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RUSVM LAM I > Final: Endocrine and Urinary > Flashcards

Final: Endocrine and Urinary Flashcards

1
Q

What is the difference between an “easy keeper” and an “overly fed” horse or pony?

A

“Easy keeper” - horse is not fed too much but is still fat/gaining weight, possibly poor quality hay/feed

“Overly fed” - poor horsemanship

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2
Q

T/F: Hepatic lipidosis is commonly a secondary condition which rarely fatal.

A

False, up to 80% fatal (but commonly secondary)

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3
Q

Match the term with the correct value:

Hyperlipidemia, Hypertriglyceridemia, Hyperlipemia

TG>500 mg/dl, plasma clear

TG<500 mg/dl, plasma clear

TG >500 mg/dl, serum cloudy

A

Hypertriglyceridemia: TG>500 mg/dl, plasma clear

Hyperlipidemia: TG<500 mg/dl, plasma clear

Hyperlipemia: TG >500 mg/dl, serum cloudy

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4
Q

What is the classical presentation of fatty liver disease?

A

Mid-winter

Mini pony female >15 yo

ADR

Inappetence

Not drinking water

With concurrent condition (colic, choke, anorexia, PPID, pregnancy)

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5
Q

What are the 2 hormones involved in fat metabolization? What activates them?

A

Lipoprotein lipase- activated by insulin (Favors TG accumulation)

Hormone sensitive lipase- activated by catecholamines/ACTH (inhibited by insulin) (Mobilizes stored fat)

*INSULIN role stressed in lecture*

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6
Q

What, in addition to supportive care and nutritonal support, is used to treat hyperlipidemia?

A

Heparin (to counteract hormone sensitive lipase)

Insulin (to trigger lipoprotein lipase)

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7
Q

What are the 3 principal components of equine metabolic syndrome (EMS)?

A

Increased adiposity

Hyperinsulinemia

Insulin resistance

Also LAMINITIC SIGNS (minor but radiographic evidence of recurrent episodes)

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8
Q

What are the 2 types of insulin resistance?

A

Compensatory: due to decreased tissue response (most common)

Uncompensatory: due to pancreatic (beta cell) insufficiency

Compensatory can lead to uncompensatory

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9
Q

What causes laminitis in horses with EMS? How is this defined clinically?

A

Persistant hyperinsulinemia

Hyperinsulinemia= >30 microU/mL when fasted

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10
Q

What metabolic issue is this preputal swelling indicative of?

A

EMS

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11
Q

Enlargment of adipose tissue in what region is used as a scoring system for EMS? What score indicates EMS?

A

Neck region

3

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12
Q

In addition to fasted insulin levels, what tests can you do to assess hyperinsulinemia?

A

Insulin tolerance test (IR= lvl not 50% decreased within 30min)

Oral sugar test (IR if >60 at either post reading)

Combine Glucose Insulin test (IR= BG above baseline for 45min or longer)

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13
Q

Why is increasing activity an important aspect of treating EMS?

A

Exercise improves insulin sensitivity

Aids in weight loss

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14
Q

What can you give if a horse with EMS has persistent obesity despite diet changes and exercise management?

A

Levothyroxine sodium

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15
Q

How could you determine whether a horse with EMS who has a low tT4 or tT3 has hypothyroidism?

A

Do TRH stimulation test, EMS will have normal TRH stim test results

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16
Q

T/F: Low T3 in conjunction with low T4 is highly indicative of hypothyroidism.

A

False, NOT indicative of hypothyroid

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17
Q

What drug decreases serum T4?

A

Phenylbutazone

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18
Q

What is primary hypothyroidism? How is it confirmed? What about secondary hypothyroidism?

A

Primary: deficiency or excess in iodine

Test= decreased T3 and T4 with elevated TSH

Secondary: pituitary or hypothalamic dysfunction

Test= [TSH]

Tertiary= defect of hormone use at periphery

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19
Q

What is the best way to diagnose hypothyroidism?

A

TRH or TSH stimulation test

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20
Q

Melanocyte stimulating hormone (MSH) is the primary product of ______ cleavage in the pars ______. It is a potent anti-inflammatory hormone as well as an anti-pyretic. In the ____ (season) the hormone level begins to increase.

A

POMC (proopiomelanocortin)

intermedia

Fall

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21
Q

What hormone does cortisol counteract? What does this contribute to?

A

Insulin

Hyperglycemia

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22
Q

PPID is a neurodegenerative disease with loss of _______ inhibitory input to the _______ of the pars intermedia.

A

Dopaminergic

Melanotropes

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23
Q

What is the most important risk factor dor PPID? What chronic condition in old horses warrents PPID as a DDx?

A

Age (common when 18-20yo)

Foot problems

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24
Q

What is the most unique and specific clinical sign associated with PPID?

A

Hirsutism

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25
Q

What plasma component causes the behavioral abnormalities seen in PPID?

A

High B-endorphins

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26
Q

Which muscles test to atrophy with PPID? Where are common areas for abnormal fat distribution seen with this disease?

A

Epaxial and gluteal

Fat: Along crest of neck, over tail head, and on sheath or mammary region, above the eyes (supraorbital fossa)

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27
Q

What are the 3 causes of PUPD/dehydration in the Cushinoid horse?

A
  1. Loss of ADH (Due to pars nervosa compression)
  2. Hypercortisolemia (increase thirst and GFR)
  3. Osmotic diuresis (due to hyperglycemia and glucosuria)
28
Q

Cushinoid horses have difficulty thermoregulating, what is a commen clinical sign associated with this?

A

Hyperhidrosis

29
Q

Infertility is a clinical sign associated with Cushing’s/PPID. What is given to treat this? When should it be discontinued and what should be given in its place?

A

Pergolite (dopamine agonist)

3 months before foaling (to avoid agalactia) and give Domperidone (increases prolactin)

30
Q

T/F: PPID is the most common cause of laminitis.

A

True

31
Q

What is a reason why horses who have laminitis due to PPID do not show clinical signs or signs of pain?

A

Increased B-endorphins can increase pain tolerance

32
Q

There is no standard for how to diagnose PPID in horses. What are some tests used and what is considered ‘gold standard’?

A

GOLD STANDARD= Dex suppresion test (Normal= cortisol suppresion <1)

ACTH plasma concentration

TRH or ACTH stim test

Less common:

MSH plasma concentration

Domperidone stim test

33
Q

When are plasma concentrations of a-MSH and ACTH the highest?

A

Autumn (Aug-Oct)

So don’t do MSH or ACTH stim tests then - false +

34
Q

What is the treatment for PPID?

A

Pergolide (dopamine agonist)

Other: Trilostane (improve CS), Cyprohepatidine (old school, appetite stimulant)

35
Q

When compared to plasma, how much more concentrated should urine be?

A

3-4 x

(900-1200 mOsm/L)

36
Q

T/F: Urine scalding is a typical in an overweight horse and can be a sign of neurological dysfunction.

A

True

37
Q

What type of urinary catheter is used in mares?

A

Balloon catheter (filled w/saline)

38
Q

What is normal USG in adults? Foals?

Is the urine acidic, alkaline or neutral normally?

A

Adults: 1.020-1.050

Foals: 1.008

Alkaline urine

39
Q

Which of the following is NOT a cause of hyperglycemia in horses?

Exercise

Xylazine

Liver failure

PPID

Corticosteroids

Septicemia

A

Liver failure

40
Q

What crystals are normal and abdundant in horse urine?

A

Calcium carbonate

Calcium oxalate

41
Q

T/F: GGT can be measured in the serum or in urine to investigate renal tubular damage.

A

False, only urine

42
Q

How many of the nephrons must be non-functional for creatinine to exceed normal values?

A

2/3 of all nephrons

43
Q

What lab tests can be done to evaluate the urinary system?

A

Fractional excretion of electrolytes (can’t do this if on fluids)

Urinary enzymes - Urine:Serum ratios

44
Q

You centrifuge discolored redish urine and it stays the same after centrifugation. What caused the pigmenturia?

A

Myoglobin

45
Q

What part of the urinary tract is blood coing from when find it in early urination? End urination? What if it is present throughout?

A

Early = Urethra or bladder

End = Proximal urethra

Throughout= Bladder or upper tract

46
Q

What are 4 causes of intravascular hemolysis?

A

IV DMSO

Water intoxication

Red maple toxicity

Neonatal isoerythrolysis

47
Q

What condition in quarter horses causes hematuria?

A

Urethral fear - fistula between urethra and corpus spongiosum (penis)

48
Q

What horses most commonly get nephroliths and urethral calculi? What do these progress to?

A

Young adult racehorses

Progress to CRF

49
Q

How do horses with nephroliths present? What can be seen on ultrasound?

A

With colic

Hydronephrosis

50
Q

What is the most common calculus?

A

Calcium based cystic calculi

51
Q

Which cystic calculi are large, friable and spiculated? Which are smooth but hard and difficult to break?

A

Calcium carbonate

Calcium phosphate

52
Q

A diet high in what predisposes to bladder stones?

A

Alfalfa

53
Q

What antimicrobials can be used for bladder infections?

A

Trimeth-Sulfa

Aminoglycosides

Penicillin

Ceftiofur

54
Q

What does retention of the urination posture for several seconds after voiding, tail flagging, flatulence during voiding, and constant dripping indicate?

A

Dysurea (Dysuria)

55
Q

What antibiotics can cause acute tubular necrosis?

A

Aminoglycosides (prolonged admin, >10d)

Oxytetracycline (used for contracted tendons in foals)

Polymixin B (used for endotoxemia)

56
Q

What are the 3 phases of ARF?

A

Induction

Maintenance

Recovery (can take 4-6 weeks for full concentrating ability)

57
Q

Which is the correct order, from most to least nephrotoxic, for these aminoglycosides?

a. Neomycin > Gentamicin > Amikacin
d. Amikacin > Gentamicin > Neomycin
c. Gentamycin > Neomycin > Amikacin

A

a. Neomycin > Gentamicin > Amikacin

58
Q

In addition to urea and creatine what enzyme can be used to monitor nephrotoxicity?

A

GGT

59
Q

Which is the correct order, from most to least nephrotoxic, for these NSAIDs?

a. Flunixin > Ketoprofen > Phenylbutazone
b. Phenylbutazone> Ketoprofen >Flunixin
c. Phenylbutazone > Flunixin > Ketoprofen

A

c. Phenylbutazone > Flunixin > Ketoprofen

60
Q

What renal biopsy finding with ARF signals a good prognosis for nephron function?

A

Intact basement membrane

61
Q

What is the IVF rate for ARF treatment? How long are fluids administered at this rate?

A

40-80 ml/kg/day

Until creatinine decreases/azotemia resolves dramatically

62
Q

What drug is given for ARF because it may be beneficial to help the healing of renal tissue? What are side effects and counterindications?

A

Misoprostol (synthetic prostaglandin analog)

Can cause diarrhea and colic

C/O’d in pregnant mares (abortion)

63
Q

In addition to decreased EPO production, what causes anemia in CRF?

A

Uremic toxins cause extravascular hemolysis (decrease RBC lifespan)

64
Q

How low do you expect albumin to be with CRF?

A

<2.5 mg/dl

65
Q

Which shows more systemic clinical signs, upper or lower urinary tract infections?

A

Upper

Fever, weightloss, illness

66
Q

Which of these is not an organism commonly associated with UTIs?

  • E.coli*
  • Streptococcus*
  • Proteus*
  • Klebsiella*
  • Pseudomonas*
A

Streptococcus

67
Q

How do you rule out psychogenic polydipsia?

A

Water deprivation test

If PP then will concentrate urine

RUSVM LAM I (19 decks)

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