formative questions

Question 1

A 15-year-old female neutered domestic short hair cat is presented with alopecia affecting her ventral neck, axillae, sternum and abdomen.

Her skin has a shiny and glistening appearance.

The cat is losing weight and has no appetite.

What is the most likely underlying diagnosis?

Answer 1

pancreatic adenocarcinoma

parneoplastic skin disease - GI signs therefore pancreatic

Question 2

A two-year-old beagle dog is presented with erythematous pododermatitis. On cytology, mallasezia is seen - what is the most appropriate treatment

Answer 2

miconazole or chlorhexidine shampoo

Question 3

A four-month-old shar-pei dog is presented with patchy alopecic lesions on his body. Demodex is seen on microscopy, what is the most appropriate treatment

Answer 3

sarolaner or amitraz

Question 4

What is the most appropriate duration of antibiotic treatment for initial management of a superficial pyoderma?

Answer 4

3-4 weeks

Question 5

what can you use to treat a ringworm infection in a cat

Answer 5

itraconazole

Question 6

Shelter medicine focuses on homeless, unwanted and vulnerable animals. What is the main driver of shelter medicine in this context?

Answer 6

improving welfare

Question 7

Approximately what percentage of vets in the UK have formal arrangements with charities to help with their veterinary work?

Answer 7

70%

Question 8

In an RSPCA hospital environment during the summer, up to what proportion of elective cat spays are likely to be pregnant?

Answer 8

30%

Question 9

What type of music has been shown to be most calming for dogs in a shelter environment?

Answer 9

classical

Question 10

What disposable PPE (personal protective equipment) should be worn for handling of animals in an isolation facility?

Answer 10

Disposable sleeves, apron, gloves & boots

Question 11

A client has a flock of 10 ex-battery chickens. She presents you with a chicken that is off its food, lethargic and has a swollen abdomen.

She reports that she has lost 2 other birds with similar clinical signs over the last 6 months.

What is the most likely diagnosis?

Answer 11

egg peritonitis - common in ex battery birds and causes ascites

Question 12

What suture material should be used to close the linea alba in a dog or cat in a routine ovariohysterectomy?

Answer 12

PDS - 2 - supports for 60 days and linea alba takes 2-3 weeks to heal

Question 13

What is the ideal time to administer intravenous perioperative antibiotics?

Answer 13

30 minutes

Question 14

What type of dressing should be chosen for a surgical wound following a routine ovariohysterectomy in a bitch?

Answer 14

Absorbent dry dressing

Question 15

Why must an anaesthetic vaporiser be maintained in a vertical position?

Answer 15

Tipping the chamber would allow the volatile agent to enter the bypass chamber and therefore will increase the concentration delivered to the patient

Question 16

A client has just adopted a 6 year old male Collie from a rescue centre. She wishes to take the dog on holiday to the South of France in 28 days and is asking that you issue a Pet Passport. The dog is identichipped and the owner has informed the ID chip company about transfer of ownership. The owner has evidence from the rescue centre about the dogs change of ownership and of vaccination against Distemper, Hepatitis Parvovirus and Leptospirosis.

You confirm that there is an ID chip in place.

What is the most appropriate advice to give this owner?

Answer 16

It may be possible for her to travel with the dog in 4 weeks time. You advise that she should wait until she receives confirmation of the change of ownership from the ID chip company and then re-present the dog for rabies vaccination

Question 17

You are carrying out an ovariohysterectomy in a Labrador bitch. The dog is breathing spontaneously and anaesthesia is being maintained with isoflurane delivered via a circle breathing system.

The ligature slips from the second ovary and the abdomen fills rapidly with blood.

While you are trying to control the haemorrhage, and after calling for additional help, what is the most important immediate action to ask the nurse to perform?

Answer 17

Fluid therapy is essential in the management of haemorrhage; initial fluid replacement therapy should start with a colloid or crystalloid. In healthy animals blood is only indicated after significant haemorrhage

Question 18

You are presented with a 13 year old female neutered domestic short hair cat with a 6 week history of weight loss.

She has a variable appetite; the owner sees her drinking occasionally from the garden pond and she intermittently vomits in the house.

She toilets outside.

On examination her heart rate is 220 beats per minute; there is right sided goitre; she has severe periodontitis and her kidneys feel smaller than you would expect for a cat of her age.

What is the most appropriate next step in this case?

Answer 18

T4/renal blood test and check her urine from a sample collected from a litter tray at home

Question 19

You are presented with a 6 month old 6kg French Lop rabbit 48 hours after routine castration.

The owner reports he is subdued and semi-anorexic.

He has been separated from his mate, is bright when interacted with at home and has not been seen interfering with his wounds.

Clinically his castration wounds looks clean and the sutures are intact.

There is no swelling palpable.

On the consulting room table he appears moderately bright.

His heart rate is 230 beats per minute; his abdomen feels ‘doughy’ and his rectal temperature is normal .

What would be the most appropriate treatment for this case?

Answer 19

Treat the rabbit for gut stasis with analgesics, metoclopramide and fluids as this is the most likely cause of the issues post GA

Question 20

You are presented with a tortoise that came out of hibernation 1 week ago. It is anorexic, but bright and alert and on clinical examination no abnormalities can be found.

What is the most appropriate next step to resolve the anorexia?

Answer 20

The main reason for not eating post hibernation are inappropriate environmental conditions. Correcting this and rehydrating the animal will encourage a significant number to start eating.

Question 21

You have referred a 3 year old female neutered Bearded collie dog who has an extreme fear of fireworks to a qualified non-veterinary Clinical Animal Behaviourist (CAB).

The CAB has sent you a report summarising the behaviour modification programme that has been suggested to the client, which includes gradual desensitisation and counter-conditioning to firework sounds.

However, since it is now mid-October they have also suggested that you may wish to prescribe adjunctive medication for the owner to give to the dog during firework events.

Assuming the dog is otherwise healthy, what would be the most appropriate type of medication to prescribe for this case?

Answer 21

This class of drugs are appropriate to be given to the dog 30-60 mins before firework events, as they will block some memory consolidation and help prevent the fireworks having a negative impact on the progress of the behaviour therapy.

benzodiazepine

Question 22

you are presented with a dog with exopthalmus of both eyes and purulent ocular discharge - 2 day onset and vision and refexes are normal - what is the first diagnostic step to take

Answer 22

check the oral cavity and sinuses as an abscess is the most likely cause or a foreign body etc
then ocular ultrasound to confirm an orbital mass

Question 23

you are presented with a cat with blood in his pupil - you can see the circumference of the pupil where is the haemarrohage

Answer 23

posterior segment

Question 24

A 14 month old indoor only male neutered domestic short hair cat is presented with a 2 day history of lethargy, reduced appetite and progressively worsening dyspnoea.

The cat’s respiratory pattern is shallow, with the inspiratory phase equivalent to the expiratory phase, and his respiratory rate is 48 breaths per minute.

Auscultation reveals an absence of lung sounds ventrally on both sides of the chest and the apical heart beat is felt to be more caudal than usual.

Cranial chest compression is markedly reduced on palpation.

He is found to be FeLV infected.

What is the most likely diagnosis?

Answer 24

cranial mediastinal lymphoma

The respiratory pattern and auscultation findings are consistent with pleural effusion; the reduced cranial chest compression suggests a cranial mediastinal mass. In this age of cat, particularly when FeLV positive, mediastinal lymphoma is most likely. Aspiration could be undertaken for confirmation

Question 25

You are presented with a 20 week old domestic long hair male entire kitten that has been fed a meat-only diet since weaning.

The kitten is stunted, is reluctant to walk and is lame on his right hind limb.

Radiography of the cat’s limbs shows markedly reduced radio-opacity of all bones and a fracture of the right femur.

What is the most likely underlying cause of these clinical signs?

Answer 25

Nutritional secondary hyperparathyroidism (nutritional osteodystrophy

Question 26

You are presented with a 1 year old female neutered domestic short hair cat that lives with 3 other cats, has outdoor access and has a severe anaemia.

The cat’s sibling was diagnosed with feline leukaemia virus (FeLV) infection 3 weeks previously.

You suspect FeLV infection in this cat and want to get an FeLV test result back for the owner as rapidly as possible.

What diagnostic test is the most appropriate to do?

Answer 26

in house FeLV p27 antigen enzyme-linked immunosorbent assay (ELISA)

immunoflorescence needs to be sent to a lab

Question 27

You are asked to examine a 14 year old female neutered domestic short hair cat with a 3 week history of progressive PU/PD, reduced activity and weight loss.

You suspect chronic kidney disease and perform cystocentesis to obtain a urine sample from the cat for in-house examination.

Results show a specific gravity of 1.016, with no protein and no glucose.

The sediment is inactive.

What is the most appropriate next step for the investigation of this case?

Answer 27

haematology and serum biochemistry

Question 28

You are presented with an 8 month old female neutered domestic short hair cat with a 2 week history of progressive lethargy and inappetance.

On clinical examination you find that she is pyrexic, has a markedly swollen abdomen (with a palpable fluid thrill) and has a yellow tinge to her mucous membranes.

What is the most likely diagnosis?

Answer 28

Feline infectious peritonitis

Question 29

You are presented with a 5 year old male neutered collie cross dog with regurgitation.

A plain lateral radiograph demonstrates marked megaoesophagus, and you wish to investigate the possibility of focal myasthenia gravis as a cause.

What would be the most appropriate test to perform?

Answer 29

Acetylcholine receptor antibody titre

Question 30

You have just diagnosed Giardia infection in a dog.

What is the most appropriate treatment?

Answer 30

fenbendazole

Question 31

You are presented with a 6 year old male neutered German shepherd dog with a history of chronic diarrhoea and weight loss (body condition score 2/9).

The dog has a good appetite and is coprophagic.

Haematology and serum biochemistry are unremarkable except for hypocholesterolaemia (2.5 mmol/l, RI 3.5-7).

A faecal examination for parasites is negative.

What would be the most useful next diagnostic test for this patient?

Answer 31

TLI is the correct answer as the history and signalment are most consistent with exocrine pancreatic insufficiency.

Question 32

A 10 year old female neutered Labrador retriever is presented with ataxia and mental depression.

She collapsed on the way into the surgery from the car.

Physical examination is otherwise unremarkable. Emergency database blood tests show a glucose of 1.8 mmol/l, (RI, 3.5-5.0).

What is the most likely toxin to be causing these clinical signs?

Answer 32

xylitol which causes hypoglycaemia (as well as hepatic toxicity) and would be consistent with these clinical signs and blood results.

Question 33

You are presented with a 6 year old entire male Boxer dog with a history of dysuria and dripping bloody urine from the tip of his penis.

His prostate is caudally positioned and enlarged on rectal examination.

There is a 5cm soft-tissue mass in his caudal abdomen on plain radiography, that is separate from and dorsal to the bladder when a negative contrast study is performed.

What is the most likely diagnosis?

Answer 33

Paraprostatic cyst - ultrasound would be the next step

Question 34

What antibiotic regime is the most appropriate choice for an uncomplicated enterotomy following a mid-jejunal foreign body removal in a 1 year old male Labrador dog?

Answer 34

Peri-operative antibiotics intravenously and none prescribed post-operatively

This is a clean contaminated procedure in a likely otherwise healthy young animal and so peri-op antibiotics are all that are required

Question 35

You are performing a post-operative check 3 days after a bitch spay.

There is significant wound swelling but the skin sutures are still intact and the wound is not hot or painful.

Ultrasound examination is consistent with a seroma, with no evidence of abdominal herniation.

What is the most appropriate treatment?

Answer 35

Restrict exercise and wait for resolution

Question 36

What combination of suture pattern and suture type is the most appropriate to use when repairing a urethrostomy in a dog?

Answer 36

Simple continuous pattern and monofilament non-resorbable suture

Question 37

What would be the most appropriate skin reconstruction technique for a cat with a full circumferential skin deficit of 4 cms length around the distal metatarsal region?

Answer 37

Free skin graft

Question 38

What is the most appropriate investigation for a chronic (over 2 months) non-healing wound on the toe of an otherwise clinically healthy 10 year old Labrador retriever?

Answer 38

Considering the information in the stem, there is high suspicion of a tumour. The toe should therefore be biopsied and submitted for histopathology

Question 39

You diagnose a pericardial effusion in an 8 year old male Labrador retriever dog.

The dog has a heart rate of 200 beats per minute and is in right sided congestive heart failure.

What is the most appropriate treatment for this case?

Answer 39

pericardiocentesis

Question 40

what electrolyte abnormality is associated with the loss of a p wave and spiking of QRS?

Answer 40

hyperkalaemia

Question 41

what is the drug of choice for atrial fibrilation

Answer 41

diltiazem

Question 42

A 7 year old male neutered Cavalier King Charles spaniel dog is presented to you for a routine vaccination.

The dog has a grade 4/6 left sided systolic apical heart murmur, radiating to the right.

His heart rate is 100 beats per minute; peripheral pulses are strong; mucous membranes are pink and the capillary refill time is normal at < 2sec.

His respiratory rate is 24 breaths per minute and lung field auscultation is unremarkable.

An echocardiogram reveals left atrial and left ventricular dilation and there is evidence of cardiomegaly on thoracic radiography (VHS = 11.3).

What is the most appropriate treatment?

Answer 42

pimobendan

Question 43

A dog presents to you in a collapsed state. Examination of the cardiovascular system reveals a heart rate of 260 bpm with poor peripheral pulses and pale mucous membranes with a CRT of 2s. What is the most likely cause of shock in this dog?

Answer 43

cardiogenic - This dog has a very high heart rate that is likely due to an arrhythmia resulting in poor cardiac output. Other causes of hypoperfusion primarily cause sinus tachycardia which does not exceed 220 bpm.

Question 44

A 8 year old Labrador presents with signs of inspiratory dyspnoea. Examination reveals marked inspiratory effort and stridor, his lung sounds are harsh bilaterally with a large amount of referred noise. He is hyperthermic (40 deg C).

Answer 44

upper airway

Question 45

A 4y FN domestic short haired cat presents to you with a 2 week history of weight loss.

She has been noted to have a decreased appetite over the last couple of days.

On major body system examination the following is recorded:

Quiet, not interested in surroundings.
Heart rate 140 bpm with bounding femoral pulses, pale mucous membranes with capillary refill time of 1 second.
Her respiratory rate is 60 bpm, she has marked respiratory effort and intermittently exhibits open mouth breathing, her lung sounds are dull ventrally bilaterally.
She is neurologically depressed. Abdominal palpation reveals hepatomegaly.

What is the next step to help stabilise the patient?

Answer 45

The next step is thoracocentesis. This cat is exhibiting significant dyspnoea. The presence of dull lung sounds ventrally is associated with pleural space disease. The most appropriate next step is to remove the cause of the dyspnoea by performing thoracocentesis.

Question 46

During anaesthesia of a horse you take an arterial blood sample for analysis and find the following results (reference ranges in brackets):

pH	7.13	(7.35-7.4)
PaCO2	76mmHg	(35-45)
HCO3	31mmol/l	(22-28)
BE	1.3	(0-4)
What is the most appropriate action to take?

Answer 46

IPPV - The blood gas picture demonstrates hypercapnia and a respiratory acidosis. Therefore IPPV is indicated to correct this

Question 47

Pre-medication with medetomidine intravenously in the dog may result in profound bradycardia immediately after administration.

What is the most likely mechanism by which the immediate bradycardia is produced?

Answer 47

Medetomidine causes peripheral vasoconstriction and an increase in blood pressure, the reduction in heart rate is a reflex response to the increase in blood pressure

Alpha 2 receptors are found in peripheral arterioles and stimulation with medetomidine causes vasoconstriction. The vasoconstriction increases arterial blood pressure and there is a reflex bradycardia

Question 48

What drug is commonly associated with profuse sweating if administered to a horse under general anaesthesia?

Answer 48

salbutamol - beta 2 agonist and causes sweating due to stimulation of the sympathetic nervous system.

Question 49

A dairy farmer reports a decrease in milk yield and low butter fats in his high yielding Holstein herd.

Further investigation finds poor reproductive performance, variable faecal consistency in the high yielding cows, dirty flanks and a large amount of tail swishing in the herd.

What test result would confirm the likely diagnosis?

Answer 49

Rumenocentesis pH < 5.5
This clinical scenario indicates subacute ruminal acidosis in the herd; indicated by the reduced milk fat, variable faecal consistency and tail swishing. The diagnosis is made by rumenocentesis and finding pH below 5.5 (acid rumen)

Question 50

An eight month old dairy heifer presents with a head tilt, facial paralysis, ptyalism and a unilateral central blindness.

Answer 50

Listeria meningitis

Question 51

On a pig fattening farm, several pigs have erosions around the mouth and on the snout.
They show obvious signs of illness and also show signs of lameness.
What notifiable disease should be suspected?

Answer 51

Foot and mouth disease
With any disease involving blisters around the mouth and on the tongue, and involving lameness, one should consider foot and mouth disease and swine vesicular disease

Question 52

You are called to examine a recently established backyard chicken flock comprised of 20 ex-battery hens.

Two of them are collapsed, dyspnoeic and mouth breathing with stertorous respiration.

Five others have bilateral nasal and ocular discharge, eyelids that appear slightly swollen and are coughing and sneezing intermittently. The remainder appear unaffected.

Given the most likely cause, what is the most appropriate antimicrobial treatment protocol ?

Answer 52

Medicate the whole flock with soluble tylosin in water for seven days and treat the two most severely affected individuals by the intramuscular route
The most likely cause of this presentation is mycoplasmosis. The macrolides, including tylosin, have good activity against mycoplasmas. Individual treatment by the parenteral route is indicated in severely sick birds that are unlikely to be drinking sufficiently.

Question 53

What clinical signs would distinguish between Babesia divergens infection and brassica poisoning?

Answer 53

Both conditions cause haemaglobinuria, with only babesiosis producing scour and pyrexia

Question 54

What is the correct order of events in a cow’s lactation cycle?

Answer 54

Calving, lactation, mammary involution, steady state, transition

Question 55

A farmer with 500 ewes decides that he wants to expand his flock and buys 200 ewe lambs to put to the ram.

What infectious cause of abortion are the ewe lambs most at risk of introducing to his flock?

Answer 55

Chlamydophila abortus

Question 56

An ill-thriven six-month old dairy replacement heifer calf is blood tested for evidence of bovine virus diarrhoea virus infection.

The result is antigen positive, antibody negative.

A repeat test three weeks later gives the same result.

When was this calf most likely to have been infected?

Answer 56

The calf was infected in utero during the first 150 days of gestation

Question 57

What is the best method to monitor the Johne’s disease status of a dairy herd?

Answer 57

Regular individual cow milk ELISA testing

Question 58

A lowland flock with ewes in good body condition score is experiencing higher levels of prolapse this lambing season.

Which ewes within the flock are most likely to be affected?

Answer 58

Higher parity ewes carrying triplets.
Risk factors that increase incidence of vaginal proplapse include increased body condtion scores, higher parities, previous vaginal prolapse, hypocalcaemia and increased litter size.

Question 59

You are called to a dairy farm to examine a cow that is three weeks post-calving. She is fed a total-mixed-ration and her milk yield has gradually decreased over the last 10 days. Her temperature is 40°C (104°F), and rumen turnover is decreased. An audible grunt is elicited when pressure is applied to the cranioventral abdominal wall. The heart sounds are muffled and jugular distension is evident.

What is the most likely diagnosis?

Answer 59

Traumatic reticuloperitonitis and pericarditis

linical findings of jugular distension are indicative of right sided heart failure and pericarditis; muffled heart sounds relate to the pericarditis; the grunt is due to pain in the pericardial area; the high temperature indicates acute infectious and inflammatory process

Question 60

You are called to a dairy farm to examine a cow that is 7 days post calving and has a sudden and severe decrease in milk yield. She is very weak, with a heart rate of 120 beats per minute, respiration rate of 55 breathes per minute and prolonged skin tenting is evident. Rumen turnover is absent, but a “ping” is evident on percussion and auscultation over the dorsal abdomen on the right-hand side. Rectal palpation is unremarkable.

What is the most likely diagnosis?

Answer 60

Abomasal torsion/volvulus

The presentation of a ping on the right side of the caudo-dorsal abdomen in a severely ill animal when rectal palpation is unremarkable is most likely due to an abomasal torsion/volvulus. By comparison, a caecal torsion is often palpable on rectal examination, the ping is typically located more caudally and the cow does not usually present as acutely.

Question 61

A dairy farm has an increase in the incidence of sole ulcers. The farmer has recently increased the herd size from 200 to 300 cows. The herd is housed all-year-round in a shed with 250 cubicles, bedded with sawdust on concrete. The cows are milked in one group.

What is the most appropriate advice to give the farmer to prevent new cases of sole ulcers?

Answer 61

Increase cubicle numbers
The correct answer is to increase the cubicle numbers. Sole ulcers are induced by increased standing times and there are not enough cubicles provided for the increasing herd size. Current advice on cubicle numbers is to offer cows 5% more cubicles than required. Therefore, this herd would now require at least 315 cubicles to satisfy a herd of 300 cows.

Question 62

You are presented with a 5 year old male neutered Dachshund dog with a 24 hour history of acute onset paraplegia.

On clinical examination his patellar reflexes are normal in both pelvic limbs; withdrawal reflexes are normal in both pelvic limbs, and a crossed extensor reflex is noted.

His perianal reflex is normal.

Where is the most likely neuroanatomical location of this patient’s lesion?

Answer 62

T3-L3 spinal cord segments

Question 63

You are presented with a 2 year old domestic short hair cat with anisocoria.

On clinical examination her right eye has a dilated pupil, unresponsive to light.

The vision is preserved in this eye, and there is a consensual response in the left eye when the light is shown in the right eye.

Her vision and pupillary light reflex are intact in the left eye, but there is no consensual response in the right eye.

Where is the most likely neuroanatomical location of this patient’s lesion?

Answer 63

Right parasympathetic branch of the oculomotor nerve

Question 64

You are examining a 5 year old male entire Border collie dog with a 4 month history of single seizures occurring once every 2 weeks.

These have been previously diagnosed as idiopathic by a colleague and the dog is not currently receiving any anti-epileptic medication.

The dog has been presented for his annual vaccination, but suddenly starts to seizure, and this does not spontaneously resolve after 5 minutes.

What is the most appropriate initial medical management for this case?

Answer 64

Intravenous or intra-rectal diazepam

Question 65

A 7 year old cross breed dog is presented to you with obtundation, a left sided head tilt, conscious proprioceptive paw placement deficits on the left and rotary nystagmus with a fast phase to the right.

Where is the most likely neuroanatomical location of this patient’s lesion?

Answer 65

Left brainstem

Question 66

A horse of one of your clients has to be slaughtered because of a serious injury.

At meat inspection, three large growths are found in the liver.

They are about the size of a tennis ball, spherical, and filled with a fluid in which a large amount of particles can be seen.

These particles look like loose sand.

What is the most likely cause of the growths?

Answer 66

Hydatid cysts, the larval stage of Ecchinococcus granulosus