No Species Specific Flashcards

1
Q

Why is toxoplasmosis a public health concern?

  • Results in mild, flu-like illness
  • Results in severe cutaneous lesions
  • Infants may be infected in utero and later show chorioretinitis along with mental retardation
  • Toxoplasmosis is not of public concern
  • Results in death of pregnant women
A

Answer: Infants may be infected in utero and later show chorioretinitis along with mental retardation

Explanation
The correct answer is infants may be infected in utero and later show chorioretinitis along with mental retardation. Flu-like symptoms can occur and lymphadenopathy may persist for months, but this is minor in comparison to the effects on in utero infants. Pregnant women usually do not show any signs of infection. There are no cutaneous lesions in humans associated with Toxoplasma gondii infection.
Interestingly, greater than 95% of AIDS patients suffering from toxoplasmosis are a result of cyst reactivation in the brain and not due to a recent infection. Their main signs are encephalitis, chorioretinitis, and sometimes pneumonia. To prevent exposure to pregnant women, recommend that they do not change their cat’s litter box (avoid feces).

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2
Q

Which of the following suture patterns used for closing hollow viscera purposefully enters the lumen?

  • Horizontal mattress pattern
  • Connell pattern
  • Ford interlocking pattern
  • Cushing pattern
A

Answer: Connell patern

Explanation
The correct answer is Connell pattern. Both the Connell and Cushing patterns are used to close hollow viscera because they are very effective at inverting tissue and creating a watertight seal. The difference between these two patterns is that Cushing pattern only goes through the submucosa and does not enter the lumen. The Ford interlocking and horizontal mattress patterns are not used for closing hollow viscera.

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3
Q

Fistulous withers refers to inflammation of the________

  • Intraspinatus
  • Nuchal ligament
  • Bicipital bursa
  • Supraspinous bursa
A

Answer: Supraspinous bursa

Explanation
The correct answer is supraspinous bursa. This bursa is variable in size and location but is usually found between the second and fifth thoracic vertebrae and can extend ventrolaterally to the margin of the scapular cartilage. The etiology is thought to be infectious. Clinical signs are pain, heat, and swelling in the region of the bursa. After days to weeks, the bursa can rupture resulting in drainage of fluid.

Brucella aborts has been identified in up to 80% of clinical cases by serology and culture. Treatment consists of flushing the fistula and appropriate antibiotics.

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4
Q

Which of these zoonotic infections are of most concern from drinking raw unpasteurized cow’s milk?

  • Mycobacterium bovis
  • Escherichia coli 0157:H7
  • Shigella
  • Salmonella typhi
  • Clostridium botulinum
A

Answer: Mycobacterium bovis

Explanation
The correct answer is mycobacterium bovis. M. bovis is a very serious zoonosis transmitted to humans by raw milk and has been largely controlled by institutional measures and milk pasteurization in the United States. E. coli 0157:H7 is found mainly in raw ground beef (probably fecal contamination). The other diseases listed are foodborne infections but of less serious concern in raw milk than M. bovis. S. typhi is the cause of typhoid fever and is not carried by farm animals, only by humans. Likewise, Shigella is a primate disease.

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5
Q

Which of the following is true about diltiazem?

  • Diltiazem speeds up the heart because it is a beta adrenergic agonist.
  • Diltiazem slows the heart by antagonizing beta adrenergic receptors.
  • Diltiazem slows the heart by inhibiting the influx of calcium into the myocardial cells.
  • Diltiazem speeds up the heart rate by increasing the influx of calcium into the myocardial cells.
A

Answer: Diltiazem slows the heart by inhibiting the influx of calcium into the myocardial cells.

Explanation
The correct answer is diltiazem slows the heart by inhibiting the influx of calcium into the myocardial cells.
Diltiazem is a calcium channel blocker used to slow the heart to treat supraventricular tachycardias, hypertrophic cardiomyopathy, and hypertension.

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6
Q

A cystotomy is on the schedule for today on a 4 year old male Chihuahua. What suture would you not use for closing the bladder?

  • Dexon
  • Polydioxanone (PDS)
  • Vicryl
  • Silk
A

Answer: Silk

Explanation
The correct answer is silk. This suture is non absorbable and thus contraindicated. Leaving non-absorbable suture in the bladder is a potential nidus for infection.

***PowerPage: Suture Materials

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7
Q

The role of a veterinarian in client communication and decision making is an important aspect of professional interaction. Three “styles” of communication have been described for such interactions:
1) Guardian (Paternalistic)
2) Teacher (Consultant)
3) Collaborator (Shared)
Which of these statements correctly describes how the style of a collaborator differs from the other 2 styles?

  • In client communication, a veterinarian with a collaborator style presents all options with equal weight regardless of their treatment preference whereas a veterinarian with a teacher or guardian style does indicate their preference for treatment
  • In client communication, a veterinarian with a collaborator style allows the client to be the primary decision maker whereas a veterinarian with a teacher or guardian style is the primary decision maker
  • In client communication, a veterinarian with a collaborator style is the primary decision maker whereas a veterinarian with a teacher or guardian style has the client be the primary decision maker
  • In client communication, a veterinarian with a collaborator style does not dominate the conversation while the veterinarian with either the guardian or teacher style does dominate the conversation
A

Answer: In client communication, a veterinarian with a collaborator style does not dominate the conversation while the veterinarian with either the guardian or teacher style does dominate the conversation

Explanation
The guardian style of veterinarian communicates in the following manner: They dominate the conversation and provide all of the information to the client. They typically present only the treatment option they feel is best and are therefore, the primary decision maker.

The teacher style of veterinarian provides information to the client but may also encourage them to seek additional information on their own. They typically dominate the conversation and present all options without emphasis toward the veterinarian’s own treatment preference.

The collaborator style of veterinarian shares decision making power and is approximately equal to the client in terms of doing most of the talking. They share medical information with the client that is relevant to the preferences provided by the client. All options are given and the client’s and veterinarian’s preferences are shared until a collaborative decision is made.

Any individual veterinarian can take on multiple roles depending on the situation and client but in general, the collaborator is viewed as the optimal choice for both veterinarian and client in the majority of situations.

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8
Q

Which correctly describes the innervation of the iris sphincter muscle in mammals?

  • Innervated by sympathetic nervous system by cranial nerve V
  • Innervated by sympathetic nervous system by cranial nerve Ill
  • Innervated by parasympathetic nervous system by cranial nerve V T
  • Innervated by parasympathetic nervous system by cranial nerve Ill
A

Answer: Innervated by parasympathetic nervous system by cranial nerve Ill

Explanation
The correct answer is that it is innervated by parasympathetic nervous system by cranial nerve Ill. The iris sphincter is stronger than the iris dilator. It receives parasympathetic innervation by cranial nerve Ill. It is comprised of smooth muscle in mammals, unlike birds, where it is striated. The innervation makes sense if you consider that when your sympathetic nervous system is activated, your eyes become dilated; that leaves the parasympathetic nervous system to constrict the pupil, which is the responsibility of the sphincter.

***PowerPage: Cranial Nerve Examination and Diseases

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9
Q

Out of all the medications you frequently prescribe, which does not fall under the FDA’s regulatory control?

  • Interceptor (milbemycin oxime) oral heartworm and parasite control
  • Gentamycin betamethasone topical spray
  • Frontline topical flea and tick medication
  • Non-steroidal anti-inflammatories (carprofen, deracoxib, etc.)
  • Compounded generic oral medication
A

Answer: Frontline topical flea and tick medication

Explanation
Preparations used as topical insecticides are regulated by the Environmental Protection Agency, or EPA. This regulation is provided by the Federal Insecticide, Fungicide and Rodenticide Act which was amended and updated in 1972. This only applies to topical applications. If any product in this group is to be given systemically, the regulation goes back to the FDA.

Oral medications such as Interceptor, NSAIDs, and even generics are regulated by the FDA. Topical antibiotics and corticosteroids such as the gentamycin betamethasone spray are regulated by the FDA.

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10
Q

You are asked to interview an applicant for a veterinary technician job at your clinic. Which of the following is an acceptable interview question for you to ask the applicant?

  • What is your native language?
  • Do you have any disabilities?
  • When did you graduate from college?
  • Do you have a high school diploma or equivalent?
  • How many children do you have?
  • Do you wish to be addressed as Mr., Mrs., Miss, or Ms?
A

Answer: Do you have a high school diploma or equivalent?

Explanation
When interviewing a potential employee, it is important to know what questions are not appropriate. In general, questions should focus on the requirements of the job and specific qualities that it takes to perform the job. In this case, a high school diploma may be a job requirement.

Discrimination laws prohibit questions based on gender, age, nationality, race, religion, sexual orientation, and disability. Questions about an individuals personal status that are not job-related are also inappropriate (i.e. do you have children?). While questions like this may seem like standard small-talk, they are not appropriate in a job interview. The other answer choices listed here all allude to such potentially discriminatory information.

Questions should be phrased in a way that is specific to the needs of the job..for example:

Do you have any responsibilities that may interfere with the hours you can work or your ability to do the job?

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11
Q

Josephine has just purchased a small animal practice. The practice currently pertorms tecal parasite testing in-house using a flotation-only method. Josephine knows that fecal centrifugation and flotation is a more sensitive method for fecal parasite testing. She would like to have the staff change testing methods right away. She plans to write a standard operating procedure to aid the transition for the staff. When creating a standard operating procedure for fecal centrifugation and flotation, which is the most appropriate plan for Josephine?

  • Hold a meeting about the correct procedure for fecal centrifugation, print the instructions and place them in a binder in the veterinarian’s office, and update the document before official inspections.
  • Send the staff an e-mail including the instructions, place the standard operating procedure in a folder in the pharmacy, and hold a yearly meeting about the correct procedure.
  • Write instructions using advanced medical terminology, place the standard operating procedure in a binder at the front desk, and update the document once yearly.
  • Create a written document using language that is easily understood by the staff, hang the document on the wall above the fecal centrifuge, and routinely screen for necessary changes in the instructions.
A

Answer: Create a written document using language that is easily understood by the staff, hang the document on the wall above the fecal centrifuge, and routinely screen for necessary changes in the instructions.

Explanation
Standard operating procedures (SOPs) should be written in clear, direct language. The SOPs should be placed in an easily visible and accessible area. SOPs should be continually updated to ensure incorporation of new techniques. When communicating SOPs, written documents are necessary. The SOP should be located in an easily accessible and convenient area. Placing SOPs in a binder away from the location of the procedure is not recommended. SOPs should be updated continuously depending on recommended changes to the procedure in question. While holding a meeting about correct procedures is helpful, the information should remain continuously available and easily accessible for all staff.

Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 137-139.

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12
Q

*Which of these options is true regarding worker’s compensation insurance?

  • It pays employees a portion of their salary if they are laid off or fired
  • It covers injuries that occur on and off the job
  • It is legally required for veterinary practices to have it for full and part time employees
  • The cost can be deducted from the employee’s paycheck
A

Answer: It is legally required for veterinary practices to have it for full and part time employees

Explanation
Worker’s compensation insurance covers injuries sustained on the job. It is required in all states and is paid for by the practice.

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13
Q

A 12 year old Yorkie presents for euthanasia due to various medical problems and you have never seen the dog before. It is a walk-in appointment, as they were unable to be seen by their regular vet today. The dog is clearly in poor condition. The man presenting the dog states that this is his mother’s dog and she is not able to bring the dog herself.

What would be the best option of the choices below?

  • Euthanize the dog as long as the man signs the consent form, because the dog is in poor condition and this is the most humane option.
  • Do not euthanize the pet since you have never seen this pet before and the owner is not present. The owner will need to be present to sign the authorization.
  • Have the medical records faxed from the regular vet so that you can confirm the history and conditions for why the dog is presenting for euthanasia, then perform the procedure after the man signs a euthanasia request form.
  • Call the owner directly to confirm her wishes for euthanasia and have another employee confirm over the phone as an additional witness. Have the agent sign the euthanasia request form.
A

Answer: Call the owner directly to confirm her wishes for euthanasia and have another employee confirm over the phone as an additional witness. Have the agent sign the euthanasia request form.

Explanation
This is a tricky situation and can be difficult to handle when the client’s emotions are involved. Clearly the dog is in poor condition and the request for euthanasia is not unreasonable. However, the owner needs to give direct permission for this to occur. Calling the owner for consent for the euthanasia is the correct way to approach this case. If the owner cannot be reached and there is no documentation for consent, then it is best to wait until there is valid documentation.

If a euthanasia appointment is scheduled in advance and they are new clients, have them bring the medical records and ensure you will have the appropriate documentation you will need to carry out the euthanasia to try and avoid this type of conflict. When they schedule the appointment, if the owner will not be present, let them know confirmation by the owner over the phone or a written statement will be needed and should be brought and kept in the medical record.

Failure to receive such consent from the dog’s owner is a serious liability for you as the veterinarian. Despite the appearance, this man could be bringing the dog in for euthanasia against the dog’s owner’s wishes and it is your responsibility to properly document that euthanasia was requested by the owner.

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14
Q

While state practice acts vary in regard to requirements for medical record keeping, there are common principles. Which of the following medical records would be unacceptable based on these practice acts?

  • Medical records are discarded 5 years after the patient was last seen
  • One medical record is used for a client that brings in 3 of her dogs
  • The medical record is in someone’s handwriting other than the veterinarian
  • The medical record states that the heart and lungs were not ausculted on an exam
A

Answer: One medical record is used for a client that brings in 3 of her dogs

Explanation
The common requirements among almost all states are the following:
1) Separate record for each patient
2) Accurate record
3) Complete record- what was normal, abnormal, and not examined
4) Legible- Can be dictated to someone else
5) Unalterable
6) Easily accessible
7) Retained for 3-5 years

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15
Q

What is the clinical study design that best addresses the “temporality” of disease causation (exposure must precede disease)?

  • Cross-sectional
  • Retrospective
  • Case-control
  • Cohort
A

Answer: Cohort

Explanation
Hill’s Criteria for disease causality includes the requirement for “temporality,” meaning that an exposure cannot be under consideration (hypothesized) as a causal factor unless it precedes the disease. Thus, any study design that does not document that exposure precedes disease cannot logically address the causal question.

A cohort study design is the only one of the options that first documents that a subject has been exposed, following initially only non-exposed subjects. The non-diseased subjects are followed to observe whether they become exposed (an “exposed” cohort), and then followed further over time to observe for disease. At the termination of the study, the risk (proportion) of disease observed in the exposed cohort is compared to that for the non-exposed cohort, by use of relative risk (RR) and attributable risk (AR).

The case-control design (also known as retrospective design) begins not with unexposed subjects but with diseased individuals (cases) that are compared with respect to exposure to a factor, using a comparison group of non-diseased subjects (controls). There is no observation over time. Similarly, cross-sectional designs compare two groups based on disease status and compare how they differ with respect to exposure status. There is no way to know whether exposure preceded disease in any of these types of designs.

Ref: Kleinbaum, Kupper, Morgenstern, Epidemiologic Research pgs. 62-70; Martin, Meek, Willeberg, pgs.155-174.

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16
Q

The relationship among incidence (I), prevalence (P), and duration (D) of disease is best expressed as:

  • P=I-D
  • I=P-D
  • I=PD
  • P=ID
A

Answer: P=ID

Explanation
The correct formula to use is P = I x D. Prevalence can generally be viewed as the product of incidence and disease duration.

Incidence is defined as the number of new cases of a disease in a given period, and prevalence is the number of total cases prevailing (counted) in the given period.

This formula is helpful in a clinical scenario to help evaluate risk. Prevalence can increase (or decrease) in two ways: 1) the number of new cases (incidence) increases (or decreases), and 2) the duration of disease increases (or decreases). If a disease goes untreated, for example, duration would likely increase (compared to treated cases), and prevalence would increase.

Similarly, if the risk of acquiring a disease increased, the prevalence would increase. Note, for example, that if the weekly incidence of a disease were 5 new cases and the duration was 2 weeks per case (on average),
generally one would expect the weekly prevalence to be 5 cases/week x 2 weeks = 10.

Ref: Veterinary Epidemiology: Principles and Methods, 1987 pg. 81, Martin, Meek, Willeberg

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17
Q

A payroll service will typically perform all of the following EXCEPT which of these choices?

  • Directly deposit money into employee accounts
  • Track vacation and sick time
  • Sign checks
  • File and send tax returns to the IRS
  • Generate payroll reports
A

Answer: File and send tax returns to the IRS

Explanation
A payroll service will typically perform direct deposit or sign checks to employees. They will also track vacation and sick time and generate payroll reports. Payroll services do perform tax withholding but they do not file actual tax returns; this is the responsibility of each individual employee.

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18
Q

You are reviewing a practice’s balance sheet in preparation to buy the practice. For most practices, the single largest asset never shows up on the balance sheet. What is this asset?

  • Practice’s goodwill
  • Practice’s cash
  • Practice’s land
  • Practice’s accounts receivable
  • Practice’s equipment and inventory
A

Answer: Practice’s goodwill

Explanation
All of the items listed here are practice assets. The only item that typically is not on a balance sheet is the practice’s goodwill. Assets on a balance sheet represent cost, not current value. Therefore, unless the practice’s goodwill was purchased from someone else, it does not appear on the balance sheet.
The practice’s goodwill is its reputation, client base, knowledge, technical skill, research, brand awareness, and associations that the practice maintains.

***PowerPage: Reading a Balance Sheet

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19
Q

Dr. Johnson has been an associate at a multi-doctor equine hospital for the past nine months. Her boss, Dr. Sharpe, sends an e-mail stating that Dr. Johnson will need to give a presentation at an upcoming career fair. The career fair is two weeks away, on a Saturday, and is scheduled for the same day as an important Johnson family event. Dr. Johnson lets her boss know that she will be unable to attend. Dr. Sharpe insists, saying that attending the event is one of Dr. Johnson’s required work responsibilities. The disagreement creates a dysfunctional working relationship, and Dr. Johnson leaves the practice for another position. Which of the following is the most appropriate way for Dr. Sharpe to communicate duties and responsibilities to associate veterinarians in the future?

  • Have the office manager send a memo to all of the associate veterinarians regarding the importance of the job fair for the community.
  • List all mandatory duties which must be completed outside of work hours in a written job description that is signed by both parties.
  • Call a meeting with all of the associates to discuss the duties expected of them outside of working hours.
  • Tell the candidates for the associate veterinarian position about the job fair during their initial interview and remind them while signing the employment contract.
A

Answer: List all mandatory duties which must be completed outside of work hours in a written job description that is signed by both parties.

Explanation
Outlining specific duties and responsibilities is necessary to maintain accountability for job performance and fairness. Job descriptions should be written for specific positions and include all the duties and responsibilities of that position. Ensuring that the duties are spelled out in a written agreement is important. Incorrect options include those which do not provide specific written information about job duties. While verbal reminders about the job fair and communicating the importance of the event are reasonable, these actions will not ensure that associate veterinarians know that participation is a required duty of their job.

Source: The Art of Veterinary Practice Management. Mark Opperman and Sheila Grosdidier. Advanstar
Communications, Inc., 2014. Page 68-69.

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20
Q

When building a successful practice, it is important to provide outstanding client service. Which of the following statements is true about how client service at a veterinary hospital is different from standard customer service in retail or other service industries?

  • Client service involves a personal, long-term relationship whereas customer service typically involves a single transaction
  • Customer service is more closely associated with value of the transaction than client service
  • Customers typically develop close relationships with employees whereas clients typically do not
  • Retail establishments desire repeat customers but the client-veterinary relationship involves a single interaction or transaction
A

Answer: Client service involves a personal, long-term relationship whereas customer service typically involves a single transaction

Explanation
The most important difference between clients and customers is that client services involves a personal long-term relationship. In veterinary medicine, this includes a relationship with the veterinarian(s), but other staff members (technicians, receptionists, etc) are the primary providers of client service. Such relationships should span the lifetime of one or multiple pets.

Higher levels of client service result in perception of greater value. A lack of quality service is one of the most common reasons that clients switch veterinary practices.

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21
Q

Which cranial nerve is most responsible for tear production?

  • CN II
  • CN VI
  • CN V
  • CN III
A

Answer: **CN VII*

Explanation
The correct answer is CN VII. The lacrimal nerve from cranial nerve VII innervates the lacrimal gland, which is located within the orbit. It is responsible for production of much of the aqueous portion of the tear film. For this reason, if an animal has signs of facial nerve problems, tear production should be checked.

***PowerPage: Cranial Nerve Examination and Diseases

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22
Q

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

  • Two injections of approved rabies vaccine
  • One injection of human rabies immune globulin followed by 2 injections of approved rabies vaccine
  • Three injections of human rabies immune globulin followed by 2 injections of approved rabies vaccine
  • Injection of human rabies immune globulin followed by 4 injections of approved rabies vaccine
  • Five injections of approved rabies vaccine
A

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

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 to injections of an approved rabies vaccine 3 days apart. PEP is not required for accidental injection of animal rabies vaccine into a human.

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23
Q

When trying to diagnose a bile peritonitis what is the method of choice for making a diagnosis?

  • Comparison between bilirubin concentration in the fluid and in serum
  • Comparison between low density lipoprotein in the fluid and in the serum
  • Comparison between alkaline phosphatase in the fluid and in the serum
  • Comparison between alanine aminotransferase in the fluid and the serum
A

Answer: Comparison between bilirubin concentration in the fluid and in serum

Explanation
The correct answer is comparison between bilirubin concentration in the fluid and in the serum. A concentration of bilirubin that is twice as high as serum is considered diagnostic.

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24
Q

Which of the following best describes Type Ill hypersensitivity?

  • An immediate hypersensitivity reaction involving the interaction of IgE and mast cell degranulation
  • An immune complex hypersensitivity involving the interaction of circulating antigen-antibody complexes in blood vessel walls causing neutrophil emigration and tissue damage
  • A delayed hypersensitivity reaction involving antigen presenting cells, antigen and T lymphocytes
  • An immediate hypersensitivity reaction involving the interaction of IgG to antigens on body tissues
A

Answer: An immune complex hypersensitivity involving the interaction of circulating antigen-antibody complexes in blood vessel walls causing neutrophil emigration and tissue damage

Explanation
There are four types of hypersensitivity reactions. Type Ill is characterized by antigen-antibody complexes. Type I is the immediate hypersensitivity reaction mediated by IgE, whereas Type Il involves IgG and body tissues (i.e. RBCs). The delayed hypersensitivity reaction (IV) involves the presentation of antigen through antigen presenting cells to lymphocytes.

***PowerPage: Hypersensitivity Reactions

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25
Q

When valuing a veterinary practice, “practice goodwill” can be one of the most significant assets. Which of the following is NOT considered part of a practice’s goodwill?

  • Brand awareness
  • Practice reputation
  • Client base
  • Owner’s equity
  • Technical skill
A

Answer: Owner’s equity

Explanation
A practice’s goodwill refers to its reputation, client base, knowledge, technical skill, research, brand awareness, and associations that the practice maintains.

Owner’s equity is a different asset that would be reported on a company’s balance sheet and is not lumped under “goodwill”.

***PowerPage: Reading a Balance Sheet

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26
Q

Many veterinary practices provide discounted goods or services to clients in certain instances. From a business standpoint, which of the following is always true about discounted services?

  • Discounts should only be given to clients on their first visit
  • Discounts should be given based on the discretion of the attending veterinarian
  • An explanation of the available discounts should be clearly displayed in the reception or waiting area
  • A discount provided to one client should be provided to all clients
  • The client should be told that they are receiving discounted goods or services
A

Answer: The client should be told that they are receiving discounted goods or services

Explanation
There are many reasons to give discounts and many types of discounts that a veterinary practice may offer depending on the practice philosophy and the types of clients that they are hoping to attract with such discounts. Examples might include discounts for senior citizens, animal rescue organizations, first time clients, employees, or other veterinary professionals. The only way to use discounts to the practice’s advantage is to make sure that clients are aware that they are receiving the benefit of a discount. How a practice may choose to market or advertise a discount may vary based on the practice philosophy. Practice managers or owners are typically responsible for choosing who to offer discounted services to; attending veterinarians often use different criteria when deciding what to discount that may not fit the business and practice interests.

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27
Q

Employees in your veterinary clinic are discussing measures to prevent disease transmission between employees and between patients. One of them asks you if using Purell hand sanitizer will prevent transmission of most pathogens. You remember reading on the label that Purell is a 65% ethyl alcohol-based antiseptic. Which of these agents would be most effectively killed by such a product?

  • Parvovirus
  • Clostridium difficile
  • Antibiotic resistant Staphylococcus aureus
  • Giardia
A

Answer: Antibiotic resistant Staphylococcus aureus

Explanation
Hand sanitizing, alcohol-based products are effective at killing many types of Gram-positive and negative bacteria, including methicillin resistant Staphylococcus aureus (MRSA), tuberculosis, and E. coli. It is also effective against many types of fungi and enveloped viruses such as influenza viruses, HIV, and hepatitis virus (one exception is rabies virus).

They are not effective against non-enveloped viruses (parvovirus), bacterial spores (Anthrax, C. difficile), and protozoan oocysts (Giardia, Isospora, Cryptosporidium).

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28
Q

You are doing paperwork in your office when a dog who has been hit by a car is rushed to the back treatment area. You are told by the receptionist that the owner has no money with them. What should you do?

  • Do everything necessary to assess and treat the dog (inducing radiographs, chest tube it needed, et.) as
    long as the owner signs a promissory note prior to you speaking to them.
  • Start basic life saving measures such as oxygen, IV catheter, and fluids for hypovolemic shock. While these things are started you perform a brief exam and evaluation of the pet prior to discussion with the owners.
  • Have the receptionist put the owner in a room and go in to discuss treatment and cost prior to providing an exam or care while a technician sits with the dog in the back monitoring vital signs.
  • Recommend they take the dog to the emergency clinic.
A

Answer: ** Start basic life saving measures such as oxygen, IV catheter, and fluids for hypovolemic shock. While these things are started you perform a brief exam and evaluation of the pet prior to discussion with the owners.**

Explanation
While there is no mandated law that requires a veterinarian to provide emergency care, it is the general consensus of the professional community that it is a veterinarian’s duty to provide at least basic life stabilizing care on presentation. In a critical situation, this should be initiated prior to contact with owner.

After initiating these measures whilst doing an exam, you will have a better picture of what type of further care and work-up this pet will need (i.e. chest radiographs, chest tube, antibiotics, surgery, etc.) at which point you can discuss care, prognosis, and costs with the owner. Then they are able to make an informed decision of whether or not to proceed.

The owner brought the dog into the hospital, thus, is expecting some level of care and evaluation. Once there is an implication that the veterinarian will render service (the pet was brought to the treatment area, the veterinarian should continue to render service. While the dog may need transfer to an emergency or overnight facility, you should still attempt to stabilize the dog prior to any transfer.

Standard legal principles say that veterinarians who wish to discontinue medical services should not do so during a critical phase of treatment and must give the client time to find another veterinarian so that no harm occurs to the animal.

A promissory note is when a party makes an unconditional promise in writing to pay a determinate sum of money. It would be better to talk to the owner after providing the basics (oxygen, fluids) to discuss exactly which procedures you would like to do and why, and discuss cost, payment methods, etc. to see how they will be able to proceed financially.

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29
Q

This suture is broken down via phagocytosis.

  • Vicryl
  • Polydioxanone (PDS)
  • Nylon
  • Catgut
    -Maxon
A

Answer: Catgut

Explanation
The correct answer is catgut. Catgut is broken down by phagocytosis and retains tensile strength for 14-28 days.

Nylon is a non-absorbable suture. Vicryl, maxon, and PDS are broken down via hydrolysis.

***PowerPage: Suture Materials

30
Q

You are about to receive an offer from a veterinary hospital for employment. Which of the following is the most common pay package offered as a percentage of gross production, including wages (whether base or percent production) and benefits?

  • 31-33%
  • 26-30%
  • 20-25%
  • 17-19%
A

Answer: 20-25%

Explanation
Most general practice veterinarians are paid a total compensation between 20-25% including pay and benefits.

For example, a veterinarian may be paid 19% of his production and receive health benefits and dues paid with other perks, or may receive a higher production pay such as 23% and no benefits. Some veterinarians choose to have a set salary and benefits. There are many acceptable offers but the most common offer is between 20-25% total production.

31
Q

Which of the following are listed on a balance sheet of a practice?

  • Assets, liability, and owner(s) equity
  • Sources and uses of cash over a period of time
  • Income and expenses over a period of time
  • Salary of each employee of the company
A

Answer: Assets, liability, and owner(s) equity

Explanation
A balance sheet is a report on the financial condition of the practice. It lists practice assets, liabilities and owners) equity at a specific point in time. It does not track income or cash flow over a period but is more of a snapshot of the company’s condition.

A profit and loss statement is the document which reports on income and expenses over a period of time. A cash flow statement is the document which reports on sources and uses of cash over a period of time.

***PowerPage: Reading a Balance Sheet

32
Q

“Bark-field” is a large corporation that is buying a previously independent local feline veterinary practice and will be gaining control of that practice. This is an example of which of the following?

  • Capital gain
  • Buy-out
  • Buy-in
  • Acquisition
  • Merger
A

Answer: Acquisition

Explanation
This is an acquisition because one entity (Bark-field) is acquiring control of another entity (the independent practice). Acquisitions are the most common form of transfer of practices and may be an internal purchase (associate buy-in) or from an external buyer.

A buy-in or buy-out refers to veterinarians of the practice. A buy-in is when an associate purchases a stake in the practice and a buy-out is when the practice purchases back that share from the associate.

A merger typically occurs when two practices on the same scale combine to create economies of scale. An example is two practices closing one location to operate out of a combined facility. A merger can also involve centralizing of tasks such as bookkeeping, inventory management, and practice management services.

Capital gains are the difference between an asset’s purchase price and selling price, when the selling price is greater.

33
Q

A practice you recently interviewed with told you they will offer you a number of ancillary benefits if you work full time. This may include:

  • Holidays off
  • Professional membership dues
  • Percentage of gross production or salary
  • Vacation allowance
  • Health insurance
A

Answer: Professional membership dues

Explanation
An ancillary benefit is an additional benefit not part of the expected core offer. Examples of these benefits include membership dues, continuing education allowance, DEA license dues, moving expenses, gym memberships, etc.

In this question, a vacation allowance, holidays off, salary, and health insurance are all expected benefits in a core offer for a full-time employee at a veterinary clinic.

34
Q

You are asked to interview an applicant for a veterinary technician job at your clinic. Which of the following is an acceptable interview question for you to ask the applicant?

  • Do you have a high school diploma or equivalent?
  • Do you have any disabilities?
  • Do you wish to be addressed as Mr., Mrs., Miss, or Ms?
  • What is your native language?
  • When did you graduate from college?
  • How many children do you have?
A

Answer: Do you have a high school diploma or equivalent?

Explanation
When interviewing a potential employee, it is important to know what questions are not appropriate. In general, questions should focus on the requirements of the job and specific qualities that it takes to perform the job. In this case, a high school diploma may be a job requirement.

Discrimination laws prohibit questions based on gender, age, nationality, race, religion, sexual orientation, and disability. Questions about an individuals personal status that are not job-related are also inappropriate (i.e. do you have children?). While questions like this may seem like standard small-talk, they are not appropriate in a job interview. The other answer choices listed here all allude to such potentially discriminatory information.

Questions should be phrased in a way that is specific to the needs of the job…for example:
Do you have any responsibilities that may interfere with the hours you can work or your ability to do the job?

35
Q

Using animals in research is generally justified by the “greater good” concept, a concept that states that the use of animals in research will result in improvements in health and medicine for both humans and animals. This concept is part of the larger ethical theory known as:

  • Contractarianism
  • Animal welfare
  • Utilitarianism
  • Animal rights
  • Kantian ethics
A

Answer: Utilitarianism

Explanation
Utilitarianism dictates that principles of conduct should be guided by providing the greatest happiness to the greatest number of individuals.

36
Q

You are examining the eyes of a dog and see that he has a positive menace response and dazzle reflex is visual but lacks a palpebral reflex. Where does he have a lesion?

  • CN II
  • Visual cortex
  • CN V
  • CN VII
A

Answer: CN V

Explanation
The correct answer is CN V. This animal has no visual deficits, as evidenced by his menace and dazzle, which rules out lesions in CN Il or the visual cortex. The normal menace response indicates that CN VII is functioning as well. The lack of a palpebral then indicates a sensory deficit for which CN V is responsible.

37
Q

You are examining the eyes of a dog and see that he has a positive menace response and dazzle reflex is visual but lacks a palpebral reflex. Where does he have a lesion?

  • CN II
  • Visual cortex
  • CN V
  • CN VII
A

Answer: CN V

Explanation
The correct answer is CN V. This animal has no visual deficits, as evidenced by his menace and dazzle, which rules out lesions in CN Il or the visual cortex. The normal menace response indicates that CN VII is functioning as well. The lack of a palpebral then indicates a sensory deficit for which CN V is responsible.

38
Q

Which of the following diseases can be caused by long-term oral antibiotic therapy?

  • Aspergillosis
  • Candidiasis
  • Erysipelas
  • Colibacillosis
  • Staphylococcosis
A

Answer: Candidiasis

Explanation
Antibiotics not only kill or inhibit the pathogenic bacteria but may also may cause destruction of beneficial flora, which can lead to an overgrowth of yeast, or Candidiasis.

39
Q

Compare the productivity of the following 2 veterinary practices:

Practice 1: There are 2 veterinarians working at this practice. They each work 5 days per week, 12 hours per day (60 hours per week). The medical service income of the practice is $900,000.

Practice 2: There are 5 veterinarians working at this practice. They each work 4 days per week, 8 hours per day (32 hours per week). The medical service income of the practice is $1,600,000.

Which practice is more productive based on medical service revenue per full-time equivalent (FTE) veterinarian?

  • Assume technician and other expenses are proportional.
  • Practice 1
  • They are equally productive
  • Practice 2
A

Answer: Practice 2

Explanation
First, calculate the number of full time equivalent (FTE) veterinarians at each clinic. Typically, a 40 hour work week is considered standard for 1 FTE.

At practice 1, there are 2 doctors working 60 hours per week or a total of 120 veterinary hours worked. 120 hours is the equivalent of three FTE veterinarians.

At practice 2, there are 5 veterinarians working 32 hours per week or a total of 160 hours. 160 hours is the equivalent of 4 FTE veterinarians.

To determine productivity based on this question, divide the medical service income by the number of FTE veterinarians at each practice.

Practice 1 - $900,000/3 FTE = $300,000 per FTE
Practice 2- $1,600,000/4 FTE= $400,000 per FTE
Practice 2 is generating $100,000 per FTE more than practice 1.

40
Q

Which of the following gas anesthetic agents will result in the quickest recovery?

  • Ether
  • Sevoflurane
  • Isoflurane
  • Halothane
A

Answer: Sevoflurne*

Explanation
The correct answer is sevoflurane. The reason for this is that it has a very low blood-gas partition coefficient.
This means that sevoflurane does not readily dissolve in the blood. As a result, the alveolar concentration is close to the same concentration present in the brain, and the concentrations will reach equivalence very rapidly.

This is in contrast to ether, which is very soluble in blood, resulting in accumulation of ether in other tissues. This accumulation results in longer times for a patient to fall asleep and wake up. Halothane and isoflurane are not as soluble as ether, but sevoflurane has the least solubility. Do not confuse solubility with MAC (minimum alveolar concentration). Remember, MAC represents the concentration at which half the population would be anesthetized. For example, the MAC of sevoflurane is approximately 2.4 whereas that for Halothane is 0.89.

***PowerLecture: Inhalant Anesthetics

41
Q

Frontline is registered by which US governmental agency?

  • US Food and Drug Administration (FDA)
  • US Department of Commerce
  • Environmental Protection Agency (EP)
  • US Department of Agriculture
A

Answer: Environmental Protection Agency (EP)

Explanation
The correct answer is the Environmental Protection Agency (EPA). This might not seem important, but insecticides that work topically are registered by the EPA and not the FDA, which means that off-label use is illegal and a violation of federal law. Off-label use would include using a different dose or frequency than the label recommendation. Products that are administered orally (milbemycin, Ivermectin) or applied topically with transdermal absorption (selemectin) are regulated by the FDA.

42
Q

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)

  • Normal
  • Metabolic Acidosis, Respiratory Acidosis
  • Metabolic Alkalosis, Respiratory Alkalosis
  • Metabolic Alkalosis, Respiratory Acidosis
  • Metabolic Acidosis, Respiratory Alkalosis
A

Answer: Metabolic Acidosis, Respiratory Alkalosis

Explanation
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.

43
Q

A new receptionist, Stacey, interrupts Dr. Blackmon several times in a ten-minute period to ask basic questions about heartworm prevention. Stacey is having trouble addressing a pet owners concerns regarding a missed dose of prevention. Dr. Blackmon speaks with the client and recommends a plan regarding the missed dose. She also explains the answers to the client’s questions to Stacey. What is the most appropriate way to ensure that common client questions are answered efficiently and correctly in the future?

  • Tell the receptionists to refer clients with questions about heartworm prevention to the FAQ section of the practices website.
  • Have the receptionists assure pet owners that all questions about heartworm prevention will be answered at the next wellness visit.
  • Instruct the receptionists to delegate routine heartworm prevention questions to a Licensed Veterinary
    Technician.
  • Develop a written script for receptionists to use to answer routine questions about heartworm prevention.
A

Answer: Develop a written script for receptionists to use to answer routine questions about heartworm prevention.

Explanation
Use of written scripts is recommended to ensure that every team member gives concise and accurate information for routine phone calls. Providing the resources to allow receptionists to answer a client’s questions in a clear, succinct way gives the impression that team is knowledgeable and professional. While delegating questions to a more knowledgeable team member is a reasonable option, the ideal plan would be to increase the knowledge level of the receptionists so that they can answer basic questions. While complex issues might be best left for an exam room discussion, basic heartworm questions should be answerable by the entire team.

Creating a frequently asked questions section on the practices website is a good idea, however the reception staff should be able to provide this information to callers.

44
Q

You are being sued for malpractice when a dog under your care for a gastric dilatation volvulus dies post-operatively. What will the examining board try to determine?

  • If you had previous experience treating gastric dilatation volvulus successfully
  • If you complied with the standard of care
  • If the dog had a high lactate prior to surgery, the prognosis was poor and you are not liable
  • If you performed the most up to date surgical procedure for treating this condition
A

Answer: If you complied with the standard of care

Explanation
The goal of the veterinary examining board is to determine if a veterinarian meets the standard of care. This is defined as the degree of prudence and caution required of an individual who is under a duty of care. A breach of the standard is necessary for a successful action in negligence.

The board looks to see that the practitioner acted in a reasonable manner. It doesn’t mean that one’s surgical technique or treatment cannot vary from that provided by average veterinarians, as long as one’s practice is not extremely inferior or outdated.

45
Q

In copper deficiency, animals may suffer from achromotrichosis (pale hair coat) as a result of this enzyme not working properly. What is the enzyme?

  • Lysyl oxidase
  • Myophosphorylase
  • Glutathione peroxidase
  • Tyrosinase
A

Answer: Tyrosinase

Explanation
The correct answer is tyrosinase. This enzyme converts L-tyrosine to melanin. Lysyl oxidase is involved with synthesis of collagen in connective tissue and it is also dependent on adequate copper levels. Glutathione peroxidase is involved in free radical protection, and selenium is necessary to keep this enzyme going.
Myophosphorylase is a muscle enzyme that is associated with a genetic disease of Charolais cattle.

46
Q

You are applying to a job at a feline-only practice. You negotiate to be paid based on commission-only at a rate of 20%. The average monthly gross production of the associates in the clinic is $35,000. If you can match this amount, what would your monthly salary be?

  • $5,000
  • $8,000
  • $7,000
  • $6,000
  • $7,500
  • $3,500
A

Answer: $7,000

Explanation
When paid on a percentage of commission, your monthly salary will be: (Monthly gross production) x (commission rate)

In this case, if you match the average associate’s production, this would be: $35,000 × 0.20 = $7,000

47
Q

The balance sheet for a veterinary practice shown below is complete except for the “Equity” value. Based on the information provided, calculate the equity? Assume all values are in US dollars.

  • 80,000
  • 120,000
  • 20,000
  • 40,000
  • 10,000
  • 200,000
A

Answer: 120,000

Explanation
The ability to read and understand a balance sheet of a veterinary practice is something that may be tested on board examinations. The critical formula to know for a balance sheet is:
Assets= Liabilities + Shareholder’s Equity
Here, Assets= $200,000 and Liabilities= $80,000. All of the other numbers on the balance sheet are not needed to answer this question as they are just components of the total assets or total liabilities.
Therefore, Equity= $120,000

48
Q

You are developing a template for the drug labels at your new hospital. Every prescription drug label should legally include the following statement:

  • Give as directed by your veterinarian
  • Off-label use of this product is not recommended
  • Stop this medication and contact your veterinarian should any adverse reactions occur
  • Caution: Federal law restricts this drug to use by the order of a licensed veterinarian
  • Shake well for liquid medications
A

Answer: Caution: Federal law restricts this drug to use by the order of a licensed veterinarian

Explanation
Federal regulation requiring labels to bear statements such as “For veterinary use only” represent a sales policy and hold no legal basis. Every label should include the Caution label (as indicated in the correct answer), dosage, route of administration, quantity of ingredient, and a lot or control number. While the other choices may be of value, they are not legally required.

49
Q

Which correctly describes the innervation of the iris sphincter muscle in mammals?

  • Innervated by sympathetic nervous system by cranial nerve V
  • Innervated by parasympathetic nervous system by cranial nerve V
  • Innervated by parasympathetic nervous system by cranial nerve Ill
  • Innervated by sympathetic nervous system by cranial nerve Ill
A

Answer: Innervated by parasympathetic nervous system by cranial nerve Ill

Explanation
The correct answer is that it is innervated by parasympathetic nervous system by cranial nerve Ill. The iris sphincter is stronger than the iris dilator. It receives parasympathetic innervation by cranial nerve Ill. It is comprised of smooth muscle in mammals, unlike birds, where it is striated. The innervation makes sense if you consider that when your sympathetic nervous system is activated, your eyes become dilated; that leaves the parasympathetic nervous system to constrict the pupil, which is the responsibility of the sphincter.

50
Q

In health, lactate is primarily metabolized by what organ and should measure less than what value (mmol L)?

  • Liver; less than 5 mmol/L
  • Liver; less than 2.5 mmol/L
  • Kidney; less than 5 mmol/L
  • Kidney; less than 2.5 mmol/L
  • Lung; less than 6.5 mmol/L
  • Pancreas; less than 6.5 mmol/L
A

Answer: Liver; less than 2.5 mmol/L

Explanation
Lactate is primarily metabolized by the liver and, in health, it should be low (< 2.5 mmol/L). The kidneys and skeletal muscle also metabolize lactate to a lesser extent. Lactate is typically associated with anaerobic metabolism and has been used to predict survival in gastric dilatation volvulus in dogs and colic and sepsis in horses.

51
Q

Leptospirosis is usually observed when livestock come into contact with urine from an infected maintenance host. Which of the following is the most important maintenance host of L. interrogans serovar Pomona?

  • Cattle
  • Dogs
  • Cats
  • Rats
  • Swine
A

Answer: Swine

Explanation
Other maintenance hosts of Pomona include opossums, skunks and racoons. For other serovars, the maintenance hosts are as follows:
Canicola- dogs
Icterohemorrhagiae- rats
Hardjo- cattle
Grippotyphosa-mice, muskrats and squirrels

52
Q

In which of these business arrangements could you be held personally financially responsible if your business partner is sued?

  • S Corporation
  • Sole proprietorship
  • General partnership
  • Limited liability company (LLC)
  • C Corporation
A

Answer: General partnership

Explanation
The key word in the question is “personally.” This means that your personal assets could be taken if you or your business partner was sued.

A sole proprietorship provides no liability protection but by definition, indicates that there is no business partner. A general partnership also has no personal liability protection. In most cases, the risk of this can be minimized with adequate insurance.

S and C corporations and LLCs provide personal liability protection but have different tax consequences.

53
Q

Technicians often assist you with your procedures and would like to be more involved. You have several procedures planned for the following week. Which of these should not be performed by a licensed veterinary technician?

  • Nasogastric tube placement
  • Anesthetic induction and intubation
  • Lymph node aspiration
  • Joint taps
  • Esophagostomy tube placement
A

Answer: Esophagostomy tube placement

Explanation
Veterinary technicians are prohibited from performing surgical procedures, prescribing medications, and making diagnoses. Surgery is defined in most states as any procedure in which the skin or tissue of the patient is penetrated, pierced, or severed for therapeutic purposes, other than giving injections.

Esophagostomy tube placement requires an incision through skin and esophagus to place the feeding tube. This constitutes surgery and should not be performed by a technician, even with supervision.

The other procedures could be performed by a licensed veterinary technician if delegated and supervised by a veterinarian. Veterinarians should only delegate those tasks commensurate with the education, training, and demonstrated abilities of the person being supervised.

Even though tissue is penetrated during blood draws, lymph node aspirations, and joint taps, for example, these constitute non-surgical sample collection and are allowed in most states.

54
Q

A veterinary practice has an annual gross income of $600,000. If it currently spends 17% of its income on inventory and it is able to decrease that to 14% without affecting sales, how much additional profit will the practice generate?

  • $9,000
  • $84,000
  • $25,000
  • $6,000
  • $18,000
A

Answer: $18,000

Explanation
Decreasing the amount spent from 17% to 14% of income means that the practice is spending 3% less of its gross income on inventory. Since sales are not changed, 3% of 600,000 is 18,000 which is the amount of additional profit.

55
Q

What zoonotic parasite is best known to affect the eyes of children?

  • Tapeworm
  • Hookworm
  • Roundworm
  • Whipworm
A

Answer: Roundworm

Explanation
The correct answer is roundworm. The roundworm, Toxocara canis, is the most common cause of visceral larval migrans in humans.

Transmission is usually fecal-oral. Children are known to play in sandboxes where dogs or cats previously defecated and subsequently inoculate their eyes. Puppies may acquire the disease transplacentally.

56
Q

What zoonotic parasite is best known to affect the eyes of children?

  • Tapeworm
  • Hookworm
  • Roundworm
  • Whipworm
A

Answer: Roundworm

Explanation
The correct answer is roundworm. The roundworm, Toxocara canis, is the most common cause of visceral larval migrans in humans.

Transmission is usually fecal-oral. Children are known to play in sandboxes where dogs or cats previously defecated and subsequently inoculate their eyes. Puppies may acquire the disease transplacentally.

57
Q

Trey is a Licensed Veterinary Technician (LVT) who has also been cross trained as a Client Service Representative (CSR). Currently the CSR team is short staffed, and Trey has been asked to cover the front desk during some of his shifts. Trey was working a CSR shift today when a patient that had been hit by a car presented on emergency. Trey found a gurney and rushed the patient into the treatment area. He worked with the other two LVTs to carry out the veterinarian’s instructions. Unfortunately, Trey left the front desk unattended, and during that time the cash box was stolen from the register. Which of the following is the most appropriate way to prevent a similar issue in the future?

  • Clearly define which role Trey is filling during a given shift and have him prioritize those duties.
  • Explain that one of the staff members should have stepped in to take Trey’s place at the front desk.
  • Place security cameras in the reception area and install a biometric lock on the cash register.
  • Formally discipline Trey for leaving the front desk unattended and have him repay the missing money.
A

Answer: Clearly define which role Trey is filling during a given shift and have him prioritize those duties.

Explanation
In order for the practice to be successful, employees must perform the duties specific to their position. Each team member should know which duties they are responsible for at a given time and prioritize those duties.
Creating written job descriptions for each position is recommended. This is important even in small practices.

Incorrect options are those which do not clearly define employee roles. While formally discipling Trey may be appropriate in some situations, this will not prevent a similar issue in the future with other staff members.

Placing security cameras and locks in the reception area may improve security, but it will not prevent role confusion in the future. Having another staff member step in to take Trey’s place may be appropriate, but there should be a specific written plan outlining the process for changing roles during a shift.

Source: The Art of Veterinary Practice Management. Mark Opperman and Sheila Grosdidier. Advanstar Communications, Inc., 2014. Page 68-69, 84-85.

58
Q

What does cyanosis generally indicate?

  • Hypoxemia -Pa02 of <50 mm Hg
  • Cyanide toxicity
  • Anemia- PCV < 15
  • Hypoventilation- PaCO2 >60
A

Answer: Hypoxemia - PaO2 of <50mmHg

Explanation
The correct answer is hypoxemia. Cyanosis or blue mucous membranes is an indicator of oxygenation and is generally observed when arterial PO2 is less than 50.

59
Q

For what type of surgery would nitrous oxide be contraindicated for use as part of an anesthetic protocol in a dog?

  • Splenic surgery
  • Gastrointestinal surgery
  • Renal surgery
  • Open chest surgery
  • Hepatic surgery
A

Answer: Gastrointestinal surgery

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.

***PowerLecture: Inhalant Anesthetics

60
Q

What is the clinical study design that best addresses the “temporality” of disease causation (exposure must precede disease)?

  • Cross-sectional
  • Retrospective
  • Case-control
  • Cohort
A

Answer: Cohort

Explanation
Hill’s Criteria for disease causality includes the requirement for “temporality,” meaning that an exposure cannot be under consideration (hypothesized) as a causal factor unless it precedes the disease. Thus, any study design that does not document that exposure precedes disease cannot logically address the causal question.

A cohort study design is the only one of the options that first documents that a subject has been exposed, following initially only non-exposed subjects. The non-diseased subjects are followed to observe whether they become exposed (an “exposed” cohort), and then followed further over time to observe for disease. At the termination of the study, the risk (proportion) of disease observed in the exposed cohort is compared to that for the non-exposed cohort, by use of relative risk (RR) and attributable risk (AR).

The case-control design (also known as retrospective design) begins not with unexposed subjects but with diseased individuals (cases) that are compared with respect to exposure to a factor, using a comparison group of non-diseased subjects (controls). There is no observation over time. Similarly, cross-sectional designs compare two groups based on disease status and compare how they differ with respect to exposure status. There is no way to know whether exposure preceded disease in any of these types of designs.

Ref: Kleinbaum, Kupper, Morgenstern, Epidemiologic Research pgs. 62-70; Martin, Meek, Willeberg, pgs.155-174.

61
Q

Which of these drugs is known to cause significant release of histamine?

  • Acepromazine
  • Butorphanol
  • Ketamine
  • Morphine
A

Answer: Morphine

Explanation
The correct answer is morphine. Morphine should probably not be used in patients with mast cell tumors for this reason. Butorphanol causes no increase in histamine even though it is also an opioid. Acepromazine actually has some antihistamine effect. Ketamine does not affect histamine levels.

62
Q

Which of the tumors listed is considered a “soft tissue sarcoma” due its locally invasive behavior and relatively low metastatic rate for most low and intermediate grade tumors?

  • Basal cell tumor
  • Osteosarcoma
  • Mast cell tumor
  • Peripheral nerve sheath tumor
  • Hemangiosarcoma
  • Histiocytic sarcoma
A

Answer: Peripheral nerve sheath tumor

Explanation
Soft tissue sarcomas include a group of mesenchymal tumors with similar biologic behavior, namely a locally invasive growth pattern and a metastatic rate of less than 20% for low- and intermediate-grade tumors. High-grade tumors have up to a 50% metastatic rate.

These tumors include peripheral nerve sheath tumors (PNST), hemangiopericytomas (HPC), fibrosarcomas
(FSA), liposarcomas, malignant fibrous histiocytomas, myxosarcomas, rhabdomyosarcomas, and leiomyosarcomas.

Hemangiosarcoma and osteosarcoma are mesenchymal in origin but are not lumped into this category due to their highly metastatic behavior. Histiocytic sarcoma and mast cell tumors are considered of round cell origin.

Basal cell tumors are epithelial in origin.

63
Q

Which of these parameters tells you that an animal is hyperventilating?

  • PaCO2 >50 mmHg
  • PaO2 >120 mmHg
  • RR >60 bpm
  • PaO2 < 80 mmHg
  • PaCO2 < 30 mmHg
A

Answer: PaCO2 < 30 mmHg

Explanation
The correct answer is PaCO2 < 30 mm Hg.

Ventilation is defined by the PaCO2. Normal is 35-45 mmHg. A hypoventilated patient has a high PaCO2, and a hyperventilated patient has a low PaCO2.

64
Q

Which of the following is an indication for performing a urine culture?

  • Low urine pH
  • Calcium crystalluria
  • Isosthenuria
  • Bilirubinuria
A

Answer: Isosthenuria

Explanation
The correct answer is isosthenuria. Isosthenuria, or low urine specific gravity, makes it difficult to identify bacteria in the sample since it is so dilute.

A culture is the most sensitive way to determine if there is an infection present.

Bacteria seen on a UA should be cultured to determine the type of bacteria present and the type of antibiotics to which it is sensitive. The presence of white blood cells in urine is indicative of a urinary tract infection, indicating that a culture should be performed. A urine culture should always be performed on a sterile sample. An elevated pH could be an indication of an infection in some patients, as could the presence of struvite crystals (not calcium) which form in a higher pH environment.

65
Q

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

  • Three injections of human rabies immune globulin followed by 2 injections of approved rabies vaccine
  • Five injections of approved rabies vaccine
  • Injection of human rabies immune globulin followed by 5 injections of approved rabies vaccine
  • Two injections of approved rabies vaccine
  • No treatment is required if the person is vaccinated
A

Answer: Two injections of approved rabies vaccine

Explanation
The correct answer is two injections of an approved rabies vaccine at Day O and Day 3. If you are not vaccinated, then you will need an injection of human rabies immunoglobulin immediately after exposure followed by 4-5 injections of an approved rabies vaccine IM over the course of 2-4 weeks. PEP is not required for accidental injection of animal rabies vaccine into a human.

66
Q

How does Clostridium botulinum toxin affect the nervous system?

  • The toxin destroys acetylcholine so it cannot bind with the post-synaptic receptor
  • The toxin acts as an acetylcholinesterase and breaks down acetylcholine as it is released
  • The toxin binds acetylcholine, making it unable to bind with the post synaptic receptor
  • The toxin blocks acetylcholine release by binding the presynaptic membrane
A

Answer: The toxin blocks acetylcholine release by binding the presynaptic membrane

Explanation
The correct answer is the toxin blocks acetylcholine release by binding the presynaptic membrane. Clostridium botulinum produces a toxin that causes progressive motor paralysis and generalized progressive weakness.

Death usually occurs due to respiratory paralysis. The bacteria often proliferate in decomposing animal or plant tissue.

***PowerPage: Clostridial Diseases

67
Q

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

  • Two 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
  • Three injections of human rabies immune globulin followed by 2 injections of approved rabies vaccine
  • Five injections of approved rabies vaccine
A

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

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.

68
Q

Sympathetic innervation of the bladder is provided by the —

  • Hypogastric nerve
  • Obturator nerve
  • Pudendal nerve
  • Sciatic nerve
  • Pelvic nerve
A

Answer: Hypogastric nerve

Explanation
The correct answer is the hypogastric nerve. The hypogastric is part of the sympathetic nervous system and innervates the urinary bladder.

The pudendal nerve is part of the somatic nervous system and branches to become the perineal nerve, which provides innervation to the external genital organs.

The pelvic nerve supplies parasympathetic innervation to the bladder and gives branches to the descending colon and erectile tissue of the penis or clitoris.

The sciatic nerve is the largest nerve in the body and originates from spinal segments L6, L7, and S1. This nerve has two main branches, the tibial and common peroneal nerves.

The obturator nerve arises from L4, L5, and L6. It is responsible for innervating the external obturator muscle, pectineus, gracilis, and adductor muscles.

69
Q

Viruses with this characteristic are significantly more resistant to environmental degradation; in other words, they survive longer in the environment.

  • Enveloped viruses
  • DNA viruses
  • RNA viruses
  • Non-enveloped viruses
A

Answer: Non-enveloped viruses

Explanation
The correct answer is non-enveloped viruses. Non-enveloped viruses are typically very resistant to environmental degradation and therefore survive longer in the environment and are harder to disinfect than enveloped viruses. For example, parvoviruses are non-enveloped viruses and are difficult to disinfect and survive in the environment longer compared to influenza viruses which are enveloped. Whether a virus is a DNA or RNA virus has no effect on its environmental durability.

70
Q

The positive predictive value is the

  • Proportion of test-negative animals that are disease-positive
  • Proportion of disease-positive animals that are test-positive
  • Proportion of test positive-animals that are disease-positive
  • Proportion of test-negative animals that are disease-negative
  • Proportion of disease-negative animals that are test-negative
A

Answer: Proportion of test positive-animals that are disease-positive

Explanation
The correct answer is the proportion of test-positive animals that are disease-positive (affected). The negative predictive value (NPV) is the proportion of test-negative animals that are disease-negative (or unaffected). The proportion of disease-positive animals that are test-positive is the definition for test sensitivity. The proportion of disease-negative animals that are test-negative is the definition for test specificity.

***PowerLecture: Epidemiology - Sensitivity