The main results of a 2015 Cochrane Review evaluating the use of corticosteroids in the treatment of sepsis included all but one of the following:
Corticosteroid administration was associated with an increased proportion of shock reversal by day 7 and by day 28.
Corticosteroid administration was associated with a reduced Sequential Organ Failure Assessment (SOFA) score by day 7, as well as a shorter ICU stay.
Corticosteroid administration was associated with an increased risk of gastrointestinal bleeding and superinfection.
Corticosteroid administration was associated with an increased risk of hyperglycemia and hypernatremia.
Corticosteroid administration was associated with a reduced Sequential Organ Failure Assessment (SOFA) score by day 7, as well as a shorter ICU stay.
A retrospective, observational, descriptive pilot study from a university teaching hospital published in 2017 evaluated the prognostic utility of platelet indices in dogs with septic peritonitis. The major findings of this study included:
Dogs with septic peritonitis had significantly increased mean values for mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW) as compared to healthy dogs.
In dogs with septic peritonitis, non-survivors had significantly higher MPV, PCT and PDW on admission as compared to survivors.
Dogs with septic peritonitis had significantly lower mean platelet counts as compared to healthy controls.
Dogs with septic peritonitis had significantly higher mean platelet counts as compared to healthy controls.
Dogs with septic peritonitis had significantly increased mean values for mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW) as compared to healthy dogs.
A retrospective case study comparing 10 dogs with suspected anaphylaxis to 22 dogs with confirmed sepsis was published in 2017. The major findings of this study included:
Dogs with suspected anaphylaxis had significantly higher peripheral blood eosinophil counts and significantly higher serum alkaline phosphatase activity than dogs with confirmed sepsis.
Dogs with suspected anaphylaxis had a significantly lower peripheral venous pH and significantly higher serum alanine aminotransferase activity than dogs with confirmed sepsis.
Dogs with suspected anaphylaxis had significantly a higher serum globulin concentration and a significantly lower peripheral venous pH than dogs with confirmed sepsis.
All of the above
Dogs with suspected anaphylaxis had a significantly lower peripheral venous pH and significantly higher serum alanine aminotransferase activity than dogs with confirmed sepsis.
The Protocolised Management in Sepsis (ProMISe) Trial was a pragmatic randomized trial comparing early, goal-directed therapy (EGDT; a 6-hour resuscitation protocol) to standard care for patients with early septic shock. Major findings included all of the following except:
The EGDT group received more intravenous fluids, vasoactive drugs and red blood cell transfusions
The EGDT group had significantly worse organ failure scores, received more days of advanced cardiovascular support, and had longer ICU stays than the standard care group
There were no differences in the rates of serious adverse events between the EGDT and standard care groups.
The EGDT group had significantly lower all-cause mortality at 90 days as compared to the standard care group.
The EGDT group had significantly lower all-cause mortality at 90 days as compared to the standard care group.
A recent prospective clinical evaluation of dogs with peritoneal effusion examined the utility of whole blood, plasma, peritoneal fluid and peritoneal fluid supernatant glucose concentration measurements obtained by a veterinary point-of-care glucometer in the identification of septic peritonitis. Major findings included all of the following except:
A glucose concentration difference of >20 mg/dl between whole blood and peritoneal fluid was a sensitive indicator of septic peritonitis.
A glucose concentration difference of >20 mg/dl between both plasma and peritoneal fluid and plasma and peritoneal fluid supernatant was a sensitive indicator of septic peritonitis.
A glucose concentration difference of >38 mg/dl between both plasma and peritoneal fluid and plasma and peritoneal fluid supernatant yielded superior specificity, positive predictive value and accuracy as compared to a cutoff of > 20 mg/dl .
All of the above.
A glucose concentration difference of >20 mg/dl between whole blood and peritoneal fluid was a sensitive indicator of septic peritonitis.
Following rattlesnake envenomation, crotalid antivenin should ideally be administered within how many hours of the bite?
1 hour
2 hours
4 hours
8 hours
4 hours
Envenomation with the Mojave toxin, which is found in the venom of certain rattlesnakes, results in the following clinical signs:
Ascending flaccid paralysis
Hemolysis and coagulopathy
Muscle tetany and seizures
Tissue necrosis and edema
Ascending flaccid paralysis
The neurotoxin present in black widow spider venom that results in clinical signs is:
Sphingomyelinase D
α-latrotoxin
Tetanospasmin
Tetrodotoxin
α-latrotoxin
A dog is exercising in the summer. The ambient temperature is 110 degrees Fahrenheit, and the relative humidity is 40%. What is the primary mechanism the dog is using to dissipate body heat?
Convection
Conduction
Radiation
Evaporation
Evaporation
A 2-year-old Labrador retriever is presented after collapsing while he was outside chasing a tennis ball on a hot sunny day. Upon presentation, the dog is laterally recumbent and minimally responsive. His rectal temperature is 108.1 degrees Fahrenheit, his heart rate is 180 bpm, his respiratory rate is 120 bpm (panting), his mucous membranes are injected, and his CRT is 4 seconds. You immediately start cooling measures and intravenous fluid therapy; during this time, the dog has a generalized seizure which ceases following midazolam administration. The following laboratory data is obtained. How many negative prognostic indicators does this dog have?
One (1)
Two (2)
Four (4)
Six (6)
Four (4)
According to a recent study published in the Journal of Veterinary Emergency and Critical Care that described heat stroke in dogs:
Older age, higher heart rate and higher rectal temperature at presentation; a longer time period between the onset of clinical signs and presentation; and the development of DIC were all significantly associated with mortality.
Older age, higher heart rate and lower rectal temperature at presentation; a shorter time period between the onset of clinical signs and presentation; and the development of DIC were all significantly associated with mortality.
Older age, higher heart rate and higher rectal temperature at presentation, as well as a longer time period between the onset of clinical signs and presentation were significantly associated with mortality. The development of DIC was not significantly associated with mortality.
Older age, higher heart rate and lower rectal temperature at presentation, as well as a shorter time period between the onset of clinical signs and presentation were significantly associated with mortality. The development of DIC was not significantly associated with mortality.
Older age, higher heart rate and higher rectal temperature at presentation, as well as a longer time period between the onset of clinical signs and presentation were significantly associated with mortality. The development of DIC was not significantly associated with mortality.
According to the same study referenced in question 11:
Abnormalities in prothrombin time and partial thromboplastin time (PT and aPTT), Protein C and fibrinogen at presentation were not predictive of mortality.
Abnormalities in PT, aPTT, Protein C and fibrinogen at presentation were associated with an increased risk of mortality.
The development of abnormalities in PT, aPTT, Protein C and fibrinogen during hospitalization were not associated with an increased risk of mortality.
A decrease in platelet count was associated with an increased risk of mortality.
Abnormalities in prothrombin time and partial thromboplastin time (PT and aPTT), Protein C and fibrinogen at presentation were not predictive of mortality.
A study published in the Journal of Cell Stress and Chaperones by Yaron Bruchim et al (January 2016, Volume 21, Issue 1, pp 123 – 130) evaluated whether serum heat shock protein 72 (eHSP70) can provide prognostic information in dogs with heat stroke. They found that the serum eHSP70 levels were elevated at the time of admission and then decreased to their lowest levels 12 hours following admission in 30 cases of naturally occurring canine heatstroke. However, serum eHSP70 levels then returned to admission levels 24 hours following admission in survivors only, indicating that eHSP70 may be predictive of survival in naturally occurring heat stroke. This is likely because heat shock proteins contribute to all of the following EXCEPT:
Facilitate protein repair.
Regulate and offer protection against apoptosis.
Decrease activation of nuclear factor-κB.
Directly act on the hypothalamus to lower body temperature.
Directly act on the hypothalamus to lower body temperature.
A recent retrospective evaluation of cats requiring mechanical ventilation (MV) following elapid snake envenomation discovered that:
Cats requiring MV following envenomation had a >90% chance of being weaned from MV and surviving to hospital discharge. Median duration of ventilation was <24 hours.
Cats requiring MV following envenomation had a <10% chance of being weaned from MV and surviving to hospital discharge. Median duration of ventilation was >72 hours.
Cats requiring MV following envenomation had a <10% chance of being weaned from MV and surviving to hospital discharge. Median duration of ventilation was < 24 hours.
Cats requiring MV following envenomation had a >90% chance of being weaned from MV and surviving to hospital discharge. Median duration of ventilation was >72 hours.
Cats requiring MV following envenomation had a >90% chance of being weaned from MV and surviving to hospital discharge. Median duration of ventilation was <24 hours.
According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)…
meeting two of the four Systemic Inflammatory Response Syndrome (SIRS) criteria is a sensitive indicator in identifying patients with sepsis and septic shock.
sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection.
severe sepsis remains a key subset of septic patients with one or more organ dysfunctions, hypotension or hypoperfusion.
septic shock is defined as a subset of sepsis which hypotension (MAP <65 mmHg) that persists despite fluid resuscitation and vasopressors
sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection.
Regarding the use of the Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) Score in the assessment of patients with suspected sepsis:
A change in the total score by two (2) or more points from baseline is considered indicative of organ dysfunction.
An increase in the SOFA score of 2 points or more is associated with an increased probability of in-hospital mortality of >10%
Use may be limited by lack of availability of laboratory data necessary to capture dysfunction in individual organ systems at a single time point.
All of the above is true.
All of the above is true.
The Compensatory Anti-inflammatory Response Syndrome (CARS) may lead to death from secondary infections as a result of…
increased immune effector cell apoptosis.
decreased monocyte production of cytokines in response to antigen stimulation.
downregulation of IL-10, allowing upregulation of TNF-alpha.
production of transforming growth factor-beta and prostaglandin E2.
downregulation of IL-10, allowing upregulation of TNF-alpha.
Toll-like receptor (TLR) 5 is a pattern recognition receptor located on the surface of _____________ that recognizes the pathogen-associated molecular pattern (PAMP) o bacterial __________________.
natural killer cells, flagellin
epithelial cells, lipopolysaccharide
dendritic cells, peptidoglycan
mast cells, diacyl lipopeptide
natural killer cells, flagellin
According to a study performed by Kumar et al that was published in 2006, what was the mortality percentage in patients with septic shock for which initiation of appropriate empirical antimicrobial therapy was delayed for at least 3 hours following recognition of a shock state?
8%
22%
43%
50%
22%
All of the following are known to affect pulse oximeter readings except:
Vasoconstriction
Darkly pigmented epithelium or mucosa
Icterus
Shock
Icterus
In a study published in 2015, Acierno et al tested the hypothesis that arterial pressures measured at any peripheral site would be equal. Which of the following was not described as a major finding from that study?
All direct arterial pressures measured from the carpal artery were significantly higher than those measured at other sites.
The systolic arterial pressure (SAP) from the dorsal pedal artery was higher than that from the carpal artery, but the mean (MAP) and diastolic (DAP) pressures were equivalent at both sites.
This study verified that all peripheral sites were comparably equivalent for the measurement of direct arterial blood pressures.
Peripheral sites were unreliable for the measurement if arterial pressures as compared to centrally placed arterial catheters.
The systolic arterial pressure (SAP) from the dorsal pedal artery was higher than that from the carpal artery, but the mean (MAP) and diastolic (DAP) pressures were equivalent at both sites.
In regards to arterial pressure waveforms, the phenomenon of distal pulse wave amplification is characterized by all of the following except:
A relatively unaffected mean arterial pressure.
A higher systolic arterial pressure.
A higher diastolic arterial pressure.
A delay in the appearance of the dicrotic notch
A higher diastolic arterial pressure.
Which statement best describes the use of non-invasive blood pressure devices in veterinary medicine?
The Doppler ultrasonographic method uses a 200-MHz ultrasound probe to detect arterial blood flow and is the most reliable method available for the measurement of systolic blood pressure in cats.
The oscillometric method is the most reliable method available for the measurement of mean arterial blood pressure and generally does not correlate well with Doppler blood pressure measurements.
It is generally accepted that the most common error made during non-invasive blood pressure measurements in small animal species is insufficient clipping of fur at the measurement site.
When measuring blood pressure in small animal species, the cuff should be placed at the level of the thoracic inlet.
The oscillometric method is the most reliable method available for the measurement of mean arterial blood pressure and generally does not correlate well with Doppler blood pressure measurements.
Your patient, a 5-year-old CM Labrador retriever, was brought to you from a house fire, where he had been trapped for some time. Which of the following statements is most correct regarding the pitfalls of the use of pulse oximetry technology with a patient like this?
Pulse oximetry will reliably estimate oxygenation in all patients regardless of soot on the fur or mucosal burns.
The accumulation of carcinogenic fumes in the patient will affect pulse oximetry readings, which may be falsely lowered due to the effects of the carcinogens on deoxygenated hemoglobin.
Shock or poor tissue perfusion will not affect the pulse oximeter readings if the probe is placed on the tongue.
Oxyhemoglobin and carboxyhemoglobin absorb light at a similar wavelength, so pulse oximetry readings in this patient may be close to 100% even if the patient is hypoxemic.
Oxyhemoglobin and carboxyhemoglobin absorb light at a similar wavelength, so pulse oximetry readings in this patient may be close to 100% even if the patient is hypoxemic.
