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SAM II > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

On Tonometry, a Low IOP Indicates ____

A

Uveitis

*Uveitis- due to Decreased Aqueous Humor Production in the face of Inflammation

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2
Q

______= Enlarged Globe Caused by Increased Intraocular Pressure from Intraocular Neoplasia or Glaucoma

_______ = Normal Size Globe that Protrudes Anteriorly due to many Diseases

A

Buphthalmos- Enlarged Globe Caused by Increased IOP from Intraocular Neoplasia or Glaucoma

Exophthalmos- Normal Size Globe but it Protrudes Anteriorly

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3
Q

Treatment for Feline Eosinophilic Keratoconjunctivitis

A

Topical Glucocorticoids

*Only if NO Corneal Ulcers

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4
Q

Are these Images of Direct or Indirect Fundic Exam?

A

Direct Opthalmic

*Tapetum will be Dorsal (Yellow)

Non-Tapetum will be Ventral (Black/Dark)

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5
Q
A

All of the Above

*Azotemia can be Prerenal, Renal or Post Renal

In this patient all the differentials are a potential cause because:

If you have Induced Pu/Pd from Cushings, as soon as a Cushings dog becomes Dehydrated they will probably develop Pre-Renal Azotemia

If the Patient is on Furosemide or Phenobarbitone, Induced Primary Polydypsia will cause Renal Medullary Washout and these animals will not be able to concentrate their Urine

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6
Q

Presenting Complaints in Cats with _____:

Severe Acute Uremia- Anorexia, Depression, Uremic Odor, Weight Loss, Oligo/Anuria

Prevalent in Cats Older than 7 Years of Age

Ureterocolic Sign

A

Ureteral Obstruction

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7
Q

Review Card:

A

QUESTION ON EXAM- Comparing and Contrasting Indirect vs. Direct. KNOW THE DIFFERENCE BETWEEN THESE TWO

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8
Q

Fundic Signs of ______ Degeneration:

Hyperreflectivity: Shiny Bright Tapetum due to Thinning of Retinal Layers allowing More Light to be Reflected back from Tapetum

Decreased Vessel Size (Attenuation)

Nontapetal Pigment Epithelial Clumping

A

Retinal Degeneration

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9
Q

Congenital Uveal Disease Described Below:

Failure of Complete Regression of Embryonic Pupillary Membrane

No Treatment

A

Persistent Pupillary Membranes

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10
Q

What is your Diagnosis?

BCS: 1.5/5 (Emaciated)

Mucous Membranes: Pale

Hydration Status: Tacky M/M, Positive Skin Tent

Abdominal Palpation: Kidneys are Firm, Small and Irregular

A

Chronic Kidney Disease

*Small Irregular Kidneys = Chronic Kidney Disease

Patient with Small Irregular Kidneys, Inadequetaly Concentrated Urine, and Azotemia = Chronic Kidney Disease

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11
Q
A

Meibomian Gland Tumor

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12
Q

Acquired Retinal Disease Described Below:

Dogs: 5-10 years Old, Often Obese

Acute/Sudden Onset of Blindness

Mydriasis (Dilated)

Slow/Absent Pupillary Light Reflex (PLRs)

Normal Fundus Exam Initially!!!!!!

A

SARDs

*Sudden Acquired Retinal Degeneration Syndrome

*Will be Question on Exam!!!- KNOW THIS

*Ex. Owner swears the Dogs vision was fine last night and woke up in the morning and dog was bumping into walls- Sudden Vision Loss

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13
Q

Lacrimal Glands are part of the _____ Layer of the Precorneal Tear Film

A

Middle Aqueous Layer

*Outer Lipid Layer is very Important because it stabilizes the entire three layers of the Tear Film and it slows evaporation

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14
Q
A

Predisilone

*Prednisilone is CONTRAINDICATED in ICGN due to the Side Effects that would Worsen the Azotemia and Increase Proteinuria

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15
Q

Calculate the Total Fluids given in the First 24 Hours

A

Dehydration: 5 x BW x 10 (First 4-6 Hours)

Insensible Loss: 22 ml/kg/day (ALWAYS)

Ongoing Loss: 250mg x 5/day

Sensible Loss: 4 ml/kg/hr

Total = 4610 ml/24 Hours

_*RE-ASSESS after 6 hours_

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16
Q
A

Descemetocele or Melting Ulcer

*Picture is of a Conjunctival Graft

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17
Q

Feline Glaucoma is usually _____ to Chronic _____.

A

Secondary

Uveitis

*In Dogs we are More concerned about Primary Glaucoma, while in Cats we always want to look at Secondary Diseases, like Chronic Uveitis

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18
Q

Type of Primary Glaucoma Described Below:

Abnormal Iridocorneal Angle due to Developmental Changes in Pectinate Ligaments forming a Sheet of Tissue rather than Individual Ligaments (Harder for Fluid to Flow out)

Inherited Change in Many Breeds

Maintain Normal Intraocular Pressure (IOP) for years, then one eye Develops Glaucoma

A

Narrow/Closed Angle

*Most Common type of Glaucoma

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19
Q

Contraindications for use of Mydriacyl for Pupillary Dilation (Mydriasis)

A

Glaucoma

Some Lens Luxations

*Before you put Tropicamide/Mydriacyl into a Patients Eye, you need to Make sure that the Intraocular Pressure is Normal and therefore no Glaucoma

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20
Q

Medical Treatment for Bullous Keratopathy

A

Topical 5% Sodium Chloride Ointment

*Minimize Edema and Bullae Formation

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21
Q

Name the Two Broad Risk Factors of Acute Renal Failure

A

Community Acquired (Ex. Leptospirosis)

Hospital Acquired (Ex. Septic Shock, NSAIDs)

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22
Q

For the General Treatment of Ulcerative Keratitis (Corneal Ulcers), which Drugs should be AVOIDED/CONTRAINDICATED

A

Corticosteroids

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23
Q

Urolithiasis Described Below:

Magnesium Ammonium Phosphate Hexahydrate

Found in Dogs commonly Related to Urinary Tract Infections

Common in Intact Toy Breed Female Dogs

Urease Producing Bacteria (NH3)

A

Struvite

*Struvite = Lower Urinary Tract Infection

*Bacteria Produce Ammonia that will change the Urine pH to Alkaline

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24
Q

Renomegaly Disease Described Below:

Prevalent in Persian and Persian Cross Cats

Autosomal Dominant

Mutation in PKD-1 Gene

Multiple Cysts Form in Both Kidneys and Increase in Size and Number with Time

A

Polycystic Kidney Disease

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25
Q

Etiologies associated with ______:

Noxious Insult- Ex. Cat Scratch, Plant Material

Anatomical Abnormalities- Ex. Ectopic Cilia

Infectious Agents- Pseudomonas Melting Ulcers

Corneal Degeneration

Nerve Damage

Keratoconjunctivitis Sicca

A

Ulcerative Keratitis (Corneal Ulceration)

*Most Common Cause of Corneal Ulceration- Noxious Stimuli such as Scratching/Trauma

*Infectious Agents- Any time you have Damage to the Cornea, can lead to Secondary Bacterial Infection. Pseudomonas causes MELTING ULCERS

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26
Q

Surgical Treatment for Keratoconjuntivitis Sicca that is Described Below:

Indications: Patients where Medical Therapy Fails

Procedure: Transposition of Parotid Salivary Duct to Conjunctival Fornix

Provides Salivary Lubrication to the Eye

A

Parotid Duct Transposition

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27
Q

Treatment for Proptosis

A

Lubricate Globe

E-Collar

If Eye won’t stay in Socket- Lateral Canthotomy or Temporary Tarsorrhaphy

If Completely Avulsed- Enucleation

*Lateral Canthotomy- Sometimes the eyeball is stuck so far out that you can’t push it back in. You will need to Cut the Lateral Canthus, push the eye back in, and then suture it together

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28
Q
A

B. Renal Insufficiency

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29
Q

Acquired Lens Disease Described Below:

Normal Aging of Lens- Lens becomes Dense

Changes Refractive Index: Bluish Grey Appearance when Light Hits eye at Angle

Does NOT affect Vision

Can see Fundus Clearly

Starts about 7 Years of Age

A

Nuclear or Lenticular Sclerosis

*Not A Disease

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30
Q

Three Routine Ocular Diagnostic Tests that should be done on all Ophthalmic Examinations

A

Schirmer Tear Test

Fluorescein Staining

Tonometry- Measure of Intraocular Pressure

*Always done in this Order- Know the Order and why!

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31
Q

In Cases of Treating Melting Ulcers, _____ should be Given in addition to Frequent Antibiotics:

Autologous Serum has Alpha 2 Macroglobulin and Alpha 1 Protease Inhibitors

A

Anticollagenase

*Using the Patients OWN Serum

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32
Q

Most common Microbial Isolate in Cases of Lower Urinary Tract Infections

A

E.Coli

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33
Q

Method for Examination of the Posterior Eye Described Below:

Uses Condensing Lens and Head Mounted Light Source

Provides Binocular View and Stereopsis (Depth)

Image will be Inverted and Reversed

A

Indirect using a Head-Mounted Light Source (Binocular Lenses)

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34
Q

Oliguria = Less than ____ ml/kg/hr Urine Production

A

0.5

*Oliguria: Production of abnormally small amounts of urine

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35
Q

Diagnosis based on Images

A

Uveitis

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36
Q

Review Card: IRIS staging for Chronic Kidney Disease

Stage I: Non Azotemic Kidney Damage

Stage II: As soon as the Patient Becomes Azotemic

Goals of Managment:

Stage I: Identify Primary Disease and Start Specific Therapy to Eliminate Disease if Possible

Stage II and III: Retroprotective Therapy to Slow Progression

Late Stage III and IV: Symptomatic Therapy

A

Proteinuria: Have to show that the Urine Protein remains elevated (Above 0.5) for an Interval Longer than Two weeks

Need to Know: Cut off for a Canine Proteinuric sample and Feline Proteinuric Sample:

Canine > 0.5 = Proteinuric

Feline > 0.4 = Proteinuric

*Proteinuria Increases Risk of Developing End-Stage Chronic Kidney Disease and Mortality. Proteinuria in Cases of Chronic Kidney Disease is a VERY Strong prognosticator for Outcome

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37
Q
A

C. Treat with 30-50% of Total Dose in Evening for 6 Months

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38
Q

Fundic Exam showing Hyporeflectivity, Hemorrhage and _____

A

Retinal Detachment

*All of the Layers around the Optic Nerve are Ballooning Forward

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39
Q

Type of Ulcerative Keratitis Described Below:

Uncomplicated Ulcer that Involves Variable Degrees of Loss of the Corneal Epithelium and Basement Membrane

Does NOT Extend into the Stroma

Smooth Appearance to Ulcer

A

Acute Superficial Corneal Ulceration (Erosion)

*Epithelial Layer of the Cornea is affected

*The Epithelial Layer is HYDROPHOBIC. Should Not see Dye Uptake if the eye is Normal. If the Epithelial Layer is Abnormal we will see Dye uptake- Dye is getting into the Stromal Layer (Hydrophilic)

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40
Q

Name the Eyelid Disease Described Below:

Aberrant Cilia Erupt form Meibomian Gland Openings

Common in Dogs- Cocker Spaniels, Poodles ect.

A

Distichiasis

*Distichiasis- Fine Hairs growing out of the Meibomian Gland Ducts

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41
Q
A

5550

*If we Suspect Acute Renal Failure: Replace all the dehydration within the First 6 Hours

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42
Q

The Tapetum is Located _____ in Direct Ophthalmoscopy

A

Dorsally

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43
Q

Test used to Quantify Proteinuria that has an Excellent Correlation with a 24 Hour Urine Protein Measurement

A

Urine Protein:Creatinine Ration

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44
Q

Most Common Intraocular Tumor in Dogs and Cats

A

Melanomas

*Refer or Enucleation

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45
Q

Specific Therapy For Acidosis caused by Acute Renal Failure

A

IV Bicarb Administration

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46
Q
A

Pre-Renal

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47
Q

Acquired Vitreal Disease Described Below:

Calcium and Phospholipids Condense within Vitreal Gel

A

Asteroid Hyalosis

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48
Q

Tear Film Disease that is Synonymous with Quantitative Tear Deficiency, which is a Progressive Disease that results in Dessication and Inflammation of the Conjunctiva and Cornea, Ocular Pain, Progressive Corneal Disease and Reduced Vision

A

Keratoconjunctivitis Sicca (Dry Eye)

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49
Q

Treatment for Renal Adenocarcinoma

A

Nephrectomy

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50
Q

Inflammation of Choroid and Retina usually due to Infectious Agents such as:

A

Chorioretinitis

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51
Q

Most Important Aspect of Treatment in Cases of Acute Renal Disease

A

Fluid Therapy

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52
Q
A

Benazepril

*In Dogs you start with an ACE Inhibitor in the Treatment of Hypertension

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53
Q

Surgical Treatment used in Cats with Reccurent Urethral Obstructions

A

Urethrostomy

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54
Q
A

Horner’s Syndrome

*Three Components of Horners Syndrome: Myiosis, Ptosis, and Enopthalmus

*Which part of the Nervous System is Damaged? Sympathetic

*When Sympathetic System is Damaged, the Pupils can’t Dilate

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55
Q

Summary Card for Glaucoma

A
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56
Q
A

D. Normal Urine SG is 1.007-1.015

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57
Q

______ Glaucoma Occurs due to Concurrent Ocular Disease that Obstructs Aqueous Outflow such as:

Uveitis (Most Common)

Lens Diseases- Ex. Lens Induced Uveitis, Lens Luxation

Intraocular Neoplasia

Trauma

A

Secondary

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58
Q

Treatment for Nonhealing Superficial Ulcers (Indolent Ulcers)

A

In Addition to Treatment for Superficial Ulcer (Antibiotics, E Collar):

Debride Ulcer- Repeat 2-3x’s at 7-14 day Intervals

IF no Response to Debridement:

Grid or Punctate Keratotomy- Create Scaffolding for cells to Migrate onto Stromal Layer

IF no Respone to Grid or Punctate Keratotomy:

Superficial Keratectomy

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59
Q

Currently Best Approximation of Glomerular Filtration Rate for a Practice Setting Described Below:

Synthesized by Breakdown of Creatine in Skeletal Muscle

Produced at Constant Rate

Influences Less by Diet

Excreted Unchanged by Kidneys

A

Creatinine

*Neither Secreted nor Reabsorbed by Kidney- Excreted Unchanged = Good Approximation of Glomerular Filtration Rate

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60
Q

Common Presenting Signs for which Kidney Disease:

PU/PD: Notcuria

GI Signs: Vomiting, Anorexia, Weight Loss, Diarrhea

Poor Body Condition/Underweight

Pale Mucous Membranes: Dehydration

Small Irregular Kidneys

A

Chronic Kidney Disease

*Earliest Sign- PU/PD

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61
Q

Review Card: Types of Ulcerative Keratitis

A

Review Card: Healing of Superficial Stromal Ulcer

1. Within 30 Minutes to a Few Hours, White Blood Cells will come in and attempt to Fill the Defect

2. Then Keratocytes (Cells of the Cornea) Transform into Fibroblasts

3. The WBC’s have Collagenases that come in and Break up some of the Collagen so the Cornea can be Restructured. If the Collagenase Activity is Excessive results in Melting Ulcer

4. Epithelial Cells fill the Defect and Fibroblasts lay down Collagen to Restore Stromal Defect

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62
Q
A

A. Conjunctivitis, Corneal Ulcer

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63
Q

Only Indication for Third Eyelid Gland Removal

A

Third Eyelid Neoplasia

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64
Q

Name Eyelid Disorder Described Below and Treatment:

Meibomian Gland Duct becomes Obstructed and Sebaceous Gland Secretions Accumulate (Yellow and White Caseous Gland Material)

Produces Local Pea-Like Swelling and Inflammation of Surrounding Tissue in Upper or Lower Eyelid

Not usually Painful

A

Chalazion (Meibomian Cyst)

Treatment- Surgical Removal

*Treat if Enlarged and Causing Discomfort

Chalazion Cysts occur on the INSIDE of the Lid

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65
Q
A

Temporary Tarsorrhaphy

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66
Q
A

Alkalosis

*Acute Renal Tubular Injury = ACIDOSIS

*The Primary Role of the Proximal Tubule is to Reabsorb Bicarbonate and Excrete Hydrogen Ions. When there is a Deficiency there these patients become Systemically Acidodic

In Addition there would be Glucosuria and a High Fractional Excretion of Sodium- Most of the Sodium that is Filtered through the Glomerulus is Reabsorbed by the Proximal Tubular Cells

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67
Q

Acquired Uveal Disease Described Below:

Old Dogs/Cats

Scalloped Margin to Pupil- Abnormal Shape

Pupillary Light Reflex (PLR) Reduced

No Treatment

A

Iris Atrophy

*Changes in the Iris due to AGE- Iris is Atrophying with Old Age

Abnormal Shape to Pupil Opening- Think IRIS Disease

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68
Q

Four Common Biochemistry Abnormalities in Patients with Chronic Kidney Disease

A

Hyperphosphatemia

Hypokalemia

Hyper/Hypocalcemia- Majority Hypocalcemia

Metabolic Acidosis

*These Biochemistry Abnormalities Manifest in Stage III and IV Chronic Kidney Disease

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69
Q

List the Four Stages of Cataract Development

A

Incipient:

No Change in Vision

Affects

Immature:

Vision affected if Bilateral

Mature:

Affects 100% of Lens

Can’t see Fundus

If Bilateral = Blind

Totally Opaque Lens

Hypermature:

Shrinking due to Reabsorption of Outer Lens Material

Partial Vision may Return- Periphery

May Induce Lens Induced Uveitis

May Predispose to Retinal Detachment

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70
Q

Name and Describe Three Methods used for Tonometry Measurement of Intraocular Pressure (IOP)

A

Indentation (Schiotz)- Detects how much Force to Indent the Cornea

Applantation (Tonopen, Accupen)- Detects how much Force is Needed to Flatten a Predetermined area of Cornea

Rebound (TonoVet)- Calculates IOP Based on the acceleration and deceleration of a Probe to and From the Corneal Surface

*Applanation and Rebound are far more Accurate and Easier to use but are Very expensive

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71
Q

Description of which Stage of Acute Renal Failure:

A

Initial Phase

*No Clinical Signs!!!

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72
Q

Type of Ulcerative Keratitis Described Below:

Epithelium Fails to Attach to Basement Membrane as Ulcer Attemps to Heal

Diffuse Ring of Less Intense Staining around the Defect- Stain diffusing underneath Poorly Attached Epithelium

Never Extends to the Stroma- Unless Concurrent Deep Ulcer

A

Nonhealing Superficial Ulcers (Indolent Ulcers)

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73
Q

Treatment of Choice for Ectopic Ureters

A

Cystoscopic Laser Ablation

*Gold Standard of Treatment and Diagnostics

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74
Q
A

Mycophenolate Mofetil

*ICGN- Immune Complex Glomerulonephritis

*Mycophenolate is the DRUG OF CHOICE for ICGN

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75
Q
A

High K+

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76
Q

Common Optic Exam Findings in Animal with _____ Disorders:

Absent Menace

Usually Dilated Pupils with Poor/Absent PLR’s

A

Retinal or Optic Nerve Disorders

*Usually Pupils will be DILATED with Retinal or Optic Nerve Disease

*If the Lesion is Located in the Fundus, Retina, or Optic Nerve you will expect to see an Abscent or Very Poor Menace and Absent/Poor Pupillary Light Reflexes (PLR’s)- KNOW THIS

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77
Q

Key Clinical Signs of which Eye Condition:

Rapid/Acute Onset of Painful Prominent Eye- Exophthalmus

Pain Opening Mouth-** **Hyperemia and Swelling of Oral Mucosa

Hyperemia (Red Eyes)

Chemosis

Protrusion of Third Eyelid

Possible Fever and Leukocytosis

A

Orbital Infection/Orbital Cellulitis

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78
Q
A

Subcutaneous Ureteral Bypass (SUB)

*Both Ureteral Stent and SUB are viable options in this Cat, However SUB is considered the Standared of Care currently

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79
Q

“Go to” Drug for Medical Treatment of Urinary Sphincter Mechanism Incompetence (SMI)

A

Phenylpropanolamine (Once Daily)

*Mainstay of Managment for Incontinent Bitches

*If you have a Dog that is Refractory to Treatment with Phenylpropanolamine, you should ADD on Estriol

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80
Q

Most commonly used Laboratory Test for Glomerular Function Described Below:

A

Urea

Limitations: There are extrarenal Factors that Contribute towards Urea Concentration: Ex. Species, Age, Liver Function, Dietary Protein Content

*These Limitations can Falsely Increase the Level of Urea and create False Positives in terms of Glomerular Filtration

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81
Q

Treatment in Cases of Recurrent Lower Urinary Tract Infections

A

Extended Antibiotic Therapy: 4-6 Weeks

Prophylactic Therapy: 6 Months (Nitrofurantoin)

*Prophylactic Therapy: Once you have steralized the Infection with 4-6 Weeks of Antibiotic Therapy, you then choose the Drug that the Bacteria is Sensitive too and Dose it Once Daily at 30-50% of Original Dose

*Prophylactic Therapy is Administered at Bedtime so that the Antibiotic will accumulate in the bladder over night

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82
Q

Azotemia does NOT Develop until Glomerular Filtration Rate has Decreased to ___%

A

25%

*Creatinine Does NOT begin to Increase above Normal until GFR is Decreased to 25% or Lower

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83
Q
A

Anisocoria

Aniscoria- condition characterized by an unequal size of the eye’s pupils

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84
Q

How would you Treat this Patient?

Diagnostics:

Healthy, Current on Vaccinations, No Flea/Tick Prevention

Anterior Fibrinous Uveitis

Lens, Retina and IOP WNL

Toxoplasma, Bartonella and Cryptococcus Titers- Negative

A

Topical and Systemic Corticosteroids (Reduces Inflammation)

Topical Atropine (Keep Eyes Dilated- Prevent Synechia)

*Diagnosis: Idiopathic Anterior Uveitis

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85
Q

Etiology of Conjuncitivis in the Cat Described Below:

Obligate Intracellular Bacterium

Chemosis

Often Folicular

A

Chlamydophila Felis Conjunctivitis

*Obligate INTRACELLULAR bacterium of Cats often causing Conjunctivitis

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86
Q

Treatment for Pannus

A

Topical Immunosuppression: Topical 0.1% Dexamethasone, Topical Cyclosporine A, or Pimecromilus (Possibly Combination of all Three)

Minimize UV Light Exposure- Sunglasses made for Dogs

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87
Q

Lacrostimulant used for the Treatment of Keratoconjunctivitis Sicca Described Below:

T cell Inhibitor

Directly Lacrimogenic

Inhibits Pigmentation and Vascularization

A

Topical Cyclosporine A

*Must be Administered BID (Twice Per Day): Q 12 Hr topically

Cyclosporine A- IDEAL Treatment for KCS

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88
Q

Corneal Layer Described Below:

Thin Basement Layer of Elastic Collagen

Does NOT Stain with Fluorescein

Corneal Ulcer that Extends to this Layer: ONLY Sides of Crater will Stain with Fluorescein

A

Descemet’s Membrane

*Descemetocele- Close to having the Eye Rupture. Only One more Layer to Complete Eye Rupture

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89
Q
A

B. IRIS III, BP, RND

*UPCR = 0.4- In a Dog this Falls into the Boarderline Urine Protein Range, therefore we would Classify him as BP (Boarderline Proteinuric)

No Blood Pressure was Measured = RND (Risk Not Determined)

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90
Q

Eye Condition Described Below:

Decreased Outflow of Aqueous Humor

A

Glaucoma

*Glaucoma Pathogenesis- Aqueous Humor can’t get out (Obstruction)

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91
Q

Use Tonomotry to Measure Intraocular Pressure (IOP) prior to _____, as ____ is Contraindicated in the Glaucomatous Eye

A

Mydriasis (Dilation)

*Always take Intraocular Pressure before Dilating the Pupil. If we find that the animal has Glaucoma, then we will NOT Dilate the eye (Contraindication)

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92
Q

Treatment for Feline Herpesviral Conjunctivitis

A

Topical Ocular Antibiotics TID-QID

Topical Ocular Antivirals

*Topical Antiviral Agents only used for Persistent, Severe, or Chronic Herpesviral Infection

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93
Q

Non-Ulcerative Keratitis Described Below:

Multifocal Puncuate Circular Grey Fluffy Cotton-Like Opacities in Corneal Stroma

Typically Asymptomatic

No Treatment found to be Helpful

A

Florida Keratopathy (Florida Spots/Caribbean Keratopathy)

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94
Q

Non-Ulcerative Keratitis Described Below:

Raised, Proliferative, White-Pink Lesion that Starts on the Lateral Conjunctiva and Progresses to Cornea and Centrally

Can Progress to Blindness

Infiltrates of Eosinophils, Plasma Cells and Lymphocytes

May be Associated with Feline Herpesvirus (FHV-1)

A

Feline Eosinophilic Keratoconjunctivitis

*Caused by Herpes until proven otherwise

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95
Q
A

Creatinine Concentration

Phosphorous

Renal Proteinuria

Blood Pressure

Elevated BUN

*No Signficant change in Prognosis due to the Presence or Absence of Hypokalemia, Hypocalcemia, and Vomiting

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96
Q

Most Common Cause of Glaucoma in Cats

A

Uveitis

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97
Q
A

Ehrlichiosis

*Immune Complex Glomerulonephritis- Antigen Antibody Complexes deposited on the Glomerulus. Usually caused by Cancer or Infectious Disease going on in the Body

*Only Ehrlichiosis is Responsible for the Deposition of Immune Complexes

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98
Q

Corneal Layer Described Below:

A

Epithelium

_*This Layer is HYDROPHOBIC- It repels Water. When we do a Fluorescein stain on a normal eye, nothing is taken up. If this Epethelium Layer is damaged, the Fluorescein will be Absorbed by the Next Layer down (Stroma)_

_*Ulcer will look SMOOTH_

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99
Q

Therapy Described Below that is Very Helpful in Patients with Advanced Staged Chronic Kidney Disease:

A

Erythropoietin Therapy

*Should be Reserved for the Last 6-8 Months of the Patients Life

When the Patient has a PCV

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100
Q

Treatment of Choice for all Lens Luxations and Subluxations

A

Lens Removal

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101
Q
A

Magn Ammonium Phosphate (Struvite)

*Radiograph: Large Radiodense Uroliths with Smooth Edges

Female Toy Breed: Shih Tsu = Struvite

Cysteine and Urate- Radiolucent

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102
Q

Which Breed is Predisposed to Development of Pannus and how Does Age play a Role in the Severity?

A

German Shepherds

Young (1-5 Years):

Severly Progressive and Extensive

Old (4-6 Years):

Slowly Progressive and Extensive

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103
Q

On Tonometry, a High IOP Indicates _____

A

Glaucoma

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104
Q

True/False: There is No Evidence to Support the use of a Renal Perscription Diet in Acute Renal Injury

A

True

*No Evidence to Support use of Renal Perscription Diet in ACUTE Kidney Injury. However, Renal Perscriptions Diets are the Most Important managment tool in CHRONIC Kidney Injury

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105
Q

Pathomechanism behind which Micturition Disorder (Urinary Incontinence):

Lack of Estrogen will Decrease Sensitivity of Smooth Muscle Receptors to Symphathetic Stimulation (Estrogen Responsive Incontinence)

A

Urinary Sphincter Mechanism Incompetence

*ESTROGEN Dependent Geriatric Dog Condition

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106
Q
A

US Guided Pyelography

*Peanut Butter has “Big Kidney Little Kidney” Syndrome

Ultrasound Guided Pyelography- Unilaterally in the Kidney we are Investigating and with the Aid of Radiographs or CT we will Image the Ureter and see if there is a Narrowing

*This Cat is Azotemic- should not use Intravenous Contrast Agent- Could Damage Kidney Function even more

107
Q

First Choice Treatment for Protein Losing Nephropathy/Glomerulonephritis

A

Immunosuppressive Therapy- Mycophenolate

108
Q

Clinical Signs of which Feline Lower Urinary Tract Disease:

Increased Frequency of Urination

Vocalizing when in Litter Tray (Pain)

Empty Bladder on Palpation (Non-Obstructive)

A

Feline Idiopathic Cystitis

*Bladder is Empty = No Obstruction

109
Q

Treatment of Hyperphosphatemia in Patients with Chonic Kidney Disease

A

Dietary Phosphate Restriction- Renal Prescription Diets

Intestinal Phosphate Binders- Aluminium Hydroxide (Mix with Food)

110
Q
A

Uveitis

111
Q
A

B. Renal Tubular Acidosis

Increased Blood Glucose: Due to Stress Hyperglycemia

Does this Blood Glucose exceed the Renal Threshold? No! Renal Threshold in a Dog is 10 mmol/L . If there is Glucose in the Urine, it is NOT because the Blood Glucose is too high, but Rather because the Proximal Tubules are not doing their Job and reabsorbing the Glucose that is Filtered

Sediment = Renal Tubular Epithelial Cells = Damage to Tubules

USG: 1.022 = Inadequtely Concentrated- Some Tubular Dysfunction

112
Q
A

Non Healing Superficial Ulcer (Indolent Ulcer)

113
Q

Corneal Layer Described Below:

A

Stroma

*Largest Layer of the Cornea!!

HYDROPHILIC- Takes up Fluorescein Stain (CRATER)

*Turn over is 2 Years- An Ulcer involving the Stroma will take a Longer time to Heal

114
Q

At which Level of Intraocular Pressure would you Diagnose Glaucoma?

A

25 and Above

115
Q

Excessive Collagenase (Enzyme) activity in Stroma = Breakdown of Collagen and a _______

A

Melting Ulcer

116
Q

Micturition Disorder Described Below:

Responsible for 85% of Incontinence Cases

Clinical Examination:

Soiled Perineal Coat/Urine Scald

Incidence is Higher in Large Breed Dogs

Typical Signalment: Spayed Geriatric Bitch

A

Urinary Sphincter Mechanism Incompetence (SMI)

*Will see evidence of Urine Leakage- Soiled Perineal Coat

117
Q

Ulcerative Keratitis Described Below:

Characterized by Vesicles in Stroma (Bubbles in Stroma)

Due to Chronic Endothelial Disease

Bullae may Coalesce to Form Large Bullae

Surrounding Stroma and Epithelium may be Edematous

A

Bullous Keratopathy

*Looks Like Bubbles in the Stroma

118
Q

Does this Patient have Exophthalmos or Buphthalmos?

Increased Intraocular Pressure (IOP)

Blind with Mydriasis (Dilated Pupil)

Painful- Pawing at Eye

Firm but should Retropulse

A

Buphthalmos

119
Q

Non-Ulcerative Keratitis Described Below:

Focally Pigmented Endothelium Opacity and Uveal Strand that Extends from Iris Collarette

Common for Strand to be resorbed leaving Patch on the Back of Cornea

Naturally Regresses from Pupillary Membrane during the First 6-8 Weeks of Life

A

Persistent Pupillary Membrane

*Usually of Minimal Significance and Generally No Therapy is Needed

120
Q
A

B. CaOx

*Min. Schnauzer = Calcium Oxalate Crystals

*Radiograph: Radiodense Uroliths

Cysteine and Urate are Radiolucent- Will not See on Radiographs

121
Q

Limitations of which Measure of Glomerular Function:

Subject to Passive Reabsorption in the Tubules

GIT Bleeding, Intravascular Hemolysis = False Positive

High Protein Diet can lead to False Positive

A

Urea

122
Q
A

Amlodipine

*In Cats we Treat Hypertension with Amlodipine in Cases of Chronic Kidney Disease

123
Q

The Conjunctiva contains Goblet Cells that Secrete the ____ Layer of the Tear Film

A

Mucin

124
Q

97% of Ureteroliths in Felines were ______

A

Calcium Oxalate

125
Q

Treatment for Superficial Punctate Keratitis

A

Topical Steroids

This is an Exception to Avoiding Topical Steroids with Corneal Ulcers!!

126
Q

Treatment for Cataracts

A

Phacoemulsification

*Prognosis: Good for Return of Vision if No Retinal Disease Present

127
Q

Intraocular Prosthesis and Intravitreal Gentamicin Injections are NOT USED IN CATS because of Possible _____ Development

A

Sarcoma

*Cats are Predisposed to Sarcoma due to any type of Eye Trauma

128
Q
A

Replace Gland via Surgery

*Cherry Eye

*NEVER Remove the Gland

What if it were a 10 Year old Dog? More Concerned about Tumors in Older Dogs. Still could Possibly be Cherry Eye but now Neoplasia is going to be on the Rule out List due to the Patients Age

129
Q

We Achieve Mydriasis (Pupillary Dilation) by application of _____ (0.5 to 1% Tropicamide)

A

Mydriacyl

*Rapidly Dilates Pupil within 15-30 Minutes

Short Duration- 6-8 Hours

130
Q

Treatment for Acute Superficial Corneal Ulceration

A

Topical Antibiotics- BNP or Gentamycin (1 Drop Q 6 Hours)

If Miosis or Uveitis Present- Atropine

Supportive: E Collar and Recheck in 1-4 Days

*Side Note: BNP is NOT Recommended in Felines. Instead it is Better to use Terramycin, Erythromycin, Chloramphenicol or Gentamicin in Cats

131
Q
A

Hetastarch

132
Q
A

Hypocoagulable State

*Glomerulonephritis = HYPERcoagulable State

133
Q

Treatment for Uncomplicated Urinary Tract Infection (UTI)

A

Empirical Antibiotics- Trimethoprim Sulfa or Amoxycilin (10-14 Days / 2 Weeks)

*Ex. Female Dog presents with Stanguria, Pollakuria and Hematuria with Malodor = Uncomplicated UTI

*Majority of these Dogs will be Cured and never have UTI again

134
Q
A

Prostatic Carcinoma

*Male NEUTERED Dog- there should be no Palpable Prostate

Prostatic Carcinoma is the ONLY choice that will occur in a Castrated Dog. All the Other choices will only Occur in Intact Dogs

135
Q

Etiology of 70% of Chronic Renal Diseases in Dogs and Cats

A

Chronic Intersitial Nephritis

*Tubular Interstitial Kidney Disease

136
Q

Treatment for Eyelash/Cilia Disorders: Trichiasis, Distichiasis, and Ectopic Cilia

A

If Asymptomatic- Monitor

DO NOT PLUCK LASHES- Regrow as Multiple

Cryoepilation (Freezing)- Surgical Treatment of Choice of Distichia

*Surgical Removal only if the Patient is showing Clinical Signs

137
Q

Type of Ulcerative Keratitis Described Below:

Superfical Ulcer that is NOT Healing within 1-2 Weeks of Treatment

Factors Preventing Healing:

Underlying Ocular Disease

Persisten Infection: Herpes Virus in Cats

Corneal Abnormalities in Dogs- Epithelium does not stick to Stroma Resulting in a Non-Healing Ulcer: Epithelium Lip or “Peel”

A

Nonhealing Superficial Ulcer (Indolent Ulcers)

_*Lip or “Peel”!!_

138
Q

Therapy for Struvites

A

Acidifying Dietary Trial (Target pH as Acid)

Antimicrobials- If Infection is Present

*Acidifying Diet will Dissolve the Struvite Stones

139
Q

Review Card: Lens Disease Treatment

A
140
Q

Four Phases of Acute Renal Failure

A

1. Intial- Not associated with Clinical Signs

2. Extension- Not associated with Clinical Signs

3. Maintenance- Highest Creatinine Concentration and Lowest

Glomerular Filtration Rate (Know This)

4. Recovery

*First Two phases are NOT associated with Clinical Signs

141
Q
A

PKD (Polycystic Kidney Disease)

*Middle Aged PERSIAN Cat with Azotemia/Renal Failure (PuPd)- There is more than 75% Destruction of the Kidney

Kidneys are Irregular and Painful!!!!- PKD

142
Q

Definitive Treatment for Patients with Acute Renal Failure

A

Extracorporal Renal Replacement Therapy (ERRT)

143
Q

True/False: Primary Infectious Conjunctivitis is Rare in Dogs, and Common in Cats due to Feline Herpesvirus

A

True

144
Q
A

Iris Stage IV Azotemia

*If a Patient is in Advanced Kidney Failure there would be No Benefit to a Biopsy and we would Worsen the Renal State

145
Q
A

B. That Iris Prolapse will Occur

*Desmetocele

146
Q

Corneal Layer Described Below:

A

Posterior Epithelium/Endothelium

*Pumps water out of the Stroma to keep it Clear

147
Q

Difference between Relapse versus Reinfection Urinary Tract Infections

A

Reinfection:

New/Different Organism

Culture/Sensitivity Positive > 7 Days after Last Treatment

Culture/Sensitivity Positive at Day 7 after Starting Antibiotics

Relapse:

Same Organism/Strain

Inappropriate Drug, Dose, Frequency or Duration

148
Q

Initial Treatment in Cases of Uveitis

A

Topical Prednisolone or Dexamethasone QID

Topical Atropine

*Only if No Corneal Ulcers

149
Q

Two Drugs that can Induce Keratoconjunctivitis Sicca

A

Sulfa Drugs

Etogesic

*KNOW THIS- Exam

150
Q
A

Trichiasis

151
Q

Non-Ulcerative Keratitis Described Below:

Pigment in Cornea and Subepithelial Surface Stroma

Inflammatory Non-Ulcerative Corneal Disease

Etiology: Distichiasis, Trichiasis, KCS (Chronic Irritation)

A

Pigmentary Keratitis

152
Q

Treatment Described Below for Nonhealing Superficial Ulcers (Indolent Ulcers):

Grid: Scar Corneal Surface with Grid Pattern

Punctate: Make Small Divets in Cornea

A

Grid and Punctate Keratotomies

153
Q

Congenital Uveal Disease Described Below:

Holes or Defects in Uveal Tissue: Iris or Choroid

Typical at 6 o’clock

A

Colobomas

154
Q

Treatment Described Below for Nonhealing Superficial Ulcers (Indolent Ulcers):

BEST chance of Success (99-100%)

Most Invasive

Remove Epithelial Layer and Parts of Stroma allowing for Reformation of Normal Epithelial Complexes

NOT Recommended in Cats- Predisposes to Corneal Sequestrum

A

Superficial Keratectomy

*ONLY used if Debridement and Grid/Punctate Keratotomy Failed

*Not Recommended as First Line due to need for General Anesthesia and Cost

155
Q

Etiology of Neonatal Ophthalmia in Cats/Kittens described Below:

Ankyloblepharon (Fused Eyelids)

Symblepharon- Conjunctival, Third Eyelid, and Corneal Surface Fuse together

A

Feline Herpesvirus

156
Q
A

Schrimer Tear Strip

157
Q

Diagnostic Technique that is CONTRAINDICATED in Stage IV IRIS or Coagulopathy

A

Biopsy

*Make sure there are No Coagulopathies

*Only Biopsy a Patient where the Results are going to Change the way that you manage your patient

158
Q

Name Third Eyelid Disease Described Below and Treatment:

Protrusion of Gland of the Third Eyelid from Behind the Third Eyelid

Frequent in Dogs < 2yrs- English Bulldogs, Cocker Spaniels

Third Eyelid Gland Protrudes at the Medial Canthus and appears as a Reddish Mass

A

Cherry Eye (Prolapse of the Gland of the Nictitans)

Treatment- Surgically Replace Third Eyelid Gland, DO NOT REMOVE GLAND- Predisposes to KCS

*If she were to give an Image of Cherry Eye, Name one other Rule Out? Tumor. If Dog is Younger than 2 Years of Age is it unlikely to be a Tumor

If she Gives this Image and says “Which is Least Likely?” In a 2 year Old Dog, it is least likely to be a TUMOR based on Age of the Dog

In Older Dogs, use FNA or Biopsy to rule out Neoplasia

159
Q

MOST COMMON cause of Conjunctivitis in Cats in Kittens

A

Feline Herpesviral Conjunctivitis

*Conjuntivitis in the Cat is HERPES until proven otherwise

160
Q

Type of Ulcerative Keratitis Described Below:

Exogenous Proteases Released by Bacteria Cause Collagenolysis of Stroma

Serious Condition

Commonly Associated with Pseudomonas

Results in Deep Ulceration

A

Melting Corneal Ulcer

161
Q

______ Glaucoma is Characterized Below:

Completely Blind

GLOBE IS ENLARGED (Buphthalmic)

No PLR (Pupillary Light Reflex)

Mydriasis (Pupil is very Dilated)

Haab’s Striae

A

Chronic

*Chronic Glaucoma- the Globe is ENLARGED. It has been going on for some time

*Haab’s Striae- Break in Descemet’s Membrane (Similar to a Stretch Mark)

162
Q
A

He is in the Initiation Phase of AKD

*Initiation Phase: is Divided into Intial Phase and Extension Phase. There is No Abnormal Creatinine Concentration in the Initiation Phase.

This Cat has been Exposed to a Toxin (All components of the Tiger Lily Plant are Nephrotoxic) and we should assume that the patient has suffered some degree of Kidney Failure

*You will Admit the Patient and start on Diuretic Fluid Therapy and repeatedly monitor the Creatinine for Changes

163
Q

Measure of Glomerular Function/Filtration that is done in IDEXX laboratories that Increases 17 Months Earlier in Cats and 9 Months Earlier in Dogs than Creatinine when there was a 40% Decline in GFR

A

SDMA (Symmetric Dimethylarginine)

*SDMA has a much Improved Sensitivity to Creatinine

SDMA: You need Less than 50% Damage to Glomerular Function before SDMA becomes Abnormal

*If you have a Patient that has Normal SDMA you can be very confident that the animal is less likely to have Renal Failure as compared to using Creatinine

164
Q
A

What Kind of Ulcer: Non Healing Superficial Ulcer

Some Other Names: Indolent Ulcer

Why does it Occur: Epithelial Layer Not Sticking to Stroma

How does Treatment Differ: Debridement

If it does Not Respond to Treatment after 2-3 Times, what Treatment is Done: Grid Keratotomy

165
Q

Developmental Retinal Disease Described Below:

Retinal Degeneration: Affected Cells Develop Normally but Degenerate at 1-7 Years of Age

Vessel Attenuation

Tapetal Hyperreflectivity

Night Vision Blindness

A

PRA (Progessive Retinal Atrophy)

_*NIGHT VISION PROBLEMS- KNOW THIS!!_

*NO TREATMENT

166
Q

Ocular Diagnostic Test Described Below:

Purpose- Detect Corneal and Conjunctival Ulcers and assess Patency of Nasolacrimal System

Hydrophilic Stroma takes up Dye if Conrea Surface is Eroded

Fluorescence seen with Cobalt Light Source- Black Lamp or Woods Lamp

A

Fluorescein Stain

167
Q

Main Presenting Complaint from Owners in Patients with Retinal or Optic Nerve Disorders

A

Decreased Vision

*Usually has to be Bilateral for most owners to Note

*Owner Reports animal can’t see well or at all anymore: Likely Bilateral Retinal or Optic Nerve Disease (Two anatomical Sites for Blindness)

168
Q

OD = Right Eye

OS = Left Eye

What is Going on in this Cat?

A

Feline Herpesvirus

*Schirmer Tear Test- Ideal if it is above 15mm/min

IOP: Greater than 25 = Glaucoma

*Possible that the Cat had Ankyloblepharon due to Herpesvirus in the Neonatal Stage of Life and Developed Symblepharon where the Conjunctiva adhered to the Cornea

169
Q

If a Patient has a UP:C (Urine Protein:Creatinine Ratio) Between 0.5 up to 2.0, this is usually an Indication of _____ Renal Damage

A

Tubular

*Due to Decreased Tubular Protein Reabsorption

UP:C tends to be

170
Q
A

Corneal Ulcer

*Disease is Keratoconjunctivitis Sicca

*KCS can cause a Corneal Ulcer but an Ulcer cannot cause KCS

171
Q
A

When the Cause of Proteinuria is not Known

*Immunosuppresive Therapy is Absolutely CONTRAINDICATED when you have not taken the time to rule out Underlying Infectious Diseases

172
Q

Method for Examining the Posterior Eye Described Below:

Commonly Used in General Practice

Advantages: Portable, More Magnified Image, Direct Upright Image

Disadvantages: Small Visual Field, Working Closer to Animals Head

A

Direct Ophthalmoscopy

173
Q

Uveal Neoplasia Described Below:

Sequela to Trauma Years (1-9) Later

Aggressive- High Mortality (Metastasis)

Treatment: Enucleate

A

Feline Ocular Sarcoma

*One of the Sequela to Cat Eye Trauma is Sarcoma

174
Q
A

Atropine

175
Q
A

Relapse

*Same Bacteria that has caused a Relapse- Haven’t Treated for Long enough or at a High enough Dose

176
Q

Direct or Indirect Fundic Exam?

A

Indirect

*Preferred Over Direct because we can see More of the Retina

177
Q

Which Method of Tonometry does NOT require Topical Anesthetic?

A

Rebound (TonoVet)

*Both Indentation and Applanation require Topical Anesthetic (Proparacaine)

*Rebound Method is Painless and Causes No Anxiety- BEST METHOD

178
Q

Most Common Eyelid Tumor in Cats

A

Squamous Cell Carcinoma

*Eyelid Tumors in Cats are usually MALIGNANT

179
Q

Method of Examination of the Posterior Eye described below:

Uses Condensing Lens, usually Hand Held, and a Focused Light Source

Image wil be Inverted and Reversed

No Stereopsis (Depth)

Work at Greater Distance from Animals Head

A

Indirect Ophthalmoscopy with Focal Light and Lens

180
Q

___% Damage to the Nephrons is Required before Creatinine becomes Elevated

A

75%

181
Q
A

66%

*Isosthenuric: Ultra Filtrate is Neither Concentrated nor Diluted, which usually infers that there is Tubular Injury

The Patient is Not Azotemic Yet. Traditional Definition of Renal Failure is 75% Damage if there is Azotemia

At what point does a Patient loose the ability to Concentrate Urine but still not develop Azotemia? 66%

182
Q
A

SARDs

*Retinal Disease: Does not cause Red Eye

183
Q

Pathogenesis of ______:

Inflammation of Uveal Tissues: Very Common

Increased Blood Flow and Vascular Permeability

Blood-Aqueous-Barrier Breakdown

Leakage of Proteins

Aqueous Flare = Cloudy (HALLMARK)

A

Uveitis

*Aqueous Flare- HALLMARK of Uveitis

Aqueous Flare: Abnormal appearance of the beam of light as it travels through the anterior chamber.

The flare is caused by light reflecting off protein In the aqueous humor.

184
Q

Most Common Eyelid Tumors in Canines

A

Meibomian Gland Adenoma

*Usually Benign- may cause Conjuctivitis, Keratitis or can be associated with Secondary Chalazion

*Eyelid Tumors in Dogs are usually BENIGN

185
Q

Congenital Retinal Disease Described Below:

Abnormal Retinal Development

Retinal Folds: Look like Dark Grey Lines

A

Retinal Dysplasia

*Looks like Worm Tracks- Retinal Folds that have a Different color to them than the Tapetal Area

186
Q

Clinical Signs Specific to ______:

Aqueous Flare

Miosis (Constricted Pupil)

Hypopyon or Hyphema

A

Uveitis

187
Q

Two Agents that Stimulate Tear Production used in Treatment of Keratoconjunctivitis Sicca

A

Topical Cyclosporine A- Initial Drug of Choice

Topical Tacrolimus

188
Q

Most Important Etiology leading to Micturition Disorders (Urinary Incontinence)

A

Urinary Spinchter Mechanism Incompetence (SMI)

189
Q

Renal Neoplasia Described Below:

More Common in Dogs

Clinical Signs:

Hematuria and Weight Loss

UNILATERAL Renomegaly

Rarely Causes Azotemia

Hypertrophic Osteopathy- Pain in Forelimbs

A

Renal Adenocarcinoma

*Usually UNILATERAL

190
Q

Uveal Neoplasia Described Below:

Starts as Multiple Patches

Becomes Confluent

Late Metastasis Possible

A

Feline Diffuse Iris Melanoma

*Older Cat with Iris Color Pigmentation Change- VERY Worried about Feline Diffuse Iris Melanoma

*Definitive Diagnosis- Enucleation and Histopathology

191
Q

Urolithiasis Described Below:

Radio-Opaque, Small Stones

Breeds: Miniature Schnauzers

Secondary to Hypercalcemic Disease- Ex. Hyperparathyroidism

A

Calcium Oxalate

192
Q

Non-Ulcerative Keratitis Described Below:

Focal Region of Necrotic Cornea, Brown-Black Color

Often History of Corneal Irritation or Feline Herpes Virus

A

Feline Sequestrum

*In Felines that have corneal Disease, Trauma in particular, they are very susceptible to having Layers of the Cornea become Necrotic and Sequestered

193
Q

Examples of which Type of Ulcerative Keratitis

A

Melting Ulcer

194
Q

Management for Ureteral Obstruction Described Below:

Soft Polyurethane Catheters that have Double Pigtail Design with Multiple Fenestrations along the Length

Surgically Placed in Cats

A

Ureteral Stent

195
Q
A

Renal Disease

196
Q
A

22 ml/kg/d

*Insensible Loss ALWAYS is 22 ml/kg/day

197
Q
A

B. Collect Blood measurement and Start IVF

*Young cat with Urethral Obstruction- First step is always to Asses patient and address any problems before you attempt to correct Hyperkalemia

198
Q

Definition of Proptosis

A

EXTREME Exophthalmos

*Proptosis- If the Eye is out so far that the animal cannot close the Eyelids over the Eye

199
Q

Dog was HBC (Hit by Car). What is this?

A

Proptosis

200
Q
A

Leptospirosis

*All of these will cause Acute Kidney Injury (AKI), But Leptospirosis is NOT Acquired in the Hospital

*After a Single Dose of Penicillin, Patients will stop spreading Leptospirosis Immediately

Leptospirosis = Community Required

201
Q

Treatment Described Below for Nonhealing Superficial Ulcers (Indolent Ulcers):

1. Topical Anesthetic Administered

2. Use Dry Cotton Swab to Peel Back Loose Corneal Epithelial Edges using Gentle Circular Motion

  1. Repeat 2-3x’s Q 7-14
A

Debridement

202
Q
A

Ureteral Obstruction

*“Big Kidney Little Kidney” Syndrome- Leading Cause of Acute Ureteral Obstruction

203
Q
A

B. We will need to Consider Prophylactic Treatment of the Other Eye

*Diagnosis: Cherry Eye

204
Q
A

Efferent Vasodilator

205
Q
A

A. Repeat a 6 week Cource of Abx

C. Recommend MDB, Radiographs and US of Bladder

*We want to repeat the course of Antibiotics- Relapse

We also want to Investigate why she has a Complicated UTI

206
Q

Name the 5 Basic Layers of the Cornea

A

Tear Film (3 Individual Layers)

Epithelium

Stroma- Largest Layer of Cornea

Descemets Membrane

Posterior Epithelium

207
Q

Review: Comparison of Creatinine and SDMA

*With Confidence, if SDMA is Normal we can Rule out Renal Failure- Very high Sensitivity

*Creatinine- Very poor Confidence in Ruling out Posibility of Renal Failure- Very Low Sensitivity

*If Creatinine is Increased, we can be very Confident that we have Confirmed Renal Failure- Very High Specificity

A
208
Q

True/False: Pannus is Controllable but NOT Curable and will Require Life Long Therapy

A

True

*Pannus = LIFE LONG Therapy

209
Q

Clinical Exam Findings for which Condition in Puppies:

Wet Coat

Inflamed Perineum

Excoriated

A

Ectopic Ureter

*Puppies

210
Q

Treatment for Calcium Oxalate Crystals

A

Therapy for Hypercalcemia

Surgical: Lithotripsy or Urohydropulsion

*Calcium Oxalate Crystals can NOT be Treated with Diets

211
Q

Non-Ulcerative Keratitis Described Below:

Very Progressive, Bilateral, Inflammatory Non-Ulcerative Lesion

Can Result in Blindness

Exacerbated by Exposure to UV Light and HIGH ALTITUDES

Breed Predisposition: German Shepherds!!!!!!, Greyhounds

A

Pannus (Chronic Superficial Keratitis)

*KNOW THIS DISEASE

Pannus = GERMAN SHEPHERDS

212
Q

Common Clinical Signs associated with _____:

Enlarged Bladder in Male Cat

Difficulty in Manually Expressing Urine

Azotemia

A

Urethral Obstruction

213
Q
A

B. Repeat the Sample in 2 Weeks time to Demonstrate Persistent Proteinuria

C. Recommend and Investigation including Abdominal Ultrasound

*UPCR = 0.5 - Significant Proteinuria

*We want to demonstrate that the Proteinuria is Persistent, so we need to Repeat the Sample in 2 weeks time

214
Q
A

Radiograph and Ultrasound of the Abdomen

*Typical Signs of Lower Urinary Tract Disease- Start with Radiograph and Ultrasound of the Abdomen just to make sure its Not Calcium Oxalate Crystals- Miniature Schnauzers are Predisposed

215
Q

Specific Therapy For Leptospirosis causing Acute Renal Failure

A

Penicillins and Doxycycline

*Leptospirosis you want to treat with an Antibiotic

216
Q

Pick out Exophthalmos Versus Buphthalmos

A

Pug- Exophthalmos

Cat- Buphthalmos

217
Q
A

Hydralazine

218
Q

Most Important Nephrotoxin in the Dog or Cat with Chronic Kidney Disease

A

PTH

*Increase in Parathryoid Hormone is the reason why Dogs and Cats become so sick

*How do we Treat Patients with Chronic Kidney Disease resulting in Hyperparathyroidism? DIET (#1 Intervention)

219
Q
A

Stage II

*Want to start Renal Diet when the Patient is Clinically Well

*It is Recommended that the Patient is on Renal Diet by Late Stage II

220
Q
A

C. Urea

Urea- Affected by a Number of Factors, including Diet, Melena, and Dehydration. If there is any compromise in the Urea Cycle, the Urea will be Falsely Low. The Least Helpful of these Diagnostic Tests if Urea

*Creatinine and Cystatin C: Equal in Terms of their Sensitivity. Even though their Specificity is very good, their Sensitvity is Pretty Poor. You need 75% Glomerular Damage prior to Manifestation of Renal Failure

SDMA: Can detect Renal Damage with only 40% of the Kidney that is Damaged

Urine Output: Great, Invasive Method of Monitoring Kidney Function. This is what we will use during acute Renal Failure to measure the Response to Fluid and the ability of the Patient to Recover

221
Q

Examples of which Type of Ulcerative Keratitis

A

Descemetocele

*Edges of Descemetocele stain but Bottom of Crater does NOT Stain

222
Q

Ureteral Obstruction from _____ or Non Mineralized Debris has become one of the most Significant Causes of Renal Disease and Acute Uremia in Cats

A

Calcium Oxalate Ureteroliths

*Number one Cause of Uremia in Cats in North America is Ureteral Stones (98% Calcium Oxalate)

*98% of Ureteral Stones are Calcium Oxalate

223
Q

Description of which Type of Lower Urinary Tract Infection:

Urinary Tract Infections Recurring 3-4 Times per year

Male Castrated Dog or Feline Urinary Tract Infection

A

Complicated

*Urinary Tract Infections in Male Castrated Dogs and Felines are uncommon and therefore Considered COMPLICATED when they occur

*Recurrent UTI: Need to Preform Cultures Pre Therapy, During Therapy and Post Therapy

224
Q

Tonometry is Contraindicated with Eyes that have Deep _____

A

Corneal Ulcers

225
Q
A

What Kind of Ulcer: Superficial Ulcer

Part of the Cornea Affected: Epithelial Layer

Treatment: Topical Antibiotics (BNP)

How Long will it take to Heal:

When will you Recheck Fluoroscein Stain: 3-4 Days

226
Q

_____ Glaucoma is Characterized by:

Commonly Unilateral

Red, Cloudy, Painful Eye

Mydriasis (Dilated) with Absent PLR’s

Decreased Vision

Retinal Edema- Blue/White Cornea

GLOBE IS NOT ELARGED- should be able to Retropulse

A

Acute

*In Acute onset Glaucoma, the Globe is NOT Enlarged

227
Q

Name Eyelid Disorder Described Below and the Treatment:

Purulent Bacterial Infection (Usually Staph) of the Meibomian Gland or Skin Gland of the Lid

Clinical Signs- Painful, Reddened, Raised Areas which occur on Lid Margins

A

Hordeoleum (Stye)

Treatment- Local Warm Pack, Topical and Systemic Anti-Inflammatories and Antibiotics

*Stye occurs on OUTSIDE of Eyelid

228
Q
A

C. Stromal Iris Atrophy

229
Q
A

Complicated UTI

230
Q
A

16 ml/hr

231
Q

Two Major Causes of Buphthalmos

A

Intraocular Neoplasia

Chronic Glaucoma

232
Q
A

Benazepril (ACEi)

233
Q

In Patients with Oliguria:

Step 1: Correct Renal Perfusion via _____\_

If the Patient does NOT respond to Step 1,

Step 2: Consider Diuretics- Furosemide, Mannitol ect.

A

Fluid Bolus

*Once a Patient is Oliguric: the First thing you do is give the Patient a Fluid Bolus and correct any Pre-Renal factors that you possibly Can.

If the Patient Fails to Respond to Fluid Bolus (No Increase in Urine Output): Consider Diuretics- Mannitol, Furosemide ect.

In Patients that are Oliguric, First you would “Fluid Challenge” them with a Fluid Bolus. You want to see an Improvement in Urine Output of More than 1 ml/kg or a Decline in Creatinine. If you are not seeing that Change then you would need to Anticipate a Referrel for Extracorporal Renal Replacement Therapy (ERRT)​

234
Q

If a Patient has a UP:C (Urine Protein:Creatinine Ratio) Between 2.0 and 8.0, this is usually an Indication of _____ Renal Damage

A

Glomerular

*Increased Glomerular Permeability

*UP:C > 2.0

235
Q
A

False

236
Q

Purpose of Tonometry is to Measure Intraocular Pressure. Normal IOP in Dogs and Cats is ____mmHg

A

10-25mmHg

237
Q

Surgical Intervention for Deep Ulcers Described Below:

Advantages:

Mechanical Support for Weak Area

Continuous Supply of Serum, Antichollagenases, and Growth Factors

Immediate Source of Replicating Fibroblasts for Collagen Regeneration in the Stroma

A

Conjunctival Graft

238
Q

True/False: Atropine and Tropicamide are Drugs used in the Treatment of Glaucoma

A

False

*Atropine and Tropicamide- Both Cause Mydriasis (Dilation) of the Pupil, which is NOT used for Glaucoma. Atropine and Tropicamide are CONTRAINDICATED In Glaucoma

*Tropicamide is used to Dilate the Pupil in order to see to the back of the eye

*In cases of Glaucoma, you want the pupil Miotic, NOT Mydriatic

239
Q

Progressive Signs of which Lacrimal Disease:

PROGRESSIVE CONJUNCTIVITIS

Lackluster Appearance

Hyperemic Conjunctiva

Mucopurulent Discharge

Corneal Ulcers

Corneal Vascularization and Pigmentation

A

Keratoconjunctivitis Sicca

*When the Eye completely Dries Out is it going to Predispose the Eye to Corneal Ulcers, Corneal Changes, and Mucopurulent Layer to Tear Film

*Ex. You see a Case of Conjunctivitis and Did NOT do a Schirmer Tear Test. You treat with Topical Antibiotics and Steroids and the Conjunctivitis got better. 2 Months later it is back in with the same clinical Signs. BETTER CHECK Schirmer Tear!!

240
Q

There is NO CURE for ______ but the Goals of Treatment are:

Stimulate Tear Production

Control Inflammation or Infection

Maintain Lubrication

Treat Ulcer if Present

A

Keratoconjunctivitis Sicca

*Treatment is FOREVER AND FOREVER

241
Q

What Values are Considered Abormal in Canines and Felines on the Schirmer Tear Test (STT)

A

Canine: < 15mm/min is Abnormal (Indicates Decreased Tear Production

Feline: < 5mm/min may be abnormal if consistent with Clinical Signs

242
Q
A

Bupthalmia

243
Q

The MOST IMPORTANT managment tool in the Treatment of Chronic Kidney Disease

A

Renal Prescription Diets

*When should these Diets be Introduced? Late Stage II Chronic Kidney Disease (Prior to the Patient becoming ill)

244
Q

Night Blindness, where the Animal is Reluctant to go Outside at Night is an early sign of _____

A

Progressive Retinal Atrophy (PRA)

245
Q

Ureteral Obstruction Described Below:

Past Unilateral Ureteral Obstruction that has Caused Kidney to Progress to Fibrotic End-Stage

Contralateral, Hypertrophied Kidney Becomes Acutely Obstructed by a Ureterolith

Renal Asymmetry

Abdominal Pain

Progessive Severe Azotemia

A

“Big Kidney-Little Kidney” Syndrome

*All you can Palpate is One Large Kidney

246
Q
A

66 ml/hr

*No Ongoing Losses- No Vomiting/Diarrhea

247
Q

Diagnostic Test that is done in Conjunction with Clinical Signs to Diagnose Keratoconjunctivitis Sicca

A

Schirmer Tear Test

*The Severity of KCS is often Proportional to the Schirmer Tear Test Values

*We want to see > 15mm/min = WNL

Make sure to do Schirmer Tear Test BEFORE the owner has applied anything to the eye

248
Q

Therapy for Feline Idiopathic Cystitis

A

Environmental Enrichment: Reduce Stress, Increase Number of Liter Boxes, Increased Activity/Playing

Dietary: Wet Food Diet

Pain Control: Analgesics-Opioids (Buprenorphene)

*Encourage Owners to Play with Cats

Diet: Change to Wet Food Diet because Dry Food Diets predispose to Feline Idiopathic Cystitis

249
Q

Type of Ulcerative Keratitis Described Below:

Extended into Stroma

Breed Predisposition: Brachycephalic

Descemetocele Ulcer and Melting Corneal Ulcer

A

Deep Ulcers

250
Q
A

B. Benign Neglect

*Iris Atrophy- Age Related Change, No Treatment

251
Q
A

Rise in Creatinine

252
Q

Biochemical Abnormality that is the Driving Force behind Chronic Kidney Disease in Dogs and Cats

A

Hyperphosphatemia

*If you have a Patient that comes in with Severe Hyperphosphatemia, you can assume this is an Advanced Stage of Chronic Renal Disease

253
Q

Renal Failure occurs with ___% or more of the Nephron population is Nonfunctional

A

75%

*As Nephrons get Destroyed, the remaining Nephrons will be Hyperfunctional- The remaining Nephrons will work twice as hard

254
Q

True/False: Urea Clearance is a Reliable Estimate of Glomerular Filtration Rate

A

False

255
Q
A

Oliguria

*Calculation: Urine Output per Hour/ Body Mass

Urine Output = 0.4 ml/kg/hr

Oliguria =

256
Q
A

Dietary Dissolution with Abx

*Struvites- Tend to Resolve with Acidifying Diet. Remember to use Antibiotics for 3 months duration because Struvites are commonly caused by Infections

257
Q

Buphthalmos = ______

A

Chronic Glaucoma

*Eyeball itself is Enlarged

258
Q

The Tapetum is Located _____ in Indirect Ophthalmoscopy

A

Ventrally

259
Q

Normal Intraocular Pressure in mmHg for Dog

A

Under 25

260
Q
A

Buphthamia

*Buphthamia is only found in Chronic Glaucoma

261
Q

True/False: Creatinine is a BETTER Indicator of GFR (Glomerular Filtration Rate) than Urea

A

True

262
Q

Standard of Care in Patients with Ureteral Obstruction Described Below:

Indwelling Ureteral Bypass using a Combination of Locking-Loop Nephrostomy/Cystotomy Tube

A

SUB

*Standard of Care

263
Q
A

A. Topical Antibiotic

*Superficial Corneal Ulcer- Treatment is Topical Antibiotic

264
Q
A

Renal

Hemoglubinuria and Ghost RBC’s- Specific Gravity of the Urine is so low that the RBC’s are Exploding and as a result releasing the Hemoglobin

This all Points to the Patient having Renal Hematuria- Presence of Proteinuria and Azotemia

SAM II (3 decks)

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