CAP End of Sem 2

Question 1

15 weeks old, Female entire, Labrador ‘Dragging’ right pelvic
limb 7 days ago. Rapid progression to loss of voluntary movement of the pelvic limbs and tail. Vital signs wnl. Rigid extension of the pelvic limbs
due to muscle contracture. The stifles could not be manually flexed and the limbs could not be abducted. Diffuse muscular pain and atrophy. Neurologic exam: paraplegia with loss of conscious proprioception and absent tendon reflexes in the pelvic limbs. Bladder distended with urinary overflow and could not be manually expressed. Anus was flaccid and dilated with no perineal reflex.
- List the problems
- What are the differential diagnoses?
- What is the most likely differential diagnosis?
- What diagnostic tests will you perform?

Answer 1

Problem list:
- Hind limb paralysis
- Muscle rigidity, pain & atrophy
- Loss of conscious proprioception
- Loss of voluntary movement of pelvic limbs
- Bladder distention with urinary overflow
- Flaccid & dilated anus with no perineal reflex

Ddx:
- Tick paralysis
- Neosporosis
- Discospondylosis
- Fibrocartilagenous embolic myelopathy (FCEM)
- Intervertebral disc disease (IVDD)
- Spinal trauma
- Snake bite

What is the most likely differential diagnosis?
- L4-S3 spinal cord lesion

What diagnostic tests will you perform?
- Radiographic series of the spine

Question 2

Describe the visible ocular changes in this 3 year old pugs eyes (looks like a chunk / cavity missing from surface of eye).
- What medication would you use to treat this eye at presentation?
- What ocular surgery could you perform to assist in the treatment of this condition?

Answer 2

Descemetocoele - ulcer has broken through the corneal basement membrane

Medication to treat at presentation:
- Prescribe patient NSAIDs (to reduce pain) & systemic antimicrobials
(to reduce potential pathogenic complications)
- Refer patient to an ophthalmic veterinarian promptly (ophthalmic
emergency)

Ocular surgery:
- Referring veterinarian is likely to perform a corneoconjunctival
transposition or conjunctival graft

Question 3

What is the major ocular abnormality pictured & what is the recommended treatment? (Picture of dog where both eyes are almost entirely milky white)

Answer 3

Condition = corneal opaqueness (bilateral cataracts)
Treatment = referral to ophthalmic veterinarian for phacoemulsification cataract surgery

Question 4

What is a differential diagnosis of this condition in an elderly dog (10yo). What is the recommended treatment? (eye has a bluish / white film to it but not as milky white or extensive as cataracts)

Answer 4

Condition = nuclear sclerosis (most likely diagnosis for animal’s signalment - common in older dogs)
Treatment = none required, no appreciable loss of vision occurs

Question 5

What ophthalmic technique could you employ to differentiate bilateral cataracts & nuclear sclerosis?

Answer 5

• To differentiate between cataracts & nuclear sclerosis, an
  ophthalmoscope can be used to visualise the fundus
• If the fundus is clear = nuclear sclerosis
• If the fundus has black areas or lacks total reflection = cataracts

Question 6

Chronic superficial keratitis is an immune mediated condition.
With reference to this condition, which of the following is incorrect:
- It presents as a progressive bilateral fibrovascular corneal infiltrate
extending into the central cornea from the lateral limbus
- Associated with corneal ulceration
- In chronic cases corneal pigmentation can cause blindness
- Third eyelid depigmentation and thickening occurs in some cases

Answer 6

• Associated with corneal ulceration

Question 7

Secondary glaucoma does not occur as a sequelae to…
- Primary lens luxation
- Uveitis
- Asteroid hyalosis
- Intraocular neoplasia

Answer 7

• Asteroid hyalosis

Question 8

With reference to Collie Eye Anomaly which of the following is
not correct:
- Congenital choroidal abnormality
- Clinical signs include choroidal hypoplasia, colobomatous defects of the optic disc, intraocular haemorrhage and retinal detachment
- Affected breeds are Collies, Shetland Sheepdogs and Border Collies
- Optimum age for diagnosis is 12 months of age

Answer 8

• Optimum age for diagnosis is 12 months of age

Question 9

Feline Herpes virus in the adult cat is not a common cause of:
- Uveitis
- Recurrent conjunctivitis
- Corneal ulceration
- KCS

Answer 9

• Uveitis

Question 10

The clinical findings associated with a retrobulbar abscess do
not include…
- Exophthalmos (abnormal protrusion of eyeball)
- Pain on opening the mouth
- Retinal detachment
- Protrusion of the third eyelid

Answer 10

?

Question 11

Select the most correct answer regarding lens luxation:
- Does not occur secondary to glaucoma, trauma or cataracts
- Is usually a secondary condition in cats
- Is usually a secondary condition in Terrier breeds
- Primary lens luxation is generally unilateral

Answer 11

• Primary lens luxation is generally unilateral

Question 12

Clinical appearance of corneal sequestrum in the cat is not characterised by:
- Initial cottage cheese like accumulation on the surface of the cornea proceeding to a black plaque on the cornea
- The early development of a focal tan coloured central corneal
lesion
- A raised black central corneal plague
- Ulceration around the plague margins, corneal oedema and
neovascularisation

Answer 12

• The early development of a focal tan coloured central corneal
  lesion

Question 13

Generalized progressive retinal atrophy does not cause…
- Nyctalopia (night blindness)
- Tapetal hyper-reflectivity
- Attenuation of retinal vessels
- Retinal detachment

Answer 13

• Retinal detachment

Question 14

Which of the following is not a feature of keratoconjunctivitis
sicca?
- Presence of a tenacious ocular discharge
- Conjunctivitis
- Schirmer tear test of 15-20mm/min
- Corneal oedema, neovascularization and pigmentation

Answer 14

• Corneal oedema, neovascularization and pigmentation

Question 15

Which of the following is not a sequel to uveitis?
- Cataracts
- Iris bombe
- Posterior and peripheral anterior synechiae formation
- Stromal melting

Answer 15

• Stromal melting

Question 16

Which diagnostic procedure would be of least use to
investigate the cause of a “red” eye ?
- Slit lamp examination
- Fluorescein stain
- Fundus examination
- Tonometry

Answer 16

• Fluorescein stain

Question 17

Which of the following factors are unlikely to predispose to
the development of entropion?
- Scar formation following trauma or surgery
- Lagophthalmos (incomplete closure of eyelids)
- Macropalpebral fissure
- Hereditary predisposition

Answer 17

• Lagophthalmos (incomplete closure of eyelids)

Question 18

The treatment of a penetrating corneal injury with iris
prolapse does not include
- Topical and systemic corticosteroids
- Topical atropine
- Surgical resection or replacement of the prolapsed iris and direct suturing of the corneal defect
- Topical and systemic antibiotics

Answer 18

• Topical and systemic corticosteroids

Question 19

Epiphora (eye watering) is not associated with:
- Uveitis
- Imperforate nasolacrimal puncta
- Keratoconjunctivitis sicca
- Ulcerative keratitis

Answer 19

• Keratoconjunctivitis sicca

Question 20

Proper examination of the lens and fundus requires a dilated
pupil. Diagnostic mydriasis is best achieved with the use of…
- Pilocarpine
- Atropine
- 1% Tropicamide
- 2% Trusopt

Answer 20

• 1% Tropicamide

Question 21

The treatment of primary glaucoma is based on the reduction of the intraocular pressure, improvement of uveoscleral outflow of
aqueous, and providing analgesia. Which of the following drugs would not
be appropriate therapy?
- Atropine
- Prostaglandin analogues
- Systemic NSAIDs
- Topical carbonic anhydrase inhibitors

Answer 21

• Prostaglandin analogues

Question 22

The best treatment for keratoconjunctivitis sicca is:
- Short term topical cyclosporin
- Long term topical cyclosporin
- Topical corticosteroids
- Topical pilocarpine PO

Answer 22

• Long term topical cyclosporin

Question 23

The best treatment option for lower lid entropion in an eight
week old Shar Pei puppy is:
- Topical antibiotics
- Tear replacement drops
- Wait until the puppy is twelve months old until surgical correction is attempted
- Immediate eyelid “tacking” surgery

Answer 23

• Immediate eyelid “tacking” surgery

Question 24

The best treatment option for a shallow corneal ulcer in a 6
year old Boxer dog that has been present for three months without
improvement despite continuous antibiotic treatment is:
- Take a culture and sensitivity and change the antibiotics
- Place a third eyelid flap
- Debride the ulcer bed and continue with topical antibiotics and lubricants
- Place a conjunctival graft over the lesion

Answer 24

• Debride the ulcer bed and continue with topical antibiotics and lubricants

Question 25

Select the correct answer regarding distichia:
- Are hairs emerging through the palpebral conjunctiva of the eyelids
- Are normal facial hairs that are in contact with the cornea
- Are hairs emerging through the Meibomian gland openings along the lid margin
- Always require surgical removal

Answer 25

• Are hairs emerging through the Meibomian gland openings along the lid margin

Question 26

The clinical signs of uveitis include:
- Exophthalmos
- Pupillary dilation (constriction)
- Pupillary miosis
- A profound purulent ocularhorn
discharge

Answer 26

• Pupillary dilation (constriction)

Question 27

Ocular emergencies include:
- Cataracts
- Horner’s syndrome
- Anterior lens luxation
- Prolapsed nictitans gland

Answer 27

• Anterior lens luxation

Question 28

The most common primary intraocular tumour in the cat is…
- Ciliary body adenomas
- Squamous cell carcinoma
- Lymphosarcoma
- Iris melanoma

Answer 28

• Squamous cell carcinoma

Question 29

Select the correct answer regarding topical corticosteroids:
- Enhance corneal epithelialization
- Reduce stromal collagenase activity
- Reduce corneal neovascularization
- Are a useful for the treatment of conjunctivitis in the cat

Answer 29

• Reduce stromal collagenase activity

Question 30

Descemet’s streaks are ruptures in Descemet’s membrane
associated with:
- Uveitis
- Corneal ulceration
- Lipid dystrophy
- Glaucoma

Answer 30

• Glaucoma

Question 31

You are presented with an adult dog with a recent
development of bilateral ovoid, white central corneal opacities.
Fluorescein uptake is negative and there is no associated discomfort or
discharge. The likely diagnosis is…
- Lipid dystrophy
- Scarring from past corneal ulceration
- Descemetocele
- Persistent pupillary membranes

Answer 31

• Lipid dystrophy

Question 32

The treatment of globe proptosis in a Shih Tzu puppy that
presents just before the clinic closes at night:
- Can be delayed until the following morning
- Medical treatment alone with topical and retrobulbar corticosteroids is instigated
- Must be treated as an ocular emergency and prompt surgical
treatment with a tarsorrhaphy should be undertaken
- Enucleation is the only treatment option

Answer 32

• Must be treated as an ocular emergency and prompt surgical
  treatment with a tarsorrhaphy should be undertaken

Question 33

Select the correct answer regarding nuclear sclerosis:
- Is commonly seen in dogs less than nine years of age
- Is commonly seen in dogs greater than nine years of age
- Is a common cause of blindness
- Always precedes the formation of cataracts

Answer 33

• Is commonly seen in dogs greater than nine years of age

Question 34

You are presented with a seven year old Lhasa Apso with a
two day history of a sudden onset of blindness. Bilateral fixed dilated pupils are present and there is no menace and dazzle response, but there is no other significant change seen on ocular examination. The differential
diagnosis would include…
- Sudden acquired retinal degeneration
- Generalized progressive retinal atrophy
- Glaucoma
- Retinal pigment epithelial dystrophy (central progressive retinal atrophy)

Answer 34

• Sudden acquired retinal degeneration

Question 35

A 9 year old Golden Retriever presents with unilateral
pupillary miosis, enophthalmos, ptosis and protrusion of the 3rd eyelid.The most likely diagnosis is:
- Corneal ulceration
- Uveitis
- Horner’s syndrome
- Blunt trauma to the globe

Answer 35

• Horner’s syndrome

Question 36

You are presented with a 6 month old Labrador with a 3 day
history of a profound unilateral purulent ocular discharge and
conjunctivitis. The Schirmer tear test is 32mm/min and a shallow corneal ulcer is present. What would be the best diagnostic procedure to establish
a diagnosis:
- Conjunctival biopsy
- Flush the nasolacrimal system
- Culture and sensitivity
- Check behind the 3rd eyelid for a foreign body

Answer 36

• Check behind the 3rd eyelid for a foreign body

Question 37

(Endocrine section) - list the diseases that cause polyuria / polydipsia.

Answer 37

• Pyometra
• Diabetes mellitus + insipidus
• Hyperthyroid
• Cushing’s
• Iatrogenic

Question 38

Discuss Diabetes Mellitus treatment, testing & monitoring.

Answer 38

?

Question 39

Discuss Cushing’s disease treatment, testing & monitoring.

Answer 39

?

Question 40

(Endocrine system). What is the somogyi effect & why does it occur?

Answer 40

?

Question 41

Trauma - what do you treat for head trauma?

Answer 41

Always ensure oxygenation

Question 42

Rat bait toxicity scenario

Answer 42

• Stabilise patient
• Apomorphine to induce vomiting - check the amount of food content removed
• The use of activated charcoal - note activated charcoal doesn’t affect already blinded toxin only free toxins
• Plasma replacements
• Monitoring i.e. CBC, biochem, PCV
• Check transfusion reactions 10-15ml/15 min increase slowly half maintenance rates > stable then increase > maintained 250ml
• Before discharge supply vitamin K for 28 days

Question 43

(Urinary surgery). Discuss ectopic ureter in a wet puppy.

Answer 43

?

Question 44

(Urinary surgery). Discuss cystic calculi diagnosis & treatment.

Answer 44

?

Question 45

(Urinary surgery). Discuss transitional cell carcinoma of bladder - how to diagnose & treatment plan.

Answer 45

Diagnosis:
- Use blood panel e.g. lymphocytes, neutrophils, epithelial cells
- Neoplastic cells, abnormal shapes, nuclei & size mitotic figrue (high = abnormal > most likely cancer vs something else)

Treatment plan:
- Piroxicam (Cox-2 inhibitor) is apparently good for transitional cell carcinomas
- Thoracic radiographs to check for metastasis before any mast cell tumour or transitional cell carcinoma treatment commences (metastasis = very poor prognosis > likely euthanasia case)

Question 46

(Urinary surgery). Differentiate between acute renal failure & chronic renal failure.

Answer 46

• Differences in USG?
• Acute renal failure will be isosthenuria
• Clinical signs on blood panels i.e. biochem, hypercalcaemia etc.

Question 47

A dog is presented with a 1cm diameter raised pink hairless dermoepidermal mass on the lateral left tarsus, diagnosed by fine needle aspiration cytology as a mast cell tumour. What clinical staging examinations are advisable?
- Bone marrow evaluation, thoracic radiographs & abdominal ultrasound examination
- Prescapular lymph node palpation, thoracic radiographs & bone marrow cytology
- Popliteal lymph node palpation & cytology, abdominal ultrasound examination
- Abdominal & thoracic radiographs, buffy coat & bone marrow evaluation

Answer 47

• Popliteal lymph node palpation & cytology, abdominal ultrasound examination

Question 48

A 9 year old male cattle dog is presented for a 2cm diameter raised pink epidermal mass with a partly ulcerated surface, located in the perianal tissue just to the right of the dorsal anus. The mass is suspected to be a perianal gland adenoma. Select from the options below the most appropriate diagnostic test & recommended therapy.
- Fine needle aspiration for diagnosis, treat with wide margin surgical excision
- Fine needle aspiration for diagnosis, treat with piroxicam
- Incisional biopsy for diagnosis, treat initially with castration
- Incisional biopsy for diagnosis, treat with piroxicam

Answer 48

• Incisional biopsy for diagnosis, treat initially with castration

Question 49

A 3-year old black Labrador is presented for a rapidly growing solitary hairless nodule on the lateral surface of its 4th toes on the right front limb. Evaluation of cytology from a fine needle aspirate of the nodule identifies a round cell tumour. Which of the following diagnoses does this rule out?
- Mast cell tumour
- Transmissible venereal tumour
- Plasma cell tumour
- Squamous cell carcinoma

Answer 49

• Squamous cell carcinoma

Question 50

A 12 year old female spayed Doberman Pinscher had a soft tissue sarcoma resection 9 months ago. Since surgery she has been treated with low dose cyclophosphamide & firocoxib to inhibit local tumour regrowth. She has had stranguria for the last week & a free catch urine sample shows haematuria on a urine dipstick analysis. What are the two most likely causes of these abnormalities?
- Von Willebrand disease, cyclophosphamide-induced sterile haemorrhagic cystitis
- Bacterial cystitis, firocoxib toxicity
- Firocoxib toxicity, Von Willebrand disease
- Cyclophosphamide-induced sterile haemorrhagic cystitis, bacterial cystitis

Answer 50

• Cyclophosphamide-induced sterile haemorrhagic cystitis, bacterial cystitis

Question 51

A 6 year old Doberman Pinscher with asymptomatic early dilated cardiomyopathy undergoes forelimb amputation for osteosarcoma. Which of the following drugs would be contraindicated for adjuvant chemotherapy following amputation?
- Zoledronate
- Cisplatin
- Carboplatin
- Doxorubicin

Answer 51

• Cisplatin

Question 52

Which of the following statements is TRUE about the treatment of nasal lymphosarcoma in cats?
- Short term prognosis following either chemo or radiation therapy is very poor
- There is an excellent long-term prognosis with most cats cured
- There is a good medium to long-term prognosis with chemo- or radiation therapy
- There is a good medium to long-term prognosis without therapy

Answer 52

• There is a good medium to long-term prognosis with chemo- or radiation therapy

Question 53

A cat is diagnosed with low-grade alimentary lymphosarcoma & is treated with chemotherapy. What cytotoxic drug is commonly used in general practice to treat this malignancy?
- Cyclophosphamide
- Vincristine
- Chlorambucil
- Cisplatin

Answer 53

• Chlorambucil

Question 54

A dog is undergoing cytotoxic chemotherapy treatment for lymphosarcoma. The dog originally presented with generalised superficial lymphadenomegaly & splenomegaly & the diagnosis was based on histopathology of an enlarged lymph node. Within a couple of weeks of starting treatment the dog has achieved complete clinical remission. What does “complete clinical remission” mean?
- The dog is cured from lymphosarcoma, providing the course of chemotherapy is completed
- The dog’s lymph nodes & spleen are normal size, but microscopic disease is likely still present
- The dog’s lymph nodes have returned to normal size, but the spleen is still enlarged
- Abnormal lymphocytes will no longer be found on the blood smear or in the lymph nodes

Answer 54

• The dog’s lymph nodes & spleen are normal size, but microscopic disease is likely still present

Question 55

A dog is presented with polydipsia, polyuria & mild inappetence. Initial laboratory investigation shows mildly increased total serum calcium.
1. Briefly outline the approach to determining whether this abnormality is significant
2. What pathologic process is the single most likely cause of hypercalcaemia in dogs?

Answer 55

1. Recheck total calcium. If still high then check ionised calcium. If normal then no further investigation.
2. Neoplasia

Question 56

A 10 year old cat is presented because of 2 weeks inappetence. On physical exam the only significant abnormality is a palpably enlarged spleen & slight dehydration based on skin tent. Haematology & serum biochemistry are unremarkable apart from slightly elevated urea & USG is 1.045.
1. What is the best interpretation of this cat’s problems? (2 marks)
2. What is the next most logical investigation to obtain a diagnosis? (1 mark)

Answer 56

1. Mild azotaemia likely pre-renal (1 mark). Inappetence might be related to splenomegaly (1 mark).
2. Fine needle aspiration of spleen is next most logical step (1 mark)

Question 57

A cat is suspected to have low grade alimentary lymphosarcoma.
1. What is the main condition it must be differentiated from? (1 mark)
2. What is the best diagnostic test to reach a firm diagnosis? (1 mark)?
3. Assuming the diagnosis is confirmed to be low grade alimentary lymphosarcoma, what is the standard treatment & what is the prognosis for the cat? (2 marks)

Answer 57

1. What is the main condition it must be differentiated from? (1 mark)
   - Inflammatory bowel disease
2. What is the best diagnostic test to reach a firm diagnosis? (1 mark)?
   - Tissue biopsy of the affected intestine with histopathology
3. Assuming the diagnosis is confirmed to be low grade alimentary lymphosarcoma, what is the standard treatment & what is the prognosis for the cat? (2 marks)
   - Standard treatment is chemotherapy (chlorambucil) & prognosis is good for medium to longer term survival

Question 58

What is entropion and how do you treat it?

Answer 58

Entropion:
- Inward folding / turning of the eyelid > rubbing on the eye > ulcers
- Breed predispositions - Rottweilers, Labs, Sharpei’s, Cocker Spaniels
- Often entropion is missed because people stain the eye with fluorescein & then just say it’s got an ulcer (but the ulcer is actually being caused by entropion)

Treatment:
- Puppies <16 weeks - temporary tacking sutures & leave definitive surgical correction once dog is more mature
- Adults - Hotz-Celsus procedure (note taking too much can lead to ectropion so better to take too little than too much!)

Question 59

What is cherry eye and how do you correct it?

Answer 59

• Cherry eye is prolapse of the gland of the third eyelid (looks like a pink glob in the inner corner of eye)
• *Note - it is not prolapse of the third eyelid itself!

Treatment:
- Surgery with Morgan Pocket Technique

Question 60

Discuss Horner’s Syndrome & the 3 key features of it.

Answer 60

• Sympathetic denervation
• Not painful

Protrusion of the third eyelid with 3 key features…
- Miosis (pupillary constriction)
- Enophthalmos (abnormal displacement of eye caudally into orbit)
- Ptosis (drooping of the upper lid)

Causes:
- Often idiopathic
- Middle ear disease
- Soft tissue neck injuries
- Iatrogenic (caused by surgical procedures)

Treatment:
- Depends on cause but if not obvious can be ignored & will often improve spontaneously

Question 61

What is distichiasis - clinical signs, breed predispositions & treatment.

Answer 61

Distichiasis:
- Abnormally positioned cilia that emerge along the eyelid margin usually through the meibomian orifices
- The hairs fall into the eyes, if there’s only a few they don’t tend to cause issued but 10-20 on each lid > irritation

Clinical signs:
- Usually incidental
- Rarely cause ulceration, usually epiphora (watery eyes) & blepharospasm
- When distichiasis is the cause of ocular irritation they usually present at young age (<2 years old)

Breed predispositions:
- Very common in spaniel / bull terriers

Treatment:
- Usually specialist cryosurgery & surgical excision under magnification

Question 62

Discuss ectopic cilia.

Answer 62

• Ectopic cilia = abnormal hairs arising through the meibomian glands however they emerge THROUGH the palpebral conjunctiva
• Usually unilateral & often associated with distichiasis

Clinical signs:
- Always cause ulceration which is non-responsive to conservative treatment
- Almost always young dogs <2 years old
- If you get a young dog with an ulcer that’s not healing within ~5 days consider ectopic cilia!

Treatment:
- Surgical excision of the offending hair

Question 63

Discuss keratoconjunctivitis sicca - clinical signs, causes, diagnosis & treatment

Answer 63

Keratoconjunctivitis sicca = dry eye. Very common!

Clinical signs:
- Reduced aqueous tear production > conjunctivitis & superficial keratitis (neovascularisation, pigmentation, scarring)
- Mucopurulent ocular discharge (often yellow)
- Secondary corneal ulceration
- Clients often don’t take very seriously but is very painful & animals can go blind if not reated properly!

Causes:
- Autoimmune - the most common cause. Usually responsive to Cyclosporin (optimmune)
- Drug induced - systemic sulphonamides commonly cause KCS.
- Canine distemper & FHV1

Diagnosis:
- Low Schirmer Tear Test readings (<15mm per min)

Treatment:
- Cyclosporine BID (optimmune) or Tacrolimus (compounding pharmacy)
- Ocular lubricant QID (viscotears or lacrilube)
- Topical antibiotic (fusidic acid - conoptal)
- Repeat schirmer tear test after 4-6 weeks
- If improvement continue above medication for life
- If no improvement consider referral for a Parotid Duct Transposition

Question 64

Discuss corneal ulceration - diagnosis, causes, treatment.

Answer 64

Diagnosis:
- Close examination & fluorescein staining
- Note - very deep ulcers (to Descemets membrane) will not stain with fluorescein

Causes:
- Traumatic injury - clients will nearly always say trauma but this is rarely the cause
- KCS (dry eye) - low STT > ulcer is not resolving due to dry eye > put on Tacrolimus
- Entropion
- Distichiasis
- Ectopic cilia
- Foreign body

Treatment:
- First must identify the cause
- Some complicated ulcers require specific types of treatment - if it is not one of these then management depends on depth
- Superficial ulcers - topical AB (e.g. tricin TID) + NSAID (carprofen). Surgery not required initially. May require debridement and/or keratotomy / keratectomy
- Less than 1/3rd depth - topical AB (Ocuflox or Gentamicin) + NSAID +/- surgery (referral for conjunctival pedicle graft or corneoconjunctival transposition)
- Greater than 1/3rd depth - topical AB (Ocuflox or Gentamicin) + NSAID +/- surgery (referral for conjunctival pedicle graft or corneoconjunctival transposition)

Question 65

Discuss indolent ulcers - predispositions, treatment.

Answer 65

• Indolent ulcers are very common
• Epithelial loss only. Ulcer remains superficial & underrun but fails to heal due to abnormal re-epithelialisation

Predispositions:
- Middle aged & older dogs (>5 years)
- Boxers, Beagles, Corgis

Treatment:
Medical:
- Will often slough off itself - initially give AB’s & re-see in a week
Surgical:
- Debridement with cotton bud under local anaesthetic then grid keratotomy under sedation (using needle to gently create grid over ulcer)
- Corneal burr - rub the surface off. Only use in shallow ulcers. Be careful with pugs / frenchies as eyes prone to melting / rupture!
- Cats - debride under topical anaesthetic (DO NOT GRID)
- Referral centre- lamellar keratectomy (100% successful in dogs, 95% successful in cats)

Question 66

Discuss melting ulcers (liquefactive stromal necrosis).

Answer 66

• Not very common but requires rapid attention - always offer referral!
• Melting ulcer = INFECTED. Rapidly progressive ulcer due to release of proteases by bacteria. Risk of globe rupture
• They get very bad within 48-72 hours - so if you’re not sure if it is a melting ulcer give them a re-visit for the next day

Causes:
- Pseudomonas & staph most common

Predispositions:
- At risk breeds - pugs, shih-tzu’s, pekingese, persian cats

Treatment:
- Autologous serum - an spin down dogs own blood & use every hour for 24hrs
- Consider swabbing to check aetiological agent - but waiting 2 days for results is too long so in the meantime start topical AB’s
- Topical fluoroquinolone (e.g. Ocuflox) or topical Gentamicin
- Systemic AB’s + NSAIDs
- Consider referral for a surgical graft

Question 67

Discuss Feline Corneal Sequestrum.

Answer 67

• Feline Corneal Sequestrum = chronic non-healing shallow corneal ulcer > sequesturm (black dead material)
• At risk breeds - Persians, Burmese

Diagnosis:
- Fluorescein stain - will uptake with vascularisation on surface of cornea

Treatment:
- Only effective treatment is surgical (does not slough off or if it does it will return)
- Referral for lamellar keratectomy & possible conjunctival graft
- Correct any underling cause of chronic ulcer e.g. entropion

Question 68

Discuss (anterior) uveitis.

Answer 68

• Uveitis = inflammation of one or more structures relating to the uvea.
• Recognise early as painful & can lead to blindness if treatment is not instigated correctly & rapidly

Clinical signs:
- Usually acute in dogs - squinting & red
- Cats - owners will nearly always say “there’s been a colour change in my cats eye”
- VKH syndrome in artic breeds of dogs - uveitis is one component of this. An immune response to melanin.

Causes:
- Dogs mostly blunt trauma
- Cats mostly infectious (FIP, FIV, FeLV)

Treatment:
- Identify & treat underlying cause
- Since a large component of anterior uveitis (regardless of aetiology) is immune-mediated damage anti-inflammatory medication is always indicated!
- Topical corticosteroids - e.g. Pred Forte (prednisolone acetate) - has good intra-ocular penetration
- Topical corticosteroids Amacin & Maxidex - not nearly as suitable. Ointment so only goes on surface, not intra-ocular penetration.
- Check no corneal ulceration first! DO NOT USE STEROIDS IN EYES WITH ULCERS!
- Initially apply Pred Forte 6x daily until uveitis settles then gradually taper dose down
- If they have really bad uveitis with an ulcer put on systemic NSAIDs (Carprofen or Meloxicam) to redue inflammation whilst waiting for ulcer to resolve > then use steroids

Question 69

Discuss hyphaema - what it is, diagnosis, causes.

Answer 69

• Hyphaema = haemorrhage within the anterior chamber (unilateral or bilateral).
• Possible but not common in dogs
• Common in cats

Diagnosis:
- Examine both eyes & perform a retinal exam if possible
- Full general physical exam as cause is often systemic disease

Causes:
- Most common cause in cats = hypertension!
- Usually older cats with kidney issues & get spontaneous bleeding in their eye due to hypertension. May present with sudden onset blindness. Immediate treatment with Amlodipine (reduces BP) > can save eyes! If not treated immediately can > retinal detachment > blindness
- Hypertension not as common a cause in dogs but can be due to diabetes or Addison’s
- Secondary to intra-ocular disease - anterior uveitis, chronic glaucoma, intra-ocular neoplasia, collie eye anomaly
- Clotting disorders e.g. IMT, warfarin toxicity, clotting factor deficiencies, anaemia

Question 70

Discuss Glaucoma - clinical signs, diagnosis, causes & treatment.

Answer 70

• Glaucoma = high pressure inside the eye
• Rapidly progresses in dogs (compared to humans)

Diagnosis:
- Clinical exam important
- PLR, vision testing (menace & dazzle)
- Examine intra-ocular structures
- Tonometry to check pressure: normal intra-ocular pressure in dogs = 10-25mmHg, cats = 10-25mmHg

Signs of glaucoma:
- Dogs usually get primary (rapidly progressing) glaucoma > get a red-eye overnight (redder than just uveitis). Pupil will be fixed if pressure is very high, on menace dog can’t see & pupillary light reflex will be abnormal
- Common signs - acute blindness, ocular pain, initially unilateral but ultimately will affect both eyes, episcleral congestion (red eye), corneal oedema (steamy cornea), mydriasis (dilated pupil)
- Cats usually get progressing secondary glaucoma

Causes:
Inherited primary glaucoma:
- More common
- Cocker Spaniels, springer spaniels, basset hounds, huskies, golden retrievers
- Abnormal formation of the iridocorneal drainage angle - this is diagnosed by gonioscopy (a specialist procedure)
- Condition is bilateral - just a matter of time before second eye is affected
Secondary glaucoma:
- Primary lens luxation (common in terriers)
- Lens luxation secondary to hypermature cataract
- Chronic uveitis
- Intra-ocular neoplasia
- Iatrogenic (vitreous prolapse following lens extraction)

Treatment:
- Referral is best!
- Topical anti-glaucoma med - Dorzolamide (Trusopt) 4-6x daily.
- Timolol (topical beta antagonist which reduces aqueous humour)
- Analgesic (systemic Carprofen)
- Treat underlying cause if secondary glaucoma
- In many instances of primary glaucoma medical therapy is not sufficient to reduce IOP or to keep it low so surgery is needed
- Surgery to reduce aqueous production (laser cyclophotocoagulation or cyclocryotherapy - freezing of ciliary body)
- Many glaucoma cases progress to blindness & require salvage procedure = enucleation or cyclopharmacoablation (intra-ocular Gentamicin > retains the globe & permanently decreases IOP > blind but comfortable eye)

Question 71

Discuss lens luxation.

Answer 71

• The lens sits just behind the pupil - usually you can’t see it because it’s clear
• Lens luxation = lens has moved in front of the iris into the anterior chamber > usually blinding
• Lens luxation can lead to glaucoma

Diagnosis:
- To examine lens use Mydriacyl (E.g. Tropicamide) - 2 drops takes about 15 mins for effect > turn lights off > use Finhoff transluminator

Predispositions:
- Inherited disease of TERRIERS (especially Jack Russell Terriers)
- Older cats can get lens luxation

Clinical signs:
- History of acute onset ocular pain / redness (usually unilateral)
- Conjunctival / episcleral reddening
- Cloudy cornea (corneal oedema)
- If anterior lens luxation should be visible within the anterior chamber

Treatment:
- Surgical emergency - REFER asap!
- Early surgical intervention is vital since irreversible glaucoma will develop if lens is not removed
- Treatment is removal of entire lens within its capsule (intracapsular lentectomy)
- The dog becomes long-sighted following lens removal
- Cost is ~$2000 for 1 lens & $3000 for both

Question 72

Discuss retinal detachment.

Answer 72

• Causes sudden onset blindness
• The detached retina can be seen from a distance with a pen light
• Bilateral retinal detachment is more common in cats - due to hypertension (BP so high it pushes off retina!)

Causes:
- Systemic hypertension - most common in cats, usually due to chronic renal failure, sometimes hyperthyroidism > hyphaema or acute vision loss or both. Treat with Amlodipine (reduce BP) immediately
- Inherited retinal disease in dogs e.g. collie eye anomaly, retinal dysplasia
- Trauma - unlikely!
- Posterior uveitis
- Iatrogenic after lens or cataract surgery

Question 73

Discuss Progressive Retinal Atrophy (PRA).

Answer 73

• Most common of the canine inherited retinal disorders

Clinical signs:
- Middle aged dogs with gradual loss of vision as retina slowly dies off
- History of initial night blindness (nyctalopia) progressing to complete vision loss - very slow to progress
- Usually dilated pupils, poor PLR’s, poor obstacle negotiation but comfortable eyes

Diagnosis:
- Turn lights off, drop swabs or some object on the ground to get them to track it with their eyes

Question 74

What are some causes of sudden onset blindness?

Answer 74

Ocular causes:
- Retinal detachment - e.g. cats with systemic hypertension
- Glaucoma (not usually bilateral)
- Optic neuritis - idiopathic, infectious, lymphoma (not common)
- Acute retinal degeneration - Enrofloxacin toxicity in cats (do not exceed 5mg/kg SID)
- SARDS (sudden acquired retinal degeneration) in dogs

Central causes:
- Head trauma
- Cerebral hypoxia (e.g. hypoxic episode during anaesthesia in cats)
- Hepatic encephalopathy
- Raised intracranial pressure (hydrocephalus, intracranial mass)
- Meningitis
- Cortical brain tumour
- Systemic toxins e.g. lead poisoning

Question 75

Differentiate clinical signs between otitis externa, otitis media & otitis interna.

Answer 75

Otitis externa:
- Pruritus
- Pain
- Inflammation
- Head shaking
- Visible discharge
- Smell

Otitis media:
- Same as otitis externa PLUS: persistent, recurrent, hearing impairment

Otitis interna:
- Deafness
- Vestibular disease - head tilt, nystagmus, ataxia

Question 76

What is the pathogenesis & clinical signs of hyperadrenocorticism (Cushing’s disease)?

Answer 76

Pathogenesis:
- Spontaneous - excessive circulating cortisol due to ACTH-secreting pituitary tumour (85-90% dogs) or functional adrenal tumour (10-15% of dogs)
- Iatrogenic - administration of excessive exogenous glucocorticoid

Clinical signs:
Systemic signs (4P’s):
- Polyuria - cortisol inhibits action of ADH on the kidney
- Polydipsia (>100ml/kg/day) - compensatory due to polyuria
- Polyphagia - animal thinks it is starving
- Panting - anxiety? feeling hot?

Other signs:
- Abdominal enlargement (pot belly) - redistribution of fat, weakness of abdominal muscles
- Muscle atrophy (catabolic effects) - abdominal wall, head “pred head”, shoulders, thighs, pelvis
- Bacterial UTI’s - very common in Cushing’s dogs (10-15%)
- Pancreatitis - because they’re polyphagic & eat stupid things
- Diabetes mellitus - certain breeds are predisposed to both Cushing’s & Diabetes
- Hypertension / CHF - increased cortisol > fluid retention > high BP
- Myopathy - they get muscle loss & a form of muscle disease secondary to Cushing’s
- Poor coat / alopecia - effect of cortisol on hair follicle cycle
- Cutaneous atrophy / skin thinning - inhibition of epidermal proliferation & collagen production
- Poor wound healing / fragile skin - weakness of dermis / lack of collagen
- Easy bruising - weakness of blood vessel walls (collagen)
- Calcinosis cutis - calcium deposition in the skin

Question 77

Discuss diagnosis & treatment of hyperadrenocorticism (Cushing’s disease).

Answer 77

Diagnosis:
- Haematology - stress leukogram: leukocytosis, mature neutrophilia, eosinopenia, lymphopenia +/- monocytosis
- Biochem - increased ALP+++ (cortisol stimulates ALP release), increased ALT (vacuolar hepatopathy > increased leakage of ALT), hypercholesterolaemia, hyperglycaemia (not very often), decreased total T4, normal TSH
- Urinalysis - low USG (<1.010, isosthenuria or even hyposthenuria as not concentrating urine), evidence of UTI (bacteriuria, blood, protein, abnormal pH)
- ACTH stim test - Synacten IV 5ug/kg tested at 0 & 1hr
- Low dose dexamethasone suppression test
- Urine cortisol: creatinine ratio - 100% sensitive (normal / negative result = dog does not have HAC), less specific (elevated / positive result = dog could have HAC or stress of illness, emotional stress etc)
- Abdominal U/S
- CT & MRI

Treatment:
- Trilostane - 1mg/kg BID (works better BID than SID). Adverse effects are Addison’s signs = lethargy, decreased appetite, vomiting, diarrhoea
- Monitor with ACTH stim test - at 10-14 days, 30 days & every 90 days. Do test 4-6 hrs after Trilostane dose.

Question 78

Discuss Hypoadrenocorticism (Addison’s Disease) - pathogenesis & clinical signs.

Answer 78

Pathogenesis:
- The immune system destroys the adrenal gland
- It is a very serious illness but once diagnosed it can usually be treated / managed quite easily
- Most dogs with Addison’s will get both glucocorticoid deficiency & mineralocorticoid deficiency (i.e. all but the adrenal medulla which produces catecholamines has been destroyed)

Signs of glucocorticoid deficiency:
- Lethargy
- GI signs - vomiting, diarrhoea, abdominal pain, weight loss
- Hypoglycaemia

Mineralocorticoid (aldosterone) deficiency:
- The ones with mineralocorticoid deficiency get the sickest
- Weakness - from electrolyte abnormalities
- Hypovolaemia
- Hypotension
- Decreased cardiac output

Question 79

Discuss diagnosis & treatment / management of hypoadrenocorticism (Addison’s disease).

Answer 79

Diagnosis:
- CBC - results are essentially opposite to Cushing’s = anaemia (mild to moderate), neutropenia, eosinophilia, lymphocytosis, hypoglycaemia, hypercalcaemia, hypoalbuminaemia, azotaemia
- ACTH stim test - in Addison’s there’s nothing (i.e. no adrenal gland) to stimulate cortisol so cortisol will be low on both tests

Immediate management:
- Acute life-threatening condition (Addisonian crisis)
- Fluid therapy - normal saline, balanced electrolytes
- Insulin, glucose or calcium may be required for hyperckalaemia >8.0
- Correct acid-base imbalances
- Correct glucocorticoid deficiency - Dexamethasone

Long term management:
- Prenisolone (low maintenance dose)
- Fludrocortisone acetate (aldosterone analogue)
- Desoxycorticosterone Privalate (DOCP) = mineralocorticoid hormone

Question 80

Discuss hypothyroidism in dogs - pathogenesis, clinical signs, diagnosis & treatment.

Answer 80

Path:
- Hypothalamus stimulates pituitary gland > pituitary gland stimulates thyroid gland > thyroid gland produces thyroid hormona > decrease in TRH & TSH
- Majority of dogs that have hypothyroidism have lymphocytic thyroiditis (low thyroid function which doesn’t get better > need supplementation)

Drugs that suppress thyroid function:
- Potentiated sulphonamides e.g. trimethoprim sulpha
- Glucocorticoids (common!)
- Diazepam
- Aspirin
- Phenylbutazone
- Phenobarbital (common!)

Cx:
- Reduced activity, chronic lethargy
- Weight gain (thyroid hormone regulates metabolism)
- Heat seeking (reduced metabolism > they get cold)
- Bradycardia
- Mild anaemia
- “Tragic face”
- Non-pruritic bilaterally symmetrical alopecia - trunk, flanks, ventrum, bridge of nose, tail
- Dull dry hair coat, fading coat colour
- Seborrheoea = greasy / oily skin

Dx:
- History & physical exam
- Haematology - mild normocytic, normochromic non-regenerative anaemia
- Biochem - hypercholesterolaemia = hallmark of hypothyroidism (if they don’t have hypercholesterolaemia its unlikely hypothyroid)
- Thyroid function testing - low T4 (on it’s own is not diagnostic but with high cholesterol it is)

Treatment:
- Sodium-levothyroxine (T4) = Thyroxine 0.02mg/kg BID > then drop to SID if good response. If you start on a dose but not getting a good repsonse then increase dose. Conversely if dog is losing weight then decrease the dose. Adverse effects (rare) include: anxiety, panting, PU, PD, polyphagia, diarrhoea, tachycardia, heat intolerance
- Post-pill testing - blood sample 4-6 hrs after most recent dose of Thyroxicne to check T4 is within normal range

Question 81

Discuss hyperthyroidism in cats - clinical signs, diagnosis, treatment.

Answer 81

• Very common in cats!
• Generally a disease of geriatric cats (12+)

Cx:
- Weight loss & polyphagia
- PU/PD
- Hyperactivity & restlessness
- Vomiting & diarrhoea
- Tachycardia
- Unkempt coat
- Palpable thyroid mass (one or both)

Complications:
- Hypertrophic cardiomyopathy (increased BP > thickening of heart)
- Retinal detachment (systemic hypertension > retinal detachment)
- Chronic kidney disease - having high thyroid function will improve kidney function. Once you treat the thyroid disease all of a sudden the kidneys don’t work as well.

Dx:
- CBC: normal or stress leukogram
- Biochem: elevated ALT, ALP, AST, 25% have azotaemia (elevated urea + creat)
- Total T4 (TT4) - high levels of TT4 strongly suggests hyperthyroidism

Tx:
- Oral anti-thyroid drugs (e.g. Carbimazole or transdermal Methimazole). Used for long term management or short term controil prior to thyroidectomy or radioactive iodine therapy
- Surgical thyroidectomy - treat with anti-thyroid medication prior to surgery to stabilise the disease. Risk of hypocalcaemia from inadvertent parathyroidectomy causing hypoparathyroidism
- Radioactive iodine therapy - gold standard if cat is likely to live several more years then it is cost effective. Need to be otherwise well (no cardiac / renal failure etc.) so best for younger cats. Advantage over oral / transdermal drugs = one & done treatment. Don’t have to tablet BIT & then regularly check bloods.
- Iodine restricted diet e.g. Hills y/d. Decreasing T4 concentrations through limiting dietary iodine availability.

Question 82

Discuss diabetes mellitus - compare types I & II & insulin dependent diabetes & non-insulin dependent diabetes.

Answer 82

Type 1:
- Absolute insulin deficiency
- Immunological destruction of beta cells > failure to produce appropriate levels of insulin
- Mostly occurs in dogs

Type 2:
- Relative insulin deficiency
- Dysfunctional beta cells > insulin resistance
- Failure of the insulin that is produced to function properly

Insulin dependent diabetes:
- Require exogenous insulin permanently
- Most dogs, some cats

Non-insulin dependent diabetes:
- Cats can switch between the two states depending on DM progression
- Some cats only need insulin therapy temporarily

Question 83

Discuss diabetes mellitus in dogs - aetiology, signalment, clinical signs, diagnosis, complications

Answer 83

Aet:
- Irreversible B cell loss
- Lack of insulin results in - impaired glucose transport, impaired glycolysis, accelerated hepatic glycogenolysis, accelerated hepatic gluconeogenesis, increased proteolysis in skeletal muscle, increased lipolysis
- > hyperglycaemia from impaired cellular glucose utilisation & increased glucagon levels

Signalment:
- Most commonly between 4-14 years, peak 7-9 years
- Females more likely than males
- Australian terriers predisposed

Cx:
- PU, PD, polyphagia
- Weight loss
- *Note - there are not many disorders that make animals eat more but still lose weight (others include exocrine pancreatic insufficiency but EPI doesn’t have PU/PD)

Dx:
- Appropriate clinical signs
- Persistent fasting hyperglycaemia on blood test
- Glucosuria (glucose on urinalysis)
- +/- Ketones on urinalysis

Complications:
- Cataracts
- Lens induced uveitis
- Diabetic neuropathy
- Diabetic nephropathy
- Systemic hypertension

Question 84

Discuss the process of starting insulin therapy for diabetes mellitus.

Answer 84

Types of insulin:
- Short acting insulin = Actrapid. Stops working within 3-4hrs administration
- Intermediate acting = Caninsulin, Humulin
- Long acting = Glargine (Lantus) - standard for cats, lasts >12hrs

Deciding on insulin:
- Caninsulin (intermediate acting) = most common for dogs
- Glargine (Lantus) (long acting) = most common for cats

Insulin syringes:
- U40 = 40 units/mL - use for Caninsulin
- U100 = 100 units/mL - use for Glargine, Actrapid, Humulin
- Make sure to use the right syringe with the right insulin or you can accidentally overdose!

Protocol for starting insulin:
- Admit the patient to hospital for min 12hrs (fed at home as usual shortly before)
- Check baseline BG level
- Administer 0.25 U/kg of Caninsulin SC
- Check BG at 2, 4, 6, 8 & 10 hrs
- If there is no evidence of hypoglycaemia (BG of <4.4 mmol/L) during this time then patient can be sent home on that dose of insulin BID
- Alternatively can now use continuous glucose monitors at home to avoid the stress of hospital stay & continuous needle pricks

Diet:
- Feed BID 10-12hrs apart
- Give insulin 20-30 mins before eating to give it time to absorb (if you know the animal will definitely eat)
- If the animal can be fussy with food then give the insulin after eating so you know they’ve definitely eaten
- Feed high fibre, low carb, high protein diet e.g. Hills or RC diabetic food

Question 85

U-40 syringe should be used for which kind of insulin?
a) Humulin
b) Glargine
c) Actrapid
d) Caninsulin

Answer 85

d) Caninsulin

Question 86

Which of the following statements about the fructosamine level is incorrect?
a) Reflects the average blood glucose in the last 6-8 weeks
b) Is a glycosylated serum protein
c) Useful for monitoring a diabetic patient
d) Useful for an aggressive diabetic patient in which a serial blood glucose curve cannot be done

Answer 86

a) Reflects the average blood glucose in the last 6-8 weeks

Question 87

Which is not characteristic of a diabetic diet?
a) High Fibre
b) High protein
c) Low Fat
d) Low carbohydrates

Answer 87

c) Low Fat (might want low fat if they have pancreatitis too but it’s not important for diabetes management)

Question 88

Discuss important BG curve factors & define what the nadir is & what level it should be.

Answer 88

• Nadir = lowest blood glucose result during the day time period
• Ideally want blood glucose curve to be flat between 5.5 & 13.8 mmol/L
• The Nadir should be between 4.4 - 7.2 mmol/L

Dosing:
- If Nadir is >7.2 mmol/L increase insulin dose
- If Nadir is <4.4 mmol/L reduce insulin dose

Duration:
- Only assess duration when nadir is between 4.4 & 7.2 mmol/L
- If duration <8hrs then change to a longer acting insulin
- If duration >12hrs then change to a shorter acting insulin

Question 89

Discuss diabetes mellitus in cats - aetiology, diabetic remission, signalment, clinical signs, diagnosis, treatment.

Answer 89

Aet:
- Islet specific amyloid deposition
- Islet beta cell degeneration
- Feline pancreatitis

Diabetic remission:
- Most cats presenting with DM appear to be insulin dependent (type I) but are actually type II (non insulin dependent)
- If the glucose toxicity can be reversed quickly enough before the islets are permanently damaged then they become non-insulin dependent or a subclinical cat

Signalment:
- May occur at any age but mostly >9yr
- More common in neutered males
- Burmese predisposed

Cx:
- PU/PD, polyphagia
- Weight loss
- May present with diabetic neuropathy
- May present in DKA
- may exhibit plantigrade stance in both legs

Dx:
- Appropriate clinical signs
- Persistent fasting hyperglycaemia
- Glycosuria
- “Non-stressed” urine sample - won’t get glucose in the urine until the blood glucose has passed the renal threshold (won’t occur with stress hyperglycaemia)
- Serum fructosamine - tells us what glucose was doing at home over last week

Treatment:
- Glargine is recommended as first choice insulin for cats - long acting
- Diet - high protein, low carb. Timing of food doesn’t matter (tend to be grazers anyway)

Complications:
- Diabetic neuropathy
- Cataracts
- Uveitis
- Hypertension
- DKA

Question 90

Discuss Diabetic Ketoacidosis (DKA).

Answer 90

Path:
- Insulin deficiency > chronic inability to metabolise glucose > lipolysis & free fatty acid oxidation
- Promotes ketogenesis > excessive ketone production leads to signs of DKA
- Ketones contribute to osmotic diuresis > concurrent loss of electrolytes & water > profound dehydration, hypovolaemia, decreased perfusion of tissue
- Ketones stimulate the CTZ in the brain to induce vomiting
- Rapidly develop acidosis, dehydration & life threatening collapse

Cx:
- History of undiagnosed / unmanaged DM
- Severe dehydration
- Weakness
- Collapse
- Altered mentation (dull, lethargy)
- Tachypnoea
- Vomiting

Dx:
- Hyperglycaemia
- Glycosuria
- Metabolic acidosis
- Ketones - b-hydroxybutyrate in blood, acetoacetic acid in urine (most urine dipsticks won’t detect this)

Management:
- Correct dehydration - IV fluids with 0.9% NaCl, LRS or Plasmalyte 148
- Correct electrolyte imbalance - based on serum K+ or add 40mmol/L KCl. Do not exceed 0.5mmol/kg/h
- Correct acid-base imbalance - IVFT + insulin. Bicarb?
- Commence insulin therapy (give rapid acting insulin + then insulin CRI) - 4-6hrs after starting IVFT. Short acting insulin (Actrapid)
- Identify & treat concurrent disease - snap CPL & abdo U/S to test for pancreatitis, urine bacterial culture for UTI, abdo U/S to screen for cushing’s, peritonitis, pyelonephritis, neoplasia, intestinal foreign body

Question 91

Case study – Sam
- 7-year-old female neutered JRT
- Inappetence for 2 days
- Lethargy
- PU/ PD in the last 2 months
- Weight loss
- Physical exam:
- HR 200, RR 60, Temp 38.1C
- MM tacky, CRT=2 secs
- Reduced skin elasticity
- Dull, lethargic
- Cranial abdominal pain with abdominal distension

Q: What is your approach?
- Start IV fluids and full blood test
- Start IV fluids, full blood test and urinalysis, abdominal u/s
- Full blood test and urinalysis
- Full blood test and abdominal u/s

Which of the following tests should be done?
A. CBC
B. Biochemistry
C. Electrolytes
D. Blood gas analysis
E. Urinalysis
F. Fasting blood glucose
G. Blood ketones
H. Total T4
I. Resting cortisol level
J. Abdominal u/s

Answer 91

• Start IV fluids, full blood test and urinalysis, abdominal u/s

A. CBC
B. Biochemistry
C. Electrolytes
D. Blood gas analysis
E. Urinalysis
F. Fasting blood glucose
G. Blood ketones
J. Abdominal u/s

Question 92

What are 3 diagnostic serum tests for glomerular filtration rate?

Answer 92

Urea:
- Synthesised in liver from ammonia
- Excreted via glomerular filtration
- Passively reabsorbed in renal tubules
- Not a reliable of GFR because some is reabsorbed back into renal tubules + liver function & protein intake influence production of BUN

Creatinine:
- Formed at a constant rate from muscle breakdown
- Excreted via glomerular filtration
- Not reabsorbed in renal tubules
- Reliable marker of GFR
- Insensitive marker of early renal disease

SDMA:
- Not impacted by lean body mass (as is creatinine)
- Creatinine doesn’t increase until up to 75% loss of kidney function whereas SDMA increases with as little as 25% loss of kidney function

Question 93

Discuss the different cutoff values for USG (hyposthenuria, isosthenuria & hypersthenuria)

Answer 93

• Hyposthenuria = USG <1.008 (dilute)
• Isosthenuria = USG 1.008-1.012
• Hypersthenuria = USG >1.012
• Concentrated = USG >1.030 (dog), USG >1.035 (cat)

Question 94

Define polydipsia & polyuria.

Answer 94

Polydipsia = water intake >80-100ml/kg/day

Polyuria = urine production >40-50ml/kg/day

Question 95

Discuss the likely diagnosis associated with each of the following key historical findings (urinary system).
- Intact bitch in season 3-6 weeks prior
- Male cat that has undergone removal of a urethral obstruction
- History of corticosteroid or diuretic drug administration
- PD/PU with increased appetite & weight loss
- PD/PU with increased appetite & weight gain
- PD/PU with decreased appetite & weight loss
- Basenji dog breed
- Generalised lymphadenopathy
- Perineal mass
- Vaginal discharge
- Cataracts
- Symmetrical alopecia on the trunk, pendulous abdomen & hepatomegaly
- Thyroid nodule
- Small irregular kidneys
- Retinal oedema, detachment, haemorrhage or vascular tortuosity
- Ascites or subcutaneous oedema

Answer 95

• Intact bitch in season 3-6 weeks prior = suggests possible pyometra
• Male cat that has undergone removal of a urethral obstruction = suggests post-obstructive diuresis
• History of corticosteroid or diuretic drug administration = suggests iatrogenic hyperadrenocorticism
• PD/PU with increased appetite & weight loss = suggests diabetes mellitus or hyperthyroidism
• PD/PU with increased appetite & weight gain = suggests hyperadrenocorticism (cushings)
• PD/PU with decreased appetite & weight loss = suggests renal structural disease or extra-renal conditions such as neoplasia
• Basenji dog breed = suggests Fanoni syndrome in Basenji dogs
• Generalised lymphadenopathy = suggests lymphoma with hypercalcaemia
• Perineal mass = suggests anal sac adenocarcinoma with hypercalcaemia
• Vaginal discharge = suggests pyometra
• Cataracts = suggests diabetes mellitus
• Symmetrical alopecia on the trunk, pendulous abdomen & hepatomegaly = suggests hyperadrenocorticism (cushings)
• Thyroid nodule (suggests hyperthyroidism)
• Small irregular kidneys = suggests chronic kidney disease
• Retinal oedema, detachment, haemorrhage or vascular tortuosity = suggests hypertension secondary to renal disease
• Ascites or subcutaneous oedema = suggests hypoproteinaemia & possibly Fanconi syndrome

Question 96

Differentiate between pre-renal, renal & post-renal azotaemia.

Answer 96

Pre-renal:
- Will get azotaemia (increased BUN + creat) but urine is still concentrated i.e. >1.030 in dogs or >1.035 in cats
- Caused by reduced renal perfusion (hypovolaemia, cardiac failure, severe dehydration, hypotension) - if blood is not flowing adequately through the kidneys then urea, creat & other waste products cannot be filtered adequately
- Large meat meal - urea production & excretion increase after a high protein meal
- Gi bleeding - blood can be considered a high protein meal so also increases urea production
- Hyponatraemia - water follows sodium so if sodium is low then total body water & blood volume is low > reduced renal perfusion > azotaemia
- Hypercalcaemia - causes constriction of the afferent arteriole in the glomerulus > decreases renal perfusion > azotaemia

Renal:
- <25% normal no. of functional nephrons
- The ability to concentrate urine is lost once >66% of the nephron population has become non-functional. The ability to eliminate nitrogenous waste products (urea + creat) is lost once >75% of the nephron population has become non-functional
- Will have azotaemia & isosthenuric or minimally concentrated urine
- Causes of acute renal failure: ischaemia, toxins (e.g. grapes, lillies)
- Causes of chronic renal disease: immune disorders, amyloidosis, neoplasia, ischaemia, toxins, inflammation / infection, hereditary / congenital, blocked urine outflow, idiopathic

Post renal:
- Occurs when there is a problem with urine excretion after the kidneys
- Animals with post renal azotaemia will likely have other blood parameters which are abnormal e.g. high K+ levels
- Causes: obstruction to urine flow (e.g. blocked male cat), rupture of excretory pathway (kidney, ureters, bladder) with urine accumulation in the body of the patient (uroperitoneum)

Question 97

Define pollakiuria, dysuria & stranguria.

Answer 97

• Pollakiuria = urinating small volumes frequently
• Dysuria = difficulty urinating associated with straining
• Stranguria = straining to urinate
• These disorders often occur together & indicate disease affecting the urinary bladder, urethra or both (lower urinary tract)

Question 98

What is the most common type of neoplasia in the lower urinary tract?

Answer 98

Transitional cell carcinoma

Question 99

What is the ideal method of urine collection for urine C & S?
- Free catch
- Cystocentesis
- Urinary catheterisation
- Manual palpation & expression

Answer 99

• Cystocentesis

Question 100

For which of the following patients would you perform an SDMA test?
- 3-year-old female German Shepherd dog with suspected UTI
- 12-year-old female neutered Maltese diagnosed with chronic kidney disease stage III
- 9-year-old male neutered JRT with polydipsia with normal creatinine on blood test
- 7-year female neutered Labrador with urinary incontinence

Answer 100

• 9-year-old male neutered JRT with polydipsia with normal creatinine on blood test

Question 101

List 5 endocrine diseases that cause PU/PD.

Answer 101

• Hyperadrenocorticism (Cushing’s)
• Hypoadrenocorticism (Addison’s)
• Diabetes mellitus
• Hyperthyroidism
• Primary hyperparathyroidism

Question 102

Discuss Urinary Tract Infections - common pathogens, diagnosis, treatment.

Answer 102

Common pathogens (from most to least common):
- E. Coli
- Staph spp
- Proteus spp
- Klebsiella spp
- Enterococcus spp
- Strep spp
- *They all ascend to the bladder via the urethra

Aet:
- Host factors that prevent infection: normal voiding, urinary tract structure, antibacterial properties of urine & prostatic secretions, colonisation of genetalia by non-pathogenic organisms, functional immune system

Uncomplicated UTI’s:
- Occur in the absence of abnormalities of host factors that normally inhibit infection
- Perform urine C & S
- Empiric AB selection - Trimethoprim sulfa & Amoxicillin
- Clinical signs & complete urinalysis improve within 48hr
- If signs don’t improve or they do initially but then it re-occurs don’t just put the animal back on the same AB’s at different dose, must do C & S!
- Repeat urine culture 5-7 days after finishing AB’s

Complicated UTI’s:
- Recurrent UTI’s or UTI’s in a young animal that shouldn’t be getting them
- Always perform urine C & S - work out if the animal has been getting the correct AB’s & has the owner been giving the right dose?
- Attempt to identify & eliminate underlying conditions e.g. disorders or micturition, mechanical / chemical damage to urothelium & mucosal barrier, altered urine composition, defective host defences

Question 103

Discuss urolithiasis.

Answer 103

• Urolithiasis = presence of stones anywhere in the urinary tract (most commonly bladder or urethra)
• 2 most common types = struvite & calcium oxalate (seen 50/50)
• Other less common types = urate (dalmatians predisposed), crystine & silicate
• Cx: stranguria, dysuria, pollakiuria, haematuria or obstruction
• Uroliths will appear when conditions are ‘right’ - pH, USG, diet, pre-existing UTI & breed

Treatment:
- Relieve urethral obstruction if present
- Remove stones surgically
- Dissolve stones with appropriate diet - note only struvite, won’t work for calcium oxalate (but can use diet to prevent recurrence of calcium oxalate). E.g. Hills s/d, Hills c/d, RC urinary s/o
- Treat UTI if present (C & S)
- Monitor urine pH & USG

Question 104

Discuss Feline Lower Urinary Tract Disease (FLUTD).

Answer 104

• Collection of conditions with lower urinary tract signs +/- inappropriate urination
• Common causes: idiopathic (>50%), uroliths, urethral plugs, anatomic defect, behaviour disorder, infection, trauma, neoplasia

Aet:
- Resembles human interstitial cystitis = sterile urine, increased bladder wall vascularity & fragility, increased sensory innervation & mast cell numbers, decreased mucosal production of glycoasminoglycans
- Contributing factors = decreased urine volume & frequency of micturition due to decreased water intake and/or dirty / unavailable litter tray, decreased physical activity, stress
- More common in young to middle aged cats

Diagnosis:
- History of: haematuria, dysuria / stranguria, pollakiuria, inappropriate urination
- Bladder palpation - usually small, may show discomfort on palpation
- CBC & biochem = normal
- Urinalysis - increased RBC’s, proteinuria, crystalluria?, usually concentrated, pH variable
- Plain & contrast radiographs or U/S to check for stones, tumour or other underlying cause
- Urine C & S to check for UTI
- Cystoscopy?

Treatment:
- 95% of young cats have sterile urine & clinical signs will resolve spontaneously in many cats within 5-7 days
- No controlled studies have demonstrated efficacy for any drug
- Analgesia (oral buprenorphine or NSAIDs)
- Increase water intake (e.g. tinned food, water fountain)
- Decrease stress – e.g. clean litter box, environmental enrichment & perhaps pheromone therapy (Feliway, CEVA Animal Health)
-Weight loss if obese

Question 105

Discuss urethral obstruction (blockage) in male cats.

Answer 105

Aet:
- Typically male cats
- Causes - urolithiasis, urethral plugs

Cx:
- Stranguria, dysuria, haematuria
- Appears uncomfortable & restless
- Vocalises during urination or licks the penis
- Lethargy, depression, then comatose, shock in late stages
- Enlarged, firm to hard painful bladder on palpation
- Bradycardia may be present in hyperkalaemic patients

Dx:
- Increased urea + creat (post-renal azotaemia)
- Hyperkalaemia
- +/- Severe metabolic acidosis
- Urinalysis (careful cystocentesis) > haematuria

Treatment:
Before unblocking…
- Stabilise the cat – IV fluid therapy
- Analgesia – methadone / buprenorphine IV
- Hyperkalaemia - IV fluid, IV glucose, IV insulin
- Calcium gluconate - cardioprotective?
- Acidosis - bicarbonate?
Unblocking…
- Heavy sedation or anaesthesia
- Clip & prep genitals
- Use open ended tom cat catheter, lubricated, gently insert into the penis until you hit the obstruction
- Attempt to flush the obstruction into the bladder using sterile saline
- Cystocentesis may be needed to relive bladder distension if severe
- Once obstruction dislodged, insert the catheter into the bladder to allow it to decompress & collect a urine sample
- Flush the bladder & suture the urinary catheter in place (make sure animal is wearing an E-collar so they can’t remove it themselves)

Hospital plan:
- Closed collection system with indwelling urinary catheters
- Correct water & electrolyte imbalances with fluid therapy
- Monitor urea & creatinine (post-renal azotaemia)
- Monitor urine output (post-obstructive diuresis)
- Hypokalameia
- Urinary catheter removed after 24 hours & cat should be observed in hospital for urination for another 12-24 hours

Question 106

Discuss Chronic Kidney Disease (CKD) & Renal Failure - clinical signs, diagnosis, staging & treatment.

Answer 106

• CKD may progress to renal failure when compensatory mechanisms cannot maintain normal renal function
• A diagnosis of CKD can be made when abnormalities associated with CRF have been present for >3 months

Cx:
- Slow onset PU/PD
- Anorexia, vomiting, diarrhoea & weight loss
- Dehydration
- Poor body condition & dull dry haircoat
- Pale MM (non-regenerative anaemia)
- Small irregular kidneys

Diagnosis:
- Urinalysis - USG 1.008-1.012 isosthenuric (but if the animal is dehydrated & you get isosthenuric urine you know something is wrong with the kidneys as should be concentrated if dehydrated). Proteinuria +/- Pyuria or bacteriuria
- Haematology - non-regen anaemia (may be masked by dehydration), mature neutrophilia & lymphopenia (stress leukogram)
- Biochem - azotaemia, elevated SDMA, hyperphosphataemia, hypokalaemia, normal to low calcium

Staging:
- IRIS staging
- Chronic kidney disease is staged according to serum creatinine & SDMA concentrations in the hydrated patient
- Purpose to provide treatment & monitoring recommendations

Treatment:
- Provision of a commercial ‘renal’ diet (decreased protein, phosphorus & sodium & supplemented with omega-3 fatty acids)
- May need to add enteric phosphate binders
- Metoclopramide, H2 blockers, gastrostomy or oesophagostomy tubes
- Systemic hypertension, use ACE inhibitors +/- amlodipine
- For proteinuria, use ACE inhibitors such as benazepril / enalapril or angiotensin receptor blocker such as telmisartan
- Intermittent supplementary fluid therapy

Question 107

Which of the following will not cause acute renal failure?
- Grapes
- Lilies
- Ethylene Glycol
- Gentamycin
- Ibuprofen
- Vit D toxicity
- Rodenticide
- Snail bait

Answer 107

• Rodenticide
• Snail bait

Question 108

What parameters do you measure whe staging (including substaging) a patient with CKD?
- Urea, creatinine, SDMA
- Urea, creatinine, blood pressure
- Creatinine, blood pressure, urine protein creatinine ratio (UPC) – can also include SDMA
- Creatinine, blood pressure, urine cortisol creatinine ratio (UCCR)

Answer 108

• Creatinine, blood pressure, urine protein creatinine ratio (UPC) – can also include SDMA

Question 109

What are the main components of struvite crystals?
- Magnesium, ammonium, phosphate
- Magnesium, aluminium, phosphate
- Calcium, ammonium, phosphate
- Calcium, magnesium, phosphate

Answer 109

• Magnesium, ammonium, phosphate

Question 110

Discuss ectopic ureter in a puppy.

Answer 110

• Ectopic ureter = congenital abnormal exiting of the ureter
• Intramural (most common in dogs) = ureter enters trigone region but fails to open at mucosal surface of bladder > continues to run within bladder wall to its exit point
• Extramural (most common in cats) = ureter runs completely separate to bladder wall then enters caudal bladder or urethra

Cx:
- Urinary incontinence as urine isn’t stored & goes directly to ureter > leaking, recurrent UTI

Affects:
- Congenital - high incidence in female Labs / Golden Retrievers

Dx:
- Excretory urogram via rads or CT +/- cystoscopy - most have hydroureter

Treatment:
- Intramural - side to side neoureterocystostomy or laser ablation
- Extramural - end to side neoureterocystostomy (reimplantation)
- Nephrectomy - if kidney is non-functional (usually severe hydronephrosis)

Question 111

What is erythema & what are some possible causes?

Answer 111

• Erythema = red skin
• Due vasodilation of blood vessels & inflamed skin
• Dermatitis = inflammation of skin, hence erythema & dermatitis can usually be used interchangeably

Possible causes:
- Parasites
- Infections
- Allergies
- Environmental insults e.g. sunburn

Question 112

Differentiate between a rash & dermatitis.

Answer 112

Rash = blotchy / spotty redness with normal skin in between
Dermatitis = red all over

Question 113

Differentiate between a papule and a pustule.

Answer 113

Papule = a red spot up to half a centimetre in diameter.
Pustule = a red spot but with a pus-filled centre (neutrophils > micro-abscessation)

Question 114

Differentiate between hyperpigmentation & hypopigmentation.

Answer 114

Hyperpigmentation:
- Skin that should be white or pink but goes balck
- Due to increased melanin in epidermis
- Occurs commonly in dogs, very rarely in cats
- Causes: post-inflammatory (chronic) is the most common cause, endocrine (cushing’s)

Hypopigmentation:
- Skin or hair that should be black or dark but goes white
- Due to decreased melanin
- Much less common than hyperpigmentation
- Causes: congenital / hereditary (e.g. albinos), vitiligo (acquired skin disease where pigment is lost), immune-mediated (e.g. lupus), environmental injury (e.g. freeze branding > patch of white skin / hair)

Question 115

Differentiate between scaling & crust.

Answer 115

Scaling (called dandruff in humans):
- Grossly visible corneocytes
- Abnormality of cornification
- Comes off & sticks to the hair

Crust:
- Mixture of stratum corneum cells (e.g. neutrophils) & tissue fluid
- Crust is attached to the skin surface unlike scaling
- Causes: pustular diseases, draining exudates, healing wounds

Question 116

What are comedones & what causes them?

Answer 116

• Comedones are also known as blackheads
• Caused by an accumulation of keratin in the hair follice
• Abnormality of follicular cornification in the follicle, not on skin surface
• Causes: Demodex (mites > excessive scale production in follicle), hormonal skin diseases (e.g. hypothyroidism / cushings > hair loss from loss of hair cycle > plugging of hair follicle with this black material)

Question 117

Discuss how to work up a skin condition / case.

Answer 117

Taking a history:
- Questionnaire to be filled out prior to appointment

Physical exam:
- Examine skin using - vision, touch, smell (e.g. odour from skin or ears)
- Examine animal from a distance - scratching, swellings, obvious hair loss
- Look for skin lesions (abnormality in the skin) - visually assess skin, palpate
- Determine distribution (where the lesions are) - look all over
- Check for parasites

Assessment:
- Based on the data you have from the history & physical exam tell us what you think is going on (i.e. what’s the predominant problem & what are the differential diagnoses)

Plan:
- Diagnostic plan > leads to treatment plan

Diagnostic tests:
- Tests to find microscopic parasites - hair plucks, skin scrapings
- Tests to find bacteria & yeast - cytology, culture
- Tests to find dermatophytes (ringworm) - woods lamp, cytology, hair plucks, culture
- Tests to investigate allergies - skin testing, IgE blood testing
- Tests to investigate alopecia - hair plucks, blood tests, hormone tests, biopsy
- Tests to investigate nodules, masses & swellings - FNA, biopsy

Treatment:
- Should be specific if possible - i.e. kill a parasite or treat an infection
- Sometimes is non-specific i.e. treating itch
- Antiparasitics
- Antibiotics
- Antifungals
- Glucocorticoids (steroids)
- Anti-allergic drugs
- Topical therapy

Question 118

List some aetiologies / differential diagnoses for pruritus.

Answer 118

Ectoparasites:
- Fleas - most commonly affect body
- Lice - most commonly affect body
- Sarcoptes - affects ears & sometimes paws
- Demodex - affects the paws. Can lead to pruritus but a lot of dogs that have demodicosis don’t have itching. More likely causes loss of hair (follicular disease)
- Otodectes - affects the ears - unlikely in adults, common in young animals
- Trombicula - small orange dots in between toes & on ears. Seasonal. More likely in rural areas.
- Ticks
- Insect bites - tend to bite animals around face / ears

Infections:
- Staphylococcal pyoderma - commonly affects paws & ears
- Malasezzia overgrowth - commonly affects paws & ears

Allergies:
- Atopic dermatitis
- Food allergy
- Contact dermatitis - usually causes rash on stomach

Miscellaneous:
- Otitis
- Acute moist dermatitis
- Acral lick dermatitis
- Anal sac problem
- Grass seeds

Question 119

Case Study
- 12month-old Jack Russell Terrier
- Has recently developed pruritus of the paws & ears
- The affected areas are erythematous on physical exam

What would be the most appropriate approach in this case?
- A trial course of prednisolone to see if the condition is steroid responsive
- Examination of hair plucks and tape strips to rule out ectoparasites and infections
- Skin biopsies to determine if the condition is allergic in nature (won’t tell you anything, waste of time & money)
- A haematology and biochemistry profile to check for a systemic cause (won’t tell you anything, waste of time & money)

Answer 119

• Examination of hair plucks and tape strips to rule out ectoparasites and infections

Question 120

Case Study – Barney
- 2-year-old male neutered West Highland White Terrier
- History: severe pruritus over dorsum for 2 months duration

What is the most likely diagnosis?
- Staph folliculitis
- Sarcoptic mange
- Atopic dermatitis
- Flea allergy dermatitis
- Demodicosis
- Malassezia dermatitis
- Hypothyroidism

Answer 120

• Flea allergy dermatitis - this particular location is characteristic of flea allergy dermatitis

Question 121

How do you differentiate between sarcoptic mange & allergy? How do you diagnose sarcoptic mange?

Answer 121

• Lesions on medial pinna of ear = allergy dog
• Lesions on outside of pinna = sarcoptic mange
• Lesions at proximal end of the limb (around elbow, hock, stifle) rather than distal end = sarcoptic mange

Diagnosis:
- By skin scraping (only ~50% of cases are able to be diagnosed by skin scraping, easily missed!)

Question 122

How to treat parasites as a cause of pruritus?

Answer 122

Isoxazolines (deal with all parasites - use to rule out parasites as a cause):
- Afoxolaner (e.g. Nexgard by Merial)
- Fluralaner (e.g. Bravecto by MSD)
- Sarolaner (e.g. Simparica by Zoetis)
- Lotilaner (e.g. Credelio by Elanco)

Others:
- Spinosad (e.g. Comfortis by Elanco)
- Fipronil (e.g. Frontline by Merial)
- Imidocloprid (e.g. Advantage or Advocate by Bayer)
- Moxidectin (e.g. Advocate by Bayer)
- Selamectin (e.g. Revolution by Zoetis)
- Indoxacarb (e.g. Activyl by MSD)

Question 123

Discuss Staphylococcal Pyoderma - an infectious cause of pruritus.

Answer 123

Path:
- Diverse range of bacteria that inhabit the skin (including Staph)
- Something causes dysbiosis of the skin (e.g. allergic or genetic predisposition to poor skin defence mechanism) > inflammation of the skin > suddenly the Staph are overgrown > if you get enough of them > lesion (papule or pustule)

Cx:
- Papules +/- pustules, epidermal collarettes (characteristic “Staph rings”), scaling
- You will see lesions with a Staph infection, not just red skin!

Treatment:
- Try to avoid using antibiotics where possible (go to treatment in the past was Cephalexin)
- Try to use topical treatments
- Need to address underlying allergy
o Apoquel – if a dog is on Apoquel for allergy it will stop the dysbiosis > Staph overgrowth
- Need to treat the inflammation – bacteria thrive on the inflammation > overgrowth so need to stop this

Question 124

Discuss Malasezzia dermatitis - an infectious cause of pruritus.

Answer 124

Path:
- Malasezzia pachydermatitis = budding yeast
- Oval, russian doll, peanut or snowman shaped.
- Malasezzia is still caused by a dysbiosis
- Can be secondary to allergy but usually Malasezzia is primary cause

Cx:
- Causes erythema, greasy skin, yellow scale, yeasty smell, hyperpigmentation, lichenification
- Tends to affect moist areas - ears, in between toes, armpits, under neck
- Basset Hounds predisposed

Treatment:
- Apoquel doesn’t work well for yeast dermatitis!
- Generally try to avoid systemic treatment
- Topical treatment - Itraconazole, ketoconazole (no longer available)
- Best treatment = Miconazole / Chlorhexidine shampoo e.g. Malaseb

Question 125

Discuss atopic dermatitis - an allergic cause of pruritus.

Answer 125

Atopic dermatitis = a genetically predisposed inflammatory & pruritic allergic skin disease with characteristic clinical features, associated most commonly with IgE antibodies to environmental allergens.

Path:
- Sensitised T cells go back into the skin & produce cytokines which trigger the ongoing inflammation > trigger the nerves > sensation of itch (IL-31 cytokine = mediator of itch)

Cx:
- Erythema on the ears, interdigital skin, muzzle, ventrum / abdomen
- Porphyrin staining on paws = what people think is saliva staining

Dx:
- Skin biopsies don’t tell you anything useful (just tells you it has red & inflamed skin)
- History
- Clinical signs
- Rule out other causes of pruritus (e.g. parasites, infections)
- Allergy testing – skin test: Inject allergen into dermis > Allergen binds to IgE on mast cell > Mast cell degranulates releasing inflammatory mediators > Vasodilation, erythema, wheal formation
- Allergy testing – IgE serology results = Preferred option in cats

Treatment:
- If severe initially use a course of steroids to get inflammation under control
- Transition to Apoquel (Oclacitinib = medium anti-inflammatory action) or Cytopoint (Lokivetmab = doesn’t provide much anti-inflammatory action) in the last week of the steroids (once inflammation has reduced)

Question 126

How do Apoquel (Oclacitinib) & Cytopoint (Lokivetmab) work?

Answer 126

• Apoquel (Oclacitinib) = janase kinase inhibitor > stops signal from being passed into cell > cell isn’t activated
• Cytopoint (Lokivetmab) = binds to IL-31 before it gets to the receptor

Question 127

Discuss food allergy - an allergic cause of pruritus.

Answer 127

Clinical features:
- Same as atopic dermatitis (erythema on ears, interdigital skin, muzzle, ventrum, porphyrin staining on paws) but may also be GI signs

Dx:
- Laboratory tests – unreliable
- Diet trials:
o Commercial diets
 Hydrolysed diets – e.g. Anallergenic (Royal Canin), Z/d (Hills)
 Anallergenic (RC) is preferrable over Z/d (Z/d can produce allergic response in a handful of dogs despite the fact it’s hydrolysed chicken)
o Allergy diets – e.g. skintopic (RC) or derm complete (Hills)
 Not nearly as effective as commercial diets but can have some benefits
o Home cooked diets
- May need to be 6-8 weeks long
- Challenge with original food at end
- Peter’s method of food trial: have the dog on medication for the first few weeks of the trial & then stop the medication. If the allergy returns it is likely related to the food.

Question 128

Discuss acute moist dermatitis.

Answer 128

Cx:
- Hot spots, pyotraumatic dermatitis, acute exudative dermatitis, wet eczema
- Highly pruritic, well circumscribed, red, exudative erosion surrounded by matted fur, caused by self-trauma

Possible causes:
- Flea allergy
- Anal sacculitis
- Otitis externa
- Atopic dermatitis
- Food allergy
- Staphylococcal pyoderma
- Spontaneous
- *Most commonly in dogs with allergies that are uncontrolled > dogs starts biting itself

Treatment:
- Topical steroid cream with an anti-biotic in it
o Main goal is to break the itch > scratch cycle
- Avoid using systemic antibiotics

Question 129

Discuss acral lick dermatitis.

Answer 129

• Dogs that lick their extremities “acral” (i.e. distal limbs) > granulomas
• Well circumscribed ulcerated plaque caused by self-trauma

Possible causes:
- Is there underlying skin disease causing the dog to lick? - Staphylococcal pyoderma, demodicosis, fungal infection, trauma, foreign bodies, atopic dermatitis, food allergy, neoplasia
- Is there underlying musculoskeletal disease? Joint disease, nerve dysfunction / pain
- Is it simply a behavioural issue? Boredom, separation anxiety, obsessive compulsive disorder

Treatment:
- Apoquel & Cytopoint typically don’t work
- Need a physical barrier e.g. bandage, E-collar
- Use steroids initially to get the inflammation down
- Might need to look into some behavioural training – is very difficult to get dogs to stop licking!

Question 130

Discuss pruritic skin diseases in cats & how to treat it.

Answer 130

Miliary dermatitis:
- Associated with fleas
- Not very common anymore due to widespread use of anti-parasitics
- Clinical signs - Crusted papules, most commonly over the dorsal back & around the neck

Feline symmetrical alopecia:
- Alopecia due to the cat overgrooming
- Question as to whether it’s a dermatological issue, behavioural issue or both
- Can be seasonal due to allergy
- Most common site = ventral abdomen (can then spread up their sides & down their legs)
- Under microscope – the ends of the hairs have been barbered / chewed off
- These cats may be more prone to hairballs as they are ingesting so much hair

Eosinophilic granuloma complex:
- Infiltration of eosinophils into the skin > lesions
- Typically associated with allergic skin disease in cats (atopic dermatitis, food allergy, flea allergy)
- Most common site = upper lip next to canine teeth (indolent ulcer)
- Eosinophilic plaques in sites where the cat can lick e.g. axilla, caudal thigh
- Cats contain a very allergenic protein in their saliva (Fel d1)

Head or neck pruritus:
- Cats scratching themselves around the head / neck with their back claws
- Approach the same as a dog with an itchy skin condition
- Diagnosis:
o Rule out parasites (fleas)
o Check for any evidence of infection (neutrophils, cocci, malasezzia etc. on cytology)
o Rule out ringworm
o Consider this an allergic skin condition – diet trial, consider allergy testing

Treatment:
- Can’t use Cytopoint in cats (it is a canine antibody – will have no effect)
- Use of Apoquel in cats is only off-label (tend not to use it unless we really have to)
- Can use Cyclosporin in cats
- Can use immunotherapy in cats
- Can use Prednisolone in cats – you have to double the dose you would use in dogs (otherwise it won’t work)

Question 131

Compare Folliculitis & furunculosis.

Answer 131

FOLLICULITIS:
- Can progress into furunculosis
- Superficial infection confined to hair follicle
- Small papule or pustule
- No bleeding
- No scarring
- Typically associated with Staph infection

FURUNCULOSIS:
- Typically associated with Staph infection
- Deep infection
- Hair follicle ruptured
- Swelling or nodule potentially with some exudate / crusts
- When you squeeze the skin you express exudate up to the surface (looks like blood but an impression smear would reveal predominantly neutrophils & macrophages = pus)
- O’s might describe as the skin is bleeding
- Much more common in short haired breeds e.g. English Bull Terriers, Dogue de Bordeaux’s PLUS GSD’s (immune related)
- Treatment: if put on AB’s will initially improve but then not resolve completely. Need sterois as well to combat intense inflammatory reaction

Question 132

Discuss juvenile cellulitis (sterile pyogranulomatous dermatitis)

Answer 132

• Diffuse infection beneath the skin’s surface
• Primarily occurs in young puppies around the age of first vaccination (8-16 weeks)
• Can affect multiple puppies in a litter
• It is a pyogranulomatous inflammation (combination of macrophages + neutrophils). It is not caused by bacteria (so called sterile).
• Can also be called sterile pyogranulomatous dermatitis
• Can make the animal systemically unwell
• Clinical signs:
  o Lethargic, anorexic, pyrexic, swelling of the face around the muzzle & eyes, purulent otitis, enlarged submandibular lymph nodes +/- swelling of other areas (paws, prepuce)
• Diagnosis:
  o Characteristic clinical signs
  o Can appear like a bacterial infection but if you do cytology on the pus there will be hardly any bacteria in it
  o Rule out demodicosis – hair pluck, skin scraping, impression smear from pus
• Treatment:
  o Gets better with steroids – but can get permanent scarring

Question 133

Discuss perianal fistulae (old term = anal furunculosis).

Answer 133

• Pretty much exclusive to German Shepherds – it is related to immune system
  o Whenever you examine a GSD examine the anus area for this condition!
• Involves the development of fistulae (tract) around the anus
• It is immune-mediated (lymphocytic)
• A lot of them seem to cope very well with the condition not appearing to be in pain
• Severe cases can look as though the anus is almost free-floating / eroding away
• Treatment:
  o Responds to immunosuppressive therapy, not anti-bacterial therapy
  o Treatment of choice = Cyclosporin
  o Start off on Cyclosporin first & then transition to Tacrolimus (topical cream) either on its own or in conjunction with Cyclosporin
  o It is costly to treat

Question 134

Discuss intertrigo (skin fold dermatitis).

Answer 134

• Often breed specific
  o E.g. Pugs, French bulldogs will often get it in the skin fold on their face
  o E.g. Cocker Spaniels will often get it in the loose gum on the outside of their mouth
  o E.g. Bulldogs in the tail fold
  o E.g. Sharpei – skin folds anywhere
• Can occur around the vulva
• Treatment:
  o Conservative option = keep them clean & dry. Wash them with Chlorhex, apply a barrier cream e.g. nappy rash
  o Curative option = surgical removal of folds

Question 135

Discuss Lupus of the nasal planum.

Answer 135

• Probably the most common autoimmune causing skin condition
• Due to an immune-mediated attack on the basal cell layer of the nose > separation of epidermis from underlying dermis
• Risk factor = UV exposure
• Common site = bridge of the nose at the junction where the nose meets the skin
• Common signs:
  o Get loss of cobblestone (spotty appearance of nose) > nose texture smooths out
  o Ulcerative
  o Will often see depigmentation due to melanocytes residing in basal cell layer
  o If it occurs for too long it can turn into squamous cell carcinoma
• Treatment:
  o Topical steroid cream or topical Tacrolimus
  o If topical treatment doesn’t work then need systemic treatment: Atopica or Cyclosporin
  o Some new research suggesting Apoquel works

Question 136

Which of the following is not a potential cause for laryngeal paralysis?
- Hypothyroidism
- A very large thyroid neoplasm
- High negative inspiratory pressure
- Cranial mediastinal neoplasia

Answer 136

• High negative inspiratory pressure

Question 137

Regarding permanent tracheostomies which of the following is correct?
- Allows easy access for anaesthesia in the upper airway patient
- Is a salvage procedure
- Is appropriate treatment for stage 1 laryngeal collapse
- Decreases the risk of tracheal collapse

Answer 137

• Is a salvage procedure

Question 138

A 5 year old Maltese terrier is presented to a vet for the first time for a chronic cough. After a thorough diagnostic evaluation you diagnose it with moderate intrathoracic tracheal collapse. How would you initially best manage the dog?
- Application of an intraluminal stent into the thoracic trachea
- Medical management including anti-inflammatories and antitussives
- Application of an intraluminal stent in the cervical trachea
- Application of external propylene rings

Answer 138

• Medical management including anti-inflammatories and antitussives

Question 139

Which of the following are secondary upper airway diseases due to high negative inspiratory airway pressures?
- Elongated soft palate
- Stenotic nares
- Hypoplastic trachea
- All stages of laryngeal collapse

Answer 139

• All stages of laryngeal collapse

Question 140

When performing a staphylectomy in a dog with brachycephalic airway syndrome, it is important to resect the correct amount of tissue. What landmark is used to judge this length correctly?
- Rostral margin of the tonsillar crypt
- The base of the epiglottis
- Caudal margin of the tonsil crypt
- Level with the rostral most portion of the cuneiform process

Answer 140

• Caudal margin of the tonsil crypt

Question 141

The anatomic sites for chest drain placement are:
- Penetrating the chest wall at the 7th or 8th intercostal space
- Penetrating the chest immediately below the costochondral junction
- Penetrating the skin at the 7th or 8th intercostal space
- Penetrating the thorax at the very dorsal aspect of the chest wall to ensure maximum tube length

Answer 141

• Penetrating the chest wall at the 7th or 8th intercostal space

Question 142

The perforated section of a chest drain ideally sits:
- Along the dorsal aspect of the chest
- Partially in the subcutaneous tissues and partially in the thoracic cavity
- In the middle of the chet (1/2 way between the spine and septum)
- Along the ventral floor of the chest

Answer 142

• Along the ventral floor of the chest

Question 143

With regards to tracheostomy tube placement in dogs which of the following is correct?
- Should pass greater than 6 tracheal rings when in situ
- None of the above
- Provide permanent airway access for laryngeal collapse
- Should be about 70% the diameter of the trachea

Answer 143

• None of the above

Question 144

If threatened a cats preferred first line of defence is:
- Escape
- Curl into a ball
- Attack
- Meow or hiss loudly

Answer 144

• Escape

Question 145

Feliway is:
- A drug used to treat aggression in cats
- A synthetic pheromone that mimics the natural familiarity pheromone
- A strong smelling spray to deter cats from soiling outside the litter tray
- A disinfectant used to disguise the smell of urine

Answer 145

• A synthetic pheromone that mimics the natural familiarity pheromone

Question 146

The critical socialisation period for developing kittens is:
- Weaning – 12 weeks
- 2-9 weeks
- Birth – weaning
- 4-16 weeks

Answer 146

• 2-9 weeks

Question 147

Scratching the furniture in the home is best managed by:
- Providing an alternative structure to scratch
- Shouting no at the cat
- Declawing the cat
- Using a water pistol on the cat

Answer 147

• Providing an alternative structure to scratch

Question 148

Which of the following statements is not correct. Caesarean section is urgently indicated in the bitch when:
- The foetal heart rate is greater than 200bpm indicating foetal distress
- There is meconium in the vagina
- The bitch is systemically unwell
- The bitch has been straining unproductively for 40min

Answer 148

• The foetal heart rate is greater than 200bpm indicating foetal distress

Question 149

Which of the following statements regarding canine mammary neoplasia is correct?
- The most common tumour type is sarcoma
- After two oestrous cycles in a bitch the lifetime risk of mammary tumour development is not significantly altered by desexing
- More than 90% of mammary tumours are malignant
- The most appropriate surgical treatment is unilateral mastectomy if the tumour is confined to one side

Answer 149

• After two oestrous cycles in a bitch the lifetime risk of mammary tumour development is not significantly altered by desexing

Question 150

Regarding cervical sialocoele in dogs which of the following is correct
- Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated
- Removal of the parotid and sublingual salivary glands on the ipsilateral side is indicated
- Repeated needle drainage is effective in 50% of cases and should be performed prior to surgery
- The sialocoele is surrounded by a secretory lining that must be excised

Answer 150

• Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated

Question 151

Which of the following statements regarding oral tumours in cats is correct
- Oral melanoma is relatively benign and rarely spreads
- Squamous cell carcinoma is the most commonly identified oral tumour in cats
- Biopsy of oral masses or ulcers is rarely indicated as it does not affect the surgical treatment
- Surgery is rarely an option for oral neoplasia in cats as the bone is frequently involved.

Answer 151

• Squamous cell carcinoma is the most commonly identified oral tumour in cats

Question 152

Elmo, a 7 year old 7kg male castrated daschund with hind limb paralysis & no deep pain sensation. Elmo’s presumptive diagnosis is intervertebral disc disease. PCV 60% (normal 35-58%), TP 85g/L (normal 52-82).
Based on the PCV & TP what is the most likely cause?
- Pain
- Overhydration
- Dehydration
- Normal for this breed

Answer 152

• Dehydration

Question 153

What condition listed is not associated with an elevation in HR?
- Hypotension
- Hypovolaemia
- Hypothermia
- Pain

Answer 153

• Hypothermia

Question 154

The American Society of Anaesthesiologists recommends categorizing patients undergoing an anaesthetic procedure into one of five possible statuses after the patient evaluation has been completed. What is the most likely ASA status for elmo? Daschund with likely IVDD - dehydrated on bloods.
- IIE
- I
- III
- VE

Answer 154

• IIE

Question 155

A 22g intravenous catheter has been placed in Elmo’s cephalic vein. What is the best sole opioid analgesic protocol for this patient, whilst awaiting surgery (route and frequency of administration). Daschund with likely IVDD.

Answer 155

Route of administration: intravenous (catheter in place)
Analgesic: Methadone

Question 156

During anaesthesia Elmo becomes hypotensive (MAP <60mmHg). What would be the first thing you would do to correct the hypotension?
- Turn down the inhalant agent, if possible
- Pinch animals toe to cause stimulation
- Increase the fluid rate
- Administer vasopressin

Answer 156

• Turn down the inhalant agent, if possible

Question 157

Elmos is placed on a non-rebreathing system and connected to the capnograph. Identify the abnormality on the capnograph trace. What would you do to resolve this?

Answer 157

Elmo is rebreathing CO2 (should be going back down to baseline)
Increase O2 flow rate

Question 158

Hypothermia is a common complication that can be expected under general anaesthesia. What precautions can you take to prevent hypothermia and if it occurs how do you treat it?

Answer 158

Prevention:
- Prewarming prior to any induction, warm IV fluids, blankets / drapes to cover during surgery. Warm air blanket during surgery. Minimise surgery time. Warm pad on the surgery table.

Treatment:
- More difficult than prevention, all above mechanisms should be employed if hypothermia occurs. Regular monitoring is important.

Question 159

Elmo’s heart rate and EtCO2 start to decrease during anaesthesia. Suddenly you notice an abnormal rhythm after the 7th QRS complex. What is this called? How would you manage it?

Answer 159

Ventricular asystole
Manage with CPRC (chest compressions, cardiac pump model, continuous and effective – most important aspect of CPRC). Adrenaline and/or vasopressin and check airway for signs of obstruction.

Question 160

What is the normal number of adult teeth in the dog?
- 42
- 40
- 30
- 45

Answer 160

• 42

Question 161

What is the normal number of adult teeth in the cat?
- 45
- 30
- 42
- 40

Answer 161

• 30

Question 162

Generally a tooth should be extracted if it has:
- Any of the above
- Periodontal disease with >50% bone loss around >1 root
- Mobility
- A complicated crown fracture where root canal therapy has been declined

Answer 162

• Any of the above

Question 163

Feline stomatitis (gingivostomatits) is caused by:
- An atypical immune response of unknown cause
- Calicivirus
- Poor dental hygiene
- Mycoplasma

Answer 163

• An atypical immune response of unknown cause

Question 164

What treatment is indicated for both of these canine teeth?
- No treatment indicated
- Crown amputation and intentional retention of the roots
- Root canal therapy
- Extraction

Answer 164

• Extraction

Question 165

What is a good choice for a suture material to use in the oral cavity?
- 2/0 poydioxannone (PDS)
- 4/0 polydioxannone (PDS)
- 0 polydioxannone (PDS)
- 4/0 Glyconate (monosyn)

Answer 165

• 4/0 Glyconate (monosyn)

Question 166

How common are caries (tooth decay) lesions in the cat?
- They have occasionally been reported
- Most cats develop them as they get older
- They have rarely been reported
- They have never been reported in the cat

Answer 166

• They have never been reported in the cat

Question 167

A cat is presented with idiopathic feline asthma. For home management the owner prefers to give inhalation therapy, rather than oral therapy. From the following list, select the combination of drugs commonly delivered as inhalation therapy for acute attach episodes as well as for chronic ongoing feline asthma.
- Antibiotic (acute), bronchodilators (chronic)
- Antibiotic (acute), corticosteroid (chronic)
- Bronchodilators (acute), corticosteroids (chronic)
- Bronchodilators (acute), NSAIDs (chronic)

Answer 167

• Bronchodilators (acute), corticosteroids (chronic)

Question 168

A geriatric Golden Retriever is presented because of noisy inspiration that is evident only when the dog is exercising strenuously. Select from the list below the most likely cause.
- Brachycephalic syndrome
- Collapsing trachea
- Laryngeal paralysis
- Aspergillosis

Answer 168

• Laryngeal paralysis

Question 169

An elderly dog is presented with 1 week of persistent sneezing and a unilateral mucopurulent nasal discharge. Which of the following options is the approach most likely to lead to a diagnosis?
- Thorough physical examination, followed by skull radiographs or CT and then rhinoscopy
- Complete blood count and chemistry panel followed by rhinoscopy, then CT scan
- Complete blood count and coagulation panel followed by rhinoscopy and cytology or biopsy
- Rhinoscopy, nasal wash, cytology and/or biopsy followed by skull radiographs or CT

Answer 169

• Thorough physical examination, followed by skull radiographs or CT and then rhinoscopy

Question 170

Which of the following statements about stertor and stridor is most correct?
- Stridor or goose honk noises are typical of brachycephalic syndrome
- Stertor and stridor indicate obstruction to airflow in the bronchi
- Stertorous respiration indicates obstruction to airflow in the larynx
- Stridor is a high pitched inspiratory noise, stertor is snoring or snorting.

Answer 170

• Stridor is a high pitched inspiratory noise, stertor is snoring or snorting.

Question 171

Which of the following would be a pre-anaesthetic concern in a brachycephalic dog?
- All of the above
- Chronic hypoventilation
- Chronic hypoxaemia (PaO2 < 85 mmHg)
- Chronic hypercapnia (PaCO2 > 45 mmHg)

Answer 171

• All of the above

Question 172

Which pre-anaesthetic drug is most likely to cause pharyngeal paralysis and soft palate relaxation resulting in upper airway obstruction?
- Benzodiazepines
- Butorphanol
- Low dose ACE
- Alpha-2 agonists

Answer 172

• Benzodiazepines

Question 173

In a pregnant bitch, progesterone and Beta endorphins are increased, this makes them less sensitive to the effects of all anaesthetic drugs.
True
False

Answer 173

False (pregnant animals are more sensitive to anaesthetic drugs)

Question 174

Photo of a dog with cataracts (both eyes milky / cloudy white).
1. What is the major ocular abnormalities and what is the recommended treatment?
2. What is a differential diagnosis of this condition in an elderly dog that was 10 years old. What is its recommended treatment?
3. What ophthalmic examination technique could you employ in this dog to tell the difference between your two possible diagnoses?

Answer 174

1. What is the major ocular abnormalities and what is the recommended treatment?
   - Cataracts - treatment?
2. What is a differential diagnosis of this condition in an elderly dog that was 10 years old. What is its recommended treatment?
   - Nuclear sclerosis. No treatment for nuclear sclerosis, degenerative disease in older animals.
3. What ophthalmic examination technique could you employ in this dog to tell the difference between your two possible diagnoses?
   - Ophthalmoscopy

Question 175

Match the following ECG / heart rhythms to the correct description:
- Pulseless electrical activity
- Perfusing rhythm
- Ventricular fibrillation
- Asystole
- Pulseless ventricular tachycardia

Answer 175

Pulses electrical activity: consistent and repeated QRS complexes, narrow complexes, no pulses associated with complexes and heart rate 126 bpm

Perfusing rhythm: consistent and repeated QRS complexes (can’t see rest of ans)

Ventricular fibrillation: consistent and repeated QRS complexes not present, random and non-repeatable ECG trace, no pulses detectable

Asystole: Consistent and repeated QRS complexes not present (cant see the rest)

Pulseless ventricular tachycardia: Consistent and repeated QRS complexes, wider complexes, no pulses associated with the complexes and a heart rate of 228

Question 176

A cat with bradyarrhythmia suddenly has cardiopulmonary arrest due to asystole. Which of the following is most correct?
- High dose of adrenaline should be used after the first CPR cycle
- Low dose of adrenaline should be used every cycle of CPR
- Atropine should be used every cycle of CPR
- Atropine should be used every other cycle of CPR

Answer 176

• Atropine should be used every cycle of CPR

Question 177

A dog suddenly develops asystole during anaesthesia. The ECG was attached to the patient; no pulse was detected. According to the recover PCR guidelines, what should be the first treatment priority?
- Start fluid therapy (bolus dose)
- Administer lose dose of adrenaline
- Connect the ETCo2 monitor
- Chest compressions

Answer 177

• Chest compressions

Question 178

Discuss 2 important litter box considerations when advising clients on designing an optimal litter box plan for their house soiling cat. (4 marks)

Answer 178

• Minimum number of trays = number of cats + 1
• Must be at least 1.5x length of the cat from nose to tail
• Daily cleaning required
• Complete disinfectant wash with enzymatic cleaner at least weekly
• Litter type of cats preference
• Tray where somewhere cat wont be disturbed

Question 179

During vaccination consultation, the owners mention their dog fluffy is chewing the door frame when she is left alone during the day and the neighbours have noticed she is barking and howling when alone. What is the best general advice to give to Fluffy’s owners?
- The dog needs to be treated like and dog and the owners need to show dominance behaviour
- A barking collar should be used to stop the barking
- The dog will improve with some obedience training
- The dog may have a mental health disorder best addressed through behavioural consultation
- The dog will likely grow out of the behaviour, so no treatment required

Answer 179

• The dog may have a mental health disorder best addressed through behavioural consultation

Question 180

An owner mentions that their dog is very reactive towards unfamiliar dogs when out on walks – when it sees another dog it will lunge towards the dog and bark with its hackles up. The dog has been doing this for the last 6 months since it was about 18 months of age. Select from the following options the most appropriate immediate suggestions you should make.
- Walk the dog as much as possible to expose it and socialise it with other dogs
- Take the dog to a balanced trainer so that a professional who uses the four quadrants of learning can help the dog
- Stop taking the dog for walks as it is currently not beneficial and likely making the dog worse
- Take the dog to a dog park and let it be surrounded by unfamiliar dogs to get it used to them even if it is reacting aggressively

Answer 180

• Stop taking the dog for walks as it is currently not beneficial and likely making the dog worse

Question 181

List the “4 M’s” of dog behavioural treatment

Answer 181

Medication
Behaviour modification
Environmental management
Monitoring progress

Question 182

A dog has been treated for generalised anxiety with fluoxetine 1mg/kg daily. Four weeks after starting treatment the owner reports that there is no improvement in the dogs behaviour. The owner is disappointed and wants to see some progress. What should be done next?
- Stop the fluoxetine immediately and start a different medication
- Wean the dog off fluoxetine over 4 weeks and then start a different baseline medication
- Increases the fluoxetine to 2mg/kg SID
- Continue to the fluoxetine for another 4 weeks before reassessing its effect

Answer 182

• Continue to the fluoxetine for another 4 weeks before reassessing its effect

Question 183

For the following clinical presentation, select the most likely diagnosis. Four year old mixed breed dog with acute onset of stertorous breathing and pain on opening mouth.
- Bacterial infection secondary to foreign body
- Bacterial infection secondary to systemic viral infection
- Oropharyngeal foreign body or injury
- Idiopathic
- Neoplasia
- Coagulopathy

Answer 183

• Oropharyngeal foreign body or injury

Question 184

10. For the following clinical presentation, select the most likely diagnosis: 2 year old male cat, with dyspnoea, tachypnoea, and pyrexia.
    Bacterial infection secondary to foreign body
    Bacterial infection secondary to systemic viral infection
    Oropharyngeal foreign body / injury
    Idiopathic
    Neoplasia
    Coagulopathy
    Tooth root abscess
    Mycotic intranasal infection
    Collapsing trachea
    Chronic bronchitis
    Cardiac disease
    Pyothorax

Answer 184

Pyothorax

Question 185

Troy is a 5 year old female spayed Great Dane with weight loss and intermittent diarrhoea for 2 months. No changes in appetite, thirst or activity level have been noticed. On examination you find the following:
- MM pink and moist
- CRT 1 second
- HR 80
- Abdominal palpation appears normal
- Temp 38.2C
- Body condition score 3/9
Based on the history and clinical signs which of the following list of differential diagnoses is most likely?
- Intestinal nematodes, cryptosporidiosis, exocrine pancreatic insufficiency, intussusception
- Inflammatory bowel disease, giardiasis, intestinal lymphoma, food intolerance
- Parvovirus infection, salmonellosis, hepatic failure, Addison’s disease
- Anaemia, poisoning, rotavirus, intestinal nematodes, campylobacteria

Answer 185

• Inflammatory bowel disease, giardiasis, intestinal lymphoma, food intolerance

Question 186

You perform all the following
- Faecal sample: negative for bacterial, parasitic and protozoal pathogens
- Haematology and biochemistry profile: all parameters within normal ranges
- Abdominal radiographs: no abnormal findings
- Abdominal ultrasonography: no abnormal findings
- Endoscopy performed by a specialised: intestines appear normal
If the faecal sample had revealed giardia trophozoites, what would have been the most effective treatment for Troy?
- A 2 week course of potentiated sulphonamides
- A 5 day course of fenbendazole
- A single dose of -mycin
- Two doses of praziquantel given 7 days apart

Answer 186

• A 5 day course of fenbendazole

Question 187

Which of the following tests would be least valuable in the further investigation of Troy?
- Intestinal biopsies taken at the time of endoscopic examination
- Prescription diet trial
- Barium radiographic contrast study
- Measurement of Trypsin like immunoreactivity

Answer 187

• Barium radiographic contrast study

Question 188

If Troy was eventually diagnosed with lympho-plasmacytic enteritis, what would be the most appropriate treatment combination?
- Metranidazole and a low fat diet
- Prednisolone and a limited antigen diet
- Loperamide and a hydrolysed diet
- Sulphasalazine and a bland diet

Answer 188

• Prednisolone and a limited antigen diet

Question 189

A prescription hydrolysed diet could be considered for Troy. What is the mechanism of action of these diets?
- Pre-digestion of protein results in peptides that are too small to aggregate IgE
- Hydrolysis of carbohydrates reduces their antigenicity
- Proteins are pre-digested to aid absorption through the intestinal wall
- Hydrolytic enzymes in the diet complement amylase, lipase and trypsin

Answer 189

• Pre-digestion of protein results in peptides that are too small to aggregate IgE

Question 190

A 10 year old Rottweiler has been vomiting intermittently for the past week. The dog is mildly lethargic and the owners believe it may be slightly polydipsic. Appetite is reduced. The owners have brought the dog in because there was a small quantity of blood in the vomitus this morning. What would be the most appropriate course of action:
- Feeding a bland diet for 3 days along with a course of maropitant
- Prescribing a 5 day course of metoclopramide
- Analysing a blood sample for evidence of metabolic disease
- Admitting the dog to hospital for fluid therapy and observation

Answer 190

• Analysing a blood sample for evidence of metabolic disease

Question 191

A 5 year old male intact Beagle presents with a 2 day history of vomiting followed by acute lethargy. Physical examination reveals tacky mucous membranes, a heart rate of 140bpm, guarding of the abdomen and a temperature of 39.9C. Which of the following is the most likely diagnosis?
- Pancreatitis
- Prostatitis
- Gastritis
- Hepatitis

Answer 191

• Pancreatitis

Question 192

The owners of a 3 year old 15kg Staffodshire Bull Terrier inform you they have seen the dog swallow a smooth pebble approximately 3cm in diameter approximately 24 hours ago. What is the most appropriate recommendation?
- Advise the pebble is likely to pass naturally
- Wait to see if it is vomited back up
- Perform a laparotomy to allow surgical removal
- Admit the dog for abdominal radiography

Answer 192

• Admit the dog for abdominal radiography

Question 193

Which of the following statements concerning bacterial tonsillitis in dogs is most correct?
- It is commonly seen in dogs following infection with parainfluenza virus
- Bacterial tonsillitis doesn’t occur in dogs
- It can be associated with dental disease in small breed dogs
- The most obvious clinical sign is a productive cough

Answer 193

• It can be associated with dental disease in small breed dogs

Question 194

What constitutes the syndrome referred to as triaditis in cats?
- Pancreatitis, IBD, cholangitis
- Cholangitis, pancreatitis, gastritis
- Lymphadenitis, pancreatitis, cholangitis
- Pancreatitis, hepatic lipidosis, IBD

Answer 194

• Pancreatitis, IBD, cholangitis

Question 195

What best describes the characteristics of pancreatitis in dogs?
- It is an acute disease associated with high mortality
- It typically causes a palpable abdominal mass in the cranial abdomen
- It causes release of pancreatic lipase into the circulation
- It is seem more commonly in toy breeds

Answer 195

• It causes release of pancreatic lipase into the circulation

Question 196

A 4 month old German Shepherd dog is presented for persistent regurgitation that occurs immediately after eating. Of the following possibilities, what is the most likely diagnosis?
- Persistent right aortic arch
- Helicobacter infection
- Ruptured gall bladder
- Gastric carcinoma

Answer 196

• Persistent right aortic arch

Question 197

Which of the following is the most likely cause of oesophagitis?
- Anaesthesia
- Chronic coughing
- Myasthenia gravis
- Lead poisoning

Answer 197

• Anaesthesia

Question 198

Which of the following liver disorders is the least likely to be seen in a cat?
- Nodular hyperplasia
- Suppurative cholangitis
- Hepatic lipidosis
- Lymphocytic cholangitis

Answer 198

• Nodular hyperplasia

Question 199

Which combination of increased liver enzymes typically indicates cholestasis?
- ALP and GGT
- ALT and ALP
- ALT and AST
- AST and ALP

Answer 199

• ALP and GGT

Question 200

What is the mode of action of Urso-deoxycholic acid (UDCA)?
- Stimulates bile flow
- Reverse hepatic lipidosis
- Anti-oxidant effects
- Appetite stimulant

Answer 200

• Stimulates bile flow

Question 201

The following haematology values are from a 9 year old female dog with lymphosarcoma, immediately before her first dose of chemotherapy with vincristine (baseline) and then one week post vincristine. The dog is anaemic at baseline and in week 1. Which of the following is the best explanation?
- Normocytic normochromic non-regenerative anaemia due to lymphosarcoma
- Normocytic normochromic non-regenerative anaemia of acute blood loss anaemia
- Microcytic hypochromic poorly regenerative anaemia indicating iron deficiency
- Microcytic hypochromic poorly regenerative anaemia indicating chronic blood loss

Answer 201

• Normocytic normochromic non-regenerative anaemia due to lymphosarcoma

Question 202

What is the specific medical term for the lesions seen in this dogs oral mucous membranes and what is the blood abnormality most likely to cause it?

Answer 202

Petechiae, thrombocytopaenia

Question 203

For the following steps, choose the most appropriate instrument from the drop down box, to use as outlined in the DVM2 desexing clinic practical manual, accompanying videos, simulation model training. The same instrument can be used more than once.
- To extend your initial blade scalpel stab incision into the linea alba to open up the abdomen in a 3kg cat
- To make the stab incision into the linea alba of a 2kg cat:
- To hold the linea alba whilst making the initial stab incision to enter the abdomen in a 3kg cat:
- To hold up the linea alba, whilst making the initial stab incision to enter the abdomen in a 30kg dog:
- The instrument used to make a subcutaneous tunnel, by elevating the subcutaneous tissue from the external rectus sheath, exposing the linea alba, in a 15kg dog spay:
- To extend your initial scalpel blade stab incision into the linea alba and to open up the abdomen in a 30kg dog:
- To clamp the ovarian pedicle before ligation in a 40kg dog spay:
- To clamp the ovarian pedicle before ligation in a 10kg dog spay
- To clamp the ovarian pedicle before ligation in a 6 month old prepubescent kitten spay weighing 2kg
- To clamp the uterine body before ligation in a 4kg cat
- To provide temporary haemostasis of a small bleeding vessel in the subcutaneous tissue:
- The forceps used to atraumatically grasp abdominal contents in a cat (e.g. bladder or intestines):
- To grasp the proper ligament to assist manipulation of the uterine horn and ovary during a spey:
- After ligation of the spermatic cord, the instrument used to grasp the ductus deferens only, immediately before releasing the pedicle back into the tunics:
- To retract both medial edges of the subcutaneous tissue to improve visualisation during linea alba sututing:
- Grasping the subcutaneous tissue during a simple continuous layer closure in a dog castrate
- Tissue forceps used when applying skin sutures in a cat:

Answer 203

To extend your initial blade scalpel stab incision into the linea alba to open up the abdomen in a 3kg cat: Straight metzenbaum’s

To make the stab incision into the linea alba of a 2kg cat: Scalpel blade (no. 15)

To hold the linea alba whilst making the initial stab incision to enter the abdomen in a 3kg cat: Adson forceps

To hold up the linea alba, whilst making the initial stab incision to enter the abdomen in a 30kg dog: rat tooth forceps

The instrument used to make a subcutaneous tunnel, by elevating the subcutaneous tissue from the external rectus sheath, exposing the linea alba, in a 15kg dog spay: curved Metzenbaum scissors

To extend your initial scalpel blade stab incision into the linea alba and to open up the abdomen in a 30kg dog: straight mayo scissors

To clamp the ovarian pedicle before ligation in a 40kg dog spay: curved Rochester Carmalt’s

To clamp the ovarian pedicle before ligation in a 10kg dog spay: curved crile forceps

To clamp the ovarian pedicle before ligation in a 6 month old prepubescent kitten spay weighing 2kg: Halstead mosquito forceps

To clamp the uterine body before ligation in a 4kg cat: Curved crile forceps

To provide temporary haemostasis of a small bleeding vessel in the subcutaneous tissue: Halstead mosquito forceps

The forceps used to atraumatically grasp abdominal contents in a cat (e.g. bladder or intestines): DeBakey forceps

To grasp the proper ligament to assist manipulation of the uterine horn and ovary during a spey: Halstead mosquito forceps

After ligation of the spermatic cord, the instrument used to grasp the ductus deferens only, immediately before releasing the pedicle back into the tunics: Halstead mosquito forceps

To retract both medial edges of the subcutaneous tissue to improve visualisation during linea alba sututing: Allis tissue forceps

Grasping the subcutaneous tissue during a simple continuous layer closure in a dog castrate: Adson brown forceps

Tissue forceps used when applying skin sutures in a cat: Adson Brown forceps

Question 204

The perforated section of a chest drain ideally sits
- Along the dorsal aspect of the chest
- In the middle of the chest
- Along the ventral floor of the chest
- Partially in the subcutaneous tissues and partially in the thoracic cavity

Answer 204

• Along the ventral floor of the chest

Question 205

With regards to tracheostomy tube placement in dogs which of the following is correct?
- Provide permanent airway access for laryngeal collapse
- Should be about 70% the diameter of the trachea
- Should pass greater than 6 tracheal rings when in situ
- None of the above

Answer 205

• None of the above

Question 206

In severe tracheal trauma it is possible to resect up to —- % of the total tracheal length.
5%
10%
15%
20%
25%

Answer 206

20%

Question 207

Regarding Flail chest on a dog choose the correct answer:
- The flail chest segment expands on inspiration
- The flail chest segment collapses on expiration
- The flail chest segment collapses on inspiration
- The flail chest segment has no effect respiration

Answer 207

• The flail chest segment collapses on inspiration

Question 208

The treatment of choice for a flail chest in a dog with respiratory compromise is:
- Internal surgical stabilisation of any rib fractures
- Placing a plastic splint on the rib cage extending past the rib fractures over normal chest wall and suturing it around the ribs of the intact chest wall
- Placing a plastic splint on the rib cage extending past the rib fractures and suturing it around the ribs within the flail chest segment
- Placing a plastic splint on the rib cage slightly smaller than the flail chest segment and suturing it around the ribs within the flail chest segment
- Surgical treatment is not needed as fractured ribs will heal by fibrosis without the need for surgery. Only medical management is needed

Answer 208

• Placing a plastic splint on the rib cage extending past the rib fractures and suturing it around the ribs within the flail chest segment

Question 209

Regarding flail chest in a dog choose the correct answer
- It is an inherent weakness of an anatomically normal chest wall due to old age
- A condition that develops when 1 rib is fractured
- A condition that develops when 2 or more ribs are fractured, once along each rib
- A condition that develops when several adjacent ribs are fractured, in two or more places along each rib.

Answer 209

• A condition that develops when several adjacent ribs are fractured, in two or more places along each rib.

Question 210

A client calls up in distress. Lucky, her 10 year old Male neutered Golden retriever, has just collapsed in the back yard and is unable to get up. She thinks he isn’t breathing well and feels cold to her touch. She is driving to the veterinary hospital and will arrive in 3 minutes.
List the steps within the primary survey you should take to assess Lucky when he arrives (3 marks).

Answer 210

3 H’s: history / hello, help, hazard

ABCDE: Air, breathing, circulation, demeanour, everything else

Question 211

When in shock, patients may present with several different clinical signs or measurable abnormalities. List any 6 of these.

Answer 211

• Vasoconstriction - pale MM, prolonged CRT, peripheral temp < core temp, reduced urine output
• Decreased mentation
• Tachycardia (cats may present with bradycardia)
• Hypotension (poor pulse quality)
• Reduced oxygen saturation (low SpO2)
• Lactate >2 mmol/L
• Metabolic acidosis

Question 212

Which of the following statements regarding mammary neoplasia is most correct?
- Surgical lumpectomy is an appropriate treatment for a small solitary mass in a single gland in the dog and cat
- Surgical lumpectomy is an appropriate treatment for a small solitary mass affecting a single gland in the dog but not the cat
- Surgical lumpectomy is an appropriate surgical treatment for a small solitary mass in the cat but not the dog
- Surgical lumpectomy is never an appropriate treatment for a small solitary mass affecting a single gland in the dog or the cat

Answer 212

• Surgical lumpectomy is an appropriate treatment for a small solitary mass affecting a single gland in the dog but not the cat

Question 213

Which of the following is not a reason to elect to perform a hysterectomy over hysterotomy for caesarean section in the bitch?
- Where there is evidence of foetal distress
- To minimise abdominal contamination
- To minimise surgical time
- Where there are dead foetuses

Answer 213

• Where there is evidence of foetal distress

Question 214

Regarding pyometra in the dog which of the following statements is not correct?
- Pyometra in oestrus typically 4-10 weeks after last diestrus
- Cystic endometrial hyperplasia develops first followed by ascending infection with bacteria from the vagina or lower urinary tract
- Pus may enter the abdomen from uterine rupture or via the oviducts
- Clinical signs of polyuria and polydipsia, lethargy and vaginal discharge are often accompanied by azotaemia and dehydration

Answer 214

• Pyometra in oestrus typically 4-10 weeks after last diestrus

Question 215

Which of the following statements regarding oral tumours in cats is most correct?
- Squamous cell carcinoma is the most commonly identified oral tumour in cats
- Oral melanoma at this location is relatively benign and rarely spreads
- Biopsy of oral masses or ulcers is rarely indicated as it does not affect the surgical treatment
- Surgery is rarely an option for oral neoplasia in cats as the bone is frequently involved

Answer 215

• Squamous cell carcinoma is the most commonly identified oral tumour in cats

Question 216

Regarding cervical sialocoele in dogs which of the following responses is most correct?
- Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated
- The mucocoele is surrounded by a secretory lining that must be excised
- Repeated needle drainage is effective in 50% cases and should be performed first
- Removal of the parotid and sublingual salivary lands on the ipsilateral side is indicated

Answer 216

• Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated

Question 217

Regarding oral tumours in dogs, which of the following statements is correct?
- Wide surgical excision with rostral mandibulectomy may be curative for a small squamous cell carcinoma associated with the lower central incisor teeth
- Malignant melanoma appears as a dark pigmented tumour on the gingiva, lip, or tongue
- There is a vaccination available for management of fibrosarcoma after surgery available for oncologists
- Pulmonary spread of fibrosarcoma is common around 80%

Answer 217

• Wide surgical excision with rostral mandibulectomy may be curative for a small squamous cell carcinoma associated with the lower central incisor teeth

Question 218

Charlie, a 12 month old Labrador, is presented with a distal cervical oesophageal foreign body as seen in the radiographs below. The owners observed the dog swallow the foreign body 3 days ago.
What clinical signs would you expect this dog to show?
- Regurgitation after eating, diarrhoea, severe dyspnoea
- Regurgitation after eating and drinking, dehydration, coughing
- Vomiting, diarrhoea, dehydration, neck pain
- Vomiting, dysphagia, neck pain

Answer 218

• Regurgitation after eating and drinking, dehydration, coughing

Question 219

What would be the best treatment option for Charlie (dog with distal cervical oesophageal foreign body)?
- Attempt endoscopically oral intervention first, if unsuccessful perform a cervical oesophagotomy
- Push the foreign body into the stomach, as it is easier to remove from that location
- Proceed immediately to a cervical oesophagotomy
- Place the dog on intraosseous fluids to allow rehydration of the surrounding soft tissue and then wait for the foreign body to pass through the gastrointestinal tract

Answer 219

• Attempt endoscopically oral intervention first, if unsuccessful perform a cervical oesophagotomy

Question 220

When closing a distal cervical oesophagotomy, to achieve the greatest initial strength it is best to:
- Close the mucosa and muscularis in two layers, leaving the mucosal knots intraluminally
- Close the mucosa and muscularis in a single layer, leaving the knots extraluminally
- Close the mucosa and muscularis in a single layers, leaving the knots intraluminally
- Either a singe or a two layer closure can be used as both closures have similar initial strength and healing potential

Answer 220

• Close the mucosa and muscularis in two layers, leaving the mucosal knots intraluminally

Question 221

Which of the following statements about oesophageal healing is correct?
- Tension on an oesophageal wound closure is likely to result in stricture formation
- Oesophageal healing is not affected by abrasion with food particles

Answer 221

• Tension on an oesophageal wound closure is likely to result in stricture formation

Question 222

Dumbo, an 8 month old male castrated Basset hound, is presented with a history of vomiting and anorexia for 2 days. No diarrhoea observed by the owner. The dog is now lethargic, you take the following radiographs:
From the two radiographs above, the primary finding that will guide you whether to surgically explore the abdomen is:
- The pup probably has a partial small intestinal obstruction
- There is a large peritoneal effusion
- The pup probably has a complete intestinal obstruction
- The pup has a gastric dilatation volvulus

Answer 222

• The pup probably has a complete intestinal obstruction

Question 223

You speak with Dumbo’s owners about the radiographic findings (complete intestinal obstruction) and strongly suggest that the pup needs an exploratory surgery. From the list below, select the most important concern that you should discuss with them about the risks of taking the pup to surgery.
- Hyperproteinaemia will delay wound healing
- Hypoproteinaemia will increase the risk of dehisence of the bowel if resection is needed
- Paralytic ileus may not be reversed as the bowel is too distended
- The peritoneal effusion will affect the pups ability to ventilate under anaesthesia during the laparotomy

Answer 223

• Hypoproteinaemia will increase the risk of dehisence of the bowel if resection is needed

Question 224

If Dumbo has gastric dilatation and volvulus which of the following statemets is correct regarding serum lactate levels?
- A very high lactate level means the dog will die so surgical exploration is not indicated
- Dogs with a lactate level over 6 have a worse prognosis, due to a higher chance of gastric necrosis
- Dogs with a decrease in serial lactate levels of 40% taken 2 hours apart have a good prognosis
- It is normal for the lactat level to stay high for 48h post surgery

Answer 224

• Dogs with a lactate level over 6 have a worse prognosis, due to a higher chance of gastric necrosis

Question 225

Antibiotic coverage for a small bowel resection surgery should be ideally started:
- After surgery has finished
- Intravensouly at induction to obtain high circulating blood levels at the time of surgery
- Orally to achieve high concentrations in the gut at the time of surgery
- Subcutaneously at the time of pre-medication

Answer 225

• Intravensouly at induction to obtain high circulating blood levels at the time of surgery

Question 226

When you open an abdominal cavity, the intestines need to be moved outside the abdominal cavity and kept there whilst you inspect deeper structures. Select the best way to decrease surgical trauma to the exteriorised bowel from the following options.
- Place dry laparotomy sponges down on the drapes prior to exteriorising the gut
- Place the gut directly onto the drapes but cover with a moist laparotomy sponge
- Place the bowel between moistened laparotomy sponges
- Place the gut directly onto the drapes and cover with a sterile impervious plastic sheet

Answer 226

• Place the bowel between moistened laparotomy sponges

Question 227

At Dumbos surgery you found this foreign body in the jejunum, where would you make your enterotomy?
- Incision on the antimesenteric border from point A to B
- Incising on the antimesenteric border from point B to C
- Incising on the mesenteric border from point B to C
- Incising on the antimesenteric border from point C to D

Answer 227

• Incising on the antimesenteric border from point C to D (towards aboral side)

Question 228

If at Dumbo’s surgery you found that the ileum has become intussuscepted into the colon at the ileocaecal colic junction, your next step would be to:
- Manually reduce the intussusception via gentle traction and assess the viability of the bowel prior to resecting any tissue that appears to be non-viable
- Resect the entire ileocaecal colic junction en bloc and perform ileocolic end to end anastomosis without attempting to reduce the intussusception
- Do not perform surgery on the intussusception as the dead bowel will pass into the colon and be passed with the stool
- Leave the intussusception as is, then pursue medical management as intussusceptions are usually due to intestinal —-

Answer 228

• Manually reduce the intussusception via gentle traction and assess the viability of the bowel prior to resecting any tissue that appears to be non-viable

Question 229

If you were to reduce the intussusception, how would you assess the viability of the intestines after reduction?
- Good pink colouration of all affected tissue
- Evidence of peristalsis returning to the section of gut
- Pulses in the mesenteric vessels supplying the affected area
- All of the above

Answer 229

• All of the above

Question 230

What effect will just removing the ileocaecal valve have on Dumbo?
- The dog will not be able to absorb any vitamin B
- The dog will have an increased functional transit time (slows down passage)
- The dog will have a decreased functional transit time (speeds up passage)
- Stricture formation is more likely than in other areas of the small or large intestine

Answer 230

• The dog will have a decreased functional transit time (speeds up passage)

Question 231

After an intestinal resection and anastomosis, what type of suture pattern causes the least intraluminal narrowing?
- Inverting
- Everting
- Appositional
- All cause similar amounts of narrowing

Answer 231

• Appositional

Question 232

What suture material should ideally be used fr the anastomosis of the large intestine in a low tension situation?
- Shorting acting Poliglecaprone
- Medium acting braided (e.g. Polyglactin)
- Long acting monofilament (e/g Polydiaxanone)
- Non-absorbable monofilament (e.g. Nylon)

Answer 232

• Long acting monofilament (e/g Polydiaxanone)

Question 233

You plan to monitor Dumbo for any early signs of infectious peritonitis in case the anastomosis site dehisces, this is best done by:
- Palpating the abdomen for post-operative pain
- Radiographing the abdomen every 24h looking for the ground glass appearance
- Performing an ultrasound of the abdomen every 24h
- Placing active suction drains in the abdomen at the time of surgery and performing cytology and glucose levels on the abdominal fluid

Answer 233

• Placing active suction drains in the abdomen at the time of surgery and performing cytology and glucose levels on the abdominal fluid

Question 234

When closing the linea alba after laparotomy, what layer has the most strength and must be included in a simple continuous closure?
- Internal rectus sheath
- Rectus abdominus muscle
- External rectus sheath
- Peritoneum

Answer 234

• External rectus sheath

Question 235

A 10 year old DSH cat, weighing 4kg, needs a tooth extraction. If using lignocaine 1% in the local block, what would be the usual volume of lignocaine considered to be safe in this cat?
0.04ml
0.4ml
1.4ml
2.0ml

Answer 235

0.4ml

Question 236

Regarding the local anaesthetic agent used in local blocks, which of the following statements is correct?
- Lidocaine has a rapid onset (2-5min) but limited duration (20-120min)
- Bupivicaine has a slightly longer onset than lidocaine but a longer duration (+12h)
- Bupivicaine administration should not exceed 3mg/kg in dogs or cats
- Lidocaine administration should not exceed 2mg/kg in dogs or cats

Answer 236

• Lidocaine has a rapid onset (2-5min) but limited duration (20-120min)

Question 237

Which of the following oral nerve blocks is most appropriate to extract a right upper canine tooth fracture?
- Right mental nerve block
- Right palatine nerve block
- Right infraorbital nerve block

Answer 237

• Right infraorbital nerve block

Question 238

Image of tooth that looks like the tip has been shaved off. What damage has occurred to Bob’s tooth?
- Enamel irritation
- Crown fracture
- Uncomplicated crown fracture
- Complicated crown fracture

Answer 238

• Complicated crown fracture

Question 239

What is the most appropriate treatment plan for Bob’s tooth? (Complicated crown fracture - looks like the top of the tooth has been shaved off)
- Extraction
- Root canal
- Monitor until it causes a problem
- Both extraction and root canal options should be offered to the client

Answer 239

• Both extraction and root canal options should be offered to the client

Question 240

If type 2 (idiopathic) tooth resorption is diagnosed in a cats tooth, it is likely that:
- Only one tooth is affected
- Another one or two teeth are likely affected
- Many or all of the teeth are affected, but this may only be microscopic
- The diagnosis is in error since cats always have an underlying cause

Answer 240

• Many or all of the teeth are affected, but this may only be microscopic

Question 241

The following history and radiographs relate to the next 3 questions. Below is a radiograph of the right caudal mandible of a 10 year old poodle dog.
The largest tooth in this radiographs is the right mandibular carnassial tooth. The blue arrow is pointing to the tooth immediately caudal to the carnassial. The tooth the blue arrow is pointing to is the:
1st molar
2nd molar
3rd premolar
4th premolar

What disease process is occurring in the tooth the blue arrow is pointing to?
Type 1 resorption
Type 2 resorption
Periodontal disease
Root fracture

What is the treatment of choice for the tooth the blue arrow is pointing to?
Complete extraction
Guided tissue regeneration
Root canal treatment
No treatment required

Answer 241

2nd molar

Periodontal disease

Complete extraction

Question 242

A 4 year old cat is presented for acute onset tetraparesis after being seen playing with a brown coloured snake. A snake venom detection test and coagulation test result are compatible with brown snake envenomation. To reduce the chance of a systemic adverse reaction, what should the cat be medicated with before infusing a vial of brown snake antivenom?
- Low dose adrenaline only
- Anti-histamine and corticosteroids together
- Corticosteroids only
- None of the above

Answer 242

• None of the above

Question 243

Consider the patients below and their signalments. Which patient would be at the highest risk of an adverse systemic reaction whilst receiving paralysis tick anti-serum if required?
- A 5 year old cat has received a tick anti-toxin serum only once before
- A 13 year old cat has received a blood transfusion
- A 6 month old dog that is naïve to all transfusions
- A 16 year old dog with severe chronic kidney disease

Answer 243

• A 5 year old cat has received a tick anti-toxin serum only once before

Question 244

When using the gait and respiratory scoring system for tick paralysis in a dog or cat, which of the following factors is not associated with a worse prognosis?
- Low respiratory score on presentation
- High gait score on presentation
- Old age
- Rapid worsening of clinical signs

Answer 244

• Low respiratory score on presentation

Question 245

An acutely ill unvaccinated 6 month old puppy with a fever, vomiting and diarrhoea, tachypnoea, an enlarged liver and corneal oedema should be suspected of having which of the following infections?
- Canine parvovirus
- Canine distemper
- Canine adenovirus
- Sever canine tachybronchitis

Answer 245

• Canine adenovirus

Question 246

Which of the following is not a zoonosis?
- Feline immunodeficiency virus
- Toxoplasmosis
- Rabies
- Leptospirosis

Answer 246

• Feline immunodeficiency virus

Question 247

A new puppy owner has been told by the breeder that she should not vaccinate her puppy with a C5 vaccine because one of the breeders dogs was vaccinated with a C5 and got kennel cough as a result. With regard to this reasoning, which of the following is not correct?
- The breeders dog may have had preclinical trachealbronchitis at the time of vaccination
- The intranasal vaccine can cause mild transient clinical signs and this is normal
- Respiratory vaccinations do not provide 100% protection against disease
- Using the intranasal vaccine subcutaneously avoids causing clinical disease

Answer 247

• Using the intranasal vaccine subcutaneously avoids causing clinical disease

Question 248

All of the following are true features of feline calicivirus carrier state except:
- Virus is shed continuously by carriers
- High, medium and low shedders exist
- Virus is shed from the tonsils and nasopharynx
- Only about 50% of carriers are shedding by 75 days post infection
- Vaccination prevents carriers from shedding the virus

Answer 248

• Vaccination prevents carriers from shedding the virus

Question 249

What is a likely cause of severe conjunctivitis in a cat that starts in one eye and several days later spreads to involve the other eye?
- Feline immunodeficiency virus
- Feline calicivirus
- Chlamydia felis

Answer 249

• Chlamydia felis

Question 250

You decide to test a cat for feline immunodeficiency virus infection. Consider the list of possible reasons for false positive and false negative diagnostic test results:
A. Health, uninfected 10 week old kitten born to an infected mother
B. Recently infected cat
C. Recently vaccinated cat
D. Overwhelming end stage disease in an infected cat
Which of these four choices could most possibly cause a false negative test result when using a conventional in-practice rapid diagnostic test kit for diagnosis of FIV?

Answer 250

B and D
B. Recently infected cat
D. Overwhelming end stage disease in an infected cat

Question 251

What distinctive and diagnostically useful clinical feature of canine distemper often develops about day 7-21 of illness?
- Cardiomyopathy
- Lymphopenia
- Conjunctivitis
- Fever
- Myoclonus (facial ticks)

Answer 251

• Myoclonus (facial ticks)

Question 252

Apart from wasting and cachexia, what are the most common terminal phase features of feline immunodeficiency virus infection?
- Stomatitis, gingivitis
- Panleukopenia like illness, acute diarrhoea
- Neurological signs, rage
- Severe anaemia, pallor

Answer 252

• Stomatitis, gingivitis

Question 253

In geriatric patients cardiac output is often increased .
True
False

Answer 253

False

Question 254

Due to hormonal and associated physiological changes in pregnant animals the minimum alveolar concentration of inhalant anaesthetics is increased.
True
False

Answer 254

False

Question 255

List three methods you can use to confirm correct placement of an endotracheal tube following intubation (1.5 marks)

Answer 255

• Visualise with laryngoscope blade on top of tube to see both arytenoids
• Look for condensation in the ETT
• Use a capnograph

Question 256

The information below relates to the next 4 questions. The following haematology values are from a 9 year old female dog with lymphosarcoma, immediately before and after her first dose of chemotherapy with vincristine (baseline) and then one week post vincristine.
The dog is anaemic at baseline and in week
1. Which of the following is the best explanation?

2. Suppose normocytic normochromic non regenerative anaemia due to lymphosarcoma was the correct answer. Which of the following is the most appropriate anaemia management strategy
3. Suppose microcytic hypochromic poorly regenerative anaemia indicating chronic blood loss was the correct answer, which of the following is the most appropriate next management step for anaemia?
4. Which of the following statements is the best assessment of the dogs 1 week neutropenia?

Answer 256

1. Which of the following is the best explanation?
   - Normocytic normochromic non-regenerative anaemia due to lymphosarcoma.
2. Suppose normocytic normochromic non regenerative anaemia due to lymphosarcoma was the correct answer. Which of the following is the most appropriate anaemia management strategy
   - No specific therapy for anaemia continue treating lymphosarcoma
3. Suppose microcytic hypochromic poorly regenerative anaemia indicating chronic blood loss was the correct answer, which of the following is the most appropriate next management step for anaemia?
   - Re-evaluate the case to determine the source of chronic blood loss
4. Which of the following statements is the best assessment of the dogs 1 week neutropenia?
   - Neutropenia is an expected adverse effect of vincristine and is likely to be temporary.

Question 257

A 7 year old neutered male Kelpie is presented for mild lethargy. Examine the CBC results below.

What is the single most important abnormality? (1 mark)

What is the likely diagnosis? (1 mark)

What drug is recommended to treat this condition? (1 mark)

Answer 257

What is the single most important abnormality? (1 mark)
- Marked lymphocytosis

What is the likely diagnosis? (1 mark)
- Lymphocytic leukemia

What drug is recommended to treat this condition? (1 mark)
- Chlorambucil

Question 258

What is the specific medical term for the lesions seen in this dogs oral mucous membrane and what is the blood abnormality most likely to cause this?

Answer 258

Petechiae
Thrombocytopaenia

Question 259

A dog is presented with a 1cm diameter raised pink hairless dermo-epidermal mass on the lateral left tarsus, diagnosed by fine needle aspiration cytology as a mast cell tumour. What clinical staging examinations are advisable?

Answer 259

Popliteal lymph node palpation and cytology, abdominal ultrasound

Question 260

A 9 year old male cattle dog is presented for a 2cm diameter raised pink epidermal mass with a partly ulcerated surface, located in the perianal tissue just to the rift of the dorsal anus. The mass is suspected to be a perianal gland adenoma. Select from the options below the most appropriate diagnostic test and recommended therapy.

Answer 260

Incisional biopsy for diagnosis, treat initially with castration

Question 261

A 3 year old black labrador is presented for a rapidly growing solitary hairless nodule on the lateral surface of its 4th toe on the right front limb. Evaluation of cytology from a fine needle aspirate of the nodule identifies a round cell tumour. Which of the following does this rule out?

Answer 261

Squamous cell carcinoma

Question 262

A 12 year old female spayed Doberman Pinscher had a soft tissue sarcoma resection 9 months ago. Since surgery she has been treated with low dose cyclophosphamide and firocoxib to inhibit local tumour regrowth. She has had stranguria for the last week and a free catch urine sample shows haematuria on a urine dipstick analysis. What are the two most likely causes of these abnormalities?

Answer 262

Cyclophosphamide induced sterile haemorrhagic cystitis, bacterial cystitis

Question 263

A 6 year old Doberman Pinscher with asymptomatic early dilated cardiomyopathy undergoes forelimb amputation for osteosarcoma. Which of the following drugs would be contraindicated for adjuvant chemotherapy following amputation.
a. Zoledornate
b. Carboplatin
c. Doxorubicin

Answer 263

c. Doxorubicin

Doxorubicin is known for its cardiotoxic effects, which can be particularly problematic in breeds like Doberman Pinschers that are prone to heart conditions such as dilated cardiomyopathy (DCM). Administering doxorubicin in a dog with even early asymptomatic DCM could exacerbate cardiac issues, increasing the risk of worsening heart disease and potentially leading to congestive heart failure

Question 264

Which of the following statements is true about the treatment of nasal lymphosarcoma in cats?
a. Short term prognosis following either chemo or radiation therapy is very poor
b. There is an excellent long term prognosis with most cats cured
c. There is a good medium – long term prognosis with chemo or radiation therapy

Answer 264

c. There is a good medium – long term prognosis with chemo or radiation therapy

Question 265

A cat is diagnosed with a low-grade alimentary lymphosarcoma and is treated with chemotherapy. What cytotoxic drug is commonly used in general practice to treat this malignancy?
a. Vincristine
b. Chlorambucil
c. Cisplatin

Answer 265

b. Chlorambucil

Chlorambucil is an alkylating agent that is well-tolerated in cats, making it suitable for low-grade alimentary lymphoma, which typically requires long-term, less aggressive treatment. It’s often combined with prednisolone for a synergistic effect and can help achieve long-term remission in many cases.
Vincristine and Cisplatin are not commonly used for low-grade alimentary lymphoma in cats. Vincristine is more often used in high-grade lymphoma protocols, while Cisplatin is generally avoided in cats due to its high nephrotoxicity.

Question 266

A dog is undergoing cytotoxic chemotherapy treatment for lymphosarcoma. The dog originally presented with generalised superficial lymphadenomegally and splenomegaly, and the diagnosis was based on histopathology of an enlarged lymph node. Within a couple of weeks of starting treatment, the dog has achieved complete clinical remission. What does “complete clinical remission” mean?

Answer 266

The dogs lymph nodes and spleen are normal size, but microscopic disease is still likely present

Question 267

A dog is presented with polydipsia, polyuria, and mild inappetence. Initial laboratory investigation shows mildly increased total serum calcium.
Briefly outline the approach to determining if this abnormality is significant (2 marks)

What pathologic process is the single most likely cause of hypercalcaemia in dogs (1 mark)

Answer 267

Briefly outline the approach to determining if this abnormality is significant (2 marks)
- Recheck total calcium, if still high then check ionised calcium. If normal, no further investigation needed.

What pathologic process is the single most likely cause of hypercalcaemia in dogs (1 mark)
- Neoplasia

Question 268

A 10 year old cat is presented because of 2 weeks innapetance. On physical examination the only significant abnormality is a palpably enlarged spleen and slight dehydration based on skin tent. Haematology and serum biochemistry are unremarkable apart from slightly elevated urea, and urine specific gravity (USG) is 1.045.

What is the best interpretation of the cats problems? (2 marks)

What is the next most logical investigation to obtain a diagnosis? (1 mark)

Answer 268

What is the best interpretation of the cats problems? (2 marks)
- Mild azotaemia, likely pre-renal, inappetence may be due to splenogmegaly

What is the next most logical investigation to obtain a diagnosis? (1 mark)
- Fine needle aspiration of spleen

Question 269

A cat is suspected to have a low grade alimentary lymphosarcoma.

What is the main condition it must be differentiated from (1 mark)

What is the best diagnostic test to reach a firm diagnosis (1 mark)

Assuming the diagnosis is confirmed to be low grade alimentary lymphosarcoma, what is the standard treatment and what is the prognosis for the cat? (2 marks)

Answer 269

What is the main condition it must be differentiated from (1 mark)
- Inflammatory bowel disease

What is the best diagnostic test to reach a firm diagnosis (1 mark)
- Tissue biopsy of the affected intestine with histopathology

Assuming the diagnosis is confirmed to be low grade alimentary lymphosarcoma, what is the standard treatment and what is the prognosis for the cat? (2 marks)
- Standard treatment is chemotherapy (chlorambucil) & prognosis is good for medium-long term survival

Question 270

The following history and examination findings relate to the next 13 questions. The owners of a 5 month old male castrated German shepherd dog have been away for 2 weeks with the dog being looked after by the neighbour. On return, they find that the dog has been vomiting for a few days followed by a period of anorexia and weight loss. No Diarrhoea has been observed. The dog will not eat anything and is now very lethargic and weak. On examination you find the following
- MM pink but very tacky
- CRT 2s
- HR 120
- Tempy 37.2
- BCS 2/9
Based on the history and clinical signs which of the following differentials which is most likely?
a. Parvovirus infection, giardiasis, helicobacteri, intestinal nematodes
b. Small intestinal obstruction, intussusception, pancreatitis, gastric FB
c. Gastric carcinoma, intestinal lymphoma, renal failure, cirrhosis

Answer 270

b. Small intestinal obstruction, intussusception, pancreatitis, gastric FB

Question 271

You admit the dog for fluid therapy, blood work and abdominal radiography. The haematology and biochemistry results are as shown.
The blood test results make liver disease and unlikely cause of this dogs signs. If the dog had been suffering from toxic hepatitis, what would have been the most likely abnormalities?
a. Minor elevation in ALT and ALKP
b. Marked elevation in bile acids and bilirubin
c. Marked elevation in ALT and mild elevation in ALKP

Answer 271

c. Marked elevation in ALT and mild elevation in ALKP

Question 272

If the dog had turned out to have toxic hepatitis, what would have been an appropriate treatment plan (in addition to fluid therapy and nutritional support).

Answer 272

Maropitant and s-adenosyl methionine

Question 273

The dog could still have pancreatitis. Which of the following biochemical abnormalities would be least likely to accompany pancreatitis?
a. Hyperglycaemia
b. Elevated ALKP
c. Hypercalcaemia

Answer 273

c. Hypercalcaemia

Hyperglycemia can occur with pancreatitis due to stress and possible disruption of pancreatic insulin regulation.
Elevated ALKP is often seen with pancreatitis, as inflammation can affect nearby liver and biliary structures, causing an increase in ALKP.
Hypercalcemia is unusual in pancreatitis and can actually be a risk factor for its development rather than a common concurrent finding. Pancreatitis is more likely to be associated with hypocalcemia due to the precipitation of calcium in areas of fat necrosis.

Question 274

If you diagnosed the dog with pancreatitis which of the following drugs would you avoid?

Answer 274

Meloxicam

Question 275

The dog is not vomiting blood so you do not suspect gastric ulceration. Which of the following is unlikely to cause gastric ulceration in dogs?
A. Renal failure
B. Hepatic failure
C. Treatment with NSAIDs

Answer 275

B. Hepatic failure

Renal failure can cause gastric ulceration due to the accumulation of uremic toxins, which irritate the gastrointestinal mucosa.
NSAID treatment is a well-known cause of gastric ulceration due to its inhibition of prostaglandin production, which is essential for maintaining the protective gastric mucosal barrier.
While hepatic failure can lead to gastrointestinal issues, including ulceration, it is less commonly a direct cause of gastric ulcers compared to renal failure and NSAID use. However, severe liver disease can predispose to GI bleeding due to coagulopathies and altered blood flow, but it is generally less associated with direct ulcer formation

Question 276

Jaundice can be seen with both liver disease and pancreatitis. What is another cause of jaundice?

Answer 276

Haemolytic anaemia

Question 277

If gastric ulceration has been present, which of the following drugs would be a useful treatment?

Answer 277

Omeprazole

Question 278

Vomiting in dogs can be caused by drug administration/ Which of the following would be least likely to cause vomiting?
a. Apomorphine
b. Enrofloxacin
c. Cyclosporin

Answer 278

b. Enrofloxacin

Apomorphine is an emetic agent commonly used to induce vomiting in dogs, making it highly likely to cause this effect.
Cyclosporin can cause gastrointestinal upset, including vomiting, especially when first introduced or if given on an empty stomach.
Enrofloxacin (a fluoroquinolone antibiotic) is less commonly associated with vomiting compared to the other two drugs, though it may cause GI upset in some cases.

Question 279

The dog is anorexic. What would be the most appropriate first step in getting it to eat?
a. Place a naso-gastric tube
b. Administer mirtazaprile
c. Identify the underlying cause

Answer 279

c. Identify the underlying cause

Anorexia in dogs can be due to a wide range of medical issues, and addressing the underlying cause is essential for effective treatment and for ensuring that appetite stimulants or feeding tubes are used appropriately

Question 280

Adbominal radiographs reveal distended loops of small intestines. Which of the following would be the most likely diagnosis?

Answer 280

Intussusception

Question 281

After treatment the dog makes a full recovery from its illness, but when it is 3 years old it develops chronic diarrhoea and weight loss, despite having a ravenous appetite. Which of the following is the most likely diagnosis?

Answer 281

Exocrine pancreatic insufficiency

Question 282

A 10 year old Rottweiler has been vomiting intermittently for the past week. The dog is mildly lethargic and the owners believe it might be slightly polydipsic. Appetite is reduced. The owners have brough the dog in because there was a small quantity of blood in the vomit this morning. What would be the most appropriate course of action?
a. Prescribing a 5 day course of metoclopramide
b. Analysing a blood sample for evidence of metabolic disease
c. Admitting the dog to hospital for fluid therapy and observation

Answer 282

b. Analysing a blood sample for evidence of metabolic disease

Question 283

A 2 year old Golden Retriever has vomited twice in the last 24 hours, once after eating. On the first occasion, the vomitus contained food. On the second, it was just a white frothy liquid. The dog appears to be bright and alert, and is behaving normally. No abnormalities are detected on physical examination. What is the most appropriate approach in this case?

Answer 283

Provide dietary advice and antiemetics

Question 284

The owners of a 3 year old 15kg Staffodshire bull terrier inform you they have seen the dog swallow a smooth pebble approximately 3cm in diameter approximately 24h ago. What is the most appropriate recommendation?

Answer 284

Admit the dog for abdominal radiography

Question 285

What constitutes the syndrome known as triaditis in cats?

Answer 285

Pancreatitis, IBD, cholangitis

Question 286

What best describes the characteristics of pancreatitis in dogs?

Answer 286

It causes release of pancreatic lipase into circulation

Question 287

Which of the following is the most likely cause of oesophagitis?

Answer 287

Anaesthesia

Question 288

Which of the following liver disorders is least likely to be seen in a cat?

Answer 288

Nodular hyperplasia

Question 289

When using the gait and respiratory scoring system for tick paralysis in a dog or cat, which factor is not associated with a worse prognosis?

Answer 289

Low respiratory score on presentation

Question 290

List 2 toxins found in Australian snake venom (1 mark)
Briefly describe the mechanism of action of each toxin you have listed (1 mark)

Answer 290

Neurotoxin: inhibits release of presynaptic AcH from neuromuscular junction (flaccid paralysis)
Myotoxin: binds skeletal muscle fibres causing progressive destruction of cells

Question 291

A 7 year old male entire labrador presents with a one day history of stranguria and haematuria.

1. List 4 differential diagnosis.
2. Describe your diagnostic approach for the above case.

Answer 291

1. List 4 differential diagnosis.
   - Urolithiasis
   - Neoplasia
   - Benign prostatic hyperplasia
   - Prostatitis
   - Toxins
2. Describe your diagnostic approach for the above case.
   - Full physical examination
   - Full blood test, urinalysis with urine culture and sensitivity
   - Abdominal radiographs to assess urinary tract and rule out obstruction
   - Abdominal ultrasound to rule out neoplasia and examine prostate

Question 292

Which of the following is not a cause of polyuria?

Answer 292

Increased ADH secretion

Question 293

Mitzi, a 14 year old female spayed DSH cat presents to you with chronic kidney disease. On presentation her serum creatinine measures 300 umol/L. She is treated with intravenous fluid therapy for 24h and her creatinine measures 200 umol/L once she has been rehydrated. Her urine protein creatinine ratio is 0.1 and her systolic blood pressure is 140 mmHg. According to the IRIS guidelines for staging of chronic kidney disease in cats Mitzi is:
A. Stage 2: substage proteinuric and normotensive
B. Stage 3: substage non-proteinuric and normotensive
C. Stage 3: substage proteinuric and normotensive

Answer 293

B. Stage 3: substage non-proteinuric and normotensive

CKD Staging (based on serum creatinine after rehydration): Mitzi’s serum creatinine is 200 µmol/L after rehydration. According to IRIS:
- Stage 2 CKD: creatinine 140-249 µmol/L.
- Stage 3 CKD: creatinine 250-439 µmol/L.
- Therefore, Mitzi falls into Stage 3 CKD.

Question 294

Which of the following is not a common cause of feline lower urinary tract disease?
a. Bacterial infection
b. Idiopathic
c. Urethral plugs

Answer 294

a. Bacterial infection

Feline Lower Urinary Tract Disease (FLUTD) is a term used to describe a group of urinary tract disorders in cats. The most common causes include:
- Idiopathic cystitis (commonly referred to as feline idiopathic cystitis or FIC), which is the most common cause and often has no known underlying cause.
- Urethral plugs, which are typically composed of a mixture of mucus, inflammatory cells, and crystals and can cause obstruction and discomfort.

Question 295

Which of the following statements regarding SDMA is not correct

Answer 295

SDMA levels start to increase when there is a 75% loss of kidney function

Question 296

Which of the following statements regarding a colopexy is incorrect?

Answer 296

The colonic mucosa is sutured to the lateral abdominal wall

Question 297

You suspect a 2 year old maltese terrier has a portosystemic shunt. Which of the following most accurately describes the expected clinical signs and expected results of diagnostic tests if performed in this dog.

Answer 297

Thin and small stature, low albumin and urea, increased pre and post prandial bile acids

Question 298

In a dog which of the following can be used to definitively confirm the bladder has not ruptured or is leaking?
a. Bladder is palpable
b. The animal is able to urinate normally
c. There is no abdominal effusion visible on abdominal radiographs
d. Any of the above
e. None of the above

Answer 298

e. None of the above

a. Bladder is palpable: While palpation of the bladder may give some insight into its size and tone, it cannot definitively rule out a rupture or leakage. In some cases, a ruptured bladder may still be palpable if it is not fully emptied or the rupture is small.

b. The animal is able to urinate normally: The ability to urinate does not rule out a bladder rupture. Some dogs may still be able to pass urine if the rupture is small or the leak is not severe.

c. There is no abdominal effusion visible on abdominal radiographs: While abdominal effusion (fluid accumulation) can be seen in cases of bladder rupture, its absence does not definitively rule out a rupture, as the fluid may not accumulate in a detectable amount, or the rupture may be localized.

To definitively confirm bladder rupture or leakage, diagnostic tests like contrast cystography, ultrasonography, or abdominal fluid analysis (to detect urine) are typically required. These tests can provide more accurate information regarding the integrity of the bladder.

Question 299

A 20kg male neutered Kelpie presents to you with a complete urethral obstruction. On radiographs you see three radiopaque uroliths lodged at the base of the os penis and several more in a distended bladder.

1. What is the most appropriate initial treatment?
2. The same dog presents to you 1 year later with another urethral obstruction at the same location. You decide to perform a permanent urethrostomy. At what location is it best to perform this?
   - Scrotal
   - Perineal
   - Pre-pubic

Answer 299

1. What is the most appropriate initial treatment?
   - Evaluate the dogs medical status and stabilise the dog before attempting to relieve the urethral obstruction
2. The same dog presents to you 1 year later with another urethral obstruction at the same location. You decide to perform a permanent urethrostomy. At what location is it best to perform this?
   - Scrotal

Easier to access surgically.
Provides wider urethral opening and better postoperative healing.
Less likely to cause complications such as stricture formation when compared to the perineal location.
The scrotal area provides a less traumatic approach, with a good outcome in terms of function and comfort.
Perineal urethrostomy is another option but is typically used for cases where scrotal urethrostomy is not feasible or desirable. It involves a more challenging approach and has a higher risk of complications such as stricture.

Pre-pubic urethrostomy is less commonly performed and is used in very specific cases, typically involving severe trauma or anatomical abnormalities of the pelvic region

Question 300

Your practice receives an urgent phone call about Jack, a Kelpie and valuable working dog. He jumped out of the work ute going 80km/h. Mr Hones said he was initially able to walk on 3 legs but now has collapsed with blue mucous membranes. Lis immediate steps you should take when Jack is presented (0.5 mark each – 3 marks total)

Answer 300

• Initial stabilisation: begin with IV access and continual monitoring.
• Bloodwork: CBC, chemistries, electrolytes, coagulation profile, blood gasses
• Oxygen delivery
• Fluid therapy
• Analgesia / sedation
• Radiographs
• AFAST / TFAST ultrasound

Question 301

In which of the following clinical scenarios would a biopsy be considered most appropriate?
a. Labrador with a lytic lesion in the distal radius and pathologic fracture
b. A 2cm mas on the rostral muzzle of a Boxer
c. Large splenic mass in a dog with no evidence of metastasis

Answer 301

a. Labrador with a lytic lesion in the distal radius and pathologic fracture

Question 302

A malignant carcinoma was diagnosed via biopsy from the 2nd digit of the right hindleg. Choose the correct statements regarding the — lymph node on the same leg?

Answer 302

The lymph node may be the sentinel lymph node for this tumour and should be evaluated by palpation and biopsy

Question 303

For management of a solitary 2cm low grade cutaneous mast cell tumour on the lower lateral aspect of the hock of a dog which of the following statements is correct?
a. During surgery care must be taken with haemostasis as mast tumour sites have increased risk of haemorrhage
b. Margins of at least 3cm in all directions are required for complete excision
c. Adjuvant chemotherapy is required after surgery a there is a high risk of spread

Answer 303

a. During surgery care must be taken with haemostasis as mast tumour sites have increased risk of haemorrhage

Mast cell tumours (MCTs) can be highly vascular, meaning they may bleed more than other types of tumours. During surgery, careful haemostasis is needed to manage this bleeding risk.

Option b: Margins of at least 3cm in all directions are generally considered ideal for complete excision of high-grade mast cell tumours or tumours in high-risk locations (e.g., near vital structures). However, for low-grade MCTs, a 2cm margin is often adequate for complete excision, particularly in well-defined, isolated tumours. 3cm margins are typically not required unless the tumour is high-grade or in a location where aggressive behaviour is expected.

Option c: Adjuvant chemotherapy is not always required for low-grade cutaneous MCTs, especially if the tumour is completely excised with clean margins and there is no evidence of metastasis. Surgery alone can often provide a cure. Chemotherapy is generally more important in cases of high-grade tumours or those with metastasis or incomplete excision.

Question 304

Regarding surgical treatment of a soft tissue sarcoma on the lateral elbow of a dog, which statement is incorrect?

Answer 304

The prognosis for osteosarcoma is grave with survival times around 4-6 months even with aggressive treatment

Question 305

Regarding haemangiosarcoma in dogs which of the following statements is correct?

Answer 305

Surgery for splenic haemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy

Question 306

Regarding wound healing which of the following is most correct?
a. Second intention healing is characterised by formation of granulation tissue, wound contraction and epithelialization
b. Secondary intention healing is characterised by formation of granulation tissue, wound contraction and epithelialization
c. Delayed primary closure is closure of the wound with sutures after granulation tissue has formed

Answer 306

b. Secondary intention healing is characterised by formation of granulation tissue, wound contraction and epithelialization

Second intention healing occurs when a wound is allowed to heal without surgical closure (i.e., no sutures are used). It involves:

Granulation tissue formation: This tissue forms in the wound bed and provides a foundation for further healing.
Wound contraction: The wound edges gradually move toward each other, reducing the size of the wound.
Epithelialization: New epithelial cells migrate across the wound surface, covering the defect

Question 307

Regarding traumatic wounds in cats which of the following statements is correct?
- Enrofloxacin is the most appropriate antibiotic for a cat bite abscess as it is effective against the bacterial floral of the skin and oral cavity
- Cat bite abscesses are best treated by drainage and lavage.
- Antibiotics are generally recommended
- Feline granulation tissue develops more quickly compared to dogs but the processes of wound contraction and epithelialization are slower.

Answer 307

• Cat bite abscesses are best treated by drainage and lavage

Question 308

A 4 year old cat sustained a large axillary defect secondary to a cat fight. Regarding axillary skin wounds in cats which of the following statements is incorrect?
a. Granulation tissue in cats forms more rapidly and is more abundant compared to dogs
b. In the region, loss of subcutaneous tissue as a result of trauma may delay healing
c. A suitable treatment option is to manage infection, close the wound and immobilise the area

Answer 308

c. A suitable treatment option is to manage infection, close the wound and immobilise the area

Axillary skin wounds in cats are particularly challenging to manage due to the region’s limited skin mobility and lack of subcutaneous tissue, which can make closure difficult and may delay healing

Question 309

Which of the following statements regarding mammary neoplasia is most correct?

Answer 309

Surgical lumpectomy is an appropriate treatment for a small solitary mass affecting a single gland in the dog but not the cat

Question 310

Which of the following is not a reason to elect to perform a hysterectomy for a caesarean section in the bitch?

Answer 310

Where there is evidence of foetal distress

Question 311

Regarding pyometra in the dog which of the following statements are not correct?

Answer 311

Pyometra occurs in oestrous typically 4-10 weeks after last diestrus

Question 312

Regarding a salivary mucocoele which of the following statements is correct?
a. The salivary gland that leaks is most commonly the parotid salivary gland
b. The mandibular and sublingual glands grain lateral to the rostral border of the frenulum
c. Along with salivary gland, removal the secretory lining of the mucocoele should be removed

Answer 312

c. Along with salivary gland, removal the secretory lining of the mucocoele should be removed

Question 313

Regarding peri-operative antimicrobial use for oropharyngeal surgery, which of the following statements is correct?

Answer 313

The oral cavity contains normal bacterial flora comprising mainly gram positive aerobes and anaerobes

Question 314

Regarding oral tumours in dogs, which of the following statements is most correct?

Answer 314

Wide surgical excision with rostral mandibulectomy may be curative for a small squamous cell carcinoma associated with the lower central incisor teeth

Question 315

A dog has been involved in a motor vehicle accident and your perform and AFAST study. Select the correct statement from the options below:

Answer 315

Fluid is more hypoechoic than the surrounding parenchymal organs such as the spleen

Question 316

A dog has been involved in a motor vehicle accident and you perform a TFAST study. Select the incorrect statement from the options below.

Answer 316

The glide sign of the B lines and/or lung surface is abnormal and indicative of pneumothorax

Question 317

For the following clinical presentation, select the most likely diagnosis: middle aged female neutered Yorkshire Terrier with a goose honking cough.

Answer 317

Collapsing trachea

Question 318

For the following clinical signs in a dog, select the most likely diagnosis. One year old Jack Russel Terrier with occasional reverse sneezing since 5 months old:
a. Bacterial infection secondary to foreign body
b. Bacterial infection secondary to systemic viral infection
c. Idiopathic
d. Neoplasia
e. Coagulopathy
f. Tooth root abscess
g. Mycotic infection

Answer 318

c. Idiopathic

Question 319

Thor is a middle aged cat presented for acute onset of open mouth breathing and reluctance to move.

1. What is your first step in clinical examination of Thor?

Thor has occasional bouts of coughing over the last 4 months. Thor is fully vaccinated and regularly treated with milbemycin oxime and praziquantel/ Physical examination was unremarkable except for respiration rate of 60, and harsh sounds over all lung fields.
2. What is the single best diagnostic procedure to perform now?

3.Suppose Thor’s diagnosis is idiopathic allergy bronchitis. What therapy should be administered, and what is the short term (12-14h) prognosis?

Answer 319

1. What is your first step in clinical examination of Thor?
   - Provide supplemental oxygen and obtain a brief history
2. What is the single best diagnostic procedure to perform now?
   - Thoracic radiographs

3.Suppose Thor’s diagnosis is idiopathic allergy bronchitis. What therapy should be administered, and what is the short term (12-14h) prognosis?
- O2 therapy, corticosteroids, bronchodilators. Good prognosis with rapid response

Question 320

Name 2 drugs administered by metered dose inhalers to cats for management of idiopathic chronic bronchodilators / feline asthma.

Answer 320

Fluticasone
Albuterol

Question 321

Three adult indoor cats from the same household are presented for inappetence, serous nasal discharge and sneezing for 3 days. The cats were acquired from a shelter 3 years go and are fully vaccinated. A dog was introduced into the household about 10 days ago. On physical examination, in addition to the above presenting complaints, all three cats have epiphora, and one cat with blepharospasm has a pinpoint corneal ulcer.

1. Name the single most likely diagnosis for these cats.
2. What tests can be done to confirm the diagnosis.

Answer 321

1. Name the single most likely diagnosis for these cats.
   - Feline Herpes Virus 1 (FHV-1)
   - The recent introduction of a dog could have caused stress in the cats, potentially leading to a reactivation of latent FHV-1 in previously infected cats, or it could have been a source of stress that contributed to an outbreak of clinical signs. FHV-1 can remain latent in cats and reactivate under stress or immunosuppression
2. What tests can be done to confirm the diagnosis.
   - PCR (Polymerase Chain Reaction): This is the most sensitive and specific test for detecting FHV-1 DNA from nasal, ocular, or oropharyngeal swabs. PCR can detect both active and latent infections.

• Virus Isolation: Although not commonly used in routine practice, virus isolation from conjunctival or nasal swabs can confirm the presence of the virus, but it requires specialized laboratory facilities and can be time-consuming.
• Serology (Antibody Titers): FHV-1 antibody titers can be tested, but this method is less useful for diagnosing active infection since many cats are already seropositive due to prior exposure or vaccination. It may be more useful for assessing the history of exposure rather than acute infection.

Question 322

A 10 year old male neutered 31kg mixed breed dog is presented because of frequent coughing and mild lethargy over the last 24h. His vital signs are:
- Rectal temperature 39.5C
- HR 80 bpm, respiratory sinus arrythmia
- RR 30bpm
- On thoracic auscultation, loud harsh sounds are heard over the trachea and lung fields, and a grave IV/VI systolic heart murmur and is hear the loudest over the left apex beat
- Based on this data is the dogs cough more likely to reflect a primary respiratory system problem or a primary cardiovascular system problem? Explain

Answer 322

Respiratory: mild pyrexia fits respiratory infection, harsh respiratory sounds and mild lethargy (cardiovascular would be soft crackles), normal heart rate (cardiovascular would expect tachycardia), sinus arrhythmia heart

Question 323

What are signs of fluid overload in the peri-operative period?

Answer 323

Serous nasal discharge, tachycardia, tachypnoea, audible respiratory crackles, pulmonary oedema, decreased O2 saturation, ascites, polyuria, exophthalmos, decreased packed cell volume, total plasma protein

Question 324

Signs that might be observed during a cushing’s reflex due to increased intracranial pressure”
Heart rate:
Blood pressure:
Respiratory rate:

Answer 324

Heart rate: bradycardia (body aims to maintain cerebral perfusion by slowing HR)

Blood pressure: hypertension (the body increases systemic vascular resistance to try to ensure adequate blood flow to brain)

Respiratory rate: irregular or abnormal (due to impaired brainstem function which controls the respiratory centres)

Question 325

An acutely ill unvaccinated 6 month old puppy with a fever, vomiting and diarrhoea, tachypnoea, an enlarged liver and corneal oedema should be suspected having which of the following?

Answer 325

Canine adenovirus 2

Question 326

What is detected by the commonly used in clinic combination tests for diagnosis of feline leukemia virus / feline immunodeficiency virus infection.
a. FeLV antibody and FIV proviral DNA
b. FeLV antigen and FIV antibody
c. FeLV antibody and FIV antigen

Answer 326

b. FeLV antigen and FIV antibody

Question 327

A 6 month old female neutered domestic shorthair is presented to your clinic for lethargy, jaundice, ascites and inappetence. What is the most likely differential diagnosis?
a. Feline infectious peritonitis
b. Feline calicivirus
c. Feline panleukopenia

Answer 327

a. Feline infectious peritonitis

Question 328

An 8 week old unvaccinated kitten presents with a 3 day history of lethargy, mild oculonasal discharge. The owners have not noted any sneezing. A physical examination reveals the oral lesions below. Which pathogen is most likely to cause this kittens presentation?

Answer 328

Feline calici virus

Question 329

Which antibiotic is the most appropriate for the treatment of Toxoplasma gondii infection in cats?

Answer 329

Clindamycin

Question 330

1. Name the route of infection for canine parvovirus (1 mark)
2. Name the 2 anatomical regions in the body where rapidly dividing cells are targeted by canine parvovirus (1 mark)
3. List 4 clinical pathology findings that may be seen on haematology and biochemistry in a dog with parvoviral enteritis (2 marks)
4. What is the most commonly used in-clinic diagnostic test for canine parvoviral enteritis (1 mark)

Answer 330

1. Name the route of infection for canine parvovirus (1 mark)
   - Faecal oral route
2. Name the 2 anatomical regions in the body where rapidly dividing cells are targeted by canine parvovirus (1 mark)
   - GI tract & bone marrow
3. List 4 clinical pathology findings that may be seen on haematology and biochemistry in a dog with parvoviral enteritis (2 marks)
   - Leukopenia
   - Polycythemia
   - Hypoglycaemia
   - Panhypoproteinaemia
4. What is the most commonly used in-clinic diagnostic test for canine parvoviral enteritis (1 mark)
   - Faecal antigen ELISA test

Question 331

Name the 3 phases of an FIV infection (1.5 marks)
List 1 clinical sign or physical examination finding associated with each phase of infection (1.5 marks)

Answer 331

Acute phase: fever, lethargy, lymphadenopathy

Asymptomatic phase: minor recurrent infections

Terminal phase: stomatitis, gingivitis, periodontitis, upper respiratory tract infection, chronic renal failure, persistent diarrhoea, chronic skin and ear infections, fever and wasting, neoplasia, ocular disease, neurologic abnormalities

Question 332

A client asks you about a kitten they are hoping to buy from a friend whose cat jut had an unplanned littler. The kittens are 5 weeks old and the client is excited to say she will be picking up her kitten tomorrow. You advise:

Answer 332

Premature separation from the queen and kittens may lead to some behavioural problems such as frustration and aggression

Question 333

Pandora syndrome is defined as:

Answer 333

Complex aetiology of lower urinary tract signs and other stress related signs like gastrointestinal upsets

Question 334

Clomicalm (clomipramine) is registered / licensed in Australia for use in cats for:

Answer 334

Urine spraying

Question 335

Cats can live as solitary hunters or in colonies. When cats form a larger group, it is often comprised of:

Answer 335

Related females and their offspring

Question 336

Please select the incorrect answer from the list below. In cats urine spraying occurs:

Answer 336

In entire cats, but not desexed cats

Question 337

A 12 year old male desexed domestic shorthair cat presents for toileting outside of the litter tray. On further questioning you learn from the owner that the cat is toileting near their litter tray, but not inside. The litter tray is a standard sized litter tray, with a lipped edge to stop the spread of the recycled litter across the floor. The tray is cleaned every day – litter scooped and replaced, and the tray is washed with an enzymatic detergent. The litter type has not changed over the last 5 years. No other behaviour problems are reported, and he is not spraying urine. Overall, he seems less active than before. The owner suspects he is depressed. He is not lying on the windowsill anymore and when he jumps down from the couch, he seems tentative to do so. Based on the information provided, as part of your work up you would highly consider the following condition:

Answer 337

Arthritis

Question 338

Serotonin syndrome, is a dangerous toxidrome, which may:
a. Be caused by a monoxamine oxidase inhibitor medication with a selective serotonin reuptake inhibitor medication
b. Produce dysphoria and cataplexy
c. Treated with the serotonin receptor antagonist, tramadol

Answer 338

a. Be caused by a monoxamine oxidase inhibitor medication with a selective serotonin reuptake inhibitor medication

Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin activity in the central nervous system. It can occur due to the interaction of medications that increase serotonin levels, most notably:

Monoamine oxidase inhibitors (MAOIs), which inhibit the breakdown of serotonin, and
Selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels by blocking its reuptake into nerve cells.

Treatment typically involves discontinuing the offending drugs, providing supportive care, and using serotonin antagonists like cyproheptadine to block serotonin receptors. Benzodiazepines may also be used for agitation

Question 339

When a dog is feeling anxious or worried, it may display the following options:

Answer 339

Fight, flight, fiddle, freeze

Question 340

You are in consultation with a dog that is showing signs of aggression towards you. It is starting at you, growling, hackles are up, and is barking at you. What traffic light zone is the dog in:

Answer 340

Red zone

Question 341

Which of the following statements regarding the psychotropic medication categories SSRI’s and TCAs is correct:

Answer 341

Both have some therapeutic actions at serotonin receptors by blocking serotonin re-uptake into the pre-synaptic membrane

Question 342

A dog is presented to you in consult with the owner reporting firework phobia. You recommend medication, behaviour medication and environmental management steps. Which single one of the following mediations would be appropriate as needed medications options for a dog with noise phobia.

Answer 342

• Trazodone

Question 343

A dog has undergone cardiac arrest and is diagnosed with asystole on the ECG. You begin chest compressions. As part of advanced life support what are the recommended vasopressors to be given to this dog and at what interval should they be administered.

Answer 343

Epinephrine: every 3-5 minutes early in CRP

Question 344

While doing chest compressions the EtCO2 of the patient is < 15mmHg during a 2 minute cycle. What is you clinical interpretation of these readings?

Answer 344

Inefficient chest compressions

Question 345

During Advanced life support what two parameters must be monitored throughout the code

Answer 345

ECG, EtCO2

Question 346

You find a dog not breathing in a hospital cage. The correct sequence for basic life support is:

Answer 346

Compressions, airway, breathing

Question 347

You are alone and a dog needs CPR, the first thing you should do is:

Answer 347

Call for help

Question 348

Defibrillation is only indicated in certain cardiac rhythms diagnosed on an ECG. Of the cardiac rhythms below, which ones would defibrillation be indicated for:
a. Unstable ventricular tachycardia, asystole
b. Unstable ventricular tachycardia, ventricular fibrillation
c. Pulseless electrical activity, unstable ventricular tachycardia

Answer 348

b. Unstable ventricular tachycardia, ventricular fibrillation
*Can’t do in asystole or pulseless electrical activity!

Question 349

Which of the following is not a potential cause for laryngeal paralysis?
a. A very large thyroid neoplasm
b. High negative inspiratory pressure
c. Cranial mediastinal neoplasia

Answer 349

b. High negative inspiratory pressure

Question 350

Is long term survival achievable if all the right lung lobes are excised in a dog, and what percentage of the dogs total lung volume do all the right lung lobes constitute?

Answer 350

No, 55%

Question 351

Of the options below which is the most common chest wall tumour in a dog?
a. Chondrosarcoma
b. Fibrosarcoma
c. Mast cell tumour

Answer 351

a. Chondrosarcoma

Question 352

When placing external tracheal stenting which one of the following is incorrect?

Answer 352

Sutures re placed through cartilaginous tracheal rings for best support

Question 353

Right sided congestive heart failure in the dog can result in:
a. Pleural effusion and ascites
b. Pulmonary oedema, pleural effusion and ascites
c. Only pulmonary oedema and not ascites or pleural effusion

Answer 353

a. Pleural effusion and ascites

*Pulmonary oedema is more associated with left sided heart failure

Question 354

The most common sign of early left sided congestive heart failure in the dog is:

Answer 354

Tachypnoea

Question 355

On physical examination of a 6 month old domestic short hair you detect a systolic heart murmur grade 5/6 that is loudest over the right heart apex. The murmur has a crescendo – decrescendo pattern. What is the most likely cause?
a. VSD
b. PDA
c. Aortic stenosis
d. Tricuspid valve dysplasia

Answer 355

d. Tricuspid valve dysplasia

Question 356

Cardiac depolarisation usually begins in the:

Answer 356

SA node

Question 357

Generalised cyanosis is caused by:
a. Left to right shunting ventricular septal defect
b. Right to left shunting atrial septal defect
c. Tricuspid dysplasia

Answer 357

b. Right to left shunting atrial septal defect

Right to left shunting atrial septal defect (ASD): In some cases, an ASD (a hole between the atria) can allow blood to bypass the lungs and flow from the right atrium to the left atrium, leading to a right to left shunt. This can result in cyanosis because deoxygenated blood from the right side of the heart is being pumped into the systemic circulation without being oxygenated.

Question 358

The S1 heart sound is due to?

Answer 358

Atrioventricular closure

Question 359

A cardiac murmur louder than S1 and S2 heart sounds that radiates to both sides of the thorax but with no palpable thrill would be most consistent with what grades of heart murmur?

Answer 359

3 or 4

Question 360

When the ultrasound beam hits a hard reflective surface of gas or mineral, there is a difference in the acoustic shadow in the tissues deep to the reflective surface. This results in a clean or a dirty shadow deep to the hyperechoic structure. Select the most accurate statement concerning acoustic shadowing from the options below:

Answer 360

A dirty acoustic shadow occurs due to the sound wave bouncing back and forth between the gas bubble and the probe surface generating an acoustic shadow that is made up of hyperechoic reverberation lines.

Question 361

Most monitoring of the ECG uses a three lead system especially the lead II trace. Lead II measures the electrical conduction between which two limbs.

Answer 361

Left forelimb and right hindlimb

Question 362

Regarding surgical treatment of a soft tissue sarcoma on the lateral elbow of a dog which statement is incorrect?
a. Incisional biopsy is always indicated to determine the grade of the tumour prior to surgery
b. Marginal resection and external beam radiation therapy might be appropriate in certain circumstances
c. Wide excision with 3cm margins laterally and a deep fascial plane would be an adequate surgical plan
d. Low grade tumours can be shelled out as they have a pseudocapsule that prevents tumour spread

Answer 362

d. Low grade tumours can be shelled out as they have a pseudocapsule that prevents tumour spread

Question 363

Regarding bone tumours in dogs which of the following statements are incorrect?
a. The recommended treatment of osteosarcoma is limb amputation followed by chemotherapy
b. Bone biopsy may be performed using a Jamshidi needle prior to definitive treatment to exclude osteomyelitis
c. The prognosis for osteosarcoma is grave with survival times around 4-6 months even with aggressive treatment
d. The most common sites of tumour metastasis of bone tumours are the lungs, regional lymph node, and other bones

Answer 363

c. The prognosis for osteosarcoma is grave with survival times around 4-6 months even with aggressive treatment

Question 364

Regarding haemangiosarcoma in dogs which of the following statements is correct?
a. The prognosis is generally good for splenic haemangiosarcoma after surgery and most dogs have a median survival time of >12 month with optimal treatment
b. Surgery for splenic haemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy
c. Adequate staging for splenic haemangiosarcoma should include incisional biopsy to exclude benign lesions prior to definitive surgery, thoracic radiographs, and ultrasound of the heart and abdomen
d. The biologic behaviour and prognosis of dermal, subcutaneous and visceral haemangiosarcoma is similar

Answer 364

b. Surgery for splenic haemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy

Question 365

An object rapidly approaches but does not touch a dogs eye making the eye blink, which cranial nerves are involved in this reflex?

Answer 365

• Cranial nerves II and VII

Question 366

Coco is a 5 month old entire male chihuahua who presents with a history of dullness since early puppyhood and failure to learn house training skills. On physical examination you notice an enlarged dome shaped head and open fontanelles.
You perform a neurological exam and abnormal findings include dull mentation, bilateral vontrolateral strabismus, bilateral absent menace response with intact pupillary light reflexes and postural reaction deficits in all four limbs

1. What is the most likely differential diagnosis?
2. Assuming the owner has no financial constraints, list 3 diagnostic tests you could perform to confirm your most likely differential diagnosis?

Answer 366

1. What is the most likely differential diagnosis?
   - Hydrocephalus
2. Assuming the owner has no financial constraints, list 3 diagnostic tests you could perform to confirm your most likely differential diagnosis?
   - Ultrasound of the brain through the open fontanelles
   - CT
   - MRI

Question 367

Sally, a year old female spayed golden retriever presents to your clinical after having her first generalized seiure. Outline your initial diagnostic approach

Answer 367

• History of access to toxins
• Physical examination
• Neurological examination
• CBC
• Serum biochemistry
• Urinalysis
• Fasting blood glucose

Question 368

Methocarbamol would be a rational choice of medication for managing what kind of intoxication?

Answer 368

• Permethrin, metaldehyde, strychnine, and some mycotoxins

Question 369

What medication can you give to counteract the severe depression sometimes caused by apomorphine?

Answer 369

• Naloxone

Question 370

How does activated charcoal work in the management of certain toxicities?

Answer 370

• It has a large surface area, some toxins adsorb to it (only unbound toxin)

Question 371

What are the likely clinical features of unsalted macadamia nut intoxication in dogs?

Answer 371

• Head and limb weakness, vomiting and diarrhoea

Question 372

What are likely consequence of xylitol intoxication in dogs?

Answer 372

• Hypoglycaemia and sometimes hepathopathy

Question 373

Sammy is a 9 year old male castrated domestic short haired cat that presents to you with clinical signs of chronic kidney disease.

1. List two clinical signs that may be seen.
2. Apart from azotaemia, list two other possible clinicopathological abnormalities you might find on haematology or biochemistry profiles in Sammy if he has chronic kidney disease.
3. You diagnose Sammy with stage III chronic kidney disease with hypertension. Describe an appropriate treatment plan for Sammy.

Answer 373

1. List two clinical signs that may be seen.
   - Weight loss, PU, PD, inappetence, vomiting, diarrhoea, dehydration, lethargy, pale mm, dull dry coat, poor BCS, oral ulceration
2. Apart from azotaemia, list two other possible clinicopathological abnormalities you might find on haematology or biochemistry profiles in Sammy if he has chronic kidney disease.
   - Non regenerative anaemia, stress leukogram, hyperphosphataemia, hypokalaemia, elevated SDMA, hypocalcaemia
3. You diagnose Sammy with stage III chronic kidney disease with hypertension. Describe an appropriate treatment plan for Sammy.
   - Renal diet, treatment for hypertension (amlodipines, ACE inhibitors – benazepril), Fluids, anti-emetics, gastric protectants, appetite stimulants

Question 374

Regarding osteosarcoma in dogs, which of the following statements is correct?

Answer 374

• The recommended treatment for osteosarcoma is limb amputation followed by chemotherapy

Question 375

An 8 year old male castrated kelpie is lame on the left forelimb. Investigation reveals hypercalcaemia and a destructive lesion of the distal radius. The biopsy diagnosis is osteosarcoma, amputation is declined. Which of the following drug combinations would be an appropriate firs line approach for palliative treatment of this dog?

Answer 375

• Zoledronate and meloxicam

Question 376

Regarding haemangiosarcoma in dogs which of the following statements is incorrect?
- Adequate staging for suspected splenic haemangiosarcoma should include thoracic radiographs and bone marrow examination
- Approximately 30% of dogs survive at least 12 months after surgery with adjuvant chemotherapy for splenic hemangiosarcoma

Answer 376

• Approximately 30% of dogs survive at least 12 months after surgery with adjuvant chemotherapy for splenic hemangiosarcoma

*Even with treatment survival is poor, typically <6 months!

Question 377

The serious adverse effects of cytotoxic chemotherapy are commonly seen in which organs?

Answer 377

• Bone marrow and gastrointestinal tract

Question 378

Which neurological condition will not improve with spinal cord decompression surgery?

Answer 378

• Fibrocartilagenous embolism

Question 379

A 6 month old female German Shepherd dog has been urinary incontinent, since the owners acquired her at 8 weeks old. Your investigation revealed she has a left extramural ectopic ureter. The right ureter is entering the bladder normally. Both her kidneys are normal on ultrasonic evaluation. Her USH was 1.035, urinalysis was normally, urinary culture negative and there was no azotaemia or electrolyte abnormalities on her biochemistry panel. CBC was normal.
Discuss the two surgical options available for this dog. In your answer mention your preferred option and why.
- Option 1:
- Option 2:
- Preferred option:

Answer 379

Option 1: Surgical re-implantation of the ectopic ureter into the bladder
This surgery involves relocating the abnormal, extramural ectopic ureter into the bladder so that it enters at a more normal anatomical site. It can be performed via laparotomy or, in some cases, laparoscopy.
The goal is to restore proper drainage of the kidney into the bladder and resolve urinary incontinence. In this procedure, the ectopic ureter is sutured into the bladder at the trigone, allowing it to rejoin the urinary system normally.

Option 2: Nephrectomy of the affected kidney
If the ectopic ureter is severe or has caused other complications, such as significant damage to the kidney, nephrectomy (removal of the affected kidney) may be considered. This would leave the normal right kidney to continue functioning. However, in this case, both kidneys are reportedly normal, so this option would not be ideal unless there were additional, undetected kidney issues.

Preferred option: Option 1 - Surgical re-implantation of the ectopic ureter into the bladder
Why this is preferred: Given that the right kidney is normal and the left kidney has no apparent damage or disease, the optimal choice is to correct the anatomy of the left ectopic ureter so it drains properly into the bladder. This surgery has a high success rate in resolving incontinence in dogs with extramural ectopic ureters and can restore normal urinary function, which is the ultimate goal. Since the kidneys are both healthy and there are no signs of infection or renal damage, nephrectomy would not be warranted.

Question 380

Which of the following statements is correct regarding inter-fragmentary strain theory?

Answer 380

• Resorption of bone from the fracture gap will decrease the inter-fragmentary strain

Question 381

You find a haematoma between the fracture fragments during open reduction of a non reconstructive comminuted humeral fracture. Which of the following statements is not correct regarding the haematoma?

Answer 381

• It should be removed to allow fracture fragments to contact one another

Question 382

Which of the following is not a function for autogenous cancellous bone grafts?

Answer 382

• Osseous structural support

Question 383

Regarding ligamentous injuries in dogs, which of the following statements is incorrect?

Answer 383

• In second degree sprain injury to the medial collateral ligaments of the hock of a dog, stressed radiographs of the region will show no instability of the tibiotarsal joint

Question 384

Regarding fracture of the metatarsal bones in dogs. Which of the following statements is incorrect?

Answer 384

• Surgical stabilisation is always required if all 4 metatarsals are fractured

Question 385

30. Regarding carpal arthrodesis in a dog, which of the following statements is incorrect?

Answer 385

• The most common indication is carpal hyperflexion injury from falls

Question 386

A 19 week old German Shepherd is presented to you for a unilateral forelimb lameness. The puppy was running in the backyard yesterday playing with the other puppy. The owner noticed a moderate lameness today. The puppy did not eat all of his morning meal and has a temperature of 39.4 You locate the pain to the elbow joint, which appears moderately swollen. The owners are very worried and request you take an x-ray just to make sure he has not broken his leg. Examine the radiograph below, of the options given what is the best treatment for this puppy?

Answer 386

• You perform and arthrocentesis and submit for cytology and bacterial culture, and start the dog on cephalexin and firocoxib in the interim and advise repeat radiographs in 3-4 weeks.

Question 387

Which of the following fracture repair methods cannot be made to provide inter-fragmentary compression?

Answer 387

• External skeletal fixator

Question 388

A 15kg 3 year old kelpie has been in a motor vehicle accident and sustained a moderately displaced fracture of the femoral diaphysis. You are developing a plan for stabilising the fracture. Considering the following stabilisation techniques, which would not be an appropriate method of fixation?

Answer 388

• Intramedullary pin and circumferential cerclage wires

Question 389

You perform the Ortolani maneuverer by abducting the leg and palpate a clunk which is diagnostic for hip dysplasia. This clunk is due to which of the following femoral head movements?

Answer 389

• Relocation into the acetabulum

Question 390

A 2 year old dog presents to your with a recent history of being hit by a car. The dog is non-weight bearing in the right himb limb. He is painful in hip extension and stands with the limb externally rotated. Which is the most likely diagnosis?

Answer 390

• Craniodorsal hip luxation

Question 391

Which type of bandage should be used to protect the shoulder after reduction of a medial shoulder luxation?

Answer 391

• Velpeau

Question 392

You are presented with a 1 year old maltese dog with intermittent hindlimb lameness with a skipping gait. Between episodes of non-weight bearing lameness he appears completely normal. What is your top differential diagnosis?

Answer 392

• Medial patella luxation

Question 393

Regarding biopsy of a tumour which of the following is correct?

Answer 393

• Biopsy is indicated in almost every case except if the biopsy will not alter treatment or carries the same risk as definitive surgery

Question 394

Cat with a fracture.

1. What do you use to fixate? Prognosis & stability of each treatment.
2. Contraindications of casting.

Answer 394

1. What do you use to fixate? Prognosis & stability of each treatment.
   - Locking plates or dynamic compression plates - used to provide internal fixation in fractures of long bones or joints. Good for complex comminuted fractures. Prevents compressive, bending & rotational forces. Provide excellent stability - they are generally more stable than external fixators & offer a more permanent solution.
   - External fixators - Consists of pins inserted into the bone through the skin connected to a stabilising frame outside the body. Ideal for fractures with soft tissue involvement or open fractures. Prevents compressive, bending & shearing forces. Prognosis & stability only good.
2. Contraindications of casting.
   - Casting is commonly used for fractures that do not involve joints, soft tissue injury, or complex fracture patterns. However, it has limitations and contraindications
   - Fractures Involving Joints: Casting may not be appropriate if the fracture involves a joint, as the immobilization can affect joint movement and healing.
   - Comminuted Fractures: For highly fragmented fractures, casting may not provide adequate stability, and surgical fixation may be needed
   - Open Fractures: If a fracture is open (exposed bone), a cast may trap bacteria and worsen infection. External fixation or surgery is preferred in these cases
   - Fractures in Highly Active Cats: For some fractures, especially in younger or more active cats, a cast may not provide sufficient immobilization and may fail to prevent displacement of the bone fragments

Question 395

Question on ligament stability for a joint; active and passive
- i.e. biceps active vs passive = medial and cranial intra joint caudal ligament
- What is its shape i.e. straight = cranial or y-shaped = caudal medial?

Answer 395

Active stabilisers:
- Active Stabilizers (e.g., muscles and tendons): These contribute to joint stability when contracting and can control motion actively. - - For example, the biceps tendon provides active stability to the shoulder joint. It prevents cranial displacement of the humeral head in the shoulder joint. It works as an active stabiliser when the muscle contracts, helping to hold the humeral head in the glenoid cavity

Passive stabilisers:
- Passive Stabilizers (e.g., ligaments): These structures provide stability by resisting forces when the muscles are not actively engaged. Ligaments help prevent excessive joint movement by limiting range of motion.
- E.g. Medial and lateral collateral ligaments (passive stabilizers): These ligaments are key passive stabilizers in the elbow and knee, restricting excessive lateral or medial movement of the joint. They provide stability by resisting forces that could displace the joint.

Shape of ligaments:
- Cranial Ligaments (e.g., cranial cruciate ligament) are often straight as they resist cranial translation or other unidirectional forces
- Caudal Medial Ligaments (e.g., caudal cruciate ligament) may be Y-shaped or bifurcated to offer support in multiple directions and resist forces from both cranial and caudal directions.

Question 396

Select the most correct answer regarding lens luxation:
- Does not occur secondary to glaucoma, trauma or cataracts
- Is usually a secondary condition in cats
- Is usually a secondary condition in Terrier breeds
- Primary lens luxation is generally unilateral

Answer 396

• Primary lens luxation is generally unilateral

Question 397

Clinical appearance of corneal sequestrum in the cat is not
characterised by…
- Initial cottage cheese like accumulation on the surface of the cornea
proceeding to a black plaque on the cornea
- The early development of a focal tan coloured central corneal
lesion
- A raised black central corneal plague
- Ulceration around the plague margins, corneal oedema and
neovascularisation

Answer 397

• The early development of a focal tan coloured central corneal
  lesion

Question 398

Generalized progressive retinal atrophy does not cause…
- Nyctalopia (night blindness)
- Tapetal hyper-reflectivity
- Attenuation of retinal vessels
- Retinal detachment

Answer 398

• Retinal detachment

Question 399

Which of the following is not a feature of keratoconjunctivitis sicca?
- Presence of a tenacious ocular discharge
- Conjunctivitis
- Schirmer tear test of 15-20mm/min
- Corneal oedema, neovascularisation & pigmentation

Answer 399

• Schirmer tear test of 15-20mm/min

Question 400

Which of the following is not a sequel to uveitis?
- Cataracts
- Iris bombe
- Posterior & peripheral anterior synechiae formation
- Stromal melting

Answer 400

• Stromal melting

Question 401

Which diagnostic procedure would be of least use to investigate the cause of a “red” eye?
- Slit lamp examination
- Fluorescein stain
- Fundus examination
- Tonometry

Answer 401

• Fluorescein stain

Question 402

Which of the following factors are unlikely to predispose to the development of entropion?
- Scar formation following trauma or surgery
- Lagophthalmos
- Macropalpebral fissure
- Hereditary predisposition

Answer 402

• Lagophthalmos

Question 403

The treatment of a penetrating corneal injury with iris
prolapse does not include
- Topical and systemic corticosteroids
- Topical atropine
- Surgical resection or replacement of the prolapsed iris and direct
suturing of the corneal defect
- Topical and systemic antibiotics

Answer 403

• Topical and systemic corticosteroids

Question 404

Epiphora (eye watering) is not associated with:
- Uveitis
- Imperforate nasolacrimal puncta
- Keratoconjunctivitis sicca
- Ulcerative keratitis

Answer 404

• Keratoconjunctivitis sicca

Question 405

Proper examination of the lens and fundus requires a dilated
pupil. Diagnostic mydriasis is best achieved with the use of…
- Pilocarpine
- Atropine
- 1% Tropicamide
- 2% Trusopt

Answer 405

• 1% Tropicamide

Question 406

The treatment of primary glaucoma is based on the reduction of the intraocular pressure, improvement of uveoslceral outflow of aqueous & providing analgesia. Which of the following drugs would not be appropriate therapy?
- Atropine
- Prostaglandin analogues
- Systemic NSAIDs
- Topical carbonic anhydrase inhibitors

Answer 406

• Prostaglandin analogues

Question 407

The best reatment for keratoconjunctivitis sicca is:
- Short term topical cyclosporin
- Long term topical cyclosporin
- Topical corticosteroids
- Topical pilocarpine PO

Answer 407

• Long term topical cyclosporin

Question 408

The best treatment option for lower lid entropion in an 8 week old Shar Pei puppy is:
- Topical antibiotics
- Tear replacement drops
- Wait until the puppy is 12 months old until surgical correction is attempted
- Immediate eyelid “tacking” surgery

Answer 408

• Immediate eyelid “tacking” surgery

Question 409

The best treatment option for a shallow corneal ulcer in a 6yo Boxer that has been present for 3 months without improvement despite continuous AB treatment is:
- Take a culture & sensitivity & change the AB’s
- Place a third eyelid flap
- Debride the ulcer bed & continue with topical antibiotics & lubricants
- Place a conjunctival graft over the lesion

Answer 409

• Debride the ulcer bed & continue with topical antibiotics & lubricants

Question 410

Select the correct answer regarding distichia:
- Are hairs emerging through the palpebral conjunctiva of the eyelids
- Are normal facial hairs that are in contact with the cornea
- Are hairs emerging through the Meibomian gland openings along the lid margin
- Always require surgical removal

Answer 410

• Are hairs emerging through the Meibomian gland openings along the lid margin

Question 411

The clinical signs of uveitis include:
- Exophthalmos
- Pupillary dilation
- Pupillary miosis
- A profound purulent ocular discharge

Answer 411

• Pupillary dilation

Question 412

Ocular emergencies include:
- Cataracts
- Horner’s syndrome
- Anterior lens luxation
- Prolapsed nictitans gland

Answer 412

• Anterior lens luxation

Question 413

Select the correct answer regarding topical corticosteroids:
- Enhance corneal epithelialisation
- Reduce stromal collagenase activity
- Reduce corneal neovascularisation
- Are useful for the treatment of conjunctivitis in the cat

Answer 413

• Reduce stromal collagenase activity

Question 414

Descemet’s streaks are ruptures in Descemet’s membrane associated with:
- Uveitis
- Corneal ulceration
- Lipid dystrophy
- Glaucoma

Answer 414

• Glaucoma

Question 415

You are presented with an adult dog with a recent development of bilateral ovoid white central corneal opacities. Fluorescein uptake is negative & there is no associated discomfort or discharge. The likely diagnosis is:
- Lipid dystrophy
- Scarring from past corneal ulceration
- Descemetocoele
- Persistent pupillary membranes

Answer 415

• Lipid dystrophy

Question 416

The treatment of globe proptosis in a Shih Tzu puppy that presents just before the clinic closes at night:
- Can be delayed until the following morning
- Medical treatment alone with topical & retrobulbar corticosteroids is instigated
- Must be treated as an ocular emergency & prompt surgical treatment with a tarsorrhaphy should be undertaken
- Enucleation is the only treatment option

Answer 416

• Must be treated as an ocular emergency & prompt surgical treatment with a tarsorrhaphy should be undertaken

Question 417

You are presented with a 7yo Lhasa Apso with a 2 day history of a sudden onset of blindness. Bilateral fixed dilated pupils are present & there is no menace & dazzle response but there is no other significant changes seen on ocular exam. The differential diagnosis would be:
- Sudden acquired retinal degeneration
- Generalised progressive retinal atrophy
- Glaucoma
- Retinal pigment epithelial dystrophy

Answer 417

• Sudden acquired retinal degeneration

Question 418

A 9yo Golden Retriever presents with unilateral pupillary miosis, enophthalmos, ptosis & protrusion of the 3rd eyelid. The most likely diagnosis is:
- Corneal ulceration
- Uveitis
- Horner’s syndrome
- Blunt trauma to the globe

Answer 418

• Horner’s syndrome

Question 419

You are presented with a 6mo Lab with a 3 day history of profound unilateral purulent ocular discharge & conjunctivitis. The Schirmer Tear Test is 32mm/min & a shallow corneal ulcer is present. What would be the best diagnostic procedure to establish a diagnosis?
- Conjunctival biopsy
- Flush the nasolacrimal system
- Culture & sensitivity
- Check behind the 3rd eyelid for a foreign body

Answer 419

• Check behind the 3rd eyelid for a foreign body