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Small Animal Medicine > Cumulative TopHat > Flashcards

Cumulative TopHat Flashcards

1
Q

Blood pressure = ___ x ___

A

CO x vascular resistance

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2
Q

What are pressure overload diseases?

A. Diseases that result in reduced relaxation function of the heart

B. Diseases that require the heart to generate greater than normal ventricular pressures to eject blood

C. Diseases that result in reduced pumping function of the heart (low SV and CO)

D. Diseases that result in a higher than normal end diastolic volume in the ventricle

A

B. Diseases that require the heart to generate greater than normal ventricular pressures to eject blood

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3
Q

What are volume overload diseases?

A. Diseases that result in reduced relaxation function of the heart

B. Diseases that require the heart to generate greater than normal ventricular pressures to eject blood

C. Diseases that result in reduced pumping function of the heart (low SV and CO)

D. Diseases that result in a higher than normal end diastolic volume in the ventricle

A

D. Diseases that result in a higher than normal end diastolic volume in the ventricle

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4
Q

What are systolic dysfunction diseases?

A. Diseases that result in reduced relaxation function of the heart

B. Diseases that require the heart to generate greater than normal ventricular pressures to eject blood

C. Diseases that result in reduced pumping function of the heart (low SV and CO)

D. Diseases that result in a higher than normal end diastolic volume in the ventricle

A

C. Diseases that result in reduced pumping function of the heart (low SV and CO)

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5
Q

What are diastolic dysfunction diseases?

A. Diseases that result in reduced relaxation function of the heart

B. Diseases that require the heart to generate greater than normal ventricular pressures to eject blood

C. Diseases that result in reduced pumping function of the heart (low SV and CO)

D. Diseases that result in a higher than normal end diastolic volume in the ventricle

A

A. Diseases that result in reduced relaxation function of the heart

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6
Q

Which murmur descriptor DOES NOT help you to determine the source of the murmur?

A. Grade

B. Point of maximal intensity (PMI) location

C. Timing

D. Quality

A

A. Grade

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7
Q

What is the clinical cause for jugular pulsation?

A) Turbulent blood flow at the pulmonic or aortic valve

B) Turbulent blood flow at the mitral valve

C) Elevated right heart pressures

D) Reduced SV

A

C. Elevated right heart pressures

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8
Q

What is the cause for a murmur with a PMI at the left base?

A) Turbulent blood flow at the pulmonic or aortic valve

B) Turbulent blood flow at the mitral valve

C) Elevated right heart pressures

D) Reduced SV

A

A. Turbulent blood flow at the pulmonic or aortic valve.

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9
Q

What is the cause for a murmur with a PMI at the left apex?

A) Turbulent blood flow at the pulmonic or aortic valve

B) Turbulent blood flow at the mitral valve

C) Elevated right heart pressures

D) Reduced SV

A

B. Turbulent blood flow at the mitral valve.

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10
Q

What is the cause for hypokinetic femoral pulses?

A) Turbulent blood flow at the pulmonic or aortic valve

B) Turbulent blood flow at the mitral valve

C) Elevated right heart pressures

D) Reduced SV

A

D. Reduced SV

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11
Q

What are the 3 radiographic hallmarks of left-sided CHF?

A
  1. Moderate to severe LA dilation
  2. Pulmonary venous dilation
  3. Interstitial to alveolar pattern
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12
Q

What are the 3 radiographic hallmarks of right-sided CHF?

A
  1. Moderate to severe right heart enlargement
  2. Dilated caudal vena cava
  3. Effusion (e.g. pleural effusion)
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13
Q

What type of descriptive information is used to stage heart disease patients using the ACVIM classification system?

A

Structural depiction of what the heart looks like

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14
Q

You have an 8 year old FS mixed breed dog with mitral valve disease and moderate left atrial enlargement on an echocardiogram.

Stage the heart disease using the ACVIM staging system.

A

Stage B2

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15
Q

What is the definition of heart failure?

A

The heart pumping an inadequate volume of blood to meet the O2 demands of tissue despite normal to high venous return.

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16
Q

The presence of fluid accumulation in the form of pulmonary edema, pleural effusion, ascites/hepatomegaly, pericardial effusion, and/or peripheral edema are clinical signs of ___ heart failure.

A

backward (congestive)

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17
Q

Which of the following alterations will help to treat a patient with heart failure?

A) Increase inotropy

B) Increase preload

C) Increase afterload

A

A. Increase intropy

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18
Q

Which of the following drugs acts to decrease preload?

A) Furosemide

B) Pimobendan

C) Enalapril

D) Digoxin

A

A. Furosemide

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19
Q

What patient signalment is predisposed to degenerative valve disease?

A) Young, large breed dogs

B) Middle aged to older large breed dogs

C) Middle aged to older small breed dogs

D) Young, small breed dogs

A

C. Middle aged to older small breeds

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20
Q

You have a long-term patient with stage A degenerative mitral valve disease that you have been diligently monitoring for disease progression.

What is the EARLIEST stage that you should recommend starting cardiac therapies (pimobendan and ACE inhibitor)?

A

When he progresses to stage B2

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21
Q

A 9 y MC Yorkie presents for evaluation of cough.

A grade IV/VI left apical systolic regurgitant murmur is noted.

Thoracic radiographs reveal a moderately dilated left atrium and mild bronchiolar lung pattern.

What is the most likely diagnosis?

A

Degenerative mitral valve disease stage B2

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22
Q

A 12 year old spayed female miniature poodle with a history of stage B2 degenerative mitral valve disease presents to your emergency clinic for an acute onset of coughing, increased breathing rates (tachypnea), and an elevated heart rate (tachycardia).

You are concerned that the patient has developed congestive heart failure.

In addition to moderate to severe cardiomegaly, what radiographic findings are expected in a dog with stage C degenerative mitral valve disease?

A) Pleural effusion and/or peritioneal effusion (ascites) and caudal vena cava dilation

B) Interstitial to alveolar pulmonary pattern and pulmonary venous dilation

C) Pleural effusion and/or peritoneal effusion

D) Interstitial to alveolar pulmonary pattern and caudal vena cava dilation

A

B) Interstitial to alveolar pulmonary pattern and pulmonary venous dilation

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23
Q

Degenerative mitral valve disease is a type of volume overload disease.

What type of ventricular hypertrophy is expected in patients with degenerative mitral valve disease?

A

Eccentric LV hypertrophy

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24
Q

You are examining a patient with a grade III/VI left apical systolic murmur. Thoracic radiographs show moderate left atrial enlargement, normal pulmonary vessels, and no evidence of pulmonary edema.

What treatments do you recommend for this stage of degenerative mitral valve disease?

A) No cardiac treatments are recommended at this stage

B) Recommend starting Pimobendan and an ACE inhibitor

C) Recommend starting Pimobendan, an ACE inhibitor, and furosemide

D) Recommend starting an ACE inhibitor and furosemide

A

B) Recommend starting Pimobendan and an ACE inhibitor

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25
Q

What is the origin of the complex in image A?

A

ventricular origin

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26
Q

What is the calculated heart rate in ECG strip A?

A

8 complexes in 30 big boxes

8*20 = 160 bpm

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29
Q

What is the pathophysiologic etiology of heart failure in a dog with DCM?

A) Too much afterload

B) Too much preload (volume overload)

C) Not enough contractility (decreased inotropy)

D) Not enough relaxation/fillinf (decreased lusitropy)

A

C. Not enough contractility (decreased intropy).

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30
Q

What is the GOLD STANDARD diagnostic test for screening dogs for ventricular arrhythmias associated with DCM?

A

Holter monitor

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31
Q

What 2 medications have been shown to slow progression of DCM in Dobermans during the asymptomatic phase?

(i.e. prolong time to development of CHF)

A

Pimobendan

ACE inhibitor (enalapril/benazepril)

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32
Q

Name 2 ORAL medications that can be used to treat ventricular arrhythmias in dogs with DCM.

A

Sotalol

Mexiletine

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33
Q

In patients with pericardial effusion and cardiac tamponade, diastolic filling of the ___ side of the heart is impaired.

A

right

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34
Q

What are the hallmarks of pericardial effusion on a thoracic radiograph?

A

Enlarged & rounded cardiac silhouette, dilated caudal vena cava, small pulmonary arteries and veins

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35
Q

What is normal pulmonary artery systolic pressure?

A

25 mmHg

Note: Diastolic is 10 mmHg

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36
Q

Is left-sided heart disease pre- or post-capillary?

A

Postcapillary

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37
Q

Is chronic bronchopulmonary disease pre- or post-capillary?

A

Precapillary

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38
Q

What drug is used for treatment of pulmonary hypertension (direct pulmonary vasodilator)?

A

Sildenafil

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39
Q

If an asymptomatic dog tests positive for heartworm disease (positive HW antigen test), what 2 medications should be started IMMEDIATELY (on the day of diagnosis)?

A
  1. HW preventative
  2. Doxycycline
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40
Q

You are examining a patient that presented to you for a recent onset of lethargy and weakness. On examination you note that the patient is obese and it is difficult to hear the heart sounds, he has a rapid hear rate at 180 bpm, and you do not appreciate a heart murmur. The patient has jugular venous distension, a palpable abdominal fluid wave, and normokinetic to hypokinetic femoral pulses that vary with the patient’s respiratory cycle. What is the most likely cause of the patient’s physical exam findings.

A

Pericardial effusion with tamponade

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41
Q

You are working as an emergency clinician on a busy night in the ER. You have two dogs that present for collapse and you confirm that they both have pericardial effusion. You want to start treatments on the least stable patient first.

What diagnostic test do you recommend for the patients to compare their hemodynamic stability?

A

Blood pressure

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42
Q

A 7-year-old male castrated Boxer presents for an episode of collapse. On physical examination, you auscult frequent premature beats with pulse deficits, but no heart murmur. An ECG shows frequent monomorphic ventricular premature complexes (VPCs) of right ventricular origin. Thoracic radiographs are unremarkable. Which of the following is the most appropriate treatment?

A) Furosemide

B) Pimobendan

C) Sotalol

D) Diltiazem

E) No treatment

A

C. Sotalol

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43
Q

Sildenafil exerts which of the following hemodynamic effects on the right ventricle?

A) Increases contractility

B) Decreases preload

C) Decreases afterload

D) Increases HR

A

C. Decreases afterload

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44
Q

Which of the following diseases are the TOP 2 most common causes of systemic hypertension in DOGS? (choose 2)

A) DMVD

B) Chronic kidney disease

C) DCM

D) DM

E) Hypothyroidism

F) Hyperadrenocorticism

A

B. Chronic Kidney Disease

F. Hyperadrenocorticism

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45
Q

Which of the following diseases are the TOP 2 most common causes of systemic hypertension in CATS? (choose 2)

A) HCM

B) Chronic kidney disease

C) Hyperthyroidism

D) DM

E) Cholangiohepatitis

F) Idiopathic cystitis

A

B. Chronic Kidney Disease

C. Hyperthyroidism

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46
Q

Which of the following are among the “target organs” negatively affected by systemic hypertension? (choose 2)

A) Kidney

B) Liver

C) Lung

D) Brain

E) GI tract

F) Joints

A

A. Kidney

D. Brain

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47
Q

Which of the following potential treatments for systemic hypertension ACTIVATES the renin-angiotensin-aldosterone system (RAAS)?

A) Amlodipine

B) Enalapril

C) Telmisartan

D) Atenolol

A

A. Amlodipine

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48
Q

Are HCM and HOCM different diseases, or morphologic variants of the same disease?

A

HOCM is a morphologic variant of HCM characterized by a dynamic left ventricular outflow tract obstruction.

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49
Q

Which is more likely to be detected on physical examination: HCM or HOCM?

A

HOCM

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50
Q

Which drug might you be MORE LIKELY to give to a cat with HOCM compared to a cat with HCM?

A) Furosemide

B) Pimobendan

C) Enalapril/Benazepril

D) Atenolol

E) Clopidogrel

A

D. Atenolol

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51
Q

What 2 cat breeds have a known genetic predisposition to H(O)CM (causative genetic mutation identified)?

A

Maine Coons and Ragdolls

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52
Q

What are the 3 most common congenital heart diseases in DOGS?

A

PDA, pulmonic stenosis, subaortic stenosis

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53
Q

What are the 2 most common congenital heart diseases in CATS?

A

AV valve dysplasia

Ventricular septal defect (VSD)

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54
Q

Does a LEFT-TO-RIGHT shunting patent ductus arteriosus (PDA) cause LEFT- or RIGHT-sided congestive heart failure (CHF)?

A

left-sided CHF

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55
Q

Which 2 of the following characteristics could be consistent with an “innocent” puppy or kitten murmur?

A) Grade III/VI or softer

B) L basilar location

C) Diastolic timing

D) Patient age >6 months

E) R apical location

A

A. Grade III/VI or softer

B. L Basilar Location

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56
Q

A 10-year-old male castrated domestic shorthair cat presents to your clinic for dyspnea. Which of the following test results would INCREASE your index of suspicion for congestive heart failure as the cause of the patient’s dyspnea?

A) TFAST showing pleural effusion

B) TXR showing VHS of 7.8

C) NTproBNP SNAP test negative

D) S4 gallop on cardiac auscultation

A

D. S4 gallop on cardiac auscultation

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57
Q

A 12-week-old female intact beagle presents for wellness examination and rabies vaccine. You auscult a grade V/VI left basilar systolic heart murmur. Based on the most likely diagnosis for this patient, which of the following is the most likely clinical outcome if this patient’s heart disease is left untreated?

A) Pulmonary hypertension

B) Caval syndrome

C) Ascites

D) Endocarditis

A

C. Ascites

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58
Q

A 12-year-old male castrated Labrador retriever presents for a wellness geriatric examination. Routine bloodwork reveals a BUN of 35 mg/dL (reference range 10-30 mg/dL) and creatinine of 1.6 (reference range 0.5-1.5 mg/dL). Urine specific gravity is 1.012, and urine dipstick reveals 3+ protein with inactive sediment. Systolic blood pressure is 190mmHg while the dog is lying calmly on the examination table. Which of the following is the most appropriate treatment and followup plan?

A) Start an ACE inhibitor (benazepril or enalapril) or telmisartan; recheck blood pressure in 1-2 weeks and add amlodipine if blood pressure remains elevated

B) Recheck blood pressure in 1-2 weeks and consider antihypertensive therapy if blood pressure remains elevated at that time

C) Start amlodipine; recheck blood pressure in 1-2 weeks and increase dose of amlodipine if blood pressure remains elevated

D) Start amlodipine; recheck blood pressure in 1-2 weeks and consider adding an ACE inhibitor (benazepril or enalapril) or telmisartan if blood pressure remains

A

A) Start an ACE inhibitor (benazepril or enalapril) or telmisartan; recheck blood pressure in 1-2 weeks and add amlodipine if blood pressure remains elevated

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59
Q

A 7-year-old male castrated domestic shorthair cat presents for dyspnea and is diagnosed with congestive heart failure (pulmonary edema) secondary to hypertrophic cardiomyopathy (HCM). Which of the following medications would be part of your initial at-home treatment plan? (choose all that apply)

A) Furosemide

B) Hydrochlorothiazide

C) Spironolactone

D) Dietary sodium restriction

E) Pimobendan

F) Atenolol

G) ACE inhibitor (enalapril or benazepril)

H) Aspirin

I) Clopidogrel

A

Don’t Forget About Cats, Please

a. Furosemide
d. Dietary sodium restriction
e. Pimobendan
g. ACE inhibitor

I. Clopidogrel

Note: For dogs it is the same protocol but Spironolactone instead of Clopidogrel (Dogs Are For Special People)

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60
Q

A 4 year FS Pit Bull presents to you with a week long history of anorexia and lethargy. Her physical exam is unremarkable other than a palpable spleen. CBC shows a moderate thrombocytopenia, but is otherwise normal. You think you see red cell inclusions that remind you of Babesia that you saw in your VCS 444 lectures. You think:

a. This cannot be Babesia as she is not anemic
b. You are ready to treat her for Babesia as the treatment for Babesia is the same regardless of the infecting Babesia species
c. It would be prudent to send off blood for Babesia PCR and to test for other vector borne disease that she could be co-infected with
d. You better have a heart to heart talk with the owners as most Babesia infections in the US progress to severe form that is almost always fatal.

A

c. It would be prudent to send off blood for Babesia PCR and to test for other vector borne disease that she could be co-infected with

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61
Q

13 YO MC Pit bull with dark colored urine. He was diagnosed with a UTI and prescribed enrofloxacin. The next day he was very weak and diagnosed with anemia.

Based on the breed and blood smear, what do you think Boz is infected with?

a. Babesia canis
b. Babesia gibsoni

A

b. Babesia gibsoni

63
Q

13 YO MC Pit bull with dark colored urine. He was diagnosed with a UTI and prescribed enrofloxacin. The next day he was very weak and diagnosed with anemia. You have done a blood smear already and suspect that it is Babesia gibsoni. What test do you want to perform next?

a. Babesia serology
b. Babesia PCR

A

b. Babesia PCR

64
Q

13 YO MC Pit bull with dark colored urine. He was diagnosed with a UTI and prescribed enrofloxacin. The next day he was very weak and diagnosed with anemia. You have done a blood smear already and suspect that it is Babesia gibsoni. You do a PCR and confirm your suspicion. How do you want to treat him?

a. Imidocarb
b. Atovaquone and azithromycin

A

b. Atovaquone and azithromycin

65
Q

Which of the following should make you question your diagnosis of anemia due to hemotropic Mycoplasma in a 2 YO MC DSH cat?

a. The cats anemia resolved with doxycycline therapy
b. The cat is FeLV/FIV negative
c. The cat lives in a multicat household and none of the other cats are sick
d. The cat’s blood is autoagglutinating
e. Your PCR comes back as positive for M. haemominutum, but negative for M. haemofelis and M. turicensis

A

e. Your PCR comes back as positive for M. haemominutum, but negative for M. haemofelis and M. turicensis

66
Q

Bear is a 4 YO MC Flatcoat retriever that has presented for acute epistaxis. He recently moved to Iowa from Puerto Rico. On PE you discovered epistaxis and a mild fever of 103.0 F. He has thrombocytopenia, a PCV of 27%, and he has 20,000 reticulocytes (low). He is 4Dx Ehrlichia SNAP positive. What do you want to do next for Bear?

a. Start treating with doxycycline
b. Euthanize because Ehrlichia has a terrible prognosis
c. Send of a tick panel for Ehrlichia PCR and serology, and to look for other co-infections
d. Transfuse with pRBCs because he is anemic

A

a and c

67
Q

Moses is an 8 YO MC mixed breed dog presented for a sudden onset of lethargy, anorexia, and vomiting. On physical examination you noted he had a fever of 105.8 with prominent mandibular lymph nodes. He is thrombocytopenic and has a morulae located in a granulocyte. The chemistry and UA were WNL. You note that he has splenomegaly on rads. His 4Dx snap test was negative across the board. What are your top differentials based on the morulae in a granulocyte?

A

E. ewingii and A. phagocytophilum

68
Q

Moses is an 8 YO MC mixed breed dog presented for a sudden onset of lethargy, anorexia, and vomiting. On physical examination you noted he had a fever of 105.8 with prominent mandibular lymph nodes. He is thrombocytopenic and has a morulae located in a granulocyte. The chemistry and UA were WNL. You note that he has splenomegaly on rads. His 4Dx snap test was negative across the board. You think he has Ehlrichia.
Why do you think the snap test was negative?

A

Too acute an infection to have performed antibodies

69
Q

Moses is an 8 YO MC mixed breed dog presented for a sudden onset of lethargy, anorexia, and vomiting. On physical examination you noted he had a fever of 105.8 with prominent mandibular lymph nodes. He is thrombocytopenic and has a morulae located in a granulocyte. The chemistry and UA were WNL. You note that he has splenomegaly on rads. His 4Dx snap test was negative across the board. You think he has Ehrlichia.
What are your next diagnostic and therapeutic tests?

A

Baseline and convalescent serology, PCR, and treat with Doxycycline

70
Q

Pete is a 7 YO MC Golden that has presented for a 3 day history of lethargy, inappetence, and vomiting. This is the first time in his life that he has not eaten. You practice in NC. He is on flea and HW prevention, not tick prevention. On his PE you note he has a 103.7 F fever, he is 5-7% dehydrated, there is ocular mucoid discharge in both eyes, and the fundic exam is WNL. There are prominent submandibular and prescapular LNs and a slightly stiff gait. His CBC reveals thrombocytopenia, and slight neutrophilia. The chemistry panel reveals albumin and the UA reveals a USG of 1.026 and 1+ protein.

What do you want to do next for pete?

a. He must have Babesia because he lives in the South. Start imidocarb right away.
b. Systemic workup including abdominal x-rays and ultrasound. Just because this is an infectious disease lecture doesn’t mean he has an infectious disease.
c. Culture his urine because he has a fever and proteinuria.
d. Perform a 4Dx SNAP test.

A

B, C, and D

71
Q

Which of the following doxycycline responsive infections is associated with a vasculitis that can lead to peripheral edema because the causative organism infects endothelial cells?

a. Mycoplasma haemofelis
b. Rickettsia rickettsii
c. Ehrlichia canis
d. Anaplasma phagocytophilum
e. Babesia canis vogeli

A

b. Rickettsia rickettsii

72
Q

Which of the following is true about Lyme disease?

a. It is caused by a protozoan parasite from the Apicomplexa phylum
b. PCR is the best test for Lyme as it has the highest sensitivity.
c. As long as you vaccinate for Lyme disease, tick control is not important
d. When dogs show clinical signs of Lyme disease, fever and arthritis are the most common signs.

A

d. When dogs show clinical signs of Lyme disease, fever and arthritis are the most common signs.

73
Q

Briggs is a 6YO MC Labrador that is presenting for vomiting, lethargy, and being stiff in all four legs for the past week. On physical examination you note that he has tacky mucus membranes. The CBC showed that he is anemic and had thrombocytopenia. Chemistry revealed that he is azotemic, has hyperphosphatemia, and low albumin. His USG is 1.015 and 4+ protein in the urine. His UPC is 7.1. What do you want to do next diagnostically for Briggs?

a. Culture urine
b. Leptospirosis test
c. 4Dx SNAP test
d. all of the above

A

d. all of the above

74
Q

Briggs is a 6YO MC Labrador that is presenting for vomiting, lethargy, and being stiff in all four legs for the past week. On physical examination you note that he has tacky mucus membranes. The CBC showed that he is anemic and had thrombocytopenia. Chemistry revealed that he is azotemic, has hyperphosphatemia, and low albumin. His USG is 1.015 and 4+ protein in the urine. His UPC is 7.1. You find out that Briggs is Lyme positive and that he has a nephropathy of some sort.

What do you want to treat Briggs with?

a. Doxycycline
b. Baytril, benazepril, clopidogrel, and Mycophenolate
c. Doxycycline, benazepril, clopridogrel, and mycophenolate
d. Doxycylcine, benazepril, clopidogrel, and cyclosportine e. Doxycycline, benazepril, and clopidogrel.

A

c. Doxycycline, benazepril, clopidogrel, and mycophenolate

The 2 main drugs that should’ve pointed you to this answer is the doxy and the mycophenolate

75
Q

You are seeing a 3 year old FS Standard Poodle for a waxing and waning history of inappetence. A minimum database (CBC/Chemistry/UA) is unremarkable. Baseline cortisol comes back as <1. What does this tell you?

a. Addison’s disease is ruled out
b. this patient most likely has Addison’s disease. Since electrolytes are normal, begin treating with prednisone alone.
c. ACTH stimulation test is needed before conclusions about Addison’s disease can be made

A

c. . ACTH stimulation test is needed before conclusions about Addison’s disease can be made

76
Q

Glucagon promotes which of the following?

a. Glycogenesis (glycogen synthesis)
b. Increased tissue utilization of glucose, amino acids, and electrolytes
c. Lipolysis
d. Gluconeogenesis

A

c. Lipolysis and d. gluconeogenesis

77
Q

A 3-year old intact female mixed breed dog presents for severe lethargy and anorexia of 24 hours duration. On exam, she has injected mucous membranes, tachycardia, a temperature of 104.5 F, weak pulses, and abdominal pain. Labwork shows an inflammatory leukogram with a left shift, severe pyuria and bacteriuria, and a blood glucose of 54 mg/dl (repeatable). Name the most likely differential for her hypoglycemia.

a. Addison’s disease
b. Insulinoma
c. Sepsis
d. Xylitol toxicity

A

c. Sepsis

78
Q

A middle-aged male neutered mixed breed dog (weight: 10 kg) presents for PU/PD and unexplained weight loss. He is otherwise acting normally at home: he has a good appetite, normal stools, normal energy, and no vomiting. His exam is unremarkable with the exception of early cataracts. You perform a minimum database and diagnose diabetes mellitus (glucose 475 mg/dl; 3+ glucose and 1+ ketones on urine dipstick). Select the most appropriate therapy for this dog.

a. 3 U NPH (Humulin-N) insulin SC every 12 hours
b. Treat as an inpatient with a DKA protocol
c. 10 U lente (vetsulin) insulin SC every 12 hours
d. 4 U glargine (Lantus) insulin SC every 12 hours

A

a. 3 U NPH (Humulin-N) insulin SC every 12 hours

79
Q

Mrs. Cat is an 11 year old female spayed DSH presenting for a 6-month history of weight loss and diarrhea. On physical exam, you note thin body condition and a gallop rhythm on auscultation. You submit a CBC, chemistry, urinalysis, and T4 with the following abnormalities noted:

  • CBC-no significant findings
  • Chemistry-ALT 147 (RI: 40-110)
  • UA-no significant findings
  • TT4-6.1 (R1:1-4)

Select the correct statement:

a. Mrs. cat has hyperthyroidism
b. Mrs. Cat does not have hyperthyroidism
c. A TSH and/or fT4ed are needed to confirm the diagnosis
d. a fT4ed and/pr T3 suppresion test are needed to confirm the diagnosis

A

a. Mrs. Cat has hyperthyroidism

80
Q

Which of the following clinical signs would not be suggestive of Cushing’s?

a. Polyphagia
b. Polyuria
c. Alopecia
d. Anorexia
e. Panting

A

d. Anorexia

81
Q

Which of the following would not be typical of a dog with Cushing’s?

a. Elevated ALP
b. Hypercholesterolemia
c. Proteinuria
d. Glucosuria
e. thrombocytosis

A

d. Glucosuria

82
Q

Dogs with undiagnosed Cushing’s can present with complications secondary to the disease. Which of the following would not be an expected complicated presentation of a dog with Cushing’s?

a. Urinary obstruction from calcium oxalate stones
b. Pruritus from Demodex skin infection
c. Bradycardia from hyperkalemia
d. Hindleg paralysis from a clot to the iliac artery
e. Acute abdomen from a ruptured gall bladder mucocele

A

c. Bradycardia from hyperkalemia

83
Q

Hercules is an 11 year old Dachshund presenting for increased thirst and urination, panting, and failure of fur to regrow since his hemilaminectomy 6 months ago. On PE you find that he has thin skin, still shaved at the site of the previous hemilaminectomy, he has a pot belly and cranial organomegaly, and there are residual proprioceptive deficits in the hindlimbs.

What do you want to do next for Hercules?

a. ACTH stimulation test
b. minimum database
c. Urine cortisol to creatinine ratio
d. Thoracic radiographs

A

b. Minimum database and d. Thoracic radiographs

84
Q

Hercules is an 11 year old Dachshund presenting for increased thirst and urination, panting, and failure of fur to regrow since his hemilaminectomy 6 months ago. On PE you find that he has thin skin, still shaved at the site of the previous hemilaminectomy, he has a pot belly and cranial organomegaly, and there are residual proprioceptive deficits in the hindlimbs.

You find lymphopenia on the CBC, elevated ALP and ALT on chemistry, and your UA shows isosthenria, 2+ protein, and rare WBC.

Now what test do you want to do next?

a. LDDS
b. ACTH stimulation test
c. Urine cortisol to creatinine ratio

A

a. LDDS

85
Q

LDDS results are: Baseline: 12 mcg/dl; 4 hours: 2 mcg/dl; 8 hours: 1.2 mcg/dl. How do you interpret his test results?

a. PDH
b. ADH
c. HAC but don’t know what type
d. Not Cushingoid

A

d. not cushingoid

86
Q

LDDS results are: Baseline: 12 mcg/dl; 4 hours: 1.3 mcg/dl; 8 hours: 10 mcg/dl. How do you interpret his test results?

a. PDH
b. ADH
c. HAC but don’t know what type
d. Not cushingoid

A

a. PDH

87
Q

LDDS results are: Baseline: 12 mcg/dl; 4 hours: 11 mcg/dl; 8 hours: 8 mcg/dl. How do you interpret his test results?

a. PDH
b. ADH
c. HAC but don’t know what type
d. Not Cushing’s

A

c. HAC, but don’t know what type

88
Q

What if Hercules was also a long-term diabetic. What would be the best test for Cushing’s?

a. LDDS
b. ACTH stimulation test
c. Urine cortisol creatinine

A

b. ACTH stimulation test

89
Q

Hercules is in the hospital for pancreatitis and DKA and you think he might be Cushingoid. What would be the best screening test for HAC in Hercules?

a. LDDS
b. Urine cortisol to creatinine ratio
c. ACTH stimulation ratio
d. none of the above

A

d. none of the above

Wait until the pancreatitis and DKA are treated

90
Q

What are classic clinical pathologic findings on the minimum database of a dog with Cushing’s?

a. Stress leukogram, significantly elevated ALT, dilute urine
b. Stress leukogram, elevated BUN, dilute urine
c. Thrombocytosis, elevated ALP, glucosuria
d. Thrombocytosis, elevated ALP, dilute urine
e. Anemia, elevated cholesterol, proteinuria

A

d. Thrombocytosis, elevated ALP, dilute urine

91
Q

In a dog with classic signs of Cushing’s (PU/PD, polyphagia, panting, elevated ALP, dilute urine) and no concurrent illness, which screening test for Cushing’s would you perform?

a. Urine cortisol to creatinine ratio
b. ACTH stimulation test
c. Low dose dexamethasone suppression test

A

c. Low dose dexamethasone suppression test

92
Q

Going back to Hercules… LDDS results were: Baseline - 12 mcg/dl, 4 hours- 8 mcg/dl, and 8 hours- 8 mcg/dl

What is your diagnosis?

a. Not Cushingoid
b. PDH
c. ADH
d. HAC, but don’t know what type

A

d. HAC, but don’t know what type

93
Q

What do you want to do next to determine what type of HAC Hercules has?

a. MRI
b. CT scan
c. Abdominal x-rays
d. Abdominal US
e. ACTH stimulation test

A

d. Abdominal US

94
Q

After ultrasound, you find an adrenal tumor. How do you want to treat him?

a. Unilateral adrenalectomy
b. Mitotane which works by inhibiting 3 beta hydroxy steroid dehydrogenase
c. Trilostane which works by causing selective necrosis of the zona fasciculata and reticularis
d. Trilostane which works by inhibiting 3 beta hydroxy steroid dehydrogenase

A

d. Trilostane which works by inhibiting 3 beta hydroxy steroid dehydrogenase

95
Q

An absolute reticulocyte count above ___ is consistent with regenerative anemia in a dog.

a. 200,000
b. 8,000

c, 20,000

d. 80,000

A

d. 80,000

96
Q

An absolute reticulocyte count above ____ is consistent with a regenerative anemia in a cat.

a. 500
b. 2,000
c. 80,000
d. 50,000

A

d. 50,000

97
Q

How would you characterize this patients anemia?

a. Microcytic, hypochromic, and nonregenerative
b. Macrocytic, hypochromic, and regenerative
c. Microcytic, hypochromic, and regenerative
d. Normocytic, normochromic, and nonregenerative

A

c. Microcytic, hypochromic, and regenerative

98
Q

What type of anemia do you think Kira has and what do you suspect its cause is?

a. Nonregenerative anemia due to her unregulated diabetes
b. Regenerative anemia due to hemolysis
c. Nonregerative anemia due to underlying cancer
d. Regenerative anemia due to blood loss

A

d. Regenerative anemia due to blood loss

101
Q

Which of the following clinicopathologic findings would support your suspicion that your patient has IMHA?

a. Microcytosis, hypoproteinemia, and thrombocytosis
b. Hyperbilirubinemia, hypophosphatemia, and hyperglycemia
c. This is a silly question. There is one definitive diagnostic test for IMHA: Coomb’s test
d. Hyperbilirubinemia, autoagglutination, and spherocytes
e. Leujopenia, hemoglobinemia, and a negative Commb’s test

A

d. Hyperbilirubinemia, autoagglutination, and spherocytosis

102
Q

Which of the following should be ruled out before making a diagnosis of primary IMHA (may be multiple answers)?

a. Non-immune hemolysis due to zinc toxicity
b. Secondary immune hemolysis due to Babesia infection
c. Non-immune hemolysis due to hyperkalemia
d. Secondary immune hemolysis due to lymphoma

A

a, b, and d

103
Q

What is the frontline immunosuppressive therapy in IMHA?

a. aspirin
b. Glucocorticoids
c. Azathioprine
d. Heparin
e. Cyclosporine

A

b. Glucocorticoids

104
Q

What is the most common reason for sudden death in IMHA?

a. Secondary infection
b. Thrombosis
c. Arrhythmia
d. Blood loss

A

b. thrombosis

105
Q

Duke is a 9 year old MC 40kg mixed breed dog. He has a HCT of 19% and spherocytes on his CBC. He is icteric, lethargic, tachypneic, and tachycardic. His PT and aPTT are within normal limits. What blood product do you want to give Duke?

a. Stored whole blood
b. Fresh frozen plasma
c. Frozen plasma
d. Packed red blood cells
e. No transfusion

A

d. Packed red blood cells

106
Q

Malaika is a 10 yearold FS DLH. Her HCT is 18% and she has stage 3 CKD. Her RR is 20 when not purring, HR is 150, and BP is 130 mmHg. Her temperature is 100 degrees F. What blood product do you want to give Malaika?

a. stored whole blood
b. fresh frozen plasma
c. frozen plasma
d. packed red blood cells
e. no transfusion

A

e. no transfusion

107
Q

Sarge is a 1 year old MC DSH. His HCT is 12%. He is icteric, vomiting, and lethargic. His HR is 220, RR 50 temperature is 98 degrees F, and his BP is 90 mmHg. You do a blood smear and find evidence of Mycoplasma. What blood product do you want to give Sarge?

a. stored whole blood
b. fresh whole blood
c. fresh frozen plasma
d. packed red blood cells
e. no transfusion

A

d. Packed red blood cells

108
Q

Jenny is a 4 year old FS German Shepherd that is presenting with a 1 week history of lethargy, inappetance, and vomiting. She is tachypneic with harsh lung sounds. Her HCT is 42%, platelet estimate is greater than 200,000, PT and aPTT are prolonged. What blood product do you want to give Jenny?

a. stored whole blood
b. fresh frozen plasma
c. packed red blood cells
d. no transfusion

A

b. Fresh frozen plasma

109
Q

Which of the following is NOT a player in primary hemostasis?

a. Platelets
b. von Willebrand factor
c. Endothelium
d. Factor IX

A

d. factor IX

110
Q

In a severely thrombocytopenic dog, what signs of bleeding might you see?

a. Epistaxis
b. Hemoabdomen
c. Melena
d. Hemoptysis

A

a, c, and d

111
Q

What is the most common acquired disorder of primary hemostasis?

a. rodenticide toxicity
b. von Willebrand disease
c. thrombocytopenia
d. liver disease

A

c. thrombocytopenia

112
Q

What ITP treatment is available that increases platelet count but would have no use in IMHA?

a. azathioprine
b. mycophenolate
c. vincristine
d. prednisone

A

c. vincristine

113
Q

What is the most common hereditary disorder of primary hemostasis?

a. melena
b. abdominal cavity hemorrhage
c. von Willebrand disease
d. macrothrombocytopenia
e. platelet count +/- vWF testing
f. Rodenticide toxicity
g. platelet consumption

A

c. von Willebrand disease

114
Q

Which of the follwing is a cause of acquired thrombocytopenia?

a. melena
b. abdominal cavity hemorrhage
c. von Willebrand disease
d. macrothrombocytopenia
e. platelet count +/- vWF testing
f. Rodenticide toxicity
g. platelet consumption

A

g. platelet consumption

115
Q

What blood products contain viable platelets?

a. stored whole blood
b. platelet rich plasma
c. fresh frozen plasma
d. fresh whole blood
e. platelet concentrate

A

b. platele rich plasma
d. fresh whole blood
e. platelet concentrate

116
Q

Brutus is a 9 year old male castrated goldendoodle. He presented for a nose bleed. He has already been worked up for nasal disease and his platelet count and clotting times are normal. What do you want to do next with Brutus?

a. BMBT
b. vWF testing
c. Chemistry panel
d. Hmm… all of the above sound like good ideas

A

d. Hmm… all of the above sound like good ideas

117
Q

Who are the key players in primary hemostasis, defects in which would lead to prolonged BMBT?

a. Coagulation factor X, fibroblasts, von Willebrand factor
b. Endothelium/vasculature, platelets, tissue factor
c. fibroblasts, platelets, von Willebrand factor
d. Endothelium/vasculature, platelets, von Willebrand factor

A

d. Endothelium/vasculature, platelets, von Willebrand factor

118
Q

Which model of secondary hemostasis better reflects your lab testing like PT and aPTT?

a. Traditional waterfall/cascade model
b. Cell-based model

A

a. Traditional waterfall/cascade model

119
Q

Which model better reflects secondary hemostasis as it happens in the dog or cat?

a. Waterfall/cascade model
b. Cell-based model

A

b. Cell-based model

120
Q

Which of the following diseases is better explained by the cell-based model than the waterfall model?

a. von Willebrand disease
b. ITP
c. Hemophilia A
d. Fibrinogen deficiency

A

c. Hemophilia A

121
Q

Which blood products contain FVIII?

a. fresh whole blood
b. stored whole blood
c. fresh frozen plasma
d. frozen plasma
e. packed red cells

A

a. Fresh whole blood
c. fresh frozen plasma

122
Q

What inhibitor of thrombin is decreased during a disease process where albumin is lost/not absorbed? The end result is risk of ______.

a. Protein C, bleeding
b. Protein S, clotting
c. Antithrombin, clotting
d. Tissue factor pathway inhibitor, bleeding

A

c. antithrombin, clotting

123
Q

You would conduct a BMBT after the following:

a. melena
b. abdominal cavity hemorrhage
c. von Willebrand disease
d. macrothrombocytopenia
e. platelet count +/- vWF testing
f. Rodenticide toxicity
g. platelet consumption

A

e. platelet count +/- vWF testing

124
Q

Cerenia (maropitant) treats vomiting by preventing the binding of which ligant to its respective receptor in the emetic center?

a. Serotonin - 5HT3
b. Dopamine - D2
c. Substance P - NK1
d. Histamine - H2

A

c. Substance P - NK1

125
Q

Entyce (capromorelin) increases appetitie by mimicking the action of which endogenous hormone in the appetitie center?

a. Serotonin
b. Dopamine
c. Leptin
d. Ghrelin

A

d. Ghrelin

126
Q

Approximately what % of dogs and cats experience clinical side effects following chemotherapy, and what % potentially require hospitalization?

a. 10%; <1%
b. 30%; 5-10%
c. 50%; 20%
d. 75%; 30%

A

b. 30%; 5-10%

127
Q

Hypercalcemia is most commonly associated with which form of canine lymphoma?

a. Multicentric
b. Extranodal
c. Mediastinal
d. Cutaneous
e. Alimentary/GI

A

c. Mediastinal

128
Q

A dog with lymphoma presenting with peripheral lymphadenopathy and uveitis would be classified with what stage of disease?

a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
e. Stage 5

A

e. Stage 5

129
Q

Which one of the following lymphoma diagnostics evaluates clonality of the lymphocyte population?

a. PARR
b. Flow cytometry
c. Immunohistochemistry
d. Immunocytochemistry

A

a. PARR

130
Q

The diagnosis of indolent lymphoma is best made by:

a. History and clinical signs
b. PARR
c. Cytrology
d. Treatment response
e. Histopathology and IHC

A

e. Histopathology and IHC

131
Q

The preferred initial treatment for most dogs with indolent lymphoma is:

a. An abbreviated CHOP-based protocol
b. Prednisone
c. CCNU (lomustine)
d. Doxorubicin
e. No treatment/monitor

A

e. No treatment/monitor

132
Q

Gastrointestinal (GI) lymphoma diagnosed in cats is most frequently low/high grade B-cell/T-cell in origin, occuring most commonly in the small/large intestines.

a. Low/T-cell/small
b. High/B-cell/large
c. Low/B-cell/small
d. Low/T-cell/large

A

a. Low/T-cell/small

133
Q

The most important mechanism by which external beam radiation therapy causes DNA damage and results in cell death is via:

a. Direct action of ionizing radiation causing double strand breaks in the cellular DNA
b. Thermal damage to cells caused by ionizing radiation
c. Indirect action of ionizing radiation via free radical induction and subsequent DNA damage
d. Inhibition of topoisomerase II

A

c. Indirect action of ionizing radiation via free radical induction and subsequent DNA damage

134
Q

Which of the following would be a possible early side effect following radiation therapy in a dog with a nasal tumor?

a. Cataract OS
b. Oral mucositis
c. Necrosis of the hard palate

d, Change in hair color in area treated

A

b. Oral mucositis

135
Q

Dogs with gross/visible MCTs are at increased risk of this systemic side effect due to the histamine present in their mast cells:

a. gastric ulceration
b. epistaxis
c. pulmonary metastasis
d. uveitis

A

a. gastric ulceration

136
Q

Mutation of which gene/receptor is assocaited with a more guarded prognosis and worse clinical outcome for dogs with mast cell tumors?

a. BRAF
b. C-KIT
c. VEGF
d. PDGF

A

B. C-KIT

137
Q

What is the most comomn type of oral tumor in the dog?

a. Fibrosarcoma
b. Melanoma
c. Squamous Cell Carcinoma
d. Lymphoma

A

b. Melanoma

138
Q

What is the most EFFECTIVE treatment with the FEWEST side effects for canine nasal tumors?

a. Surgery
b. Palliative Radiation therapy
c. Definitive Radiation Therapy
d. Stereotactic Radiation Therapy

A

d. Stereotactic Radiation Therapy

139
Q

Canine TCC is most commonly found in the:

a. Apex of the bladder
b. Trigone of the bladder
c. Urethra
d. Prostate

A

b. Trigone of the bladder

140
Q

What procedure is most likely to result in seeding of a TCC?

a. FNA of mass or bladder
b. Cytoscopy of bladder
c. Surgery to remove bladder mass

A

c. Surgery to remove bladder mass

141
Q

Which of the following cancers is the most common cause of hypercalcemia of malignancy?

a. Lymphoma
b. Osteosarcoma
c. Hemangiosarcoma
d. Transitional Cell Carcinoma

A

a. Lymphoma

142
Q

Which of the following is osteosarcoma?

a. A
b. B
c. C
d. all of these

A

b.B

144
Q

Even with aggressive therapy (such as surgery or radiation therapy, and chemotherapy) survival times for most dogs with OSA are, on average, 9-12 months. Why?

a. All dogs with OSA are older and thus have a shorter expected survival time
b. 80% of dogs develop a pathologic fracture within 1 year of diagnosis
c. 90% of dogs have micrometastatic disease at presentation

A

c. 90% of dogs have micrometastatic disease at presentation

145
Q

The most effective treatment option for canine splenic hemangiosarcoma (HSA) is:

a. surgery alone
b. surgery and doxorubicin chemotherapy
c. Surgery and carboplatin chemotherapy
d. Surgery and low-dose cyclophosphamide

A

b. surgery and doxorubicin chemotherapy

146
Q

Which of the following does not fall into the category of a soft tissue sarcoma?

a. osteosarcoma
b. spindle cell sarcoma
c. rhabdomyosarcoma
d. leiomyosarcoma

A

a. osteosarcoma

147
Q

Which of the following is NOT a cause of mammary carcinoma in dogs?

a. obesity
b. age
c. exposure to herbicides
d. exposure to estrogen

A

c. exposure to herbicides

148
Q

Over 90% of ______ mammary tumors are malignant.

A

feline

149
Q

True or False: Multiple vaccinations given at the same time increase the chances of FISS development

A

True

150
Q

Which of the following is the correct surgical margin recommendation for a FISS?

a. 2-3 cm lateral margins; 1 fascial plane
b. 2-3 cm lateral margins; 2 fascial planes deep
c. 5 cm margins; 1 fascial plane deep
d. 5 cm lateral margins; 2 fascial planes deep

A

d. 5 cm lateral margins; 2 fascial planes deep

151
Q

The most comon feline oral tumor is:

a. squamous cell carcinoma
b. fibrosarcoma
c. melanoma
d. lymphoma

A

a. squamous cell carcinoma

152
Q

Which of the following viruses directly leads to feline cancer?

a. FeLV
b. FIV
c. Feline Papillomavirus
d. feline herpesvirus

A

a. FeLV

Small Animal Medicine (100 decks)

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