Download May, 2011 BENCHMARK

May 2011 BENCHMARK
A 7-year-old, male castrated Great Dane is presented due to increased respiratory rate
and occasional soft coughing. A 1/6 systolic murmur is ausculted and a subtle gallop
sound is heard. Increased bronchovesicular sounds are present.
Thoracic radiographs are taken.
1. What is the vertebral heart score for this patient? Describe how it is measured.
2. Which heart sound is the likely cause of the gallop sound that was heard on
auscultation?
3. Please list the physiologic or pathophysiologic causes of the four heart sounds.
4. An echocardiogram is performed on the Great Dane. Shown below is the right
parasternal long axis view of the heart. What is the likely diagnosis based on this
image?
5. Please list which heart chamber correlates with the numbers on the echo picture
above.
1)
2)
3)
4)
6. Below is an M-mode view performed during the same echocardiogram. Calculate the
fractional shortening for this dog. What is considered normal fractional shortening in a
dog?
7. You choose to treat this dog with furosemide, enalapril and pimobendan. Please list
the mechanisms of action of these three drugs
8. 4yo M/N German Shepherd dog with a history of chewing up his owner’s albuterol
inhaler. Physical exam reveals a rapid, irregular heart rate with pulse deficits.
Lead II EKG, paper speed 25mm/sec:
a) What is the rate during the fast phase?
b) What is this rhythm?
c) Name three options for treatment of this arrhythmia
9. 9yo FS Mastiff. History: 2hr history of retching and distended abdomen.
a) What is the rate?
b) What is the arrhythmia?
c) Name three options for treatment of this arrhythmia
10. 7yo M/N Miniature Schnauzer. History of collapsing at home
Lead II EKG, paper speed 25mm/sec
a) What is the rate?
b) What is the rhythm?
c) Name three treatment options for this arrhythmia. For each of the options you
have chosen, list the mechanism of action and two possible complications.
Treatment
Mechanism of Action
Complications
11. A 10-year old mixed large breed dog presents with a history of acute dyspnoea.
Physical examination reveals a tachycardia with an irregularly irregular heart rhythm.
Lung sounds are harsh with crackles focally on the left hand side.
You make an ecg (paper speed 50mm/s).
a) What is the rate?
b) What is the rhythm?
c) Echocardiography is consistent with dilated cardiomyopathy. Discuss the
suitability of this patient to undergo cardioversion of this rhythm?
12. The following different parenteral antiarrhythmic agents can be used in an
attempt to control various arrhythmias. Give one indication, the VaughnWilliams anti-arrhythmic class (if applicable), mechanism of action, and side
effects of the drugs listed.
Drug
Diltiazem
Lidocaine
Procainamide
Amiodarone
Magnesium
Indication
Class Mechanism of
Action
Side Effects
Esmolol
Sotolol
13. List five negative pathophysiologic affects of chronic severe tachycardia on the
heart?
Icarus, a 7 yr MN Shih Tzu, is presented following a collapse episode. Primary survey
identified a patent airway, tachypnea, expiratory dyspnea, cyanosis of the oral mucous
membranes, left-sided III/IV apical holosystolic murmur, and jugular venous distension.
After initial stabilization, you obtain the following survey thoracic radiographs.
14. Please identify at least three (3) radiographic abnormalities.
15. Define hypoxic pulmonary vasoconstriction. How does it contribute to the
development of pulmonary hypertension?
16. List the three (3) main mechanisms that lead to secondary pulmonary hypertension.
17. Please list at least five (5) echocardiographic changes typically associated with
pulmonary hypertension.
18. For each of the following medications potentially used in the treatment of pulmonary
hypertension, please provide the mechanism of action / justification for use.
1. Oxygen
2. Heparin
3. Inhaled nitric oxide
4. Theophylline
5. Enalapril
6. Hydralazine
7. Intravenous adenosine
8. Epoprostenol
9. Sildenafil
19. You elect to place a pulmonary artery catheter (PAC). Describe proper placement /
flotation of a PAC.
20. Provide the normal systolic, diastolic and mean pulmonary artery pressures in small
animals:
A. Systolic:
B. Diastolic:
C. Mean:
21. Please draw the expected waveform with associated pressures (mmHg) when the
PAC is in each of the following locations:
1. Right atrium
2. Right ventricle
3. Pulmonary artery
4. Wedged in pulmonary capillary
23. Please list three (3) potential complications pulmonary artery catheter placement.