PCS III Written Exam 1

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Know the 5 basic principles of cattle behavior

cattle want to see you as you enter their space, want to avoid you while keeping an eye on you, want to go toward and be with other cattle, avoid pressure and seek escape, focus thought by though, seeking escape (need time to think)

What two instincts drive the principles of cattle behavior?

prey and herd instincts

Define the Flight Zone ("the Bubble")

the distance from an animal that a handler must maintain for the animal to feel comfortable; when a person enters the flight zone, the animal will move

What and where is the point of balance in cattle?

the point within the flight zone at which the animal will move forward if you are behind it, and backwards if you are in front of it; in cattle, the shoulder

Be able to discuss and determine which imaging modality to use in the diagnostic work-up of a horse with colic and a lame dog.

FLASH vs FAST ultrasounds

FLASH: fast, localized, abdominal sonography for horses; FAST: focused assessment with sonography in trauma

In a colicking horse with lots of reflux, high lactate on belly tap, and dehydration/hypovolemia, what imaging modality would make the most sense first?

abdominal ultrasonography

Besides ultrasonography, what other imaging modality can help you evaluate a full sized adult horse with colic?

radiography

What processes would could abdominal radiographs help you diagnose in a horse?

sand, gas, enteroliths

What would sand look like in an abdominal ultrasound of a horse?

hyperechoic, with shadow on ventral colon wall

What are things to consider when selecting an imaging modality?

performance of test, amount of info, cost, turnaround time of results, accuracy of results, reliability of operator, availability of equipment, opportunity for remote consultation

What are you looking for when performing a FLASH ultrasound?

peritoneal fluid, GI tract abnormalities (distended, content, motility, wall), kidneys, pleural space (effusion, consolidation)

What is the best indication for radiographs over ultrasound?

bones, getting an overall/big picture

What is the best indication for ultrasound over radiographs?

soft tissues, slice by slice or small parts

Radiograph or ultrasound: looking for bone remodeling

radiographs

Radiograph or ultrasound: osteophytes

radiographs

Radiograph or ultrasound: joint space measurement

radiographs

Radiograph or ultrasound: see through or around bandage/casting material

radiographs

Radiograph or ultrasound: generalized or focal swelling

radiographs

Radiograph or ultrasound: bone/joint alignment

radiographs

Radiograph or ultrasound: superficial cortical bone lesion

ultrasound

Radiograph or ultrasound: joint effusion

ultrasound

Radiograph or ultrasound: articular cartilage

ultrasound

Radiograph or ultrasound: ligaments

ultrasound

Radiograph or ultrasound: menisci

ultrasound

Radiograph or ultrasound: joint capsule

ultrasound

Radiograph or ultrasound: gas pockets

ultrasound

What are main differences between performing imaging on horses vs dogs?

obvi horses are much larger, images are typically obtained standing in horses and recumbent in dogs, pathology differences

List (in order) the layers of the ocular fundus that can be visualized during routine ophthalmoscopy and identify normal variations of these layers

from most internal to external: neurosensory retina containing retinal blood vessels converging at optic nerve, retinal pigmented epithelium (may be non-pigmented), choroid, sclera

subalbinotic sclera and choroid: normal or abnormal?

normal

collie eye anomaly: normal or abnormal?

normal

tigroid choroid: normal or abnormal?

normal

feline subalbinotic with tapetum: normal or abnormal?

normal

atapetal choroid: normal or abnormal?

normal

blue tapetum: normal or abnormal?

normal

mottled tapetum: normal or abnormal?

normal

non-pigmented RPE canine: normal or abnormal?

normal

non-pigmented RPE feline: normal or abnormal?

normal

completely pigmented RPE: normal or abnormal?

normal

partially pigmented RPE: normal or abnormal?

normal

stars of winslow in horses: normal or abnormal?

normal

smaller tapetum in horses: normal or abnormal?

normal

What nerve do we block motor function for equine periocular nerve blocks?

block auriculopalpebral nerve (CNVII) to block motor function to orbicularis oculi muscle

Where do we block the auriculopalpebral nerve for equine periocular nerve blocks?

local anesthetic injected SQ on caudal to posterior ramus of the mandible, dorsal to highest point of zygomatic arch, or caudal to bony process of frontal bone where it lies on zygomatic arch

What nerve do we block sensory function for equine periocular nerve blocks?

block supraorbital nerve (CNV) to block sensation from upper eyelid

Where do we block the supraorbital nerve for equine periocular nerve blocks?

local anesthetic injected SQ into supraorbital fossa, which is a depression just below where the boney orbital rim widens medially

Normal intraocular pressures for dogs and cats

10-20mmHg

Normal intraocular pressures for horses

10-30mmHg

A difference of ____mmHg intraocular pressures between eyes is considered abnormal

8

low intraocular pressures are consistent with _____________.

uveitis

high intraocular pressures (>25mmHg in dogs/cats and >30mmHg in horses) with vision loss is consistent with _______________.

glaucoma

With repeat tonometry tests, which is your most accurate reading?

lowest

What is applanation tonometry?

Measures pressure needed to flatten part of the cornea.

Can be held at any angle, but needs to be flat against the surface; Tonopen

What is rebound tonometry?

Hand-held contact tonometer based on the induction-impact method of intraocular pressure measurement, must be held vertically at all times; tonovet

Why a CBC would be indicated and how you would make that recommendation to a client?

anemia, pale MM, melena, suspicion for thrombocytopenia, fever, dehydration, evidence of infectious disease

Why you would run a CBC in-house instead of an outside lab?

to get immediate answers in a more critical patient; follow up with a blood smear

Develop a systematic approach for reading and interpretating a CBC for a companion animal

Interpret a CBC for a patient when provided with the signalment and clinical scenario

classify anemias, leukogram, etc

For medications used in the management of gastrointestinal disease, discuss the mechanism of action and decide whether each is indicated for a patient with a gastric ulcer

What is the first choice therapy for equine gastric ulcers? MOA?

proton pump inhibitors; omeprazole, esomeprazole, pantoprazole

Maropitant MOA

NK1 receptor antagonist

metoclopramide MOA

dopamine receptor antagonist at CRTZ

Ondansetron MOA

5-HT3 antagonist

famotidine MOA

H2 receptor antagonist

How/why do NSAIDs like carprofen and flunixin cause gastric ulcers?

inhibit COX, causing a subsequent decrease in mucosal prostaglandins that normally regulate the secretion of bicarbonate, mucus, and HCl

Ranitidine MOA

H2-antagonist

Sucralfate MOA

adheres to ulcerative mucosa to form a protective barrier

misoprostol MOA

PGE1 analog; increases gastric mucosal blood flow and decreases HCl secretion + anti-inflammatory properties

Misoprostol contraindications

pregnancy

Given a patient with a medical condition, determine criteria to define success or failure of a treatment

repeat testing, monitoring for improved clinical signs

Recognize clinical signs that help to distinguish disorders of primary hemostasis from disorders of secondary hemostasis (and vice versa)

primary: petechiae, ecchymoses, bleeding at mucous membranes, bleeding after venipuncture; secondary: hematomas, bleeding into muscles, joints, body cavities, delayed bleeding after venipunture

Select appropriate diagnostic tests to evaluate a patient for a disorder of primary hemostasis and/or secondary hemostasis

primary: platelet count, BMBT, vWF concentration; secondary: PT, PTT, individual factor concentrations

Given a scenario and a patient's platelet count, PT, and PTT result, develop a list of differential diagnoses and use this to determine which test should be performed next to achieve a diagnosis

List disorders of primary hemostasis

vasculitis, disorders of platelets (decreased production, destruction, sequestration, etc), decreased platelet function, vWd

List disorders of secondary hemostasis

liver disease (decreased vitamin K absorption), anticoagulant rodenticide toxicity, hemophilia A & B

thrombocytopenia is a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

primary; normal PT and normal PTT but decreased platelet count

Von Willebrand Disease is a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

primary; normal PT, usually normal PTT, but prolonged BMBT

Hemophilia A is a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

secondary; normal PT, prolonged PTT

hemophilia B is a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

secondary; normal PT, prolonged PTT

factor XII deficiency is a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

secondary, normal PT, prolonged PTT

vitamin K deficiency is a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

secondary; prolonged PT and PTT

liver disease causes a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

secondary; prolonged PT and PTT

DIC is a (primary/secondary) hemostatic disorder, what would the PT and PTT look like?

mixed; prolonged PT and PTT

Localize a neurological lesion based on abnormalities on the neurological exam

General proprioceptive ataxia clinical signs

"wobbly" ataxia; abnormal limb stance and gait (circumduction, abduction or adduction, crossing), NO head involvement

Vestibular ataxia is dysfunction of the ______________ or ______________, impacting balance.

inner ear or brainstem

What CN does vestibular disease involve damage to?

CN VIII

Vestibular ataxia clinical signs

head tilt, asymmetric ataxia, leaning, falling, rolling, circling towards the side of the lesion (side with less vestibular tone), abnormal nystagmus (spontaneous, positional, lack of normal), vestibular strabismus "eye-drop"; central vestibular disease will also have mentation changes

A neurologic patient that is markedly obtunded (i.e., mentation change) probably has a ________________ lesion.

brainstem

A neurologic patient that is alert, but the owner notes "hasn't been themselves" at home (i.e., behavior change) probably has a ________________ lesion.

forebrain

In animals with cervical lesions, which limbs are affected?

All 4 limbs, hind more than front

Make a prioritized list of differentials based on the neuro patient signalment and history

Understand how to use the time-sign graph to determine major categories for differential diagnoses for a patient with neurological signs

In a neurologic patient that has had clinical signs its entire life, the most likely (general) cause is _______________. (think time-sign graphs)

anomalous/congenital

In a neurologic patient that developed clinical signs acutely, and they improve over weeks to months, the most likely (general) cause is _______________. (think time-sign graphs)

trauma/vascular

In a neurologic patient that developed clinical signs somewhat slowly and they got worse over time, the most likely (general) cause is _______________. (think time-sign graphs)

infectious/inflammatory

In a neurologic patient that developed clinical signs slowly and got worse over time, especially getting worse in the last few weeks to months, the most likely (general) cause is _______________. (think time-sign graphs)

neoplasia

In a neurologic patient that developed clinical signs very slowly and got worse over time, the most likely (general) cause is _______________. (think time-sign graphs)

degenerative

Prioritize diagnostics in the face of financial limitations

think about what gives you the most information, what can prove or rule out the most likely differentials; what will make the patient feel better? What can we accomplish with the money we have? What is the prognosis?