Questions Flashcards
What molecules is POMC (pro-opiomelanocortin) a precursor of?
Adrenocorticotropic hormone (ACTH) and beta-lipotropin (B-LPH)
Various melanocyte stimulating hormones happen next in the pathway.
What class of antibiotics are also motilin agonists?
Macrolides to include erythromycin and azithromycin
What is the rate cutoff for distinguishing between AIVR and ventricular tachycardia?
180 bpm
What type of organism is most likely to result in a Type II immune response? What cells are associated with such a response?
Parasites / helminths
CD4+ TH2 cells, eosinophils, basophils, mast cells
What is the ryanodine receptor, and what receptor is it attached to?
It is a protein located in the wall of the sarcoplasmic reticulum. It is connected to a dihydropyridine receptor located in the wall of the T tubule. When the AP travels down the T tubule, it changes the DHP receptor, which then open the ryanodine receptor, allowing calcium out of the sarcoplasmic reticulum.
What does vitamin D toxicity cause the serum phosphorus and calcium to do? What is the biologically active form of vitamin D? Does this increase or decrease PTH activity?
It causes hypercalcemia and hyperphosphatemia.
1,25-dihydroxycholecalciferol
Decreases PTH activity (negative feedback since PTH activates it in the kidney)
Describe the pathway for norepinephrine production.
The amino acid tyrosine is converted to dopamine, which is then converted to norepinephrine.
What commonly used antibiotics concentrate within the urine?
Aminopenicillins
Other commonly used in people include TMS, nitrofurantoin and fluoroquinolones
What class of antibiotics is best used to treat actinomycosis?
Penicillins
What is the mechanism of action of calcitonin?
Inhibits osteoclast activity (doesn’t directly decrease parathyroid activity)
What pharmacokinetic value determines the extent of exposure of a drug over time following its administration?
AUC
Where are bile acids reabsorbed along the GIT? What is this pathway called?
Ileum
Enterohepatic circulation
What value is higher in chylous effusions than in serum, and should be measured to confirm a diagnosis of chylous effusion?
Triglycerides
CD25 is associated with what type of T cell?
T regulatory cells
What do the following hormones do in regards to increasing or decreasing fatty acid release?
- Epinephrine
- Growth hormone
- Thyroid hormone
- Glucagon
- Insulin
- Epinephrine - increase
- Growth hormone - increase
- Thyroid hormone - increase
- Glucagon - increase
- Insulin - decrease
Where is glucagon manufactured?
The pancreatic alpha cells
What does the parietal cell secrete?
Hydrogen protons (with Cl)
In people, intrinsic factor is also secreted from the parietal cells.
What hormones increase pancreatic secretions?
Acetylcholine, secretin and cholecystokinin
What is the mechanism of action for sildenafil?
It is a phosphodiesterase V inhibitor. This blocks degradation of the second messenger cAMP, and ultimately increases NO production.
What is the pathophysiologic mechanism behind foxglove toxicity?
This is a cardiac glycoside, with the same MOA as digoxin - inhibition of Na-K-ATPase pump. This results in intracellular accumulation of Na and Ca - positive inotropy occurs, but also significant arrhythmias, often bradyarrhythmias. Vomiting and lethargy are common.
Which diuretic is potassium sparing? Why are the other ones potassium wasting?
Spironolactone. This inhibits aldosterone action on the principal cells in the distal nephron, preventing K secretion.
Other diuretics are primarily potassium wasting because they increase flow through the nephron, lowering the amount of potassium seen by the principal cells, favoring a concentration gradient to move potassium out of the principal cells into the urine.
What causes acetylcholine to be released from the pre-synaptic neuron terminal?
Influx of calcium into the neuron via voltage gated calcium channels triggered by the action potential reaching the nerve terminal.
What is the Frank-Starling law of the heart?
Increased volume in the ventricle (ie preload) stretches the cardiac myocytes / sarcomeres out to a longer length, facilitating a stronger heart beat. The farther stretched the sarcomeres are, the more they can contract and more blood they can move.
What is the form of babesia that causes RBC lysis?
Merozoites, which form from asexual reproduction of the sporozoites which invaded the RBC.
Best treatment recommendation for babesiosis?
Atavaquone and azithromyzin combination
What is the mechanism of action of sulfa drugs?
Inhibition of folate / folic acid synthesis by bacteria, and a subsequent inability to produce additional DNA. Often this makes the drugs more bacteriostatic as opposed to bacteriocidal.
What is insulin’s action on lipoprotein lipase?
Activates lipoprotein lipase to facilitate movement of fats into adipocytes.
(Cleaves the triglycerides from circulating lipoproteins so they can get into the adipocytes)
Where do aminoglycosides cause nephrotoxicity?
Proximal tubule (glucosuria, ketonuria, casts)
What is the function of surfactant in the lungs?
To decrease surface tension within the alveoli, preventing collapse
Where on the Wigger’s diagram is represented by atrial contraction?
There is a small bump labeled ‘a’ in most diagrams. Causes a modest elevation in ventricular volume and pressure, prior to the large pressure increase in the ventricle associated with ventricular systole.
How do bradykinin and prostaglandins increase GFR?
They cause afferent arteriolar vasodilation.
Other molecules to do this include NO and dopamine. (And kind of angiotensin 2 and ANP)
How do pH alterations impact the ability of oxygen to bind to hemoglobin?
Acidosis — decreased binding (as would be expected in the tissues where oxygen needs to be dropped off)
Alkalosis — increased binding
What can cause a false positive protein reaction on a urine dipstick?
Alkalosis (>7.5)
What is thrombomodulin and where is it located?
Thrombomodulin is an anticoagulant molecule expressed on vascular endothelial cells.
It binds to thrombin (normally pro-coagulant, removing it from circulation) and activates protein C, which is anti-coagulant (inhibits factors 5 and 8).
Which organ converts lactate to glucose in an anaerobic states?
Liver
The lactate is typically produced in the muscles, and then uptaken by the liver.
This is why in cases with liver dysfunction, LRS is not an ideal fluid therapy.
How does hemorrhage stimulate thirst?
With hemorrhage, there is reduced blood flow through the kidneys. This activates the RAAS, and results in production of angiotensin II. This is the most potent stimulator of thirst.
Which channel closes during the third portion of the cardiac action potential (resulting in repolarization)?
Slow calcium channels close.
What happens during the process of apoptosis?
Proteins called capsases become activated, which triggers destruction of the cytoskeleton, resulting in cellular shrinkage. The nucleus also becomes fragmented. The cell debris eventually gets eaten by macrophages.
What is the main action of secretin on the pancreas? What is the main stimulus for secretin (should be intuitive)?
What do the other hormones that act on the pancreas do?
Secretin results in increased bicarbonate secretion in the pancreatic juices. It is stimulated by the presence of H+ in the duodenum.
CCK and Ach promote production of pancreatic enzymes.
What type of anemia occurs with chronic blood loss?
Microcytic hypochromic - reflective of iron deficiency anemia
What are the name of the parasympathetic nervous plexi within the wall of the GIT?
Submucosal (controls secretions / hormones)
Myenteric (controls muscle movements / peristalsis)
What nerve supplies parasympathetic innervation to the urinary bladder?
Sympathetic? Somatic?
Pelvic nerve (S1-3)
Hypogastric (L1-4)
Pudendal (S1-3)
There are two ways that cytotoxic T cells kill other cells. What are they?
- Perforin pathway (forms pores in the target cell)
- CD95 pathway, results in activation of a death-inducing signaling complex (DISC) that triggers apoptosis
What do the juxtaglomerular cells secrete? In response to what?
Renin - low pressure in the renal afferent arteriole (where the juxtaglomerular cells are) signals secretion of this molecule.
Apparently they also release renin when told to do so by the macula densa as a part of the juxtaglomerular complex.
What does a low fractional excretion of sodium (<1%) signify in a patient with an acute azotemia? In a clinically normal animal?
In an acutely azotemic patient, it signifies volume depletion. The kidneys try and reabsorb as much sodium (and water) in this state to restore volume. A higher value may indicate tubular injury.
In a normal patient, it is actually normal for a FE of Na to be <1%.
Classic signs of LMN disease?
Neurogenic atrophy, hypo to a-reflexia, hypotonia, short and choppy gait
What are the signs of Horner’s disease?
Ptosis
Enophthalmos
Miosis
Elevated third eyelid
Sweating and nasal congestion may be obvious in horses
Is glucose found in the urine of healthy dogs? Why not?
No. It reabsorbed completely in the proximal tubule with sodium via SGLT2.
What is the formula for accuracy?
Sensitivity?
Specificity?
PPV?
NPV?
(TP + TN) / (TP + TN + FP + FN)
Sensitivity - TP / TP + FN
Likelihood that animal with disease tests positive
Specificity - TN / TN + FP
Likelihood that an animal without disease tests negative
PPV - TP / TP + FP
Likelihood that a test positive represents an actual positive
NPV - TN / TN + FN
Likelihood that a test negative represents an actual negative
What is odds ratio?
The chance that a case (ie diseased patient) was exposed to the disease versus a healthy was exposed to disease
A x D / B x C
Limited amounts of this molecule lead to ketosis?
Oxaloacetate — this molecule is produced during carbohydrate metabolism via the CAC. It is what binds to acetyl CoA (ketone body) and allows for further processing of acetyl CoA in the CAC. Without oxaloacetate (as would occur during diabetes when glucose can’t be utilized), ketones can’t be processed and start to accumulate, leading to ketosis.
How do ketone bodies form? What are names of the ketone bodies?
They form from metabolism of triglycerides. Acetyl CoA is split from triglycerides (mostly in the liver), and two acetyl CoA molecules join together - acetoacetic acid. This is what can enter the CAC for ATP production.
Acetoacetic acid can be converted to beta-hydroxybutyric acid and acetone. All of these are ketone bodies.
What removes particulate debris in the lungs?
Resident macrophages
What are Heinz bodies made of? What is the most common cause of them?
Precipitates of denatured hemoglobin
Oxidative damage to RBC
What is zoonotic from dogs and horses?
Staphylococcus aureus
What molecule is the cause of gross lipemia following 24 hours?
Very low density lipoproteins (VLDLs)
What are the two main ways the dogs acquire neosporosis?
Vertically via transplacental transmission from infected dams (bradyzoites reactivate to tachyzoites).
Horizontally via ingestion of tissue cysts (bradyzoites) in infected intermediate hosts.
Iron is transported in the bloodstream in what form?
Transferrin
What type of hypoxia is not responsive to supplemental oxygen therapy?
Anemia
And maybe cyanide poisoning, and R to L shunts
How is Pythium acquired?
Through breaks in skin / GIT if ingested from contaminated water
What two organ systems can be affected by Cyanobacteria toxicity / blue-green algae?
Liver
CNS
Toxins produced by the bacteria / algae cause the signs.
What does the T helper 2 response involve?
These lymphocytes secrete IL-4 and IL-5 to increase IgE production and recruit eosinophils, respectively.
What type of cells recognize MHC
II molecules?
T helper lymphocytes AKA CD4
What is chloride exchanged with in the GIT in order to be absorbed? Where?
Bicarbonate via a HCO3-Cl exchanger, in the ileum and colon
What is the predominant carbohydrate breakdown product absorbed by the intestines?
Glucose (80%)
Galactose and fructose are also absorbed, but there is not as much of them.
How does tetanus antitoxin work?
What is a toxoid?
It is an antibody that binds to free circulating tetanus toxin, facilitating its clearance from the body.
Toxoid is a chemically altered toxin that can be given like a vaccine to help the body respond to a real toxin.
What drug class is lidocaine a part of?
It is a class 1b anti-arrhythmic, sodium channel blocker
What is a strong stimulus for erythropoietin stimulus?
Hypoxia, primarily in the kidneys
What is the definition of functional residual capacity?
The amount of air left in the lungs after a normal expiration.
What two heart diseases can cause a hyperkinetic femoral pulse?
PDA
Aortic insufficiency
Increased diastolic runoff causes a decreased diastolic pressure, which is what is palpated as hyperkinetic (pulse pressure is systolic minus diastolic pressure)
What does TLR4 recognize? TLR5?
LPS, flagellin
What are the three pathways used to activate complement, which are part of the innate or adaptive immune response, what was does the classical pathway involve?
- Alternative pathway (actually the most common), recognizes PAMPs
- Lectin pathway, also recognizes PAMPs
- Classical pathway, involves antibodies bound to antigen
The first two are part of the innate immune response, and the classical is part of the adaptive response given its reliance on antibody production.
The classical pathway activates / involves a C1 complex.
What is a common RBC morphological feature associated with IMHA?
Spherocytosis
Hormones secreted from the anterior pituitary gland?
ACTH
Growth hormone (somatotropin)
TSH
Prolactin
LH
FSH
(MSH is as well)
What happens when alveolar oxygen concentration (PAO2) drops below normal levels (ie ~70 mmHg)?
Pulmonary vasoconstriction due to the hypoxic-pulmonary vasoconstriction response to promote V/Q matching
What is the S3 heart sound, and in what disease state is it heard in?
S3 represents early ventricular filling, and is audible when the ventricle is enlarged as in DCM.
What is a common endocrine cause of hypokalemia in cats?
Hyperaldosteronism
Delayed hypersensitivity is associated with what cell type? What is another name for delayed hypersensitivity?
T lymphocytes (remember specifically cytotoxic T cells and TH1)
Type IV hypersensitivity
What percent of the population falls within 1 standard deviation of the mean? 2? 3?
68
95
99
What activates the carotid body?
Low levels of PaO2; potentially also hypoxia…
(O in body for O2)
A combination of clear plasma with red urine could be compatible with?
Renal hematuria OR rhabdomyolysis; urine centrifugation would result in a clear supernatant with renal hematuria, but stay red with rhabdomyolysis due to myoglobinuria.
What is one of the ways that the kidneys keep the body from becoming hypervolemic / hypernatremic when excess water and sodium are absorbed/consumed?
What is a disease state where this is important in?
Pressure natriuresis and diuresis
Hyperaldosteronism
What viral organism is a cause of myocarditis in puppies and cerebellar hypoplasia in cats?
Parvovirus
What is the definitive means of diagnosing rabies?
Direct IFA (which detects antigens) on brainstem tissue.
What are 3 stimuli for H+ release by the parietal cells?
Gastrin
Ach
Histamine
What do natural killer cells produce? What part of the immune response are they?
Interferon gamma
Innate immune response
What type of hypersensitivity reaction is IMHA?
Type II - attack against a membrane associated antigen
What is the primary constituent of chylomicrons?
Triglycerides (how these are transported all over the body, to and from adipocyte stores)
Dogs with peri-anal fistulas often have what disease process concurrently?
Treatment of choice?
Breed of dog over-represented for this condition?
Colitis
Cyclosporine
German shepherd
What is the mechanism of phenylpropanalamine?
Alpha 1 adrenergic receptor agonist
Used for urinary incontinence to target these receptors in the urethra
What is the most specific modality for diagnosing pancreatitis in dogs?
Pancreatic lipase
During peak viremia of FIV, what cell does the virus replicate in and eventually cause depletion of?
CD 4 T lymphocytes
A staffordshire bull terrier with a right sided grade III/VI heart murmur that presents with an increased respiratory rate and bilateral crackles most likely has:
Pulmonary hypertension caused by idiopathic pulmonary fibrosis (Staffies and Westies are predisposed to idiopathic pulmonary fibrosis)
What is the treatment recommendation for sinonasal aspergillosis following endoscopic debridement?
Topical clotrimazole
What medication is used for treatment of granulomatous colitis? What breed is primarily affected?
Enrofloxacin
Boxers
What cell type depletion causes lymphopenia in feline retroviral infections?
CD4 T helper cells
What cell type recognizes cancerous cells lacking MHC I molecules?
Natural killer cells (aka large granular lymphocytes)
“How do bacteria cause DIC?”
Inhibition of anti-thrombin
Reduced prostacyclin concentrations are commonly implicated in what disease process? What other molecule is decreased that we can actually intervene with pharmacologically?
Pulmonary hypertension
Nitric oxide (PDEVi results in elevated NO levels)
What are the cells associated with estrus on vaginal cytology?
Which stages are associated with neutrophils? Neutrophils and bacteria? Basal cells?
Estrus = superficial / shrunken angular cells without nuclei
Anestrus = just nucleated basal cells
Proestrus = early you have lots of basal cells with bacteria and neutrophils; later you get less basal cells and more superficial cells
Diestrus = reverse of proestrus (superficial cells turn into basal cells); some neutrophils
What diagnostic should be done in a male beagle that is PU/PD and is hyposthenuric, and has no other lab or clinical abnormalities?
Water deprivation test to rule out psychogenic polydipsia v diabetes insipidus.
If DI confirmed, then give desmopressin to distinguish between nephrogenic (no response) and central (response).
What is the mainstay of dietary modification regarding treatment of calcium oxalate urolithiasis?
Increasing water consumption
Following IVF therapy, a persistently azotemic cat with ureterolithiasis and associated pyelectasia should be treated with a:
Subcutaneous ureteral bypass system
What class of antibiotics is amoxicillin a part of, and what is its mechanism of action?
It is a beta lactam antibiotic that reduces bacterial cell wall synthesis (peptidoglycan).
What lab values would be consistent with a diagnosis of primary hyperparathyroidism?
Elevated calcium (ionized)
Normal or high PTH
Low phosphorus
What is the mechanism of action for pimobendan?
It is a positive inotrope that causes troponin C sensitization to calcium, as well as being a PDEIII inhibitor
What oral medications can be used to treat dogs with atropine responsive second degree AV block?
Propenthaline and hyoscyamine
What is the first treatment choice for a cat with diabetic ketoacidosis?
Rehydration with Norm-R
Not NaCl because it is acidifying
What is a main tenet of antibiotic stewardship?
Transition / use a narrow spectrum choice based off of culture and sensitivity testing
What would support the diagnosis of steroid responsive meningitis arteritis in a young Boxer dog?
Elevated IgA levels in serum; elevated IgA CSF levels are not as specific as serum because they are also elevated in other inflammatory CNS conditions.
Production of effusion in cats with FIP is caused by what molecule?
VEGF (vascular endothelial growth factor) produced by infected macrophages / monocytes
What chemotherapy can result in anaphylaxis following repeated exposure?
L-asparaginase
What two classes of chemotherapeutics act via disruption of the mitotic spindle?
Vinca alkaloids - they block formation of the mitotic spindle activity during metaphase
Taxanes - block depolymerization of the mitotic spindle once it’s formed, at the end of metaphase.
What chemotherapy medication for CHOP can be given while awaiting MDR1 mutation testing?
Cyclophosphamide
What is the role of calcitriol therapy in patients with CKD?
CKD can result in renal secondary hyperparathyroidism, and elevated PTH levels. Calcitriol (which is just synthetic vitamin D) can inhibit PTH production.
What is the most effective way to diagnosis a PTE?
CT angiography
How does hypercalcemia result in PU/PD?
It causes nephrogenic diabetes insipidus (ADH receptor inhibition at the level of the kidney).
What is the main treatment option for dogs with copper storage disease in the symptomatic period?
D-penicillamine to chelate the excess copper.
Silibinin/silymarin is used for treatment of this toxicity?
SAMe? What is the injectable form of this medication?
Amanita mushroom toxicity
Acetaminophen toxicity; n-acetylcysteine
What is a very common clinicopathologic finding of hyperthyroidism in cats?
ALT elevation
What is SDMA reflective of, and what do increases in this value reflect?
SDMA is a surrogate for GFR, and when it’s high, GFR is reduced.
What should a CKD cat with proteinuria be treated with?
ACE-inhibitor like enalapril
Dogs that have severe proteinuria with otherwise normal labwork. What is the most likely protein that is being lost?
Albumin
AT3 is the same size and is presumably also lost, leading to hypercoagulability.
What is the main pathophysiologic mechanism that leads to clinical signs in dogs with PDAs?
Left sided congestive heart failure as the left heart is volume overloaded.
What breeds are over-represented for taurine-related DCM?
Golden Retrievers and Cocker spaniels (American and English)
What are some common essential amino acids in cats?
What happens with deficiency of the first one?
Arginine (dogs too) and taurine (cats only)
Hyperammonemia because arginine is crucial in the urea cycle.
What is an essential fatty acid in dogs and cats?
Linoleic acid (cats also need archadonic acid)
What is a sequela of hyperlipidemia in older miniature Schnauzers?
Glomerular disease and subsequent proteinuria; the high circulating lipid levels can cause lipid thromboemboli in the glomeruli.
What two routes of administration are subject to first pass metabolism?
Rectal and oral
What is considered a hallmark cranial nerve abnormality associated with myasthenia gravis?
Fatiguable palpebral reflex
What is a hallmark cranial nerve abnormality associated with cerebellar disease?
An ipsilateral absent menace response
What is a very sensitive and specific test to diagnose clinical toxoplasmosis in cats?
IgM levels in CSF
A cat who is positive for FIV as well should raise your suspicion even more!
Most common clinical manifestation of Lyme disease in dogs?
Arthritis
What is the classic liver enzyme elevation associated with hepatic lipidosis in cats?
ALP
If GGT is elevated, consider something else or something in addition to lipidosis.
What is a cellular marker that can be used to diagnosis acute leukemia?
CD34
What are some B cell markers?
CD 20, CD 21, CD 45, CD 79
What is the best diagnostic test to detect dynamic airway collapse?
Fluoroscopy
What is a major acute phase protein in cats?
What are three other ones?
Serum amyloid A
Others include CRP (main one in dogs), haptoglobin and alpha-1-acid glycoprotein