October - November NAVLE Test Sample Questions

Question 1

An 8-year old Quarterhorse brood mare presents with an acute onset of colic. On presentation she has a heart rate of 58, respiratory rate of 28, and is seen rolling on the ground. CRT is approximately 3.0 seconds and mucous membranes are slightly red. Her rectal temperature is 101.6F (38.7 C). Gastrointestinal sounds are completely absent and gastric reflux yielded 15L of brown-to yellow- colored fluid. Peritoneal fluid analysis yielded a cloudy yellow fluid with a protein of 2.8 gm/dl and white blood cell count of 11,354/ul. Which of the following is not a likely diagnosis?

• Small intestinal volvulus
• Epiploic foramen entrapment
• Strangulating lipoma
• Mesenteric rent

Answer 1

Answer: Strangulating lipoma

Explanation
The correct answer is strangulating lipoma. The clinical signs are consistent with any of the answer choices.
However, a strangulating lipoma is least likely to be the case since this horse is still relatively young.
Strangulating lipomas are commonly seen in older horses.

**PowerPage: Top 8 Equine Acute Colics
**PowerLecture: Gastrointestinal Disorders

Question 2

A relative calls you to ask how she can stop her 4-year old Cockapoo from begging for food at the table. You advise her not to pay any attention to the dog when it is showing this behavior. What behavioral principle is this?

• Negative reinforcement
• Avoidance learning
• Negative punishment
• Noncontingent reinforcement
• Extinction of operant conditioning

Answer 2

Answer: Extinction of operant conditioning

Explanation
Operant conditioning is the use of consequences to modify the occurrence of a behavior. In this case, the dog has learned that begging behavior has previously been met with positive consequences (i.e. being fed or receiving attention). Extinction is the lack of any consequence following a behavior. When a behavior is inconsequential, producing neither favorable nor unfavorable consequences, it will occur with less frequency.

When a previously reinforced behavior is no longer reinforced with either positive or negative reinforcement, it leads to a decline in the response.

Negative reinforcement occurs when a behavior is followed by the removal of an aversive stimulus thereby increasing that behavior’s frequency. An example is a loud noise continuously sounding until a lever is pressed, upon which the loud noise is removed. This will encourage the behavior of pressing the lever.
Negative punishment, also called punishment by contingent withdrawal, occurs when a behavior is followed by the removal of a favorable stimulus, such as taking away a child’s toy following an undesired behavior, resulting in a decrease in that behavior.

Avoidance learning is when a behavior results in the cessation of an aversive stimulus. For example, holding your ears to shield them from a loud, high-pitched sound helps avoid the aversive stimulation of that obnoxious sound.

Noncontingent reinforcement is the delivery of reinforcing stimuli regardless of the animal’s behavior. This causes that behavior to decrease because it is not required in order to receive the reward.

Question 3

An 8-year old male tomcat presents for having a one week history of progressive lethargy, anorexia, occasional sneezing, conjunctivitis, and nasal discharge. On physical exam you see several ulcerations in the mouth. What is the most likely diagnosis?

• Chlamydophila felis
• Feline calicivirus
• Feline herpesvirus
• Foreign body
• Bordetella bronchiseptica

Answer 3

Answer: Feline calicivirus

Explanation
The correct answer is feline calicivirus. This is a very typical question. It is important to know some of the major differences in feline upper respiratory infections. We hope you did not fall for the foreign body. If you did don’t worry there is hope. Feline calicivirus is known for its ability to cause oral ulceration. Clinical signs associated with this virus include lethargy, anorexia, fever, conjunctivitis, sneezing, nasal discharge, oral ulceration, and, rarely, nasal ulceration. Feline herpes virus presents with conjunctivitis, coughing, sneezing, fever, anorexia, and rarely oral ulceration. You may also see dendritic ulcers in the eye, which is considered pathognomonic for the virus. Cats infected with Chlamydophila will show such signs as conjunctivitis and occasional sneezing. It is usually pretty difficult to distinguish these unless you observe the “red flag” clinical sign such as oral ulcers for FCV.

Question 4

Transmission of brucellosis in pigs is often via which of the following routes?

• Aerosol transmission
• Vectored by biting insects
• Fecal-oral transmission
• Venereal transmission, and through aborted fetuses

Answer 4

Answer: Venereal transmission, and through aborted fetuses

Explanation
The correct answer is venereal transmission, and through aborted fetuses. Pigs are often infected by ingestion of infected aborted fetuses, fetal membranes, and fluids discharged during abortion. Infection can also occur through infected semen via natural breeding, or poorly planned artificial insemination. Transmission is also possible through broken skin and mucous membranes.

***PowerLecture: Reproduction

Question 5

A diagnostic ratio is the ratio of income from diagnostic procedures relative to income from goods (i.e. drugs). Which of the following types of veterinarians usually has the lowest diagnostic ratio?

• Avian veterinarian
• Veterinary specialist
• Livestock veterinarian
• Companion animal veterinarian

Answer 5

Answer: Livestock veterinarian

Explanation
Diagnostic ratio is often used as a measure to evaluate productivity. Companion animal veterinarians often have a ratio near 1:1. Avian practitioners often have higher diagnostic ratios and livestock veterinarians usually dispense many more drugs relative to the number of diagnostic procedures they perform and therefore have a low diagnostic ratio (approximately 1:4). The diagnostic ratio of veterinary specialists varies widely by specialty.

Question 6

Frequently, owners question the value of spaying or neutering a dog. In this case, you have a hesitant owner that has come in with her new female Bichon Frise of twelve weeks of age. Which of the following statements is the most accurate statement?

• Spaying your dog will not eliminate the likelihood of developing a pyometra later in life
• Spaying your dog will result in an 73% chance of a cranial cruciate ligament tear
• Spaying after the first heat cycle will result in an approximately 8% likelihood of mammary cancer
• Spaying your dog will eliminate all inappropriate eliminations in the household

Answer 6

Answer: Spaying after the first heat cycle will result in an approximately 8% likelihood of mammary cancer

Explanation
Spaying is very important in decreasing the incidence of mammary carcinoma. Spaying prior to the first heat results in a 0.5% incidence of mammary carcinoma. A spay after the first heat results in an increased incidence of 8%. Finally, a spay after the second heat yields an approximately 24% incidence of mammary carcinoma.

Pyometra is a disease which manifests itself as a result of hormonal imbalance during diestrus. A properly performed ovariectomy will eliminate the chances of this occurring.

Although there are scattered reports concerning the association of cranial cruciate ligament disease and early spaying, there are currently no definite associations.

Question 7

Which of these compounds is effective at inducing emesis in the cat?

• Acepromazine
• Xylazine
• Ketamine
• Diazepam

Answer 7

Answer: Xylazine

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

Question 8

A 3-year old male castrated domestic short hair cat is given a large dose of oxymorphone for analgesia. Shortly after intramuscular administration of the drug, the cat is excessively sedate and barely rousable. Which drug can be used to reverse the oxymorphone?

• Yohimbine
• Buprenorphine
• Morphine
• Naloxone

Answer 8

Answer: Naloxone

Explanation
The correct answer is naloxone. Butorphanol can also be used to reverse mu agonists like oxymorphone (but it wasn’t in the list of choices). It is a partial mu antagonist, kappa agonist. Morphine is a mu agonist and would have a similar effect on the cat as oxymorphone. Buprenorphine is a partial mu agonist, kappa antagonist and would not effectively reverse the effects of pure mu agonists. Yohimbine is used to reverse alpha 2 agonists such as xylazine. Naloxone is the only opioid antagonist amongst the choices that can be used to effectively reverse the mu agonists.

*** PowerLecture: Opiates

Question 9

An 8-year old male castrated cat presents to your clinic for a decreased appetite and slight weight loss over the past 2 months. Physical examination is unremarkable except for mild cranial organomegaly detected on abdominal palpation. You perform diagnostic tests and find the following results:

Complete blood count shows:
Hematocrit - 26% (30-45 %)
White blood cell count- 18,155/ul (5,500-19,500/ul)
Neutrophils- 12,100/ul (2,500-12,500/ul)
Lymphocytes- 5,055/ul (1,500-7,000/ul)
Monocytes- 300/ul (0-900/ul)
Eosinophils- 700/ul (0-800/ul)
Platelets- 270,000/ul (300,000-800,000/ul)

Serum chemistry shows:
Creatinine- 1.2 mg/dl (0.9-2.2 mg/dl)
Blood urea nitrogen (BUN) - 22 mg/dl (19-34 mg/dl)
Glucose- 138 mg/dl (60-120 mg/dl)
Albumin= 3.4 g/dl (2.8-3.9 g/dl)
Globulin= 6.2 g/dl (2.6-5.1 g/dl)
ALP- 85 IU/L (0-45 IU/L)
ALT - 214 IU/L (25-97 IU/L)
GGT- 9 IU/L (0-6 IU/L)
Total bilirubin- 0.9 mg/dl (0-0.1 mg/dl)

You perform an abdominal ultrasound and find that the liver appears subjectively enlarged. The echogenicity of the liver is normal and the gall bladder is normal in appearance. No other abnormalities are seen.

You perform an ultrasound guided liver biopsy. Histopathology indicates infiltration of lymphocytes and plasma cells but not neutrophils into portal areas but not into bile ducts.

With treatment, what is the cat’s prognosis?

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

Answer 9

Answer: Good, mean survival is greater than 2 years

Explanation
The case described is consistent with lymphocytic portal hepatitis. Clinically, this condition can appear similar to chronic cholangiohepatitis in terms of signalment, clinical signs and laboratory findings. The key to this diagnosis is the liver biopsy. Typical findings for lymphocytic portal hepatitis is infiltration of lymphocytes and plasma cells but not neutrophils into portal areas. This is in contrast to chronic cholangiohepatitis which typically has neutrophils in portal areas.

Chronic cholangiohepatitis carries a fair prognosis with about half of cats doing poorly (dead or euthanized within 3 months) and half of cats responding favorably to treatment with long term survival. For cats with lymphocytic portal hepatitis, although treatment can be challenging, the disease is very slowly progressive and the reported mean survival is approximately 3 years.

Question 10

About 1 hour after a difficult labor where the calf had to be pulled out with force, the cow goes down. She is pale and her heart rate is 100/min. What happened?

• Uterine tear
• Hypocalcemia
• Pelvic fracture
• Obturator paralysis

Answer 10

Answer: Uterine tear

Explanation
The correct answer is uterine tear.

With a traumatic fracture or damage to nerves, the cow would have gone down right away rather than an hour later.

Hypocalcemia is possible but less likely in this case where the calf had to be forcibly extracted which can result in a uterine tear, and would be unlikely to make her pale and tachycardic.

Question 11

It’s Halloween time once again, and you are on the overnight emergency rotation. You have a patient coming down that has ingested an unknown amount of dark chocolate candies about an hour earlier. Which of the following is a clinical sign you may see in a dog with chocolate toxicosis?

• Cardiac tachyarrhythmias
• Miosis
• Hypoglycemia
• Coagulopathy

Answer 11

Answer: Cardiac tachyarrhythmias

Explanation
The correct answer is cardiac tachyarrhythmias. The toxic principle of chocolate is methylanthines (specifically theobromine and caffeine). Methylxanthines can cause CNS excitation, tachycardia, and vasoconstriction. Signs include vomiting, diarrhea, hyperactivity, polyuria, polydipsia, lethargy, tachycardia, cardiac arrhythmias, seizures, and death.

It may also cause pupil dilation (mydriasis), therefore miosis (constricted pupils) is not the correct answer choice. Chocolate ingestion is not associated with coagulopathy or hypoglycemia.

Question 12

Which of the following is considered to be a component of addressing maladaptive behavior and animal welfare issues?

• Light cycle changes
• Extra water
• Environmental enrichment
• Extra food
• Treats

Answer 12

Answer: Environmental enrichment

Explanation
Environmental enrichment should be used to curb maladaptive behaviors and welfare issues.

Question 13

What is the end-point of warfarin therapy in an animal with a pulmonary thromboembolism?

• A partial thromboplastin time of 1.5 to 2 times normal
• A thrombin time of 1.5 to 2 times normal
• An activated clotting time of 1.5 to 2 times normal
• A prothrombin time of 1.5 to 2 times normal

Answer 13

Answer: A prothrombin time of 1.5 to 2 times normal

Explanation
The correct answer is a PT time of 1.5 to 2 times normal.

PT is the best of these indexes to monitor warfarin therapy since, at these doses (usually 0.1-0.2 mg/kg), PTT and ACT will be unchanged. An even better method is to use the international normalization ratio (INR), which is a fancy way of taking into account how different PT reactions are run. The goal is to get an INR of 2.0 to 3.0.

Question 14

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?

• Abdominocentesis
• Complete blood count and serum chemistry
• Serum lactate
• Abdominal ultrasound
• Thoracic radiographs

Answer 14

Answer: Abdominocentesis

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.

Question 15

Which of these is a possible primary cause for anterior uveitis as shown in this dog with aqueous flare?

• Coccidioides immitis infection
• Keratoconjunctivitis sicca
• Systemic Lupus Erythematosis
• Cataracts

Answer 15

Answer: Coccidioides immitis infection

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

Question 16

You are performing a post-mortem examination on a cow that died of unknown causes. On exam, you find that the liver is enlarged, diffusely lighter yellow in color than usual, and is easily friable. You put a section into formalin and it floats. Which of the following best describes the likely pathogenesis?

• Copper toxicity
• Lipofuscinosis
• Hepatic lipidosis
• Chronic active hepatitis
• Hepatic lymphoma

Answer 16

Answer: Hepatic lipidosis

Explanation
The best choice is hepatic lipidosis. Affected livers usually appear as described in this example due to swelling from lipid vacuoles within the hepatocytes. The section floats in formalin due to decreased density of the lipid vacuoles.

Lipofuscinosis is a storage disease that usually gives the liver a dark appearance. Copper toxicity can cause the liver to appear pale tan or bronze but would not cause the other abnormalities. Chronic active hepatitis will often progress to cirrhosis. Lymphoma could cause the enlarged liver but should not cause the liver to float.

***PowerLecture: Hepatic Disorders

Question 17

You want to give a 22 pound cat a 5 mg/kg dose of a drug. The drug comes as a 2.5% solution. How many milliliters should you give the cat?

• 4.4
• .4
• 8.8
• 20
• 2
• .2

Answer 17

Answer: 2

Explanation
First, you must recognize that the cat’s weight is given in pounds and should immediately be converted to kilograms. There are 2.2 lbs/kg so this is a 10 kg cat.

Second, you must be able to convert a percent solution to mg/ml. A 2.5% solution is 25 mg/ml. This is hard for some students to remember. A memory tip is that a 100% solution would be 1 gram/ml. Therefore a 50% solution would be 500mg/ml, and a 5% solution would be 50 mg/ml.

The math to solve this question is:
22 lbs x (1 kg/2.2 lbs) x 5mg/kg x (1ml/25mg) = 2 ml

Question 18

What is the holding layer of the esophagus?

• Submucosa
• Serosa
• Muscularis
• Mucosa

Answer 18

Answer: Submucosa

Explanation
The correct answer is the submucosa. At one time, it was thought that the mucosa was the holding layer, but it has now been shown that it is the submucosa. The submucosa is essentially the holding layer for all hollow viscera.

Question 19

You are presented with a valuable cow for diagnosis and treatment. She was paste wormed yesterday using a paste gun and benzimidazole wormer. Today she has inappetence, mild bloat, extended head, drooling, and swelling and pain in the throat area. Her temperature is 104.5F (40.3C) on a cool morning. You diagnose ______

• Actinobacillosis
• Choke
• Allergy to benzimidazole wormers
• Malignant catarrhal fever
• Pharyngeal trauma

Answer 19

Answer: Pharyngeal trauma

Explanation
On some occasions, a paste gun or other foreign body such as stick or wire in feed can penetrate the thin mucosa of the pharynx and result in severe acute infection and foreign body reaction. The mild bloat is due to the vagal nerve involvement of the inflamed throat region.

Question 20

What is the treatment for a persistent corpus luteum that will allow a return to estrus in a mare?

• Progesterone injection
• Gonadotropin-releasing hormone (GnRH) injection
• PGF-2-alpha (prostaglandin) injection
• Human chorionic gonadotropin (hCG) injection

Answer 20

Answer: PGF-2-alpha (prostaglandin) injection

Explanation
The correct answer is PGF-2-alpha injection. PGF will cause lysis of the corpus luteum in mares if the corpus luteum is more than about 5 days old. If you are unsure how old the corpus luteum is, you can repeat the injection in about 7 days. This will allow a return to normal cycling. Remember, injection of PGF may cause mild-moderate abdominal pain (colic, cramping) after administration. Progesterone injection would not change things because the horse already has high levels of progesterone due to the persistent corpus luteum. hCG stimulates ovulation, but if the horse has high progesterone from the corpus luteum, it will not exhibit a behavioral estrus. GnRH would have similar effects.

***PowerLecture: Estrous Cycle

Question 21

A 9-year old male castrated mixed breed dog presents with a history of intermittent coughing and increased respiratory effort. He had been treated empirically for the past two weeks with antibiotics and no clinical improvement has been appreciated. The owners have finally consented to chest radiographs and those reveal an atelectic right middle lung lobe and no visualization of the bronchi in the region of the middle lung lobe. Which of the following options is the most likely differential?

• Heart failure
• Aspiration pneumonia
• Persistent aortic arch
• Lung lobe torsion

Answer 21

Answer: Lung lobe torsion

Explanation
The history and radiographic findings should help rule out aspiration pneumonia and heart failure. A persistent right aortic arch (PRAA) is highly unlikely as this is a congenital condition diagnosed early on in life. Clinical signs of a PRAA include regurgitation, a ravenous appetite, and a poor body condition. Radiographic signs would show a narrowing of the esophagus at the location of the anomaly and a megaesophagus cranial to the site of the vascular anomaly. Occasionally you will also see a megaesophagus caudal to the vascular anomaly.

We currently don’t know the exact etiology of lung lobe torsions; however deep chested dogs such as Afghan hounds are predisposed. Additionally it is thought that having a pleural effusion or a prior lung lobectomy may facilitate a lobe torsion. Clinical signs are usually similar to those in this question. A tip off to the potential of having a lung lobe torsion is that the bronchi of the right middle lung lobe cannot be visualized. Pleural effusion and atelectasis are also supportive but may also be appreciated other disease processes such as trauma and a lung lobe abscess.

Annotations:
Orange: The right middle lung lobe has a diffuse reticular pattern throughout and associated lobar sign
Green circle: There is abrupt blunting of the main right bronchus after the tracheal bifurcation.
This patient did not have pleural effusion. A large portion of patients with lung lobe torsion do have pleural effusion concurrently.

Radiographs provided by Adrien Hespel, DVM, MS, DACVR and University of Tennessee College of Veterinary Medicine

Question 22

A 4-year old female spayed Doberman pinscher presents for lethargy and decreased appetite. The owner reports that over the past week, the dog has become increasingly listless and reluctant to go for walks You examine the dog and find mild joint effusion of the tarsi. T-104.3 F 40.2 C, HR-102 bpm, RR-32 bpm. The remainder of your physical exam is unremarkable.

Complete blood count and chemistry panel show:
Hematocrit - 28% (Normal 36%-50%)
White Blood Cell Count - 15,500/ul (Normal 7,000-17,000/ul)
Thrombocytes - 246,000/ul (Normal 200,000-900,000/ul)
Calcium - 9.8 mg/d (Normal 8-11 mg/dl)
Phosphorus - 3.4 mg/dl (Normal 2.4-4.9 mg/dl)
Total Protein - 5.8 g/dl (Normal 5.5-7.3 g/dl)
Alkaline Phosphatase - 68 IU/l (Normal 10-80 IU/l)
Alanine Aminotransferase - 14 IU/l (Normal 3-33 IU/I)
Blood Urea Nitrogen - 20 mg/dl (Normal 10-22 mg/dl)
Creatinine - 1.6 mg/dl (Normal 0.5-2.2 mg/dl)
Glucose - 104 mg/dl (Normal 60-125 mg/dl)

Urinalysis is within normal limits and urine culture was negative. Radiographs of the tarsal joints show joint effusion to no bony abnormalities. You perform arthrocentesis of each tarsal joint. You are able to aspirate about 0.15 ml from each joint; the fluid is thin and turbid. You do not have enough joint fluid to submit for analysis and culture so you make a slide for cytology which shows 3-4 nondegenerate neutrophils per high power field and occasional mononuclear cells. You are suspicious that the dog may have immune-mediated polyarthritis (IMPA). Which of the following are all known potential inciting causes or predisposing factors for this condition?

• Hemangiosarcoma, fungal osteomyelitis, cruciate ligament disease
• Synovial cell sarcoma, renal insufficiency, hyperthyroidism
• Penetrating joint trauma, gastric dilatation-volvulus, ingestion of onions
• Systemic lupus erythematosus, sulfonamide exposure, mammary adenocarcinoma
• Hypothyroidism, anal sac carcinoma, leptospirosis vaccination

Answer 22

Answer: Systemic lupus erythematosus, sulfonamide exposure, mammary adenocarcinoma

Explanation
IMPA is often classified as being erosive or nonerosive. This case is an example of the nonerosive form based on the lack of radiographic evidence of cartilage or subchondral bone destruction. The erosive form is rare and is thought to account for <1% of the cases of IMPA.

IMPA can be associated with a variety of systemic diseases or precipitating factors including systemic infectious, inflammatory or neoplastic disease or reactions to drugs or vaccines. Systemic lupus erythematosus is a progressive multiorgan autoimmune disease which frequently manifests with polyarthritis and may also cause concurrent hemolytic anemia, thrombocytopenia, glomerulonephritis, skin lesions, and lymphadenopathy.

Drug induced IMPA has been associated with a variety of medications including sulfonamides, lincomycin, erythromycin, cephalosporins, phenobarbital, and penicillins. Vaccine associated polyarthritis has been suggested but association has been difficult to prove. Some breeds of dogs have particular predispositions to IMPA including Akitas (in association with meningitis) and Shar-Peis (in association with “Shar-Pei fever”). IMPA can also be associated with chronic infectious or inflammatory diseases including pyoderma, urinary tract infections, pneumonia, endocarditis, mastitis, heartworm, fungal infection, and severe periodontal disease.

Chronic inflammatory bowel disease, intestinal overgrowth, and ulcerative colitis have been associated with IMPA. Distant neoplasia has also been associated with IMPA including squamous cell carcinoma, mammary adenocarcinoma, leiomyoma, heart based tumors, and seminoma.

Question 23

Maple syrup urine disease is a genetic disorder associated with spongiform changes in the brain and caused by a deficiency of this enzyme in Hereford and polled Shorthorn calves. It usually shows up at 2 to 3 days of age. Which of the following enzymes is the correct one ?

• Pyruvate kinase
• Branched-chain ketoacid decarboxylase
• Acetyl-CoA carboxylase
• Carnitine acyl translocase

Answer 23

Answer: Branched-chain ketoacid decarboxylase

Explanation
The correct answer is branched-chain ketoacid decarboxylase, which will cause accumulation of 2-keto-3-methylvaleric, 2-ketoisocaproic, and 2-isovaleric acids along with their precursors isoleucine, leucine, and valine.

These are excreted in the urine and result in a burnt maple syrup smell (hence the name of the disease). This hereditary disease causes an encephalopathy. Acetyl-CoA carboxylase turns acetyl-CoA into malonyl CoA in fatty acid synthesis. Carnitine acyl translocase helps bring fatty acids across the inner mitochondrial membrane for degradation. Pyruvate kinase turns phosphoenol-pyruvate into pyruvate in the glycolysis pathway.

Question 24

You have been called to a swine farm with 2400 pigs weighing around 150 lbs because of sudden onset of respiratory signs. Upon arrival you find over 50% of the pigs are coughing. They are off feed and lethargic. The owner reports the coughing just started 2 days ago. The pigs have been vaccinated for porcine reproductive and respiratory syndrome virus (PRRS), Mycoplasma hyopneumoniae, porcine circovirus type 2 (PCV2), and swine influenza. What is your top differential?

• Mycoplasma hyopneumoniae
• Classical swine fever
• Porcine circovirus type 2 (PCV2)
• Swine influenza
• Streptococcus suis
• Porcine reproductive and respiratory syndrome virus (PRRS)

Answer 24

Answer: Swine influenza

Explanation
The correct answer is swine influenza. The rapid spread within a population (>50% in just 2 days) is characteristic for swine influenza. Although this group of pigs had been vaccinated for swine influenza, the great diversity in the virus (especially due to antigenic shift) does not guarantee that the particular vaccine used will contain influenza strains that match or cross protect against the specific virus the herd has been exposed to.

PRRS and PCV2 viruses both can cause respiratory problems in pigs, but they tend to move very slowly within a population. Mycoplasma hyopneumoniae clinically presents as a more chronic problem. Strep. suis can cause pneumonia but usually is more of a problem for an individual or small group of pigs. Classical swine fever is currently not present in the US and manifests as a systemic and enteric problem in pigs and not associated with pneumonia.

Question 25

What is the treatment of choice for nasal aspergillosis in dogs?

• Systemic antifungal therapy (i.e. traconazole)
• Systemic corticosteroids
• Surgery and antibiotics
• Topical antifungal therapy (i.e. Clotrimazole)

Answer 25

Answer: Topical antifungal therapy (i.e. Clotrimazole)

Explanation
The correct answer is topical antifungal therapy. Topical antifungal therapy is considered more efficacious and less costly than long-term systemic antifungal therapy. Corticosteroids would be contraindicated. Surgery and antibiotics would not be successful in controlling a fungal infection. The currently recognized treatment of choice is clotrimazole, a synthetic imidazole that has an 80% cure rate with single administration. The main potential complication is CNS exposure to the drug if there has been erosion of the cribriform plate.

Question 26

A 10-year old female spayed Siamese cat presents for a new lump the owner found a month ago. She was spayed last year before she was adopted from the shelter. The owner states that the lump has grown over the last month, and it doesn’t seem to bother the cat. On exam, the 2 cm lump is located on the left 2nd mammary gland, and no other lumps are noted. The lump is freely moveable, and chest radiographs are clear. What is the chance that this tumor is malignant?

• 50%
• 85%
• 5%
• 20%

Answer 26

Answer: 85%

Explanation
70-90% of all feline mammary tumors are malignant. Spaying a cat before 6 months of age reduces the risk for mammary tumors by 7 fold.

The statistics for dogs is a 50:50 chance of malignancy for a single mammary mass.

Question 27

A 2-month old female Maltese presents for a physical exam. Auscultation of the heart reveals a grade 5 out of 6 continuous murmur heard best over the left heart base. Her arterial pulses are bounding. Thoracic radiographs show an enlarged left heart and pulmonary vasculature. What is the most likely diagnosis?

• Ventricular septal defect
• Patent ductus arteriosus
• Aortic stenosis
• Pulmonic stenosis

Answer 27

Answer: Patent ductus arteriosus

Explanation
The correct answer is patent ductus arteriosus. PDAs results from the failure of ductus closure after birth resulting in a shunt (usually left-to-right) from the aorta to the pulmonary artery. The shunting causes excess volume in the pulmonary arteries, veins, left atrium, left ventricle, and aortic arch. The signalment of the dog and described clinical features and diagnostic findings are classic for PDA. In addition to the enlarged left heart and pulmonary vasculature, there is also usually an aneurysmal bulge of the aorta near the PDA on the DV view.

The bounding pulses result from a widened pulse pressure (difference between systolic and diastolic pressure) because of the run-off of blood from the aorta to the pulmonary artery. PDAs are the most common congenital heart defect in dogs. The most common congenital heart defect in other domestic species is ventricular septal defect.

Question 28

A Thoroughbred race horse has been moved from California to Florida in July and is experiencing poor performance, exercise intolerance and tachypnea. You observe the horse working out one hot afternoon and see these signs, but you also note that the horse is not sweating. You check the rectal temperature and note that it is 104F (40 C). What is the diagnosis?

• Anhidrosis
• Diabetes insipidus
• Hypothyroidism
• Influenza
• Equine Cushing’s

Answer 28

Answer: Anhidrosis

Explanation
Anhidrosis is the inability to sweat, which can be fatal if not addressed. The cause is unknown. It tends to occur in hot humid climates, and may occur in horses raised in the climate, or more commonly, horses brought into the climate. The most successful treatment is to move the horse back to a more favorable climate.

Question 29

Treatment of gastric ulceration is extremely common in racetrack medicine. Which of the following is a Hydrogen- Potassium ATPase blocker?

• Omeprazole
• Cimetidine
• Misoprostol
• Sucralfate

Answer 29

Answer: Omeprazole

Explanation
The correct answer is omeprazole. Omeprazole is a proton pump blocker (hydrogen-potassium ATPase).
Cimetidine is an H2 antagonist as well as ranitidine and famotidine. Sucralfate protects the mucosa by binding to ulcers and protecting from further damage. PgE1 analogs (misoprostol) increase gastric blood flow, decrease gastric secretion of acid, and increase mucous and bicarbonate secretion.

Question 30

A 4-year old dog presents for excessive licking of the right carpus of a 2-month duration. Upon examination you note an oval wound that is thickened, alopecic, and ulcerated. Based on clinical findings you make a presumptive diagnosis of acral lick dermatitis. Which statement is NOT true for acral lick dermatitis?

• Arthritis may be contributing to the lesion
• These lesions are frustrating to treat because an underlying cause can be hard to find
• 50% of cases are diagnosed as idiopathic or psychogenic
• Allergies may be contributing to the lesion
• The lesion should resolve with topical antibiotic treatment

Answer 30

Answer: The lesion should resolve with topical antibiotic treatment

Explanation
Most acral lick lesions are solitary and affect the carpus or metacarpus. About 50% will be diagnosed as idiopathic or psychogenic, but other diseases must be ruled out first including bacteria, fungal, demodicosis, trauma, allergy, and underlying joint disease. A full work-up may include skin cytology, fungal culture, biopsy, diet trial, skin testing, radiographs of the joint, and addressing behavioral disorders.

Most of these lesions will have a deep bacterial infection and treatment should include systemic antibiotics based on a deep culture sample. Topical antibiotics may not penetrate the area well enough to resolve the infection.

Management also includes treating the underlying cause. Many veterinarians will also prescribe topical or intralesional steroids. If no cause is found, then antidepressants or anxiolytics may be started.

These lesions will rarely go away unless the underlying cause is identified and properly treated.

Question 31

This 2 year-old female spayed Siamese cat presents for further evaluation of the masses seen in the image. The patient was recently rescued and there is no other history available. On physical examination, there are no overt abnormalities appreciated other than the masses visualized. A fine needle aspirate is performed and consistent with a mast cell tumor. Given the breed, the histiocytic subtype is suspected. Which of the following is the most appropriate treatment plan if the owners don’t have unlimited funds?

• Excise the nodules with a minimum of 3 cm margins and one fascial plane deep
• Excise the nodules while obtaining a minimum of 1cm margins
• Monitor as the lesions will most likely spontaneously regress
• These lesions will regress with a 4 week treatment of radiation therapy

Answer 31

Answer: Monitor as the lesions will most likely spontaneously regress

Explanation
Contrary to cutaneous mast cell tumors in dogs, young Siamese cats (less than 4yr) with the histiocytic subtype of mast cell neoplasia will typically have their tumors spontaneously regress. Therefore, as long as the patient is not suffering it is reasonable to wait for these to resolve on their own. In general, it is safe to say that feline mast cell neoplasia is much less aggressive than is seen in dogs. Cutaneous mast cell tumors do not need the aggressive surgical margins that are typically recommended for Grade Il or Ill canine mast cell tumors.

Furthermore, follow up radiation therapy is rarely indicated.

Question 32

The image below is from an aspirate taken from a lytic bone lesion seen on radiographs of a nine year old female Vizsla dog. Choose the correct cell type of origin AND classification.

• Epithelial origin; carcinoma
• Mesenchymal origin; sarcoma
• Epithelial origin; sarcoma
• Leukocyte origin; round cell tumor

Answer 32

Answer: Mesenchymal origin; sarcoma

Explanation
This is an osteosarcoma. The classification scheme for tumors by cell of origin and cytologic description is:
Sarcoma- These tumors come from mesenchymal cells and are named by the specific cell type such as fibroblasts (fibrosarcoma) and osteoblasts (osteosarcoma). Cytologically, they tend to appear as isolated spindle-shaped cells with elongated cytoplasm and often oval nuclei. Those are the features you should have identified in the image. If you identified several cells that have pink areas in the cytoplasm which likely represent osteoid, well done!

Carcinoma- These tumors come from epithelial cells including cells of glandular tissues such as salivary glands, mammary glands, and cells lining most tissues including squamous cells or transitional cells. The cytologic appearance is that of cohesive clusters of cells. Cells are often polygonal in shape.

Round cell tumors- There are 5 round cell tumors and most but not all come from blood cells. They are lymphoma, mast cell tumors, plasma cell tumors, histiocytic tumors, and transmissible venereal tumors.
Remember, these are sometimes also referred to as sarcomas (i.e. lymphosarcoma or histiocytic sarcoma).
Cytologically, they appear usually as large populations of cells that are not in defined clusters. The cells have a round shape, often with unique identifiable features such as the purple granules in mast cell tumors.

Question 33

An adult horse presents to you for recurrent seasonal pruritus during the summer months that seems to be worsening. On physical examination, you find multiple excoriations along the poll, mane, and tail. What is the most likely cause of this horse’s pruritus?

• Hypoderma
• Habronema
• Haematobia
• Onchocerca
• Culicoides

Answer 33

Answer: Culicoides

Explanation
The correct answer is Culicoides. Culicoides hypersensitivity, also referred to as sweet itch, occurs due to allergy to the saliva of the gnat. It recurs seasonally in the warmer months and tends to worsen with age. Typically, horses are pruritic and develop lesions on the poll, mane, and tail from self trauma, although ventral midline dermatitis can occur as well. More chronically, scarring can occur. Treatment is to decrease exposure to the gnat and to treat with steroids.

Habronemiasis is a condition where the larvae of the stomach worm migrate and emerge creating granulomatous lesions, usually around the eye, male genitalia, or lower extremities. Inside the granulomas, you can find dead larvae.

Haematobia irritans is a bigger problem in cattle than horses (they reproduce in cow feces) but can affect horses, especially ones that are near cattle. It typically causes ventral midline dermatitis with wheals with a central crust that progress to alopecia and ulceration with fairly focal lesions, rather than more diffuse lesions caused by Culicoides.

Onchocerca can cause dermatitis in the horse due to hypersensitivity to dying microfilariae. Lesions include alopecia and scaling of the ventral midline, face, and pectoral region. Often, lesions are diamond shaped and there may be a “bull’s eye” lesion on top of the head. Onchocerca is nonseasonal, in contrast to Culicoides hypersensitivity, and variably pruritic. Ocular lesions can also occur with Onchocerca including uveitis, conjunctivitis, and keratitis.

Lastly, Hypoderma is also a bigger problem in cattle but can occur in horses and typically creates nodules on the dorsum that have a pore on top.

Question 34

Which of these is an appropriate treatment for a dog that has ingested diluted bleach within the past 10 minutes?

• Administer apomorphine
• Administer intravenous fluids
• Administer milk to dilute the stomach contents
• Administer non-steroidal anti-inflammatory drugs
• Administer activated charcoal

Answer 34

Answer: Administer milk to dilute the stomach contents

Explanation
The correct answer is to dilute the stomach contents with milk. Bleach, even when diluted can be corrosive as can many household cleaners. This can result in severe burning of the mouth, esophagus, and stomach. Lesions from acids usually appear soon after exposure, while lesions from alkalis may not appear until 8-12 hours later.

Do not induce vomiting with apomorphine because further damage can occur to the esophagus. Activated charcoal does not bind to these products and shouldn’t be used. IV fluids is unlikely to be of any benefit immediately following the ingestion of the bleach unless the animal happens to already be sick or dehydrated.

NSAIDs may help with pain or discomfort but can also contribute to the formation of ulcers within the GI tract.

The recommended course of action is to dilute with milk or water and start Gl protectants for several days. If the patient becomes depressed or anorectic, evaluate it for ulcers.

Question 35

A female ferret of unknown age presented for acute onset of severe lethargy (see image). The owners obtained the pet 2 weeks ago from an elementary school class which had owned the ferret for 6 years. It is not known if the ferret was spayed. Physical exam reveals depression and thin body condition. Heart rate is 200 bpm. The spleen feels enlarged but no masses are palpable. Blood glucose measures “Lo” on a glucometer. Which of the following treatments are most useful long term for the likely condition?

• Ovariohysterectomy and intravenous fluids
• Prednisone and diazoxide
• Adrenalectomy and trilostane
• Meloxicam and amoxicillin
• Insulin and potassium supplementation

Answer 35

Answer: Prednisone and diazoxide

Explanation
This ferret’s clinical signs and blood glucose are most consistent with insulinoma. Medical management consists of prednisone and diazoxide alone or in combination. Dietary management with a high protein and low carbohydrate diet is also important. Surgical removal of the tumor is also an option in otherwise healthy ferrets.

***PowerPage: Ferret Neoplastic Diseases

Question 36

A 4-week old intact male Gordon Setter presents for an acutely swollen face and lethargy. On physical examination you note pronounced submandibular lymphadenopathy, and occasional pustules on the face in addition to the swelling. Cytology does not reveal an infectious cause. Which of the following is an appropriate treatment?

• Anti-inflammatory doses of glucocorticoids
• Immunosuppressive doses of glucocorticoids
• Cephalexin
• Ketoconazole

Answer 36

Answer: Immunosuppressive doses of glucocorticoids

Explanation
This is a classic clinical presentation for juvenile cellulitis (puppy strangles). This disease is characterized by sterile granulomas and pustules that respond dramatically to glucocorticoids. The cause is thought to be an underlying immune dysfunction. Immunosuppressive glucocorticoid therapy should not be started until other infectious diseases have been ruled out. At a minimum a deep skin scrape, skin cytology, and trichogram should be performed to rule out Demodex, bacteria, and fungal infection.

Question 37

An adult macaw presents to you for a cloacal prolapse. The cloacal tissue appears pink but blanches when 5% acetic acid solution is applied, and small fleshy proliferations are seen. What is the likely cause of the prolapse?

• Cloacal papilloma
• Proventricular dilatation disease (PDD)
• Enteritis
• Egg binding

Answer 37

Answer: Cloacal papilloma

Explanation
The correct answer is cloacal papilloma. This is the most common gastrointestinal tumor of birds, and is seen most commonly in Amazons and macaws. A viral etiology is suspected but not proven. Treatment is surgical removal or chemical cautery. Egg binding can cause cloacal prolapse, but does not cause fleshy proliferations.

Enteritis and PDD are unlikely to cause prolapse.

Question 38

A sheep presents to you for nasal discharge and face rubbing. You perform cytology on the copious discharge and note numerous eosinophils and mast cells. What is the most likely diagnosis?

• Actinomyces sinusitis
• Melophagus ovinus infestation
• Sheep diphtheria (Fusobacterium necrophorum)
• Oestrus ovis infestation
• Enzootic nasal tumor

Answer 38

Answer: Oestrus ovis infestation

Explanation
The correct answer is Oestrus ovis infestation. Adult flies deposit larvae around the animals’ nostrils; the larvae then migrate up the nasal passages into the turbinates and sinuses. With time and multiplication of the larvae, hypersensitivity develops with the marked clinical signs of nasal discharge and face rubbing and shaking.

Secondary bacterial infection can occur. The discharge usually contains numerous eosinophils and mast cells, which confirms the diagnosis in this case. Further confirmation could be achieved with radiographs showing mineralized bots or with endoscopy, but this is not usually necessary.

Enzootic nasal tumor could have similar clinical signs but tends to cause more dyspnea and would not have the eosinophils and mast cells seen in the discharge.

Fusobacterium causes necrotic laryngitis in sheep when there is perforation to the mucous membranes.

Clinical signs are more of coughing and dyspnea; there would not be nasal discharge. Actinomyces pyogenes infection is also unlikely to cause nasal discharge and if it did, you would not observe eosinophils and mast cells in the discharge. Treatment of Oestrus ovis is with ivermectin.

Question 39

A 4-year old female Brittany Spaniel presents for further evaluation of suspected dystocia. Her gestation length is approximately 60 days and the owners note that she has been extremely restless, panting, and vomited once in the past 8 hours. On vaginal examination, there is no obviously obstructed puppy. Radiographs of the dog show no evidence of fetal gas or alteration in spatial relationship between the fetal bones. What is the best treatment for this dog?

• Perform a Caesarian section
• Administer intramuscular dexamethasone sodium phosphate
• Continue to monitor carefully without disturbing her and have the dog return in 24 hours if she has not delivered the puppies
• Administer intramuscular oxytocin

Answer 39

Answer: Continue to monitor carefully without disturbing her and have the dog return in 24 hours if she has not delivered the puppies

Explanation
Based on the history and clinical examination findings, this dog has presented in stage 1 of labor. This stage is typically 6-12 hours of length and can persist for up to 36 hours. In this stage, it is expected for the dog to exhibit panting, trembling, nesting behavior, and restlessness. Occasionally dogs will also vomit. At this point, there is sub-clinical uterine contraction and dilation of the cervix. Stage 2 will also last approximately 6-12 hours (and persist up to 36hr) and is characterized by abdominal straining which coincides with uterine contraction.

Puppy delivery occurs during Stage 2 at an interval of 30-60min (up to 4 hours). Stage 3 involves the expulsion of fetal membranes as well as involution of the uterus. Fetal membranes are usually passed 5-15 minutes after birth of a pup before another puppy can be delivered from the same horn.

Thick greenish discharge (lochia) is seen in all stages of labor and may persist for up to three weeks.

Complete uterine involution and endometrial recovery occurs in approximately 3 months.

Question 40

Having just repaired a femoral fracture on an 8 year old male Labrador with mild chronic renal insufficiency, your technician asks you for post operative orders. Which of these drugs is contraindicated for analgesia in your patient?

• Carprofen
• Butorphanol
• Ketamine
• Gabapentin
• Tramadol
• Dexmedetomidine

Answer 40

Answer: Carprofen

Explanation
Carprofen is a non-steroidal anti-inflammatory and has analgesic properties but may exacerbate the chronic renal disease by causing decreased blood perfusion to the kidneys by vasoconstricting the afferent arteries by diminishing the effects of prostaglandins. Dexmedetomidine and ketamine can each be used as a constant rate infusion to provide pain control. Butorphanol is an opioid that has partial agonist and antagonist effects on the mu and kappa receptors. Tramadol is a synthetic opioid. Remember Tramadol is now a controlled substance.

Gabapentin is an anticonvulsant that is often used for its analgesic effects, particularly against neuropathic pain.

Question 41

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

• Enterobius vermicularis, Fenbendazole
• Tritrichomonas foetus, Ronidazole
• Cryptosporidium, Clindamycin
• Paragonimus kellicotti, Praziquantel
• Giardia intestinalis, Fenbendazole
• Taenia taeniaformis, Praziquantel

Answer 41

Answer: Tritrichomonas foetus, Ronidazole

Explanation
Tritrichomonas foetus is a flagellated parasite most commonly found in kittens that have had an unresponsive diarrhea. The parasite can be very difficult to diagnose. It is most often responsive to Ronidazole.

Paragonimus is a lung fluke. The eggs are typically passed in the feces. Fenbendazole and Praziquantel have been effective against this parasite.

Giardia is unlikely if the ELISA is negative as it is a very sensitive test.

Taenia is a tapeworm and is not a flagellated parasite. It is treated with Praziquantel.

Cryptosporidium is a coccidian that invades the small intestinal villi after ingestion of infected oocysts. It can be diagnosed with PCR. It is treated with clindamycin, azithromycin, or tylosin most commonly. It is usually an opportunist, so evaluation for underlying disease is appropriate.

Enterobius vermicularis, or pinworm, is a parasite of people and primates but not cats and dogs.

Question 42

A local farmer calls you because they are having reproductive problems in their 600 head sow farm. For the past month they have been having trouble with sows not becoming pregnant. The heat cycles in about 20% of the sows have been quite unusual. These sows seem to be in heat for 5-6 days. They have been breeding them once a day as long as they are in heat. Their semen costs are getting out of hand and their 30 day pregnancy check for the past 2 weeks has only been 60%. Gilts appear to be affected more severely. Some gilts even seem to be in heat all the time. The farmer knows they had been busy emptying the manure pit and spreading manure on nearby fields most of last week which has changed their usual time for heat checking sows. This week they went back to their normal breeding schedule but are still having problems. What would you recommend they do next?

• Collect nasal swabs from 10 affected sows for influenza virus testing
• Collect blood samples for 20 sows (10 affected and 10 non-affected) for parvovirus testing
• Collect gestation and lactation feed samples for mycotoxin testing
• Collect a water sample for nitrogen testing
• Collect a urine sample for leptospirosis testing

Answer 42

Answer: Collect gestation and lactation feed samples for mycotoxin testing

Explanation
The correct answer is to collect gestation and lactation feed samples for mycotoxin testing; specifically zearalenone testing. The indications of a prolonged heat cycle suggest high estrogens. This is a case of cystic ovarian disease. High levels of zearalenone mycotoxins in the feed are the most common cause of cystic ovaries in swine. Although, parvovirus causes reproductive problems, it usually causes a high incidence of mummies. Leptospirosis manifests as late term abortions. Influenza virus infections cause an acute respiratory outbreak with high fevers and abortions. Clinical signs associated with nitrate poisoning include high respiration rate, increased incidence of diarrhea, reduced feed intake, poor growth, and increased abortions.

Question 43

When considering a dog that is hypoventilating you realize that the dog is in

• Metabolic alkalosis
• Metabolic acidosis
• Respiratory acidosis
• Respiratory alkalosis

Answer 43

Answer: Respiratory acidosis

Explanation
The correct answer is respiratory acidosis. There is bound to be some sort of acid-base question on the exam. This question might look tricky, but it is truly simple. Think about the information you are given; all you know is the dog is hypoventilating.

So there is build up of CO2; in effect the dog is in respiratory acidosis. Remember, CO2=Acid. Since you have no other information, there is no way to diagnose a metabolic acidosis or alkalosis.

Some causes of respiratory acidosis include airway obstruction, open pneumothorax or flail chest, neuromuscular disease, abdominal enlargement, pleural space disease, and bicarbonate therapy.

Question 44

Which of these chemotherapeutic drugs causes irreversible tissue sloughing if the drug is perivascularized or given any route other than IV to a dog?

• Cisplatin
• L-Asparaginase
• Doxorubicin
• Mitoxantrone

Answer 44

Answer: Doxorubicin

Explanation
The correct answer is doxorubicin.

Perivascularization of this drug causes a severe irreversible tissue slough that may require amputation.

Some other chemotherapy drugs such as vincristine cause a more localized severe reaction if perivascularized. L-Asparaginase can be safely given subcutaneously or intramuscularly.

Cisplatin can be given intralesionally.

Carboplatin is always given IV but if perivascularized, does not cause a severe reaction.

Question 45

You perform thoracocentesis on a cat with pleural effusion. The fluid has a hazy gold color and a protein content of 7 g/dl and 7,000 cells/uL. These cells are primarily non-degenerative neutrophils with lesser numbers of other white blood cells and mesothelial cells.

What is the most appropriate interpretation of these findings?

• This effusion is strongly suggestive of
  neoplasia
• This effusion is strongly suggestive of FIP
• This is a chylous effusion Your Answer
• This effusion is a classic exudate; the cat has
  pyothorax

Answer 45

Answer: This effusion is strongly suggestive of FIP

Explanation
The correct answer is that this effusion is strongly suggestive of FIP. FIP causes a classic straw or gold colored effusion with high protein content (about equal to serum protein) and moderate cell counts.

An exudate would tend to have somewhat higher cell counts and lower protein. The protein content is not consistent with chyle or neoplasia.

***PowerPage: Feline Infectious Peritonitis and Enteric Coronavirus

Question 46

Which of the following is the most likely cause of lymphoplasmacytic rhinitis as seen in this patient?

• Canine adenovirus-2
• Bartonella
• The specific etiology is still unknown
• Parainfluenza virus-3

Answer 46

Answer: The specific etiology is still unknown

Explanation
As the name implies, these patients have a mixed population of lymphocytes and plasma cells when biopsied. Many consider the condition to be an idiopathic immune-mediated disorder. PCR studies have been performed in affected patients in search of parainfluenza virus-3, canine adenovirus-2, Bartonella, and Chlamydophila.

None of these agents were found to be a potential cause. Typical clinical signs include a history of unilateral or bilateral nasal discharge of several months duration. Large-breed dogs are more often affected and the age may vary.

Question 47

An 11-year old female spayed Siamese cat presents for consultation on a mass found on her ventral abdomen. The cat was previously used for breeding and was just spayed and adopted by her owner 4 years ago. The mass was noticed about a month ago and has grown slightly since it was first found. The mass is firm, painless, and measures 3 cm in diameter. You perform a fine needle aspirate of the mass, which shows a proliferation of abnormal appearing epithelial cells most suggestive of a mammary carcinoma. What is the cat’s prognosis?

• The cat’s long-term prognosis is good only if
  she is treated with chemotherapy after surgery
• The cat’s long-term prognosis is poor because
  surgery is ineffective at treating these tumors
• The cat’s long-term prognosis is poor since most mammary carcinomas in cats will metastasize
• The cat’s long-term prognosis is good because
  the tumor was found early while it is still small
• The cat’s long-term prognosis is good since
  most mammary carcinomas in cats do not metastasize

Answer 47

Answer: The cat’s long-term prognosis is poor since most mammary carcinomas in cats will metastasize

Explanation
Mammary tumors in cats are almost always malignant and the large majority of them will eventually metastasize. This is in contrast to mammary tumors in dogs, in which 50% are malignant, and 50% of those that are malignant will eventually metastasize. Similar to dogs, cats that are spayed after they have had one or more heat cycles have a much greater risk of developing mammary tumors.

If staging shows no visible evidence of metastasis, treatment is generally aimed at surgical removal of the tumor followed by chemotherapy to try and slow the development of metastasis. Generally, the type of surgery that is recommended is a unilateral mastectomy to remove all of the glands on the affected side to reduce the risk of recurrence in those glands. The tumor is also greater than 2 cm in size, which is associated with a worse prognosis in cats.

Question 48

Mucosal disease, or alternatively, chronic Bovine Virus Diarrhea (BVD) occurs in cattle when:

• A 5-month old calf is persistently infected with a strain of BVD virus which coats platelets; platelets are then removed by the RE system resulting in a bleeding diathesis.
• BVD type 2 infects a 5-month old calf.
  A 5-month old calf is infected with CPE
  biotype of BVD virus and then superinfected with a nonCPE biotype of BVD virus.
• A 5-month old calf which was persistently infected as a fetus with a non cytopathic (nonCPE) biotype of BVD virus is superinfected with a cytopathic (CPE) biotype of BVD due to rearranging of the parent non-CPE viral RNA.
• A 5-month old calf which was persistently infected with the nonCPE biotype of BVD virus as a fetus forms antigen-antibody complexes which cause a fatal immune-mediated disorder.

Answer 48

Answer: A 5-month old calf which was persistently infected as a fetus with a non cytopathic (nonCPE) biotype of BVD virus is superinfected with a cytopathic (CPE) biotype of BVD due to rearranging of the parent non-CPE viral RNA.

Explanation
This is the correct answer because it describes the current understanding of the pathogenesis of both mucosal disease and chronic BVD.
A 5-month old calf is infected with CPE biotype of BVD virus and then superinfected with a nonCPE biotype of BVD virus is incorrect because it does not say that there was persistent fetal infection; also, the order of the superinfection is the reverse of what causes mucosal disease or chronic BVD.

A 5-month old calf which was persistently infected with the nonCPE biotype of BVD virus as a fetus forms antigen-antibody complexes which cause a fatal immune-mediated disorder is incorrect because this is not the mechanism by which mucosal disease or chronic BVD occur.
All other answer choices are incorrect because they each describe one of the acute clinical syndromes from primary infection, rather than either mucosal disease or chronic BVD.

***PowerPage: Bovine Viral Diarrhea

Question 49

A 1-year-old macaw is presented to you for necropsy after recent arrival at a pet shop subsequent to quarantine. It had acutely become anorexic and depressed with ruffled plumage. At necropsy, you find necrotic foci in the liver (see image) and kidneys as well as splenomegaly. Histopathology shows Cowdry type-A intranuclear inclusion bodies in the liver and renal parenchyma. Which of these is a likely diagnosis?

• Infectious coryza
• Newcastle disease
• Avipoxvirus infection
• Pacheco’s disease
• Marek’s disease

Answer 49

Answer:: Pacheco’s disease

Explanation
The correct answer is Pacheco’s disease, caused by a herpes virus. The incubation for this disease can be longer than most quarantine periods. The clinical findings and necropsy results are consistent with this infection, and the finding of the inclusion bodies confirms the diagnosis.

Marek’s disease is also caused by a herpesvirus, and is characterized by lethargy and unilateral leg paresis.

Avipoxvirus infection causes scabbing skin lesions or diptheric lesions in the respiratory tract.

Infectious coryza is a bacterial disease that causes nasal discharge and facial swelling.

Newcastle virus causes signs that can range from respiratory, Gl, or neurologic signs.

***PowerPage: Psittacine Viral Diseases

Question 50

A dwarf rabbit presents for a right sided head tilt and history of circling to the right. Which of the following is a likely diagnosis?

• Encephalitozoon cuniculi
• Treponema cuniculi
• Myxomavirus
• Bordetella bronchiseptica

Answer 50

Answer: Encephalitozoon cuniculi

Explanation
The correct answer is Encephalitozoon cuniculi.
There is a high prevalence of E. cuniculi although it only infrequently causes disease. Head tilt and torticollis are the common clinical signs.

Treponema cuniculi is the causative agent for rabbit syphilis. Bordetella bronchiseptica is part of the normal flora of the rabbit respiratory tract and does not generally cause clinical signs.
Myxomavirus can be a common cause of pneumonia.

Question 51

Which of the following tests has the highest specificity for 200 cats, 100 with the disease and 100 without?

• 85 true positive, 85 true negative, 15 false negative, 15 false positive
• 95 true positive, 65 true negative, 5 false negative, 35 false positive
• 75 true positive, 95 true negative, 25 false negative, 5 false positive
• 50 true positive, 80 true negative, 50 false negative, 20 false positive

Answer 51

Answer: ** 75 true positive, 95 true negative, 25 false negative, 5 false positive**

Explanation
The correct answer is 75 true positive, 95 true negative, 25 false negative, 5 false positive. Specificity is determined by the percentage of true negatives versus false positives in cats that do not have the disease of interest.

***PowerLecture: Epidemiology - Sensitivity

Question 52

A 4-month old kitten arrives at your clinic with a 3-day history of anorexia, lethargy, vomiting, and diarrhea. On physical exam the cat is 5% dehydrated and has a temperature of 103.9F (39.9 C). What is your primary differential?

• Feline panleukopenia virus
• Foreign body
• Feline infectious peritonitis
• Feline immunodeficiency virus

Answer 52

Answer: Feline panleukopenia virus

Explanation
The correct answer is feline panleukopenia virus. These clinical signs most closely correlate with panleukopenia.

One must piece together the signalment, history, and clinical findings. Usually a cat with a foreign body will not have diarrhea and a fever. It is unlikely for a 4-month old kitten to have FIV due to maternal antibody protection. It is also unlikely for FIP to present in such a manner. With the wet form of FIP, you may see dyspnea due to pleural effusion and abdominal distention due to ascites. With the dry form of FIP it will depend on the organ that is affected. You may see a hepatopathy, splenomegaly, renal failure, etc.

Question 53

You are asked to examine a pen of very young dairy calves (4 to 8 weeks of age) with the complaints of aural discharges, head tilts (see image), and ataxia. You also find one with facial paralysis and another with unilateral nystagmus as you examine them. The affected ones have fevers of 103 to 105F (39.4 to 40.6 C). What organism is most likely to be causing these signs?

• Histophilus somni
• Mycoplasma bovis
• E. coli
• Mannheimia hemolytica
• Salmonella dublin

Answer 53

Answer: Mycoplasma bovis

Explanation
M. bovis may be spread to young calves via milk. In very young dairy calves it can cause otitis media with aural discharge, head tilt, nystagmus, ataxia, and even facial nerve paralysis.

It also causes respiratory disease and can cause arthritis and tenosynovitis in older calves. Mastitis, abortion and other signs can also be caused by M. bovis.

Question 54

A long time client of your clinic is concerned because four of her cats recently started itching. The owner explains that she recently brought home a new kitten from a shelter and after a few days all of her cats became pruritic. On physical examination you observe hypotrichosis and widespread miliary dermatitis. Some cats have crusted lesions on the tip of their pinnae. All cats have intense scaling over the rump. You perform an acetate tape impression and observe multiple mites on low power. Which mite are you most concerned about?

• Demodex canis
• Sarcoptes
• Pneumonyssoides caninum
• Demodex cati
• Cheyletiella

Answer 54

Answer: Cheyletiella

Explanation
Cheyletiella mites are large mites that affect cats, dogs, rabbits, and humans. This mite is highly contagious which is why all of her cats are itching after introduction of the new kitten (likely the source of infection). The incidence of Cheyletiella has declined in the United States due to the use of topical flea preventatives. The mites live in the stratum corneum and, unlike Sarcoptes, these mites do not burrow. This mite can be found with acetate tape impressions, fecal examination (identify the eggs), or using a flea comb. Lime sulfur dips or flea products can be used for treatment.

Demodex canis and cati live in hair follicles and you would not find these mites on acetate tape. They would require a deep skin scrape. Also, Demodex canis only affects dogs and Demodex cati is not contagious. A good differential for this case would be Demodex gatoi, which is contagious and can be found on acetate tape since it lives in the stratum corneum.

Sarcoptes rarely infects cats. This mite is very difficult to find. Superficial skin scraping would be needed since this mite burrows into the stratum corneum.

Pneumonyassoides caninum is a nasal mite that can result in facial pruritus. Dogs are mainly affected. Diagnosis is by mite identification grossly with rhinoscopy or in nasal flushes.

Question 55

You diagnose a colony of mice with lymphocytic choriomeningitis (LCM). What is your next step?

• Euthanize the colony
• Do nothing; the disease is self-limiting
• Notify the federal authorities
• Treat aggressively with antibiotics

Answer 55

Answer: Euthanize the colony

Explanation
The correct answer is to euthanize the colony. LCM is caused by an RNA arenavirus. The disease is a zoonotic concern, so euthanasia is recommended for animals affected with the disease.

Question 56

The image shows radiographs from a newborn calf which sustained a fracture of the tibia during delivery. You do not have surgery facilities nor equipment. What is the best NONsurgical method for repair?

• Apply full-length fiberglass cast and Thomas splint
• Apply heavy cotton wraps from the foot to the hip, confine calf in sling
• Apply Thomas splint from foot to hip
• Apply fiberglass cast from foot to stifle
• Put calf in small water bath so that he is barely weight-bearing for 24 hours a day for 6 weeks

Answer 56

Answer: Apply full-length fiberglass cast and Thomas splint

Explanation
A calf this age will tolerate a cast and splint well and the bones tend to heal rapidly, usually in 6 to 10 weeks (even this ugly tibial fracture). The cast must be changed every two to three weeks as the calf is growing rapidly at this stage. The cast can reach from the bottom of the foot up to the stifle. The Thomas splint goes from the pelvis to the foot and minimizes stifle movement.

Annotations:
Green Circle. There is moderate soft tissue swelling surrounding the fracture.
Complete, closed, markedly comminuted fracture of the left tibia
Orange line: Fissures line

Radiographs provided by Adrien Hespel, DVM, MS, DACVR and University of Tennessee College of Veterinary Medicine

Question 57

The swinging flashlight test is often used in ophthalmologic exams to check pupilary responses in each eye. A positive Marcus Gunn sign is considered pathognomic for diagnosing a unilateral prechiasmal lesion. Which of the following is observed?

• When light is directed into the normal eye, the pupil in the abnormal eye will stay dilated
• When light is directed into the abnormal eye, the pupil on that side will constrict
• When light is directed into the abnormal eye, the pupil in the normal eye stays dilated I
• When light is directed into the normal eye, the pupil in that eye stays dilated

Explanation
Normally, when light is directed into the eye, the signal is transferred from the retina, through the optic nerve, past the chiasm and down the optic tract. From there, it is directed to both oculomotor nerves to cause pupil constriction bilaterally. When there is a pre-chiasmal lesion, light shining in the abnormal eye will have an interrupted signal that cannot get past the chiasm and both pupils stay dilated. When light is shone into the normal eye, both pupils will constrict due to cross-over fibers that stimulate the oculomotor nerve of the abnormal eye.

Question 58

Swine dysentery is caused by which of the following?

• Isospora suis
• Coronavirus
• Trichuris suis
• Lawsonia intracellularis
• Brachyspira hyodysenteriae

Answer 58

Answer: Brachyspira hyodysenteriae

Explanation
The correct answer is Brachyspira hyodysenteriae (formerly known as Serpulina hyodysenteriae).

Swine dysentery causes mucohemorrhagic diarrhea. Fibrinonecrotic typhlitis and colitis occur, but the small intestine is unaffected. Those affected include 3 week olds to adults that were previously unexposed.

Lawsonia intracellularis causes proliferative enteropathies. Trichuris suis is a whip worm. Corona virus causes porcine epidemic diarrhea and transmissible gastroenteritis.

PowerLecture: Gastrointestinal Diseases

Question 59

A herd of pigs is presented for multiple 1-2 cm round papules, pustules, vesicles, and scabs on their ventral abdomens. Young and growing pigs are most severely affected. What is the most likely diagnosis?

• Erysipelas
• Pseudorabies
• Swine pox
• Greasy pig disease

Answer 59

Answer: Swine pox

Explanation
The correct answer is swine pox. The disease is caused by a poxvirus that causes the skin lesions described in the question. All ages can be affected, but it is more commonly seen in young and growing pigs. The disease is often transmitted by biting insects, particularly lice. The disease usually does not require treatment, unless the lesions become secondarily infected. Broad-spectrum antibiotics may be helpful in this situation. Hog lice and insect vectors should be investigated and eliminated to help control swine pox. Erysipelas causes diamond-shaped skin lesions and necrosis of the ears and tail. Greasy pig disease or exudative epidermitis is caused by Staphylococcus hyicus. It causes dark, greasy, brown skin lesions in the axilla, groin, head, and face.

Pseudorabies affects the CNS, respiratory system, and causes reproductive failure.

***PowerLecture: Dermatology

Question 60

During routine surveillance of a rainbow trout hatchery, the younger fish are noted to be swimming in an erratic pattern. On closer evaluation, the fish seem to be deformed around the head and spine. One of these fish is sacrificed for necropsy, and diffuse necrosis of the cartilage and spores in the cartilage are observed. What is your diagnosis?

• Hole in the Head disease
• Ich (Ichthyophthirius multifiliis)
• Gill rot
• Whirling disease

Answer 60

Answer: Whirling disease

Explanation
The correct answer is whirling disease. The causative agent is Myxobolus (aka Myxosoma) cerebralis which is a myxosporean parasite of salmonid fish. Rainbow trout are most commonly affected and the parasite can cause deformation of the head and spine resulting in the inability to swim properly. Skeletal deformation is not seen in the etiologies of the other potential answers. Ich results from a protozoan parasite that causes white spots on the gills and skin, along with erratic behavior.

Hole in the Head disease is seen in tropical fish, especially cichlids, with pitting-like lesions of the head and lateral line. The etiologic agent of Hole in the Head is still controversial and likely includes multiple factors including poor water quality, improper nutrition, and heximita infection.

Gill rot is a fungal disease caused by Branchiomyces spp. with clinical signs related to respiratory distress due to thrombosis and necrosis of the gills.

Question 61

What species are primarily affected by both internal and external caseous lymphadenitis, a manifestation of Corynebacterium pseudotuberculosis?

• Cows and sheep
• Goats and pigs
• Pigs and horses
• Sheep and goats
• Horses and cows

Answer 61

Answer: Sheep and goats

Explanation
The cutaneous abscesses caused by this organism also affect cattle. Horses experience pectoral abscesses, internal abscesses, and other sites, as well ulcerative lymphangitis (also caused by C. pseudotuberculosis) of the limbs.

***PowerLecture: Caseous Lymphadenitis

Question 62

Demodicosis often coincides with bacterial infections. On a recheck examination of an 8-month old pit bull with demodicosis you find swelling and furunculosis over the lateral thighs that is draining serosanguinous fluid. Cytology of the fluid reveals 4+ cocci, and you diagnose a deep bacterial pyoderma. You culture the lesion and start Clindamycin based on the culture results. The dog returns in four weeks for another recheck examination. No bacteria are found on cytology, and clinically the dog looks excellent. You repeat a skin scrape and find Demodex mites. You inform the owner to continue Ivermectin. What should you do regarding continuation of antibiotics?

• Continue the antibiotics for another 2 weeks.
• Discontinue the antibiotics, since cytology was negative and the clinical signs have resolved
• Perform another culture and if positive keep treating; if negative discontinue antibiotics
• Continue the antibiotics until the demodex has resolved

Answer 62

Answer: Continue the antibiotics for another 2 weeks.

Explanation
Deep pyodermas involve tissues deeper than the epidermis including the dermis and even subcutis. Most often deep infections have resulted from an uncontrolled superficial infection. Deep lesions usually heal on the surface before the deeper infection is resolved; making clinical cure difficult to assess. Therefore, antibiotic treatment should be continued for 7-21 days after the tissues return to normal. In general, deep infections can require 6-8 weeks of antibiotic treatment and even 12 weeks for severe cases. Superficial infections require 3-4 weeks of antibiotic therapy or one week past clinical resolution.

Culture results will often be positive in normal dogs since normal dogs will have bacteria on their skin surface and in hair follicles. It is better to manage based on clinical signs. Cytology can miss deeper infections and it is better to extend antibiotic treatment even if cytology is negative.

It is not necessary to continue the antibiotics until resolution of demodicosis. Keep in mind that many Demodex patients will require several months of treatment. It is better to prevent recurrence of bacterial infections with topical therapy such as benzoyl peroxide shampoos.

Question 63

A middle-aged spayed female ferret presents with progressive bilaterally symmetric alopecia. You are suspicious of adrenal gland disease and run sex steroid hormone blood levels. Which of the following hormones is not usually elevated in ferrets with adrenal disease?

• Androstenedione
• Estradiol
• Cortisol
• 17a-hydroxyprogesterone

Answer 63

Answer: Cortisol

Explanation
Cortisol levels are usually within normal limits. Therefore, many of the tests that are used in small animals to diagnose Cushing’s disease (corticotropin stimulation test, dexamethasone suppression test) are not useful for ferrets.

Adrenocortical hyperplasia/neoplasia should be considered in any ferret that presents with a non-inflammatory alopecia. The prevalence of this disease in the United States is estimated at 70%. Genetic factors, early sterilization, and prolonged photoperiod from indoor housing likely contribute to the high incidence. In ferrets, adrenal gland disease is most often due to hyperplasia followed by adenocarcinoma and then adenomas. Other clinical signs include pruritus, lethargy, sexual aggression, vulvar swelling, dysuria/stranguria, tenesmus, and mammary gland enlargement.

Treatment of choice is adrenelectomy. Other treatment options include leuprolide acetate (long acting gonadotropin releasing hormone agonist) and deslorelin acetate (GnRH analog).

Question 64

A breeding pair of blue and gold macaws (Ara ararauna) are laying eggs that are being taken for artificial incubation. As seen in the image below, several of the eggs have died near hatch (between 21-24 days of incubation). Egg necropsy, combined with microbiology, demonstrates a bacterial infection with Pseudomonas aeruginosa. Which of the following could be performed to try to salvage the remaining eggs in the incubator?

• Decrease incubation temperature
• Inject eggs with nystatin
• Inject eggs with piperacillin
• Increase incubation temperature
• In-ovo vaccination with Pseudomonas bacterin

Answer 64

Answer: Inject eggs with piperacillin

Explanation
A normal, healthy egg should hatch sterile. Occasionally, eggs may be infected by low level bacterial contamination. Infection may occur as a result of ovarian, oviductal or cloacal infection. Contamination is by minute cracks or pin-holes in the shell at the time of handling or egg collection.

All eggs should be candled so that any non-viable eggs may be removed from the incubator prior to possible contamination of healthy eggs. The incubator should be sanitized.

Pseudomonas infection in eggs can be treated by injection of an appropriate antibiotic such as piperacillin. A small hole is drilled, using a sterile 27 gauge needle over the air cell, and the antibiotic is injected into the air cell.

The hole is sealed with white, water-soluble glue (being careful not to cover additional areas of the shell as this would reduce water loss from the egg during incubation). Any chick that hatches should be cultured for bacteria immediately upon breaking open the shell, and antibiotic therapy should be commenced depending on the culture results. Nystatin should be given concurrently at 100,000 U per 400 g of body weight to prevent secondary infections with Candida spp.

Question 65

The image shows radiographs from a newborn calf which sustained a fracture of the tibia during delivery. You do not have surgery facilities nor equipment. What is the best NONsurgical method for repair?

• Apply heavy cotton wraps from the foot to the hip, confine calf in sling
• Put calf in small water bath so that he is barely weight-bearing for 24 hours a day for 6 weeks
• Apply Thomas splint from foot to hip
• Apply full-length fiberglass cast and Thomas splint
• Apply fiberglass cast from foot to stifle

Answer 65

Answer: Apply full-length fiberglass cast and Thomas splint

Explanation
A calf this age will tolerate a cast and splint well and the bones tend to heal rapidly, usually in 6 to 10 weeks (even this ugly tibial fracture). The cast must be changed every two to three weeks as the calf is growing rapidly at this stage. The cast can reach from the bottom of the foot up to the stifle. The Thomas splint goes from the pelvis to the foot and minimizes stifle movement.

Annotations:
Green Circle. There is moderate soft tissue swelling surrounding the fracture.
Complete, closed, markedly comminuted fracture of the left tibia
Orange line: Fissures line

Radiographs provided by Adrien Hespel, DVM, MS, DACVR and University of Tennessee College of Veterinary Medicine

Question 66

You diagnose a dog with a larger left to right ventricular septal defect with advanced sequelae to the abnormality. Which of the following is the most likely radiographic appearance of this dog’s thorax?

• Left atrial and left ventricular enlargement with pulmonary hyperperfusion
• Enlargement of all 4 heart chambers and hyperperfusion of the pulmonary vasculature
• Right ventricular and left atrial enlargement with pulmonary vasculature hypoperfusion
• Right ventricular enlargement with pulmonary hyperperfusion and a normal left heart

Answer 66

Answer: Left atrial and left ventricular enlargement with pulmonary hyperperfusion

Explanation
The correct answer is left atrial and left ventricular enlargement with pulmonary hyperperfusion. In dogs with a VSD, the shunt occurs during systole when both ventricles are contracting so blood is shunted from the left ventricle almost directly into the pulmonary artery. The right ventricle acts as a conduit between the left ventricle and pulmonary artery and is less commonly affected by the shunted blood. The excess blood flow is found in the pulmonary vasculature, left atrium, and left ventricle, thus enlarging these structures.

Question 67

A 5-year old cow presents with skin lesions confined to the nonpigmented areas (see image). The affected skin is dry and raised at the periphery. The skin of the teats appears dry. Which of the following could result in this presentation?

• Ingestion of lupine
• Ingestion of moldy feed containing aflatoxins
• Ingestion of Pteridum aquilinum (bracken fern)
• Ingestion of Quercus spp.

Answer 67

Answer: Ingestion of moldy feed containing aflatoxins

Explanation
This is a case of photosensitization based on the skin lesions confined to the nonpigmented areas. Primary photosensitization can occur when photodynamic agents are absorbed from the G.l. tract such as Hypericum perforatum (St. John’s wort), Fagopyrum esculentum (buckwheat), Ammi majus (bishop’s weed), and Cymopterus watsonii (spring parsley). Secondary (hepatogenous) photosensitization occurs when the liver’s excretion of phylloerythin is impaired due to liver damage. Phylloerythin is derived from the breakdown of chlorophyll by rumen microbes. The best answer in this question is aflatoxins because they are known to cause liver damage.

Bracken fern toxicity causes acute hemorrhagic syndrome in cattle. Lupine toxicity primarily causes birth defects. Quercus (oak) toxicity causes Gl and renal dysfunction.

Question 68

A foal presents for colic caused by the organism shown in the image below (microscopic image from 40X, organism is approximately 100 um). By which of these mechanisms is colic occurring?

• Enterolith formation
• Immune mediated hypersensitivity
• Intestinal impaction
• Larval migration
• Thrombosis of the mesenteric artery

Answer 68

Answer: Intestinal impactation

Explanation
This is an image of a Parascaris equorum egg. It is almost spherical in shape with a brown color and contains a single-celled zygote.

In foals, a significant ascarid burden with Parascaris equorum can lead to intestinal impaction and associated colic. Thrombosis of the mesenteric artery occurs with Strongylus vulgaris infestations. Immune mediated hypersensitivities may occur in adult horses with Parascaris equorum infestations but is unlikely to be a significant cause of the morbidity seen in foals. Larval migration can occur with Parascaris equorum but typically will affect the lungs or liver and this stage of the parasite does not lead to colic. Enteroliths are not caused by gastrointestinal parasitism.

Question 69

A foal presents for colic caused by the organism shown in the image below (microscopic image from 40X, organism is approximately 100 um). By which of these mechanisms is colic occurring?

• Enterolith formation
• Immune mediated hypersensitivity
• Intestinal impaction
• Larval migration
• Thrombosis of the mesenteric artery

Answer 69

Answer: Intestinal impactation

Explanation
This is an image of a Parascaris equorum egg. It is almost spherical in shape with a brown color and contains a single-celled zygote.

In foals, a significant ascarid burden with Parascaris equorum can lead to intestinal impaction and associated colic. Thrombosis of the mesenteric artery occurs with Strongylus vulgaris infestations. Immune mediated hypersensitivities may occur in adult horses with Parascaris equorum infestations but is unlikely to be a significant cause of the morbidity seen in foals. Larval migration can occur with Parascaris equorum but typically will affect the lungs or liver and this stage of the parasite does not lead to colic. Enteroliths are not caused by gastrointestinal parasitism.

Question 70

Which of the following disorders of goats can be controlled by genetic testing?

• Scrapie
• Penile papillomas
• Beta mannosidosis
• Corynebacterium pseudotuberculosis

Answer 70

Answer: Beta mannosidosis

Explanation
Beta mannosidosis is a disorder of Anglo-Nubian goats that causes fatal neurological symptoms in newborns and is an autosomal recessive mode of inheritance.

Scrapie is a prion-caused disorder. In sheep, scrapie can be controlled by genetic testing to eliminate the susceptible animals. To date that is not possible with goats. Corynebacterium pseudotuberculosis is a bacterial disease known as boils. Papillomas are viral.

Question 71

Which of the following foods is considered toxic to parrots?

• Habanero peppers
• Chicken
• Avocado
• Blueberries
• Cheese

Answer 71

Answer: Avocado

Explanation
A toxin, known as persin, is a phytochemical found in the Guatemalan type of avocado which causes myocardial necrosis in the budgerigar, parrot and possibly other pet bird species. Blueberries and peppers (even “hot” peppers) are not toxic to psittacines. Chicken and cheese are high in fats and are not appropriate to feed parrots, but there is no toxicity associated with them.

***PowerPage: Toxicities of Pet Birds

Question 72

A 12-year old male neutered West Highland Terrier presents with diffuse hyperkeratosis of the footpads which are also fissured and ulcerated (see image). He also has a few lesions along the tips of the ears and near the eyes. He is currently taking famotidine, phenobarbital for seizures which have been well controlled, and occasional prednisone due to his severe allergies. Lab work shows the following abnormalities:
HCT 30% (RR 36-50%)
ALT 630 IU/L (RR 3-33 IU/L)
ALP 550 IU/L (RR 10-80 IU/L)
AST 325 IU/L (RR 0-20 IU/L)
Skin scrapes are negative so you perform a skin biopsy to make a definitive diagnosis, as you are concerned that his skin lesions are being caused by which of the following conditions?

• Demodecosis
• Systemic lupus erythematosus
• Hepatocutaneous syndrome
• Zinc deficiency

Answer 72

Answer: Hepatocutaneous syndrome

Explanation
Hepatocutaneous syndrome refers to a necrotizing skin disorder that is often associated with metabolic or vacuolar liver diseases. Diseases that potentially cause this syndrome in the dog include glucagonoma, phenobarbital-induced hepatopathy, mycotoxin hepatopathy, copper-associated hepatitis, glucagon-secreting hepatic tumors, and hepatopathies of unknown origin. Hepatocutaneous syndrome is most often associated with some sort of hepatopathy in the dog. Your clues in this patient were the history of phenobarbital use, elevated liver enzymes, and the skin lesions.

Skin biopsy and histology are required for definitive diagnosis of this condition. Abnormalities include marked, diffuse parakeratotic hyperkeratosis, intercellular and intracellular edema, keratinocyte degeneration, and hyperplastic basal cells. These changes create a characteristic red, white, and blue histologic appearance (see image). Biopsy samples should be taken from multiple sites, with footpad samples included. Ultrasound of the liver often shows a pathognomonic honeycomb appearance.

Question 73

A group of 30 housed 4-6 month-old Friesian heifer calves presents with multifocal several-centimeter skin lesions like the ones seen in the image. The lesions are primarily located around the head and neck but are also seen more sparsely in other areas. The lesions are superficial, dry, scaly and do not appear pruritic. The underlying skin is not thickened. The cows are eating and behaving otherwise normally. Which of the following tests will help confirm your presumptive diagnosis?

• Microscopic examination of a hair/skin scraping from edge of the lesions
• Bacterial culture of the most severe lesions
• Measure serum zinc levels
• Genetic testing
• Measure serum and liver copper levels

Answer 73

Answer: Microscopic examination of a hair/skin scraping from edge of the lesions

Explanation
You should be most suspicious of ringworm based on the lesion appearance and distribution. Microscopic examination from the periphery of the lesions is likely to reveal fungal hyphae of Trichophyton spp.
Dermatophyte culture would also be a good option. Ringworm will typically regress over many months without treatment but untreated lesions may present risk of transmission including zoonotic transmission. Topical treatments including 4% lime sulfur, 0.5% sodium hypochlorite (1:10 household bleach), 0.5% chlorhexidine, 1% povidone-iodine, natamycin, and enilconazole may be options and likely work best if any crusts are removed prior to application.

Question 74

A group of 4-month old outdoor pigs are presented for icterus, failure to thrive, unthriftiness, and dyspnea. Necropsy of one of the pigs shows white spots in the liver, pulmonary edema, and many roundworms in the small intestine, stomach, and bile ducts. What is the most likely diagnosis?

• Fasciola hepatica
• Ascaris suum
• Trichuris suis
• Metastrongylus spp.
• Stephanurus dentatus

Answer 74

Answer: Ascaris suum

Explanation
The correct answer is Ascaris suum. Ascaris suum are found in the small intestine of pigs. If there is a large burden of the worms, they can cause obstruction of the intestine, migrate into the bile ducts and cause icterus.

Migration through the liver causes fibrosis or “white spots.” Pulmonary edema can also be a sequela of the larvae, causing abdominal breathing or “thumps.”

Ascaris suum infections are common in outdoor swine due to high environmental contamination. Trichuris suis is a whipworm found in the cecum and large intestine. Metastrongylus is a lung worm. Stephanurus dentatus is the kidney worm of pigs. Fasciola hepatica is a liver fluke.

**PowerPage: Swine Diarrhea
**PowerLecture: Respiratory Diseases

Question 75

You suspect a canine patient to be hypothyroid. The total T4 levels are equivocal for hypothyroidism. Which test should you perform next?

• Reverse T3
• Free T4 by radioimmunoassay
• Thyroid biopsy
• Free 4 by equilibrium dialysis
• T3

Answer 75

Answer: ** Free 4 by equilibrium dialysis**

Explanation
The correct answer is free T4 by equilibrium dialysis. Free T4 is the thyroid hormone not bound to plasma proteins and can enter cells. Its measurement gives a more consistent assessment of thyroid function than total T4. The equilibrium dialysis method of measuring free T4 is more accurate than radioimmunoassay.
Measurement of T3 in hypothyroid dogs can often be high, low, or normal, and thus difficult to interpret.

***PowerPage: Hypothyroidism

Question 76

What is the age of a beef cow which has only the first and second permanent incisors present?

• Approximately 1.5 years
• Approximately 2.5 years
• Approximately 1 month
• Approximately 6 months

Answer 76

Answer: Approximately 2.5 years

Explanation
The correct answer is approximately 2.5 years of age. A good rule of thumb is that the permanent incisors are in wear at 1.5, 2.5, 3.5 and 4.5 years of age (permanent incisors 1, 2, 3, and 4 respectively).

Question 77

Which of the following will decrease the perceived value of veterinary services by a client?

• Services are provided after extended waiting periods
• Seeking client input by inviting clients to share their opinions about the hospital
• A clean and attractive hospital
  -Providing comprehensive pet healthcare services such as nutrition counseling, behavior consultations, grooming, and training classes
• Use of printed materials such as client education handouts

Answer 77

Answer: Services are provided after extended waiting periods

Explanation
A significant amount of value that is perceived by veterinary clients has nothing to do with the quality of medicine you are practicing.

Clients appreciate practices that provide services in a timely manner that do not keep them waiting for extended periods. They enjoy a clean, attractive hospital that is free of clutter and odors. They perceive value in printed materials from the practice and the ability to receive comprehensive care for their pet from a single location. They also appreciate having the opportunity to offer their opinions.

Question 78

A 6-month old domestic short hair cat presents for its first physical exam. Cardiac auscultation reveals a grade IV/VI holosystolic murmur on the right thorax. Thoracic radiographs were unremarkable and echocardiography showed a small turbulent jet flowing through the ventricular septum from the left ventricle to the right ventricle. Which of the following do you tell the owner?

• The prognosis is guarded to poor in the long run because the cat will likely develop heart failure early in life.
• Surgical correction is required because the defect will become bigger as the cat grows.
• The cat should be started on prophylactic medical therapy for heart failure since surgical correction is not feasible.
• The prognosis is very good with small ventricular septal defects and no treatment is needed.

Answer 78

Answer: The prognosis is very good with small ventricular septal defects and no treatment is needed.

Explanation
The correct answer is the prognosis is very good with small ventricular septal defects and no treatment is needed. The prognosis of small VSDs is very good. Some will close by themselves within the first year of life. It is unlikely that a small VSD will cause any significant problems such as heart failure, though follow-up evaluation is warranted to monitor cardiac size and function. Large VSDs carry a guarded prognosis and require cardiac bypass for surgical correction or novel device closure via transcatheter techniques; neither of which are commonly employed in animals. Small VSDs cause a relatively more turbulent jet of blood through the small defect, causing a louder murmur than a large VSD.

Question 79

A 5-year old gelding is presented for a nodular mass lesion on its lateral neck region. A biopsy of the regions reveals collagen degeneration and granulomatous inflammation with eosinophils. Which of the following is not a reasonable treatment option for this horse?

• Sublesional steroid injections
• Chlorhexidine scrub and warm compressing
• Surgical excision of the mass
• Systemic antibiotics

Answer 79

Answer: Chlorhexidine scrub and warm compressing

Explanation
The correct answer is chlorhexidine scrub and warm compressing. The described lesion is an equine eosinophilic granuloma, also known as nodular necrobiosis of collagen, or collagenolytic granuloma. The lesions are nodular, non-ulcerative, and are not pruritic. The masses are histologically similar to eosinophilic granulomas in cats. The etiology of the lesions is believed to be associated with insect bites, trauma, or multifactorial causes. Treatment may include systemic antibiotics, surgical excision, or sublesional corticosteroid injections.

Question 80

A 10 year-old FS Sheltie is presented to you for stranguria, pollakiuria and hematuria. An in-house urinalysis shows no evidence of infection, but there are some large cells on the slide that look unusual to you. You perform a flash ultrasound and notice a thickening at the trigone of the bladder. What is the most likely diagnosis?

• Severe vaginitis
• Transitional cell carcinoma
• Squamous cell carcinoma
• Urolithiasis
• Urinary tract infection

Answer 80

Answer: Transitional cell carcinoma

Explanation
The most common urinary bladder tumor is transitional cell carcinoma. You can often see abnormal cells on the urinalysis, but use the caution in diagnosing on urinalysis alone, as inflammation can cause a similar appearance with a much more positive prognosis. Biopsy is needed for definitive diagnosis. Chemotherapy can help these patients shrink the tumor for a time (for a better quality of life); however, the overall prognosis is grave.

Question 81

A 1 year-old pit bull presents for a recheck examination of demodicosis. At the last examination you diagnosed demodicosis by skin scrape and placed the dog on Ivermectin. The dog’s clinical signs have improved greatly, and your skin scrape is negative. On physical examination there is mild crusting and hypotrichosis. What is the next step?

• Discontinue Ivermectin today since the skin scrape was negative
• Inform the owner you would like to re-evaluate in one month for another skin scrape; if the skin scrape is negative, we can then discontinue Ivermectin
• Discontinue Ivermectin and switch to topical therapy with benzoyl peroxide since the signs are mild now and benzoyl peroxide has fewer side effects
• Continue Ivermectin, but inform the owner you can discontinue the treatment once clinical signs have fully resolved
• Inform the owner that he can discontinue Ivermectin in two weeks

Answer 81

Answer: Inform the owner you would like to re-evaluate in one month for another skin scrape; if the skin scrape is negative, we can then discontinue Ivermectin

Explanation
The correct answer is re-evaluate in one month for another skin scrape. If the skin scrape is negative you can discontinue Ivermectin use. Resolution of demodicosis and cessation of treatment requires two negative skin scrapes one month apart even if all clinical signs have resolved. Benzoyl peroxide is an antimicrobial and is used as an adjuvant treatment in patients who have Demodex. Benzoyl peroxide has no effect on the mite.

Question 82

Zoonotic diseases commonly carried by raccoons include rabies and_______

• Trichinella
• Baylisascaris
• Toxocara
• Echinococcus

Answer 82

Answer: Baylisascaris

Explanation
The correct answer is Baylisascaris. Baylisascaris procyonis is an ascarid parasite of raccoons that causes mild signs in raccoons but can undergo aberrant migration in humans and cause fatal central nervous system signs.

Question 83

Charlie, a 4-year old female spayed Labrador has a history of getting into the garbage. She presented with a 3-day history of anorexia, vomiting, and lethargy. You perform radiographs and appreciate an empty stomach, significantly distended loops of bowel in the mid to cranial abdomen, and a radiopaque region consistent with a foreign body. The patient is taken to surgery and these are your findings (see below). Clearly this patient will need an intestinal resection and anastomosis. When will you be able to tell Charlie’s owners that you feel confident the resection/anastomosis procedure was successful?

• 5 days after surgery
• As long as there were no complications and you are confident of your repair you can tell them immediately
• At Charlie’s suture removal in 10-14 days
• 7 days after Charlie’s surgery
• After Charlie is eating and defecating

Answer 83

Answer: 5 days after surgery

Explanation
The correct answer is 5 days after surgery. If you remember the principles of healing, 3-5 days corresponds to the end of the lag phase of intestinal healing. After that point, there is typically enough collagen that has been incorporated into the healing intestine such that dehiscence will not occur. The mortality rate for patients that have intestinal dehiscence is 73-80%.

Risk factors that have been associated with an increased chance of dehiscence include traumatic intestinal injuries, intestinal foreign bodies, peritonitis at the time of surgery, and serum albumin less than 2.5 g/dl.

***PowerLecture: Intestinal Obstruction

Question 84

Which of these forms of chocolate contains the highest concentration of theobromine?

• Semi-sweet chocolate
• White chocolate
• Unsweetened baking chocolate
• Milk chocolate

Answer 84

Answer: Unsweetened baking chocolate

Explanation
The correct answer is unsweetened baking chocolate. This contains about 7 times more theobromine than milk chocolate. White chocolate has very little methylxanthines. Semi-sweet chocolate is in between.

Question 85

Dutchess, a five year old female spayed Labrador Retriever, presents to the emergency clinic with a 2 day history of lethargy, inappetance, diarrhea, and vomiting. On physical exam, she is painful on abdominal palpation, 7% dehydrated, and febrile. Abdominal radiographs were performed and showed evidence of ascites and gas distension in the small intestines. Preliminary blood work showed a PCV of 32% (35-57 %), TP 2.2 g/dl (5.4-7.5 mg/dl), glucose 57 mg/dl (76-119 mg/dl), Na 140 mEq/L (142-152 mEq/L), Cl 115 mEq/L (110-124 mEq/L), K 3.9 mEq/L (3.9-5.1 mEq/L). Given the surgical findings (see image below) what is the likely abdominal fluid glucose level?

• Approximately the same as the blood glucose
• At least 10 mg/dl greater than the blood glucose
• At least 10 mg/dl less than the blood glucose
• At least 20 mg/dl greater than the blood glucose
• Atleast 20 mg/dl less than the blood glucose

Answer 85

Answer: ** Atleast 20 mg/dl less than the blood glucose**

Explanation
The correct answer is at least 20 mg/dL less than the blood glucose. The image depicts a perforated colon, which will result in a septic abdomen due to the normal colonic flora emptying into the abdomen. A concentration difference > 20 mg/dL between blood and peritoneal fluid glucose concentration provides a rapid and reliable means to differentiate a septic peritoneal effusion from a nonseptic peritoneal effusion in dogs and cats.

Question 86

An 8-year old mixed breed dog returns to your clinic for further evaluation after the owner noticed a foul odor and discharge coming from a recent wound repair performed by your colleague 4 days ago. The dog apparently tried to jump over a barbed wire fence and caught himself in the inguinal region. You are now dealing with an even larger wound in the inguinal region. Below is an image of the repair you performed. How was this wound treated?

• Genicular flap
• Caudal superficial epigastric flap
• Microvascular free transfer flap
• Deep circumflex iliac flap
• Full thickness skin graft

Answer 86

Answer: Caudal superficial epigastric flap

Explanation
The correct answer is caudal superficial epigastric flap. This is an axial pattern flap and as with all axial pattern flaps, it is named after its primary blood supply. The caudal superficial epigastric flap provides the primary blood supply to the 3rd, 4th, and 5th mammary glands. With familiarity of the dog’s anatomy you can preserve the blood supply and rotate the area of skin to cover a defect as was done with this patient.
A full thickness skin graft is a section of skin that is completely elevated from one region and applied to a defect. A skin graft is a poor choice for this patient since the wound is in a high motion area. Skin grafts do not survive in high motion areas.

A microvascular free transfer flap involves elevating a section of skin and isolating its blood supply and then re-anastomosing its blood supply with vasculature in the area of the defect. These procedures require an operating microscope and are very difficult to perform.

Both the genicular and deep circumflex iliac flaps are axial pattern flaps that are in different regions.

Question 87

You get called to a farm that is having trouble with mid-term abortion in their cows. As you are driving up to the farm you see one of the farm dogs and you notice that the dog appears to be suffering from diffuse muscle atrophy and has trouble ambulating in the hindlimbs. You immediately make an association between the dog and the abortions. What is your primary differential?

• Neospora caninum
• Chlamydophila felis
• Epizootic bovine abortion
• Toxoplasma gondii
• Brucella bovis

Answer 87

Answer: Neospora caninum

Explanation
The correct answer is Neospora caninum, a protozoan parasite. The definitive host is the dog (or coyote or other canidae) which acquires the infection by eating infected meat and spreads it to cows by shedding oocysts in the pasture or feed. Although clinical signs are mainly seen as abortions and abnormal calves in herbivores, dogs may suffer from neurologic and muscular abnormalities. Infection to other dogs is usually as a result of transplacental spread. IFA is usually performed to make the diagnosis.

Question 88

An 8-year-old Warmblood gelding is presented to you for repeated but intermittent clinical signs of exercise intolerance, weakness, muscle fasiculations and a stiff abnormal hind-limb gait. The owners do not ride their horse regularly, but notice these clinical signs most often at the start of a trail ride. Based on the history, signalment and clinical signs, which of the following diseases to you suspect?

• Glycogen Branching Enzyme Deficiency (GBED)
• Polysaccharide Storage Myopathy (PSSM)
• Malignant Hyperthermia
• Hyperkalemic Periodic Paralysis (HYPP)
• Immune-Mediated Myositis

Answer 88

Answer: Polysaccharide Storage Myopathy (PSSM)

Explanation
Based on the breed and clinical signs, PSSM should be a top consideration. A subset of horses have a storage disorder in which there is an accumulation of glycogen and abnormal polysaccharide within the skeletal muscle.

PSSM has been linked to an autosomal dominant mutation of the glycogen synthase gene in Quarter Horses.

However, other breeds, such as Paint, Appaloosas, Warmbloods and draft horses can also be affected.

Horses with PSSM often have elevations in creatine kinase and aspartate aminotransferase; rhabdomyolysis in PSSM likely results from an energy deficiency within the contracting muscles.

Question 89

You are on a service trip in Africa to provide veterinary care to local horses. You examine a 4-year old horse with mucopurulent nasal discharge, lethargy, and depression. On physical exam, the horse has a temperature of 103.4F (39.7 C) and has markedly enlarged mandibular lymph nodes. You are initially suspicious of Strangles but you should also be concerned about which exotic disease that can have a similar presentation?

• Rift Valley Fever
• African Horse Sickness
• Dourine
• Surra
• Glanders

Answer 89

Answer: Glanders

Explanation
The horse’s presentation is also consistent with the nasal form of glanders.

Glanders is a bacterial disease caused by Burkholderia mallei (previously known as Pseudomonas mallei). It is thought to be endemic in regions of the Middle East, Asia, Africa, and South America. In addition to horses, glanders can be seen in donkeys, mules, and small ruminants. Glanders is primarily a concern in horses because they can be chronic or occult carriers that intermittently shed this deadly and potential zoonotic pathogen.

Burkholderia mallei causes 3 different forms of disease; nasal glanders, pulmonary glanders, and cutaneous glanders (also referred to as Farcy).

The nasal form presents with high fever, loss of appetite and labored breathing with cough. Viscous mucopurulent discharge or crusting may be present around the nares. There may be ulceration of the upper respiratory passages that resolve in the form of star-shaped cicatrices (“stellate scars”). Regional lymph nodes may be enlarged and indurated and may rupture or adhere to deeper tissues.

The pulmonary form often develops over several months, beginning as a fever with dyspnea and cough. Lung lesions commence as light colored nodules surrounded by hemorrhage or as diffuse pneumonia. The nodules may become caseous or calcified and discharge contents to the upper respiratory tract. Nodules may also be found in other organs.

The cutaneous form develops over several months, beginning with cough and dyspnea as well. Eventually, nodules develop in subcutaneous tissue along the course of the lymphatics of the legs, costal areas, and ventrum. They can rupture and excrete infectious purulent exudate. Infected lymphatics may form thickened cord-like lesions that sometimes coalesce into a string of beads appearance known as “farcy pipes”. Nodular lesions of other organs may also be found.

Burkholderia mallei can be identified in smears made from fresh lesions as mainly extracellular straight Gram-negative rods with rounded ends. Several diagnostic tests exist including PCR, ELISA, and Western Blot but the two that you actually need to know about because they are used in international trade are complement fixation (CF) serology and the mallein test. The mallein test is considered the most reliable, sensitive, and specific test; it involves injection of mallein purified protein derivative intradermally into the lower eyelid. The test is read at 24 and 48 hours and a positive reaction is characterized by edematous swelling or purulent discharge.

Horses should not be treated; local authorities should be notified if a case is suspect and if disease is confirmed, horses must be humanely destroyed and affected carcasses should be burned and buried.

Dourine is a trypanosomal venereal disease. Surra is a trypanosomal disease causing primarily fever, weakness, and lethargy. Rift Valley Fever is a viral disease primarily of ruminants causing influenza-like signs and hepatic lesions. African Horse Sickness is a viral respiratory disease of horses but signs are primarily pulmonary whereas the horse in this case has nasal signs and mandibular lymph node enlargement.

Question 90

What tumor type is most frequently implicated in causing feminization syndrome in dogs including gynecomastia, sexual attraction of males, and bilaterally symmetric alopecia?

• Mammary carcinoma
• Sertoli cell tumor
• Leydig cell tumor
• Seminoma

Answer 90

Answer: Sertoli cell tumor

Explanation
The correct answer is Sertoli cell tumors. The tumor sometimes secretes estrogen and other hormones, which can lead to this syndrome.

Question 91

Oral surgery in conjunction with another elective surgery in an otherwise healthy dog is usually not recommended for which of the following reasons?

• Combining two surgeries increases anesthetic time, making the one longer procedure riskier than having two shorter, individual anesthetic procedures.
• There is no increased risk in doing both surgeries, as long as the oral procedure is performed after the elective procedure.
• Oral surgeries cause significant bacteremia, which may be an endogenous source of wound infection.
• There is no increased risk in performing both procedures, as long as a different set of sterile gloves and instruments are used for each procedure.

Answer 91

Answer: Oral surgeries cause significant bacteremia, which may be an endogenous source of wound infection.

Explanation
The correct answer is oral surgeries cause significant bacteremia, which may be an endogenous source of wound infection. In an otherwise healthy dog, the increased length of anesthesia in combining two procedures should not significantly increase the risk of anesthesia. The order in which the procedures are performed does not eliminate the risk of infection associated with the bacteremia. Changing gloves and instruments between procedures helps maintain sterility exogenously, but does not eliminate risk of infection associated with the endogenous bacteremia.

Question 92

Daffodil is a 4 year-old male neutered domestic shorthaired cat that first presented to your hospital for straining in the litter box. The cat was brought in by the pet sitter, who is watching Daffodil while the owners are out of town. She has never watched Daffodil before but as far as she knows Daffodil has no history of medical issues. The pet sitter is unsure how long he has been straining or if the cat has been urinating or defecating. The pet sitter also does not know what food the cat is on or if he has been eating. Daffodil is not on any medications.
On physical exam you note that Daffodil is lethargic and 10% dehydrated.
T = 102.2 F (39 C)
P= 100 (120-140 beats/min)
R= 40 (20-40 breaths/min)
You palpate a firm, non-expressible bladder and immediately become very concerned.
What chemistry abnormality concerns you most based on this brief history and exam?

• Elevated ALT/ALP
• Hypoalbuminemia
• Azotemia
• Hyperkalemia
• Hyperglycemia

Answer 92

Answer: Hyperkalemia

Explanation
The correct answer is hyperkalemia. This patient is showing a classic presentation of urinary tract obstruction.

You would expect the patient to have post-renal azotemia due to the urethral obstruction; you would also expect elevated blood glucose due to stress.

Elevated liver enzymes may be present if the cat has not been eating. Hepatic lipidosis is an important concern (since the eating history is unknown); however, there is no evidence of that at this time.

Low blood albumin levels should not occur in this case.

With the non-expressible firm bladder and bradycardia, you should be extremely concerned about hyperkalemia, which is life-threatening if left untreated. Hyperkalemia results from the inability to excrete potassium in the urine. Hyperkalemia changes the ability of the cell wall to repolarize, resulting in decreased cell membrane potential. This can result in decreased myocardial excitability and conduction and then severe bradycardia.

Question 93

Which of the following breeds is predisposed to canine familial dermatomyositis?

• Siberian Huskies
• Golden Retrievers
• Collies
• Doberman

Answer 93

Answer: Collies

Explanation
The correct answer is collies. Collies and Shetland Sheepdogs are predisposed to canine familial dermatomyositis. The disease causes atrophy of muscles and erosion, crusting, and alopecia of skin, which is exacerbated by heat and sun exposure. Treatment is often unrewarding and includes high doses of corticosteroids, vitamin E, and omega-3 fatty acids.

Question 94

Which of the following is true about post-operative care in a dog that had a parathyroid adenoma removed?

• Post-operative care is minimal and requires checking serum calcium once a week for one month.
• The patient is less likely to be hypocalcemic post-operatively if the patient’s pre-operative serum calcium is markedly high.
• The patient’s serum calcium should be monitored daily for about a week to check for the development of hypocalcemia.
• Serum calcium post-operatively should be kept below the normal range to stimulate the production of
  PTH from the atrophied chief cells of the normal parathyroid tissue.
• It is most important to monitor serum calcium post-operatively to make sure the patient does not continue to be hypercalcemic.

Answer 94

Answer: The patient’s serum calcium should be monitored daily for about a week to check for the development of hypocalcemia

Explanation
The correct answer is the patient’s serum calcium should be monitored daily for about a week to check for the development of hypocalcemia. Post-operatively, it is important to monitor for hypocalcemia daily for the first seven days regardless of the absence of clinical signs for hypocalcemia. The higher the pre-operative serum calcium concentration, the more likely the patient will become hypocalcemic post-operatively. Post-operative monitoring of serum calcium should be daily for the first seven days, then weekly for 4 weeks. Vitamin D and calcium supplementation should be given accordingly. Serum calcium concentration should be maintained in the low normal range, not below normal, to stimulate production of PTH by the parathyroid cells.

Question 95

Which of these is most likely to relieve dyspnea in a cat with feline bronchial disease (feline asthma)?

• Alpha-2 agonist
• Alpha-2 antagonist
• Alpha-1 agonist
• Beta-2 agonist
• Beta-2 antagonist

Answer 95

Answer: Beta-2 agonist

Explanation
The correct answer is beta-2 agonist. Beta-2 agonists will relax bronchial smooth muscle. The one most commonly used for this purpose is terbutaline.

***PowerPage: Feline Asthma

Question 96

Alew and the dipsicet fests are normal You make a blood smear and see an organism at the margin of the red! You make a blood smear and see an organism at the margin of the red blood
cells. What is your treatment of choice for this animal?

• Oxytetracycline
• Corticosteroids
• Chloramphenicol
• Procaine Penicillin

Answer 96

Answer: Oxytetracycline

Explanation
The correct answer is oxytetracycline. The cow has Anaplasmosis, a rickettsial organism that is transmitted by ticks. Infected calves have a low mortality rate, but adult cattle have a 20-50% mortality rate with this disease.

Question 97

Nine out of 100 adult cattle are found weak, depressed, and staring into space. On physical exam, they are found to be pale, icteric, and febrile. None of them have hemoglobinuria. The nine cattle all arrived at the ranch approximately one month ago. What is your most likely diagnosis?

• Bacillary hemoglobinuria
• Anthrax
• Anaplasmosis
• Leptospirosis

Answer 97

Answer: Anaplasmosis

Explanation
The correct answer is Anaplasmosis. The causative agent is Anaplasma marginale. The clinical signs are fairly straight forward, and you need to pick up on a couple key features. The fact that new adults are sick is one feature because cattle are resistant to clinical Anaplasmosis as calves. Also, it should be remembered that hemoglobinuria with Anaplasmosis is never seen because it is all extravascular hemolysis. Since there is no hemoglobinuria, leptospirosis, bacillary hemoglobinuria, and anthrax can be ruled out. Additionally, icterus with anthrax is not seen.

Question 98

Which of the following is a non-adrenergic vasoconstrictor that can be used in dogs?

• Isoproterenol
• Dobutamine
• Vasopressin
• Epinephrine
• Phenylephrine

Answer 98

Answer: Vasopressin

Explanation
The correct answer is vasopressin. Epinephrine and phenylephrine are adrenergic vasoconstrictors.
Isoproterenol and dobutamine cause vasodilation. Vasopressin (also known as anti-diuretic hormone) is a V-1 receptor, non-adrenergic, vasoconstrictor.

Question 99

A 5-month old female kitten presents with a history of spitting up about 20 minutes after eating. The food comes up in a bolus and appears to be a passive process from what the owner describes. You believe the cat is regurgitating. The owner has been liquefying the diet and elevating her during and after feedings and it seems she does well with this. Based on this history, which of the following congenital malformations would you be most concerned about?

• Persistent right aortic arch
• Mucopolysaccharidosis
• Myotonia congenita
• Peritoneopericardial diaphragmatic hernia
• Diaphragmatic hernia

Answer 99

Answer: Persistent right aortic arch

Explanation
Persistent right aortic arch (PRAA) is reported but pretty rare in cats. It is seen more frequently in dogs, particularly a few predisposed breeds (Irish Setters, German Shepherds, Great Danes). Despite being a relatively uncommon disease, you should have been able to reach the appropriate answer by ruling out the other options because they cause different clinical signs.

This is how PRAA develops: During fetal development, there is a right and left aortic arch. Normally the left aortic arch forms the main artery that extends off the heart and travels to the abdominal region. In cases of PRAA, the right aortic arch develops into the aorta and the esophagus becomes trapped by the ligamentum arteriosum that extends from the pulmonary artery to the aorta. There are several other variants of how the vascular anomaly can occur. Clinical signs commonly are present from a very young age, often near time of weaning. Treatment is surgical and the prognosis with early surgical intervention is good.

Cats born with congenital diaphragmatic hernias often have mild breathing difficulties, especially when the cat is stressed. Sometimes they are incidentally diagnosed years later, although this is less common. In another presentation there may also be mild gastrointestinal upset. In severe cases, there can be respiratory distress, abnormal heart rhythm, muffled heart and lung sounds, and other signs of systemic shock. The abdomen may feel empty when palpated.

Cats born with peritoneopericardial diaphragmatic hernia (PPDH) are usually asymptomatic with discovery being made when diagnostic tests (radiographs, contrast studies, ultrasound) are performed for other reasons.

Occasionally, cats will develop vomiting, diarrhea, and abdominal pain or cardiorespiratory signs.

Cats born with mucopolysaccharidosis (usually Siamese cats) have an enzyme deficiency that results in problems with the joints and/or bones.

Cats born with myotonia congenita (very rare) have muscle stiffness and may be heavily muscled with little body fat.

***PowerLecture: Vascular Ring Anomalies

Question 100

Cats with taurine deficiency develop which of the following?

• Myocarditis
• Hypertrophic cardiomyopathy
• Dilated cardiomyopathy
• Restrictive cardiomyopathy

Answer 100

Answer: Dilated cardiomyopathy

Explanation
The correct answer is dilated cardiomyopathy.

Taurine is an essential amino acid for cats because they cannot synthesize it. Taurine deficiency causes dilated cardiomyopathy (DCM). Since DCM is relatively uncommon otherwise in cats, taurine deficiency should be suspected in any cat with DCM.

Question 101

You are looking at Diff-quick stained slides of joint fluid from a 7-year old Labrador with shifting-leg lameness and fever. You see a moderate to large number of nondegenerate neutrophils, accounting for 95% of the cell population, and scattered small mononuclear cells (accounting for 5% of the cell population). How would you describe this joint fluid?

• This is a normal cell population for joint fluid
• Suggestive of osteoarthritis
• Suppurative, nonseptic inflammation
• Pyogranulomatous inflammation
• Granulomatous inflammation
• Suggestive of neoplasia

Answer 101

Answer: Suppurative, nonseptic inflammation

Explanation
The marked predominance of nondegenerate neutrophils without apparent intracellular organisms makes this suppurative, nonseptic inflammation. Primary differentials include immune-mediated polyarthritis and polyarthritis due to rickettsial disease.

A small mononuclear cell population is normally present in joint fluid, but neutrophils are not.

“Granulomatous” describes a predominantly mononuclear cell population (lymphocytes, macrophages, plasma cells), and “pyogranulomatous” describes a mixed population of neutrophils and mononuclear cells. Osteoarthritis may result in a mild increase in mononuclear cells with a few neutrophils, but should not produce markedly inflammatory joint fluid.

Question 102

You are evaluating a 4 year old Thoroughbred for intermittent epistaxis. Upon examination of skull radiographs (see image), what is the most likely diagnosis for the epistaxis?

• Exercise induced pulmonary hemorrhage
• Ethmoid hematoma
• Guttural pouch mycosis
• Nasal adenocarcinoma

Answer 102

Answer: Ethmoid hematoma

Explanation
The most likely cause of the epistaxis based on the radiographs is ethmoid hematoma. These lesions are angiomatous masses that originate from the mucosal lining of the ethmoid conchae or walls of the maxillary or frontal sinus. Guttural pouch mycosis also can result in epistaxis but typically has no radiographic changes.

Although horses can get tumors in the nasal passages, this is relatively rare. Exercise-induced pulmonary hemorrhage also can result in epistaxis, but the blood originates from the lungs. In the radiograph provided, notice the smooth, well-defined soft tissue mass in the sinus region of this horse. No osseous changes or fluid lines are apparent in this radiograph. In this particular case (ethmoid hematoma), the soft tissue mass is actually dorsal to the ethmoid turbinates (ethmoids are normal appearance in this case). Upon surgical removal, a definitive diagnosis of ethmoid hematoma was confirmed.

Question 103

You are called out to a horse farm to look into a recent storm of abortions. You find out that about 4 months ago, many of the foals developed copious nasal discharge. This was not treated, and the foals recovered over several weeks. The abortions that are currently occurring are in mares that are in their last trimester. What is your diagnosis?

• Equine adenovirus
• Equine herpesvirus
• Equine viral arteritis virus
• Equine influenza

Answer 103

Answer: Equine herpesvirus

Explanation
The correct answer is equine herpesvirus. The key to answering this question is in the time frame. The foals developing clinical signs of herpesvirus infection several months prior to an abortion storm is classic for this virus. The mares are typically asymptomatic initially and then abort. It causes abortions in horses 7-11 months pregnant. Equine influenza and adenovirus do not cause abortions although they do cause respiratory signs.

Equine viral arteritis is the second best choice, but it generally causes more mild respiratory signs and abortions during various stages of pregnancy. There also would not be the same lag period from when the foals got sick until when the mares started aborting.

***PowerPage: Abortion in Horses

Question 104

A Paint horse is found to be approximately 7% dehydrated after a several day trail ride. Assuming there are no other ongoing losses and the horse weighs 500kg how many liters of fluid will you need to give this horse over a 24 hour period to correct the deficit and account for maintenance requirements?

• 65L
• 125L
• 35L
• 75L
• 40L

Answer 104

Answer: 65L

Explanation
To determine this answer you must figure out the deficit and calculate the horse’s maintenance needs. The deficit is 35L (deficit x BW). Maintenance needs for a horse is approximately 60ml/kg/day. In this case, 30L.
Adding the deficit and maintenance fluids together yields a total of 65 liters.

Question 105

A 4 year old Beefmaster bull presents with frothy nasal discharge, subcutaneous emphysema, an infrequent loud cough, heart rate of 88, and open-mouthed breathing. Additionally, crackles and wheezes are audible throughout the lung fields. Radiographic findings show an interstitial pattern and no consolidation. You cannot detect any consolidation on physical exam either. Blood work shows no signs of sepsis. About two weeks ago this bull was moved from a poor pasture to a very lush pasture. What is your diagnosis?

• Silo filler’s disease
• Fibrinous pleuropneumonia
• Farmer’s lung
• Bovine respiratory syncytial virus
• Fog fever

Answer 105

Answer: Fog fever

Explanation
The correct answer is fog fever, also called acute bovine pulmonary edema and emphysema. It is one of the atypical interstitial pneumonias. The key to making this diagnosis is the history, but the clinical signs are important too. This bull has atypical pneumonia (diffuse, non-septic lung disease). This can be determined because there are no signs of sepsis, he has an intermittent loud cough as opposed to a soft, painful, cough, and he has widespread crackles and wheezes without consolidation. Given this, fibrinous pleuropneumonia (shipping fever) can be ruled out. BRSV may have similar signs but there is a characteristic “honking” cough which this bull does not have, and usually is only this severe in young animals. Now you can rule out farmer’s lung and silo filler’s disease. This is where the history is especially important. With farmer’s lung, the animal will have allergies, so his signs will be episodic. Usually, the animal will be housed indoors and be exposed to the allergen; going outside will improve his situation. With silo filler’s disease (bronchiolitis obliterans) there is typically a history of the animal being housed close to the silo which often results in inhalation of toxic silo gases. Finally, there is the history of switching from a poor pasture to a lush pasture two weeks ago. This is classic for fog fever. The lush plants are high in tryptophan which is subsequently metabolized in the rumen to 3-methyl indole (toxic to the lungs).

Question 106

A 9 year old male castrated English Setter presents for lethargy, anorexia, and tachypnea. Your physical exam reveals markedly muffled heart sounds. Which of the following is most supportive of a diagnosis of pericardial effusion in this dog?

• Thoracic radiographs where the interface of the heart and lung parenchyma is obscured
• Waterhammer pulses
• Weak pulses and hepatomegaly
• 3rd degree AV block
• Electrical alternans and pulsus paradoxus

Answer 106

Answer: Electrical alternans and pulsus paradoxus

Explanation
The correct answer is electrical alternans and pulsus paradoxus. Electrical alternans is an ECG finding in which the height of QRS complexes alternate due to the physical swinging of the heart as it contracts within the pericardial effusion. Pulsus paradoxus is an exaggerated decrease in arterial pulse quality during inspiration caused by increased right-sided filling at the expense of reduced left ventricular filling because the heart is constrained by the pericardial effusion. Third degree AV block does not occur with pericardial effusion.

Obscuring of the cardiac/pulmonary parenchyma interface is usually due to pulmonary parenchyma changes or pleural effusion. Weak pulses and hepatomegaly are not specific to pericardial effusion, though are often present in dogs with severe pericardial effusion. Waterhammer pulses are palpated with PDAs or severe aortic regurgitation.

Question 107

An 8-year old female spayed domestic short hair cat presents for her yearly physical exam. Your oral exam reveals multifocal lesions of absent dental substance on multiple teeth consistent with feline odontoclastic resorption lesions (FORL). Which of the following statements about FORL is true?

• The lesions are usually incidental findings that are not clinically significant and do not need to be treated
• The lesions are usually non-painful
• FORL is now a rare clinical finding since commercial diets have become more strictly regulated
• The lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions

Answer 107

Answer: The lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions

Explanation
The correct answer is the lesions can be internal and external, so dental radiographs should be taken to further investigate the extent of the lesions. FORL lesions are usually very painful and are more common now than before. Up to 67% of cats presenting for dental care may be affected. The exact etiology of FORL is not known, but studies have shown an association of FORL and diets low in calcium, magnesium, phosphorus, and potassium. Periodontal disease is also often found in association with FORL. Treatment should include addressing associated periodontal disease and possibly extraction of teeth affected by deep lesions.

***PowerLecture: Dentistry

Question 108

You receive a call from a small family farmer who would like to blood test 5 pigs for the upcoming county fair. The county fair is in just 10 days. They bred their 2 sows to 2 high value boars. They purchased the semen from a national boar stud. All pigs have been growing quite well, to the point they were concerned the pigs will be too heavy for the fair. As the second pig is snared and you start to collect your blood sample, it starts shaking uncontrollably. It turns blotchy and goes into respiratory distress. As the pig is released, you try some chest compressions but are not successful. The pig dies. The owner grants permission to necropsy the pig. You perform the necropsy immediately. It is difficult to position the pig for necropsy as it is still stiff. Necropsy reveals pulmonary edema and pale soft musculature often containing hemorrhages. Which of the following should be your recommendation to the owner?

• Treat all remaining pigs with injectable procaine penicillin
• Add 10 mg/lb of chlortetracycline to the feed
• Change genetics for his next matings
• Water supply should be checked for adequate flow
• Check feed for mycotoxins

Answer 108

Answer: Change genetics for his next matings

Explanation
The correct answer is to talk to the owner about changing his genetics for his next mating. The sudden rigor mortis of the pig as well as the soft pale muscle on a pig that just died is very suggestive of porcine stress syndrome (PSS). PSS is a simple recessive genetic myopathy. Pigs with heavy muscling and fast growth (desired characteristics in show pigs) can many times carry this gene. This condition can be eliminated from a herd through the selection of genetics. In this case at least one of the sows must be a carrier that was bred to a carrier boar. Antibiotics, water, and mycotoxins have no effect on the clinical presentation of the condition. This genetic condition often results in death of the pig when triggered by excitement, stress or placed under some anesthetics (especially halothane).

Question 109

You examine a 2 year old horse with the complaint of bilateral nasal discharge and lethargy for about a week. The horse has a temperature of 102F (38.9 C), HR 40, and RR 25. The nasal discharge is non-odorous and contains multiple bacteria and neutrophils. The lateral throat area is swollen and tender on palpation. Lateral radiographs reveal fluid lines in the area of the guttural pouches. You submit some of the liquid pus for culture. What treatment is now most indicated?

• IM tetracycline daily for 2 weeks
• Immediate surgical drainage
• Daily catheterization and lavage of the pouches
• Systemic treatment with antifungal drugs for 4 weeks
• Systemic erythromycin for one month

Answer 109

Answer: Daily catheterization and lavage of the pouches

Explanation
Irrigation should use saline or saline plus an appropriate and non-irritating antimicrobial drug. Systemic antimicrobial drugs are also used, but the hallmark of successful therapy is lavage and drainage. For inspissated pus or refractory cases, surgical drainage may be necessary.

Question 110

A 3-year old male castrated cat presents to your clinic for inappetence and depression of 3 days duration. On physical exam, the cat is febrile with a temperature of 103.6F (39.8 C) and is 8% dehydrated.

Complete blood count shows:
Hematocrit - 36% (30-45 %).
White blood cell count- 25,678/ul (5,500-19,500/ul)
Neutrophils- 21,678/ul (2,500-12,500/ul)
Lymphocytes- 3,300/ul (1,500-7,000/ul)
Monocytes- 200/ul (0-900/ul)
Eosinophils- 500/ul (0-800/ul)
Platelets- 210,000/ul (300,000-800,000/ul)

Serum chemistry shows:
Creatinine- 1.8 mg/dl (0.9-2.2 mg/dl)
Blood urea nitrogen (BUN) - 30 mg/dl (19-34 mg/dl)
Glucose- 70 mg/dl (60-120 mg/dl)
Albumin= 3.2 g/dl (2.8-3.9 g/dl)
Globulin= 2.8 g/dl (2.6-5.1 g/dl)
ALP- 95 IU/L (0-45 IU/L)
ALT- 349 IU/L (25-97 IU/L)
GGT - 12 IU/L (0-6 IU/L)
Total bilirubin- 1.1 mg/dl (0-0.1 mg/dl)

You perform an abdominal ultrasound and find that the liver appears subjectively enlarged. The echogenicity of the liver and spleen are normal. The gall bladder appears mildly enlarged; no choleliths are seen. The pancreas does not appear sonographically enlarged or abnormal. The kidneys and the remainder of the abdomen appear unremarkable. You perform an ultrasound guided liver biopsy. Histopathology indicates fibrosis associated with portal triads, bile duct proliferation, and centrilobular accumulation of bile with casts in canalicular areas. With treatment, what is the cat’s prognosis?

• 90% chance of long term survival although the cat will be predisposed to similar episodes in the future
• 90% chance of surviving greater than 3 months but only a 25% chance of surviving greater than 1 year
• 10% chance of surviving greater than 3 months
• 50% chance of long term survival, 50% chance of dying within 3 months

Answer 110

Answer: 50% chance of long term survival, 50% chance of dying within 3 months

Explanation
The case described is very consistent with acute cholangiohepatitis. This condition is usually seen in younger cats (mean age 3-3.5 years) and is more common in males than females. This is in contrast to chronic cholangiohepatitis which occurs in older cats (mean age 9 years). Acute cholangiohepatitis patients are more likely to be depressed, dehydrated and febrile.

Bloodwork in cholangiohepatitis often shows a neutrophilia with or without a left shift. Mild increases in bilirubin and ALP are common, often with more severe elevations of ALT. The sonographic and biopsy findings are also consistent with the diagnosis of acute cholangiohepatitis and make other differentials such as hepatic lipidosis or lymphocytic portal hepatitis less likely.

Treatment of choice for this disease includes antibiotics with aerobic and anaerobic coverage that are excreted unchanged in the bile. Examples of antibiotics excreted unchanged in the bile include tetracyclines, ampicillin, amoxicillin, erythromycin, chloramphenicol, and metronidazole. Usually erythromycin, tetracycline, and choloramphenicol are not the first choices unless they are indicated based on culture and sensitivity because erythromycin is not effective against gram negative bacteria, tetracycline is hepatotoxic, and chloramphenicol may cause anorexia. Ampicillin or amoxicillin with clavulanic acid are good choices and metronidazole may be used to expand the anaerobic coverage. Ursodeoxycholic acid (Actigall) is useful in all types of inflammatory liver disease because of its anti-inflammatory and anti-fibrotic properties on the liver. It also increases fluidity of biliary secretions.

With treatment, it is thought that the response of acute and chronic cholangiohepatitis cases is similar with about half of animals dying or being euthanized within 90 days and half of them having prolonged survival.

Question 111

Preventing transmission and the effects of flukes such as Fasciola hepatica on cattle in the southern United States where it is wet and warm in spring and summer depends on several factors, such as keeping cattle out of marsh areas where snails exist. What other major intervention would best help control the number of flukes in cattle?

• Optimal preventive treatment 2 to 3 months after major transmission season
• Treating all cattle which show clinical signs of heavy fluke infestation
• Running periodic fecal sedimentation tests for fluke eggs and treating when numbers go up
• Vaccinating against Clostridium hemolyticum (redwater)

Answer 111

Answer: Optimal preventive treatment 2 to 3 months after major transmission season

Explanation
The major transmission season differs by geographic area, being later in the north and also affected by irrigation of pasture in the west. Treating with a flukecide 2 to 3 months after major transmission season is effective at controlling flukes in most herds, but in some herds a second treatment to remove flukes acquired late in the season (such as on irrigated pasture) may be necessary.

Vaccinating against Clostridium hemolyticum is also a good idea but will not control the fluke numbers.

Question 112

A 2-year old female spayed Labrador Retriever presents for a right forelimb lameness and radial valgus in the right antebrachium. Which of the following is a possible therapeutic option for this dog?

• Casting the limb, activity restriction, and non-steroidal anti-inflammatory drugs
• Periosteal stripping of the concave aspect of the bone
• Corrective osteotomy
• Arthrodesis of the elbow

Answer 112

Answer: Corrective osteotomy

Explanation
The correct answer is corrective osteotomy. Corrective osteotomies of the radius and ulna are often performed to relieve pain and the functional abnormalities induced by angular limb deformities.

Question 113

A 2-year old female spayed mixed breed dog presents in acute oliguric renal failure. The dog has a history of drinking ethylene glycol two days ago. What step should be taken next?

• Start treating the dog with 4-Methylpyrazole IV and give a guarded to poor prognosis to the owner.
• Start treating the dog with ethanol IV and give a guarded to poor prognosis to the owner.
• Tell the owner the dog has a guarded to poor prognosis and may need hemodialysis.
• Start treating the dog with activated charcoal orally and tell the owner the dog has a guarded prognosis.

Answer 113

Answer: Tell the owner the dog has a guarded to poor prognosis and may need hemodialysis.

Explanation
The correct answer is tell the owner the dog has a guarded to poor prognosis and may need hemodialysis. 4-MP and ethanol act by preventing alcohol dehydrogenase from converting ethylene glycol to its toxic metabolites.
In animals where oliguric renal failure has already begun, most of the ethylene glycol will already have been metabolized, so there is no benefit to giving ethanol or 4-MP. Activated charcoal should only be given if the ethylene glycol was ingested within 2 hours.

***PowerPage: Toxins in the Garage (ethylene glycol, household cleaners)

Question 114

How do you prevent pregnancy when using boars for heat identification in sows?

• Surgical vasectomy
• Allow the boar to mount the sow without allowing penetration of the penis into the vagina
• Castration
• Remove boar immediately after mounting

Answer 114

Answer: Surgical vasectomy

Explanation
The correct answer is surgical vasectomy. The most reliable way to detect a sow in heat is if she stands for a boar trying to mount her. To prevent pregnancy of the sow, and to prevent injury to the herdsmen, the boar is vasectomized or epididymectomized. Castration would eliminate sex hormones that would motivate the boar to mount the sow.

Question 115

What is the approximate daily water requirement for a rabbit?

• 240 ml/kg
• 15 ml/kg
• 60 ml/kg
• 120 ml/kg
• 30 ml/kg

Answer 115

Answer: 120mL/kg

Explanation
The correct answer is 120 ml/kg day. This is considerably higher than a dog or cat.

Question 116

Which of the following is not typically a cause of chronic renal failure in small animals?

• Amyloidosis
• Leptospirosis
• Polycystic kidney disease
• Familial nephropathy

Answer 116

Answer: Leptospirosis

Explanation
The correct answer is leptospirosis. Leptospirosis typically manifests as acute renal failure.

Question 117

What is the difference between stertor and stridor?

• Stridor is audible without a stethoscope, while stertor requires a stethoscope to hear
• Stridor indicates upper airway obstruction, while stertor indicates lower airway disease
• Stridor is another word for wheeze while, stertor is another word for crackles
• Stertor is a gurgling noise usually generated in the nasal passages, while stridor is a high-pitched sound usually generated near the larynx

Answer 117

Answer: Stertor is a gurgling noise usually generated in the nasal passages, while stridor is a high-pitched sound usually generated near the larynx

Explanation
The correct answer is that stertor is a gurgling noise usually generated in the nasal passages while stridor is a high-pitched sound usually generated near the larynx. This is always a source of confusion for veterinary students. Both noises are audible without the aid of a stethoscope and indicate an extrathoracic problem.

Question 118

A 5-year old male castrated Chihuahua mix presents with a 2 day history of limping in the hind limbs. The owner reports that he is usually very active and now he seems very hesitant to jump on and off of the couch. On physical exam, the patient appears to be slightly weak in the hind, reminiscent of a drunken gait. There are no conscious proprioceptive deficits. The patellar and gastrocnemius reflexes are normal. There is resistance noted when turning the neck to the left and pain elicited on deep neck palpation. Mentation is appropriate and the cranial nerves are intact. The owners have financial concerns and can only attord limited treatment and diagnostics. In light of these constraints, what is the best treatment option?

• Intravenous dexamethasone sodium
  phosphate at 6 hour intervals for 36 hours and strict rest
• Immunosuppressive doses of prednisone with
  strict rest
• Non-steroidal anti-inflammatory therapy and strict rest
• Tramadol and acepromazine with strict rest

Answer 118

Answer: Non-steroidal anti-inflammatory therapy and strict rest

Explanation
The most recent literature shows that 50% of dogs with clinical signs of intervertebral disc disease will improve with medical management alone. Medical management involves restricted activity and anti-inflammatory therapy.

Prednisone, methyl-prednisolone sodium succinate, and non-steroidal anti-inflammatories are commonly used.
Prednisone, if used, should be prescribed at an anti-inflammatory dose and not
immunosuppressive. Dexamethasone sodium phosphate has only been shown to increase the likelihood of side effects and complications such as urinary tract infection and is therefore not recommended.

Question 119

Which of these animals’ erythrocytes are normally nucleated?

• Horse
• Pig
• Chicken
• Cat
• Goat

Answer 119

Answer: Chicken

Explanation
The correct answer is chicken. Non-mammalian vertebrates (birds, reptiles, amphibians, and fish) have nucleated red blood cells (erythrocytes). The other answer choices are all mammals.

Question 120

A new client from North Carolina comes to your practice to bring in her 5 year-old male neutered hound dog, Bart, and her 10 year-old male neutered domestic short hair, Spaz, for examination. Spaz has been doing fine and just needs his yearly preventative care, but Bart has been lethargic with weight loss and intermittent lameness. On physical exam, you note that the dog has a thin body condition score of 3/9, generalized lymphadenopathy and a fever of 104.2 F (40.1 C). The cat seems completely normal and healthy enough for vaccinations. During your attempt to vaccinate Spaz, he gets very agitated and scratches the owner on the arm. She notes that Spaz is kind of a difficult cat and that he has scratched her many times before; after one incident, the owner needed antibiotics for an infection that spread to her armpit from one of the cat’s scratches. She mentions that she probably should have told you that Spaz can be difficult prior to the exam. Given the dog’s (and owner’s) clinical signs and travel history, what disease might you suspect at this time?

• Ehrlichia
• Lyme
• Bartonella
• Babesia
• Toxoplasmosis

Answer 120

Answer: Bartonella

Explanation
Bartonella henselae is the bacterium that causes cat-scratch disease. In cat-scratch disease, the owner is infected with the bacteria from flea feces when the cat bites or scratches the owner. Commonly, the bacteria cause fever, malaise, weight loss and lymphadenopathy. Often, cats show no clinical signs. Dogs can be exposed via tick or flea vector and show signs similar to humans, including possible endocarditis. With the dog and cat being from a southern state, both animals were at risk of exposure from Bartonella species.

Question 121

Turkeys and chickens should not be housed together in order to prevent transmission of_______ to_____

• Lymphoid leukosis, chickens
• Lymphoid leukosis, Turkeys
• Histomonas meleagridis, Chickens
• Histomonas meleagridis. Turkeys

Answer 121

Answer: Histomonas meleagridis. Turkeys

Explanation
The correct answer is Histomonas meleagridis to turkeys. This protozoan parasite, also called blackhead or infectious enterohepatitis, is fatal to turkeys but less pathogenic to chickens. It causes extensive necrosis of the liver and cecum. For this reason, chickens and turkeys should not be housed together and turkeys should not be housed in areas where chickens were previously housed.

Question 122

A male neutered domestic short hair cat presents to you with urinary obstruction. Your treatment room diagnostics show a BUN > 140 mg/dL (19-34 mg/dl) and a K+ of 9.0 mEq/L (3.7-6.1 mEq/L). You immediately give the cat dextrose and fluids and successfully unblock your patient. An hour later, you monitor your patient and find him trembling uncontrollably. What should you check first?

• A blood pressure
• A spot ECG
• A K+ level
• An ionized calcium level

Answer 122

Answer: An ionized calcium level

Explanation
In some cases, during the immediate post-obstructive period, cats will develop hypocalcemic tetany. The mechanism is considered to be secondary to laws of mass action that drive down calcium as a result of existing hyperphosphatemia. Judicious use of calcium gluconate can quickly restore their electrolyte balance and prevent further complications such as hypocalcemic seizures.

Question 123

A 7-year old male castrated Doberman presented for lethargy, anorexia, and a left forelimb lameness. He was started on meloxicam two days ago for neck pain and improved significantly, but he became very lethargic and inappetent last night and had a tarry stool. On physical exam, he had full range of motion in his neck, a hunched stance, conscious proprioceptive deficits in all feet, and his left forelimb was held in an abducted stance. He had a short choppy gait in his thoracic limbs and long lanky gait in his hind limbs. Hematochezia was noted on rectal palpation. Brief ultrasound did not show any evidence of pleural, pericardial, or abdominal effusion. The owners do not wish to pursue any diagnostics. What is your recommended treatment plan for the neurologic disease process you suspect?

• Discontinue meloxicam. Start an oral opioid-based pain medication for 5 days. Then start an anti-inflammatory dose of a steroid.
• Add an opioid pain medication (such as Tramadol) and recommend strict cage rest for 14 days.
• Recommend euthanasia; it is likely a tumor.
• Switch him from meloxicam to prednisone and recommend strict cage rest.

Answer 123

Answer: Discontinue meloxicam. Start an oral opioid-based pain medication for 5 days. Then start an anti-inflammatory dose of a steroid.

Explanation
This dog has the classic two-engine gait characteristic of Wobbler’s syndrome. The hematochezia noted on rectal exam, and the history of a tarry stool (suggesting upper Gl bleeding) is likely due to the meloxicam which should be discontinued immediately. Medical management for Wobbler’s syndrome involves an anti-inflammatory dose of a steroid. A washout period is recommended after stopping meloxicam and before starting prednisone.

Further diagnostics for Wobbler’s syndrome involves imaging (cervical radiographs, myelogram, MRI or CT) and it can be helpful in ruling out neoplasia or traumatic injuries. The left forelimb lameness and abducted stance are likely due to a pinched nerve however further imaging would be needed for confirmation.

Question 124

An Ayrshire cow needs treatment for lead toxicity. Which of the following treatments is contraindicated?

• Sodium EDTA
• Calcium EDTA
• Dimercaprol
• Penicillamine

Answer 124

Answer: Sodium EDTA

Explanation
The correct answer is sodium EDTA. This is because the EDTA may bind up all the calcium and produce a hypocalcemia. Giving Ca EDTA will provide protection from that via the extra calcium.

Question 125

A farmer arrives with a dead 5 week old chicken and many of his chickens have been doing poorly. Clinical signs include watery diarrhea, incoordination, prostration, and vent picking. Necropsy on the dead chick reveals a swollen cloacal bursa that is edematous and yellow with hemorrhage. There is also congestion and hemorrhage of the pectoral, thigh, and leg muscles. What is the most likely diagnosis?

• Avian influenza
• Salmonella
• Marek’s disease
• Infectious bursal disease

Answer 125

Answer: Infectious bursal disease

Explanation
The correct answer is infectious bursal disease, also sometimes called gumboro disease. This disease is caused by a birna virus and is most readily isolated from the bursa of fabricius. It is highly contagious and difficult to eliminate from the environment. Subclinical infections commonly occur in chicks less than 3 weeks of age and are of most economic significance. In clinical infection, the signs and necropsy findings are as described. There is no effective treatment, but a vaccine is available.

Question 126

A 6-year old male neutered domestic short hair cat presents with the tongue lesion shown in the photo (see image). The lesion is unilateral and nodular with ulceration. What is the most accurate description of this lesion?

• Miliary dermatitis
• Collagenolytic granuloma
• Eosinophilic ulcer
• Eosinophilic plaque

Answer 126

Answer: Collagenolytic granuloma

Explanation
The image and description are most consistent with a collagenolytic granuloma. Feline eosinophilic granuloma complex consists of 3 separate clinical sydromes:
1) The collagenolytic granuloma (also known as eosinophilic granuloma or linear granuloma) usually occurs on the nose, chin, oral cavity (as in this case), or caudal thighs. The lesions are typically raised and ulcerative or nodular as seen here.

2) 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.
3) 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.

Question 127

You have submitted tissues from a dead dairy cow near a sheep feedlot that died 7 days after exhibiting clinical signs of corneal opacity, high fever, lymphadenopathy, and CNS signs. The lab reports that the brain has lymphocytic perivasculitis. Which of the following disorders is the most likely diagnosis?

• Histophilus somni infection
• Malignant catarrhal fever (MCF)
• Grain overload (rumen acidosis)
• Polioencephalomalacia
• Bovine virus diarrhea virus (BVDV)

Answer 127

Answer: ** Malignant catarrhal fever (MCF)**

Explanation
Malignant catarrhal fever (MCF) in North America is caused by sheep-associated ovine herpesvirus-2. A very high percentage of sheep and goats in North America are infected with OHV-2 and can transmit the virus to susceptible cattle, bison, deer, and other related species, even if only in close proximity and not in direct contact. The virus causes lymphocytic vasculitis and can be fatal.

BVD does cause fever, but uncommonly results in corneal opacity. The marked lymphadenopathy and lymphocytic vasculitis are not consistent with BVD.

***PowerLecture: Malignant Catarrhal Fever - MCF

Question 128

A 10-week-old, intact male Australian Shepherd puppy presented to your clinic on Friday for his first vet visit following adoption from a reputable breeder the day before. Your colleague performed a physical exam, administered pyrantel pamoate, and gave the puppy his first distemper-parvo combination vaccine. (No fecal sample was available for evaluation.) Monday morning, the puppy presents for having diarrhea with mucus since Friday evening. He is still playful and energetic, with a great appetite. Which of the following diagnostics should be performed first?

• Giardia snap test
• Fecal smear
• Fecal float
• Fecal centrifugation
• Baermann fecal examination

Answer 128

Answer: Fecal centrifugation

Explanation
The best answer to this question is to perform a fecal by centrifugation as the first step. Fecal centrifugation is the current standard and primary means for analysis of intestinal parasitism and should be performed several times on all pups during their first year of life and then every six months in adult dogs according to the Companion Animal Parasite Council (CAPC).

The fecal centrifugation method has a much higher chance of egg retrieval and identification compared to passive fecal floats and fecal smears in saline, although the latter would be an appropriate secondary test to evaluate for motile Giardia trophozoites. However, because a negative fecal smear does not rule out giardiasis, a Giardia snap test is another secondary level test that could then be performed.

A fecal examination via the Baermann technique is one of the least likely diagnostics to be utilized because it is time- and labor-intensive, requires a relatively large amount of fecal material, and is not very sensitive (a negative test does not rule out infection because fecal shedding of larvae is intermittent).

Question 129

A 17-year old Thoroughbred mare presents for chronic lameness. The owner reports that the mare has been off and on lame in the left foreleg for the past year or so. The farrier has been trying to correct a “bulge” on the hoof wall at the toe. Her hoof wall is very poor quality and crumbly. Today, she is 4/5 lame in the left forelimb. She is walking on her sole and the sole is convex. She has hoof tester sensitivity over the toe area. You perform radiographs of the foot which are shown. Which of the following treatments is considered useful for this chronic condition when refractory to conventional medical management?

• Arthrodesis of the joint
• Palmar digital neurectomy
• Surgical exploration and flushing of the joint
• Deep digital flexor tenotomy

Answer 129

Answer: Deep digital flexor tenotomy

Explanation
The case descriptions and radiographs are consistent with chronic laminitis. The dorsal hoof wall is much thicker distally due to P3 rotation. Gas tracks under the dorsal hoof wall are evident and there is a round lucent defect in the cranial medial aspect of the sole. There is P3 osteopenia and remodeling of the distal aspect of P3.

Although the optimal treatment for chronic laminitis remains controversial, the best answer is clearly deep digital flexor tenotomy. Deep digital flexor tenotomy is reported in several studies to be useful in the management of chronic laminitis, particularly when the distal phalanx is rotated or pedal bone penetration is present. Unfortunately, chronic laminitis is sometimes refractory to this therapy as well. Other reported options include dorsal hoof wall resection, curettage of regions of septic osteitis, and many types of corrective shoes.

Again, all of these options may be ineffective.

The options of arthrodesis and surgical exploration of the joint are poor choices as this is not a joint disease.
Palmar digital neurectomy is a procedure used to manage navicular disease and results in desensitization of the heel.

Question 130

One 3-week old calf in a group of young calves being fed milk replacer has been depressed, growing poorly and appears unthrift with a rough hair coat. She recently began kicking at her flank, teeth grinding, and vocalizing with an arched back. She has developed white, putty-like feces and is dehydrated. Which of the following is the most likely underlying cause of the problem?

• Congenital rumen stasis
• Excessive carbohydrate in the milk replacer
• Dysfunction of the esophageal groove
• Atresia coli
• Intussusception of the small intestine

Answer 130

Answer: Dysfunction of the esophageal groove

Explanation
This is a typical description of esophageal groove dysfunction in a calf resulting in rumen acidosis.

To review normal physiology, the esophageal groove (also known as reticular groove) is a specialized part of the ruminant stomach that closes in response to drinking milk, directing it directly to the abomasum. When dysfunctional, milk goes to the rumen where it is fermented by rumen microbes and converted to volatile fatty acids and lactic acid. The resulting rumen acidosis leads to the clinical signs described in this case. For this reason, this phenomenon is sometimes referred to as rumen drinking.

For this reason, this phenomenon is sometimes referred to as rumen drinking.

Question 131

You diagnose a horse with vesicular stomatitis. What should you do next?

• Notify the state and federal authorities
• Vaccinate the horse
• Euthanize the horse immediately
• Start the horse on anti-viral medications

Answer 131

Answer: Notify the state and federal authorities

Explanation
The correct answer is notify the state and federal authorities. Vesicular stomatitis is a disease that must be reported to state and federal authorities. There is no specific treatment for the disease. Secondary infections should be treated symptomatically.

Question 132

Which of the following is the most common cause of pericarditis in cattle as shown in the photograph?

• Traumatic reticuloperitonitis
• Stephanurus edentatus
• Streptococcus
• Clostridium perfringens
• Haemophilus

Answer 132

Answer: Traumatic reticuloperitonitis

Explanation
The correct answer is hardware disease (traumatic reticuloperitonitis). Cattle ingest wires which then perforate the reticulum and migrate into the pericardium and cause an infection. In small ruminants, Clostridium perfringens will cause pericarditis. In swine, pericarditis may be caused by haemophilus, streptococcus, and Stephanurus edentatus.

***PowerLecture: Traumatic Reticuloperitonitis

Question 133

A 6-year-old female spayed Dalmatian, with a history of several recent urinary tract infections, presents for lower urinary signs. You recommend a urine culture and sensitivity, as well as radiographs to rule out stones. Radiographs are within normal limits. You are unable to obtain urine via a blind cystocentesis, so you perform ultrasound-guided cystocentesis. As you collect your sample, you note the presence of several small cystic calculi. You advise the owner that surgical removal of the stones may be required, although you suspect that they can be dissolved medically. In addition to a prescription medication, what diet do you recommend for this patient?

• A diet that is low in protein and alkalinizing
• A diet that is low in phosphate and magnesium
• A diet that is low in protein, calcium, and vitamin D
• A diet that is low in sodium and acidifying

Answer 133

Answer: A diet that is low in protein and alkalinizing

Explanation
Based on the dog’s breed and the fact that the stones are not radiopaque, you feel confident that this dog has urate stones. Urate uroliths may be dissolved and prevented with a diet that is alkalinizing and low in protein, with the addition of allopurinol. Allopurinol decreases uric acid, thus decreasing the likelihood of urate crystals which, over time, turn into stones.

Avoiding high protein, calcium, and vitamin D in the diet aids in the prevention of calcium oxalate stones.
A low phosphate and magnesium diet will help to prevent struvite stone development.

Sodium restriction (in conjunction with 2-MPG supplementation) is used to prevent cystine stones.

Question 134

A young horse presents for further evaluation as a result of having consistent discomfort whenever a bit is used. The veterinarian confidently tells the owners he can fix the problem with a simple removal of the wolf tooth. Which tooth is the veterinarian going to remove?

• First molar
• Canine
• First premolar
• Third molar
• Fourth incisor

Answer 134

Answer: First premolar

Explanation
The first premolar may cause problems with the bit, and is thus often electively removed by veterinarians.

***PowerLecture: Dentistry

Question 135

You are presented with a 6-month old colt with a 5-day history of lethargy, intermittent diarrhea, weight loss, and ventral edema. A quick check of the PCV and TP reveal a PCV of 30% (28-42%) and TP of 3.2 g/dl (6.8-8.2 g/dI). Abdominal ultrasound (see image) demonstrates thickening of the small intestinal wall. What is the most likely diagnosis based on signalment, history and clinical findings?

• Salmonella infection
• Intermittent jejunal intussusception
• Clostridioides difficile enteritis
• Lawsonia intracellularis infection

Answer 135

Answer: Lawsonia intracellularis infection

Explanation
Although not as commonly as in pigs, L. intracellularis can infect horses (and other species). Similar to pigs, the infection usually involves weanling age horses and causes thickening of the small intestine and hypoproteinemia. The low protein is commonly observed as ventral edema clinically. Both Clostridioides and Salmonella can cause diarrhea at any age but are not as commonly associated with ventral edema.
Intussusceptions do occur but also typically result in colic.

***PowerLecture: Foal Diarrhea

Question 136

A 3-month old Holstein female calf has severe unilateral corneal ulceration, opacity and melting, along with mild conjunctivitis and marked neovascularization. The calf also exhibits photophobia, blepharospasm, and lacrimation. What is the most likely cause of this?

• Bluetongue virus
• Histophilus somni (formerly Haemophilus somnus)
• Chlamydophila pecorum
• Infectious bovine keratoconjunctivitis (IBK)
• Colesiota (Rickettsia) conjunctivae

Answer 136

Answer: Infectious bovine keratoconjunctivitis (IBK)

Explanation
The most common bacteria causing this is Moraxella bovis, although other organisms including Neisseria species and Moraxella ovis can also induce similar lesions in cattle. Also, IBR and mycoplasma seem to be risk factors that may increase the risk of developing IBK.

Question 137

What is polychromasia typically a sign of in cats?

• Regeneraive anemia
• Immune-mediated hemolytic anemia
• Disseminated intravascular coagulation
• Oxidative damage

Answer 137

Answer: Regeneraive anemia

Explanation
The correct answer is regenerative anemia. Polychromasia indicates that less mature red blood cells are being released into circulation as is seen in a regenerative response.

Question 138

Which of these conditions is associated with excess dietary calcium and vitamin D in young horses?

• Nutritional secondary hyperparathyroidism
• Osteochondrosis
• Goiter
• Rickets

Answer 138

Answer: Osteochondrosis

Explanation
The correct answer is osteochondrosis. Rickets and nutritional secondary hyperparathyroidism are caused by calcium deficiency or excess phosphorus. Goiter is caused by insufficient or excess iodine.

Question 139

Cricopharyngeal achalasia is a condition in which________

• The pharyngeoesophageal sphincter is flaccid
• The pharyngeoesophageal sphincter fails to relax
• The pharyngeoesophageal sphincter is not present
• The pharyngeoesophageal sphincter is hypertrophied

Answer 139

Answer: The pharyngeoesophageal sphincter fails to relax

Explanation
The correct answer is the pharyngeoesophageal sphincter fails to relax. This is a rare congenital condition which is usually diagnosed in dogs at weaning. Treatment involves a cricopharyngeal myectomy.

Question 140

A 3-year old Charolais calved 10 days ago and now presents to you for reduced appetite, depression, and decreased milk production. As soon as you enter the barn, you can smell a fetid odor. You examine the cow and note a watery, red-brown uterine discharge. Rectal palpation reveals a large fluid-filled uterus with moderate tone. Which of the following most likely predisposed the cow to this condition?

• Exposure to Taylorella equigenitalis
• Dystocia
• Bull infected with Tritrichomonas foetus
• Contaminated milking equipment
• Brucella abortus infection

Answer 140

Answer: Dystocia

Explanation
This case describes the presentation of a cow with metritis. Metritis typically occurs within 2 weeks of calving and is characterized by cows that are off-feed, depressed, and have decreased milk production. They often have fetid reddish-brown discharge and may have failure to pass the placenta.

The risk factors associated with development of metritis in cows include retained fetal membranes, dystocia, stillbirth, and twinning. Lesser risk factors are uterine prolapse, milk fever, dirty calving environments and ketosis.

Taylorella equigenitalis is a cause of venereal disease in horses but not cows. Tritrichomonas foetus typically causes infertility in the first half of gestation. Brucella abortus causes late gestation abortions and may cause placentitis. Contaminated milking equipment may be associated with certain types of mastitis but not metritis.

Question 141

Farmer Bob has stopped at your veterinary clinic to drop off a dead 20 lb pig he found this morning in his nursery. Bob knows the pigs just died while he was doing the daily chores. This is the second pig to die recently and would like you to perform a necropsy. All other pigs appear normal. You perform the necropsy and find the following lesions (see photo). The pig had not been treated with any antibiotics. You swab the heart sac area and set up an in-house culture using a blood agar plate. The following day, Bob calls back and he wants you to visit the farm as he now has 10 dead pigs from the same 550 head nursery. Right before you leave the clinic you check your culture and do not see any growth. You necropsy all deceased pigs and find that 9 out of the 10 pigs have the exact same lesions as the pig from yesterday. The other dead pig had no gross lesions. As you look at the other live pigs you do not find any significant abnormalities. What should you do next?

• Vaccinate the pigs for Actinobacillus pleuropneumoniae (APP)
• Submit samples from 3 of the dead pigs to a diagnostic lab for a complete workup
• Vaccinate the pigs for porcine circovirus type 2 (PCV2)
• Select 3 live pigs for euthanasia so you can collect fresh samples for submission to a diagnostic laboratory for a complete workup
• Inject all pigs with ceftiofur

Answer 141

Answer: ** Inject all pigs with ceftiofur**

Explanation
The correct answer is to inject all pigs with ceftiofur, which is approved for use in treatment and control swine respiratory disease associated with several common pathogens. The photo shows the classical lesions of polyserositis associated with Glaesserella parasuis (Glasser’s disease). Although Streptococcus suis is also known to cause polyserositis in this age pigs it is easily grown on blood agar plates. Glasserella parasuis requires blood agar supplementation with NAD. Your in-house blood agar culture did not show any growth suggesting no live bacteria, or some other organism requiring special growing conditions. Glaesserella parasuis causes a severe vasculitis leading to polyserositis (photo). Most pigs carry G. parasuis in their tonsils with no clinical signs. The bacteria then become systemic and cause acute death. It is unknown what causes the bacteria to go systemic and cause acute death, but stress and concurrent PRRS viral infection are known to be associated with clinical outbreaks. Because the disease is so quick acting (peracute), it is impossible to know which pigs are early in the disease. Therefore, the only option is to go through and systematically inject all pigs with a long acting ceftiofur.

Most, if not all, S. suis and G. parasuis isolates are susceptible to ceftiofur. Immediate response is necessary to minimize future mortalities.

It is important to note, that injecting pigs with any antibiotic will only stop the current outbreak and not eliminate the bacteria from that group of pigs. Although you may want to submit samples from some of the dead pigs to a diagnostic laboratory for official confirmation, this is not the top priority at this time as the pigs require immediate attention (it will take 2 - 3 days to get results back from the diagnostic lab). With no apparent clinical signs, there is no way to identify which pigs to select for euthanasia and submission to a diagnostic lab.

From the clinical history, there are no indications that vaccinations for PCV2 or APP are necessary at this time.

Question 142

Glomerular filtration rate is most reliably assessed by which test?

• BUN
• Serum creatinine
• Urine protein: creatinine ratio
• Urine specific gravity

Answer 142

Answer: Serum creatinine

Explanation
The correct answer is serum creatinine. A rise in serum creatinine is proportional to a fall in GFR. A 4-fold increase in creatinine corresponds to a 4-fold decrease in GFR.

Question 143

What is the permanent dental formula for a dog?

• 2(13/3 C1/1P4/4 2/3)
• 2(13/3 C1/1 P3/4 M1/3)
• 2(13/3 C1/1 P2/4 M3/3)
• 2(13/3 C1/1 P3/2 M1/1)

Answer 143

Answer: 2(13/3 C1/1P4/4 2/3)

Explanation
The correct answer is 2(13/3 C1/1 P4/4 M2/3). Remember the dog has 42 teeth total.

Question 144

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

Answer 144

Answer: Connell pattern

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.

Question 145

What is the usual amount of time required for a horse to heal sufficiently from suspensory ligament desmitis?

• 4-6 months
• 60-90 days
• 14-28 days
• 7-9 months

Answer 145

Answer: 7-9 months

Explanation
The correct answer is 7-9 months. Ligaments heal in a similar fashion as tendons; it is a gradual process involving production, replacement, and reorganization of collagen. About 55% of horses with suspensory ligament desmitis return to their normal use so the prognosis is guarded.

Question 146

A concerned breeder wants to know the most common cause of dystocia in the bitch. What is your answer?

• Malformation
• Uterine inertia
• Narrow birth canal
• Malpresentation
• Fetal oversize

Answer 146

Answer: Uterine inertia

Explanation
The correct answer is uterine inertia. Studies show that this the most common cause of dystocia followed by malpresentations, fetal oversize, narrow canal, and malformations.

Question 147

What is the causative agent of laryngotracheitis in chickens?

• Coronavirus
• Orthomyxovirus
• Herpesvirus
• Paramyxovirus

Answer 147

Answer: Herpes virus

Explanation
The correct answer is herpesvirus. Infectious laryngotracheitis is an acute infection which results in dyspnea, coughing, rales, and bloody tracheal discharge. Mortality is variable but can reach up to 50%. Diagnosis is based on clinical signs but is confirmed by demonstration of intranuclear inclusion bodies in the tracheal epithelium or by isolation of the virus through tissue samples. Treatment is aimed at prevention and supportive care if cost effective. Vaccination is recommended.

***PowerPage: Poultry: Infectious Laryngotracheitis

Question 148

Which of the following toxic plants results in acute death?

• Ragwort
• Moldy sweet clover
• Milkweed
• Bracken fern

Answer 148

Answer: Milkweed

Explanation
The correct answer is milkweed. Milkweed is a cardiac glycoside which can cause acute clinical signs and death.

Bracken fern toxicity causes bone marrow depression in ruminants and can take up to 3 months to show clinical signs. Moldy sweet clover leads to coagulopathy via vitamin K antagonism after consumption over long periods of time. Ragwort is a pyrrolizidine alkaloid which causes liver disease after several months of consumption.

***PowerPage: Poisonous Plants

Question 149

**Most equine uroliths are composed of which of the following substances?*

• Magnesium ammonium phosphate
• Calcium oxalate
• Cysteine
• Calcium carbonate
• Phosphate

Answer 149

Answer: Calcium carbonate

Explanation
The correct answer is calcium carbonate. Equine urine contains high amounts of calcium carbonate. Magnesium ammonium phosphate (aka struvite crystals) is also occasionally noted in horse urine.

Question 150

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

• Progressive Retinal Atrophy (PRA)
• Glaucoma
• Sudden Acquired Retinal Degeneration Syndrome (SARDS)
• Taurine Deficiency

Answer 150

Answer: Progressive Retinal Atrophy (PRA)

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

Question 151

What is the potential metabolic consequence of continuous saliva loss in cattle?

• Metabolic alkalosis
• Hypokalemia
• Hypocalcemia
• Metabolic acidosis

Answer 151

Answer: Metabolic acidosis

Explanation
The correct answer is metabolic acidosis. Ruminant saliva contains a large amount of bicarbonate to help neutralize fatty acids being produced in the rumen.

***PowerLecture: Vagal Indigestion

Question 152

Max, a 6-year-old male neutered Domestic Longhair, is presented for an annual wellness examination and vaccines. He is an indoor-only cat and his owner is not aware of any health concerns. His physical exam is unremarkable, except for his body condition score of 8/9. Upon further discussion, you learn that his owner is currently feeding him one can of food twice daily, in addition to dry food that is offered free choice. You work with Max’s owner to create a nutritional plan to help Max lose weight. In order to ensure that this plan is as beneficial as possible, what instructions do you give to Max’s owner?

• Make sure Max receives extra fiber in his diet
• Make sure Max is eating every day
• Make sure to restrict Max’s water intake
• Make sure Max gets a multivitamin every day

Answer 152

Answer: Make sure Max is eating every day

Explanation
In an obese cat such as Max, hepatic lipidosis can develop quickly in the case of inappetence. Therefore, it is very important for Max’s owner to make sure that he is eating every day.

While additional fiber may ensure the cat feels full, it is not the most important piece of advice here. It is not good advice to restrict water intake.

Dietary supplements are not necessary if Max is eating a well-balanced diet for weight loss.

Question 153

A 5-year old cat presents to you with an acute presentation of marked upper respiratory signs as well as ulcerative and edematous lesions of the skin on the head and limbs. Which of the following viruses can cause this type of syndrome in cats?

• Feline viral rhinotracheitis
• Panleukopenia
• Feline immunodeficiency virus
• Feline leukemia virus
• Calicivirus

Answer 153

Answer: Calicivirus

Explanation
Typically, feline calicivirus is an upper respiratory pathogen that may cause oral ulcerations +/- conjunctival chemosis. However, outbreaks of highly virulent and often lethal feline calicivirus infections have been seen.
This is frequently referred to as “Virulent systemic feline calicivirus (VS-FCV).” These infections are characterized by the signs described above; typically cats develop a severe acute upper respiratory tract disease first, followed by characteristic signs of cutaneous edema and ulcerative lesions on the skin and paws. Edema is located mainly on the head and limbs. Some cats may be jaundiced due to hepatic necrosis and/or pancreatitis.

Thromboembolism and coagulopathy caused by DIC may be observed including petechiae, ecchymoses, epistaxis or hematochezia.

Feline viral rhinotracheitis is a herpesvirus and causes respiratory symptoms but not the more severe signs described here.

Panleukopenia selectively damages rapidly dividing tissues, namely the bone marrow and gastrointestinal tract.

Neither FeLV nor FIV alone can cause the severe respiratory and ulcerative/edematous lesions described in this case.

Question 154

An adult conure presents to you for progressive right sided lameness. On physical exam, you palpate an abdominal mass. What diagnostic test do you recommend?

• Urinalysis
• Abdominal radiograph
• Complete blood count
• Right leg radiographs
• Serum biochemistry

Answer 154

Answer: Abdominal radiograph

Explanation
The correct answer is abdominal radiograph. Based on the description, you should suspect a renal mass (carcinoma) causing progressive compression of the ischiatic nerve. A radiograph would be the best test of these choices to confirm that diagnosis. Radiographs of the right leg would rule out orthopedic disease, but would not show the primary mass. Urinalysis would most likely not show evidence of neoplastic cells.

Question 155

An 8-year-old male neutered Airedale errier presents to your clinic with the chiet complaint of anorexia and lethargy. The owner reports his symptoms started last night. Physical exam reveals a fever of 104.7°F, decreased skin turgor, lymphadenopathy of the popliteal and submandibular lymph nodes, swollen and painful joints, and a mild cough. Three Dermacentor spp. ticks were found attached to the skin around the dog’s ears. A CBC and blood chemistry profile are performed with the results shown below. What is your next step for diagnosis and treatment?

• Empirical treatment with intravenous fluid therapy and doxycycline
• Paired antibody titer for RMS and tetracycline
• Paired antibody titer for RMS and doxycycline
• In-house 4DX SNAP test and tetracycline

Answer 155

Answer: Paired antibody titer for RMS and doxycycline

Explanation
The clinical signs and laboratory results with the presence of Dermacentor ticks make Rocky Mountain Spotted Fever the top differential in this case. There is no in-house laboratory test for RMSF, so that is not a logical next step. A single antibody titer for RMS is not diagnostic of RMS even with clinical disease as this only indicates antibodies to the RMS, not active infection. Treatment with doxycycline is considered the treatment of choice and should be started immediately, even without a definitive diagnosis, because patients can decline rapidly without treatment.

A paired antibody titer with a 4-fold increase plus clinical disease is considered diagnostic for RMSF and treatment with doxycycline should be started immediately making this the best answer for this question.

Question 156

You are examining a 4-year-old racing Thoroughbred gelding for a 1-day history of reluctance to move. The gelding is bright and responsive with the only abnormalities noted on physical examination being tachycardia (56 beats/min), reluctance to move, and pain upon palpation of the muscles of the back and hindquarters (i.e. epaxial, gluteal, semimembranosus). The trainer states that this horse has shown these clinical signs a few times in the past. Based on initial examination, what initial clinicopathologic tests would be helpful in determining the most likely cause of the exam findings?

• Evaluation of blood urea nitrogen (BUN) and creatinine to rule-out renal disease
• Evaluation of aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (GGT) to rule-out liver disease
• Evaluation of sodium, chloride, potassium and calcium to rule-out a significant electrolyte derangement
• Evaluation of creatine kinase (CK) and aspartate aminotransferase (AST) to rule-out myopathy

Answer 156

Answer: Evaluation of creatine kinase (CK) and aspartate aminotransferase (AST) to rule-out myopathy

Explanation
Based on the clinical signs, the most likely cause is recurrent exertional rhabdomyolysis, commonly observed in racing Thoroughbreds. Typical clinical signs include muscle cramping of the major muscle groups; the cramping is painful and consequently causes the tachycardia, tachypnea, and profuse swelling. The muscle pain can be exacerbated upon physical examination by firm palpation of the larger muscle groups. The most sensitive serum enzyme to evaluate myositis is creatine kinase, a muscle specific enzyme with a short half-life. AST is not muscle specific but does become elevated at a slower pace, as compared to CK. Thus CK will rise and fall quickly whereas AST will increase and decrease slower once the myositis has resolved.

Question 157

A 3-year-old spayed female Sphinx cat presents severely pruritic with well-circumscribed skin lesions on the inner thigh and ventral abdomen. The lesions are raised, thickened, and erythematous. The inguinal lymph nodes are bilaterally inflamed as well. You perform an impression smear of the lesions which reveals eosinophils, mast cells, and epithelial cells. Results from a Complete Blood Count are shown below. What is your immediate next step?

• Prescribe twice weekly lime sulfur dips for 1 month
• Treat with 7-day course of prednisolone BID, then taper
• Biopsy the lesions and submit for histopathology
• Bone marrow aspirate
• Perform diagnostics to stage the disease (Chemistry profile, abdominal/thoracic radiographs, abdominal US, etc.)

Answer 157

Answer: Treat with 7-day course of prednisolone BID, then taper

Explanation
Eosinophili plaques, Indolent ulcers, and Eosinophilic granulomas are all components of Eosinophilic Granuloma Complex (EGC) which is a hypersensitivity reaction in cats. The presence of eosinophils in the impression smear and the noted eosinophilia on the CBC lead to one of these components as the diagnosis.

This cat’s presentation as severely pruritic, the location of the lesions, and the presence of eosinophilia makes the eosinophilic plaque the most likely diagnosis. The appropriate initial treatment for this condition is a course of glucocorticoids.

Based solely on the description of the lesions, a mast cell tumor or cutaneous lymphoma are valid options/differentials for this patient, but the bloodwork and impression smear results rule them out. Thus, biopsy, staging, or bone marrow aspirates are not indicated at this time.

Lime sulfur dips would be indicated with a diagnosis of dermatophytosis.

Question 158

Which of the following is true of Trichuris suis?

• It is a roundworm found in pig stomachs causing vomiting
• It is a thread worm in pigs found in the cecum
• It is a whipworm that causes mucohemorrhagic diarrhea in pigs of all ages
• It is a kidney worm in pigs that causes renal failure
• It is a roundworm that is found in the lungs of pigs and causes coughing

Answer 158

Answer: It is a whipworm that causes mucohemorrhagic diarrhea in pigs of all ages

Explanation
The correct answer is it is a whipworm that causes mucohemorrhagic diarrhea in pigs of all ages. Trichuris suis occurs most commonly in pigs less than 6 months of age but can affect any age group. Clinical signs include dehydration, anorexia, mucohemorrhagic diarrhea, and sometimes death. The worms are found in the cecum and colon. Controlling the disease includes treating sows with anthelmintics a week or two before farrowing and moving them to a clean pasture. Raising swine off soil also helps control the disease.

Question 159

You have been called to a large farm that just lost 60 pigs overnight. You decide to perform some necropsies to get a better feel for what is going on. How many pigs should you necropsy?

• Keep necropsying dead pigs until you see a pattern
• Select the 10 worst dead pigs for necropsy
• Necropsy all 60 dead pigs
• Randomly select 30 dead pigs for necropsy
• Dead pigs have no value, go directly to the barn and look at the other pigs

Answer 159

Answer: Keep necropsying dead pigs until you see a pattern

Explanation
The correct answer is to keep necropsying dead pigs until you see a general pattern of what system(s) may be affected. Although untreated, acutely affected, euthanized pigs are the best for diagnostic sampling, since decomposition can distort or make difficult to identify some gross pathology, many times recently dead pigs can still provide enough information to help guide in figuring out what is causing the mortalities.

When dealing with large populations of animals you must be able to differentiate individual pig problems from population problems, therefore you need to necropsy more than one dead pig. It is not efficient to necropsy all pigs or even just select 30 head. Doing only 10 head may or may not provide you with a true picture of what is going on in the whole herd.

Diagnostic sampling (including correct animals to sample) and live pig evaluation will also be important in helping you figure out what may be causing the high mortality on this farm.

Question 160

A 2-year old mare presents for head shaking and rubbing of the ear. A skin scraping of the ear reveals a mite organism. What organism should you be most suspicious of?

• Demodex
• Chorioptes
• Sarcoptes
• Psoroptes

Answer 160

Answer: Psoroptes

Explanation
The correct answer is Psoroptes. Psoroptic mange is a reportable disease. Clinical signs may or may not be present. When they are present, pruritus of the ear is commonly observed. A definitive diagnosis is based on skin scrapings and otoscopic examination.

Question 161

Where in the Gl tract is cobalamin (Vitamin B12) absorbed?

• Colon
• Ileum
• Cecum
• Jejunum
• Duodenum

Answer 161

Answer: Ileum

Explanation
The correct answer is ileum. Disease affecting the ileum will commonly lead to Cobalamin deficiency.

Question 162

Which of the following is a lentivirus?

• Rabies
• Panleukopenia
• Feline leukemia virus
• Feline immunodeficiency virus

Answer 162

Answer: Feline immunodeficiency virus

Explanation
The correct answer is feline immunodeficiency virus. FeLV is a retrovirus in the oncornaviridae subfamily.
Panleukopenia is a parvovirus, and rabies is in the rhabdoviridae family.

Question 163

A rancher has called you to diagnose and treat several nursing beef calves in a group which have suddenly developed blindness and dullness. One is down and unable to rise (see photo). Another is vocalizing ceaselessly, and all the affected calves appear dull and unaware of your presence. The affected animals have normal TPR. You pass a stomach tube and wash out some rumen contents, noting an oil sheen on the water in the bucket where the contents have been caught. You then go into the nearby barn and find an open drum half filled with used motor oil. Based on these findings, which of the following conditions do you need to treat these calves for?

• Rabies
• Lead poisoning
• Listeriosis
• Malignant catarrhal fever (MCF)
• Histophilus somni (TEME)

Answer 163

Answer: Lead poisoning

Explanation
Used motor oil contains tetraethyl lead when leaded gasoline was used. Cattle are sometimes curious and will actually drink used motor oil, resulting in acute lead poisoning. Treatment involves chelation therapy with calcium disodium EDTA. Thiamine has also proven useful, as well as several other adjunct therapies. Removal of the oil from the rumen and Gl tract may also prove beneficial.

***PowerLecture: Central Nervous System

Question 164

A 7-year old cockatoo presents to you for evaluation of the skin. The owner reports the skin lesions seem to have started shortly after an incident when the bird was “mouthed” by the family dog but did not appear to be significantly injured at the time. On your examination, you note the skin lesions shown in the photo. You perform a biopsy and culture of the region which confirms Staphylococcal dermatitis. Which of the following antibiotics is useful against Staphylococcus when administered orally (including in water or food) in birds?

• Oxytetracycline
• Ketoconazole
• Terbinafine
• Amoxicillin
• Metronidazole

Answer 164

Answer: Amoxicillin

Explanation
Amoxicillin is effective against Gram-positive bacteria, especially Staphylococcus. It is absorbed orally and can be administered in water to birds with susceptible bacterial infections.

Metronidazole is useful in birds against anaerobic infections such as Clostridium and some motile protozoa such as Trichomonas, Giardia and Cochlosoma.

Ketoconazole is an antifungal sometimes used for Candida infections. Terbinafine is an antifungal used to treat Aspergillus and dermatophytes.

Gentamicin is toxic to birds.

Oxytetracycline is poorly absorbed orally and is given intramuscularly although it can cause irritation/necrosis at injection sites.

Question 165

According to the FD&C Act under Title 21 of the United States Code, who has been given authority to govern the manufacturing, distribution, and use of veterinary drugs that are distributed between states?

• Congress
• Each individual state has its own authority
• Drug Enforcement Agency
• Environmental Protection Agency

Answer 165

Answer: Drug Enforcement Agency

Explanation
The Drug Enforcement Agency, or DEA, has the sole authority over drugs distributed between states.

Question 166

Which of these is least likely to result in hypothyroidism in a foal?

• Inadequate iodine intake by the foal
• Excessive iodine intake by the mare
• Inadequate iodine intake by the mare
• Pituitary adenoma

Answer 166

Answer: **Pituitary adenoma **

Explanation
The correct answer is pituitary adenoma. Pituitary adenomas are rare causes of hypothyroidism although they can cause Cushing’s disease. However, they usually occur in old horses (average age is about 20 years). In a foal, an iodine deficiency can lead to hypothyroidism because iodine is required in thyroid hormone. lodine excess can also cause hypothyroidism due to damage to the thyroid. This is referred to as the Wolff-Chaikoff effect, although you don’t need to know that name. lodine deficiency or excess can come from the mare or from the foal’s diet. Hypothyroidism in foals can be life-threatening and can cause abnormalities including physeal dysgenesis, incoordination, limb deformities, tendon ruptures, stillbirths, weakness, and death.

Question 167

Which of these is not a clinical sign of bluetongue in sheep?

• Teratogenesis
• Edema of the muzzle and face
• Seizures
• Profuse nasal discharge
• Lameness

Answer 167

Answer: Seizures

Explanation
The answer is seizures. Clinical signs of bluetongue result from generalized vasculitis and generally include fever, edema, nasal discharge, crusting around the nose, hyperemic mucous membranes, oral ulcers, pulmonary edema, lameness (from coronitis and myositis), diarrhea, leukopenia, and teratogenesis.

Cyanosis of the tongue is how the disease got its name.

***PowerLecture: Blue Tongue

Question 168

A 10-month old Arabian presents for persistent superficial and deep digital flexor tendon contracture. What surgical option does this patient have?

• Deep digital flexor tenotomy
• Distal check desmotomy and proximal check desmotomy
• Proximal check desmotomy only
• Distal check desmotomy only

Answer 168

Answer: Distal check desmotomy and proximal check desmotomy

Explanation
The correct answer is distal check desmotomy and proximal check desmotomy. The distal check desmotomy relieves the deep digital flexor contracture while proximal check desmotomy relieves superficial digital flexor contracture. If the contracture is severe, it may recur 2-4 months after surgery. At such time, a suspensory desmotomy is an option but subluxation at the proximal interphalangeal joint is a common consequence.

***PowerPage: Top 9 Equine Lameness

Question 169

A 12-year old female spayed Persian cat is presented to you for a 4 cm mass on the dorsal neck. On exam, the mass is a firm, freely movable, subcutaneous mass that is hairless and appears slightly melanotic. You take thoracic radiographs and bloodwork which are unremarkable. You perform a marginal excision and submit the mass for histopathology which comes back as a basal cell carcinoma that is completely but narrowly excised and has a high mitotic rate of 25 per 10 high-powered fields (400x). What should you recommend for adjunct treatment and follow-up?

• Observation of the site for recurrence
• External beam radiation therapy
• Chemotherapy with doxorubicin
• Wider excision of tissue around the surgical field

Answer 169

Answer: Observation of the site for recurrence

Explanation
Basal cell tumors are common in older cats and most (greater than 90%) display benign behavior, even when histologically malignant with a high mitotic rate.

If the tumor is diagnosed by cytology or histopathology without surgical removal, many veterinarians will recommend monitoring without surgical removal although these masses can ulcerate or get fairly large.