Paging Dr. Fick
Recite Ficks law of diffusion (in an English accent)
Ficks law states that the amount of gas that crosses a sheet is proportional to the surface area and inversely proportional to the thickness of the sheet.
Hypoxemia refers to a PaO2 less than what?
80 mmHg
What causes a release of ANP and what is its effect?
Released with response to atrial distension. Leads to sodium and water loss.
What are the radiographic opacities?
Gas, fat, soft tissue/fluid, bone, metal
What hollow organ would be closed with a simple continuous in the mucosa/submucosa and inverting pattern in the seromuscular layer.
The stomach
Where are urticating hairs on a tarantula found?
The abdomen.
What is the functional residual capacity?
The amount of air remaining in the lungs after normal expiration.
Name the five commonly cultured bacteria in canine pneumonia.
Pasteurella
E. coli
Staphylococcus
Stretococcus
Mycoplasma
CaO2 = ??
(1.34xHgbxSaO2)+(0.003xPaO2)
For what condition(s) would you prefer a left lateral abdominal radiograph? For what condition(s) would you prefer a right lateral radiograph?
Left: looking for foreign material in the pylorus
Right: GDV
What is the difference between an anti-septic and disinfectant.
An anti-septic is used on a living organism. Disinfectant is used on non-living things.
Give an example of a diffusion limited and a perfusion limited gas.
One study identified that a certain percentage of cats with a peripheral eosinophilia had allergic airway disease. What percent of cats did they find this to be the case in?
9%
Describe the primary location of alpha-1, alpha-2, beta-1, beta-2 receptors and the consequence of activation.
Alpha - 2: GI tract and peripheral arteries and veins; decreased secretions, motility, and tone (hence why the GI tract is considered the shock organ in the dog) and vasoconstriction
Beta-1: Heart; increased ionotropy and chronotropy
Beta-2: Skeletal muscle vessels, coronary arteries (vasodilation); bronchial smooth muscle (relaxation)
You are completing an abdominal ultrasound for a dog diagnosed with a mast cell tumor. What two locations are most likely to contain disease?
Spleen and liver
What are the three phases of wound healing?
Inflammation, proliferation, maturation
How many mEq/L of Na+ is there in 7.2% saline?
1232 mEq/L
What is the alveolar ventilation equation?
Va=(Vco2/Pco2)xK
What two classes of bronchodilators are commonly used in veterinary medicine?
B2 receptor agonists
methylxanthines
Draw the steps involved smooth muscle contraction.
1. Action potential
2. Membrane depolarization
3. L-type voltage gated Ca2+ allows influx of Ca2+
4. Ca + calmodulin
5. CaCalmodulin complex binds to MLCK
6. Phosphorylation of Myosin
7. Myosin released from actin allowing for it to bind again and contract.
What are the Roentgen signs? Hint, there are 6
1. Size 2. Shape 3. Number. 4. Position. 5. Opacity. 6. Margination
What is the holding layer of the small intestine?
The submucosa (highest amount of collagen).
What is a conditionally essential amino acid that becomes depleted relatively quickly in critical illness?
Glutamine
Name the pressures throughout the cardiopulmonary system.
RA 2mmHg; RV 25/0; MPA 25/8; La 5; LV 120/0; aorta 120/80
Define veterinary ARDS
1. Acute onset (<72hrs) of tachypnea and labored breathing at rest
2. Known risk factors
3. Evidence of pulmonary capillary leak without increased capillary pressure (bilateral diffuse infiltrates on rads; bilateral dependent density gradient on CT; proteinaceous fluid within the conducting airways; increased extravascular lung water)
4. Inefficient gas exchange
a. Hypoxemia without PEEP or CPAP and known FiO2
i. PaO2/FiO2 <200mmHg
ii. Increased A-a
iii. Venous admixture
b. Increased dead space ventilation
5. Evidence of diffuse pulmonary inflammation
a. TTW/BAL with neutrophilia
b. TTW/BAL with biomarkers of inflammation
c. Molecular imaging
List 6 functions of vasopressin
Maintain blood osmolality and blood volume
Control BP
Body temp.
Insulin release
Corticotropin release
Memory
Social behavior
Uterine mobility
Liver glycogenolysis
Platelet aggregation
Secretion of aldosterone
Secretion of factor VIII
What are the relative echogenicities of the spleen, liver, and kidney?
Kidney(darkest), liver, spleen(Brightest)
What is the average gastric emptying time in the dog (based on a 1933 study)?
Claritin is used to treat what condition in children, beyond allergies?
Bone pain (per AG)
The nose accounts for what percentage of airway resistance in dogs?
80%
What is lung compliance?
Compliance is the distensibility of the lung and defined by change in volume/change in pressure. This is different from elastance which is the inverse of this.
Up to 3 B-lines/field
1. Culture
2. Cytological evidence of bacteria
3. Paired BG >/= 20
4. Paired lactate >/= 2.5
5. TNCC >/= 13,000 (86% sensitive, 100% specific)
How much does urine weigh?
It is 1g/ml
It is found in the medulla. Its primary function is timing of the respiratory cycle.
What are the two major types of ventilator breaths?
Spontaneous and mandatory
Why is diltiazem and not amlodopine used in supraventricular arrhythmias?
Both drugs are calcium channel blockers and both only work at voltage-sensitive L-type channels. There are different isoforms of these channels which likely explains why different drugs work at different locations. L-type calcium channels are responsible for phase 0.
In cardiac depolarization, membrane L-type channels allow a small amount of calcium in, which triggers a larger release of calcium from the SR. Calcium binds to troponin C resulting in a change in the troponin-tropomyosin complex. This leads to exposure of the actin filament which then allows cross-linking with myosin.
Diagnostic accuracy of a lung ultrasound protocol (Vet BLUE) for detection of pleural fluid, pneumothorax and lung pathology in dogs and cats (JSAP 2021) compared POCUS to CT. Of the conditions assessed, POCUS had the highest degree of accuracy for identifying what?
Alveolar-interstitial syndrome (~75% depending on criteria used)
VetBLUE correctly identified consolidation at 14/24 sites, pleural effusion (2/3), and pneumothorax (33%)
Bilirubin has to be how many times greater in abdominal effusion vs. peripheral sample to indicate a bile peritonitis?
It should be 2x as high.
Where animal does protamine sulfate come from?
Protamine sulfate is used to reverse heparin. It is harvested from the sperm of fish (usually salmon).
What are the primary muscles involved in inspiration?
Diaphragm, chest wall muscles, and some neck muscles.
What is a trigger variable?
This is the parameter that initiates inspiration. May be time, change in air pressure, or change in gas flow.
What findings are used to determine the probability of the presence of pulmonary hypertension?
Tricuspid regurgitation velocity; ventricles; pulmonary artery; right atrium and caudal vena cava
What are e-lines on POCUS?
What are three possible indications in severe acute pancreatitis?
1. infected pancreatitic necrosis
2. EHBO
3. Continued deterioration despite medical therapy
What is the volume (mls) of 1 unit using a U100 syringe?
0.01mls
Do central chemoreceptors respond more to changes in CO2 or O2?
Central chemoreceptors are responsible for the majority of the response changes in CO2 and pH. Peripheral chemoreceptors exclusively respond to hypoxemia and are also influenced by CO2 and pH.
What is the difference between a scalar and loop?
Give 5 differentials for pericardial effusion (neoplasia counts as 1)
1. Neoplasia 2. Idiopathic 3. LA rupture 4. Coagulopathy 5. Infection
What do 'window width' and 'window level' refer to in regards to CT
Window width is the range of ct numbers an image will contain. The window level refers to the mean number. So for bone, where less distinction between shades of grey is important the width will be very high. In an abdomen, where the distinction between shades of grey is important, the width will be smaller and the available grey shades will be compressed to provide more detail.
The celiac artery is a branch of the abdominal aorta. It gives rise to what other arteries?
Why is the Ashwell-Morell receptor significant?
Ashwell-Morell receptors will bind desialylated platelets which provides feedback to stimulate TPO production. In ITP, it is thought that this is not stimulated so thrombopoietin is not increased resulting in an inappropriately normal or low level.
Describe the "120" rule.
When breathing 21% O2 at sea level, PaCO2+PaO2 can be used to identify venous admixture. A value less than 120 suggests presence of venous admixture.
Pressure waveforms typically take on two different forms. What are they?
Exponential rising (volume control modes with constant flow) or a square waveform (pressure control)
Describe the difference between Morbitz Type I vs. Morbitz Type II
Type 1: PR interval gradual gets longer until there is a blocked P wave (no QRS complex after P wave)
Type 2: PR intervals are consistent but some P waves do not conduct.
In patients with pericardial effusion, what is the PPV and NPV for echocardiogram in identifying right atrial HSA (range is acceptable)?
PPV = 92-100%
NPV = 64-87%
This TA stapler fires three rows of staples.
The TA30 V3; Thoracoabdominal staplers come in three sizes based on the total length of their cartridge - 30mm, 55mm, and 90mm. The 55 and 90 are only available with two rows of staples but the 30 also comes in a version called the V3 (V for vascular, and 3 indicating 3 rows of staples). We try to use the V3 for lung and liver lobectomies whenever the hilus of the lobe allows it (i.e. 30mm or less) because of the extra row of staples.
A full E-tank will measure at how many PSI?
2,200 PSI