Most Difficult Questions Category Flashcards
How soon after administration of a dose of dexamethasone for induction of parturition in a cow do you expect parturition?
A. 24 hours
B. 48 hours
C. 8 days
D. 12 hours
B. 48 hrs
Parturition may occur anytime between 2 and 7 days but on average it occurs on the second day. A dose of
25-30 mg IM is sufficient.
A 8-year old Siamese cat presents to you with a single 2 cm skin mass on top of his head that is well circumscribed, hairless, dome-shaped and fixed to the overlying skin but freely movable from underlying fascia. The mass has been present for months and has been slowly growing. What is the most likely diagnosis?
A. Basal cell tumor
B. Squamous cell carcinoma
C. Cutaneous lymphosarcoma
D. Mast cell tumor
A. Basal cell tumor
The correct answer is basal cell tumor. This is the most common skin tumor in the cat (about 20% of all feline skin tumors). These tumors are usually hairless, dome-shaped, raised masses as described. They are most frequently found on the head, neck, and shoulders. They are almost always benign although histologically, they may have aggressive characteristics.
Which of these parameters tells you that an animal is hyperventilating?
A. PaCO2 < 30 mmHg
B. RR >60 bpm
C. PaO2 >120 mmHg
D. Pa02 < 80 mmHg
E. PaCO2 >50 mmHg
Answer: A PaCO2 < 30 mmHg
The correct answer is PaCO2 < 30 mm Hg. Ventilation is defined by the PaCO2. Normal is 35-45 mmg. A hypoventilated patient has a high PaCO2, and a hyperventilated patient has a low PaCO2.
Topic: Cytauxzoon Felis
Cytauxzoon felis is a protozoal organism and transmission to cats is through tick bites. Cats usually show clinical signs 1-3 weeks after infection. Signs can be non specific and include anorexia, lethargy, dyspnea, and icterus. Cats will also commonly have a marked pyrexia.
The organism invades the reticuloendothelial cells of the lungs, spleen, liver, lymph nodes, and other organs so cranial organomegaly can often be present. The bone marrow can be affected causing pancytopenias. Thrombocytopenia is likely related to the development of disseminated intravascular coagulation, which can cause spontaneous bleeding. There is no effective therapy and prognosis is poor to grave. Current treatment recommendations include the antimalarial drug atovaquone combined with the antimicrobial azithromycin as well as fluids, heparin and supportive care.
Anti-protozoal medications such as imidocarb have been used with varying success. Corticosteroids and antibiotics such as doxycycline, enrofloxacin, and marbofloxacin are commonly used to treat Mycoplasma haemofelis, but they are ineffective against Cytauxzoon.
Immune mediated hemolytic anemia, cholangiohepatitis, and FIP should also be considered as differentials.
Intravenous fluids, heparin therapy, blood transfusion; grave
Topic: Eosinophillic Granuloma Complex
Feline eosinophilic granuloma complex consists of 3 separate clinical syndromes.
A. The collagenolytic granuloma (also known as eosinophilic granuloma or linear granuloma) usually occurs on the (4) ? The lesions are typically ________ and ___________ or ____________.
B. The eosinophilic plaque occurs most frequently on the _____________ and ____________ ___________ but can appear other places. They appear as ? They frequently have a ___________ appearance and unlike eosinophilic ulcers, these are often ________. This condition is histopathologically similar to miliary dermatitis and is usually associated with underlying allergy.
C. The eosinophilic ulcer (also known as indolent ulcer) typically occurs on the ? and may be _________ or _________. They often have a characteristic central area of _______ to _______ tissue with a slightly raised circumferential edge
The underlying cause of eosinophilic ulcers and collagenolytic granulomas are _________, although an underlying allergic cause such as arthropod bites and/or cutaneous hypersensitivity have been suggested.
Treatment of collagenolytic granulomas is also controversial so it is unlikely that you would be asked about treatment of this disorder on a board exam aside from knowing that you should attempt to identify and remove/treat underlying allergy or biting arthropod problems.
Some cases respond to antibiotic therapy but most require glucocorticoid therapy.
A. The collagenolytic granuloma (also known as eosinophilic granuloma or linear granuloma) usually occurs on the nose, chin, oral cavity, or caudal thighs. The lesions are typically raised and ulcerative or nodular.
B. The eosinophilic plaque occurs most frequently on the abdomen and medial thighs but can appear other places. They appear as single or multiple, raised, red, often ulcerated lesions of varying size (0.5-7 cm). They frequently have a cobblestone appearance and unlike eosinophilic ulcers, these are often pruritic. This condition is histopathologically similar to miliary dermatitis and is usually associated with underlying allergy.
C. The eosinophilic ulcer (also known as indolent ulcer) typically occurs on the upper lip and may be unilateral or bilateral. They often have a characteristic central area of yellow to pink tissue with a slightly raised circumferential edge
The underlying cause of eosinophilic ulcers and collagenolytic granulomas are unknown, although an underlying allergic cause such as arthropod bites and/or cutaneous hypersensitivity have been suggested.
Treatment of collagenolytic granulomas is also controversial so it is unlikely that you would be asked about treatment of this disorder on a board exam aside from knowing that you should attempt to identify and remove/treat underlying allergy or biting arthropod problems.
Some cases respond to antibiotic therapy but most require glucocorticoid therapy.
What is pictured below?
Eosinophillic granuloma - chin
What is pictured below?
Eosinophillic ulcer - top lip
What is pictured below>
Eosinophillic granuloma - mouth
What is pictured below?
Eosinophillic plaque
Which of these is the most important treatment for salmon poisoning?
A. Oxytetracycline
B. Ivermectin
C. Praziquantel
D. Fenbendazole
The correct answer is oxytetracycline.
Salmon poisoning commonly occurs in the ?
Dogs contract the disease by ingesting _____ _______ containing the fluke ____________ _________ which carries the rickettsial organism _____________ __________________.
The most common vector is _____ _________, hence the name. Other cases have occurred from the ingestion of (2)?
Clinical signs include ?
Rare cases can develop neurrological signs such as _________ and ?
Because the signs are caused by a rickettsial organism, treatment is with a __________-type of drug. Left untreated, _____% of dogs will die.
________________ is usually given to eliminate the fluke in order to prevent contamination of other waterways.
Salmon poisoning commonly occurs in the Pacific Northwest (Washington, Oregon, Northern California, and southern Vancouver Island in Canada). Dogs contract the disease by ingesting raw fish containing the fluke Nanophyetus salmincola which carries the rickettsial organism Neorickettsia helminthoeca.
The most common vector is raw salmon, hence the name. Other cases have occurred from the ingestion of freshwater trout and salamanders. Clinical signs include fever, vomiting, diarrhea, enlarged lymph nodes, and depression. Rare cases can develop neurologic signs such as seizures and muscle twitching.
Because the signs are caused by a rickettsial organism, treatment is with a tetracycline-type of drug. Left untreated, 90% of dogs will die.
Praziquantel is usually given to eliminate the fluke in order to prevent contamination of other waterways.
A 2-year old MN DSH has recently been treated for a urethral obstruction. He went home last week from the hospital on an acidifying canned diet for this condition. The owner reports he is passing urine in moderate amounts, but he is still straining frequently. You re-examine the cat and find that the bladder is empty on palpation and the wall feels a little thickened. You are confident that the cat has not re-blocked and the cat’s bloodwork shows normal electrolytes and renal values. Which of the following medications may help the cat with this problem?
A. Prednisolone
B. Amitriptyline
C. Phenylpropanolamine
D. Phenexybenzamine
E. Methocarbamol
Explain your answer choice!!
This cat is likely suffering from hypertonicity of urethral muscle, which was incited from the recent obstruction and urinary catheter. This can cause spasms, which makes urinating painful and not easily controlled. Phenoxybenzamine can be used in this case to reduce internal urethral sphincter tone such that the cat may urinate more easily.
Methocarbamol is a muscle relaxant but would not directly help spasms of the urethra.
Prednisolone is not used to help reduce inflammation or spasms in the urethra and may predispose the cat to contracting a urinary infection, especially while his bladder and urethra are compromised.
Phenylpropanolamine is used to treat urinary incontinence from urethral hypotonicity most often in dogs and would be contraindicated in this case.
Amitriptyline is an anti-depressant medication that has been implicated as part of a treatment plan for cats with cystitis, although benefit has never been proven. Because cats with cystitis can flare up during times of stress, the amitriyptyline has been thought to helo prevent this. This medication would not work to stop spasms in the urethra.
Which of these tests is used to diagnose a Corynebacterium pseudotuberculosis infection with internal abscesses in horses?
A. Zinc sulfate turbidity test
B. Coggin’s test
C. KOH test
D. Synergistic hemolysis inhibition test
The correct answer is the synergistic hemolysis inhibition test. Other clinicopathologic data that would support an internal abscess would include leukocytosis, hyperfibrinogenemia and hyperglobulinemia. A KOH test is used to diagnose dermatophytes. The zinc sulfate turbidity test evaluates for failure of passive transfer. The Coggin’s test is for equine infectious anemia. Remember, goats get C.
pseudotuberculosis as well.
You are in charge of a slaughter house and are asked about why so many of the culled dairy cattle in a recent shipment have liver abscesses (see photo) and what can be done about it. The abscesses result in a significant financial loss for the owner because the liver is condemned, and he is concerned. What is the cause?
A. Foot abscesses showering bacteria to the liver
B. Rumen acidosis
C. Liver fluke migration
D. Black disease
E. Traumatic reticuloperitonitis with hepatic involvement
Explain your answer choice!
Dairy cattle which are fed a high concentrate diet should be gradually introduced to it. Even so, an additional dietary buffer may be needed. The herd veterinarian should check rumen pH on about 5 high-producing cows by needle stick of the rumen 2 to 3 hours after they are fed. If some fall below pH 5.5, additional sodium bicarbonate should be added to the ration.
The low rumen pH causes rumenitis allowing bacteria to translocate through the mucosa and be filtered from the hepatic portal circulation by the liver, resulting in one or more hepatic abscesses.
The key to picking rumenitis is that there are many culled dairy cattle coming in with this problem of hepatic abscess. If it were feet or hardware it would only occasionally lead to a liver abscess.
A horse is referred to your practice for further evaluation and treatment of glomerulonephritis. Which of the following is not a treatment option?
A. Long term furosemide administration
B. Low protein diet
C. Corticosteroids
D. Plasma transfusion
The correct answer is long term furosemide administration.
Horses with glomerulonephritis are usually polyuric. Furosemide is only indicated for oliguric renal failure.
The other choices are commonly used in the treatment and management of glomerulonephritis. A low protein diet will help decrease the amount of proteinuria and blood urea nitrogen circulating at any given time, therefore helping reduce the degree of azotemia.
What is the most appropriate medical treatment for transitional cell carcinoma at the trigone of the bladder, as depicted in the photo?`
Transitional cell carcinoma of the bladder in dogs can be palliatively managed with non-steroidal anti-inflammatory drugs such as piroxicam. Progression-free interval and survival can be extended with the addition of chemotherapy. The most commonly used agents are carboplatin, cisplatin, and mitoxantrone. Although cisplatin is effective against TCC, it has increased nephrotoxicity with piroxicam and is less commonly used these days in the author’s experience. Secondary infections can be treated with appropriate antibiotics.
You are investigating a case of high mortality in 14 week old pigs. You are suspicious of Porcine circovirus associated disease (PCVAD). What sample do you need to submit to a laboratory to confirm your diagnosis?
A. Serum sample for virus isolation
B. Whole blood for complete blood count (CBC)
C. Serum sample for PCR testing
D. Lymphoid tissue for histology
E. Serum sample for ELISA antibody testing
The correct answer is lymphoid tissue for histology. A diagnosis of PCVAD requires 3 parts:
1) at least a doubling of mortality (clinical history)
2) demonstration of lymphoid depletion (histopathology)
3) high number of PCV2 antigen in the lesion (immunohistochemistry on tissue)
In a dog, Cushing’s response is characterized by a?
A. Compensatory hyperadrenocorticism to maintain cerebral perfusion
B. Compensatory increase in mean arterial pressure to maintain cerebral perfusion pressure
C. Compensatory decrease in systolic blood pressure to maintain peripheral perfusion
D. Compensatory elevation in blood glucose to enhance cerebral function
The correct answer is a compensatory increase in mean arterial pressure to maintain cerebral perfusion pressure.
Cerebral perfusion pressure= Mean arterial pressure - intracranial pressure or (CPP=MAP-ICP).
This response is seen in situations where intracranial pressure increases such as in brain trauma. In this case, you need to think before you intervene to decrease your patient’s mean arterial pressure as this might eliminate cerebral blood flow and kill your patient.
You examine a 4-year old Holstein dairy cow which freshened 2 weeks ago. She has a history of abrupt cessation of lactation and loss of interest in feed. T=105F, HR=90 and RR=30. The cow has an arched back and is treading and swishing her tail frequently. On rectal exam you find an enlarged and painful left kidney. You catch urine in a cup after stimulating her to urinate. Which description of the urine best fits what you would expect to find in this cow?
Amytoid casts
Hemoglobinuria
Cloudy and bloody
Correct Answer
-Crystats present
Ketonuria
Explanation
This cow is likely to have acute pyelonephritis. It is most commonly ascending and associated with E. coli, other coliforms, or Corynebacterium renale. You could also use ultrasound to confirm the diagnosis, but finding neutrophils, RBCs and bacteria with these signs is indicative of acute pyelonephritis.
A farmer complains to you that many of his sheep have been doing poorly. You visit his flock and find many listless, emaciated adult sheep that are dyspneic and tachypneic. The sheep have normal temperatures, appetites, and no adventitious lung sounds. What is your top differential?
Pasteurella pneumonia
-Oestrus ovis infestation
Ovine Progressive Pneumonia
Correct Answer
Chlamydia psittaci pneumonia
Explanation
Ovine Progressive Pneumonia is caused by a lentivirus, also known as Maedi-Visna virus. This generally causes a chronic, progressive condition, and affected sheep tend to be afebrile and maintain their appetites as long as they do not develop secondary bacterial pneumonia. This is in contrast to Pasteurella pneumonia, which tends to be much more acute. Clinical signs of Oestrus ovis tend to be more confined to the nares. Chlamydial pneumonia is rare in sheep.
A 6-month old male German Shepherd Dog presents for castration. A 4/6 left systolic murmur is heard best over the apex of the heart. Thoracic radiographs reveal a moderately enlarged left atrium. What is the most likely diagnosis?
Aortic stenosis
Tricuspid valve dysplasia
Mitral valve dysplasia
Correct Answer
Myxomatous degeneration of the mitral valve
Your Answer
Explanation
The correct answer is mitral valve dysplasia. This abnormality is a congenital anomaly of the mitral valve. The valve leaflets may be thickened, fused, fibrosed, etc. The chordae tendinae or the papillary muscles attaching to the mitral valve may be irregular as well.
German Shepherd Dogs, Great Danes, and other large breed dogs are predisposed to this disease. Myxomatous mitral valve degeneration occurs in older dogs, but would otherwise result in similar physical exam and radiographic findings as those described. Tricuspid dysplasia results in an enlarged right heart, and the murmur would be heard best on the right side of the dog. Aortic stenosis results in concentric hypertrophy of the left heart, which may or may not be detectable on radiographs. Also, the murmur is heard best at the left heart base with aortic stenosis.
Which of these compounds is effective at inducing emesis in the cat?
Ketamine
Acepromazine
Diazepam
Xylazine
Your Answer
Correct Answer
Explanation
The correct answer is xylazine. Xylazine can cause emesis fairly reliably in cats. The other drugs listed do not.
A 3-year old Golden Retriever presents for acute onset of a non-painful myelopathy localized to the spinal segments from T3-L3. The dog has superficial and deep pain perception and some motor function present in its pelvic limbs. It also has hyperreflexive patellar and gastrocnemius reflexes. The dog is diagnosed with a fibrocartilagenous embolism (FCE). What do you tell the owners?
The dog should be treated with heparin to prevent further emboli
Your Answer
The dog should have decompressive surgery
♥ Most cogs with FCEtstally get beter on theirown with mersingeare
Correct Answer
The dog will prebably continue to get worse and has a poor prognosis
Explanation
The correct answer is most dogs with FCE usually get better on their own with nursing care. FCE is caused by an embolus of disc material in the spinal vasculature. It is unknown how the disc material gets into the vasculature. The prognosis of dogs with FCE varies. Most dogs get better with supportive and nursing care. The loss of pain perception and lower motor neuron signs are poor prognostic indicators.
A pregnant cow has a uterine torsion. Which of these therapeutic interventions should you attempt if the torsion is clockwise?
Push forward on the vagina while rolling the cow counterclockwise
Perform uterine surgery to relieve the torsion
Administer oxytocin
Push forward on the vagina while rolling the cow clockwise
Correct Answer
Explanation
The correct answer is push forward on the vagina while rolling the cow clockwise, which may seem counter-intuitive. By stabilizing the uterus and rotating the cow around it, you can attempt to relieve the torsion.
A longtime client has come in with a new cat for evaluation of pruritis. The pet was rescued off the streets just a few days ago and now the owner has become slightly itchy. On examination the coat is noted to be dry with small areas of alopecia. The ears and neck region appear to be the most severely affected. The owner is concerned she has become infected with whatever is affecting her new cat. Based on your findings, what will you tell the owner?
From what I have found, the cause of your itchy skin is not associated with your new cat
Both you and your cat are likely affected with the same organism and I recommend you seek professional help to help resolve your probable infection
You will need to treat all dogs and eats within the household
The organism identified is resistant to most insecticides but does respond to ivermectin
The image illustrates a louse. Fortunately, lice are host specific and therefore are not considered zoonotic. They spend their entire life-cycle, which is approximately 21 days, on the host. Lice will lay their eggs (nits) on hair shafts which may be identified as white flakes on the hair shafts. There are two types of lice, Anoplura (sucking louse) and Mallophaga (biting louse).
Interestingly, lice are very susceptible to most insecticides (selamectin, ivermectin, imidacloprid, pyrethrin spray, fipronil, lime sulfur dip, etc.) It is recommended that treatment be repeated 10-14 days after the initial treatment to eliminate any nits that may have hatched after the first treatment. Another good idea is to clean any bedding and the environment and treat all animals of the same species in the
household.
A 5-year old domestic medium haired female cat presents to you for poor appetite and vomiting over several days. On physical exam, you note pale, icteric mucous membranes, mild generalized lymphadenopathy, and hepatosplenomegaly. HR-230 bpm, RR-44 bpm, T-103.8F.
Bloodwork reveals:
HCT-11% (25-47)
Retic- 340,000/ul (10,500-51,000)
WBC-19,000/ul (5,500-14,540)
Platelets-120,000/ul (220,000-539,000)
A chemistry panel is pending but you order a blood transfusion right away. Unfortunately, the cat’s condition rapidly declines and the cat dies.
Post-mortem exam reveals generalized icterus and splenomegaly (see image). Which of the following was the cat most likely suffering from?
Immune-mediated hemolytic anemia
Toxic hepatocellular necrosis
Pancreatitis
Biliary obstruction
Explanation
The only answer choice that readily explains the acute presentation and severe regenerative anemia is immune-mediated hemolytic anemia (IMHA). The icterus could be caused by any of the choices but in this case, is apparently prehepatic due to hemolysis. Keep in mind that in cats, IMHA usually occurs secondary to an underlying infectious or inflammatory disease, although primary idiopathic IMHA does occur as well.
The largest U.S. broiler hatcheries now apply Marek’s disease vaccine by what method?
Coarse spray of Marek’s disease virus in aerosol chamber at one day of hatch
In ovo injection of live virus at day 18 of incubation
Subcutaneous injection of live virus in chicks at one day of hatch
Subcutaneous injection of killed virus in chicks at one day of hatch
In ovo injection of killed virus at day 18 of incubation
Explanation
The Marek’s disease vaccine is recommended for in ovo vaccination of 18- to 19-day-old healthy embryonated chicken eggs. The vaccine may also be used for subcutaneous vaccination of healthy one-day-old chickens, but in large-volume chicken hatcheries, the in ovo method is used
A rancher in the Rocky Mountains has found that many of the beef calves born this season are deformed with cleft palates, arthrogryposis, and crooked spines. The pregnant cows were grazing on pastures that have had a large amount of several species of the plant pictured. What is the problem that caused these congenital anomalies?
Larkspur
Tansy ragwert
Lupine
Locoweed
Oleander
Some lupines contain alkaloids called sparteine and anagyrine. Cows eating lupine during early gestation often give birth to calves with cleft palates, crooked legs and distorted/malformed spines. Six of the poisonous species implicated in “crooked calf disease” are silky lupine (L. sericeus), tailcup lupine (L. caudatus), velvet lupine (L. leucophyllus), silvery lupine (L. argenteus), lunara lupine (L. formosus), and yellow lupine (L. sulphureus).
A 1-year-old male castrated Basset Hound presents for epistaxis from both nostrils, a small amount from blood from the right and a larger amount from the left. There is no history of trauma but he does go for frequent walks, and as a typical Basset, usually has his nose to the ground.
His heart and lungs sound normal. You note a few ecchymotic hemorrhages on the thin skin under his abdominal region. You discuss the various causes of this issue with the owner and perform some labwork, including a coagulation panel, and the important values to note are as follows:
PCV 34%
Reticulocytes 110K
Platelets 180K/uL (143-448 K/uL)
Prothrombin Time (PT) 6.9s (6.3-13.3 seconds)
Partial Thromboplastin Time (PTT) 10.9s (10.6-16.8 seconds)
Based on this information, what is your top differential?
Canine thrombopathia
Nasal foreign body
Rodenticide toxicity
Immune-mediated thrombocytopenia
Explanation
The correct answer is canine thrombopathia. The disease is an autosomal recessive trait seen in Basset Hounds where platelets fail to aggregate and secrete their granules in response to normal stimuli. These dogs are at an increased risk for bleeding spontaneously, and an injury or surgical procedure could cause excessive hemorrhage. Platelet numbers and coagulation parameters are normal in this condition.
It isn’t an issue with platelet number, but of function.
Rodenticide would cause elevated clotting times.
Immune-mediated thrombocytopenia would cause a low platelet count.
A nasal foreign body would be less likely to cause a bilateral bleed and would not attribute to the ecchymotic hemorrhages noted on the abdominal skin.
A 3-month old dog presents for acute lameness, and you diagnose a fracture based on the radiograph below. You contact a surgeon to repair the fracture and explain to him that the dog has what type of fracture?
Type I Salter-Harris fracture of the distal femur
Type I Satter Harris fracture of the distal femur
Type V Satter Harris fracture of the distal femur
Long oblique femoral fracture
Type III Salter-Harris fracture of the distal femur
Physeal fractures are commonly described in Salter-Harris nomenclature. In this system, a type I is a fracture through the physis, a type Il is fracture partway through the physis extending up into the metaphysis, a type Ill is a fracture partway through the physis extending down into the epiphysis, a type IV is a fracture through the metaphysis, physis, and epiphysis, and a type V is a crush injury to the physis
Which of these groups is considered predisposed to developing nasal aspergillosis?
Dogs in large groups or kennels
Brachycephalies
Immunocompromised dogs
Hunting dogs
Dolichocephalic
Explanation
The correct answer is dolichocephalics. Aspergillus is typically a disease of healthy, apparently immunocompetent dogs that are young to middle-aged. Dolichocephalic breeds are overrepresented. Immunocompromise does predispose to development of disseminated aspergillosis. Being in a large group of dogs does not increase risk, as it is not a contagious disease. Aspergillus is fairly ubiquitous in the environment, and hunting dogs are probably not exposed significantly more than any other dog.
You examine a Basset Hound with primary glaucoma in one eye. What would you tell the owner about his prognosis for the other eye?
It will probably develop glaucoma within the next 1-3 months
It has no increased chance of developing glaucoma
This is very strange because glaucoma almost always occurs bilaterally
It will probably also develop glaucoma in 6-12 months
Explanation
The correct answer is that it will probably also develop glaucoma in 6-12 months. The usual course for primary glaucoma is development in 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.
Which of the following statements is true about degenerative disc disease in dogs?
A. Hansen’s Type 1 disc disease usually involves chondrodystrophic dogs. It is usually chronic, non-painful, and is not considered an emergency.
B. Hansen’s Type 1 disc disease usually involves chondrodystrophic dogs. It is usually acute, painful, and should be considered an emergency.
C. Hansen’s Type 2 disc disease usually involves non-chondrodystrophic dogs. It is usually acute, painful, and should be considered an emergency.
D Hansen’s Type 2 disc disease usually involves non-chondrodystrophic dogs. It is usually chronic, painful, and should be considered an emergency.
Explanation
The correct answer is Hansen’s Type 1 disc disease usually involves chondrodystrophic dogs (Dachshunds, Corgis, Shih-Tzus, etc.). It is usually acute, painful, and should be considered an emergency.
Clostridioides difficile is a spore-forming bacteria commonly associated with enterocolitis and diarrhea in adult horses and foals. Which of the following statements is NOT correct in regard to C. difficile in horses?
Administration of non-steroidal anti-inflammatory medications. For example flunixin meglumine, is a risk factor for the development of C. difficile enterocolitis.
Transmission of C. difficile occurs via the oral fecal route.
C. difficile is a Gram-positive, rod shaped, obligate anaerobe:
The 2 main virulence toxins are toxin A and toxin B.
C. difficile can survive for prolonged periods of time in the spore form.
Explanation
The correct answer is NSAID treatment is a risk factor for the development of C. difficile enterocolitis. Remember all the other answers are correct, so hopefully you can take away some of these important facts from this question. Risk factors for the development of disease include antibiotic treatment and hospitalization, but does not include administration of NSAIDs.
Which of the following is the best way to find Giardia canis trophozoites?
Direct fecal smear
Fecal sedimentation
Fecal flotation
Baermann technique
Explanation
Giardia trophozoites and cysts are typically found on a direct fecal smear. Giardia cysts can be found on fecal flotation also. The organism can also be detected by FA and ELISA.
The Baermann technique is a method of recovering larvae from fecal material and is most commonly used when looking for nematode parasites, most often lungworm.
A 16-year old pregnant Standardbred mare presents with an acute onset of colic. On presentation, she has a heart rate of 64, respiratory rate of 32, and is pawing. CRT is approximately 3.0 seconds, and mucous membranes are red. Her rectal temperature is 101.3F (38.5 C). Gastrointestinal sounds are completely absent, and gastric reflux yielded 16L of brown- to yellow-colored fluid. Which of the following is a possible diagnosis?
Cecal impaction
Left dorsal colon displacement
Mesenteric rent
Right dorsal colon displacement
Nephrosplenic entrapment
Explanation
The correct answer is a mesenteric rent. A mesenteric rent can result in a strangulating intestinal obstruction. Other causes of strangulating intestinal obstructions include intussusceptions, hernias, epiploic foramen incarceration, volvulus, and strangulating lipomas. Left dorsal colon displacement is the same thing as splenic entrapment and will typically not result in a colic presentation this severe.
A 9-month old foal presents with difficulty walking. You immediately note that the foal appears to have a flexural deformity of the right forelimb consisting of an increased dorsal hoof wall angle of 80 degrees such that the heel does not contact the ground. The coronary band is prominent.
You take radiographs which confirm a broken forward hoof-pastern angle. What is the most appropriate treatment for this type of flexural limb deformity?
Desmotomy of the accessory ligament of the deep digital flexor tendon
Superior check ligament desmotomy
Transection of the insertion of the semitendinosus
Lateral digital extensor tenectomy
Explanation
This case describes a severe flexural deformity of the distal interphalangeal joint, also known as “clubfoot”. This is typically a congenital condition in young horses although it can be acquired. A genetic component is suspected. Mild cases can sometimes be managed conservatively with NSAIDs, farriery, exercise and nutritional changes. Severe cases often require surgery; the surgical procedure of choice is desmotomy of the accessory ligament of the deep digital flexor tendon (also known as inferior check ligament desmotomy). The accessory ligament of the deep digital flexor tendon (inferior check ligament) runs from the palmar surface of the proximal metacarpus to the deep flexor tendon in the mid-metacarpal region.
The superior check ligament originates above the knee and attaches to the superficial flexor tendon, and its primary purpose is to support the tendon. Superior check ligament surgery is used to treat a bowed tendon.
Lateral digital extensor tenectomy is a procedure used to treat stringhalt. Transection of the insertion of the semitendinosus is used to treat fibrotic myopathy.
A 2-year old male castrated Beagle presents for vomiting and diarrhea. The blood smear for a CBC shows microfilariae in the peripheral blood.
Which of the following parasites must be ruled out?
Filaroides osleri
Strongyloides stercoralis
Uncinaria stenocephala
VAcanthocheilonema reconditum
Explanation
The correct answer is Acanthocheilonema reconditum (previously Dipetalonema reconditum). Acanthocheilonema reconditum is a blood parasite that looks similar to the microfilariae of Dirofilaria immitis, the agent of Heartworm disease. The two parasites must be differentiated because Acanthocheilonema reconditum is not pathogenic and is therefore not treated. Uncinaria stenocephala, Strongyloides stercoralis, and Filaroides osleri would not be found in the blood.
A 3-year old female intact Doberman presents to your clinic for a routine spay. The owner states she has not recently been in heat and has been healthy her entire life. Aside from a thorough physical examination and routine blood work, what additional diagnostic test should be performed prior to surgery?
Chest radiographs
Abdominal ultrasound
Buccal mucosal bleeding test
Activated clotting time
Explanation
Doberman Pinschers are predisposed to having von Willebrand’s Disease (VWD). Specifically, Dobermans have increased incidence of have Type 1 WD. In this type, there is a reduced presence of functional von Willebrand factor. This factor is crucial in initial clot formation and attracts platelets and allows them to bind to exposed subendothelium after injury. A buccal mucosal bleeding test should result in a clot in less than 4 minutes in normal dogs. An abnormal result warrants further investigation to confirm the presence of vWD in order to take the appropriate measures prior to surgery.
Chest radiographs are not necessary prior to anesthetizing this patient for an elective procedure unless there are physical examination findings which indicate radiographs of the chest. An abdominal ultrasound is a potentially good choice if there is concern that the uterus is enlarged or the animal is pregnant; however, there is no history presented that would make you believe that is the case, and it is impractical to perform an abdominal ultrasound for a routine procedure unless there is a clear indication. The activated clotting test evaluates the intrinsic and common coagulation pathways, and there is no concern with dysfunction in these.
A 4-year-old male Akita presents with a foreign body obstruction. You perform an intestinal resection and anastomosis surgery due to the compromised appearance of the intestine at the foreign body site. The dog recovered well after surgery. Five days postoperatively, he presents again with a history of inappetence and has a 104.8 F (40.4 C) temperature. What is the best diagnostic test to confirm your clinical suspicion?
Complete blood count and serum chemistry
Thoracie radiographs
Abdominocentesis
Abdominal ultrasound
Serum lactate
Explanation
You should be highly suspicious of leakage at the surgery site and resultant septic peritonitis. The most common time for anastomosis failure is 3-5 days postoperative;y. This is due to the degradation of fibrin at the site prior to deposition of sufficient collagen.
Abdominocentesis would likely reveal a septic inflammatory process, confirming your clinical suspicion with the finding of intracellular bacteria. A CBC and chemistry are helpful adjunct diagnostic tests but are not specific for septic peritonitis. An abdominal ultrasound would not distinguish between normal postoperative abdominal fluid and/or free gas and a septic effusion. Serum lactate, although helpful, is also not specific for sepsis. Thoracic radiographs could be useful to assess for less likely complications such as aspiration pneumonia.
A 7-year old male castrated cat presents for respiratory distress with open-mouth breathing. You initially place him in oxygen and obtain thoracic radiographs when he is stabilized. The films are shown here. What is your diagnosis?
See other radiograph on other side
Explanation
The correct answer is left-sided congestive heart failure. The cardiac silhouette is tall suggestive of left ventricular enlargement, and there is an alveolar pattern in the lung fields. The pulmonary vasculature is also dilated. Remember that cats in heart failure can have edema distributed in patchy infiltrates throughout the lungs, in contrast to dogs where it is more typically in the perihilar region.
Asthma is less likely as no clear bronchial markings are seen and because of the infiltrate. Neoplasia is a consideration, but doesn’t explain the cardiac enlargement. Pneumonia could also cause this pattern of infiltrate (although it is more typically cranioventral), but also does not explain the cardiomegaly. There is no evidence of tracheal collapse, which is an exceedingly rare condition in the cat.
Annotations:
Orange: The cardiac silhouette is diffusely enlarged moderately
Yellow circle: Areas of alveolar pattern
Blue: pulmonary veins
Red: Pulmonary arteries. In this case there is enlargement of both the pulmonary arteries and veins
Green: pleural fissure line, most likely indicative of pleural effusion
A 4-year old hunting horse presents to you for lameness. The owner reports that the horse developed a short-striding lameness of the left hind limb after an event this week and that the horse is reluctant to bear full weight on the left hind leg. On examination, you notice a prominent bump to the left of midline on the topline of the hindquarters (croup). You suspect a sacroiliac luxation or subluxation. What is the preferred treatment for this injury?
Open reduction and an Anderson sling
Closed reduction and an Ehmer sling
Supportive care
Total hip arthroplasty
Explanation
Sacroiliac luxations in horses are generally considered untreatable. The condition will often stabilize with time and supportive care with rest and NSAIDs. Some horses may return to their previous level of activity or competitiveness but most have residual limitation. Reduction is not typically an option. Total hip arthroplasty has been reported in horses but is typically reserved for severely injured horses that do not improve with supportive care.
In the Spring of 2001, a syndrome later termed Mare Reproductive Loss Syndrome, also known as MRLS, occurred in central Kentucky. This resulted in the abortion of 20-30% pregnant mares. Which of the following was NOT a manifestation of MRLS?
Neonatal foal deaths
Early fetal loss
Late-term abortion
Fibrinous pericarditis
Fetal or neonatal hemoabdomen
Explanation
The correct answer is fetal or neonatal hemoabdomen. All other choices listed were potential disease manifestations of MRLS. The exact pathogenesis of MRLS is still unknown, but the presence of eastern tent caterpillars was strongly associated with the disease. Later, experimental studies in which pregnant mares were exposed to or fed, via NG tube, eastern tent caterpillars resulted in early and late fetal loss.
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
Metronidazole every 12 hours for 7 days
Nothing; you already treated the kitten appropriately
Famotidine every 24 hours for 3 days
Praziquantel once, then repeat in 3 weeks, then 3 months
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.
A 3-year old Golden Retriever presents for acute onset of a non-painful myelopathy localized to the spinal segments from T3-L3. The dog has superficial and deep pain perception and some motor function present in its pelvic limbs. It also has hyperreflexive patellar and gastrocnemius reflexes. The dog is diagnosed with a fibrocartilagenous embolism (FCE). What do you tell the owners?
The dog should be treated with heparin to prevent further emboli
The dog will probably continue to get worse and has a poor prognosis
The dog should have decompressive surgery
Most dogs with FCE usually get better on their own with nursing care
Explanation
The correct answer is most dogs with FCE usually get better on their own with nursing care. FCE is caused by an embolus of disc material in the spinal vasculature. It is unknown how the disc material gets into the vasculature. The prognosis of dogs with FCE varies. Most dogs get better with supportive and nursing care. The loss of pain perception and lower motor neuron signs are poor prognostic indicators.
A 7-year-old mixed breed dog presents for re-evaluation of demodicosis and severe flea allergic dermatitis. The dog’s skin is doing much better since being on Ivermectin, and you plan to continue treatment. The owner is very concerned about the area around the tail base, as the patient has been extremely pruritic in that region. You suspect flea allergy dermatitis and ask the owner if she is still using flea medications. The owner explains that she stopped the flea medication when Ivermectin was started. You ask about the other animals in the household, and the owner replies that the rabbit and cat have no clinical signs. The owner also states that the cat and rabbit continue to sleep with the dog despite his skin condition. Which flea medication would be a good choice for this patient?
Permethrin
Lufenuron
Pyriproxyfen
Afoxalaner
Spinosad
Explanation
From the list of medications Afoxalaner (Nexgard) is the best choice. This flea medication contains an adulticide; whereas, pyriproxyfen and Lufenuron are only insect growth regulators. Spinosad should never be used with extra-label doses of Ivermectin and is probably why this client discontinued flea medications in the first place. Permethin is an excellent flea medication, as it is a repellent and adulticide, but it is toxic to cats. Fipronil is toxic to rabbits.
A 2-year old Brown Swiss with an abomasal torsion is likely to have which electrolyte abnormalities?
Paradoxic aciduria, hypochloremia, and hyperkalemia
Hyperglycemia, hypochloremia, and hyperkalemia
Hyperkalemia, hypocalcemia, and metabolic alkalosis
Hyperchloremia, hypokalemia and metabolic acidosis
Hypochloremia, metabolic alkalosis, and hypokalemia
Explanation
The correct answer is hypochloremia, metabolic alkalosis, and hypokalemia. As a result of torsion, affected animals sequester HCl in the abomasum, get hypochloremia and metabolic alkalosis. Additionally, animals become dehydrated and try to maintain adequate blood pressure by conserving sodium through renal mechanisms. Because there is an alkalosis, potassium is sequestered even more than usual in cells leading to hypokalemia. Normally the kidney excretes some potassium because of the need to maintain an equal number of anions and cations in the urine. But when there is insufficient potassium available, in order to reabsorb sodium to maintain blood pressure, hydrogen ions are excreted rather than potassium. This results in acidic urine at the same time as metabolic alkalosis, a condition known as paradoxic aciduria.
A 2-year old MN DSH presents for anorexia and vomiting of 2 days duration. Physical examination reveals the cat is dehydrated, but otherwise no abnormalities are noted.
Bloodwork shows the following: BUN 55 mg/dl (19-34 mg/dl), creatinine 3.8 mg/dl (0.9-2.2 mg/dl), sodium 135 mEq/L (146-156 mEq/L), potassium 3.1 mEq/L (3.7-6.1 mEq/L), chloride 85 mEq/L (115-130 mEq/L), TCO2 38 (13-21 mEq/L), HCT 60% (30-45 %). Urinalysis: USG 1.058 (>1.035), negative sediment.
You started the cat on 0.9% NaCl IV to treat the dehydration. Based on this history and blood results, what is your top differential diagnosis?
Renal lymphoma
Upper gastrointestinal obstruction
Urethrat blockage
Hypoadrenocerticism
Acute renal failure
Explanation
Because of this cat’s history and blood results, an upper Gl obstruction is highly suspected. Hypochloremic metabolic alkalosis is a classic finding in a pet with an upper Gl obstruction and should be ruled out first, especially in a young cat with these clinical signs.
Acute renal failure is unlikely since the azotemia appears to be pre-renal (the urine is hyperconcentrated due to dehydration).
Hypoadrenocorticism, or Addison’s disease, is very unlikely in a cat. In a pet with Addison’s, the most common electrolyte finding would be an elevated potassium level.
A urethral obstruction would likely cause a post-renal azotemia and hyperkalemia. On physical examination, a large and painful bladder would be palpated. A cat having urethral obstruction going on for this period of time would be very critical and have other clinical signs.
Renal lymphoma would be a potential cause of acute renal failure which is unlikely in this young cat with a pre-renal azotemia.
