Feline II Flashcards
This 2-year old domestic short haired cat presents for ocular pain and the changes seen in the photograph. The palpebral fissure of the left eye is larger than the right. What is the most likely diagnosis?
- Herpesvirus
- Anterior uveitis
- Glaucoma
- Chorioretinitis
Answer: Glaucoma
Explanation
The correct answer is glaucoma. Key features to note is that the eye is buphthalmic and painful. There is corneal edema present as is evident by the blue haze over the cornea. An appropriate next step would be to inspect the eye for aqueous flare and measure pressures.
A 10-year old female spayed calico has presented for further evaluation of a previously diagnosed mass in the neck region. The mass had been diagnosed as a thyroid adenocarcinoma and has now abscessed. Chest radiographs show a bronchial pattern with no obvious evidence of metastasis. Blood work shows a slightly decreased T3 and T4. Which of the following is a likely complication from this mass?
- Renal failure
- Horner’s syndrome
- Hypertrophic cardiomyopathy
- Hypercalcemia
Answer: Horner’s syndrome
Explanation
The correct answer is Horner’s syndrome. This is likely as a result of direct disruption of the sympathetic trunk traveling along the neck. Any time there is a neck mass present, it is important to evaluate the patient for the possibility of Horner’s syndrome. Additionally, disruption of the recurrent laryngeal nerve should be considered as this will result in laryngeal paralysis.
Hypercalcemia of malignancy is always a possibility with any mass; however, it is not reported commonly with thyroid adenocarcinomas in cats.
Hypertrophic cardiomyopathy can be a feature of hyperthyroidism, which is usually secondary to a thyroid adenoma. Based on this patient’s blood work, there is no evidence of hyperthyroidism.
Renal failure is not a reported complication.
Which of the following conditions frequently results in hypercalcemia in a cat?
- Administration of a fleet enema to a cat
- Intoxication with cholecalciferol based rodenticide
- Nutritional secondary hyperparathyroidism
- Ethylene glycol toxicosis
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.
A 3-year-old male intact cat presents with a progressive history of coughing for the past 3 months. The cat lives indoors and outdoors and is not on any medications. Blood work shows a moderately elevated neutrophil count with a mild lymphopenia. Chest radiographs demonstrate a moderate bronchointerstitial pattern. The owners consented to a laryngeal exam, bronchoscopy, and a transtracheal wash. The image below is from the transtracheal wash. What is this organism and what is the treatment for it?
- Aelurostrongylus abstrusus and ivermectin
- Strongylus endentatus and fenbendazole
- Spirocerca lupi and ivermectin
- Toxocara cati and fenbendazole
Answer: Aelurostrongylus abstrusus and ivermectin
Explanation
The feline lungworm in cats is Aelurostrongylus abstrusus. Treatment with ivermectin and fenbendazole have been reported to be successful.
Toxocara cati is a roundworm (ascarid) in which cats become infected by ingesting larvated eggs.
The life cycle is complicated and involves migration through the liver and lungs.
Eventually the larvae come up the mucociliary apparatus and are then swallowed where they develop in the small intestine. Eggs can readily be found in the feces, while adults can be visualized within the small intestine. Clinical signs in the kittens include poor body condition and a pot-bellied appearance.
Vomiting may also be present. Diagnosis is best made via a fecal flotation and a transtracheal wash is unlikely to be as rewarding. Treatment options include selemectin, fenbendazole, pyrantel pamoate, milbemycine oxime, and moxidectin. It has been recommended that all kittens be dewormed beginning at 2 weeks of age until they are approximately 8 weeks old, at which point they should be transitioned to a heartworm preventative that is also effective against ascarids.
Strongylus edentatus is one of the large strongyles of horses found in the large intestines. Treatment includes ivermectin, moxidectin, pyrantel, and fenbendazole.
Spirocerca lupi is an esophageal worm found in dogs. They are found in the esophageal, aortic, and gastric walls of dogs that have eaten infected dung beetles, chickens, reptiles, or rodents. Chronic infection may cause neoplastic transformation of the surrounding tissues into sarcomas or rupture and life-threatening hemorrhage of the aorta.
Treatment is with ivermectin or doramectin.
Which of the following is not a common reason for a hyperthyroid cat to have a T4 value in the normal range?
- Immune destruction of the thyroid gland causing a decrease of T4 into the normal range
- Concurrent disease causing euthyroid sick syndrome
- Mild disease in which there are subtle clinical signs and a T4 in the high normal range
- Fluctuation of T4 early on in the disease
Answer: Immune destruction of the thyroid gland causing a decrease of T4 into the normal range
Explanation
The correct answer is immune destruction of the thyroid gland causing a decrease of T4 into the normal range. Immune destruction of the thyroid gland occurs in hypothyroid dogs but does not typically occur in cats. Euthyroid sick syndrome occurs when concurrent illness causes T4 to decrease from being high down into the normal range, or from the normal range to below normal.
Fluctuations of T4 down into the normal range can occur early on in the disease.
Occult hyperthyroidism occurs when the T4 is in the high normal range and the clinical signs are mild. In these pets, a free T4 by equilibrium dialysis can make the diagnosis of hyperthyroidism.
A 1-year old female stray domestic short hair cat was presented for pruritus. Your physical exam revealed a generalized miliary dermatitis and dark brown flecks in the fur. Which of the following findings are most consistent with the most likely diagnosis?
- Mites found on ear swabbing, peripheral eosinophilia, anemia
- Anemia, peripheral eosinophilia, tapeworm infestation
- Yeast organisms found on impression smear
- Mites found on skin scraping, peripheral eosinophilia, and anemia
Answer: Anemia, peripheral eosinophilia, tapeworm infestation
Explanation
The correct answer is anemia, peripheral eosinophilia, tapeworm infestation. The cat has flea allergy dermatitis, which often manifests as a miliary dermatitis. Anemia occurs when there is a large burden of fleas feeding on the cat, peripheral eosinophilia is seen with allergies or parasite infestations, and tapeworms are transmitted by the ingestion of fleas carrying tapeworm eggs. The brown flecks in the fur found on physical exam are flea dirt, which are the feces of fleas after ingesting blood. (We know this a somewhat vague question, but we feel you need to get accustomed to these types of questions.
***PowerPage: Flea Allergy Dermatitis
A 16-year old, male-neutered cat comes in for further evaluation of intermittent vomiting and anorexia. The cat has a history of renal insufficiency and hyperthyroidism. Both of these are currently being managed well according to the owner. On physical exam the patient is found to be slightly lethargic and perhaps a little dehydrated. After performing blood work there is still no clear indication as to why the patient is not feeling well. The BUN was 42 mg/dl (19-34 mg/dl) and creatinine 2.0 mg/dl (0.9-2.2 mg/dl). The rest of the chemistry panel was unremarkable. The CBC showed a hematocrit of 25% (30-45%) which has been longstanding.
An abdominal ultrasound was performed and a mass associated with the pancreas was identified. The 2cm mass was at the mid-body of the right limb of the pancreas. Chest radiographs were subsequently performed and found to be within normal limits. The owners elected to take the cat for removal of this mass. Which post-operative concern is least likely?
- Renal values should be monitored closely for signs of acute on chronic renal failure
- Bilirubin levels should be monitored closely for signs of extrabiliary obstruction
- Patient should be monitored closely for increased vomiting and abdominal pain
- Hypoglycemia post-surgery, which needs close blood glucose monitoring
Answer: Hypoglycemia post-surgery, which needs close blood glucose monitoring
Explanation
When performing mass resections of the pancreas the ideal situation is a mass associated with the tail of the pancreas. Otherwise they can be very difficult to excise in their entirety and you run the risk of disrupting the flow of pancreatic enzymes into the duodenum. The pancreas is responsible for secreting insulin which is what stimulates glucose to be removed from the blood stream and taken into the cell. A patient with a mass in the pancreas that is causing hypoglycemia has an insulinoma (seen in dogs). Removal of an insulinoma can occasionally lead to hyperglycemia and diabetes mellitus requiring insulin administration in dogs, but there is no indication of an insulinoma based on the normal blood glucose level on the chemistry panel indicated in the question.
Manipulation of the pancreas can result in pancreatitis and if the inflammation is severe enough an extrahepatic biliary obstruction could occur and result in elevated bilirubin levels. Extrahepatic billiary obstructions secondary to pancreatitis can require surgical intervention. Clinical signs of pancreatitis will likely manifest themselves in the form of persistent abdominal pain and vomiting.
Since this patient has renal insufficiency it is important to monitor renal values closely. Remember that it takes about 75% of the kidneys to be damaged before the values go up so any elevation in renal values may be cause for alarm. This is particularly important if the patient was hypotensive during surgery and renal perfusion was potentially compromised
What breathing pattern is the hallmark of feline asthma?
- Labored breathing
- Expiratory push
- Restrictive breathing
- Obstructive breathing
Answer: **
Explanation
Asthma causes expiratory dyspnea, or a marked abdominal push seen on expiration with normal inspiration.
This occurs as a result of collapse of the lower airways during expiration. This occurs in asthmatics because negative intrathoracic pressure (exerted during expiration) can more easily cause collapse of the thickened and weak bronchial walls. This traps air inside the alveoli. During the next inspiratory cycle, there is decreased fresh air exchange and increasing hypoxemia.
Obstructive breathing is characterized by long slow inspirations and can be accompanied by stridor or stertor.
This occurs as a result of upper airway disease such as laryngeal paralysis, brachycephalic airway syndrome etc.
Restrictive breathing occurs as a result of pleural space disease and causes short, shallow and rapid breathing.
Labored breathing is a catch-all phrase to describe short rapid and deep breathing. This generally occurs with pulmonary parenchymal diseases such as pulmonary edema or pneumonia.
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
- Corticosteroids
- Thiacetarsamide
- Surgical removal
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
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?
- Hematoxylin and eosin staining for polycystic regions
- Trichrome staining for connective tissue
- Congo red staining for amyloid
- Silver stain for type Ill collagen deposition
- Immunoflourescent staining for immune complexes
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.
Krissy, a 10-year old female spayed Himalayan, has had chronic constipation problems over the last year and has been diagnosed with megacolon. Today she presents for vomiting and straining to defecate. She is currently taking Lactulose to help with her bowel movements. You palpate hard feces in the colon. You give her an enema and manually evacuate most of the hard stools. Which of the following medications could also be used to help treat and try to prevent this problem in the future?
- Metronidazole
- Omeprazole
- Prednisolone
- Sulfasalazine
- Cisapride
Answer: Cisapride
Explanation
There are five main treatment objectives for cats with megacolon. These include adequate hydration status, removal of impacted feces, laxative therapy, promotility agents for the colon, and dietary fiber.
This cat may benefit from Cisapride, which is a benzamide prokinetic drug. Due to the chronic stretching of the colon from the feces impactions, the colon can no longer move the feces out of the body in a normal way. This medication has anecdotally been shown to help cats evacuate feces more efficiently, especially in mild or moderate cases. Some cats may also benefit from a fiber source such as psyllium or canned pumpkin.
If the constipation problems continue despite the above mentioned treatments, colectomy should be considered.
Prednisolone is used sometimes in treating inflammatory bowel disease, but for megacolon is not indicated.
Metronidazole and Sulfasalazine are antibiotics sometimes used for diarrhea or inflammatory bowel disease.
Omeprazole is a proton pump inhibitor used for prevention of gastric ulcers and upper Gl disease and would not be helpful for megacolon.
What is the most common cause of Cat Scratch Disease in humans?
- Borrelia burgdorferi
- Bartonella quintana
- Bartonella henselae
- Clostridium perfringens
Answer: Bartonella henselae
Explanation
The correct answer is Bartonella henselae. Usually, you will see a papule at the site of inoculation followed by fever and local lymphadenopathy one week later. The lymphadenopathy will last months but is self-limiting.
Neat! Cats are generally asymptomatic. B. quintana is the cause of Trench Fever in humans, which is transmitted by the human louse. Borrelia burgdorferi is the causative agent of Lyme disease.
A woman presents a middle-aged male intact domestic short hair to your clinic. She found him as a stray where she lives out in the country. She noticed he was lethargic and hanging around her yard, so she was feeding him in order to capture him and bring him to the vet. She states there are many stray cats and prairie dogs around her property. On physical exam, the cat is lethargic, has a temperature of 104.9F (40.5 C), severe mandibular lymphadenopathy with a draining tract under the chin, and is covered in fleas. His breathing is tachypneic. What do you do first?
- Gram stain cytology of the draining tract lesion
- Run a CBC/Chemistry/Urinalysis, flush the abscess with dilute chlorhexidine solution, and start broad spectrum antibiotics
- Clean the abscess and send the cat home on a 3-week course of Doxycycline tablets followed with 6 cc of water
- Euthanize the cat immediately
- Wear protection and quarantine the animal, then call the state veterinarian
Answer: Wear protection and quarantine the animal, then call the state veterinarian
Explanation
This animal is exhibiting signs of plague caused by the bacteria Yersinia pestis. Plague is usually transmitted by the bites of infected fleas. Carnivores can also contract plague when they eat an infected rodent. Clinical symptoms can occur in 1-2 days in cats, but in humans, the incubation period can be up to 8 days.
A tentative diagnosis can be made with a Gram’s stain cytology of infected material, such as the draining lesion of this cat. Yersinia pestis is a gram negative bacterium and has a bipolar safety-pin appearance. Definitive diagnosis is based on culture. However, before collecting any samples, the state vet or CDC should be contacted. The samples have to be collected and submitted under strict guidelines to prevent the spread of disease.
Plague is highly zoonotic and bubonic, septicemic, pneumonic, and meningeal forms can occur. Early treatment is critical for survival. Antibiotic treatment early in the course of disease can greatly improve prognosis. Any persons exposed at all to this cat should seek treatment, including hospital staff, the owner, her family, etc.
Because of the cat’s clinical status, the most likely thing that will occur is euthanasia, but the state veterinarian will give instructions on how best to handle this animal.
Which of the following is incorrect concerning feline heartworm disease?
- Migration of larvae to ectopic regions (outside of the heart and pulmonary arteries) is less common than in dogs
- Cats typically have much lower adult worm burdens than dogs
- A negative microfilaria test does not rule out heartworm disease
- Antibody tests can detect the exposure of the host to both male and female worms
Answer: Migration of larvae to ectopic regions (outside of the heart and pulmonary arteries) is less common than in dogs
Explanation
Cats do typically have fewer adult worms than dogs because of increased natural resistance. Cats are often microfilaria negative despite an active infection (either from all male worm infections, or occult disease).
Antibody testing can detect exposure to both male and female worms; however, in cats, larvae are more likely to migrate to ectopic locations such as the brain, skin, and ocular tissue.
***PowerPage: Heartworm Disease
Mickey, a 2-year old male neutered Siamese, presents with a history of weight loss and vomiting occasionally. His blood work shows ALP 291 IU/L (0-45 IU/L) and ALT 272 IU/L (25-97 IU/L). Bile acids are mildly elevated with pre-prandial 3.9 umol/L (0-5 umol/L) and post-prandial 39 umol/L (0-15 umol/L). FeLV/FIV testing and toxoplasmosis titers are negative. Ultrasound was normal overall. You perform an exploratory laparotomy and take biopsies of the liver which is mildly yellow in color but normal in texture. The histopathology report shows non-suppurative moderate pleocellular lymphoplasmacytic periportal cholangiohepatitis. Cultures of the liver are negative. Which of the following therapies are the best treatment option?
- Metronidazole and chlorambucil
- L-carnitine, Vitamin E, and Vitamin K
- Pancreazyme powder and weekly cyanocobalamin injections
- Budesonide and metoclopramide
- Prednisolone, ursodiol
Answer: Prednisolone, ursodiol
Explanation
The biopsy results show cholangiohepatitis which is inflammation of the biliary system and liver parenchyma. It can be autoimmune in nature, or may be triggered by underlying infection or neoplasia.
Concurrent diseases often include pancreatitis and inflammatory bowel disease.
The main treatment of non-suppurative cholangiohepatitis is prednisolone since it is most often immune in origin. Ursodiol is often used for its immunomodulatory, hepatoprotectant, and antifibrotic effects. It helps with the flow of bile through the liver. Other helpful therapies include S-adenosylmethionine (SAMe) and Vitamin E.
Pancreazyme powder and vitamin B12 injections (cyanocobalamin) can be useful in chronic pancreatitis but would not be the best treatment for cholangiohepatitis.
Budesonide is a steroid that may be beneficial for inflammatory bowel disease but would likely not provide enough systemic anti-inflammatory effects for the liver disease.
Metronidazole or Clavamox are often used in conjunction with prednisolone if infection is suspected but is not the primary treatment for this disease. Antibiotics are more important in suppurative cases.
Chlorambucil is used as an immunosuppressant in refractory cases of cholangiohepatitis when the prednisolone is not enough to control the disease.
L-carnitine may be beneficial if hepatic lipidosis is a concurrent problem from the anorexia but is not a treatment for cholangiohepatitis. Vitamin E is a good antioxidant for the liver. Vitamin K may be used in cases of liver failure especially prior to surgery for liver biopsies.
The 1-year old female spayed Siamese cat in the picture shown below presents for ataxia and quiet mentation. On physical exam, the cat is quiet and responsive. She has a dome-shaped head and is ataxic when walking. Which of the following is a treatment option for the condition affecting this cat?
- Thiamin supplementation
- Phenobarbital
- Clindamycin
- Surgical closure of open fontanelle
- Furosemide
Answer: Furosemide
Explanation
The cat in the picture has hydrocephalus. The cause can be genetic, particularly in Siamese cats or due to exposure to toxins, such as griseofulvin during gestation or exposure to the feline panleukopenia virus during gestation.
Treatment is aimed at reducing the formation of CSF. Medical treatments include prednisolone, furosemide, oral carbonic anhydrase inhibitors, and surgical placement of a shunt from the ventricles of the brain into the peritoneal cavity. Anti-convulsant drugs may be recommended if seizures occur.
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
- 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
- You will need to treat all dogs and cats within the household
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.
A 6-year old cat is brought to your clinic after falling off of the owner’s balcony. The cat is stressed but alert with moderate bleeding noted around the mouth.
Temperature - 102.4 F, 39.1 C
Heart rate- 220 beats per minute, no murmurs or arrhythmias
Respiratory rate- 40 breaths per minute, all lung fields clear
Thoracic radiographs are unremarkable. You perform an oral exam and note the mandibular abnormality show in the photo. Which of the following treatment options is most appropriate once the cat is stable?
- Circummandibular cerclage wire placed caudal to canine teeth
- External fixator with 4 Kirschner wires
- Bone screw fixation across mandibular symphysis
- Tape muzzle and conservative therapy
- Intramedullary pin placement in the mandibular canal
Answer: Circummandibular cerclage wire placed caudal to canine teeth
Explanation
Separations of the mandibular symphysis are seen commonly with “high-rise syndrome” or when cats fall from heights because they frequently are able to rotate in mid-air, landing on all 4 feet to break the fall but often also landing with their lower jaw hitting the ground at the same time. This is sometimes referred to as a symphyseal fracture but it is not a true fracture as the mandibular symphysis never fully ossifies or fuses.
Symphyseal separation occurs with this type of trauma and right and left rami become distracted as is evident in the photo. The standard treatment is circummandibular cerclage wire placed caudal to the lower canine teeth with the wire tightened once the hemi-mandibles are aligned. A hypodermic needle is often used to guide placement of the wire.
A cat comes to your clinic non-weight bearing on the right rear leg. Radiographs reveal a large lytic and proliferative bone lesion affecting the proximal tibia. What do you advise the owner?
- If this is osteosarcoma, it is slow to metastasize in cats (unlike dogs) and some cats are cured with amputation
- This is most likely synovial cell sarcoma as it is the most common bone tumor in cats
- This is unlikely to be osteosarcoma, as it rarely affects the hind limbs in cats
Answer: If this is osteosarcoma, it is slow to metastasize in cats (unlike dogs) and some cats are cured with amputation
Explanation
Bone tumors are relatively rare in cats, but the most common bone tumor in cats is osteosarcoma. In cats, osteosarcomas are slow to metastasize so amputation in many cases can be curative. Osteosarcomas are most commonly found in the hind limbs in cats.
