SAIM

Question 1

Adrenal tumors

Which one is more common: tumor in the adrenal cortex or medulla?

Answer 1

Adrenal cortex! 75% of cases, with 57% being malignant.

Question 2

Adrenal tumors

Tumors < 2 cm (longitudinal) are more likely to be carcinomas.

Answer 2

False. Bigger than 2 cm.

If smaller: adenoma is most likely.

Question 3

Adrenal tumors

How often we see metastasis with adrenocortical carcinomas?
a) 1%
b) 5%
c) 10%
d) 50%

Answer 3

50%.

Liver and lungs most common, other sites algo possible.

Question 4

Adrenal tumors

When adrenal dependent hyepradrenocorticism (ADH) is suspected, which is the best endocrine screening test?

Answer 4

LDDST.

Differentiation from PDH generally is determined by imaging.

Question 5

Canine adrenocortical tumors

Prognosis for patients after adrenalectomy?

Answer 5

Excellent for patients that survived 4 weeks post-op.

Average life expectancy 3 years.

Question 6

Prognosis with SRT for dogs with adrenocortical tumors with vascular invasion.

Answer 6

MST 1030 days.

Question 7

Feline adrenocortical tumors

T/F. Lab testing often reveals hypokalemia.

Answer 7

True.

Also, metabolic alkalosis.

CS are muscle weakenss and hypertension.

Question 8

Feline adrenocortical tumors

When adrenalectomy is not a choice, medical treatment involves:

Answer 8

Potassium supplementation, antihypertensive drugs, and the aldosterone antagonist.

(Amlodipine, spironolactone).

Question 9

Adrenal medullary tumors

Pheochromocytomas secrete what?

They are neoplastic chromaffin cells.

Answer 9

Catecholamines.

Question 10

Adrenal medullary tumors

T/F. Exercise intolerance is not a CS in dogs with pheochromocytomas.

Answer 10

False. It is, along with episodic collapse, panting, anxiety, restlessness.

Question 11

Adrenal medullary tumors

What is a pathognomonic abnormality in regular lab work in dogs with pheochromocytomas?

Answer 11

None.

Question 12

Adrenal medullary tumors

What is superior to measure catecholamines and their metabolites: plasma or urine?

Answer 12

Urine.

Bc there is excretion through urine.

Specially metanephrines. Although reference ranges not well established.

Question 13

Adrenal medullary tumors

What is the most commonly medication used in dogs with pheochromocytomas?

Answer 13

Phenoxybenzamine.

It’s an alpha adrenergic antagonist. Started 20 d before surgery.

Question 14

Adrenal medullary tumors

Prognosis for dogs with adrenal medullary tumor if surgical treatment and no metastasis.
a) 804 d
b) 128 d
c) 374 d
d) 14 d

Answer 14

374 days.

1 year.

Question 15

Surgical management of adrenal tumors

3 pre-operative considerations:
M………. V……… F……….

Answer 15

Evidence of metastatic disease, vascular invasion, functional.

Abdominal CT is very helpful for surgical planning and staging.

Question 16

Surgical management of adrenal tumors

Prognostic factors

Answer 16

Size of tumor >5 cm, tumor thrombus, tumor type, transfusion…

Perioperative mortality is 15-37%.

Question 17

Surgical management of adrenal tumors

Perioperative mortality:
a) 15-37%
b) 1-3%
c) 30 - 61%

Answer 17

15-37%.

Question 18

Incidental adrenal masses

T/F. Adrenalectomy should be considered for functional masses >2.5 cm.

Answer 18

True! And also if locally invasive.

Regular monitoring if these criteria are not met (every 3 months).

Question 19

Hyperthyroid cats

What’s the percentage of cats with hyperthyroidism that have concurrent CKD?
a) 25 - 75%
b) 5-10%
c) 15 - 50%

Peterson 2024

Answer 19

15-50%.

Although diagnosing azotemic CKD is challenging bc untreated hyperthyroidism increases RBF and GFR and decreases body muscle mass, so it lowers creatinine.

Question 20

Hyperthyroid cats

Why does hyperthyroidism affect the diagnosis of CKD?

Peterson 2024

Answer 20

Increased cardiat output –> increased renal blood flow and decreased glomural filtration rate and body muscle mass.

Question 21

Hyperthyroidism cats

What’s the reported median survival time for cats with hyperthyroidism?

Peterson 2024

Answer 21

1.6 to 4 years

Question 22

Hyperthyroid cats

Euthyroid cats experienced the most significant increase in creatinine how long after the treatment?

Peterson 2024

Answer 22

4 weeks.

So after that period of time, we can have a good idea about how his creatinine is.

Question 23

Hyperthyroid cat

Concurrent azotemia might shorten long-term survival in cats with ‘masked’ azotemic CKD.

Peterson 2024

Answer 23

True.

Which makes sense because cats with isolated CKD, even in IRIS stage 2-3, already have shortened survival times.

Question 24

Hyperthyroid cats

Survival time of hyperthyroid cats that are clearly azotemic prior to treatment is not different from cats without azotemia prior to treatment.

Peterson 2024

Answer 24

False. Pretreatment azotemia does decrease survival time.

Crea > 2 mg/dL.

Question 25

# Hyperthyroid cat Predicting whether an untreated cat with hyperthyroidism has concurrent (but masked) CKD does not matter because it does not affect survival time. ## Footnote Peterson 2024

Answer 25

False. It is crucial because they tend to have shorter survival times.

Question 26

# Hyperthyroid cat What's the median survival time for non-azotemic cats treated with I131? a) 2 years b) 5.1 years c) 3.5 years d) 4.3 years ## Footnote Peterson 2024

Answer 26

4.3 y.

Question 27

Keeping cats hyperthyroid can affect kidney function. ## Footnote Dr. DeMonaco

Answer 27

True.

Question 28

# Hyperthyroid cat Up to how percentage of hyperthyroid cats can have systemic hypertension? ## Footnote Stammeleer, Xifra 2024

Answer 28

48%. ## Footnote Range is 7-48%.

Question 29

# Hyperthyroid cat Hypertension, when present, resolves in many hyperthyroid cats after successful treatment. | Stammeleer, Xifra 2024

Answer 29

Correct. ## Footnote And cats uncommony develop new hypertension after treatment.

Question 30

# Hyperthyroid cat 2 important things to do in the physical exam of hyperthyroid cats. | Stammeleer, Xifra et al 2024

Answer 30

Fundic exam and blood pressure.

Question 31

# Hyperthyroid cat Persistent or newly detected hypertension was related to azotemia or iatrogenic hypothyroidism. | Stammeleer, Xifra et al 2024

Answer 31

False, was not. Most likely 'situational' hypertension, as hyperthyroid-induced hypertension should resolve after treatment.

Question 32

# Pancytopenia Pancytopenia is defined as anemia, neutropenia, and thrombocytopenia, and it's exclusively due bone marrow disease. ## Footnote EClinPath

Answer 32

False, there are very few extramedullary diseases that produce pancytopenia but there are some.

Question 33

# Pancytopenia Name some examples of extramedullary diseases causing pancytopenia. ## Footnote EClinPath

Answer 33

Severe bacterial sepsis, Cytauxzoon felis and FIP. ## Footnote Reasons: anemia of inflammatory disease, left shift, toxic changes, sequestration or consumption of platelets.

Question 34

# Pancytopenia Mechanisms (and causes) of pancytopenia (more than 1 are correct): a) Bone marrow aplasia b) BM hyperplasia c) BM hypoplasia d) Effective hematopoiesis

Answer 34

BM aplasia and hypoplasia. ## Footnote Also, BM necrosis, ineffective hematopoiesis and BM neoplasia.

Question 35

# Pancytopenia Mycotoxins, hormones (estrogen) and infectious organisms can cause bone marrow aplasia. ## Footnote EClinPath

Answer 35

True. ## Footnote Also, Drugs, immune-mediated disease, for infectious Ehrlichia canis.

Question 36

# Pancytopenia Bone marrow necrosis is an uncommon cause of pancytopenia, and can be due to (more than 1 answer is possible): a) Radiation b) Ehrlichia canis c) Vasculitis d) Drugs ## Footnote EClinPath

Answer 36

All but Ehrlichia. ## Footnote Also, viruses (e. g. canine parvovirus).

Question 37

# Pancytopenia Bone marrow hypoplasia can be due to the same causes as bone marrow aplasia, which are...? ## Footnote EClinPath

Answer 37

Drugs, hormones (estrogen), immunemediated disease, infectious disease (E. canis) and mycotoxins.

Question 38

# Pancytopenia Ineffective hematopoiesis can be due to n_____ or non-n_____ conditions.

Answer 38

Neoplastic or non-neoplastic.

Question 39

# Pancytopenia Name some of the neoplastic causes of ineffective hematopoiesis. ## Footnote EClinPath

Answer 39

Histiocytic sarcoma and myelodysplastic syndrome.

Question 40

# Pancytopenia Why does hystiocytic sarcoma cause ineffective hematopoiesis (more than 1 possible)? a) Hemophagocytosis b) Vasculitis c) Necrosis of the bone marrow d) Immune-mediated destruction ## Footnote EClinPath

Answer 40

Most likely hemophagocytosis by the tumor cells, although d) and alterations in the bone marrow microenvironment are also possible.

Question 41

# Pancytopenia Precursor-directed (non-regenerative) immune-mediated anemias cause pancytopenia by means of which mechanism? a) BM necrosis b) BM neoplasia c) BM hypoplasia d) Ineffective hematopoiesis ## Footnote EClinPath

Answer 41

d) Ineffective hemat. It most likely causes immune-mediated destruction of marrow progenitors.

Question 42

# Pancytopenia Phenobarbital can cause pancytopenia by means of ineffective hematopoiesis. ## Footnote EClinPath

Answer 42

True! ## Footnote An altered marrow microenvironment from drug or toxic injury can result in pancytopenia with ineffective hematopoiesis.

Question 43

# Pancytopenia Which of the following are BM neoplasias (more than 1 possible)? a) Lymphoma b) Multiple myeloma c) Acute myeloid leukemia d) Histiocytic sarcoma ## Footnote EClinPath

Answer 43

All of them! Can be divided in 'arising in the bone marrow' (c) or 'infiltrating' the BM (a, b, d).

Question 44

# Gallbladder Gallbladder innervation involves which nerVe? ## Footnote DeMonaco

Answer 44

Parasympathetic and sympathetic via VAGUS nerve and splanchnic nerves respectively.

Question 45

# Gallbladder dogs

Answer 45

Protects from intestinal contents. Sphincter of Oddi.

Question 46

# Gallbladder dogs Erhythromicin is analogue of which hormone

Answer 46

Motilin | Which is important in the XXX phas

Question 47

# Gallbladder dogs When the sphincter of Oddi is opened, what happens to the GB?

Answer 47

It empties.

Question 48

# GB dogs What of these are not component of the bile? a) Bile acids b) Electrolytes and cholesterol c) Phospholipids d) CCK

Answer 48

CCK. ## Footnote CCK stimulates the secretion of bile acids, along with glucagon and secretin.

Question 49

# GB Mucin secretion is important for protection of GB e.............

Answer 49

Epithelium.

Question 50

# GB Bile acids are synthesized by the liver from: a) Mucin b) Cholesterol c) Bacteria

Answer 50

Cholesterol.

Question 51

# GB dogs The most common type of cholangitis is: a) Neutrophilic b) Granulomatous c) Eosinophilic d) Lymphothitic

Answer 51

Neutrophilic cholangitis.

Question 52

# GB dogs Can we see hyperbilirubinemia and elevated liver enzymes in neutrophilic cholangitis in dogs?

Answer 52

Yes, very commonly.

Question 53

Diagnosis of canine cholangitis, which one(s) are indicated?: a) Cholecystocentesis b) Culture bile c) Bile cytology d) Biopsy of the liver

Answer 53

All of them! ## Footnote Complications of percutaneous ultrasound cholecystocentesis: 3.4%. Avoid in mucocele bc it can cause rupture.

Question 54

# GB Can cholecystocentesis be fatal in cats?

Answer 54

Yes, it can cause collapse from vagal stimulation. ## Footnote Confirmar.

Question 55

# GB What are the bacteria typically observed on canine cholangitis or cholecystitis? a) E. coli b) Pasteurella c) Enterococcus d) Clostridium

Answer 55

All but Pasteurella. ## Footnote Clavamox (for Enterococcus), unasyn, baytril if no culture was performed.

Question 56

# GB Why do cats don't get mucocele as much as dogs?

Answer 56

Bc of the number of mucosecretin glands (o algo así, los gatos tienen menos).

Question 57

# GB mucocele What breeds are predisposed? a) German Pointer b) Schnauzer c) Shelties d) Dalmatians

Answer 57

B and c.

Question 58

# GB What's the typical appearance of GB mucocele in the AUS? a) Watermelon b) Orange c) Honeycomb d) Kiwi

Answer 58

Kiwi!! ## Footnote We can't use AUS to exclude GB mucocele rupture.

Question 59

# GB Medical management is not an option for GB mucocele.

Answer 59

False, it is, and they can do okay for a long period of time (as long as no complications). ## Footnote Mainly ursodiol and diet +/- antibiotics. It very rarely will cause resolution (it will stay static or slowly progress).

Question 60

# GB GBM complications: Rupture and obstruction etc etc