Certificate of Veterinary Nursing in Emergency & Critical Care
Sample Paper – Paper 1
Cert VN ECC
Sample Paper Questions & Answers
Paper One
Note: There are usually 6 questions for this paper to be complete within 90 minutes
1.
(12 marks)
A dyspnoeic dog is presented with a suspected pleural effusion.
a) You provide the dog with supplemental oxygen and prepare to perform thoracocentesis.
(i) List the equipment you would prepare for the thoracocentesis procedure (2 marks)
ANS:
Syringe
Needle/catheter
Extension tubing
3-way tap
something to collect the fluid in
Clippers
Scrub (e.g. chlorhex)
Sterile gloves
(ii) What tests would be performed on the fluid following collection?
(1 mark)
ANS: (1/2 mark for 2 of the following)
PCV/TS
Cytology
Culture (bacteriology)
(accept lipids/cholesterol if suspect chylothorax)
(iii) Other than suspected pleural effusion, give one other rationale for performing
thoracocentesis
(1 mark)
ANS: Trauma associated with high velocity impacts e.g. RTA and high rise falls
Intermittent positive pressure ventilation (IPPV) which suddenly deteriorates
Suspected pneumothorax
b) Following removal of 400 ml of serosanguinous fluid from the left side, and 120 ml from
the right, chest radiographs are taken.
(i) Describe the positioning for radiographs and note any considerations you should
make for taking your exposure.
(3 marks)
ANS:
Page 1 of 7
Certificate of Veterinary Nursing in Emergency & Critical Care
Sample Paper – Paper 1
The basic views of the chest are lateral and dorsoventral. Two lateral views (right and left) are
usually taken as the resultant x-rays can look different due to compression of the underlying soft
tissue. Where a mass is present in one lung, it will be clearer on the radiograph where it is
positioned dorsally. Right or left lateral refers to the position the animal was in when the radiograph
was taken; so a right lateral means that the animal was lying on their right side.
No rotation on positioning. Where the animal is positioned in dorsal or ventral recumbency care
should be taken to ensure that the animal is not leaning to one side as any rotation of the vertebrae
can make interpretation difficult. Vertebrae should lie directly over the sternum.
Animals should not be placed on their back for a VD if they have any physical exam
findings suggestive of CV instability.
Always best to x-ray after chest drainage due to dyspnoea but if you need to x-ray care should be
taken with this patient and DV view may be preferable. O2 should be available in case of issues
Fully inflated lungs will produce a clearer radiograph therefore an x-ray should be taken either on
inspiration if the animal is breathing voluntarily, or if using IPPV on full inflation. Care
though should be taken not to overinflate the lungs.
Exposure time should be kept as low as possible by using a high kV and low mAs.
However, if pleural fluid is present then exposure factors will have to be increased;
conversely if a pneumothorax is suspected these should be reduced.
c) List ONE pro and ONE con for each of the following methods of supplementing oxygen.
(i) Oxygen Mask/Flow by
(1 mark)
ANS: (1/2 mark for one of each P and C)
P: easy/quick/readily available/well tolerated
C: Difficult to determine how much oxygen they are getting.
(ii) Nasal Catheter
(1 mark)
ANS: (1/2 mark for one P and one C)
P: high levels of oxygen, esp if bilateral
C: stress to dyspnoeic patient during placement, not for use in cat or with
stenotic nares
(iii) Oxygen Cage
(1 mark)
ANS: (1/2 mark for one P and one C)
P: High levels of oxygen, able to control CO2 and humidity
C: Difficult to assess dog/cat when in cage
d) What does pulse oximetry measure?
(1 mark)
Page 2 of 7
Certificate of Veterinary Nursing in Emergency & Critical Care
Sample Paper – Paper 1
ANS: % of haemoglobin that is saturated with oxygen
e) What does capnography measure?
(1 mark)
ANS: End tidal CO2
2.
(12 marks)
A dog is presented to your clinic in shock.
a) Name 6 physical examination findings you would expect in a patient with shock
(3 marks)
ANS: (1/2 mark for each)
Tachycardia
Pale mucous membranes/red mucous membranes
Prolonged CRT
Weak pulses
Depressed Mentation
Tachypnoeic
Cold extremities
b) Name the 3 main categories of shock recognised in small animals
(3 marks)
ANS:
Hypovolaemic
Septic/distributive
Cardiogenic
c) What type of shock may result following systemic infection with E. Coli?
(1 mark)
ANS: Septic/distributive
d) Make short explanatory notes on why cardiogenic shock occurs
(2 marks)
ANS: This as its name suggests is when the heart suffers major forward failure such
that the cardiac output is insufficient to allow perfusion of the whole body. This can
occur due to cardiomyopathies for example. Hypertrophic cardiomyopathy of cats may
result in cardiogenic shock because the ventricular muscle wall is so thickened that the
heart cannot fill with blood effectively and so the cardiac output drops. Dilated
cardiomyopathy of dogs and cats may result in cardiogenic shock by failure of the thin
ventricular walls to push blood through the circulation
e) Give one example of available intravenous fluids for each of the following types. (brand or
type – brand numbers not acceptable)
(3 marks)
(i) Hypotonic crystalloid
Page 3 of 7
Certificate of Veterinary Nursing in Emergency & Critical Care
Sample Paper – Paper 1
ANS:
Hypotonic crystalloid
D5W (5% dextrose in water)
0.18% NaCL with dextrose
(ii) Isotonic crystalloid
ANS: one of...
Hartmann’s
Lactated ringers
Ringers
0.9% NaCl (normal saline)
(iii) Colloid
ANS: one of...
Dextrans
Hetastarch/pentastarch/tetrastarch
Gelofusine
3.
(12 marks)
a) Name two radiographic positive contrast agents. Give an example of an appropriate
study when they might be used and possible complication or side effect for each.
(3 marks)
ANS: (1/2 mark for each agent ½ mark for example of study ½ for side effect
possible complication)
Barium –
GI (non-perforated), irritation/peritonitis/constipation
Iodine –
Any urinary/GI study, myelogram, angiogram etc
Cardiac abnormalities and seizures
b) The two main types of ultrasound probe are termed sector and linear probes. Which
one is most likely to be used in small animal veterinary medicine and why? (1 mark)
ANS: Sector as they cover small area of patient so more detail, whereas linear show
large areas of the body.
c) Name 4 reasons where ultrasonography may be of use in emergency medicine
diagnostics.
(2 marks)
Page 4 of 7
Certificate of Veterinary Nursing in Emergency & Critical Care
Sample Paper – Paper 1
ANS: (1/2 mark for any 4 of the following) Free fluid to assist with abdominocentesis;
presence of tumours in liver spleen, bladder; linear foreign bodies; visualisation of
abnormalities of bile ducts and gall bladder; prostatic disease; presence of foetus(es)
d) Name three side effects of propofol in cats.
(3 marks)
ANS:

Hypotension

Hypoventilation/apnoea

Heinz body formation
e) Describe the intra-operative monitoring on an exploratory thoracotomy and lung
lobectomy.
(3 marks)
ANS: (1/2 mark each)

TPR

Blood pressure

ECG

Pulse-ox or blood gas

End-tidal CO2
Assessing depth of anaesthesia
4.
(12 marks)
a) Define the following terms:
Term
(3 marks)
Definition
Microenteral feeding
Nosocomial infection
Enterocytes
ANS:
Term
Definition
Microenteral feeding
very small amounts of nutrition are provided via the gastrointestinal tract.
Nosocomial infection
Infection acquired whilst the patient is in hospital.
Enterocytes
The cells that line the gastrointestinal tract.
b) A dog weighing 25kg is admitted with a severe upper alimentary tract infection, and is unable to
feed normally. It is likely to require nutritional support for some weeks and has a PEG tube placed
Page 5 of 7
Certificate of Veterinary Nursing in Emergency & Critical Care
Sample Paper – Paper 1
Calculate the RER for this patient
ANS:
 RER = (30 x body weight in kg) + 70
 = (30 x 25) +70
 = 750 + 70
 = 820 kcal/24 hours
(2 marks)
c) Give a nursing and feeding plan for this patient after placement of the PEG tube
(7 marks)
ANS:
 CHECK PLACEMENT BEFORE FOOD IS GIVEN
 Day 1: Nothing for 1st 24 hours
 Day 2: Next 12 hours small amounts H2O (5mls/kg) flushed through the tube every
couple of hours
 Day 2/3: After 36 hours start with half daily requirement with suitable liquid food
(410kcal) divided into 6-8 small feeds monitor for signs of
nausea/regurgitation/discomfort
 Day 3 onwards: full amount divided into 4-6 feeds per day
 Patient H20 intake?
 Check hydration status
 Keep wound and dressings cleaned
 Flush tube before and after feeds
 Ensure no patient interference
5.
(12 MARKS)
a) Name one anti-cholinergic/anti-muscarinic drug, and one use for them in anaesthesia
(2 marks)
ANS:
Atropine sulphate or glycopyrrolate. Their main use is to reduce oral and respiratory
tract secretions and relieve vagally induced bradycardia.
b) Name 2 side-effects of non-steroidal anti-inflammatory drugs
ANS: renal damage and gastric ulceration
(2 marks)
c) Name 4 examples of a non-rebreathing circuit
ANS: Ayres t piece, Humphrey ADE, Magill, Lack, Modified Bain’s
(4 marks)
d) What are 2 advantages of the non-rebreathing anaesthetic system over the rebreathing
system
(2 marks)
ANS:
 Lower airway resistance (and so more useful for smaller patients)
 Inspired volatile agent content broadly equivalent to that set on the vaporiser
 Denitrogenation is not required
 Rapid change of the anaesthetic concentration and therefore anaesthetic depth of the
patient is possible
Page 6 of 7
Certificate of Veterinary Nursing in Emergency & Critical Care
Sample Paper – Paper 1
e) What are 2 advantages of the rebreathing anaesthetic system over the non-rebreathing
system
(2
marks)
ANS:





Lower gas flow rates required and so larger patients may be accommodated
Because they are closed, heat and moisture is not lost
Less environmental pollution
Lower volume of volatile anaesthetic agent used for anaesthetic period
Lower total oxygen volume used for anaesthetic period
6. (12 marks)
a) A dog is presented with abdominal effusion (ascites). Describe what you would see on
imaging of the abdomen using:
a. Plain radiographs
b. Ultrasound
(4 marks)
ANS
 Loss of serosal detail on AXR
 Hypoechoic fluid on AUS
b) Name 2 contrast agents you could use to visualize a bladder tumour?
ANS
 Air
 Omnipaque (Iodinated contrast agents such as iohexol)
 Urografin (ionic contrast – sodium and meglumine daitroazate)
(2 marks)
c) Match the following blood smear findings (cell morphology) with the most likely condition.
(4 marks)
1. Basophilic stippling
A. Regenerative response
2. Spherocytes
B. Paracetamol Intoxication
3. Heinz bodies in cats
C. Lead intoxication
4. Large polychromatic cells
D. Immune-mediated haemolytic anaemia
ANS: 1C, 2D, 3B, 4A
d) Vitamin K is required for the functional activation of which coagulation factors?
(2 marks)
ANS: II, VII, IX, X
Page 7 of 7