Gastrointestianal SBAs Flashcards
1
Q
Scenario: A 3-year-old French Bulldog presents with a history of regurgitation, especially after eating. The dog is otherwise bright, alert, and responsive.
Lead-in: Which of the following conditions is most likely to be associated with this dog’s regurgitation?
Options:
a) Oesophagitis
b) Megaesophagus
c) Hiatal hernia
d) Vascular ring anomaly
e) Oesophageal foreign body
A
Answer: c) Hiatal hernia
Explanation: Hiatal hernias are becoming increasingly common in brachycephalic breeds like French Bulldogs and can cause regurgitation.
2
Q
Scenario: A 7-year-old Golden Retriever presents with a history of chronic regurgitation and weight loss. The dog is otherwise healthy and has no other clinical signs.
Lead-in: Which of the following is the most likely cause of this dog’s clinical signs?
Options:
a) Megaesophagus
b) Oesophageal foreign body
c) Oesophagitis
d) Hiatal hernia
e) Vascular ring anomaly
A
Answer: a) Megaesophagus
Explanation: Megaesophagus is a common cause of chronic regurgitation and weight loss in dogs, particularly in breeds like Golden Retrievers.
3
Q
Scenario: A 2-year-old Labrador Retriever presents with a history of vomiting and diarrhea. The dog is otherwise healthy and has no other clinical signs.
Lead-in: Which of the following diagnostic tests would be the most appropriate next step?
Options:
a) Abdominal radiography
b) Barium swallow study
c) Endoscopy of the esophagus and stomach
d) Hematology and serum biochemistry profile
e) Exploratory laparotomy
A
Answer: a) Abdominal radiography
Explanation: Abdominal radiography can help identify signs of intestinal obstruction, such as dilated bowel loops or foreign bodies.
4
Q
Scenario: A 10-year-old cat presents with a history of chronic vomiting and weight loss. Abdominal ultrasound reveals thickening of the stomach wall.
Lead-in: Which of the following is the most likely cause of this cat’s clinical signs?
Options:
a) Inflammatory bowel disease
b) Gastric foreign body
c) Neoplasia
d) Pancreatitis
e) Hyperthyroidism
A
Answer: c) Neoplasia
Explanation: Neoplasia, or cancer, can cause thickening of the stomach wall and lead to chronic vomiting and weight loss in cats.
5
Q
Scenario: A 4-year-old West Highland White Terrier presents with a history of acute onset vomiting and anorexia. The dog is otherwise healthy and has no other clinical signs.
Lead-in: Which of the following is the most likely cause of this dog’s clinical signs?
Options:
a) Dietary indiscretion
b) Gastroenteritis
c) Oesophageal foreign body
d) Pancreatitis
e) Peritonitis
A
Answer: a) Dietary indiscretion
Gastroenteritis would likely present with diarrhoea as well.
Oesphageal foreign body would present with regurgitaiton rather than vomitting.
Pancreatitis is a more severe disease with lethargy and abdominal pain (+/- D++)
Peritonitis would cause severe systemic disease.
6
Q
Scenario: A 10-year-old Labrador Retriever presents with a history of chronic vomiting and weight loss. The dog is otherwise healthy and has no other clinical signs.
Lead-in: Which of the following is the most likely cause of this dog’s clinical signs?
Options:
a) Dietary indiscretion
b) Inflammatory bowel disease
c) Gastric foreign body
d) Neoplasia
e) Pancreatitis
A
Answer: d) Neoplasia
Explanation: Neoplasia, or cancer, is a common cause of chronic vomiting and weight loss in older dogs.
7
Q
Scenario: A 4-year-old Domestic Shorthair cat presents with a history of acute onset vomiting and anorexia following treatment for an upper respiratory infection.
Lead-in: Which of the following is the most likely cause of this cat’s clinical signs?
Options:
a) Marbofloxacin -induced oesophagitis
b) Amoxicillin-induced oesophagitis
c) Clindamycin-induced oesophagitis
d) Cefovecin-induced oesophagitis
e) Doxycycline-induced oesophagitis
A
Answer: e) Doxycycline-induced oesophagitis
Explanation: Doxycycline is a common antibiotic that can cause oesophagitis in cats, leading to acute onset vomiting and anorexia.
Clindamycin is thought to cause it as well but this is less common.
8
Q
Scenario: A 7-year-old Persian cat presents with a history of chronic regurgitation and weight loss. The cat is otherwise healthy and has no other clinical signs.
Lead-in: Which of the following is the most likely cause of this cat’s clinical signs?
Options:
a) Megaesophagus
b) Oesophageal foreign body
c) Oesophagitis
d) Hiatal hernia
e) Pericardio-peritoneal diaphragmatic hernia (PPDH)
A
Answer: a) Megaoesphagus
Pericardio-peritoneal diaphragmatic hernia (PPDH) – Unlikely, though seen more in cats than it is dogs.
PPDH is congenital and may cause respiratory signs, gastrointestinal signs, or cardiac issues, depending on severity.
Chronic regurgitation is not a primary feature unless the hernia compresses the oesophagus significantly.
9
Q
Scenario: A 7-year-old Cocker Spaniel presents with a history of regurgitation of undigested food. The dog is otherwise BAR. Thoracic radiographs reveal a dilated oesophagus.
Lead-in: Which of the following treatment options is most likely to be successful in the long-term management of this dog?
Options:
a) Surgical correction of a vascular ring anomaly
b) Omeprazole (20mg, once daily)
c) Metoclopramide (5mg/kg, three times daily)
d) Dietary modification and management of aspiration pneumonia
e) Prednisolone (1mg/kg, once daily)
A
Answer: d) Dietary modification and management of aspiration pneumonia
Explanation: The dog most likely has megaoesophagus, which is often idiopathic in adult dogs. Management of this condition focuses on increasing the passage of food into the stomach by altering the consistency of food and feeding the dog from a height. Aspiration pneumonia is a common complication of megaoesophagus and should be treated promptly.
10
Q
Scenario: A 5-week-old male entire Labrador Retriever puppy presents with a 2-week history of vomiting, which occurs shortly after feeding. The puppy is losing weight.
Lead-in: Which of the following is the most likely cause of this puppy’s clinical signs?
Options:
a) Dietary indiscretion
b) Inflammatory bowel disease
c) Gastric foreign body
d) Persistent right aortic arch
e) Pancreatitis
A
Answer: d) Persistent right aortic arch
Explanation: Labrador Retrievers are predisposed to persistent right aortic arch, which causes regurgitation as the oesophagus is entrapped. This condition typically presents at the time of weaning, when the puppy transitions to solid food.
11
Q
Scenario: A 2-year-old cat presents with a history of vomiting and dullness. The cat is 8% dehydrated. Haematology reveals a PCV of 58% and TPP of 90 g/L. Biochemistry reveals a potassium of 2.2 mmol/L.
Lead-in: Which of the following treatment options is most appropriate for this cat?
Options:
a) Maropitant (1mg/kg, SC)
b) Metoclopramide (0.2 mg/kg, IV, three times daily)
c) Intravenous fluid therapy with Hartmann’s solution
d) Sucralfate (1g, three times daily)
e) Referral for surgical removal of a foreign body
A
Answer: c) Intravenous fluid therapy with Hartmann’s solution
Explanation: The cat is hypokalaemic and significantly dehydrated, so intravenous fluid therapy is the most appropriate treatment. Hartmann’s is appropriate as it is a balanced electrolyte solution.
12
Q
Scenario: A 10-year-old female spayed Domestic Shorthair cat is presented with a 3-month history of vomiting and weight loss. The cat is currently on a hypoallergenic diet, but has not shown any improvement.
Lead-in: Which of the following would be the most appropriate next step in the investigation of this cat’s vomiting?
Options:
a) Change to a different hypoallergenic diet
b) Start treatment with prednisolone
c) Perform abdominal radiography
d) Perform upper gastrointestinal endoscopy
e) Perform exploratory laparotomy
A
Answer: d) Perform upper gastrointestinal endoscopy
Explanation: Upper gastrointestinal endoscopy allows for direct visualisation of the oesophagus, stomach, and duodenum, and can help to identify any abnormalities, such as inflammatory bowel disease, foreign bodies, or masses. Biopsies can also be collected for histopathology, which can be helpful in reaching a definitive diagnosis. Radiography could be done while the cat is under GA but radiography on its own provides less diagnostic value (shows masses/osbtructions, +/- structural defects)
13
Q
Scenario: A 3-year-old male neutered domestic shorthair cat presents with a history of chronic small bowel diarrhoea.
Lead-in: Which finding on histopathology would support a diagnosis of inflammatory bowel disease?
a) Villous blunting and fusion
b) Crypt necrosis and neutrophilic infiltration
c) Granulomatous inflammation with multinucleated giant cells
d) Crypt hyperplasia with protozoal organisms
e) Lymphatic dilation with lipid-laden macrophages
A
Answer: a) Villous blunting and fusion
Explanation: IBD is histopathologically confirmed by the presence of inflammatory cells in the intestinal mucosa, which can lead to architectural changes like villous blunting and fusion.
Crypt necrosis + neutrophils = bacterial infection
Granulomatous = FIP
Protazoal organisms = coccidia, giardia
Lymphatic drainage = lymphangiectasia = PLE
14
Q
Scenario: A 5-year-old Labrador Retriever presents with chronic diarrhoea and weight loss despite polyphagia.
Lead-in: Which diagnostic test would be most helpful in determining the underlying cause of the dog’s diarrhoea?
Options:
a) Faecal flotation
b) Abdominal radiography
c) Serum trypsin-like immunoreactivity (TLI)
d) Colonoscopy
e) ACTH stimulation test
A
Answer: c) Serum trypsin-like immunoreactivity (TLI)
Explanation: The dog’s clinical signs are suggestive of exocrine pancreatic insufficiency (EPI), and a low serum TLI is highly sensitive and specific for diagnosing EPI.
15
Q
Scenario: A 7-year-old German Shepherd Dog presents with a history of chronic small bowel diarrhoea.
Lead-in: Which of the following is the most likely primary cause of the dog’s diarrhoea?
Options:
a) Food responsive enteropathy
b) Lymphoma
c) Pancreatitis
d) Hypoadrenocorticism
e) Campylobacter infection
A
Answer: a) Food responsive enteropathy
Explanation: Food responsive enteropathy is the most common primary cause of chronic diarrhoea in dogs
16
Q
Scenario: A 2-year-old Boxer presents with a history of chronic large bowel diarrhoea and haematochezia.
Lead-in: Which of the following diagnostic tests would be most helpful in determining the underlying cause of the dog’s diarrhoea?
Options:
a) Faecal culture for Clostridium perfringens
b) Colonoscopy with histopathology
c) Serum folate and cobalamin levels
d) ACTH stimulation test
e) Abdominal ultrasound
A
Answer: b) Colonoscopy with histopathology
Explanation: Colonoscopy with histopathology is the most direct way to visualise the colonic mucosa and identify any abnormalities, such as inflammatory bowel disease or neoplasia.
17
Q
Scenario: A 6-month-old kitten presents with a history of chronic small bowel diarrhoea and weight loss.
Lead-in: Which of the following is the most likely cause of the kitten’s diarrhoea?
Options:
a) Intestinal parasites
b) Inflammatory bowel disease
c) Exocrine pancreatic insufficiency
d) Hypoadrenocorticism
e) Dietary indiscretion
A
Answer: a) Intestinal parasites
Explanation: Intestinal parasites are a common cause of chronic diarrhoea in kittens.
18
Q
Scenario: A 9-year-old Labrador Retriever presents with a history of chronic small bowel diarrhoea and weight loss.
Lead-in: Which of the following is the most important initial step in the management of the dog’s diarrhoea?
Options:
a) Start treatment with prednisolone
b) Perform abdominal radiography
c) Change to a hypoallergenic diet
d) Perform faecal culture and sensitivity
e) Start treatment with metronidazole
A
Answer: c) Change to a hypoallergenic diet
Explanation: A significant proportion of dogs with chronic enteropathy will respond to a hypoallergenic diet, so this is an important initial step in management.
19
Q
Scenario: A 12-year-old Yorkshire Terrier presents with a history of lethargy, chronic small bowel diarrhoea, vomitting and weight loss.
Lead-in: Which of the following diagnostic tests would be most helpful in determining the underlying cause of the dog’s diarrhoea?
Options:
a) Faecal flotation
b) Abdominal radiography
c) Serum trypsin-like immunoreactivity (TLI)
d) Colonoscopy
e) ACTH stimulation test
A
Answer: e) ACTH stimulation test
Explanation: The dog’s age and clinical signs raise the suspicion of hypoadrenocorticism, which can be diagnosed with an ACTH stimulation test.
A) Parasites = acute signs
B) Radiograph = could detect masses (older dog, could be neoplasia)
C) EPI = No mention of normal appetite
D) This would be for investigating large bowel diarrhoea
20
Q
Scenario: A 6-year-old German Shepherd Dog presents with a history of chronic small bowel diarrhoea and weight loss.
Lead-in: Which of the following is the most important initial step in the management of the dog’s diarrhoea?
Options:
a) Start treatment with prednisolone
b) Perform abdominal radiography
c) Change to a hypoallergenic diet
d) Perform faecal culture and sensitivity
e) Start treatment with metronidazole
A
Answer: c) Change to a hypoallergenic diet
Explanation: A hypoallergenic diet trial is the most important initial step in managing chronic diarrhoea in dogs, as it can help identify food responsive enteropathy.
21
Q
Scenario: A 3-year-old Miniature Schnauzer presents with acute onset of profuse bloody diarrhoea and haemoconcentration. There are no other abnormalities on haematology.
Lead-in: Which of the following is the most likely diagnosis?
Options:
a) Parvovirus enteritis
b) Haemorrhagic gastroenteritis (HGE)
c) Intussusception
d) Inflammatory bowel disease
e) Pancreatitis
A
Answer: b) Haemorrhagic gastroenteritis (HGE)
Explanation: HGE is characterized by acute profuse bloody diarrhoea and haemoconcentration, often with a high PCV. Unlike parvovirus, there is no pancytopaenia with HGE.
22
Q
Scenario: A 4-month-old kitten presents with acute onset of diarrhoea.
Lead-in: Which of the following is the most likely infectious cause of the kitten’s diarrhoea?
Options:
a) Campylobacter jejuni
b) Clostridium perfringens
c) Feline panleucopenia virus
d) Salmonella species
e) Tritrichomonas foetus
A
Answer: c) Feline panleucopenia virus
Explanation: Feline panleucopenia virus is a common cause of acute diarrhoea in kittens.
23
Q
Scenario: A 1-year-old dog is diagnosed with parvovirus enteritis.
Lead-in: Which of the following is the most important component of the treatment plan?
Options:
a) Antibiotic therapy
b) Corticosteroid therapy
c) Dietary change
d) Fluid therapy
e) Probiotic therapy
A
Answer: d) Fluid therapy
Explanation: Fluid therapy is crucial for correcting dehydration and electrolyte imbalances in dogs with parvovirus enteritis
24
Q
Scenario: A dog presents with chronic diarrhoea. Blood tests reveal hypoalbuminemia and hypocholesterolemia.
Lead-in: Which of the following is the most likely cause of these findings?
Options:
a) Acute pancreatitis
b) Dietary indiscretion
c) Giardia infection
d) Protein-losing enteropathy (PLE)
e) Salmonellosis
A
Answer: d) Protein-losing enteropathy (PLE)
Explanation: PLE is characterized by the loss of both albumin and globulins through the gastrointestinal tract, leading to hypoalbuminemia and hypocholesterolemia.
25
Scenario: A cat presents with chronic small bowel diarrhoea.
Lead-in: Which of the following biochemistry results would be most consistent with this condition?
Options:
a) Hypercalcemia
b) Hypokalemia
c) Hyponatremia
d) Hypoalbuminemia
e) Hyperglycemia
Answer: d) Hypoalbuminemia
Explanation: Chronic diarrhoea can lead to protein loss through the gastrointestinal tract, resulting in hypoalbuminemia.
26
Scenario: A 2-year-old German Shepherd Dog presents with a 6-month history of intermittent small bowel diarrhoea. Multiple faecal flotations have been negative for parasites.
Lead-in: Which of the following is the most likely reason for the negative faecal results?
Options:
a) Giardia cysts are too small to be detected by flotation.
b) Giardia trophozoites are the only diagnostic stage.
c) Giardia cysts are shed intermittently.
d) The dog has been treated for giardia previously.
e) The dog is not infected with giardia.
Answer: c) Giardia cysts are shed intermittently.
Explanation: Giardia cysts can be shed intermittently, making diagnosis challenging even with repeated faecal flotations.
27
Scenario: A 5-year-old cat presents with a 3-month history of large bowel diarrhoea. A diagnosis of giardia infection is confirmed.
Lead-in: Which of the following is the most appropriate treatment?
Options:
a) Fenbendazole
b) Metronidazole
c) Prednisolone
d) Ronidazole
e) Tylosin
A is the licenced treatment.
28
Based off the findings of this image, which differential is most likely:
a) Canine parvovirus.
b) Guardia.
c) Clostridial spp.
d) Salmonella spp.
e) Adenovirus
Parvo
29
Scenario: A 9-week-old Labrador Retriever puppy presents with a 2-day history of profuse haemorrhagic diarrhoea, vomiting, and lethargy. The puppy is pyrexic (40°C) and tachycardic (160 bpm). Mucous membranes are pale with a prolonged capillary refill time (3 seconds).
Lead-in: Which of the following is the most appropriate treatment plan for this puppy?
Options:
a) Hartmann's solution to effect, metoclopramide CRI, amoxicillin-clavulanate IV, maropitant SC
b) 0.9% saline to effect, ondansetron IV, metronidazole IV, omeprazole PO
c) Hartmann's solution to effect, maropitant SC, amoxicillin-clavulanate IV, sucralfate PO
d) Plasma transfusion, metoclopramide CRI, enrofloxacin IV, omeprazole PO
e) Hartmann's solution to effect, ondansetron IV, amoxicillin-clavulanate IV, maropitant SC
Answer: e) Hartmann's solution to effect, ondansetron IV, amoxicillin-clavulanate IV, maropitant SC
Explanation: The puppy's clinical presentation is consistent with severe parvovirus enteritis with potential sepsis. The treatment plan should include aggressive fluid therapy with Hartmann's solution to correct dehydration, electrolyte imbalances, and acidosis. Ondansetron is a potent antiemetic that can be administered intravenously to control vomiting and nausea. Broad-spectrum antibiotics like amoxicillin-clavulanate are crucial to address potential secondary bacterial infections due to the compromised GI mucosal barrier. Maropitant is another effective antiemetic that can be given subcutaneously for prolonged control of vomiting.
Why the other options are incorrect:
a) Hartmann's solution to effect, metoclopramide CRI, amoxicillin-clavulanate IV, maropitant SC: Metoclopramide, a prokinetic drug, may be contraindicated in severe gastroenteritis due to the risk of exacerbating intestinal inflammation and potential perforation.
b) 0.9% saline to effect, ondansetron IV, metronidazole IV, omeprazole PO: While 0.9% saline is suitable for rehydration, metronidazole is not the first-line antibiotic for secondary bacterial infections in parvovirus enteritis. Omeprazole, a proton pump inhibitor, is not indicated in the acute management of parvovirus.
c) Hartmann's solution to effect, maropitant SC, amoxicillin-clavulanate IV, sucralfate PO: Sucralfate is not as effective as other antiemetics in controlling vomiting in parvovirus enteritis.
d) Plasma transfusion, metoclopramide CRI, enrofloxacin IV, omeprazole PO: While plasma transfusion may be considered in cases of severe hypoproteinaemia or extensive blood loss, it is not the most important initial component of the treatment plan. Metoclopramide and enrofloxacin are not the preferred choices in this case.
30
Scenario: A 4-year-old male neutered Jack Russell Terrier presents with a 2-day history of profuse watery diarrhoea, vomiting, and anorexia. He has a packed cell volume (PCV) of 65% and a total protein (TP) of 54 g/L. A complete blood count reveals no leukopenia.
Lead-in: Which of the following is the most likely diagnosis?
Options:
a) Canine parvovirus enteritis
b) Acute haemorrhagic diarrhoea syndrome (AHDS)
c) Hypoadrenocorticism
d) Pancreatitis
e) Intussusception
Answer: b) Acute haemorrhagic diarrhoea syndrome (AHDS)
Explanation: The dog's clinical presentation of acute onset profuse watery diarrhoea, vomiting, and haemoconcentration (elevated PCV) with normal TP and no leukopenia is most consistent with AHDS (also known as HGE).
31
A 1-year-old male neutered Cocker Spaniel presents with a one-week history of progressive lethargy, inappetence, and vomiting. On physical examination, you note marked jaundice and abdominal distension with a fluid wave. Serum biochemistry reveals a total bilirubin of 150 µmol/L, elevated ALT (450 IU/L), AST (350 IU/L), ALP (600 IU/L), and a decreased albumin of 20 g/L. Abdominal ultrasound reveals a small amount of free fluid and a tortuous vessel entering the caudal vena cava.
Lead-in: The most likely diagnosis in this case is:
Options:
a) Acute hepatitis
b) Extrahepatic biliary obstruction
c) Congenital portosystemic shunt
d) Hepatic neoplasia with metastasis
e) Gallbladder mucocele rupture
Answer: c) Congenital portosystemic shunt
Explanation: The combination of jaundice, elevated liver enzymes, low albumin, ascites, and the ultrasound finding of a tortuous vessel entering the caudal vena cava strongly suggests a congenital portosystemic shunt. While other options could cause jaundice and elevated enzymes, the specific ultrasound finding and the young age make a shunt most likely.
32
Scenario: A 12-year-old spayed female West Highland White Terrier presents with a chronic history of intermittent vomiting and diarrhoea. Over the past month, the owner has noticed progressive lethargy and increased thirst. On examination, the dog is jaundiced. Serum biochemistry reveals elevated ALT (300 IU/L), ALP (750 IU/L), and total bilirubin (90 µmol/L). Bile acid stimulation test shows markedly elevated pre- and post-prandial bile acid concentrations. Liver biopsy reveals periportal fibrosis and copper accumulation.
Lead-in: The most appropriate long-term management for this patient would include:
Options:
a) Prednisolone and ursodeoxycholic acid
b) Dietary protein restriction and lactulose
c) Copper chelating agents and a low-copper diet
d) S-adenosylmethionine (SAMe) and vitamin E supplementation
e) Antibiotics and corticosteroids
Answer: c) Copper chelating agents and a low-copper diet
Explanation: The breed predisposition (West Highland White Terrier), chronic signs, elevated bile acids, and biopsy findings of periportal fibrosis and copper accumulation are consistent with copper storage hepatopathy. The mainstay of long-term treatment is to reduce copper accumulation using chelating agents and a low-copper diet.
33
A 7-year-old castrated male Domestic Shorthair cat presents with acute onset of anorexia and lethargy. Physical examination reveals marked jaundice. Serum biochemistry shows a total bilirubin of 200 µmol/L, markedly elevated ALT (1200 IU/L) and AST (800 IU/L), and normal ALP and GGT. Urine analysis reveals bilirubinuria.
Lead-in: Based on these findings, the most likely cause of jaundice in this cat is:
Options:
a) Feline infectious peritonitis (FIP)
b) Hepatic lipidosis
c) Cholangitis/cholangiohepatitis
d) Acute viral hepatitis
e) Haemolytic anaemia
Answer: b) Hepatic lipidosis
Explanation: The acute onset of anorexia and lethargy in an obese cat, along with marked jaundice, very high transaminases (ALT and AST), relatively normal cholestatic enzymes (ALP and GGT), and bilirubinuria, is highly suggestive of hepatic lipidosis.
34
Scenario: A dog with confirmed leptospirosis is being treated with intravenous ampicillin. After 48 hours of treatment, the dog's jaundice has not improved, and its renal parameters (urea and creatinine) have worsened.
Lead-in: Which of the following would be the most appropriate next step in managing this patient's antibiotic therapy, considering UK licensing and EMA antibiotic categorisation?
Options:
a) Continue intravenous ampicillin at the same dose for another 48 hours.
b) Switch to oral doxycycline once the dog can tolerate oral medication.
c) Switch to intravenous enrofloxacin.
d) Add subcutaneous gentamicin to the current ampicillin therapy.
e) Discontinue antibiotics and provide supportive care only.
Answer: b) Switch to oral doxycycline once the dog can tolerate oral medication.
Explanation: While ampicillin is a suitable initial choice for leptospirosis, if there is no improvement or worsening after 48 hours, switching to doxycycline is often recommended for the second phase of treatment, especially if the dog can take oral medication. Enrofloxacin and gentamicin are higher category antibiotics and should be reserved for more resistant cases or if doxycycline is contraindicated.
35
A 4-year-old Beagle presents with a history of intermittent abdominal pain and vomiting. On physical examination, there is mild jaundice. Serum biochemistry reveals mildly elevated ALT and ALP, and a moderate increase in total bilirubin. Abdominal ultrasound shows a thickened gallbladder wall and immobile echogenic material within the gallbladder lumen.
Lead-in: The most likely diagnosis is:
Options:
a) Acute cholecystitis
b) Gallbladder mucocele
c) Extrahepatic biliary obstruction due to pancreatitis
d) Hepatic neoplasia
e) Immune-mediated hepatitis
Answer: b) Gallbladder mucocele
Explanation: The combination of clinical signs (intermittent abdominal pain, vomiting, mild jaundice) and the characteristic ultrasound findings of a thickened gallbladder wall and immobile echogenic material ("kiwi fruit" appearance) are highly suggestive of a gallbladder mucocele.
36
Scenario: A jaundiced cat has a serum total bilirubin level of 120 µmol/L. Further investigation reveals elevated ALP and GGT, and abdominal ultrasound shows dilation of the common bile duct.
Lead-in: The most likely cause of this cat's jaundice is:
Options:
a) Haemolytic anaemia
b) Hepatic lipidosis
c) Extrahepatic biliary obstruction
d) Acute viral hepatitis
e) Immune-mediated cholangitis
Answer: c) Extrahepatic biliary obstruction
Explanation: The combination of jaundice, elevated cholestatic enzymes (ALP and GGT), and dilation of the common bile duct on ultrasound strongly indicates an obstruction in the flow of bile out of the liver.
37
A dog with chronic hepatitis is being managed with prednisolone and azathioprine. The owner reports that the dog has become increasingly lethargic and inappetent over the past few days, and you note mild jaundice on examination. Serum biochemistry reveals a significant increase in ALT and bilirubin compared to previous levels.
Lead-in: The most likely reason for this recent deterioration is:
Options:
a) Progression of the underlying chronic hepatitis
b) Development of pancreatitis secondary to medication
c) Drug-induced hepatotoxicity from azathioprine
d) Development of a portosystemic shunt
e) An unrelated episode of acute gastroenteritis
Answer: c) Drug-induced hepatotoxicity from azathioprine
Explanation: Azathioprine is an immunosuppressant used in the treatment of chronic hepatitis but is known to have potential hepatotoxic side effects. The recent worsening of liver parameters (ALT and bilirubin) in a dog already being treated for chronic hepatitis with this medication makes drug-induced hepatotoxicity a strong possibility.
38
A 10-year-old Labrador Retriever presents with a history of polyuria, polydipsia, and weight loss. On physical examination, you note mild jaundice. Serum biochemistry reveals elevated ALP and GGT, and a mildly elevated glucose. Bile acid stimulation test is normal. Abdominal ultrasound is unremarkable.
Lead-in: Based on these findings, which of the following is the least likely differential diagnosis for the jaundice?
Options:
a) Hepatocutaneous syndrome
b) Endocrine-associated hepatopathy (e.g., Cushing's disease)
c) Leptospirosis
d) Pancreatic carcinoma causing biliary obstruction
e) Idiopathic chronic hepatitis
Answer: c) Leptospirosis
Explanation: While leptospirosis can cause jaundice and elevated liver enzymes, the history of polyuria, polydipsia, weight loss, and mildly elevated glucose, along with normal bile acids and unremarkable ultrasound, makes endocrine-associated hepatopathy (like Cushing's disease) or hepatocutaneous syndrome more likely. Pancreatic carcinoma causing biliary obstruction and idiopathic chronic hepatitis are also possibilities. Leptospirosis typically presents with more acute signs and often renal involvement.
39
Scenario: A cat with suspected cholangitis is being considered for antibiotic therapy. The cat weighs 4 kg.
Lead-in: Which of the following antibiotic options would be the most appropriate first-line choice for this condition, considering UK licensing and EMA antibiotic categorisation?
Options:
a) Intravenous gentamicin at 5 mg/kg once daily.
b) Oral amoxicillin-clavulanate at 12.5 mg/kg twice daily.
c) Oral enrofloxacin at 5 mg/kg once daily.
d) Subcutaneous cefovecin at 8 mg/kg once.
e) Oral metronidazole at 10 mg/kg twice daily.
Answer: b) Oral amoxicillin-clavulanate at 12.5 mg/kg twice daily.
Explanation: Amoxicillin-clavulanate has good efficacy against common bacterial causes of cholangitis in cats and is often a first-line choice. Gentamicin and enrofloxacin are higher category antibiotics. Cefovecin is a long-acting injectable antibiotic and might be considered later but isn't typically first-line. Metronidazole is often used in combination with other antibiotics for cholangitis but not usually as a sole first-line agent.
40
Scenario: A dog with a known liver tumour develops sudden onset of severe abdominal pain and collapse. On physical examination, the abdomen is tense and painful on palpation, and the mucous membranes are pale.
Lead-in: The most likely complication that has occurred is:
Options:
a) Rupture of the liver tumour with haemorrhage
b) Development of acute pancreatitis
c) Torsion of a liver lobe
d) Metastasis of the tumour to the spleen with splenic rupture
e) Acute portal vein thrombosis
Answer: a) Rupture of the liver tumour with haemorrhage
Explanation: The sudden onset of severe abdominal pain, collapse, and pale mucous membranes in a dog with a known liver tumour strongly suggests rupture of the tumour and subsequent intra-abdominal haemorrhage.
41
Scenario: A cat with hepatic encephalopathy is being treated with lactulose.
Lead-in: What is the primary mechanism by which lactulose helps to reduce the clinical signs of hepatic encephalopathy?
Options:
a) It directly neutralizes ammonia in the bloodstream.
b) It increases the intestinal transit time, reducing ammonia absorption.
c) It acidifies the colonic contents, trapping ammonia as ammonium.
d) It stimulates the growth of beneficial gut bacteria that metabolize ammonia.
e) It inhibits the production of urea in the liver.
Answer: c) It acidifies the colonic contents, trapping ammonia as ammonium.
Explanation: Lactulose is a non-absorbable disaccharide that is metabolised by colonic bacteria to produce organic acids, lowering the colonic pH. This acidic environment traps ammonia (NH3) as ammonium (NH4+), which is poorly absorbed and is then excreted in the faeces.
42
Scenario: A liver biopsy from a dog reveals a lymphocytic portal hepatitis with piecemeal necrosis.
Lead-in: This histological pattern is most consistent with:
Options:
a) Acute toxic hepatopathy
b) Nodular hyperplasia
c) Chronic immune-mediated hepatitis
d) Hepatic amyloidosis
e) Metastatic neoplasia
Answer: c) Chronic immune-mediated hepatitis
Explanation: Lymphocytic portal hepatitis with piecemeal necrosis is a characteristic histological finding in chronic immune-mediated hepatitis in dogs.
43
Scenario: You are presented with a jaundiced cat. Initial bloodwork reveals elevated total bilirubin, ALT, AST, and ALP. You perform an abdominal ultrasound that shows no evidence of biliary obstruction. Cytology of a fine-needle aspirate of the liver reveals neutrophils and bacteria.
Lead-in: The most likely diagnosis is:
Options:
a) Hepatic lipidosis
b) Lymphoma
c) Neutrophilic cholangitis
d) Feline infectious peritonitis (FIP)
e) Amyloidosis
Answer: c) Neutrophilic cholangitis
Explanation: The combination of jaundice, elevated liver enzymes (including ALP), absence of biliary obstruction on ultrasound, and the finding of neutrophils and bacteria on liver cytology strongly supports a diagnosis of neutrophilic cholangitis.
44
Scenario: A dog with known liver disease presents with a sudden onset of neurological signs including disorientation, head pressing, and seizures.
Lead-in: Which of the following blood parameters would be most helpful in confirming hepatic encephalopathy as the cause of these signs?
Options:
a) Serum albumin
b) Serum creatinine
c) Blood glucose
d) Arterial ammonia
e) Serum bile acids
Answer: d) Arterial ammonia
Explanation: Hepatic encephalopathy is caused by the accumulation of neurotoxins in the bloodstream due to liver dysfunction. Ammonia is a key neurotoxin, and measuring arterial ammonia levels can help confirm the diagnosis.
45
Scenario: A 5-year-old Border Collie presents with jaundice and a history of recent weight loss. Serum biochemistry reveals elevated ALT, ALP, and total bilirubin. Genetic testing reveals a mutation associated with copper storage disease in this breed.
Lead-in: Which of the following dietary recommendations would be most appropriate for the long-term management of this dog?
Options:
a) A high-protein, low-fat diet
b) A low-protein, high-fibre diet
c) A diet restricted in copper
d) A diet supplemented with B vitamins
e) A highly digestible, bland diet
Answer: c) A diet restricted in copper
Explanation: Border Collies are predisposed to copper storage disease. The primary dietary recommendation for long-term management is a diet that is restricted in copper to help reduce the accumulation of copper in the liver.
46
A 9-year-old Great Dane presents with a sudden onset of abdominal distension and non-productive retching. On physical examination, the heart rate is 140 bpm, mucous membranes are pale, and a tympanic resonance is noted on abdominal percussion.
Lead-in: The most appropriate initial diagnostic step in this case is:
Options:
a) Abdominal ultrasound
b) Survey abdominal radiographs (right lateral view)
c) Complete blood count and biochemistry panel
d) Thoracic radiographs
e) Arterial blood gas analysis
Answer: b) Survey abdominal radiographs (right lateral view)
Explanation: The clinical signs are highly suggestive of gastric dilatation-volvulus (GDV). A right lateral abdominal radiograph is the most appropriate initial diagnostic step to confirm the diagnosis by visualizing the characteristic "Smurf hat" or "boxing glove" appearance of the gas-filled, rotated stomach.
47
During surgery to correct a gastric dilatation-volvulus in a 50kg Labrador, the surgeon notes that a portion of the stomach wall appears devitalized.
Lead-in: Which of the following would be the most appropriate next surgical step?
Options:
a) Perform a tube gastrostomy
b) Perform a splenectomy
c) Perform a partial gastrectomy
d) Perform an incisional gastropexy only
e) Administer intravenous antibiotics and close the abdomen
Answer: c) Perform a partial gastrectomy
Explanation: Devitalized stomach wall indicates necrosis and poses a risk of perforation and peritonitis. Partial gastrectomy to remove the affected tissue is necessary to improve the prognosis.
48
A 6-year-old spayed female Boxer presents with a two-day history of lethargy, inappetence, and abdominal pain. On physical examination, her temperature is 39.5°C, heart rate is 110 bpm, and the abdomen is diffusely painful on palpation. Abdominal ultrasound reveals the presence of free fluid with increased echogenicity.
Lead-in: The most likely type of fluid present in the abdomen is:
Options:
a) Transudate
b) Modified transudate
c) Exudate
d) Haemorrhage
e) Urine
Answer: c) Exudate
Explanation: The presence of abdominal pain, fever, and free fluid with increased echogenicity on ultrasound suggests inflammation and infection within the abdomen, consistent with an exudate.
49
A cat is presented with a history of anorexia and lethargy. On physical examination, you note a large volume of free abdominal fluid. Abdominocentesis reveals a fluid with a creatinine concentration four times that of the serum creatinine concentration.
Lead-in: The most likely diagnosis is:
Options:
a) Septic peritonitis
b) Haemoabdomen
c) Uroabdomen
d) Bile peritonitis
e) Feline infectious peritonitis (FIP) effusion
Answer: c) Uroabdomen
Explanation: A creatinine concentration in the abdominal fluid significantly higher than that in serum is diagnostic for uroabdomen, indicating leakage of urine into the abdominal cavity.
50
A 2-year-old male neutered Domestic Shorthair cat is brought to the clinic after being witnessed ingesting antifreeze (ethylene glycol) approximately 30 minutes prior to presentation. The cat is currently bright and alert with no obvious clinical signs.
Lead-in: The most appropriate immediate treatment would be:
Options:
a) Administration of intravenous fluids and monitoring
b) Induction of emesis followed by activated charcoal administration
c) Administration of fomepizole intravenously
d) Administration of ethanol intravenously
e) Immediate peritoneal dialysis
Answer: b) Induction of emesis followed by activated charcoal administration
Explanation: Given the recent ingestion (within 1-2 hours) and lack of clinical signs, the immediate priority is to try and remove the toxin from the body. Induction of emesis is indicated, followed by activated charcoal to adsorb any remaining toxin in the gastrointestinal tract. Fomepizole is an antidote for ethylene glycol toxicity in dogs but is less effective in cats. Ethanol is also an antidote but has a narrow margin of safety.
51
A dog presents with a tense, painful abdomen and is in shock. Point-of-care ultrasound (POCUS) reveals the presence of a large amount of free fluid that appears anechoic. Abdominocentesis yields a sample of frank blood with a PCV similar to peripheral blood.
Lead-in: The most likely cause of this presentation is:
Options:
a) Septic peritonitis
b) Uroabdomen
c) Haemoabdomen
d) Bile peritonitis
e) Pancreatitis
Answer: c) Haemoabdomen
Explanation: The presence of a large amount of free blood in the abdomen, as indicated by the anechoic fluid on ultrasound and the high PCV of the abdominal fluid, confirms a haemoabdomen.
52
Scenario: Presents with severe abdominal pain, there is no history aside from a resent deep pyoderma which resolved with Co-Amoxiclav 2 months ago. You diagnose septic peritonitis secondary to a perforated duodenal ulcer. The dog weighs 15 kg.
Lead-in: Which of the following antibiotic combinations would be the most appropriate initial treatment?
Options:
a) Intravenous amoxicillin and metronidazole.
b) Intravenous Co-Amoxiclav, enrofloxacin and metronidazole
c) Intravenous cefuroxime
d) Intravenous gentamicin and penicillin G
e) Intravenous Co-Amoxiclav and Metronidazole.
Answer B.
Explanation, the treatment for septic peritonitis with a perforated colon is as follows:
Septic peritonitis:
Amoxicillin/clavulanate 20 mg/kg IV q8h
ADD fluoroquinolone if recent (<3 months) beta lactam administration
If amoxicillin/clavulanate unavailable
Cefuroxime 20 mg/kg IV q8h AND clindamycin 11 mg/kg IV q12h OR
metronidazole 10 mg/kg IV q12h
If colonic perforation
ADD metronidazole 10 mg/kg IV q12h
Definitive source control essential as soon as possible
Transition to oral administration when clinical signs improve.
53
Scenario: Following surgical correction of a gastric dilatation-volvulus, a dog develops ventricular tachycardia.
Lead-in: Which of the following medications is the most appropriate first-line treatment for this arrhythmia in this setting?
Options:
a) Atropine
b) Lidocaine
c) Digoxin
d) Diltiazem
e) Propranolol
Answer: b) Lignocaine (Lidocaine)
Explanation: Ventricular tachycardia is a common and potentially life-threatening complication following GDV surgery, often due to splenic torsion and reperfusion injury. Lignocaine is the first-line antiarrhythmic drug for treating ventricular tachycardia in dogs.
54
Scenario: A cat presents with a history of lethargy and inappetence. On physical examination, you palpate a cranial abdominal mass. Abdominal ultrasound confirms a large mass associated with the liver.
Lead-in: Which of the following is the most appropriate next step in obtaining a definitive diagnosis?
Options:
a) Monitor the cat for further clinical signs
b) Perform a fine-needle aspirate of the mass
c) Start empirical treatment with corticosteroids
d) Perform a liver function test (bile acid stimulation)
e) Repeat abdominal ultrasound in one week
Answer: b) Perform a fine-needle aspirate of the mass
Explanation: To obtain a definitive diagnosis of the liver mass, cytological examination of a fine-needle aspirate is the least invasive and often most informative next step. This can help differentiate between neoplasia, inflammation, or other types of lesions.
55
Scenario: A dog is suspected of having ingested a large quantity of dark chocolate (containing theobromine) approximately 4 hours ago. The dog is a 20kg Labrador and is currently showing signs of hyperactivity and a slightly elevated heart rate.
Lead-in: Which of the following treatments is most appropriate at this stage?
Options:
a) Administer activated charcoal only
b) Induce emesis with apomorphine
c) Perform gastric lavage
d) Administer intravenous fluids and monitor
e) Administer activated charcoal and monitor cardiac function
Answer: b) Induce emesis with apomorphine
Explanation: Given the recent ingestion (within a few hours) and the onset of mild clinical signs, inducing emesis is still a beneficial step to remove as much of the toxin as possible. Apomorphine is an effective emetic agent in dogs. Activated charcoal can be given after emesis to adsorb any remaining theobromine.
56
Scenario: A cat with a history of chronic kidney disease presents with acute onset of severe vomiting and abdominal pain. On physical examination, the abdomen is tense and painful. Abdominocentesis yields a small amount of bile-stained fluid.
Lead-in: The most likely cause of this presentation is:
Options:
a) Acute pancreatitis
b) Perforation of a gastrointestinal ulcer
c) Rupture of the gallbladder or bile duct
d) Intestinal obstruction
e) Mesenteric torsion
Answer: c) Rupture of the gallbladder or bile duct
Explanation: The presence of bile-stained fluid in the abdomen (bile peritonitis) indicates a rupture of the gallbladder or bile duct, leading to severe abdominal pain and vomiting.
57
Scenario: A dog with known Addison's disease presents with acute vomiting, diarrhoea, and severe abdominal pain. Serum biochemistry reveals hyponatraemia and hyperkalaemia.
Lead-in: Which of the following is the most critical initial treatment for this patient?
Options:
a) Administration of intravenous antibiotics
b) Administration of intravenous fluids with glucocorticoid supplementation
c) Administration of anti-emetics and analgesics
d) Abdominal radiography to rule out obstruction
e) Dietary management with bland food
Answer: b) Administration of intravenous fluids with glucocorticoid supplementation
Explanation: The clinical signs and electrolyte abnormalities (hyponatraemia and hyperkalaemia) are consistent with an Addisonian crisis, which is a life-threatening emergency. The most critical initial treatment involves rapid intravenous fluid administration and supplementation with glucocorticoids (e.g., intravenous hydrocortisone or dexamethasone) to address the adrenal insufficiency.
58
Scenario: A dog that has ingested a large amount of grapes presents to your clinic. The owner is unsure of the exact time of ingestion but estimates it to be within the last 6 hours. The dog is currently asymptomatic.
Lead-in: What is the most appropriate next step in managing this case?
Options:
a) Administer activated charcoal and monitor renal parameters.
b) Induce emesis followed by activated charcoal and monitor renal parameters.
c) Immediately start intravenous fluid therapy to protect the kidneys.
d) Monitor the dog at home for any signs of kidney disease.
e) No treatment is necessary as the dog is currently asymptomatic.
Answer: b) Induce emesis followed by activated charcoal and monitor renal parameters.
Explanation: Grapes can cause acute kidney injury in dogs. Even if the dog is asymptomatic, it is important to try and remove the toxin from the system by inducing emesis (if within a reasonable timeframe, generally a few hours) followed by activated charcoal to bind any remaining toxins. Monitoring renal parameters (urea and creatinine) is crucial to detect any kidney damage.
59
Scenario: During an exploratory laparotomy for suspected septic peritonitis, the surgeon identifies a perforated foreign body in the jejunum.
Lead-in: After removing the foreign body and performing intestinal resection and anastomosis, what is the most important step to take before closing the abdomen?
Options:
a) Place a surgical drain in the abdominal cavity.
b) Perform a thorough lavage of the abdominal cavity with sterile saline.
c) Administer a large dose of intravenous antibiotics.
d) Perform a prophylactic gastropexy.
e) Euthanize the patient due to the severity of the peritonitis.
Answer: b) Perform a thorough lavage of the abdominal cavity with sterile saline.
Explanation: In cases of septic peritonitis, thorough lavage of the abdominal cavity with sterile saline is crucial to remove as much contaminated material (bacteria, inflammatory mediators) as possible before closing the abdomen, which helps to improve the prognosis.
60
Scenario: A cat presents with a history of chronic intermittent vomiting. Radiographs reveal a possible linear foreign body. During exploratory laparotomy, a linear foreign body is found anchored at the base of the tongue and extending into the small intestine, causing plication.
Lead-in: The most appropriate surgical approach to remove this foreign body is:
Options:
a) Multiple enterotomies along the length of the plicated intestine.
b) A single enterotomy distal to the most caudal point of plication.
c) Resection and anastomosis of the affected sections of the intestine.
d) Transection of the foreign body at the base of the tongue and gentle traction.
e) A single enterotomy proximal to the most cranial point of plication.
Answer: a) Multiple enterotomies along the length of the plicated intestine.
Explanation: Linear foreign bodies cause plication of the intestines, and attempting to pull the foreign body from one end can cause significant damage and tearing. Multiple enterotomies along the plicated segments allow for the careful removal of the foreign body at several points, minimizing trauma to the intestinal wall. Resection and anastomosis might be necessary if there is devitalized tissue, but the primary approach is usually multiple enterotomies.
61
The mechanism of theobromine toxicity involves its action as a cardiac stimulant and a __________ diuretic
methylxanthine
62
In cats with paracetamol toxicity, the formation of methaemoglobin leads to __________ and cyanosis.
haemoglobinuria
63
Second-generation anticoagulant rodenticides, such as brodifacoum, have a __________ half-life, increasing the risk of prolonged bleeding.
long
64
The primary target organ for ethylene glycol toxicity is the __________, where its metabolites cause acute injury.
kidneys
65
The specific component in lilies responsible for nephrotoxicity in cats is not fully elucidated but is thought to be a __________ compound.
water-soluble
66
Besides gastrointestinal signs, ibuprofen toxicity in dogs can also cause acute __________ failure due to reduced renal blood flow.
renal
67
Ingestion of alkaline household cleaners can result in __________ necrosis of the oesophagus.
liquefactive
68
The specific tremorgenic mycotoxin commonly associated with mouldy bread and pasta is __________.
Penitrem A
69
The haemolytic anaemia caused by onion and garlic toxicity is characterised by the formation of __________ in erythrocytes.
Heinz bodies
70
Scenario: A cat presents with a history of progressive abdominal distension, lethargy, and anorexia. Abdominocentesis reveals a viscous, straw-coloured fluid with a high protein content and a positive Rivalta's test.
Lead-in: The most likely underlying pathogenesis of this effusion is:
Options:
a) Increased hydrostatic pressure due to right-sided heart failure.
b) Decreased oncotic pressure due to severe hypoproteinaemia.
c) Increased vascular permeability due to immune-mediated vasculitis.
d) Impaired lymphatic drainage secondary to neoplastic infiltration.
e) Transudation of fluid due to portal hypertension.
Answer: c) Increased vascular permeability due to immune-mediated vasculitis.
Explanation: The findings are highly suggestive of the effusive (wet) form of feline infectious peritonitis (FIP). The high protein content and positive Rivalta's test indicate an exudative effusion resulting from the characteristic immune-mediated vasculitis associated with FIP.
71
72
Scenario: A juvenile Hermann's tortoise is presented with a cloacal prolapse. On examination, the prolapsed tissue appears fresh and slightly swollen with some adhered substrate. The tortoise is moderately dehydrated and the owner reports anorexia for several weeks.
Lead-in: Which of the following is the most critical initial step in managing this tortoise?
Options:
a) Immediate surgical reduction of the prolapse.
b) Application of hyperosmolar solutions to reduce swelling.
c) Gentle cleaning of the prolapsed tissue and manual reduction.
d) Addressing the dehydration and underlying cause of anorexia.
e) Administration of broad-spectrum antibiotics.
Answer: d) Addressing the dehydration and underlying cause of anorexia.
Explanation: While addressing the prolapse is important, the underlying dehydration and anorexia are critical to the tortoise's survival. Identifying and treating the cause of the anorexia and rehydrating the tortoise should be prioritised before or alongside attempting to reduce the prolapse.
73
Scenario: A parrot presents with a chronic history of regurgitation and weight loss despite a reported adequate seed-based diet. On physical examination, the crop feels thin and flaccid, with delayed emptying. Faecal examination reveals whole, undigested seeds.
Lead-in: Which of the following is the most likely underlying cause of these clinical signs?
Options:
a) A primary bacterial infection of the crop requiring antibiotic therapy.
b) Inappropriate husbandry leading to hypovitaminosis A and squamous metaplasia.
c) An early parasitic infestation affecting the proventriculus and ventriculus.
d) Proventricular dilatation disease affecting the enteric nervous system.
e) A dietary intolerance to a specific component of the seed mix.
Answer: d) Proventricular dilatation disease affecting the enteric nervous system.
Explanation: The chronic regurgitation, weight loss, delayed crop emptying, and undigested seeds strongly suggest proventricular dilatation disease (PDD). This disease affects the enteric nervous system, leading to motility disorders of the gastrointestinal tract.
74
Scenario: A cat in a multi-cat household has been diagnosed with the non-effusive (dry) form of FIP.
Lead-in: Which of the following is the most accurate statement regarding the risk of FIP development in the other cats in the household?
Options:
a) The other cats are at high risk of developing the dry form of FIP.
b) The other cats are at high risk of developing the effusive form of FIP.
c) The other cats are at increased risk of feline enteric coronavirus (FECV) infection but not necessarily FIP.
d) The other cats have a very low risk of developing any form of FIP.
e) The other cats should be immediately isolated and treated prophylactically.
Answer: c) The other cats are at increased risk of feline enteric coronavirus (FECV) infection but not necessarily FIP.
Explanation: FIP is not directly contagious. Cats are infected with feline enteric coronavirus (FECV), and in a small percentage of cases, this virus mutates to the virulent FIP virus. Cats exposed to the same FECV strain are unlikely to transmit the mutated FIPV. However, the risk of FECV infection is higher in multi-cat environments.
75
Scenario: A dog with ascites secondary to severe hypoalbuminaemia is presented for abdominocentesis.
Lead-in: Which of the following best describes the type of fluid expected?
Options:
a) A high protein transudate with a low cellularity.
b) A low protein transudate with a low cellularity.
c) An exudate with high protein and high cellularity.
d) A modified transudate with moderate protein and cellularity.
e) Pure blood with a high PCV.
Answer: b) A low protein transudate with a low cellularity.
Explanation: Hypoalbuminaemia leads to a decrease in oncotic pressure within the blood vessels. This results in fluid leaking into the abdominal cavity, forming a protein-poor transudate with low cellularity.
76
Scenario: A rabbit presents with a history of reduced faecal output and abdominal discomfort. On physical examination, the abdomen feels firm and distended. Radiographs reveal a large amount of gas within the stomach and small intestine.
Lead-in: Which of the following is the least likely underlying cause of this presentation in a rabbit?
Options:
a) Dietary indiscretion with excessive carbohydrate intake.
b) Stress-induced gastrointestinal stasis.
c) Dental disease leading to inadequate mastication.
d) Bacterial overgrowth producing excessive gas.
e) Intussusception causing mechanical obstruction.
Answer: e) Intussusception causing mechanical obstruction.
Explanation: While intussusception can cause abdominal discomfort and reduced faecal output, the primary radiographic finding would likely be a soft tissue mass rather than a large amount of gas throughout the stomach and small intestine. The other options are more common causes of gastrointestinal stasis and gas accumulation in rabbits.
77
Scenario: A cat with suspected FIP is undergoing diagnostic testing. An abdominal effusion is present.
Lead-in: Which of the following laboratory findings in the ascitic fluid would be most supportive of a diagnosis of FIP?
Options:
a) A total protein concentration less than 25 g/L.
b) A serum amyloid A (SAA) concentration within the normal range.
c) A low albumin to globulin (A:G) ratio (e.g., <0.4).
d) A predominance of neutrophils on cytological examination.
e) A glucose concentration similar to that of serum.
Answer: c) A low albumin to globulin (A:G) ratio (e.g., <0.4).
Explanation: In FIP, the inflammatory response leads to increased globulin production, while albumin levels may decrease. This results in a characteristically low albumin to globulin (A:G) ratio in the effusion fluid.
78
Scenario: A cockatiel presents with chronic weight loss, lethargy, and regurgitation. On physical examination, the bird is thin, and the keel bone is prominent. Faecal examination reveals the presence of undigested seeds.
Lead-in: Which of the following is the most likely underlying cause of these signs?
Options:
a) Heavy metal toxicity (e.g., lead or zinc).
b) Proventricular dilatation disease (PDD).
c) Avian influenza virus infection.
d) Psittacine beak and feather disease (PBFD).
e) Vitamin A deficiency.
Answer: b) Proventricular dilatation disease (PDD).
Explanation: Chronic weight loss, lethargy, regurgitation, and the presence of undigested seeds in the faeces are classic signs of proventricular dilatation disease (PDD), a neuropathic disease affecting the gastrointestinal tract of birds, particularly psittacines.
79
Scenario: A dog with a known history of liver disease develops ascites.
Lead-in: Which of the following mechanisms is most likely contributing to the development of ascites in this dog?
Options:
a) Increased hepatic synthesis of albumin leading to increased oncotic pressure.
b) Decreased portal venous pressure due to impaired hepatic blood flow.
c) Increased lymphatic drainage from the liver.
d) Decreased hepatic synthesis of albumin leading to decreased oncotic pressure.
e) Increased renal excretion of sodium and water.
Answer: d) Decreased hepatic synthesis of albumin leading to decreased oncotic pressure.
Explanation: The liver is the primary site of albumin synthesis. In liver disease, impaired liver function can lead to decreased albumin production, resulting in reduced oncotic pressure in the blood vessels and subsequent fluid leakage into the abdominal cavity, causing ascites.
80
Scenario: A ferret presents with a history of melena, lethargy, and a palpable abdominal mass. Abdominal ultrasound reveals a mass associated with the spleen.
Lead-in: While splenic neoplasia is a possibility, which other common condition in ferrets should be a high differential for this presentation?
Options:
a) Adrenal gland disease.
b) Insulinoma.
c) Canine distemper.
d) Gastric ulceration.
e) Foreign body ingestion.
Answer: b) Insulinoma.
Explanation: Insulinoma, a tumour of the pancreatic beta cells causing excessive insulin production, is a very common condition in ferrets. While it typically presents with signs of hypoglycaemia (weakness, seizures), it can sometimes cause melena due to gastrointestinal ulceration secondary to increased gastric acid production stimulated by hypoglycaemia, and a palpable abdominal mass due to enlarged pancreatic lymph nodes. Splenic involvement can also occur.
81
**Scenario:** A 5-year-old male neutered Boxer dog presents with a two-week history of tenesmus and passing small amounts of fresh blood with faeces. On rectal examination, a raised, ulcerated lesion is palpated approximately 4 cm inside the anal canal. Regional lymph nodes are not palpably enlarged.
**Lead-in:** What is the most likely differential diagnosis based on these findings?
**Options:**
a) Anal sac adenocarcinoma
b) Perianal gland adenoma
c) Rectal polyp
d) Anal furunculosis
e) Rectal adenocarcinoma
**Answer:** e) Rectal adenocarcinoma
**Explanation:** The location of the lesion (anal canal), the presence of ulceration and fresh blood, and the tenesmus are more suggestive of a rectal adenocarcinoma. While anal sac adenocarcinoma can cause tenesmus and bleeding, it typically arises from the anal sac. Perianal gland adenomas are usually located in the perianal skin. Rectal polyps can cause rectal bleeding but are less likely to be ulcerated. Anal furunculosis typically involves multiple draining tracts and ulcerated lesions in the perianal skin, often with a history of chronic disease.
82
Scenario: A 3-year-old female neutered domestic shorthair cat presents with a history of infrequent and difficult passage of small, hard stools for the past month. The cat has a good appetite and is otherwise bright and alert. On physical examination, the colon is palpated to be markedly distended with firm faecal material.
Lead-in: Which of the following is the most likely underlying cause of this cat's constipation?
Options:
a) Colonic neoplasia
b) Pelvic canal stenosis
c) Dietary indiscretion with hair ingestion
d) Idiopathic megacolon
e) Hypothyroidism
Answer: d) Idiopathic megacolon
Explanation: The history of chronic constipation with a markedly distended colon in an otherwise healthy cat is highly suggestive of idiopathic megacolon. While pelvic canal stenosis (often secondary to pelvic fracture) can cause constipation, it usually has a more acute onset or a history of trauma. Dietary indiscretion and hair ingestion can lead to constipation, but usually not to the degree of megacolon. Colonic neoplasia is a less common cause of constipation in young cats. Hypothyroidism is rare in cats and is more typically associated with lethargy and weight gain.
83
Scenario: A 6-month-old male entire Labrador puppy is presented for a ventral midline swelling in the inguinal region that becomes more prominent when the puppy is standing or straining. The swelling is soft, reducible, and non-painful on palpation.
Lead-in: What is the most likely type of hernia in this puppy?
Options:
a) Umbilical hernia
b) Scrotal hernia
c) Femoral hernia
d) Inguinal hernia
e) Perineal hernia
Answer: d) Inguinal hernia
Explanation: The location of the swelling in the inguinal region, its reducibility, and the puppy's age are characteristic of an inguinal hernia. Umbilical hernias are located at the umbilicus. Scrotal hernias involve the scrotum. Femoral hernias occur through the femoral canal, which is less common. Perineal hernias are located in the perineal region.
84
Scenario: A 10-year-old male castrated Jack Russell Terrier presents with a one-week history of anorexia and lethargy. Physical examination reveals pale mucous membranes, a heart murmur, and abdominal distension. Abdominocentesis yields a straw-coloured fluid with a low protein content.
Lead-in: Based on the limited information, which of the following broad categories is LEAST likely to be the primary cause of this dog's anorexia and weight loss?
Options:
a) Reduced energy intake
b) Increased energy expenditure/usage
c) Reduced energy absorption/utilisation
d) Mechanical inability to eat
e) Reluctance to eat
Answer: d) Mechanical inability to eat
Explanation: The presence of abdominal distension and pale mucous membranes, along with a heart murmur, suggests a systemic illness potentially leading to increased energy expenditure (e.g., due to underlying disease like heart failure with ascites) or reduced energy absorption/utilisation (e.g., due to gastrointestinal or other organ dysfunction). While reduced energy intake is a direct cause of anorexia, mechanical inability to eat is less likely given the history and other clinical findings, as there is no mention of oral or pharyngeal abnormalities. Reluctance to eat could be a component of the anorexia, but it's a mechanism rather than a primary broad category of weight loss.
85
Scenario: During a routine pre-anaesthetic assessment of a healthy 4-year-old Labrador undergoing a dental procedure, the anaesthetist plans to use an infraorbital nerve block.
Lead-in: Which of the following anatomical structures will be desensitised by this nerve block?
Options:
a) All mandibular teeth on the injected side
b) The tongue on the injected side
c) The skin of the nose and upper lip on the injected side
d) The soft tissues of the buccal aspect of the caudal maxilla
e) The muscles of mastication on the injected side
Answer: c) The skin of the nose and upper lip on the injected side
Explanation: The infraorbital nerve block, also known as the rostral maxillary block, desensitises the skin of the nose, the skin and mucosa of the muzzle and upper lip, and the incisors, canine, and premolars (excluding the palatal root of the fourth premolar) of the maxilla on the injected side. It does not affect the mandible, tongue, caudal maxilla soft tissues, or muscles of mastication.
86
Scenario: A 7-year-old female entire Rottweiler is presented for an acute onset of severe tenesmus and a painful swelling in the perineal region to the right of the anus. On rectal examination, a deviation of the rectum is noted.
Lead-in: Which of the following muscles is most likely to be involved in the development of this condition?
Options:
a) External anal sphincter
b) Internal anal sphincter
c) Levator ani muscle
d) Coccygeus muscle
e) Internal obturator muscle
Answer: c) Levator ani muscle
Explanation: The clinical signs are highly suggestive of a perineal hernia. Perineal hernias typically occur due to a weakening or separation of the muscles forming the pelvic diaphragm, most commonly involving the levator ani muscle, often in conjunction with the external anal sphincter and coccygeus muscle. The internal anal sphincter is smooth muscle and less likely to be primarily involved in the hernia formation. The internal obturator muscle can be involved, particularly if a more lateral bulge is noted.
87
Scenario: A 2-year-old French Bulldog is presented with regurgitation of undigested food shortly after eating. The episodes have been occurring for several weeks, and the dog has a history of being a "picky eater" and is slightly underweight.
Lead-in: Based on the breed and clinical signs, which of the following conditions is a strong differential diagnosis?
Options:
a) Megaesophagus secondary to myasthenia gravis
b) Esophageal foreign body
c) Hiatal hernia
d) Pyloric stenosis
e) Acute oesophagitis
Answer: c) Hiatal hernia
Explanation: French Bulldogs, along with other brachycephalic breeds, are predisposed to hiatal hernias. The clinical signs of regurgitation shortly after eating, being underweight, and a history of being a picky eater can be consistent with a hiatal hernia causing intermittent gastro-oesophageal reflux. Megaesophagus typically presents with regurgitation of undigested food at various times after eating. An oesophageal foreign body would likely cause more acute and severe signs. Pyloric stenosis causes vomiting of digested food. Acute oesophagitis could cause regurgitation but is less likely to be a chronic, intermittent issue.
88
Scenario: A cat undergoing anaesthesia for a subtotal colectomy is at increased risk of infection due to the high bacterial load in the colon.
Lead-in: Which of the following antibiotic protocols is recommended for this procedure?
Options:
a) Single dose of amoxicillin-clavulanate pre-operatively
b) Cefuroxime and metronidazole administered pre-operatively
c) Enrofloxacin administered post-operatively for 5 days
d) Triple therapy with amoxicillin, metronidazole, and enrofloxacin
e) Gentamicin administered intra-operatively
Answer: b) Cephalosporin and metronidazole administered pre-operatively
Explanation: The material specifically mentions using antibiotics effective against gram-negative aerobes and anaerobes for subtotal colectomy, and gives the example of cephalosporins and metronidazole. A single dose of amoxicillin-clavulanate may not provide sufficient coverage. Enrofloxacin alone does not cover anaerobic bacteria well. Triple therapy is generally reserved for more severe infections. Gentamicin has nephrotoxic potential and is not a typical first-line choice for this type of surgery.
89
Scenario: A 6-month-old male entire Labrador puppy is diagnosed with a reducible inguinal hernia containing omentum. The puppy is otherwise healthy.
Lead-in: Which of the following is the most appropriate surgical treatment for this puppy?
Options:
a) Application of a truss until skeletal maturity
b) Herniorrhaphy involving apposition of the external inguinal ring
c) Herniorrhaphy involving apposition of the internal inguinal ring
d) Leaving the hernia to resolve spontaneously
e) Injection of sclerosing agents into the hernial sac
Answer: b) Herniorrhaphy involving apposition of the external inguinal ring
Explanation: Surgical repair is the treatment of choice for inguinal hernias to prevent incarceration or strangulation. Herniorrhaphy involves reducing the herniated contents and closing the hernial ring. For inguinal hernias, the defect is typically at the external inguinal ring.
90
Scenario: A 4-year-old male neutered Cavalier King Charles Spaniel presents with a two-month history of anal irritation, licking at the perineum, and occasional scooting. On physical examination, there are two small, firm, non-painful swellings at the 5 and 7 o'clock positions relative to the anus.
Lead-in: Which of the following would be the most appropriate initial medical treatment?
Options:
a) Oral prednisolone at 0.5 mg/kg once daily for 14 days
b) Topical application of a corticosteroid cream twice daily for 7 days
c) Surgical excision of the masses
d) Regular expression of the anal sacs every 3 days
e) Oral antibiotics such as cefalexin at 15 mg/kg twice daily for 21 days
Answer: b) Topical application of a corticosteroid cream twice daily for 7 days
Explanation: Initial treatment for perianal gland adenomas often involves topical corticosteroids to reduce inflammation and size.
91
Scenario: A 7-year-old female neutered domestic shorthair cat has been diagnosed with idiopathic megacolon refractory to medical management with lactulose and dietary modification.
Lead-in: Which of the following surgical procedures is the treatment of choice for this condition?
Options:
a) Colopexy
b) Rectal pull-through
c) Subtotal colectomy
d) Anal sacculectomy
e) Lateral perineal herniorrhaphy
Answer: c) Subtotal colectomy
Explanation: Subtotal colectomy is the surgical treatment of choice for refractory idiopathic megacolon in cats.
92
Scenario: A 10-year-old male castrated Labrador underwent a perineal herniorrhaphy 48 hours ago. He is currently hospitalised and recovering well.
Lead-in: Which of the following is the most important aspect of post-operative management to minimise the risk of recurrence?
Options:
a) Strict cage rest for 4 weeks
b) Feeding a low-fibre diet to reduce straining
c) Regular perineal skin cleaning with antiseptic solution
d) Administration of oral corticosteroids for 7 days
e) Use of a faecal softener (e.g., lactulose at 0.5 ml/kg PO twice daily)
Answer: e) Use of a faecal softener (e.g., lactulose at 0.5 ml/kg PO twice daily)
Explanation: Using a faecal softener like lactulose at 0.5 ml/kg PO twice daily is crucial post-operatively to minimise straining during defecation and reduce the risk of recurrence after perineal herniorrhaphy.
93
Scenario: A 10-year-old domestic shorthair cat presents with a history of weight loss despite an increased appetite, polyuria, polydipsia, and occasional vomiting. On physical examination, the cat is thin with a poor coat and has a heart rate of 220 bpm.
Lead-in: Which of the following would be the most appropriate initial diagnostic test to investigate this cat's condition?
Options:
a) Resting serum total thyroxine (T4) concentration
b) Thyroid stimulating hormone (TSH) concentration
c) Free thyroxine (fT4) by equilibrium dialysis
d) Triiodothyronine (T3) suppression test
e) Thyroid scan
Answer: a) Resting serum total thyroxine (T4) concentration
Explanation: The clinical signs are highly suggestive of hyperthyroidism in a cat. The initial diagnostic test of choice is a resting serum total T4 concentration, which is typically elevated in hyperthyroid cats.
94
Scenario: A 7-year-old spayed female Labrador Retriever has been diagnosed with primary hypothyroidism based on clinical signs (lethargy, weight gain, alopecia) and laboratory findings (low total T4 and elevated TSH).
Lead-in: What is the recommended long-term treatment for this dog?
Options:
a) Oral administration of levothyroxine at 20 μg/kg once daily
b) Oral administration of liothyronine at 10 μg/kg twice daily
c) Oral administration of levothyroxine at 10 μg/kg twice daily
d) Subcutaneous injection of thyrotropin-releasing hormone (TRH) once weekly
e) Dietary supplementation with iodine
Answer: a) Oral administration of levothyroxine at 20 μg/kg once daily
Explanation: The treatment of choice for hypothyroidism in dogs is oral supplementation with synthetic levothyroxine (T4). The typical starting dose is around 20 μg/kg once or twice daily.
95
Scenario: A 12-year-old cat has been treated for hyperthyroidism with oral methimazole for the past 6 months. The owner reports the cat is now less active and seems to have gained some weight.
Lead-in: Which of the following secondary conditions is most likely to have developed, and how should it be monitored?
Options:
a) Hyperadrenocorticism, monitored by ACTH stimulation test
b) Hypothyroidism, monitored by serum total T4 concentration
c) Diabetes mellitus, monitored by blood glucose curve
d) Chronic kidney disease, monitored by serum creatinine and urea concentrations
e) Hypertension, monitored by serial blood pressure measurements
Answer: b) Hypothyroidism, monitored by serum total T4 concentration
Explanation: Iatrogenic hypothyroidism is a common secondary condition in cats treated for hyperthyroidism with methimazole. Monitoring serum total T4 concentration is essential.
96
Scenario: A 5-year-old neutered male Beagle presents with a history of progressive weight gain over the past 6 months. His appetite is reported to be normal, and he is otherwise healthy on physical examination.
Lead-in: Which of the following endocrine conditions is LEAST likely to be the primary cause of weight gain with a normal appetite in dogs?
Options:
a) Hypothyroidism
b) Hyperadrenocorticism
c) Insulinoma
d) Acromegaly
e) Diabetes insipidus
Answer: e) Diabetes insipidus
Explanation: Diabetes insipidus is not typically associated with weight gain.
97
Scenario: Which of the following combinations of clinical signs would be most suggestive of hyperthyroidism in a cat?
Options:
a) Weight gain, lethargy, bradycardia, and constipation
b) Weight loss, polyphagia, tachycardia, and hyperactivity
c) Weight loss, anorexia, bradycardia, and hypothermia
d) Weight gain, polyuria, bradycardia, and dullness
e) Weight loss, polydipsia, bradycardia, and poor coat
Answer: b) Weight loss, polyphagia, tachycardia, and hyperactivity
98
Scenario: A 3-year-old female spayed Golden Retriever presents with a history of progressive weight loss over the past 2 months despite a consistently good appetite. There are no other significant findings on physical examination.
Lead-in: Which of the following would be the most appropriate next step in the diagnostic work-up for this dog?
Options:
a) Trial of a high-calorie diet for 4 weeks
b) Routine bloodwork (haematology and biochemistry) and urinalysis
c) Abdominal ultrasound
d) Faecal examination for parasites
e) Thyroid function testing
Answer: b) Routine bloodwork (haematology and biochemistry) and urinalysis
Explanation: Routine bloodwork and urinalysis are essential first-line diagnostics for weight loss with a normal appetite.
99
Scenario: A 7-year-old neutered male Cocker Spaniel presents with a chronic history of halitosis and a reluctance to eat hard food. On oral examination, there is gingival recession and significant calculus accumulation around the maxillary fourth premolar. Dental radiography reveals approximately 50% attachment loss on this tooth.
Lead-in: Which of the following is the most appropriate treatment for the maxillary fourth premolar in this dog?
Options:
a) Supragingival scaling and polishing under general anaesthesia
b) Subgingival curettage and root planing under general anaesthesia
c) Extraction of the maxillary fourth premolar under general anaesthesia
d) Application of a periodontal gel containing chlorhexidine
e) Administration of oral antibiotics such as clindamycin at 11 mg/kg twice daily for 10 days
Answer: c) Extraction of the maxillary fourth premolar under general anaesthesia
Explanation: Dental radiography showing 50% attachment loss indicates advanced periodontal disease. In such cases, extraction is generally the recommended treatment to eliminate the source of infection and pain.
100
Scenario: A 4-year-old domestic shorthair cat presents with severe gingivostomatitis. Oral examination reveals widespread inflammation of the gingiva, buccal mucosa, and glossitis.
Lead-in: Which of the following is considered a mainstay of medical management for severe feline gingivostomatitis?
Options:
a) Long-term oral prednisolone at 0.25 mg/kg once daily
b) A course of broad-spectrum antibiotics such as amoxicillin-clavulanate at 12.5 mg/kg twice daily for 2 weeks
c) Frequent use of topical antiseptic mouthwash containing chlorhexidine
d) Dental extraction of all premolar and molar teeth
e) Dietary change to a dental kibble
Answer: a) Long-term oral prednisolone at 0.25 mg/kg once daily
Explanation: Immunomodulatory drugs like prednisolone are often used long-term to manage the inflammatory component of severe feline gingivostomatitis. While antibiotics and chlorhexidine mouthwash may provide some benefit, they are usually not sufficient on their own. In refractory cases, full mouth extractions are often necessary.
101
Scenario: During a routine dental examination of an 8-year-old Labrador, a smooth, pink, pedunculated mass is noted on the gingiva adjacent to the mandibular first molar.
Lead-in: What is the most appropriate next step in the management of this oral mass?
Options:
a) Monitor the mass for any changes in size or appearance
b) Apply a topical antiseptic to the mass twice daily
c) Obtain a biopsy of the mass for histopathological examination
d) Treat with a course of oral antibiotics
e) Perform surgical excision with wide margins
Answer: c) Obtain a biopsy of the mass for histopathological examination
Explanation: Any oral mass should be biopsied to determine its nature (benign or malignant) and guide appropriate treatment.
102
Scenario: A 5-year-old brachycephalic dog presents with crowding of the premolar teeth. The mandibular second premolar is rotated mesially, causing trauma to the opposing maxillary gingiva.
Lead-in: Which of the following is the most appropriate treatment for the malocclusion caused by the rotated mandibular second premolar?
Options:
a) Extraction of the rotated mandibular second premolar
b) Orthodontic movement of the rotated premolar
c) Crown reduction of the rotated premolar
d) Application of a dental sealant to the rotated premolar
e) Gingivoplasty of the traumatised maxillary gingiva
Answer: a) Extraction of the rotated mandibular second premolar
Explanation: Extraction of a maloccluded tooth causing trauma is often the most practical and effective treatment in veterinary dentistry. Orthodontic movement is possible but may not be feasible in all cases. Crown reduction may not resolve the traumatic occlusion.
103
Scenario: A cat has undergone surgical extraction of a maxillary canine tooth.
Lead-in: Which of the following local anaesthetic blocks would have provided the most effective analgesia for this procedure?
Options:
a) Inferior alveolar nerve block
b) Mental nerve block
c) Infraorbital nerve block
d) Auriculotemporal nerve block
e) Palatine nerve block
Answer: c) Infraorbital nerve block
Explanation: The infraorbital nerve block provides sensory anaesthesia to the maxillary incisors, canine tooth, and associated structures.
104
Scenario: During a dental procedure on a cat, a furcation lesion is identified on the mandibular first molar. There is no gingival recession associated with this lesion.
Lead-in: What is the classification of this furcation lesion?
Options:
a) Class I
b) Class II
c) Class III
d) Class IV
e) Class V
Answer: a) Class I
Explanation: A Class I furcation lesion involves early involvement where the probe tip can just enter the furcation area. Class II involves the probe entering the furcation but not passing through. Class III involves the probe passing through the furcation. There is no Class IV or V classification for furcation lesions.
105
Scenario: A dog presents with a fractured mandibular fourth premolar with pulp exposure.
Lead-in: Which of the following is the most appropriate treatment option to address the exposed pulp and maintain the tooth's vitality, if feasible?
Options:
a) Extraction
b) Root canal therapy
c) Crown amputation with intentional root retention
d) Application of a bonding agent to seal the fracture
e) Vital pulp therapy
Answer: e) Vital pulp therapy
Explanation: In cases of recent pulp exposure (typically within 48 hours) in young, otherwise healthy teeth, vital pulp therapy may be attempted to promote healing and maintain tooth vitality. Root canal therapy is another option for pulp exposure but is more involved. Extraction is definitive but results in tooth loss.
106
Scenario: A dog presents with a large, ulcerated mass on the hard palate.
Lead-in: Which of the following types of oral tumours is most commonly found at this location in dogs?
Options:
a) Melanoma
b) Squamous cell carcinoma
c) Fibrosarcoma
d) Osteosarcoma
e) Acanthomatous ameloblastoma
Answer: b) Squamous cell carcinoma
Explanation: Squamous cell carcinoma is a common oral tumour in dogs and has a predilection for the tonsils and the hard palate.
107
Scenario: Following extraction of multiple teeth in a dog, a mucoperiosteal flap was raised and sutured to close the extraction sites.
Lead-in: Which of the following suture patterns is most commonly used for appositional closure of oral mucosal flaps?
Options:
a) Simple continuous
b) Simple interrupted
c) Horizontal mattress
d) Vertical mattress
e) Purse-string
Answer: b) Simple interrupted
Explanation: Simple interrupted sutures are commonly used for appositional closure of oral mucosal flaps as they provide good tissue adaptation and allow for some independent movement of the suture line.
108
Scenario: Which of the following is a common indication for performing a subtotal colectomy in cats?
Options:
a) Rectal prolapse
b) Anal sac adenocarcinoma
c) Feline idiopathic megacolon unresponsive to medical management
d) Perineal hernia with rectal diverticulum
e) Atresia ani
Answer: c) Feline idiopathic megacolon unresponsive to medical management
Explanation: Subtotal colectomy is the surgical treatment of choice for feline idiopathic megacolon when medical management fails.
109
Scenario: A 6-month-old kitten presents with noticeable swelling and discomfort in the ventral mandible. Radiographs reveal a unilocular radiolucent area associated with the crown of an unerupted mandibular canine tooth.
Lead-in: What is the most likely diagnosis?
Options:
a) Abscess
b) Cystic odontoma
c) Dentigerous cyst
d) Ameloblastoma
e) Fibrosarcoma
Answer: c) Dentigerous cyst
Explanation: A dentigerous cyst is an odontogenic cyst that surrounds the crown of an unerupted tooth. It appears as a radiolucent area on radiographs.
110
Scenario: During a dental cleaning under general anaesthesia, a mobile tooth with significant gingival recession and purulent discharge is noted. The tooth can be easily moved buccally and lingually.
Lead-in: What is the likely periodontal index for this tooth?
Options:
a) Periodontal Index 0
b) Periodontal Index 1
c) Periodontal Index 2
d) Periodontal Index 3
e) Periodontal Index 4
Answer: d) Periodontal Index 3
Explanation: Periodontal Index 3 indicates advanced periodontal disease with significant attachment loss, mobility, and often purulent discharge.
111
Scenario: Which of the following is a common complication following a rostral mandibulectomy in a dog?
Options:
a) Excessive salivation
b) Difficulty swallowing
c) Mandibular drift
d) Trismus
e) Damage to the facial nerve
Answer: c) Mandibular drift
Explanation: Mandibular drift, a deviation of the remaining mandible towards the side of the surgery, can occur following a mandibulectomy, especially if a significant portion of the mandible is removed.
112
Scenario: A cat presents with a chronic, non-healing ulcer on the lip.
Lead-in: Which of the following oral tumours is most common in cats and can present as a persistent ulcer?
Options:
a) Melanoma
b) Squamous cell carcinoma
c) Fibrosarcoma
d) Osteosarcoma
e) Acanthomatous ameloblastoma
Answer: b) Squamous cell carcinoma
Explanation: Squamous cell carcinoma is the most common oral tumour in cats and often presents as a locally invasive and ulcerative lesion.
113
Scenario: A dog presents with a history of straining to defecate and passing small amounts of bloody faeces. On examination, there is a swelling noted in the perineal region.
Lead-in: Which of the following is the most likely underlying condition?
Options:
a) Bacterial infection of the anal glands
b) Blockage of the rectum by a foreign body
c) Perineal hernia
d) Rectal prolapse
e) Anal sac adenocarcinoma
Answer: c) Perineal hernia
Explanation: Perineal hernias involve a defect in the pelvic diaphragm, allowing abdominal contents to protrude, which can lead to straining during defecation (tenesmus) and potentially blood in the faeces if the rectum is involved.
114
Scenario: A cat has been repeatedly straining in the litter box without producing much faeces. The owner reports the cat seems uncomfortable and is vocalising more than usual.
Lead-in: Which of the following conditions is most likely causing these clinical signs?
Options:
a) Dietary indiscretion leading to mild colitis
b) Feline idiopathic megacolon
c) Intussusception of the small intestine
d) Acute pancreatitis
e) Urinary tract infection
Answer: b) Feline idiopathic megacolon
Explanation: Feline idiopathic megacolon is characterised by chronic constipation and dilation of the colon, leading to infrequent or difficult passage of stools, often with straining and discomfort.
115
Scenario: A large breed dog is presented to the emergency clinic with a distended abdomen and non-productive retching. The owner reports the dog ate a large meal and then went for a run about an hour ago.
Lead-in: What is the most likely diagnosis in this case?
Options:
a) Acute pancreatitis
b) Gastric dilatation-volvulus (GDV)
c) Intestinal obstruction
d) Splenic torsion
e) Food bloat without volvulus
Answer: b) Gastric dilatation-volvulus (GDV)
Explanation: Large breed, deep-chested dogs are predisposed to GDV, which is often triggered by eating a large meal followed by exercise. The classic signs include abdominal distension and non-productive retching.
116
Scenario: A cat presents with lethargy, jaundice, and a history of anorexia for several days. The cat was previously overweight.
Lead-in: Which of the following complications is the most likely concern in this case?
Options:
a) Acute kidney injury
b) Hepatic lipidosis
c) Pancreatitis
d) Intestinal obstruction
e) Cardiomyopathy
Answer: b) Hepatic lipidosis
Explanation: Anorexia in overweight cats can lead to the rapid mobilisation of fat stores, overwhelming the liver and causing hepatic lipidosis, characterised by jaundice and lethargy.
117
Scenario: A bird presents with regurgitation and a visibly distended crop. On palpation, the crop feels firm and doughy.
Lead-in: Which of the following is the most likely cause of this presentation?
Options:
a) Proventricular dilatation disease
b) Crop impaction
c) Heavy metal toxicity
d) Psittacine beak and feather disease
e) Avian influenza
Answer: b) Crop impaction
Explanation: A distended, firm crop suggests an impaction, where food or foreign material is trapped in the crop, preventing normal passage. Regurgitation is a common sign.
118
Scenario: A tortoise is presented with a prolapsed cloaca. The tissue appears fresh and is covered in dirt. The tortoise is moderately dehydrated and has not eaten for a few weeks.
Lead-in: What is the immediate priority in managing this case?
Options:
a) Administering broad-spectrum antibiotics
b) Attempting to manually reduce the prolapse after cleaning and lubrication
c) Placing the tortoise in a warm bath to rehydrate it
d) Taking radiographs to assess for underlying causes
e) Performing immediate surgical resection of the prolapsed tissue
Answer: b) Attempting to manually reduce the prolapse after cleaning and lubrication
Explanation: The immediate priority for a fresh cloacal prolapse is to gently clean and lubricate the tissue and attempt manual reduction. Surgical intervention may be necessary if the prolapse is not reducible or if the tissue is severely damaged.
119
Scenario: During a routine dental examination of a 5-year-old Beagle, you note mild gingivitis and calculus on all teeth. Dental probing reveals no periodontal pockets greater than 2mm, and there is no gingival recession.
Lead-in: According to the World Small Animal Veterinary Association (WSAVA) periodontal disease staging, what stage of periodontal disease does this dog most likely have?
Options:
a) Stage 0
b) Stage 1
c) Stage 2
d) Stage 3
e) Stage 4
Answer: b) Stage 1 (Gingivitis)
Explanation: Stage 1 periodontal disease is characterised by gingivitis with no attachment loss. The presence of gingivitis and calculus without periodontal pockets or gingival recession aligns with this stage. Stage 0 is normal with no gingivitis or attachment loss. Stages 2, 3, and 4 involve increasing degrees of attachment loss, including periodontal pockets and gingival recession.
120
Scenario: A 3-year-old neutered male cat presents with severe gingivitis, stomatitis, and glossitis. The cat is painful on oral examination and is reluctant to eat.
Lead-in: Which of the following conditions is most likely responsible for these clinical signs in this cat?
Options:
a) Periodontal disease
b) Tooth resorption
c) Feline calicivirus infection
d) Oral squamous cell carcinoma
e) Trauma
Answer: c) Feline calicivirus infection
Explanation: Severe gingivitis, stomatitis, and glossitis are common clinical signs associated with feline calicivirus infection. While periodontal disease can cause gingivitis, it typically doesn't involve such severe inflammation extending to the stomatitis and glossitis. Tooth resorption is a common dental issue in cats but doesn't usually cause widespread oral inflammation of this severity. Oral squamous cell carcinoma is a possibility for oral lesions, but it usually presents as a mass rather than diffuse inflammation. Trauma could cause oral lesions, but the widespread nature of the inflammation in this case makes an infectious aetiology more likely.
121
Scenario: A dental radiograph of a maxillary fourth premolar tooth in a dog reveals a fracture extending from the crown down into the pulp chamber.
Lead-in: What is the most appropriate treatment for this tooth?
Options:
a) Professional dental cleaning and polishing
b) Extraction
c) Application of a bonding agent to seal the fracture
d) Root canal treatment
e) Observation
Answer: d) Root canal treatment
Explanation: A fracture extending into the pulp chamber exposes the vital pulp tissue, leading to pain and potential infection. Root canal treatment aims to remove the infected or inflamed pulp tissue, disinfect the root canal system, and fill it to seal it off, thus preserving the tooth. Professional dental cleaning and polishing address plaque and calculus but do not treat pulp exposure. Extraction is an option, but root canal treatment can save the tooth. Simply sealing the fracture with a bonding agent would not address the exposed pulp. Observation would lead to continued pain and infection
122
Scenario: A 12-year-old Boxer presents with a large, ulcerated mass on the gingiva of the upper right jaw. Regional lymph nodes are enlarged.
Lead-in: Based on the breed and location of the mass, which of the following is the most likely type of oral tumour?
Options:
a) Amelanotic melanoma
b) Squamous cell carcinoma
c) Fibrosarcoma
d) Osteosarcoma
e) Acanthomatous ameloblastoma
Answer: b) Squamous cell carcinoma
Explanation: Squamous cell carcinoma is the most common malignant oral tumour in dogs. While malignant melanoma is also common, it often appears pigmented (though amelanotic forms exist). Boxers are predisposed to gingival hyperplasia, which is benign, but given the ulcerated nature and enlarged lymph nodes, a malignant process is more likely. Fibrosarcoma and osteosarcoma are less common in this location, and osteosarcoma typically affects bone. Acanthomatous ameloblastoma is a benign tumour arising from dental tissues and is locally invasive but does not typically metastasise to regional lymph nodes.
123
Scenario: A 9-year-old cat presents with a firm, non-ulcerated mass on the hard palate.
Lead-in: Which of the following is the most likely type of oral tumour in this location in a cat?
Options:
a) Malignant melanoma
b) Squamous cell carcinoma
c) Fibrosarcoma
d) Osteosarcoma
e) Acanthomatous ameloblastoma
Answer: b) Squamous cell carcinoma
Explanation: Squamous cell carcinoma is the most common oral tumour in cats and frequently occurs on the tongue base or tonsils but can also be found on the hard palate. Malignant melanoma is less common in cats and often pigmented. Fibrosarcoma and osteosarcoma are rarer in the oral cavity of cats. Acanthomatous ameloblastoma is of dental origin and less common in cats.
124
Scenario: A veterinary student is learning how to perform a dental examination in a dog. They are instructed to use a periodontal probe.
Lead-in: What is the primary purpose of using a periodontal probe during a dental examination?
Options:
a) To remove calculus from the tooth surface
b) To assess the depth of the gingival sulcus and detect periodontal pockets
c) To identify fractured teeth
d) To check for tooth mobility
e) To evaluate the presence of gingival recession
Answer: b) To assess the depth of the gingival sulcus and detect periodontal pockets
Explanation: A periodontal probe is a calibrated instrument used to measure the depth of the gingival sulcus or periodontal pocket, which is a key indicator of periodontal disease. While a probe can sometimes help in detecting calculus or identifying furcation involvement, its primary purpose is to assess pocket depth. Other instruments or techniques are used to identify fractured teeth, check for tooth mobility, and evaluate gingival recession.
125
Scenario: You are about to perform a dental extraction in a cat. You decide to use a local anaesthetic block to provide analgesia.
Lead-in: Which of the following local anaesthetic agents is most commonly used for dental blocks in cats and dogs?
Options:
a) Lidocaine
b) Procaine
c) Bupivacaine
d) Mepivacaine
e) Ropivicaine
Answer: c) Bupivacaine
Explanation: Bupivacaine is a long-acting local anaesthetic commonly used for dental blocks in cats and dogs due to its efficacy and duration of action.
126
Scenario: A 6-year-old cat is undergoing a dental procedure under general anaesthesia. The procedure involves extraction of a mandibular molar tooth. You plan to perform a local anaesthetic block for post-operative pain management.
Lead-in: Which nerve block would be most appropriate to provide analgesia to this tooth?
Options:
a) Infraorbital block
b) Mental nerve block
c) Mandibular nerve block
d) Maxillary nerve block
e) Palatine nerve block
Answer: c) Mandibular nerve block
Explanation: The mandibular nerve block provides analgesia to the entire ipsilateral mandible, including the molar teeth. The infraorbital block affects the rostral maxilla. The mental nerve block provides analgesia to the rostral mandible (incisors and canine). The maxillary nerve block affects the maxilla. The palatine nerve block primarily affects the hard palate.
127
Scenario: A dog has undergone extraction of multiple teeth. The veterinary surgeon has placed sutures to close the gingival flaps.
Lead-in: Which of the following suture materials is most appropriate for oral surgery in dogs and cats?
Options:
a) Polygalactin (Vicryl)
b) Nylon
c) Poliglecaprone 25 (Monocryl)
d) Stainless steel
e) Polypropylene
Answer: c) Poliglecaprone 25 (Monocryl)
Explanation: Poliglecaprone 25 (Monocryl) is a monofilament absorbable suture material that provides good tensile strength and typically absorbs within 90-120 days, making it suitable for oral surgery where suture removal can be challenging.
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Scenario: A 2-year-old Labrador Retriever presents with a proliferative, cauliflower-like mass on the gingiva. The mass is non-painful on palpation.
Lead-in: Which of the following is the most likely diagnosis based on the clinical appearance?
Options:
a) Squamous cell carcinoma
b) Malignant melanoma
c) Fibrosarcoma
d) Acanthomatous ameloblastoma
e) Epulis
Answer: e) Epulis
Explanation: An epulis is a benign, proliferative gingival mass that is a common finding in dogs. They often have a cauliflower-like appearance and are typically non-painful. While other oral tumours can occur on the gingiva, the description is most consistent with an epulis. Acanthomatous ameloblastoma is also a gingival mass but is locally invasive and may have a more aggressive appearance. Squamous cell carcinoma and malignant melanoma are usually more ulcerated or pigmented, respectively. Fibrosarcoma can occur in the oral cavity but is less commonly described as cauliflower-like
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Scenario: You are examining a dental radiograph of a cat's premolar tooth and observe a radiolucent lesion extending from the cementoenamel junction towards the pulp. The tooth appears otherwise normal.
Lead-in: What is the most likely diagnosis for this radiographic finding?
Options:
a) Caries
b) Periodontal abscess
c) Tooth resorption
d) Pulpitis
e) Periapical granuloma
Answer: c) Tooth resorption
Explanation: Tooth resorption is characterised by the destruction of tooth structure, often starting at the cementoenamel junction and appearing as a radiolucent lesion on radiographs. Caries (dental decay) is less common in cats. A periodontal abscess would typically involve bone loss around the tooth root. Pulpitis is inflammation of the pulp and may not always be visible radiographically in the early stages. A periapical granuloma is usually associated with pulp necrosis and appears as a radiolucent area at the apex of the root.
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Scenario: A 5-year-old cat is scheduled for extraction of a maxillary third premolar tooth.
Lead-in: How many roots does a typical maxillary third premolar tooth in a cat have?
Options:
a) One
b) Two
c) Three
d) Four
e) Five
Answer: c) Three
Explanation: The maxillary third premolar tooth in a cat typically has three roots. This is important to consider when planning the extraction technique to ensure all roots are completely removed.
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Scenario: A dog has undergone a surgical extraction of a mandibular molar tooth. The veterinary surgeon has closed the surgical site with sutures.
Lead-in: What is the most important post-operative instruction to give the owner regarding care for the surgical site?
Options:
a) Encourage chewing on hard toys to promote healing.
b) Apply topical antiseptic ointment to the site three times daily.
c) Feed a soft diet for 2-3 weeks.
d) Brush the surgical site vigorously with a hard-bristled toothbrush.
e) Restrict exercise for 2 days.
Answer: c) Feed a soft diet for 2-3 weeks.
Explanation: Feeding a soft diet for 2-3 weeks after oral surgery helps to minimise trauma to the healing surgical site and prevents food from getting trapped in the wound. Chewing on hard toys should be avoided as it can disrupt healing. Topical antiseptic ointments are generally not routinely recommended unless specifically indicated. Vigorous brushing of the surgical site should be avoided to allow healing. While exercise restriction is important, a soft diet is more directly related to the oral surgical site.
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