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| Section | Weight | Objectives |
|---|---|---|
| Pain Management / Analgesia | 7% | - Pain assessment, pharmacologic and non-pharmacologic control - Multimodal analgesia protocols |
| Anesthesia | 13% | - Anesthetic agents, equipment, monitoring - Recovery and emergency management - Pre-anesthetic assessment and preparation |
| Dentistry | 7% | - Dental anatomy, disease recognition - Dental cleaning, polishing, radiography - Periodontal care and patient education |
| Diagnostic Imaging | 6% | - Radiography: positioning, safety, technique - Ultrasound, other imaging modalities - Image quality assessment and documentation |
| Pharmacy and Pharmacology | 13% | - Controlled substance management - Drug classification, dosage calculation, administration routes - Anatomy, physiology, pathophysiology related to agents - Preparation, dispensing, storage, safety and disposal |
| Emergency Medicine / Critical Care | 7% | - Toxicology, trauma, first aid procedures - Triage, shock, respiratory/cardiac emergencies |
| Communication and Veterinary Professional Support Services | 5% | - Client education, communication techniques - Practice management, team collaboration - Medical records, ethics, legal and regulatory compliance |
| Animal Care and Nursing | 20% | - Husbandry, nutrition, fluid therapy - Specialized care for exotic, large or neonatal patients - Infection control, sanitation, isolation - Physical examination, patient assessment |
| Laboratory Procedures | 9% | - Parasitology, microbiology, cytology - Sample collection, handling and processing - Hematology, clinical chemistry, urinalysis |
| Surgical Nursing | 13% | - Surgical preparation, instrumentation, aseptic technique - Intraoperative and postoperative care - Wound management, suture materials and techniques |
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NEW QUESTION # 627
When thinking about your preanesthetic plan, you need to consider the benefits of selected agents and any contraindications to their use. What condition in your patient would prevent you from using an anticholinergic as part of your premedication protocol?
Answer: C
Explanation:
Anticholinergics are not true anesthetics, and these drugs are, instead, used to thwart the effects of parasympathetic nervous system stimulation. Anticholinergics are used to prevent or treat vagally stimulated bradycardia, such as may occur with surgical manipulation or secondary to specific medications, such as alpha2-agonists or opioids. They work by increasing the heart rate through the antagonistic action against acetylcholine. As a result, this increases blood pressure, cardiac output, and heart rate. They can be given as part of the premedication but may not be warranted in many cases.
Additional benefits and/or negative effects of anticholinergics include:
*Decreased secretions
*Bronchodilation - This can cause a significant increase in anatomical dead space, increasing the risk of hypoxemia and decreased ventilation
*Mydriasis (especially in cats)
*May create thicker mucus within the airways in horses, ruminants, and cats - caution with dosing
*Decreases GI activity through the ability to inhibit peristalsis
However, contraindications, regardless of benefit, include:
*Patients with underlying tachyarrhythmias and primary cardiac disease
*Patients with concurrent diseases that cannot tolerate tachycardia
*Geriatric patients without complete workups - a decreased function of organ systems in general with age +/- any underlying disease
*Patients with constipation or ileus - could be made much worse by the use of anticholinergics
*Can induce colic in horses or bloat in ruminants
*Not recommended for rabbits. Part of this recommendation pertains to concerns for ileus. However, many rabbits produce atropine esterase, which causes the breakdown of atropine, rendering it ineffective.
Examples of anticholinergics include atropine and glycopyrrolate.
Because these drugs decrease gastric motility and can worsen ileus and constipation, these drugs should be avoided in patients with underlying conditions or species like rabbits, horses, and ruminants that may be predisposed to severe disease if peristalsis is decreased.
Anticholinergics treat bradycardia and slow down the gut, likely improving diarrhea and drying up secretions, so patients with excessive ptyalism would benefit from their use.
NEW QUESTION # 628
All of the following are true when considering the dehiscence of a surgical site, except:
Answer: A
Explanation:
A seroma is a collection of serum that accumulates under the incision, usually in the superficial skin layer. A seroma is non-painful but flocculent and must be differentiated from a hematoma or break in the body wall. It often occurs because animals are not sufficiently exercise-restricted. Still, it can also happen when surgery requires excessive dissection of the nearby tissue or if the tissue planes are not adequately and sufficiently opposed. Seromas can take time, but usually heal without intervention or with warm compresses +/- bandaging in some instances and depending on the type of surgery/location of the abnormality.
Unlike a seroma, however, an incisional dehiscence is a more major complication that warrants intervention.
Dehiscence refers to the breakdown of all surgical incisional layers (or surgically repaired wounds). It is an uncommon but potential complication of any wound repair or surgical incision. Further, it can increase the risk of developing evisceration (for abdominal surgeries) and/or sepsis. Dehiscence can result for various reasons, including:
*Separation of surgical incisional layers due to excess licking by the patient, often due to owners who fail to put the e-collar on when advised and when not with the patient. Proper education is required. No owner can watch their pet 100% of the time, and just because they do not lick in our presence doesn't mean they will not when unattended.
*Separation of surgical incisional layers due to excess activity by the patient. Failing to restrict exercise as directed by the veterinarian can lead to stretching and pulling on the incision, leading to breakdown and increasing the risk of dehiscence and other complications.
*Suture breakage, improperly tied sutures and knots that slip, or poor surgical technique.
NEW QUESTION # 629
You are performing anesthesia for the veterinarian, performing a spay and gastropexy (prophylactically) on an 18-month-old female Great Dane. She was premedicated about 3.5 hours ago, but an emergency came in, so surgery time was delayed. She was premedicated with methadone, dexmedetomidine, and induced with propofol. She is being maintained on oxygen and isoflurane. The patient remained stable and at an appropriate plane of anesthesia during the ovariohysterectomy. However, the veterinarian is starting to perform the gastropexy. As she begins to tack the stomach to the body wall, you notice that the patient's heart rate is increasing, her blood pressure is increasing, and her breathing has become more shallow. You are concerned that she is light and reacting to painful stimuli. You think that you saw the foot twitch a bit as well. You inform your doctor and suggest that the patient needs additional pain management.
All of the following would be appropriate at this time, except:
Answer: D
Explanation:
This patient sounds like she is starting to wake up on the table. This could be because the plane of anesthesia isn't deep enough or, more likely, because the duration of methadone (4-5 hours) has been reached and the patient is responding to painful stimuli. Thus, while one could increase the percentage of gas being delivered, which may result in a deeper plane of anesthesia, the patient will likely still show signs of pain (elevated heart rate and blood pressure). Knowing that, while routine, the procedure stimulates visceral pain receptors, you recommend pain management to your veterinarian.
Appropriate medications at this time include long-acting opioids such as methadone or hydromorphine. Hydromorphone, however, can cause vomiting and would only be recommended if a pre-operative dose of Cerenia was used (as is becoming standard of care). Additional options would be a short-acting bolus of fentanyl followed by a CRI. Alternative options include using a local anesthetic (lidocaine) as a pain medication. With this, we use a bolus and then a CRI. However, this medication can cause GI upset and may not be the best choice for this procedure. Further, it may be stronger than is necessary for the remaining duration of the surgery.
This patient needs immediate pain relief. So, regardless of the drug and drug class chosen (ketamine and dexmedetomidine can also be used as a bolus, followed by a CRI in healthy patients for pain management), you want something that will provide immediate and continued pain relief for the duration of the procedure.
Nocita (bupivacaine liposome injectable suspension) is a long-acting local anesthetic that effectively controls pain (usually at the incisional site/into a wound at the end of the surgical procedure) for up to 72 hours post-operatively. However, it does not start acting immediately, and the patient is in pain while the surgery continues. Thus, it is not appropriate at this time. It should be included as part of the multi-modal pain management to aid in post-op pain control. It may limit the need for rescue pain meds, including additional opioids post-op.
NEW QUESTION # 630
A blood agar plate is a cultural medium used as a primary isolation medium and a streak for colony isolation. This medium contains trypticase soy agar with which of the following?
Answer: B
Explanation:
A blood agar plate contains trypticase soy agar with 5% blood. A blood agar plate is used for organism isolation and for the subculture of organisms. Many laboratories choose to use a combination of blood agar and a selective medium split plate to allow the growth of most bacteria.
NEW QUESTION # 631
What sort of diet is best suited for a patient in renal failure?
Answer: B
Explanation:
A diet low in protein slows the progression of renal disease by reducing the amount of work the kidneys perform to process protein. Protein restriction decreases proteinuria and protects the kidney.
Veterinary patients with renal disease are not placed on a diets that are grain-free, high in fat, or low in carbohydrates.
Joanna M. Bassert, VMD. McCurnin's Clinical Textbook for Veterinary Technicians, 9th Edition. Pg 650.
Mosby's Comprehensive Review for Veterinary Technicians 5th Edition. Pg 281.
NEW QUESTION # 632
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