropriate vasodilation causing blood pooling in capillaries

envenomation

poisoning caused by the bites or stings of animals

Obstructive shock

Happens when venous blood return to the heart is impaired. Usually GDV or pericardial tamponade (collapse of the right atrium from increased pressure). This type of shock is resolved by treating the underlying cause

Cardiogenic shock

This type of shock occurs secondary to heart issues. Patients will have weak pulses, hypotension, pale MM, cold limbs, pulmonary edema, etc. Treatment involves improving heart function

Administering __________ is contraindicated in cardiogenic shock cases

fluids

Fluid filled structures will emit a __________/____________ sound when percussed

dull or flat

Mentation can be categorized as

Normal, dull/depressed, obtunded/delirious, stuporous, or comatose

One milliliter of urine is equivalent to one _______ of urine

gram

Which organs can't be palpated in dogs unless the patient is very thin?

The kidneys and liver

Concentrated urine is associated with

chronic kidney disease, heart failure, and azotemia

Turbid urine is caused by

the increased presence of white blood cells

What species has platelets that can be normally found in clumps?

Cats

One of the best ways to assess pulmonary function is through measurement of __________ blood gases

Arterial

blood gas analysis measures the:

acid-base status of blood

What is the respiratory component of blood gas analysis?

PaCO2- partial pressure of CO2 dissolved in blood

What is the most common acid-base issue?

Metabolic acidosis

Metabolic acidosis is commonly caused by:

diabetic acidosis and kidney failure

The colloid osmotic pressure helps determine:

if the vessel is letting plasma proteins leak into the interstitial space

What are indications for obtaining colloid osmotic pressure (COP)?

Vasculitis, SIRS, and hypovolemia

What is a normal lactate concentration?

2.5 mmol or less

HCO3 is commonly referred to as

Bicarbonate

A increased aPTT/PTT value can be indicative of what kind of toxin ingestion?

Rat poison

The prothrombin time (PT) test evaluates which pathways?

Extrinsic and common pathways

A blood sample with a low PCV and a high TS/TP value can indicate

protein overproduction with anemia/ bone marrow diseases or other chronic illnesses like feline infectious peritonitis

A blood sample with a low PCV and a normal TS/TP value can indicate

anemia from RBC destruction or decreased production of RBC

A blood sample with a high PCV and a high TS/TP value can indicate

dehydration

A blood sample with a high PCV and a low TS/TP value can indicate

Protein loss or decreased production with splenic contraction and dehydration (commonly seen in hemorrhagic gastroenteritis)

What PCV & TS values are associated with bone marrow diseases (anemia) and chronic illnesses like feline infectious peritonitis?

A low PCV with a normal TS value

Urine is considered "dilute" if it has a specific gravity value of less than:

1.008 g/dl

What are the three main types of monitoring utilized in an emergency and critical care setting?

Physical exam, clinical pathologic, and device based monitoring

A elevated lactate level is most commonly caused by what?

A decrease in blood flow to the cells- either locally or systemically

You should wait ______ to ______ seconds to gain a accurate pulse oximetry reading.

20 to 30 seconds

Patients should ideally have a pulse oximetry reading higher than:

95%. Patients below 94% need supplemental oxygen

Which coagulation test involves adding a blood sample to diatomaceous earth?

Activated clotting time (CT or ACT)

Diastolic Arterial Pressure (DAP)

residual pressure in the arteries when the left ventricle is filling during diastole

Mean arterial pressure (MAP) formula

MAP= DAP + 1/3 (SAP-DAP)

The P wave on a EKG represents

atrial depolarization (systole)

The QRS complex represents

ventricular depolarization (systole)

The T wave on a EKG represents

ventricular repolarization (diastole)

What species is sensitive to lidocaine toxicity?

Cats

Glycopyrrolate and atropine are contraindicated in patients with:

Tachycardia, ileus, and urinary obstructions

What does epinephrine do?

Epinephrine increases the heart rate, relaxes smooth muscle, stabilizes mast cells, and is a potent bronchodilator.

Central Venous Pressure (CVP)

Estimates the blood pressure of the right atrium. This value helps aid IV treatment an is an indicator of the heart's ability to function as a pump, blood volume capacity, and vasomotor tone

Central Venous Pressure (CVP) evaluates the pressure within the ___________ ____________

right atrium

Capnography

Measurement of exhaled CO2 gases- used as an estimate of CO2 levels in arteries.

What condition causes a sudden drop in the etCO2 value?

Heart failure

A low etCO2 reading occurs with:

fast respiratory rates, overzealous assisted ventilation, and hypothermia

A elevated etCO2 value indicates the patient is ______________ CO2

retaining

vasomotor tone

The partial smooth muscle constriction in the arterial walls. Vasomotor tone sets the resting level of blood pressure and can be manipulated to contract/relax

Metabolic acidosis is associated with which conditions?

Shock, sepsis, diabetic ketoacidosis, diarrhea, and chronic renal failure

What two values measure red blood cell mass?

HCT and PCV

What happens when a anticoagulant blood tube is overfilled?

The blood clots because the anticoagulant to blood ratio is off

White electrodes are placed on the right __________

forelimb

Where are black electrodes placed on a patient?

On the left forelimb

Where are green electrodes placed on a patient?

Right hindlimb

How can you remember electrode placement areas?

Christmas comes at the end of the year (red/green electrodes go on the back limbs) & you shake salt and pepper shakers with your hands (black/white on front limbs)

Fetatome

a device that is used to cut a fetus into smaller parts that can be extracted vaginally more easily

Metritis

inflammation of the wall of the uterus

Tympany

high-pitched, musical, drumlike percussion note heard when percussing over the stomach and intestine

Primary survey

Initial assessment when triaging that gives information on vital aspects of the patient. Uses ABC format- Airway/Attitude, Breathing, and Cardiovascular/Circulation

Patients with mucus membranes that are __________, __________, or __________ colored need supplemental oxygen

Blue, purple, and dusky