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Endocrine Flashcards

1
Q

Based on Fenn. et. al what is the reported XX of cats undergoing hypophysectomy for treatment of acromegaly?
a. post-operative mortality
b. improvement in glycaeic control of survivors
c. % achieving remission
d. Median time to remission
e. recurrence rate of DM in cats that initially achieved remission?

A

a. 15%
b. 95%
c. 71%
d. 9 days
e. 12%

https://paperpile.com/app/p/26ddffb2-9bae-0694-88ba-3c16c39ad6a2

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2
Q

What percentage of analysed compounded trilostane packets contained an acceptable strength of trilostane in Korea?

A

40.9%

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3
Q

Incidence of hypoA in dogs?

A

2.3 cases per 10,000 dog years

https://paperpile.com/app/p/9a9096be-d2fe-0335-9571-5b219eb3f024

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4
Q

RR of hypoA in female dogs

A

1.85

https://paperpile.com/app/p/9a9096be-d2fe-0335-9571-5b219eb3f024

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5
Q

RR of death in dogs with hypoA compared to other dogs?

A

1.9

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6
Q

What percentage of cats achieved remission in a trial of exenatide ER formulation?

A

40%, the authors extrapolated rates may be more like 20% in larger studies

https://paperpile.com/app/p/dd7a38d2-a3a4-04ce-abc7-b07104127fad

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7
Q

What is the relationship between hyperTH in cats and hypocobalaminaemia, what should you do if you document low B12 in a hyperthyroid cat?

A
  • 13% of hyperthyroid cats had reduced B12 concentration pre-treatment
  • This normalised in 2/5 of these cases following treatment
  • None of the cats had increased MMA concentration
  • No correlation of B12 with T4 or clinical scores of hyperthyroidism. Therefore no treatment is required.

Essentially it is worth considering whether GI disease is present if you have a hyperthyroid cat with hypocobalaminaemia as it only occurs in a very low percentage of cases. It is also not something that requires treatment.

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8
Q

What breeds had the highest:
1. ET-1 concentration
2. PRA
3. Cortisol

A

Newfoundlands had the highest ET-1 concentration (3x higher than other breeds)
- Dacshunds had the highest PRA (2x higher than Newfoundland and Boxers)
- Cortisol highest in Finnish Lapphunds (3x higher than Boxers)

n.b. only 9 breeds studied

https://paperpile.com/app/p/47b2f75a-bfee-0787-88fc-4c98811b1dc0

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9
Q

What metabolic derrangements are known to occur in overweight dogs following a high-fat meal?

A

Overweight dogs had increased TG response and higher fasting cortisol/creatinine ratio to lean dogs

https://paperpile.com/app/p/17bbae0b-1ba5-0533-9172-6c047e70b8ac

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10
Q

What is the relationship in breed variation between Greyhounds, eicosanoid metabolites, SPB and albuminuria?

A
  • Hydroxyeicosatetraenoic acid (HETE) isomers higher in grehyounds than non-greyhounds.
  • Dihydroxyeicosatrienoic acid (DHET) isomers also higher in greyhounds
  • Albuminuria correlated to total DHET
  • SBP correlated to 11,12 EET and 20(S) DHET
  • SBP and 8,9 EET were inversely correlated
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11
Q

What is the relationship in breed variation between Greyhounds, eicosanoid metabolites, SPB and albuminuria?

A
  • Hydroxyeicosatetraenoic acid (HETE) isomers higher in grehyounds than non-greyhounds.
  • Dihydroxyeicosatrienoic acid (DHET) isomers also higher in greyhounds
  • Albuminuria correlated to total DHET
  • SBP correlated to 11,12 EET and 20(S) DHET
  • SBP and 8,9 EET were inversely correlated

https://paperpile.com/app/p/69937740-70fc-0006-b845-8b7642a8df39

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12
Q

In what conditions, other than diabetes mellitus is ketosis expected in cats?

A

Hepatic lipidosis particularly (73% of cases), CKD (21% cats) and hyperthyroidism (20% cats).

https://paperpile.com/app/p/fd9304b5-6751-0bba-8188-cff268ae6569

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13
Q

Which enzyme is responsible for the synthesis of aldosterone in the adrenal cortex, where is this expressed and what enzyme is likely responsible for the differential production of cortisol/aldosterone between these zones?

A

CYP11B2 (aldosteone synthase)
Expression is in the zona glomerulosa and zona fasciculata
CYP17 expression is higher in the zona fasciculata which may be why this zone produces cortisol

https://paperpile.com/app/p/10e74817-6f04-04c7-b29d-7cd66790027b

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14
Q

Which steroidogenic enzyme is responsible for the production of cortisol in the adrenal cortex?

A

11 b-hydroxylase cytochrome P450 (CYP11B1)

https://paperpile.com/app/p/10e74817-6f04-04c7-b29d-7cd66790027b

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15
Q

What is the relationship between BHB in dogs with acute pancreatitis vs. sick dogs without acute pancreatitis, and fasted dogs?

A

Highest in AP then sick then fasted dogs

https://paperpile.com/app/p/c01a4428-5b44-0f7e-ab98-15c1c194c642

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16
Q

% of dogs with DKA that have increased cPLI? What other marker did cPLI correlate with?

A

73%, increased cPLI was associated with lower CO2

https://paperpile.com/app/p/58dd8a27-4acc-0867-92a5-badbf1963d83

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17
Q

Period prevalence of felineDM in the UK

A

0.58%

https://paperpile.com/app/p/0e653787-de9b-0569-a88a-86034ba312a2

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18
Q

Risk factors for feline DM in the UK?

A

Age > 6 years
Bodyweight when > 4kg
Breed: tonkinese, Norweigan Forest, Burmese

https://paperpile.com/app/p/0e653787-de9b-0569-a88a-86034ba312a2

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19
Q

What marker may be used to assess soft tissue proliferation in cats with acromegaly?

A

N-Terminal Type III Procolagen Propeptide

https://paperpile.com/app/p/9c0a496b-affc-0c06-91ef-bf2696d3a5a2

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20
Q

To what degree do flash glucose measurements differ from reference laboratory glucose concentrations in dogs?

A

2.3mg/dL (0.1mmol/l). less accurate at lower glucose concentrations where the FSL tends to read lower

https://paperpile.com/app/p/3445f29f-a1d6-0577-b8c8-d255a9a05f57

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21
Q

What is the relationship of pituitary size to survival and DFI in dogs with HAC undergoing hypoP?

A

Bigger pituitart and P/B ratio associated with shorter DFI and survival

https://paperpile.com/app/p/5e2a1f28-b7be-0c3c-9c6f-697ca30e6d59

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22
Q

Which of the following is associated with a increased chance of reccurance of HAC in dogs following HypoP?
a - LDDST result
b - eACTH
c - UCCR
d - ACTH stimulation test results?

A

c

https://paperpile.com/app/p/5e2a1f28-b7be-0c3c-9c6f-697ca30e6d59

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23
Q

What dose of cosynotropin may be used for diagnosis of HAC compared to monitoring of HAC treatment?

A

Use 5ug/kg for diagnosis but a dose of 1ug/kg can be used for monitoring

https://paperpile.com/app/p/b10b7580-4396-0f8b-9179-f8c4898a477b

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24
Q

What proportion of cats with hyperthyroidism are underweight at the time of diagnosis and how does this change with treatment?

A

1/3 cats are underweight at diagnosis and the majority gain weight and BCS but around 45% of not completely regain their muscle mass. The majority of weight loss seems to be associated with muscle loss.

https://paperpile.com/app/p/c61d823c-0d3d-00b2-ab65-203af860ddad

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25
Why do we use the cut-off of 55nmol/L basal cortisol for the exclusion of hypoA?
It has better sensitivity (99.4%) compared to the lower cutoff of 22nmol/L (sensitivity 96.9%). https://paperpile.com/app/p/d9b8ba39-9ebc-0133-b233-2804ed312d29
26
What is the association of treatment of dogs with trilostane for PDH and no treatment on survival, any other factors significant in MV?
Treated dogs did not reach their MST whereas the MST for untreated dogs was 506 days. Treatement was the only significant factor in MV analysis. https://paperpile.com/app/p/596957f1-8333-076f-89fe-b1a9107b079d
27
Environmental risk factors for DM in cats
Indoor cat Obesity Being a greedy eater Feeding dry food (if normal weight) https://paperpile.com/app/p/ce6e3572-285b-0ce7-a7af-dc0bab71ef27
28
What is the relationship between dose of I131 therapy and the incidence of treatment failure vs. azotaemia?
Low dose (2mCi) did not have an increase in treatment failure compared to standard dose (4mCi). No difference between doses in the incidence of azotaemia but creatinine did trend higher in the standard dose group. https://paperpile.com/app/p/ce2e42c4-f257-0e2f-a0cf-9499389b56af
29
What is the relationship between diagnostics at diagnosis and trilostane doses in dogs with PDH and GBM/cholestasis compared to dogs with PDH without evidence of cholestatic disease?
- PDH dogs with GBM were deemed to have more severe clinical signs, higher cholesterol concentrations and higher post-ACTH corstisol at the time of diagnosis - Dogs with GBM had higher 2.5x higher trilostane doses than thoe without - Dogs with imaging evidence of cholestasis had 1.5x higher trilostane doses than normal group https://paperpile.com/app/p/3ebd887c-5f05-0369-bb0f-26eb262b3667
30
What POMC mutation has been found to NOT be associated with DM in labrador retrievers?
14 base pair deletion at exon 3, no association with DM but is associated with obesity in this breed https://paperpile.com/app/p/eb90b48c-619b-0888-9b5a-be1a13ffa694 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873617/
31
What degree of ionised hypercalcaemia has been associated with a higher risk of develoment of post-treatment hypocalcaemia in dogs with primary hyperparathyroidism?
>1.81mmol/l associated with increased risk of post-treatment iCa <1.00mmol/L https://paperpile.com/app/p/cc173fee-5fc4-0a2e-8df9-49df72e29f00
32
How ot treat a HS cat with pasireotide and success of this therapy
8mg/kg LAR q1m - Remission achieved in 3/8 (37.5%) treated cats - Improved insulin resistance overall - No significant decrease in frutosamine or median blood glucose - Significant decrease in insulin doses - Diarrhoa was frequent, followed by hypoglycaemia and worsening polyphagia. https://paperpile.com/app/p/354a6a55-7b9a-019b-8401-fc4ce38a3b88
33
How long should levothyroxine be discontinued for if you want to re-assess thyroid function in. a dog that has been supplemented but that you did not suspect had hypothyroidism?
1 week, this is a valid assumption if the dog has been treated up to 16 weeks https://paperpile.com/app/p/976fc95d-f3be-040e-9b69-27e31e5e47e4
34
Results of treatment of dogs withhyperlipidaemia with bezafibrate, time and success rate, effect on liver enzymes and cholesterol.
- 4 - 10mg/kg bezafibrate - Normalisation of serum TG after 30 days in 91.3% dogs, cholesterol only decreased in 66.7% dogs - TG decreased more in dogs with primary hyperlipidaemia than those with secondary - ALT activitydecreased significantly after 30 days of treatment - They did not actually measure ALP https://paperpile.com/app/p/0b42daeb-4211-0f9c-9abf-784906ccfcce
35
What percentage of thyroid cysts will resolve with RAI in hyperthyroid cats?
50% https://paperpile.com/app/p/0ac342e5-7ae0-0160-8a84-1c1f641fda36
36
What would be acceptable scenarios to interpret ACTH stimulation tests where tetracosactide has been known to be administered perivascularly?
Healthy dogs Dogs with HAC that are being monitored on trilostane treatment. https://paperpile.com/app/p/656ad8a9-fd8e-0e16-8018-f2e5c3758031
37
What is the relationship between breed and coat length and riskof hyperthyroidism in cats?
- DSH had increased risk of hyperthyroidism compared to pure-bred cats - Longhaired DSH were more likely to develop hyperthyroidism. - No association with coat colour or pattern https://paperpile.com/app/p/d4abd7ca-0d30-065a-8f4a-341105d8432d
38
What is the relationship between homocysteine, folic acid and hypothyroidism?
- Hypothyroid dogs had higher homocystenie and lower folic acid than healthy dogs and this is similar to what is seen in humans. - Homocysteine was inversely correlated to folic acid, TT4, fT4 https://paperpile.com/app/p/2847d0f0-c5f3-0fe0-917d-4fff1f8a531b
39
Percenatge of dogs with hypoadrenocorticism with elevated TSH and how long this takes to resolve with glucocorticoid treatment.
- Around 1/3 dogs with hypoA had increased cTSH values. - cTSH normlaised in most of these cases withiin 2 - 4 weks but took up to 4 months after initiation of glucocorticoids. https://paperpile.com/app/p/2f33adde-253e-0581-8a33-833a43518a79
40
What threshold of total calcium may be specific for diagnosis of ionsed hypercalcaemia in dogs, what condition applies to this value?
12mg/dL (2.99mmol/L) had a good PPV but poor sensitivity for ionised hypercalcaemia in non-hyperphosphataemic dogs.
41
What non-neutral short acting rh insulin has been shown to be effective in DKA management in cats?
Lispro - it resulted in shorter time to normoglycaemia than regular insulin in this study
42
What is true of the diagnostic accuracy of FGMS in dogs with DKA?
Analytical accuracy criteria are not met but results are acceptable for clinical accuracy
43
What is the mode of inheritance of DM in American Eskimo Dogs?
Polygnic
44
Are glucose readings higher in dogs in the day or night?
Night
45
What is the relationship between internded vs. delivered dose for pen vs. syringe injection methods?
Pens tend to underestimate wheras syringes may overdose
46
Which of the following injection devices has the greatest accuracy/precision up to 16U? a) JuniorSTAR b) Vetpen c) 100U/mL syringe d) 40U/mL syringe
d) JuniorSTAR and VetPen were both accurate up to 4U
47
What is the reported percentage of post-hypoglycaemic hyperglycaemia in diabetic cats and what was chracteristic of these patients?
25% Cats that had PHH had greater glucose variability and poorer control overall
48
What is the relationship of diabtic remission, IGF-1bp and TC in cats>?
IGFBP-3 and TC increase in cats following initiation of insulin treatment that go into remission compared to those that dont. N.B in this study IGF-1 increased 2 - 4 weeks after starting insulin treatment
49
MST of acromegalic cats undergoing hypoP
853 - 1347 days
50
What is the OR of diagnosis of CKD in DM cats?
4.47
51
What markers of oxidative changes are present in feline erythrocytes in cats that have DM?
Increased carbonyls and lower cytoplasmic thiobarbutyric acid reactive substances and thiols. Although these values improve with treatment they remain different from healthy cats after 12 - 16 weeks of treatment
52
What alteration allows the prolongation of duration of action of rh insulin in cats?
Fusion of the insulin to Ig Fc
53
What is the expected lag time of FGMS measurements compared to blood glucose in rapidly changing blood glucose?
30 minutes
54
Which vitamins have been shown to be decreased in dogs with EPI receiving pancreatic enzyme supplementation?
Vitamin A and E. Note that in dogs with WL vitamin D was lower
55
Should an enteric coated pancreatic enzyme supplement be used over standard supplements?
No, there is no effect of the enteric coated preperations compared to normal
56
What is the relationship of hyperadrenocorticism and calcium homeostasis?
HAC dogs seem to have increased phosphate, lower 25OHD and lower FGF23 than healthy controls although their iCa and tCa was not significantly different to controls
57
What are the strongest predictive clinical variables for prediction of HAC?
Sex, age, breed, polydipsia, vomiting, potbelly/hepatomegaly, alopecia, pruritis, ALP and USG
58
What are the following and their PPV for prediction of HAC? a) Lack of suppression pattern b) Partial supression pattern c) Escape pattern -d)Inverse pattern
a) both time points >27.5nmol/L and > 50% baseline (PPV 93.9%) b) both time points >27.5% but either <50% baseline (PPV 73.1%) c) 3h < 27.5 but 8h >27.5 (PPV 35.7%) d) 3h > 27.5 and 8h <27.5 (PPV 40%)
59
What percentage of dogs with HAC willhave concurrent adrenal and pituitart lesions on imaging?
5% 10% of dexamethasone resistant dogs had both 41% of dexamethasone resistant dogs have adrenal lesions without pituitary tumours
60
What is the likely duration of action of trilostance in dogs?
<8h
61
What clinical parameters ARE useful in monitoring hyperadrenocorticism treatement with trilostane
Haptoglobin, ALT and GGT Interestingly several studies have shown that UCCR< ACTHst, BC and eACTH are NOT useful in determing clinical control
62
What percentage of dogs with HAC will experience reduction in degree of hypertension over the course of a year of treatment?
47% n.b. 1/3 of dogs developed hypertension over a year of follow up
63
What percentage of compounded trilostane packets have acceptable strength of trilostane?
40.9%
64
What diagnostic cut-off for basal cortisol predicts ACTH stimulation cortisols that may be considered adequate? What percentage of dogs monitored using this method may have reduced adrenocortical reserve?
>3.2ug/dL (88nomol/L) - this predicts at post-ACTH cortisol of >2 (55umol/L) 21% wil have a BC >3.2 but post-ACTH stim <3.2ug/dL n.b. it is not clear what the timing of these tests were in relation to the trilostane administration
65
What drug added to a trilostane protocol may result in a reduction in pituitary macroadenoma size?
Pasireotide
66
What steroid hormonal derrangemnts have been noted in cats with hyperaldosteronism?
Increased progesterone and corticosterone Reduced cortisol
67
What is the prevalence of hypoA in dogs with chronic gastrointestinal signs? What clinical signs and electrolyted abnromalities were seen in these dogs?
4% Many of the dogs had malaena/haematochezia but not had electrolyte derrangements
68
What dose of tetracosactide can be used in the diagnosis of hypoA?
1ug/kg was found to be equivalent to 5ug/kg
69
What is the disadvantage of using the manufacturer dose of DOCP in the treamtent of hypoA and what lower dose may be effective and safe in treatment?
Increased PRA occurs in dogs on higher doses. Two studies have shown that lower doses (1.1mg/kg being the lowest) seem to be safe and effective and result in many less dogs having increased PRA
70
What biomarker may be increased in dogs with PDH vs. those wiht SARDS?
Urine MT6s:creatinine - although higher in PDH compared to SARDS it is not higher than in normal dgs
71
What percentage of Mn Schnauzer will achieve normotriglyceridaemia with a low fat diet and over what time frame?
44% over 2 - 3 months
72
What liver enzyme reduces with liposomal encapsulated fenofibrate?
ALP
73
What is the relationship between pre-operative calcium, calcitriol supplementation and post-operative hypocalcaemia in dogs with primary hyperparathyroidism?
Dogs with a iCa >1.81 have a greater incidence of post-operative iCa <1.00mmol/l although another study showed that pre-operative calcium was positively correlated with post-operative calcium and calcitriol supplementation did not influence post-operative calcium concentration
74
Prevalence of subclinical bacturia in hyperTH cats?
4.3%
75
What is the relationship of hyperTH to coagulation status in cats?
Cats with hyperTH have higher fibrinogen, AT activity and vWF:Ag concentration, however, hyperTH is not associated with an overall hypercoaguable state and TT4 is not a predictor of a hypercoaguable state
76
What cut-off of post-RAI TT4 is well associated with treatment failure? What percentage of cats that have treatment failure will become euthyroid without further intervention?
Treatment failure was present in all cats with TT4 > 150nmol/L 40% cats with treatment failure will become euthyroid without further intervention and 86% cats having a second RAI treatment will be treated successfully
77
What percentage of cats treated with bilateral thyroidectomy will develop persistent or recurrent hyperthyroidism?
22% will not be cured and 44% cats that are initially euthyroid will develop recurrent hyperthyroidism in the long term
78
What clinical feature of the thyroid gland is expected in cats with spontaneous primary hypothyroidism?
Goitre
79
If you want to diagnose hypothyroidism in a sick cat what test would be appropriate?
TSH stimulation test
80
What stimulatory testing could be considerd in dogs with suspected euthyroid sick syndrome to rule out hypothyroidism?
BAsal GH measurement and TRY stimulation test: - Basal GH is higher in hypothyroid dogs - TRH stimulation will result in an increase in GH in hypoTH dogs but not ESS dogs and TSH will increase in ESS dogs but not hypothyroid dogs
81
How soon after levothyroxine treatment should behavioural sactivity scores increase?
6 weeks
82
What is the effect of hypothyroidism on cardiac function?
It midly reduces it but this is reversible with treatment
83
What percentage of dogs with insulinoma are expected to be hyperglycaemic, what percentage of these will subsequently require long term insulin?
33%, 19%
84
What features of insulinoma are associated with survival and relapse of disease?
Stage I vs. II/III and post-operative hypoglycaemia
85
In feline maintenance diets, what mineral is reduced in canned food and is declared Ca/P typically higher or lower than analysed values?
Mg reduced in canned foods Ca/P are typicaly declared to be lower than what is found on analysis
86
What supplements may reduce the proportion of phagocytic granulocytes in cats?
Arginine and orthinine
87
What puppy diet factors have been noetd to increase/decrease the risk of subsequently developing food allergy?
Increase: Fruits, mixed-oil supplements, dried animal parts, drinking from puddles Decrease: Tripe, human scraps, fish oioil supplements, >20% raw food, <80% dry food
88
Minimum sensitity and maximum sensitivity for various tests of pancreatitis in dogs?
Sens = 73.9% Specificity = 83.8%
89
What pancreatic disease, specifically has been associated with increased SPEC cPLI?
Pancreatc neoplasia
90
Which of the following PLI tests has the best repeatability? a) SPEC cPLI b) DGGR lipase c) VetScan CPL d) Vcheck cPL
a
91
Which canine scoring system has been correlate to serum CPLI measuremets?
Modified canine activity index (n.b. this is also linked to survival in acute pancreatitis)
92
Sensitivity and specificity for AUS in diagnosis of acute pancreatitis?
43% and 92%
93
Association of ADMA and mortality in dogs with AP?
MAy be associated
94
Percentage of dogs with EHBDO secondary to pancreatitis that will survive
79%
95
Whatis the relationship between timing of clinical signs, peak bilirubin concentration and improvement in clincal signs in dogs with EHBDO secondary to acute pancreatitis?
Peak bilirubin occurs around 8d following the onset of clinical signs, but clinical improvement tends to occur before this. Biliribin will start to decrease approximately 15 days after the onset of clincal signs
96
What coagulation parameter has been associated with death in canine acute pancreatiti
Low AT levels
97
What relationship is there between changes in T4 cocentrations and the accuracy of dry chemistry analysers?
become less accurate at higher concentrations
98
What is the most common acid-base abnormality in dogs with pavoviral enteritis?
Metabolic acidosis with respiratory alkalosis
99
What percentage of dogs treated with MCT supplementation had a reduction in seizure frequency >50% over 6 months?
10%
100
Mucopolysaccharidosis type-1 a) what is it b) what breed has this been described in? c) what is the causative mutation d) Whati s the treatment
a) A lysosomal storage disorder that results in the accumulation of dermatan and heparan sulfates in cells which precipitated MODS b) Golden Retrievers c) IDUA exon 10 deletion d) Pentosan polysulfate
101
Which endocrine results have predicted survival in dogs and cats with critical illness?
Cats: TT4 and TSH Dogs: cortisol ( cut off 209nmol/L)
102
What is the most common concurrent clinical abnormality in cats with EPI?
IBD
103
What percentage of dogs will have an incidental adrenal mass on CT and what increaswes the chances of this being detected?
9.3%, being older or evaluated for neoplasia increases the chance of finding an incidental adrenal mass
104
What percentage of cortisol results wil be discordant from laboratory reference methods in samples from dogs on an ELISA?
25%
105
What lipid derrangements are asssociated with survival in sick dogs?
Hypertriglyceridaemic or hypocholesterlaemic dogs are less likely to survive
106
Why is there an issue with using humn glucometers in veterinary medicine?
Humans have approximately equal amounts of free and Hb-bound glucose whereas dogs and cats have more free glucose
107
MST of dogs with functional thyroid tumnours treated surgically
1,072 days
108
MST of dogs with parathyroid carcinoma
2 years

Specialty Revision (13 decks)

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