FELINES Flashcards
Cats are evil
When performing a subtotal colectomy on a feline patient, what blood vessel limits the amount of colon that you are able to remove?
a. Pudendal artery
b. Caudal mesenteric artery
c. Ileocolic artery
d. Left colic artery
c. Ileocolic artery
The site for colonic resection is limited by tension on the ileocolic artery when trying to suture your new end of colon to the rectum. Sometimes the tension is too great and instead of a colocolic anastomosis, an ileocolic anastomosis must be performed. Essentially you are trying to connect a section of ascending colon to the rectum. Now that can be pretty far! Performing an ileocolic anastomosis is not ideal because you eliminate the ileocecal valve, and that may predispose the animal to bacterial overgrowth. The caudal mesenteric artery gives branches to the rectum and descending colon. The left colic artery also feeds the descending colon. The pudendal artery supplies the external genitalia. The ileocolic artery provides blood supply to the ascending and transverse colon.
An 11-yr-old male neutered domestic long-haired cat presented with hair loss on his ventral abdomen. Hairs are completely absent from the site and the skin exhibits a shiny luster. Which of the following organs is most likely affected?
a. Pancreas
b. Kidney
c. Heart
d. Small intestine
a. Pancreas
Alopecia of the ventral abdomen is a paraneoplastic syndrome and is considered a cutaneous marker of pancreatic carcinoma. In rare cases Diabetes and Cushing’s can also present similarly.
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?
a. Povidone-iodine scrub
b. Full body lyme sulfur dip, itraconazole
c. Doxycycline
d. Athlete’s foot cream (clotrimazole)
e. Lufenuron
b. 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 4-month old kitten arrives at your clinic with a 3-day history of anorexia, lethargy, vomiting, and diarrhea. On physical exam the cat is 5% dehydrated and has a temperature of 103.9F (39.9 C). What is your primary differential?
a. Feline infectious peritonitis
b. Feline panleukopenia virus
c. Foreign body
d. Feline immunodeficiency virus
b. Feline panleukopenia virus
These clinical signs most closely correlate with panleukopenia. One must piece together the signalment, history, and clinical findings. Usually a cat with a foreign body will not have diarrhea and a fever. It is unlikely for a 4-month old kitten to have FIV due to maternal antibody protection. It is also unlikely for FIP to present in such a manner. With the wet form of FIP, you may see dyspnea due to pleural effusion and abdominal distention due to ascites. With the dry form of FIP it will depend on the organ that is affected. You may see a hepatopathy, splenomegaly, renal failure, etc.
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?
a. Aelurostrongylus abstrusus and ivermectin
b. Strongylus endentatus and fenben dazole
c. Toxocara gati and fenbendazole
d. Spirocerca lupi and ivermectin
a. Aelurostrongylus abstrusus and ivermectin
The feline lungworm in cats is Aelurostrongylus abstrusus. Treatment with ivermectin and fenbendazole have been reported to be successful.
Toxocara gati 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 is not a clinical sign of Horner’s syndrome?
a. Ptosis
b. Enophthalmos
c. Conjunctivitis
d. Prolapsed third eyelid
e. Miosis
c. Conjunctivitis
Horner’s syndrome is caused by disruption of the sympathetic trunk. The prolapsed third eyelid occurs as a result of enophthalmos.
A 12-year old female spayed Himalayan cat presents to you for acute onset of left hind limb lameness after leaping off of the counter to the floor this morning. The cat is non-weight bearing and very painful around the left stifle. You take a radiograph (shown below). Which of the following conclusions can you make about the cat’s injury?
a. The cat has a bone tumor that will likely metastasize within 6 months if she is not given chemotherapy
b. This fracture could be reduced and surgically plated or would heal after 8 weeks with strict confinement with external coaptation
c. Strict rest appears to be all that is needed because the bony structures appear normal
d. A pathologic fracture occurred when the cat jumped off of the counter
d. A pathologic fracture occurred when the cat jumped off of the
There is marked osteolysis of the proximal tibia with a pathologic fracture. This fracture will not heal with either rest or with rigid fixation due to the presence of underlying disease that resulted in the osteolysis. The most likely cause is a tumor of the bone. In cats, unlike dogs, many bone tumors do not have a high metastatic rate and do not necessarily require adjunct chemotherapy although histopathology would be needed to confirm the tumor type and grade.
A client of yours calls you, concerned that she just found rice-like worms on the hind end of her 8 year-old, indoor-only cat. You think back fondly about how your professors told you not to describe lesions as food. You suspect tapeworms and recommend that the owner bring the cat in for an exam. What else are you expecting to find on physical exam?
a. Ear mites
b. Cachexia
c. Icterus
d. Ascites
e. Fleas/flea dirt
e. Fleas/flea dirt
Adult fleas contain the cysticercoid life stage of the common tapeworm Dipylidium caninum. As cats groom themselves, they ingest the adult flea; the tapeworm then develops into its adult form in the intestines. It is a common myth that cats won’t get fleas or intestinal parasites if they are indoors-only. While these patients are at a decreased risk, they still can become infected/infested with the right exposure.
A 2-year old indoor-outdoor female spayed domestic short hair cat presents to you for inappetance and vomiting. The cat vomits and the contents include several 3 cm long nematodes with spine-covered heads. You are able to identify the worms as Gnathostoma. Which of the following is true about these worms?
a. The life cycle involves a rodent intermediate host
b. The parasite is typically found in dry, dusty environments
c. Proper disposrsal of feces eliminates the threat of transmission to other animals
d. The life cycle involves a flea intermediate host
e. The parasite does not cause disease in humans
c. Proper disposrsal of feces eliminates the threat of transmission to other animals
The life cycle of Gnathostoma involves a small copepod intermediate host (similar to Dracunculus worms). Copepods are small crustaceans that are found in freshwater habitats (i.e. ponds). Eggs passed in the feces are not infectious unless first ingested by copepods so proper disposal of feces prevents transmission to other animals.
Adult worms live in the mucosa of the stomach and cause gastritis. They can also create nodules in the stomach which can ulcerate and lead to severe peritonitis. Human cases of gnathostoma usually occur from ingestion of undercooked fish or other animals and can cause gastritis or peritonitis. Larva may undergo cutaneous or neural migration (rare).
Control is typically achieved by preventing cats from hunting in areas where the parasite is found. It is thought that albendazole is effective against gnathostomiasis.
A 7-year old spayed DSH cat presents to your clinic with a history of chronic respiratory and ocular disease. You notice nasal discharge, facial swelling, and distortion of the nose (sort of like a “roman nose”). Additionally, there is moderate submandibular lymphadenopathy. Radiographs of the head reveal increased opacity and turbinate destruction. What is the diagnosis?
a. Blastomycosis
b. Coccidiodomycosis
c. Squamous cell carcinoma
d. Aspergillosis
e. Cryptococcosis
e. Cryptococcosis
The correct answer is cryptococcosis (Cryptococcus neoformans), a yeast-like fungus which has narrow based budding. In a cat, the respiratory, central nervous system, eyes, and skin are usually the areas that you will see affected. Most of the cases will have nasal involvement characterized by facial swelling, distortion, chronic snuffling and discharge, and granulomatous masses seen coming out of the nostril. Squamous cell carcinoma of the nasal planum will usually present in the form of ulcerative lesions and is seen in older cats. Coccidioidomycosis rarely causes lesions in cats and they will present as skin lesions if it does. Cats are rarely affected by Blastomyces or Aspergillus.
A man presents his middle aged female spayed indoor/outdoor cat for having difficulty breathing. Her gums are pink but she has moderate tachypnea and temperature is 104.1 F (40.1 C). The lung sounds are quiet. You perform a thoracocentesis and retrieve a pleural effusion that is white with a yellow tinge. It has a foul odor when you empty the syringe. What treatment do you advise?
a. Euthanasia due to the cat likely having FIP and the prognosis is grave
b. Drain the effusion via thoracocentesis and start furosemide for congestive heart failure
c. Drain the fluid via thoracocentesis, start a low fat diet and benzopyrone (Rutin)
d. Culture the fluid and start antibiotics, the fluid will resorb after the infection is treated
e. Place a chest tube to drain and lavage chest and administer IV antibiotics
e. Place a chest tube to drain and lavage chest and administer IV antibiotics
This cat has pyothorax which is an accumulation of pus within the pleural cavity. In cats, the most common cause is a bite wound that introduces bacteria into the chest cavity. It can also be seen with migrating foreign body, or extension of pneumonia into the pleural space. At minimum, hospitalization with chest tube, drainage and lavage of the pleural space, and antibiotics are needed. Sometimes surgical exploration is required.
While this cat could have FIP, the foul odor and presence of bacteria indicate a suppurative infection which is not typical for FIP.
Congestive heart failure can present as pleural effusion in cats, but fever and this type of effusion are not typical of heart failure.
Culturing the fluid is important. However, the fluid will not resorb and the fluid must be removed and the pleural space lavaged.
A low fat diet and Rutin are treatments for pleural effusion caused by chylothorax which is an accumulation of lymphatic fluid within the pleural space.
Which of the following agents is the cat in the photograph most likely affected with?
a. Mycoplasma
b. Calicivirus
c. Chlamydophila felis
d. Herpesvirus
b. Calicivirus
The correct answer is calicivirus. This upper respiratory tract pathogen is known for causing oral ulcers in cats along with nasal discharge, chemosis, and other upper respiratory signs. Herpes virus will cause ocular, dendritic ulcers, and less commonly cause oral ulcers. Mycoplasma and Chlamydophila are not associated with oral ulceration.
A 5-week old domestic short hair kitten is presented for ataxia and tremors. The owner notes that the kitten was found several weeks ago and has always had tremors and difficulty keeping its balance. On physical exam, the kitten is ataxic, hypermetric, has a wide based stance, and head tremors. The kitten is otherwise normal on physical exam. What is the neuroanatomic location of the kitten’s lesion?
a. Cerebral cortex
b. Cerebellum
c. Brainstem
d. Pons
b. Cerebellum
The correct answer is cerebellum. Cerebellar dysfunction results in inability to regulate and measure motor function. Clinical signs of cerebellar lesions include ataxia, dysmetria, vestibular signs, delayed postural reactions, and sometimes upper motor neuron signs in the limbs. In utero or perinatal infection of kittens with feline panleukopenia virus often results in cerebellar hypoplasia, leading to the clinical signs mentioned in the question.
An 8-year old female spayed Siamese cat shown in the picture below presents for a right-sided head tilt and a horizontal nystagmus with the fast phase to the left. On physical exam, the cat has the described head tilt and nystagmus. She is circling to the right and her mentation is normal. What is your next step?
a. Complete blood count and chemistry panel
b. Magnetic resonance imaging (MRI) of the head
c. Otic exam
d. Radiographs of the head
e. Computed tomography (CT) of the head
c. Otic exam
Any dog or cat that presents with vestibular signs such a head tilt, nystagmus, and circling should have an otic exam as part of its physical exam.
Vestibular disease can be central or peripheral in origin. Although, advanced imaging such as a MRI or CT scan of the head is often recommended for vestibular disease to better characterize the brain and inner ear, an otic exam is the least invasive way to evaluate the patient and should be the next step, even prior to running blood work.
Also, it is important to check blood pressure in an animal presenting with vestibular disease. Hypertension and vascular accident can be an important cause to rule out. It is a good idea to get the blood pressure before you draw the blood to minimize stress during the blood pressure readings.
What is a major cross match in a cat?
a. Donor plasma vs. recipient red blood cells
b. Donor red blood cells vs. recipient plasma
c. Donor and recipient red blood cells vs. donor plasma
d. Donor red blood cells vs. recipient red blood cells
b. Donor red blood cells vs. recipient plasma
The correct answer is donor cells vs. recipient plasma. A major cross match is when you test donor cells vs. recipient plasma. A minor cross match is donor plasma vs. recipient cells.
A 13-year old female domestic short hair presents for a lump on her abdomen. Physical exam shows the 3cm lump is associated with the 4th mammary gland. What do you tell the owner?
a. The tumor is most likely a mammary gland tumor, which are mostly benign in cats
b. The tumor is most likely mammary hyperplasia which resolves after spaying
c. The tumor is most likely a cyst adenoma, which is benign
d. The tumor is most likely a mammary gland tumor, which are mostly malignant in cats
e. The tumor is most likely an injection site sarcoma
d. The tumor is most likely a mammary gland tumor, which are mostly malignant in cats
Eighty to 90% of mammary gland tumors in cats are considered malignant and the majority of them will metastasize. Injection site sarcomas typically occur on the dorsal or lateral trunk, or on the legs where injections are given. Injections are rarely administered into the mammary tissue. Mammary hyperplasia typically occurs in younger cats.
Changes in the diets of cats to prevent struvite urolithiasis have resulted in an increased prevalence of what disease?
a. Cysteine urolithiasis
b. Urinary tract infections
c. Urate urolithiasis
d. Calcium oxalate urolithiasis
d. Calcium oxalate urolithiasis
The correct answer is calcium oxalate urolithiasis. Struvites are soluble at low pH. Acidifying diets have resulted in an increased prevalence of calcium oxalate urolithiasis.
A 6-year old male neutered domestic short hair cat presents with the tongue lesion shown in the photo (see image). The lesion is unilateral and nodular with ulceration. What is the most accurate description of this lesion?
a. Eosinophilic ulcer
b. Miliary dermatitis
c. Eosinophilic plaque
d. Collagenolytic granuloma
d. Collagenolytic granuloma
The image and description are most consistent with a collagenolytic granuloma. Feline eosinophilic granuloma complex consists of 3 separate clinical sydromes:
1) The collagenolytic granuloma (also known as eosinophilic granuloma or linear granuloma) usually occurs on the nose, chin, oral cavity (as in this case), or caudal thighs. The lesions are typically raised and ulcerative or nodular as seen here.
2) The eosinophilic plaque occurs most frequently on the abdomen and medial thighs but can appear other places. They appear as single or multiple, raised, red, often ulcerated lesions of varying size (0.5-7 cm). They frequently have a cobblestone appearance and unlike eosinophilic ulcers, these are often pruritic. This condition is histopathologically similar to miliary dermatitis and is usually associated with underlying allergy.
3) The eosinophilic ulcer (also known as indolent ulcer) typically occurs on the upper lip and may be unilateral or bilateral. They often have a characteristic central area of yellow to pink tissue with a slightly raised circumferential edge
The underlying cause of eosinophilic ulcers and collagenolytic granulomas are unknown, although an underlying allergic cause such as arthropod bites and/or cutaneous hypersensitivity have been suggested.
Treatment of collagenolytic granulomas is also controversial so it is unlikely that you would be asked about treatment of this disorder on a board exam aside from knowing that you should attempt to identify and remove/treat underlying allergy or biting arthropod problems. Some cases respond to antibiotic therapy but most require glucocorticoid therapy.
An 8-year old female spayed domestic short hair cat presents for her yearly physical exam. Your oral exam reveals multifocal lesions of absent dental substance on multiple teeth consistent with feline odontoclastic resorption lesions (FORL). Which of the following statements about FORL is true?
a. The lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions
b. The lesions are usually non-painful
c. FORL is now a rare clinical finding since commercial diets have become more strictly regulated
d. The lesions are usually incidental findings that are not clinically significant and do not need to be treated
a. The lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions
Which life stage requires greatest energy requirement in the cat (kcal/kg/day)?
a. Early pregnancy
b. Late pregnancy
c. Lactation
d. Growth (kitten)
c. Lactation
The correct answer is lactation. The metabolic demands of lactation are far greater than those of growth or pregnancy.
Oral administration of which of these drugs has been implicated as a cause of esophageal strictures in cats?
a. Doxycycline
b. DIazepam
c. Azithromycin
d. Potassium bromide
a. Doxycycline
The correct answer is doxycycline. There is also evidence that clindamycin can cause stricture formation. For this reason, it is recommended that after pilling a cat with doxycycline, it is followed with a small volume (5-10 mls) of water.
Chaotic electrical activity and mechanical activity during cardiac arrest is most consistent with _______.
a. Electromechanical dissociation
b. Ventricular fibrillation
c. Ventricular asystole
d. Third degree block
b. Ventricular fibrillation
The correct answer is ventricular fibrillation. Ventricular fibrillation is the best choice. Ventricular asystole is characterized by no electrical or mechanical activity. Electromechanical dissociation consists of rhythmic electrical activity and no mechanical activity. Third degree block is not seen during a cardiac arrest.
A 3-month old kitten presents for mucoid diarrhea and anemia. You have recently seen several other puppies and kittens with similar clinical signs that were infected with Strongyloides stercoralis. What is the best way to confirm this diagnosis in this cat?
a. Baermann fecal technique
b. Direct fecal smear
c. Fecal flotation
d. Fecal sedimentation
a. Baermann fecal technique
The correct answer is Baermann fecal technique. Strongyloides stercoralis mainly causes a mucoid diarrhea and possibly anemia in puppies and kittens. It passed in the feces in the L1 larvae form. The best technique for recovering larvae is the Baermann technique. Fecal flotations are good for eggs that float. Fecal sedimentation is good for eggs that sink, such as most fluke eggs. A direct fecal smear can find any type of egg or larva passed in feces but does not concentrate the sample to improve the yield in finding the eggs or larvae.
A 2-year old MN DSH has recently been treated for a urethral obstruction. He went home last week from the hospital on an acidifying canned diet for this condition. The owner reports he is passing urine in moderate amounts, but he is still straining frequently. You re-examine the cat and find that the bladder is empty on palpation and the wall feels a little thickened. You are confident that the cat has not re-blocked and the cat’s bloodwork shows normal electrolytes and renal values. Which of the following medications may help the cat with this problem?
a. Phenylpropanolamine
b. Methocarbamol
c. Phenoxybenzamine
d. Prednisolone
e. Amitriptyline
c. Phenoxybenzamine
This cat is likely suffering from hypertonicity of urethral muscle, which was incited from the recent obstruction and urinary catheter. This can cause spasms, which makes urinating painful and not easily controlled. Phenoxybenzamine can be used in this case to reduce internal urethral sphincter tone such that the cat may urinate more easily.
Methocarbamol is a muscle relaxant but would not directly help spasms of the urethra.
Prednisolone is not used to help reduce inflammation or spasms in the urethra and may predispose the cat to contracting a urinary infection, especially while his bladder and urethra are compromised.
Phenylpropanolamine is used to treat urinary incontinence from urethral hypotonicity most often in dogs and would be contraindicated in this case.
Amitriptyline is an anti-depressant medication that has been implicated as part of a treatment plan for cats with cystitis, although benefit has never been proven. Because cats with cystitis can flare up during times of stress, the amitriyptyline has been thought to help prevent this. This medication would not work to stop spasms in the urethra.
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?
a. Tape muzzle and conservative therapy
b. Circummandibular cerclage wire placed caudal to canine teeth
c. External fixator with 4 Kirschner wires
d. Intramedullary pin placement in the mandibular canal
Bone screw fixation across mandibular symphysis
b. Circummandibular cerclage wire placed caudal to canine teeth
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.
An 8-year old male neutered domestic short hair cat presents for anorexia and vomiting of 8 days duration. On physical exam, you notice what is illustrated in the picture below. The cat has a body condition score of 8 out of 9 and is mildly dehydrated and depressed. The remainder of the physical exam is normal. Blood work shows marked elevation in alkaline phosphatase (ALP) and bilirubin. Abdominal ultrasound shows an enlarged and uniformly hyperechoic liver. Aspiration of the liver shows hepatocytes with lipid filled vacuoles. What do you recommend to the owner?
a. Treatment with amoxicillin clavulanate
b. Treatment with insulin therapy
c. Treatment with prednisolone
d. Placement of a esophagostomy tube with tube feeding
e. Surgical removal of the affected liver
d. Placement of a esophagostomy tube with tube feeding
The cat has hepatic lipidosis. This condition is often seen with obese cats that have become anorexic for several days, causing mobilization of excessive fat stores into the liver. Treatment is aimed at supplying nutrition to the cat to stop the cycle of fat being mobilized into the liver. The most effective way of doing this is with tube feedings.
Prednisolone, antibiotics, insulin therapy and surgery are not warranted specifically with hepatic lipidosis, but may be effective in treating some of the causes that result in the cat becoming anorexic in the first place. Common causes for anorexia leading to hepatic lipidosis include inflammatory bowel disease, cholangiohepatitis, neoplasia, and pancreatitis.
Which of the following can be treated with enalapril?
a. Protein-losing nephropathy
b. Protein losing enteropathy
c. Acute renal failure
d. Hypotension
a. Protein-losing nephropathy
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used as a vasodilator, antihypertensive agent, and heart failure treatment. It works by preventing the conversion of angiotensin I to angiotensin II, thus reducing aldosterone concentrations and causing diuresis. Its dilatory effects on the efferent arterioles of glomeruli help to palliate protein losing nephropathies. It is often used in conjunction with diuretics.
An owner presents her 2-year old female cat to your clinic because the cat is in heat. She would like to schedule an ovariohysterectomy but would like to have it done when the cat is not in heat since you informed her that the procedure can be slightly more difficult when cats are in heat. The owner is about to leave for a vacation and wants to schedule the procedure when she returns. If the cat is not bred, how long will it take for her to return to estrus (assuming she is not bred and does not ovulate)?
a. 2-3 months from the end of the current estrus
b. 4-6 months from the end of the current estrus
c. 1-3 weeks from the end of the current estrus
d. 7-9 months from the end of the current estrus
e. 2-3 days from the end of the current estrus
c. 1-3 weeks from the end of the current estrus
Estrus in cats, defined as the behavioral receptivity to mating, typically lasts about 7 days (usually between 4-10 days)
Interestrus, the period between one estrus and the next, has a variable duration of 7-21 days.
Cats are induced ovulators. If a queen ovulates but does not become pregnant, a psuedopregnancy occurs and corpora lutea develop and secrete progesterone. This inhibits GnRH release from the hypothalamus and secretion of LH and FSH from the anterior pituitary, preventing return to estrus (typically for 45-50 days). Additional clinical signs of pseudopregnancy are rare in cats.
Which of the following is not a common concurrent disease in cats with diabetic ketoacidosis?
a. Pancreatitis
b. Hyperthyroidism
c. Bacterial infections
d. Hyperadrenocorticism
e. Cardiac disease
d. Hyperadrenocorticism
The correct answer is hyperadrenocorticism. Hyperadrenocorticism commonly occurs in DKA of dogs, but not in cats. Pancreatitis and bacterial infections commonly occur in DKA dogs and cats. Cardiac disease can be a common concurrent disease in a cat with DKA. Hyperthyroidism commonly occurs in DKA cats, but not dogs.
A 1-year-old female indoor cat from Florida was presented for an after-hours emergency examination. Approximately, 72 hours after spending the night locked out on the family’s screened-in porch, the cat developed acute severe facial pruritus and was presented for the lesions shown in the image below. Similar lesions were seen on the ear tips and paws; only thinly haired areas with dark hair were affected. The cat was otherwise healthy. Skin scrapings were negative. Impression smears of the nose revealed inflammatory exudates comprised of approximately 75% eosinophils and lesser numbers of neutrophils, lymphocytes, and mast cells.
Which of the following is the best diagnostic or treatment plan?
a. Intradermal skin testing for allergens
b. Bacterial culture of lesions
c. Confine the cat indoors for 5-7 days
d. Dietary trial with novel protein source
e. Institute aggressive flea control
c. Confine the cat indoors for 5-7 days
Explanation
The history, onset, clinical appearance, as well as the cytologic and histologic findings are most consistent with insect bite hypersensitivity. There are other reasonable but less likely differentials including pemphigus foliaceus, food allergy or atopy, and dermatophytosis.
The best way to rule in/out the most likely diagnosis is to confine the cat indoors and see if the lesions resolve as none of the other differentials would be expected to respond. It would be premature to institute skin testing for allergies or a dietary trial for food allergy. Aggressive flea control is not a bad idea, but the lesion distribution is less likely for flea allergy dermatitis. Cats are very sensitive to several pesticides. Bacterial culture would likely result in growth of normal superficial bacteria and not indicate the underlying pathology.
It also may be necessary to initiate an anti-pruritic therapy to reduce further self-trauma by the cat.
Which of these chemotherapeutic drugs cause fatal pulmonary edema in cats?
a. Carboplatin
d. Doxorubicin
c. Vincristine
d. CIsplatin
e. 5-Fluoruracil
d. CIsplatin
The correct answer is cisplatin. The famed statement, “cis-plat splats cats” is quite appropriate. 5-fluorouracil is also contraindicated for use in cats, but it is neurotoxic. Carboplatin, vincristine and doxorubicin are all used in cats.
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?
a. Normal to enlarged adrenal glands
b. Hypoechoic pancreas and hyperechoic mesentery
c. Bilateral adrenal atrophy
d. Hyperechoic liver and moderate hepatomegaly
a. 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 hypoechoic pancreas and hyperechoic mesentery is highly suggestive of pancreatitis which is not associated with fragile skin in cats. A hyperechoic liver and moderate hepatomegaly can be suggestive of hepatic disease such as hepatic lipidosis or lymphoma which would not result in fragile skin either.
Dolly, a 3-year old female spayed Siamese mix, presents with a history of weight loss over the last month. She is now vomiting occasionally and has a decreased appetite over the last 2 weeks. She has not eaten in the last 2 days. She is current on vaccines. Temperature is 103.7 F (39.8 C). You can palpate an abdominal mass effect in the mid to caudal abdomen. You believe the cat has a foreign body and are concerned about a possible intestinal perforation. Abdominal tap is negative. Pre-anesthetic bloodwork shows neutrophils 25,000 /ul (2,500-12,500/ul), bands 3,000 /ul (0-300/ul), globulins 6.9 g/dL (2.6-5.1 g/dl). Your x-ray machine is not working today and you recommend an abdominal exploratory. Upon exploratory, the intestines are severely hyperemic and the mesenteric lymph nodes are greatly enlarged. You cannot find a foreign body and no perforations are seen. There is a small amount of yellow tinged sticky ascites. What do you do?
a. Refer to an oncologist for work up of gastrointestinal lymphoma
b. Perform a fecal flotation and start sulfafimethoxine for a severe coccidial infection
c. Biopsy the lymph node and intestine and discuss a poor prognosis with the owner
d. Euthanize the cat on the table since you are unable to reach the owner over the phone about the poor prognosis
e. Start the cat on prednisolone and hypoallergenic diet for severe inflammatory bowel disease
c. Biopsy the lymph node and intestine and discuss a poor prognosis with the owner
This cat most likely has Feline Infectious Peritonitis, or FIP, which is caused by a mutation of a feline corona virus. Fever, weight loss, and gastrointestinal symptoms are the most frequent presentation. However, this virus may attack multiple organs and can be difficult to diagnose; the only definitive way to diagnose this disease is via histopathology. Clinical symptoms, blood results, and corona virus titers can all be used in combination to help aid in the suspected diagnosis of FIP. Unfortunately, there is no cure for this disease and it is currently considered a fatal disease.
Due to this cat’s declining and critical health and strong evidence to support the diagnosis of FIP, euthanasia may be the most humane option. If the owner cannot be reached, however, it is the best option to go ahead and take biopsies while you are in surgery and then discuss the prognosis and differentials in detail when you can reach the owner. An animal should not be euthanized without owner consent.
Inflammatory bowel disease should not cause ascites and fever.
Parasites can lead to ascites, but typically would not cause the elevations of white blood cells and globulins with fever.
While lymphoma may be a possibility, it is less likely in this young cat. The biopsies would help to differentiate.
Which insulin is most similar in composition to feline insulin?
a. Human insulin
b. Canine insulin
c. Porcine insulin
d. Bovine insulin
d. Bovine insulin
Feline insulin is closest in its amino acid sequence to bovine insulin, differing by only one amino acid in the A-chain. Canine insulin however is identical to porcine insulin in its amino acid sequence. It is quite dissimilar from feline insulin, differing by four amino acids. Feline and human insulin sequences differ by four amino acids.
Although feline insulin is closest in sequence to bovine insulin, some cats can be managed quite well on other forms of insulin. Insulin glargine (Lantus), an engineered human insulin, is the current recommended insulin for cats. ProZinc (a protamine zinc recombinant human insulin) is also an option and has been FDA approved for use in diabetic cats. PZI (bovine zinc insulin) is no longer manufactured.
A 3-year old cat presents with pyrexia and dyspnea. On exam, you detect decreased respiratory sounds ventrally. Pleural fluid is obtained and smears are made from the sediment. What is the etiology of this cat’s pleural effusion?
a. Cryptococcus
b. Streptococcus
c. Toxoplasma
d. Feline infectious peritonitis (FIP)
c. Toxoplasma
In addition to the neutrophils seen cytologically, you should have seen toxoplasma gondii tachyzoites multiplying within macrophages and neutrophils.
Cryptococcus is a narrow, budding, thin-walled yeast surrounded by a clear capsule. Streptococcus appears as small, round bacterial cocci. FIP effusion is typically characterized by a nonseptic exudate.
Which of the following statements is correct regarding the treatment of pancreatitis in cats?
a. They should not be fed until the pancreatitis begins to resolve
b. They sholuld be fed through a jejunostomy tube
c. THey should be fed a regular commercial diet if eating
d. They should be fed a low-protein diet
e. They should be fed a low-fat diet
c. THey should be fed a regular commercial diet if eating
The correct answer is feed a regular commercial diet if eating. Cats do not require a low-fat nor a low-protein diet and usually do not require a period of being NPO. Withholding food for an extended period may be likely to induce hepatic lipidosis in some cats. Additionally, some studies suggest that stimulation of pancreatic enzymes via feeding is actually necessary in affected cats. A jejunostomy feeding tube may be occasionally recommended in severe cases of pancreatitis with dogs, but is less likely necessary in cats. If anorectic, usually an esophagostomy feeding tube is sufficient.
A 2-year old indoor, vaccinated, spayed female DSH presents with a 6-month history of lesions involving the feet. The owner reports that initially, only the posterior paws were involved but the lesions progressed to involve all four paws. The owner reports the cat did not improve after previous treatment with several antibiotics or a one week course of prednisone at 1 mg/kg.
On examination, you note that all of the metacarpal and metatarsal pads are soft, swollen and discolored as shown in the image. You note that the cat is uncomfortable when walking and occasionally licking the pads; one of the pads is fissured.
Bloodwork reveals a mild monocytosis and mild hyperglobulinemia. Which of the following tests will be most helpful in determining the diagnosis?
a. Abdominal ultrasound
b. Serum electrophoresis
c. Biopsy of the pad lesions
d. Radiographs of the involved regions
e. Fungal culture of the lesion
c. Biopsy of the pad lesions
This is a case of plasma cell pododermatitis which is a relatively uncommon idiopathic disorder of cats. While the history and description of the lesions is consistent with this uncommon disorder, other differentials could include pemphigus foliaceus, pemphigus vulgaris, or lupus erythematosus. A chemical or physical trauma could cause lesions such as these but do not fit well with the history. Neoplasia, infection, or sterile pyogranulomas are possible but would be unlikely to affect all paws simultaneously. Eosinophilic granuloma complex is also possible.
Biopsy is likely the only way to differentiate between most of these possibilities. Because plasma cell pododermatitis is rare, it is unlikely that you would be asked about details of this disorder. With plasma cell pododermatitis, you would expect to see intense plasmacytic infiltration of the dermal tissue, potentially with other inflammatory cell types present due to secondary infection. The disease is not thought to have an infectious cause at this time. Treatment usually involves long courses (10 weeks) of Doxycycline. Approximately, 80% of cats will respond to Doxycycline. If a good response is not seen than systemic glucocorticoids can be tried. Surgical excision of the foot pad may be necessary in cases that fail to respond to medical management.
Although this question involves a rare disease that you probably would not be expected to know very much about, the question itself involves critical thinking and clinical judgement that you should be able to reason through if you can construct an appropriate list of differential diagnoses. The ability to read through the details of a complicated case and identify the information needed to decide what to do next will be an important skill on your board exam.