Exam 2 Flashcards
(264 cards)
1
Q
On Tonometry, a Low IOP Indicates ____
A
Uveitis
*Uveitis- due to Decreased Aqueous Humor Production in the face of Inflammation
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
3
Q
Treatment for Feline Eosinophilic Keratoconjunctivitis
A
Topical Glucocorticoids
*Only if NO Corneal Ulcers
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)
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
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
7
Q
Review Card:
A
QUESTION ON EXAM- Comparing and Contrasting Indirect vs. Direct. KNOW THE DIFFERENCE BETWEEN THESE TWO
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
9
Q
Congenital Uveal Disease Described Below:
Failure of Complete Regression of Embryonic Pupillary Membrane
No Treatment
A
Persistent Pupillary Membranes
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
11
Q
A
Meibomian Gland Tumor
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
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
14
Q
A
Predisilone
*Prednisilone is CONTRAINDICATED in ICGN due to the Side Effects that would Worsen the Azotemia and Increase Proteinuria
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_
16
Q
A
Descemetocele or Melting Ulcer
*Picture is of a Conjunctival Graft
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
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
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
20
Q
Medical Treatment for Bullous Keratopathy
A
Topical 5% Sodium Chloride Ointment
*Minimize Edema and Bullae Formation
21
Q
Name the Two Broad Risk Factors of Acute Renal Failure
A
Community Acquired (Ex. Leptospirosis)
Hospital Acquired (Ex. Septic Shock, NSAIDs)
22
Q
For the General Treatment of Ulcerative Keratitis (Corneal Ulcers), which Drugs should be AVOIDED/CONTRAINDICATED
A
Corticosteroids
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
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
25
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_**
**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_
26
_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_**
**Parotid Duct Transposition**
27
Treatment for **Proptosis**
**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_
28
**B. Renal Insufficiency**
29
**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_
**Nuclear or Lenticular Sclerosis**
\*Not A Disease
30
Three Routine _Ocular Diagnostic Tests_ that should be done on all **Ophthalmic Examinations**
**Schirmer Tear Test**
**Fluorescein Staining**
**Tonometry-** Measure of Intraocular Pressure
_**\***Always done in this Order- Know the Order and why!_
31
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**_
**Anticollagenase**
_**\***Using the Patients OWN Serum_
32
Most common Microbial Isolate in Cases of **Lower Urinary Tract Infections**
**E.Coli**
33
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_**
**Indirect using a Head-Mounted Light Source (Binocular Lenses)**
34
**Oliguria** = Less than ____ ml/kg/hr Urine Production
**0.5**
**\*Oliguria:** _Production of abnormally small amounts of urine_
35
Diagnosis based on Images
**Uveitis**
36
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_
_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**_
37
**C. Treat with 30-50% of Total Dose in Evening for 6 Months**
38
**Fundic Exam** showing Hyporeflectivity, Hemorrhage and \_\_\_\_\_
**Retinal Detachment**
_**\***All of the Layers around the Optic Nerve are Ballooning Forward_
39
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_
**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)_
40
Name the _Eyelid Disease_ Described Below:
**_Aberrant Cilia Erupt form Meibomian Gland Openings_**
_Common in Dogs- Cocker Spaniels, Poodles ect._
**Distichiasis**
_\*Distichiasis- Fine Hairs growing out of the Meibomian Gland Ducts_
41
**5550**
**\***If we Suspect Acute Renal Failure: Replace all the dehydration within the First 6 Hours
42
The _Tapetum_ is Located _____ in **Direct Ophthalmoscopy**
**Dorsally**
43
Test used to Quantify **Proteinuria** that has an Excellent Correlation with a 24 Hour Urine Protein Measurement
**Urine Protein:Creatinine Ration**
44
**Most Common Intraocular Tumor** in Dogs and Cats
**Melanomas**
_**\***Refer or Enucleation_
45
Specific Therapy For _Acidosis_ caused by **Acute Renal Failure**
**IV Bicarb Administration**
46
**Pre-Renal**
47
**Acquired Vitreal Disease** Described Below:
**_Calcium and Phospholipids Condense within Vitreal Gel_**
**Asteroid Hyalosis**
48
**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
**Keratoconjunctivitis Sicca (Dry Eye)**
49
Treatment for **Renal Adenocarcinoma**
**Nephrectomy**
50
**Inflammation of Choroid and Retina** usually due to Infectious Agents such as:
**Chorioretinitis**
51
Most Important Aspect of Treatment in Cases of **Acute Renal Disease**
**Fluid Therapy**
52
**Benazepril**
_**\***In Dogs you start with an ACE Inhibitor in the Treatment of Hypertension_
53
Surgical Treatment used in Cats with **Reccurent Urethral Obstructions**
**Urethrostomy**
54
**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_
55
Summary Card for **Glaucoma**
56
**D. Normal Urine SG is 1.007-1.015**
57
\_\_\_\_\_\_ **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_
**Secondary**
58
Treatment for **Nonhealing Superficial Ulcers (Indolent Ulcers)**
_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**
59
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_**
**Creatinine**
_**\***Neither Secreted nor Reabsorbed by Kidney- Excreted Unchanged = Good Approximation of Glomerular Filtration Rate_
60
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_**
**Chronic Kidney Disease**
**\***Earliest Sign- PU/PD
61
Review Card: **Types of Ulcerative Keratitis**
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_
62
**A. Conjunctivitis, Corneal Ulcer**
63
Only Indication for **Third Eyelid Gland Removal**
**Third Eyelid Neoplasia**
64
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_
**Chalazion (Meibomian Cyst)**
**Treatment- Surgical Removal**
**\***Treat if Enlarged and Causing Discomfort
_Chalazion Cysts occur on the INSIDE of the Lid_
65
**Temporary Tarsorrhaphy**
66
**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_
67
**Acquired Uveal Disease** Described Below:
**_Old Dogs/Cats_**
**_Scalloped Margin to Pupil- Abnormal Shape_**
_Pupillary Light Reflex **(PLR) Reduced**_
_No Treatment_
**Iris Atrophy**
_**\*Changes in the Iris due to AGE**- Iris is Atrophying with Old Age_
_Abnormal Shape to Pupil Opening- Think IRIS Disease_
68
Four Common Biochemistry Abnormalities in Patients with **Chronic Kidney Disease**
**Hyperphosphatemia**
**Hypokalemia**
**Hyper/Hypocalcemia-** _Majority Hypocalcemia_
**Metabolic Acidosis**
_**\***These Biochemistry Abnormalities Manifest in Stage III and IV Chronic Kidney Disease_
69
List the Four Stages of **Cataract Development**
**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_
70
Name and Describe Three Methods used for **Tonometry** Measurement of Intraocular Pressure (IOP)
**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_
71
Description of which Stage of **Acute Renal Failure:**
**Initial Phase**
_**\***No Clinical Signs!!!_
72
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_
**Nonhealing Superficial Ulcers (Indolent Ulcers)**
73
Treatment of Choice for **Ectopic Ureters**
**Cystoscopic Laser Ablation**
_**\***Gold Standard of Treatment and Diagnostics_
74
**Mycophenolate Mofetil**
**\***ICGN- Immune Complex Glomerulonephritis
**_\*Mycophenolate is the DRUG OF CHOICE for ICGN_**
75
**High K+**
76
Common Optic Exam Findings in Animal with _____ Disorders:
**_Absent Menace_**
**_Usually Dilated Pupils with Poor/Absent PLR's_**
**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_**
77
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_
**Orbital Infection/Orbital Cellulitis**
78
**Subcutaneous Ureteral Bypass (SUB)**
**\***Both Ureteral Stent and SUB are viable options in this Cat, However **SUB is considered the Standared of Care currently**
79
"Go to" Drug for Medical Treatment of **Urinary Sphincter Mechanism Incompetence (SMI)**
**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_**
80
_Most commonly used_ Laboratory Test for **Glomerular Function** Described Below:
**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_
81
Treatment in Cases of **Recurrent Lower Urinary Tract Infections**
**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_
82
Azotemia does NOT Develop until **Glomerular Filtration Rate** has Decreased to \_\_\_%
**25%**
_\*Creatinine Does NOT begin to Increase above Normal until GFR is Decreased to 25% or Lower_
83
**Anisocoria**
_Aniscoria- condition characterized by an unequal size of the eye's pupils_
84
**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_
**Topical and Systemic Corticosteroids** (Reduces Inflammation)
**Topical Atropine** (Keep Eyes Dilated- Prevent Synechia)
_**\***Diagnosis: Idiopathic Anterior Uveitis_
85
Etiology of **Conjuncitivis** in the _Cat_ Described Below:
**_Obligate Intracellular Bacterium_**
**_Chemosis_**
_Often Folicular_
**Chlamydophila Felis Conjunctivitis**
_**\***Obligate INTRACELLULAR bacterium of Cats often causing Conjunctivitis_
86
Treatment for **Pannus**
**Topical Immunosuppression:** _**Topical 0.1% Dexamethasone, Topical Cyclosporine A, or Pimecromilus** (Possibly Combination of all Three)_
**Minimize UV Light Exposure-** Sunglasses made for Dogs
87
_Lacrostimulant_ used for the Treatment of **Keratoconjunctivitis Sicca** Described Below:
**_T cell Inhibitor_**
**_Directly Lacrimogenic_**
_Inhibits Pigmentation and Vascularization_
**Topical Cyclosporine A**
_**\***Must be Administered BID (Twice Per Day): Q 12 Hr topically_
**_Cyclosporine A- IDEAL Treatment for KCS_**
88
**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**_
**Descemet's Membrane**
_**\***Descemetocele- Close to having the Eye Rupture. Only One more Layer to Complete Eye Rupture_
89
**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)_
90
**Eye Condition** Described Below:
_Decreased Outflow of Aqueous Humor_
**Glaucoma**
\*Glaucoma Pathogenesis- Aqueous Humor can't get out (Obstruction)
91
Use **Tonomotry** to Measure Intraocular Pressure (IOP) prior to \_\_\_\_\_, as ____ is _Contraindicated in the Glaucomatous Eye_
**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)
92
Treatment for **Feline Herpesviral Conjunctivitis**
**Topical Ocular Antibiotics TID-QID**
**Topical Ocular Antivirals**
**\***_Topical Antiviral Agents only used for Persistent, Severe, or Chronic Herpesviral Infection_
93
**Non-Ulcerative Keratitis** Described Below:
**_Multifocal Puncuate Circular Grey Fluffy Cotton-Like Opacities in Corneal Stroma_**
_Typically Asymptomatic_
_No Treatment found to be Helpful_
**Florida Keratopathy (Florida Spots/Caribbean Keratopathy)**
94
**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)**_
**Feline Eosinophilic Keratoconjunctivitis**
_**\***Caused by Herpes until proven otherwise_
95
**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_
96
Most Common Cause of **Glaucoma** in _Cats_
**Uveitis**
97
**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_**
98
**Corneal Layer** Described Below:
**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**_
99
Therapy Described Below that is Very Helpful in Patients with **Advanced Staged Chronic Kidney Disease:**
**Erythropoietin Therapy**
_**\***Should be Reserved for the Last 6-8 Months of the Patients Life_
_When the Patient has a PCV_
100
_Treatment of Choice_ for all **Lens Luxations and Subluxations**
**Lens Removal**
101
**Magn Ammonium Phosphate (Struvite)**
**_\*Radiograph: Large Radiodense Uroliths with Smooth Edges_**
**_Female Toy Breed: Shih Tsu = Struvite_**
_Cysteine and Urate- Radiolucent_
102
Which Breed is Predisposed to Development of **Pannus** and how Does Age play a Role in the Severity?
**German Shepherds**
**Young (1-5 Years):**
_Severly Progressive and Extensive_
**Old (4-6 Years):**
_Slowly Progressive and Extensive_
103
On _Tonometry_, a **High IOP** Indicates \_\_\_\_\_
**Glaucoma**
104
True/False: There is No Evidence to Support the use of a _Renal Perscription Diet_ in **Acute Renal Injury**
**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**_
105
Pathomechanism behind which **Micturition Disorder (Urinary Incontinence):**
**_Lack of Estrogen will Decrease Sensitivity of Smooth Muscle Receptors to Symphathetic Stimulation (Estrogen Responsive Incontinence)_**
**Urinary Sphincter Mechanism Incompetence**
_**\***ESTROGEN Dependent Geriatric Dog Condition_
106
**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
First Choice Treatment for **Protein Losing Nephropathy/Glomerulonephritis**
**Immunosuppressive Therapy- Mycophenolate**
108
Clinical Signs of which **Feline Lower Urinary Tract Disease:**
## Footnote
**_Increased Frequency of Urination_**
**_Vocalizing when in Litter Tray (Pain)_**
**_Empty Bladder on Palpation (Non-Obstructive)_**
**Feline Idiopathic Cystitis**
_**\***Bladder is Empty = No Obstruction_
109
Treatment of _Hyperphosphatemia_ in Patients with **Chonic Kidney Disease**
**Dietary Phosphate Restriction- Renal Prescription Diets**
**Intestinal Phosphate Binders- Aluminium Hydroxide (Mix with Food)**
110
**Uveitis**
111
**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
**Non Healing Superficial Ulcer (Indolent Ulcer)**
113
**Corneal Layer** Described Below:
**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
At which Level of Intraocular Pressure would you Diagnose **Glaucoma**?
**25 and Above**
115
**Excessive Collagenase** (Enzyme) activity in Stroma = Breakdown of Collagen and a \_\_\_\_\_\_\_
**Melting Ulcer**
116
**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_**
**Urinary Sphincter Mechanism Incompetence (SMI)**
_**\***Will see evidence of Urine Leakage- Soiled Perineal Coat_
117
**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_
**Bullous Keratopathy**
_**\***Looks Like Bubbles in the Stroma_
118
Does this Patient have **Exophthalmos or Buphthalmos**?
**_Increased Intraocular Pressure (IOP)_**
_**Blind** with **Mydriasis (Dilated Pupil)**_
**_Painful_**_- Pawing at Eye_
**_Firm but should Retropulse_**
**Buphthalmos**
119
**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_
**Persistent Pupillary Membrane**
_**\***Usually of Minimal Significance and Generally No Therapy is Needed_
120
**B. CaOx**
**_\*Min. Schnauzer = Calcium Oxalate Crystals_**
**_\*Radiograph: Radiodense Uroliths_**
_Cysteine and Urate are Radiolucent- Will not See on Radiographs_
121
_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_**
**Urea**
122
**Amlodipine**
_**\***In Cats we Treat Hypertension with Amlodipine in Cases of Chronic Kidney Disease_
123
The _Conjunctiva_ contains **_Goblet Cells_** that Secrete the ____ Layer of the Tear Film
**Mucin**
124
97% of **Ureteroliths** in Felines were \_\_\_\_\_\_
**Calcium Oxalate**
125
Treatment for **Superficial Punctate Keratitis**
**Topical Steroids**
**_This is an Exception to Avoiding Topical Steroids with Corneal Ulcers!!_**
126
Treatment for **Cataracts**
**Phacoemulsification**
_**\***Prognosis: Good for Return of Vision if No Retinal Disease Present_
127
_Intraocular Prosthesis_ and _Intravitreal Gentamicin Injections_ are NOT USED IN CATS because of Possible _____ Development
**Sarcoma**
_\*Cats are Predisposed to Sarcoma due to any type of Eye Trauma_
128
**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
We Achieve **Mydriasis (Pupillary Dilation)** by application of _____ (0.5 to 1% Tropicamide)
**Mydriacyl**
_**\***Rapidly Dilates Pupil within 15-30 Minutes_
_Short Duration- 6-8 Hours_
130
Treatment for **Acute Superficial Corneal Ulceration**
**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
**Hetastarch**
132
**Hypocoagulable State**
**_\*Glomerulonephritis = HYPERcoagulable State_**
133
Treatment for **Uncomplicated Urinary Tract Infection (UTI)**
**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
**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
Etiology of 70% of **Chronic Renal Diseases** in Dogs and Cats
**Chronic Intersitial Nephritis**
_**\***Tubular Interstitial Kidney Disease_
136
Treatment for Eyelash/Cilia Disorders: **Trichiasis, Distichiasis, and Ectopic Cilia**
**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
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"**_
**Nonhealing Superficial Ulcer (Indolent Ulcers)**
_**\*Lip or "Peel"!!**_
138
Therapy for **Struvites**
**Acidifying Dietary Trial (Target pH as Acid)**
**Antimicrobials-** _If Infection is Present_
_\*Acidifying Diet will Dissolve the Struvite Stones_
139
Review Card: **Lens Disease Treatment**
140
Four Phases of **Acute Renal Failure**
**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
**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
_Definitive Treatment_ for Patients with **Acute Renal Failure**
**Extracorporal Renal Replacement Therapy (ERRT)**
143
True/False: **Primary Infectious Conjunctivitis** is Rare in Dogs, and Common in Cats due to _Feline Herpesvirus_
**True**
144
**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
**B. That Iris Prolapse will Occur**
_\*Desmetocele_
146
**Corneal Layer** Described Below:
**Posterior Epithelium/Endothelium**
_**\***Pumps water out of the Stroma to keep it Clear_
147
Difference between **Relapse versus Reinfection** _Urinary Tract Infections_
**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
Initial Treatment in Cases of **Uveitis**
**Topical Prednisolone or Dexamethasone QID**
**Topical Atropine**
_**\***Only if No Corneal Ulcers_
149
Two Drugs that can Induce **Keratoconjunctivitis Sicca**
**Sulfa Drugs**
**Etogesic**
_**\***KNOW THIS- Exam_
150
**Trichiasis**
151
**Non-Ulcerative Keratitis** Described Below:
**_Pigment in Cornea and Subepithelial Surface Stroma_**
_Inflammatory Non-Ulcerative Corneal Disease_
**_Etiology: Distichiasis, Trichiasis, KCS (Chronic Irritation)_**
**Pigmentary Keratitis**
152
Treatment Described Below for **Nonhealing Superficial Ulcers (Indolent Ulcers):**
## Footnote
**Grid: _Scar Corneal Surface with Grid Pattern_**
**Punctate: _Make Small Divets in Cornea_**
**Grid and Punctate Keratotomies**
153
**Congenital Uveal Disease** Described Below:
**_Holes or Defects in Uveal Tissue: Iris or Choroid_**
_Typical at 6 o'clock_
**Colobomas**
154
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_
**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
Etiology of **Neonatal Ophthalmia** in _Cats/Kittens_ described Below:
_**Ankyloblepharon** (Fused Eyelids)_
_**Symblepharon-** Conjunctival, Third Eyelid, and Corneal Surface Fuse together_
**Feline Herpesvirus**
156
**Schrimer Tear Strip**
157
Diagnostic Technique that is CONTRAINDICATED in **Stage IV IRIS or Coagulopathy**
**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
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_**
**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
MOST COMMON cause of **Conjunctivitis** in Cats in Kittens
**Feline Herpesviral Conjunctivitis**
_**\***Conjuntivitis in the Cat is HERPES until proven otherwise_
160
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_
**Melting Corneal Ulcer**
161
\_\_\_\_\_\_ **Glaucoma** is Characterized Below:
**_Completely Blind_**
**_GLOBE IS ENLARGED (Buphthalmic)_**
_No PLR (Pupillary Light Reflex)_
**_Mydriasis (Pupil is very Dilated)_**
_Haab's Striae_
**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
**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
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**
**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
_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
**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_**
**PRA (Progessive Retinal Atrophy)**
_**\*NIGHT VISION PROBLEMS- KNOW THIS!!**_
_**\***NO TREATMENT_
166
**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_
**Fluorescein Stain**
167
Main _Presenting Complaint_ from Owners in Patients with **Retinal or Optic Nerve Disorders**
**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
OD = Right Eye
OS = Left Eye
**What is Going on in this Cat?**
**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
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
**Tubular**
_**\***Due to Decreased Tubular Protein Reabsorption_
**_UP:C tends to be_**
170
**Corneal Ulcer**
_\*Disease is Keratoconjunctivitis Sicca_
_\*KCS can cause a Corneal Ulcer but an Ulcer cannot cause KCS_
171
**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
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_
**Direct Ophthalmoscopy**
173
**Uveal Neoplasia** Described Below:
**_Sequela to Trauma Years (1-9) Later_**
_Aggressive- **High Mortality (Metastasis)**_
**_Treatment: Enucleate_**
**Feline Ocular Sarcoma**
_**\***One of the Sequela to Cat Eye Trauma is Sarcoma_
174
**Atropine**
175
**Relapse**
_**\***Same Bacteria that has caused a Relapse- Haven't Treated for Long enough or at a High enough Dose_
176
_Direct or Indirect_ Fundic Exam?
**Indirect**
_**\***Preferred Over Direct because we can see More of the Retina_
177
Which Method of **Tonometry** does NOT require Topical Anesthetic?
**Rebound (TonoVet)**
_**\***Both Indentation and Applanation require Topical Anesthetic (Proparacaine)_
_\*Rebound Method is Painless and Causes No Anxiety- BEST METHOD_
178
Most Common **Eyelid Tumor** in _Cats_
**Squamous Cell Carcinoma**
_\*Eyelid Tumors in Cats are usually MALIGNANT_
179
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_
**Indirect Ophthalmoscopy with Focal Light and Lens**
180
\_\_\_% Damage to the Nephrons is Required before **Creatinine** becomes Elevated
**75%**
181
**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
**SARDs**
_\*Retinal Disease: Does not cause Red Eye_
183
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)_**
**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
Most Common **Eyelid Tumors** in _Canines_
**Meibomian Gland Adenoma**
_\*Usually Benign- may cause Conjuctivitis, Keratitis or can be associated with Secondary Chalazion_
_\*Eyelid Tumors in Dogs are usually BENIGN_
185
**Congenital Retinal Disease** Described Below:
_Abnormal Retinal Development_
**_Retinal Folds: Look like Dark Grey Lines_**
**Retinal Dysplasia**
_**\***Looks like Worm Tracks- Retinal Folds that have a Different color to them than the Tapetal Area_
186
Clinical Signs Specific to \_\_\_\_\_\_:
## Footnote
**_Aqueous Flare_**
**_Miosis (Constricted Pupil)_**
**_Hypopyon or Hyphema_**
**Uveitis**
187
Two Agents that _Stimulate Tear Production_ used in Treatment of **Keratoconjunctivitis Sicca**
**Topical Cyclosporine A-** _Initial Drug of Choice_
## Footnote
**Topical Tacrolimus**
188
Most Important Etiology leading to **Micturition Disorders (Urinary Incontinence)**
**Urinary Spinchter Mechanism Incompetence (SMI)**
189
**Renal Neoplasia** Described Below:
_More Common in Dogs_
**Clinical Signs:**
_Hematuria and Weight Loss_
**_UNILATERAL Renomegaly_**
_Rarely Causes Azotemia_
**_Hypertrophic Osteopathy- Pain in Forelimbs_**
**Renal Adenocarcinoma**
**\***Usually UNILATERAL
190
**Uveal Neoplasia** Described Below:
**_Starts as Multiple Patches_**
_Becomes Confluent_
_Late Metastasis Possible_
**Feline Diffuse Iris Melanoma**
*_**\***Older Cat with Iris Color Pigmentation Change- VERY Worried about Feline Diffuse Iris Melanoma_*
_\*Definitive Diagnosis- Enucleation and Histopathology_
191
**Urolithiasis** Described Below:
_Radio-Opaque, Small Stones_
**_Breeds: Miniature Schnauzers_**
**_Secondary to Hypercalcemic Disease-_** _Ex. Hyperparathyroidism_
**Calcium Oxalate**
192
**Non-Ulcerative Keratitis** Described Below:
_**Focal Region of Necrotic Cornea**, Brown-Black Color_
_Often **History of Corneal Irritation or Feline Herpes Virus**_
**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
Examples of which Type of **Ulcerative Keratitis**
**Melting Ulcer**
194
Management for **Ureteral Obstruction** Described Below:
**_Soft Polyurethane Catheters that have Double Pigtail Design with Multiple Fenestrations along the Length_**
_Surgically Placed in Cats_
**Ureteral Stent**
195
**Renal Disease**
196
**22 ml/kg/d**
**_\*Insensible Loss ALWAYS is 22 ml/kg/day_**
197
**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
Definition of **Proptosis**
**EXTREME Exophthalmos**
_**\***Proptosis- If the Eye is out so far that the animal cannot close the Eyelids over the Eye_
199
Dog was HBC (Hit by Car). What is this?
**Proptosis**
200
**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
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**_
3. **_Repeat 2-3x's Q 7-14_**
**Debridement**
202
**Ureteral Obstruction**
_**\***"Big Kidney Little Kidney" Syndrome- Leading Cause of Acute Ureteral Obstruction_
203
**B. We will need to Consider Prophylactic Treatment of the Other Eye**
_**\***Diagnosis: Cherry Eye_
204
**Efferent Vasodilator**
205
**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
Name the 5 Basic Layers of the **Cornea**
**Tear Film** (3 Individual Layers)
**Epithelium**
**Stroma-** _Largest Layer of Cornea_
**Descemets Membrane**
**Posterior Epithelium**
207
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_
208
True/False: **Pannus** is Controllable but _NOT Curable_ and will Require _Life Long Therapy_
**True**
_**\***Pannus = LIFE LONG Therapy_
209
Clinical Exam Findings for which Condition in **Puppies:**
**_Wet Coat_**
**_Inflamed Perineum_**
_Excoriated_
**Ectopic Ureter**
_**\***Puppies_
210
Treatment for **Calcium Oxalate Crystals**
**Therapy for Hypercalcemia**
**Surgical: Lithotripsy or Urohydropulsion**
_**\***Calcium Oxalate Crystals can NOT be Treated with Diets_
211
**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_
**Pannus (Chronic Superficial Keratitis)**
_**\***KNOW THIS DISEASE_
_Pannus = GERMAN SHEPHERDS_
212
Common Clinical Signs associated with \_\_\_\_\_:
**_Enlarged Bladder in Male Cat_**
_Difficulty in Manually Expressing Urine_
_Azotemia_
**Urethral Obstruction**
213
**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
**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
Specific Therapy For _Leptospirosis_ causing **Acute Renal Failure**
**Penicillins and Doxycycline**
_**\***Leptospirosis you want to treat with an Antibiotic_
216
Pick out **Exophthalmos** Versus **Buphthalmos**
**Pug- Exophthalmos**
**Cat- Buphthalmos**
217
**Hydralazine**
218
Most Important Nephrotoxin in the Dog or Cat with **Chronic Kidney Disease**
**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
**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
**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
Examples of which Type of **Ulcerative Keratitis**
**Descemetocele**
_\*Edges of Descemetocele stain but Bottom of Crater does NOT Stain_
222
**Ureteral Obstruction** from _____ or Non Mineralized Debris has become one of the most Significant Causes of Renal Disease and Acute Uremia in Cats
**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
Description of which Type of **Lower Urinary Tract Infection:**
## Footnote
**_Urinary Tract Infections Recurring 3-4 Times per year_**
**_Male Castrated Dog or Feline Urinary Tract Infection_**
**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_
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**Tonometry** is Contraindicated with Eyes that have Deep \_\_\_\_\_
**Corneal Ulcers**
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_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
\_\_\_\_\_ **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_
**Acute**
_**\***In Acute onset Glaucoma, the Globe is NOT Enlarged_
227
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_
**Hordeoleum (Stye)**
**Treatment- Local Warm Pack, Topical and Systemic Anti-Inflammatories and Antibiotics**
_**\***Stye occurs on OUTSIDE of Eyelid_
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**C. Stromal Iris Atrophy**
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**Complicated UTI**
230
**16 ml/hr**
231
Two Major Causes of **Buphthalmos**
**Intraocular Neoplasia**
**Chronic Glaucoma**
232
**Benazepril (ACEi)**
233
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._
**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)_**
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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
**Glomerular**
**\***_Increased Glomerular Permeability_
**_\*UP:C \> 2.0_**
235
**False**
236
Purpose of **Tonometry** is to Measure _Intraocular Pressure_. Normal IOP in Dogs and Cats is \_\_\_\_mmHg
**10-25mmHg**
237
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_
**Conjunctival Graft**
238
True/False: Atropine and Tropicamide are Drugs used in the Treatment of **Glaucoma**
**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_**
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_Progressive Signs_ of which **Lacrimal Disease**:
**_PROGRESSIVE CONJUNCTIVITIS_**
_Lackluster Appearance_
**_Hyperemic Conjunctiva_**
**_Mucopurulent Discharge_**
**_Corneal Ulcers_**
**_Corneal Vascularization and Pigmentation_**
**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!!_
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There is **NO CURE** for ______ but the Goals of Treatment are:
**_Stimulate Tear Production_**
_Control Inflammation or Infection_
_Maintain Lubrication_
_Treat Ulcer if Present_
**Keratoconjunctivitis Sicca**
_**\***Treatment is FOREVER AND FOREVER_
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What Values are Considered Abormal in Canines and Felines on the **Schirmer Tear Test (STT)**
**Canine: \< 15mm/min** is Abnormal (Indicates Decreased Tear Production
**Feline: \< 5mm/min** may be abnormal if consistent with Clinical Signs
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**Bupthalmia**
243
The MOST IMPORTANT managment tool in the Treatment of **Chronic Kidney Disease**
**Renal Prescription Diets**
_**\***When should these Diets be Introduced? Late Stage II Chronic Kidney Disease (Prior to the Patient becoming ill)_
244
**Night Blindness**, where the Animal is Reluctant to go Outside at Night is an early sign of \_\_\_\_\_
**Progressive Retinal Atrophy (PRA)**
245
**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_
**"Big Kidney-Little Kidney" Syndrome**
_**\***All you can Palpate is One Large Kidney_
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**66 ml/hr**
_\*No Ongoing Losses- No Vomiting/Diarrhea_
247
Diagnostic Test that is done in Conjunction with Clinical Signs to Diagnose **Keratoconjunctivitis Sicca**
**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_**
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Therapy for **Feline Idiopathic Cystitis**
**_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_
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Type of **Ulcerative Keratitis** Described Below:
**_Extended into Stroma_**
_Breed Predisposition: Brachycephalic_
**_Descemetocele Ulcer and Melting Corneal Ulcer_**
**Deep Ulcers**
250
**B. Benign Neglect**
_**\***Iris Atrophy- Age Related Change, No Treatment_
251
**Rise in Creatinine**
252
Biochemical Abnormality that is the Driving Force behind **Chronic Kidney Disease** in Dogs and Cats
**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
**Renal Failure** occurs with \_\_\_% or more of the Nephron population is Nonfunctional
**75%**
_**\***As Nephrons get Destroyed, the remaining Nephrons will be Hyperfunctional- The remaining Nephrons will work twice as hard_
254
True/False: **Urea** Clearance is a Reliable Estimate of _Glomerular Filtration Rate_
**False**
255
**Oliguria**
**\***Calculation: Urine Output per Hour/ Body Mass
**Urine Output = 0.4 ml/kg/hr**
**_Oliguria =_**
256
**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
Buphthalmos = \_\_\_\_\_\_
**Chronic Glaucoma**
_**\***Eyeball itself is Enlarged_
258
The _Tapetum_ is Located _____ in **Indirect Ophthalmoscopy**
**Ventrally**
259
Normal **Intraocular Pressure** in mmHg for Dog
**Under 25**
260
**Buphthamia**
_**\***Buphthamia is only found in Chronic Glaucoma_
261
True/False: **Creatinine** is a BETTER Indicator of **GFR (Glomerular Filtration Rate)** than Urea
**True**
262
_Standard of Care_ in Patients with **Ureteral Obstruction** Described Below:
## Footnote
**_Indwelling Ureteral Bypass using a Combination of Locking-Loop Nephrostomy/Cystotomy Tube_**
**SUB**
_**\***Standard of Care_
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**A. Topical Antibiotic**
_**\***Superficial Corneal Ulcer- Treatment is Topical Antibiotic_
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**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**_
