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ACVECC Board Study > Previous Benchmark MC Questions > Flashcards

Previous Benchmark MC Questions Flashcards

1
Q

Drug X is highly protein bound. Your patient’s albumin has decreased acutely due to a septic process. You are concerned since hypoalbuminemia will generally increase the concentration of free/unbound Drug X and increase its volume of distribution (Vd). Which of the following concomitant changes might counter your concern?

a. Increasing free/unbound Drug X will decrease Drug X efficacy.
b. Your patient will lose muscle mass due to catabolism and decrease Vd.
c. An increase in inflammatory mediators/globulins will bind Drug X.
d. Increasing free/unbound Drug X will increase its metabolism and clearance

A

D

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2
Q

For effective analgesia, it is generally recommended to administer opioids parenterally. Which mechanism of the metabolism of opioids is this recommendation meant to avoid?

a. Metabolism by intestinal epithelial cells
b. First pass metabolism by the liver
c. Metabolism by phase II conjugation
d. Inhibition of cytochrome P450 mediated metabolism

A

B

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3
Q

Which of the following is a pharmacodynamic factor that explains drug tolerance?

a. Increased renal excretion
b. Increased production of cAMP
c. Decreased drug receptor affinity
d. Decreased drug absorption

A

C

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4
Q

In systemic inflammation, cytokines trigger coagulation through the binding of which coagulation factor?

a. Factor II
b. Factor VII
c. Factor VIII
d. Factor X

A

B

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5
Q

Activation of pattern recognition receptor, such as Toll Like Receptors, initiates signaling cascades through which transcription regulator?

a. Nuclear Factor Kappa B (NFkB)
b. Tissue Factor (TF)
c. High-mobility group box 1 (HMGB1)
d. Complement activation

A

A

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6
Q

Ineffective cellular oxygen utilization is a contributing factor to the development of multiple organ dysfunction syndrome by which mechanism?

a. Increased reactive oxygen species through upregulation of eNOS-generated nitric oxide.
b. Interlukin-1 can directly inhibit electron transport chain complexes III, IV and V.
c. Reactive oxygen species damage leads to release of cytochrome c into cytosol triggering apoptotic death.
d. Released mitochondrial DNA, acts as a PAMP, triggering cytokine generation via TLR-9.

A

C

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7
Q

You have a 40 kg septic patient with an albumin of 1.6 g/dL (16 g/L), and you desire to give a transfusion to raise their albumin to 2.5 g/dL (25 g/L). What is the albumin deficit in grams?

a. = 162 grams
b. = 324 grams
c. = 216 grams
d. = 120 grams

A

D

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8
Q

Albumin synthesis is under the influence of:

a. thyroxine.
b. insulin.
c. vasopressin.
d. epinephrine.

A

A

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9
Q

Hypoalbuminemia may potentiate the toxicity of which of the following medications?

a. theophylline
b. salicylates
c. diazepam
d. vancomycin

A

C

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10
Q

Glycine is a neurotransmitter with both excitatory and inhibitory effects in the central nervous system. Similar to GABA, glycine exerts inhibitory effects by increasing ______________ ion conductance.

a. calcium
b. sodium
c. chloride
d. potassium

A

C

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11
Q

Which of the following is the mechanism of action of levetiracetam?

a. Enhancement of responsiveness to the inhibitory postsynaptic effects of GABA.
b. Modulating voltage-gated calcium-dependent neurotransmitter release.
c. Inhibit neuronal voltage-dependent sodium and T-type calcium channels.
d. Hyperpolarization of the neuronal cell membrane via the chloride channel.

A

B

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12
Q

Which of the following statements is NOT a true statement regarding N-methyl-D-aspartate (NMDA) receptors?

a. Glutamate and aspartate are major agonists for the NMDA receptor.
b. Glycine is a co-agonists of NMDA receptors.
c. Activated NMDA channels permit the influx of Na+ and Ca2+ into the cell and K+ out.
d. At normal membrane potentials, the NMDA channels are blocked by extracellular Na+.

A

D

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13
Q

Increasing severity levels of critical illness can result in what changes to a patient’s volume of distribution. Which of the following statements is the most correct?

a. Increased volume of distribution, resulting in reduced antimicrobial exposure at their site of infection.
b. Decreased volume of distribution, resulting in reduced antimicrobial exposure at their site of infection.
c. Increased volume of distribution, resulting in increased antimicrobial exposure at their site of infection.
d. Decreased volume of distribution, resulting in increased antimicrobial exposure at their site of infection

A

A

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14
Q

Multi-drug resistance is present when bacteria are resistant to:

a. 1 agent in > 2 separate antimicrobial categories.
b. 1 agent in ≥ 3 separate antimicrobial categories.
c. 3 agents in > 2 separate antimicrobial categories.
d. 3 agents in > 3 separate antimicrobial categories.

A

B

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15
Q

With concentration-dependent antimicrobials, it has been demonstrated that maximal bacterial killing is achieved when antimicrobial concentrations are maintained at _________ the MIC of the infecting pathogen.

a. 1 - 2 times 
b. 2 - 4 times
c. 4 – 6 times
d. 8 - 10 times
A

D

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16
Q

What is the corticosteroid of choice for critical illness-related corticosteroid insufficiency?

a. Dexamethasone
b. Fludrocortisone
c. Hydrocortisone
d. Prednisone

A

C

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17
Q

Under which conditions are corticosteroids recommended in septic shock, by the Surviving Sepsis Campaign International Guidelines published in 2016?

a. Fluid-loaded, vasopressor resistant
b. Severe vasculitis, non-vasopressor dependent
c. Extra-pulmonary sepsis, vasopressor dependent
d. Post fluid resuscitation, prior to use of albumin

A

A

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18
Q

Which of the following can cause a Type A hyperlactatemia?

a. Hyperthyroidism
b. Muscle tremors
c. Thiamine deficiency
d. Malignancy

A

B

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19
Q

According to the Stewart approach to acid-base analysis, the following were identified as determinants of acid-base balance:

a. PCO2, HCO3-, and ATOT
b. PCO2, SID, and ATOT
c. SID, HCO3-, and ATOT
d. PCO2, SID, and pH

A

B

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20
Q

The formula for calculating free water loss in a patient is: Free water deficit = ([Na+]p ÷ normal [Na+]p] – 1) x (0.6 x BWkg). What does the “0.6” in bold represent?

a. Intracellular water
b. Plasma volume
c. Total body water
d. Interstitial water

A

C

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21
Q
  1. The duration of local anesthetic action is primarily determined by:

a. Lipid solubility
b. Protein binding
c. High pKa
d. Low pKa

A

B

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22
Q

The potency of local anesthetics is primarily determined by:

a. Lipid solubility
b. Protein binding
c. High pKa
d. Low pKa

A

A

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23
Q

Local anesthetics act by binding reversibly to a target receptor in the voltage-gated _____________ channel of nerves, preventing the conduction of the action potential in any nerve fiber.

a. potassium
b. sodium
c. calcium
d. chloride

A

B

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24
Q

Toxic epidermal necrolysis has been associated with the administration of the following medication:

a. Phenobarbital
b. Morphine
c. Cyclosporine
d. Clindamycin

A

A

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25
Q

Which of the following is most likely to help prevent infection in the initial management of an accidental traumatic wound?

a. Irrigation of the wound using 0.5% chlorhexidine solution
b. Use of topical antibiotic ointment
c. Application of a cleansing dressing
d. Removal of contamination using tap water

A

D

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26
Q

Using the Rule of Nines’s, calculate the total body surface area for an animal who has sustained burns to both forelimbs, the head and neck, and thorax.

a. 18%
b. 27%
c. 36%
d. 45%

A

D

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27
Q

Vitamin B12 and folic acid deficiency can lead to a maturation failure of erythropoiesis because they are required:

a. for the development of thymidine triphosphosphate, a component of DNA.
b. to deliver transferrin to the red blood cell mitochondria where heme is synthesized.
c. to prevent oxidative injury to the intracellular proteins of red blood cells.
d. for metabolizing glucose and forming small amounts of adenosine triphosphate.

A

A

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28
Q

Growth and reproduction of hematopoietic stem cells is under the influence of _______________ produced by marrow stromal cells?

a. Tumor necrosis factor – alpha
b. Interleukin-2
c. Interleukin-3
d. Interleukin-6

A

C

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29
Q

Glycosides exert their cardiotoxic effects via which primary mechanism?

a. Agonism of voltage-gated Na+ ion channel receptors, causing persistent depolarization
b. Inhibition of Na+/K+-ATPase pumps on myocardial cell membranes
c. Inhibition of acetylcholinesterase causing overstimulation of muscarinic acetylcholine receptors
d. Inhibition of cytochrome oxidase, causing cellular hypoxia

A

B

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30
Q

What electrolyte abnormality may be seen following administration of digoxin-specific antibody fragments for the treatment of digoxin or oleander toxicity?

a. Hypercalcemia
b. Hypocalcemia
c. Hyperkalemia
d. Hypokalemia

A

D

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31
Q

An experimental study evaluating the likelihood of first responder contamination with an inert powder while treating dogs with simulated opioid overdose found which of the following?

a. Intranasal naloxone administration was associated with a higher risk of first responder contamination than intramuscular naloxone.
b. A surgical gown, face mask and gloves were sufficient to prevent possible human exposure.
c. Intramuscular naloxone administration was not associated with a risk of first responder contamination.
d. Intranasal naloxone administration was associated with an increased risk of the first responder being bitten.

A

A

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32
Q

A retrospective study conducted in 2021 and published in the Journal of Veterinary Emergency and Critical Care examined the cases of 125 dogs with non-steroidal anti-inflammatory drug (NSAID) overdose and reported which variable as having been significantly associated with death or euthanasia?

a. Ingestion of human-formulated NSAIDs
b. Maximum dose of NSAIDs ingested
c. Presence of both vomiting and diarrhea
d. Duration of anorexia prior to admission

A

D

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33
Q

Brown et al. published a study in the Journal of Veterinary Internal Medicine in 2015 evaluating fractional excretion of electrolytes during hospitalization in dogs with acute kidney injury. Which of the following changes observed over 7 days were significantly associated with 30-day survival?

a. Increased fractional excretion of sodium
b. Decreased fractional excretion of sodium
c. Increased fractional excretion of potassium
d. Decreased fractional excretion of potassium

A

B

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34
Q
  1. Costa et al. published a randomized controlled clinical study in the American Journal of Veterinary Research in 2021 to assess the frequency of gastroesophageal reflux (GER) in dogs undergoing general anesthesia after hydromorphone premedication with or without acepromazine or dexmedetomidine. Which of the following drugs were significantly associated with less frequent GER?

a. Hydromorphone and dexmedetomidine
b. Hydromorphone and acepromazine
c. Only hydromorphone
d. No significant difference between these drug combinations

A

A

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35
Q

Which one of the following is the equation for pulmonary vascular resistance?

a. (Mean arterial pressure – right atrial pressure)/Cardiac output
b. (Mean pulmonary arterial pressure – left atrial pressure)/Cardiac output
c. (Mean pulmonary arterial pressure – right atrial pressure)/Cardiac output
d. (Mean arterial pressure – left atrial pressure)/Cardiac output

A

B

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36
Q

Which one of the following is responsible for increase in pulmonary arterial pressure?

a. Nitric oxide
b. Prostacyclin
c. Endothelin
d. Atrial natriuretic peptide

A

C

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37
Q

Which of the following is the mechanism for developing pulmonary vasodilation in response to nitric oxide?

a. Nitric oxide increases cGMP concentration
b. Nitric oxide decreases cGMP concentration
c. Nitric oxide increases cAMP concentration
d. Nitric oxide decreases cAMP concentration

A

A

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38
Q

Your patient has a urethral obstruction with severe hyperkalemia. You elect to start calcium gluconate for cardioprotection. What is the mechanism by which calcium gluconate can exert this cardioprotective effect?

a. Decreases the resting membrane potential.
b. Decreases the threshold membrane potential.
c. Increases the resting membrane potential.
d. Increases the threshold membrane potential.

A

D

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39
Q

A young patient presents with acute abdominal pain and distention. Peritoneal effusion is diagnosed, and serosanguinous fluid is collected. Testing is performed on the fluid, and a diagnosis of uroperitoneum is reached due to

a. effusion BUN > 1.5 x blood BUN.
b. effusion creatinine > 2.0 x blood creatinine.
c. effusion potassium > 3.0 x blood potassium.
d. effusion lactate > 2.0 x blood lactate.

A

B

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40
Q

The following hormone or autocoid is responsible for constricting afferent and efferent arterioles resulting in a reduction of GFR and renal blood flow:

a. Angiotensinogen
b. Endothelial derived nitric oxide
c. Epinephrine
d. Prostaglandins

A

C

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41
Q

Binding of ______________ to the platelet surface results in the generation of a procoagulant membrane surface and release of platelet granules.

a. thrombin
b. tissue factor
c. microparticles
d. collagen

A

A

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42
Q

Although there are several factors that have been linked to acute traumatic coagulopathy (ATC), only _________________________ has been globally accepted as a cause of ATC.

a. systemic inflammation
b. hypothermia
c. ongoing tissue hypoperfusion
d. hemodilution

A

C

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43
Q

Thrombin limits the advancement of hemostatic plugs into normal vascular endothelium by:

a. inactivating thrombomodulin that is bound to endothelial cells.
b. activating protein S when it is complexed with thrombomodulin.
c. thrombin-thrombomodulin activation of TAFI.
d. activating protein C which upregulates FVa and FVIIIa activity.

A

C

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44
Q

According the 2019 CURATIVE guidelines published in the Journal of Veterinary Emergency and Critical Care, which of the following patients are at high risk for thrombosis?

a. A dog with severe pancreatitis
b. A cat receiving steroid therapy
c. A dog with adrenal gland carcinoma
d. A cat with hypertrophic cardiomyopathy

A

D

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45
Q

Which of the following drug options are preferred choices for prevention of thrombosis in dogs and cats based on the 2019 CURATIVE guidelines published in the Journal of Veterinary Emergency and Critical Care?

a. Direct Xa inhibitors and low molecular weight heparin
b. Unfractionated heparin and direct Xa inhibitors
c. Warfarin and low molecular weight heparin
d. Direct Xa inhibitors and warfarin

A

A

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46
Q

Based on the 2019 CURATIVE guidelines in the Journal of Veterinary Emergency and Critical Care, which anticoagulant should be monitored using anti-Xa levels?

a. Rivaroxiban
b. Unfractionated heparin
c. Low molecular weight heparin
d. Warfarin

A

B

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47
Q

Which cells are thought to be responsible for generating slow, undulating changes in resting membrane potential in the gastrointestinal tract, also known as “slow waves”?

a. Oxyntic cells
b. Interstitial cells of Cajal
c. Ganglion cells
d. Enterochromaffin-like cells

A

B

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48
Q

An animal is intubated while undergoing mechanical ventilation and has decreased saliva production. Reduced amounts of which components of saliva predisposes the animal to oral ulceration despite frequent oral rinses?

a. Thiocyanate ions, proteolytic enzymes, and antibodies
b. HCO3-, ptyalin, mucin, and glycoproteins
c. Potassium ions, alpha-amylase, and water
d. Chloride ions, neutrophils, and ferritin

A

A

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49
Q

By what mechanism may NSAIDs induce gastric ulceration?

a. Increased prostaglandin concentrations
b. Local hyperoxia causing increased free radical production
c. Reduce production of bicarbonate-rich mucous secretions
d. Increased formation of nitric oxide

A

C

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50
Q

Transport of CO2 in the blood is enhanced

a. due to carbonic anhydrase in red blood cells converting CO2 to HCO3-.
b. when hemoglobin is oxidized allowing more CO2 to bind as carbaminohemoglobin.
c. due to the affinity of CO2 for deoxygenated hemoglobin created by the Bohr effect.
d. when the dissolved fraction carried in the bloodstream increases to 30%.

A

A

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51
Q

Which of the following accurately characterizes the 5 normal phases of a capnograph?

a. No carbon dioxide should be measured at Phase II.
b. The steep incline in Phase II is when CO2-free gas enters the airway.
c. Inspiration begins in Phase III.
d. End tidal CO2 is measured at the end of the alveolar plateau.

A

D

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52
Q

The clinical effect of both hyponatremia and hypernatremia are mostly related to their effects on cell volume. By interacting with which of the molecules listed below, does sodium directly mediate this effect?

a. Aldosterone
b. ATP
c. Water
d. Glucose

A

C

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53
Q

Which of the following is the primary stimulus for vasopressin release from the neurohypophysis.

a. Volume depletion
b. Nausea
c. Hyperkalemia
d. Hypertonicity

A

D

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54
Q

Which of the following diseases processes causes hypernatremia?

a. Typical hypoadrenocorticism
b. Nephrogenic diabetes insipidus
c. Hypoaldosteronism
d. Primary polydipsia

A

B

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55
Q

Deficiencies in which of the following may cause clinical signs of obtundation, weakness, incoordination, cervical ventroflexion, that may be misinterpreted as hepatic encephalopathy?

a. Potassium and phosphate
b. Cobalamin and thiamine
c. Thiamine and magnesium
d. Thiamine and potassium

A

D

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56
Q

Amino acid solutions for parenteral administration range from 3% to 15%. Due to the osmolarity, use of a central venous catheter is recommended for administration of solutions greater than ________.

a. 4%
b. 6%
c. 10%
d. 12%

A

B

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57
Q

The supplementation of arginine may be contraindicated in patients with:

a. pulmonary hypertension.
b. acute kidney injury.
c. severe sepsis.
d. acute lung injury.

A

C

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58
Q

The mechanism by which staphylococci become resistant to methicillin and related antimicrobials is:

a. decreased number of penicillin-binding proteins in the bacterial cell wall.
b. decreased number of drug receptors in the bacterial cell wall.
c. mutations in the gene structure of the penicillin-binding proteins in the bacterial cell wall.
d. mutations in the gene structure of the drug receptors in the bacterial cell wall.

A

C

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59
Q

Which of the following antimicrobials is bacteriostatic at clinical concentrations?

a. Animoglycosides
b. Macrolides
c. Beta-lactams
d. Fluroquinolones

A

B

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60
Q

Which of the following is the ideal dosing of an antibiotic with a concentration-dependent activity?

a. Once daily dosing
b. Total daily dose, divided
c. Continuous infusion
d. Based on the post-antibiotic effect

A

A

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61
Q

Which of the following make up the Acute Patient Physiology and Laboratory Evaluation (APPLEfast) 5-variable model?

a. Blood glucose concentration, serum albumin, PT, aPTT, and white blood cell count.
b. Plasma lactate concentration, blood glucose concentration, platelet count, white blood cell count, and mentation score.
c. Plasma lactate concentration, mentation score, PT, aPTT, and serum albumin.
d. Blood glucose concentration, platelet count, serum albumin, plasma lactate score, and mentation score.

A

D

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62
Q

The veterinary trauma score (VetCOT) in canine trauma patients was constructed based on which of the following variable?

a. Plasma lactate and ionized calcium obtained within 2 hours of admission, and the presence or absence of clinical signs consistent with either head or spinal trauma.
b. Plasma lactate and blood glucose concentration obtained within 6 hours of admission to the hospital, and the presence or absence of clinical signs consistent with either head or spinal trauma.
c. Plasma lactate and ionized calcium obtained within 6 hours of admission to the hospital, and the presence or absence of clinical signs consistent with either head or spinal trauma.
d. Plasma lactate and blood glucose concentration obtained within 2 hours of admission to the hospital, and the presence or absence of clinical signs consistent with either head or spinal trauma.

A

C

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63
Q

The Modified Glasgow Coma Scale (mGCS) is based on a 1-6 scale across 3 categories (motor, brainstem reflexes, and level of consciousness). Alternatively, the Animal Trauma Triage (ATT) Score uses a 0-3 scale across 6 body system categories (perfusion, cardiac, respiratory, eye/muscle/integument, skeletal, and neurologic). Based on your knowledge of these two scoring systems, which of the following patients would give you the greatest concern?

a. A 4 year old MC Golden Retriever that was hit by a car and has a mGCS of 15 and an ATT score of 4.
b. A 1 year of FS DSH that was hit by a car and has a mGCS of 18 and an ATT score of 0.
c. A 4 year old MC Golden Retriever that was hit by a car and has a mGCS of 4 and an ATT score of 15.
d. A 1 year old, FS DSH that was hit by a car and has a mGCS of 4 and an ATT score of 4.

A

C

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64
Q

A Veterinary Committee on Trauma registry study comparing trauma in toy versus giant breed dogs found which of the following were predictive of non-survival independent of patient size?

a. Animal trauma triage score, base excess, and modified Glasgow Coma Scale
b. Lactate, blunt trauma, and modified Glasgow Coma Scale
c. Penetrating trauma, animal trauma triage score, and packed red cell volume
d. Transfusion requirement, animal trauma triage score, and lactate

A

A

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65
Q

A retrospective study by Saint Pierre et.al. published in the Journal of Veterinary and Emergency and Critical Care in 2021 on prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room found that hyperlactatemia was common and associated with mortality. Which of the following is correct?

a. Lactate clearance = [(plasma lactate at T0 – plasma lactate at T1)/plasma lactate at T1] x 100.
b. A delta lactate > 4.5 mmol/L was 100% specific for non-survival in patients with hyperlactatemia measured within 1 hour of admission to the ER.
c. The most common cause of hyperlactatemia was respiratory disease in dogs and shock in cats.
d. Delta lactate was defined as the initial plasma lactate concentration – plasma lactate concentration measured within 6 hours of admission.

A

B

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66
Q

A retrospective Journal of Veterinary Emergency and Critical Care study evaluating the utility of blood cultures in dogs just justified the use of blood cultures because

a. 80% yield positive growth to guide antibiotic therapy.
b. antibiotic therapy guided by culture results improved survival.
c. the proportion of resistance was higher than expected.
d. antibiotic therapy guided by culture results reduced length and cost of stay.

A

C

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67
Q

Cholesterol desmolase converts cholesterol into what hormone in the rate limiting step common to the synthesis of all adrenal steroid hormones?

a. Pregnenolone
b. Progesterone
c. 17-Hydroxypregnenolone
d. 11-Dexoycorticosterone

A

A

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68
Q

With regards to patients with septic shock, the 2008 CORTICUS trial found that low-dose hydrocortisone therapy, compared to placebo, was associated with

a. improved survival.
b. more rapid pressor weaning regardless of ACTH results.
c. no change in incidence of superinfection.
d. shorter ICU stays.

A

B

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69
Q

Physiologic functions of thyroid hormone include:

a. an increase in cellular metabolic activity by increasing the number and size of golgi complexes in the cell.
b. an increase concentration of cholesterol and triglycerides and a decrease concentration of free fatty acids.
c. an increase in the activity of the Na-K-ATPase and an increase in permeability of the cell membrane to K+ ions.
d. increased pulse pressure from increased systolic pressure and decreased diastolic pressure.

A

D

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70
Q

What is the mechanism of action of albuterol for the treatment of hyperkalemia?

a. Activation of the beta-2 receptor lowers the threshold membrane potential restoring normal membrane excitability.
b. Beta-agonist drugs stimulate the Na+-K+-2Cl- cotransporter on the luminal surface of the thick ascending limb of the loop of Henle.
c. Beta-agonists drugs stimulate the Na+-K+-ATPase pump promoting translocation of extracellular K+ into the cell.
d. Beta-adrenergic stimulation increases the activity of the Na+-Cl- cotransporter, increasing water reabsorption and diluting extracellular K+.

A

C

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71
Q

Which of the following statements correctly describes the mechanism of action for β-adrenergic agonists used for the treatment of airway bronchoconstriction?

a. Stimulation of beta receptors on the neutrophil cell membrane inhibit the release of pro-inflammatory cytokines.
b. Stimulation of the β2 receptors increase intracellular cAMP concentrations resulting in bronchial smooth muscle relaxation.
c. Inhibition of phosphodiesterase-3 and -4 increases intracellular cAMP concentrations resulting in reduction in pro-inflammatory cytokine release.
d. Inhibition of vagal-mediated cholinergic smooth muscle tone in the respiratory tract

A

B

72
Q

Which statement best describes the management of allergic airway disease?

a. Oral prednisone, prednisolone, and methylprednisolone acetate are commonly used medications for the maintenance of allergic airway disease.
b. Use of inhaled fluticasone has been shown to decrease airway inflammatory cells, prostaglandins, and inflammatory cytokines.
c. Administration of enteral bronchodilators prior to inhalant bronchodilator therapy increases the overall efficacy of treatment.
d. Treatment with anthelminthic medication is only recommended after diagnosis of parasitic allergic airway disease.

A

B

73
Q

Which of the following statements best characterizes frozen plasma?

a. Frozen plasma is plasma which was frozen by 4 hours after collection/separation and can be stored for up to 5 years.
b. Frozen plasma is plasma which was frozen more than 8 hours after collection/separation and has lower concentrations of factors V and VIII.
c. Frozen plasma is plasma has been stored up to 12 months and has lower concentrations of factors V, VII, and vWF.
d. Frozen plasma is plasma which was frozen more than 8 hours after collection/separation and is deficient in factors II, VII, IX and XI.

A

B

74
Q

Albumin is a highly charged molecule in the blood, which is responsible for 80% of colloidal osmotic pressure (COP or oncotic pressure) in healthy animals. Albumin’s large contribution to COP is mostly due to Van’t Hoff’s law, which states

a. the negative charge attracts sodium ions, which then attracts water across the vascular endothelium.
b. the negative charge attracts red blood cells, which then attracts water across the vascular endothelium.
c. the COP generated by a particle is indirectly proportional to its molecular weight.
d. the COP generated by a particle is directly proportional to its concentration in the blood.

A

C

75
Q

Human intravenous immunoglobulin (hIVIG) has been used in human medicine for years to treat conditions such as HIV, Guillain-Barre syndrome, and Kawasaki disease. It has been studied with variable success in veterinary medicine. Which of the following is a proposed mechanism of action for IVIG?

a. Inhibition of T-cell receptor-activated transduction pathway
b. Suppress lymphocyte proliferation and decrease antibody synthesis by B cells
c. Inhibit the release of IL-1, TNF-ɑ, and prostaglandins from leukocytes
d. Inhibition of complement, decreasing circulating cytokines

A

D

76
Q

Uveitis is a condition that occurs secondary to primary ocular conditions or extraocular conditions. The following are findings on a physical and ophthalmologic exam that are consistent with the diagnosis of uveitis:

a. aqueous flair and decreased intraocular pressure.
b. aqueous flair and increased intraocular pressure.
c. buphthalmos and aqueous flair.
d. buphthalmos and decreased intraocular pressure.

A

A

77
Q

All of the following treatments can be used to help reduce an acute increase in intraocular pressure in a patient with glaucoma:

a. Prednisolone acetate, latanaprost, and dorzolamide
b. Dorzolamide, timolol, or latanaprost
c. Timolol, prednisolone acetate, or dorzolamide
d. Latanaprost, tropicamide, or timolol

A

B

78
Q

Which of the following are the most common bacteria isolated from “melting” corneal ulcers?

a. Staphylococcus sp. and Pseudomonas sp.
b. E. coli and Staphylococcus sp.
c. E. coli and Beta-hemolytic streptococcus
d. Beta-hemolytic streptococcus and Pseudomonas sp.

A

D

79
Q

Which of the following continuous renal replacement therapies is a purely convective modality?

a. Continuous venovenous hemofiltration (CVVH)
b. Continuous venovenous hemodialysis (CVVHD)
c. Continuous venovenous charcoal hemodialysis (CVVCHD)
d. Continuous venovenous hemodiafiltration (CVVHDF)

A

A

80
Q

Aminoglycoside toxicity leads to acute renal failure as a result of injury to the

a. glomerulus.
b. proximal tubule.
c. loop of Henle.
d. distal tubule.

A

B

81
Q

The following biomarker has been found to be able to detect acute kidney injury prior to elevations in creatinine concentrations:

a. Neutrophil gelatinase associated lipocalin
b. Procalcitonin
c. C-reactive protein
d. Soluble urokinase-type plasminogen receptor

A

A

82
Q

High-flow nasal oxygen therapy is an option for animals with moderate hypoxemia. Flow rates up to 60 L/min can be tolerated by most patients. Which of the following statements best describes why these flow rates are tolerated?

a. The variable FiO2 can be chosen for patient need.
b. Soft silicone nasal prongs allow a more diffuse jet.
c. The oxygen is delivered in heated and humidified air.
d. Most animals are receiving some degree of sedation.

A

C

83
Q

Which of the following causes of hypoxemia will have a normal A – a oxygen gradient on room air and will be responsive to oxygen?

a. Diffusion impairment
b. Hypoventilation
c. Right to left shunting
d. Low V/Q regions

A

B

84
Q

When assessing platelet function, platelet aggregometry

a. using the weak agonist collagen will help promote adherence and platelet granule release.
b. using the strong agonist epinephrine will help promote adherence and platelet granule release.
c. may use a collagen/ADP test to confirm an abnormal collagen/epinephrine test.
d. reporting a normal closure time indicates normal platelet function.

A

C

85
Q

Platelets have two types of organelles, 𝜶 granules and dense-core granules. Which statement differentiates dense-core granules from 𝜶 granules?

a. The dense-core granules are more abundant than 𝜶 granules.
b. Dense granules contain a high amount of fibrinogen
c. The dense-core granules store von Willebrand factor and clotting factor V.
d. The dense-core granules store ATP, ADP, serotonin, and calcium.

A

D

86
Q

Which of the following statements best describes the interaction between platelets and the vascular endothelium?

a. The negative charge on platelets and heparan sulfate in endothelial cells may help prevent platelet adhesion under normal conditions.
b. Platelet adhesion is mediated by glycoproteins receptors in the platelet membrane that are known as ligands.
c. Endothelial damage exposes ligands including collagen which binds to glycoprotein Gp1b/1a in the platelet membrane.
d. Nitric oxide inhibits platelet adhesion to endothelium and aggregation mediated via cAMP and its transduction mechanism

A

A

87
Q

According to the modified Starling hypothesis, the development of interstitial edema is predominately dependent on the

a. microvascular hydrostatic pressure.
b. oncotic pressure of the endothelial surface layer.
c. interstitial oncotic pressure.
d. filtration coefficient of the tissue bed.

A

A

88
Q

In acute hypervolemia induced by crystalloid and/or colloid fluid resuscitation, what mediator causes deterioration of the endothelial surface layer?

a. Nitric oxide synthase
b. Atrial natriuretic peptide
c. Tumor necrosis factor-⍺
d. C-reactive protein

A

B

89
Q

Given the emerging understanding of the importance of the endothelial glycocalyx in the pathophysiology of critical illness, it is a logical therapeutic target. How is doxycycline postulated to preserve the endothelial glycocalyx?

a. Anti-inflammatory properties
b. Antioxidant properties
c. Inhibition of heparanase
d. Inhibition of matrix metalloproteinase

A

D

90
Q

Magnesium deficit can result in

a. hypokalemia due to impaired renal reabsorption across the Na-K-Cl cotransporter.
b. decreased neuronal excitability and decreased neuromuscular transmission.
c. vascular smooth muscle dilation resulting in systemic hypotension.
d. intracellular sodium deficit due to impairment of the Na-K-ATPase pump.

A

A

91
Q

Phosphates are key intracellular buffers in the body because they are

a. weak acids.
b. strong acids.
c. weak bases.
d. strong bases.

A

A

92
Q

The renal lesion(s) that has/have been reported in dogs with Borrelia burgdorferi antibodies is/are

a. diffuse tubular necrosis and regeneration.
b. eosinophilic interstitial nephritis.
c. polyclonal antibody identification.
d. vacuolar-hydropic degeneration.

A

A

93
Q

According to the 2021 study in the Journal of Veterinary Internal Medicine, which of the following is TRUE with respect to patients with Leptospirosis and those patients with leptospiral pulmonary hemorrhage syndrome (LPHS)?

a. Significant elevations of serum markers of endothelial cell activation (sICAM-1) and dysfunction (VEGF andAng-2) are unique to LPHS and are not observed in other causes of acute kidney injury.
b. Concentrations of serum markers of endothelial cell activation (sICAM-1) and dysfunction (VEGF andAng-2) are significantly increased in day 1 samples of dogs with leptospirosis with or without LPHS compared to clinically healthy control dogs.
c. Soluble ICAM-1 and VEGF concentrations at admission were not significantly higher in nonsurvivors than survivors and increased serum concentrations did not predict a negative outcome with high accuracy.
d. Infection with Leptospira spp. leads to a specifically high degree of endothelial activation and dysfunction as suggested by in vitro models.

A

B

94
Q

The clinical signs of tetanus infection are the result of the tetanus toxin

a. binding reversibly to the presynaptic sites on inhibitory interneurons of the brain and spinal cord.
b. preferentially binding to motor inhibitory neurons sparing the neurons of the autonomic nervous system.
c. entering motor nerves at the neuromuscular endplate and then traveling antegrade to the next motor nerve cell body.
d. inhibiting the release of glycine and ɣ-aminobutyric acid (GABA) neurotransmitters of the inhibitory interneurons of the brain and spinal cord.

A

D

95
Q

Which of the following antiemetics is a neurokinin-1 (NK-1) receptor antagonists with both central and peripheral activity?

a. Metoclopramide
b. Dolasteron
c. Maropitant
d. Meclizine

A

C

96
Q

Increased neural stimulation of the vomiting center in the medulla may come from the central and/or peripheral sources. Central afferents to the vomiting center may come from which of the following anatomic locations?

a. Chemoreceptor trigger zone
b. Cerebrum
c. Vestibular center
d. All of the above

A

D

97
Q

Urethral sphincter mechanism incontinence (USMI) is the most common urinary storage disorder in dogs. The urethral sphincter mechanism involves smooth muscle of the urethra, surrounding support tissues, submucosal vasculature and urothelium. USMI is proposed to result from reduced muscular responsiveness and tone changes to periurethral tissues. What is the rationale for treatment with estrogens [Incurin (estriol) or diethylstilbestrol]?

a. Increasing the number and sensitivity of beta receptors in the urethral sphincter.
b. Increasing the number and sensitivity of alpha receptors in the urethral sphincter.
c. Increasing the number and sensitivity of the muscarinic receptors in the urethral sphincter.
d. Increasing the number and sensitivity of the nicotinic receptors in the urethral sphincter.

A

B

98
Q

In a paper by Langlois et.al. published in the Journal of Veterinary Internal Medicine in 2020, the use of metronidazole in acute diarrhea can shorten the duration of diarrhea by an average of ____________________.

a. 12 hours
b. 24 hours
c. 36 hours
d. 48 hours

A

C

99
Q

In a paper by Frykfors von Hekkel published in Veterinary Surgery 2020, which of the following injuries or factors were more likely to be associated with intrathoracic injury?

a. Subcutaneous emphysema, rib fracture, and smaller size of injured dog
b. Pleural effusion, pneumothorax, and weight ratio between biting dog and injured dog of > 2:1
c. Multiple bite wounds, pseudo-flail chest, and subcutaneous emphysema
d. Pseudo-flail chest, rib fracture, and pneumothorax

A

D

100
Q

Rapoport et.al. published a study evaluating the prognostic value of the Koret CT score in dogs with traumatic brain injury in the Veterinary Journal 2020. What cutoff value was found to predict survival (85% sensitivity and 100% specificity)?

a. 1
b. 3
c. 5
d. 7

A

B

101
Q

The vital capacity of the lungs includes which lung volumes?

a. tidal volume, functional residual volume, expiratory reserve volume
b. tidal volume, expiratory reserve volume, inspiratory reserve volume
c. tidal volume, residual volume, inspiratory reserve volume
d. tidal volume, residual volume, expiratory reserve volume

A

B

102
Q

Anatomic dead space in the lung is defined as

a. the portion of tidal volume that relies upon diffusion for gas flow.
b. the portion of the airway that contains occasional alveolar buds.
c. one-third of the tidal volume.
d. the volume of the conducting airways.

A

D

103
Q

For a patient in sternal recumbency, the regional ventilation and perfusion for the dorsal region of the lung can be described as

a. low ventilation and low perfusion.
b. low ventilation and high perfusion.
c. high ventilation and low perfusion.
d. high ventilation and high perfusion.

A

A

104
Q

Which of the following statements is correct regarding the natural barrier of the stomach that consists of mucus, gel, bicarbonate and surfactant phospholipids?

a. The layer is known as the stirred layer.
b. The layer prevents penetration of pepsin.
c. The layer cannot be penetrated by bile salts.
d. The layer contains peptides that decrease gel viscosity.

A

B

105
Q

Within the stomach, prostaglandins

a. inhibit acid secretion from chief cells.
b. stimulate bicarbonate secretion from parietal cells.
c. promote mast cell activation.
d. preserve tight junctions between epithelial cells.

A

D

106
Q

When suturing small intestines which layer is the primary holding layer?

a. serosa
b. muscularis
c. submucosa
d. mucosa

A

C

107
Q

Which of the following hormones increases the release of free fatty acids from adipocytes?

a. epinephrine
b. insulin
c. E-series prostaglandins
d. dopamine

A

A

108
Q

Under physiologic conditions, where does the activation of pancreatic zymogens occur?

a. pancreatic duct
b. pancreatic acinar cells
c. gastric lumen
d. duodenum

A

D

109
Q

Trypsinogen is activated by the enzyme ___________, secreted by the intestinal mucosa in response to chyme in contact with the gastrointestinal tract mucosa?

a. enterokinase
b. trypsin
c. chymotrypsinogen
d. amylase

A

A

110
Q

Which of the following are ALL examples of non-enzymatic free radical scavengers?

a. carotene, cobalamin, glutamate
b. vitamin E, glutathione, melatonin
c. vitamin K, vitamin C, vitamin D
d. catalase, NADH, vitamin C

A

B

111
Q

Which of the following is the mechanism by which steroid-induced immunosuppression reduces red blood cell destruction in immune-mediated hemolytic anemia?

a. rapid decrease in erythrophagocytosis by macrophages
b. rapid decrease in immunoglobulin concentration
c. rapid decrease in membrane attack complex formation
d. rapid decrease in pro-inflammatory interleukins

A

A

112
Q

Erythropoietin production should increase in which of the following scenarios?

a. myeloproliferative disorders
b. post-red blood cell transfusion
c. symptomatic onion toxicity
d. systemic hypertension

A

C

113
Q

An animal is transferred to you for continued care 5 days following intestinal resection and anastomosis for a gastrointestinal foreign body. Upon arrival, you note that the patient is obtunded, tachycardic and febrile, with brick red mucous membranes and weak pulses. The patient has abdominal pain and AFAST reveals an abdominal fluid score of 2/4. The patient’s doppler blood pressure is 83 mmHg. In-house blood work reveals a lactate of 4.1 mmol/L, blood glucose of 57.6 mg/dl (3.2 mmol/L), an elevated creatinine and hyperbilirubinemia. A blood smear notes an inflammatory leukogram with left shift, and abdominal fluid cytology notes intracellular bacteria. According to the Sepsis-3 definitions, this patient has

a. SIRS.
b. sepsis.
c. septic shock.
d. severe sepsis.

A

B

114
Q

According to the 2018 Surviving Sepsis Campaign update, which of the following are components of the hour-1 bundle of care which should be applied to this patient?

a. Remeasure serum lactate concentration and obtain blood cultures prior to the administration of antibiotics.
b. Administer empiric broad spectrum antibiotics and administer fresh frozen plasma to provide colloidal support.
c. Administer vasopressors if the patient remains hypotensive after fluid resuscitation and commence low-dose dopamine for renal protection.
d. Rapidly administer a crystalloid bolus for hypotension and use sodium bicarbonate therapy to improve hemodynamics or reduce vasopressor requirements.

A

A

115
Q

The patient initially responded to therapy with the target mean arterial pressure achieved. However, two-hours later the patient deteriorated with worsening hypotension despite adequate volume resuscitation (based on ultrasonographic assessment of cardiac filling and vena cava collapsibility) and the addition of a 1 mcg/kg/min norepinephrine continuous rate infusion. According to the 2016 Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock, what is the most appropriate next step for this patient?

a. Administer an albumin infusion.
b. Administer intravenous hydrocortisone.
c. Add a dobutamine CRI.
d. Add a vasopressin CRI.

A

D

116
Q

Sepsis is now recognized to involve early activation of both pro- and anti-inflammatory responses. In this patient’s scenario, which toll-like receptor (TLR) and its pathogen-associated molecular pattern was likely involved in inducing the patient’s innate immune system?

a. TLR 4; Lipopolysaccharide
b. TLR 5; Flagellin
c. TLR 6; Lipopeptide
d. TLR 9; DNA

A

A

117
Q

Hypotension associated with sepsis is due to

a. increased production of prostaglandin F2.
b. decreased production of plasminogen activator inhibitor 1.
c. increased expression of inducible nitric oxide synthase.
d. decreased expression of interleukin-10.

A

C

118
Q

Elevation of serum procalcitonin concentration in septic patients is primarily due to

a. increased secretion of procalcitonin stimulated by interferon-.
b. increased synthesis of procalcitonin by extra-thyroidal tissues.
c. decreased conversion of procalcitonin into calcitonin in thyroid parafollicular cells.
d. decreased renal clearance of procalcitonin.

A

B

119
Q

Increased levels of endogenous or exogenous catecholamines in sepsis lead to elevated plasma lactate concentrations secondary to

a. decreased cyclic guanosine monophosphate production via ɑ1-adrenergic stimulation.
b. decreased cyclic guanosine monophosphate production via β2-adrenergic stimulation.
c. increased cyclic adenosine monophosphate production via ɑ1-adrenergic stimulation.
d. increased cyclic adenosine monophosphate production via β2-adrenergic stimulation.

A

D

120
Q

Which of the following is a glycosaminoglycan component of the endothelial glycocalyx that has been investigated as a potential biomarker of endothelial glycocalyx degradation due to sepsis?

a. heparan sulfate
b. P-selectin
c. C-reactive protein
d. syndecan-1

A

A

121
Q

Increased potassium in the extracellular fluid may lead to abnormal cardiac function due to

a. decreased resting membrane potential of the cardiac myocyte.
b. increased resting membrane potential of the cardiac myocyte.
c. increased translocation of calcium into the cardiac myocyte.
d. decreased translocation of calcium into the cardiac myocyte.

A

A

122
Q

Which of the following factors may lead to an increase in extracellular potassium?

a. metabolic alkalosis
b. mineral acidosis
c. aldosterone
d. -adrenergic stimulation

A

B

123
Q

What effect does insulin have on extracellular potassium?

a. Insulin causes de-activation of the Na+/K+ pump, leading to increased extracellular K+.
b. Insulin and K+ are co-transported into the cell leading to decreased extracellular K+.
c. Insulin stimulates the Na+/H+ antiporter, leading to the activation of the Na+/K+ pump and ultimately decreasing extracellular K+.
d. Insulin stimulates the Na+/H+ antiporter, shifting H+ into cells and causing K+ translocation into the extracellular fluid compartment.

A

C

124
Q

Influx of which of the following occurs early in the development of ischemia-reperfusion injury, with the degree of subsequent damage dependent on both the extent and duration of the subsequent increase in its intracellular concentration?

a. magnesium
b. potassium
c. calcium
d. nitrogen

A

C

125
Q

Which of the following can combine with hydrogen peroxide to from the hydroxy radical following reperfusion of ischemic tissues?

a. iron
b. hydrogen
c. oxygen
d. xanthine

A

A

126
Q

N-acetylcysteine (NAC) is used as an antioxidant for the treatment of ischemia-reperfusion injury. NAC blocks the formation of hydroxyl radicals by contributing to the increased production of which of the following?

a. tocopherol
b. ascorbic acid
c. isoprostanes
d. glutathione

A

D

127
Q

Which class of antifungals is preferred in the treatment of aspergillosis?

a. pyrimidines
b. azoles
c. synthetic allylamines
d. echinocandins

A

B

128
Q

How do nonsteroidal anti-inflammatory drugs adversely affect renal perfusion during states of decreased blood flow?

a. selective inhibition of the cyclooxygenase-1 (COX-1) enzyme
b. decreased peroxidase-mediated scavenging of free radicals
c. inhibition of organic anion transporter pumps
d. inhibition of localized prostaglandin-mediated vasodilation

A

D

129
Q

What is the main type of toxicity caused by amphotericin B, and what is the associated mechanism of the action?

a. hepatotoxicity; induces mammalian P-450 enzymes to cause increased transaminase activity
b. vasculitis and ulcerative dermatitis; spontaneous histamine release with rapid infusion
c. nephrotoxicity; binding of cholesterol in proximal tubular cells causes renal vasoconstriction and renal tubular acidosis
d. myelosuppression; inhibition of colony stimulating factor in granulocytes

A

C

130
Q

Which of the following organisms is most commonly associated with immune-mediated erythrocyte destruction in the dog?

a. Dirofilaria immitus
b. Neospora caninum
c. Babesia gibsoni
d. Borrelia burgdorferi

A

C

131
Q

Which of the following statements about Cytauxzoon felis is true?

a. Cytauxzoon felis is transmitted from infected bobcats to the domestic cat by the Ixodes pacificus tick.
b. Cytauxzoon felis infected macrophages line the gastrointestinal tract lumen, and merozoites released from enterocytes infect erythrocytes.
c. Antemortem diagnosis is based on demonstration of the erythrocytic phase on blood smears stained with methylene blue.
d. The treatment of choice for Cytauxzoon felis includes doxycycline and atovaquone

A

C

132
Q

Which of the following statements about Mycoplasma is true?

a. Acute infection with Mycoplasma haemofelis often results in severe, primarily intravascular hemolytic anemia in cats.
b. Cats that recover from acute infections with M. haemofelis may remain chronically infected for months – years.
c. Hemotropic mycoplasma are rickettsial organisms.
d. Felines do not generally develop clinical symptoms secondary to M. haemofelis infection unless immunocompromised.

A

B

133
Q

A retrospective study published in the Journal of Veterinary Emergency and Critical Care in 2020 evaluated the shock index (SI) in healthy dogs and in dogs with vehicular trauma. In 124 dogs with vehicular trauma, SI was statistically higher in dogs that died compared to those that survived to discharge. In addition, SI was positively correlated with which of the following?

a. plasma lactate concentration
b. modified Glasgow Coma score
c. Animal Trauma Triage score
d. APPLEfull score

A

C

134
Q

A retrospective study of 149 dogs with secondary septic peritonitis published in the Journal of Veterinary Emergency and Critical Care in 2020 found an incidence of recurrent secondary septic peritonitis of approximately 10%. In this study, dogs with recurrent secondary septic peritonitis had significantly ________________________ prior to the first surgery.

a. higher serum lactate and bilirubin concentrations
b. lower albumin concentrations and higher packed cell volumes
c. lower serum albumin concentrations and higher serum lactate concentrations
d. higher serum bilirubin concentrations and higher packed cell volumes

A

B

135
Q

A prospective experimental study in healthy dogs published in the Journal of Veterinary Emergency and Critical Care in 2021 evaluated routine coagulation assays as potential alternatives to rivaroxaban-specific anti-Xa activity (RIVA) for monitoring rivaroxaban therapy. Which of the following had the best correlation to RIVA?

a. prothrombin time
b. activated partial thromboplastin time
c. Rapid thromboelastography maximum amplitude (MA)
d. Rapid thromboelastography G value

A

A

136
Q

Which of the following is correct regarding the transcellular transport of calcium in the gastrointestinal tract and kidney?

A. Calcium binds irreversibly to mobile cytosolic calcium-binding proteins which have multiple sites for calcium and prevent alteration in intracellular calcium concentration.

B. 1,25-dihydroxycholecalciferol increases the calcium binding protein on the intestinal epithelial brush border to transport Ca2+ into the cell cytoplasm.

C. In the distal tubule and duodenum, calcium enters the basolateral side passively through calcium selective channels and is actively transported out the luminal membrane.

D. Stimulation of the iCa2+ receptor in the kidney increases NaCl, iCa2+ and iMg2+ in the proximal convoluted tubule.

A

B

137
Q

Which statement correctly identifies the functions of the major hormones that control normal calcium homeostasis?

A. Calcitriol stimulates Ca2+ uptake from the gastrointestinal tract and stimulates parathyroid hormone synthesis.

B. Parathyroid hormone stimulates renal reabsorption of Ca2+ and phosphate, as well as renal production of calcitriol.

C. Fibroblast Growth Factor-23 increases renal reabsorption of Ca2+ and decreases renal production of calcitriol.

D. Calcitriol inhibits osteoclastic bone resorption activity and decreases renal tubular reabsorption of Ca2+.

A

C

138
Q

In addition to the initiation of saline diuresis, which of the following is the most appropriate initial therapy in a patient with severe, life threatening ionized hypercalcemia of undetermined cause?

A. Spironolactone

B. Bisphosphonates

C. Dexamethasone

D. Calcitonin

A

D

139
Q

Treatment of severe ionized hypocalcemia (iCa2+ <0.7 mmol/L) in a stable, asymptomatic patient should be…

A. Initially withheld with ongoing monitoring.

B. Initiated regardless of other factors.

C. Dependent on the albumin level.

D. Dependent on the magnesium level.

A

B

140
Q

Crotalidae Polyvalent Immune Fab (CroFab) consists of ovine IgG with which region removed?

A. F(ab) region

B. F(ab’)2 region

C. Fv region

D. Fc region

A

D

141
Q

What component of snake venom is thought to cause echinocytosis?

A. Myocardial depressant factor

B. Protein C activator

C. Linoleic acid

D. Phospholipase A2

A

D

142
Q

In a study by Viall et.al. published in the Journal of the American Veterinary Medical Association in 2019, the authors conclude which of the following?

A. Hypocholesterolemia was a predictor of survival in sick dogs.

B. Hypotriglyceridemia was a predictor of survival in sick dogs.

C. Dyslipidemias were not a concern in this population of dogs.

D. Septic dogs were more likely to have altered lipid profiles.


A

A

143
Q

Bilirubin metabolism and secretion into the bile follows which of the pathways described below?

A. Unconjugated bilirubin is transported in the plasma by multidrug-resistance protein 2, is actively taken up by the hepatocyte, and then excreted into bile.

B. Heme is broken down by reticuloendotheilial system, freeing bilirubin to be cotransported with cholesterol, which permits diffusion into hepatocyte and bile.

C. Bound to albumin in plasma, bilirbuin dissociates in the hepatocyte sinusoid, become bound to glucuronic acid in the hepatocyte, excreted into bile.

D. Heme ring is broken down by Kupffer cells and the products remain unconjugated which facilitates secretion across the canalicular membrane into the bile.

A

C

144
Q

The following cell type is a key mediator in the development of hepatic dysfunction during a systemic inflammatory response:

A. Hepatocyte

B. Sinusoidal endothelial cell

C. Stellate fat cell

D. Kupffer cell

A

D

145
Q

A 2017 study by Kuzi et.al. published in the Veterinary Record investigating feline hepatic lipidosis found that the following was associated with increased mortality.

A. Male sex

B. Hypocholesterolemia

C. Pancreatitis

D. Low β-hydroxybutyrate

A

B

146
Q

A 2019 study published in the Journal of Veterinary Internal Medicine by Francey et.al. evaluated physiologic and metabolic changes that occurred during therapeutic plasma exchange. Which of the following was associated with an increased risk of citrate toxicity?

A. Renal impairment

B. Hyperbilirubinemia

C. Hypoalbuminemia 

D. Renal and hepatic impairment

A

A

147
Q

There are four general methods by which solute clearance occurs during renal replacement therapy. Which of the following definitions describes the concept of convection?

A. Movement of particles from a higher to a lower concentration.  

B. Movement of water along a hydrostatic pressure gradient.  

C. Binding of particles to the dialyzer membrane.

D. Removal of solutes with water via solvent drag.

A

D

148
Q

Which of the following is correct about the acute phase protein CRP?

A. CRP is produced by hepatocytes in response to release of INF-Ɣ and IL-13.

B. CRP reaches peak concentration in 36 – 50 hours following secretion.

C. The severity of increase has been correlated with patient mortality.

D. The prolonged half-life and high specificity make it an ideal marker for sepsis.

A

B

149
Q

The classical pathway of complement system activation is primarily initiated by interaction between an antigen and…

A. Mannose-binding lectins.

B. C3b fragments.

C. Antibodies.

D. Tumor necrosis factor-ɑ.

A

C

150
Q

Major histocompatibility complex (MHC) II proteins present antigens to…

A. Regulatory T lymphocytes.

B. Helper T lymphocytes.

C. Cytotoxic T lymphocytes.

D. B lymphocytes.

A

B

151
Q

Which of the following is a product of degranulating mast cells during anaphylaxis?

A. Heparin

B. Interleukin-10

C. Prostaglandin E2 (PGE2)

D. Annexin A1 (ANXA1)

A

A

152
Q

The alternative immunologic pathway (non-IgE dependent) of anaphylaxis involves…

A. Eosinophils.

B. Basophils.

C. IgA.

D. IgG.

A

D

153
Q

Activation of a G-protein second messenger system in the postsynaptic neuron can result in the following downstream effect:

A. There is prolonged opening of the specific ion channels through the postsynaptic membrane.

B. Cyclic adenosine monophosphate (cAMP) becomes inactive, causing quiescence of the neuron.

C. Activation of intracellular enzyme systems that lead to increased intracellular calcium concentrations.

D. Gene transcription is halted, leading dysfunction of cellular machinery and ultimately cell apoptosis.

A

A

154
Q

The G-Protein in “second messenger” systems are composed of the components?

A. alpha and gamma

B. beta and gamma

C. alpha, beta and gamma

D. alpha, beta, gamma, and zeta

A

C

155
Q

What is the mechanism of action by which glucagon causes an increase in blood glucose?

A. As a large polypeptide hormone, glucagon competitively inhibits the insulin receptor on the cell surface, thereby increasing blood glucose concentrations.

B. Glucagon activates adenylyl cyclase in the hepatic cell membrane, activating secondary messenger systems and ultimately, leads to degradation of glycogen.

C. Glucagon enhances glycogenolysis by increasing the amount of amino acids taken up by the hepatocytes.

D. Glucagon activates the enzymes responsible for the conversion of phosphoenoylpyruvate to pyruvate, the rate limiting step of gluconeogenesis.

A

B

156
Q

Tissues of which of the following organs do not require insulin to assist in the uptake of glucose?

A. Pancreas

B. Liver

C. Heart

D. Brain

A

D

157
Q

Which of the following is not a characteristic finding of the propofol-related infusion syndrome in people?

A. Methemoglobinemia

B. Rhabdomyolysis

C. Hypokalemia

D. Cardiac arrhythmias

A

C

158
Q

In a case report by Mallard et al published in the Canadian Veterinary Journal in 2018, which of the following medications was used to treat methemoglobinemia suspected to be secondary to the propofol-related infusion syndrome in a dog?

A. N-acetylcysteine

B. Norepinephrine

C. Dexamethasone

D. Vitamin C

A

A

159
Q

Which of the following best describes why immune cells can be suppressed by opioids?

A. Immune cells such as lymphocytes and NK cells have mu opioid receptors on their surface.

B. Opioids causes respiratory depression and increase in PaCO2 resulting in decreased respiratory burst of neutrophils.

C. Chronic morphine administration can lead to upregulation of INF-ɣ, IL-5 and IL-10 cytokines.

D. Inhibition of the OP1 and OP3 receptor on B lymphocytes results in peripheral immunosuppression.

A

A

160
Q

Dexmedetomidine exerts clinical effects due to stimulation of primarily alpha-2 receptors. Which of the following anatomic sites do not have alpha-2 receptors?

A. Vascular smooth muscle

B. Sinoatrial node

C. Cerebral cortex

D. Spinal cord

A

B

161
Q

Which of the following prokinetic drugs is a motilin agonist?

A. Cisapride

B. Ranitidine

C. Erythromycin

D. Metoclopramide

A

C

162
Q

Which of the following prokinetic drugs may cause extrapyramidal signs?

A. Metoclopramide

B. Bethanechol

C. Cisapride

D. Erythromycin

A

A

163
Q

Which of the following prokinetic agents has been associated with prolonged QT syndrome in people limiting is commercial availability in veterinary medicine?

A. Domperidone

B. Cisapride

C. Metoclopramide

D. Ranitidine

A

B

164
Q

Which type of sensory neurons rapidly transmit sharp, acute pain that is discrete and localizable?

A. A-alpha fibers

B. A-delta fibers

C. C fibers

D. D fibers

A

B

165
Q

What is allodynia?

A. Increased reactivity or sensitivity to painful stimuli

B. Phantom pain

C. Painful reaction to an innocuous stimulus

D. Acute nociceptive pain

A

C

166
Q

Which neurotransmitter is normally inhibitory but can become excitatory in the spinal cord after peripheral nerve injury?

A. NMDA

B. Aspartate

C. Glutamate

D. GABA

A

D

167
Q

Good hand hygiene is an important factor in controlling nosocomial infection. Which statement is most correct regarding performing proper hand hygiene?

A. Hand hygiene should be performed after examining a patient but is not necessary before.

B. Hand hygiene should be performed before touching indwelling catheters but not after.

C. Hand hygiene is not necessary before contact with wound dressings but should be performed after.

D. Hand hygiene should be performed before and after removing gloves.

A

D

168
Q

Which of the following statements is most accurate regarding antiseptics?

A. Povidone iodine is effective against all gram-positive and gram-negative bacteria, unenveloped viruses, fungi, bacterial spores and mycobacteria but has decreased effectiveness in the face of organic material.

B. Alcohol is effective against all gram-positive and gram-negative bacteria, unenveloped viruses, some fungi, bacterial spores, mycobacteria, but has no residual activity.

C. Sodium hypochlorite is effective against all gram-positive and gram-negative bacteria, unenveloped viruses, fungi, bacterial spores and mycobacteria, and is effective against biofilms.

D. Chlorhexidine solution is effective against all gram-positive and gram-negative bacteria, unenveloped viruses, fungi and mycobacteria, but is not sporicidal.

A

C

169
Q

Which of the following antibiotics is paired with its correct mechanism of action?

A. Aminoglycosides and inhibition of DNA gyrase and nucleic acid synthesis

B. Chloramphenicol and inhibition of ribosomal 50s replication and protein synthesis

C. Fluoroquinolones and inhibition of ribosomal 30s replication and protein synthesis

D. Tetracyclines and inhibition of RNA polymerase and nucleic acid synthesis

A

B

170
Q

What are potential risk factors for the development of multidrug-resistant bacteria?

A. Induction of plasmid-mediated Amp-C enzymes by gram-negative bacteria.

B. Induction of extended spectrum beta lactamases by gram-negative bacteria.

C. Infection from a community-acquired setting in immunosuppressed pets.

D. Transmission of commensal bacteria between humans and their pets.

A

A

171
Q

Which vessel type is responsible for vascular resistance?

A. Large arteries

B. Large veins

C. Capillaries

D. Arterioles

A

D

172
Q

Which of the following statements is correct regarding cardiac and arterial pressures?

A. Normal peak systolic pressure in the right atrium is 15 - 30 mmHg and right ventricle is 90 – 150 mmHg.

B. Left ventricular peak systolic pressure in a healthy animal is 5-6 times greater than right ventricular peak systolic pressure.

C. Mean blood pressure can be estimated by dividing systolic pressure by 3 and adding this to diastolic pressure.

D. Diastolic pressure in the great arteries is generally measured at the beginning of diastole, when pressures are the lowest.

A

B

173
Q

A study by Williams et al published in Veterinary Surgery in 2020 evaluated regarding the microorganisms associated with incisional infections after gastrointestinal surgery in small animals. Based on the study’s results, which of the following was concluded regarding the most common bacterial isolate and its susceptibility to common perioperative antimicrobials (e.g. cefazolin and cefoxitin)?

A. Staphylococcus aureus; resistant

B. Staphylococcus aureus; sensitive

C. Staphylococcus pseudintermedius; sensitive

D. Escherichia coli; resistant

A

D

174
Q

Regarding the primary outcome of a study published by the STARRT-AKI Investigators in the New England Journal of Medicine in 2020, the timing of initiation of renal-replacement therapy for acute kidney injury found that…

A. Early initiation was associated with a lower risk of death at 90 days.

B. Conventional guidelines for initiation were associated with a lower rate of renal recovery.

C. Early initiation was not associated with a lower risk of death at 90 days.

D. Conventional guidelines for initiation were not associated with a lower rate of renal recovery.

A

C

175
Q

In a study by Kantyka et al published in the Journal of Veterinary Emergency and Critical Care in 2020, which of the following agents was proven to be most effective in preventing vomiting induced by the administration of 50 mg/kg IV tranexamic acid?

A. Ondansetron

B. Maropitant

C. Metoclopramide

D. No agent was more effective versus placebo

A

B

ACVECC Board Study (7 decks)

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