BCSE FC’s Flashcards

Question

Which choice correctly lists the order in which gases pass through a typical circular (closed) anesthetic circuit? Reducing valve, flowmeter, vaporizer, patient, COz canister Vaporizer, reducing valve, flowmeter, CO2 canister, patient Reducing valve, vaporizer, patient, CO2 canister, flowmeter Flowmeter, reducing valve, vaporizer, patient, COz canister

Answer 1

Answer: Reducing valve, flow meter, vaporizer, patient, CO2 canister Gases flow through a circular/closed anesthetic circuit in the order: Reducing valve, flowmeter, vaporizer, patient, CO2 canister. Carrier gas exits the high pressure tank through the pressure reducing valve, which maintains a steady gas pressure regardless of the pressure of the tank. It then flows through the flowmeter, which controls the amount of carrier gas delivered to the patient, then the vaporizer, where anesthetic vapor is produced from the liquid. Anesthetic vapor carried by the carrier gas exits the vaporizer and flows into the breathing circuit for inhalation. Exhaled gases pass through a CO2 absorbent canister and are then rebreathed in a circle system, or are eliminated in a non-rebreathing system. STRATEGY HINT: This is an ORDER question. If you already know that the CO2 canister is LAST in the order, you can narrow your choices down to two, right away. When you see ordering questions, look for things you are pretty sure must go FIRST or LAST, and then work from those choices to fill in between.

Answer 2

Answer: Reducing valve, flow meter, vaporizer, patient, CO2 canister Gases flow through a circular/closed anesthetic circuit in the order: Reducing valve, flowmeter, vaporizer, patient, CO2 canister. Carrier gas exits the high pressure tank through the pressure reducing valve, which maintains a steady gas pressure regardless of the pressure of the tank. It then flows through the flowmeter, which controls the amount of carrier gas delivered to the patient, then the vaporizer, where anesthetic vapor is produced from the liquid. Anesthetic vapor carried by the carrier gas exits the vaporizer and flows into the breathing circuit for inhalation. Exhaled gases pass through a CO2 absorbent canister and are then rebreathed in a circle system, or are eliminated in a non-rebreathing system. STRATEGY HINT: This is an ORDER question. If you already know that the CO2 canister is LAST in the order, you can narrow your choices down to two, right away. When you see ordering questions, look for things you are pretty sure must go FIRST or LAST, and then work from those choices to fill in between.

Answer 3

Answer: Read the tag or label. The best way to evaluate the contents of a compressed gas tank is to read the tag or label. Relying on tank color can lead to catastrophic accidents if the contents are different than the tank color. Most gasses are available in various sizes of tanks and the colors can vary by country and/or may become worn off with repeated refills. It is never a good idea to sniff a compressed gas. The pressure gauge will vary with how full the tank is.

Answer 4

Answer: Guaifenisin Guaifenesin is an anti-tussive (anti-cough) and decongestant medication that also works as a muscle relaxant. Guaifenesin is often used to provide a smooth anesthetic induction and maintenance in horses. FYl - in horses, butorphanol (Torbugesic®) is a commonly used opiate with analgesic (anti-pain) and anti-tussive properties. Diphenhydramine is just another name for the antihistamine decongestant Benadryl®, used to treat anaphylaxis (immediate whole-body allergic reaction) in horses and allergies in many species. Dextromethorphan is a cough suppressant, but it is not used to induce anesthesia. Acepromazine is a sedative, but not a cough suppressant. Pheny|propanolamine is a decongestant used to increase urethral tone in cases of urinary incontinence in dogs.

Answer 5

Answer: Decreases salivation. Use anti-cholinergics (e.g., atropine, glycopyrrolate) as pre-medicants prior to anesthetic induction with ketamine to decrease salivation and airway secretions, and increase heart rate. Anti-cholinergics do not affect eye opening but they do cause pupil dilation. Remember that many anesthetic drugs (e.g., opiates, inhalant anesthetics) promote bradycardia (slowed heart rate) and may also decrease respirations.

Answer 6

Answer: IV Alfaxalone is a U.S. Drug Enforcement Agency (DEA) schedule IV controlled substance. Alfaxalone is a neuroactive steroid used in cats and dogs for the induction and maintenance of general anesthesia. It may be administered IV or IM and, similar to propofol, it does not provide any analgesia. The DEA schedules drugs into one of five categories based on their accepted medical use and the abuse/dependence potential. Schedule I drugs have a high risk for abuse and are the most restricted. Schedule V drugs have the least potential for abuse.

Answer 7

Answer: Opioids Use opioids to treat acute pain in many animals, including dogs and cats. Mu receptor opioid agonists (morphine, oxymorphone, hydromorphone, etc) are the most potent and effective, especially for short-term therapy. Long-term use is limited by side effects such as sedation, dysphoria, and constipation, along with a lack of oral alternatives. Kappa receptor agonists, such as butorphanol, have fewer adverse side effects but analgesia is weaker and for a shorter duration. Alpha-2 agonists are good analgesics, but they cause sedation and have significant adverse cardiovascular effects. Benzodiazepines do not provide analgesia when used alone. The negative endocrine and immune effects of corticosteroids limit their use for pain. Non-steroidal anti-inflammatories are good for mild/moderate acute/chronic pain with close monitoring of renal and gastrointestinal function.

Answer 8

Answer: Tracheal necrosis Overinflation of an endotracheal tube cuff can cause tracheal necrosis due to pressure of the cuff on the mucosal lining of the trachea. Risk increases the longer the tube is in place. Overinflation also increases incidence of tracheal tear if the tube is manipulated in this state. Respiratory distress would be expected secondary to tracheal necrosis/tearing. As the airway itself is patent and protected while the tube is in place, blood gas levels and anesthesia delivery should not be affected by cuff overinflation. Kelli Johnsen CVT, VTS (ECC) provides information on preventing tracheal trauma secondary to endotracheal intubation.

Answer 9

Answer: 2nd degree AV block This is 2nd degree atrioventricular (AV)_block. 2nd degree AV block is more common in horses at rest, when the heart rate is low, as it is associated with increased vagal (parasympathetic) tone. When sympathetic tone increases, as with exercise, excitement, pain, etc., the heart rate increases and AV block disappears. 2nd degree AV block can be diagnosed without an ECG. The rhythm is regularly irregular, the pause is equal to 2X the normal interval between contractions, the 4th heart sound (S4) is audible during the pause, and the irregularity disappears when the HR increases. Click this link to see this ECG with legend. Check out this Joint ACVIM/ECEIM Consensus Statement on Recommendations for Management of Equine Athletes with Cardiovascular Abnormalities. Refs: Wilson Clin Vet Advisor: The Horse, pp 55-8, Bassert, Beal and Samples, McCurnin's Clinical Textbook for Veterinary Technicians, 9th ed. pp. 867-68 and Anesthesia & Analgesia for Vet Techs, 4th ed. pp. 20-1, 147-9.

Answer 10

Answer: From the point of the nose to the xiphoid. The tube for gastric decompression should be the same as the length from the point of the nose to the xiphoid. Measure the tube and mark it with tape. A tube too long can cause damage and too short will be ineffective. Gastric decompression is typically performed under sedation at the same time as IV fluid resuscitation in dogs with gastric dilation/volvulus (GDV) prior to surgical correction via midline laparotomy. After placing a mouth gag, pass the tube through the mouth and into the esophagus. Keep the head slightly ventroflexed to facilitate passage into the esophagus instead of the trachea. Confirm proper passage in the esophagus via at least one of these methods: palpate two firm tubes in the neck, patient is not coughing, see the tube in the neck, have an assistant blow a small amount of air into the tube while ausculting it in the stomach with a stethoscope, or negative pressure when light suction is applied to the end of the tube. Caution must be used to avoid perforating the esophagus, as it can be difficult to get through the potentially twisted cardiac sphincter into the stomach. If passage of the tube is unsuccessful, it may be necessary to use percutaneous needle gastric decompression. GDV is an acute enlargement and rotation of the stomach, mostly seen in large- and giant-breed dogs. The enlarged stomach compresses the caudal vena cava, leading to hypovolemia; pushes on the diaphragm, causing respiratory dysfunction; and puts pressure on Gl contents, leading to bacterial translocation and endotoxemia. Even with immediate medical and surgical therapy, the mortality rate is 20â45%.

Answer 11

Answer: Perform a repeat ELISA test in 3 months A positive ELISA for feline immunodeficiency virus (FIV) in a kitten <6 months of age means the cat has antibodies to FIV; repeat an FIV ELISA when the cat is >6 months because maternal antibodies (Ab) have waned by this age. If the cat is still positive, and not vaccinated, consider a confirmatory test such as a Western blot. An ELISA cannot distinguish between a natural FIV infection, circulating maternal antibody, or vaccination-related antibodies, so false positives may occur. Unfortunately, there is no commercially available test to distinguish between vaccine-induced and infection-induced Ab. After vaccination, both Western blot and ELISA testing are falsely positive. https://www.merckvetmanual.com/immune-system/immunologic-diseases/secondary-immunodeficiencies-in-animals#Feline-Immunodeficiency-Virus_v3277196 Feline Immunodeficiency Virus in Animals Feline immunodeficiency virus (FIV) has been identified in domestic and wild felids. The infection is endemic in cats throughout the world. The virus is shed in the saliva, and biting is the principal mode of transmission. As a result, free-roaming, male, and aged cats are at the greatest risk of infection. A transient fever, lymphadenopathy, and neutropenia follow infection. Most cats initially recover and appear to be clinically normal for many months or years before progressive immunodeficiency leads to secondary infections and deaths. The virus targets lymphocytes, leading to a gradual loss of CD4+ helper T cells, which results in a loss of cell-mediatec immunity. Cats with acquired immunodeficiency induced by FIV then develop chronic secondary and opportunistic infections of the respiratory, Gl (including mouth), and urinary tracts, as well as the skin. FIV-infected cats have a higher than expected incidence of FeLV-negative lymphomas, usually of the B-cell type, and myeloproliferative disorders (neoplasia and dysplasias).

Answer 12

Answer: Unlikely to cause anemia. Feline Mycoplasma haemominutum is typically a subclinical infection, and it is unlikely to cause anemia. It is the most common hemotropic mycoplasma identified in cats; diagnose with PCR testing. Remember, in an anemic cat a positive PCR for M. haemominutum is unlikely to be the cause. Continue assessment for other causes of anemia (e.g., M. haemofelis infection, retroivral infection, Gl blood loss). Other mycoplasmas can cause acute disease. M. haemofelis is the most pathogenic of the feline hemotropic mycoplasmas and typically causes a regenerative, hemolytic anemia. Coinfection with M. haemominutum or M. turicensis is possible. Diagnose these with PCR. Doxycycline is effective at reducing bacteremia in cats w/ anemia due to mycoplasmal infection; however, no antimicrobial Tx eliminates the infection. Do not use antimicrobials in cats that are PCR positive without clinical signs of anemia. https://www.merckvetmanual.com/circulatory-system/blood-parasites/hemotropic-mycoplasma-infections-in-animals

Answer 13

Answer: Inhalation is hazardous to laboratory staff Do not perform culture of Histoplasma capsulatum because inhaling the fungus is hazardous to the laboratory staff. Mycelial growth of the organism occurs at room temperature, and any inhaled microconidia are infectious. The fungus produces yeast in body tissues, a form that is not transmissible between animals. While contamination of culture media with bacteria is of concern, labs have developed a variety of methods to reduce this occurrence. There is no PCR test available. Definitive diagnosis relies on cytology or histopathology to demonstrate organisms in tissue. Alternatively, you can submit urine, serum, or CSF for antigen testing with a quantitative ELISA. There is risk of cross-reactivity of the fungal ELISA test with other fungal antigens, most notably Blastomyces. https://www.merckvetmanual.com/generalized-conditions/fungal-infections/histoplasmosis-in-animals

Answer 14

Answer: Phagocytosis •The heterophil is the avian version of a neutrophil and one of its primary functions is phagocytosis. They are the first cell to respond to infectious/inflammatory disease and they are characterized by a multilobed nucleus and intracytoplasmic granules. Similar to other species, look for increased heterophil counts with infection/inflammation and stress. Heterophils in Pet Birds - Comprehensive Veterinary Information Definition: • Heterophils: Equivalent to mammalian neutrophils, primarily responsible for phagocytosis and bactericidal activity. Characteristics: • Structure: Contain lysosomal enzymes, visible granules. • Function: First responders to infection/inflammation, forming caseous material rather than liquid pus. Clinical Relevance: • Heterophilia: Indicates infection or stress response. • Heteropenia: Often associated with overwhelming infection or viral disease. Pathophysiology: • Infectious Response: Heterophils migrate to infection sites, ingest pathogens, and form granulomas with macrophages. Assessment: • Blood Smear: Identifies heterophil presence and morphology. • Complete Blood Count (CBC): Monitors heterophil levels in response to disease.

Answer 15

Answer: Pulmonary contusion Pulmonary contusions can cause a low venous PCO2 because these hypoxemic patients hyperventilate. Remember, CO2 is more diffusible than 02 so increased ventilation results in decreased PCO2 even if hypoxemia is the trigger. Other causes of hyperventilation include pain and anxiety. PCO2 also decreases as a compensatory mechanism with primary metabolic acidosis. Respiratory compensation for acute metabolic disturbances can happen within 15 minutes, but metabolic compensation for respiratory disturbances takes 24 hours. Always look at the pH first to determine if acidemia or alkalemia is present and then assess PCO2 and HCO3 to diagnose a primary respiratory vs. metabolic disturbance. Here is an excellent summary of acid-base disturbances from the Cornell University eClinPath website. https://www.merckvetmanual.com/emergency-medicine-and-critical-care/specific-diagnostics-and-therapy/trauma-in-emergency-medicine-in-small-animals?autoredirectid=20423 https://eclinpath.com/chemistry/acid-base/types-of-disturbances/ Pulmonary Contusions in Small Animals - Comprehensive Veterinary Information Definition: • Pulmonary Contusions: Bruising of the lung tissue caused by trauma, leading to alveolar hemorrhage and edema. Pathophysiology: • Injury Mechanism: Blunt trauma causes alveolar capillary damage, resulting in bleeding and fluid leakage into the alveoli. • Physiological Impact: Impairs gas exchange, leading to hypoxemia (low blood oxygen levels) and increased work of breathing. Clinical Signs: • Respiratory Distress: Labored breathing, crackles or rales on auscultation. • Hypoxemia: Low arterial oxygen levels, cyanosis. • Blood Gases: • Hypoxemia: PaO2 < 80 mmHg. • Hypercapnia: Elevated PaCO2 if ventilation is severely compromised. • Acidosis: Respiratory or mixed acidosis due to impaired gas exchange and tissue hypoxia. Assessment: • Diagnostic Imaging: Radiographs may show patchy infiltrates 12-24 hours post-injury. • Blood Gas Analysis: Identifies hypoxemia, hypercapnia, and acidosis. Treatment: • Oxygen Therapy: Supplemental oxygen to maintain adequate oxygenation. • Mechanical Ventilation: Positive-pressure ventilation for severe cases with significant respiratory compromise. • Fluid Management: Judicious use to avoid exacerbating pulmonary edema.

Answer 16

Answer: Inhibin This is a granulosa cell tumor (GCT). Serum inhibin levels are increased in ~90% of mares with GCTs and serum testosterone is elevated in 50-60% of affected mares. Ball et al showed that anti-Müllerian hormone is increased in 98% of affected mares. Progesterone is not typically elevated but is often measured. Dx: You may see classic behavior changes of aggressive, stallion-like behavior and prolonged estrous cycles or alternatively, anestrus. Look for characteristic findings on ovarian palpation/ultrasound per rectum, and bloodwork as discussed above. Ultrasound findings should not be confused with anovulatory hemorrhagic follicles. GCT are common slow growing tumors that do not typically spread. The affected ovary becomes large and firm and typically has a cystic, honey-combed appearance. The inhibin produced by the GCT makes the contralateral ovary small and inactive. Rx: Surgical removal (via laparoscopy; ventral midline or flank laparotomy; or transvaginally). The remaining ovary will cycle again normally but it may take 6-12 months. Refs: Brinsko, Blanchard et al., "Manual of Equine Reproduction", 3rd ed., Ball et al., "Determination of serum anti-Müllerian hormone concentrations for the diagnosis of granulosa-cell tumours in mares," Equine Vet J. 2013 Mar;45(2):199-203,. Image courtesy of Kalidoskopika. https://www.merckvetmanual.com/behavior/normal-social-behavior-and-behavioral-problems-of-domestic-animals/behavioral-problems-of-horses

Answer 17

Answer: 33% PCV Normal hemoglobin concentration (Hb, g/dl) is about one-third (33%) of the packed cell volume (PCV) in normal dogs, cats, horses, cows, sheep, goats, and pigs. So, in a cat with a PCV of 30%, the Hb will be roughly 10 g/dl. And in a dog with a PCV of 45%, the Hb will be roughly 15 g/dl. Remember, Hb is a protein in erythrocytes that helps to transport oxygen. Follow this link to see Small and large Animal reference values One exception to the 33% rule is South American camelids, whose hemoglobin is 40%-45% of the PCV, presumably an adaptation to high altitude, lower oxygen environments. https://eclinpath.com/hematology/tests/hemoglobin/

Answer 18

Answer: Winter Dermatophytosis (ringworm) most likely occurs in cattle that have been stabled for the winter. It is most commonly seen in calves as periocular lesions although it can become generalized. Trichophyton verrucosum is the most common cause of ringworm in cattle. The lesions are typically scaling areas of alopecia with gray crust formation and often ring-shaped; non-pruritic. Tx is not usually required as cattle often spontaneously recover. There are no approved antifungal agents in cattle. Antifungals approved in other animals or humans could be used if a meat and milk withdrawal time can be determined. Image courtesy, Dr. Lisle George https://www.merckvetmanual.com/integumentary-system/dermatophytosis/dermatophytosis-in-cattle

Answer 19

Answer: Severe equine asthma Think of severe equine asthma (sEA, formerly "heaves" or "recurrent airway obstruction") as the top DDx in an older (over seven years), stabled, coughing, wheezing afebrile horse with tachypnea at rest. Airborne exposure to irritants or allergans cause an inflammatory immune response in the lungs, resulting in airway inflammation (mucus, increased white blood cells), bronchoconstriction, and chronic remodeling. Exacerbated by dust, hay, mold so first step of Tx is to decrease exposure to dust by housing outside if possible or using dust-free bedding and wetting the hay. Tx with bronchodilators (e.g., albuterol/clenbuterol) plus corticosteroids. Some horses have pasture-associated sEA and are more difficult to manage. Dx: classic exam findings, bronchoalveolar lavage results (increased mucus and neutrophils), and normal to mildly increased neutrophil count/fibrinogen/serum amyloid A (due to chronic inflammation). Can administer a bronchodilator (e.g., atropine or n-butylscopolammonium bromide [Buscopan®, carried by most equine vets]) to alleviate an acute episode and help confirm the Dx. The ACVIM consensus statement on inflammatory airway disease nicely covers equine asthma, though the terminology has been updated even since its publication date. Would expect a fever and more severe neutrophilia/hyperfibrinogenemia/increased SAA with pneumonia. Lack of fever and finding of thoracic wheezes make upper respiratory infection unlikely. Neoplasia is not impossible but uncommon; rule out asthma first. Asthma in Horses: https://www.merckvetmanual.com/respiratory-system/respiratory-diseases-of-horses/asthma-in-horses

Answer 20

Answer: Pain, excitement, hypovolemia Pain, excitement, and hypovolemia can all cause tachycardia in a hospitalized horse. Normal heart rate for a horse is between 28-44 beats per minute (bpm). Hospitalized animals should be continually monitored for any changes, including signs of pain. Pain is now considered the 4th vital sign and is evaluated by the use of pain scales in humans, small animals, and horses.

Answer 21

Answer: Coccidioidomycosis Think of coccidioidomycosis, mostly in one to two year old dogs in the arid and semiarid Southwestern U.S., Mexico and Central America. Organisms vary in size (20-80 micrometers to 200 micrometers) spherules with a double-contoured wall. Mature spherules (sporangia) contain tiny endospores (sporangiospores) 2-5 micrometers in diameter. THINK DUSTY DESERT. spores are carriea on aust ana innared. Epidemics may occur alter aust storms or excavation. Asymptomatic animals common, but may nave a aisseminatea form or a respiratory form. In the lungs, may see discrete, variable-sized nodules with a firm, gray-white cut surface on necropsy, resembling tuberculosis lesions. Think of cryptococcus mainly in cats with a granulomatous rhinitis and sinusitis. This nasal cavity disease in cats sometimes causes a swollen "roman nose" appearance. A nasopharyngeal polyp would be on the DDX in a young cat with unilateral nasal discharge, but those animals should not have facial lesions or abundant fungal organisms on a smear. CGPT: Coccidioidomycosis in Animals CGPT: Overview of Tuberculosis in Animals CGPT: Cryptococcosis in Animals CGPT: Study case.

Answer 22

Answer: Coccidioidomycosis Think of coccidioidomycosis, mostly in one to two year old dogs in the arid and semiarid Southwestern U.S., Mexico and Central America. Organisms vary in size (20-80 micrometers to 200 micrometers) spherules with a double-contoured wall. Mature spherules (sporangia) contain tiny endospores (sporangiospores) 2-5 micrometers in diameter. THINK DUSTY DESERT. spores are carriea on aust ana innared. Epidemics may occur alter aust storms or excavation. Asymptomatic animals common, but may nave a aisseminatea form or a respiratory form. In the lungs, may see discrete, variable-sized nodules with a firm, gray-white cut surface on necropsy, resembling tuberculosis lesions. Think of cryptococcus mainly in cats with a granulomatous rhinitis and sinusitis. This nasal cavity disease in cats sometimes causes a swollen "roman nose" appearance. A nasopharyngeal polyp would be on the DDX in a young cat with unilateral nasal discharge, but those animals should not have facial lesions or abundant fungal organisms on a smear. CGPT: Coccidioidomycosis in Animals CGPT: Overview of Tuberculosis in Animals CGPT: Cryptococcosis in Animals CGPT: Study case.

Answer 23

Answer: Aspergullius spp Aspergillus is the fungus most commonly associated with guttural pouch mycosis. Aspergillus spp. typically form plaques on the caudodorsal aspect of the medial compartment of the guttural pouch, causing damage to the internal carotid artery and cranial and sympathetic nerves. This results in the clinical signs of epistaxis, dysphagia, and Horner syndrome. Spontaneous and severe hemorrhage may result in sudden death. Actinomyces spp. are the cause of lumpy jaw in cattle, infections associated with foxtail migration in dogs, and pyogranulomatous porcine mastitis. Actinomyces spp. are occasionally isolated from submandibular abscesses in horses. The toxins produced by the growth of Fusarium spp. on corn (fumonisins) are the cause of equine leukoencephalomalacia (moldy corn poisoning), a central nervous system disease characterized by blindness, circling, ataxia, and obtundation. Conidiobolus spp. infection results in the development of ulcerative, pyogranulomatous lesions, most commonly of the nasal mucosa and subcutaneous tissues of horses. CGPT: Guttural Pouch Mycosis in Horses

Answer 24

Answer: Aspergullius spp Aspergillus is the fungus most commonly associated with guttural pouch mycosis. Aspergillus spp. typically form plaques on the caudodorsal aspect of the medial compartment of the guttural pouch, causing damage to the internal carotid artery and cranial and sympathetic nerves. This results in the clinical signs of epistaxis, dysphagia, and Horner syndrome. Spontaneous and severe hemorrhage may result in sudden death. Actinomyces spp. are the cause of lumpy jaw in cattle, infections associated with foxtail migration in dogs, and pyogranulomatous porcine mastitis. Actinomyces spp. are occasionally isolated from submandibular abscesses in horses. The toxins produced by the growth of Fusarium spp. on corn (fumonisins) are the cause of equine leukoencephalomalacia (moldy corn poisoning), a central nervous system disease characterized by blindness, circling, ataxia, and obtundation. Conidiobolus spp. infection results in the development of ulcerative, pyogranulomatous lesions, most commonly of the nasal mucosa and subcutaneous tissues of horses. CGPT: Guttural Pouch Mycosis in Horses

Answer 25

Answer: Fecal-Oral Fecal-oral is the primary means of transmission of the causative agent of paratuberculosis (Mycobacterium avium subspecies paratuberculosis, also called Johne's disease). The organism is excreted in large numbers in feces of infected animals and in lower numbers in colostrum and milk. M. avium subsp paratuberculosis is TOUGH - it can survive more than a YEAR on pasture and even longer in water. Transplacental transmission does occur in some cases, but it is not the primary means. Since there is no treatment for paratuberculosis, prevention and control are most important to minimize its impact on herds. CGPT: Paratuberculosis in Ruminants (Johne’s Disease) https://www.cfsph.iastate.edu/Factsheets/pdfs/paratuberculosis.pdf

Answer 26

Answer: Porcine proliferative enteritis. The top differential for this presentation is porcine proliferative enteropathy (a.k.a. ileitis). Caused by Lawsonia intracellularis, it is a common condition in growing-finishing pigs and young breeding pigs. Think thickened intestine. Ileitis more commonly causes acute, non-hemorrhagic diarrhea (watery, brown) with most recovering spontaneously and some developing chronic diarrhea and loss of condition. The hemorrhagic form presents as described in this question, with pale pigs, bloody manure, and sudden death. The main rule-out is gastric ulcers, which would not typically affect so many pigs at once. Clostridium perfringens type C enteritis causes a highly fatal, necrohemorrhagic enteritis, but typically occurs in NEWBORN piglets one to five days of age, and up to three weeks. Escherichia coli causes outbreaks of mild, non-hemorrhagic, diarrhea in piglets about one to three days after they are born. Coccidiosis (Cystoisospora suis) is seen at approximately seven to 11 days of age, but up to three weeks is possible. Porcine Proliferative Enteropathy (PPE) in Pigs Definitions and Causative Agent: • PPE: A diarrheal disease in growing-finishing pigs and young breeding pigs. • Causative Agent: Lawsonia intracellularis, a gram-negative intracellular bacterium. Clinical Findings: • Nonhemorrhagic Form: Sudden diarrhea, reddish brown feces, potential chronic necrotic enteritis. • Hemorrhagic Form: Cutaneous pallor, weakness, melena, sudden death, abortions in pregnant gilts. Lesions: • Affected Areas: Jejunum, ileum, cecum, colon. • Gross Pathology: Thickened intestinal walls, edematous mesentery, enlarged mesenteric lymph nodes, necrotic mucosa with fibrinonecrotic membrane, surface hemorrhages. Diagnosis: • Methods: PCR assay, immunohistochemistry, histopathology, silver stains. • Differentiation: Exclude Salmonella and swine dysentery. Treatment and Control: • Antimicrobials: Parenteral for acute cases, feed or water medication for groups. • Vaccination: Effective in mitigating disease severity. CGPT: Gastric Ulcers in Pigs CGPT: Clostridium perfringens Type C Enteritis in Pigs CGPT: Enteric Colibacillosis in Pigs CGPT: Coccidiosis of Pigs

Answer 27

Answer: Inguinal Hernia This is an inguinal hernia in a piglet. A common problem in pigs; treat surgically via a midline skin incision, cranial to scrotum. Important to ligate and excise the vas deferens and blood vessels. Both inguinal rings should be closed to prevent herniation post-surgery. Prevent seroma formation by removing the tunic, cremaster muscle, and extra subQ tissue; surgically close any dead space. Follow this link to a good Merck diagram of inguinal hernia anatomy in a horse. Intersex syndrome is described in pigs and goat (rare), but look for male and female genitalia. Perineal hernia is more a problem of middle-aged pure-bred dogs. In cryptorchid animals, a testicle is RETAINED, not protruding.

Answer 28

Answer: Below stifle, lateral left hind Administer the feline leukemia virus (FeLV) vaccine below the stifle, on the lateral left hind. Administer vaccines in standard locations so adverse reactions can be correlated with a specific vaccine. Always keep a record of where vaccinations are given. FeLV and rabies vaccinations may be associated with the development of injection site sarcomas. Administration of vaccines in the distal limb allows for more rapid identification of swelling/mass development and permits limb amputation for treatment if a sarcoma develops. The standard feline vaccine locations are: FeLV: LEFT hind, below stifle Rabies: RIGHT hind, below stifle FVRCP: RIGHT front, below elbow Feline Leukemia Virus Disease - Comprehensive Veterinary Information Definitions and Terminology: • Feline Leukemia Virus (FeLV): A retrovirus causing immunosuppression, anemia, and lymphoma in cats. Causative Agents: • Pathogen: Feline leukemia virus (FeLV) with subtypes FeLV-A, FeLV-B, FeLV-C, FeLV-T. Physiopathology: • Transmission: Via saliva, nasal secretions, urine, feces, and milk. • Pathogenesis: Virus infects lymphoid tissue, spreads to bone marrow, causing immunosuppression, anemia, and neoplasia. Clinical Findings: • Symptoms: Lethargy, weight loss, anemia, chronic infections, lymphoma. • Disease Forms: Abortive, regressive, and progressive infections. Diagnosis: • Tests: ELISA, PCR, IFA. • Laboratory Confirmation: Detects FeLV antigen or proviral DNA. Treatment: • Antiviral Therapy: Limited efficacy. • Supportive Care: Manage secondary infections, regular health monitoring. Prevention: • Vaccination: Essential for at-risk cats. • Environmental Control: Clean and disinfect living CGPT: Definitions and Vaccination Principles

Answer 29

Answer: Barrow. A male pig castrated before puberty is called a barrow. A boar is an intact male pig. A young female pig that has not had a litter yet is called a gilt. A sow is an adult female pig that has had a litter of piglets. A wether is a castrated male sheep, while a ram is an intact male sheep. A ewe is a female sheep. A female ferret is called a jill and a male is called a hob.

Answer 30

A Bain system is a tube within a tube. New oxygen and anesthetic gas is inhaled down the inner tube, and exhaled gas exits through the outer tube. (Note there is a modified form of a circular system called a "universal F circuit" that is also a tube inside a tube). A Bain anesthetic circuit run at a HIGH flow rate of -300 ml/kg/min will not allow rebreathing of exhaled gasses. At MODERATE flow rates (ie: ~20-300 ml/kg/min or less) the Bain circuit functions as a PARTIAL rebreathing system, and the animal rebreathes some of the exhaled gasses. Refs: Bassert, Beal and Samples, McCurnin's Clinical Textbook for Veterinary Technicians, 9th ed., pp. 1025-27 and Tighe and Brown, Mosby's Comprehensive Review for Veterinary Technicians, 4th ed. p. 458.

Answer 31

Answer: Azole antifungal: oxygen therapy Treat pulmonary histoplasmosis in cats with azole antifungals and oxygen support if short of breath. Itraconazole or fluconazole are the azoles of choice in cats. We also often use glucocorticoids to mitigate the inflammatory response secondary to fungal death from the azole. Histoplasmosis (Histoplasma capsulatum) is a noncontagious, chronic granulomatous disease in cats and dogs (and humans) spread by inhalation of infected bird or bat feces. It can cause pneumonia, peripheral lymphadenopathy, optic neuritis, and nonspecific signs of weight loss and fever (more respiratory signs in cats vs. more Gl signs in dogs). Bronchodilators may worsen pneumonia by opening airways, allowing microbes to spread from affected to unaffected tissue, which can worsen infection. Pentoxifylline enhances red blood cell deformability and is not used to treat pulmonary histoplasmosis in cats. Ketoconazole is not available in a nebulized form. Pulmonary edema is not a component of pulmonary histoplasmosis in cats, so furosemide is not indicated. Metronidazole is an antibiotic, not an azole antifungal. Amphotericin B is not a first-line drug for pulmonary histoplasmosis. Use it to treat systemic fungal infections, or those refractory to treatment with azole antifungals. CGPT: Histoplasmosis in Animals

Answer 32

Answer: Ear cleaning and topical miconazole Treat this case of Malassezia spp. otitits externa with regular ear cleaning and a topical antifungal agent such as ketoconazole. Perform an otoscopic exam on all patients presenting for ear disease. It is essential to assess the integrity of the tympanic membrane prior to determining the best Tx option. Malassezia pachydermatis is most commonly implicated. It is a commensal yeast, however, disruption of the normal skin barrier (e.g., due to hypersensitivity, conformation, or endocrine disease) can result in overgrowth. Malassezia spp. infections are often highly pruritic and head shaking is common in dogs with otitis.

Answer 33

Answer: Remove 3rd phalanx by severing digital extensor and elastic tendons dorsally, digital flexor tendon ventrally, and collateral ligaments laterally between P2 and P3 To perform an onychectomy, remove the third phalanx by severing the digital extensor and elastic tendons dorsally, digital flexor tendon ventrally, and collateral ligaments laterally between P2 and P3. The most common nail bed tumors in cats include squamous cell carcinoma, soft tissue sarcoma, melanoma, osteosarcoma, and mast cell tumor. Depending on the lesion present, complete excision may also include amputation of adjacent phalanges. Remember that onychectomy is a painful surgery and multimodal pain control is required, including preoperative treatment with an NSAID and opioids, digital nerve blocks with bupivicaine, and post-operative NSAIDs and opioids. Robenacoxib (Onsior ®) is the preferred NSAID for use in cats.

Answer 34

Answer: Sudden onset of clinical signs attributable to the abdomen An acute abdomen refers to sudden onset of clinical signs attributable to the abdomen. It may or may not be surgical. Gastric distention and volvulus in dogs; enteritis, peritonitis, or ruptured bladder in any species; abomasal displacements in cattle; and large colon volvulus in horses are some of the potential causes of an acute abdomen.

Answer 35

Answer: Sudden onset of clinical signs attributable to the abdomen An acute abdomen refers to sudden onset of clinical signs attributable to the abdomen. It may or may not be surgical. Gastric distention and volvulus in dogs; enteritis, peritonitis, or ruptured bladder in any species; abomasal displacements in cattle; and large colon volvulus in horses are some of the potential causes of an acute abdomen.

Answer 36

Answer: Proud flesh Proud flesh is excessive growth of cauliflower-like granulation tissue around a healing wound. Especially common with lower-leg wounds in horses. A hygroma is inflammation of an acquired bursa that develops where normally there is no bursa due to trauma to the dorsum of the carpus. Villonodular synovitis is an inflammation of the synovial membrane of the dorsoproximal aspect of the forelimb fetlock joints. Ulceroproliferative faucitis is a progressively worsening gingivitis and stomatitis in cats. The glossopalatine arches (fauces) often have severely ulcerated, friable, inflamed, and proliferative lesions. Click here to see a cat with ulceroproliferative faucitis. CGPT: Chronic Proliferative Synovitis in Horses CGPT: Oral Inflammatory and Ulcerative Disease in Small Animals

Answer 37

Answer: Kidney A blunt point needle is used on friable tissues such as kidney and liver. Taper needles have a pointed end and are used for subcutaneous tissue, intestine, and fascia. Cutting needles are used for tough tissues such as skin. Click here to see a pictorial review of needle point types. https://wcvm.usask.ca/vsac205/Lab4/needles.php#Designoftheneedlepointtip%0D%0A For a good review of surgical basics, instruments, draping and approaches see the University of Saskatchewanâs Basic Surgical Skills course. https://wcvm.usask.ca/vsac205/index.php

Answer 38

Answer: 2-0 absorbable, monofilament (Monocryl) 2-0 Monocryl (absorbable, monofilament) would be the ideal choice among these to close a urinary bladder. Recommended suture types for bladder closure (and other hollow viscera) are absorbable, monofilament, and relatively small size. For urinary bladders, nonabsorbable suture may cause formation of cystic calculi. Silk is nonabsorbable multifilament, Ethion is nonabsorbable monofilament. PDS and Dexon are absorbable but the sizes given of #2 and #4 are way too large for a urinary bladder (#2 is used to close equine linea alba, for example). Remember that suture sizes range from 10-0 (finest, 0.02 mm diameter)) to #7 (heaviest, 0.9 mm diameter). Check out this great summary - Principles of Veterinary Suturing, courtesy of The University of Texas at San Antonio. CGPT: Comprehensive Guide for BCSE Test Preparation: Principles of Veterinary Suturing

Answer 39

Answer: Kilovoltage Kilovoltage (kVp) controls the penetrating ability of an x-ray. Generally, increasing kVp increases film blackness. Milliamperes (mA) are the QUANTITY of electrons produced by the x-ray machine and exposure time (sec) is how LONG you expose the animal to these rays. Together, milliampere-seconds equals mA multiplied by time (mA X sec=mAs), which controls the intensity of an x-ray. More mA, or longer exposure time, means a DARKER x-ray. Usually you want a HIGH mA setting, and a very SHORT exposure time (like 1/20 of a second) so that even if the animal moves, you still get a sharply focused x-ray. For bone, which has a lot more natural contrast because it is so hard, use a lower kVp and a higher mAs.

Answer 40

Answer: Osteochondritis dissecans (OCD) There is an osteochondritis dissecans (OCD) lesion on the caudal aspect of the humeral head. Think of OCD with shoulder lameness in a young (4 - 10 mo), male (3x more likely than female), fast-growing, large breed dog. Click here to see the affected area circled on the caudal humeral head. Although OCD lameness may present on only one side, always perform radiographs of the contralateral limb. Click here to see the normal left shoulder (bottom), same dog, compared to the right (top). In dogs, the joints most commonly affected by OCD include: • Shoulder: caudal humeral head • Elbow: medial humeral condyle • Hock (tarsocrural joint): medial or lateral trochlear ridges of talus • Stifle (knee): lateral or medial femoral condyle Osteochondrosis is abnormal endochondral ossification that disrupts the normal transition of cartilage to bone. These cartilage cells thicken and weaken with normal joint use, causing damage to the cartilage; including cracks, fissures, and flap formation (then called OCD). Joint incongruity and debris leads to synovitis and ultimately arthritis.

Answer 41

Answer: Osteochondritis dissecans (OCD) There is an osteochondritis dissecans (OCD) lesion on the caudal aspect of the humeral head. Think of OCD with shoulder lameness in a young (4 - 10 mo), male (3x more likely than female), fast-growing, large breed dog. Click here to see the affected area circled on the caudal humeral head. Although OCD lameness may present on only one side, always perform radiographs of the contralateral limb. Click here to see the normal left shoulder (bottom), same dog, compared to the right (top). In dogs, the joints most commonly affected by OCD include: • Shoulder: caudal humeral head • Elbow: medial humeral condyle • Hock (tarsocrural joint): medial or lateral trochlear ridges of talus • Stifle (knee): lateral or medial femoral condyle Osteochondrosis is abnormal endochondral ossification that disrupts the normal transition of cartilage to bone. These cartilage cells thicken and weaken with normal joint use, causing damage to the cartilage; including cracks, fissures, and flap formation (then called OCD). Joint incongruity and debris leads to synovitis and ultimately arthritis.

Answer 42

Answer: Neoplastic The process is highly likely to be neoplastic. There is severe lysis of all of the bones of the first digit of the right manus, with nearly complete destruction of the metacarpal bone and proximal phalynx. There is severe regional soft tissue swelling over the medial aspect of the right manus as well. The second metacarpal bone has thinning and irregularity of the cortex. There is a transverse fracture in the mid diaphysis of the third metacarpal bone, the margins of the fractures are irregular and there is a moderate irregular periosteal proliferation present circumferentially around the fracture. CGPT: Bone Tumors in Dogs and Cats

Answer 43

Answer: Ghost image A ghost image occurs when a second image is taken too quickly after a previous image that required a very high exposure. A ghostâ of the first exposure will be visible on the second image because the detector plate has not yet lost all of its charge. Elongation occurs when the x-ray beam is not centered on the structure being radiographed, causing the image to appear longer than its normal size. The heel effect occurs when the x-ray beam is more intense at the cathode side compared to the anode side, resulting in uneven x-ray photon distribution. This phenomenon is related to the angle of the anode target area and the absorption of the x-ray beam by the anode target material. Foreshortening occurs when the structure being radiographed is lifted off the table, causing the structure to appear shorter than its actual size.

Answer 44

Answer: Interstitial pattern, air bronchograms The circled area of the canine lateral thoracic radiographs shows a diffuse interstitial lung pattern and air bronchograms. An interstitial lung_pattern is characterized by decreased visualization of the cardiac and diaphragmatic silhouettes and pulmonary vessels. Pulmonary nodules are also considered an interstitial lung patttern. Air bronchograms are the hallmark of an alveolar pattern. They occur when tiny alveolar air spaces are infiltrated with inflammatory fluid, hemorrhage, or neoplasia. The soft-tissue opacity of fluid/cells within alveoli highlights the air within larger airways (i.e., bronchi). Click here to see air bronchograms on a DV view of a canine thorax.

Answer 45

Answer: Dental Dental film is wrapped in light-tight paper and does not utilize an intensifying screen such as would be found in a film-held in a cassette. Non-screen films are used primarily in dental films and industrial radiology where high resolution is needed.

Answer 46

Answer: Fistulous withers. Actinomyces bovis causes lumpy jaw in cattle and has been isolated from horses with fistulous withers and poll evil. More importantly, remember that BRUCELLA ABORTUS is associated with fistulous withers. Follow this link to see a Merck image of fistulous withers. https://www.merckvetmanual.com/multimedia/v4738075 Equine viral arteritis (EVA) is another name for epizootic cellulitis and equine typhoid. Glanders (and Farcy), are caused by Burkholderia (Pseudomonas) mallei. Think ULCERATING NODULES in the upper respiratory tract, lungs, and skin. Horses do NOT get transmissible serositis, which is a chlamydial polyarthritis. Just about every animal on a farm can get transmissible serositis EXCEPT horses (sheep, calves, goats, and pigs). Ref: Smith, Van Metre, and Pusterla's Large Animal Internal Medicine, 6th ed., pp. 1248- Link: Actinomycosis in Cattle, Swine, and Other Animals https://www.merckvetmanual.com/generalized-conditions/actinomycosis/actinomycosis-in-cattle,-swine,-and-other-animals Link: Bursitis in Large Animals https://www.merckvetmanual.com/musculoskeletal-system/bursitis-in-large-animals/bursitis-in-large-animals?redirectid=4312?ruleredirectid=30 Link: Brucellosis in Cattle https://www.merckvetmanual.com/reproductive-system/brucellosis-in-large-animals/brucellosis-in-cattle Link: Equine Viral Arteritis https://www.merckvetmanual.com/generalized-conditions/equine-viral-arteritis/equine-viral-arteritis?redirectid=3175?ruleredirectid=30 Link: Glanders in Horses and Other Animals https://www.merckvetmanual.com/generalized-conditions/glanders/glanders-in-horses-and-other-animals?redirectid=30621 Link: Chlamydial Polyarthritis in Large Animals https://www.merckvetmanual.com/musculoskeletal-system/arthropathies-in-large-animals/chlamydial-polyarthritis-in-large-animals?autoredirectid=18373

Answer 47

Answer: Spirocerca lupi. A disease of dogs in the Southern U.S. and tropical climates, Spirocerca lupi (esophageal worms) make reactive granulomas of variable size in the esophageal, gastric or aortic walls. Large granulomas may become neoplastic (osteosarcoma, fibrosarcoma). Some dogs develop spondylitis or enlargement of the extremities characteristic of hypertrophic osteopathy. Typically asymptomatic, but large granulomas can cause esophageal obstruction. https://www.merckvetmanual.com/multimedia/v4732838 Spirocercosis may also lead to aneurysm in the thoracic aorta or an ossifying spondylitis of the posterior thoracic vertebrae. Habronema spp. (Habronema muscae, H. microstoma and Draschia megastoma) in horses can cause tumorlike stomach nodules and sometimes cutaneous lesions. Blastomycosis, most common in dogs, cats and humans is characterized by pyogranulomatous lesions in various tissues. Placental infection in horses with Coccidioides immitis have been described, leading to abortion and osteomyelitis. Ref: Cote, Clinical Veterinary Advisor-Dogs and Cats, 4th ed. pp. 933-5.\ Link: Spirocerca Lupi in Small Animals https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-small-animals/spirocerca-lupi-in-small-animals Link: Bone Tumors in Dogs and Cats https://www.merckvetmanual.com/musculoskeletal-system/osteopathies-in-small-animals/bone-tumors-in-dogs-and-cats Link: Hypertrophic Osteopathy in Dogs https://www.merckvetmanual.com/musculoskeletal-system/osteopathies-in-small-animals/hypertrophic-osteopathy-in-dogs Link: Cutaneous Habronemiasisi in Animals https://www.merckvetmanual.com/integumentary-system/helminths-of-the-skin/cutaneous-habronemiasis-in-animals Link: Habronema spp Infection in Horses https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-horses/habronema-spp-infection-in-horses?redirectid=27859 Link: Blastomycosis https://www.merckvetmanual.com/generalized-conditions/fungal-infections/blastomycosis Link: Coccidiomycosis https://www.merckvetmanual.com/generalized-conditions/fungal-infections/coccidioidomycosis Link: Paraneoplasic Hypertrophic Osteopathy in 30 dogs https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012418/

Answer 48

Answer: Delayed hypersensitivity. Type IV (or delayed) hypersensitivity reactions are cell-mediated and occur more than 12 h after antigen exposure. Antigen presented by macrophages and monocytes activate T lymphocytes. Those T cells release cytokines and chemokines which cause tissue damage and the clinical signs associated with type IV hypersensitivity reactions. Type IV hypersensitivity is directed against intracellular antigens such as mycobacteria, fungi, some parasites, and, in some situations, cell antigens (i.e., transplant rejection and tumor immunity). Examples of delayed hypersensitivity include: Dermal contact hypersensitivity (poison ivy in humans) Granulomatous reactions to mycobacteria, Coccidioides, Blastomyces, Histoplasma Lymphocytic choriomeningitis (in hamsters, mice) Old-dog encephalitis (canine distemper) Autoimmune thyroiditis (also has a type I component) Keratoconjunctivitissicca(KCS) Ref: Cote, Clinical Veterinary Advisor: Dogs and Cats 4th ed p 204 Link: Hypersensitivity Diseases in Animals https://www.merckvetmanual.com/immune-system/immunologic-diseases/hypersensitivity-diseases-in-animals#v3277442 Link: Canine Distemper Overview https://www.merckvetmanual.com/generalized-conditions/canine-distemper/canine-distemper-overview Link: Nasolacrimal and Lacrimal Apparatus https://www.merckvetmanual.com/eye-diseases-and-disorders/ophthalmology/nasolacrimal-and-lacrimal-apparatus

Answer 49

Answer: Rodent. Plague, caused by Yersinia pestis, is carried by FLEAS and found in wild RODENTS (ground squirrels, wood rats) and RABBITS. Among pets, think of septic CATS with ABSCESSES, in the WESTERN United states (and Hawaii), May-October. ZOONOTIC and REPORTABLE About 10 cases of human plague are reported each year, most often infected via a flea bite. Refs: U.S. Centers for Disease Control, MMWR, Human plague 4 States- Sep 1, 2006 / 55(34); 940-3, Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. p.1077. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5534a4.htm Link: Overview of Plague https://www.merckvetmanual.com/generalized-conditions/plague/overview-of-plague Plague in Animals - Comprehensive Veterinary Information Definitions and Terminology: • Plague: A serious, life-threatening disease caused by Yersinia pestis, a gram-negative, facultative coccobacillus. Causative Agents: • Pathogen: Yersinia pestis. Epidemiology and Transmission: • Hosts: Maintained between rodent species and their fleas. • Transmission: Flea bites, ingestion of infected rodents, contact with infected fluids/tissues, aerosol droplets. • Risk Factors: Roaming in enzootic areas, hunting rodents, exposure to infected fleas. Clinical Findings: • Cats: • Bubonic Plague: High fever, lethargy, anorexia, lymphadenopathy (buboes). • Septicemic Plague: High fever, lethargy, anorexia, vomiting, diarrhea, sepsis signs. • Pneumonic Plague: Fever, dyspnea, oral/nasal discharge, coughing/sneezing. • Dogs: Transient fever, anorexia, rarely severe disease. Diagnosis: • Tests: PCR, direct fluorescent antibody (DFA), culture (gold standard). • Sample Collection: Lymph node aspirates, whole blood, fresh tissue. Treatment: • Antibiotics: Fluoroquinolones, doxycycline, trimethoprim-sulfonamide, gentamicin, chloramphenicol. • Supportive Care: Hospitalization, isolation, appropriate PPE for handlers. Control and Public Health: • Prevention: Flea control, avoiding exposure to rodents, maintaining pets indoors. • Public Health Response: Notify health officials, implement isolation and disinfection procedures, prophylactic antibiotics for exposed humans. Physiopathology: • Infection Route: Flea bite introduces bacteria, which spread through the lymphatics to lymph nodes, causing buboes, and potentially disseminating via the bloodstream (septicemic) or to the lungs (pneumonic).

Answer 50

Answer: Clostridium perfringens type C. These are the hemorrhagic intestines of Clostridium perfringens type C. Affects piglets up to three weeks old with a severe hemorrhagic necrotizing diarrhea. High mortality. Brachyspira (Serpulina) hyodysenteriae is a treponemal spirochete that causes swine dysentery. Think MUCOID hemorrhagic diarrhea (ie: large intestine) in pigs 6 to 20 weeks old. Diarrheic pigs become dehydrated, profoundly weak, and emaciated. Lawsonia intracellularis causes porcine proliferative enteritis, a common diarrheal disease in growing-finishing pigs and younger breeding pigs. Hemorrhagic bowel syndrome is thought to be caused by intestinal volvulus - causes sudden death without diarrhea in rapidly growing 4- to 6-month-old swine. Shiga toxin-producing Escherichia coli (STEC) causes EDEMA disease in recently weaned um pen piglets with peracute death or neurological signs: ataxia, paralysis, and recumbency, and head swelling. Refs: Ogilvie's NVMS Large An Int Med, p. 72, Jackson, PGG and Cockcroft, PD. Handhook of nie diseases 2007. n 94-95 Link: Clostridium perfringens Type C https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/clostridium-perfringens-type-c-enteritis-in-pigs Link: Swine Dysentery https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/swine-dysentery Link: Porcine Proliferative Entheropathy https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/porcine-proliferative-enteropathy?autoredirectid=16618 Link: Hemorrhagic Bowel Syndrome https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/hemorrhagic-bowel-syndrome-in-pigs Link: Overview of Edema Disease https://www.merckvetmanual.com/generalized-conditions/edema-disease/overview-of-edema-disease

Answer 51

Answer: Clostridium perfringens type C. These are the hemorrhagic intestines of Clostridium perfringens type C. Affects piglets up to three weeks old with a severe hemorrhagic necrotizing diarrhea. High mortality. Brachyspira (Serpulina) hyodysenteriae is a treponemal spirochete that causes swine dysentery. Think MUCOID hemorrhagic diarrhea (ie: large intestine) in pigs 6 to 20 weeks old. Diarrheic pigs become dehydrated, profoundly weak, and emaciated. Lawsonia intracellularis causes porcine proliferative enteritis, a common diarrheal disease in growing-finishing pigs and younger breeding pigs. Hemorrhagic bowel syndrome is thought to be caused by intestinal volvulus - causes sudden death without diarrhea in rapidly growing 4- to 6-month-old swine. Shiga toxin-producing Escherichia coli (STEC) causes EDEMA disease in recently weaned um pen piglets with peracute death or neurological signs: ataxia, paralysis, and recumbency, and head swelling. Refs: Ogilvie's NVMS Large An Int Med, p. 72, Jackson, PGG and Cockcroft, PD. Handhook of nie diseases 2007. n 94-95 Link: Clostridium perfringens Type C https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/clostridium-perfringens-type-c-enteritis-in-pigs Link: Swine Dysentery https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/swine-dysentery Link: Porcine Proliferative Entheropathy https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/porcine-proliferative-enteropathy?autoredirectid=16618 Link: Hemorrhagic Bowel Syndrome https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-pigs/hemorrhagic-bowel-syndrome-in-pigs Link: Overview of Edema Disease https://www.merckvetmanual.com/generalized-conditions/edema-disease/overview-of-edema-disease

Answer 52

Answer: Dicrocoelium dendriticum. Dicrocoelium dendriticum is found in the bile ducts. Refs: The Merck Veterinary Manual online edition. Link: Dicrocoelium dendriticum in Ruminants https://www.merckvetmanual.com/digestive-system/fluke-infections-in-ruminants/dicrocoelium-dendriticum-in-ruminants Key Information on Dicrocoelium dendriticum Infections in Ruminants Etiology and Epidemiology • Causative Agent: Dicrocoelium dendriticum, a small liver fluke. • Hosts: Sheep, goats, cattle. • Geographic Distribution: Europe, Asia, North America. Life Cycle • Intermediate Hosts: Terrestrial snails (first), ants (second). • Development: Metacercariae ingested by ruminants, migrate to bile ducts. Clinical Findings • Signs: Often subclinical; chronic infections cause liver cirrhosis, bile duct fibrosis, reduced productivity. • Lesions: Enlarged, fibrotic bile ducts; liver fibrosis. Diagnosis • Methods: Detection of small, brown, operculated eggs in feces, liver biopsy, necropsy findings. Treatment and Control • Medications: Albendazole (10 mg/kg), triclabendazole. • Prevention: Manage snail and ant populations, prevent contamination of grazing areas.

Answer 53

Answer: Nematode. Heartworms are a filarial type of nematode or roundworm. https://www.merckvetmanual.com/circulatory-system/heartworm-disease/heartworm-disease-in-dogs,-cats,-and-ferrets?redirectid=30615 Refs: Bassert, Beal and Samples, McCurnin's Clinical Textbook for Veterinary Technicians, 9thed. p. 417. Heartworm Disease in Dogs, Cats, and Ferrets - Comprehensive Study Guide Definition • Heartworm Disease (Dirofilariasis): Caused by Dirofilaria immitis, primarily affects pulmonary arteries, causing inflammation and pulmonary hypertension, leading to right-sided heart failure. Causative Agent • Dirofilaria immitis: Transmitted by mosquitoes (Aedes, Anopheles, Culex). Pathophysiology • Life Cycle: • Mosquitoes ingest microfilariae from infected host. • Develop into infective larvae (L3) within the mosquito. • L3 larvae are transmitted to new host during mosquito feeding. • Larvae migrate to subcutaneous tissue, molt to L4, and then to young adults. • Young adults migrate to pulmonary arteries and develop into mature worms. • Host Response: • Mechanical damage by live heartworms. • Dead heartworms cause severe vascular reactions. • Chronic infections lead to inflammation, scarring, and pulmonary hypertension. • High heartworm burden exacerbates clinical signs, especially in active dogs. Clinical Signs • Dogs: • Cough, exercise intolerance, weight loss, dyspnea, syncope, ascites, and right-sided CHF. • Severe cases: Caval syndrome with tricuspid valve insufficiency, hemolysis, anemia, and organ dysfunction. • Cats: • Coughing, dyspnea, vomiting, lethargy, anorexia, weight loss, sudden death. • Heartworm-associated respiratory disease (HARD) syndrome. • Ferrets: • Weight loss, fatigue, cough, labored breathing, heart murmur, jugular distension, ascites, pleural effusion, sudden death. Diagnosis • Dogs: • Antigen tests (preferred for routine screening). • Microfilaria tests (direct smear, Knott test). • Thoracic radiography, echocardiography for cardiac assessment. • Cats and Ferrets: • Antigen and antibody tests. • Echocardiography for visualizing heartworms. Treatment • Dogs: • Melarsomine: Organic arsenic compound, IM injections (split-dose regimen). • Doxycycline: Eradicates Wolbachia, reducing heartworm viability. • Macrocyclic Lactones: Preventatives, also used for non-arsenical protocols. • Supportive Care: Exercise restriction, manage complications (e.g., pulmonary thromboembolism). • Cats and Ferrets: • No approved adulticide treatment. • Supportive care, corticosteroids for inflammation, manage respiratory distress. Prevention • Macrocyclic Lactones: Monthly preventatives (ivermectin, milbemycin, moxidectin, selamectin). • Environmental Control: Reduce mosquito exposure, regular testing.

Answer 54

Answer: It is caused by an organism that thrives in necrotic tissue. Tetanus is a neurologic disease caused by absorption of a neurotoxin produced by the spore-forming anaerobe Clostridium tetani. It is most often seen when a wound is contaminated with spores as necrotic tissue is required for the organism to grow. The toxin is released with turnover of bacterial cells. Tetanus is not contagious and is seen in individual animals. The incubation period varies from 10 days to a few weeks depending on the wound environment. Cats and birds are quite resistant to this toxin, dogs are fairly resistant, whereas horses and humans are very sensitive to the development of tetanus. It can be prevented by regular vaccination and proper wound care. Refs: The Merck Veterinary Manual online edition. Bassert, Beal and Samples, McCurnin's Clinical Textbook for Veterinary Technicians, 9tled, pp. 265 Link: Tetanus in Animals https://www.merckvetmanual.com/generalized-conditions/clostridial-diseases/tetanus-in-animals Tetanus in Animals - Comprehensive Information for BCSE Test Definitions and Causative Agent: • Tetanus (Lockjaw): A neurological disease caused by the neurotoxin produced by Clostridium tetani, an anaerobic bacterium found in soil and intestines. • Transmission: Introduced through deep puncture wounds, docking, castration, and sometimes through minor or healed wounds. Pathogenesis: • Neurotoxin Mechanism: Inhibits inhibitory neurotransmitters by cleaving synaptobrevin, causing muscle spasms, rigidity, and respiratory failure. • Nerve Pathways: Toxin travels retrograde along motor nerves to the CNS, causing ascending and descending tetanus. Clinical Findings: • Symptoms: Localized stiffness, generalized stiffness, tonic spasms, hyperesthesia, difficulty in prehension and mastication (lockjaw), respiratory failure, cardiac arrhythmias, opisthotonos, “sawhorse” stance in horses. • Incubation Period: Typically 10-14 days. • Species Differences: Horses, lambs, and humans are highly susceptible; dogs and cats are relatively resistant. Diagnosis: • Methods: Clinical signs, recent trauma history, detection of toxin in serum, PCR assay on wound material, gram-stained smears, and anaerobic culture. Treatment and Control: • Medications: • Tetanus Antitoxin: 300,000 IU IV every 12 hours for horses, caution in dogs and cats due to anaphylaxis risk. • Antibiotics: Penicillin or broad-spectrum antimicrobials. • Muscle Relaxants: Curariform agents, tranquilizers, barbiturates, diazepam. • Supportive Care: Wound cleaning, darkened environment, high feeding devices, slings for support. • Vaccination: Tetanus toxoid for active immunization; booster shots for previously immunized animals; vaccination of mares and foals in high-risk areas.

Answer 55

Answer: Nothing. The preferred answer is "nothing". Campylobacter jejuni from contaminated chicken is one of the leading causes of enterocolitis IN HUMANS, but the chickens themselves are asymptomatic. Click for more on avian campylobacter. https://www.merckvetmanual.com/poultry/avian-campylobacter-infection/avian-campylobacter-infection Refs: The Merck Veterinary Manual online edition. Campylobacteriosis in Birds - Comprehensive Study Guide Definition • Campylobacteriosis: Infection of the intestinal tract with Campylobacter spp., typically asymptomatic in birds but can cause disease under specific conditions. Causative Agents • Common Species: Campylobacter jejuni, C. coli, C. lari • Disease-causing Species: C. hepaticus, C. bilis (cause spotty liver disease) Pathophysiology • Transmission: Fecal-oral route, environmental contamination, vertical transmission (egg surface or transovarial). • Colonization: Intestinal colonization often without clinical signs. C. hepaticus and C. bilis can cause spotty liver disease with hepatic necrosis. Clinical Signs • General: Often asymptomatic in poultry. • Spotty Liver Disease: Multifocal necrotic hepatitis, decreased egg production, increased mortality (up to 15%). Lesions • Spotty Liver Disease: Focal hepatic necrosis, distended jejunum, disseminated hemorrhagic enteritis. Diagnosis • Methods: Clinical signs, bacteriologic culture, PCR assay. • Challenges: Difficult culture due to susceptibility to common antimicrobials in enrichment media. Treatment and Control • Antimicrobials: For C. hepaticus outbreaks (chlortetracycline, lincomycin). • Biosecurity: Improved hygiene, rodent control, exclusion of wild birds, insect eradication. • Preventative Measures: Chlorination of drinking water, competitive exclusion, bacteriophage therapy, and vaccination research. Zoonotic Risk • Humans: C. jejuni is a significant cause of foodborne enteritis, primarily through undercooked poultry meat.

Answer 56

Answer: Ostertagia infestation. An abomasum with a cobblestone or "Moroccan leather" appearance is pathognomonic for Ostertagia. Ostertagia is one of the three stomach worms of cattle. Worms enter hypobiosis in the winter in the north and summer in the south then emerge in the spring in the north and fall in the south. Coccidiosis is a hemorrhagic diarrhea of calves, usually younger than in this question, expect more tenesmus, frank blood. Anaplasmosis presents as an anemia, with fever and icterus. Ref: Smith, Van Metre, and Pusterla's Large Animal Internal Medicine, 6th ed., pp. 1503- Link: Gastrointestinal Parasites of Cattle https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-ruminants/gastrointestinal-parasites-of-cattle Link: Coccidiosis of Cattle https://www.merckvetmanual.com/digestive-system/coccidiosis/coccidiosis-of-cattle Link: Anaplasmosis in Ruminants https://www.merckvetmanual.com/circulatory-system/blood-parasites/anaplasmosis-in-ruminants?autoredirectid=17931

Answer 57

Answer: Infection of umbilical structures. Infection of umbilical structures, called omphalitis, is a common comorbidity with umbilical hernia in calves (and foals). Umbilical hernias are a common finding in neonatal calves, and they are frequently associated with umbilical abscessation. Easily reducible umbilical masses are typically uninfected while infected masses may be difficult to reduce and accompanied by other clinical signs such as heat in the area, drainage, fever, inappetance, and ill thrift. Uncomplicated, easily reducible hernias are more common in Holsteins and may be heritable. It is possible to have infected umbilical remnants while the exterior umbilical structures appear completely normal. May need to use deep palpation, ultrasound, and/or bloodwork to rule out these more hidden infections. Surgical repair with resection of infected structures is the treatment of choice for umbilical hernias in calves and foals. Link: Hernias in Animals https://www.merckvetmanual.com/digestive-system/congenital-and-inherited-anomalies-involving-the-digestive-system/hernias-in-animals?autoredirectid=20413 Link: Umbilical masses / hernias in calves [link] https://www.acvs.org/large-animal/umbilical-masses-hernias-in-calves/ **Umbilical Masses/Hernias in Calves Comprehensive Overview** Definitions and Etiology • Umbilical Hernias: Protrusion of abdominal contents through the umbilical ring, the most common congenital defect in calves. • Etiology: Defects in the closure of the abdominal wall at birth; can be hereditary or due to infection. Clinical Signs • Simple Hernias: Reducible bulge at the umbilicus, calves appear normal otherwise. • Infected Hernias: Fever, inappetence, poor growth rates, frequent urination, urination through the umbilicus. Diagnostic Methods • Physical Examination: Palpation to assess reducibility and presence of infection. • Ultrasonography: Determines infection extent and content of the hernia. • Laboratory Tests: White blood cell counts, bacterial culture from fluid collections. Treatment and Mechanism of Action • Surgical Repair: Preferred treatment, involves removing the hernia sac and any infected tissue. • Simple Hernias: Repair under sedation or general anesthesia. • Infected Hernias: Drain abscesses, extensive removal if infection reaches the bladder. • Post-Surgical Care: Antibiotics, NSAIDs (with caution), gradual reintroduction to feed, confinement to reduce tension on the surgical site. Prognosis • Simple Hernias: Generally favorable with proper surgical intervention. • Complicated/Infected Hernias: Higher risk of complications such as peritonitis, poorer prognosis. Key Points for Veterinary Professionals • Comprehensive Diagnosis: Includes physical examination, ultrasonography, and laboratory tests. • Timely Surgical Intervention: Essential to prevent complications and ensure recovery. • Post-Operative Care: Critical for successful healing and minimizing recurrence.

Answer 58

Answer: Phylloerythrin. Phylloerythin is a photosensitizing agent derived from microbial breakdown of chlorophyll in the GI tract. If the liver is damaged, then phylloerythin builds up in the plasma. This phylloerythin absorbs and releases light energy in the skin, causing SECONDARY photosensitization. This is the most common type of livestock photosensitization. So, when sheep eat hepatotoxic Tetradymia spp. and Artemisia nova, the compromised liver allows toxic photosensitizing phylloerythrin to build up. PRIMARY photosensitization occurs in the absence of hepatic disease when a photodynamic agent is ingested/injected/absorbed. Hypericum perforatum (St. John's wort) is an example of a plant that causes primary photosensitization. Tetracycline is a medication that can cause primary photosensitization. Congenital inherited photosensitization is seen in some breeds of cattle and sheep. [link] (https://www.merckvetmanual.com/integumentary-system/photosensitization/overview-of-photosensitization-in-animals?autoredirectid=23401#Primary-Photosensitization-(Type-I)_v3281714)

Answer 59

Answer: Polioencephalomalacia. The two most common causes of polioencephalomalacia (PEM) are: - Low thiamine (due to thiaminase activity from plants like bracken fern or low thiamine diets) - High sulfur in the diet (which can come from a high molasses-urea diet, corn or sugar cane byproducts, water, or other plants, including alfalfa, Canada thistle (Cirsium arvense), kochia, (Kocchia scoparia), and lambsquarter (Chenopodium spp).

Answer 60

Answer: Calcium oxalate monohydrate. Expect to see calcium oxalate monohydrate (6-sided prisms/spindles or "picket fences") crystals, which can appear as early as three hours post-ingestion in cats and six hours in dogs. Click here to see an image of "picket fence" calcium oxalate monohydrate crystals (image on right) on Cornell's eClinPath website. Bilirubin crystals can actually be seen in normal dogs (though they are NOT normal in other animals).

Answer 61

Answer: Administer Vitamin E / Selenium to all calves. Treat the other calves with vitamin E/selenium. Think of white muscle disease when you see sudden death and endocardial plaques in a young calf, lamb, or kid with a history of recent vigorous exercise. Follow this link to a Merck image of pale ventricular myocardium. Typically seen in young, fast-growing animals (ie: calves 2 weeks-6 mos). Clinical signs may include dyspnea (due to myocardial disease), stiff gait, arched back, weakness, recumbent but BAR (bright, alert, responsive). Sudden death may resemble enterotoxemia, but would usually see acute bloody diarrhea, convulsions, opisthotonos in first days of life with enterotoxemia. lonophores are cardiotoxic, so they should be removed until a diagnosis is confirmed. CGPT: Nutritional Myopathies in Ruminants and Pigs - Comprehensive Study Guide

Answer 62

Answer: Anorexia, vomiting and icterus Aflatoxicosis causes acute hepatic failure leading to vomiting, anorexia, icterus, and sudden death. Clinical signs may be initially vague and insidious. See hemorrhage secondary to coagulopathy with advanced disease. Aflatoxicosis is caused by toxigenic strains of Aspergillus (A. flavus, A. parasiticus) on corn (maize), other cereal grains, peanuts, and soybeans - all common ingredients in dog food. There is no specific treatment, and the prognosis is poor to grave. Treat as for any acute toxic hepatopathy, including IV fluid therapy, antioxidants (n-acetyl cysteine or s-adenosy! methionine), and gastrointestinal support. If aflatoxicosis is a concern, retain a food sample and/or package labels for testing and reporting. Direct concerns regarding pet food contamination to the Safety Reporting Portal and the U.S. Food and Drug Administration (FDA) Consumer Complaint Coordinators (unfortunately no similar reporting systems exist in Canada). CGPT: Comprehensive Summary of Aflatoxicosis in Animals

Answer 63

Answer: 4-methylpyrazole. When the shortest effective treatment course is desirable, 4-methylpyrazole is the treatment of choice for ethylene glycol toxicity. Ethanol is effective and not wrong per se, but it is not among the choices, and the treatment protocol for ethanol requires a longer stay in intensive care than 4-methyl pyrazole (fomepizole, 4-MP). Methanol (wood alcohol) is toxic to animals, most commonly found in windshield washer fluid, where it acts as antifreeze. Blindness can occur in people who drink methanol.

Answer 64

Anewer: Onion powder. Onion or garlic toxicosis can be caused from the chronic overconsumption of garlic powder, such as in cats fed an exclusive diet of baby foods. Excessive consumption of plants from the Allium genus can cause methemoglobinemia with resultant Heinz body anemia. Click here to see a cultivated onion and wild onion (common in North America). Refs: Cote, Clinical Veterinary Advisor-Dogs and Cats, 3rd ed. pp. 719-20 and the Merck Veterinary Manual online .

Answer 65

Chloramphenicol has been associated with bone marrow suppression/ aplastic anemia in exposed humans, and is CONTRAINDICATED IN FOOD ANIMALS.

Answer 66

Answer: Selectively inhibits cyclooxigenase (COX)-2 Robenacoxib (Onsior ®) is a selective COX-2 inhibitor, whereas aspirin is non-selective and inhibits both COX-1 and COX-2. In the pathway of arachidonic acid metabolism, NSAIDs block prostaglandin (PG) synthesis by inhibiting the COX enzyme. This provides their analgesic, antipyretic, and anti- inflammatory actions. There are two isoforms: COX-1 is needed for synthesis of PGs involved in normal physiologic functions - think GI tract, kidneys, and platelets. COX-2 is inducible and results in production of PGs that cause inflammation, fever, and pain. COX-1 inhibitors (e.g., aspirin, phenylbutazone, flunixin meglumine) are associated with risk of GI ulceration and renal toxicity. Selective COX-2 inhibitors (e.g., robenacoxib, deracoxib, firocoxib, carprofen, meloxicam) are generally considered safer due to less risk of side effects, but toxicity can still occur and they should always be used with caution in cats. Here are the FDA guidelines for NSAID use in pets. https://www.fda.gov/animal-veterinary/animal-health-literacy/get-facts-about-pain-relievers-pets#Approved Pain Relievers for Pets - Comprehensive Information for BCSE Test Definitions and Causative Agents: • NSAIDs: Nonsteroidal anti-inflammatory drugs to manage pain and inflammation. • Mechanism: Inhibit cyclooxygenase enzymes (COX-1 and COX-2) to reduce prostaglandin synthesis. Approved NSAIDs for Pets: • Dogs: • Carprofen: Osteoarthritis, post-surgery. • Deracoxib: Osteoarthritis, post-surgery. • Firocoxib: Osteoarthritis, post-surgery. • Grapiprant: Osteoarthritis. • Meloxicam: Osteoarthritis, injectable. • Robenacoxib: Post-surgery (3 days max). • Cats: • Meloxicam: Single post-surgery injection. • Robenacoxib: Post-surgery (3 days max). Side Effects: • Common: GI upset, vomiting, diarrhea, decreased appetite. • Severe: Liver toxicity, kidney damage. Monitoring and Precautions: • Long-term Use: Regular blood tests for liver and kidney function. • Interactions: Avoid concurrent use with other NSAIDs or corticosteroids. Benefits and Risks: • Benefits: Effective pain and inflammation control. • Risks: Potential for severe side effects, especially in cats. Contraindications: • Avoid: OTC NSAIDs (aspirin, ibuprofen) and acetaminophen in pets.

Answer 67

Answer: Vasopressin, vasopressin receptors agonist, vasoconstriction Vasopressin (a.k.a. anti-diuretic hormone, ADH) is released in large amounts from the pituitary gland in response to physiologic/ circulatory shock, particularly with hypotension. It acts on vasopressin (V) receptors on blood vessels (V1) to causes vasoconstriction. Use vasopressin during cardiopulmonary cerebral resuscitation to increase venous return to the heart via peripheral vasoconstriction. In health, ADH acts at receptors on renal tubules and collecting ducts (V2) to prevent water excretion in response to increased plasma osmolality. So, when dehydrated, ADH helps retain fluid to return blood volume and osmolality to normal. https://www.merckvetmanual.com/emergency-medicine-and-critical-care/specific-diagnostics-and-therapy/cardiopulmonary-resuscitation-of-small-animals?autoredirectid=20436 https://www.merckvetmanual.com/endocrine-system/the-pituitary-gland/the-pituitary-gland-in-animals#Neurohypophysis_v3270703 Cardiopulmonary Resuscitation (CPR) of Small Animals: Comprehensive Overview for BCSE Test Definitions and Terminology • Cardiopulmonary Resuscitation (CPR): Emergency procedure to maintain circulatory flow and oxygenation during cardiac arrest. • Basic Life Support (BLS): Initial emergency care including chest compressions and ventilation. • Advanced Life Support (ALS): Involves drug administration, ECG monitoring, and defibrillation. Causative Agents and Conditions Requiring CPR • Cardiac Arrest: Caused by arrhythmias, hypoxia, trauma, severe electrolyte imbalances, or underlying diseases. Symptoms and Clinical Signs • Absence of Pulse and Breathing: Sudden collapse, unresponsiveness, cyanosis. Diagnostics and Monitoring • Electrocardiogram (ECG): Determines cardiac rhythm. • Capnography: Measures end-tidal CO2 for assessing CPR quality and return of spontaneous circulation (ROSC). Basic Life Support (BLS) Steps 1. Airway: Ensure the airway is clear. 2. Breathing: Provide positive-pressure ventilation. 3. Circulation: Perform chest compressions. • Compression Rate: 100-120 compressions per minute. • Compression Depth: 1/3 to 1/2 the width of the chest. • Compression-to-Ventilation Ratio: 30:2 for single rescuer; 15:2 for two rescuers. Advanced Life Support (ALS) Steps 1. Defibrillation: For ventricular fibrillation or pulseless ventricular tachycardia. 2. Drug Administration: • Epinephrine: 0.01 mg/kg IV every 3-5 minutes. • Atropine: For bradycardia/asystole, 0.04 mg/kg IV. • Lidocaine: For ventricular arrhythmias, 2 mg/kg IV. 3. Fluids: Isotonic crystalloids for volume expansion. Post-Resuscitation Care • Monitoring: Continuous ECG, blood pressure, oxygenation. • Supportive Care: Mechanical ventilation, fluid therapy, temperature regulation. Possible Complications • Rib Fractures: Due to chest compressions. • Organ Damage: From inadequate perfusion or trauma. • Neurological Sequelae: From prolonged hypoxia. Key Points for BCSE Test • Understand CPR Protocols: BLS and ALS steps, drug doses, and indications. • Diagnostic Tools: ECG and capnography interpretations. • Post-Resuscitation Care: Monitoring and supportive treatments. • Complications and Management: Recognize and address CPR-related injuries.

Answer 68

Answer: Chloramphenicol Chloramphenicol is associated with bone marrow suppression/ aplastic anemia in humans, and is PROHIBITED IN FOOD ANIMALS. Use with extreme caution in small animals due to the risk of inadvertent human exposure and potentially fatal aplastic anemia. Note that trimethoprim-sulfa, a sulfonamide antimicrobial, is associated with hemolytic anemia and bone marrow suppression in dogs. Link: Phenicols Use in Animals https://www.merckvetmanual.com/pharmacology/antibacterial-agents/phenicols-use-in-animals?autoredirectid=19878 Link: Sulfonamides and Sulfonamide Combinations Use in Animals https://www.merckvetmanual.com/pharmacology/antibacterial-agents/sulfonamides-and-sulfonamide-combinations-use-in-animals?autoredirectid=19879 Phenicols Use in Animals General Properties • Chloramphenicol: Neutral nitrobenzene derivative, lipid-soluble, stable, available as free base or esters (e.g., palmitate, sodium succinate). • Thiamphenicol and Florfenicol: Modified structures with improved efficacy and reduced toxicity. Florfenicol includes a fluorine molecule to decrease resistance. Antimicrobial Activity • Mode of Action: Inhibits microbial protein synthesis by binding to the 50S ribosomal subunit, impairing peptidyl transferase activity. • Bacteriostatic: Usually, but can be bactericidal at high concentrations. Bacterial Resistance • Chloramphenicol Resistance: Plasmid-mediated via chloramphenicol acetyltransferase (cat gene), enzymatic inactivation, permeability blocks, and altered ribosomal binding sites. • Florfenicol: Resistance reduced by structural modifications preventing acetylation. Pharmacokinetics • Absorption: Rapid from GI tract in nonruminants; delayed for ester forms. IM and IP injections also used. • Distribution: Extensive tissue penetration, high concentrations in kidneys, liver, bile, CSF, aqueous humor, and milk. • Biotransformation: Primarily hepatic metabolism through glucuronide conjugation. • Excretion: Mainly renal; also biliary with enterohepatic cycling. Therapeutic Indications and Dosage • Chloramphenicol: Systemic and local infections, especially against MRSA, Salmonella, Pasteurella, Mycoplasma, and Brucella. • Florfenicol: Approved for bovine respiratory disease, used in cattle, swine, and fish. Special Clinical Concerns • Adverse Effects: Bone marrow suppression, gastrointestinal disturbances, potential delayed healing, reproductive effects in rats. • Drug Interactions: Inhibits microsomal enzymes, prolonging effects of concurrent drugs. Avoid combination with macrolides and lincosamides. • Laboratory Interferences: Increases in alkaline phosphatase activity and prothrombin time, decreases in blood cell counts. • Drug Withdrawal: Strict regulations for food-producing animals; specific withdrawal times vary by country.

Answer 69

Answer: Naloxone Use naloxone, a pure opioid antagonist, to reverse oxymorphone. Naloxone is effective at all the opioid receptors (mu, kappa, and delta) but has a greater activity at the mu receptor. Yohimbine, an alpha-2 antagonist, is used primarily to reverse the effects of xylazine. Atipamezole, also an alpha-2 antagonist, reverses alpha-2 agonists such as medetomidine and dexmedetomidine. Flumazenil reverses benzodiazepines. Diamorphine is heroin. https://www.merckvetmanual.com/toxicology/toxicities-from-human-drugs/toxicities-from-illicit-and-abused-drugs

Answer 70

Anewer: Lower starting dose than other long-acting insulins The starting dose for detemir in dogs is lower than for other long-acting insulins. Detemir is a human insulin analog. There is a increased risk of hypoglycemia with detemir, and due to lower dosing recommendations is typically not used in dogs <10 kg. Typical starting dose is 0.1 units/kg subcutaneously every 12 hours.

Answer 71

Answer: Clotting factors. Paracrine means hormones or agents are released locally and act on nearby tissues. Clotting factors and histamine are examples of paracrine agents. Exocrine glands release hormones into ducts. Think of digestion (e.g., salivary glands, stomach, liver, pancreas) as well as sweat glands and mammary glands. Endocrine glands release hormones into blood (e.g., pituitary, adrenal, and thyroid glands).

Answer 72

Answer: 40mL/kg Plasma contains albumin, globulins, coagulation factors, and antithrombin. Administer 40 mL/kg of plasma to raise the blood albumin by 1 gm/dL, which is often expensive and inefficient since it is necessary to use such large volumes. For example, a 30-kg dog with a blood albumin of 1.4 mg/dL would require 1.2 L of plasma to raise the blood albumin to 2.4 mg/dL. Ideally, treat hypoalbuminemia with a purified albumin product, such as canine serum albumin or human albumin. This limits the volume administered and ensures the patient is not receiving unnecessary proteins (e.g., coagulation factors or globulin). The same 30-kg dog would require 540 mL of 5% canine serum albumin to increase the blood albumin to 2.4 mg/dL. However, in some circumstances plasma is the best option. The dose of plasma to treat secondary coagulopathies is 10-15 mL/kg. Here is a good article from VetGirl about plasma administration. Link: Coagulation Protein Disporders in Animals. https://www.merckvetmanual.com/circulatory-system/hemostatic-disorders/coagulation-protein-disorders-in-animals Coagulation Protein Disorders in Animals Overview • Hemostasis: Involves vascular response, platelet plug formation, and coagulation cascade. • Coagulation Cascade: Series of enzymatic steps leading to fibrin clot formation. Common Disorders 1. Hemophilia A: Deficiency in Factor VIII. • Clinical Signs: Prolonged bleeding, hematomas, hemarthrosis. • Diagnosis: Coagulation assays (PTT). 2. Hemophilia B: Deficiency in Factor IX. • Similar presentation to Hemophilia A. • Diagnosis: Specific Factor IX assays. 3. Von Willebrand Disease (vWD): Deficiency or dysfunction of von Willebrand factor (vWF). • Types: Type I (partial deficiency), Type II (qualitative defect), Type III (complete absence). • Clinical Signs: Mucosal bleeding, epistaxis, prolonged bleeding. • Diagnosis: vWF antigen test, platelet function tests. 4. Vitamin K Deficiency: Affects synthesis of Factors II, VII, IX, and X. • Causes: Dietary deficiency, malabsorption, rodenticide toxicity. • Clinical Signs: Bleeding tendencies, hemorrhage. • Diagnosis: Prolonged PT and PTT, response to vitamin K therapy. Diagnosis and Testing • Coagulation Profiles: Prothrombin time (PT), activated partial thromboplastin time (aPTT). • Specific Factor Assays: Identify specific deficiencies. • Genetic Testing: For hereditary disorders. Treatment • Replacement Therapy: Administration of deficient clotting factors (e.g., cryoprecipitate for Hemophilia A, plasma for Vitamin K deficiency). • Supportive Care: Blood transfusions, antifibrinolytics. • Prevention: Avoidance of trauma, careful surgical planning, prophylactic treatment. https://vetgirlontherun.com/ffp-vetgirl-veterinary-ce-blog/ 1. Fresh Frozen Plasma (FFP) • Harvested from fresh whole blood, frozen at -18°C within 8 hours. • Contains all coagulation factors, viable for 1 year at -30°C. • Treats coagulation factor deficiencies: liver disease, rodenticide toxicity, hereditary coagulopathies. • Dose: 10-15 mL/kg. 2. Frozen Plasma (FP) • Harvested outside the 8-hour window or used FFP beyond 12 months. • Viable for 5 years, lacks labile factors V and VIII. • Used in anticoagulant rodenticide poisoning. • Dose: 10-15 mL/kg. 3. Fresh Whole Blood • Contains red blood cells, platelets, and clotting factors. • Dose: 20-25 mL/kg. 4. Usage Considerations • Plasma products not effective for hypoalbuminemia due to low colloid osmotic pressure. • High volume (40 mL/kg) needed to raise albumin level by 0.5-1 g/dL. • Use filters during transfusion to prevent clot formation. • Not typically beneficial for immunodeficiencies or parvovirus. 5. Clinical Applications • Essential for critically ill or coagulopathic patients. • Cost-effective use of resources in appropriate clinical scenarios.

Answer 73

Answer: Cerebellum. With bilateral cerebellar lesions, think exaggerated, jerky spastic gait, head tremors, and incoordination. Unilateral lesions of the cerebellum are associated with ipsilateral dysmetria (inability to regulate movement) and paradoxical head tilt. Cerebellar signs might be confused with vestibular signs. Cerebellar ataxia = loss of ability to regulate movement: An exaggerated, jerky spastic gait and head tremors are classic cerebellar signs. Strength is fine. The resting posture of a cerebellar patient may a broad-based stance. Vestibular ataxia=loss of equilibrium/balance: In one-sided vestibular disease look for head tilt, abnormal nystagmus and circling with proprioception intact. Vestibular dysfunction may also cause ipsilateral falling. Vestibular is the only neurologic system involved with movement where the postural reactions are 100% ok. Proprioceptive ataxia = loss of awareness of position/movement of body parts. Link: Vestibular Disease in Dogs and Cats. https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951444 Link: Where is the lesion--localizing disease in the nervous system (Proceedings) https://www.dvm360.com/view/where-lesion-localizing-disease-nervous-system-proceedings Localizing Neurological Lesions 1. Neurological Examination Goals • Determine lesion location. • Identify lesion nature. 2. Functional Nervous System Overview • Motor System • Lower Motor Neurons (LMN): Found in spinal cord segments and brainstem cranial nerve nuclei (III-VII, IX-XII). • Upper Motor Neurons (UMN): Initiate and maintain movement; originate in brain and brainstem. • Sensory System • Pain Sensation: Superficial pain pathways in dorsolateral spinal cord; deep pain pathways are bilateral and multisynaptic. • Proprioception: Pathways in dorsal spinal cord; project to cerebral cortex and cerebellum. 3. Localizing Disease within CNS • Spinal Cord • C1-C5: Tetraparesis/tetraplegia, hemiparesis, respiratory weakness. • C6-T2: Thoracic limb weakness, absent spinal reflexes in thoracic limbs. • T3-L3: Ataxia, Schiff-Sherrington posture, intact segmental reflexes. • L4-S2: Pelvic limb weakness, reduced spinal reflexes. • S1-S3: Urinary/fecal incontinence, reduced perineal reflex. • Brain Stem • Cranial Nerves III-XII: Tetraparesis, proprioception deficits, potential respiratory/cardiac issues. • Vestibular System • Peripheral: Inner ear, associated with cranial nerve VIII. • Central: Brainstem and cerebellum nuclei; controls eye movement and extensor tone. • Clinical Signs: Head tilt, ataxia, nystagmus, strabismus, cranial nerve abnormalities. • Cerebellum • Functions: Coordinates movement rate and range. • Clinical Signs: Dysmetria, hypermetria, intention tremors, opisthotonus, vestibular signs. • Thalamus and Hypothalamus (Diencephalon) • Functions: Autonomic visceral functions, endocrine regulation. • Clinical Signs: Mental status changes, behavior alterations, visual deficits, endocrine disturbances. • Cerebrum • Functions: Behavior, mental status, proprioception. • Clinical Signs: Seizures, blindness, contralateral proprioception deficits, circling, stupor/coma. 4. Clinical Signs for Lesion Localization • Motor Dysfunction: Paralysis, weakness, ataxia. • Sensory Dysfunction: Anesthesia, hypesthesia, hyperesthesia, loss of reflexes. • Autonomic Signs: Incontinence, temperature regulation issues, appetite changes. • Behavioral Changes: Aggression, pacing, head pressing. 5. Diagnostic Approach • Anatomical Localization: Based on clinical signs and neurological examination. • Differential Diagnosis List: Weighted according to lesion location. • Prognostic Information: Based on severity and location of the lesion.

Answer 74

Pig Pseudorabies, also called Aujesky's disease, is caused by a herpes virus and is seen primarily in pigs. Link: Pseudorabies in Pigs https://www.merckvetmanual.com/nervous-system/pseudorabies/pseudorabies-in-pigs?autoredirectid=14329 Pseudorabies in Pigs for BCSE Test 1. Etiology • Caused by a DNA herpesvirus. • Primarily affects swine; other species can be incidentally infected. 2. Epidemiology • Transmitted via nose-to-nose or fecal-oral contact. • Indirect transmission through aerosolized virus. • Survives in various environments (nonchlorinated water, soil, feces). 3. Clinical Findings • Young piglets: CNS disease, high mortality. • Weaned pigs: Respiratory disease. • General signs: Fever, anorexia, weight loss, sneezing, dyspnea. • Nonporcine species: Sudden death, pruritus, CNS signs, fever. 4. Pathogenesis • Viral replication in nasal, pharyngeal, or tonsillar epithelium. • Spreads via lymphatics and nervous tissue to the brain. 5. Lesions • Gross: Often undetectable; serous rhinitis, necrotic tonsillitis. • Microscopic: Nonsuppurative meningoencephalitis, neuronal necrosis, necrotic bronchitis. 6. Diagnosis • Based on reproductive failure and CNS signs in piglets. • Confirmed by serology, PCR, virus isolation. • Differential ELISA distinguishes between vaccination and natural infection antibodies. 7. Treatment and Control • No specific treatment; vaccination is highly effective. • Vaccination reduces viral shedding and improves survival. • Eradication strategies: Whole-herd depopulation, test and removal, offspring segregation. 8. Key Points • Reportable disease. • Commercial pig industry in the USA is free of pseudorabies. • Effective vaccination programs.

Answer 75

Answer: Two to three weeks The interestrus interval is two to three weeks. Cats are seasonally polyestrous and induced ovulators. Estrus in the cat generally lasts seven to ten days (range one to ten days). UNlike dogs, the feline estrus cycle is controlled by day length. In North America, cats go through an anestrus period in December and January when day length is less than 12 hours. Link: Breeding Management of Dogs and Cats. https://www.merckvetmanual.com/management-and-nutrition/management-of-reproduction-dogs-and-cats/breeding-management-of-dogs-and-cats?redirectid=30630 Breeding Management of Dogs and Cats for BCSE Test General Overview 1. Reproductive Cycle in Dogs • Phases: Anestrus, Proestrus, Estrus, Diestrus. • Ovulation timing is critical for successful breeding. • Vaginal cytology and hormone assays (LH, progesterone) are key diagnostic tools. • AI techniques: Fresh, chilled, or frozen semen. Detailed Reproductive Phases in Dogs 1. Anestrus • Ovarian inactivity, uterine involution. • Low FSH and LH levels, basal estrogen and progesterone. 2. Proestrus • Attraction but no receptivity to males. • Estrogen rises, causing vaginal epithelial proliferation. • Progesterone remains low until LH surge. 3. Estrus • Receptive behavior, vulvar discharge diminishes. • Ovulation occurs post-LH surge; peak fertility. • Increasing progesterone, decreasing estrogen. 4. Diestrus • Refractory to breeding, vaginal cytology shift. • High progesterone levels, declining estrogen. • Lasts 2-3 months if non-pregnant. Luteinizing Hormone and Progesterone • LH Surge • Triggers ovulation, short duration. • Daily measurement necessary for precise timing. • Progesterone Levels • Rise correlates with LH surge. • Key for timing breedings, pregnancy confirmation. Breeding Management Techniques • Natural Breeding • Timed based on estrous cycle, LH, and progesterone levels. • Artificial Insemination (AI) • Fresh, chilled, or frozen semen used. • Accurate ovulation timing crucial for success. Feline Breeding Management • Induced ovulators; multiple matings required. • Quiet, familiar environment for mating. • Pregnancy evaluation: 21-30 days post-breeding.

Answer 76

Answer: 70-75 days An experienced practitioner can reliably feel placentomes around 70-75 days. You can reliably feel the "membrane slip" of chorioallantoic membranes rectally at 30-35 days and fremitus (vibration in uterine artery of the gravid uterine horn) between 120-150 days. One way to remember these is that the EARLIEST occurs in REVERSE alphabetical order ie: Slip 30-35 days Placentomes 70-75 days Fremitus 120-150 days

Answer 77

Answer: Intestine Binding of mu opioid receptors in the myenteric plexus, the submucosal plexus, and the longitudinal muscles of the intestine result in ileus that ultimately causes constipation. Binding of the mu receptor stimulates increased segmental contractions but decreases propulsive movement of stool aborally. Morphine may cause cramping and prolong transit time which increases water absorption in the colon and dries the feces. Constipation is not common with short term use, but patients chronically treated with gpioids should be monitored closely and treated with stool softeners and/or laxatives. Link: Analgesics Used in Animals https://www.merckvetmanual.com/management-and-nutrition/pain-assessment-and-management/analgesics-used-in-animals?autoredirectid=20977

Answer 78

Answer: 64-69 days Gestation length in cats is about 64 days from the LH surge, which is typically 24h prior to ovulation. Remember that cats are induced ovulators, and will not ovulate until breeding has occurred. Cats are seasonally polyestrous, and are "long-day breeders," which means an increased day length stimulates the estrous cycle. Feline estrus typically lasts five to eight days. Link: The Reproductive System in Animals https://www.merckvetmanual.com/reproductive-system/reproductive-system-introduction/the-reproductive-system-in-animals?redirectid=30657

Answer 79

Answer: Eyelid motor paralysis Motor paralysis (akinesia) of the eyelid. The palpebral branch of the auriculopalpebral nerve (a branch of the facial nerve) provides motor innervation to the orbicularis oculi muscle. Blockade of this nerve facilitates examination of the eye by preventing the horse from closing the eyelids. This nerve is blocked just lateral or dorsal to upper edge of the zygomatic arch; the nerve is palpable in this location. Alternatively, it can be blocked in the spot just caudal to the mandible and below the zygomatic bone. No analgesia is produced with this block alone, the patient can still feel you touching the eyelid. Desensitization of the upper 2/3 of the eyelid can be produced by blocking the frontal nerve (also called supraorbital n.) at the supraorbital foramen. Desensitization of the cornea is achieved with a topical ophthalmic anesthetic such as proparacaine. Dilation (mydriasis) of the pupil is typically produced when necessary for a fundic examination with a topical anticholinergic. Sedation may also be necessary for some horses, especially when the eye is quite painful. Remember, they can still see you coming!