SA MED - ONCOLOGY EXAMS

Question 1

If a new vaccine were developed to treat a particular tumor in dogs, it is most likely to be effective:

• when disease burden is high with a large tumor present
• when there are detectable metastatic lesions present
• when there is minimal disease present
• if it is given along with immune suppressive therapy such as high doses of prednisone

Answer 1

When there is minimal disease present

Question 2

Characteristics of malignant cells according to Hanahan and Weinberg include:

• insensitivity to growth signals
• limited replicative potential
• tissue invasion and metastasis potential
• inability to promote angiogenesis

Answer 2

Tissue invasion and metastasis potential

Question 3

Malignant transformation of cells can occur due to mutation in DNA or an epigenetic change that leads to changes in the cells causing:

• increased apoptosis in the cells
• suppression of oncogenes in the cells
• activation of tumor suppressor gene cells
• alteration of DNA repair capabilities in the cells

Answer 3

Alteration of DNA repair capabilities in the cells

Question 4

Taking a small piece of tissue from a mass is referred to as an “incisional biopsy.” An advantage to doing an incisional biopsy versus an excisional biopsy is:

• to determine what further staging tests may be needed prior to removing the mass
• negligible, the mass should just be removed in total as the first diagnostic step
• to reduce the total amount of tissue you will need to remove later
• the biopsy results will always be more accurate on a small piece of tissue versus the whole mass

Answer 4

To determine what further staging tests may be needed prior to removing the mass

Question 5

Abdominal ultrasound is an especially important test for staging if:

• the tumor is a carcinoma in the oral cavity
• the tumor is a round cell tumor and local therapy is possible
• the tumor is a high-grade sarcoma on a front foot
• the tumor is an osteosarcoma and lung metastases have already been noted

Answer 5

The tumor is a round cell tumor and local therapy is possible

Question 6

Saying a treatment for a tumor will give a median survival of 1.5 years means:

• 75% of dogs receiving the treatment will die within the first year after the time of diagnosis
• all dogs receiving the treatment will die within 1.5 years after the end of treatment
• some dogs receiving the treatment will live more than 2 years from the time of diagnosis
• at 1.5 years 50% of dogs will have died from their tumor whether they received treatment or not

Answer 6

Some dogs receiving the treatment will live more than 2 years from the time of diagnosis

Question 7

With an osteosarcoma of the distal radius in a 10-year-old mixed breed male neutered dog:

• with chemotherapy alone the dog will probably have 1 year of good quality of life
• with amputation alone the dog will probably have one year of good quality of life
• with palliative radiation alone the dog will probably have one year of good quality of life
• none of the above are probable

Answer 7

None of the above are probable

Question 8

You are treating a dog with a chemotherapy protocol which involves weekly treatments with a rotating schedule of Vincristine, Cyclophosphamide, and Doxorubicin. Vincristine is the drug to be given today but is temporarily unavailable. Which drug/drugs would be reasonable substitutes?

• Cyclophosphamide
• Doxorubicin
• Vinblastine
• Lomustine

Answer 8

Vinblastine

Question 9

Based on several studies, approximately what are the chances that a dog living to the age of ten years or beyond will die of cancer?

• 10%
• 20%
• 45%
• 70%

Answer 9

45%

Question 10

Which of the following characteristics is most typical of a malignant lesion rather than a benign lesion?

• distinct borders of the lesion
• presence of similar abnormal cells in the draining lymph node
• dysfunction caused by compression of adjacent normal structures
• mitotic index of two mitoses per ten high power fields

Answer 10

Presence of similar abnormal cells in the draining lymph node

Question 11

What is the purpose of requesting a determination of tumor grade from a pathologist?

• predict the cause of the tumor
• predict the likelihood of complete excision
• predict the likelihood of metastasis
• predict the response to chemotherapy

Answer 11

Predict the likely hood of metastasis

Question 12

Hypertrophic osteopathy is associated with what condition?

• osteodestructive tumors
• large breed, rapidly growing dogs
• pulmonary masses
• central nervous system tumors

Answer 12

Pulmonary masses

Question 13

The presence of an enlarged internal iliac lymph node on abdominal ultrasound should suggest that a tumor hunt be focused on which anatomical location?

• cranial mammary glands
• intestinal tract
• liver and spleen
• perianal region

Answer 13

Perianal region

Question 14

Which of the following contributes most significantly to cancer cachexia?

• decreased oral intake of food due to side effects of chemotherapy drugs being given
• inefficient glucose utilization by tumors
• poor absorption of nutrients due to the tumor’s effect on the GI tract
• having too much grain in the diet

Answer 14

Inefficient glucose utilization by tumors

Question 15

Metronomic chemotherapy can exert its anti-tumor effects in cancer patients via several mechanisms. Which of the following is not likely?

• resolution of immune dysregulation by suppression of T regulatory cells
• inhibition of angiogenesis by inhibiting endothelial cell mobilization
• inhibition of receptor tyrosine kinases
• tumor cell growth suppression by constant low-dose exposure to chemotherapy

Answer 15

Inhibition of receptor tyrosine kinases

Question 16

Which drug would you most consider for treatment of high grade B cell lymphoma in a dog if the owner only wanted to use one drug?

• Chlorambucil
• Cytosine arabinoside
• L-aspariginase
• Doxorubicin

Answer 16

Doxorubicin

Question 17

When dealing with cats with tumors, performing radical surgery from the start is usually important for most tumor types except:

• mammary tumors
• vaccine associated sarcomas
• cutaneous mast cell tumors
• cutaneous squamous cell carcinomas

Answer 17

Cutaneous mast cell tumors

Question 18

Side effects of radiation therapy:

• are related to how fast a treated tissue is normally dividing
• are related to the type of tumor being treated
• are the same in all tissues normal or neoplastic
• tend to be more severe when therapy is spread out over a long period of time

Answer 18

Are related to how fast a treated tissue is normally dividing

Question 19

Regarding mast cell tumors in dogs:

• when a dog presents with a mass diagnosed via cytology as a mast cell tumor an ultrasound guided aspirate of the spleen should always be done prior to trying to remove the mass
• mast cell tumors arise as primary tumors in the abdominal cavity as frequently as they arise in the skin
• a biopsy is needed to determine the grade of the tumor and to help define appropriate staging tests and therapy

Answer 19

A biopsy is needed to determine the grade of the tumor and to help define appropriate staging tests and therapy

Question 20

A 20-year-old mixed breed dog presents with enlarged mandibular, scapular and axillary lymph nodes and you diagnose high grade lymphoma from a fine needle aspirate and cytology. The dog is happy and has no other clinical signs. With no further diagnostics this dog would be staged at least:

• Stage II A
• Stage III A
• Stage II B
• Stage III B

Answer 20

Stage II A

Question 21

An owner brings their Rottweiler with a soft tissue sarcoma diagnosed at another veterinarian on the lower front limb to you for treatment options. The mass is roughly 2x2 cm and overlies the carpus. The owner does not want a biopsy - they just want it removed. You explain to the owner that options for treatment could be:

• remove the mass but if clean margins are not attained they will need follow-up therapy, preferably with radiation therapy
• remove the mass but if clean margins are not attained follow up high dose chemotherapy would be curative
• remove the mass but if clean margins are not attained the leg would need to be amputated as soon as possible or the tumor will metastasize
• the mass is so small there is no need to remove it as it is not bothering the dog at this time

Answer 21

Remove the mass but if clean margins are not attained they will need follow-up therapy, preferably with radiation therapy

Question 22

If you were trying to invent a tumor cell line that was very sensitive to chemotherapy (and therefore all your new drugs would appear very efficacious) what necessary characteristics would be required?

• exponential growth rate and genomic stability
• slow growth rate and genomic stability
• exponential growth rate and an unstable genome
• slow growth rate and an unstable genome

Answer 22

Exponential growth rate and genomic stability

Question 23

Which of the following is inappropriately linked with a paraneoplastic syndrome?

• lymphoma and hypercalcemia
• pancreatic tumor and myasthenia gravis
• nasal fibrosarcoma and polycythemia
• apocrine gland adenocarcinoma of the anal sac and hypercalcemia

Answer 23

Pancreatic tumor and myasthenia gravis

Question 24

A 9-year-old mixed breed dog presents with a subcutaneous mass on the lateral left thigh about 2x3 cm in size. The owner wants you to remove it so you do your best but you warn the owner that if you do not know what it is ahead of time it is difficult to predict how successful your surgery will be. you do the surgery and send in the mass for histopathology. The results of pathology say the mass is subcutaneous hemangiosarcoma and surprisingly you achieved 1 cm clean margins in all directions. The owner is happy but you now have to tell them this tumor may also be in other locations and you need to do some staging. Which group of tests is needed and appropriate though possibly not complete?

• cardiac echo, abdominal ultrasound, bone marrow aspirate
• thoracic radiographs, abdominal ultrasound, bone scan
• cardiac ultrasound, thoracic radiographs, abdominal ultrasound
• cardiac echo, abdominal ultrasound, serum protein electrophoresis

Answer 24

Cardiac ultrasound, thoracic radiographs, abdominal ultrasound

Question 25

A cat presents to you for a dental and you run routine blood work (CBC and serum chemistries as preanesthetic screening). There are no significant abnormalities other than 10% of the cells counted as white blood cells are actually mast cells.

• This cat most likely has a mast cell tumor in the spleen and we need to discuss a splenectomy
• This cat has a metastatic mast cell tumor and should be euthanized immediately
• This is odd but it happens in cats with bad teeth from time to time so it is good to proceed with the dental
• This is common in cats with food allergies; we need to change the cat’s diet

Answer 25

This cat most likely has a mast cell tumor in the spleen and we need to discuss a splenectomy.

Question 26

Diagnosing an osteosarcoma in a dog can be done with a fine needle aspirate of suspected bone lesion and staining for this:

• calcium and PTH
• alkaline phosphatase
• monocyte markers
• erythropoietin

Answer 26

Alkaline phosphatase

Question 27

Which of the following oral tumors is least likely to metastasize?

• melanoma
• acanthamotous ameloblastoma
• squamous cell carcinoma
• fibrosarcoma

Answer 27

Acanthomatous ameloblastoma

Question 28

Squamous cell carcinoma of the oral cavity can have different prognoses depending on the location and the species. Which of the following locations seems to have the best prognosis with appropriate therapy, when presenting with a squamous cell carcinoma:

• feline tonsil
• canine tongue
• canine tonsil
• feline maxilla

Answer 28

Feline tonsil

Question 29

Regarding transitional cell carcinomas (uroepithelial cell carcinomas) in dogs:

• they usually occur at the apex and can be surgically removed
• they usually cause the death of the patient because of metastatic disease more than due to local disease
• they can respond quite well (median of 6 months) to therapy with just an NSAID
• they are more common in male dogs than females

Answer 29

They can respond quite well (median of 6 months) to therapy with just an NSAID

Question 30

A dog comes to you with a mass on a front toe. The dog is fat and you are having a very hard time locating the prescapular lymph node. For which of the following tumor types would it be least important to sample the node?

• melanoma
• fibrosarcoma
• squamous cell carcinoma
• histiocytic sarcoma

Answer 30

Fibrosarcoma

Question 31

A 10-year-old chocolate Labrador retriever presents to you for a second opinion. About six months ago the dog had a small mass on the center of the right pinna that would occasionally bleed. It was small (owner says garbanzo bean sized) and didn’t seem problematic. About one month ago another dog in the house bit the pinna while playing and it did not heal. The pinna was amputated to stop it from bleeding at the site of the wound. The surgical site never healed well, the dog scratched it frequently, an the other dog also licked at it frequently. The owner asks what can be done to get the mass/proliferative area to heal.

On physical exam you can see the mass on the dog’s head. You examine the dog and find that not only is the area firm and quite large (about 10x10 cm with a depth of about 3 cm) but there also appears to be round masses ventral to the ear and another one further down the neck. The dog is not painful, his temperature, pulse, and respiration are all within normal limits and no abnormalities are noted on thoracic auscultation or abdominal palpation.

Your differentials for the mass would include (circle all that apply):

• viral papillomatosis
• transmissible venereal tumor
• aural hematoma
• suture granuloma
• a tumor of the pinna

Answer 31

Suture granuloma
Tumor of the pinna

Question 32

A 10-year-old chocolate Labrador retriever presents to you for a second opinion. About six months ago the dog had a small mass on the center of the right pins that would occasionally bleed. It was small (owner says garbanzo bean sized) and didn’t seem problematic. About one month ago another dog in the house bit the pinna while playing and it did not heal. The pinna was amputated to stop it from bleeding at the site of the wound. The surgical site never healed well, the dog scratched it frequently, an the other dog also licked at it frequently. The owner asks what can be done to get the mass/proliferative area to heal.

On physical exam you can see the mass on the dog’s head. You examine the dog and find that not only is the area firm and quite large (about 10x10 cm with a depth of about 3 cm) but there also appears to be round masses ventral to the ear and another one further down the neck. The dog is not painful, his temperature, pulse, and respiration are all within normal limits and no abnormalities are noted on thoracic auscultation or abdominal palpation.

You explain to the owner you would like to do some diagnostic tests to figure out what the mass is and to be able to offer therapy options. The owner then admits they are limited on funds and will only approve three tests. Which of the following three tests would be most cost effective and helpful for guiding this client?

• CBC and serum chemistries
• thoracic radiographs
• biopsy of the mass
• CT of head and neck
• CT of thorax
• fungal and bacterial culture of the mass

Answer 32

CBC and serum chemistries
thoracic radiographs
Biopsy of the mass

Question 33

A 10-year-old chocolate Labrador retriever presents to you for a second opinion. About six months ago the dog had a small mass on the center of the right pins that would occasionally bleed. It was small (owner says garbanzo bean sized) and didn’t seem problematic. About one month ago another dog in the house bit the pinna while playing and it did not heal. The pinna was amputated to stop it from bleeding at the site of the wound. The surgical site never healed well, the dog scratched it frequently, an the other dog also licked at it frequently. The owner asks what can be done to get the mass/proliferative area to heal.

On physical exam you can see the mass on the dog’s head. You examine the dog and find that not only is the area firm and quite large (about 10x10 cm with a depth of about 3 cm) but there also appears to be round masses ventral to the ear and another one further down the neck. The dog is not painful, his temperature, pulse, and respiration are all within normal limits and no abnormalities are noted on thoracic auscultation or abdominal palpation.

The owner is worried this could be a tumor/cancer and asks you if you have any idea - how it might be treated if it turns out to be a tumor? You answer that without knowing what it is that it’s a difficult question, but your best guess is:

• it is most likely to be something that will be treated with surgery alone
• most likely to be something treated with chemotherapy alone
• most likely something treated with radiation therapy alone
• will likely require multimodal therapy

Answer 33

Will likely require multimodal therapy

Question 34

Extra credit:

What TV show ah occasionally shown up as images in some of the oncology lectures?

Answer 34

Family Guy

Question 35

Extra credit:

In the entire history of the Pullman campus (as of 2019) of WSU, how may times has the campus closed due to snow?

Answer 35

4

Question 36

On the growth curve shown at what time point is chemotherapy likely to be most effective?

• Point 1
• Point 2
• Point 3
• At all points 1-3

Answer 36

Point 1

Question 37

Which of the following tumors is inappropriately linked to a paraneoplastic syndrome?

• alopecia and pancreatic lymphoma in cats
• hypoglycemia and insulinoma
• polycythemia and renal tumor
• hypercalcemia and anal sac adenocarcinoma

Answer 37

Alopecia and pancreatic lymphoma in cats

Question 38

Malignant transformation of cells leading to cancer can be due to:

• activation of the process of apoptosis
• activation of oncogenes from the cell’s DNA
• activation of tumor suppressor genes
• consuming too much grain in the diet

Answer 38

Activation of oncogenes from the cell’s DNA

Question 39

Radiation therapy is most effective for treatment of a tumor that:

• has had surgery 5 times previously, has come back faster every time and now has regrown again to its original size
• is small yet mitotically active
• is small and seems to be stable/not growing
• is high grade and of a tumor type that is likely to metastasize

Answer 39

Is small yet mitotically active

Question 40

Side effects of radiation therapy:

• are related to the type of tumor being treated
• are the same in all tissues
• tend to be related to how fast a treated tissue is normally dividing
• tend to be more severe when therapy is spread out over a long period of time

Answer 40

Tend to be retaliated to how fast a treated tissue is normally dividing

Question 41

You send home a dose of oral cyclophosphamide with an owner to administer the following day. The most important thing to remind the owner is that:

• cardiac ultrasounds will need to be monitored in the future because the drug is cardiotoxic
• if the dog won’t take the pills crush them and mix with peanut butter to administer
• watch for signs of frequent urination or squatting to urinate without passing anything and stop the drug if this is seen
• watch for vomiting because this drug occasionally causes pancreatitis

Answer 41

Watch for signs of frequent urination or squatting to urinate without passing anything and stop the drug if this is seen

Question 42

Metronomic chemotherapy can help fight cancer by:

• suppressing endothelial cell migration and blocking angiogenesis
• blocking tyrosine kinase receptors
• suppressing T helper cells
• killing tumor cells more effectively than maximum tolerated dose because the drug is present on a more constant basis

Answer 42

Suppressing endothelial cell migration and blocking angiogenesis

Question 43

With osteosarcoma in cats:

• it is important to start chemotherapy early because the tumors metastasize more quickly than they do in dogs
• to avoid amputation because cats cannot tolerate chemotherapy well and metastases will show up quickly
• to amputate the leg because cats do very well on three legs and metastases come slowly in cats with osteosarcoma
• to irradiate the leg because the cat will do better than with amputation

Answer 43

To amputate the leg because cats do very well on three legs and metastases come slowly in cats with osteosarcoma

Question 44

Sexual predispositions are known for some tumors; which of th following is an incorrect association:

• castrated male dogs and prostate tumors
• castrated male dogs and perianal gland adenomas
• intact female dogs and mammary tumors
• female dogs (intact or spayed) and bladder tumors

Answer 44

Castrated male dogs and perianal gland adenomas

Question 45

When administering chemotherapy to a rough coated collie (like Lassie) which of the following drugs would require MDR1 testing for a mutation prior to administration?

• L-asparagine (Elspar)
• Cyclophosphamide
• Vincristine
• Carboplatin

Answer 45

Vincristine

Question 46

When it comes to cancer:

• cats have less gastrointestinal lymphoma than dogs
• feline sarcomas require larger surgical margins to cure with surgery alone than in dogs
• cats are more likely than humans or dogs to get cancer in their lifetime
• feline tonsil squamous cell carcinomas are more difficult to treat than in dogs

Answer 46

Feline carcinomas require larger surgical margins to cure with surgery alone than in dogs

Question 47

The presence of an enlarged left inguinal lymph node on physical examination should suggest that a search for a tumor include a concerted exam of which of these anatomical locations?

• prostate
• left ventral abdomen or mammary chain
• left hind foot
• left perianal region

Answer 47

Left ventral abdomen or mammary chain

Question 48

Hemangiosarcoma would be high on your differential list for which of the following scenarios?

• a lytic bone lesion with blood in the surrounding subcutaneous tissue, anemia, and increased alkaline phosphatase on serum chemistries
• a grossly enlarged spleen with normal echogenicity, anemia and sphere types in peripheral blood
• a subcutaneous mass which seems to be primarily blood filled, anemia, schistocytes and acanthocytes in the peripheral blood, elevated FDPs or D-dimers
• a heart based mass with no signs of pericardial effusion and normal bloodwork

Answer 48

A subcutaneous mass which seems to be primarily blood filled, anemia, schistocytes and acanthocytes in the peripheral blood, elevated FDPs or D-dimers

Question 49

With a mast cell tumor located in the dorsal neck of a dog, which of the following would indicate the worst prognosis:

• the mass measures 4 cm in diameter
• poorly differentiated mast cells are seen in significant numbers in a Buffy coat smear
• aspirates of the prescapular node are positive for poorly differentiated mast cells
• it is a grade III mast cell tumor

Answer 49

Poorly differentiated mast cells are seen in significant numbers in a Buffy coat smear

Question 50

When removing soft tissue sarcomas:

• the grade of the tumor will determine how big of a margin you need to take
• the largest possible margins should always be taken
• if clean margins are not achieved in cats, radiation can be used to kill the remaining tumor cells with good success
• if an initial surgery leaves dirty margins a second surgery can usually more easily achieve clean margins because a portion of the tumor was already taken away

Answer 50

The largest possible margins should always be taken

Question 51

The most common drugs used to treat lymphoma in the dog are:

• prednisone, doxorubicin, Carboplatin, vincristine
• prednisone, doxorubicin, Toceranib (Palladia), vincristine
• prednisone, doxorubicin, procarbazine, vincristine
• prednisone, doxorubicin, cyclophosphamide, vincristine

Answer 51

Prednisone, doxorubicin, cyclophosphamide, vincristine

Question 52

What is the main reason for asking a pathologist for a tumor grade?

• to find out the origin of the tumor
• to find out by which route the tumor is most likely to spread (blood or lymphatics)
• to predict the likelihood of being able to perform a complete surgical removal
• to plan your staging procedures

Answer 52

To plan your staging procedures

Question 53

The best option for treating hypoglycemia due to malignancy is:

• feed lots of sugar on a regular basis
• start oral prednisone
• identify the tumor and treat or remove it
• feed many small high protein meals

Answer 53

Identify the tumor and treat or remove it

Question 54

In regards to benign versus malignant lesions:

• malignant lesions usually kill their host
• benign lesions cannot kill their host
• benign lesions do not metastasize
• cells are generally well differentiated in benign lesions

Answer 54

Benign lesions do not metastasize

Question 55

A dog presents with a lytic lesion in the right proximal humerus. An aspirate is done and diagnosis is osteosarcoma. In discussing therapy options with the clients you tell them:

• With chemotherapy alone the dog can be comfortable and have a good quality of life for about one year
• with amputation alone the dog can have a good QOL for about one year
• with palliative radiation of the leg and follow up chemotherapy the dog can have good QOL for about one year
• with amputation and follow up chemotherapy the dog can have good QOL for about one year

Answer 55

With amputation and follow up chemotherapy the dog can have good quality of life for about one year

Question 56

Transitional cell carcinomas are often treated with a non-steroidal anti-inflammatory:

• This is because the tumors are painful and these reduce the pain the dog experiences and therefore they can live longer
• These drugs block COX2 and this is often unregulated in transitional cell carcinomas
• These drugs will have no effect unless given in combination with traditional chemotherapy
• These drugs inhibit T regulatory cells thus allowing the immune system to destroy the transitional cell carcinomas

Answer 56

These drugs block COX2 and this is often unregulated in transitional cell carcinomas

Question 57

Surgical treatment with complete removal of mammary glands 3, 4, and 5 on the left side only would be appropriate therapy for:

• a six-year-old female intact Boxer with several small masses in the 3rd left mammary gland
• a nine-year-old female spayed short haired cat with a mass in the 4th left mammary gland
• a ten-year-old female spayed mixed breed dog with a mass in the 4th left mammary gland
• an eight-year-old female spayed Cocker Spaniel with an inflammatory mammary carcinoma in the right 4th and 5th glands

Answer 57

A ten-year-old female spayed mixed breed dog with a mass in the left 4th mammary gland

Question 58

The most common oral tumor in dogs is:

• squamous cell carcinoma
• acanthomatous ameloblastoma
• osteosarcoma
• malignant melanoma

Answer 58

Malignant melanoma

Question 59

An eleven-year-old intact female dog presents to you for a mass on the rostral mandible surrounding the right canine tooth. It is fleshy and depigmented. Appropriate diagnostics initially in your clinic should include/but are not limited to:

• CT of the head, chest, and abdomen and biopsy the mass while sedated for imaging
• Thoracic radiographs, radiographs of the rostral mandible, and biopsy of the mass under sedation, plus aspiration of the right mandibular lymph node
• Radiographs of the rostral mandible under sedation and biopsy of the mass, plus abdominal U/S
• Thoracic radiographs, then anesthetize the dog for radiographs of the rostral mandible and surgical removal of the mass attempting to get margins by removing a portion of the mandible

Answer 59

Thoracic radiographs, radiographs of the rostral mandible, and biopsy of the mass under sedation, plus aspiration of the right mandibular lymph node

Question 60

A cat presents to you for weight loss and inappetence. On physical examination you feel a mass in the abdomen approximately 4 cm in diameter and fairly moveable. You do a fine needle aspirate and diagnose the cat with high grade lymphoma. If lymphoma cannot be found in another location via staging and the mass is found to be small intestine in origin:

• the mass should be surgically removed as this will cure the cat of lymphoma
• the cat will require chemotherapy for treatment
• the cat is an excellent candidate for radiation therapy of the tumor to potentially cure the lymphoma since it is localized and lymphoma is highly sensitive to radiation
• the outcome with treatment is so poor the cat should be euthanized

Answer 60

The cat will require chemotherapy for treatment

Question 61

Regarding metastasis of cancer cells to a new location:

• if cells have metastasized they will be detected via staging examinations
• sarcomas tend to travel via lymphatics
• once cancer cells have reached a new location they grow by digesting the host cell population and using this for energy
• cells must detach from the primary tumor and manage to get into blood or lymphatics to travel to distant locations

Answer 61

Cells must detach from the primary tumor and manage to get into blood or lymphatics to travel to distant locations

Question 62

Lymphoma in dogs:

• will fail to respond to chemotherapy if it is Stage Vb disease
• is more commonly T-cell in origin than B-cell
• can present with normal peripheral lymph nodes
• is Stage II only when one mandibular node and one popliteal node are enlarged

Answer 62

Can present with normal peripheral lymph nodes

Question 63

A 10-year-old male castrated Golden Retriever comes to your clinic for a dental. You take blood as a pre-anesthesia screening. The results come back with no abnormalities other than lymphocytosis of 100,000 uL (normal is 0.9 - 4 x 10^3/uL) and all lymphocytes are small and mature. The dog has never traveled outside of the Pacific Northwest. You would advise the owner:

• the dog has acute leukemia and this is a terminal disease; you should warn the owner against a dental
• you should advise going forward with the dental as the lymphocytosis is most likely due to dental disease
• this dog has chronic lymphocytic anemia and should be treated with Chlorambucil and Prednisone
• this dog has lymphoma and will only live about one month unless treated aggressively; he should be started soon on a combination of prednisone, vincristine, cyclophosphamide, and doxorubicin

Answer 63

This dog has chronic lymphocytic leukemia and should be treated with Chlorambucil and Prednisone.

Question 64

A 5-year-old Golden Retriever presents to you because the owners found masses in the neck area. You find the masses are prescapular lymph nodes and aspirate one. The aspirate is diagnostic for high grade lymphoma. The owner is surprised because the dog has been behaving normally otherwise and does not act sick. The owner wants to know exactly what stage of lymphoma their dog has. You can palpate mandibular, prescapular, and popliteal lymph nodes, and they are all enlarged. You do thoracic radiographs and note that the hilar lymph nodes are large. You ultrasound the abdomen and find numerous enlarged lymph nodes; the liver and spleen appear normal, but you aspirate them anyway. There is no evidence of lymphoma in these aspirates. You perform a bone marrow aspirate as well, and it shows only normal hematopoiesis. What stage is this dog?

• Stage II a
• Stage III a
• Stage III b
• Stage IV b

Answer 64

Stage III a

Question 65

There is only one CT appointment available for the next month. A thoracic CT would be most beneficial for guiding treatment options for which of the following:

• a dog with a low grade soft tissue sarcoma of the distal extremity where the owner is considering amputation of the leg since this is the only way to completely remove the tumor
• a dog with a mass over the chest wall that is high grade sarcoma extending into the muscles between the ribs; three ribs will need to be removed to remove the mass
• a dog with a grade 3 mast cell tumor on the lateral right thigh area
• a dog with an oral squamous cell carcinoma that will require hemimandibulectomy to remove the tumor; the oral cavity was CT’d previously at another practice

Answer 65

A dog with a mass over the chest wall that is high grade sarcoma extending into the muscles between the ribs; three ribs will need to be removed to remove the mass

Question 66

A 10-year-old female spayed shepherd cross dog presents to your clinic for lameness in the left hind leg that seemed to appear over the last two days. The dog lives on three acre as and roams freely; the owner only noticed the lameness after they came home yesterday evening. Historically the dog was fine per the owner other than the lameness but there has been a 3 kg weight loss since the dog was seen last year. The dog lives in Pullman and has never left the area.

You do a general physical exam and find: T-102.9, P-80, R-24, weight 35 kg, BCS 3.5/5. The dog is BAR in clinic but toe-touching lame on the left hind and slow to walk in. The heart and lungs auscult normally, and there are no palpable problems in the abdomen. Orthopedically you localize the primary area of pain to the distal tibia and possibly the tibiotarsal joint, but you are not sure which. There is slight soft tissue swelling at the distal tibia as well. You begin to discuss the need for diagnostics and the owner wants to know what some possible diagnoses are before they will let you go forward with tests. Your possible list could include:

Choose all that apply.

• septic joint
• Addison’s disease
• immune mediated arthritis manifesting clinically in one joint
• primary bone tumor
• primary tumor of the joint
• ruptured cruciate
• Coccidiomycosis

Answer 66

Septic joint
Immune mediated arthritis manifesting clinically in one joint
Primary bone tumor
Primary tumor of the joint

Question 67

A 10-year-old female spayed shepherd cross dog presents to your clinic for lameness in the left hind leg that seemed to appear over the last two days. The dog lives on three acre as and roams freely; the owner only noticed the lameness after they came home yesterday evening. Historically the dog was fine per the owner other than the lameness but there has been a 3 kg weight loss since the dog was seen last year. The dog lives in Pullman and has never left the area.

You do a general physical exam and find: T-102.9, P-80, R-24, weight 35 kg, BCS 3.5/5. The dog is BAR in clinic but toe-touching lame on the left hind and slow to walk in. The heart and lungs auscult normally, and there are no palpable problems in the abdomen. Orthopedically you localize the primary area of pain to the distal tibia and possibly the tibiotarsal joint, but you are not sure which. There is slight soft tissue swelling at the distal tibia as well.

Test(s) you would recommend to try and get an idea about what it might be: (Choose all that apply)

• radiograph the limb
• blood culture
• Coombs test
• coagulation tests: PT and PTT

Answer 67

Radiograph the limb

Question 68

A 10-year-old female spayed shepherd cross dog presents to your clinic for lameness in the left hind leg that seemed to appear over the last two days. The dog lives on three acre as and roams freely; the owner only noticed the lameness after they came home yesterday evening. Historically the dog was fine per the owner other than the lameness but there has been a 3 kg weight loss since the dog was seen last year. The dog lives in Pullman and has never left the area.

You do a general physical exam and find: T-102.9, P-80, R-24, weight 35 kg, BCS 3.5/5. The dog is BAR in clinic but toe-touching lame on the left hind and slow to walk in. The heart and lungs auscult normally, and there are no palpable problems in the abdomen. Orthopedically you localize the primary area of pain to the distal tibia and possibly the tibiotarsal joint, but you are not sure which. There is slight soft tissue swelling at the distal tibia as well.

The owner wants to know what you will do if you see something wrong with the bone or joint on the radiographs. You answer that if a joint swelling or bone lesion is seen your first step(s) would most likely be:

• take a fine needle aspirate
• send the client and dog elsewhere to CT the leg
• run titers for Coccidiomycosis
• amputate the leg and get a diagnosis by sending the whole leg in for analysis

Answer 68

Take a fine needle aspirate

Question 69

(Student written EC question)

Which of the following causes of hypercalcemia is correctly linked to its calcium and phosphorus pattern:

• primary hyperparathyroidism: high Ca, low P
• vitamin D toxicosis: high Ca, low P
• malignant humoral hypercalcemia: high CA, high P
• bone lysis: high Ca, low P

Answer 69

Primary hyperparathyroidism
High calcium
Low phosphorus

Question 70

During radiation therapy all of the following drugs should be compatible with the treatment except:

• a non-steroidal anti-inflammatory
• Tetracycline
• Enalapril
• an antioxidant

Answer 70

Antioxidant

Question 71

Which of the following drugs is linked correctly with its appropriate specific toxicity?

• Cisplatin and seizures
• doxorubicin and cardiac toxicity
• Lomustine and peripheral nerve toxicity
• vincristine and liver toxicity

Answer 71

Doxorubicin and cardiac toxicity

Question 72

Which of the following classic hallmarks of cancer, described by Hanahan and Weinberg, describes the main phenomenon we are trying to block with metronomic chemotherapy?

• evasion of apoptosis
• insensitivity to anti-growth signals
• sustained angiogenesis
• limitless reproductive potential

Answer 72

Sustained angiogenesis

Question 73

Which of the following characteristics is more likely with a malignant versus a benign lesion?

• presence of similar abnormal cells in the draining lymph node
• distinct borders of the lesion
• dysfunction caused by compression of adjacent normal structures
• mitotic index of 1 mitosis per 10 high power fields

Answer 73

Presence of similar abnormal cells in the draining lymph node

Question 74

When removing soft tissue sarcomas:

• The size of the tumor prior to surgery will determine how well chemotherapy is going to work against the tumor post-surgery
• if clean margins are not achieved in cats, radiation can be used to kill the remaining tumor cells with good success
• if an initial surgery leaves dirty margins a second surgery can more easily achieve clean margins because a portion of the tumor was already removed
• the largest possible margins should always be taken at the time of the first surgery

Answer 74

The largest possible margins should always be taken at the time o f the first surgery

Question 75

The most common drugs used to treat lymphoma in the dog are:

• prednisone, doxorubicin, vincristine, Toceranib (palladia)
• prednisone, doxorubicin, vincristine, cyclophosphamide
• prednisone, doxorubicin, vincristine, carboplatin
• prednisone, doxorubicin, vincristine, carprofen

Answer 75

Prednisone, doxorubicin, vincristine, cyclophosphamide

Question 76

Osteosarcoma in the dog:

• occurs most commonly in the bones near the elbow in the epiphysis
• can be diagnosed with cytology and staining with alkaline phosphatase stain
• occurs only in the long bones of the body
• can be diagnosed with cytology and a silver stain

Answer 76

Can be diagnosed with cytology and staining from alkaline phosphatase stain

Question 77

The presence of an enlarged internal iliac lymph node on abdominal ultrasound should suggest that a tumor hunt be focused on which anatomical location:

• cranial mammary glands
• perianal region
• duodenum or Jejunum
• liver and spleen

Answer 77

Perianal region

Question 78

A thoracic CT would be most appropriate for staging a:

• cat with a mast cell tumor on the lateral neck
• dog with an osteosarcoma of the distal radius that is going to receive palliative radiation only
• dog with a low-grade sarcoma over the left abdominal wall
• cat with a fibrosarcoma over the wing of the ilium that is going to have a hemipelvectomy

Answer 78

Cat with a fibrosarcoma over the wing of the ilium that is going to have a hemipelvectomy

Question 79

Many owners want to keep their pets healthy by home cooking their food. You applaud their dedication to their pet and tell them:

• feeding diets low in protein and fat has been shown to starve tumors
• home cooking has been shown to increase the incidence of mammary tumors in dogs
• removing all carbohydrates from the diet has been shown to starve tumors
• formulating diets without grain has been shown to prevent cancer

Answer 79

Home cooking has been shown to increase the incidence of mammary tumors in dogs

Question 80

Malignant transformation of cells leading to cancer could be possible with all but one of the following mechanisms:

• activation of the process of apoptosis
• activation of oncogenes from the cell’s DNA
• alteration in DNA repair mechanisms
• inactivation of tumor suppressor genes

Answer 80

Activation of the process of apoptosis

Question 81

Chemotherapy is most likely to be effective when treating a tumor that is:

• located in the CNS
• localized in the SQ tissue and slow growing
• very rapidly dividing
• genetically unstable

Answer 81

Very rapidly dividing

Question 82

Side effects of radiation would be seen soonest in which tissue assuming all tissue received equal doses of radiation:

• skin
• bone
• muscle
• nervous tissue

Answer 82

Skin (fastest dividing)

Question 83

Which of the following paraneoplastic syndromes is inappropriately paired with a possible tumor type?

• insulinoma - hypoglycemia
• erythrocytosis - renal tumors
• hypertrophic osteopathy - brain tumors
• hypercalcemia - lymphoma

Answer 83

Hypertrophic osteopathy - brain tumors

*should be large thoracic tumors

Question 84

Regarding mast cell tumors:

• cats usually present for large, fast growing skin masses
• dogs usually present for signs compatible with mast cell tumors in the spleen and liver
• Toceranib is 90% effective at controlling all canine mast cell tumors
• the grade of a canine mast cell tumor will help guide your staging procedure and treatment options offered

Answer 84

The grade of a canine mast cell tumor will help guide your staging procedures and treatment options offered

Question 85

Sexual predispositions are known for some tumors. Which of the following is an incorrect association:

• intact male dogs and prostate tumors
• female dogs (intact or spayed) and bladder tumors
• intact male dogs and perianal gland adenomas
• castrated male dogs and osteosarcomas

Answer 85

Intact male dogs and prostate tumors

Question 86

A primary tumor is removed from the subcutaneous tissue of a mixed breed dog with clean surgical margins. The tumor is high grade and of a type known to have high metastatic potential. The patient shows no evidence of metastasis at the time of tumor removal. This means that:

• radiation therapy would be a good option as follow up to surgical removal because the tumor is localized at this time
• metastatic foci may be present, and the dog should receive chemotherapy if there is a drug known to have an effect against the tumor
• chemotherapy would not be appropriate because no metastases have been found
• the dog must be part Golden Retriever

Answer 86

Metastatic foci may be present, and the dog should receive chemotherapy if there is a drug known to have an effect against the tumor.

Question 87

A unilateral complete left sided mastectomy is appropriate for all of the following conditions except:

• a 6-year-old female intact Boxer with masses in the 2nd, 3rd, and 4th glands
• a 9-year-old female spayed domestic short haired cat with a mass in the left 4th gland
• a 10-year-old female spayed Poodle with an inflammatory mammary carcinoma in the left 4th and 5th glands
• a 12-year-old male castrated long haired cat with a mass in the 2nd left gland

Answer 87

A 10-year-old female spayed Poodle with an inflammatory mammary carcinoma in the left 4th and 5th glands

Question 88

Hyperproteinemia on blood work is further characterized via protein electrophoresis as a monoclonal gammopathy. This would be highly suggestive of which of the following tumors:

• any tumor with inflammation
• multiple myeloma / plasma cell tumor
• mast cell tumor
• histiocytic sarcoma

Answer 88

Multiple myeloma / plasma cell tumor

Question 89

A 9-year-old female spayed Labrador presents to your clinic for PU/PD and anorexia. You run a CBC/chem/UA and the only abnormalities noted are isosthenuria and hypercalcemia (17 mg/dL, normal 9-11.3). Which of the following therapies to control calcium can interfere with further diagnostics:

• furosemide and saline diuresis
• bisphosphonates
• calcitonin
• prednisone

Answer 89

Prednisone
Can interfere with lymphosarcoma diagnosis

Question 90

Performing 3-view thoracic radiographs is always warranted for a cancer patient but would be an essential diagnostic step prior to therapy in all butt one of the following situations. For which situation are thoracic radiographs least important before starting the treatment?

• amputation of a dog leg you suspect has osteosarcoma
• removing a mammary mass as an excisional biopsy
• starting chemotherapy for a dog diagnosed with lymphoma in peripheral lymph nodes
• removing a spleen due to the presence of a bleeding splenic mass and hemoabdomen

Answer 90

Starting chemotherapy for a dog diagnosed with lymphoma in peripheral lymph nodes

Question 91

With a mast cell tumor located on the dorsal neck of a dog, which of the following factors would indicate the worst prognosis?

• the mass measures 4 cm in diameter
• poorly differentiated mast cells are seen in significant numbers in a Buffy coat smear
• aspirates of the prescapular node are positive for poorly differentiated mast cells
• on biopsy the mitotic index is 7

Answer 91

Poorly differentiated mast cells are seen in significant numbers in a Buffy coat smear

Question 92

A cat presents to you for weight loss and inappetence. On physical examination you feel a mass in the abdomen approximately 4 cm in diameter and fairly moveable. You do a fine needle aspirate and diagnose the cat with high grade lymphoma. If lymphoma cannot be found in any other location via staging and the mass is found to be small intestine in origin which one of the following would be important to discuss with the owner?

• the outcome with treatment is so poor the cat should be euthanized
• the cat will need to have the mass removed surgically as this is a localized tumor and surgery could cure the cat of lymphoma
• the cat will require chemotherapy for treatment
• the cat could be treated with radiation therapy and potentially cured since the tumor is localized and lymphoma is highly sensitive to radiation

Answer 92

The cat will require chemotherapy for treatment.

Question 93

XXXXXXXXXXX to treat a particular tumor in dogs, it would most likely be effective:

• when disease burden is high with a large tumor present for the immune system to attract
• when there are detectable metastatic lesions present
• when there is minimal disease present
• if it is given along with immune suppressive therapy such as prednisone to inhibit side effects

Answer 93

When there is minimal disease present

Question 94

Regarding urothelial cell carcinomas in dogs:

• they usually occur at the apex and can be surgically removed
• they usually cause the death of the patient because of metastatic disease more than due to local disease
• they can respond quite well (median of 6 months) to therapy with just an NSAID
• they are more common in male dogs than females

Answer 94

They can respond quite well (median of 6 months) to therapy with just an NSAID

Question 95

Hemangiosarcoma would be high on your differential list for which of the following scenarios:

• a subcutaneous mass which seems to be primarily blood filled, anemia, schistocytes, and acanthocytes in the peripheral blood, elevated clotting times and FDPs
• A fluid-filled body cavity, normal CBC but mild anemia, mild hypoproteinemia, and increased alkaline phosphate on serum chemistries
• a grossly enlarged spleen with normal echogenicity, anemia, and spherocytes in peripheral blood
• a heart-based mass with no signs of pericardial effusion and normal blood work

Answer 95

A subcutaneous mass which seems to be primarily blood filled, anemia, schistocytes, and acanthocytes in the peripheral blood, elevated clotting times an FDPs

Question 96

When an owner asks how long their dog will live with chemotherapy which is being prescribed for a particular tumor and you say the median survival time for this tumor with therapy is 11 months, what does this mean?

• if they treat their dog with the prescribed chemotherapy, the dog will have no evidence of tumor for 11 months
• if they treat their dog with the prescribed chemotherapy, the dog may live only five months
• if they treat their dog with the prescribed chemotherapy, the dog will live at least 11 months
• if they treat their dog with any chemotherapy, he will live 11 months and then die

Answer 96

If they treat their dog with the prescribed chemotherapy, the dog may live only five months

Question 97

A 10-year-old mixed breed 20 kg female spayed dog presents to your general veterinary clinic for bad breath and poor appetite. The owner has also noticed small amounts of blood in the water bowl the last three days. You look in the mouth and see a fleshy mass in the palate and then the dog shuts her mouth quite strongly - you nearly lose your fingers.

She will absolutely not allow you to open the mouth again. The only other abnormality noted on physical is mild enlargement of the left mandibular lymph node. You discuss with the owner your suspicions which include which of the following (choose all that apply):

• foreign body or injury to the gingival
• tooth root abscess
• mast cell tumor
• squamous cell carcinoma
• nasal carcinoma
• acanthomatous ameloblastoma

Answer 97

All of the above

Question 98

A 10-year-old mixed breed 20 kg female spayed dog presents to your general veterinary clinic for bad breath and poor appetite. The owner has also noticed small amounts of blood in the water bowl the last three days. You look in the mouth and see a fleshy mass in the palate and then the dog shuts her mouth quite strongly - you nearly lose your fingers.

The owner is very worried and would like you to start your diagnostics as soon as possible but will not allow any anesthesia or sedation. Your proposed plan of initial diagnostics done without anesthesia includes (choose all that apply):

• fine needle aspiration of the mass
• fine needle aspiration of the mandibular lymph nodes
• CBC and serum chemistries
• thoracic radiographs
• skull radiographs
• abdominal radiographs

Answer 98

Fine needle aspiration of mandibular lymph nodes
CBC and serum chemistries
Thoracic radiographs

Question 99

A 10-year-old mixed breed 20 kg female spayed dog presents to your general veterinary clinic for bad breath and poor appetite. The owner has also noticed small amounts of blood in the water bowl the last three days. You look in the mouth and see a fleshy mass in the palate and then the dog shuts her mouth quite strongly - you nearly lose your fingers.

The owner tells you that some blood work was done two days ago at another veterinary clinic and pulls the paper from a binder she has been carrying. The CBC and chemistry shows mild normocytic normochromic anemia (PCV 30; normal is 36-56). No other abnormalities are noted.

After hearing the plan, the owner allows you to do the tests you ordered today and agrees to schedule further tests under anesthesia the following day. The further tests you would recommend would be (choose all that apply):

• no tests in clinic; send the dog to a radiologist for a CT of the head and schedule additional tests once the CT results are available. The further tests you would recommend would be (choose all that apply):
• no tests in clinic; schedule an appointment with a surgeon ASAP
• perform an excisional biopsy of the mass without further imaging
• perform excision of the mandibular node
• perform an incisional biopsy of the mass

Answer 99

Perform an incisional biopsy of the mass

Question 100

Extra credit

California sea lions are dying from cancer at very high rates (up to 25% of stranded seals). On necropsy they are being found to have urogenital carcinomas often with evidence of widespread metastasis. This tumor is similar to cervical cancer in humans or somewhat like our canine friends’ urothelial tumors. They are found in adult females and males and occasionally even subadult animals. A.l epidemiologists need a hypothesis before they can begin to look for potential causes of this increased finding in dead seals. What might be your hypothesis and how might you try to determine if this were true?

Answer 100

(Example answer - received full points)

I would hypothesize that sea lions may be exposed to an environmental toxin or a virus (similar to HPV in humans) that is carcinogenic.

Viral isolation could be attempted in affected sea lions.

Question 101

The best way to label slides to send off for cytology is to:

• apply a small sticker to the slide and write on it with a pencil or black ink
• write on the frosted portion of the slide with pencil
• write on the frosted portion of the slide with black ink
• write on the frosted side of the slide with permanent black ink

Answer 101

Write on the frosted portion of the slide with pencil

Question 102

Rabies and feline leukemia vaccines in cats should be given:

• in a different spot every year
• over the thoracic wall area
• low on the hind limbs
• in the dorsal intrascapular area or just rostral in the subcutaneous tissue of the neck

Answer 102

Low on the hind limbs

Question 103

A ten-year-old white female spayed English Bulldog has a 1 cm erythematous mass on the ventral abdomen. You biopsy the mass with a 5 cm biopsy punch, and it is a dermal hemangiosarcoma. Appropriate therapy for this dog is likely to include:

• radiation locally
• surgical removal with margins
• doxorubicin chemotherapy
• multimodality therapy with all of the above

Answer 103

Surgical removal with margins

Question 104

A five-year-old Dalmatian presented to you for a mass over the right carpus. The owner describes the mass as having been about 2 cm in size and slowly growing over one month, but after Benadryl was given this morning because the dog seemed itchy for allergies, the mass is now smaller. Your top differential at this time (though not a diagnosis) would be:

• it is not a tumor, it is something related to the dog’s allergies
• it is a mast cell tumor
• it is cutaneous lymphoma
• it is a soft tissue sarcoma

Answer 104

It is a mast cell tumor

Question 105

Changes seen in a complete blood count that are commonly seen in dogs with hemangiosarcoma and can be suggestive in diagnosing a possible mast cell tumor:

• neutropenia
• thrombocytosis
• schistocytes
• circulating mast cells

Answer 105

Schistocytes

Question 106

XXXXXXXXX hypercalcemia:

• thyroid tumors
• lymphosarcoma
• nasal adenocarcinomas
• anal sac adenocarcinomas

Answer 106

Lymphosarcoma

Question 107

As regards nutrition and metabolism in canine cancer patients:

• low carbohydrate / high fat and protein diets may help cats with cancer that are eating a normal amount of food but are still losing weight
• grain free diets have been shown to increase survival in canine lymphoma patients
• grain in the diet is known to cause cancer
• the “Warburg effect” refers to cancer cells and not being able to use glucose as an energy source and therefore proteins are degraded so they can use the amino acids

Answer 107

Low carbohydrate / high fat and protein diets may help cats with cancer that are eating a normal amount of food but are still losing weight.

Question 108

You are sent an email advertisement for anew drug for the treatment of mast cell tumors in dogs that is given orally. Things you would want to know before using the drug would be:

• toxicity and efficacy; what percent of patients respond and for how long?
• is the data reported in a peer reviewed journal
• was a control group used to support the data
• all of the above

Answer 108

All of the above

Question 109

A 12-year-old male castrated domestic short hair cat presents with a mass in the caudal oral cavity that palpates like it is coming from the mandible. He has recently had a decrease in appetite. You advise the owner:

• The mass is most likely some kind of cancer so a hemimandibulectomy should be scheduled soon with a surgeon so we can get a diagnosis and then decide whatever other staging procedures are needed
• the mass is most likely an osteosarcoma and these can do well in cats with surgical removal
• The mass is most likely an oral squamous cell carcinoma and this can be difficult to treat
• The cat should be euthanized as the mass is likely cancer and he is suffering

Answer 109

The mass is most likely an oral squamous cell carcinoma and this can be difficult to treat.

Question 110

Surgery is most likely to be curative as a single modality for a tumor that is:

• low stage and low grade
• low stage and any grade
• low grade and any stage
• high grade at any stage as long as all the lesions found can be surgically removed as well as the primary

Answer 110

Low stage and low grade

Question 111

It was very cold and snowy this week. A client let their 8-year-old male castrated Doberman outside in the yard with two feet of snow on the ground, and when he came back 10 minutes later, he was holding up his left hind leg and acting painful. Even the owner noticed that they leg looked odd. You examine the dog and find a possible fracture of the distal femur. You want to take radiographs but need to sedate the dog first. You advise the owner:

• if the limb is fractures, you will surgically repair it that afternoon
• you would like to take thoracic radiographs as well as limb radiographs because this could be an osteosarcoma and amputation needs to be considered
• if the leg is fractured a splint can be applied and it should heal fine
• if the leg is fractured, it may be due to a tumor so when you repeat the fracture you will take a biopsy to find out what it is

Answer 111

You would like to take thoracic radiographs as well as limb radiographs, because this could be an osteosarcoma and amputation needs to be considered

Question 112

Regarding cancer development:

• any somatic cell that develops an alteration in the DNA will be mutated and will lead to cancer
• cancer cells develop very different mechanisms for growth and cell division than normal cells
• a benign tumor has no mutations in the genome or it would be malignant
• oncogenes and tumor suppressor genes actually arise from normal cellular proteins

Answer 112

Oncogenes and tumor suppressor genes actually arise from normal cellular proteins

Question 113

Which of the following drugs would require MDR testing prior to administration in a Rough Coat Collie:

• cyclophosphamide
• mitoxantrone
• vinblastine
• none of the above

Answer 113

Vinblastine

Question 114

A monoclonal gammopathy in a dog would be suggestive of which of the following:

• inflammatory response to something; possibly a tumor
• T-cell lymphoma
• histiocytic sarcoma
• multiple myeloma / plasma cell tumor

Answer 114

Multiple myeloma / plasma cell tumor

Question 115

An owner with a ten-year-old female spayed mixed breed dog noticed masses on the caudal ventral abdomen. You find that the masses are the inguinal lymph nodes and aspirate them for cytology. The diagnosis on cytology comes back high grade lymphoma. The owner has done his homework and staging-wise he only wants to know if his dog has stage V lymphoma or not. What test or tests do you need to do to find this out?

• bone marrow aspirate
• CBC, chemistries, thoracic and abdominal radiographs
• flow cytometry of the lymph node aspirate, and bone marrow aspirate for cytology
• abdominal ultrasound and aspiration of liver and spleen for cytology

Answer 115

Bone marrow aspirate

Question 116

A large breed dog is experiencing conjunctivitis secondary to radiation of a nasal tumor and is rubbing his eye. Which of the following treatments would be beneficial therapy for the side effects the dog is experiencing:

• Elizabethan collar or similar to prevent rubbing of the eye
• an ophthalmologic ointment containing a steroid to decrease the irritation
• Aquaphor or aloe vera (OTC) applied in the eye to help the conjunctiva heal
• Daily cleaning the skin around the eye and eyelid with clorhexidine

Answer 116

Elizabethan collar or similar to prevent rubbing of the eye

Question 117

Clinically one can most immediately distinguish between benign and malignant lesions based on the clinical identification of which of the following:

• rapid growth of a mass
• pain on palpation of the mass
• finding of metastatic lesion
• presence of neurological deficits

Answer 117

Finding of metastatic lesions

Question 118

A dog has two different tumor types being treated with radiation therapy at the same time with curative intent protocols of 18 fractions of 3 Gy. One of the tumors has been growing very fast and is said to be a high grade carcinoma in the nasal passages, the other is a slow growing intermediate grade subcutaneous sarcoma over the left lateral thigh (has been there for years). Which of the following is most likely to be true:

• the carcinoma will respond slower than the sarcoma and could metastasize to the lymph nodes
• the sarcoma will respond slower than the carcinoma and is unlikely to metastasize to the lymph nodes
• carcinoma will respond faster than the sarcoma and will be cured
• the tumors will respond at the same rate to radiation

Answer 118

The sarcoma will respond slower than the carcinoma sand is unlikely to metastasize to the lymph nodes

Question 119

Your plan is to aspirate a 2 cm mass on the hind leg of a dog for cytology. Which of the following is true:

• it is best to anesthetize the dog as the procedure will probably be very painful
• this diagnostic test is likely to give a diagnosis of tumor stage and grade
• this is a good first step to diagnose the mass and will yield the best results if this is a soft tissue sarcoma
• a biopsy may still be required to diagnose the mass

Answer 119

A biopsy may still be required to diagnose the mass

Question 120

Transitional cell carcinomas are often treated with NSAIDS.

• there will be no effect on the tumor unless given in combination with traditional chemotherapy drugs
• the primary effect is to help reduce the pain the dog experiences and therefore they can live more comfortably for a longer period
• these drugs block COX2, and this is often unregulated in transitional cell carcinomas
• these drugs inhibit T regulatory cells thus allowing the immune system to destroy the transitional cell carcinomas

Answer 120

These drugs block COX2, and this is often unregulated in transitional cell carcinomas.

Question 121

What is the major purpose of requesting a determination of tumor grade from a pathologist?

• direct the staging procedure needed to evaluate for metastasis
• predict the likelihood the tumor can be completely excised locally
• find the cause of the tumor
• predict the response to chemotherapy

Answer 121

Direct the staging procedure needed to evaluate for metastasis

Question 122

The metastatic potential for oral tumors in dogs is variable depending on the type of tumor. Which of the following statements is correct:

• squamous cell carcinoma of the mandible is highly likely to metastasize to lungs
• acanthomatous epulis is likely to metastasize to lymph nodes but not to lungs
• melanoma of the oral cavity is likely to metastasize to lymph nodes and to lungs
• fibrosarcoma of the maxilla is highly likely to metastasize to the lymph nodes and lungs

Answer 122

Melanoma of the oral cavity is likely to metastasize to lymph nodes and to lungs

Question 123

What is a legitimate reason for not obtaining biopsy / histopathology of a tumor to gain a diagnosis:

• an owner declines histopathology and just wants a mass removed
• the local lymph nodes palpate normally, and thoracic radiographs were clean
• clinically the mass did not appear to be invasive, and it was slow growing
• biopsy of the mass is dangerous and is likely to kill the patient

Answer 123

Biopsy of the mass is dangerous and is likely to kill the patient