DOGS Flashcards

Question

Avoidance learning as a behavioral principle

Answer 1

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

Answer 2

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.

Answer 3

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

Answer 4

Alkaline urine (pH above 7)

Answer 5

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.

Answer 6

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.

Answer 7

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.

Answer 8

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).

Answer 9

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

Answer 10

Immune-mediated hemolytic anemia

Answer 11

Dogs: Anemia Humans: Cutaneous larval migrans

Answer 12

Hookworms; thin walled appearance with 2-8 cells present

Answer 13

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.

Answer 14

Toxocara (Roundworms)

Answer 15

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.

Answer 16

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

Answer 17

fracture through the physis

Answer 18

fracture partway through the physis extending up into the metaphysis

Answer 19

fracture partway through the physis extending down into the epiphysis

Answer 20

fracture through the metaphysis, physis, and epiphysis

Answer 21

crush injury to the physis

Answer 22

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

Answer 23

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

Answer 24

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

Answer 25

Upper motor neuron signs in all limbs

Answer 26

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

Answer 27

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

Answer 28

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.

Answer 29

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

Answer 30

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

Answer 31

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.

Answer 32

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.

Answer 33

pleural fissure lines on both lateral and ventrodorsal projections

Answer 34

hemorrhage, edema or pus in the lobes of the lungs

Answer 35

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

Answer 36

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

Answer 37

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

Answer 38

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

Answer 39

ACTH Stimulation test

Answer 40

PU, PD, Polyphagia, and weight loss

Answer 41

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

Answer 42

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.

Answer 43

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.

Answer 44

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

Answer 45

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.

Answer 46

they frequently have a portosystemic shunt

Answer 47

hip dysplasia

Answer 48

Subaortic stenosis

Answer 49

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

Answer 50

left cranial cruciate ligament rupture with meniscal cartilage tear

Answer 51

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.

Answer 52

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

Answer 53

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.

Answer 54

when the blood glucose is around 180mg/dL

Answer 55

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.

Answer 56

6-12 months

Answer 57

Osteosarcoma

Answer 58

Osteosarcoma, chondrosarcoma, fibrosarcoma, and hemangiosarcoma

Answer 59

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

Answer 60

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.

Answer 61

3rd Degree AV Block

Answer 62

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.

Answer 63

Caused by the presence of gas forming bacteria

Answer 64

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

Answer 65

ACTH stimulation test

Answer 66

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.

Answer 67

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.

Answer 68

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

Answer 69

Lacrimation, hypertension and swallowing

Answer 70

Panhypoproteinemia (deficiency of all proteins in the blood)

Answer 71

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.

Answer 72

Diabetes mellitus

Answer 73

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.

Answer 74

Urine protein:creatinine ratio

Answer 75

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

Answer 76

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

Answer 77

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

Answer 78

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

Answer 79

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.

Answer 80

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.*

Answer 81

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

Answer 82

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.

Answer 83

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.

Answer 84

Melanoma; large cell with black melanin pigment

Answer 85

ONCEPT vaccine

Answer 86

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.

Answer 87

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.

Answer 88

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.

Answer 89

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.

Answer 90

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

Answer 91

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

Answer 92

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).

Answer 93

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

Answer 94

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.

Answer 95

Confine the dog and observe it for 10 days

Answer 96

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

Answer 97

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.

Answer 98

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.

Answer 99

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.

Answer 100

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.

Answer 101

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

Answer 102

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.

Answer 103

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

Answer 104

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.

Answer 105

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.

Answer 106

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.

Answer 107

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.

Answer 108

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.

Answer 109

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.

Answer 110

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.

Answer 111

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.

Answer 112

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.

Answer 113

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

Answer 114

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

Answer 115

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

Answer 116

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

Answer 117

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.

Answer 118

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

Answer 119

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.

Answer 120

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.

Answer 121

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.

Answer 122

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.

Answer 123

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

Answer 124

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

Answer 125

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.

Answer 126

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.

Answer 127

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.

Answer 128

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.

Answer 129

Systemic lupus erythmatosus, sulfonamide exposure, mammary adenocarcinoma

Answer 130

anorexia, weight loss, fever, lethargy, lymphadenopathy

Answer 131

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.

Answer 132

Ventricular Premature Complexes (VPCs)

Answer 133

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.

Answer 134

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.

Answer 135

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.

Answer 136

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.

Answer 137

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.

Answer 138

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.

Answer 139

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

Answer 140

Urine protein:creatinine ratio

Answer 141

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.

Answer 142

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.

Answer 143

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.

Answer 144

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.

Answer 145

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.

Answer 146

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.

Answer 147

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.

Answer 148

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.

Answer 149

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.

Answer 150

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.

Answer 151

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.

Answer 152

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.

Answer 153

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.

Answer 154

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.

Answer 155

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

Answer 156

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.

Answer 157

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.

Answer 158

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.

Answer 159

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.

Answer 160

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.

Answer 161

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.

Answer 162

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.

Answer 163

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.

Answer 164

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.

Answer 165

Ticks; babesia is an intraerythrocytic parasite transmitted by infected ticks

Answer 166

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.

Answer 167

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.

Answer 168

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.

Answer 169

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.

Answer 170

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.

Answer 171

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.

Answer 172

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.

Answer 173

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.

Answer 174

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.

Answer 175

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

Answer 176

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.

Answer 177

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.

Answer 178

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.

Answer 179

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.

Answer 180

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.

Answer 181

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.

Answer 182

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.

Answer 183

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.

Answer 184

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.

Answer 185

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.

Answer 186

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.

Answer 187

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.

Answer 188

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.

Answer 189

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.

Answer 190

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.

Answer 191

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.

Answer 192

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.

Answer 193

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.

Answer 194

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.

Answer 195

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

Answer 196

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.

Answer 197

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)

Answer 198

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.

Answer 199

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

Answer 200

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.

Answer 201

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.

Answer 202

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.

Answer 203

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.

Answer 204

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.

Answer 205

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

Answer 206

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

Answer 207

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.

Answer 208

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.

Answer 209

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

Answer 210

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.

Answer 211

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.

Answer 212

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.

Answer 213

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.

Answer 214

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.

Answer 215

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.

Answer 216

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.

Answer 217

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.

Answer 218

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.

Answer 219

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.

Answer 220

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.

Answer 221

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.

Answer 222

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.

Answer 223

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.