CANINES Flashcards
All about bitches! maybe not
Which of the following clinical signs is not consistent with discoid lupus erythematosis in dogs?
a. Alopecia and crusting the muzzle, lips, and periorbitally
b. Depigmentation of the nasal planum
c. Loss of “cobblestone” appearance of the nasal planum
d. Hyperpigmentation of ventral abdomen
d. Hyperpigmentation of ventral abdomen
Clinical signs consistent with DLE include depigmentation, erythema, scaling, and loss of the “cobblestone” appearance of the nasal planum. Alopecia, crusting, scaling, and ulcerations can also be seen on the face, muzzle, lips, pinnae, and periorbitally
You are presented with a bitch that whelped her first litter 2 weeks ago. Two of the pups have died and the remaining 2 have neurological signs, suckle poorly, and cry constantly. Which of the following choices is the primary differential diagnosis?
a. Canine herpes virus
b. Canine parvovirus
c. Neonatal septicemia
d. Transplacental roundworm infection
e. Congenital disease
a. Canine herpes virus
Canine herpes virus (CHV) rarely causes disease other than mild respiratory signs in adult dogs. However, naive newborn pups have high morbidity and mortality if infected at less than 3 weeks of age. Naive bitches should be exposed to CHV prior to breeding or the bitch and pups quarantined for 3 weeks before and after whelping. Canine parvovirus in neonates can cause vomiting, diarrhea, or acute death due to cardiovascular failure in pups 3-8 weeks old
A 2-year old male neutered cat presents to you depressed, hypersalivating, and ataxic with muscle tremors. The owner reports that a pyrethrin-based spot-on formulation for flea control belonging to their Golden Retriever was accidentally applied on the cat earlier today. Which of the following drugs will you use to treat the cat’s clinical signs?
a. Methocarbamol
b. Amoxicillin
c. Acepromazine
d. Atropine
e. 2-PAM
a. Methocarbamol
Pyrethrins alter the activity of the sodium ion channels of nerves, which prolongs the period of sodium conductance. This increases the length of depolarization resulting in repetitive nerve firing. Cats are particularly sensitive to pyrethrin-containing products and can develop clinical signs within hours after administration. Affected animals should be bathed to remove remaining product. Minor clinical signs such as hypersalivation and ear twitching are usually self-limiting and do not require treatment. Control of marked tremors or seizures can be achieved with methocarbamol (Robaxin).
A 7-year old female spayed Standard Poodle presents with weakness and lethargy. A chemistry panel shows a Na+ = 130 mEq/L (142-152 mEq/L), K+ = 6.5 mEq/L (3.9-5.1 mEq/L), BUN 55 mg/dl (8-28 mg/dl), creatinine 1.9 mg/dl (0.5-1.7 mg/dl). The test to run for a definitive diagnosis would be which of the following?
a. Electrocardiogram
b. Thoracic radiographs
c. ACTH stimulation test
d. Bile acids test
c. ACTH stimulation test
The chemistry profile above is highly suggestive of hypoadrenocorticism. An ACTH stimulation test would give a definitive diagnosis for Addison’s disease if the plasma cortisol concentration is low after ACTH administration. A bile acids test is not indicated since liver function is not in question. Thoracic radiographs may show microcardia, hypoperfused lungs, and rarely megaesophagus. ECG abnormalities would be consistent with hyperkalemia, which includes wide, flat, or absent P waves, widened QRS complexes, tall spiking T waves, and bradycardia.
A 5 year old female spayed Cocker Spaniel is presented with a strange expression. Her right ear and lip appear to drop. There is ptosis O.D. (right eye) and the dog is drooling on the exam table. What anatomic structure is damaged?
a. Facial nerve
b. Left side inner ear
c. Trigeminal nerve
d. Right side inner ear
e. Left side medulla, motor intact
a. Facial nerve
Think of facial nerve paralysis (CN 7) with a unilaterally droopy face. Remember the facial nerve is motor to the muscles of facial expression (explaining the right side dropped ear, lip and eyelid) and innervates the lacrimal and salivary glands. Loss of innervations can lead to a dry eye, and possibly to exposure keratitis if animal losses ability to close eyelid from damage to facial nerve innervation of the orbicularis oculi muscle. Idiopathic in 75% of canine cases (25% of cats) Can also see these signs with middle ear damage (from otitis media), from facial nerve trauma (ear surgery in dogs, or pressure from halter buckles in anesthetized horse), or neoplasia Follow this link to see a horse with facial nerve damage: note the nose pulled to horse’s left. (means facial nerve damaged on right). Think more of a dropped jaw with trigenimal nerve neuropathy (CN 5-dogs, horses).
You are called out on a house-call to see the 3-year-old male Labrador Retriever shown in the photo below. He presents for bilateral periocular edema (see photo) and facial pruritus. This has been a recurrent problem for the last 4 months. The owners reported the dog would be normal for several days, and then acutely develop the periocular swelling and itching. These episodes always happened while the dog was inside the house.
The previous episodes would last for several hours, and then the edema would resolve en route to the veterinary clinic. After each episode, the dog had some residual periocular or facial pruritus for 1-2 days.
You perform conjunctival swabs and aspirates of the edematous area which reveal large numbers of eosinophils.
What is the most likely underlying cause of the dogs signs?
a. Bacterial infection
b. Parasitism
c. Hypersensitivity
d. Autoimmune disorder
e. Neoplasia
c. Hypersensitivity
Edema as you see here is a common clinical sign of a type I hypersensitivity reaction or allergy. The intermittent nature of the episodes suggests some type of allergic reaction, most likely infrequent contact with a potent allergen to which the dog has become sensitized. An underlying allergic etiology is further supported by the presence of eosinophils.
Identifying the underlying allergy in cases like this one can be challenging, and a thorough history and investigation of the dog’s environment is warranted.
The other answer choices presented are less consistent with the recurrent and sudden clinical signs that are repeatedly observed.
A 12-year-old mixed breed female spayed dog presents with a several-month history of lethargy, hair loss, and greasy skin. The patient’s face, feet, and tail are not clinically affected and she is mildly pruritic. This photomicrograph shows the results of impression cytology obtained from the patient. What is the most likely name of the organism pictured?
a. Staphylococcus pseudointermedius (Staphylococcus intermedius)
b. Malassezia globosa
c. Malassezia pachydermatis
d. Staphylococcus hyicus
a. Staphylococcus pseudointermedius (Staphylococcus intermedius)
Intracytoplasmic cocci from a dog’s skin are most likely Staphylococcus pseudintermedius (formerly called Staphylococcus intermedius), which is the species host-adapted to canines. Staphylococcus hyicus is host-adapted to pigs, so is less likely to be isolated from a dog. Malassezia (yeast) organisms are much larger than cocci and are not observed within the cytoplasm of neutrophils.
A 3-year old West Highland White Terrier presents for flea allergic dermatitis. The owner is concerned because she is on an appropriate adulticide and insect growth regulator, but live fleas are still being found on the patient. Additionally, the dog also has moderate signs of flea allergy dermatitis; papular/pustular dermatitis in the lumbosacral region. Why might the treatment be failing?
a. Owner is not applying the product properly and not treating the environment
b. Owner is not treating the environment
c. Owner is not applying the product properly
d. Owner is not applying the product properly and is not treating other pets in the household
e. Owner is not applying the product properly, owner is not treating the environment, and other pets in the household are not on flea control
f. Other pets in the household are not on flea control
e. Owner is not applying the product properly, owner is not treating the environment, and other pets in the household are not on flea control
This question is a review of the most common reasons for failure of a flea product to work. Education is extremely important when starting flea treatment. Always question how the owner applies the product, whether the environment is being treated, and make sure all pets in the household are undergoing treatment. One is often surprised how many owners apply topical products just to the hair of their animals. Many owners (and veterinarians) blame lack of response to resistance against flea adulticides; however, it is much more likely (in the majority of cases) that it is due to one of these 3 listed reasons.
A four-year old Labrador Retriever presents with an aural hematoma of the right ear. Given the cytological findings from an ear swab as seen in this image, which one of the following ear cleaning combinations will you not send home with your patient?
a. Mometasone, gentamicin, clotrimazole
b. Thiabendazole, neomycin, and dexamethasone
c. Gentamicin, betamethasone valerate, and clotrimazole
d. Neomycin, bacitracin, and polymyxin B
d. Neomycin, bacitracin, and polymyxin B
This patient has a high number of malassezia yeast visualized on cytology. This organism can be responsible for perpetuating otitis externa. It is not unusual to see yeast in the ear canal of a dog; however, yeast numbers of greater than 5 per high powered field can be considered abnormal.
Other clinical signs of otitis externa may include ear pain, pruritis, aural discharge, bad odor, and neurologic signs.
Effective treatments for uncomplicated otitis externa typically contain an antifungal, antibiotic, and an anti-inflammatory. Since this dog primarily has a yeast infection it is imperative that the ear medication prescribed has an anti-fungal. The answer choices provided are commonly known as triple antibiotic ointment (neomycin, bacitracin, and polymyxin B), Tresaderm (thiabendazole, neomycin, and dexamethasone), Mometamax (mometasone, gentamicin, clotrimazole), and Otomax (gentamicin, betamethasone valerate, and clotrimazole). Note that the triple antibiotic ointment does not contain an anti-fungal.
Additionally, the ears should be cleaned before applying the ear medication. Many ear cleaners contain antifungals too (Triz Ultra + Ketoconazole), which may enhance treatment response.
Demodicosis often coincides with bacterial infections. On a recheck examination of an 8-month old pit bull with demodicosis you find swelling and furunculosis over the lateral thighs that is draining serosanguinous fluid. Cytology of the fluid reveals 4+ cocci, and you diagnose a deep bacterial pyoderma. You culture the lesion and start Clindamycin based on the culture results. The dog returns in four weeks for another recheck examination. No bacteria are found on cytology, and clinically the dog looks excellent. You repeat a skin scrape and find Demodex mites. You inform the owner to continue Ivermectin. What should you do regarding continuation of antibiotics?
a. Continue the antibiotics for another 2 weeks
b. Discontinue the antibiotics, since cytology was negative and the clinical signs have resolved
c. Continue the antibiotics until the demodex has resolved
d. Perform another culture and if positive keep treating; if negative discontinue antibiotics
a. Continue the antibiotics for another 2 weeks
Deep pyodermas involve tissues deeper than the epidermis including the dermis and even subcutis. Most often deep infections have resulted from an uncontrolled superficial infection. Deep lesions usually heal on the surface before the deeper infection is resolved; making clinical cure difficult to assess. Therefore, antibiotic treatment should be continued for 7-21 days after the tissues return to normal. In general, deep infections can require 6-8 weeks of antibiotic treatment and even 12 weeks for severe cases. Superficial infections require 3-4 weeks of antibiotic therapy or one week past clinical resolution.
Culture results will often be positive in normal dogs since normal dogs will have bacteria on their skin surface and in hair follicles. It is better to manage based on clinical signs. Cytology can miss deeper infections and it is better to extend antibiotic treatment even if cytology is negative.
It is not necessary to continue the antibiotics until resolution of demodicosis. Keep in mind that many Demodex patients will require several months of treatment. It is better to prevent recurrence of bacterial infections with topical therapy such as benzoyl peroxide shampoos.
Microsporum canis, Trichophyton mentagrophytes, and Microsporum gypseum are the three most common dermatophytes affecting dogs and cats. It is important to obtain fungal cultures and determine the species since the above species have different sources of infection. Knowing the source of the infection is critical to determining an appropriate treatment plan. Please match the following dermatophyte species with its primary source of infection.
a. Microsporum canis (dogs); Microsporum gypseum (plants), Trichophyton mentagrophytes (rodents)
b. Microsporum canis (cats); Microsporum gypseum (soil), Trichophyton mentagrophytes (soil)
c. Microsporum canis (cats); Microsporum gypseum (rodents), Trichophyton mentagrophytes (dogs)
d. Microsporum canis (dogs); Microsporum gypseum (soil), Trichophyton mentagrophytes (cats)
e. Microsporum canis (cats), Microsporum gypseum (soil), Trichophyton mentagrophytes (rodents)
e. Microsporum canis (cats), Microsporum gypseum (soil), Trichophyton mentagrophytes (rodents)
Microsporum gypseum is geophilic (meaning that it loves to grow in soil). This species often affects dogs that like to dig. Trichophyton mentagrophytes is zoophilic and usually rodents serve as the host; dogs such as hunting dogs or roaming cats are most commonly affected. Microsporum canis is most commonly contracted from cats. It is extremely important to know which species of dermatophyte is causing the infection in order to prevent re-exposure. For example, in dogs with Microsporum gypseum, preventing them digging in the yard is going to be an important part of the treatment plan.
A 5-year old male neutered German Shepherd presents with a history of nasal dermatitis. Previous treatment with a 2-week course of antibiotics and prednisone resulted in partial improvement of the lesions followed by recurrence. On physical examination, you see the lesions on the nasal planum and oral mucosa shown in the images.
You perform a biopsy, and histopathology shows clefts characterized by residual basal keratinocytes remaining attached to the basement membrane zone and having a “tombstone” appearance. The intact primary bullae are non-inflammatory, but there is mononuclear inflammation of the superficial dermis. IgG and complement deposition between keratinocytes at all levels of the epidermis is present. The histologic diagnosis is pemphigus vulgaris. Which of the following is appropriate information to give the client regarding the treatment AND prognosis for this condition?
a. Treatment with fluconazole and/or clotrimazole is recommended and the long-term prognosis is good for most dogs
b. 0.1-0.5 mg/kg of prednisolone twice daily with possible addition of azathioprine is recommended and the long-term prognosis is good for most dogs
c. Treatment with 0.1-0.5 mg/kg of prednisolone twice daily with the possible addition of topical tacrolimus is recommended and the long-term prognosis is good for most dogs
d. 2-4 mg/kg of prednisolone twice daily with possible addition of azathioprine is recommended but the long-term prognosis is poor
e. 2-4 mg/kg of prednisolone and concurrent treatment with retinoids is recommended but the long-term prognosis is poor
d. 2-4 mg/kg of prednisolone twice daily with possible addition of azathioprine is recommended but the long-term prognosis is poor
Pemphigus vulgaris is an autoimmune disorder causing vesicles, ulceration, and crusting. It can affect the whole body, but it especially affects the mucocutaneous junctions and oral mucosa. The onset of the disease can be sudden (acute) or gradual over many weeks (chronic).
The disorder is caused by an IgG autoantibody that binds to intracellular adhesion molecules (desmoglein) causing a loss of cohesion between keratinocytes resulting in acantholysis, vesicle formation, and eventually ulceration.
The treatment is immunosuppressive therapy with corticosteroids and frequently additional immunomodulatory or immunosuppressive drugs such as azathioprine, cyclophosphamide, chlorambucil, or others. Unfortunately, long-term therapy is generally required and these treatments cause serious side-effects long-term. Prognosis is poor and euthanasia is often performed.
A 5-month-old pit bull puppy presents for a small area of hair loss. The lesion is well-demarcated, and the dog is not pruritic. Upon examination, you notice mild crusting around the lesion. You perform skin cytology and no bacteria or yeast is observed. Skin scrape reveals a few cigar-shaped mites. What is your next step?
a. Initiate therapy with Ivermectin
b. Initiate therapy with Amitraz dips
c. Benign neglect and monitor the lesions
d. Initiate therapy with Lyme sulfur dips
c. Benign neglect and monitor the lesions
Localized, juvenile onset demodicosis usually resolves without treatment as the immune system develops. Because this patient only has a small area of alopecia and few mites, starting therapy with Ivermectin and Amitraz dips is pre-mature. Both these therapies have marked side effects. Ivermectin causes neurological signs, and Amitraz can cause allergic reactions, hypothermia, bradycardia, and hyperglycemia (especially in small puppies). Lyme sulfur dips are not effective against follicular Demodex mites (as found in dogs). Demodex gatoi is found in cats and is a superficial mite that can be treated with Lyme sulfur.
A 2-year-old neutered male greyhound presents for crusting along his ear pinnae and elbows. The owner also explains that the dog is intensely pruritic. The dog mainly lives indoors but is also let outside into the backyard. The owner lives on a large rural property that is heavily wooded. You perform cytology, which returns negative for bacteria and yeast. You are highly suspicious of Sarcoptes. Which of the following would be most useful to help in your diagnosis of Sarcoptic mange?
a. Pinnal-pedal reflex, clinical signs, superficial skin scrape
b. Deep skin scrape, pinnal-pedal reflex, clinical signs
c. Clinical signs, superficial skin scrape, trichogram
d. Histopathology, deep skin scrape, trichogram
e. Superficial skin scrape, histopathology, trichogram
a. Pinnal-pedal reflex, clinical signs, superficial skin scrape
A superficial skin scrape is most useful. A deep skin scrape is used for Demodex mites, which reside in the hair follicles. Superficial skin scraping is indicated for Sarcoptic mange, since this mite lives in the stratum corneum. Pinnal-pedal reflex can be positive in 70% of Sarcoptic mange infestation but can also be positive in any dog with pruritus. Clinical signs are helpful because Sarcoptes typically infects the non-haired portions of the skin such as the ear pinnae, elbows, hocks, and ventral abdomen. If the mite is not found on skin scraping and you have clinical signs indicative of Sarcoptes then a therapeutic trial is warranted. Keep in mind that in most cases you will not be able to find the mite.
A trichogram would not be indicated. This method can be used to diagnose dermatophytosis and sometimes Demodex. Histopathology will reveal a perivascular dermatitis that is non-specific. Rarely are the mites found on histopathology.
A 5 year old, male neutered, West Highland White Terrier presents for the skin lesions seen in the picture below. He has a history of lethargy and poor appetite. The lesions partially responded to antibiotics initially, but then began to progress again. You take a biopsy of the skin which shows cutaneous blastomycosis. What is the next most important diagnostic test?
a. Blastomyces antibody titer
b. Abdominal radiographs
c. Thoracic radiographs
d. Deep skin scraping
d. Blastomyces antigen test
c. Thoracic radiographs
Blastomycosis is caused by a dimorphic fungus and generally occurs in the Missouri, Mississippi, Tennessee, and Ohio river valleys. Pulmonary involvement occurs in the majority of cases, so thoracic radiographs are an important step to staging the patient. Other organs that can be affected include the lymph nodes, eyes, bones, central nervous system, and urinary tract.
Abdominal radiographs are not very sensitive to detect involvement with internal organs. Abdominal ultrasound, if available, would be preferred over abdominal radiographs.
Antibody tests are neither sensitive nor specific and are not very useful once a diagnosis is already made.
What breed of dog develops a dermatosis that seems to be related to a relative Zinc deficiency?
a. Siberian Husky
b. Bull dog
c. Cocker Spaniels
d. Shetland Sheepdog
a. Siberian Husky
This syndrome has also been seen in Alaskan Malamutes. They develop a crusting skin disease referred to as Zinc Responsive Dermatosis, where there is scaling, crusting, and alopecic dermatitis most frequently around the eyes, ears, prepuce, scrotum and vulva.
Absolute dietary deficiency of Zinc is rare. Zinc responsive dermatosis is related to defective intestinal absorption of Zinc. Oral Zinc supplementation can bring rapid resolution in most patients.
A 5-year old West Highland White Terrier presents for seborrhea oleosa and pruritus. You perform skin scrapes and a cytology and diagnose Malassezia dermatitis. Which of the following is the best treatment option?
a. Ketoconazole
b. Cephalexin
c. Griseofulvin
d. Carprofen
e. Prednisone
a. Ketoconazole
This medication, along with other -azoles (fluconazole, itraconzole), are commonly prescribed treatments for Malassezia. Terbinafine is another antifungal medication that is becoming more popular for the treatment of Malassezia and dermatophytosis. Although, Griseofulvin is an antifungal it is not effective against Malassezia. Prednisone and carprofen may help with inflammation, but not clear the infection.
A 2-year old female spayed Dachshund presents for further evaluation as a result of a mass on the pinna noted by the owner. On physical exam, the only abnormality noted was this mass. Cytology is consistent with a histiocytoma. Which of the following is the most reasonable treatment option?
a. Chemotherapy using lomustine
b. Radiation therapy
c. Benign Neglect
d. Cryotherapy
e. Radical surgical excision
c. Benign Neglect
Histiocytomas are typically benign and will often present as a small, raised mass that may or may not be ulcerated. Fortunately, these masses usually regress on their own, and surgical or medical intervention is typically not necessary.
A 5-year old female Golden Retriever presents for lethargy, dark runny stool, and dehydration. Bloodwork from yesterday showed markedly elevated plasma endogenous ACTH levels, K+ = 6.2 (3.9-5.1 mEq/L), Na+ = 135 (142-152 mEq/L), BUN = 62 mg/dl (8-28 mg/dl). Long-term maintenance therapy for this patient should most likely include:
a. Supplementation with physiologic doses of prednisone
b. IV fluids and daily doses of IV dexamethasone sodium phosphate
c. Mineralcorticoid, glucocorticoid, and NaCl supplementation
d. Mineralcorticoid supplementation alone
c. Mineralcorticoid, glucocorticoid, and NaCl supplementation
This dog has hypoadrenocorticism which is usually a deficiency in both glucocorticoids and mineralocorticoids. Elevated endogenous plasma ACTH concentrations with hypoadrenocorticism means the disease is due to primary adrenocortical insufficiency and failure to produce both types of corticosteroids (as opposed to secondary adrenocortical insufficiency, when the pituitary does not produce sufficient ACTH). Maintenance treatment of this disease includes supplementation with mineralocorticoids (e.g. Fludrocortisone acetate), glucocorticoids (e.g. Prednisone), and sodium chloride in the diet. IV fluids and dexamethasone sodium phosphate is used in an acute crisis.
Which is not a consequence of insulin deficiency in diabetes mellitus in a dog?
a. Weight gain leading to obesity
b. Increased mobilization of fat
c. Increased hepatic gluconeogenesis
d. Impaired energy utilization
e. Hepatic lipidosis and ketosis
a. Weight gain leading to obesity
Insulin deficiency causes weight loss, not weight gain. An insulin-deficient dog is essentially starving the cells of its body. Its energy utilization is impaired because it can’t import glucose into its cells. In response to the decreased energy in the body’s cells, the liver upregulates gluconeogenesis and glycogenolysis, exacerbating the hyperglycemia. The mobilization of fat is increased to supply the body with an alternative energy source. As adipocytes are broken down, the resulting free fatty acids are imported to the liver where they are converted to energy, triglycerides (which are stored in the liver causing hepatic lipidosis), and ketones (causing ketosis).
Which of the following is true of canine hypothyroidism?
a. It more commonly occurs in older, large breed dogs
b. It causes a voracious appetitie leading to weight gain
c. It causes thinning and increased fragility of skin
d. It can cause calcinosis cutis
a. It more commonly occurs in older, large breed dogs
Canine hypothyroidism can cause many skin changes including hyperpigmentation, alopecia, pyoderma, and seborrhea, but thinning and increased fragility of the skin does not occur. This is more consistent with hyperadrenocorticism, or Cushing’s disease. Calcinosis cutis is also a clinical sign of Cushing’s disease. Weight gain does occur with hypothyroidism due to a slower metabolism. Affected animals usually do not have a voracious appetite.
A 7-year old female Standard Poodle presents to you for acute onset of vomiting and weakness after the owners returned from vacation. On physical exam, you estimate that the dog is 7% dehydrated, has a respiratory rate of 36 breaths per minute, heart rate of 44 beats per minute and temperature of 99 degrees F. You quickly attach ECG leads and expect to see which of the following abnormalities?
a. Ventricular tachycardia
b. Tall, narrow QRS complexes
c. No P waves
d. Inverted T waves
c. No P waves
Based on the history and the physical exam findings of dehydration and bradycardia, you should be concerned about hypoadrenocorticism. Hypoadrenocorticism patients are typically hyperkalemic. ECG abnormalities with hyperkalemia include wide, flat, or absent P waves, widened QRS complexes, tall spiking T waves, and bradycardia.
A 7-year old female spayed Golden Retriever that you suspect has Addison’s disease has bloody diarrhea, inappetance, and is dehydrated. What should be your next step?
a. Give IV dexamethasone and subcutaneous fluids
b. Start aggressive IV fluid therapy and run chemistry panel
c. Give Lysodren
d. Run a chemistry panel and perform an abdominal ultrasound
b. Start aggressive IV fluid therapy and run chemistry panel
Addisonian patients often present in hypovolemic shock, so the first step to treating this dog is to restore vascular volume with IV fluids and to run a chemistry panel to check the extent of electrolyte abnormalities (hyponatremia, hyperkalemia, and elevated BUN). IV dexamethasone would not take precedence over restoring vascular volume, and subcutaneous fluid treatment is not aggressive enough for treatment of hypovolemia. Abdominal ultrasound would not be a priority in this case but could eventually be helpful in ruling in/out other differentials.
Lysodren is used for treating hyperadrenocorticism. One possible complication of Lysodren treatment is to make a dog Addisonian, which often causes the animal to present with the signs described as in the question.
A dog presents to you with suspected hyperadrenocorticism. You would like to try to diagnose and differentiate between pituitary dependent and adrenal dependent hyperadrenocorticism with one test. Which of the following tests for hyperadrenocorticism is primarily a screening test, but can also be a differentiating test?
a. ACTH stimulation test
b. High dose dexamethasone supression test
c. Endogenous ACTH level
d. Low dose dexamethasone suppression test
e. Urine cortisol:creatinine ratio
d. Low dose dexamethasone suppression test
The 8-hour post-dexamethasone sample is used to determine if the pet has hyperadrenocorticism. If the 8-hour sample is above 1.4 ug/dL, the test is diagnostic for hyperadrenocorticism (either pituitary dependent or adrenal dependent). If the 4-hour sample is below 1.4 ug/dL or less than half of the baseline value, it is diagnostic for pituitary dependent hyperadrenocorticism.
The urine cortisol:creatinine ratio is a screening test to rule out hyperadrenocorticism, if it is normal. The endogenous ACTH level and high dose dexamethasone suppression tests are differentiating tests only. An ACTH stimulation test is a screening test but cannot differentiate pituitary versus adrenal dependent hyperadrenocorticism.
A 5-year old male mixed breed dog presents with polyuria, polydipsia, polyphagia, and weight loss. The most likely diagnosis is ______.
a. Exocrine pancreatic insufficiency
b. Diabetes mellitus
c. Hyperadrenocorticism
d. Hypothyroidism
b. Diabetes mellitus
Diabetes mellitus is the most likely diagnosis of those listed above. The 4 classic signs of DM are PU, PD, PP, and weight loss.
EPI patients have PP and weight loss but are not PU and PD. Hyperadrenocorticism patients have PU, PD, and PP, but do not lose weight. None of the clinical signs described are consistent with hypothyroidism in a dog.
Which is not a consequence of insulin deficiency in diabetes mellitus in a dog?
a. Weight gain leading to obesity
b. Impaired energy utilization
c. Hepatic lipidosis and ketosis
d. Increased hepatic gluconeogenesis
e. Increased mobilization of fat
a. Weight gain leading to obesity
Insulin deficiency causes weight loss, not weight gain. An insulin-deficient dog is essentially starving the cells of its body. Its energy utilization is impaired because it can’t import glucose into its cells. In response to the decreased energy in the body’s cells, the liver upregulates gluconeogenesis and glycogenolysis, exacerbating the hyperglycemia. The mobilization of fat is increased to supply the body with an alternative energy source. As adipocytes are broken down, the resulting free fatty acids are imported to the liver where they are converted to energy, triglycerides (which are stored in the liver causing hepatic lipidosis), and ketones (causing ketosis).
What is the primary goal in the initial treatment of diabetic ketoacidotic dogs?
a. Lowering the elevated blood glucose
b. Controlling obesity or concurrent disorders causing insulin resistance
c. Correction of acidosis, electrolyte abnormalities, and hyperosmolality
d. Getting the animal to eat
c. Correction of acidosis, electrolyte abnormalities, and hyperosmola
Initial treatment of DKA patients is aimed at correcting acidosis by administering bicarbonate (if the total bicarbonate is markedly low), correcting electrolyte abnormalities with IV fluids, potassium and phosphorus supplementation, and correction of hyperosmolality. Regulating blood glucose, getting the animal to eat, controlling obesity and concurrent disease should be addressed after immediate life-threatening issues are resolved.
A 7-year old, male, castrated shepherd mix presents for polyuria and polydipsia. The physical exam reveals a body condition score of 4/9 and 5% dehydration. The urine specific gravity is 1.006. The urinalysis, chemistry panel, and CBC are otherwise unremarkable. Which of the following is the most likely diagnosis?
a. Central diabetes insipidus
b. Fanconi syndrome
c. Chronic renal failure
d. Diabetes mellitus
a. Central diabetes insipidus
Diabetes mellitus is ruled out with a normal blood glucose on the chemistry panel and lack of glucose in the urine on the urinalysis. Chronic renal failure is ruled out because there is no azotemia on the chemistry panel. Fanconi syndrome usually occurs in Basenjis and is ruled out because there is no glucose in the urine.
A 9-year old male, neutered German Shepherd dog is presented to your clinic for evaluation of tenesmus, tail chasing, and hematochezia. Malodorous mucopurulent discharge is noted near his anus. On examination, you find multiple ulcerations around his perineum. Rectal examination reveals reduced anal tone and mucosal thickening. What are your treatment recommendations for this dog?
a. Initiate therapy with metronidazole
b. Initiate chemotherapy with the alkylating agent, melphalan, as this is the treatment of choice for anal sac adenocarcinoma
c. Initiate therapy with cyclosporine
d. Initiate broad-spectrum antibiotics to treat for an infected anal gland abscess
e. Surgically correct with a 360-degree anoplasty
c. Initiate therapy with cyclosporine
The signalment, history and clinical signs are most consistent with a perianal fistula. Although the pathogenesis is not fully understood, this disease is thought to be primarily immune-mediated. The treatment of choice for perianal fistula is medical management with cyclosporine, as resolution is achieved in greater than 65% of dogs. Surgical correction may lead to fecal incontinence or stricture formation, however surgery for removal of the anal sacs in combination with cyclosporine has recently shown promise.
If this was an anal gland abscess, lancing the abscess and drain placement with systemic antimicrobial therapy would be indicated. If you suspected this to be a cancerous process, a minimum database including CBC, chemistry, thoracic radiographs and abdominal ultrasound are recommended for disease staging. The treatment of choice for anal sac adenocarcinoma is surgical resection, followed by adjunct therapy.
Which of these is an adrenergic vasopressor in dogs?
a. Glycopyrrolate
b. Dopamine
c. Atropine
d. Hydralazine
b. Dopamine
Adrenergic vasopressors are frequently used to treat hypotension during anesthesia. Drugs in this category are dopamine, dobutamine, ephedrine, phenylephrine, and norepinephrine. Atropine and glycopyrrolate are anticholinergic drugs. Hydralazine is a vasodilator used to treat hypertension.
A 7-month-old miniature Schnauzer is presented with a history of straining to urinate. Which one of the following choices is the most likely diagnosis based on the post-contrast study?
a. Urethral tear
b. Urethral stricture
c. Normal radiographs
d. Cystic wall mass
e. Cystic calculi
b. Urethral stricture
This puppy has a urethral stricture.
There are no abnormalities involving the abdomen or urinary tract on the pre-contrast lateral radiograph. A contrast urethrogram was performed.
A Foley catheter was placed in the distal urethra and the balloon inflated. Non-ionic contrast medium was injected, and several radiographs were taken during this procedure.
There is a focal narrowing of the urethra 1cm caudal to the os penis. This narrowed area is visible on contrast projections.
Urethral strictures may form secondary to trauma or lodged calculi. The normal urethral narrows through the pelvis, then widens slightly at the prostate gland.
True narrowing or filling defects should be visible on multiple images. Air bubbles can mimic filling defects but will move to different locations in the urethra as contrast is injected
A vaccinated Pomeranian dog arrives at your clinic after biting a human. What should happen to the dog?
a. Confine the dog and observe it for 10 days
b. Euthanize the dog and test for rabies
c. Vaccinate the dog immediately and quarantine for 10 days
d. Vaccinate the dog immediately and quarantine for 45 days
e. Vaccinate the dog after 6 month quarantine
a. Confine the dog and observe it for 10 days
With a healthy, vaccinated dog, the 10 day confinement period can be carried out in the owner’s home. You would only need to euthanize and test if the dog is an unvaccinated stray. If the dog was not up-to-date on vaccinations, you would either euthanize and test or quarantine for 10 days in an approved facility.
The answer choice to vaccinate the dog immediately and quarantine for 45 days would be recommended if the dog were bitten by an animal that was rabid or suspected to be rabid.
Which of the fungal infections is considered contagious, either to other animals or to man (zoonotic)?
a. Sporptrichosis
b. Cryptococcosis
c. Aspergillosis
d. Coccidioidomycosis
e. Blastomycosis
a. Sporptrichosis
All of these fungal diseases can infect both animals and people. However, they are not considered contagious (not to be confused with infectious) with the exception of Sporothrix. This is because they are mainly acquired from the environment, and transmission from animal to animal is rare. Sporothrix, especially in cats, is a high risk to veterinarians and care should be taken to limit contact with exudates and lesions in cats.
Aspergillus is generally considered a ubiquitous fungus that causes infection due to host factors such as immunosucceptibility or certain breed predilections. Cryptococcus is also not a contagious disease (do NOT confuse this with cryptosporidium, which is very contagious and zoonotic as several of my colleagues can attest to profusely). Cryptococcus infection occurs from inhalation of the yeast from the environment, frequently avian habitats, as it survives ideally in pigeon droppings. Essentially, histoplasma, blastomyces, and Coccidioides are also all environmental diseases as well and not considered contagious.
Incidentally, there is a true story of a pathologist who did acquire Coccidioides from an animal that was having a necropsy. It is likely that the fungus reverted to the mycelial phase and produced infectious arthroconidia at the low temperatures achieved in the dead animal. This is also a risk when changing bandages for the same reason. These fungi are also potentially infectious when they are being grown on culture plates. So even though they are not technically contagious (at least in terms of how the board examiners view them), there are still risks.
Which of these drugs can cause aplastic anemia in humans?
a. Clindamycin
b. Neomycin
c. Chloramphenicol
d. Enrofloxacin
e. Sulfadiazine
c. Chloramphenicol
Even though this is a human question, this is something you do need to know for board exams. This potential side effect of chloramphenicol is why it is not allowed for use in food animals and that it is used with caution in companion animals. The person administering this drug should take precautions to avoid coming into contact with it.
Zoonotic diseases commonly carried by raccoons include rabies and ____________.
a. Trichinella
b. Toxocara
c. Echinococcus
d. Baylisascaris
d. Baylisascaris
Baylisascaris procyonis is an ascarid parasite of raccoons that causes mild signs in raccoons but can undergo aberrant migration in humans and cause fatal central nervous system signs.
A 2-year old Siberian Husky presents for crusting and scaling of his foot bads, periorbitally, and along his mucocutaneous junctions. Based on the breed and clinical signs, which supplement should be added to this dog’s diet?
a. Copper
b. Zinc
c. Vitamin E
d. Calcium
b. Zinc
Huskies are predisposed to zinc-responsive dermatosis in which individuals have a higher requirement for zinc in their diets due to a defect in abdorption of the element. Clinical signs include crusting and scaling of foot bads, elbows, eyes, and mucocutaneous junctions.
You are examining a dog for lameness and on radiographs; tiy fubd gtoertrophic osteopathy of the metacarpal bones. What is the likely cause of this lesion?
a. Pulmonary neoplasia
b. Ca deficiency
c. Vitamin D deficiency
d. Bone tumor
e. Trauma
a. Pulmonary neoplasia
Hypertrophic osteopathy is visible as periosteal proliferation in the diaphyses of affected bones. Usually the metacarpal and metatarsal bones are affected first, and it may progress to the long bones. Lameness, pain, and swelling are usually evident. Joints are unaffected. The cause is usually primary or metastatic pulmonary neoplasia, although other diseases in the thorax including bronchopneumonia, Spirocerca infection, or congestive heart failure, may also be associated. Less commonly, abdominal neoplasia may be seen with this lesion
a 6-year old male castrated Borzoi dog presnts to you with a one-year history of polyuria and polydipsia with no other clinical signs. A urinalysis confirms a specific gravity of 1.003 and no other abdnormalities
Serum chemistry shows:
Ca 10.1mg/dL (9.1-11.7mg/dL)
P: 3.2 mg/dL (2.9-5.3 mg/dL)
Bilirubin: 0.1mg/dL ((0.0-0.3mg/dL)
Albumin: 2.9g/dL (2.3-3.1 g/dL)
Globulin: 2.5 g/dL (2.7-4.4 g/dL)
ALT: 40 u/L (10-109 u/L)
Glucose: 104mg/dL (76-119mg/dL)
BUN: 8 mg/dL (8-28 mg/dL)
Creatinine: 0.6 mg/dL (0.5-1.7 mg/dL)
Cholesterol 120 mg/dL (135-278 mg/dL)
You tentatively diagnose central diabetes insipidus and elect to try the dog on desmopression (DDAVP) to see if the PU/PD resolves. Which of the following reasons best explains why you might not see a response the first 24-48 hours, even if your diagnosis is correct?
a. It takes a few days for the hypothalamus to respond to DDAVP and to start making antidiuretic hormone (ADH)
b. It may take up to 3 days to overcome medullary washout from being polyuric and polydipsic
c. Trauma to the hypothalamus or pituitary causing CDI will never respond to antidiuretic hormone (ADH)
d. It may take up to 3 days to reactivate the antidiuretic hormone (ADH) receptors in the kidneys
b. It may take up to 3 days to overcome medullary washout from being polyuric and polydipsic
DDAVP is a synthetic ADH used to replace the lacking endogenous hormone. DDAVP does not induce the hypothalamus to make ADH. Medullary washout commonly occurs with CDI from prolonged PU and PD> It may take up 3 days to get the medullary sodium concentration and concentrating mechanisms back in order. ADH receptors in the kidneys are not affected in CDI.
A domestic short hair cat presents for decreased appetite due to chronic renal disease. Which of the following is an appropriate appetite stimulant?
a. Omeprazole
b. Famotidine
c. Metoclopramide
d. Mirtazapine
e. Maropitant
d. Mirtazapine
Although, all of the options given can potentially help a cat with renal disease feel better, the only medication considered an appetite stimulant is mirtazapine. Martazapine works by increasing norepinephrine in the system, which acts as an alpha-receptor agonist, causing an increase in appetitie. It is also a serotonin receptor antagonist, which inhibits 5HT2 and 5HT3 receptors, so it acts as an anti-emetic as well.
Famotidine (Pepcid) is an H-2 receptor blocker while omeprazole (Prilosec) is a proton pump inhibitor. Both reduce gastric acid secretion.
Maropitant (Cerenia) is a neurokinin-1 inhibitor, which inhibits Substance P in the CNS
Metoclopramide is a prokinetic and anti-emetic drug. The mechanism for its anti-emetic effects is from antagonism of dopamine at its receptors in the chemo-receptor trigger zone of the brain.
You perform a low-dose dexamethasone suppression test on a dog you suspect has Cushing’s syndrome. The 4-hour blood cortisol level and 8-hour blood cortisol level are approximately equially elevated above the normal range. What can you conclude from this information?
a. The dog has iatrogenic Cushing’s syndrome
b. The dog has a cortisol-secreting adrenal tumor
c. The dog has pituitary-dependent hyperadrenocorticism
d. A high-dose dexamethasone suppression test could help differentiate pituitary versus adrenal dependent hyperadrenocorticism
d. A high-dose dexamethasone suppression test could help differentiate pituitary versus adrenal dependent hyperadrenocorticism
The correct answer is you should run a high-dose dexamethasone suppression test. Elevated blood cortisol concentration 4 hours and 8 hours post low- dose dexamethasone administration is diagnostic for hyperadrenocorticism, but it does not allow differentiation between PDH and a cortisol secreting adrenal tumor. Dexamethasone is more rapidly metabolized in dogs with either type of hyperadrenocorticism (approximately 4 hours to metabolize as opposed to 30 hours in normal dogs). In PDH animals, the 4-hour post-cortisol concentration may sometimes be suppressed, whereas cortisol from adrenal tumors will not be suppressed after administration of a low dose dexamethasone. A high-dose dexamethasone test will suppress a larger percentage of PDH patients (up to 75% will be suppressed, showing a decrease in cortisol after 4 hours). Less reliable test to differentiate PDH from an adrenal tumor include endogenous plasma ACTH concentration or abdominal ultrasound.
Which of these dietary recommendations is most appropriate to give to someone raising a large breed puppy?
a. Calcium levels in the diet do not play a factor in skeletal development
b. Calcium in the diet of large breed puppies is of less clinical importance than it is in small breeds.
c. It is important to limit calcium intake to prevent skeletal abnormalities
d. It is important to supplement calcium to prevent skeletal abnormalities
c. It is important to limit calcium intake to prevent skeletal abnormalities
In fast-growing, large-breed puppies, diets high in calcium have been shown to predispose them to osteochondrosis and retained cartilage cores.
Which of the following is the treatment of choice for Trichuris vulpis in dogs?
a. Fenbendazole
b. Ivermectin
c. Imidacloprid
d. Praziquantel
a. Fenbendazole
Trichuris vulpis is the canine whipworm. It commonly inhabits the cecum and causes diarrhea, weight loss, or hematochezia in severe infections. Light infections are subclinical. Treatment is with fenbendazole or milbemycin oxime.
Which of these clinical findings would you expect in a case of lymphagiectasia in a Belgian sheepdog as depicted in the photo?
a. Hypercalcemia
b. Hypercholesterolemia
c. Panhypoproteinemia
d. Lymphocytosis
c. Panhypoproteinemia
Lymphagiectasia is a classic example of a protein-losing enteropathy. It is characterized by dilation and dysfunction of intestinal lymphatics and leakage of protein-rich lymph into the intestinal lumen. As a result, protein, cholesterol, and lymphocytes are all lost. Calcium is also frequently low due to either low albumin or vitamin D and calcium malabsorption
Which of the following is a non-adrenergic vasoconstrictor that can be used in dogs?
a. Epinephrine
b. Dobutamine
c. Phenylephrine
d. Vasopressin
e. Isoproterenol
d. Vasopressin
Epinephrine and phenylephrine are adrenergic vasoconstrictors. Isoproterenol and dobutamine cause vasodilation. Casopression (also known as anti-diuretic hormone) is a V-1 receptor, non-adrenergic, vasoconstrictor
A 8-year old male Doberman Pincher is being treated by your colleague for dilated cardiomyopathy. You hear an arrhythmia on exam and record the following ECG. What is your diagnosis?
a. Atrial premature complexes
b. Atrial fibrillation
c. Sinus arrhythmia
d. Normal sinus rhythm
e. Second degree AV block
b. Atrial fibrillation
Although the rate is not fast, there are no discernible P waves and the R-R interval varies with each beat. This irregularly irregular rhythm is a hallmark of atrial fibrillation. Normal sinus rhythm and sinus arrhythmia are incorrect as there are no P waves apparent. Atrial premature complexes i wrong because the irregularity is from the fibrillation waves in the atria, not a discrete premature focus. Second degree heart block is not correct because no P waves are seen, as would be expected with intermittent block
This 8-year old female spayed Pug is being treated for ketatoconjunctivitis sicca without much success. You suspecte this is a result of poor owner compliance with the medications you prescribed. What is the most likely Schirmer tear test value?
a. 6mm/min
b. 15mm/min
c. 27mm/min
d. 22mm/min
a. 6mm/min
A normal Schirmer tear test is considered to be greater than 15mm/min. A value between 10-15 mm/min is considwered marginal and may or may not be consistent with Keratoconjunctivitis Sicca (KCS), which is dry eye. When diagnosing KCS it is important to have a good clinical picture, especially when the Schirmer tear test is in the gray area.
Which of the following can be used to reverse the effects of medetomidine?
a. Naloxone
b. Xylazine
c. Atropine
d. Atipamezole
d. Atipamezole
Medetomidine is an alpha 2 agonist sedative/analgesic often used for premedication to general anesthesia, chemical restraint, and for epidural anesthesia/analgesia. Atipamezole is a potent alpha 2 antagonist that reverses the effects of alpha 2 agonists. Other alpha 2 antagonists include yohimidine and tolazoline
A 4-year old female spayed breed dog presents for further evaluation. She has a 24 hour history of increased respiratory rate and decreased appetitie. Owners note that she is an inddor/outdoor dog. Based on these radiographs. What is the best treatment?
a. Left caudal lung mass removal
b. Pericardiocentesis
c. Intravenous furosemide
d. Thoracocentesis
d. Thoracocentesis
This patient has a left sided pneumothorax. Pneumothorax can be secondary to trauma, ruptured bullae, infection, or neoplasia. The radiograph shows an elevated heart off the sternum as well as collapse of the lung lobes. Notice there are no bronchi or vessels extending caudally toward the diaphrgm due to collapse of the lung
Pericardiocentesis would be indicated if you had a very large globoid heartm suggestive of pericardial effusion. The heart does not appear enlarged and there is no pulmonary edema making intravenous furosemide a poor choice. Do not confuse a collapsed lung lobe for a lung mass
Which of these groups is considered predisposed to developing nasal aspergillosis?
a. Dogs in large groups or kennels
b. Hunting dogs
c. Brachycephalics
d. Immunocompromised dogs
e. Dolichocephalic
e. Dolichocephalic
Aspergillus is typically a disease of healthy, apparently immunocompetent dogs that are young to middle-aged. Dolichocephalic breeds are overpresented. Immunocompromise does predispose to development of disseminated aspergillosis. Being in a large group of dogs does not increase risk, as it is not a contagious disease. Aspergillus is fairly ubiquitous in the environment, and hunting dogs are probably not exposed significantly more than any other dogs
a 3-year old German Shepherd presents for multiple subcutaneous nodules on the right front limb that have been present for about one week. The dog is otherwise healthy. The owner states that the dog lives mostly outdoor in a wooded area with ponds in Florida. You are highly suspicious of pythium; what is the best therapeutic option for this disease?
a. Prednisone
b. Ivermectine
c. Lufenuron
d. Antifungal therapy
e. Amputation and treatment with an antifungal
f. Amputation and treatment with doxycycline
e. Amputation and treatment with an antifungal
Pythium is an aquatic organism that inhabits ponds of the Southeast United States. These organisms have different cell walls than regular fungi, which makes them difficult to treat since most antifungal treatments target fungal cell wall synthesis. Prognosis is extremely poor with this disease and amputation (if the lesions are localized to an affected limb) is currently the best option. Amputation should always be followed with multiple long-term antifungal therapies. Owners should be warned that local postoperative recurrence is common. Dogs are most commonly affected, but this disease can also occur in cats. It has also been reported in humans and horses.
Doxycycline is an antibiotic and would not be effective for this disease. Prednisone would be contraindicated for pythium. Lufenuron is a chitin synthesis inhibitor used for flea control and would not be effective. Ivermectin is an anti-parasite drug and would not be effective
A two-year oldDachshund presents for hairloss (see image). He is not pruritic. Both ears are affected. No other hair loss is noted over the rest of his body. His physical exam is unremarkable. In house skin scrapings are negative for mites. Blood work and thyroid levels are unremarkable. What is the most likely cause?
a. Endocrine disorder
b. Mite infection
c. Bacterial infection
d. Immune-mediated
e. Breed related
e. Breed related
Canine pinnal alopecia is a form of pattern alopecia. Pinnal alopecia is most commonly diagnosed in Dachshunds, but can be seen in Chihuahuas, Boston Terries, Bull Terries, Yorkshire Terriers, and Italian Greyhounds. The condition usually occurs in dogs older than 1 year of age and results in slowly, progressive, bilateral pinnal alopecia. The ear margins may become chronically hyperpigmented and thickened. The condition is benign and requires no specific treatment.
Distribution of the alopecia is an important key to determining the underlying diagnosis. It may help in distinguishing inflammatory from non-inflammatory causes, thus narrowing down your differential list. Inflammation results in a patchy pattern of alopecia that is not symmetrically distributedl whereas, many of the noninflammatory alopecias have a symmetrical pattern of alopecia. Hypothyroidism often causes alopecia of the tail and may also be associated with alopecia of the nose bridge. Hair loss begins with the pinna at 6 to 9 months of age and may progress to complete pinnal alopecia. Total body alopecia with pigmentation may occur with age. Treatment with oral melatonin may cause hair regrowth with this and other pattern baldness syndromes. Other medications that can be used with variable success are pentoxifylline and Omega 3 oils topically.
Which of these biochemical profiles are most consistent with the diagnosis of insulinoma in a dog?
a. Blood glucose = 150mg/dL, Serum insulin-low
b. Blood glucose =150 mg/dL, Serum insulin-high
c. Blood glucose = 45mg/dL, Serum insulin-high
d. Blood glucose = 45mg/dL, Serum insulin-low
c. Blood glucose = 45mg/dL, Serum insulin-high
An insulinoma can result in an animal having normal to high insulin levels in the face of low blood glucose levels because the normal controls of insulin secretion are lost
A dog presents to your clinic for coughing and fever a week after going hunting. You work the dog up, perform bronchoscopy and remove a plant awan from the lungs. What bacterial infection is this dog predisposed to?
a. Pasteurella multocida
b. Actinomyces
c. Staphylococcus pseudointermedius
d. Nocardia
e. Staphylococcus aureus
b. Actinomyces
This is a filamentous, branching, gram positive bacteria that is a normal inhabitant of the mouth and oropharynx. It is commonly associated with grass awn migration. These are usually contaminated in the oropharynx and the migrate through the body from the respiratory of GI tracts. Many times it takes months to oyears to make a diagnosis. Nocardia is a ubiquitous soil saprophyte found everywhere and is usually introduced via the respiratory tract.
A 4 year old female Collie presents to you for lethargy. The owner reports she has been drinking more and urinating frequently. She has also vomited several times. Her temperature is 104F (40C). An abdominal radiograph of the dog is shown below. What is the most appropriate treatment plan for this dog?
a. Parenteral fluids and antibiotics
b. Emergency ovariohysterectomy
c. Adrenalectomy
d. Enterotomy or gastrointestinal resection-anastomosis
e. Administer IV calcium gluconate
f. Splenectomy
b. Emergency ovariohysterectomy
The history and radiograph are consistent with a diagnosis of puometra due to the presence of fluid-filled uterine loops in the caudal abdomen. Pyometra can be managed medically in some cases with hormonal and antibiotic therapy but in most cases, the treatment of choice is ovariohysterectomy to remove the infected tissue and prevent future pyometra at subsequent heats.
A 10-year old Shih Tzu presents for collapse. A diagnostic work up shows a mass on the right kidney, which was subsequently removed and biopsied as renal carcinoma. Which one of the following can be associated with renal carcinoma?
a. Polycythemia
b. Hyperadrenocorticism
c. Hyperestrogenism
d. Thrombocytopathy
e. Hypercalcemia
a. Polycythemia
Renal carcinomas have been associated with erythropoietin secretion, causing elevations in hematocrit as a paraneoplastic syndrome.
Hypercalcemia is associated with anal sac adenocarcinomas, lymphomas and other tumors
Thrombocytopathy can be seen with hemangiosarcoma and multiplelyeloma
Hyperestrogenism can be seen with Sertoli cell tumors
a 1-year old femal spayed Pit Bull presents for a focal area of alopecia that is well circumscribed, erythematous, and scaling. A deep skin scraping reveals Demodex mites. Which of the following is true regarding treatment for demodicosis?
a. Treatment of localized Demodex in young dogs is usually unnecessary. It usually clears up on its own
b. The dog should be separated from people and treated aggressively with topical agents like Goodwinol (rotenone) because the disease is zoonotic
c. Shampoos containing benzoyl peroxide should not be used in this patient
d. Ivermectin should be used in all patients with demodicosis
a. Treatment of localized Demodex in young dogs is usually unnecessary. It usually clears up on its own
It usually clears up on its own. Ivermectin is usually used to treat generalized Demodex and should not be used in heartworm positive animals and herding dogs like collies and Shepherds (remember that Ivermectin also kills turtles!). Benzoyl peroxide shampoos should be used with demodicosis patients. Although, benzoyl peroxide can not directly kill the mite it aids in follicular flushing. Demodex is a species-specific mite and is not considered zoonotic. Goodwinol is a topical agent sometimes used for localized demodicosis.
Which of the fungal infection is considered contagious, either to other animals or to man (zoonotic)?
a. Aspergillosis
b. Sporotrichosis
c. Coccidioidomycosis
d. Blastomycosis
e. Cryptococcosis
b. Sporotrichosis
All of these fungal diseases can infect both animals and people. However, they are not considered contagious (not to be confused with infectious) with the exception of Sporothrix. This is because they are mainly acquired from the environment, and transmission from animal to animal is rare. Sporothrix, especially in cats, is a high risk to veterinarians and care should be taken to limit contact with exudates and lesions in cats.
Aspergillus is generally considered a ubiquitous fungus that causes infection due to host factors such as immunosucceptibility or certain breed predilections. Cryptococcus is also not a contagious disease (do NOT conduse this with cryptosporidium, which is very contagious and zoonotic). Cryptococcus infection occurs from inhalation of the yeast from the environment, frequently avian habitats, as it survives ideally in pigeon droppings. Essentially, histoplasma, blastobyces, and Coccidioidesare also all environmental diseases as well and not considered contagious.
Which of these drugs can cause aplastic anemia in humans?
a. Clindamycin
b. Neomycin
c. Chloramphenicol
d. Enrofloxacin
e. Sulfadiazine
c. Chloramphenicol
Even though this is a human questions, this is something you do need to know for board exams. This potential side effect of chloramphenicol is why it is not allowed for use in food animals and that it is used with caution in companion animals. THe person administering this drug shold take precautions to avoid coming into contact with it.
What is the method of choice for diagnosing rabies?
a. Immunohistochemistry
b. RT-PCR
c. Gross pathologic lesions
d. Direct fluorescent antibody test
e. Visualization of Negri bodies
d. Direct fluorescent antibody test
There are no gross pathologic lesions associated with rabies. A diagnostic microscopic lesion is the visualization of Negri bodies. Most commonly they occur in the hippocampus in carnivores and Purkinje cells in herbivores. However, these are only seen 50% of the time. Immunohistochemistry allows strain differentiation and the ability to differentiate vaccine vs. wild-type. RT-PCR has been used on autolyzed brain tissue that is difficult to evaluate with fluorescent antibodies, but this is not the test of choice at this time. Direct FA is the current preferred method of diagnosis; it is both rapid and sensitive. Usuallyimpression of the medulla, cerebellum, and hippocampus are performed.
How much protein should you feed a dog with hepatic insufficiency or hepatic encephalopathy?
a. The maximum amount of protein they will tolerate without causing signs of encephalopathy
b. The minimum amount of protein they will tolerate without developing hypoproteinemia
c. The toal quantity of protein is not important as long as they eat predominantly meat proteins rather than dairy proteins
d. 1.0 gram protein/kg/day
a. The maximum amount of protein they will tolerate without causing signs of encephalopathy
Dogs with hepatic insufficiency or hepatic encephalopathy need to have their protein levels restricted to reduce clinical signs associated with liver dysfunction; however, restricting protein intake to the point where hypoproteinemia develop is excessive. If too little protein is fed to these patients, muscle catabolism may occur. PRoteins derived from meat sources are more prone to causing encephalopathy than proteins from dairy sources due to the high levels of nucleic acids and other nitrogenous compounds found in meat that are converted to ammonia
Which of the following organisms is best visualized under dark field microscopy?
a. Ehrlichia
b. Mycobacterium
c. RIckettsia
d. Aspergillus
e. Leptospira
e. Leptospira
The causative agent of leptospirosis is a gram negative organism that stains poorly, if at all. Dark field microscopy is the best way to identify this organism. Leptospira also grows very slowly. There are 7 serovars out of over 220 that tend to cause disease in animals
Which of these is the best measure of liver function in the dog from a routine chemistry panel?
a. Alkaline phosphatase (ALP)
b. Alanine aminotransferase (ALT)
c. Creatinine
d. Blood urea nitrogen (BUN)
d. Blood urea nitrogen (BUN)
ALT and ALP are liver enzymes and can indicate ongoing damage to the liver or cholestasis but do not tell you anyting about liver function. Creatinine is produced by muscle and cleared by the kidney so it tells you nothing about liver function. Urea is produced by liver and is one measure of liver function; it will be low in cases of liver failure. Other tests of liver function on a routine chemistry panel are cholesterol, glucose, bilirubin, and albumin. Bile acids also test liver function, but are not on a routine chemistry panel. It is important to realize that in cases of end-stage liver failure, the liver function parameters will be affected, while frequently, liver enzymes will be normal.
A 2.5-year old miniature Schnauzer presents for further evaluation as a result of stranguria. Abdominal ultrasound identified uroliths and the dogwas taken to surgery for a cystotomy. Stone analysis revealed urate staones. You call the owners to inform them of the resutls and recommend which diagnostic test?
a. Creatinine kinase levels
b. ACTH stimulation test
c. Low dose dexamethasone suppression test
d. Pre- and post-prandial bile acids test
d. Pre- and post-prandial bile acids test
Urate stones in a small breed dog are usually secondary to a portosystemic shunt until proven otherwise. A portsystemic shunt results in blood from the abdomen being shunted away from the liver and into the main circulation. If shunted, the liver does not have an opportunity to detoxify the blood, which among other toxins, is very high in ammonia. The excess ammonia is excreted bia the kidneys. High levels of ammonia can result in formation of ammonium biurate crystals and ultimately stones.
An ACTH stimulation test is used to help diagnose hypoadrenocorticism and hyperadrenocorticism. A low dose dexamethasone test is used to help diagnose hyperadrenocorticism. Creatine kinase levels are evaluated when there is a suspected myopathy
A 1-year-old female spayed COrgi presents for a seizure. At home , she vomited what appeared to be paint chips. Peripheral blood cytology and a complete blood count showed 20 nucleated red blood cells/100 white blood cells, basophilic stippling, and neutrophilic leukocytosis (see image). She received a dose of diazepam, which has controlled her seizures. What is the treatment of choice?
a. N-acetylcysteine
b. D-penacillamine
c. Doxycycline
d. Ca-EDTA
d. Ca-EDTA
This dog is showing signs of lead poisoning. Clinical signs are primarily gastrointestinal and neurologic. Animals are usually exposed in old buildings or areas of renovation where they have access to lead paint, old batteries, lead fishing weights, etc. Old food and water dishes can also be a source if lead paint was used. Lead blood levels can be measured; however, they do not necessarily correlate with severity of clinical signs. Toxic blood levles are greater than 0.4 ppm. Bloodwork can show an elevated number of nucleated RBCs without anemia. Basophilic stippling is a classic finding with lead toxicity but not specific. Ca-EDTA is the chelator used to treat lead poisoning. Succimer can also be given orally. D-penacillamine has been used to chelate lead, copper, iron and mercury. It is used more commonly for copper toxicity. N-acetylcysteine is used for acetaminophen toxicity and hepatotoxicity. Basophilic stippling can sometimes confused with erythrocytic parasite for which doxycycline may be the treatment of choice.
The mean circulating life span of a white blood cell in a dog is approximately ________.
a. 48 hours
b. 120 minutes
c. 5-9 days
d. 5-9 hours
d. 5-9 hours
Platelets have a circulating half life of 5-7 days and red blood cells have an approximate life span of 110 days in dogs
NOTE: The approximate life span of RBCs in other species ( in days) is as follows: cats-to, cow-160, horse-145, pig-86, sheep-150
A 1-year old female spayed Doberman Pinscher has presented after being hit by a car. Initial radiographs show mild contusions, and the patient appears to be otherwise stable. A right mid-shaft long oblique femoral fracture has been identified. Routine pre-operative blood work is unremarkable. A buccal mucosal bleeding test (BMBT) is elevated at 6 minutes. What will you administer prior to surgery?
a. Vitamin K
b. Whole blood transfusion
c. 1,25 dihydrocholecalciferol
d. Desmopressin acetate (DDAVP)
d. Desmopressin acetate (DDAVP)
Administration of desmopression results in release of von Willebrand factor, which will help this patient with clotting. Given this dog’s breed and elevated BMBT there is a very strong likelihood she is afflicted with von Willebrand’s disease. In Dobermans this results in an inability to form a clot. This can be life threatening if the dog is taken to surgery.
A whole blood transfusion does not provide an adequate source of von Willebrand factor but may be necessary if the patient’s bleeding cannot be controlled despite appropriate pre-operative measures. 1,25 dihydrocholecalciferol is the active form of vitamin D which aids intestinal resorption of calcium. The BMBT does not assess factors 2, 7, 9, 10 and therefore vitamin K is not indicated.
A 7-year old male neutered Gold Retriever presents for lethargy and pale mucous membranes. A purple top (EDTA) tube of blood is drawn. A blood smear is made and examined. These is a moderate regenerative anemia with an increase in spherocytes. Mild agglutination is suspected. A Spherocytes are consistent with which disease condition?
a. Iron deficiency
b. Cobalamine and folate deficiency
c. Grape and raisin toxicity
d. Immune mediated hemolytic anemia
d. Immune mediated hemolytic anemia
In immune mediated hemolytic anemia RBCs are coated with immunoglobulins and are then engulfed by macrophages. As a result, the RBC will lose a portion of its cell membrane but not hemoglobin. With the loss of part of the cell membrane, spherocytes appear smaller (without volume loss), no central pallow, and stain deeply red.
In iron deficiency, RBC will be hypochromic (less red) and smaller (microcytic) due to less volume.
Cobalamin and folate are necessary for DNA synthesis. Giant schnauzers have an inherited cobalamin malabsorption which results in macrocytes and ovalocytes in circulation.
Grape and raisin toxicity result in acute renal failure
A 2-year old male castrated Bull Mastiff with a history of travel in the west coast presents to your clinic for a chronic cough a recent development of lameness of his right hind limb. On physical exam you notice a draining lesion over the lame region of the right hind limb. You perform chest radiographs and see a diffuse bronchointerstitial pattern which is nodular in some regions. You also identify filar lymphadenopathy. You suspect that you know what you are dealing with and perform a broncho-alveolar lavage for cytology. Just as you suspected, you see spherules. What is your diagnosis?
a. Coccidioidomycosis
b. Aspergillosis
c. Histoplasmosis
d. Blastomycosis
e. Cryptococcus
a. Coccidioidomycosis
The travel history and clinical signs are consistent with this answer. Additionally, finding spherules on cytology is pathognomonic for Coccidioidomycosis. Prolonged antifungal treatment will be necessary. Fluconazole is the treatment of choice. Ketoconazole and itraconazole are good choices. With blastomycosis you see broad based budding of the yeast. With Cryptococcus neoforms you will see narrow-based budding.
The image below is from an aspirate taken through the soft palate from a mass in the nose of an 8-year old male neutered Rhodesian Ridgeback dog. Choose the correct cell type of origin AND classification
a. Epithelial origin; carcinoma
b. Epithelial origin; sarcoma
c. Mesenchymal origin; sarcoma
d. Mesenchymal origin; carcinoma
e. Leukocyte origin; round cell tumor
f. Mesenchymal origin; round cell tumor
a. Epithelial origin; carcinoma
This is a nasal adenocarcinoma. The classification scheme for tumors by cell of origin and cytologic description is:
Carcinoma - These tumors come from epithelial cells including cells of glandular tissues, such as salivary glands, mammary glands, and cells lining most tissues including squamous cells and transitional cells. The cytologic appearance is that of COHESIVE CLUSTERS of cells. Here, you can see some of the tight cellular junctions in the cluster which is typical. Cells are often polygonal in shape.
Sarcoma - These tumors come from mesenchymal cells and are named by the specific cell type such as fibroblasts (fibrosarcoma) and osteoblasts (osteosarcoma). Cytologically, they tend to appear as isolated spindle-shaped cell with elongated cytoplasm and often oval nuclei.
Round cell tumors - These are 5 round cell tumors and most but not all come from blood cells. They are lymphoma, mast cell tumors, plasma cell tumors, histiocytic tumors, and transmissible venereal tumors. Remember, these are also sometimes also referred to as sarcomas (i.e. lymphosarcoma or histiocytic sarcoma). Cytologically, they appear usually as large populations of cells that are not in defined clusters. The cells have a round shape, often with unique identifiable features such as the purple granules in mast cell tumors
A 1 yr 2 mo old Great Dane presents for further evaluation of persistent lameness of the right hind limb. Previously he had been seen by your associate who had recommended radiographs in an attempt to localize the pain since the orthopedic exam was unrewarding. The patient was sent home on carprofen for 2 weeks which helped a little. He is here today for a recheck and tadiographs because he is just nogetting better according to the owner. What will you tell the owner based on the radiographic findings?
a. Your dog is affected with panosteitis and we need to continue to treat medically. His prognosis is ultimately excellent
b. There are no significant findings on the radiograph. I recommend a lateral projection to be more complete
c. Your dog may be affected with juvenile onset osteosarcoma and we should perform a bone biopsy to rule this in or out
d. I’m concerned your dog may have hip dysplasia and would like to perform a distraction view to determine his distraction index
a. Your dog is affected with panosteitis and we need to continue to treat medically. His prognosis is ultimately excellent
The radiographs show a patchy opaque region within the medullary canal that might be described as slightly mottled when compared to the left side. One can appreciate this from the lesser trochanter and distal half-way down the femur. There is no evidence of cortical thinning or overt lysis suggestive of a neoplasitc process. If the veterinarian were to palpate this region, it would be very painful to the patient.
The cause of panosteitis is currently unknown, but it is thankfully self-limiting and generally only affects dogs less than 2 years of age. German shepherds tend to be predisposed. Treatment is supportive with NSAIDs. Owners are warned that their dog could develop panosteitis in other limbs as well.
The hips do not have any overt signs of degenerative changes suggesting hip dysplasia. If the veterinarian were to sedate the patient, it would be prident to check for Ortolani to be on the safe side.
A 10 year old female spayed mixed breed dog presents for further evaluation of progressivelameness in the hind. The owner notes that she has begun intermittently scuffing her hind limbs, has somewhat of a weak or drunken gait in the hind as she walks, and is having trouble rising. Given the answer choices below, what is the best treatment?
a. Prolonged antibiotic therapy with clindamycin
b. Dorsal laminectomy
c. Total hip replacement bilaterally
d. Removal of the right TPLO plate
b. Dorsal laminectomy
This patient’s clinical signs are consistent with neurological deficits. Although you do not have all of the information necessary to reach a definitive diagnosis, you should have been able to deduce that this patient probably needs a dorsal laminectomy to relieve disc compression.
In order to definitively diagnose the condition, you would want to proceed with a complete exam, basic bloodwork, and a CT or MRI of the lumbosacral region. Although this patient does exhibit evidence of hip dysplasia radiographically, the clinical signs are not characteristic of a dog with pain secondary to hip dysplasia. There is no indication of osteomyelitis on these radiographs and the clinical signs are not necessarily suggestive of osteomyelitis. Removing the TPLO plate might be tempting if you identified a broken screw (proximal screw of the right tibia). However, this broken screw is likely an incidental finding and does not cause the patient any discomfort since the TPLO site appears to be healed.
It is important not to skip ahead to image interpretation without carefully reading the question. Doing so in this case would likely lead you to select the incorrect answer.
A 1-year-old male neutered Chihuahua presents for a 3 month history of intermittent limping and non-weight bearing on the left hind limb. On physical exam, it is difficult to determine the source of pain as the paitnet seems to try to bite on any manipulation of the left hind limb. The patient was sedated and these radiographs were obtained. WHat is your diagnosis and treatment?
a. Left hip septic arthritis. Perform joint culture and begin appropriate antibiotic therapy
b. Left hip dysplasia. Perform femoral head and neck ostectomy or total hip replacement
c. Avascular necrosis of the femoral head. Perform femoral head and neck ostectomy or total hip replacement
d. Left patellar luxation. Perform trochlear wedge recession with tibial tuberosity transposition
c. Avascular necrosis of the femoral head. Perform femoral head and neck ostectomy or total hip replacement
Based on the breed and age of the patient, avascular necrosis of the femoral head should immediately be the top differential. This condition is also known as Legg-Calves-Perthes disease and results in a collapse or fragmentation of the femoral epiphysis (as seen on the radiographs) because of a disruption in blood flow. The cause of blood flow interruption is unknown. The condition occurs in young small-breed dogs prior to closure of the capital femoral physis. The condition can be seen bilaterally in 10-17% of patients. Dogs are usually 6-7months of age when they first start showing clinical signs, but the age may range from 3-13 months. Treatment with a femoral head and neck ostectomy (FHO) generally yields excellent results. Alternatively, if owners demand perfect biomechanics, a total hip replacement may be considered, but most veterinarians tend to recommend an FHO.
Radiographs will typically show a shortening of the femoral neck as well as osteochondrosis with chronicity, as appreciated in this patient. Note the significant muscle atrophy of the patient’s left limb as compared to the right. Patellar luxation should always be a differential in any small breed dog and this should be ruled out via palpation since the patient may not necessarily be luxated at the time the radiograph was taken. The patient’s patellas are in a normal position in this radiograph.
Septic arthritis of the femoral head is an uncommon condition which is more often seen in large-breed dogs with a history of degenerative joint disease of the hips. They present with acute lameness, severe hip pain, and are usually febrile. Radiographs usually show degenerative joint disease along with potentially lytic areas associated with the femoral head. Neoplasia should also be considered in these cases.
Small-breed dogs are less likely to have hip dysplasia as compared to large-breed dogs and should be kept as a lower differential
What is the recommended surgical treatment for canine patients with laryngeal paralysis?
a. Soft palate resection
b. Unilateral artenoid lateralization
c. Resection of the laryngeal saccules
d. Partial laryngectomy
b. Unilateral artenoid lateralization
Resection of the soft palate is performed when dogs have respiratory problems as a result of having elongated soft palate. Resection of the laryngeal saccules is performed when they are everted and causing resrpiatory distress. A partial laryngectomy is performed in cases where there may be a mass or tumor to be removed.
Of the options below, which would be the best material to close this incision?
a. Ethilon
b. Catgut
c. Vicryl
d. Polydioxanone
d. Polydioxanone
This suture material is absorbable and monofilament. Polydioxanone (PDS) is broken down by hydrolysis and will last longer than catgut, which is better when working with the bladder. On the other hand, you do not want a non-absorbable material as this predisposes the patient to urinary tract infections as a result of the permanent presence of foreign material. Vicryl is a multifilament suture which also has a higher likelihood of failing due to the ability of bacteria to lodge in between the filaments.
15-25% of diaphragmatic hernias are not diagnosed until several weeks after trauma; therefore, it is important to perform thoracic radiographs in all animals that undergo significant trauma to avoid having an animal later go into respiratory distress and die. How should you treat a diaphragmatic hernia as shown below?
a. Fascia lata graft using a simple interrupted pattern
b. Mesh graft using porcine small intestinal submucosa
c. Simple continuous pattern of an absorbable suture, such as polydioxanone
d. This hernia is too large and has exceeded the repair limits; the patient should be humanely euthanized
c. Simple continuous pattern of an absorbable suture, such as polydioxanone
Acute, traumatic, diaphragmatic hernias should be repaired primarily without the use of any “substitute” material for the diaphragm to reduce the risk of complications. It is very rare to have insufficient tissue/muscle to close an acute defect to the diaphragm. Using the native diaphragmatic wall decreases the risk of failure because this technique involves tissue with a direct blood supply as opposed to a mesh type material that is foreign to the body.
The following image shows a 3-D CT reconstruction of a 7-year old mixed breed small dog with a history of pain on opening the mouth for the past 2 weeks. The patient initially received a dental prophylaxis and cleaning under the assumption that the pain was related to moderate dental disease. When the pain persisted skull radiographs were performed and showed evidence of a mixed proliferative and lytic mass at the proximal aspect of the vertical ramus. What muscle attaches to this region?
a. Pterygoid
b. Temporalis
c. Digastricus
d. Masseter
b. Temporalis
The mass depicted in this three dimensional CT reconstruction involves the coronoid process. The ramus of the mandible consists of three distinct processes, the most dorsal being the coronoid process. It projects into the temporal fossa and provides an area for attachment of the temporalis muscle. The condylar (or condyloid) process is just ventral and slightly caudal to the coronoid process. This process is a point of articulation between the maxilla (retroarticular process) and mandible. Disruption of this region will result in temporomandibular joint luxation. The most ventral process is the angular process. This structure provides an area for attachment of the digastricus muscle. The masseter muscle inserts laterally on the mandible, while the pterygoid muscle inserts medially. The masseter, pterygoid, and temporalis muscles function to close the mouth while the digastricus opens the mouth.
Dutchess, a five year old female spayed Labrador Retriever, presents to the emergency clinic with a 2 day history of lethargy, inappetance, diarrhea, and vomiting. On physical exam, she is painful on abdominal palpation, 7% dehydrated, and febrile.
Abdominal radiographs were performed and showed evidence of ascites and gas distension in the small intestines. Preliminary blood work showed a PCV of 32% (35-57 %), TP 2.2 g/dl (5.4-7.5 mg/dl), glucose 57 mg/dl (76-119 mg/dl), Na 140 mEq/L (142-152 mEq/L), Cl 115 mEq/L (110-124 mEq/L), K 3.9 mEq/L (3.9-5.1 mEq/L). Given the surgical findings (see image below) what is the likely abdominal fluid glucose level?
a. At least 20 mg/dL greater than the blood glucose
b. At least 10 mg/dL greater than the blood glucose
c. At least 20 mg/dL less than the blood glucose
d. At least 10 mg/dL less than the blood glucose
e. Approximately the same as the blood glucose
c. At least 20 mg/dL less than the blood glucose
The correct answer is at least 20 mg/dL less than the blood glucose. The image depicts a perforated colon, which will result in a septic abdomen due to the normal colonic flora emptying into the abdomen. A concentration difference > 20 mg/dL between blood and peritoneal fluid glucose concentration provides a rapid and reliable means to differentiate a septic peritoneal effusion from a nonseptic peritoneal effusion in dogs and cats.
Attached are x-rays of a 4-year old 63 pound German Shepherd mix. She presented yesterday with toe touching mixed with non-weight bearing continuing for the past 5 days. She was therapeutically started on Tramadol, Previcox and acepromazine as this pet is very active and hard to keep still. On the basis of the signalment and radiographic findings. What clinical exam finding would you expect to find and on which limb?
a. This patient is expected to have bone pain on palpation of the distal femur on the right hind limb
b. This patient is expected to have patellar luxation of the left hind limb
c. This patient is expected to have tibial thrust on the right hind limb
d. This patient is expected to have cranial drawer on the left hind limb
d. This patient is expected to have cranial drawer on the left hind limb
Based on the radiographic finding of marked stifle effusion of the left stifle noted by the displacement of the infrapatellar fat pad (cloudy area as compared to right stifle) this patient likely has a cranial cruciate ligament rupture. The history and signalment help you to arrive at this top differential.
Other differentials such as immune mediated polyarthritis or joint infection would be ruled out after a thorough orthopedic exam. During this exam one can expect to find tibial thrust, cranial drawer, and pain on extension of the stifle.
Cranial cruciate ligament injuries are the most common orthopedic problem seen in dogs and should be a high differential for any large breed, active dog, with an acute history of lameness. Patellar luxation is relatively uncommon in large breed dogs and would be a very low differential. The right stifle radiograph has no effusion associated with the joint but does show some boney changes that are likely incidental, perhaps from prior trauma, at the distal aspect of the patella.
An 8-month old Labrador Retriever mix presents for further evaluation of limping in the right hindlimb after running, for approximately 6 weeks duration. On physical exam pain is localized to the tarsus. The owner consented to radiographs of both tarsi. Based on the findings, what will you tell the owner?
a. Your dog likely has ligamentous damage given the amount of changes and I recommend a splint application for 6 weeks with weekly splint changes
b. Your dog likely has osteochondrosis dissecans of the medial trochlear ridge and removal of the flap and curretage is recommended
c. Your dog likely has a fragmented medial trochlear ridge and needs arthroscopic removal of the fragment
d. Your dog likely has a joint infection given the degree of radiographically visible swelling and I recommend a joint tap
b. Your dog likely has osteochondrosis dissecans of the medial trochlear ridge and removal of the flap and curretage is recommended
The radiographs show evidence of effusion when compared to the contralateral limb. There is also a widened joint space of on the medial aspect at the level of the tibio-tarsal joint with flattening of the medial trochlear ridge. Those specific findings are highly suggestive of osteochondrosis dissecans (OCD). The signalment of the patient also fits with this diagnosis.
Young dogs are not typically affected by fragmentation of the medial trochlear ridge. If you selected this answer you are probably confusing yourself with a fragmented medial coronoid process which is a component of elbow dysplasia.
A joint infection of six weeks duration is highly unlikely and we would expect the dog to be more clinical if it was present for that length of time. Lethargy, inappetance, and pyrexia would be expected. The radiographic findings would probably show severe degenerative changes if it were ongoing for six weeks.
A ligamentous injury cannot be ruled out on this radiograph alone. Stress radiographs would be necessary to see if there is excessive laxity of the joint. If the findings consistent with OCD were not present, offering the owners stress radiographs as the next step would be reasonable.
A dog presents to your clinic with tenesmus and swelling near the anus as seen in the image. On examination, there is a fluctuant swelling lateral to the anus, and on rectal exam, you note lateral dilatation of the rectum. Which of the following is the most common signalment for dogs presenting with this problem?
a. They are younger intact males
b. There is no age or sex predilection
c. They are older intact females
d. They are older intact males
e. They are younger intact females
d. They are older intact males
This is a case of a perineal hernia. Older intact male dogs are most commonly affected. Overrepresented breeds include Boxers, Collies, Kelpies, Pekingese, and Boston terriers. The hernia results from a weakened pelvic diaphragm. It is thought that there may be a hormonal component which results in weakening with time.
A 5-month old male Shar-pei presents for further evaluation of persistent regurgitation. There is no history of trauma or recent anesthesia. The dog is thin and has a ravenous appetite. Your differentials include persistent right aortic arch, idiopathic megaesophagus, and hiatal hernia. After imaging with fluoroscopy you confirm the diagnosis of hiatal hernia. Which of the following is best treatment choice?
a. Placement of esophagostomy tube until skeletal maturity is reached
b. Plication of the small intestines
c. Esophagopexy in conjunction with a left-sided gastropexy
d. Euthanasia due to grave prognosis
e. Esophageal resection and anastomosis of affected region
c. Esophagopexy in conjunction with a left-sided gastropexy
Performing these will help prevent the esophagus from herniating back into the thoracic cavity. The left-sided gastropexy increases the barrier pressure at the gastroesophageal junction. Resection and anastomosis of any region of the esophagus is associated with significant morbidity and mortality and should be avoided if possible. Additionally this does not necessarily address the problem. Placement of an esophagostomy tube does not fix any problems. Perhaps if medical management is pursued, a gastrostomy tube or jejunostomy tube is more appropriate. Plication of the small intestines was previously performed in animals that had intestinal intussusceptions and later found to not be substantially beneficial.
Which of the following is not a treatment option for a ruptured cranial cruciate ligament for a dog?
a. Recession trochleoplasty
b. Weight reduction
c. Leveling of the tibial plateau
d. Cranial transposition of the fibular head
a. Recession trochleoplasty
This technique is part of a surgical repair method for luxating patellas. Weight reduction is nearly always a therapeutic component to managing orthopedic disease. Leveling of the tibial plateau and cranial transposition of the fibular head are two surgical options for correcting a torn cranial cruciate ligament.
A 2-year old Golden Retriever presents to you after jumping from a height of 15 feet and sustaining a severe carpal hyperextension injury in his right carpus. The treatment of choice for this dog is _________.
a. Cast for 6-8 weeks
b. Splint and cage rest for 3 weeks
c. Non-steroidal anti-inflammatory drugs and cage rest for 3 weeks
d. Carpal ardesis
d. Carpal ardesis
Arthrodesis is the treatment of choice for severe hyperextension injuries to the carpus. This procedure is accomplished by debridement of the articular cartilage of the joints, implantation of a cancellous autograft into the debrided joint spaces, and fixing a bone plate across the injured joints.
A seven-month old male German Shepherd became acutely lame on the right forelimb 5 days ago. The dog presents on emergency due to acute exacerbation of lameness. On your exam, the dog has a temperature of 103.6 F (39.8 C) and was toe touching lame on the right forelimb and reluctant to stand or walk. There was no evidence of external trauma. Deep palpation of the right humerus elicited pain and you take radiographs of the right humerus which are shown below (see image). Based on the most likely diagnosis, what is the prognosis for this condition with supportive treatment only?
a. Excellent, >95% of dogs recover
b. Grave, <5% of dogs recover
c. Good, 80-90% of dogs recover
d. Poor, 10-20% of dogs recover
e. Fair, 40-60% of dogs recover
a. Excellent, >95% of dogs recover
This is a case of panosteitis based on the young age of the patient and radiographic presence of focal intramedullary densities within the humeral diaphysis. Minor differentials could include osteomyelitis. Panosteitis is a self-limiting, painful condition characterized by limping and lameness. It typically affects the long bones of young dogs, usually between the ages of 5 to 18 months. It can occur with any breed, but it is more common in medium- to large-sized dog breeds.
Treatment is primarily supportive consisting of limiting activity and anti-inflammatory drugs. Pain lasts from weeks to months and resolves in nearly all cases. While these treatments reduce the pain associated with the condition, they may not alter the duration or course of the disease.
A 2-year old male neutered German Shepherd presents with a history of intermittent lameness of the right pelvic limb. You do not appreciate any cranial drawer motion on exam and he has no pain in his long bones. On gait examination you notice a bunny-hopping type gait. What would you advise?
a. Radiographs of the right stifle due to a likely partial cranial cruciate rupture
b. Strict rest for 2 months and NSAID therapy for likely panosteitis
c. Testing for tick-borne disease
d. Pelviv radiographs to evaluate for evidence of dysplasia
d. Pelviv radiographs to evaluate for evidence of dysplasia
A bunny-hopping gait is most often seen in cases of hip dysplasia. Radiographs of the hips would be the next best step.
Since there is no cranial drawer movement, there is not likely a CCL rupture. Panosteitis can be seen in younger dogs which are growing and would cause pain in the long bones. Typically lameness from rickettsial disease is painful and may affect multiple joints or limbs.
A 5-month old male intact Doberman presents for forelimb lameness of 2 days duration. You localize the pain to the carpus on physical exam and take the following radiograph. What is your diagnosis?
a. Panosteitis
b. Hypertrophic osteodystrophy
c. Septic arthritis
d. Hypertrophic osteopathy
b. Hypertrophic osteodystrophy
The radiograph shows the classic signs of hypertrophic osteodystrophy. There is a double physeal line in the metaphysis and areas of bony proliferation. The metaphyses are flared as well.
Panosteitis has a patchy trabecular pattern.
Hypertrophic osteopathy is a disease of older animals generally associated with metastatic disease. The main radiographic finding is periosteal reaction around the metacarpals, tarsals and digits. More than one limb is usually affected and if seen, further diagnostics to look for a primary site of neoplasia is warranted.
Soft tissue swelling and joint effusion are seen with septic arthritis and bony changes can be seen with chronic disease.
Which of the following is not performed as part of the repair of medial patellar luxation in a dog?
a. Lateral imbrication
b. Partial meniscectomy
c. Transposition of the tibial tuberosity
d. Wedge resection
b. Partial meniscectomy
There is no reason to remove the menisci, as these are not involved with patellar luxation. A wedge resection involves making a deeper trochlear groove for the patella to slide in. Lateral imbrication and transposition of the tibial tuberosity will help pull the patella a little more laterally, as they are usually predisposed to luxating medially.
Which of the following is an appropriate objective in the repair of an articular fracture in a dog?
a. Avoid rigid fixation of the fracture
b. 50% or greater alignment
c. Early return to function
d. 6-8 weeks of strict post-operative rest
c. Early return to function
With articular fractures, the 3 major goals of the clinician are:
1) Rigid fixation of the fracture fragments; neglecting to do this will result in loose fracture fragments within the joints that will promote osteoarthritis.
2) Anatomic realignment (50% or even 75% is not adequate with articular fractures, in contrast to long bone fractures)
3) Early return to function. With long bone fractures, extended rest is recommended to promote stability and healing of the bone. The opposite is true in articular fractures where prolonged rest after repair will promote fibrosis, causing decreased range of motion in the joint.
A 6-year old male neutered Springer Spaniel presents for lethargy and difficulty walking. The owner reports that over the past week, the dog has become increasingly listless with decreased appetite and seems stiff as though he is “walking on eggs”. You examine the dog and find joint pain and effusion bilaterally affecting the carpi, tarsi, stifle, and elbow. The dog also appears uncomfortable on firm spinal palpation. T-103.1 F (39.5 C), HR-118 bpm, RR-30 bpm with intermittent panting. The remainder of your physical exam is within normal limits. You perform a complete blood count and chemistry panel revealing the following:
Hematocrit - 32% (Normal 36%-50%)
White Blood Cell Count - 14,500/ul (Normal 7,000-17,000/ul)
Thrombocytes - 195,000/ul (Normal 200,000-900,000/ul)
Calcium - 10.8 mg/dl (Normal 8-11 mg/dl)
Phosphorus - 2.9 mg/dl (Normal 2.4-4.9 mg/dl)
Total Protein - 6.9 g/dl (Normal 5.5-7.3 g/dl)
Alkaline Phosphatase - 78 IU/l (Normal 10-80 IU/l)
Alanine Aminotransferase - 18 IU/l (Normal 3-33 IU/l)
Blood Urea Nitrogen - 17 mg/dl (Normal 10-22 mg/dl)
Creatinine - 1.1 mg/dl (Normal 0.5-2.2 mg/dl)
Glucose - 91 mg/dl (Normal 60-125 mg/dl)
Urinalysis was within normal limits and urine culture was negative. Radiographs of the affected joints show joint effusion and no bony abnormalities. You perform arthrocentesis of each carpus, the left elbow and right tarsus. You are able to aspirate up to about 0.3ml from each joint; the fluid is thin and turbid; you submit the fluid for analysis. The protein level in the joint fluid ranges from 3.2-3.5 g/dl and the nucleated cell counts are 12,000-18,000 cells/ul consisting primarily of neutrophils, approximately 90% of which are nondegenerate. Smaller numbers of mononuclear cells are present. Culture of the synovial fluid is negative and a panel for tick titers is all negative.
Which of the following treatments is most appropriate based on the presumptive diagnosis?
a. Arthroscopy and amoxicillin
b. Enalapril and furosemide
c. Prednisone and azathioprine
d. Doxycycline and enrofloxacin
e. Plasma transfusion and intravenous fluids
c. Prednisone and azathioprine
This case is most consistent with immune-mediated polyarthritis (IMPA). IMPA is often classified as being erosive or nonerosive. This case is an example of the nonerosive form based on the lack of radiographic evidence of cartilage or subchondral bone destruction. The erosive form is rare and is thought to account for <1% of the cases of IMPA.
Nonerosive IMPA can be associated with a variety of systemic diseases or precipitating factors including systemic infectious, inflammatory or neoplastic disease or reactions to drugs or vaccines but it is most commonly idiopathic with no association to another disease process. In the described case, no risk factors or signs of concurrent disease were mentioned. Tick-borne arthropathy is less likely with the negative tick titers obtained, but since not every type of tick can be tested for, some clinicians may opt to treat with an antibiotic like doxycycline concurrently with the immunosuppressive drugs.
The clinical signs associated with IMPA are anorexia, weight loss, fever, lethargy, and lymphadenopathy. Up to 25% of dogs present with only nonspecific signs of systemic illness and without apparent gait abnormality or joint effusion. It is an important consideration for dogs with fever of unknown origin and may be the cause up to 20% of the time. IMPA is diagnosed by synovial fluid analysis although additional baseline diagnostics are indicated to screen for potential systemic or infectious causes. Normal synovial fluid is clear and viscous with <2.5 g/dl protein and <3,000 cells/ul with predominantly mononuclear cells. Joint fluid in IMPA may be thin, turbid, and increased in volume with higher amounts of protein and cells, often primarily nondegenerate neutrophils.
Treatment of idiopathic IMPA centers on immunosuppressive therapy, often starting with prednisone and sometimes including an additional immunosuppressive drug such as azathioprine or cyclophosphamide. About 80% of dogs will respond to immunosuppressive doses of prednisone; however, about one half of dogs require long-term or additional drug therapy to maintain remissio
Which of the following reasons explains why Dalmatians are predisposed to urinary tract obstructions?
a. Dalmatians have a genetic defect in the immune system of their lower urinary tract, predisposing them to bacterial cystitis and the formation of struvite stones, which can cause urinary tract obstructions.
b. Dlmatians have a genetic defect in making allantoin from urates in their liver. The low solubility of urates predisposes the dogs to forming urate stones, which can cause urinary tract obstructions.
c. Dalmatians are born with a congenital defect that predisposes them to urethral narrowing and the formation of urethral strictures.
d. Dalmatians have a genetic defect in the renal tubular reabsorption of cysteine, predisposing them to a build-up of cysteine and the formation of cysteine stones, which can cause urinary tract obstructions.
b. Dlmatians have a genetic defect in making allantoin from urates in their liver. The low solubility of urates predisposes the dogs to forming urate stones, which can cause urinary tract obstructions.
The low solubility of urates predisposes the dogs to forming urate stones which can cause urinary tract obstructions. Medical management involves feeding a low purine diet to neutralize or alkalinize the urine pH and administration of allopurinol, a xanthine oxidase inhibitor.
What type of urinary stone is likely to form in an animal being treated with too much allopurinol?
a. Struvite
b. Urate
c. Calcium oxalate
d. Cysteine
e. Xanthine
e. Xanthine
Allopurinol is used in the treatment of urate stone forming Dalmatians. It acts by inhibiting the enzyme, xanthine oxidase, which metabolizes xanthine. The idea is that by stopping the purine metabolism pathway at this point, uric acid will not be formed in high quantities. However, if given at too high of a dose, xanthine will accumulate to levels where xanthine stones will form.
Which of the following is most suggestive of pyelonephritis?
a. Small, irregular kidneys on ultrasound
b. Bacterial or white blood cells in the urine
c. Pain on abdominal palpation
d. Bacterial or white blood cell casts in urine
d. Bacterial or white blood cell casts in urine
Bacterial or white blood cell casts are highly suggestive of a past or present bacterial infection in the kidneys. Bacteria or white blood cells in the urine may be due to cystitis. Small, irregular kidneys may be due to any chronic pathology in the kidneys. Pain on abdominal palpation can be caused by pain from any abdominal organ or structures adjacent to the abdomen. Other signs associated with pyelonephritis include fever, anorexia, depression, and vomiting. A nephropyelogram may show blunted, dilated calices and dilated, tortuous ureters. Renal biopsy and culture would give the definitive diagnosis of pyelonephritis.
You are presented with a 6-year old female spayed toy poodle mix who has a 4 day history of stranguria and pollakiuria. The owner says that this is the 3rd time she has had these signs in the last 4 months; each of the other times the signs resolved after a week of amoxicillin.
Physical exam is normal except for discomfort on bladder palpation.
CBC and chemistry panels are within normal limits. Urinalysis results are as follows:
USG = 1.030 pH = 8.5 Color = yellow Clarity = turbid Glucose = neg Protein = 3+ Ketones = neg RBC = 50-100/hpf WBC = 20-30/hpf Bacteria = ++++ cocci Crystals = 4+ magnesium ammonium phosphate crystals
Abdominal radiographs show several large (>2 cm) rounded mineral opacities in the bladder.
What is the most likely diagnosis, and what are your treatment options?
a. Ammonium urate stones. Treat with culture-based antibiotics, dietary dissolution, and management of underlying liver disease
b. Calcium oxalate stones. Treat with culture-based antibiotics, and either dietary dissolution or surgical removal of stones.
c. Xanthine stones. Treat with culture-based antibiotics, allopurinol, and increased dietary protein
d. Struvite urolithiasis. Treat with culture-based antibiotics, and either dietary dissolution or surgical removal of stones
e. Cystine stones. Treat with culture-based antibiotics, surgical removal and decreased dietary calcium
d. Struvite urolithiasis. Treat with culture-based antibiotics, and either dietary dissolution or surgical removal of stones
Large bladder stones in the presence of UTI and alkaline urine are usually struvite, particularly when accompanied by struvite (magnesium ammonium phosphate) crystalluria. In dogs, struvite stones are almost invariably infection-associated. The infecting organisms are usually urease-producers (Staphylococus, Proteus, Klebsiella, some E. coli) which alkalinize the urine and favor struvite formation. The single most important long-term management is prevention of infection.
Calcium oxalate stones are usually small (1 cm or less), are often present in the absence of UTI, and cannot be dissolved.
Cystine stones occur most often in Newfoundland dogs, dachshunds, and bulldogs. They are radiolucent and occur due to metabolic defects.
Urate stones are usually small and many. They are frequently radiolucent and can be related to underlying liver disease.
A 6-month old Labrador Retriever presents for failure to thrive and stranguria. Abdominal ultrasound shows a small liver and stones in the urinary bladder. Abdominal radiographs show no visible stones. How can this be explained?
a. The dog has calcium oxalate stones
b. The dog has urate stones in its bladder
c. An artifact from the ultrasound was perceived as stones. There are really no stones in the bladder
d. The dog has struvite stones
b. The dog has urate stones in its bladder
The dog is described as having a portosystemic shunt which is often accompanied by urate stones in the bladder. Urate stones (and cysteine stones) are radiolucent, so they can’t be detected by radiography. Remember “I can’t C U”: (“C” is for cysteine, and “U” is for urate).
A 2-year old female spayed mixed breed dog presents in acute oliguric renal failure. The dog has a history of drinking ethylene glycol two days ago. What step should be taken next?
a. Start treating the dog with 4-Methylpyrazole IV and give a guarded to poor prognosis to the owner
b. Tell the owner the dog has a guarded to poor prognosis and may need hemodialysis
c. Start treating the dog with ethanol IV and give a guarded to poor prognosis to the owner
d. Start treating the dog with activated charcoal orally and tell the owner the dog has a guarded prognosis
b. Tell the owner the dog has a guarded to poor prognosis and may need hemodialysis
4-MP and ethanol act by preventing alcohol dehydrogenase from converting ethylene glycol to its toxic metabolites. In animals where oliguric renal failure has already begun, most of the ethylene glycol will already have been metabolized, so there is no benefit to giving ethanol or 4-MP. Activated charcoal should only be given if the ethylene glycol was ingested within 2 hours.
A 4-year old male castrated Basenji presents for polyuria, polydipsia, and weight loss. Blood work shows P=2.5 (2.9-5.3 mg/dl), K= 3.1 (3.9-5.1 mEq/L), total CO2= 12 (17-25 mmol/L). The remainder of the blood work is within normal limits. Urinalysis shows 3+ glucose. Which of the following is your most likely differential diagnosis?
a. Diabetes mellitus
b. Fanconi syndrome
c. Pyelonephritis
d. Pyometra
b. Fanconi syndrome
Fanconi syndrome is an inherited disease in Basenjis. The disease involves renal tubular defects causing an abnormal loss of electrolytes and solutes leading to hypophosphatemia, hypokalemia, and metabolic acidosis. DM is less likely because serum glucose is normal. The lab abnormalities present in this dog are not consistent with pyelonephritis. Pyometra is not a viable choice as the signalment describes a male.
What region of the bone is affected in hypertrophic osteodystrophy?
a. Physis
b. Epiphysis
c. Diaphysis
d. Metaphysis
d. Metaphysis
Hypertrophic osteodystrophy (HOD) is a condition seen in young, growing large breed dogs. It affects the metaphyses of all long bones and appears as an abnormal radiolucent line within the metaphysis. The disease is usually self-limiting but can cause limb deformities or systemic illness. The etiology is unknown but may be correlated with Ca/P levels and balance, vitamin C deficiency, and certain diseases including distemper.
In an animal with pleural effusion, which radiographic view will give you the best view of the heart?
a. Dorsoventral
b. Ventrodorsal
c. Left lateral
d. RIght lateral
b. Ventrodorsal
Pleural effusion obscures the heart completely on a dorsoventral radiograph and at least partially on lateral radiographs. Ventrodorsal positioning usually moves the pleural fluid away from the heart and allows for a radiographic view of the heart to be obtained. Of course, in dyspneic animals, it may not be wise to position them ventrodorsally.
A type III Salter Harris fracture involves what part of the bone?
a. Metaphysis and physis
b. Metaphysis, physis, and epiphysis
c. Epiphysis and physis
d. Metaphysis and epiphysis
c. Epiphysis and physis
A type I Salter-Harris fracture is physeal only. Type II involves the physis and metaphysis, type III involves the physis and epiphysis, type IV involves physis, metaphysis, and epiphysis, and type V is a compression injury to the physis.
A 12-year old English Bulldog presents with anorexia and severe, generalized pain. What is the best description of the lesions in this radiograph?
a. Monostotic, non-aggressive
b. Polyostotic, aggressive
c. Monostotic, aggressive
d. Polyostotic, non-aggressive
b. Polyostotic, aggressive
There are multiple lytic lesions in the cervical and thoracic vertebrae, especially visible in C2 and in the spinous processes of the T1-T8. There are also lytic lesions in the proximal humerus of one leg and in the bones of the skull.
You are examining a dog for lameness and on radiographs; you find hypertrophic osteopathy of the metacarpal bones. What is the likely cause of this lesion?
a. Pulmonary neoplasia
b. Ca deficiency
c. Vitamin D deficiency
d. Bone tumor
e. Trauma
a. Pulmonary neoplasia
Hypertrophic osteopathy is visible as periosteal proliferation in the diaphyses of affected bones. Usually the metacarpal and metatarsal bones are affected first, and it may progress to the long bones. Lameness, pain, and swelling are usually evident. Joints are unaffected. The cause is usually primary or metastatic pulmonary neoplasia, although other diseases in the thorax including bronchopneumonia, Spirocerca infection, or congestive heart failure, may also be associated. Less commonly, abdominal neoplasia may be seen with this condition.
Which of the following is most likely to cause the abnormality seen in this radiograph?
a. Penetrating thoracic trauma
b. Osteosarcoma
c. Aspiration pneumonia
d. Pyometra
e. Blastomycosis
b. Osteosarcoma
The abnormality in the radiograph is multiple pulmonary nodules consistent with metastatic neoplasia. Systemic fungal disease would be a reasonable differential for this radiographic pattern but is not as good of a choice, especially with no evidence of hilar lymphadenopathy. Aspiration pneumonia would cause an alveolar infiltrate centered in the cranioventral lung region, and penetrating trauma would likely cause pneumothorax. There is no evidence of pneumothorax in this study.
A 6-month old Chocolate Labrador presents for limping and failure to gain weight. He is housed in an outdoor kennel with other hunting dogs. He is fed a large breed dry puppy food. He received his puppy shots at 8, 12, and 16 weeks old. He is quiet, alert, and responsive. His body condition score is 3/9, with rib exposure and poor fat deposition. His mucous membranes are pale pink, with a capillary refill time of 2 seconds. His heart and lungs auscult normally. No abnormalities are felt on abdominal palpation. He is an intact male, and both testicles are descended. The only abnormalities are the pads of his two front feet and left hind foot (see image) that he chews at frequently. What is diagnostic test of choice?
a. Radiographs
b. PCV and TP
c. Skin scraping
d. Fecal float
e. Biopsy
d. Fecal float
Hookworms (Ancylostoma and Uncinaria) are intestinal parasites that suck blood and can cause anemia, enteritis, coughing during larval migration, and dermatitis. Any young dog that is failing to thrive and/or has pale mucous membranes should be tested for intestinal parasites. Hookworm dermatitis, also called Ancylostomiasis is typically seen in conditions with poor sanitation and/or in kennels.
Hookworms can be transmitted in utero, during nursing, or via 3rd stage larva penetrating the skin. The most commonly affected skin areas are the pads and interdigital spaces of the feet, but can include any surface that contacts the ground. The larva migrate through the dog’s tissues before arriving in the intestines. They cause significant anemia, failure to thrive, or sudden death in young dogs. In mild cases, deworming protocols are often enough; with severe cases blood transfusions and parenteral treatments are often necessary.
Skin scraping and impression smears of the affected skin areas are typically unrewarding for isolating parasites. A PCV/TP would show signs of anemia, but not the underlying etiology. Complete blood cell count and chemistry will often show anemia that is regenerative and an eosinophilia. Radiographs would be unrewarding in this case. A biopsy may show migrating larva if biopsied soon after trauma, however this is not a diagnostic test routinely used.
Which of the following is the treatment of choice for a Taenia infection in dogs?
a. Fenbendazole
b. Pyrantel
c. Praziquntel
d. Ivermectin
c. Praziquntel
Pyrantel and ivermectin are not known to be effective against Taenia infections. Fenbendazole is effective against Taenia pisiformis, but not other subspecies of Taenia, making it a less desirable answer choice.
A 3-year old German Short Hair Pointer presents for vomiting, lethargy, and diarrhea. A fecal exam reveals the eggs of Nanophyetus salmincola, the salmon poisoning fluke. What treatment should be administered to treat the symptoms of the dog?
a. Penicillin
b. Fenbendazole
c. Tetracycline antibiotics
d. Praziquantel
c. Tetracycline antibiotics
The causative agent for the dog’s clinical signs is Neorickettsia helminthoeca. Treatment of choice for this rickettsial agent is tetracycline antibiotics. The fluke itself is not responsible for the clinical signs, but may be treated effectively with Praziquantel.
Which of the following is most likely to be the vector for Lyme disease?
a. Dermacentor variabilis
b. Dermacentor andersoni
c. Ixodes pacificus
d. Rhipicephalus sanguineus
e. Amblyomma americanum
c. Ixodes pacificus
Ticks acquire the infection at any stage and are most likely to get it from the white-footed mouse, Peromyscus leucopus. Dermacentor variabilis and Dermacentor andersoni are known to transmit Rocky Mountain Spotted Fever. Amblyomma americanum may transmit canine granulocytic ehrlichiosis which is caused by E. ewingii and Anaplasma phagocytophila. Rhipicephalus sanguineus is known to transmit Ehrlichia canis.
A 12 year-old female spayed mixed breed dog presents for further evaluation of intermittent vomiting of 2 weeks duration. A general physical exam was performed and found to be unremarkable. Blood work was performed and the following abnormalities were observed: CK 1019 IU/L (52-368 IU/L), AST 106 U/L (13-15 IU/L), ALK Phos 864 U/L (1-114 IU/L), ALT 340 U/L (10-109 IU/L). An abdominal ultrasound was performed and revealed a massive, multilobular, heterogenous mass associated with the right medial liver lobe. The remaining liver lobes appeared to be unaffected. Based on the history, blood work, and findings what is the likely long-term survival of this patient if surgery is pursued and a hepatocellular carcinoma is diagnosed?
a. Approximately 28 days
b. Approximately 700 days
c. Approximately 1400 days
d. Approximately 300 days
c. Approximately 1400 days
Single solitary liver masses are generally considered a surgical disease as long there is no overt evidence of metastasis or concern that the mass is a metastatic lesion as opposed to a primary tumor arising from the liver. Primary liver masses include hepatomas, hepatocellular carcinomas, bile duct adeonomas, bile duct carcinomas, and rarely, neuroendocrine tumors. Hepatocellular carcinomas are the most common liver tumor of dogs and second most common in cats. Adenomas will have a better prognosis, however hepatocellular carcinomas generally carry a good prognosis after surgical excision as well.
Bile duct carcinomas have a much more guarded prognosis with an average survival time of approximately 6 months. The prognosis for neuroendocrine tumors of the liver is poor.
What tumor type is most frequently implicated in causing feminization syndrome in dogs including gynecomastia, sexual attraction of males, and bilaterally symmetric alopecia?
a. Sertoli cell tumor
b. Mammary carcinoma
c. Seminoma
d. Leydig cell tumor
a. Sertoli cell tumor
The tumor sometimes secretes estrogen and other hormones, which can lead to this syndrome.
This radiograph is of a 10-year old male castrated mixed-breed dog that has been progressively more lame on the left forelimb over the past 3 weeks. Owners report that he has always been healthy and still has a great appetite. There is a travel history of visiting Nevada approximately 8 months ago. What is the recommendation for this patient?
a. Strongly recommend performing a total elbow replacement given the severe degree of osteoarthritic changes
b. Strongly recommend initiating glucosamine and chondroitin therapy as well as NSAIDs
c. Strongly recommend a CBC and chemistry panel and the initiate anti-fungal therapy for a minimum of six months
d. Strongly recommend chest radiographs and biopsy prior to initiating treatment
d. Strongly recommend chest radiographs and biopsy prior to initiating treatment
This radiograph has a component of lytic and proliferative lesions that cross the joint. The differentials include neoplasia, fungal osteomyelitis, or bacterial osteomyelitis. Since the bony involvement is crossing the joint, it is most likely a synovial cell sarcoma. Osteosarcoma, fibrosarcoma, and chondrosarcomas are less likely to cross a joint as seen in this image. The marked lytic component seen should eliminate severe osteoarthritis as a differential. Anti-fungal therapy or any definitive treatment should ideally not be initiated until a diagnosis is obtained.
The radiograph shown here was actually taken after obtaining a core biopsy of the bone for histopathology.
A 10-year old Shih Tzu presents for collapse. A diagnostic work up shows a mass on the right kidney, which was subsequently removed and biopsied as renal carcinoma. Which one of the following can be associated with renal carcinoma?
a. Polycythemia
b. Hyperadrenocorticism
c. Hyperestrogenism
d. Thrombocytopathy
e. Hypercalcemia
a. Polycythemia
Renal carcinomas have been associated with erythropoietin secretion, causing elevations in hematocrit as a paraneoplastic syndrome.
Hypercalcemia is associated with anal sac adenocarcinomas, lymphomas and other tumors.
Thrombocytopathy can be seen with hemangiosarcoma and multiple myeloma.
Hyperestrogenism can be seen with Sertoli cell tumors.
Hyperadrenocorticism is caused by functional adrenal or pituitary tumors.
A 12-year old mixed breed MC dog presents to an emergency clinic with a history of increased respiratory rate, anorexia, lethargy, inappetance and a soft cough over the past 3 days. One week ago the patient had a large mass removed from the left pelvic limb. The owners are unable to tell you the diagnosis of the mass. On physical exam, the patient is depressed, has slightly decreased lung sounds, and the incision associated with mass removal is intact. Chest radiographs were performed as shown in this image. What is the radiographic diagnosis and appropriate treatment?
a. The patient has severe bronchoconstriction and a bronchodilator should be prescribed
b. This patient has metastatic lesions throughout the lungs and only palliative treatment can be recommended
c. The patient has severe aspiration penumonia and should be started on broad spectrum antibiotics, IV fluids, and oxygen support
d. The patient has severe pulmonary edema secondary to heart failure and durosemide should be administered.
b. This patient has metastatic lesions throughout the lungs and only palliative treatment can be recommended
This dog was not staged prior to surgical removal of the mass and likely had visible metastatic nodules at the time of surgery. The only other potential differential with this radiographic finding would be granulomatous disease which is unlikely given the history.
A 7-year old female Lhasa Apso presents to you for lethargy and inappetence. On your exam, you detect mandibular lymphadenopathy and perform a fine needle aspirate. You see the aspirate depicted here. Which of these treatments would be given to this patient as part of a first line therapy?
a. Carboplatin
b. Itraconazole
c. Doxycycline
d. Prednisone
e. Milbemycin
d. Prednisone
This is a case of lymphoma. The cytology depicts the classic finding of a population of lymphoid cells that are predominantly lymphoblasts based on their size and characteristics. If you were unsure about their size due to magnification, there is a neutrophil in the lower left corner for comparison. The lymphoblasts are considerably larger than the neutrophil. Mature lymphocytes would be smaller than a neutrophil. Note that there is a mitotic figure in the middle of the slide.
There are many treatments and protocols for lymphoma and some of the main agents known to have efficacy are prednisone, doxorubicin, cyclophosphamide, vincristine, L-asparaginase, and lomustine. There are many other efficacious chemotherapeutics for lymphoma but carboplatin is not considered a first line treatment for lymphoma in dogs.
The other drugs listed are antifungal (itraconazole), antibiotic (doxycycline) and anti-parasitic (milbemycin).
What type of tumor in the dog is commonly associated with signs of local inflammation as shown in the image?
a. Cutaneous melanoma
b. Mast cell tumor
c. Hemangiosarcoma
d. Mammary carcinoma
e. Lymphoma
b. Mast cell tumor
Mast cells contain granules with inflammatory mediators including heparin and histamine and commonly cause local inflammation. They can also cause paraneoplastic signs associated with hyperhistaminemia and hyperheparinemia.
Half of mammary tumors in dogs are benign and half are malignant. Even the malignant ones do not usually have associated inflammation with the noteworthy exception of a relatively rare type of tumor called an inflammatory mammary carcinoma that carries a very poor prognosis.
Hemangiosarcoma and lymphoma are both malignant tumors but are not usually associated with extensive inflammation. Cutaneous melanoma in the dog is benign in 80-90% of cases in contrast to humans.
Which of the following is a common finding on a complete blood count in a dog with a ruptured splenic hemangiosarcoma?
a. Thrombocytosis
b. Eosinophilia
c. Neutropenia
d. Schistocytes
e. Heinz body anemia
d. Schistocytes
Schistocytes are fragmented red blood cells that are mechanically broken up due to the irregular vessels and fibrin strands they pass through in hemangiosarcoma patients. Other typical findings on a CBC in a patient with hemangiosarcoma are thrombocytopenia, anemia (although not with Heinz bodies), and leukocytosis.
A 10-year old female spayed boxer presented for a mass on the left side of the neck. The mass was diagnosed as a mast cell tumor based on fine needle aspirate. Screening with thoracic radiographs, abdominal ultrasound and bloodwork was unremarkable. The owners elected for surgical removal and clean 3 cm margins were obtained in all directions. The mass was submitted for histopathology and was categorized as a grade 3 (or high grade) tumor. What is your recommendation to the owner?
a. Start a tyrosine kinase inhibitor chemotherapy drug
b. Monitor the surgical site for recurrence; abdominal ultrasounds every 3-4 months
c. Radiation therapy for the surgical site and prescapular lymph node; abdominal ultrasound every 3-4 months
d. Start a doxorubicin based chemotherapy protocol
a. Start a tyrosine kinase inhibitor chemotherapy drug
Under the Patnaik grading system, grade 3 tumors are highly metastatic. Mast cell tumors are highly responsive to radiation therapy, but with clean excision and wide surgical margins, local recurrence is unlikely. Metastasis is the primary concern and a wait and monitor approach is not advised. Even with no evidence of metastasis at the time of surgery, chemotherapy should be initiated as soon as possible. Common protocols include single agent or alternating vinblastine and lomustine. Tyrosine kinase inhibitors, such as toceranib (Palladia) and masitinib (Kinavet, which is no longer available), target c-kit, a stem cell factor receptor involved in mast cell proliferation and differentiation. Palladia and Kinavet are FDA approved for treatment of high-grade canine cutaneous mast cell tumors.
A 6-year old Schipperke presents with a 1-month history of progressive weakness and decreased appetite. The owner reports the dog is slightly polyuric and polydipsic. Your physical exam is unremarkable except that the dog seems subdued and a bit uncomfortable. You perform bloodwork which shows the following results:
Hematocrit - 28% (Normal 36%-50%)
White Blood Cell Count - 16,000/ul (Normal 7,000-17,000/ul)
Thrombocytes - 324,000/ul (Normal 200,000-900,000/ul)
Calcium - 13.2 mg/dl (Normal 8-11 mg/dl)
Phosphorus - 2.9 mg/dl (Normal 2.4-4.9 mg/dl)
Total Bilirubin - 0.1 mg/dl (Normal 0.06-0.61 mg/dl)
Total Protein - 7.2 g/dl (Normal 5.5-7.3 g/dl)
Albumin - 2.3 g/dl (Normal 2.2-4.2 g/dl)
Globulins - 4.9 g/dl (Normal 2.6-4.5 g/dl)
Alkaline Phosphatase - 45 IU/l (Normal 10-80 IU/l)
Aspartate Aminotransferase - 8 IU/l (Normal 0-20 IU/l)
Alanine Aminotransferase - 17 IU/l (Normal 3-33 IU/l)
Gamma-Glutamyl Transferase - 2 IU/l (Normal 1.3-12 IU/l)
Blood Urea Nitrogen - 17 mg/dl (Normal 10-22 mg/dl)
Creatinine - 1.4 mg/dl (Normal 0.5-2.2 mg/dl)
Glucose - 96 mg/dl (Normal 60-125 mg/dl)
Cholesterol - 180 mg/dl (Normal 125-250 mg/dl)
You perform whole-body radiographs which are shown below. Which of the following choices are two tests that will help you confirm the most likely diagnosis?
a. Urinalysis, renal biopsy
b. Bone marrow biopsy, serum electrophoresis
c. Ultrasound of neck, measure serum parathyroid hormone
d. ACTH stimulation test, dexamethasone supression test
e. Echocardiogram, heartworm antigen test
b. Bone marrow biopsy, serum electrophoresis
This dog has signs and bloodwork findings that are consistent with but not specific for multiple myeloma. The hypercalcemia and hyperglobulinemia are both mild and are consistent with this diagnosis but would not be sufficient alone to jump to that conclusion. The key finding in these case is the radiographic evidence of multiple punctate lucencies including in the body of C4, several of the thoracic dorsal spinous processes, the left ilium, and the right and left humeral diaphyses. These lesions are strongly suggestive of multiple myeloma; however, definitive diagnosis of multiple myeloma requires satisfying at least two of the following criteria:
- Monoclonal gammopathy
- Radiographic evidence of osteolytic bone lesions (satisfied in this case)
- >5% neoplastic cells or >10-20% plasma cells in the bone marrow
- Immunoglobulin light chain proteinuria (Bence-Jones proteinuria)
Therefore, the best answer in this question is to perform serum electrophoresis to assess monoclonal gammopathy and a bone marrow biopsy to look for neoplastic infiltration of plasma cells.
Which of these is a major potential adverse side effect of the chemotherapeutic drug adriamycin in dogs?
a. Cardiotoxicity
b. Ileus
c. Nephrotoxicity
d. Anaphylaxis
e. Cystitis
a. Cardiotoxicity
In addition to the usual side effects of chemotherapeutic drugs such as myelosuppression and GI side effects, a major concern with adriamycin administration is dose dependent cardiotoxicity. The drug that causes ileus is vincristine. The drug that causes anaphylaxis is L-asparaginase. The drug that causes nephrotoxicity is cisplatin. The drug that causes cystitis is cyclophosphamide.
Which of the following problems is seen more frequently in male dogs than females?
a. Urinary tract infections
b. Addison’s disease (hypoadrenocorticism)
c. Mammary cancer
d. Aggression
e. Adenocarcinoma of the anal sac
d. Aggression
More males than females present to veterinary behaviorists for aggression. The other diseases listed have been reported or suggested to occur more frequently in females in some reports.
A 3-month-old pit bull terrier presents with generalized alopecia and crusting of the skin (see image). A deep skin scraping shows the dog has generalized demodicosis. What should you tell the owners?
a. Transmission of the infection was from the bitch to the puppy. The bitch be treated for Demodex because she is the source of the infection. The puppy does not need to be treated.
b. The dog likely has an inherited defect in cellular immunity. The dog should not be bred
c. It is very common for pit bull puppies to get generalized Demodex infections. The puppy should be treated for the infection, but the prognosis is good
d. Generalized Demodex infections usually resolve on their own without treatment
b. The dog likely has an inherited defect in cellular immunity. The dog should no
The dog should not be bred. Generalized demodicosis in juveniles and puppies is usually caused by an inherited defect in cell immunity. They should be treated with a mite killing agent like ivermectin, amitraz, or milbemycin, as well as with oral antibiotics for secondary bacterial infections. Spontaneous remission of the infection can occur, but the prognosis is always guarded. Demodex mites are part of the natural flora of a dog’s skin, so they are normally present all the time. Adult dogs that develop generalized demodicosis are usually immune-suppressed.
Which dog breed is genetically predisposed to exocrine pancreatic insufficiency?
a. German Shepherd Dog
b. Bernese Mountain Dog
c. Irish Setter
d. Golden Retriever
a. German Shepherd Dog
EPI is believed to be an autosomal recessive trait in German Shepherd Dogs that results in atrophy of the exocrine pancreas. Dogs lose the ability to digest fat and protein and become emaciated. They have voluminous, soft feces, a voracious appetite, and may develop pica. The trypsin-like immunoreactivity (TLI) is diagnostic for EPI. Treatment entails adding powdered pancreatic enzyme extract, or raw pancreas to meals. These dogs should not be bred.
Which of the following breeds is predisposed to acanthosis nigricans?
a. Dachshund
b. Boxer
c. Chihuahua
d. Great Dane
e. Labrador Retriever
a. Dachshund
The primary inherited form of this condition almost exclusively occurs in Dachshunds. Other dogs may get a form of the condition secondary to other skin diseases. The condition is characterized by hyperpigmentation of the axillary and groin regions and can spread to other parts of the body. Secondary bacterial infections, yeast infections, and seborrhea commonly develop in the affected regions. The mode of inheritance has been proposed to be autosomal recessive or polygenic inheritance.
You are evaluating the blood work of a dog that is hit by a car. These are the following findings:
HCO3-12 mmol/L (17-24 mmol/L)
Total CO2-14 mmol/L (14-26 mmol/L)
Lactate-2.3 mmol/L (0.5-2.0mmol/L).
What is your assessment?
a. Metabolic alkalosis
b. Respiratory acidosis
c. Metabolic acidosis
d. Respiratory alkalosis
c. Metabolic acidosis
A low bicarbonate and total CO2 level is consistent with a metabolic acidosis. An elevated blood lactate of greater than 2.0 mmol/L implies that there is anaerobic metabolism occurring in this patient as a result of inadequate tissue perfusion, perhaps due to bleeding and trauma.
Nothing can be said about respiratory acidosis or alkalosis because no PaCO2 or pH is provided.
A 10 year old female spayed Schipperke dog presents to your emergency clinic for profuse vomiting for several days and weakness. You perform initial bloodwork and find that her blood pH is 7.6 (7.35-7.45) and her potassium is 1.8 mmol/L (3.4-4.9 mmol/L). She weighs 12 kg. You immediately start her on intravenous fluids supplemented with potassium. What is the maximum rate of intravenous potassium that would be considered safe to administer to this dog?
a. 12 mEq/hr
b. 24 mEq/hr
c. 18 mEq/hr
d. 3 mEq/hr
e. 6 mEq/hr
e. 6 mEq/hr
The maximum safe rate of potassium infusion is 0.5 mEq/kg/hr. As this dog weighs 12 kg, the maximum is 6 mEq/hr. This is one of those rates that you need to know. Administering potassium more rapidly than this can result in fatal arrhythmias.
A 4-year old female spayed mixed breed dog presents for further evaluation. She has a 24 hour history of increased respiratory rate and decreased appetite. Owners note that she is an indoor/outdoor dog. Based on these radiographs, what is the best treatment?
a. Left caudal lung mass removal
b. Pericardiocentesis
c. Intravenous furosemide
d. Thoracocentesis
d. Thoracocentesis
This patient has a left sided pneumothorax. Pneumothorax can be secondary to trauma, ruptured bullae, infection, or neoplasia. The radiograph shows an elevated heart off the sternum as well as collapse of the lung lobes. Notice there are no bronchi or vessels extending caudally toward the diaphragm due to collapse of the lung.
Pericardiocentesis would be indicated if you had a very large globoid heart, suggestive of pericardial effusion. The heart does not appear enlarged and there is no pulmonary edema making intravenous furosemide a poor choice. Do not confuse a collapsed lung lobe for a lung mass.
In a dog, Cushing’s response is characterized by a _______.
a. Compensatory decrease in systolic blood pressure to maintain peripheral perfusion
b. Conpensatory hyperadrenocorticism to maintain cerebral perfusion
c. Compensatory increase in mean arterial pressure to maintain cerebral perfusion pressure
d. Compensatory elevation in blood glucose to enhance cerebral function
c. Compensatory increase in mean arterial pressure to maintain cerebral perfusion pressure
Cerebral perfusion pressure= Mean arterial pressure - intracranial pressure or (CPP=MAP-ICP).
This response is seen in situations where intracranial pressure increases such as in brain trauma. In this case, you need to think before you intervene to decrease your patient’s mean arterial pressure as this might eliminate cerebral blood flow and kill your patient.
A 9 year old Greyhound presents to your clinic with an ulcerating mast cell tumor, located subcutaneously over the left scapula. You immediately schedule the dog for a wide surgical excision after no evidence of metastatic disease is identified on a complete blood count, serum chemistry, thoracic radiographs, and abdominal ultrasound. Your technician asks you if there are any drugs she should avoid using in this dog. You tell her the following drugs are contraindicated in this patient:
a. Acepromazine and ivermectin
b. Atracurium and acepromazine
c. Ivermectin and thiopental
d. Propofol and morphine
e. Morphine and thiopental
e. Morphine and thiopental
In this case, thiopental is contraindicated because the patient is a sighthound. Thiopental is an ultra-short acting barbiturate. Recovery depends on redistribution to tissues, including fat. Because sighthounds have very little fat, they have prolonged recoveries and greater complications with these drugs.
Morphine is contraindicated in this patient due to the ulcerating mast cell tumor. Morphine can cause histamine release and should be avoided in mast cell tumor patients.
A 2-year-old neutered male greyhound presents for crusting along his ear pinnae and elbows. The owner also explains that the dog is intensely pruritic. The dog mainly lives indoors but is also let outside into the backyard. The owner lives on a large rural property that is heavily wooded. You perform cytology, which returns negative for bacteria and yeast. You are highly suspicious of Sarcoptes. Which of the following would be most useful to help in your diagnosis of Sarcoptic mange?
a. Pinnal-pedal reflex, clinical signs, superficial skin scrape
b. Deep skin scrape, pinnal-pedal reflex, clinicla signs
c. Clinical signs, superficial skin scrape, trichogram
d. Histopathology, deep skin scrape, trichogram
e. Superficial skin scrape, histopathology, trichogram
Pinnal-pedal reflex, clinical signs, superficial skin scrape
A superficial skin scrape is most useful. A deep skin scrape is used for Demodex mites, which reside in the hair follicles. Superficial skin scraping is indicated for Sarcoptic mange, since this mite lives in the stratum corneum. Pinnal-pedal reflex can be positive in 70% of Sarcoptic mange infestation but can also be positive in any dog with pruritus. Clinical signs are helpful because Sarcoptes typically infects the non-haired portions of the skin such as the ear pinnae, elbows, hocks, and ventral abdomen. If the mite is not found on skin scraping and you have clinical signs indicative of Sarcoptes then a therapeutic trial is warranted. Keep in mind that in most cases you will not be able to find the mite.
A trichogram would not be indicated. This method can be used to diagnose dermatophytosis and sometimes Demodex. Histopathology will reveal a perivascular dermatitis that is non-specific. Rarely are the mites found on histopathology.
A 2-year old female spayed Dachshund presents for further evaluation as a result of a mass on the pinna noted by the owner. On physical exam, the only abnormality noted was this mass. Cytology is consistent with a histiocytoma. Which of the following is the most reasonable treatment option?
a. Chemotherapy using lomustine
b. Radiation therapy
c. Benign Neglect
d. Cryotherapy
e. Radical surgical excision
c. Benign Neglect
Histiocytomas are typically benign and will often present as a small, raised mass that may or may not be ulcerated. Fortunately, these masses usually regress on their own, and surgical or medical intervention is typically not necessary.
A 5-year old Collie presents for erosive/ulcerative dermatitis of the nasal planum. The lesion is well-demarcated and confined to the nasal planum and philtrum. There is a loss of cobblestone appearance and hypopigmentation. Which of the following is least likely to result in the above clinical signs?
a. Pemphigus foliaceous
b. Discoid lupus erythmatosus (cutaneous lupus)
c. Dermatophytosis
d. Mucocutaneous pyoderma
e. Cutaneous lymphoma
c. Dermatophytosis
Pemphigus and discoid lupus are autoimmune conditions that can result in ulcerative nasal dermatitis with loss of cobblestone appearance. Cutaneous lymphoma, in rare cases, can affect just the nose. Mucocutaneous pyoderma can also result in similar signs, but this condition usually has involvement in other areas such as the mucocutaneous junctions of the mouth, prepuce, and anus.
Dermatophytosis (ringworm) often affects the muzzle; however, it rarely affects the nasal planum. This is because dermatophytes live in hair follicles and there are no hair follicles on the nasal planum. Many times you will observe dermatophytosis on the muzzle and the lesions will stop abruptly where the nasal planum starts.
The next step for this dog would be to biopsy.
A 4 year-old neutered male Doberman Pinscher presents for symmetrical alopecia, lethargy, and weight gain despite a normal appetite. The owner reports that the dog has recently become very itchy. Upon dermatological examination, you find areas of alopecia on the flanks and axillary region. There is also erythema and waxy crusts involving the axillae and forelegs. You take cytology from these areas and find Malassezia. Complete blood count reveals a mild normochromic, normocytic anemia. Chemistry panel shows a very mild hypercholesterolemia. What is your next treatment and next diagnostic step?
a. Griseofulvin, free T4
b. Fluconazole, intradermal allergy test
c. Griseofulvin, intradermal allergy test
d. Doxycycline, free T4
e. Fluconazole, free T4
e. Fluconazole, free T4
From the options listed, fluconazole is the best treatment plan for this dog’s Malassezia dermatitis. Griseofulvin is an antifungal but is expensive and causes myelosuppression and gastrointestinal upset; it is not the first choice for Malassezia dermatitis. Other azoles like itraconazole and ketoconazole are also good choices. Terbinafine is being used more often for Malassezia dermatitis since it has fewer side effects than azoles. Ketoconazole, itraconazole, and fluconazole can be hepatotoxic.
Underlying causes of Malassezia dermatitis include allergies, endocrinopathy, immunodeficiency syndromes, and other systemic illnesses. This dog is presenting with classic signs of an endocrinopathy with initially non-pruritic symmetrical alopecia. The clinical signs of lethargy and weight gain along with the blood work results is indicative of hypothyroidism, and your next diagnostic step would be a free T4. Intradermal testing is not recommended at this time, since the dog was initially not itchy and only became pruritic presumably after infection with Malassezia.
Doxycycline would not be indicated since it is an antibiotic.
A 4-month old intact male Collie presents for severe dermatitis along his nose and ears (see image). The areas are sensitive on palpation but not pruritic. No other areas are affected. Skin scraping and cytology are negative for mites or bacteria. Fungal culture is negative. Anti-nuclear antibody tests are ordered and are also negative. How do you educate the owner based on your presumptive diagnosis?
a. Long-term immunosuppressive medications are needed
b. Biopsy and culture are necessary, long-term therapy often needed
c. The disease is not curable; euthanasia should be discussed
d. The disease is familial, and is often cyclic and will regress
d. The disease is familial, and is often cyclic and will regress
Familial dermatomyositis is a familial disease seen in Collies, Shetland sheepdogs, and other collie breeds. Diagnosis can be made with skin or muscle biopsies, but can be difficult as the clinical and histopathologic signs can wax and wane. Inciting causes can include vaccinations, sunlight, viral infections, or drugs. Some cases; however, will come and go without obvious inciting causes. Some cases can become severe enough to include muscle atrophy; megaesophagus has also been seen with this disease.
Treatments are often symptomatic and supportive and include Vitamin E supplements, Omega 3 fish oils, treatments for any secondary bacterial infections, and pentoxifylline. Prednisone can also be used to get more severe cases under control. Avoiding prolonged sun exposure can also help.
Educating the owner on the fact that signs will reoccur despite treatment can alleviate some owner frustrations. Often times signs will regress with or without treatments. Educate owners on neutering animals to prevent propagation of diseased animals.
A 1-year old male Shar Pei presents with the clinical signs shown in the photo below. Recognizing that this sign is classic for Familial Shar Pei Fever (FSF), what other finding is LEAST likely to be present?
a. Normal synovial fluid cytology
b. Panosteitis
c. Body temperature between 105 and 107 degree F
d. Proteinuria
b. Panosteitis
Familial Shar Pei Fever (FSF) is characterized by high fever and unilateral or bilateral tarsal swelling as seen in the photo. This swelling affects tissues around the joint, rather than within the tarsus itself. FSF may be a distinct entity from amyoloidosis but animals with FSF are predisposed to amyoloidosis, resulting in proteinuria. Panosteitis is not associated with FSF.
A 9-year old female spayed Chihuahua presents to you with the skin abnormality shown below. She has similar lesions all over the rest of her body. A superficial and deep skin scraping show many moving “cigar shaped” mites. Which of these products is the only FDA approved for treatment of this disease?
a. Lime Sulfur
b. Ivermectin (Ivomec)
c. Amitraz (Mitaban)
d. Chlorhexadine
c. Amitraz (Mitaban)
This is a case of generalized demodicosis which can occur in older dogs as well as young dogs. It is caused by the commensal mite, Demodex canis, and is often secondary to an underlying disease or immunosuppression. There are several treatment options (and you should probably know them all) but the only FDA-approved treatment is Amitraz (Mitaban). Ivermectin and milbemycin are also used to treat this condition in part because it is difficult to obtain Mitaban. Mitaban is used as dip and should be administered in a hospital, which is time consuming when there are other treatment options that can be similarly effective although used “off-label”. Mitaban should be used cautiously in animals with skin lesions since more systemic absorption of Mitaban will occur which increases the likelihood of toxic affects.
A 14-year old Husky presents for the signs seen here (see image). What do you tell the owner regarding prognosis?
a. Permanent discoloration will spread over entire body
b. Color change may occur seasonally
c. May ulcerate, immunotherapies needed
d. This will reverse after treatment
b. Color change may occur seasonally
This is seasonal nasal hypopigmentation. Season associated lightening of the nasal planum occurs during winter months and can darken in the spring and summer. Complete depigmentation is not noted. Hypopigmentation and discoloration of the nose and mucocutaneous junctions can vary from benign immune-mediated diseases, such as vitiligo that lower the amount of melanocytes in the skin to seasonal variations in coloring, commonly called a “Dudley Nose” or “Snow Nose”. Certain breeds are more predisposed than others, such as Siberian Huskies, Golden and Labrador Retrievers, and Bernese Mountain Dogs. This can be seen in any breed.
With vitiligo, which is a benign immune related depigmentation, antimelanocyte antibodies can be found in circulation and a biopsy will show decreased melanocytes. Typically multiple areas will be affected, including ear tips, footpads, claws, and hair coat. Breeds predisposed to vitiligo can include German Shepherd Dogs, Collies, Rottweilers, Doberman Pinschers, and Giant Schnauzers
There are no treatments to prevent these disorders, and they typically cause no harm to the animals.
The patient imaged below is a 5 year-old male castrated dog that has been afflicted with pemphigus vulgaris. The patient’s lesions are located at the mucocutaneous junctions including the prepuce, anus, and gingiva. Given the likely treatment regimen of this patient, which of the following medications would you not prescribe?
a. Fluconazole
b. Maropitant
c. Enrofloxacin
d. Firocoxib
d. Firocoxib
Pemphigous vulgaris is an auto-immune disease which requires immunosuppressive therapy. This patient is likely on a steroid and possibily other immunosuppressives. Firocoxib (Previcox) is a nonsteroidal anti-inflammatory (NSAID) with specific inhibition at the Cox-2 sites and sparing of Cox-1 receptors. As with any NSAID, it is contraindicated to give this medication in conjuction with a steroid due to the high likelihood of side effects. Combination of an NSAID with a steroid may result in renal compromise and failure, in addition to gastric ulceration and increased risk of gastrointestinal perforation.
The other medications listed have no known adverse side effect when given with a steroid. Enrofloxacin has been known to cause blindness in cats at high doses. Maropitant is a popular anti-emetic/anti-nausea medication used in small animals. This medication has the potential of accumulating, therefore a washout period is recommended if used for more than 5 days. Fluconazole is a fungistatic triazode. It has the potential for hepatoxicity and therefore patients on this medication should have their liver parameters periodically evaluated.
A 4-year old male neutered mixed breed dog presents for a one-month history of weight loss, coughing, and limping. The owner recently noticed swelling and draining wounds on his legs (see image). The dog is on flea and tick preventative and heartworm preventative. The dog recently moved with the owner from Mississippi. The dog has a temperature of 103F (39.4 C). His lungs sound harsh and no murmurs are ausculted. Multiple nodules are felt under the skin along his legs; a few of which are draining a yellow to clear material that is not malodorous. His blood work shows a monocytosis, neutrophilia, low albumin, and elevated globulins. What is contraindicated?
a. Animal-human interaction
b. Biopsy
c. Radiographs
d. Cytology of discharge
e. Glucocorticoids
e. Glucocorticoids
Based on physical exam findings, bloodwork, and history, fungal infection should be the primary differential. This is blastomycosis, a fungus whose spores are found predominantly throughout Ohio, Mississippi, and Tennessee. Spores are typically inhaled causing pulmonary disease before disseminating throughout the body. Commonly affected organs include the skin, bones, eyes, lymphatic system, and lungs. Less commonly affected organs can include the prostate, mammary glands, heart, and CNS.
Diagnosis can often be made on cytology of draining wounds. Biopsy of affected areas can also demonstrate organisms. AGID and antigen testing can detect Blastomycosis as well; however, you may have false negative AGIDs with early infection and the urine antigen test can be cross-reactive with Histoplasmosis.
Treatment can be difficult and includes antifungals, often long term, and NSAIDs. Glucocorticoids are often contraindicated as they may cause further immunosuppression. Some studies have shown that brief use of intravenous dexamethasone in the face of life threatening dyspnea during treatment with anti-fungals may be beneficial, but this is currently still under scrutiny.
Zoonotic transmission is generally low in living animals. Few reports of infection through dog bites have been reported. Necropsies of infected animals have resulted in infections through needle sticks, cuts, or inhalation. Warn owners the disease is an environmental pathogen, and can cause infection in people living in endemic areas.
Radiographs may show osteomyelitis of bones and nodular to diffuse interstitial patterns in the lungs. Pulmonary signs can mimic metastatic lesions. Severity can indicate overall prognosis.
Which of the following endocrine imbalances does not commonly cause a dermatosis in dogs?
a. Central diabetes insipidus
b. Hyperadrenocorticism
c. Sertoli cell tumors
d. Hypothyroidism
a. Central diabetes insipidus
Males with Sertoli cell tumors may develop bilateral alopecia with occasional pruritus and papular eruptions. Hypothyroid dogs often develop alopecia, seborrhea, and pyoderma. Hyperadrenocorticism patients commonly develop hyperpigmentation, alopecia, calcinosis cutis, seborrhea, and pyoderma.
A 7-year old German Shepherd dog presents for a second opinion of bilateral distal forelimb wounds. The owners note that they are not excessively pruritic but the patient will lick at the region. A biopsy had previously been performed with a microscopic description of chronic focal nodular pyogranulomatous dermatitis and destructive furunculosis without evidence of neoplasia or underlying etiology. In light of these findings, acral lick dermatitis is suspected. Which of the following is NOT a reasonable treatment strategy?
a. Combined systemic triamcinalone and clindamycin therapy
b. Basket muzzole or E-collar
c. Ivermectin and prednisone therapy
d. Fluoxetine
c. Ivermectin and prednisone therapy
Acral lick dermatitis is considered a chronic and repetitive condition in which a dog continuously traumatizes a region as a result of obsessive licking. The licking is usually secondary to pruritis from allergies and will lead to infection. There could be multiple causes for this such as a neuropathy or underlying orthopedic disease; however, this behavior is considered to be obsessive-compulsive, and the patient may need to be evaluated for other anxiety related behaviors.
Since these lesions are not parasitic in origin the answer choice with Ivermectin is considered the poorest treatment option. All other choices may be used alone or in combination to help break the cycle and achieve healing of the lesion. Triamcinalone is a steroid. Clindamycin is an antibiotic. Fluoxetine (aka Prozac) is used to treat depression and obsessive-compulsive disorders. Basket muzzles and e-collars are commonly used as well to help stop the licking.
A 3-year old German Shepherd presents for multiple subcutaneous nodules on the right front limb that have been present for about one week. The dog is otherwise healthy. The owner states that the dog lives mostly outdoors in a wooded area with ponds in Florida. You are highly suspicious of pythium; what is the best therapeutic option for this disease?
a. Prednisone
b. Ivermectin
c. Lufenuron
d. Antifungal therapy
e. Amputation and treatment with an antifungal
f. Amputation and treatment with doxycycline
e. Amputation and treatment with an antifungal
Pythium is an aquatic organism that inhabits ponds of the Southeast United States. These organisms have different cell walls than regular fungi, which makes them difficult to treat since most antifungal treatments target fungal cell wall synthesis. Prognosis is extremely poor with this disease and amputation (if the lesions are localized to an affected limb) is currently the best option. Amputation should always be followed with multiple long-term antifungal therapies. Owners should be warned that local postoperative recurrence is common. Dogs are most commonly affected, but this disease can also occur in cats. It has also been reported in humans and horses.
Doxycyline is an antibiotic and would not be effective for this disease. Prednisone would be contraindicated for pythium. Lufenuron is a chitin synthesis inhibitor used for flea control and would not be effective. Ivermectin is an anti-parasite drug and would not be effective.
A 7-year-old mixed breed dog presents for re-evaluation of demodicosis and severe flea allergic dermatitis. The dog’s skin is doing much better since being on Ivermectin, and you plan to continue treatment. The owner is very concerned about the area around the tail base, as the patient has been extremely pruritic in that region. You suspect flea allergy dermatitis and ask the owner if she is still using flea medications. The owner explains that she stopped the flea medication when Ivermectin was started. You ask about the other animals in the household, and the owner replies that the rabbit and cat have no clinical signs. The owner also states that the cat and rabbit continue to sleep with the dog despite his skin condition. Which flea medication would be a good choice for this patient?
a. Permethrin
b. Afoxalaner
c. Pyriproxyfen
d. Lufenuron
e. Spinosad
b. Afoxalaner
From the list of medications Afoxalaner (Nexguard) is the best choice. This flea medication contains an adulticide; whereas, pyriproxyfen and Lufenuron are only insect growth regulators. Spinosad should never be used with extra-label doses of Ivermectin and is probably why this client discontinued flea medications in the first place. Permethrin is an excellent flea medication, as it is a repellent and adulticide, but it is toxic to cats. Fipronil is toxic to rabbits.
A 5-year old intact male Pomeranian presents for slowly progressing alopecia of the trunk that is sparing the head and limbs. Skin cytology revealed no infectious organisms or inflammatory cells. CBC and chemistry panel were unremarkable. You explain to the owner that you are most concerned about an endocrinopathy and would like to pursue further endocrine testing. Thyroid panel and ACTH stimulation test are both within reference range. Given the history, what is the best treatment option?
a. Trilostane
b. Mitotane
c. Growth hormone supllementation
d. Castration
e. Levothyroxine
d. Castration
Based on the history and ruling out other endocrinopathies this patient likely has hair cycle arrest (Alopecia X). The pathogenesis of this disease is not known. This condition is common in Pomeranians, Chow Chows, Alaskan Malamutes, Toy Poodles, and Samoyeds. The most common clinical signs are truncal alopecia and hyperpigmentation. The treatment of choice (if the dog is intact) is to neuter; however, it is not uncommon to see a relapse in clinical signs 1-2 years after neutering. Melatonin may help new hair to grow if a relapse occurs. Trilostane, mitotane, and growth hormone supplementation have been tried with varying success. Levothyroxine is a thyroid supplement and would not be indicated.
A 2-year old female spayed miniature poodle presents for a focal area of alopecia (5cm in diameter) on the right caudal-lateral thigh. The area is also hyperpigmented. The owner explains that the original lesion was a nodule, but over the last couple of months the hair started to fall out and the skin turned dark. The owner reports that otherwise the dog has been doing well. You ask if any topical medications or treatments have been done on or near the area. The owner reports that she has not done any treatments. The only medications the dog has received are her yearly vaccines (4 months ago) and heartworm preventative. Based on the history and physical exam findings, what are you most concerned about and what diagnostic would you like to perform?
a. You are concerned about a vaccine reaction; biopsy
b. You are concerned about an allergic reaction; food trial
c. You are concerned about an autoimmune disease; biopsy
d. You are concerned about an endocrinopathy; thyroid panel
a. You are concerned about a vaccine reaction; biopsy
The lesion is highly suggestive of a vaccine reaction; particularly post-rabies vaccination panniculitis (inflammation of the sub-cutaneous) due to location and description of the lesion. Rabies vaccine is often given in the right hind limb.
Initially, this condition presents with a nodule where the vaccine occurred and then complete alopecia occurs 1-3 months afterwards. Many times there is a long delay between vaccination and clinical signs (up to 6 months). Lesions usually resolve on their own, but use of pentoxifylline or prednisone can be effective. Definitive diagnosis would require a skin biopsy.
An allergic reaction or endocrinopathy is less likely since the lesion is focal. Endocrinopathies usually result in bilaterally symmetrical alopecia. Hair loss due to allergies is usually a result of pruritus, which was not mentioned in the history. This would be an atypical location and lesion for an autoimmune condition.
What is the most appropriate method for diagnosis of dermatophytosis in order to develop the best treatment and management recommendations?
a. White colony growth and red color change at 5 to 7 days
b. Analysis of endothrix or ectothrix spores in hairs
c. Wood’s lamp fluorescence of hair
d. Microscopic examination of macroconidia
d. Microscopic examination of macroconidia
Proper management of dermatophytosis requires identification of genus and species, which can only be done from microscopic examination of macroconidia. Only about 50% of Microsporum canis strains fluoresce with ultraviolet light (Wood’s lamp). Microsporum gypseum and Microsporum canis can both present as white colony growth with a pH change at 5 to 7 days, but require different management strategies. The source of M. gypseum is soil; the ultimate source of M. canis is a potentially asymptomatic cat.
A 5-month-old Shih Tzu presents for greasy skin, pruritus, and mild hair loss of the face. You perform skin cytology and no bacteria or yeast are observed. What test, that is part of the minimum dermatological database, would you perform next?
a. Complete blood count
b. Diet trial
c. Intradermal skin test
d. Skin scrape
e. Bacterial culture
d. Skin scrape
Demodex injai typically causes greasy seborrhea, especially on the face and dorsal trunk. Terriers and Shih Tzus may be predisposed. Some dogs may be pruritic. This mite is long and slender when compared with Demodex canis.
A diet trial and intradermal skin test may be indicated in the future if the skin scrape is negative. A bacterial culture may be needed if bacteria were seen on cytology. There is no indication to perform a CBC. None of the other tests would be considered part of a dermatological database
A 5-month old intact female mixed breed presents to your hospital for the progressive lesions seen on the image provided. The owner described the lesions as initially being papules and vesicles which eventually ruptured. Recently, the owner has also noticed that the muscles of the face appear to be atrophied. Muscle and skin biopsies were performed which came back supportive of a diagnosis of dermatomyositis. Which of the following medications is not useful for the treatment of this condition?
a. Cyclosporine
b. Prednisone
c. Pentoxifylline
d. Hycodan
d. Hycodan
Dermatomyositis is a relatively unusual condition that results in skin lesions as well as myositis. The skin lesions initially appear as papules and vesicles which then rupture, ulcerate, and may progress to crusty alopecic lesions. The myositis sets in a little later and atrophy of the temporalis muscle is often seen. In more severe cases the muscles of the distal extremities become involved and megaesophagus may be observed. Since muscle changes usually lag, other diagnostic tests such as a skin scraping and cytology are performed first to rule out other common conditions. The condition has a variable prognosis as the clinical signs may wax and wane. Medical management usually consists of pentoxifylline, prednisone, and cyclosporine. Prednisone and cyclosporine serve as immunomodulatory medications. Pentoxifylline is used to help improve bloodflow. Hycodan contains hydrocodone and is used as a cough suppressant.
A 1 year old German Shepherd presents for pruritus and folliculitis. The owner explains the pruritus began around 7 months of age and seems to be progressive. The patient is on monthly flea control and heartworm prevention medications. Examination reveals a generalized folliculitis over the dorsal trunk, thorax, and abdomen. You perform skin cytology, skin scrape, and dermatophyte culture. The skin scrape and dermatophyte culture were negative. Skin cytology reveals 4+ cocci and degenerative neutrophils. CBC/Chem and thyroid panel were within normal limits. You explain to the owner that the dog has a superficial bacterial dermatitis that is secondary to an underlying allergy. What is your next step?
a. Systemic antibiotics for 3-4 weeks and intradermal skin test
b. Systemic antibiotics for 3-4 weeks and start a diet with a novel protein diet
c. Systemic antibiotics for 1-2 weeks and start a diet trial with a novel protein diet
d. Topical antibiotics and intradermal skin test
e. Systemic antibiotics for 2-3 weeks and intradermal skin test
b. Systemic antibiotics for 3-4 weeks and start a diet with a novel protein diet
Superficial bacterial infections require antibiotics for at least three weeks. Deep infections require antibiotics for 6-8 weeks. The decision to stop antimicrobial therapy should ideally be based on clinical signs. The general rule is to stop antibiotics 2 weeks after clinical resolution. In practice, this can be difficult because it would require multiple re-checks. Topical therapy with an antimicrobial shampoo can be beneficial, but this infection appears generalized and severe; therefore systemic antibiotic therapy is warranted.
As with any bacterial infection there is usually an underlying cause. The logical next step would be to perform a diet trial and rule out food allergy before work-up of environmental allergies. Environmental allergy is a diagnosis of exclusion and flea, food, and contact allergies must be ruled out before a diagnosis of environmental allergies is made. Additionally, intradermal testing cannot determine if a patient has environmental allergies or not, since normal dogs will also test positive. Additionally, this dog most likely has a food allergy based on the age of onset of clinical signs. Food allergy occurs usually before a year of age whereas environmental allergies occur after 9 months to 1 year of age.
The best diagnostic test to differentiate pituitary dependent hyperadrenocorticism from adrenal dependent hyperadrenocorticism in dogs is which of the following
a. Serum cortisol
b. Low-dose dexamethasone suppression test
c. Urine cortisol : creatinine ratio
d. High-dose dexamethasone suppression test
d. High-dose dexamethasone suppression test
HDDST will suppress cortisol secretion in about 75% of PDH patients 3-6 hours post dexamethasone administration. Cortisol secretion does not become suppressed with dexamethasone administration with adrenal dependent hyperadrenocorticism. If cortisol secretion is suppressed with a HDDST, PDH is diagnosed. If cortisol is not suppressed, there is a 50-50 chance that the hyperadrenocorticism is due to PDH or an adrenal tumor.
LDDST will suppress cortisol secretion in approximately 65% of pituitary dependent hyperadrenocorticism patients. The urine cortisol:creatinine ratio measures the significance of urine cortisol concentration and may be increased with both PDH and ADH. Serum cortisol levels may be affected in many different situations such as stress; therefore they are an unreliable indicator of disease. An elevated serum cortisol level will not differentiate between PDH and ADH.
What test should be run to monitor the efficacy of treatment for an Addisonian dog being treated with supplemental mineralocorticoids and glucocorticoids?
a. ACTH stimulation test
b. Urine cortisol creatinine ratio
c. Serum sodium and potassium
d. Serum chloride and phosphorus
e. Resting cortisol level
c. Serum sodium and potassium
Addisonian patients deficient in mineralocorticoids will usually exhibit the classic findings of hyponatremia and hyperkalemia. Monitoring serum sodium and potassium concentration while treating with exogenous mineralocorticoids is the best way to determine if the level and frequency of dosage is adequate for the patient.
An ACTH stimulation test can be used to monitor the efficacy of treatment of a patient with Cushing’s disease, but does nothing for an Addisonian.
Which of the following is not a classic bloodwork finding for a dog with hypoadrenocorticism?
a. Anemia
b. Hypoglycemia
c. Hyperkalemia
d. Azotemia
e. Hypernatremia
e. Hypernatremia
The classic laboratory finding for an Addisonian includes hyponatremia, hyperkalemia, azotemia, anemia, acidosis, hypoglycemia, and of course a low resting cortisol level or low ACTH stimulation test result.
Which of the following statements is true regarding a 6-year old Cocker Spaniel that has polyuria, polydipsia, and blood glucose consistently around 160 mg/dl (normal 76-119 mg/dl)?
a. A urinalysis should be run and will likely show large amountsof glucose and ketone in the urine
b. The polyuria and polydipsia are not likely caused by diabetes mellitus. Further diagnostic tests should be pursued to look for the cause of polyuria and polydipsia
c. The dog has diabetes mellitus. The polyuria is caused by osmotic diuresis of glucose spilling into the urine, and the polydipsia is secondary to the polyuria
d. The dog has diabetes mellitus. The polyuria is caused by the kidneys being refractory to antidiuretic hormone. The polydipsia is secondary to the polyuria.
b. The polyuria and polydipsia are not likely caused by diabetes mellitus. Further diagnostic tests should be pursued to look for the cause of polyuria and polydipsia
In a dog with normal kidneys, glucose does not begin to spill into the urine until the blood glucose is around 180 mg/dl. In a cat, glucose does not begin to spill into the urine until the blood glucose reaches between 200-280 mg/dl. Another cause for the PU, PD should be sought in this patient. When the blood glucose is high enough to spill into the urine, the polyuria seen is caused by an osmotic diuresis resulting from the osmotic pull of the glucose in the urine. The kidneys are not refractory to antidiuretic hormone with DM.
A 9-year old male, neutered German Shepherd dog is presented to your clinic for evaluation of tenesmus, tail chasing, and hematochezia. Malodorous mucopurulent discharge is noted near his anus. On examination, you find multiple ulcerations around his perineum. Rectal examination reveals reduced anal tone and mucosal thickening. What are your treatment recommendations for this dog?
a. Initiate broad-spectrum antibiotics to treat for an infected anal gland abscess
b. Initiate therapy with cyclosporine
c. Initiate chemotherapy with the alkylating agent, melphalan, as this is the treatment of choice ofr anal sac adenocarcinoma
d. Surgically correct with a 360-degree anoplasty
e. Initiate therapy with metronidazole
b. Initiate therapy with cyclosporine
The signalment, history and clinical signs are most consistent with a perianal fistula. Although the pathogenesis is not fully understood, this disease is thought to be primarily immune-mediated. The treatment of choice for perianal fistula is medical management with cyclosporine, as resolution is achieved in greater than 65% of dogs. Surgical correction may lead to fecal incontinence or stricture formation, however surgery for removal of the anal sacs in combination with cyclosporine has recently shown promise.
If this was an anal gland abscess, lancing the abscess and drain placement with systemic antimicrobial therapy would be indicated. If you suspected this to be a cancerous process, a minimum database including CBC, chemistry, thoracic radiographs and abdominal ultrasound are recommended for disease staging. The treatment of choice for anal sac adenocarcinoma is surgical resection, followed by adjunct therapy.
What is the treatment of choice for perianal fistulas?
a. Immunosuppressive drugs
b. Intestinal prokinetic drugs
c. Antibiotic therapy
d. Radiation therapy
a. Immunosuppressive drugs
Antibiotics may reduce symptoms temporarily but will not cure perianal fistulas. Surgery used to be the treatment of choice, but it carries a guarded prognosis due to the risk of fecal incontinence. Perianal fistulas are an immune mediated disease, and medical management with immunosuppressive therapy, perhaps with cyclosporine, is now the initial treatment of choice. However, a combination of surgery and immunosuppressive therapy is not uncommon. German shepherds are predisposed to development of perianal fistulas.
A 6-week old mixed breed dog acquired from a shelter presents for diarrhea, increased respiratory effort, and seizures. You suspect the puppy has distemper. What is the definitive diagnostic test for canine distemper?
a. Immunofluorescent assay on affected epithelium
b. Enamel hypoplasia
c. Hyperkeratosis of foot bads
d. The combination of gastrointestinal, respiratory, and neurologic clinical signs
e. Detection of virus via serology
a. Immunofluorescent assay on affected epithelium
Although the clinical signs are supportive for distemper, the definitive diagnosis is examination of blood or tissue by immunofluorescent assay. This can be performed on tracheal, vaginal, respiratory, or other epithelium. These samples may be negative if the dog is only showing neurologic signs or if a circulating antibody is present. The diagnosis can then be made by serology for distemper IgM or increased CSF to serum virus specific IgG. In addition, a distemper PCR test is now available and is performed on swabs of ocular or nasal discharge. The test can have false positives in some vaccinated animals; however, animals showing signs consistent with distemper that are PCR positive should be considered likely infected with distemper.
An obese, sedentary, female Bichon Frise of 5 months of age walks into your clinic as a result of having mucous-laden diarrhea of one week duration. You perform a gram stain of the feces and visualize “gull shaped” gram negative rods. What is the most likely diagnosis?
a. Cryptosporidium
b. Clostridium difficile
c. Campylobacteriosis
d. Salmonellosis
c. Campylobacteriosis
This is a gram negative motile, thin, S shaped or gull shaped rod. It can occur singly, in pairs or in chains. C. jejuni is most commonly isolated. You can also isolate this organism with fresh fecal swabs streaked onto Campylobacter blood agar plate which grows in an oxygen-reduced atmosphere in 3-4 days. Salmonella is a gram negative bacillus. C. difficile is a gram positive rod. Cryptosporidium is a coccidian parasite. Fun Fact: Kids with puppies are 16 times more likely to acquire campylobacteriosis.
A 4 year old male Akita presents with a foreign body obstruction. You perform an intestinal resection and anastomosis surgery due to the compromised appearance of the intestine at the foreign body site. The dog recovered well after surgery. Five days post-operatively, she presents again with a history of inappetance and has a 104.8 F (40.4 C) temperature. What is the best diagnostic test to confirm your clinical suspicion?
a. Complete blood count and serum chemistry
b. Abdominal ultrasound
c. Serum lactate
d. Thoracic radiographs
e. Abdominocentesis
e. Abdominocentesis
You should be highly suspicious of leakage at the surgery site and resultant septic peritonitis. The most common time for anastomosis failure is 3-5 days postoperative. This is due to the degradation of fibrin at the site prior to deposition of sufficient collagen.
Abdominocentesis would likely reveal a septic inflammatory process, confirming your clinical suspicion with the finding of of intracellular bacteria. A CBC and chemistry are helpful adjunct diagnostic tests but are not specific for septic peritonitis. An abdominal ultrasound would not distinguish between post-operative abdominal fluid and/or free gas and a septic effusion. Serum lactate, although helpful, is also not specific for sepsis. Thoracic radiographs could be useful to assess for less likely complications such as aspiration pneumonia.
Which of these findings is most supportive of a diagnosis of HGE (hemorrhagic gastroenteritis)?
a. Packed cell volume of 45%
b. Total solids of 6.0
c. Chronic hemorrhagic diarrhea
d. Positive fecal test for coccidia
b. Total solids of 6.0
HGE is characterized by acute onset of hemorrhagic diarrhea accompanied by marked hemoconcentration. HGE can be due to a hypersensitivity reaction in the intestines or from Clostridium perfringens enterotoxin. It usually affects small dogs such as Miniature Poodles and Miniature Schnauzers. They develop a raspberry jam-like diarrhea, vomiting, and abdominal pain. The key findings are a high PCV of 55-60 and normal total protein that is not as high as would be expected from the degree of hemoconcentration, probably due to protein loss into the intestine.
A 5-year old male castrated English Springer Spaniel presents for a dental exam. The dog has a history of aggressive chewing on tennis balls and frisbees. The oral exam reveals brown, worn-down incisors, canines, and premolars. The dog is otherwise normal and healthy. What is the cause for the teeth turning brown?
a. Excessive chewing has predisposed the teeth to infection. The brown coloration is a sign of bacterial infection
b. The dog was probably given tetracycline antibiotics as a puppy, which causes a permanent brown discoloration of teeth
c. The teeth are brown due to the formation of tertiary dentin, which stains easily
d. The excessive chewing has worn away the enamel of the teeth. The underlying dentin is naturally brown.
c. The teeth are brown due to the formation of tertiary dentin, which stains easily
Aggressive chewing of things like rocks, tennis balls, cage bars, etc. causes abrasion of dentin. Tertiary dentin, which is produced as a response to the wearing of the teeth, stains easily. Tertiary dentin will usually prevent the exposure of the pulp cavity unless its production cannot keep up with its rapid wear.
Which of these is an important nutritional goal in the management of struvite urolithiasis?
a. Maintaining urine specific gravity of <1.020
b. Increasing magnesium in the diet
c. Increasing dietary protein
d. Maintaining a urine pH of 8 to 8.5
a. Maintaining urine specific gravity of <1.020
An important principle in management of any patient with urolithiasis is to maintain dilute urine so that solutes do not concentrate to the degree that they form precipitates that lead to stone formation. Struvite stones (magnesium ammonium phosphate) tend to form in alkaline urine so ideal urine pH for struvite stone formers is usually around 6.5. Other principles of management are to decrease urea in the urine, often done by moderate protein restriction and to decrease the minerals involved (magnesium and phosphate). Finally, a key element in struvite stone formation is the presence of a urinary tract infection, particularly with urease-producing microbes, most notably staphylococcus and proteus. Monitoring, preventing, and treating UTIs is an important aspect of management of these patients.
The Pug in the picture presents on emergency. What is the likely cause of this condition?
a. Intoxication
b. Glaucoma
c. Infection
d. Immune mediated disease
e. Trauma
e. Trauma
Traumatic proptosis is very common in brachycephalic breeds and is the lesion in the picture.
You are examining a 12-year old male castrated mixed breed dog with progressive exophthalmos and third eyelid protrusion of the left eye over the past month as shown here. On palpation, no pain is elicited but the eye does not retropulse. The owner reports that otherwise the dog has been behaving normally, and physical exam is otherwise unremarkable. What is the most likely diagnosis?
a. Retrobulbar abscess
b. Intraocular neoplasia
c. Orbital neoplasia
d. Endophthalmitis
c. Orbital neoplasia
These are the typical signs of orbital neoplasia, which is somewhat common in older dogs. Infections are usually accompanied by more systemic signs and localized pain and erythema. Endophthalmitis and intraocular neoplasia would not cause exophthalmos but would manifest with intraocular signs.
You have been managing a 7-year old male Cocker Spaniel for immune-mediated hemolytic anemia and recurrent urinary tract infections with prednisone and trimethoprim sulfa antibiotics. He now presents to you for the ocular abnormalities visible in the photo. What test is most likely to confirm your tentative diagnosis?
a. Dilated fundic exam
b. Corneal biopsy
c. Schirmer tear test
d. Tonometry
e. Pupillary light response
c. Schirmer tear test
This dog has a severe mucoid ocular discharge and corneal changes that are most consistent with keratoconjunctivitis sicca (dry eye). The history of TMS antibiotics is a likely etiology. The diagnostic test of choice for KCS is a Schirmer tear test. The other choices are not specific for the diagnosis of this condition.
Keratoconjunctivitis sicca, as seen in the image, comes from an abnormality in which of these structures?
a. Nasolacrimal duscts
b. Meibomian gland
c. Lacrimal galnd and gland of the 3rd eyelid
d. Conjunctival goblet cells
c. Lacrimal galnd and gland of the 3rd eyelid
KCS comes from a decrease of the aqueous portion of the tear film. This is produced by the lacrimal gland and the gland of the 3rd eyelid. Remember, there are three layers of the tear film. The mucous portion lies against the cornea and keeps the tear film adhered to it. This is made by conjunctival goblet cells. The aqueous portion has nutritional and immunologic factors and is in the middle. It is produced by the lacrimal gland and the gland of the 3rd eyelid. The lipid portion of the tear film is the most outer part, and it allows for even spreading and prevents evaporation of tears. It is produced by the meibomian glands.
Which of these is usually the cause of glaucoma as depicted in this dog?
a. Decreased outflow of aqueous
b. Increased production of aqueous
c. Increased outflow of aqueous
d. Increased production of vitreous
a. Decreased outflow of aqueous
Glaucoma is an increase in IOP which is dependent on production of aqueous and outflow of aqueous. Clinical increases are always from decreased outflow although treatment can be aimed at either increasing outflow or decreasing production of aqueous.
The image of the eye below is from a canine patient diagnosed with keratoconjunctivitis sicca (KCS). This condition causes a decrease in tear production which then results in the classic changes observed in this image. Which of the following is not an etiology of the disease?
a. Long-term atropine administration
b. Sulfonamide toxicity
c. Immune mediated
d. Penicillin toxicity
d. Penicillin toxicity
In canine patients, the most common cause of KCS is immune mediated. This is why these patients are treated with cyclosporine, a t-cell modulator. Penicillins have not been documented to result in KCS. Sulfonamide containing antibiotics, such as TMS have been shown to cause KCS in some patients. Long-term atropine administration has also been shown to result in KCS. Atropine is a parasympatholytic and will result in decreased tear production. Etodolac has also been associated with KCS in dogs. The corneal pigmentation seen is a nonspecific response to chronic irritation or inflammation. There is also evidence of corneal vascularization which occurs as part of the inflammatory and healing response.
Which of these are you least likely to see in acute glaucoma as depicted in this dog?
a. Corneal edema
b. Pain
c. Buphthalmos
d. Episcleral injection
c. Buphthalmos
Acute glaucoma can be a very painful condition characterized by epiphora, episcleral injection, corneal edema, and sometimes mydriasis. Buphthalmos, or an enlarged globe, does not usually occur with an acute rise in IOP and is seen more chronically.
An 11-year old male castrated Border Collie presents in laterally recumbency. The owners noticed he had been limping on his right front leg for the past three days. He has free access to the backyard, but did not come back to the house this morning for breakfast and the owners found him outside laterally recumbent. On physical exam, he has extensor rigidity of all four legs with extension of his head and neck (as seen in the image). His lips and ears are contracted and pulled back. There is a wound between digits 2 and 3 on the right forelimb with a draining tract. Which of the following should be discussed with the owner?
a. Confirmatory diagnosis involves finding the exotoxin from Clostidium botulinum in serum, feces, vomit, or food samples
b. Tetanus antitoxin will help to reverse the clinical signs
c. Tetanus antitoxin can cause anaphylaxis
d. Removal of the tick will help reverse clinical signs
c. Tetanus antitoxin can cause anaphylaxis
The facial contraction and smirk is a characteristic sign of tetanus. Tetanus is caused by the neurotoxin produced by Clostridium tetani. This bacteria enters the body through a wound and begins producing tetanospasmin, a potent neurotoxin that blocks GABA release at the motor end plate and causes sustained muscle contraction.
Treatment involves wound debridement, sedation, antibiotics, and minimizing external stimuli as these animals are hyperesthetic. Tetanus antitoxin is given after an initial test dose to monitor for anaphylaxis. Antitoxin prevents further toxin binding but does not affect already bound toxin so it helps decrease progression of clinical signs but will not reverse the signs present.
Tick paralysis starts with hind limb weakness which progresses to a stiff forelimb gait and flaccid paralysis. Patients will improve quickly after removal of the tick. Clostridium botulinum causes botulism which is characterized by lower motor neuron paresis/paralysis starting in the pelvic limbs and progressing to quadriplegia. There is decreased muscle tone in all limbs.
The five-year old female Doberman Pincsher in the photo below whelped 8 puppies 4 weeks ago. She presents to you dehydrated and lethargic with temperature of 104.9 F (40.5 C). Her left inguinal mammary gland is hard, painful, hot, and reddish purple as seen in the image. What is the most likely diagnosis?
a. Hypocalcemia
b. Mammary carcinoma
c. Gynecomastia
d. Mastitis
e. Pyometra
d. Mastitis
With the recent history of whelping, fever, and a firm, red, painful mammary gland, the most likely diagnosis is mastitis. The puppies should be removed and weaned and warm compresses applied to the gland to promote draining. Antibiotics that penetrate the barrier between the bloodstream and mammary gland should be considered such as trimethoprim-sulfa, clindamycin, and cephalosporins.
A 1-year-old female Doberman pinscher presents to you with vulvar swelling and bloody vaginal discharge as shown in the photograph. She has not been receptive to males. Which of the following is the most likely explanation?
a. Presentation of closed pyometra
b. Presentation of open pyometra
c. Normal appearance of proestrus
d. Normal appearance of diestrus
e. Normal appearance of estrus
c. Normal appearance of proestrus
Vulvar swelling and edema occur with rising estrogen levels in proestrus. Bloody vaginal discharge occurs during proestrus due to diapedesis of blood from the engorged endometrium as blood travels through the cervix into the vagina. The bitch is not in estrus based on the lack of receptivity to males.
The 6-year old 13 kg male cryptorchid Schnauzer in the image below presents for weakness, lethargy, intermittent epistaxis and melena of 1 week’s duration. Physical findings include gynecomastia, a pendulous prepuce, symmetrical truncal alopecia, a palpable mid-abdominal mass, pale mucous membranes and a fever of 103.5 F (39.7 C). The dog’s hematocrit is 14% (35-57%), with a total protein of 7.0 g/dl (5.4-7.5 g/dl). A blood smear reveals normocytic, normochromic anemia with a platelet count of 34,000/microliter (211,000-621,000/ul). The white blood cell count is 2,500/microliter (5,000-14,100/ul). Which of the following is most likely responsible for this dog’s signs?
a. Cortisone deficiency
b. Thyroid hormone deficiency
c. Testosterone excess
d. Estrogen excess
e. Cortisone excess
d. Estrogen excess
This dog’s presentation should lead you to the presumptive diagnosis of an estrogen secreting tumor; likely a Sertoli cell tumor or seminoma. The dog was described as cryptorchid; dogs with cryptorchidism are prone to testicular tumors. The signs of male femininization such as gynecomastia and the signs of bone marrow suppression are most suggestive of estrogen toxicity.
Which of the following is the most likely cause of lymphoplasmacytic rhinitis as seen in this patient?
a. Parainfluenza virus-3
b. The specific etiology is still unknown
c. Canine adenovirus-2
d. Bartonella
b. The specific etiology is still unknown
As the name implies, these patients have a mixed population of lymphocytes and plasma cells when biopsied. Many consider the condition to be an idiopathic immune-mediated disorder. PCR studies have been performed in affected patients in search of parainfluenza virus-3, canine adenovirus-2, Bartonella, and Chlamydophila. None of these agents were found to be a potential cause. Typical clinical signs include a history of unilateral or bilateral nasal discharge of several months duration. Large-breed dogs are more often affected and the age may vary.
What is the most likely complication associated with the post-anesthetic recovery of the dog in the photograph receiving Clotrimazole?
a. Laryngeal inflammation
b. Seizure
c. Bacterial rhinitis
d. Aspiration pneumonia
a. Laryngeal inflammation
Seizure is a possible sequela if the cribriform plate is compromised. If this were the case, the complication would likely be fatal. With severe swelling, the administration of corticosteroids and re-intubation is indicated. Sometimes these dogs may need to be intubated for days.
A 5 year old female Weimaraner presents to your clinic with the presenting complaint of cough and difficulty breathing. On exam, the dog is subdued but responsive with a temperature of 103.3F (39.6 C), heart rate of 120 beats per minute and respiratory rate of 50 breaths per minute. You perform chest radiographs which are shown below. A CBC shows a hematocrit of 31% (35-57%), neutrophil count of 17,275/ul (2,900-12,000/ul), monocyte count of 1,484/ul (100-1,400/ul) and eosinophil count of 630/ul (0-1,300/ul). What is the treatment of choice?
a. Oxygen and durosemide
b. Oxygen and dexamethasone sodium phosphate
c. Oxygen, acepromazine, and hydromorphone
d. Oxygen, ampicillin, and enrofloxacin
d. Oxygen, ampicillin, and enrofloxacin
This case and radiograph represent an example of a severe bronchopneumonia. While it would be appropriate to consider more diagnostics, such as a transtracheal wash for cytology and culture, you may have to make a choice without all of that information on your exam. For the information that you do have, aggressive and broad spectrum antimicrobial therapy with ampicillin and enrofloxacin is the best answer, with supportive care with oxygen as needed. Furosemide and oxygen would be the recommended treatments for a dog with congestive heart failure. Sedation and oxygen might be needed for a dog in severe distress from airway obstruction. Corticosteroids would not be an acceptable primary treatment for pneumonia.
A 4-year-old male castrated Beagle presented with an acute onset of being down in the hind end.
On neurological examination, the patient’s cranial nerves are intact. He has bilateral hind limb conscious proprioceptive deficits and no motor function in either hind limb. There are normo-reflexive gastrocnemius reflexes and normal to hyper-reflexive patellar reflexes bilaterally. The thoracic limbs are neurologically normal. Superficial and deep pain responses are present.
A myelogram shows the lesion in the photo below. You discuss treatment options with the owner and she declines surgery. Which of the following is the most important aspect of medical management of the likely condition?
a. Strict cage rest
b. Non-steroidal anti-inflammatory drugs (NSAIDs)
c. Exercise and physical therapy
d. Muscle relaxants
e. If the owner declines surgery, euthanasia is the only humane alternative
a. Strict cage rest
By far, the most likely diagnosis is intervertebral disc disease (IVDD) based on the history and myelogram showing a collapsed intervertebral space at T12-13 and an extradural compressive lesion originating from the same site. IVDD can be managed by surgical decompression or non-surgically. The most important aspect of non-surgical management of IVDD is STRICT cage rest, usually for a full 8 weeks.
Exercise should be avoided during the period of cage rest. Steroids, analgesics, and/or muscle relaxants may be useful additions to the management of these dogs.
You are reviewing a myelogram of a 7-year-old male neutered Border Collie with its owner. As you show the radiographs to the owner (see below), you explain that a positive contrast agent (iohexol) was injected to help visualize lesions. More specifically, where is the contrast injected during a myelogram?
a. Epidural space
b. Subarachnoid space
c. Intraventricular space
d. Subdural space
e. Intramedullary space
b. Subarachnoid space
A myelogram is a positive-contrast radiographic study where a contrast agent such as iohexol or iopamidol is injected into the subarachnoid space where CSF accumulates.
A 4 year old female spayed German Shorthaired Pointer presents with the complaint of exercise intolerance and lethargy. Thoracic radiographs are taken and are shown below. What therapy is appropriate for the most likely diagnosis?
a. Enalapril
b. Pyridostigmine
c. Rimadyl
d. Inhaled fluticasone
e. Sucralfate
b. Pyridostigmine
The important thing to do in this case is to both read the question carefully and view the radiograph in concert with each other. This dog has signs and findings that are most consistent with myasthenia gravis and resultant megaesophagus. Accordingly, pyridostigmine, which is an acetylcholinesterase inhibitor (anticholinesterase), is the best answer choice. If you chose sucralfate because you saw the megaesophagus and thought the dog must have esophagitis, your thinking was accurate but you ignored the dog’s clinical signs of weakness. If this dog had presented for regurgitation, that would have been a more appropriate course of action. Acquired myasthenia gravis can also be treated with systemic corticosteroids to decrease immune attack of acetylcholine receptors, but inhaled fluticasone would not do the trick. Enalapril and NSAIDs are not indicated in this patient.
Based on the direction of this dog’s head tilt, where would you localize the lesion to if he has a paradoxical vestibular syndrome?
a. Right cranial nerve VIII (vestibulocochlear nerve)
b. Right cerebellum
c. Left cerebellum
d. Left cerebral hemisphere
e. Left cranial nerve VIII (vestibulocochlear nerve)
b. Right cerebellum
This dog has a left head tilt by definition because his left ear is closer to the ground. The key to answering this question is seeing the left head tilt and reading that the question asks about PARADOXICAL vestibular disease.
Vestibular disease can be peripheral or central, and central vestibular disease can be classic in appearance or paradoxical. Peripheral vestibular disease is due to a lesion in the inner ear or vestibular portion of cranial nerve VIII. Classic central vestibular disease is due to a lesion in the brainstem or cerebellum. Signs with peripheral and classic central vestibular disease include head tilt, falling, and circling to the same side as the lesion with nystagmus with fast phase to the opposite side.
With paradoxical vestibular disease, the lesion is in certain regions of the cerebellum (flocculonodular lobe) or caudal cerebellar peduncle and produces signs to the opposite sides from which is seen with peripheral and classic central disease.
A 9-year old male Queensland Heeler presents with a four day history of progressive tetraparesis. Physical exam showed him to be weakly ambulatory with support. As part of your initial workup, you take chest X-rays which are shown below. Which of the following next steps is the most appropriate test to confirm your clinical suspicion about the cause of the dog’s signs?
a. CT scan of the thorax
b. Tensilon response test
c. MRI of the brain
d. Myelogram
e. Bronchoalveolar lavage and culture
b. Tensilon response test
The correct answer is a Tensilon (edrophonium) response test. Hopefully, you were able to identify the mass in the cranial mediastinum on the chest radiograph, as this was one of the keys to this case. This, in conjunction with the dog’s other signs, are suggestive that this dog has a thymoma and associated secondary myasthenia gravis. Tensilon (edrophonium) is a rapidly acting anticholinesterase that reverses signs of myasthenia within minutes in most dogs.
A chest CT would be a valid test to confirm the presence of the mediastinal mass and might be an appropriate test before surgery but would not bring you closer to a diagnosis if you already have identified the mass. An MRI of the brain would assess a CNS cause of the dog’s signs, which are unlikely, given the other findings. Similarly, a myelogram would assess if a spinal cord lesion caused the dog’s signs, but the rest of the findings in this case should point you in a different direction.
A 12-year old female Dalmatian has a Holter monitor placed for an arrhythmia heard on exam. The following trace is from that monitor; similar abnormalities were seen frequently throughout the 24hrs. What is your treatment recommendation for this arrhythmia?
a. Pimobendan
b. Amlodipine
c. Mexiletine
d. Diltiazem and furosemide
c. Mexiletine
The Holter ECG shows a couplet of ventricular premature complexes. If frequent ventricular ectopy is seen, particularly with runs or R-on-T episodes, treatment is advised with oral ventricular antiarrhythmics. Mexiletine is an oral class I antiarrhythmic that is well-tolerated in dogs. Pimobendan improves systolic function, but does not treat arrhythmias. Amlodipine is a calcium channel blocker used for patients with systemic hypertension. Diltiazem is used for supraventricular tachycardias to slow conduction down the AV node. Furosemide is a diuretic used in the treatment of heart failure, it does not have antiarrhythmic properties.
A 10 year old male intact Labrador Retriever presents to your clinic for a two week history of lethargy, decreased appetite, and one episode of vomiting. You auscult a very regular bradycardia, perform an ECG and obtain the following. All of the following are true concerning this arrhythmia except_______________.
a. A permanent pacemaker is almost always indicated in patients with this rhythm
b. Intravenous lidocaine administration is always contraindicated with this arrhythmia
c. This arrhythmia is often secondary to hyperkalemia
d. Although atropine is indicated with the bradyarrhythmia, it will rarely increase the ventricular rate
c. This arrhythmia is often secondary to hyperkalemia
The rhythm diagnosis is third degree (complete) AV block. Atropine is often administered in attempts to increase the ventricular rate in these patients but almost never significantly increases the heart rate. The cause of complete AV block is normally unknown, but is rarely improved with medical management or time, thus typically necessitating an artificial pacemaker. Intravenous lidocaine is ABSOLUTELY contraindicated in these patients since this may abolish the ventricular escape rhythm. Though atrial standstill may be secondary to hyperkalemia, this rhythm is clearly not an atrial standstill since there are P-waves evident (hence atrial depolarization).
An 11-year old female Pomeranian presents to you for coughing and exercise intolerance. On exam: Wt: 9.25 lbs, T: 101.2F (38.4 C), HR: 132 bpm, RR: Panting, mucous membranes are pink. She has mild tracheal sensitivity and a grade III-IV/VI left apical holosystolic murmur and grade II/VI right apical holosystolic murmur. Femoral pulses are strong and synchronous, with a regular rhythm. She has harsh lung sounds bilaterally. On abdominal palpation, you note hepatomegaly. You find bilateral luxating patellas.
You take chest radiographs (see image) and decide to treat the dog based on these findings. Which medication plan is most appropriate?
a. Furosemide and enalapril
b. Atropine and temporary pacemaker
c. Immiticide (Melarsomine)
d. Clavamox and enrofloxacin
a. Furosemide and enalapril
The radiograph here shows a severe symmetrical alveolar pattern in the perihilar region extending to the right and left caudal lung lobes. The heart is tall on the lateral view causing dorsal elevation of the trachea.
This, in conjunction with the physical findings, is compatible with left congestive heart failure (CHF) secondary to mitral valve regurgitation. The dog also has hepatic congestion evident by enlargement on the radiograph. Treatment for CHF include diuretics (furosemide/Lasix, hydrochlorothiazide, spironolactone), arterial vasodilators (enalapril, benazepril, amlodipine, hydralazine), positive inotropes (pimobendan), and venodilators (nitroglycerine).
Clavamox and enrofloxacin are antibiotics which could be used to treat pneumonia, but that is not this dog’s problem. Immiticide is the treatment for heartworm. Atenolol is a beta blocker and not part of the management of mitral regurgitation or CHF. Atropine or a pacemaker would be indicated for conduction problems.
This ECG recording (bottom recording) is from a 10-year old miniature poodle with a history of heart disease that is untreated. She presented for a 3-day history of diarrhea and decreased appetite. On physical examination you auscult a grade III/VI heart murmur and clear lung sounds. There are no obvious pulse deficits palpated. What is the appropriate treatment for this arrhythmia?
a. No anti-arrhythmic therapy is necessary at this time
b. Begin the patient on oral mexiletine and recheck an ECG strip in 5 days
c. Give the patient a bolus of lidocaine and begin continuous infusion for twelve hours and then try to wean off the lidocaine
d. Give the paitnet an intravenous injection of furosemide and begin oral administration of furosemide
a. No anti-arrhythmic therapy is necessary at this time
There are several general guidelines/recommendations regarding treatment of ventricular premature contractions which is what is shown on the ECG strip. These include a heart rate of over 180 bpm, pulse deficits, clinical signs, and VPCs for over 20 seconds in duration. In this case, the heart rate is visible on the recording and clearly not elevated. The patient’s physical exam findings are not suggestive of an immediate problem secondary to the arrhythmia. There are many dogs with intermittent VPCs that are not of clinical importance. However, it is recommended that the patient be evaluated regularly and ideally have a consultation with a cardiologist to ensure the progression of heart disease is being minimized.
Furosemide is not indicated as there is not an indication that the patient is fluid overloaded or in fulminant heart failure.
Mexiletine is a Class IB anti-arrhythmic and is not necessary given the lack of severity in the ECG findings.
A 9 year old female spayed black Labrador Retriever presents to your clinic with the complaint of collapse and lethargy. On exam, the dog is subdued but responsive with a temperature of 100.9F (38.3 C), heart rate of 170 beats per minute, and respiratory rate of 40 breaths per minute. You perform chest radiographs which are shown below. A CBC shows a hematocrit of 31% (35-57%), neutrophil count of 6,275/ul (2,900-12,000/ul), monocyte count of 984/ul (100-1,400/ul) and eosinophil count of 630/ul (0-1,300/ul). What is the treatment of choice?
a. Terbutaline
b. Broad spectrum antibiotics
c. Furosemide
d. Pericardiocentesis
e. Melarsomine
d. Pericardiocentesis
This radiograph and case are a good example of pericardial effusion with the classic finding of a markedly enlarged heart with a globoid shape. The most common type of effusion by far is hemorrhage which can be idiopathic or from neoplasia such as hemangiosarcoma. Based on this finding, in conjunction with the dog’s tachycardia, a pericardial tap for both diagnostic and therapeutic purposes is indicated. Furosemide is contraindicated in cases of pericardial effusion because it will decrease preload in the right side of the heart and can promote circulatory failure. Melarsomine is the treatment for heartworm. Antibiotics are very unlikely to help this dog unless the effusion is from some sort of infectious pericarditis, which would be extremely unusual in dogs.
A 12-year-old mixed breed female spayed dog presents with a several-month history of lethargy, hair loss, and greasy skin. The patient’s face, feet, and tail are not clinically affected and she is mildly pruritic. This photomicrograph shows the results of impression cytology obtained from the patient. What is the most likely name of the organism pictured?
a. Malassezia pachydermatis
b. Staphylococcus hyicus
c. Malassezia globosa
d. Staphylococcus pseudintermedius (Staphylococcus intermedius)
d. Staphylococcus pseudintermedius (Staphylococcus intermedius)
Intracytoplasmic cocci from a dog’s skin are most likely Staphylococcus pseudintermedius (formerly called Staphylococcus intermedius), which is the species host-adapted to canines. Staphylococcus hyicus is host-adapted to pigs, so is less likely to be isolated from a dog. Malassezia (yeast) organisms are much larger than cocci and are not observed within the cytoplasm of neutrophils.
The radiograph below is of a patient with a mild increase in respiratory rate of 54 bpm that was admitted after being found wandering along the middle of the road. On physical examination, the patient is bright, alert, and responsive. There are decreased lung sounds in the left dorsal quadrant and several abrasions are noted on the forelimbs. Pulse oximetry on the gingiva was 94%. What is the best treatment option?
a. Perform a right sided thoracocentesis on the dorsal aspect of the chest
b. Place a thoracotomy tube on the right side
c. Perform a right sided thoracocentesis on the ventral aspect of the chest
d. Perform a left sided thoracocentesis on the ventral aspect of the chest
e. Perform a left sided thoracocentesis on the dorsal aspect of the chest
e. Perform a left sided thoracocentesis on the dorsal aspect of the chestThis is a classic radiograph of a left sided pneumothorax. This case provides the advantage of having a “normal” right side. Notice the lungs are collapsed on the left and no vasculature or airways can be appreciated on the left as compared to the right. In a standing patient it is best to perform a thoracocentesis dorsally since air rises. This will yield the most amount of air to aspirate. In most cases with a pneumothorax secondary to trauma it is not necessary to place a chest tube as the leak seals over quickly, making a chest tube excessive; however, patients that are tapped must be monitored closely for recurrence of pneumothorax. If air build up persists more aggressive treatment such as a chest tube with or without continuous suction should be considered.
The stray dog in the photo comes into your clinic with the lesions shown. A deep skin scraping confirms a diagnosis of Demodex. Which of the following statements about Demodectic mange is true?
a. Demodex most commonly affects the neck and dorsal trunk of dogs
b. Focal demodex infections must be treated quickly, or they will spread and become more severe
c. Demodex mites are commensal organisms that can be found in skin without clinical signs
d. The diagnosis of demodectic mange is performed by a superficial skin scraping
c. Demodex mites are commensal organisms that can be found in skin without clinical signs
The correct answer is demodex mites are commensal organisms that can be found in skin without clinical signs. Focal demodex lesions will usually resolve spontaneously without any treatment. Demodex are found down at the hair follicle, so diagnosis is made by a deep skin scraping. The most commonly affected areas on a dog include the face, muzzle, periorbital region, and thoracic limbs.
What endocrine disorder is MOST likely to cause myxedma, resulting in a similar facial appearance to the Shar Pei?
a. Hyposomatropism
b. Hyperadrenocorticism
c. Hypothyroidism
d. Hyperthyroidism
c. Hypothyroidism
Myxedema, an increased amount of mucin and other ground substances in the dermis, can be a marker for hypothyroidism. Other endocrinopathies that can be associated with myxedema include excesses of growth hormone such as acromegaly.
A 6-year old female spayed Beagle presents for lethargy. On exam you detect a heart rate of 25 beats per minute and record an ECG, which is shown here. What is the treatment of choice?
a. Pacemaker implantation
b. Furosemide
c. Sotalol
d. Atropine administered intramuscularly
e. Doxycycline
a. Pacemaker implantation
The correct answer is pacemaker implantation. The rhythm is complete heart block (also known as 3rd degree AV block). There is no consistent PR interval; the ventricular beats are escape beats. Atropine can be considered, but is typically not effective in 3rd degree AV block. The only way to restore a normal heart rate in this patient is by implanting a pacemaker, which will require referral to a cardiologist.
Sotalol is a ventricular antiarrhythmic, which would actually be dangerous in this patient because it may suppress the ventricular escape focus. Furosemide and doxycycline will not prove beneficial for this rhythm disturbance.
What is the most common tumor of the oral cavity in the dog, as seen in the photo?
a. Melanoma
b. Acanthomatous epulis
c. Fibrosarcoma
d. Lymphoma
a. Melanoma
The correct answer is melanoma. Melanoma comprises about 1/3 of all oral tumors in dogs. Many oral melanomas may be amelanotic, as the one in the photograph appears to be. The second most common tumor is squamous cell carcinoma followed by fibrosarcoma and acanthomatous epulis.
Which of these clinical findings would you expect in a case of lymphangiectasia in a Belgian Sheepdog as depicted in the photo?
a. Hypercholesterolemia
b. Hypercalcemia
c. Panhypoproteinemia
d. Lymphocytosis
c. Panhypoproteinemia
The correct answer is panhypoproteinemia. Lymphangiectasia is a classic example of a protein-losing enteropathy. It is characterized by dilation and dysfunction of intestinal lymphatics and leakage of protein-rich lymph into the intestinal lumen. As a result, protein, cholesterol, and lymphocytes are all lost. Calcium is also frequently low due to either low albumin or vitamin D and calcium malabsorption.
What is the main cause of nuclear sclerosis, as depicted in this dog?
a. Genetics
b. Uveitis
c. Aging
d. Glaucoma
e. Cataracts
c. Aging
The correct answer is aging. Aging is the only cause of nuclear sclerosis. It is a normal change to the lens resulting in partial loss of transparency in the middle of the lens.
A 6-year old Schipperke presents with a 1-month history of progressive weakness and decreased appetite. The owner reports the dog is slightly polyuric and polydipsic. Your physical exam is unremarkable except that the dog seems subdued and a bit uncomfortable. You perform bloodwork which shows the following results:
Hematocrit - 28% (Normal 36%-50%)
White Blood Cell Count - 16,000/ul (Normal 7,000-17,000/ul)
Thrombocytes - 324,000/ul (Normal 200,000-900,000/ul)
Calcium - 13.2 mg/dl (Normal 8-11 mg/dl)
Phosphorus - 2.9 mg/dl (Normal 2.4-4.9 mg/dl)
Total Bilirubin - 0.1 mg/dl (Normal 0.06-0.61 mg/dl)
Total Protein - 7.2 g/dl (Normal 5.5-7.3 g/dl)
Albumin - 2.3 g/dl (Normal 2.2-4.2 g/dl)
Globulins - 4.9 g/dl (Normal 2.6-4.5 g/dl)
Alkaline Phosphatase - 45 IU/l (Normal 10-80 IU/l)
Aspartate Aminotransferase - 8 IU/l (Normal 0-20 IU/l)
Alanine Aminotransferase - 17 IU/l (Normal 3-33 IU/l)
Gamma-Glutamyl Transferase - 2 IU/l (Normal 1.3-12 IU/l)
Blood Urea Nitrogen - 17 mg/dl (Normal 10-22 mg/dl)
Creatinine - 1.4 mg/dl (Normal 0.5-2.2 mg/dl)
Glucose - 96 mg/dl (Normal 60-125 mg/dl)
Cholesterol - 180 mg/dl (Normal 125-250 mg/dl)
You perform whole-body radiographs which are shown below. Which of the following choices are two tests that will help you confirm the most likely diagnosis?
a. Urinalysis, renal biopsy
b. ACTH stimulation test, dexamethasone suppression test
c. Echocardiogram, heartworm antigen test
d. Bone marrow biopsy, serum electrophoresis
e. Ultrasound of neck, measure serum parathyroid hormone
d. Bone marrow biopsy, serum electrophoresis
This dog has signs and bloodwork findings that are consistent with but not specific for multiple myeloma. The hypercalcemia and hyperglobulinemia are both mild and are consistent with this diagnosis but would not be sufficient alone to jump to that conclusion. The key finding in these case is the radiographic evidence of multiple punctate lucencies including in the body of C4, several of the thoracic dorsal spinous processes, the left ilium, and the right and left humeral diaphyses. These lesions are strongly suggestive of multiple myeloma; however, definitive diagnosis of multiple myeloma requires satisfying at least two of the following criteria:
- Monoclonal gammopathy
- Radiographic evidence of osteolytic bone lesions (satisfied in this case)
- >5% neoplastic cells or >10-20% plasma cells in the bone marrow
- Immunoglobulin light chain proteinuria (Bence-Jones proteinuria)
Therefore, the best answer in this question is to perform serum electrophoresis to assess monoclonal gammopathy and a bone marrow biopsy to look for neoplastic infiltration of plasma cells.
A 10-year old male Labrador retriever presents to you with complaints of tenesmus and a swelling near his anus (see image). On examination, there is a fluctuant swelling lateral to the anus, and on rectal exam, there is a lateral deviation of the rectum. What is the most likely diagnosis?
a. Perineal hernia
b. Megacolon
c. Perianal adenoma
d. Apocrine gland anal sac adenocarcinoma
a. Perineal hernia
The correct answer is perineal hernia. Adult intact male dogs (and cats) are at increased risk of perineal hernias. The deviation of the rectum on rectal palpation is how the diagnosis is usually made. The cause is often not identified, but it frequently occurs as a sequela to chronic tenesmus.
Which of these is least likely a cause for anterior uveitis as shown in this dog with aqueous flare?
a. Hypertension
b. Coccidioides immitis infection
c. Trauma
d. Systemic Lupus Erythematosis
e. Lymphoma
d. Systemic Lupus Erythematosis
The correct answer is systemic lupus erythematosis. SLE causes many signs, but anterior uveitis is not considered one of them. The causes of uveitis include infection (bacterial, viral, fungal, rickettsial), immune mediated (lens-induced uveitis), neoplasia, hypertension, and trauma. Over 50% of the time, the cause is not found and the uveitis is termed idiopathic.
Keratoconjunctivitis sicca, as seen in the image, comes from an abnormality in which of these structures?
a. Lacrimal gland and gland of the 3rd eyelid
b. Conjunctival goblet cells
c. Nasolacrimal ducts
d. Meibomian gland
a. Lacrimal gland and gland of the 3rd eyelid
The correct answer is lacrimal gland and gland of the 3rd eyelid. KCS comes from a decrease of the aqueous portion of the tear film. This is produced by the lacrimal gland and the gland of the 3rd eyelid. Remember, there are three layers of the tear film. The mucous portion lies against the cornea and keeps the tear film adhered to it. This is made by conjunctival goblet cells. The aqueous portion has nutritional and immunologic factors and is in the middle. It is produced by the lacrimal gland and the gland of the 3rd eyelid. The lipid portion of the tear film is the most outer part, and it allows for even spreading and prevents evaporation of tears. It is produced by the meibomian glands.
Which of the following is an adequate treatment for the dog in the picture?
a. Diphenhydramine
b. Phenoxybenzamine
c. Atropine
d. Diethylstilbesterol
a. Diphenhydramine
The correct answer is diphenhydramine. This dog has a swollen muzzle most likely due to type 1 hypersensitivity. Diphenhydramine is an anti-histamine and will reduce the clinical signs associated the allergic reaction.
This radiograph is of a dog with a one month history of coughing. What is your diagnosis?
a. Pneumonia
b. Lung mass
c. Pneumothorax
d. Lymphoma
b. Lung mass
The correct answer is lung mass. At this point we don’t know if this is a metastatic lesion or a primary lung mass. Further diagnostics would be indicated determine the origin of the mass. The mass is located in the region of the caudal vena cava.
This is an ECG recording of a 9-year old male castrated Golden Retriever that had a bleeding splenic mass surgically removed approximately 4 hours ago. The heart rate is currently 186 bpm. The patient received 0.08mg/kg of hydromorphone approximately 45 minutes ago. PCV is currently at 24 (normal 33-58%). What is the best treatment option?
a. This patient is severely anemic and requires a blood transfusion immediately
b. The patient is having breakthrough pain due to the low dose of hydromorphone and should be given an adequate dose of hydromorphone
c. This is not an alarming heart rate or ECG and requires no treatment
d. Provide a lidocaine bolus followed by a continous infusion of lidocaine
d. Provide a lidocaine bolus followed by a continous infusion of lidocaine
This patient is exhibiting premature ventricular contractions which is commonly observed after splenectomy. Any patient that has a splenectomy should be monitored closely for that reason. Most of the time these are not severe enough to require treatment. There are some general guidelines for when to treat VPCs which include excessive pulse deficits, the patient is clinically affected, a heart rate greater than 180 bpm, or greater than 20 second stretch of continuous VPCs.
In this case it is important to know that the patient was just given a dose of post-operative pain medication (at an appropriate dose) which rules out an elevated heart rate secondary to pain.
The patient is anemic, but he is not anemic to the point of requiring an emergency transfusion. Transfusions are usually not administered unless there is expected ongoing blood loss (which is not the case) or the PCV is less than 20.
Lidocaine is an anti-arrhythmic and is the typically the drug of choice for treatment of VPCs. A bolus is administered first to determine if the rhythm is responsive to lidocaine and then a CRI is initiated at 20-80 micrograms per kilogram per minute.
A 7-year old female Lhasa Apso presents to you for lethargy and inappetence. On your exam, you detect mandibular lymphadenopathy and perform a fine needle aspirate. You see the aspirate depicted here. Which of these treatments would be given to this patient as part of a first line therapy?
a. Doxycycline
b. Prednisone
c. Itraconazole
d. Carboplatin
e. Milbemycin
b. Prednisone
This is a case of lymphoma. The cytology depicts the classic finding of a population of lymphoid cells that are predominantly lymphoblasts based on their size and characteristics. If you were unsure about their size due to magnification, there is a neutrophil in the lower left corner for comparison. The lymphoblasts are considerably larger than the neutrophil. Mature lymphocytes would be smaller than a neutrophil. Note that there is a mitotic figure in the middle of the slide.
There are many treatments and protocols for lymphoma and some of the main agents known to have efficacy are prednisone, doxorubicin, cyclophosphamide, vincristine, L-asparaginase, and lomustine. There are many other efficacious chemotherapeutics for lymphoma but carboplatin is not considered a first line treatment for lymphoma in dogs.
The other drugs listed are antifungal (itraconazole), antibiotic (doxycycline) and anti-parasitic (milbemycin).
A 7-year old male intact Chesapeake Bay Retriever presents to your clinic with the presenting complaint of an intermittent cough. On exam, the dog is bright and alert with a temperature of 100.5F (38.1 C), heart rate of 110 beats per minute and respiratory rate of 30 breaths per minute. You perform chest radiographs which are shown below. A CBC shows a hematocrit of 39% (35-57%), neutrophil count of 8,659/ul (2,900-12,000/ul), monocyte count of 984/ul (100-1,400/ul) and eosinophil count of 1,980/ul (0-1,300/ul). What is the treatment of choice for the most likely diagnosis?
a. Pericardiocentesis
b. Immiticide (Melarsomine)
c. Furosemide
d. Enrofloxacin
e. Terbutaline
b. Immiticide (Melarsomine)
The correct answer is Immiticide (melarsomine). The dog in this radiograph has the classic findings for heartworm disease, including right sided ventricular enlargement with very prominent pulmonary arteries.
Heartworm in the dog is caused by Dirofilaria immitis. The treatment of choice for heartworm is Immiticide which is given by intramuscular injection.
Furosemide is a treatment for congestive heart failure, which this dog shows no evidence of. Terbutaline is a bronchodilator, which would be of little use in this case. Broad-spectrum antibiotics are useful for the treatment of pneumonia and other infections but are not effective against heartworm. Pericardiocentesis is obviously the treatment for pericardial effusion, but this dog’s radiographs do not show the classic globoid heart you might see with pericardial effusion.
Adulticidal treatments for heartworm are melarsomine and thiacetarsamide.
What is the primary abnormality visible in this radiograph from a dog?
a. Pulmonary edema
b. Pleural effusion
c. Dilated cardiomyopathy
d. Vena caval syndrome
e. Diaphragmatic hernia
e. Diaphragmatic hernia
Note the raised trachea, with lung lobes floating in the dorsal chest; lung borders outlined clearly by opacity, but the cardiac silhouette indistinct
DDx includes NOTHING GOOD—neoplasia, CHF, hypoalbuminemia (secondary to protein-losing nephropathy/liver disease), heartworm, diaphragmatic hernia, trauma/hemothorax, lung lobe torsion to name a few.
Pulmonary edema looks different-Think splotchy, cotton-ball lungs, where the tissue of the lung itself is heavy with fluid.
A 9 year old female spayed black Labrador Retriever presents to your clinic with the complaint of collapse and lethargy. On exam, the dog is subdued but responsive with a temperature of 100.9F (38.3 C), heart rate of 170 beats per minute, and respiratory rate of 40 breaths per minute. You perform chest radiographs which are shown below. A CBC shows a hematocrit of 31% (35-57%), neutrophil count of 6,275/ul (2,900-12,000/ul), monocyte count of 984/ul (100-1,400/ul) and eosinophil count of 630/ul (0-1,300/ul). What is the treatment of choice?
a. Broad spectrum antibiotics
b. Pericardiocentesis
c. Furosemide
d. Terbutaline
e. Melarsomine
b. Pericardiocentesis
The correct answer is pericardiocentesis. This radiograph and case are a good example of pericardial effusion with the classic finding of a markedly enlarged heart with a globoid shape. The most common type of effusion by far is hemorrhage which can be idiopathic or from neoplasia such as hemangiosarcoma. Based on this finding, in conjunction with the dog’s tachycardia, a pericardial tap for both diagnostic and therapeutic purposes is indicated. Furosemide is contraindicated in cases of pericardial effusion because it will decrease preload in the right side of the heart and can promote circulatory failure. Melarsomine is the treatment for heartworm. Antibiotics are very unlikely to help this dog unless the effusion is from some sort of infectious pericarditis, which would be extremely unusual in dogs.
On the morning of a beautiful summer day, a five-year old, male German Pointer played unattended in the backyard garden. During the following 24 hours the right side of the dog’s face became swollen as seen in the image below. The dog developed urticaria and became lethargic, unable to walk and vomited several times. Which of the following are the best treatment options for the likely condition?
a. Diazepam, methocarbamol, and non-steroidal anti-inflammatories
b. Antihistamines, corticosteroids, and epinephrine
c. Drain the swelling, administer antibiotics
d. Induce vomiting, administer activated charcoal, intravenous fluids
e. Furosemide, oxygen, and nitroglycerin
b. Antihistamines, corticosteroids, and epinephrine
The dog has angioedema +/- anaphylaxis, likely caused by an insect bite or sting. A snake bite should also be ruled out by trying to visualize the bite or questioning the owners. This is a type I hypersensitivity reaction and is treated by removing the offending agent if possible and providing supportive care with anthistamines, corticosteroids, and epinephrine as needed.
A 4-month old male intact Great Dane presents for lethargy and reluctance to stand. He is non-weight bearing on his left forelimb. You localize pain and swelling to the distal radius and ulna and take the following radiograph. What do you tell the owner about recovery and prognosis?
a. Prognosis is good but angular limb deformity is a possible complication as the physis is involved. Coaptation is recommended and healing should occur rapidly as he is still young
b. Prognosis is poor. Amputation is recommended and there is a high rate of metastasis to the lungs. Survival time is less than 1 year even with chemotherapy
c. Prognosis is guarded. Recovery induces antibiotics and joint lavage
d. Prognosis is usually good but angular limb deformity is a possible complication. Recovery relies on supportive care and can take days to weeks. Most dogs with this disease will have 1 or 2 episodes and recover
d. Prognosis is usually good but angular limb deformity is a possible complication. Recovery relies on supportive care and can take days to weeks. Most dogs with this disease will have 1 or 2 episodes and recover
Hypertrophic osteodystrophy (HOD) is a disease of large, rapidly growing dogs. The distal metaphyses of the forelimbs are more commonly affected and can be swollen. Radiographic findings include metaphyseal flaring and the classic “double physeal line.” Treatment is supportive with anti-inflammatories or steroids, pain medications, and activity restriction.
Septic arthritis can cause lameness, joint pain and swelling. Radiographs can show bone destruction and osteolysis with chronic disease as well as irregularities in the joint space. Osteosarcoma causes bony lysis and proliferation at the metaphyseal region of long bones. These are commonly in the distal radius/ulna, proximal humerus, proximal tibia, and distal femur (“away from the elbow and towards the knee”). Age does not rule out this disease as it has been diagnosed in animals as young as 6 months.
A two-year old Dachshund presents for hair loss (see image). He is not pruritic. Both ears are affected. No other hair loss is noted over the rest of his body. His physical exam is unremarkable. In house skin scrapings are negative for mites. Blood work and thyroid levels are unremarkable. What is the most likely cause?
a. Immune-mediated
b. Bacterial infection
c. Breed related
d. Mite infection
e. Endocrine disorder
c. Breed related
Canine pinnal alopecia is a form of pattern alopecia. Pinnal alopecia is most commonly diagnosed in Dachshunds, but can be seen in Chihuahuas, Boston Terriers, Bull Terriers, Yorkshire Terriers, and Italian Greyhounds. The condition usually occurs in dogs older than 1 year of age and results in slowly, progressive, bilateral pinnal alopecia. The ear margins may become chronically hyperpigmented and thickened. The condition is benign and requires no specific treatment.
Distribution of the alopecia is an important key to determining the underlying diagnosis. It may help in distinguishing inflammatory from non-inflammatory causes, thus narrowing down your differential list. Inflammation results in a patchy pattern of alopecia that is not symmetrically distributed; whereas, many of the noninflammatory alopecias have a symmetrical pattern of alopecia. Hypothyroidism often causes alopecia of the tail and may also be associated with alopecia of the nose bridge. Hair loss begins with the pinna at 6 to 9 months of age and may progress to complete pinnal alopecia. Total body alopecia with pigmentation may occur with age. Treatment with oral melatonin may cause hair regrowth with this and other pattern baldness syndromes. Other medications that can be used with variable success are pentoxifylline and Omega 3 oils topically.
What treatment should you recommend for the dog in the photograph?
a. Surgical removal of the abnormality
b. Surgical replacement of the abnormality
c. No treatment is indicated
d. Enucleation (wide surgical excision)
e. Surgical removal of the abnormal structure followed by chemotherapy for likely metastatic disease
b. Surgical replacement of the abnormality
This image shows a dog with bilateral “cherry eye” or prolapse of the gland of third eyelid. The recommended therapy is gland replacement by the Morgan pocket technique or Kaswan anchoring technique. Removal of the gland places dogs at increased risk of developing keratoconjunctivitis sicca (KCS).
You perform thoracocentesis on a dog with pleural effusion. The fluid is an opaque pink color and has a protein content of 2.5 g/dl. There are 3,000 cells/uL. You suspect that it is chyle. What is the test of choice to definitively classify this fluid?
a. Glucose concentration of the fluid compared to serum
b. Differential cell count on the fluid
c. Thoracic radiographs
d. Triglyceride concentration of the fluid compared to serum
e. Culture and sensitivity of the fluid
d. Triglyceride concentration of the fluid compared to serum
Explanation
The correct answer is triglyceride concentration of the fluid compared to serum. The fluid described is most consistent with a chylous effusion. The best way to definitively classify chyle is finding an elevated triglyceride level compared to serum. If you chose differential cell count, this is also a good answer because most chylous effusions are composed primarily of lymphocytes, unlike other effusions. However, with prolonged loss of lymphocytes, chronic chylous effusions may be composed primarily of neutrophils, which may lead you to believe it is an exudate. Radiographs and culture and sensitivity may be appropriate tests but will not help you classify the fluid. Glucose concentration of the fluid is not useful in this instance. It is sometimes used to diagnose pyothorax as glucose concentrations are typically < 10 mg/dl.
Which of the following is not an appropriate medical treatment for a dog with a tumor of the cells shown in the image?
a. Vinblastine (Velban)
b. Famotidine (Pepsid)
c. Piroxicam
d. Prednisone
e. Diphenhydramine (Benadryl)
c. Piroxicam
This is an example of a mast cell tumor. All of the choices are acceptable treatments except for Piroxicam. Because mast cells contain and secrete histamine, administration of an H2 antagonist such as famotidine and an H1 antagonist such as diphenhydramine can reduce systemic signs associated with histamine release. Prednisone and Vinblastine are both appropriate chemotherapeutics for mast cell tumors in dogs. Piroxicam is a cyclooxygenase inhibitor (NSAID) and is not an effective chemotherapeutic for mast cell tumors. Additionally, its potential to cause adverse side effects to the stomach and small intestine can increase the risk of gastroenteritis or perforation in a dog with hyperhistaminemia.
What structure in this dog’s eyes is affected?
a. Optic nerve
b. Retina
c. Lens
d. Anterior uvea
e. Cornea
c. Lens
The correct answer is lens. This dog has bilateral incomplete cataracts. Cataracts have a variety of causes including aging, intraocular disease, endocrine disease (especially diabetes mellitus) and radiation exposure. A cataract is characterized by increasing opacity to the lens of the eye. It can be difficult to judge depth on a photograph but the answer should be apparent due to the classic appearance and the fact that you can only see the affected area through the pupil.
A 8-year old male Doberman Pinscher is being treated by your colleague for dilated cardiomyopathy. You hear an arrhythmia on exam and record the following ECG. What is your diagnosis?
a. Second degree AV block
b. Sinus arrhythmia
c. Atrial premature complexes
d. Normal sinus rhythm
e. Atrial fibrillation
e. Atrial fibrillation
The correct answer is atrial fibrillation. Although the rate is not fast, there are no discernible P waves and the R-R interval varies with each beat. This irregularly irregular rhythm is a hallmark of atrial fibrillation. Normal sinus rhythm and sinus arrhythmia are incorrect as there are no P waves apparent. Atrial premature complexes is wrong because the irregularity is from the fibrillation waves in the atria, not a discrete premature focus. Second degree heart block is not correct because no P waves are seen, as would be expected with intermittent block.
This Italian Greyhound in the photograph presented after being stepped on by the owner. Radiographs show a transverse mid-diaphyseal fracture of the radius and ulna. What is the best treatment option?
a. Internal fixation
b. Cast for 8 weeks
c. Splint
d. Amputation
a. Internal fixation
The correct answer is internal fixation. Proper internal fixation will achieve the best reduction and thereby maximize the chances of adequate healing. Small breed dogs have a decreased blood supply to distal limbs, which results in a slower healing of fractures and a higher incidence of non-union when there is no surgical intervention.
A 4-year old Dachshund presents for biting and chewing the nails of all four paws. The owner explains that the behavior started this summer, but the patient seems to be generally itchy every summer since he was one year old. Please refer to the picture for the physical examination findings. Based on the history and physical examination, which of the following is your most likely diagnosis?
a. Malassezia infection
b. Trauma
c. Neoplasia
d. Symmetrical lupoid inychodystrophy
e. Sarcoptes scabiei
a. Malassezia infection
Malassezia infection of the claws often produces a red-brown discoloration. Other clues that this is more likely Malassezia include biting at the nails (sign of pruritus), multiple claws are infected, and the dog has other symptoms of allergy (pruritus in summer months), which could be this patient’s underlying disease. Trauma and neoplasia are less likely since multiple claws are infected, and these typically are not pruritic unless there is a secondary bacterial component. Symmetrical lupoid onychodystrophy results in severe splitting and deformation of the nails. Sarcoptes does not discolor the nails.
What substance is responsible for the wrinkled appearance of Shar Peis?
a. Collagen
b. Mucin
c. Lipid
d. Keratin
b. Mucin
Excess amounts of the dermal ground substance component mucin is responsible for the wrinkled appearance of Shar-Peis.
A 3-month-old pit bull terrier presents with generalized alopecia and crusting of the skin (see image). A deep skin scraping shows the dog has generalized demodicosis. What should you tell the owners?
a. Transmission of the infection was from the bitch to the puppy. The bitch should be treated for Demodex because she is the source of the infection. The puppy does not need to be treated.
b. The dog likely has an inherited defect in cellular immunity. The dog should not be bred
c. Generalized Demodex infections usually resolve on their own without treatment
d. t is very common for pit bull puppies to get generalized Demodex infections. The puppy should be treated for the infection but the prognosis is good.
b. The dog likely has an inherited defect in cellular immunity. The dog should not be bred
The correct answer is the dog likely has an inherited defect in cellular immunity. The dog should not be bred. Generalized demodicosis in juveniles and puppies is usually caused by an inherited defect in cell immunity. They should be treated with a mite killing agent like ivermectin, amitraz, or milbemycin, as well as with oral antibiotics for secondary bacterial infections. Spontaneous remission of the infection can occur, but the prognosis is always guarded. Demodex mites are part of the natural flora of a dog’s skin, so they are normally present all the time. Adult dogs that develop generalized demodicosis are usually immune-suppressed.
A 4-month-old terrier cross presents for inability to eat. The puppy is bright, alert, and responsive on exam. Heart rate is 148, respiratory rate is panting, and temperature is 101.8 F (38.8 C). The puppy is extremely painful when his lower jaw is palpated, and cries and pulls away when you attempt to open his mouth. Sedated oral exam is unremarkable. Radiographs are available for review (see image). What do you tell the owner about prognosis?
a. This will regress within a year, and symptomatic support is needed for discomfort
b. Surgical removal of dentigerous cysts will likely be curative, however, long term dental disease is common
c. This can be cured with antibiotics based on culture and sensitivity. NSAIDs can be used for discomfort
d. Chemotherapy can prolong quality of life for a few months, however, prognosis is grave
a. This will regress within a year, and symptomatic support is needed for discomfort
Craniomandibular osteopathy (CMO) is seen in young dogs and is exemplified in this radiograph. Terrier breeds predominate, but CMO can be seen in any breed. The disease is self-limiting and regresses typically by 1 year old. It is thought to be a type of hypertrophic osteodystrophy (HOD) and occurs mostly in the mandible but can also affect the tympanic bulla, temporal bones, and temporomandibular joints. Treatment is supportive with nonsteroidal anti-inflammatories to control pain, similar to HOD. Radiographic signs will also regress with time.
An 8-year-old dog is found recumbent and non-responsive in a horse pasture. His left pupil is small, the right one is moderately dilated but responds to light. The right upper eyelid and lip are droopy, hanging lower than normal. Head trauma is suspected. The mucous membranes are pale pink, capillary refill time is 1-2 seconds.
T=98.7oF (37.0oC) [N 100-102.5oF, 37.8-39.2oC]
HR=56 [N 90-160 beats/min]
THe respiratory rate and pattern are quite variable
Her breathes fast and deep for 5-6 breaths, then more slowly and shallowly, then is apneic for 10 seconds. The pattern repeats over and over. What is this respiratory pattern?
a. Orthopnea
b. Cheyne-Stokes breathing
c. Apneustic respiration pattern
d. Agonal respiration
e. Kussmaul pattern
b. Cheyne-Stokes breathing
Cheyne-Stokes is a respiratory pattern seen in patients with head trauma and damage to the respiratory centers. It occurs with direct or ischemic damage to the brain, or when cerebral edema and/or increased intracranial pressure are present.
It is a usually a bad sign as herniation of the brain may be imminent.
Cheyne-Stokes also occurs in patients who are too deep under anesthesia, and is reported as a side effect of morphine in humans. Other signs of brain damage in this patient are the bradycardia and abnormal pupils
A 7-year-old pit bull mix presents with these skin lesions (see image) and mild pruritus. What is the LEAST likely differential?
a. Bacterial pyoderma
b. Demodectic mange
c. Permphigus
d. Sarcoptic Mange
d. Sarcoptic Mange
The lesions in the image are pustules, which form with neutrophilic inflammation and are accumulations of dead or dying polymorphonuclear leukocytes. Pustules are seen with differing types of dermatitis ranging from bacterial pyoderma, demodicosis, allergic reaction, and pemphigus. Determining the primary etiology will aid in proper treatment and resolution. Diagnostics that are always appropriate for diagnosing skin infections include skin scraping, impression smears, hair plucking for fungal culture, and biopsies if the preliminary diagnostics are unrewarding. Woods lamp can be used as well to diagnose dermatophytosis; however a negative results does not preclude a dermatophyte infection and culture should be pursued.
Demodicosis is the only mite infection that has been known to cause pustules or papules. Sarcoptes, Cheyletiella, and Otocaria are not known to cause pustules. Sarcoptes is also usually associated with intense, not mild, pruritis. Dermatophytosis and Trombiculosis can cause pustules, but this is not routinely seen.
You examine a Vizsla with blood in the anterior chamber of the eye as shown in this image and keratic precipitates on the posterior cornea. What is the most accurate diagnosis based on these findings?
a. Glaucoma
b. Coagulopathy
c. Keratitis
d. Chorioretinitis
e. Anterior uveitis
e. Anterior uveitis
The correct answer is anterior uveitis. Hyphema and keratic precipitates are specific signs of anterior uveitis. At this point, the cause is undetermined in this animal. While some of these other answer choices may be present in conjunction with uveitis, they are not described by the signs listed in the question.
A 7-year old intact female Basset Hound presented to your hospital for further evaluation after her owner identified a growing mass associated with her vulva. On physical examination, the mass is firmly associated with the vulva and there is mild erythema noted on the surface. A rectal exam is unremarkable and the patient does not have a history of stranguria. A complete blood count and chemistry panel is performed and a slight elevation in calcium is noted at 11.9 mg/dL and cholesterol is 327 mg/dL. Based on the image below and the available information, what is the best treatment choice?
a. Broad-spectrum antibiotic therapy
b. Diphenhydramine and Famotidine therapy
c. Cyclosporine and prednisone therapy
d. Surgical debulking followed by radiation therapy
d. Surgical debulking followed by radiation therapy
The image shows a classic example of a mast cell tumor. Note the large number of mast cells (bluish-purple round cells) and all the granules that are present throughout the inside and outside of the cells. Treatment of mast cell tumors in this region usually involves debulking gross disease with surgery and then radiation therapy, as it is difficult to achieve clean margins at this location. The adjuvant radiation therapy results in very good long term control for most mast cell tumors.
Prednisone and diphenydramine may be used as anti-inflammatories, but they do not result in control or cure of the disease. Diphenhydramine and Famotidine are excellent therapies to use in the mean time before surgery. Cyclosporine causes T-cell modulation and is typically used for immune-mediated conditions. Mast cell tumors are not immune-mediated. There is no bacteria noted on the slide that would imply antibiotic therapy is needed.
A 9-year old male neutered Rottweiler presents to you with a one-month history of lameness of the right forelimb. The dog is painful on palpation of the proximal humerus. Which is the most likely differential diagnosis to discuss with the owner?
a) Osteomyelitis
b) Hypertrophic osteopathy
c) Old healed fracture
d) Primary bone tumor
d) Primary bone tumor
The signalment of a large breed, older dog, and a radiographically aggressive bone lesion in the proximal humerus are most suggestive of primary bone neoplasia. The destructive element of the lesion indicates its aggression, and the location in one bone, in a site of predisposition for cancer, make fungal osteomyelitis less likely.
A seven-month old male German Shepherd became acutely lame on the right forelimb 5 days ago. The dog presents on emergency due to acute exacerbation of lameness. On your exam, the dog has a temperature of 103.6 F (39.8 C) and was toe touching lame on the right forelimb and reluctant to stand or walk. There was no evidence of external trauma. Deep palpation of the right humerus elicited pain and you take radiographs of the right humerus which are shown below (see image). Based on the most likely diagnosis, what is the prognosis for this condition with supportive treatment only?
a. Poor, 10-20% of dogs recover
b. Grave, <5% of dogs recover
c. Fair, 40-60% of dogs recover
d. Good, 80-90% of dogs recover
e. Excellent, >95% of dogs recover
e. Excellent, >95% of dogs recover
This is a case of panosteitis based on the young age of the patient and radiographic presence of focal intramedullary densities within the humeral diaphysis. Minor differentials could include osteomyelitis. Panosteitis is a self-limiting, painful condition characterized by limping and lameness. It typically affects the long bones of young dogs, usually between the ages of 5 to 18 months. It can occur with any breed, but it is more common in medium- to large-sized dog breeds.
Treatment is primarily supportive consisting of limiting activity and anti-inflammatory drugs. Pain lasts from weeks to months and resolves in nearly all cases. While these treatments reduce the pain associated with the condition, they may not alter the duration or course of the disease.
