August - September 2024

Question 1

How is cryptosporidiosis treated in reptiles?

• Metronidazole
• Fenbendazole
• Sulfa antibiotics
• Penicillin
• There is no effective treatment

Answer 1

Answer: There is no effective treatment

The correct answer is there is no effective treatment. Clinical signs of cryptosporidiosis in reptiles include regurgitation, weight loss, and debilitation. The organism causes thickening of the gastrointestinal mucosa and loss of motility.
Diagnosis is made by acid-fast staining of fresh feces or regurgitated food. Since there is no effective treatment euthanasia is often recommended.

Question 2

You arrive to a canine breeding kennel to help them with an outbreak of diarrhea that appears to be of the malabsorptive and maldigestive kind. You perform several fecal smears to help find a diagnosis. On several of the smears you notice a protozoal organism swimming around in a “falling leaf” motion when you are at 40x. These organisms also have a ventral concave disc, are pear shaped, binucleate, and are approximately 15 × 8 micrometers. What is the organism?

• Cryptosporidium
• Tritrichomonas foetus
• Isospora
• Giardia

Answer 2

Answer: Giardia

The correct answer is Giardia. Young, immunodeficient, and grouped animals tend to show signs. This question provides a classic description of the motile trophozoite. Remember, the cyst is the infective mode, not the trophozoite.

T. foetus has an undulating membrane which helps you differentiate from Giardia along with 3-5 anterior flagella. Additionally, T. foetus is not commonly found in dogs. When looking for Isospora, you would expect to see them on a fecal flotation in the form of ocysts.

Cryptosporidium would be round and slightly smaller than a red blood cell. Acid-fast or fluorescent antibody stains are performed on direct fecal smears to help find these small organisms.

Question 3

A dog spayed at what time has the least likelihood of developing malignant mammary tumors?

• After third estrus
• Between first and second estrus
• Between second and third estrus
• Before first estrus

Answer 3

Answer: Before first estrus

The correct answer is before first estrus.
Development of mammary tumors in the dog is hormone dependent. As such, ovariohysterectomy before a heat cycle prevents the hormonal effects on the mammary glands that predispose them to developing tumors. Dogs spayed prior to an estrus are 0.05% times as likely to develop a mammary tumor as an intact dog. That risk rises to 8% and 26% after one and two heats respectively, with no decrease in risk if they are spayed subsequent to a third heat.

Question 4

A cat arrives at your clinic after being attacked by a raccoon. This cat is unvaccinated. What should you do?

• Vaccinate immediately and quarantine for 45ndays
• Euthanize immediately or quarantine for 4 months. Vaccinate for rabies at time of entry into quarantine
• Euthanize immediately or vaccinate immediately and quarantine for 45 days
• Euthanize immediately or quarantine for 6 months, and vaccinate 1 month before release
• Euthanize immediately

Answer 4

Answer: Euthanize immediately or quarantine for 4 months. Vaccinate for rabies at time of entry into quarantine

Per the 2016 Rabies Guidelines:
Since the cat is unvaccinated, it should either be euthanized and tissue submitted for rabies testing OR immediately vaccinated for rabies and quarantined for 4 months.

The Direct Fluorescent Antibody Test detects viral antigens and should be tested on two locations from the brain (brainstem and cerebellum) and is the test of choice for rabies diagnosis.

If the cat was current on rabies vaccination, the guidelines direct to booster the rabies vaccination immediately and have the owners observe closely indoors for 45 days.

If owners are able to provide proof the cat had been previously vaccinated for rabies, but is overdue: guidelines direct to booster rabies vaccination immediately and keep the cat indoors under owner observation for 45 days.

Question 5

Which of the following drugs and treatment intervals are appropriate for preventing heartworm disease in dogs?
Milbemycin twice daily
Ivermectin once a month
Milbemycin oxime once daily
Ivermectin once daily
Diethylcarbamazine once monthly

Answer 5

Answer: Ivermectin once a month

The correct answer is ivermectin once monthly.
Diethylcarbamazine (DEC) can be used to prevent heartworm, but is administered once daily.
Milbemycin oxime is another preventative used once monthly.

Question 6

A 3-month-old pit bull terrier presents with generalized alopecia and crusting of the skin (see image). A deep skin scraping shows the dog has generalized demodicosis.
What should you tell the owners?

• The dog likely has an inherited defect in cellular immunity. The dog should not be bred.
• It is very common for pit bull puppies to get generalized Demodex infections. The puppy should be treated for the infection but the prognosis is good.
• Transmission of the infection was from the bitch to the puppy. The bitch should be treated for Demodex because she is the source of the infection. The puppy does not need to be treated.
• Generalized Demodex infections usually resolve on their own without treatment.

Answer 6

Answer: The dog likely has an inherited defect in cellular immunity. The dog should not be bred.

The correct answer is the dog likely has an inherited defect in cellular immunity. The dog should not be bred. Generalized demodicosis in juveniles and puppies is usually caused by an inherited defect in cell immunity. They should be treated with a mite killing agent like ivermectin, amitraz, or milbemycin, as well as with oral antibiotics for secondary bacterial infections.

Spontaneous remission of the infection can occur, but the prognosis is always guarded. Demodex mites are part of the natural flora of a dog’s skin, so they are normally present all the time. Adult dogs that develop generalized demodicosis are usually immune-suppressed.

Question 7

Young turkeys on a large new farm are showing stunting, poor feathering, and short thick bowed legs. Histologically they have chondrodysplasia. The most likely cause of this is?

• Selenium deficiency
• Copper deficiency
• Choline deficiency
• Magnesium deficiency
• Vitamin E deficiency

Answer 7

Answer: Choline deficiency

This occurs in both chicks and young turkeys, but turkeys have a particularly high choline requirement. The clinical signs described should lead you to suspect this deficiency.

Question 8

Which of these breeds of dogs has a congenital ocular anomaly characterized by choroidal hypoplasia, manifested by varying degrees of visual dysfunction with signs of large bizarre choroidal vessels visible on fundic exam as depicted here?

Collie
Toy Poodle
Boston Terrier
German Shepherd Dog
West Highland White Terrier

Answer 8

Answer: Collie

The correct answer is collie. Collie Eye Anomaly is seen in up to 80% of the breed. Some are completely blind and others show no visual deficits.

Other signs include optic disc coloboma, retinal hemorrhage and retinal separation.

Question 9

Tammy, a veterinary assistant, is having a disagreement with Stella, the practice’s Lead Veterinary Technician. Tammy discusses the issue with the practice owner, Dr. Farooqui. Meanwhile, Stella discusses the issue with the practice’s Office Manager. Dr. Farooqui and the Office Manager each recommend different solutions to the issue. Unfortunately, the conflicting recommendations worsen the disagreement between Tammy and Stella.

Which of the following is the most appropriate way for the practice to address employee disputes in the future?

• Have the practice’s office manager address all problems in a weekly meeting.
• Instruct the staff members to bring all problems to the attention of the practice owner.
• Create a chart outlining the hierarchy of authority for handling problems in the practice.
• Designate a panel of three employees to address problems within the practice.

Answer 9

Answer: Create a chart outlining the hierarchy of authority for handling problems in the practice.

Each staff member should know their relationship to one another in the clinic’s hierarchy of authority.

This information should be written and organized into an easy-to-understand chart. Communication channels should be outlined so that all staff members know who to approach with problems.

Designating a single person to handle all clinic issues is inefficient. While an advisory panel may be helpful in certain circumstances, creating a clear hierarchy of authority in which each staff member knows who to report to is ideal.

Source: The Art of Veterinary Practice Management. Mark Opperman and Sheila Grosdidier. Advanstar Communications, Inc., 2014. Page 83-84.

Question 10

A 3-year-old male castrated golden retriever presents to your emergency clinic by a good samaritan. He reports finding the dog severely limping and bleeding while he was on a hike. On your examination, the dog has a large bleeding wound on the lateral aspect of the left elbow.

• The dog has a gunshot wound
• The dog was caught in an animal trap
• The dog fell from a significant height
• The dog has a penetrating wound from a sharp object
• The dog was attacked by an animal

The dog is alert with pink mucous membranes and normal vital parameters. He is non-weight bearing lame on the left forelimb. You start the dog on fluids and analgesics and apply a sterile bandage before taking a radiograph of the left elbow which is shown below. How would you interpret the radiograph?

Answer 10

Answer: The dog has a gunshot wound

The metal dense shrapnel and highly comminuted fracture of the distal humerus and proximal radius and ulna are indicative of a gunshot wound. The dog should be assessed for life threatening injuries including penetrating trauma to body cavities and for any evidence of hemorrhage. This fracture probably cannot be stabilized due to the degree of comminution.

Arthrodesis could potentially be attempted but more likely, the dog will require an amputation.

Question 11

You are examining a 12-year old spayed female Border Collie. You note that her pupillary light reflex is slow and incomplete. Her menace and palpebral responses are normal. You see that the iris-pupil margin is somewhat irregular.

Fundic exam is shown in the image. What is the most likely cause of the slow PLR? Both eyes are similarly affected.

• Uveal neoplasia
• Cranial nerve III deficits
• Progressive retinal atrophy
• Iris atrophy

Answer 11

Answer: Iris atrophy

The correct answer is iris atrophy. This is a normal canine fundus in the picture. Iris atrophy is a normal aging change seen in almost all dogs over 10 years old. It leads to scalloping of the iris margin and sometimes a moth-eaten stroma. It can cause absent or incomplete PLRs, dyscoria, or anisocoria.

Progressive retinal atrophy is less likely, especially with a normal fundic exam. It would be weird to have bilateral CN III deficits. This is not how uveal neoplasia usually manifests.

Question 12

Which of the following is considered to be a component of addressing maladaptive behavior and animal welfare issues?

• Extra water
• Environmental enrichment
• Treats
• Light cycle changes
• Extra food

Answer 12

Answer: Environmental enrichment

Explanation
Environmental enrichment should be used to curb maladaptive behaviors and welfare issues.

Question 13

Dr. Wyatt is the owner of a practice that employs five Licensed Veterinary Technicians. One of the more recent hires, Jennifer, is newly licensed. Jennifer’s ability to work independently and perform technical procedures such as jugular venipuncture or placement of intravenous catheters is lower than that of the other technicians. Dr. Wyatt plans to conduct a formal review of Jennifer’s progress. Which of the following is the most appropriate goal to set for Jennifer at the review meeting?

• Jennifer will improve her success rate of jugular venipuncture to 100% within the next four weeks.
• Jennifer will learn to consistently draw jugular blood samples and place intravenous catheters by the end of the day.
• Jennifer will improve her success rate of intravenous catheter placement to 80% within the next eight weeks.
• Jennifer will refine her technical skills and will improve her ability to work independently.

Answer 13

Answer: Jennifer will improve her success rate of intravenous catheter placement to 80% within the next eight weeks

This is the best option because it meets the SMART objectives for goal-setting: specific, measurable, achievable, realistic and timed. This option states a specific goal (improving intravenous catheter placement), provides a measure of success (increasing the success rate to 80%), and gives a timeline that is both achievable and realistic (8 weeks). Options that do not include a way to measure success and/or do not include a specific timeline are incorrect. Expecting substantial improvement in technical skills in one day is not realistic. Expecting the success rate of a technical skill to improve to 100% is also not realistic.

Question 14

An 8-month old dwarf rabbit presents to you for the lesions seen in this photograph of the eye. Which of the following therapies is LEAST LIKELY to be helpful in the management of this condition?

• Removal of the lens with phacoemulsification
• Topical steroids
• Corneal debridement and grid keratotomy
• Oral albendazole

Answer 14

Answer: Corneal debridement and grid keratotomy

Explanation:
This is a case of Encephalitozoon cuniculi (E. cuniculi). Encephalitozoon cuniculi is a microsporidian parasite of rabbits that causes neurologic and renal disease. This parasite directly infects the lenses of rabbits and causes phacoclastic cataracts (meaning it can break through the lens capsule) and uveitis. (If you were able to identify this, congratulations; that is truly outstanding!)

If you were not able to identify this as an Encephalitozoon cuniculi infection, it may still have been possible to reason through this question provided that you identified the white cataract and the signs of uveitis in the picture. If you observed those two things, you should realize that lens removal is the treatment for the cataract and steroids for the uveitis. You would then choose between albendazole and grid keratotomy. There is no corneal disease or ulceration in this rabbit’s eye, and that is what corneal debridement and grid keratotomy are used for. So remember on your exam, even if you are not sure exactly what the image is, you can often reason your way through the answer choices to make a good choice.

Question 15

Leptospirosis is usually observed when livestock come into contact with urine from an infected maintenance host.

Which of the following is the most important maintenance host of L. interrogans serovar Pomona?

• Cattle
• Dogs
• Swine
• Cats
• Rats

Answer 15

Answer: Swine

Explanation
Other maintenance hosts of Pomona include opossums, skunks and racoons. For other serovars, the maintenance hosts are as follows:
Canicola- dogs
Icterohemorrhagiae- rats
Hardjo- cattle
Grippotyphosa-mice, muskrats and squirrels

Question 16

In canine patients with primary hyperparathyroidism, a chemistry panel would show:

A. Hypocalcemia, hypophosphatemia

B. Hypocalcemia, hyperphosphatemia

C. Hypercalcemia, hypophosphatemia

D. Hypercalcemia, hyperphosphatemia

Answer 16

Answer: Hypercalcemia, Hypophosphatemia

The correct answer is hypercalcemia, hypophosphatemia. Patients with primary hyperparathyroidism would have hypercalcemia and normo to hypophosphatemia due to the law of mass action in which phosphorus decreases as calcium increases and vice versa.

Question 17

Which of the following is a causative agent of infectious bovine keratoconjunctivitis as shown in this image?

A. Moraxella bovis
B. Thelazia
C. E. coll
D. Histophilus somni

Answer 17

Answer: Moraxella bovis

The correct answer is Moraxella bovis.

Thelazia is the eye worm. Histophilus somni is a cause of many syndromes, but is rarely found in the eye. E. coli is not an ocular pathogen.

Question 18

A 1.5-year-old spayed female cat presents with a 7-day history of vocalizing, rolling, and allowing a male neutered cat in the household to mount her. The cat has gone through one similar episode 1 month ago. She otherwise has been behaving normally and has no other health problems. You performed an ovariohysterectomy on the cat at 3 months of age. You perform vaginal cytology which shows some cornified epithelial cells but is inconclusive. You measure serum lutenizing hormone of 0.2 ng/ml (normal for an ovariectomized female is >1 ng/ml). Which of the following is the most appropriate course of action?

A. Exploratory laparotomy to remove the ovarian remnant
B. Order MRI of the brain to rule out a pituitary tumor
C. Measure serum estrogen and progesterone levels
D. Measure serum testosterone levels

Answer 18

Answer: Exploratory laparotomy to remove the ovarian remnant.

This is a classic description of ovarian remnant syndrome, which is when a cat goes into estrus after previously having an ovariohysterectomy (OVH).

This can occur anywhere from weeks to years after OVH and typically the clinical signs consistent with estrus are sufficient to conclude that the cat is in estrus and has ovarian tissue present. Additional diagnostic tests that are consistent with ovarian remnant syndrome include:

Serum estrogen >70 pmol/L indicate that the cat has estrogen production from the ovary. The problem with this test is that estrogen measurements may fluctuate and can be unreliable.

Serum progesterone >6 nmol/L after induced ovulation is sufficient to conclude that corpora lutea formed and released progesterone.

Testing for serum LH levels can also help confirm the diagnosis. In intact queens, LH is consistently maintained at basal levels due to negative feedback from ovarian estradiol secretion. After OVH, this control is lost and LH concentrations increase. LH <1 ng/mL is consistent with the presence of an ovary as it is in this case.

Surgery is the treatment of choice. Many practitioners prefer to do surgery during estrus or diestrus when the ovarian tissue is enlarged and easier to locate. Remnants may be bilateral so a complete exploratory laparatomy is necessary. Ovarian tissue is most commonly at the ovarian pedicle but can also be in the mesentery or elsewhere.

Question 19

You examine the eyes of a 45-year-old Amazon parrot as part of a pre-purchase examination for a valued client.

On retinal examination, you notice a black, somewhat tubular structure extending from the retina into the vitreous. What would you recommend next?

• Treat the bird with ivermectin for suspected ocular nematodiasis
• Discuss photoactive laser treatment for ocular melanoma
• Do nothing since this is a nomal structure
• Treat the bird with itraconazole for suspected ocular mycosis

Answer 19

Answer: Do nothing since this is a nomal structure

This normal anatomic structure is called the
“pecten” and is present in all birds. It is a highly vascularized intraocular organ and is believed to nourish the retina and control the pH of the vitreous body.

Question 20

The synthesis of which of these clotting factors is dependent on vitamin K?

• Factor V
• Factor VIII
• Factor VI
• Factor IX
• Factor III

Answer 20

Answer: Factor IX

Explanation
The correct answer is factor IX. The vitamin K dependant factors are II, VII, IX, and X. This is important when animals are exposed to a vitamin K antagonist, such as many rodenticides.

Question 21

Which of the following is not a method to prevent ringtail in rats?

• Increase humidity in the environment
• Provide nesting material in the environment
• Provide a wire-bottom cage for the rat
• Keep environmental temperatures between
• 70-74 degrees Fahrenheit

Answer 21

Answer: Provide a wire-bottom cage for the rat

Explanation
The correct answer is to provide a wire-bottom cage for the rat. Ringtail is an annular constriction of the tail found in weanling rats and rats kept in wire-bottom cages. The condition causes the tail to constrict, undergo dry gangrene, and fall off.

Factors contributing to ringtail include increased environmental temperatures, low humidity, impaired blood supply to the tail, and possibly drafts. The tail stumps usually heal with no complications.

Question 22

You need to perform emergency splenectomy to remove a mass in the spleen. You want to choose anesthetic agents that do not cause the spleen to enlarge/engorge.

With that in mind, which of the following options is the best combination?

• Xylazine and thiopental
• Acepromazine followed by diazepam and ketamine
• Acepromazine and propofol
• A mixture of thiopental and propofol
• Morphine followed by diazepam and ketamine

Answer 22

Answer: Morphine followed by diazepam and ketamine

Explanation
Acepromazine can cause splenic enlargement and sequestration of red blood cells in the spleen. This is often striking and evident on radiographic or sonographic exams of animals sedated with acepromazine. Thiopental is a thiobarbiturate which induces splenic engorgement; this makes surgical manipulation and removal of the spleen more difficult.
Xylazine, diazepam, ketamine, propofol, and opioids such as morphine do not increase the size of the spleen.

Question 23

Measuring which of the following physiological parameters can help provide an indication of the welfare of animals when undergoing transitory procedures:

Plasma glucocorticoid and heart rate levels
Brain waves and body condition scoring
Stress hormones and approachability
Heart rate and lameness scoring

Answer 23

Answer: Plasma glucocorticoid and heart rate levels

Explanation
Elevated plasma glucocorticoid levels and heart rate are associated with stress responses and are easily measurable, accurate indicators of welfare.

Question 24

There are a number of drugs that are used extra label in beef cattle. When working with any food animal, you always have to consider milk and meat withdrawal. What is the meat withdrawal (in days) for xylazine, tolazoline, lidocaine, and meloxicam, respectively?

• 15, 1, 8, 4
• 3, 7, 3, 18
• 4, 8, 4, 15
• 4, 1, 18, 21
• 7, 18, 21, 15

Answer 24

Answer: 4, 8, 4, 15

Explanation
The correct answer is 4, 8, 4, and 15. Remember that xylazine is extremely potent in cattle, taking 10% of the dose that would be given to a horse of equivalent size is sufficient.

Tolazoline is an alpha 2 antagonist. Give the same volume as xylazine.

Lidocaine is commonly used during c-sections in cattle. If a producer is doing a c-section as a salvage procedure, it is important to inform that person that the cow cannot go to slaughter for 4 days.

Visit www.farad.org to search for this type of information.

Meloxicam is being used more and more. It is longer acting (~ 4 days) than banamine, but banamine only has 4 days of meat withdrawal. If you plan on going into production medicine, it is important to memorize the numbers for these commonly used drugs so that you can inform the producer.

Question 25

An Atlantic salmon net pen operator calls you with concerns about loss of fish during the seawater phase of rearing. They report that especially during warm temperatures, fish experience high mortality due to Vibriosis. They are currently using florfenicol-medicated feed to treat these outbreaks. The net pen operator is concerned about the consequences of the repeated antibiotic treatments they are administering, and they are looking to you for alternative options for managing Vibriosis. You inform them that

• Net pens are a biosecure environment and should not have Vibriosis.
• Vaccines are excellent for managing Vibriosis.
• Antibiotics are the only option to manage Vibriosis.
• Ampicillin is a superior antibiotic for Vibriosis management.

Answer 25

Answer: Vaccines are excellent for managing Vibriosis

Vibriosis is a common disease of saltwater fish, caused by Gram-negative rods in the Vibrio genus.

Common clinical signs are hemorrhage, inflammation along the ventral and lateral body, ulcers, and petechiae on the fins, vent, and mouth.

Net pens are not a biosecure environment because they are exposed to untreated water with wild fish and other animals that can cause disease in the fish being reared.

Antibiotic medicated feeds may be prescribed by a veterinarian.

Ampicillin is not an FDA-approved antibiotic medicated feed treatment and is illegal to use in these Atlantic salmon. Repeated use of antibiotics may cause resistance, and an excellent alternative to treatment is the prevention of Vibriosis via vaccines, such as Aquavac®.

Vaccines for fish are often given orally via feed or via prolonged immersion in a bath.

Question 26

What is the most common cause of exocrine pancreatic insufficiency in the dog?

• Pancreatic neoplasia
• Pancreatic infection
• Chronic pancreatitis
• Pancreatic acinar atrophy

Answer 26

Answer: Pancreatic acinar atrophy

The correct answer is pancreatic acinar atrophy.

This is an idiopathic condition where the exocrine cells of the pancreas atrophy with minimal inflammation. Chronic pancreatitis is a much more common cause of EP in cats than dogs. For this reason, dogs with EPI do not usually have concurrent diabetes mellitus because the endocrine cells are spared, whereas cats often do have concurrent DM. Neoplasia and infection are rare causes of EPI.

Question 27

Employees in your veterinary clinic are discussing measures to prevent disease transmission between employees and between patients. One of them asks you if using Purell hand sanitizer will prevent transmission of most pathogens. You remember reading on the label that Purell is a 65% ethyl alcohol based antiseptic. Which of these agents would be most effectively killed by such a product?

• Influenza virus
• Isospora canis
• Parvovirus
• Bacillus anthracis

Answer 27

Answer: Influenza virus

Hand sanitizing, alcohol based products are effective at killing many types of Gram positive and negative bacteria, including methicillin resistant Staphylococcus aureus (MRSA), tuberculosis, and E. coli. It is also effective against many types of fungi and enveloped viruses such as influenza viruses, HIV, and hepatitis virus (one exception is rabies virus).

They are not effective against non-enveloped viruses (parvovirus), bacterial spores (Anthrax, C. difficile), and protozoan oocysts (Giardia, Isospora, Cryptosporidium).

Question 28

A 10-year old male castrated Collie presents for what the owner calls heart failure. Which of the following is not a typical sign of right heart failure?

• Exercise intolerance
• Muscle wasting
• Hepatomegaly
• Tachypnea
• Cough

Answer 28

Answer: Cough

Explanation
The correct answer is cough. Coughing is typically a sign of left heart failure that occurs with the development of pulmonary edema and/or bronchial compression from an enlarged left atrium. In right heart failure, tachypnea and dyspnea can develop due to pleural effusion.

Hepatomegaly occurs due to venous congestion from the damming of blood into the liver. Exercise intolerance develops because a decrease in cardiac output causes a decrease in oxygenation of tissues.

Muscle wasting occurs from loss of protein into effusions and from hepatic and Gl malfunction.

Other signs of right heart failure include lethargy, weakness, venous distention, ascites, and peripheral edema.

Question 29

A 5-month old female cat presents to you for weight loss, chronic diarrhea and steatorrhea. The organism seen in a stained fecal smear is shown in the image below (this is a magnified 40X image, the organism is approximately 15 x 8 um). Which treatment is most appropriate?

• Tylosin
• Penicillin
• Sulfadimethoxin
• Fenbendazole

Answer 29

Answer: Fenbendazole

The organism is Giardia which can be recognized as a trophozoite with two nuclei outlined by adhesive discs. Giardia should be distinguishable from trichomonads which have a single nucleus and an undulating membrane.

The best treatments for Giardia are either fenbendazole or metronidazole.

Question 30

Which of the following is not a clinical sign of hypovitaminosis A in box turtles?

• Renal disease
• Posterior paresis
• Palpebral edema
• Respiratory disease
• Squamous metaplasia of epithelium

Answer 30

Answer: Posterior paresis

Explanation
The correct answer is posterior paresis.

Hypovitaminosis A most commonly affects box turtles that are fed imbalanced diets of fruit and insects that have little vitamin A. Clinical signs include edema of the eyelids, chronic respiratory disease, renal disease (due to the squamous metaplasia of renal tubules blocking collecting ducts), squamous metaplasia of epithelium, and secondary infections of the eyes, skin, and respiratory system. Treatment includes oral or parenteral vitamin A supplementation.

Question 31

Which statement about hypertrophic osteopathy (HO), as depicted in the radiograph below, is true?

• HO occurs in association with a thoracic mass
• HO usually starts in the proximal appendages and spreads distally
• HO is characterized by sclerosis of the subchondral bone of long bones
• HO occurs in young, large breed dogs

Answer 31

Answer: HO occurs in association with a thoracic mass

Explanation
The correct answer is HO occurs in association with a thoracic mass.

There is no breed or age predisposition for HO. The disease usually starts at the distal extremities and develops proximally. HO is characterized by periosteal proliferation near joints, not sclerosis of the subchondral bone.

Question 32

A 5-year old female intact New Zealand White rabbit presents for hematuria, anorexia, and weight loss. What is the most likely differential?

• Pregnancy
• Normal estrous
• Rabbit syphilis
• Porphyrinuria
• Uterine adenocarcinoma

Answer 32

Answer: Uterine adenocarcinoma.

Uterine adenocarcinoma is the most common neoplasia of female rabbits, with up to 80% incidence among intact females of certain species. Because of this, all female rabbits that are not breeders should be spayed. The most common signs of uterine ACA are hematuria, anorexia, depression, dysuria, and milk production.

Pregnancy would be unlikely to cause hematuria. Rabbits are induced ovulators and do not exhibit estrous.

Hematuria must be distinguished from porphyrinuria, which is a normal red or orange pigment in the urine of some rabbits. However, porphyrinuria does not cause anorexia and weight loss.

Rabbit syphilis is a sexually transmitted disease caused by Treponema paraluis cuniculi. It causes perineal lesions but does not cause hematuria.

Question 33

The relationship among incidence (I), prevalence (P), and duration (D) of disease is best expressed as:

• P=ID
• I=P-D
• P=I-D
• I=PD

Answer 33

Answer: P=ID

The correct formula to use is P = 1 x D. Prevalence can generally be viewed as the product of incidence and disease duration.

Incidence is defined as the number of new cases of a disease in a given period, and prevalence is the number of total cases prevailing (counted) in the given period.

This formula is helpful in a clinical scenario to help evaluate risk. Prevalence can increase (or decrease) in two ways: 1) the number of new cases (incidence) increases (or decreases), and 2) the duration of disease increases (or decreases). If a disease goes untreated, for example, duration would likely increase (compared to treated cases), and prevalence would increase.

Similarly, if the risk of acquiring a disease increased, the prevalence would increase. Note, for example, that if the weekly incidence of a disease were 5 new cases and the duration was 2 weeks per case (on average), generally one would expect the weekly prevalence to be 5 cases/week x 2 weeks = 10.

Ref: Veterinary Epidemiology: Principles and Methods, 1987 pg. 81, Martin, Meek, Willeberg

Question 34

Which of the following are effects of non-steroidal anti-inflammatory drugs that are non-selective COX inhibitors?

Inhibition of inflammation, destruction of platelets, reduction of fever
Gastrointestinal ulcer formation, destruction of platelets, inhibition of neutrophil function
Reduction of swelling, analgesia, inhibition of neutrophil function
Gastrointestinal ulcer formation, inhibition of
platelet function, analgesia

Answer 34

Answer: Gastrointestinal ulcer formation, inhibition of platelet function, analgesia

Explanation
The correct answer is gastrointestinal ulcer formation, inhibition of platelet function, analgesia. NSAIDs reduce inflammation and pain by blocking the COX-1 and COX-2 pathways. Non-selective COX inhibitor side effects include Gl ulcers, inhibition of platelet function, renal damage, and reduction of fever.

Question 35

What is the duration of a mare’s estrous cycle?

9-15 days
19-26 days
41-52 days
27-37 days
53-60 days

Answer 35

Answer: 19 -26 days

Explanation
The correct answer is 19-26 days. Estrus in a mare can last 2-10 days but, on average, is 6 days long. The mare is a polyestrous animal from the beginning of spring through summer. The estrous cycle’s duration lasts 19-26 days.

Question 36

What is the significance of xanthochromia on a CSF tap?

• Evidence of nervous coccidiosis
• Evidence of prior hemorrhage
• Evidence of neoplasia
• Evidence of an infectious process

Answer 36

Answer: Evidence of prior hemorrhage

Explanation
The correct answer is evidence of prior hemorrhage. This is that yellow discoloration that can be seen for at least a week after bleeding in the CSF.

A black discoloration would be diagnostic for melanoma.

Question 37

Measuring which of the following physiological parameters can help provide an indication of the welfare of animals when undergoing transitory procedures:

Plasma glucocorticoid and heart rate levels
Brain waves and body condition scoring
Stress hormones and approachability
Heart rate and lameness scoring

Answer 37

Answer: Plasma glucocorticoid and heart rate levels

Explanation
Elevated plasma glucocorticoid levels and heart rate are associated with stress responses and are easily measurable, accurate indicators of welfare.

Question 38

When considering a dog that is hypoventilating you realize that the dog is in

• Metabolic acidosis
• Respiratory alkalosis
• Metabolic alkalosis
• Respiratory acidosis

Answer 38

Answer: Respiratory acidosis

The correct answer is respiratory acidosis.

There is bound to be some sort of acid-base question on the exam.

This question might look tricky, but it is truly simple. Think about the information you are given; all you know is the dog is hypoventilating. So there is build up of CO2; in effect the dog is in respiratory acidosis. Remember, CO2=Acid. Since you have no other information, there is no way to diagnose a metabolic acidosis or alkalosis.

Some causes of respiratory acidosis include airway obstruction, open pneumothorax or flail chest, neuromuscular disease, abdominal enlargement, pleural space disease, and bicarbonate therapy.

Question 39

You are working at a small animal clinic performing a cystotomy on a 7 year old male Dalmatian. You glance at your anesthetic monitoring equipment and notice that the oxygen saturation on your pulse oximeter is 90%. Assuming that your equipment is working normally, what does this mean about your patient’s oxygenation status?

• Arterial oxygen pressure is 100 mm Hg, which is normal for this patient
• This oxygen saturation is low for a patient under anesthesia breathing 100% oxygen but would be normal for an animal breathing room air, which is 21% oxygen
• This is concerning because normally, a patient’s oxygen saturation does not exceed 50%
• Arterial oxygen pressure is 60 mm Hg, and oxygen saturation may drop precipitously if it decreases further
• Arterial oxygen pressure is 40 mm Hg and will result in potentially serious tissue hypoxia due to inadequate oxygen delivery

Answer 39

Answer: Arterial oxygen pressure is 60 mm Hg, and oxygen saturation may drop precipitously if it decreases further

When assessing an anesthetized patient with pulse oximetry, it is important to realize several things:

- The shape of the oxygen saturation curve is sigmoid, and until you reach oxygen pressures of < 60 mm Hg, there is very little change in oxygen saturation. Because an anesthetized patient breathing 100% oxygen should have about 500 mm Hg oxygen in the arterial blood, this can drop a long way before a dramatic change to oxygen saturation occurs.

However, the time to intervene is early when you see saturation percentages decrease because it means that your patient is oxygenating very poorly, especially if they are breathing 100% oxygen, and even a relatively small further decline could dramatically reduce their oxygen saturation, resulting in tissue hypoxia and dangerous consequences.

An oxygen saturation of 98-100% corresponds to > 100 mm Hg oxygen in arterial blood
An oxygen saturation of 95% corresponds to 80 mm Hg An oxygen saturation of 90% corresponds to 60 mm Hg An oxygen saturation of 50% corresponds to 30 mm Hg An oxygen saturation of 10% corresponds to 10 mm Hg

By the way, in room air, arterial oxygen pressure should normally be 80-100 mm Hg and oxygen saturation is 95-100%

Question 40

What is the treatment for proliferative bowel disease in ferrets?

• Nonsteroidal anti-inflammatory drugs
• Antibiotics
• Anthelmintics
• Corticosteroids
• Antiprotozoals

Answer 40

Answer: Antibiotics

Explanation
The correct answer is antibiotics.

Proliferative bowel disease in ferrets is caused by Lawsonia, an intracellular bacterium. The organism is very susceptible to chloramphenicol and has a variable susceptibility to other antibiotics.

Question 41

Which of the following signs is strictly associated with central vestibular disease?

• Head tilt toward the side of the lesion
• Circling toward the side of the lesion
• Non-positional horizontal nystagmus
• Positional, vertical nystagmus

Answer 41

Answer: Positional, vertical nystagmus.

Explanation
The correct answer is positional, vertical nystagmus. Positional and vertical nystagmus only occur with central vestibular disease.

Circling, head tilt, and horizontal nystagmus all occur with either central or peripheral vestibular disease.

Question 42

An 8-year old female spayed domestic short hair cat presents for her yearly physical exam. Your oral exam reveals multifocal lesions of absent dental substance on multiple teeth consistent with feline odontoclastic resorption lesions (FORL). Which of the following statements about FORL is true?

• The lesions are usually non-painful
• The lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions
• The lesions are usually incidental findings that are not clinically significant and do not need to be treated
• FORL is now a rare clinical finding since commercial diets have become more strictly regulated

Answer 42

Answer: The lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions

The correct answer is the lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions. FORL lesions are usually very painful and are more common now than before.

Up to 67% of cats presenting for dental care may be affected.

The exact etiology of FORL is not known, but studies have shown an association of FORL and diets low in calcium, magnesium, phosphorus, and potassium. Periodontal disease is also often found in association with FORL.

Treatment should include addressing associated periodontal disease and possibly extraction of teeth affected by deep lesions.

Question 43

An owner brings in her 4-year old domestic short hair cat for decreased appetite and sneezing. She has very limited funds for diagnostics, but approves a fine needle aspirate of the swelling you noticed over the bridge of the nose. You perform the aspirate and look at the slide under the microscope (see image). What medication should you prescribe for this cat?

• Fluconazole
• Clindamycin
• Fenbendazole
• Chlorambucil

Answer 43

Answer: Fluconazole

Explanation
The cytology from the fine needle aspirate shows cryptococcus.

Cryptococcus is an encapsulated fungus and is treated with anti-fungal medications such as fluconazole or itraconazole.

Clindamycin is used to treat toxoplasma.

Fenbendazole is used to treat intestinal parasites such as hookworms, roundworms, and Giardia.

Chlorambucil is a chemotherapeutic agent often used in treating lymphoma.

Question 44

A 3-year old male castrated domestic short hair cat presents to you for weight gain, polyuria and polydipsia over the course of 6 months. His previous veterinarian made a diagnosis of diabetes and has tried to control this with insulin but has not been successful. On examination, you detect prognathism, hepatomegaly, and a grade III/VI heart murmur. You suspect that the cat may have an underlying disorder that is contributing to his poorly-controlled diabetes. Which of the following diagnostic tests will be most helpful in confirming your suspicion?

• Abdominal ultrasound
• MRI of the brain
• Serum insulin:glucose ratio
• Serum folate and cobalamin levels
  Serum T4 levels

Answer 44

Answer: MRI of the brain

Explanation
This cat has clinical signs most consistent with acromegaly (weight gain, prognathism, organomegaly, and diabetes mellitus that is difficult to control). This condition results from a growth hormone (GH) secreting pituitary tumor. GH or insuline-like growth factor (IGF) assays can be diagnostic but are not offered by many veterinary laboratories. Advanced imaging techniques are the most reliable way to diagnose a pituitary mass in this instance. This cat is not likely to be hyperthyroid due to the history of weight gain. Hyperadrenocorticism as a cause of insulin-resistant diabetes mellitus is less likely given the cat’s other clinical signs; nevertheless, adrenal function testing such as an ACTH stimulation test or dexamethasone suppression test to rule out hyperadrenocorticism should be considered.

Question 45

A 3 year old male neutered Maltese who was recently adopted from the shelter presents for kennel cough. He is currently on doxycycline. You would also like to send a cough suppressant and write a prescription for hydrocodone. In order to prescribe this medication, what does the law require?

• A current premise license
• A signed written consent form from the owner acknowledging this is a controlled substance
• A list of side effects of this medication provided to the owner
• A current DEA license

Answer 45

Answer: A current DEA license

Hydrocodone is a controlled substance. Controlled substances cannot be prescribed unless the veterinarian holds a current DEA license.

Pharmacists require a DEA number in order to process these prescriptions.

A premise license is held by the owner of the building of the veterinary hospital.

A conversation with the owner of possible side effects of any medications sent with the pet should occur, but a written list is not required by law.

Question 46

It’s 6:00 PM, and Dr. Freels is running late for his last appointment of the day, which was scheduled for 5:30 PM. Unfortunately, Dr. Freels diagnosed a new case of diabetes mellitus in a canine patient at the 4:30 PM appointment and the education needed for the pet owner to begin insulin today took more than thirty minutes. Dr. Freels often runs late when new diabetes cases are diagnosed because client education required is so specific and takes so much time. Dr. Freels’ lead technician recommends delegating client education for diabetes to the technical staff instead and offering a bonus for technicians who would like to be trained in diabetes education. Which of the following is the most appropriate goal for Dr. Freels to set for the technicians regarding training for diabetes education responsibilities?

• Allow six months for the technicians to increase their understanding of diabetes management and improve their public speaking skills.
• Give the technicians a four-week timeframe to review assigned materials, achieve at least an 80% score on a written examination, and pass an oral examination regarding diabetes education for dog and cat owners.
• Instruct the technicians to read information about diabetes management in dogs and cats with the goal of being able to discuss the information independently with pet owners.
• Tell the technicians to read some textbooks and journal articles regarding diabetes education and be prepared to achieve a 100% score on a written examination within one week.

Answer 46

Answer: Give the technicians a four-week timeframe to review assigned materials, achieve at least an 80% score on a written examination, and pass an oral examination regarding diabetes education for dog and cat owners.

Goals should be set using SMART objectives: specific, measurable, attainable, realistic, and timed. This option has a clearly defined timeline and objective. The 80% score goal is measurable.

Also, a strategy for achieving an outcome is clearly identified. No specific strategy for achieving these changes is identified in the incorrect options. A one-week timeframe to achieve a perfect score is not realistic and therefore not attainable. Options which do not include a specific measure of success are incorrect.

Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett.
Wiley-Blackwell, 2010. Pages 134-136.

Question 47

A clinic sees two different patients named “Sadie” on the same day. Blood is drawn for both patients, and samples are sent to an external reference laboratory. Sadie A’s results support a diagnosis of diabetes mellitus. However, those results do not fit with Sadie A’s history. Sadie B does have signs of diabetes mellitus, but her results are normal. After discussion with the clients, you arrange for both dogs to have their blood drawn again. When the new results arrive, it is obvious that the tubes for the original samples were mislabeled. What is the most appropriate step to avoid another labeling error at the clinic in the future?

• Create a written standard operating procedure for submission of laboratory samples.
• Talk privately with the assistant who mislabeled the original laboratory samples.
• Hold a staff meeting to discuss the procedure for submission of laboratory samples.
• Take disciplinary action against the assistant who mislabeled the original laboratory samples.

Answer 47

Answer: Create a written standard operating procedure for submission of laboratory samples.

Creating a written standard operating procedure (SOP) for submission of laboratory samples is the best option for prevention of future labeling errors.

Written SOPs are the best way to ensure that team members adhere to established procedures for frequently occurring processes. Talking privately with the assistant who mislabeled the tubes and/or taking disciplinary action against that team member may be appropriate options, however this will not reduce the chances of a future labeling mistake by another team member. Holding a staff meeting to discuss proper procedures is important, however this will not reduce the chances of a future labeling mistake by new employees or anyone not in attendance at the meeting.

Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett.
Wiley-Blackwell, 2010. Pages 136-138.

Question 48

In a well-leveraged practice, which of the following jobs should be performed by a veterinarian?

• Restrain a patient for a rectal exam
• Induction and monitoring of anesthesia for a splenectomy
• Prescribing medications to a patient with roundworms
• Taking a thoracic radiograph
• Perform a complete blood count

Answer 48

Answer: Prescribing medications to a patient with roundworms

In a well-run practice, veterinarians should be performing the tasks that they alone are qualified to do, namely to make a diagnosis and prognosis, prescribe drugs, and perform surgery.

Technical tasks should be performed by technicians including surgical assisting, laboratory procedures, radiography, anesthesia, patient treatment and nursing, and client education.

Veterinary assistants have no AVMA-accredited training programs and act as support for veterinarians and technicians, for tasks that do not require the higher level of training or expertise.

These generally include patient handling and restraint and assisting with various radiographic, laboratory, and pharmaceutical tasks. It is critical that they have documented skill and safety training for any technical tasks that they perform.

Question 49

What is the approximate daily water requirement for a rabbit?

• 120 ml/kg
• 240 ml/kg
• 60 ml/kg
• 15 ml/kg
• 30 ml/kg

Answer 49

Answer: 120ml/kg

Explanation
The correct answer is 120 ml/kg day. This is considerably higher than a dog or cat.

Question 50

Two 9-year old female spayed Labrador retrievers presented for their next chemotherapy treatments. Both were diagnosed with multicentric lymphoma and have been receiving the CHOP protocol. One received doxorubicin (Adriamycin) and one received vincristine (Oncovin) today. Your technician informs you that both unfortunately had extravasations occur and wants to know what she should do. Which drug is a worse vesicant and what should be done to the injection site?

• Vincristine. Cold compress to contain the spread of drug
• Doxorubicin. Cold compress to contain the spread of drug
• Doxorubicin. Warm compress to disperse the drug
• Vincristine. Warm compress to disperse the drug

Answer 50

Answer: Doxorubicin. Cold compress to contain the spread of drug

Explanation
Intravenous chemotherapy drugs can cause severe tissue necrosis (doxorubicin) or irritation (vincristine) if extravasation occurs. Treatment for both should begin immediately. In both cases, the catheter should be left in place and as much of the drug should be aspirated as possible.

Treatment for doxorubicin extravasation involves cold compressing the site to promote vasoconstriction, however perivascular necrosis may still occur and may progress days to weeks later. In severe cases involving doxorubicin, debridement or limb amputation may be needed.

Vincristine extravasation should be treated with warm compresses to disperse the drug and enhance systemic absorption.

Extravasation should be prevented through patient restraint training, use of catheters that have been placed on the first stick, and careful monitoring during administration. The peripheral veins should be avoided for blood draws if possible on all patients receiving chemotherapy.

Question 51

You receive a message from a koi owner who has been experiencing moderate mortality in their pond this summer. You arrive at midday and perform water quality testing, the results of which are provided (see image).

They report that many fish have severe skin lesions that are red and raised with deep ulcers exposing the underlying muscle. New fish were added to the pond this past fall. The owner was hesitant to call you at first, because they were worried they might need to depopulate their pond. You call them back and inform them that:

• The prognosis is good with antibiotic treatment.
• The prognosis is grave and depopulation will be required.
• The prognosis is excellent with no treatment required.
• The prognosis is guarded and depopulation is recommended.
• The prognosis is excellent with salt treatment.

Answer 51

Answer: The prognosis is good with antibiotic treatment.

The top differential diagnosis for this case is
“Furunculosis” caused by Aeromonas salmonicida.

The classic clinical sign is large, swollen skin lesions mistakenly referred to as “furuncles” (since fish don’t have hair). Other clinical signs include hemorrhage, kidney and vent swelling, and ulcers.

For food fish, furunculosis may be treated with oxytetracycline, sulfadimethoxine and
ormetoprim, and florenicol medicated feeds via a Veterinary Feed Directive. In a koi pond, you may use injectable antibiotics if the population is small.

If left untreated, furunculosis may lead to serious mortality.

Koi herpesvirus (Cyprinid herpesvirus Type 3) is not a top differential because mortality at this temperature would be extremely high, approaching 80-100% if new fish had been introduced several months ago. Clinical signs of KHV include gill necrosis and enophthalmia. The clinical signs in this case are also not indicative of Spring Viremia of Carp. Spring Viremia of Carp would present with extremely high mortality and internal ecchymotic hemorrhages. SVC also usually presents at a lower temperature (50-64°F).

A quarantine protocol and improved biosecurity measures may be helpful to discuss with the owner since they introduced new fish recently.

Question 52

Dr. Macintyre is the owner of a practice that is due for state inspection soon. Part of the inspection will involve a detailed review of the practices safety protocols. Dr. Macintyre downloaded a checklist from the state website that outlines the preparations which should be made prior to the inspection. He delegates the task of ensuring compliance with the guidelines to the office manager. As the inspection date approaches, Dr. Macintyre notices that several important items on the checklist have not been completed. Which of the following is the best approach to ensure that the tasks are completed appropriately?

• Take no action and wait for the office manager to complete the assigned tasks.
• Remove the office manager from the project and reassign the tasks to another team member.
• Complete the tasks independently and formally discipline the office manager.
• Schedule a meeting with the office manager to review the project timeline.

Answer 52

answer: Schedule a meeting with the office manager to review the project timeline.

Following delegation of a task, defining a project timeline is recommended. Performance should be tracked throughout the project. Avoid undermining the delegated responsibility. Delegation of tasks does not mean abdication of responsibility.

Regular check-ins should be scheduled with the employee who is in charge of the delegated tasks.

Completing tasks that have been delegated to another team member, or delegating those tasks to a new team member, undermines that team member’s responsibilities and authority.

Source: The Art of Veterinary Practice Management. Mark Opperman and Sheila
Grosdidier. Advanstar Communications, Inc., 2014. Page 104-105.

Question 53

A7-year old female spayed English Springer Spaniel presents for difficulty breathing and lethargy. Physical exam shows pale mucous membranes and increased respiratory effort. You collect blood for a complete blood count and a chemistry panel and you place a drop of blood with a drop of saline on a glass slide. After swirling the sample around, you can grossly see what is shown in the picture. What’s your diagnosis?

• Hemolysis
• Vitamin K antagonist toxicity
• Immune mediated hemolytic anemia
• Rouleaux formations
• Evan’s syndrome

Answer 53

Answer: Immune mediated hemolytic anemia

The image shows a positive slide agglutination test. The dark patches in the sample are caused by antibodies attached to the surface of the erythrocytes cross linking the cells together causing these clumps. This is highly suggestive of an immune mediated reaction to antigen on the individual’s red blood cells.

Rouleaux formations are red blood cells stacked together as a result of their natural discoid shape and large surface area causing them to have an affinity for each other. They typically resemble a stack of coins or cookies.

Evan’s syndrome is an autoimmune condition characterized by an immune attack on erythrocytes, platelets, and occasionally leukocytes as well. You would not be able to diagnose this on a slide agglutination test alone.

Vitamin K antagonist toxicity with rodenticide causes a coagulopathy but should not cause hemagglutination.

Question 54

What is the primary mode of transmission of West Nile Virus (WNV) between birds?

Via feces
Via placenta
Via mosquitoes
Via Cnemidocoptes mites
Via saliva

Answer 54

Answer: Via mosquitoes

Mosquito vectors are the primary mode of transmission for WNV between birds and other hosts (horses, humans). There are infrequent documented cases of the disease being spread by feces or saliva. No mites have been documented to transmit the disease. Birds do not have a placenta.

West Nile Viral Infection in Equids: NAVLE Study Guide

Definitions and Causative Agents

•	West Nile Virus (WNV): A Flavivirus transmitted by mosquitoes, causing encephalitis in equids. Horses are considered “dead-end” hosts, as they do not spread the virus further.

Pathogenesis

•	Virus Structure: The virus has an RNA genome that encodes structural proteins (C-prM-E) and nonstructural proteins (NS1-NS5).
•	Transmission Cycle: WNV is maintained in a bird-mosquito cycle. Horses become infected through mosquito bites, developing subclinical or clinical neurological disease.

Clinical Signs

•	Symptoms: Ataxia, limb weakness, recumbency, muscle fasciculations, hyperesthesia, and cranial nerve deficits like facial nerve paralysis. Severe cases may lead to tetraplegia and death.
•	Fatality Rate: Ranges from 22% to 44% in clinical cases.

Diagnosis

•	Tests: Real-time RT-PCR to detect viral RNA, ELISA for detecting IgM antibodies, and post-mortem immunohistochemistry in nervous tissues.
•	Considerations: WNV viremia is short, making early detection challenging. IgM antibodies indicate recent infection, whereas IgG antibodies may persist from vaccination or past exposure.

Treatment

•	Supportive Care: Includes anti-inflammatory drugs, fluids, and measures to reduce stimuli (e.g., padded stalls).
•	Experimental Therapies: Use of WNV antibodies and antiviral drugs like ribavirin and interferon, though no proven efficacy in horses.

Prevention

•	Vaccination: Several vaccines are available, including inactivated virus vaccines and recombinant vaccines using canarypox vectors. Annual boosters are recommended.
•	Mosquito Control: Essential to reduce exposure; involves minimizing outdoor activity during peak mosquito times and using repellents.

Pathology

•	Histopathological Findings: Mild to severe polioencephalomyelitis, with lesions primarily in the brainstem and spinal cord. Neuronophagia and perivascular infiltrates are common.

Prognosis

•	Outcome: Varies; many horses recover, but some have residual neurological deficits.

Question 55

lonized serum calcium levels are influenced by three regulatory hormones. Of the following, which are the correct three?

• Thyroid hormone, 25-hydroxycholecalciferol D3, and calcitonin
• Parathyroid hormone (PTH), calcitonin, and 1,25-dihydroxycholecalciferol D3
• Parathyroid hormone (PTH), Vitamin D3, and calcitriol
• Thyroxine, calcitonin, and parathyroid hormone (PTH)
• Vitamin D3, somatotropin and parathyroid hormone (PTH)

Answer 55

Answer: Parathyroid hormone (PTH), calcitonin, and 1,25-dihydroxycholecalciferol D3

Explanation
PTH comes from parathyroid chief cells in response to hypocalcemia. Calcitonin is from thyroid parafollicular glands in response to hypercalcemia. 1,25-dihydroxycholecalciferol D3 is of renal origin and sometimes called calcitriol.

Ionized serum calcium levels are regulated by three key hormones: Parathyroid hormone (PTH), calcitonin, and 1,25-dihydroxycholecalciferol D3 (calcitriol). PTH is secreted by parathyroid chief cells in response to low calcium levels, calcitonin by thyroid parafollicular cells in response to high calcium, and 1,25-dihydroxycholecalciferol D3 is produced by the kidneys.

Question 56

Highly pathogenic avian influenza (HPAI) has become endemic in some domestic ducks in Asia. Wild ducks and geese can move the virus, often without showing clinical illness. What is the human health concern?

• The HPAl can transfer genes from pig or human influenza strains, which allow the avian flu to become infectious to humans
• Some human genotypes are inherently susceptible to the avian influenza strains and, thus, a portion of the population could die from exposure to the HPAI
• The HPAl can spontaneously mutate or rearrange and become highly pathogenic for humans as well as birds
• The avian influenza strains are not pathogenic to humans, but the porcine (pig) strains are.
• Humans exposed to live pigs carrying pig flu in a market could start a major pandemic

Answer 56

Answer: The HPAl can transfer genes from pig or human influenza strains, which allow the avian flu to become infectious to humans

Explanation
While the highly pathogenic avian influenza strains can kill domestic ducks and poultry, they do not normally cause major public health issues unless they acquire the genes that allow them to attach to human respiratory mucosa and become pathogenic for humans. This is how a worldwide influenza pandemic could occur.

Question 57

Which of the following is an appropriate objective in the repair of an articular fracture in a dog?

• 6-8 weeks of strict post-operative rest
• Early return to function
• Avoid rigid fixation of the fracture
• 50% or greater alignment

Answer 57

Answer: Early return to function

Explanation
The correct answer is early return to function. With articular fractures, the 3 major goals of the clinician are:
Rigid fixation of the fracture fragments; neglecting to do this will result in loose fracture fragments within the joints that will promote osteoarthritis.

Anatomic realignment (50% or even 75% is not adequate with articular fractures, in contrast to long bone fractures).

Early return to function. With long bone fractures, extended rest is recommended to promote stability and healing of the bone. The opposite is true in articular fractures where prolonged rest after repair will promote fibrosis, causing decreased range of motion in the joint.

Question 58

An obese, sedentary, female Bichon Frise of 5 months of age walks into your clinic as a result of having mucus-laden diarrhea of one-week duration. You perform a gram stain of the feces and visualize “gull-shaped” gram-negative rods. What is the most likely diagnosis?

• Salmonellosis
• Cryptosporidium
• Campylobacteriosis
• Clostridioides difficile

Answer 58

Answer: Campylobacteriosis

Explanation
The correct answer is Campylobacteriosis. This is a gram negative motile, thin, S-shaped or gull-shaped rod. It can occur singly, in pairs, or in chains. C. jejuni is most commonly isolated. You can also isolate this organism with fresh fecal swabs streaked onto Campylobacter blood agar plates, which grows in an oxygen-reduced atmosphere in 3-4 days. Salmonella is a gram-negative bacillus. C. difficile is a gram-positive rod.

Cryptosporidium is a coccidian parasite. Fun Fact:
Kids with puppies are 16 times more likely to acquire Campylobacteriosis.

Question 59

A number of chickens in a flock have been dying acutely with dyspnea and mucoid discharge from the mouth and watery, whitish diarrhea in some birds. On postmortem, evaluation, you find vascular hyperemia of the abdominal organs. Which of the following findings would support a diagnosis of fowl cholera?

• A positive tracheal wash culture for mycoplasma
• Intranuclear inclusion bodies in tracheal epithelium
• Multifocal necrosis in the liver with large, granular basophilic intracytoplasmic inclusions
• Intracytoplasmic inclusion bodies in the chorioallantoic membrane of inoculated chick embryos
• Gram negative bacteria in blood or tissues

Answer 59

Answer: Gram negative bacteria in blood or tissues

Explanation
Fowl cholera is caused by Pasteurella multocida, a Gram negative, non motile, pleomorphic rod. As with most poultry diseases, it is preferable to prevent introduction of the disease into a flock with biosecurity measures. If treatment is attempted, it should ideally be based on culture and sensitivity but sulfonamides, tetracyclines, or penicillin are most often used.

Intranuclear inclusion bodies from the tracheal epithelium are seen with Infectious Laryngotracheitis caused by a herpesvirus.

Fowlpox virus produces intracytoplasmic inclusions. Liver necrosis with large, granular basophilic intracytoplasmic inclusions is consistent with avian chlamydiosis.

Question 60

The largest U.S. broiler hatcheries now apply Marek’s disease vaccine by what method?

• Coarse spray of Marek’s disease virus in aerosol chamber at one day of hatch
• In ovo injection of live virus at day 8 of incubation
• Subcutaneous injection of live virus in chicks at one day of hatch
• In ovo injection of killed virus at day 18 of incubation
• Subcutaneous injection of killed virus in chicks at one day of hatch

Answer 60

Answer: In ovo injection of live virus at day 8 of incubation

Explanation
The Marek’s disease vaccine is recommended for in ovo vaccination of 18- to 19-day-old healthy embryonated chicken eggs. The vaccine may also be used for subcutaneous vaccination of healthy one-day-old chickens, but in large-volume chicken hatcheries, the in ovo method is used.

Question 61

A 2-year old Quarter Horse presents for intermittent muscle fasciculation followed by weakness. What condition should you suspect?

A. Stringhalt
B. Hyperkalemic periodic paralysis
C. Tetanus
D. Grass tetany
E. Myotonia

Answer 61

Answer: Hyperkalemic periodic paralysis

Explanation
The correct answer is hyperkalemic periodic paralysis (HYPP). HYPP is seen in Quarter Horses due to a point mutation in a key part of a skeletal muscle sodium channel subunit. This results in elevation of the resting membrane potential to increase the likelihood of depolarizing. Excess concentrations of potassium can result in failure of the sodium channels to inactivate. Therefore, treatment is directed at decreasing dietary potassium.

Question 62

“Paige” is a 6-year-old Shar-Pei mix who presented with a history of coughing, lethargy, and intermittently favoring her right forelimb. You are practicing in the southwest, and test her for Coccidioides immitis and get the following results: Coccidioides IgG Antibody Positive Coccidioides IgM Antibody Positive Immunodiffusion Titer: AB Present @ > or equal to 1:256 You recommend starting her on anti-fungal medications and prescribe itraconazole. The owner would like to know if she will have any side effects. Which of the following is a known adverse effect of itraconazole administration in a dog?

• Hyperactivity
• Ulcerative skin lesions
• Renal toxicity
• Neurologic symptoms

Answer 62

Answer: Ulcerative skin lesions.

The correct answer ulcerative skin lesions. About 7% of dogs using Itraconazole will develop ulcerative skin lesions when used at a higher dosage rate. Decreased appetite, nausea, and diarrhea may also be seen.

Nephrotoxicity is seen when using Amphotericin B. Hyperactivity and neurologic symptoms are not known side effects.

Coccidioidomycosis in Animals - Comprehensive Veterinary Information

Definitions and Terminology:

•	Coccidioidomycosis (Valley Fever): A dustborne, noncontagious fungal infection caused by Coccidioides spp. fungi.

Causative Agents:

•	Species: Coccidioides immitis and Coccidioides posadasii.

Physiopathology:

•	Transmission: Inhalation of arthrospores from contaminated dust.
•	Pathogenesis: Fungi form spherules in the lungs, which can disseminate to other organs.

Clinical Findings:

•	Dogs: Chronic respiratory disease, cough, fever, lethargy, anorexia, and weight loss. Disseminated disease can affect the CNS, skin, bones, eyes.
•	Cats: Dermatologic signs, fever, weight loss, respiratory issues, lameness, neurologic and ophthalmologic abnormalities.
•	Horses: Placental infection, abortion, osteomyelitis.
•	Ruminants and Pigs: Subclinical infections with lung lesions.

Diagnosis:

•	Histopathology: Identification of spherules in tissues.
•	Serologic Testing: AGID, EIA, LFA for antibodies.
•	MRI: Useful for CNS involvement.
•	CSF Analysis: EIA for antigen and antibodies.

Treatment:

•	Antifungal Therapy: Fluconazole (5-10 mg/kg, q24h) or itraconazole (10 mg/kg, q24h) for 6-12 months.
•	Surgery: For excision of granulomas when feasible.
•	Supportive Care: Necessary for chronic cases.

Prognosis:

•	Guarded to Good: Depending on the extent of disease and response to treatment.

Question 63

A 13-year old spayed female Miniature Poodle presents with two mobile, soft, well-circumscribed, subcutaneous sternal masses, 3 cm and 6 cm in diameter, respectively. The owner had noticed one mass three months previously. Fine needle aspiration of both masses is performed and smears are prepared. A representative field of both specimens is illustrated below (Wright’s 20X). What is your diagnosis?

• Mesenchymal neoplasia (sarcoma)
• Fungal granuloma
• Mast cell tumor
• Lipoma

Answer 63

Answer: Lipoma.

The cells depicted are well-differentiated adipocytes. These cells are large, appear in aggregates or sometimes singly, and contain fat that stains negatively with Wright’s, such that the cytoplasm appears clear. The cells possess a small, round or ovoid, pyknotic nucleus that may be compressed and located in the periphery of the cell. This benign tumor is a lipoma, which is common in dogs. If the mass hinders the animal, it may be removed surgically. Infiltrative lipomas, and their malignant counterpart, liposarcomas, are less common.

When sampling for cytology, frequently the first indication that a lipoma has been aspirated is the clear, oily appearance of the material ejected from the aspiration needle onto the slide. Care must be taken while staining to ensure that the material does not wash off the slide, as fat does not adhere readily to the glass surface.

Note: Gentle heat fixing of greasy material to a slide may be of benefit in keeping adipose cells adherent to slides during staining. This can be accomplished by holding a slide over a Bunsen burner or lighter or gentle heating on a heating tray/bar for a few seconds so that the side opposite to that containing the cellular material is slowly warmed. The slide must be left to cool completely before staining. Slides coated with poly-l-lysine, which are used for Papanicolaou staining and/or increased adherence of tissue sections to slides, are also helpful in promoting cellular adherence and eliminating loss of cells during staining.

Sometimes, local fat will be aspirated and cannot be reliably differentiated from the adipose cells of a lipoma. If there is any doubt as to the presence of a discrete mass, surgical removal with histological evaluation is recommended.

Question 64

A three-year-old female goat presents in poor body condition, slightly depressed, and febrile. The goat is mildly pruritic. The skin shows mild to moderate erythema and alopecia and marked hyperkeratosis and crusting on all four extremities, as shown in the image below. Skin scrapings are negative for mites. A cytology taken from the underside of a crust shows parallel stacks or rows of cocci (“railroad tracks”) between keratinocytes, also shown below. Which one of the following choices is the most likely diagnosis?

• Dermatophytosis
• Pyoderma
• Streptococcus infection
• Dermatophilosis
• Malassezia dermatitis

Answer 64

Answer: Dermatophilosis

Dermatophilosis is a crusting dermatitis caused by the filamentous bacteria Dermatophilus congolensis, seen in all ruminants and horses. Also called “lumpy wool” or “rain scald/rot.”

Infection is seen most often in younger or systemically ill/immunocompromised animals. Many are housed in areas with poor hygiene or without shelter. Excessive moisture, rainy conditions, skin damage, and concurrent illness that results in immunosuppression are predisposing factors.

Loss of the protective sebaceous film layer seen on healthy skin is thought to be an important factor in the pathogenesis.

Carrier animals and fomites such as grooming tools are also important as this can be contagious in at-risk animals.

Thick crusts, which usually contain the organism, look like the end of a paint brush when removed from the animal and are a typical finding. On cytology (impression smear of a crust) the “railroad track” appearance of the gram-positive cocci is classic for dermatophilosis.

The infection self-resolves after a few weeks in most animals without treatment. Can use topical and systemic antimicrobials in persistent cases.

Link: Dermatophiolosis (“Rain Rot”) in Horses
https://www.merckvetmanual.com/horse-owners/skin-disorders-of-horses/dermatophilosis-rain-rot-in-horses?autoredirectid=22723

Question 65

You perform a low-dose dexamethasone suppression test on a dog you suspect has Cushing’s syndrome. The 4-hour blood cortisol level and 8-hour blood cortisol level are approximately equally elevated above the normal range. What can you conclude from this information?

• The dog has iatrogenic Cushing’s syndrome
• The dog has pituitary-dependent hyperadrenocorticism
• The dog has a cortisol-secreting adrenal tumor
• A high-dose dexamethasone suppression test could help differentiate pituitary versus adrenal dependent hyperadrenocorticism

Answer 65

Answer: A high-dose dexamethasone suppression test could help differentiate pituitary versus adrenal dependent hyperadrenocorticism

Explanation
The correct answer is you should run a high-dose dexamethasone suppression test.

Elevated blood cortisol concentration 4 hours and 8 hours post low-dose dexamethasone administration is diagnostic for hyperadrenocorticism, but it does not allow differentiation between PDH and a cortisol secreting adrenal tumor. Dexamethasone is more rapidly metabolized in dogs with either type of hyperadrenocorticism (approximately 4 hours to metabolize as opposed to 30 hours in normal dogs). In PDH animals, the 4-hour post-cortisol concentration may sometimes be suppressed, whereas cortisol from adrenal tumors will not be suppressed after administration of a low dose of dexamethasone. A high-dose dexamethasone test will suppress a larger percentage of PDH patients (up to 75% will be suppressed, showing a decrease in cortisol after 4 hours). Less reliable tests to differentiate PDH from an adrenal tumor include endogenous plasma ACTH concentration or abdominal ultrasound.

For the PowerPage on this topic, view Hyperadrenocorticism (Cushing’s Disease)

Question 66

You are examining an 9-year old spayed female mixed breed dog that became acutely blind after being normal yesterday. Ophthalmic and fundic exams are normal. What is the most likely cause of the dog’s blindness?

• Retinal detachment
• Progressive Retinal Atrophy (PRA)
• Primary brain tumor
• Sudden Acquired Retinal Degeneration Syndrome (SARDS)

Answer 66

Answer: Sudden Acquired Retinal Degeneration Syndrome (SARDS)

Explanation
The correct answer is SARDS.

SARDS is a condition seen usually in middle-aged obese female spayed dogs.

They develop acute blindness and initially have no optic or fundoscopic lesions. In 1-2 months, they will develop retinal vascular attenuation and tapetal hyperreflectivity. A primary brain tumor would be more likely to show progressive signs. Retinal detachment and progressive retinal atrophy would show changes in the retina on fundic exam.

Question 67

You are performing one of your first myelograms on a 6-year old Dachshund dog. On recovery from anesthesia, the dog starts to seizure. What should be your first intervention?

• Give a loading dose of potassium bromide (KBr) IV
• Give 0.5 mg/kg diazepam IV
• Give 0.05 mg/kg acepromazine IV
• Put the dog on a 5% dextrose containing IV fluid
• Re-anesthetize the dog

Answer 67

Answer: Give 0.5mg/kg diazepam IV

Explanation
It is likely that the radiographic contrast used in the myelogram has caused this seizure. Diazepam (or midazolam) is the first drug you should reach for in a seizuring dog.

Re-anesthetizing the patient may not stop the seizure activity. KBr is loaded over several hours and would not be effective acutely; in addition, this is not a patient that should need maintenance therapy for seizures, and therefore would not benefit from a loading dose of KBr. Due to the inciting cause, hypoglycemia is unlikely to have caused the seizure and giving dextrose immediately is unnecessary.

Question 68

A clinic sees two different patients named “Sadie” on the same day. Blood is drawn for both patients, and samples are sent to an external reference laboratory. Sadie A’s results support a diagnosis of diabetes mellitus. However, those results do not fit with Sadie A’s history. Sadie B does have signs of diabetes mellitus, but her results are normal. After discussion with the clients, you arrange for both dogs to have their blood drawn again. When the new results arrive, it is obvious that the tubes for the original samples were mislabeled. What is the most appropriate step to avoid another labeling error at the clinic in the future?

• Talk privately with the assistant who mislabeled the original laboratory samples.
• Hold a staff meeting to discuss the procedure for submission of laboratory samples.
• Take disciplinary action against the assistant who mislabeled the original laboratory samples.
• Create a written standard operating procedure for submission of laboratory samples.

Answer 68

Answer: Create a written standard operating procedure for submission of laboratory samples.

Explanation
Creating a written standard operating procedure (SOP) for submission of laboratory samples is the best option for prevention of future labeling errors. Written SOPs are the best way to ensure that team members adhere to established procedures for frequently occurring processes. Talking privately with the assistant who mislabeled the tubes and/or taking disciplinary action against that team member may be appropriate options, however this will not reduce the chances of a future labeling mistake by another team member. Holding a staff meeting to discuss proper procedures is important, however this will not reduce the chances of a future labeling mistake by new employees or anyone not in attendance at the meeting.

Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 136-138.

Question 69

Which of these is an effective drug to induce emesis in the dog?

• Azathioprine
• Magnesium hydroxide
• Xylazine
• Apomorphine

Answer 69

Answer: Apomorphine

Explanation
The correct answer is apomorphine. Apomorphine is an opioid dopaminergic agonist that acts on the chemoreceptor trigger zone to induce vomiting in dogs. In can be administered IM, SC, IV, or in the conjunctival sac. Xylazine is a fairly effective emetic in the cat but is not used in the dog for this purpose. Azathioprine is an immunosuppressive drug not used to induce vomiting. Magnesium hydroxide or Milk of Magnesia is a cathartic but is not used for vomiting.

Question 70

A dog presents to you after being struck in the head with a baseball bat. The dog is obtunded, but the rest of the physical exam is normal. Which of the following factors should you try to achieve in this patient to minimize intracranial pressure?

• High PaO2
• Low mean arterial pressure
• High cerebral metabolic rate
• High PaCO2

Answer 70

Answer: High PaO2

Explanation
The correct answer is high PaO2. PaCO2, blood pressure, Pa02, cerebral metabolism, and certain drugs can affect cerebral blood volume and intracranial pressure. In head trauma patients, you want to prevent an increase in intracranial pressure by keeping cerebral blood flow relatively low without causing hypoxia. To keep cerebral blood flow in the low-normal range, the cerebral metabolic rate and PaCO2 should be kept low. Factors that would cause the cerebral metabolic rate to go up include fever, seizures, pain, etc. Mean arterial pressure should be maintained in the normal range to prevent hypotension, hypoxia, and cerebral ischemia.

Question 71

Demodicosis often coincides with bacterial infections. On a recheck examination of an 8-month old pit bull with demodicosis you find swelling and furunculosis over the lateral thighs that is draining serosanguinous fluid. Cytology of the fluid reveals 4+ cocci, and you diagnose a deep bacterial pyoderma. You culture the lesion and start Clindamycin based on the culture results. The dog returns in four weeks for another recheck examination. No bacteria are found on cytology, and clinically the dog looks excellent. You repeat a skin scrape and find Demodex mites. You inform the owner to continue Ivermectin. What should you do regarding continuation of antibiotics?

• Perform another culture and if positive keep treating; if negative discontinue antibiotics
• Continue the antibiotics until the demodex has resolved
• Continue the antibiotics for another 2 weeks.
• Discontinue the antibiotics, since cytology was negative and the clinical signs have resolved

Answer 71

Answer: Continue the antibiotics for another 2 weeks.

Explanation
Deep pyodermas involve tissues deeper than the epidermis including the dermis and even subcutis. Most often deep infections have resulted from an uncontrolled superficial infection. Deep lesions usually heal on the surface before the deeper infection is resolved; making clinical cure difficult to assess. Therefore, antibiotic treatment should be continued for 7-21 days after the tissues return to normal. In general, deep infections can require 6-8 weeks of antibiotic treatment and even 12 weeks for severe cases. Superficial infections require 3-4 weeks of antibiotic therapy or one week past clinical resolution.

Culture results will often be positive in normal dogs since normal dogs will have bacteria on their skin surface and in hair follicles. It is better to manage based on clinical signs. Cytology can miss deeper infections and it is better to extend antibiotic treatment even if cytology is negative.

It is not necessary to continue the antibiotics until resolution of demodicosis. Keep in mind that many Demodex patients will require several months of treatment. It is better to prevent recurrence of bacterial infections with topical therapy such as benzoyl peroxide shampoos.

Question 72

A 12-year old intact male Boston terrier presents with a history of straining to defecate over the past 2 months. On physical examination, a bulge is immediately noted in the right perineal region (see image). A rectal exam is also consistent with a perineal hernia. When discussing complications associated with repair of a perineal hernia which of the following is NOT a concern?

• Infection
• Failure of repair
• Femoral nerve paralysis
• Fecal incontinence

Answer 72

Answer: Femoral Nerve Paralysis

Explanation
Femoral nerve paralysis is not a reported complication.

The surgical region is not near the femoral nerve.

Incontinence can occur if over 50% of the external anal sphincter is damaged. Infection is a very common complication due to the region in which the surgery is being performed. Failure of repair is also a complication due to the weak nature of the muscles being used to repair the defect.

Question 73

A 2-year old indoor only male neutered domestic short haired cat presents for difficulty urinating. He is lethargic, weak, and vocalizing while frequently posturing to urinate. The owner states he has been doing this since last night, only passing a very tiny amount of urine. Which of the following fluids will you choose once his urethral obstruction is relieved?

• 0.9% sodium chloride
• Hetastarch
• 0.9% Saline with 20 meq/L Potassium supplementation
• Lactated ringers with 16 meq/L Potassium supplementation

Answer 73

Answer: 0.9% sodium chloride

Explanation
The most common electrolyte disturbance from a urethral obstruction is hyperkalemia. This occurs from an impaired urinary excretion of potassium. This can cause life-threatening arrhythmias and needs to be quickly addressed, especially if potassium exceeds 7 mEq/L. 0.9% Sodium chloride is the fluid of choice to treat this disturbance. If this fluid is not available, then Lactated Ringer’s would be a good alternative due to the low potassium concentration in those fluids. In extreme cases, dextrose may need to be added to the fluids because this stimulates insulin secretion and helps to move the potassium intracellular. Sodium bicarbonate and calcium gluconate can also help this shift of potassium in extreme cases.

**PowerPage: Urethral Obstruction (Feline)

Question 74

A 10-year old female spayed domestic short hair named Angel presents with a history of increased drinking and urinating for 2 weeks and weight loss. She has not eaten in 2 days. Bloodwork shows blood glucose 457 mg/dL and her urine shows 3+ glucose, 2+ ketones. Which type of insulin would be recommended for this patient at this time?

• Glargine (Lantus) insulin
• PZI insulin
• Vetsulin
• Humulin-R (regular insulin)
• Humulin-N (NPH)

Answer 74

Answer: Humulin R (regular insulin)

Explanation
This cat is in a state of diabetic ketoacidosis. Due to this status, the recommended insulin type is Humulin-R, or regular insulin. This is a shorter acting insulin which will help to get the ketonuria to resolve more efficiently.

After the ketosis has resolved and the cat is hydrated, eating, drinking, and electrolytes are stable, the cat can be switched to a longer acting insulin. Glargine or PZI are the insulin types of choice for long term control in felines after the ketoacidosis has been corrected, but other insulin types can also be used.

Question 75

Which of the following animals has oval erythrocytes that do NOT have nuclei?

• Frogs
• Elephants
• Chicken
• Llama
• Mouse

Answer 75

Answer: Llama

Explanation
Camelids have ovoid anucleated erythrocytes. Mice and elephants have round erythrocytes. Frogs and chickens have nucleated erythrocytes.

***PowerPage Top 10 Things to Know for Camelids

Question 76

A dog presents for an acute onset of right hind limb lameness. On physical exam you note the limb to be slightly externally rotated and shorter than the contralateral limb. You suspect a coxofemoral luxation. What is the most likely direction of luxation?

• Craniodorsal
• Caudodorsal
• Caudoventral
• Ventral
• Dorsal

Answer 76

Answer: Craniodorsal

Explanation
The correct answer is craniodorsal. Interestingly, over 80% of coxofemoral luxations occur in a craniodorsal direction in dogs. The key players in maintaining the femur in its socket are the ligament of the head of the femur, dorsal acetabular rim, and joint capsule. If any two of these are compromised, a luxation will most likely result.

**PowerLecture: Hip Luxation

Question 77

How much sodium bicarbonate must be given to a 470kg horse that has a base deficit of 13 to completely correct this deficit?

600 mEg
1100 mEg
2400 mEg
4500 mEg
900 mEg

Answer 77

Answer: 2400 mEq

Explanation
The best answer is 2400 mEq. The formula you need to know to calculate how much sodium bicarbonate you need (depending on your reference source) is 0.4 x BW × Base Deficit. Plug and chug (using 0.4) and you get 2444, which is the closest answer.

In practice, you may choose to fix only part (often half) of the total calculated bicarbonate and reassess, but this question asks how much is needed to completely correct the deficit.

If you need a reminder, the base deficit is the amount of base that you would need to add to a solution (i.e. plasma) to achieve a pH of 7.4. In general, the normal HCO3 concentration in blood is around 22-24 mEq/L. The base deficit is simply calculated by subtracting the patient’s HCO3 concentration (i.e. 10 from the normal concentration [23]).

Question 78

A 5-year old cow presents with skin lesions confined to the nonpigmented areas (see image). The affected skin is dry and raised at the periphery. The skin of the teats appears dry. Which of the following could result in this presentation?

• Ingestion of Pteridum aquilinum (bracken fern)
• Ingestion of moldy feed containing aflatoxins
• Ingestion of lupine
- Ingestion of Quercus spp.

Answer 78

Answer: Ingestion of moldy feed containing aflatoxins

Explanation
This is a case of photosensitization based on the skin lesions confined to the nonpigmented areas.

Primary photosensitization can occur when photodynamic agents are absorbed from the G.. tract such as Hypericum perforatum (St. John’s wort), Fagopyrum esculentum (buckwheat), Ammi majus (bishop’s weed), and Cymopterus watsonii (spring parsley). Secondary (hepatogenous) photosensitization occurs when the liver’s excretion of phylloerythrin is impaired due to liver damage.

Phylloerythrin is derived from the breakdown of chlorophyll by rumen microbes. The best answer in this question is aflatoxins because they are known to cause liver damage.

Bracken fern toxicity causes acute hemorrhagic syndrome in cattle. Lupine toxicity primarily causes birth defects. Quercus (oak) toxicity causes Gl and renal dysfunction.

Question 79

A 5-year old cow presents with skin lesions confined to the nonpigmented areas (see image). The affected skin is dry and raised at the periphery. The skin of the teats appears dry. Which of the following could result in this presentation?

• Ingestion of Pteridum aquilinum (bracken fern)
• Ingestion of moldy feed containing aflatoxins
• Ingestion of lupine
- Ingestion of Quercus spp.

Answer 79

Answer: Ingestion of moldy feed containing aflatoxins

Explanation
This is a case of photosensitization based on the skin lesions confined to the nonpigmented areas.

Primary photosensitization can occur when photodynamic agents are absorbed from the G.. tract such as Hypericum perforatum (St. John’s wort), Fagopyrum esculentum (buckwheat), Ammi majus (bishop’s weed), and Cymopterus watsonii (spring parsley). Secondary (hepatogenous) photosensitization occurs when the liver’s excretion of phylloerythrin is impaired due to liver damage.

Phylloerythrin is derived from the breakdown of chlorophyll by rumen microbes. The best answer in this question is aflatoxins because they are known to cause liver damage.

Bracken fern toxicity causes acute hemorrhagic syndrome in cattle. Lupine toxicity primarily causes birth defects. Quercus (oak) toxicity causes Gl and renal dysfunction.

Question 80

An iguana is presenting for a change in behavior described as hyperactivity and irritability. The iguana has also recently stopped eating and seems to have an enlarged abdomen. What is the most likely diagnosis?

• Foreign body ingestion
• Volvulus
• Gravid female
• Neoplasia

Answer 80

Answer: Gravid female

Explanation
The correct answer is gravid female. The clinical signs described are typical for a gravid female.
They are most likely to present from November to June. On physical exam you can typically feel the lumps in the abdomen which are the large eggs.

Intervention in the form of an ovariohysterectomy is performed if attempts at inducing oviposition fail.

Question 81

You are performing a welfare audit of a poultry flock and observing signs of bumblefoot. Why is a disease in general an animal welfare concern?

• Due to the ability of the disease to cause abnormal behaviors
• Due to the ability of the disease to change social hierarchies
• Due to the ability of the disease to prevent interaction with humans
• Due to the ability of the disease to cause loss of production
• Due to the ability of the disease to cause pain.

Answer 81

Answer: Due to the ability of the disease to cause pain.

Explanation
Pain due to disease is a welfare concern. The other options are not welfare concerns associated with the disease.

Question 82

You are examining the eyes of a cat and find it has no dazzle reflex, menace response and is not visual out of one of its eyes, but it does have a palpebral reflex. Where is the lesion?

• Visual cortex
• CN Il
• CN V
• CN VII

Answer 82

Answer: CNII

Explanation
The correct answer is CN II. The presence of a palpebral indicates normal function of CN V and VII. The dazzle reflex examines CN Il separate of the visual cortex (an animal with a cortical lesion will still have a dazzle reflex).

Therefore the lesion is in CN II.

Question 83

A 12-year-old female spayed Labrador Retriever dog is presented for dental cleaning. After she is induced under general anesthesia, her pulse oximetry drops below normal at 91%. Thoracic radiographs show the following changes (see images below). What is the most clinically significant finding evident on thoracic radiographs from this dog?

• Spondylosis deformans is present
• Osteochondritis dissecans is evident in the left shoulder
• There is a gastric foreign body
• Left cranial lung lobe has alveolar infiltrates
• Heart is globoid is appearance

Answer 83

Answer: Left cranial lung lobe has alveolar infiltrates

This dog has pneumonia of the left cranial lung lobe. There are diffuse alveolar infiltrates within the left cranial lung lobe with air bronchograms.

You should cancel the anesthetized procedure and wake up the patient because she is oxygenating poorly. Recheck radiographs are recommended once she is awake to rule out any component of atelectasis due to recumbency and sedation.

There is an incidental gastric foreign body (rounded metal opacity within the stomach that is in close association with additional irregular metal opacity).

The dog does have spondylosis deformans, which is a very common and incidental radiographic finding in older dogs.

Although these changes are present, they are not the most clinically important findings on these radiographs.

Question 84

A 9 month old shepherd cross presents for lethargy and exercise intolerance. Your physical exam reveals dark red mucous membranes and a heart murmur. A CBC reveals a hematocrit of 70% (35-57%). Which of the following could NOT explain the given findings?

• Atrial septal defect with tricuspid stenosis
• Atrial septal defect with systemic hypertension
• Tetralogy of Fallot
• PDA with pulmonary hypertension

Answer 84

Answer: Atrial septal defect with systemic hypertension

Explanation
The correct answer is atrial septal defect with systemic hypertension. This dog’s polycythemia developed due to shunting of venous blood into the arterial circulation (aka right-to-left shunting) leading to hypoxemia and an increased drive for erythropoiesis and secondary polycythemia. This can be caused by any of the other 3 answer choices. An atrial septal defect with systemic hypertension results in oxygenated blood shunting into the venous circulation or left-to-right shunting, which usually does not cause hypoxemia

Question 85

A 9 month old shepherd cross presents for lethargy and exercise intolerance. Your physical exam reveals dark red mucous membranes and a heart murmur. A CBC reveals a hematocrit of 70% (35-57%). Which of the following could NOT explain the given findings?

• Atrial septal defect with tricuspid stenosis
• Atrial septal defect with systemic hypertension
• Tetralogy of Fallot
• PDA with pulmonary hypertension

Answer 85

Answer: Atrial septal defect with systemic hypertension

Explanation
The correct answer is atrial septal defect with systemic hypertension. This dog’s polycythemia developed due to shunting of venous blood into the arterial circulation (aka right-to-left shunting) leading to hypoxemia and an increased drive for erythropoiesis and secondary polycythemia. This can be caused by any of the other 3 answer choices. An atrial septal defect with systemic hypertension results in oxygenated blood shunting into the venous circulation or left-to-right shunting, which usually does not cause hypoxemia

Question 86

A client brings in her dog that recently ingested rodenticide. You check the box and see that the active ingredient is cholecalciferol. The dog appears clinically normal right now. What would you be concerned might happen if you do nothing at this time?

• Development of intestinal perforation
• Development of liver tailure
• Development of coagulopathy
• Development of organ mineralization
• Development of neurologic signs

Answer 86

Answer: Development of organ mineralization

Explanation
The correct answer is development of tissue mineralization. Cholecalciferol (Vitamin D3) acts by becoming converted to calcitriol and increases calcium and phosphorus levels leading to mineralization of organs, especially the kidneys.

For the PowerPage on this topic, view Rodenticide Toxicity

Question 87

In the middle of a surgery the primary surgeon on the case requests a pack of non-absorbable suture. Which will you give the surgeon?

• Prolene
• Polydioxanone (PDS)
• Maxon
• Catgut
• Dexon

Answer 87

Answer: Prolene

Explanation
The correct answer is prolene. Prolene is a monofilament non-absorbable suture which retains great tensile strength. This type of suture along with nylon suture is usually used on skin.

PDS is a monofilament suture which is degraded by hydrolysis. Absorption is complete in approximately 182 days, and it retains tensile strength for 28-56 days. Dexon is a braided, multifilament, absorbable suture which is absorbed by hydrolysis in 100-120 days. Tensile strength is lost in 7-14 days. Catgut is broken down by phagocytosis and retains tensile strength for 14-28 days. Maxon is absorbed by hydrolysis starting at day 60 and completely absorbed by 6 months. Tensile strength is retained for about 21 days.

***PowerPage: Suture Materials

Question 88

An adult rabbit presents to you for chronic mucopurulent nasal discharge and sneezing. Which of these agents is likely responsible for the rabbit’s clinical signs?

• Pasteurella multocida
• Treponema cuniculi
• Eimeria stediae
• Clostridium spiroforme

Answer 88

Answer: Pasteurella multocida

Explanation
The correct answer is Pasteurella multocida. This is a common cause of infectious disease in rabbits and is the causative agent of “snuffles”.

Of the choices listed, Pasteurella is the only respiratory pathogen. The upper respiratory syndrome is the most common presentation for Pasteurella in rabbits, but it can affect many other systems and can cause enzootic pneumonia, otitis media/interna, conjunctivitis, meningitis, encephalitis, reproductive tract infections, abscesses, and septicemia.

Question 89

What causes the Whitten effect (buck effect)?

• Introduction of a new male
• Removal of an old female
• Removal of an old male
• Introduction of a new female

Answer 89

Answer: Introduction of a new male

Explanation
The correct answer is introduction of a new male.

This induces sheep and goats to ovulate at the same time.

Question 90

What causes the Whitten effect (buck effect)?

• Introduction of a new male
• Removal of an old female
• Removal of an old male
• Introduction of a new female

Answer 90

Answer: Introduction of a new male

Explanation
The correct answer is introduction of a new male.

This induces sheep and goats to ovulate at the same time.

Question 91

Which of the following is seen more commonly with acute renal failure than with chronic renal failure?

• Metabolic acidosis
• Anemia
• Hyperphosphatemia
• Anuria

Answer 91

Answer: Anuria

Explanation
The correct answer is anuria. Hyperphosphatemia occurs in both acute and chronic renal failure.

Anemia is seen in chronic renal failure due to decreased erythropoietin, shortened RBC lifespan, uremic inhibition of erythropoiesis, etc. Metabolic acidosis occurs in both acute and chronic renal failure from decreased bicarbonate production by the kidneys and from retention of metabolic acids.

Question 92

Calculate the extracellular volume of a 450kg horse.

• 270L
• 300L
• 180L
• 45L
• 90L

Answer 92

Answer: 90L

Explanation
The correct answer is 9OL. Total body water is 60% of body weight. Extracellular fluid is approximately 1/3 of total body water, therefore
450kg x .6 = 270L total body water 270L x .33 = 89.1L ECF.

ECF is composed of plasma, interstitial fluid and transcellular lymph such as CS and synovial fluid.

Question 93

A 2-year-old neutered male greyhound presents for crusting along his ear pinnae and elbows. The owner also explains that the dog is intensely pruritic. The dog mainly lives indoors but is also let outside into the backyard. The owner lives on a large rural property that is heavily wooded. You perform cytology, which returns negative for bacteria and yeast. You are highly suspicious of Sarcoptes. Which of the following would be most useful to help in your diagnosis of Sarcoptic mange?

• Deep skin scrape, pinnal-pedal reflex, clinical
  signs
• Histopathology, deep skin scrape, trichogram
• Pinnal-pedal reflex, clinical signs, superficial skin scrape
• Superficial skin scrape, histopathology,
  trichogram
• Clinical signs, superficial skin scrape,
  trichogram

Answer 93

Answer: Pinnal-pedal reflex, clinical signs, superficial skin scrape

Explanation
A superficial skin scrape is most useful. A deep skin scrape is used for Demodex mites, which reside in the hair follicles. Superficial skin scraping is indicated for Sarcoptic mange, since this mite lives in the stratum corneum. Pinnal-pedal reflex can be positive in 70% of Sarcoptic mange infestation but can also be positive in any dog with pruritus.

Clinical signs are helpful because Sarcoptes typically infects the non-haired portions of the skin such as the ear pinnae, elbows, hocks, and ventral abdomen. If the mite is not found on skin scraping and you have clinical signs indicative of Sarcoptes then a therapeutic trial is warranted.

Keep in mind that in most cases you will not be able to find the mite.

A trichogram would not be indicated. This method can be used to diagnose dermatophytosis and sometimes Demodex.

Histopathology will reveal a perivascular dermatitis that is non-specific. Rarely are the mites found on histopathology.

Question 94

You are examining an ataxic horse and your differential diagnoses include equine protozoal myeloencephalitis, cervical vertebral malformation, equine degenerative myeloencephalopathy, equine herpes myeloencephalitis, polyneuritis equi, and verminous myeloencephalitis.

Which of the following clinical presentations is most consistent with equine protozoal myeloencephalitis?

• Progression from hyperesthesia to anesthesia
  with progressive paralysis of the tail, rectum, bladder, and urethra leading to urine dribbling
• Acute onset with concurrent fever and respiratory signs following abortions on a farm
• Lateralization of signs and concurrent neurogenic muscle atrophy of the quadriceps and gluteal regions
• Symmetric ataxia that is worse in the
  hindlimbs than the forelimbs
• Sudden onset and rapid progression of clinical
  signs

Answer 94

Answer: Lateralization of signs and concurrent neurogenic muscle atrophy of the quadriceps and gluteal regions

Explanation
With EPM, the important signs to remember are asymmetry, ataxia, and atrophy. Lateralization of the signs (asymmetry) and quadriceps and/or gluteal muscle atrophy are most consistent with EPM.

Herpes myeloencephalitis is caused by EHV1 and often has an acute onset following an episode of fever, cough and nasal discharge or following abortions on a farm. This condition often affects more than one horse on a farm. The ataxia and weakness is usually symmetric.
Cervical vertebral stenotic myelopathy (CVM) and equine degenerative myeloencephalopathy typically cause symmetric signs with the hindlimbs usually a grade worse than the forelimbs. The signs of CVM may be worsened by flexing or hyperextending the neck.

Polyneuritis equi is more common in mature horses and usually starts with hyperesthesia progressing to anesthesia. There is progressive paralysis of the tail, rectum, bladder and urethra leading to urine dribbling.

Verminous myeloencephalitis is less common and the onset is usually sudden with rapid deterioration and death.

***PowerPage: Equine Protozoal Myeloencephalitis

Question 95

A veterinarian wishes to know which plants are photosensitizing. He provides you with samples from the hay to pick from, and you tell him that _______ can cause secondary photosensitization.

• Hypericum perforatum
• Erodium
• Ammi majus
• Amsinckia intermedia

Answer 95

Answer: Amsinckia intermedia

Explanation
The correct answer is Amsinckia intermedia. This plant (aka fiddleneck, fireweed, and tarweed) contains pyrrolizidine alkaloids. PAs are hepatotoxic and cause three classical liver lesions.

Do you recall them?

Megalocytosis, biliary duct hyperplasia, and fibrosis.

As a result of liver damage, the liver will be unable to clear normal chlorophyll breakdown products such as phylloerythrin, which causes photosensitization secondary to liver damage. The other answer choices are primary photosensitizing agents.

***PowerLecture: Hepatic Disorders

Question 96

An adult horse presents to you for recurrent seasonal pruritus during the summer months that seems to be worsening. On physical examination, you find multiple excoriations along the poll, mane, and tail. What is the most likely cause of this horse’s pruritus?

• Culicoides
• Onchocerca
• Habronema
• Hypoderma
• Haematobia

Answer 96

Answer: Culicoides

Explanation
The correct answer is Culicoides. Culicoides hypersensitivity, also referred to as sweet itch, occurs due to allergy to the saliva of the gnat. It recurs seasonally in the warmer months and tends to worsen with age. Typically, horses are pruritic and develop lesions on the poll, mane, and tail from self trauma, although ventral midline dermatitis can occur as well. More chronically, scarring can occur. Treatment is to decrease exposure to the gnat and to treat with steroids.

Habronemiasis is a condition where the larvae of the stomach worm migrate and emerge creating granulomatous lesions, usually around the eye, male genitalia, or lower extremities. Inside the granulomas, you can find dead larvae. Haematobia irritans is a bigger problem in cattle than horses (they reproduce in cow feces) but can affect horses, especially ones that are near cattle. It typically causes ventral midline dermatitis with wheals with a central crust that progress to alopecia and ulceration with fairly focal lesions, rather than more diffuse lesions caused by Culicoides.

Onchocerca can cause dermatitis in the horse due to hypersensitivity to dying microfilariae. Lesions include alopecia and scaling of the ventral midline, face, and pectoral region.
Often, lesions are diamond shaped and there may be a “bull’s eye” lesion on top of the head.
Onchocerca is nonseasonal, in contrast to Culicoides hypersensitivity, and variably pruritic.
Ocular lesions can also occur with Onchocerca including uveitis, conjunctivitis, and keratitis.

Lastly, Hypoderma is also a bigger problem in cattle but can occur in horses and typically creates nodules on the dorsum that have a pore on top.

Question 97

You examine a 6 year old horse for head tilt to the left (left ear is lower, see image). The owner first observed it 2 days ago and it has since worsened. On PE, T=102F (38.9 C), and pulse and respiratory rate are normal. Other CNS signs include mild facial paralysis, mild ataxia, and nystagmus that does not change with head position. What is the most likely diagnosis?

• Cerebellar abiotrophy
• Leukoencephalomalacia
• Vestibular disease
• Nigropallidal encephalomalacia
• Locoweed poisoning

Answer 97

Answer: Vestibular disease

Explanation
These signs are compatible with mild infectious vestibular disease caused by bacterial otitis media/interna. Other possible causes of vestibular disease are guttural pouch mycosis, polyneuritis equi, viral labyrinthitis, and traumatic skull fractures.

Question 98

Which of the following is not a possible cause for icterus in a horse?

• Oleander ingestion
• Anorexia
• Hemolysis
• Clostridium piliformis
• Theiler’s disease

Answer 98

Answer: Oleander ingestion

Explanation
The correct answer is oleander ingestion. Oleander contains a cardiac glycoside and will kill a horse by causing arrhythmias and stopping the heart.

Anorexia and hemolysis cause a prehepatic icterus.

Theiler’s disease is an acute, diffuse, necrotizing hepatitis that occurs after receiving serum products and can cause a hepatic icterus. Tyzzer’s disease is caused by Clostridium piliformis and can cause a hepatic icterus.

***PowerLecture: Hepatobiliary Disorders

Question 99

The procedure performed on the patient’s right hip is a triple pelvic osteotomy. On the patient’s left hip a total hip replacement has been performed. Which one of the following statements is true?

• Triple pelvic osteotomies will eliminate progression of arthritis
• Triple pelvic osteotomies should only be performed in dogs free of radiographic signs of degenerative joint disease
• The most common complication associated with total hip replacements is caudoventral luxation
• Total hip replacements should only be done in dogs that are over 2 years of age

Answer 99

Answer: Triple pelvic osteotomies should only be performed in dogs free of radiographic signs of degenerative joint disease

Explanation
Triple pelvic osteotomies (TPO) are designed to increase the dorsal coverage of the femoral head.

If there are degenerative changes at the time of surgery then the likelihood of achieving good results with the procedure is diminished. This is why this surgery is typically performed in dogs that are 6mo - lyr of age. TPOs will not eliminate the progression of arthritis; however, it is believed that the degree of arthritis will be less and that many patients are clinically sound despite having radiographic evidence of arthritis.

Total hip replacements (THR) can be performed as soon as the physes in the region have finished their growth. THRs have been performed in dogs as young as 1 year of age and sometimes even younger. A caudoventral luxation can occasionally occur with a total hip replacement; however, craniodorsal luxations are a much more common.

Question 100

A 9-year old female spayed Calico cat presents for weight loss. She is strictly indoors with one other cat. There is no travel history. She is hyperactive at home and has a ravenous appetite. You note she has lost weight from her previous visit. On examination you hear a II/VI parasternal murmur. Abdominal palpation is unremarkable. In house lab work shows an ALT of 240 U/L (25-97 U/L), and ALP of 250 U/L (0-45 U/L). Her complete blood cell count is unremarkable. Her blood pressure is 200 mmH. What do you tell the owner regarding long term care?

• Palliative therapy can provide quality of life support, but long term outcome is poor.
• Life long therapy is necessary, and control is often successful
• Supportive therapy often fails after a few weeks to months. Consider euthanasia when failure occurs.
• Life long therapy is necessary; management and control can be difficult.

Answer 100

Answer: Life long therapy is necessary, and control is often successful

Explanation
Ravenous appetite with weight loss, hyperactivity, heart murmur, and high blood pressure would most likely indicate hyperthyroidism; especially in an older cat. Medical management can be successful with methimazole daily for the rest of the cat’s life. Other treatment options include surgical thyroidectomy (not recommended since surgery can induce hypothyroidism) or radioactive iodine therapy. Hill’s Y/D food has limited iodine, strict dietary management is required for any chance of success if using the Y/D as the treatment choice.

It is important to screen and rescreen for renal disease prior to and after starting methimazole.

Hyperthyroidism can mask renal disease due to increased blood pressure and blood flow through the kidneys leading to increased glomerular filtration rate. Owner must be warned that even if no signs are seen prior to initiating treatment, renal disease may be diagnosed at a later time.

Definition:
Feline hyperthyroidism (FHT) is a common endocrine disorder in older cats caused by excessive production of thyroid hormones (thyroxine [T4] and triiodothyronine [T3]), usually due to thyroid adenomas or hyperplasia.

Causative Agents:
- Primary Causes: Thyroid adenomas or adenomatous hyperplasia.
- Environmental Factors: Exposure to certain chemicals like bisphenol A and phthalates, iodine content in diet, and possibly genetic predisposition.

Pathophysiology:
- Thyroid Hormone Overproduction: Leads to an increased metabolic rate.
- Systemic Effects: Hyperthyroidism affects multiple organ systems, causing metabolic, cardiovascular, and gastrointestinal disturbances.

Symptoms:
- Weight loss despite increased appetite
- Polyuria, polydipsia
- Increased vocalization, hyperactivity
- Vomiting, diarrhea
- Tachycardia, tachypnea
- Unkempt hair coat

Clinical Changes:
- Physical Examination: Palpable thyroid nodule, weight loss, muscle wasting, heart murmurs, arrhythmias.
- Laboratory Findings: Elevated total T4, sometimes with increased ALT and alkaline phosphatase.

Diagnosis:
1. Clinical Examination: Detailed history and physical examination.
2. Laboratory Tests:
- Total T4 Measurement: Primary diagnostic test. Elevated levels confirm hyperthyroidism.
- Free T4 by Equilibrium Dialysis (fT4ed): Used when T4 levels are borderline.
- Thyroid Stimulating Hormone (TSH): Low TSH supports the diagnosis of hyperthyroidism.
3. Imaging:
- Thyroid Scintigraphy: Evaluates functional thyroid tissue and confirms the diagnosis.
- Additional Imaging: Chest radiographs and echocardiography to assess cardiac involvement.

Treatment:
1. Radioactive Iodine (I-131):
- Mechanism: Selectively destroys hyperactive thyroid tissue.
- Administration: Single injection or oral capsule.
- Advantages: High cure rate (>95%), minimal side effects, treats ectopic thyroid tissue.
- Disadvantages: Requires special facilities, isolation post-treatment.

2. Medical Therapy:
   
   • Methimazole: Inhibits thyroid hormone synthesis.
     
     • Dosage: 1.25-2.5 mg/cat twice daily, adjusted based on response.
     • Forms: Oral and transdermal.
     • Side Effects: Gastrointestinal upset, facial pruritus, hepatopathy, blood dyscrasias.
   • Carbimazole: Metabolizes to methimazole, similar mechanism and side effects.
3. Surgical Thyroidectomy:
   
   • Indication: When radioactive iodine is not an option.
   • Procedure: Unilateral or bilateral removal of thyroid glands.
   • Complications: Hypocalcemia, recurrence, anesthetic risks.
4. Dietary Therapy:
   
   • Iodine-Restricted Diet: Controls thyroid hormone production by limiting dietary iodine.
   • Effectiveness: 75-83% success rate in reducing T4 levels and clinical signs.

Monitoring:
- Initial Follow-Up: 2-4 weeks after starting treatment.
- Long-Term Monitoring: Every 4-6 months for stable cases.
- Parameters: T4 levels, CBC, chemistry panel, urinalysis, and blood pressure.

Prognosis:
- General Outcome: Good with appropriate treatment. Median survival up to 5.3 years for non-azotemic cats.
- Complications: Untreated hyperthyroidism can lead to significant morbidity and mortality.

Summary:
Feline hyperthyroidism requires a systematic approach to diagnosis, including clinical signs, laboratory tests, and imaging. Treatment options include radioactive iodine, medical therapy, surgical thyroidectomy, and dietary management. Regular monitoring is crucial to manage the disease and any concurrent conditions effectively.

For more detailed information, refer to the full PDF document.

Question 101

You examine a very ill 4-year old Holstein dairy cow on a large commercial dairy. She freshened one week ago and was producing well, until she was found down and unwilling to rise this morning when you were called. T=103F or 39.4 C, HR=90, and R=35. The scleral vessels are dark are enlarged, her rumen is fairly empty and the motility is poor, and she appears too weak to rise. Rectal exam reveals an involuting uterus which can be retracted, discharging a brownish red mucoid non-odorous lochia through the vagina. The left rear quarter of her udder is swollen, hot, painful, and discolored (see image), and contains a serum-like secretion with clumps of fibrin in it. What is your diagnosis?

• Coliform mastitis
• Grain overload
• Displaced abomasum
• Metritis
• Hypocalcemia (milk fever)

Answer 101

Answer: Coliform mastitis

Explanation
This is a case of severe acute coliform mastitis, and the absorbed endotoxin (LPS) is causing many of the systemic signs observed. The cow needs to be aggressively treated with IV fluids, NSAIDS, and supportive nursing. The gland should be frequently milked out. The use of both intramammary and systemic antimicrobial drugs to which most coliforms are susceptible is still controversial, but is often done in cows in a severe state of illness as in this case. While this cow may have secondary hypocalcemia, treatment with calcium needs to be approached cautiously, as endotoxic animals have very sensitive myocardium and arrest may occur if calcium is given IV. If given, preferred routes of calcium administration would be subcutaneous or oral.

Definition:
Coliform mastitis is a form of mastitis in dairy cattle caused by gram-negative, lactose-fermenting bacteria, primarily Escherichia coli, Klebsiella spp., and Enterobacter spp.

Pathophysiology:
- Invasion: Bacteria enter through the teat canal, proliferate in the mammary gland, and release endotoxins.
- Immune Response: Endotoxins trigger an acute inflammatory response, characterized by neutrophil influx and cytokine release.
- Systemic Effects: Severe cases can lead to systemic toxemia, including fever, shock, and even death.

Causes:
- Environmental Factors: Contaminated bedding, water, and equipment; poor milking hygiene; and trauma to the teats.
- Specific Pathogens: E. coli and Klebsiella are common environmental pathogens associated with coliform mastitis.

Symptoms:
- Local: Swollen, firm udder, with watery, bloody, or pus-laden milk.
- Systemic: Fever, anorexia, dehydration, and in severe cases, shock.

Clinical Changes:
- Milk Changes: Reduced milk yield, abnormal milk appearance (watery or containing clots).
- Udder Changes: Swelling, heat, and pain in the affected quarter(s).

Assessment:
- Clinical Signs: Observation of milk and udder condition, systemic symptoms.
- Laboratory Tests: Somatic cell count (SCC) in milk, bacterial culture to identify the causative agent.

Treatment:
- Antibiotics: Systemic and intramammary antibiotics, ideally chosen based on sensitivity testing.
- Cephalosporins: Commonly used due to efficacy against gram-negative bacteria.
- Aminoglycosides and Fluoroquinolones: Used for severe cases but require careful monitoring for residues in milk.
- Supportive Care: Fluid therapy to manage dehydration and shock, anti-inflammatory drugs to reduce fever and pain.

Prevention:
- Hygiene: Proper milking procedures, clean and dry bedding, regular equipment maintenance.
- Teat Care: Use of post-milking teat dips to reduce bacterial colonization.
- Vaccination: Some vaccines are available for prevention against E. coli and Klebsiella spp.

Prognosis:
- Severity: Varies based on the extent of infection and timeliness of treatment.
- Outcomes: Potential for chronic infections, reduced milk production, and, in severe cases, death or culling.

Epidemiology:
- Incidence: Higher in herds with poor environmental management; outbreaks can occur in warmer climates or with improper bedding materials.
- Zoonotic Risk: Although rare, some coliform bacteria can be zoonotic, posing a risk to humans.

Key Points:
- Early Detection: Critical for effective treatment; regular monitoring of SCC and milk quality is essential.
- Veterinary Involvement: Regular herd health assessments and consultations for mastitis management and antibiotic stewardship.

For more detailed information, visit the Merck Veterinary Manual.

Question 102

A 12-year old Himalayan cat presents to an emergency clinic with a 2-day history of progressive dyspnea. The cat is an indoor-outdoor cat and was previously healthy. It is currently not on any medications and is up to date on all vaccinations. On physical examination the cat appears stressed and is intermittently open-mouth breathing. On auscultation of the chest there are decreased heart sounds and lung sounds. There are no obvious murmurs noted. The patient appears to be taking rapid, shallow, breaths. Radiographs confirm the presence of pleural effusion and the owners consent to a thoracocentesis which yields a clear-to-milky white fluid. Which of the following comparisons will you make to confirm the presence of chylothorax?

• Compare pleural fluid alkaline phosphatase to serum alkaline phosphatase levels
• Compare pleural fluid triglyceride level to serum triglyceride levels
• Compare pleural fluid lactate to serum lactate levels
• Compare pleural fluid glucose to serum glucose levels

Answer 102

Answer: Compare pleural fluid triglyceride level to serum triglyceride levels

Explanation
The pleural fluid obtained has a milky white appearance as a result of its high triglyceride content. Any patient that has an effusion triglyceride content higher than that of the serum is considered to have a chylothorax. Chyle is lymphatic fluid which contains a high quantity of fat. Abnormal flow or pressures in the thoracic duct are thought to cause exudation of chyle from lymphatic vessels into the thorax.

The presence of chylomicrons in the sample, a cholesterol content greater than or equal to that of the serum, and a positive ether clearance test are also supportive chylothorax.

Chylous fluid is typically white to pink in color, opaque and can have a variable specific gravity (1.019-1.050 in the cat). The protein level is variable (2.6-10.3 g/dL) and the white blood cell count can be over 7,000 cells/ul.

A decreased glucose compared to that of serum is consistent with an infectious etiology. Lactate elevations can be expected in any patient that is undergoing anaerobic metabolism and a difference in lactate levels between the chyle and serum is not diagnostic for chylothorax. Alkaline phosphatase levels will not help in the diagnosis of chylothorax. In cats, the Siamese and Himalayans are predisposed.

Question 103

A turtle presents with a history of lethargy, anorexia, and swelling of the ears. What is the treatment of choice?

• Corticosteroids
• No treatment, the condition is self-limiting
• Euthanasia
• Lance tympanic membranes to drain material and begin supplementation of vitamin A

Answer 103

Answer: Lance tympanic membranes to drain material and begin supplementation of vitamin A

Explanation
The correct answer is to lance the tympanic membranes and begin supplementing with vitamin A.

Accumulations in the ear due to squamous metaplasia and secondary infection can result from vitamin A deficiency. The best thing to do is start systemic antibiotics, drain the ears, and provide appropriate nutrition.

Question 104

A 1 year old female sheep presents to you with a discrete mass on the ventral neck. In cross section, the mass has an “onion-ring” appearance of concentric layers of fibrous tissue separated by inspissated caseous exudate. An aspirate shows many small gram-positive rods both intracellularly and extracellularly. What is the likely etiology?

• Mycoplasma mycoides
• Escherichia coli
• Mycobacterium paratuberculosis
• Corynebacterium pseudotuberculosis

Answer 104

Answer: Corynebacterium pseudotuberculosis

Explanation
The correct answer is Corynebacterium pseudotuberculosis. This is a classic description of how caseous lymphadenitis presents in sheep. Infection may occur via penetration through superficial skin wounds and sometimes through unbroken skin. The pus contains large numbers of bacteria that can survive for months in the environment and be a source of infection. Typical clinical signs are a slowly growing, non-painful mass at the point of entry or a local lymph node. Treatment is usually not attempted as this tends to be a chronic recurring disease causing economic loss. Carriers can be a source of infection to other animals.

***PowerPage: Top 10 Sheep and Goat Diseases

***PowerLecture: Caseous Lymphadenitis

• Causative Agent: Corynebacterium pseudotuberculosis
• Transmission: Through skin wounds, environmental contamination, and respiratory secretions
• Pathogenesis: Bacteria enter through skin or mucous membranes, travel to lymph nodes, and form encapsulated abscesses.

• External Form: Abscesses in peripheral lymph nodes (e.g., submandibular, prescapular, prefemoral)
• Internal Form: Chronic weight loss, respiratory signs (cough, nasal discharge)

• Definitive Diagnosis: Culture of purulent material
• Serologic Tests: Detect antibodies, but interpretation requires caution

• Management: Culling, antimicrobial therapy (intralesional and systemic), abscess drainage and isolation
• Antibiotics: Penicillin, rifampin, tulathromycin, oxytetracycline

• Biosecurity: Strict hygiene, disinfection, and isolation of affected animals
• Vaccination: Species-specific vaccines
• Quarantine: New animals should be tested and isolated before introduction to the herd

For more detailed information, visit the Merck Veterinary Manual.

Question 105

A feedlot asks you to examine a 6-month old steer calf that is showing bloat. He has been in the feedlot for 2 weeks, is not gaining weight, and is still on a transition ration. He is the only animal in the pen affected. You find he has T=104 F (40 C), HR=96, RR=38, and the cranioventral lungs sound harsh with wheezing on both inspiration and expiration. The areas are also consolidated on percussion. The rumen contains gas which disappears when you pass a stomach tube, but the rumen has very poor motility. What is your diagnosis?

• Type 1 vagal indigestion (free gas bloat)
• Frothy bloat
• Type 3 vagal indigestion (failure of pyloric outflow)
• Left displaced abomasum
• Type 2 vagal indigestion (failure of omasal transport)

Answer 105

Answer: Type 1 vagal indigestion (free gas bloat)

Explanation
Free gas bloat in young animals is often secondary to bacterial bronchopneumonia, and mediastinal lymph node inflammation that affects the thoracic vagus nerve. Once the gas accumulates, it stops motility and decreases appetite. Treat the pneumonia with antimicrobials. The gas can also be relieved by creating a small temporary rumen fistula.

***PowerLecture: Vagal Indigestion

Question 106

Broiler chickens often develop lesions that negatively impact welfare in which part of their bodies due to the rapid muscle growth that they experience?

• Breast muscle
• Head
• Feet and legs
• Reproductive organs
• Comb

Answer 106

Answer: Feet and legs

Explanation
Rapid growth is associated with limb and foot lesions in broilers.

Question 107

Which of the following is not passed by passive contact and sharing of a litter box?

• Feline panleukopenia
• Feline immunodeficiency virus
• Feline corona virus
• Feline leukemia virus
• Feline herpes virus

Answer 107

Answer: Feline immunodeficiency virus

Explanation
The correct answer is feline immunodeficiency virus. The virus is shed in the saliva and is transmitted mainly through bites. The disease mostly affects older, outdoor male cats which have a higher likelihood of getting into fights and being bitten by other cats. Having the disease makes them immunosuppressed and more susceptible to infections. The remainder of the answer choices can be passed via passive contact.

• Feline Immunodeficiency Virus (FIV): A lentivirus, similar to HIV, causing an acquired immunodeficiency syndrome in cats.
• Causative Agent: FIV, a member of the retrovirus family, primarily affecting domestic cats.

• Cell Tropism: FIV replicates in CD4+ and CD8+ lymphocytes, macrophages, astrocytes, and microglial cells. Over time, FIV leads to immunosuppression, resulting in increased susceptibility to infections.
• Immune Response: Initial immune response includes neutralizing antibodies and a cellular immune reaction. However, a latent infection arises, where viral replication continues at low levels, leading to a gradual decline in immune function. CD4+ cell counts decrease, and CD8+ cells increase, disrupting the CD4:CD8 ratio.

• Stages of Infection:
  
  1. Acute Phase: Fever, lethargy, lymphadenopathy, and neutropenia. This stage may last weeks to months.
  2. Asymptomatic Phase: The cat appears healthy but harbors the virus. This stage can last years.
  3. Chronic Clinical Signs: Weight loss, persistent fever, anemia, leukopenia, stomatitis, behavioral changes, and recurrent infections.
  4. Terminal AIDS-Like Phase: Severe immunosuppression, opportunistic infections, neoplasia, and neurological abnormalities.

• Antibody Testing: ELISA and Western blotting are the primary diagnostic tools, detecting antibodies against FIV. False positives may occur in low-prevalence areas, necessitating confirmatory testing.
• Virus Isolation: Not practical for routine diagnosis but can be done via blood cell culture.

• Antiviral Therapy:
  
  • AZT (Zidovudine): Inhibits viral replication, improves immune function, and prolongs life expectancy. Dosage: 5 mg/kg orally or subcutaneously twice daily.
  • Other Antiviral Agents: PMEA, D4T, and others have shown potential in vitro but are not widely available for clinical use.
• Symptomatic Management: Treatment of secondary infections, supportive care, and regular monitoring of blood cell counts.

• Risk Mitigation: Prevent exposure to FIV by keeping cats indoors, neutering them, and avoiding contact with infected or unknown cats.

• Variable: Depends on the stage of the disease at diagnosis and response to treatment. Some cats may live for years with minimal clinical signs, while others may progress rapidly to severe immunosuppression and associated complications.

This detailed guide outlines the critical aspects of FIV, focusing on diagnosis, treatment, and management strategies essential for the NAVLE exam.

Question 108

A 10-yr old, 825 gram, male, Moluccan cockatoo named “Ira” is presented to your clinic with a complaint of feather loss on the distal end of the right wing. A feather cyst had been removed from this area three months earlier. Physical examination reveals a thickened, yellow, friable skin lesion on the dorsal aspect of the right metacarpus. You make a contact smear of the area and cytology reveals macrophagic inflammation with multi-nucleated giant cells and cholesterol clefts as seen in the image below. What condition is this most compatible with?

• Cutaneous xanthomatosis
• Bacterial dermatitis
• Cutaneous gout
• Avian poxvirus
• Cutaneous lymphoma

Answer 108

Answer: Cutaneous xanthomatosis

Explanation
Cutaneous xanthomatosis is a unique condition of birds caused by excessive accumulation of lipids in the skin. It is a macrophagic inflammatory response, with multinucleated giant cells and cholesterol crystals observed cytologically. A xanthoma is a benign growth and is most prevalent in cockatiels, budgies and cockatoos. They are typically non-aggressive, but at times can become locally invasive causing irritation and self-mutilation of the site. The etiology is unknown but a high fat diet and inactivity may contribute.

Gout is a build-up of uric acid, and typically causes swollen painful joints. Bacterial dermatitis is usually associated with a heterophilic or mixed inflammation. Poxvirus lesions have clusters of squamous epithelial cells with eosinophilic cytoplasmic vacuoles. Cutaneous lymphoma yields highly cellular samples of immature lymphocytes.

Question 109

A vaccinated Persian cat arrives at your clinic two days after biting a human. What is your course of action?

• Confine pet and observe for 10 days
• Vaccinate after 6-month quarantine
• Euthanize and test
• Vaccinate immediately and quarantine for 45 days

Answer 109

Answer: Confine pet and observe for 10 days

Explanation
The correct answer is to confine and observe the cat for 10 days. You would only need to euthanize and test if the cat is a stray. If the cat was not up to date on vaccinations, you would either euthanize and test, or quarantine for 10 days in an approved facility.

Question 110

A 3-year old male castrated cat presents to your clinic for inappetence and depression of 3 days duration. On physical exam, the cat is febrile with a temperature of 103.2F (39.6 C) and is 5% dehydrated. The cat appears icteric.
Complete blood count shows:
Hematocrit - 36% (30-45%)
White blood cell count- 23,678/ul (5,500-19,500/ul)
Neutrophils- 20,678/ul (2,500-12,500/ul)
Lymphocytes- 2,300/ul (1,500-7,000/ul)
Monocytes- 300/ul (0-900/ul)
Eosinophils- 400/ul (0-800/ul)
Platelets- 180,000/ul (300,000-800,000/ul)
Serum chemistry shows:
Creatinine- 1.2 mg/dl (0.9-2.2 mg/dl)
Blood urea nitrogen (BUN)- 24 mg/dl (19-34 mg/dl)
Glucose- 77 mg/dl (60-120 mg/dl)
Albumin= 3.3 g/dl (2.8-3.9 g/dl)
Globulin= 2.5 g/dl (2.5-5.1 g/dl)
ALP- 305 IU/L (0-45 IU/L)
ALT- 449 IU/L (25-97 TU/L)
GGT- 22 IU/L (0-6 IU/L)
Total bilirubin - 4.5 mg/dl (0-0.1 mg/dl)
You perform an abdominal ultrasound and find that the liver appears enlarged. The echogenicity of the liver is normal. The wall of the common bile duct is hyperechoic and the duct is distended (6mm). You identify a cholelith that is causing complete obstruction of the common bile duct. The gall bladder is enlarged and the wall is thickened with a layered appearance.

Which of the following treatment plans is most appropriate for this cat?

• Supportive care and fluid therapy plus treatment with ampicillin, metronidazole, ursodeoxycholic acid
• Supportive care and fluid therapy plus treatment with neomycin and lactulose
• Supportive care and fluid therapy plus prompt placement of an esophagostomy tube and enteral feeding
• Supportive care and fluid therapy plus treatment with prednisolone, vitamin K1, and ursodeoxycholic acid
• Surgical decompression and biliary-to-intestinal diversion (cholecystoduodenostomy or cholecystojejunostomy) after stabilizing the patient with appropriate supportive care and fluid therapy

Answer 110

Answer: Surgical decompression and biliary-to-intestinal diversion (cholecystoduodenostomy or cholecystojejunostomy) after stabilizing the patient with appropriate supportive care and fluid therapy

Explanation
The case described is acute cholangiohepatitis secondary to complete biliary obstruction from a cholelith.

Surgical decompression is indicated when discrete choleliths are seen or complete biliary obstruction is identified. In this case, there are both.

If this had been a more typical case of cholangiohepatitis without choleliths or complete biliary obstruction, the treatment of choice would be supportive care and fluid therapy plus treatment with ampicillin, metronidazole, ursodeoxycholic acid.

Choleliths are relatively rare in dogs and cats compared to humans but are seen sporadically.

Question 111

A client comes to a veterinary clinic because their pet needs radiographs taken. The attending veterinarian orders the radiograph to be taken; a technician performs the radiographic procedure. A radiologist then reads the radiographs and the client pays for them. Whose property is the radiograph?

• The attending veterinarian
• The technician
• The radiologist
• The practice
• The client

Answer 111

Answer: The practice

Explanation
Radiographs are part of the patient’s medical record and belong to the practice where they were taken and must be kept for a specified period of time depending on state laws.

Question 112

While examining the blood smear from a horse, you detect multiple intracytoplasmic inclusion bodies inside the neutrophils that appear as aggregates of round dark purple dots. What do you suspect these indicate?

• Herpesvirus type 3
• Borrelia burgdorferi
• Neorickettsia risticii
• Anaplasma phagocytophilum

Answer 112

Answer: Anaplasma phagocytophilum

Explanation
The correct answer is Anaplasma phagocytophilum (previously known as Ehrlichia equi). Anaplasma phagocytophilum infection can cause morulae to be present in neutrophils and eosinophils. Neorickettsia ristici (Potomac horse fever) can cause morulae in monocytes but these are rarely seen on blood smears. Borrelia organisms are not seen in peripheral blood and herpes inclusion bodies are intranuclear and would not be seen in a blood smear.

Question 113

What should be told to owners of dogs that are infected with Echinococcus granulosus?

• The parasite causes hydatid cyst disease in humans, which can be fatal
• The parasite is highly pathogenic and causes hydatid cyst disease in dogs, but is not a zoonotic threat to humans
• The parasite is transmitted by the ingestion of fleas, so the dog should be treated for fleas
• The dog acquired the infection by ingesting a rat or bird

Answer 113

Answer: The parasite causes hydatid cyst disease in humans, which can be fatal

Explanation
The correct answer is the parasite causes hydatid cyst disease in humans, which can be fatal. Echinococcus granulosus is the hydatid tapeworm which is non-pathogenic in dogs but is highly pathogenic to fatal in humans and other intermediate hosts in which a hydatid cyst forms. The infection is acquired in dogs by eating raw sheep meat or viscera infected with the parasite. All dogs suspected of being infected should be treated with praziquantel.

More information about Cestodes can be found in the PowerPage called, “Selected Parasites of Small Animal Species: Cestodes.”

***PowerPage: Selected Parasites of Small Animal Species: Cestodes

Question 114

What is the most common bacterial cause of infectious pneumonia in sheep and goats?

• Mannheimia hemolytica
• Pasteurella pneumoniae
• Mycoplasma bovis
• Histophilus somni

Answer 114

Answer: Mannheimia hemolytica

Explanation
The correct answer is Mannheimia hemolytica, formerly called Pasteurella hemolytica. Mannheimia pneumonia is the most common infectious bacterial disease of sheep and goats. Most cases are caused by M. hemolytica type A. A variety of predisposing factors are suspected. Clinical signs include fever, depression, mucopurulent nasal discharge, coughing, pulmonary crackles and wheezes, and tachypnea. Necropsy lesions are fibrinopurulent pleuropneumonia.

Pasteurella multocida is also a cause of pneumonia in sheep and goats. P pneumoniae is a made up name.

Question 115

What is the most common cause of infectious abortion in sheep in North America?

• Coxiella
• Campylobacter
• Leptospira
• Bluetongue virus
• Brucella

Answer 115

Answer: Campylobacter

Explanation
Campylobacter infection (or vibriosis) is the most significant cause of abortion in sheep in North America. C jejuni is the most common and C. fetus is the other main cause of abortion.

Other common causes are Toxoplasma and Chlamydia psittaci.

Bluetongue is much less common. Brucella ovis rarely causes abortion in sheep although it does cause epididymitis. Sheep are not very susceptible to abortion from leptospirosis. Q fever, or Coxiella burnetii, is an uncommon cause of abortion and is more of concern due to zoonotic potential.

Question 116

A 6-month old male intact Weimaraner presents for the right forelimb swelling seen in the picture. He is also pyrexic at 104 F (40 C) and reluctant to walk. His litter-mate had the same clinical signs which resolved with a course of prednisone. What should you ask the owners to support the diagnosis you suspect?

• Does the dog have a travel history?
• Has the dog been in contact with snakes, spiders or other wildlife?
• Was the dog vaccinated recently?
• Is there a history of trauma?

Answer 116

Answer: Was the dog vaccinated recently?

Explanation
This puppy likely has hypertrophic osteodystrophy (HOD). Weimaraners are predisposed and litter-mates will commonly be affected. Although the exact cause is unknown, the leading hypothesis is recent vaccination leading to hyper-reactivity of the immune system. In a study of 53 Weimaraners with HOD, all had been vaccinated within the past 30 days.

Trauma resulting in a fracture or septic arthritis is untreatable with steroids. A snake or spider bite can cause a large amount of swelling but resolution with oral steroids alone may not be enough. Fungal disease can cause bony changes as well but if the litter-mate was affected by the same disease process, steroids should have worsened the disease.

Question 117

Several young sheep (3-4 months old) in a flock are showing signs of depression, head pressing, opisthotonos, diarrhea and blindness. As you investigate this problem, you realize that the farmer has been mistakenly feeding them horse feed. What disease do the sheep most likely have?

• Brain abscesses
• Polioencephalomalacia
• Listeriosis
• Hepatic encephalopathy

Answer 117

Answer: Polioencephalomalacia

Explanation
The correct answer is polioencephalomalacia (thiamine deficiency). This most commonly occurs in lambs being fed diets that are high in concentrates or molasses such as horse feed. This occurs because in normal lambs, ruminal bacteria produce sufficient thiamine to meet their requirements. Excess feeding of concentrates leads to ruminal acidosis, decreases the population of thiamine-producing bacteria, and increases production and activity of ruminal thiaminase. Other causes of polioencephalomalacia are bracken fern ingestion due to thiaminase in the plant, overdose of amprolium which is a thiamine analog, and high dietary sulfate.

Clinical signs include cortical blindness, head pressing, and incoordination progressing to recumbency, opisthotonos and convulsions. Treatment is with thiamine replacement. Diagnosis is usually based on clinical signs and necropsy findings, but blood thiamine levels and erythrocyte transketolase activity can be measured.

Classic necropsy lesions are a soft, edematous cerebral cortex with gray-yellow discoloration and flattened gyri.

***PowerPage: Top 10 Sheep and Goat Diseases

Question 118

Several young sheep (3-4 months old) in a flock are showing signs of depression, head pressing, opisthotonos, diarrhea and blindness. As you investigate this problem, you realize that the farmer has been mistakenly feeding them horse feed. What disease do the sheep most likely have?

• Brain abscesses
• Polioencephalomalacia
• Listeriosis
• Hepatic encephalopathy

Answer 118

Answer: Polioencephalomalacia

Explanation
The correct answer is polioencephalomalacia (thiamine deficiency). This most commonly occurs in lambs being fed diets that are high in concentrates or molasses such as horse feed. This occurs because in normal lambs, ruminal bacteria produce sufficient thiamine to meet their requirements. Excess feeding of concentrates leads to ruminal acidosis, decreases the population of thiamine-producing bacteria, and increases production and activity of ruminal thiaminase. Other causes of polioencephalomalacia are bracken fern ingestion due to thiaminase in the plant, overdose of amprolium which is a thiamine analog, and high dietary sulfate.

Clinical signs include cortical blindness, head pressing, and incoordination progressing to recumbency, opisthotonos and convulsions. Treatment is with thiamine replacement. Diagnosis is usually based on clinical signs and necropsy findings, but blood thiamine levels and erythrocyte transketolase activity can be measured.

Classic necropsy lesions are a soft, edematous cerebral cortex with gray-yellow discoloration and flattened gyri.

***PowerPage: Top 10 Sheep and Goat Diseases

Question 119

You are on a service trip in Africa to provide veterinary care to local horses. You examine a 4-year old horse with mucopurulent nasal discharge, lethargy, and depression. On physical exam, the horse has a temperature of 103.4F
(39.7 C) and has markedly enlarged mandibular lymph nodes. You are initially suspicious of Strangles but you should also be concerned about which exotic disease that can have a similar presentation?

• Glanders
• Dourine
• Rift Valley Fever
• Surra
• African Horse Sickness

Answer 119

Answer: Glabders

Explanation
The horse’s presentation is also consistent with the nasal form of glanders. Glanders is a bacterial disease caused by Burkholderia mallei (previously known as Pseudomonas mallei). It is thought to be endemic in regions of the Middle East, Asia, Africa, and South America. In addition to horses, glanders can be seen in donkeys, mules, and small ruminants.

Glanders is primarily a concern in horses because they can be chronic or occult carriers that intermittently shed this deadly and potential zoonotic pathogen.

Burkholderia mallei causes 3 different forms of disease; nasal glanders, pulmonary glanders, and cutaneous glanders (also referred to as Farcy).

The nasal form presents with high fever, loss of appetite and labored breathing with cough.
Viscous mucopurulent discharge or crusting may be present around the nares. There may be ulceration of the upper respiratory passages that resolve in the form of star-shaped cicatrices (“stellate scars”). Regional lymph nodes may be enlarged and indurated and may rupture or adhere to deeper tissues.

The pulmonary form often develops over several months, beginning as a fever with dyspnea and cough. Lung lesions commence as light colored nodules surrounded by hemorrhage or as diffuse pneumonia. The nodules may become caseous or calcified and discharge contents to the upper respiratory tract. Nodules may also be found in other organs.

The cutaneous form develops over several months, beginning with cough and dyspnea as well. Eventually, nodules develop in subcutaneous tissue along the course of the lymphatics of the legs, costal areas, and ventrum. They can rupture and excrete infectious purulent exudate. Infected lymphatics may form thickened cord-like lesions that sometimes coalesce into a string of beads appearance known as “farcy pipes”. Nodular lesions of other organs may also be found.

Burkholderia mallei can be identified in smears made from fresh lesions as mainly extracellular straight Gram-negative rods with rounded ends.
Several diagnostic tests exist including PCR, ELISA, and Western Blot but the two that you actually need to know about because they are used in international trade are complement fixation (CF) serology and the mallein test. The mallein test is considered the most reliable, sensitive, and specific test; it involves injection of mallein purified protein derivative intradermally into the lower eyelid. The test is read at 24 and 48 hours and a positive reaction is characterized by edematous swelling or purulent discharge.

Horses should not be treated; local authorities should be notified if a case is suspect and if disease is confirmed, horses must be humanely destroyed and affected carcasses should be burned and buried.

Dourine is a trypanosomal venereal disease. Surra is a trypanosomal disease causing primarily fever, weakness, and lethargy. Rift Valley Fever is a viral disease primarily of ruminants causing influenza-like signs and hepatic lesions. African Horse Sickness is a viral respiratory disease of horses but signs are primarily pulmonary whereas the horse in this case has nasal signs and mandibular lymph node enlargement.

Question 120

A client of yours calls you, concerned that she just found rice-like worms on the hind end of her 8 year-old, indoor-only cat. You think back fondly about how your professors told you not to describe lesions as food. You suspect tapeworms and recommend that the owner bring the cat in for an exam. What else are you expecting to find on physical exam?

• Ascites
• Fleas/flea dirt
• Cachexia
• Icterus
• Ear mites

Answer 120

Answer: Fleas/flea dirt

Explanation
Adult fleas contain the cysticercoid life stage of the common tapeworm Dipylidium caninum. As cats groom themselves, they ingest the adult flea; the tapeworm then develops into its adult form in the intestines. It is a common myth that cats won’t get fleas or intestinal parasites if they are indoors-only.

While these patients are at a decreased risk, they still can become infected/infested with the right exposure.

Question 121

A foal presents for colic caused by the organism shown in the image below (microscopic image from 40X, organism is approximately 100 um). By which of these mechanisms is colic occurring?

• Immune mediated hypersensitivity
• Enterolith formation
• Intestinal impaction
• Larval migration
• Thrombosis of the mesenteric artery

Answer 121

Answer: Intestinal impaction

Explanation
This is an image of a Parascaris equorum egg. It is almost spherical in shape with a brown color and contains a single-celled zygote.

In foals, a significant ascarid burden with Parascaris equorum can lead to intestinal impaction and associated colic. Thrombosis of the mesenteric artery occurs with Strongylus vulgaris infestations.

Immune mediated hypersensitivities may occur in adult horses with Parascaris equorum infestations but is unlikely to be a significant cause of the morbidity seen in foals. Larval migration can occur with Parascaris equorum but typically will affect the lungs or liver and this stage of the parasite does not lead to colic. Enteroliths are not caused by gastrointestinal parasitism.

Question 122

A foal presents for colic caused by the organism shown in the image below (microscopic image from 40X, organism is approximately 100 um). By which of these mechanisms is colic occurring?

• Immune mediated hypersensitivity
• Enterolith formation
• Intestinal impaction
• Larval migration
• Thrombosis of the mesenteric artery

Answer 122

Answer: Intestinal impaction

Explanation
This is an image of a Parascaris equorum egg. It is almost spherical in shape with a brown color and contains a single-celled zygote.

In foals, a significant ascarid burden with Parascaris equorum can lead to intestinal impaction and associated colic. Thrombosis of the mesenteric artery occurs with Strongylus vulgaris infestations.

Immune mediated hypersensitivities may occur in adult horses with Parascaris equorum infestations but is unlikely to be a significant cause of the morbidity seen in foals. Larval migration can occur with Parascaris equorum but typically will affect the lungs or liver and this stage of the parasite does not lead to colic. Enteroliths are not caused by gastrointestinal parasitism.

Question 123

The goose shown in the image below was found weak on the shore of a local pond where oil had been dumped. The goose was covered in oil, dehydrated and weak but responsive. Which of the following is an important acute clinical effect of oil on affected birds?

• Disruption of function of the plumage
• Lead toxicity
• Nephrotoxicity
• Contact dermatitis
• Hepatotoxicity

Answer 123

Answer: Disruption of function of the plumage

Explanation
Feathers serve a critical waterproofing and insulatory function which is disrupted by oil and can rapidly result in hypothermia. Other concerns for oiled birds include Gl irritation from ingestion of oil during preening, hemolytic anemia, and pneumonia due to inhalation of oil.
Treatments include heat, supportive care, and activated charcoal. Once stabilized, frequent high pressure, warm, mild detergent baths and clean warm water rinses until water beads freely off of the feathers is important. Birds should be placed in warm air flow until dry and they should be maintained on self-skimming ponds for several days after washing to ensure full waterproofing.

Question 124

About 10-15% of the chickens in a large commercial flock have begun showing signs of wing or leg paralysis and weight loss. Some affected birds have a gray iris or irregular pupils. Which of the following management/prevention strategies is thought to be a cost-effective method to control this disease?

• Addition of fenbendazole to water
• Addition of lincomycin to water or bacitracin
  to feed
• In-ovo vaccination
• Improved insect/arthropod control
• Addition of copper-sulfate to water

Answer 124

Answer: In-ovo vaccination

Explanation
The disease described in this question is most consistent with Marek’s disease. Marek’s disease is a herpesvirus that causes neurologic signs, cutaneous signs, or visceral tumors.

Key signs that should make you think of Marek’s disease are:
1) Thickened nerves (vagus, brachial, and sciatic)
2) Paralysis of legs, wing, and/or neck
3) Gray iris or irregular pupils
4) Raised, rough skin around feather follicles
5) Gray foci of neoplastic tissue in liver, spleen, kidney, lungs, heart, and muscle

Diagnosis is usually based on some combination of these findings. The disease is extremely widespread and infectious in flocks worldwide and there is no effective treatment.

Vaccination is the key to the prevention and control of Marek’s disease. Additionally, improved hygiene and/or an all-in/all-out production strategy can be helpful. There are many different specific types of vaccines (against different serotypes/strains) available but it is unlikely that you would be asked about those details on a board exam. Vaccination strategies and management of young animals is important though because there is a window of weeks before vaccines administered at hatching can provide protective immunity. In-ovo vaccination is now used in commercial broiler chickens because it can be performed via automated machines with precision and reduces labor costs.

Question 125

About 10-15% of the chickens in a large commercial flock have begun showing signs of wing or leg paralysis and weight loss. Some affected birds have a gray iris or irregular pupils. Which of the following management/prevention strategies is thought to be a cost-effective method to control this disease?

• Addition of fenbendazole to water
• Addition of lincomycin to water or bacitracin
  to feed
• In-ovo vaccination
• Improved insect/arthropod control
• Addition of copper-sulfate to water

Answer 125

Answer: In-ovo vaccination

Explanation
The disease described in this question is most consistent with Marek’s disease. Marek’s disease is a herpesvirus that causes neurologic signs, cutaneous signs, or visceral tumors.

Key signs that should make you think of Marek’s disease are:
1) Thickened nerves (vagus, brachial, and sciatic)
2) Paralysis of legs, wing, and/or neck
3) Gray iris or irregular pupils
4) Raised, rough skin around feather follicles
5) Gray foci of neoplastic tissue in liver, spleen, kidney, lungs, heart, and muscle

Diagnosis is usually based on some combination of these findings. The disease is extremely widespread and infectious in flocks worldwide and there is no effective treatment.

Vaccination is the key to the prevention and control of Marek’s disease. Additionally, improved hygiene and/or an all-in/all-out production strategy can be helpful. There are many different specific types of vaccines (against different serotypes/strains) available but it is unlikely that you would be asked about those details on a board exam. Vaccination strategies and management of young animals is important though because there is a window of weeks before vaccines administered at hatching can provide protective immunity. In-ovo vaccination is now used in commercial broiler chickens because it can be performed via automated machines with precision and reduces labor costs.

Question 126

A 10 year-old male intact Golden retriever presents to your hospital for sudden onset lethargy and decreased appetite. He has had no vomiting or diarrhea and the owners do not think he has gotten in to anything unusual. However, they do think he might sometimes deal with constipation, as they will often see him straining to defecate. On physical exam he is mildly dehydrated, with a fever and a soft non-painful abdomen. You are concerned and want to talk to your co-workers about the case. Before you go to talk to them, you remember the words of your internship mentor to never come talk to him about a case unless you have done both retinal and rectal exams on your patient. The retinal exam is normal, but you palpate an enlarged and irregular prostate, which seems to make your patient uncomfortable. Excitedly you realize you don’t need to ask your colleagues for help as you now have a plan of your own. You send off a urine sample for culture. Which antibiotic do you reach for in the meantime?

• Cefpodoxime
• Metronidazole
• Enroftoxacin
• Amoxicillin
• Cephalexin

Answer 126

Answer: Enrofloxacin

Explanation
You should be suspicious for prostatitis in this patient. Your antibiotic choice should be based on culture and sensitivity results, but because your patient is sick you will want to start an antibiotic that has good penetration of the prostate until the culture results are back. Chloramphenicol, erythromycin, trimethoprim and fluoroquinolones are able to pass the blood-prostate barrier.

Cephalexin and cefpodoxime are cephalosporins and may be effective if the blood-prostate barrier is disrupted, but they would not be the first choice.

Question 127

A 5-year-old Collie presents for erosive/ulcerative dermatitis of the nasal planum. The lesion is well-demarcated and confined to the nasal planum and philtrum. There is a loss of cobblestone appearance and hypopigmentation. Which of the following is top differential that would result in the above clinical signs?

• Zinc deficiency
• Folliculitis
• Dermatophytosis
• Discoid lupus erythematosus

Answer 127

Answer: Discoid lupus erythematosus

Explanation
Discoid lupus (along with Pemphigus foliaceus) are autoimmune conditions that can result in ulcerative nasal dermatitis and loss of cobblestone appearance.

Dermatophytosis (ringworm) often affects the muzzle. However, it rarely affects the nasal planum, because dermatophytes live in hair follicles and there are no hair follicles on the nasal planum. (This is also why it would not be folliculitis). Zinc-responsive dermatosis typically causes scaling and crusting but not usually erosions or ulcers.

The next step for this dog would be to biopsy.

Question 128

A 5 year old Rottweiler comes into your clinic after being kicked by a horse this morning. Physical exam is unremarkable except for a skin wound along the chest. You take thoracic radiographs and note three 1-2 cm regions of localized consolidation. What should you tell the client?

• These are most likely pulmonary contusions, they constitute a medical emergency and your dog needs surgery
• These are most likely pulmonary contusions, since your dog is not showing respiratory signs, they are not a problem
• These are most likely pulmonary contusions; your dog needs to be carefully monitored for the next day as they may worsen and lead to breathing problems
• These are most likely pulmonary contusions, we should recheck X-rays in 10 days to see if they are progressing or regressing

Answer 128

Answer: These are most likely pulmonary contusions; your dog needs to be carefully monitored for the next day as they may worsen and lead to breathing problems

Explanation
The correct answer is these are most likely pulmonary contusions; your dog needs to be carefully monitored for the next day as they may worsen and lead to breathing problems. Pulmonary contusions can cause respiratory deterioration in the apparently stable patient for up to 24 hours after trauma. They usually then improve over the next 24-48 hours. In this case, careful monitoring is probably indicated for 24 hours followed by recheck radiographs. These are indicated to detect possible abscesses, early pneumonia, cysts, or other related injuries.

Question 129

A rancher has just found a big 2 month-old calf dead in the field and asks you to perform a post-mortem to determine the cause of death. He is worried about a contagious disease in his herd. You find the lungs are edematous and there is mild bronchopneumonia, but this lesion (see image) is found in the heart. Which diagnosis best fits?

• Tetralogy of Fallot
• Bacterial endocarditis
• Ventricular septal defect
• Pulmonary stenosis
• Patent ductus arteriosus

Answer 129

Answer: Ventricular septal defect

Explanation
Congenital ventricular septal defect is one of the most commonly encountered congenital cardiac defects in cattle. It may be a relatively benign of cause death, depending on size. If the rancher sees several calves with this defect, he should discontinue using the bull responsible.

Question 130

A horse presents for further evaluation as a result of a progressive onset of strange behavior, according to the owner. On physical exam, the horse is noted to have a jerky and awkward motion when trying to initiate movement. The horse is noted have an exaggerated arc and flight of the limbs when stepping over a curb. Where is the lesion most likely to be?

• Midbrain
• Cerebrum
• Cerebellum
• Pons
• Medulla

Answer 130

Answer: Cerebellum

Explanation
The correct answer is cerebellum. The cerebellum is responsible for the coordination and regulation of range, rate, and strength of movement along with balance and posture. Clinical signs associated with cerebellar disease include intention tremors, hypermetria, hypometria, and ataxia. Mentation will be normal if the disease is strictly confined to the cerebellum.

Question 131

Which of the following is a causative agent of infectious bovine keratoconjunctivitis as shown in this image?

• Thelazia
• E. coli
• Histophilus somni
• Moraxella bovis

Answer 131

Answer: Moraxella bovis

Explanation
The correct answer is Moraxella bovis. Thelazia is the eye worm. Histophilus somni is a cause of many syndromes, but is rarely found in the eye. E. coli is not an ocular pathogen.

***PowerPage: Infectious Bovine Keratoconjunctivitis (Pinkeye)

Question 132

The animal welfare concerns for indoor cats do not include:

• Potential for the development of obesity and other lifestyle diseases
• Potential for owner surrender due to inappropriate behaviors
• Loss of the ability to express natural behaviors such as hunting
• Potential for the development of boredom due to a barren environment
• Concern about the number of animals lost when cats hunt

Answer 132

Answer: Concern about the number of animals lost when cats hunt

Explanation
The impact on other animals is not a consideration for welfare as it relates to indoor cats.

Question 133

There are several procedures that are typically performed while correcting medial patellar luxation in dogs. Which one of the following is not performed while repairing a medially luxating patella?

• Block recession of the trochlear groove
• Medial release of the soft tissues
• Medial transposition of the tibial tuberosity
• Lateral imbrication of the retinaculum

Answer 133

Answer: Medial transposition of the tibial tuberosity

Explanation
The correct answer is medial transposition of the tibial tuberosity. If you have a medially luxating patella, you need to transpose the tibial tuberosity laterally in order to line up the patellar tendon with the rest of the stifle in an effort to reduce the likelihood of patellar luxation. The two most important procedures that reduce the incidence of recurrence are lateral transposition of the tibial tuberosity and modifying the trochlear groove of the femur.

***PowerLecture: Patellar Luxation

Question 134

Which correctly describes the innervation of the iris sphincter muscle in mammals?

• Innervated by sympathetic nervous system by cranial nerve Ill
• Innervated by parasympathetic nervous system by cranial nerve V
• Innervated by sympathetic nervous system by cranial nerve V
• Innervated by parasympathetic nervous system by cranial nerve Ill

Answer 134

Answer: Innervated by parasympathetic nervous system by cranial nerve Ill

Explanation
The correct answer is that it is innervated by parasympathetic nervous system by cranial nerve Ill. The iris sphincter is stronger than the iris dilator. It receives parasympathetic innervation by cranial nerve Ill. It is comprised of smooth muscle in mammals, unlike birds, where it is striated. The innervation makes sense if you consider that when your sympathetic nervous system is activated, your eyes become dilated; that leaves the parasympathetic nervous system to constrict the pupil, which is the responsibility of the sphincter.

***PowerPage: Cranial Nerve Examination and Diseases

Question 135

A 6-year old male neutered domestic short hair cat presents with the chin lesion shown in the photo (see image). The lesion is unilateral and nodular with ulceration. What is the most accurate description of this lesion?

• Miliary dermatitis
• Eosinophilic plaque
• Collagenolytic granuloma
• Eosinophilic ulcer

Answer 135

Answer: Collagenolytic granuloma

Explanation
The image and description are most consistent with a collagenolytic granuloma. Feline eosinophilic granuloma complex consists of 3 separate clinical syndromes:

1) The collagenolytic granuloma (also known as eosinophilic granuloma or linear granuloma) usually occurs on the nose, chin (as in this case), oral cavity, or caudal thighs. The lesions are typically raised and ulcerative or nodular as seen here.

2) The eosinophilic plaque occurs most frequently on the abdomen and medial thighs but can appear other places. They appear as single or multiple, raised, red, often ulcerated lesions of varying size (0.5-7 cm). They frequently have a cobblestone appearance and unlike eosinophilic ulcers, these are often pruritic. This condition is histopathologically similar to miliary dermatitis and is usually associated with underlying allergy.

3) The eosinophilic ulcer (also known as indolent ulcer) typically occurs on the upper lip and may be unilateral or bilateral. They often have a characteristic central area of yellow to pink tissue with a slightly raised circumferential edge

The underlying cause of eosinophilic ulcers and collagenolytic granulomas are unknown, although an underlying allergic cause such as arthropod bites and/or cutaneous hypersensitivity have been suggested.

Treatment of collagenolytic granulomas is also controversial so it is unlikely that you would be asked about treatment of this disorder on a board exam aside from knowing that you should attempt to identify and remove/treat underlying allergy or biting arthropod problems. Some cases respond to antibiotic therapy but most require glucocorticoid therapy.

Question 136

A 3-month old dog presents for acute lameness, and you diagnose a fracture based on the radiograph below. You contact a surgeon to repair the fracture and explain to him that the dog has what type of fracture?

• Type Ill Salter-Harris fracture of the distal femur
• Long oblique femoral fracture
• Type V Salter-Harris fracture of the distal femur
• Type I Salter-Haris fracture of the distal femur l
• Type IV Salter-Harris fracture of the distal femur

Answer 136

Answer: Type I Salter-Haris fracture of the distal femur l

Explanation
Physeal fractures are commonly described in Salter-Harris nomenclature. In this system, a type I is a fracture through the physis, a type Il is fracture partway through the physis extending up into the metaphysis, a type Ill is a fracture partway through the physis extending down into the epiphysis, a type IV is a fracture through the metaphysis, physis, and epiphysis, and a type V is a crush injury to the physis

Question 137

You diagnose gapeworm (Syngamus trachea) infection in a backyard chicken flock and discuss control measures with the flock owner. A common paratenic (transport host) in the Syngamus life cycle is:

• Deer tick
• Earthworm
• Cat
• Mouse
• Wild birds

Answer 137

Answer: Earthworm

Explanation
Earthworms, slugs, and snails can serve as paratenic hosts, eventually being eaten by the chicken to transmit the infection.

The gapeworm resides in the trachea and lungs of various birds (domestic or wild). Infection can happen directly by ingestion of infective eggs or larvae. Normally, significant field infection is due to ingestion of the transport host, which can include earthworms, snails, and arthropods.

Question 138

A 3-year old Jersey dairy cow presents 8 days after parturition with decreased milk production, anorexia, teeth grinding, episcleral injection, and colicky behavior. On physical exam, you observe distention of the right flank, a wide region of right sided monotone pinging from the 9th rib to behind the 13th rib and extending down in a line from the hip to the elbow at the 9th rib, and no rumen contractions. On rectal exam, you note normal-appearing feces and a large turgid structure palpable to the right of midline and as far forward as you can reach. The cow is negative for xiphoid pain. Temperature is 103.3F (39.6 C) degrees, HR=98, and respiration is 44. What is the most likely diagnosis?

• Abomasal torsion
• Intussusception
• Gas in the spiral colon
• Cecal displacement or volvulus

Answer 138

Answer: Abomasal torsion

Explanation
The correct answer is abomasal torsion. The clinical signs described are classic for an abomasal torsion. These are much less common than left or right displaced abomasum. However, the risk factors for developing abomasal torsion appear to be the same. This finding is a surgical emergency and must be corrected before cows go into shock. Another factor is that many times you may be able to palpate abomasal torsion rectally, but not always (esp difficult in large Holstein cows).

Cecal displacement and cecal volvulus can be ruled out because you would likely be able to palpate these disease processes via rectal examination as a soft loaf of bread that you can get all the way around. The ping is usually high in the right flank and does not extend to the 9th rib on a line from hip to elbow. Animals with intussusception are very colicky and have scant dark red feces. The intussusception can be found sometimes by rectal palpation as a firm painful mass. Gas in the spiral colon is a frequent finding in any sick cow with poor GI motility and is not a primary disease problem. It is diagnosed by finding an 8-inch circular ping high on the last rib or just behind it.

Question 139

A 7-year old female spayed Golden Retriever that you suspect has Addison’s disease has bloody diarrhea, inappetance, and is dehydrated. What should be your next step?

• Start aggressive IV fluid therapy and run a chemistry panel
• Run a chemistry panel and perform an abdominal ultrasound.
• Give IV dexamethasone and subcutaneous fluids
• Give Lysodren

Answer 139

Answer: Start aggressive IV fluid therapy and run a chemistry panel

Explanation
The correct answer is start aggressive IV fluid therapy and run a chemistry panel.
Addisonian patients often present in hypovolemic shock, so the first step to treating this dog is to restore vascular volume with IV fluids and to run a chemistry panel to check the extent of electrolyte abnormalities (hyponatremia, hyperkalemia, and elevated BUN). IV dexamethasone would not take precedence over restoring vascular volume, and subcutaneous fluid treatment is not aggressive enough for treatment of hypovolemia.

Abdominal ultrasound would not be a priority in this case but could eventually be helpful in ruling in/out other differentials.

Lysodren is used for treating hyperadrenocorticism. One possible complication of Lysodren treatment is to make a dog Addisonian, which often causes the animal to present with the signs described as in the question.

Question 140

A 4-year-old spayed female German Shepherd is seen for aggressive chewing and licking at her back legs. After the matted coat is shaved and removed you see the lesions affecting her skin, most severe on her left leg (see image). You diagnose a deep pyoderma. She is started on a limited ingredient diet, chlorhexidine shampoo, and you need to send oral antibiotics. Which of the following treatments would be appropriate?

• Amoxicillin for 4 weeks
• Trimethoprim-sulfa for 8 weeks
• Clindamycin for 4 weeks
• Cephalexin for 8 weeks

Answer 140

Answer: Cephalexin for 8 weeks

Explanation
Deep pyodermas involve tissues deeper than the epidermis, including the dermis and even subcutis. The skin may heal on the surface before the deeper infection is resolved; making clinical cure difficult to assess. In general, deep infections can require 6-8 weeks of antibiotic treatment (and even 12 weeks for severe cases) for resolution.

Deep pyoderma can be secondary to allergies, skin fold anomalies, endocrine disorders, immune mediated skin diseases, bacterial and/or fungal skin infections, or migrating foreign bodies. Determining the underlying etiology will help with resolution and minimize chances of treatment failure and re-occurrence.
Diagnostics should include skin scraping and impressions, culturing for bacteria and fungi, biopsy, and blood work. Treatments typically include antimicrobials that have demonstrated effectiveness, antifungals if needed, and frequent topical treatments with chlorhexidine shampoo and removal of the dead tissue and debris.

Incidentally, the German Shepherds are predisposed to severe deep pyodermas that can be difficult to treat.
Discussing this with your client will help give them realistic expectations for treatment. German Shepherds are at a higher risk of developing dry eye from Trimethoprim-sulfa; therefore, it is not recommended for this condition due to the length of time required to treat a deep pyoderma.

Question 141

Several cows on a farm have developed large very hard masses along the jaw and you have diagnosed Actinomycosis. What management change would you recommend?

• Supplement iodine in the feed
• Initiate insect control measures
• Remove scabrous feeds
• Euthanize all affected cows

Answer 141

Answer: Remove scabrous feeds

Explanation
The bacteria causing lumpy jaw (Actinomyces bovis) is a normal inhabitant of the cow’s oral cavity or rumen and causes disease when it is able to invade into damaged mucosa, most frequently caused by scabrous or prickly feed.

Question 142

When does neonatal isoerythrolysis occur in horses?

• 1-4 week old foals
• 1-4 month old foals
• 0 In utero
• 0-4 day old foals

Answer 142

Answer: 0-4 day old foals

Explanation
The correct answer is 0-4 day old foals. In utero, the foal is protected from the mare’s antibodies due to epitheliochorial placentation (in humans, this condition occurs in utero). The foal takes in colostrum during its first 24 hours of life from the mare and develops the condition fairly acutely. Remember NI develops because the newborn foal expresses alloantigens on its red blood cells inherited from the sire that the mare does not have. If the mare becomes sensitized to the sire’s specific antigen, maternal antibodies are produced and absorbed by the foal soon after birth. This subsequently results in lysis of the red blood cells. Pre-parturient blood testing between the mare and stallion may help in identifying the likelihood of this occurring.

***PowerPage: Neonatal soerythrolysis

Question 143

Extension of an infection from the respiratory tract to the middle ear can occur when an infectious agent travels through the___________

• Canal of Schlemm
• Eustachian tube
• Mandibular foramen
• Semicircular canal
• Cavernous sinus

Answer 143

Answer: Eustachian tube

Explanation
The correct answer is eustachian tube. This tube connects the pharynx and the inner ear. The semicircular canals are part of the inner ear. The canal of Schlemm is in the eye. The mandibular foramen is in the mandible, as the name implies. The cavernous sinus is a portion of the skull where the cranial nerves heading toward the eyes travel.

Question 144

This 3-year old female Budgerigar presents on emergency for a 3-day history of being fluffed at the bottom of the cage with a decreased appetite. The owners noticed red tissue protruding from the vent today. Her diet is seed only with a cuttle bone, and she is housed with a male. She has no previous medical history, but did lay a clutch of eggs last year. They appeared normal to the owner. What is a common predisposing factor for this condition in seed-eating birds?

• Calcium excess
• Vitamin A deficiency
• Hypercholesterolemia
• Calcium deficiency

Answer 144

Answer: Calcium deficiency

Explanation
With seeds as a primary diet, many reproductively active females do not maintain adequate calcium levels to be able to lay eggs normally. This leads to weakened contractions of the reproductive tract and an inability to pass eggs through the oviduct. Initial therapy should consist of fluid support and calcium prior to attempt to reduce the prolapse.

While vitamin A deficiency is often present in seed-eating birds, the clinical syndromes associated with this are more commonly squamous metaplasia affecting the oral mucosa, respiratory and renal systems.
Hypercholesterolemia is often associated with seed-diets, but does not generally result in egg-binding or prolapse, as reproductively active birds will normally have elevated levels of cholesterol for egg production.
Excessive amounts of oral calcium are generally not absorbed by the gastrointestinal tract and are excreted, making it difficult to over-supplement with oral calcium.

Question 145

Which of these options is true regarding worker’s compensation insurance?

• It is legally required for veterinary practices to have it for full and part time employees
• It pays employees a portion of their salary if they are laid off or fired
• The cost can be deducted from the employee’s paycheck
• It covers injuries that occur on and off the job

Answer 145

Answer: It is legally required for veterinary practices to have it for full and part time employees

Explanation
Worker’s compensation insurance covers injuries sustained on the job. It is required in all states and is paid for by the practice.