ACVIM General Flashcards
1
Q
List major signs of SLE.
A
thrombocytopenia
polyarthritis
leukopenia
skin lesions
hemolytic anemia
glomerulonephritis
polymyositis
2
Q
Where are the skin lesions typically located in pemphigus foliaceous?
A
face, nasal planum, pinnae, foot pads, nipples
NOT typically a mucocutaneous junctions
3
Q
A young cat presents with facial excoriations - what is the most likely diagnosis?
A
food allergy
4
Q
Which cells express MHC I vs. MHC II?
A
MHC I = all cells
MHC II = APCs
5
Q
What types of organisms are Th1 most active against? Th2?
A
Th1 = intracellular bacteria, protozoa
Th2 = extracellular parasites
6
Q
What is released when eosinophils degranulate?
A
major basic protein (destroys parasites)
eosinophil peroxidase (EPO)
eosinophil derived neurotoxin (EDN)
eosinophilic cationic protein (ECP)
platelet activating factor
leukotrienes
histamines
proteases
cytokines
7
Q
*What molecules on the endothelium help initiate migration of leukocytes?
A
E and P selectin
8
Q
Describe the pathophysiology of anemia of inflammatory disease.
A
increased hepcidin leads to decreased iron absorption and recycling, which leads to iron sequestration
9
Q
Describe whether the following would be increased or decreased in anemia of inflammatory disease: [Fe], TIBC, stainable Fe in bone marrow, ferritin.
A
decreased [Fe]
decreased TIBC
increased stainable Fe in BM
increased ferritin
10
Q
Describe whether the following would be increased or decreased in iron deficiency anemia: [Fe], TIBC, stainable Fe in bone marrow, ferritin.
A
decreased [Fe]
normal or increased TIBC
decreased stainable [Fe] in BM
decreased ferritin
11
Q
A dog becomes sick days after being bit by a snake - what type of hypersensitivity reaction is this?
A
type IV
12
Q
*What surface antigen is important for an APC cell to express in order to activate T helper cells?
A
*MHC II
13
Q
https://s3.amazonaws.com/classconnection/493/flashcards/7874493/png/screen_shot_2017-05-27_at_122810_pm-15C4ABCE30265022DF5.png
A
Right bundle branch block
14
Q
https://s3.amazonaws.com/classconnection/493/flashcards/7874493/png/screen_shot_2017-05-27_at_122802_pm-15C4ABD1A5F354041BF.png
A
Left bundle branch block
15
Q
https://s3.amazonaws.com/classconnection/493/flashcards/7874493/png/screen_shot_2017-05-26_at_121443_pm-15C458A283B31000CF4.png
A
atrial flutter
16
Q
*What breed of dog gets DCM associated with taurine deficiency?
A
*American Cocker Spaniels
17
Q
What are the components of tetrology of Fallot?
A
VSD
pulmonic stenosis
right venticular hypertrophy
overriding aorta
18
Q
Should digoxin be dosed based on lean body weight or total body weight?
A
lean body weight
19
Q
Resting membrane potential is dependent on active/passive movement of which ion?
A
passive movement of potassium
20
Q
*Which dog breeds are predisposed to developing VSD?
A
*English Bulldog, Lakeland terrier, Westies
21
Q
What is the MOA of dobutamine?
A
beta1 agonist
22
Q
*What is the MOA of cisapride?
A
5HT4 agonist, also enhances release of acetylcholine at the myenteric plexus
23
Q
What is the MOA of mirtazapine?
A
central presynaptic alpha2 antagonist –> increased norepi release
also blocks 5HT3, 5HT2, and H1 receptors
24
Q
What is the MOA of amphotericin B?
A
binds ergosterol and forms pores –> leakage of ions causes fungal cell death
25
What is the MOA of phenylpropanolamine?
indirect alpha (and beta) agonist
26
What is the MOA of phenoxybenzamine? Does it have any effect on beta adrenergic receptors?
non-competitively blocks alpha adrenergic receptors
no effects on beta receptors
27
According to Gompertzian theory, small tumors grow faster/slower than large tumors; and larger tumors are more/less susceptible to chemotherapy.
smaller tumors grow faster
larger tumors less susceptible to chemo due to poor blood supply and slower cell division (chemo targets rapidly dividing cells)
28
What type of cancer is associated with glistening ventral alopecia in cats?
pancreatic adenocarcinoma
29
What should you do when you have a dog that is 1 week post-vincristine and has a neutrophil count of 1600, but is feeling well?
postpone chemo x 1wk and recheck CBC give full dose if neut count >2000
30
What drug binds to mTOR?
sirolimus (rapamycin)
31
Which cells are the pacemaker cells of the intestine?
interstitial cells of Cajal in the myenteric plexus
32
List the breakdown products of the following: lactose, sucrose, maltose.
lactose = glucose + galactose
sucrose = glucose + fructose
maltose = glucose + glucose
33
Which of the following can be absorbed in the intestines of the adult dog: polysaccharides, monosaccharides, disaccharides?
only monosaccharides
34
What is GLUT 5?
Fructose transporter in small intestine
35
Where in the small intestine is folate absorbed? cobalamin?
folate = proximal small intestine
cobalamin = ileum
36
After ingestion, cobalamin binds to ______ to transport to the duodenum, protecting B12 for degradation in the stomach.
R protein
37
What are homocysteine and methylmalonic acid levels used to assess?
cobalamin status - both will be elevated in hypocobalaminemia
38
What PAMP does TLR 5 recognize?
flagellin
39
In cats elevations in serum ALP are more specific for what disease and why?
More specific for hepatobiliary disease because cats are not susceptible to drug induced elevations.
40
What causes a false positive protein on a urine dipstick? A false negative?Term
False positive:
1.) Alkaline urine
2.) Contact time (too long)
3.) Detergents - ammonium compounds and chlorhexidine
4.) Active sediment
False negative:
1.) Bence-Jones proteinuria
2.) Dilute urine
41
What is the binding capacity of iron in hemoglobin?
Hb is a tetramer of 4 globulin chains, each globulin contains a heme group and an iron molecule, which binds one O2.
42
Ceruloplasmin, a ferroxidase that facilitates the transfer of iron in macrophages to transferrin, requires what other ion?
Cu++
43
What is the hallmark of iron deficiency anemia?
Decreased MCV (microcytosis) --> occurs before erythrocyte precursors divide in an attempt to reach their full hemoglobin content --> more divisions = smaller than normal erythrocytes. ξ
44
Platelet antibody assay
Direct assay which detects antibody present on the surface of the platelets or megakaryocytes
45
What disease can result in a false positive PARR result?
Ehrlichiosis
46
https://s3.amazonaws.com/classconnection/725/flashcards/12190725/jpg/rbbb-v12-15C4B4DDCCC1AEE8B30.jpg
Right bundle branch block
47
What is isovolumetric relaxation?
After semilunar valves shut, ventricular pressure slowly decreases, until AV valves open up again
48
What non-acid fast staining bacteria causes a pyogranulomatous pleural effusion?
Actinomyces
49
Glipizide stimulates and diazoxide inhibits the __ channel on the ___ cell?
K channel; beta cell
50
The k channel on beta cells is stimulated by what drug? Inhibited by what other drug?
Stimulated: glipizide
Inhibited: diazoxide
51
What does GLUT4 do?
Glucose entry into all other cells (not brain, kidney, beta cells)
52
What does GLUT2 do?
Glucose entry into beta cells
53
What does GLUT1 do?
Glucose entry into the brain and kidneys
54
T/F: Cyanide toxicity is responsive to oxygen therapy.
False! There is enough O2 present it just cannot be used appropriately. ξ
55
What are the causes of pre-hepatic portal hypertension?
1. congenital atresia
2. fibrosis
3. thrombus
4. neoplasia
5. extra-luminal compression
6. hepatic AV-fistula
56
What are causes of post-hepatic portal hypertension?
1. Right atrium (rt CHF, pulmonary hypertension, pericardial dz)
2. Budd-Chiari syndrome (obstruction in the CVC or large hepatic veins --> obstruction of hepatic venous outflow
57
Oslerus osleri is a parasite of which species? Lives where? Is diagnosed how?
Lung worm in dogs
Lives and causes nodules at the tracheal bifurcation
Dx by visualizing nodules, finding ova and larva in wash, finding ova on fecal float
58
Aleustrongulylus abstrusus is a parasite of what species? Lives where? And is dx how?
Lung worm of the cat
Lives in the terminal and respiratory bronchioles, and alveolar ducts
Dx by finding ova and larva in wash fluid, or ova on Baermann fecal
59
What drug reverses diazepam?
Flumazenil
60
Most common source of transmission of Cryptosporidium homini?
Water with fecal contamination
61
What is often associated with superficial necrolytic dermatitis?
Liver disease and glucagonoma
62
What is a cohort study?
Groups are followed prospectively over time and evaluated for outcomes and risk. Used to estimate disease outcomes, incidence, and relative risks.
63
What is often associated with superficial necrolytic dermatitis?
Liver disease and glucagonoma
64
What is paradoxical aciduria?
Occurs when there is a metabolic alkalosis caused by gastric fluid losses --> hypoCl and hypoK. The hypoCl --> decreased NaCl reabsorption in PCT --> increased Na absorption in the DCT, but d/t hypoK, Na/H exchange predominates --> aciduria
65
In a healthy animal, uptake of oxygen across the blood gas barrier is diffusion/perfusion limited?
Perfusion limited
66
In a dog with pulmonary interstitial fibrosis, uptake of oxygen across the blood gas barrier is diffusion/perfusion limited?
Diffusion limited
67
Uptake of carbon monoxide across the blood gas barrier is diffusion/perfusion limited?
Diffusion limited
68
Uptake of nitrous oxide across the blood gas barrier is diffusion/perfusion limited?
Perfusion limited
69
What is the most common route of transmission of toxoplasmosis in cats?
Ingestion of bradyzoites in tissue cysts
70
Where in the body does angiostrongylus vasorum live?
The pulmonary arteries and right heart (french heartworm).
71
Eucoleus aerophilus
lung worm of dogs and cats
lives in trachea, bronchi and bronchioles
72
What stage of Eucoleus aerophilus would you expect to find in a TTW?
Ova
73
What factors inhibit platelet function?
NO, prostacyclin, ADPase, viscosity (MM)
74
Vasopressin (AHD) can cause ____ to be released from endothelial cells.
vWF
75
Which cell type is CD8+?
Cytotoxic T-cells; binds MHC I
76
Killer-cell inhibitory receptors (KIR) on NK cells bind to ___ on normal cells, protecting them from NK attack.
MHC I, which all normal cells express. Virus-infected and tumor cells expresses less MHC I --> NK attack.
77
Viral and bacterial infections lead to the production of this CD4+ cell, and its cytokines?
TH1; IL-2, IFN-y, TNF-B
78
Allergens and parasitic infections lead to the production of this CD4+ cell, and its cytokines?
TH2; IL-4, 5, 10, 13
79
Feline neonatal isoerythryolysis occurs in what scenario?
Type A or AB kittens born to a type B queen. Queen passes anti-A antibodies to kittens in colostrum, can lead to hemolytic anemia and death.
80
What cytokines are responsible for class switching?
IL-4, TGF-B, IFN-y
81
What is the role of TNF in the body?
It is the primary mediator of inflammation and fever; stimulates T-cell production. Produced by macrophages, monocytes, and NK cells.
82
What does IFNy do?
Activates monocytes , macrophages, and NK cells; inhibits TH2. Produced by TH1 cells.
83
IL-2?
T-cell growth factor; produced by TH0 and TH1 cells.
84
Where do the classical and alternative pathways of complement converge?
C3b (right before C5-9 form the MAC).
85
Describe the ideal canine universal blood donor.
DEA 1.1 negative; ideally DEA 1.2 negative.
86
What % of dogs are DEA4 positive?
>98%
87
What are the 3 feline blood types? Describe their alloantibody characteristics.
Type A - most cats in NA, weak anti-B antibodies (~35%).
Type B - very strong anti-A antibodies (95%); severe rxn to A blood.
Type AB - very rare blood type; no antibodies to A or B.
88
Why do all cats need to be typed and cross-matched before any blood transfusion?
Due to their naturally occurring allo-antibodies.
89
What is the most common UA finding in a dog with IMHA?
Bilirubinuria
90
Which negative test rules out DIC?
D-dimer
91
Calculation for osmolarity
= (2xNa) + (Glu/18) + (BUN/2.8)
92
What is the primary cytokine secreted by NK cells?
IFN-y
93
What is the strongest anti-coagulative factor? What does it inhibit? What accelerates its activity?
Anti-thrombin (III); inhibits factors 2, 9, 10, 11, 12, plasmin, kallikrein; binding heparin accelerates activity
94
What causes dilation of the glomerular afferent arteriole?
Prostaglandins, bradykinin --> increased GFR
95
Where is Mg2+ reabsorbed in the kidney?
Thick ascending limb of the loop of Henle.
96
What is the mechanism of non-regenerative anemia in CKD?
* Decreased EPO
* Decreased RBC lifespan
* Uremic gastropathy
* Increased bleeding tendencies (impaired plt function)
* Vit B deficiencies --> defective EPO (B12, 6, folic acid, niacin, 2)
97
Explain Type II RTA
* AKA proximal RTA
* Defect in HCO3- reabsorption in PCT --> HCO3- lost in urine
* Urine becomes acidic, pH
98
Explain Type I RTA
* Can't get rid of H+; cannot reabsorb Na+
* Cannot make enough HCO3-
* Increased urine pH, >6.0, less acidic
* DCT last chance to acidify urine
* Much more k+ loss
* Very LOW serum HCO3-
99
Acidifying diet
Struvites ONLY
100
Alkalinizing diets
Xanthine, calcium oxalate, cysteine (+ 2-MPG, D-Pen), uric acid (+ allopurinol)
101
What causes increased urine production in CKD?
Renal hypertension --> glomerular hyperfiltration in 30% cats, 60% dogs
102
What is the treatment for membranoproliferative glomerulonephritis?
Immunosuppressive therapy (corticosteroids +/- other drugs)
103
What dog breed has a hereditary PLE / PLN disease?
Soft-coated wheaten terriers
104
A UPC >2 indicates what?
Glomerular disease
105
What is oxybutynin?
Muscarinic receptor antagonist (prevents overactive bladder contractions).
106
What is the treatment for calcium oxalate crystalluria?
* Increasing H2O intake, dilute urine
* Potassium citrate to increase urine pH
* Physical removal of stones
107
What is the MOA of phenoxybenzamine? And what effect does it have?
Irreversible, non-selective alpha antagonist.
Relaxes urethral smooth muscle, decrease urethral sphincter tone.
108
List 2 other drugs (besides phenoxybenzamine) that also antagonize alpha-1 receptors.
Prazosin
Phenothiazines
109
On average, how long does it take for signs of FLUTD to resolve?
5-7 days, in 92% of cases
110
What 2 drugs can be used to increase bladder contraction? How do they work?
1.) Bethanechol - direct agonist of muscarinic receptor
2.) Neostigmine - indirect muscarinic agonist - blocks AChE
* Both increase parasympathetic activity
111
Oslerus osleri resides where in the dog?
tracheal bifurcation
112
Paragonimus kellicotti resides where?
lung fluke resides in RIGHT CAUDAL LUNG LOBE
113
How is pneumocystis carinii transmitted?
airborne transmission
114
Which breeds are predisposed to Pneumocystis carinii?
mini dachshund CKCS +/- yorkies documented to have low globulin levels (IgA, IgG, IgM) and impaired lymphocyte function
115
Where in the body does Pneumocystis carinii reside?
alveolar spaces
116
Which breed of cat is predisposed to disseminated mycobacterium?
Abyssinian
117
Which breeds are predisposed to canine leproid granuloma?
short coated breeds - boxers, mastiffs
118
Which stain causes Mycobacterium to appear red?
Ziehl-Neelsen stain (acid fast stain)
119
T/F: Blastomyces can be transmitted from animals to people or from people to people from aerosols.
FALSE! Can only be inhaled from the SOIL
120
The Blastomyces urine antigen test (EIA) cross reacts with what other organism?
Histoplasma
121
What is the main mode of transmission of Coccidiodes immitis?
inhalation of arthroconidia
122
Which cat breed is predisposed to disseminated histoplasmosis?
persians
123
How is histoplasmosis typically transmitted?
inhalation of microconidia from soil
124
T/F: Sporothrix schenckii is zoonotic.
True!
125
Which organism causes "Rose Gardeners Disease" and typically effects cats via direct inoculation of the organism into the skin? It is cigar shaped with a thin halo on methenamine silver and PAS stain.
Sporothrix schenckii
126
What is the minimum temperature necessary for development of Dirofilaria into the L3 stage in the mosquito?
57F
127
What is the Knott's test used for?
to detect microfilaria of heartworm also can help differentiate heartworm (straight body with straight tail) from Acanthalonema reconditum (curved body with button hook tail)
128
How do heartworm and Acanthelonema reconditum differ in terms of motility?
heartworm has stationary writhing movement A. reconditum has rapid, directional movement
129
What is the definitive host for Hepatozoon?
it's the tick!!! ...verrry tricky
130
What is the vector for Hepatozoon canis? Hepatozoon americanum?
H. canis = rhipicephalus H. americanum = amblyomma
131
The dog is the definitive/intermediate host for Hepatozoon.
intermediate host
132
Shar Peis have been shown to frequently have a deficient in which immunoglobulin?
IgA
133
Weimeraners are predisposed to a deficiency in which immunoglobulin?
IgG
134
CKCS that are deficient in which immunoglobulin are predisposed to Pneumocystis carinii and demodicosis?
IgG
135
Which breed of dog has been shown to be predisposed to C3 deficiency with autosomal recessive inheritance?
Brittany Spaniel
136
CLAD occurs in which breed and is associated with a deficiency in which molecules?
Irish Setters deficiency in integrin molecules CD11b and CD18
137
Is CLAD associated with a high or low WBC count?
very high WBC count with a severe left shift
138
Trapped neutrophil syndrome is a condition seen in what breed? What is the pathophysiology?
autosomal recessive in Border Collies (widespread in the breed) results in neutropenia due to failure to release neutrophils from the bone marrow - typically die by 4mo
139
Severe combined immunodeficiency occurs in which breed? Briefly, what is the pathophysiology?
Jack Russells Lymphocyte development is blocked in the prolymphocyte stage --> deficiency in B and T cells --> death at 8-14wks
140
What breeds get x-linked SCID?
MALE Cardigan Welsh Corgis and Bassett Hounds
141
Which breed gets lethal acrodermatitis? This condition is associated with low levels of which immunoglobulin?
bull terriers (autosomal recessive) low levels of IgA
142
The zona glomerulosa lacks ______ (enzyme) which is why it is unable to produce cortisol.
17-alpha hydroxylase
143
The zona glomerulosa contains ____ (enzyme), which is why it is the only layer of the adrenal that can make aldosterone.
aldosterone synthase
144
Does dopamine stimulate or inhibit aldosterone release?
inhibits
145
What enzyme prevents cortisol from reacting with the mineralocorticoid receptor in aldosterone-target tissues?
11-betahydroxysteroid dehydrogenase type 2 converts cortisol-->cortisone (cortisone has decreased affinity for mineralocorticoid receptor
146
Which cells in the kidney produce erythropoietin?
type I renal interstitial cells
147
Transcription of EPO is regulated by _____
hypoxia-inducible factor hypoxia causes decrease in degradation of HIF --> activates EPO transcription element
148
Inflammation causes an increase/decrease in hepcidin levels. How does this effect iron?
inflammation increases hepcidin this causes serum iron levels to fall due to iron trapping within macrophages and liver cells and decreased gut iron absorption
149
What type of reticulocyte predominates in cats?
punctate
150
What is the lifespan of a platelet?
7 days
151
What is contained in alpha granules of platelets?
factor V fibrinogen P-selectin
152
What is the other name for the fibrinogen receptor?
GPIIb/IIIa
153
What is the other name for the von Willebrand receptor?
GPIb
154
von Willebrand factor is synthesized and stored where?
endothelial cells
155
Clopidogrel acts on which receptor?
P2Y12 (ADP receptor)
156
Platelets are cross-linked by what?
fibrinogen
157
Tenase is composed of which clotting factors?
IXa, VIIIa, VIIa, tissue factor
158
Prothrombinase is composed of which clotting factors?
Xa and Va
159
Which breed of dog is predisposed to PFK deficiency?
English Springer Spaniel (Also Cocker Spaniel, Whippet)
160
An English Springer Spaniel presents with intermittent dark urine, which commonly develops following strenuous exercise, prolonged barking, and extensive panting. What disease is most likely?
PFK deficiency Causes hemolysis following strenuous activity (associated with respiratory alkalosis)
161
Hematology counters count which type of reticulocyte?
aggregate reticulocytes
162
Which breed is predisposed to hereditary stomatocytosis with chrondrodysplasma?
Alaskan Malamute
163
Which breed gets hereditary stomatocytosis with hypertrophic gastritis?
Drentse Patrijshond
164
Which breeds have hereditary stomatocytosis with no associated clinical signs?
Mini and standard Schnauzers Pomeranians
165
Which breed of dog is predisposed to hereditary spherocytosis?
Golden Retriever due to reductions in erythrocyte membrane spectrin
166
Ghost cells are more common in extravascular/intravascular hemolysis
intravascular
167
Which breed is predisposed to hereditary macrocytosis?
toy and mini poodles +/- greyhounds
168
What are Howell-Jolly bodies?
small nuclear remnants within RBCs - may be seen in association with regenerative anemia or after splenectomy
169
What anesthetic has been associated with Heinz body formation?
propofol
170
Which heavy metal causes basophilic stippling of RBCs?
lead poisoning
171
Which breeds can have a hereditary microcytosis?
Akita, Shiba Inu
172
FeLV is associated with microcytic/macrocytic anemia
macrocytic
173
Chylomicrons are composed mostly of what?
~93% triglycerides and phospholipids (5% cholesterol, 2% apoproteins)
174
What are the biproducts of fatty acid catabolism?
Ketones: acetone, acetoacetate, B-hydroxybuterate
175
B-oxidation of fatty acids occurs where?
Mitochondria ONLY
176
What is the role of chylomicrons?
They facilitate transfer of exogenous lipids from the intestines to adipose tissue or the liver.
177
What is the most common cause of EPI in dogs?
Pancreatic acinar atrophy - secondary to immune mediated atrophic lymphocytic pancreatitis. (GSD, rough-coated collies)
178
What is the most common cause of EPI in cats?
Chronic pancreatitis
179
Why does EPI causes a low B12?
Decreased pancreatic intrinsic factor (needed for absorption); increased utilization by GI bacteria.
180
What gene mutation predisposes Schnauzers to pancreatitis?
SPINK1
181
What is the most sensative and specific test to dx pancreatitis?
cPLI (immunoassay for exocrine function); Spec cPL = same performance.
182
Why should metoclopramide be avoided in pancreatitis?
Pancreatic blood flow is regulated by dopaminergic receptors - metoclopramide is a dopamine antagonist --> decreased pancreatic perfusion
183
What does alpha 2 macroglobulin do? How can it be used in pancreatitis?
Alpha 2 macroglobulin scavanges for activated proteases in plasma; shown to be decreased in pancreatitis. Can supply with FFP - no proven benefit.
184
What is the #1 clinical sign in cats with pancreatitis?
Lethargy
185
When will a dog with PLE not be panhypoproteinemic?
Basenji enteropathy and with Histoplasmosis - globulins are normal to increased in both.
186
What is the most common cause of PLE?
Lymphangiectasia
187
What is the best test to confirm PLE?
Fecal alpha-1 proteinase inhibitor
188
What is the best test for Tritrichomonas foetus infection in cats?
Fecal PCR
189
What is the best test to diagnose Pythiosis?
ELISA for pythium antibodies - highly sensitive and specific
190
Both E. coli and Salmonella are resistant to treatment with what drug?
Tylosin
191
What is the role of pancreatic polypeptide? Where is it secreted from?
Released from the F (PP) cells of the endocrine pancreas; inhibition of pancreatic enzyme and fluid secretion - slows absorption.
192
Describe Basenji enteropathy.
Lymphoplasmacytic enteritis + PLE; hypoalbuminemia + hyperglobulinemia; marked elevation in IgA
193
What 3 clinical syndromes result from taurine deficiency in cats?
Retinal atrophy, DCM, developmental abnormalities in kittens born to deficient queens.
194
What is the role of metallothioneine in the GIT?
Binds to copper in enterocytes, remains until enterocyte is shed in feces; higher dietary Zn levels induce metallothioneine, reduce Cu absorbed
195
How is trypsinogen activated to trypsin in the GIT?
Trypsinogen initially converted to trypsin by brush border enzyme enterokinase. Trypsin is then able to catalyze all other inactive precursors, including more trypsin.
196
Which prostaglandin is protective in the stomach?
PGE - helps maintain mucosal blood flow, increases mucus and bicarb secretion, decreases H+ secretion, increases epithelial turnover
197
A low B12 indicates disease is what part of the GIT?
Ileum (distal SI) (folate = proximal SI)
198
Dog w/ large bowel diarrhea, rectal scrape reveals small, round organisms w/ light halo inside macrophages. What is the dx and tx?
Histoplasmosis; Itraconaole + supportive for colitis.
199
What is the best sample to culture in feline cholangiohepatitis?
Bile, collected via GB aspirate.
200
Ammonium biurate crystalluria
PSS
201
What is the difference between MVD and PSS using scintigraphy?
MVD has normal shunt fraction, 60%. Normal contrast should go portal vein - liver - heart; PSS: portal vein - heart - liver.
202
Which vitamins are stored in the liver?
A, D, B12
203
T/F: Cats with hepatic lipidosis will often be hypokalemic.
True: cats with underlying CKD or with renal lipid accumulation can have potassium wasting --> hypokalemia.
204
What is the role of microsomal triglyceride transport protein (MTTP)?
Required to transport chylomicrons into circulation from the GIT and VLDL from the liver.
205
Name an inhibitor of microsomal triglyceride protein (MTP).
Dirlotapide
206
What converts glucose to sorbitol?
Aldose reductase
207
How would you treat esophagitis?
Cisapride to improve LES tone, omeprazole to reduce acid, sucralfate to bind erosions
208
What cause increased LES tone?
Gastric pressure, gastric acidity, gastrin, histamine, Ach
209
What is the treatment for Helicobacter?
Amoxicillin, metronidazole, omeprazole, bismuth salicyclate
210
What is the treatment for Cu hepatitis?
Chelation w/ penicillamine or trientine, decreased absorption w/ Zn
211
What is the defining characteristic of a gastric ulcer?
Erosion affecting the muscular layer.
212
What fat soluble vitamins do cats require?
Vit A, D, E, K
213
Why do cats require vitamin A?
They are unable to convert beta carotene to retinol.
214
What maintains BG in fasting dogs? Cats?
Glycogenolysis in dogs; gluconeogenesis in cats.
215
What is the gold standard test for measuring SI permeability?
Lactulose / rhamnose test.
216
What is the primary physiologic cause of diarrhea?
Hypomotility.
217
What is the likely cause of hepatobiliary pu/pd?
Loss of renal medullary concentration gradient d/t inability to produce urea --> polyuria w/ secondary polydypsia.
218
T/F: SAS increases the risk of endocarditis.
True
219
What is the MOA of azothioprine? What are the most come AEs?
A purine analogue that inhibits DNA synthesis. AEs - pancreatitis, hepatotoxicity
220
What is the gold standard test for thyroid function?
TSH stimulation test
221
Who secretes calcitonin?
Parafollicular cells (C cells) of the thyroid.
222
Who secretes PTH?
Chief cells of the parathyroid.
223
What is leptin?
Released when fat stores reach a certain level; satiety hormone.
224
What is ghrelin?
A hunger hormone.
225
T/F: 80% of dogs develop cataracts w/in 16 months of diagnosis w/ DM.
True.
226
What kind of insulin is used in dogs?
NPH, Vetsulin (lente)
227
How does the liver metabolize xenobiotics?
Phase 1 - p450; Phase 2 - conjugation
228
What is the MOA of octreotide?
Somatostatin analogue - inhibits insulin, glucagon, GH
229
What is the most frequently used insulin in cats?
Glargine
230
What should a diet for canine DM contain?
Fiber
231
What is the MOA of mitotane?
Causes necrosis of the zona fasiculata and reticularis of the adrenal cortex --> reduced secretion.
232
What is the most common cause of hypercalcemia in cats?
Idiopathic
233
What is treatment for lungworm in cats?
Moxidectin + Imidacloprid (Advantage Multi) - single dose was 100% effective.
Mild infections are usually self-limiting; may not require tx.
234
What is the most accurate way to confirm ocular/CNS toxoplasma in a cat?
PCR + Abs of CSF or aqueous humor
235
Which test correlates best with clinical toxoplasmosis?
Elevated IgM antibodies
236
An 8 week old kitten tests positive for FIV on an antibody ELISA. Do you believe this result? What should your follow-up protocol be?
Don't believe - maternal antibodies can be present at this age, causing +ve.
Recommend retesting at 12 weeks. If still positive test every 1-2 months, until 6 months old - if still +ve = infected.
237
You find a gram +ve, non-acid-fast, filamentous organism on cytology from a thoracocentesis in a golden retriever. Your culture is currently pending. What is your presumptive diagnosis, and what antimicrobial treatment would you initiate?
Actinomyces; start high dose penicillin.
Hope you submitted an anaerobic culture!!
238
What is the diagnostic test of choice for Mycoplasma hemofelis?
PCR - detects 16S rRNA gene.
May not detect asymptotic carrier state.
239
What is the treatment of choice for Mycoplasma hemofelis?
Doxycycline for at least 2 weeks.
Enrofloxacin is a good alternative.
240
T/F: Cats who are infected with and recover from infection with Mycoplasma hemofelis do not develop a persistent, asymptotic carrier state.
False - they often do become asymptotic carriers, and can exhibit recrudescence.
241
How would you treat a dog diagnosed with Neorickettsia helminthoeca?
Doxycycline AND praziquantel
242
A 5 yo, MN, Labrador retriever presents with anorexia, V+, D+, and marked thirst. While obtaining a history the O notes he took the dog fishing last weekend.
On examination the dog is noted to be pyrexic with enlarged lymph nodes.
What is your suspected diagnosis? How would you confirm this?
Neorickettsia helminthoeca
Dx: operculate trematode eggs on fecal; intracytoplasmic rickettsial bodies on LN aspirate.
243
Percentage of nosocomial veterinary ICU infections?
Most common organisms?
~16%
Salmonella & MRSA
244
What stage of heartworm is infectious?
L3
245
Streptococcus is gram +ve, catalase _______.
Staphylococcus is gram +ve, catalase _______.
Strep = catalase negative.
Staph = catalase positive.
246
What is the best way to dx bartonellosis? What disease might it cause in dogs?
Dx: ePCR + serology
Dz: endocarditis
247
What is C-peptide?
Peptide that connects A and B chains of proinsulin, and is cleaved in vesicle.
Secreted with insulin, in equal amounts.
248
What enzyme converts cholesterol to pregnenolone?
Cholesterol deamolase
249
What does cholesterol desmolase do?
Converts cholesterol to pregnenolone.
250
What is the mechanism of action of selegiline?
MOA inhibitors --> increased dopamine (blocks metabolism) --> ACTH.
Used for cognitive dysfunction.
251
What is CIRCI?
Critical illness-related corticosteroid insufficiency.
252
What diagnostic result would you expect to find in a pet with CIRCI?
A blunted response to ACTH stimulation (low delta cortisol)
253
How would you treat idiopathic hypercalcemia in a cat (stepwise)?
1. Diet - high fiber, renal failure, CaOx
2. Steroids
3. Bisphosphonates
254
What dog breed is predisposed to primary hyperparathyroidism?
Keeshonds
255
What breed of dog is predisposed to congenital megaesophagus?
Wire haired fox terrier
256
What are the clinical signs you would see in a case of dysautonomia?
Bilateral mydriatic pupils and elevated 3rd eyelids, decreased anal tone, decreased tear production, ME, GI signs.
257
What tests could you perform to test for dysautonomia?
Pupil constriction w/ very low dose pilocarpine; no elevation in HR with atropine, no flare response to SQ histamine.
258
What is the treatment of choice for Babesia?
Atovaquone + azithromycin; imidocarb less effective
259
What is the treatment of choice for Leishmania?
Antimonials + allopurinol
260
What is the MOA of the azole drugs?
Prevent ergosterol synthesis by inhibiting p450 enzymes, necessary for cell wall production.
261
What amino acid is a potent stimulator of insulin secretion?
Arginine
262
What essential amino acid in cats is used in the urea cycle?
Arginine
263
What clinical signs are noted in a cat with an arginine deficiency?
Arginine deficiency results in hyperammonemia --> signs of HE (salivation, neuro, hyperesthesia, emesis, death)
264
How is excess copper excreted?
In the bile via COMMD1
265
What is the most common cause of icterus in sepsis?
Cholestasis
266
T/F: Ascites is most often seen in cats with suppurative cholangitis.
False! A high protein, low cellularity ascites is seen with lymphocytic cholangitis.
267
What blood test might help differentiate between PSS and MVD? What would you expect to see?
Protein C; if very low (<70%) strongly suggestive of a PSS.
268
What is the MOA of felbamate?
Blocks NMDA excitation, potentiates GABA inhibition.
269
What is the MOA of zonisamide?
T-type Ca2+ channel blocker --> prevents spread of AP
270
A young dog with myoclonus likely has what disease?
Distemper
271
What are the most common clinical signs associated with Neospora in a puppy?
LMN signs w/ spastic gait.
272
What is the treatment for Neospora?
TMS, pyrimethamine, clindamycin
273
Why is treatment with KBr avoided in cats?
Causes pneumonitis and pancreatitis in cats.
274
What antibiotics should be avoided in a dog with myasthenia gravis? Why?
Ampicillin and aminoglycosides. Impair neuromuscular transmission. (Phenothiazine do also!)
275
____ is an important cofactor for cerebral aerobic glycolytic metabolism.
Thiamine
276
What is the diagnostic test of choice for Leptospirosis?
MAT - look for 4x increase in Abs; may be seronegative during 1st week of dz.
277
What is the main abnormality noted in dogs and cats with Mycoplasma?
Anemia
278
What is the treatment for Mycoplasma?
Doxycycline
279
How do you diagnose Anaplasma?
Identification of morulae, 4Dx ELISA
280
What is the known vector for Leishmania?
Sand-fly
281
What is the infective stage of Leishmania?
Promastigote
282
Describe the histo findings in Coonhound paralysis.
Peripheral demyelinating neuropathy with lymphocytic radiculitis.
283
What are the diagnostic criteria for multiple myeloma?
1.) Atypical plasma cells in the BM; 2.) Osteolysis - punched out lesions; 3.) Monoclonal gammopathy; 4.) Bence Jones proteinuria
284
Adverse effect of pegylated liposomal doxorubicin?
Palmar plantar erythrodysethesia syndrome (PPES)
285
What is p53?
Tumor suppressor gene
286
A dog has recently been diagnosed with a thymoma, and has concurrent aspiration pneumonia. How do you explain this?
Megaesophagus secondary to paraneoplastic myasthenia gravis.
287
Where on the bone does osteosarcoma most commonly occur?
Metaphyseal region
288
What is samarium?
A bone seeking radionucleotide used for palliative OSA tx.
289
What drug is used for its anti-estrogenic effects in mammary neoplasia?
Tamoxifen
290
An exon 11 ckit mutation in a mast cell tumor carries a better/worse prognosis.
Worse
291
____ is important in transaminase reactions.
Pyridoxine (B6)
292
What is the MOA of theophylline?
Competitive phosphodiesterase inhibitor and adenosine antagonist --> increased Epi.
293
What test would you use to screen for Lyme disease?
C6 peptide snap ELISA - differentiates active infection from vaccination. If positive, should follow up with quant C6 and a UPC.
294
How do you calculate the bicarb deficit?
0.3 x kg x (24-bicarb)
295
Which chemotherapy agents are nephrotoxic?
Cisplatin, streptozotocin, CCNU (lomustine), doxorubicin (cats)
296
What is the MOA of amitriptyline?
tricyclic antidepressant: anticholinergic, antihistamine, analgesic, anti-inflammatory
297
How do you treat juvenile cellulitis (puppy strangles)?
Corticosteroids + antibiotics if secondary infection present.
298
A young puppy presents with a swollen face, numerous non-pruritic cutaneous pustules, and lymphadenopathy. What is your suspected diagnosis?
Puppy strangles (aka juvenile cellulitis)
299
What is the most common Lepto serovar in dogs?
Grippotyphosa
300
What are the pathogenic proteins of Lepto?
LipL32, OMP
301
How do you treat Lepto in a dog?
Ampicillin for the leptospiremic phase; doxycycline for the carrier phase.
302
A CKCS presents for progressive dyspnea, and radiographs show a marked interstitial pattern. A BAL reveals numerous trophozoites. What is your presumptive diagnosis? How would you treat?
Pneumocystosis; TMS
303
How do you treat Cytauxzoonosis?
Atovaquone + azithromycin; imidocarb less effective
304
What vaccine formulation provides the best antigenic response? Which vaccine should this type NOT be used for?
Modified live give strongest response; not ML for rabies --> encephalitis.
305
What is the 3-year mortality for Flevo?
80%
306
What do we know about Feline Calicivirus VSD (virulent systemic dz)?
Previously developed FCV vaccines are NOT protective; high feline mortality (33-60%).
307
What clinical signs are seen with organophosphate toxicity?
SLUD (muscarinic signs), muscle fasiculations (nicotinic signs).
308
What is the treatment for OP toxicity?
2-PAM, +/- atropine
309
What is the MOA of amitraz toxicity? Where would exposure occur? How would you treat?
MOA: alpha 2 agonist; tick collars; tx: yohimbine
310
Treatment for lead toxicity?
Succimer, CaEDTA, D-penicillamine, cathartics + Mg sulfate, thiamine
311
The canine parvovirus vaccine is based on which subtype?
CPV2b
312
Glucocorticoids induce ____ which inhibits phospholipase A2, which converts AA into ______.
lipocortin-1; eicosanoids
313
What are 2 striated muscle relaxants?
Benzodiazepines and dantrolene
314
Where does CAV1 cause disease? CAV2?
Liver; upper respiratory tract / lungs
315
Describe the concept of hysteresis with regards to respiration.
During inspiration, you need to overcome the surface tension in the lungs which is creating a collapsing force on the lungs. Lungs produce surfactant, which greatly reduces the surface tension, but it doesn't go to zero. Therefore, when you are breathing in, the pressure increases immediately, but the volume does not increase significantly until you overcome surface tension
316
Surfactant is synthesized by _______.
type II alveolar cells
317
The most important stimulus controlling the level of resting ventilation is:
pH of CSF on central chemoreceptors (West)
318
What enzyme converts cholesterol to pregnenolone in the adrenal?
cholesterol desmolase (rate limiting step)
319
List 5 things that increase lower esophageal sphincter tone.
gastrin
histamine
ACh
gastric distention
gastric acidity
320
Describe the response to the following in patients with dysautonomia: pilocarpine response test, STT, atropine response test, intradermal histamine test.
pilocarpine response test - rapid miosis
STT - low or no tears
atropine response test - no increase in HR
intradermal histamine test - no flare
321
EPI in dogs is most commonly caused by ____. What about cats?
dogs - acinar atrophy
cats - chronic pancreatitis
322
What is the mechanism of tetanospasmin?
irreversibly binds to presynaptic sites in inhibitory neurons --> inhibits glycine and GABA
323
What is the MOA of amphotericin B?
binds with ergosterol forming pores in fungal cell membrane that cause rapid leakage of monovalent ions (K+, Na+, H+ and CläšÍ) and subsequent fungal cell death
324
What is the MOA of azole antifungals?
inhibit the enzyme lanosterol 14 ‘±-demethylase (P450); the enzyme necessary to convert lanosterol to ergosterol
325
What is the MOA of zonisamide?
blocks sodium and T-type calcium channels, which leads to the suppression of neuronal hypersynchronizationξ
326
Thiamine is an important cofactor for ______
cerebral aerobic glycolytic metabolism
327
Which layer must be effected for a lesion to be considered a gastric ulcer?
muscularis
328
Type A cats have very strong/weak anti-B antibodies, and type B cats have very strong/weak anti-A antibodies.
Type A cats have very weak anti-B antibodies, and type B cats have very strong anti-A antibodies.
329
Why is vasopressin used in patients with vWD?
induces release of vWF from endothelial cells
330
What are the components of MOPP and what types of drugs are they?
mechlorethamine, oncovin (vincristine), procarbazine
MP = alkylating agents
O = anti-microtubule agent
331
What should you do if your patient becomes thrombocytopenic on CCNU?
discontinue treatment because effects are cumulative
332
What is the nadir for CCNU?
14 days (compared with 7 days for most other drugs)
333
What is tamoxifen used for?
antiestrogenic effects in mammary neoplasia
334
What happens to ammonia levels if arginine levels are low?
hyperammoniemia due to the need for arginine in the urea cycle
335
Does C6 cross react with antibodies produced from vaccination for Lyme?
no!
336
During fasting, dogs maintain their BG in normal range via _____, whereas cats maintain their BG in normal range via _______.
dogs - glycogenolysis
cats - gluconeogenesis
337
What is the MOA of oxybutynin?
muscarinic receptor antagonist
338
Glucocorticoids induce ____ which inhibits phospholipase A2
lipocortin
339
For which virus is a killed vaccine always recommended?
rabies
340
What is the treatment for pneumocystis carinii?
TMS
341
What is the MOA of neostigmine?
blocks acetylcholinesterase
342
What is the MOA of bethanechol?
selectively stimulates muscarinic receptors
343
What is LipL32?
pathogenic outer membrane protein (OMP) of lepto
344
What is the main MOA of amitraz toxicity? What is the treatment?
alpha2 agonist tx: yohimbine
345
What organism can cause a false positive on PARR?
Ehrlichia
346
Which of the following are NOT susceptible to tylosin: Staphylococcus, E. coli, Streptococcus, Salmonella, Corynebacterium?
E. coli Salmonella
347
What do the following chemotherapeutics have in common: doxorubicin, cisplatin, streptozocin, lomustine?
potential for nephrotoxicity
348
FLUTD signs resolve in 5-7 days in ___% of cases
92%
349
What is the MOA of amitriptylline?
tricyclic antidepressant (serotonin-norepi reuptake inhibitor) also anticholinergic, antihistamine, analgesic, anti-inflammatory
350
What alpha receptor does acepromazine act on?
alpha 1 antagonist this is not the main mechanism though - D2 receptor antagonism is main mechanism
351
What is the MOA of dantrolene?
antagonizes ryanodine receptor, thereby inhibiting release of Ca from SR muscle relaxant
352
What is puppy strangles and how do you treat it?
juvenile cellulitis (unknown etiology) treat with pred 2mg/kg/d and antibiotics if concern for secondary infection
353
What are the treatments for lead poisoning?
CaEDTA, Succimer (chelating agent), D-penicillamine, thiamine (reduces tissue deposition), MgSO4 (as cathartic)
354
What is the most prevalent strain of parvovirus?
CPV-2b
355
What is the lactulose/rhamnose test used to assess? What does a high lactulose/rhamnose ratio represent? What about a low lactulose/rhamnose ratio?
test for intestinal permeability (lactulose travels paracellularly, rhamnose travels transcellularly) high lactulose/rhamnose = increased permeability because more laculose moving between cells low lactulose/rhamnose = normal permeability because less movement between cells
356
Which valve is most commonly affected in dogs with endocarditis?
mitral
357
Which heart conditions have been associated with an increased risk of endocarditis?
subaortic stenosis
PDA NOT DMVD
358
What is the osmolal gap and what is it used for?
difference between serum osmolality and calculated serum osmolality used to screen for possible toxins (ethylene glycol, ethanol, propylene glycol, acetone)
359
What are the two main cytokines released by NK cells?
TNA-alpha, IFN-gamma
360
Describe the role of perforin and granzymes upon their release from NK cells.
perforins create pores in the target cell's membrane, which allow entry of granzymes, which induce apoptosis
361
What makes up the majority of the chylomicron?
triglycerides
362
Hyperventilation would have what effect on cerebral blood flow?
hyperventilation --> decreased PaCO2 --> vasocontriction --> decreased cerebral blood flow
363
What is enterokinase and where does it come from?
comes from duodenum converts trypsinogen to trypsin
364
T/F: Bradykinin is inactivated in the lung
True! Up to 80%
365
Cimetidine is a major inducer/inhibitor of P450.
inhibitor
366
ketoconazole is an inhibitor/inducer of P450 and an inhibitor/inducer of P-glycoprotein.
inhibitor of both!
367
Phenobarbital is an inducer/inhibitor of P45
inhibitor
368
Which antibiotic inhibits phenobarbital clearance?
chloramphenicol can result in sedation if used together
369
What drug interaction is a concern when enrofloxacin is used concurrently with theophylline?
enrofloxacin inhibits CYP1A2 metabolism of theophylline --> increased theophylline blood levels need to dose reduce theophylline in these patients
370
What should you do if enrofloxacin and theophylline need to be given concurrently?
Reduce the dose of theophylline by 30%
371
E. canis causes _________ ehrlichiosis.
Monocytic
372
What is seen with chronic E. canis infection?
1. Pancytopenia from bone marrow hypoplasia Same signs as acute phase, plus
2. Dyspnea, uveitis, retinal hemorrhage, deems, PLN, polymyositis
3. Monoclonal gammopathy
373
What is the treatment for Bartonella?
Aminoglycosides +\- doxycycline
Long term:
Doxycycline + Baytril - dogs
Doxycycline + pardofloxacin - cats
374
Ehrlichia ewingii causes _______ ehrlichiosis.
granulocytic
375
In dogs the meronts of Hepatozoon canis infect the _____ system and Hepatozoon americanum infects ______.
Hemolymphatic (spleen, BM, etc.)
Skeletal and cardiac muscle
376
What are the most common organisms to cause bacterial endocarditis?
Staph and Strep = most common; E. coli and Bartonella too
377
Osmolar gap?
The difference between the calculated serum osmolarity and the measured serum osmolarity. Osmolar gap = measured - calculated.
378
What is the most common presenting complaint in a hypercalcemic animal?
PU/PD
379
What causes PU/PD with hypercalcemia?
HyperCa2+ inhibits the response of renal tubules to ADH --> NDI
380
A normal PTH level in the face of hypercalcemia is consistent with what?
Hyperparathyroidism (should be LOW)
381
What is the best method to detect microparticles?
Flow cytometry
382
Drugs / toxins that limit hemoglobin production?
Lead, chloramphenicol, azathioprine, allopurinol, phenobarbital
383
A collie presents w/ a dx of large cell lymphoma. O want to pursue treatment w/ CHOP, but you are hesitant pending his MDR mutation status. What drugs in this protocol should NOT be given? What drugs can you give?
UNSAFE: vincristine, doxorubicin; SAFE: Cytoxan, CCNU (not CHOP)
384
Mixed metabolic / respiratory disorder?
When pCO2 and HCO3- are BOTH abnormal and in opposite directions. Low pCO2, high HCO3- = resp/met alkalosis; high pCO2, low HCO3- = resp/met acidosis
385
What is the most common finding in a dog with acetaminophen toxicity? A cat?
Dog = hepatotoxicity; cat = methemoglobinemia/anemia
386
What is the toxic metabolite in acetaminophen toxicity?
NAPQI
387
How do you treat an acetaminophen toxicity?
N-acetylcysteine, SAMe, supportive
388
What is the MOA of tacrolimus?
Calcineurin inhibitor --> inhibits IL-2 prod'n and T-cell proliferation, same as cyclosporine. Much more potent then cyclo.
389
What happens during apoptosis?
Caspase cascade activated --> activation of endonucleases --> disassembly of nuclear material and microtubules (cytoskeleton) --> bleb formation --> apoptotic bodies to be eaten by phagocytes.
390
What is the main role of carbonic anhydrase?
Converts CO2 + H2O H+ + HCO3- (carbonic acid dissociates to)
391
What is the difference between recurrent, reinfection, and relapse UTI?
Recurrent: presence of 3+ UTIs over a 12 month period
Reinfection: dx of UTI w/in 6 months of cessation of previous, successful treatment, with isolation of a DIFFERENT organism
Relapse: recurrence of UTI, after seemingly successful tx, and isolation of the SAME organism.
392
A mutation in TLR-4 that increases NF-KB translocation to the nucleus and increased cytokine prod'n would increase/decrease the risk of sepsis and increase/decrease susceptibility to gram negative organisms.
Decrease, decrease.
TLR-4 recognizes LPS on gram - bacteria --> NF-KB activation --> pro-inflammatory cytokine release.
393
What are the factors that affect vasodilation / vasoconstriction in pulmonary hypertension?
Vasodilation: NO, prostacyclin (PGI2)
Vasoconstriction: endothelin, thromboxane, serotonin
394
Where are NK cells made?
Come from lymphocyte precursors in the BM, widespread - LN, BM, spleen; NOT found in thymus - don't undergo thymic processing
395
How do feline seizures usually initiate?
Complex partial seizures - aka psychomotor seizures (maniacal running, aggression, tail chasing, etc.). Can terminate as generalized seizures.
396
What is the most important component of DKA treatment?
Fluid therapy!! Then correction of electrolytes, then hyperglycemia.
397
What parasite causes tracheal thickening w/ masses?
Eucoleus aerophilus (Oslerus osleri causes nodules at the tracheal bifurcation and bronchi)
398
T/F: Multiple myeloma can interfere with coagulation.
True: primarily via globulins inhibiting platelet aggregation and TF release.
399
LDDST results demonstrate suppression at 4 hours, and suppression escape at 8 hours. What is your diagnosis?
PDH (No suppression would be AT or PDH, and suppression at both would r/o HAC)
400
What does stimulation of the baroreceptor reflex cause?
Receptors detect elevated BP --> Net effect lowering arterial BP 1.) Vasodilation of peripheral veins and arterioles 2.) Decreased HR 3.) Decreased strength of cardiac contraction
401
What is the best indication/sign of an UMN spinal lesion?
UMN: paresis, normal to increased tone, ataxia, UMN bladder (large, difficult express), and normal spinal reflexes. LMN: decreased tone/flaccidity, reduced/absent reflexes.
402
How much bicarb is resorbed in the PCT?
80-90% of filtered bicarb is resorbed in PCT
403
Where in the renal tubules does gentamycin toxicity occur?
Proximal tubular epithelial cells --> accumulate, cause injury
404
What decreases GFR?
Increased glomerular oncotic pressure (more pull), decreased glomerular hydrostatic pressure (less push)
405
_____ is released by endothelial cells and inhibits Plt activation. _____ is released from dense Plt granules and is a Plt agonist (recruits and activates).
Nitric oxide (NO); Serotonin
406
What are ANAs? Directed against what?
ANAs = anti-nuclear antibodies; directed against self nuclear components.
407
What type of hypersensitivity reaction causes hemolysis after a blood transfusion?
Type II - antibody mediated cytotoxicity - activates classical complement cascade.
408
What do microRNA do?
Down regulate specific gene expression
409
How is an action potential transmitted in muscle?
T-tubules, which penetrate to interior muscle fibers, allow AP's to spread all the way through the muscle fiber --> Ca2+ release --> contraction
410
What facilitates glucose transport in the PCT?
Early PCT: SGLT2 (apical membrane) resorbs ~90% glucose; GLUT2 (basolateral) facilitates passive transport of glucose from fell to interstitial space. Late PCT: SGLT1 (apical) resorbs ~10% filtered glucose; GLUT1 (basolateral) from cell to interstitium
411
Fragments of LPS are what?
PAMPS: from gram - bacteria, recognized by TLR-4 --> activation of innate immunity
412
How does peptide reabsorption occur in the GIT?
Pepsin and pancreatic enzymes --> digestion of proteins into small mono/di/polypeptides --> further degraded by peptidases at brush border. AA and di/tripeptides transported into enterocytes --> additional peptidases in cell break down to single AA.
413
What percentage of total body water is ECF?
ECF = 33% (1/4 plasma, 3/4 interstitial fluid); ICF = 66%
414
What stimulates ADH?
1.) Increased plasma [Na+], osmolarity
2.) decreased arterial BP
3.) decreased blood volume
415
What can be found in the empty stomach of a horse and dog?
Maybe intrinsic factor (cats only have it from pancreas), or maybe PGE?????
416
If you are going to euthanize an animal based on a test result, do you want it to be very specific or sensitive?
Specific - fewest false positives!
417
How does aspirin inhibit platelet aggregation?
Inhibits COX-1 (irreversible) --> decreased thromboxanes (and prostaglandins)
418
What factor most affects blood flow through a vessel?
Radius
419
What determines osmotic force?
Number of particles (not mass of particles)
420
What increases cardiac contractility (Ca, Na, K, other)?
Ca++ --> contraction and force of; Na+ entering causes upstroke of the AP
421
How does a neutrophil kill phagocytized bacteria?
Respiratory burst: NADPH oxidase creates bactericidal oxidants (H2O2); digestive enzymes: released from granules into phagolysosome.
422
Signs of a forebrain lesion?
Seizures, behavior changes, normal gait w/ circling/pacing/head pressing, contralateral vision impairment w/ normal PLRs
423
PLR pathway?
Retina, optic n. (II), chiasm --> decussate, optic tract, pretectate nucleus --> decussate back, parasympathetic nucleus oculomotor n. --> efferent down oculomotor n., ciliary ganglion, postganglionic ciliary n, iris sphincter m.
424
In the PLR pathway which CN nerve carries the afferent signal? The efferent?
Afferent = CN II (optic)
Efferent = CN III (oculomotor)
425
What part of the PCR determines specificity?
Primers
426
What test requires live organisms?
Lepto MAT (microscopic agglutination test)
427
MHC has high nucleotide substitution in the codon. What does this mean for selection pressure?
This is advantageous, allows animal to respond to wider variety of offending antigens. Increases survivability of animal.
428
When bicarbonate is secreted from the pancreas it is associated with what?
(Options ?: Hydrogen in the duct, Na in the blood, osmosis of water, CO2 in the blood)
Osmosis of water.
Bicarb is actively transported with Na into the ductal lumen --> creates an osmotic pressure gradient --> osmosis of water into the duct.
H+ ions move into the blood in exchange with Na.
429
What thyroid hormone acts the quickest on its target cell?
T3
T4 is rapidly convert to T3 inside the cell.
430
What inhibits glucagon secretion?
Increased BG, somatostatin
431
What stimulates insulin secretion?
Increased BG, FFA, AA
GI hormones: gastric, CCK, secretin, GIP
Parasympathetic stimulation
B-adrenergic stimulation
Insulin resistance; obesity
Sulfonylurea drugs (glipizide)
432
When should a Lepto PCR be used? A MAT?
MAT is the best test to use after 5 days of infection.
PCR should be used early in the course of dz, <5 days. Can be used up to 3 days on antibiotics.
433
How would you treat a non-compressive myelopathy?
Strict cage rest
Anti-inflammatories and analgesics
Fluid therapy if in shock or concerned about spinal perfusion.
434
2 examples of portal vein atresia
Portal vein hypoplasia and microvascular dysplasia.
usually asymptomatic
*
* elevated total serum bile acids
*
* normal protein C, AUS, scintigraphy
435
What retinal pathology is seen in cats with taurine deficiency?
Focal retinal atrophy at the area centrallis (pathognomonic).
Progresses to diffuse retinal degeneration.
Supplementation can stop progression, but not reverse!
436
What is the idea diet for a cat with DM?
High protein
Low carb
Helps maintain ideal body weight and preserve lean muscle.
437
What arrhythmia might you see on an ECG from a dog being treated with doxorubicin?
Right bundle branch block
438
A dog with a creatinine of 4.5 would be what IRIS stage?
Stage 3
439
A cat with a creatinine of 2.1 would be an IRIS stage what?
Stage 2
440
What causes lipemic serum?
Increased triglycerides
(E.g. Post-prandial, DM, HL, pancreatitis, neoplasia)
441
1.) An endogenous ACTH level above the reference range is consistent with _______.
2.) ACTH below/within the reference range is consistent with _______.
1.) primary hypoadrenocorticism
- adrenals not making steroids --> feedback stimulates ACTH prod'n
2.) secondary hypoadrenocorticism
- pituitary not creating enough ACTH to appropriately stimulate adrenals --> feedback has no effect on ACTH prod'n
442
What side effect of methimazole can be reduced with topical treatment?
GI adverse effects
443
What stain can be used to detect mast cell granules?
Toluidine blue
444
Besides hypokalemia, what other electrolyte abnormally can potentate digoxin toxicity?
Hypercalcemia
Digoxin causes increase in intracellular Ca - hyperCa adds to this effect --> toxicity
445
What percentage of dogs with cerebral infarcts are hypertensive?
25-30%
446
What is the most common presentation of SLE?
Polyarthritis
447
Where is most CSF produced?
Choroid plexus
448
What are the primary effects (4) of GH?
1. promotes protein deposition
2. decreases carbohydrate utilization
3. stimulates cartilage and bone growth
4. induces production of somatostatins
449
What are the major stimulators (6) of GH?
1. starvation
2. hypoglycemia, low blood FAs
3. exercise
4. excitement
5. trauma
6. ghrelin
450
True test + / All dz + = ?
Sensitivity
451
True test + / All test + = ?
Positive predictive value
452
What prokinetic drug causes decreased acetylcholinesterase activity
Neostigmine
453
What is the treatment for zinc toxicity?
1. remove source
2. PPI
3. sucralfate
454
What channel is responsible for the automaticity of pacemaker cells?
Na+ channels
455
How does Na leave the basolateral and paracellular surfaces of the renal epithelial cells?
Via Na-K ATPase
456
What are the primary pyrogens (3)?
IL-1, IL-6, TNF-alpha
457
T/F: Diazepam should be given to control seizures in a dog with HE.
FALSE! These are metabolized by the liver - use keppra or KBr instead. If a benzo was given reverse with flumazanil.
458
Underlying causes of feline pericardial dz?
Left sided CHF, FIP
459
Phenotypic characterization of T regulatory cells includes expression of which two surface antigens and transcription of which gene?
CD4 and CD25
transcription of FoxP3
460
What are myeloid-derived suppressor cells?
immature cells of myeloid lineage derived from bone marrow progenitor cells
increased in cancer and contribute to global immunosuppressive state
461
What does LGI stand for in reference to epilepsy?
leucine-rich glioma-inactivated protein
462
What happens at the presynaptic membrane in LGI mutants?
potassium channel in presynaptic membrane close more rapidly --> extended depolarization and increased Ca influx --> excessive neurotransmitter release --> focal seizures
also bind presynaptic to post-synaptic proteins to shorten synaptic cleft
463
What mutation is associated with benign familial juvenile epilepsy of Lagotto Romagonolos?
LGI2 mutation, autosomal recessive
focal seizures starting at 6wk that usually resolves by 10wks
464
What mutation pre-disposes Belgian Shepherds to adult-onset epilepsy?
ADAM23 mutation
focal seizures that may or may not become generalized
465
What is the best currently-available test for diagnosis of Bartonella infection?
BAPGM culture + PCR (ePCR from Galaxy diagnostics)
466
The FeLV SNAP test assesses for antigen/antibody . The FIV SNAP test assesses for antigen/antibody.
FeLV - antigen FIV - antibody
467
How often should blood donors be screened for infectious diseases?
at least once a year
468
T/F: Routine blood culture is recommended as part of the screening for potential blood donors
False! Transfusion of blood from animals with transient bacteremia has NOT been documented to cause disease in a recipient
469
T/F: Transfusion of microfilaria from a blood donor can lead to heartworm infection in the recipient.
False! But it caninterfere with diagnostic testing, causing infection in mosquitos, and can carry Wolbachia
470
B. canis vogeli is most common in which breed? B. gibsoni is most common in which breed?
B. canis vogeli = greyhound B. gibsoni = pitbull
471
Laishmania donovani is considered endemic in which breed of dogs in North America?
foxhounds
472
The IFA assay for Leishmania cross-reacts with which other pathogen?
Trypanosoma cruzi
473
What is the vector for Trypanosomiasis in the US?
feces-contaminated bite from (or ingestion of) triatomine bugs (kissing bugs)
474
Which infectious disease in dogs is most associated with acute or chronic myocarditis - leishmania, trypanosoma, hepatozoon, ehrlichia?
trypanosoma
475
T/F: Lyme can be transmitted by transfusion
FALSE! (or at least it has not been documented)
476
T/F: Dogs that are seropositive for lyme should be excluded from the blood donor pool
FALSE! They should not be excluded since lyme does not appear to be transmitted via blood transfusion
477
Should healthy blood donors be screened for RMSF?
No! Infected dogs are acutely ill and no subclinical carrier state is known to exist Even seropositive dogs should not be excluded as donors if they are clinically healthy
478
What is the definitive host for bartonella?
cats!
479
Should Bartonella seropositive cats be excluded as blood donors?
Not if they are PCR negative... high seroprevalence in cats (up to 93%) would make it difficult to find suitable blood donors otherwise
480
Cytauxzoon felis undergoes schizogony in ____ cells and merogony in ____ cells.
schizogony in myeloid cells merogony in RBCs
481
Which stage of Cytauxzoon development is associated with clinical illness?
schizogony
482
T/F: Healthy cats in endemic areas do not need to be screened for Cytauxzoonosis
False! They should be screened (PCR) because signs do not begin until 10-21d post-infection
483
What is the diagnostic test of choice for screening blood donor cats for M. hemofelis?
PCR
484
T/F: Mycoplasma hemofelis can survive in stored whole blood for up to 1 month
False! M. hemofelis is inactivated during storage of whole blood for 1 week
485
What specific antigen does the FeLV ELISA test for?
p27
486
T/F: FeLV can be transmitted by blood transfusion
True!
487
Why would it be ideal to use PCR for FeLV screening of feline blood donors?
Because regressive infection can occur with undetectable antigenemia but proviral DNA still present in the blood... FeLV provirus is infected, so PCR for proviral DNA would be ideal
488
How is FIV most commonly transmitted?
bite wounds
489
Which proteins are used in FIV SNAP tests to detect antibodies?
p24 and p15
490
Which species is the reservoir host for Rickettsia felis?
DOGS! Tricky tricky....
491
What are the roles of the following in the cardiomyocyte: troponin T, troponin I, troponin C?
troponin T = secures tropomyosin to the actin filament troponin I = inhibitory subunit that inhibits hydrolysis of ATP required for actin-myosin interaction troponin C - binds calcium to allow filaments to interact
492
Why is troponin C unfit for use as a cardiac biomarker?
the cardiac and skeletal isoforms are completely homologous
493
List 3 mechanisms of cytosolic cardiac troponin release without cell death
1. increased membrane permeability 2. intracellular proteolysis 3. release of membranous vesicles containing cytosolic troponin
494
Which troponin is released in higher concentrations after a cardiac insult - troponin T or troponin I?
troponin I
495
T/F: Troponin concentrations correlate with the degree of cardiac injury on histopath
true!
496
List some substances in the blood that can falsely increase serum troponin concentrations.
elevated ALP hemolysis lipemia fibrin rheumatoid factor immune complexes
497
Which breeds of dogs might have inherently higher CTnI concentrations compared with other breeds?
greyhounds and boxers (or do all the boxers just have ARVC?....)
498
T/F: There is overlap between troponin concentration in healthy individuals and those with cardiac disease
True!
499
Increased troponin concentrations in critically ill patients has been associated with higher levels of what cytokines?
TNF-alpha, IL-6
500
In veterinary studies an association between cardiac troponin concentrations and short-term case fatality hasbeen found in dogs with which conditions?
GDV parvo babesia SIDS
501
Which cardiac troponin has been noted to be elevated in azotemic dogs?
cTnI
502
Which troponin is the cardiac injury marker of choice in dogs and cats?
cTnI
503
What are criteria for initiation of anti-epileptic drug treatment?
1. identifiable structural lesion or prior history of brain disease/injury 2. acute repetitive seizures (>3 in 24h) or status epilepticus (>5min) 3. 2 or more seizure events within 6mo 4. prolonged, severe, or unusual post-ictal periods
504
Why can the elimination half life of phenobarbital progressively decrease with chronic dosing?
because it is an auto-inducer of hepatic microsomal enzymes (p450)
505
How long is the median elimination half life of KBr?
15.2 days!
506
Diets high in _____ result in excess renal excretion of KBr.
chloride
507
What is the only anti-epileptic drug specifically approved for dogs in the US?
primidone
508
Primidone is rapidly metabolized to which major active metabolite?
phenobarbital
509
T/F: Keppra undergoes extensive hepatic metabolism.
False! it is not metabolized in the liver and is excreted essentially unchanged in the urine
510
What are 3 major risks of treatment with phenobarbital?
hepatotoxicity idiosyncratic blood dyscrasias necrolytic dermatitis
511
After starting pheno treatment, when should drug monitoring be performed?
2 weeks, 6 weeks, then every 6mo or 2 weeks after a dose change
512
What are 3 side effects of potassium bromide treatment?
pancreatitis sedation ataxia
513
The hypogastric nerve comes from which spinal segments in cats? in dogs?
L2-L5 in cats, L1-L4 in dogs
514
The pelvic nerve fibers to the bladder comes from which nerve segments in dogs?
S2-S3
515
The pudendal nerve comes from which nerve segments in the dog?
S1-S3
516
In cats, sensory fibers from the lower urinary tract mainly travel within which nerves? In dogs? What about for sensation of overdistension?
cats - pelvic and hypogastric dogs - pelvic both species sense overdistension by the hypogastric nerve
517
____ fibers in the bladder wall sense bladder distension and send information to _____ which communicates with _____ to stimulate voiding
a-delta fibers in the bladder wall sense bladder distension and send information to pontine micturition center and peraqueductal grey matter which communicates with the cerebral cortex to stimulate voiding
518
The pontine micturition center inhibits ___ nerve and stimulates ___ nerve. The pontine storage center stimulates _____ and _____ nerves
The pontine micturition center inhibits hypogastric nerve and stimulates pelvic nerve. The pontine storage center stimulates hypogastric and pudendal nerves
519
Describe LMN bladder.
detrusor hyporeflexia/areflexia + sphincter hypotonia/atonia •ÄÊ increased bladder capacity/residual volume, constant urine leakage
520
Describe UMN bladder
detrusor overactivity causes•ÄÊ periodic elevated intravesical pressure and urine leakage with detrusor-sphincter dyssynergia during attempts to empty bladder
521
Which fibers can become activated in suprasacral spinal injury and can contribute to "reflex voiding"?
C fibers
522
Why do dogs with spinal cord injury have an increased risk of pyelonephritis?
increased intravesicular pressure with detrusor overactivity leads to vesicoureteral reflux
523
What treatments can be considered for detrusor overactivity following spinal cord injury?
1. antimuscarinics (oxybutynin, botox in bladder wall) 2. vanilloids (capsaicin) intravesciularly or intradetrusor 3. tramadol
524
What treatments can be considered for bladder atony in the acute phase following suprasacral spinal cord injury?
bethanechol alpha blockers (prazosin, tamsulosin) muscle relaxants (diazepam)
525
Fluoroquinolones and aminoglycosides are most efficacious in what urine pH?
alkalineåÊ
526
Tetracyclines and beta lactams work best in what urine pH?
acidic pH (but pH doesn't matter for amoxicillin or clavamox)
527
Does T. foetus cause large or small bowel diarrhea in cats?
large bowel diarrhea
528
What is the treatment of choice for T. foetus infection in cats?
ronidazole
529
Why are Trichomonads capable of living as lumen dwellers in oxygen-poor mucosal environments?
they lack mitochondria and use hydrogenosomes for ANAEROBIC metabolism
530
T/F: Trichomonads survive for long periods outside the host.
False! They cannot live for long outside the host as they do not form environmentally stable cysts
531
List 4 factors contributing to T. foetus pathogenicity in cats.
1. sialic-acid binding lectins 2. adhesin proteins 3. lipophosphoglycan 4. cysteine proteases
532
T/F: Infection with trichomonas in cats confers lifelong acquired immunity.
False!
533
Trichomonas has a sexual/asexual lifecycle and aerobic/anaerobic metabolism
asexual lifecycle anaerobic metabolism
534
List 3 scenarios in which surgical removal of struvite uroliths may be considered.
1. medications or dissolution foods cannot be given or are contraindicated 2. urolith cannot be adequately bathed in modified urine 3. uncontrollable infection despite appropriate medical management/owner compliance
535
T/F: Struvite nephroliths should be medically dissolved.
True!
536
T/F: Dissolution should be attempted in cats with obstructive upper urinary tract uroliths.
False!
537
Uric acid is transported to the liver, where it is metabolized by _____ (enzyme) into _______.
metabolized by hepatic uricase to allantoin
538
What genetic mutation is associated with urate stone production in dogs?
SLC2A9
539
T/F: Dissolution of urate stones is typically not possible in dogs/cats with uncorrected liver disease (such as PSS)
TRUE
540
What is the target urine pH for dissolution of cysteine stones?
~7.5 thiol binding drugs efficacy is increased at this pH or higher
541
T/F: Nonclinical urocystoliths should always be removed, even if they are unlikely to cause an obstruction
False! recommend periodic monitoring - consider removal if clinical signs develop
542
Over 90% of nephroliths and ureteroliths in cats are composed primarily of _______
calcium oxalate
543
Experimental ureteral occlusion in healthy dogs results in a __% permanent decrease in GFR by 7d, __% by 14d, and __% by 40d
35% by 7d 54% by 14d 100% by 40d
544
In preventing calcium oxalate stone recurrence, a target USG for dogs is ____ and for cats is ____
dogs < 1.020 cats < 1.030
545
Diets for dogs with cystinuria should be LOW in which two amino acids, and should contain ADEQUATE amounts of what other 2 amino acids?
low in: methionine & cystine adequate in: taurine & carnitine
546
Which sulfur-containing amino acid is a precursor to cystine?
methionine
547
How does 2-MPG (Thiola) work?
reduces cystine to 2 cysteine molecules which bind to thiol thiol-cysteine is 50x more soluble than cystine this effect is potentiated by urinary alkalinization
548
*Which stage of toxoplasmosis infects the placenta?
*tachyzoite
549
*Which breed is associated with thrombocytopenia due to macroplatelets?
*Cavalier King Charles Spaniel
550
*Which does firocoxib inhibit - COX-1, COX-2, or both?
*Primarily COX-2
551
*What is the range of protein content in FIP effusion?
*3.9 - 9.8
552
*What is the cellularity of effusion in FIP?
*<5000/uL (low-moderate cellularity)
553
*What types of cells are seen in FIP effusion?
*macrophages, neutrophils, some lymphocytes
554
*What is the MOA of doxycycline?
*inhibits protein synthesis by binding 30s subunit
555
Is doxycycline bacteriocidal or bacteriostatic?
bacteriostatic
556
How is Hepatozoon americanum transmitted?
dog ingests tick (Amblyomma maculatum)
557
*Describe labwork findings in dogs infected with Hepatozoon americanum?
* SEVERE neutrophilia (often 200k neut or higher)
| also. .. mild-mod NR anemia, mild increase in ALP, +/- hyperglobulinemia
558
*What regulates CSF pressure?
*arachnoid villi
559
*Why might you get a false negative result on 2M antibody assay in a dog with masticatory myositis? What should you do if you suspect this?
*if patient has been treated with immunosuppressive doses of steroids for 7-10d or if end-stage/chronic disease (muscle fibrosis). Recommend muscle biopsy
560
Which muscles should be biopsied in dogs suspected of having masticatory myositis?
temporalis and masseter muscles (both innervated by mandibular branch of trigeminal nerve - have 2M muscle fibers)
561
*Which antibiotics have good penetration for the prostate?
*antibiotics that are nonionized at a neutral pH with HIGH fat solubility: enrofloxacin, clindamycin, TMS
562
*T/F: Corticosteroids are contraindicated in cases of traumatic brain injury
*True! Treatment with corticosteroids increases risk of death in patients with traumatic brain injury
563
Toxoplasma oocysts take how many days to become infective after being shed in feces?
1-5d, therefore daily scooping of litter box is important
564
What is the definitive host of Toxoplasma gondii?
cats
565
How can Toxoplasma gondii be transmitted?
consumption of oocysts passed in feces of cats
consumption of bradyzoites encysted in tissue
transplacental transmission via tachyzoites
566
T/F: Cats with clinical toxoplasmosis are likely to be shedding oocysts in their feces.
False! They are unlikely to be shedding during clinical infection
567
Clinical signs of toxoplasmosis are caused by...
proliferation of asexual stages extraintestinally (this is why cats with clinical signs are unlikely to be passing oocysts in feces)
568
*Describe the use of IgM and IgG titers in diagnosis of toxoplasmosis.
*IgM - active for recent infection ( 1:256
IgG - appear after 4wks of infection and remain high for years. Can use convalescent IgG titers 3-4 wks apart - 4-fold rise in titer is consistent with active infection.
569
*Aside from serum, what other samples can be analyzed for toxoplasma antibodies?
*CSF, aqueous humor
570
*What is the vector for Cytauxzoon felis?
*Lone star tick (Amblyomma americanum)
571
*What is the nautral host for Cytauxzoon?
*bobcat
572
*Does cytauxzoon undergo cat-cat transmission or vertical transmission?
*probably not either (at least not in experimental models)
573
*What is the infectious stage of cytauxzoon? What cells do they infect?
*sporozoites infect mononuclear phagocytes
574
*Describe the 2 major stages of development of Cytauxzoon.
*schizogony - asexual reproduction that occurs in WBC
merogony - sexual reproduction that occurs when WBC rupture and release piroplasms, which infect RBC
575
*What is the predominant cause of clinical disease and death in cats with cytauxzoonosis?
*schizont-infected WBC occlude blood vessels, causing "parasitic thrombi" resulting in ischemia and tissue necrosis
576
How is cytauxzoonosis diagnosed?
detection of piroplasms in RBCs on bloodsmears, or less commonly detection of schizonts on blood smears (feathered edge) or on FNA of LNs, liver, or spleen
PCR can also be performed
577
What are the most common bloodwork findings in cats with cytauxzoonosis?
leukopenia with toxic neutrophils, thrombocytopenia, NN anemia, hyperbilirubinemia, hypoalbuminemia
578
What medications have been associated with the highest survival rates in cats with cytauxzoonosis?
combinationof atovaquone and azithromycin
579
*Drop jaw is caused by paralysis of which nerve? Which muscles would be atrophied?
*mandibular branch of trigeminal nerve
temporalis, masseter, pterygoid
580
*What bacteria are the most common cause of diskospondylitis in dogs?
*coagulase-positive Staphylococcus spp. (aureus, intermedius)
581
*The presence of what bacteria in a tracheal wash specimen would be indicative of oropharyngeal contamination?
*Simonsiella
582
What are these organisms seen on endotracheal wash? What do they represent?
Simonsiella, representative of oropharyngeal contamination
583
*Which aflatoxin is most commonly encountered in food-related toxicosis?
*aflatoxin B1 (AFB1) - associated with corn, grains, peanuts, soybeans, treenuts, cottonseed
584
*What fungus commonly produces aflatoxins found in foods?
*Aspergillus
585
*How does aflatoxin cause hepatotoxicity?
due to low glutathione levels for neutralization of aflatoxins
586
*Why are dogs so sensitive to aflatoxicosis?
*due to low glutathione levels for neutralization of aflatoxins
587
*What is the treatment of choice for tritrichomonas infection?
*ronidazole
588
*What is the most important extracellular buffer?
*HCO3-
589
*What activates pepsinogen to pepsin?
*low pH in stomach
590
*List adverse effects of misoprostol.
*GI distress
uterine contractions & vaginal bleeding in female dogs (uncommon)
abortion if given during pregnancy
591
*What is a microRNA?
*a small non-coding RNA molecule (containing about 22 nucleotides) found in plants, animals and some viruses, that functions in RNA silencing and post-transcriptional regulation of gene expression
592
*What is the most potent stimulator of aldosterone secretion? List 2 other stimulators of aldosterone secretion.
*Strongest stimulus = hyperkalemia
2 other stimuli = angiotensin II, ACTH
593
*Describe stage A DMVD
*At high risk for developing DMVD but without a murmur (such as all Cavaliers without murmurs)
594
*Describe stage B DMVD.
*Patients with structural heart disease that have never developed clinical signs of CHF
595
*What is the difference between stage B1 and stage B2 in DMVD?
*Stage B1 - asymptomatic patients with no evidence of cardiac remodeling
Stage B2 - asymptomatic patients with hemodynamically significant regurgitation resulting in left heart enlargement
596
*Describe stage C DMVD.
*Patients with past or current clinical signs of CHF
597
*Describe stage D DMVD
*Patients with end-stage CHF, refractory to standard therapy
598
*Would you expect hyper- or hyponatremia in cases of nephrogenic diabetes insipidus?
*hypernatremia due to pure water loss
599
What is the main stimulus for ADH release?
Increased serum osmolality
600
Which 2 electrolyte abnormalities have been determined to be a CAUSE of nephrogenic diabetes insipidus?
hypercalcemia and hypokalemia
both situations interfere with action of ADH in collecting ducts
601
How do thiazide diuretics reduce polyuria in dogs with NDI?
Inhibit resorption of Na+ in distal tubule --> decreased total body sodium --> increased resorption of Na+ and water in proximal tubule --> decreased Na+ concentration in distal tubule --> increased WATER resorption in distal tubule
602
*Secretion of glucagon is inhibited by...
*insulin
somatostatin
FFAs
ketoacids
urea
603
*How do you calculate odds ratio using this chart?
*odds ratio = ad/bc
604
In what type of study would you calculate an odds ratio?
case control study
605
*Extracellular fluid accounts for what proportion of total body water? What proportion is interstitial and vascular?
*1/3 of total body water is ECF-
3/4 of that is interstitial, 1/4 vascular
606
*Which inflammatory mediator is the strongest chemokine?
*leukotriene B4
607
*Define functional residual capacity
*The volume of air present in the lungs at the end of passive expiration
608
*Which 2 cardiac abnormalities will result in hyperkinetic pulses?
*aortic insuffiency and PDA
609
*How do cardiac glycosides (digoxin, ouabain, foxglove) work?
*inhibit Na-K-ATPase pump
610
*What nerve innervates the external urethral sphincter? What type of innervation is it?
*pudendal nerve, somatic acting on nicotinic receptors
611
What nerves innervates the detrusor? What types of innervation are they?
hypogastric - sympathetic acting on beta3 receptors (stimulation results in detrusor relaxation)
pelvic - parasympathetic acting on muscarinic receptors (stimulation results in detrusor contraction)
612
Which nerve innervates the internal urethral sphincter? What type of innervation is this?
hypogastric nerve - sympathetic (acts on alpha1 receptors to contract internal sphincter)
613
*What constitutes the largest pool of iron in the body?
*hemoglobin
614
*What type of immunoglobulin is involved in type I hypersensitivity reactions?
*IgE
615
*Which cells stimulate B cells to produce IgE in type I hypersensitivity reactions?
*CD4+ Th2 cells
616
*Glomerulonephritis is an example of what type of hypersensitivity reaction?
*type III (immune complex)
617
Describe type II hypersensitivity reactions.
cytotoxic hypersensitivity - antibodies produced by B cells bind to antigens on patient's own cells and activate complement
618
What types of immunoglobulins are involved in type II hypersensitivity reactions?
IgG and IgM
619
Describe type III hypersensitivity reactions.
Immune-complex reaction - excess amounts of antigen bind antibodies and form complexes, which deposit in small vessels, joints, and glomeruli
620
Describe type IV hypersensitivity reactions.
Cell-mediated (delayed) - CD4 Th1 cells recognize antigen on MHCII and activate CD8 T cells which destroy affected cells
621
NK cells are what type of lymphocytes?
large granular lymphocytes
622
*NK cells contain granules, which release what?
*perforin and granzymes
623
Is enrofloxacin bacteriocidal or bacteriostatic?
bacteriocidal
624
Is enrofloxacin concentration- or time-dependent?
concentration dependent
625
*What is the mechanism of action of enrofloxacin?
*inhibits DNA gyrase, which prevents DNA coiling and DNA synthesis
626
*What is the mechanism of TMS?
*inhibits bacterial folate synthesis
627
*Long term use of TMS can result in what endocrine condition in dogs?
*hypothyroidism, with consistent clinical signs
628
*Cryptosporidium hominis is an obligate parasite of what species?
*humans
629
*List 2 major endogenous pyrogens. List a few minor endogenous pyrogens as well.
*Major: IL-1 and IL-6
Minor: TNF-beta, TNF-alpha, IL-8, IFN-alpha, IFN-beta, IFN-gamma
630
*Which lipoproteins contain the highest triglyceride content?
*VLDL
631
Which lipoprotein contains the highest cholesterol content in dogs and cats? What about in other species?
HDL in dogs and cats (Ettinger)
LDL in all other species
632
*Dexamethasone is how many times more potent than prednisone?
*7x more potent
633
What is the large form of Babesia in dogs?
B. canis
634
What is the small form of Babesia in dogs?
B. gibsoni
635
What is the main tick vector for Babesia?
Rhipicephalus sanguineus (brown dog tick)
636
Which stage of Babesia INFECTS the RBC?
sporozoites
637
*Which stage of Babesia causes HEMOLYSIS of RBCs?
*merozoites
638
Which Babesia species is associated with pitbulls?
B. gibsoni
639
*Which immunoglobulin is primarily associated with mucosal surfaces?
*IgA
640
*Which amino acid deficiency is associated with retinal degeneration in cats?
*taurine deficiency
641
*List common signs of hepatic encephalopathy in cats.
*hypersalivation , seizures, head pressing, ataxia, weight loss, GI signs
642
*What cell type does metronomic chemotherapy target?
*endothelial cells lining the blood vessels that supply tumors
643
*What is the MOA of diazoxide?
*directly inhibits pancreatic insulin secretion by inhibiting closure of K channels on beta cells, preventing depolarization
also stimulates beta adrenergic system to enhance hyperglycemia
644
*FeLV and FIV infection results in decreased numbers of what cell type?
*CD4 lymphocytes
645
*A hypoglycemic patient is noted to have a gastric mass. What is the most likely type of tumor?
*leiomyosarcoma
646
*Which NSAID has been shown to be effective in treatment of lymphoplasmacytic rhinitis?
*piroxicam
647
*Tetanus antitoxin binds what form of the tetanus toxin in the body?
*Free toxin
648
*In what cases is treatment of salmonellosis indicated?
*Only in severe cases or in SEPTIC salmonellosis. Treatment of intestinal salmonellosis can result in development of antibiotic-resistant strains and prolonged shedding
649
*Which toll-like receptor is responsible for recognizing lipopolysaccaride?
*TLR-4
650
*What is the ligand for TLR-4?
*lipopolysaccaride (LPS)
651
*What percentage of sodium is reabsorbed in the proximal convoluted tubule?
*65%
652
*List 3 drugs in which intralipid therapy could be useful
ivermectin, permethrin, baclofen
653
*What dose of steroids is used in dogs with PLE?
*immunosuppressive doses (2mg/kg/d)
654
*Why is polydipsia associated with steroid administration an especially important issue in dogs being treated for PLE?
*Because increases in free water can result in dramatic worsening of edema/ascites
655
*What is the initial treatment of choice for dogs with idiopathic PLE?
*Immunosuppressive doses of steroids. Cyclosporine can also be considered as monotherapy
656
*Which breed is predisposed to development of idiopathic head tremors?
*English Bulldogs
657
*IMHA is most commonly associated with what immunoglobulin binding to erythrocytes?
*IgG, however some dogs will have IgG and IgM (more common in intravascular hemolysis)
658
*What is the Baermann fecal test used for?
*Detection of nematode larvae (typically used to diagnose lungworm)
659
*What electrolyte abnormality exacerbates digoxin toxicity?
*hypokalemia
660
*Why does hypokalemia exacerbate digoxin toxicity?
*Digoxin binds the Na/K/ATPase pump in the position normally occupied by K+. If potassium levels are low, then more digoxin can bind to the pumps, precipitating toxicity
661
*Which worsens hepatic encephalopathy - acidosis or alkalosis?
*Alkalosis... shifts reaction equilibrium [NH3 + H+ NH4+] left, towards production of nonionized ammonia, which is the form that penetrates neuronal membranes
662
*Which worsens hepatic encephalopathy - hypokalemia or hyperkalemia?
*Hypokalemia because it causes potassium to shift extracellularly in exchange for H+ moving intracellularly --> alkalosis, which results in more nonionized ammonia, which penetrates neuronal membranes
663
Which worsens hepatic encephalopathy - hypoglycemia or hyperglycemia?
Hypoglycemia - because it potentiates the activity and production of other neurotoxins
664
*What exacerbates release of ALP from hepatocyte cell membranes in cholestasis?
*Bile acids
665
*Why does effusion form in cats with FIP?
*Immune-complex vasculitis, and FIP infected monocytes releasing VEGF and other factors, increasing permeability and causing effusion
666
*What is the MOA of cyclosporine?
*binds to T-cell cyclophilin & blocks calcineurin-mediated T-cell activation at G0 phase of cell cycle (mainly T helper cells). Also inhibits cytokine production and release (especially IL-2)
667
*What is the largest pool of iron in the body?
*Hemoglobin (66% of iron stores)
668
*What oral immunosuppressive is the treatment of choice for perianal fistulas in dogs?
*cyclosporine
669
*What is the MOA of phenylpropanolamine?
*sympathomimetic - alpha and beta adrenergic agonist
670
*Why is cisplatin use contraindicated in cats?
*Results in fatal pulmonary edema
671
*List clinical signs of marijuana toxicity in dogs.
*depression, hypersalivation, mydriasis, hypermetria, vomiting, urinary incontinence, tremors, hypothermia, bradycardia
At high doses: nystagmus, agitation, tachycardia, ataxia, seizures, hyperexcitability
672
*T/F: Intralipid therapy can be used in marijuana toxicity.
*True! Marijuana is highly lipophilic
673
*T/F: Marijuana undergoes enterohepatic recirculation
*True! Therefore, re-dose activated charcoal at 4-8hr intervals
674
*What characteristics of marijuana result in slow elimination from the body?
* 1. highly lipophilic
2. highly protein bound
3. large volume of distribution
4. enterohepatic recirculation
675
*What muscles are innervated by cranial nerve 3?
*dorsal rectus
ventral rectus
medial rectus
ventral oblique
levator palpebrae
contains parasympathetic fibers for pupillary constriction
676
*What is mesna?
*A chemoprotectant medication used to prevent cyclophosphamide-induced hemorrhagic cystitis
677
Which chemotherapeutic agent is associated with hemorrhagic cystitis?
cyclophosphamide
678
*Why is liposomal amphotericin B less nephrotoxic than regular amphotericin B?
*Liposome prevents the medication from early degradation/inactivation, while also enhancing drug delivery to diseased tissue and decreasing the amount of free drug
679
*What is the MOA for maropitant?
*neurokinin-1 receptor antagonist. Acts in CNS to inhibit action of substance P, a major neurotransmitter involved in vomiting. Suppresses central AND peripheral emesis
680
*How does glargine work to provide long-acting glycemic control?
*Following SQ injection, the acidic solution is neutralized & microprecipitates are formed that slowly release small amounts of insulin glargine
681
*What is the MOA of clopidogrel?
*Inhibits both primary AND secondary platelet aggregation.
Active metabolite binds selectively to platelet surface ADP-receptors & inhibits ADP binding, thereby reducing platelet aggregation. Irreversibly alters ADP receptor so the platelet is affected for its lifespan.
682
*How does metoclopramide improve GI motility?
*sensitizes upper GI smooth muscle to the effects of acetylcholine
683
What is the MOA of metoclopramide's anti-emetic effects? Why is it less effective in cats?
Dopamine antagonist, weak inhibitor of 5HT3
Less effective in cats because they have few dopamine receptors in the CNS
684
What are the vitamin K dependent clotting factors?
II, VII, IX, and X
also protein C and protein S
685
*What is the recommended test for diagnosing heartworm infection in cats?
*Heartworm antibody test -- cats often have very few worms, if they are all male then the antigen test will be negative!
686
What is the tradename for oclacitinib?
Apoquel
687
*What are adverse effects associated with oclacitinib?
*GI side effects
Polydipsia
Lethargy
Lymphadenopathy
Increase susceptibility to infection (pneumonia, demodicosis)
Neoplasia?
688
*List effects of TNF-alpha on adipose tissue.
*inhibition of:
carbohydrate metabolism, lipogenesis, & thermogenesis
stimulation of lipolysis
689
*What electrolyte causes the upstroke of the action potential in nerve cells?
*Na+... opening of voltage-gated Na channels results in inward Na+ current
690
*At the neuromuscular junction, what causes release of neurotransmitter?
*Influx of calcium
691
*List the essential fatty acids for dogs.
*Linoleic
Alpha-linolenic
Gamma-linoenic
+/- eicosapentaenoic
+/- docosahexaenoic
692
*List the essential fatty acids for cats
*Arachidonic
Linoleic
Alpha-linolenic
Gamma-linoenic
+/- eicosapentaenoic
+/- docosahexaenoic
693
*Which fatty acid is considered essential in cats, but not dogs? Why is this true?
*Arachidonic acid... Dogs can convert linoleic acid to arachidonic acid, but cats cannot
694
*In early goal-directed therapy of patients in shock, what is the target MAP?
*65-90mmHg
695
*In early goal-directed therapy of patients in shock, what is the target CVP?
*8-12mmHg
696
*In early goal-directed therapy of patients in shock, what is the target UOP?
*at least 0.5mL/kg/hr)
697
*In goal-directed resuscitation of shocky patients, what is the sequence recommended for pressors, pRBCs, fluids, and inotropic agents in most cases?
fluids --> pressors --> pRBCs --> inotropic agents
698
*List the 4 categories of causes of pulmonary hypertension.
* 1. left-sided CHF (most common)
2. primary lung disease (fibrosis, chronic bronchitis, tracheal collapse)
3. diseases affecting pulmonary arteries (heartworm, L-->R shunts)
4. chronic thrombotic/embolic disease (heartworm, PTE)
699
*A split S2 sound has been associated with what condition?
*pulonary hypertension
700
*What are typical clinical signs associated with pulmonary hypertension?
*cough, exercise intolerance, syncope, tachypnea, respiratory distress
701
*Which prostaglandin is decreased in patients with pulmonary hypertension?
*Prostacyclin (also known as PGI2)
702
*A notched QRS is seen in what congenital cardiac condition?
*tricuspid valve dysplasia
703
*What results in constriction of the pulmonary arteries?
*Hypoxemia, endothelin
704
*What results in dilation of the pulmonary arteries?
*prostacyclin, nitric oxide, increased PO2
705
What is the MOA of dirlotapide?
dirlotapide = slentrol.
microsomal triglyceride transfer protein (MTTP) inhibitor. Blocks assembly & release of lipoproteins into bloodstream, thereby reducing fat absorption. Also elicits satiety signal from lipid-filled enterocytes
706
*What are the most common bloodwork findings in dogs with hemophagocytic histiocytic sarcoma?
*Coombs negative regenerative anemia
hypoalbuminemia
thrombocytopenia
hypocholesterolemia
mildly prolonged PTT
mild hyperbilirubinemia
707
*For what types of glomerular disease may steroids be most indicated?
* 1. fulminant cases where immediate immunosuppression is required, or
2. multi-systemic immune-mediated diseases where their use has proven beneficial (i.e. concurrent IMPA or IMHA)
708
*When pancreatic bicarbonate is secreted, what follows?
*sodium and water (via osmosis)
709
*Pancreatic bicarbonate is secreted in exchange for _____.
*Chloride
710
https://s3.amazonaws.com/classconnection/493/flashcards/7874493/png/screen_shot_2016-12-28_at_41521_pm-1594749DCB62A1DE507.png
*Atrial fibrillation
711
*What is the most potent stimulator of hydrogen secretion in the distal tubule?
*CO2
712
What is the lifespan of an erythrocyte in a dog? cat?
dog: 110 days
cat: 70 day
713
*Which WBC has the shortest half life in the dog?
*eosinophil (T1/2 = 10hrs)
714
*T/F: Staphylococcus aureus from horses and dogs can be transmitted to people.
*True
715
*CD36 deficiency is linked to what conditions?
*hyperlipidemia, hypertension, insulin resistance
716
*T/F: CD36 plays an important role in fatty acid metabolism.
*True!
717
*Why might you see an elevated T3 or T4 in a dog with thyroiditis?
*Anti-thyroid hormone antibodies can produce a spurious increase in these hormones unless free T4 is measured by equilibrium dialysis
718
*What disease might you suspect if you had a dog with an elevated TT4 and TSH?
*Thyroiditis resulting in hypothyroidism. Anti-T4 antibodies can cause spuriously increased TT4 concentrations. Would expect free T4 (by equilibrium dialysis) to be low
719
*What is the most common primary brain tumor in dogs?
*Meningioma (~50%), second would be glioma
720
*What is the most common secondary brain tumor in the dog?
*Hemangiosarcoma
721
*Cholecystokinin (CCK) is secreted from what cells?
*I cells of duodenum and jejunum
722
*List 2 stimuli for secretion of CCK.
*1. small peptides and amino acids 2. fatty acids
723
*List 5 functions of CCK.
*1. stimulate panc enzyme secretion 2. stimulate panc HCO3 secretion 3. stimulate contraction of gallbladder and relaxation of sphincter of oddi 4. stimulates growth of exocrine pancreas and gallbladder 5. inhibits gastric emptying
724
*Secretin is secreted from what cells?
*S cells of duodenum
725
*List 2 things that stimulate secretion of secretin.
*1. H+ in the duodenum 2. fatty acids in the duodenum
726
*List 4 functions of secretin.
*1. stimulate panc HCO3 secretion 2. stimulate biliary HCO3 secretion 3. inhibit gastric acid secretion 4. inhibit trophic effects of gastrin on gastric mucosa
727
*What is the main breakdown product of carbohydrates in the small intestine?
*Glucose
728
*What is the MOA of mitoxantrone?
*type II topoisomerase inhibitor - disrupts DNA synthesis and repair by intercalation between DNA bases
729
*What drug is used in dogs with polycythemia vera?
*Hydroxyurea
730
What 3 factors are used to determine the appropriate dose of a given drug?
1. C max (maximum concentration)
2. volume of distribution (V d )
3. bioavailability (F)
dose = (C max x V d ) / F
731
*What surface antigen is important for an APC cell to express in order to activate and stimulate T helper cells?
*MHC II
732
What is secreted in the bile that aids in iron absorption?
*apotransferrin
733
*What is the lifespan of a neutrophil in normal tissue?
*24-48h
734
In generation of the respiratory burst in neutrophils, oxygen combines with _____ to produce superoxide.
NADPH
735
*What is the first step in the classical complement pathway?
*C1 initiates classical complement pathway by binding to Ag-IgG and becomes activated --> cleaves C2 and C4 --> cleave C3
736
Which complement factors form the MAC?
C5-C9
737
What type of organisms are targeted by defensins?
organisms with cholesterol-free, negatively charged membrane (bacteria, fungi, viruses)
738
Where are perforins located? Where are defensins located?
perforins = cytotoxic T cells, NK cells
defensins = neutrophil granules, epithelial cells
739
*What are Heinz bodies and how are they formed?
*Hemoglobin remnants in RBC form from oxidative damage
740
Where are L-selectins found? Where are P-selectins found? Where are E-selectins found?
```
L-selectin = WBCs
P-selectin = platelets and endothelium
```
E-selectin = endothelium
741
Glanzmann's thrombasthenia is seen in which breed? It is associated with absent or reduced ______.
Otterhound, Great Pyrenees
absent or reduced GPIIb-IIIa complex --> abnormal platelet adhesion
742
What is Chediak-Higashi syndrome and which breed is predisposed?
Blue smoke persian cats
Results in disordered lysosomal trafficking and impaired lysosome degranulation, neutroenia, reduced # dense granules in platelets
743
What are contained within dense granules of platelets?
ADP, ATP, calcium, serotonin
744
What is different between aspirin's effect on thromboxane and other NSAIDs' effect?
aspirin's effect is irreversible whereas others are transient
745
What breed is predisposed to cyclic neutropenia?
grey collies
746
*What is the defect seen in dogs with CLAD? Which breed is predisposed?
Irish Setters
autosomal recessive --> missense mutation in ITGB2 gene coding for beta2 integrin CD18
also have deficiency in CD11 integrin
decreased neutrophil adherence
747
*What would be seen in the following parameters with iron deficiency anemia? - [Fe], TIBC, stainable BM iron, [ferritin]
*decreased [Fe], increased/normal TIBD, decreased BM iron, decreased ferritin
748
*What would be seen in the following parameters with anemia of inflammatory disease? - [Fe], TIBC, stainable BM iron, [ferritin]
*decreased [Fe], decreased TIBC, increased BM iron, increased ferritin
749
*What do the following test: ACT, PT, PTT?
*ACT and PTT - intrinsic and common pathways
PT - extrinsic and common pathways
750
Are there such thing as Y-linked diseases?
yes, but very rare
751
*If you breed 2 affected animals with an autosomal recessive disease, will there be normal offspring?
*no! all will be homozygous affected
752
Which of the following is in the GI tract: apotransferrin, transferrin, ferritin?
apotransferrin
753
T/F: EPO is made exclusively in the renal epithelial cells.
False! 90% made in kidney, 10% made in the liver
754
What features of the endothelium are antithrombotic?
1. smooth surface
2. layer of NEGATIVELY-charged glycocalyx which repels clotting factors and platelets
3. thrombomodulin (binds thrombin and activates protein C)
755
Protein C inactivates which factors?
factor V and VIII
756
*Which ILs are absent in x-linked SCID?
*IL-2, IL-2, IL-7, IL-9, IL-15
757
What is the most common cause of death in x-linked SCID?
overwhelming bacterial or viral infection
758
Describe levels of IgM, IgG, and IgA in x-linked SCID.
normal IgM level
reduced/absent IgG
absent IgA
759
T/F: High shear stress induces expression of GPIIb/IIIa.
true
760
Which complement factor plays an important role in opsonization?
C3b
761
Which complement component is important for WBC chemotaxis?
C5a
762
Is immune complex deposition more likely when there are equal numbers of antigens and antibodies or when there is an absolute elevation in antibodies?
equal numbers
763
What is type I vWD?
most common form (Dobies)
low plasma vWF but normal multimer distribution
clinical signs if 15% or lower vWF:Ag
764
What is type II vWD?
causes moderate to severe bleeding
disproportionate loss of high-MW multimers
german short and wire haired pointers
765
What is type III vWD?
total loss of vWF, severe bleeding
dutch kookiers, scotties
766
*Can animals with hemophilia A survive to a reproductive age?
*Yes, but can die at birth from umbilical hemorrhage
767
*What is the definition of an autoimmune disease?
*Loss of immune tolerance to your own tissues
768
*What is contained in granules of basophils?
*heparin, histamine, serotonin, bradykinin
769
Are basophils precursors of mast cells?
no!
770
Which enzyme in fat metabolism is stimulated by heparin?
lipoprotein lipase
771
By binding to and activating ____, heparin inhibits which 5 clotting factors?
binds to and activates antithrombin-3
inhibits II, IX, X, XI, XII
772
Why might hyperkalemia occur in patients treated with heparin?
due to suppression of aldosterone by heparin
773
*Which immunoglobulin is most abundant in the body?
IgG
774
Which immunoglobulin can cross the placenta?
IgG
775
*Which immunoglobulin is found in secretions?
*IgA
776
T/F: IgA works by activating complement
False! IgM activates complement, IgA does not
777
What is the half life of IgE, IgM, and IgG?
```
IgE = 2d
IgM = 5d
```
IgG = 23d
778
What is the inheritance pattern of Pelger-Huet anomaly? Which breeds are affected?
autosomal dominant
Australian shepherds (also heelers, cockers, foxhounds, GSDs, others)
779
*What causes a rightward shift in the O2-Hgb dissociation curve? What does a rightward shift mean?
decreased pH
increased CO2
increased temp
increased 2,3-DPG
rightward shift means O2 is released at tissues more easily!
780
*What is the most common form of CO2 in the blood?
*HCO3
781
*What is the primary stimulus of the respiratory center in the medulla?
*H+
782
How does CO2 stimulate the respiratory center in the medulla?
Since H+ is the main stimulus, but cannot cross BBB, CO2 crosses BBB and combines with H2O to form H2CO3, which dissociates into H+ and HCO3- and H+ then activates the respiratory center
783
Peripheral chemoreceptors are located _____ and respond to _____
located in aortic and carotid bodies
respond to decreased O2 (and less-so to increased CO2 and increased H+)
784
*What is the definition of tidal volume?
*The volume of air inspired/expired in a normal breath
785
What is functional residual capacity?
The amount of air that remains in the lungs after normal expiration
786
What is residual lung capacity?
The amount of air remaining in the lung after the most forceful expiration
787
*What is the limiting factor in terms of how much air can be expelled during maximal expiration?
compression of the airways by intrathoracic pressure
788
*What part of the airways presents the LEAST resistance to airflow?
*Terminal bronchioles - because there are so many of them that the cross-sectional area of the terminal bronchioles is much higher than that of the larger airways
789
*What form of iron binds oxygen in the RBC?
*ferrous iron (Fe2+)
790
List one substance that is activated in the lung and one that is inactivated in the lung.
angiotensin I activated to angiotensin II by ACE
bradykinin inactivated in the lung (also by ACE)
791
List 5 substances that are cleared by the lung
serotinin
norepi (up to 30%)
PGE2
PGF2a
leukotrienes
792
*Where is the pneumotaxic center and what does it do?
*located in the pons, controls rate and depth of breathing
793
What is the difference between the ventral and dorsal respiratory groups in the medulla?
dorsal - causes inspiration
ventral - causes expiration
794
What are the 5 causes of hypoxemia?
1. low FiO2
2. V/Q mismatch
3. R-->L shunt
4. Diffusion impairment
5. hypoventilation
795
Which cause of hypoxemia does NOT improve with oxygen supplementation?
R--L shunt
796
What causes of hypoxemia result in an INCREASED A-a gradient?
diffusion barrier
V/Q mismatch
R--L shunt
797
Which causes vasodilation - endothelin or bradykinin?
bradykinin causes vasodilation
endothelin causes vasoconstriction
798
Is NO a vasodilator or vasoconstrictor?
vasodilator via increase in cGMP
799
How does sildenafil work in the lungs?
inhibits PDE-5, which is an enzyme that degrades cGMP --> increased cGMP (prolonging effects of NO to cause vasodilation)
800
Which is a more powerful vasoconstrictor - angiotensin II or vasopressin?
vasopressin
801
Describe the signaling pathway from baroreceptors in response to increased BP.
Increased BP --> increased stretch --> signal from carotid sinus transmitted through Hering's nerve ( CN IX ), signal from aortic arch transmitted through CN X --> tractus solitarius in medulla
802
What happens with each heart sound - S1-S4?
S1 - AV valves close
S2 - semilunar valves close
S3 - rapid ventricular filling
S4 - atrial kick
803
What causes a split S2?
inspiration (large dogs)
pulmonary hypertension
L-R shunts
pulmonic stenosis
RBBB
ectopic beats
ventricular pacing
804
What does wandering pacemaker look like on ECG?
transient changes in the size, shape, and direction of P waves
taller P waves when HR is fast, shorter when HR slow
805
What is the difference between Mobitz type I and II AV block?
type I = gradually prolongs PR interval until block occurs
type II = fixed PR interval, then suddenly blocks (more commonly pathologic)
806
What are the points on the body to use for a vagal maneuver?
ocular pressure on both eyes
carotid sinus massage at the upper neck
807
Describe effects of PGI2 at the following receptors: IP receptor, EP1 receptor, EP 2 receptor
IP receptor - vasodilation, inhibit platelet aggregation, bronchodilation
EP1 - bronchoconstriction, smooth muscle contraction
EP2 - bronchodilation, smooth muscle relaxation
808
What happens in the stomach when PGE2 binds to the EP3 receptor?
decreased gastric acid secretion, increased gastric mucous secretion, increased gastric HCO3 secretion
809
Differentiate class Ia, Ib, and Ic anti-arrhythmics and when you use them
Ia - intermediate Na ch. blockers - quinidine, procainamide - SVT, VT
Ib - fast - lidocaine, mexilitine - VT
Ic - slow - propafenone, flecainamide - SVT
810
Class II antiarrhythmics are what types of drugs?
beta blockers - used for supraventricular tachycardias
811
Which of the following is a nonselective beta blocker? atenolol, propanolol, esmolol, metoprolol, carvedilol
propanolol - nonselective beta blocker
carvedilol - nonselective beta blocker and alpha1 blocker
812
What is the MOA of class III antiarrhythmics? Give 2 examples.
prolong action potential duration and refractory period by inhibiting the repolarizing potassium channel
amiodarone, sotalol
813
Which drug exhibits properties of ALL 4 classes of antiarrhythmics?
amiodarone
814
Calcium channel blockers are used to control what types of arrhythmias?
supraventricular tachycardias
815
What is the MOA of type IV anti-arrhythmics? What are the 2 types?
inhibit slow inward Ca channel currents (L-type) to slow sinus rate and AV conduction
dihydropyridines = act on vasculature (amlodipine)
non-dihydropyridines = act on SA & AV nodes (diltiazem, verapamil)
816
*What are the typical clinical signs of heartworm in cats?
*Asthma-like signs, vomiting, +/- CNS signs (aberrant migration), or no signs
817
What is the most common congenital heart disease in cats?
VSD
818
What is the most common congenital heart disease in dogs?
PDA
819
A young cat has a grade IV/VI heart murmur with the PMI on the right side and large pulmonary arteries on rads - what is the most likely diagnosis?
VSD
820
*T/F: Right to left PDAs should be surgically repaired
*FALSE!!! Reverse PDA means that pulmonary hypertension is BAD. Fixing shunt will worsen PH and cause death
821
Eisenmenger's physiology refers to what?
right to left shunting (shunt reversal) with PDA
822
T/F: A right to left shunting VSD results in differential cyanosis
False! Only a R-L PDA causes differential cyanosis because the shunt occurs in the descending aortal after the vessels to the front end branch off. R-L VSD would cause cyanosis of cranial AND caudal MM
823
Sepsis results in what type of shock?
distributive
824
What is the shock organ in the dog? cat?
```
dog = GI tract
cat = lung
```
825
*On what part of the kidney does mannitol act?
*proximal tubule by decreasing water reabsorption via osmotic diuresis
826
Loop diuretics act on what part of the loop of henle?
thick ascending limb - inhibit Na/K/2Cl cotransporter
827
What is the MOA of thiazide diuretics?
inhibit Na-Cl cotransport in early distal tubule
828
Where in the kidney do carbonic anhydrase inhibitors act? What do they do?
proximal tubule - inhibits H+ secretion and HCO3- resorption, which leads to decreased Na+ resorption as a result of lack of Na-H counter transport --> osmotic diuresis by Na+ and HCO3-
829
Which diuretic can cause ototoxicity - spironolactone, mannitol, furosemide, hydrochlorothiazide?
furosemide
830
*Where is the most Mg reabsorbed by the kidney?
In the thick ascending limb of the LOH - backleak of K+ from Na/K/2Cl cotransporter leads to positive luminal charge, which drives Mg and Ca to diffuse from lumen via paracellular route
831
*What would be the expected fractional excretion of Na in pre-renal azotemia?
*FE<1% because in an effort to restore volume status, more Na will be reabsorbed, reducing the amount in urine
832
*How will the following effect GFR: chronic hypertension, PGE2, norepi, endothelin, angiotensin II?
chronic hypertension - decrease
PGE2 - increase
norepi - decrease
endothelin - decrease
angiotensin II - stays the same (prevents decrease)
833
What form of glomerulonephritis is associated with lyme disease?
membranoproliferative glomerulonephritis
834
What are the 3 layers of the glomerular filtration membrane?
endothelial cells, basement membrane, podocytes
835
What is type I renal tubular acidosis? How can it be diagnosed?
DISTAL RTA - failure to excrete H+
dx: urine cannot be maximally acidified because occurs in distal tubules - ammonium Cl test (normal dogs will drop urine pH<5)
836
What electrolyte abnormalities would you expect with type I RTA?
hyperchloremic metabolic acidosis
hypokalemia
increased urine calcium
837
What is type II renal tubular acidosis?
PROXIMAL RTA
failure to reabsorb HCO3 in proximal tubule
urine can still be maximally acidified due to compensation by the rest of the kidney
838
What electrolyte abnormalities would you fine in type II RTA?
hyperchloremic metabolic acidosis, +/- hypokalemia, +/- glucosuria form Fanconi's
839
T/F: You need to biopsy both cortex and medulla of the kidney in order to diagnose glomerulonephritis in the kidney.
False! Only need cortex
840
*T/F: Renal tubular acidosis causes a high anion gap acidosis
False! Causes a non-anion gap acidosis (hyperchloremic metabolic acidosis)
841
Which type of renal tubular acidosis requires more bicarbonate supplementation?
type II (proximal)
842
What is the major route of calcium reabsorption in the proximal tubule?
paracellular route (most calcium)
20% moves transcellular by diffusing into the cell, then pumping across basolateral membrane with CaATPase or NaCa counter transporter
843
In the proximal tubule, phosphate reabsorption occurs primarily via what mechanism?
transcellular movement with a transport maximum (which can be adjusted by PTH levels)
844
Can you dissolve struvite stones in a cat if the urine osmolality is high?
NO!
845
*What defect in Dalmatians results in urate stone formation?
* reduced transport of uric acid into hepatocytes for conversion to allantoin leading to hyperuricemia AND absent uric acid reabsorption in the proximal tubule following glomerular filtration
846
What is the inheritance pattern of the urate transporter defect in Dalmations? What percent of Dalmations are affected?
autosomal recessive
100% of dalmations are affected (homozygous)
847
*At what age are Dalmatians with urate uroliths most commonly affected?
*median age is 3.5y
848
Polyuria is defined as >___mL/kg/d
Polydipsia is defined as >___mL/kg/d
polyuria >50mL/kg/d
polydipsia >100mL/kg/d
849
If there is no concentration of urine during a desmopressin response test, what is the diagnosis?
nephrogenic DI
850
Which ketones are detected on urine dipsticks?
acetoacetate (mainly), also acetone
NOT BHB
851
Which protein is the urine dipstick more sensitive to - hemoglobin or myoglobin?
hemoglobin
852
Can cysteine stones be dissolved?
Yes - low protein alkalinizing diet + thiol-containing drugs (2-MPG or D-penicillamine)
853
Can urate stones be dissolved?
Yes - purine-restricted diet, urinary alkalinization, allopurinol (xanthine oxidase inhibitor)
854
What is the most common side effect in pituitary dwarves treated with GH?
diabetes mellitus
also hypersensitivity reactions, carbohydrate intolerance
855
How do glucocorticoids affect carbohydrate, lipid, and protein metabolism?
stimulate glycogen deposition and gluconeogenesis
stimulate lipolysis
catabolism of protein
856
How does insulin affect carbohydrate, fat, and protein metabolism?
stimulates glycogen deposition and gluconeogenesis
inhibits lipolysis
anabolic of protein
857
How does glucagon affect carbohydrate and fat metabolism?
stimulates glycogenolysis and gluconeogenesis
stimulates lipolysis
858
Where are hormone receptors typically located for steroids?
in the cytoplasm
| also nucleus
859
Where are hormone receptors typically located for peptide hormone and catecholamines?
cell surface
860
Where are hormone receptors located for thyroid hormones?
nucleus
861
*What is the MOA of methimazole?
blocks thyroid hormone synthesis by inhibiting thyroid peroxidase
862
T/F: Thyroid nodules may enlarge in response to treatment with methimazole
true - because TSH will stimulate the thyroid
863
What percent of dogs with hypothyroidism have a normal TSH?
15-20%
864
A normal TT4 in a dog with hypothyroidism may be due to _____
anti-T4 antibodies
865
In which breeds might you want to look at TT3 when testing for hypothyroidism?
sighthounds - they NORMALLY have low fT4 and TT4, but TT3 is not normally low
in other breeds, TT3 is not very useful
866
In hypothyroid dogs, what SINGLE value has the highest Sn, Sp, and accuracy for detection of hypothyroidism?
fT4 by ED
867
What would be expected on muscle biopsy in a dog with hypothyroidism?
type II myofiber atrophy
868
*Ketone bodies are formed in the liver when there are decreased levels of _____
*oxaloacetate
869
T/F: During starvation or DKA, the liver uses ketones as an energy source
False! The liver CANNOT use ketones for energy because it lacks succinyl-CoA transferase (AKA beta-ketoacyl CoA transferase)
870
What is the MOA of glipzide?
sulfonurea that increases insulin secretion
binds potassium channels on beta cells & closes them --> depolarizes cell --> Ca influx --> insulin release
871
What is the best course of action to treat a diabetic once a Somogyi has been recognized?
reduce insulin dose by at least 50%
872
What are SGLTs and where are they located?
Na-glucose cotransporters
SGLT1 - small intestines, and a little in proximal tubule
SGLT2 - proximal tubule
873
Insulin activates/inhibits glucokinase
activates
874
When insulin is absent, glucose phosphatase is activated/inhibited
activated to release glucose base into circulation
875
T/F: High concentrations of amino acids stimulate glucagon release
true - particularly in response to arginine.
glucagon promotes conversion of AAs to glucose
876
*What is the MOA of trilostane?
*inhibits 3-beta hydroxysteroid dehydrogenase
877
What are the most common clinical signs in a dog with a macroadenoma?
listlessness, mental dullness, inappetance
878
*What would you expect renin levels to be in hyperaldosteronism?
*low or normal
879
What would the urine and serum osmolality be in SIADH?
high urine osmolality, low serum osmolality
880
What would you see on vaginal cytology during anestrus?
mostly acellular - scant small parabasal cells, occasional neutrophils, few bacteria
881
What would you see on vaginal cytology during proestrus?
shift from small parabasal cells to large intermediate cells to cornified superficial cells
882
What would you see on vaginal cytology during estrus?
80-100% superficial cornified cells, pyknotic nuclei
NO neutrophils
883
What would you see on vaginal cytology during diestrus?
parabasal cells, neutrophils
884
Describe hormone levels in canine anestrus
basal estrogen levels, progesterone nadir, high FSH
towards end - pulsatile GnRH secretion and elevation in LH
885
Describe hormone levels in canine proestrus
increase in estrogen levels to peak, decreased FSH levels, basal progesterone levels
886
Describe hormone levels in canine estrus
LH surge --> declining estrogen and increasing progesterone
887
Descrube hormone levels in canine diestrus
low estrogen, steady increase in progesterone which decreases 24 hours prior to parturition
888
Most dogs whelp ___ days after the onset of diestrus
56 days
889
*Which of the following would NOT be useful as to terminate pregnancy from a mismating? Bromocriptine, misoprostol, progesterone, estrogen, mifepristone
progesterone
890
*If a dog has a large flaccid bladder that is easily expressed, what is the most likely neurolocalization in the spinal cord?
*L4-S3
891
A dog presents with a left head tilt, circling to the left, with right-sided CP deficits, right strabismus - where is the lesion?
RIGHT central vestibular
this is paradoxical central vestibular (associated with central pontine lesion or lesion in flocculonodular lobe) causing head tilt and circling contralateral, but other signs ipsilateral
892
Can a dog with vertical nystagmus have peripheral vestibular disease?
Nope! vertical nystagmus is only seen in central vestibular disease
893
In peripheral vestibular disease, the fast phase of nystagmus is towards/away from the lesion.
fast phase away
894
*What is the major source of CSF in the brain?
*choroid plexus
895
*What drug would be useful if there was overstimulation at BOTH nicotinic and muscarinic receptors?
2-PAM
atropine/glyco only work at muscarinic receptors
896
*What nerve innervates the external urethral sphincter?
*pudendal nerve (S1-S3)
897
*An 8mo boxer presents febrile with neck pain and CSF analysis shows 80% neutrophils and increased protein levels - what is the most likely diagnosis?
*SRMA
| GME/NME typically cause a MONOnuclear pleocytosis
898
*A dog presents with tetraparesis, normal peripheral reflexes, and decreased palpebral reflexes. Which of the following is most likely - MG, botulism, tick paralysis, polyradiculoneuritis?
MG
all others would cause decreased peripheral reflexes
899
Which of the following may cause hyperesthesia: botulism, tick paralysis, polyradiculoneuritis?
polyradiculoneuritis
900
Which tick most commonly causes tick paralysis in the US? Australia?
dermacentor in US, ixodes in australia
901
What is the mechanism of tick paralysis? Does it affect cranial nerves?
neurotoxin from female tick interferes with acetylcholine release at NMJ
usually does NOT affect cranial nerves
902
*What is the mechanism of botulinum toxin?
*cleavage of SNARE proteins, which mediate docking of ACh-containing vesicles to the presynaptic endplate for release of ACh
903
*Where is the most CSF drained from?
*arachnoid villi
904
Which muscles are innervated by the mandibular branch of CN V? Which does NOT have 2M muscle fibers?
masseter
temporalis
pterygoid
tesnor tympani
tensor veli palatini (eustachian tube)
digastricus (does NOT have 2M fibers)
905
T/F: The digastricus muscle is affected by masticatory myositis.
False! it does NOT contain 2M muscle fibers
906
What is the initial response to decreased cerebral blood flow in head trauma?
increased blood pressure --> reflex bradycardia (Cushing's reflex)
907
Which of the following would contribute to increased intracranial pressure: increased CO2, decreased CO2, hypoxemia?
hypoxemia and hypercapnia would contribute because both would cause vasodilation
908
*Is Horner's syndrome a disease of the sympathetic or parasympathetic system?
*sympathetic - loss of sympathetic innervation
909
Describe location of lesions for 1st, 2nd, and 3rd order localizations of Horner syndrome.
1st order = central lesions involved hypothalamospinal tract (transection of cervical spine)
2nd order - preganglionic lesions (compression of sympathetic chain)
3rd order - post-ganglionic (lesion at the level of the internal carotid)
910
*Which cranial nerves contain sympathetic and parasympathetic fibers?
*CN III, VII, IX, X
911
From which spinal segments do preganglionic neurons of sympathetic nerves originate?
T1-L3
912
ACh typically inhibits/excites GI activity, Norepi typically inhibits/excites GI activity
ACh excites
| Norepi inhibits
913
Where does osteosarcoma typically metastasize to first?
lungs
NOT local lymph nodes
914
*What is the most common oral neoplasia in cats?
*SCC
915
What locations of canine melanoma tend to carry a better or worse prognosis?
haired skin - often benign
digit - worse prognosis
oral - worse prognosis
916
How does the melanoma vaccine work?
uses human tyrosinase to induce antibodies to tyrosinase, which is necessary for melanin synthesis
917
*What is the major side effect of cisplatin in cats?
*fatal pulmonary edema
918
*What is the major side effect of 5-fluoroacil in cats?
*neurotoxicity, cerebral hemorrhagic necrosis
919
*What two factors have the strongest association with prognosis in dogs with lymphoma?
*T cell associated with worse prognosis than B cell
substage B (clinically ill) has worse prognosis than not clinically ill
920
T/F: For mast cell tumors and soft tissue sarcomas in dogs - tumor grade carries prognostic significance
true
921
*What forms of lymphoma are most common in cats with FeLV?
*mediastinal, multicentric
922
What markers are associated with T cell vs. B cell lymphoma?
T cell = CD3
| B cell = CD21, CD79a
923
List 4 alkylating agents. MOA?
cyclophosphamide, CCNU, mustargen, chlorambucil
insert an alkyl group and change DNA structure - NOT cell phase specific
924
List 2 antitumor antibiotics. MOA?
mitoxantrone, doxorubicin
cause cross-linking (intercalation) of DNA. NOT cell phase specific
925
List 4 antimetabolite drugs. MOA?
methotrexate (folic acid antagonist)
5-FU (pyrimidine analog)
cytosar (pyrimidine analog)
azathioprine (purine analog)
masquerade as (or inhibit production of) chemicals needed for DNA synthesis, thereby disrupting synthesis by incorporation into DNA. Affect S phase of cell cycle
926
List 2 platinum drugs. MOA?
cisplatin, carboplatin
cross-links DNA at guanine residues.
NOT cell cycle specific
927
List 3 plant alkaloids. MOA?
vincristine, vinblastine, paclitaxel
inhibit mitotic spindle (tubulin). Acts on M phase of cell cycle
928
How does Elspar work?
Breaks down asparagine, which is an essential amino acid for the cancer cells
929
What is the MOA of hydroxyurea?
inhibits RNA and DNA by destruction of RNA reductase
S phase specific
930
List 3 receptor tyrosine kinases. MOA?
toceranib, mastinib, imatinib
block receptor tyrosine kinases thereby downregulating angiogenesis and signaling cascades
931
Which 3 chemo drugs cross the BBB?
CCNU, cytosar (cytarabine), procarbazine
932
Which antibiotics cross the BBB?
"TOM'S CD"
TMS, ofloxacin, metronidazole, sulfas, chloramphenicol, doxycycline
(intermediates - most penicillins, imipenem, aminoglycosides, some higher cephalosporins)
933
What is the difference in distribution of AgNOR in normal animals vs. in cancer?
normal - tight and in nucleus
cancer - dispersed in cytoplasm
(prognostic in LSA, STS, mammary carcinoma)
934
Which of the following is NOT an expected side effect of radiation therapy for SCC in a cat: epilation, lip erythema, vomiting, desquamation?
vomiting
935
___% of dogs with osteosarcoma are thought to have micrometastasis at the time of diagnosis.
90%
936
*What is the most common skin tumor in the cat?
*basal cell tumor
937
*Which drug inhibits platelet derived growth factor activity in vaccine-associated sarcoma in cats?
*imatinib (Gleevec)
938
What is the predominant route of transmission of neospora in dogs?
transplacental transmission via tachyzoites
also ingestion of bradyzoites in tissue
939
What are the definitive hosts for neospora?
dog and coyote
940
*How is cryptococcus diagnosed?
Latex agglutination test for P21 capsular antigen
can also identify on cytology with Romanowsky stain
941
How is Campylobacter diagnosed?
gram stain + culture on selective media +/- PCR
all in conjunction with clinical signs since healthy dogs can have campy
942
How is anaplasma infection diagnosed?
detection of morulae in neutrophils + positive antibody titer (IFA or Western Blot), or
4-fold increase or decrease in antibody titer in 4wks, or
positive PCR result
943
T/F: Botulism is associated with hyperesthesia
False! Botulism does NOT cause hyperesthesia (but polyradiculoneuritis can)
944
T/F: Botulism does not involve the cranial nerves
False! Botulism can involve the cranial nerves
945
*What is the MOA of tetanus?
*tetanospasmin block release of inhibitory neurotransmitters glycine and GABA --> prevents inhibitory action of Renshaw cells leading to muscle tetany
946
T/F: Tetanus causes clinical signs within 24 hours of infection
False! Clinical signs typically occur 5-10 days after a wound is infected, but can occur weeks later after the wound has healed
947
*What is the most commonly used diagnostic for Ehrlichia? What is the best diagnostic for Ehrlichia?
*Most common = ELISA SNAP
Best = Indirect IFA
948
*What is the treatment of choice for Ehrlichia? What are other drugs that can be used?
doxycycline
others: chloramphenicol, imidocarb, amicarbalide
949
*Which of the following would be resistant to Unasyn: Staph aureus, Bacteroides, Pseudomonas?
*Pseudomonas are not sensitive to Unasyn or Clavamox because they have beta-lactamase activity that is not well inhibited by beta-lactamase inhibitors, also have drug efflux pumps
950
What protein is responsible for methicillin resistance in Staphylococcus species?
penicillin-binding protein 2A (PBP2A)
951
*What is the most common clinical sign associated with Borreliosis?
*polyarthritis and fever
952
What is the best treatment for giardia?
fenbendazole
metronidazole reportedly less effective than fenbendazole
953
What is the best treatment for Cryptosporidiosis?
azithromycin, but dz is usually self-limiting in immunocompetent animals
also paramomycin, but this is nephrotoxic
954
What part of the intestines does Cryptosporidium most commonly inhabit?
ileum
955
Alabama Rot is also known as ____, and occurs almost exclusively in which breed?
cutaneous and renal glomerular vasculopathy
racing or training greyhounds
956
Describe labwork findings in Alabama rot.
mod-severe thrombocytopenia
hypoalbuminemia
proteinuria
anemia - microangiopathic hemolysis
elevated ALT (mild)
957
Alabama rot is most similar to what condition affecting children?
Hemolytic uremic syndrome (HUS) caused by E. coli shiga-like toxin
958
Which of the following organism has been implicated in canine infectious tracheobronchitis: Pasteurella, Acinetobacter, Mycoplasma, Staphylococcus?
Mycoplasma
| also Bordetella, viruses, etc
959
*Which tick carries Hepatozoon americanum? Which carries H. canis?
*H. americanum - amblyomma
H. canis - rhipicephalus
960
What is the most sensitive test for Mycoplasma hemofelis?
PCR
cytology has poor sensitivity (organisms only visible during peak parasitemia)
961
*What factors would you look for in choosing an antibiotic to give to an FIV infected cat with a UTI?
bactericidal
MIC as far from breakpoint as possible
narrowest spectrum possible
962
*What is the most common cause of diskospondylitis in dogs?
staph intermedius - treat with Clavamox or 1st generation cephalosporin
963
*A weakly acid-fast gram positive bacteria is seen on a cytology from a cat lung - what it is and which antibiotic should you use?
Likely Nocardia - use TMS
964
*What would you see on histopath of the brain in rabies?
*NONSUPPURATIVE inflammation, acute polioencephalitis, necrotizing encephalitis
965
*What test is used to definitively diagnose Rabies?
*demonstration of viral antigen by direct fluorescent antibody on medulla, cerebellum, hippocampus
966
*What is the name of the intracellular inclusions seen in Rabies? Where are they most consistently found?
*Negri bodies. Most consistently found in the hippocampus
967
*What would you see on skin biopsy in a dog with RMSF?
* necrotizing vasculitis with perivascular polymorphonuclear and lymphoreticular cell infiltrates
968
RMSF is transmitted by which tick?
dermacentor
969
*What are the most common clinical manifestations of Hepatozoonosis?
*polymyositis and fever
970
What might you see on limb radiographs in a dog with Hepatozoonosis?
periosteal reaction
971
What is the diagnostic of choice for diagnosis of Hepatozoonosis?
muscle biopsy with visualization of organisms (biceps femoris or semitendinosus)
972
What is the treatment for Hepatozoonosis?
1. treat with all 3 - TMS, clindamycin, pyrimethamine x 2wks (kills extracellular bugs)
2. start decoquinate (coccidiostat) in food once daily for at least 2yrs to life to prevent asexual reproduction
973
T/F: No treatment has been shown to successfully eliminate the intracellular merozoites in Hepatozoonosis.
True! So you need to keep on decoquinate lifelong
974
*When should a pregnant woman scoop the litter to avoid toxoplasmosis?
*daily! because at least 24 hours is required for oocysts to reach the infective stage
975
*The Baermann fecal is used to detect ______
nematode larvae - Aelurostrongylus (cat lungworm) and Crenosoma vulpis (dog lungworm)
Filaroides hirthi and Oslerus osleri are better detected using flotation techniques
976
*The test for FeLV detects which protein?
p27
977
*Western blot is used to detect ______
*protein
978
Which disinfectant has residual activity after washing hands?
chlorhexidine??
979
T/F: Leptospirosis causes disease by intracellular replication
True
980
*What is the best way to treat polyps in cats with the least likely chance of recurrence?
*ventral bulla ostetomy
981
*What is the mechanism of beta lactams? Cidal or static? Concentration or time dependent?
*inhibits bacterial cell wall synthesis by inhibiting penicillin binding proteins
bactericidal, time dependent
982
What is the mechanism of vancomycin?
inhibits synthesis of peptidoglycan in cell wall of gram POSITIVE bacteria
983
What is the mechanism of aminoglycosides? Cidal or static? Concentration or time dependent?
inhibits 30s ribosomal subunit to inhibit protein synthesis
cidal, concentration dependent
984
Why are beta lactams considered synergistic with aminoglycosides?
beta lactams enhance entry of aminoglycosides into bacteria
985
What is the mechanism of clindamycin? Cidal or static? Concentration or time dependent?
inhibits protein synthesis by binding 50s ribosomal subunit
static, time dependent
986
What is the mechanism of macrolides? Cidal or static? Concentration or time dependent?
inhibits protein synthesis by binding to 50s ribosomal subunit
static, time dependent
987
What is the mechanism of tetracyclines? Cidal or static? Concentration or time dependent?
inhibits protein synthesis by binding 30s ribosomal subunit
static, time dependent
988
What is the mechanism of fluoroquinolones? Cidal or static? Concentration or time dependent?
inhibits DNA gyrase
cidal, concentration dependent
989
What is the mechanism of sulfonamides? Cidal or static?
inhibits bacterial folate synthesis
static, but cidal when combined with trimethoprim
990
What is the mechanism of chloramphenicol? Cidal or static?
inhibits protein synthesis by binding to 50s ribosomal subunit
static, cidal at high doses
991
Will cefazolin kill pseudomonas?
nope
992
*What type of signs would be seen with neurotoxicity from metronidazole? What is the treatment?
*central vestibular signs
discontinue drug and treat with diazepam
993
Which aminoglycosides are toxic to the cochlear nerve? vestibular nerve?
cochlear = amikacin, neomycin (MOST oto/nephrotoxic), kanamycin
vestibular = stroptomycin, gentamycin
994
*What is the half-life of potassium bromide?
*2-3 weeks
995
*Which of the following would phenobarbital interfere with: gabapentin, KBr, ampicillin, cimetidine?
cimetidine?
996
*Which NSAID causes irreversible inhibition of COX?
*aspirin
997
Which of the following is NOT effective against coccidians: monensin, TMS, docoquinate, ivermectin?
ivermectin
998
Which of the following could NOT be treated with carbonic anhydrase inhibitors: glaucoma, metabolic alkalosis, Addison's, hyperkalemia, for diuresis?
Addison's
999
What is the mechanism of mycophenolate?
inhibits inosine monophosphate dehydrogenase (enzyme for purine biosynthesis) --> inhibits B and T cell proliferation during S phase
1000
What is the MOA of leflunomide?
inhibits pyrimidine biosynthesis
1001
*What is the stimulus for the enterocolic reflex?
*stretch in the stomach leads to increased motility in the colon
1002
What activates pepsinogen to pepsin?
low pH in the stomach
1003
What is the most important function of pepsin?
protein digestion - specifically collagen (which is affected little by other digestive enzymes)
1004
What is the most potent substance that causes release of exocrine pancreatic enzymes?
CCK
1005
How does MgSO4 cause diarrhea?
osmotic diarrhea
1006
What is secreted by delta cells of the pancreas?
somatostatin
also gastrin in fetal life
1007
Describe location and effects of activation of 5HT3 and 5HT4 receptors. What is the ligand for these receptors?
serotonin is ligand
5HT3 = in CRTZ, vomiting center, duodenum. Activation causes vomiting/nausea
5HT4 = in intestines. Activation causes increased motility
1008
What are the mechanisms of metoclopramide?
inhibits D2 receptors on CRTZ
5HT4 agonist, 5HT3 antagonist (?), increases sensitivity to ACh and increases release of ACh
1009
How does ranitidine act as a prokinetic?
acetylcholinesterase activity
1010
Explain how histamine, ACh, and gastrin activate the parietal cells.
histamine - binds H2 receptor --> G protein --> increased cAMP
gastrin - binds CCK B receptor --> IP 3 --> increased calcium... ALSO stimulates histamine release
ACh - binds M3 receptor -->IP3 --> increased calcium
1011
Treatment with omeprazole will result in increased/decreased/normal gastrin levels.
increased gastrin levels
1012
T/F: omeprazole binds irreversibly.
True
1013
How does ursodiol work?
hydrophilic bile acid that induces cholehepatic shunting, thereby increasing water and HCO3 in the bile
also has immunomodulatory effects (inhibits IL-1, IL-2, immunoglobulins from beta cells
1014
How does zinc inhibit hepatic fibrosis?
inhibits prolyl hydroxylase, thereby suppressing collagen production
(colchicine and steroids also do this)
1015
How does D-penicillamine treat hepatic fibrosis?
inhibits lysyl hydroxylase thereby disrupting cross-linking of collagen
1016
Why can zinc be used as a treatment for copper toxicity?
because it upregulates metallothionein production, thereby binding copper and keeping it in the cells - minimizes GI absorption
1017
Copper is a component of which important enzymes?
superoxide dismutase
cytochrome C oxidase
monoamine oxidase
1018
Copper is transported from the liver to other sites in the body primarily by what?
ceruloplasmin
1019
A genetic defect in which protein is repsponsible for defective biliary copper excretion in Bedlington terriers?
COMMD1
1020
Which lipoprotein has the highest amount of protein?
HDL
1021
*Which enzyme breaks down triglycerides in chylomicrons?
*lipoprotein lipase
1022
Which amino acid is needed for update of fatty acids into the mitochondria for beta oxidation?
carnitine
1023
What is required for entry of acetyl CoA into the TCA cycle?
oxaloacetate
1024
*What are signs of thiamine deficiency in cats?
*central vestibular signs
| cervical ventroflexion
1025
Is TPN still good after 48 hours?
yep - good for 5 days in the fridge
1026
*What is better for a dog with an insulinoma - high or low glycemic index foods?
*low glycemic index foods
1027
How can you differentiate between post-prandial lipidemia and true hyperlipidemia?
separate serum and put in refridgerator
post-prandial - cream layer on top (chylomicrons)
hyperlipidemia - cloudy throughout (triglycerides)
1028
*Is refeeding syndrome more likely with a high carbohydrate diet or a high protein diet?
*high carbohydrate diet
1029
List the essential amino acids for dogs and cats.
phenylalanine, valine, tryptophan, methionine, arginine, threonine, taurine (CATS!), histidine, isoleucine, leucine, lysine
PVT MATT HILL
1030
What are the signs of niacin (vitamin B3) deficiency?
oral/tongue ulceration in dogs, uncontrolled drooling, growth problems
pellagra = dermatitis, diarrhea, dementia, death
1031
What are the most common causes of thiamine deficiency?
feeding fish with thiaminases
feeding meat preserved with sulfites
1032
Vitamin B6 (pyridoxine) acts as a coenzyme for ____ in the liver
transamination of amino acids
1033
What enzyme is inhibited by anticoagulant rodenticides?
vitamin K epoxide reductase, which converts vitamin K back to its active form for use in activation of clotting factors
1034
Cats require taurine for what purpose?
bile acid conjucation
1035
*Which protein source has the lowest purine content - glandular tissue, animal protein, vegetable protein?
vegetable protein
1036
A cat is fed a homecooked diet has megaloblasts on a blood smear. What is the cat likely deficient in?
cobalamin or folate
1037
What happens to the following levels in ethylene glycol toxicity: glucose, phosphate, calcium?
hyperglycemia
hyperphosphatemia
hypocalcemia
1038
What type of urine crystals are seen in ethylene glycol toxicity?
calcium oxalate monohydrate
1039
How does strychnine cause toxicity?
inhibits glycine (inhibitory neurotransmitter) --> increased excitability
1040
What is the MOA of cyanide toxicity?
inhibits cytochrome oxidase in electron transport chain in mitochondria --> cannot use oxygen and cannot produce ATP
most severely effects heart and brain (because they rely most on aerobic metabolism
1041
What is the antidote for cyanide toxicity?
hydroxycobalamin - reacts with cyanide to form cyanocobalamin, which is excreted by the kidney
1042
What is the rate limiting step in metabolism of ethylene glycol?
alcohol dehydrogenase converts EG to glycoaldehyde
1043
Which metabolite of ethylene glycol contributes most to the increased anion gap acidosis?
glyoxylic acid
1044
What is the MOA of ivermectin?
binds to glutamate-gated chloride channels in membranes of invertebrate nerve & muscle cells, causing increased permeability to chloride ions
1045
Clinical signs of ivermectin toxicity result by what mechanism? What are typical signs?
agonism of CNS GABA
depression, ataxia, weakness, recumbency, coma
(also NOT from GABA effects - mydriasis, hypothermia, vomiting, salivation, shallow breathing)
1046
What is the MOA of organophosphates?
inhibits acetylcholinesterase --->parasympathetic overload
1047
List the strong ions
Na, K, Mg, Ca, Cl, lactate, ketones, SO4
1048
What disinfectants will kill lepto?
1:1 10% bleach
iodine
quaternary ammonium
accelerated H2O2
1049
When does urinary shedding of lepto start?
7-10d after infection
1050
Doxycycline clears lepto from ______
ALL sites (blood and kidney)!
1051
Ampicillin clears lepto from ______
blood, but NOT kidney (doxy needed to clear carrier state)
1052
T/F: chloramphenicol is effective in treating lepto
False!
1053
T/F: 3rd generation cephalosporins are effective in treating lepto
True!
1054
T/F: 1st generation cephalosporines are effective in treating lepto
False!
1055
T/F: fluoroquinolones are effective in treating lepto
False!
1056
T/F: MAT does NOT accurately predict the infecting serogroup for lepto
True!
1057
What is the recommendation for treating exposed dogs that live in the same household as a dog infected with lepto?
treat with 14d course of doxy
1058
What is the recommended treatment for clearance of lepto from the renal tubules?
doxycycline 5mg/kg PO BID x 14d
1059
Lepto serovars differ from eachother based on what?
the carbohydrate component of LPS
1060
Which 2 serogroups of lepto most commonly affect dogs?
L. interrogans (ictohemorrhagiae, pomona, canicola)
L. kirschneri (grippotyphosa)
1061
What is seen on renal histopath in cases of lepto AKI?
acute interstitial nephritis/necrosis
1062
T/F: MAT testing for lepto is seroVAR specific, but not seroGROUP specific
False! MAT is seroGROUP specific, but seroVARs within the same serogroup can cross-react
1063
During what period is lepto PCR more sensitive when performed on blood compared with urine?
During the first 10d of infection the highest # of organisms are present in blood... after that, the highest # are present in urine
1064
On a molecular level, the endotoxins produced by lepto inhibit ____ within the nephron.
Na/K/ATPase pumps
1065
What are 2 findings you might see on AUS in a dog with lepto AKI?
1. medullary band of increased echogenicity
| 2. renomegaly
1066
T/F: Lepto is inactivated by freezing, but not UV radiation
False! it is inactivated by both!
1067
What type of microscopy can be used to identify leptospires?
darkfield microscopy
1068
T/F: Lepto vaccines cause more reactions than other routinely administered vaccinations in dogs.
False!
1069
Low levels of which specific GAG might play a role in FLUTD pathogenesis in cats?
GP-51
1070
Expression of substance P is increased/decreased in the bladder in cats with FLUTD
increased
1071
Abnormalities in the dorsal/ventral root in the lumbosacral region have been noted in cats with FLUTD.
dorsal root ganglion
30% larger, altered neuropeptide profiles, slowly desensitizing capsaicin currents
1072
Where in the brain is the origin of the excitatory pathway to the bladder?
locus coeruleus (located within the pons)
1073
Which part of the brain contains the largest number of noradrenergic neurons and is the most important source of norepinephrine in the CNS?
locus coeruleus
1074
Describe changes found in the adrenals of cats with FLUTD.
small adrenals with decreased size of the zona fasciculata and zona reticularis
1075
Which is more pronounced in cats with FLUTD: sympathetic or adrenocortical response?
sympathetic > adrenocortical
1076
Tyrosine hydroxylase is increased/decreased in the brain in cats with FLUTD
increased
1077
Tyrosine hydroxylase is the rate limiting step in synthesis of what?
catecholamines
1078
Describe type I and type II idiopathic cystitis.
type I - nonulcerative (most common), possibly neuropathic in origin
type II - ulcerative (uncommon), related to intrinsic inflammatory bladder pathology
1079
How might maternal stress contribute to FLUTD development in cats?
stressed out mom cat --> stress hormones cross placenta --> impaired adrenal development
1080
List positive effects of environmental enrichment in cats with FLUTD.
decreased LUT signs, decreased catecholamines, decreased bladder permeability, increased cardiac function, decreased acoustic startle response
1081
What types of portal hypertension would be expected to result in transudative ascites?
prehepatic and presinusoidal
1082
What type of portal hypertension would result in a modified transudate ascites?
sinusoidal, post-sinusoidal, post-hepatic
1083
What is the recommended diuretic for control of ascites in dogs with portal hypertension?
spironolactone
1084
What is more SPECIFIC for diagnosis of multiple acquired shunts - ammonia levels or bile acids?
ammonia levels
1085
What is most sensitive for diagnosis of multiple acquired shunts - pre- or post-prandial bile acids?
post-prandial bile acids
1086
A portal vein to aorta ratio of _____ is supportive of pulmonary hypertension.
<0.65
1087
What percentage of ascites is safe to remove in a single tap?
20-50%
1088
Describe the liver's blood supply and the proportional contribution of each vessel.
25% of cardiac output goes to liver
hepatic artery = 10-15%
portal vein = 75-80%
1089
Portal vein pressure = _____ - _____
portal blood flow - intrahepatic resistance
1090
Define Budd-Chiari syndrome.
Obstruction in the hepatic venous outflow in the caudal vena cava or larger extrahepatic arteries due to intraluminal (tumor, thrombus, webbing) or extraluminal (tumor) compression
1091
A hepatic venous portal gradient of > _____mmHg is suggestive of multiple acquired shunts.
>12mmHg
1092
What types of portal hypertension would lead to the formation of multiple acquired shunts?
pre-hepatic and hepatic, but NOT post-hepatic
1093
Right heart failure is an example of what type of portal hypertension - pre-hepatic, hepatic, or post-hepatic?
post-hepatic
1094
Budd-Chiari is an example of what type of portal hypertension - pre-hepatic, hepatic, or post-hepatic?
post-hepatic
1095
Non-cirrhotic portal hypertension is an example of what type of portal hypertension - pre-hepatic, hepatic, or post-hepatic?
hepatic, pre-sinusoidal
1096
Chronic hepatitis causes hepatic portal hypertension which is pre-sinusoidal, sinusoidal, or post-sinusoidal?
sinusoidal
1097
Portal thrombus is an example of what type of portal hypertension - pre-hepatic, hepatic, or post-hepatic?
pre-hepatic
1098
What is hepatorenal syndrome?
reversible renal failure due to profound renal vasoconstriction secondary to release of vasoactive factors in response to splanchnic vasodilation
1099
What is hepatopulmonary syndrome?
release of nitric oxide results in microvascular pulmonary vasodilation, leading to V/Q mismatch
1100
List 4 factors that decrease portal venous pressure.
anesthesia
exercise
inspiration
fasting
1101
List 4 factors that increase portal venous pressure.
post-prandial
expiration
increased intraabdominal pressure (barking, defecation)
increased sodium intake/blood volume expansion
1102
What is the most important vasodilator in the liver?
nitric oxide
1103
What do hepatic stellate cells transform into when stimulated by hepatic injury?
fibrogenic myofibroblasts
1104
In dogs with portal hypertension, there is vasodilation/constriction in the intrahepatic vasculature, and vasodilation/constriction in the splanchnic vasculature
vasoconstriction in intrahepatic vasculature
vasodilation in splanchnic vasculature
1105
Is hypo- or hypernatremia expected in dogs with portal hypertension? Why?
Hyponatremia due to increased ADH release in response to decreased effective circulating volume
1106
List 3 breed predisposed to noncirrhotic portal hypertension.
Rottweilers
Dobermans
Cocker Spaniels
1107
What is the only hepatic encephalopathy toxin that can be measured?
ammonia
1108
Which enteric pathogen is a gram positive anaerobic spore-forming rod?
Clostridium
1109
What are the 2 forms of C. difficile?
1. vegetative cells - actively growing form that CAUSE INTESTINAL DISEASE. Will die outside the body
2. spores - highly resistant, survive years in the environment, responsible for TRANSMISSION
1110
Which form of C. diff causes disease? Which is responsible for transmission?
vegetative cells cause disease, spores cause transmission
1111
What are the toxins involved in C. diff infection?
toxin A (TcdA) and toxin B (TcdB)
1112
What is the treatment for C. difficile infect?
metronidazole 10mg/kg BID x 5d
1113
What is the gold standard for diagnosis of C. difficile?
cell culture cytotoxicity assay to detect TcdB - but not commonly used because very time consuming test
1114
What are the 5 bioptypes of C. perfringens? What is the most common biotype causing infection?
biotypes A-E
type A is most common
1115
What virulence factor causes diarrhea in C. perfringens infection?
CPE (C. perfringens enterotoxin)
1116
T/F: C. perfringens is isolated from ~80% of dogs with and without diarrhea.
True!
1117
What is the best way to diagnose C. perfringens infection?
ELISA for CPE in combination with PCR for enterotoxigenic strains of C. perfringens
1118
T/F: Spore count in C. perfringens infection predicts the severity of diarrhea.
False!
1119
List 4 risk factors for C. difficile infection in dogs?
1. immunocompromised owner
2. owner or dog on Abs
3. exposure to children
4. visiting human hospital
1120
Describe the microbial characteristics of Salmonella.
gram negative, ubiquitous, facultative anaerobe
1121
T/F: Salmonella has a similar prevalence in dogs with and without diarrhea.
True!
1122
When are antibiotics indicated in treatment of Salmonella?
in systemically ill or immunocompromised patients
1123
What antibiotics are recommended for use in systemically ill or immunocompromised patients with Salmonella?
ampicillin + enrofloxacin
1124
Is antibiotic therapy indicated in a patient with Salmonella if the OWNER is immunocompromised but the patient is not systemically ill or immunocompromised?
no!
1125
Describe the microbial characteristics of Campylobacter.
Gram negative, microaerophilic motile rods
1126
T/F: Campylobacter infection seems to be more prevalent in adult dogs/cats as opposed to puppies/kittens
False! Clinical disease more common in dogs/cats <1yo
1127
Which Campylobacter is most frequently isolated from dog feces?
C. upsaliensis
1128
List 3 factors associated with increased risk of Campylobacter carriage.
Stress, crowded housing, concurrent disease, age <1yr, home cooked diet, feeding table scraps
1129
T/F: Identification of gull-wing shaped bacteria on gram stain of feces is diagnostic for Campyolbacter.
False! This is suggestive of Campylobacter, but not diagnostic, because other bacteria (Arcobacter) and nonpathogenic Campy have similar morphology
1130
In what cases is antibiotic treatment for Campylobacter infection warranted?
systemic illness/fever, immunocompromised, hemorrhagic diarrhea
1131
What antibiotic is used for Campylobacter infection?
erythromycin or azithromycin (but no published studies on azithromycin)
can use fluoroquinolone, but higher rate of resistance
1132
What is the rate of response to antibiotic treatment for dogs with Campylobacter? Cats?
dogs - 50-73%
| cats - 50%
1133
T/F: A direct link has been made between C. jejuni infection in people and the presence of a dog in the household
True! Especially if the dog is <6mo
1134
Describe the microbial characteristics of E. coli
gram negative non-sporeforming rods
1135
List 3 dog breeds predisposed to granulomatous colitis.
Boxer, Border collie, Frenchie
1136
Describe clinical signs of granulomatous colitis in Boxers
Severe large bowel diarrhea, weight loss, inappetance
1137
Describe histopath lesions in granulomatous colitis in Boxers.
pathognomonic - mucosal infiltration with large # PAS-positive macrophages, & evidence of mucosal ulceration and loss of goblet cells
1138
What diagnostic should be submitted if you suspect granulomatous colitis in a boxer?
biopsies with FISH and culture
1139
What is the treatment of choice for adherent-invasive E. coli?
enrofloxacin 10mg/kg SID x 8 weeks - do not stop before 8 weeks because this precipitates resistance to antibiotics
1140
Why is hand washing preferred over alcohol-based hand sanitizers when handling dogs with enteropathogenic bacteria?
Clositrial spores are resistant to alcohol-based hand sanitizers
1141
What disinfectants are effective against Clostridial spores?
1:10 bleach or accelerated H2O2
1142
What is the definition of cachexia?
A complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass
1143
How does weight loss in healthy animals differ from weight loss in animals with chronic disease?
healthy animals - metabolic adaptations result in fat being used as energy source
chronic disease - no metabolic adaptations occur, resulting in amino acids being used as energy source
1144
In cardiac cachexia, there is a shift from type I/II muscle fibers to type I/II muscle fibers
Shift from type I (oxidative) muscle fibers to type II (glycolytic)
1145
Which type of muscle fibers is more resistant to atropy - type I or type II?
type I is MORE resistant
1146
T/F: Total body weight is a sensitive measure of muscle loss
False! duh
1147
Cardiac cachexia effects about __% of humans and dogs with CHF
50%
1148
T/F: Cardiac cachexia tends to be worse in dogs with left-sided CHF, as opposed to right-sided
False! worse in right-sided CHF
1149
What is the obesity paradox with regards to cardiac cachexia?
obesity may be associated with a protective effect once CHF is present (likely due to increased lean body mass reserve)
1150
What is the definition of sarcopenia?
muscle loss seen during aging, in the ABSENCE of disease (and whether or not obesity is present)
1151
T/F: Both cachexia AND sarcopenia are associated with increased mortality rates.
True!
1152
List the 4 major mechanisms of cachexia.
1. increased energy requirement
2. decreased nutrient absorption
3. decreased energy intake
4. altered metabolism
1153
Ghrelin is an endogenous ligand for what receptor?
growth hormone secretagogue receptor
1154
Ghrelin is secreted by ____ cells in response to _____.
secreted by gastric endocrine cells in response to fasting --> increased food intake
1155
What are the main 3 cytokines involved in cachexia?
TNF, IL-1, IL-6
1156
How do cytokines contribute to cachexia?
cause anorexia, increase energy metabolism, accelerate LBM loss
1157
Which 2 cytokines are involved in cardiac myocyte hypertrophy and fibrosis and have negative inotropic effects?
TNF and IL-1
1158
Which cytokine signaling pathway is involved in cachexia?
NF-kB
1159
T/F: Omega-3s have been shown to decrease inflammatory cytokines and improve muscle mass in dogs with CHF.
True!
1160
What is the most important proteolytic patyway in cachexia?
ubiquitin-proteosome pathway
1161
The ubiquitin proteosome pathway is activated by _____.
NF-kB
1162
The catabolic effects of glucocorticoids appear to occur via activation of what proteolytic pathway?
ubiquitin-proteosome pathway
1163
Myostatin levels are increased/decreased in CHF
increased (myostatin negatively regulates skeletal muscle)
1164
T/F: atrial natriuretic peptide inhibits lipolysis.
False! it stimulates lipolysis
1165
Which adipokine is found in highest concentrations within the adipocyte?
adiponectin
1166
What are two effects of adiponectin?
1. anti-inflammatory effects
| 2. decreases body weight
1167
T/F: IGF-1 concentrations are a predictor of survival in dogs with CHF
True!
1168
Ghrelin increases/decrease growth hormone
increases
1169
Omega-3 fatty acids work to decrease amounts of which two cytokines involved in cachexia?
TNF and IL-1
1170
What are two types of pre-neoplastic DNA mutations in cells?
increased expression of oncogenes (myc, ras, abl, bcl-2)
decreased expression of tumor-suppressor genes (Rb, p-53)
1171
Ingestion of coat-associated particular carcinogens (such as tobacco smoke) and flea collar exposure are associated with what type of cancer in cats?
oral SCC
1172
Ocular trauma/chronic uveitits can predispose to what type of cancer in cats?
ocular sarcoma
1173
Prolonged solar exposure can predispose to what type of cancer in cats and dogs?
SCC
1174
Chronic myositis can predispose to what type of cancer in dogs?
lymphosarcoma
1175
Injections/vaccinations can predispose to what type of cancer in cats (and dogs)?
sarcoma
1176
Implanted medical devices can predispose to what types of cancer in dogs?
myxosarcoma, osteosarcoma
1177
Spirocirca lupi is associated with development of what type of cancer in dogs?
esophageal osteosarcoma/fibrosarcoma
1178
In dogs and cats, papillomavirus can predispose to what type of cancer?
SCC
1179
Describe the two polarization states of macrophages and their role in cancer.
M1 = produce IL-12 --> tumoricidal
M2 = produce IL-10 --> promote tumor progression
1180
List 2 major signaling pathways involved in cancer promotion.
NF-kB
| Mitogen activated protein kinase (MAPK) pathway
1181
How do free radicals promote cancer development?
oxidative damage and nitration of DNA bases --> increased risk for DNA mutations that may be nonrepairable and persist in subsequent generations
1182
What is the primary mediator of pathologic angiogenesis (associated with cancer and chronic inflammation)?
VEGF-A
1183
Strains of H. pylori that secrete a protein known as CagA are invariably associated with ____ in humans
gastric cancer
1184
Asbestos exposure is associated with development of what type of neoplasia?
mesothelioma
1185
Macrophages in injection-site sarcomas often contain a bluish-gray foreign material identified to be _____
aluminum, likely remnants of vaccine adjuvants
1186
Carcinomas of the urothelium in cattle have been associated with enzootic hematuria caused by grazing on pastures rich in _____
bracken fern!
1187
What is the only nutraceutical noted to have a significant effect on OA based on a systematic review of the literature?
omega-3 fatty acids
1188
What are the two major classes of bactericidal antimicrobial peptides in the mammalian immune system?
defensins and cathelicidins
1189
What are the major targets of pattern recognition receptors (PRRs)?
pathogen-associated molecular patterns (PAMPs) or microbial-associated molecular patterns (MAMPs)
PAMPs and MAMPs are the same thing
1190
T/F: PAMPs are generally invariant molecules shared by an entire class of microorganisms.
True - this allows for a relatively small number of PRRs recognizing vast numbers of potential pathogens
1191
What are DAMPs?
danger-associated molecular patterns = markers of endogenous cell damage
1192
Type I acute phase proteins are induced by which two cytokines?
IL-1 and TNF
1193
List 3 type I acute phase proteins.
serum amyloid A
CRP
C3
C4
1194
Type II acute phase proteins are induced by which cytokine?
IL-6
1195
List 3 type II acute phase proteins.
fibrinogen
ferritin
alpha1-antitrypsin
alpha2-macroglobulin
1196
What is the role of C-reactive protein in acute phase reactions?
enhances microbial phagocytosis and complement binding
1197
What is the role of serum amyloid A in acute phase reactions?
leukocyte recruitment and activation
1198
What are the two main types of pattern recognition receptors?
toll like receptors (TLRs)
| NOD-like receptors (NLRs)
1199
TLR2 recognizes what? TLR2 forms heterodimers with which other two TLRs?
recognizes diverse array of PAMPs (lipotechoic acid from gram + bacteria, peptidoglycan, hemagglutinin, polysaccharides, lipoproteins)
Forms heterodimers with TLR1 and TLR6
1200
Which TLR is responsible for recognizing LPS on gram negative bacteria?
TLR4
1201
Which TLR is expressed in epithelial cells of respiratory and intestinal tract and recognizes flagellin?
TLR5
1202
Which caspase is thought to be the "executioner caspase" in inflammation?
caspase-1
1203
Which two cell types are the main sources of TNF-alpha?
macrophages and T cells
1204
T/F: Decreased concentrations of TNF-alpha correlate with increased mortality in dogs with parvovirus.
False! Increased concentrations of TNF alpha correlate with increased mortality in canine parvo, but NOT in septic cats
1205
What is the difference between TNFR1 (TNF receptor 1) and TNFR2 in function?
TNFR1 = proinflammatory and apoptotic
TNFR2 = promotes tissue repair and angiogenesis
1206
Which cytokines are involved in the "hyperacute" period after innate immune stimulation in sepsis?
TNF-alpha and IL-1
1207
Which cytokine is the major endogenous pyrogen in fever?
IL-1
1208
Which interleukin is anti-inflammatory?
IL-10
1209
What is MIF, and what is its role in sepsis?
Macrophage migratory inhibitory factor - produced by anterior pituitary in SIRS/sepsis... delays apoptosis of activated monocytes/macrophages
1210
Acute phase proteins are released from which organ?
liver
1211
Describe the effects of bradykinin.
Enhances vasodilation, increases vascular permeability, and reduces platelet function
1212
Which factor plays a major role in initiation of coagulation in SIRS/sepsis?
tissue factor
1213
Conventional T cells are transformed into T regulatory cells by exposure to which cytokines?
IL-10 and TGF-beta
1214
What is the role of Tregs?
interact with immune cells to suppress development of autoaggressive responses and maintain the population of periphera CD4+ T cells
1215
TSH is secreted from which cells?
thyrotrophs in adenohypophysis (anterior pituitary)
1216
Adiponectin and IGF-1 are positive/negative acute phase proteins in canine endotoxemia.
negative acute phase proteins
1217
In the acute phase response, G-CSF is released from what cells?
monocytes
1218
Which clotting factor is expressed by microparticles?
tissue factor
1219
vWF is higher/lower in dogs with sepsis.
higher
1220
Kallikrein plays what role in coagulation associated with sepsis?
accelerates fibrinolysis by converting plasminogen to plasmic, also activates factor XII to activate the complement pathway
1221
Hyperthyroidism in cats resembles what condition in humans?
toxic nodular goiter
1222
High plasma concentrations of ____ are needed for appropriate iodine uptake by thyroid cells for 131I scanning
TSH
1223
What type of transporter is responsible for iodine uptake into thyroid follicular cells? How is it activated?
Na-I symporter, activated by cAMP as a result of TSH binding TSH receptor
1224
What transporter is responsible for iodine efflux from the thyroid follicular cell into the follicular lumen?
pendrin
1225
What enzyme iodinates tyrosil residues of thyroglobulin?
thyroid peroxidase - in the presence of hydrogen peroxide
1226
What is the main use for recombinant human TSH in people?
pre-treatment with TSH prior to 131I therapy increases thyroidal uptake of 131I --> decreased dose and deliver of 131I to extrathyroidal tissues
1227
In what circumstances would a TSH stimulation test be useful in dogs?
When hypothyroidism is suspected by a diagnosis cannot be made based on TT4 and TSH concentrations alone
1228
What is a major risk of high dose 131I therapy?
fatal myelosuppression
1229
What would you expect on a TSH stimulation test in a euthyroid cat vs. a cat with hyperthyroidism?
euthyroid cat - marked increase in TT4 after 6h
hyperthyroid cat - little change in TT4 due to decreased thyroid functional reserve, but can be similar to euthyroid cats if borderline T4 to start with, so not that useful
1230
Are type IV hypersensitivity reactions B cell or T cell mediated?
T cell mediated
1231
TEN is an example of what type of hypersensitivity reaction?
type IV
1232
Urticaria is an example of what type of hypersensitivity reaction?
type I
1233
What are the cell types involved in type I hypersensitivity responses?
B cells producing IgE, which activates mast cells and basophils
1234
Define anaphylactoid reaction. Given an example of a drug that can cause this.
Drug directly induces release of proinflammatory molecules without involvement of immune system. DIFFERENT FROM ANAPHYLAXIS!
ex. morphine - stimulates histamine release directly from mast cells
1235
Drug-induced pemphigus is an example of what type of hypersensitivity reaction?
type II
1236
SLE is an example of what type of hypersensitivity reaction?
type III
1237
Type III hypersensitivity reactions involve which immunoglobulin?
IgG
1238
What is the mean time of onset for a delayed hypersensitivity reaction?
2 weeks
1239
Erythema multiforme is what type of hypersensitivity reaction?
type IV
1240
What are haptens?
chemically reactive small molecules
1241
What types of cells are classically seen in cases of pemphigus foliaceus?
acantholytic cells
1242
Describe lesions in Sweet's syndrome
severe neutrophilic dermatosis with painful erythematous plaques/nodules
1243
What test can be performed to assess whether a drug may have resulted in a delayed hypersensitivity reaction?
lymphocyte transformation test
1244
Superficial suppurative necrolytic dermatitis has been described in which breed, in association with treatment with what?
Mini Schnauzers in association with treatment with shampoos
1245
Which type of drug hypersensitivity reactions DO NOT resolve with discontinuation of the drug - drug associated, drug-induced, or drug-triggered?
drug triggered
1246
List three protective mechanisms that help to prevent pancreatitis from occurring in normal animals.
pancreatic enzymes stored as zymogens (inert)
zymogen granules stored separately away from lysosomal granules
pancreatic secretory trypsin inhibitor
antiproteases in circulation which inactivate trypsin
1247
What is cathepsin B?
a major lysosomal protease involved in trypsin activation
1248
Which interleukin is known as the neutrophil chemotactic factor?
IL-8
1249
Substance P binds to what type of receptors?
NK-1
1250
Which cells of the intestine is most susceptible to changes in the microcirculation?
epithelial cells (due to decreased pO2 gradient at the tip of the villi) --> more susceptible to hypoxia
1251
T/F: Cyclophosphamide confers a survival benefit when used in patients with IMHA
False! No benefit over pred alone, and may actually increase mortality
1252
T/F: The use of individually adjusted doses of heparin is associated with improved survival in IMHA
True!
1253
What is the overall mortality rate for dogs with IMHA?
50-70%
1254
T/F: IVIG confers a survival benefit in dogs with refractory IMHA.
False
1255
T/F: Use of low-dose aspirin in IMHA is associated with improved survival.
True
1256
What has been identified as a negative prognostic indicator in IMHA most consistently in dogs?
hyperbilirubinemia
1257
Why might it be a good idea to combine silymarin with phosphatidylcholine?
phosphatidylcholine is a solubilizing substance that improves bioavailability of silymarin
1258
Why is silymarin bioavailability enhanced in cats?
because it undergoes glucuronidation in the liver and cats have limited glucuronidation capacity
1259
Why are bile concentrations of silymarin 100x higher than serum?
because it undergoes enterohepatic circulation
1260
What is the main MOA for silymarin?
increases glutathione levels in hepatic/intestinal tissue --> free radical scavenging and inhibition of lipid peroxidation
1261
How does silymarin suppress hepatic fibrosis?
silibinin (active metabolite) disrupts stellate cell DNA synthesis and migration --> decreased conversion to myofibroblasts
1262
T/F: Silymarin increases bile flow.
True - dose-dependent increase in bile flow due to stimulation of bile salt synthesis
1263
T/F: The use of silymarin in dogs with Amanita intoxication results in an increased mortality rate
False! Decreases mortality rate
1264
What is the active ingredient in milk thistle?
silibinin
1265
Name the two fish oil omega 3 fatty acids
eicosapentaenoic acid (EPA)
docosahexanoic acid (DHA)
1266
EPA and DHA are short/long chain mono/poly -unsaturated fatty acids.
long-chain polyunsaturated fatty acids (PUFAs)
1267
What type of fatty acid is alpha-linolenic acid?
omegat 3 fatty acid found in plant products (canola oil, flaxseed, etc)
1268
Which is more potent - alpha-linolenic acid or EPA?
EPA
alpha-linolenic is a much less potent source of omega-3s than fish oils
1269
T/F: In mammals, alpha-linolenic acid can be efficiently converted to EPA and DHA.
False! Mammals cannot efficiently convert ALA to EPA and DHA
1270
Which omega-6 fatty acid is considered essential for all mammals?
linoleic acid
1271
Linoleic acid is efficiently converted to _____ in dogs, but not in cats
arachidonic acid - this is why AA is essential in cats
1272
Why do cats require arachidonic acid?
because they have limited delta-6 desaturase activity, which converts linoleic acid to arachidonic acid
1273
Why are EPA and DHA less proinflammatory than arachidonic acid?
EPA & DHA serve as substrate for production of 3-series prostaglandins & 5-series leukotrienes, which are less proinflammatory compared with the 2-series prostaglandins & 4-series leukotrienes produced from AA
1274
The presence of arachidonic acid in phospholipid membranes results in production of what platelet activator?
thromboxane A2
1275
How does supplementation with EPA and DHA result in altered platelet function?
results in production of thromboxane A3, a less potent platelet activator compared with thromboxane A2
but does not cause a clinically relevant effect
1276
Why should you discontinue high doses of omega-3s before surgery?
because the first stage of wound healing involves inflammation and omega-3s might blunt this phase of wound healing
1277
Why should vitamin E be added to omega-3 supplements?
prevents lipid peroxidation of omega-3s
1278
How does vitamin E act as an antioxidant?
acts as a hydrogen donor to free radicals
1279
What are manifestations of vitamin E deficiency in cats?
muscular degeneration, retinal degeneration, steatitis
1280
What is the role of leukotriene B4?
initiates neutrophil chemotaxis, recruitment, and degranulation
1281
What is the difference between leukotriene B4 and B5?
B4 is more potent and B5
1282
Omega-3 fatty acids induce production of which leukotriene?
B5
1283
T/F: Omega-3s cause hyperglycemia in cats
False! They might actually improve glycemic control and insulin sensitivity
1284
What is the difference between aspirin and omega3s in terns of effects on thromboxane A2?
aspirin = irreversibly inhibits thromboxane A2,
omega 3s = competitive inhibition of thromboxane A2 with arachidonic acid
1285
What are the two most common agents implicated in healthcare-acquired infection in veterinary facilities?
Salmonella and MRSA
1286
The renal cortex receives __% of renal blood flow.
90%
1287
Which cells of the kidney are most susceptible to ischemic injury?
cells of the proximal tubule and thick ascending limb of the loop of Henle
1288
What are the 3 parameters that determine the IRIS AKI grade?
```
creatinine
urine production (oliguric/nonoliguric)
```
need for dialysis
1289
Describe grade I AKI based on the IRIS grading scheme.
AKI patients that are nonazotemic or those with creatinine concentrations that are immediately responsive to adequate volume therapy
1290
An increase in creatinine by ____ within 48 hours can be considered confirmatory evidence of AKI.
0.3
1291
The ideal biomarker for kidney injury should be able to:
1. detect kidney injury at early stage
2. localize kidney injury (glomerular, tubular)
3. differential pre-, post, and nonrenal injury
4. predict severity of injury
5. monitor effects of intervention
1292
Positively/negatively charged proteins pass through the glomerular filtration barrier more easily.
positively charged
1293
Retinol-binding protein is a blood/urinary biomarker used to detect dysfunction in which part of the nephron?
urinary biomarker
detects proximal tubular dysfunction
1294
For dogs, what defines "borderline proteinuria" according to IRIS staging of CKD?
0.2-0.5
1295
The presence of high molecular weight proteins (such as IgG) in the urine suggests damage to what part of the nephron?
glomerulus
1296
Urinary cystatin C is a renal biomarker that reflects damage to what part of the nephron?
renal tubules
1297
Serum cystatin C is a biomarker that is used to assess what?
GFR
1298
Describe the flow of cystatin C through the kidney
freely filtered by the glomerulus, reabsorbed and catabolized by renal tubules (does NOT re-enter bloodstream or get excreted in urine) - no tubular secretion occurs
1299
Where in the kidney are the following enzymes located? NAG, GGT, ALP, AAL, LDH
NAG, ALP: lysosomes
GGT, AAP: brush border
LDH: proximal tubular cells
1300
Urinary NAG, ALP, and GGT reflect damage to what part of the nephron?
proximal tubules
1301
What cells make Tamm-Horsfall protein?
cells in the thick ascending limb of LOH
1302
What makes up the matrix of all urinary casts?
Tamm Horsfall protein
1303
Increased/decreased Tamm-Horsfall protein is indicative of tubular dysfunction in dogs.
decreased
1304
KIM-1 stands for what and is located where in the nephron?
KIM-1 = kidney injury molecule-1
transmembrane protein expressed on luminal surface of proximal tubules during acute or chronic tubular injury
1305
What are the 2 most common side effects of NSAIDs in dogs?
vomiting and diarrhea
1306
T/F: NSAIDs suppress bicarbonate secretion and mucus production in the stomach.
true!
1307
What is the most common predisposing factor for GI ulceration in dogs?
NSAID treatment
1308
Hepatotoxicity from NSAIDs is thought to be dose-dependent/idiosyncratic?
idiosyncratic
1309
Nephrotoxicity from NSAID administration is typically dose-dependent/idiosyncratic.
dose dependent
1310
What types of cells product microparticles?
platelets, endothelial cells, RBCs, WBCs
1311
Are microparticles pro- or anti-inflammatory?
proinflammatory
1312
Are microparticles pro- or anti-coagulant?
procoagulant
1313
What 4 transporters are responsible for maintaining the distribution of phospholipids in the membrane bilayer of eukaryotic cells?
flippases
floppases
scramblases
aminophospholipid translocase
1314
In Scott Syndrome, there is a deficiency in which membrane transporter?
scramblase. This leads to deficient phosphatidyl serine exposure and microparticle release
1315
Scott Syndrome affects what breed?
GSD
1316
What ion is responsible for initiating the cascade of enzymatic events that rapidly changes the expression of phospholipids in the membrane bilayer, resulting in a rise in procoagulant activity?
cytosolic calcium
1317
T/F: Microparticles can transfer genetic material to target cells
True! Target cells can acquire new surface antigens and biological activity via these mechanisms
1318
How is microparticle formation a defense mechanism against the complement cascade?
allows membrane shedding of complement components from the cell surface
1319
Production of platelet-derived microparticles is triggered by what 3 things?
thrombin
collagen
exposure to high shear
1320
How can erythrocyte-derived microparticles result in severe vasoconstriction?
via scavenging of nitric oxide
1321
What happens to microparticle concentrations in stored blood products?
increased concentration of microparticles with increased storage time
1322
What can be done to decrease microparticle production in stored blood products?
leukodepletion
1323
Describe the changes in RBC morphology that occur ex vivo during RBC storage.
initially - reversibly change shape to echinocytes (ATP depletion)
later - irreversible spheroechinocytes are formed (complete depletion of ADT, ATP, AMP) --> rigid membranes, microparticle generation
1324
What diagnostic is the gold standard for detection of microparticles?
flow cytometry
1325
What may be seen on functional MRI during a migraine?
activation (hyperoxia and blood volume increase) of the red nucleus and substantia nigra
increased photoreceptor activity in the occipital cortex during the interictal period
1326
T/F: The brain parenchyma is insensate.
true
1327
Intracranial structures rostral to the tentorium cerebelli are innervated by _____.
trigeminal nerve
1328
What is cortical spreading depression (CSD)?
a phenomenon that proceeds migraines and is associated with visual aura
intracellular Ca++ rises --> depolarization --> vasodilation and inflammation
1329
T/F: Migraines in people are typically hereditary
True! polygenic inheritance
1330
Blood serotonin levels increase/decrease at the onset of a migraine
decrease
1331
What is the MOA of topiramate?
1. inhibits voltage-gated Na channels
2. inhibits high voltage-gated calcium channels
3. inhibits glutamate-mediated neurotransmission
4. enhances GABA chloride flux
5. modulates trigeminovascular signaling
1332
What group of neurons is implicated in primary headaches?
trigeminal cervical complex (TCC) - formed from neurons of trigeminal nucleus caudalis (TNC) and cervical extension
1333
T/F: In immune-complex GN, typically ALL glomeruli are affected.
True!
1334
What lesions would you expect in the glomerular basement membrane in dogs with immune-complex GN?
spikes, holes, and/or double or irregular contours
1335
Renal amyloidosis is diagnosed with what stain?
Congo red stain --> green birefringent material
1336
Where in the nephron amyloid typically deposited in renal amyloidosis?
mesangium and glomerular basement membrane
1337
Which stain is used to assess collagen deposition in renal biopsies?
Masson's trichrome
1338
Immune-complex GN is diagnosed by finding staining for what antibodies?
antibodies against C3, and AT LEAST 1 class of immunoglobulin
1339
What type of staining identifies immunoglobulins in immune-complex GN?
immunofluorescence staining
1340
What is tier I with regards to glomerular disease in dogs? Tier IA and IB?
persistent renal proteinura without hypoalbuminemia or azotemia
IA = no discernible sequellae
IB = with hypertension
1341
What is tier II with regards to dogs with glomerular dz? IIA vs. IIB?
renal proteinuria with hypoalbuminemia but not azotemia
IIA = without hypertension
IIB = with hypertension
1342
What is tier III with regards to dogs with glomerular disease? IIIA, IIIB, and IIIC?
renal proteinuria with renal azotemia
IIIA = no hypertension or hypoalbuminemia
IIIB = with hypertension, without hypoalbuminemia
IIIC = with hypoalbuminemia +/- hypertension
1343
What is C6?
peptpeptid associated with the VIsE gene of B. burgdorferi, which is ONLY expressed in the mammalian host and not within the tick or the Lyme vaccine - indicates natural infection
1344
How long after infection are antibodies to C6 detected?
3-4 weeks post-infection
1345
T/F: Light microscopy alone can be used to diagnose immune-mediated glomerular disease
False! Need transmission electron microscopy and immunostaining
1346
Which should be dosed based on lean body weight - lipid-soluble drugs or water-soluble drugs?
water soluble drugs... obesity leads to lower volume of distribution and higher plasma concentration b/c decreased ECF volume
1347
Obesity leads to a higher/lower volume of distribution for fat-soluble drugs, which results in a higher/lower plasma concentration
higher volume of distribution --> lower plasma concentration
therefore DO NOT dose based on LBW
1348
What is the goal of hepatic drug metabolism?
to make the drug more water soluble for renal excretion
1349
What are the two phases of hepatic drug metabolism?
phase I = oxidation, reduction, and hydrolysis (may inactivate or create an active metabolite
phase II = conjugation (with glucuronide, sulfate, glutathione or acetyl group) - cats have low capacity for glucuronidation
1350
Almost all of a drug has been eliminated after how many half lives?
5-7 half-lives
1351
Which receptor is blocked by angiotensin receptor blockers?
angiotensin II type I receptor
1352
In normal dogs, which drug more effectively blocks the pressor response of angiotensin I: enalapril or telmisartan?
telmisartan
1353
When could spironolactone be used in dogs with glomerular disease?
in animals with high aldosterone concentrations and persistent proteinuria despite ACEi, ARB, or both
1354
What is kayexelate?
intestinal POTASSIUM binder - can use with hyperkalemia secondary to ACEi therapy
1355
Potassium levels greater than ___ during ACEi/ARB treatment warrant a modification in treatment.
>6.5mmol/L
1356
What are the therapeutic targets for treatment of proteinuria with ACEi in dogs?
UPC<0.5 or reduction in UPC of 50% or greater without inappropriate worsening of renal function
1357
In proteinuric dogs with stage I or II CKD, an increase in creatinine up to ___ is acceptable following ACEi therapy.
30%
1358
In dogs with CKD, how do omega-6 PUFAs effect GFR?
increase GFR
1359
What effects do omega-3 PUFAs have in CKD?
1. decreased glomerular capillary pressure
2. altered urinary excretion of eicosanoids
3. delayed progression of CKD
1360
What ratio of omega6:omega3 fatty acids should be targeted in dogs with glomerular disease?
5:1
1361
T/F: Reduction in protein intake helps to reduce proteinuria
True!
1362
Which type of thromboembolism is more common in glomerular disease - venous or arterial?
venous
1363
In glomerular disease, there is an increase in which PROcoagulant factors?
V, VIII, fibrinogen
1364
Changes in vessel wall and platelet activation appear to be of greater importance for venous OR arterial thromboembolism?
arterial thromboembolism
1365
Blood stasis and changes in pro/anticoagulant factor levels appear to be more important for arterial or venous thromboembolism?
venous thromboembolism
1366
What drug is recommended for thromboprophylaxis in dogs with glomerular disease?
1-5mg/kg aspirin daily
1367
Describe the variation in blood pressure seen in sight hounds.
tend to have BP ~20mmHg higher than other breeds
1368
Target organ damage from hypertension is known to affect what body systems?
ocular, CNS, cardiovascular
1369
Antihypertensive medications should be instituted in dogs with glomerular disease when systolic BP exceeds ____ or diastolic BP exceeds _____
systolic >160
| diastolic >100
1370
If hypertension is identified in a dog with glomerular disease that is not receiving an ACE inhibitor, what is the first drug that should be started to control the hypertension?
ACEi... then a calcium channel blocker can be added later to control the hypertension
1371
Why is it recommended to only use amlodipine in conjunction with an ACE inhibitor in dogs with glomerular disease?
amlodipine preferentially dilates the afferent arteriole, which can further promote proteinuria if not used in conjunction with an ACEi
1372
Volume contracted patients would be expected to have higher/lower fractional excretion of sodium compared with volume-expanded patients
lower fractional excretion of sodium
1373
When should diuretics be used in dogs with nephrotic syndrome?
only in situations where organ function is critically impaired (i.e. ascites/pleural effusion that impairs respiration)
1374
Red granular staining on the capillary walls of the glomerulus with Masson's trichrome stain is most suggestive of ____
immune complex deposition
1375
When should glucocorticoids be used in dogs with glomerular disease?
short-term administration for fulminant cases in need of immediate immunosuppression OR in multisystemic immune-mediated diseases (such as lupus, IMHA) where glucocorticoids are indicated
1376
How does mycophenolate work?
inhibits inosine monophosphate dehydrogenase --> selective inhibition of T cell and B cell proliferation by inhibiting synthesis of purines
1377
What drug is recommended as the first choice for treatment of dogs with peracute or rapidly progressive immune-mediated glomerular disease in dogs?
mycophenolate
1378
Cyclosporine exerts its activity by binding to what cytosolic protein?
cyclophilin
1379
The cyclosporine-cyclophilin complex inhibits ____, which is essential for transcription of _____.
inhibits calcineurin, which is essential for the transcription of IL-2
1380
What interleukin is responsible for activation of T cells?
IL-2
1381
What is the MOA of cyclophosphamide?
alkylating agent -
interferes with DNA replication, RNS transcription and replication and disrupts nucleic acid function
1382
What type of drug is chlorambucil?
alkylating agent
1383
What is the MOA of azathioprine?
purine analog that interferes with normal cell DNA and RNA synthesis --> cytotoxicity to lymphocytes
1384
How long does it typically take for azathioprine to be fully effective in dogs?
2-5 weeks or more
1385
What are the adverse effects associated with azathioprine?
myelosuppression, GI upset, hepatic disease/failure, acute panreatitis
1386
What immunosuppressive drug protocols are recommended for dogs with peracute or rapidly progressive glomerular disease?
mycophenolate +/- pred
or, cyclophosphamide +/- pred
1387
T/F: In glomerular disease, response to treatment with immunosuppressives is reflected in histopath changes in renal biopsies
true
1388
Why might the magnitude of proteinuria decrease in animals in the late stages of progressive kidney disease?
because of a reduction in the number of remaining nephrons through which protein loss can occur
1389
T/F: prednisone activates phospholipase A2
False! porednisone inhibits phospholipase A2
1390
T/F: Renal biopsy is recommended for dogs with glomerular disease and IRIS CKD stage 4.
False! renal biopsy should NOT be performed in dogs with IRIS Stage 4 CKD
1391
T/F: Immunosuppressive treatment is recommended for dogs with familial nephropathy.
False!
1392
T/F: Immunosuppressive treatment is recommended for dogs with amyloidosis.
False!
1393
T/F: immunosuppressive drugs are ONLY indicated for glomerular causes of proteinuria, not tubular causes
True
1394
What type of familial GN do Bernese Mtn Dogs get?
membranoproliferative GN - this is one of few familial nephropathies that MAY respond to immunosuppressive treatment
1395
What is the reported survival time for dogs with azotemia and/or nephrotic syndrome as a result of glomerular disease?
<60 days
1396
What are the major adverse effects of methotrexate?
bone marrow suppression, hepatotoxicity
1397
T/F: Even in the absence of compatible clinical signs, testing for Cushing's should be pursued prior to adrenalectomy for treatment of an adrenal mass.
True!
1398
T/F: Measurement of a single basal cortisol concentration has no value in diagnosis of HAC in dogs
True!
1399
What are the 3 most commonly used SCREENING tests for HAC?
LDDST, UCCr, ACTH stim
1400
How long do you need to wait after administering prednisone to be able to accurately measure serum cortisol levels?
24 hours
...but there will still be some risk for adrenal suppression secondary to steroid administration during this time.
1401
List 4 drugs (aside from corticosteroids) that effect the HPA axis in dogs.
reglan
buprenorphine
codeine
desmopressin
clomipramine
1402
What is the screening test of choice for HAC in dogs?
LDDST
1403
What types of drugs may cause false positive results on a LDDST?
agents that increase P450 (phenobarbital) because they accelerate dexamethasone clearance
1404
With the LDDST, a diagnosis of HAC is based on cortisol measurement at which time point?
8 hour timepoint
1405
What is the sensitivity and specificity of the LDDST in diagnosing HAC in dogs?
```
Sn = 85-100%
Sp = 44-73%
```
1406
What is the criteria for identification of PDH based on LDDST?
4hr [cortisol] below lab cut-off or <50% of basal [cortisol] OR 8hr [cortisol] <50% baseline but above lab cut-off
1407
What test is the gold standard for diagnosis of IATROGENIC HAC in dogs?
ACTH stim
1408
What is the sensitivity and specificity of the ACTH stim for diagnosis of spontaneous HAC in dogs?
```
Sn = 57-95%
Sp = 59-93%
```
1409
What is the sensitivity and specificity of the UCCr for diagnosis of spontaneous HAC in dogs?
Sn = 75-100%, Sp = 20-25%
1410
What is the most accurate stand-alone differentiating test for types of HAC?
endogenous [ACTH]
not often performed due to difficulty with sample handling
1411
What percentage of dogs with PDH will suppress on a HDDST?
75%
1412
What percentage of dogs with PDH that do NOT suppress on a LDDST will suppress on a HDDST?
12%
1413
The HDDST uses a dose of dexamethasone ___ times the dose needed for the LDDST
10x
1414
List 3 features that are associated with the presence of a malignant adrenal tumor.
adrenal width >4cm
vena cava invasion
metastasis
1415
What is the pituitary flush on CT? What happens to the pituitary flush in PDH?
in a normal pituitary gland, the posterior gland will light up first with IV contrast (due to arterial blood supply).
...pituitary flush is absent or displaced/distorted in dogs with PDH
1416
What is the purpose of a noninferiority clinical trial?
to show that an investigational drug is at least as effective as an established treatment within a predetermined margin
designed because of ethical concern of comparing the a placebo in situations where established treatment exists
1417
What are type I and type II error?
type I = false positive. incorrect rejection of a true null hypothesis
type II = false negative. incorrect retaining of a false null hypothesis
1418
What is a main mechanism of IVDD development in chondrodystrophoid dogs?
premature senescence of notochordal cells and replacement of by chondrocyte-like cells
1419
What type of IVDD typically effects chondrodystrophic dogs?
Hansen type I - dehydration of nucleus pulposus, dystrophic calcification, stress on annulus fibrosus, extrusion of disk material
1420
Non-chondrodystrophic dogs more commonly get what type of IVDD?
Hansen type II (fibroid degeneration) - thickening of the annulus --> protrusion into vertebral canal
1421
Nuclear extrusion in IVDD results in what types of lesions?
contusive and compressive
1422
Annular protrusion in IVDD results in what type of spinal injury?
compressive
1423
Why should we not use the term "type III IVDD" to describe traumatic disc extrusion?
because no pre-existing disc degeneration is present in these cases
1424
Influx of which ion into neuronal cell bodies following contusive spinal injury results in activation of autodestructive pathways leading to apoptosis and necrosis?
Calcium
1425
Which 3 cytokines are released from microglial cells following spinal cord injury?
IL-1, TNFalpha, NO
1426
What would you find on neuro exam in a case with spinal shock?
depressed spinal reflexes caudal to the lesion... which may confuse you and make you think the lesion is in the intumescence
1427
T/F: Myelomalacia occurs as a consequence of ischemia
True
1428
Where in the spinal cord can IVDD cause peripheral nerve compression?
vertebral canal in the LS region
foramina at any intervertebral space (with lateral herniation)
1429
Most thoracolumbar disc herniations occur between ___ and ___ disk spaces. Most cervical disc herniations occur between ___ and ___ disk spaces.
T11-L1
C2-C4
1430
Chronic IVDD is most common in which 3 locations?
caudal cervical
thoracolumbar junction
L7/S1
1431
What mutation is associated with degenerative myelopathy in dogs?
SOD1
1432
What is the advantage of MRI over CT in compressive spinal lesions?
ability to detect nonmineralized compressive material such as hemorrhage with MRI
1433
What are the recovery rates for type I IVDD with and without surgery?
50% with conservative management
90% with surgery
1434
What types of type II IVDD cases are candidates for surgery?
moderate-to-severe compression that may be exacerbated by a dynamic component (especially in the cervical region)
1435
How do anti-inflammatory doses of steroids benefit dogs with chronic compressive spinal lesions?
decrease vascular permeability --> decreased edema
1436
Anaplasma phagocytophilum infects ____ (cell) and is transmitted by what type of tick?
granulocytes
ixodes
1437
Anaplasma platys infects ____ (cell) and is transmitted by what type of tick?
platelet
rhipicephalus
1438
What type of tick can transmit Bartonella?
ixodes... also fleas and other ticks
1439
Borrelia burgdorferi is transmitted by what type of tick?
ixodes
1440
All species of Babesia are transmitted by ____ (tick), except B. microti, which is transmitted by _____ (tick)
rhipicephalus
B. microti = ixodes
1441
Cytauxzoon felis infects ____ (cells) and is transmitted by what type of tick?
RBC, schizonts in macrophages
amblyomma and dermacentor
1442
Ehrlichia canis infects ____ (cell) and is transmitted by what type of tick?
monocytes
rhipicephalus
1443
Ehrlichia chaffeensis infects ____ (cell) and is transmitted by what type of tick?
monocytes
amblyomma
dermacentor
1444
Ehrlichia ewingii infects ____ (cell) and is transmitted by what type of tick?
granulocytes
amblyomma
1445
Hepatozoon americanum is transmitted by what type of tick?
INGESTION of amblyomma
1446
Leishmania infects ____ (cell) and is transmitted by what bug?
macrophages
sandfly, also vertical transmission
1447
Rickettsia rickettsii infects ____ (cell) and is transmitted by what type of tick?
endothelial cells
dermacentor, rhipicephalus
1448
What breeds are predisposed to lyme nephritis?
goldens and labs
1449
How do you define successful treatment of lyme based on C6?
> or = 50% decrease in C6 from pre-treatment values
1450
What drugs are used to treat leishmania infection?
allopurinol
miltefosine
antimonials (meglumine)
paromomycin (aminocidine)
1451
Treatment with allopurinol predisposes to formation of what type of urolith?
xanthine
1452
What is the MOA of cyclosporine?
binds cyclophilin --> cyclosporine-cyclophilin complex inhibits calcineurin which is involved in transcription of genes for cytokines ( IL-2, IL-4, TNFa, INFgamma) --> inhibition of T cell function and cell mediated immunity, inhibition of T cell proliferation
1453
T/F: Oral bioavailability of cyclosporine is very consistent from patient to patient
False! High degree of variability from 23-45% bioavailability
1454
Cyclosporine has a small/large volume of distribution
large volume of distribution (accumulates in skin, liver, kidneys, fat)
1455
Which is higher - cyclosporine tissue concentrations or serum concentrations?
tissue concentrations
1456
T/F: Cyclosporine is metabolized by cytochrome P450 enzymes
True
1457
List drugs that INCREASE cyclosporine concentrations by inhibition of P450
ketoconazole, azithromycin, chloramphenicol, fluoroquinolones, macrolides, reglan, omeprazole, metronidazole, cisapride, cimetidine, steroids
1458
List drugs that DECREASE cyclosporine concentrations by induction of P450
phenobarbital, clindamycin, famotidine, TMS, steroids
1459
T/F: Glucocorticoids may EITHER decrease or increase blood concentrations of cyclosporine
true! can do either
1460
What is the major site of metabolism of cyclosporine? How is it excreted?
liver (also kidneys and small intestine to a lesser degree)
excreted in bile (minimal renal excretion)
1461
T/F: Compounded formulations are adequate and inexpensive alternatives to brand name cyclosporine
False! DO NOT use compounded formulations due to variable bioavailability
1462
What type of cancer has been associated with cyclosporine treatment?
lymphoma
1463
During treatment with cyclosporine, what type of vaccines are recommended?
only killed vaccines
1464
What is the only condition in dogs for which systemic use of cyclosporine is approved?
atopy
1465
T/F: Therapeutic drug monitoring is recommended for dogs with atopy being treated with cyclosporine.
False! Therapeutic drug monitoring is NOT recommended as blood concentrations do not correlate with clinical improvement
1466
Cyclosporine can be used in conjunction with ____ to reduce dose/cost of cyclosporine treatment.
ketoconazole
1467
T/F: Therapeutic drug monitoring IS recommended if using cyclosporine in conjunction with ketoconazole.
True - need to make sure not achieving toxic cyclosporine level
1468
T/F: Cyclosporine is NOT effective in treatment of pemphigus foliaceus
True!
1469
What is the MOA of paclitaxel?
suppression of microtubule spindle dynamics --> blockage of metaphase-anaphase transitions --> inhibition of mitosis and induction of apoptosis
1470
Where is paclitaxel metabolized?
liver
1471
T/F: Paclitaxel is a substrate for ABC-transporter cellular drug efflux pumps (MDR1)
true
1472
What are the most common adverse effects in dogs on Paccal Vet (paclitaxel)?
transient neutropenia, inappetance, mild V/D, mild hypersensitivity reactions
trials for mammary tumors and SCC
1473
What are the 4 stages of seizure?
prodrome --> aura --> ictus --> post-ictal
impossible to differentiate prodrome and aura in animals
1474
What breed of cat appears to be overrepresented for idiopathic epilepsy?
european shorthair
1475
Necrosis of the hippocampus and piriform lobe in cats is associated with what clinical signs?
acute cluster seizures, salivation, aggression
1476
What is "basic epileptogenicity level"?
inherent tendency to generate seizures - different for different regions of the brain
1477
What part of the brain is thought to have the highest basic epileptogenicity level (BEL) in cats?
temporal lobe
1478
T/F: Plasma concentrations of buprenorphine correlate with level of analgesia in cats
False! plasma concentrations DO NOT correlate with level of analgesia in cats (negative hysteresis)
1479
Which is the preferred route of buprenorphine administration in cats: IV, IM, SC, transmucosal?
IV or IM
SC route does not provide adequate analgesia
Transmucosal may be best when combined with an NSAID or other form of pain control
1480
T/F: Buprenorphine has a rapid onset of action when given IV
False! Onset of analgesia is typically ~30-45mins
1481
What are the two main pathophysiologic mechanisms thought to contribute to MODS/
immune system dysregulation and subsequent mitochondrial dysfunction
1482
In reference to MODS/sepsis, what does CARS stand for? What is the main cytokine associated with CARS?
compensatory anti-inflammatory response syndrome
IL-10
1483
Oxidative stress and proinflammatory cytokine signaling lead to uncoupling of oxidative phosphorylation via what mechanism in MODS?
MPT (mitochondrial permeability transition), in which a pore is opened on the inner mitochondrial membrane which results in an inappropriate proton gradient and uncoupling of oxidation from phosphorylation
1484
What are the 2 stages of hepatic damage caused by sepsis/SIRS?
1. hepatic hypoperfusion --> decreased protein synthesis, lactate clearance, gluconeogenesis, glycogenolysis
2. Kupffer cell activation --> proinflammatory cytokines cause further damage
1485
What happens to the gut flora after a severe insult such as polytrauma or cardiac arrest?
gut flora is immediately destroyed and the number of intestinal pathogenic bacteria gradually increases
1486
T/F: Endotoxin given IV causes an increase in the number and strength of jejunal contractions
False! Decreases number/strength of jejunal contractions
1487
Cardiovascular dysfunction in MODS is characterized by what structural change in the heart?
biventricular dilatation
1488
How does NO production lead to decreased cardiac contractility in dogs with MODS?
downregulation of beta adrenergic receptors and decreased cytosolic calcium
1489
Cardiovascular dysfunction occurring secondary to sepsis is referred to as ____
septic shock!
1490
What are the 2 main forms of AKI associated with MODS? Which is more common?
1. acute tubular necrosis, hypoperfusion, ischemia
| 2. histopathologically normal kidneys - apoptosis caused by inflammatory cytokines and endotoxin (MOST COMMON)
1491
T/F: Corticosteroid tissue resistance increases in acute inflammatory diseases such as sepsis
True! This may contribute to CIRCI
1492
T/F: Prognosis in dogs with MODS does not correlate with the number of dysfunctional organ systems.
False! Survival is inversely proportional to the number of dysfunctional organ systems
1493
What would you expect to see in a dog with CIRCI on an ACTH stim?
basal cortisol within or above reference interval with dampened cortisol secretion after ACTH administration - difference between pre and post < 3ug/dL
1494
Urinary cystatin C can be used as a marker for damage where in the nephron?
proximal tubule
1495
What is considered the gold standard for GFR measurement?
inulin clearance
1496
Cystatin C levels increase/decrease as GFR decreases
increase
1497
T/F: Serum cystatin C appears to be a good marker for kidney damage in dogs.
False! There is overlap between healthy dogs and dogs with CKD
1498
Astrocytomas and oligodendrogliomas are overrepresented in what types of dogs?
brachycephalic breeds
1499
Choroid plexus tumors are overrepresented in what breed?
Golden retrievers
1500
What are the most common secondary brain tumors in cats?
lymphoma and pituitary tumors
1501
What is the typical CSF finding in dogs with intracranial neoplasia?
moderately increased TNCC (predominantly mononuclear) and increased TP
(or can be normal)... most tumors not diagnosed on CSF
1502
CSF of most dogs with meningiomas has what TNCC?
<5 cells/uL
1503
Most brain tumors in dogs are hypo/iso/hyper intense on T1 and hypo/iso/hyper intense on T2
hypo or iso intense on T1, hyperintense on T2
1504
The presence of a "dural tail" on MRI is associated with what type of tumor?
meningioma
1505
The presence of ring enhancement on an MRI is suggestive of what type of tumor?
glioma, but can happen with a variety of other intracranial diseases
1506
Diffusion weighted imaging might be useful in differentiating what types of conditions on MRI?
differentiation of neoplasia from bacterial abscessation/infarction (which would cause restricted diffusion)
1507
What are the 2 main components of palliative care for intracranial tumors?
1. corticosteroids to target peritumoral edema
| 2. anti-epileptics
1508
T/F: Adjunctive radiation therapy has been shown to be beneficial compared with surgery alone in treatment of meningiomas in dogs.
True!
1509
Why might an animal with a hereditary disease (such as congenital myasthenia gravis in Dachshunds) appear to "grow out of" the disorder?
replacement of defective neonatal protein with the adult form
1510
Which set of hereditary diseases is characterized by a neonatal to middle-aged onset, clinical signs of ataxia, blindness, weakness, dementia, or seizures, a progressive course, and is diagnosed based on necropsy, liver or leukocyte inclusions, or urine or CSF metabolites?
lysosomal storage disorders
1511
Why might not all animals with a particular genetic mutation develop clinical signs of disease?
variable penetrance
1512
What is the most common type of DNA variant?
SNP (single nucleotide polymorphism)
1513
What is the result of a missense mutation?
change the codon so a different amino acid is specified
1514
What is the result of a nonsense mutation?
changes amino acid-specifying codon to a premature stop codon
1515
Why do demyelinating disorders often produce cerebellar signs?
Because the cerebellum depends on fast conduction of proprioceptive information during movement and demyelination shows conduction velocity
1516
In which dog breeds has spinocerebellar ataxia been identified as a genetic disease?
Jack Russell and Parson Russell Terriers
1517
Exercise-induced collapse occurs in which breed?
Labs
1518
Episodic falling is a genetic condition in which breed?
CKCS
1519
What is the ABCB1 gene?
also known as MDR1 gene - encodes the drug transporter P-glycoprotein from the ABC (ATP-binding cassette superfamily)
1520
How does P-glycoprotein cause drug resistance?
using energy derived from ATP hydrolysis to transport substrates across the plasma membrane (from in cell to extracellular space), often against a steep concentration gradient
1521
Which of the following has been shown to be a P-glycoprotein substrate - alkylating agents, doxorubicin, platinum compounds, vinca alkaloids, tyrosine kinase inhibitors, mitoxantrone?
vinca alkaloids, doxorubicin, tyrosine kinase inhibitors
1522
Which cardiac drugs are P-glycoprotein substrates?
digoxin, diltiazem, verapamil
1523
Which immunosuppressants are P-glycoprotein substrates?
cyclosporine, tacrolimus
1524
Which opioids are P-glycoprotein substrates in dogs?
butorphanol, loperamide
1525
Which antiparasitics are P-glycoprotein substrates?
ivermectin, mibemycin, moxidectin, selamectin, doramectin
1526
Which commonly used sedative is a P-glycoprotein substrate?
acepromazine
1527
Which anti-emetic is a P-glycoprotein substrate?
ondansetron
1528
Which antifungals are P-glycoprotein substrates?
ketoconazole
| itraconazole
1529
Which antibiotics are P-glycoprotein substrates?
erythromycin
tetracycline
doxycycline
levofloxacin
sparfloxacin
1530
In what types of locations is P-glycoprotein expressed in normal cells?
1. at barriers to drug absorption (apical border of intestinal epithelium)
2. at drug elimination site (biliary canaliculi, renal tubular epithelial cells)
3. capillary endothelial cells at "sanctuary sites" (BBB, testes, placenta)
1531
T/F: Heterozygotes for the MDR1 mutation have decreased P-gp function
True! intermediate phenotype with decreased P-gp function
1532
P-glycoprotein plays an important role in what type of drug excretion?
biliary excretion - this increases their sensitivity to myelosuppressive and GI effects of certain chemotherapeutics
1533
Which antimicrobials act as P-glycoprotein INHIBITORS?
erythromycin
ketoconazole
itraconazole
1534
Which antidepressants act as P-glycoprotein INHIBITORS?
fluoxetine
| paroxetine
1535
Which cardiac drugs act as P-glycoprotein INHIBITORS?
diltiazem
quinidine
verapamil
nicardepine
1536
Which immunosuppressives act as P-glycoprotein INHIBITORS?
cyclosporine
| tacrolimus
1537
Why are P-glycoprotein inhibitors not currently used for anti-cancer treatment?
because they cannot discriminate btetween P-gp expressed by normal tissues (which protects the patient) and P-gp in cancerous tissue
1538
Why might ketozonazole exacerbate ivermectin toxicosis?
ketoconazole inhibits P-glycoprotein mediated biliary excretion
1539
T/F: Compounding antimicrobials from bulk chemicals is reasonable if other routes of drug delivery are not practical
False! compounding of antimicrobials from bulk chemicals should be abolished
1540
What is cascade reporting with regards to bacterial culture and sensitivity results?
secondary antimicrobial agents are only automatically reported if an organism is resistant to primary agents
1541
T/F: For most bacterial organisms a minimum duration of antibiotic treatment is necessary to prevent emergence of resistance.
False. This is a common misconception and there is no foundation to this
Antibiotics should never be continued once there is clinical and microbiological evidence that an infection has been eliminated
1542
T/F: Animals with subclinical bacteruria should always be treated with antibiotics to clear the bacteria.
False! These cases should not be treated
1543
What is the age distribution of dogs with osteosarcoma?
median age 7y, bimodal age distribution with smaller peak at 18-24mos
1544
What percent of dogs with osteosarcoma present with detectable lung mets? What percent develop distant mets within 1yr without chemo?
15%
| 90% develop mets without chemo within 1yr
1545
T/F: Dogs that experience acute bacterial infection secondary to limb-salvage surgery for osteosarcoma have increased survival times
True!
1546
The Fas receptor is associated with what cellular process?
apoptosis
1547
Phenotypic characterization of T regulatory cells includes expression of which two surface antigens and transcription of which gene?
CD4 and CD25
transcription of FoxP3
