DOGS

Question 1

Campylobacteriosis

Answer 1

Gram negative motile, thin, S-shaped or gull shaped rod. It can occur singly, in pairs or in chains. C. jejuni is the most commonly isolated.
Clinical signs: mucus-laden diarrhea

Question 2

What needs to be monitored after the removal of an insulinoma?

Answer 2

Hyperglycemia; monitoring blood glucose is important. When performing mass resections of the pancreas the ideal situation is a mass associated with the tail of the pancreas. Otherwise they can be very difficult to excise in their entirety and you run the risk of disrupting the flow of pancreatic enzymes into the duodenum. The pancreas is responsible for secreting insulin which is what stimulates glucose to be removed from the blood stream and taken into the cell. A patient with a mass in the pancreas that is causing hypoglycemia has an insulinoma. Removal of an insulinoma can occasionally lead to hyperglycemia and diabetes mellitus requring insulin administration in dogs.

Question 3

Salmonella

Answer 3

Gram-negative bacillus

Question 4

C. difficile

Answer 4

Gram positive rod

Question 5

Cryptosporidium

Answer 5

Coccidian parasite

Question 6

Struvite urolithiasis

Answer 6

Large bladder stones in the presence of a UTI and alkaline urine are usually struvite, particularily when accompanied by struvite (magnesium ammonium phosphate) crystalluria. The infecting organisms are usually urease-producers (Staphylococus, Proteus, Klebsiella, some E. coli) which alkalinize the urine and favor struvite formation. The single most important long-term management is prevention of infection.

Question 7

Calcium oxalate stones

Answer 7

are usually small (1cm or less), are often present in the absence of a UTI and can’t be dissolved

Question 8

Cystine stones

Answer 8

occur most often in Newfoundland dogs, dachshunds, and bulldogs. They are radiolucent and occur due to metabolic defects.

Question 9

Urate stones

Answer 9

are usually small and many. They are frequently radiolucent and can be related to underlying liver disease.

Question 10

What is the most common urinary bladder tumor?

Answer 10

Transitional Cell Carcinoma

Question 11

Transitional Cell Carcinoma

Answer 11

most common urinary bladder tumor.
Clinical signs: stranguria, pollakiuria, hematuria
Diagnosis: abnormal cells often seen on urinalysis, but can’t diagnose on UA alone. Biopsy is needed for definitive diagnosis.
Treatment: chemotherapy can help these patients shrink the tumor for time (for a better quality of life); however the prognosis is grave.

Question 12

What is the blood parasite that looks similar to microfilariae of Dirofilaria immitis?

Answer 12

Acanthocheilonema reconditum

Question 13

What is the difference in treatment between Acanthocheilonema reconditum and Dirofilaria immitis?

Answer 13

Acanthocheilonema reconditum is not pathogenic and is therefore not treated.

Question 14

What is Central Venous Pressure a measure of?

Answer 14

direct measure of blood pressure in the cranial vena cava. Venous blood volume, venous vessle tone, and cardiac output determine the CVP. CVP is an estimate of preload, not a direct measurment.

Question 15

What test is both a screening test and a differentiating test for hyperadrenocorticism?

Answer 15

Low dose dexamethasone suppression test. If the 8 hour sample is above 1.4ug/dL, the test is diagnostic for hyperadrenocorticism (either pituitary or adrenal dependent). If the 4 hour sample is below 1.4ug/dL or less than half of the baseline value, it is diagnostic for pituitary dependent hyperadrenocorticism.

Question 16

What are the different screening tests for hyperadrenocorticism?

Answer 16

-Low dose dexamethasone suppression test
-urine cortisol:creatinine ratio
-ACTH stimulation test

Question 17

What tests can be used to differentiate pituitary versus adrenal dependent hyperadrenocorticism?

Answer 17

-low dose dexamethasone suppression test
-Endogenous ACTH
-high dose dexamethasone suppression tests

Question 18

What is the most common direction of luxation in a coxofemoral luxation?

Answer 18

Craniodorsal

Question 19

What imaging modality is best to identify the lesion in an IVDD suspected patient?

Answer 19

MRI; best imaging modality to visualize the spinal cord

Question 20

A 4yr old Dachshund has just presented for an acute onset of hind limb ataxia. On PE, there is a lack of voluntary motion of the pelvic limb along with conscious proprioceptive deficits. There is no panniculus reflex caudal to L3.

What diagnosis do you suspect?

Answer 20

Type 1 disc herniation
-this is acute while type 2 is slow and chronic
-Dachshunds are very predisposed to disc disease (particularly type 1)

Question 21

What is the most common complication following an intestinal resection and anastomosis surgery?

Answer 21

Septic peritonitis

Question 22

What is the most common time frame for an anastomosis failure?

Answer 22

3-5 days postoperatively; this is due to the timing of degradation of fibrin at the site prior to deposition of sufficient collagen

Question 23

Negative reinforcement as a behavioral principle

Answer 23

occurs when a behavior is followed by the removal of an aversive stimulus thereby increasing that behaviors frequency. An example is a loud noise continuously sounding until a lever is pressed, upon which the loud noise is removed. This will encourage the behavior of pressing the lever.

Question 24

Negative punishment as a behavioral principle

Answer 24

also called punishment by contingent withdrawal, occurs when a behavior is followed by the removal of a favorable stimulus, such as taking away a child’s toy following an undesired behavior, resulting in a decrease in that behavior.

Question 25

Avoidance learning as a behavioral principle

Answer 25

is when a behavior results in the cessation of an adversive stimulus. For example, holding your ears to shield them from a loud, high-pitched sound helps avoid the aversive stimulation of that obnoxious sound

Question 26

Noncontingent reinforcement as a behavioral principle

Answer 26

is the delivery of reinforcing stimuli regardless of the animal's behavior. This causes that behavior to decrease because it is not required in order to receive the reward.

Question 27

Extinction of operant conditioning as a behavior principle

Answer 27

when a behavior is inconsequential, producing neither favorable nor unfavorable consequences, it will occur with less frequency. When a previously reinforced behavior is no longer reinforced with either positive or negative reinforcement, it leads to a decline in the response

Question 28

What type of pH do struvite/magnesium ammonium phosphate crystals form in?

Answer 28

Alkaline urine (pH above 7)

Question 29

What is the appropriate treatment for a dermatitis known to be caused by a food allergy?

Answer 29

Feed a diet with a novel protein and carbohydrate sources or a hydrolyzed diet. Hydrolyzed diets are a good alternative to novel protein diets when the diet history is unknown or the pet has been exposed to many proteins. Hydrolyzed diets reduce the size of the protein and thus minimize the ability to cross link with IgE and cause mast cell degranulation.

Question 30

Transmissible Venereal Tumor (TVT) | Cause, appearance, diagnosis

Answer 30

TVT is a sexually transmitted tumor found throughout the world, particularily in areas with high populations of stray dogs. The tumor cells are transferred from one dog to the next by physical contact, which typically consists of sniffing, licking, and copulation. In male dogs, it can present as a mass on the penis. On FNA there will be a large number of round cells with vacuoles in the cytoplasm present.

Question 31

Prolapsed glands of the third eye lid (cherry eye) | cause, treatment

Answer 31

Congenital defect that will likely be passed on to future generations if the dog is bred. Repair consists of replacing the prolapsed gland and tacking it to the periorbital rim or using the Morgan pocket technique. Surgical removal is not recommended as you will remove the tear gland and predispose the dog to iatrogenic keratoconjunctivitis sicca.

Question 32

Treatment for urate stones

Answer 32

Alkalizing diet and allopurinol therapy; urate stone formation is promoted by acidic urine and diets high in purines which are metabolized to uric acid. Generally a low-purine alkalizing diet is recommended. Allopurinol therapy may also be used to reduce uric acid production, but it requires monitoring as it may predispose dogs to different types of stones (Xanthine).

Question 33

What percentage of mammary masses are malignant?

Answer 33

50%; before taking to surgery important to do chest radiographs to check for metastasis.

Question 34

Which disorder is most commonly associated with an increased risk of thromboembolism? a. immune mediated hemolytic anemia b. hypoadrenocorticism c. wobbler syndrome d. idiopathic epilepsy

Answer 34

Immune-mediated hemolytic anemia

Question 35

What is the main clinical sign of Hookworms in dogs and people?

Answer 35

Dogs: Anemia Humans: Cutaneous larval migrans

Question 36

What parasite is this?

Answer 36

Hookworms; thin walled appearance with 2-8 cells present

Question 37

How do hookworms infect dogs?

Answer 37

They penetrate through the skin in young pups and migrate to the lungs where they are coughed up and swallowed and mature in the small intestine. There, the worms suck blood and cause bleeding ulcers; up to 0.1ml of blood per worm can be lost per day.

Question 38

What parasite causes visceral and ocular larva migrans in people?

Answer 38

Toxocara (Roundworms)

Question 39

Progressive Retinal Atrophy (PRA)

Answer 39

Inherited retinal disease seen in several breeds, but most common in Toy and Mini Poodles. Age of onset is variable. Clinical signs: night blindness progressing to complete blindness due to loss of rods prior to cones. Diagnosis: retinal lesions including on fundic examination tapetal hyperreflectivity, gray, vermiform lines on the fundus, retinal vascular attenuation, and a pale optic disc.

Question 40

Immune-mediated polyarthritis (IMPA) | Cause, Signs, Diagnosis, Treatment

Answer 40

Cause: can be associated with a variety of systemic diseases or precipitating factors including systemic infectious, inflammatory or neoplastic disease or reactions to drugs or vaccines but it is most commonly idiopathic with no association to another disease process. Clinical signs: anorexia, weight loss, fever, lethargy, and lymphadenopathy Diagnosis: synovial fluid analysis (normal fluid is clear and viscous with <2.5g/dl protein and <3,000 cells/ul with predominantly mononuclear cells) with IMPA may be thin, turbid, and increased in volume with higher amounts of protein and cells, often primarily nondegenerate neutrophils Treatment: immunosuppressive therapy (prednisone) and sometimes including an additional immunosuppressive drug such as azathioprine or cyclophosphamide

Question 41

Type I Salter-Harris fracture

Answer 41

fracture through the physis

Question 42

Type II Salter-Harris Fracture

Answer 42

fracture partway through the physis extending up into the metaphysis

Question 43

Type III Salter-Harris Fracture

Answer 43

fracture partway through the physis extending down into the epiphysis

Question 44

Type IV Salter-Harris Fracture

Answer 44

fracture through the metaphysis, physis, and epiphysis

Question 45

Type V Salter-Harris Fracture

Answer 45

crush injury to the physis

Question 46

When a patient has a septic abdomen (for example a perforated colon) what is the likely abdominal fluid glucose level?

Answer 46

At least 20mg/dl less than the blood glucose. If the difference is not that great it is indicative of nonseptic peritoneal effusion.

Question 47

If a patient has upper motor neuron signs in the hind limbs, where is the lesion? a. C6-T2 b. C1-C5 c. Caudal to L4 d. T3-L3

Answer 47

T3-L3; hyper-reflexive spinal reflexes and increased muscle tone in the pevlic limbs are consistent with UMN lesion

Question 48

What type of signs would an L4 and caudal lesion result in?

Answer 48

Lower motor neuron signs in the pelvic limbs - decreased reflexes and decreased tone

Question 49

What type of signs does a C1-C5 lesion cause?

Answer 49

Upper motor neuron signs in all limbs

Question 50

What type of signs does a C6-T2 lesion cause?

Answer 50

Lower motor neuron signs in the thoracic limbs and upper motor neuron signs in the pelvic limbs

Question 51

What muscle should the surgeon incorporate in the closure of the abdominal incision of a male dogs intestinal foreign body removal? a. gluteal muscle b. gracillis muscle c. pectineus muscle d. preputialis muscle

Answer 51

Preputialis muscle; this muscle is usually cut when making a midline incision in male dogs and should be incorporated into the closure to avoid penile deviation

Question 52

Which of the following is most suggestive of pyelonephritis? a. bacterial or WBC casts in urine b. pain on abdominal palpation c. bacteria or WBC in the urine d. small, irregular kidneys on ultrasound

Answer 52

Bacterial or white blood cell casts in the urine; highly suggestive of a past or present bacterial infection in the kidneys. Bacteria or WBC in the urine may be due to cystitis. Small, irregular kidneys may be due to any chronic pathology in the kidneys. Pain on abdominal palpation can be caused by pain from any abdominal organ or structures adjacent to the abdomen. Other signs associated with pyelonephritis include: fever, anorexia, depression and vomiting.

Question 53

What is the prognosis of Pemphigus vulgaris with treatment?

Answer 53

Poor; long-term therapy is generally required and the treatment causes serious side-effects long-term

Question 54

What is the treatment for Phemphigus vulgaris?

Answer 54

2-4 mg/kg of prednisolone twice daily with the possible addition of azathioprine is recommended

Question 55

What is Pemphigus vulgaris?

Answer 55

An autoimmune disorder causing vesicles, ulceration and crusting. It can affect the whole body, but it especially affects the mucocutaneous junctions and oral mucosa. The onset of the disease can be sudden or gradual. The disorder is caused by an IgG autoantibody that binds to intracellular adhesion molecules (desmoglein) causing a loss of cohesion between kratinocytes resulting in acantholysis, vesicle formation and eventually ulceration.

Question 56

What findings are shown on this echocardiogram? a. left ventricular concentric hypertrophy b. right ventricular concentric hypertrophy c. pulmonic stenosis d. mitral valve prolapse e. tricuspid valve endocarditis

Answer 56

Mitral valve prolapse; the mitral valve is bending back into the left atrium consistent with mitral valve prolapse. The valve is also thick and mitral regurgitation is likely. The left ventricular lumen is dilated and walls appear of normal thickness, so concentric hypertrophy is not present. The pulmonic valve is not seen in this image plane. The right ventricle is not well seen either, but in the very near field, the right ventricular wall appears normal. What can be seen of the tricupsid valve does not appear to have any vegetations consistent with endocarditis.

Question 57

What radiographic changes are indicative of pleural effusion?

Answer 57

pleural fissure lines on both lateral and ventrodorsal projections

Question 58

What are possible causes of a lobar sign on radiographs?

Answer 58

hemorrhage, edema or pus in the lobes of the lungs

Question 59

Osteochondritis Dissecans (OCD) | Cause, signs, diagnosis, treatment

Answer 59

Causes: young and growing large breed dogs Signs: limping and painful on palpation Diagnosis: radiographic evidence of effusion when compared to the contralateral limb. May see a widened joint space Treatment: removal of the flap and curettage

Question 60

What is the most common ocular tumor?

Answer 60

Meibomain adenoma and it is usually benign; located on the margin of the eyelid

Question 61

What is a Chalazion?

Answer 61

is an obstruction of the meibomian gland and appears as a swelling within the eyelid rather than projecting from it.

Question 62

Puppy strangles

Answer 62

Cause: unknown, but thought to be immune-mediated Predisposed breeds: labs, goldens, beagles, dachshunds, pointer breeds Clinical signs: febrile, anorexic, lethargic, generalized lymphadenopathy, pustules around the muzzle, pinnae, and eyes Diagnosis: skin scraping to rule out demodex Treatment: prednisone

Question 63

What is the diagnostic test to diagnose Addison's disease?

Answer 63

ACTH Stimulation test

Question 64

What are the 4 classical signs of diabetes mellitus?

Answer 64

PU, PD, Polyphagia, and weight loss

Question 65

FNA of a mass on the digit of a 10 yr old GSD; What is the most likely diagnosis?

Answer 65

Melanoma; cells with large nuclei, stippled chromatin with prominent and sometimes multiple nucleoli Treatment: if there is no evidence of metastasis the affected digit should be amputated

Question 66

If a dog has a positive menace response and dazzle reflex is visual but lacks a palpebral reflex, where does he have a lesion?

Answer 66

CN V; no visual deficits as evidenced by his menace and dazzle which rules out lesions in CN II or the visual cortex. The normal menace response indicates that CN VII is functioning as well. The lack of a palpebral then indicates a sensory deficit for which CN V is responsible.

Question 67

Which of the following is an indication for performing a urine culture? a. low urine pH b. isosthenuria c. bilirubinuria d. calcium crystalluria

Answer 67

Isosthenuria; or low specific gravity, makes it difficult to identify bacteria in the sample since it is so dilute. A culture is the most sensitive way to determine if there is an infection present.

Question 68

What is the most likely name of the organism pictured? a. malassezia globosa b. malassezia pachydermatis c. staphylococcus hyicus d. staphylococcus pseudintermedius (Staphylococcus intermedius)

Answer 68

Staphylococcus pseudintermedius; intracytoplasmic coci from a dog's skin are most likely Staphylococcus pseudintermedius which is the species host-adapted to canines

Question 69

What breed of dog is predisposed to forming urate uroliths due to a metabolic defect?

Answer 69

Dalmatians; have a metabolic defect where they are unable to convert uric acid to allantoin, a much more soluble compound. As a result, urate levels in the urine reach high levels and frequently form stones.

Question 70

What is the reason that Yorkies tend to make urate stones?

Answer 70

they frequently have a portosystemic shunt

Question 71

What is a bunny-hopping gait suggestive of?

Answer 71

hip dysplasia

Question 72

What is the likely diagnosis of the following case: a 1 yr old male neutered Newfoundland presents for a physical exam. Cardiac auscultation reveals a 3/6 systolic murmur at the left heart base. Thoracic radiographs show mild left-sided cardiomegaly with left atrial enlargement and segmental enlargement of the ascending aorta.

Answer 72

Subaortic stenosis

Question 73

Proestrus

Answer 73

clincial signs: valvular swelling with mild to moderate hemorrhagic vaginal discharge Vaginal cytology: <90% cornified cells; predominantly parabasal and intermediate cells; It is common for early proestrus to be characterized by these cells and gradually transition until nearly 100% of the cells are cornified by estrus

Question 74

What is the most likely diagnosis for a dog that presents for left pelvic limb lameness and the medial aspects of both stifles are thickened. On manipulation of the left stifle it reveals cranial motion of the tibia relative to the femur and a clicking sound from the joint on flexion and extension

Answer 74

left cranial cruciate ligament rupture with meniscal cartilage tear

Question 75

A dog has a head tilt to the left; where would you localize the lesion to if he has paradoxical vestibular syndrome?

Answer 75

Right cerebellum; since the left ear is closer to the ground and the question is asking for paradoxical localization the lesion is in certain regions of the cerebellum or caudal cerebellar peduncle and produces signs to the opposite sides from which is seen with peripheral and classic central disease.

Question 76

What is the post-exposure prophylaxis protocol after being exposed to rabies for a vaccinated human?

Answer 76

Two injections of approved rabies vaccine at Day 0 and Day 3.

Question 77

What is the post-exposure prophylaxis protocol after being exposed to rabies for a non-vaccinated human?

Answer 77

An injection of human rabies immunoglobulin immediately after exposure followed by 4-5 injections of an approved rabies vaccine IM over the course of 2-4 weeks.

Question 78

In dogs with normal kidneys, when does glucose begin to spill into the urine?

Answer 78

when the blood glucose is around 180mg/dL

Question 79

Is diabetes mellitus suspected in a dog that has PU/PD and a blood glucose consistently around 160mg/dL (normal 76-119mg/dL)?

Answer 79

No, another cause for the PU/PD should be sought in this patient. When the blood glucose is high enough to spill into the urine (~180mg/dL), the polyuria seen is caused by an osmotic diuresis resulting from the osmotic pull of the glucose in the urine.

Question 80

What is the time frame for the contralateral eye to follow the development of primary glaucoma in the inital eye?

Answer 80

6-12 months

Question 81

What is the most common primary bone tumor in the dog?

Answer 81

Osteosarcoma

Question 82

What are the different primary bone tumors in the dog?

Answer 82

Osteosarcoma, chondrosarcoma, fibrosarcoma, and hemangiosarcoma

Question 83

What is the radiographic diagnosis and appropriate treatment?

Answer 83

This patient has metastatic lesions throughout the lungs and only pallative treatment can be recommended.

Question 84

What is the treatment of choice for a primary lung tumor in the dog?

Answer 84

Excision with wide surgical margins; if a primary lung tumor can be excised with wide margins, usually with a lung lobectomy, this is the best chance for a cure. Chemotherapy may be useful in cases where the tumor can't be excised. Long-term prognosis is still guarded because benign pulmonary neoplasia is uncommon.

Question 85

What is this ECG representative of?

Answer 85

3rd Degree AV Block

Question 86

What is Tetralogy of Fallot?

Answer 86

A congenital defect of the heart which includes pulmonic stenosis, dextro-positioned aorta (over-riding), RIGHT ventricular hypertrophy, and a ventricular septal defect. It causes shunting of venous blood across the VSD into the arterial circulation which leads to hypoxemia, and an increased drive for erythropoiesis, causing polycythemia (increase in the absolute RBC mass in the body). Affected animals tend to be underdeveloped in size and have a history of exercise intolerance, dyspnea, tachypnea, or syncope due to hypoxemia. Thoracic radiographs usually show a normal to mildly enlarged cardiac silhouette with right ventricular enlargement and pulmonary hypoperfusion due to the shunting of venous blood into the arterial circulation.

Question 87

How does emphysematous cystitis occur?

Answer 87

Caused by the presence of gas forming bacteria

Question 88

What are possible underlying causes of emphysematous cystitis?

Answer 88

Cushing's disease, diabetes mellitus, chronic urinary tract infections and bladder stones

Question 89

A 10-year-old male castrated standard poodle presented for possible foreign body ingestion. The dog has otherwise been normal as far as the owners can tell. Abdominal radiographs are taken and the only abnormality you find is in the bladder. Based on your radiographic findings, you discuss possible causes of the abnormality and diseases to rule out. What test do you recommend? a. T4 b. Basal cortisol c. ACTH stimulation test d. Tick titers

Answer 89

ACTH stimulation test

Question 90

A 12yr old male intact English bulldog presents for a drop of blood noted coming from the penis. The dog has no other prior medical history. On exam, both testicles are descended and palpate normal in size. A rectal exam reveals a large, but symmetrical prostate gland. You extrude the penis and note the following. What is your recommendation? a. There is a mass at the tip of the penis, you should amputate the tip and submit to histopathology. b. There is an abscess of the penile tip, antibiotic therapy should be begun after a culture is obtained. c. This is a urethral prolapse and can be repaired by performing a urethropexy d. There is a mass at the tip of the penis, which will likely respond to radiation therapy.

Answer 90

This is a urethral prolapse and can be repaired by performing a urethropexy; this conditon is almost exclusive to young English bulldogs. The cause of urethral prolapse is not always determined but may be secondary to excessive masturbation, sexual excitement, or an infection. Treatment involves either urethropexy to replace the prolapse or amputation of the tip.

Question 91

Oral surgery in conjunction with another elective surgery (such as growth removal) in an otherwise healthy dog is usually not recommended due to what reason?

Answer 91

Oral surgeries cause significant bacteremia, which may be an endogenous source of wound infection. The order in which the procedures are performed does not eliminate the risk of infection associated with the bacteremia. Changing gloves and instruments between procedures helps maintain sterility exogenously, but does not eliminate risk of infection associated with the endogenous bacteremia.

Question 92

Which is a sign of anesthesia being too deep? a. Swallowing b. Elevated PaCO2 c. Hypertension d. Deep breathing e. Lacrimation

Answer 92

Elevated PaCO2; as anesthetic depth increases, hypoventilation occurs due to shallower breathing.

Question 93

What are signs that a patient is too light under anesthesia?

Answer 93

Lacrimation, hypertension and swallowing

Question 94

Which clinical finding would you expect in a case of lymphangiectasia in a Belgian Sheepdog as depicted in the photo? a. Lymphocytosis b. Hypercalcemia c. Hypercholesterolemia d. Panhypoproteinemia

Answer 94

Panhypoproteinemia (deficiency of all proteins in the blood)

Question 95

What is lymphangiectasia a classic example of?

Answer 95

Protein losing enteropathy; characterized by the dilation and dysfunction of intestinal lymphatics and leakage of protein-rich lymph into the intestinal lumen. As a result, protein, cholesterol, and lymphocytes are all lost. Calcium is also frequently low due to either low albumin or Vitamin D and calcium malabsorption.

Question 96

A 5 year old male mixed breed dog presents with PU/PD, polyphagia and weight loss. What is the most likely diagnosis? a. Exocrine pancreatic insufficiency b. Diabetes mellitus c. Hypothyroidism d. Hyperadrenocorticism

Answer 96

Diabetes mellitus

Question 97

What pressure should the anesthetist not exceed if manually bagging a patient during anesthesia?

Answer 97

20cm H2O

Question 98

A 1yr old male Shar-Pei presents with the clinical signs below. Recognizing this condition, what other finding would you expect to find?

Answer 98

Elevated body temperature; this presentation is classic for Familial Shar-Pei Fever. It is characterized by high fever and unilateral or bilateral tarsal swelling. This swelling affects tissues around the joint, rather than within the tarsus itself, meaning that we would expect normal synovial cytology.

Question 99

What is the best test to monitor proteinuria long term? a. BUN:Creatinine Ratio b. Urine Culture and sensitivity c. Urine protein:creatinine ratio d. Blood pressure e. abdominal ultrasound

Answer 99

Urine protein:creatinine ratio

Question 100

What is a symbolic loss?

Answer 100

Symbolic pet losses occur when companion animals represent another loss in a client's life.

Question 101

What is primary loss?

Answer 101

primary loss is felt following the death of a client's personal pet

Question 102

What is secondary loss?

Answer 102

Secondary losses include the disruptions to the life of the client that are created by the primary loss.

Question 103

What is ambiguous loss?

Answer 103

Ambiguous loss is experienced when the client does not know the fate of their companion animal, such as in cases of lost pets.

Question 104

What is the best material to close this incision? a. Polydioxanone b. Ethilon c. Catgut d. Vicryl

Answer 104

Polydioxanone; this suture material is absorbable and monofilament, PDS is broken down by hydrolysis and will last longer than catgut, which is better when working with the bladder. On the other hand, you do not want a non-absorbable material as this predisposes the patient to urinary tract infections as a result of the permanent presence of foreign material. Vicryl is a multifilament suture which also has a higher likelihood of failing due to the ability of bacteria to lodge in between the filaments.

Question 105

What suture would you not use for closing the bladder? a. silk b. dexon c. vicryl d. PDS

Answer 105

Silk; this is non absorbable and thus contraindicated. Leaving non absorbable suture in the bladder is a potential nidus for infection. *Vicryl is a multifilament suture which also has a higher likelihood of failing due to the ability of bacteria to lodge in between the filaments.*

Question 106

What is the most important treatment for hemorrhagic gastroenteritis?

Answer 106

Intravenous fluids; extremely important to prevent shock, disseminated intravascular coagulation and renal failure.

Question 107

What treatment would you not recommend? a. dips b. burn off c. manual removal d. pour on

Answer 107

Burn off; this may cause the ticks to become agitated and regurgitate their stomach contents into the surrounding tissues they are feeding from. This would cause severe inflammation and pruritis and can also lead to tick borne diseases. Burning could also harm the patient. The correct removal would be to grasp the ticks with forceps just behind their heads and gently apply traction until they release. Twisting will cause the heads to stay lodged under the skin. For larger numbers as seen in the image, Fipronil pour-ons and Permethrin topicals can be used to kill off the ticks.

Question 108

Interpret the following blood gas results from a 4 year old female spayed dog: a. normal b. metabolic alkalosis; respiratory alkalosis c. metabolic alkalosis; respiratory acidosis d. metabolic acidosis; respiratory alkalosis e. metabolic acidosis; respiratory acidosis

Answer 108

Metabolic acidosis; respiratory alkalosis - the normal base deficit/excess of a dog is about (-5-0mmol/L). This means that this dog has a base deficit and therefore a metabolic acidosis. Although this dog has a base deficit, she still has a normal anion gap (8-25mmol/L). There is a slight acidemia as normal pH is approximately between 7.35-7.45. Finally, a normal pCO2 is approximately 40. This dog is hyperventilating and blowing off CO2. In other words, she is blowing off acid; therefore she has respiratory alkalosis.

Question 109

What disease do you suspect?

Answer 109

Melanoma; large cell with black melanin pigment

Question 110

What is the treatment for metastatic melanoma?

Answer 110

ONCEPT vaccine

Question 111

What is a microvascular free transfer flap?

Answer 111

A microvascular free transfer flap involves elevating a section of skin and isolating its blood supply and then re-anastomosing its blood supply with vasculature in the area of the defect. These procedures require an operating microscope and are very difficult to perform.

Question 112

What type of repair is this? a. genicular flap b. caudal superficial epigastric flap c. microvascular free transfer flap d. full thickness skin graft e. deep circumflex iliac flap

Answer 112

Caudal superficial epigastric flap - this is an axial pattern flap and as with all axial pattern flaps, it is named after its primary blood supply. The caudal superficial epigastric flap provides the primary blood supply to the 3rd, 4th, and 5th mammary glands. With familiarity of the dog's anatomy you can preserve the blood supply and rotate the area of skin to cover a defect as was done with this patient.

Question 113

What is a full thickness skin graft? When would it be contraindicated?

Answer 113

A full thickness skin graft is a section of skin that is completely elevated from one region and applied to a defect. A skin graft is a poor choice for wounds located in a high motion area.

Question 114

Which organism is best visualized under dark field microscopy? a. mycobacterium b. aspergillus c. ehrlichia d. rickettsia e. leptospira

Answer 114

Leptospira; the causative agent of leptospira is a gram negative organism that stains poorly, if at all. Dark field microscopy is the best way to identify this organism. Leptospira also grows slowly. There are 7 serovars out of over 220 that tend to cause disease in animals.

Question 115

What is a possible therapeutic option for a dog with right forelimb lameness and radial valgus in the right antebrachium? a. casting the limb, activity restriction and NSAIDs b. periosteal stripping of the concave aspect of the bone c. arthrodesis of the elbow d. corrective osteotomy

Answer 115

Corrective osteotomy of the radius and ulna are often performed to relieve pain and the functional abnormalities induced by angular limb deformities

Question 116

When performing an enterotomy in a dog it is best to cut on the ______.

Answer 116

Antimesenteric border; cutting on this part of the intestine will minimize the likelihood of hitting blood vessels and will thus decrease the chances of bleeding

Question 117

What is a clinical sign that may be seen in a dog with chocolate toxicosis?

Answer 117

Cardiac tachyarrhythmias; the toxic priniciple of chocolate is methylxanthines (specifically theobromine and caffeine) Methylxanthines can cause CNS excitation, tachycardia, and vasoconstriction. Signs include: vomiting, diarrhea, hyperactivity, PU/PD, lethargy, cardiac arrhythmias, seizures and death. It may also cause pupil dilation (mydriasis).

Question 118

Which organ or organ system is primarily responsible for metabolizing phenobarbital?

Answer 118

Liver

Question 119

What is the mean circulating life span of a neutrophil in a dog? a. 5-9 days b. 48 hours c. 120 minutes d. 5-9 hours

Answer 119

5-9 hours; neutrophil lifespan in all species as far as we know are less than 24 hours

Question 120

What is the lifespan of RBC?

Answer 120

110 days

Question 121

What is the circulating half-life of platelets?

Answer 121

5-7 days

Question 122

What is the definitive diagnostic test for canine distemper?

Answer 122

Immunofluorescent assay on affected epithelium; examination of blood or tissue. This can be performed on tracheal, vaginal, respiratory, or other epithelium. These samples may be negative if the dog is only showing neurologic signs or if a circulating antibody is present.

Question 123

A vaccinated dog bites a human, what should happen to the dog?

Answer 123

Confine the dog and observe it for 10 days

Question 124

What changes are seen on electroretinogram (ERG) with sudden acquired retinal degeneration syndrome (SARDS) in dogs? a. normal ERG amplitude b . decreased ERG amplitude (weakened response) c. flat-line ERG (no response) d. increased ERG amplitude (exaggerated response)

Answer 124

Flat-line ERG (no response); an animal with SARDS has a flate-line ERG from day 1 of onset of the condition

Question 125

A 9 month old pitbull presents for hindlimb lameness that developed suddenly several days ago. He is painful on the left tibia. What is the most appropriate treatment?

Answer 125

Carprofen; this is a case of panosteitis based on the young age of the patient and the radiographic presence of focal intramedullary densities within the tibial diaphysis. Panosteitis is a self-limiting, painful condition characterized by limping and lameness. Typically affects the long bones of young dogs, usually between the ages of 5-18 months.

Question 126

What is the cause for these findings? a. chronic myelogenous leukemia b. acute myelogenous leukemia c. chronic lymphocytic leukemia d. acute lymphoid leukemia e. high grade lymphoma

Answer 126

Chronic lymphocytic leukemia; chronic describes the clinical course of the diseaase, which is considered indolent or slowly progressive. The neoplastic cells of chronic leukemias are well differentiated or mature cells therefore, CLL is considered a chronic or indolent form of leukemia made up of SMALL, MATURE LYMPHOCYTES. These are difficult to distinguish from normal lymphocytes. The mildly prominent lymph nodes and prominent spleen are classic findings for chronic leukemias. The large disease burden within the bone marrow and relatively less affect lymphoid tissues (relative to lymphoma) makes this a lymphocytic leukemia as opposed to a small cell or low grade lymphoma.

Question 127

Sertoli Cell Tumor | what is it? clinical signs

Answer 127

Estrogen secreting sertoli cell tumors are quite common in cryptorhid testes. Clinical signs: truncal alopecia, hyperpigmentation, gynecomastia, urinating in a female position, and bone marrow dyscarasias such as aplastic anemia, attraction of other males can also occur.

Question 128

A 7yr old FS Spaniel presents for difficulty breathing and lethargy. PE shows pale mm and increased RR. You collect blood for a CBC and Chem and place a drop of blood with a drop of saline on a glass slide. What's your diganosis?

Answer 128

IMHA; image shows a positive agglutination test. The dark patches in the sample are caused by antibodies attached to the surfaace of the erythrocytes cross linking the cells together causing these clumps.

Question 129

You examine a dog with bilateral blepharospasm, mucoid ocular discharge, and 360 degree corneal vascularization. What test will most likely determine the diagnosis? a. tonometry b. fundic exam c. fluorescein dye stain d. schirmer tear test

Answer 129

Schirmer tear test; a mucoid ocular discharge is the primary sign of keratoconjunctivits sicca (KCS).

Question 130

You diagnose a dog with a larger left to right ventricular septal defect with advanced sequelae to the abnormality. What is the likely radiographic appearance of the dog's thorax?

Answer 130

Left atrial and left ventricular enlargement with pulmonary hyperperfusion. In dogs with VSD, the shunt occurs during systole when both ventricles are contracting so blood is shunted from the left ventricle almost directly into the pulmonary artery. The right ventricle acts as a conduit between the left ventricle and pulmonary artery and is less commonly affected by the shunted blood. The excess blood flow is found in the pulmonary vasculature, left atrium, and left ventricle, thus enlarging these structures.

Question 131

What treatment is commonly used for protein losing nephropathies, such as - glomerulonephritis, amyloidosis and their sequelae? a. high protein diet b. antibiotics c. acepromazine d. angiotensin-converting enzyme inhibitors

Answer 131

Angiotensin-converting enzyme inhibitors; ACE inhibitors also reduce proteinuria by causing dilation of the efferent arterioles of the nephrons.

Question 132

A 6 yr old previously healthy dog presents in acute respiratory distress. On PE you auscult a split second heart sound. You take neck and thoracic radiographs which appear normal. What is the most likely cause of dyspnea? a. pneumothorax b. CHF c. pulmonary thromboembolism d. aspiration pneumonia

Answer 132

Pulmonary thromboembolism; this should be immediately suspected in any dog with profound dyspnea and unremarkable radiographs. The split second heart sound is heard due to pulmonary hypertension from PTE. CHF - the heart would be enlarged and there is no pulmonary edema on rads. Aspiration penumonia is not likely due to normal lung fields. Pneumothorax there would be decreased dorsal lung sounds and radiographic changes.

Question 133

A 4 yr old FS Husky presents for crusting and hyperkeratosis around the eyes, nose, and mouth. A skin scraping did not identify an etiology. How would you treat the dog? a. daily wiping with chlorhexidine pads b. zinc supplementation c. corticosteroids d. ivermectin

Answer 133

Zinc supplementation; zinc responsive dermatopathy occurs most frequently in the siberian husky. The exact cause is unknown, but it has been linked to defective intestinal absorption of zinc.

Question 134

What is the most appropriate method to diagnose dermatophytosis? a. wood's lamp fluorescence of hair b. microscopic examination of macroconidia c. white colony growth and red color change at 5-7 days d. analysis of endothrix or ectothrix spores in hairs

Answer 134

Microscopic examination of macroconidia. Only about 50% of Microsporum canis strains fluoresce with UV light (Wood's lamp). Microsporum gypseum and Microsporum canis both present as white colony growth with a pH change at 5-7 days, but require different mangaged strategies.

Question 135

A 2 yr old mix presents for a mass on her upper lip that the owners noticed 3 weeks ago. It has not grown in size and doesn't bother the dog. On PE the dog is BAR, and no other significant findings. The mass is smooth, less than 1cm in diameter and localized to the skin. How do you recommend confirming your tentative diagnosis and what is the prognosis? a. biopsy, prognosis fair b. FNA, prognosis good c. surgical excision, no prognosis without histopathology d. monitor, prognosis likely guarded

Answer 135

FNA, prognosis likely good; in young dogs small localized masses along the head, ears and limbs are often histiocytomas, a benign collection of histiocytes with a few other inflammatory cells present. They can occur in younger dogs and often resolve after a few months. A few histiocytomas can ulcerate, and multiple histiocytomas can be found on one animal. Those that do not regress on their own can be surgically excised.

Question 136

KCS as seen in the image, comes from an abnormality in what structure? a. conjunctival goblet cells b. lacrimal gland and gland of the third eyelid c. meibomian gland d. nasolacrimal ducts

Answer 136

lacrimal gland and gland of the third eyelid; KCS comes from a decrease of the aqueous portion of the tear film. This is produced by the lacrimal gland and the gland of the third eyelid.

Question 137

When examining the eye of a 6 yr old Lab, you see the brown, round circular masses shown in the image free floating in the anterior chamber. What is the most likely diagnosis?

Answer 137

Uveal cyst; cysts are free floating or may be attached to the pupillary margin or posterior iris. Cysts will also transilluminate whereas melanomas will not. Cysts are also very spherical or ovoid and smooth while melanomas are usually fleshier-appearing masses.

Question 138

A positive Ortolani sign occurs in affected dogs when what bone is manipulated? a. humerus b. femur c. radius d. tibial

Answer 138

Femur; during manipulation one may hear/feel a "clunk" which is actually subluxation of the coxofemoral joint. This test is important to perform in puppies in order to assess for hip dysplasia. A positive ortolani sign indicates joint laxity.

Question 139

Does PT or PTT become prolonged first?

Answer 139

PT; due to factor VII having the shortest half-life so since PT measures the extrinsic system which contains factor VII, it becomes prolonged first.

Question 140

After performing a closed reduction surgery on a craniodorsal luxation of the coxofemoral joint what bandage would you place? a. Ehmer sling b. Spica splint c. Velpeau sling d. Robert Jones splint e. Schroeder-Thomas splint

Answer 140

Ehmer sling; it prevents weightbearing and aids in maintaining some degree of abduction and internal rotation of the affected limb. In dogs, they are placed and maintained for 7-10 days.

Question 141

What are Velpeau slings used for?

Answer 141

Placed on the front limb to prevent weight bearing, they are often placed after medial shoulder instability surgery.

Question 142

What are Spica splints used for?

Answer 142

Large padded bandages placed over the affected limb and torso, often in order to immobilize proximal fractures.

Question 143

What is a Schroeder-Thomas splint used for?

Answer 143

Another type of splint that has been used in the past for fracture immobilization.

Question 144

What diagnostic test is best to confirm suspicion of septic peritonitis?

Answer 144

Abdominocentesis; it will reveal a septic inflammatory process and show intracellular bacteria.

Question 145

What is the treatment protocol for a dog that ingests rat poison that contains brodifacoum?

Answer 145

Induce emesis and administer oral activated charcoal. Then begin treating with Vitamin K1 for 6 weeks. Brodifcacoum is a vitamin K antagonist and when ingested it causes hemorrhaging after several days due to the lack of production of new clotting factors.

Question 146

What organism causes Salmon-poisoning disease?

Answer 146

Neorickettsia helminthoeca. Dog eats a fish that had a fluke (Nanophyetus salmincola) which had Neorickettsia helminthoeca

Question 147

A 6 yr old Lab presents for sudden onset of anorexia, depression, vomiting and diarrhea. The dog recently went on a fishing trip with the owner 1 week ago. CBC results include leukocytosis and thrombocytopenia. A low albumin is noted on the chemistry panel. Fecal sedimentation shows trematode eggs. What is the diganosis? a. Cryptosporidium b. Salmonella c. Parvovirus d. Salmon-poisoning disease

Answer 147

Salmon-poisoning disease. Signalment gives a heads up that the dog is a sporting breed. History practically gives the answer when you combine it with the physical exam findings. Fecal should confirm your suspicion.

Question 148

What congenital defect would explain the occurrence of a GSD regurgitating after being weaned from its mother's milk? a. Persistent right aortic arch b. Pulmonic stenosis c. Patent ductus arteriosus d. Diaphragmatic hernia of the small intestine

Answer 148

Persistent right aortic arch; this vascular ring anomaly is an inherited defect that causes constricting obstruction of the esophagus at the level of the heart base. There is a breed predilection for GSD and Irish Setters.

Question 149

A 12 yr old, MN, mix presents with progressive exopthalmos and third eyelid protrusion of the left eye over the past month. On palpation, no pain is elicited but the eye does not retropulse. Otherwise the dogs is acting normally. What is the most likely diagnosis? a. Orbital neoplasia b. Retrobulbar abscess c. Intraocular neoplasia d. Endophthalmitis

Answer 149

Orbital neoplasia; somewhat common in older dogs. Infections woulld have more systemic signs, localized pain and erythema. Endophthalmitis and intraocular neoplasia would not cause exopthalmos but would manifest with intraocular signs.

Question 150

A 10 yr old, MN, GSD presents for slowly progressive weakness in the hind limbs. He has conscious proprioception deficits in both rear limbs and the dorsal nail surfaces are worn. His front limbs are normal, the hind limbs are hyper-reflexive and he is able to hold his urine and feces until let outside. What is the most likely diagnosis? a. Intervertebral disc disease in C7-T2 spinal segment b. Hip dysplasia c. Degenerative myelopathy d. Lyme disease e. Fibrocartilaginous embolism

Answer 150

Degenerative myelopathy; according to this patient's clinical signs there is a lesion from T3-L3, evidenced by the upper motor neuron signs in the hind limbs and no clinical signs in the front limbs. Because the disease is progressive, fibrocartilaginous embolism can be ruled out. Hip dysplasia can be difficult to differentiate from degenerative myelopathy in some patients, but the reflexes should not be affected with degenerative joint disease. Lyme disease would likely be acutely painful and/or recurrent in nature.

Question 151

An 8 yr old, MN, mix canine presents with a several-month history of lethargy, hair loss, and greasy skin. The patient's face, feet and tail are not clinically affected and he is not pruritic. What is the most likely cause of the hair loss? a. Sarcoptes b. Flea allergy c. Malignant melanoma d. Endocrinopathy

Answer 151

Endocrinopathy. Flea allergy and sarcoptes would be extremely pruritic. The dark coloration of the skin reflects hyperpigmentation associated with inflammation not neoplasia.

Question 152

What are the side effects of non-selective COX inhibitors?

Answer 152

GI ulcers, inhibition of platelet function, and renal damage.

Question 153

Which of these groups is considered predisposed to developing nasal aspergillosis? a. dogs in large groups or kennels b. hunting dogs c. immunocompromised dogs d. brachycephalics e. dolichocephalic

Answer 153

Dolichocephalic; aspergillus is typically a disease of healthy, apparently immunocompetent dogs that are young to middle-aged. Dolichocephalic breeds are overrepresented. Immunocompromised dogs are predisposed to development of disseminated aspergillosis. Being in a large group of dogs does not increase risk, as it is not contagious. Aspergillus is fairly ubiquitous in the environement, and hunting dogs are probably not exposed significantly more than any other dog.

Question 154

What zoonotic parasite is best known to affect the eyes of children? a. whipworm b. roundworm c. hookworm d. tapeworm

Answer 154

Roundworm; Toxocara canis, is the most common cause of visceral larval migrans in humans. Transmission is usually fecal-oral. Children are known to play in sandboxes where dogs or cats previously defecated and subsequently inoculate their eyes. Puppies may acquire the disease transplacentally.

Question 155

An 11 yr old, MN, Golden presents for collapse with muffled heart sounds on examination. You ultrasound the heart and obtain the following image; the right atrium and right ventricle are labeled. A large mass is seen in the right atrioventricular groove with pericardial effusion. What is the likely diagnosis? a. Hemangiosarcoma b. Lymphoma c. Chemodectoma d. Pulmonary adenocarcinoma e. Idiopathic pericardial hemorrhage

Answer 155

Hemangiosarcoma; it has a predilection for the right auricle of dogs, with Goldens being predisposed. Stabilization of this patient will require pericardiocentesis; prognosis is guarded and may include chemotherapy, pericardiectomy, or rarely auriculectomy. Chemodectoma arises from the ascending aorta and heart base; lymphoma is rare in the heart of dogs and is more commonly metatstic than a single mass. Idiopathic pericardial hemorrage is incorrect because there is clear evidence of a mass.

Question 156

A 5 yr old, M, Doberman presents for lethargy, weight loss, syncope, and cough. After PE, radiographs and echocardiography diagnose DCM. What should you tell the owner? a. The dog's prognosis is good with treatment of furosemide, enalapril, and digoxin b. The dog's prognosis is good with cardiac pacemaker implantation c. The dog has a guarded long term prognosis, even with treatment of heart failure d. The dog's prognosis is fair. Since the dog is showing minimal clinical signs of heart failure at this time, the dog may still have several years before it can no longer be managed medically.

Answer 156

The dog has a guarded long-term prognosis, even with treatment of heart failure. Animals with DCM historically had a very poor long-term prognosis, particularly Dobermans. However, with the addition of pimobendan, average survival time has increased from approximately 3 months to one year. The clinical signs exhibited by this animal are not mild and show that he is already in moderate to severe heart failure. Medical treatment would include a diuretic like furosemide, an ACE inhibitor like enalapril, pimobendan +/- spironolactone. A cardiac pacemaker would not help this animal since the problem is not with the heart's rhythm, but with the heart's contractility.

Question 157

What are the potential inciting causes or predisposing factors for Immune-mediated polyarthritis (IMPA)? a. systemic lupus erythmatosus, sulfonamide exposure, mammary adenocarcinoma b. synovial cell sarcoma, renal insufficiency, hyperthyroidism c. penetrating joint trauma, gastric dilation volvulus, ingestion of onions d. hemangiosarcoma, fungal osteomyelitis, cruciate ligament disease e. hypothyroidism, anal sac carcinoma, leptospirosis vaccination

Answer 157

Systemic lupus erythmatosus, sulfonamide exposure, mammary adenocarcinoma

Question 158

What are the clinical signs associated with Immune mediated polyathritis (IMPA)?

Answer 158

anorexia, weight loss, fever, lethargy, lymphadenopathy

Question 159

How is IMPA diagnosed?

Answer 159

synovial fluid analysis although additional baseline diagnostics are indicated to screen for potential systemic or infectious causes. Normal joint fluid is clear and viscous with <2.5 g/dl protein and <3,000 cells/ul with predominantly mononuclear cells. Joint fluid in IMPA may be thin, turbid, and increased in volume with higher amounts of proteins and cells, often primarily nondegenerate neutrophils.

Question 160

This is an ECG recording of a 9 yr old, MN, Golden that had a bleeding splenic mass surgically removed approximately 4 hours ago. The heart rate is currently 186 bpm. The patient received 0.08 mg/kg of hydromorphone approximately 45 minutes ago. PCV is currently at 24% (normal 33-58%). What is shown on the ECG below? a. Ventricular Premature Complexes (VPCs) b. 3rd Degree AV Block c. Supraventricular Tachycardia d. 1st Degree AV Block

Answer 160

Ventricular Premature Complexes (VPCs)

Question 161

Which of the of the following is the most likely diagnosis for cough in a 2-month old puppy? a. toxascaris leonina infection b. dirofilaria immitis infection c. trichuris vulpis infection d. toxocara canis infection

Answer 161

Toxocara canis infection; this is a roundworm that is passed along to puppies transplacentally. The roundworms migrate from the small intestines to through the liver and lungs, which is what causes the animal to cough. Beyond 6 months of age, the larvae distribute to the somatic tissue, where their development is arrested. Dirofilaria immitis or heartworm disease takes at least 6 months before the infection is patent. It would take even longer for the infection to progress to CHF, causing the dog to cough. Trichuris vulpis, the canine whipworm and Toxascaris leonina, another canine roundworm, do not migrate through the lungs.

Question 162

This image is from an aspirate taken from a lytic bone lesion seen on radiographs of a nine year old female Vizsla dog. What is the cell type of origin and classification? a. mesenchymal origin; carcinoma b. epithelial origin; sarcoma c. mesenchymal origin; sarcoma d. epithelial origin; carcinoma e. leukocyte origin; round cell tumor

Answer 162

Mesenchymal origin; sarcoma - this is an osteosarcoma. Sarcoma: these tumors come from mesenchymal cells and are named by the spcific cell type such as fibroblasts (fibrosarcoma) and osteoblasts (osteosarcoma). Cytologically, they tend to appear as isolated spindle-shaped cells with elongated cytoplasm and often oval nuclei. Those are the features identifable in the image.

Question 163

What is the cell of origin and cytologic description of carcinomas? a. epithelial cells; cohesive clusters of cells b. mesenchymal; isolated spindle-shaped cells c. leukocyte origin; cohesive clusters of cells d. round cell origin; large populations of cells that are not in defined clusters

Answer 163

Epithelial cells including cells of glandular tissues such as salivary glands, mammary glands, and cells lining most tissues including squamous cells or transitional cells. The cytologic appearance is that of cohesive clusters of cells and cells are often polygonal in shape.

Question 164

What is the cell of origin and cytologic description of round cell tumors? a. epithelial cells; cohesive clusters of cells b. mesenchymal; isolated spindle-shaped cells c. leukocyte origin; cohesive clusters of cells d. round cell origin; large populations of cells that are not in defined clusters, the cells have a round shape, often with unique identifiable features

Answer 164

Round cell origin; large populations of cells that are not defined clusters, the cells have a round shape, often with unique identifiable features such as the purple granules in mast cell tumors. There are 5 round cell tumors and most but not all come from blood cells. Lymphoma, mast cell tumors, plasma cell tumors, histiocytic tumors and transmissible venereal tumors.

Question 165

A 5yr, FS, Jack Russell arrives at your clinic with coughing and nasal discharge of 2 days in duration. The dog has a history of being kenneled last week while the owners were on vacation. She has been lethargic since she got home and did not eat her breakfast this morning. Her temp is 102.8, HR 140, and RR 30. What is your top differential? a. Simonsiella b. Bordetella bronchiseptica c. Coccidiodes immitis d. Pneumonyssoides caninum

Answer 165

Bordetella bronchiseptica; based on the recent history of being boarded. Bordetella uses pili to attach to ciliated respiratory epithelial cells, which causes upper respiratory symptoms. Mycoplasma may also cause these clinical signs. Canine parainfluenza virus is the most common viral cause. Simonsiella is a normal inhabitant of the nasopharynx and therefore is the least likely organism to cause the described clinical signs. Pneumonyssoides is the nasal mite, and while it may cause nasal symptoms, it is rare. Coccidiodes, or "Valley Fever" is a fungal disease in the southwest that may cause coughing and systemic disease.

Question 166

Which abormal heart sound are you LEAST likely to be able to auscult in a dog? a. sinus arrhythmia b. first degree AV block c. gallop rhythm d. atrial fibrillation

Answer 166

First degree AV block; this is a very subtle prolongation between the P and the R wave which can usually only be recognized by evaluation of an ECG strip.

Question 167

This dog has been on chronic steroid therapy and has now developed this lesion seen in the photo. Biopsy results of the skin show a broad based budding organism. What is the diagnosis? a. aspergillosis b. blastomycosis c. coccidioidomycosis d. cryptococcosis

Answer 167

blastomycosis; being on chronic steroids resulted in immunosuppression and acquiring subsequent infection.

Question 168

What test is recommended to monitor proteinuria long term? a. BUN:creatinine ratio b. Urine protein:creatinine ratio c. abdominal ultrasound d. blood pressure e. urine culture and sensitivity

Answer 168

Urine protein:creatinine ratio

Question 169

Which of the following radiographic changes are characteristic of an aggressive bone lesion? a. indistinct lesion margins b. homogenous periosteal reaction c. sharp lesion margins d. organized trabecular bone

Answer 169

Indistinct lesion margins; aggressive bone lesions are poorly defined transition zones between normal and abnormal bone, moth-eaten appearance to the bone, and active periosteal reaction, especially heterogenoeous reaction.

Question 170

Lucy is a 11 yr, FS, Lab that presents in acute respiratory distress after playing fetch on a hot summer day. On exam, Lucy is panting heavily and a loud stridor is audible. The owners say that Lucy's bark has changed over the past couple of months. What is the most common complication/side effect of the recommended treatment for Lucy's condition? a. tracheal collapse b. drooling c. aspiration pneumonia d. kidney disease e. megaesophagus

Answer 170

Aspiration penumonia as surgical laterlization (tie-back) is the treatment of choice for laryngeal paralysis, but with the chronically opened airway, aspiration pneumonia can be a common side effect. If surgery is not an option, prednisone can be given to help reduce laryngeal inflammation.

Question 171

A 2 yr, FS, Boxer presents for vomiting and diarrhea for 3 days. On presentation, the dog is dehydrated with pale and dry mucous membranes and a prolonged CRT. Also the dog's HR is 200 bpm and the femoral pulses are weak. What type of shock is the dog in? a. anaphylactic shock b. hypovolemic shock c. obstructive shock d. distributive shock e. cardiogenic shock

Answer 171

Hypovolemic shock; characterized by a critical reduction in intravascular volume (severe dehydration, hemorrhage, third-space loss). The decrease in intravascular volume (pre-load) results in a decrease in stroke volume and subsequently cardiac output, which will eventually result in a decrease in tissue perfusion and oxygenation.

Question 172

What is cardiogenic shock a result of and what is it associated with?

Answer 172

Cardiogenic shock is the result of a decrease in myocardial contractility with subsequent decrease in oxygen delivery. It is always associated with primary heart disease.

Question 173

When does obstructive shock occur?

Answer 173

when there is abnormal blood distribution that imparies blood return such as in GDV where obstruction of the vena cava can occur or in pericardial tamponade.

Question 173

On routine physical exam, you find Diplidium caninum segments on the perianal region of a dog. What assumption can be made? a. the dog should be treated for fleas and tapeworms b. the dog acquired the infection by eating uncooked beef c. the dog acquired the infection by coprophagia d. the dog was infected in utero by transplacental transmission

Answer 173

The dog should be treated for fleas and tapeworms; fleas are a required intermediate host of Dipylidium caninum. Dogs become infected by swallowing fleas that carry the tapeworm eggs. Finding proglottids of this tapeworm in the feces or perianally indicates the presence of fleas on the dog.

Question 174

A 5 yr old, MN, West Highland White Terrier presents for skin lesions. He has a history of lethargy and poor appetite. The lesions partially responded to antibiotics initially, but then began to progress again. You take a biopsy of the skin which shows cutaneous blastomycosis. What is the next most important diagnostic test? a. thoracic radiographs b. deep skin scraping c. blastomyces antigen test d. blastomyces antibody titer e. abdominal radiographs

Answer 174

Thoracic radiographs; pulmonary involvement occurs in the majority of cases, so thoracic rads are an important step to staging the patient. Blastomycosis is caused by a dimorphic fungus and generally occurs in the Missouri, Mississippi, Tennessee, and Ohio river valleys. Other organs that can be affected besides the skin and lungs include the lymph nodes, eyes, bones, CNS, and urinary tract.

Question 175

You have been managing a 7 yr old, M, Cocker Spaniel for IMHA and recurrent UTIs with prednisone and trimethoprim sulfa antibiotics. He now presents for ocular abnormalities. What test is most likely to confirm your tentative diagnosis? a. corneal biopsy b. PLR c. dilated fundic exam d. Schirmer tear test e. Tonometry

Answer 175

Schirmer tear test; the dog has severe mucoid ocular discharge and corneal changes that are most consistent with keratoconjunctivitis sicca (dry eye). The history of TMS antibotics is a likely etiology.

Question 176

A 10 yr old, FS, Dachshund presents for further evaluation of progressive lameness in the hind. The owner notes that she has begun intermittently scuffing her hind limbs, has somewhat of a weak or drunken gait in the hind as she walks, and is having trouble rising. What is the best treatment? a. prolonged antibiotic therapy with clindamycin b. femoral head ostectomy c. dorsal laminectomy d. total hip replacement bilaterally

Answer 176

Dorsal laminectomy; the patient's clinical signs are consistent with neurological deficits. Although you do not have all the information necessary to reach a definitive diagnosis, you should have been able to deduce that this patient probably needs a dorsal laminectomy to relieve disc compression. In order to definitively diagnose this condition you would want to proceed with a complete exam, basic bloodwork, and a CT or MRI of the lumbosacral region. Although this patient does exhibit evidence of hip dysplasia radiographically, the clinical signs are not characteristic of a dog with pain secondary to hip dysplasia. There is no indication of osteomyelitis on these radiographs and the clinical signs are not necessaarily suggestive of osteomyelitis.

Question 177

A 2yr old, MN, Boxer presents for exercise intolerance and syncopal episodes. Cardiac auscultation reveals a 4/6 left systolic murmur heard best at the base of the heart. Thoracic radiographs show a mildly enlarged left ventricle and left atrium, and segmental enlargement of the ascending aorta. What is the most likely diagnosis? a. aortic stenosis b. MVD c. pulmonic stenosis d. boxer cardiomyopathy

Answer 177

Aortic stenosis; the breed, clinical history of syncope, radiographic findings, and auscultation findings are most consistent with aortic stenosis. Echocardiography would be the best method for diganosiing the disease in which you would find left ventricular hypertrophy, stenosis of the aortic outflow tract, and post-stenotic dilation of the aorta. Pulmonic stenosis would result in changes in the right heart and pulmonary outflow tract. MVD typically occurs in older animals, results in a murmur heard best at the left apex, and would not cause dilation of the ascending aorta. Boxer cardiomyopathy (or arrhythmogenic right ventricular cardiomyopathy) is principally an electrical disease causing frequent VPCs to occur. Dilation of the heart may occur in 10-15% of cases. The best way to diagnse Boxer cardiomyopathy is with a 24 hour cardiac holter monitor.

Question 178

A 6yr old, MN, Dachshund presented for further evaluation after an acute onset of a "drunken gait". On PE, hind limb ataxia is confirmed as well as decreased motor on both hind limbs (worse in the right), conscious proprioceptive deficits, and hyper-reflexive patellar reflex on the right. The forelimbs appear to be unaffected. Where is the lesion localized? a. C1-C5 b. C1-T2 c. T11-T13 d. T3-L3 e. L4-S3

Answer 178

T3-L3; this signalment and clinical signs are consistent with IVDD. Dachshunds are the most common breed to develop IVDD. The clinical signs described in this case are not complete but do give you enough information to determine that upper motor neuron signs are present (hyper-reflexive). This immediately eliminates the possibility of having a caudal spinal cord injury as those result in lower motor neuron signs (hypo-reflexia). Deficits of the forelimbs are usually associated with neck lesions. A Schiff-Sherington posture is one exception which the forelimbs are affected but the lesion is not in the neck. Although it is very common for lesions to be between T11-T13 such a specific location is not defined by the neurologic exam findings provided.

Question 179

What is the hormonal profile of a female dog in estrus? a. rising estrogen, falling progesterone b. rising estrogen, rising progesterone c. falling estrogen, rising progesterone d. falling estrogen, falling progesterone

Answer 179

Falling estrogen, rising progesterone; this is what stimulates the LH surge and leads to ovulation and the behavioral changes in estrus where a female will stand to be bred.

Question 180

A 2 yr old, MN, Bull Mastiff with a history of travel in the west coast presents for a chronic cough and a recent development of lameness of his right hind limb. On PE, there is a draining lesion over the lame region of the right hind limb. You perform chest rads and see a diffuse bronchointerstitial pattern which is nodular in some regions. There is also hilar lymphadenopathy. A BAL for cytology reveals spherules. What is the diagnosis? a. blastomycosis b. coccidioidomycosis c. cryptococcus d. aspergillosis e. histoplasmosis

Answer 180

Coccidioidomycosis; the travel history and clinical signs are consistent with this. Additionally, finding spherules on cytology is pathognomonic for coccidioidomycosis. Prolonged antifungal treatment will be necessary. Fluconazole is the treatment of choice. Ketaconazole and itraconcazole are good choices. Blastomycosis would have broad based budding of yeast and with cryptoccus neoformans there would be narrow based budding.

Question 181

What is a potential effect of chronic anterior uveitis in dogs? a. progressive retinal atrophy (PRA) b. corneal scarring c. Keratoconjunctivitis sicca d. lacrimal gland destruction

Answer 181

Corneal scarring; due to the inflammatory mediators in the anterior chamber, they can destroy the corneal and lens proteins. It can lead to glaucoma when debris from uveitis plugs the iridocorneal angle. Uveitis cannot extend into the lacrimal glands and destroy them, and thus doesn't cause KCS. PRA occurs when the photoreceptors in the retina develop abnormally, causing early onset blindness, it is a heritable disease and not caused by chronic anterior uveitis.

Question 182

When measuring Vitamin B12 (Cobalamine) and Folate levels in a dog with suspected small intestinal bacterial overgrowth, which finding is most supportive of this diagnosis? a. increased folate, increased cobalamin b. decreased folate, increased cobalamin c. decreased folate, decreased cobalamin d. increased folate, decreased cobalamin

Answer 182

increased folate, decreased cobalamin; the reason for this is that bacteria synthesize folate leading to decreased absorption of cobalamin

Question 183

Which of the folowing is a cause of hypoxemia for a dog? a. high FIO2 b. manual ventilation c. low FIO2 d. hyperventilation

Answer 183

low FIO2; low FIO2 means the animal will not be obtaining enough oxygen and will ultimately become hypoxemic. Hypoventilation (not hyperventilation) will lead to a lack of oxygen. Manual ventilation (or mechanical ventilation) would not cause hypoxemia, it would help lower the CO2 when a patient is hypoventilating.

Question 184

What is Craniomandibular osteopathy (CMO)?

Answer 184

Affects young dogs. Terrier breeds predominate. The disease is usually self-liming and typically regresses by 1 year old, although not always. It is thought to be a type of hypertrophic osteodystrophy (HOD) and occurs mostly in the mandible but can also affect the tympanic bulla, temporal bones and temporomandibular joints. Treatment is supportive with NSAIDs to control pain. Prognosis is highly dependent on whether the patient is able to open/close its mouth to prehend and chew food, to generally sustain themselves through the course of the disease. Radiographic signs will regress with time.

Question 185

A 2yr, FS, Spaniel presents with sneezing and ocular discharge. On PE, the dog appears systemically healthy with normal vital parameters. You are suspicious of a viral upper respiratory tract infection with possible secondary bacterial infection and prescribe a 2-week course of cephalexin. 10 days later, the dog returns with a fever and severe cutaneous ulcerations as shown in the image which the owner says began just 3 days ago. Skin biopsy confirms coagulative necrosis of the epidermis with mixed inflammation in the dermis and epidermis. What should the owner be told? a. concerned that the dog has nasal lymphoma that has now disseminated systemically including to the skin; she should be fully staged and treated for lymphoma b. concerned about a severe and potentially life-threatening cutaneous drug reaction and the dog should be hospitalized for supportive care and testing c. concerned that the dog has an aspergillus infection which was not susceptible to cephalexin and she now has systemic aspergillus; the dog should be hospitalized and started on antifungals. d. concerned about the development of a drug-resistant and aggressive form of streptococcus and the dog should be quarantined with additional antibiotics prescribed pending cultures

Answer 185

Most concerned about a severe and potentially life-threating cutaneous drug reaction and the dog should be hospitalized for supportive care and testing; the history and clinical appearance are very concerning for toxic epidermal necrolysis which is usually associated with an adverse reaction to a drug. In severe cases such as the dog shown in this image, there is concern for extensive loss of fluids, electrolytes, and colloids as well as secondary bacterial infection of the skin. Concurrent medications should be withdrawn and aggressive supportive care, analgesia, and use of a different antibiotic protocol are indicated. The prognosis is guarded depending on response to removal of a suspected inciting cause. The other possibilities listed in this question are less consistent with the cutaneous lesions shown and the very rapid onset and progression as well as the histopathologic findings.

Question 186

What type of hypersensitivity (HPS) and what class of immunoglobulin are MOST IMPORTANT in the pathogenesis of atopic dermatitis in dogs? a. Type IV HPS, IgE b. Type IV HPS, IgA c. Type I HPS, IgE d. Type I HPS, IgA

Answer 186

Type I HPS, IgE; atopic dermaitits is mediated primarly by IgE and is considered Type I, or immediate hypersensitivity reaction. In some species, IgG may also play a role.

Question 187

What is usually the cause of glaucoma as depicted in this dog? a. increased production of vitreous b. decreased outflow of aqueous c. increased production of aqueous d. decreased outflow of vitreous e. increased outflow of aqueous

Answer 187

Decreased outflow of aqueous; glaucoma is an increase in IOP which is dependent on production of aqueous and outflow of aqueous. Clinical increases are always from decreased outflow although treatment can be aimed at either increaseing outflow or decreasing production of aqueous.

Question 188

A 3yr, mini poodle presents for an acute, painful swelling on the left ventral neck. A FNA reveals stringy, blood-tinged fluid with few cells. What is the most likely diagnosis? a. mast cell tumor b. abscess c. reactive lymph node d. mucocele

Answer 188

Mucocele; 2-4 yr old poodles are the classic signalment for this condition. The usual presentation is a mass that may be painful and may produce saliva on aspiration. An abscess, mast cell tumor, or reactive lymph node would all be more cellular.

Question 189

What tumor is associated with causing GI ulcers, perioperative hypotension and coagulation abnormalities in dogs? a. lymphoma b. melanoma c. hemangiosarcoma d. mast cell tumors

Answer 189

mast cell tumors; many of the clinical signs of mast cell tumors are related to the factors released by mast cells including histamine, heparin, and other vasoactive amines. Histamine can cause ulcers via activation of H2 receptors on gastric parietal cells. Heparin can cause coagulopathy. Histamine and other vasoreactive amines can lead to vasodilation and hypotension.

Question 190

A 4yr old female brittany spaniel presents for further evaluation of suspected dystocia. Her gestation length is approximately 60 days and the owners note that she has been extremely restless, panting, and vomited once in the past 8 hours. On vaginal examination, there is no obviously obstructed puppy. Radiographs of the dog show no evidence of fetal gas or alteration in spatial relationship between the fetal bones. What is the best treatment? a. perform a c-section b. administer IM oxytocin c. continue to monitor carfully without disturbing her and have the dog return in 24 hours if she has not delivered the puppies d. administer IM dexamethasone sodium phosphate

Answer 190

Continue to monitor carefully without disturbing her and have the dog return in 24 hours if she has not delivered the puppies; the dog has presented in stage 1 of labor. This stage is typically 6-12 hours of length and can persist for up to 36 hours. In this stage, it is expected for the dog to exhibit panting, trembling, nesting behavior and restlessness. Occasionally dogs will also vomit. At this point, there is sub-clinical uterine contraction and dilation of the cervix. Stage 2 will also last approximately 6-12 hours (and persist up to 36 hours) and is characterized by abdominal straining which coincides with uterine contraction. Puppy delivery occurs during Stage 2 at an interval of 30-60 min (up to 4 hours). Stage 3 involves the expulsion of fetal membranes as well as involution of the uterus. Fetal membranes are usually passed 5-15 minutes after birth of a pup before another puppy can be delivered from the same horn. Thick greenish discharge (lochia) is seen in all stages of labor and may persist for up to 3 weeks. Complete uterine involution and endometrial recovery occurs in approximately 3 months.

Question 191

A 6yr, F, Cocker spaniel presents to ER for lethargy and anorexia. On PE, icteric MM are noticed. PCV is 13 (normal 35-57%). And a blood smear is checked and spherocytes are seen. There appear to be adequate platelets and WBC. What is the most likely cause of anemia? a. hemangiosarcoma b. myelophthisis c. onion toxicity d. immune mediated disease e. chronic disease

Answer 191

Immune mediated disease; the finding of spherocytes on blood smear distinguishes this from onion toxicity (Heinz body anemia) and chronic disease. Also, hemangiosarcoma and myelophthisis would not have spherocytes and should not cause icterus.

Question 192

How is Babesia transmitted? a. vectored by the Reduvid bug b. transmitted fecal orally c. vectored by mosquitoes d. vectored by ticks

Answer 192

Ticks; babesia is an intraerythrocytic parasite transmitted by infected ticks

Question 193

What breed is predisposed to acanthosis nigricans? a. Boxer b. Great Dane c. Labrador d. Dachshund e. Chihuahua

Answer 193

Dachshund; the primary inherited form of this condition occurs almost exlusively in Dachshunds. Other dogs may get a form of the condition secondary to other skin diseases. The condition is characterized by hyperpigmentation of the axillary and groin regions and can spread to other parts of the body. Secondary bacterial infections, yeast infections, and seborrhea commonly develop in the affected regions. The mode of inheritance has been proposed to be autosomal recessive or polygenic inheritance.

Question 194

A 2.5 yr old, mini Schnauzer presents for further evaluation as a result of stranguria. Abdominal US identified uroliths and the dog was taken to surgery for a cystotomy. Stone analysis revealed urate stones. You call the owners to inform them of the results and recommend what test? a. pre- and post-prandial bile acids test b. creatine kinase levels c. low dose dexamethasone suppression test d. ACTH stimulation test.

Answer 194

Pre- and post-prandial bile acids test; urate stones in a small breed dog are usually secondary to a portosystemic shunt until proven otherwiase. A portosystemic shunt results in blood from the abdomen being shunted away from the liver and into the main circulation. If shunted, the liver does not have an opportunity to detoxify the blood, which among other toxins, is very high in ammonia. The excess ammonia is excreted via the kidneys. High levels of ammonia can result in formation of ammonium biurate crystals and ultimately stones. An ACTH stimulation test is used to help diagnose hypoadrenocorticism and hyperadrenocorticism. A low dose dexamethasone test is used to help diagnose hyperadrenocorticism. Creatine kinase levels are evaluated when there is a suspected myopathy.

Question 195

A 12 yr old, English Bulldog presents with anorexia and severe, generalized pain. What is the best description of the lesion in the radiograph? a. polyostotic, aggressive b. monostotic, non-aggressive c. monostotic, aggressive d. polyostotic, non-aggressive

Answer 195

Polyostotic, aggressive; there are multiple lytic lesions in the cervical and thoracic vertebrae, especially visible in C2 and in the spinous processes of the T1-T8. There are also lytic lesions in the proximal humerus of one leg and in the bones of the skull.

Question 196

A 3yr, old, Golden presents for acute onset of a non-painful myelopathy localized to the spinal segments from T3-L3. The dog has superficial and deep pain perception and some motor function present in its pelvic limbs. It also has hyperreflexive patellar and gastrocnemius reflexes. The dog is diagnosed with a fibrocartilagenous embolism (FCE). What do you tell the owners? a. the dog should be treated with heparin to prevent further emboli b. the dog should have decompressive surgery c. the dog will probably continue to get worse and has a poor prognosis d. most dogs with FCE usually get better on their own with nursing care

Answer 196

Most dogs with FCE usually get better on their own with nursing care; FCE is caused by an embolus of disc material in the spinal vasculature. It is unknown how the disc material gets into the vasculature. The prognosis of dogs with FCE varies. Most dogs get better with supportive care and nursing care. The loss of pain perception and lower motor neuron signs are poor prognostic indicators.

Question 197

A 1yr, F, Golden presents with bilateral exophthalmos that has taken place over the past 2 days. T = 102.2F, HR = 140bpm, RR = 30bpm and lab work is unremarkable. She does not seem painful, and no swelling around the eyes is evident. Pupillary light response is normal in both eyes and there is minimal resistance to retropulsion of the globes. The masticatory muscles do not appear to be affected and there is no difficulty opening the mouth. What conditon is suspected? a. lymphoma b. extraocular polymyositis c. retrobulbar abscess d. orbital neoplasia

Answer 197

Extraocular polymyositis; this is a condition seen in young Golden's. It is kind of similar to masticatory muscle myositis in that it occurs due to an autoimmune reaction against muscle antigens. It is treated with prednisone +/- azathioprine. The condition can be differentiated from these other conditons because orbital neoplasia and retrobulbar abscesses are usually unilateral. Abscesses are usually accompanied by more systemic signs. Orbital neoplasia is usually more slowly progressive and seen in older animals. Lymphoma could present in a similar fashion but is less likely in such a young dog with no other signs.

Question 198

A 10 yr, MC, GSD presents for an acute onset of ptosis, drooping of the lip, and drooping of the cheek all on the left side. What nerve is damaged? a. CN VII b. CN VI c. CN III d. CN V

Answer 198

CN VII; this is the facial nerve which is responsible for motor of the facial muscles as well as sensation in the ear and lacrimation. CN V is most responsible for sensation. CN III is the oculomotor nerve and serves in movement of the eye. CN VI is also involved in movement of the eye.

Question 199

Which of the following is true about post-operative care in a dog that had a parathyroid adenoma removed? a. serum calcium post-op should be kept below normal to stimulate the production of PTH from the atrophied chief cells of the normal parathyroid tissue b. it is most important to monitor serum calcium post-op to make sure the patient does not continue to be hypercalcemic c. post-op care is minimal and requires checking serum calcium once a week for one month d. the patient is less likely to be hypocalcemic post-op if the patient's pre-op serum calcium is markedly high e. the patient's serum calcium should be monitored daily for about a week to check for the development of hypocalcemia

Answer 199

the patient's serum calcium should be monitored daily for about a week to check for the development of hypocalcemia; post-op it is improtant to monitor for hypocalcemia daily for the first seven days regardless of the absence of clinical signs for hypocalcemia. The higher the pre-operative serum calcium concentration, the more likely the patient will become hypocalcemic post-op. Post-op monitoring of serum calcium should be daily for the first 7 days then weekly for 4 weeks. Vitamin D and calcium supplementation should be given accordingly. Serum calcium concentration should be maintained in the low normal range, not below normal, to stimulate production of PTH by the parathyroid cells.

Question 200

What is the best measure of liver function in the dog from a routine chemistry panel? a. ALP b. BUN c. ALT d. Creatinine

Answer 200

BUN; ALT and ALP are liver enzymes and can indicate ongoing damage to the liver or cholestasis, but do not tell you anything about liver function. Creatinine is produced by muscle and cleared by the kidney so it tells you nothing about liver function. Urea is produced by the liver and is one measure of liver function; it will be low in cases of liver failure. Other tests of liver function on a routine chemistry panel are cholesterol, glucose, bilirubin, and albumin. Bile acids also test liver function but are not on a routine chemistry panel. It is important to realize that in cases of END-STAGE Liver Failure, the liver function parameters will be affected, while frequently, liver enzymes are NORMAL.

Question 201

A 6yr old Boxer presents with the complaint of blepharospasm of 2 weeks duration. A Schirmer tear test and tonometry of the affected eye are normal, but on fluorescein dye stain there is an intensely staining area surrounded by a "halo" of lighter stain. What is the most likely diagnosis? a. Indolent corneal ulcer b. Herpesvirus infection c. Infected corneal ulcer d. Descemetocele

Answer 201

Indolent corneal ulcer; the 2-week duration and staining pattern are typical of indolent ulcers. Boxers are also frequently affected by this condition. An indolent ulcer occurs due to a defect in the ability of the corneal epithelium to adhere.

Question 202

When performing surgery on a patient with compromised liver function what test should be performed prior to surgery? a. BUN b. coagulation panel c. PIVKA d. Bile acids e. WBC

Answer 202

Coagulation panel; a compromised liver may not be able to produce enough coagulation factors; thus a surgical procedure would bring the risk of that the animal could bleed to death

Question 203

What is the diagnostic test of choice for diagnosing exocrine pancreatic insufficiency? a. fecal float and smear b. PLI (pancreatic lipase immunoreactivity) c. TLI (trypsin-like immunoreactivity) d. Serum cobalamin/folate levels

Answer 203

TLI; this is a sensitive test for pancreatic exocrine function. PLI is a test used more for diagnosing pancreatitis. Vitamin B12/folate levels would be a useful test to do in cases of EPI because of possible malaabsorption of folate or concurrent bacterial overgrowth in the small intestine affecting these factors, but it is not a very sensitve test for diagnosing EPI. Fecal examination is also an unreliable way to try to diagnose pancreatic disease but may be useful for ruling out other causes of diarrhea.

Question 204

Which of these would you expect to be prolonged soonest after ingestion of an anticoaagulant rodenticide by a dog? a. Partial thromboplastin time (PTT) b. Prothrombin time (PT) c. Activated Clotting time (ACT) d. Thrombin time (TT)

Answer 204

PT; these compounds act by inhibiting vitamin K, which is required for synthesis of clotting factors II, VII, IX and X. Factor VII has the shortest half-life of these and will be depleted first. Since PT measures the extrinsic system which contains factor VII, it becomes prolonged first.

Question 205

What is the most appropriate method for diagnosis of dermatophytosis in order to develop the best treatment and management recommendations? a. microscopic examination of macroconidia b. analysis of endothrix or ectothrix spores in hairs c. Wood's lamp fluorescence of hair d. white colony growth and red color change in 5-7 days

Answer 205

Microscopic examination of macroconidia; proper management of dermatophytosis requires identification of genus and species. Only about 50% of microsporum canis strans fluoresce with UV (wood's lamp). Microsporum gypseum and Microsporum canis can both present as white colony growth with a pH change at 5-7 days, but required different management strategies. The source of M. gypseum is soil; the ultimate source of M.canis is a potentially asymptomatic cat.

Question 206

A 4yr old spaniel presents with acute onset non-weight bearing lameness in the right hind limb. A femoral pulse can't be felt in the leg. A thromboembolic disease is suspected as the underlying cause. Which disorder is more commonly associated with an increased risk of thromboembolism? a. Hypoadrenocorticism b. idiopathic epilepsy c. wobbler syndrome d. immune-mediated hemolytic anemia

Answer 206

Immune-mediated hemolytic anemia; pulmonary thromboembolism is the most common site for thromboembolic disease. In this patient, the thrombus is likely lodged at the iliac bifurcation, causing an obstruction of blood flow distal to the site of impaction. Hyperadrenocorticism (not hypoadrenocorticism) can cause a hypercoagulable state and increase the risk for a thromboembolism. There has been no association between idiopathic epilepsy and increased risk of thromboembolism. Wobbler syndrome is cervical spondylomyelopaathy, a adisease of the cervical spine (mostly in large-breed dogs) causing spinal cord or nerve root compression, neck pain, and neurologic symptoms.

Question 207

A 3yr old, mix dog presents after falling from a height of 10 feet and landing on the caudal half of his body. Since the fall, the dog has been dribbling urine and dropping feces as it walks. Neurologic exam reveals no abnormalities in the thoracic limbs, and a hypo-reflexive patellar, gastrocnemius and withdrawal reflexes in the pelvic limbs. Where is the lesion in the spinal cord? a. C6-T2 b. C1-C5 c. L4-S3 d. T3-L3

Answer 207

L4-S3; the spinal cord is divided into the 4 regions listed above in the dog. Lesions at C1-C5 would manifest as UMN signs in the thoracic and pelviv limbs. Lesions at C6-T2 would manifest aas LMN for the throacic limbs and UMN for the pelvic limbs. Lesions of T3-L3 would not affect the thoracic limbs and would cause UMN signs in the pelvic limbs. Lesions at L4-S3 would manifest as normal thoracic limbs and LMN signs in the pelvic limbns, anus, and bladder.

Question 208

A 1yr old, MN, chihuahua presents for a 3 month history of intermittent limping and non-weight bearing on the left hind limb. On PE, it is difficult to determine the source of pain as the patient seems to try to bite on any manipulation of the left hind limb. The patient was sedated and these radiographs were obtained. What is your diagnosis and treatment? a. avascular necrosis of the femoral head. Perform femoral head and neck ostectomy or total hip replacement. b. left hip septic arthritis. Perfrom joint culture and begin appropriate antibioic therapy. c. left hip dysplasia. Perfrom femoral head and neck ostectomy or total hip replacement d. left patellar luxation. Perfrom trochlear wedge recession with tibial tuberosity transposition

Answer 208

Avasculaar necrosis of the femoral head, perfrom femoral head aand neck ostectomy or total hip replacement; based on the breed and age of the patient, avascular necorsis of the femoral head should immediately be the top differential. This conditon is also known as Legg-Calve-Perthes disease and results in a collapse or fragmentation of the femoral epiphysis because of a disruption in blood flow. The cuase of blood flow interruption is unknown. The condition occurs in young small-breed dogs prior to closure of the captial femoral physis. The condition can be seen bilaterally in 10-17% of patients. Dogs are usually 6-7 months of age when they first start showing clinical signs but the age may range from 3-13 months. Treatment with a femoral head and neck ostectomy (FHO) generally yields excellent results. Alternatively, if owners demand perfect biomechanics a total hip replacement may be considered but most veterinarians tend to recommend an FHO.

Question 209

A 7 month old, M, GSD became acutely lame on the right forlimb 5 days ago. The dog presents on ER due to acute exacerbation of lameness. On exam, the dog has a temp of 103.6F and was toe touching lame on the right forelimb and reluctant to stand or walk. There was no evidence of external trauma. Deep plapation of the right humerus elicited pain and you take radiographs of the right humers which are shown bleow. Based on the most likey diagnosis, what is the prognosis for this conditon with supportive treatment only? a. Excellent, >95% of dogs recover b. Grave, <5% of dogs recover c. Poor, 10-20% of dogs recover d. Fiar, 40-60% of dogs recover e. Good, 80-90% of dogs recover

Answer 209

Excellent, >95% of dogs recover; this is a case of panosteitis based on the young age of the patient and radiographic presence of focal intramedullary densities within the humeral diaphysis . Mino differentials could include osteomylepitis. Panosteitis is a self-limiting, painful condition, characterized by limping and lameness. It typically affects the long bones of young doesg, usually between the ages of 5-18 months. It can occur with any breed, but is more common in medium - large breeds.

Question 210

Zoonotic diseases commonly carried but raccoons include rabies and ________. a. Baylisascaris b. Echinococcus c. Trichinella d. Toxocara

Answer 210

Baylisascaris; Bayisascaris procyonis is an ascarid parasite of raccoons that causes mild signs in raaccoons but can undergo aberrant migration in humans and cause fatal central nervous system signs.

Question 212

Pictured is a cytology of a ruptured pustule from a dog with pruritus. What is the most common etiologic agent causing pyoderma in the dog? a. Staphylococcus pseudintermedius b. Staphylococcus aureus c. Streptococcus canis d. Mycoplasma canis

Answer 212

Staphylococcus pseudintermedius; pyoderma is common in dogs because the canine stratum corneum is a less efficient barrier to bacteria than in other species. Dogs lack an ostial plug in their follicles, a characteristic which allows bacteria to invade and colonize more readily. Mixed bacterial infections are possible, but Staph. pseudintermedius is the most common primary bacterial invader.

Question 213

What is the best way to find Giardia canis trophozoites? a. fecal flotation b. direct fecal smeaar c. Baermann technique d. fecal sedimentation

Answer 213

Direct fecal smear; giardia trophozoites and cysts are typically found on a direct fecal smear. Giardia cysts can be found on fecal floation also. The organism can also be detected by FA and ELISA. The Baermann technique is a method of recovering larvae from fecal material and is most commonly used when looking for nemaatode parasites, most often lungworm.

Question 214

A boxer presents for exercise intolerance and syncopal episodes. Cardiac auscultation reveals a grade 4/6 left systolic murmur heard best at the base of the heart. Thoracic radiographs show a mildly enlarged left ventricle and left atrium, and segmental enlargement of the ascending aorta. What test will confirm the tenative diagnosis? a. CT scan b. Echocardiogram c. Coombs' test d. HWT e. 24 hour holter ECG monitor

Answer 214

Echo; the breed, history, rads and auscultation are most consistent with aortic stenosis. Echo would be best for diagnosing and would show left ventricular concentric hypertrophy, stenosis of the aortic outlfow tract, and post-stenotic dilation of the ascending aorta. A holter is the test of choice for arrhythmogenic right ventricular cardiomyopathy (ARVC) which is also seen in boxers and causes syncope but does not fit with the physical exam or radiographic findings. Also called boxer cardiomyopathy, ARVC is a disease associated with fibrofatty infiltrate into the right ventricle resulting in electrical conduction disturbances and resultaant VPCs. A CT scan would not add more info., and cardiac motion typically causes resolution problems with thoracic CT scans. The signs are not consistent with heartworm, which is primarily a right heart problem, or with hemolytic anemia, which a Coombs' test might be useful for.

Question 215

Which of the following is a common problem leading to poor glycemic control in dogs with diabetes mellitus? a. continuous deposition of amyloid in pancreatic islets b. feeding canned food c. keeping insulin in the fridge d. concurrent endocrine disease

Answer 215

Concurrent endocrine disease; such as infection, hyperadrenocorticisim, and pancreatitis can commonly caused increased insulin resistance, making diabetes difficult to regulate. Amyloid deposition is a cause for DM in cats, but does not change the effectiveness of insulin therapy. DM in dogs is not caused by amyloid depositon. Most insulins are supposed to be kept in the fridge. Feeding canned food should not contribute, so long as the diet is of good quality and adequate for diabetic regulation. Owners will commonly overdose their animals by administering additional insulin than what had been prescribed or administering insulin when the animal has not eten. Improper storage, handling and administration are other common causes of ineffective insulin therapy.

Question 216

How many days after an intestinal resection and anastomosis can a surgeon notify the owner's that they're confident the procedure was successful? a. 5 days after surgery b. after the patient is eating and defecating c. immediately as long as there were no complications d. at the suture removal in 10-14 days

Answer 216

5 days after surgery; the principles of healing, 3-5 days corresponds to the end of the lag phase of intestinal healing. After that point, there is typically enough collagen that has been incorporated into the healing intestine such that dehiscence will not occur. The mortality rate for patients that have intestinal dehiscence is 73-80%. Risk factors that have been associated with an increased chance of dehiscence include traumatic intestinal injuries, intestinal foreign bodies, peritonitis at the time of surgery and serum albumin less than 2.5 g/dL.

Question 217

A 5yr old, MN, Welsh corgi presents with the complaint of mild lethargy and reluctance to play for 1 week. He is decreased weight bearing on the left pelvic limb and has swelling of the stifle. Radiographs confirm the presence of effusion but no bony changes. On arthrocentesis of the left stifle 1.0ml of cloudy fluid is withdrawn. What additional diagnostic test is most important? a. total protein of the fluid b. echocardiogram c. arthroscopy d. culture of the fluid e. urinalysis

Answer 217

Culture of the fluid; this is a description of septic arthritis based primarily on the cytologic findings of neutrophils and bacteria in the joint fluid cytology. The bacteria are within the neutrophils (intracellular bacteria) which assures that this is not contamination on your slide. All of the other answer choices might be reasonable recommendations but the most important diagnostic test is to culture the joint fluid to determine the etiologic agent and its antibiotic susceptibility as this will most directly impact your choice of therapy. The treatment of choice for septic arthritis is a prolonged (at least one month) course of an appropriate antibiotic. In some cases, drainage/lavage of the joint or surgery may be necessary.

Question 218

Which digit has been partially amputated in the picture below (this is the right forelimb of a dog)? a. 2nd digit b. 5th digit c. 1st digit d. 4th digit e. 3rd digit

Answer 218

3rd digit; dog digits are numbered 1-5 starting medially with the small 1st metacarpal that is associated with the dewclaw (essentialy like the thumb on a primate). This digit is not well visible in the photograph, but you should still be able to see that it is the third digit that has had the ungual crest and process amputated.

Question 220

What profile would you expect in a dog with hypervitaminosis D? a. High Ca, Low P b. Low Ca, Low P c. Low Ca, High P d. High Ca, High P

Answer 220

High Ca, High P; excessive intake of vitamin D is aassociated with an increase in 25-hydroxyvitamin D3 levels. At high levels, 25-hydroxyvitamin D3 competes with 1,25-dihydroxyvitamin D3 for its receptors on the intestines and bone causing increased absorption of Ca and P from the intestinal tract and resorption of bone causing increased levels of circulating Ca and P. A common source of confusion is that this is in contrast to PTH which causes high Ca but generally causes unchanged or normal phosphorus because it also enhances renal phosphorus excretion.

Question 221

Which of the following is most likely to cause the abnormality seen in this radiograph? a. Blastomycosis b. Pyometra c. Osteosarcoma d. Aspiration Pneumonia e. Penetrating thoracic trauma

Answer 221

Osteosarcoma; the abnormality in the radiograph is multiple pulmonary nodules consistent with metastatic neoplasia. Systemic fungal disease would be a reasonable differential for this radiographic pattern but is not as good of a choice, especially with no evidence of hilar lymphadenopathy. Aspiration pneumonia would cause an alveolar infiltrated centered in the cranioventral lung region, and penetrating trauma would likely cause pneumothorax. There is no evidence of pneumothorax in this study.

Question 222

A 9yr old, MN, Rottweiler presents with a one month history of lameness of the right forelimb. The dog is painful on palpation of the proximal humerus. Which is the most likely differential diagnosis to discuss with the owner? a. Primary bone tumor b. Osteomyelitis c. Hypertropic osteopathy d. Old healed fracture

Answer 222

Primary bone tumor; the signalment of a large breed, older dog and radiographically aggressive bone lesion in the proximal humerus are most suggestive of primary bone neoplasia. The destructive element of the lesion indicates its aggression, and the location in one bone, in a site of predisposition for cancer, make fungal osteomyelitis less likely.

Question 223

A 6 yr old, M cryptorchid, Schnauzer presents for weakness, lethargy, intermittent epistaxis, and melena for 1 week. PE include gynecomastia, a pendulous prepuce, symmetrical truncal alopecia, a palpable abdominal mass, pale MM, and a fever. The dog's HCT is 14% (35-57%) with a total protein of 7.0 g/dL (5.4-7.5 g/dL). A blood smear reveals normocytic normochromic anemia with a platelet count of 34,000/microliter (211,000-621,000/ul). The WBC is 2,500/ul (5,000-14,100.ul) What is most likely responsible for the dogs signs? a. testosterone excess b. thyroid hormone deficiency c. estrogen excess d. cortisone deficiency e. cortisone excess

Answer 223

Estrogen excess; this dog's presentation should lead you to the presumptive diagnosis of an estrogen secreting tumor; likely a sertoli cell tumor or seminoma. The dog was described as cryptorchid; dogs with cryptorchidism are prone to testicular tumors. The signs of male feminization such as gynecomastia and the signs of bone marrow suppression are most suggestive of estrogen toxicity.

Question 224

What does cyanosis generally indicate? a. hypoventilation - PaCO2 >60 b. cyanide toxicity c. anemia PCV < 15 d. hypoxemia - PaO2 of < 50 mmHg

Answer 224

Hypoxemia - PaO2 < 50 mmHg; cyanosis or blue mucous membranes is an indicator of oxygenation and is generally when arterial PO2 is less than 50.

Question 225

A 10 yr old, MN, Schnauzer presents laterally recumbent and minimally responsive. He was normal yesterday, but today on PE his temp is 97F, HR 50 bpm, RR 50 brpm, 8% dehydrated, systolic BP 80 mmHg. He groans when his abdomen is palpated and there is a small pocket of ascites on US exam. Cytology reveals moderate amount of neutrophils with no obvrious bacteria. An in-house chemistry panel is WNL (glucose 145, sodium 145, potassium 4.1 and lactate 0.8) The ascites glucose is 100 and lactate is 2.8. What is the recommendation? a. surgical exploratory b. colloid fluid therapy and antibiotics c. crystalloid fluid therapy and antibiotics d. start active warming and give a dose of atropine

Answer 225

Surgical exploratory laparotomy; this dog has a septic abdomen and requires surgical intervention. Sepsis is suspected if the glucose in the ascites is at least 20 mg/dL less than the peripheral blood. A blood lactate level of 2.0 mmol/L lower than the ascites lactate level is also highly suggestive of a septic abdomen. The presence of intracellular bacteria would also be diagnostic for a septic abdomen. The hypotension, bradycardia, and hypothermia can be attributed to the sepsis as well. An abdominal ultrasound may help to determine the source. Rehydration and antibiotics are necessary components of treatment but ultimately surgical exploratory is necessary.

Question 226

Rufus, a 10 yr old, MN, Lab presents for acute abdominal pain, vomiting and distended abdomen. Pancreatitis is suspected due to table scrap consumption history. His PLI snap test is a strong positive, and his CBC and Chem are below. Based on the results there is one value that is very concerning for Rufus's prognosis. What test is recommended? a. Abdominal US b. bone marrow biopsy c. chest rads d. toxicology screen e. PT, PTT, FDP

Answer 226

PT, PTT, and FDP; diseases that cause severe inflammation can induce disseminated intravascular coagulation (DIC) complex. The severe inflammation from pancreatitis can cause massive endothelial injury, resulting in vasculitis. This starts the coagulation cascade, which can be so severe that it uses up all the clotting factors; the patient then becomes susceptible to bleeding disorders. DIC can be difficult to diagnose especially in the early stages of the disease, when the clinician would most like to discover it. Patients with clinical signs and the 3 of the following 4 laboratory findings have DIC (increased PT, increased PTT, increased FDP and decreased PLT)

Question 227

For what type of surgery would nitrous oxide be contraindicated for use as part of an anesthetic protocol in a dog? a. open chest surgery b. gastrointestinal surgery c. splenic surgery d. hepatic surgery e. renal surgery

Answer 227

Gastrointestinal surgery; nitrous oxide moves into closed gas spaces such as the intestines. As such , its use is contraindicated in bowel surgeries. Nitrous oxide also decreases fractional inspired oxygen levels although this can be managed and monitored in most instances. Nitrous oxide is contraindicated when pathology such as pulmonary bullae are present.

Question 228

What is the maximum safe rate of potassium infusion? a. 0.5 mEq/kg/hr b. 5 mEq/kg/hr c. 2 mEq/kg/hr d. 0.3 mEq/kg/hr

Answer 228

0.5 mEq/kg/hr; is the maximum safe rate of potassium infusion, administering potassium more rapidly than this can result in fatal arrhythmias

Question 229

What is the definitive diagnostic test for canine distemper? a. Immunoflurescent assay on affected epithelium b. hyperkeratosis of foot pads c. the combination of gastrointestinal, respiratory, and neurologic clinical signs d. enamel hypoplasia e. detection of virus via serology

Answer 229

Immunofluorescent assay on affected epithelium; although the clinical signs are supportive for distemper, the definitive diagnosis is examination of blood or tissue by immunofluorescent assay. This can be performed on tracheal, vaginal, respiratory, or other epithelium. These samples may be negative if the dog is only showing neurologic signs or if a circulating antibody is present. The diagnosis can then be made by serology for distemper IgM or increased CSF to serum virus specific IgG. in addition, a distemper PCR test is now available and is performed on swabs of ocular or nasal discharge. The test can have false positives in some vaccinated animals; however, animals showing signs consistent with distemper that are PCR positive should be considered likely infected with distemper.

Question 230

How is pulmonary thromboembolism definitively diagnosed in a live patient? a. cytology b. contrast radiographs c. plain radiographs d. blood gas analysis

Answer 230

Contrast radiographs; angiography is the gold standard for diganosing PTE. If positive, there are sudden interruptions in blood and contrast flow. Plain radiographs are often normal or have mild changes. Cytology samples would mainly show blood and wouldn't be considered diagnostic or definitive. Blood gas changes typical for PTE are hypoxemia and hypocapnia, but these are not specific for PTE. CT angiography is also a reasonable test to confirm PTE.

Question 231

What are Addisonian dogs usually deficient in? a. mineralocorticoids only b. both glucocorticoids and mineralocorticoids c. glucocorticoids only d. epinephrine and estradiol

Answer 231

Both glucocorticoids and mineralocorticoids; primary hypoadrenocorticism is caused by destructive or atrophy of all layers of the adrenal cortex, causing a deficiency in both types of corticosteroids. Remember, mineralocorticoids come from the zona glomerulosa, and glucocorticoids come from both the zona fasiculata and zona reticularis. The less common form of hypoadrenocorticism is caused by inadequate ACTH production by the pituitaary and results in a deficiency of glucocorticoids only.

Question 232

A 7yr old, FS, spaniel presents to ER for several day history of progressive weakness and lethargy. She has no recent history of travel or tick exposure. On PE her temp is 104.7F, HR 128bpm, RR 42brpm, MM = pale pink, CRT = 1.5sec. A blood smear is below. Based on the most likely diagnosis, which of the following treatments is most appropriate? a. plasma transfusion, vitamin K supplementation b. erythropoietin injections and iron supplementation c. packed RBC transfusion, immunosuppressive doses of corticosteroids d. platelet rich plasma transfusion and anti-inflammatory doses of corticosteroids e. fresh whole blood transfusion, ampicillin

Answer 232

Packed RBC transfusion, immunosuppressive doses of corticosteroids; this description is most compatible with IMHA. On the blood smear there are small numbers of erythrocytes compared to the numbers of platelets and leukocytes. There is also polychromasia with some red blood cells appearing very pale and others appearing a more purple color, consistent with regenerative response from the bone marrow. It may be difficult to appreciate spherocytes on this blood smear, but that is another classic finding of IMHA.

Question 233

What fungal infection is considered to be contagious, either to other animals or to man (zoonotic)? a. cryptococcosis b. blastomycosis c. sporotrichosis d. cocidioidomycosis e. aspergillosis

Answer 233

Sporotrichosis; all of these fungal diseases can infect both animals and people however, they are not considered contagious besides Sporothrix. This is because they are mainly acquired from the environment and transmission from animal to animal is rare. Sporothrix, especially in cats, is a high risk to veterinarians and care should be taken to limit contact with exudates and lesions in cats.

Question 234

How is cryptococcus obtained? a. inhalation b. aerosols c. saliva from infected species d. feces

Answer 234

Inhalation; yeast is inhaled from the environment, frequently in avian habitats, as it survives ideally in pigeon droppings.

Question 235

What are causes of chronic renal failure in small animals? a. amyloidosis b. polycystic kidney disease c. familial nephropathy d. all of the above e. leptospirosis

Answer 235

All of the above; leptospirosis typically manifests as acute renal failure

Question 236

A patient presents after being found wandering along the middle of the road. On PE, RR = 54bpm, decreased lung sounds in the left dorsal quadrant and several abrasions are noted on the forelimbs. Pulse oximetry on the gingiva was 94%. What is the best treatment option? a. perform a left sided thoracocentesis on the ventral aspect of the chest b. perform a left sided thoracocentesis on the dorsal aspect of the chest c. perform a right sided thoracocentesis on the ventral aspect of the chest d. perform a right sided thoracocentesis on the dorsal aspect of the chest e. place a thoracotomy tube on the right side

Answer 236

Perform a left sided thoracocentesis on the dorsal aspect of the chest; the radiograph shows a pneumothorax. Notice the lungs are collapsed on the left and no vasculature or airways can be appreciated on the left as compared to the right. In a standing patient it is best to perform a thoracocentesis dorsally since air rises. This will yield the most amount of air to aspirate. In most cases with a pneumothorax secondary to trauma it is not necessary to place a chest tube as the leak seals over quikly, making a chest tube excessive; however patients that are tapped must be monitored closing for recurrence of pneumothorax. If air builds up persists more aggressive treatment such as a chest tube with or without continuous suction should be considered.

Question 237

Which of the following tests for hyperadrenocorticism is primarily a screening test, but can also be a differentiating test? a. Endogenous ACTH level b. High dose dexamethasone suppression test c. low dose dexamethasone suppression test d. urine cortisol:creatinine ration e. ACTH stimulation test

Answer 237

LDDST; the 8 hr post-dexamethasone sample is used to determine if the pet has hyperadrenocorticism. If the 8 hr sample is above 1.4ug/dL, the test is diagnostic for hyperadrenocorticism (either pituitary dependent or adrenal dependent). If the 4 hr sample is below 1.4ug/dL or less than half of the baseline value, it is diagnostic for pituitary dependent hyperadrenocorticism. The urine cortisol:creatinine ratio is a screening test to rule out hyperadrenocorticism, if it is normal. The endogenous ACTH level and high dose dexamethasone suppression tests are differentiating tests only. An ACTH stimulation test is a screening test but can't differentiate PDH vs. ADH.

Question 238

Which of these tumor types is frequently testosterone-dependent and is therefore found most frequently in dogs that are intact males or have testosterone-secreting tumors? a. mast cell tumors b. apocrine gland anal sac adenocarcinoma c. perianal adenoma d. squamous cell carcinoma

Answer 238

Perianal adenoma; these tumors are primarily seen in older male intact dogs. These tumors will often shrink or resolve after castration.

Question 239

A 9 yr old, M, Lab presents for acute onset of circling to the right, head tilt to the right, nystagmus to the left, and vomiting. The rest of the physical exam is unremarkable. CBC, Chem, UA, and otic exam were unremarkable. After 14 days of supportive care, the dog has completely recovered on its own. What is the most likely disease this dog had? a. inflamed polyp in the middle ear b. otitis interna c. bacterial meningitis d. canine idiopathic vestibular disease (old dog vestibular disease)

Answer 239

Canine idiopathic vestibular disease (old dog vestibular disease); this disease is usually diagnosed after all other vestibular causes have been ruled out. Otitis interna would be ruled out with an otic exam, CBC and lack of pain and fever. Bacterial meningitis could be ruled out by a CBC and lack of pain and fever. Polyps in the ear rarely occur in dogs; most aural polyps are in cats. In additon an otic exam would rule out a polyp.

Question 240

A 4 month old intact female Yorkie presents for circling and head pressing, especially after eating. A CBC is within normal reference intervals. UA reveals ammonium biurate crystals. Which diagnostic test would be most informative in confirming your suspected diagnosis? a. ALT, AST, and GGT levels b. MRI of the brain c. Pre- and post-prandial bile acids d. Trypsin-like immunoreactivity

Answer 240

Pre- and post-prandial bile acids; based on the breed and young age of the animal with these neurologic signs and ammonium biurate cyrstalluria, a portosystemic shunt should immediately be your top differential. A pre- and post-prandial bile acid test assesses hepatic function. The enterohepatic circulation is highly effective in normal animals but not animals with shunts. Bile salts excreted in bile return to the liver by intestinal absorption and portal blood. /high pre- and post-prandial bile acids indicate a decrease in hepatic function. In congential and acquired portal systemic shunts, bile acids are allowed to bypass the liver and enter systemic blood. This results in markedly elevated post-prandial bile acid levels. ALT is a liver specific leakage enzyme, however, it does not reflect liver function. ALT may be within reference intervals in animals with decreased hepatic mass. AST is also a heptocyte leakage enzyme but does not reflect liver function. It is not a as liver-specific and is found in erythrocytes and cardiac and skeletal muscles. The animal's neurologic signs are likely from hepatic encephaolopathy from a portosystemic shunt so an MRI would not confirm your diagnosis. TLI is the test of choice to diagnose exocrine pancreatic insufficiency.

Question 241

Cushings response is characterized by a __________. a. compensatory increase in mean arterial pressure to maintain cerebral perfusion pressure b. compensatory hyperadrenocorticism to maintain cerebral perfusion c. compensatory decrease in systolic blood pressure to maintain peripheral perfusion d. compensatory elevation in blood glucose to enhance cerebral function

Answer 241

Compensatory increase in mean arterial pressure to maintain cerebral perfusion pressure. Cerebral perfusion pressure = mean arterial pressure - intracranial pressure or (CPP = MAP - ICP) This response is seen in situations where intracranial pressure increases such as in brain trauma. In this case, you need to think before you intervene to decrease your patient's mean arterial pressure as this might eliminate cerebral blood flow and kill your patient.

Question 242

What is the best treatment for a hiatal hernia? a. placement of esophagostomy tube until skeletal maturity is reached b. esophageal resection and anastomosis of affected region c. esophagopexy in conjunction with a left-sided gastropexy d. euthanasia due to grave prognosis e. plication of the small intestines

Answer 242

esophagopexy in conjunction with a left-sided gastropexy; performing these will help prevent the esophagus from herniating back into the thoracic cavity. The left-sided gastropexy increases the barrier pressure at the gastroesophageal junction. Resection and anastomosis of any region of the esophagus is associated with significant morbidity and mortality and should be avoided if possible. Additionally this does nt necessarily address the problem. Placement of an esophagostomy tube does not fix any problems. Perhaps if medical management is pursued, a gastrostomy tube or jejunostomy tube is more appropriate. Plication of the small intestines was previously performed in animals that had intestinal intussusceptions and later found to not be substantially beneficial.

Question 243

What is the best diagnostic test to differentiate between PDH and ADH hyperadrenocorticism in the dog? a. LDDST b. Urine cortisol:creatinine ratio c. HDDST d. Serum cortisol

Answer 243

HDDST; will suppress cortisol secretion in about 75% of PDH patients 3-6 hours post dexamethsone administration. Cortisol secretion does not become suppressed with dexamethasone administration with adrenal dependent hyperadrenocorticism. If cortisol secretion is suppressed with a HDDST, PDH is diagnosed. If cortisol is not suppressed, there is a 50/50 chance that the hyperadrenocorticism is due to PDH or an adrenal tumor. LDDST will suppress cortisol secretion in approximately 65% of PDH patients. The urine cortisol:creatinine ratio measures the significance of urine cortisol concentration and may be increased with both PDH and ADH. Serum cortisol levels may be affected in many different situations such as stress; therefore they are an unreliable indicator of disease. An elevated serum cortisol level will not differentiate between PDH and ADH.

Question 244

What endocrine imbalance does not commonly cause a dermatosis in dogs? a. central diabetes insipidus b. hypothyroidism c. sertoli cell tumors d. hyperadrenocorticism

Answer 244

Central diabetes insipidus; males with sertoli cell tumors may develop bilateral alopecia with occasional pruritus and papular eruptions. Hypothyroid dogs often develop alopecia, seborrhea, and pyoderma. Hyperadrenocorticism patients commonly develop hyperpigmentation, alopecia, calcinosis cutis, seborrhea, and pyoderma.

Question 245

A 15 yr old, FS, mini schnauzer presents for running into walls. On opthalmic examination, there is tapetal hyperreflectivity and vascular attenuation of the retina. The dog is also reportably exhibiting signs of PU, PD, Polyphagia, weight gain and lethargy. What is the most likely cause of this dog's blindness? a. Sudden Acquired Retinal Degeneration Syndrome (SARDS) b. Glaucoma c. Keratoconjunctivitis Sicca d. Lens luxation e. Cataracts

Answer 245

SARDS; most commonly affects spaniels, dachshunds, and pugs. Middle-aged, overweight female spayed dogs are most likely to be affected and affected dogs often present with symptoms that are normally associated with Cushing's disease, such as PU, PD, polyphagia, weight gain, and lethargy. Electroretinography performed by an opthalmologist can definitively diagnose the disease. There is unfortunately no effective treatment for this degenerative retinal condition.

Question 246

What are the most common clinical signs seen with canine hypothyroidism? What is the prognosis? a. PU/PD, weight loss, increased appetite, hyperactivity. Prognosis fair, continued therapy needed. b. PU/PD, weight gain, alopecia, pendulous abdomen. Prognosis poor, continued therapy required. c. weight gain, alopecia, pyoderma, lethargy. Prognosis good, continued therapy required. d. Lethargy, panting, weight gain, alopecia. Prognosis excellent, medications needed short term.

Answer 246

Weight gain, alopecia, pyoderma, lethargy. Prognosis good, continue therapy required. Loss of thyroid hormone affects a wide range of systemic physiology, but clinical manifestations most commonly include weight gain due to slower metabolism, skin diseases ranging from alopecia to pyoderma, hyperkeratosis, and lethargy due to decreased energy levels. Hypothyroidism = dogs become fat, lazy, heat seeking missiles of skin disease. Prognosis is very good for hypothyroidism as long as the owners are compliant. Supplementing with levothyroxine orally for the rest of the animal's life is necessary, with periodic monitoring of serum thyroid levels.

Question 247

What is the most common complication associated with an ovariohysterectomy? a. hemorrhage b. recurrent estrus c. uterine stump pyometra d. ligation of a ureter

Answer 247

hemorrhage; if hemorrhage of the left ovarian pedicle, use the mesocolon to retract the jejunum medially to expose the left paravertebral space. If bleeding associated with the right ovarian pedicle, use the mesoduodenum to retract the jejunum medially and expose the right paravertebral space. The other options do not occur as frequently.

Question 248

When considering a dog that is hypoventilating you realize the dog is in ________. a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis

Answer 248

respiratory acidosis; the dog is hypoventilating so there is a build up of CO2 - in effect the dog is in respiratory acidosis. CO2 = Acid. Some causes of respiratory acidosis include airway obstruction, open penumothorax or flail chest, neuromuscular disease, abdominal enlargement, pleural space disease, and bicarbonate therapy.

Question 249

What breed of dog has a congenital ocular anomaly characterized by choroidal hypoplasia, manifested by varying degrees of visual dysfunction with signs of large bizarre choroidal vessels visible on fundic exam as depicted here? a. Boston Terrier b. West Highland White Terrier c. Collie d. GSD e. Toy Poodle

Answer 249

Collie; collie eye anomaly is seen in up to 80% of the breed. Some are completely blind and others show no visual deficits. Other signs include optic disc coloboma, retinal hemorrhage and retinal seperation.

Question 250

A 5 month old Yorkie presents for failure to thrive and ataxia of 2 days duration. A chemistry panel shows a bilirubin of 0.9 mg/dL (0-0.3 mg/dL), BUN of 5.2 mg/dL (8-28 mg/dL). Which of the following is most likely in this dog? a. end stage liver disease due to fibrosis b. multiple intra-hepatic portosystemic shunts c. multiple extra-hepatic portosystemic shunts d. a single extra-hepatic portosystemic shunt e. a single intra-hepatic portosystemic shunt

Answer 250

single extra-hepatic portosystemic shunt; toy breed dogs, particularly Yorkies are predisposed to congenital, single, extra-hepatic portosystemic shunts. Larger breed dogs with congenital liver shunts tend to develop intrahepatic shunts. Acquired shunts in older animals are almost always extraheptic.

Question 252

A 3 yr old, MC, GSD presents with difficulty rising and laying down in the pelvic limbs. You perform pelvic rads that reveal severe hip dysplasia on the right side, while the left side appears normal. The owner does not have the funds for a total hip replacement surgery. Which of the following would be the best long-term treatment option for this dog? a. Prolotherapy b. Femoral head ostectomy (FHO) c. Amputation d. Triple Pelvic Osteotomy (TPO)

Answer 252

FHO; since the hip issue is only on one side, and since a total hip replacment will not be an option for this dog due to finances, removing the affected joint would be the best long-term option to relieve the pain. Triple pelvic osteotomy should only be performed in young dogs (less than a year old) that have minimal secondary degenerative changes and deep acetabulums. NSAIDs are often used to medically manage patients with dysplastic hips, but since this dog is only 3 years of age, medical management only would not be ideal for the long term. Prolotherapy is an alternative method of treatment, where the joint is injected with an irritant solution and is supposed to cause scar tissue formation to help re-stabilize the joint. Because this joint is proliferative and painful, this would not be an ideal treatment option for the longer term. Amputation would be extreme and not necessary for this condition.

Question 253

A 3 yr old, F, Doberman presents for a spay. Besides a PE and bloodwork, what additional diagnostic test should be performed prior to surgery? a. Buccal mucosal bleeding test b. Chest rads c. Activated clotting time d. Abdominal ultrasound

Answer 253

Dobermans are predisposed to having von Willebrand's Disease (vWD). Specifically Dobermans have increased incidence of Type 1 vWD. In this type, there is a reduced presence of functional von willebrand factor. This factor is crucial in initial clot formation and attracts platelets and allows them to bind to exposed subendothelium after injury. A buccal mucosal bleeding test should result in a clot in less than 4 minutes in normal dogs. An abnormal result warrants further investigation to confirm the presence of vWD in order to take the appropriate measures prior to surgery. Chest rads are not necessary prior to anesthetizing this patient for an elective procedure uncless there are PE findings which indicate radiographs of the chest. An abdominal US is a potentially good choice if there is concern that the uterus is enlarged or the animal is pregnant; however, thre is no history presented that ould make you believe that is the case, and it is impractical to perform an abdominal ultrasound for a routine procedure unless there is a clear indication. The activated clotting test evaluates the intrinsic and common coagulation pathways, and there is no concern with dysfunction in these.