Feline Flashcards
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: 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.
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: 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.
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
Cyptococcisis
Bacterial rhinitis
Answer: Cyptococcosis
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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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
Itis contaglousto other Cats
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.
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: 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.
Which of the following plants is potently nephrotoxic to cats?
Nasturtium
Stargazer lily
Poinsettia
Peace lily
Calla lily
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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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.
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: 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
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: 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.
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: 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.
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: 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.
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: Collagenolytic granuloma
Explanation
The image and description are most consistent with a collagenolytic granuloma. Feline eosinophilic granuloma complex consists of 3 separate clinical syndromes:
- 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.
- 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.
- 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.
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: 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.
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: 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
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: 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.
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: 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.
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: 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.
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: 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
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: 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
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: 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.
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: 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.
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: 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.
