Spring 2016 Flashcards by Riley Shugg

The mechanism by which NSAIDs drugs can cause gastric ulceration is best described by:
a. up regulation of prostaglandin synthesis allows for an increase in acid production and damage to the mucosal lining of the stomach.
b. gastic pH is increased allowing Helicobacter to proliferate and directly damage the gastric mucosa
c. prostaglandin E2 and I2 production are reduced inhibiting mucus secretion and increasing acid production
d. COX-1 inhibition directly increases gastrin and histamine activation of acid secretion in parietal cells

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Which of the following is a stimulator of acid secretion in the stomach and the associated intracellular signaling pathway?
a. gastrin, increased Ca
b. histamine, increased Ca
c. acetaminophen, increased cAMP
d. acetylcholine, increased cAMP

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A 3 year old lab is recovering in your hospital after a gastrostomy for a tennis ball. He begins to regurgitate repeatedly 12 hours post-operatively. As a part of your treatment you start an antacid. Which of the following is correct
a. misoprostal will increased prostaglandin E2 and mucosal healing and is the strongest antacid
b. H2 receptor antagonists adminstered once daily provides adequate acid suppression
c. sucralfate will buffer pH of gastric contents and allow healing of the surgical site
d. PPIs administered every 12 hours will reduce acid quickly.

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Which of the following is not a risk factor for pancreatitis in the dog?
a. SPINK1 gene
b. obesity
c. toxoplasmosis
d. diabetes mellitus

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A 6mo puppy presents to your clinic with a history of vomiting, jaundice, and red colored urine. You perform basic bloodwork and urinalysis and find a non- regenerative anemia with Heinz bodies, icterus, and elevated ALP, isothenuria, bilirubinuria, pigmenturia. Which is a potential cause?
a. zinc foreign body
b. leptospirosis
c. hemoabdomen and HSA
d. ethylene glycol ingestion

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In a recent study, Kempf et al compared the efficacy of cisapride and metoclopramide in dogs to increase lower esophageal sphincter (LES) tone. Which of the following best describes the main finding of the study?
a. Metoclopramide failed to increase LES tone when administered orally.
b. Cisapride and metoclopramide were both unable to increase LES tone.
c. Both medications were able to increase LES tone, but cisapride had undesirable side effects.
d. Both medications were able to increase LES tone, but the effect did not last past 2 hours.

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Which of the following laboratory findings is/are most consistent with a hepatic cause of icterus?

A. anemia and elevated direct (i.e. conjugated) bilirubin
b. elevated canine pancreatic lipase and GGT
C. elevated ammonia
d. decreased BUN

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The mechanism of action of omeprazole is:
A. inhibition of histamine-2-mediated sources of acid production
B. inhibition of gastric acid secretion at the final common pathway of the H+/K+-ATPase proton pump
c. inhibition of gastrin-mediated sources of acid production
d. inhibition of chole-cystikinin secretion

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Which of the following is the mechanism of action of maropitant?
A. Neuro-Kinin 1 antagonist
B. 5-HT3 antagonist
C. D2-dopaminergic receptor antagonist
D. α-1 and α-2 receptor antagonist

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A benefit of intermittent bolus delivery of nutrition via a feeding tube (nasogastric or nasoesophageal) as compared with continuous delivery is:
A. Delivery of higher percentage of prescribed nutrition
B. Fewer mechanical complications
C. Lesser gastric residual volumes
D. Lesser incidences of vomiting or regurgitation

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Which of the following is a factor that can precipitate the development of hyperammonemia and hepatic encephalopathy?
A. acidosis
b. hypokalemia
c. low protein intake
d. diarrhea

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Which of the following metabolic derangements is NOT associated with refeeding syndrome include:
Hypomagnesemia
Hypophosphatemia
Hyperkalemia
Hyperglycemia

Hyperglycemia

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Which of the following are considered predisposing factors to the development of gastric dilatation-volvulus?
i. familial (first degree relative) history of GDV
ii. advancing age
iii. overweight body condition
iv. raised food bowl

not overweight, but all others

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The definition of intra-abdominal hypertension is:
An increase of IAP (intra-abdominal pressure) of more than 20 mmHg that is associated with new organ dysfunction or failure.

An increase of IAP of more than 20 mmHg.

A sustained or repeatable increase in IAP of greater than 12 mmHg that is associated with new organ dysfunction or failure.

A sustained or repeatable increase in IAP of greater than 12 mmHg.

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Abdominal perfusion pressure (APP) is:
APP = MAP - IAP
APP = MAP + IAP
APP = SBP - IAP
APP = IAP – MAP

APP = MAP - IAP

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Which of the following is most correct regarding lungs with a high compliance:
these lungs would have a steep slope on their pressure-volume curve
the pressure-volume curve is not a good indicator of compliance
these lungs would have increased hysteresis
these lungs would require a large distending pressure to effect a small change in volume

these lungs would have a steep slope on their pressure-volume curve

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Physiologic dead space can be increased by:
an excessively long endotracheal tube
hyperoxic vasodilatation
pulmonary thromboembolism
increased pulmonary arterial pressure

increased pulmonary arterial pressure

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Which of the following is most correct regarding setting ventilator alarms?

a. the low airway pressure alarm should be set 5-10 cmH2O above the patient’s peak airway pressure
b. the high airway pressure alarm is suggestive of patient disconnection from the circuit
c. a low tidal volume alarm may indicate a drop in compliance or an increase in resistance
d. the low pressure airway alarm is suggestive of an airway obstruction

a low tidal volume alarm may indicate a drop in compliance or an increase in resistance

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Which of the following is a preventative strategy for ventilator-associated lung injury?

Limit tidal volume to 15ml/kg
Allow permissive hypercapnia and hypoxemia
PEEP should not exceed
PIP should not exceed 35 cmH2O

PIP should not exceed 35 cmH2O

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Which of the following is not suggestive of a diagnosis of pulmonary thromboembolism?

antithrombin concentrations <50-75% of normal
enlarged right ventricle in the presence of pulmonic stenosis
alveolar infiltrates on thoracic radiography
An (A-a) gradient >25

enlarged right ventricle in the presence of pulmonic stenosis

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According to the study from Edwards, et al. published in JVECC 2014 and investigating the use of positive pressure ventilation (PPV) in congestive heart failure (CHF):

Survival-to-discharge rate was 77% for dogs and cats with CHF treated with PPV
Unless PaCO2 is >50mmHg, CHF is not an indication for PPV
PPV is not indicated in CHF unless the patient is unresponsive to diuretic therapy
an increase in expiratory effort for > 6 hours is an indication for PPV

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Survival-to-discharge rate was 77% for dogs and cats with CHF treated with PPV

When O2 binds to hemoglobin and displaces CO2 from the blood into the alveoli this is known as the ________________.
Bohr effect
Haldane effect
Chloride shift
Respiratory exchange ratio

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Haldane effect

Which of the following best describes the role that airway receptors play in the sensation of dyspnea?

Neuroepithelial bodies (NEB), a tracheobronchial receptor, are directly sensitive to hypoxia.

Slowly adapting receptors (SARs) are unmyelinated fibers, which contribute to the sensation of dyspnea when there is smooth muscle stretch.

C-fibers located solely in the alveoli are responsible for mucus secretion and bronchoconstriction.

The use of inhaled furosemide, a rapidly adapting receptor (RAR) sensitizer, has been used successfully in the treatment of dyspnea caused by congestive heart failure and asthma.

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Neuroepithelial bodies (NEB), a tracheobronchial receptor, are directly sensitive to hypoxia.

Which of the following is not a complication of inappropriately applied positive end expiratory pressure (PEEP)?

Decreased venous return and cardiac output from high airway pressure and mean intrathoracic pressure.

Decreased perfusion to well ventilated areas of the lung causing increased PaCO2-ETCO2 difference, PaCO2, and dead space.

Volutrauma leading to the development of increased permeability of the alveolar capillary membrane, pulmonary edema, and decreased lung compliance.

Increased right ventricular afterload, which increases end-diastolic volume, decreases ejection fraction, and shifts the intraventricular septum to the left.

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Volutrauma leading to the development of increased permeability of the alveolar capillary membrane, pulmonary edema, and decreased lung compliance.

What percentage of the trachea can be resected in a mature dog with tracheal trauma? 10 – 20% 25 – 50% 50 – 75% Tracheal resection is not advised

25 – 50%

In a recent retrospective study on use of a 10% pentastarch, a hydroxyl-ethyl starch (HES), Hetastarch and its association with acute kidney injury and death, the authors’s conclusions suggests that: There is a dose dependent relationship between HES use and acute kidney injury 10% HES administration was associated with a decreased risk of death and acute kidney injury There was no association between administration of 10% HES and acute kidney injury While increased risk of acute kidney injury may occur with 10% HES, administration was associated with a decrease in overall mortality

There is a dose dependent relationship between HES use and acute kidney injury

Adequate tissue oxygenation depends on the rate of oxygen delivery to the tissues (DO2) and the uptake of oxygen at the capillary beds (VO2). Cardiac output and arterial oxygen content (CaO2) are contributing factors. CaO2 is calculated by which of the following formula? (FiO2 (Patm – PH2O) – (PaCO2/0.8) (Hb x 1.34 x SaO2) + (PaO2 x 0.003) VO2/(Ca – CV) (CO x SVR) + CVP

(Hb x 1.34 x SaO2) + (PaO2 x 0.003)

In a recent prospective study on Shock Index (SI), the authors found that the SI is an easy and noninvasive parameter to measure if a dog may be in shock on presentation to an emergency service. Which of the following defines the Shock Index? Systolic blood pressure/mean arterial pressure Mean arterial pressure/heart rate Heart rate/systolic blood pressure Heart rate/respiratory rate

Heart rate/systolic blood pressure

In a recent observational trial of dogs in shock with low central venous oxygen saturation despite normalization of heart rate and blood pressure, the authors indicate that: Some of these dogs had occult shock and poor perfusion despite normalization of heart rate and blood pressure Normalization of ScvO2 during resuscitation was associated with an increased 28 day survival Lactate is still a more reliable indicator of survival in patients undergoing shock resuscitation A post resuscitation CVP of >8mmHg was associated with improved ScvO2 and survival to discharge

Some of these dogs had occult shock and poor perfusion despite normalization of heart rate and blood pressure

Which of the following cytokines are associated with the proinflammatory state in systemic inflammatory response syndrome (SIRS)? IL-10 TGF – β Bradykinin IL-13

Bradykinin

During states of hypovolemia, baroreceptors activate the hypothalamic-pituitary-adrenal axis to stimulate the release of ADH (vasopressin) to cause sodium and water retention. Which of the following hormones are responsible for increasing water and sodium excretion during volume overexpansion. Atrial natriuretic peptide (ANP) Aldosterone Endogenous cortisol Renin

Atrial natriuretic peptide (ANP)

Which of the following fluids has the highest colloid osmotic pressure? Hypertonic saline (7.5% NaCl) Normal Saline (0.9% NaCl) Fresh frozen plasma Oxyglobin®, an hemoglobin-based oxygen carrier

Oxyglobin®, an hemoglobin-based oxygen carrier

Which of the following substances is considered an ineffective osmole (only one apply)? Chloride Potassium Urea nitrogen Glucose

Potassium

Which of the following changes with isotonic dehydration? a. Extra-cellular volume decreases and intra-cellular volume decreases b. Extra-cellular volume decreases and intra-cellular volume remains unchanged c. Extra-cellular volume decreases and intra-cellular volume increases d. Intra-cellular volume decreases and extra-cellular volume increases

b. Extra-cellular volume decreases and intra-cellular volume remains unchanged

In patients with severe hyponatremia with increase plasma osmolality, which of the following is the best recommended target for correction of the patients sodium concentration? a. Increase sodium concentration no more than 1mmol/l every 2 hours b. Increase sodium concentration no more then 2mmol/l every 2 hours c. Increase sodium concentration back to normal within 12 hours d. Increase sodium concentration back to normal within 24 hours

a. Increase sodium concentration no more than 1mmol/l every 2 hours

The use of 0.9% NaCl when compared to balanced electrolyte fluids (e.g lactated ringers, plasma-lyte) is associated with which of the following morbidities a. Hyperchloremic metabolic acidosis only b. Hyperchloremic metabolic alkalosis only c. Hyperchloremic metabolic alkalosis and increased risk of acute kidney injury d. Hyperchloremic metabolic acidosis and increased risk of acute kidney injury

Hyperchloremic metabolic acidosis and increased risk of acute kidney injury

In patients with congestive heart failure that clinical dehydration and requiring IV fluids for rehydration which of the following solutions is most appropriate to administer to the patient? a. 0.45% NaCl in 2.5% dextrose supplemented with potassium b. 7.2% NaCl c. Hydroxyethyl starch (130/0.4) in 0.9% NaCl d. 0.9%NaCl supplemented with potassium

0.45% NaCl in 2.5% dextrose supplemented with potassium

Regarding synthetic colloids, which of the following statements is most accurate? a. Higher molecular weight confers greater intravascular persistence b. Lower molecular weight confers greater intravascular persistence c. Higher C2:C6 ratio confers greater intravascular persistence d. Lower C2:C6 ratio confers greater intravascular persistence

Higher C2:C6 ratio confers greater intravascular persistence

Which of the following is considered a normal colloid osmotic pressure of canine plasma? a. 20 mmHg b. 14 mmHg c. 27 mmHg d. 32 mmHg

a. 20 mmHg

Which of the following is the most important initiator of coagulation? a . Factor IX b. Tissue factor c. Factor X d. Tenase complex

Tissue factor

In a 2014 study by Holowaychuk, which of the following was the best indicator of survival for dogs with trauma-induced coagulopathy? a. PT b. aPTT c. ACT d. D-dimers

aPTT

Which of the following best describes clinical signs associated with secondary hemostatic disorders? a. Epistaxis b. Melena c. Gingival bleeding d. Hemothorax

Hemothorax

Which of the following is a major mechanism(s) responsible for the coagulopathy seen with the use of hydroxethyl starch solutions? a. Activation of tissue factor pathway inhibitor b. Thrombocytopenia c. Activation of antithrombin d. Interaction with factor VIII/von Willlebrand factor complex

Interaction with factor VIII/von Willlebrand factor complex

Which of the following coagulation protein routinely circulates in the blood in its active form? a. Factor VII b. Factor X c. Factor IX d. Factor V

Factor VII

A recent study evaluating platelet closure time (PCT) in greyhounds treated with hydroxyethyl starch (HES) 130/0.4 found that. a. HES 130/0.4 caused significant increases in PCT compared to 0.9% NaCl b. HES 130/0.4 significantly increased PCT but did not appear to cause relevant platelet dysfunction beyond hemodilution c. 0.9% NaCl did not lead to increase PCT d. Controlled hemorrhagic shock in Greyhounds caused a significant change in PCT

HES 130/0.4 significantly increased PCT but did not appear to cause relevant platelet dysfunction beyond hemodilution

What is the best therapeutic option for a dog undergoing an elective procedure diagnosed with von Willebrand’s disease? a. Fresh frozen plasma b. Frozen plasma c. Cryoprecipitate d. Aqueous vasopressin

Cryoprecipitate

Which of the following is not a major hypothesis for the systemic hypocoagulation and hyperfibronolytic state that has been termed “acute traumatic coagulopathy (ATC)”? ATC is disseminated intravascular coagulation (DIC) with a hyperfibrinolytic phenotype ATC results from enhancement of the thrombomodulin-thrombin-Protein C pathway ATC results from a marked sympathoadrenal response causing widespread catecholamine-induced endothelial damage ATC is caused by loss/dilution of platelets and hemostatic factors

ATC is caused by loss/dilution of platelets and hemostatic factors

What is the rationale for using desmopressin acetate (DDAVP) as a prohemostatic agent?   Synthetic vasopressin analog, works via V2 receptors, triggers release of subendothelial vWF stores and FVIII.   Lysine analog, blocks binding and activation of plasminogen.  Also inhibits interleukins and has adjunctive anti-inflammatory effects.   Serine protease, inactivates FVa and FVIIIa Prevents activation of plasmin, thereby inhibiting fibrinolysis

Synthetic vasopressin analog, works via V2 receptors, triggers release of subendothelial vWF stores and FVIII.  

Initiation: vascular damage or inflammation brings TF bearing cells into contact with plasma.  Circulating _____ binds to TF and is activated.  Small amounts of thrombin are generated, which activates platelets at the site.   fVIII fVII fV fXIII

fVII

Amplification: Thrombin generated during initiation activates platelets, triggering the release of secondary agonists.  Thrombin also activates factors ___ and ___ , cleaves circulating complexes of vWF/FVIII, and then activates free FVIII.   FV and FXI FV and FVII FVII and FXII FV and FXI

FV and FXI

According to a 2015 prospective study of the use of apixaban in cats: When administered PO or IV, apixaban was an effective Xa inhibitor in cats.   IV apixaban was an effective Xa inhibitor, however poor bioavailability limits utility when administered PO.   When administered PO or IV, apixaban was an effective platelet inhibitor, with prolonged closure times measured using PFA-100.   IV apixaban administration was associated with urticaria and facial pruritis  

When administered PO or IV, apixaban was an effective Xa inhibitor in cats

Spring 2016 Flashcards

(51 cards)