Cats and Dogs

Question 1

What does a bitch pre-breeding exam consist of?

Answer 1

* Signalement, history

* General exam, hereditary disease

* Special reproductive exam

• digital palpation of vagina and vulva
• vaginoscopy
• cytology
• microbiology is a waste of time and money– always bacteria present

* B. canis test

Question 2

In a bitch, when can you accurately diagnose a pregnancy by the different methods? What should you never use?

Answer 2

Ultrasonography > 20 days post LH surge

Abdominal palpation > 25 days post LH surge

Relaxin test > 28 days post LH surge

Radiography > 44 days post LH surge

** recall serum progesterone levels are NEVER to be used as an indicator of pregnancy in the bitch

Question 3

How do you estimate the whelping date?

Answer 3

57+/- 1 day post D1 of dioestrus

* 65 +/- 1 day post LH surge

* 65 +/- 8 days post breeding (because there is such a long fertile period in the dog and the fertility of the sperm is so long, it gives a long window)

Question 4

When is birth abnormal in a bitch?

Answer 4

* Whelping not observed after temperature drop

* Active labour > 4 hours and no pup produced

* green-coloured or malodorous vaginal discharge (before the first puppy comes out, it means the placenta separated)

* interval between pups > 30 minutes (with myometrial contractions)

* interval between pups > 2 hours (without myometrial contractions)

* signs of pain or diffuse vaginal bleeding

Question 5

With elective caesarean section, how do you decide when it is time?

Answer 5

* Important to know d0 and D1

* progesterone drops 24 to 48 hours prepartum

* rectal temps drop 8 to 24 hours

* check fetal heart rates in last couple of days

Question 6

If you suspect uterine inertia, what should you do?

Answer 6

* Assess hypocalcaemia clinically (do not just rely on blood Ca levels– they can be normal in a hypocalcaemic bitch)

* give 10% Ca solution IV

* Listen to heart while administering calcium

* Give calcium to effect

* oxytocin may be helpful but often not necessary

Question 7

When might you see eclampsia in a bitch? What are the clinical signs? Treatment? Prevention?

Answer 7

Observed mainly in toy breed with large litters

* Clinical signs: tremors, nervousness, salivation; late stage: opisthotonus

* Treatment: Calcium IV to effect, oral calcium supplementation, wean puppies if > 4 weeks

* Prevention: adequate Ca: P ratio pre partum

Question 8

When/ why might metritis occur in a bitch? Clinical signs? Diagnosis? Treatment?

Answer 8

* 0-7 days post partum due to retained foetal membranes/ fetuses, dystocia etc. and secondary infection

* Clinical signs: fever, anorexia, vaginal discharge, doughy enlarged uterus

* Diagnosis: cytology: neutrophils, bacteria (phagocytosed), membrane parts; WBC: leukogram can be normal initially

* Treatment: treat shock, AMs (broad spectrum), evacuate uterus

Question 9

When might you see subinvolution of placental sites in a bitch? Clinical Signs? Treatment?

Answer 9

(delayed involution of placental sites)

* More often in bitches

* Clinical signs: sanguineous vaginal discharge > 6 weeks post partum

*Treatment: often self-limiting, OHE if necessary

Question 10

What are the clinical signs and pathogenesis of false pregnancy in a bitch? Treatment?

Answer 10

* mammary development and galactorrhea

* Nesting and mothering behavior

* abdominal distension/ uterine enlargement

** Pathogenesis: decreased progesterone; increased prolactin

** Treatment: Prolactin antagonist (e.g. cabergoline)

Question 11

What is the percentage of intact bitches that end up with pyometra?

Answer 11

24% of intact bitches before 10 years of age

Question 12

What is the usual cause of canine pyometra? What percentage show clinical signs within 12 weeks of their last heat?

Answer 12

* E.coli is isolated in 96% of clinical cases

* 75-93% of affected bitches show clinical signs within 12 weeks of their last heat

Question 13

Why does progesterone create the perfect environment for bacteria?

Answer 13

* Stimulates proliferation and secretion of endometrial glands (“uterine milk”)

* keep cervix functionally closed

* inhibits myometrial contractions

* Reduces immune response to pathogens

** effects are exacerbated if the uterus is previously primed with oestrogen– multiple oestrus cycles without pregnancy will have a “cumulative effect” (Cystic Endometrial Hyperplasia (CEH))

Question 14

What is the classic canine pyometra case?

Answer 14

* Middle aged to old (mean age: 7.25 years)

* Intact

* In dioestrus

* Has not been pregnant

Question 15

What is the atypical canine pyometra case?

Answer 15

* Breed predisposition e.g. Golden Retriever, Mini Schnauzer, Saint Bernard, Collie, Rottweiler etc.

* Anecdotal familial clustering

Question 16

What are the two types of pyometra? What are the clinical signs?

Answer 16

Open and closed (referring to the patency of the cervix)

* Clinical signs: not definitive… pyometra should be suspected in any intact bitch presenting 4-12 weeks after having been in heat, with vaginal discharge, depressiong, PU/PD, vomiting and/or pyrexia

Question 17

Treatment of canine pyometra

Answer 17

Ovariohysterectomy… if breeding the animal– evacuate the uterus:

• if you just gave AMs– likely uterine rupture and possible death due to endotoxaemia
• low dose prostaglandin F2alpha
• can be used in combination with aglepristone (given 24 hours prior to PGF2alpha
• treat bacterial infection with broad spectrum AM
• treat systemic signs if indicated

Question 19

Prognosis for recurrence of canine pyometra?

Answer 19

* 10-80%

** if no response to treatment within 5 days:

• poor prognosis in regard to future fertility
• increased risk of recurrence of disease

Question 20

Prognosis for future pregnancy?

Answer 20

* Dependent on uterine health

* prolonging anoestrus with androgens (e.g. mibolerone) recommended

* bitch should be bred on every heat until desire numbers of puppies are reached–> then spayed

Question 21

What is the pregnancy rate of a bitch (fertile male and female)? When is a fertility exam justified? When is it ideally done?

Answer 21

* 75% chance to produce a litter

* only 6% of bitches miss twice in two consecutive cycles

* Therefore after two empty consecutive cycles, fertility exam justified- ideally done in anoestrus (few months before next expected heat)

Question 22

Oestrus induction in a bitch?

Answer 22

* Deslorelin (GnRH agonist) implant or long acting injection

Question 23

What can a prolonged cycle indicate?

Answer 23

* Follicular cysts (cytology can confirm cycle is prolonged, ultrasound can diagnose– follicles fail to luteinise)

* ovarian neoplasia

* iatrogenic

Question 24

Treatment of follicular cysts?

Answer 24

GnRH or hcG

Question 25

When does a dog typically get vaginitis? Clinical signs? Tx?

Answer 25

Puppy- prior to first oestrus

Adult- after first oestrus and in spayed females

* CS: discharge, may attract male dogs

* TX: puppy vaginitis spontaneously resolves often, check for brucellosis, phenylpropanolamine for adults

Question 26

What is split heat?

Answer 26

* Physiological and behavioural signs of proestrous occur without progress to oestrus (common in young bitches)

* after 4 weeks “normal oestrous cycle” with ovulation occurs

Question 27

Who is primarily impacted with shortened anoestrus? TX?

Answer 27

German Shepherds–

TX: delay oestrous with androgens (mibolerone; Cheque Drops)

Question 28

What is ovarian remnant syndrome? Clinical signs? Tx?

Answer 28

* piece of ovarian tissue left behind at time of spaying

* bitches present with signs of prooestrous (+/- bleeding)

* can do hcG/GnRH stimulation test

* laparoscopy during oestrus or luteal phase

Question 29

How can we tell if a bitch is spayed?

Answer 29

* look for midline incision

* measure LH and FSH–> would be high due to lack of negative feedback

Question 30

How do you diagnose prostatic diseases?

Answer 30

* Sample of prostatic fluid–> collect ejaculate

Question 31

What percentage of intact male dogs have benign prostatic hypertrophy/plasia (BPH)? TX?

Answer 31

> 90%

* TX: Castration

Question 32

What are the major prostatic diseases? What are they often secondary to ? What’s the only one that is not treated by castration?

Answer 32

Benign Prostatic Hypertrophy/plasia (BPH)

* prostatitis- acute or chronic

* Prostatic abscesses- often secondary to prostatitis

* prostatic cysts

* Neoplasia: castration is not a cure!– grave prognosis by the time diagnosed it has almost always metastasized… almost always malignant adenocarcinoma

Question 33

What can occur with Prostatomegaly?

Answer 33

* haematuria, haemospermia, tenesmus (flat faeces), dysuria, poor semen quality/ infertility, acute prostatitis: fever, anorexia, lethargy

Question 34

Prostatomegaly diagnosis?

Answer 34

* Rectal palpation: size, symmetry, surface, pane

* RX

* Cytology and culture of prostatic fluid

* Urinalysis

* Retrograde cysturethrography

Question 35

Treatment of prostatomegaly (except neoplasia)

Answer 35

Finasteride (5 alpha reductase inhibitor) or progesterone until breeding career is over… consider freezing semen

Question 36

What is unique about feline repro?

Answer 36

mate multiple times to ovulate

Question 37

How do you terminate pregnancy in a bitch?

Answer 37

* Ovariohysterectomy

* If not okay, then first confirm she is pregnant (if it too early, do not give anything):

• PGF2alpha (dogs are not as sensitive as other species- over a course of 5 days)
• dopamine agonists (prolactin, maintenance of pregnancy, antagonist)
• aglepristone (block progesterone receptors)
• corticosteroids

or a combination of the above

Question 38

Speak through the stages of whelping (length too).

Answer 38

Question 39

With a potential obstructive dystocia, what should be done?

Answer 39

* it is an emergency

*two procedures should always be done:

1. vaginal exam (to feel or see stressed pup, check for contractions (hypocalcaemia if no contractions; obstructive if contractions)
2. ultrasonography (if they are alive and how stressed they are)

Question 40

What should you think about with an infertile bitch?

Answer 40

Question 41

What should you think about in a bitch that fails to cycle?

Answer 41

* karotyping

Question 42

What should you think about with an irregular oestrous cycle in a bitch?

Answer 42

Question 43

Common repro related disease in cats

Answer 43

Question 51

What are special considerations for neonate (first 6 weeks) and paediatric (first 12 weeks) anaesthesia?

Answer 51

* limited organ reserve

* exaggerated or prolonged effects of anaesthesia

* CV: low myocardial contractile mass, low ventricular compliance, SV and cardiac reserve are limited, CO is rate dependent, persistence of fetal circulation in foal up to 3 days (right to left shunt)

* Symp NS not full developed: minimal increase in HR and myocardial contractility–> further impairing ability to increase CO, poor vasomotor control and inadequate response to blood loss

*Resp: pulmonary reserve is minimal, more compliant chest–> greater work of breathing, higher minute volume

* Thermoregulation: immature thermoregulatory system, high body surface to mass ratio, prone to hypothermia

Question 52

Major physiological differences affecting pharmacological properties of anaesthetics?

Answer 52

1. Hypoalbuminemia–> more free drug
2. Increased permeability of BBB
3. Increased percentage of body water content–> greater apparent volume of distribution
4. Fixed circulating fluid volume–> more susceptible to hypovolaemia
5. Low body fat percentage– less drug redistribution in adipose tissue
6. Immature hepatic metabolism- increased duration of action
7. Immature GFR- increase duration of action
8. higher metabolic rate– increase oxygen consumption and CO production

Question 53

What should anaesthetic protocol include with drugs for neutering?

Answer 53

Sedative, muscle relaxant, analgesia, hypnotic

Question 54

What might you use as premedication in a young adult for anaesthesia in a dog and cat?

Answer 54

* IM medetomidine & methadone- cats and dogs (or Ace & hydromorphone- dogs, or ketamine & midazolam & methadone- cats)

Question 55

What might you use in IV anaesthetic induction in a young adult dog or cat?

Answer 55

* Propofol +/- diazepam (or Alfaxalone +/- diazepam, or diazepam & ketamine)

Question 56

What might you use for maintenance in a young adult dog or cat?

Answer 56

Isoflurane in oxygen, balanced crystalloid solution (5 ml/kg/h)

Question 57

What might you use for loco-regional analgesia in a young adult dog or cat?

Answer 57

* Line block with bupivacain or ropivacaine

* intra-testicular block with lignocaine (dogs)

Question 58

What would you use in a young adult dog or cat for post op analgesia?

Answer 58

* NSAID (carprofen or meloxicam), +/- opioid

Question 59

What might you use for neutering premed in paediatric dog or cat?

Answer 59

IM anaesthetic–> acepromazine (low dose) & methadone- dogs and cats (or hydromorphone (dogs), or ketamine (low dose) & midazolam & methadone-cats)

Question 60

What might you use for neutering paediatric patient dog or cat IV anaesthetic induction?

Answer 60

* Propofol +/- diazepam

* Alfaxalone +/- diazepam

Question 61

What might you use for maintenance in a paediatric patient in a dog or cat?

Answer 61

* isoflurane in oxygen, balanced crystalloid solution, +/- dextrose solution at 2 to 5 mL/kg/hr

Question 62

What might you use for Loco-regional analgesia in a paediatric patient in a dog or cat?

Answer 62

Caution to total volume administered

* line block with bupivacaine or ropivacaine

* intra-testicular block with lignocaine (dogs)

Question 63

What might you use for post op analgesia in a paediatric patient in a dog or cat?

Answer 63

NSAID (carprofen or meloxicam) +/- opioid

Question 64

CV changes induced by pregnancy? CV changes during labor?

Answer 64

* estrogens decrease vascular resistance, combined with CO– BP unchanged, increased HR and SV

* Blood volume increased by 40%– plasma > RBCs = decreased PVC = decreased [Hb]

* Labor:

• Increased HR, CO, BP, and central venous pressure (CVP), increase oxytocin levels
• in dorsal recumbency, gravid uterus will compress caudal vena cava= decrease venous return which will decreased blood for to uterus

Question 65

Respiratory physiological changes induced by pregnancy

Answer 65

* Progesterone increases CNS sensitivity to CO2– normal PaCO2 decreased to 30 mmHg, increased minute ventilation

* increased tissue oxygen demands (VO2)

* Decreased functional residual capacity (FRC)- gravid uterus pushes up on diaphragm= less space for lungs, more sensitive to hypoxemia and hypercapnia

* decreased FRC + increased minute ventilation = faster induction with inhalants

Question 66

Physiological changes to the GIT during pregnancy

Answer 66

* Gravid uterus pushing on stomach

* Decreased gastric motility

* decreases oesophageal sphincter tone

* risk of regurgitation increased

Question 67

Physiological changes to liver and kidneys during pregnancy

Answer 67

* Increased hepatic and renal blood flow– GFR increased by up to 60%, BUN and creatinine decreased

Question 68

Physiological changes induced by pregnancy to uterus

Answer 68

* Uterine blood flow changes during pregnancy and labour

* Uterine contraction and oxytocin decrease uterine blood flow–> decreased foetal viability, effect worsen by anaesthesia

Question 69

What are conditions that favour drugs crossing the placenta?

Answer 69

Drug: * Poor ionization in the dam- non-ionized can pass but becomes ionized and cannot pass back out

* Low molecular weight

* low protein binding

* high lipid solubility

(qualities of a good anaesthetic drug but bad for the foetus)

Placenta:

* thickness and surface area of placenta determine how much drug will transfer

* concentration gradient (dam to fetus) another determination

Patient:

* pH

*pK

Question 70

General considerations when choosing drugs for Caesarean section

Answer 70

* Be prepared and quick

* Use smallest doses possible

* consider local anaesthetics

* Avoid long acting drugs

* Choose reversible drugs if possible

* Minimize inhalant concentration (reduced MAC in pregnancy)

* Dam is at increased risk for vomiting and regurgitation

* have warming devices, oxygen, intubation kits, dry gauze to wipe secretions from mouth and nose ready

* Emergency drugs ready: reversal agents (for dam and puppies), epinephrine, atropine, dextrose

Question 71

Premedication for Caesarean section

Answer 71

* Opioids- minimal resp effects vs. analgesia–> methadone

* Avoid Acepromazine or alpha 2 agonists (NO XYLAZINE)

* May skip pre-med

* pre oxygenate the patient!!!

Question 72

Induction drugs for Caesarean section

Answer 72

* Propofol, Alfaxalone

* Can consider Fentanyl + Midazolam if dam is exhausted after prolonged dystocia

Question 73

Maintenance drugs in caesarean section

Answer 73

* propofol/isoflurane or sevoflurane

* will require IPPV due to dorsal recumbency

* Consider additional analgesics after removal or puppies

* don’t forget local analgesia

* Ephedrine maintains uterine blood flow while treating hypotension

Question 74

Things to remember with puppy or kitten resuscitation

Answer 74

* Oxygen is the single most important thing you can provide

* Rub vigorously to stimulate breathing

* Doxapram under tongue if nothing

* provide warmth and oxygen rich environment

* reversal of the drugs given to the dam that could have transferred to the puppies through the placenta

Question 75

Drugs for recovery after Caesaerean section

Answer 75

NSAIDs +/- Tramadol for dam for post-op pain

Question 76

When should you desex female dogs?

Answer 76

6 months of age (in a shelter 8-12 weeks of age– claimed decreased stress and operative time, assurance de-sexed when rehomed)

Question 77

What is the ovarian artery a direct branch of? What does it supply?

Answer 77

The aorta

* The ovarian a. supplies the ovary and the cranial aspect of the uterus

Question 78

Where does the right ovarian vein drain into? Where does the left ovarian vein drain into?

Answer 78

* Right ovarian vein drains into the caudal vena cava

* Left ovarian vein drains into the left renal vein

Question 79

Ovariohysterectomy in season

Answer 79

Question 80

What is a major benefit of canine and feline spays?

Answer 80

Question 81

What suspends the uterus and ovary from the abdominal cavity? What makes up x?

Answer 81

Broad ligament: mesovarium, mesosalpinx, mesometrium

Question 82

What attaches the ovary to the uterine body? What does it continue on as?

Answer 82

Proper ligament (continused caudally as the round ligament that courses within the broad ligament, passing through the inguinal canal)

Question 83

Indications for Caesarean Section

Answer 83

Question 84

What is the uterine artery a branch of?

Answer 84

Internal pudendal artery

Question 85

What lymphatic drainage exists from the canine and feline repro tract? Innervation?

Answer 85

* hypogastric and lumbar LNs

* Hypogastric plexus (symp), pelvic nerves (PS)

Question 86

Why is ventral midline preferred over flank?

Answer 86

* Better access to peritoneal cavity if problems occur

* Can check haemostasis

* Access to right ovary can be difficult through flank approach

* Anecdotally increased incidence of seroma with flank procedures (3 x muscle layers)

Question 87

Size of OVE incision in a dog? Cat? What should you always do first?

Answer 87

Canine: 1-2 cm caudal to the umbilicus extending 5 cm

Feline: 3-4 cm incision centred over the midpoint between the cranial rim of the pelvis and the umbilicus

* express the bladder

Question 88

Clinical signs of pyometra and clinical pathology?

Answer 88

Question 89

Diagnosis of pyometra

Answer 89

* abdominal palpation, radiographs, ultrasound (most sensitive– demonstrates presence of fluid and thickness of uterine wall)

Question 90

Mean age of pyos?

Answer 90

6

Question 91

Answer 91

Vaginal oedema– during oestrogenic phase, vaginal mucosa becomes swollen allowing a transverse fold to prolapse through vulva (esp Brachycephalic breeds)… regresses spontaneously, OVH permanent relief

Question 92

Why do you avoid using chromic catgut in a continuous manner?

Answer 92

Less tensile strength and its loss of tensile strength relies on phagocytosis not hydrolysis and its rate is unpredictable

Question 93

Neoplasia of the vulva/vagina dogs

Answer 93

Question 94

Epesioplasty

Answer 94

Episoplasty is most commonly used in the treatment of chronic perivulvar dermatitis secondary to skin

folds and or infantile external genitalia. Cresenteric resection of redundant skin folds improves the

micro

environment, prevents vaginal hooding and allows improved air circulation and drying of

perivulvar skin.

Medical therapy with appropriate antimicrobial agents should be instituted prior to

surgery

Question 95

Consequences of being entire

Answer 95

Question 96

Indications for castration

Answer 96

Question 97

Complications of OVH

Answer 97

* Haemorrhage, most common (76% of all complications)

* Wound healing complications e.g. suture reaction (esp cats), seroma, fistulous tracts

* Stump pyometra- progesterone produced by remnants of ovarian tissue or exogenous

* Ureteral ligation

* Ovarian remnant syndrome (mammary development, bleeding)

* Urinary incontinence (11-20%)

* Weight gain (26-38% gain reported)

Question 99

When is scrotal ablation performed?

Answer 99

Question 104

Signs and symptoms of a Sertoli cell tumour

Answer 104

Question 105

Signs and symptoms, consequences of interstitial (Leydig) tumours

Answer 105

Question 106

Size of incision in caesarean section ventral midline approach

Answer 106

2-3 cm cranial to and 5-6 cm caudal to the umbilicus

Question 107

Clinical signs and diagnostic approach to testicular masses

Answer 107

* Also histo via excisional biopsy

* for high breeding value animals- testicular sampling (FNA and biopsy)

Question 108

Why should you rub instead of swing a foetus?

Answer 108

Safer, swinging has been implicated in causing brain damage

Question 109

What sutures and materials in a C-section?

Answer 109

* Cushing or Lembert pattern with synthetic absorbable monofilament suture

Question 110

Why does pyo often occur during dioestrous?

Answer 110

* Cervix closed and progesterone increases secretions of uterine glands, inhibits myometrial contraction and closes the cervix, results in cystic endometrial hyperplasia, inhibits the leukocyte response facilitating bacterial colonisation

Question 113

Treatment of pyometra

Answer 113

* PGF2alpha luteolysis (lowering progesterone) + Broad spectrum antibiotics (Clavulox or enrofloxacin)

* Surgical : OVH, care not to rupture distended uterus, lavage

Question 115

Clinical signs and treatment of paraphimosis?

Answer 115

Question 116

Urethral prolapse clinical signs and symptoms?

Answer 116

Question 117

Treatment of urethral prolapse

Answer 117

Question 118

Penile neoplasia tumour types in dogs and cats

Answer 118

Question 119

Diagnosis and treatment of penile tumours?

Answer 119

Question 120

How do you differentiate Vaginal Prolapse from Vaginal Oedema?

Answer 120

Circumferential prolapse of the vagina

Question 125

Lump on a scrotum- what do you want to rule out first?

Answer 125

Mast Cell Tumour with FNA

Question 126

Timing of castration

Answer 126

6-9 months as optimal age (no demonstrated negative effects in dogs and cats

Question 128

Complications with castration

Answer 128

* Scrotal bruising/haematoma

* Haemorrhage

* Dermatitis

* Infection/abscess

* Persistent Priapism in cats

Question 129

Fertility in cryptorchids

Answer 129

* Bilaterally affected animals- sterile; unilaterally affected animals- sub-fertile

Question 130

Most common primary testicular neoplasms in dogs

Answer 130

Interstitial Cell Tumours (aka Leydig)

Sertoli Cell Tumours

Seminomas

Question 131

In an abdominal cryptorchid, where do you look for the testicle(s)?

Answer 131

Underneath the bladder

Question 134

What is a seminoma?

Answer 134

* Neoplastic change in cells responsible for spermatogenesis

Question 136

Cryptorchid confirmation of location

Answer 136

* Abdominal or inguinal

* Palpation (fat, LNs)

* Ultrasound

Question 137

Clinical signs of prostatic disease

Answer 137

* Dyschezia/ constipation

* Urethral bleeding/ discharge

* Pyrexia

* Hindlimb stiffness- weakness

Question 138

Diagnosis of prostatic disease

Answer 138

* Radiography (mineralisation associated with neoplasia in castrated dogs, displacement of adjacent tissues- colon, bladder, osteolysis of vertebral bodies, positive contrast studies)

* U/S– enhances accuracy of FNA or biopsy

* Fluid samples for cytology and culture can be obtained by: sampling ejaculate, prostatic wash , U/S guided FNA

Question 139

Indications of prostate surgery? Caution? Omentalisation?

Answer 139

* Biopsy, prostatic abscess, cystic disease, prostatic neoplasia

* avoid the dorsolateral aspects- neurovascular pedicle

*Omentum: vascular supply, lymphatic drainage, immuno-competent cells

Question 140

Partial vs. Complete Prostatectomy

Answer 140

* Partial prostatectomy: potential for significant blood loss, temporary arterial occlusion, pre-place catheter to ID the urethra,

* Complete: Malignant neoplasia sole indication (uncommon due to late dx, early metastatic dx, lack of impact on distant disease, likely incontinence)

Question 141

What is phimosis?

Answer 141

* Inability to extrude penise because preputial orifice is too small (congenital) or acquired due to trauma, infection, scarring, neoplasia…. from urine pooling and balanoposthitis, erectile pain

** Surgery- enlargement of a narrowed preputial os using a v-shaped incision on the dorsal surface and apposition of mucosa to skin

Question 142

Paraphimosis

Answer 142

* INability to retract within the prepuce– congenital or acquired (trauma, infection, internal rolling and entanglement with hair)

Question 148

What does a state of mild metabolic acidosis do to calcium?

Answer 148

Increases serum calcium level through increased tissue responsiveness to PTH

Question 149

What do we need Ca most for parturtion?

Answer 149

Muscle contractions

Question 150

Commercial Labrado breeding colon 7% rate of stillbirths in the last 2 years, uterine inertia- compared to GSD from colony with low SB/inertia rate

* high venous pH during whelping

* similar total Ca concentrations

* Lower ionised Ca concentrations

* higher PTH concentration

Answer 150

Likely Congenital– crossing with other breeds now

Changed food similar to what you’d do in dairy cows– which lowered the stillbirth rate

Question 151

What tells you something: total Ca or ionized Ca?

Answer 151

** Ionized Ca

Question 152

What are the local effects of MCT?

Answer 152

* Degranulation of MCT

• oedema
• ulceration
• swelling

Question 153

Paraneoplastic effects of a MCT

Answer 153

Question 154

Clinical presentation of MCT in dogs

Answer 154

Can be bad: rapid growht, local swelling, paraneoplastic signs, palpably enlarged spleen or draining LNs, anatomic location (mucocutaneous junctions and inguinal region)

Question 156

What are the histological classifications of MCTs? What additional therapies might be used in different grades

Answer 156

* Grade 1- benign

* Grade 2- hasn’t decided

* Grade 3- aggressive with early metastases

Question 157

How big are the margins for each histological classification?

Answer 157

Question 158

What is meant by 3D surgical margins?

Answer 158

Question 159

What would you do next?

A. FNA lump

B. FNA lump & spleen/liver

C. FNA lump, spleen, liver and get bone

D. Get incisional biopsy of mass

Answer 159

A. FNA lump BECAUSE your best chance to cure is your first cut

Question 160

Answer 160

FNA cytology confirms MCT

Question 161

Answer 161

A

Question 162

Grade 1 MCT with incomplete margins

Answer 162

** a C- kit - if the tumour has a c- kit mutation known to be sensitive to tyrosine kinase inhibitor. Not quite Chemotherapy but similar idea. Wouldn’t choose C because it makes the dogs really sick and we aren’t even sure it will work– and we are not in Brisbane. It is not in an area that would have few side effects (e.g. a limb)

** B. probably

Question 163

A. FNA lump

B. FNA lump and pre scapular lymph node

C. FNA lump, lymph node, and do further staging

D. Get incisional biopsy of mass

Answer 163

Rapid develop, so it is aggressive, so FNA lump and pre scapular lymph node (B)

Question 164

FNA cytology = MCT

* FNA cytology LN poor cellular yield but occasional mast cell noted

Answer 164

A

Question 165

A. Nothing- watch, wait, and see

B. Adjunctive chemotherapy

C. Revision surgery only

D. Refer for radiation

Answer 165

C. Revision Surgery (+ B is the optimal)

Question 166

A. Limb amputation

B. Palliative chemotherapy only

C. Systemic chemotherapy

D. Refer

Answer 166

C or D gold standard

Question 167

A. The prognosis for Billyis poor as he has multiple MCT

B. Adjunctive chemotherapy is necessary regardless of MCT grade

C. Staging is still necessary for each MCT

Answer 167

C. Staging is still necessary for each MCT

Question 168

Important considerations for treatment of MCT?

Answer 168

Question 169

When is a marginal incision acceptable?

Answer 169

Question 170

What are the common MCT dermal tumours?

Answer 170

Question 172

What are soft tissue sarcomas?

Answer 172

* Skin and S/C most common locations but can be anywhere

* Slow growing

* Locally invasive

* Low metastatic rate (grade dependent)

Question 173

Soft Tissue Sarcoma (STS) presentation?

Answer 173

Question 174

STS metastasis?

Answer 174

Question 175

STS prognosis

Answer 175

Question 176

STS Diagnosis

Answer 176

Question 177

STS treatment?

Answer 177

* Pseudocapsule- tumour cells at capsule invade surrounding tissue

* Make STS appear easy to shell out– DO NOT shell out tumour

* Margin status predictive of local recurrence

* Local recurrence common after incomplete surgical resection

Question 178

STS treatment depending on margins– complete or incomplete and grade?

Answer 178

Question 179

What would you do next?

A. Incisional biopsy

B. Excisional biopsy

C. Amputate leg

D. Refer

Answer 179

A. Incisional biopsy

Question 180

Incisional biopsy shows Grade 1 STS

Answer 180

C. Marginal excision and radiation

(Can do amputation, no indication for metronomic chemotherapy)

Question 181

Incisional biopsy shows Grade III STS

Answer 181

A. amputate leg is the most curative but depends on owner…. otherwise B and C

** STS’ are not that responsive to chemotherapy

Question 182

What are spot on products?

Answer 182

Question 183

What are the active ingredients in Frontline? Mode of actions? How is it absorbed? Who can you NOT use it in?

Answer 183

Question 184

Who can Fibronil spray be used in? Who can it NOT be used in?

Answer 184

Question 185

What is the active ingredient in advantage? Mode of action? How is it absorbed? What does it treat?

Answer 185

Question 186

What is advantix? Who can you NOT use it in? What is it for?

Answer 186

Imidacloprid + permethrin (fleas, ticks, and mossies)

Question 187

What are the active ingredients in advocate? What is it for?

Answer 187

Question 188

What is the active ingredient in Revolution? How is it absorbed? Who CAN it be used in safely (as opposed to ivermectin)?

Answer 188

Question 189

What is the active ingredient in Activyl? What does it treat?

Answer 189

Question 190

What are the four types of oral flea prevention?

Answer 190

Question 191

General principles of diagnosing a MCT

Answer 191

* Cytology usually diagnostic & prognostic

* Can consider incisional biopsy– more $, great risk wound breakdown

* thorough planning is best

Question 192

What are topical anti-inflammatories used in SA?

Answer 192

Question 194

What are the types of topical medications used in animals?

Answer 194

Question 197

What are the different schedules of drugs?

Answer 197

Question 198

What are transdermal patches? Example?

Answer 198

Question 199

What are the two times you might consider using antibiotics and gluctocorticoids together?

Answer 199

* Dogs with a normal HPA axis- the use of GC with antibiotics may be counter productive

* But short term use of combinations of corticosteroids and antibiotics with comparable pharmacokinectics on the skin like aminoglycoside antibiotics can be of clinical benefit

Question 202

Why does infection triggered itch respond poorly to glucocorticoids?

Answer 202

* Protease pathway is not blocked

Question 203

Common breeds associated with atopic dermatitis? Associated with demodex?

Answer 203

Question 205

What do you need for dermatology in a SA clinic?

Answer 205

Question 206

What bacterial infections commonly occur in domestic animal skin infections?

Answer 206

Question 208

How does MRSP spread its resistance?

Answer 208

Question 210

Properly set up microscope for unstained cytology

Answer 210

Question 211

Why are dogs skin more susceptible to infection vs. humans?

Answer 211

Question 213

DDX?

Answer 213

Alopecia

* Excess loss or failure to grow

* DDX:

• excess loss: self trauma or folliculitis
• failure to grow: endocrinopathy

Question 214

Diagnostic approach to alopecia

Answer 214

Question 216

Answer 216

Pyo traumatic dermatitis (aka hot spot)

* considered surface infection in most cases (usually staph)

* Treat with topical drugs

Question 217

Answer 217

Treat topically

Question 218

Answer 218

* oral antibiotics for 2-3 weeks

Short acting Dex (36 hours)– not steroids on going!!

* Topical antibiotic with steroid– e.g. He always uses fusiderm or neocort– (but does not penetrate, has lignocaine in it which is toxic to the skin so longer than a week causes a chemical burn– so never in thin skins– nowhere near scrotum in male dogs)

Question 219

When would you perform a Trichogram?

Answer 219

1. Trauma
2. Dermatophytosis (ringworm)
3. Parasites
4. Anagen: Telogen ratio

Question 220

Answer 220

Question 221

Answer 221

Does not need oral antibiotics

Answer 222

Does not need oral antibiotics– topical will be faster, quicker, easier

Question 223

Answer 223

Question 224

Answer 224

Question 225

Answer 225

Malassezia but could be bacteria so cytology

Question 227

Answer 227

Question 229

Cytology for surface infections

Answer 229

Question 231

Answer 231

Question 232

Answer 232

Question 233

Answer 233

Question 234

Answer 234

Question 235

Answer 235

Question 236

Answer 236

Question 237

Treatment for surface infections

Answer 237

Question 238

Maintenance and Prevention of Skin Infections

Answer 238

Question 239

Answer 239

Question 240

Answer 240

Question 241

Answer 241

Question 242

Answer 242

Question 243

Answer 243

Question 245

Diagnostics for pustules? Papules? Crusts? Annular scale (dry lesions)?

Answer 245

Question 246

Answer 246

Eosinophil- does not mean allergy, just means skin infection

Question 247

Answer 247

Degenerative neutrophil- toxic effects because of bacterial– just means bacterial infection

Question 248

Systemic treatment for bacterial infections? Shampoos? What is the minimum course?

Answer 248

Treat for at least 7 days after clinical resolution, minimum of 3 weeks

Question 249

Superficial bacterial infections take aways

Answer 249

Answer 250

Question 251

Why do deep infections occur?

Answer 251

Question 252

Deep infection diagnosis? Length of treatment? Likely microorganisms involved?

Answer 252

Question 253

Choosing antibiotics for deep infections

Answer 253

Question 254

Questions to ask for repeat derm infections

Answer 254

Question 255

Common recurrent derm infections

Answer 255

Question 256

Dermatophytosis- 3 common species?

Answer 256

Question 257

Diagnosis of dermatophytosis

Answer 257

Question 258

Answer 258

Question 259

Treatment for dermaphytosis

Answer 259

Question 260

When do you use a skin scraping?

Answer 260

Question 261

How do you perform a skin scraping?

Answer 261

Question 262

Deep skin scrapings, looking for?

Answer 262

Question 263

Tips in deep skin scrape

Answer 263

Question 265

Stained cytology microscope set up

Answer 265

Question 266

When do you take an impression smear?

Answer 266

Question 267

What is unique about cat MCTs?

Answer 267

* Staging more important

* Splenectomy more helpful

* No histological grading scheme but nasty appearance normally poor prognosis

* Surgery curative if possible

* Radiation poor results

* Chemotherapy if metastatic disease

* Tyrosine kinase inhibitors maybe

Question 268

Answer 268

Question 269

What are the early lesions in dry scaly or greasy skin? Chronic lesions?

Answer 269

Question 270

Diagnostics for pustules, papules and crusts

Answer 270

Question 271

Diagnostics for alopecia

Answer 271

Question 272

Answer 272

Question 273

Answer 273

Question 274

Answer 274

Question 276

Considations with Nodules

Answer 276

Question 277

Diagnostics with nodules

Answer 277

Question 296

What is meant by integrated flea control?

Answer 296

* Blood meal –> lay eggs (50/day)

* Eggs hatch faster when warmer

* Adults are less than 5% of population

* Flea dirt- digested blood and excrement from adult fleas

* Treat all animals in household with adulticide and IGR

* Environment? Flea bombs

* Wash bedding- hot water

* Vacuum, empty out vacuum bags

Question 298

What are the common bacterial pathogens in pyoderma?

Do you need to use oral antibiotics?

Which antibiotics could you use?

What tests could you do to help make these decisions?

Question 300

How are topically administered drugs absorbed?

Answer 300

Two ways:

* Drugs absorbed transdermally into the plasma e.g. fentanyl patch

* Long acting– topical administered and act locally e.g. fipronil

Question 301

What are the benefits of topical drug administration? Challenges?

Answer 301

* Convenience, compliance, safety, maximize local drug concentrations

CHALLENGES:

* Penetration of stratum corneum- intercellular, transcellular, sweat glands/ hair follicles

* Absorption- lipids solubility, penetration enhancers (e.g. propylene glycol)

* skin is an organ, not just a barrier- some metabolism does occur in the skin

* Human safety (petting after application)- young children

* Metabolism phase I and phase II metabolic processes

* Species variation (wool on sheep vs. pigs)

Question 305

Combined antibiotic and corticosteroid cream in treatment of moderate to severe eczema, friend or foe?

Answer 305

Rapid resolution but increase in fucidin resistant S. aureus

Question 306

What are the presumed benefits of shampoo treatment? However, what is the other possibility?

Answer 306

* Removal of allergens, decrease antimicrobial load (chlorhex and miconazole), reduce itch (colloidal oatmeals)

* Surfactants are irritants– shampoo with 44 ingredients

Question 309

Why is cytology so important in making good therapeutic choices with the skin?

Answer 309

Skin has limited ways it can react

Question 312

What is a good antibiotic for Staph skin infections? If it doesn’t get better, what might be the problem?

Answer 312

Cephalexin

** Could be fungal, could be MRSP

Question 314

MRSP risk factors

Answer 314

*Dog comes in with infection with a history of visits from multiple vet clinics, most common place to pick up is vet waiting rooms

* Dogs who have been hospitalized

* Dogs with a history of antibiotics AND drugs that affect the immune system (GCs, cyclosporin, etc.) ** immune system does not discriminate between staph and resistant staph

* High density living- contact with other dogs- grooming salons

* dogs who have had lots of ear infection– enough systemic absorption of antibiotics to change and skew staph bacteria towards resistance

Question 317

Why do dogs get skin infections?

Answer 317

*Anatomical reasons– face folds like bull dogs

*Microclimate changes– left wet

*Decreased exfoliation/follicular obstruction

*Decreased immunity

*Self trauma (scratching)

*Atopic dermatitis

Question 320

What is always true about Malassezia?

Answer 320

* Almost always surface infection, but bacteria can be surface, superficial or deep

Question 331

If you see a rod shaped bacteria in a year, what is it likely to be?

Answer 331

Pseudomonas

Question 333

How do you know if Malassezia is what is causing the problem?

Answer 333

Treat for it and see if it goes away

Question 335

Surface infections, what kind of treatment?

Answer 335

Surface treatment

Question 349

Other Causes of folliculitis? Pustules?

Answer 349

* Folliculitis: demodicosis, dermatophytosis

* Pustules: pemphigus foliaceous, contact allergy

Question 369

Pustules/ papules and crusts general DDX

Answer 369

Infection, immune mediated, allergy

Question 372

When would you use scapel blade cytology?

Answer 372

Dry papules for bacteria or cell types, acantholytic cells

Question 380

When do you use FNA

Answer 380

Nodules, tumours, cysts

Question 484

Equipment for opthamology

Answer 484

* Focal light– intense, bright light source with fibre optics

* Handheld magnification

* equipment to look at the fundus (interior surface of the eye retina, optic disc, macula, fovea, and posterior pole)– direct opthalmoscope or 20 D hand held lens

* Schirmer tear test strips

* topical local anaesthesia

* local anaesthetic for regional nerve blocks

* sterile spatula, MC and S swabs, glass microscope slides

* Tonometer

* Fluorescein stain

* Mydriatic NOT atropine

* Saline for irrigation

Question 486

Diagnostic samples in an ophthalmic exam

Answer 486

Sherman Tear Test- evaluates tear production– at the beginning of the examination

Microbial Culture and Sensitivity

Question 487

Dark room exam in ophthalmology

Answer 487

* Aniscoria- direct opthalmoscope set to zero– look at both eyes simultaneous– get the dogs or cats attention– retro illuminate the eyes– highlights the pupil size.

* Outside of eye - looking at eyelids, third eyelid, conjunctiva, and sclera (surface occular structures)

* anterior segment- cornea, AC, iris

* Dilate pupil (tropicamide): lens, vitreous, fundus exam

* Measure intraocular pressure (IOP)– concerned with inner structures of the eye

Question 488

Light room exam

Answer 488

* Assess vision in light room

* Menace (care with cats as creating air currents can move whiskers)

* Moving object, visual placing

* Dazzle reflex

* Obstacle course exam

* Assess symmetry, size & position of the orbit, globes and eyelids

* Check for any discharge, redness or swelling around the eyes

* Palpate bony orbit, retropel globe

Question 491

Answer 491

Retroillumination– ulcer, cyst, lens opacities determining if there is cataract or advanced aging change, if they do have cataract how much of the lens is affected– immature or mature where the whole lens is affected

Question 492

What is used to dilate pupils?

Answer 492

Mydriacyl (Alcon) tropicamide opthalmic solution

This anticholinergic preparation blocks the responses of the sphincter muscle of the iris and the ciliary muscle to cholinergic stimulation, dilating the pupil (mydriasis). The stronger preparation (1%) also paralyzes accommodation. This preparation acts in 15-30 minutes, and the duration of activity is approximately 3-8 hours. Complete recovery from mydriasis in some individuals may require 24 hours. The weaker strength may be useful in producing mydriasis with only slight cycloplegia. Heavily pigmented irides may require more doses than lightly pigmented irides.

Question 493

What is aqueous flare?

Answer 493

Checking for uveitis– characterising the degree of inflammation

* Frequently occurs with anterior segment disease in horses

* focal light essential to detect aqueous flare

** look for reflected light– opposite side

*left its reflecting off the iris, the right it is reflecting off the lens– we are looking in between looking at the aqeous humour hoping it is nice and black– if it is foggy there is flare such as RBCs or fibrin

Question 494

What is the Schirmer Tear Test?

Answer 494

Question 495

Corneal Cytology

Answer 495

* e.g. blunt end of scalpel scrape at the edge of the ulcer

** looking for bacteria, fungus, type of white cells

Question 496

Tonometry

Answer 496

Does the dog have uveitis or glaucoma?

* pressure reading does not matter, looking at the difference

Question 497

How do you perform fluorescein staining?

Answer 497

* Touch to bulbar conjunctiva– not too much stain- DO NOT touch the cornea with the Fluorsecein strip as it causes false positives

** fluorescein binds to mucous threads, granulation tissue, rough epithelium and it will sit in shallow facets (healed corneal ulcers with a shallow stromal deficit) – flush excess stain from the eye to avoid false positives

* Fluorescein can also determine patency of nasolacrimal ducts– apply dilute fluorescein liberally to the eye and fluorescein should be present in the nose within 5-10 minutes… this should be performed in all cases of conjunctivitis

Question 498

Nerve blocks in a horse for the eye

Answer 498

Auriculopalpebral nerve provides motor supply to

orbicularis occuli muscle (branch of CN VII)

•

Frontal nerve provides sensation to the upper eyelid

and dorsal periocular skin (branch of CN V)

•

Blocking both nerves provides total akinesia and

analgesia to upper eyelid

Question 499

Markers for the Auriculopalpebral N. block

Answer 499

Question 500

Markers for the horse Frontal N. block

Answer 500

Question 501

Fundus examination

Answer 501

Question 502

Direct ophthalmoscopy

Answer 502

Highly magnified upright image of the fundus. Peripheral regions of the fundus are hard to examine.

* Turn the magnification setting to zero (real image allows for a better image of the fundus), brightest setting of light, resting against the examiner’s brow

* once a fundus reflection is viewed by retroillumination, slowly move forwards towards the eye– the fundus comes into focus when the direct ophthalmoscope is about 1-2 cm from the eye

Question 503

Indirect ophthalmoscopy

Answer 503

* Better “scanning” view of the fundus but technically more difficult to perform

* different regions of the fundus can be simultaneously compared for disease

* 20 D lens is most common

* Inverted view of the fundus

Question 504

Answer 504

Fundus

Question 505

What is performed last in an ophthalmix exam

Answer 505

Fluorescein staining– performed last so it does not interfere with other tests like the Sherman Tear Test (STT)

Question 506

Eye exam with discharge

Answer 506

Question 507

What should you always perform in any discharging eye exam? When?

Answer 507

Question 508

With magnification in a discharging eye exam, what are you checking for?

Answer 508

Exam for entropion, distichiasis, trichiasis, ectropic cilia, punctal atresia, under the eyelid for any foreign objects

Question 509

What are you checking for with cytology in a discharging eye consult?

Answer 509

* any animal with inflamed eyelids or conjunctivitis

* Detecting infection, discerning between acute and chronic disease and will help determine antibiotic selection

Question 510

What are you checking for with fluorescein in a discharging eye exam?

Answer 510

* Determining whether the NLD is working

NLD= nasolacrimal duct

Question 511

Answer 511

Fluorescein

Question 512

Flushing the NLDs

Answer 512

tap water, sterile saline, or artificial tears

Question 513

Answer 513

Describe what you see:

* Epiphora (watery ocular discharge), overflow onto periocular skin, cornea clear, senile nuclear sclerosis

* Unpigmented eyelids

DDX:

* Block NLD, punctal atresia (absence of puncta)?

* Conjunctivitis- allergic, bacterial, viral, UV radiation (solar?)– common in unpigmented eyelids of dogs– eyelids also get sunburnt/ reddened

* Surface irritation- ectopic cilium, distichiasis, trichiasis

* FB?

** Further testing: STT, Conjunctival cytology, Fluorescein passage to nose, NLD flush or explore under GA

Question 514

* 2 yo MN Labrador

* 3-4 week history of bilateral, eyelid swelling, mucopurulent discharge, swelling and redness in both eyes

Answer 514

Describe what you see:

* upper and lower eyelid erythema, oedema and alopecia. Mild watery discharge.

DDX:

* Bacterial, funal, viral, parasitic, immune- mediated blephartitis

* Neoplasia- MCT, Lymphosarcoma (LSA), sebaceous adenoma, lipoma

* Inflammatory conditions- nodular fasciitis, histiocytosis

TESTS:

* Skin scraping, sticky tape cytology, incisional biopsy, deep tissue microbial culture and sensitivity

TREATMENT:

* Bactericidal antibiotics which are effective against staph and strep

* Oral steroidal anti-inflammatory medications

* Review in 2 weeks… prolonged treatment may be required

Question 515

Answer 515

Describe what you see:

* Narrow palpebral fissure, water discharge along lower eyelid margin, trichiasis, entropion

* Hair in contact with the tear duct (trichiasis- long hair gets in there OR eyelid conformation abnormal)

* Can’t see the lower eyelid margin either– eyelid is rolled in

* (Some cases also have concurrent ulceration)

DDX:

* Entropion- primary or secondary?

* Trauma

* Conjunctival FB

* Corneal ulceration

* Feline Herpes Virus infection

* (Distichiasis, ectopic cilium)

TESTS: apply topical anaestheisa- entropion may resolve indicating spastic entropion is present; fluorescein stain- is there concurrent ulceration?

* Diagosis: Entropion– Certain breeds predisposed: Rottweiler, Shar Pei, Great Dane, Weimaraner, Mastiff

• entropion is common in young and older dogs and cats

TREATMENT:

* young cats– secondary to FHV conjunctivitis & corneal ulceration

* older dogs and cats it occurs secondary to orbital fat atrophy and enophthalmos

* Treat primary cause if present e.g. FHV, trauma, FB

* Tackingi n young animals

* Surgical correction of eyelid position

Question 516

Answer 516

Describe what you see:

* moderate to marked stick, mucopurulent ocular discharge, left eye

* Dull cornea, corneal vascularisation (keratitis)- well advanced

TEST:

STT, cytology (secondary bacterial conjunctivitis), fluorescein stain, MC& S unlikely to be necessary

Diagnosis:

Keratoconjunctivitis (KCS) or dry eye– common in dogs– certain breeds predisposed: Cavaliers, West Highlands, Bulldogs, Pugs, Cocker Spaniels, Schnauzers

• dogs with Degenerative Myelopathy (DM) and older dogs predisposed
• cats with FHV

TREAMTENT:

• clean eyes
• optimmune, cyclosporin or Tacrolimus eye drops/ ointments
• topical preservative free lubricants- applied regularly
• topical antibiotics
• canthoplasty or PDT (photodynamic therapy) surgery in refractory cases

Question 517

Answer 517

Describe what you see:

* Epiphora, upper eyelid distichiasis

* Dull cornea with faint axial oedema and ulceration

DDX:

* Distichiasis (abnormal growth of lashes), ectopic cilium, trichiasis

* (Trauma)

* (Alkaline burn)

* (Chronic corneal epithelial defect)

TESTS

* Fluorescein staining to confirm ulceration

DIAGNOSIS

* Careful examination revealed distichiasis (bilateral) and secondary corneal ulceration

* Distichiasis common cause of epiphora (overflow of tears) in dogs

* Symptoms of disease more frequent in short- coated (bristly-haired) dog breeds e.g. Staffordshire Bull Terrier, Bull Dogs, Labrador, Boxers

* Less of an issue in Cavaliers and Poodles

TREATMENT:

*Transconjunctival excision in thick-eyelid breeds

* Cryosurgery in thin-eyelid breeds

Question 518

Answer 518

Transconjunctival exicision

Question 519

Answer 519

Describe what you see:

* swollen hyperaemic eyelids & periorbital region

* Conjunctival hyperaemia

* Third Eyelid (TE) protrusion

* Mild mucopurulent ocular discharge

* Mild exophthalmos (abnormal protrusion of eyeball)

DDX:

* Orbital trauma, orbital FB, Orbital infection: cellulitis & abscess, Orbital cyst, neoplasia, haemorrhage, severe uveitis, chronic glaucoma

TESTS:

* Physical palpation- open mouth! Check for abscesses- roof of the mouth

* Retropulsion

* Examination of the mouth

* Orbital ultrasound, CT, MRI

* Exploratory surgery

DIAGNOSIS:

* Ultrasound examination confirmed orbital abscess and probable FB

TREATMENT:

* Dental abscesses are a common cause for orbital cellulitis or abscess, so make sure you examine the mouth

* Neoplasia accounts for approx 50% of orbital diseases

* Many neoplasia is often primary and malignant

Question 520

Special considerations when examining cats in an ophthalmic exam?

Answer 520

Place at the edge of table

* Looking down towards the ground, less likely to have their third eyelids prolapse (thinking they might jump off the table)

* Measure BP in all cats > 8 years of age because they are prone to primary or secondary hypertension which is a blinding condition– try to pick it up before they detatch their retinas

Question 522

What is meant by Parallax in ophthalmology?

Answer 522

Using a light source to illuminate the deeper structures of the eye and looking at it from another direction

Question 535

What are the three causes of discharging eyes? What should you always do?

Answer 535

1. Increased ocular discharge
2. Impaired drainage
3. Both increased production and impaired drainage (rare)

** Always STT!! at the start of the exam (recall GA and sedation cause temporary reduction in STT in all species)

Question 550

What makes up the fibrous tunic?

Answer 550

Cornea and sclera

Question 551

The vascular tunic is made up of the choroid, the ciliary body and the?

Answer 551

iris

Question 552

In some species, there is a highly reflective layer in the choroid that assists vision in dim light. Name the structure.

Answer 552

Tapetum (lucidum)

Question 553

What are the two types of photoreceptors?

Answer 553

Rods and cones

Question 554

Which photoreceptor is most sensitive in dim light?

Answer 554

Rods

Question 555

The function of the lens is to focus light on the retina. What other part of the eye focuses light?

Answer 555

The cornea

Question 556

What proportion of the focusing is achieved by the lens?

Answer 556

About one third

Question 557

The lens becomes cloudy with age. What is this called?

Answer 557

Senile nuclear sclerosis

Question 558

What is the semi-solid feature between the lens and the retina?

Answer 558

The vitreous

Question 559

What part of the tear film do the meibomian glands produce? What are they also known as?

Answer 559

The outer fatty layer (contributes to the lacrimal fluid)

** Aka Tarsal glands

Question 560

What is the function of the gland of the third eyelid?

Answer 560

It produces part of the tear film

Question 561

The tear film is made up of three layers

Answer 561

Lipid, aqueous, mucous layer

Question 562

What cells produce the mucous layer?

Answer 562

The goblet cells of the conjunctiva and the corneal epithelium

Question 563

What cranial nerve supplies sensory innervation to the cornea?

Answer 563

CN V- trigeminal

Question 564

Retroillumination vs. focal illumination

Answer 564

Conducted at the same time

Focal is just the surface

Retroillumination is where you use the same light source but use the back wall of the eye to reflect light back towards us

Question 565

When do you conduct an STT?

Answer 565

Question 566

Keys with cloudy eyes

Answer 566

Question 567

Answer 567

Question 568

Cloudy Cornea DDX

Answer 568

Question 569

Answer 569

Question 570

Answer 570

No retroillumination– it is not glowing

Question 571

Answer 571

Question 572

Answer 572

Question 573

What is aqueous flare?

Answer 573

White cell infiltration into the aqueous humour – particulate matter in the air

Question 574

what is this called? General information? Treatment?

Answer 574

*cats and horses rarely develop cataracts that is vision threatening, however different for dogs

Question 575

Stages of xx?

Answer 575

Cataracts– insipiant (immature), moderate, mature (whole lens + causing vision loss)… hyper mature– lens shrinks like a raisin

Question 576

Stages of Cataract Surgery?

Answer 576

Lens removal using an instrument like a pen to aspirate it out and then lens replacement

Question 577

Answer 577

Cats and horses more variable- becomes noticeable when they are very old (cats 15-16; horses just becomes more yellow 20-25)

** See the pearl in the lens– middle eye have cataracts too– top, look like spoke wheels from a car

Question 578

Answer 578

Question 579

What is this? DDX?

Answer 579

semi set jelly and with age it becomes more liquified

Cholesterol like inclusions

Question 580

How do you check IOP? Problem with increased IOP?

Answer 580

Tonometry

* Pressure build up in the eye causes endothelial disfunction = oedema

Question 581

What would you do instead of a fundus exam in a cloudy eye?

Answer 581

Indirect ophthalmoscopy

Question 582

Special considerations in a cloudy eye with fluorescein stain?

Answer 582

Question 583

Answer 583

Question 584

Causes of Ulcers and what you should do next

Answer 584

Question 585

Treatment for ulcer

Answer 585

* iris when it gets inflamed, it is sticky– so can predispose to glaucoma and other things

* antibiotics to avoid vision and eye loss, serious consequences to infection

NSAIDs- pain relief and tx of underlying inflammation

Question 586

Answer 586

Bandage Contact Lens for protection

Question 587

Answer 587

Describe: watery discharge, brown, rectangular shaped corneal lesion, mild focal corneal oedema, fluorescein positive, miosis

DDX: Corneal FB, corneal fungal plaque, iris prolapse

Diagnosis: careful examination with magnification revealed corneal FB

TX: do not use forceps, 10 ml syringe with broken-off 25G needle. Removal with hydropulsion, alternative 2 x 25G needles to flick off… topical BS AB eye drop or ointment, oral NSAIDs, atropine? doxy? BCL? or TEF?

Question 588

Other than BCL, what is another option?

Answer 588

Treatment for uncomplicated ulceration

Question 589

Answer 589

* painful left eye

* moderate to severe conjunctival hyperaemia and chemosis

* Large, dorsal paraxial corneal epithelial erosion

* Fluorescein positive

DDX:

• Trauma
• Chronic epithelial erosion/indolent ulceration
• Alkaline ‘burn’ of the cornea
• Distichasis, trichiasis, ectopic cilia
• Other …

Diagnosis: •Slit lamp examination revealed upper central eyelid ectopic cilium

Treatment: Transconjunctival excision of hair

Question 590

Answer 590

Describe

• Mild conjunctival hyperaemia
• Watery discharge
• Corneal ulceration with loose epithelial margins
• Mild focal corneal oedema

DDX

Trauma

Indolent ulceration

Alkaline ‘burn’ of the cornea

Distichasis, trichiasis, ectopic cilia

Other …

Treatment: Sterile Debridement & grid keratotomy, heavy sedation, topical anaesthesia (+GA), BCL/TEF/TT?, oral or injectable NSAIDs, topical AB eye drops, doxy

Question 591

Test epithelium

Answer 591

* Is it stuck down? = healthy, easy to peel off in a sheet then we know we are dealing with chronic epithelial erosion or indolent ulceration, etc.

Question 592

Answer 592

Describe: A complicated ulcer– stromal defect

• Blepharospasm
• Epiphora
• Conjunctival hyperaemia, chemosis
• Corneal ulceration, oedema, keratomalcia
• Aqueous flare

DDX:

• Bacterial ulcerative keratitis (commonly Pseudomonas)
• Corneal bullae
• Trauma, Alkaline injury

Tests: Cytology and MC&S

Treatment: topical fluoroquinalone antibiotics (saw rod shaped bacteria)… Ocuflox, topical atropine (sometimes in cats) we want to dilate the pupil so no complications from iris adhesions, oral doxy (vibravet), oral NSAIDs

** No bandage and no TEF because the eye is infected

Question 593

Answer 593

Describe:

• 6 week old female kitten
• Sudden onset painful, closed & watery left eye
• Depression
• Sneezing & snuffly
• Mucopurulent discharge
• Blepharospasm
• Conjunctival hyperamemia, chemosis
• Corneal ulceration, keratomalacia

DDX:

• FHV, Calicivirus, Chlamydophila
• Bacterial, fungal keratitis
• Trauma, alkaline burn
• Eyelid abnormalities …entropion, trichiasis, distichiasis

TESTS:

• PCR for infections disease
• Corneal cytology?
• STT? Precorneal tear film deficiency?
• NONE??

Diagnosis: •Tentative diagnosis of acute lytic FHV keratoconjunctivitis was made

Treatment:

• Oral antivirals … Famvir
• Oral doycycline … Vibravet
• Oral Lysine
• Oral NSAIDs … Metacam
• Topical Antiviral … Idoxuridine, Cidofovir
• Topical lubricants

Question 594

Answer 594

Describe:

• Diffuse, severe corneal oedema of endothelial origin (endothelium thin sheet on the cornea responsible for water balance)
• Moderate perilimbal hyperaemia
• Fluorescein negative
• Mild buphthalmos?

DDX

• Glaucoma (high intraocular pressure)
• Lens luxation
• Severe uveitis (low intraocular pressure)
• Corneal endothelial degeneration
• Keratitis

TESTS:

• Schirmer test test … 20 mm, both eyes
• Tonometry … IOP L 65 mmHg; R 12 mmHg– test for glaucoma and uveitis
• Gonioscopy, ocular ultrasound

Diagnosis: Primary glaucoma often associated with breeds/ inherited because the angle was normal (secondary glaucoma with an identifiable cause–e.g. trauma and full of blood or retinal detachment and now has glaucoma…. is treated differently)

Treatment:

• Trusopt, Azopt or Cosopt (Carbonic Anhydrase Inhibitor)reduce aqueous production
• Xalatan, Travatan (Prostaglandin analogues)- reduce outflow of aqueous out of the eye
• Topical corticosteroids anti inflammatory– all have some degree of inflammation (uveitis)– high pressure = inflammation
• Oral pain relief
• Laser glaucoma surgery??
• PROPHYLAXIS FOR FELLOW EYE!! CAI indefinitely once or twice a day to help delay onset of glaucoma

** Guarded prognosis longterm– unrecognized for days or weeks and already blind

Question 595

Answer 595

Describe:

• Mild pain (third eyelid prolapse)
• Dilated pupil
• Anterior lens luxation
• Mild cloudiness

DDX

• Primary lens luxation
• Glaucoma & lens luxation
• Uveitis and secondary lens luxation
• Other lens abnormalities e.g. lens coloboma, microphakia

TESTS

• CONSENSUAL PLR, menace response
• Tonometry … IOP 24 mmHg
• Fluorescein stain … negative

Anterior Lens Luxation treatment

• Anterior lens lux = emergency
• Early lens removal surgery may help preserve vision
• Due to complications e.g. retinal detachment & glaucoma, complications higher than cataract surgery
• Medical management whilst awaiting surgery:
• Topical corticosteroids e.g. Prednefrin Forte or Maxidex
• Oral corticosteroids or NSAIDs
• Topical Atropine BID
• Topical Cosopt/Azopt/Trusopt
• Do not apply XALATAN
• Trap lens in posterior segment with Xalatan
• Long term prognosis if managed well is similar to surgery of anterior lens lux
• Enucleation or intraocular prosthesis best for chronic lens luxation & blindness

Question 596

Vision loss in dogs DDX

Answer 596

Congenital

Developmental issue (cataracts, lens luxation, etc.)

Sudden (with a clear eye or cloudy eye) or progressive

Question 597

Why is evaluation of vision loss challenging in animals?

Answer 597

Question 598

What tests for assessing vision? Ancilliary vision tests?

Answer 598

Basic neurological exams… light response, dazzle, obstacle course

* Ancilliary vision test- like doing an ECG on the heart, it is a sequence of light flashes used to stimulate the retina and teh electrical response is recorded by a contact electrode on the cornea

* used predominantly to diagnose retinal disease e.g. SARDs and PRA, if normal in a blind animal it indicates central disease is present

Question 599

Congenital/development causes of vision loss

Answer 599

Question 600

Answer 600

Question 601

Answer 601

Question 602

Answer 602

Coloboma – if large vision loss as well

Tortuous vessels

Question 603

Answer 603

Do not have in AUS

Question 604

Sudden vision loss with a clear eye DDX

Answer 604

Question 605

Answer 605

Syndrome– infectious disease viral and fungal especially cats– cryptococcus, aspergillosis

* German shepherds- aspergillosis

* Vislas or other long nose dogs- granulomas

** or immune mediated– small white fluffy dogs– Granulomatous Meningoencephalitis (GME)

Question 606

Diagnosis? Treatment and Prognosis for optic neuritis?

Answer 606

Risk with corticosteroids especially for cats because they can end up with disseminated crypto

Question 607

What is Sudden Acquired Retinal Degeneration Syndrome (SARDS)?

Answer 607

Thought to be immune mediated (may be associated with Immune Mediated Retinitis)

Sudden loss of vision in dogs (more common in females) which affects the retina– NOT CATS

* IN some dogs vision loss is over a period of weeks, some over night

* Any breed can be affected but small breeds may be predisposed

* DIAGNOSIS: Flat Electroretinogram (ERG)– no retinal function (absence of photoreceptor activity) even though they have a normal eye

DDX: causes of central (neurological) blindness and optic neuritis, both of which have a normal ERG

Question 608

Answer 608

* most common in vet med are exudates or haemorrhage accumulation beneath the retina

DDX: hypertension, bullous retinal detachments (clear fluid under the retina), hypoproteinaemia, hyperviscosity, polycythemia, uveodermatologic syndrome and idiopathic

** Traction detachments: occur with organization and contraction of fibrous membranes (usually after inflammation and haemorrhage) which pull off the retina

* Rhegmatogenous retinal detachments: occur with tearing of the retina, which allows liquefied vitreous to enter the subretinal space, rare in animals

Question 609

Causes? If bilateral?

Answer 609

Question 610

Treatment of retinal detachment

Answer 610

Question 611

Central blindness? Diagnosis?

Answer 611

By the time they lose vision due to neurological disease they often have other issues – e.g. seizures, ataxic, facial nerve paralysis

Question 612

Ivermectin Toxicity

Answer 612

* generally on farms with dogs that have access to large animal anthelmintic preparations

Acute onset blindness (DDX SARD, optic neuritis, central lesion)

* negative menace response, dazzle response and PLR– blindness may be central without ocular lesions– but often see characteristic retinal oedema and folds with papilloedema

Question 613

Sudden Vision Loss- Cloudy Eye DDX

Answer 613

Question 614

What can cataracts be secondary to?

Answer 614

Cataracts

Diabetes- can develop rapidly (weeks)

Question 615

Answer 615

Question 616

Answer 616

Bilateral: think systemic disease

* unilateral- young dog– think trauma

…. in old dog– think neoplasia

** older cat– think hypertension (any cat)

Question 617

Answer 617

Question 618

Progressive Vision Loss DDX

Answer 618

Question 619

Answer 619

•
ALWAYS Bilateral and symmetrical
•
Inherited in some breeds
•
Degenerative condition of photoreceptors
–
Rods then later cones
•
Night vision loss first
•
Fundic changes
–
Blood vessel thinning
–
Tapetal hyper-reflectivity
–
ONH becomes grey
•
May see secondary cataracts late in disease

Question 620

Answer 620

Question 621

Surface Ocular disease

Answer 621

Question 622

•
Toy Poodle
•
Left eye
–
Reduced menace response
–
PLR reduced
•
Obstacle course
–
Tentative when right eye covered
•
You perform a fundus exam

Answer 622

Diagnosis: **optic nerve hypoplasia (OR optic nerve atrophy)

Question 623

Answer 623

Question 624

Answer 624

** problem if it was a breeding dog but not otherwise

Question 625

Answer 625

Retinal haemorrhage secondary to hypertension

Question 626

Answer 626

Question 627

5 yo French Bulldog

Sudden vision loss

Tests?

Answer 627

Tests: PLR, vision test, fundus exam, CBC/Biochemistry, urinalysis, MRI +/- CSF tap, thoracic radiographs

** Findings: PLR absent, mydriasis, menace absent, bumping into obstacles, optic nerve head looks unusual

Question 628

Answer 628

Medial lower eyelid entropion, large eyelid opening

STT:4 mm/ min right eye

6mm/min left eye

* Diffuse corneal melanosis- chronic corneal irritation

Diagnosis: Keratoconjunctivitis sicca (dry eye), oversized eyelid openings, medial lower eyelid entropion

Question 629

Function of lacrimation? Three layers? How does it drain?

Answer 629

* Required to moisten and nourish cornea and flush away foreign objects, a waste product– stimulated by conjunctival, corneal, or nasal irritation

* Three layers: lipid layer ( spreads tear film evenly and reduces evaporation); aqueous layer (lacrimal gland and gland of the TE); inner mucous layer (from goblet cells in conjunctiva and corneal epithelium- binds tears to the cornea)

** Drains via lacrimal puncta and canaliculi to nasolacrimal ducts

Question 630

Vascular supply to the eye?

Answer 630

* External ophthalmic artery- principal supply to the eye
branches from the Maxillary artery

* Internal ophthalmic artery supplies CNII and spreads over retina from optic disc

Question 631

Ophthalmological exam

Answer 631

1. Examine from distance: symmetry and eye position
2. Examine more closely: menace response and globe retropulsion and digital orbital examination
3. Focal light examination: pupillary light reflexes (direct and consensual), dazzle response, anterior chamber exam (depth, abnormal contents?), initial lens examination (pupillary dilation required for complete exam)
4. Examination under magnification: eyelids, conjunctiva, sclera, corneal surface, anterior chamber, iris (colour and topography)
5. Schirmer Tear Test (Normal dog 15 mm/60 sec; Normal cat 10 mm/ 60 sec)
6. Collect diagnostic samples
7. Perform tonometry and check beneath the third eyelid
8. Fluorescein stain: check for corneal ulceration, passage to nares when nasolacrimal duct is patent (usually within 5-10 minutes)
9. Mydriacyl (Alcon) application to dilate pupil: examin lens with focal light and magnification; examine the fundus

Question 632

Normal range of duration for stage one of parturition of a bitch is? Is there evidence of straining in stage one?

Answer 632

6 to 12 hours

No evidence of straining in stage 1

Question 633

What is the normal interval between pups in stage 2 or parturition in the bitch?

Answer 633

15 minutes to 2 hours

Question 634

Is a green to black vulval discharge normal in a bitch during parturiton? Ewe?

Answer 634

Bitch- yes ; ewe- no

Question 635

Average gestational length in a cat? Rabbit?

Answer 635

Cat- 65 days; Rabbit- 30 days

Question 636

What does it mean for a newborn to be altricious? What is an example of a species that is?

Answer 636

Their skin is without pigment or hair at birth. Rabbit.

Question 637

Where does the green-black discharge come from in the bitch?

Answer 637

Part of the chorion

Question 638

What are the stimuli to the straining reflex in an animal during parturition?

Answer 638

* Stretching of the vagina, stretching of the cervix, suckling of the puppies already born.

Question 639

Acepromazine is a sedative, it is not an analgesic. What is it likely to cause in a bitch?

Answer 639

* Hypotension with an associated reflex tachycardia

Question 640

What is ventricular tachycardia?

Answer 640

* A rapid and irregular heart rate associated with premature contractions (VPC’s) identified on an ECG trace

Question 641

Will morphine cross the placenta to enter the unborn puppy?

Answer 641

Yes

Question 642

What is a possible consequence to puppies of morphine administration during whelping?

Answer 642

Depressed post natal respiratory drive

Question 643

With a bitch during parturition with generalized skeletal muscle twitching, abscence of straining when vagina is distended with speculum, and failure to deliver a pup after two or more hours– what might you think is one of the problems?

Answer 643

Hypocalcaemic

Question 644

What hormones deal with mobilizing stored calcium?

Answer 644

* Parathyroid hormone

* Cholecalciferol

Question 645

What could the vet have done better in the case of two dead pups and dead mom?

Answer 645

* Correction of hypocalcaemia with IV calcium gluconate prior to surgery

*Aggressive fluid therapy piror to surgery for correction of fluid balance and any acid/ base anomalies was indicated

* if pre medication is required (though commonly not required) then a low dose or partial mixed opioid would be more appropriate (butorphanol or bprenorphine). Acepromazine provides excellent sedation but is profoundly hypotensive. Morphine provides excellent analgesia but causes marked cardiovascular depression

* clip prior to anathesia so she doesn’t have to be under as long

* pre-oxygenating the bitch is a good idea since all induction agents, and inhaled gaseous anaesthetics are cardio-respiratory depressive

* Isoflurane inhalation should be kept to a minimum to reduce cardio respiratory depression and resulting hypotension

* prior preparation is important- a warm dry area should already be prepared for the puppies

Question 646

Normal readings for STT dog? cat? horse?

Answer 646

* Dogs 15-25 mm/ 60 sec (less than 10 diagnostic for dry eye)

* Cats 10 mm (less than 5mm is diagnostic for dry eye)

* Horses 20-30 mm (less than 10 mm is diagnostic for dry eye)

Question 647

Normal IOP readings in a dog? Cat? Horse?

Answer 647

* Dog 12-25 mmHg

* Cats 12-25 mmHg

* Horses 15-30 mmHg

Question 648

Punctal atresia

Answer 648

Absence of one or more puncta in eyelids– function to collect lacrimal fluid

Question 649

Dacryocystitis

Answer 649

* Inflammation of the nasolacrimal sac/duct

Question 650

Entropion

Answer 650

Turned in upper or lower eyelid

Question 651

Distichiasis

Answer 651

Hair or cilia growing through meibomian (tarsal) glands

Question 652

Ectopic cilia

Answer 652

Hair or cilia growthing through conjunctiva

Question 653

Trichiasis

Answer 653

* Hair from the skin/ face touching the eyes

Question 654

Corneal ulceration

Answer 654

Defect of the corneal epithelium with or without loss of the stroma (supportive tissue of the epithelium)

Question 655

Blephartitis? Conjunctivitis?

Answer 655

Blepharitis- inflammation of the eyelids

Conjunctivitis- inflammation of the conjunctiva (the mucous membrane that covers the front of the eye and lines the inside of the eyelids)

Question 656

Uveitis

Answer 656

Inflammation of the uvea– iris, ciliary body and/or choroid

Question 657

Keratoconjunctivitis sicca

Answer 657

Inflammation of the cornea and conjunctiva in dry eyes

Question 658

Corneal oedema

Answer 658

Increased water content in the cornea giving it a blue/white appearance

Question 659

Keratomalacia (Melting corneal ulceration)

Answer 659

severe form of corneal ulceration associated stromal degeneration and loss

Question 660

Corneal lipid dystrophy

Answer 660

Unusual bilateral and symmetrical opacity of the cornea, not associated with inflammation

Question 661

Keratitis

Answer 661

Inflammation of the cornea

Question 662

Pannus

Answer 662

aka Superficial Stromal Keratitis is an immune mediated disease of dog conjunctiva and cornea, exacerbated by UV radiation

Question 663

Corneal sequestration

Answer 663

* Degenerative process of the cat cornea where by it becomes amber/black colour

Question 664

Aqueous flare

Answer 664

Cells and protein observed in the anterior chamber when the eye is inflamed (uveitis)

Question 665

Cataract

Answer 665

Opacity of the lens or lens capsule

Question 666

Lens luxation

Answer 666

Disinsertion of the lens so that it luxates into the anterior or posterior chambers

Question 667

Glaucoma

Answer 667

Increased intraocular pressure resulting in damage to the optic nerve

Question 668

Vitreous degeneration

Answer 668

Degeneration of the vitreous. Usually associated with liquefaction

Question 669

Optic nerve hypoplasia vs. optic nerve atrophy

Answer 669

Optic nerve hypoplasia- Congenitally small optic disc usually due to decreased numbers of retinal ganglion cells– fundoscopically the nerve appears small, round and grey– Toy and miniature poodles probably autosomal recessive (and other breeds)

* Optic nerve atrophy- acquired degernation of optic nerve

Question 670

Collie eye anomaly

Answer 670

Congenital disorder of the retina, occasionally associated with retinal detachment or optic nerve head colobomas occur in some severe affected dogs which can also result in retinal detachment and therefore blindness

(Shetland Sheepdogs, Australian shepherds, Border Collies, and some other breeds)

* main lesion is choroid hypoplasia (pale area lateral to the optic disc with bizarre choroidal vessels)

Question 671

Retinal dysplasia

Answer 671

Congenital disorder of the retina, occasionally associated with retinal detachment

Question 672

Progressive Retinal Atrophy

Answer 672

An inherited disorder leading to vision loss

Question 673

Optic neuritis

Answer 673

* Inflammation of the optic nerve– bilateral or unilateral– if the inflammation extends into the globe, the optic disc will appear swollen, elevated and hyperaemic. The margins of the optic nerve also become indistinct

* Can be caused by Distemper or other viral diseases, fungal disease (especially Cryptococcus in cats), neoplasia, granulomatous meningoencephalitis, or be idiopathic

* Diagnostics: CBC, chemistry panel, urinalysis, chest radiographs, and titers as indicated, MRI or CT scan possibly indicated, CSF taps have the highest diagnostic yield

** Treatment directed at the primary cause– vision can be preserved if treated early

Question 674

Nyctalopia? Hemeralopia?

Answer 674

Nyctalopia- loss of night vision

Hemeralopia- loss of day vision

Question 675

Episcleritis/ episclerokeratitis

Answer 675

Inflammation of the fibrous coat of the eye

Question 676

What is stress? What is a stress response? What happens if the stress response is interupted?

Answer 676

Question 677

Physiology of stress

Answer 677

HPA axis: neural responses, endocrine responses, immune responses

* Autonomic system- sympathetic stimulation– adrenal medulla releases adrenalin: increase HR and BP, hydrolysis of glycogen to glucose, focussed attention and responses

Question 678

What are compulsive disorders? What are there causes?

Answer 678

* Stereotypies: repeated motor patterns

* Compulsions: fixation on a goal

* Repetitive, exaggerated, sustained

* Out of context behaviours

* Interferes with normal functioning

Question 679

Examples of breed dispositions of compulsive disorders

Answer 679

Question 680

What are displacement behaviours?

Answer 680

Unable to express stress, frustration, conflict (psychological causes of compulsive disorders) results in displacement or redirected behaviours

Question 681

What is a major psychological stressor for pets? What is true of psychological stressors?

Answer 681

* Lack of control and predictability (e.g. inconsistent owner interactions, lack of training and inconsistent commands)

* Stressors are additive (threshold theory, one stressor may initiate compulsive response but other stressors maintain the behaviour)

LOOK for multiple causes

Question 682

Pathophysiology of compulsive disorders

Answer 682

Question 683

Examples of compulsive disorders in dogs

Answer 683

Question 684

Examples of compulsive disorders in cats

Answer 684

Question 685

Treatment of compulsive disorders

Answer 685

* Acute management of self harming- bandages, muzzle

* Reducing stress– Request-Response-Reward interactions (instead of punishment); Consistent routine; Daily walks- aerobic exercise, stimulation, social interaction; opportunity to control aspects of the environment e.g. meals from food dispensing toys

** Pharmacotherapy: SSRIs (fluoxetine, sertraline); TCAs (clomipramine, amitriptylline, doxepin), Do not use if NOT anxiety based skin condition, most effective in early stage!! So treat early!! Wean off after two months of complete clinical resolution– 75% for 2 weeks, then 50% for 2 weeks, then 25% for 2 weeks– recommence at lowest effective dose if reappears

Question 686

DDX to compulsive disorders

Answer 686

* CNS lesions– circling (brain stem and forebrain, vestibular, lumbosacral stenosis, hydrocephalus, neuromas)

* Seizures

* Sensory neuropathies (reduced pain in distal extremities, trigeminal dysfunction (cats)

* Musculo-skeletal (response to pain may mimic or trigger CD)

* Dermatological (anything that causes licking)

* Conditioned behaviour (attention seeking)

* Acute conflict behaviour (occurs in response to a trigger)

Question 687

Diagnosis of Compulsive disorders- characteristics that allow some certainty in diagnosis

Answer 687

Question 688

Failure of compulsive disorder treatment due to?

Answer 688

Poor owner compliance, long problem duration, did not attempt treatment

Question 689

Answer 689

* More common in large breeds

* Male 2X > females

* Differentials: Dermatological, neurological or displacement behaviour

Treatment: behavioural and dermatological

Question 690

Causes of licking in dogs and cats

Answer 690

Question 691

Treatment for acral lick dermatitis (lick granuloma)

Answer 691

Removal of stressors, response substitution (no punishment), acute management of self harming, medication

Question 692

What should you do about flank sucking?

Answer 692

*Dobermans

* Damp ruffled skin to raw open sores

* If no physical damage with normal functioning then may be acceptable coping mechanism

* IN some cases constant sucking when not sleeping or engaged in other activity

Question 693

Tail Chasing DDX? What should you do about it?

Answer 693

* DDX: conflict, frustration, reinforced, epileptic, episodic behaviour, neuropathological, psychotic/hallucinary, dermatitis

Treatment: other possibilities: Neuropathic pain: Gabapentin, Carbamazepine

Question 694

Possible pathological reasons for aggression?

Answer 694

* Anal glands, otitis, dental disease

* Skin problems–association with pruritis or malodours skin disorders that received vet treatment and biting family members

Question 695

Psychogenic Alopecia (Overgrooming)

Answer 695

* History: environmental or social change may be trigger, more common in indoor cats (confinement stress? social stress? social isolation?), excessive grooming, chewing, pulling out hair (away from owner is previously punished)

* Hair loss: focal, partial, bilateral, common in groin, ventrum, medial and caudal thighs, skin normal to erythematous and/or abraded

* Cats: licking can be conflict behaviour, becomes generalized, stress may affect the immune system, large percentage of cases have underlying medical problems: allergy, endocrine, infections: parasitic, fungal, bacterial, trichogram important to determine cause is grooming (but still multiple aetiologies)

** DIAGNOSIS OF EXCLUSION

Question 696

Answer 696

Question 697

Hyperaesthesia in cats clinical signs

Answer 697

Question 698

DDX to Hyperaesthesia in cats

Answer 698

Question 699

Treatment of Hyperaesthesia in cats

Answer 699

Question 700

What is canine atopic dermatitis?

Answer 700

A genetically predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features most commonly associated with IgE antibodies to environmental allergens

Question 701

What is the difference between normal skin and skin with atopic dermatitis?

Answer 701

If we look closely at the EM of a normal dog SC we can see normal lamellar appearance to the intercellular spaces

However if we look at the skin from an AD dog this lamellar structure is gone.

There is significant evidence for both innate and acquired barrier defects in atopic humans and dogs.

• It is thought that in humans (and likely in dogs) that inherited innate barrier function defects are a (if not the) major primary risk factor for atopic dermatitis.
• Decreased ceramides in lesional and nonlesional skin
• Decreased expression of filaggrin in atopic Beagles and humans
• In huamn patients with a genetic predisposition toward AD, upregulation of the stratum corneum chymotryptic enzyme results in premature breakdown of the corneodesmosomes and thinning of the stratum corneum (and higher pH from dec FLG also encourages this).

Question 702

Why does AD vary so much between dogs and breeds?

Answer 702

* Complex genotype that varies between breeds and gene pools. Breeding programs to eliminate AD are therefore unlikely to succeed but this complexity could explain variations in clinical phenotype and response to treatment.

Question 703

increased risk for AD

Answer 703

* Urban life

* High human population density

* increased average annual rainfall

* Adoption at the age of 8 to 12 weeks

* Regular bathing of young healthy dogs

Question 704

DDX atopic dermatitis

Answer 704

Question 705

Diagnostic Plan- Step 1 in potential Atopic dermatitis

Answer 705

1. Is it scabies/ flea/ demodex— give Bravecto/Nexgard to rule out

** Also resolve infection

Question 706

What if the dog is still itchy when infection free from Bravecto or Nexgard?

Answer 706

Contact avoidance trial– booties, coat, avoid grass in the park, etc.

Classical atopic areas– food elimination trial

Question 707

What is a skin prick test?

Answer 707

Question 708

What is an elimination diet?

Answer 708

* Eliminate suspected allergy, symptoms disappear then reappear when you feed it again, then disappear when you take it away, and reappear when you give it one more time (REPEATABLE)

** MINIMUM 6 to 8 weeks, total compliance needed

* Reassess before rechallenge… if 14 days and no flare… sequential rechallenge

Question 709

What is a restricted antigen diet?

Answer 709

* Avoid antigens found in their original diet… e.g. fed beef prior, change to venison though may have to home cook as many dog foods have undeclared types of protein, etc.

* but not clinically proven therefore– best is Home cooked NOVEL protein and NOVEL carbohydrate

Purified maize to remove all proteins, ;line cleaning , ELISA testing

The aim of this diet is to ensure all hydrolysed peptides are of very low molecular weight (< 1 kDa) in order to ensure they are non-immunogenic. This diet is essentially purified corn starch (protein removed) and hydrolysed chicken, turkey, duck feathers. To minimise risks of diet contamination there is complete cleaning of manufacturing lines before production, single diet production and post production quality control (PCR to check for poultry and beef proteins) and chromatography to ensure anallergenic molecular weight of the hydrolysis.

Independent studies showing usefulness of these diets for elimination diets are still lacking. There are two company sponsored trials involving a total of 34 dogs using a non-validated pruritus score and a validated CADESI 03 lesional score, that showed significant improvement in dog’s global score when this diet was fed to dogs with suspected cutaneous food reactions (many of which had previously failed on hypoallergenic diets). Palatability was reported to be high. These were low evidence studies based on design but warrants further evaluation.

Question 710

What are hydrolysate diets?

Answer 710

Enzymatically modified to reduce the molecular weight of proteins to reduce the risk of immunogenic reaction. The aim is to overcome the difficulty in identifying a novel protein source.

** but not clinically proven therefore– best is Home cooked NOVEL protein and NOVEL carbohydrate

Purified maize to remove all proteins, ;line cleaning , ELISA testing

The aim of this diet is to ensure all hydrolysed peptides are of very low molecular weight (< 1 kDa) in order to ensure they are non-immunogenic. This diet is essentially purified corn starch (protein removed) and hydrolysed chicken, turkey, duck feathers. To minimise risks of diet contamination there is complete cleaning of manufacturing lines before production, single diet production and post production quality control (PCR to check for poultry and beef proteins) and chromatography to ensure anallergenic molecular weight of the hydrolysis.

Independent studies showing usefulness of these diets for elimination diets are still lacking. There are two company sponsored trials involving a total of 34 dogs using a non-validated pruritus score and a validated CADESI 03 lesional score, that showed significant improvement in dog’s global score when this diet was fed to dogs with suspected cutaneous food reactions (many of which had previously failed on hypoallergenic diets). Palatability was reported to be high. These were low evidence studies based on design but warrants further evaluation.

Question 711

So what do I feed during a food trial?

Answer 711

• Croc and tapioca
• RC Anallergenic *
• Home cooked

Question 712

What are some irritants for an AD dog?

Answer 712

* Environmental irritants, shampoos, exogenous environmental proteases– they can all activate kerationcytes to participate in and modulate the immunological response

Question 713

So what can happen with a poor barrier?

Answer 713

Increased water loss–> dry skin–> itch

Increased allergen dose–> allergy flare–> itch

Irritants–> irratable skin–> itch

Question 714

Treatment general rules AD

Answer 714

* Life long disease– cannot cure a Westie of being a Westie

* Not an allergy- failure to address all aspects of the disease, the barrier dysfunction, the allergic components and infections will lead to failure

* Continual maintenance required– not stopping and starting treatment

* Treatment needs to consider client’s life style, compliance, etc.– consider quality of life for the animal

Question 715

Answer 715

Question 716

Answer 716

• Infection control
• Flea control
• Mild shampoos
• Topical glucocorticoids
• Oral and injectable glucocorticoids
• Oclacitinib (Apoquel)

NO EVIDENCE FOR: Antihistamines, Fatty acids, Cyclosporine

Question 717

Why is shampoo therapy often beneficial with AD?

Answer 717

Shampoo therapy is often useful in AD because (see above).

Some formulations have sustained-released microcapsules which break open once the coat dries to release contents

Ingredients in shampoos that may help moisturise are fatty acids, lipids, urea, glycerin, colloidal oatmeal and chitosanide

e.g. Epi-soothe Spherulites® (Virbac) oatmeal and chitosanide;

Allergroom S® (Virbac) contain glycerin, lactic acid, urea and chitosanide.

HOWEVER: not all dogs are improved by shampoo therapy. Can increase barrier dysfunction by drying due to their detergent action (stripping lipids), can increase pH which leads to increasing chymotryptic activity leading to premature breakdown of corneodesmosomes that hold the stratum corneum together to create the barrier. And can irritate dysfunctional skin.

Shampoos should not be relied upon as the sole moisturising treatment except in very mild cases.

It should also be remembered that even “non-irritant” shampoos may irritate skin with a dysfunctional epidermal barrier. Not all dogs are improved by shampooing!

Question 718

What other treatment options aside from shampoo for AD?

Answer 718

* Fuciderm– topical ointments

* Settle inflammation with daily use at first then drop back to twice weekly and add in moisturizer.

* Wet wrap therapy- apply cream over affected area, wet T-shirt, write out and put on damp to improve penetration, repeat BID in severe cases 20 minutes BID. Lower limbs can use glad wrap occlusion and vet wrap

* Oclacitinib (Apoquel)- JAKs inactivate the intracellular proteins called STATs to induce gene transcription– induce JAK/STAT pathways– short term use but side effects of pyoderma, skin nodules, otitis externa, demodicosis

Question 719

Maintenance of AD

Answer 719

• Identification and avoidance of flare factors (infections, shampoos, botanical contacts, fleas, foods, emotional stress)
• Allergen specific immunotherapy- suppression of DCs that support generation of effector T cells (Th1, Th2, Th17 cells), Ag specific IgE, mast cells, basophils, eosinophils, effector T cell migration into tissue and induction of IgG4. IL-10 from Treg cells has multiple effects on reduction of allergic inflammation.
• Cyclosporine- problm causes broad spectrum suppression of T cell functions (PE every 6 months- urine culture after 12 weeks on therapy and every year)
• Topical glucocortiocoids- problem longterm side effects
• Oral glucocorticoids- minimal effective dose if you have to e.g. topical steroids with low dose twice weekly GCs topical on the day prior to oral dosing
• Topical immunomodulators
• Recombinant interferon
• Antihistamines
• Fatty acids
• Barrier treatments- fixing the skin barrier- Omegaderm supplementation improved epidermal lipid levels in atopic dogs

Question 720

DDX for white/ grey crusts?

Answer 720

Question 721

DDX for yellow crust?

Answer 721

Question 722

DDX for dark crusts?

Answer 722

Question 723

Clinical features? Diagnosis? Treatment
?

Answer 723

Sebaceous adenitis: Immune destruction of sebaceous glands

* Breed related: Akita, Samoyed, Vizsla, Maltese, Gold Ret, Std Poodle, GSD, Cats, Rabbits

* Diagnosis: Histopathology (end stage or active inflammation)

* Treatment: Ciclosporin if active

—End stage

—Oil soaks

—Cover baby oil/coconut oil 30 mins

—Wash off and descale with Palmolive detergent

—Phytosphingosine shampoo/mousse/conditioner

Repeat as needed eg monthly soaks to normalise skin and weekly phytosphingosine

Question 724

Answer 724

Question 725

Clinical signs? Diagnostics? Treatment?

Answer 725

Pemphigus foliaceous (PF)

* Auto-antibodies, desmosomal proteins, loss of cellular cohesion

* Clinical forms: breed related (Jack Russels, Akita, Alaskan Malamute, Keeshonds; cats: DSH, Siamese derivations), drug induced/ triggered, secondary to chronic skin disease

* Clinical signs: pustular disease: Papules, pustules, crusts, follicular pustules cause alopecia

* Diagnosis: Cytology– acantholytic cells (keratinocytes that have lost their adhesions– cell becomes a sphere– form rafts, a row stuck together– round, blue and bigger than a neutrophil)

* Therapeutic trials: Antimicrobials: Enrofloxacin, Clindamycin

Treatment: Cats sometimes responsive to low dose pred, not so much dogs. Dogs require steroid sparing immunosuppression azathioprine– bone marrow suppression, hepatopathy, pancreatitis (require close monitoring)

Question 726

Answer 726

Pemphigus foliaceous

Question 727

How big should you punch biopsy be for PF?

Answer 727

Deep recuts at 500 micron intervals

Question 728

Pathogenesis?

Answer 728

Discoid lupus erythematosus

Pathogenesis: UV induced, basal cell cytotoxicity, Ab and Cell mediated injury

* Breeds: Scotch Collies, Border Collies, Shetland Sheep Dogs, Maremma, Weimeraner, Kelpie, any

* Clinical signs: depigmentation, loss of architecture, erosion/ ulceration/ crusting, nasal planum (BEWARE mucocutaneous pyoderma and nasal hyperkeratosis)

* Diagnosis: antibacterial trial, histopathology

* Treatment: sun avoidance, pimecrolimus 1% (ELIDEL); oral corticosteroids short duration, doxy and nicotinic acid

Question 729

Answer 729

Lupoid onychodystrophy

Diagnosis: failure to respond to antibiotics or biopsy (dew claw amputation, referral for digit sparing biopsy of the germinal epithelium)

Treatment: Aggressive early Tx, CyA (Cyclosporin) + Glucocorticoids, Fatty acids

Question 730

Answer 730

Cutaneous histiocytosis- dendritic cell proliferation

Diagnosis: FNA, histopath (culture, special stain)

* Treatment: Prednisolone, Doxy and B3, CyA (Ciclosporin)

Question 731

Answer 731

Cutaneous vasculitis

* Pathophysiology: AbAg excess, endothelial injury, ischaemia

* Clinical signs: Purpura, erosions, ulcers, crusts, alopecia, extremities +/- multifocal

* Diagnostic approach: Drug history, systemic disease, histopath, imaging, blood culture, urine culture

* Treatment: Improve perfusion: pentoxifyline, immunomodulation: referral, prednisolone, dapsone, azathioprine

Question 732

Answer 732

Erythema multiforme

Pathophysiology: Cytotoxic T cell attack on keratinocytes, drug, viral, neoplasia

Clinical signs: variable lesions, serpiginous, arciform, target lesions, multifocal ulceration

* Diagnostic approach: histopathology (ALONG THE EDGES), selection is critical to diagnosis, drug history, thoracic radiograph, PCR (feline herpes)

* Treatment: Cyclosporin

Question 733

Answer 733

Packed with eosinophils.. bitten on lateral aspect

Question 734

Keys to appropriate flea control

Answer 734

* Correct medication interval, correct application technique (may have to watch them), correct timing with shampoos/ swimming (avoid within 2 days before or after Frontline, avoid 2 hours after revolution, avoid 12 hours after advantage), correct dose for each pet, all pets in the house treated

** Efficacy drops at the end of the month

* Speed of kill is not instantaneous

* Environmental fleas can persist > 140 days

* Closed environment = easier to control

Question 735

Speed of control for top flea treatments?

Answer 735

Question 736

If dogs or cats live in a closed environment, what kind of flea treatment is needed?

Answer 736

Question 737

If dogs and cats live in open environments, what kind of flea control?

Answer 737

Question 738

DDX for pruritis in a dog or cat

Answer 738

AD, food allergy, scabies, bacterial pyoderma, Malassezia dermatitis

Question 739

Likely problems with failing flea control

Answer 739

* Poor compliance, access to flea “nests”, untreated animals, resistance

Question 740

If you suspect flea “nests”- what should you recommend?

Answer 740

* Determine if inside or outside the home

* Inside–> prolonged emergence

* Outside–> indefinite emergence–> requires ongoing adulticides

** can also use flea shampoos once weekly– & avoid daily swimming

Question 741

How do you recognize flea bite hypersensitivity?

Answer 741

* Historical clues: spring/ summer exacerbation, inadequate flea control, fleas not always seen,

* Primary lesion: crusted papules

* Treatment/ Diagnosis (response to tx, trial): Nitenpyram or spinosad, nexgard, bravecto, activyl

** can give short term Pred/Apoquel if required… environmental flea treatment

* Long term: other pets in house. Dogs: IGR +/- adulticide; Cats: Selemectin/ Comfortis/ Activyl

Question 742

Answer 742

Scabies- Sarcoptes scabei var canis (obligate parasite, foxes, cats, humans)

* Burrow through stratum corneum

* Can survive up to 3 weeks off host (longer at lower temps)

* Disease: Hypersensitivity to mite antigens, pruritis is low until seroconversion

Lesions: PRIMARY: papules and hyperkeratosis; Secondary- from pruritis

Distribution: sparsely haired regions

Zoonosis

Diagnosis: superficial skin scrapes: papules, elbows, pinnae

** only find mites 10% of the time

Therapeutic trials: Revolution, Nexgard, or Bravecto

Treatment: Antibiotics if secondary infection, Pred only if not infected, warn clients of possible worsening first week

Question 743

What are the two kinds? Predisposing factors? Where are they?

Answer 743

Demodex canis (obligate parasite, transmitted at birth, present in all dogs, disease results from genetic/ immunological factors, concurrent disease, immunosuppressive drugs)

Predisposing factors: mean age onset 4.2-5.9 years, terriers juvenile < 18-36 months– breed, body condition, oestrus, fair-good prognosis… adult: hyperA, hypoTh, leishmaniasis, neoplasia, immunosuppressive drugs, 50% idiopathic… localized disease or generalised disease

** Aetiology: identified in follicles and sebaceous glands

* History: chronic disease (especially AD), prior decrease in immune drug use, young onset with no underlying causes)

Diagnosis: deep skin scrape, trichnograms- periocular, paws, exudative/pustular samples, tape preps (also:biopsy, otic swabs, LN aspirate)… look for concurrent bacterial infection (cytology, culture and sensitivty) OR look for underlying disease if adult onset– biochem and haematology, thyroid assessment, ACTH stim, radiographs and ultrasound

** Treatment: “benign neglect” desexing recommended, treat underlying condition.. do not treat with miticidal therapy because you want to see if it becomes generalized or can resolve on its own… spontaneous recovery rare. Concurrent infections common (S. pseudintermedius, Pseudomonas spp)– so Cephalexin, Clindamycin, Enrofloxacin

** If you have to treat: MLs

Question 744

What are some signs of a sore eye?

Answer 744

* Blepharospasm (closing the eye)

* Weeping eye

* Rubbing the eye

* Sleeping more than usual

* Protects the eye

Question 745

DDX? Tests? Treatment?

Answer 745

* Conjunctival cytology, skin scraping, FNA, biopsy

* With allergic conjunctivitis usually associated with other conditions- skin, ears, feet

* Tx: anti-inflammatory drugs- topical, systemic

* Antibiotics- Cephalexin 22 mg/kg BID, Clindamycin

Question 746

Answer 746

Topical steroids

Question 747

Answer 747

Question 748

Answer 748

TX: Lysine powder

Question 749

Initial DDX? Tests? Found inflammatory cells & epithelial cells, diagnosis? Treatment?

Answer 749

* DDX: infection, degeneration, ulceration

Tests: corneal cytology, MC&S, fluorescein stain

Diagnosis: Ulcerative Keratitis with stromal loss (deep corneal ulceration)

**Treatment: - debride and conjunctival graft (referral)

• temporary tarsorrhaphy (stitch the TE up)
• topical antibiotics- drops preferred- Ofloxacin, Chloramphenicol, fortified Cephalexins (750 mg in 15 ml artificial tears)
• topical atropine (if the iris is spasming, because it is painful)
• supportive therapy- pain relief, anti-inflammatory medication

Question 750

DDX? Tests? Diagnosis? Treatment?

Answer 750

Inflammation, degeneration, ulceration (does not always have fluoroscein uptake, also any area that is degenerate allowing the stain through the intracellular junctions, it will take up the stain… difference ulceration takes up the stain rapidly, degenerative cells takes up the stain slowly/ incompletely… check the other eye in the mean time…. use wood’s lamp)

* Fluoroscein stain, corneal cytology, MC & S

** Diagnosis: ulcerative keratitis- chronic corneal erosion (indolent ulcer, recurrent ulcer, Boxer ulcer)

** Treatment: surgery

• Debride with cotton bud/high speed ophthalmic burr (cut grooves in the cornea in the form of a ring, referral)
• Bandage contact lens
• Third eyelid flap/temporary tarsorrhaphy not usually necessary
• Topical antibiotic +/- topical atropine
• Supportive therapy - pain relief, anti-inflammatory medication

Question 751

Answer 751

Fungal Keratitis (rare in a dog, more common in horses)

* Fluorescein stain, corneal cytology, MC&S

* Topical antifungal medication- voriconazole (Rolls Royce of antifungals), itraconazole

* anti-inflammatory medication

* Possible surgery

Question 752

Answer 752

Question 753

Cytology: eosinophils

Answer 753

Diagnosis: Eosinophilic Keratitis

Treatment: - topical anti-inflamm/ immunomodulating medication

• Dexamethasone (Maxidex) drops
• Cyclosporin (Optimmune) or compounded Tacrolimus

Question 754

Answer 754

* DDX: FB, ulceration, neoplasia, perforation and iris prolapse

Tests: Fluorescein, MC&S, Corneal cytology, excisional biopsy

* Diagnosis: Feline Keratitis Nigrans– corneal sequestration, secondary to Feline Herpes Virus keratitis, lower eyelid entropion, exposure (especially Persians)

Treatment: - treat primary cause, artificial tears (for comfort), medical therapy unrewarding, surgery- keratectomy with “button” graft, pedicle graft or corneoconjunctival transposition

Question 755

Answer 755

DDX: inflammation, immune- mediated disease, lipid aqueous, neoplasia

Tests: transillumination, examine using magnification, haematology, serum analysis, aqueocentesis

Diagnosis: anterior uveitis– Cat- neoplasia (lymphoma), FIP virus, Toxoplasmosis, FeLV, Cryptococcus, possibly FHV

– Dogs- neoplasia (lymphoma), uveodermatological syndrome

Answer 756

Lymphoma in cat

Question 757

Answer 757

•Treat primary cause eg. Toxoplasmosis, Cryptococcosis

•

•Anti-inflammatory/immunomodulating medication - topical, systemic

•

•Secondary glaucoma or phthisis bulbi not uncommon

•

•Surgery - enucleation

Question 758

DDX? Tests?

IOP= 50 mmHg

Diagnosis?

Answer 758

Inflammation, ulceration, glaucoma- increased intraocular pressure, neoplasia

Tests: PLR, menace, tonometry, ultrasound, gonioscopy on fellow eye

* Diagnosis: primary IOP > 40 mmHg; secondary- lens induced uveitis

* Treatment: treat primary cause e.g. uveitis and anti-inflammatory medication; reduce production of aqueous (CA inhibitors)– diode laser ablation, increased outflow (PG analogues), pain relief, surgery- enucleation

Question 759

Functions of the hair coat

Answer 759

* Environmental protection

* Maintenance of skin microclimate

* psychosocial functions

Question 760

Answer 760

Actinic keratosis

Question 761

Hypotrichosis vs. alopecia

Answer 761

Hypotrichosis- reduction in the number of hairs in a normally haired region

Alopecia- lack of hair in a normally haired region

Question 762

Scientific name for shedding? Hair growth? Hair rest phase? Short involution phase?

Answer 762

* Exogen

* Anagen (poodles have a longer growth phase which is why they need a haircut)

* Telogen

* Catagen

Follicular cycling is complex and not fully understood. Essentially the cycle can be broken up into anagen (growing phase), catagen (involution phase), telogen (resting phase) and exogen (shedding phases). Very few dogs need a hair-cut. Hairs grow, for a genetically predetermined period to reach the desired hair length and then remain in the resting phase, telogen. This conserves energy, protein and lipid. The telogen hair is NOT easily epilated. It is tightly anchored within the follicular shaft until the exogen phase. Control of cycling is largely by intrinsic factors such as growth factors, genetic factors, adhesion molecules and receptor expression within the follicle itself (epithelial-mesenchymal interactions) but can be modified by extrinsic factors like the environment (light, temperature and nutrition) and endocrine factors.

Question 763

Answer 763

Anagen

Question 764

Answer 764

Telogen (resting)

Question 765

Examples of intrinsic and extrinsic factors of the hair growth cycle

Answer 765

Question 766

Mechanisms of hair loss and examples

Answer 766

1. Hair being lost prematurely (excessive loss)

A. Mechanical- pruritus, psychogenic, abnormal behaviours

B. Folliculitis- bacterial, fungal, parasitic

2. Hair failing to be replaced (failure to grow)

A. disruption of follicular cycling without structural change to follicle- HyperA, HypoTh, Alopecia X…etc.

B. Distruption of follicular cycling WITH structural change to follicle- pattern baldness, colour associated follicular dysplasia, non- colour associated follicular dysplasia, follicular lipidosis

C. Folliculopathy- ischamic alopecia, traction alopecia, topical flea spot treatment alopecia, thermal injury

3. Absence of follicles

A. Congenital alopecia- anhidrotic ectodermal dysplasia, hairless breeds

B. Cicatricial alopecia

Question 767

Diagnostics of hair loss

Answer 767

* Age

• 0-4 weeks (congenital alopecias)
• 0-9 months (black haired follicular dysplasia, pattern baldness, follicular lipidosis)
• 6 months to 3 years (colour dilute follicular dysplasia)
• 2 to 4 years (non-colour linked follicular dysplasia)
• 3 to aged (endocrinopathy, alopecia X)

* Breed: e.g. Alopecia X (Pomeranians, Miniature Poodles, Alaskan Malamute); Follicular Lipidosis (Rottweiler)

* Sex/ entire or neutered:

• female (hypo or hyper oestrogenism, ventral pattern baldness)
• male (testicular neoplasia, hypogonadism, pinnal pattern baldness)

* History: systemic with cutaneous manifestations? Or just skin disease?

* Physical exam: e.g. temporal muscle wastage HyperA, neuromuscular disease +/- tragic facial expression (hypoTh)

** Dermatological exam: hair colour, dull hair? faded hair (colour change seen where follicular development is altered)> Changes in hair texture (mechanical hair loss and diseases with structural change to the follicle)? Area affected? Skin atrophy (hyperA or just senile change)? Increased skin thickness (hypoTh)? Comedones (follicular hyperkeratosis, rule out demodicosis and sebaceous adenitis)?

The optical appearance of the hair coat is determined by the uniformity of reflected light from the hair. A healthy coat with an even layer of sebum coating the outer cuticle of the hair shaft reflects light evenly and therefore looks shiny. When hairs stop growing for any reason (cycling disruption, folliculopathy) the “tiles” of the outer cuticle tend to open. This leads to uneven surface and altered light reflection creating an optically dull coat. A dull coat then usually represents prolongation in telogen and ALL the follicular cycling abnormality should be considered.

** Diagnostic tests

Question 768

History suggestive of HyperA

Answer 768

lpolydipsia, polyuria 80-90%

lpolyphagia 80-90%

lmuscle weakness and lethargy 50-80%

lincreased panting 30%

lrecurrent skin infections

lurolithiasis

lanterior cruciate repair

Question 769

History suggestive of hypothyroidism

Answer 769

lweight gain

lheat seeking behaviour

lmuscle weakness and lethargy

lrecurrent skin infections

ldecreased fertility (females)

lbehavioural changes

Question 770

Answer 770

drug induced alopecia- flea spot on treatment

Question 771

Answer 771

Canine Recurrent Flank Alopecia (CRFA)- indoor dogs that do not receive appropriate light affecting their pineal gland, etc.

Question 772

Answer 772

Phlebectasia- HyperA

Question 773

Answer 773

*pheomelanin resistant to oxidation–bronzing = sign something is wrong with the hair coat– it is not growing properly

** could mean the dog has a lot of sun exposure as well, but less likely

Question 774

Answer 774

Cushingoid– skin problems due to lack of exfoliation

Question 775

Cosmetic vs. Systemic disease using a trichogram

Answer 775

* looks normal- no pendulous abdomen

* Mechanical trauma- doesn’t have to be from scratching

Question 776

Answer 776

Folliculitis– trichogram shows Demodex

Question 777

Answer 777

Follicular dysplasia in a Doberman

Question 778

Answer 778

Colour dilute follicular dysplasia

Question 779

Answer 779

Follicular casting

• Vertically orientated scale (follicular casting) is where the scale extends into the follicle and aligned parallel to the longitudinal axis of the hair shaft (demodicosis, follicular cycling defects).

Question 780

Common causes of canine otitis externa

Normal otitic flora in a dog

Answer 780

1. Allergic dermatitis (41/100)
2. Foreign body (12/100)
3. Ear mites (7/100)
4. Uknown (32/100)

Question 781

Why canine otitis externa?

Answer 781

Microclimate change = inflammation and maceration therefore opportunistic infection

Allergies– atopic dermatitis or food allergy

** Microclimate changes: anything that causes inflammation of the ear canals– parasites, FBs, allergies, irritants, other diseases involving EAC such as PF, juvenile cellulitis…..anything that increases the moisture of the ear canals– swimming, over use of ear cleaners, high environmental humidity, breed factors, stenosis of proximal canal, etc…. anything that interferes with self cleaning– damage to the tympanic membrane, polyps, neoplasia or large FBs, hyperplasia of the canal lining secondary to otitis, congenital or acquired stenosis, etc.

Question 782

Why treatment fails in canine otitis externa? What does otitis externa actually mean?

Answer 782

• Medication cannot penetrate to the bottom of the ear canal due to exudate, stenosis, polyps etc.
• The wrong dose of medication is applied
• The wrong choice of medication (must be active against target organisms, stable, safe e.g. if tympanic membrane is not intact)
• Poor owner compliance
• Failure to control inflammation
• Maceration. Your treatment also alters the microclimate of the ear. Long duration (longer than 2 to 3 weeks) or combination (aqueous cleaners with commercial ear drops with oily vehicles) leads to MACERATION of the ear canal. A macerated epithelium cannot form an effective epithelial barrier. The vehicles in the ear drops, plasticized gels, propylene glycol, mineral oil etc then become toxic to the epithelium and can promote ongoing inflammation.

* Otitis externa means inflammation of external auditory canal (not necessarily infection)– infectious otitis externa means otitis complicated by bacterial or fungal infection

Question 783

Basic principles of treatment of canine otitis externa

Answer 783

1. Resolve the current infection– remove all exudate, collect samples from all levels of the ear canal, ID the integrity of the tympanic membrane, assess the ear canal for glandular and epidermal hyperplasia, stenosis due to oedema or stenosis due to fibrosis, check for polyps and FBs and tumours… treat microbial overgrowth and address microclimate change by resolving inflammation (topical or systemic GCs), re-examine and repeat cytology is essential… treat for 7 days beyond cytological cure
2. Control trigger disease– microclimate change– visualization for FBs (video otoscopy), systemic disease treatment
3. Control secondary predisposing factors– sequelae that occure due to chronic inflammation of the EAC that will guaruntee relapse of the otitis externa irrespective of whether the trigger factor has been controlled– e.g. epidermal and or glandular hyperplasia, inflammatory polyps, fibrosis, stenosis, calcification of the EAC, cerumenoliths, otitis media, cholesteotomas and complete occlusion of the EAC

Question 784

Answer 784

Keratosis obturans- ball of wax– automatic ear cleaning is disrupted for some reason– need to remove surgically

Question 785

Answer 785

epithelial hyperplasia– reversible… have to get it back to normal in order to avoid recurrent otitis externa… these ears needs oral pred!

Question 786

Answer 786

• Glandular hyperplasia. This is less amenable to treatment and glandular hyperplasia may persist post treatment and is often associated with rapid cerumen accumulation and recurrent otitis. Cerumenolytics and or drying agents are needed in such cases as long-term maintenance. These dogs are problematic. Currently I use AQUA EAR â for the drying agent and will commonly add dexamethasone 10mg/ 10mls to make a 0.1% concentration if irritancy is a problem. Where a cerumenolytic is required I will use PAWs EAR CLEANER â followed 5 minutes later by EPIOTIC. PAWs has a detergent like action that emulsifies the lipids in cerumen but if not flushed out can cause irritation..

Question 787

Common reasons for treatment failure in otitis externa? How much ear meds in a cat? Large dog?

Answer 787

1. Inadequate dose of aural medications. Making sure they know how much medication to put in and how to do it properly
2. Failing to adequately clean the ear
3. Failing to control inflammation
4. Poor owner compliance
5. Wrong choice of medication e.g. gentamicin not effective in the presence of pus, polymixin is a poor choice for Pseudomonas in AUS
6. Failure to address trigger factors– e.g. atopic dermatitis
7. Failure to re-assess patient, confirm cytological resolution and continue treatment for 7 days past clinical and cytological resolution
8. Failure to address secondary changes e.g. epidermal or glandular hyperplasia
9. Bacterial or fungal resistance
10. Maceration due to diluted shampoos and overzealous use of ear cleaning agents

Question 788

If the tympanic membrane is not intact, what drugs are safe to use aurally?

Answer 788

Squalene is middle ear safe… would have to rely on e.g. systemic antibiotics if bacterial though generally they are not as effective

Question 789

How deep of a sample can you get when you are using a swab in a dog that is awake? Why is this a problem

Answer 789

* Different bugs in different parts of the ear canal

Question 790

Tx?

Answer 790

** problem with gentamicin– won’t work with pus in the ear

Question 791

Answer 791

Question 792

Why does culture and sensitivity mean nothing for ear infections?

Answer 792

Heavy growth means nothing– not a quantitative culture

** qualitative

* In vitro

* same sampling limitations

* Sensitivity/ resistance can be misleading– e.g. Pseudomonas spp. 9 different strains, so they may all grow but may all have different sensitivity (different antibiograms)

* there will also be passenger bacteria e.g. Corynebacteria, Enterococcus that you can ignore

Question 793

When to think about culture with ear infections?

Answer 793

Question 794

What happens when you treat ears longterm?

Answer 794

When you treat ears for extended period, you get a lot of build up that causes the ear to remain wet and therefore makes it difficult to clean up the infection (toxic environment for the epithelium)…. so you have to get rid of the buildup.

* Squalene is as close as you can get to normal ear wax in terms of lipid concentration
* So ears with chronic treatment– get ears clean and then use Pred and Squalene to get ears clean

Question 795

Young Cavalier with ear infections

Answer 795

Primary Secretory Otitis Media– must be treated early or permanent hearing loss… neurological signs, head, cervical pain…. end up with facial nerve paralysis but can be reversed if you recognize it early

** won’t allow mucous to drain through the eustachian tube

Question 796

Take home messages ear disease? When do refer?

Answer 796

uVisualise everything

uA clean ear is half way there

uCytology, cytology, cytology, revisits

uCulture RESISTANT infections

uYou can not fix ears without ear drops

uDemonstrate administration

uDon’t neglect underlying disease/trigger

uDon’t neglect secondary changes

Question 797

Eosinophilic Granuloma Complex– what is this?

Answer 797

NOT a diagnosis– reaction pattern of the skin

Eosinophil recruitment– simply by cytokines…

Allergies ** often is an allergy– flea allergy, atopic dermatitis, etc.

Viral infection

Fungal infection

Furunculosis

Tissue necrosis

Neoplasia

Question 799

Answer 799

Miliary dermatitis

* DDX:

lFolliculitis (dermatophytosis, bacterial)

lAllergy (flea, atopy, food, mosquito)

lEctoparasites (Otodectes, Cheyletiella)

lImmune mediate (Pemphigus)

lNutritional (EFAs, biotin def)

** Historical clues

lNutritional (diet)

lFleas, Cheyletiella, Otodectes (current flea control)

lFood allergy (if seasonal)

lAtopy/Fleas (seasonal)

lPersians (dermatophytosis)

lCattery (dermatophytes, Cheyletiella)

** Clinical clues

lHead (atopy, food allergy, Otodectes)

lNeck (fleas, atopy, food allergy)

lPre-auricular (atopy, food)

lLimbs/paws (atopy, food)

lTail base, caudal thighs (fleas)

Question 800

Persian cats with miliary disease

Answer 800

Always ring worm until proven otherwise

Question 801

Answer 801

Feline Herpes Virus

Question 802

Answer 802

Answer 803

Question 804

Diagnostic recipe for miliary dermatitis

Answer 804

* Wood’s lamp (M. canis glows 80% of the time)

* Fungassay (hairs on the fungal assay, check everyday– colonies starting to grow and red change at the same time)

* Cytology/antimicrobial trial

lBiopsy ( if nasal planum/pads)

lInsect elimination trial

lFood trial

lIntradermal skin testing/Allercept serum testing

Question 805

Answer 805

Acantholytic cells– PF

Question 806

Problem

Answer 806

Cut into the crust for biopsy (nasal planum/pads)

Question 807

Flea trial– what to use?

Food trial?

** If trials are not diagnostic … then what??

Answer 807

** Food trial and flea trial at the same time

lNovel protein (6-8weeks) (add EPO and B1)

lControl concurrent infection

lDo concurrently with flea elimination diet

lIndoor housing

**So you don’t have to keep the cat on steroids long term…. Intradermal skin testing/ Allercept serum testing is another option

Question 808

Answer 808

Indolent ulcer- 98% of the time they are infected

DDX: SCC, feline sarcoid (papilloma virus)

* Causes: flea allergy, atopy, food allergy, over-grooming, idiopathic

* Diagnosis: cytology/antimicrobial trial, biopsy, insect elimination trial, food trial, intradermal skin testing

** Convenia! Because of anaerobic activity or clindamycin (not Cephalexin as no activity against anaerobes)

Question 810

Answer 810

Eosinophilic plaque (really itchy!= e-collar)- pockets of degenerative neutrophils, full of bacteria

* Clinical clues: lick accessible areas ONLY (can help differentiate), erythematous/yellow foci, moist surface, extremely pruritic

* DDX: infectious granulomas, neoplasia, xanthoma (in diabetic cats– but are not itchy so you can tell them apart)

* Causes: flea bite hypersensitivity, atopy, food allergy, Idiopathic, reaction to their own saliva??

* Diagnostic recipe: Cytology (surface and FNA), AM trial (oral and topical), biopsy (if poorly responsive), insect elimination trial, food trial, intradermal skin testing/ Allercept serum testing

Question 811

Answer 811

Oral granuloma/ ulcer (clinical clues: yellow foci)

** in the mouth– rare to have infections therefore won’t respond to AMs

* Causes: flea bite hypersensitivity, atopy, food allergy, idiopathic

* DDX: neoplasia, infectious granulomas

** TX: Ciclosporin

** Can be anaemic without owner noticing because swallowing blood

Question 812

Specific v. non-specific Eosinophilic Granulomatous Complex Management– e.g. if you can’t get an answer

Answer 812

Question 813

Why would you avoid Dex in cats if you could?

Answer 813

Diabetes

** Dex dose/ 7 = pred equivalent

** Steroid sparing strategies – minimal effective dose

Question 814

Answer 814

* Feline herpetic dermatitis

Eosinophilic inflammation

Intra-nuclear inclusion bodies

IHC

Re-activation of latent infection

Question 815

Answer 815

Mosquito allergy

lNose, pinnae and LATERAL pads

lOutside exposure

lSeasonal

** Tx: avoidance, vitamin B1 in humans

Question 816

Answer 816

Mastocytosis

Question 817

Why does grooming help?

Answer 817

Trichogram with broken hairs– know it is mechanical– but don’t know if psychogenic or otherwise

Self trauma in lick areas means eosinophilic dermatitis on DDx

Work up

lFlea trial

lFood trial (less likely if no involvement of the head)

lIntradermal skin testing?, biopsy?, behavioural consult?

Question 818

How does the direct cutaneous arteries and vein supply in the subdermal plexus- apnniculus muscle help us in surgery?

Answer 818

Arterial supply that spreads out over a large area of the skin– allows us to rotate and transpose large areas of the skin to different parts of the body

helps us with ** tension issues or large dead spaces

Question 819

How do we make incisions and close wounds?

Answer 819

Question 820

What does perpendicular closure in relation to tension lines result in? What does diagonal closure result in?

Answer 820

Question 821

Stage I of wound healing? How long?

Answer 821

Question 822

What is the second phase of wound healing? How long?

Answer 822

Question 823

What is the third phase of skin healing? How long?

Answer 823

Question 824

How does wound healing impact treatment/ surgery in practice?

Answer 824

Recognize there are different stages and adapt treatment accordingly

Question 825

What are Halsted’s Principles?

Answer 825

Question 826

When would you place a surgical drain?

Answer 826

* area of high movement e.g. axilla

* bite wound- drain before definitive closure

Question 827

Answer 827

* drains AROUND the drain– not through the lumen– so if you are expecting a lot of exudate produced, then use a larger drain= larger surface area

** ascending infection can be a problem…

** need for sterile gauze bandage for infection but also so exudate doesn’t get everywhere

Question 828

Answer 828

** fenestration internal

Question 829

How would you make your own active drain?

Answer 829

Question 830

Routine surgery closure

Answer 830

* Subcutaneous, intradermal, and skin sutures

Question 831

Closure of a laceration

Answer 831

* Deep superficial, superficial deep

Then simple interupted

** in limbs assess ligament and tendon damage

Question 832

How do you handle a seroma? Where is it more likely to occur?

Answer 832

** if you drain it will likely just reform, but also potential for bacterial infection because of the protein enriched serum as an excellent medium to grow bacteria

Question 833

Closure of an abscess?

Answer 833

Skin closure

• Abscess

•

Causes:

–

Penetration (e.g.

FB like grass

awns or

plant

material or

bite wound)

–

Infection

(e.g. anal gland

abscess)

•

Clip liberally and sterile surgery

•

Sample (centesis

or swab) for C&S

•

Lance and drain abscess

•

Lavage with 0.9% NaCl

•

Passive or active drain

•

Start empirical antimicrobial

Question 834

How do cat and dog bite wounds differ?

Answer 834

Cat bites- cellulitis

* All will be contaminated, mixed bacterial population, aerobic, anaerobic

Question 835

Bite wounds management

Answer 835

* Assess the whole patient and stabilize, external may be tip of the iceberg

* IV fluids, oxygen, imaging

* minimize further contamination– sterile gauze sponges, sterile gel, liberally clip hair around puncture wound, cleanse skin around the wound with warm saline and surgical preparation solution

** Explore wound– be prepared for bigger surgery (thoracotomy or laparotomy)

* IV antibiotics (cephalosporins)

** Explore, debride, lavage (0.9% NaCl), collect samples C&S– close dead space, primary closure of skin if possible but nothing wrong with leaving wound open if contamination present (follow with delayed primary or secondary closure) and use drains…

Question 836

Open wound management

Answer 836

** through the phases of healing and repair– granulation tissue (resistant to infection due to excellent blood supply)

** Lavage– pulsatile lavage, gravity flow, or manual (8 psi) delivery via 35-60 ml syringe with 18-29 gauge needle

* Debridement– surgical, mechanical… daily or twice daily dressing changes

Question 837

Answer 837

Question 838

Dealing with tension

Answer 838

* Undermining

* Walking sutures

* tension releasing incisions

* tension suture patterns

* plasty techniques

Question 839

Undermining

Answer 839

* does predispose to more dead space formation– so only use in a small area (2 cm laterally)

Question 840

Tension releasing incisions

Answer 840

on the leg for example as limited amount of tissue

Question 841

Tension sutures

Answer 841

* horizontal mattress can compromise blood supply if you’re cranking up on it tight– so vertical preferred

* stents- IV tubing cut into small lengths, spreads tension out

Question 842

Plasty procedures

Answer 842

** flank

Question 843

Answer 843

Question 844

Examples of local flaps used in closure

Answer 844

Question 845

Indications for ear surgery

Answer 845

Question 846

Parts that make up the external ear, middle ear, inner ear?

Answer 846

Question 847

Vascular supply of the ear? Motor and sensory?

Answer 847

Question 848

Difference in anatomy of middle ear in cats vs. dogs

Answer 848

Question 849

What clinical signs with otitis externa/media? Why document pre surgically?

Answer 849

Question 850

Pre surgical assessment, what tests?

Answer 850

Question 851

What is it? Tx?

Answer 851

* remove blood clot, reduce the dead space, prevention of further trauma (immobilizing the ear and treating the primary disease)

* Linear or S-shaped or punch biopsy on inner surface of the ear to drain the haematoma (stent tubing for drainage)… close the dead space– full thickness sutures through the pinna. PARALLEL incisions to the LONG axis ofthe pinna00 to prevent damage to the vascular supply of the pinna

** SUTURES PLACED WITH A STRAIGHT NEEDLE

Question 852

Laceration of the ear treatment

Answer 852

Question 853

Common SA neoplasia of the ear

Answer 853

Question 854

Answer 854

SCC (chronic non-healing wounds)

* White cats have 13.4 x greater risk than coloured

* pinnectomy +/- vertical canal resection

Question 855

Lateral wall resection indications

Answer 855

Indications:

–

Facilitate management of otitis externa that is

controlled with medication

–

Removal of benign neoplasia of external canal

–

NOT

indicated if stenosis of canal is

present or

Cocker Spaniels

–

Success rate 35- 50%

Question 856

Total ear canal ablation and LBO? Potential Complications?

Answer 856

Indicated for end stage otitis externa/ media

* Hyperplastic, stenotic vert and horizontal canals

* removal of entire ear canal and lateral bulla osteotomy to drain bulla

Question 857

Indications for an anal sacculectomy

Answer 857

(4 o’clock and 8 o’clock)

Question 858

Open vs. Closed Anal Sacculectomy

Answer 858

* open- open up anal sac– non-neoplastic– advantage– you can see you have removed everything (internal is grey and glistening surface, easy to ID)….disadvantage- have to cut across the external anal sphincter therefore more trauma and more potential for infections

* closed approach- parianal approach- dissect down until the stalk… indicated for neoplasia. Do not need to transect. Can leave tissue behind

Question 859

* results: FNA- hepatoid cells

* Thoracic radiographs- WNL

* Rectal palpation- no palpable sublumbar node enlargement

* Palpation of mass- freely moveable

Answer 859

Perianal Adenoma (most common perianal tumor in intact male dogs: hepatoid gland tumors, cicumanal gland tumors… androgen dependent– often have a concurrent testicular tumor as well (interstitial cell tumor)

** slow growing, non-painful, freely moveable, may occur on tail head, prepuce or scrotum, +/- ulcerated, diffuse form

TX: Resection and castration, castration alone if diffuse form, castration + cryosurgery for small lesions ** Always submit for histopathology!

** Good prognosis > 90% cured with castration and mass removal… recurrences may be adenocarcinoma

Question 860

hint: castrated!

Answer 860

Perineal Adenocarcinoma

Next step: biopsy!

* Adenoma are androgen dependent… castrated male dog– think adenocarcinoma

**work up: caudal radiographs or ultrasound, rectal exam, chest radiographs for metastasis, +/0 adanced imaging to assess degree of invasiveness

** Treatment: aggressive surgical removal with margins if possible– radiation if margins are incomplete… does not respond to castration

Question 861

Answer 861

Anal Sac Adenocarcinoma

* Large, invasive subcutaneous mass

* Hypercalcaemia- paraneoplastic syndrome (Lymphoma is most common, Anal Sac Adenocarcinoma is the next most common)

* Female

* Tx: surgery on primary mass +/- lymph nodes depending on if they are involved

** Correct hypercalcaemia prior to anaesthesia or surgery

Question 862

Basics of canine breeding… puberty?

Answer 862

Dogs are non-seasonal breeders and ovulate spontaneously.
The onset of puberty in the bitch corresponds with the first oestrus and will occur anytime between 3.5 and 24 months (average: 10-12 months). In general, small breeds experience their first oestrus earlier and large breeds later. For some breeds it can be physiologic to not show heat up to the age of 24 or even 30 months of age, e.g. Afghan hound, Greyhound, Whippet, Saluki.

Question 863

What is progesterone in ng/ml at the LH surge? Ovulation?

Answer 863

Plasma progesterone levels begin to increase slowly in late prooestrus but suddenly double (between 1.5 – 2.5 ng/ml) at the time of the LH surge, making measuring progesterone plasma levels a valuable tool to indirectly determine the LH surge.
Ovulation occurs approximately 2 days after the LH peak and is not dependent upon breeding. Canine oocytes are ovulated as primary oocytes and need to go through a phase of maturation before they can be fertilized. It takes 48 to 72 hours for them to undergo meiotic division to become secondary oocytes.

** 5 ng/ml at OVULATION

Question 864

What is d0? d1-7? D1?

Answer 864

Question 865

Difference in the progesterone curve in a pregnant v. non-pregnant bitch? What is true of dogs and progesterone?

Answer 865

Less sensitive to progesterone… no intrinsic mechanism of luteolysis

Question 866

What does the pre-breeding exam consist of?

Answer 866

Question 867

When does ovulation occur in a bitch? When are oocytes mature? Where do you inseminate with fresh semen and how? Where do you inseminate with frozen semen and how?

Answer 867

* fresh semen- vagina- natural or AI with catheter

* Frozen- uterus- AI with transcervical insemination (TCI) or surgically (because of limited lifespan)

Question 868

How can you tell when you should breed?

Answer 868

* At the first sign of prooestrus (vulvar swelling/ bleeding), take the first vaginal smear for cytology and a serum sample for progesterone determination.
Keep doing this every other day until the serum progesterone indicates it is the time of the LH surge (doubling of serum progesterone level, most commonly ~ 1.5 – 2.5 ng/ml). Stop cytology at the first day of dioestrus (D1).

** Breeding reflexes– flagging, lordosis, standing for the male, reduced vaginal discharge (light coloured serosanguineous in the beginning, darker in the end)

** exfoliative cytology– keratinized and cornified cells in prooestrus and oestrous… becoming less in Dioestrous where leukoctyes can then come through and you will also get the intermediate cells and parabasal cells since the keratinized and cornified layer has now sloughed

* Vaginoscopy– vaginal folds swollen, moist, hyperaemic, gradually starting to shrink– folds becoming increasingly shrunken/angular (crenulated), pale in color, dry

Question 869

Breeding reflexes in a bitch

Answer 869

Question 870

How vaginoscopy can show pro-oestrous, oestrous, and dioestrous? How else does it help with determining breeding dates?

Answer 870

Question 871

What can vaginal cytology help you determine?

Answer 871

Question 872

Answer 872

Question 873

List the cells you will see in vaginal cytology including all of the phases

Answer 873

Question 874

Answer 874

Question 875

Answer 875

Question 876

Answer 876

Because the neutrophils can’t get through the keratinized/ cornified layer

Question 877

Answer 877

Question 878

When do you start sampling exfoliative cytology? What days? What else should you assess?

Answer 878

Question 879

Serum progesterone at LH surge? Ovulation? Fertile period?

Answer 879

Question 880

Pros and cons of vaginal semen deposition in natural mating? AI?

Answer 880

Question 881

Pros and cons of TCI intrauterine semen deposition? Norwegian catheter? Surgical?

Answer 881

Question 882

Time of breeding– natural or frozen?

Answer 882

Question 883

What is a roll prep? What would you use it for?

Answer 883

* ear infection cytology