Want to exchange some questions?

[Kenichiro Yagi]

Hello,

With the exam closing in, I thought I'd solicit for practice questions
by providing them myself. Please add questions if you'd like!
Hopefully I haven't gotten any details wrong. It is 12am...

My question:

An ECG tracing shows a very small P wave, widened QRS complex, a
spiked T wave, and a prolonged P-R interval, and bradycardic. What
electrolyte imbalance do you expect to see?

This female West Highland white terrier has been anorexic, vomiting,
is severely hyponatremic (as well as the electrolyte imbalance seen in
first part), and severely dehydrated. An IV crystalloid infusion is
started, but what would be the drug of choice for immediate treatment?

[amy flint]

I'd expect to see Hyperkalemia, and the drug of choice would be insulin? with the aim to push the excess K+ into the intracellular space. Glucose would also have to be supplemented in this case due to the insulin tx

> Date: Tue, 30 Aug 2011 00:17:50 -0700
> Subject: Want to exchange some questions?
> From: kiy...@gmail.com
> To: AVECCT...@googlegroups.com

[Liz Hughston]

Hyperkalemia as indicated by the EKG but with combined with the hyponatremia I think we're looking at a possible Addisonian crisis.  For immediate protection of the heart I would recommend that the DVM order insulin (+/- dextrose), and possibly calcium gluconate for its cardioprotective properties.  Then a bolus of 0.9% saline, ACTH stim test followed by administration of steroids (dexamethasone or hydrocortisone) IV.  Once Addison's is confirmed, DOCP administration can be instituted.

Liz

[Kenichiro Yagi]

Yes, I was looking for hyperkalemia on the ECG tracing.

The Westy is Addisonian (hypoadrenocorticism) and the drug I was
looking for was dexamethasone since we can give the patient
dexamethasone to provide glucocorticoids, but not affect the outcome
of the ACTH stim test.

Great points about dextrose and insulin treatment for the hyperkalemia
(dependent on degree and responsiveness to treatment).
Be sure to monitor ECG during Ca gluconate infusion.

Next question:

A feline patient presented with acetone smelling breath and a serum
glucose of 720mg/dL. The patient was given an unknown amount of
regular insulin, and the serum glucose was 150mg/dL 2 hours later, and
the patient was stuporous, bordering comatose. Your co-worker tells
you the patient was alert upon admission.

What is a possible explanation for this (explain the mechanism)?
What are treatment options?

[Kenichiro Yagi]

Which of the following is not a treatment option for cholecalciferol
ingestion? Of these that are, how does it help?

a. Calcitonin
b. Furosemide
c. LRS
d. Prednisone

[Kenichiro Yagi]

Which of the following is not a potential treatment for Acetaminophen
toxicity?
a. N-acetylcysteine
b. Vitamin C
c. Cimetidine
d. Blood Transfusion
e. none of the above

[Liz Hughston]

No calcitonin!  The goal is to reduce serum calcium levels.

The other three will work to reduce serum calcium levels:

b: Furosemide:  loop diuretic which also increases renal secretion of calcium

c: LRS: the best choice for diuresis as it does not contain calcium (unlike Plasmalyte/Normosol)

d: Prednisone:  increases renal secretion of calcium

[Liz Hughston]

b:  Vitamin C may decrease the amount of acetaminophen excreted by the kidneys

[Liz Hughston]

Oops!  LRS does contain calcium ... and calcitonin also increases renal excretion of calcium

sorry for the too-fast response :)

Liz

[Kenichiro Yagi]

The answers in my head are...

Cholecalciferol:
c. LRS - contains calcium. 0.9% NaCl is said to be the best fluid
choice due to it's sodium content, inducing calciuresis.

Calcitonin works to reduce serum Calcium in hypercalcemia by
preventing resorption of calcium in renal tubules and inhibiting
osteoclast activitity (resorption).
Prednisone inhibits gastrointestinal calcium absorption.

Acetaminophen:
e. none of the above.

Vitamin C facilitates conversion of methemoglobin to reduced
hemoglobin. I didn't read anything on negative effects of
acetaminophen excretion. Can you point me to that info?

[Kenichiro Yagi]

Another quick one:

Dopamine is a...
a. alpha adrenergic agent
b. beta adrenergic agent
c. both a and b
d. none of the above

[Liz Hughston]

From The University of Maryland Medical Center (so, human source):

"Acetaminophen (Tylenol) -- High doses of vitamin C may lower the amount of acetaminophen passed in urine, which could cause the levels of this drug in your blood to rise."

http://www.umm.edu/altmed/articles/vitamin-c-000339.htm

[alicia fukunaga]

Here's the info I was reading from the "Small Animal Critical Care Medicine"  regarding acetaminophen toxicity treatment, and the possible answers:

 

a. N-Acetylcyststeine - Yes, is the principle treatment for the neutralization and direct binding of the toxic metabolite, NAPQI.

b. Vitamin C - Yes, facilitates the conversion of methemoglobin to reduced hemoglobin. Dosing is the same for canines and felines, listed as 30mg/kg PO or IV, q 6-12.

c. Cimetidine - Yes, potential antagonism for the cytochrome P450 pathway

d. Blood Transfusion - Yes. "Transfusion therapy with whole blood, packed red blood cells, or oxyglobin should be considered when anemia or methemoglobinemia is severe enough to cause signs of reduced oxygen carrying capacity."  pg. 336

 

Ali

[Kenichiro Yagi]

Which of the following drugs may be chosen as a vasopressor CRI for a
patient in septic shock, and why? (good to go through each and say why
or why not)
a. Norepinephrine at 2mcg/kg/min
b. Dopamine at 1mcg/kg/min
c. Dobutamine at 10mcg/kg/min
d. Fentanyl at 0.7mcg/kg/min

On Sep 4, 1:52 pm, alicia fukunaga <alicia.fukun...@gmail.com> wrote:
> Here's the info I was reading from the "Small Animal Critical Care
> Medicine"  regarding acetaminophen toxicity treatment, and the possible
> answers:
>
> a. N-Acetylcyststeine - Yes, is the principle treatment for the
> neutralization and direct binding of the toxic metabolite, NAPQI.
> b. Vitamin C - Yes, facilitates the conversion of methemoglobin to reduced
> hemoglobin. Dosing is the same for canines and felines, listed as 30mg/kg PO
> or IV, q 6-12.
> c. Cimetidine - Yes, potential antagonism for the cytochrome P450 pathway
> d. Blood Transfusion - Yes. "Transfusion therapy with whole blood, packed
> red blood cells, or oxyglobin should be considered when anemia or
> methemoglobinemia is severe enough to cause signs of reduced oxygen carrying
> capacity."  pg. 336
>
> Ali
>
>
>
>
>
>
>
> On Sun, Sep 4, 2011 at 1:04 PM, Liz Hughston <mackhughs...@gmail.com> wrote:
> > From The University of Maryland Medical Center (so, human source):

> > *
>
> > "Acetaminophen (Tylenol)* -- High doses of vitamin C may lower the amount

[Kenichiro Yagi]

Which of the following drugs may be useful in treatment for
vasodilatory shock, central diabetes insipidus, and von Willebrand's
disease?
a. Dobutamine
b. Vasopressin
c. Epinephrine
d. Isoproterenol

[Jonathan]

Great questions Ken!

[Kenichiro Yagi]

Thanks!

Do you have any for us? :)
Oh, and quick question about the exam itself. Should I worry about
memorizing dosages for every single drug out there?

[Jonathan]

Nope. Just their mechanism of action, etc. I dont think its really up
to us as techs to remember them though many of us do. Not to say that
I think we shouldn't. I've caugh many mistakes from the DVM due to my
knowledge of drug doses! I'll see if I can come up with a few. Super
tired tonight!

> > > started, but what would be the drug of choice for immediate treatment?- Hide quoted text -
>
> - Show quoted text -

[Karen Zee]

This was incredibly helpful to me as I went into my test. Thanks a bunch!!

- Karen Z

[amy flint]

Hi to all you have sat the 2011 exam, congratulations! hope the wait to find out your results isn't too tortuous!
-amy
 

> Subject: Re: Want to exchange some questions?
> From: ksze...@gmail.com
> Date: Thu, 15 Sep 2011 21:06:48 -0500
> To: avecct...@googlegroups.com

[Jonathan]

Karen, If you know of anyone that is interested in preparing their
application and for the exam please forward the groups address to
them! :) Glad it was at least a little helpful!