VETM3430 - Clinical Medicine - Final Exam

Cleaning versus disinfection

Cleaning versus disinfection

Cleaning:

Removes loose soils, preparing the surface or object to be disinfected.

Disinfection:

Kills germs on the surface, preventing them from spreading.

Active versus passive survelliance

Active:

- Conducted with express purpose of finding outcomes

- Continuous monitoring of all incoming patients regardless health status in order to detect a pathogen

Passive:

- Uses information and/or samples collected for other purposes

- Monitoring of pathogens based on disease indicators

- Ex. Monitoring disease trends

Nosocomial infection

Is hospital acquired infection

*They do not have to manifested while hospitalized (examples surgical infections, invasive device infections, diarrhea, respiratory disease)

Zoonosis

An infection indigenous to animals, but naturally transmissible to humans

Three methods to implement the principles of preventing infection

- Decrease exposure
- Decrease susceptibility
- Increase resistance

Identify the elements necessary for successful implementation of a passive surveillance program for infection control

- Establish a consistent case definition so results can be compared over time
- To centralize the available data
- To have a designated ICP who compiles, evaluates and reports on the data on a regular basis.

Disposal for designated waste garbage and what counts as designated waste

Designated waste is put in translucent pink bags, designated waste includes:
- Blood STAINED items
- Medical related plastics
- Medical glass (broken class must be wrapped or boxed)
- Fluids from containers must be drained

What goes in the recycling?

- Aluminum
- Boxboard
- Cardboard
- Glass
- Paper
- Plastic
- Polycoat
- Steel

What goes in the sharps container?

- Needles
- Stylets
- Scalpel blades
- Used vacutainers
- Blood vials
- Empty vaccine containers
- Hematocrit tubes

How do you dispose of regular garbage?

Black plastic bags

Disposal of biohazardous waste and what is included in biohazardous material?

Put in orange biohazard bags

- Blood SOAKED items
- Animal tissues
- All garbage from infectious cases

OVC dress code

- CA: Lab coats must be worn
- LA: Steel shoes and coveralls
- Gloves should be worn when working with horses
- It is prohibited to wear OVC clothes outside of OVC
- No dirty PPE in the cafeteria

Why does handling matter to producers?

- It impacts productivity (meat quality, milk yield, ADG)
- Handling can cause stress, which impacts welfare
- Keeps humans safe

Four principles of large animal handling

- Visual perception and field of view
- Flight zone
- Point of balance
- Facility use and design

Describe the visual perception and field of view of production animals?

Due to eyes being set on the sides of their head, production animals have panoramic view, meaning they can see almost 360 degrees, mostly for detecting movement.

Depth perception is limited to a very narrow field of view.

How do texas gates work?

They are grated bridges that take advantage of the limited depth perception of cows, makes them think they can not cross.

Why shouldn't you move production animals from directly behind them?

Because they cannot see you and they want to have their eyes on you (as they are prey animals). Therefore, you should move them at the side, so you are in their field of vision.

Factors that influence the size of the flight zone?

- Isolating animals vs handling with a companion (alone = bigger)

- Speed of movememnt of the approaching handler (faster speed = bigger zone)

- State of arousal (excited animals = bigger zone)

- Novelty and expanse of the environment (the more novel the environment and the more expansive the environment = the larger the zone)

Being in a flight zone of sheep causes what to happen?

It causes the sheep to scatter. Therefore, retreating from the flight zone slows or stops movement of the sheep.

How does point of balance work?

When the handler is moving parallel to the animal, it will move in the opposite direction to the handler's direction of the travel. The point of the balance is at the shoulder.

In order to effectively move large animals, good facility design includes

- Solid chute sides - cannot see people or shadows
- Louvres in the squeeze chute
- Use the crowd tub at less than capacity to give animals room
- Use herding or flocking to your advantage when designing a facility
- Use the flight zone and point of balance to move animals through chute systems

What is trigger stacking?

Several triggers together, that may not be too much on their own, can make an animal reach their fear level threshold. This happens a lot in veterinary clinics.

Stress hormones can cause

- Altered blood components
- Altered metabolism
- Impaired immune function and wound healing

Components of low-stress handling

- Adapting to the individual animal
- Using minimum restraint necessary for safety
- Using alternatives to traditional heavy restraint (ex. distractions and positive reinforcement, alternative methods for safety, chemical restraint, spread things out over multiple appointments, training for procedures)

How to approach handling an animal begins with

- Checking the animal's record
- Observing the animal's behaviour
- Asking the owner/animal care staff questions

General signs of fear in a dog?

- Lowered posture
- Trying to withdraw/hide
- Aggression
- Licking lips
- Panting
- Bows furrowed, ears to side
- Moving in slow motion
- Acting sleepy or yawning
- Hypervigilant
- Suddenly won't eat
- Moving away
- Pacing
- Avoiding eye contact/whale eye
- Retraction of lips
- Lowered tail, possible wagging
- Inguinal position
- Trembling
- Urination
- Defecation

Positive feline behaviours

- Approaching
- Rubbing
- Playing

Fearful feline behaviours

- Posture
- Ear position
- Pupil dilation
- Lip licking

Offensive feline behaviours

- Direct eye contact
- Lashing tail
- Swatting
- Growling, hissing, yowling

Neutral position of dogs

- Flat back
- Tension
- Straight tail
- Posture is standing straight

Offensive behaviour in dogs

- Direct eye contact/hard eye contact
- Freezing/body tension
- Facial tension
- Eye to ear distance increased
- Growling
- Lip lifting/commissure pushed forward/mouth closed/inhibited bit
- Piloerection

General principles of SA handling (three in total)

- Properly manage the environment
- Adapt to the individual patient, use a preventative approach
- Ensure appropriate communication between handlers

Appropriate introductions to an animal include the following principles...

- Trust isn't transferable - just because the animal is okay with you doesn't mean they are okay with a new person. Start fresh with each new person.
- Adjust your energy to the animal
- Passive approach - let them come to you -give them time and treats

Managing the environment includes

- Optimize animal comfort
- Minimize disturbances
- Minimize odours

Getting cats out of carriers

- Let the cat come out on their own
- Remove the top of the carrier if possible
- Don't remove the cat if you don't have to

How to help your clients set their animals up for success?

From a pet's young age...

- Tell them to expose their animals to crates, cars and unfamiliar people outside of the vet
- Give treats at the clinic
- Practice handling and physical exam procedures at home and pair this with treats and play

Body condition scores (out of 9) and % body fat % under weight

Underweight:

- BCS 1/9 = 40% underweight

- BCS 2/9 = 30% underweight

- BCS 3/9 = 20% underweight

Ideal weight:

- BCS 4/9 = 15% body fat

- BCS 5/9 = 20% body fat

Overweight:

- BCS 6/9 = 25% body fat

- BSC 7/0 = 30% body fat

Obese:

- BCS 8/9 = 35% body fat

- BCS 9/9 > 40% body fat

Two main parts of pet food labels?

1. Principal display panel
2. Information panel

What is included in the principal display panel of a pet food bag?

1. Product identity

- Includes product name and brand name

2. Designator

- The species in which the food is intended for

3. Quantity statement

- Net quantity of contents (net weight)

- Must be within the bottom 30% of the panel

4. Nutritional claims

- Not required, but can include things like "100% nutritious", "natural", "organic", "holistic", "human-grade"

5. Bursts and flags

- Highlights certain features of the food, examples include presence of certain ingredients, absence of certain ingredients/nutrients

What does a natural claim mean on pet food?

- No artificial flavours or colours
- No synthetic preservatives

What does an organic claim mean?

Refers to the procedure by which the ingredients are grown, harvested and processed but not the quality of the product

What does a holistic claim mean?

Nothing

How to diagnose a food allergy?

Do an elimination trial

What is gluten?

Protein found in wheat, barley, and rye

CFIA definition of edible versus inedible

Edible:

Fit for human consumption, from a slaughterhouse, meat processor, butcher or other source

Inedible:

Not fit for human consumption. Different categories, include animal food, non-specified risk materials, medicinal purposes, not edible by their nature (ex. feathers), condemned meat products. Can be fed to pets as long as it is not condemned or a SRM.

What is included in the information panel of pet food?

1. Ingredient statement

- Does not tell nutritional value

- EACH ingredient must be listed, descending order by their weight (including water weight)

2. Guaranteed analysis

- Minimum percentage of crude protein

- Minimum percentage of crude fat (maximum percentage of crude fat under some circumstances)

- Maximum percentages of crude fiber

- Maximum percentages of moisture

3. Nutritional adequacy statement

- Says whether the diet is complete and balanced

- For veterinary prescription diets, they say contain a statement abut only being fed as directed by the veterinarian

- Life stage statement (growth, reproduction, maintenance)

4. Feeding guidelines

- Directions on how to feed

5. Statement of caloric content

- Must be expressed kcal/kg

6. General information

- The name and the address of the manufacturer, distributor or dealer

AAFCO definition of meat

Clean flesh derived from slaughtered mammals (includes striated skeletal muscle or muscle found in the tongue, diaphragm, heart, esophagus)

AAFCO definition of meat by-products

The non-rendered, clean parts other than meat, derived from slaughtered mammals (includes lungs, liver, spleen, kidney, brain, blood, bone)

AAFCO definition of poultry

Clean combination of flesh and skin with our without accompanying bone, derived from the parts or whole carcass of poultry

AAFCO definition of poultry by-products

Non-rendered clean parts of carcass of slaughtered poultry such as heads, feet, viscera

CFIA rules surrounding the use of the term organic in on pet food?

Organic (can use the organic logo):

- 95% of content is organic

Contains x% organic ingredients:

- Multi ingredient product with 70-95% organic content

Organic claims in ingredients list:

- Multi ingredient products with <70%

How do pet foods guarantee their food is complete and balanced?

1. Formulation method - less expensive and time consuming, uses a computer, criticized method

OR

2. Feeding trial method - preferred method

Categories of nutritional adequacy?

1. Diet is adequate as sole source of nutrition
2. Diet is inadequate as a sole source of nutrition with instructions for owner to complete the diet (add water, oil, meat, etc)
3. Diet is inadequate as the sole source of nutrition

Guidelines for homemade diets

DOGS:
- 25-30% cooked meat
- 2:1 to 3:1 carb to protein ratio

CATS:
- 35-50% cooked meat
- 1:1 to 2:1 carb to protein ratio

Both need separate source for calcium, vitamins, minerals, may or may not need a separate fat source

Highly digestible carbs

- Corn
- White rice
- White potato
- Wheat

High fibre

- Brown rice
- Sweet potato
- Green peas
- Oatmeal

How often should you follow up with clients who use a homemade diet?

- 2x a year for healthy pets
- 3x a year for medical conditions

Evidence against raw diets

- Food-borne infection (salmonella, E.coli, etc.)
- Risk of nutritional deficiencies or excesses, toxic levels of Ca+, Vitamin A and D
- Bones in the meat can be a chocking hazard

What is in the circle of nutrition?

1. Animal specific factors

- Breed, age, sex, physiological status, activity level

2. Diet specific factors

- Medical conditions, medications, GI signs, appetite

- Appropriateness of diet, caloric density, alternative diets, treats/snacks, storage of diet, dietary changes

3. Feeding management and environmental factors

- Weight change, BCS, MCS, dentition + oral cavity, skin, coat and ears, fecal consistency

- Amount fed, feeding frequency, timing, location, feeding method, unmonitored sources

- Husbandry and house hold, enrichment and activity, competition, changes to environment

A nutritional assessment includes

1. Screening - for every patient, every time
2. Extended evaluation - if there are risk factors found on the screening form

What are considered risk factors for an optional and extended evaluation?

These require an optional extended evaluation:

- Extreme high or low activity level

- Multiple pets in a household

- Gestation

- Lactation

- Growth period

- Age of > 7 years

These require a mandatory extended evaluation:

- History of GI problems

- Previous ongoing medical conditions or diseases

- Currently receiving medications and/or dietary supplements

- Unconventional diet

- Snacks, treats, table food > 10% of total calories

- Inadequate or inappropriate housing

- Body condition score less than 4 or greater than 5 (on 9 pt scale)

- Muscle condition score (mild, moderate, severe muscle wasting)

- Unexplained weight change

- Dental abnormalities or disease

- Poor skin or hair coat

- New medical conditions

How to BCS a dog? What is it scored out of?

- Palpate shoulders, ribs cage, vertebrae, abdomen, hips and tail base
- Scored out of 9

How to MCS a dog?

- Palpate temporal bones, scapulae, lumbar vertebrae and pelvis
- Can divide into localized versus muscle loss

Role of CFIA in regards to pet food?

- Regulating import and export of pet food
- Oversee rendering industry

What is the role of Competitions Bureau of Industry Canada in regards to pet food?

Legislates pre-packaged food

Role of Health Canada in regards to pet food?

Substantiation of health claims

Role of Environment Canada in regards to pet food?

- Pesticides in raw materials and feeds
- Processing plant discharge

Role of Pet Food Association of Canada in regards to pet food?

Trade organization representing pet food manufacturers and ensuring a standardized approach

Regulations regarding specified risk materials (SRM) of bovine animals?

SRMs of bovines are not able to be fed to pets (since BSE)

Value chain for animal products

1. Human food
2. Pharmaceuticals
3. Pet food
4. Animal (livestock) feeds
5. Industrial uses
6. Fertilizers
7. Fuels

What does AAFCO stand for?

Association of American Feed Control Officials

Why don't feeding guidelines work for all mature dogs at maintenance?

- Exercise/activity levels
- The amount of treats/people food the animal is getting

Are ingredient lists helpful on pet food?

No, animals require nutrients not ingredients. Ingredient lists are only helpful if the animal has an ingredient allergy.

Labelling of meat (beef example)

"Beef" = >70% of the product
"Beef gravy" = >78% water
"Beef formula" = >10% of the product
"With beef" = >3% of the product
"Beef flavour" = <3% of the product

What do you need to do if the food is labelled as an "as is" basis?

Correct for the moisture content in the food

Principles of history taking

- Establish the animal's normal environment
- Identify risk factors for illness
- Describe any concerns
- Establish a rapport and client conversation

Why take a history?

- Up to 85% of data necessary to obtain a diagnosis comes from history
- History alone has significantly higher correlation to accurate diagnosis
- Missed diagnoses are most often due to breakdowns related to history taking
- Raises diagnostic accuracy by 60% without additional testing

Components of history

1. Identify the presenting complaint

- WHY did they come?

2. Develop the presenting complaint

- DETAILS, such as chronology, triggers, any treatments or interventions already tried

3. Body systems

- Localizing (GI, respiratory, changes in water consumption, lameness)

- Non-localizing (mentation, appetite)

4. General overviews

- Risk factors, such as human, animal, environment, diet, vaccines, parasite prophylaxis, environment, travel history, genetics, medications, past medical and surgical history

Signs versus symptoms

Signs - objective observation - something we can see

Symptoms - subjective observation made by the patient

In vet med we deal with signs, not symptoms

Signalment includes?

How you describe the animal:
- age
- sex
- breed
- species

Problem oriented medical approach

An approach to the identification and resolution of problems presented by your patients and their owners, includes:

- Evaluating the patient
- Displaying medical data, plans, outcomes in the medical record
- Diagnosing and treating the patient

Components of POMA

1. Create your data base

- History and physical exam

2. Assessment

- Immediacy of problem

- Problem list (collection of ABNORMALITIES)

- Lesion localization

- Disease

3. Plans

- Diagnostic

- Treatment

- Client education

What is a problem?

- Past and current diagnoses
- Clinical signs
- Physical exam abnormalities
- Laboratory findings

How should you write a problem list?

In order of more important to least. Some problems will be incidental or inactive.

DAMNIT problem list

D - degenerative, development
A - anomalous, accident, autoimmune
M - metabolic, mechanical
N - nutritional, neoplastic
I - inflammatory, infectious, ischemic, iatrogenic, idiopathic
T - trauma, toxic

Subjective versus objevtive

Subjective:

- Information you receive from the client, measureable information

- Eg. Presenting complaint, past medical history

Objective:

- Data that we can measure or signs observed during examination

- Eg. Heart rate

What should a prognosis include?

- % survival, function, quality of life (with what intervention?)
- Financial and logistical commitment for owner

Things involved in a SA distance exam?

- Behaviour/mentation
- Posture/gait
- BCS
- Respiration rate + effort

Vital signs for dogs

Temperature: 38 - 39.5

Pulse: 60-140

Respiratory rate: 10-30

Pulse quality

Mucous membranes - should be pink or pigmented

Weight, body condition - out of 9

Hydration - skin tent, mucous membranes, eyes/conjunctiva (should be shiny)

Vital signs for cats

Temperature: 38-39.5

Pulse: 120-240

Respiratory rate: 24-42

Pulse quality

Mucous membranes - should be pink or pigmented

Weight, body condition - out of 9

Hydration - skin tent, mucous membranes, eyes/conjunctiva (should be shiny)

Bell versus diaphragm

Bell: Best for low frequency sounds
Diaphragm: Best for high frequency

Goals of a cardiac auscultation?

1. Determine heart rate and rhythm
2. Detect abnormal extra heart sounds
3. Detect decreased or absent heart sounds

What does a gallop represent?

Diastolic dysfunction

What does a murmur indicate?

Turbulent blood flow

Left versus right heart auscultation

LEFT listen at:

- Base (3rd intercostal space) - aortic and pulmonic valve

- Apex (5th intercostal space) - mitral valve

RIGHT listen at:

- Middle (5th intercostal space) - tricuspid valve

- Sternum (5th intercostal space) - ventricular septal defect if present

Why might an abdomen be distended?

- Fat
- Fluid
- Feces
- Food
- Flatus
- Formidable organomegaly

Palpable organs in most patients

- Spleen
- Kidneys (sometimes in dogs, usually in cats)
- Intestines
- Bladder if distended
- Liver (if it is enlarged)

Palpable structures in rectal examination

- Rectal wall
- Anal glands (positioned at 4 and 8 o'clock)
- Prostate
- Urethra
- Sublumbar lymph nodes

How to sex kittens

Males:

Greater distance between urogenital opening and anus

Females:

Urogenital opening and anus very close together

Signs of forelimb lameness

- Head lift when affected limb hits the ground
- Shortened stance phase