ACVIM General Flashcards
List major signs of SLE.
thrombocytopenia
polyarthritis
leukopenia
skin lesions
hemolytic anemia
glomerulonephritis
polymyositis
Where are the skin lesions typically located in pemphigus foliaceous?
face, nasal planum, pinnae, foot pads, nipples
NOT typically a mucocutaneous junctions
A young cat presents with facial excoriations - what is the most likely diagnosis?
food allergy
Which cells express MHC I vs. MHC II?
MHC I = all cells
MHC II = APCs
What types of organisms are Th1 most active against? Th2?
Th1 = intracellular bacteria, protozoa
Th2 = extracellular parasites
What is released when eosinophils degranulate?
major basic protein (destroys parasites)
eosinophil peroxidase (EPO)
eosinophil derived neurotoxin (EDN)
eosinophilic cationic protein (ECP)
platelet activating factor
leukotrienes
histamines
proteases
cytokines
*What molecules on the endothelium help initiate migration of leukocytes?
E and P selectin
Describe the pathophysiology of anemia of inflammatory disease.
increased hepcidin leads to decreased iron absorption and recycling, which leads to iron sequestration
Describe whether the following would be increased or decreased in anemia of inflammatory disease: [Fe], TIBC, stainable Fe in bone marrow, ferritin.
decreased [Fe]
decreased TIBC
increased stainable Fe in BM
increased ferritin
Describe whether the following would be increased or decreased in iron deficiency anemia: [Fe], TIBC, stainable Fe in bone marrow, ferritin.
decreased [Fe]
normal or increased TIBC
decreased stainable [Fe] in BM
decreased ferritin
A dog becomes sick days after being bit by a snake - what type of hypersensitivity reaction is this?
type IV
*What surface antigen is important for an APC cell to express in order to activate T helper cells?
*MHC II
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atrial flutter
*What breed of dog gets DCM associated with taurine deficiency?
*American Cocker Spaniels
What are the components of tetrology of Fallot?
VSD
pulmonic stenosis
right venticular hypertrophy
overriding aorta
Should digoxin be dosed based on lean body weight or total body weight?
lean body weight
Resting membrane potential is dependent on active/passive movement of which ion?
passive movement of potassium
*Which dog breeds are predisposed to developing VSD?
*English Bulldog, Lakeland terrier, Westies
What is the MOA of dobutamine?
beta1 agonist
*What is the MOA of cisapride?
5HT4 agonist, also enhances release of acetylcholine at the myenteric plexus
What is the MOA of mirtazapine?
central presynaptic alpha2 antagonist –> increased norepi release
also blocks 5HT3, 5HT2, and H1 receptors
What is the MOA of amphotericin B?
binds ergosterol and forms pores –> leakage of ions causes fungal cell death
What is the MOA of phenylpropanolamine?
indirect alpha (and beta) agonist
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
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)
What type of cancer is associated with glistening ventral alopecia in cats?
pancreatic adenocarcinoma
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
What drug binds to mTOR?
sirolimus (rapamycin)
Which cells are the pacemaker cells of the intestine?
interstitial cells of Cajal in the myenteric plexus
List the breakdown products of the following: lactose, sucrose, maltose.
lactose = glucose + galactose
sucrose = glucose + fructose
maltose = glucose + glucose
Which of the following can be absorbed in the intestines of the adult dog: polysaccharides, monosaccharides, disaccharides?
only monosaccharides
What is GLUT 5?
Fructose transporter in small intestine
Where in the small intestine is folate absorbed? cobalamin?
folate = proximal small intestine
cobalamin = ileum
After ingestion, cobalamin binds to ______ to transport to the duodenum, protecting B12 for degradation in the stomach.
R protein
What are homocysteine and methylmalonic acid levels used to assess?
cobalamin status - both will be elevated in hypocobalaminemia
What PAMP does TLR 5 recognize?
flagellin
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.
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
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.
Ceruloplasmin, a ferroxidase that facilitates the transfer of iron in macrophages to transferrin, requires what other ion?
Cu++
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. Œæ
Platelet antibody assay
Direct assay which detects antibody present on the surface of the platelets or megakaryocytes
What disease can result in a false positive PARR result?
Ehrlichiosis
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Right bundle branch block
What is isovolumetric relaxation?
After semilunar valves shut, ventricular pressure slowly decreases, until AV valves open up again
What non-acid fast staining bacteria causes a pyogranulomatous pleural effusion?
Actinomyces
Glipizide stimulates and diazoxide inhibits the __ channel on the ___ cell?
K channel; beta cell
The k channel on beta cells is stimulated by what drug? Inhibited by what other drug?
Stimulated: glipizide
Inhibited: diazoxide
What does GLUT4 do?
Glucose entry into all other cells (not brain, kidney, beta cells)
What does GLUT2 do?
Glucose entry into beta cells
What does GLUT1 do?
Glucose entry into the brain and kidneys
T/F: Cyanide toxicity is responsive to oxygen therapy.
False! There is enough O2 present it just cannot be used appropriately. ξ
What are the causes of pre-hepatic portal hypertension?
- congenital atresia
- fibrosis
- thrombus
- neoplasia
- extra-luminal compression
- hepatic AV-fistula
What are causes of post-hepatic portal hypertension?
- Right atrium (rt CHF, pulmonary hypertension, pericardial dz)
- Budd-Chiari syndrome (obstruction in the CVC or large hepatic veins –> obstruction of hepatic venous outflow
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
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
What drug reverses diazepam?
Flumazenil
Most common source of transmission of Cryptosporidium homini?
Water with fecal contamination
What is often associated with superficial necrolytic dermatitis?
Liver disease and glucagonoma
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.
What is often associated with superficial necrolytic dermatitis?
Liver disease and glucagonoma
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
In a healthy animal, uptake of oxygen across the blood gas barrier is diffusion/perfusion limited?
Perfusion limited
In a dog with pulmonary interstitial fibrosis, uptake of oxygen across the blood gas barrier is diffusion/perfusion limited?
Diffusion limited
Uptake of carbon monoxide across the blood gas barrier is diffusion/perfusion limited?
Diffusion limited
Uptake of nitrous oxide across the blood gas barrier is diffusion/perfusion limited?
Perfusion limited
What is the most common route of transmission of toxoplasmosis in cats?
Ingestion of bradyzoites in tissue cysts
Where in the body does angiostrongylus vasorum live?
The pulmonary arteries and right heart (french heartworm).
Eucoleus aerophilus
lung worm of dogs and cats
lives in trachea, bronchi and bronchioles
What stage of Eucoleus aerophilus would you expect to find in a TTW?
Ova
What factors inhibit platelet function?
NO, prostacyclin, ADPase, viscosity (MM)
Vasopressin (AHD) can cause ____ to be released from endothelial cells.
vWF
Which cell type is CD8+?
Cytotoxic T-cells; binds MHC I
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.
Viral and bacterial infections lead to the production of this CD4+ cell, and its cytokines?
TH1; IL-2, IFN-y, TNF-B
Allergens and parasitic infections lead to the production of this CD4+ cell, and its cytokines?
TH2; IL-4, 5, 10, 13
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.
What cytokines are responsible for class switching?
IL-4, TGF-B, IFN-y
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.
What does IFNy do?
Activates monocytes , macrophages, and NK cells; inhibits TH2. Produced by TH1 cells.
IL-2?
T-cell growth factor; produced by TH0 and TH1 cells.
Where do the classical and alternative pathways of complement converge?
C3b (right before C5-9 form the MAC).
Describe the ideal canine universal blood donor.
DEA 1.1 negative; ideally DEA 1.2 negative.
What % of dogs are DEA4 positive?
> 98%
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.
Why do all cats need to be typed and cross-matched before any blood transfusion?
Due to their naturally occurring allo-antibodies.
What is the most common UA finding in a dog with IMHA?
Bilirubinuria
Which negative test rules out DIC?
D-dimer
Calculation for osmolarity
= (2xNa) + (Glu/18) + (BUN/2.8)
What is the primary cytokine secreted by NK cells?
IFN-y
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
What causes dilation of the glomerular afferent arteriole?
Prostaglandins, bradykinin –> increased GFR
Where is Mg2+ reabsorbed in the kidney?
Thick ascending limb of the loop of Henle.
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)
Explain Type II RTA
- AKA proximal RTA
- Defect in HCO3- reabsorption in PCT –> HCO3- lost in urine
- Urine becomes acidic, pH
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-
Acidifying diet
Struvites ONLY
Alkalinizing diets
Xanthine, calcium oxalate, cysteine (+ 2-MPG, D-Pen), uric acid (+ allopurinol)
What causes increased urine production in CKD?
Renal hypertension –> glomerular hyperfiltration in 30% cats, 60% dogs
What is the treatment for membranoproliferative glomerulonephritis?
Immunosuppressive therapy (corticosteroids +/- other drugs)
What dog breed has a hereditary PLE / PLN disease?
Soft-coated wheaten terriers
A UPC >2 indicates what?
Glomerular disease
What is oxybutynin?
Muscarinic receptor antagonist (prevents overactive bladder contractions).
What is the treatment for calcium oxalate crystalluria?
- Increasing H2O intake, dilute urine
- Potassium citrate to increase urine pH
- Physical removal of stones
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.
List 2 other drugs (besides phenoxybenzamine) that also antagonize alpha-1 receptors.
Prazosin
Phenothiazines
On average, how long does it take for signs of FLUTD to resolve?
5-7 days, in 92% of cases
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
Oslerus osleri resides where in the dog?
tracheal bifurcation
Paragonimus kellicotti resides where?
lung fluke resides in RIGHT CAUDAL LUNG LOBE
How is pneumocystis carinii transmitted?
airborne transmission
Which breeds are predisposed to Pneumocystis carinii?
mini dachshund CKCS +/- yorkies documented to have low globulin levels (IgA, IgG, IgM) and impaired lymphocyte function
Where in the body does Pneumocystis carinii reside?
alveolar spaces
Which breed of cat is predisposed to disseminated mycobacterium?
Abyssinian
Which breeds are predisposed to canine leproid granuloma?
short coated breeds - boxers, mastiffs
Which stain causes Mycobacterium to appear red?
Ziehl-Neelsen stain (acid fast stain)
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
The Blastomyces urine antigen test (EIA) cross reacts with what other organism?
Histoplasma
What is the main mode of transmission of Coccidiodes immitis?
inhalation of arthroconidia
Which cat breed is predisposed to disseminated histoplasmosis?
persians
How is histoplasmosis typically transmitted?
inhalation of microconidia from soil
T/F: Sporothrix schenckii is zoonotic.
True!
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
What is the minimum temperature necessary for development of Dirofilaria into the L3 stage in the mosquito?
57F
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)
How do heartworm and Acanthelonema reconditum differ in terms of motility?
heartworm has stationary writhing movement A. reconditum has rapid, directional movement
What is the definitive host for Hepatozoon?
it’s the tick!!! …verrry tricky
What is the vector for Hepatozoon canis? Hepatozoon americanum?
H. canis = rhipicephalus H. americanum = amblyomma
The dog is the definitive/intermediate host for Hepatozoon.
intermediate host
Shar Peis have been shown to frequently have a deficient in which immunoglobulin?
IgA
Weimeraners are predisposed to a deficiency in which immunoglobulin?
IgG
CKCS that are deficient in which immunoglobulin are predisposed to Pneumocystis carinii and demodicosis?
IgG
Which breed of dog has been shown to be predisposed to C3 deficiency with autosomal recessive inheritance?
Brittany Spaniel
CLAD occurs in which breed and is associated with a deficiency in which molecules?
Irish Setters deficiency in integrin molecules CD11b and CD18
Is CLAD associated with a high or low WBC count?
very high WBC count with a severe left shift
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
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
What breeds get x-linked SCID?
MALE Cardigan Welsh Corgis and Bassett Hounds
Which breed gets lethal acrodermatitis? This condition is associated with low levels of which immunoglobulin?
bull terriers (autosomal recessive) low levels of IgA
The zona glomerulosa lacks ______ (enzyme) which is why it is unable to produce cortisol.
17-alpha hydroxylase
The zona glomerulosa contains ____ (enzyme), which is why it is the only layer of the adrenal that can make aldosterone.
aldosterone synthase
Does dopamine stimulate or inhibit aldosterone release?
inhibits
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
Which cells in the kidney produce erythropoietin?
type I renal interstitial cells
Transcription of EPO is regulated by _____
hypoxia-inducible factor hypoxia causes decrease in degradation of HIF –> activates EPO transcription element
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
What type of reticulocyte predominates in cats?
punctate
What is the lifespan of a platelet?
7 days
What is contained in alpha granules of platelets?
factor V fibrinogen P-selectin
What is the other name for the fibrinogen receptor?
GPIIb/IIIa
What is the other name for the von Willebrand receptor?
GPIb
von Willebrand factor is synthesized and stored where?
endothelial cells
Clopidogrel acts on which receptor?
P2Y12 (ADP receptor)
Platelets are cross-linked by what?
fibrinogen
Tenase is composed of which clotting factors?
IXa, VIIIa, VIIa, tissue factor
Prothrombinase is composed of which clotting factors?
Xa and Va
Which breed of dog is predisposed to PFK deficiency?
English Springer Spaniel (Also Cocker Spaniel, Whippet)
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)
Hematology counters count which type of reticulocyte?
aggregate reticulocytes
Which breed is predisposed to hereditary stomatocytosis with chrondrodysplasma?
Alaskan Malamute
Which breed gets hereditary stomatocytosis with hypertrophic gastritis?
Drentse Patrijshond
Which breeds have hereditary stomatocytosis with no associated clinical signs?
Mini and standard Schnauzers Pomeranians
Which breed of dog is predisposed to hereditary spherocytosis?
Golden Retriever due to reductions in erythrocyte membrane spectrin
Ghost cells are more common in extravascular/intravascular hemolysis
intravascular
Which breed is predisposed to hereditary macrocytosis?
toy and mini poodles +/- greyhounds
What are Howell-Jolly bodies?
small nuclear remnants within RBCs - may be seen in association with regenerative anemia or after splenectomy
What anesthetic has been associated with Heinz body formation?
propofol
Which heavy metal causes basophilic stippling of RBCs?
lead poisoning
Which breeds can have a hereditary microcytosis?
Akita, Shiba Inu
FeLV is associated with microcytic/macrocytic anemia
macrocytic
Chylomicrons are composed mostly of what?
~93% triglycerides and phospholipids (5% cholesterol, 2% apoproteins)
What are the biproducts of fatty acid catabolism?
Ketones: acetone, acetoacetate, B-hydroxybuterate
B-oxidation of fatty acids occurs where?
Mitochondria ONLY
What is the role of chylomicrons?
They facilitate transfer of exogenous lipids from the intestines to adipose tissue or the liver.
What is the most common cause of EPI in dogs?
Pancreatic acinar atrophy - secondary to immune mediated atrophic lymphocytic pancreatitis. (GSD, rough-coated collies)
What is the most common cause of EPI in cats?
Chronic pancreatitis
Why does EPI causes a low B12?
Decreased pancreatic intrinsic factor (needed for absorption); increased utilization by GI bacteria.
What gene mutation predisposes Schnauzers to pancreatitis?
SPINK1
What is the most sensative and specific test to dx pancreatitis?
cPLI (immunoassay for exocrine function); Spec cPL = same performance.
Why should metoclopramide be avoided in pancreatitis?
Pancreatic blood flow is regulated by dopaminergic receptors - metoclopramide is a dopamine antagonist –> decreased pancreatic perfusion
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.
What is the #1 clinical sign in cats with pancreatitis?
Lethargy
When will a dog with PLE not be panhypoproteinemic?
Basenji enteropathy and with Histoplasmosis - globulins are normal to increased in both.
What is the most common cause of PLE?
Lymphangiectasia
What is the best test to confirm PLE?
Fecal alpha-1 proteinase inhibitor
What is the best test for Tritrichomonas foetus infection in cats?
Fecal PCR
What is the best test to diagnose Pythiosis?
ELISA for pythium antibodies - highly sensitive and specific
Both E. coli and Salmonella are resistant to treatment with what drug?
Tylosin
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.
Describe Basenji enteropathy.
Lymphoplasmacytic enteritis + PLE; hypoalbuminemia + hyperglobulinemia; marked elevation in IgA
What 3 clinical syndromes result from taurine deficiency in cats?
Retinal atrophy, DCM, developmental abnormalities in kittens born to deficient queens.
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
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.
Which prostaglandin is protective in the stomach?
PGE - helps maintain mucosal blood flow, increases mucus and bicarb secretion, decreases H+ secretion, increases epithelial turnover
A low B12 indicates disease is what part of the GIT?
Ileum (distal SI) (folate = proximal SI)
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.
What is the best sample to culture in feline cholangiohepatitis?
Bile, collected via GB aspirate.
Ammonium biurate crystalluria
PSS
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.
Which vitamins are stored in the liver?
A, D, B12
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.
What is the role of microsomal triglyceride transport protein (MTTP)?
Required to transport chylomicrons into circulation from the GIT and VLDL from the liver.
Name an inhibitor of microsomal triglyceride protein (MTP).
Dirlotapide
What converts glucose to sorbitol?
Aldose reductase
How would you treat esophagitis?
Cisapride to improve LES tone, omeprazole to reduce acid, sucralfate to bind erosions
What cause increased LES tone?
Gastric pressure, gastric acidity, gastrin, histamine, Ach
What is the treatment for Helicobacter?
Amoxicillin, metronidazole, omeprazole, bismuth salicyclate
What is the treatment for Cu hepatitis?
Chelation w/ penicillamine or trientine, decreased absorption w/ Zn
What is the defining characteristic of a gastric ulcer?
Erosion affecting the muscular layer.
What fat soluble vitamins do cats require?
Vit A, D, E, K
Why do cats require vitamin A?
They are unable to convert beta carotene to retinol.
What maintains BG in fasting dogs? Cats?
Glycogenolysis in dogs; gluconeogenesis in cats.
What is the gold standard test for measuring SI permeability?
Lactulose / rhamnose test.
What is the primary physiologic cause of diarrhea?
Hypomotility.
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.
T/F: SAS increases the risk of endocarditis.
True
What is the MOA of azothioprine? What are the most come AEs?
A purine analogue that inhibits DNA synthesis. AEs - pancreatitis, hepatotoxicity
What is the gold standard test for thyroid function?
TSH stimulation test
Who secretes calcitonin?
Parafollicular cells (C cells) of the thyroid.
Who secretes PTH?
Chief cells of the parathyroid.
What is leptin?
Released when fat stores reach a certain level; satiety hormone.
What is ghrelin?
A hunger hormone.
T/F: 80% of dogs develop cataracts w/in 16 months of diagnosis w/ DM.
True.
What kind of insulin is used in dogs?
NPH, Vetsulin (lente)
How does the liver metabolize xenobiotics?
Phase 1 - p450; Phase 2 - conjugation
What is the MOA of octreotide?
Somatostatin analogue - inhibits insulin, glucagon, GH
What is the most frequently used insulin in cats?
Glargine
What should a diet for canine DM contain?
Fiber
What is the MOA of mitotane?
Causes necrosis of the zona fasiculata and reticularis of the adrenal cortex –> reduced secretion.
What is the most common cause of hypercalcemia in cats?
Idiopathic
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.
What is the most accurate way to confirm ocular/CNS toxoplasma in a cat?
PCR + Abs of CSF or aqueous humor
Which test correlates best with clinical toxoplasmosis?
Elevated IgM antibodies
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.
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!!
What is the diagnostic test of choice for Mycoplasma hemofelis?
PCR - detects 16S rRNA gene.
May not detect asymptotic carrier state.
What is the treatment of choice for Mycoplasma hemofelis?
Doxycycline for at least 2 weeks.
Enrofloxacin is a good alternative.
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.
How would you treat a dog diagnosed with Neorickettsia helminthoeca?
Doxycycline AND praziquantel
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.
Percentage of nosocomial veterinary ICU infections?
Most common organisms?
~16%
Salmonella & MRSA
What stage of heartworm is infectious?
L3
Streptococcus is gram +ve, catalase _______.
Staphylococcus is gram +ve, catalase _______.
Strep = catalase negative.
Staph = catalase positive.
What is the best way to dx bartonellosis? What disease might it cause in dogs?
Dx: ePCR + serology
Dz: endocarditis
What is C-peptide?
Peptide that connects A and B chains of proinsulin, and is cleaved in vesicle.
Secreted with insulin, in equal amounts.
What enzyme converts cholesterol to pregnenolone?
Cholesterol deamolase
What does cholesterol desmolase do?
Converts cholesterol to pregnenolone.
What is the mechanism of action of selegiline?
MOA inhibitors –> increased dopamine (blocks metabolism) –> ACTH.
Used for cognitive dysfunction.
What is CIRCI?
Critical illness-related corticosteroid insufficiency.
What diagnostic result would you expect to find in a pet with CIRCI?
A blunted response to ACTH stimulation (low delta cortisol)
How would you treat idiopathic hypercalcemia in a cat (stepwise)?
- Diet - high fiber, renal failure, CaOx
- Steroids
- Bisphosphonates
What dog breed is predisposed to primary hyperparathyroidism?
Keeshonds
What breed of dog is predisposed to congenital megaesophagus?
Wire haired fox terrier
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.
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.
What is the treatment of choice for Babesia?
Atovaquone + azithromycin; imidocarb less effective
What is the treatment of choice for Leishmania?
Antimonials + allopurinol
What is the MOA of the azole drugs?
Prevent ergosterol synthesis by inhibiting p450 enzymes, necessary for cell wall production.
What amino acid is a potent stimulator of insulin secretion?
Arginine
What essential amino acid in cats is used in the urea cycle?
Arginine
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)
How is excess copper excreted?
In the bile via COMMD1
What is the most common cause of icterus in sepsis?
Cholestasis
T/F: Ascites is most often seen in cats with suppurative cholangitis.
False! A high protein, low cellularity ascites is seen with lymphocytic cholangitis.
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.
What is the MOA of felbamate?
Blocks NMDA excitation, potentiates GABA inhibition.
What is the MOA of zonisamide?
T-type Ca2+ channel blocker –> prevents spread of AP
A young dog with myoclonus likely has what disease?
Distemper
What are the most common clinical signs associated with Neospora in a puppy?
LMN signs w/ spastic gait.
What is the treatment for Neospora?
TMS, pyrimethamine, clindamycin
Why is treatment with KBr avoided in cats?
Causes pneumonitis and pancreatitis in cats.
What antibiotics should be avoided in a dog with myasthenia gravis? Why?
Ampicillin and aminoglycosides. Impair neuromuscular transmission. (Phenothiazine do also!)
____ is an important cofactor for cerebral aerobic glycolytic metabolism.
Thiamine
What is the diagnostic test of choice for Leptospirosis?
MAT - look for 4x increase in Abs; may be seronegative during 1st week of dz.
What is the main abnormality noted in dogs and cats with Mycoplasma?
Anemia
What is the treatment for Mycoplasma?
Doxycycline
How do you diagnose Anaplasma?
Identification of morulae, 4Dx ELISA
What is the known vector for Leishmania?
Sand-fly
What is the infective stage of Leishmania?
Promastigote
Describe the histo findings in Coonhound paralysis.
Peripheral demyelinating neuropathy with lymphocytic radiculitis.
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
Adverse effect of pegylated liposomal doxorubicin?
Palmar plantar erythrodysethesia syndrome (PPES)
What is p53?
Tumor suppressor gene
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.
Where on the bone does osteosarcoma most commonly occur?
Metaphyseal region
What is samarium?
A bone seeking radionucleotide used for palliative OSA tx.
What drug is used for its anti-estrogenic effects in mammary neoplasia?
Tamoxifen
An exon 11 ckit mutation in a mast cell tumor carries a better/worse prognosis.
Worse
____ is important in transaminase reactions.
Pyridoxine (B6)
What is the MOA of theophylline?
Competitive phosphodiesterase inhibitor and adenosine antagonist –> increased Epi.
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.
How do you calculate the bicarb deficit?
0.3 x kg x (24-bicarb)
Which chemotherapy agents are nephrotoxic?
Cisplatin, streptozotocin, CCNU (lomustine), doxorubicin (cats)
What is the MOA of amitriptyline?
tricyclic antidepressant: anticholinergic, antihistamine, analgesic, anti-inflammatory
How do you treat juvenile cellulitis (puppy strangles)?
Corticosteroids + antibiotics if secondary infection present.
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)
What is the most common Lepto serovar in dogs?
Grippotyphosa
What are the pathogenic proteins of Lepto?
LipL32, OMP
How do you treat Lepto in a dog?
Ampicillin for the leptospiremic phase; doxycycline for the carrier phase.
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
How do you treat Cytauxzoonosis?
Atovaquone + azithromycin; imidocarb less effective
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.
What is the 3-year mortality for Flevo?
80%
What do we know about Feline Calicivirus VSD (virulent systemic dz)?
Previously developed FCV vaccines are NOT protective; high feline mortality (33-60%).
What clinical signs are seen with organophosphate toxicity?
SLUD (muscarinic signs), muscle fasiculations (nicotinic signs).
What is the treatment for OP toxicity?
2-PAM, +/- atropine
What is the MOA of amitraz toxicity? Where would exposure occur? How would you treat?
MOA: alpha 2 agonist; tick collars; tx: yohimbine
Treatment for lead toxicity?
Succimer, CaEDTA, D-penicillamine, cathartics + Mg sulfate, thiamine
The canine parvovirus vaccine is based on which subtype?
CPV2b
Glucocorticoids induce ____ which inhibits phospholipase A2, which converts AA into ______.
lipocortin-1; eicosanoids
What are 2 striated muscle relaxants?
Benzodiazepines and dantrolene
Where does CAV1 cause disease? CAV2?
Liver; upper respiratory tract / lungs
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
Surfactant is synthesized by _______.
type II alveolar cells
The most important stimulus controlling the level of resting ventilation is:
pH of CSF on central chemoreceptors (West)
What enzyme converts cholesterol to pregnenolone in the adrenal?
cholesterol desmolase (rate limiting step)
List 5 things that increase lower esophageal sphincter tone.
gastrin
histamine
ACh
gastric distention
gastric acidity
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
EPI in dogs is most commonly caused by ____. What about cats?
dogs - acinar atrophy
cats - chronic pancreatitis
What is the mechanism of tetanospasmin?
irreversibly binds to presynaptic sites in inhibitory neurons –> inhibits glycine and GABA
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
What is the MOA of azole antifungals?
inhibit the enzyme lanosterol 14 ‘±-demethylase (P450); the enzyme necessary to convert lanosterol to ergosterol
What is the MOA of zonisamide?
blocks sodium and T-type calcium channels, which leads to the suppression of neuronal hypersynchronizationξ
Thiamine is an important cofactor for ______
cerebral aerobic glycolytic metabolism
Which layer must be effected for a lesion to be considered a gastric ulcer?
muscularis
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.
Why is vasopressin used in patients with vWD?
induces release of vWF from endothelial cells
What are the components of MOPP and what types of drugs are they?
mechlorethamine, oncovin (vincristine), procarbazine
MP = alkylating agents
O = anti-microtubule agent
What should you do if your patient becomes thrombocytopenic on CCNU?
discontinue treatment because effects are cumulative
What is the nadir for CCNU?
14 days (compared with 7 days for most other drugs)
What is tamoxifen used for?
antiestrogenic effects in mammary neoplasia
What happens to ammonia levels if arginine levels are low?
hyperammoniemia due to the need for arginine in the urea cycle
Does C6 cross react with antibodies produced from vaccination for Lyme?
no!
During fasting, dogs maintain their BG in normal range via _____, whereas cats maintain their BG in normal range via _______.
dogs - glycogenolysis
cats - gluconeogenesis
What is the MOA of oxybutynin?
muscarinic receptor antagonist
Glucocorticoids induce ____ which inhibits phospholipase A2
lipocortin
For which virus is a killed vaccine always recommended?
rabies
What is the treatment for pneumocystis carinii?
TMS
What is the MOA of neostigmine?
blocks acetylcholinesterase
What is the MOA of bethanechol?
selectively stimulates muscarinic receptors
What is LipL32?
pathogenic outer membrane protein (OMP) of lepto
What is the main MOA of amitraz toxicity? What is the treatment?
alpha2 agonist tx: yohimbine
What organism can cause a false positive on PARR?
Ehrlichia
Which of the following are NOT susceptible to tylosin: Staphylococcus, E. coli, Streptococcus, Salmonella, Corynebacterium?
E. coli Salmonella
What do the following chemotherapeutics have in common: doxorubicin, cisplatin, streptozocin, lomustine?
potential for nephrotoxicity
FLUTD signs resolve in 5-7 days in ___% of cases
92%
What is the MOA of amitriptylline?
tricyclic antidepressant (serotonin-norepi reuptake inhibitor) also anticholinergic, antihistamine, analgesic, anti-inflammatory
What alpha receptor does acepromazine act on?
alpha 1 antagonist this is not the main mechanism though - D2 receptor antagonism is main mechanism
What is the MOA of dantrolene?
antagonizes ryanodine receptor, thereby inhibiting release of Ca from SR muscle relaxant
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
What are the treatments for lead poisoning?
CaEDTA, Succimer (chelating agent), D-penicillamine, thiamine (reduces tissue deposition), MgSO4 (as cathartic)
What is the most prevalent strain of parvovirus?
CPV-2b
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
Which valve is most commonly affected in dogs with endocarditis?
mitral
Which heart conditions have been associated with an increased risk of endocarditis?
subaortic stenosis
PDA NOT DMVD
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)
What are the two main cytokines released by NK cells?
TNA-alpha, IFN-gamma
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
What makes up the majority of the chylomicron?
triglycerides
Hyperventilation would have what effect on cerebral blood flow?
hyperventilation –> decreased PaCO2 –> vasocontriction –> decreased cerebral blood flow
What is enterokinase and where does it come from?
comes from duodenum converts trypsinogen to trypsin
T/F: Bradykinin is inactivated in the lung
True! Up to 80%
Cimetidine is a major inducer/inhibitor of P450.
inhibitor
ketoconazole is an inhibitor/inducer of P450 and an inhibitor/inducer of P-glycoprotein.
inhibitor of both!
Phenobarbital is an inducer/inhibitor of P45
inhibitor
Which antibiotic inhibits phenobarbital clearance?
chloramphenicol can result in sedation if used together
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
What should you do if enrofloxacin and theophylline need to be given concurrently?
Reduce the dose of theophylline by 30%
E. canis causes _________ ehrlichiosis.
Monocytic
What is seen with chronic E. canis infection?
- Pancytopenia from bone marrow hypoplasia Same signs as acute phase, plus
- Dyspnea, uveitis, retinal hemorrhage, deems, PLN, polymyositis
- Monoclonal gammopathy
What is the treatment for Bartonella?
Aminoglycosides +- doxycycline
Long term:
Doxycycline + Baytril - dogs
Doxycycline + pardofloxacin - cats
Ehrlichia ewingii causes _______ ehrlichiosis.
granulocytic
In dogs the meronts of Hepatozoon canis infect the _____ system and Hepatozoon americanum infects ______.
Hemolymphatic (spleen, BM, etc.)
Skeletal and cardiac muscle
What are the most common organisms to cause bacterial endocarditis?
Staph and Strep = most common; E. coli and Bartonella too
Osmolar gap?
The difference between the calculated serum osmolarity and the measured serum osmolarity. Osmolar gap = measured - calculated.
What is the most common presenting complaint in a hypercalcemic animal?
PU/PD
What causes PU/PD with hypercalcemia?
HyperCa2+ inhibits the response of renal tubules to ADH –> NDI
A normal PTH level in the face of hypercalcemia is consistent with what?
Hyperparathyroidism (should be LOW)
What is the best method to detect microparticles?
Flow cytometry
Drugs / toxins that limit hemoglobin production?
Lead, chloramphenicol, azathioprine, allopurinol, phenobarbital
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)
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
What is the most common finding in a dog with acetaminophen toxicity? A cat?
Dog = hepatotoxicity; cat = methemoglobinemia/anemia
What is the toxic metabolite in acetaminophen toxicity?
NAPQI
How do you treat an acetaminophen toxicity?
N-acetylcysteine, SAMe, supportive
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.
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.
What is the main role of carbonic anhydrase?
Converts CO2 + H2O H+ + HCO3- (carbonic acid dissociates to)
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.
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.
What are the factors that affect vasodilation / vasoconstriction in pulmonary hypertension?
Vasodilation: NO, prostacyclin (PGI2)
Vasoconstriction: endothelin, thromboxane, serotonin
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
How do feline seizures usually initiate?
Complex partial seizures - aka psychomotor seizures (maniacal running, aggression, tail chasing, etc.). Can terminate as generalized seizures.
What is the most important component of DKA treatment?
Fluid therapy!! Then correction of electrolytes, then hyperglycemia.
What parasite causes tracheal thickening w/ masses?
Eucoleus aerophilus (Oslerus osleri causes nodules at the tracheal bifurcation and bronchi)
T/F: Multiple myeloma can interfere with coagulation.
True: primarily via globulins inhibiting platelet aggregation and TF release.
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)
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
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.
How much bicarb is resorbed in the PCT?
80-90% of filtered bicarb is resorbed in PCT
Where in the renal tubules does gentamycin toxicity occur?
Proximal tubular epithelial cells –> accumulate, cause injury
What decreases GFR?
Increased glomerular oncotic pressure (more pull), decreased glomerular hydrostatic pressure (less push)
_____ 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
What are ANAs? Directed against what?
ANAs = anti-nuclear antibodies; directed against self nuclear components.
What type of hypersensitivity reaction causes hemolysis after a blood transfusion?
Type II - antibody mediated cytotoxicity - activates classical complement cascade.
What do microRNA do?
Down regulate specific gene expression
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
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
Fragments of LPS are what?
PAMPS: from gram - bacteria, recognized by TLR-4 –> activation of innate immunity
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.
What percentage of total body water is ECF?
ECF = 33% (1/4 plasma, 3/4 interstitial fluid); ICF = 66%
What stimulates ADH?
1.) Increased plasma [Na+], osmolarity
2.) decreased arterial BP
3.) decreased blood volume
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?????
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!
How does aspirin inhibit platelet aggregation?
Inhibits COX-1 (irreversible) –> decreased thromboxanes (and prostaglandins)
What factor most affects blood flow through a vessel?
Radius
What determines osmotic force?
Number of particles (not mass of particles)
What increases cardiac contractility (Ca, Na, K, other)?
Ca++ –> contraction and force of; Na+ entering causes upstroke of the AP
How does a neutrophil kill phagocytized bacteria?
Respiratory burst: NADPH oxidase creates bactericidal oxidants (H2O2); digestive enzymes: released from granules into phagolysosome.
Signs of a forebrain lesion?
Seizures, behavior changes, normal gait w/ circling/pacing/head pressing, contralateral vision impairment w/ normal PLRs
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.
In the PLR pathway which CN nerve carries the afferent signal? The efferent?
Afferent = CN II (optic)
Efferent = CN III (oculomotor)
What part of the PCR determines specificity?
Primers
What test requires live organisms?
Lepto MAT (microscopic agglutination test)
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.
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.
What thyroid hormone acts the quickest on its target cell?
T3
T4 is rapidly convert to T3 inside the cell.
What inhibits glucagon secretion?
Increased BG, somatostatin
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)
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.
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.
2 examples of portal vein atresia
Portal vein hypoplasia and microvascular dysplasia.
usually asymptomatic
*
- elevated total serum bile acids
- normal protein C, AUS, scintigraphy
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!
What is the idea diet for a cat with DM?
High protein
Low carb
Helps maintain ideal body weight and preserve lean muscle.
What arrhythmia might you see on an ECG from a dog being treated with doxorubicin?
Right bundle branch block
A dog with a creatinine of 4.5 would be what IRIS stage?
Stage 3
A cat with a creatinine of 2.1 would be an IRIS stage what?
Stage 2
What causes lipemic serum?
Increased triglycerides
(E.g. Post-prandial, DM, HL, pancreatitis, neoplasia)
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
What side effect of methimazole can be reduced with topical treatment?
GI adverse effects
What stain can be used to detect mast cell granules?
Toluidine blue
Besides hypokalemia, what other electrolyte abnormally can potentate digoxin toxicity?
Hypercalcemia
Digoxin causes increase in intracellular Ca - hyperCa adds to this effect –> toxicity
What percentage of dogs with cerebral infarcts are hypertensive?
25-30%
What is the most common presentation of SLE?
Polyarthritis
Where is most CSF produced?
Choroid plexus
What are the primary effects (4) of GH?
- promotes protein deposition
- decreases carbohydrate utilization
- stimulates cartilage and bone growth
- induces production of somatostatins
What are the major stimulators (6) of GH?
- starvation
- hypoglycemia, low blood FAs
- exercise
- excitement
- trauma
- ghrelin
True test + / All dz + = ?
Sensitivity
True test + / All test + = ?
Positive predictive value
What prokinetic drug causes decreased acetylcholinesterase activity
Neostigmine
What is the treatment for zinc toxicity?
- remove source
- PPI
- sucralfate
What channel is responsible for the automaticity of pacemaker cells?
Na+ channels
How does Na leave the basolateral and paracellular surfaces of the renal epithelial cells?
Via Na-K ATPase
What are the primary pyrogens (3)?
IL-1, IL-6, TNF-alpha
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.
Underlying causes of feline pericardial dz?
Left sided CHF, FIP
Phenotypic characterization of T regulatory cells includes expression of which two surface antigens and transcription of which gene?
CD4 and CD25
transcription of FoxP3
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
What does LGI stand for in reference to epilepsy?
leucine-rich glioma-inactivated protein
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
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
What mutation pre-disposes Belgian Shepherds to adult-onset epilepsy?
ADAM23 mutation
focal seizures that may or may not become generalized
What is the best currently-available test for diagnosis of Bartonella infection?
BAPGM culture + PCR (ePCR from Galaxy diagnostics)
The FeLV SNAP test assesses for antigen/antibody . The FIV SNAP test assesses for antigen/antibody.
FeLV - antigen FIV - antibody
How often should blood donors be screened for infectious diseases?
at least once a year
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
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
B. canis vogeli is most common in which breed? B. gibsoni is most common in which breed?
B. canis vogeli = greyhound B. gibsoni = pitbull
Laishmania donovani is considered endemic in which breed of dogs in North America?
foxhounds
The IFA assay for Leishmania cross-reacts with which other pathogen?
Trypanosoma cruzi
What is the vector for Trypanosomiasis in the US?
feces-contaminated bite from (or ingestion of) triatomine bugs (kissing bugs)
Which infectious disease in dogs is most associated with acute or chronic myocarditis - leishmania, trypanosoma, hepatozoon, ehrlichia?
trypanosoma
T/F: Lyme can be transmitted by transfusion
FALSE! (or at least it has not been documented)
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
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
What is the definitive host for bartonella?
cats!
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
Cytauxzoon felis undergoes schizogony in ____ cells and merogony in ____ cells.
schizogony in myeloid cells merogony in RBCs
Which stage of Cytauxzoon development is associated with clinical illness?
schizogony
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
What is the diagnostic test of choice for screening blood donor cats for M. hemofelis?
PCR
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
What specific antigen does the FeLV ELISA test for?
p27
T/F: FeLV can be transmitted by blood transfusion
True!
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
How is FIV most commonly transmitted?
bite wounds
Which proteins are used in FIV SNAP tests to detect antibodies?
p24 and p15
Which species is the reservoir host for Rickettsia felis?
DOGS! Tricky tricky….
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
Why is troponin C unfit for use as a cardiac biomarker?
the cardiac and skeletal isoforms are completely homologous
List 3 mechanisms of cytosolic cardiac troponin release without cell death
- increased membrane permeability 2. intracellular proteolysis 3. release of membranous vesicles containing cytosolic troponin
Which troponin is released in higher concentrations after a cardiac insult - troponin T or troponin I?
troponin I
T/F: Troponin concentrations correlate with the degree of cardiac injury on histopath
true!
List some substances in the blood that can falsely increase serum troponin concentrations.
elevated ALP hemolysis lipemia fibrin rheumatoid factor immune complexes
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?….)
T/F: There is overlap between troponin concentration in healthy individuals and those with cardiac disease
True!
Increased troponin concentrations in critically ill patients has been associated with higher levels of what cytokines?
TNF-alpha, IL-6
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
Which cardiac troponin has been noted to be elevated in azotemic dogs?
cTnI
Which troponin is the cardiac injury marker of choice in dogs and cats?
cTnI
What are criteria for initiation of anti-epileptic drug treatment?
- 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
Why can the elimination half life of phenobarbital progressively decrease with chronic dosing?
because it is an auto-inducer of hepatic microsomal enzymes (p450)
How long is the median elimination half life of KBr?
15.2 days!
Diets high in _____ result in excess renal excretion of KBr.
chloride
What is the only anti-epileptic drug specifically approved for dogs in the US?
primidone
Primidone is rapidly metabolized to which major active metabolite?
phenobarbital
T/F: Keppra undergoes extensive hepatic metabolism.
False! it is not metabolized in the liver and is excreted essentially unchanged in the urine
What are 3 major risks of treatment with phenobarbital?
hepatotoxicity idiosyncratic blood dyscrasias necrolytic dermatitis
After starting pheno treatment, when should drug monitoring be performed?
2 weeks, 6 weeks, then every 6mo or 2 weeks after a dose change
What are 3 side effects of potassium bromide treatment?
pancreatitis sedation ataxia
The hypogastric nerve comes from which spinal segments in cats? in dogs?
L2-L5 in cats, L1-L4 in dogs
The pelvic nerve fibers to the bladder comes from which nerve segments in dogs?
S2-S3
The pudendal nerve comes from which nerve segments in the dog?
S1-S3
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
____ 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
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
Describe LMN bladder.
detrusor hyporeflexia/areflexia + sphincter hypotonia/atonia •ÄÊ increased bladder capacity/residual volume, constant urine leakage
Describe UMN bladder
detrusor overactivity causes•ÄÊ periodic elevated intravesical pressure and urine leakage with detrusor-sphincter dyssynergia during attempts to empty bladder
Which fibers can become activated in suprasacral spinal injury and can contribute to “reflex voiding”?
C fibers
Why do dogs with spinal cord injury have an increased risk of pyelonephritis?
increased intravesicular pressure with detrusor overactivity leads to vesicoureteral reflux
What treatments can be considered for detrusor overactivity following spinal cord injury?
- antimuscarinics (oxybutynin, botox in bladder wall) 2. vanilloids (capsaicin) intravesciularly or intradetrusor 3. tramadol
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)
Fluoroquinolones and aminoglycosides are most efficacious in what urine pH?
alkalineåÊ
Tetracyclines and beta lactams work best in what urine pH?
acidic pH (but pH doesn’t matter for amoxicillin or clavamox)
Does T. foetus cause large or small bowel diarrhea in cats?
large bowel diarrhea
What is the treatment of choice for T. foetus infection in cats?
ronidazole
Why are Trichomonads capable of living as lumen dwellers in oxygen-poor mucosal environments?
they lack mitochondria and use hydrogenosomes for ANAEROBIC metabolism
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
List 4 factors contributing to T. foetus pathogenicity in cats.
- sialic-acid binding lectins 2. adhesin proteins 3. lipophosphoglycan 4. cysteine proteases
T/F: Infection with trichomonas in cats confers lifelong acquired immunity.
False!
Trichomonas has a sexual/asexual lifecycle and aerobic/anaerobic metabolism
asexual lifecycle anaerobic metabolism
List 3 scenarios in which surgical removal of struvite uroliths may be considered.
- 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
T/F: Struvite nephroliths should be medically dissolved.
True!
T/F: Dissolution should be attempted in cats with obstructive upper urinary tract uroliths.
False!
Uric acid is transported to the liver, where it is metabolized by _____ (enzyme) into _______.
metabolized by hepatic uricase to allantoin
What genetic mutation is associated with urate stone production in dogs?
SLC2A9
T/F: Dissolution of urate stones is typically not possible in dogs/cats with uncorrected liver disease (such as PSS)
TRUE
What is the target urine pH for dissolution of cysteine stones?
~7.5 thiol binding drugs efficacy is increased at this pH or higher
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
Over 90% of nephroliths and ureteroliths in cats are composed primarily of _______
calcium oxalate
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
In preventing calcium oxalate stone recurrence, a target USG for dogs is ____ and for cats is ____
dogs < 1.020 cats < 1.030
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
Which sulfur-containing amino acid is a precursor to cystine?
methionine
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
*Which stage of toxoplasmosis infects the placenta?
*tachyzoite
*Which breed is associated with thrombocytopenia due to macroplatelets?
*Cavalier King Charles Spaniel
*Which does firocoxib inhibit - COX-1, COX-2, or both?
*Primarily COX-2
*What is the range of protein content in FIP effusion?
*3.9 - 9.8
*What is the cellularity of effusion in FIP?
*<5000/uL (low-moderate cellularity)
*What types of cells are seen in FIP effusion?
*macrophages, neutrophils, some lymphocytes
*What is the MOA of doxycycline?
*inhibits protein synthesis by binding 30s subunit
Is doxycycline bacteriocidal or bacteriostatic?
bacteriostatic
How is Hepatozoon americanum transmitted?
dog ingests tick (Amblyomma maculatum)
*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
*What regulates CSF pressure?
*arachnoid villi
*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
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)
*Which antibiotics have good penetration for the prostate?
*antibiotics that are nonionized at a neutral pH with HIGH fat solubility: enrofloxacin, clindamycin, TMS
*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
Toxoplasma oocysts take how many days to become infective after being shed in feces?
1-5d, therefore daily scooping of litter box is important
What is the definitive host of Toxoplasma gondii?
cats
How can Toxoplasma gondii be transmitted?
consumption of oocysts passed in feces of cats
consumption of bradyzoites encysted in tissue
transplacental transmission via tachyzoites
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
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)
*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.
*Aside from serum, what other samples can be analyzed for toxoplasma antibodies?
*CSF, aqueous humor
*What is the vector for Cytauxzoon felis?
*Lone star tick (Amblyomma americanum)
*What is the nautral host for Cytauxzoon?
*bobcat
*Does cytauxzoon undergo cat-cat transmission or vertical transmission?
*probably not either (at least not in experimental models)
*What is the infectious stage of cytauxzoon? What cells do they infect?
*sporozoites infect mononuclear phagocytes
*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
*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
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
What are the most common bloodwork findings in cats with cytauxzoonosis?
leukopenia with toxic neutrophils, thrombocytopenia, NN anemia, hyperbilirubinemia, hypoalbuminemia
What medications have been associated with the highest survival rates in cats with cytauxzoonosis?
combinationof atovaquone and azithromycin
*Drop jaw is caused by paralysis of which nerve? Which muscles would be atrophied?
*mandibular branch of trigeminal nerve
temporalis, masseter, pterygoid
*What bacteria are the most common cause of diskospondylitis in dogs?
*coagulase-positive Staphylococcus spp. (aureus, intermedius)
*The presence of what bacteria in a tracheal wash specimen would be indicative of oropharyngeal contamination?
*Simonsiella
What are these organisms seen on endotracheal wash? What do they represent?
Simonsiella, representative of oropharyngeal contamination
*Which aflatoxin is most commonly encountered in food-related toxicosis?
*aflatoxin B1 (AFB1) - associated with corn, grains, peanuts, soybeans, treenuts, cottonseed
*What fungus commonly produces aflatoxins found in foods?
*Aspergillus
*How does aflatoxin cause hepatotoxicity?
due to low glutathione levels for neutralization of aflatoxins
*Why are dogs so sensitive to aflatoxicosis?
*due to low glutathione levels for neutralization of aflatoxins
*What is the treatment of choice for tritrichomonas infection?
*ronidazole
*What is the most important extracellular buffer?
*HCO3-
*What activates pepsinogen to pepsin?
*low pH in stomach
*List adverse effects of misoprostol.
*GI distress
uterine contractions & vaginal bleeding in female dogs (uncommon)
abortion if given during pregnancy
*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
*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
*Describe stage A DMVD
*At high risk for developing DMVD but without a murmur (such as all Cavaliers without murmurs)
*Describe stage B DMVD.
*Patients with structural heart disease that have never developed clinical signs of CHF
*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
*Describe stage C DMVD.
*Patients with past or current clinical signs of CHF
*Describe stage D DMVD
*Patients with end-stage CHF, refractory to standard therapy
*Would you expect hyper- or hyponatremia in cases of nephrogenic diabetes insipidus?
*hypernatremia due to pure water loss
What is the main stimulus for ADH release?
Increased serum osmolality
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
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
*Secretion of glucagon is inhibited by…
*insulin
somatostatin
FFAs
ketoacids
urea
*How do you calculate odds ratio using this chart?
*odds ratio = ad/bc
In what type of study would you calculate an odds ratio?
case control study
*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
*Which inflammatory mediator is the strongest chemokine?
*leukotriene B4
*Define functional residual capacity
*The volume of air present in the lungs at the end of passive expiration
*Which 2 cardiac abnormalities will result in hyperkinetic pulses?
*aortic insuffiency and PDA
*How do cardiac glycosides (digoxin, ouabain, foxglove) work?
*inhibit Na-K-ATPase pump
*What nerve innervates the external urethral sphincter? What type of innervation is it?
*pudendal nerve, somatic acting on nicotinic receptors
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)
Which nerve innervates the internal urethral sphincter? What type of innervation is this?
hypogastric nerve - sympathetic (acts on alpha1 receptors to contract internal sphincter)
*What constitutes the largest pool of iron in the body?
*hemoglobin
*What type of immunoglobulin is involved in type I hypersensitivity reactions?
*IgE
*Which cells stimulate B cells to produce IgE in type I hypersensitivity reactions?
*CD4+ Th2 cells
*Glomerulonephritis is an example of what type of hypersensitivity reaction?
*type III (immune complex)
Describe type II hypersensitivity reactions.
cytotoxic hypersensitivity - antibodies produced by B cells bind to antigens on patient’s own cells and activate complement
What types of immunoglobulins are involved in type II hypersensitivity reactions?
IgG and IgM
