Canine 2.0 Flashcards
What does enrofloxacin cause in young puppies? What age range?
Enrofloxacin causes cartilage abnormalities (bubble-like changes to articular cartilages)
Seen when given between 2-8 months
What does tetracycline antibiotics cause as a side effect in young animals?
Causes enamel hypoplasia and teeth staining in young animals
What is the Cushing’s response?
Increase in systolic mean arterial pressure …
What are CS of blastomycosis in a dog? Dx?
Which breeds are predisposed to GDV?
Large breed or giant pure bred dogs that are usually deep-chested such as Great Danes, Saint Bernards, Weimaraner, and Irish Setters
What does it mean when you find epithelial cells in a lymph node?
Not normal, usually means metasis
What is Dilated Cardiomyopathy (DCM)?
A primary myocardial disease characterized by cardiac enlargement and impaired systolic function.
DCM is the most common cardiomyopathy seen in dogs.
Which breeds are prone to develop DCM?
- Doberman
- Irish Wolfhound
- Great Dane
- St. Bernard
- Newfoundland
- Leonberger
- Boxer
- Giant Schnauzer
- Cocker Spaniel
- Flat Coat Retriever
These breeds are mainly large breed dogs.
What are early clinical signs of DCM?
- Fainting
- Lethargy
- Exercise intolerance
Many dogs are asymptomatic until they suddenly exhibit symptoms associated with heart failure.
What heart failure signs are associated with left-sided congestive heart failure?
Respiratory distress.
Left-sided heart failure leads to fluid accumulation in the lungs.
What heart failure signs are associated with right-sided congestive heart failure?
Abdominal distention from ascites.
Right-sided heart failure leads to fluid accumulation in the abdomen.
How is DCM diagnosed?
Based on echocardiography, clinical signs, auscultation, and radiographic findings.
Echocardiography will show predominantly systolic cardiac dysfunction.
What does an echocardiogram show in cases of DCM?
Predominantly systolic cardiac dysfunction (poor contractility and shortening fraction).
This is essential for diagnosing DCM.
True or False: Many dogs with DCM exhibit symptoms of heart failure immediately.
False.
Many dogs are asymptomatic until they suddenly develop symptoms.
What is Familial Arrhythmogenic Cardiomyopathy primarily seen in?
Boxers.
This condition has key features that differ from DCM.
What is a controversial treatment for subclinical dogs?
Some cardiologists recommend ACE inhibitors and/or pimobendan
What therapy should be instituted for dogs with arrhythmias?
Therapy should be instituted for dogs with arrhythmias
What are treatment options for ventricular tachycardia in Boxers and Dobermans?
- Sotalol
- Amiodarone
- Mexilitine
- Very low dose Atenolol
What is Familial Arrhythmic Cardiomyopathy also known as?
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
What type of genetic trait does Familial Arrhythmic Cardiomyopathy appear to be?
Autosomal dominant trait
What is the major clinical sign of ARVC?
Syncope
What is required for the diagnosis of ARVC?
A 24 hour Holter monitor
Why is a brief ECG insufficient for diagnosing ARVC?
It may dramatically overestimate or underestimate the frequency of VPCs
How can ARVC be classified in terms of severity?
Three levels of severity
What is the threshold for >100 VPCs in asymptomatic dogs consistent with disease?
> 100 VPCs per 24 hours or runs of couplets, triplets, or ventricular tachycardia
What warrants treatment for asymptomatic dogs with VPCs?
> 1000 VPCs per 24 hours, runs of ventricular tachycardia, or evidence of R on T
What are two treatment options for symptomatic dogs with syncope?
- Sotalol
- Combination of mexilitine and atenolol
What should be done if a poor response is seen with one treatment option for symptomatic dogs?
The other option may be more effective
How should dogs with systolic dysfunction and heart failure be treated?
As dogs with DCM
What supplement do some cardiologists advocate for dogs with heart failure?
L-carnitine
What is diabetes mellitus in dogs and cats caused by?
Inadequate insulin production or peripheral insulin resistance
Diabetes mellitus is a common endocrine problem in these animals.
What are the key clinical signs of diabetes in dogs and cats?
PU/PD, polyphagia, weight loss
Less common signs include plantigrade stance in cats and cataracts in dogs.
How is diabetes mellitus diagnosed in dogs and cats?
By documenting persistent hyperglycemia, glucosuria, and/or ketonuria.
What are the treatments for diabetes mellitus in dogs and cats?
Dietary changes and insulin.
What are the two presentations of diabetes in dogs and cats?
Healthy diabetic and severe diabetic ketoacidosis (DKA).
What are the clinical signs of a healthy diabetic?
- PU/PD
- Polyphagia
- Weight loss
- Recurrent infections
- Plantigrade stance (cats)
- Cataracts (dogs)
What are the clinical signs of severe diabetic ketoacidosis (DKA)?
- Anorexia
- Vomiting
- Weakness
- Severe metabolic acidosis
- Blood glucose > 500 mg/dl
True or False: A healthy diabetic may have a previous history of signs similar to those seen in severe DKA.
True.
What is a common blood glucose level indicating hyperglycemia?
> 300 mg/dl
Stress can cause hyperglycemia, particularly in cats.
What are the two types of glucosuria that may be present in a diabetic patient?
Glucosuria +/- ketonuria
Stress in cats can also cause glucosuria.
What are common blood-work abnormalities associated with diabetes?
- Metabolic acidosis
- Elevated liver enzymes
- Elevated cholesterol
What do ancillary tests like fructosamine and glycosylated hemoglobin reflect?
The patient’s glycemic status
What is the primary treatment for a healthy diabetic dog or cat?
Insulin injections
What percentage of cats require insulin injections?
90%
What types of insulin are acceptable for managing healthy diabetics?
- Vetsulin
- PZI
- NPH
- Lente
- Ultralente
- Glargine
How often should insulin injections typically be administered?
Twice daily
What should insulin therapy be monitored by?
Blood glucose curves
What is the purpose of monitoring insulin therapy with blood glucose curves?
To ensure sufficient potency and duration without causing a Somogyi effect
What are oral hypoglycemics used for?
To decrease insulin requirements or insulin resistance
What is the most widely used oral hypoglycemic?
Glipizide (Glucotrol)
What is the efficacy of Glipizide?
Controversial
Name two other oral hypoglycemics that are not well evaluated in dogs and cats.
- Metformin (Glucophage)
- Rosiglitazone (Avandia)
- Acarbose
What is critical for the diet of a diabetic patient?
Consistency in type of food, amount, and time of feeding
What type of diet is recommended for diabetic patients?
- High fiber
- Moderately fat-restricted
What type of diet may be beneficial for diabetic cats?
High protein and low carbohydrate diets
What is the primary treatment for severe DKA?
Aggressive IV Fluids - 0.9% saline with potassium and phosphate supplementation as needed.
What type of insulin is preferred for treating severe DKA?
Regular insulin
How can regular insulin be administered in severe DKA?
Intermittently (q 6-8 hrs) or by continuous IV infusion.
What is necessary when administering insulin for severe DKA?
Frequent blood glucose monitoring and insulin dose adjustment.
When should bicarbonate therapy be considered in DKA treatment?
If metabolic acidosis is severe and/or not improving with IV fluids.
What should be identified and addressed in patients with severe DKA?
Any concurrent infections or diseases.
What is heartworm disease in dogs caused by?
Dirofilaria immitis
Dirofilaria immitis is the scientific name for the heartworm.
Is heartworm disease more common in dogs or cats?
Dogs
Heartworm disease is less common in cats but has important differences.
What is the primary vector for the transmission of heartworm?
Mosquito
Mosquitoes transmit the L3 larvae of Dirofilaria immitis.
What is a key method for diagnosing heartworm in dogs?
Heartworm antigen test
The antigen test is effective in dogs but not all cats.
What treatment is commonly used for heartworm in dogs?
Melarsomine
Treatment with melarsomine must be done carefully to avoid complications.
What is the recommended prevention method for heartworm?
Monthly ivermectin
Ivermectin is recommended for heartworm prevention in dogs.
How long can adult Dirofilaria worms live?
3-5 years
Adult worms can grow to be 15-30 cm long and reside in the pulmonary artery.
What condition can result from the presence of Dirofilaria worms in dogs?
Right ventricular hypertrophy
The presence of worms leads to changes in the heart’s structure.
What are some clinical signs of heartworm disease in dogs?
Exercise intolerance, cough, dyspnea, ascites
These signs may be consistent with right heart failure.
What type of larvae are transmitted through mosquito bites in heartworm disease?
L3 larvae
L3 larvae are the infective stage of Dirofilaria immitis.
What bacteria has been identified in heartworms in recent years?
Wohlbachia
Wohlbachia is an endosymbiotic bacteria found in heartworms.
What are the two presentations of heartworm in cats?
Acute and Chronic
Acute presentation is due to worms dying and resulting embolism/inflammation.
List some signs of acute heartworm presentation in cats.
- Salivation
- Tachycardia
- Shock
- Hemoptysis
- Neurologic signs
- Acutely dying
These signs can indicate severe reactions to heartworm infestation.
What is HARD in cats?
Heartworm associated respiratory disease
HARD appears similar to asthma but occurs secondary to heartworm infestation.
List some clinical signs associated with chronic heartworm presentation in cats.
- Cough
- Dyspnea
- Exercise intolerance
- Vomiting
- Anorexia
- Weight loss
These signs reflect the impact of chronic heartworm infestation on a cat’s health.
What is the test of choice for diagnosing heartworm in dogs?
Heartworm antigen test
This test detects antigens from adult female worms.
What might the modified Knott’s test detect?
Microfilaria
It is less sensitive than the antigen test.
What are some diagnostic findings for heartworm in dogs?
- Right sided cardiac enlargement on thoracic radiographs
- Enlarged pulmonary arteries
- Proteinuria
- Eosinophilia
These findings can indicate heartworm infestation in dogs.
What issue may affect the heartworm antigen test in cats?
False negatives due to low worm burden or all male infections
This means a negative result does not always rule out infection.
What does the heartworm antibody test indicate in cats?
Exposure but not necessarily infection
Antibody tests can show prior exposure to heartworms.
What diagnostic tools can provide a diagnosis of heartworm in cats?
- Thoracic radiographs
- Echocardiography
These tools can help visualize heartworm presence in some cases.
On an echocardiogram, how do heartworms appear?
As a distinct ‘double lined echodensity’
This characteristic appearance helps in identifying heartworms.
What is the treatment of choice for dogs with heartworm?
Melarsomine
The American Heartworm Society recommends a split protocol for adulticide therapy.
What does the split protocol for adulticide therapy include?
A single injection followed in 4-6 weeks by 2 injections 24 hours apart
This protocol minimizes the risk of thromboembolic disease.
What bacteria found in heartworm can be treated to enhance effectiveness of heartworm treatment?
Wohlbachia
Treatment options include doxycycline, azithromycin, or rifampin.
What alternative treatment is not currently recommended by the American Heartworm Society?
Using monthly heartworm preventative and waiting for adults to die
This method is less effective compared to melarsomine treatment.
Name two historical treatments for heartworm.
Thiacetarsamide and levamisole
These treatments are no longer commonly used.
Why do cats not tolerate melarsomine well?
Cats typically have a different response to the drug
Treatment for cats is usually symptomatic.
What is the usual treatment approach for heartworm in cats?
Symptomatic treatment with heartworm preventative, bronchodilators, and/or corticosteroids
This continues until the worms die, which can take 2-3 years.
List two oral options for heartworm prevention in dogs and cats.
- Ivermectin (Heartgard™)
- Milbemycin (Sentinel™)
These are effective preventative measures.
List two topical options for heartworm prevention.
- Selamectin (Revolution™)
- Moxidectin and imidacloprid (Advantage Multi™)
These topical treatments also provide effective prevention.
What is Hemangiosarcoma (HSA)?
HSA is a malignancy of endothelial cells that line blood vessels, commonly occurring in the spleen of dogs.
What are the two forms of Hemangiosarcoma?
The two forms are visceral and cutaneous Hemangiosarcoma.
What induces cutaneous Hemangiosarcoma?
Cutaneous Hemangiosarcoma is induced by ultraviolet radiation from the sun.
Which breeds are most commonly affected by Hemangiosarcoma?
Large breed dogs such as German Shepherds, Golden Retrievers, and Labrador Retrievers are most commonly affected.
What is the most commonly affected organ in Hemangiosarcoma?
The spleen is the most commonly affected organ.
What are other commonly affected organs in Hemangiosarcoma?
Other commonly affected organs include the right atrium, liver, retroperitoneal space, and subcutaneous tissue.
What is significant about Hemangiosarcoma in relation to the brain?
It is the most common tumor to metastasize to the brain.
How do dogs often present with Hemangiosarcoma?
Dogs often present with acute hemoabdomen, hypovolemic shock, or pericardial effusion and cardiogenic shock.
What might a dog with Hemangiosarcoma experience in terms of symptoms?
Dogs may have a history of ‘good days’ and ‘bad days’ associated with small bouts of internal hemorrhaging.
How does Hemangiosarcoma metastasize?
It is highly metastatic via blood vessels and direct contact seeding within the abdomen if the tumor ruptures.
What is the median survival time for dogs with Hemangiosarcoma?
Median survival times generally do not exceed 1 year, regardless of treatment.
What diagnostic tool is used for Hemangiosarcoma?
Abdominal ultrasound is used to identify free abdominal fluid and lesions.
What does Hemangiosarcoma often appear as on an abdominal ultrasound?
HSA often appears cavitary and fluid-filled.
What is a limitation of fine needle aspirate cytology in diagnosing Hemangiosarcoma?
Fine needle aspirate cytology is often unrewarding as samples are filled with blood and the tumor is poorly exfoliative.
What is the recommended procedure for suspected splenic lesions?
Splenectomy
Recommended for lesions with a chance of rupturing, such as cavitary or large fluid-filled lesions.
What is a risk associated with incisional biopsies that do not remove the entire tumor?
Hemorrhage
Incisional biopsies include techniques like Tru-cut and punch biopsy.
What is the purpose of thoracic radiographs in the context of suspected splenic lesions?
To identify pulmonary metastasis and pericardial effusion
What is the sensitivity of cardiac ultrasound for finding cardiac masses?
Questionable unless effusion is present
Why are CT or MRI often recommended for surgical planning in cases of HSA?
They are used for tumors affecting the subcutaneous space or retroperitoneal space
What common findings can be seen in a CB, chemistry panel, and urinalysis?
Anemia, thrombocytopenia, presence of schistocytes
Anemia may occur with or without a regenerative response.
What coagulation issue may arise if there is disseminated intravascular coagulation (DIC)?
Prolonged clotting times
What should be ruled out in questionable cases of hemoabdomen?
Rodenticide toxicity
What is the initial treatment for hemoabdomen?
Resuscitate and stabilize with IV fluids and blood products
What surgical procedure is performed to address the primary tumor?
Exploratory surgery to remove the primary tumor and biopsy abnormal tissues
What chemotherapy is used to help delay the development of metastasis?
Adriamycin-based chemotherapy
What factors influence the prognosis of the splenic form of the disease?
Stage of the disease and administration of Adriamycin
What is the median survival time with surgery alone?
3 weeks to 3 months
What is the median survival time for Stage I treated with surgery and Adriamycin-based chemotherapy?
9 months
What is the median survival time for Stage II treated with surgery and Adriamycin-based chemotherapy?
5 to 6 months
What is the median survival time for Stage III treated with Adriamycin chemotherapy?
3.5 months
What is Cutaneous Hemangiosarcoma induced by?
Chronic sun exposure
This type of cancer is specifically related to prolonged exposure to sunlight.
Which breeds of dogs are at increased risk for Cutaneous Hemangiosarcoma?
- Breeds with unpigmented skin and white haircoat
- Thin short hair
- High amounts of sun exposure
- Fawn colored Pit Bulls
- Whippets
- Dalmatians
- English Pointers
These breeds are particularly vulnerable due to their coat and skin characteristics.
What are the commonly affected sites for Cutaneous Hemangiosarcoma?
- Sparsely haired areas
- Ventral abdomen
- Medial thighs
- All sun-exposed areas
These areas are more susceptible to malignant transformation.
What is the relationship between Cutaneous Hemangiosarcoma and squamous cell carcinoma?
Can occur in conjunction with solar-induced squamous cell carcinoma
This indicates that dogs with one type of skin cancer may be at risk for developing another.
How does the biological behavior of Cutaneous Hemangiosarcoma differ from visceral and subcutaneous forms?
About 1/3 may metastasize and are more likely associated with advanced, invasive forms of the disease
This highlights the severity and potential spread of this cancer type.
What is the primary treatment for invasive or problematic lesions of Cutaneous Hemangiosarcoma?
Surgery to remove invasive or problematic lesions
This is a common approach to manage the condition when it becomes severe.
What preventive measures can be taken for dogs at risk of Cutaneous Hemangiosarcoma?
- Apply sunblock
- Keep indoors during intense sunlight hours
These measures are particularly important for dogs with thin hair coats and unpigmented skin.
What is the prognosis for dogs with Cutaneous Hemangiosarcoma?
May live for years with these tumors
However, new tumors will form since all of the affected skin is abnormal.
What is hypothyroidism in dogs commonly associated with?
Older dogs
Hypothyroidism can also be congenital (cretinism) in rare cases.
What are key clinical signs of hypothyroidism in dogs?
- Weight gain
- Lethargy
- Alopecia
- Pyoderma
- Other skin changes
What is the typical initial diagnostic test for hypothyroidism in dogs?
Basal T4 levels
Additional endocrine tests are often needed for confirmation.
What is the treatment for hypothyroidism in dogs?
Synthetic thyroid hormone (levothyroxine) orally
What is the most common cause of hypothyroidism in dogs?
Lymphocytic thyroiditis
What syndrome can lead to misdiagnosis of hypothyroidism in dogs?
Euthyroid sick syndrome
What hormones does the thyroid gland synthesize?
- Thyroxine (T4)
- Triiodothyronine (T3)
What physiological effects do thyroid hormones have?
- Increase metabolic rate
- Increase oxygen consumption
- Increase heart rate
- Promote erythropoiesis
- Enhance catecholamine response
What are catabolic effects of thyroid hormones?
Effects on muscle and adipose tissue
What are common clinical signs of hypothyroidism related to skin?
- Alopecia - often bilaterally symmetric
- Pyoderma
- Hyperkeratosis
- Seborrhea
- Hyperpigmentation
What cardiovascular signs may be associated with hypothyroidism in dogs?
- Bradycardia
- Weak pulses
- Low voltage ECG complexes
What are common abnormalities found on routine blood work?
- Mild non-regenerative anemia
- Hypercholesterolemia
These abnormalities can indicate underlying health issues in dogs.
What is the preferred screening test for hypothyroidism in dogs?
Serum total T4 level
Normal ranges for serum total T4 levels can vary by laboratory.
True or False: Dogs with normal T4 levels can be considered hypothyroid.
False
Dogs with normal T4 levels are not hypothyroid.
What should be done if a dog has low T4 levels?
Confirm with at least one of the following:
* Treat any identified underlying conditions
* cTSH and free T4 by equilibrium dialysis levels
* TSH stimulation test
* Trial of T4 replacement therapy and assess response
These steps help determine if the dog is truly hypothyroid.
What results indicate hypothyroidism in dogs when checking cTSH and free T4 levels?
- Increased cTSH
- Low free T4
These results are crucial for confirming hypothyroidism.
What should be expected from a TSH stimulation test in hypothyroid dogs?
Low T4, even after TSH stimulation
This test helps to assess the thyroid’s response to stimulation.
What is the recommended treatment for hypothyroidism in dogs?
Oral administration of levothyroxine
This medication replaces the deficient thyroid hormone.
How should the dosing of levothyroxine be determined?
Based on the dog’s ideal body weight
Optimal dosing varies among dogs and requires regular evaluation of T4 levels.
What should be done after beginning levothyroxine therapy?
Evaluate T4 levels
Monitoring is essential to ensure the effectiveness of the treatment.
What can hypoadrenocorticism be described as in clinical presentations?
The Great Imitator
What are the classic signs associated with Addison’s disease?
Vague and mild clinical signs, bloodwork abnormalities, severe gastrointestinal signs, cardiac abnormalities
Name a key tip-off sign of hypoadrenocorticism.
Bradycardia in the face of cardiovascular collapse
What is the significance of a Na: K ratio < 27?
It is a key diagnostic indicator for hypoadrenocorticism
What is the diagnostic test of choice for hypoadrenocorticism?
ACTH stimulation test
What fluid is considered the best choice for rapid infusion in critical therapies for Addison’s disease?
0.9% NaCl
What is the primary cause of inadequate adrenal production in hypoadrenocorticism?
Idiopathic adrenocortical atrophy
What are glucocorticoids necessary for?
Homeostatic function and glucose regulation
What can mineralocorticoid deficiency lead to?
Inability to retain sodium, excrete potassium and hydrogen, resulting in hypotonic dehydration, hyperkalemia, and metabolic acidosis
True or False: Hypoadrenocorticism is extremely common in species other than dogs.
False
Fill in the blank: A severe episode of hypoadrenocorticism may be brought on by _______.
stress (new household member, a move, a medical procedure, etc.)
What critical therapies are used in the treatment of Addison’s disease?
Rapid infusion of fluids, treatment of severe hyperkalemia, corticosteroids
What are atypical patients with hypoadrenocorticism deficient in?
Only glucocorticoids or mineralocorticoids
What is the typical age range for dogs affected by the condition described?
3-7 years, mean 4 years old
What percentage of affected dogs are female?
70% females
Which breeds are predisposed to the condition?
- Standard Poodles (black)
- Portuguese Water Dogs
- Great Danes
- Rottweilers
- West Highland White Terriers
- Wheaton Terriers
What acute clinical signs may be observed?
- Hypovolemic shock
- Weakness
- Vomiting (may include hematemesis)
What chronic signs may worsen during stressful periods?
- Polyuria
- Polydipsia
What electrolyte imbalances are associated with this condition?
- Hyperkalemia
- Hyponatremia (Na: K ratio of < 27)
- Hypochloremia
- Hypercalcemia
- Hypoglycemia
What can pre-renal azotemia be confused with?
Renal failure
What is the specific gravity value indicative of the condition?
Low specific gravity (<1.030)
What is absent on CBC that is typically present in stress leukograms?
Stress leukogram
What are the characteristics of a stress leukogram?
- Neutrophilia
- Lymphopenia
- Monocytosis
- Eosinopenia
What lab findings indicate gastrointestinal blood loss?
- Decreased albumin from protein losing enteropathy
- Increased BUN from gastrointestinal bleeding
What cardiac abnormalities may be observed?
- Bradycardia
- ECG changes consistent with hyperkalemia (tall tented T waves, diminished to absent P waves, prolonged P-R interval, wide QRS complexes)
What findings may be seen on ultrasound?
- Megaesophagus
- Microcardia
- Small adrenal glands
What is the test of choice for diagnostic confirmation?
ACTH Stimulation Test
What cortisol levels are considered normal after ACTH stimulation?
Post-stimulation cortisol levels >10 ug/dl
What post-stimulation cortisol level is considered diagnostic?
Post-stimulation levels <2 ug/dl
What effect does administration of steroids other than dexamethasone have on the ACTH Stimulation Test?
It will invalidate the test
What is the initial treatment for acute presentation of adrenal insufficiency?
Rapid administration of fluids
60-90 ml/kg is commonly cited as a ‘shock dose’, but many prefer incremental boluses of 10-30 ml/kg.
What fluid is classically the fluid of choice in the treatment of acute adrenal crisis?
0.9% NaCl
This helps restore perfusion to organs and reduce hyperkalemia.
What is the purpose of administering calcium gluconate in cases of hyperkalemia?
Temporary cardio-protection
It may be necessary in addition to glucose, insulin, or bicarbonate to promote intracellular shift of potassium.
Which intravenous glucocorticoid is often preferred and why?
Dexamethasone SP
It will not interfere with diagnostic tests.
What is the starting dose of prednisone for chronic adrenal insufficiency treatment?
0.5 mg/kg/day
This is a supraphysiologic dose for one week before tapering down to maintenance.
What is the typical maintenance dose range for prednisone or prednisolone?
0.1-0.2 mg/kg/day
This is after starting at a supraphysiologic dose.
What should be done during times of stress regarding corticosteroid dosing?
Give 2-4X maintenance dose
This is crucial for managing stress in patients with adrenal insufficiency.
What are the options for lifetime mineralocorticoid supplementation?
Oral fludrocortisone or injectable DOCP
Fludrocortisone is given daily; DOCP is administered every 3-4 weeks.
Fill in the blank: The rapid administration of fluids helps to restore _______.
blood volume
True or False: Fluid therapy alone is always sufficient to treat hyperkalemia.
False
Cardiac abnormalities may require additional treatments.
