1
Q
What is TNF-alpha and where does it come from?
A
Pro-inflammatory cytokine from activated M1 macrophages
It is used in conditions like Crohn’s disease and arthritis.
2
Q
Name the pro-inflammatory cytokines.
A
- IL-1
- IL-6
- IL-8
- TNF alpha
These cytokines play a role in promoting inflammation.
3
Q
Name the anti-inflammatory cytokines.
A
- IL-10
- IL-1ra
- TGF-B
- IL-4
- IL-3
These cytokines help to reduce inflammation.
4
Q
What is the precursor for prostaglandins?
A
PGH2
Prostaglandins have various roles in inflammation and physiological functions.
5
Q
What does PGI2 do and where is it produced?
A
Vasodilation + decreased platelet aggregation (Kidney)
It is produced by COX-2.
6
Q
What does PGE2 do and where is it produced?
A
Vasodilation + inflammation; maintenance of stomach integrity (Kidney)
It is produced by COX-1.
7
Q
What does TXA2 do and where is it produced?
A
Vasoconstriction + platelet aggregation (Platelets)
It is produced by COX-1.
8
Q
What is the required oxygen tension for neutrophils?
A
> 40 mmHg
This is necessary for their function.
9
Q
What is the required oxygen tension for wound healing?
A
> 10 mmHg
This is important for angiogenesis and epithelialization.
10
Q
Where does NO come from and what does it do?
A
From endothelial cells; works on vascular smooth muscle
It is present during inflammation and proliferation.
11
Q
What is the peak effect timing of histamine?
A
15-20 minutes
Histamine plays a key role in inflammatory responses.
12
Q
Define autocrine signaling.
A
Cells of similar or identical phenotype in the local environment
This type of signaling affects the same cell type.
13
Q
Define paracrine signaling.
A
Adjacent cells of different phenotype
This type of signaling affects nearby but different cell types.
14
Q
What are the classifications of stem cells and their potency?
A
- Fetal/Perinatal: multipotent
- Adult: multipotent
- Inducible pluripotent: made from somatic cells
- Embryonic: pluripotent
These classifications indicate the differentiation potential of stem cells.
15
Q
What class are Mesenchymal Stem Cells (MSCs) and what is their potency?
A
Adult stem cells, multipotent
They can differentiate into one germ line.
16
Q
What benefits do mesenchymal stem cells provide?
A
- Produce anabolic and anti-inflammatory agents
- Immunomodulatory/immunosuppressive effects
- Rapid proliferation and massive number of cells
These properties make them valuable in therapeutic applications.
17
Q
Where do cytokines in bone healing arise from?
A
From platelet alpha granules
They have osteopromotive functions.
18
Q
How long can you store fresh whole blood?
A
< 6 hours
This is crucial for maintaining its viability.
19
Q
What is the distribution of total body water?
A
- ICF: 2/3, 40% BW
- ECF: 1/3, 20% BW
- ECF distribution: 75% interstitial, 25% intravascular (plasma)
Understanding this distribution is important for fluid therapy.
20
Q
What percentage of crystalloids is distributed in the body after a bolus?
A
75% into interstitial space within 20-30 min, 25% in intravascular space
This highlights the rapid distribution of crystalloids.
21
Q
What are the potential risks of human albumin administration in dogs?
A
- Acute or delayed hypersensitivity reactions
- Volume overload
- Coagulopathy
These risks necessitate careful monitoring.
22
Q
How do you calculate % dehydration?
A
- 8%: decreased skin turgor, dry mm
- 8-10%: +/- sunken eyes, prolonged CRT
- 10-12%: severe skin tent, prolonged CRT
- > 12%: shocky, death imminent
This assessment is critical in fluid therapy.
23
Q
What are the two types of lactic acidosis?
A
- Type A: hypoxia
- Type B: normal O2 delivery but mitochondrial dysfunction
Understanding these types is important for diagnosing metabolic issues.
24
Q
What does CVP measure and where is the catheter placed?
A
Placed between vena cava and R atrium; measures right heart function
Normal CVP is 0-5 mmHg.
25
What are the **four classes of hemorrhage**?
* Class I: up to 15% of circulating blood volume
* Class II: 15-30%
* Class III: 30-40%
* Class IV: >40%
## Footnote
Each class indicates severity and clinical signs.
26
What does **PT** measure?
Extrinsic + common pathway, factor 7
## Footnote
It is used to assess secondary hemostasis.
27
What does **APTT** measure?
Intrinsic + common pathway, factors 8, 9, 11, 12
## Footnote
It is also used to assess secondary hemostasis.
28
What is the **normal value for ACT**?
70-120 seconds
## Footnote
This test is used to evaluate coagulation.
29
What is the function of **vWF**?
Facilitates platelet adhesion to exposed subendothelium, platelet aggregation, binding factor 8
## Footnote
It prolongs the half-life of factor 8.
30
What blood product is given for **von Willebrand disease**?
Cryoprecipitate (for type 1 vWD) + Desmopressin
## Footnote
This treatment helps manage bleeding disorders.
31
What does **desmopressin** do?
Releases subendothelial vWF, VIII, and plasminogen stores
## Footnote
It is used in the treatment of vWD.
32
What is the best test for **von Willebrand disease**?
ELISA
## Footnote
Prolonged BMBT with normal PLT count is only supportive.
33
What occurs during **non-fatal uncomplicated starvation**?
* Insulin decreases
* Glucagon increases
* BG maintained by hepatic glycogenolysis and gluconeogenesis
* Fatty acids become primary energy source
## Footnote
The body adapts to using ketone bodies derived from FA metabolism over time.
34
What are the phases of **wound healing**?
* Inflammation
* Proliferation
* Maturation
## Footnote
Understanding these phases is crucial for effective treatment.
35
What does **VEGF** and other GFs cause endothelial cells to do?
Proliferate and form a tube that becomes new capillary lumen
## Footnote
This process is essential for angiogenesis.
36
Factors that cause **poor healing** of the GI tract include?
* Shear stresses from increased intraluminal pressure
* Bacterial flora (aerobic/anaerobic)
* Decreased perfusion during shock
* Mature collagen formation fails when PaO2 < 40mmHg
* Anastomotic failure when PaO2 < 10mmHg
## Footnote
These factors can significantly impair the healing process in the gastrointestinal tract.
37
What is the type of **collagen** and its amount in the scar of healed skin?
Type 3 collagen – 10%
## Footnote
This type of collagen predominates initially in wound healing.
38
Final skin scar strength compared to unwounded tissue is?
70-80% strength of unwounded tissue
## Footnote
This indicates that scars are not as strong as the original tissue.
39
Neutrophils do not function if **PaO2** is below what level?
< 40mmHg
## Footnote
Adequate oxygen tension is critical for neutrophil function in wound healing.
40
How do **myofibroblasts** form and where do they work?
TGF-beta transforms fibroblasts into myofibroblasts after granulation tissue establishment
## Footnote
Myofibroblasts play a crucial role in wound contraction.
41
In wound healing, dogs have a greater density of **collateral subcutaneous vessels** compared to cats. True or False?
TRUE
## Footnote
This vascular difference contributes to the differences in healing rates between the two species.
42
How does the **trunk** heal compared to the **limb**?
Loose skin at trunk heals by contraction; tighter skin on limbs heals by epithelialization
## Footnote
The type of skin affects the healing process.
43
What are the collagen types and percentages for the **GI tract** vs **dermis**?
Unwounded dermis = 80% type 1, 20% type 3; GI tract submucosa = 68% type 1, 20% type 3, 12% type 5
## Footnote
The composition of collagen differs significantly between these tissues.
44
When to expect a **GI seal** and what type?
Fibrin seal with serosa in 3 days
## Footnote
This is an important aspect of gastrointestinal healing.
45
What is the **bone makeup** in terms of collagen and healing?
70% mineral, 5% water, 25% matrix (90% type I collagen)
## Footnote
Bone healing involves a progression of collagen types.
46
What happens at **PaO2** < 40?
Neutrophils can't work; less collagen production in GI tract
## Footnote
Oxygen levels are critical for effective healing.
47
Healing strength percentages for **skin** at various time points are?
* 5-10% at 2 weeks
* 25% at 1 month
* 80% at 1 year
## Footnote
This shows the gradual increase in strength of healing skin.
48
Dependency on **suture** for tendon/ligament healing lasts for how long?
3 weeks
## Footnote
Sutures are crucial for maintaining alignment during early healing.
49
Role of **keratinocytes** in wound healing?
* Release IL-1 (first step of inflammation)
* Secrete VEGF and MMPs for epithelialization and endothelial formation
## Footnote
Keratinocytes are key players in the inflammatory response and healing process.
50
What stimulates and modulates **angiogenesis**?
Cytokines (VEGF) predominantly produced by keratinocytes, macrophages, and platelets
## Footnote
Angiogenesis is critical for supplying nutrients and oxygen to healing tissues.
51
Bladder healing time for mucosa reepithelialization is?
2-4 days
## Footnote
The bladder has a relatively rapid healing process.
52
Intact **female dogs** heal faster than intact males. True or False?
TRUE
## Footnote
Gender differences can impact healing rates.
53
What are the classifications of **SSIs**?
* Superficial SSI
* Deep SSI
* Organ/Space SSI
## Footnote
These classifications help in diagnosing and managing surgical site infections.
54
Key risk factors for **SSIs** include?
* Duration of surgery
* Duration of anesthesia
* Surgery site prep
* Method of wound closure
* Antimicrobial prophylaxis
* Comorbidities
## Footnote
Understanding these factors can help mitigate infection risks.
55
Best antibiotic for **orthopedic surgery**?
Cefazolin (Staph)
## Footnote
This antibiotic is effective against common pathogens in orthopedic procedures.
56
When are **perioperative antibiotics** recommended?
* Contaminated and dirty surgeries
* Some clean-contaminated procedures
* Procedures with implants
* Clean surgeries >90min
## Footnote
Timing and type of surgery dictate the need for prophylactic antibiotics.
57
What is the **MOA of steam sterilization**?
Kill microorganisms through coagulation and denaturation of proteins by moist heat
## Footnote
This method is effective for sterilizing surgical instruments.
58
What is the **MOA of ethylene oxide**?
Alkylation of proteins and nucleic acids, obstructing cell metabolism and reproduction
## Footnote
Ethylene oxide is used for sterilizing heat-sensitive items.
59
What are the types of **crushing** and **non-crushing tissue forceps**?
* Crushing: Babcock, Allis, Ochsner-Kocher
* Non-crushing: Doyen, DeBakey, Cooley, Satinsky
## Footnote
Different types of forceps are used based on the need to preserve or compress tissue.
60
What is the definition of **asepsis**?
Complete absence of contamination by pathogenic organisms
## Footnote
Asepsis is crucial in surgical environments to prevent infections.
61
What is the **contact time** for high-level disinfectants?
20-30 minutes
## Footnote
Adequate contact time is essential for effective disinfection.
62
What is the most common form of **veterinary surveillance**?
Passive
## Footnote
Passive surveillance is often used due to its simplicity and cost-effectiveness.
63
What is the difference in thermal damage between **cutting electrocautery** and **Harmonic scalpel**?
Ultrasonic = LESS thermal damage; electricity is NOT transferred through patient
## Footnote
This distinction is important for minimizing collateral damage during surgery.
64
What is the difference between **monopolar** and **bipolar** electrocautery regarding electricity flow through the patient?
Monopolar: electricity transferred through patient; Bipolar: no flow of current through patient
## Footnote
Monopolar electrocautery is used for cutting and coagulation, while bipolar is used for localized coagulation.
65
In **pure cut mode** of monopolar electrocautery, what is the current delivered percentage and power range?
100% of the time, P = 50-80W
## Footnote
This mode is characterized by low voltage.
66
What is the power setting and voltage for **coagulation mode** in monopolar electrocautery?
P = 30-50W, 9000V at 50W setting
## Footnote
Coagulation mode uses interrupted waves.
67
What are the thermal damage levels in electrocautery from highest to lowest?
* Coagulation
* Blend
* Cutting
## Footnote
Coagulation causes the most thermal damage.
68
How does wound healing differ between **monopolar electrocautery** and **blade incisions**?
Delayed wound healing with electrocautery vs scalpel blade
## Footnote
Electrocautery can lead to more thermal damage affecting healing.
69
What setting should be used with electrosurgery when going through a **metal hemostat**?
Cutting setting; for coaptive coagulation
## Footnote
This ensures effective cutting through metal instruments.
70
What is the penetration depth of **CO2 laser** compared to **Nd:YAG laser**?
* CO2: 0.1 mm
* Nd:YAG: 5 mm
## Footnote
CO2 lasers have shallow tissue penetration, while Nd:YAG lasers penetrate deeper.
71
What color light does the **argon laser** emit?
Blue-green light
## Footnote
This color is highly absorbed by hemoglobin, useful for vascular lesions.
72
Which laser is particularly useful in **arthroscopic surgery**?
Ho:YAG
## Footnote
This laser is effective for soft tissue procedures.
73
What are the **common absorbable suture tensile strengths** and absorption times?
* Surgical chromic gut: 0% at 2-3 weeks, 14-80 days
* Vicryl: 50% at 2-3 weeks, 56-70 days
* Dexon S: 50% at 2-3 weeks, 90 days
* Monocryl: 50% at 1 week, 70-80% lost at 2 weeks, 119 days
* PDS II: 50% at 5-6 weeks, 180 days
* Maxon: 50% at 4-5 weeks, 180 days
## Footnote
These sutures have varying absorption rates and tensile strengths.
74
What is the **Esmarch equation** for tourniquet pressure?
P = T/RW
## Footnote
P = tourniquet pressure, T = bandage tension, R = radius of limb curvature, W = bandage width.
75
What are **Halsted’s Principles** of surgical technique?
* Gentle tissue handling
* Meticulous hemostasis
* Strict aseptic technique
* Preservation of blood supply
* Eliminate dead space
* Accurate tissue apposition
* Minimal tension on tissues
## Footnote
These principles guide effective surgical practices.
76
What is the effect of **acid environment** on PDS sutures?
PDS loses all strength in 3 days
## Footnote
Acidic environments can rapidly degrade certain sutures.
77
What is the **best light source** for endoscopy?
Xenon
## Footnote
It provides increased light intensity and better color rendition.
78
What happens to **mitochondria** and vascular supply after 1 hour of tourniquet application?
Mitochondrial changes occur
## Footnote
Prolonged tourniquet use can lead to significant tissue damage.
79
What is the **route of metastasis** for round cells?
Lymphatics
## Footnote
Different cell types have distinct routes for metastasis.
80
What is **LaPlace’s law** in relation to bandaging?
Pressure = (NxT)/(RxW)
## Footnote
This law describes how pressure is distributed under a bandage.
81
What is the **function of thrombin** in hemostasis?
Converts endogenous fibrinogen to fibrin
## Footnote
Thrombin is crucial in the clotting process.
82
What is the first step in **initiation** of cancer?
Heritable mutation
## Footnote
Followed by a second mutation that promotes growth advantage of a mutated cell.
83
What causes **base alterations** in nuclear material?
Mutagen exposure
## Footnote
This exposure can lead to irreversible steps in cancer development.
84
True or false: All initiated cells develop into clinically detectable **neoplasia**.
FALSE
## Footnote
Not all initiated cells progress to detectable neoplasia.
85
For chemical carcinogens to cause tumor growth, what must occur?
Initiated cell must be exposed to promoting agent
## Footnote
This is essential for tumor development.
86
What benign lesions can result from **initiation and promotion**?
* Papillomas
* Polyps
## Footnote
These lesions are precursors to more serious conditions.
87
What occurs during **tumor progression**?
* Ability to invade surrounding tissue
* Establish new blood vessels
* Metastasize
## Footnote
These changes signify advanced cancer development.
88
What is the role of the **p53** gene?
Tumor suppressor gene
## Footnote
It regulates the cell cycle and serves as a checkpoint for apoptosis.
89
What is the composition of **articular cartilage**?
* 50% collagen (85-90% type II)
* 35% proteoglycan
* 10% other glycoproteins
## Footnote
Chondrocytes make up 2-10% of articular cartilage by volume.
90
What factors affect the **swelling pressure** in cartilage?
* Density
* Distribution
* Molecular conformation of charged groups on proteoglycans
## Footnote
These factors influence cartilage's mechanical integrity.
91
What are the two types of **entheses**?
* Fibrous entheses
* Fibrocartilaginous entheses
## Footnote
These types differ based on their composition and location.
92
What is the most abundant **GAG** (glycosaminoglycan)?
Chondroitin
## Footnote
The nonsulfated GAG is hyaluronic acid.
93
What characterizes **Type I** muscle fibers?
* Rich in mitochondria
* Sustained contraction
* Low velocity and low force
## Footnote
These fibers are primarily fueled by oxidative metabolism.
94
What is the role of **calcium** in muscle contraction?
Binds troponin complex
## Footnote
This binding leads to a conformational change that exposes binding sites for myosin.
95
What types of **collagen** are found in different tissues?
* Bone: type I
* Articular cartilage: type II
* Tendon and ligaments: type I
* Muscle: type I (slow), type II (fast)
## Footnote
Different tissues have specific collagen types that contribute to their function.
96
What are the **four tenets** of bone healing?
* Mechanics
* Scaffold
* Growth factors
* Cells
## Footnote
These factors are crucial for effective bone healing.
97
What is **Wolff’s Law**?
Bone adapts to loads placed on it
## Footnote
This principle is a primary regulator of bone remodeling.
98
What is the **epiphyseal line**?
Indication of closed growth plate
## Footnote
It signifies the end of bone growth.
99
What is the difference between **direct** and **indirect bone healing**?
* Direct: primary stability, no callus formation
* Indirect: callus formation, involves multiple stages
## Footnote
Each type of healing has distinct processes and outcomes.
100
What is the **function of osteoclasts** at fracture sites?
Remove dead bone
## Footnote
This process helps widen the fracture gap and allows for healing.
101
What is the **AMI** (area moment of inertia) formula for pins and screws?
AMI = radius to the fourth power
## Footnote
This formula is crucial for understanding the mechanical properties of fixation devices.
102
What is the role of **locking compression plates**?
* Generate axial compression
* Protect interfragmentary compression
* Prevent compressive and shear forces
## Footnote
These plates are used in various fracture types to stabilize bone.
103
What is the **tension and failure** of double loop cerclage?
* Loop tension: 390N
* Load resisted before loosening: 660N
## Footnote
This information is critical for understanding the mechanical properties of cerclage techniques.
104
What is the **load resisted before loosening** in the context of IM pin principles?
660N
## Footnote
This value indicates the maximum load that can be resisted before the pin loosens.
105
Indications for **IM pin** use include:
* Large comminuted fractures
* Bending forces reduction
* Decreased internal plate stress
* Increased fatigue life of the plate
* Reduced strain at the screw hole
## Footnote
IM pins are used to counteract bending forces and stabilize fractures.
106
What are the **principles** of elastic plate synthesis?
* Indicated for skeletally immature <6 mo
* Diaphyseal fractures
* Uses long, thin compliant plates
* Secured with few screws to increase working length
* Preserves periosteum
## Footnote
This method aims to minimize shear forces and maintain blood supply.
107
What are the **complications** associated with elastic plate synthesis?
* Implant failure
* Nonunion
* Osteomyelitis
* Sequestration
## Footnote
These complications can arise due to the nature of the bone and the surgical technique used.
108
What are the **four tenets of bone healing and regeneration**?
* Mechanics
* Scaffold
* Growth factors (BMP-2)
* Cells (MSCs)
## Footnote
These factors are essential for effective bone healing and regeneration.
109
Define **viable nonunion**.
Biologic environment adequate, healing response occurs
## Footnote
This type of nonunion indicates that some biological activity is present at the fracture site.
110
What is **hypertrophic nonunion** characterized by?
Considerable callus due to excessive motion or inadequate mechanical environment
## Footnote
This results in fibrous tissue instead of bone or cartilage.
111
What is the most common bacteria identified in **osteomyelitis**?
Staphylococcus sp (60%)
## Footnote
S. pseudintermedius is the most common strain identified.
112
What are the **four classifications of bone grafts**?
* Osteogenic
* Osteoinduction
* Osteoconduction
* Osteopromotion
## Footnote
Each classification describes a different mechanism by which bone grafts facilitate healing.
113
What is the **most common donor site** for autogenous cancellous bone graft harvest?
Proximal aspect of the humerus
## Footnote
Other sites include the wing of the ilium and proximomedial region of the tibia.
114
What factors are released from platelet alpha granules in **PRP**?
* IGF-1
* PDGF
* TGF-beta
## Footnote
These factors are categorized as osteopromotive.
115
What is the **glycocalyx**?
Pericellular matrix that surrounds cell membranes of bacteria
## Footnote
It helps bacteria resist phagocytic engulfment by white blood cells.
116
What is the **mode of failure** for elastic plate synthesis?
Plastic deformation
## Footnote
The screw-bone interface is typically preserved during this failure mode.
117
What are the **principles of biologic osteosynthesis**?
* Indirect fracture reduction
* Stabilization using bridging implants
* Limited reliance on secondary implants
* Minimal use of bone grafts
## Footnote
These principles emphasize the biological component of healing.
118
What is the **goal** of tendon repair?
End to end anastomosis
## Footnote
This aims to eliminate gaps and restore function while protecting from strain.
119
What is the **most predictive force plate reading** in gait analysis?
Peak vertical force or vertical impulse
## Footnote
This measurement is crucial for assessing gait performance.
120
Where do **hair follicles** live?
Dermis and upper part of hypodermis
## Footnote
Hair follicles are embedded in the skin layers.
121
How is the skin’s **vascular supply** divided up?
* Superficial/subpapillary plexus
* Middle/cutaneous plexus
* Deep/subdermal/SQ plexus
## Footnote
Blood supply runs parallel to skin and gives off projections to the skin.
122
What is the difference between **secondary closure** and **third intention wound healing**?
Secondary closure equals third intention healing
## Footnote
Both terms refer to the closure of a wound after granulation tissue forms.
123
Define **primary closure** and **first intention healing**.
Healing of a sutured wound
## Footnote
This type of healing occurs immediately after surgical intervention.
124
What is **delayed primary closure**?
Surgical closure 3-5 days after wound initiation, before granulation tissue
## Footnote
This method allows for initial healing before closure.
125
What is the **re-epithelialization rate** of wound healing?
Approximately 1 mm/d
## Footnote
Perfect apposition leads to an epithelial seal within 24 to 48 hours.
126
What percentage of normal skin is achieved by **14 days**?
* 5% to 10% at 14 days
* 25% at 3-5 weeks
* 70% to 80% at several months
* 80% after 1 year
## Footnote
Skin healing progresses over time, reaching significant recovery after a year.
127
What are the species differences in wound healing regarding **perfusion** and **breaking strength**?
* Cats’ sutured wounds at 7 days = ½ wound breaking strength vs dogs
* Cats lower cutaneous perfusion for the first week after surgery
* Dogs have greater density of collateral subcutaneous vessels
## Footnote
Cats heal more by contraction along wound edges, while dogs heal by central pull of fibroblasts.
128
What is the **golden period** of wounds, and what is the threshold for bacterial infection risk?
* Golden period: 3-6 hours
* Threshold: 10^5 CFU per gram of tissue/ml of exudate
## Footnote
This period is critical for effective wound management.
129
How many throws are needed for **suture knot security**?
* 3 to 6 throws for 3-0 Vicryl, Caprosyn, and Prolene
* 4 throws for remaining 3-0 sutures
* At least 5 throws for 2-0 PDS
## Footnote
The number of throws varies based on suture type.
130
Describe the **timing of wound healing**.
* Vasoconstriction: 5 to 10 min
* Vasodilation: 30-60 min
* Transudate increases over 3 days
* Mononuclear cells predominate by day 5
* Early repair within 3-5 days
## Footnote
The healing process involves several phases, starting with vascular responses.
131
What is the method to produce **7-8 psi for wound irrigation**?
Attach a 16-22g needle to a fluid administration set and 1L fluid bag, place under 300mmHg pressure using a pressure cuff
## Footnote
This technique ensures proper irrigation pressure.
132
What are the **topical wound dressings** for open wound management?
* Hypertonic saline dressing
* Honey
* Sugar
* Enzymatic agents [collagenase]
* Maggots
* Topical abx ointment [neosporin]
* Silver
* Hydrogel
* Hydrocolloid
* Alginate
* Bioscaffolds [porcine SIS]
* Chitosan
* Growth factors
* Nonadherent, semiocclusive [telfa]
* Antimicrobial-impregnated gauze bandage
## Footnote
These dressings serve various purposes, including antimicrobial action and moisture retention.
133
What is the **dilution of chlorhexidine** for wound prep?
0.05% to 0.1% solution of chlorhexidine or 0.1% to 0.01% solution of povidone-iodine
## Footnote
These dilutions ensure effective antiseptic action.
134
What is honey’s **mechanism of action** (MOA)?
Produces 0.003% hydrogen peroxide, releases oxygen-derived free radicals
## Footnote
Honey's antibacterial properties are enhanced by its phytochemicals and acidic pH.
135
What are the **indications and contraindications** for calcium alginate bandages?
* Indications: wounds with moderate or copious exudates
* Contraindications: dry wounds, bleeding wounds, surgical implants, or 3rd degree burns
## Footnote
Calcium alginate is effective in managing exudate but not suitable for all wound types.
136
Classify the types of **wounds**.
* Abrasion
* Puncture wound
* Laceration
* Degloving injury
* Thermal burn
* Decubital ulcer
## Footnote
Understanding wound types is crucial for appropriate treatment.
137
What is the **conceptual effect of microbial burden** on the wound?
[# of microorganisms x virulence]/host resistance
## Footnote
This formula helps assess the risk of infection in wounds.
138
What pressure should be used for **VAC** over open wounds and grafts?
* -80 mmHg if gauze-based system
* -125 mmHg if foam-based system
* -65 to -75 over grafts
## Footnote
VAC therapy promotes healing by improving perfusion and reducing edema.
139
What are the classifications of **burns**?
* First-degree: only epidermis affected
* Second-degree: full-thickness epidermal necrosis
* Third-degree: extends through dermis
* Fourth-degree: extends to underlying muscle or fascia
* Fifth-degree: extension to bone
## Footnote
Each degree indicates the severity and depth of the burn.
140
Why are **burns slow to heal**?
Lower wound healing cytokines, < 5% of normal levels of fibroblast growth factor-2 (FGF-2)
## Footnote
This results in a reduced healing response compared to normal surgical wounds.
141
What is the **local inflammatory response** to burns?
* Vasodilation
* Increased capillary permeability
* Edema
* Inflammatory cell influx
## Footnote
These responses are critical for initiating healing.
142
Where is the **zone of stasis** in a burn?
Middle zone with decreased perfusion, vulnerable to further insult
## Footnote
This area can restore viability if not further damaged.
143
How does **carbon monoxide toxicity** occur?
Preferentially binds hemoglobin → carboxyhemoglobin → leftward shift of oxyhemoglobin dissociation curve
## Footnote
This reduces oxygen delivery to tissues and is not detected by pulse oximetry.
144
What is the **splenic connection** to the portal system?
Splenic vein collects blood from many hilar veins and drains into the gastrosplenic vein before entering the portal vein
## Footnote
This connection is vital for blood flow regulation.
145
What percentage of circulation goes to the **spleen**?
* Can store 10-20% of dog’s RBC mass
* 30% of platelet mass
## Footnote
The spleen plays a significant role in blood storage and regulation.
146
What are the **gustatory vs non-gustatory papillae** on the tongue?
* Gustatory: fungiform, vallate, foliate papillae
* Non-gustatory: filiform, conical papillae
## Footnote
These papillae serve different functions in taste and texture perception.
147
Where do the **salivary glands** empty into?
* Parotid: opens at upper 4th premolar
* Zygomatic: opens at last upper molar
* Mandibular: opens at sublingual caruncle
* Sublingual: alongside mandibular at sublingual caruncle
## Footnote
Understanding gland openings is essential for oral health.
148
What artery is most concerning in a **caudal hemi-maxillectomy**?
Major palatine artery
## Footnote
This artery supplies the hard palate and is at risk during the procedure.
149
What are the **layer differences** in the esophagus?
Has adventitia instead of serosa
## Footnote
This distinction is important for surgical considerations.
150
What cranial nerves are involved in the **phases of swallowing**?
* CN V (trigeminal)
* CN VII (facial)
* CN IX (glossopharyngeal)
* CN X (vagus)
* CN XII (hypoglossal)
## Footnote
These nerves coordinate the complex process of swallowing.
151
What is the most common **vascular ring anomaly**?
PRAA with left ligamentum arteriosum
## Footnote
This anomaly affects the aortic arch and can lead to clinical complications.
152
What is the **blood supply** to the esophagus?
* Cervical: cranial & caudal thyroid aas
* Thoracic: bronchoesophageal aa for cranial ⅔
* Esophageal branch of aorta for caudal ⅓
## Footnote
Understanding blood supply is crucial for surgical interventions.
153
What glands are found in the **stomach**?
* Cardiac glands: serous secretion
* Pyloric glands: mucus
* Gastric glands proper: parietal, chief, mucous neck, endocrine cells
## Footnote
Each gland has specific functions in digestion.
154
What is the physiology of the **propulsive movements** of the GI?
Contractive retropulsion reduces digestible food particles to 0.1-0.63mm
## Footnote
This process is essential for effective digestion.
155
What is the **blood supply** to the stomach?
* Celiac divides into splenic, hepatic, and L gastric
* Splenic feeds L pancreas and becomes L gastroepiploic
* Hepatic continues as R gastric
## Footnote
The blood supply is vital for the stomach's function and health.
156
What are the **physiologic effects of food** in a segment of intestine?
* Segmental contraction to mix ingesta
* Peristaltic contraction to move it aborally
## Footnote
These contractions are crucial for digestion and nutrient absorption.
157
What artery supplies the **fundus** of the stomach?
L gastric
## Footnote
The **L gastric artery** supplies the fundus and lesser curvature of the stomach.
158
What are the **physiologic effects** of food in a segment of the intestine?
* Normal gut motility
* Rhythmic segmentation
* Migrating myoelectric complexes
## Footnote
These processes help in mixing ingesta and moving it aborally.
159
What is the role of **cholecystokinin** in the small intestine?
Produced in response to nutrients, stimulates enzyme release
## Footnote
Cholecystokinin plays a crucial role in digestion.
160
Where is **water absorption** primarily occurring in the small intestine?
* 50% in jejunum
* 75% in ileum
## Footnote
These areas are critical for nutrient absorption.
161
What is the **blood supply** of the cecum?
Ileocolic a.
## Footnote
The common colic artery supplies the cecum via the ileocolic artery.
162
What are the **phases of colonic healing**?
* Lag phase
* Proliferative phase
* Maturation phase
## Footnote
Each phase has distinct characteristics and timelines.
163
What factors negatively affect **colonic healing**?
* Hypoperfusion
* Poor wound apposition
* Infection
* Chemo drugs
* Zinc and iron deficiency
## Footnote
These factors can hinder the healing process significantly.
164
What is the **innervation** involved with defecation?
* Intrinsic (enteric n. plexus)
* Extrinsic (parasympathetic n.)
## Footnote
This coordination is essential for the defecation reflex.
165
What are the **glands** of the anus and perineum?
* Circumanal glands
* Anal glands
* Paranal sinus glands
## Footnote
These glands play roles in secretion and scent marking.
166
What is the **blood supply** to the liver?
* Hepatic artery (20%)
* Portal vein (80%)
## Footnote
The liver receives oxygenated blood from both sources.
167
What is the function of the **ductus venosus**?
Shunt between left umbilical vein and right vitelline vein
## Footnote
It allows oxygenated blood to bypass the liver.
168
What cells in the pancreas secrete **digestive enzymes**?
Acinar cells
## Footnote
These cells make up the exocrine pancreas.
169
What is the **pancreatic blood supply**?
* Celiac artery
* Splenic artery
* Cranial pancreaticoduodenal a.
* Caudal pancreaticoduodenal a.
## Footnote
These arteries supply the pancreas with blood.
170
What is the **anatomical location** of the pancreas in relation to the omentum?
* Right lobe = mesoduodenum
* Left lobe = dorsal leaf of greater omentum
## Footnote
The pancreas is closely associated with the proximal duodenum.
171
How do **gastrinomas** arise?
From malignant transformation of delta cells
## Footnote
This leads to excessive gastrin and gastric acid hypersecretion.
172
What cartilage do the **alar folds** come from?
Bulbous extension of the ventral nasal conchae
## Footnote
This structure is important for the formation of the nostril.
173
What is the function of **palatine muscles**?
Close to prevent aspiration into nasopharynx
## Footnote
Proper function is crucial for safe swallowing.
174
What are the **cartilages** of the larynx?
* Epiglottis
* Thyroid
* Cricoid
* Arytenoid
## Footnote
These cartilages are essential for laryngeal function.
175
What is the **normal tracheal width-to-height ratio**?
1:1
## Footnote
This ratio is important for maintaining airway patency.
176
What is the **ventilation** process?
* Inspiration
* Expiration
## Footnote
These processes involve movement of air in and out of the alveoli.
177
What is the **diffusion of gas** across the blood-gas interface governed by?
Fick’s law
## Footnote
This law describes the rate of gas transfer through tissue.
178
What stimulates **peripheral chemoreceptors**?
Lower pH than blood
## Footnote
Changes in PaO2 are less sensitive; if PaO2 <60mmHg, hypoxic ventilatory drive is activated.
179
Normal ventilation in dogs and cats is approximately **______ mL/air/kg/inspiration**.
10
## Footnote
Alveolar ventilation is the effective ventilation, while the remainder is considered dead space.
180
According to **Fick’s law**, diffusion of gas across the blood-gas interface is directly proportional to which factors?
* Surface area available for diffusion
* Diffusion coefficient of the gas
* Difference in gas partial pressure
## Footnote
It is inversely proportional to tissue thickness.
181
What is the **thickness** of the lung's diffusion surface?
0.3 um
## Footnote
This thickness is ideal for gas diffusion.
182
The diffusion coefficient of **CO2** is how many times greater than that of **O2**?
20x
## Footnote
This allows CO2 to diffuse more rapidly than O2.
183
What is the **Haldane effect**?
Deoxygenated hemoglobin has a greater affinity for CO2 than oxygenated hemoglobin
## Footnote
This means deoxygenated venous blood transports more CO2 than oxygenated blood.
184
What can cause **hypoxemia**?
* Hypoventilation
* Low FiO2
* Diffusion impairment
## Footnote
Other causes include V/Q mismatch and shunting.
185
True or false: **Hypercapnia** can be caused by excitement on recovery.
FALSE
## Footnote
Causes include hyperthermia, airway obstruction, cervical disc, and pleural space disease.
186
What does a **high V/Q** indicate?
Low blood flow or increased dead space from pulmonary thromboembolism (PTE)
## Footnote
A low V/Q indicates decreased ventilation from pneumonia or alveolar collapse.
187
What is the **Aa gradient** threshold for severe gas exchange impairment?
>30 mmHg
## Footnote
If the Aa gradient is >20, oxygen should be administered.
188
What is the **functional residual capacity**?
Volume of air remaining in the lung at the end of a normal exhalation (~45ml/kg)
## Footnote
It represents the point of passive equilibrium between lung collapse and chest expansion.
189
What is **Starling’s law**?
Normal capillary hydrostatic pressure > pleural hydrostatic pressure favors pleural fluid production
## Footnote
Fluid tends to enter the pleural space from parietal pleura and is absorbed by visceral pleural lymphatics.
190
What causes **pleural effusion** in right-sided CHF?
Increased parietal capillary hydrostatic pressure
## Footnote
This leads to fluid accumulation due to alterations in hydrostatic pressure, colloid osmotic pressure, vascular permeability, or lymphatic function.
191
What is the **primary channel** for lymph return in the thorax?
Thoracic duct
## Footnote
It does not include the right thoracic limb, shoulder, and cervical regions.
192
What is the **pressure-volume loop** of the heart?
A plot representing the relationship between pressure and volume during a cardiac cycle
## Footnote
It consists of filling, isovolumetric contraction, ejection, and isovolumetric relaxation phases.
193
What does **Bernoulli’s equation** describe in cardiology?
Systolic pressure gradient across a defect is determined by peak pulmonic ejection velocity
## Footnote
Higher velocity results in lower pressure.
194
What is the **most common uterine tumor** in dogs and cats?
* Dogs: Leiomyoma
* Cats: Adenocarcinoma
## Footnote
These tumors are significant in veterinary medicine.
195
What is the diameter of the **distal feline ureter**?
0.4 mm
## Footnote
The upper canine ureter is 0.07 times the length of the L2 vertebral body.
196
What is the role of **beta-adrenergic control** during the resting phase of the bladder?
Detrusor muscle relaxation (storage phase)
## Footnote
Parasympathetic control is active during the voiding phase.
197
What is the **innervation** of the **pelvic nerve**?
S1-3
## Footnote
The pelvic nerve is responsible for parasympathetic innervation related to bladder function.
198
What do **stretch receptors** initiate in the urinary system?
Urination
## Footnote
They stimulate parasympathetic activity and depress sympathetic outflow.
199
What type of receptors cause **detrusor muscle contraction**?
Muscarinic receptors
## Footnote
These receptors are involved in bladder wall contraction.
200
What is the role of the **pudendal nerve**?
Somatic control of striated urethral musculature
## Footnote
It provides voluntary control over urination.
201
What is the **urethral length** in male cats?
8.5 to 10.5 cm
## Footnote
The urethra narrows distally with varying diameters.
202
What is the **urethral length** in male dogs?
25 cm
## Footnote
Female dog urethra length is 7-10 cm and 0.5 cm wider.
203
What do the **different zones** of the adrenal gland secrete?
* Zona glomerulosa: mineralocorticoids (aldosterone)
* Zona fasiculata: glucocorticoids
* Zona reticularis: sex steroids
## Footnote
The adrenal medulla secretes catecholamines.
204
What is the **function** of the **RAAS** system?
Regulates blood pressure and fluid balance
## Footnote
It involves renin, angiotensin, and aldosterone.
205
What is the **epinephrine to norepinephrine ratio** in dogs?
60/40
## Footnote
In cats, the ratio is 70/30.
206
What is the **innervation** of the **thyroid gland**?
Thyroid nerve (branch of cranial laryngeal nerve)
## Footnote
It runs closely with the cranial thyroid artery.
207
What is the **blood supply** to the thyroid gland?
* Cranial thyroid artery
* Caudal thyroid artery
## Footnote
Cats do not have a caudal thyroid artery.
208
What is the **most common source of hemorrhage** during TECA?
Retroglenoid vein
## Footnote
This vein is associated with the external ear canal.
209
210
Are **aminoglycosides** contraindicated in renal disease patients?
No; they are just at higher risk.
## Footnote
Can give once a day or increase dosing interval, keep hydrated, monitor renal values and UA.
211
What are the **adverse effects** of aminoglycosides?
* Glomerular tubular nephrotoxicity
* Ototoxicity
## Footnote
Do not give with furosemide, NSAIDs, diuretics, ACE inhibitors, or amphotericin B.
212
What is the difference between **bactericidal** and **bacteriostatic** antibiotics?
* Bactericidal: Beta-lactams, Glycopeptides, Aminoglycosides, Fluoroquinolones, Rifamycins, Nitroimidazoles, Potentiated sulfonamides
* Bacteriostatic: Sulfonamides, Tetracyclines, Phenicols, Lincosamides, Macrolides
## Footnote
*“The Monitor Likes The Static” (tetracyclines, macrolides, lincosamides, trimethoprims, sulfonamides)*.
213
What is the **MOA** of **Beta-lactams**?
Cell wall synthesis
## Footnote
This class of antibiotics disrupts the formation of bacterial cell walls.
214
Which antibiotics are **time dependent**?
* Beta-lactams
* Glycopeptides
* Sulfonamides
* Tetracyclines
* Phenicols
* Lincosamides
## Footnote
Efficacy is best predicted by the time that the drug remains above MIC.
215
Which antibiotics are **concentration dependent**?
* Fluoroquinolones
* Aminoglycosides
* Rifamycins
* Metronidazole (+/- time)
## Footnote
Efficacy is best predicted by the magnitude of Cmax vs MIC.
216
What is the **most common bacteria** in septic otitis media?
Staph pseudintermedius
## Footnote
This bacterium is frequently associated with ear infections in dogs.
217
Which antibiotics **cross the blood-brain barrier**?
* 3rd gen cephalosporin
* Doxy (better if inflamed)
* Chloramphenicol
* Metronidazole
* Fluoroquinolones
* Sulfas
## Footnote
These antibiotics can penetrate the central nervous system.
218
What is a mechanism of **resistance** developed against **beta-lactams**?
* Inactivation by beta-lactamases
* Altered PBP
* Efflux through pumps
* Loss or change in porins
## Footnote
These mechanisms allow bacteria to survive despite the presence of beta-lactam antibiotics.
219
What is the **first intermediary** after arachidonic acid metabolism?
PGH1
## Footnote
This is a precursor in the synthesis of prostaglandins.
220
What is the precursor to **prostaglandins**?
PGH2
## Footnote
PGH2 is converted into various prostaglandins and thromboxanes.
221
COX-1 is ___ and COX-2 is ___?
COX-1 = constitutive; COX-2 = inducible
## Footnote
COX-1 is always present, while COX-2 is produced in response to inflammation.
222
Do **NSAIDs** cause a direct effect on the spinal cord?
Yes
## Footnote
This occurs via inhibition of PGE.
223
How does **NSAID GI toxicity** occur?
* Local effects: Mucosal irritation
* Systemic effects: Inhibition of endogenous prostaglandin production
## Footnote
This leads to gastric damage and increased risk of ulcers.
224
What are the effects of **COX-1** and **COX-2** inhibition?
* COX-1: Normal physiologic functions
* COX-2: Inducible, synthesized by inflammatory cells
## Footnote
COX-1 products include thromboxane, while COX-2 products include PGE2.
225
What does **PGE** do?
Contributes to pain associated with inflammation
## Footnote
Prostaglandin E2 is a potent nociceptive stimulus.
226
What is **Misoprostol**?
Analogue of prostaglandin E1 (PGE1)
## Footnote
Used for NSAID-induced ulceration; contraindicated with IBD and pregnancy.
227
What is the **NSAID dose relationship** with GI toxicity vs hepatic toxicity?
* GI toxicity: Greater dose = higher risk
* Hepatic toxicity: Unpredictable, non-dose related
## Footnote
Idiosyncratic hepatic necrosis occurs within a few days.
228
Describe the **NSAID mechanism of renal injury**.
* Decreased renal perfusion
* Sodium and fluid retention
* Decreased tubular function
* Azotemia
## Footnote
COX-1 and COX-2 mediate renal effects of prostaglandins.
229
Where is **Deracoxib** excreted?
Predominantly in feces
## Footnote
Up to one-fifth may be excreted in urine.
230
What is a side effect of **Acetaminophen** in cats?
Hemolytic anemia (methemoglobinemia)
## Footnote
Cats are particularly sensitive to acetaminophen toxicity.
231
Describe **aspirin toxicity**.
* Depression
* Vomiting
* Hyperthermia
* Electrolyte imbalances
* Convulsions
* Coma
* Death
## Footnote
Toxicity is more likely in cats due to slow metabolism.
232
What are the **central and peripheral MOA** of NSAIDs?
* Peripheral: Correlate poorly with analgesia
* Central: Inhibition of prostaglandin synthesis
## Footnote
Central mechanisms include interaction with opioid and serotonin systems.
233
What is **tepoxalin** and how does it work?
Only dual-acting NSAID
## Footnote
Inhibits COX-1, COX-2, lipoxygenase-5; protects against gastrointestinal toxicity.
234
What is the effect of **TXA2I** on leukotriene activity?
Protection against gastrointestinal toxicity, preventing leukocyte adherence
## Footnote
This helps maintain blood flow.
235
How long does it take for **NSAIDs** to reach therapeutic concentration in plasma following oral absorption?
* Carprofen: 1 hr
* Deracoxib: 2 hrs
* Firocoxib: 1-5 hrs
* Meloxicam: 7-8 hrs
## Footnote
All NSAIDs are high protein binding (>90%) and well absorbed after oral administration.
236
What are the **NSAID side effects** related to gastric and duodenal ulcers?
* Gastric ulcers: COX-1 inhibition increases risk
* Duodenal ulcers: COX-2 inhibition increases risk
## Footnote
COX-1 synthesizes protective prostaglandins in the stomach, while COX-2 is involved in healing in the duodenum.
237
What is the treatment for **NSAID ulcers**?
Misoprostol, H2 blocker better than PPI
## Footnote
Misoprostol has synergistic anti-inflammatory effects with NSAIDs.
238
Which **NSAIDs** have lower efficacy with food?
* Robenacoxib
* Phenylbutazone
* Flunixin
* Meclofenamate
## Footnote
These NSAIDs are affected by food intake.
239
Name the **COX-1 & COX-2** NSAIDs.
* COX-1 & COX-2: Aspirin, flunixin, ibuprofen, ketoprofen, ketorolac, meclofenamic acid, naproxen, phenylbutazone, Piroxicam, tolfenamic acid
* COX-2 selective: Carprofen, Deracoxib, Etodolac, Firocoxib, Meloxicam, Robenacoxib, Vedaprofen
## Footnote
These classifications help in understanding their selectivity and potential side effects.
240
What is the **screw diameter** limit in relation to bone diameter?
Screw diameter should not exceed 40% of the diameter of the bone
## Footnote
This ensures proper fit and stability.
241
What is the **optimal tightness** of a screw?
70% stripping torque
## Footnote
This level of tightness is recommended for effective fixation.
242
What are the **bellies of the triceps brachii muscle**?
* Long
* Lateral
* Medial
* Accessory
## Footnote
These heads contribute to the muscle's function in extending the elbow.
243
What are the **external rotators of the hip**?
* Gemelli
* Quadratus femoris
* Internal obturator
* External obturator
## Footnote
These muscles facilitate lateral rotation of the hip.
244
What is the only **femoral attachment** of the menisci?
Femoral ligament of the lateral meniscus
## Footnote
This ligament connects the lateral meniscus to the medial femoral condyle.
245
What is the **meniscus** also known as?
meniscofemoral ligament
## Footnote
It connects from the caudal lateral meniscus dorsally to the medial femoral condyle facing the intercondylar fossa.
246
Name the **other meniscus attachments**.
* intermeniscal ligament
* cranial meniscotibial ligament
* caudal meniscotibial ligament
* medial collateral ligament
## Footnote
These ligaments are associated with the medial meniscus.
247
The **caudal (medial) cruciate ligament** arises from where?
intercondylar fossa from the craniolateral aspect of the medial femoral condyle
## Footnote
It extends caudodistally to insert on the craniolateral edge of the popliteal notch of the tibia.
248
The **cranial (lateral) cruciate ligament** attaches to which part of the femur?
caudomedial aspect of the lateral femoral condyle
## Footnote
It runs diagonally across the intercondyloid fossa to attach to the cranial intercondyloid area of the tibia.
249
How many **bones** are in the tarsus?
7 bones
## Footnote
There are 6 articulations in the tarsus.
250
What joint of the tarsus has **90% motion**?
Tarsocrural joint
## Footnote
This joint is primarily responsible for movement in the tarsus.
251
What are the **types of central tarsal bone fractures**?
* Type I: Nondisplaced dorsal slab fracture
* Type II: Displaced dorsal slab fracture
* Type III: Large displaced medial fragment
* Type IV: Medial slab fracture with a dorsal slab fracture
* Type V: Comminuted fracture
## Footnote
These fractures are almost exclusively found in racing Greyhounds.
252
What muscles make up the **common calcaneal tendon**?
* Gastrocnemius
* Superficial digital flexor (SDF)
* Biceps femoris
* Semitendinosus
* Gracilis
## Footnote
These muscles contribute to the tendon that attaches to the calcaneus.
253
Where does the **facial nerve** exit the cranial vault?
Stylomastoid foramen
## Footnote
It provides motor innervation to the external ear.
254
Do cranial nerves **1-4** come from the cerebrum?
No
## Footnote
All cranial nerves arise from the brainstem except for the olfactory nerves.
255
What is the **normal ICP** range?
5-12 or 8-15 mmHg
## Footnote
Durotomy decreases ICP by 65% compared to 15% with craniotomy alone.
256
What is the **Monroe-Kelley doctrine**?
Pressure-volume relationship between CSF, blood, and brain
## Footnote
It states that any increase in volume of one must be offset by a decrease in volume of another.
257
What is the **flow of CSF**?
Produced by ependymal cells in choroid plexus, reabsorbed by arachnoid villi
## Footnote
Typical flow: Lateral ventricle → 3rd ventricle → mesencephalic aqueduct → 4th ventricle → subarachnoid space.
258
What is the **Cushing’s reflex**?
Systemic hypotension or elevation of ICP causes increased systemic vasomotor tone
## Footnote
This leads to vasoconstriction and reflex bradycardia.
259
What is the **connection between the cerebral hemispheres** called?
Corpus callosum
## Footnote
It is a thick bundle of nerve fibers that connects the two hemispheres.
260
What is the **normal CPP**?
CPP = MAP – ICP; 82 +/- 5 mmHg
## Footnote
For every 1 mmHg change in PaCO2, there is a 5% change in CPP.
261
What is the **function of microglial cells**?
Immune cells of CNS
## Footnote
They play a role in the immune response within the central nervous system.
262
What is the **pain pathway** to the brain?
Nociceptors → primary afferent nerve fibers → synaptic sites in dorsal horn → spinothalamic tract → thalamus
## Footnote
Pain is interpreted in the cerebral cortex.
263
What is the **effect of inhalants on cerebral vasculature**?
At <1 MAC, sevoflurane does not increase cerebral blood flow velocities
## Footnote
At doses > 1 MAC, vasodilatory effects predominate.
264
What is the **ASA Status** for a healthy animal?
ASA 1
## Footnote
This status indicates no systemic illness.
265
Does **Buprenorphine** have a ceiling effect?
Yes
## Footnote
This means higher doses do not produce increased effects.
266
What is the potency of **Fentanyl** compared to other opioids?
100x
## Footnote
Fentanyl is significantly more potent than other opioids like Oxycodone and Buprenorphine.
267
Does **Methadone** have NMDA effects and cause less excitation in cats than other opioids?
Yes
## Footnote
Methadone may be associated with fewer excitatory responses in cats compared to other opioid medications.
268
Does **Remifentanil** cause serotonin syndrome if given with other medications that cause it?
No, meperidine
## Footnote
Remifentanil is metabolized by plasma esterases.
269
Does **Buprenorphine** have a ceiling effect?
Yes; higher doses don’t increase analgesia or side effects but prolongs durations
## Footnote
The ceiling effect means that after a certain dose, increasing the amount does not enhance the effect.
270
What is the **MOA of Tramadol**?
Analogue of codeine, weak action at mu receptor, analgesia from serotonin and adrenergic effects
## Footnote
Tramadol is a serotonin reuptake inhibitor and can cause serotonin syndrome when given with an MAOi.
271
What is **Codeine** classified as?
Prodrug
## Footnote
Codeine is converted to morphine and codeine-6-glucuronide.
272
What percentage can opioids reduce **MAC** by?
40-60%
## Footnote
This reduction is significant in anesthetic management.
273
What is the **MOA of Trazodone**?
Phenylpiperazine anti-depressant, serotonin antagonist and reuptake inhibitor
## Footnote
Trazodone is often used for its sedative effects.
274
What is **Dexmedetomidine** and its MOA?
Alpha adrenergic agonist (alpha 2:alpha 1 = 1600:1)
## Footnote
It decreases norepi release in the CNS; peak sedation in 10 min, peak analgesia in 20 min.
275
Where is **ketamine** primarily secreted?
Kidneys
## Footnote
This is important for dosing in patients with renal impairment.
276
What is the **MOA of Alfaxalone**?
Steroid molecule that enhances GABA- and glycine-mediated CNS depression
## Footnote
Alfaxalone is known for its use in anesthesia.
277
What is the duration of action of **Bupivicaine**?
6-8h or 3-10h
## Footnote
Bupivicaine has a longer duration due to higher lipid solubility and protein binding.
278
What is the difference in **onset of action** between Lidocaine and Bupivicaine?
Lidocaine: fast (5 min); Bupivicaine: slower (45 min)
## Footnote
Lidocaine can be given safely IV, while Bupivicaine cannot due to cardiotoxicity.
279
What local anesthetic causes the **LEAST chondrotoxicity**?
Mepivacaine
## Footnote
Mepivacaine is preferred for intra-articular administration.
280
What is the order of **blockage** in loss of pain/sensation?
* Loss of sensation
* Temp
* Sharp pain
* Light touch
* Motor
## Footnote
This order is crucial for understanding the effects of local anesthetics.
281
What is the **location of an epidural**?
L7-S1
## Footnote
The epidural space is between the dura mater and the ligamentum flavum.
282
What are some **adverse effects** or complications of an epidural?
* Hypoventilation
* Bradycardia
* Hypotension
* Infection
* Total spinal anesthesia
## Footnote
These complications can arise from improper administration or spread of local anesthetics.
283
What is the **MOA of neuromuscular blockade** for depolarizing agents?
Mimics effects of Ach at NM junction, persistent state of depolarization → flaccid paralysis
## Footnote
Succinylcholine is a common depolarizing agent.
284
What is the **onset and duration** of Atracurium?
Onset: 5 min; Duration: 30 min
## Footnote
Atracurium is unique as it is degraded by Hoffman elimination.
285
What are the **NMBA reversals** and how do they work?
* Neostigmine
* Edrophonium
## Footnote
They inhibit acetylcholinesterase, allowing Ach to build up and restore NM transmission.
286
What is the **normal tidal volume** in dogs?
10-20 ml/kg; average 15
## Footnote
This is important for calculating ventilation needs during anesthesia.
287
What is **absorption atelectasis**?
Alveolus filled with 100% oxygen collapses as O2 is removed
## Footnote
Nitrogen acts as a scaffold to prevent collapse.
288
What do **valves** ensure in an anesthesia circuit?
Unidirectional flow to the patient
## Footnote
If the valves malfunction, the patient can rebreathe expired air, i.e., CO2.
289
What is the **normal tidal volume** in dogs?
10-20 ml/kg; average 15
## Footnote
This is the volume of air that is inhaled or exhaled during normal breathing.
290
What is **absorption atelectasis**?
Alveolus filled with 100% oxygen gradually collapses as O2 is removed by pulmonary blood flow
## Footnote
Nitrogen is needed to act as a scaffold and structural support since it’s not as readily absorbed.
291
What are the **fresh gas types** and their corresponding details?
* Oxygen: Green/H&E, PSI: E=1900, H=2200, Volume: E=660, H=6900
* Medical air: Yellow/E, PSI: 2200, Volume: 6550
* Nitrous oxide: Blue/E, PSI: 745, Volume: 1590
* CO2: Grey/E, PSI: 838, Volume: 1590
* Nitrogen: Black/H, PSI: 2200, Volume: 6400
## Footnote
These details include color, pressure, and volume for different gas types.
292
What are the **MAC values** of the inhalants?
* Iso: 1.3 (dog), 1.7 (cat)
* Sevo: 2.1 (dog), 3.1 (cat)
* Des: 7.2 (dog), 10.3 (cat)
* Halo: 0.9 (dog), 1.1 (cat)
* NO: 222 (dog), 255 (cat)
## Footnote
MAC (Minimum Alveolar Concentration) values indicate the potency of inhaled anesthetics.
293
What is the **fresh gas flow** for rebreathing and non-rebreathing circuits?
* Rebreathing: 10xBW^.75
* Non-rebreathing: 3 x MV (minute volume = RR x TV); about 200-500 ml/kg
## Footnote
BW = body weight, RR = respiratory rate, TV = tidal volume.
294
Is the inhalant vaporizer knob indicative of concentration of inhalant in the circuit with a rebreathing and non-rebreathing circuit?
* Rebreathing: concentration less than knob setting
* Non-rebreathing: concentration equals knob setting
## Footnote
This is due to dilution effects in rebreathing circuits.
295
Indications for **non-rebreathing** circuits?
Patients <5 Kg
## Footnote
Concentration of inhalant delivered equals what vaporizer is set to, with no dilution.
296
Why would you add **Helium to Oxygen** in an anesthesia circuit and what is the ratio?
70:30 ratio to decrease flammability when using lasers
## Footnote
This mixture helps maintain safety during procedures involving lasers.
297
What effect does **PEEP and IPPV** have on cardiac output?
Decreases CO
## Footnote
Positive End-Expiratory Pressure (PEEP) and Intermittent Positive Pressure Ventilation (IPPV) can reduce cardiac output.
298
What does the **internal pressure regulator** do in an anesthesia circuit?
Regulates pressure from wall outlet or tank to be 50 PSI
## Footnote
This ensures safe delivery of gases.
299
How big is the **reservoir bag**?
5-10 x tidal volume
## Footnote
This is essential for adequate gas exchange.
300
How are **anesthetic vapors categorized**?
Classified by regulation of vapor output, method of vaporization, vaporizer location, temperature compensation, and agent specificity
## Footnote
Most vaporizers are out of circuit, variable-bypass, flow-over, temperature compensated, and agent-specific.
301
What is the **I:E ratio** and what is it set to?
Typically 1:2 (range 1:1-1:4)
## Footnote
Expiration is longer than inspiration to allow for venous return.
302
What is the **Cheyne-Stokes breathing pattern**?
Increase in rate and depth, then slower, followed by brief period of apnea
## Footnote
This pattern cycles between hyper and hypoventilation.
303
What is a **pressure relief valve**?
Pressure reduced to 50 PSI by the anesthesia machine
## Footnote
This is from a tank pressure of 2200 PSI.
304
How to read an **O2 flowmeter**?
Top of bobbin, middle of ball
## Footnote
This indicates the flow rate of oxygen.
305
What other gases can you mix with **O2**, and why would you?
40% oxygen:air combo has less atelectasis due to nitrogen content
## Footnote
Nitrogen helps keep alveoli open.
306
What happens if you use **100% O2**?
Get absorption atelectasis
## Footnote
This occurs due to the lack of nitrogen to support alveoli.
307
What is **Functional Residual Capacity**?
Amount of air remaining in lungs at end expiration, 45 mL/kg
## Footnote
This is important for understanding lung function.
308
What are the **soda lime ingredients** and MOA?
* Sodium hydroxide
* Potassium hydroxide
* Calcium hydroxide
* Water
## Footnote
MOA: Exhaled CO2 reacts with water to form carbonic acid, which dissociates to free protons and carbonate.
309
What are the **one lung ventilation indications**?
* Thoracoscopy
* Pericardiectomy
* Lung lobectomy
* Thymoma excision
## Footnote
Techniques include selective intubation, bronchial blocker, double lumen endobronchial tube.
310
What is **V/Q mismatch**?
* High V/Q: PTE (responds well to O2)
* Low V/Q: pneumonia, ARDS (poorly responsive to O2)
* R→L shunt: not responsive
## Footnote
This describes ventilation and perfusion relationships in the lungs.
311
What is the effect of inhalants on **hepatic blood flow**?
* Iso: does not impact
* Enflurane, halothane, sevo: do impact
## Footnote
This is important for liver function during anesthesia.
312
What is the **dead space** of an anesthetic circuit?
Where inspiration and expiration coincide, typically end of ET tube and Y piece of tubing
## Footnote
This area does not participate in gas exchange.
313
What is the **O2 flow rate** for mask pre-oxygenation?
4-5L/min
## Footnote
This rate helps ensure adequate oxygenation before anesthesia.
314
What does **ETCO2** reflect?
Accurate, reliable, constant monitor of arterial CO2
## Footnote
It can indicate changes in pulmonary perfusion and cardiac output.
315
What is **malignant hyperthermia** associated with?
Hypercarbia, hyperthermia, muscle rigidity, cardiac arrythmias, death
## Footnote
It is caused by a defect in the ryanodine receptor involved in calcium release in muscles.
316
What can trigger **malignant hyperthermia**?
* Succinylcholine
* Halothane/halogenated inhalant
## Footnote
These agents can lead to severe complications.
317
How to treat **malignant hyperthermia**?
* Get off inhalant
* Propofol CRI
* IV Dantrolene
## Footnote
Dantrolene stabilizes the sarcoplasmic reticular membrane and decreases calcium release.
318
Which anesthetic drug negatively affects **neonate survival** during Cesarean section?
Xylazine
## Footnote
This drug should be avoided in pregnant animals due to its effects.
319
What is **hyperesthesia**?
Exaggerated response to pain
## Footnote
It results from increased central or peripheral sensitization.
320
What is the effect of **hypoproteinemia** on anesthetic drugs?
Less protein binding, more unbound drug available
## Footnote
This can lead to increased effects of anesthetic drugs.
321
How do you use a **Touhy needle**?
Curved at distal tip to help direct catheter
## Footnote
It is used for single injection or to facilitate indwelling epidural or perineural catheters.
322
What is the **insulinoma anesthetic protocol**?
* Preop: small freq meals
* Glucocorticoids to promote insulin resistance
* Monitor BG q30min
* Dextrose containing fluids
* Glucagon CRI
## Footnote
This protocol helps manage blood glucose levels during anesthesia.
323
How long does it take a **CRI** to reach therapeutic level?
4-5 half lives
## Footnote
This is important for achieving effective drug levels.
324
What are the differences between **dopamine and dobutamine**?
* Dopamine: dose-dependent receptor effects, B1/B2 at higher doses, alpha-1 at high doses
* Dobutamine: primarily B1, but high doses affect B2 and alpha-1
## Footnote
Both are positive inotropic drugs used to treat decreased stroke volume.
ACVS Phase 1 (BA)
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