DVM 4 Specific Flashcards

Question

What does it mean that effects of radiation are stochastic or deterministic?

Answer 1

\* Stochastic- increased risk with increased dose-- the dose of radiation you receive, a higher dose of radiation will increase the probability of a stochastic effect e.g. a genetic mutation leading to cancer-- higher radiation dose or exposure will increase the chance of cancer developing (this is the one that is important in vet med) \*\* no threshold below which the risk of the effect will cease & effects are cumulative over a lifetime \* Deterministic- inevitable at high doses-- in contrast with stochastic effects, the severity of the effect, not the probability, increases with increasing dose. Exposure below a certain threshold will not result in the effect (THERE IS A THRESHOLD). e.g. radiation induced skin burns, uncommon however in medicine

Answer 2

\* direct effects may damage DNA, protein or other macromolecules \* Indirect effects create free radicles within cytoplasm and these free radical damage macromolecules \*\* Cell may either repair itself or if DNA damage has occurred a mutation may result, causing cell death, cancer, or birth defects

Answer 3

\* Department of Health which administers The Radiation Act 2005-- species that business must have a management licence to possess a radiation source and conduct a radiation practice & individuals must have a use licence

Answer 4

\* A national governing body -- Australian Radiation Protection and Nuclear Safety Agency-- responsibility for protecting the health and safety of the people and environment from the harmful effects of ionising radiation. They publish a series of codes and standards then implement in the form of legislation. RPS 17: Radiation Protection in Veterinary Medicine (2009) \*\* Also provide "Personal Radiation Monitoring Service"-- monitors and records occupational exposure to radiation

Answer 5

\* Thermoluminescent Dosemeter (TLD)- electrons int he crystal structure of the TLD card are excited to high energy levels as a result of irradiation and are trapped in the crystal structure. By heating the material, electrons return to their ground state and light is emitted. The amount of ligh is proportional to the radiation dose that the TLD material has received. Filters are used to allow only certain radiation to pass. \* Film badges- degree of darkening can be measured and will indicate the absorbed dose. But dose to film does not equal dose to tissue. \* pocket dosimeters-- different to TLDs and film badges... pocket dosimeters can be read instantaneously-- useful when high exposures are expected.

Answer 6

Rapidly dividing tissue

Answer 7

20 mSv per year, averaged over consecutive years \* 50 mSv in a single year \*\* Avg annual dose for veterinarians is around 16 microSv = 0.016 mSv

Answer 8

\* As Low As Reasonably Achievable \*\* Is the radiograph necessary for the patient and management of the case? Would ultrasound or a blood test answer the clinical question? \* Minimize retaking radiographs, minimize manual restraint, under no circumstances should any part of your body be within the primary x-ray beam

Answer 9

\* Useful beam \* Leakage radiation \* Scatter radiation

Answer 10

Modifying 1. Time (take good radiographs the first time around) 2. Distance from the radiation source-- the energy of the scatter radiation will decrease as distance from the radiation source increases, according to the inverse square law... e.g. so by doubling the distance from the radiation source, you will reduce your radiation exposure by a factor of 4. (avoid manual restraint, use ancillary positioning devices such as sand bags, stand well back) 3. Shielding- concrete walls, PPE

Answer 11

Lead equivalent of 0.25 mm will shield scatter radiation with energy of up to 100 keV (electron volt)

Answer 12

\* Generated in the x-ray tube by firing a high energy electron beam at a tungsten target 1. A source of electrons (cathode) 2. An obstacle- free path for the passage of high speed electrons 3. A target (the anode) in which the electrons can interact, releasing energy in the form of x-rays 4. a method of accelerating the electrons- electrical potential difference applied between the cathode and anode

Answer 13

ARPANSA RPS 17 + ALARA by observing time distance and shielding principles

Answer 14

\* cathode acts as a source of electrons \* it is of a tungsten coiled filament mounted within a molybdenum focusing cup. Tungsten has a high melting point and a high atomic number. When a current is run through the cathode filament, it heats up and releases electrons.

Answer 15

\* when an electrical potential difference is applied across the x-ray tube, the anode has a positive charge relative to the cathode and attracts the electrons \* When electrons collide with the anode, 99% of the kinetic electron energy is converted to heat and only 1% gets converted into x-rays Because of the heat produced anodes have a tungsten target which is resistant to heat. This is mounted on a copper base which helps conduct heat away from the target. (Either rotating-- more powerful x-ray machines-- or stationary-- dental and portable-- copper base)

Answer 16

\* Contains the cathode and anode within the vacuum. The x-ray tube has a small exit window through which the x-ray photons escape. The tube is surrounded by oil which helps dissipate the heat and acts as an electrical insulator.

Answer 17

Quantity= the number of x-ray photons produced Quality- the energy of the x-ray photons, hence their penetrating power Intensity- the amount of x radiation per unit area. The intensity is determined both by the number of photons and the energy of each photon

Answer 18

The electrical current of the cathode circuit. This is an adjustable parameter that the x-ray machine operate can control, known as the Milliamperage (mA) setting. Increasing mA increases the number of electrons within the electron cloud

Answer 19

Increasing milliamperage (mA) increases the number of electrons within the electron cloud

Answer 20

\* In order to accelerate the electron cloud toward the anode and produce x-rays, a potential difference or kilovoltage (kV) is applied between the anode and the cathode. The highter the kV, the greater the acceleration and thus the greater the energy of the electrons-- the greater the energy of electrons-- the greater the resultant x-rays which EQUALS HIGHER QUALITY X-rays \*\* kVp- kilovoltage peak- the maximum voltage available at the kV setting and is an adjustable paramter that the x-ray machine operator can control

Answer 21

\* The potential difference between the anode and cathode is only applied for a very short period of time (milliseconds)-- the exposure time is an adjustable parameter that the x-ray operator can control. A long exposure time allows may electrons to impact with the anode, while a short exposure time allows fewer electrons to impact with the anode

Answer 22

both the mA setting and the time setting (s) \*\* mA determines the number of electrons produced, while time determines the number of electrons that hit the anode \*\* some x-ray machines allow the operator to select the mA and s independently \*\* kVp setting determines the energy of the electrons and therefore the energy of the resultant x-rays and thus the quality or penetrating power of the x-rays

Answer 23

Intensity = quality and quantity of x-ray photons \* this is so that enough x-ray photons penetrate the patient and interact with the x-ray detector to form the image \* The x-ray operator achieves this by manipulating the kVp, mA, and second settings on the machine to be appropriate for the anatomic area that is being radiographed

Answer 24

The area of the target with which the electrons collide... the size of the focal spot influences the detail (edge definition) of the image and also affects the heat loading capacity of the machine. e.g. a stationary anode is limited to having a larger focal spot in order to accomodate higher temperatures. The focal spot of a rotating anode can be smaller due to the larger surface area over which electrons impact the target and superior ability of a rotating anode to dissipate heat. Common focal spot sizes in veterinary medicine are 1-2 mm^2

Answer 25

The device to limit the size and shape of the primary x-ray beam \* To minimize scattered radiation, the primary beam should be confined to a size and shape that will just cover the region of diagnostic interest

Answer 26

Less scatter radiation is produced which improves image contrast and image quality and radiation safety...

Answer 27

\* Converting the AC into a direct current (DC) without losing any electricity-- full wave rectification creates a nearly constant electrical potential across the x-ray tube as both halves of the alternative voltage are used to produce x-rays \* A consideratlbe portion of the exposure time is still lost however while the voltage is in the valley between the two pulses

Answer 28

Present in most modern machines- produce an almost constant electrical potential difference between the anode and the cathode, which results in: 1. More power available to the x-ray tube per unit time and therefore for shorter exposure 2. Intensity of the x radiation generated is higher 3. Radiation quality is greater because it contains less low energy x-rays 4. Tube utilisation is more efficient because the target is not subjected to bombardment of low energy electrons, which only create heat \*\* main disadvantage is the increased cost of the machine relative to more simply rectification machines

Answer 29

\* The control panel- allows the operator to select appropriate setting for the voltage (kVp), tube current (mA), and the time of exposure (sec) \* The transformer assemby- step up or step down transformers to increase or decrease the voltage as required (which is needed to boil electrons from the filament and to accelerate these electrons from the cathode to the anode) \* The rectification circuit- incoming mains electricity is alternating current (AC), when x-ray exposure is made and a potential difference is applied across the x-ray tube, direct current (DC) is required. Most efficient systems produce constant positive lectrical potential, cheaper units the DC is more variable and only reaches peak voltage (kVp) for a small proportion of the time

Answer 30

\* Preparation- press and hold the button on the hand piece half way down; the cathode is heated by the cathode current and the anode starts rotating \* Exposure- when the system is ready, the operator fully depresses the button; this causes the potential voltage to occur for the set exposure time

Answer 31

Each x-ray machine has a tube rating expressed in kilowatts-- the tube rating dictates themaximum combinations of kVp, mA and time that can be safely used without over-loading the tube Based on: 1. Focal spot size 2. Target angle 3. Anode speed 4. Electrical current

Answer 32

Differences in attenuation between different components of the object to be radiographed. Attenuation is the proportion of x-rays that are stopped/ absorbed by a given thickness of matter

Answer 33

1. Transmission- the x-ray photon passes straight through 2. Photoelectric effect- x-ray photons can be absorbed 3. Compton effect- x-ray photons can be scattered \*\* Which one of these interactions predominates is determined by: - energy of the x-ray beam (kVp) - atomic number of the absorber. Remember more interactions occur with matter that has a high atomic number - thickness and density of the part being radiographed. It makes sense that thicker or denser objects will stop more x-rays.

Answer 34

PE results in complete absorption of an x-ray photn by an atom and the ejection of an orbital electron, which produces a positive ion. Largely responsible for radiographic contrast. The main way x-rays are attenuated at 40-120 kV. The primary interaction between x-rays and bone. \*\* Probability of the PE depends on: 1. Energy of the x-ray photon (must be above threshold kV) 2. Atomic number of the absorber (elements with a higher atomic number are more likely to have PE absorption)

Answer 35

In low energy x-rays (50 to 70 kVp) \* high Z material (more in iodine, barium and lead than in oxygen, carbon or hydrogen) \*\* PE explains why better contrast is achieved with low kVp and why iodine and barium (used in radiographic contrast studies) stop more x-rays than organic matter \*\* soft tissue is made up of hydrogen, carbon, nitrogen, and oxygen-- avg atomic number of 7.. vs. bone which is mostly calcium (atomic number 20)

Answer 36

Decrease the kVp setting

Answer 37

Atomic number is Z82-- materials made from elements with a high atomic number are good absorbers of x-rays

Answer 38

Part of a cassette. An important characteristic of intensifying screens. Faster screens requires less radiation (lower mAs, usually achieved with shorter exposure time)-- at the expense of detail however.

Answer 39

Responsible for almost all the scatter radiation produced in diagnostic radiology No useful function in diagnostic radiation because 1. Scattered radiation poses a safety threat 2. Decreases contrast of the radiographic images (e.g. the difference between black and white on the radiograph is less obvious) \*\* Likelihood of the compton effect 1. Very dense absorbers are more likely to produce compton scatter 2. large volumes of irradiated tissue are more likely to produce compton scatter-- thick body aprts e.g. fat dog abdomen, horse back or shoulder; or poorly collimated image will produce more scatter 3. High kVp settings thuse higher energy x-ray photons are more likely to produce compton scatter

Answer 40

Use a grid They should always be used when the patient thickness is greater than 10 cm because more scatter is produced in thicker body parts Placed between the patient and the detector- so under the patient or under the table between the patient and the cassette

Answer 41

Sigmoidal \* Ideally, most of the radiographic image should be exposed in the linear portion of the curve. If the film is exposed at the shoulder or toe of the sigmoidal curve, the image will appear overexposed (too dark) or under exposed (too light) respectively

Answer 42

\* x-ray film consists of a polyester base coated on both sides with a gelatin emulsion containing silver halide crystals. When visible light or x-rays interact with silver halide crystals- an invisible image is formed then processed to be made visible-- by exposing the silver halide to an x-ray photon or light photon which activates the crystals which precipitate silver... which aggregates producing darkenened areas \*\* Most commonly used x-ray films are double emulsion- having emulsion on both sides of the base (single emulsion can be used with pocket pets)

Answer 43

Cassettes are used in traditional film-screen and computed radiology (can be reusable) \* rigid lightproof containers that hold both the intensifying screens and the radiographic film. Double emulsion film is used in cassettes with two screenes which therefore results in two images on either side of the film

Answer 44

\* Intensifying screens in a cassette convert x-ray photon energy into light photons, which expose the x-ray film. The use of film with intensifying screens (film-screen) is a more efficient detection system than x-ray film alone and allows a reduction in radiation exposure up to 100 times. \* X-ray films are only sensitive to one colour of light and different screen types give off different colours

Answer 45

Measure of the blackness of film-- primarily controlled by mAs

Answer 46

Term used to describe how sensitive the film is to x-ray or light photons. Film that has a high speed rating is very sensitive to photons, an adequate optical density can be achieved with lower radiation exposure. The trade off for fast fil is that it has slightly lower detail/ spatial resolution compared to slower film.

Answer 47

Exposure range over which acceptable optical densities are produced. Film with a wide latitude will accept a significant variation in exposure factors or processing without exhibiting any great chance in optical film density. Most x-ray film has WIDE LATITUDE making it relatively easy to avoid under or over exposure... narrow latitude film or high contrast film is less forgiving with exposure factors-- FILM LATITUDE VARIES INVERSELY with FILM CONTRAST

Answer 48

Slow speed 100 to 200- higher in detail, small body part, very little movement so longer exposure times okay to use

Answer 49

Fast speed- 400 to 600 speed

Answer 50

400 speed- fast system. Move a lot so short exposure time

Answer 51

1. The Developer- chemical solution that converts the latent image on the film to a visible image by reducing exposed silver halide crystals to black metallic silver. \*\* Time and temperature dependent (chemical reaction occurs at a greater rate at higher temperatures)-- usually at 20C about 3 minutes to develop 2. The rings- x-ray film retains developer in the gelatin and if this were transferred to a fixer the alkaline developer would neutralize the acid fixer-- so rinsing stops the developing processes and prevents carry over the fixer 3. The Fixer- removes unexposed silver halide crystals. Fixation also hardens the gelatin coating so that it can be dried without damaging the film surface. Fixed fro twice the development time to ensure maximum hardening of the emulsion. An incompletely fixed film takes on a milky or cloudy appearance. 4. Wash Bath- removes the remaining silver complexes and excess fixer. (20-30 minutes) 5. Dry the film. Hanging.

Answer 52

Image can have good contrast or good latitude but not both \* And once the film has been exposed to the x-rays, the contrast and latitude can't be adjusted

Answer 53

1. Image acquisition- x-ray photons strike a reusable storage phosphor imaging plate (IP)-- placed in a plate reader where it is scanned by a laster beam which releases the stored latent image as visible light. Then the IP plate is erased for reuse by scanning the plate with an intense white light 2. Image processing- using algorithms the computer evaluates and manipulates the digital data 3. Image display- the user can then apply post processing techniques such as edge enhancement, magnification, adjustment of contrast range and dynamic range

Answer 54

\* Direct systems use an electronic detector made of amorphous silicon or selenium or a charged couple device to capture the image. The detector is attached to the computer system via a cable. The signal is transmitted to the computer and reassembled into a digital image.

Answer 55

Due to the wider latitude, the number of retakes due to poor exposure are reduced BUT although digital image contrast can be manipulated by viewing software, subject contrast is still influenced by collimation, scatter and kVp settings

Answer 56

An underexposed digital image will have a grainy appearance Quantum mottle is caused by the discrete nature of an x-ray photon; underexposure results in an insufficient number of x-ray photons reaching the detector to fully form the image \*\*\* think of black paint spots outlining something

Answer 57

Radiographic contrast depends on: 1. Subject contrast- due to attenuation of the x-ray beam in different tissues; low kVp will produce high subject contrast as long as the kVp is high enough to penetrate the tissue (higher kVp = more compton scattering) 2. Film contrast- homogeneity in size of silver halide crystals within the film emulsion, over or under exposure-- technical factors, over or under deveopment will push film contrast to the toe or shoulderof the characteristic curve and produce low contrast image 3. Fog and Scatter- inadvertent exposure of the x-ray film to light High contrast is preferred for bone images; low contrast is preferred for chest and abdominal images

Answer 58

\* Spatial resolution of digital systems is not as good as film-screen systems, but it is not a clinical limitation

Answer 59

1. Creation of a histogram- maps optical density vs. frequency which allows mathematical manipulation of the raw data- histogram is compared to an expected histogram for the anatomic area selected to be radiographed 2. Data adjusted for under or over exposure- histogram shifts left or right to compensate 3. Enhancement of image contrast, using a look up table 4. Edge enhancement or smoothing- complex mathematical function is applied to the raw data to allow processing in the spatial frequency domain-- boundaries such as bone margins can be smoothed or enhanced

Answer 60

Archiving and distribution of digital images

Answer 61

\* Optical density, radiographic contrast (subject contrast, film contrast, fog and scatter, digital image contrast), detail (spatial resolution, edge definition), technical faults

Answer 62

By adjusting mAs (mA or seconds) setting

Answer 63

Too dark over-all due to overexposed (too much radiation reached the film-- likely because mAs setting was too high) or over-developed. \*\* may also occur if film-focal distance is too short \*\* If too dark then reduce mAs +/- increase the film focal distance

Answer 64

\* check kVp settings-- have to be high enough to produce x-rays that will penetrate the patient \* most common cause of under- exposure is too low mAs setting... therefore increase the mAs and maybe increase the kVp

Answer 65

Helps us determine the best x-ray machine settings (kVp, mA, seconds) \* technique charts are specific to the x-ray machine, film-screen speed, film to focal distance, whether a grid is used \*\* measure the thickness of the area you intend to radiograph and read off the technique chart what the ideal kVp and mAs setting should be

Answer 66

1. Thickness of the absorber 2. The density 3. Atomic number 4. Energy of the radiation

Answer 67

\* Reduce production of scatter by 1. Selecting lower kVP (still has to be high enugh to penetrate the patient) 2. restricting the collimator field to only the area of interest \* Reduce impact of scatter on the x-ray image - using a grid when you radiograph body parts thicker than 10 cm - having a small air gap between the patient and the cassette 3. Reduce scatter radiation dose to the operator - PPE - distance

Answer 68

The image processing algorithm and windowing of the image by viewing software (still impacted by subject contrast and scatter radiation)

Answer 69

Spatial resolution and edge definition

Answer 70

\* determined by the x-ray detector-- ability to distinguish between two adjacent contrasting objects \*\* gilm- screen has better spatial resolution than digital... but advantages of edge-enhancement, superior latitude and ability to zoom images outweighs the disadvantage of lower spatial resolution \*\* Spatial resolution of film-screen is determined by the size of the halide crystals of the film emulsion and the size of the phosphor crystals of the intensifying screen \*\* Spatial resolution of digital radiography is determined by the size of the detector elements and size of the pixel matrix used to store the image

Answer 71

Edge definition geometric factors that determine: 1. Focal spot size (small focal spot produces a shart image, think of hand and iphone) 2. Focal spot to film distance (as large as possible is important to improve image sharpness and reduce magnification) 3. Object to film distance (close to the film as possible to improve image sharpness and reduce magnification)

Answer 72

Motion of the patient or cassette \* Minimized by shortening exposure time, sedation and anaesthesia \*\* Cassette motion a problem in equine radiography where cassettes may be positioned by a cassette holder \* blurry images can also be caused by geometric factors taht increase the penumbra

Answer 73

Unequal magnification of different parts of the same object

Answer 74

\* object being radiographed must also be parallel to the film

Answer 75

1. Transmission into deeper tissues 2. Refraction (bending) of sound as it passes from a tissue of one density to a tissue of a different density 3. Attenuation of sound, which is a reduction in amplitude or intensity of the pressure wave

Answer 76

Since the x-ray beam is divergent the periphery of radiographic images have different projections-- e.g. spine radiographs

Answer 77

\* Sound reflection or transmission characteristics of a tissue, largely dependent on the density of the tissue and speed of sound within the tissue. Because we assume constant speed of sound in soft tissue, density is the most important component in this equation \*\* It is not exact value of acoustic impedence that matters but the difference in acoustic impedence between two tissues \*\* At boundaries between soft tissue and boen or soft tissue and air there are large differences in acoustic impedance resulting in little sound transmission and the image is displayed as a shadow-- THIS IS WHY WE CLIP ANIMALS FUR, clean the skin and apply coupling gel-- this removes air between the skin and transducer

Answer 78

\* converts electrical energy to acoustic energy and acoustic energy to electrical signals \* consist of piezoelectric crystals aligned within the footprint of the transducer and when a voltage is applied the crytal vibrates and produces a sound-- each one has a unique frequency at which is vibrates and will produce sound of an inherent frequency. The tranducer transmits sound pulses for 1% of the time and listens for returning echoes 99% of the time. \*\* The operator can select the main frequency band that is used for imaging, selecting higher frequencies for imaging superficial structures and lower frequencies for deeper

Answer 79

\* Structure or feature not normally present in an image, but visible as a result of an external agent or action-- fake out e. g. film screen dark marks caused by pressure on the film or white marks-- dust or hair int eh cassette which prevents light from the intensifying screen from reaching the film e. g. grid cut off appears as light areas caused by misalignment or inappropriate placement of a focussed grid e. g. milk/ opaque image- typically a problem with manual processing- incomplete fixation leaving behind silver halide crystals OR brown image-- incomplete washing leaving fixer behind which oxidises over time OR linear roller marks with automatic processors with dirty rollers e. g. digital artefacts- grainy image = underexposure; double image- double exposure with both images displayed due to wide latitude radiography; moire artefact- bands or lines from ; white lines on a CR image- dirty plate readers; misapplication of the algorithm- poor collimation and beam centering can result in mis-application of the algorithm and poor image contrast resolution; uberschwinger- excessive edge enhancement appears as a thin black rim around high denisty object such as bone margins or metal implants and may mimic bone lysis

Answer 80

Dependent on the spatial pulse length

Answer 81

Work by having different physical density and atomic number hence different radiogrpahic density than normal patient tissue. \* Positive and negative contrast agents

Answer 82

\* Negative contrast agents are gaseous and do not effectively absorb x-rays so appear radiolucent (dark) \*\* room air, carbon dioxide, nitrous oxide \*\* used to inflate organs e.g. GIT- pneumogastrogram or pneumocolon, or urinary tract- pneumocystogram \*\* Risk of fatal air embolism if any gas leaks into the vascular space e.g. damaged mucosa from necrotising haemorrhageic cystitis-- to minimize risk of death from air embolism when performing pneumocystogram place patient in left lateral recumbency and use CO2 or NO which are more soluble than room air (would be reabsorbed in the right ventricle otherwise could become trapped in pulmonary artery or travel and occlude pulmonary circulation)

Answer 83

\* Positive contrast agents have a higher atomic number than soft tissue, thus are an efficient absorber of x-rays and appear more radiopaque \* iodine- Z= 53; barium Z= 56 \*\* Barium used in the GIT-- irritant so not IV-- excreted by the GIT \*\* Iodinated contrast agents are ionic or non-ionic. Ionic agents are markedly hyperosmolar relative to blood so are associated with adverse reactions such as hypotension, nephrotoxicity and thrombosis-- excreted by the kidneys, biliary tract, GIT, saliva \*\* All iodinated agents can trigger allergic reactions \* Iodinated agents-- angiography (IV), cytography (urinary tract), myleography (spinal cord) \*\* Myelography should only be performed with non-ionic!!

Answer 84

\* Dorsoventral OR ventrodorsal radiograph of the body- head at the top and the patient's right on the viewers left side \* Lateral radiograph- animal standing with the head to the viewers left and dorsal (for the body) or proximal (for the limbs) to the top of the screen \* Craniocaudal or dorsopalmar/ dorsoplantar- proximal is to the top and the lateral aspect displayed to the viewers left (no matter whether you are looking at the left or right limb)

Answer 85

\* internal structure of organs- size, shape, margins \* dynamic evaluation of blood flow-- which can provide some information on organ function e.g. echocardiography where blood flow and changes to the heart size over the cardiac cycle can be measured \* more sensitive at detecting pathology, low specificity for identifying a specific disease \* GIT e.g. heptobiliary disease, pancreatitis, vascular anamolies such as portosystemic shunts

Answer 86

\* Hair coat clipped, skin cleaned and alcohol applied to defat the skin, ultrasound gel applied to provide good acoustic coupling (transmission of sound) to reduce artefact and allow the ultrasound probe to slide over the skin

Answer 87

Sedation will affect cardiac function, so preferably an unsedated animal

Answer 88

\* Abdominal- animals should be fasted \* musculoskeletal ultrasound- may benefit from using a stand off pad since structures are superficial and often hard

Answer 89

The operator can choose what part of the scale to assign the central colour gray

Answer 90

Simultaenous use of real time B mode imaging and spectral doppler.

Answer 91

\* Sound is a pressure wave with properties of wavelength, frequency, velocity and amplitude \* For a given velocity, wavelength and frequency are inversely related e.g. high frequency = short wavelength. \* ultrasound has frequencies between 2 and 20 MHz \* Ultrasound assume constant speed of sound at 1540 m/sec (which is the average speed of sound in soft tissues)

Answer 92

\* Sound attenuation depends on the distance travelled and teh frequency of sound \* High frequency tranducer for superficial \* low frequency to image deeper structures

Answer 93

Physical law that governs the pressure drop in a gluid flowing through a long cylindical pipe. Clinically you can think about how it governs the pressure needed to push a volumetric rate of fluids e.g. in ml/hr through your tube (catheter) \*\* both length and radius have an effect on catheter flow but the radius effect is much greater than length. Double the length, you double the pressure it takes to get fluid through at the same rate.... Catheters have a high resistance to flow. 18 gauge are the biggest we use in peripheral veins.

Answer 94

\* consider frequency of the transducer and the footprint or shape of the field of view of the transducer

Answer 95

Imagine with a high frequency transducer and imaging within the focal zone

Answer 96

Low dynamic range settings are used for echocardiography \* High dynamic range for abdominal ultrasonography \* You will have the best perception of contrast resolution when imaging with a low gain setting in a darkened room

Answer 97

Allows imaging of the distribution of radiopharmaceuticals within the body using a gamma camera. It allows imaging of both structure and function

Answer 98

Technetium- as it decays, the nucleus is converted to a more stable state by emitting gamma radiation which is detected by a gamma camera. It has a half life of 6 hours-- long enough for most imaging procedures to take place but short enoug hthat the radioactivity of the patient rapidly decays, typically reaching background levels within 24 hours... thus minimizing radiation dosage to the patient, staff and owners

Answer 99

\* Static mode- provides anatomic information about the distribution of the radiopharmaceutical at one point in time, allowing determination of organ size, shape, position and pattern of distribution that may be specific for a disease state e.g. bone scintigraphy-- shows areas of active bone turnover as seen with physes, stress fractures, infection or bone neoplasia \*\* dynamic mode provides functional information allowing measurement of rate of accumulation or removal or the radiopharmaceutical within an organ-- example is portal scintigraphy where a series of images is acquired over a four minute period allowing mapping of the passage of pertechnetate through the portal circulation, liver and heart

Answer 100

Appear more radiopaque-- higher atomic number

Answer 101

Technetium methylene diphosphonate (MDP)- taken up by areas of active bone turnover \*\* bone scintigraphy is much more sensitive than radiography at detecting bone lesions but is relatively non-specific

Answer 102

Technetium pertechnetate-- trapped and concentrated by thyroid follicular cells, mimicking biological behavior of iodide \*\* useful to evaluate hyperthyroidism-- determines whether cervical masses are thyroidal or non-thyroidal in origin... differentiates between bilateral and unilateral disease, detection of ectopic thyroid tissue, and functional metastic lesions

Answer 103

Sensitive and specific for diagnosis of portosystemic shunts-- even quantification of the severity of the shunt-- Technetium is administered into either the colon or into the spleen where it is taken up by portal circulation

Answer 104

Cross sectonal imaging modality based on x-rays. It gives excellent contrast resolution compared with conventional radiography. Produces high detailed cross sectional images with no superimposition of overlying structures. \*\* Helical scanners are the preferred type of machine-- newer helical CT scanners have multiple rows of detector arrays-- multi-slice CT scanners have very rapid acquisition times

Answer 105

\* Superimposition of structures in radiography prevents identification of lesions \* Improved soft tissue contrast is required \* lesions are suspected but not demonstrated with conventional modalities such as radiology or ultrasound \*\* e.g. brain and spinal imaging (MRI is best however but CT is more sensitive than MRI at detecting early brain haemorrhage with trauma), nasal disease to avoid superimposition, Tympanic bulla (changes seen with otitis media for example), musculoskeletal imagine (bone loss, complex trauma e.g. pelvic fractures provides 3D reconstructions), thoracic imaging (pulmonary metastases), abdominal imaging, foreign bodies and draining sinuses (localisation of abscesses and foreign bodies)

Answer 106

Excretory urography- to look for ectopic ureters and tumors and to evaluate kidney function

Answer 107

Urethrocystogram

Answer 108

\* imaging of hydrogen atoms throughout the body-- measures how hydrogen atoms are influenced by radiofrequency pulses \* Most common source is water \* MR images are based on the distribution of water and the interaction of water with its surrounding molecules \* MRI exploits the property of hydrogen as a magnetic dipole-- the rotating positive charge of the hydrogen atom induces a magnetic field-- thus hydrogen atoms have a magnetic moment (direction and strength of their magnetic field)-- with a strong magnetic field-- the magnetic moments of the hydrogen atoms align with the external magnetic field

Answer 109

\* superior contrast resolution-- for soft tissue especially neural or musculoskeletal tissue... sensitive to the detection of early lesions \*\* takes a long time so susceptible to motion artifact from respiration or peristalsis \*\* most pathologies involve increased water content (tumours, inflammation, oedema, infection) and MRI is highly sensitive at detecting most diseases

Answer 110

ischemia, inflamm, distension, traction-- FB obstruction, pancreatitis, obstructive neoplasm, biliary obstruction, etc.

Answer 111

\* Rehydration in response to e.g. interstitial dehydration due to increased losses from vomiting and diarrhoea, coinciding with reduced intake (inappetance) \* Maintenance-- e.g. if he doesn't eat/drink

Answer 112

TBW = 60% of 25 kg = 15 L ICF = 40% of 25 kg = 10 L ECF intravascular = 1.25 L ECF interstitial = 3.75 L \*\* If PCV if 50%-- the other 50% is water (plasma). The IV volume of water (plasma) is 1.25 L, so that means that PCV is also 1.25 L... therefore a total blood volume of 2.5 L (2.5 L, 10% of body weight)-- clinically important in resuscitative fluid therapy where one sequentially boluses portions of blood volume at a time until targeted resuscitation goals are met.

Answer 113

\* Isotonic: LRS (Hartmann's) or 0.9% NaCl because he is not acidemic already \* Amount: - deficit = 25 kg \* 0.5 \* 1000 = 1250 mL, 52 ml/ hr + maintenance... maintenance= ((25\*30) + 70)/24= 34 ml/hr. 86.2 ml/hr + ongoing losses... 28 ml/hr on going losses?? 114 ml/hr

Answer 114

\* Stress response, catecholamine/ cortisol release

Answer 115

\*\* water would shift into the IV compartment from both the interstitial and intracellular compartments-- then as normal serum sodium concentration is re-established the balance between the ICF and ECF will normalize

Answer 116

290- 310 mOsm/l in dogs; 300-310 in cats \* Serum osmolality = 2 (Na+K)+ glucose+ urea (in mmol/L)

Answer 117

Spectral doppler

Answer 118

Phased array

Answer 119

\* Final osmolality is the sum of the number of mmols solutes present in the bag. Irrespective of their size or charge, it is the simple sum

Answer 120

\* LRS is balanced as it contains an electrolyte composition similar to serum \* 5% dextrose in water, 0.9% NaCl, 0.45% with 2.5% dextrose all non-balanced

Answer 121

Goal is 2.5% dextrose in 1000 mL. \* to convert any percentage to mg/ml just add a zero... so 2.5% solution is 25 mg/ml \* If you want a 2.5% solution, you need 25 mg/ml and since there are only 1000 ml in the bag of LRS, you would need 25,000 mg dextrose in 1 L total solution. Since 50% dextrose - 500 mg/mL, you would add 50 mL dextrose to your bag of LRS after removing 50 ml of the LRS \*\* The osmolality of 50% dextrose is 2780 mOsm/L, so 2.78 mOsm/ml... since you are starting with a bag of Hartmann's which has 272 mOsm in it, and you took out 50 mls, you are left with a bag of 245 mOsm in it (272-(50\*0.272))= 253 mOsm. Then you will add back in 139 mOsm from the dextrose (2.78 mOsm/ml x 50 ml = 139 mOsm), so 258 + 139 - 397 mOsm

Answer 122

Need, safety for the animal, other options that do not involve radiation

Answer 123

DNA damage

Answer 124

Examples: sandbags, radioluscent pads, cassette holders, positioning troughs, other- compression bands

Answer 125

must have a user license

Answer 126

Ionizing electromagnetic radiation

Answer 127

20 mSv per annum over a period of 5 years

Answer 128

Time (as few x-rays as possible), distance, and shielding

Answer 129

Number of shades of gray in an image \* Subject contrast- different tissues absorb a different amount of rays

Answer 130

Something that is not real, NOT a microchip

Answer 131

\* select the smaller focal spot when possible (as the focal spot becomes larger the penumbra is increased because blurring of the edges) \* Keep FFD as large as possible (about 100 cm)-- focal spot to film distance (closer the x-ray tube is to the film, the greater the image magnification and greater the penumbra)- improve image sharpness and reduces magnification \* keep the OFD as small as possible (object to film distance)-- improves image sharpness and reduces magnification

Answer 132

\* Positive contrast agents: barium and iodinated contrast agents \* Helium is NOT a negative contrast agent

Answer 133

High Atomic number is an efficient absorber of photons

Answer 134

\* Barium is mainly excreted through faeces \* Iodinated contrast agents are mainly excreted through urine

Answer 135

Ionic agents have high osmolality which have adverse reactions-- nauseau and vomiting. \* The iodinated anion is really the only part of the molecule that is important for radiographic purposes, both the anion and cation are osmotically active and when they dissociate in solution, tend to thave osmolalities double that of equivalent non-dissociating non-ionic compounds

Answer 136

Iodinated- non-ionic agents reduce the incidence of contrast media induce nephrotoxicity (CMN) in excretory urograms

Answer 137

Non-ionic iodinated-- seizures, hyperthermia, prolonged recovery from anaesthesia, and intensification of pre-existing neural signs are postmyelographic effects commonly reported in dogs. Neurotoxicity of contrast media as well can occur-- direct chemotoxic effects on neural tissue and their hyperosmolality

Answer 138

Excretory urogram

Answer 139

Ultrasound

Answer 140

Non-ionic iodinated

Answer 141

Air emboli

Answer 142

Renal failure

Answer 143

Osmolality

Answer 144

Biochemistry and urinalysis

Answer 145

C. The wavelength of sound is inversely proportional to the frequency

Answer 146

\* High frequency transducer, imaging within the focal zone

Answer 147

Irregular surfaces and different tissue interfaces (NOT frequency and distance travelled-- they are not physical properties)

Answer 148

Low frequency

Answer 149

Better sound transmission so it can glide

Answer 150

Amplitude of each returning echo, low intensity echoes are black and high intensity echoes are white

Answer 151

Femoral head/neck exostoses - may be a thin line of enthesophytes on the caudal aspect of the femoral head (Morgan line or “caudolateral curvilinear osteophyte”…even though it’s really an enthesophyte)

Answer 152

T11-12, T12-13, T13-L1 and L1-L2. The intercapital ligament prevents extrusion of the nucleus pulposus in the cranial and midthoracic IVDs.

Answer 153

anisokaryosis within the one cell Spindle appearance-- meschenchymal cells seen individually and in small bundles \* Spindyloid with pale round to oval nuclei with some binucleation \* Soft tissue sarcoma- locally aggressive but rarely metastasize, concerned it may be more aggressive. Histopathology is required for grading

Answer 154

1. Why has the WBC been corrected? Due to the presence of NRBC using the formula: Corrected WBC= (WBCx100)/ (100+NRBC) 2. Is the analyser differential count accurate? NO. Bands are included with normal nuetrophils, high monocytes 3. Morphological abn? Leukocytes- left shift and toxic change. Occasional activated lymphocytes (after they bind to an antigen-- they are activated). Erythrocytes- agglutination, spherocytosis, anisocytosis, macrocytosis, polychromasia. 4. Error flag for PLT count? Clumping 5. Characterise the anaemia? Moderate macrocytic hypochromic anaemia that is markedly regenerative. 6. Macrocopic agglutination in blood tube 7. Most likely cause of haematology abn? IMHA would account for the regenerative anaemia with normal protein, spherocytosis and agglutination. The metarubricytosis is likely secondary to the regenerative response. 8. ALP- sources of ALP include hepatocytes and biliary epithelial cells, bone, gut, placenta, and corticosteroid induction in dogs. The elevation in this case could reflect mild cholestasis or corticosteroid induction (endogenous or exogenous). IMHA tests-- : CBC, Biochemistry, Blood Gases, PCV/TP, Blood Smear, Saline auto-agglutination, (Direct Coomb’s test), Blood Pressure, Coagulation profile, urinalysis (haemoglobinuria- intravascular haemolysis OR bilirubinuria), May be second line, though highly suspicious: infectious titers/ PCR testing: Idexx panel– tick/vector canine comprehensive Real PCR panel (Anaplasmosis, Babesia, Mycoplasma - depends on your area), (ELISA for heartworm antigen- depends on where you are) \*\* Essential to look for underlying disease process in order to correct or to R/O if primary IMHA --Coomb’s test- agglutination of RBCs after the addition of an antibody mixture to the patient’s blood. Antibodies in the mixture will bind to Ig or Complement proteins as they are bound to the RBCs. Serial dilutions of the antibody mixture are added to the patient’s blood to quantify the degree of agglutination. False positives and false negatives may be frequently observed if post transfusion or other disease process.

Answer 155

Morphological abnormalities acquired during maturation under conditions that intensely stimulate neutrophilc production and shorten the maturation time in the boen marrow. This accelerated maturation occurs secondary to cytokine stimulation, which is usually in reponse to inflammation. Animals recovering from bone marrow injury or who are administered hematopoietic cytokines (e.g. granulocyte-colony stimulating factor or G-CSF) can also show accelerated maturation in neutrophils or toxic change. On the standard hemogram, the presence of toxic change is reported under the WBC exam section and is subjectively graded as mild, moderate and marked. Most of the toxic changes reflect asynchrony of maturation between the nucleus and cytoplasm.

Answer 156

EDTA \* Routine haematology in mammals \* Routine fluid cytology \* Endogenous ACTH, Cyclosporin, PCR tests, genetic tests, Catecholamines, Lead \* NOT suitable for most biochemistry assays \* NOT suitable for culture \* Na/K EDTA irreversibly chelates calcium preventing clotting

Answer 157

Heparin \* Routine biochemistry \* Ammonia \* Routine haematology and biochemistry in avians and reptiles \* NOT suitable for most serology \*\* Sodium heparin inhibits clotting through activation of antithrombin III

Answer 158

Serum \* Routine biochemistry \* Drugs (gel tubes may be unsuitable) \* Serology \* Hormones \* Protein electrophoresis \* Sterile plain tubes for fluid culture and cytology (NOT SST or gel tubes) \*\* Gel aids separation from cells from serum

Answer 159

Fluoride Oxalate \* Glucose \* L-lactate \* Not suitable for routine biochemistry or haematology \*\* Sodium Fluoride/ Potassium Oxalate-- stops erythrocyte utilisation of plasma glucose. Binds calcium to prevent coagulation.

Answer 160

Citrate \* Coagulation testing e.g. PT, APTT, Fibrinogen, FVIII, FIX, VWF \* Haematology (need to correct for dilution) \* Blood products \*\* Sodium citrate inhibits coagulation through binding of calcium, must be filled with correct blood volume

Answer 161

1. Scattergram- broad monocyte cloud which is merging with the eosinophil cloud. Slight merging of the neutrophil and lymphocyte clouds. Suggest the differential list is likely to be inaccurate. 2. May be large round cells with variable numbers of deeply purple large cytoplasmic granules. Mast cells. Due to merging of eosinophil cloud may also be counting the eosinophils as monocytes. 3. No-- abn-- band neutrophils, eosinophils, mast cells, basophils 4. Leukocytes- left shift and mild toxic change. Occasional neutrophils containing purple cytoplasmic granules (likely phagocytosed mast cell granules). Rare activated lymphocyte. Erythrocytes- rouleaux, mild anisocytosis. 6. Hypocalcaemia likely to reflect hypoalbuminaemia (reduced protein bound fraction). Can further assess my measuring ionized Calcium. hypoalbuminaemia could reflect GI loss, renal loss, or reduced synthesis due to inflammation (negative acute phase inflammation) 7. Tests to further workup-- Abdo U/S to further assess liver and spleen, and FNA/biopsy of any suspect lesion. Check for cutaneous masses and GIT bleeding (GIT ulceration can occur secondary to MCTs due to histamine release). Ionized calcium. 8. Most likely visceral or disseminated MCT (splenic or multiple organs) if no cutaneous massess present-- depression, anorexia, weight loss, vomiting. More commonn in cats compared to dogs.

Answer 162

6 yo female neutered Beagle with shifting lameness. You notice she has swollen carpi and hocks. The dog also has a mild fever and a grade 2/6 heart murmur. 1. Primary DDX 2. What tests would you consider and what samples should be collected for these tests? 1. Immune mediated polyarthritis- inflammatory, erosive (Grey Hounds, Mycoplasma?), Rheumatoid or non-erosive (idiopathic, diag. of exclusion, secondary to remote infection, GI disease, Neoplasia (type 4, rare), SLE (body attacks nucleated cells, why it is diffuse), drugs- sulfonamide), Breed related-- secondary to renal failure and amyloidosis.... may be accompanied by glomerulonephritis, anaemia, thrombocytopaenia, leukopaenia, retinitis, myositis, aseptic meningitis. Another DDX- Coagulopathy (heart murmur). Multiple Myeloma. 2. Arthocentesis- Markedly elevated cell count (4-350 x 10^9/L, mostly neutrophils)-- submit for culture, negative result does not rule out septic arthritis (Mycoplasma), FOUR JOINTS. Infectious arthritis v. autoimmune. Joint fluid is really hard to grow bacteria. (joint tap—plain, serum, EDTA—not EDTA for culture—one drop—smear—then swab into jelly material—discuss with a pathologist on how to best use) \* Antibody- Anti ANAs- plain tube. Serum testing. \* Synovial biopsy especially if difficulty obtaining joint fluid \* Blood culture- expensive bottles and expire—surgical prep (under GA). Send away for culture. 2-3 samples. Good for multiple resistant infections if you’ve tried multiple antibiotics with no luck. \* Radiography of joints-- mineralisation of periarticular tendons and ligaments-- after several weeks of erosive forms \* Osteosarcoma- FNA (18 G needle, 70-80% of the time diagnostic or Radiographs can help)

Answer 163

1. Neoplasia: Chronic lymphocytic leukaemia can occur in an animal of any age... Thymomas have also been associated with peripheral lymphocytosis. Infectious agents: Ehrlichia canis- granular lymphocytosis in the bloood, not in AUS Endocrine: Hypoadrenocorticism can result in lymphocytosis, but this is usually mild. Physiologic: Excitement can result in lymphocytosis, usually mild and occus more commonly in young animals, cats, and horses. 2. Significant numbers of granular lymphocytes. Describe the morphology. Granular lymphocytes are intermediate lymphocytes with round nuclei of clumped chromatin, occasionally showing with a faint nucleolus and abundant pale cytoplasm, often containing a cluster of fine pink-purple granules. These lymphocytes are not usually foudn in the circulation in such high numbers and are therefore classed as atypical. 4. Eosinopenia... why does the scattergram indicate this is incorrect? Neutrophiil and eosinophil clouds are not well separated. 6. Most likely cause of haematological abnormalities? HIgh number of these cells and their monomorphic morphology strongly supports a granular lymphocyte lymphoic leukaemia or a stage V granular lymphocyte lymphoma. In dogs, cells with this morphology are often of splenic rather than marrow origin. Their size, clumped chromatin and indistinct nucleoli suggests this is more likely to be a chronic lymphocytic leukaemia rather than an acute lymphoic leukaemia. The cytoplasmic granules support either T cell or NK cell origin. 7. What others tests?

Answer 164

1. Is the anaemia regenerative or non-regenerative? Regeneratie-- moderate macrocytic hypochromic anaemia that is mildly regenerative as there is a reticulocytosis and polychromasia is evident on the blood smear. 2. What RBC morphologic changes can you ID on the blood smear? Eccentrocytes (up to 25% of erythrocytes), occasional large Heinz bodies, polychromasia, anisocytosis, macrocytosis, pyknocytes (resemble spherocytes but with a small membrane tag) 3. What is the likely mechanism for the anaemia? Oxidative injury causing haemolytic anaemia. 4. What are the potential causes for this disorder?

Answer 165

1. What is abn about the histogram? Intermediate to large atypical mononuclear cells present. Round nuclei of granular chromatin with 1-3 variably distinct nucleoli and moderate amount of deep basophilic cytoplasm, resembling intermediate to large lymphocytes. Occasional mitotic figures are evident along with frequent basket cells. It is likely that many of these atypical cells are being counted as monocytes and neutrophils based on their large size. 2. What are the potential causes for a marked lymphocytosis? Which is more likely in this case and why? Stage V Lymphoma- most likely given the peripheral lymphadenopathy and magnitude of lymphocytosis \* Lymphoid leukemia- in this case lymphadenopathy suggests LN origin (ie lymphoma) is more likely than bone marrow origin (ie leukemia) \* Myeloid Leukaemia- both myeloid and lymphoid leukaemias can have similar cytomorphology \* Inflammation- not at this magnitude of lymphocytosis \* Physiologic- not at this magnitude of lymphocytosis and unlikely in an adult dog \* Endocrine- hypoadrenocorticism- not at this magnitude of lymphocytosis 3. What are the potential mechanisms for thrombocytopaenia? Which is most likely? Reduced bone marrow production due to myelophthisis- most likely given the marrow is likely heavily infiltrated with the lymphoma Sequestration- seen with splenomegaly and splenic masses DIC- can be a complication of lymphoma IMTP- can be a complication of lymphoma but less likely as they often present with much lower counts and mucosal bleeding (petechiation) 4. Why might Kelly have hepatopathy? Likely reflects infiltration of the liver with neoplastic cells 5. Potential causes for hypoglycaemia? Paraneoplastic syndrome, Storage artefact- utilisation of glucose by erythrocytes and leukocytes, Hypoadrenocorticism, Hepatic disease- other functional parameters are normal so less likely (ie cholesterol, albumin, urea) 6. What are the potential causes of anaemia? Characterise from smear. \* Mild polychromasia and thus anaemia is likely mildly regenerative and hence could reflect: - blood loss e.g. mucosal bleeding secondary to thrombocytopenia- often not seen until PLT count \< 30 x 10^9/L - blood loss- coagulopathy secondary to liver disease (unlikely to be hepatic failure but consider PT/APTT to further assess) - Haemolysis- IMHA can be triggered by lymphoma- no evidence on the smear - Haemolysis- microangiopathic e.g. DIC- no evidence of shear injury on the smear but worthwhile to check PT and APTT and if available D-dimers (fibrin degradation product, a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two D fragments of the fibrin protein joined by a cross link) or FDPs (fibrin degradation product- components of blood produced by clot degeneration) given the thrombocytopenia \*\* Reticulocyte count manual or automated in order to assess if regenerative 7. How would you further assess this case?

Answer 166

1. Evaluate the blood smear. What erythrocyte morphologic abn can you ID? Microcytes, hypochromasia, polychromasia, keratocytes, schistocytes, dacrocytes, rare spherocytes 2. What is RDW-SD and how does this help us evaluate an anaemia? RDW-SD= red cell distribution width std deviation (a measure of erythrocyte anisocytosis). An increase could reflect macrocytosis, microcytosis or both. The low MCV with high RDW-SD and reticulocytosis suggests both microcytosis and macrocytosis are likely in this case. 3. Describe the anaemia. DDX? Moderate microcytic hypochromic regen. anaemia. Marked reticulocytosis-- regenerative. Haemorrhage or haemolysis. The low protein suggests haemorrhage is much more likely. Microcytosis is seen with iron deficiency, or with portosystemic shunts, and can also be normal in some Asiatic breeds eg Akita, Chow Chow, Shiba Inu Given the regen. anaemia is microcytic and there are GIT signs than iron deficiency due to chronic GIT haemorrhage is most likely. The schistocytes, keratocytes, etc. support microvascular damage to erythrocytes which is likely to reflect increased cell fragility due to iron deficiency in this case. 4. Compare the patient RBC/PLT scattergram with the normal dog scattergram. What does Bluey's scattergram suggest? The erythrocytes and reticulocytes have merged with the platelets in the scattergram. The reason the populations have merged is that the microcytosis and presence of macroplatelets has meant that the erythrocytes and platelets are similar in size. 5. What is PDW and MPV? What the increases in these values reflect? PDW= PLT distro width (a measure of platelet anisocytosis) MPV= mean PLT volume IN this case the high PDW and MPV suggest macroplatelets are present 6. What are your DDX for the azotaemia? How could you further evaluate this patient? There is a mild increase in urea only with the creatinine being low normal. This suggests prerenal azotaemia is most likely. Potential causes include dehydration, increased protein breakdown, hypovolaemia. GIT haemorrhage leads to increased protein in the GIT and mimics the effect of a high protein diet. IN this case the GIT bleeding is likely the cause of the high urea. Dehydration is usually associated with increased Hct, increased TP, and increased Na and Cl. In this case Na and Cl are normal. Looking at Hct and TP in this case for evidence of dehydration is problemative as the bleeding is likely making these values low.

Answer 167

1. Eval the leukocyte scattergram for Misty vs. normal cat. There is merging of the lymphocyte and neutrophiilc clouds and thus the differential may be inaccurate. THis is usually due to the presence of immature neutrophils (bands and neutrophils with toxic change which leads to higher fluorescence of these cells). This is confirmed on the smear as there is a significant left shift and toxic change, consistent with a marked inflammatory response. 2. The analyser flagged the PLT results. Eval PLT histogram-- what are the potential causes for the elevation from the baseline? The elevation from baseline indicates overlap of the PLT and RBC histograms. This could reflect the presence of macroplatelets, microcytic erythrocytes or platelet clumping. The MCV is normal, only occasional macroplatelets are evident and small PLT clumps are present in the feathered edge-- the PLT clumping is likely a result of the abn histogram.

Answer 168

6 yo female neutered Beagle with shifting lameness. You notice she has swollen carpi and hocks. The dog also has a mild fever and a grade 2/6 heart murmur. 1. Primary DDX 2. What tests would you consider and what samples should be collected for these tests? 1. Immune mediated polyarthritis- inflammatory, erosive (Grey Hounds, Mycoplasma?), Rheumatoid or non-erosive (idiopathic, diag. of exclusion, secondary to remote infection, GI disease, Neoplasia (type 4, rare), SLE (body attacks nucleated cells, why it is diffuse), drugs- sulfonamide), Breed related-- secondary to renal failure and amyloidosis.... may be accompanied by glomerulonephritis, anaemia, thrombocytopaenia, leukopaenia, retinitis, myositis, aseptic meningitis. Another DDX- Coagulopathy (heart murmur). Multiple Myeloma. 2. Arthocentesis- Markedly elevated cell count (4-350 x 10^9/L, mostly neutrophils)-- submit for culture, negative result does not rule out septic arthritis (Mycoplasma), FOUR JOINTS. Infectious arthritis v. autoimmune. Joint fluid is really hard to grow bacteria. (joint tap—plain, serum, EDTA—not EDTA for culture—one drop—smear—then swab into jelly material—discuss with a pathologist on how to best use) \* Antibody- Anti ANAs- plain tube. Serum testing. \* Synovial biopsy especially if difficulty obtaining joint fluid \* Blood culture- expensive bottles and expire—surgical prep (under GA). Send away for culture. 2-3 samples. Good for multiple resistant infections if you’ve tried multiple antibiotics with no luck. \* Radiography of joints-- mineralisation of periarticular tendons and ligaments-- after several weeks of erosive forms \* Osteosarcoma- FNA (18 G needle, 70-80% of the time diagnostic or Radiographs can help)

Answer 169

1. Questions to ask the owner? 2. Potential causes of malaena? Ulcers in GIT, tumors or oesophagus or stomach, infections, FB in GIT, Disorders involving inflammation of the intestinal system, kidney failure, drug toxicity, diet with raw food 3. Further tests? Low RCC, Low Hb, Low Ht, High Urea, Low PLT (9!), Neutrophiilia, Lymphopaenia, Monocytosis, Reticulocytosis, Low TSS, Low TP \*\* consistent with GI bleed-- stress leukogram. \*\* Ensure not associated with coagulopathy-- Coagulation panel \* Confirm GI bleeding exists \* Is the cause ulcer or numerous erosions that cannot be resected? \* Determine underlying cause? Abdominal radiographs generally do not help diagnose GI ulceration, but they can help exclude GI obstruction, intussusceptions, and peritonitis. Abdominal ultrasonography may show abnormalities in GI wall thickness or presence of a mass, but its primary utility is the identification of non-GI lesions. Endoscopy allows visualization of the esophagus, stomach, duodenum, and colon and identification of mucosal lesions and ulcers. Endoscopy also allows for fine-needle aspirates of lesions or collection of biopsy samples, although full-thickness surgical biopsies may be required to identify infiltrative disease and tumors. Ulcerated areas should be biopsied only on the periphery to avoid perforation. Gastric fluid can be tested for pH to help diagnose hypersecretory states. \*\* Blood smear-- microcytic, hypochromic anaemia (iron deficiency anaemia), takes time to develop so may be normocytic, normochromic. BUN to Creatinine ratio has been reported with GI haemorrhage especially with upper GI haemorrhage... not always the case. \*\* Faecal occult blood test can be performed. False positive can occur due to eating of meat or certain types of bacteria within the GIT. Meat free diet for 72 hours before faecal occult blood test. \*\* ACTH, CBC, biochem, imaging and endoscopy to determine underlying... coag profile may identify rodenticide toxicity or clotting factor deficiencies)

Answer 170

1. Is the mild anaemia regenerative or non-regenerative? What erythrocyte morphologic abnormalities can you ID in the blood smear? The mild normocytic normochromic anaemia is non regenerative as there is no polychromasia/ reticulocytosis. There is metarubricytosis (immature erythrocytes and their release into the blood-- called polychromasia-- due to lead toxicity, phosphofructokinase deficiency, anaemia) and basophilic stippling. 2. What are the potential causes for the increased nRBCs? \* As there is no polychromasia/ reticulocytosis this is not part of the regenerative response thus is termed inappropriate metarubricytosis. Potential causes include lead poisoning, heat stroke/ hyperthermia, splenic disease, sepsis, inflammation, dyserythropoeisis e.g. erythroid leukaemia, myelodysplastic syndrome (a group of cancers in which immature blood cells in the bone marrow do not mature and therefore do not become healthy blood cells). 3. Why has the WBC count been corrected? Analysers utilising impedance counts include the NRBCs as leukocytes. We can correct the WBC count with: Corrected WBC= (WBC x 100)/ (100+NRBC) 4. What further tests?

Answer 171

* D. Clenbuterol (Tocolytic) Beta2 adrenergic receptor agonists- acts on vascular smooth muscle, myometrium, and the bronchial tree * Uterine pushing-under hormonal control * Abdominal pushing- under reflex, skeletal muscles * You must give an epidural and tocolytic if you want to stop-- not common to have to give both-- so the epidural stops her straining. Don't reach for tocolytic too quick because you can use her uterine pushing for her to help after your reposition. * Don't use xylazine- uterotonic- harder to get the uterus up to your surgical site. She may also sit down. (same with Ace, PGF2alpha- uterotonic)

Answer 172

b. ocular menace reflex- takes time to develop (learned response) and can't see the response, dark in there

Answer 173

D. Radial Nerve paralysis- rolling on the front foot, drag their foot and throw their front limb forward with their shoulder-- damage with any short of trauma to the shoulder-- recumbency can damage the radial nerve as well from doing the forelimb splits (damage the brachial plexus)

Answer 174

Sciatic Nerve Can end up with peroneal (upside down P) or tibial nerve damage (upside down T)

Answer 175

* Long acting corticosteroids used to induce parturition impair the secretion of proteins that are critical to normal cellular and hormonal immune responses, an effect that is strongly linked with changes in the composition of the WBCs. The resulting immune suppression is still profound at the time of parturition * Increased incidence of RFMs when induced to calve (long acting produce lower incidence of RFMs compared to short acting corticosteroids or prostaglandins) * Increased incidence of mastitis especially coliform mastitis endotoxaemia, peracute metritis, septicaemia, enteritis * Photosensitivity reaction can occur in the non-pigmented skin and teats of induced cows, in some cases can be severe enough to preclude milking. CS used to induce parturition MAY lead to hepatic damage * Premature calves reduced chances of survival however most studies report that when calving is induced using short acting CS or PGs within two weeks of term, little difference is seen in the number of stillbirths, calf vigour or calf mortality compared with natural calves except when Long acting CS’ have been previously used (gestation 283 days, 9.3 months) * Blood in milk is probably the least likely….

Answer 176

c) Penethamate hydrochloride- APVMA - register drugs in AUS \*\* Care with using intramammary antibiotics as if the milk is gluggy may not penetrate teat canals well-- may need systemic antibiotics even if she is not systemically unwell

Answer 177

a) insufficient fibre in the herd's diet- increases acetate and butyrate- milk production is less but butterfat concentration is higher (vs. higher energy (concentrates) means more proprionate-- more glucose, lactose, more volume)-- milk production will go down but quality goes up-- most farmers are paid on butterfat content (b- insufficient energy in a cows diet-- butterfat and milk concentration will actually go up, c- excessive VFAs (acetate, butyrate, proprionate (further broken down into lactose-- draws water into udder and increases volume of milk, ketones, glucose) fed to the cows-- product of rumen digestion, cows make VFAs, e- inadequate rumen bypass protein in the concentrate ration-- bacteria break down protein and use it themselves but by products of amino acids which is how the cow gets protein, d- excess ionophores in the concentrate ration would kill cattle just like horses)

Answer 178

c) Phenylbutazone- look it up in MIMs

Answer 179

e) Eimeria zuernii Severely affected cattle develop thin, bloody diarrhea that may continue for \>1 wk, or thin feces with streaks or clots of blood, shreds of epithelium, and mucus. They may develop a fever; become anorectic, depressed, and dehydrated; and lose weight. Tenesmus is common because the most severe enteritis is confined to the large intestine, although pathogenic coccidia of cattle can damage the mucosa of the lower small intestine, cecum, and colon.

Answer 180

d) Fibrinogen

Answer 181

a) Plain tube

Answer 182

b) Staph epidermidis

Answer 183

e) Anthrax

Answer 184

d) 6 days-- more than 60 hours

Answer 185

b) Progesterone

Answer 186

e) Pasture bloat

Answer 187

e) Flaccidity of the tail

Answer 188

Bactoscan- up to 200,000 premium milk with bonus 1 cent per litre, \> 400,000 penalized 10%, \>600,000 for more than a couple of weeks 30 cent penalty (depends on the company) \* Thermoduric- 600, OK

Answer 189

3 week submission rate dependent on heat detection and oestrous

Answer 190

normal heifer replacement rate- 20-25%

Answer 191

Distal paravertebral block Indicated for same as proximal paravertebral block * The dorsal and ventral branches of the spinal nerves T13, L1 and L2 are desensitized at distal ends of L-1, L-2 and L-4. * A 7.5-cm, 18-gauge needle is inserted ventral to tips of respective transverse processes in cows - approx 10-20 ml of a 2% lidocaine solution injected in a fan-shaped infiltration pattern. * Needle completely withdrawn and reinserted dorsal to transverse process, where the cutaneous branch of dorsal branch is injected with about 5 ml of the analgesic. * Procedure repeated for the second and fourth lumbar transverse processes. 10-20 ml 2% lidocaine is used per site and onset and duration similar to proximal technique.

Answer 192

\> 5% new cases every month 17 cases/120 milkings/ period of time \* 2-3 squirts of milk-- if you still have changes in the milk 3-4 squirts in, she has mastitis

Answer 193

Strep uberis, Strep agalatia, strep dysgalactia, Staph aureus, Coliforms (e. coli, Klebsiella)

Answer 194

Poultry (41.7) Beef (34) Pigs (25.5) Small Ruminants (10.4)

Answer 195

False: Carcasses are randomly selected for testing under these programs

Answer 196

Surveillance for notifiable diseases and biosecurity.

Answer 197

Code Alimentarius

Answer 198

All of the above

Answer 199

World Trade Organisation (WTO)

Answer 200

Australian Pesticides and Veterinary Medicines Authority (APVMA)

Answer 201

1. Lairage 2. Electrical Stunning 3. Evisceration 4. Post-mortem carcass inspection 5. Trimming

Answer 202

Weasand- oesophagus Stick- throat cut Bung- rectum Pluck- heart and lungs

Answer 203

Foreign materials

Answer 204

[1. Freedom from hunger and thirst](http://www.cve.edu.au/abattoirresource/five-freedoms-continued#collapseOne) In order to decrease the amount of faecal contamination and gut spillage during carcass dressing, animals presented to abattoirs are kept off food prior to slaughter. However, transport hauliers and abattoir management have to be aware of certain species and age-related standards regarding time off feed. For example, bobby calves cannot go longer than 18 hours since their last feed. Water should be available at all times to all species, and animals should be able to drink within an hour of arrival at the abattoir. [2. Freedom from discomfort](http://www.cve.edu.au/abattoirresource/five-freedoms-continued#collapseTwo) [3. Freedom from pain, injury and disease](http://www.cve.edu.au/abattoirresource/five-freedoms-continued#collapseThree) [4. Freedom to express normal behaviour](http://www.cve.edu.au/abattoirresource/five-freedoms-continued#collapseFour) [5. Freedom fear and distress](http://www.cve.edu.au/abattoirresource/five-freedoms-continued#collapseFive)

Answer 205

Staff competency

Answer 206

All of the above

Answer 207

True ## Footnote This statement is true. Head-to-body electrical stunning causes cardiac arrest resulting in death prior to slaughter. According to Halal rules, this is not permitted.

Answer 208

insensibility

Answer 209

All of the above

Answer 210

Slips and falls

Answer 211

Excessively dirty

Answer 212

Animal whose condition is not easily or quickly determined- retained for further inspection Animal that is affected by a disease that would respond to treatment- returned for further treatment Animal cannot move unassisted- emergency slaughter Animal that is excessively soiled- rejected from slaughter Animal with clinical mastitis- restricted slaughter

Answer 213

To protect the health of the consumer

Answer 214

This statement is false. Inspection of the head is not a requirement for export of sheep, as it is with cattle.

Answer 215

Diverted to retain rail for trimming

Answer 216

Johne’s disease- intestines and mesentery condemned Contagious ecthyma- affected carcass parts condemned Acute arthritis- carcass and all parts condemned Generalized bruising- carcass and all its parts condemned for human consumption (but OK for animal food) Hydatids- affected organs condemned

Answer 217

* Sequestrum- excessive granulation tissue

Answer 218

Protect it and transport it

Answer 219

* Exertional rhabdo

Answer 220

18-37 liters/day

Answer 221

* AE: Fever and nasogastric reflux

Answer 222

* 5kg feed

Answer 223

* septic arthritis

Answer 224

* SI strangulation from pedunculated lipoma, volvulus

Answer 225

ANSWER = C. DJD is almost always already present in the stifle at the time of diagnosis as the process of inflammation in the joint starts the cartilage degeneration. All cruciate stabilising surgeries can do is slow down this progression. The joint can never be 100% normal but the pain from an unstable joint and the risk of meniscal tears can be reduced. Answer A and B incorrect – a joint that has been damaged can never be 100% normal again and although stabilisation of the joint will reduce pain associated with the condition, the main function is long term management to delay the progression of DJD

Answer 226

1. [Gentle] tissue handling 2. Meticulous [haemostasis] 3. Preserve [blood] supply 4. Maintain strict [aseptic] technique 5. Minimum [tension] across tissues 6. Accurate [apposition] of tissues 7. Eliminate [dead] space

Answer 227

The submucosa has all the collagen and healing potential, so apposition of this layer is most important for primary healing, a continuous pattern allows even tension if performed correctly and tightens at the site during distension. Omentum can be used to augment the enterotomy closure (acts as drainage).

Answer 228

The caudal pole of the medial meniscus is most commonly injured when the cranial cruciate ligament is damaged, since it is less mobile due the attachment to the collateral ligament and an unstable joint leads to increased shear force from internal rotation and cranial translation of the tibia.

Answer 229

Blunt dissection can be performed in a longitudinal and lateral plane to expose the linea alba using metzembaum scissors. If necesaary subcutaneous tissue overlying the linea alba can be carefully resected to improve visualisation. Correct – this gives the best exposure of the linea alba and improves accuracy for the abdominal incision. Any dead space created can be closed by suturing the subcutaneous layer.

Answer 230

Perform a complete splenectomy and submit for histopathology The spleen is highly vascular and has a very thin capsule that makes it almost impossible to suture, therefore haemorrhage is a significant problem, so a complete splenectomy is preferred over biopsy or partial splenectomy. Answer A is incorrect as cytology often will not give a definitive diagnosis, a tissue sample is preferred

Answer 231

conscious proprioception is the first clinical sign to change, followed by voluntary motor function, urinary/faecal continence and finally deep pain perception.

Answer 232

Transection of the duodenocolic ligament allows easier manipulation and access of this segment, as it acts as an anchor point making exteriorisation difficult.

Answer 233

Stifle hyperextension often causes significant reaction when stifle pain (and likely cruciate disease) is present. Hyperextension causes tensioning of the gastrocnemius tendon, producing cranial thrust with cranial tibial translation

Answer 234

If less than 70% of the intestine is resected long term complications are minimal

Answer 235

Differential Diagnoses? úDietary indiscretion úPancreatitis úIntestinal obstruction úGastric ulceration úHepatitis úPeritonitis úOther ‘acute abdominal’ crisis? úHypoadrenocorticism úDKA §Which diagnostic test(s) would you do next? § úAbdominal radiographs úAbdominal ultrasound úAbdominocentesis §How would you treat the patient? § úFluid therapy (0.9% NaCl indicated by electrolytes) plus potassium chloride úExploratory laparotomy

Answer 236

Anaemia úDecreased production úDestruction úLoss úSequestration Low cholesterol úLiver disease úDecreased intake Hypoglycaemia úArtefact úInsulin overdose úInsulin-producing tumour úAdvanced liver failure úSepsis úHypoadrenocorticism Azotaemia úRenal úPre-renal Hyperproteinaemia úDehydration úHyperglobulinaemia (not in this case) § Reduced Na: K ratio úHypoadrenocorticism úRenal and urinary tract disease (low sodium) úSevere liver disease úSevere GI disease Incl. whipworm úAcidosis úChronic heart failure úSevere muscle injury (crush) \*\* Renal disease and hypoA §How would you confirm a diagnosis of hypoadrenocorticism? úACTH stimulation test \*\* no response to ACTH rejection= hypoA mmediate §Intravenous fluid therapy with 0.9% NaCl à restores blood volume and decreases potassium immediately §Replacement of adrenal steroids úHydrocortisone or úDexamethasone or úDOCP §Long-term Management úDOCP (Desoxycorticosterone Pivalate) plus prednisolone/cortate, or úFludrocortisone plus prednisolone/cortate

Answer 237

1. Pre-hepatic causes • Haemolysis 2. Hepatic causes * Injury to hepatocytes * Hepatitis * Neoplasia • 3. Post hepatic causes • Bile duct obstruction Post-hepatic disease seems most likely (clinically “well”, AP very high but ALT marginally increased only, and acholic faeces) §What are the main DDx? Bile duct cancer Cholelithiasis Pancreatic disease (mass, pancreatitis) Duodenal mass §How would you investigate further? Abdominal ultrasound Abdominal radiology Exploratory laparotomy \*\* What test should you consider BEFORE surgery? (and why?) Clotting status ! Bile duct obstruction à reduced fat absorption à reduced vitamin K absorption à reduced clotting factors 2, 7, 9 & 10

Answer 238

§Abdominal mass úNeoplasia, lymph node, intestinal foreign body, organomegaly (spleen), granuloma §Weight loss with increased appetite úHyperthyroidism, EPI, malabsorption due to intestinal disease, diabetes mellitus, cardiac cachexia §Tachycardia, cardiac murmur úCardiac disease (congenital or acquired-such as hypertrophic cardiomyopathy) úAnaemia §Possible polyuria and polydipsia úRenal insufficiency, hyperthyroidism, diabetes mellitus, hepatic insufficiency, hypercalcaemia §Pale mucous membranes úAnaemia Decreased production Destruction Loss Sequestration úCardiac disease §FeLV and FIV negative §Imaging úNormal thoracic radiographs úHepatomegaly, splenopathy, and multiple small nodules (likely lymph nodes) on abdominal ultrasound

Answer 239

§Minimise stress and handling §Oxygen (oxygen cage \> flow by \> facemask) §Get IV access §? Should you try thoracocentesis NO §Bronchodilator YES- which one? úTerbutaline IV or SC úSalbutamol / albuterol by inhalation úAminophylline (IM) úNorepinephrine IV (IM, SC) §? Furosemide IV §? Glucocorticoids Dexamethasone IV (IM, SC) Prednisolone sodium succinate IV §?Nitroglycerine topically What diagnostic tests would you do NEXT? §Thoracic radiographs úWhen? §Blood tests- pick the most useful úComplete blood count úBiochemistry úHW testing úBlood gas úFIV/FeLV úToxoplasma titre úCoronavirus titres §Faecal examination + Baermann §Lung cytology úHow? §Echocardiogram §Laboratory data §Peripheral eosinophilia úInflammatory/allergic úParaneoplastic úParasitic úSystemic eosinophilic disease §What is your interpretation? §Diffuse bronchial pattern, hyperinflation, flattening and caudal displacement of diaphragm §What does this suggest? §Suggests inflammation of airways §DDx asthma, lymphoma, lungworm, less likely pneumonia, FIP, fungal §What would you do next? §On lung cytology \> 50% of cells are eosinophils; no aetiological agents are seen §What other test would you do on this samples? Culture, specify Mycoplasma. This sample was negative §What are your DDx now? §Feline bronchial disease §Heart worm (Dirofilaria immitis) §Parasites: Aelurostrongylus abstrusus, Capillaria aerophila, Paragonimus spp. §Fungal disease §Hypereosinophillic syndrome §What is the most likely diagnosis? Feline Bronchial Disease §Acute setting úOxygen úMinimise stress / handling úIV or inhaled bronchodilators ú+/- IV glucocorticoids §Chronic setting úGlucocorticoids – PO, inhaled úBronchodilators – PO, inhaled úRx secondary infections

Answer 240

§Severe regenerative anaemia úRed cell destruction (inc. IMHA, onion or Zn toxicity, microangiopathic haemolytic anaemia, DIC), red cell loss (haemorrhage) §Spherocytes úRed cell destruction as above §Microscopic auto-agglutination úRed cell auto-antibodies §Neutrophilia with left shift úNon specific bone marrow stimulation, infection §Monocytosis úStress response, inflammation, immune mediated disease, haemolysis §Immune mediated haemolytic anaemia úPrimary – idiopathic úSecondary – infectious, neoplasia, drug, Zn FB §What questions do you have for the owners? úPrior drug history (including vaccines, over the counter and preventative health-care) úTravel history - ticks úToxicity ? Including foreign bodies, onions etc úPrior disease úPrior transfusions §Search for an underlying cause úThoracic radiographs úAbdominal ultrasound ú+/- Infectious disease panels (geographically dependant) E.g. HW, Babesia canis or Gibsoni, Ehrlichia spp., Rickettsia ú+/- BM – if no response to Rx, for BM disorder ú+/- PT/APTT (ACT), FDP, fibrinogen, AT III for DIC §+/- Cross match / blood type úOnly if has had prior transfusion §Initial treatment plan for idiopathic (primary) IMHA úpRBC transfusion (or whole RBC transfusion if not available) úPrednisolone 1 mg/kg BID PO until normal PCV and and no auto-agglutination or spherocytes, then taper ~ 10-20% every 2-4 weeks while monitoring PCV to lowest effective dose úAzathioprine 1-2 mg/kg SID PO for 1 week, then EOD, then taper., or start at 1-2 mg/kg eod. úLow dose aspirin. Why? úMonitor PCV q 12-24 hr initially úLong (months) treatment duration úPrognosis – fair, variable if discharged

Answer 241

Ultrasound ideal – non invasive, evaluates kidneys and urinary bladder, check for uroliths, mass, wall changes (can’t see entire urethra, usually don’t see ureters). Bladder wall can look more distended / irregular when small Normal wall layering is preserved §After urinalysis and imaging, what is the most likely diagnosis? § §Idiopathic FIC (FLUTD) §Treatment: úPain relief for 3- 5 days (e.g. buprenorphine) or NSAIDs (ensure eating and hydrated) ú+/- smooth muscle relaxants (phenoxybenzamine), +/- skeletal muscle relaxants (prazosin / dantrium) ú+/- anti-anxiety medication (usually if chronic problem), may consider Feliway ® úGood hydration §Prevention: úAddress obesity úRisk factors in this case for FIC – obesity, new cat next door, dry food diet, only 1 litter tray, fed ad lib. úReduce stress, resolve inter-cat conflict, weight loss, increase number and cleanliness of litter trays, increase owner interaction / playing, increase water intake úHill’s c/d §Prognosis úUsually resolves in 1 week ú45% relapse in 6 months, 70% relapse in 1 year úYet with diet – relapse rates reduced by 89% (1.2 incident days / 1,000 days vs. 11.2 incident days / 1,000 days with controls

Answer 242

§Blood tests? úBlood work shows dehdyration and leucocytosis úLCAT positive \> 1: 1024 §Cytology? úFungal organisms (cryptococcosis) on cytology §Imaging? úNasal radiographs úHead CT scan úWhy do we need these if we have a diagnosis?

Answer 243

\* Meds,hypovolaemia, underlying disease, hypoT, cuff size Check patient, turn iso down, fluid bolus

Answer 244

\* pain, drugs, stress, underlying disease, fluid overload, cuff size, too light anaesthetic, renal disease, hyperA \* check patient, increase iso, increase propofol or increase methadone

Answer 245

\* Lung disease \* FB in the tube- mucus plug-- you can often hear it (sound of bag)- cat flu, Bordatella bronchiseptica, suction tube \* Check patient, CRT, reposition, check tubing- make sure not breath holding- give breath, tube in oesophogus? Pre-oxygenate, increase oxygen, not reading properly, decrease iso/ reverse drugs

Answer 246

Phenothiazine- alpha 1 adreno receptor antagonist 6-8 hours Hypotension, vasodilation, splenomegaly Contraindication: CV disease, hypothermia (2C decrease in temp), avoid in epileptics, mild anti-emetic, avoid in Boxers, HUskies, C-section as it crosses the placental barrier

Answer 247

Opioid mu receptor 4-5 hours Sedation, bradycardia, nausea, salivation (Cerenia) \* Reversal: Nalaxone, Butorphanol

Answer 248

Anticholinergic, 10-15 minutes, Tachycardia, increase in BP, Decrease in gastric motility, increase chance or regurg, side effects: anti- SLUD \* Use more eye lube

Answer 249

Alpha 2 agonist, reflex bradycardia, kittens--\> faster, CARE asphyxiation, 45 minutes, Atipamezole

Answer 250

\< 60 mmHg, ephedrine 0.1 mL/kg, decrease iso, give fluid (bolus first)

Answer 251

Palpebral reflex, jaw tone, central eye position, increase HR, increase BP, increased RR

Answer 252

Eye position (medial), stable vitals, jaw and palpebral reflex

Answer 253

Bradycardia- dilated pupils, dry eyes, RR decrease, eye position- centrla, decrease in vitals

Answer 254

Increase iso, give some breaths, top up on propofol, 3-5 minutes quicker with non-rebreathing

Answer 255

\* Decrease iso, give reversal

Answer 256

Decrease in perfusion, vasoconstriction, blood loss, anaemia

Answer 257

B. Call the exotic disease hotline

Answer 258

D. Insufficient chilling of the bulk vat- epithelial and inflammatory cells- not bacterial cells (BMCC)-- somatic cells

Answer 259

Oxytocin (IM)- may want it for heifers after first calving

Answer 260

True Under the Prevention of Cruelty Act 1986-- 24D- you have the authority under 24A POCTA inspector can decide to destroy an animal if not on the person's dwelling

Answer 261

A. Administer an epidural injection of lignocaine. B. don't do!! vasodilation, hot water, wash with room temperature water C. Frog leg position D. Face the animal slightly down hill

Answer 262

D. Stab those cows with breathing difficulties in the left flank with a knife (do simultaneously with A) A. Get the herd out of the paddock. (would be highest priority if you don't have help) B. Administer bloat oil to the cows with a drench gun C. Call the knackery to remove the dead stock

Answer 263

Eimeria zuernii- Coccidiosis Mycobacterium paratuberculosis- JD Streptococcus uberis- Mastitis Clostridium hemolyticum- bacillary haemoglobinuria

Answer 264

B. 6 weeks of age (rumen development)

Answer 265

Meloxicam- anti-inflammatory Trimedexil- LA Corticosteroid- induction of parturition Cloxacillin- injectable treatment of mastitis Engemycin (Oxytet)- broad spectrum injectable antibiotic

Answer 266

A. The ewe is grazing improved pasture of 500 kg dry matter/ha availability-- she would be on 1000 kg dry matter/ha (twin bearing 1200)

Answer 267

C. All affected cattle should be given a course of IM injections of penicillin registered for use in cattle.

Answer 268

C. Hyperthyroidism and renal insufficiency can be excluded

Answer 269

d) Tricuspid valve dysplasia

Answer 270

B. Mineralisation within the parenchyma

Answer 271

D) Diabetic ketoacidosis

Answer 272

B) Collapsing trachea

Answer 273

B. ulna carpal bone

Answer 274

microcytic, hypochromic, potentially severe anaemia with a variable regenerative response

Answer 275

Mild to moderate, nonregenerative, normochromic and normocytic \* secondary to chronic inflammation or infection, neoplasia, liver disease, hyperA or hypoA, hypothyroidism

Answer 276

Heinz bodies and eccentrocytes Strong regenerative response, macrocytosis, aniscocytosis, hypochromasia

Answer 277

Moderate to marked regenerative response, macrocytic, hypochromic

Answer 278

CCPs (Critical Control Point)/ Critical Limits (CLs) Milk pasteurization Down to 5C within 24 hours or at 60C or hotter when it is received, displayed, transported or stored Nitrite (prevents C. botulinum) Meat cooked at 65C for 10 minutes Metal detector

Answer 279

Gloves, closed toed shoes, lab coat, face and eye protection

Answer 280

Tested intwo stages: 1. Screening test of a large sample of mature animals from the herd- HT J PCR or ELISA 2. Test of animals that showed a reaction to the bacteria Follow up faecal culture or tissue culture and histopathological investigation of any reactors---histology- high specificity and sensitivity but requires animal slaughter and immediate collection of samples

Answer 281

Stage I: Involvement of a single Lymph Nodes (or lymphoid tissue in a single organ) only Stage II: Regional involvement of multiple LNs (either in front half or back half of the body) Stage III: Generalized lymph node enlargement (this typically refers to enlargement of lymph nodes in BOTH the front and back half of the body) Stage IV: Involvement of the liver and/or spleen Stage V: Involvement of blood, bone marrow, central nervous system, or other organs \*\* Usually diagnosed in Stage III Substage a: Where there are no systemic signs of disease (i.e. the patient generally seems healthy and symptom free) Substage b: Where there ARE systemic signs of disease (i.e. the patient demonstrates general symptoms of not feeling well) \*\* substages consistent predictor of whether or not a dog will go into remission \*\* Staging tests (ALL): - chest rads - abdo U/S - full blood panel - bone marrow aspirate - urinalysis

Answer 282

For both disk extrusions and protrusions-- strict cage rest 4 to 6 weeks duration (two to three walks 5-10 minutes on leash are allowed-- but harness if cervical)-- followed by 4 to 6 weeks of progressive exercise re-introduction \* Pain relief: \* Tramadol 2 to 10 mg/kg at least three times a day \* Gabapentin 10 to 20 mg/kg 3 times per day \* NSAIDs for a few days \*\* Tramadol and Gabapentin first and add some NSAIDs if necessary \*\* Corticosteroids are C/I as they have increased morbidity (risk of GI disorders by 3 and risk of UTI by 5 without any benefit)

Answer 283

Phenoxybenzamine hydrochloride (alpha adrenergic antagonist) relaxed internal urethral sphincter Diazepam- relaxes the striated fibres of the external urethral sphincter

Answer 284

\* Bethanechol- parasympathomimetic drug facilitates the detrusor contraction

Answer 285

Idiopathic Cerebellitis/ Shaker Dog Disease/ White hair shaker syndrome \* Maltese, West highland white terriers, Bichon frise, spitz, samoyed, beagle, dachshund, yorkies, spring spaniels Clinical signs: tremors in all four limbs and head, absent menace response, nystagmus, head tilt, tetraparesis, paraparesis, +/- hypermetria and body swaying, rarely seizures \*\*UNK pathogenesis-- acquired autoimmune disorder affecting neurotransmitter synthesis (dopamine, epinephrine, and norepinephrine) has been hypothesized \* Immunosuppressive doses of CS e.g. prednisolone at 1-2 mg/kg PO BID until clinical remission followed by the lowest dose that controls the signs Concurrent administration of Diazepam 0.5 mg/kg TID for 4 weeks speeds resolution of clinical signs

Answer 286

TT4- if normal- dog probably doesn't have hypoT, if low could be hypoT Free T4 (equilibrium dialysis)- low TSH- high BUT still could be euthyroid sick \* if unsure and want to know.. U/S, scintigraphy, TSH, thyroid biopsy, treatment trial \*\* circulating antithyroglobulin antibodies can detected in as many as half of dogs with hypoT-- autoimmune thyroiditis \* Certain breeds have lower T4-- Grehounds, sight hounds, Alaskan Sled Dogs (intense racing or training) \*euthyroid sick syndrome- any illness can affect thyroid function tests (or drugs- GCs, phenobarbital, sulfonamides, clomipramine and aspirin)

Answer 287

goal is 25 mg/mL.....25,000 mg dextrose in 1000 mL (or 1 L) Since 50% is 500 mg/mL, 25,000/500 = 50 mL-- you need to remove 50 mL first \* Osmolarity of 50% dextrose is 2780 mOsm/L, so 2.78 mOsm/mL. Since you are starting with a bag of Hartman's which has 272 mOsm in it, you took out 50 mLs you are left with a bag with 258 mOsm in it (272- (50\*0.272))= 258 mOsm. Then you add back in 139 mOsm from dextrose [2.78 mOsm/mL x 50 mL= 139 mOsm], so 258+139=397 mOsm.

Answer 288

HeartGuard Plus

Answer 289

4 in 1-- mainly magnesium but also calcium as often hypocalcaemia coincides

Answer 290

Oral dextrose or oral propylene glycol or IV glucose

Answer 291

Snatch rearing/ dirty mob/clean mob

Answer 292

Canine distemper virus (and nasal planum= pathognomonic)

Answer 293

Uric acid-- consider with clinical signs, protein level, PCV and water intake

Answer 294

Mycoplasma

Answer 295

\* Bupivacaine v. Lignocaine - Bupivacaine longer duration (up to 8 hours when combined with epinephrine) but more cardiotoxic, lower toxic dose - Lidocaine duration of action dependent on uptake but around 1 hour, 2 hours with epinephrine-- may cause some local irritation and swelling which is esp a problem in a horse \* Meloxicam v. Carprofen (Rimadyl) - Meloxicam: 12-24 hours (up to), onset of effect 1 hour - wash out period of 5-7 days before starting a new NSAID-- LONG half life in dogs - Carprofen longer onset of action-- absorbed faster when administered orally vs. subcut. - 18-24 hours after sub cut in cats - Rimadyl (Carprofen) accepted as safer?? \* Buprenorphine v. Methadone - Bup- partial mu opioid agonist (high affinity for mu receptor but only partial activity therefore moderate analgesia and variable sedation), s/e bradycaria, respiratory depression, etc., slow onset of action (30-40 minutes) and a long duration of action (6-12 hours), especially effective in cats-- considered safe in cats with HCM - Methadone- pure mu opioid agonist, s/e dysphoria, nausea, reduced GIT motility, respiratory depression, and bradycardia, short onset of action (lipid soluble and cross the brain barrier quickly), provides 4-6 hours of analgesia + binds to the NMDA receptor in the CNS where it works as an antagonist which prevents central sensitisation and wind up, two phenomena involved in the development of chronic and neuropathic pain

Answer 296

\* butorphanol v. methadone - methadone: mu receptor agonist, non-competitive inhibitor of NMDA receptors, reduces reuptake of norepinephrine and serotonin which may contribute to its analgesic effects, C/i CHF, hypertension, head injuries, elevated CSF pressures, and geriatric or severely debilitated patients-- can reverse Methadone... 4-6 hours for analgesia - butorphanol: partial opiate agonist/antagonist, C/i liver disease, hypothyroidism or renal insufficiency, Addison's , head trauma, increased CSF pressure or other CNS dysfunction (e.g. coma), geriatric or severely debilitated patients... sedation 2-4 hours; analgesia \< 1 hour \*propofol TIVA v. isoflurane \*spontaneous v. mechanical ventilation - mechanical ventilation would be better than spontaneous in this situation in order to control CO2 levels

Answer 297

Aldosterone antagonist used as a potassium sparing diuretic or for adjunctive treatment for heart failure (controversial in dogs)-- should not be substituted for Furosemide in CHF C/I Addison's, Hyperkalaemia, anuria, acute renal failure, renal impairment \*\* Used in patients not responding to Furosemide and ACE inhibitors, who develop hypokalaemia on other diuretics and are unwilling or unable to supplement with exogenous potassium sources

Answer 298

Best test to diagnose hyperA? Best test to monitor hyperA?

Answer 299

Trilostane can treat both PDH and AT. However when no signs of metastasis, surgery is the prefered treatment for AT. Trilostane may control clinical signs, but is not associated with reduction in size of tumour. When treating a larger dog, mitotane treatment may be preferred for economic reasons. \* Similar survival times, but less side effects apparently with Trilostane \* Do not use in animals with hepatopathy or pre-existing renal disease s/e v+ & d+, hyperkalaemia, hypoA, adrenal necrosis (sudden death or hypoA) \*Taken with food-- controls signs of HAC 67-100% of cases within 3-6 months \* Trilostane is a synthetic steroid which competitively and reversibly inhibits the action of an enyme essential to the production of steroid hormones. Peak serum concentration in dogs seen in 1.5; at 18 hours the drug has been completely metabolized. \*\* Monitor-- ACTH stim test 6 monthly - monitoring at 10 days, 1 month, then every 3 months for signs of hypocortisolaemia (addison's) are observed or the dose is adjusted. Blood samples should be obtained 2-6 hours after the trilostane is given. (Trilostane changes the appearance of the adrenals on U/S, they increase in size and become more heterogenous, thus they may be mistaken for adrenal tumours).

Answer 300

Foals: 80-100 mL/kg/day Adults: 40-60 mL/kg/day 15 L/day \* middle of the range 50\*300

Answer 301

Many dogs have normal K+ levels on admission but within 24 hours hypokalaemia occurs. Often compounded by the administration of IV crystalloid solutions deficient in potassium ions. Potassium supplementation is sometimes warranted.

Answer 302

Effective at resisting bending forces. Easily overcome by axial (compression/distraction) and rotation forces unless the fracture configuration allows an interlock between the major fragments

Answer 303

Ortolani sign \* Laxity is the primary abnormality in juvenile hip dysplasia \* Mediolateral translation of the proximal femur relative to osseous portions of the pelvis- positive Ortolani sign \* Assessment of pain during forced extension

Answer 304

Energy of the scatter radiation will decrease as distance from the radiation source increases according to the inverse square 25%?

Answer 305

\* Ununited anconeal process (UAP) \* Fragmentation of the medial coronoid process (FMCP or FCP) \* Osteochrondritis dissecans of the medial humeral condyle (OCD) \* Elbow incongruity \*\* Evolution of treatments: - Lag screw fixation, ulnar osteotomy, then fixation + osteotomy + IM pin

Answer 306

There are a few different signs to look for when you suspect free peritoneal gas. Serosal surfaces, especially ones that you would not normally see (liver lobes) become visible from the high contrast between gas and soft tissue. You will also see gas that is not contained within the gastrointestinal tract. These gas bubbles often have odd, angular shapes. Gas also tends to rise to the highest point in the abdomen, which is under the diaphragm in both projections. Look for the diaphragm to be outlined by gas on both sides. It is usually highlighted by gas (lungs) on the cranial side, but the caudal side should have stomach wall or liver adjacent to it. When outlined on both sides by gas, the diaphragm will appear as a very thin, sharp, soft tissue line. The major diagnostic differentials for the distended abdomen in this dog were gastric dilatation–volvulus, hemoabdomen, a ruptured gastrointestinal tract causing pneumoperitoneum, uroperitoneum, and ascites due to right-sided heart failure, hepatic failure, or protein-losing nephropathy/enteropathy. Pneumoperitoneum can generally be diagnosed on lateral and dorsoventral radiographs if there is a substantial amount of gas present, as in this case. Right lateral recumbency is not recommended because gas bubbles will rise to the left side and may be confused with gas in the gastric fundus.

Answer 307

SDFT inserts much higher up

Answer 308

Buprenorphine Routine pain assessment will be integral to successful use of buprenorphine in the clinical setting. Buprenorphine has a delayed onset of action, and analgesic effects may take 30 to 45 minutes following intravenous or intramuscular injection. The authors also point out that duration of action may be shorter than previously thought and repeated dosing may be required. For this reason, cats should be consistently re-evaluated for pain following buprenorphine administration. Whenever possible, intravenous is the preferred route of administration (0.02 mg/kg), as it will have the fastest speed of onset and superior duration of action compared with other routes. Buccal buprenorphine should be reserved for cats that have received premedication with a full mu agonist such as morphine, methadone, or fentanyl. A multimodal analgesic plan that includes a nonsteroidal anti-inflammatory agent or loco-regional anesthesia should be considered whenever possible.

Answer 309

mA- milliamperage second - amount of x-rays that will be produced at the target area. Overall exposure (blackness) is controlled by mAs kVp- kilovoltage peak max value of the applied x-ray tube voltage during x-ray production \*\* Many shades are gray are produced when using high kVp and low mAs -- abdomen and lung \*\* Increasing kVp increases the number of photons produced and the penetration of the x-ray beam-- may cause image to be over-exposed-- too black Preferred Relative Exposures: • Skeletal – High mAs with low kVp • Abdomen – Medium mAs with medium kVp • Thorax – Low mAs with high kVp

Answer 310

In a study of bacteria isolated from pleural fluid from 51 dogs, obligate anaerobes were isolated from 60 per cent of samples, and a mixture of obligate anaerobes and facultative anaerobes from 44 per cent (Walker and others 2000). The most common anaerobes isolated were Peptostreptococcus anaerobius, Bacteroides species and Fusobacterium species, and aerobes isolated were Actinomyces species, Pasteurella species, Escherichia coli and Streptococcus canis. Therefore, empirical antibiotics chosen for canine pyothorax should have activity against anaerobic and facultative bacteria, be distributed into the pleural space and have low toxicity. Walker and others (2000), recommend the beta lactams ceftizoxime, clindamycin and metronidazole. Cytological and histopathological descriptions of pleural samples often report ‘filamentous … \*\* if it was empirical AM tx of septic peritonitis-- beta lactam (e.g. ampicillin) combined with an aminoglycoside or a fluoroquinolone.

Answer 311

Flystrike dressings contain one of a range of chemicals: diazinon, propetamphos and chlorfenvinphos (OPs), cyromazine (IGR), ivermectin (ML), and spinosad (spinosyn). OPs are generally not recommended because of extensive resistance in flies to this group. The IGRs will help to prevent re-strike while the wound heals but will not kill any third instar larvae until they attempt to pupate. Prevention relies mainly on reducing the susceptibility of the sheep, using a range of breeding, surgical, husbandry and chemical measures.  Mulesing is being used less and less as animal welfare pressures accumulate.  The major chemical preventives are the fly-specific IGRs cyromazine and dicyclanil, mostly used as long-wool products.

Answer 312

\*\*Can't find safety index for OPs-- but sounds like Levamisole is worst... OPs and Slicylanilides are bad too, may be tied... OPs for fish SI- 1.7 then they would be worse Salicylanilides sheep: drug of choice for Haemonchus resistance limited but spreading dogs: effective against hookworms but rarely used Imidazothiazoles- Levamisole Activity: • broad spectrum • all GINs & lungworms • NOT effective against inhibited larvae and flatworms • Immunomodulatory effect at lower doses (2-3mg/kg)

Answer 313

Tail docking & ear cropping: In 2004, tail docking for non-therapeutic reasons was banned across Australia. Since then it has been illegal to dock dogs' tails unless there is a veterinary medical reason for the operation.Aug 23, 2014 Debarking: Owners of dogs who are debarked in NSW or Victoria must show an official council order identifying the dog as a nuisance barker, and sign a statutory declaration. Victoria goes further in requiring the vet to notify the Bureau of Animal Welfare within seven days of each procedure.

Answer 314

\* FLUTD \* Idiopathic cystitis \* UTI--Infections e.g. Leptospirosis \* Neoplasia \* metabolic disorders (e.g. chronic renal disease where uremia results in cystitis \* renal disease

Answer 315

Feline Upper Respiratory Tract Infection \* FHV-1 is more virulent than most calicivirus strains but less common.

Answer 316

How often does a female dog come into heat? Most dogs come into heat twice per year, or about every six months, although the interval can vary between breeds, and from dog to dog. Small breed dogs may cycle three times per year, while giant breed dogs may only cycle once every 12-18 months. When young dogs first begin to cycle, it is normal for their cycles to be somewhat irregular. It can take up to 2 years for a female dog to develop regular cycles. There is no season of the year which corresponds to a breeding season for domesticated dogs.

Answer 317

\* used to improve stallion libido-- too much results in a negative feedback on the hypothalamus and pituitary, reducing gonadotrophins (LH and FSH) release and hence stimulation of the testis including sperm production.

Answer 318

IBD (or EPI)

Answer 319

Potential complications –Facial nerve damage –Haemorrhage –Can have some hearing after surgery –Fistulation if tissue left in situ

Answer 320

PCV normal 32-52% TP 4.6 - 6.9 g/dL (46-49 g/L) \* Sanguinous diarrhoea- may be frank blood Clostridium perfringens ENTEROCOLITIS IN FOALS AND COLOTYPHLITIS IN ADULTS - a spore forming, gram-positive rod that is an obligate anaerobe Diagnosis: Usually made on the basis of Clostridium perfringens isolation (moderate to large growth), identification of the toxic gene (this would be great to have available in Australia) and of course, clinical signs of enterocolitis in foals and colitis/colotyphlitis in adults – remember that diarrhea can be sanguinous but does not have to be

Answer 321

PCV 35-45% TP 6.5-80 g/dL (65-80 g/L) \* Elevated TP: dehydration, less common- chronic inflammation, neoplasia, infectious disease (e.g. FIP), multiple myeloma \* Lower TP: haemorrhage, malabsorption, liver disease (e.g. lack of production of albumin), GI disease (e.g. protein losing enteropathy), or kidney disease (e.g. protein losing nephropathy)

Answer 322

Damage to the cornea or FB, patency of the nasolacrimal duct

Answer 323

mydriatic (atrophine or tropicamide)-- prevents development of posterior synechiae and to provide analgesia via cycloplegia (paralysis of the ciliary muscle) \* Dilation of the pupil should be maintained until clinical improvement of uveitis is observed (1-3 x per day) \* Prolonged pupillary dilation is not of concern as long as the IOP remains below 25 mmHg \* Tropicamide can also be used but requires frequent administration (6-8 hours) duration is not as long as atropine

Answer 324

There isn't one??

Answer 325

No... renal toxin Clinical signs are dose- and time-dependent and can be divided into those caused by unmetabolized EG and those caused by its toxic metabolites. The onset of clinical signs is almost immediate and resembles alcohol (ethanol) intoxication. Dogs and cats exhibit vomiting due to GI irritation, polydipsia and polyuria, and neurologic signs (CNS depression, stupor, ataxia, knuckling, decreased withdrawal and righting reflexes). Polydipsia occurs due to osmotic stimulation of the thirst center, and polyuria occurs due to an osmotic diuresis and decreased production and release of antidiuretic hormone. As CNS depression increases in severity, dogs and cats drink less; however, the osmotic diuresis continues and results in dehydration. Dogs may appear to transiently recover from these CNS signs ~12 hr after ingestion. Oliguric acute renal failure usually develops between 12 and 24 hr in cats and between 36 and 72 hr in dogs. Signs include lethargy, anorexia, dehydration, vomiting, diarrhea, oral ulcers, salivation, tachypnea, and possibly seizures or coma. The kidneys are often swollen and painful on abdominal palpation.

Answer 326

\*DDX: high worm counts or heavy larval challenge \* Diagnosis: WECs (+/- oocysts), faecal smears and culture, post mortem (ileum, caecum, colon): TWC, gut smears and culture, histo, response to treatment Weaner enteritis: often mixed aetiology: sub-optimal management, nematodes, undernutrition, Se/Vitamin E deficiency, M. ovis

Answer 327

\*often secondary in small ruminants \* Spontaneous recovery without treatment in 2-3 weeks \* LA oxytet parenterally or injected subconjunctivally-- not cloxacillin for sheep

Answer 328

Chief Veterinary Officer, Department of Agriculture and Water Resources (National), Agriculture VIctoria Stun-to-stick intervals The stun-to-stick interval is the time from application of stunning equipment to the start of bleeding. A maximum stun-to-stick interval of 15 seconds is recommended for all species in the field. In the abattoir, all pigs, sheep and goats should also be stuck within 15 seconds. However, on the majority of cattle lines, where the carcase must be hoisted to a bleed area, maximum stun-to-stick intervals of 60 seconds for the penetrative captive-bolt and 30 seconds for the non-penetrative captive-bolt are acceptable. It is essential that equipment is well maintained and that stunning is carried out accurately, using the correct cartridge, to ensure that animals are effectively and irreversibly stunned.

Answer 329

Endogenous ACTH assay-- preferred screening test, single blood sample, seasonal variation (autumnal hyperactivity) Other possibilities: \* Dex suppression test Oral (in feed) glucose tolerance test Fasting plasma insulin concentration (\> 20 micoU/mL suggests EMS)

Answer 330

Third Degree = complete perforation of the vaginal wall and rectum producing a single opening to the rectum and vagina (First Degree Vulval lacerations should be repaired immediately. Second Degree The wound should be surgically repaired after the formation of granulation tissue.) Third Degree Treatment of third degree perineal laceration is always surgical and the aim is to restore normal anatomy. If the foaling injury is less than 3 hours old, immediate repair can be considered but is rarely performed. There is usually extensive bruising and laceration therefore repair should be delayed until bruising has subsided and granulation tissue has formed, usually a minimum of 6–8 weeks after foaling. Preparation for surgery: A laxative diet should be fed. The horse should be placed in stocks and sedated and restrained appropriately. The tail should be wrapped and tied, an epidural administered and the rectum emptied and packed to prevent contamination. The area should be clipped and scrubbed and dorsolateral and ventrolateral retention sutures placed. There are two techniques for repair of a third degree perineal laceration: The Aanes technique is a two-stage repair technique: Stage 1 is the reconstruction of the recto-vestibular shelf (the perineal body is left open). The wound is dissected to 2-3cm past the defect and then the shelf is closed in two layers - a simple continuous pattern is used in the tissue beneath the rectal mucosa to invert it and a six-bite interrupted purse-string suture is used to close the perineal shelf and vaginal mucosa. Stage 2 involves the closure of the perineal body 3–4 weeks later. The site should be infiltrated with local anaesthetic prior to surgery. Excess tissue is removed and the edges of skin are sutured from the anal sphincter to the most ventral point of the incision. To eliminate dead space additional sutures may be placed deep to the perineal body. It is important that no sutures are placed in the anal sphincter. Sutures should be removed after 7-10 days. The Goetze technique is a one-stage operation that involves everting the rectal mucosa into the rectum and vaginal mucosa into the vagina using a purse string suture Endometrial swabs should be taken once the wound has healed to check for the presence of endometritis.

Answer 331

\* Hyperglycaemia, glucosuria, ketonuria, and metabolic acidosis \* CBC, biochem, urinalysis, urine culture, and blood gas analysis

Answer 332

ACTH stimulation test for diagnosis (evaluates the ability of the zona fasciculata and zona reticularis of the adrenal cortex to respond to a maximal stimulus to produce cortisol-- animals that do not have enough functional adrenal cortical tissue to respond appropriately) Na/K \< 27:1 (hyperkalaemia and hyponatraemia) \*\* DDX of hyperK and hypoNa: Addisons, renal and urinary tract disease (anuric renal failure, obstructive uropathy, uroabdomen), severe GI disease, trichuriasis- assosiated pseudohypoadrenocorticism, severe metabolic or respiratory acidosis, peritoneal effusion, chylothorax, CHF, pregnancy, artifacts (erythrocyte lysis in Akitas, marked thrombocytosis, marked leukocytosis) \* Patients with chronic or intermittent GI signs or actue severe GI illness-- check Na/K \* fecal analysis is indicated in patients suspected of having hypoA

Answer 333

Patients with secondary hypoadrenocorticism do not have electrolyte abnormalities. Lack only glucocorticoid activity-- so they generally present with non-specific signs-- chronic or intermittent lethargy, weakness, vomiting, diarrhoea, anorexia, and weight loss.... \* Presence of hypoglycemia (symptomatic or asymptomatic), lymphocytosis, eosinophilia, or an inappropriately normal lymphocyte count in a moderately to severely ill patient should prompt consideration of atypical hypoadrenocorticism \*\* Suspect hypoA in patients with unexplained GI disease/ collapse/ hypoglycemia or other vague illness

Answer 334

Leukocytosis with a mild left shift Marked leukocytosis or leukopenia with a degenerative left shift can be present in cases of GI perforation and secondary bacterial peritonitis or sepsis \* Wide variety of electrolyte and acid-base changes have been described \* Proximal GI obstruction- hypochloraemia, hypokalaemia, metabolic alkalosis \* Distal GI obstruction- metabolic acidosis \* Hyperlactaemia and hemoconcentration (increased PCV and TS) are frequently identified

Answer 335

Ruminants vulnerable because ruminal flora reduces nitrate to ammonia with nitrite (10 times more toxic than nitrate) as an intermediate product \* acute - methemoglobin formation= anoxia, secondary effects due to vasodilatory action of the nitrite ion on vascular smooth muscle may occur \* Nitrate- also from accidental ingestion of fertilizer or other chemicals \* excess nitrate in plants- associated with damp weather conditions and cool temperatures (13C) or when growth is rapid during hot, humid summer weather. Drought conditions when plants are immature may leave vegetation with high nitrate concentration. Decreased light or cloudy can increase nitrate concentration of plants \* weak heartbeat, rapid, muscle tremors, weakness, ataxia, subnormal body temperature, brown or cyanotic membranes, pinpoint or larger haemorrhages on serosal surfaces, hydroperitoneum and ascites, edema and haemorrhage in the lungs and digestive system \*Diagnosis: lab analysis of pre and post mortem species-- but exposure v. toxicity, plasma is the preferred premortem specimen because some plasma protein-bound nitrite could be lost in the clot if serum was collected \* TX: slow IV injection of 1% methylene blue in distilled water or isotonic saline given at 4-22 mg/kg \* Control: animals may adapt to higher nitrate content in feeds, especially when grazing summer annuals such as sorghum-Sudan hybrids. Multiple small feeds can help animals adapt. Feeding grain with high- nitrate forages may reduce nitrite production.

Answer 336

C. Fenbendazole

Answer 337

C Ammonium biurate

Answer 338

C pain relief and infection

Answer 339

D due to longer lasting bupivicaine

Answer 340

C Cranioventral due to inhalation

Answer 341

Degenerative myelopathy

Answer 342

\* No stress leukogram but sick patient \* Sick patient has slightly low- low normal BC (especially with low cholesterol +/- albumin) \* Azotaemic patients with other suggestive changes \* Inappropriate relative/absolute bradycardia \* Patients with clinical hypoglycaemia \* Patients with mild hypercalcaemia

Answer 343

Metabolic acidosis

Answer 344

A. The Victorian Dept of Economic Development, Jobs, Transport and Resources

Answer 345

E Kelly forceps

Answer 346

Gentamicin

Answer 347

Buprenorphine

Answer 348

Hypercapnia

Answer 349

It requires a low fresh-gas flow rate

Answer 350

An 8 year old cat with acute on chronic renal disease following an oesophageal tube placement

Answer 351

Risk of priaprism

Answer 352

A: Obstructive disease- brachycephalic dogs often have stenotic nares, everted laryngeal saccules, elongated soft palates, and hypoplastic tracheas, all of which cause obstructions to airflow and increase the work of breathing

Answer 353

A: Decreased oxygen affinity for haemoglobin - FiO2 does not change oxygen affinity for haemoglobin (and we didn't talk about this in lecture either)

Answer 354

A: Decreased RR (respiratory rate) - opioids all have the potential to decrease respiratory rate and tidal volume which causes hypoventilation

Answer 355

A: False - ventilation can only be accurately assessed by measuring either the CO2 in the blood (PaCO2) or in the expired gases (EtCO2).

Answer 356

**Tumor (aka neoplasm) -An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer)**

Answer 357

DNA repair • DNA is constantly being damaged • Intrinsic – DNA replication errors – Oxidative damage • Extrinsic –carcinogens, UV, radiation, etc • Multiple DNA repair mechanisms –may not be perfect • ‘Lethal’ DNA lesions apoptosis • If DNA lesion is not repaired or induction of apoptosis fails, mutation may be passed on to daughter cells • Global defects in DNA repair = increased risk of cancer

Answer 358

• Age – DNA replication is imperfect -approximately 10^5 DNA lesions/cell/day – Increased number of replications = increased risk of mutation cancer • Chemical carcinogens –mutagenesis and carcinogenesis strongly linked • Tobacco smoke –p53 (tumor suppressor gene) mutations • UV light – Point mutations in p53 in SCC – Also causes oxidative damage, DNA strand breaks • Radiation – Direct damage –DNA strand breaks – Indirect –production of reactive oxygen species • Viruses –may insert oncogenes into genome, and/or induce chronic inflammation (oxidative damage) • Polyaromatichydrocarbons – Bind to DNA –reduced DNA repair activity – Oxidative damage – p53 mutations

Answer 359

Interpretation: minimal anemia without evidence of regeneration (no polychromasia); mild mature neutrophilia Differential diagnoses: Anemia – chronic disease or inflammatory disease, chronic blood loss, may be 3rd standard deviation and within reference limits for this dog; Mild Clinical Pathology Cases: Liver 6 neutrophilia – glucocorticoid response (stress) or adrenaline response (excitement), less likely true inflammation Further tests: Biochemistry, urinalysis, fecal occult blood Interpretation: Mild decrease in creatinine (likely clinically insignificant), evidence of hepatocellular damage (increase ALT), evidence of cholestasis (increase bilirubin with large amount being conjugated bilirubin, increased AP, increased cholesterol) Differential diagnoses: Hepatic or post-hepatic cholestasis due to neoplasia (hepatic, biliary or pancreatic), gallbladder mucocele, pancreatitis, cholangiohepatitis Further tests: Abdominal radiographs and/or ultrasound, liver fine needle aspirate for cytology Final diagnosis: Pancreatic adenocarcinoma

Answer 360

Interpretation: Mild decrease in creatinine (likely clinically insignificant), mild to moderate hyperglycemia (consider glucocorticoid induces stress or adrenaline release with pain), evidence of hepatocellular damage (increased GLDH, AST), evidence of cholestasis (increase in bilirubin, GGT and AP), evidence of striated muscle damage (increase CK) Differential diagnoses: Cholestasis (need to run conjugated bilirubin to help determine type but with degree likely hepatic or post-hepatic with possible contribution from anorexia), cholangiohepatitis, hepatic toxin Further tests: Conjugated bilirubin, abdominal imaging (likely ultrasound) Final diagnosis: Cholelithiasis Ten horses with clinical signs consistent with cholelithiasis were evaluated. Fever, icterus, mild intermittent colic, and weight loss were reported. Clinical laboratory abnormalities included leukocytosis, hyper-proteinemia, and hyperfibrinogenemia. Gamma glutamyltransferase and liver isoenzyme of lactate dehydrogenase activities also were high. Choleliths were observed via ultrasonography of the liver in 5 of the 8 horses evaluated, and increased echogenicity of the hepatic parenchyma and dilated bile ducts were observed in all horses. Seven horses were treated medically, 5 of which died or were euthanatized. Three horses were treated surgically, of which only 1 survived. Cholelith composition varied, but cholesterol, calcium bilirubinate, and mixed bile pigments were most commonly observed. The horse does not have a gall bladder (which stores bile), so bile from the liver flows directly into the small intestine.

Answer 361

Interpretation: Marked anemia, mild hyperphosphatemia, mild decrease in creatinine and urea (may be due to using adult reference values for a foal), moderate hyperglycemia (likely secondary to glucocorticoid stress or adrenaline release with fear), evidence of hepatocellular damage (increased GLDH, increase AST), evidence of cholestasis (increase in bilirubin), evidence of striated muscle damage (increase CK), evidence of bone growth (increased AP) Clinical Pathology Cases: Liver 11 Differential diagnoses: Neonatal isoerythrolysis or Tyzzer’s disease Further tests: Coombs test, minor cross matching with mare’s serum and foals red cells Final diagnosis: Neonatal Isoerythrolysis