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AAVSB VTNE Exam Questions
Page 9 of 58
161.
You are taking a bird’s history and realize that this may be a more critical patient than the owner led you to believe. The owner tells you that the bird is falling off the perch and fluffed up standing on the floor. The owner did appreciate his tail bobbing while standing on the floor but didn’t think anything of it. You hear increased respiratory sounds audible while weighing the bird and suspect the bird is actually in respiratory distress. You run the bird to the emergency team. The owner hadn’t appreciated the abnormal breathing but did say that he is a relatively new bird owner and had been painting in another room the past few hours.
All of the following explain the avian respiratory tract’s predisposition to issues with toxic fumes, except:
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Ability to pull air into their lungs
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The large volume of space in the avian respiratory tract
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Unidirectional airflow
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The highly efficient gas exchange system
Correct answer: Ability to pull air into their lungs
A bird’s airway’s spatial relationship between the blood capillaries and the air produces a highly effective and sensitive means of gas exchange with molecules of any kind in the air. The lungs in birds are small, making up only about 2% of the body’s volume. They house the network of air and blood capillaries that exchange gas and are attached to the thoracic vertebrae and ribs. However, unlike mammals, birds also have air sacs. These slightly vascularized, thin-walled membranes encompass up to 80% of the respiratory volume. Nine sacs exist, four of which are paired. They connect to the primary bronchi and ventrobronchi and act as reservoirs for air. They also aid in buoyancy and thermoregulation. Air is first taken into the air sacs, and here it is both humidified and warmed. Thus, overall, birds have a large overall respiratory tract capacity.
Paired air sacs include:
- Cranial thoracic
- Caudal thoracic
- Cervical
- Abdominal air sacs
The unpaired air sac is called the interclavicular air sac. It resides within the thoracic inlet between the collar bones (clavicles).
A bird’s expiration pushes air into the lungs, where the gas exchange can occur. Thus, birds do not pull air into the lungs. Rather, it is pushed into the lungs, suggesting birds, over other species, really can get a ‘breath of fresh air.’ Their airways are inelastic and do not deflate or inflate like mammalian lungs.
Fresh air flows in one direction, continuously in the lungs, and doesn’t mix with dirty air containing any waste, leaving no residual air in the airways.
The avian air system is also very efficient at gas exchange. The high efficiency is achieved due to the design of airflow between the air itself and the blood capillaries. These air capillaries sit at right angles to the blood capillaries, so carbon dioxide is constantly removed from the blood while oxygen is added.
Because of this sensitive system, toxic fumes are also easily taken in and displace oxygen. Commonly seen toxic fumes include:
- Heated Teflon-coated pans or covers of light bulbs
- Concentrated bleach and other disinfectants
- Oil-based paints
- Varnishes
- Exhaust fumes
Symptoms of toxicity include:
- Loss of balance
- Standing fluffed up on the floor
- Respiratory rales
- Raspy breathing sounds
- Tail bobbing with obvious respiratory dyspnea
- Severe respiratory distress
- Death
Treatment requires oxygen therapy, but the prognosis is poor. Proper education to new and potential bird owners and, ultimately, prevention is key.
162.
Which of the following is considered a psychotropic medication?
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Alprazolam
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Digoxin
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Chlorpheniramine
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Furosemide
Correct answer: Alprazolam
Psychotropic medications affect the mental state of patients and potentially treat behavior problems. Alprazolam is a benzodiazepine. Benzodiazepines are fast-acting medications with a short duration. They are best used for predictable, anxiety-provoking situations.
Digoxin is a cardiac glycoside medication. Chlorpheniramine is a histamine antagonist medication, more commonly known as an antihistamine. Furosemide is a loop diuretic.
163.
When preparing a small animal patient for a double contrast lower GI study, all of the following are typically needed except:
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Clipping of the fur over the abdomen
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Sedation or anesthesia
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Fasting
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Enema
Correct answer: Clipping of the fur over the abdomen
It is not necessary to clip the fur for lower GI contrast procedures, but is typically needed for abdominal ultrasonography.
The entire GI tract must be empty, requiring fasting and enemas. Most animals do not tolerate the colon distension needed for a complete study without sedation or anesthesia.
164.
Which of the following is used to prevent decubital ulcers in hospitalized patients?
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Pressure-relieving sleeves
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Frequent feedings
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Antacids every 4 to 6 hours
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Elizabethan collars
Correct answer: Pressure-relieving sleeves
Decubital ulcers are caused by skin compression over bony prominences. Pressure-relieving sleeves or donut-shaped bandages can help minimize the pressure between skin and surface. Animals should also be kept on dry, clean, soft surfaces to prevent the formation of ulcers. Additionally, if recumbent, their positions should be changed every 2-4 hours to minimize the risk of ulcer formation.
Decubital ulcers are not prevented by feeding the patient frequently, giving the patient an antacid, or by keeping an Elizabethan collar in place.
165.
You obtain a glucose reading via glucometer and find the value abnormal. What organ is responsible for the maintenance of blood glucose levels?
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Pancreas
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Liver
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Heart
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Kidneys
Correct answer: Pancreas
The pancreas is an endocrine organ that is responsible for producing insulin and glucagon. These hormones are necessary for regulating blood sugar levels.
The liver regulates the body's nutritional metabolism and produces bile. The heart circulates blood through the body. The kidneys filter the blood to produce urine and regulate electrolytes.
166.
Which of the following anesthetic monitoring parameters suggests hypoxemia?
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SpO2 = 87%
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SpO2 = 98%
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EtCO2 = 45
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EtCO2 = 60
Correct answer: SpO2 = 87%
A pulse oximeter can estimate hypoxemia or low levels of oxygen in the blood. When a patient is on 100% oxygen on an anesthetic circuit, the SpO2 should not decrease below 97%. When breathing room air, this may decrease to 95%. Because of the oxygen-hemoglobin dissociation curve, subtle changes in SpO2 will occur despite prominent decreases in blood oxygen levels. A saturation level of less than 90% suggests hypoxemia.
A more accurate, though technically challenging and more expensive, way to monitor blood oxygen levels is via arterial blood gas analysis.
End tidal carbon dioxide (EtCO2) reflects hyper- and hypocapnia, which are measures of carbon dioxide and not oxygen.
167.
You have a horse client who routinely self-treats his horses without calling for an evaluation. He often retains leftover medications, and recently had a horse who was not training right. His gait was off, and he didn't seem to want to run at full gallop. The owner had Banamine at home from another horse. The previously prescribed horse was a Percheron, who stood 18 hands. Today's horse of concern, a warmblood, only stands 15.5 hands and is in an appropriate body condition. The owner finally calls you because the horse isn't eating much the past few days and seems lethargic. Additionally, today, he has been stretching out more in strange postures and grinding his teeth.
What do you discuss with the owner as a possible cause?
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Probable GI ulceration secondary to NSAID use
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Colic
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Gastrointestinal parasitism
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Endocrine disease
Correct answer: Probable GI ulceration secondary to NSAID use
Banamine (flunixin meglumine) is a common NSAID (non-steroidal anti-inflammatory) pain medication used in large animals. However, GI side effects can occur in most species. In dogs, we tend to see vomiting and/or diarrhea and, less commonly, GI ulceration. However, in horses, ulceration can occur more commonly.
While we do not know the actual weight of the current horse, just given the size measurements and breeds mentioned, the Percheron, who was originally prescribed a specific weight-based dose vs. the current smaller warm blood, should spark concern. He was likely overdosing the horse on the NSAID, increasing the risk of ulceration.
Anorexia or decreased appetite, lack of desire to run at a gallop, and lethargy are vague signs. They could suggest a lameness or other painful musculoskeletal issue or something systemic. The abnormal posturing and stretching suggest more closely and more likely abdominal disease. The patient doesn't appear to be rolling, kicking at himself, or showing other more severe signs consistent with colic. No diarrhea is described, and often GI parasites alone won't cause the other clinical signs.
Again, we are choosing the best answer given the history provided. We must consider NSAID toxicity or overdose and GI ulcerations first because it fits. We are triaging over the phone to give the owner information. A variety of endocrine diseases could be present and can manifest in many ways, including causing GI ulceration. But the key here is recognizing that the NSAIDs may be a problem and advising the owner to discontinue them and to have the horse evaluated at the clinic or via a farm visit as soon as possible.
168.
Which of the following is used in resuscitation of patients with asystole?
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Epinephrine
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Naloxone
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Lidocaine
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Calcium gluconate
Correct answer: Epinephrine
On an electrocardiogram (ECG), there are three main arrhythmias associated with cardiac arrest or impending cardiac arrest:
- Asystole is the absence of mechanical and electrical heart activity and is commonly treated with epinephrine, an intravenous vasopressor.
- Pulseless electrical activity (PEA) occurs when a mechanical heartbeat is absent despite electrical activity evident on an ECG and is treated with epinephrine, naloxone, or vasopressin.
- Ventricular tachycardia refers to a rapid heart rate pattern and is most often treated with lidocaine.
Calcium gluconate is used in cases of hyperkalemia, not asystole.
169.
What tissue comprises the majority of tooth volume?
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Dentin
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Bone
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Cementum
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Enamel
Correct answer: Dentin
Dentin constitutes the majority of a tooth. It lies just below the surface enamel layer and encases the pulp cavity. It is sensitive to pressure and temperature changes. It has a tubular structure that is porous to bacteria. Thus, once dentin is exposed, it should be assumed that the pulp cavity will eventually become infected.
Teeth are not composed of bone. Enamel forms the outer surface layer of the tooth crown. Cementum forms the outer surface layer of the tooth's root.
170.
You are preparing equipment and materials for the upcoming small animal surgery. You want to get all the following ready for the induction phase of anesthesia, except:
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Suction catheter
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Laryngoscope and appropriately sized blade
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Rolled gauze
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Syringe
Correct answer: Suction catheter
Standard materials and equipment for routine catheterization of most species, regardless of patient size, may include:
- Pre- and induction anesthetic agents
- Laryngoscope and appropriately sized blade for appropriate species
- Rolled gauze for securing the tube once placed (IV tubing or, when in doubt, a shoelace can also be used)
- Gauze sponge to help hold the tongue out of the way by the restraining technician
- A syringe to inflate the tube's cuff:
- 3 ml for cats
- 12 ml for dogs and pigs
- 20 ml for small ruminants, foals, calves
- 60 ml for horses and adult cattle
- An exam light that helps further illuminate the patient and the airway
- A stylet when intubating small ruminants or swine when using narrow tubes or when needing added rigidity to support the tube and facilitate placement
- Lidocaine
Suction catheters are generally not considered standard equipment and are unlikely needed, especially in properly fasted animals and animals with which care has been taken to flush the mouth out when appropriate.
171.
Which gram-positive rod causes caseous lymphadenitis in goats and sheep?
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Corynebacterium pseudotuberculosis
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Bacillus anthracis
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Trueperella pyogenes
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Listeria monocytogenes
Correct answer: Corynebacterium pseudotuberculosis
Corynebacterium pseudotuberculosis is the gram-positive rod that causes caseous lymphadenitis in goats and sheep.
Bacillus anthracis is a gram-positive rod causing anthrax. Trueperella pyogenes is a gram-positive rod found in the skin and mucous membranes of cattle. Listeria monocytogenes is a gram-positive rod that causes neurologic illness in ruminants.
172.
Which of the following topical medications causes the patient's pupils to dilate in order to facilitate a more thorough ocular exam?
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Atropine
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Tobramycin
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Proparacaine
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Ketotifen fumerate
Correct answer: Atropine
Atropine causes dilation of the pupils by relaxing the pupillary sphincter muscle, which helps facilitate a more thorough ocular exam and control ciliary spasms of the eye, providing pain relief. When administered intravenously, atropine is also used to counteract organophosphate poisoning, prevent bradycardia, and slow a hypermotile gut. Finally, it provides pain relief. Other commonly used topical ophthalmic drops used for mydriasis (pupil dilation) include tropicamide and phenylephrine.
Tobramycin is an antibiotic used to treat bacterial eye infections. Proparacaine is a topical anesthetic used to numb the eye for procedures to facilitate examination of painful eyes. Ketotifen is an antihistamine used for allergic conjunctivitis.
173.
Which of the following would indicate an ethylene oxide leak inside the veterinary hospital?
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A smell similar to ether
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A strong smell similar to rotten eggs
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Moisture gathering on the floor of the surgery suite
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A blue haze in the air of the surgery suite
Correct answer: A smell similar to ether
Ethylene oxide (ETO) is a colorless gas with a slight odor similar to ether. If veterinary professionals suspect there has been an ETO leak, they should evacuate the premises and contact emergency personnel. ETO is thought to be carcinogenic, so precautions need to be taken when used.
Ethylene oxide does not smell like rotten eggs. As a gas, ETO would not cause moisture to gather on the floor. It is colorless, so a blue haze would not appear in the air.
174.
After performing a bacterial culture on a plate, all of the following characteristics help identify the bacteria except:
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Color of colony growth
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Cell wall structure
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Growth characteristics
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The shape of the bacteria
Correct answer: Color of colony growth
A plated culture should be carefully inspected after it has been allowed to sit 24 to 48 hours, inverted, lid facedown. The technician should quantify the level of growth that occurred, indicating whether an infection is mild, moderate, or severe. When it is time to microscopically evaluate the individual colonies, the cell wall structure and bacterial shape, in combination with the growth characteristics, help to identify the organism. Additional tests, media, or stains may be needed to further help identify the organism.
The color of the culture is not an accurate identifier in determining the species of bacteria grown.
175.
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:
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Incisional line block with Nocita® (bupivacaine liposome injectable suspension)
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Fentanyl bolus 3 mcg/kg followed by a CRI at 1-5 mcg/kg/hr
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Repeat methadone pre-operative dose at 0.25 mg/kg IV
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Lidocaine 1 mg/kg IV bolus followed by a CRI at 25-50 mcg/kg/min
Correct answer: Incisional line block with Nocita® (bupivacaine liposome injectable suspension)
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.
176.
Which of the following does not play a role in patient preparation nor aid in good image production with ultrasound when evaluating the urinary tract system?
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Allow the pet to urinate before the procedure, so they remain calm and collected
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Clip any fur or hair
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Remove any dirt, as it can decrease image quality
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Ensure sedation or anxiolytic administration when needed
Correct answer: Allow the pet to urinate before the procedure so they remain calm and collected
Fur or hair traps air, and since air reflects the beam before reaching the pet, the image quality is poor. We want to ideally shave a patient prior to imaging and use alcohol or ultrasound gel to improve the conduction of the sound waves. Dirt can impede the beam and also decrease image quality. Finally, suppose a patient is too hyper or stressed or aggressive, or simply moving too much. In that case, we may need to calm them down and administer pain meds or a combination thereof to ensure patient safety, patient comfort, and technician and ultrasonographer safety.
However, suppose we are imaging the urinary bladder and related structures. In that case, we do not want the pet to urinate before evaluation. The presence of urine in the bladder helps provide contrast between the hypoechoic urine (fluid) and its structures. If the patient were to urinate, the bladder would no longer be fluid-filled. This may make identifying the structure, no longer anechoic, difficult.
177.
Which of the following is a key factor in fecal parasite screening?
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Age of the stool being sampled
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Amount of light to which the sample has been exposed
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The type of food last eaten by the pet
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Number of people who have handled the sample
Correct answer: Age of the stool being sampled
It is best to analyze fresh stool samples for the most sensitive and specific results. Since most tests visually detect ova and parasites themselves, desiccated or samples beyond a few hours at refrigerated temperatures will lose sensitivity. Samples that were not promptly collected can become contaminated with soil nematodes and pollens and generate false-positive results.
The amount of light to which the sample has been exposed, the last meal the pet ate, and the number of people who have handled the sample may affect fecal parasite screening, but the freshness of the fecal sample is the key factor.
178.
What is the medical abbreviation for the right ear?
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AD
-
OU
-
AU
-
AS
Correct answer: AD
The Latin phrase auris dextra means "right ear" and is abbreviated as AD.
OU means both eyes. AU means both ears. AS means left ear.
179.
At what approximate angle should the sharpening stone and the blade’s face be when sharpening instruments?
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110 degrees
-
75 degrees
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150 degrees
-
210 degrees
Correct answer: 110 degrees
When sharpening any instrument, always ensure you are close to a 110-degree angle. With curettes, remember to sharpen the toe area. Sharpening guides help explain this clearly and should be followed until you become a pro at instrument sharpening.
Thus, 75, 150, and 210 degrees would be incorrect and insufficiently sharpen an instrument.
180.
You are asked to calculate drug dosages for an MLK CRI for a post-op hit-by-car patient with multiple fracture repairs. The patient is stable coming out of surgery, but you want to ensure the pet remains both stable and pain-free.
All of the following explain why CRIs may be beneficial to patients, except:
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A higher dose of analgesia is achieved over a shorter period
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They prevent peaks and valleys seen with the administration of some medications, such as opioids
-
A lower dosage is delivered at any given time, resulting in fewer dose-related side effects
-
The use of two or more drugs from different drug classes provides additive or synergistic benefits
Correct answer: A higher dose of analgesia is achieved over a shorter period
CRIs use one or more drugs from various drug classes to provide continuous pain management. By giving the medication(s) in this fashion, lower dosages of medications are needed, resulting in fewer side effects. Additionally, if side effects develop, the medication(s) can easily be titrated to lessen the impact. When combined, the use of opioids +/- alpha2-agonists +/- local anesthetics provide synergistic benefits. Each drug works on a different aspect of the pain pathway. Thus, CRIs help address more than one factor contributing to a patient's pain.
A CRI does not provide higher doses over a shorter period of time. In fact, lower doses spread out incrementally over a longer period of time than with intermittent injections, creating a more predictable and uniform pain management means of delivery.