Prelim TQs Flashcards
What are the normal size for adrenal glands on U/S for dogs based on weight (< 10kg, 10-30kg, > 30kg)?
< 10 kg = 0.54cm
10-30kg = 0.68cm
> 30 kg = 0.80cm
Which cells of exocrine pancreas produce glucagon?
A) Alpha cells
B) Beta cells
C) D cells
D) F cells
Answer = A
Alpha = glucagon
Beta = insulin
D cells = somatostatin
F cells = pancreatic polypeptide
In U/S of the thyroid gland, you encounter a hypoechoic nodule within the parenchyma which you suspect may be a normal parathyroid gland. What is the PPV that this is true on histopathology? What is an alternative DDX for this structure?
74% that the nodule is truly a parathyroid gland (74% PPV)
A small percentage of these nodules will actually be LOBULAR THYROID TISSUE/THYROID LOBULES
A dog presents for a cervical U/S. Bloodwork shows elevated ionized calcium. rDVM PTHrP is positive. What finding do you expect to see associated with the parathyroid glands?
A) Bilaterally enlarged parathyroid glands
B) Unilateral enlargement of the parathyroid glands
C) All parathyroid glands will be inconspicuous or absent
D) A mixture of big and small parathyroid glands
Answer = C
With hypercalcemia of malignancy ALL parathyroid glands will be small.
Where does the neurohypophysis originate from?
The floor of the hypothalamus
What are the 7 hormones released by the hypothalamus?
1) Corticotrophin releasing hormone
2) Thyroid releasing hormone
3) Gonad releasing releasing
4) Prolactin releasing hormone
5) Prolactin inhibitory hormone
6) Growth releasing hormone
7) Growth hormone inhibitory hormone
The inner dural/meningeal layer of the hypophysis (pituitary gland) forms what?
Diaphragma sellae
Which lobe is the posterior lobe of the hypophysis?
A) Adenohypophysis
B) Neurohypophysis
B) Neurophypophysis
What 2 hormones are produced by the neurohypophysis?
1) Oxytocin -> uterine and udder smooth muscle contraction
2) Vasopressin/antidiuretic hormone -> vasoconstriction & fluid resorption by kidneys
What structure arises from the roof the mouth (Rathke’s pouch)?
Adenohypophysis
T or F, the adenohypophysis has NO direct vascular connection to the hypothalamus?
FALSE
Adenohypophysis has DIRECT vascular connection to hypothalamus
What signal intensity is the pituitary gland on T1 images?
HYPERintense due to vasopressin granules
Using dynamic CT for assessment of pituitary-dependent Cushing’s, what is the expected attenuation of the gland with a microadenoma?
Microadenoma often ISOattenuating to rest of pituitary parenchyma
Using dynamic contrast enhanced CT for pituitary adenomas, what is the characteristic feature?
A) Microadenomas are either hypo- or hyperattenuating to rest of gland
B) Displacement of pituitary flush
C) Marked early enhancement of the mass
D) None of the above
Answer = B
Some masses have diffusely abnormal enhancement.
Pituitary flush is STRONGER in normal glands. With adenomatous hyperplasia or mass formation, the flush will be displaced, distorted, smaller, or absent
What is the NORMAL brain to pituitary ratio?
A) Less than or equal to 0.31
B) Greater than or equal to 0.31
C) Less than or equal to 0.52
D) Greater than or equal to 0.52
Answer = A
Ratio MAY BE INCREASED if mass present
Which portion of the pituitary gland enhances first following contrast administration?
Neurohypophysis in the CENTER enhances first followed by peripheral adenohypophysis
Describe the pattern and type of enhancement (homogeneous versus heterogeneous) of the NORMAL feline hypophysis?
Homogeneous enhancement
2 patterns: central then peripheral (seen in 4 cats) or dorsal/peripheral then central (seen in 4 cats)
What is the optimal window width and window level for evaluation of the pituitary gland at the brain:pituitary edge and pituitary:bone edge, respectively?
A) WW/WL 80/250 & 240/250
B) WW/WL 240/250 & 80/250
C) WW/WL 250/240 & 250/80
D) WW/WL 250/80 and 250/240
Answer = D
WW 250 WL 240 for bone pituitary edge
WW 250 WL 80 for brain pituitary edge
Overall BEST window is WW 250 WL 80
What is the correct pattern indicative of restricted diffusion on DWI/ADC?
A) DWI hypo/ADC hyper
B) DWI hyper/ADC hypo
C) DWI hyper/ADC normal
D) none of the above
Answer = B
Restricted diffusion on DWi/ADC maps usually indicates what kind of edema and is associated with what disease process?
Cytotoxic edema
Associated with acute ischemic infarcts
Describe the appearance of unrestricted diffusion on DWI/ADC maps, what kind of edema is it associated with, and what disease process does it indicate?
Unrestricted diffusion = DWI hypo, ADC hyper
Associated with VASOGENIC edema & indicates tissue cavitation in chronic infarcts
Describe DWI/ADC “pseudonormalization”….Additionally, What kind of edema and disease process is it associated with?
DWI hyper, ADC NORMAL
Corresponds to concomitant cytotoxic & vasogenic edema in SUBACUTE infarcts
Which of the following cranial nerves is NOT involved in the oropharyngeal phase of deglutition?
A) CrN 5
B) CrN 9
C) CrN 11
D) CrN 12
Answer = C
CrN 5,7,9, 10, & 12 are associated with deglutition
What 2 muscles make up the cranial esophageal sphincter?
Cricopharyngeus & Thyropharygeus
Which cranial nerve is responsible for oral dysphagia?
A) CrN 5
B) CrN 7
C) CrN 10
D) CrN 12
Answer = D, CrN 12 (hypoglossal)
Gastric size is considered normal in a foal when the _________ of the stomach is approximately half the _________
Normal when the height (width?) is approximately half the length
Distension of small bowel loops (in foals) is considered to be present when their diameter is greater than ___________?
SmI diameter is greater than the length of L1 vertebral body
Radiographic feature of undernourishment in a tortoise is __________?
Decreased visceral bulk compared to lung field volume
Clumping of barium contrast during upper GI study can be caused by all of the following except which?
A) Rapid administration of barium
B) Mixing of barium with fat or mucus
C) Too small of a bolus of contrast administered
D) Delated gastric emptying due to fullness of ileum (gastroileal reflex)
Answer = A
What are the sonographic signs associated with gastrointestinal pythiosis in dogs?
- Stomach/duodenum/jejunum/colon can be affected
- Gastrointestinal wall thickening with focal/multifocal loss of wall layering
- Jejunal lymphadenopathy
Which 5 broad disease categories should be considered with the presence of small intestinal corrugation?
1) Enteritis
2) Peritonitis
3) Pancreatitis
4) Neoplasia
5) Bowel wall ischemia
What is the sonographic appearance of a retained surgical sponge on U/S?
HYPOechoic mass with a HYPERechoic center
A dog presents with clinical signs of retching and gulping. Physical examination reveals enlarged salivary glands. Normal body temperature. Bloodwork is normal. What is the primary DDX and treatment recommended?
Sialoadenosis
Tx = phenobarbital
Which of the following is/are NOT a feature seen on U/S of parvovirus enteritis in puppies?
A) Fluid-filled atonic small intestine
B) Hyperechoic mucosal speckling
C) Enlarged jejunal lymph nodes
D) Reduced mucosal wall thickness of the duodenum & jejunum
E) B, C & D
F) C & D
G) All the above
Answer = C ; incorrect because lymph nodes are NORMAL in size
Answers A, B, & D are true
When measuring the proventriculus:keel ratio in Amazon parrots, which of the following affects measurements?
A) Repeat imaging within an 8 hour period
B) Fasting/feeding status
C) Use of anesthesia/sedation
D) Rotation/obliquity from a true lateral projection
Answer = D
No significant effect was identified due to anesthesia, feeding, fasting, or repeated imaging through an 8-h period.
T or F, up at ~80% of enterotomy sites may be visible sonographically at least 6 months following surgery?
Answer = TRUE, 79%
- Enterectomy scar typically appeared as mild focal intestinal WALL THICKENING (91%) with ALTERED (91%) or absent wall layering (9.1%) over a short distance of the bowel.
- INTRAMURAL HYPERECHOIC FOCI (64%), most likely representing fibrosis or non-absorbed suture material of the visible enterectomy sites.
- focal accumulation of INTRALUMINAL GAS (82%) at the enterectomy site.
- Additional ultrasonographic features included the presence of an irregular hyperechoic rim bordering the enterectomy site (50%), and a focal deviation of the intestinal course (45.5%).
What is the CT appearance of necrotizing pancreatitis?
A) Thickening and hyperattenuation of parenchyma, non-enhancing necrotic regions
B) Thickening and hypoattenuation of parenchyma, non-enhancing necrotic regions
C) Thickening and hyperattenuation of parenchyma, contrast-enhancing necrotic regions
D) Thickening and hypoattenuation of parenchyma, contrast-enhancing necrotic regions
Answer = B
What are 5 most frequent non-pancreatic tumors that are associated with HYPOglycemia?
1) Leiomyoma
2) Leiomyosarcoma
3) Hepatoma
4) Hepatocellular carcinoma
5) Tumors with extensive hepatic metastases
What tumor is associated with Zollinger-Ellison syndrome? And what is Zollinger-Ellison syndrome?
Pancreatic gastrinoma
Islet cell tumor that secretes excessive amounts of gastrin -> gastric acid hypersecretion -> erosive gastritis & duodenitis
What is a sonographic finding that is unique to malignant pancreatic tumors?
A) Hypoechoic echogenicity & multiple nodular appearance
B) Hyperechoic nodular appearance
C) Single nodule/mass exceeding 2cm
D) Pancreatic thickening, lymphadenopathy, abdominal effusion
Answer = C
True or false, renal hypoechoic subcapsular thickening has a poor positive predictive value and poor specificity for detection of feline lymphosarcoma?
FALSE.
Good PPV - 81%
Good specificity - 85%
POOR sensitivity 61%, POOR NPV 67%
A dog presents with lameness/difficulty walking and crusting, ulcerated lesions of the paws. What sonographic finding may be observed?
A) Nodular hyperplasia of various organs
B) Hyperechoic liver with honeycomb pattern
C)Hypoechoic nodules of the liver and spleen
D) None of the above
Answer = B
Dog likely has superficial necrolytic dermatitis (crusting and erythematous skin lesions)
Earliest indication of bile duct obstruction is _________ and occurs at ______ hours?
Gallbladder and cystic duct dilation at 24 hours.
CBD enlargement evident in 24-48 hours, while peripheral intrahepatic biliary duct dilation was seen in 5-7 days.
Combination of what 3 things has a 100% PPV and 51% NPV for congenital PSS?
Small liver (microhepatica), large kidneys (renomegaly), and uroliths
All dogs/cats with a PV:AO ratio of ________ had an extrahepatic PSS or idiopathic noncirrhotic portal hypertension?
A) Greater than or equal to 0.8
B) Less than or equal to 0.8
C) Greater than or equal to 0.65
D) Less than or equal to 0.65
Answer = D
Dogs & cats with a PV:Ao ratio ≥ 0.8 or PV:CVC ratio ≥ 0.75 did NOT have an extrahepatic PSS
Common bile duct diameter of ________in seen in 97% of cats with extrahepatic biliary obstruction.
> 5mm
In cats with an extrahepatic biliary obstruction, < 50% have what sonographic finding?
A) Gallbladder distension
B) Cystic/common bile duct dilation
C) A visible sonographic cause of obstruction (e.g. stone)
D) Gallbladder wall thickening
Answer = A
Ultrasound identified all obstructive choleliths (calculus or plugs) in the common bile duct.
However, neither common bile duct diameter nor appearance or any other ultrasonographic feature allowed differentiation between tumor and inflammation as the cause of obstruction.
In cats with sonographic features of extrahepatic biliary obstruction, _____________seems to be associated with obstructive cholelithiasis?
A) Progressively elevated liver enzymes
B) Gallbladder wall thickening and ductal dilation
C) Short duration of C/S (< 10 days)
D) Long duration of C/S ( > 10 days)
Answer = C
What is hepatocutaneous syndrome?
Hepatocutaneous syndrome (Superficial necrolytic dermatitis) belongs to a group of syndromes in which cutaneous signs signal the presence of systemic disease.
It is characterized by parakeratosis, superficial necrolysis, and basilar hyperplasia of the epidermis, in association with an unusual hepatopathy accompanied by certain metabolic derangements.
Sonography of the liver reveals a hyperechoic network surrounding hypoechoic areas of parenchyma, resulting a “Swiss cheese-like” appearance
In a study using CEUS for characterization of canine focal liver lesions, which of the following is FALSE?
A) Sonazoid is a useful agent because it has a parenchymal phase due to its ability to be phagocytized by Kupffer cells
B) In the portal phase there were no characteristic findings between benign and malignant lesions
C) In most dogs, malignant tumors were clearly hypoechoic to the surrounding normal liver during the arterial phase
D) During the arterial phase, malignant nodules had different echogenicity to the surrounding liver during arterial phase (e.g. nodular hyperplasia isoechoic, hepatocellular carcinoma hyperechoic, hemangiosarcoma hypoechoic)
Answer = C
False because malignant tumors are HYPOechoic to normal liver during PARENCHYMAL phase, not arterial phase
In comparison of computed tomographic angiography and intraoperative mesenteric portovenography for extrahepatic portosystemic shunts, diagnostic intra-operative mesenteric portovenography is indicated in what circumstances?
In cases that have undergone diagnostic PRE-operative computed tomographic angiography there is NO indication for diagnostic intra-operative mesenteric portovenography BEFORE ligation.
In contrast, portovenography performed “after” temporary full ligation of the shunt provides clinical useful information and might be considered an integral investigation during shunt attenuation surgery.
Normal ferret vertebral column:
a) C7, T13, L5, S3
b) C7, T14, L5, S3
c) C7, T14, L6, S3
d) C6, T13, L5, S3
Answer = C
C7, T14, L6, S3
Which of the following vertebral column & species is INCORRECT?
A) Dog/Cat: C7, T13, L7, S3
B) Ferret: C7, T14, L6, S3
C) Horse: C7, T18, L6, S5
D) Cow: C7, T13, L6, S3
Answer = D
Cow = C7, T13, L6, S5
Defective osteoclastic resorption of bone is the principle feature of _______?
A) Mucopolysaccharidosis
B) Osteochondrodysplasia
C) Osteoporosis
D) Osteopenia
Answer = C
What are 2 disease processes that may cause diffuse medullary sclerosis?
FeLV
PKU deficiency
Osteogenesis imperfecta is secondary to abnormal ________ production.
abnormal Type 1 collagen production
Which cat breed is predisposed to MPS 6?
Siamese
Which of the following are seen with mucopolysaccharidosis?
A) Epiphyseal dysplasia, late closing & widened physes, disproportionate dwarfism
B) Epiphyseal dysplasia, widened irregular physes, disproportionate dwarfism
C) Normal epiphyses but late closing physes, osteopenia, proportionate dwarfism
D) None of the above
Answer = B
MPS causes osteopenia, epiphyseal dysplasia, wide & irregular physes, disproportionate dwarfism, vertebral fusion, & possible stunting
NO evidence of late closing physes
Scottish Fold osteochondrodysplasia is an autosomal (dominant or recessive) trait?
Autosomal DOMINANT trait
Describe the radiographic changes associated with Scottish Fold osteochondrodysplasia?
- Shortened & irregular size/shape of tarsus, carpus, metatarsus, metacarpus, phalanges, & vertebrae (caudal)
- Narrowed joint spaces
- New bone production around distal limb joints
- Diffuse osteopenia
- Formation of plantar calcaneus exostosis
What are the radiographic features of congenital hypothyroidism and which disease is a differential diagnosis that may appear similarly?
A) Epiphyseal dysplasia & delayed growth plate closure; DDX = pituitary dwarfism
B) Delayed growth plate closure, irregular size/shape of multiple bones; DDX = MPS
C) Diffuse osteopetrosis, proportionate dwarfism; DDX = pituitary dwarfism
D) Multiple stages of various fracture healing; diffuse osteopenia; DDX = osteogenesis imperfect
Answer = A
Congenital hypothyroidism causes disproportionate dwarfism, block-like trunks, broad short skulls, epiphyseal dysplasia & delayed growth plate closure
Which dog breed is predisposed to craniomandibular osteopathy?
West Highland White Terriers
-also Scottish, Cairn, Boston, & other terriers
Skull radiographs of a young Terrier mix presenting for difficulty chewing show bony proliferation of the calvarium, tentorium osmium & petrous temporal bone. What is the radiographic diagnosis?
Craniomandibular osteopathy
-tympanic bullae, mandibles, TMJ joints may also be affected
(Males or females) are overrepresented with panosteitis?
Males
Panosteitis lesions are commonly found near what structure?
Nutrient foramen, may originate there but can expand to fill entire medullary cavity
Which dog breed(s) are predisposed to calvarial hyperostosis?
Bullmastiffs
Weimaraners
T or F, Legg-Calve-Perthes disease (avascular femoral head necrosis) is usually bilateral
FALSE, usually unilateral but can be bilateral in 12-20%
What is the typical signalment of a dog with a bone cyst?
A) Middle age to older, female large breed dog
B) Middle age to older, male small breed dog
C) Young, male large breed dog
D) Young, female small breed dog
Answer = C
Young dogs of larger breeds most affected
GSDs & Dobermans overrepresented
Males predisposed
At which bone location do bone cysts occur in?
Metaphysis or adjacent diaphysis of long bones
-Spares epiphyses & growth plates
- Distal radius & ulna MOST OFTEN affected
A young dog fell off a bed months ago and suffered a tibial fracture. Presenting months later with a painful expansile mass at the site of fracture. Radiographs show an expansile cyst-like bone lesions with triangular laminated periostea proliferation. What is the primary differential?
A) Fracture recurrence
B) Synostosis production
C) Fibrous dysplasia
D) Aneurysmal bone cyst
Answer = D
Can occur in young or geriatric animals
Cause of aneurysmal bone cyst unknown - tumors, developmental abnormalities, trauma-induced hemorrhage causing venous obstruction or arteriovenous shunts
Localized partial disruption of medullary blood flow results in endosteal bone resorption & outward periosteal displacement (Codman’s triangle)
A young dog sustained a traumatic injury to the jaw and owners have noticed a progressive firm, non painful bulge along his mandible and the regional tooth is displaced. What is the next diagnostic step & your primary differential?
A) CT; tooth root abscess
B) Radiographs; giant cell granuloma
C) Radiographs; mandibular fx
D) Aspirate; abscess from traumatic injury
Answer = B
Giant cell granulomas are rare, non-neoplastic masses initiated by trauma-associated intraosseous hemorrhage.
Affect mandible/maxilla of YOUNG dogs
Lesion is round/ovoid, expansile, uniloculated radiolucency surrounded by rim of nonreactive bone. Adjacent teeth may lose lamina dura & be displaced
Nutritional secondary hyperparathyroidism results from diets providing excess ________, insufficient ______, or both. The imbalance produces ______calcemia, which increases secretion of ______(which hormone).
Nutritional secondary hyperparathyroidism = excess phosphorus, insufficient calcium -> HYPOcalcemia -> excess PTH secretion
PTH secretion normalizes blood calcium by calcium resorption from bone, increased intestinal calcium resorption, & causes renal phosphate excretion & calcium retention
In both nutritional secondary hyperparathyroidism and Rickets there is diffuse osteopenia and thin cortices of the bones, however there is a difference in the _____ _____, which are NORMAL in nutritional secondary hyperparathyroidism but abnormal in Rickets (characteristic appearance is ________).
Difference in GROWTH PLATES
Growth plates NORMAL in secondary nutritional hyperparathyroidism but not in Rickets
Growth plates in Rickets are thickened & have a “cup” appearance of the adjacent metaphysis
What is the radiographic appearance of hypervitaminosis A?
A) Diffuse osteopenia, bowed diaphyses of long bones
B) Epiphyseal dysplasia, widened physes
C) Exurberant exostoses & enthesophytes involving cervical & cranial thoracic vertebrae
D) None of the above
Answer = C
What are the 3 types of viable non-union fractures? And describe them
Hypertrophic non-union (elephant’s foot) = ABUNDANT callus but FAILS to bridge gap usually due to rotational instability
Slightly hypertrophic non-union (horse foot callus) = SOME callus formation but without fracture gap bridging usually due to rotational or angular instability in simple RU or tibial fractures
Oligotrophic non-union = minimal to no callus formation usually seen in avulsion fractures
What are the 4 types of non-viable non-union fractures? and describe them
1) Dystrophic non-union : intermediate fragment becomes united with one of the two main fragment ends but not the other
2) Necrotic non-union: generally involving comminuted fractures which creates avascular pieces of bone
3) Defect non-union: significant bone loss at fx site causing excessive gap formation that cannot be bridged
4) Atrophic non-union: RARE, usually involves simple distal RU fractures in toy breeds
Hematogeneous osteomyelitis occurs most commonly at the _________ region of bone.
A) Epiphyseal
B) Metaphyseal
C) Diaphyseal
B = Metaphyseal
Why are horses with hematogeneous osteomyelitis MORE likely to have concurrent septic arthritis than dogs/cats?
Horses have transphyseal vessels at birth unlike dogs/cats
Medullary bone infarcts are usually found in conjunction with which disease(s)?
- Usually osteosarcoma
- Occasionally associated with skeletal fibrosarcoma or renal adenocarcinoma
Bone infarcts are usually found in which region of the bone?
A) Distal to distal 1/3 of diaphysis
B) Epiphysis
C) Proximal or distal metaphyses
D) Any region of bone
Answer = A
- Also mainly found in femur or distal to elbow
Which is associated with more aggressive periosteal reaction, continuous or interrupted pattern?
Interrupted periosteal reaction is MORE aggressive
Continuous periosteal reactions = solid, lamellar, lamellated
Interrupted periosteal reactions = brushlike/palisade (thick or thin), sunburst, amorphous
Place the following 6 types of periosteal reaction in order from LEAST to MOST aggressive: sunburst, lamellated, brush-like, solid, amorphous, and lamellar.
LEAST -> MOST aggressive
1) Solid
2) Lamellar (parallel)
3) Lamellated (onion skin) - may be seen with osteomyelitis particularly fungal osteomyelitis
4) Brush-like/Palisade : the thinner or more speculated it is the MORE aggressive it is ; may be seen with acute hematogeneous osteomyelitis & hypertrophic osteopathy
5) Sunburst
6) Amorphous: technically NOT a periosteal reaction but neoplastic new bone production
Which 2 bone pathologies cause diffuse osteopenia & bone fractures?
A) Hypervitaminosis A & nutritional secondary hyperparathyoridism
B) Nutritional secondary hyperparathyroidism & Rickets
C) MPS & osteogenesis imperfecta
D) Osteogenesis imperfecta & secondary nutritional hyperparathyroidism
Answer = D, Osteogenesis imperfecta & nutritional secondary hyperparathyroidism
A young adult male cat presents with proliferative lesions of the tarsal joints with ill-defined regions of osteolysis. What is the primary differential?
Periosteal proliferative polyarthritis - a form of erosive immune polyarthritis
- this disease is more common in cats > dogs
- mainly affects tarsi & carpi
Rheumatoid arthritis is a form of (erosive or non-erosive) polyarthritis?
Rheumatoid arthritis = EROSIVE immune-based arthritis
Systemic lupus erythematosus is a form of (erosive or non-erosive) polyarthritis?
SLE = NON-erosive immune based arthritis
Systemic lupus erythematous is a multi systemic disease characterized by simultaneous/sequential development of what conditions?
- IMHA
-IMTP - Leukopenia
-Glomerulonephritis - Dermatitis
- Polymyositis
- Pleuritis
- CNS disease
- Symmetric polyarthritis
T or F, idiopathic arthritis can be associated with neoplasia?
True.
Neoplasia-associated idiopathic arthritis has been seen with SCC, heart base tumors, leiomyomas, mammary adenocarcinoma, & feline myeloproliferative diseases (FeLV, FIV)
Which dog breed is predisposed to polyarthritis/polymyositis syndrome?
A) Australian Shepherds
B) Spaniels
C) German Shepherds
D) Dobermans
Answer = B, Spaniels
- Polyarthritis/polymyositis seen in limb & TMJ ; dogs may be unable to open their mouths
Traumatic shoulder luxation is more likely to occur in which direction?
A) Proximal
B) Distal
C) Medial
D) Lateral
Answer = C
What are the components of a Monteggia fracture?
A) Fracture of distal radius & ulna
B) Fracture of proximal radius & ulna with radial head luxation
C) Fracture of proximal radius and ulna & ulnar head luxation
D) Fracture proximal ulna with an associated radial head luxation
Answer = D
The long digital extensor tendon originates from which femoral condyle?
Originates from lateral femoral condyle
What is the function of the long digital extensor tendon?
Flexes the tarsocrural joint & extends the digits
Which 5 structures combine to form the common calcaneal tendon in the dog?
1) Gastrocnemius
2) Gracilis
3) SemiTENDINosus
4) SDFT
5) Biceps femoris
Includes soleus muscle in cats
In most long bones, growth plates contribute approximately ____% of final bone length and epiphyseal growth centers contribute approximately ____%.
Growth plates ~75-80%
Epiphyseal growth centers ~20-25%
Growth plate is located between the ______ and ______.
Epiphysis and metaphysis
What are the 4 regions of the growth plate in order from the epiphyseal side to the metaphyseal side?
Epiphysis
Resting zone
Proliferative zone
Hypertrophy zone
Calcification zone
Metaphysis
Which is the only region of the growth plate that is vascularized?
A) Hypertrophic
B) Resting
C) Proliferative
D) Calcification
Answer = B
Which humeral and femoral condyle, respectively, are MORE predisposed to OCD lesions?
A) Medial humeral, Medial femoral
B) Lateral humeral, Lateral femoral
C) Medial humeral, Lateral femoral
D) Lateral humeral, Medial femoral
Answer = C
Medial aspect of humeral condyle and lateral > medial femoral condyle
What is the most common site affected by osteochondrosis lesions in HORSES?
A) Humeral head
B) Tarsus
C) Stifle
D) Fetlock
Answer = A
Humeral head is the MOST COMMON OC(D) site in horses
In regards to OC of the stifle joint in horses, which site(s) is/are usually affected?
Lateral trochlear ridge of the femur
In regards to OC of the tarsus in horses, which site(s) is/are usually affected?
Lateral trochlear ridge
Distal intermediate ridge of the tibia
Which joint is the fetlock joint?
Metacarpo/tarso phalangeal joint
Higher atomic numbers of barium (Z = ____) and iodine (Z = _____) versus soft tissue (Z = 7), means that barium and iodine absorb (more/less) photons X-rays photons than soft tissue.
Barium: Z= 56
Iodine: Z = 53
Barium/iodine absorb MORE photons and therefore increase the radiopacity of the tissues/organs containing these agents
If a positive contrast GI study is indicated and perforation is a concern, what type of contrast medium should be used?
Iodinated water soluble contrast medium
______ contrast media, due to their dissociation in solution, have a GREATER osmolality than _______ agents.
Ionic ; non-ionic
When a hyperosmolar contrast medium is injected intravenously, the osmolality of the ______ fluid increases, which will cause a shift of fluid _____ of adjacent cells.
A) Intracellular; out
B) intracellular; in
C) extracellular; in
D) extracellular; out
Answer = D
______ contrast media are LESS nephrotoxic than ______ contrast media and should be used on any patient with impaired renal function.
Non-ionic media are LESS nephrotoxic
_____ and ______ negative contrast agents are MORE SOLUBLE than room air and are therefore less likely to cause fatal air embolism.
CO2 and NO2
The presence of ___________ is an important feature of contrast medium induced nephrotoxicity.
Persistent nephrogram
Immediately following intravenous contrast administration your canine patient begins to have dyspnea, hypotension, and tachycardia. What is the primary concern and what is the next step?
A) Anaphylaxis; administer diphenhydramine
B) Air embolism; place in left lateral recumbency & decline head
C) Air embolism; place in right lateral recumbency & perform CT angiography
D) This is a normal reaction following intravenous contrast administration
Answer = B
Left lateral recumbency and tipping head down/body raised to 45 degree angle traps air in RIGHT VENTRICLE APEX and prevents it from going into pulmonary arteries.
For a patient with compromised cardiac function, which contrast medium is preferred?
A) Non-ionic
B) Ionic
Answer = A
When performing a mesenteric arteriogram and portogram, respectively, which vessels are used?
A) Carotid artery; Cranial vena cava
B) Brachial artery; jugular vein
C) Femoral artery; jejunal vein
D) Femoral artery; splenic vein
Answer = C
You perform a swallow study on a dog with a possible esophageal stricture using barium. The fluoroscopic examination is inconclusive and the IM team would like to immediately perform endoscopy. What is your recommendation?
A) Proceed with endoscopy for final diagnosis.
B) Wait 1-2 hours before proceeding to allow dilution of positive contrast barium.
C) Perform CT instead.
D) Do not perform endoscopy until the following day.
Answer = D
if endoscopy is to be performed following iodinated contrast media should be used, NOT barium (barium will ruin scope)
True or false, inhalation of ionic iodinated contrast media can result in significant pulmonary edema?
True
A pneumocolonogram should be performed in which laterality?
Right lateral recumbency
- Unless a PSS is suspected, then left lateral recumbency should be used to limit risk of fatal air embolism
Match the following conditions with their associated nephrogram appearances:
- Systemic hypotension
- Acute renal obstruction
- Contrast induced renal failure
- Acute extra renal obstruction
- Polyuric renal failure
A) Fair to good initial opacification followed by progressively increasing opacity
B) Fair to good initial opacification followed by persistent opacity
C) Poor initial opacification followed by progressively decreasing opacity
D) Poor initial opacification followed by progressively increasing opacity
Systemic hypotension = A, B, D
Acute renal obstruction = A
Contrast induced renal failure = A, B
Acute extra-renal obstruction = D
Polyuric renal failure = C
Primary glomerular dysfunction & severe generalized renal disease will have what appearance on a contrast nephrogram?
A) Good initial opacification followed by progressively increasing opacity
B) Poor initial opacification followed by decreasing opacity
C) Poor initial opacification followed by persistent opacity
D) Good initial opacification followed by persistent opacity
Answer = C
Renal ischemia results in what contrast nephrogram appearance?
A) Poor initial opacification followed by progressively increasing opacity
B) Poor initial opacification followed by persistent opacity
C) Poor initial opacification followed by progressively decreasing opacity
D) None of the above
Answer = A
Which 2 disease processes have the same appearance of poor initial opacification following by progressively decreasing opacity on a contrast nephrogram?
A) Systemic hypotension & acute extra-renal obstruction
B) Polyuric renal failure & inadequate contrast dose
C) Inadequate contrast dose & systemic hypotension
D) Renal ischemia and systemic hypotension
Answer = B
What is the ONLY type of contrast medium that should be used for myelography?
Non-ionic iodinated contrast (e.h. iohexol, iopamidol)
What volume of contrast is used for myelography and into what region is the contrast administered?
A) 0.25mL/kg; epidural
B) 0.45mL/kg; epidural
C) 0.45mL/kg; subarachnoid space
D) 0.25mL/kg; subarachnoid space
Answer = C
Hyperthyroidism results in (increased or decreased) gastrointestinal transit time?
Hyperthyroidism -> DECREASED (faster) transit time [causes diarrhea]
Which of the following statements regarding equine mast cell tumor is false?
A) ~ 1/3 of cases are Arabians
B) Possible predisposition in males
C) Limb lesions are often firm, immovable, close to joints, & calcified
D) Subcutaneous mast cell tumor of the limb has a characteristic appearance that is often unmistakable for other differentials
Answer = D
Can be misdiagnosed as calcinosis circumscripta
Which of the following characteristics is not typical of feline restrictive orbital myofibroblastic sarcomas (FROMS)?
A) History of reduced retropulsion or possible retrobulbar mass
B) Unilateral orbital involvement that in many cases extends to contralateral orbit and lips/oral cavity
C) Marked contrast enhancement of episcleral/scleral tissues
D) Discrete mass lesion
Answer = D
- FROMS affects middle age to older cats
- 92% have concurrent involvement of contralateral eye and/or lips and oral cavity
- Can see osteolysis of adjacent orbital structures and nasal cavity
Describe the MRI characteristics of an acute hydrated nucleus pulposus extrusion?
- Ventral midline location
- Bilobed or “seagull-shaped” extradural compressive material
- Compressive material is homogeneously T2 hyperintense with isointense non-degenerative nucleus pulposus lying immediately dorsal to the affected intervertebral disc
- IV disc is narrowed with reduced volume of nucleus pulposus & an ill-defined dorsal annulus fibrosus
- possible T2 hyperintense intramedullary/intraparenchymal lesion in spinal cord overlying affected IV disc
- variable contrast enhancement of extruded nucleus pulposus
The characteristic “seagull-shape” lesion on spinal MRI is associated with what disease condition and represents what anatomical structure?
Seagull shape is associated with compressive acute hydrated nucleus pulposus disc extrusion
- Seagull shape due to presence of meningovertebral ligament which attaches the ventral surface of the spinal cord dura mater to the dorsal surface of the vertebral bodies
What is the sensitivity and specificity of contrast CT for compressive acute hydrated nucleus pulposus extrusion?
High Sn & Sp, 91% and 100% respectively
Which feature on MRI imaging is reliable for identification of intradural extramedullary IV disc extrusion?
Y sign
- ONLY seen in T2 SAGITTAL (not dorsal or transverse)
- Y sign = division of the dura and arachnoid layers causing CSF to surround the intradural disc material
Which gene is responsible for the susceptibility of chondrodystrophic dogs to Hansen Type1 IVDD?
FGF4 retrogene
Which neural cell is most affected with hepatic encephalopathy?
Astrocytes
Which substance can accumulate in the centrilobular hepatocytes and cause oxidative damage?
A) Vitamin B12
B) Zinc
C) Copper
D) Vitamin A
Answer = C , copper
All of the following statements describe acquired traction diverticula except which?
A) involve mucosa, submits, & muscularis layers
B) result from inflammation in the chest cavity in close proximity to esophagus
C) fibrous tissue is produced which contracts and then pulls the wall outward
D) all the above are true
Answer = a
With traction diverticula all layers of the esophagus including the serosal layer are involved
What is the direction of rotation of the pylorus in a GDV?
Pylorus & duodenum first migrate VENTRALLY and CRANIALLY. Viewed from a caudal to cranial direction, the stomach rotates in a CLOCKWISE fashion around the distal esophagus.
What are 3 causes for enlarged pulmonary arteries?
1) Pulmonary hypertension - secondary to chronic respiratory disease
2) Heartworm disease
3) PTE
What are 3 ddx for enlarged pulmonary arteries and veins?
1) Left to right cardiac shunts
2) IV fluid overload
3) Thyroid toxicosis
In animals with pleural effusion, rounding of the borders of the lungs suggests ______ or ______.
Chronicity or inflammation of the pleural cavity
What 5 cranial nerves are involved in the oropharyngeal phase of swallowing?
CrN 5,7,9,10 & 12
Which 2 muscles make up the cranial esophageal sphincter?
Cricopharyngeus & thyropharyngeus
Which best describes the rotation of a GDV?
A) pylorus & duodenum first move dorsally and rotates in a clockwise direction about distal esophagus (viewed from surgeon perspective)
B) pylorus and duodenum first move ventrally and rotates in a clockwise direction about distal esophagus
C) pylorus and duodenum first move dorsally and rotates in a counterclockwise direction
D) pylorus and duodenum first move ventrally and rotates in counterclockwise direction
Answer = B
Describe the sensitivity and specificity of radiographs for gastric pneumatosis?
A) low; low
B) high; high
C) low; high
D) high; low
Answer = C
Low sensitivity 14%
High specificity 93%
What is the most common gastric neoplasia?
A) leiomyosarcoma
B) fibrosarcoma
C) lymphoma
D) adenocarcinoma
Answer= D
Normal gastric size in foals is _____?
A) diameter = length of L1
B) gastric height = 1/2 gastric length
C) gastric height = gastric length
D) diameter = 2x length of L1
Answer = B
What is considered pathologic gastrointestinal distension in foals?
A) 2X diameter of adjacent bowel loops
B) Diameter greater than length of L1
C) Diameter greater than length of L2
D) no practical measurement is found to be significant
Answer = B
What is a radiographic sign of undernourishment in a tortoise?
Reduced visceral bulk relative to lung field volume
Which of the following statements regarding effect of sedation on gastrointestinal transit time is true?
A) with ketamine/ace transit time is significantly shortened
B) a GI motility problem is suspected, a ketamine/valium combination should never be used
C) ketamine alone decreases the number of gastric contractions
D) a combination of ketamine/acepromazine is required to decrease the number of gastric contractions
Answer = A
B is false because ket/val should be used in those instances
Answers C & D are false because both ketamine alone and ketamine/ace INcrease gastric contractions
Following ingestion, describe the changes in blood flow in the celiac and cranial mesenteric arteries:
A) There is postprandial splanchnic vessel contraction
B) Significant postprandial decrease in the pulsatility and resistive indices of both vessels
C) In both vessels the end diastolic velocity, the mean velocity, and the flow volume decreased significantly postprandially.
D) Vascular changes occurred significantly earlier in the cranial mesenteric artery than in the celiac artery.
Answer = B
A is false because there is postprandial splanchnic vessel DILATION
C is false because the diastolic velocity, mean velocity & flow volume INCREASED postprandially
D is false because vascular changes occur earlier in the celiac artery > cranial mesenteric.
Describe the sonographic appearance of a retained surgical sponge:
Hypoechoic mass with an irregular hyperechoic center
Which medication is used to treat sialoadenosis?
Phenobarbital
Which of the following statements regarding sonographic post-operative assessment of enterotomy sites is false?
A) Most sites at 6 months post-op or longer still have absent wall layering
B) almost 80% of sites remain visible at 6 months post-operatively or longer
C) ~2/3 of sites have persistent hyperechoic intramural foci
D) Many sites have persistent intraluminal gas foci at the enterotomy site
Answer = A
A is false because the majority, ~90% have ALTERED wall layering while only ~10% have absent layering
What is the gold standard test for diagnosis of exocrine pancreatic insufficiency?
A) Surgical pancreatic biopsy
B) Pancreatic fine needle aspirates
C) Low trypsin-like immunoreactivity pancreatic testing
D) Ultrasound
Answer = C
Diagnosis is a functional test, NOT histology
An insulinoma is a functional tumor of which pancreatic cell?
A) Delta cell
B) PP cell
C) Beta cell
D) Alpha cell
Answer = C
What are the 5 non-pancreatic tumors associated with hypoglycemia?
1) Leiomyoma
2) Leiomyosarcoma
3) Hepatoma
4) Hepatocellular carcinoma
5) Tumors with extensive hepatic metastasis
Zollinger Ellison syndrome results from a tumor of the ________ which produces _______ causing severe __________ and ________.
Pancreas tumor
Secretes/produces excessive gastrin
Causing severe erosive gastritis and duodenitis
What is the only defining characteristic between pancreatic neoplasia and nodular hyperplasia in cats on ultrasound?
Only imaging finding unique to malignant pancreatic neoplasia was a nodule or mass >2cmD in at least one dimension
The sensitivity and specificity for hypoechoic subcapsular thickening for diagnosis of renal lymphoma is what?
A) Excellent sensitivity and specificity
B) Medium to poor sensitivity, good specificity
C) good sensitivity; medium to poor sensitivity
D) medium to poor sensitivity and specificity
Answer = B
61% sensitivity; 85% specificity
67% NPV; 81% PPV
A mixed breed cat is referred for abdominal U/S due to azotemia. Numerous bilateral anechoic cystic foci are present bilaterally in both kidneys partially effacing the normal renal architecture. What concurrent sonographic finding may be visualized and what breed of cat do you suspect this may be?
A) Hypoechoic pancreatic enlargement with peripancreatic steatitis
B) Numerous nodules/masses within the liver and spleen
C) Peritoneal and retorperitoneal effusion and cystitis
D) Small, irregular liver with hyperechoic cystic parenchyma
1) Burmese
2) Siamese
3) Persian
4) Scottish Fold
Answers = A (Small, irregular liver with hyperechoic cystic parenchyma) and 3 - Persian
- This cat has congenital polycystic kidney disease which is predisposed in Persians.
- 48% of cats with PCKD have hepatic fibrosis and 10-40% have hepatic cysts
Dog is presented for crusting of nose and difficulty walking. PE shows some hyperkeratosis of the paws. What is your primary DDX, the next diagnostic step, and what are you expecting to find?
Comment for superficial necrotic dermatitis associated with hepatocutaneous syndrome.
Recommend AUS and liver assessment will show a diffusely hyperechoic liver with hypoechoic nodules creating a “honeycomb” or “Swiss cheese” appearance.
Histology - relative normal hepatocytes are surrounded by areas of parenchymal collapse
Earliest sign of bile duct obstruction in dogs is _____ at ____ hrs.
Distension of the gallbladder and cystic duct at 24 hours
Bile duct obstruction can cause Common bile duct enlargement in _______(time) while peripheral intrahepatic duct dilation can take up to ____ (time).
CBD enlargement in 24-48 hours
Intrahepatic duct dilation in 5-7 days
Combination of what 3 things has a 100% PPV for a portosystemic shunt?
Renomegaly
Microhepatica
Cystolithiasis
All dogs/cats with a PV: aorta ratio of ________ either have an extrahepatic portosystemic shunt or idiopathic noncirrhotic portal hypertension.
≤ 0.65
In cats with biliary obstructions, which of the following statements is/are true?
A) Over 50% have gallbladder distension.
B) Ultrasonographic features of obstruction can differentiate between neoplastic and inflammatory obstructive causes.
C) A long duration of clinical signs is associated with obstructive cholelithiasis.
D) Common bile duct diameter >5 mm is seen is almost all obstructed patients.
E) A, B and D are true.
F) A and D are true.
G) A, C, and D are true.
Answer = F
B is false because no U/S features accurately differentiated between causes of obstruction.
C is false because a SHORT duration of C/S (10 days or less) is mostly associated with obstructive cholelithiasis.
Contrast-enhanced ultrasound of the liver is useful for the identification of malignant hepatic nodules because?
A) The agent has a parenchymal phase due to phagocytosis by the hepatocytes.
B) Malignant nodules are hypoechoic during the arterial phase.
C) Malignant nodules are hypoechoic during the parenchymal phase and have different echogenicity from nodular hyperplasia during the arterial phase.
D) There are no characteristic findings during the portal phase.
Answer = C
A is false because it is phagocytized by Kuppfer cells.
B is false because the malignant nodules are hypoechoic during the PARENCHYMAL phase.
D is true but not helpful for the identification of malignant nodules.
In the arterial phase: nodular hyperplasia is isoechoic, hepatocellular carcinoma is hyperechoic & hemangiosarcoma is hypoechoic in all 3 phases (arterial, parenchymal, venous)
In a study of patients with extrahepatic portosystemic shunts that underwent preoperative computed tomographic angiography and intra-operative mesenteric portography, when intra-operative mesenteric portography useful?
A) Before shunt ligation
B) Before, during, and after shunt ligation
C) After shunt ligation
D) It is never useful.
Answer = C
In dogs that have undergone preoperative CT angiography, intra-op mesenteric portography BEFORE shunt ligation is NOT helpful.
In dogs that have undergone preoperative CT angiography, intra-op mesenteric portography, “after” temporary shunt ligation may provide useful clinical information.
What is Bernoulli’s equation?
∆P = 4V2
Match the correct description with the phase of cardiac cycle:
1) QRS complex
2) P wave
3) T wave
A) Ventricular repolarization
B) Atrial depolarization
C) Ventricular depolarization
1) QRS complex = C, ventricular depolarization
2) P wave = B, atrial depolarization
3) T wave = A, ventricular repolarization
What organ releases renin?
Kidneys, specifically from the juxtaglomerular apparatus within the AFFERENT arteriole of the glomerulus
What 3 things stimulate renin release?
1) Sympathetic nervous system activation (β1-adrenoceptors)
2) Renal arterial HYPOtension (e.g. renal artery stenosis or systemic hypotension)
3) Decreased sodium chloride delivery to distal convoluted tubule
Once renin release is stimulated, what is the cascade of events that occurs to regulate systemic vascular resistance and blood volume?
- Renin release is stimulated from JG apparatus and is released into blood.
- Renin acts on a circulating substrate within the blood, angiotensinogen (which is synthesized by the liver) and cleaved to decapeptide angiotensin 1.
- Angiotensin 1 undergoes further cleavage by angiotensin converting enzyme (ACE) which is primarily derived from the vascular endothelium of the LUNGS, although the brain/heart/other vessels can synthesize ACE.
- ACE cleaves angiotensin 1 to create octapeptide angiotensin 2, which is the active form.
What 6 things occur as a result of angiotensin 2 synthesis/conversion?
1) Stimulates VASCULAR CONSTRICTION –> increased systemic vascular resistance & arterial pressure
2) Stimulates ALDOSTERONE RELEASE from adrenal cortex –> SODIUM CHLORIDE RETENTION within the kidneys
3) Stimulates VASOPRESSIN/ANTI-DIURETIC HORMONE RELEASE from posterior pituitary –> increases renal fluid retention
4) Stimulates thirst centers within the brain
5) Facilitates NOREPINEPHRINE RELEASE from sympathetic nerve endings –> enhances SYSTEMIC VASOCONSTRICTION sympathetic nervous system functions
6) Stimulates CARDIAC & VASCULAR HYPERTROPHY
Erythropoietin is mostly formed in the ________ in response to ________.
- 90% of production is from the kidneys (< 10% is extrarenal in the liver)
- Production is stimulated by systemic hypoxia
An increased tricuspid regurgitant jet velocity of _______ m/s indicates pulmonary hypertension.
> 2.8 m/s
Budd Chiari syndrome describes ______________ and the development of ___________________ due to obstruction of _____________.
Post-sinusoidal hypertension
Development of high protein peritoneal effusion
Obstruction of hepatic venous return to the heart
Abnormal cardiac _________ is identified by an E:A ratio < 1.
Abnormal relaxation = E:A ratio < 1
An E:A ratio < 1 indicates an increased dependence on ___________ for ventricular filling.
Increased dependence on atrial contraction
________ filling is due to ________ left atrial pressures and a __________ left ventricle.
A) Restricted; decreased; stiff/poorly compliant
B) Unrestricted; increased; relaxed/compliant
C) Restricted; increased; stiff/poorly compliant
D) Unrestricted; decreased; relaxed/compliant
Answer = C
- Restrictive filling is due to increased LA pressures and a stiff/poorly compliant LV
- E:A ratio >2
- Short E wave
- Shortened E wave deceleration time
- Shortened IVRT
Initially in feline HCM, you may see E:A reversal, however overtime the disease leads to _________ dysfunction as left atrial pressures increase. This in turn causes ___________of the mitral inflow pattern.
A) systolic; normalization
B) diastolic; normalization
C) systolic; pseudonormalization
D) diastolic; pseudonormalization
Answer = D
- Abnormal relaxation is identified by:
E:A ratio < 1. - This indicates increased dependence on atrial contraction for ventricular filling
- A wave velocity exceeds E wave velocity (E:A reversal)
- As diseases such as feline HCM progress, and the LA pressure increases, then the early diastolic PG between the LA and LV is increased. (Diastolic dysfunction)
- Therefore, E wave velocities increase again, giving pseudonormalization of the mitral inflow pattern (E:A >1).
Dexmedetomidine was associated with a small but significant ________ in cardiac silhouette size on ______________, _____________, and ____________ radiographs in healthy cats.
Small, significant INCREASE in heart size
Right lateral (VHS), VD & DV (percentage width) radiographs
In heartworm disease, infective larvae of stage ______ can transmit the disease ______ weeks after ingesting a blood meal.
Infective L3 larvae
2-3 weeks after blood meal
CT changes associated with the prepatent period of heartworm disease in dogs include:
A) Intermittent periarterial interstitial infiltrates & peripheral tortuosity/enlargement of the caudal lobar arteries
B) Right-sided heart enlargement
C) Diffuse bronchointerstitial pulmonary pattern and cranial/caudal caudal lobar arterial enlargement
D) All the above are seen
E) A and C
F) C and D
Answer = A
-Initial changes on CT (@ 125 days) during the prepatent phase of infection included enlargement/tortuosity of the peripheral caudal lobar pulmonary arteries and intermittent periarterial interstitial infiltrates.
-The changes were progressive, involving additional arteries over time, but remained mild.
-With the presence of adult filariae a filling defect was observed in the caudal lobar pulmonary artery using CT angiography (@ 216 days).
- Radiographs did NOT become abnormal until 216 days (mildly enlarged and blunted caudal lobar pulmonary artery was visible radiographically, and a mild interstitial pulmonary pattern was noted)
- Prepatent phase is ~6-7 months.
What is the most common congenital cardiac defect in foals?
A) ASD
B) VSD
C) Aortic stenosis
D) PDA
Answer = B
When acute aortic regurgitation was created experimentally in 21 dogs to examine the relationship of the regurgitant jet to observed echocardiographic findings, irrespective of the direction of the jet, what feature was seen in 100% of the mitral valves?
A) Prolapse of the valve
B) Systolic fluttering of the anterior mitral leaflet
C) Diastolic fluttering of the anterior mitral leaflet
D) Diastolic fluttering of both the anterior and septal mitral leaflets
Answer = C
What is the main mechanism of heart failure in feline HCM?
Diastolic dysfunction due to reduced LV compliance
In radiographs of left to right shunting PDAs, what percentage have the characteristic “triple bump” enlargement and which structures are enlarged?
A) 64%
B) 43%
C) 26%
D) 15%
Answer = C, 26% have enlargement of the descending aorta, MPA, and left atrium/auricle
T or F, there is a gender predisposition in PDAs?
True, 3:1 female to male
2D and M-mode echocardiography detected left atrial enlargement in 35% of left to right PDAs and an increased __________ diameter in diastole (82%) and systole (84%) as the most common abnormalities.
Left ventricular
Mitral valve leaflet prolapse occurs more frequently in which gender and in almost 50% of dogs the _______ leaflet is affected.
MALES > females
48% have prolapse of the ANTERIOR leaflet versus only ~7% with septal/posterior leaflet affected
Which of the following conditions does NOT cause small pulmonary arteries and veins on radiographs?
A) Pericardial effusion with tamponade
B) Peripheral arteriovenous fistula
C) Positive pressure ventilation
D) Right to left shunts (e.g. reverse PDA, TOF)
Answer = B
What are the most common causes of pericardial effusion in dogs and cats, respectively?
Dogs = neoplasia
Cats = heart failure
________hepatic portosystemic shunts are the most common type and are most prevalent in _________________.
Extrahepatic PSS
SMALL breed dogs/cats
Intrahepatic PSS are more prevalent in ___________ and of the intrahepatic shunts, the _______________ represent the most common type.
Intrahepatic PSS = LARGE BREED dogs
Left divisional shunts, caused by patent ductus venosus = most common intrahepatic type
A PV:AO ratio of ________ predicts the presence of a ______hepatic shunt, whereas a ratio of ______ excludes this type of PSS.
A PV-aorta ratio of ≤ 0.65 predicts the presence of an EXTRAhepatic shunt, whereas a ratio ≥ 0.8 excludes this type of PSS.
- However, a LOW PV/aorta ratio could also be found in dogs with primary PV hypoplasia (idiopathic noncirrhotic portal hypertension), leading to multiple acquired PSS because of portal hypertension.
- PV/aorta ratios ≥ 0.8 are seen only in animals with a normal portal system, microvascular dysplasia, intrahepatic PSS, or portal hypertension caused by chronic liver disease.
Normal PV velocity is _______
~15cm/S
PV velocity may be increased in patients with ______hepatic shunts and decreased in patients with _______hepatic shunts.
Increased PV velocity in patients with IHPSS and decreased in patients with EHPSS.
Portal hypertension is suspected when the portal flow is significantly _________ in velocity (mean ______ cm/s) or _______(Direction - hepato_______), especially if the vein is normal in size or dilated.
PV flow significantly REDUCED in velocity (mean < 10 cm/s) or REVERSED (hepatofugal)
In regards to PSS, there are no biochemical, hematologic, or urine assessments that are abnormal in every case EXCEPT ________ measurements.
Total serum bile acids ( > 25 uM/L)
In patients with arterioportal fistula, a dual-phase CT clearly outlined the filling of intrahepatic portal branches during the _________ phase, whereas a standard single-phase scan would not have.
Arterial
Using dual-phase CT of arterioportal fistulae, all of the following may be visualized EXCEPT:
A) Small portal veins with hepatopetal flow
B) Celiac artery enlargement
C) Abnormal aorta decreases in size caudal to the celiac artery
D) Cranial mesenteric artery and caudal vena cava are small indicative of stealing of blood by the fistula
Answer = A
A is false because portal veins are ENLARGED and flow is hepatoFUGAL
Using the concept of Virchow’s triad, thromboembolism can result from what 3 factors:
- Damage to vascular endothelium
- Hypercoaguable state
- Vascular stasis
What is the most common condition associated with splenic vein thrombus?
Neoplasia 54% (lymphoma)
The 6 most common conditions associated with splenic vein thrombosis are:
54% ____________
43% ____________
26% ____________
20% ____________
18% ____________
16% ____________
54% Neoplasia
43% exogenous corticosteroid administration
26% systemic inflammatory response syndrome
20% disseminated intravascular coagulation
18% pancreatitis
16% immune-mediated disease
Lymphoma was the most common neoplasia
IMHA was the most common immune-mediated disease
JVIM 2010
In a study of the prevalence of portal vein thrombosis on CT angiography in dogs, which broad disease category contained the highest percentage of portal vein thrombosis?
A) DIC
B) SIRS
C) Pancreatitis
D) Neoplasia
Answer = C, pancreatitis
- In this study, similar outcome between dogs with portal vein thrombosis and those without
- Of the 21 dogs with a PV thrombosis that had an U/S, only 19% of the thrombi were diagnosed successfully with U/S
In the dog, the thoracic duct usually empties into which structure?
A) Right brachiocephalic vein
B) Left brachiocephalic vein
C) Right subclavian
D) Left subclavian
Answer = B
In cats, several branches of thoracic duct may empty into the bijugular trunk and subclavian vein.
Using CT and lymphangiography in dogs with idiopathic chylothorax, the most likely finding associated with the duct was _____________; in fact 0% had thoracic duct ___________.
More likely to see thoracic duct lymphangiectasia. NO dogs had thoracic duct rupture.
Using CT lymphangiography immediately after thoracic duct ligation in dogs with idiopathic chylothorax, it was demonstrated that _____% had missed branches of the thoracic duct.
A) 14%
B) 27%
C) 33%
D) > 50%
Answer = B
In radiographs of cats with multiple myleoma, up to 58% had multifocal osteolytic lesions. Additionally, a large percentage had organomegaly of which 3 organs?
A) Cardiomegaly, hepatomegaly, renomegaly
B) Hepatomegaly, splenomegaly, renomegaly
C) Cardiomegaly, splenomegaly, renomegaly
D) Cardiomegaly, hepatomegaly, splenomegaly
Answer = D
- 67% had cardiomegaly; of these, 2 had pulmonary vascular enlargement and cardiogenic pulmonary edema.
- 58% had hepatomegaly and 33% splenomegaly
Which statement best describes the association between abdominal lymph node heterogeniety and malignancy in dogs and cats?
A) Heterogeneous lymph nodes are significantly associated with malignancy only in cats
B)Heterogeneous lymph nodes are significantly associated with malignancy only in dogs
C)Heterogeneous lymph nodes are significantly associated with malignancy in both cats and dogs.
D)Heterogeneous lymph nodes are not significantly associated with malignancy in cats or dogs.
Answer = B
- 91% of heterogeneous canine lymph nodes were malignant, and there was a significant association between heterogeneity and malignancy in abdominal lymph nodes.
- 63% of heterogeneous feline lymph nodes were malignant, with NO significant association between heterogeneity and malignancy.
- suggest that canine abdominal lymph node heterogeneity is more commonly associated with malignant than benign lymphadenopathy.
- Heterogeneity in feline abdominal lymph nodes is nonspecific.
Regarding the ability of the resistive index (RI) and pulsatility index (PI) to allow differentiation between normal, reactive, and neoplastic lymph nodes which of the following statements is true?
A) There is no significant difference in the RI and PI in non-neoplastic vs. neoplastic medial iliac and mesenteric lymph nodes.
B) There is a significant difference between RI and PI between neoplastic and non-neoplastic lymph nodes, however sensitivity and specificity was poor.
C) Values higher than 0.67 for the RI and 1.02 for the PI in medial iliac lymph nodes and higher than 0.76 for the RI and 1.23 for the PI in mesenteric lymph nodes had a high sensitivity and specificity for differentiating benign from neoplastic lymph nodes.
D) Values lower than 0.67 for the RI and 1.02 for the PI in medial iliac lymph nodes and lower than 0.76 for the RI and 1.23 for the PI in mesenteric lymph nodes had a high sensitivity and specificity for differentiating benign from neoplastic lymph nodes.
Answer = C
-There is a significant difference in the RI and PI in non-neoplastic vs. neoplastic medial iliac and mesenteric lymph nodes.
- Propose a cutoff of 1.02 and 1.23 for PI, and 0.67 and 0.76 for RI, for mesenteric and medial iliac lymph nodes, respectively, with HIGHER values being found in neoplastic lymph nodes compared to normal/reactive nodes. Therefore the RI and PI appear to be suitable predictors of malignancy, however only the PI might be suitable for distinguishing between normal and reactive nodes.
Using gray scale U/S for detection of hepatic and splenic lymphoma in dogs, which best describes the sensitivity and specificity most accurately?
A) Poorly sensitive and specific for both liver and spleen.
B) Poor sensitivity and specificity for spleen but good sensitivity and specificity for liver.
C) Good sensitivity, poor specificity for spleen and poor sensitivity, poor specificity for liver.
D) Good specificity, poor sensitivity for liver and good sensitivity, poor specificity for spleen.
Answer = C
Spleen: 100% sensitivity, 23% specificity, 65% PPV, 100% NPV, and 68% accuracy
Liver = 73% sensitivity, 81% specificity, 77% PPV, 76% NPV, and 77% accuracy
Recommend that aspirates be performed for detection of lymphoma in the spleen of dogs only when it appears abnormal ultrasonographically and that cytology of the liver be performed, regardless of ultrasonographic appearance, to determine the presence or absence of lymphoma.
The majority of cats with a “honeycomb” appearance of the spleen on U/S have which histopathologic diagnosis?
A) Extramedullary hematopoiesis
B) Neoplasia
C) Splenitis
D) Lymphoid hyperplasia
Answer = D
- None of the spleen was considered normal on cytology and four types of lesions were found: lymphoid hyperplasia (64%), neoplasia (16%), extramedullary haematopoiesis (12%), and splenitis (8%).
Prevalence of “‘honeycomb” pattern ~7%
Using contrast-enhanced U/S of the spleen, what is the effect of dexmedetomidine sedation on the images? What about butorphanol?
Dexmedetomidine significantly decreases the splenic enhancement and gives a diffuse parenchymal hypoechogenicity.
Butorphanol had no effect of enhancement or parenchymal echogenicity.
Regarding fibrocartilaginous embolism of the spinal cord fill in the following:
Breed/size predisposition: ___________
Most common location(s): ___________
What is the cause: _________________
Young, adult non-chondrodystrophic breeds
Lumbar (47%) and cervical (30%) intumescences
Asymmetric myelopathy -Degenerative intervertebral disk and specifically degenerative nucleus pulposus is source of fibrocartilage
An 8 yo MN German Shepherd presents for unilateral left pelvic limb lameness. Owner states that sometimes he has seen the patient chewing at his tail and seems to have more difficulty navigating the stairs. Has recently had one or two accidents in the house. Which of the following statement(s) is/are true?
A) The most likely differential is neoplasia (e.g. peripheral nerve sheath tumor)
B) The patient will likely have a normal to exaggerated patellar reflex.
C) An MRI should be ordered for further evaluation.
D) The patient is unlikely to have any pain on palpation of the spine.
Answers B & C are true.
Patient is likely suffering from cauda equina syndrome.
- Results in compression/inflammation of the sacral/caudal nerves within vertebral canal or L7 nerves passing through foramina.
C/S = Urinary/fecal incontinence; LMN bladder - large, flaccid; LS pain on palpation; uni/bilateral pelvic limb lameness; normal to exaggerated patellar reflex [reflex evaluates L4/L5 spinal cord segments, nerve roots, & ventral branches of femoral nerve]; altered tail carriage; difficulty ambulating and with stairs; paresthesia/dysesthesia manifested as licking or chewing the tail, the perineum, or the extremities.
What is the most common location for nephroblastomas?
Intradural extramedullary between T9-L3
- intramedullary location is possible, while extradural location is very uncommon
What is the most common tumor affecting the spine in cats?
Lymphoma
What is the most common location of spinal lymphoma in cats?
A) Intradural
B) Intramedullary
C) Extradural
D) mixed between extradural and intradural
Answer = C
Most common location of spinal lymphoma in cats is extradural or mixed extra- and intradural (affecting the leptomeninges and/or the spinal cord).
Cats affected by spinal lymphoma are typically ________ in age with a __________ duration of clinical signs.
Typically young
Short duration of C/S
On MRI of the spinal cord, a defect of the center portion of a vertebral endplate with central material that is isointense to the intervertebral disc material, reactive endplate changes characterized by T2 and STIR hyperintensity and T1 hypointensity, and mild endplate enhancement is seen. What is the primary differential diagnosis?
INTRAvertebral disc herniation (aka Schmorl’s node)
The Cushing’s reflex is a physiological response to increased intracranial pressure characterized by ________________ and ____________.
Bradycardia and increased blood pressure/systemic hypertension
Match the following correctly:
1) Normal adult gray matter intensity compared to white matter on T1
2) Normal adult gray matter intensity compared to white matter on T2
3) Mature appearance of white/gray matter at _______ weeks
4) Maturation of gyri & sulci complete at ________ weeks
5) T1 isointense transition in normal juveniles at _______ weeks
6) T2 isointense transition in normal juveniles at ________ weeks
A) 3-4 weeks
B) 16 weeks
C) Gray matter hyperintense to white matter
D) 4-8 weeks
E) 2 weeks
F) Gray matter hypointense to white matter
1 = F, Normal adult gray matter HYPOintense compared to white matter on T1
#2 = C, normal adult gray matter is HYPERintense to white matter on T2
# 3 = B, mature white/gray matter appearance at 16 wks
#4 = E, maturation of gyri/sulci at 14 days
#5 = A, T1 isointense transition in juveniles at 3-4 wks
#6 = D, T2 isointense transition in juveniles at 4-8 weeks
An interthalamic adhesion size of ________ is characteristic of brain atrophy.
< 5mm
MRI features of leukoariosis include bilaterally symmetrical T2 and FLAIR _______intensity, __________intensity on ADC map, of the ________ matter and mostly located adjacent to _______________. _______ contrast enhancement.
Bilaterally symmetrical , T2 and FLAIR HYPERintensity, hyperintense on ADC (due to water diffusion from axon loss), of the WHITE matter and mostly adjacent to the lateral ventricles. NO contrast enhancement.
MRI changes of the brain associated with brain atrophy include _________, _________, and _____________.
Ventriculomegaly
Widened sulci
Interthalamic adhesion atrophy
MRI changes of the brain associated with hepatic encephalopathy include _______intensity of the _________, _________, and _________ on ____weighted images.
Hyperintensities of the lentiform nuclei, globus pallidus, and putamen on T1 weighted images.
Lesions are not contrast-enhancing and are not seen on T2W images.
MRI lesions seen with hepatic encephalopathy are considered due to what?
A) Copper deposition
B) Global hypoxemia
C) Manganese deposition
D) Zinc deposition
Answer = C
Which of the following statements about feline hippocampal necrosis is false?
A) Lesions are non-contrast enhancing
B) Lesions are T2 hyperintense, T1 hypointense and have no mass effect
C) Lesions localized to hippocampus and piriform lobes
D) Lesions are bilaterally symmetric
Answer = A
Lesions are NOT enhancing
Granular cell tumors are characterized as _______ axial, _________(shape) masses spanning along the ___________ of the ________, _______, or ________ (locations) without _______ involvement. Lesions are T1 ________, T2 _______, and have _________ peritumoral edema and _______ mass effect.
- Extra-axial, sessile or plaque-like masses
- located along convexity of the cerebrum, falx cerebri, or ventral floor of the cranial vault
- NO bone involvement
- Masses are T1 mildly HYPERintense, T2/FLAIR iso to hyperintense, with moderate to severe peritumoral edema and moderate to severe mass effect
What is the most common brain tumor in dogs and cats?
Meningiomas
What is the most common brain location for meningiomas?
Rostrotentorial
Higher grade meningiomas were found to have higher or lower ADC values than lower grade tumors?
Higher grade tumors -> LOWER ADC values
Which 2 dog breeds are predisposed to primary CNS histiocytic sarcoma?
Corgi & Shetland Sheepdog
Meningiomas and histiocytic sarcomas can share many imaging features, such as a dural tail sign, however histiocytic sarcomas tend to be ________ in size with more ________involvement compared to meningiomas.
Histiocytic sarcomas tend to be larger with more leptomeningeal involvement.
Additionally the meningeal involvement and peritumoral edema are more extensive than meningiomas
The most common ventricular tumor in dogs is? In cats?
Dogs = choroid plexus tumor
Cat = ependymoma
Which 2 dogs breeds are predisposed to lung lobe torsions?
Pugs and Afghans
Which 2 lung lobes are most likely to be torsed in dogs and which sized dogs are associated with each?
Right middle - Afghans/large breed dogs
Left cranial - Pugs/small breed dogs
A Boxer is presented for a dilated pupil with absent PLR and decreased physiologic nystagmus. A brain MRI is performed and based on your presumption of the most likely diagnosis what findings do you expect?
A) T1, T2 hyper intense extraaxial mass with strong enhancement and mass effect
2) Enlargement of the optic nerve unilaterally with meningeal enhancement and strong contrast enhancement
3) large extra axial heterogenous mass within the pituitary fossa with moderate mass effect and strong enhancement
4) unilateral enlargement of the oculomotor nerve which is T2 hyper, T1 iso and mildly enhancing
Answer = D
Suspect idiopathic oculomotor neuropathy,
- C/S include unilateral areflexive mydriasis (meaning dilated pupil that does not react to PLR test), ptosis, dorsolateral strabismus, external ophthalmoparesis (decreased adduction of the affected eye when testing physiologic nystagmus)
-Mild to marked enlargement of the affected oculomotor nerve, usually UNILATERAL
-Variable signal intensity, but usually T2 iso to hyperintense to gray matter, pre contrast T1 iso, T2 FLAIR iso/hypo/hyper
-Mild to marked contrast enhancement
What 5 structures run through the tympano-occipital and orbital fissure together?
1) CrN 3 (oculomotor)
2) CrN 4 (trochlear)
3) CrN 6 (abducens)
4) Ophthamlic branch of CrN 5 (trigeminal)
5) Internal carotid artery
-concurrent involvement of these nerves is observed when a space-occupying lesion affecting the area around the pituitary fossa (cavernous sinus) is present.
-extend from the tympanooccipital fissure to the orbital fissure, and flank the pituitary fossa and dorsum sellae.
- They communicate rostrally with the ophthalmic plexus through the orbital fissures and caudally with the ventral petrosal sinuses through the petro-occipital foramina.
The parasympathetic efferent fibers of CrN 3 are responsible for _________
pupillary constriction
The most common clinical signs associated with cavernous sinus syndrome include:
1) __________________, 2) _______________, 3) ___________, 4) _________________, 5) reduced to absent ________________, 6) ____________, and 7) reduced to absent _______________.
1) External ophthalmoparesis/ophthalmoplegia (paralysis of the muscles that move the eyes)
2) Internal ophthalmoparesis/ophthalmoplegia (reduced abduction or adduction of the eyes)
3) Areflexive mydriasis
4) Ptosis
5) Reduced to absent corneal sensation
6) Oculosympathetic denervation aka Horner’s syndrome
7) Reduced to absent periorbital/nasofacial hypalgesia (reduced pain sensation)
T or F, with cavernous sinus syndrome vision is usually affected.
FALSE, vision is usually NOT affected
Lissencephaly is hereditary in which dog breed?
Lhasa Apso
Which disease is characterized by thickening of the cerebral cortex and hypoplasia of the cerebral gyri?
Lissencephaly
Central blindness is a neurologic deficit associated with what intracranial disease process?
Polymicrogyri
Which dog breed has a hereditary predisposition to polymicrogyri?
Standard Poodles
What are the characteristic features seen on MRI with polymicrogyri?
Increased number of small, disorganized gyri in the dorsal and lateral cerebral cortex.
Which of the following is not a component of Dandy-Walker malformation complex?
A) Hypoplasia or aplasia of the cerebellar vermis
B) Cerebellar hypoplasia
C) Cystic dilation of the 4th ventricle
D) Enlargement of the posterior fossa
Answer = B
Which dog breed is predisposed to Dandy Walker malformation?
Eurasier
A 2 month old kitten is presented for signs of abnormal gait, head bobbing, and intention tremors. The owners say the signs have been present for at least 4 weeks. A brain MRI is performed. What is the most likely finding and suspected etiology for the clinical signs?
A) Expansile extra-axial mass of the forebrain with T1 hyperintensity; psmammamatous meningioma
B) Marked ventriculomegaly with foramen magnum herniation and syrinx formation; caudal occipital malformation and secondary obstructive hydrocephalus
C) Cerebellar hypoplasia; in utero panleukopenia infection
D) Bilaterally symmetric, non-enhancing T2 hyperintense, T1 hypointensities of the piriform lobes & hippocampus; feline hippocampal necrosis
Answer = C
Which of the following most appropriately describes the lesions observed with MRI of the brain in cats with feline infectious peritonitis?
A) Bilaterally symmetric, non-enhancing T2 hyperintense, T1 hypointensities of the piriform lobes & hippocampus
B) Bilateral symmetric T2 hyperintensities of the white matter surrounding the ventricles
C) Strong enhancement of the meningeal, ependymal & periventricular regions + dilation of the lateral, 3rd, or 4th ventricles
D) Multifocal intraparenchymal mass lesions of the cerebral cortex and forebrain with indistinct margins
Answer = C
- When present, parenchymal lesions have distinct margins in most cases, a trend noted more frequently with FIP than with other causes of feline meningoencephalitis.
What is the classical clinical sign and breed associated with agenesis or dysgenesis of the corpus callosum?
Hypodipsic hypernatremia
Miniature Schnauzers
Various quantitative MRI measurements have been tested to help distinguish normal dogs from those with cerebellar degeneration. The ratio between the brainstem and cerebellum mid-sagittal cross-sectional area has ______% sensitivity and ____% specificity using a cut off of ____%.
100% Sn
100% Sp
89% cutoff
- affected dogs have HIGHER brainstem:cerebellar ratios
In Staffordshire bull terriers, 2 methods for assessing cerebellar degeneration include the relationship between the cerebellar CSF space and the cerebellum and the brain to cerebellum ratio. Using cut-offs of ____% and ___%, respectively, both methods have a high sensitivity (93%) and high specificity (100% and 93%).
CSF space surrounding the cerebellum in relation to the cerebellum (cerebellar CSF space) on T2W sagittal images: a cut-off of 12.8% was able to distinguish affected from unaffected American Staffordshire Terriers with a sensitivity and specificity of 93% and 100%, respectively.
Brain-to-cerebellum ratio (relative cerebellar size): a cut-off of 13.3% was able to distinguish affected from unaffected American Staffordshire Terriers with a sensitivity and specificity of 93 and 94%, respectively.
The features of epidural hemorrhage include: a well-defined ____________(shaped) extra-axial mass which may cross ______________ but usually does NOT cross _________.
Lenticular/biconvex shaped (think “E”pidural and “E”yeball - lenticular)
May cross dural folds such as falx cerebri and osseous tentorium cerebelli but usually NOT suture lines
The features of subdural hemorrhage include: a peripheral _______-shaped mass which may cross __________ but does NOT cross _____________.
Crescent shaped
May cross suture lines but does NOT cross dural folds (e.g. falx cerebri, osseous tentorium)
There are numerous potential mimics of intracranial hemorrhage on T1 weighted images. What are 7 things that display T1 hyperintensities that should not be confused for hemorrhage.
1) Melanin
2) Flow artifacts
3) Lipid
4) Protein effects (colloid cysts, Rathke’s cleft cyst, epidermoid cyst, laminar cortical necrosis)
5) Manganese/iron/copper/gadolinium
6) Calcification
7) Vasopressin within pituitary gland
There are numerous potential mimics of intracranial hemorrhage on T2 weighted images. What are 7 things that display T2 hypointensities that should not be confused for hemorrhage.
1) Gas
2) Flow effects (rapid or turbulent flow)
3) High cellularity (e.g. lymphoma)
4) Protein effects (high protein levels)
5) Iron or copper deposition
6) Calcification
7) Secretory granules in pituitary adenomas
Large mineral deposits will be T1 _______intense.
Large mineral = T1 HYPOintense
A complete hypointense hemosiderin rim on T2 and T2* sequences is commonly seen in _________ than with _____________.
A) Neoplastic hemorrhage; benign hematoma
B) Subdural hemorrhage; epidural hemorrhage
C) Epidural hemorrhage; subdural hemorrhage
D) Benign hematoma; neoplastic hemorrhage
Answer = D
Which of the following is a feature of primary fracture healing?
A) There is no observable callus formation
B) Involves both endochondral and intramembranous ossification
C) Fracture gap is > 800 microns
D) The limb can function during the healing process
Answer = A
For primary/direct fracture healing the fracture gap mus be very small (< 300um) and NO relevant callus is observed. If there is no gap then contact healing occurs and the cortical union is achieved by internal remodeling of the Haversian systems
In classical healing, callus formation involves ____________ and ______________ osssification.
Endochondral and intramembranous ossification
___________ ossification forms bone directly from ___________ cells and undifferentiated mesenchymal cells in the periosteum ________(which direction) the fracture site without _____________.
Intramembranous ossification forms bone directly from osteoprogenitor cells and undiffferentiated mesenchymal cells in the periosteum AWAY FROM the fracture site without a cartilage precursor.
_____________ ossification occurs by ossification of ________ produced by recruitment, proliferation, and differentiation of ___________________cells from the periosteum and external soft tissues ________(which direction) the fracture site.
Endochondral ossification occurs by ossification of cartilage produced by the recruitment, proliferation, and differentiation of undifferentiated mesenchymal cells from the periosteum and external soft tissues adjacent to the fracture site.
Steps:
granulation tissue → connective tissue → fibrous tissue → cartilage → mineralized cartilage → woven bone → lamellar bone → cortical bone
What are the following steps of endochondral ossification in order:
_______ tissue –> ________ tissue –> __________ tissue –> ____________ —–> mineralized _________ –> _________ bone —–> ________ bone —–> ________bone
A) Connective tissue; granulation tissue ; fibrous tissue; mesenchyma; mineralized cartilage; lamellar bone; woven bone; cortical bone
B) Granulation tissue; fibrous tissue; connective tissue; cartilage; mineralized cartilage; woven bone; lamellar bone; cortical bone
C) Fibrous tissue; granulation tissue; connective tissues; cartilage; mineralized lacunar cells; woven bone; lamellar bone; cortical bone
D) Granulation tissue; connective tissue; fibrous tissue; cartilage; mineralized cartilage; woven bone; lamellar bone; cortical bone
Answer = D
What are the expected healing times for clinical union by classical healing for the following ages:
< 3 months old = ________
3-6 months old = _________
6-12 months old = ___________
> 12 months old = ____________
< 3 months old = 2-3 wks
3-6 months old = 4-6 wks
6-12 months old = 5-8 wks
> 12 months old = 7-12 wks
Which is faster, primary or classical bone healing?
Classical healing aka bridging osteosynthesis is faster
What are the 3 types of biologically active or viable non-unions?
1) Hypertrophic non-union (elephant’s foot callus)
- abundant callus but failure to bridge fracture gap (rotation instability)
2) Slightly hypertrophic non-union (horse’s foot callus)
- some callus formation but failure to bridge fracture gap (rotational or angular instability)
3) Oligotrophic non-union
- none to limited callus formation
Within a wound, granulation tissue begins to form within ________ days.
3-4 days
Multiple cartilaginous exostoses usually occur at the ________ of long bones.
A) Epiphysis
B) Metaphysis
C) Diaphysis
D) can occur anywhere
Answer =B
-usually metaphyseal
-can occur on any bone EXCEPT SKULL
In the initial inflammatory phase of wound fracture healing, there is an accumulation of _________within the medullary cavity, between the fracture ends, and underneath the elevated periosteum. This eventually forms a ________ and regional osteocyte death begins the inflammatory response with vaso______, plasma exudation, and inflammatory cell migration.
Accumulation of hemorrhage that eventually forms a clot.
Within the reparative phase of fracture healing, about ______ days post-injury the hematoma is organized and _______forms from pluripotential _______cells.
7 days post-injury
pluripotential cells of mesenchymal origin
When does the remodeling phase of the fracture repair occur?
Remodeling occurs when the fracture is clinically healed.
Renal secondary hyperparathyroidism results in __________ secretion.
Excessive parathyroid hormone (PTH) secretion
When renal function is decreased, _________ is not excreted which leads to high blood levels of ______ and low blood levels of __________.
A) Calcium, phosphorus, calcium
B) Sodium chloride, phosphorus, calcium
C) Phosphorus, phosphorus, calcium
D) calcium, calcium, phosphorus
Answer = C
Decreased renal function causes decreased conversion of the inactive form __________ into it’s active form _______, which in turn causes reduced ____________ resorption from the small intestinal tract which promotes hypocalcemia.
Decreased conversion of the Inactive form of vitamin D (calcidiol) to active form calcitriol in kidneys with reduced function. Less active Vitamin D leads to less intestinal resorption of calcium
Increased osteoclastic resorption in renal secondary hyperparathyroidism results in osteo___________ which affects mainly the _________ and ____________.
Osteoporosis mainly within the mandible and maxilla (and cancellous bones of the skull)
Excess glucocorticoids, as can be seen with hyperadrenocorticism, inhibits absorption of ___________ from the _________ through antagonistic effect on __________. This causes ___________ deficiency.
Excess glucocorticoids inhibit calcium absorption from the small intestine which causes vitamin D deficiency.
Osteochondroma tumors typically cease growing in _______ when they reach skeletal maturity, however in ________they continue to grow throughout adult life. The latter is linked to __________ infection.
A) dogs; cats; FeLV infection
B) dogs; cats; FIP infection
C) cats; dogs; Parvo infection
D) cats; dogs; fungal infections
Answer = A
Rickets is ________?
Hypovitaminosis D
Hypovitaminosis D results in which of the following?
A) Proportionate dwarfism
B) Irregular blunted and sclerotic epiphyses
C) Widening and flaring of the physes
D) All the above
Answer = C
Hypovitaminosis D, also called Rickets, results in generalized OSTEOPENIA.
Physes are widened and flared, especially affecting the distal radius/ulna and costochondral junctions
Physes are wide and radiolucent
Beaked margins to the metaphyses resulting in an inverted cup-shaped physeal appearance
Delayed physeal closure
Results in stunted growth and disproportionate dwarfism
What is the difference in appearance between juveniles and adults affected by hypervitaminosis A?
In young animals. bone growth may be severely or permanently retarded/blunted (appositional growth aka diameter of bones is normal)
In adults, bony exostoses are predominant particularly affecting the cervical vertebral bodies (confluent exostoses and bony arthrodesis)
T or F, pituitary dwarfism causes generalized osteopenia?
FALSE
Which of the following congenital anomaly/anomalies involve epiphyseal dysplasia?
A) Hypervitaminosis A
B) Chondrodysplasia
C) Congenital hypothyroidism
D) Hypovitaminosis D
E) Mucopolysaccharidosis
Answers = B, C, and E
Chondrodysplasia,, congenital hypothyroidism, and MPS all involve epihyseal dysplasia.
Additionally, pituitary dwarfism also causes epiphyseal dysplasia
The poster child for pituitary dwarfism is ______________ due to a congenital deficiency of ___________.
German Shepherds
Deficiency of growth hormone (usually have pituitary cysts or pituitary hypoplasia on CT/MRI)
A young dog presents with incomplete epiphyseal ossification and delayed physeal closure. There is no evidence of osteopenia, however the dog has stunted growth. Which is the most likely cause?
A) Hypovitaminosis A
B) Hypovitaminosis D
C) Pituitary dwarfism
D) Mucopolysaccharidosis
Answer = C
Hypovitaminosis A causes bulky, ill-shaped bones
Hypovitaminosis D (Rickets) causes osteopenia
Mucopolysaccharidosis also causes osteopenia and also does not cause delayed physeal closure
Which of the following feature(s) are seen with congenital hypothyroidism?
A) Concurrent megacolon
B) Valgus deformities
C) Delayed epiphyseal and metaphyseal ossification
D) Thinning of the radial and ulnar cortices
E) Increased medullary opacity
F) Short broad skulls
Answers = A, B, E, F
C is false because only epiphyseal changes are seen, NO metaphyseal lesions.
- Epiphyses have delayed ossification with irregularly formed, fragmented or stippled appearance
D is false because the radial and ulnar cortices are THICKENED with increased medullary opacity (NO osteopenia)
T or F, panosteitis has a gender predisposition?
TRUE. Males > females
A structural defect in __________ leads to the heritable disease Osteogenesis Imperfecta.
Collagen Type 1
What are the two most likely differentials for a young dog or cat that presents with multiple fractures, generalized osteopenia, and possibly cortical thinning.
Osteogenesis imperfecta and nutritional secondary hyperparathyroidism
Which two systemic diseases may be associated with diffuse osteosclerosis?
Cats with FeLV ( produces medullary sclerosis and non-regenerative anemia)
Dogs, particularly Basenjis, with pyruvate kinase deficiency
Osteochondrosis results from a failure of ______________. The cartilage initially progresses through what appears to be a normal sequence of development, but then it becomes abnormal in the ________ zone.
Failure of endochondral ossification
Abnormal in the hypertrophic zone
Which breed and gender of dog are predisposed to systemic Aspergillosis?
German Shepherds
FEMALES > males
Which of the following statements about feline chronic progressive polyarthritis is true?
A) Disorder occurs exclusively in female cats
B) Disorder is a non-erosive polyarthropathy with 2 forms - a periosteal proliferative form and erosive form
C) There is no evidence of underlying or concurrent systemic disease in any affeted cats
D) None of the above are true
Answer = D
A is false because the disease occurs exclusively in MALES
B is false because the disease is an EROSIVE polyarthritis.
2 forms - most prevalent form of the disease was characterized by osteopenia and periosteal new bone formation surrounding affected joints. (periosteal proliferative form- MORE COMMON). Marginal periarticular erosions and collapse of the joint spaces with fibrous ankylosis occurred with time, but joint instability and deformities were NOT seen.
The second form of the disease was characterized by severe subchondral marginal erosions, joint instability, and deformities. (erosive form)
C is false because FeFSV (feline synctyia virus) was isolated from blood/serology in ALL cats, but FeLV only isolated in 60% of patients
What 4 musculoskeletal disorders/diseases affect the epiphysis/ cause epiphyseal dysplasia?
1) Congenital hypothyroidism
2) Mucopolysaccharidosis
3) Pituitary dwarfism
4) Multiple epiphyseal dysplasia of Beagles
What are the earliest diagnostic imaging findings in juvenile dogs with discospondyitis?
Earliest radiographic change = narrowed intervertebral disc space (found in disk spaces ≤ 2 weeks after evaluation for signs of vertebral pain)
Subluxation of adjacent vertebrae was identified either initially or within 2 weeks
Vertebral endplate lysis was NOT an initial radiographic feature
A middle age Boxer presents for unilateral hindlimb paresis. He has been showing progressive signs of decreased ambulation and discomfort for months. Physical examination reveals lumbosacral pain and an exaggerated patellar reflex. Based on your presumptive diagnosis of ___________ you perform radiographs in which you would anticipate seeing what lesion most commonly?
A) Peripheral nerve sheath tumor; widening of the intervertebral foramen
B) Lumbosacral osteochondrosis; narrowed L7-S1 disc space with craniodorsal osseous defect on S1 endplate and regional sclerosis
C) Lumbosacral osteochondrosis; narrowed L7-S1 disc space with caudodorsal osseous defect on L7 endplate and regional sclerosis
D) Peripheral nerve sheath tumors; lesions not expected to be seen on radiographs & would recommend MRI
Answer = B
Majority of dogs with lumbosacral osteochondrosis have lesions related to the craniodorsal aspect of the sacrum in 91% and the caudodorsal aspect of the L7 vertebra in the remaining 9%
In all 34 dogs, deformity of either the dorsal aspect of the cranial sacral end-plate or the caudal seventh lumbar end-plate was present. All dogs had a radiolucent defect in the dorsal aspect of the affected end-plate and one or more osseous fragments in the vertebral canal. Lipping, angling and sclerosis of the dorsal part of the affected end-plate was present in 29 dogs. A narrowed intervertebral space was present in 26 of the 31 dogs with sacral osteochondrosis and in two of the three dogs with L7 osteochondrosis.
A 5 yo MN MBD presents with chronic, progressive forelimb lameness months after a fall. You perform radiographs and see mottled osteolysis of the intermedioradial carpal bone. Which of the following statements is true?
A) Dog likely has a traumatic non-healed fracture with secondary sequestrum formation.
B) The lameness will likely resolve following pancarpal arthrodesis.
C) Radiographs should be taken of the other carpus and tarsus to check for erosive polyarthritis.
D) Joint sampling should be recommended.
E) C and D are both true.
Answer = B
This likely represents avascular necrosis of the intermedioradial carpal bone.
Histopathology of the bone demonstrated replacement of healthy bone/bone lamellae with granulation tissue suggestive of ischaemic necrosis.
Lameness resolved following pancarpal arthrodesis.
Similar features of Preiser disease in humans; oftentimes present with a history of trauma
In a study assessing the detection of a puppy line, metaphyseal sclerosis, and caudolateral curvilinear and circumferential femoral head osteophytes in the early detection of canine hip dysplasia which of the following statements is FALSE?
A) Distinction of the caudolateral curvilinear osteophyte from the puppy line has not been established.
B) There is no significant relationship between the occurrence of a puppy line, a circumferential femoral head osteophyte, or femoral metaphyseal sclerosis at 15-17 weeks and canine hip dysplasia or degenerative joint disease incidence at 42-52 weeks.
C) When both a caudolateral curvilinear osteophyte and circumferential femoral head osteophyte were present at 24-27 weeks, hip dysplasia and degenerative joint disease was evident in all such hips by 42-52 weeks of age.
D) Presence of a caudolateral curvilinear osteophyte in at least one hip at 24-27 weeks was significantly related to the diagnosis of canine hip dysplasia by 42-52 weeks of age.
Answer = C
C is false because when BOTH a caudolateral curvilinear osteophyte and a circumferential femoral head osteophyte were present in a hip at 24–27 weeks, DEGENERATIVE JOINT DISEASE was evident in all such hips by 42–52 weeks of age.
No significant relationship was found between occurrence of a puppy line, a circumferential femoral head osteophyte, or femoral metaphyseal sclerosis at ________ weeks and canine hip dysplasia or degenerative joint disease incidence at 42–52 weeks.
A) 10-12 weeks
B) 13-15 weeks
C) 15-17 weeks
D) 18-20 weeks
Answer = C
Presence of a caudolateral curvilinear osteophyte in at least one hip at _______weeks was significantly related to the diagnosis of __________ by 42–52 weeks.
A) 24-27 wks; DJD
B) 24-27 wks; canine hip dysplasia
C) 15-17 wks; DJD
D) 15-17 wks; canine hip dysplasia
Answer = B
When both a caudolateral curvilinear osteophyte and a circumferential femoral head osteophyte were present in a hip at _______ weeks, ______________ was evident in all such hips by 42–52 weeks of age.
A) 24-27 wks; DJD
B) 24-27 wks; canine hip dysplasia
C) 15-17 wks; DJD
D) 15-17 wks; canine hip dysplasia
Answer = A
What is the most common cause of primary nail bed tumors in dogs?
A) Squamous cell carcinoma
B) Melanoma
C) Keratoacanthoma
D) Soft tissue sarcoma
Answer = A
Squamous cell carcinoma (SCC) is the most common cause of primary nail bed tumor in dogs.
Followed by melanoma, osteosarcoma, soft-tissue sarcoma, and mast cell tumor.
Keratoacanthoma grows more rapidly and LESS commonly causes ulceration compared to squamous cell
What are the 4 masticatory muscles and which one of these is typically less affected or not affected by canine masticatory muscle myositis?
1) Masseter muscle
2) Temporalis muscle
3) Pterygoid muscle
4) Digastricus muscle
- Digastricus muscle is typically less affected or not affected at all because it contains predominantly Type 2A fibers, NOT type 2M
Canine masticatory muscle myositis is an immune-mediated disorder in which auto-antibodies against type ________ muscle fibers are produced in the muscles.
2M muscle fibers
In early stages of canine masticatory muscle myositis, there are multifocal ill-defined areas of T2 _______intensity that are ________ on T1W images compared to normal muscles. Additionally the muscles are edematous. At the chronic stage, there is muscle atrophy and areas of ________intensity on T1 and T2W images likely due to accumulation of _____________.
Initial stages = areas of T2 hyperintensity that are iso to slightly hypo- or hyperintense on T1
Chronic stages - iso to hypointensity on T1 and T2 due to accumulation of fibrous connective tissue
MRI features of gastrocnemius musculotendinopathy are usually seen in _____________ dog breed and characterized by _________intensity in the ________head of the gastrocnemius muscle and _______ sesamoid bone in T2, T2*, and STIR images with _______ contrast enhancement.
A) Border Collies; hyperintensity; medial; medial; minimal
B) Terriers; hypointensity; lateral;lateral; minimal
C) Border Collies; hyperintensity; lateral;lateral; marked
D) Terriers; hyperintensity; medial; medial; marked
Answer = C
In MR images there was HIGH SIGNAL intensity in the LATERAL head of the gastrocnemius muscle around the sesamoid bone in T2-weighted, T2*-weighted, and STIR images and an iso- to mildly hyperintense signal in T1-weighted images with MARKED contrast enhancement.
The breed affiliation to Border Collies is striking, and a relation to biomechanical forces or motion pattern may be possible.
LATERAL sesamoid bone with abnormal regional soft tissue mineralization was identified in ALL radiographs
Except for the dog with the most extensive lesion all dogs had an excellent outcome.
Horses whose tendon or ligament lesions resolved on _______ images at the time of the recheck examination are significantly more likely to be sound than horses whose lesions persisted on _______ images.
A) T2 FSE
B) T1 FSE
C) T1 GRE
D) STIR
Answer = D
Horses whose tendon/ligament injuries which are visualized on ______ images may represent injuries that actively contribute to lameness, whereas lesions visualized only on _______sequences remain of uncertain clinical significance.
Lesions seen on STIR images more likely represent injuries that contribute to lameness
Lesions visualized only on T1W GRE images are of uncertain clinical significance
The following characteristics are observed with higher frequency on CT myelography in degenerative myelopathy versus normal dogs:
1) Spinal cord ______ and _________
2) Disc __________
3) ____________ of the subarachnoid space
4) _______ spinal cord (size)
5) Paraspinal muscle ________
1) Spinal cord stenosis and deformity
2) Disc protrusion
3) Focal attenuation of the subarachnoid space
4) Small spinal cord
5) Paraspinal muscle atrophy
In the equine femoropatellar joint, osteochondrosis dissecans is more commonly associated with the _________ trochlear ridge of the distal femur.
LATERAL trochlear ridge of the distal femur
____________ is more sensitive than ____________ for OCD lesions affecting the medial trochlear ridge of the distal femur in equine stifle joints.
A) Radiography; ultrasonography
B) Ultrasonography; radiography
C) Neither modality is very sensitive
D) Both modalities are very sensitive
Answer = B
Comparing U/S and radiography for the diagnosis of OCD in the equine femoropatellar joint, there is ________% specificity regardless of the site and imaging procedue except for the distal 3rd of the medial trochlear ridge on U/S.
100% specificity
Specificity was 100% regardless of the site and imaging procedure except for the distal third of the MTR (94% for ultrasound). The sensitivity varied, depending on lesion site.
On cross sectional MRI studies of the canine carpus, cyst-like lesions have been detected at the _________aspect of the intermedioradial carpal bone. These are non-articular lesions and their conspicuity on radiographs is ________.
A) Caudolateral; poor
B) Caudolateral: high
C) Dorsolateral; poor
D) Dorsolateral: high
Answer = C
25 cadaveric canine carpi were obtained and a total of 13 lesions were detected on MRI. Based on MRI, six carpi with lesions of varying size and one normal carpus were submitted for histological evaluation. Five of the abnormal carpi had nonarticular cyst-like lesions; one specimen with a positive magnetic resonance image for a cyst-like lesion had no cyst-like lesion on histology.
In foals with infectious arthritis, on MRI osseous lesions in the epiphysis, metaphysis, and physis appeared as T2, STIR, and proton density ____________foci with a _______ halo.
Hyperintense foci with a hypointense halo
Which modality is the most accurate for detection of wooden foreign bodies in the canine manus?
A) Radiographs
B) U/S
C) CT
D) MRI
Answer = C
CT was the most accurate modality for detection of wooden foreign bodies overall and within each of the three individual regions, followed by US and MR imaging, respectively.
US evaluations were most limited in the metacarpal pad, where distal acoustic shadowing from the pad surface hindered evaluation of the tissues in some specimens.
Degenerative myelopathy most commonly affects what breed of dog?
A) Rottweilers
B) Labrador Retrievers
C) German Shepherds
D) Great Danes
Answer = C
If a segment of lung has low oxygen concentration in the alveoli, arterioles serving that segment will _______ in response.
Constrict
This regional constriction will move blood to more well-ventilated areas in order to improve gas:ventilation ratio
Match the following correctly:
A) Metabolic acidosis
B) Respiratory acidosis
C) Metabolic alkalosis
D) Respiratory alkalosis
1) Decreased CO2
2) Increased CO2
3) Increased bicarbonate
4) Decreased bicarbonate
A -metabolic acidosis = 4 - decreased bicarbonate
B - respiratory acidosis = 2 - increased CO2 (hypoventilation)
C - metabolic alkalosis = 3 - increased bicarbonate
D - respiratory alkalosis = 1 - decreased CO2 (hyperventilation)
When CO2 rises in cases of respiratory _______, metabolic compensation will occur resulting in a __________ in bicarbonate.
Increased CO2 = respiratory acidosis
Metabolic compensation = increased bicarbonate
HCO3 + H <-> H2CO2 <-> CO2 + H2O
In this case, a rise in CO2 shifts the equation to the left resulting in increased bicarbonate
When CO2 decreases in cases of respiratory _________, metabolic compensation will occur resulting in a _________in bicarbonate.
Decreased CO2 = respiratory alkalosis
Metabolic compensation = decreased bicarbonate
HCO3 + H <-> H2CO2 <-> CO2 + H2O
In this case, a decrease in CO2 shifts the equation to the right resulting in decreased bicarbonate
Visceral pleural blood supply is derived mainly from the ______________.
A) Aorta
B) Pulmonary artery
C) Bronchial artery
D) Intercostal artery
Answer = B
The visceral blood supply to the pulmonary artery; however the bronchial artery circulation plays a major role
Within the pleural system, the _________pleura has a greater role in fluid absorption because of the __________ hydrostatic pressure and _______ vascularity.
A) Visceral pleura; lower pressure; greater vascularity
B) Parietal pleura; lower pressure; greater vascularity
C) Visceral pleura; higher pressure; greater vascularity
D) Parietal pleura; higher pressure; greater vascularity
Answer = A
Surfactant is formed by which cells?
Type 2 pneumocytes
Surfactant ________ the surface tension of the liquid in the alveoli. Insufficient surfactant results in very high ________ due to ______ surface tension which leads to __________lung inflation.
Surfactant DECREASES surface tension in the alveoli.
Insufficient surfactant results in high elasticity due to high/increased surface tension which leads to DECREASED lung inflation.
Which 2 dog breeds are most likely to be affected by primary ciliary dyskinesia?
A) Dachshunds; Bichon Frise
B) Old English Sheepdogs; Dachshunds
C) Bichon Frise, Old English Sheepdogs
D) Lhasa Apso, Bichon Frise
Answer = C
Mutation in CCDC39 gene is responsible for the disease in Old English Sheepdogs
What components are involved in Kartagener’s syndrome, and it is associated with what disease?
Kartagener’s syndrome is a recessive ciliary disorder consisting of situs inversus, bronchiectasis, and chronic sinusitis.
Associated with primary ciliary dyskinesia.
Using radiography for evaluation of pneumothorax in dogs, which of the following statements is true?
A) Inspiratory views are superior to expiratory views
B) The majority of dogs developed unilateral pneumothorax.
C) Volumes of air equal to 5mL/kg, 15mL/kg, and 45mL/kg had resolved in all dogs by days 7, 10, and 14, respectively.
D) Vertical beam right lateral recumbent and expiratory horizontal beam VD views were most effective for detection of pneumothorax.
Answer = C
A is false because EXPIRATORY views are superior for pneumothorax detection.
B is false because 92% of dogs developed bilateral pneumothorax.
D is false because the 2 best views for detection of pneumothorax are a vertical beam left lateral recumbency and expiratory horizontal beam VD.
Separation of the visceral and parietal pleural surfaces on the HB VD view was a better indication of small amounts of air in the pleural space than separation of the heart from the sternum on VB lateral view.
Right lateral recumbent view, regardless of orientation, was most sensitive for the detection of differences in the amount of air in the pleural space
Why is the right middle lung lobe so prone to collapse with chronic respiratory disease?
High pleural surface area to lung volume ratio –> leads to less collateral circulation
Additionally, the vertical orientation of the right middle bronchus facilitates mucus plug formation
What are the most common tracheal tumors in dogs and cats?
Dogs = osteochondroma
Cat = epithelial malignancies (e.g. squamous cell carcinoma)
What are the most common laryngeal tumors in dogs and cats?
Dogs = epithelial malignancies
Cats = lymphoma
A 1 year old MBD is presented for coughing. The dog has no prior history of being sick although was recently adopted from Puerto Rico. Treatment with antibiotics orally was not effective. Thoracic radiographs are performed and a soft tissue opaque nodule is seen near the tracheal bifurcation that is partially superimposed over the tracheal lumen. What is the next recommended most sensitive diagnostic test?
A) Transtracheal wash
B) Bronchoalveolar lavage
C) Bronchoscopy
D) Computed tomography
Answer = C
The primary differential diagnosis for this tracheal/principal bronchial mass is Oslerus osleri (Filaroides osleri).
Most sensitive means of diagnosis = bronchoscopy
metastrongyloid nematode with a worldwide distribution but is a relatively uncommon diagnosis in North America.
In the lungs, the larvae of Oslerus osleri (Filaroides osleri) develop into adults and form nodules in the tracheal and principal bronchi sub-epithelium.
What are the 2 most consistent radiographic findings in the lungs of dogs/cats affected by paragonimiasis?
Ill-defined nodular interstitial densities and distinct air-filled pneumatocysts
Which of the following statements regarding Paragonimus infections in dogs and cats is false?
A) Pleural effusion is common.
B) Hilar lymphadenopathy is uncommon.
C) Multilocated pneumatocysts are most characteristic in dogs, while ill-defined nodular interstitial densities are more common in cats
D) Some cases may show a signet ring shadow on radiographs
Answer = A
A is FALSE because NO cases had pleural effusion.
Hilar lymphadenopathy (n = 1) and pneumothorax (n = 4) are uncommon findings.
All of the following are radiographic findings in dogs with Angiostrongylus vasorum except:
A) Bronchial thickening
B) Pulmonary vein enlargement
C) Peripheral alveolar pattern
D) Multilobar interstitial pattern
Answer = B
Thoracic radiographs of 16 dogs infected naturally with Angiostrongylus vasorum showed signs of bronchial thickening, an interstitial pattern, and a multifocal and/or PERIPHERAL alveolar pattern.
In contrast with dogs with heartworm (Dirofilaria immitis), NO pulmonary vascular lesions were identified.
Which of the following statements regarding CT findings of dogs with natural infections by Angiostrongylus vasorum is true?
A) Pleural effusion is commonly seen
B) > 75% of cases have variably-sized, hyperattenuating parenchymal nodules
C) Lesions are predominantly in the peribronchovascular regions
D) Tracheobronchial lymphadenopathy, parenchymal banding, and pulmonary arterial thrombi are all relatively common findings
Answer = D
A is false because pleural effusion was not seen in any case
B is false because only ~50% of cases have ill-defined parenchymal nodules
C is false because the lesions are predominantly PERIPHERAL in pleural and subpleural zones
Acute cerebral hemorrhage on CT may be associated with Angiostrongylus vasorum and appears as __________.
Sharply marginated homogeneous hyperattenuated regions
Exercise induced pulmonary hemorrhage in horses is usually seen in the ____________ lung region and characterized as ____________ that are usually more circumscribed toward the ________ and less well-defined towards the _______.
Caudodorsal lung region
Interstitial opacities with a wispy appearance
More circumscribed towards the hilus and less well-defined towards the periphery
A horse presents with a chronic lameness of unspecified origin. Thoracic radiographs are taken and a structured interstitial pattern with a miliary to reticulonodular appearance within the dorsal and caudodorsal lung fields is identified. What is the primary differential diagnosis?
A) Multicentric metastatic neoplasia
B) Multicentric fungal disease
C) Equine fragility syndrome
D) Parasitic pneumonia
Answer = C
Equine fragility syndrome aka silicosis infection
Affected horses have chronic lameness of vague origin; skeletal deformities that include lateral bowing of 1 or both scapulae, lateral bowing of the rib cage, and lordosis; and decreased range of motion of the cervical vertebrae. affect multiple foci in multiple bones of the axial skeleton and proximal portion of the appendicular skeleton (scapulae, ribs, vertebrae, and pelvis). Known antemortem radiographic abnormalities, limited to bones that can be assessed radiographically, include cervical vertebral body lucencies and periarticular facet exostoses, as well as segmental rib thickening consistent with bone remodeling
Osteolytic foci were apparent in trabecular and cortical bone tissue of scapulae, ribs, vertebrae, and affected long bones. Two distinct pulmonary radiographic patterns were observed in the lung sections. The first pattern was characterized by a diffuse, miliary pattern comprised of small mineral opacities (1–3 mm); the second pattern consisted of larger foci of mineral opacity (20–30 mm)
Prior reports of noncardiogenic pulmonary edema of neurogenic origin have described a _________________ pattern in the ________ lung fields. In a recent study, in cases of post-obstructive noncardiogenic pulmonary edema, the increased pulmonary opacity was more often ______, _______, and __________ in distribution.
Bilaterally symmetrical, interstitial to alveolar pattern in the caudodorsal lung fields in neurogenic noncardiogenic pulmonary edema
In post-obstructive noncardiogenic pulmonary edema the distribution is more often ASYMMETRIC, UNILATERAL, and DORSAL
T or F, rib fractures in newborn foals are more common in colts rather than fillies.
FALSE. Rib fractures are more common in Fillies.
Which of the following regarding rib fractures in newborn foals is true?
A) Most occur on the right side of the chest
B) Most common site of injury is the costochondral junction or immediately dorsal to it
C) Radiographs detect more rib fractures than ultrasound
D) Colts are more commonly than fillies
Answer = B
A is false because most fractures occur on the LEFT side of the chest
C is false because U/S detects 4X as many fractures as radiographs
D is false because Fillies are more commonly affected than colts
In ultrasound assessment of laryngeal paralysis in dogs, asymmetric or absent motion of the ____________ (which cartilage - be specific) is seen.
Cuneiform process of the arytenoid cartilage
Normal laryngeal movement = ___________of the ________cartilage and vocal cords during inspiration.
Abduction of the arytenoid cartilages –> widens the rima glottidis and decreases resistance to airflow
Equine multinodular interstitial pulmonary pattern is associated with ____________ (pathogen).
Equine Herpes Virus Type 5
The combination of ________radiographs was the most sensitive 2 view combination for detecting pulmonary metastases in dogs.
A) L lateral+ VD
B) R lateral + VD
C) VD + DV
D) R lateral + L lateral
Answer = D
Based on our findings, a change in diagnosis would have been made in 15% of patients when comparing the L+VD or R+VD series to the three-view series (85% agreement) and in 12% of patients when comparing the R+L series to the three-view series (88% agreement).
The combination of both lateral radiographs was the most sensitive two-view combination for detecting pulmonary metastases.
Thoracic radiographs as a predictor of heart base masses in dogs have a high ___________ but a poor _________.
A) High PPV, poor NPV
B) High sensitivity, poor specificity
C) High specificity, poor sensitivity
D) High NPV, poor PPV
Answer = C
High specificity = how well a test identifies an animal as NOT having the disease when the disease is absent (it correctly identifies the patients without the disease)
High sensitivity = how well a test identifies an animal as having a disease when the disease is present (it correctly identifies the patient with the disease)
Highly specific, poorly sensitive = we know what it is if we see it, but we don’t always see it
Highly sensitive, poorly specific = we see the changes, but we don’t know what they mean
Using CT, the characteristics of metastatic tracheobronchial lymphadenopathy in dogs includes a transverse maximum diameter of > _______ or lymph node:thoracic body height ratio of > _______, above which metastatic infiltration is very likely.
A) > 5.5mm; > 0.6
B) > 7mm; > 0.85
C) > 12 mm: > 1.05
D) > 15mm; > 1.2
Answer = C
Transverse maximum lymph node diameter of > 12 mm or lymph node to thoracic body height ratio of > 1.05 are proposed cutoffs, above which metastatic involvement is very likely
Lymph node contrast enhancement pattern was also significantly correlated to disease.
A heterogenous and/or ring pattern was related to metastatic disease
A _________ contrast enhancement of tracheobronchial lymph nodes in dogs on CT was significantly correlated to metastatic neoplasia.
Heterogeneous and/or ring enhancement
The most common radiographic pulmonary of pulmonary lymphoma in dogs is __________.
Answer = An unstructured interstitial pattern
The most common radiographic pulmonary pattern in dogs was an unstructured interstitial infiltrate, followed by masses and/or nodules, alveolar infiltration, and bronchial infiltration.
In cats, the two most common radiographic pulmonary patterns of lymphoma are ____________ and __________.
Answer = pulmonary nodules and/or masses and bronchial infiltrates
What dog(s) are predisposed to pneumocystis carinii pneumonia? These dogs are suspected to have underlying _____________.
Cavalier King Charles Spaniels and Miniature Dachshunds
Suspected to have underlying immunodeficiency
What is the expected CT distribution and appearance of pneumocystis carinii penumonia?
A) Multilobar or diffuse ground glass opacity
B) Focal peripheral alveolar pattern or consolidation
C) Multilobar hyperattenuating ill-defined pulmonary granulomas
D) Multilobar peribronchial thickening and peribronchial interstitial infiltrates
Answer = A
Less consistent imaging findings = parenchymal bands, bronchial dilation, and signs consistent with pulmonary hypertension
The detrusor muscle acts to expel urine following ____________activation via the ________ nerve.
Detrusor muscle –> PARASYMPATHETIC activation via PELVIC nerve –> pee
Striated urethralis muscle innervated by the __________ nerve which provides ________ innervation.
Striated urethralis muscle –> SOMATIC innvervation of PUDENDAL nerve —> pee
Smooth muscle sphincter provides involuntary tonic resistance when activated by __________ innervation via _________ nerves.
Smooth muscle sphincter –> SYMPATHETIC innervation of HYPOGASTRIC nerves –> storage
In dogs < 4 months old, renal resistivity index is ________ than in older dogs and plasma renin is ________than in older dogs.
A) Lower; lower
B) Higher; higher
C) Higher; lower
D) Lower; higher
Answer = B
Weak linear relationship between RI and plasma renin activity in dogs < 4 months old
Pathophysiology: Renal blood flow and GFR are low in young, neonatal dogs due to undeveloped kidneys. To maintain adequate GFR in the face of low mean neonatal arterial pressure there is an increase in renin secretion (activated RAAS system in neonates) which in turn leads to decreased renal arterial diameter and increased renal RI.
_____________ dogs are predisposed to renal dysplasia. Common ultrasonographic findings include poor corticomedullary distinction, multifocal hyperechoic speckles in the ___________, or a diffusely hyperechoic ________.
Cairn Terriers
Hyperechoic speckles in renal MEDULLA
Diffusely hyperechoic MEDULLA
Iohexol clearance can be used as a measure of GFR in cats and dogs. In dogs, iohexol clearance should be normalized to ____________. While in cats, normalization to _____________, _______________, and ________________ were all satisfactory. Fill in the blanks with the appropriate number/numbers
A) Body weight
B) Intracellular fluid volume
C) Extracellular fluid volume
D) Body surface area
In dogs = D ; normalization to body surface area
In cats, A, C, and D; normalization to body surface area, body weight, and extracellular fluid volume all satisfactory
An approximately 6 year old female German Shepherd presents with numerous firm nodules in the skin and subcutis and vague signs of lethargy and inappetence. Bloodwork is unremarkable and an abdominal ultrasound is recommended for further evaluation. What are some possible findings in this dog and the presumptive diagnosis if seen?
A) Hyperechoic liver with numerous hypoechoic nodules throughout; hepatocutaneous syndrome
B) Generalized renal atrophy and degenerative changes; chronic renal disease
C) Bilateral solid & cystic renal nodules and nodular heterogeneous lesions within the uterus; hereditary multifocal renal cystadenoarcinoma
D) Heterogeneous cavitated splenic and hepatic nodules/masses; metastatic hemangiosarcoma
Answer = C, HEREDITARY MULTIFOCAL RENAL CYSTADENOCARCINOMAS
A probably hereditary syndrome has been described in the German shepherd dog that is characterized by:
- multifocal renal cystadenocarcinomas
- nodular dermatofibrosis
- uterine leiomyomas (in females)
Both intramural and extraluminal urethral lesions may cause inward displacement of the urethral wall, however extraluminal lesions usually have _________ borders into the lumen while intramural lesions usually have ______ angulation into the lumen.
A) Gradually tapering; sharp
B) Distinct; indistinct
C) Indistinct; distinct
D) Sharp; gradually tapering
Answer = A
__________ breed of dog has a 19X increase in risk of transitional cell carcinoma of the urinary bladder compared to other breeds.
Scottish Terriers
The _________dog is reported to have a prostate that is ~4X the size of dogs of a similar weight/size.
Scottish Terrier
A 1 year old large, mixed breed dog is presented for repeat episodes of stranguria, hematuria, and lethargy. U/S is performed and a lobular, heterogeneous trigonal mass protruding into the lumen is identified. What breed is the dog most likely and what is the primary DDX?
A) Benign polyploid cystitis; German Shepherd
B) Granulomatous cystitis; Rottweiler
C) Urothelial carcinoma; Labrador Retriever
D) Rhabdomyosarcoma; Saint Bernard
Answer = D
Urinary bladder botryoid rhabdomyosarcoma
Characterized by multilobular, grape-like masses that protrude into bladder lumen
Most common location is trigonal
Most often found in young ( < 2 years old), large-breed dogs
Saint Bernards are over-represented
Dalmation dogs are predisposed to _______ urinary calculi.
A) Urate
B) Calcium oxalate
C) Struvite
D) Xanthine
Answer = A
Most silica uroliths have a characteristic _______appearance although this is not seen in 100% nor were all stones with this appearance made of silica.
Answer = jack stone
Regarding radiographic features of suspected suture-associated cystic calculi in dogs, which of the following is true?
A) All calculi were struvite in composition
B) Location is predominantly within the cranioventral region
C) Appearance is usually multiple, short predominantly linear mineral foci
D) May be a relationship with synthetic nonabsorbable suture material
Answer = C
A is false because all were CALCIUM OXALATE in composition
B is false because most calculi localized in the CENTER of the bladder
D is false because many used MONOFILAMENT ABSORBABLE suture
_____________ is the most common renal neoplasia in cats.
Lymphoma
An elevation in the mean renal resistive index, RI > _______, was found in dogs with clinical diagnoses of acute renal failure and congenital dysplasia.
A) > 0.5
B) > 0.6
C) > 0.7
D) > 0.8
Answer = C
When a renal resistive index of >0.70 is considered abnormal, there is a _________ sensitivity and _______specificity for determining normal versus abnormal kidneys in dogs suspected to have renal dysplasia.
A) Poor sensitivity, high specificity
B) Poor sensitivity, poor specificity
C) High sensitivity, high specificity
D) High sensitivity, poor specificity
Answer = A - poor sensitivity, high specificity
38% Sn, 96% Sp
once RI gets that bad then the dog probably has renal failure from congenital dysplasia -highly specific, but could still have congenital dysplasia at lower RI values that we just can’t see - POORLY sensitive)
Renal pelvic dilation of _______always indicated obstruction in dogs and cats.
Pelvic width ≥ 13 mm always indicated obstruction.
When does fetal mineralization occur in the dog?
A) 38 days
B) 40 days
C) 43 days
D) 45 days
Answer = C, 43 days (~20-22 days before parturition)
When does fetal mineralization occurs in the cat?
A) 43 days
B) 38 days
C) 32 days
D) 27 days
Answer = B, 38 days (~25-29 days before parturition)
Fetal heartbeat in the dog is detectable at ______ days.
A) 30-32 days
B) 28-25 days
C) 23-25 days
D) 20-23 days
Answer = C, 23-25 days
Fetal heartbeat in the cat is detectable at ______ days.
A) 16-18 days
B) 18-20 days
C) 22-24 days
D) 26-28 days
Answer =A, 16-18 days
Normal fetal heart rate is _________________.
~220-240 bpm or approximately 2x that of the mother
Slight fetal distress is between 180-220 bpm
Severe fetal distress is < 180bpm
Using U/S to assess the timing of pregnancy in Beagles, at what days is the liver hypoechoic compared to the lung?
A) Day 33-39
B) Day 39-47
C) Day 35-39
D) Day 38-42
Answer = D, day 38-42
Day 33-39 is detection of the skeleton
Day 39-47 is detection of the kidney
Day 35-39 is detection of the bladder and stomach
Of the fetal structures, what is the most accurate measure for estimation of gestational age in dogs?
A) Crown to rump length
B) Body diameter
C) Chorionic cavity diameter
D) Head diameter
Answer = D, head diameter
Chorionic cavity diameter was the most accurate of the extra-fetal structures for estimating gestational age.
Using transrectal U/S in horses to diagnose abnormal embryonic development and a vesicle without an embryo, mares should be examined on day ________ after ovulation. If an embryo is not identified at that time, mares should be reexamined every 1-3 days until day ______.
A) Day 20; Day 25
B) Day 22; Day 28
C) Day 24; Day 9
D) Day25; Day 30
Answer = D
In foals and calves, the __________is the most commonly affected structure in umbilical remnant infections.
A) Umbilical artery
B) Urachus
C) Umbilical vein
D) patent urachus
Answer = B
~79% of foals had an infected urachus
- association between an umbilical infection and a patent urachus was NOT evident in foals
How many umbilical veins do foals have?
ONE
What are 4 signs of fetal death in the dog and cat?
1) Intravascular fetal gas - usually in heart +/- vessels or umbilicus (~6 hours post mortem)
2) Collapse of skeletal elements - overlap of cranial bones/calvarial collapse (~2 days post mortem)
3) Malpositioned fetus
4) Altered spatial relationship between skeletal bones, especially the vertebral column - “bag of bones” or “C-shaped”
Pyometra occurs under the influence of ________ hormone and therefore almost always occurs during _______.
A) Estrogen; estrus
B) Estrogen; diestrus
C) Progesterone; estrus
D) Progesterone; diestrus
Answer = D
What are the 2 mechanisms by which pyometra causes polyuria/polydipsia?
1) E. coli endotoxin reduces sodium absorption from loop of Henle –> PUPD
2) Reversible renal tubular insensitivity to ADH/vasopressin
__________ is a common clinical finding in dogs with ovarian tumors, attributable to tumor metastasis in ______________.
Ascites
tumor metastasis in peritoneal lymphatic vessels which causes lymphatic obstruction
Of the 3 main types of ovarian tumors: 1) _________, 2) ___________, 3__________. Which is the most common in dogs and cats, respectively?
1) Epithelial tumors - e.g. papillary adenoma/adenocarcinoma, carcinoma, cystadenoma
2) Germ cell tumors
3) Sex cord stromal cell tumors - e.g. granulosa cell, thecoma, luteoma
- Epithelial tumors comprise ~40-50% of canine cases
- In cats, > 50% are granulosa cell tumors ( more than 50% of these are malignant)
The germ cell tumors are the LEAST common type in dogs
In the relationship between prostatic mineralization and cytologic diagnosis of neoplasia, what is the PPV, NPV, Sn, and Sp in intact and neutered dogs?
Mineralization in intact dogs has a 22% PPV, 96% NPV, 67% Sn, 77% SP
Mineralization in neutered dogs has a 100% PPV, 50% NPV, 84% Sn, 100% Sp
Approximately 70% of _________ tumors in dogs arising from abdominal testes are functional and associated with ___________.
Sertoli cell tumors
Associated with feminizing paraneoplastic syndrome called hypoestrogenism
Describe the relative signal characteristics/tissue attenuation of carotid body paragangliomas to adjacent musculature on MRI and CT?
Masses are iso to hypoattenuating to adjacent muscle on CT
Masses are hyperintense to adjacent muscle on T1 and T2W MRI
On CT and MRI, carotid body paragangliomas show ______contrast enhancement.
Strong, heterogeneous enhancement
Thyroid stimulation hormone (TSH) is secreted by the _______.
Anterior pituitary (adenohypophysis)
What are the 3 functions of thyroid peroxidase?
1) Oxidizes dietary iodide to iodine (as it passes through apical wall of thyroid follicle cell)
2) Helps to incorporate iodine into thyroglobulin molecule using tyrosine as a substrate
3) catalyzes coupling of DIT and DIT to form thyroxine (T4)
Thyroxine, also called ______, is comprised of _____ + ________ and is the biologically _______ form.
Thyroxine = T4
T4 = DIT + DIT
T4 = biologically INACTIVE
Triiodothyronine, also called _____, is comprised of _______ + ________ and is the biologically ________ form.
Triiodothyronine = T3
T3 = MIT + DIT
T3 = biologically ACTIVE
The process by which iodine attaches to a thyroglobulin/tyrosine ring is _____________.
Organification
Organification forms monoiodotyrosine (MIT) and diiodotyrosine (DIT)
Which of the following tissues does NOT increase in response to an increased basal metabolic rate from thyroid hormone?
A) GI smooth muscle
B) Vascular smooth muscle
C) Kidney
D) Liver
E) Gastric mucosa
Answer = A, GI smooth muscle
Tissues that increased their basal metabolic rate in response to thyroid hormone = cardiac muscle, skeletal muscle, vascular smooth muscle, kidney, liver, and gastric mucosa
Tissues that are NOT stimulated by thyroid hormone = GI smooth muscle, brain, lungs, gonads, and lymph nodes
What is the mechanism of action of Methimazole?
Inhibits thyroperoxidase by:
1) Interferes with iodine incorporation into tyrosyl residues of thyroglobulin (AKA inhibits organification of iodine)
2) Inhibits iodinated tyrosyl residues from coupling to form iodinated thyronines (AKA inhibits coupling of DIT + DIT to form T4)
Parathyroid nodules that are ________ in diameter are more likely to be parathyroid adenomas or carcinomas, whereas those nodules ________________________________ in diameter are more often primary hyperplastic or secondary to chronic renal disease or hypercalcemia of malignancy/
Parathyroid nodules that are ⋝ 4 mm in diameter are more likely to be parathyroid adenomas or carcinomas
The majority of dogs with pituitary-dependent hyperadrenocorticism have _________adenomas located within the _______hypophysis.
A) macroadenomas; neurohypophysis
B) macroadenomas; adenohypophysis
C) microadenomas; neurohypophysis
D) microadenomas; adenohypophysis
Answer = D
Almost 40% have microadenomas vs 15-20% which have macroadenomas
Tumors of the neurohypophysis are RARE
With regards to adrenal tumors, solid lesions exceeding ______ generally predict benign or malignant neoplasia rather than hyperplasia.
Masses greater > 2cm are either benign or malignant neoplasia
Adrenal tumors exceeding ________ usually indicate malignant neoplasia.
Masses greater than 4cm usually indicate malignant neoplasia.
In a CT of nonparenchymal hemangiosarcoma in dogs, one may see intense foci of contrast enhancement within tumors which corresponds to _______________.
Contrast medium residing within vascular channels
____________ is the primary center of ossification.
A) Epiphysis
B) Physis
C) Metaphysis
D) Diaphysis
Answer = C
Name the 4 zones of a physis in order from the metaphysis to epiphysis:
Metaphysis
Zone of calcification
Zone of hypertrophy (WEAKEST zone -physeal fractures occur here!)
Zone of proliferation
Zone of resting/reserve
Epiphysis
Humeral condylar ossification occurs at ________ weeks in the dog.
6-10 weeks
- Spaniels predisposed to intercondylar fractures
Ossification of the proximal humerus occurs at ________months in the dog and ______ months in the cat.
Proximal humeral ossification dog = 12-18 months (Contributes 80% of growth)
“ “ cat = 18-24 months
The anconeal process should be fused by _______ in dogs.
Anconeal process fusion < 5 months in dogs
The tibial tuberosity apophysis should fuse by _______ months in dog and of the 3 physes the ______ and the ______ is the last one to close.
Tibial tuberosity closure between 10-12 months
Apophysis to metaphysis = last one to close between 6-12 months
The arches of the atlas (C1) fuse at _________ days.
C1 arches = 106 days
*Mnemonic: arches is 6 letters, 106 days
Intercentrum of the atlas (C1) fuses at ____ days.
C1 intercentrum = 115 days
Centrum of proatlas of C2 (axis) fuses to C1 at _________ days
Centrum of proatlas + C1 = 100-110 days
Physeal closure of the greater trochanter, distal femur, and tibial tuberosity occurs earlier ______ cats versus ______ cats. No effect was shown for any physis when comparing ________ cats to ________ cats.
Earlier physeal closure in MALE INTACT cats versus male neutered cats.
No difference in physeal closure in FEMALE intact versus female spayed cats.
*Physeal closure occurs LATER IN LIFE when males are neutered
- Similar results are seen in male dogs, where growth plate closure was delayed in all neutered dogs. The younger the patient is when neutered, the LONGER the physes will be open
The degree of ossification of the carpal/tarsal bones in neonatal foals that are ______________ or are ____________ at birth may be incomplete.
Born prematurely (< 320 days gestation) or are “small for gestational age”
In these cases, radiographs of the carpi/tarsi should be performed to assess the skeletal ossification index.
Grade 1 = some cuboidal bones with no ossification
Grade 2 = all cuboidal bones had some ossification
Grade 3 = small and round cuboidal bones
Grade 4 = normal, bones shaped like adult counterparts
T____ is usually the anticlincal vertebrae in dogs. T______ is more common in small breed dogs. Anticlincal vertebrae can be T ______ to T _______.
T11 is usually the anticlinal vertebrae.
T10 is more common in small dogs.
Anticlinal vertebrae can be T10-T12.
For an oblique view of the equine temporomandibular joint which view should be used?
A) Rostral 25 lateral 50 ventral caudodorsal
B) Rostral 25 lateral 50 dorsal caudoventral
C) Rostral 35 lateral 50 ventral caudodorsal
D) Rostral 35 lateral dorsal caudoventral
Answer = C
The _______ process is the large vertical process of the ramus of the mandible which serves as the distal insertion for the _________ muscle.
Coronoid process
Distal insertion for temporalis muscle
The most common site for equine sinonasal tumors is the ___________.
A) Sphenopalatine sinus
B) Rostral maxillary sinus
C) Caudal maxillary sinus
D) Conchofrontal sinus
Answer = C, caudal maxillary sinus
What is the ORIGIN of the middle and accessory gluteal muscles?
Wing of the ilium
The infraglenoid tubercle serves as the origin for which 2 muscles?
Teres minor - origin more cranially
Triceps, long head - origin more caudally
The acromion is the origin of the ________ in dogs, cats, and cows.
Deltoideus
The biceps femoris, semitendinosus, and semimembranosus originate from the ___________.
Ventral surface of the ischiatic tuberosity
The corcacoid process is prominent in _________. It is located on the _______aspect of the supraglenoid tubercle and is the origin of the ________ muscle.
coracoid process prominent in CATS
- MEDIAL aspect of the supraglenoid tubercle
- Origin of the CORACOBRACHIALIS
In the scapula, the horse and pig do NOT have a ___________.
Acromion process
The greater tubercle of the humerus is located on the ________aspect and serves as the insertion site for the _________, _________, and _________ muscles.
Greater tubercle is the large process cranioLATERAL to humeral head.
Insertion site for:
1) supraspinatous = total insertion most cranioproximal
2) infraspinatous -lateral margin
3) teres minor -more caudodistal, just proximal to deltoid tuberosity
The lesser tubercle of the humerus is located on the _______ side and serves as the insertion for the __________ muscle.
Lesser tubercle on MEDIAL aspect of humerus
Insertion site for SUBSCAPULARIS muscle
The humeral condyle is divided into two parts: the more medial __________ and the more lateral ____________.
Trochlea = MEDIAL , articulates with trochlea of ulna
Capitulum = LATERAL , articulates with radial head
The lateral epicondyle of the humerus gives rise to the _______ muscles of the carpus and digit and lateral collateral ligament.
Lateral epicondyle = Extensor muscles
The supinator arises from the ________ humeral epicondyle.
Supinator = lateral humeral epicondyle
In dogs, the opening between the radial fossa and olecranon fossa is called the _________________ foramen and ________ passes through it.
SupraTROCHLEAR foramen
NOTHING passes through it
In cats, the opening in the medial humeral epicondyle is called the ___________ foramen and _______________ passes through it.
SupraCONDYLAR foramen
Brachial artery and median nerve pass through it
In a lateromedial flexed radiograph of the equine carpus, the _________ carpal bone is proximal to the ________ carpal bone in the proximal row. In the distal row, the ______ carpal bone is proximal to the _________ carpal bone.
Intermediate carpal bone is proximal to the radial carpal bone - think Radial drops like a Rock.
4th carpal bone is proximal to 3rd carpal bone - think descending order from proximal to distal
On radiographic studies of the equine carpus, an avulsion fracture/fragment may be observed on the ______aspect of the ulnar carpal bone. The ________ projection was useful for evaluating the size and shape of the avulsed bone fragment, and the _______ projection added information on the relative proximity of the fragment to its fracture bed. This avulsion fracture is associated with the ___________________ ligament.
Fragment on MEDIAL aspect of ulnar carpal bone
DLPMO projection useful for size/shape of fragment
DP view useful for proximity of fragment to fracture bed.
LATERAL palmar intercarpal ligament
For accurate radiography of the distal /3rd phalanx of a cow, the best view is:
A) Dorsal 30 proximo-palmarodistal oblique
B) Medial 30 proximo-palmarodistal oblique
C) Medial 65 proximo-palmarodistal oblique
D) Dorsal 65 proximo-palmarodistal oblique
Answer = D
For distal phalanx in cow = Dorsal 65 proximo-palmarodistal oblique
For accurate radiography of the lateral 3rd phalanx in a cow, the best view is:
A) Lateral 20 proximal-mediodistal oblique
B) Medial 20 proximal-laterodistal oblique
C) Lateral 30 proximal-mediodistal oblique
D) Medial 30 proximal-laterodistal oblique
Answer = C
For lateral 3rd phalanx = lateral 30 proximal-mediodistal oblique
What 3 muscles INSERT on the greater trochanter of the femur?
Middle gluteal
Deep gluteal
Piriformis
The 3rd trochanter of the femur is located on the ________ side and serves as the insertion site for the _________ muscle.
3rd trochanter = LATERAL margin of femur, distal to greater trochanter
Insertion site for SUPERFICIAL gluteal
Of the femoral condyles, the ________ condyle is larger in dogs and the _______ condyle is larger in horses.
LATERAL femoral condyle larger in DOGS
MEDIAL femoral condyle larger in HORSES
The cranial cruciate ligament runs from the _____________ part of the __________condyle of the femur, somewhat diagonally across the intercondyloid fossa to the ________________ of the tibia.
Runs from CAUDOMEDIAL margin of LATERAL femoral condyle to the CRANIAL INTERCONDYLOID REGION of the tibia
The lateral malleolus of the tibia is a separate ossification center in the horse that fuses by _______ months of age.
A) 2 months
B) 3 months
C) 5 months
D) 6 months
Answer = B
The gracilis and semitendinosus insert on the __________.
Cranial border of the tibia
What makes up the common calcaneal tendon in the dog? what about the cat?
1) Gastrocnemius (major component)
2) Superficial digital flexor
3) Gracilis
4) SemiTENDINosus
5) Biceps femoris
In the cat there is the addition of the SOLEUS muscle laterally
In the horse tarsus there is a separate center of ossification of the ____________, which may be absent at birth but gradually ossifies and fuses to the _______ by 16-24 months of age.
Separate center of ossification of the TUBER CALCANEI which fuses to calcaneus
In horses, the _________passes over the sustentaculum tali. If there is flattening of the proximal aspect of the sustentaculum tali, then the _________ may slip __________ and _________ (directions)
Deep digital flexor tendon
DDFT may slip dorsally and medially
In horses with cases of septic calcaneal bursitis, which of the following statements is false?
A) Wounds involving only the subcutaneous bursa have an excellent prognosis.
B) Damage to the tuber calcanei presents a poorer prognosis than involvement of only the soft tissue structures.
C) < 50% of horses with involvement of the tuber calcanei survived
D) > 90% of the horses with involvement of the intertendinous calcaneal bursa survived.
Answer = D
D is false because 75% of horses with wounds involving the intertendinous calcaneal bursa survived.
Involvement of the tuber calcanei presented a fair to guarded prognosis, with only 44% of horses with involvement of this structure surviving.
The bicipital bursa communicates with scapulohumeral joint in _________ (species) but NOT in __________ (species).
Communication of the shoulder joint & bicipital bursa in DOGS but NOT IN HORSES
True or false, cats have a nuchal ligament.
FALSE. Cats do NOT have a nuchal ligament.
Dogs have one - spans from the spinous processes of C2 to T1
Which tendon inserts on the extensor process of P3 in horse feet?
Common (long) digital extensor tendon
Common in the forelimb, long in the hindlimb
Where does the lateral digital extensor tendon end in the horse?
Inserts on the roughening on the dorsal aspect of P1
The cruciate intersesamoidean ligament in the horse originates on the ________________ and inserts on the ____________.
Cruciate ligament origin = base of proximal metacarpophalangeal sesamoids
Insertion = palmar proximal P1
The oblique sesamoidean ligament inserts on __________.
Mid palmar P1
The straight sesamoidean ligament inserts via the ________ on __________.
Inserts via middle scutum on proximal P2
Of the 3 synovial compartments of the equine stifle joint which of the following statements is FALSE?
A) Medial and lateral femorotibial joints never communicate.
B) Communication of the femoropatellar joint with both the medial and lateral femortibial joints is < 20%
C) Communication of the femoropatellar joint with the medial femoropatellar joint is more common.
D) Communication of the femoropatellar joint with the lateral femoropatellar joint is more common.
Answer = D
D is false because lateral femorotibial joint communication is only ~3% versus ~65% with medial femorotibial
Which vascular ring anomaly can cause respiratory signs in addition to esophageal regurgitation?
Double aortic arch
In U/S of the umbilicus in foals and calves, what is the correct number of umbilical arteries and veins that should be seen?
A) both foals and calves each have 2 umbilical arteries and 2 umbilical veins
B) Foals have 1 umbilical artery and 2 umbilical veins while calves have 2 of each
C) Calves have 1 umbilical vein and 2 umbilical arteries, while foals have 2 of each
D) Foals have 1 umbilical vein and 2 umbilical arteries, while calves have 2 of each.
Answer = D
During U/S of the umbilicus, foals are scanned _____________ and calves are scanned ______________.
Foals are scanned along midline
Calves are scanned along the right side
In regards to umbilical ultrasound in foals and calves, in which do the umbilical arteries rupture and retract at birth leading to a lack of visualization within the umbilical stalk.
In CALVES the umbilical ARTERIES RUPTURE & RETRACT at birth
In the external umbilical stalk, the urachal remnant may be seen in _________ but should never be seen in __________. (Fill in foals and calves)
Urachal remnant may be seen in FOALS
Urachal remnant should NOT be seen in CALVES
At the bladder apex, in _________ the urachal remnant may be seen between the two umbilical arteries. (Fill in foals and calves)
FOALS may see urachal remnant at bladder apex
Which vessels join to form the Circle of Willis in dogs?
1) Right and left ROSTRAL CEREBRAL ARTERIES and their rostral communicating arteries
2) Caudal communicating arteries from the INTERNAL CAROTID arteries
3) Basilar artery
What is the anatomic difference in the blood flow in the Circle of Willis in the cat, that is not seen in dogs?
In cats, the basilar artery carries blood AWAY from the circle (vs carries blood toward the circle in dogs).
In cats, the MAXILLARY ANASTAMOSING RAMUS supplies the circle
In arterial blood flow of the brain in dogs, the rostral cerebellar arteries arise from the ______________. In horses they arise from the ___________.
Dogs rostral cerebellar arteries arise from caudal part of the arterial circle.
In horses, rostral cerebellar arteries arise from the basilar artery.
In arterial blood flow of the brain, the caudal cerebellar arteries arise from the __________.
Basilar artery
The hypophyseal portal system arises from the ____________ and supplies blood to the ___________.
Arises from the hypothalamus (aka hypothalamic hypophyseal portal system)
Supplies the adenohypophysis (anterior pituitary)
After enhancement of the ___________ arteries and arterial cerebral circle, the ________portion of the pituitary gland also known as the _________hypophysis enhances maximally.
First enhancement of the INTERNAL CAROTID arteries and Circle of Willis then enhancement of the CAUDAL/CENTRAL portion of the pituitary gland which is the NEUROhypophysis
The external jugular vein is formed by the joining of the _________ and _________ veins.
Maxillary vein + linguofacial vein = external jugular vein
The brachiocephalic trunk in dogs/cats is formed by the joining of the _________ and ___________ veins.
Brachiocephalic trunk = subclavian + external jugular veins
In horses, the joining of the external jugular veins and subclavian veins forms the _____________.
External jugular + subclavian veins = Cranial vena cava in horses
The arterial blood supply to the gray and while matter of the spinal cord is supplied by the ______________ and ____________ arteries, respectively.
A) Radial arteries; vertical artery
B) Vertical artery; radial arteries
C) Ventral spinal artery; perforate arteries
D) Perforate artery; ventral spinal artery
Answer = B
Ventral Spinal Artery (unpaired) = Largest & follows the ventral fissure of the spinal cord
- The ventral spinal artery branches = vertical artery which supply the ‘core’ of the cord – the gray matter & the adjacent white matter by an approach through the ventral fissure
- Dorsolateral spinal arteries (paired): run close to the furrow from which the dorsal roots of the spinal nerves arise
- The greater part of the white matter is supplied by the radial arteries branching from the dorsolateral arteries and the surface plexus
An R2A anomaly can cause pulmonic stenosis, primarily in Bulldogs, and occurs when the ________ coronary artery arises from the _______ coronary artery and passes __________ to the main pulmonary artery.
R2A = LEFT coronary artery arises aberrantly from the right coronary artery and passes CRANIAL or PRE-PULMONIC to the main pulmonary artery
The first branch off the aortic arch is the _____________, which then trifurcates into which 3 vessels.
First branch off the aortic arch is the brachiocephalic trunk.
Brachiocephalic trunk –> LEFT common carotid first then RIGHT common carotid and then right subclavian
The blood supply to the femoral head is composed of which 3 vessels?
1) Lateral circumflex: external iliac -> femoral
2) Medial circumflex: external iliac -> deep femoral
3) Caudal gluteal: branch of internal iliac
From which 2 echocardiography views can a PDA be visualized?
Right parasternal short axis view
Left parasternal cranial view
There should no ________flow in the pulmonary. If _________flow is observed, it is important to search for a _______.
No DIASTOLIC flow in the pulmonary artery.
If DIASTOLIC flow is observed, search for a PDA.
The _________ echo view is optimized to view the right ventricular outflow tract in dogs with suspected pulmonic stenosis.
Left parasternal
Pulmonic stenosis pressure gradients:
_________mmHg = mild
_________mmHg = moderate
_________mmHg = severe
PS
30-50 mmHg = mild
50-75mmHg = moderate
> 75mmHg = severe
Aortic stenosis pressure gradients:
________mmHg = mild
________mmHg = moderate
________mmHg = severe
Aortic stenosis
< 50 mmHg = mild
50-80 mmHg = moderate
> 80 mmHg = severe
On which lateral thoracic radiographic projection may the heart have increased sternal contact?
RIGHT lateral
On which lateral thoracic radiographic projection may the apex of the heart be slightly dorsally displaced from the sternum?
LEFT lateral
Cranial pulmonary lobar arteries are best separated on the ___________ view. In this view, the right cranial lobar arteries will be _________ to the left.
Best separated on LEFT LATERAL view
Right cranial lobar arteries VENTRAL to the left
Normal foals usually have clear lung fields within ________ hours of birth.
A) 4 hours
B) 6 hours
C) 9 hours
D) 12 hours
Answer = D
In horses with bacterial endocarditis, vegetative lesions were most frequently found on the _______ valve and secondarily on the ______ valve.
A) Tricuspid; mitral
B) mitral; tricuspid
C) mitral; aortic
D) aortic; mitral
Answer = C
In equine neonatal thoracic radiographs, the craniocaudal and apicobasilar dimensions of the heart were ________ and ________ times teh length of a midthoracic vertebral body, respectively in normal, immature and septicemic foals.
Apicobasilar measurement were ________ up to ________ in foals with respiratory distress syndrome.
Craniocaudal measurement = 5.7-6.3
Apicobasilar measurement 6.7-7.8
Apicobasilar measurements GREATER up to 8.0-8.7 in foals with respiratory distress syndrome.
On U/S, the roots of the brachial plexus appear as a cluster of small, round, __________ structures surrounded by a ___________ in the axillary approach.
HYPOechoic structures with a HYPERechoic rim
The femoral nerve runs through the ___________ muscle with ____________ artery and vein.
Ilipsoas/Psoas
External iliac artery/vein
The pudendal nerves runs from ___ to _____ and provides motor innervation to __________.
S1-S3
Motor to urethral and anal sphincters (Remember pudendal = pee)
The slips of white matter/axons extending into individual gyri describes which portion of the brain?
A) Sulci
B) Internal capsule
C) Corona radiata
D) Corpus callosum
Answer =C
The white matter/axons connecting the right and left cerebral hemispheres is the ________?
A) Sulci and gyri
B) Internal capsule
C) Corona radiata
D) Corpus callosum
Answer = D
The white matter/axons carrying information from the neocortex (cerebrum) to the brainstem (thalamus) is the _______?
A) Sulci and gyri
B) Internal capsule
C) Corona radiata
D) Corpus callosum
Answer = B
The fold of dura within the longitudinal fissure is the ____________.
Falx cerebri
The fold of dura within the transverse fissure, between the cerebrum and cerebellum, is the ________.
Tentorium cerebelli
The tentorium cerebelli arises from the _________.
Parietal bone
Unlike the dura mater within the spinal cord which only has 1 layer, the dura mater within the cranium has two layers - the ________ and ________.
Periosteal dura and meningeal dura
-There is NO epidural space
- Cranial venous sinuses are located between the periosteal and meningeal dura
Pachymeninges = _______ arachnoid
Leptomeninges = ________ arachnoid
Pachymeninges = dura arachnoid
Leptomeninges = pia arachnoid
What structure is H-shaped on dorsal planes brain MRI images?
Quadrigeminal cistern
Using CT for determining the optimal window width and level for measurement of the canine pituitary height, which of the following statements is true?
A) Underestimation of pituitary height is most likely due to erroneous placement f the edge of the edge of the basisphenoid bone using a high level and wide window
B) The most accurate measurements using a single window width/window level were obtained at WW 80, WL 250.
C) Detection of the pituitary at a brain-pituitary gland edge of WW 80, WL 250 was accurate.
D) Detection of the pituitary at a bone-pituitary gland edge of WW 250, WL 240 was accurate.
Answer = D
Using a single window setting, the most accurate measurements were obtained with a WW-WL 250–80
Using different window settings for detection of the brain– pituitary gland edge (WW250– WL80) and the bone–pituitary gland edge (WW250–WL240) provided the most accurate measurement of the height of the pituitary gland.
Underestimation of the height of the pituitary gland on CT images is most likely due to erroneous placement of the edge of the basisphenoid bone using a- low level and a narrow window.
What is the function of the septum pellucidum?
Separation of the lateral ventricles
CSF circulates in the subarachnoid space and is absorbed into venous sinuses by _______.
Arachnoid villi
CSF in the subarachnoid space flows in which direction?
Rostrally
What is the origin and exit of the oculomotor nerve?
Origin = midbrain
Exit = orbital fissure (wing of basisphenoid bone)
What C/S results from dysfunction of the oculomotor nerve?
Ventrolateral strabismus
Anisocoria (mydriasis)
Absent/reduced PLR
Oculomotor functions: 1) Somatic (motor) to eyelid & ocular muscles; 2) parasympathetic (motor) visceral to ciliary muscles
What is the function of the trochlear nerve? And what C/S results from its dysfunction?
Trochlear function = motor to dorsal oblique ocular muscle
C/S of dysfunction = dorsolateral strabismus
What is the exit for the ophthalmic branch of the trigeminal nerve?
Trigeminal canal (rostromedial petrous portion of temporal bone) -> orbital fissure
What is the exit for the maxillary branch of the trigeminal nerve?
Trigeminal canal (petrous temporal bone) —> ROUND foramen (basisphenoid bone, caudal to orbital fissure) –> alar canal (pterygoid process)–> rostral alar foramen (basisphenoid)
- There is NO alar canal in CATS*
What is the exit for the mandibular branch of the trigeminal nerve?
Trigeminal canal –> OVAL foramen (basisphenoid)
What is the function of the ophthalmic branch of the trigeminal nerve?
SENSORY input from globe, periorbital tissue, medial canthus of eye, and nasal mucosa (septum)
What is the function of the maxillary branch of the trigeminal nerve?
SENSORY input from lateral canthus of eye, maxillary region, and nasal mucosa
What are the functions of the mandibular branch of the trigeminal nerve?
1) Sensory input from mandibular and auricotemporal areas
2) Motor to masticatory muscles: temporalis, masseter, medial & lateral pterygoid, and ROSTRAL portion of the digastricus
3) Motor to TENSOR VELI PALATINI - opens auditory canal/Eustachian tube
What C/S result from dysfunction of the ophthalmic branch of the trigeminal nerve?
Decreased PLR (medial canthus)
Decreased corneal reflex
Decreased nasal septum sensation
What C/S result from dysfunction of the maxillary branch of the trigeminal nerve?
Decreased PLR (lateral canthus)
Decreased nasal mucosa sensation
Decreased sensation to upper lip
What C/S result from dysfunction of the mandibular branch of the trigeminal nerve?
Masticatory muscle atrophy
DROP JAW
Effusion in tympanic bulla (tensor veli palatini dysfunction)
Decreased sensation to lower lip
Decreased lacrimation
What is the exit of the abducens nerve?
Orbital fissure
Which cranial nerves exit the orbital fissure?
Oculomotor (CrN 3)
Trochlear (CrN 4)
Ophthalmic branch of trigeminal (CrN 5)
Abducens (CrN 6)
What is the function of the abducens nerve and what C/S results from its dysfunction?
Function: motor to lateral rectus extraocular muscle and retractor bulbi
C/S from dysfunction = MEDIAL strabismus
What is the exit for the facial nerve?
Internal acoustic meatus (petrous temporal bone) —> facial canal –> stylomastoid foramen
What are the functions of the facial nerve?
Motor to CAUDAL DIGASTRICUS and muscles of facial expression
Sensory input from rostral tongue
Parasympathetic to salivary and lacrimal glands
What C/S result from dysfunction of the facial nerve?
Facial asymmetry - lip or ear droop
Decreased PLR
Decreased lacrimation
Which 2 cranial nerves exit from the internal acoustic meatus?
Facial (stylomastoid foramen) and vestibulocochlear
What is the function of the vestibulocochlear nerve and what C/S result from its dysfunction?
Sensory inout from inner ear pertaining to hearing and balance.
C/S of dysfunction = head tilt, deafness, nystagmus
What is the exit of the glossopharyngeal nerve?
Jugular foramen —> tympano-occipital fissure
What C/S result from dysfunction of the glossopharyngeal nerve?
Dysphagia
What are the functions of the glossopharyngeal nerve?
1) Sensory input from caudal tongue and pharyngeal mucosa
2) Motor to pharynx
3) Parasympathetic to zygomatic and parotid salivary glands
Where is the common exit for the glossopharyngeal, vagus, and accessory cranial nerves?
Jugular foramen –> tympano-occipital fissure
What are the functions of the vagus nerve?
1) Motor to esophagus, pharynx, and larynx
2) Parasympathetic to heart, lungs, and abdominal viscera
3) Sensory input from pharynx, larynx, trachea, and ear canal
What C/S result from dysfunction of the vagus nerve?
Dysphagia
Voice change
Inspiratory stridor
Aspiration
What is the function of the accessory cranial nerve?
Motor to trapezius, sternocephalicus, and brachiocephalicus
What C/S result from dysfunction of the accessory nerve?
Neck muscle paralysis and atrophy
What is the exit of the hypoglossal nerve?
Hypoglossal canal
What is the function of the hypoglossal nerve and what C/S result from its dysfunction?
Motor to tongue
C/S of dysfunction = tongue paralysis, abnormal deviation of tongue (TOWARDS lesion), tongue atrophy
With forebrain lesions, which of the following if affected will show ipsilateral signs and which will show contralateral C/S?
Gait/posture, including circling:
Cranial nerves:
Postural reactions:
Gait/posture = ipsilateral
Cranial nerves = contralateral
Postural reactions = contralateral
The combination of normal or near-normal gait in conscious proprioceptive deficits, which are usually ________, is a hallmark of ________dysfunction.
Cerebral dysfunction = combo of normal/near normal gait and CONTRALATERAL proprioceptive deficits
All of the C/S associated with cerebral disease may be seen in patients with ________ disorders.
diencephalic
Large lesions of the __________ may produce stupor or coma as it includes part of the reticular activating system.
Diencephalon
Focal lesions of the diencephalon and/or cerebrum may results in menace response deficits that are primarily _________ to the lesion.
Contralateral
- sensory modality of vision is carried by the optic nerves (CrN II), which are associated with the forebrain (cerebrum and diencephalon). Axons of the optic nerve arise from the ganglion neurons of the retina. The majority of axons in each optic nerve carrying visual information for cerebral cortical recognition cross to the opposite side at the level of the optic chiasm (65% crossing in the cat; 75% in the dog). These axons then synapse on neurons in the lateral geniculate nucleus (LGN) of the diencephalon. These LGN neurons, in turn, relay information to the occipital area of the cerebral cortex for the perception of sight.
With midbrain/brainstem lesions, which of the following if affected will show ipsilateral signs and which will show contralateral C/S?
Gait:
Posture/head tilt:
Cranial nerves:
Postural reactions:
Gait: ipsilateral, spastic gait
Posture: usually normal, but head tilt may be ipsilateral or contralateral
Cranial nerves: ipsilateral
Postural reactions: ipsilateral
The anatomic landmark for focal lesions that will produce ipsilateral gait and postural reaction deficits appears to be in the vicinity of the ____________.
Lesions rostral to the midbrain cause __________ postural reaction deficits and mild or inapparent ____________paresis.
Vicinity of caudal midbrain and rostral pons
Lesions ROSTRAL to midbrain cause CONTRAlateral postural reaction deficits and CONTRAlateral paresis
The tectum refers to the ________aspect of the _________; tegmentum refers to the _________ of the ___________
Tectum = DORSAL aspect/ROOF of MIDBRAIN
Tegmentum = BODY of the MIDBRAIN
Brainstem lesions __________ to the diencephalon may lead to ____________ deficits in facial sensation, whereas forebrain lesions produce ______________deficits.
Brainstem lesions CAUDAL to diencephalon may cause IPSILATERAL
Forebrain lesions cause CONTRALATERAL facial deficits
Lesions in the rostral medulla will frequently cause _____________ signs, with or without ________ nerve deficits.
Lesions in caudal medulla will cause ___________, ___________, and occasionally tongue paresis.
Rostral medulla lesions frequently cause CENTRAL VESTIBULAR signs with or without FACIAL nerve deficits
Caudal medulla lesions = dysphonia, dysphagia
Fill in the blanks for a C1-C5 myelopathy:
Mental status: ___________
Posture/gait: _____________
Cranial nerves: __________
Postural reactions: __________
Spinal reflexes: _________
Palpation: ____________
Pain perception: ___________
Mentation = Normal
Posture/gait:
- neck posture may be normal, low, rigid, torticollis
-tetraparesis/plegia or IPSILATERAL thoracic & pelvic limbs
Cranial nerves: Normal, possible IPSIlateral Horner’s
Postural reactions: Normal or decreased x4 or in IPSIlateral limbs (pelvic»_space; thoracic)
Spinal reflexes: Normal to increased x4 or in IPSIlateral limbs
Palpation: Muscle tone normal to increased x4, NO atrophy, +/- neck pain
Pain: normal to decreased or absent superficial or deep pain
Fill in the blanks for a C6-T2 myelopathy:
Mental status: ___________
Posture/gait: _____________
Cranial nerves: __________
Postural reactions: __________
Spinal reflexes: _________
Palpation: ____________
Pain perception: ___________
Mentation = Normal
Posture/gait:
- neck posture may be normal, low, rigid
-tetra or monoparesis/plegia or of IPSILATERAL thoracic & pelvic limbs
- double engine gait (short in front, long in hind)
Cranial nerves: Normal, possible IPSIlateral Horner’s
Postural reactions: Normal or decreased x4, one limb, or in IPSIlateral limbs (pelvic»_space; thoracic)
Spinal reflexes: Normal in pelvic limbs but normal to decreased in thoracic limbs
- may have IPSIlateral reduced or absent cutaneous trunci reflex with C8-T1 lesion)
Palpation: Muscle tone normal to increased in pelvic limbs an decreased to absent in thoracic limbs, atrophy in thoracic limbs but NOT pelvic, +/- caudal neck pain
Pain: normal to decreased or absent superficial or deep pain
Fill in the blanks for a T3-L3 myelopathy:
Mental status: ___________
Posture/gait: _____________
Cranial nerves: __________
Postural reactions: __________
Spinal reflexes: _________
Palpation: ____________
Pain perception: ___________
Mentation = Normal
Posture/gait:
- Normal thoracic limbs
- Para or monoparesis or plegia
+/- Schiff Sherrington posture
Cranial nerves: Normal
Postural reactions:
- Normal in thoracic limbs
- Deficits in one or both pelvic limbs
Spinal reflexes:
- Normal x 4
- Possibly increased in pelvic limbs
- Reduced or absent cutaneous trunci reflex caudal to lesion
Palpation:
- Muscle tone normal in thoracic limbs
- Muscle tone normal to increased in pelvic limbs
- NO atrophy in pelvic limbs
+/- thoracic pain
Pain: normal to decreased or absent superficial or deep pain
Fill in the blanks for a L4-L6 myelopathy:
Mental status: ___________
Posture/gait: _____________
Cranial nerves: __________
Postural reactions: __________
Spinal reflexes: _________
Palpation: ____________
Pain perception: ___________
Mentation = Normal
Posture/gait:
- Normal thoracic limbs
- Para or monoparesis or plegia
Cranial nerves: Normal
Postural reactions:
- Normal in thoracic limbs
- Deficits in one or both pelvic limbs
Spinal reflexes:
- Normal in thoracic limbs
- DECREASED TO ABSENT patellar reflexes in one or both pelvic limbs with normal withdrawal reflexes
Palpation:
- Muscle tone normal in thoracic limbs
- Muscle tone decreased to absent in extensor muscles of one or both pelvic limbs
- Muscle atrophy possible in iliopsoas, quadriceps, and sartorius
+/- caudal lumbar spinal pain
Pain: normal to decreased or absent superficial pain perception over pelvic limb regions innervated by femoral nerve
Fill in the blanks for a L6-S3 myelopathy:
Mental status: ___________
Posture/gait: _____________
Cranial nerves: __________
Postural reactions: __________
Spinal reflexes: _________
Palpation: ____________
Pain perception: ___________
Mentation = Normal
Posture/gait:
- Normal thoracic limbs
- AMBULATORY
- Para or monoparesis or plegia of sciatic innervated muscles –> difficulty rising, jumping, low or plantigrade gait of one or both pelvic limbs
- Tail paresis or plegia
Cranial nerves: Normal
Postural reactions:
- Normal in thoracic limbs
- Deficits in one or both pelvic limbs
Spinal reflexes:
- Normal in thoracic limbs
- Normal patellar reflexes
- DECREASED TO ABSENT WITHDRAWAL reflexes in one or both pelvic limbs
- Decreased or absent perianal and/or perineal reflexes
Palpation:
- Muscle tone normal in thoracic limbs
- Muscle tone decreased to absent in one or both pelvic limbs
+/- Tail tone reduced or absent
+/- anal sphincter dilation
+/- muscle atrophy in caudal thigh, hip, and distal pelvic limb muscles innvervated by sciatic nerve or its branches
+/- LS and/or rectal palpation pain
Pain: normal to decreased or absent superficial or deep pain perception in pelvic limbs or tail
Fill in the blanks with regard to micturition:
Sympathetic = __________ nerve, __ to ___, = Store
Parasympathetic = ________ nerve, __ to ___ = Pee
Somatic, __________ muscle = __________ nerve, ___ to ____, = Pee
Sympathetic = Hypogastric nerve, L1 to L4, = Store
Parasympathetic = Pelvic nerve, S1 to S3, = Pee
Somatic, striated urethralis muscle = Pudendal nerve, S1-S2, = Pee
For micrurition, parasympathetic innervation via the _______ nerve –> _______contraction and relaxation of _______ –> pee
Parasympathetic innervation via PELVIC nerve (S1-S3) —> bladder muscle contraction and relaxation of urethral sphincter and striated urethralis muscle (pudendal somatic innervation) —> pee
Lesions near the __________may produce “paradoxical vestibular syndrome” which causes C/S similar to central vestibular disease except the head tilt is ___________ to the side of the lesion.
Caudal cerebellar peduncle
Head tilt CONTRALATERAL to side of lesion
Probability of vitreal degeneration increases with ____________ age and is more common in _______ (gender).
Probability increases with INCREASING AGE
FEMALES > males
The sensitivity and specificity of ocular ultrasound for evaluation of vitreal degeneration is _______ and ______ respectively.
Sn = 39%
Sp = 100%
On ocular ultrasound age-related, ______________can be distinguished from ____________ based on appearance as ___________is seen as multiple, _______reflective triangular echoes evenly distributed in the vitreous while _________ is seen as multiple, small, motile, ________ reflective, point-like echoes lying mainly in the ventral aspect of the vitreous.
Vitreal degeneration can be distinguished from asteroid hyalosis.
Asteroid hyalosis = multiple HIGHLY reflective triangular echoes evenly distributed in the vitreous
Vitreal degeneration = multiple, small, motile POORLY reflective point-like echoes within the ventral aspect of the vitreous
Contrast-enhanced ocular ultrasound is _______% accurate for detection and differentiation between retinal detachment and vitreous membrane.
100% accurate
_______________ was seen in 100% of cases with a detached retina using contrast-enhanced ultrasound.
Persistent vascularization
- except for PHPV or PHA, a free-floating membranous structure visible in the posterior segment on B-mode ultrasonography and demonstrating blood flow indicates retinal detachment.
N.B. - Persistent hyperplastic primary vitreous (PHPV) or persistent hyaloid artery (PHA) are caused by the failure of normal regression of the components of primary vitreous
The guttural pouches are evaginations of the ____________ in horses.
Eustachian tube/auditory canal
A cholesteatoma is an expansile ear mass with a mean attenuation of ______HU
~55-56HU
Which best describes the contrast enhancement pattern of cholesteatomas?
A) Marked heterogeneous enhancement of the bulla contents
B) Mild homogeneous enhancement of the bulla contents
C) Moderate homogeneous central enhancement on the bulla contents with a more peripherally enhancing rim
D) No enhancement of the bulla contents with occasional rim enhancement
Answer = D
Which species does not have a zygomatic salivary gland?
Horses
Correctly match the esophageal musculature with the appropriate species:
A) Striated muscle throughout its length
B) Cranial 2/3 is striated muscle, caudal 1/3 is smooth muscle
1) Equine
2) Canine
3) Bovine
4) Feline
1) Equine = B - mixture of striated and smooth muscle
2) Canine = A - entirely striated
3) Bovine = A - entirely striated
4) Feline = B - mixture of striated and smooth
In horses, the __________ divides the _________portion of the stomach (cardia/fundus) from the ___________ portion of the stomach (body/antrum/pylorus)
Margo plicatus
Non-glandular = cardia/fundus
Glandular = body/antrum/pylorus
What is the order of the ascending large colon in horses?
Right ventral colon
Sternal flexure
Left ventral colon
Pelvic flexure
Left dorsal colon
Diaphragmatic flexure
Right dorsal colon
During a normal canine neonatal ultrasound examination, which of the following statements is true?
A) None had peritoneal effusion.
B) Mid-abdominal mesenteric lymph nodes were difficult to identify.
C) Mean duodenal wall thickness was greater (average ~3.8mm) than the remainder of the gastrointestinal tract
D) The mean gastric wall thickness was greater ~6mm) than the remainder of the gastrointestinal tract.
Answer = C
A is false, because ALL had a mild amount of anechoic peritoneal effusion
B is false because homogeneous, hypoechoic jejunal nodes were easily found with a mean thickness of ~7mm
D is false because mean stomach wall thickness was 2.7 mm (range 2.2–3.7 mm), the mean jejunal wall thickness was 2.5 mm (range 1.2–3.4 mm), and the mean colonic wall thickness was 1.3 mm (range 0.7–2.0 mm).
The quadrate lobe of the liver is located between the _________ and ________ lobes. Additionally it is __________ to the porta hepatis.
Quadrate between right medial and left medial lobes
Quadrate lobe is VENTRAL to porta hepatis
The caudate lobe is _________ to the porta hepatis and has 2 processes - the papillary process, which is to the _______ of the medial plane and the caudate process which is adjacent to _______.
Caudate lobe DORSAL to porta hepatis
Papillary process to LEFT of midline
Caudate process contains RIGHT RENAL FOSSA
Liver lobe torsion most frequently occurs in the _________ lobe in rabbits and ________ lobe in dogs.
Rabbits = CAUDATE lobe (Hint: think Cuddly rabbit - Caudate)
Dogs = LEFT LATERAL
The gallbladder is located in the fossa between the _______ and ________ lobes.
GB between quadrate and RIGHT medial lobe
Common bile duct diameter up to _____mm in cats and _____mm in dogs.
CBD diameter
4mm in cats, 3mm in dogs
The accessory pancreatic duct opens into the ____________. In up to _____% of cats it is ABSENT, however in dogs is it ______ present and functions as the _________.
Accessory pancreatic duct opens into MINOR DUODENAL PAPILLA.
Accessory panc duct absent in 80% of cats
Accessory panc duct in dogs is ALWAYS PRESENT and function as the MAIN duct
The pancreatic duct opens into the __________.
Pancreatic duct opens into MAJOR DUODENAL PAPILLA
In dogs, the pancreatic duct opens separate from ____________. In cats, the pancreatic duct is __________ and opens _____________.
Dogs pancreatic duct OPENS SEPARATE from CBD (panc duct ~0.6mmD)
In cats, the pancreatic duct is ALWAYS PRESENT and is the MAIN DUCT and OPENS CONFLUENT WITH CBD (up to 1mmD or up to 2.5mmD in OLD cats)
The epiglottis is normally ________ to the soft palate in dogs and cats. In horses, the epiglottis ___________ to the soft palate.
Dog/cat: epiglottis VENTRAL to soft palate
Horse: epiglottis DORSAL to soft palate
The tracheal bronchus, present in _______ and ______, supplies the ________ lobe.
Tracheal bronchus: PIG and COW
Right cranial lobe
What hemilung attaches to/branches off the right side of the carina/principal bronchus?
Accessory lung lobe
What congenital condition can occur simultaneously with pulmonic and aortic stenosis?
Tracheal hypoplasia
The ratio of tracheal height to an adjacent bony landmark is more reliable for comparison between horses and tracheal height measurements should be made with the _______ vertebrae.
Ratio = ???
C5 vertebrae
Ratio: tracheal height / C5 vertebral body LENGTH = 0.37
In cats, both pleural cupula extend to __________. In dogs during full inspiration, the _____ pleural cupula extends further dorsally into the thoracic inlet.
Cats: both extend to level of 1st ribs
Dogs: LEFT pleural cupula extends further during inspiration
A statistically significant ________in ________heart size and in VHS (_________) occurs with manual inflation of the lungs under anesthesia.
Significant REDUCTION in SUBJECTIVE heart size and VHS (OBJECTIVE) during manual anesthetic inflation
In dogs and cats, the cardiac notch is formed by the ventrally diverging margins of the _________ and __________ lung lobes.
Right cranial and right middle
In horses, the cardiac notch is __________ and is larger on the ___________.
Present bilaterally, but larger on the LEFT
The effect of head position on tracheal diameter is variable and of clinical importance in dressage horses. The ___________ position yields the largest pharyngeal diameter. The smallest pharyngeal diameter is seen in the ________ position.
EXTENDED MIDWAY position = largest pharyngeal diameter
DORSAL FLEXED = smallest pharyngeal diameter
The soft tissue opacity between the caudodorsal lung lobes and the vertebral column in cats is due to _____________.
The cranial extent of the PSOAS MINOR muscle.
- this becomes larger in bigger, predatory cats (e.g. cheetahs, leopards,etc)
The medial compartment of the guttural pouch contains all of the following EXCEPT:
A) Internal carotid artery
B) External carotid
C) Cranial cervical ganglion
D) CrN 9-12
Answer =B
External carotid is in LATERAL compartment
What structures are contained within the smaller lateral compartment of the guttural pouch?
External carotid artery
CrN 7
The surgical approach to the guttural pouch is termed Viborg’s triangle. What are the borders?
1) Cranial border = caudal border of mandible
2) Ventral border = linguofacial vein
3) Caudodorsal border = tendon of sternocephalicus
The mediastinal serous cavity is a normal anatomic space in the caudal mediastinum between the ____________ and ________. What disease process can occur here?
Mediastinal serous cavity where paraesophageal empyema can occur is between the parietal pleura of the right caudal lobe and the esophagus.
-Cranial extension of the omental bursa, separated from the peritoneal cavity by the diaphragm
In endemic areas, spirocercosis can cause esophageal lesions that may be seen on thoracic radiographs. In these regions, _____ and ______ projections are recommended for better visualization of descending aortic aneurysms and to avoid interpreting the normally visible esophagus in ______ as a mass in large breed dogs.
Recommend DV and Right lateral views in endemic regions
In left lateral recumbency the esophagus may be normally seen in large breed dogs and confused with a mass
Spirocercosis can cause esophageal lesions. When assessing thoracic radiographic positioning for visualization of caudodorsal mediastinal masses it was found that masses were seen equally well in left vs right lateral recumbency as well as in DV vs VD positions, but in _________ views 86% of masses were detected whereas in ______ views only 50% of masses were identified.
DV/VD views 86% of masses were detected whereas in lateral views only 50% of masses were identified.
Which 6 bones are pneumatized in birds?
1) Femur
2) Humerus
3) Ribs
4) Clavicles
5) Coracoids
6) Vertebrae
Match the following correctly:
1) Mesonephros
2) Pronephros
3) Metanephros
A) Develop into actual kidneys
B) Develop into “kidneys” then become gonads
C) Develop into “kidneys” then regress
1) Mesonephros = B, develop into kidneys then become gonads
2) Pronephros = C, develop into kidneys then regress
3) Metanephros = A, develop into actual kidneys
Which structure does not pass through the inguinal canal in male dogs?
A) Femoral artery
B) Vaginal tunic
C) Spermatic cord
D) Genitofemoral nerves
Answer = A
Inguinal canal in males = vaginal tunic, spermatic cord, genitofemoral nerves, & EXTERNEL PUDENDAL vessels
In females which structures pass through the inguinal canal?
Vaginal process
Round ligament of the uterus
Genitofemoral nerves
External pudendal vessels
Neoplastic transformation of cryptorchid testicles occurs ~ ___ to____ X more often than in descended testicles.
A) 8.7-11.6
B) 9.2-13.6
C) 5.5 - 20.1
D) 6.6 - 19.7
Answer = B
Neoplastic transformation occurs in the undescended testes of dogs approximately 9.2 to 13.6 times more frequently than in canine scrotal testes.
________________ tumors are the most likely to occur in retained testicles, followed by ___________.
Sertoli cell tumors = #1
Seminomas = #2
Adrenal size on ultrasound:
≤ _______cm for dogs < 10 kg
≤ _______cm for dogs 10–30 kg
≤ _______cm for dogs > 30 kg
≤ 0.54 cm for dogs < 10 kg
≤ 0.68 cm for dogs 10–30 kg
≤ 0.80 cm for dogs > 30 kg
Use of a cutoff of less than _________ mm (sensitivity 90%, specificity 100%) for the thickness of the left adrenal gland and less than _________mm (sensitivity 82% and specificity 90%) for the thickness of the right adrenal gland with ultrasonography supports a suspicion of primary hypoadrenocorticism.
Left < 2.8mm
Right < 3.05mm
The ______ cells of the pancreas produce glucagon?
A) F cells
B) D cells
C) Beta cells
D) Alpha cells
Answer =D
Alpha cells = glucagon
Beta cells = insulin
D cells = Somatostatin
F cells = pancreatic polypeptide
The thyroid glands lie laterally alongside the trachea, medial to the ___________artery.
Common carotid artery
The thyroid gland is embryologically derived from the ________ cells of the ___________.
A) Ectoderm cells; pharyngeal floor
B) Ectoderm cells; pharyngeal roof
C) Endoderm cells; pharyngeal roof
D) Endoderm cells; pharyngeal floor
Answer = D
In 10 cadaver dogs, 35 structures were identified sonographically as parathyroid glands but only ____% glands (____% positive predictive value) were proven to be normal parathyroid glands histopathologically.
Of the false positives, _____% were proven to be __________.
74% of glands (74% PPV) were normal parathyroid glands
Of the FPs, 14% were proven to be LOBULAR THYROID TISSUE
What 2 hormones are released from the neurohypophysis, the _______ lobe of the pituitary gland?
1) Oxytocin
2) Vasopressin/ anti-diuretic hormone
Neurohypophysis = caudal or posterior pituitary
Non-ionic contrast media dilutes more _______ and to a _______ extent than ionic contrast media, thereby resulting in _______ contrast borders.
Non-ionic contrast dilutes MORE SLOWLY and to a LESSER EXTENT –> SHARPER contrast borders
You are performing a positive contrast upper GI study on a dog that you suspect may have an intestinal perforation. Which contrast medium is most suitable for the study?
A) Iohexol
B) Ditriazoate
C) Ioxaglate
D) Iothalamate
Ionic contrast media are _______ anti-coagulant than non-ionic, and therefore _____ likely to cause clot formation.
Ionic contrast MORE anti-coagulant therefore LESS likely to cause clots versus non-ionic
Radiopacity directly proportional to density and volume of CM:
therefore, if _______ volume (double-contrast) -> ________ density required
and if _______ volume (single-contrast) -> ______density desired to allow x-ray-penetration
Low volume (e.g. double contrast) –> HIGH density
Large volume (e.g. single contrast) –> LOW density
What 4 disease processes can be assessed for using a positive contrast selective right ventricular angiogram?
1) Tricuspid insufficiency
2) Right to left shunt
3) Pulmonic stenosis
4) Dirofilariasis
What 3 disease processes can be assessed for using a positive contrast selective left ventricular angiogram?
1) Subaortic stenosis
2) Mitral insufficiency
3) VSD with left to right shunting
What disease processes can be assessed for using a positive contrast selective aortic angiogram?
1) Aortic insufficiency (e.g. secondary to endocarditis)
2) Aortic aneurysms (e.g. secondary to Spirocerca, ductus diverticulum associated with PDA)
3) Aortic stenosis (stenosis, coarctation, thrombosis, embolism)
4) PDA
5) Coronary artery anomalies
6) Aortic arch anomalies
