Feline

Question 1

Which of these is most likely to relieve dyspnea in a cat with feline bronchial disease (feline asthma)?

Beta-2 agonist
Alpha-2 antagonist
Beta-2 antagonist
Alpha-1 agonist
Alpha-2 agonist

Answer 1

Answer: Beta-2 agonist

The correct answer is beta-2 agonist. Beta-2 agonists will relax bronchial smooth muscle. The one most commonly used for this purpose is terbutaline.

Question 2

A 10-year-old female spayed DSH presents to you after the pet-sitter found her with the following wound (see image). She is strictly indoors and the pet-sitter notes that she has otherwise been normal. She is the only animal in the house. She was previously diagnosed with diabetes mellitus and has been receiving her insulin on a consistent schedule but she continues to be polyuric and polydipsic. Her haircoat is unkempt and her abdomen is slightly pendulous. A CBC was unremarkable. Chemistry panel showed hyperglycemia and her urine specific gravity was 1.040. An abdominal ultrasound was performed. Which ultrasonographic finding is consistent with the likely underlying disease process?

• Hypochoic pancreas and hyperechoic
  mesentery
• Normal to enlarged adrenal glands
• Bilateral adrenal atrophy
• Hyperechoic liver and moderate hepatomegaly

Answer 2

Answer: Normal to enlarged adrenal glands

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 hypochoic 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.

Question 3

A cat presents to you with a history of unilateral mucopurulent nasal discharge and a proliferative soft tissue mass over the bridge of the nose. On physical exam, you note aqueous flare as well as the abnormalities listed above. Lung sounds are normal. What is the most likely diagnosis?

• Aspergillosis
• Nasal adenocarcinoma
• Squamous cell carcinoma
• Cryptococcisis
• Bacterial rhinitis

Answer 3

Answer: Cryptococcosis

The correct answer is cryptococcosis. Cats are commonly affected by Cryptococcus neoformans. Most common clinical signs are mucopurulent discharge and a proliferation on the nose (“Roman nose”). Ocular and CNS involvement may also be seen. It is an important differential for uveitis in a cat. Aspergillus is uncommon in cats and shouldn’t cause uveitis. Squamous cell carcinoma is common on the nose of cats, especially white ones exposed to the sun but is usually an ulcerated rather than a proliferative lesion.

Question 4

Which of the following are not efficacious methods for diagnosing feline infectious peritonitis?

• Immunohistochemistry and RT-PCR
• Serology and histopathology
• RT-PCR and 7B protein ELISA test
• Serology and 7B protein ELISA test
• Histopathology and 7B protein ELISA test

Answer 4

Answer: Serology and 7B protein ELISA test

Explanation
The correct answer is serology and 7B protein ELISA test.

Some FIP viruses do not have the 7B protein. So, this test is not sensitive for FIP virus. Immunohistochemistry or RT-PCR can be used to demonstrate virus on biopsy specimens (RT-PCR does not work on serum or feces). However, this is not always necessary because histopathology (gold standard for antemortem diagnosis) can show characteristic lesions of disseminated pyogranulomatous and fibrinonecrotic reaction around small veins.

If you can’t remember any of these at least remember that corona titers are completely useless! They will only tell you if the cat has been exposed to a corona virus.

Most cats have been exposed to a corona virus at some point in their lives. So the best choice is serology and the 7B protein ELISA test since neither of these are efficacious.

Question 5

You have a cat that needs to stay on inhalation anesthesia and remain recumbent following a major surgery. What pulmonary complication is likely to occur from prolonged recumbency and anesthesia in this patient?

• Lobar consolidation
• Pulmonary contusions
• Pulmonary mineralization
• Atelectasis

Answer 5

Answer: Atelectasis

Explanation
The correct answer is atelectasis. Atelectasis or the incomplete expansion of a lung due to loss of air from alveoli is a common complication of prolonged recumbency and inhalation anesthesia.

Lobar consolidation differs from atelectasis in that it refers to filling of airways with fluid. This occurs usually in inflammation.

Pulmonary mineralization occurs from inflammation, infection, or neoplasia in the lung parenchyma.

Pulmonary contusions are usually from trauma.

The other main cause of atelectasis is decreased pulmonary surfactant in newborns or in ARDS or near drownings.

Incidentally, another good answer to this question would be aspiration pneumonia.

Question 6

An owner presents to you concerned that her cat is having an unplanned pregnancy. You take radiographs and can make out 6 fetal skeletons. The owner wants to know at what age the fetal skeletons typically become visible in cats. What should you tell her?
21-28 days
13-18 days
36-45 days
25-35 days

Answer 6

Answer: 36-45 days

Explanation
The normal gestational period in cats is 63 days after impregnation.
Ultrasound can be used to confirm pregnancy as early as 13 days.
A developing fetus can usually be palpated by day 21-28.
Fetal skeletons are radiographically detectable at around 42 days (range 36-45 days). An enlarged uterus may be visible radiographically as early as day 25-35.

Question 7

A client calls and says her cat was chewing on her lily plant two days ago and is now acting very sick. You tell her to bring the cat in immediately so that you can perform which of the following?

• Induce emesis and administer activated charcoal
• BUN and creatinine levels
• Abdominal radiographs to diagnose intestinal obstruction
• ALT, AST, GGT, and total bilirubin levels

Answer 7

Answer: BUN and creatinine levels

Lily plant toxicosis is extremely serious and can cause rapid and fatal acute renal failure in cats. If ingestion is suspected, decontamination and aggressive fluid therapy, and monitoring of renal values are recommended immediately.
In this case, since 2 days have passed, inducing emesis and administering activated charcoal would not be helpful. What you can do is check renal values (BUN and creatinine) and treat for acute renal failure.

Ruling out an intestinal obstruction in a cat with this history is reasonable but not the best of the choices given.

Question 8

A 6-year old female spayed indoor only domestic medium hair presents with a large raw lesion on its upper left lip. The owner reports the lesion has come and gone over the past few years. Which of these treatments would likely be most helpful?

• Topical trifluridine and systemic clindamycin
• immunosuppressive therapy and a change to a hypoallergenic diet
• Wide surgical excision and chemotherapy
• Marginal surgical excision and radiation therapy

Answer 8

Answer: Immunosupressive therapy and a change to a hypoallergenic diet.

Explanation
This cat’s image and clinical history of a disappearing and recurring lip ulcer is consistent with an indolent ulcer, part of the eosinophilic granuloma complex. These are mostly found on the upper lip of cats. These lesions can also extend into the oral cavity and can be found at the tongue base or hard palate. Typical treatment involves high doses of corticosteroids and identifying possible underlying allergic disease. Sometimes, antibiotics are indicated if severe infection is present. A hypoallergenic diet can be helpful if food allergy is the cause. Many times, the etiology is unknown but allergy is suspected.

Squamous cell carcinoma is also a differential; however, in a cat that has a lesion that comes and goes, this is much less likely.

Viral infections in cats usually present with upper respiratory and/or ocular signs.

Question 9

A 3-year old male castrated cat presents to your clinic for inappetence and depression of 3 days duration. On physical exam, the cat is febrile with a temperature of 103.6F (39.8 C) and is 8% dehydrated. Complete blood count shows:
Hematocrit - 36% (30-45 %)
White blood cell count- 25,678/ul (5,500-19,500/ul)
Neutrophils- 21,678/ul (2,500-12,500/ul)
Lymphocytes- 3,300/ul (1,500-7,000/ul)
Monocytes- 200/ul (0-900/ul)
Eosinophils- 500/ul (0-800/ul)
Platelets- 210,000/ul (300,000-800,000/ul)
Serum chemistry shows:
Creatinine- 1.8 mg/dl (0.9-2.2 mg/dl)
Blood urea nitrogen (BUN) - 30 mg/dl (19-34 mg/dl)
Glucose- 70 mg/dl (60-120 mg/dl)
Albumin= 3.2 g/dl (2.8-3.9 g/dl)
Globulin= 2.8 g/dl (2.6-5.1 g/dl)
ALP- 95 IU/L (0-45 IU/L)
ALT- 349 IU/L (25-97 IU/L)
GGT - 12 IU/L (0-6 IU/L)
Total bilirubin- 1.1 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 and spleen are normal. The gall bladder appears mildly enlarged; no choleliths are seen. The pancreas does not appear sonographically enlarged or abnormal. The kidneys and the remainder of the abdomen appear unremarkable. You perform an ultrasound guided liver biopsy. Histopathology indicates fibrosis associated with portal triads, bile duct proliferation, and centrilobular accumulation of bile with casts in canalicular areas. With treatment, what is the cat’s prognosis?

• 50% chance of long term survival, 50% chance of dying within 3 months
• 90% chance of long term survival although the cat will be predisposed to similar episodes in the future
• 10% chance of surviving greater than 3 months
• 90% chance of surviving greater than 3 months but only a 25% chance of surviving greater than 1 year

Answer 9

Answer: 50% chance of long term survival, 50% chance of dying within 3 months

The case described is very consistent with acute cholangiohepatitis. This condition is usually seen in younger cats (mean age 3-3.5 years) and is more common in males than females. This is in contrast to chronic cholangiohepatitis which occurs in older cats (mean age 9 years). Acute cholangiohepatitis patients are more likely to be depressed, dehydrated and febrile.

Bloodwork in cholangiohepatitis often shows a neutrophilia with or without a left shift. Mild increases in bilirubin and ALP are common, often with more severe elevations of ALT. The sonographic and biopsy findings are also consistent with the diagnosis of acute cholangiohepatitis and make other differentials such as hepatic lipidosis or lymphocytic portal hepatitis less likely.

Treatment of choice for this disease includes antibiotics with aerobic and anaerobic coverage that are excreted unchanged in the bile. Examples of antibiotics excreted unchanged in the bile include tetracyclines, ampicillin, amoxicillin, erythromycin, chloramphenicol, and metronidazole. Usually erythromycin, tetracycline, and choloramphenicol are not the first choices unless they are indicated based on culture and sensitivity because erythromycin is not effective against gram negative bacteria, tetracycline is hepatotoxic, and chloramphenicol may cause anorexia. Ampicillin or amoxicillin with clavulanic acid are good choices and metronidazole may be used to expand the anaerobic coverage. Ursodeoxycholic acid (Actigall) is useful in all types of inflammatory liver disease because of its anti-inflammatory and anti-fibrotic properties on the liver. It also increases fluidity of biliary secretions.

With treatment, it is thought that the response of acute and chronic cholangiohepatitis cases is similar with about half of animals dying or being euthanized within 90 days and half of them having prolonged survival.

Question 10

A 10-year old feline domestic shorthair presents for symmetrical truncal alopecia. On physical examination you note that the alopecia appears non-inflammatory.
Skin cytology reveals no infectious organisms or inflammatory cells. You further inquire about how the cat has been doing at home. The owner explains that the cat is extremely active and is eating more but seems to be losing weight. You are highly suspicious of an endocrine disease. What is the best diagnostic and treatment plan based on the most likely differential?

• ACTH stimulation test and initiate treatment with mitotane
• Thyroid panel and supplementation with liothyronine every 8 hours
• Thyroid panel and supplementation with levothyroxine every 24 hours
• Thyroid panel and change to a low iodine diet
• ACTH stimulation test and initiate treatment with trilostane

Answer 10

Answer: Thyroid panel and change to a low iodine diet

Based on the history and physical examination findings this patient most likely has hyperthyroidism. Hyperthyroidism is the most common endocrinopathy of cats.

Patients with hyperthyroidism exhibit signs of an accelerated basal metabolic rate including hyperactivity, polyphagia, and tachycardia. Some cats will experience polydipsia, polyuria, and gastrointestinal signs (diarrhea, vomiting). The cutaneous signs that this cat is demonstrating are non-specific but are suggestive of an endocrinopathy. There are multiple treatments for hyperthyroidism including surgical thyroid excision, radioactive iodine treatment, anti-thyroid drugs (methimazole), and low iodine prescription diets.

Levothyroxine (T4) and liothyronine (T3) are treatments for hypothyroidism. Cats seldom experience hypothyroidism; if they do, it is usually congenital in onset.

An ACTH stimulation test is used to support a diagnosis of hypercortisolism. Feline hypercortisolism is a rare disease. Cats with hypercortisolism usually present due to unregulated diabetes mellitus. They present with polyuria, polydipsia, fragile skin, alopecia, and weight loss. They are usually not hyperactive.

Question 11

Your client is pregnant and is worried about acquiring toxoplasmosis from her cat. What do you advise?

• Submit toxoplasmosis titers from the cat. A positive cat infected with toxoplasmosis can shed multiple times in its lifetime and pose a zoonotic risk.
• Have a housemate empty the litter box daily as a simple precaution to prevent infection as it takes 1-3 days for passed oocysts in the stool to sporulate into an infective form.
• Submit toxoplasmosis titers from the cat. A IgG titer of 1:64 or greater suggests recent or active infection that could pose a danger.
• Toxoplasmosis titer should be performed on the owner by a human physician. A positive titer indicates antibodies to the organism that will prevent infection in the first trimester. A negative titer indicates she should remove her cats from her environment.

Answer 11

Answer: Have a housemate empty the litter box daily as a simple precaution to prevent infection as it takes 1-3 days for passed oocysts in the stool to sporulate into an infective form.

Toxoplasmosis gondii is a protozoal organism. The cat is the definitive host; the entire life cycle of the organism can be completed within this host. Most cats become infected when they consume an exposed rodent with bradyzoites encysted in their tissues. Only recently infected cats generally shed oocysts in their stool, and cats typically only shed these oocysts for 1-2 weeks. Most cats will only have one shedding episode in their lifetime.

A IgM (not IgG) titer of 1:64 or greater suggests recent or active infection and that cat is at risk of shedding oocysts in their stools. Oocysts are not infective until they sporulate. This process takes > 24 hours, so emptying the litter box daily is advised, preferably by someone who is not pregnant.

If an owner has owned cats for a long while, it is possible that they may have previously been exposed and therefore have mounted an immune response to the organism. If so, it may be advisable to test for Toxoplasma antibody titers in the owner. A sufficient antibody titer will mean the client is protected from infection during the first trimester.

Question 12

Which of these is most likely to relieve dyspnea in a cat with feline bronchial disease (feline asthma)?

• Beta-2 antagonist
• Alpha-1 agonist
• Alpha-2 antagonist
• Alpha-2 agonist
• Beta-2 agonist

Answer 12

Answer: Beta-2 agonist

Explanation
The correct answer is beta-2 agonist.

Beta-2 agonists will relax bronchial smooth muscle. The one most commonly used for this purpose is terbutaline.

Question 13

A 9-year FS Domestic Long Hair presents for lethargy, weakness, and 2 seizures. The owner states that yesterday she gave the cat an enema she picked up from the drug store. The owner thought she had been constipated because she hadn’t defecated in several days and appeared uncomfortable. She said it was a Fleet enema and that she had no problem administering it, but the cat vomited a few times afterward. Sassy is 5% dehydrated and obtunded on examination. She is having slight tremors. Your in-house laboratory won’t have bloodwork available for 2 hours. Which of the following treatments will most likely be indicated?

• Potassium phosphate, IV fluid therapy, methocarbamol
• Potassium phosphate, IV fluid therapy, diazepam
• Calcium gluconate, IV fluid therapy, phosphorus binders
• Insulin and dextrose, IV fluid therapy
• Potassium phosphate, a plain warm water enema, IV fluid therapy

Answer 13

Answer: Calcium gluconate, IV fluid therapy, phosphorus binders

There are different Fleet enemas, some of which contain hypertonic sodium phosphate and are contraindicated in cats. Cats develop an electrolyte disturbance caused by the absorption of sodium and phosphate from the colon. This results in hypernatremia and hyperphosphatemia.

The high phosphorus leads to precipitation of serum calcium and thus hypocalcemia. This hypocalcemia can cause weakness, lead to shock, and cause muscle tremors or seizures. The treatment for this toxicity is to correct the electrolyte disturbance and correct the dehydration. IV fluid therapy and calcium gluconate are the initial treatments, and many times phosphorus binders are helpful to more quickly decrease the serum phosphorus.

Unless the cat is actively seizing, diazepam would not be indicated. The administration of calcium should help to stop the tremoring this cat is exhibiting. Potassium phosphate is clearly contraindicated, since the phosphorus is already too high. Insulin and dextrose are sometimes used in severe cases of hyperkalemia, which is not suspected in this case.

Question 14

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?

• Good, mean survival is greater than 2 years
• Grave, mean survival is < 2 months
• Poor, mean survival is < 6 months
• Fair, mean survival is about 1 year

Answer 14

Answer: Good, mean survival is greater than 2 years

Explanation
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.

Question 15

A 12-week old female kitten presents to you for head-shaking and scratching her ears. She is one of several kittens in the litter displaying similar signs. On physical exam, there are excoriations around the pinna, and excessive reddish-brown ceruminous discharge in both ears (see image). You clean out the debris from the ear and examine the material under the microscope. On microscopic exam, you see several ear mites, consistent with Otodectes infestation. Which of the following treatments is effective against this parasite?

Fluocinolone
Imidacloprid
Enrofloxacin
Praziquantel
Milbemycin

Answer 15

Answer: Milbemycin

Ear mite infestation with Otodectes cynotis is consistent with the signs described, and the finding of the mites microscopically should have confirmed your clinical suspicion in this case.

There are several effective treatments for ear mites, these include:
Milbemycin is the active ingredient in the otic solution Milbemite. This otic solution is applied directly into the ears and is usually effective in a single treatment although it is sometimes repeated once.

Ivermectin is available as an otic solution (Acarexx). Similar to Milbemite, it is applied directly into the ears and is usually effective in a single treatment although it is sometimes repeated once. Injectable ivermectin is not FDA approved for treatment of ear mites.

Selamectin (Revolution) and moxidectin (Advantage Multi) are approved for control of otodectes but may be more effective as a preventative for ear mites than for immediate treatment of a significant infestation. These formulations are applied topically to the skin between the shoulders.

Thiabendazole, an ingredient in Tresaderm, is effective against yeast and ear mites if used for >10 days.

The other drugs listed here are not effective against otodectes ear mites. Imidacloprid is the active ingredient in Advantage; it is a nicotine based insecticide that is effective against fleas.

Enrofloxacin is a fluoroquinolone antibacterial that is available in an otic solution (Baytril otic) but is not effective against ear mites.

Praziquantel (a component of Droncit and Drontal) is an anthelmintic that is used against gastrointestinal parasites, primarily cestodes (tapeworms).

Fluocinolone is a corticosteroid that is a component of Synotic and is not an antiparasitic.

Question 16

A 3 year old indoor/outdoor MN feline named Dudley presents to your clinic because the owner saw “some white rice-looking things” around his anus. They were small and flat and seemed to be moving. Some of them were dried up. Which of the following treatments would be best?

Fipronil (Frontline)
Selamectin (Revolution)
Fenbendazole (Panacur)
Pyrantel (Strongid)
Praziquantel (Droncit)

Answer 16

Answer: Praziquantel.

This cat likely has a tapeworm infection. Tapeworm segments are typically flat and white and small, resembling a grain of rice. The most common tapeworms in cats are Taenia taeniaeformis and Dipylidium caninum. The only medication that will treat both types is praziquantel.
Praziquantel is in the products Drontal Plus and Profender, approved for the use in cats. Drontal Plus also contains pyrantel. Profender also contains emodepside. Both are also effective against roundworm and hookworm.
Pyrantel is not effective against tapeworms and treats hookworm and roundworm infection.
Fenbendazole (or Panacur), treats Taenia but not Dipylidium, and also treats hookworm, roundworm, and whipworm infection.
Revolution treats and prevents hookworm, roundworm, heartworm, fleas, and ear mites in cats.
Frontline treats and prevents fleas and ticks. A flea control should be recommended since Dipylidium is transmitted by ingestion of an infected flea. Taenia is transmitted through eating an infected prey.

Question 17

You refer a cat with hairloss to the dermatologist and the cat is diagnosed with Demodex gatoi. Which is true regarding Demodex gatoi?

• It does not typically cause pruritis
• It is found mostly in the ear canal
• It is long and slender and lives in the hair follicle
• It is contagious to other Cats

Answer 17

Answer: It is contagious to other cats

Explanation
Demodex gatoi and Demodex cati are the two demodex mites seen in cats. Demodex gatoi is the more short and stubby mite which lives superficially and Demodex cati is the long slender mite which lives in the hair follicles. Demodex gatoi is considered contagious to other cats and causes pruritus.

Question 18

What is the surgical treatment of choice for cats with chronic obstipation and megacolon that is refractory to medical therapies?

Colonoplasty
Subtotal colectomy
Enterotomy and reclosure after removal of feces
Colostomy

Answer 18

Answer: Subtotal colectomy

Explanation
The correct answer is subtotal colectomy. This technique usually entails transecting the ascending colon a few centimeters distal to the cecum and the descending colon a few centimeters proximal to the pubis and anastomosing them together, trying to preserve the ileocolic junction. The other procedures listed are not successful therapies for megacolon.

Question 19

Which of the following plants is potently nephrotoxic to cats?

• Nasturtium
• Stargazer lily
• Poinsettia
• Peace lily
• Calla lily

Answer 19

Answer: Starazer lily

Explanation
The Stargazer lily is a member of the Lilium family and is a severe nephrotoxicant in cats; a single exposure can cause severe acute renal failure. All parts of the plant are considered toxic to cats if bitten or ingested.

The toxicity of poinsettias is actually minimal, and is generally limited to oral irritation and/or mild gastrointestinal upset.

Peace lily and Calla lily are not true lilies, and are not a nephrotoxicants.

Nasturtium is a common garden flower and is nontoxic, is actually edible, and has a peppery flavor.

Question 20

Sydney is a 1.5-year old male neutered DSH, previously feral but now an indoor only cat. He has a history of controlled diabetes mellitus and recent bloodwork was within normal limits aside from an elevated blood glucose of 200 mg/dl (60-120mg/dl).
He presents to you today for difficulty breathing and x-rays showed pleural fluid. You remove 250mL of serosanguinous fluid and you are concerned about the possibility of feline infectious peritonitis (FIP); which of the following tests would be most helpful in ruling out FIP (which has the highest negative predictive value?

Immunofluorescence staining for coronavirus in macrophages in effusion fluid
Coronavirus antibody detection in effusion fluid
Rivalta’s test
Reverse-transcriptase polymerase chain reaction (RT-PCR) for coronaviral RNA in serum

Answer 20

Answer: Rivalta’s test

Explanation
Of the tests listed, Rivalta’s test has the highest negative predictive value in the diagnosis of FIP. This means that a negative test is likely associated with the cat truly not having the disease. In two separate studies, Rivalta’s test has been shown to have a negative predictive value (NV) greater than 90% (Hartmann 2003, JVIM: showed PPV-86% and NPV-97%, and Fischer 2012, Vet Clin Path: showed PPV=58% and NPV=93.4%). False positives are more commonly seen in older cats and cats with lymphoma or bacterial infections but negative results are relatively convincing compared to most other diagnostic tests for this disease.

Rivalta’s test involves filling a reagent tube with distilled water and 1 drop of acetic acid (98%). On the surface of this solution, 1 drop of the effusion
fluid is added and if the drop disappears and the solution remains clear, the Rivalta’s test is negative. If the drop retains its shape, stays attached to the surface, or slowly floats down to the bottom of the tube as a drop, Rivalta’s test is defined as positive.

The other tests listed tend to have high PVs and are more specific but have more false negatives and are not as good for ruling out the disease.

Question 21

Which of the following are not efficacious methods for diagnosing feline infectious peritonitis?
RT-PCR and 7B protein ELISA test
Histopathology and 7B protein ELISA test
Serology and histopathology
Immunohistochemistry and RT-PCR
Serology and 7B protein ELISA test

Answer 21

Answer: Serology and 7B protein ELISA test

The correct answer is serology and 7B protein
ELISA test. Some FIP viruses do not have the 7B protein. So, this test is not sensitive for FIP virus.
Immunohistochemistry or RT-PCR can be used to demonstrate virus on biopsy specimens (RT-PCR does not work on serum or feces). However, this is not always necessary because histopathology (gold standard for antemortem diagnosis) can show characteristic lesions of disseminated pyogranulomatous and fibrinonecrotic reaction around small veins. If you can’t remember any of these at least remember that corona titers are completely useless! They will only tell you if the cat has been exposed to a corona virus. Most cats have been exposed to a corona virus at some point in their lives. So the best choice is serology and the 7B protein ELISA test since neither of these are efficacious.

Question 22

A cat presents in status epilepticus. The cat is moving violently and it will be difficult to place an IV catheter.
What is the best treatment option for this cat to stop the seizure?

Diazepam rectally
Diazepam intramuscularly
Pentobarbital intravenously
Phenobarbital sublingually

Answer 22

Answer: Diazepam rectally

Explanation
The correct answer is diazepam rectally. Diazepam is a benzodiazepine that is very effective at suppressing seizure activity. Intramuscular diazepam is absorbed very slowly and would not be a good option for this actively seizuring cat. This is a controversial question, and you may argue that diazepam has been associated with acute hepatic necrosis in cats.

Question 23

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?

0.9% Saline with 20 meq/L Potassium
supplementation
Lactated ringers with 16 meq/L Potassium supplementation
0.9% sodium chloride
Hetastarch

Answer 23

Answer: 0.9% sodium chloride

Explanation
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.

Question 24

A 3-yr-old indoor only spayed female domestic short-haired cat presents with hair loss on the ventral abdomen. Analysis of the hairs shows blunt, “barbered” tips, although no crusts or excoriations are present. Which of the following is the LEAST likely cause?

Flea allergy dermatitis
Psychogenic alopecia
Atopic dermatitis
Food allergy

Answer 24

Answer: Psychogenic alopecia

Explanation
The “barbered” tips indicate that the cat is excessively grooming her abdomen. Nevertheless, the most likely diagnosis is some type of allergic dermatitis. Psychogenic alopecia is extremely rare in cats and is a diagnosis of exclusion. Allergic dermatitis in cats can present as an apparently non-inflammatory alopecia; the ventral abdomen may be the only site affected.

Question 25

A 12-week old female kitten presents to you for head-shaking and scratching her ears. She is one of several kittens in the litter displaying similar signs. On physical exam, there are excoriations around the pinna, and excessive reddish-brown ceruminous discharge in both ears (see image). You clean out the debris from the ear and examine the material under the microscope. On microscopic exam, you see several ear mites, consistent with Otodectes infestation. Which of the following treatments is effective against this parasite?

Imidacloprid
Enrofloxacin
Milbemycin
Praziquantel
Fluocinolone

Answer 25

Answer: Milbemycin

Explanation
Ear mite infestation with Otodectes cynotis is consistent with the signs described, and the finding of the mites microscopically should have confirmed your clinical suspicion in this case. There are several effective treatments for ear mites, these include:

Milbemycin is the active ingredient in the otic solution Milbemite. This otic solution is applied directly into the ears and is usually effective in a single treatment although it is sometimes repeated once.

Ivermectin is available as an otic solution (Acarexx). Similar to Milbemite, it is applied directly into the ears and is usually effective in a single treatment although it is sometimes repeated once. Injectable ivermectin is not FDA approved for treatment of ear mites.

Selamectin (Revolution) and moxidectin (Advantage Multi) are approved for control of otodectes but may be more effective as a preventative for ear mites than for immediate treatment of a significant infestation. These formulations are applied topically to the skin between the shoulders.

Thiabendazole, an ingredient in Tresaderm, is effective against yeast and ear mites if used for >10 days.

The other drugs listed here are not effective against otodectes ear mites. Imidacloprid is the active ingredient in Advantage; it is a nicotine based insecticide that is effective against fleas. Enrofloxacin is a fluoroquinolone antibacterial that is available in an otic solution (Baytril otic) but is not effective against ear mites. Praziquantel (a component of Droncit and Drontal) is an anthelmintic that is used against gastrointestinal parasites, primarily cestodes (tapeworms). Fluocinolone is a corticosteroid that is a component of Synotic and is not an antiparasitic.

Question 26

A middle aged MN stray cat is left on the doorstep of your clinic. The cat has a large dry crusted area of alopecia over his nose. A skin scraping of the area is negative. The lesion fluoresces under Wood’s lamp examination. Which of the following would be the best treatment?

Povidone-iodine scrub
Doxycycline
Athlete’s foot cream (clotrimazole)
Full body lyme sulfur dip. iraconazole
Lufenuron

Answer 26

Answer: Full body lyme sulfur dip. iraconazole

Explanation
This cat has a ringworm infection caused by Microsporum canis. This fungi fluoresces blue under a Wood’s lamp in 50% of cases.

The best treatment for ringworm infection would include a combination topical and oral therapy. Lyme sulfur dip or an antifungal shampoo containing miconazole would be acceptable. Oral antifungals such as itraconazole or fluconazole are most effective with the least side effects.

Povidone-iodine scrub has not been shown to be effective against ringworm.

Lufenuron is classified as an insect development inhibitor because of its ability to inhibit chitin synthesis, thus in the past has been said to have some effect against fungal infections. This has been debated and not widely supported as a treatment for ringworm.

Doxycycline is an antibiotic and would not be effective in treatment of fungal disease.

Athlete’s foot cream (clotrimazole) may have some effect at treating the lesion. Most over-the-counter creams such as this also include a steroid like betamethasone which would not be desired. Although this lesion appears to be localized to the nasal area, ringworm may also be subclinical and this cat may have infection elsewhere in the skin that is not grossly visible. Therefore, the best therapy is a combination of topical and oral.

The best treatment for the cat’s ringworm infection caused by Microsporum canis is a combination of topical and oral antifungal therapies. A full-body lime sulfur dip or an antifungal shampoo containing miconazole can be used topically, while itraconazole or fluconazole are effective oral antifungals with minimal side effects. Povidone-iodine scrub is not effective against ringworm, and lufenuron, while debated, is not widely supported as a treatment. Doxycycline, an antibiotic, is ineffective against fungal infections. Athlete’s foot cream (clotrimazole) might help, but many over-the-counter creams also contain steroids like betamethasone, which are not recommended. Given the potential for subclinical infection, a combination approach is best.

Dermatophytosis (Ringworm) in Dogs and Cats: Comprehensive Veterinary Guide
Definition:
Dermatophytosis, commonly known as ringworm, is a superficial fungal infection affecting the skin, hair, and occasionally claws. It is caused by dermatophytes, primarily Microsporum canis, Trichophyton mentagrophytes, and Microsporum gypseum.

Pathophysiology:
• Infection Mechanism: Fungi invade the keratinized tissues, leading to infection. Spores can germinate and invade skin and hair shafts under favorable conditions.
• Host Response: Infection severity is influenced by the host’s immune response, with compromised immunity leading to more severe disease.

Causes:
• Primary Pathogens: Microsporum canis is the most common cause in cats and dogs.
• Transmission: Direct contact with infected animals, fomites, or contaminated environments. Microtrauma to the skin facilitates infection.

Symptoms:
• General: Hair loss, scaling, crusting, erythema, papules, hyperpigmentation, and variable pruritus.
• Specific Forms: Kerion (nodular lesions) in dogs, pseudomycetomas in Persian cats, and exudative paronychia in cats.

Clinical Changes:
• Lesion Characteristics: Circular, alopecic areas with scaling and crusting. Lesions can be pruritic or non-pruritic.

Diagnosis:
• Direct Examination: Microscopic examination of hairs and scales for fungal elements.
• Wood’s Lamp: Used to identify M. canis infections by fluorescing hairs.
• Fungal Culture: Confirms infection by growing the fungus from hair or skin samples.
• PCR Testing: Detects fungal DNA but cannot distinguish between viable and nonviable spores.

Treatment:
• Systemic Antifungal Therapy:
• Itraconazole: 5 mg/kg orally, daily in a pulse therapy schedule (week on/week off).
• Other Options: Ketoconazole and terbinafine in dogs; avoid ketoconazole in cats.
• Topical Therapy: Lime sulfur rinses, enilconazole, or miconazole/chlorhexidine shampoos to disinfect the coat and reduce environmental contamination.
• Environmental Cleaning: Essential to remove spores; includes mechanical cleaning and disinfection.

Prognosis:
• Self-Limiting: In healthy animals, dermatophytosis can resolve without treatment, but treatment is recommended to prevent spread.
• Clinical and Mycologic Cure: Requires resolution of lesions and negative fungal cultures or PCR tests.

Prevention:
• Hygiene and Isolation: Isolate infected animals and maintain proper hygiene to prevent spread.

https://www.merckvetmanual.com/integumentary-system/dermatophytosis/dermatophytosis-in-dogs-and-cats?query=feline ringworm https://www.merckvetmanual.com/integumentary-system/dermatophytosis/dermatophytosis-in-dogs-and-cats?query=feline ringworm

Question 27

A 4-month old male domestic short hair cat presents for multifocal areas of raised alopecia on its face. You highly suspect that the cat has dermatophytosis, but a Wood’s lamp exam shows no fluorescence of the fur or skin. What should you do next?

• Begin aggressive treatment with ketoconazole
• Collect samples for fungal cultures
• Send the cat home and have the owner bring it back when the lesion is bigger to re-examine it with the Wood’s lamp
• Take a punch biopsy of the lesion for a diagnosis

Answer 27

Answer: Collect samples for fungal cultures

Explanation
The correct answer is collect samples for fungal cultures. Fungal culture is the most definitive diagnostic for dermatophytosis. Ketoconazole is not recommended in cats because it causes them to vomit. Examination of the lesions under a Wood’s lamp does not definitively rule out dermatophytosis; only about 50% of Microsporum canis organisms actually fluoresce under a Wood’s lamp. Other dermatophyte species do not fluoresce at all. A punch biopsy at this point is not indicated yet, since other preliminary tests have not been run.

Question 28

The 9-month old female spayed DSH cat shown in the photo presents with a wound on the lateral thoracic wall, and she has a matted haircoat. Physical exam is otherwise unremarkable. The owner reported that the wound started as a small swelling that gradually enlarged over the last week. The kitten is not febrile, and the wound is cool and nonpainful upon palpation. You explore the wound and a moving organism is seen in the hole. How was this organism most likely contracted?

Via infection from the environment
Via mosquito bite
Via ingestion from mother’s milk
Via cat scratch or bite

Answer 28

Answer: Via infection from the environment

Explanation
This is an example of Cuterebra infestation. Cats are not natural hosts for this parasite, and the larva should be carefully removed. The wound should be enlarged enough to allow the entire larva to be removed without breaking it, because retained parts can cause infections or adverse reactions.

Cuterebra are large bee-like flies that do not bite or feed. They lay their eggs on stones, vegetation, or near the openings of animal burrows. The natural hosts of this organism are rabbits and rodents. Cats and dogs become infested when they come into contact with the larvae on rocks, vegetation, or near the openings of rabbit and rodent dens. The larvae attach to the fur as the animal passes and enter the body during grooming or via open wounds. They do not typically enter through the skin. Larvae undergo aberrant migration and localize to the skin of the neck, head, and trunk. Cuterebra infestations are seen most commonly in the late summer and fall.

Question 29

A 13-year-old female spayed domestic short hair cat presents for progressive ptyalism and halitosis. On anesthetized oral exam, you find the sublingual lesion seen in the image below. Which of the following differential diagnoses is most likely and appropriately matched with its prognosis?

Squamous cell carcinoma. Prognosis is poor with treatment
Squamous cell carcinoma. Prognosis is good with treatment
Bacterial granuloma. Prognosis is poor with treatment
Eosinophilic granuloma complex. Prognosis is guarded with treatment
Eosinophilic granuloma complex. Prognosis is poor with treatment

Answer 29

Answer: Squamous cell carcinoma. Prognosis is poor with treatment

Explanation
The top differential for a mass lesion of the tongue of an older cat is squamous cell carcinoma. Other differentials including eosinophilic granuloma complex, FIP granuloma, fungal granuloma, and bacterial granuloma are much less common.

Squamous cell carcinoma is a locally aggressive form of neoplasia that is associated with a poor prognosis unless it is caught very early (usually as an incidental finding). Median survival times for cats with this disease is about 2 months with only 10% still living 1 year after diagnosis.

Eosinophilic granulomas are thought to be a hypersensitivity reaction and the prognosis is thought to be good with treatment and identification of an underlying cause.

Question 30

A 6-year old male neutered domestic short hair cat presents with the chin lesion shown in the photo. The lesion is unilateral and nodular with ulceration. What is the most accurate description of this lesion?

Eosinophilic plaque
Eosinophilic ulcer
Collagenolytic granuloma
Miliary dermatitis

Answer 30

Answer: Collagenolytic granuloma

Explanation
The image and description are most consistent with a collagenolytic granuloma. Feline eosinophilic granuloma complex consists of 3 separate clinical syndromes:

1. The collagenolytic granuloma (also known as eosinophilic granuloma or linear granuloma) usually occurs on the nose, chin (as in this case), oral cavity, or caudal thighs. The lesions are typically raised and ulcerative or nodular as seen here.
2. The eosinophilic plaque occurs most frequently on the abdomen and medial thighs but can appear other places. They appear as single or multiple, raised, red, often ulcerated lesions of varying size (0.5-7 cm). They frequently have a cobblestone appearance and unlike eosinophilic ulcers, these are often pruritic. This condition is histopathologically similar to miliary dermatitis and is usually associated with underlying allergy.
3. The eosinophilic ulcer (also known as indolent ulcer) typically occurs on the upper lip and may be unilateral or bilateral. They often have a characteristic central area of yellow to pink tissue with a slightly raised circumferential edge

The underlying cause of eosinophilic ulcers and collagenolytic granulomas are unknown, although an underlying allergic cause such as arthropod bites and/or cutaneous hypersensitivity have been suggested.
Treatment of collagenolytic granulomas is also controversial so it is unlikely that you would be asked about treatment of this disorder on a board exam aside from knowing that you should attempt to identify and remove/treat underlying allergy or biting arthropod problems. Some cases respond to antibiotic therapy but most require glucocorticoid therapy.

Question 31

A 10-year old feline domestic shorthair presents for symmetrical truncal alopecia. On physical examination you note that the alopecia appears non-inflammatory. Skin cytology reveals no infectious organisms or inflammatory cells. You further inquire about how the cat has been doing at home. The owner explains that the cat is extremely active and is eating more but seems to be losing weight. You are highly suspicious of an endocrine disease. What is the best diagnostic and treatment plan based on the most likely differential?

ACTH stimulation test and initiate treatment with mitotane
Thyroid panel and supplementation with liothyronine every 8 hours
Thyroid panel and supplementation with levothyroxine every 24 hours
Thyroid panel and change to a low iodine diet
ACTH stimulation test and initiate treatment with trilostane

Answer 31

Answer: Thyroid panel and change to a low iodine diet

Explanation
Based on the history and physical examination findings this patient most likely has hyperthyroidism.

Hyperthyroidism is the most common endocrinopathy of cats.

Patients with hyperthyroidism exhibit signs of an accelerated basal metabolic rate including hyperactivity, polyphagia, and tachycardia. Some cats will experience polydipsia, polyuria, and gastrointestinal signs (diarrhea, vomiting). The cutaneous signs that this cat is demonstrating are non-specific but are suggestive of an endocrinopathy. There are multiple treatments for hyperthyroidism including surgical thyroid excision, radioactive iodine treatment, anti-thyroid drugs (methimazole), and low iodine prescription diets.

Levothyroxine (T4) and liothyronine (T3) are treatments for hypothyroidism. Cats seldom experience hypothyroidism; if they do, it is usually congenital in onset.

An ACTH stimulation test is used to support a diagnosis of hypercortisolism. Feline hypercortisolism is a rare disease. Cats with hypercortisolism usually present due to unregulated diabetes mellitus. They present with polyuria, polydipsia, fragile skin, alopecia, and weight loss. They are usually not hyperactive.

The best diagnostic and treatment plan for this cat is a thyroid panel and changing to a low iodine diet. The cat’s signs of hyperactivity, weight loss despite increased appetite, and non-inflammatory symmetrical truncal alopecia are indicative of hyperthyroidism, the most common feline endocrinopathy. Hyperthyroidism can be managed through various treatments, including surgical thyroid excision, radioactive iodine, anti-thyroid drugs like methimazole, and low iodine prescription diets.

Hyperthyroidism in Animals: Comprehensive Veterinary Guide
Definition:
Hyperthyroidism is an endocrine disorder resulting from excessive production of thyroid hormones (thyroxine [T4] and triiodothyronine [T3]), primarily affecting cats over 7 years old.

Pathophysiology:
• Thyroid Gland Dysfunction: Typically caused by functional thyroid adenoma or adenomatous hyperplasia, leading to excessive thyroid hormone production.
• Hormonal Effects: Increased metabolic rate and various systemic effects due to elevated T4 and T3 levels.

Causes:
• Primary: Functional thyroid adenomas or hyperplasia (common in cats).
• Secondary: Rare in cats, but can include thyroid carcinoma (<3% of cases) and iatrogenic causes due to over-administration of levothyroxine in hypothyroid dogs or dietary factors.

Symptoms:
• Behavioral: Hyperactivity, excessive vocalization.
• Appetite and Weight: Weight loss despite a good or increased appetite.
• Gastrointestinal: Vomiting, voluminous stool.
• Urinary: Polyuria-polydipsia.
• Cardiovascular: Tachycardia, tachypnea.
• Coat Changes: Dry or greasy coat.
• Rare Symptoms: Apathy, anorexia, lethargy, listlessness.

Clinical Changes:
• Thyroid Nodules: Often palpable.
• Laboratory Findings: Elevated total T4 concentrations, sometimes accompanied by increased ALT and alkaline phosphatase activities.

Diagnosis:
• Clinical Signs: Observation of typical symptoms and physical findings.
• Serum Testing: High total T4 concentration is diagnostic. Free T4 (fT4) testing and T3 suppression test can be used for further confirmation if T4 is borderline.
• Imaging: Thyroid scintigraphy may be necessary for complex cases.

Treatment:
1. Radioiodine Therapy: Preferred curative treatment, selectively destroys hyperactive thyroid tissue.
2. Antithyroid Medications: Methimazole (initial dose 1.25–2.5 mg/cat twice daily), inhibits thyroid hormone synthesis. Monitor for GI upset, agranulocytosis, thrombocytopenia, hepatopathy, and pruritus.
3. Dietary Management: Iodine-deficient therapeutic diet for non-candidates of other treatments, leading to euthyroid state in 8-12 weeks if strictly adhered to.
4. Surgery: Thyroidectomy, either unilateral or bilateral, effective but carries risks of anesthesia and postoperative complications like hypoparathyroidism.

Prognosis:
• Variable: Dependent on early diagnosis and effective management. Untreated, can lead to complications like heart disease, hypertension, and renal failure.

Key Points for Veterinary Professionals:
• Routine Screening: Monitor older cats for early detection.
• Comprehensive Management: Include monitoring of renal function and blood pressure during and after treatment.
• Long-term Follow-Up: Regular monitoring of thyroid hormone levels and clinical signs.

Question 32

A fungal culture from a cat’s hair reveals the following finding. How will you treat this cat topically?

Lyme sulfur dip
Ivermectin
Hydrocortisone cream
This is an environmental contaminant and does not require treatment

Answer 32

Answer: Lime sulfur dip

Explanation
This is an image of the dermatophyte microsporum canis; one of several organisms that cause ringworm.

Approximately 90% of cats affected with a dermatophyte will have microsporum canis. The clinical signs can vary tremendously, however the classic “ringworm” lesion appears as a central/circular region of alopecia with a ring of edema or crusting.

Lime sulfur dips are very effective at treating dermatophyte infections. You will likely have to do several treatments and also consider systemic therapy. Other topical treatments include miconazole shampoo and enilconazole (currently not available in the United States).

In cats and dogs ivermectin has been used as a microfiliaricide, ecto- and endo-parasiticide.

Hydrocortisone cream will not have any effect on dermatophytes and its sole use would potentially predispose the patient to additional secondary complications.

Question 33

Which of the following are not efficacious methods for diagnosing feline infectious peritonitis?

RT-PCR and 7B protein ELISA test
Histopathology and 7B protein ELISA test
Serology and histopathology
Immunohistochemistry and RT-PCR
Serology and 7B protein ELISA test

Answer 33

Answer: Serology and 7B protein ELISA test

Explanation
The correct answer is serology and 7B protein ELISA test. Some FIP viruses do not have the 7B protein. So, this test is not sensitive for FIP virus. Immunohistochemistry or RT-PCR can be used to demonstrate virus on biopsy specimens (RT-PCR does not work on serum or feces). However, this is not always necessary because histopathology (gold standard for antemortem diagnosis) can show characteristic lesions of disseminated pyogranulomatous and fibrinonecrotic reaction around small veins. If you can’t remember any of these at least remember that corona titers are completely useless! They will only tell you if the cat has been exposed to a corona virus. Most cats have been exposed to a corona virus at some point in their lives. So the best choice is serology and the 7B protein ELISA test since neither of these are efficacious.

The correct answer is serology and 7B protein ELISA test. Some FIP viruses do not have the 7B protein, making this test not sensitive for FIP. Serology only indicates exposure to a coronavirus, which is common in cats and not specific for FIP. Histopathology is the gold standard for antemortem diagnosis, showing characteristic lesions of disseminated pyogranulomatous and fibrinonecrotic reactions around small veins. Immunohistochemistry or RT-PCR can also demonstrate the virus on biopsy specimens but is not always necessary.

Laboratory Tests for FIP Diagnosis
1. Effusion Analysis:
• Sample: Abdominal, thoracic, or pericardial effusion
• Tests:
• Physical Characteristics: Yellow, sticky fluid
• Total Protein: >35 g/L
• A:G Ratio: <0.4
• Cell Count: <5 x 10^9 cells/L
• Cytology: Pyogranulomatous inflammation with macrophages and non-degenerate neutrophils
• Sensitivity: High
• Specificity: Moderate to high
• Utility: Most useful when effusion is present; primary diagnostic tool
2. Rivalta’s Test:
• Sample: Effusion
• Procedure: Mix effusion with acetic acid and observe for precipitate formation
• Sensitivity: 91%
• Specificity: 66%
• Utility: Good initial test; a negative result makes FIP unlikely, while a positive result requires confirmation
3. Polymerase Chain Reaction (PCR):
• Sample: Blood, effusion, tissue biopsies
• Types of PCR:
• Conventional PCR: Detects FCoV RNA
• Real-time RT-PCR: Quantifies viral RNA
• Nested RT-PCR: Increases sensitivity
• Sensitivity: High
• Specificity: High
• Utility: Confirms presence of FCoV RNA; differentiates between virulent and non-virulent strains
4. Immunocytochemistry (ICC):
• Sample: Effusion cell pellet, tissue biopsies
• Procedure: Staining for FCoV antigens in cells
• Sensitivity: High
• Specificity: Moderate (false positives possible)
• Utility: Confirms FCoV in macrophages; used in combination with other tests
5. Serology:
• Sample: Serum
• Tests:
• FCoV Antibody Titers: Measure antibody levels against FCoV
• Sensitivity: Variable
• Specificity: Low (due to widespread FCoV exposure)
• Utility: Not definitive for FIP; supportive evidence when combined with other tests
6. Serum Protein Electrophoresis:
• Sample: Serum
• Procedure: Separates serum proteins to identify globulin patterns
• Findings: Increased globulins, decreased albumin-to-globulin ratio
• Utility: Supports diagnosis; not definitive
7. Alpha-1-Acid Glycoprotein (AGP):
• Sample: Serum or effusion
• Tests:
• AGP Levels: Elevated in FIP
• Sensitivity: High
• Specificity: High
• Utility: Useful for supportive diagnosis; part of a panel of tests

Summary of Diagnostic Test Utility
• Effusion Analysis: High diagnostic accuracy when effusion is present; primary diagnostic tool.
• Rivalta’s Test: Quick, cost-effective initial test; high NPV.
• PCR (various types): High sensitivity and specificity; confirms viral RNA presence and differentiation.
• Immunocytochemistry: Useful in confirming FCoV presence in cells; moderate specificity.
• Serology: Provides supportive evidence; not definitive.
• Serum Protein Electrophoresis: Identifies characteristic protein changes; supportive evidence.
• Alpha-1-Acid Glycoprotein (AGP): High sensitivity and specificity; part of comprehensive diagnostic panel.

Best Samples for Laboratory Testing
• Effusion Fluid: For physical, cytological, and molecular tests.
• Blood (Serum, Plasma): For serology, AGP, and protein electrophoresis.
• Tissue Biopsies or FNAs: For histopathology, PCR, and ICC.

https://journals.sagepub.com/doi/pdf/10.1177/1098612X221118761?download=true

Question 34

A 14 year-old indoor/outdoor female spayed domestic short hair presents to your clinic with weight loss and lethargy. On physical examination the cat is cachexic with an unkempt coat. No other abnormalities are noted on exam. You perform a complete blood count, biochemistry profile, urinalysis and total T4. The only significant abnormality on the laboratory work is 2+ protein in the urine. What is your next diagnostic step?

Renal biopsy
Urine culture and sensitivity
Chest radiographs and abdominal ultrasound
Fecal test
Urine protein: creatinine ratio and Retroviral test

Answer 34

Answer: Urine protein: creatinine ratio and Retroviral test

Explanation
This cat likely has protein-losing nephropathy (PLN). PLN is less common in cats than in dogs but does occur, especially in conjunction with Feline Immunodeficiency Virus (FIV) infections. With a quiet urine sediment and elevated protein level your next step should be a urine protein:creatinine ratio (UPC) to determine if the proteinuria is real. With any sick indoor/outdoor cat a retroviral test to determine FeLV/FIV status is indicated.

Other causes of PLN include glomerulonephritis, amyloidosis, and inflammatory conditions such as pyelonephritis. None of the other diagnostic options are wrong, but you would first want to confirm the proteinuria before pursuing a work-up for that specific finding.

Question 35

Which of the following is not a common sequela of hypertrophic cardiomyopathy in cats?

Left heart failure
Thromboembolism
Systolic anterior motion of the mitral valve
Right heart failure

Answer 35

Answer: Right heart failure

Explanation
The correct answer is right heart failure. HCM in cats usually only affects the left heart. Thromboemboli occur due to stasis of blood in the dilated left atrium. Left heart failure occurs as the left ventricle becomes stiffer, and blood backs up into the pulmonary vasculature. Systolic anterior motion of the mitral valve occurs when the anterior leaflet of the mitral valve blocks the left ventricular outflow tract during systole due to thickening of the ventricle wall and displacement of the valve leaflet.

Right heart failure is not a common sequela of hypertrophic cardiomyopathy (HCM) in cats. HCM primarily affects the left heart, leading to left heart failure as the left ventricle stiffens and blood backs up into the pulmonary circulation. Thromboembolism can occur due to blood stasis in the dilated left atrium. Systolic anterior motion of the mitral valve is also seen as the thickened ventricle wall displaces the mitral valve leaflet, obstructing the left ventricular outflow tract during systole.

Comprehensive Information on Feline Hypertrophic Cardiomyopathy (HCM) for NAVLE Preparation
Definition
• Hypertrophic Cardiomyopathy (HCM): The most common form of feline cardiomyopathy, characterized by concentric left ventricular hypertrophy (LVH) without another cardiac or systemic disease capable of producing this magnitude of hypertrophy.

Etiology
• Genetic Basis:
• Identified mutations in Maine Coons and Ragdolls, specifically in the myosin binding protein C gene (A31P and R820W mutations).
• Likely hereditary in Sphynx cats and suspected in other breeds like Bengal, American Shorthair, British Shorthair, Persian, and Siberian.
• Unidentified causes: In many cases, particularly in mixed-breed cats.

Pathophysiology
• Myocardial Hypertrophy: The LV wall thickens due to abnormal sarcomere function, which increases myocardial contractility, leading to diastolic dysfunction.
• Diastolic Dysfunction: A stiff LV results in elevated left atrial (LA) pressure, causing LA enlargement and increased pulmonary venous pressure, leading to pulmonary edema (PE) and pleural effusion (PLE).
• Systolic Anterior Motion (SAM): Common in HCM, where the anterior mitral valve leaflet moves into the LV outflow tract (LVOT) during systole, causing dynamic LVOT obstruction (DLVOTO) and contributing to mitral regurgitation.

Clinical Signs
• Asymptomatic: Many cats remain subclinical.
• Symptomatic:
• Heart Failure Signs: Dyspnea, PE, PLE, tachypnea.
• Arterial Thromboembolism (ATE): Hindlimb paralysis, pain, and cold extremities.
• Sudden Death: In some cases, without prior signs.

Diagnosis
• Echocardiography: Gold standard for diagnosing HCM, showing LV hypertrophy, SAM, LA enlargement, and reduced diastolic function.
• Radiography: Useful for identifying severe LA enlargement and signs of left heart failure.
• Cardiac Biomarkers:
• NT-proBNP: Elevated in severe HCM but not reliable as a standalone diagnostic test.
• Cardiac Troponin I (cTnI): Elevated in HCM, especially in cases with myocardial injury or heart failure.
• Electrocardiography (ECG): Can reveal arrhythmias but is not sensitive enough to detect all cases.

Treatment
1. Asymptomatic Cats (Stage B1):
• No medical treatment recommended if there is mild hypertrophy and normal to mildly enlarged LA.
• Monitoring: Regular follow-ups to detect progression to severe LA enlargement or heart failure.
• Avoidance of triggers: Anesthesia, surgery, and fluid therapy should be carefully managed to prevent heart failure.
• Beta Blockers (e.g., Atenolol): May be considered in cats with severe SAM and DLVOTO, although evidence of efficacy is limited.
2. Symptomatic Cats (Heart Failure/ATE):
• Furosemide: Diuretic therapy to reduce pulmonary edema.
• ACE Inhibitors (e.g., Enalapril): To reduce afterload and mitigate heart failure symptoms.
• Antithrombotic Therapy (e.g., Clopidogrel, Aspirin): To prevent ATE.
• Beta Blockers (e.g., Atenolol): For cats with severe SAM or ventricular arrhythmias.
• Calcium Channel Blockers (e.g., Diltiazem): Previously used but now less favored due to gastrointestinal side effects and lack of clear efficacy.

Prognosis
• Varies: Many cats with subclinical HCM may live a normal life span, while others progress to heart failure or suffer sudden death.
• Severe Cases: Poor prognosis, especially in cats with heart failure or ATE.

Complications
• ATE: Common in cats with LA enlargement and sluggish blood flow, often leading to hindlimb paralysis.
• Sudden Death: Possible, especially in cases with severe myocardial disease or ventricular arrhythmias.

Breed-Specific Considerations
• Maine Coon and Ragdoll: Genetic testing for specific mutations is recommended, and affected cats should not be bred.
• Sphynx: Possible genetic predisposition to HCM, though not fully confirmed.

Question 36

An 11-year old female spayed domestic short haired cat presents to you for a physical exam. The owner reports that the cat typically sleeps a lot, and she has not noticed any abnormalities at home. A grade Ill/VI left parasternal systolic murmur is ausculted; the heart rate is 180 beats per minute. The owner is immediately concerned about the heart murmur so you perform a complete blood count, chemistry panel, T4 levels, and urinalysis to start.
СВС
HCT 32% (40-45%)
WBC 8,430/ul (5,500-19,500/ul)
platelets 218,000/ul (300,000-800,000/ul)
Chemistry
BUN 24 mg/dl (19-34 mg/di) creatinine 1.2 mg/dl (0.9-2.2)
ALT 32 U/L (25-97 U/L)
albumin 3.1 g/dl (2.8-3.9 g/dl)
globulin 2.9 g/l (2.6-5.1 g/dl)
Urinalysis is within normal limits with USG=1.029.
The T4 is 1.8 ug/dl (0.8-4.0)
You refer her to your local cardiologist for an echocardiogram. He reports finding a normal left atrial size, moderate left ventricular concentric hypertrophy, and systolic anterior motion of the mitral valve (SAM) with normal fractional shortening. No electrical disturbances were seen on an ECG he performed. The cat’s systolic blood pressure was 130 mmg in his clinic. Which of the following should be considered for the treatment of this cat?

Spironolactone
Atenolol
Furosemide
Digoxin
Nitroglycerin paste

Answer 36

Answer: Atenolol

Explanation
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.

Atenolol is the appropriate treatment for this cat with hypertrophic cardiomyopathy (HCM). Atenolol, a beta-blocker, helps reduce left ventricular outflow obstruction by lowering heart rate and left ventricular contractility, and also decreases myocardial oxygen demand. Other medications like nitroglycerin, spironolactone, and furosemide are used in cases of heart failure, which this cat does not have. Digoxin is not indicated as the cat does not have supraventricular tachyarrhythmia or systolic dysfunction.

Question 37

A lethargic cat arrives with bradycardia. You decide to perform an ECG and see a lack of a P waves and a widened QRS complex. What do you suspect?

Hypekalemia
Warfarin toxicity
Hypercalcemia
Mobitz Type-1 Block
Wenckebach

Answer 37

Answer: Hypekalemia

Explanation
The correct answer is hyperkalemia. This sounds like hyperkalemia. You rock if you got it! ECG findings associated with hyperkalemia include an increased P-R interval, widened QRS complexes, lack of P waves, and tall tented T waves.

Hyperkalemia is suspected in this case. ECG findings associated with hyperkalemia include a widened QRS complex, lack of P waves, increased P-R interval, and tall tented T waves. These signs align with the presentation of the lethargic cat with bradycardia.

Question 38

A 7-year old male castrated cat presents for respiratory distress with open-mouth breathing. You initially place him in oxygen and obtain thoracic radiographs when he is stabilized. The films are shown here. What is your diagnosis?

Neoplasia
Feline asthma syndrome
Left-sided congestive heart failure
Pneumonia
Tracheal collapse

Answer 38

Answer: Left-sided congestive heart failure

Explanation
The correct answer is left-sided congestive heart failure. The cardiac silhouette is tall suggestive of left ventricular enlargement, and there is an alveolar pattern in the lung fields. The pulmonary vasculature is also dilated. Remember that cats in heart failure can have edema distributed in patchy infiltrates throughout the lungs, in contrast to dogs where it is more typically in the perihilar region.

Asthma is less likely as no clear bronchial markings are seen and because of the infiltrate. Neoplasia is a consideration, but doesn’t explain the cardiac enlargement. Pneumonia could also cause this pattern of infiltrate (although it is more typically cranioventral), but also does not explain the cardiomegaly. There is no evidence of tracheal collapse, which is an exceedingly rare condition in the cat.

Annotations:
Orange: The cardiac silhouette is diffusely enlarged moderately
Yellow circle: Areas of alveolar pattern
Blue: pulmonary veins
Red: Pulmonary arteries. In this case there is enlargement of both the pulmonary arteries and veins Green: pleural fissure line, most likely indicative of pleural effusion

Radiographs provided by Adrien Hespel, DVM, MS, DACVR and University of Tennessee College of Veterinary Medicine

Question 39

Vascular ring anomalies occur rarely in dogs and cats. They are typically diagnosed early in life. Which of the following is not a typical finding in animals with vascular ring anomalies?

Regurgitation
Aspiration Pneumonia
Poor Body Condition
Diarrhea

Answer 39

Answer: Diarrhea

Explanation
The correct answer is diarrhea. Animals with vascular ring anomalies usually develop clinical signs shortly after being weaned onto solid foods. Vascular ring anomalies will result in constriction of the esophagus which, in turn, does not allow ingesta to travel through the esophagus. These animals will subsequently regurgitate. With enough regurgitation, they can eventually end up with aspiration pneumonia. These animals usually have a voracious appetite; however, they are in poor body condition since they cannot get food past their vascular ring anomaly.

Diarrhea is not a typical finding in animals with vascular ring anomalies. These animals commonly develop regurgitation due to esophageal constriction caused by the anomaly, leading to poor body condition and, in some cases, aspiration pneumonia. Despite a strong appetite, their inability to pass food results in malnutrition, but diarrhea is not associated with this condition.

Comprehensive Information on Vascular Ring Anomalies (VRA) in Dogs for NAVLE Preparation
Definition
• Vascular Ring Anomalies (VRA): Congenital abnormalities of the aortic vasculature that result in the esophagus and trachea being partially or completely encircled, leading to esophageal compression and clinical signs, particularly regurgitation.

Etiology
• Embryonic Development Errors: Aberrant development of the third, fourth, or sixth aortic arches results in the persistence of abnormal vascular structures that encircle the esophagus and trachea.
• Types of VRA:
• Type 1 (Persistent Right Aortic Arch [PRAA] with Left Ligamentum Arteriosum): The most common type, where the right fourth aortic arch persists as the adult aorta, compressing the esophagus with a left ligamentum arteriosum.
• Type 2 (PRAA with Aberrant Left Subclavian Artery): Compression occurs due to the presence of an aberrant left subclavian artery.
• Type 3 (PRAA with Left Ligamentum Arteriosum and Aberrant Left Subclavian Artery): Two sites of compression, making surgical correction more complex.
• Type 4 (Double Aortic Arch): Both the left and right fourth aortic arches persist, encircling the esophagus and trachea, and can cause respiratory signs in addition to regurgitation.
• Additional types: Include anomalies such as an anatomically normal left aortic arch with aberrant right ductus arteriosus or subclavian artery, each causing varying degrees of esophageal compression.

Pathophysiology
• Esophageal Compression: Aberrant vessels encircle the esophagus and compress it, leading to cranial esophageal dilation (megaesophagus) and subsequent regurgitation, especially of solid foods.
• Secondary Effects: Chronic regurgitation increases the risk of aspiration pneumonia, which can complicate the condition and worsen the prognosis.

Clinical Signs
• Postprandial Regurgitation: The most common sign, particularly in young dogs soon after weaning.
• Respiratory Signs (in double aortic arch anomalies): Coughing, dyspnea, and stridor due to tracheal compression.
• Failure to Thrive: Affected dogs may show poor weight gain and stunted growth due to chronic regurgitation and inability to retain nutrients.

Diagnostic Methods
1. Imaging:
• Barium Esophagram: Reveals esophageal dilation cranial to the heart base, indicative of esophageal compression.
• Thoracic Radiographs: May show leftward deviation of the trachea at the heart base.
• CT Angiography: The gold standard for identifying the specific compressive vessels and planning surgery.
• Echocardiography: Useful in some cases to assess the heart and surrounding vasculature.
2. Endoscopy:
• Esophagoscopy: Useful for ruling out other causes of esophageal compression and assessing mucosal lesions.

Treatment
• Surgical Management:
• Surgical Correction: The primary treatment involves thoracotomy to ligate and resect the constricting vascular structures. A left intercostal thoracotomy is typically performed, but the approach may vary based on the specific type of anomaly.
• Type-Specific Approaches: Double aortic arches (type 4) may require a more complex surgical approach, including resection of one arch and anastomosis to preserve aortic function.
• Minimally Invasive Surgery: Thoracoscopic surgery has been successfully performed for certain types of VRA (e.g., type 1 and type 3), offering benefits such as reduced postoperative pain and quicker recovery times.
• Postoperative Care:
• Analgesia: Effective pain management is crucial for recovery.
• Dietary Management: Postoperative regurgitation may persist, requiring continued feeding of moist, elevated food until the esophagus recovers.
• Monitoring for Complications: Aspiration pneumonia is a major concern and should be monitored closely.

Prognosis
• Variable Outcomes:
• Surgical Success: Many dogs improve significantly after surgery, though some may continue to experience mild regurgitation.
• Complications: Persistent regurgitation and aspiration pneumonia are potential complications, which can influence the long-term prognosis.
• Survival Rates: A high percentage of dogs that survive the immediate postoperative period (>2 months) generally experience good long-term outcomes, though some may require lifelong dietary management.

Epidemiology
• Breed Predisposition: Purebred dogs, particularly German Shepherd Dogs, Labrador Retrievers, and Greyhounds, are overrepresented. A sex predilection has not been definitively established.
• Congenital Nature: Although a hereditary component has not been fully confirmed, cases have been reported in littermates, supporting recommendations to avoid breeding affected dogs.

https://avmajournals.avma.org/downloadpdf/view/journals/javma/254/6/javma.254.6.728.pdf

Question 40

Treatment for hypertrophic cardiomyopathy in cats (as depicted in the pathologic image) is aimed at which of the following?

Improving diastolic filling by decreasing heart rate
Improving systolic function by decreasing heart rate
Improving systolic function by increasing heart rate
Improving diastolic filling by increasing heart rate

Answer 40

Answer: Improving diastolic filling by decreasing heart rate

Explanation
The correct answer is improving diastolic filling by decreasing heart rate. The primary problem with HCM is thickening of the wall of the left ventricle, impairing diastolic filling. There is usually no problem with contractility and systolic function. Slowing the heart rate provides for longer diastolic filling, allowing the left ventricle to fill more effectively. Decreasing the heart rate also decreases the severity of systolic anterior motion of the mitral valve.

For this reason, the medications used most frequently to slow the heart rate are:
Beta- blockers (i.e. atenolol: 6.25-12.5 mg/cat orally qD-BID, or metoprolol: 0.5-1 mg/kg TID)
Calcium channel blockers: diltiazem: 1-2 mg/kg TID (PO) or 7.5 mg per cat TID
For cases with severe left atrial enlargement or cats in heart failure, also consider:
ACE inhibitors (i.e. enalapril or benazepril: 0.25-0.5 mg/kg once daily)
Diuretics: furosemide (Lasix): 1-2 mg/kg BID-TID

Preventing thromboembolic disease with aspirin or clopidogrel (Plavix).

Also, always keep in mind that you want to identify and treat possible underlying hypertension or hyperthyroidism that could be contributing to the disease.

Improving diastolic filling by decreasing heart rate is the primary goal in treating hypertrophic cardiomyopathy (HCM) in cats. HCM causes thickening of the left ventricular wall, impairing diastolic filling. Slowing the heart rate allows more time for the left ventricle to fill effectively and reduces the severity of systolic anterior motion of the mitral valve. Common treatments include beta-blockers (e.g., atenolol, metoprolol) and calcium channel blockers (e.g., diltiazem). In severe cases, ACE inhibitors (e.g., enalapril) and diuretics (e.g., furosemide) may be used, along with thromboembolism prevention. Identifying and managing underlying hypertension or hyperthyroidism is also essential.

Question 41

Treatment for hypertrophic cardiomyopathy in cats (as depicted in the pathologic image) is aimed at which of the following?

Improving diastolic filling by decreasing heart rate
Improving systolic function by decreasing heart rate
Improving systolic function by increasing heart rate
Improving diastolic filling by increasing heart rate

Answer 41

Answer: Improving diastolic filling by decreasing heart rate

Explanation
The correct answer is improving diastolic filling by decreasing heart rate. The primary problem with HCM is thickening of the wall of the left ventricle, impairing diastolic filling. There is usually no problem with contractility and systolic function. Slowing the heart rate provides for longer diastolic filling, allowing the left ventricle to fill more effectively. Decreasing the heart rate also decreases the severity of systolic anterior motion of the mitral valve.

For this reason, the medications used most frequently to slow the heart rate are:
Beta- blockers (i.e. atenolol: 6.25-12.5 mg/cat orally qD-BID, or metoprolol: 0.5-1 mg/kg TID)
Calcium channel blockers: diltiazem: 1-2 mg/kg TID (PO) or 7.5 mg per cat TID
For cases with severe left atrial enlargement or cats in heart failure, also consider:
ACE inhibitors (i.e. enalapril or benazepril: 0.25-0.5 mg/kg once daily)
Diuretics: furosemide (Lasix): 1-2 mg/kg BID-TID

Preventing thromboembolic disease with aspirin or clopidogrel (Plavix).

Also, always keep in mind that you want to identify and treat possible underlying hypertension or hyperthyroidism that could be contributing to the disease.

Improving diastolic filling by decreasing heart rate is the primary goal in treating hypertrophic cardiomyopathy (HCM) in cats. HCM causes thickening of the left ventricular wall, impairing diastolic filling. Slowing the heart rate allows more time for the left ventricle to fill effectively and reduces the severity of systolic anterior motion of the mitral valve. Common treatments include beta-blockers (e.g., atenolol, metoprolol) and calcium channel blockers (e.g., diltiazem). In severe cases, ACE inhibitors (e.g., enalapril) and diuretics (e.g., furosemide) may be used, along with thromboembolism prevention. Identifying and managing underlying hypertension or hyperthyroidism is also essential.

Question 42

Which of the following is true of cats with hypertrophic cardiomyopathy?

• Left ventricular hypertrophy results in poor diastolic filling and left atrial dilation
• Affected cats are predisposed to thromboemboli due to stasis of blood in the left ventricle
• Hypertrophy of the cardiac muscle is usually precipitated by hypertension or aortic stenosis
• Affected cats are usually geriatric males older than 12 years of age

Answer 42

Answer: Left ventricular hypertrophy results in poor diastolic filling and left atrial dilation

Explanation
The correct answer is left ventricular hypertrophy results in poor diastolic filling and left atrial dilation. HCM is a primary cardiomyopathy that is not precipitated by factors such as hypertension or aortic stenosis. Cats affected with HCM are usually diagnosed at a young to middle age, not when they are geriatric.

Thromboembolism is a common result of HCM, but it is due to thrombus formation in the static blood of the dilated left atrium, not from the left ventricle.

Left ventricular hypertrophy results in poor diastolic filling and left atrial dilation is true of cats with hypertrophic cardiomyopathy (HCM). HCM is a primary cardiomyopathy, not caused by hypertension or aortic stenosis. It typically affects cats at a young to middle age, not geriatric cats. Thromboembolism is common in HCM due to thrombus formation in the dilated left atrium, not the left ventricle.

Comprehensive Information on Feline Cardiogenic Arterial Thromboembolism (CATE) for NAVLE Preparation

Definition

•	Cardiogenic Arterial Thromboembolism (CATE): A severe condition in cats where thrombi, originating from the heart, embolize to distant sites, most commonly affecting the terminal aorta (“saddle thrombus”), leading to ischemic injury and significant morbidity.

Etiology
• Underlying Cardiac Diseases:
• Hypertrophic Cardiomyopathy (HCM)
• Dilated Cardiomyopathy (DCM)
• Restrictive Cardiomyopathy (RCM)
• Unclassified/Ischemic Cardiomyopathy (UCM/ICM)
• Pathogenesis: Fulfillment of Virchow’s triad:
• Blood stasis: Impaired left ventricular filling results in left atrial dilation and dysfunction.
• Endothelial injury: Exposure of subendothelial collagen promotes thrombus formation.
• Hypercoagulable state: Increased platelet hypersensitivity, decreased antithrombin and protein C activities, and elevated factor VIII and fibrinogen levels.

Pathophysiology
• Thrombus Formation:
• Platelet adhesion leads to activation and aggregation at sites of endothelial injury.
• Thrombus Composition: Initially platelet-rich, evolving into a fibrin-rich thrombus that can embolize.
• Embolization:
• Terminal aorta (“saddle thrombus”): The most common site, leading to hindlimb paralysis.
• Brachial arteries: 10% of cases, leading to forelimb paralysis.
• Less common sites: Renal, cerebral, and splanchnic infarctions.

Clinical Signs
• Hindlimb Ischemic Neuromyopathy:
• Paresis or paralysis of pelvic limbs.
• Absent reflexes and cold, pulseless limbs.
• Firm, painful musculature and cyanotic nail beds.
• Forelimb Ischemic Neuromyopathy: Similar to pelvic limb infarction but affecting the thoracic limbs.
• Renal Infarction: Acute renal failure and renal pain.
• Cerebral Infarction: Neurologic deficits such as seizures, stupor, and sudden death.
• Additional Findings:
• Hypothermia: Due to decreased blood flow.
• Biochemical changes: Elevated muscle enzymes (AST, ALT, CK), hyperglycemia, azotemia, hypercholesterolemia, and hypocalcemia.

Diagnosis
• Clinical Signs: Acute onset of limb paralysis, pain, and cyanotic nail beds.
• Imaging: Radiographs, echocardiography, and potentially advanced imaging (e.g., nuclear perfusion studies).
• Blood Tests: Muscle enzyme elevations, azotemia, and metabolic derangements.

Treatment
1. Acute Management:
• Induce Hypocoagulable State:
• Unfractionated Heparin (UH): Dosing at 250-375 IU/kg IV initially, followed by 150-250 IU/kg SC every 6-8 hours.
• Low Molecular Weight Heparins (LMWH): Dalteparin at 100 IU/kg SQ every 12 hours or enoxaparin at 1.0-1.5 mg/kg SQ every 12 hours.
• Improve Blood Flow:
• Thrombolytic Therapy: Tissue plasminogen activator (t-PA) dosing at 0.25-1 mg/kg per hour IV, with a total dose of 1-10 mg/kg.
• Monitor for reperfusion injury, which may require aggressive management of hyperkalemia and acidosis.
• Pain Management:
• Narcotics: Butorphanol, hydromorphone, buprenorphine, and oxymorphone.
• Fentanyl: For severe or refractory cases.
2. Chronic Management/Prevention:
• Antiplatelet Therapy:
• Aspirin: Low-dose regimen (5 mg/cat every 48 hours) for prevention, with a focus on minimizing gastrointestinal side effects.
• Clopidogrel: Superior to aspirin, standard dosing at 18.75 mg/cat PO daily.
• Anticoagulant Therapy:
• Warfarin: Starting dose of 0.06-0.09 mg/kg PO daily, with frequent monitoring required (INR target of 2-3).
• LMWHs: For long-term thromboprophylaxis.
• Supportive Care:
• Nutritional support and physical therapy to maintain limb function.
Prognosis
• Variable: Survival rates range from 33-39%.
• Better outcomes: Unilateral limb infarction has a better prognosis compared to bilateral involvement.
• Monitoring for complications: Reperfusion injury is the most critical complication, especially in cats with severe infarction.

Complications
• Reperfusion Injury: Sudden return of blood flow can lead to hyperkalemia and metabolic acidosis.
• Chronic Ischemia: Limb necrosis, contracture, and possible amputation may be necessary.

Question 43

Which of these diseases is most commonly associated with aortic thromboembolism (saddle thrombus) in cats?

Hyperadrenocorticism
Feline asthma
Renal insufficiency
Hypertrophic cardiomyopathy
Rodenticide toxicity

Answer 43

Answer: Hypertrophic cardiomyopathy

Explanation
The correct answer is hypertrophic cardiomyopathy. This disease tends to lead to dilation of the left atrium with blood stasis in the chamber. Thrombi form there and frequently lodge at the bifurcation of the aorta, leading to acute paraparesis and pain.

Question 44

Which of the following can be treated with enalapril?

Hypotension
Acute renal failure
Protein-losing nephropathy
Protein losing enteropathy

Answer 44

Answer: Protein-losing nephropathy

Explanation
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used as a vasodilator, antihypertensive agent, and heart failure treatment. It works by preventing the conversion of angiotensin I to angiotensin Il, thus reducing aldosterone concentrations and causing diuresis. Its dilatory effects on the efferent arterioles of glomeruli help to palliate protein losing nephropathies. It is often used in conjunction with diuretics.

Protein-losing nephropathy can be treated with enalapril. As an ACE inhibitor, enalapril reduces aldosterone levels, promotes diuresis, and has a vasodilatory effect on the efferent arterioles of glomeruli, helping to manage protein-losing nephropathies. It is often used alongside diuretics. Enalapril is not used for hypotension, acute renal failure, or protein-losing enteropathy.

Comprehensive NAVLE Study Guide: Protein-Losing Nephropathy (PLN) in Small Animals
Definitions and Etiology
• Protein-Losing Nephropathy (PLN): A renal disorder characterized by excessive protein loss through the kidneys, primarily due to glomerular disease. Common forms include immune-mediated glomerulonephritis (IMGN), amyloidosis, and glomerulosclerosis.
• Causative Agents: Often idiopathic but can be associated with infections (e.g., Lyme disease, Leishmaniasis), immune-mediated conditions, neoplasia, or genetic predispositions in certain breeds.

Pathophysiology
• Glomerular Dysfunction: The glomerulus normally filters blood, allowing small molecules like water to pass through while retaining larger proteins. In PLN, glomerular damage allows proteins like albumin to leak into the urine (proteinuria), leading to hypoalbuminemia.
• Inflammatory and Immune Responses: PLN often involves immune complex deposition in the glomeruli, triggering inflammation, complement activation, and progressive renal damage.
• Secondary Effects: Chronic proteinuria leads to systemic effects like hypertension, hyperlipidemia, and a hypercoagulable state, increasing the risk of thromboembolism.

Clinical Signs
• Early Stages: Often asymptomatic except for proteinuria detected on routine screening.
• Advanced Stages: Signs of nephrotic syndrome, including edema, ascites, pleural effusion, and weight loss. Progressive renal failure may present with polyuria, polydipsia, vomiting, and lethargy.

Diagnosis
• Urine Protein/Creatinine Ratio (UPC): Quantifies proteinuria, with higher values indicating significant glomerular leakage.
• Microalbuminuria (MA): Early indicator of glomerular disease, often used in screening.
• Renal Biopsy: Provides definitive diagnosis, with histopathological evaluation using light microscopy (LM), transmission electron microscopy (TEM), and immunofluorescence (IF) to classify glomerular lesions.
• Imaging: Abdominal ultrasound may reveal renal changes or associated complications like effusions.

Treatment
• Medical Management:
• ACE Inhibitors (e.g., Enalapril, Benazepril): Reduce proteinuria by decreasing glomerular filtration pressure and protecting renal function.
• Antithrombotic Therapy (e.g., Aspirin): Low-dose aspirin to reduce the risk of thromboembolism.
• Immunosuppressive Therapy: Considered in cases of active immune-mediated disease, including corticosteroids, cyclosporine, or mycophenolate.
• Antibiotics: If an infectious cause (e.g., Lyme nephritis) is identified, appropriate antimicrobial therapy (e.g., doxycycline) is initiated.
• Supportive Care:
• Dietary Management: Low-protein, low-phosphorus diets with omega-3 fatty acid supplementation are recommended to slow disease progression and manage hyperlipidemia.
• Antihypertensives: Amlodipine may be added for better blood pressure control if ACE inhibitors are insufficient.

Complications
• Hypertension: Frequently associated with PLN, leading to further renal damage and increased risk of hypertensive crises.
• Thromboembolic Events: Due to a hypercoagulable state, animals with PLN are at high risk for thromboembolic complications, which can be life-threatening.
• Progression to Renal Failure: If untreated, PLN can lead to end-stage renal disease (ESRD), requiring intensive management or renal replacement therapy (e.g., dialysis or transplant).

Prognosis
• Variable: Depending on the underlying cause and response to treatment, PLN can range from a manageable chronic condition to a rapidly progressive disease leading to renal failure and death.

Question 45

A 2-kg kitten is being spayed at the humane society; she is intubated and is on isoflurane gas for maintenance. She is on IV fluids at 10 mL/hr. Her blood pressure starts to drop during the procedure. You have already given her a bolus of fluids. Which of the following should you do first to try to increase her blood pressure?

Give a 90 ml/kg bolus of a crystalloid fluid intravenously
Turn off the heat support to prevent peripheral vasodilation which decreases blood pressure
Give a dose of atropine
Turn down the anesthetic gas

Answer 45

Answer: Turn down the anesthetic gas

Explanation
Anesthetic gas is a potent vasodilator and causes profound hypotension, especially in small patients.

Decreasing the vaporizer setting in addition to crystalloids and colloids can help to facilitate getting the blood pressure up. If the pressure cannot be managed by these simple measures, drugs such as dobutamine may be needed to help with blood pressure during the procedure. A dose of atropine will not increase blood pressure directly; it will only increase heart rate. Good heat support actually helps to keep the blood pressure more stable and is especially important in small patients to prevent hypothermia. A 90 ml/kg bolus would be a “shock dose” of fluids for a dog but is too much for a cat, and this cat is hypotensive for other reasons.

Turn down the anesthetic gas is the correct action. Anesthetic gases, like isoflurane, are potent vasodilators and can cause significant hypotension, especially in small patients like kittens. Reducing the vaporizer setting, along with continued fluid support, can help raise blood pressure. Atropine increases heart rate but doesn’t directly address blood pressure. Maintaining good heat support is crucial for stable blood pressure, especially in small patients. A 90 mL/kg bolus is excessive for a cat and unnecessary in this situation.

Question 46

A 10-year old FS DSH presents for losing her balance. The owner said she seems to be unsure of her distance in the last day when jumping up onto the counter and has bumped into the couch a couple of times. Her fundic examination shows engorged retinal vessels of the right eye, and the left retina appears hazy and is difficult to see any detail of the optic nerve or vessels. Both pupils are markedly dilated, and there is no menace of the left eye. The right eye is still visual. You suspect the left eye has a detached retina. You check her blood pressure, and she is calm while you take several readings using a Doppler. Her average systolic blood pressure is 260 mmHg. You are confident the reading is accurate. Which of the following medications would be the best choice for this cat?

Atenolol
Pimobendan
Enalapril
Amlodipine
Furosemide

Answer 46

Answer: Amlodipine

Explanation
This cat is extremely hypertensive and should be treated immediately with medication to reduce blood pressure. Normal systolic blood pressure for a cat is around 160 mmHg or less. Sometimes it may be slightly increased when the cat is stressed. Hypertension can lead to many complications including hypertensive retinopathy (retinal detachment), hypertensive heart disease, neurologic complications, and progression of renal disease.

If the blood pressure can be stabilized quickly, there is a good chance the retina will re-attach with time.

Underlying causes of hypertension in the cat include hyperthyroidism and renal disease. This cat should be further evaluated for these conditions.

Amlodipine is the treatment of choice for hypertension in cats. It is a calcium channel blocker and works by preventing calcium influx into vascular smooth muscle cells, thereby causing vasodilation. This relaxes the vessels and allows for reduced blood pressure.

Atenolol is a beta blocker and is often used in tachycardic patients with hyperthyroidism. It does not adequately control systemic hypertension in most cases.

Furosemide is a diuretic used in treating congestive heart failure. Enalapril is an ACE-inhibitor and does help to decrease blood pressure in some cases by causing vasodilation. However, in a cat with severe hypertension, enalapril alone would not likely provide adequate control. Pimobendan is a calcium sensitizer that increases cardiac contractility. It is sometimes used in cats with dilated cardiomyopathy. It is most often used in dogs as an adjunctive treatment for pulmonary hypertension or congestive heart failure.

Amlodipine is the best choice for this cat with severe hypertension. Amlodipine, a calcium channel blocker, reduces blood pressure by causing vasodilation, which can help prevent complications like hypertensive retinopathy (retinal detachment), heart disease, and neurologic issues. If the blood pressure is stabilized quickly, the detached retina may reattach. Underlying conditions like hyperthyroidism and renal disease should also be evaluated. Other medications, such as atenolol, furosemide, enalapril, and pimobendan, do not adequately control severe systemic hypertension in cats.

Feline Systemic Hypertension (FSH)
• Definition: FSH is a chronic increase in systemic arterial blood pressure, commonly secondary to other conditions like chronic kidney disease (CKD) or hyperthyroidism.
• Causative Agents:
• Primary Hypertension: Rare in cats, where the underlying cause is unknown.
• Secondary Hypertension: Often results from chronic kidney disease (CKD), hyperthyroidism, or hyperaldosteronism. CKD is the most common cause of systemic hypertension in cats.

Pathophysiology:
• Renal Pathophysiology:
• CKD leads to the activation of the renin-angiotensin-aldosterone system (RAAS), causing vasoconstriction, sodium retention, and volume overload, which contribute to increased blood pressure.
• Thyroid Pathophysiology:
• In hyperthyroidism, increased thyroid hormone levels enhance the cardiac output and systemic vascular resistance, leading to elevated blood pressure.

Clinical Signs:
• Target Organ Damage (TOD):
• Ocular: Retinal hemorrhage, detachment, and blindness.
• Cardiovascular: Left ventricular hypertrophy (LVH), heart failure.
• Neurological: Seizures, disorientation.
• Renal: Worsening of CKD.

Diagnosis:
• Blood Pressure Measurement:
• The gold standard method is indirect blood pressure measurement using Doppler or oscillometric methods. Consistent readings above 160 mmHg suggest hypertension.
• Assessment of Target Organ Damage (TOD):
• Ocular Examination: Look for retinal hemorrhage or detachment.
• Cardiac Examination: Identify signs of left ventricular hypertrophy through echocardiography.
• Renal Function Tests: Evaluate for worsening CKD.

Management:
• Antihypertensive Medications:
• Amlodipine: A calcium channel blocker, is the first-line drug for feline hypertension. It reduces blood pressure by dilating systemic arterioles.
• Dose: 0.625-1.25 mg per cat once daily.
• Angiotensin-Converting Enzyme (ACE) Inhibitors: Such as benazepril, are used in cases where CKD is present, as they help reduce proteinuria and slow the progression of kidney disease.
• Dose: 0.5 mg/kg orally once daily.
• Beta-Blockers: These may be used adjunctively if there is significant tachycardia, especially in cases of hyperthyroidism.
• Propranolol: 0.2-0.4 mg/kg orally every 8-12 hours.
• Spironolactone: An aldosterone antagonist, may be used in cases with hyperaldosteronism.
• Dose: 2 mg/kg orally once daily.

Monitoring:
• Regular Blood Pressure Checks: Every 1-3 months.
• Renal Function Tests: Monitor for worsening renal function, especially after initiating antihypertensive therapy.
• Ocular and Neurological Exams: Frequent checks to detect early signs of target organ damage.

Clinical Pearls:
• Early Diagnosis is Key: Early detection and management of hypertension can prevent irreversible target organ damage, particularly blindness.
• Combination Therapy: Some cases may require a combination of drugs, especially if there is concurrent CKD or other underlying conditions.
• Patient Monitoring: Continuous monitoring of blood pressure and renal function is crucial in managing systemic hypertension.

Question 47

A 3-year old, indoor-only, male castrated Maine Coon cat is presented to you for acute-onset of hindlimb pain and paresis. Physical examination reveals a grade Ill left parasternal heart murmur and minimal movement in the hind legs. Femoral pulses are bilaterally absent, and the hindlimb toes are cold to the touch. The cat is tachypenic, but lung sounds are normal. What is the most likely diagnosis?

Lymphoma of the spinal cord
Tetanus
Chlorpyrifos toxicity
T3-3 intervertebral disc disease
Thrombus at the aortic bifurcation (saddle thrombus)

Answer 47

Answer: Thrombus at the aortic bifurcation (saddle thrombus)

Explanation
Maine Coon cats are predisposed to development of hypertrophic cardiomyopathy at a young age.

Consequently, left atrial enlargement predisposes to atrial thrombus formation, and these clots frequently lodge in the arterial supply to the hindlimbs. The trifurcation is where the aorta divides into the two external iliac arteries and the common origin of the internal iliac arteries. Classic findings due to a clot at the aortic trifurcation include posterior paresis/paralysis, hindlimb pain, cyanotic nailbeds, absent femoral pulses, and a firm leg musculature. Other signs of cardiac disease/failure (murmur or pulmonary edema) are often but not always evident at presentation.

Neither cord lesions, tetanus, nor toxicities should cause the vascular compromise evident on this cat’s physical exam.

Thrombus at the aortic bifurcation (saddle thrombus) is the most likely diagnosis. Maine Coon cats are predisposed to hypertrophic cardiomyopathy, leading to left atrial enlargement and thrombus formation. These clots often lodge at the aortic trifurcation, causing hindlimb paralysis or paresis, absent femoral pulses, cold limbs, and cyanotic nailbeds. Other conditions like spinal cord lesions, tetanus, or toxicities do not explain the vascular compromise seen in this case.

Question 48

A 6-year old intact male domestic short haired cat presents with acute onset exophthalmos of the right eye in the past 2 days. He is painful on palpation around his eye and head. The eye can be retropulsed some, but there is resistance present. He has not been eating in the past day and has a rectal temperature of 103.4F (39.7 C). What is the most likely diagnosis?

• Anterior uveitis
• Retrobulbar abscess
• Glaucoma
• Orbital neoplasia

Answer 48

The answer is a retrobulbar abscess. Acute, painful exophthalmos is usually due to retrobulbar abscessation. These lesions are usually painful and may be swollen. These animals are frequently systemically ill with fever and leukocytosis. Causes of retrobulbar abscesses include penetrating wounds, foreign bodies, spread from dental or sinus infection, and hematogenous spread. Glaucoma does not cause exophthalmos, although, chronically it can cause buphthalmos which may appear similar. Anterior uveitis also does not cause exophthalmos.

Question 49

What is the main mode of transmission for feline leukemia virus?

• Shedding of virus via feces
• Fomite transmission
• Shedding of virus via saliva
• Aerosol transmission

Answer 49

Answer: Shedding of virus via saliva

The correct answer is shedding of virus via saliva. The main mode of transmission is via saliva. It requires prolonged, close contact. Cats may shed the virus for months to years. Transmission may also occur through reuse of instruments and blood. Virus is shed in saliva, tears, urine, and feces.

Feline Leukemia Virus (FeLV) Disease: NAVLE Study Guide

• Feline Leukemia Virus (FeLV): A retrovirus causing immunosuppression, anemia, and neoplasia in cats.
• Classification: Retrovirus, Oncovirinae family.
• Genome: Enveloped virus with a positive-sense single-stranded RNA genome, requiring a double-stranded DNA intermediate (provirus stage) for replication.

• Virus Subgroups:
  
  • FeLV-A: Archetypal form, primary infection.
  • FeLV-B: Increases neoplastic diseases.
  • FeLV-C: Associated with severe anemia.
  • FeLV-T: Infects T lymphocytes, leading to immunodeficiency.
• Lifecycle: Oronasal replication in lymphoid tissue, primary viremia phase, systemic spread to spleen, lymph nodes, bone marrow, and other tissues. Secondary viremia involves bone marrow transmission with leukocytes and platelets in peripheral blood.
• Infection Outcomes: Abortive, regressive, or progressive.

• Symptoms:
  
  • Acute Stage: Mild fever, malaise, lymphadenopathy, cytopenia.
  • Chronic Stage: Immunosuppression, anemia, lymphomas, reproductive issues, secondary infections.
• Disease Associations: Chronic gingivostomatitis, systemic vasculitis, glomerulonephritis, polyarthritis, anemia, leukemia, neurologic disorders, FeLV-associated enteritis.

• Testing:
  
  • Point-of-Care (POC) ELISA/RIM: Detects FeLV antigen.
  • Confirmatory Tests: Microplate ELISA, PCR assay for proviral DNA, immunofluorescent antibody (IFA) testing.
  • Quantitative PCR: Distinguishes between regressive and progressive infections.
• Neoplasia Diagnosis: Cytologic examination, bone marrow analysis, biopsy with histologic examination.

• Supportive Care: High-quality nutrition, regular preventive healthcare.
• Antiretroviral Drugs: Limited evidence; zidovudine may reduce viral loads but has side effects.
• Interferons: Mixed results; some benefit from parenteral feline interferon omega.
• Management: Strict indoor environment, routine vaccinations, parasite prevention, early treatment of secondary infections.

• Vaccination: Effective but does not prevent FeLV in already infected cats.
• Testing: Regular testing for at-risk cats, new acquisitions, and before blood donation.
• Management: Prevent contact with infected cats, good husbandry practices, and stress minimization.

• Infection Management: Early identification, supportive care, and prevention of secondary infections are crucial.
• Life Expectancy: Varies; average survival time post-diagnosis is 2.4 years, with high mortality within 3 years.

For further detailed information, please refer to the Merck Veterinary Manual article on FeLV.

Question 50

Coat color and sun exposure likely predisposed this cat to developing the tumor seen in the photo.

• Basal cell tumor
• Squamous cell carcinoma
• Melanoma
• Mast cell tumor

Answer 50

Answer: Squamous cell carcinoma

The correct answer is squamous cell carcinoma. White cats or cats with areas of white fur on the face or ears are predisposed to developing squamous cell carcinoma from UV light. These lesions are usually ulcerative and appear around the nose, ears, or eyelids.

Question 51

A practice is using an FeLV test with a sensitivity of 90% and a specificity of 95%.

Assuming the prevalence of feline leukemia in the area is 5%, what is the predictive value negative (PVN) of the test?

A - 45%
B - 88%
C - 55%
D - 99%
E - 75%

Answer 51

Answer: 99%

PVN is 99%.

The trick with this kind of question is to pick an imaginary number of animals that you test, like 1000, and fill out your 2x2 table from there.

Follow the links to see diagrams step by step.

If prev is 5% then there must be 50/1000 cats with FeLV and 950 cats that are disease-free.

A 90% sensitive test will correctly call 45/50 positive (box “a”), and IN-correctly call 5/50 negative, (box “C”: these are the false negs).

If 50/1000 animals are infected, then 950/1000 are disease-free.

Your 95% specific test will correctly call 902/950 disease-free (box “d”: 0.95 X 950=902) and INcorrectly call 48/950 positive, (box “b”: these are the false pos).

Now your a,b,c,d boxes are all filled, it is easy to calculate PVN=d/(c+d)= 902/(902+5)=99%.

https://zukureview.com/zuku-qod/navle/2008?chosen=Q%2B2h/BXxNr7bG6%2B1OL2/cg%3D%3D&utm_source=Zukureview+Subscribers&utm_campaign=4836ac0b08-EMAIL_CAMPAIGN_2024_09_05_03_50&utm_medium=email&utm_term=0_1c9568dbdc-4836ac0b08-%5BLIST_EMAIL_ID%5D

Question 52

A young cat with a pot belly and dull coat has vomited up a hairball that contains a large tapeworm and many smaller worms (shown up close in the second picture below). What are the smaller parasites?

• Strongyloides stercoralis
• Ancylostoma tubaeforme
• Trichuris vulpis
• Spirocerca lupi
• Toxocara cati

Answer 52

Answer: Toxocara cati.

These are adult Toxocara cati, large roundworms that are common in kittens and puppies. Clinical presentation is as in this cat, and worms can be seen in vomit or feces.
Affected animals may have mucoid diarrhea or —with early infection-coughing due to larval migration causing eosinophilic pneumonia.

Kittens are infected by eating embryonated infective eggs or-rarely-by transmammary transmission (vs. T. canis in dogs - transplacental and transmammary transmission is common).

Dx: Identify adult worms in vomit or feces or eggs in feces. Must distinguish the spherical, pitted-shelled eggs of T. canis and T. cati from the oval, smooth-shelled eggs of Toxascaris leonina.

Rx: Pyrantel (most widely used; considered safe during pregnancy), milbemycin, moxidectin, piperazine, emodepside, fenbendazole, or selamectin.

Rx queen in last week of pregnancy, thenT nursing queen and kittens. Eggs are sticky making it difficult to decontaminate the environment.

ZOONOTIC: humans can develop visceral larva migrans or ocular larva migrans.

Strongyloides stercoralis adults are only ~2 mm in length and almost transparent.
https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-small-animals/strongyloides-sp-in-small-animals

Trichuris vulpis (whipworms) are 45-75 mm long and slender with a thicker posterior (~1/3 the worm).
https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-small-animals/whipworms-in-small-animals

Ancylostoma tubaeforme (hookworms) are 12-15 mm long. Click here to see A. caninum (similar).
https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-small-animals/hookworms-in-small-animals

Spirocerca lupi are bright red and 40-70 mm long.
https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-small-animals/spirocerca-lupi-in-small-animals

Ref: Côté, Clinical Veterinary Advisor: Dogs and Cats, 4th ed. pp. 894-5. Images courtesy of Kalumet and Beentree.

Link: Roundworms in Small Animals
https://www.merckvetmanual.com/digestive-system/gastrointestinal-parasites-of-small-animals/roundworms-in-small-animals

Question 53

A middle aged MN stray cat is left on the doorstep of your clinic. The cat has a large dry crusted area of alopecia over his nose. A skin scraping of the area is negative. The lesion fluoresces under Wood’s lamp examination (see image). Which of the following would be the best treatment?

• Full body lyme sulfur dip, itraconazole
• Doxycycline
• Lufenuron
• Povidone-iodine scrub
• Athlete’s foot cream (clotrimazole)

Answer 53

Answer: Full body lyme sulfur dip, itraconazole.

This cat has a ringworm infection caused by Microsporum canis. This fungi fluoresces blue under a Wood’s lamp in 50% of cases.

The best treatment for ringworm infection would include a combination topical and oral therapy. Lyme sulfur dip or an antifungal shampoo containing miconazole would be acceptable. Oral antifungals such as itraconazole or fluconazole are most effective with the least side effects.

Povidone-iodine scrub has not been shown to be effective against ringworm.

Lufenuron is classified as an insect development inhibitor because of its ability to inhibit chitin synthesis, thus in the past has been said to have some effect against fungal infections. This has been debated and not widely supported as a treatment for ringworm.

Doxycycline is an antibiotic and would not be effective in treatment of fungal disease.

Athlete’s foot cream (clotrimazole) may have some effect at treating the lesion. Most over-the-counter creams such as this also include a steroid like betamethasone which would not be desired. Although this lesion appears to be localized to the nasal area, ringworm may also be subclinical and this cat may have infection elsewhere in the skin that is not grossly visible. Therefore, the best therapy is a combination of topical and oral.

Question 54

A 9-year old spayed female Siamese cat is presented to you for a 6-month history of polydipsia (the owner has documented water consumption of 110 ml/kg/day) and a 1 month history of weight loss and progressively decreasing appetite. Which of the following is a likely differential to explain these clinical signs?

• Hyperthyroidism
• Exocrine pancreatic insufficiency
• Hypertrophic cardiomyopathy
• Renal failure
• Diabetes mellitus

Answer 54

Answer: Renal failure.

Explanation
Renal failure is the differential most likely to be associated with pu/pd accompanied by decreasing appetite and weight loss.

Most cats with diabetes mellitus have normal to increased appetites; diabetic ketoacidotic animals can be ill, but usually DKA follows a period of pu/pd, weight loss, and normal to increased food intake.

Hyperthyroid cats can be pu/pd and have weight loss, but appetite is most often increased.

Some EPI animals show pu/pd and most have weight loss, but most are ravenously hungry.

Most animals with HCM are not pu/pd, and the disease is not routinely closely associated with decreased appetite or weight loss.

Question 55

You are treating Molly, an 8-year old feline, for hyperthyroidism. She is currently on methimazole 2.5 mg orally every 12 hours. Her labwork, including renal values, have been stable since diagnosis 2 months ago and her thyroid level is under control. The only concern is that Molly is experiencing extreme facial pruritis leading to excoriations. You believe this is due to a side effect of the medication. What other treatment option would be the best therapy for Molly?

• lapazole
• Levothyroxine
• 1-131 therapy
• Thyroidectomy
• Imidocarb

Answer 55

Answer: 1-131 therapy

Explanation
The treatment of choice for hyperthyroidism in a case such as this would be radioactive iodine, or 1-131 therapy. Molly would be a good candidate for this procedure since her renal values have remained stable while on methimazole.

Tapazole is a brand name for methimazole, which is her current medication.

Thyroidectomy can be performed, but many times some thyroid tissue is left behind or there is ectopic thyroid tissue, which means the hyperthyroidism continues or can recur at a later time. Also, this procedure carries more risk than does I-131 therapy.

Imidocarb is an anti-protozoal medication and has no indication for treatment of hyperthyroidism.

Levothyroxine is a thyroid supplement used for treating hypothyroidism.

Question 56

Which of these is not an ocular manifestation of herpesvirus in cats?

• Corneal dermoid
• Corneal sequestrum
• Coniunctivitis
• Eosinophilic keratitis
• Corneal ulcers

Answer 56

Answer: Corneal dermoid

Explanation
The answer is corneal dermoid. Corneal dermoids are congenital lesions. Eosinophilic keratitis and corneal sequestrum are specific corneal lesions caused by herpes infections. Corneal ulcers can be initiated by herpes virus. Conjunctivitis is also caused by herpesvirus, although there are many other causes as well, including calicivirus.

PowerLecture: Herpesvirus - Ocular

Question 57

A stray cat has been dropped off by a good samaritan after having witnessed the cat jump from a 3-story abandoned warehouse. On physical examination the cat has an avulsed lower lip and is very lame on the front left forelimb. Thankfully the cat had a microchip and the owners are eventually located. However, they refuse to spend any money on additional diagnostics. What is the best treatment option for the injuries likely sustained to the left forelimb.

• Reduction of traumatic elbow luxation
• Dynamic compression plating of the distal radial fracture
• Cage rest for the scapular luxation sustained
• Carpal arthrodesis

Answer 57

Answer: Carpal arthrodesis

Explanation
It is instinctive for cats to always try to land on their feet and as a result they are predisposed to sustaining hyperextension injuries to the carpal joints when landing from a distance. Disruption of the carpal ligaments carries a guarded prognosis with conservative therapy and stabilization via pancarpal arthrodesis is strongly recommended.

Distal fractures of the radius are a common condition seen in small breed dogs as a result of having decreased blood flow to the distal aspect of the radius. Scapular luxation is rare and surgical repair is recommended. Traumatic luxation is not commonly seen secondary to landing from a high distance.

Question 58

A 6-year old female spayed stray cat presents to you with a two-day history of progressive lethargy, vomiting, and inappetence. Upon physical examination, the patient has a temperature of 103.9 F (39.9 C), a small abscess forming on her right lateral trunk, and is showing aggressive behavior towards the clinical staff members and other animals (see picture below). What is your top differential for this patient and what is the next appropriate step you should take?

• Rabies, euthanasia with submission of the brain (frozen) for enzyme-linked immunosorbent assay (ELISA)
• Pasteurella multocida, anesthetize the patient using an induction agent, lance the abscess, and prescribe oral Amoxicillin
• Actinomyces, anesthetize the patient using an induction agent, lance the abscess, and prescribe oral Clavamox
• Rabies, euthanasia with submission of the head (refrigerated) for direct fluorescent antibody testing (dFA)
• Staphylococcus aureus, sedate the patient, flush the abscess, and administer a Convenia injection

Answer 58

Answer: Rabies, euthanasia with submission of the head (refrigerated) for direct fluorescent antibody testing (dFA)

Explanation
There are two phases associated with rabies infection in canines and felines. The initial phase is called the prodromal phase and often consists of vague clinical signs (including vomiting, lethargy, inappetence, and fever) along with furious or psychotic behavior. Cats, in particular, may develop erratic behavior such as anxiousness, staring, wild/spooky/blank appearing eyes. When confined to a kennel, they may strike or attack moving objects, including people. Other common clinical signs seen in cats are muscle tremors, ataxia, and weakness. This phase of the disease may last from 1-4 days.
The second phase of rabies is called the dumb phase and may develop around day five of disease (if the cat has not succumbed to the disease already). Clinical signs are often neurological and include LMN paralysis (especially if a limb is injured), CNS signs, or generalized paralysis.

According to the CDC, rabies testing should be performed in a qualified laboratory in accordance with the established national standard.

Euthanasia should be performed in such a way as to maintain the integrity of the brain so that the laboratory can recognize the anatomical parts. Submission of the entire head or brain is acceptable for a small animal but must be kept refrigerated or on wet ice and never frozen. Chemical fixation of the submitted tissues should be avoided.

The gold standard diagnostic test for rabies is the direct fluorescent antibody test (dFA). This test is performed on brain tissue from animals suspected of being rabid and can only be performed post-mortem. This is the test that all qualified rabies laboratories present in the United States perform on animals suspected of having rabies.

Question 59

You are examining a white cat with an ulcerative lesion along the lower eyelid. The owner reports that he thinks it is an old fight wound, but it has been there for 6 months and seems worse than it did initially. What is the most likely cause of this lesion?

• Hyperplasia
• Neoplasia
• Trauma
• Inflammation

Answer 59

Answer: Neoplasia

Explanation
The correct answer is neoplasia. This is a classic history for squamous cell carcinoma. The only thing missing is a history of UV exposure. It is important to remember that even though this is a neoplasm, it is an ulcerative lesion rather than a proliferative one. Lack of pigmentation and UV exposure both lead to the lesions on the eye and ear margins. Depending on their size, they can be treated with surgery or radiation. If small enough, the treatment of choice is a single dose of radiation with a Strontium-90 probe which delivers high doses of radiation but does not penetrate more than a couple of millimeters and can only be used for small lesions.

Question 60

Which of these characteristics of a skin mass are suggestive of a benign rather than a malignant mass in a cat?

• Rapid growth
• Well circumscribed
• Fixed to underlying tissues
• Ulceration

Answer 60

Answer: Well circumscribed

Explanation
The correct answer is well circumscribed. Although the only way to say definitively is with microscopic examination, in general, benign tumors are well circumscribed, slow-growing, with minimal inflammation incited. Malignant tumors tend to have more ill-defined margins, grow faster, have more associated inflammation, may ulcerate, and tend to be fixed to underlying tissues.

Question 61

You have a 6-kg cat that you wish to raise his PC from 15 to 25%. You plan to administer packed red blood cells. How many milliliters of packed red blood cells will this cat need?

• 30 ml
• 60 ml
• 15 ml
• 120 ml

Answer 61

Answer: 60mL

Explanation
The correct answer is 60 ml. In order to raise the PCV 1% you will need to give 1ml/kg of packed red blood cells.

So it takes 6mls to raise this cat’s PCV by 1%. If we are going to increase it by 10% we will need 60ml of packed red blood cells.

Question 62

A 9-year FS Domestic Long Hair presents for lethargy, weakness, and 2 seizures. The owner states that yesterday she gave the cat an enema she picked up from the drug store. The owner thought she had been constipated because she hadn’t defecated in several days and appeared uncomfortable.

She said it was a Fleet enema and that she had no problem administering it, but the cat vomited a few times afterward. Sassy is 5% dehydrated and obtunded on examination. She is having slight tremors. Your in-house laboratory won’t have bloodwork available for 2 hours. Which of the following treatments will most likely be indicated?

• Insulin and dextrose, IV fluid therapy
• Calcium gluconate, IV fluid therapy, phosphorus binders
• Potassium phosphate, IV fluid therapy, methocarbamol
• Potassium phosphate, IV fluid therapy, diazepam
• Potassium phosphate, a plain warm water enema, IV fluid therapy

Answer 62

Answer: Calcium gluconate, IV fluid therapy, phosphorus binders

Explanation
There are different Fleet enemas, some of which contain hypertonic sodium phosphate and are contraindicated in cats. Cats develop an electrolyte disturbance caused by the absorption of sodium and phosphate from the colon. This results in hypernatremia and hyperphosphatemia.
The high phosphorus leads to precipitation of serum calcium and thus hypocalcemia. This hypocalcemia can cause weakness, lead to shock, and cause muscle tremors or seizures. The treatment for this toxicity is to correct the electrolyte disturbance and correct the dehydration. IV fluid therapy and calcium gluconate are the initial treatments, and many times phosphorus binders are helpful to more quickly decrease the serum phosphorus.

Unless the cat is actively seizing, diazepam would not be indicated. The administration of calcium should help to stop the tremoring this cat is exhibiting. Potassium phosphate is clearly contraindicated, since the phosphorus is already too high. Insulin and dextrose are sometimes used in severe cases of hyperkalemia, which is not suspected in this case.

Question 63

A 3-year old male neutered Siamese cat has 6 cm of tissue protruding from his anus. The owner states when they woke up he was like that. She states he has had no diarrhea, constipation, vomiting, or straining that they are aware of but they have been out of town for the last 2 days. You are unable to reduce the lesion initially with gentle manipulation. The tissue appears grossly healthy and no necrosis is noted. You are not sure if this is a prolapsed rectum or a colorectal intussusception. How can you tell?

• The only way to definitively tell is by exploratory surgery.
• Pour dextrose over the tissue and see if it reduces. If it reduces, it is a prolapse.
• Do a barium enema and see if the barium goes into the colon. If it does, it is a prolapse.
• Take a left lateral radiograph of the abdomen and rectal region.
• Gently slide a thermometer alongside the prolapsed tissue. If it only goes in a short distance, this is a prolapse. If it goes in a significant distance, this would be an intussusception.

Answer 63

Answer: Gently slide a thermometer alongside the prolapsed tissue. If it only goes in a short distance, this is a prolapse. If it goes in a significant distance, this would be an intussusception.

Explanation
The best way to distinguish is to pass a blunt probe between the protruding mass and anus. If the probe contacts a fornix within a couple of centimeters it is likely a rectal prolapse, but if it passes 5-6 centimeters easily then an intussusception is more likely.

A dextrose solution may help to reduce edema associated with the tissue but would not in itself reduce the protrusion.

Exploratory surgery would be indicated and is the recommended treatment for intussusceptions. This would be a definitive way of determining if it is a prolapse vs. intussusception but this is the more invasive way of determining and is not the only way. If it is a rectal prolapse, more conservative therapy should be considered before surgery.

Question 64

A 6-year old domestic short hair cat presents for anorexia and lethargy. On physical examination, she has a BCS of 8/9 and has icteric mucous membranes. Bloodwork shows an elevated ALT 320 (25-97 U/L), ALP 170 (0-45 U/L), and normal GGT 3 (O-6 U/L). What is the most likely diagnosis?

• Hepatic neoplasia (adenocarcinoma, lymphoma)
• Cholangiohepatitis
• Hepatic lipidosis
• Hyperadrenocorticism

Answer 64

Answer: Hepatic lipidosis

Explanation
The correct answer is hepatic lipidosis. This is a classic example of an obese cat that has become anorectic and icteric. The chemistry profile is the key tip-off though, because of the elevations in ALT and ALP with normal GGT. Cholangiohepatitis or neoplasia should elevate both ALP and GGT. These signs are not consistent with Cushing’s in a cat and neither is the chemistry profile.

Question 65

You need to perform emergency splenectomy to remove a mass in the spleen. You want to choose anesthetic agents that do not cause the spleen to enlarge/engorge. With that in mind, which of the following options is the best combination?

• Xylazine and thiopental
• Acepromazine followed by diazepam and ketamine
• Morphine followed by diazepam and ketamine
• Acepromazine and propofol
• A mixture of thiopental and propofol

Answer 65

Answer: Morphine followed by diazepam and ketamine

Explanation
Acepromazine can cause splenic enlargement and sequestration of red blood cells in the spleen. This is often striking and evident on radiographic or sonographic exams of animals sedated with acepromazine. Thiopental is a thiobarbiturate which induces splenic engorgement; this makes surgical manipulation and removal of the spleen more difficult.

Xvlazine. diazepam. ketamine. propofol. and opioids such as morphine do not increase the size of the spleen.

Question 66

A 10 year old female spayed Labrador Retriever has presented for difficulty getting up in the hind and apparent back pain for the last 3-4 weeks. Upon questioning the owner, you are told that her appetite is diminished but she is still eating. An orthopedic exam finds no pain or discomfort elicited on manipulation of the hips or stifles. A neurologic exam identifies substantial pain in the lumbosacral region; however, conscious proprioception is intact, and patellar reflexes are normal.
Radiographs of the lumbosacral region identify a lytic lesion at the L7-S1 endplates as well as surrounding bony proliferation. Which of the following diagnostic tests is likely to provide the most helpful additional information given your findings?

• Abdominal ultrasound
• Blood draw for creatine kinase levels
• Stifle arthrocentesis
• Urine culture
• Chest radiographs

Answer 66

Answer: Urine culture

Explanation
The diagnosis you should have in mind is discospondylitis. Be sure not to confuse this with spondylosis, which is typically not clinically significant and can be expected in most older dogs. The radiographic description is relatively specific for this condition. Neoplasia in the spine should be lower on your differential list because it typically does not cross joints. Disc herniation cannot be ruled out, and advanced imaging would be necessary to know for certain, but given the exam and radiographic findings, discospondylitis should be your top differential.

Discospondylitis is usually bacterial in origin, with Staphylococcus being the most common organism involved. Other organisms identified include Brucella canis, E. coli, Pasteurella, Aspergillus, and Streptococcus.

In an attempt to identify the causative agent, urine and blood cultures should be considered. The other answer choices are not as high yield in identifying the specific bacterial cause or underlying etiology.

Question 67

A 3-year old male castrated domestic short hair cat presents to you for weight gain, polyuria and polydipsia over the course of 6 months. His previous veterinarian made a diagnosis of diabetes and has tried to control this with insulin but has not been successful. On examination, you detect prognathism, hepatomegaly, and a grade III/VI heart murmur. You suspect that the cat may have an underlying disorder that is contributing to his poorly-controlled diabetes. Which of the following diagnostic tests will be most helpful in confirming your suspicion?

• MRI of the brain
• Abdominal ultrasound
• Serum T4 levels
• Serum insulin:glucose ratio
• Serum folate and cobalamin levels

Answer 67

Answer: MRI of the brain

Explanation
This cat has clinical signs most consistent with acromegaly (weight gain, prognathism, organomegaly, and diabetes mellitus that is difficult to control). This condition results from a growth hormone (GH) secreting pituitary tumor.
GH or insuline-like growth factor (IGF) assays can be diagnostic but are not offered by many veterinary laboratories. Advanced imaging techniques are the most reliable way to diagnose a pituitary mass in this instance. This cat is not likely to be hyperthyroid due to the history of weight gain. Hyperadrenocorticism as a cause of insulin-resistant diabetes mellitus is less likely given the cat’s other clinical signs; nevertheless, adrenal function testing such as an ACTH stimulation test or dexamethasone suppression test to rule out hyperadrenocorticism should be considered.

Question 68

A 14-year old male castrated domestic long hair was diagnosed with hyperthyroidism in your clinic. What additional test should be run before starting treatment for hyperthyroidism?

• СВС
• Bile acids
• Chemistry panel
• Thoracic radiographs

Answer 68

Answer: Chemistry panel

The correct answer is chemistry panel. A chemistry panel should be run first to get a baseline assessment of renal function and liver function.

Occult renal insufficiency is often masked by the hemodynamics of hyperthyroidism.
Hyperthyroidism often causes increased renal perfusion and increased GFR. In these cats, when hyperthyroidism is treated, the renal insufficiency is unmasked and they become azotemic. For this reason, most clinicians start treatment with methimazole, and recheck renal function when the T4 is normal. If there is no evidence of underlying renal disease, a permanent treatment for hyperthyroidsim can then be recommenced, such as -131 therapy.
The liver enzymes and liver function tests on a chemistry panel should also be assessed since medical management of hyperthyroidism with methimazole can be hepatotoxic.

Hyperthyroidism itself can cause increases in liver enzymes, so it is ideal to have baseline liver enzymes before starting treatment.
CBCs in hyperthyroid cats are usually unremarkable.

Bile acids test is not warranted.

Thoracic radiographs may show cardiomegaly, pulmonary edema, or pleural effusion; however, cardiovascular effects of hyperthyroidism are usually reversible with treatment of the hyperthyroidism.

For the PowerPage’” on this topic, view
Hyperthyroidism

Question 69

A 1.5-year-old spayed female cat presents with a 7-day history of vocalizing, rolling, and allowing a male neutered cat in the household to mount her. The cat has gone through one similar episode 1 month ago. She otherwise has been behaving normally and has no other health problems. You performed an ovariohysterectomy on the cat at 3 months of age.

You perform vaginal cytology which shows some cornified epithelial cells but is inconclusive. You measure serum lutenizing hormone of 0.2 ng/ml (normal for an ovarietomized female is >1 ng/ml).
Which of the following is the most appropriate course of action?

• Measure serum estrogen and progesterone
  levels
• Measure serum testosterone levels
• Order MRI of the brain to rule out a pituitary tumor
• Exploratory laparotomy to remove the ovarian remnant

Answer 69

Answer: Exploratory laparotomy to remove the ovarian remnant

This is a classic description of ovarian remnant syndrome, which is when a cat goes into estrus after previously having an ovariohysterectomy (OVH).

This can occur anywhere from weeks to years after OVH and typically the clinical signs consistent with estrus are sufficient to conclude that the cat is in estrus and has ovarian tissue present. Additional diagnostic tests that are consistent with ovarian remnant syndrome include:
Serum estrogen >70 pmol/L indicate that the cat has estrogen production from the ovary. The problem with this test is that estrogen measurements may fluctuate and can be unreliable.

Serum progesterone >6 nmol/L after induced ovulation is sufficient to conclude that corpora lutea formed and released progesterone.
Testing for serum LH levels can also help confirm the diagnosis. In intact queens, LH is consistently maintained at basal levels due to negative feedback from ovarian estradiol secretion. After OVH, this control is lost and LH concentrations increase. LH < 1 ng/mL is consistent with the presence of an ovary as it is in this case.

Surgery is the treatment of choice. Many practitioners prefer to do surgery during estrus or diestrus when the ovarian tissue is enlarged and easier to locate. Remnants may be bilateral so a complete exploratory laparatomy is necessary.

Ovarian tissue is most commonly at the ovarian pedicle but can also be in the mesentery or elsewhere.

Question 70

You need to perform a CBC and take thoracic radiographs on a somewhat fractious cat. You sedate the cat with an intramuscular injection of medetomidine. While on the X-ray table, you become concerned that the cat is not doing well and you decide you want to reverse the effects of medetomidine. What should you give the cat?

• Flumazenil
• Xylazine
• Atropine
• Atipamezole
• 2-pralidoxime

Answer 70

Answer: Atipamezole

Explanation
Atipamezole (trade name: Antisedan), an alpha-2 antagonist, is the reversal agent for medetomidine (trade name: Dormitor). Medetomidine is an alpha-2 agonist.

Xylazine would be another example of an alpha-2 agonist. Yohimbine is its reversal agent. Other alpha-2 agonists are clonidine, detomidine, dexmedetomidine and romifidine 2-pralidoxime is a reversal agent for cholinesterase inhibitors.

Flumazenil is a reversal agent for benzodiazepines

Atropine is a muscarinic antagonist of acetylcholine and may be dangerous to use after administration of alpha-2 agonists. This is because alpha-2 agonists cause marked vasoconstriction and high afterload on the heart.

Giving atropine and increasing the heart rate can place further stress on the heart. You do not want to set in motion peripheral vasoconstriction and compensatory bradycardia brought on by the alpha-2, then increase the heart rate against that high afterload. This could make for an unhappy heart in the event underlying subclinical heart disease is present.

Question 71

Which of the following is the most common cause of Bartonellosis in cats in the United States?

• B. henselae
• B. vinsonii
• B. weissii
• B. quintana
• B. clarridgeiae

Answer 71

Answer: B. henselae

Explanation
The correct answer is Bartonella henselae.

B. quintana is the cause of Trench Fever in humans which is transmitted by the human louse. B. carridgeiae and B. weissi are other species that can infect cats, but not as often. B. vinsonii has been associated with endocarditis in several dogs.

Question 72

A 13-year-old female spayed domestic short hair cat presents for progressive ptyalism and halitosis. On anesthetized oral exam, you find the sublingual lesion seen in the image below. Which of the following differential diagnoses is most likely and appropriately matched with its prognosis?

• Eosinophilic granuloma complex. Prognosis is guarded with treatment
• Bacterial granuloma. Prognosis is poor with treatment
• Squamous cell carcinoma. Prognosis is good with treatment
• Squamous cell carcinoma. Prognosis is poor with treatment
• Eosinophilic granuloma complex. Prognosis is poor with treatment

Answer 72

Answer: Squamous cell carcinoma. Prognosis is poor with treatment

Explanation
The top differential for a mass lesion of the tongue of an older cat is squamous cell carcinoma. Other differentials including eosinophilic granuloma complex, FIP granuloma, fungal granuloma, and bacterial granuloma are much less common.

Squamous cell carcinoma is a locally aggressive form of neoplasia that is associated with a poor prognosis unless it is caught very early (usually as an incidental finding). Median survival times for cats with this disease is about 2 months with only 10% still living 1 year after diagnosis.

Eosinophilic granulomas are thought to be a hypersensitivity reaction and the prognosis is thought to be good with treatment and identification of an underlying cause.

Question 73

Sissy is a fourteen-year-old female spayed Domestic Shorthair cat who has been chronically vomiting for the past month. Dr. Smith notes a mass in the cranial abdomen on palpation. After several appointments to discuss the mass, the owner declines referral for ultrasound and exploratory surgery with a specialist. Instead, the owner chooses exploratory surgery with Dr. Smith. Before surgery, the owner explains that she intends to proceed with humane euthanasia if the mass is inoperable and that she does not wish to be present if euthanasia occurs. In surgery, Dr Smith identifies a large, inoperable mass near the pylorus. Based on this information, what is the most appropriate way for Dr. Smith to proceed?

• Obtain verbal consent via phone, then have the owner return to the clinic to sign a written consent form prior to euthanasia.
• Obtain verbal consent for euthanasia via phone, with a second staff member listening to and confirming the owner’s consent, then document the conversation in the medical record before proceeding with euthanasia.
• Accept verbal consent for euthanasia via phone, proceed with euthanasia, and have the owner mail in a written consent form.
• Proceed with euthanasia based on the owner’s previous statements regarding her wishes. Since the possibility of euthanasia was previously discussed, further consent and documentation is not necessary.

Answer 73

Answer: Obtain verbal consent for euthanasia via phone, with a second staff member listening to and confirming the owner’s consent, then document the conversation in the medical record before proceeding with euthanasia.

Explanation
For cases involving a previously known client and patient, in which the possibility of euthanasia is discussed in advance of an anesthetic procedure, verbal consent via phone is acceptable. Having more than one staff member confirm the consent for euthanasia via phone and document the conversation is recommended. In such a case, written consent is not essential, and insisting on written consent may create more stress for the client. When accepting consent for euthanasia via phone, having a second staff member confirm the client’s wishes is recommended. If verbal consent for euthanasia has been given and the procedure has already been completed, then written consent is unnecessary. Having the owner return to the clinic to sign a written consent form may create more stress for the client. However, some type of owner consent is required prior to humane euthanasia. Consent prior to euthanasia is always necessary.

Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-
Blackwell, 2010. Pages 55-56.

Question 74

You are examining the eyes of a cat and find it has no dazzle reflex, menace response and is not visual out of one of its eyes, but it does have a palpebral reflex. Where is the lesion?

• Visual cortex
• CN VII
• CN II
• CN V

Answer 74

Answer: CN II

Explanation
The correct answer is CN II. The presence of a palpebral indicates normal function of CN V and VII. The dazzle reflex examines CN Il separate of the visual cortex (an animal with a cortical lesion will still have a dazzle reflex).

Therefore the lesion is in CN Il.

Question 75

Which of these is not recommended in vaccinating cats due to the risk of vaccine induced sarcomas?

• Vaccinate intramuscularly
• Reduce frequency of vaccination
• Use non-adjuvanted vaccines when available
• Vaccinate in a distal limb

Answer 75

Answer: Vaccinate intramuscularly

Explanation
The answer is to vaccinate intramuscularly. Vaccine-associated sarcomas are thought to be associated with inflammation at vaccine sites and possibly associated with adjuvants, particularly aluminum-based adjuvants.

The frequency is estimated to be about 3 tumors per 10,000 vaccines administered. Intramuscular vaccination is not recommended because tumors that develop intramuscularly will not be diagnosed until later because they will be hidden; they will also potentially be deeper and more difficult to excise. Distal limb vaccination is recommended due to the ability to determine which vaccine may have been the cause, and because mass excision or limb amputation is more feasible than removing deep intrascapular masses.

***PowerPage: Injection Site Sarcoma

***PowerLecture: Injection Site Sarcoma (3:55).

Question 76

A lethargic cat arrives with bradycardia. You decide to perform an ECG and see a lack of a P waves and a widened QRS complex. What do you suspect?

• Wenckebach
• Hyperkalemia
• Warfarin toxicity
• Hypercalcemia
• Mobitz Type-1 Block

Answer 76

Answer: Hyperkalemia

Explanation
The correct answer is hyperkalemia. This sounds like hyperkalemia. You rock if you got it! ECG findings associated with hyperkalemia include an increased P-R interval, widened QRS complexes, lack of P waves, and tall tented T waves.

Question 77

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?

• Observation of the site for recurrence
• Chemotherapy with doxorubicin
• Wider excision of tissue around the surgical field
• External beam radiation therapy

Answer 77

Answer: Observation of the site for recurrence

Explanation
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.

Question 78

A 5-year old cat presents to you with an acute presentation of marked upper respiratory signs as well as ulcerative and edematous lesions of the skin on the head and limbs. Which of the following viruses can cause this type of syndrome in cats?

• Feline viral rhinotracheitis
• Panleukopenia
• Calicivirus
• Feline leukemia virus
• Feline immunodeficiency virus

Answer 78

Answer: Calicivirus

Explanation
Typically, feline calicivirus is an upper respiratory pathogen that may cause oral ulcerations +/- conjunctival chemosis. However, outbreaks of highly virulent and often lethal feline calicivirus infections have been seen.
This is frequently referred to as “Virulent systemic feline calicivirus (VS-FCV).” These infections are characterized by the signs described above; typically cats develop a severe acute upper respiratory tract disease first, followed by characteristic signs of cutaneous edema and ulcerative lesions on the skin and paws. Edema is located mainly on the head and limbs. Some cats may be jaundiced due to hepatic necrosis and/or pancreatitis.

Thromboembolism and coagulopathy caused by DIC may be observed including petechiae, ecchymoses, epistaxis or hematochezia.

Feline viral rhinotracheitis is a herpesvirus and causes respiratory symptoms but not the more severe signs
described here.

Panleukopenia selectively damages rapidly dividing tissues, namely the bone marrow and gastrointestinal tract.

Neither FeLV nor FIV alone can cause the severe respiratory and ulcerative/edematous lesions described in this case.

Question 79

An 11-year old female spayed Siamese cat presents for further evaluation after developing a mass over the scapular region. The mass is approximately 2cm in diameter. An aspirate of the mass confirms your suspicion, what is your surgical plan?

• Radical excision of the mass
• Excisional biopsy
• Excision with 2 cm margins
• Excision with 1 cm margins

Answer 79

Answer: Radical excision of the mass

Explanation
This is a probable vaccine associated fibrosarcoma. These tumors are slow to metastasize but extremely aggressive locally. A radical excision of the mass will be your best opportunity at a surgical cure. All other answer choices will likely result in poor margins and recurrence.

Question 80

Mousie, a 3-year old FS DLH, has been vomiting once daily for the past week. Clinically, she otherwise acts normally. Bloodwork and radiographs are within normal limits. The owners have seen chunks of hair in her vomit. She is currently on no medications and is eating Fancy Feast. Which of the following would you recommend?

• Prednisolone
• Maropitant
• Lactulose
• Laxatone
• Metoclopramide

Answer 80

Answer: Laxatone

Explanation
This young long-haired cat is apparently having a hairball problem. Frequent brushing, a higher quality diet, and a hairball treatment such as Laxatone (petroleum/mineral oil gel) should be recommended for this cat.
Lactulose is a stool softener often used to help with constipation.

Metoclopramide is an anti-emetic and promotility agent and may be beneficial for hairballs if a high quality diet and laxatone fail to correct the problem.

Maropitant (Cerenia) is a central and peripheral acting anti-emetic approved for the use in dogs.

Prednisolone is a corticosteroid which could be used for treatment of underlying inflammatory conditions.

Question 81

Which of the following causes the lesions seen in this picture of a cat’s retina?

• Niacin deficiency
• Taurine deficiency
• Thiamin deficiency
• Cobalamin deficiency
• Arginine deficiency

Answer 81

Answer: Taurine deficiency

Explanation
Cats with taurine deficiency can develop feline central retinal degeneration (FCRD) in addition to cardiomyopathy. This is because photoreceptors contain large amounts of taurine and cats cannot synthesize it.

The classic lesion is an elliptical area of tapetal hyperreflectivity starting in the area centralis dorsolateral to the optic disk that progresses to a horizontal band and eventually can involve the entire fundus.
Thiamin deficiency can be seen in cats fed raw fish diets when thiaminase depletes the body of thiamin, which causes neurologic symptoms.

Arginine is an essential amino acid in cats that is used to make ornithine, which binds to ammonia that is formed from the catabolism of protein. Arginine deficiency results in build up of ammonia and signs similar to hepatic encephalopathy.

Niacin deficiency in cats causes weight loss, anorexia, poor hair coat, ulceration and erythema of the tongue and palate, and diarrhea.

Cobalamin deficiency causes inappetance, lethargy, and failure to thrive.

Question 82

Suzie-Q, a 6-month old female spayed domestic short hair was recently adopted from the humane society. She has had watery diarrhea since adoption. Her fecal float and Giardia ELISA tests were negative. She was treated with metronidazole with no clinical improvement. You soak a cotton tip swab with saline and swab the rectum. You see elongated motile oval shaped protozoan organisms that do not look like Giardia lamblia. What organism might this be and what is the appropriate therapy?

• Cryptosporidium, Clindamycin
• Paragonimus kellicotti, Praziquantel
• Tritrichomonas foetus, Ronidazole
• Taenia taeniaformis, Praziquantel
• Giardia intestinalis, Fenbendazole
• Enterobius vermicularis, Fenbendazole

Answer 82

Answer: ** Tritrichomonas foetus, Ronidazole**

Explanation
Tritrichomonas foetus is a flagellated parasite most commonly found in kittens that have had an unresponsive diarrhea. The parasite can be very difficult to diagnose. It is most often responsive to Ronidazole.

Paragonimus is a lung fluke. The eggs are typically passed in the feces. Fenbendazole and Praziquantel have been effective against this parasite.

Giardia is unlikely if the ELISA is negative as it is a very sensitive test.

Taenia is a tapeworm and is not a flagellated parasite. It is treated with Praziquantel.

Cryptosporidium is a coccidian that invades the small intestinal villi after ingestion of infected oocysts. It can be diagnosed with PCR. It is treated with clindamycin, azithromycin, or tylosin most commonly. It is usually an opportunist, so evaluation for underlying disease is appropriate.

Enterobius vermicularis, or pinworm, is a parasite of people and primates but not cats and dogs.

Question 83

What are the main vectors of tularemia?

• Fleas
• Stable flies
• Ticks
• Mosquitoes

Answer 83

Answer: Ticks

Explanation
The correct answer is ticks.

Cats and dogs can also be infected following contact with other animals such as rodents and especially rabbits. This is zoonotic and a potential biological warfare agent. Dogs are relatively resistant to tularemia. Cats show depression, fever, anorexia, general lymphadenopathy, and oral ulceration.

Humans have three forms of the disease, ulceroglandular, pneumonic, and typhoidal.

Question 84

A client calls and says her cat was chewing on her lily plant two days ago and is now acting very sick. You tell her to bring the cat in immediately so that you can perform which of the following?

• ALT, AST, GGT, and total bilirubin levels
• BUN and creatinine levels
• Abdominal radiographs to diagnose intestinal obstruction
• Induce emesis and administer activated charcoal

Answer 84

Answer: BUN and creatinine levels

Explanation
Lily plant toxicosis is extremely serious and can cause rapid and fatal acute renal failure in cats. If ingestion is suspected, decontamination and aggressive fluid therapy, and monitoring of renal values are recommended immediately.

In this case, since 2 days have passed, inducing emesis and administering activated charcoal would not be helpful. What you can do is check renal values (BUN and creatinine) and treat for acute renal failure.

Ruling out an intestinal obstruction in a cat with this history is reasonable but not the best of the choices given.

Question 85

Which of the following is not a component of therapy for chronic renal failure?

• H2 receptor antagonists
• Oral phosphate binding agents
• Glucocorticoids Correct Answer
• Calcium channel blocking agents
• Restricted dietary protein

Answer 85

Answer: Glucocorticoids

Explanation
The correct answer is glucocorticoids.

Restriction of dietary protein decreases the formation of nitrogenous wastes and helps to palliate hyperphosphatemia.

Phosphate binding agents prevent the absorption of phosphorus from the intestines. H2 blockers decrease gastric acid secretion helping to prevent vomiting and the formation of gastric ulcers. Calcium channel blockers, like amlodipine, are used to palliate hypertension.

Glucocorticoids are not usually indicated in chronic renal failure patients.

***PowerPage: Chronic Renal Insufficiency

Question 86

The card shown below is used for determining feline blood types. On the card, the circle on the left has antibodies against the type B feline antigen. The circle on the right has antibodies against the type A feline antigen. 50 ul of anticoagulated blood from a cat has been mixed with 50 ul of saline and added to each circle on the card 2 minutes ago. What is the cat’s blood type?

• Mik
• А
• АВ
• B

Answer 86

Answer: A

Explanation
The card shown is one of several widely used in-practice test kits for feline blood typing. The presence of agglutination as seen in the circle on the right occurs because the anti-A antibodies on the card bind the type A antigen present of the cat’s red blood cells. Agglutination in both wells would indicate an AB cat, which is rare.

Mik is a recently identified feline blood group antigen; a proportion of type A cats lack expression of Mik and have a serum alloantibody for Mik. This can be a cause of acute hemolytic transfusion reactions in cats, even if they are matched for their blood type. This card (and most blood typing kits) do not test for Mik.

Question 87

An 8-year old male castrated domestic shorthair presents for facial lesions. You diagnosed him with hyperthyroidism 1 month ago and he has been doing well on methimazole. The cat has been fed the same diet for the past 4 years. He is indoors only and on flea preventative. There have been no changes to his environment that the owner can think of. What of the following do you recommend?

• Try a novel protein diet trial for 4 weeks
• Discontinue methimazole and consider I-131 therapy
• Administer a Depo-medrol injection
• Refer to a dermatologist for allergy testing

Answer 87

Answer: Discontinue methimazole and consider I-131 therapy

Explanation
Facial pruritis leading to self-induced excoriations is one of the side effects that can be seen with methimazole therapy. If it occurs, it is typically seen during the first three months of therapy. Along with facial excoriations, clinical signs can also include crusting of the ears. The recommended treatment is to discontinue methimazole and either switch to the Hill’s y/d diet or consider surgery or I-131 therapy.

Other causes of skin lesions include atopy, food allergy, and allergic flea dermatitis, but methimazole sensitivity should be considered in any cat with facial excoriations regardless of how long they have been taking the drug.

Question 88

A 10-year old female spayed domestic short hair named Angel presents with a history of increased drinking and urinating for 2 weeks and weight loss. She has not eaten in 2 days. Bloodwork shows blood glucose 457 mg/dL and her urine shows 3+ glucose, 2+ ketones. Which type of insulin would be recommended for this patient at this time?

• Glargine (Lantus) insulin
• Vetsulin
• PZI insulin
• Humulin-N (NPH)
• Humulin-R (regular insulin)

Answer 88

Answer: Humulin-R (regular insulin)

Explanation
This cat is in a state of diabetic ketoacidosis. Due to this status, the recommended insulin type is Humulin-R, or regular insulin. This is a shorter acting insulin which will help to get the ketonuria to resolve more efficiently. After the ketosis has resolved and the cat is hydrated, eating, drinking, and electrolytes are stable, the cat can be switched to a longer acting insulin. Glargine or PZI are the insulin types of choice for long term control in felines after the ketoacidosis has been corrected, but other insulin types can also be used.

Question 89

A 7-year old fractious cat has been coming in every day for the past week to get ear treatments. Because the cat is so difficult to handle, you have been needing to sedate the cat in order to clean and medicate his ears.
The owner comments that the cat has not been eating well, she suspects due to the stress of coming to the clinic every day. You decide that you will change your sedation protocol to include a drug that can rapidly increase appetite in cats. Which of these drugs has this effect?

• Diazepam
• Ketamine
• Dexmedetomidine
• Acepromazine
• Propofol

Answer 89

Answer: Diazepam

Explanation
Diazepam is a benzodiazepine sedative that can effectively cause appetite stimulation in cats. It is best administered intravenously to achieve this effect. Repeated oral administration of diazepam has been associated with acute fulminant hepatic necrosis. This side effect is thought to be related to metabolism of the drug in the liver to toxic metabolites. This is more severe when administered orally due to first pass metabolism.

The other drugs listed do not have this effect. Acepromazine is a phenothiazine sedative.

Dexmedetomidine is an alpha-2 agonist drug used for sedation. It is the S-enantiomer of medetomidine. Propofol is a rapid-acting anesthetic agent often used for induction of anesthesia.

Ketamine is a dissociative anesthetic.

Question 90

You check blood gases on a cat in the intensive care unit with renal disease.
They read as:
PaCO2= 28 (28-34 mmHg)
pH= 7.23 (7.25-7.4)
Pa02=100 (90-100 mmHg)
Base excess= -8 (-5 to +2 mmol/L)
HCO3 = 12 (16-20 mmol/L)
What can you conclude?

• The cat has primary metabolic acidosis with compensatory respiratory alkalosis
• The cat has a mixed respiratory and metabolic acidosis
• The cat has primary respiratory alkalosis with compensatory metabolic acidosis
• The cat has primary respiratory acidosis with compensatory metabolic alkalosis
• The cat has primary metabolic alkalosis with compensatory respiratory acidosis

Answer 90

Answer: The cat has primary metabolic acidosis with compensatory respiratory alkalosis

Explanation
The correct answer is that the cat has primary metabolic acidosis with compensatory respiratory alkalosis. The low pH tells you the cat is acidemic so the primary disorder must be an acidosis because compensatory mechanisms will never overshoot the primary abnormality. In this case, the negative base excess or low HCO3 tells us there is a metabolic acidosis (renal disease can cause this). The low PaCO2 tells us there is a respiratory alkalosis or hyperventilation. The primary abnormality must be the metabolic acidosis. The respiratory alkalosis can then be interpreted as compensatory.

Question 91

Behavioral issues in cats, which can become welfare concerns, often result from which of the following?

• Lack of vaccinations
• Lack of food and water
• Kidney disease
• Living indoors
• Lack of variety in the environment

Answer 91

Answer: Lack of variety in the environment

Explanation
Behavioral issues in cats can often be prevented or treated with proper environmental enrichment.

Question 92

You see an 8-month old kitten with the effusive form of feline infectious peritonitis and perform euthanasia. The kitten was having severe diarrhea around the house when it became ill. The owner has a 2 year old cat at home and wants to know what this cat’s prognosis is since it has been exposed to the sick kitten. Currently this cat is clinically healthy. What do you tell her?

• Her other cat may develop symptoms within the next two weeks because FIP is highly contagious
• Place the cat on L-lysine to prevent or suppress any infection with FIP
• Feline infectious peritonitis is not contagious and because her other cat died of FIP does not mean this cat will succumb to the disease
• You recommend a coronavirus titer to determine it the cat is actively infected
• Perform a PCR on the cat’s feces to see if the virus is being shed

Answer 92

Answer: Feline infectious peritonitis is not contagious and because her other cat died of FIP does not mean this cat will succumb to the disease

Explanation
Feline infectious peritonitis is not a contagious disease. It is a disease that is caused by a mutation of feline enteric coronavirus. It is unknown why in some patients this virus mutates and causes the FIP syndrome. It is most likely to occur in young or immunocompromised cats. Her other cat is not necessarily going to get FIP just from exposure. In fact, the majority of the cat population has been exposed to the feline enteric coronavirus.

Because most cats in the general population have been exposed, it makes interpretation of coronavirus titers difficult. The titers can be elevated due to prior exposure and not from FIP. The titers can only be interpreted in lieu of clinical signs, blood results, etc.

L-lysine is an anti-viral medication that may have some benefit for suppression of herpes virus but would not be a prevention or treatment choice for coronavirus.

The coronavirus is shed in the cat’s feces during active infection with coronavirus. Some infected cats do not shed the virus. The virus attacks the intestinal tract and causes Gl upset. PCR on the feces would detect coronavirus, but does not distinguish between the enteric coronavirus and the mutated FIP form of the virus.

Question 93

The following 4 cats present to you with signs of polyuria and polydipsia. Which of the following cats could you consider a DDAVP trial on?

• 5-year old DSH, female spayed, adequately hydrated, serum BUN-8, creatinine 0.9, urine specific gravity-1.040
• 8-year old DSH male castrated, 7% dehydrated, serum BUN- 45, creatinine-2.7, urine specific gravity-1.050
• 9-year old DSH male castrated, 5% dehydrated, serum BUN- 35, creatinine-2.4, urine specific gravity-1.010
• 6-year old DSH, female spayed, adequately hydrated, serum BUN-10, creatinine-0.7, urine specific gravity-1.007

Answer 93

Answer: 6-year old DSH, female spayed, adequately hydrated, serum BUN-10, creatinine-0.7, urine specific gravity-1.007

Explanation
The correct answer is 6-year old DSH, female spayed, adequately hydrated, serum BUN-10, creatinine-0.7, urine specific gravity-1.007. A DDAVP trial is generally performed in animals that are polyuric and polydipsic after ruling out other causes (Diabetes mellitus, renal insufficiency, hypercalcemia, liver failure, hyperadrenocorticism, hyperthyroidism, etc) to determine whether the PU/PD is due to diabetes insipidus or psychogenic polydipsia.
The 6-year old cat is the only suitable candidate because she has normal renal values and a low urine specific gravity in the face of adequate hydration. Dehydrated patients should not be started on DDAVP. Diabetes insipidus does not usually lead to dehydration. Diabetes insipidus is rare in cats.

Patients with elevated renal values and isosthenuric urine should also not be tested because renal insufficiency is the likely cause of their PU/PD. Patients with concentrated urine also do not need a DDAVP trial because they are able to concentrate their urine.

***PowerPage: Polyuria and Polydipsia

Question 94

Which of the following is not a common concurrent disease in cats with diabetic ketoacidosis?

• Bacterial infections
• Pancreatitis
• Hyperthyroidism
• Hyperadrenocorticism
• Cardiac disease

Answer 94

Answer: Hyperadrenocorticism

Explanation
The correct answer is hyperadrenocorticism.
Hyperadrenocorticism commonly occurs in DKA of dogs, but not in cats. Pancreatitis and bacterial infections commonly occur in DKA dogs and cats.

Cardiac disease can be a common concurrent disease in a cat with DKA.

Hyperthyroidism commonly occurs in DKA cats, but not dogs.

Question 95

A 13-year-old male castrated Domestic Longhair cat presents for polyphagia, weight loss, and vomiting. The owner notes that the cat appears restless, more active, and more aggressive than before. Which test would diagnose the most likely cause for these signs?

• Serum T4
• Gastroduodenoscopy and biopsy
• Abdominal ultrasound
• Liver panel
• Renal panel and urinalysis

Answer 95

Answer: Serum T4

Explanation
The correct answer is serum T4. This cat is most likely hyperthyroid. Polyphagia, weight loss, and hyperactivity are classical clinical signs in a cat with hyperthyroidism. Other signs might include a dull haircoat, PU/PD, vomiting, diarrhea, and aggression.

Lethargy, anorexia, and weakness are uncommon but can occur in a rare form of the condition called apathetic hyperthyroidism.

***PowerPage: Hyperthyroidism

Question 96

Which of the following causes the lesions seen in this picture of a cat’s retina?

• Arginine deficiency
• Cobalamin deficiency
• Thiamin deficiency
• Taurine deficiency
• Niacin deficiency

Answer 96

Answer: Taurine deficiency

Explanation
Cats with taurine deficiency can develop feline central retinal degeneration (FCRD) in addition to cardiomyopathy. This is because photoreceptors contain large amounts of taurine and cats cannot synthesize it. The classic lesion is an elliptical area of tapetal hyperreflectivity starting in the area centralis dorsolateral to the optic disk that progresses to a horizontal band and eventually can involve the entire fundus.

Thiamin deficiency can be seen in cats fed raw fish diets when thiaminase depletes the body of thiamin, which causes neurologic symptoms.
Arginine is an essential amino acid in cats that is used to make ornithine, which binds to ammonia that is formed from the catabolism of protein.

Arginine deficiency results in build up of ammonia and signs similar to hepatic encephalopathy.

Niacin deficiency in cats causes weight loss, anorexia, poor hair coat, ulceration and erythema of the tongue and palate, and diarrhea.

Cobalamin deficiency causes inappetance, lethargy, and failure to thrive.

Question 97

A woman brings her two cats into your clinic. She is worried because she has a young daughter who loves to play with her cats but she is concerned about Bartonella transmission resulting in cat scratch disease. You perform culture, PCR, and Western Blot on her cats, and those tests are negative. Which of these measures would be the most important way to decrease the chance of her cats acquiring Bartonella from another cat?

• Frequently clean the litterbox
• Monthly heartworm medication (ivermectin)
• Strict flea control measures
• Spaying them to prevent sexual activity
• Preventing bites or scratches from other cats

Answer 97

Answer: Strict flea control measures

Explanation
While transmission of Bartonella from cats to humans is primarily via scratches and occasionally bites, the same is not true for cat-to-cat transmission. Arthropod vectors are the main mode of transmission, particularly the cat flea, Ctenocephalides felis. Direct transmission from cat-to-cat or vertically from queen to kitten in a flea-free environment is very unlikely.

Question 98

A cat presents to you with a history of unilateral mucopurulent nasal discharge and a proliferative soft tissue mass over the bridge of the nose. On physical exam, you note aqueous flare as well as the abnormalities listed above. Lung sounds are normal. What is the most likely diagnosis?

• Bacterial rhinitis
• Squamous cell carcinoma
• Cryptococcosis
• Aspergillosis
• Nasal adenocarcinoma

Answer 98

Answer: Cryptococcosis

Explanation
The correct answer is cryptococcosis. Cats are commonly affected by Cryptococcus neoformans. Most common clinical signs are mucopurulent discharge and a proliferation on the nose (“Roman nose”). Ocular and CNS involvement may also be seen. It is an important differential for uveitis in a cat. Aspergillus is uncommon in cats and shouldn’t cause uveitis. Squamous cell carcinoma is common on the nose of cats, especially white ones exposed to the sun but is usually an ulcerated rather than a proliferative lesion.

***PowerLecture: Cryptococcus

Question 99

Treatment for hypertrophic cardiomyopathy in cats (as depicted in the pathologic image) is aimed at which of the following?

• Improving systolic function by decreasing heart rate
• Improving diastolic filling by increasing heart rate
• Improving systolic function by increasing heart rate
• Improving diastolic filling by decreasing heart rate

Answer 99

Answer: Improving diastolic filling by decreasing heart rate

Explanation
The correct answer is improving diastolic filling by decreasing heart rate. The primary problem with HCM is thickening of the wall of the left ventricle, impairing diastolic filling. There is usually no problem with contractility and systolic function. Slowing the heart rate provides for longer diastolic filling, allowing the left ventricle to fill more effectively. Decreasing the heart rate also decreases the severity of systolic anterior motion of the mitral valve.

For this reason, the medications used most frequently to slow the heart rate are:
1) Beta- blockers (i.e. atenolol: 6.25-12.5 mg/cat orally qD-BID, or metoprolol: 0.5-1 mg/kg TID)
2) Calcium channel blockers: diltiazem: 1-2 mg/kg TID (PO) or 7.5 mg per cat TID

For cases with severe left atrial enlargement or cats in heart failure, also consider:
3) ACE inhibitors (i.e. enalapril or benazepril: 0.25-0.5 mg/kg once daily)
4) Diuretics: furosemide (Lasix): 1-2 mg/kg BID-TID
5) Preventing thromboembolic disease with aspirin or clopidogrel (Plavix).

Also, always keep in mind that you want to identify and treat possible underlying hypertension or hyperthyroidism that could be contributing to the disease.

Question 100

You are presented with your long-term 13-year old male neutered domestic longhair patient. You are managing it for poorly controlled diabetes mellitus. At home, the cat is markedly polyuric, polydipsic, polyphagic, and has increased in weight from 7.2 kg (15.8 pounds) to 9.0 kg (19.8 pounds) over the last 3 months. The cat is currently receiving 15 units of protamine zinc insulin every 12 hours with meals. On physical exam, the cat is quiet and mentally dull. He has an enlarged head, paws, and liver on abdominal palpation. A blood glucose curve shows values between 400 mg/dL-500 mg/dL (normal range of 60-125mg/dL) on each reading throughout the day. What is the most effective treatment for the uncontrolled diabetes?

• Increasing the amount of insulin
• lodine 131
• Decreasing the amount of insulin
• Surgical exploration of the abdomen
• External beam radiation therapy

Answer 100

Answer: External beam radiation therapy

Explanation
This cat has the signs and symptoms of acromegaly. Acromegaly is caused by excessive growth hormone release from the pars distalis from a tumor in the pituitary gland. Excessive growth hormone causes a defect in the insulin receptors on target cells causing insulin resistant diabetes mellitus. The enlarged head, paws, abdominal organs, and weight gain are due to the anabolic effects of the growth hormone.

The most effective way to treat a pituitary tumor in veterinary medicine is with external beam radiation.

Other less effective treatments include high doses of insulin to try and control the diabetes, and somatostatin analogs (octreotide) to try and inhibit the release of growth hormone from the tumor. Surgical excision has been used as a form of treatment in people with pituitary tumors, but this has only been rarely reported in cats.

Prior to instituting therapy, pituitary imaging (CT scan +/- MRI) should be performed

Question 101

Which of the following is the most common cause of Bartonellosis in cats in the United States?

• B. vinsonii
• B. weissii
• B. clarridgeiae
• B. quintana
• B. henselae

Answer 101

Answer: B. henselae

Explanation
The correct answer is Bartonella henselae. B. quintana is the cause of Trench Fever in humans which is transmitted by the human louse. B. clarridgeiae and B. weissii are other species that can infect cats, but not as often. B. vinsonii has been associated with endocarditis in several dogs.

Question 102

Which is contraindicated in cats with chronic feline bronchial disease (feline asthma)?

• Prednisolone
• Atropine
• Doxycycline
• Theophylline

Answer 102

Answer: Atropine

Explanation
The correct answer is atropine. Atropine is contraindicated because it thickens bronchial secretions and encourages mucous plugging of the airway. Theophylline is a bronchodilator used to treat asthma.

Corticosteroids are used to reduce airway inflammation in feline asthma. Doxycycline is sometimes given to cats with feline bronchial disease to treat suspected Mycoplasma infections. Another drug that is contraindicated in cats is any beta-blocker because stimulation of the beta-2 receptors in the smooth muscle of the bronchioles causes bronchodilation; blocking these receptors with a beta-blocker causes bronchoconstriction.

Question 103

A 3-month-old healthy kitten tests positive for FeLV (feline leukemia virus) on your in-house ELISA. What do you tell the client about her kitten?

• An IFA (Immunofluorescent Antibody Testing) should be submitted. If it is negative, then the kitten is not infected with FELV.
• An IFA (Immunofluorescent Antibody Testing) should be submitted. If it is positive as well, the kitten is truly infected with FELV.
• If the ELISA is repeated again in 3 months and it is negative, then the kitten is not infected with FELV.
• A western blot test should be submitted.

Answer 103

Answer: An IFA (Immunofluorescent Antibody Testing) should be submitted. If it is positive as well, the kitten is truly infected with FELV.

Explanation
FeLV is a retrovirus that is transmitted both horizontally and vertically in the cat. Once a cat is exposed, the virus is propagated throughout lymphoid tissue, resulting in amplification in the spleen, lymph nodes, GALT, intestinal crypt epithelia, and bone marrow. Once the bone marrow is infected, peripheral viremia occurs by release of infected neutrophils and platelets. Finally, excretion of the virus in saliva and urine does not occur until 28-56 days after infection, once there is widespread infection of epithelial and glandular tissue.
ELISA tests for the p27 virus antigen in the serum. The IFA (Immunofluorescent Antibody) tests for p27 antigen in leukocytes and platelets.

Because some cats can neutralize the virus before progression/amplification in the body, a positive ELISA may eventually turn negative after a few weeks (in this situation, the IFA will remain consistently negative). If there has been propagation of the virus to the bone marrow, then the IFA will be positive. If the cat has a positive ELISA test with a negative IFA, it is important to repeat the ELISA again in 3 months to see whether virus neutralization occurred.

Unfortunately, in some cats, an ELISA turning negative 3 months later does not prove that the pet has overcome the infection. Some cats will sequester the virus in their bone marrow resulting in only a positive IFA upon retesting.

Question 104

Dextrose, insulin, sodium bicarbonate and calcium gluconate are all drugs used to treat life-threatening hyperkalemia in emergencies such as urethral obstructions. All these drugs, except one, work to lower potassium via intracellular translocation. Which drug has a different mechanism of action in treating hyperkalemia?

• Calcium gluconate
• Sodium bicarbonate
• Insulin
• Dextrose

Answer 104

Answer: Calcium gluconate

Explanation
Dextrose, insulin, and sodium bicarbonate infusions all drive potassium intracellularly. Calcium gluconate does nothing to lower the measurable serum potassium. Calcium gluconate is used to treat hyperkalemia by antagonizing the effects of elevated serum potassium on the myocardium. Its action is targeted at keeping the myocardial tissue normally excitable so the heart rhythm does not develop a life threatening bradycardia as seen with untreated hyperkalemia.

Question 105

Which of these drugs should never be given to a cat?

• Prednisolone
• Acetaminophen
• Dexamethasone
• Diphenhydramine
• Ketoprofen

Answer 105

Answer: Acetminophen

Explanation
The correct answer is acetaminophen. Because cats lack glutathione and the enzyme glucoronyl transferase, acetaminophen is metabolized differently. Cats accumulate toxins that result in methemoglobinemia and cell death. The blood becomes dark and the cats become dyspneic and develop facial edema. Immediate gastrointestinal decontamination is needed if the ingestion was within 2-3 hours. Treatment includes N-acetylcysteine, SAMe, vitamin C and supportive care.

Question 106

A 10-year old spayed female barn cat presents with dyspnea and cyanosis. Based on your physical exam, you suspect pyothorax. Thoracocentesis yields a foul-smelling purulent material. You make a smear of the exudate and perform a Gram stain. The cytology is shown below (100X objective) and you see the Gram-positive branched filamentous rods identified by the arrows. Based on this finding, you suspect that the cat has an infection with either Actinomyces spp. or Nocardia spp. Which of the following tests would differentiate the two?

• Trypan blue exclusion test
• Acid-fast stain
• Congo red stain
• Potassium hydroxide preparation (KOH test)
• Silver stain

Answer 106

Answer: Acid-fast stain

Explanation
Acid-fast staining is used to differentiate specific types of bacteria known as acid-fast organisms. Acid-fast stain is most commonly used to look for Mycobacteria, which are acid-fast. Nocardia and some bacterial spores and coccidian parasites are also acid-fast. In this case, an acid-fast stain would differentiate Nocardia (which is acid-fast) from Actinomyces (which is not acid-fast).

A KOH test is used to aid in the diagnosis of fungal infection, usually cutaneous infections from dermatophytes.

Congo red stain is typically used to stain for amyloid fibrils and may sometimes be used to identify a specific type of Shigella. Trypan blue is a cellular viability stain. Silver staining is used to identify proteins, commonly type Ill collagen. It may also be used to identify certain fungal organisms.

Question 107

A cat owner says that she is concerned about potential transmission of cat scratch disease to her roommate. Which of the following would be the most effective way to reduce the likelihood of disease transmission?

• Monitor the cat closely for signs of illness and seek immediate veterinary care
• Recommend cleaning the litter box daily
• Use effective flea control medications
• Use effective tick preventive medications

Answer 107

Answer: Use effective flea control medications

Explanation
Cat scratch disease, caused by Bartonella henselae, results in fever and lymphadenopathy, particularly in immunocompromised people. Cats typically do not display any clinical signs of disease, so monitoring the cat would not be helpful. Fleas are implicated in disease transmission with the bacteria seen in flea feces. It is thought that typically, cats with infected flea feces on their claws scratch and inoculate the bacteria into people.

Cats can also be bacteremic and have bacteria present in their saliva.

Question 108

A 10-year-old indoor/outdoor male castrated domestic short-hair cat presented to you for a 4-day history of lethargy and anorexia after the owner removed a tick found on the cat’s hind leg. On physical exam, you notice scleral hemorrhage (see picture) and hepatomegaly. The cat has a temperature of 105.2F (40.7 C) and is markedly dehydrated and icteric. Bloodwork revealed a normochromic, normocytic, non-regenerative anemia and thrombocytopenia. Blood smear showed signet ringed shaped organisms within erythrocytes. What treatment would you recommend to the owner and what is the prognosis?

• Prednisolone, blood transfusion, doxycycline; good
• Intravenous fluids, heparin therapy, blood transfusion; grave
• Placement of an esophagostomy tube and feeding therapy, blood transfusion; fair
• Intravenous fluids, prednisolone, blood transfusion; grave

Answer 108

Answer: Intravenous fluids, heparin therapy, blood transfusion; grave

Explanation
Cytauxzoon felis is a protozoal organism and transmission to cats is through tick bites. Cats usually show clinical signs 1-3 weeks after infection. Signs can be non specific and include anorexia, lethargy, dyspnea, and icterus.

Cats will also commonly have a marked pyrexia. The organism invades the reticuloendothelial cells of the lungs, spleen, liver, lymph nodes, and other organs so cranial organomegaly can often be present. The bone marrow can be affected causing pancytopenias. Thrombocytopenia is likely related to the development of disseminated intravascular coagulation, which can cause spontaneous bleeding. There is no effective therapy and prognosis is poor to grave. Current treatment recommendations include the antimalarial drug atovaquone combined with the antimicrobial azithromycin as well as fluids, heparin and supportive care.
Anti-protozoal medications such as imidocarb have been used with varying success.

Corticosteroids and antibiotics such as doxycycline, enrofloxacin, and marbofloxacin are commonly used to treat Mycoplasma haemofelis, but they are ineffective against Cytauxzoon. Immune mediated hemolytic anemia, cholangiohepatitis, and FIP should also be considered as differentials.

Question 109

A 6-year old male Siamese cat presents to you for evaluation of respiratory difficulty, chronic cough, lethargy, and decreased appetite. On your exam, the cat is quiet and 5% dehydrated. T-103.4F (39.7 C), HR-180 bpm, RR- 40. Body condition score is 3/9. The cat has harsh lung sounds and coughs occasionally. You note mild peripheral lymphadenopathy.

A CBC shows:
HCT - 39% (30-45%)
WBC-17,300/ul (5,500-19,500/ul)
Neutrophils- 13,800/ul (2,500-12,500/ul)
Bands- 600/ul (0- 300/ul)
Lymphocytes-1,900 (1,500-7,000/ul)
Monocytes- 600/ul (0-900/ul)
Eosinophils- 400/ul (0-800/ul)

You perform a needle aspirate from an enlarged lymph node. A representative cytology is shown in the image below. What is your diagnosis?

• Blastomycosis
• Lymphoma
• Histoplasmosis
• Metastatic sarcoma
• Metastatic carcinoma
• Cryptococcosis

Answer 109

Answer: Blastomycosis

Explanation
Blastomycosis, caused by Blastomyces dermatitidis, is a systemic fungal disease that primarily affects dogs, humans, and cats. It is a dimorphic soil fungus that is found in the Mississippi, Missouri, and Ohio River valleys and also the mid-Atlantic states and the Canadian provinces of Quebec, Manitoba and Ontario.

Infection occurs primarily through inhalation. This is a systemic infection that can cause damage to any organ or system including the central nervous system but the most common clinical signs and physical exam findings include:
Depression, anorexia, weight loss, fever, lameness, lymphadenopathy, harsh lung sounds, draining skin lesions, chorioretinitis, uveitis, and cough.

Clinical signs may be suggestive of disease but definitive diagnosis depends on identification of the organism.

As seen in the image, Blastomyces appears as a round to ovoid yeast measuring 8-25 um. It is pale pink when stained with H & E with a refractile, double-contoured wall. They have single broad-based buds.

Blastomyces is treated with systemic antifungal therapy, usually itraconazole.

Question 110

Which is contraindicated in cats with chronic feline bronchial disease (feline asthma)?

• Atropine
• Prednisolone
• Doxycycline
• Theophylline

Answer 110

Answer: Atropine

Explanation
The correct answer is atropine. Atropine is contraindicated because it thickens bronchial secretions and encourages mucous plugging of the airway. Theophylline is a bronchodilator used to treat asthma.
Corticosteroids are used to reduce airway inflammation in feline asthma. Doxycycline is sometimes given to cats with feline bronchial disease to treat suspected Mycoplasma infections. Another drug that is contraindicated in cats is any beta-blocker because stimulation of the beta-2 receptors in the smooth muscle of the bronchioles causes bronchodilation; blocking these receptors with a beta-blocker causes bronchoconstriction.

Question 111

An 8-week old Abyssinian cat recently obtained from a cattery presents to you for an examination and the owner reports that the cat has had diarrhea. On fecal float, you find multiple structures like the one shown in the photo (see image). What should you treat the cat with?

• Praziquantel (Droncit)
• Selamectin (Revolution)
• Amoxicillin and clavulanate (Clavamox)
• Sulfadimethoxine (Albon)
• Pyrantel (Strongid)
• Metronidazole (Flagyl)

Answer 111

Answer: Sulfadimethoxine (Albon)

Explanation
This is an image of Isospora from a cat. Isospora are parasitic coccidia that can cause diarrhea as this cat is showing. Treatment for coccidia is usually with sulfonamides such as sulfadimethoxine or trimethoprim sulfa.

For the other drugs listed:
Droncit- Primarily for cestodes (tapeworms)
Revolution- For fleas, heartworms, hookworms, roundworms, and ear mites Strongid- Primarily for roundworms and hookworms Clavamox- A broad spectrum antibacterial
Metronidazole- Primarily for anaerobes, also used for giardia

Question 112

Which of the following agents is the cat in the photograph most likely affected with?

• Chlamydophila felis
• Mycoplasma
• Calicivirus
• Herpesvirus

Answer 112

Answer: Calicivirus

Explanation
The correct answer is calcivirus. This upper respiratory tract pathogen is known for causing oral ulcers in cats along with nasal discharge, chemosis, and other upper respiratory signs. Herpes virus will cause ocular, dendritic ulcers, and less commonly cause oral ulcers. Mycoplasma and Chlamydophila are not associated with oral ulceration.

Question 113

The last appointment of the day is a free humane society exam on a newly adopted male neutered Domestic Longhair cat named Freddy. He was brought into the shelter by a good Samaritan 2 weeks ago as a stray and there is no prior history. As part of your routine evaluation of new adoptions, an enzyme-linked immunosorbent assay (ELISA) test for feline leukemia (FeLV) is performed on a blood sample from Freddy. The test is positive. Which of the following conclusions can be definitively drawn from this test result?

• Freddy should be euthanized because he will likely die from FeLV-related disease
• Freddy has been exposed to the virus and may be currently infected
• Freddy has lymphosarcoma
• Freddy has been exposed to the virus but is probably not currently infected

Answer 113

Answer: Freddy has been exposed to the virus and may be currently infected

Explanation
The correct answer is the cat has been exposed to the virus and may currently be infected.

A single, positive ELISA test detects the FeLV group-specific viral antigen (p27), which is diagnostic for FeLV infection. However, it is possible that the cat may still clear the virus (regressive infection). An immunofluorescent antibody (IFA) test should be performed, or the cat should be isolated and another ELISA test should be performed one to two months later. If the IFA or a second ELISA is positive, then the infection will probably persist (progressive infection) and FeLV-related disease will develop in the future - but exactly how far in the future is unknown.

In an otherwise healthy cat, euthanasia at the time of diagnosis is not appropriate. The decision to treat or euthanize a cat at any point should not be based solely on the presence of retrovirus infection. Retroviral testing can only diagnose infection, not clinical disease, and cats infected with FIV or FeLV may live for many years.

Although neoplasia can be associated with FeLV, the ELISA test indicates nothing about the presence or absence of lymphosarcoma.

Question 114

Which of the following conditions frequently results in hypercalcemia in a cat?

• Ethylene glycol toxicosis
• Intoxication with cholecalciferol based rodenticide
• Nutritional secondary hyperparathyroidism
• Administration of a fleet enema to a cat

Answer 114

Answer: Intoxication with cholecalciferol based rodenticide

Explanation
The correct answer is intoxication with cholecalciferol-based rodenticide. Cholecalciferol gets converted to active vitamin D to cause increased bone resorption of calcium and gut absorption of calcium leading to a sometimes fatal hypercalcemia. Nutritional secondary hyperparathyroidism results when an animal’s diet contains too much phosphorus resulting in decreased serum calcium. Ethylene glycol also causes hypocalcemia due to chelation of calcium by metabolites of ethylene glycol such as oxalate. Fleet enemas are also high in phosphorus and lead to a decrease in serum calcium due to the law of mass action.
For the PowerPage’” on this topic, view [o Hypercalcemia

Question 115

You shine a light in a cat’s right eye and see that the right eye constricts but not the left eye. You then shine a light in the left eye and the left eye does not constrict but the right eye constricts. Where is there a lesion in the pathway?

• Afferent to left eye
• Efferent to left eye
• Efferent to right eye
• Afferent to right eye

Answer 115

Answer: Efferent to left eye

Explanation
The correct answer is efferent to left eye because no matter which eye the light is shined in, there is no motor (or efferent) response in the left eye.

Question 116

A cat arrives at your clinic after being attacked by a raccoon. This cat is unvaccinated. What should you do?

• Euthanize immediately or quarantine for 4 months. Vaccinate for rabies at time of entry into quarantine
• Euthanize immediately or vaccinate immediately and quarantine for 45 days
• Euthanize immediately
• Vaccinate immediately and quarantine for 45 days
• Euthanize immediately or quarantine for 6 months, and vaccinate 1 month before release

Answer 116

Answer: Euthanize immediately or quarantine for 4 months. Vaccinate for rabies at time of entry into quarantine

Explanation
Per the 2016 Rabies Guidelines:
Since the cat is unvaccinated, it should either be euthanized and tissue submitted for rabies testing OR immediately vaccinated for rabies and quarantined for 4 months.

The Direct Fluorescent Antibody Test detects viral antigens and should be tested on two locations from the brain (brainstem and cerebellum) and is the test of choice for rabies diagnosis.

If the cat was current on rabies vaccination, the guidelines direct to booster the rabies vaccination immediately and have the owners observe closely indoors for 45 days.

If owners are able to provide proof the cat had been previously vaccinated for rabies, but is overdue: guidelines direct to booster rabies vaccination immediately and keep the cat indoors under owner observation for 45 days.

Question 117

Which of these is not a round cell tumor that could be seen in a cat?

• Mast cell tumor
• Lymphoma
• Plasma cell tumor
• Basal cell tumor

Answer 117

Answer: Basal cell tumor

Explanation
The answer is basal cell tumor. Basal cell tumors are epithelial tumors (epithelioma/carcinoma). The round cell tumors include lymphoma, mast cell tumor, plasma cell tumor, histiocytoma, transmissible venereal tumor, +/-melanoma and certain neuroendocrine tumors depending on which definition you are reading.

Question 118

The 13-year old male neutered domestic short hair cat shown in this photo presents to you with a 6-month history of progressive weight loss and an unkempt hair coat. You question the owner regarding his activity level and she mentions the activity seems the same other than the fact that he is more easily agitated.
Which of the following values is most likely to be elevated in this cat?

• Serum cholesterol
• Serum ALT
• Serum creatinine
• Urine specific gravity

Answer 118

Answer: Serum ALT

Explanation
This cat has several classic features of hyperthyroidism. You might expect to find a palpable thyroid nodule as well. In addition to an elevated T4, clinicopathologic features of hyperthyroidism include erythrocytosis and a stress leukogram (neutrophilia, lymphopenia) due to increased circulating catecholamines.

Increased catabolism of muscle tissue in hyperthyroid cats may result in increased BUN, but not creatinine. In fact, glomerular filtration rate (GFR) is increased in hyperthyroid cats, which may lower the BUN and creatinine and mask underlying renal insufficiency.

Although hyperthyroidism increases GFR, the effect of thyroid hormone excess on the urinalysis can vary. Most cats, however, will have decreased urine specific gravity and may exhibit polyuria.

The increased metabolic rate in hyperthyroidism results in liver hypermetabolism; therefore, serum activities of liver enzymes are commonly increased (ALT, ALP) in 80-90% of hyperthyroid cats. The increase in ALT is usually mild to moderate (100-400 IU/L). If the ALT is greater than 500, concurrent hepatic disease should be suspected. Serum cholesterol is usually normal, but can be moderately decreased, due to increased hepatic clearance mediated by thyroid hormones.

***PowerPage: Hyperthyroidism

Question 119

A 3-year old cat presents with pyrexia and dyspnea. On exam, you detect decreased respiratory sounds ventrally. Pleural fluid is obtained and smears are made from the sediment. What is the etiology of this cat’s pleural effusion?

• Streptococcus
• Toxoplasma
• Feline infectious peritonitis (FIP)
• Cryptococcus

Answer 119

Answer: Toxoplasma

Explanation
In addition to the neutrophils seen cytologically, you should have seen toxoplasma gondii tachyzoites multiplying within macrophages and neutrophils.

Cryptococcus is a narrow, budding, thin-walled yeast surrounded by a clear capsule. Streptococcus appears as small, round bacterial cocci. FIP effusion is typically characterized by a nonseptic exudate.

Question 120

The 2-year old intact female domestic short hair cat shown in the picture below presents for bilateral mammary masses. The cat has a normal activity and appetite at home. On physical exam, the cat is bright and alert. All mammary glands are enlarged but non-painful on palpation. What is the treatment for this cat?

• Ovariohysterectomy
• Radiation therapy
• Bilateral radical mastectomy followed by chemotherapy
• Bilateral radical mastectomy without chemotherapy
• Antibiotics

Answer 120

Answer: Ovariohysterectomy

Explanation
The cat in the image has mammary gland hyperplasia or fibroadenomatous/fibroepithelial hyperplasia. It most commonly occurs in young, intact female cats due to increased progesterone exposure. It is characterized by affecting one or more mammary glands, which become enlarged and are non-painful. Most affected cats are systemically well and do not show signs of illness or pain. Treatment for the condition is removal of the source of progesterone via ovariectomy or ovariohysterectomy. If no source of progesterone can be identified, or if the glands do not respond to spaying, a progesterone receptor blocker such as aglepristone can be administered as well.

Differential diagnoses for this condition include mammary neoplasia and mastitis. Mammary cancer more commonly affects older cats and would be less likely to affect all glands simultaneously and symmetrically like the cat shown in the picture. Mastitis would be painful, inflamed, and the cat would likely be acting systemically ill.

Question 121

A male neutered 12-year old domestic short hair cat presents for right forelimb persistent lameness of one month duration. The cat is a strictly indoor cat and has no other health problems. The owners feel he has been progressively worsening over the last week and his appetite is reduced. An orthopedic exam isolated his pain to the proximal humerus and radiographs showed a lytic lesion consistent with osteosarcoma. You offer to perform an amputation and the owners want to know his prognosis after amputation. What is his prognosis after amputation alone?

• 12 months or more
• 6 months
• 3 months
• 4 weeks

Answer 121

Answer: 12 months or more

Explanation
Cats with appendicular osteosarcoma have a much better prognosis than dogs with osteosarcoma due to a lower rate of metastasis. Some papers cite a survival time of over 2 years, but a more recent study sited approximately 12 months. In comparison, dogs with appendicular osteosarcoma have a median survival time of approximately 3-4 months with amputation alone. Metastasis to the lungs in dogs is usually the reason for death.

Question 122

A 10-year old FS DSH presents for losing her balance. The owner said she seems to be unsure of her distance in the last day when jumping up onto the counter and has bumped into the couch a couple of times. Her fundic examination shows engorged retinal vessels of the right eye, and the left retina appears hazy and is difficult to see any detail of the optic nerve or vessels. Both pupils are markedly dilated, and there is no menace of the left eye. The right eye is still visual. You suspect the left eye has a detached retina. You check her blood pressure, and she is calm while you take several readings using a Doppler. Her average systolic blood pressure is 260 mmg. You are confident the reading is accurate. Which of the following medications would be the best choice for this cat?

• Furosemide
• Amlodipine
• Enalapril
• Pimobendan
• Atenolol

Answer 122

Answer: Amlodipine

Explanation
This cat is extremely hypertensive and should be treated immediately with medication to reduce blood pressure. Normal systolic blood pressure for a cat is around 160 mmHg or less. Sometimes it may be slightly increased when the cat is stressed. Hypertension can lead to many complications including hypertensive retinopathy (retinal detachment), hypertensive heart disease, neurologic complications, and progression of renal disease.

If the blood pressure can be stabilized quickly, there is a good chance the retina will re-attach with time.
Underlying causes of hypertension in the cat include hyperthyroidism and renal disease. This cat should be further evaluated for these conditions.

Amlodipine is the treatment of choice for hypertension in cats. It is a calcium channel blocker and works by preventing calcium influx into vascular smooth muscle cells, thereby causing vasodilation. This relaxes the vessels and allows for reduced blood pressure.

Atenolol is a beta blocker and is often used in tachycardic patients with hyperthyroidism. It does not adequately control systemic hypertension in most cases.

Furosemide is a diuretic used in treating congestive heart failure. Enalapril is an ACE-inhibitor and does help to decrease blood pressure in some cases by causing vasodilation. However, in a cat with severe hypertension, enalapril alone would not likely provide adequate control. Pimobendan is a calcium sensitizer that increases cardiac contractility. It is sometimes used in cats with dilated cardiomyopathy. It is most often used in dogs as an adjunctive treatment for pulmonary hypertension or congestive heart failure.

Question 123

Which of the following conditions frequently results in hypercalcemia in a cat?

• Intoxication with cholecalciferol based rodenticide
• Nutritional secondary hyperparathyroidism
• Administration of a fleet enema to a cat
• Ethylene glycol toxicosis

Answer 123

Answer: Intoxication with cholecalciferol based rodenticide

Explanation
The correct answer is intoxication with cholecalciferol-based rodenticide. Cholecalciferol gets converted to active vitamin D to cause increased bone resorption of calcium and gut absorption of calcium leading to a sometimes fatal hypercalcemia. Nutritional secondary hyperparathyroidism results when an animal’s diet contains too much phosphorus resulting in decreased serum calcium. Ethylene glycol also causes hypocalcemia due to chelation of calcium by metabolites of ethylene glycol such as oxalate. Fleet enemas are also high in phosphorus and lead to a decrease in serum calcium due to the law of mass action.

***PowerPage: Hypercalcemia

Question 124

A 7-year old male castrated cat presents to you for difficulty eating. On examination, you see that there are dental lesions on the buccal surfaces of several premolar and first molar teeth. The cat shows signs of discomfort when you palpate around these teeth and the surrounding gingiva appears inflamed. You suspect that the cat has odontoclastic resorptive lesions. You perform dental radiographs which show evidence of endodontic necrosis. Which of the following is the most appropriate treatment recommendation?

• Affected teeth should be extracted and Vitamin D supplementation may reduce the likelihood of development of similar lesions in other teeth
• Dental extraction is a less expensive option but restorative dental techniques are effective at stopping progression of disease in most cats
• Affected teeth should be extracted and it is likely that other teeth will be affected in the future
• Affected teeth should be treated by removal of the crown and coronal part of the root with a dental burr followed by suturing the gingiva across the root
• Administration of an analgesic may provide relief until the lesion spontaneously resolves

Answer 124

Answer: Affected teeth should be extracted and it is likely that other teeth will be affected in the future

Explanation
As described in this case, feline odontoclastic resorptive lesions commonly affects cats with increasing incidence as cats age. One or more lesions are found in about 50% of the domestic cat population over 5 years old. Lesions are often seen at the buccal surfaces of premolars and the first molar teeth at the gingival margin.

Canine teeth can also be affected but usually lesions occur in the roots and the crown may appear normal.
There have been many theories about the cause of these lesions including a relationship to plaque-induced inflammation, microfractures of the cemental surface, and mineral deficiencies but most of these theories are no longer supported. It is now believed that abnormal formation or mineralization of cementum results in cemental resorption. There may be a relationship to high levels of vitamin D.

For treatment, there are reports of using alendronate, a bisphosphonate which inhibits demineralization of bone. Also, laser therapy has been used. However, neither of these treatments are currently accepted as standard care of this disease and extraction is the only current treatment that offers permanent prevention of pain to the patient. Restorative dental procedures are retained without recurrence in <25% of cats in 2-3 years.

In cases where lesions are entirely confined to the crown with no deep periodontal pockets and no radiographic evidence of endodontal necrosis, one can consider retaining the root. However, in the case described, complete extraction is the most appropriate recommendation. Because the incidence of lesions increases with age, it is likely that the cat in this case will develop lesions in other teeth in the future. Excessive Vitamin D should be avoided but other recommendations for prevention are controversial. Diligent dental care is certainly recommended.

***PowerLecture: Dentistry

Question 125

A 3-year old male castrated cat presents to your clinic for inappetence and depression of 3 days duration. On physical exam, the cat is febrile with a temperature of 103.6F (39.8 C) and is 8% dehydrated.

Complete blood count shows:
Hematocrit - 36% (30-45 %)
White blood cell count- 25,678/ul (5,500-19,500/ul)
Neutrophils- 21,678/ul (2,500-12,500/ul)
Lymphocytes- 3,300/ul (1,500-7,000/ul)
Monocytes- 200/ul (0-900/ul)
Eosinophils- 500/ul (0-800/ul)
Platelets- 210,000/ul (300,000-800,000/ul)

Serum chemistry shows:
Creatinine- 1.8 mg/dl (0.9-2.2 mg/dl)
Blood urea nitrogen (BUN) - 30 mg/dl (19-34 mg/dl)
Glucose- 70 mg/dl (60-120 mg/dl)
Albumin= 3.2 g/dl (2.8-3.9 g/dl)
Globulin= 2.8 g/dl (2.6-5.1 g/dl)
ALP- 95 IU/L (0-45 IU/L)
ALT- 349 IU/L (25-97 IU/L)
GGT - 12 IU/L (0-6 IU/L)
Total bilirubin- 1.1 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 and spleen are normal. The gall bladder appears mildly enlarged; no choleliths are seen. The pancreas does not appear sonographically enlarged or abnormal. The kidneys and the remainder of the abdomen appear unremarkable.

You perform an ultrasound guided liver biopsy. Histopathology indicates fibrosis associated with portal triads, bile duct proliferation, and centrilobular accumulation of bile with casts in canalicular areas.

Which of the following treatment plans is most appropriate for this cat?

• Supportive care and fluid therapy plus prompt placement of an esophagostomy tube and enteral feeding
• Supportive care and fluid therapy plus treatment with ampicillin, metronidazole, ursodeoxycholic acid
• Supportive care and fluid therapy plus treatment with neomycin and lactulose
• Surgical decompression and biliary-to-intestinal diversion (cholecystoduodenostomy or cholecystojejunostomy) after stabilizing the patient with appropriate supportive care and fluid therapy
• Supportive care and fluid therapy plus treatment with prednisolone, vitamin K1, and ursodeoxycholic acid

Answer 125

Answer: Supportive care and fluid therapy plus treatment with ampicillin, metronidazole, ursodeoxycholic acid

Explanation
The case described is very consistent with acute cholangiohepatitis. This condition is usually seen in younger cats (mean age 3-3.5 years) and is more common in males than females. This is in contrast to chronic cholangiohepatitis which occurs in older cats (mean age 9 years). Acute cholangiohepatitis patients are more likely to be depressed, dehydrated and febrile.

Bloodwork in cholangiohepatitis often shows a neutrophilia with or without a left shift. Mild increases in bilirubin and ALP are common, often with more severe elevations of ALT. The sonographic and biopsy findings are also consistent with the diagnosis of acute cholangiohepatitis and make other differentials such as hepatic lipidosis or lymphocytic portal hepatitis less likely.

Treatment of choice for this disease includes antibiotics with aerobic and anaerobic coverage that are excreted unchanged in the bile. Examples of antibiotics excreted unchanged in the bile include tetracyclines, ampicillin, amoxicillin, erythromycin, chloramphenicol, and metronidazole. Usually erythromycin, tetracycline, and choloramphenicol are not the first choices unless they are indicated based on culture and sensitivity because erythromycin is not effective against gram negative bacteria, tetracycline is hepatotoxic, and chloramphenicol may cause anorexia. Ampicillin or amoxicillin with clavulanic acid are good choices and metronidazole may be used to expand the anaerobic coverage. Antibiotics should be administered for at least 2 months.

Ursodeoxycholic acid (Actigall) is useful in all types of inflammatory liver disease because of its anti-inflammatory and anti-fibrotic properties on the liver. It also increases fluidity of biliary secretions.
Prednisolone is sometimes used in treatment of inflammatory liver disease. Vitamin K1 is indicated when liver disease causes coagulopathy. This is usually not the case for acute cholangiohepatitis. Neomycin and lactulose may be used in animals that develop signs of hepatic encephalopathy. Surgical decompression is indicated when discrete choleliths or complete biliary obstruction is indentified. Enteral feeding is the most important treatment for hepatic lipidosis but as described above, this case is much more consistent with acute cholangiohepatitis.

Question 126

Which of these antibiotics is very poorly absorbed from the feline gastrointestinal tract, provided the tract is intact?

• Neomycin
• Clindamycin
• Sulfadiazine
• Chloramphenicol

Answer 126

Answer: Neomycin

Explanation
The correct answer is neomycin. As with most aminoglycosides, neomycin is poorly absorbed through the GI tract. For this reason, it is sometimes used orally to alter intestinal flora without systemic absorption. The other antibiotics are absorbed from the Gl tract.

Question 127

A 5-year-old male neutered domestic short hair presents with miliary dermatitis. The owner explains that the pruritus and skin lesions started about 1.5 years ago and have progressed since then. The cat lives indoors only, and no other animals are in the household. The cat is not on any flea control, since the owner has never noticed any fleas. You perform a dermatological examination and no flea excrement or fleas are found. What do you tell the owner?

• The clinical signs are likely due to flea allergy dermatitis and flea treatment is necessary
• The clinical signs are most likely not related to flea allergy dermatitis, as neither fleas nor flea excrement were found on examination; further work-up of environmental allergies should be performed
• The clinical signs are most likely not related to flea allergy dermatitis since the cat lives indoors and is affected all year long; recommend a diet trial with a novel protein diet
• The clinical signs are likely due to flea allergy dermatitis and flea treatment is not necessary since neither fleas nor flea excrement were found on examination; recommend treating with a short course of steroids

Answer 127

Answer: The clinical signs are likely due to flea allergy dermatitis and flea treatment is necessary

Explanation
The correct answer is that you are suspicious of flea allergy dermatitis and flea treatment is necessary. In warmer climates, flea allergies can be seen year-round. And like other allergic disorders, flea allergy dermatitis can also be progressive. It is not surprising that fleas or flea excrement were not detected.

Animals, particularly cats, who are pruritic typically either scratch or lick off the fleas and their excrement. The clue that suggests flea allergy dermatitis is that the cat has miliary dermatitis and is not on any flea control. However, the cat may also have a food and/or environmental allergy. Flea treatment should be considered before work-up of food or environmental allergies, since a work-up can be lengthy and expensive. Steroids can be used to treat flea allergy dermatitis, but this is only palliative therapy and should be used with appropriate flea medication.

Question 128

A 10-year old male castrated cat that you have previously diagnosed with hyperthyroidism presents to you for acute onset of blindness. You perform an ophthalmic exam and note retinal hemorrhage. What diagnostic test should you perform first?

• Coagulation times
• Blood pressure
• Free T4 levels by equilibrium dialysis
• Serum BUN and creatinine
• Total T4 levels

Answer 128

Answer: Blood pressure

Explanation
The correct answer is blood pressure. Cats with hyperthyroidism are likely to develop hypertension. If this is severe enough (≥180-200 mmg systolic), they can be at risk for acute retinal detachment or hemorrhage resulting in blindness. Prompt resolution of the hypertension is critical to prevent further damage to the eye and other organs.

Question 129

A cat owner brings his 1-year old intact male cat to your clinic and is at his wit’s end with his cat due to scratching and destruction of his furniture. He requests an onychectomy. He says he has “tried everything” including frequent nail trims, the use of nail caps, and installation of scratching posts. Which of the following is consistent with AVMA recommendations in such instances?

• Castration is likely to reduce scratching and should be considered first
• Destruction of property is not a sufficient rationale to consider onychectomy in domestic cats
• Surgical tendonectomy should be considered as a more humane alternative
• Peri-operative analgesic use is imperative if onychectomy is performed

Answer 129

Answer: Peri-operative analgesic use is imperative if onychectomy is performed

Explanation
The revised AVMA policy on “Declawing of Domestic Cats” reads as follows:
The AVMA discourages the declawing (onychectomy) of cats as an elective procedure and supports non-surgical alternatives to the procedure. The AVMA respects the veterinarian’s right to use professional judgment when deciding how to best protect their individual patient’s health and welfare. Therefore, it is incumbent upon the veterinarian to counsel the owner about the natural scratching behavior of cats, the alternatives to surgery, as well as the details of the procedure itself and subsequent potential complications. Onychectomy is a surgical amputation and if performed, multi-modal perioperative pain management must be utilized.

Ref: AVMA position statement on the declawing of domestic cats - February 2020

The only answer choice here that is in agreement with the above statement is that peri-operative analgesic use is imperative if onychectomy is performed. Scratching is considered a normal behavior and is not considered to be hormonally driven; therefore, castration is not likely to prevent further scratching.

Question 130

Which statement regarding Tritrichomonas blagburni (also known as Tritrichomonas foetus) infection in cats is FALSE?

• Ronidazole given at 20mg/kg po q 24 hours x 14 days is an effective treatment
• If T. blagburni is not identified and treated properly, it will cause small bowel diarrhea indefinitely
• T. blagburni can be detected best by culture or PCR testing and can be identified on a wet mount
• Not all infected kittens or cats will have symptoms of diarrhea

Answer 130

Answer: If T. blagburni is not identified and treated properly, it will cause small bowel diarrhea indefinitely

Explanation
T. blagburni (also known as Tritrichomonas foetus) is a protozoal infection that causes large bowel diarrhea in cats. It typically affects young cats; even if left untreated, most cats will outgrow their symptoms within 2 years.

T. blagburni resembles Giardia on a wet mount but can be distinguished from Giardia by its “falling leaf” pattern.

Ronidazole is the most effective drug available to treat this infection. It should be used only at recommended doses as it can cause neurotoxicity at higher doses. Not all cats with this infection have symptoms as some cats may be asymptomatic carriers.

More information about this Protozoa and others can be found by reading the PowerPage called Selected
Parasites of Small Animal Species: Protozoa.

***PowerPage: Selected Parasites of Small Animal Species: Protozoa

Question 131

A 1-year-old domestic short hair presents for patchy alopecia that is most severe around the eyes. The owner reports that the other cats in the household have similar lesions and the cats are itchy. You are very suspicious of Demodex. Which diagnostic test would be most useful?
- Deep skin scrape
- Bacterial culture
- Supericial skin scrape
- Fungal culture
- Trichogram

Answer 131

Answer: Supericial skin scrape

Explanation
The key to this question lies in realizing that the cat most likely has Demodex gatoi since this is the only Demodex species that is contagious. Also Demodex gatoi is often very itchy. Demodex gatoi differs from Demodex cati in that it infects the epithelium and not the hair follicle. Thus, the best test would be a superficial skin scrape.

The best diagnostic test for Demodex cati would be a deep skin scrape. A trichogram refers to analyzing hair and is a useful test for dermatophytes and follicular mites. A bacterial culture may be indicated if you have a secondary infection. A fungal culture is not useful for Demodex.

Question 132

A client brings in her 3-year old cat who she heard scream in her basement and then found recumbent and vocalizing. Since then, the cat has become very rigid with muscle spasms. What could have happened?

• Wasp envenomation
• Copperhead snake bite
• Black widow spider bite
• Brown recluse spider bite

Answer 132

Answer: Black widow spider bite

Explanation
The correct answer is black widow spider bite. Latrodectus mactans and L. hesperus are the scientific names for this spider. They make a toxin that binds to calcium channels, increasing membrane permeability and enhancing depolarization. Ascending motor paralysis and destruction of peripheral nerves endings occur. A single bite may be serious to adult humans and could kill a small animal. Clinical signs occur almost immediately with pain, due in part to the release of acetylcholine, which stimulates contraction of major muscle groups. There may be ascending motor paralysis, muscle spasms, muscle rigidity, and salivation. Death from respiratory or cardiovascular failure is possible.

Question 133

A 3-year old male castrated domestic short hair cat presents for crusting and pruritus around the face, neck, and ears. Which of the following should be least likely on your list of differential diagnoses?

• Dermatophytosis
• Notoedres acariasis
• Arthropod bite hypersensitivity
• Eosinophilic granuloma

Answer 133

Answer: Eosinophilic granuloma

Explanation
The correct answer is eosinophilic granuloma. Eosinophilic granulomas or linear granulomas are usually linear in shape and pink-yellow in color. Typically, they don’t crust and are not usually pruritic. Notoedres acariasis, insect bite hypersensitivity, and dermatophytosis more characteristically cause pruritis, crusting, and often affect the head, neck, and ears.

Question 134

A 3-year old male castrated domestic short hair cat presents for crusting and pruritus around the face, neck, and ears. Which of the following should be least likely on your list of differential diagnoses?

• Dermatophytosis
• Notoedres acariasis
• Arthropod bite hypersensitivity
• Eosinophilic granuloma

Answer 134

Answer: Eosinophilic granuloma

Explanation
The correct answer is eosinophilic granuloma. Eosinophilic granulomas or linear granulomas are usually linear in shape and pink-yellow in color. Typically, they don’t crust and are not usually pruritic. Notoedres acariasis, insect bite hypersensitivity, and dermatophytosis more characteristically cause pruritis, crusting, and often affect the head, neck, and ears.

Question 135

Which of the following is the screening test of choice for hyperthyroidism in the cat?

• Total T4 level
• Serum iodine levels
• Thyroid-stimulating hormone levels
• Free T4 by equilibrium dialysis

Answer 135

Answer: Total T4 level

Explanation
The correct answer is total T4 levels. This test is routinely available and reliable in the vast majority of hyperthyroid cats for diagnosing hyperthyroidism and monitoring therapy. Free T4 by equilibrium dialysis can be increased with diseases other than hyperthyroidism, so this test should always be paired with a total T4. The total T4 should be increased or in the high end of the normal range in conjunction with a high free T4, in order to make a diagnosis of hyperthroidism. TSH levels are used to aid in the diagnosis of canine hypothyroidism (if they are increased), but they are not used in cats to diagnose hyperthyroidism.
For the PowerPage” on this topic, view por Hyperthyroidism

Question 136

An owner presents to you concerned that her cat is having an unplanned pregnancy. You take radiographs and can make out 6 fetal skeletons. The owner wants to know at what age the fetal skeletons typically become visible in cats. What should you tell her?

• 21-28 days
• 25-35 days
• 36-45days
• 13-18 days

Answer 136

Answer: 36-45days

Explanation
The normal gestational period in cats is 63 days after impregnation.

Ultrasound can be used to confirm pregnancy as early as 13 days.

A developing fetus can usually be palpated by day 21-28.

Fetal skeletons are radiographically detectable at around 42 days (range 36-45 days). An enlarged uterus may be visible radiographically as early as day 25-35.

Question 137

Which clinical finding is most supportive of hyperthyroidism in a cat?

• Polyphagia
• Palpable nodule in the area of the thyroid gland
• Weight loss
• Low body condition score
• Restlessness

Answer 137

Answer: Palpable nodule in the area of the thyroid gland

Explanation
The correct answer is palpable nodule in the area of the thyroid gland. A palpable thyroid nodule would be most supportive of hyperthyroidism in a cat out of all the answer choices listed. The other individual clinical findings alone are less specific to hyperthyroidism and are seen as signs in many other common diseases. Polyphagia can also be seen in diabetes mellitus, exocrine pancreatic insufficiency, intestinal parasitism, etc. Weight loss and low body condition can be due to cancer, diabetes mellitus, malnutrition, etc. Restlessness can be caused by pain, anxiety, pheochromocytoma, etc.

***PowerPage: Hyperthyroidism

Question 138

You are presented a 6-month male DSH for hypersalivation and tremoring. The owner applied an over the counter topical flea medication this morning when she found 2 fleas on him. She did not bring the box from the flea medication. How should you immediately treat the cat?

• Bath to wash off the medication, IV fluids, IV methocarbamol
• Warm water enema, IV fluids, IV diazepam
• Rinse off the topical medication and recommend flea collar only for ectoparasite control in the future
• IV dextrose to correct a likely hypoglycemia caused from the medication
• Rinse mouth out, activated charcoal

Answer 138

Answer: Bath to wash off the medication, IV fluids, IV methocarbamol

Explanation
This cat is apparently suffering from Pyrethin toxicity. Many cats are sensitive to flea medications, especially some over the counter varieties. The medication should be quickly washed off with a bath. The mouth should also be carefully rinsed depending on the status of the cat if ingestion is suspected. This often happens with cats that groom then lick the medication from the paws. IV catheter and fluids should be started immediately.

Methocarbamol, a muscle relaxant, is the first best choice to stop the tremoring. If this is unsuccessful, valium can also be used, and if active seizures are occurring should be given immediately. Phenobarbital or Propofol drip can be given if seizures are refractory.

It is not likely that this medication has caused a hypoglycemia and dextrose is not indicated. A warm water enema would not be helpful as the toxicity is not occurring due to absorption of medication from the cat’s colon. Rinsing the mouth and activated charcoal may be indicated, but the initial treatments to stabilize the cat with the bath, fluids, and muscle relaxant are more critical on presentation.

Flea collars are often ineffective and many cats are sensitive to these as well. If the owner would like flea control, a veterinarian prescribed medication would be advised. Good choices for flea control include feline
Frontline or Revolution.

Question 139

Which is not a clinical sign of Horner’s syndrome?

• Enophthalmos
• Ptosis
• Miosis
• Prolapsed third eyelid
• Conjunctivitis

Answer 139

Answer: Conjunctivitis

Explanation
The correct answer is conjunctivitis. Horner’s syndrome is caused by disruption of the sympathetic trunk. The prolapsed third eyelid occurs as a result of enophthalmos.

***PowerLecture: Spinal Cord Localization

Question 140

Which is not a clinical sign of Horner’s syndrome?

• Enophthalmos
• Ptosis
• Miosis
• Prolapsed third eyelid
• Conjunctivitis

Answer 140

Answer: Conjunctivitis

Explanation
The correct answer is conjunctivitis. Horner’s syndrome is caused by disruption of the sympathetic trunk. The prolapsed third eyelid occurs as a result of enophthalmos.

***PowerLecture: Spinal Cord Localization

Question 141

Which of the following is not a common sequela of hypertrophic cardiomyopathy in cats?

• Left heart failure
• Systolic anterior motion of the mitral valve
• Thromboembolism
• Right heart failure

Answer 141

Answer: Right heart failure

Explanation
The correct answer is right heart failure. HCM in cats usually only affects the left heart. Thromboemboli occur due to stasis of blood in the dilated left atrium. Left heart failure occurs as the left ventricle becomes stiffer, and blood backs up into the pulmonary vasculature. Systolic anterior motion of the mitral valve occurs when the anterior leaflet of the mitral valve blocks the left ventricular outflow tract during systole due to thickening of the ventricle wall and displacement of the valve leaflet.

Question 142

Which of the following is caused by taurine deficiency in cats?

• Cataracts
• Retinal degeneration
• Anterior uveitis
• Iris atrophy
• Glaucoma

Answer 142

Answer: Retinal degeneration

Explanation
The correct answer is retinal degeneration. Taurine deficiency in cats causes retinal degeneration as well as dilated cardiomyopathy. Since most commercial cat diets have adequate taurine supplementation, it is now rare to see this occurrence unless the cat is on a home-cooked diet.

Question 143

A 12-year-old female spayed Siamese cat presents for weight loss and progressive vomiting of 2 months duration. On physical exam, the intestines feel diffusely thickened and the cat has a body condition score of 2/9. Blood work shows a low albumin of 1.9 g/dL (normal 2.4-3.9 g/dL), and normal kidney and thyroid values. Abdominal ultrasound confirms the diffusely thickened intestines. There are also several mildly prominent and hypoechoic mesenteric lymph nodes. You suspect the cat has cancer. What is the most appropriate treatment for the type of cancer you suspect in this patient?

• Cyclophosphamide, vincristine, doxorubicin, and prednisone
• Radiation therapy
• Carboplatin
• Chlorambucil and prednisolone
• Surgical resection

Answer 143

Answer: Chlorambucil and prednisolone

Explanation
The cat most likely has small cell or low-grade intestinal lymphoma based on the history and clinical findings.

This is considered an indolent or slowly progressive form of lymphoma and can be effectively treated with chlorambucil and prednisolone. This form of lymphoma is sometimes thought to develop from the progression of inflammatory bowel disease in cats. Chlorambucil is an oral alkylating agent that is usually well tolerated with few side effects. Many cats can live several years with this form of lymphoma and this treatment.

Cyclophosphamide, vincristine, doxorubicin, and prednisone are the drugs in a CHOP chemotherapy protocol used to treat dogs and cats (and people) with high grade or large cell lymphoma, which more commonly manifests as a large focal mass rather than diffusely thickened intestines.

Carboplatin is not known to be an effective chemo agent for low-grade lymphoma in cats.

Surgery and radiation therapy are not good treatment options due to the diffuse nature of the cancer.

Question 144

Which of the following is true of cats with hypertrophic cardiomyopathy?

• Hypertrophy of the cardiac muscle is usually precipitated by hypertension or aortic stenosis
• Affected cats are usually geriatric males older than 12 years of age
• Left ventricular hypertrophy results in poor diastolic filling and left atrial dilation
• Affected cats are predisposed to thromboemboli due to stasis of blood in the left ventricle

Answer 144

Answer: Left ventricular hypertrophy results in poor diastolic filling and left atrial dilation

Explanation
The correct answer is left ventricular hypertrophy results in poor diastolic filling and left atrial dilation. HCM is a primary cardiomyopathy that is not precipitated by factors such as hypertension or aortic stenosis. Cats affected with HCM are usually diagnosed at a young to middle age, not when they are geriatric.

Thromboembolism is a common result of HCM, but it is due to thrombus formation in the static blood of the dilated left atrium, not from the left ventricle.

Question 145

Which of the following feline behaviors would be reduced the most by castration?

• Cat-human aggression
• Roaming behavior
• Urine marking
• Male-female aggression
• Inter-male aggression

Answer 145

Answer: Roaming behavior

Explanation
Castration has been shown to reduce roaming behavior by 90% in cats, inter-male aggression by 60% and urine marking by 50%. Castration would have minimal to no effect on male-female and cat-human aggression.

Question 146

Suzie-Q, a 6-month old female spayed domestic short hair was recently adopted from the humane society. She has had watery diarrhea since adoption. Her fecal float and Giardia ELISA tests were negative. She was treated with metronidazole with no clinical improvement. You soak a cotton tip swab with saline and swab the rectum. You see elongated motile oval shaped protozoan organisms that do not look like Giardia lamblia. What organism might this be and what is the appropriate therapy?

• Tritrichomonas foetus, Ronidazole
• Taenia taeniaformis, Praziquantel
• Enterobius vermicularis, Fenbendazole
• Cryptosporidium, Clindamycin
• Paragonimus kellicotti, Praziquantel
• Giardia intestinalis, Fenbendazole

Answer 146

Answer: Tritrichomonas foetus, Ronidazole

Explanation
Tritrichomonas foetus is a flagellated parasite most commonly found in kittens that have had an unresponsive diarrhea. The parasite can be very difficult to diagnose. It is most often responsive to Ronidazole.

Paragonimus is a lung fluke. The eggs are typically passed in the feces. Fenbendazole and Praziquantel have been effective against this parasite.

Giardia is unlikely if the ELISA is negative as it is a very sensitive test.

Taenia is a tapeworm and is not a flagellated parasite. It is treated with Praziquantel.

Cryptosporidium is a coccidian that invades the small intestinal villi after ingestion of infected oocysts. It can be diagnosed with PCR. It is treated with clindamycin, azithromycin, or tylosin most commonly. It is usually an opportunist, so evaluation for underlying disease is appropriate.

Enterobius vermicularis, or pinworm, is a parasite of people and primates but not cats and dogs.

Question 147

The patient imaged below has a very rare condition known as Ehlers-Danlos syndrome. What is the primary etiology of this condition?

• Defect in collagen production
• Excessive uric acid deposition between collagen fibrils
• Defect in the stratum corneum
• Elevated cortisol levels

Answer 147

Answer: Defect in collagen production

Explanation
Ehlers-Danlos syndrome is a hereditary condition in which a defect in collagen production results in abnormal Type | collagen. This renders the skin very pliable, thin, and susceptible to trauma. Patients with this condition should not be bred. Treatment consists of appropriate housing and lifestyle modifications and prompt treatment of secondary infections. Cats with hyperadrenocorticism may develop a similar skin fragility syndrome, which as the name implies, results in a very thin, easily damaged, friable skin. Uric acid deposition within joints is known as gout. There is no known condition in which deposition in skin associated collagen causes these clinical signs.

Question 148

Tommy, a 4-year old male neutered domestic short hair, presents to you for frequent urination. Urinalysis reveals 4+ struvite crystals. An abdominal radiograph shows a 1 cm round calculus in the bladder. Tommy does not have a urethral blockage, and urine culture is negative. The owner says surgery to remove this stone is not an option due to finances. Which of the following would be the most important treatment for Tommy?

• Acidifying diet
• Metacam
• Alkalinizing diet
• Clavamox
• Potassium citrate

Answer 148

Answer: Acidifying diet

Explanation
This cat most likely has a struvite bladder stone. This cannot be determined without a stone analysis, but based on the signalment of the patient, the crystalluria, and the radiograph, this is the most likely type. These types of stones typically form in urine with a high pH. Therefore, an acidifying diet would be appropriate for stone dissolution.

Calcium oxalate stones are the most common type of stone to form in acidic urine. For this type, an alkalinizing diet would be the most appropriate.

Clavamox would only be indicated if this cat had a urinary tract infection sensitive to this antibiotic. This cat had a negative urine culture.

Metacam can be used short-term to help with pain and inflammation associated with the cystitis from this condition but unfortunately Metacam is no longer recommend for use in cats in the United States.
Potassium citrate is a supplement that can be given in addition to an alkalinizing diet to prevent the formation of calcium oxalate stones. This would be contraindicated in this case.

Question 149

You confirmed chylous pleural effusion in your feline patient and referred to a specialist. The owner wants to discuss treatment options with you. The cat has had an extensive workup and no underlying cause has been found. Medical management has been tried for the last 3 months to no avail. The cat has been on a low fat diet and Rutin with intermittent thoracocentesis when needed. Which of the following treatments would be the best option and be most likely to resolve the effusion?

• Chemotherapy
• Ligation of thoracic duct and pericardectomy
• Vitamin E and milk thistle supplementation
• Place a chest tube to keep drained consistently for 1 week and this should resolve the fluid
• Somatostatin

Answer 149

Answer: Ligation of thoracic duct and pericardectomy

Explanation
Surgery is the treatment of choice if medical therapy is failing. The best chance for resolution of a chylous effusion is ligating the thoracic duct and pericardectomy. Even with surgery, the effusion can still continue but this is the best chance for a cure.

Somatostatin is a naturally occurring substance in gastric, pancreatic, and biliary secretions. In recent years, analogues of somatostatin have been used to successfully treat chylothorax in humans. The mechanism by which non-traumatic chylothorax may benefit from this treatment is unclear; however, resolution of pleural fluid (chyle and postoperative serosanguineous effusion) in both dogs and cats has occurred after administration of octreotide (somatostatin). It is extremely expensive and not as likely to cure the effusion as surgery would.

Vitamin E and milk thistle supplements are sometimes used in cases of liver disease but not indicated for chylous effusion.

Despite chest tube placement to keep the fluid drained, the effusion will continue to occur because the drain does not stop the fluid from being produced.

Chemotherapy would not be indicated in a case of idiopathic chylous effusion.

Question 150

A 14 year-old indoor/outdoor female spayed domestic short hair presents to your clinic with weight loss and lethargy.
On physical examination the cat is cachexic with an unkempt coat. No other abnormalities are noted on exam. You perform a complete blood count, biochemistry profile, urinalysis and total T4. The only significant abnormality on the laboratory work is 2+ protein in the urine. What is your next diagnostic step?

• Urine culture and sensitivity
• Fecal test
• Chest radiographs and abdominal ultrasound
• Renal biopsy
• Urine protein: creatinine ratio and Retroviral test

Answer 150

Answer: Urine protein: creatinine ratio and Retroviral test

Explanation
This cat likely has protein-losing nephropathy (PLN). PLN is less common in cats than in dogs but does occur, especially in conjunction with Feline Immunodeficiency Virus (FIV) infections. With a quiet urine sediment and elevated protein level your next step should be a urine protein:creatinine ratio (UPC) to determine if the proteinuria is real. With any sick indoor/outdoor cat a retroviral test to determine FeLV/FIV status is indicated.

Other causes of PLN include glomerulonephritis, amyloidosis, and inflammatory conditions such as pyelonephritis. None of the other diagnostic options are wrong, but you would first want to confirm the proteinuria before pursuing a work-up for that specific finding.

Question 151

Your colleague is preparing to perform a punch biopsy of a dermal mass in a cat under local anesthesia. He adds epinephrine to his lidocaine before administering the local anesthetic. What is the rationale for adding epinephrine?

• Epinephrine acts as a pharmacologic antagonist to the systemic effects of lidocaine, which cats can be particularly sensitive to
• Epinephrine neutralizes the acidic pH of lidocaine, decreasing the pain on injection
• Epinephrine allows the lidocaine to be more rapidly cleared
• Epinephrine prolongs the duration of lidocaine’s effects
• Epinephrine, when given by this route, has a sedative effect on cats

Answer 151

Answer: Epinephrine prolongs the duration of lidocaine’s effects

Explanation
Epinephrine is used with lidocaine to cause local vasoconstriction, preventing rapid systemic absorption. This is typically done to prolong the duration of local anesthetic effects of lidocaine by maintaining it at the site. It can decrease systemic uptake and toxicity, but it is not a lidocaine antagonist.

Epinephrine does not neutralize the pH of lidocaine; sodium bicarbonate is sometimes added for this purpose.

Question 152

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?

• Fluconazole
• Doxycycline
• Clindamycin
• Thiamine
• Phenobarbital

Answer 152

Answer: Clindamycin

Explanation
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.

Question 153

Which of the following is not a common post-operative complication of thyroidectomy for hyperthyroidism in cats?

• Esophageal stricture
• Horner’s syndrome
• Laryngeal paralysis
• Hypocalcemia
• Hypothyroidism

Answer 153

Answer: Esophageal stricture

Explanation
The correct answer is esophageal stricture.
Esophageal stricture is not a common post-op complication of thyroidectomy. Hypocalcemia can occur due to damage or excision of the parathyroid glands. Horner’s syndrome occurs when the sympathetic trunk running through the neck is damaged. Laryngeal paralysis occurs with damage to the recurrent laryngeal nerve running through the neck. Hypothyroidism can occur secondary to removal of the affected thyroid gland or glands.

Question 154

What is the most appropriate way to initially manage a cat with pyothorax from a cat bite wound from several weeks ago after thoracocentesis?

• Place a thoracostomy tube, lavage three times daily with Lactated Ringer’s Solution, appropriate systemic antibiotic for 6 weeks
• Place a thoracostomy tube and place under continuous suction; lavage with an appropriate antibiotic every 6 hours
• Thoracotomy to explore for abscesses, then place thoracostomy tube and lavage twice daily with saline plus an antibiotic added to the lavage fluid
• Perform thoracocentesis whenever the cat becomes dyspneic or tachypneic, appropriate systemic antibiotics for 14 days

Answer 154

Answer: Place a thoracostomy tube, lavage three times daily with Lactated Ringer’s Solution, appropriate systemic antibiotic for 6 weeks

Explanation
The correct answer is to place a thoracostomy tube, lavage three times daily with LRS, appropriate systemic antibiotic for 6 weeks. If the cause of the pyothorax is identifiable, such as a foxtail, attempts should be made to treat that cause. In this instance, the initial wound is probably no longer visible or treatable. Aggressive management of these patients is necessary. Placement of a thoracostomy tube with continuous suction or intermittent aspiration is necessary. Lavage 2-4 times per day for 1 hour with an isotonic fluid should be performed. There is no advantage to adding antibiotics to the lavage fluid, although heparin is beneficial.

Systemic antibiotics based on culture and sensitivity should be administered for a minimum of 4-6 weeks. If there is no improvement in 3-4 days, surgery is indicated to explore for abscesses, foreign bodies, etc.
Pyothorax is an accumulation of pus in the pleural space. The fluid is classified as an exudate and the cells usually consist of neutrophils. If it is a bacterial pyothorax such as that from a cat bite, the neutrophils will be degenerate. Fungi and agents such as Actinomyces and Nocardia often cause exudates of non-degenerate neutrophils and macrophages. Reactive mesothelial cells are often seen in the effusion as well.

Question 155

You are presented with a cat that is coughing at home, and you perform a bronchoalveolar lavage (BAL) or endotracheal wash. Which cell type, when present in BAL or endotracheal wash cytology, is suggestive of feline asthma?

• Basophils
• Eosinophils
• Neutrophils
• Lymphocytes
• Monocytes

Answer 155

Answer: Eosinophils

Explanation
The diagnosis of feline asthma is based on lower airway cytology with an increased number or percent of eosinophils. The other cell types, especially neutrophils, can be found, but are not suggestive of asthma.

Bacterial infection should be ruled out with a culture of the BAL fluid. The treatment of feline asthma involves the use of corticosteroids and bronchodilators, along with evaluation of a thorough history for any environmental triggers of the immune system.

Question 156

Which of the following is not passed by passive contact and sharing of a litter box?

• Feline immuno deficiency virus
• Feline corona virus
• Feline panleukopenia
• Feline leukemia virus
• Feline herpes virus

Answer 156

Answer: Feline immuno deficiency virus

Explanation
The correct answer is feline immunodeficiency virus. The virus is shed in the saliva and is transmitted mainly through bites. The disease mostly affects older, outdoor male cats which have a higher likelihood of getting into fights and being bitten by other cats. Having the disease makes them immunosuppressed and more susceptible to infections. The remainder of the answer choices can be passed via passive contact.

Question 157

Which of the following feline behaviors would be reduced the most by castration?

• Male-female aggression
• Inter-male aggression
• Cat-human aggression
• Roaming behavior
• Urine marking

Answer 157

Answer: Roaming behavior

Explanation
Castration has been shown to reduce roaming behavior by 90% in cats, inter-male aggression by 60% and urine marking by 50%. Castration would have minimal to no effect on male-female and cat-human aggression.

Question 158

A 3-year old male neutered domestic shorthair cat who is extremely obese presents with hepatic lipidosis. His ALP is
520 U/L (0-45U/L) and his ALT is 305 U/L (25-97 U/L). He stopped eating when his owner left him in a kennel when he went out of town. You need to place a feeding tube in addition to his other treatments since the owner is unable to force feed him and give him medications. You know that nutrition is the mainstay of treatment of hepatic lipidosis. Where is the proper location to place his esophagostomy tube?

• Left paracostal region 2-3 cm caudal and parallel to the last rib
• Left side of neck
• Ventral region of the neck
• Right side of the neck
• An esophagostomy tube is not appropriate for this cat due to his obesity and risk of anesthetic

Answer 158

Answer: Left side of neck

Explanation
Esophagostomy tube placement is typically performed under general anesthesia. The patient is placed in right lateral recumbency and the left lateral and ventral cervical area is clipped and an aseptic preparation performed. The feeding tube is pre-measured from the site of placement to roughly the 12-13th rib. A curved hemostat or right-angled forceps is introduced through the mouth and into the proximal esophagus. Later, pressure is applied to press the tip of the forceps against the skin caudal to the ramus of the mandible. A stab incision is made through the skin and subcutaneous tissue over the tip of the forceps at the LEFT SIDE of the neck. The tip of the forceps is then pushed through the small stab incision. Some surgeons prefer to push the forceps through the esophagus and subcutaneous tissue to avoid trauma to the vessels and nerves on the side of the neck. With adequate lateral pressure of the forceps, these structures should be moved away from the tip of the forceps. The end of the feeding tube is grasped with the forceps and pulled into the esophagus and out the mouth. The tip of the feeding tube is then redirected into the esophagus and advanced digitally or with the forceps until it straightens out distal to the entry point into the esophagus. The feeding tube is then advanced to the marked position and secured using a Chinese finger trap pattern. A lateral thoracic radiograph is taken to assess placement of the feeding tube into the distal esophagus and adjustments are made if necessary.

Esophagostomy tubes can be placed on the right side if necessary, however the esophagus is thought to be oriented more toward the left and therefore it is preferred to place the tube on the left.

An esophagostomy tube is appropriate for this cat if the cat is clinically stable enough to undergo a brief anesthetic. The other option would be a nasogastric feeding tube.

The left paracostal approach describes a gastrostomy feeding tube placement.

Question 159

Which cell type is least likely to be infected by feline immunodeficiency virus?

• Cytotoxic T-cell (CD8+)
• T helper (CD4+)
• B cell
• Platelet
• Macrophage

Answer 159

Answer: Platelet

Explanation
The correct answer is platelet. All are affected except for the platelet. After inoculation, replication occurs in lymphoid and salivary tissues.

Eventually, the virus spreads to mononuclear cells, while viremia is suppressed by the host immune response (asymptomatic carrier phase) that can last several years. A slow decline in the number of CD4+ cells is seen, resulting in failure of the immune system. Cats are often about 10-15 years old by the time this occurs.

Question 160

Which cell type is least likely to be infected by feline immunodeficiency virus?

• Cytotoxic T-cell (CD8+)
• T helper (CD4+)
• B cell
• Platelet
• Macrophage

Answer 160

Answer: Platelet

Explanation
The correct answer is platelet. All are affected except for the platelet. After inoculation, replication occurs in lymphoid and salivary tissues.

Eventually, the virus spreads to mononuclear cells, while viremia is suppressed by the host immune response (asymptomatic carrier phase) that can last several years. A slow decline in the number of CD4+ cells is seen, resulting in failure of the immune system. Cats are often about 10-15 years old by the time this occurs.

Question 161

A cat presents with a mid diaphyseal femoral fracture. The cat lives both indoors and outdoors and the owner is unsure of how the fracture occurred. Which repair method will result in the highest likelihood of failure?

• Limited contact dynamic compression plate with 6 cortices engaged in each fragment
• Type I External Fixation
• Intramedullary pin
• Interlocking nail

Answer 161

Answer: Intramedullary pin

Explanation
The least effective repair method of the choices listed is to place an intramedullary pin in a femoral fracture.
Intramedullary pins are strongest in bending but do not provide enough stability by themselves. They are great as an adjunct to a bone plate. Placing a Type I external fixator on a femur is acceptable, however many feel that the fixator pins result in substantial morbidity when going through the large musculature of the femur. A limited contact dynamic compression plate is an acceptable method of repair as well as an interlocking nail which would provide great strength in bending, limit axial motion, and limit rotational motion.

Question 162

A cat owner presents to you because her cat has been urinating outside of the litter box. Which of the following types of litter has been shown to be preferentially utilized by cats?

• Non-clumping clay litter
• Towels
• Silica (pearl) litter
• Clumping litter
• Shredded paper

Answer 162

Answer: Clumping litter

Explanation
There have been a couple of studies to evaluate this. The most commonly referred to is by Borchelt, 1991 that showed that unscented, finely particulate matter (“clumping” or “scoopable”) litter is preferred by most cats. A more recent study (Neilson, 2001) assessed newer silica litter products and found that cats preferred clumping litter.

Of course, individual cats may vary, and there may be other factors such as location or previous experiences that influence a cat’s litter preference.

Question 163

A 3-year old male DSH cat presents to your clinic for dyspnea. On physical exam the cat is febrile. You identify pleural effusion and obtain a sample. The fluid has a protein of 9 g/dL and is thick. The cellularity is low and the predominant cell type is neutrophils. What is your primary differential?

• Lymphoma
• Feline immunodeficiency virus
• Thymoma
• Feline infectious peritonitis
• Feline leukemia virus

Answer 163

Answer: Feline infectious peritonitis

Explanation
The correct answer is FIP. With FIP, the classical lesion is pyogranulomatous vasculitis due to antigen-antibody complexes depositing in the venular endothelium, which results in pleural and peritoneal effusion. Usually, the effusion has a high protein (5-12 g/dL) and is low in cellularity. The predominant cells are neutrophils. The fluid may be clear to yellow and contain fibrin clots. Given the low cellularity, neoplasia is lower on your list. FeLV and FIV do not usually present with pleural effusion.

***PowerPage: Feline Infectious Peritonitis and Enteric Coronavirus

Question 164

A 4-year old FS cat presents for its annual exam which is unremarkable. The owner complains about a chronic cough so you perform a CBC and chemistry panel.
HCT- 45% (30-45%)
WBC-10,500/ul (5,500-19,500/ul)
Neutrophils- 4,000/ul (2,500-12,500/ul)
Lymphocytes- 1,000ul (1,500-7,000/ul)
Monocytes- 500/ul (0-900/ul)
Eosinophils- 5000/ul (0-800/ul)
Na- 145 mEq/L (146-156 mEq/L)
K-4.1 mEq/L (3.7-6.1 mEq/L)
CI-115 mEq/L (115-130 mEq/L)
ALT-40 U/L (25-97 U/L)
AST-30 U/L (7-38 U/L)
Albumin- 2.8 g/dl (2.8-3.9 g/dl)
Globulin- 4.9 g/dl (2.6-5.1 g/dl)
BUN-16 mg/dl (19-34 mg/dl)
Creatinine- 1.1 mg/dl (0.9-2.2 mg/dl)
You perform a routine fecal flotation; an image from the fecal flotation is shown below. What is your diagnosis?

• Aelurostrongylus
• Capillaria
• Trichuris
• Paragonimus

Answer 164

Answer: Capillaria

Explanation
The correct answer is Capillaria. This is consistent with the clinical signs of cough. The peripheral eosinophilia could be caused by any of the parasites listed. Therefore, it is important to be able to recognize parasite eggs.

Capillaria ova, as seen in the image, look similar to Trichuris eggs but are smaller and have asymmetric terminal plugs. Most cases of Capillaria are asymptomatic but chronic cough may be seen. Paragonimus is found by fecal flotation and have a single operculum. Aelurostrongylus larvae are recovered by Baermann.

Question 165

An indoor only 6-year old female spayed domestic short haired cat presents in respiratory distress. The breathing pattern is rapid and shallow and there is no history of trauma. The owner reports she has been breathing more rapidly over the last week. You do not auscult any crackles or wheezes and the heart sounds normal. The lung fields are very quiet overall. You administer oxygen immediately. What should you do first?

• Tharacocentesis
• Perform a barium swallow radiographic study
• Furosemide injection
• Lateral and ventrodorsal radiograph

Answer 165

Answer: Thoracocentesis

Explanation
If a cat presents with rapid shallow breathing, quiet lung sounds, and a heart that auscults normally, pleural space disease, including effusion or pneumothorax, is the most likely cause of the breathing pattern.

Various types of pleural effusion include blood (hemothorax) which could result from trauma or coagulopathy, pus (pyothorax) which could be caused by a migrating foreign body or other infection in the pleural space, chyle (chylothorax) which occurs from unknown causes or a ruptured thoracic duct, other neoplastic effusions (such as lymphoma), or infection (such as FIP).

If the chest tap is positive, thoracocentesis should be completed in an attempt to stabilize the animal’s respiratory status before taking radiographs. The only case in which the fluid should not be removed is hemothorax, if an active bleed into the pleural space is suspected. Cytology and analysis of the fluid collected will be helpful in the diagnosis; it is not always possible to tell the cause of the effusion by gross observation.

In pets that are in distress, it is best to take a dorsoventral radiograph instead of a ventrodorsal view since placing them on their back can cause further distress and could potentially lead to respiratory arrest.

Cats in congestive heart failure may have crackles on auscultation and often have a heart murmur or gallop rhythm.

Diaphragmatic hernia typically has the same breathing pattern, but usually the lung sounds are not as quiet as they are with effusions.

A barium swallow would not be performed first in this case; stabilizing the patient always comes first. If a diaphragmatic hernia were suspected, the patient should be held upright to try and keep the abdominal organs from invading the chest cavity.

Question 166

A 1-year-old female indoor cat from Florida was presented for an after-hours emergency examination. Approximately 72 hours after spending the night locked out on the family’s screened-in porch, the cat developed acute severe facial pruritus and was presented for the lesions shown in the image below. Similar lesions were seen on the ear tips and paws; only thinly haired areas with dark hair were affected. The cat was otherwise healthy. Skin scrapings were negative. Impression smears of the nose revealed inflammatory exudates comprising approximately 75% eosinophils and lesser numbers of neutrophils, lymphocytes, and mast cells. Which of the following is the best diagnostic or treatment plan?

• Institute aggressive flea control
• Bacterial culture of lesions
• Confine the cat indoors for 5-7 days
• Dietary trial with novel protein source
• Intradermal skin testing for allergens

Answer 166

Answer: Confine the cat indoors for 5-7 days

Explanation
The history, onset, clinical appearance, as well as the cytologic and histologic findings are most consistent with insect bite hypersensitivity. There are other reasonable but less likely differentials including pemphigus foliaceus, food allergy or atopy, and dermatophytosis.

The best way to rule in/out the most likely diagnosis is to confine the cat indoors and see if the lesions resolve as none of the other differentials would be expected to respond. It would be premature to institute skin testing for allergies or a dietary trial for food allergy. Aggressive flea control is not a bad idea, but the lesion distribution is less likely for flea allergy dermatitis. Cats are very sensitive to several pesticides. Bacterial culture would likely result in growth of normal superficial bacteria and not indicate the underlying pathology.

It also may be necessary to initiate an anti-pruritic therapy to reduce further self-trauma by the cat.

Question 167

A 6-year old Somali cat was presented with a history of polyuria, polydipsia, weight loss, vomiting and lethargy (see image). The cat had not been eating well for the past 3 days.
Physical examination found the cat approximately 8% dehydrated and mentally depressed. There was evidence of weight loss. Thoracic and abdominal examination was unremarkable. The retinas were normal.
Initial laboratory data:
PCV - 55% (28-45%)
Total protein - 8.5 g/dl (6.0-7.9 g/dl)
BUN labstick - 50-80 mg/dl (19-34 mg/dl)
Glucose by labstick - 460 mg/dl (60-120 mg/dl)
Sodium - 165 mEq/L (146-156 mEq/L)
Potassium - 2.6 mEq/L (3.7-6.1 mEq/L)
venous pH - 7.2 (7.25-7.4)
Bicarbonate - 8 mEq/L (13-25 mEq/L)
Urinalysis:
Specific Gravity - 1.026
4+ glucose
2+ ketones
1+ protein
5 WBCs/hpf and intracellular cocci
Initial indirect blood pressure was 120/80 mmHg.
Which of the following two treatments are most important to the cat’s immediate recovery?

• Low protein diet and phosphorous binders
• Crystalloids and insulin
• Bicarbonate and ampicillin
• Calcium gluconate and colloids
• Enalapril and methimazole

Answer 167

Answer: Crystalloids and insulin

Explanation
You should recognize that this cat has many of the signs and findings of diabetic ketoacidosis.

Specifically, those signs in this case include PU/PD, anorexia, weight loss, azotemia, cystitis, dehydration, ketonuria, and hyperg lycemia.

The most important treatments for this cat are gradual correction of dehydration, typically with isotonic crystalloids such as lactated Ringer’s solution supplemented with potassium.

Concurrently with correction of dehydration, insulin therapy should be initiated with regular insulin at approximately 1 unit/kg/day with monitoring of blood glucose. This can be done with intermittent dosing or a continuous infusion of insulin. Parameters must be made in order to help determine if more or less insulin is needed.

Bicarbonate is useful in some cases but should only follow rehydration as overzealous bicarbonate therapy can lead to alkaline overshoot, hypokalemia, hypocalcemia, paradoxical CSF acidosis, hypernatremia, and hyperosmolality.

Ampicillin is a good antibiotic choice due to bactericidal activity against Gram-positive cocci and high urine concentrations pending urine culture and sensitivity results. It is not the most important treatment initially.

Question 168

Dolly, a 3-year old female spayed Siamese mix, presents with a history of weight loss over the last month. She is now vomiting occasionally and has a decreased appetite over the last 2 weeks. She has not eaten in the last 2 days. She is current on vaccines. Temperature is 103.7 F (39.8 C). You can palpate an abdominal mass effect in the mid to caudal abdomen. You believe the cat has a foreign body and are concerned about a possible intestinal perforation. Abdominal tap is negative. Pre-anesthetic bloodwork shows neutrophils 25,000 /ul (2,500-12,500/ul), bands 3,000 /ul (0-300/ul), globulins 6.9 g/dL (2.6-5.1 g/dl). Your x-ray machine is not working today and you recommend an abdominal exploratory. Upon exploratory, the intestines are severely hyperemic and the mesenteric lymph nodes are greatly enlarged. You cannot find a foreign body and no perforations are seen. There is a small amount of yellow tinged sticky ascites. What do you do?

• Start the cat on prednisolone and hypoallergenic diet for severe inflammatory bowel disease
• Euthanize the cat on the table since you are unable to reach the owner over the phone about the poor prognosis
• Perform a fecal flotation and start sulfadimethoxine for a severe coccidial infection
• Biopsy the lymph node and intestine and discuss a poor prognosis with the owner
• Refer to an oncologist for work up of gastrointestinal lymphoma

Answer 168

Answer: Biopsy the lymph node and intestine and discuss a poor prognosis with the owner

Explanation
This cat most likely has Feline Infectious Peritonitis, or FIP, which is caused by a mutation of a feline corona virus. Fever, weight loss, and gastrointestinal symptoms are the most frequent presentation. However, this virus may attack multiple organs and can be difficult to diagnose; the only definitive way to diagnose this disease is via histopathology. Clinical symptoms, blood results, and corona virus titers can all be used in combination to help aid in the suspected diagnosis of FIP. Unfortunately, there is no cure for this disease and it is currently considered a fatal disease.

Due to this cat’s declining and critical health and strong evidence to support the diagnosis of FIP, euthanasia may be the most humane option. If the owner cannot be reached, however, it is the best option to go ahead and take biopsies while you are in surgery and then discuss the prognosis and differentials in detail when you can reach the owner. An animal should not be euthanized without owner consent.
Inflammatory bowel disease should not cause ascites and fever.

Parasites can lead to ascites, but typically would not cause the elevations of white blood cells and globulins with fever.

While lymphoma may be a possibility, it is less likely in this young cat. The biopsies would help to differentiate.

Question 169

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?

• Mycoplasma
• Calicivirus
• Chlamydophila felis
• Herpesvirus

Answer 169

Answer: Chlamydophila felis

Explanation
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.

Question 170

A two-year old, castrated male, outdoor mixed-breed cat presented because he would posture to urinate and could not pass urine. The owners reported that the cat had vomited yellow foam twice in the last 2 hours. He had not eaten since he fell from the top of the refrigerator about 12 hours ago. Physical examination revealed a temperature of 97.8 F (36.6 C), weak femoral pulses and HR 140 bpm. The cat was estimated to be 8% dehydrated. There was a large subcutanous hematoma throughout the inguinal and perineal area (see image).
Urethral catheterization was unsuccessful. The urinary bladder was palpable, approximately half full with fluid.
Radiographic examination of the abdomen found good abdominal contrast and a fluid-filled urinary bladder.
Initial blood tests found:
BUN -120 mg/dl (19-34 mg/dl)
Creatinine - 8.0 mg/dl (0.9-2.2 mg/dl)
K+ - 8.0 mEq/ (3.7-6.1 mEq/L)
Na+ - 145 mEq/ (146-156 mEq/L)
Venous blood gas: pH- 7.15 (7.25-7.4)
HCO3-12 mmHg (17-24 mmHg)
PCO2 - 45 mmHg (29-42 mmHg)
Which of the following additional diagnostic tests are all indicated?

• Abdominal ultrasound, reticulocyte count, platelet count
• Arterial blood pressure, urine culture, serum protein electrophoresis
• Intravenous pyelogram, urinalysis, bile acids levels
• Thoracic radiographs, blood glucose levels, thyroid hormone levels
• Electrocardiogram, retrograde urethrogram, coagulation panel

Answer 170

Answer: Electrocardiogram, retrograde urethrogram, coagulation panel

Explanation
The cat’s inability to urinate, severe azotemia, hyperkalemia and metabolic acidosis suggest a post-renal urinary tract obstruction. The retained urine in the bladder and unsuccessful catheterization as well as inguinal and perineal hematomas suggest urethral blockage or rupture rather than a bladder problem.

An electrocardiogram is indicated based on the cat’s hyperkalemia and bradycardia to assess for arrhythmias. If present, the cat could be treated with either calcium gluconate or with regular insulin followed by glucose. Arterial blood pressure measurement is valid consideration as well.

A retrograde urethrogram with water soluble contrast media would outline a urethral stricture, rupture or blockage. If this does not reveal an abnormality, an intravenous pyelogram would highlight the urinary tract bilaterally. An ultrasound would direct further investigation into the kidneys, urinary bladder and other abdominal organs.

Assessment of the cat’s coagulation profile is indicated due to the skin hematoma.

There is no indication in the cat’s findings for a reticulocyte count, bile acids levels, thyroid hormone levels, or serum-protein electrophoresis.

Question 171

What is the strongest indication for a blood transfusion in a cat?

• Acute blood loss with PCV of 15
• Chronic blood loss with PCV 15
• Chronic blood loss with PCV 27
• Acute blood loss with PCV of 22

Answer 171

Answer: Acute blood loss with PCV of 15

Explanation
The correct answer is an acute blood loss with a PCV of 15. Usually, a blood transfusion is indicated in a dog or cat with a PCV of less than 20.

However, an animal with chronic blood loss will have compensated and adapted to the state of anemia and is not as critical. An animal that undergoes acute blood loss is much more critical as they have not had an opportunity to compensate.

Question 172

A 2-year old MN DSH presents for anorexia and vomiting of 2 days duration. Physical examination reveals the cat is dehydrated, but otherwise no abnormalities are noted.
Bloodwork shows the following: BUN 55 mg/dl (19-34 mg/dl), creatinine 3.8 mg/dl (0.9-2.2 mg/dl), sodium 135 mEq/L (146-156 mEq/L), potassium 3.1 mEq/L (3.7-6.1
mEq/L), chloride 85 mEq/L (115-130 mEq/L), TCO2 38
(13-21 mEq/L), HCT 60% (30-45 %). Urinalysis: USG
1.058 (>1.035), negative sediment.
You started the cat on 0.9% NaCl IV to treat the dehydration. Based on this history and blood results, what is your top differential diagnosis?

• Hypoadrenocorticism
• Upper gastrointestinal obstruction
• Urethral blockage
• Acute renal failure
• Renal lymphoma

Answer 172

Answer: Upper gastrointestinal obstruction

Explanation
Because of this cat’s history and blood results, an upper Gl obstruction is highly suspected.

Hypochloremic metabolic alkalosis is a classic finding in a pet with an upper Gl obstruction and should be ruled out first, especially in a young cat with these clinical signs.

Acute renal failure is unlikely since the azotemia appears to be pre-renal (the urine is hyperconcentrated due to dehydration).

Hypoadrenocorticism, or Addison’s disease, is very unlikely in a cat. In a pet with Addison’s, the most common electrolyte finding would be an elevated potassium level.

A urethral obstruction would likely cause a post-renal azotemia and hyperkalemia. On physical examination, a large and painful bladder would be palpated. A cat having urethral obstruction going on for this period of time would be very critical and have other clinical signs.

Renal lymphoma would be a potential cause of acute renal failure which is unlikely in this young cat with a pre-renal azotemia.

Question 173

A longtime client has come in with a new cat for evaluation of pruritis. The pet was rescued off the streets just a few days ago and now the owner has become slightly itchy. On examination the coat is noted to be dry with small areas of alopecia. The ears and neck region appear to be the most severely affected. The owner is concerned she has become infected with whatever is affecting her new cat. Based on your findings, what will you tell the owner?

• From what I have found, the cause of your itchy skin is not associated with your new cat
• You will need to treat all dogs and cats within the household
• The organism identified is resistant to most insecticides but does respond to ivermectin
• Both you and your cat are likely affected with the same organism and I recommend you seek professional help to help resolve your probable infection

Answer 173

Answer: From what I have found, the cause of your itchy skin is not associated with your new cat

Explanation
The image illustrates a louse. Fortunately, lice are host specific and therefore are not considered zoonotic. They spend their entire life-cycle, which is approximately 21 days, on the host. Lice will lay their eggs (nits) on hair shafts which may be identified as white flakes on the hair shafts. There are two types of lice, Anoplura (sucking louse) and Mallophaga (biting louse).

Interestingly, lice are very susceptible to most insecticides (selamectin, ivermectin, imidacloprid, pyrethrin spray, fipronil, lime sulfur dip, etc.) It is recommended that treatment be repeated 10-14 days after the initial treatment to eliminate any nits that may have hatched after the first treatment. Another good idea is to clean any bedding and the environment and treat all animals of the same species in the household.

Question 174

A cat presents with dyspnea and coughing. On a routine blood smear you find a Dirofilaria immitis microfilaria. How would you treat this cat?

• Ivermectin
• Melarsomine
• Thiacetarsamide
• Surgical removal
• Corticosteroids

Answer 174

Answer: Corticosteroids

Explanation
The correct answer is corticosteroids. Treating with any agent that is an adulticide may potentially result in embolization, release of antigen, and acute death, making this a controversial choice. Corticosteroids work well in reducing inflammation associated with infection and will help alleviate clinical signs. Cats are different than dogs in that heartworms cannot survive as long and the cats are sometimes able to eliminate the worm.

Surgical removal has been attempted but is not a common practice and may also result in acute death.

***PowerPage: Heartworm Disease

Question 175

A 1.5-year-old female Persian cat presents with dramatically enlarged mammary glands that the owner says have developed over several weeks. A brief ultrasound shows that the cat is not pregnant. What hormone is responsible for feline mammary hyperplasia (hypertrophy)?

• Estrogen
• Testosterone
• Prolactin
• Progesterone

Answer 175

Answer: Progesterone

Explanation
Feline mammary hyperplasia, or fibroadenomatous hyperplasia, is a benign, often drastic enlargement of the mammary glands typically seen in younger cats. This syndrome classically has a rapid onset and is seen in pregnant and non-pregnant, unspayed females. It is uncommonly seen in males and spayed females.
In cycling females, this condition is caused by hormonal stimulation from a functional ovary producing progesterone. Megesterol acetate is a synthetic progesterone that can cause this side effect.

It is generally treated by ovariohysterectomy. If the mammary gland has become severely infected or ulcerated, a mastectomy may be required.

Question 176

A cat presents with a nonspecific history of slightly decreased appetite, lethargy, and odd behavior. A leukogram shows the following values:
WBC 18,630 cells/ul (5,400-23,600/ul)
band neutrophils 100 cells/uL (0-300/ul)
segmented neutrophils 16,432 cells/uL (1,600-15,600/ul)
lymphocytes 1587 cells/uL (1,000-7,400/ul)
monocytes 352 cells/uL (0-700/ul) eosinophils 154 cells/uL (0-230/ul)
basophils 5 cells/uL (0-300/ul)
What is your interpretation of the leukogram?

• Degenerative left shift
• Infection
• Physiologic leukogram
• Normal
• Left shift

Answer 176

Answer: Physiologic leukogram

Explanation
A “physiologic leukogram” is from an epinephrine-mediated excitation response and is commonly seen in cats who get excited upon entering a veterinary clinic. You can see the classic mild neutrophilia along with normal to increased lymphocytes and no monocytosis. Although there are bands present in the blood work this is a normal amount according to reference levels provided, and is thereby not considered a left shift.

Question 177

A pregnant woman brings her cat to you to perform Toxoplasma gondii titers on it. The cat has no clinical signs. What would be appropriate to tell the woman?

• Cats seropositive for Toxoplasma gondii shed oocysts most of the time, so the woman should separate herself from the cat and its feces.
• Toxoplasma oocysts take about 5 days to sporulate and become infective, so as long as the woman has the cat’s litterbox cleaned before 5 days have passed, she should not have to worry about being infected.
• A single serum titer should be able to determine if the cat is likely shedding oocysts presently.
• A large percentage of cats are seropositive for Toxoplasma gondii, but are not necessarily shedding oocysts.

Answer 177

Answer: A large percentage of cats are seropositive for Toxoplasma gondii, but are not necessarily shedding oocysts.

Explanation
The correct answer is a large percentage of cats are seropositive for Toxoplasma gondii but are not necessarily shedding oocysts. Infected cats will usually only shed oocysts for 1-2 weeks when they are initially infected.

They usually don’t shed again unless they become severely immune-compromised. Paired serum titers should be taken 1-2 weeks apart in order to determine the stage of infection. A rise in the consecutive titers would mean the cat was recently infected. Titers that aren’t significantly different can be interpreted as the cat having an old infection and is less likely to be actively shedding oocysts. Infectivity of the oocysts occurs with sporulation, which occurs within 1-5 days after shedding.

Question 178

A 4-year old female Abyssinian cat presents to you with a complaint of weight loss and polyuria and polydipsia. On exam, the cat appears slightly underweight, but otherwise there are no significant findings.
You perform a complete blood count, chemistry panel, and urinalysis. The cat has a hematocrit of 27%, white blood cell count of 4,500/uL, and 350,000 platelets/uL. The chemistry panel shows Ca=10.5 mg/dL, P=3.5 mg/dL, bilirubin=0.l mg/dL, albumin=2.7 g/dL, globulin=2.7 g/dL, ALT=50 IU/L, glucose=104 mg/dL, BUN=59 mg/dL, Creatinine=3.8 mg/dL, and cholesterol= 120 mg/dL. Urinalysis shows a specific gravity of 1.010 with no bilirubin, glucose, or ketones detected and trace protein.
You measure systolic blood pressure of 160 mmHg. Abdominal ultrasound shows subjectively small kidneys with increased renal echogenicity.
Due to the cat’s young age and breed, you suspect an underlying hereditary condition to the cat’s renal disease. The owner reports that the breeder she obtained the cat from promised her that the line was free of any genetic disorders. You explain to the owner that a kidney biopsy may be the only way to rule in or out this hereditary disease. What specific test should you recommend on the biopsy sample?

• Immunoflourescent staining for immune complexes
• Trichrome staining for connective tissue
• Silver stain for type Ill collagen deposition
• Congo red staining for amyloid
• Hematoxylin and eosin staining for polycystic regions

Answer 178

Answer: Congo red staining for amyloid

Explanation
Of the many forms of amyloidosis, reactive (secondary) systemic amyloidosis is seen in the cat as a familial disorder of the Abyssinian, Siamese, and Oriental Shorthair. Amyloid deposition occurs most frequently in the kidney (Abyssinian) and liver (Siamese and Oriental Shorthair) although other sites can be affected. Clinical signs in the Abyssinian are typically those of chronic renal failure. Hypertension may be secondary to glomerulotublar disease.

Renal or liver biopsies can confirm the diagnosis but are often unnecessary due to the risk of hemorrhage, and there may only be minimal change to therapeutic decision making. Congo red staining of biopsy samples should be requested because hematoxylin and eosin staining do not always show amyloid deposits.

Therapy consists of general management of the renal failure, proteinuria, hepatopathy, and hypertension if they exist. There are reports of using dimethyl sulfoxide (DMSO) or colchicine for these cats as well.
Obviously, this cat should not be bred.

Question 179

A 12-year old cat presents with an abnormal gait and appears to be walking with the both hocks dropped down low to the ground. The owner says the cat has been losing weight and drinking a lot of water. What diagnostic test should you run?

• BUN and Creatinine
• Echocardiogram
• Blood glucose
• MRI of the brain

Answer 179

Answer: Blood glucose

Explanation
This cat is presenting with a plantigrade stance with the hocks dropped low to the ground. This finding is most often associated with a diabetic neuropathy. A blood glucose test is fast and inexpensive, and helps rule diabetes mellitus in or out. Additionally, a urinalysis to check for glucose and ketones would be appropriate. The urinalysis will be especially helpful when trying to differentiate between stress and diabetes. Most patients with stress hyperglycemia will not have glucose in the urine. Chronic unregulated diabetes often results in weight loss, polyuria and polydipsia, and can lead to this plantigrade stance. Chronic renal failure, which also causes weight loss and polyuria and polydipsia, does not cause the plantigrade stance. Cerebellar disease may result in ataxia, but the gait usually appears hypermetric or exaggerated and may have a sway to it.

Echocardiogram would be an appropriate choice if you were suspicious of a saddle thrombus. This is a clot in the aorta, which typically blocks off blood flow at the inguinal region and results in cold hindlimbs and loss of femoral pulses. The thrombus may affect one or both limbs depending on its location. This is most often associated with underlying cardiac disease, and, in this condition, the cat usually presents with dragging one or both hindlimbs. You will be unable to feel a femoral pulse in the affected limbs), and the affected limb(s) is/are often painful.

Question 180

A 12-year old cat presents with an abnormal gait and appears to be walking with the both hocks dropped down low to the ground. The owner says the cat has been losing weight and drinking a lot of water. What diagnostic test should you run?

• BUN and Creatinine
• Echocardiogram
• Blood glucose
• MRI of the brain

Answer 180

Answer: Blood glucose

Explanation
This cat is presenting with a plantigrade stance with the hocks dropped low to the ground. This finding is most often associated with a diabetic neuropathy. A blood glucose test is fast and inexpensive, and helps rule diabetes mellitus in or out. Additionally, a urinalysis to check for glucose and ketones would be appropriate. The urinalysis will be especially helpful when trying to differentiate between stress and diabetes. Most patients with stress hyperglycemia will not have glucose in the urine. Chronic unregulated diabetes often results in weight loss, polyuria and polydipsia, and can lead to this plantigrade stance. Chronic renal failure, which also causes weight loss and polyuria and polydipsia, does not cause the plantigrade stance. Cerebellar disease may result in ataxia, but the gait usually appears hypermetric or exaggerated and may have a sway to it.

Echocardiogram would be an appropriate choice if you were suspicious of a saddle thrombus. This is a clot in the aorta, which typically blocks off blood flow at the inguinal region and results in cold hindlimbs and loss of femoral pulses. The thrombus may affect one or both limbs depending on its location. This is most often associated with underlying cardiac disease, and, in this condition, the cat usually presents with dragging one or both hindlimbs. You will be unable to feel a femoral pulse in the affected limbs), and the affected limb(s) is/are often painful.

Question 181

Taurine deficiency in cats causes what abnormality in the eye?

• Anterior uveitis
• Progressive retinal atrophy
• Sudden acquired retinal degeneration
• Glaucoma
• Central retinal degeneration

Answer 181

Answer: ** Central retinal degeneration**

Explanation
The answer is central retinal degeneration. Cats with taurine deficiency can develop feline central retinal degeneration (FCRD) in addition to cardiomyopathy. This is because photoreceptors contain large amounts of taurine, and cats cannot synthesize it. The classic lesion is an elliptical area of tapetal hyperreflectivity starting in the area centralis dorsolateral to the optic disk that progresses to a horizontal band and eventually can involve the entire fundus.

Question 182

Which of these is not a round cell tumor that could be seen in a cat?

• Basal cell tumor
• Plasma cell tumor
• Lymphoma
• Mast cell tumor

Answer 182

Answer: Plasma cell tumor

Explanation
The answer is basal cell tumor. Basal cell tumors are epithelial tumors (epithelioma/carcinoma). The round cell tumors include lymphoma, mast cell tumor, plasma cell tumor, histiocytoma, transmissible venereal tumor, +/-melanoma and certain neuroendocrine tumors depending on which definition you are reading.

Question 183

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)?

• 2-3 days from the end of the current estrus
• 4-6 months from the end of the current estrus
• 7-9 months from the end of the current estrus
• 1-3 weeks from the end of the current estrus
• 2-3 months from the end of the current estrus

Answer 183

Answer: 1-3 weeks from the end of the current estrus

Explanation
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 GRH 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.

***PowerLecture: Estrous Cycle

Question 184

Which of the following is true regarding feline heartworm disease testing?

• A positive antigen test is diagnostic; a negative antigen test rules out infection
• A positive antibody test is diagnostic; a negative antibody test lowers your index of suspicion
• A positive antigen test is diagnostic; a negative antigen test is inconclusive
• A positive antibody test increases your index of suspicion; a negative antibody test rules out infection
• Antibody and antigen testing are not helpful in the diagnosis of feline heartworm

Answer 184

Answer: A positive antigen test is diagnostic; a negative antigen test is inconclusive

Explanation
An antigen test will be positive if there are female worms present. However, if there is an all male worm infection, you can have a false-negative test result.
The heartworm antibody test is prone to false-positive results because a positive test can result from a cat that has been exposed, but cleared the infection. A negative antibody test cannot absolutely rule out infection as some animals with a low worm burden may not mount a sufficient antibody response to be measured.
The antibody test and the antigen test in cats each have their pitfalls. When used together, they can be useful in many cases.

Question 185

A 5-year old female spayed domestic short haired cat presents for a right sided head tilt, vertical nystagmus, and circling to the right. Where is the lesion in this cat?

• Left central vestibular disease
• Right peripheral vestibular disease
• Right central vestibular disease
• Left peripheral vestibular disease

Answer 185

Answer: Right central vestibular disease

Explanation
The correct answer is right central vestibular disease. Vertical nystagmus is seen only in central vestibular disease. Head tilt and circling are usually toward the side of the lesion (unless the animal has paradoxical vestibular disease in which case the head tilt and circling is away from the lesion).

Question 186

A 6-year old domestic short hair cat presents for anorexia and lethargy. On physical examination, she has icteric mucous membranes. Bloodwork shows a markedly elevated GGT 28 (0-6 U/L) and ALP 170 (0-45 U/L). Which is the most likely diagnosis?

• Hepatic lipidosis
• Renal failure
• Cholangiohepatitis
• Hyperadrenocorticism

Answer 186

Answer: **

Explanation
The correct answer is cholangiohepatitis. Hepatic lipidosis is incorrect due to the elevated GGT, which usually stays normal in these cases. Renal failure is incorrect because it would not cause icterus or liver enzyme elevations. Hyperadrenocorticism is incorrect because it is not consistent with the clinical signs.

Cholangiohepatitis in cats can be due to ascending infection or immune-mediated damage to the liver and is commonly seen in conjunction with inflammatory bowel disease and/or pancreatitis.

Question 187

Which of the following is true about doxorubicin used in cats?

• It causes neurotoxicity
• It causes renal toxicity
• It causes sterile hemorrhagic cystitis
• It commonly causes heart failure

Answer 187

Answer: It causes renal toxicity

Explanation
In cats, doxorubicin does not cause clinical problems with the heart as commonly as it does in dogs. Its effects on the kidneys is generally thought to be more of a concern in cats. Sterile hemorrhagic cystitis is caused by cyclophosphamide in dogs, but not in cats. 5-fluorouracil causes neurotoxicity in cats and should never be used in cats.

Question 188

An owner calls concerned that her 2 month-old kitten vomited a worm. You just saw the kitten for an exam the week before and gave a dose of Pyrantel during the appointment. According to the owner, the worm looks like a piece of spaghetti. What course of action do you take for the most likely diagnosis?

• Famotidine every 24 hours for 3 days
• Metronidazole every 12 hours for 7 days
• Nothing; you already treated the kitten appropriately
• Continue dosing with Pyrantel every 3 weeks until the kitten is 3 to 4 months old
• Praziquantel once, then repeat in 3 weeks, then 3 months

Answer 188

Answer: Continue dosing with Pyrantel every 3 weeks until the kitten is 3 to 4 months old

Explanation
You would recommend to examine the worm and perform a fecal flotation for definitive diagnosis of the worm and to diagnose concurrent parasites. Most likely, based on the history and description, this patient is dealing with a Toxocara infection. Toxocara cati can be transmitted from queen to kitten via transmammary infection.

Environmental control is also extremely important as grooming is a common source of egg ingestion. Due to the life cycle of roundworms, it is important to continue to treat every 2-3 weeks until the patient is 3-4 months old. It is unlikely that a one-time treatment of Pyrantel will resolve the issue.

Question 189

You have been presented with a 3-year old cat that was supposed to have been spayed at about 6 months of age. The current owner got her as a spayed cat, but every few months the cat is acting like she is in heat. Which of the following would help to confirm an ovarian remnant in this cat?

• Elevated serum lutenizing hormone level
• Low serum progesterone level
• Vaginal cytology showing bacteria and white blood cells with a low number of cornified epithelial cells
• Abdominal ultrasound
• Vaginal cytology showing mostly cornified epithelial cells

Answer 189

Answer: Vaginal cytology showing mostly cornified epithelial cells

Explanation
The presence of cornified epithelial cells on a vaginal cytology swab helps to confirm that the cat is in estrus.
The swab should be taken during the time the cat is exhibiting the behavior. In a queen under the influence of estrogen, you should see greater than 90 percent superficial cells.

If an LH level (lutenizing hormone) is low, an ovarian remnant is likely. If it is high it does not rule it out.
Progesterone level is unlikely to be helpful because unless the cat ovulates, it will not rise.

Abdominal ultrasound is not usually helpful due to the small nature of a remnant and also because the remnant isn’t always located at the ovary; it can also have a piece transplanted into other tissue such as the liver or omentum and can be very difficult to find. It is best to try and diagnose with cytology and then via exploratory laparotomy.

Question 190

Which of these chemotherapeutic drugs cause fatal pulmonary edema in cats?

• 5-Fluoruracil
• Doxorubicin
• Cisplatin
• Vincristine
• Carboplatin

Answer 190

Answer: Cisplatin

Explanation
The correct answer is cisplatin. The famed statement, “cis-plat splats cats” is quite appropriate. 5-fluorouracil is also contraindicated for use in cats, but it is neurotoxic. Carboplatin, vincristine and doxorubicin are all used in cats.

Question 191

A 6-year old female spayed cat presents for a well circumscribed, raised, yellow-pink linear lesion on the caudal thigh. What is the most likely diagnosis?

• Mast cell tumor
• Deep pyoderma
• Cutaneous histiocytoma
• Eosinophilic granuloma
• Bronchoalveolar carcinoma

Answer 191

Answer: Eosinophilic granuloma

Explanation
The correct answer is eosinophilic granuloma. Eosinophilic granulomas or linear granulomas are usually linear in shape and pink-yellow in color. Typically, they don’t crust and are not usually pruritic. They are thought to be due to hypersensitivity and allergies to fleas, food, or inhalants. However, they are often idiopathic. Treatment is aimed at controlling the hypersensitivity. Antibiotics and corticosteroids are sometimes used. In cats younger than 1 year many spontaneously regress over 3-5 months.

Question 192

You have been presented with a 9-year-old female spayed domestic shorthair cat with a history of polyuria, polydipsia, and weight loss. She has been eating a dry cat food that the owner purchased at the grocery store, labeled for adult cats. The cat’s blood glucose is 400 mg/dL (normal is 60-125mg/dL) and she has 3+ glucosuria (normal is negative for glucose in urine), diagnostic for diabetes mellitus. You start the cat on insulin. What should you recommend for her diet?

• A low carbohydrate diet
• A low fat diet
• A high fat diet
• A low protein diet
• A high fiber diet

Answer 192

Answer: A low carbohydrate diet

Explanation
A low carbohydrate canned diet will help to improve glycemic control in a diabetic cat. It may even help to put the cat into diabetic remission for a period of time, where she will not require exogenous insulin. High fiber diets are helpful in the regulation of canine diabetes mellitus.

Question 193

A 14-year old cat presented with a sudden total loss of sight and obvious hyphema completely filling the left anterior chamber. There was no ocular pain and the right pupil remained dilated and nonresponsive. Fundoscopic examination of the left eye was not possible but the right fundus is shown. *What diagnostic tests are recommended to confirm the most likely underlying cause of this abnormality?

• Thoracic radiographs, serum ionized calcium levels, parathyroid hormone assay
• Abdominal ultrasound, pre- and post-prandial bile acids
• Intraocular pressure measurement, complete blood count, coagulation profile
• Systolic blood pressure measurement, serum chemistry panel, and thyroid hormone levels
• Blood glucose curve, serum fructosamine levels, urinalysis

Answer 193

Answer: Systolic blood pressure measurement, serum chemistry panel, and thyroid hormone levels

Explanation
This is an image of a retinal detachment. In a cat of this age, the most likely underlying cause or abnormality is hypertension, likely secondary to renal and/or thyroid disease. Therefore, the best answer choice is to measure systolic blood pressure, serum chemistry to assess renal values, and thyroid hormone levels to assess for hyperthyroidism.

Question 194

Most cats have type A blood. This makes transfusion of cats with type B blood potentially problematic. Which feline breeds are most likely to have type B blood?

• Siamese, domestic long hair
• Oriental Shorthair, Siamese
• Tonkinese, Oriental Shorthair
• British Shorthair, Devon Rex

Answer 194

Answer: British Shorthair, Devon Rex

Explanation
Besides the domestic short and long haired breeds, Tonkinese, Oriental Shorthairs and Siamese are typically blood type A.

Common B blood type breeds include British Shorthairs, Devon and Cornish Rex, Ragdolls, Scottish Fold,
Persians, and Himalayans.

Question 195

A 10-year old female spayed cat presents to your emergency clinic with an acute onset of coughing and dyspnea. On physical exam, you detect open mouthed breathing, a marked abdominal effort, and a respiratory rate of 54 breaths per minute. Her temperature is 102.7F (39.3 C), and her chest radiographs appear as below. What is the most appropriate next step for this cat?

• CBC, Chemistry panel, urinalysis and a heartworm test
• Parenteral ampicillin and enrofloxacin with supplemental oxygen
• Thoracocentesis to remove fluid from the pleural space
• Parenteral terbutaline with supplemental oxygen
• Thoracocentesis to remove air from the pleural space

Answer 195

Answer: Parenteral terbutaline with supplemental oxygen

Explanation
The correct answer is parenteral terbutaline with supplemental oxygen. The history, physical exam, and radiographs are consistent with a diagnosis of feline asthma. The radiographic findings in this case are a diffuse bronchial pattern consisting of airway thickening appearing as so called “tracks and doughnuts.”

Terbutaline is a beta-2 agonist that allows bronchial smooth muscle relaxation and along with oxygen, are two important aspects of the emergency management of a cat in acute respiratory distress from asthma. In reality, you probably should have administered these therapies prior to radiographs as the stress of handling a cat in acute respiratory distress can be dangerous. Along those lines, restraining this cat to pull blood is similarly contraindicated until she has been stabilized. Thoracocentesis for pleural effusion or pneumothorax are inappropriate, as this cat does not have either of those problems at this time.

Some of the “doughnuts” have been circled in orange. The bronchial pattern is diffuse throughout the lungs.
Radiographs provided by Adrien Hespel, DVM, MS, DACVR and University of Tennessee College of Veterinary Medicine

Question 196

What is the most common cause of cataracts in cats?

• Trauma
• Inherited
• Diabetes mellitus
• Anterior uveitis

Answer 196

Answer: Anterior Uveitis

Explanation
The correct answer is anterior uveitis. Anterior uveitis is the most common cause of cataracts in cats.

Possible causes of uveitis include idiopathic, primary ocular causes, trauma, infectious causes and manifestation of systemic diseases among other causes. Diabetes mellitus generally only causes cataracts in dogs. Inherited cataracts are also uncommon in cats and are seen more often in purebred dogs. Trauma is a potential cause of cataracts either through directly disrupting lens fibers or by causing uveitis, but it is not seen as frequently.

Question 197

A 6-year old domestic short hair cat presents for anorexia and lethargy. On physical examination, she has icteric mucous membranes. Bloodwork shows a markedly elevated GGT 28 (0-6 U/L) and ALP 170 (0-45 U/L). Which is the most likely diagnosis?

• Renal failure
• Hepatic lipidosis
• Cholangiohepatitis
• Hyperadrenocorticism

Answer 197

Answer: Cholangiohepatitis

Explanation
The correct answer is cholangiohepatitis. Hepatic lipidosis is incorrect due to the elevated GGT, which usually stays normal in these cases. Renal failure is incorrect because it would not cause icterus or liver enzyme elevations. Hyperadrenocorticism is incorrect because it is not consistent with the clinical signs.
Cholangiohepatitis in cats can be due to ascending infection or immune-mediated damage to the liver and is commonly seen in conjunction with inflammatory bowel disease and/or pancreatitis.

Question 198

A 3-year old male castrated DSH cat presents to you for pica. The owner reports that the cat chews and eats various fabrics including the owner’s garments. The owner reports that this behavior seemed to begin shortly after her daughter was born. As part of the treatment for the cat’s anxiety-related behavioral problems, you prescribe, clomipramine (Clomicalm), a tricyclic antidepressant (TCA). Which of the following is a list of potential side effects you should warn the cat’s owner about?

• Acute renal failure, constipation and lethargy
• Hepatic necrosis, coagulopathy and anorexia
• Dyspnea, cough, and lethargy
• Thrombocytopenia, fever, and anorexia
• Vomiting, constipation, and anorexia

Answer 198

Answer: Vomiting, constipation, and anorexia

Explanation
Side effects of clomiprimine include vomiting, constipation, decreased appetite or anorexia, dry mouth, tachycardia, arrythmia, and sedation.

Hepatic necrosis, respiratory signs, renal failure, thrombocytopenia, and fever are not thought to be significant side effects of the drug.

Question 199

When performing a perineal urethrostomy which nerve must you preserve?

• Pudendal nerve
• Ulnar nerve
• Hypogastric nerve
• Femoral nerve
• Sciatic nerve

Answer 199

Answer: Pudendal nerve

Explanation
The correct answer is pudendal nerve. This is the main nerve in the region of the surgery that is at risk of being severed. Severing the nerve could result in urinary incontinence due to loss of somatic innervation to the urethral sphincter. Just to review..the pudendal nerve will supply somatic innervation to the external sphincter of the bladder and also to striated muscle on the urethra. The hypogastric nerves are those responsible for sympathetic innervation and parasympathetic innervation is via the pelvic nerve.

Question 200

What is the classic lesion seen with feline infectious peritonitis?

• No classic lesion observed
• Vascular cuffing
• Pyogranulomatous vasculitis
• Cellular degeneration
• Negri bodies

Answer 200

Answer: Pyogranulomatous vasculitis

Explanation
The correct answer is pyogranulomatous vasculitis. Good job if you picked it. Pyogranulomatous vasculitis will occur due to the deposition of antigen-antibody complexes in the venular endothelium. Complement-mediated inflammation results in pleural and peritoneal effusion (wet form) and partial cell-mediated immune response results in slow viral replication with granuloma formation (dry form). Negri bodies may be seen with rabies. Cellular degeneration and vascular cuffing are seen with many disease processes.