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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Diagnostic Imaging | 7% | - Imaging Techniques
|
| Topic 2: Laboratory Procedures | 12% | - Diagnostic Testing
|
| Topic 3: Animal Care and Nursing | 20% | - Patient Care
|
| Topic 4: Anesthesia | 15% | - Anesthetic Procedures
|
| Topic 5: Surgical Nursing | 11% | - Perioperative Procedures
|
| Topic 6: Emergency Medicine and Critical Care | 8% | - Emergency Procedures
|
| Topic 7: Pharmacy and Pharmacology | 12% | - Medication Preparation
|
| Topic 8: Dentistry | 8% | - Dental Procedures
|
| Topic 9: Pain Management and Analgesia | 7% | - Pain Control
|
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156. Frage
When viewing an ultrasound image of the liver, the veterinarian comments that a circular structure appears anechoic. What does this term mean?
Antwort: A
Begründung:
Echogenicity is a term describing the gray scale observed with B-mode (brightness-mode) ultrasound. It is typically expressed in statements comparing echogenicity of one tissue to another. For example, "The liver mass is hyperechoic" (assumed as compared to the surrounding liver and usually not stated specifically), or, "The spleen is hyperechoic to the liver." The following terms are used when describing echogenicity:
*Anechoic: The image is completely black and does not need a comparative tissue
*Hypoechoic: The structure is a lighter shade of gray than X tissue
*Hyperechoic: The structure is a darker shade of gray than X tissue
*Isoechoic: The structure is an equivalent shade of gray to X tissue
In increasing levels of echogenicity from least to most of normal tissues/fluids: Urine, bile, and minimally cellular fluids < renal medulla < renal cortex < liver < prostate < spleen When comparing echogenicities of one tissue or fluid to another, organs need to be compared at the same control settings.
157. Frage
Which joints are evaluated by PennHIP radiographs?
Antwort: A
Begründung:
PennHIP radiographs evaluate for laxity within the coxofemoral joints (hips).
The PennHIP technique is not used for the stifle (knee), jaw (TMJ), or where the head joins the neck (atlantooccipital joint).
158. Frage
The Animal Medicinal Drug Use Clarification Act (AMDUCA) was added to the Federal Food, Drug, and Cosmetic act for what purpose?
Antwort: B
Begründung:
The Animal Medicinal Drug Use Clarification Act (AMDUCA) permits veterinarians to legally prescribe or use in a vet hospital some approved veterinary and human medications to treat a variety of species off-label, assuming specific conditions have been met. In other words, it provides for extra-label drug use.
Together, the FDA (Federal Drug Administration) and the EPA (Environmental Protection Agency) establish specific drug withdrawal times for a variety of drugs in food animals.
The U.S. Pharmacopoeia (USP) is a list of all medications and related products and their active ingredients.
The Federal Drug Administration (FDA)'s Center for Veterinary Medicine (CVM) functions as the governing entity that regulates the manufacture and distribution of a variety of medical items such as devices, medications, and food additives for veterinary species.
159. Frage
What is the optimal level of anesthesia for most invasive surgical procedures?
Antwort: B
Begründung:
During stage III, the animal loses pain sensations. Some reflexes are inhibited, while necessary bodily functions continue. Stage III is divided into light stage III, surgical, and deep stage III. These planes correspond to inadequate, optimal, and excessive depth of anesthesia.
Stage II, the excitement stage, refers to the point at which the animal begins breathing irregularly and no longer has voluntary control. Here we may see vocalization or paddling. Stage II, medium plane, is an incorrectly used combination of terms. Stage III, deep stage anesthesia, is incorrect because this level of anesthesia is where the patient is almost at the point of not breathing and should be avoided.
160. Frage
You are asked to assist in managing a 6-YO MN Doberman. He presented as a GDV and had surgery 24 hours prior. He is not yet eating and, despite a Nocita incisional block, remains painful on abdominal palpation. You alert the overnight emergency doctor.
He has orders for hydromorphone as needed, but you feel this wouldn't be a good idea for all of the following reasons, except:
Antwort: D
Begründung:
In healthy animals, hydromorphone can cause GI upset and vomiting. It is a pure mu-agonist opioid and, like all opioids, can cause significant ileus (gut stops moving or dramatically slows down). This can lead to further GI upset and constipation. It may not be the best option for a patient when getting him to eat is paramount to healing the stomach/GI tract. Further, while it is a reversible drug, it does remain in the system for up to six hours or more, depending on the patient. Many vets also feel that for visceral pain, it is less effective than other pain medication options.
Most likely, this patient received Cerenia, either on presentation or as part of the surgical pre-op protocol. However, vomiting with hydromorphone is common (more so with IM than IV administration). Still, a fentanyl CRI (which can be easily stopped, and any slowing of the GI tract or other abnormalities can be easily resolved) may be a better option. Many feel it is better at controlling visceral pain. Additional options would be dexmedetomidine, lidocaine, or ketamine CRI. All potential options come with their own side effects. Further, depending on the severity of pain, a combination of an opioid and lidocaine +/- ketamine (FLK, for example) may be used to ensure adequate pain supply yet lessen the amount of each drug needed, thereby hopefully improving quality of life and encouraging eating.
If CRIs are not an option, choosing methadone over hydromorphone for intermittent injections may be beneficial, as we see less GI upset (anti-emetic properties). However, it can be costlier and needs to be dosed more frequently. Further, a shortage is ongoing as of October 2023 and, thus, it may not be a viable option.
161. Frage
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