Small Animal Flashcards

Question

Osteomyelitis

Answer 1

* **Osteomyelitis** is an infection in a bone * Posttraumatic osteomyelitis is more common in small animals and results from direct inoculation of infectious agents during trauma or surgery. Bone is naturally resistant to infection, and adjuvants play a crucial role in shifting surgical contamination toward bacterial proliferation

Answer 2

* **Taenia taeniaeformis** is a **parasitic tapeworm**, with cats as the primary definitive hosts. * Sometime dogs can also be the definitive host. * The intermediate hosts of this tapeworm are primarily **rodents and less frequently lagomorphs** which the cat must kill and **ingest their liver** in order to acquire the tapeworm infection

Answer 3

* Tritrichomonas foetus is a flagellated parasite most commonly found in kittens that have had an unresponsive diarrhea. * The parasite can be very difficult to diagnose. It is most often responsive to **Ronidazole** * It is an obligate parasite of the reproductive and the gastrointestinal tract of bovine and feline host respectively, leading to trichomonosis

Answer 4

* **Cryptosporidium** is a coccidian that invades the small intestinal villi after ingestion of infected oocysts. It can be **diagnosed with PCR**. * It is treated with **clindamycin, azithromycin, or tylosin** most commonly. * It is **usually an opportunist,** so evaluation for underlying disease is appropriate.

Answer 5

* **Topical cyclosporine and a topical steroid** * The treatment of KCS is aimed at **reducing immune destruction of the lacrimal glands**. * Topical cyclosporine (Optimmune) and a topical steroid (frequently in a triple antibiotic/steroid ointment) are the treatment of choice. * **You should be cautious using steroids in acute cases due to the** **_risk of corneal ulceration_**

Answer 6

* **Schiff-Sherrington** and **T3-L3 spinal cord segments** * Schiff-Sherrington posture is characterized by **thoracic limb extension** with **normal to sometimes decreased tone in the pelvic limbs**

Answer 7

**TRUE** * The ascending reticular activating system (RAS), or reticular formation, is a network of anatomically and physiologically distinct nuclei in the brain stem that function to “**activate” the cerebral cortex and maintain consciousness**

Answer 8

* is characterised by all **four-limb extension** with **opisthotonus** and **stuporous or comatose mental status** * would result in a **brainstem lesion** causing extension of all limbs and decreased level of consciousness stupor or coma

Answer 9

* **Young adult dogs (between 6 months and 6Yr of age)** with **normal interictal neuro exam**

Answer 10

* **FALSE**

Answer 11

* **Forebrain and ARAS (Brainstem)** are responsible for level of **awakeness** * **Extracranial (systemic) or Intracranial (structural)** * ARAS (cell bodies) gets sensory input to transmit to the cortex to activiate forebrain A normal mental status is mainly **maintained by the brainstem and the forebrain** by the **ascending reticular activating system**. If the changes are subtle, the owner is the best person to let us know if the mental status of the animal is abnormal. Animals with severe systemic disease can appear obtunded and it does not mean there is a primary intracranial lesion * **ANY TEST WE DO ON A NEURO EXAM THAT REQUIRES CONSCIOUSNESS MUST REACH THE CONTRALATERAL FOREBRAIN - where as BRAINSTEM IS ALWAYS IPSILATERAL TO THE TEST WE DO**

Answer 12

* Midbrain (Mesencephalon) * Pons (Ventral Metencephalon) - dorsal being cerebellum * Medulla Oblongata - myelencephalon

Answer 13

**Two or more epileptic seizures within a 6 month period. Inter-ictal period equal to or less than 6 months**

Answer 14

* Age between **6 months and 6 years** * **Normal in the interictal period** * **Normal** physical and neurological examinations * Metabolically **normal** * The most **common type of seizure** is **generalised tonic-clonic**

Answer 15

* **\< 6 months and \> 6 years of age** * **Abnormal neurological examination** in the **interictal period** (_23% still have a normal neuro exam_) * **Asymmetric (lateralising) deficits** * Metabolically normal * Focal or Generalised

Answer 16

* **Any age** * **Abnormal neurological examination** consistent with diffuse, bilateral **often symmetric forebrain involvement** * Neurological signs **may be preceded or accompanied** by **gastrointestinal, cardiovascular or respiratory signs** * Significantly **higher risk of developing status epilepticus** **as the first manifestation** of a seizure disorder * The most frequent causes of reactive seizures are **intoxications (39 %)**, **hypoglycaemia (32%) and electrolyte disorder (11%) .** * **Note: Hepatic Encephalopathy being next (9%) along with "other metabolic derangements" (9%)**

Answer 17

* The **interictal period is ≤ 6 months** (i.e. 2 or more epileptic seizures within a 6 month period) * The patient has experienced **status epilepticus** or **cluster seizures** * The patient has **severe postictal signs** (e.g. aggression, blindness) or **postictal phase that last longer than 24 hours** * The epileptic seizure f**requency and/or duration is increasing and/or seizure severity is deteriorating over 3 interictal period**

Answer 18

* **Narrowing of the intervertebral disc space** is the most reliable diagnostic indicator for type I intervertebral disc disease

Answer 19

**Partial faecal incontinence** is the most common long-term complication

Answer 20

**Surgery** is associated with **good outcomes and short recovery times**

Answer 21

This condition is often associated with **pyrexia and abnormalities in blood work**

Answer 22

**Inner ear and vestibulocochlear nerve (CN VIII)**

Answer 23

* positional strabismus * positional nystagmus or spontaneous or resting nystagmus

Answer 24

Dysconjugate nystagmus

Answer 25

* T2 = both fluid and fat are hyperintense (white) * T1= can't see the CSF as hyperintense anymore, is now hypointense. fat is still hyperintense (can be good for soft tissue detail)

Answer 26

* Time and supportive care! - they do tend to improve * anti-emetics: odancetron or maropitant * positional feeding * eye lubrication * assisted walking for urination * padded kennel - as they roll around and can injure themselves

Answer 27

Hypothyroidism

Answer 28

* may indicate pain in presentation * Some brachycephalic dogs, specifically those with coiled, very short or absent tails, are at an increased risk of abnormally shaped vertebrae that do not align correctly, which may lead to deformity of the spine including curvature and twisting (kyphosis and/or scoliosis).

Answer 29

* acute intervertebral disc extrusion on MRI * Can see the dehydrated disc material imposing on the spinal cord through vertebral canal

Answer 30

* paraplegic * loss of nociception * rapidly progressively worse * when medical management has failed or if their pain is still severe with medical treatment * **really need a solid rest period after surgery!**

Answer 31

* often characterized by the sudden onset of dysfunction of the spinal cord and pain. * **Chronic** intervertebral disk extrusions are more common in large-breed dogs.

Answer 32

* an infection, trauma or autoimmune reaction can target the meninges (protective tissue) and cause inflammation, leading to neurological problems and impaired movement * Meningomyelitis refers to the more serious condition where the protective meninges and the nerves themselves are inflamed * **Medium to large breed dogs seem particularly susceptible to this condition, and are most affected while under the age of 2** **Clinical Signs** * Difficulty walking * Abnormal behavior * Dilated or constricted pupils incongruent with ambient light * Trouble controlling urination or defecation * Reduction in reflexes * Trouble swallowing * Pain tracing back to spinal column * Fever **Types** * Steroid-responsive * Infectious * Trauma **Causes** * Autoimmune reaction erroneously attacking the meninges * Infection of the spinal column * Trauma to the spinal column or spinal cord.

Answer 33

* Need to localize to either the **peripheral or central vestibular system** and **whether the clinical signs have improved, remained static or gotten worse over time**; and **if the signs have improved, how rapidly have they improved** * Common causes of acute onset vestibular signs in old dogs include **idiopathic vestibular disease, otitis media/interna, ischemic stroke, and neoplasia.** * Other important but less common causes may include **hypothyroidism, toxins/drug (e.g. metronidazole), or meningoencephalitis**

Answer 34

**Meningitis of Unknown Origin** * Meningoencephalitis is a term referring to inflammation of the brain and the surrounding fluid and tissues * meningoencephalitis can often be further characterized into one of three types: granulomatous meningoencephalomyelitis (GME) necrotizing meningoencephalitis (NME) necrotizing leukoencephalitis (NLE) * Meningoencephalitis of unknown origin is a term used to describe those **cases of meningoencephalitis in which MRI and cerebrospinal fluid (CSF) analysis indicate inflammatory, non-infectious central nervous system (CNS) disease but diagnosis through histopathological analysis is not available.** In a situation in which microscopic evaluation of nervous system tissue is impossible or impractical, meningoencephalitis of unknown origin may be diagnosed.

Answer 35

* **Meningoencephalitis of unknown origin** is **most commonly seen in small-breed dogs,** suggesting a possible genetic basis for the condition. * Large-breed dogs, however, can also occasionally develop the disease. * **Females** are affected more frequently than males and affected dogs are **typically over six months of age**

Answer 36

* Most commonly, signs of meningoencephalitis include seizures, muscle tremors, blindness, head tilt, vestibular signs (dizziness or falling over), or a head tilt. * Affected dogs may also exhibit abnormal behaviors, such as compulsive walking in circles. Some dogs may appear painful or become paralyzed. * These signs may develop suddenly, or they may progress slowly over a period of weeks to months.

Answer 37

* **Meningiomas** * In the dog, primary intracranial neoplasia represents ~2–5% of all cancers and is especially common in certain breeds including **English and French bulldogs and Boxers** * The most common types of primary intracranial cancer in the dog are meningioma, glioma, and choroid plexus tumors, generally occurring in **middle aged to older dogs**

Answer 38

* The spinal cord disease seen in **Pugs** affecting the **front legs** is called **spinal arachnoid diverticulum (SAD)**

Answer 39

* plantigrade (more likely neuropathy location) - more likely to see with neuromuscular condition than palmigrade * plamagrade (more a neuromuscular generalization) * ventroflexion of neck (cat) - **common Dx: hypokalemia** - tend to see more in myopathies than junctionopathies

Answer 40

* LMN's * NMJ * Muscle groups **\*shouldnt see ataxia in these cases really! but sometimes the sensory pathways can be affected, but motor signs will likely predominate in these cases (proprioception deficits unlikely to present unless severe)** * **more generalized muscle weakeness than ataxic - can have some ataxia but predominant sign should be paresis** * **can often have decent postural reactions to a point, even when quite severely tetraparetic - sometimes may be too weak to turn foot back over**

Answer 41

* **Neuromuscular disease** * almost always reduced or absent in a neuropathy * if reflexes are relatively intact but generalised weakness and proprioeption intact - may think junctionopathy or myopathy * exercise intolerance or "fatigue" on palpebral reflex - juntionopathy * important to check for localized or generalized muscle atrophy * can note pain or even hypertrophy! * pain could indicate **myositis**

Answer 42

* it will probably also develop glaucoma in **6-12 months** * The usual course for primary glaucoma is development in one eye with the contralateral eye following in 6-12 months. These animals have an iridocorneal angle that becomes increasingly compromised during the first few years of life and eventually causes an acute pressure spike in the eye.

Answer 43

* **High IOP** that causes characteristic degenerative **changes in the globe, optic nerve, and retina with subsequent loss of vision** * **_diagnosis_**: IOP \> **25-30 mmHg (dogs)** or **\>31 mmHg (cats)** as well as **changes in vision, appearance of the globe, optic nerve and/or retina**

Answer 44

* Develops when **normal outflow of the aqueous humor is impaired** * May be the result of **primary eye disease** (narrow or closed filtration angles and goniodysgenesis, which have a genetic predisposition) * May be **secondary** to other eye diseases - primary lens luxation, anterior uveitis, intraocular tumor or hyphema)

Answer 45

* **dogs** are more likely to have a genetic predisposition of anomalous configuration of the filtration angles * **Dog** - primary and secondary glaucoma * **Cat** - primary is rare. secondary seen in Px with signs of long standing **uveitis** (affecting older cats of \>6 years) or **lens luxation**

Answer 46

* These crystals are fairly common in dogs and cats with **congenital or acquired portal vascular anomalies**, with or without concomitant ammonium urate uroliths. * Ex: porto-systemic shunt * They have been seen in animals on chemotherapy with increased uric acid production

Answer 47

* A **pre- and post-prandial bile acid test assesses hepatic function**. * The enterohepatic circulation is highly effective in normal animals but not animals with shunts. Bile salts excreted in bile return to the liver by intestinal absorption and portal blood. * **High pre- and post-prandial bile acids indicate a decrease in hepatic function**. * In congenital and acquired portal systemic shunts, bile acids are allowed to bypass the liver and enter systemic blood. This results in markedly elevated post-prandial bile acid levels.

Answer 48

* **ALT** is a liver specific leakage enzyme; however, it does not reflect liver function. ALT may be within reference intervals in animals with decreased hepatic mass * **AST** is also a hepatocyte leakage enzyme but does not reflect liver function. It is not as liver-specific and is found in erythrocytes and cardiac and skeletal muscles.

Answer 49

* TLI is the test of choice to diagnose **exocrine pancreatic insufficiency**. * Trypsinogen is a proenzyme (a non-activated enzyme) that is secreted into the small intestine by the pancreas, along with other pancreatic digestive enzymes. * When it reaches the small intestine, trypsinogen is converted to trypsin, an enzyme that helps to digest proteins. * In healthy animals, a small amount of trypsinogen escapes from the pancreas into the blood circulation and can be **measured in a blood sample by a test called trypsin-like immunoreactivity.** * Dogs with exocrine pancreatic insufficiency have reduced functional pancreatic tissue and so less trypsinogen is produced. Therefore, less trypsinogen escapes into the blood circulation, resulting in low levels of serum TLI. * **A single fasting blood sample is sent to a veterinary referral laboratory for trypsin-like immunoreactivity determination.** * Typically, by the time that clinical signs of exocrine pancreatic insufficiency are apparent most dogs will have **significantly reduced concentrations of trypsin-like immunoreactivity.** * However, if a dog has concurrent pancreatitis, or if a sample is taken shortly after a meal, the amount of trypsin-like immunoreactivity may be temporarily increased into the normal range.

Answer 50

* **single, congenital**, and **extrahepatic** * Small breed – Yorkshire terriers, Maltese, Pugs, Miniature Poodles etc. a. Congenital, extrahepatic, single ● Usually less than 1 year of age ● If large breed, there may be higher likelihood of an intrahepatic shunt. ● Cats with shunts may have classic “copper” colored eyes (iris).

Answer 51

**Clinical signs vary:** ## Footnote ● Can range from apparently normal to comatose or seizuring. ● Frequently undersized for breed as compared to littermates. ● Polyphagia ● Vomiting, diarrhea, PU/PD ● May have neurologic deficits or inappropriate behavior such as head pressing or star gazing, especially after eating. a. Hepatic Encephalopathy

Answer 52

* **Acanthocheilonema reconditum** (previously Dipetalonema reconditum) * Acanthocheilonema reconditum is a blood parasite that **looks similar to the microfilariae of Dirofilaria immitis**, the agent of Heartworm disease. The two parasites must be differentiated because Acanthocheilonema reconditum is not pathogenic and is therefore not treated * Microfilariae are present in the blood and can be mistaken for other parasites. Distinguish between Acanthocheilonema reconditum and Dirofilaria immitis microfilariae circulating in blood by **modified Knott’s procedure.**

Answer 53

* **Uncinaria stenocephala** is a nematode that parasitizes dogs, cats, and foxes as well as humans. It is rare to find in cats in the United States. * Uncinaria stenocephala is the **most common canine hookworm in cooler regions**, such as Canada and the northern regions of the US, where it can be found primarily in foxes * would NOT find on a blood smear

Answer 54

* **Strongyloides stercoralis** is a small, slender nematode that when fully mature is ~2 mm long, located at the base of the villi in the anterior half of the small intestine of dogs and cats. The worms are almost transparent and all but impossible to see grossly at necropsy. * Usually, infections are associated with **warm, wet, crowded, unsanitary housing**. * The species found most often in dogs is **identical to that found in people.**

Answer 55

* **Filaroides osleri** is a metastrongyloid nematode that lives in granulomatous nodules located on the **mucosal surface** of the distal trachea, tracheal bifurcation and first division bronchi in dogs and wild canid species. * This is a **direct life cycle**, so forms the exception in the superfamily Metastrongyloidea. * The eggs are laid, and hatch within the trachea. They then transform into the larvae, which are coughed up and swallowed. They enter the intestine, and are passed out in the feces. * The bitch may transfer the larvae to the pup during grooming, or infection may come about via ingestion of the larvae. The larvae mature and travel to the lungs * The prepatent period is 10-18 weeks.

Answer 56

* **pudendal nerve.** * This is the main nerve in the region of the surgery that is at risk of being severed. Severing the nerve could result in urinary incontinence due to loss of somatic innervation to the urethral sphincter. * the **pudendal nerve** will supply somatic innervation to the external sphincter of the bladder and also to striated muscle on the urethra. * The **hypogastric nerves** are those responsible for **sympathetic innervation** * **parasympathetic** innervation is via the **pelvic nerve**

Answer 57

* a fold or corrugation. the manner of folding or condition of being folded ex: may see in a Rx of intussusception

Answer 58

* **Fibrosarcoma** * Vaccine-associated fibrosarcomas are very well documented in cats.

Answer 59

**HORNERS SYNDROME** * **M**iosis * **T**hird Eyelid Protrusion * **S**unken Eye - enopthalmia * **Pt**osis - droopy eye Guttural Pouch mycosis (in horses), otisis media and Brachial Plexus Avulsion (torn attachment from SC)

Answer 60

* Cats are relatively deficient in activity of the enzyme **glucuronyl transferase** which conjugates acetaminophen to glucuronic acid for excretion. * For a given dose of acetaminophen, less than 3% of acetaminophen glucuronide is excreted by cats, while humans and dogs eliminate 50-60% as the glucuronide conjugate.

Answer 61

* Small breed dogs have a decreased blood supply to distal limbs, which results in a slower healing of fractures and a higher incidence of non-union when there is no surgical intervention. * Might have best result with such methods as internal fixation

Answer 62

often consistent with damaged medial meniscus cartilage found in the stifle

Answer 63

A type I Salter-Harris fracture is physeal only. Type II involves the physis and metaphysis, type III involves the physis and epiphysis, type IV involves physis, metaphysis, and epiphysis, and type V is a compression injury to the physis

Answer 64

Baylisascaris procyonis is an ascarid parasite of raccoons that causes mild signs in raccoons but can undergo aberrant migration in humans and cause fatal central nervous system signs

Answer 65

* **perianal adenoma.** * These tumors are primarily seen in older male intact dogs. * These tumors will often shrink or resolve after castration

Answer 66

* Animals with hepatic encephalopathy require **protein reduction in their diets**. * **Lactulose** is given because it decreases colonic pH, trapping ammonia, and decreases transit time through the gut, leading to decreased ammonia uptake because ammonia contributes to hepatic encephalopathy. * **Oral neomycin** is used to dampen urease-producing microflora of the gut and consequently, decrease ammonia production in the gut. * It has also been shown that **vegetable and dairy proteins** are better tolerated than meat proteins

Answer 67

**CN VII is responsible for lacrimation**. Deficits in lacrimation would cause exposure keratitis

Answer 68

* Post-operatively, it is important to monitor for hypocalcemia daily for the **first seven days** regardless of the absence of clinical signs for hypocalcemia. * The higher the pre-operative serum calcium concentration, the more likely the patient will become hypocalcemic post-operatively. * Post-operative monitoring of serum calcium should be **daily for the first seven days, then weekly for 4 weeks.** * **Vitamin D and calcium supplementation** should be given accordingly. * Serum calcium concentration should be maintained in the low normal range, not below normal, to stimulate production of PTH by the parathyroid cells of the atrophied tissue.

Answer 69

* **ACTH low, cortisol high**. * Prednisone is a synthetic corticosteroid that **cross reacts with assays measuring endogenous cortisol levels**, causing an artificially elevated cortisol measurement on blood tests. * The feedback mechanism on the pituitary gland inhibits ACTH production, making it low.

Answer 70

**Cholesterol** is elevated in up to 90% of hyperadrenocorticism cases * **BUN** is usually low in patients with hyperadrenocorticism secondary to the increased diuresis that occurs with elevated cortisol levels. * **ALT** increases due to swelling and death of some hepatocytes. * **SAP** increases due to a steroid-induced isoenzyme of SAP from the liver. Mild cholestasis due to swelling of hepatocytes also contributes to a minor part of the increase in SAP. * **T4** is often low in patients with Cushinga??s because they are euthyroid sick. * **Potassium** is usually elevated with hypoadrenocorticism (not hyperadrenocorticism)

Answer 71

* CVP is a decent measure of circulating volume. * **A normal CVP can range from 0-10 cmH2O.** * It is important to interpret the CVP in light of your patient's clinical signs and to observe the trend in CVP measurements.

Answer 72

* One of the most common uroliths in Dalmatians is composed of **urate crystals**. * Urate bladder stones are most commonly the result of a genetic abnormality that causes a **defect in the metabolism of uric acid** * **not visible radiographically** * Urate stone formation is promoted by acidic urine and diets high in purines which are metabolized to uric acid. Generally a low-purine alkalizing diet is recommended. * Allopurinol therapy may also be used to reduce uric acid production but it requires monitoring as it may predispose dogs to different types of stones (Xanthine) * Soy is high in purines and is not recommended for dogs prone to forming urate stones

Answer 73

* The isotonic crystalloids shock dose in dogs is **90 ml/kg (10-20mL/Kg a bolus)** * In cats, the isotonic crystalloids shock dose is **_40-60 ml/kg_**. * Synthetic colloids can be administered at a dose of 10-20 ml/kg in dogs and 5-10 ml/kg in cats and hypertonic saline at a dose of 5 ml/kg.

Answer 74

* **Dilated Cardiomyopathy** * Although taurine deficiency is rare nowadays, it has been associated with DCM in cats and some dogs (English Cocker Spaniels). * Commercial cat and dog foods now contain acceptable levels of taurine. * In cats, **retinal dysplasia** also occurs with taurine deficiency.

Answer 75

* **KCS** * severe mucoid ocular discharge and corneal changes that are most consistent with **keratoconjunctivitis sicca** (dry eye) * The diagnostic test of choice for KCS is a Schirmer tear test

Answer 76

* **Feline infectious peritonitis is not a contagious disease**. It is a disease that is caused by a mutation of feline enteric coronavirus. * It is unknown why in some patients this virus mutates and causes the FIP syndrome. It is most likely to occur in young or immunocompromised cats. Her other cat is not necessarily going to get FIP just from exposure. * In fact, the majority of the cat population has been exposed to the feline enteric coronavirus. Because most cats in the general population have been exposed, it makes interpretation of coronavirus titers difficult. The titers can be elevated due to prior exposure and not from FIP. The titers can only be interpreted in lieu of clinical signs, blood results, etc.

Answer 77

Often depends on age or presentation! * **Vasculitis** * **Liver Disease** * **Electrocution** * **Seizures** * **Toxins** * **Envenomation (venom injection)** * **DIC** * **Direct Trauma** * **Sepsis**

Answer 78

* **Methimazole (BID)** - It is important to screen and rescreen for renal disease prior to and after starting methimazole. Hyperthyroidism can mask renal disease due to increased blood pressure and blood flow through the kidneys leading to increased glomerular filtration rate. Owner must be warned that even if no signs are seen prior to initiating treatment, renal disease may be diagnosed at a later time * **Surgical thyroidectomy** (not often recommended as can induce hypothyroidism or tissue can be left behind leading to hyperthroidism recurrence) * **Radioactive Iodine therapy** - may reconsider though if renal parameters abnormal * optional: Hill's Y/D food has limited iodine, strict dietary management is required for any chance of success if using the Y/D as the treatment choice

Answer 79

* possibility of **Horner's Syndrome** * Additionally, disruption of the recurrent laryngeal nerve should be considered as this will result in laryngeal paralysis

Answer 80

* The correct answer is that this effusion is strongly **suggestive of FIP**. * FIP causes a classic straw or gold colored effusion with high protein content (about equal to serum protein) and moderate cell counts. * An exudate would tend to have somewhat higher cell counts and lower protein. * The protein content is not consistent with chyle or neoplasia

Answer 81

* **Cryptococcosis** is a systemic **fungal disease** that may affect the respiratory tract (especially the nasal cavity), CNS, eyes, and skin (particularly of the face and neck of cats). * The causal fungi, Cryptococcus neoformans and C gattii, exist in the environment and in tissues in a yeast form. * Infection occurs worldwide. * The fungi are found in soil and fowl manure, especially in pigeon droppings. * Transmission is by inhalation of spores or contamination of wounds. * In avian droppings, it may occur in a noncapsulated form as small as 1 μm, which can be inhaled into the deeper portions of the lungs. * **Cryptococcosis is most common in cats** but also is seen in dogs, cattle, horses, sheep, goats, birds, and wild animals. In people, many cases are associated with a defective cell-mediated immune response * **Demonstration of the organism**, visible as small yeasts surrounded by a large capsule is occasionally seen with Cryptococcus. **Serology** is also very useful for diagnosis. The **latex agglutination test** against the cryptococcal antigen is very sensitive and specific and can be used to document disease or monitor therapy. It can be run on serum, CSF, or urine

Answer 82

* the presence of an abnormally large number of lymphocytes in the cerebrospinal fluid

Answer 83

* **Atelectasis** * Atelectasis or the incomplete expansion of a lung due to loss of air from alveoli is a common complication of prolonged recumbency and inhalation anesthesia. * Lobar consolidation differs from atelectasis in that it refers to filling of airways with fluid. This occurs usually in inflammation * The other main cause of atelectasis is decreased pulmonary surfactant in newborns or in **ARDS** (acute respiratory distress syndrome) or **near drownings**. * Incidentally, another good answer to this question would be aspiration pneumonia.

Answer 84

* **Demodex gatoi** * **pruritis -** Demodex gatoi is often very itchy * Demodex gatoi differs from Demodex cati in that it infects the epithelium and not the hair follicle. * Thus, the best test would be a **superficial skin scrape.** * The best diagnostic test for Demodex cati would be a deep skin scrape

Answer 85

* Hair analysis * A trichogram refers to analyzing hair and is a useful test for dermatophytes and follicular mites.

Answer 86

* The pleural fluid obtained has a milky white appearance as a result of its high triglyceride content. * Any patient that has an **effusion triglyceride content higher than that of the serum** is considered to have a chylothorax. Chyle is lymphatic fluid which contains a high quantity of fat. * Abnormal flow or pressures in the thoracic duct are thought to cause exudation of chyle from lymphatic vessels into the thorax. * The presence of chylomicrons in the sample, a cholesterol content greater than or equal to that of the serum, and a positive ether clearance test are also supportive chylothorax. * Chylothorax implies a chyle leak that is due to the disruption or blockade of the thoracic duct or its tributaries. * It is by definition: the accumulation of chyle in the pleural space * In cats, the **Siamese and Himalayans** are predisposed * dog: Afghan Hounds and Shiba Inus

Answer 87

* **Triglyceride-rich fluid from the intestinal lymphatics that empties into the venous system in the thorax** * Chylous fluid is typically white to pink in color, opaque and can have a variable specific gravity (1.019-1.050 in the cat). The protein level is variable (2.6-10.3 g/dL) and the white blood cell count can be over 7,000 cells/ul * **Pseudochylous effusion -** effusion that contains less triglycerides and more cholestrol compared to serum * **Thoracic Lymphangiectasia** - tortuous, dilated lymphatics found in many animals with chylothorax * Fibrosing pleuritis can commonly be associated with **chylothorax** and pyothorax

Answer 88

can be caused by any disease process that increases systemic venous pressure at the entrance of the thoracic duct to the venous system * **cardiac causes**: pericardial disease, cardiomyopathy, heartworm disease, congential diseases, other causes of Right Side Heart Failure * **Non-cardiac**: neoplasia (especially mediastinal lymphoma in cats), lung lobe torsion, diagphragmatic hernia, venous granuloma, venous thrombus * **Trauma/Rupture**: LESS COMMON, thoracic duct rutpure from trauma - either surgical (thoracotomy) or non surgical (RTA) * **IDIOPATHIC** MOST COMMON

Answer 89

* **Immunofluorescence staining for coronavirus in macrophages in effusion fluid** * Of the tests listed, immunofluorescence staining for coronavirus in macrophages in effusion fluid has the highest positive predictive value for confirming FIP (reportedly as high as 100%). The NPV of this test is relatively low (57%) so a negative test doesn't rule out FIP * **Rivalta's test** has a low PPV (58-86% depending on the population tested) and a high NPV (93-97%). * The presence of anti-coronavirus antibodies in serum has a PPV=0.44 and NPV=0.90 although high concentrations (\>1:1600) has a higher PPV=0.94. The presence of immune-complexes in serum is also not specific for coronavirus with a reported PPV=0.67 and NPV=0.84.

Answer 90

* **Radical excision of the mass** * This is a probable vaccine associated fibrosarcoma. These tumors are slow to metastasize but extremely aggressive locally. A radical excision of the mass will be your best opportunity at a surgical cure * Doing 1-2cm margin excisions will likely result in poor margins and recurrence.

Answer 91

* Chemosis is the swelling (or edema) of the conjunctiva. It is due to the oozing of exudate from abnormally permeable capillaries. In general, chemosis is a nonspecific sign of eye irritation

Answer 92

**Chlamydophila felis** * severe chemosis is characteristic of chlamydia infections * This upper respiratory tract pathogen does not cause oral ulcers in cats * The most common signs of chlamydia in cats involve the eyes or the upper respiratory tract (nose or throat), and only when infection is not treated does it spread to the lungs. * Chlamydia can be successfully treated with a course of oral and topical antibiotics. * Treatment must be continued for a **minimum of four weeks and for at least ten days after the eyes appear normal**. * Since some cats can be infected sub-clinically (not show signs themselves, but act as a source of infection to other cats) treatment should be given to all of the cats in the household.

Answer 93

* **Rabies vaccine given in distal right rear leg, FeLV vaccine given in distal left rear leg, _no vaccines should be given in intrascapular space_** * These recommendations were made to facilitate earlier diagnosis and easier treatment of vaccine-associated fibrosarcomas in cats. * They also were made to allow findings to be correlated with which vaccine(s) was (were) causing the tumors. * It was recommended that **other vaccines be given in the distal right front leg**.

Answer 94

* **No.** * **NSAIDS** and **corticosteroids** compromise the mucus-bicarbonate protection of the stomach. * **Renal disease** and the corresponding uremia cause decreased mucosal blood flow and gastric hypersecretion. * **Liver disease** causes gastric ulcers by decreasing mucosal blood flow secondary to portal hypertension and thrombosis. Liver failure is also associated with increased histamine and gastrin levels leading to gastric hypersecretion

Answer 95

* **Cisplatin** * The famed statement, "cis-plat splats cats" is quite appropriate. * **5-fluorouracil** is also contraindicated for use in cats, but it is **neurotoxic**. * Carboplatin, vincristine and doxorubicin are all used in cats.

Answer 96

2(I3/3 C1/1 P3/2 M1/1)

Answer 97

2 x (3I/1C/4P/2M / 3I/1C/4P/3M)

Answer 98

The normal gestational period in cats is **63 days after impregnation**. (about 9 weeks) Ultrasound can be used to confirm pregnancy as early as 13 days. A developing fetus can usually be palpated by day **21-28**. **Fetal skeletons** are radiographically detectable at around **42 days (range 36-45 days)**. An enlarged uterus may be visible radiographically as early as day 25-35.

Answer 99

* **Discospondylitis** is an infection (-itis) of the intervertebral disc (disco-) and adjacent vertebral endplates (spondylo-). * Discospondylitis in dogs and cats typically starts in the vertebral end plate, then spreads to the adjacent intervertebral disc * It is most often due to a bacterial infection, but fungal organisms are occasionally identified. * The minimal vascular supply of the intervertebral disc further enables infection within the disk. * The most commonly isolated organisms are **Staphylococcus aureus**, S. and **Staph pseudintermedius** * Discospondylitis is most commonly seen in young to middle-aged medium- to large-breed dogs. * Less commonly, it has been reported in small-breed dogs and cats. * Predisposed breeds include Great Danes, boxers, Rottweilers, English bull dogs, German shepherd dogs, Doberman pinschers, and Rhodesian ridgebacks

Answer 100

* Coloboma means a thinning or a hole in the eye structure. In this context, it is an indication of how thin the iris is. * The animal is born with the coloboma; it’s an area of the iris that never formed properly. Large holes allow more light to enter the eye through the pupil, resulting in squinting. The coloboma can be mild or severe. In severe cases, there is a sort of notch in the margins of the pupil. * The iris coloboma, which is relatively uncommon, does not affect vision, and it does not progress to anything else. * Unless your affected pet herds sheep or cattle, this sensitivity to light is not usually a big problem. Nothing can be done to treat it, although it’s possible to buy dog goggles

Answer 101

* Traumatic injury to the **C6 to T2 nerve roots** that innervate the thoracic limb can lead to brachial plexus avulsion in dogs, cats, and birds. * With severe extension or abduction of the limb, the nerve roots stretch or tear from their attachment to the spinal cord. * Clinical signs vary with the extent of root involvement. Complete avulsion results in flaccid paralysis of the limb, anesthesia distal to the elbow, ipsilateral Horner syndrome, and ipsilateral loss of the cutaneous trunci (panniculus) reflex. * The injured animal bears little or no weight on the limb and drags the dorsal surface of the paw on the ground. Sensation to the ventral surface of the paw is spared if only the cranial nerve roots are affected. Avulsion of the caudal nerve roots causes loss of sensation on the caudal surface of the limb with variable loss on the cranial surface

Answer 102

The symptoms of eating yew are different for each dog as it depends on the part of the plant they consumed (needles, bark, cones), the amount that was eaten, and the overall health of your dog. Can be fatal! **Common symptoms are:** * Abdominal pain * Diarrhea * Drooling * Enlarged pupils * Nausea * Vomiting * If too much vomiting has caused dehydration: * Coma * Death * Difficulty breathing * Dilated pupils * Life-threatening changes in heart rate and blood pressure * Seizures * Tremors * Weakness

Answer 103

* **Sago palm** contains cycasin, which is the primary active toxic agent resulting in severe liver failure in dogs. Ingestion results in acute gastrointestinal signs (e.g., drooling, inappetance, vomiting, diarrhea) within 15 minutes to several hours after ingestion * Sago palms are naturally found in tropical/subtropical environments; they are also used as ornamental Bonsai houseplants. * Central nervous system signs (e.g., weakness, ataxia, seizures, tremors, etc.) and severe liver failure can be seen within 2-3 days post-ingestion * Aggressive decontamination and treatment should be initiated. Even with aggressive treatment, the **survival is about 50%**

Answer 104

* **Foxglove,** while very beautiful with its trumpet like blossoms, are very poisonous to dogs, cats, and even humans! Foxglove contains naturally-occurring poisons that affect the heart, specifically **cardenolides** or **bufadienolides** Onset of toxicity symptoms will vary depending on how much your dog consumes. Symptoms include: * Weakness * Collapse * Drooling * Nausea * Abdominal pain * Frequent urination * Vomiting * Diarrhea * Dilated pupils * Tremors * Seizures * Cardiac arrhythmias * Slowed pulse * Death

Answer 105

* Pelger-Huët anomaly is an inherited disorder characterized by the hyposegmentation of neutrophils (a type of white blood cell), whereby the nucleus of the cells has only two lobes or no lobes at all. * For the most part, this is a harmless disorder which affects several breeds of dogs, including the American foxhound, Australian shepherd, and basenji.

Answer 106

* Von Willebrand's disease is a blood clotting disorder frequently found in Weimaraners and Dobermans * conduct diagnostic testing for blood clotting time or a specific DNA blood test for Von Willebrand's disease or other similar disorders to check for this problem before we perform surgery * It is caused by a deficiency in the amount of a specific protein needed to help platelets (the blood cells used in clotting) stick together and form clots to seal broken blood vessels. The deficient protein is called **von Willebrand factor (vWF)**

Answer 107

* **Infectious canine hepatitis (ICH)** is a worldwide, contagious disease of dogs with signs that vary from a slight fever and congestion of the mucous membranes to severe depression, marked leukopenia, and coagulation disorders. * Most common in dogs **less than a year old** * ICH is caused by a **nonenveloped DNA virus**, canine adenovirus 1 **(CAV-1)**, which is antigenically related only to CAV-2 (one of the causes of infectious canine tracheobronchitis), but CAV-1 is antigenically distinct from CAV-2 * The infection targets parenchymal organs (especially liver), eyes and endothelium * virus is shed in salive and feces and replicates in Kupffer cells to then damage adjacent hepatocytes producing a massive viremia when released * CAV-1 is resistant to lipid solvents (such as ether), as well as to acid and formalin. It survives outside the host for weeks or months, but a 1%–3% solution of sodium hypochlorite (household bleach) is an effective disinfectant * Recovered dogs shed virus in their urine for ≥6 mo. Initial infection occurs in the tonsillar crypts and Peyer patches, followed by viremia and disseminated infection. * Vascular endothelial cells are the primary target, with hepatic and renal parenchyma, spleen, and lungs becoming infected as well. * Chronic kidney lesions **(immune complex glomerulonephritis)** and **corneal clouding (“blue eye”)** result from **immune-complex reactions** after recovery from acute or subclinical disease. * Oedematous and thickened gall bladder considered **pathopneumonic lesion** * **Dx:** microscopic evidence of inclusion bodies, severe hypoglycemia (due to hepatic injury) and complement fixation test (CFT)

Answer 108

* **Shedding of virus via saliva** * The main mode of transmission is via saliva. It requires prolonged, close contact. * Cats may shed the virus for months to years. * Transmission may also occur through reuse of instruments and blood. * Virus is shed in saliva, tears, urine, and feces.

Answer 109

* **Salmon poisoning disease** is caused by the bacterium **Neorickettsia helminthoeca**. * Sometimes the disease is complicated by a second agent, Neorickettsia elokominica, which causes Elokomin fluke fever. * Animals become infected by eating trout, salmon, or Pacific giant salamanders that are infected with rickettsia-infected fluke larvae. It is the rickettsiae bacteria that cause the disease; the fluke infection itself produces few or no signs of disease. * Transmission by dog to dog contact is rare.

Answer 110

* Diagnosis of FeLV infection is based on a cat's medical history and clinical signs and the results of tests to determine whether the virus is present in the blood. * A positive test will identify the presence of **FeLV or its antigens**. * Two types of tests commonly used for this purpose are an **ELISA** (enzyme-linked immunosorbent assay), which can be performed in a veterinary clinic and is routinely carried out as the initial FeLV screening test; and an **IFA** (immunoflourescent assay), a confirmatory test that, because of the technology required, must be done at a commercial laboratory

Answer 111

* diagnosis of **FIV infection in unvaccinated cats**, the ELISA is used to detect specific antiviral antibodies circulating in the blood. * These anti-FIV antibodies are produced during the normal immune response to the viral infection. The IFA is not used to confirm FIV infection. * Instead, the suspected presence of **FIV-associated antibodies** can be substantiated by means of a so-called Western blot, in which specific antibodies to FIV can be identified. * This procedure, like the IFA, must be carried out at a laboratory that is specially equipped for the test; results will typically be available within a week. * **Once cats have been vaccinated against FIV, the antibody assay for the virus is no longer useful**, since the test cannot distinguish between antibodies produced as a result of infection and those produced following vaccination. **Unfortunately, there is no test available at present to diagnose FIV in FIV-vaccinated cats**

Answer 112

* is a surgical procedure to perform a resection of the posterior soft palate to remove tissue and open up the airway. * This procedure is commonly used on brachycephalic dogs

Answer 113

* Pemphigus Foliaceus is the most common autoimmune skin disease in dogs and cats. * PF is often observed in middle-aged and older patients. * Pemphigus foliaceus typically causes hair loss, scabs, and ulcers (open sores) around the head, face and ears * Pemphigus is a disease of dogs, cats, horses and goats and is a type of autoimmune skin disease. These diseases result when the immune system functions abnormally, targeting normal cells and structures of the body * **attacks the hemidesmosomes**

Answer 114

* **Gnathostoma** will produce clinical symptoms in humans of **gnathostomiasis** which is caused by the migration of the immature worms. * Migration of the larvae in the subcutaneous tissues causes sporadic, painful, pruritic swellings, commonly referred to as cutaneous larva migrans. * Migration of the larvae to other tissues, which is termed visceral larva migrans, can result in **cough, hematuria, ocular involvement, and even eosinophilic meningitis.** Frequently, eosinophilia is seen. The nematodes Gnathostoma spinigerum and Gnathostoma hispidum primarily infect vertebrate animals * zoonotic!

Answer 115

* Hiatal hernias, also known as diaphragmatic hernias, form at the opening (hiatus) in the diaphragm where the esophagus (tube that carries food the stomach) joins the stomach. When the muscle tissue around the hiatus becomes weak, the upper part of the stomach may bulge through the diaphragm into the chest cavity * A Hiatal Hernia is most commonly seen in **English Bulldogs.** **Brachycephalic dogs (those with a shortened nose such as English Bulldogs, French Bulldogs and Pugs)** are at an increased risk of displacement of the stomach in to the chest as the negative pressures within the chest created by their abnormal airway, act to ‘suck’ the stomach through the opening in the diaphragm. * Dogs with hiatal hernia frequently vomit or regurgitate (passive reflux of stomach contents) due to the abnormal position of the stomach. These signs most commonly occur during peak activity or when the dog becomes excited

Answer 116

* Myelography is the special radiographic technique by which the spinal cord is outlined by a positive contrast medium injected into the sub-arachnoid space. * Prompt and accurate diagnosis is the foremost requirement for treating spinal trauma in dogs. Radiography is one of the most important diagnostic aids for localization of spinal injuries. Plain radiography, though, reveals fractures and luxations in spine, yet, usually fail to suggest any compression (Horlein, 1978) and other soft tissue disorders. * Myelography performed following plain radiography, aids in confirmation and localization of spinal injury and evaluation of its severity and extent

Answer 117

* Hypophysectomy is a surgery performed in people, dogs and cats for the treatment of clinical pituitary tumors and other masses within the region of the pituitary gland. * Can often be treatment for cats with acromegaly (pioneered by the RVC)

Answer 118

* **Discoid lupus erythematosus (DLE)**, also known as cutaneous lupus erythematosus, is an autoimmune disease that affects the skin. * There are two other types of lupus that affect the skin: **vesicular cutaneous lupus erythematosus** and **exfoliative cutaneous lupus**, both of which are relatively uncommon. * Discoid lupus erythematosus is the most common type of cutaneous (skin) lupus in dogs. This condition is very rare in cats. Dogs with DLE develop crusting and scabbing of the skin, most commonly starting around the nose, as well as a loss of skin pigmentation in the affected area * Discoid lupus erythematosus is an auto-immune disease, in which the body’s own immune system is activated to attack the body. This immune attack kills a layer of cells within the skin, causing the surface of the skin to slough. * The underlying cause of DLE is unknown. It has been noted that ultraviolet (UV) light appears to worsen DLE and the condition is more common in sunny climates. Inflammation triggered by UV radiation is thought to contribute to this condition.

Answer 119

* Also called **juvenile cellulitis** or **sterile granulomatous dermatitis** and **lymphadenitis** * **Puppy strangles** is a classical disease though fortunately not a common one. It comes up suddenly, manifesting as **marked swelling of the muzzle, eyelids, and face in a puppy between the ages of 3 weeks and 6 months of age**. The owner may be inclined to think the puppy was bitten by a stinging insect or a spider * The inner surface of the ear flaps are commonly involved as well and occasionally lesions in other body areas occur. Lesions are painful more than they are itchy. * Despite the extreme inflammation and secondary infections, the heart of treatment for this condition is immune-suppression. * High doses of corticosteroids such as prednisone are needed as this condition is an immune-mediated disease and no specific underlying cause has been identified.

Answer 120

* **Low ACTH, high cortisol** * Prednisone is a synthetic corticosteroid that cross reacts with assays measuring endogenous cortisol levels, causing an artificially elevated cortisol measurement on blood tests. * The feedback mechanism on the pituitary gland inhibits ACTH production, making it low

Answer 121

* **Metaphysis** * Hypertrophic osteodystrophy (HOD) is a condition seen in **young, growing large breed dogs.** * It affects the **metaphyses of all long bones** and appears as an a**bnormal radiolucent line within the metaphysis.** * The disease is usually self-limiting but can cause **limb deformities or systemic illness.** * The etiology is unknown but may be correlated with Ca/P levels and balance, vitamin C deficiency, and certain diseases including distemper.

Answer 122

* **Temporary**: eye lubricants, stay sutures possibly * **Permanent:** surgical procedure to remove a narrow segment of skin and muscle from the eyelid with stitches used to evert the eyelid to a normal position. The sutures are removed in 2 weeks.

Answer 123

* **Hypertrophic Osteodystrophy (HOD)** is a bone disease that occurs in fast-growing large and giant breed dogs. * The disorder is sometimes referred to as **metaphyseal osteopathy**, and typically first presents between the ages of 2 and 7 months. * developmental, auto-inflammatory disease of the bones that is usually first seen between the age of 7 weeks and 8 months. * In general, most cases will appear for the first time when the puppy is between 3 – 5 months of age. Relapses may occur until about 20 months of age * males seem more often affected * HOD pups usually present for **reluctance to move, decreased/absent appetite and fever**. * Painful swellings around the metaphyseal regions are usually found on physical examination. * Body temperature can be very high, even up to 106 degrees F

Answer 124

* Treatment of panosteitis and HOD is **supportive and symptomatic**. * Pain medications and non-steroidal anti-inflammatory (NSAID) medications are key. * HOD pups may need to be hospitalized for IV fluids, other treatments to bring body temperature down, electrolyte supplementation and more aggressive pain control. * There is no definitive treatment for either of these disease processes. We support them through the worst of it, while allowing the process to run its course. * The overall prognosis for panosteitis and HOD is good with full recovery typical. * However, HOD carries a relatively worse prognosis due to the **systemic signs of illness and severe discomfort.**

Answer 125

* metabolic bone disease of large breed, younger dog * Panosteitis affects the long bone diaphyses (shafts) of slightly older pups (approx. 5-18 months of age) * There is no reported sex predisposition for panosteitis

Answer 126

* **Facial Dermatitis** * **Response to lysine supplementation** - may help inhibit the replication of the herpes virus * **Dendritic ulcers** - (superficial branching ulcers seen with Rose-bengal staining) are pathognomonic for herpes * **Symblepharon** - adhesion of part of the conjunctiva onto the cornea/limbus in cats with herpes induced epithelial erosions

Answer 127

* elongated soft palate = can drape over teh trachea and obstruct the airway = can be from high exxcitement or sleeping * **stenotic nares =** more air turbulence --\> harder to breathe * hypoplastic trachea

Answer 128

**Soft Palate Resection** * be careful when shortening the palate * if it is too short then they may be further predisposed to aspiration pneumonia * right amount needs to be removed: * Barely cover the epiglottis so you can protect from aspiration pneumonia * achieve as much transfer of air trhough the trachea as possible

Answer 129

* An **acquired pathophysiology** of BOAS * not usually seen when intubating a dog * can be seen when there is a lot of resistance * can become inflamed and eventually evert (picture) * Clinical Signs * When everted, should be trimmed out * be very careful after extubation!! - there can be a lot of swelling and odema - actually pre-treat these patients with steroids as the swelling can obstruct the airway and become an emergency!

Answer 130

commonly associated with BOAS * No good treatment * DO NOT confuse with a collapsing trachea * Can potentially progress to this, but usually separate entities * If very severe, laryngeal collapse can occur with very advanced BOAS * If this occurs, typically permanent tracheostomy tube is the only good treatment

Answer 131

**pruritis is the predominant clinical sign of allergic skin disease** * ****flea allergy dermatitis (FAD) * atopic dermatitis * food allergy * contact allergy some dogs may have combinations of these!

Answer 132

* When the skin becomes thick and leathery * often from pruritic conditions

Answer 133

* **Feline indolent ulcers**, also referred to as rodent ulcers or eosinophilic ulcers, are a cutaneous reaction pattern in cats that affect the muco-cutaneous junction of the oral cavity. * Most indolent ulcers occur on the upper lip near the philtrum or adjacent to the upper canine teeth. * Most commonly observed as an ulcerative symmetrical lesion on the upper lip

Answer 134

**Grade 1**-least likely to metastasize. Well differentiated and superficial. Usually curative with surgical excision. **Grade 2**- well to good differentiation. SQ involvement. Prognosis is varied and dependent upon cell surface markers, signs of metastasis, and local reoccurrence. Can be cured with surgery. **Grade 3**- Poorly differentiated. Poor prognosis with likelihood of metastasis, reoccurrence. Aggressive treatment needed. In order to determine prognosis it is ideal to fully stage the animal with local lymph node aspiration, metastasis check in the abdomen and thorax, blood work, and grade of the tumor itself. More recently, it has been discovered that the **amount of mitotic figures** identified per high per field correlates greatly with how aggressive the tumor will behave recommended margins for MCT's atm: 3cm wide margins, 1 fascial plane deep

Answer 135

* the classic pathologic finding in cases of rabies is the presence of **negri bodies in the pyramidal cells of Ammon's horn and the Purkinje cells of the cerebellum** (although it is more readily diagnosed by fluorescent antibody)

Answer 136

* Epidural morphine is an effective analgesic for **12-24 hours** * think orthopedic Sx! - very painful post-op * Fentanyl is a short acting opioid and would only be effective over 12 hours if given repeatedly or as a constant rate infusion (CRI). * The effects of hydromorphone last only 4-6 hours

Answer 137

* what most of us think of as regular diaphragmatic hernias and can be congenital or traumatic (RTA) in origin * Trauma can cause an abrupt increase in intra-abdominal pressure forcing the lungs to rapidly deflate causing a large pleuroperitoneal pressure gradient. * This pressure gradient can cause the diaphragm to tear at its weakest point, typically the muscular portions.

Answer 138

Based on clinical signs and blood-work/urinalysis ● Hyperglycemia (often \>300 mg/dl) a. NOTE: Stress can cause hyperglycemia, particularly in cats ● Glucosuria +/- ketonuria a. NOTE: While less common, stress in cats can cause glucosuria too ● Other common blood-work abnormalities a. Metabolic acidosis b. **Elevated liver enzymes and cholesterol** ● Ancillary tests of **fructosamine and glycosylated hemoglobin** reflect the patient’s glycemic status over several weeks

Answer 139

* **Somogyi effect**: Somogyi effect, when insulin lowers your blood sugar too much, it can trigger a release of hormones that send your blood sugar levels into a rebound high

Answer 140

**_Severe DKA_** a. **Aggressive IV Fluids** – 0.9% saline with potassium and phosphate supplementation as needed. Need K+ as after insulin Tx, glucose will drag K+ into cells with it and this can cause your heart to stop (but also don't add too much too quick)! PO4- should be supplied to allow for ATP production and if there isn't enough P in the body, hemolytic anemia may occur (might need blood transfusion if DKA is bad enough) b. **Regular insulin**: Regular insulin is the fast-acting insulin of choice for severe DKA. It can be given intermittently (q 6-8 hrs) or by continuous IV infusion. i. With either, frequent blood glucose monitoring and insulin dose adjustment is necessary to achieve gradual decline in blood glucose level. c. **Bicarbonate Therapy** - if metabolic acidosis is severe and/or not improving with IV fluids. d. Identify and address any concurrent infections or diseases. Need to monitor every couple of hours: * acid/base * glucose * K+ * PO4- * PCV

Answer 141

* **neutrophilia** * **lymphopenia** * **eosinopenia** * potentially **monocytosis** * It occurs primarily in dogs

Answer 142

* Middle aged **FEMALES** * This results in mineralocorticoid (aldosterone) and glucocorticosteroid (cortisol) deficiency. * Patients typically present with a history of waxing and waning or fulminant gastrointestinal (GI) signs or of acute collapse (i.e., hypoadrenocortical [addisonian] crisis). * Physical examination may be normal; however, signs of hypovolemic shock are usually present in patients experiencing hypoadrenocortical crisis * The classic laboratory findings in hypoadrenocortical dogs are azotemia (pre-renal), hyperkalemia, and hyponatremia, with a sodium:potassium ratio of less than 27:1. * Patients with "atypical" hypoadrenocorticism usually present with GI signs and do not have the classic laboratory abnormalities of typical hypoadrenocorticism * **ACTH stimulation test is the gold standard for confirming Dx**

Answer 143

Immunosuppressive doses of corticosteroids should be started 1. **Cyclophosphamide** - can be given to help induce remission 2. **Azathioprine** - can be used to help maintain remission and given long-term , usually with fewer side effects than corticosteroids 3. **Prednisone** (or prednisolone with cats) \*\*may want to give famotidine in addition when giving corticosteroids to prevent stomach ulcers

Answer 144

* **Approximately 80%** of T3-L3 herniations are located in the **T13-L1 region**.

Answer 145

* **Fibrocartilaginous embolism (FCE)** occurs when materials that are usually found within the vertebral disc of the spine migrate into the nearby vascular system (veins and arteries) and block one of the spinal cord vessels. * **Most dogs with FCE usually get better on their own with nursing care** * It is unknown how the disc material gets into the vasculature. The prognosis of dogs with FCE varies. * Most dogs get better with supportive and nursing care. * The loss of pain perception and lower motor neuron signs are poor prognostic indicators.

Answer 146

* De-clawing

Answer 147

* The correct answer is the dog's renal function is capable of diluting urine. * The dog is hyposthenuric (specific gravity between **1.001-1.007**) which requires work to dilute the urine. Renal failure cannot be diagnosed without knowing the animal's BUN and creatinine status. * You can not say the dog is PU/PD without knowing the quantity of water it drinks and quantity of urine it produces. * A dehydrated animal should have concentrated urine, instead of dilute urine.

Answer 148

**Melanoma** * The cytology shows cells with **large nuclei**, **stippled chromatin** with **prominent and sometimes multiple nucleoli** (labeled with 1). A few cells (labeled with a 2) have dark green/black melanin granules. * Melanoma is an important differential for a nail bed tumor. * At this site, they are frequently malignant and the local lymph node should be palpated and aspirated. * Additional staging (thoracic radiographs and abdominal ultrasound) should also be considered. If there is no evidence of metastasis, the affected digit should be amputated

Answer 149

Typically around T8-T9 area

Answer 150

* **Steroid responsive meningitis-arteritis (SRMA)** in dogs is an ‘immune mediated’ or ‘auto-immune’ condition where inflammation occurs in the blood vessels in the lining of the nervous system (the meninges) * The main clinical signs of SRMA are spinal pain and an elevated temperature – this pain is severe in the neck but can also be present to a lesser extent in the lower back. * The pain is most severe when trying to touch the chin to the chest. * Other neurological abnormalities are not expected with this condition. Most dogs will be inappetent and reluctant to exercise.

Answer 151

* In a dog with normal kidneys, glucose does not begin to spill into the urine until the blood glucose is around **180 mg/dl**. * In a cat, glucose does not begin to spill into the urine until the blood glucose reaches between **200-280 mg/dl**. * When the blood glucose is high enough to spill into the urine, the polyuria seen is caused by an osmotic diuresis resulting from the osmotic pull of the glucose in the urine. * The kidneys are not refractory to antidiuretic hormone with DM

Answer 152

* Doxorubicin * Extravasation, or leaking of a drug outside of a vein, of some chemotherapeutics can cause mild to moderate tissue irritation, but doxorubicin can cause tissue sloughing, necrosis, and wounds that can take months to heal and may require amputation * Some other chemotherapy drugs such as **vincristine** cause a more localized severe reaction if perivascularized. **L-Asparaginase** can be safely given subcutaneously or intramuscularly. **Cisplatin** can be given intralesionally. **Carboplatin** is always given IV but if perivascularized, does not cause a severe reaction

Answer 153

* **"Primary" spontaneous pneumothorax** in dogs results from rupture of pulmonary blebs or bullae. Pulmonary blebs are local accumulations of air within the visceral pleura, whereas bullae are confluent alveoli. * This condition has been reported most commonly in large, deep chested breeds of dog * A bulla is similar to an air bubble in the lung that can rupture, and releases air into the pleural space, causing pneumothorax. It can happen spontaneously

Answer 154

1. **Prodromal Phase** - consists of vague clinical signs (including vomiting, lethargy, inappetence, and fever) along with furious or psychotic behavior. Cats, in particular, may develop erratic behavior such as anxiousness, staring, wild/spooky/blank appearing eyes. When confined to a kennel, they may strike or attack moving objects, including people. Other common clinical signs seen in cats are muscle tremors, ataxia, and weakness. This phase of the disease may last from **1-4 days** 2. **Dumb Phase** - Clinical signs are often neurological and include LMN paralysis (especially if a limb is injured), CNS signs, or generalized paralysis. - develops a**round day 5** if the animal hasn't already succumbed

Answer 155

* The UPC ratio provides an accurate and fully quantitative assessment of proteinuria unlike the urine dipstick which is less sensitive and specific for the detection of protein in urine. * Proteinuria is an important concern given its correlation with poor patient outcome. The UPC Ratio has shown a significant correlation with the morbidity of the patient—the higher the UPC ratio value, the worse the prognosis

Answer 156

* The urine cortisol/creatinine ratio is usually evaluated in animals suspected of having Cushing's disease (also known as hyperadrenocorticism). * When an animal has Cushing’s disease, it produces an excessive amount of cortisol. This increased blood cortisol concentration results in increased loss of cortisol into the urine. * Therefore, the urinary cortisol/creatinine ratio is usually increased in animals with Cushing's disease * **High sensitivity, low specificity!**

Answer 157

* **Addison’s should be on the differential diagnosis list.** * This is especially true in breeds such as Rottweilers, Great Pyrenees, and Portuguese Water Dogs.

Answer 158

C-reactive protein is one of the most sensitive markers of **inflammation** in dogs. Measurement of CRP is useful to confirm the presence of underlying inflammation (particularly in the absence of other clinical or laboratory indicators of inflammation) and to monitor response to therapy

Answer 159

* **bacterial contamination** - risk to animals and humans interacting with the env't! hard to rid of and they are often multi-resistant bacteria * **nutritional inadequacy** - analysis shows they aren't COMPLETE diets. nutritional hyperparathyroidism may occur = too much PO4- in the diet and not enough Ca2+ * **GI obstruction/perforation** - particularly if they are feeding bones with the raw food diet * **Hyperthyroidism** - may get too much thyroxine in the diet - could shows signs of hyperthyroidism

Answer 160

* **DCM** * can sometimes be related to Grain-free diets (boutique diets) where exotic ingredients are used (lentils, etc.) that don't have some of the aa's necessary for a complete diet

Answer 161

An oxygen saturation of **98-100%** corresponds to **\> 100 mm** Hg oxygen in arterial blood An oxygen saturation of **95%** corresponds to **80 mm Hg** An oxygen saturation of **90%** corresponds to **_60 mm Hg_** An oxygen saturation of **50%** corresponds to **30 mm Hg** An oxygen saturation of **10%** corresponds to **10 mm Hg** * The shape of the oxygen saturation curve is sigmoid, and until you reach oxygen pressures of \< 60 mm Hg, there is very little change in oxygen saturation. Because an anesthetized patient breathing 100% oxygen should have about 500 mm Hg oxygen in the arterial blood, this can drop a long way before a dramatic change to oxygen saturation occurs * However, the time to intervene is early when you see saturation percentages decrease because it means that your patient is oxygenating very poorly, especially if they are breathing 100% oxygen, and even a relatively small further decline could dramatically reduce their oxygen saturation, resulting in tissue hypoxia and dangerous consequences

Answer 162

* Acceptable treatment options for mycoplasma in cats are **doxycycline and enrofloxacin**. * Cats should be **treated for 3 weeks in most cases**. * **_Remember that doxycycline can cause esophageal stricture in cats, and administration should be followed by water._** * This therapy should be effective in most cases but often does not completely eliminate the organism from the body, and cats may remain carriers of the pathogen.

Answer 163

* The **hypogastric nerve** is a part of the sympathetic nervous system. This nerve provides innervation primarily to **beta receptors** in the **detrusor muscle** and **alpha receptors** in the **internal urethral sphincter**. * The **pelvic nerve** is a part of the **parasympathetic nervous system**. The nerve primarily innervates the **detrusor muscle of the bladder wall**. * The **pudendal nerve is a somatic nerve**. It provides innervation to the **external urethral sphincter**. * During the **voiding phase** of micturition, the **parasympathetic nervous system is active**. The pelvic nerve stimulates cholinergic receptors in the detrusor muscle that result in contraction of the bladder and expulsion of urine. * During the **storage phase**, the **sympathetic and somatic nervous systems are active**. The hypogastric nerve stimulates beta receptors in the detrusor muscle which causes the muscle to relax. It also stimulates alpha receptors in the internal urethral sphincter, which causes the sphincter to contract. While this is going on, the external urethral sphincter is contracting as a result of stimulation from the pudendal nerve.

Answer 164

* **110 days** in dogs * cats-**70** * cow-**160** * horse-**145** * pig-**86** * sheep-**150**

Answer 165

* **Dipylidium caninum**, also called the flea tapeworm, double-pored tapeworm, or cucumber tapeworm, is a cyclophyllid cestode that infects organisms afflicted with fleas and canine chewing lice, including dogs, cats, and sometimes human pet-owners, especially children * treated with **Praziquantel (Droncit)**

Answer 166

* **Pythium** is an aquatic organism that inhabits ponds of the Southeast United States. * These organisms have different cell walls than regular fungi, which makes them difficult to treat since most antifungal treatments target fungal cell wall synthesis. * **Prognosis is extremely poor with this disease** and amputation (if the lesions are localized to an affected limb) is currently the best option. * Amputation should always be followed with multiple long-term antifungal therapies. * Owners should be warned that local **postoperative recurrence is common.** Dogs are most commonly affected, but this disease can also occur in cats. It has also been reported in humans and horses

Answer 167

**Progesterone** * Progesterones promote endometrial growth, suppress myometrial activity, and i**nhibit leukocyte response to infection**. * Pyometra almost always occurs in **diestrus** when **progesterone is high and estrogen is low**

Answer 168

* **Apomorphine** is the drug of choice to induce emesis in dogs that have eaten a toxic substance. * Apomorphine is a **dopamine agonist** and may be reversed with **naloxone.** * Adverse effects are uncommon with appropriate doses of apomorphine but can include profound CNS depression or hyperexcitabilty, tachycardia or bradycardia, or respiratory depression. * **Xylazine is the emetic of choice in cats,** and yohimbine, tolazoline, or atipamezole can be used for reversal

Answer 169

* **SUBMUCOSA**

Answer 170

**Myasthenia Gravis** * Thymoma combined with MG and megaesophagus has a poor prognosis * Tensilon (edrophonium) is a rapidly acting anticholinesterase that reverses signs of myasthenia within minutes in most dogs * Dogs with acquired MG have a 1-year mortality rate of 60%, and 48% of affected dogs may die within 2 wk of being diagnosed, due to severe respiratory compromise

Answer 171

* **Avoid in young animals if possible!** * **_Enrofloxacin_** causes **cartilage abnormalities in growing puppies** * ****Bubble-like changes to articular cartilage can be seen when given to dogs from 2- to 8- months of age. * **Enamel hypoplasia and teeth staining** is caused by **_tetracycline antibiotics_** given to young animals.

Answer 172

* **Cricopharyngeal achalasia** is characterized by inadequate relaxation of the cricopharyngeal muscle, which leads to a relative inability to swallow food or liquids. * **The pharyngeoesophageal sphincter fails to relax** * It is seen primarily as a **congenital defect** but is occasionally seen in adult dogs. * This is a rare congenital condition which is usually diagnosed in dogs at weaning. * Treatment involves a **cricopharyngeal myectomy**

Answer 173

* Phenoxybenzamine is a **non-selective, irreversible alpha blocker.** * adrenal mass (**pheochromocytoma)**: Uncontrolled hypertension is associated with an increased mortality rate. * Interestingly, in a recent study, pre-treatment with phenoxybenzamine for several weeks prior to surgery in order to control hypertension showed an increase in survival time * **Pheochromocytomas** are rare tumors that originate from the adrenal medulla. They have been most commonly reported in dogs, horses, and cattle. * Clinical signs associated with pheochromocytomas are nonspecific, and these tumors can be challenging to diagnose * As long as the pheochromocytoma is being removed by a skilled surgeon familiar with vascular surgery, there is **no increase in mortality noted if caval thrombosis is present**; however, invasion of disease such that a nephrectomy needs to be performed is associated with increased mortality.