Incorrect/Trouble MCQ - Practice Questions

Question 1

What is the method of choice for diagnosing rabies?

A. Visualization of Negri bodies
B. Immunohistochemistry
C. RT-PCR
D. Gross pathologic lesions
E. Direct fluorescent antibody test

Answer 1

Explanation
The correct answer is direct fluorescent antibody test. There are no gross pathologic lesions associated with rabies. A diagnostic microscopic lesion is the visualization of Negri bodies. Most commonly they occur in the hippocampus in carnivores and Purkinje cells in herbivores. However, these are only seen 50% of the time. Immunohistochemistry allows strain differentiation and the ability to differentiate vaccine vs. wild-type. RT-PCR has been used on autolyzed brain tissue that is difficult to evaluate with fluorescent antibodies, but this is not the test of choice at this time. Direct FA is the current preferred method of diagnosis; it is both rapid and sensitive. Usually impressions of the medulla, cerebellum, and hippocampus are performed.

Question 2

Which of the following is a possible sequela to a CN VII (facial nerve) deficit?

Exposure keratitis
Strabismus of the eyes
Loss of motor function in the muscles of mastication
Nystagmus

Answer 2

The correct answer is exposure keratitis. CN VIl is responsible for lacrimation. Deficits in lacrimation would cause exposure keratitis. Loss of motor function in the muscles of mastication would occur in CN V (mandibular branch) deficits. Strabismus of the eyes would be caused by deficits in CN III (oculomotor nerve), CN IV (trochlear nerve) or CN VI (abducent nerve). Nystagmus occurs with CNS disease or CN VIII deficits.

Question 3

A 4-year old male castrated Dachshund presents for further evaluation after developing acute hind end paresis. A neurologic exam warranted advanced imaging and a myelogram was performed. Based on the image below, where is the lesion?

Right side T12-T13
Left side T12-T13
Left side L2-L3
Right side L2-L3
Left side T13-L1

Answer 3

The correct answer is left side T13-L1. Looking at the myelogram one can appreciate the contrast column on the right side acutely stop at approximately the level of T13-L1. Furthermore, the dye column appears to be deviated toward midline both cranial and caudal to the region of the disruption. This is characteristic of extradural compression. The most common cause of this in a Dachshund is a disc herniation.

Red circle: There was attenuation of the contrast columns from the cranial aspect of T13 to `the caudal aspect of L1. There was marked rightward deviation of the left contrast column on the VD view.

Question 4

A 7 year old Poodle presents for a left sided head tilt, a ventral strabismus on the left, and right horizontal nystagmus. The dog is obtunded, has conscious proprioception deficits in both right limbs, and a right sided facial paralysis. Where is the lesion?

Peripheral nerve on the right
Central nervous system on the right
Peripheral nerve on the left
Central nervous system on the left

Answer 4

The correct answer is central nervous system on the right. This dog has paradoxical vestibular disease. This disease is usually caused by a destructive lesion in the CNS in which there is loss of inhibition of the vestibular output on the side of the lesion. There is therefore a relative increase in vestibular output on the side of the lesion, causing vestibular signs on the side opposite the lesion (yes, this can be confusing). In this case, the right sided lesion has vestibular signs that would normally localize the lesion to the left side. When the lesion causes vestibular signs and proprioceptive deficits, the lesion is ipsilateral to the side with the proprioceptive deficits.

Question 5

What is the correct post-exposure prophylaxis protocol after being exposed to rabies for an unvaccinated human?

Three injections of human rabies immune globulin followed by 2 injections of approved rabies vaccine

Two injections of approved rabies vaccine

Five injections of approved rabies vaccine

Injection of human rabies immune globulin followed by 4 injections of approved rabies vaccine

One injection of human rabies immune globulin followed by 2 injections of approved rabies vaccine

Answer 5

Explanation
The correct answer is injection of human rabies immune globulin followed by 4-5 injections of approved rabies vaccine.
The recommended protocol per the 2020 CDC guidelines is as follows: “Postexposure prophylaxis (PEP) consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14.” HTTP://www.cdc.gov/rabies/
If you are not vaccinated, then you will need an injection of human rabies immune globulin immediately after exposure followed by 4-5 injections of an approved rabies vaccine IM over 2-4 weeks. If you have been vaccinated, all that is needed are two injections of an approved rabies vaccine 3 days apart. PEP is not required for accidental injection of animal rabies vaccine into a human.

Question 6

The key here is to recognize that the question is asking about peripheral vestibular disease; otherwise, metronidazole would be a good choice as a cause of central vestibular disease. Chlorheadine is a topical drug implicated in ototoxicity and peripheral vestibular disease.
Another excellent choice would be aminoglycosides including neomycin, kanamycin, tobramycin, amikacin and gentamicin.

Question 7

A 3 year old mixed breed dog presents after falling from a height of 10 feet and landing on the caudal half of his body. Since the fall, the dog has been dribbling urine and dropping feces as it walks. Neurologic exam reveals no abnormalities in the thoracic limbs, and hypo-reflexive patellar, gastrocnemius, and withdrawal reflexes in the pelvic limbs. Where is the lesion in the spinal cord?

C6-72
T3-L3
L4-53
C1-C5

Answer 7

The correct answer is L4-S3. The spinal cord is divided into the 4 regions listed above in the dog. Lesions at C1-C5 would manifest as UMN signs in the thoracic and pelvic limbs. Lesions at C6-2 would manifest as LMN for the thoracic limbs and UMN for the pelvic limbs.
Lesions at T3-L3 would not affect thoracic limbs and would cause UMN signs for the pelvic limbs. Lesions at L4-S3 would manifest as normal thoracic limbs and LMN signs in the pelvic limbs, anus, and bladder.

Question 8

A 10 year old female spayed Labrador Retriever has presented for difficulty getting up in the hind and apparent back pain for the last 3-4 weeks.
Upon questioning the owner, you are told that her appetite is diminished but she is still eating. An orthopedic exam finds no pain or discomfort elicited on manipulation of the hips or stifles. A neurologic exam identifies substantial pain in the lumbosacral region; however, conscious proprioception is intact, and patellar reflexes are normal.
Radiographs of the lumbosacral region identify a lytic lesion at the L7-S1 endplates as well as surrounding bony proliferation. Which of the following diagnostic tests is likely to provide the most helpful additional information given your findings?

Chest radiographs
Abdominal ultrasound
Blood draw for creatine kinase levels
Stifle arthrocentesis
Urine culture

Answer 8

Explanation
The diagnosis you should have in mind is discospondylitis. Be sure not to confuse this with spondylosis, which is typically not clinically significant and can be expected in most older dogs. The radiographic description is relatively specific for this condition. Neoplasia in the spine should be lower on your differential list because it typically does not cross joints. Disc herniation cannot be ruled out, and advanced imaging would be necessary to know for certain, but given the exam and radiographic findings, discospondylitis should be your top differential.
Discospondylitis is usually bacterial in origin, with Staphylococcus being the most common organism involved. Other organisms identified include Brucella canis, E. coli, Pasteurella, Aspergillus, and Streptococcus.
In an attempt to identify the causative agent, urine and blood cultures should be considered. The other answer choices are not as high yield in identifying the specific bacterial cause or underlying etiology.

Question 9

Intramuscular injections into the caudal aspect of the thigh muscles are most often associated with damage to which major nerve in the dog?

Tibial
Lateral cutaneous sural
Sciatic
Peroneal

Answer 9

The correct answer is sciatic. The sciatic is the most commonly damaged nerve from intramuscular injections given into the caudal musculature of the thigh. The sciatic, also known as the ischiatic nerve, is the largest nerve in the body of the dog. It arises from L6, L7, S1, and sometimes S2 nerve roots. It begins as the lumbosacral trunk exits the pelvis and travels down the caudal thigh. It then splits into the tibial nerve and common peroneal nerve further distal down the thigh.

Question 10

A couple comes in frantic to your hospital with their two Labrador retrievers. Both dogs are unable to walk and need to be carried into the hospital. The owners had been camping with the dogs over the weekend and report that one of the dogs started to show signs of weakness in the hind end near the end of the trip. They assumed he was tired from running around as their other dog seemed more quiet on the way home as well. This morning when they woke up neither dog could stand and one of the dogs had trouble eating breakfast. Both dogs are up to date on vaccinations and preventatives.
The dogs are non-painful, tetraplegic, hypo-reflexive in all four limbs, superficial and deep pain intact, and their tails continue to wag. One of the dogs has decreased tongue tone. You do not find any external lesions. Initial complete blood count, chemistry panel and urinalysis are normal.
Of the following options, what is the most likely diagnosis for both dogs?

Myasthenia gravis
Botulism
Tick bite paralysis
Intervertebral disc disease
Coonhound paralysis

Answer 10

Explanation
When two patients are affected with the same symptoms your first thoughts should be something contagious, a toxin, or an environmental factor. All of the options are reasonable explanations for worsening paralysis; however, the history of camping and two patients being affected make something infectious high on your list of differentials. Intervertebral disc disease would be highly unusual to affect two large-breed dogs at the same time, and pain is often initially noticed on spinal palpation. Coonhound paralysis or idiopathic polyradiculoneuritis is often preceded by raccoon bite, systemic illness or vaccination, and no external wounds were seen on either patient. Tick bite paralysis resolves when the tick is removed. Myasthenia gravis can show similar signs (especially the difficulty with eating and swallowing), but it tends to show some improvement after rest and would be unlikely to spontaneously occur in two patients at the same time. Botulism is contracted from eating contaminated food containing the Clostridium botulinum type C neurotoxin. It can be found in carrion and spoiled food. Given that the dogs were out camping, they likely ate contaminated food when the owners weren’t looking and therefore became ill at the same time. The difference in severity between patients is likely related to the quantity of toxin ingested.

Question 11

A 3 year old male neutered Doberman presents for weakness and difficulty walking. Your physical exam shows the dog is ataxic in all limbs, has conscious proprioception deficits in all limbs, and has a stiff, stilted gait in all limbs. All spinal reflexes are hyper-reflexive, and all limbs have increased muscle tone. Where is the anatomic localization of the lesion?

C6-2 of the spinal cord
C1-C5 of the spinal cord
T3-L3 of the spinal cord
L4 and caudal of the spinal cord

Answer 11

The correct answer is C1-C5 of the spinal cord. All 4 limbs are showing signs of an upper motor neuron lesion, which would be consistent with a C1-C5 myelopathy or multifocal spinal lesions. A C6-2 lesion would manifest as lower motor neuron signs in the thoracic limbs and upper motor neuron signs in the pelvic limbs. A T3-L3 lesion would manifest as upper motor neuron signs in the pelvic limbs with normal thoracic limbs. A L4 and caudal lesion would manifest as lower motor neuron signs in the pelvic limbs with normal thoracic limbs.
Remember that multifocal lesions in different areas of the spinal cord can make neuroanatomic localization trickier.

Question 12

This 4-year old male castrated Chinese Crested presented with an acute onset of being down in the hind end. On neurological examination, the patient’s cranial nerves are intact, there is bilateral hind limb conscious proprioceptive deficits, no motor function in either hind limb, superficial pain is absent in the hind limbs. There are normo-reflexive gastrocnemius reflexes bilaterally, hyper-reflexive patellar reflexes bilaterally, and no obvious pain on palpation of the spine. The patient was hesitating to move the neck to the left and right on manipulation, but when offered a treat to the side the patient did not seem to have trouble moving the head from side to side. The most likely diagnosis is intervertebral disc herniation. Based on the neurological exam where is the site of your laminectomy most likely to be?

C2-С3
C7-T1
L4-L5
T13-11

Answer 12

The neurological exam findings, signalment, and history are all consistent with intervertebral disc disease. All small breed dogs are predisposed to disc herniation as compared to larger breeds. The most over-represented breed is the Dachshund.
The findings in the neurological exam that help determine the location are the following:
1) Conscious proprioceptive deficits only in the hind
2) Hyper-reflexive patellar reflex
3 Loss of motor in the hind
4) Lack of superficial pain in the hind
These findings should help you realize that the lesion is between T3-L3 or L3-S1. However, hyper-reflexia in the hind should stand out.
Hyper-reflexia in the hind limbs is an upper motor neuron sign and is supportive of a T3-L3 lesion. Therefore, L4-L5 is not the best answer.
Approximately 80% of T3-L3 herniations are located in the T13-L1 region.
There is no indication of forelimb involvement or neck pain which makes neck involvement less likely.

Question 13

An 8 year old female spayed Labrador presents to you for progressive muscle loss on the skull. You examine the dog and see the changes visible in the photograph. The changes appear to be confined to the right side only. Which of the following conditions is most likely?

Right trigeminal neuropathy
Idiopathic polyradiculoneuritis
Myotonia
Right facial neuropathy
Masticatory muscle myositis

Answer 13

The correct answer is right trigeminal neuropathy. Hopefully, you were able to identify the presence of significant muscle atrophy of the right masseter and temporalis musculature. The nerve innervating these muscles is the trigeminal nerve. Recall that the trigeminal nerve (cranial nerve V) has primarily a sensory function, with the exception of innervating the muscles of mastication. The facial nerve (CN VII) innervates the muscles of facial expression and is the main motor nerve innervating the face but is not responsible for the muscles that are atrophied in this case. Masticatory muscle myositis is an autoimmune condition that chronically leads to atrophy of the same muscle group, but what differentiates this case is that the signs are unilateral. Idiopathic polyradiculoneuritis is the medical term for a condition sometimes referred to as Coonhound paralysis, which is a condition that diffusely affects all motor nerves.

Question 14

A 9-year old male Queensland Heeler presents with a four day history of progressive tetraparesis. Physical exam showed him to be weakly ambulatory with support. As part of your initial workup, you take chest X-rays which are shown below. Which of the following next steps is the most appropriate test to confirm your clinical suspicion about the cause of the dog’s signs?

CT scan of the thorax
Tension response test
Bronchoalveolar lavage and culture
MRI of the brain
Myelogram

Answer 14

The correct answer is a Tensilon (edrophonium) response test. Hopefully, you were able to identify the mass in the cranial mediastinum on the chest radiograph, as this was one of the keys to this case. This, in conjunction with the dog’s other signs, are suggestive that this dog has a thymoma and associated secondary myasthenia gravis. Tensilon (edrophonium) is a rapidly acting anticholinesterase that reverses signs of myasthenia within minutes in most dogs.
A chest CT would be a valid test to confirm the presence of the mediastinal mass and might be an appropriate test before surgery but would not bring you closer to a diagnosis if you already have identified the mass. An MRI of the brain would assess a CNS cause of the dog’s signs, which are unlikely, given the other findings. Similarly, a myelogram would assess if a spinal cord lesion caused the dog’s signs, but the rest of the findings in this case should point you in a different direction.

Question 15

A 5 year old male castrated German Shepherd Dog presents for a right thoracic limb monoplegia after jumping out of the back of a moving pickup truck. On physical exam, you observe superficial abrasions over his body, a right sided Horner’s syndrome, and dragging of his right thoracic limb. He has no conscious proprioception, motor function, or deep pain anywhere in the right thoracic limb. What should you tell the owner?

The dog has damage to the radial nerve. Electrodiagnostic procedures should be run to determine how much nerve function remains in the limb.

The dog has a brachial plexus avulsion but will likely regain function in the limb in several months.

The dog suffered a brachial plexus avulsion and will most likely need to have the leg amputated.

Physical therapy will greatly improve the chances that the dog will regain function of the limb.

Answer 15

The correct answer is the dog suffered a brachial plexus avulsion and will most likely need to have the leg amputated. Dogs that are hit by cars or who jump out of moving cars often suffer brachial plexus avulsions. Complete nerve root avulsions are not treatable and usually require amputation of affected limbs. Partial avulsions carry a better prognosis but require large amounts of time and physical therapy before seeing any improvement. The lack of deep pain and motor function in the limb is a negative prognostic indicator supporting the diagnosis of a complete brachial plexus avulsion.

Question 16

Which of the following is the most common presentation for a patient with idiopathic epilepsy?

A 5-month old Yorkshire Terrier that has generalized tonic-clonic seizures, often after eating. The dog is sometimes obtunded between seizures.

X A 2-month old Chihuahua that presents in status epilepticus after vomiting and not eating for a day. This is the first seizure the dog has been observed having.

A 3-year old Labrador Retriever that recently began having generalized tonic-clonic seizures approximately once weekly, most frequently at night when resting. The dog appears and behaves normally between seizures.

A 9 year old Bexer that recently began having focal meter seizures that began weekly but are now becoming mere severe and frequent

Answer 16

Despite the term, idiopathic epilepsy refers to a specific condition and should not be applied to any patient with seizures of unknown cause. Most dogs with idiopathic epilepsy begin having seizures between 1 and 5 years of age. Breeds commonly affected include Beagles, Keeshonds, Dachshunds, Labrador and Golden Retrievers, Shetland Sheepdogs, Irish Wolfhounds, Vizslas, and English Springer Spaniels.
Idiopathic epilepsy is much less common in cats.
While not always the case, the classic descriptions of patients with idiopathic epilepsy describe generalized tonic-clonic seizures without interictal abnormalities with seizures beginning during the 1 to 5 year age range.
The Yorkshire Terrier described shows signs most consistent with a portosystemic shunt.
The Chihuahua described shows signs most consistent with hypoglycemia.
The Boxer’s signalment and signs are most consistent with intracranial neoplasia.

Question 17

You have a 6-kg cat that you wish to raise his PCV from 15 to 25%. You plan to administer packed red blood cells. How many milliters of packed red blood cells will this cat need?
30 ml
60 ml
15 ml
120 ml

Answer 17

The correct answer is 60 ml. In order to raise the PCV 1% you will need to give 1ml/kg of packed red blood cells. So it takes 6mls to raise this cat’s PCV by 1%. If we are going to increase it by 10% we will need 60ml of packed red blood cells.

Question 18

A 12-year-old female spayed Siamese cat presents for weight loss and progressive vomiting of 2 months duration. On physical exam, the intestines feel diffusely thickened and the cat has a body condition score of 2/9. Blood work shows a low albumin of 1.9 g/dL (normal 2.4-3.9 g/dL), and normal kidney and thyroid values. Abdominal ultrasound confirms the diffusely thickened intestines. There are also several mildly prominent and hypochoic mesenteric lymph nodes. You suspect the cat has cancer. What is the most appropriate treatment for the type of cancer you suspect in this patient?

Chlorambucil and prednisolone

Radiation therapy

Cyclophosphamide, vincristine, doxorubicin, and prednisone

Surgical resection

Carboplatin

Answer 18

The cat most likely has small cell or low-grade intestinal lymphoma based on the history and clinical findings. This is considered an indolent or slowly progressive form of lymphoma and can be effectively treated with chlorambucil and prednisolone. This form of lymphoma is sometimes thought to develop from the progression of inflammatory bowel disease in cats. Chlorambucil is an oral alkylating agent that is usually well tolerated with few side effects. Many cats can live several years with this form of lymphoma and this treatment.
Cyclophosphamide, vincristine, doxorubicin, and prednisone are the drugs in a CHOP chemotherapy protocol used to treat dogs and cats (and people) with high grade or large cell lymphoma, which more commonly manifests as a large focal mass rather than diffusely thickened intestines.
Surgery and radiation therapy are not good treatment options due to the diffuse nature of the cancer.
Carboplatin is not known to be an effective chemo agent for low-grade lymphoma in cats.

Question 19

A 7 year old Bull Mastiff presents to your clinic with a complaint of lethargy. Physical exam is unremarkable. A CBC shows a markedly elevated white blood cell count of 150,000/ul (5,000-14,100/ul), consisting mostly of lymphocytes and unclassifiable circulating cells. You are concerned about the possibility of leukemia and elect to perform a bone marrow aspirate. You decide to use propofol for sedation/anesthesia in order to perform the brief procedure. Which of these should you monitor most carefully at induction with this agent?
Heart rate
Eye position
Respiration
Blood pressure

Answer 19

Propofol’s most common adverse side effect is temporary apnea. You should always be prepared to intubate and ventilate a patient when administering propofol due to the potential for severe apnea. It is certainly not wrong to monitor blood pressure and heart rate to assess anesthetic depth and vital signs, even for a brief procedure; but by far, the most important thing to watch is respiration.

Question 20

For what type of surgery would nitrous oxide be contraindicated for use as part of an anesthetic protocol in a dog?
Splenic surgery
Open chest surgery
Hepatic surgery
Renal surgery
Gastrointestinal surgery

Answer 20

Explanation
The correct answer is gastrointestinal surgery. Nitrous oxide moves into closed gas spaces such as the intestines. As such, its use is contraindicated in bowel surgeries.
You should also be aware that nitrous oxide decreases fractional inspired oxygen levels although this can be managed and monitored in most instances. Nitrous oxide is contraindicated when pathology such as pulmonary bullae are present.

Question 21

You ask your technician to give a 1 ml/kg dose of lidocaine to a dog that is having ventricular premature complexes. You realize after it is too late that she miscalculated the dose and gave 10 times what you asked for. What is the most common early sign of lidocaine toxicity in dogs?

Peripheral neuropathy
Central nervous system depression
Profound bradycardia
Anaphylaxis
Apnea

Answer 21

In dogs, toxicity of lidocaine is manifest primarily as CNS signs. Drowsiness or agitation may progress to muscle twitching and convulsions at higher doses. This occurs before respiratory or cardiac depression. Hypotension may develop if an IV bolus is given too rapidly.
Cats are more sensitive to lidocaine toxicity and may show cardiac suppression and CNS excitation.

Question 22

You have just arrived at the clinic at which you are working, and a clinician promptly approaches you and informs you that your Bichon Frise patient’s CVP (central venous pressure) is -1 cmH2O. What is your assessment of the animal’s condition?

CVP is not a good measure of circulating volume
The animalis hypovolemic
Normal
Overhydrated

Answer 22

The correct answer is the animal is hypovolemic. CVP is a decent measure of circulating volume. A normal CVP can range from 0-10 mH2O. It is important to interpret the CVP in light of your patient’s clinical signs and to observe the trend in CVP measurements.

Question 23

Which anesthetic agent is implicated in malignant hyperthermia?
Ketamine
Nitric oxide
Halothane
Acepromazine

Answer 23

The correct answer is halothane. This is mainly an entity in swine but may be seen in other animals. It is a rare induction of a hyper-metabolic reaction in skeletal muscle of susceptible individuals by halothane. The syndrome is characterized by muscle rigidity, increased body temperature, increased oxygen consumption and production of CO2.

Question 24

Which of the following drugs and potential side effects are paired correctly together?
L-asparaginase - anaphylaxis
Doxorubicin - cystitis
Vincristine - cardiac toxicity

Lomustine - pancreatitis

Answer 24

L-asparaginase is a protein enzyme and therefore may elicit an immune response. Anaphylaxis is rare but usually would occur only after a patient had received a prior dose and developed antibodies to it.
Vincristine is associated with paralytic ileus.
Lomustine is associated with hepatotoxicity.
Doxorubicin is associated with cardiotoxicity.
Cystitis is associated with cyclophosphamide.
Pancreatitis is associated with L-asparaginase or doxorubicin.

Question 25

Which of these is a major potential adverse side effect of the chemotherapeutic drug doxorubicin (Adriamycin) in dogs? Ileus Nephrotoxicity Cystitis Cardiotoxicity Anaphylaxis

Answer 25

Explanation The correct answer is cardiotoxicity. In addition to the usual side effects of chemotherapeutic drugs such as myelosuppression and Gl side effects, a major concern with adriamycin administration is dose dependent cardiotoxicity. The drug that causes ileus is vincristine. The drug that causes anaphylaxis is L-asparaginase. The drug that causes nephrotoxicity is cisplatin. The drug that causes cystitis is cyclophosphamide.

Question 26

If you have 25% mannitol and you wish to give 500 mg per kg to a 15 kg dog, how much should you give? 3 mls 60 mls 30 mls 300 mls 600 mls

Answer 26

The correct answer is 30 mls. 25% corresponds to 250 mg/ml strength. At a dose of 500 mg/kg, the total dose for a 15 kg dog should be 7,500 mg which divided by 250 mg/ml equals 30 mls.

Question 27

You are evaluating the blood work of a dog that is hit by a car. These are the following findings: HCO3-12 mmol/L (17-24 mmol/L) Total CO2-14 mmol/L (14-26 mmol/L) Lactate-2.3 mmol/L (0.5-2.0mmol/L). What is your assessment? Respiratory alkalesis Metabolic alkalosis Metabolic acidosis Respiratory acidosis

Answer 27

Explanation The correct answer is metabolic acidosis. A low bicarbonate and total CO2 level is consistent with a metabolic acidosis. An elevated blood lactate of greater than 2.0 mmol/L implies that there is anaerobic metabolism occurring in this patient as a result of inadequate tissue perfusion, perhaps due to bleeding and trauma. Nothing can be said about respiratory acidosis or alkalosis because no PaCO2 or pH is provided.

Question 28

Which of these compounds is an antidote for ethylene glycol toxicity? 3-Methyl indole 2-Pralidoxime 1,25 cholecalciferol 4-Methypyrazole

Answer 28

The correct answer is 4-Methylpyrazole (4-MP). It is used to inhibit alcohol dehydrogenase and is considered the preferred treatment for treating ethylene glycol toxicoses in dogs. 4-MP does not cause hyperosmolality, metabolic acidosis, and CNS depression like ethanol treatment can. 4-MP is given to dogs IV over a 36-hour period. The initial dose is 20 mg/kg (slow IV over 15-30 minutes), then 15mg/kg (slow IV) at 12 and 24 hours, and then 5mg/kg is given at 36 hours. 4-MP is not effective in cats.

Question 29

An 8-year old female Chow Chow presents to you for difficulty eating. On oral exam, you see a 3 cm mass in the caudal maxilla. You are unable to obtain a fine needle aspirate because of the mass's location but you detect an enlarged mandibular lymph node and aspirate it. A representative field from the aspirate is shown in the image below. In addition to surgery (+/- radiation), which of the following is an APPROVED treatment option for this disease that you would mention to the owner? Doxorubicin ONCEPT vaccine Mitoxantrone Palladia Vincristine

Answer 29

The image shows a lymph node with metastatic melanoma (the large cell with black melanin pigment). The ONCEPT vaccine, also commonly referred to as the "melanoma vaccine" was given a conditional product license in 2007 and was USDA approved in 2010 as a therapeutic vaccine for cancer treatment. Palladia is a receptor tyrosine kinase inhibitor approved for use in mast cell tumors in dogs. Doxorubicin, vincristine and mitoxantrone are human chemotherapy drugs commonly used off-label in veterinary oncology but not routinely for melanoma.

Question 30

A 1-year-old female spayed Corgi presents for a seizure. At home, she vomited what appeared to be paint chips. Peripheral blood cytology and a complete blood count showed 20 nucleated red blood cells/100 white blood cells, basophilic stippling, and a neutrophilic leukocytosis (see image). She received a dose of diazepam, which has controlled her seizures. What is the treatment of choice? D-penacillamine A acetyleysteine Ca-EDTA Doxyeyeline

Answer 30

Explanation This dog is showing signs of lead poisoning. Clinical signs are primarily gastrointestinal and neurologic. Animals are usually exposed in old buildings or areas of renovation where they have access to lead paint, old batteries, lead fishing weights, etc. Old food and water dishes can also be a source if lead paint was used. Lead blood levels can be measured; however, they do not necessarily correlate with severity of clinical signs. Toxic blood levels are greater than 0.4 ppm. Bloodwork can show an elevated number of nucleated RBCs without anemia. Basophilic stippling is a classic finding with lead toxicity but not specific. Ca-EDTA is the chelator used to treat lead poisoning. Succimer can also be given orally. D-penacillamine has also been used to chelate lead, copper, iron and mercury. It is used more commonly for copper toxicity. N-acetylcysteine is used for acetaminophen toxicity and hepatotoxicity. Basophilic stippling can sometimes be confused with erythrocytic parasites for which doxycycline may be the treatment of choice.

Question 31

Question 32

Interpret the following blood gas results from a 4 year old female spayed dog: Base excess= -8 (-5 to 0 mmol/L) Anion gap=18 (8-25 mmol/L) pH 7.30 (7.35-7.45) pCO2=29 (34-40 mmHg) Metabolic Acidosis, Respiratory Alkalosis Metabelie Alkatosis, Respiratery Alkatesis Metabolic Alkalosis, Respiratory Acidosis Metabolic Acidosis, Respiratory Acidosis Normal

Answer 32

The correct answer is metabolic acidosis, respiratory alkalosis. The normal base deficit/excess of a dog is about -5 to 0 mmol/L. This means that this dog has a base deficit and therefore a metabolic acidosis. Although this dog has a base deficit, she still has a normal anion gap (18-25 mmol/L). There is a slight acidemia as normal pH is approximately between 7.35-7.45. Finally, normal pCO2 is approximately 40. This dog is hyperventilating and blowing off CO2. In other words, she is blowing off acid; therefore she has respiratory alkalosis. Causes of metabolic acidosis with a normal anion gap can include loss of bicarbonate due to diarrhea.

Question 33

A 10 year old female spayed Schipperke dog presents to your emergency clinic for profuse vomiting for several days and weakness. You perform initial bloodwork and find that her blood pH is 7.6 (7.35-7.45) and her potassium is 1.8 mmol/L (3.4-4.9 mmol/L). She weighs 12 kg. You immediately start her on intravenous fluids supplemented with potassium. What is the maximum rate of intravenous potassium that would be considered safe to administer to this dog? 6 mEq/hr 3 mEq/hr 12 mEq/hr 24 mEq/hr 18 mEq/hr

Answer 33

Explanation The maximum safe rate of potassium infusion is 0.5 mEq/kg/hr. As this dog weighs 12 kg, the maximum is 6 mEq/hr. This is one of those rates that you need to know. Administering potassium more rapidly than this can result in fatal arrhythmias.

Question 34

A 5-year old mixed breed female spayed dog presents with a non-healing wound over the antebrachium. The cytological smear has been made and can be seen below. What is your treatment of choice? Amputation followed by chemotherapy Itraconazole for several months Cephalexin for several months Amphotericin B for 28 days Marbofloxacin for 28 days

Answer 34

In this slide, a broad based budding yeast is visualized. This is characteristic of blastomyces. Cryptococcus displays a narrow based budding. Treatment of fungal organisms is usually long term (minimum 3-5 months) as they are difficult to eliminate. Antibiotics are ineffective against fungi. Occasionally, antibiotics may be prescribed if a secondary bacterial infection is suspected. Amphotericin B (an injectable anti-fungal) is not a first choice because it is associated with a greater degree of side effects, especially nephrotoxicity, and the treatment period offered is too short. In resistant or severe cases, sometimes a course of amphotericin B is considered. In those cases, a lipid based amphotericin product (such as Abelcet) should be used, and the renal values must be closely monitored. An ocular exam, chest radiographs, and thorough palpation of local lymph nodes should be performed to ensure there is no other involvement.

Question 35

A 2-year old female spayed Coonhound presented for unilateral swelling of the muzzle. She lives on a large piece of property and has free reign of the backyard so the owners did not witness the event. They mentioned that coyotes and rattlesnakes have been seen in their yard before, as well as bees and spiders. On physical exam, there is significant firm swelling of the left muzzle and pain on palpation. There are no obvious signs of external trauma. You perform a blood smear in-house and find that she is thrombocytopenic and has 3+ echinocytes. PT and PTT were both severely elevated. What should be recommended to the owner? Pain medication and warm compressing Pain medication and antivenom Pain medication and plasma transfusion to treat the coagulopathy Pain mediation, sedation and thorough examination for wounds and a bee stinger

Answer 35

Even without external evidence of fang punctures, the presence of echinocytes, thrombocytopenia and prolonged PT and PTT in conjunction with the unilateral painful muzzle swelling is supportive of a rattlesnake bite. Other possible causes of echinocytes include hemangiosarcoma and liver disease which are not likely in the present scenario. Bee stings and spider bites can cause pain and unilateral or bilateral muzzle swelling depending on the location but echinocytes should not be present. 25% of rattlesnake bites are dry bites but the presence of echinocytes indicates toxin within the blood so antivenom should be administered immediately. The main side effect of antivenom is anaphylaxis but serum sickness can occur 1-2 weeks post treatment. Venom can be neurotoxic, coagulopathic, or a hybrid. There are three different types of antivenom available. The product produced by Fort Dodge is FDA approved but only treats the coagulopathic venom. Antivipmin is USDA but not FDA approved and treats both neurotoxic and coagulopathic venom. Crofab is a human product that also treats both but is extremely expensive. Plasma will not correct the coagulopathy since the toxin directly affects clotting factors.

Question 36

You examine a Basset Hound with primary glaucoma in one eye. What would you tell the owner about his prognosis for the other eye? This is very strange because glaucoma almest always occurs bilaterally It will probably also develop glaucoma in 6-12 months It has no increased chance of developing glaucema It will probably develop glaucoma within the next 1-3 months

Answer 36

Explanation The correct answer is that it will probably also develop glaucoma in 6-12 months. The usual course for primary glaucoma is development ir one eye with the contralateral eye following in 6-12 months. These animals have an iridocorneal angle that becomes increasingly compromised during the first few years of life and eventually causes an acute pressure spike in the eye.

Question 37

Which of these breeds of dogs has a congenital ocular anomaly characterized by choroidal hypoplasia, manifested by varying degrees of visual dysfunction with signs of large bizarre choroidal vessels visible on fundic exam as depicted here? Collie German Shepherd Dog Boston Terrier West Highland White Terrier Toy Poodle

Answer 37

The correct answerr is collie eye anomaly. It is

Question 38

Which of these is a possible primary cause for anterior uveitis as shown in this dog with aqueous flare? Coccidioides immitis infection Keratoconjunctivitis sicca Cataracts Systemic Lupus Erythematosis

Answer 38

The correct answer is Coccidioides (fungal) infection. SLE causes many signs, but anterior uveitis is not considered one of them. The causes of uveitis include infection (bacterial, viral, fungal, rickettsial), immune-mediated (lens-induced uveitis), neoplasia, hypertension, and trauma. Over 50% of the time, the cause is not found, and the uveitis is termed idiopathic. Chronic uveitis can lead to cataract formation, glaucoma and other eye issues.

Question 39

On physical examination of a dog, you find the mass depicted here projecting from the margin of the upper eyelid. What is the most likely diagnosis? Chalazion Meibomian adenoma Entropion Melanoma

Answer 39

The correct answer is meibomian adenoma. The description fits the appearance and location of a meibomian gland adenoma. This is the most common ocular tumor of the dog and is usually benign. A chalazion is an obstruction of the meibomian gland and appears as a swelling within the eyelid rather than projecting from it. Entropion is an infolding of the eyelid. Melanoma is a reasonable differential but is less common, especially with the location of this mass at the eyelid margin.

Question 40

Which of these is not a proper treatment for glaucoma (primary or secondary) in a dog? Topicat tatanoprest (prestagtandin anatog) Topical mannitol Topical derzetamide (carbenic anhyerase inhibitor) Oral methazelamide (carbonic anhydrase inhibiter) IV mannitol .

Answer 40

The answer is topical mannitol. Carbonic anhydrase inhibitors act by decreasing aqueous production which is partially dependent on the conversion of carbon dioxide to bicarbonate. It can be used topically or systemically. Latanoprost (Xalatan) is a prostaglandin analog frequently used topically in the treatment of glaucoma. IV mannitol works to decrease IOP through its properties as an osmotic attractant. It is not used topically

Question 41

You are examining the eyes of a dog with all the signs of Horner's syndrome. After instilling topical hydroxyamphetamine, there is no change. You then instill topical phenylephrine and in 5 minutes, the eye returns to normal. What can you conclude about this dog's Horner's? The Horner's has been present for a long time The Horner's is idiopathic in origin He has a pre-ganglionic lesion He has a post-ganglionic lesion The Horner's has only been present for less than 24 hours

Answer 41

The answer is that he has a post-ganglionic lesion. Hydroxyamphetamine acts by encouraging release of norepinephrine (NE) from the postsynaptic neuron. If there is a pre-ganglionic lesion, NE will still be released by the postsynaptic neuron and signs will resolve. If there is a post-ganglionic lesion, there will be no NE to release. Also, with a post-ganglionic lesion, denervation hypersensitivity to NE occurs. As a result, adding phenylephrine topically can cause a rapid response. With pre-ganglionic lesions, the response usually takes greater than 20 minutes.

Question 42

A 15-year-old female spayed miniature schnauzer presents for running into walls. You diagnose acute vision loss. On ophthalmic examination, you observe tapetal hyperreflectivity and vascular attenuation of the retina. After questioning the owner, you determine that the dog is also exhibiting polyuria, polydipsia, polyphagia, weight gain, and some lethargy. Based upon the available information, what is the most likely cause of this dog's blindness? Lens Luxation Keratoconjunctivitis Sicca Glaucoma Sudden Acquired Retinal Degeneration Syndrome (SARDS) Cataracts

Answer 42

Explanation SARDS most commonly affects brittany spaniels, miniature spaniels, dachshunds, and pugs. Middle-aged, overweight female spayed dogs are most likely to be affected, and affected dogs often present with symptoms that are normally associated with Cushing's disease, such as polyuria, polydipsia, polyphagia, weight gain, and lethargy. Electroretinography performed by an ophthalmologist can definitively diagnose the disease. There is unfortunately no effective treatment for this degenerative retinal condition.

Question 43

You are examining a 3-year old female Miniature Poodle whose owner complains that she has been bumping into things more and more recently, especially at night. On fundic examination, you note tapetal hyperreflectivity, gray, vermiform lines on the fundus, retinal vascular attenuation, and a pale optic disc. Which of these choices is the most likely cause of her problem? Glaucoma Sudden Acquired Retinal Degeneration Synereme (SARDS) Progressive Retinal Atrophy (PRA) Taurine Deficiency

Answer 43

The correct answer is PRA. Progressive retinal atrophy, sometimes called progressive retinal degeneration is an inherited retinal disease seen in several breeds but most notably Toy and Miniature Poodles. Age of onset is variable, but signs are usually night blindness progressing to complete blindness due to loss of rods prior to cones. Retinal lesions are classically the ones described in this case. It is differentiated from SARDS by the clinical course and the fact that there are no retinal lesions in acute SARDS. You could see similar retinal lesions from glaucoma but would expect more clinical signs and you wouldn't have night blindness progressing. Taurine deficiency causes retinal lesions in cats not dogs, and they have a different appearance.

Question 44

A cat presents with a mid diaphyseal femoral fracture. The cat lives both indoors and outdoors and the owner is unsure of how the fracture occurred. Which repair method will result in the highest likelihood of failure? Intramedullary pin Interlocking nail Type I External Fixation Limited contact dynamic compression plate with 6 cortices engaged in each fragment

Answer 44

The least effective repair method of the choices listed is to place an intramedullary pin in a femoral fracture. Intramedullary pins are strongest in bending but do not provide enough stability by themselves. They are great as an adjunct to a bone plate. Placing a Type I external fixator on a femur is acceptable, however many feel that the fixator pins result in substantial morbidity when going through the large musculature of the femur. A limited contact dynamic compression plate is an acceptable method of repair as well as an interlocking nail which would provide great strength in bending, limit axial motion, and limit rotational motion.

Question 45

An 8-week old male kitten has just presented to your clinic after having one of his paws crushed by the owner who accidentally closed one of the household doors on his foot. The cat is very vocal on presentation and non-weight bearing. A general examination found no overt health problems and the only injury localized is that of the metacarpal region. Radiographs are performed and a fracture of metacarpal Il and IV are diagnosed. Both fractures are noted to have about 50% overlap with their respective fragment. What is the best treatment option for this kitten? Dowel pin fixation of metacarpal Il will result in sufficient stability for healing Dynamic compression plate stabilization of metacarpal ll and IV Spoon splint bandage changes every 2 weeks for a total of 8 weeks Spoon splint bandage with bandage changes every 5 days for a total of 2 weeks

Answer 45

Explanation There are several aspects to consider when determining the best treatment. The age of this cat provides an enormous advantage to bone healing. This is a kitten and bone plating and dowel pinning will be exceptionally challenging in a patient this small. A cat this young will likely achieve complete healing in approximately 2 weeks. Metacarpal bone fragments that have decent apposition and less than 50% displacement will usually heal with conservative management and proper stabilization. Adult cats with fractures involving both weight bearing metacarpals or severely displaced fractures are considered good candidates for surgery. Therefore, the best answer is to place a spoon splint for 2 weeks. Note that the bandage is changed every 5 days to prevent any restriction of growth and development secondary to the splint. In adult animals, bone healing typically will occur in 8-12 weeks.

Question 46

You are closing an abdominal incision after completing a spay surgery on a cat. What is the holding layer of the abdomen? External abdominal oblique External rectus sheath Transversus abdominis Muscularis Submucosa Rectus abdominis

Answer 46

Explanation The correct answer is external rectus sheath. This is true for most species, not just cats. The submucosa is the holding layer for most of the gastrointestinal tract (esophagus, intestines)

Question 47

An owner calls concerned that her 2 month-old kitten vomited a worm. You just saw the kitten for an exam the week before and gave a dose of Pyrantel during the appointment. According to the owner, the worm looks like a piece of spaghetti. What course of action do you take for the most likely diagnosis? Continue dosing with Pyrantel every 3 weeks until the kitten is 3 to 4 months old Metronidazele every 12 hours for 7 days Nothing; you already treated the kitten appropriately Fametidine every 24 hours for 3 days Praziquantel once, then repeat in 3 weeks, then 3 months

Answer 47

Explanation You would recommend to examine the worm and perform a fecal flotation for definitive diagnosis of the worm and to diagnose concurrent parasites. Most likely, based on the history and description, this patient is dealing with a Toxocara infection. Toxocara cati can be transmitted from queen to kitten via transmammary infection. Environmental control is also extremely important as grooming is a common source of egg ingestion. Due to the life cycle of roundworms, it is important to continue to treat every 2-3 weeks until the patient is 3-4 months old. It is unlikely that a one-time treatment of Pyrantel will resolve the issue.

Question 48

Your client raises show rabbits and her cat named Neffer has been eating the rabbit feces. She brings Neffer's fecal matter in for examination and the fecal float reveals Eimeria (see image). Which of the following treatments are indicated for this cat? Sulfadimethoxine Sulfasalazine Doxycycline No treatment is necessary Fenbendazole

Answer 48

This coccidian is not parasitic in dogs and cats and no treatment is necessary for the cat. The parasite has shown up on fecal exam because it is merely passing through the digestive tract secondary to coprophagy. Eimeria is identified as having 4 sporocysts or a distinct micropyle cap. Eimeria are parasitic in birds, reptiles, and herbivores. The owner should be informed of the parasite, and her rabbits should be treated. Isospora is the infectious coccidian in dogs and cats and is treated with Sulfadimethoxine (Albon).

Question 49

Which of these compounds is effective at inducing emesis in the cat? Ketamine Acepromazine Diazepam Xylazine

Answer 49

The correct answer is xylazine. Xylazine can cause emesis fairly reliably in cats. The other drugs listed do not.

Question 50

Which is not a common cause of gastric ulcers in dogs and cats? NSAIDS Corticosteroids Renal Failure Opioids Liver Failure

Answer 50

Explanation The answer is opioids. NSAIDS and corticosteroids compromise the mucus-bicarbonate protection of the stomach. Renal disease and the corresponding uremia cause decreased mucosal blood flow and gastric hypersecretion. Liver disease causes gastric ulcers by decreasing mucosal blood flow secondary to portal hypertension and thrombosis. Liver failure is also associated with increased histamine and gastrin levels leading to gastric hypersecretion.

Question 51

Question 52

A 5-month old female cat presents to you for weight loss, chronic diarrhea and steatorrhea. The organism seen in a stained fecal smear is shown in the image below (this is a magnified 40X image, the organism is approximately 15 x 8 um). Which treatment is most appropriate? Tylosin Sulfadimethoxine Fenbendazole Penicillin

Answer 52

Explanation The organism is Giardia which can be recognized as a trophozoite with two nuclei outlined by adhesive discs. Giardia should be distinguishable from trichomonads which have a single nucleus and an undulating membrane. The best treatments for Giardia are either fenbendazole or metronidazole.

Question 53

A 6-year old domestic short hair cat presents for anorexia and lethargy. On physical examination, she has icteric mucous membranes. Bloodwork shows a markedly elevated GGT 28 (0-6 U/L) and ALP 170 (0-45 U/L). Which is the most likely diagnosis? Hepatic lipidosis Renal failure Cholangiohepatitis Hyperadrenocorticism

Answer 53

Explanation The correct answer is cholangiohepatitis. Hepatic lipidosis is incorrect due to the elevated GGT, which usually stays normal in these cases. Renal failure is incorrect because it would not cause icterus or liver enzyme elevations. Hyperadrenocorticism is incorrect because it is not consistent with the clinical signs. Cholangiohepatitis in cats can be due to ascending infection or immune-mediated damage to the liver and is commonly seen in conjunction with inflammatory bowel disease and/or pancreatitis.

Question 54

An 8-week old Abyssinian cat recently obtained from a cattery presents to you for an examination and the owner reports that the cat has had diarrhea. On fecal float, you find multiple structures like the one shown in the photo (see image). What should you treat the cat with? Sulfadimethexine (Albon) X Praziquantel (Droncit) Pyrantel (Strongid) Metronidazole (Flagy!) Amoxicillin and clavulanate (Clavamox) Selamectin (Revolution)

Answer 54

Explanation This is an image of Isospora from a cat. Isospora are parasitic coccidia that can cause diarrhea as this cat is showing. Treatment for coccidia is usually with sulfonamides such as sulfadimethoxine or trimethoprim sulfa. For the other drugs listed: Droncit- Primarily for cestodes (tapeworms) Revolution- For fleas, heartworms, hookworms, roundworms, and ear mites Strongid- Primarily for roundworms and hookworms Clavamox- A broad spectrum antibacterial Metronidazole- Primarily for anaerobes, also used for giardia

Question 55

Suzie-Q, a 6-month old female spayed domestic short hair was recently adopted from the humane society. She has had watery diarrhea since adoption. Her fecal float and Giardia ELISA tests were negative. She was treated with metronidazole with no clinical improvement. You soak a cotton tip swab with saline and swab the rectum. You see elongated motile oval shaped protozoan organisms that do not look like Giardia lamblia. What organism might this be and what is the appropriate therapy? Taenia taeniaformis, Praziquantel Paragonimus kellicotti, Praziquantel Tritrichomonas foetus, Ronidazole Enterobius vermicularis, Fenbendazole Cryptosporidium, Clindamycin Giardia intestinalis, Fenbendazole

Answer 55

Explanation Tritrichomonas foetus is a flagellated parasite most commonly found in kittens that have had an unresponsive diarrhea. The parasite can be very difficult to diagnose. It is most often responsive to Ronidazole. Paragonimus is a lung fluke. The eggs are typically passed in the feces. Fenbendazole and Praziquantel have been effective against this parasite. Giardia is unlikely if the ELISA is negative as it is a very sensitive test. Taenia is a tapeworm and is not a flagellated parasite. It is treated with Praziquantel. Cryptosporidium is a coccidian that invades the small intestinal villi after ingestion of infected oocysts. It can be diagnosed with PCR. It is treated with clindamycin, azithromycin, or tylosin most commonly. It is usually an opportunist, so evaluation for underlying disease is appropriate. Enterobius vermicularis, or pinworm, is a parasite of people and primates but not cats and dogs.

Question 56

Grave, mean survival is < 2 months Poor, mean survival is < 6 months Fair, mean survival is about 1 year Good, mean survival is greater than 2 years

Answer 56

Explanation The case described is consistent with lymphocytic portal hepatitis. Clinically, this condition can appear similar to chronic cholangiohepatitis in terms of signalment, clinical signs and laboratory findings. The key to this diagnosis is the liver biopsy. Typical findings for lymphocytic portal hepatitis is infiltration of lymphocytes and plasma cells but not neutrophils into portal areas. This is in contrast to chronic cholangiohepatitis which typically has neutrophils in portal areas. Chronic cholangiohepatitis carries a fair prognosis with about half of cats doing poorly (dead or euthanized within 3 months) and half of cats responding favorably to treatment with long term survival. For cats with lymphocytic portal hepatitis, although treatment can be challenging, the disease is very slowly progressive and the reported mean survival is approximately 3 years.

Question 57

Mickey, a 2-year old male neutered Siamese, presents with a history of weight loss and vomiting occasionally. His blood work shows ALP 291 IU/L (0-45 IU/L) and ALT 272 IU/L (25-97 IU/L). Bile acids are mildly elevated with pre-prandial 3.9 umol/L (0-5 umol/L) and post-prandial 39 umol/L (0-15 umol/L). FeLV/FIV testing and toxoplasmosis titers are negative. Ultrasound was normal overall. You perform an exploratory laparotomy and take biopsies of the liver which is mildly yellow in color but normal in texture. The histopathology report shows non-suppurative moderate pleocellular lymphoplasmacytic periportal cholangiohepatitis. Cultures of the liver are negative. Which of the following therapies are the best treatment option? Prednisolone, ursodiol Budesonide and metoclopramide Metronidazole and chlorambucil Pancreazyme powder and weekly cyanocobalamin injections L-carnitine, Vitamin E, and Vitamin K

Answer 57

The biopsy results show cholangiohepatitis which is inflammation of the biliary system and liver parenchyma. It can be autoimmune in nature, or may be triggered by underlying infection or neoplasia. Concurrent diseases often include pancreatitis and inflammatory bowel disease. The main treatment of non-suppurative cholangiohepatitis is prednisolone since it is most often immune in origin. Ursodiol is often used for its immunomodulatory, hepatoprotectant, and antifibrotic effects. It helps with the flow of bile through the liver. Other helpful therapies include S-adenosylmethionine (SAMe) and Vitamin E. Pancreazyme powder and vitamin B12 injections (cyanocobalamin) can be useful in chronic pancreatitis but would not be the best treatment for cholangiohepatitis. Budesonide is a steroid that may be beneficial for inflammatory bowel disease but would likely not provide enough systemic anti-inflammatory effects for the liver disease. Metronidazole or Clavamox are often used in conjunction with prednisolone if infection is suspected but is not the primary treatment for this disease. Antibiotics are more important in suppurative cases. Chlorambucil is used as an immunosuppressant in refractory cases of cholangiohepatitis when the prednisolone is not enough to control the disease. L-carnitine may be beneficial if hepatic lipidosis is a concurrent problem from the anorexia but is not a treatment for cholangiohepatitis. Vitamin E is a good antioxidant for the liver. Vitamin K may be used in cases of liver failure especially prior to surgery for liver biopsies.

Question 58

A 16-year old, male-neutered cat comes in for further evaluation of intermittent vomiting and anorexia. The cat has a history of renal insufficiency and hyperthyroidism. Both of these are currently being managed well according to the owner. On physical exam the patient is found to be slightly lethargic and perhaps a little dehydrated. After performing blood work there is still no clear indication as to why the patient is not feeling well. The BUN was 42 mg/d (19-34 mg/dl) and creatinine 2.0 mg/dl (0.9-2.2 mg/di). The rest of the chemistry panel was unremarkable. The CBC showed a hematocrit of 25% (30-45%) which has been longstanding. An abdominal ultrasound was performed and a mass associated with the pancreas was identified. The 2cm mass was at the mid-body of the right limb of the pancreas. Chest radiographs were subsequently performed and found to be within normal limits. The owners elected to take the cat for removal of this mass. Which post-operative concern is least likely? Patient should be monitored closely for increased vomiting and abdominal pain Renal values should be monitored closely for signs of acute on chronic renal failure Hypoglycemia post-surgery, which needs close blood glucose monitoring Bilirubin levels should be monitored closely for signs of extrabiliary obstruction Explanation When performing mass resections of the pancreas the ideal situation is a mass associated with the tail of the pancreas. Otherwise they can be very difficult to excise in their entirety and you run the risk of disrupting the flow of pancreatic enzymes into the duodenum. The pancreas is responsible for secreting insulin which is what stimulates glucose to be removed from the blood stream and taken into the cell. A patient with a mass in the pancreas that is causing hypoglycemia has an insulinoma (seen in dogs). Removal of an insulinoma can occasionally lead to hyperglycemia and diabetes mellitus requiring insulin administration in dogs, but there is no indication of an insulinoma based on the normal blood glucose level on the chemistry panel indicated in the question. Manipulation of the pancreas can result in pancreatitis and if the inflammation is severe enough an extrahepatic biliary obstruction could occur and result in elevated bilirubin levels. Extrahepatic billiary obstructions secondary to pancreatitis can require surgical intervention. Clinical signs of pancreatitis will likely manifest themselves in the form of persistent abdominal pain and vomiting. Since this patient has renal insufficiency it is important to monitor renal values closely. Remember that it takes about 75% of the kidneys to be damaged before the values go up so any elevation in renal values may be cause for alarm. This is particularly important if the patient was hypotensive during surgery and renal perfusion was potentially compromised.

Answer 58

Explanation When performing mass resections of the pancreas the ideal situation is a mass associated with the tail of the pancreas. Otherwise they can be very difficult to excise in their entirety and you run the risk of disrupting the flow of pancreatic enzymes into the duodenum. The pancreas is responsible for secreting insulin which is what stimulates glucose to be removed from the blood stream and taken into the cell. A patient with a mass in the pancreas that is causing hypoglycemia has an insulinoma (seen in dogs). Removal of an insulinoma can occasionally lead to hyperglycemia and diabetes mellitus requiring insulin administration in dogs, but there is no indication of an insulinoma based on the normal blood glucose level on the chemistry panel indicated in the question. Manipulation of the pancreas can result in pancreatitis and if the inflammation is severe enough an extrahepatic biliary obstruction could occur and result in elevated bilirubin levels. Extrahepatic billiary obstructions secondary to pancreatitis can require surgical intervention. Clinical signs of pancreatitis will likely manifest themselves in the form of persistent abdominal pain and vomiting. Since this patient has renal insufficiency it is important to monitor renal values closely. Remember that it takes about 75% of the kidneys to be damaged before the values go up so any elevation in renal values may be cause for alarm. This is particularly important if the patient was hypotensive during surgery and renal perfusion was potentially compromised.

Question 59

Which of the following statements is correct regarding the treatment of pancreatitis in cats? They should not be fed until the pancreatitis begins to resolve They should be fed a low protein diet They should be fed through a jejunestenny tube They should be fed a regular commercial diet if eating They should be fed a low-fat diet

Answer 59

The correct answer is feed a regular commercial diet if eating. Cats do not require a low-fat nor a low-protein diet and usually do not require a period of being NPO. Withholding food for an extended period may be likely to induce hepatic lipidosis in some cats. Additionally, some studies suggest that stimulation of pancreatic enzymes via feeding is actually necessary in affected cats. A jejunostomy feeding tube may be occasionally recommended in severe cases of pancreatitis with dogs, but is less likely necessary in cats. If anorectic, usually an esophagostomy feeding tube is sufficient.

Question 60

A 7-year old male castrated cat presents to you for difficulty eating. On examination, you see that there are dental lesions on the buccal surfaces of several premolar and first molar teeth. The cat shows signs of discomfort when you palpate around these teeth and the surrounding gingiva appears inflamed. You suspect that the cat has odontoclastic resorptive lesions. You perform dental radiographs which show evidence of endodontic necrosis. Which of the following is the most appropriate treatment recommendation? Affected teeth should be extracted and Vitamin D supplementation may reduce the likelihood of development of similar lesions in other teeth Affected teeth should-be treated by removal of the crown and corenal part of the root with a dental burr fellewed by suturing the gingiva acress the root Dental extraction is a less expensive option but restorative dental techniques are effective at stopping progression of disease in most cats Affected teeth should be extracted and it is likely that other teeth will be affected in the future Correct Answer Administration of an analgesic may provide relief until the lesion spentaneously resolves Explanation As described in this case, feline odontoclastic resorptive lesions commonly affects cats with increasing incidence as cats age. One or more lesions are found in about 50% of the domestic cat population over 5 years old. Lesions are often seen at the buccal surfaces of premolars and the first molar teeth at the gingival margin. Canine teeth can also be affected but usually lesions occur in the roots and the crown may appear normal. There have been many theories about the cause of these lesions including a relationship to plaque-induced inflammation, microfractures of the cemental surface, and mineral deficiencies but most of these theories are no longer supported. It is now believed that abnormal formation or mineralization of cementum results in cemental resorption. There may be a relationship to high levels of vitamin D. For treatment, there are reports of using alendronate, a bisphosphonate which inhibits demineralization of bone. Also, laser therapy has been used. However, neither of these treatments are currently accepted as standard care of this disease and extraction is the only current treatment that offers permanent prevention of pain to the patient. Restorative dental procedures are retained without recurrence in <25% of cats in 2-3 years. In cases where lesions are entirely confined to the crown with no deep periodontal pockets and no radiographic evidence of endodontal necrosis, one can consider retaining the root. However, in the case described, complete extraction is the most appropriate recommendation. Because the incidence of lesions increases with age, it is likely that the cat in this case will develop lesions in other teeth in the future. Excessive Vitamin D should be avoided but other recommendations for prevention are controversial. Diligent dental care is certainly recommended.

Answer 60

Explanation As described in this case, feline odontoclastic resorptive lesions commonly affects cats with increasing incidence as cats age. One or more lesions are found in about 50% of the domestic cat population over 5 years old. Lesions are often seen at the buccal surfaces of premolars and the first molar teeth at the gingival margin. Canine teeth can also be affected but usually lesions occur in the roots and the crown may appear normal. There have been many theories about the cause of these lesions including a relationship to plaque-induced inflammation, microfractures of the cemental surface, and mineral deficiencies but most of these theories are no longer supported. It is now believed that abnormal formation or mineralization of cementum results in cemental resorption. There may be a relationship to high levels of vitamin D. For treatment, there are reports of using alendronate, a bisphosphonate which inhibits demineralization of bone. Also, laser therapy has been used. However, neither of these treatments are currently accepted as standard care of this disease and extraction is the only current treatment that offers permanent prevention of pain to the patient. Restorative dental procedures are retained without recurrence in <25% of cats in 2-3 years. In cases where lesions are entirely confined to the crown with no deep periodontal pockets and no radiographic evidence of endodontal necrosis, one can consider retaining the root. However, in the case described, complete extraction is the most appropriate recommendation. Because the incidence of lesions increases with age, it is likely that the cat in this case will develop lesions in other teeth in the future. Excessive Vitamin D should be avoided but other recommendations for prevention are controversial. Diligent dental care is certainly recommended.

Question 61

A 5-year old female spayed cat presents to you with the primary complaint of lethargy. You perform bloodwork and find a hematocrit of 16% (30-45%). The anemia is regenerative with 3.5% reticulocytes (0-0.6%). PCR is positive for circulating DNA of Mycoplasma haemominutum. Which drug is effective for treatment of Mycoplasma? Itraconazole Cyproheptadine Clavamox Metronidazole Doxycycline

Answer 61

Acceptable treatment options for mycoplasma in cats are doxycycline and enrofloxacin. Cats should be treated for 3 weeks in most cases. Remember that doxycycline can cause esophageal stricture in cats, and administration should be followed by water. This therapy should be effective in most cases but often does not completely eliminate the organism from the body, and cats may remain carriers of the pathogen.