FELINE Flashcards
what is skin fragility syndrome and what is it associated with?
The clinical signs, patient’s medical history, and lack of overt trauma is highly suggestive of skin fragility syndrome. Typically, these patients appear to have a normal looking coat from a distance but when palpated or manipulated one must be very careful, particularly when scruffing the patient.
Skin fragility syndrome in cats is commonly associated with poorly regulated diabetes mellitus due to hyperadrenocorticism. Cushing’s disease can cause insulin resistance. Clinical signs are similar to those seen in dogs (pendulous abdomen, polyuria, polydipsia, polyphagia, lethargy, and muscle wasting). The hyperadrenocorticism can be iatrogenic, adrenal dependent or pituitary dependent. In cats, approximately 80% have a pituitary tumor while 20% have an adrenal tumor. ACTH stimulation test is not recommended in cats due to poor sensitivity. The low dose dexamethasone suppression test is recommended to confirm hyperadrenocorticism. Urine cortisol-creatinine ratio can be used as a screening tool. The UCCR has a high sensitivity so a negative test makes Cushing’s highly unlikely.
Abdominal ultrasound can be used to support your diagnosis. With pituitary dependent Cushing’s (which constitutes 80% of cats), you would expect normal to hypertrophied/enlarged adrenal glands. The excessive ACTH secreted from the pituitary gland produces an excessive amount of cortisol and adrenal hypertrophy.
Bilateral adrenal atrophy can be seen with hypoadrenocorticism. A hypoechoic pancreas and hyperechoic mesentery is highly suggestive of pancreatitis which is not associated with fragile skin in cats. A hyperechoic liver and moderate hepatomegaly can be suggestive of hepatic disease such as hepatic lipidosis or lymphoma which would not result in fragile skin either.
What brain tumor has the best prognosis?
Menigoma
What are common biochem markers for FIP?
Hyperglobinemia and low albumin/globuin ratios on effusions
What are the findings on histopath with FIP?
pyogranulatmous inflammation with perivascular cuffing and vasculitis
If a cat ingests rodenticide, what is the best drug to give to induce vomiting?
xyalzine (best only for cats) or apomorphine
A 4-year old cat is not eating and has a 104.2F (40.1 C) temperature. The abdomen is mildly distended and abdominocentesis reveals a serosanguinous fluid. On examination you note a string anchored under the base of the tongue. Which of the following tests can help you confirm your clinical suspicion?
Based on the clinical exam you should be concerned that this patient may have an intestinal perforation and a septic abdomen secondary to a linear foreign body. If the glucose of the abdominal effusion is 20 mg/dl or more points lower than that of peripheral blood, this helps to confirm sepsis. This is due to the bacteria consuming the glucose in the abdominal fluid. Another way of confirming sepsis is to do a fluid cytology, and, if bacteria are seen, this is strongly suggestive. Upper GI perforations tend to have lower counts of bacteria and can sometimes be more difficult to confirm. Lower GI perforations have higher bacterial counts and bacteria are more readily seen.
An elevated neutrophil count/toxic neutrophils suggest an inflammatory or infectious cause but does not confirm a septic abdomen.
An elevated temperature in this case could be due to inflammation or infection but does not confirm sepsis.
A urine dipstick is not a reliable means of checking for leukocytes in any fluid (including urine in some species) and would be of no value in this case.
A 12-year old female spayed Persian cat is presented to you for a 4 cm mass on the dorsal neck. On exam, the mass is a firm, freely movable, subcutaneous mass that is hairless and appears slightly melanotic. You take thoracic radiographs and bloodwork which are unremarkable. You perform a marginal excision and submit the mass for histopathology which comes back as a basal cell carcinoma that is completely but narrowly excised and has a high mitotic rate of 25 per 10 high-powered fields (400x). What should you recommend for adjunct treatment and follow-up?
Basal cell tumors are common in older cats and most (greater than 90%) display benign behavior, even when histologically malignant with a high mitotic rate.
If the tumor is diagnosed by cytology or histopathology without surgical removal, many veterinarians will recommend monitoring without surgical removal although these masses can ulcerate or get fairly large.
A 4-year old FS indoor/outdoor cat presents for two seizure episodes over the last few days. Physical exam reveals aqueous flare in both eyes and a temperature of 103.5F. There are no other cats in the household, and the owner is feeding a raw meat diet. A comprehensive blood panel is submitted and results are as follows: FeLV/FIV/FCV negative, Heartworm antibody negative, Toxoplasma IgM 1:1024, IgG 1:512, Cryptococcus negative, neutrophils 28,000/uL (2,500-12,500/ul), chemistries all WNL. The cat is current on vaccinations including Rabies. Which of the following medications is indicated?
The neurologic symptoms and uveitis in this cat are being caused by the protozoan Toxoplasma gondii. Cats are the definitive host for this organism. The cat was likely infected through eating raw meat or infected prey. An elevated IgM titer shows active infection with the organism.
The most common symptoms are lethargy, decreased appetite, and fever. The disease can cause diarrhea, upper respiratory symptoms, inflammation of the eyes, and neurologic disease. The treatment for this infection is the antibiotic Clindamycin.
Doxycycline is an antibiotic used in treating other infections in cats such as Hemobartonella and Mycoplasma.
Thiamine deficiency can occur and lead to seizures in cats fed a diet deficient in this vitamin. Because this is an outdoor cat with capability of predation, a thiamine deficiency would be unlikely. There is a test for thiamine levels if deficiency is suspected. Further questioning of this cat’s raw diet would be helpful.
Fluconazole is an anti-fungal medication used in treating Cryptococcus neoformans, Coccidioides immitis, and other fungal diseases.
Phenobarbital would only be indicated if the seizures become frequent or severe. It is best to treat the underlying cause of the seizures first.
How do you treat HCM?
This case describes typical findings for a cat with hypertrophic cardiomyopathy (HCM). Nitroglycerin, oxygen, spironolactone, and furosemide are indicated for cats with heart FAILURE from HCM, which this cat does not have.
Use of a beta-blocker such as atenolol is advocated by some cardiologists, particularly when left ventricular outflow obstruction exists. Atenolol alleviates the obstruction by reducing heart rate, LV contractility, and also reduces myocardial oxygen demands. Diltiazem and antithrombotics may also be considered.
Digoxin is used to slow atrioventricular conduction in the setting of supraventricular tachyarrhythmias or for systolic dysfunction. As the cat does not have a supraventricular tachyarrhythmia and has normal fractional shortening, digoxin is not indicated for this cat.
How many permanent teeth do cats have?
30
Active feline leukemia virus infections are least common in what age group?
The correct answer is greater than 10 years. With FeLV, an age-related resistance is seen. The outcome of infection will depend on the infectious dose, immune status, age, and virus strain. Cats with an inadequate immune response may recover clinically but develop persistent shedding and viremia. FeLV-related disease occurs months to years later, and may be triggered by stress, immunosuppression or glucocorticoids.
This 8-week old domestic short hair cat presented with an acute onset of severe chemosis as seen in the photo. The cat is systemically healthy otherwise with no oral or corneal lesions. Which of the following diseases most commonly causes severe chemosis in the absence of other systemic signs?
The correct answer is Chlamydophila felis. The key is to note the severe chemosis which is characteristic of chlamydophila infections. This upper respiratory tract pathogen does not cause oral ulcers in cats. Herpes virus will cause ocular, dendritic ulcers, and less commonly cause oral ulcers, and is commonly associated with systemic disease. Calicivirus also causes more systemic disease and can cause oral ulcers. Mycoplasma is not associated with such severe chemosis.
A 2-year old indoor only male neutered domestic short haired cat presents for difficulty urinating. He is lethargic, weak, and vocalizing while frequently posturing to urinate. The owner states he has been doing this since last night, only passing a very tiny amount of urine. Which of the following fluids will you choose once his urethral obstruction is relieved?
The most common electrolyte disturbance from a urethral obstruction is hyperkalemia. This occurs from an impaired urinary excretion of potassium. This can cause life-threatening arrhythmias and needs to be quickly addressed, especially if potassium exceeds 7 mEq/L. 0.9% Sodium chloride is the fluid of choice to treat this disturbance. If this fluid is not available, then Lactated Ringer’s would be a good alternative due to the low potassium concentration in those fluids. In extreme cases, dextrose may need to be added to the fluids because this stimulates insulin secretion and helps to move the potassium intracellular. Sodium bicarbonate and calcium gluconate can also help this shift of potassium in extreme cases.
An owner presents her 2-year old female cat to your clinic because the cat is in heat. She would like to schedule an ovariohysterectomy but would like to have it done when the cat is not in heat since you informed her that the procedure can be slightly more difficult when cats are in heat. The owner is about to leave for a vacation and wants to schedule the procedure when she returns. If the cat is not bred, how long will it take for her to return to estrus (assuming she is not bred and does not ovulate)?
Estrus in cats, defined as the behavioral receptivity to mating, typically lasts about 7 days (usually between 4-10 days)
Interestrus, the period between one estrus and the next, has a variable duration of 7-21 days.
Cats are induced ovulators. If a queen ovulates but does not become pregnant, a psuedopregnancy occurs and corpora lutea develop and secrete progesterone. This inhibits GnRH release from the hypothalamus and secretion of LH and FSH from the anterior pituitary, preventing return to estrus (typically for 45-50 days). Additional clinical signs of pseudopregnancy are rare in cats.
An 8-year old male castrated cat presents to your clinic for a decreased appetite and slight weight loss over the past 2 months. Physical examination is unremarkable except for mild cranial organomegaly detected on abdominal palpation. You perform diagnostic tests and find the following results:
Complete blood count shows:
Hematocrit - 26% (30-45 %)
White blood cell count- 18,155/ul (5,500-19,500/ul)
Neutrophils- 12,100/ul (2,500-12,500/ul)
Lymphocytes- 5,055/ul (1,500-7,000/ul)
Monocytes- 300/ul (0-900/ul)
Eosinophils- 700/ul (0-800/ul)
Platelets- 270,000/ul (300,000-800,000/ul)
Serum chemistry shows: Creatinine- 1.2 mg/dl (0.9-2.2 mg/dl) Blood urea nitrogen (BUN)- 22 mg/dl (19-34 mg/dl) Glucose- 138 mg/dl (60-120 mg/dl) Albumin= 3.4 g/dl (2.8-3.9 g/dl) Globulin= 6.2 g/dl (2.6-5.1 g/dl) ALP- 85 IU/L (0-45 IU/L) ALT- 214 IU/L (25-97 IU/L) GGT- 9 IU/L (0-6 IU/L) Total bilirubin- 0.9 mg/dl (0-0.1 mg/dl)
You perform an abdominal ultrasound and find that the liver appears subjectively enlarged. The echogenicity of the liver is normal and the gall bladder is normal in appearance. No other abnormalities are seen.
You perform an ultrasound guided liver biopsy. Histopathology indicates infiltration of lymphocytes and plasma cells but not neutrophils into portal areas but not into bile ducts.
With treatment, what is the cat’s prognosis?
The case described is consistent with lymphocytic portal hepatitis. Clinically, this condition can appear similar to chronic cholangiohepatitis in terms of signalment, clinical signs and laboratory findings. The key to this diagnosis is the liver biopsy. Typical findings for lymphocytic portal hepatitis is infiltration of lymphocytes and plasma cells but not neutrophils into portal areas. This is in contrast to chronic cholangiohepatitis which typically has neutrophils in portal areas.
Chronic cholangiohepatitis carries a fair prognosis with about half of cats doing poorly (dead or euthanized within 3 months) and half of cats responding favorably to treatment with long term survival. For cats with lymphocytic portal hepatitis, although treatment can be challenging, the disease is very slowly progressive and the reported mean survival is approximately 3 years.
