Board Review Session 5-21-12

Resources:
VetMedTeam -review course
www.capcvet.org -parasite review and iphone app
zukureview
www.vettechprep.com
itunes.apple.com/us/app/vtne-exam-prep-veterinary
www.vtstudy.com

Job Sites:
www.vetquest.com/classifieds
www.wheretechsconnect.com
navta.net
vettechplus.com (Canada)
vettechrelief.com (temporary/relief work)
veterinaryteamjobs.com
our "official" Facebook page (will be out in the next week or 2)

Recommended books:
Practice Questions: http://www.amazon.com/Review-Questions-Answers-Veterinary-Technicians/dp/0323068014/ref=sr_1_2?ie=UTF8&qid=1337635934&sr=8-2
Review/overview: http://www.amazon.com/Mosbys-Comprehensive-Review-Veterinary-Technicians/dp/0323052142/ref=pd_bxgy_b_img_b
Review and Practice: http://www.amazon.com/Veterinary-Technician-Exam-Editors-LearningExpress/dp/1576857387/ref=pd_sim_b_3

Surgery:

• A ventilator would connect where the reservoir bag goes because it does exactly what you'd do manually ventilating the patient.
• In the circle: manometer, CO2 absorbent, reservoir bag, valves to keep everything circulating in one direction, the patient
• Out of the circle: vaporizer (precision), flow meter, etc.
• Rebreather: circle, changes take 2-5min to take effect
• Non-rebreather: no absorbent, changes take effect in about 30sec, usually for smaller patients (under 15kg)
• Reservoir bag sizing: ~10ml/kg minimum X 5-6.  If 10kg = 100ml X 5 = 500ml.  Always use the next size up, so 1L.
• If a reservoir bag is too big there's more dead space which means it takes longer for changes to take effect and you can't see the bag moving making monitoring respiration harder.
• Manometers measure in 1 of 2 units: cm of H2O or mmHg.  Normal breathing should not excede 4cmH2O or 2-3mmHg and when bagging you should not excede 20cmH2O or 14mmHg.
• Atelectasis = the collapse of alveoli (they stick together), we sigh patients periodically during surgery to prevent this.
• Rebreathing types: 
• Closed: doesn't necessarily mean the pop-off is off, just that you are only meeting and not exceeding the oxygen needs of the patient.  No waste.
• Semi-closed: oxygen requirements are exceeded, excess is vented, what we usually use, wasteful, but easier to manage/safer
• Open: face mask, cat box, etc causes increased stage II excitement, most wasteful
• Barbiturates: long acting, short acting, ultra short acting.
• Hepatic enzyme inducer = metabolized faster once activated, like alcohol tolerance, it builds up over time and continued use (mostly an issue with phenobarbitol use in epileptic patients). 
• lowers RR and HR, apnea expected after bolus is given
• Protein-bound: blood proteins are albumin and globulins, both made by the liver.  
• When bound to protein it is inactive, but this is accounted for in the dosing.  A patient with a lower TP has less inactive drug and can OD.  
• Lipid soluble: ultra short acting is the most lipid soluble.  Blood is water, the lipid soluble drugs pass the blood brain barrier.
• Water soluble gas anesthetics act slower and clear the system slower, they last a long time because they don't want to leave the blood (water).
• Fat soluble gas anesthetics act quicker and clear quicker because they readily leave the blood and are blown off by the lungs.
• MAC: Minimum Alveolar Concentration, the percentage of gas that causes movement to stop in 50% of patients.
• Maintenance is estimated to be MAC X 1.5, so a gas anesthetic with a MAC of 2 will have a maintenance around 2 X 1.5 = 3%.  (This is without premed.)
• Avoid barbiturates in sighthounds and very thin animals.
• Obese patients require a lower dose and wake quicker.
• Thin patients can OD because there's no fat for the drug to attach to.
• Slough when given perivascularly.  If this happens, infuse with fluid, heat, and massage.Non-reversable
• Not analgesic, so more is required for painful surgeries.  Also don't prevent wind-up
• The following potentiate bartiturates: low TP, acidosis, hypovolemia, atropine, hypothyroid (lower metabolism)
• Ace is contraindicated in boxers, stallions (penile prolapse)
• Atropine is contraindicated in ruminants (decreases gut motility)
• MAC vs MIC, MIC is Minimum Inhibitory Concentration, used to find the antibiotic dosage that'll be effective against a problem bacteria
• Culture & Sensitivity: the size of the zone of inhibition does not determine the efficacy of a drug by itself.  The size of the zone is effected by the size of the molecule as well as by it's efficacy, so a table is referred to to decide which drug is more effective.
• Narcotics are potent respiratory inhibitors.
• Math: There are many C1 C2 = V1 V2 problems on the exam.  Dr Keller suggests changing all concentrations to mg/ml and all volumes to ml.  Also be VERY careful not to answer with the final volume if what they are asking for is the amount of water that needs to be added!!!
• 1 grain = 60-68mg.  Use 60mg and choose the closest answer from the multiple choice.  Atropine comes in 1/120gr which is 60mg/120 = 0.5mg.
• Vaccines:
• Dogs:
• Blue eye is associated with Adenovirus 1, Adenovirus 2 does not cause symptoms and is used in current vaccines.
• Borellia burgdorferi = Lyme
• Paralyzes cillia = Bordatella
• Effects the tips of villi = Corona
• Kills crypt cells (which create villi) = Parvo
• Causes hard pad = Distemper
• Causes enamel hypoplasia = any illness that causes extreme hyperthermia (Distemper is one)
• CS include URI: Distemper, Hepatitis, Parainfluenza, Bordetella
• Cats:
• Pneumonitis = Rhinotrachetits 
• Non-enveloped virus = Distemper (feline parvo-like virus)
• Panleukopenia = Distemper 
• Rhinotracheitis = a herpes virus, URI symptoms, canker sores especially on cornea, goes vanerial and causes abortion if cat is pregnant
• Retroviruses: FIV, FVLV
• Bacterial = Chlamydia
• Spread through aerosol: Rhino, Calici
• Spread through vomit and diarrhea = Distemper
• Spread through close contact / body secretions:  FIV (Feline Immunodeficiency Virus)
• FIP cannot be caught, it's FECV (Feline Enteric Corona Virus) that mutates within the body to become FIP
• FVLV exposure results in:
• fought off, complete recovery
• dormancy, hides in bone marrow
• CS
• FVLV can be tested via ELISA and IFA.
• ELISA: usually in-house, only tells you an animal was exposed, not if viremic or not.  If positive, an IFA should be done 6 weeks later.
• IFA: will be negative if the virus is completely latent, done 6 weeks after an ELISA to try to catch it before it'd be completely dormant
• Heart:
• S1 = 1st sound, A/V closure, systole, highest BP, louder, longer, lower pitch, "lub"
• S2 = 2nd sound, SL closure, diastole, lowest BP, softer, shorter, higher pitch, "dub"
• mitral valve = bicuspid
• oscillometer measures blood pressure and gives a digital readout
• doppler measures blood pressure and requires you to listen
• MAP = Mean Arterial Pressure (most accurate BP measurement)
• Murmors are graded I-VI, 6 is worst, 5 & 6 have a "thrill". Can also be described as systolic/diastolic, crescendo/decrescendo, holosystolic, PDA, etc
• Left side: PAM (pulmonic = most cranial, aortic = middle, mitral = most caudal)
• Right side: Tricuspid
• EKG's
• P = atrium depolarization
• QRS = ventricle depolarization
• T = ventricle repolarization
• Insufficient means not fully closed, Stenotic is not fully opened (actually the vessel is narrowed not a valve problem)
• Drugs:
• Alpha 2 Agonists: xylazine, Domitor, detomidine
• Benzo's: valium, medazolam
• Organophosphate toxicity: SLUDDE (salivation, lacrimation, urination, deficiation, diarrhea, emesis)
• Treated with atropine
• Phenothiazine derivatives: Chlorpromazine, Ace
• Alpha 1, 2 and Beta 1 and 2 stimulents = epinephrine, norepinephrine (sympathomimetic)
• Cappa and Mu receptors are effected by Narcotics
• Anticholenergic drugs are anti-rest eg Atropine
• Ceiling effect = butorphanol (has an agonist/antagonist effect, used for anti-cough, analgesic, but blocks other narcotics)
• Horses:
• Lipazzan origin: Spain
• Horse found in the Bedouin desert: Arabian
• Draft breed in england = Shire
• Racing horse in US: Quarter horse
• Long distance horse: thoroughbred
• Walk/run horse: Tennesee Walking horse
• Bred for speed: Apaloosa
• Strength: Arabian
• Original horse breed = Morgan
• Nez Pierce horse = Apaloosa
• Belgium = Belgian
• Before WWI only 3 sires existed = Friesian
• Knights used = Shire
• Pink skin, amber eyes = Cream Draft
• 14.2 hands to the wither
• Polyestrus: cow/sow
• Seasonal polyestrus: 
• horses (late winter to spring/summer, when light increases)
• goats/sheep (as light decreases)
• TDN: total digestive nutrition = the amount of energy in a food, corn is high in TDN, beans are lower, but higher in protein.
• Ketosis: happens because colostrum is high in sugar, Tx is IV Dextrose fast with Dexamethasone (which makes the liver squeeze out sugar)
• All animals are born immunocompetant (able to make antibodies), colostrum is needed to get over being exposed to so many new antigens after being born.
• Milk Fever is caused by low calcium -all of it is put into the milk.  Tx is IV 23% calcium gluconate SLOWLY!!! 
• Causes "wry neck", animal can't move neck because calcium is needed for nerve function
• Fat has 2.25 X the energy of carbs.
• Calcium is made from vitamin D3 and sunlight (UV)
• FAD: Foreign Animal Disease
• Anthrax: anaerobic, spore forming, DON'T OPEN CARCASS!, prevents clotting, if spores are inhaled it's 99% fatal
• Foot and Mouth Disease: effects cloven hoofed animals (horses are immune as are carnivores)
• Hog Cholera 
• Trichanosis (uncooked pork)
• Toxoplasma gondii: definitive host = cat
• PRRS (Porcine Respiratory & Reproductive Syndrome), causes pneumonia and abortion, an concern at zoos
• Roughage vs Concentrate: 
• Concentrate has more protein (corn, beans) but cause obesity.
• Roughage =  hay
• Hind gut fermenters: horses, 
• Pre-gut fermenters: bovine, end product of ammonia is used by bugs for protein
• Ammonia converted by hepatocytes into urea and diluted and excreted by the kidneys as urine
• High BUN with normal kidneys can be caused by a blocked cat, cachexia, malnutrition, starvation
• #1 nutrient = water!
• 8-21% is the minimum protein needed by domestic animals in their diet. Younger animals need more protein than older ones.
• Selenium is deficient in the midwest and over abundant in the west
• Feed additives:
• males are given female hormones to make their muscle soft
• females are given male hormones to make more muscle
• CMT = California Mastitis Test, tests for DNA (the cow's somatic cells or bugs')
• Bulk tank, SCC (Somatic Cell Count)
• Withdrawl time must be kept in mind when antibiotics and other drugs are given.
• Iron shots given to piglets because there isn't enough in pig colostrum
• IgG is found in colostrum
• A colt turns 1 year old on January 1st
• Anatomy names: pastern, fetlock, canon, splints, knee, stifle
• Left paralumbar fossa = auscultation of rumen
• Right paralumbar fossa = auscultation of horse cecum
• Paralumbar fossa landmarks: last rib, lateral process of the lumbar vertebrae, external abdominal oblique
• Esophagus is on the left side
• Iron shots should not be given in the ham muscle because it turns the meat black
• In carnivores the colon is dorsal to the cecum and the cervix is dorsal to the bladder
• Horse Diseases
• EIA (Equine Infectious Anemia) aka Swamp Fever, Coggins test
• EEE/WEE/VEE: transmitted through arthropods, hard to isolate once an animal is positive
• EME
• Rhino -40% of respiratory disease in shows, a virus
• Shipping fever
• Strangles caused by Strep equi, LN swell and "strangle"
• Flu
• most viruses cause abortion
• When visiting a farm with sick or dead animals the order of examination should be: babies, old animals, pregnant animals, and sick/dead animals LAST to prevent spread of infectious disease.
• Tetnis -the bacterial toxin causes death, paralyzes muscles, saw horse stance, lock jaw, nictitating membrane prolapse, hyperesthesia, can be transmitted through open castration.
• Naval/Joint Ill: caused by umbilical infection -DIP IT!!!
• FPT: Failure of Passive Transfer.  
• Colostrum needs to be received in 12-24hrs.  
• After that IV GGT can be given, but not orally because the intestines can no longer absorb the large molecules.
• Colostrum banking: freeze 1 pint of colosturm, lasts 1-2years.
• Can use cow colostrum in horses if nothing else is available
• Founder: ventral rotation of the 3rd phalanx.
• Insensitive lamina grows on the hoof inward
• Sensitive lamina grows on the bone outward and interdigitates with insensitive lamina
• Paravertebral nerve block
• proximal paravertebral nerve block, dorsal roots and ventral roots
• Bovine Diseases
• BRD: Bovine Respiratory Disease
• Red Nose
• Ruminations occur at 2x/minute
• Esophageal/Reticular groove: allows milk to bypass rumen and go to abomasum for absorbtion
• Foot & Mouth Disease, deer can be carriers
• Neosporum caninum -dogs and canids are the host, cause abortion in bovine
• Displaced abomasum
• Rumination: regurgitation, remastication, reinsalivation, redeglutition
• Milk is weighed in pounds
• Disinfection of teats is done far to near
• Milking is done near to far
• Reproduction
• Baby pigs prone to hypothermia
• Piloerector muscle causes hair to stand (goosebumps), aids to preserve warmth, but doesn't work when hair is wet, or covered with mud/feces
• Anterior Pituitary makes ?
• Posterior Pituitary secretes oxytocin
• Hypothalamus makes oxytocin
• FSH: Follicle Stimulating Hormone
• Estrogen: made by follicles
• Estrogen produces signs of heat
• LH (Luteinizing Hormone) causes ovulation and makes the CL (Corpus Luteum)
• Egg is released into peritoneum, estrogen causes fimbria to direct egg into oviduct
• Oxytocin causes milk letdown and uterine contractions
• In mares 1 CL is not enough to maintain pregnancy so she cycles again to produce another CL for the progesterone
• PGF2a brings animals into heat, used to synchronize their cycles
• Dystocia: Presentation (head/tail 1st), Position (hips/back to dam's pelvis), Posture (legs or head back)
• During parturition don't work against the dam, reposition fetus when she's relaxed.
• Calf Jack:  During parturition don't pull when the dam is relaxed, pull when she's pushing and pull slightly upward
• Rest after neonate's head is out, give them a chance to breathe before pulling the rest of the way out.
• The higher the SG of colostrum the better.
• Castration equipment and open (emasculator -nut to nut) vs closed (emasculatome, banding)
• Parasitology:
• Nematodes are round worms, they have L1, L2, L3 stages (no others do).  
• L3 is always the infective stage except in lungworms
• In carnivores lungworms are spread from dams to pups via licking
• Heartworm:  Dirofilaria immitus
• the male and female worms produce microfilaria which are pre-larval stage and not infective
• L1, L2, and L3 stages take place in the mosquito
• L3 stages come out with mosquito saliva and enter the animal through the skin
• L4 stage migrates to muscle and stays there awhile
• then the larva enter a vein, become L5 and travel to the heart where they become adults
• Adult worms live 7 years, microfilaria can remain for 2-3 years
• Fecal float solutions have a higher SG than water so the ova will float.  One example os Sheather's solution (sucrose)
• Tracheal Migration: intestine > liver > lung > trachea > pharynx > swallowed
• Whip worms don't undergo tracheal migration.
• Whips live in cecum/colon.
• Trichostrongylids (hooks)
• Ostertagia ostertagia, hypobiosis/overwintering
• Cestodes, tapes: require intermediat host (indirect lifecycle)
• onchosphere with hexacanth embryo
• infective stage = cystacircus
• orbatid mite is the IH for ruminants
• rabbits for taenia
• flea for dog/cat tapes
• proglotid, scolex, rostellum
• Trematodes -snails, water required
• Protozoa: infective stage = sporozoite
• Isospora = small animal
• Eimeria = large animal
• Neosporum caninum: cow ingests sporozoite, goes to brain, infects calf when cow gets pregnant, calf can be born alive as a carrier, born alive free of infection, or aborted.
• Dewormers (know).  Ivermectin kills just about everything.
• Equine pinworms are NOT zoonotic!
• Hydatid cysts = ecchinococcus
• Flukes target organ is the liver, gallbladder, bile duct
• Transmission: transdermal, transmammary, transplacental
• Insects have 3 body parts, eyes, antenna, 6 legs
• Arachnids have 2 body parts, no eyes, no antenna, 8 legs
• Insects and arachnids are both arthropods 
• Egg, Larva (Instar), Pupa, Adult
• It takes a minimum of 3 weeks for the cat flea lifecycle to complete
• Heartworm can be diagnosed in the following ways: direct blood smear, buffy coat, modified knotts (blood is lysed and spun), Difil (filter), ELISA
• What is above the buffy coat in a microhematocrit?  Plasma
• EDTA works by binding calcium
• Wigglers and tumblers = mosquito
• Fly lays eggs which can become maggots in as little as 18 hours
• Fly strike = stable fly = Stomoxys calcitrans
• Flies that won't go in barns?  Horse and Face 
• Cause pinkeye: face flies
• Thyamin deficiency in cattle = polio (not related to human polio)
• Permanent feeders = horn flies
• Screw worm: eradicated in the US, still have them in Mexico, have been found in Texas.  Maggots live in and eat live tissue.
• Stable Fly requires vegetation 
• Ixodid = hard tick (have scuttum and festoons)
• Miasis = infestation with maggots
• Facultative = maggots live on surface, eat dead skin
• Obligatory = burrow, breathing hole (Bot flies)
• Acariasis = infestation with mites = mange
• Pediculosis = infestation with lice
• Nits = eggs of lice found on hair
• Mallophaga = large head mite
• Anoplura = small head mite
• Keds = only fly that doesn't have wings
• Rocky Mountain Spotted Fever is spread by ticks
• Corioptes = Night Crazies
• Otodectes = ear mites
• Hemostasis
• Intrinsic/blood pathway is activated by rough blood flow eg artery w/ hole
• faster
• XII > X > II > I
• Extrinsic/tissue pathway is activated by injury
• slower
• III (thromboplastin) > VII (hagemen factor) > X > II (prothrombin to thrombin) > I (fibrin)
• No one test tests both pathways.
• APTT (and any other test that starts with "A") tests intrinsic and common pathways.
• OSPT, PT (and tests that start with letters other than "A") test extrinsic and common pathway.
• Endothelial injury results in a hole, vessel becomes sticky because of VonWillebran's factor, platelets adhere and secrete seratonin which lowers blood pressure, platelets become viscous and metamorphasize becoming larger and more sticky, thrombin adheres to the platelets and they form a platelet plug
• Platelet plug is water soluble
• Scratches on the inside of a red top tube activate hageman's factor (VII) and the blood clots
• Cetaceans, reptiles, and birds do not have hageman's factor (VII)
• Prothrombin > Thrombin > XII (excess thrombin activates XII)
• Factor XIII strengthens the clot and is self-limiting so that the clot doesn't just keep growing and growing
• Clot = thrombus
• When a clot breaks loose it's called an embolism, usually lodges in lungs because the vessels there are the smallest
• Blood cells
• 3 types: Leukocytes, Erythrocytes, Thrombocytes
• Leukocyte types: granulocytes, agranulocytes
• Granulocytes: neutrophils, eosinophils, basophils
• Agranulocytes: Monos (pleomorphic), Lymphs (very little cytoplasm)
• Stain: Blue, Red, Purple (burp).  Blue = methyl alcohol, makes cells stick to slide
• Basophilic granules in granulocyte = Dohle bodies = only in neutrophils
• Non-refractile inclusion in erythrocyte = Howell Jolly Body
• Leukocytopoesis, granulopoesis, etc
• Neutropenia, fewer than normal neutrophils
• Immature neutrophil = band = stab
• Opsonization = rendering antigen weak so humoral immunity can phagocytize it
• Only cell that leaves circulation and returns = lymphocytes
• how lymphs exit blood vessel = diapedesis
• Margination = chemotaxic factors cause cells to adhere to margins of blood vessels
• Normally 50% of blood cells are marginal in dogs
• Normally 70% of blood cells are marginal in cats
• Stress, excitement, etc cause epinephrine to be released, BP rises, and marginal cells release and go into circulation causing what appears to be a high WBC even though there is no real increase in cells.  This is NOT associated with a left shift since production is not increased.
• When blood sits before being viewed cells become hypersegmented and bands become segs
• T-cells are from thymus
• B-cells are from bone marrow
• IgG, IgA, IgM, IgE, IgD all made by plasma cells
• MPS = Mononuclear Phagocyte System
• Eosinophils increase with worms, wheezes, and weird diseases
• Only blood cell not made in bone marrow = lymphocytes
• Immunocyte = activated cell, basophilic cytoplasm
• Erythrocytes made in bone marrow
• Platelets are made by megakaryocytes
• IMHA: blood cells are coated with antibodies, spleen can't eat them all, half-eaten cells remain in circulation as spherocytes.
• IMHA also causes hemaglobinuria and hemaglobinemia
• Equine have no polychromatophils/reticulocytes
• The difference between polychromatophils and reticulocytes is just the stain that's used.  Reticulocytes are stained with NMB (New Methylene Blue)
• Pancreatitis causes injury to the common bile duct, the inflammation causes the common bile duct to become blocked, this backs up the bile that's released into it as well, as the bile backs up more cellular damage occurs releasing liver enzymes
• AST - leakage enzyme, liver specific
• GGT - injury to bile duct, bile duct specific
• ALK Phos/ALP - not specific, in every organ, but only bone and bile duct show on test
• increased ALP in pups likely due to fast growing bone
• increased ALP in older dogs can be osteosarcoma
• increased ALP with vomiting is common in bile duct blockage/pancreatitis
• Creatinine - made by normal muscle metabolism, no function, a waste product,  filtered by kidneys.  Increase can indicate kidney not filtering properly.  Also increased with overexercise or blocked cats.
• BUN -can be caused by kidney issues

About the test:

• 225 questions, only 200 count.  25 questions are being tested for next year's test and don't count, but they don't tell you which ones those are.
• 7 domains
• You are patted down before entering the room for the test.
• You get paper/pencil or a white board and marker
• Calculator is on the screen
• Test allows you to mark questions unknown, review, cross out answers, and enter notes.  Also a summary page that'll tally questions you marked "unknown", etc.
• Tell you pass/fail after a survey, but actual pass/fail based on how others did during your test period, so a "pass" doesn't guarantee you passed -you have to wait for the official letter.
• Study Jan's math cheat sheet
• Parasympathetic/Sympathetic
• Inflammatory, Stress, Excitement responses
• Old tests