Small Animal

Question 1

Amphotericin B

Answer 1

• Injectable Anti-fungal drug
• Amphotericin B damages the ergosterol of the fungal cell membrane
• The need for intravenous administration and the nephrotoxicity of amphotericin B limits its usefulness in long term treatment of fungal infections
• often 28 day course of Tx
• It is still very effective for initial treatment of fungal infections because of its rapid action and intravenous route.
• In dogs with blastomycosis involving the central nervous system it appears to be superior to itraconazole
• In those cases, a lipid based amphotericin product (such as Abelcet) should be used, and the renal values must be closely monitored

Question 2

Blastomycosis

Answer 2

• Blastomycosis is a systematic yeastlike fungal infection caused by the organism Blastomyces dermatitidis, which is commonly found in decaying wood and soil.
• Blastomycosis occurs most frequently in male dogs, but female dogs are also susceptible

Question 3

Acanthosis nigricans

Answer 3

• Hyperpigmentation condition
• The condition is characterized by hyperpigmentation of the axillary and groin regions and can spread to other parts of the body.
• Secondary bacterial infections, yeast infections, and seborrhea commonly develop in the affected regions.
• The mode of inheritance has been proposed to be autosomal recessive or polygenic inheritance
• The primary inherited form of this condition almost exclusively occurs in Dachshunds. Other dogs may get a form of the condition secondary to other skin diseases
• Signs are usually evident by 1 year of age

Question 4

B.A.R.F. Diet

Answer 4

• The B.A.R.F diet stands for two common phrases: ‘Biologically Appropriate Raw Food’ and ‘Bones and Raw Food
• BARF diet is a raw meat and bone diet
• Can be a risk for Salmonella! - may note hemorrhagic diarrhoea
• CDC: “Dogs and cats that become ill from Salmonella infection generally will have diarrhea that may contain blood or mucus. Affected animals may seem more tired than usual, and may have a fever or vomit.”

Question 5

Incipient Cataract

Answer 5

• focal cataract
• Incipient cataracts cover less than 15 percent of the surface area of the lens,”
• Many dogs won’t notice these, and they’ll rarely undergo surgery to remove the cataract at this stage.

Question 6

“Bunny- Hopping” Gait

Answer 6

• A bunny-hopping gait is most often seen in cases of hip dysplasia.
• Radiographs of the hips would be the next best step.

Question 7

Cushing’s Reflex

Answer 7

• Cushings reflex is when there is hypertension in the presence of bradycardia -> indication that the ICP might be increased
• The Cushing reflex (vasopressor response, Cushing reaction, Cushing effect, and Cushing phenomenon) is a physiological nervous system response to acute elevations of intracranial pressure (ICP) resulting in Cushing’s triad of widened pulse pressure (increasing systolic, decreasing diastolic), bradycardia, and irregular respirations

Question 8

3 phases of Status Epilepticus

Answer 8

Question 9

First Line Drugs with Status Epilepticus Tx

Answer 9

• Diazepam (0.5 - 2 mg/kg IV or Rectal)
• Midazolam (0.1 - 0.3 mg/kg IV or IM, intranasal)

Question 10

Second Line Drugs with Status Epilepticus Tx

Answer 10

• Phenobarbital (2-6 mg/kg IV or IM)
• Levetiracetam (20-60 mg/kg IV)

Question 11

Third Line Drugs with Status Epilepticus Tx

Answer 11

• Propofol CRI
• Midazolam/Diazepam infusion
• ketamine infusion?

Question 12

5 common clinical signs of vestibular disease in SA

Answer 12

Question 13

Pleurostotonus

Answer 13

• Head/Body turn
• ears level (unlike in head tilt)
• Often indicative of Forebrain lesion (likely in thalamus) rather than vestibular disease

Question 14

2 types of nystagmus

Answer 14

• Physiological
• Pathological

Question 15

Pendular nystagmus

Answer 15

• nystagmus is not always asociated with vestibular disease! - cats can have pendular nystagmus
• once recognized, often do not recommend any further diagnostics or Tx - does not affect vision or QoL

Question 16

Vestibular Ataxia

Answer 16

• tends to be very unilateral
• can be mild to severe
• these Px often won’t show signs of paresis, just difficulty walking - may be reluctant to walk, but the STRENGTH of the legs should be relatively normal
• often head tilt will be present
• to differentiate from spinal or cerebellar ataxia: vestibular ataxia often worsens when position of the head and body changes - CS’s may be more severe when you place them back on the ground (tight circles, more severe ataxia)

Question 17

Peripheral or Central Vestibular Disease?

how to tell?

Answer 17

Question 18

Differentials for Peripheral and Central Vestibular Disease?

Answer 18

• PSOM often seen in Cavalier King Charles Spaniels
• hypothyroidism as a cause is quite controversial - could use bloods to rule out

Question 19

Bilateral Vestibular Disease signs

(+ 3 common causes)

Answer 19

• metronidazole toxicities more common in dogs
• thiamine deificency in cats

Question 20

Most common causes of acute vestibular disease

(2)

Answer 20

• both should spontaneously start to improve over a couple days
• in the case of a stroke though, there may be an underlying cause so it is important to investigate if indicated

Question 21

Idiopathic (geriatric) Vestibular Syndrome

Answer 21

• used to be much more commonly seen in geriatric patients, but now can be seen in all age groups
• not really specific treatments available, but often give anti-emetics and supportive therapy

Question 22

2 most common underlying causes of Cerebrovascular accidents - Ischemic Infarct in SA

Answer 22

• Hypertension
• HAC (cushings)

but many other possibilities!
50% of dogs with this Dx have underlying disease present

• especially in our older Px’s! - may have risk of relapse

Question 23

Task Force definition of Canine Atopic Dermatitis

Answer 23

“a genetically predisposed inflammatory and pruritic allergic skin disease with characterisitic clinical features associated with IgE antibodies most commonly directed against environmental allergens”

• not often inhalant, more commonly percutaneous

Question 24

Paragonimus kellicotti

Answer 24

• North American lung fluke
• Paragonimus kellicotti and P westermani usually are found in cysts, primarily in the lungs of dogs, cats, and several other domestic and wild animals.
• They also have been found rarely in other viscera or the brain.
• Infection is most common in China, southeast Asia, and North America.
• The eggs are typically passed in the feces.
• Fenbendazole and Praziquantel have been effective against this parasite.

Question 25

Osteomyelitis

Answer 25

• 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

Question 26

Is the ELISA test for Giardia sensitive?

Answer 26

Yes.

Question 27

Taenia taeniaformis

Answer 27

• 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

Question 28

Tritrichomonas foetus

Answer 28

• 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

Question 29

Cryptosporidium spp. in SA

Answer 29

• 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.

Question 30

What is the treatment of choice for chronic canine keratoconjunctivitis sicca?

Answer 30

• 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

Question 31

Answer 31

• 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

Question 32

The most important system to maintain a normal mental status is the ascending reticular activating system

True or False?

Answer 32

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​

Question 33

Decerebrate Rigidity Posture

Answer 33

• 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

Question 34

If the cat shows a strong withdrawal reflex, this is indicative of good superficial nociception

True or False?

Answer 34

FALSE

Question 35

Idiopathic epilepsy is most common in….

Answer 35

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

Question 36

Reactive seizures can only be caused by metabolic derangement

True or False?

Answer 36

• FALSE

Question 37

Altered Mental Status:

what must be involved?

What can be the causes?

Answer 37

• 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

Question 38

Which 3 structures for the brainstem?

Answer 38

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

Question 39

The International veterinary epilepsy task force (Bhatti et al. BMC Veterinary Research (2015) 11:176) has produced guidelines on starting antiepileptic medications. Regarding the interictal period, the recommendation is to start antiepileptic treatment if a dog is experiencing:

Answer 39

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

Question 40

Typical Presentation of Patients with Idiopathic (functional) epileptic seizures

(5)

Answer 40

• 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

Question 41

If seizures are provoked by intracranial/cerebral pathology. A typical presentation includes:

Answer 41

• < 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

Question 42

A typical presentation of a patient with reactive seizures include:

(4)

+ what are the 33 most frequent causes of reactive seizures?

Answer 42

• 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%)

Question 43

Tier I, Tier II, and Tier III

(confidence of Idiopathic Epilepsy Diagnosis)

Answer 43

Question 44

The International veterinary epilepsy task force has provided us with general guidelines on starting AED (anti-epileptic drugs). Treatment should be initiated if:

(

Answer 44

• 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 frequency and/or duration is increasing and/or seizure severity is deteriorating over 3 interictal period

Question 45

What statement is true about the use of spinal radiographs in the diagnosis of type I intervertebral disc disease?

Answer 45

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

Question 46

What is the most common long-term consequence of acute non-compressive nucleus pulposus extrusion?

Answer 46

Partial faecal incontinence is the most common long-term complication

Question 47

What is an effective treatment for acute type I cervical intervertebral disc disease?

Answer 47

Surgery is associated with good outcomes and short recovery times

Question 48

What is often associated with steroid responsive meningitis and arteritis?

Answer 48

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

Question 49

Which structures are part of the ‘peripheral’ vestibular system?

Answer 49

Inner ear and vestibulocochlear nerve (CN VIII)

Question 50

What are clinical signs of vestibular disease?

(nystagmus/strabismus)

Answer 50

• positional strabismus
• positional nystagmus or spontaneous or resting nystagmus

Question 51

What type of nystagmus is suggestive for central vestibular syndrome

Answer 51

Dysconjugate nystagmus

Question 52

T2 vs. T1 weighted sequence on MRI

Answer 52

• 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)

Question 53

Idiopathic Vestibular Disease Tx

Answer 53

• 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

Question 54

What endocrine disease can be linked to facial paresis and/or vestibular disease?

Answer 54

Hypothyroidism

Question 55

kyphosis

Answer 55

• 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).

Question 56

Answer 56

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

Question 57

acute intervertebral disc extrusion

When to go to Sx (hemilaminectomy to remove material or release trapped nerve roots)?

(4)

Answer 57

• 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!

Question 58

Acute intervertebral disk extrusions

Answer 58

• 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.

Question 59

Meningomyelitis in Dogs

Describe

(8) symptoms
(3) types
(3) Causes

Answer 59

• 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.

Question 60

Common Causes of Acute Vestibular Disease in Older Dogs

Answer 60

• 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

Question 61

MUO

Answer 61

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.

Question 62

What dogs are most commonly affected with meningoencephalitis of unknown origin?

Answer 62

• 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

Question 63

What are the clinical signs of meningoencephalitis of unknown origin?

(MUO)

Answer 63

• 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.

Question 64

The most common extra-axial meningeal origin tumors in dogs?

Answer 64

• 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​

Question 65

What breed is spinal arachnoid diverticulum (SAD) most commonly seen in?

Which limbs are most commonly affected?

Answer 65

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

Question 66

Common giveaway postures for neuromuscular cases

(2)

Answer 66

• 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

Question 67

components of Neuromuscular system

(3)

Answer 67

• 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

Question 68

what might reduced reflexes and muscle tone indicate on a neuro exam?

Answer 68

• 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

Question 69

You examine a Basset Hound with primary glaucoma in one eye. What would you tell the owner about his prognosis for the other eye?

Answer 69

• 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.

Question 70

Define Glaucoma

Diagnosis: What IOP would you expect via tonometry, applanation or rebound?

Answer 70

• 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

Question 71

Pathophysiology of Glaucoma in SA

Primary or secodary disease?

Answer 71

• 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)

Question 72

Common Signalment of glaucoma in SA

(cats vs. dogs)

Answer 72

• 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

Question 73

Ammonium Biurate Crystalluria

Answer 73

• 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

Question 74

Pre- and post- prandial Bile Acid Test

Answer 74

• 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.

Question 75

ALT

AST

Answer 75

• 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.

Question 76

Common causes of raised ALP

Answer 76

Question 77

What is trypsin-like immunoreactivity?

Answer 77

• 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.

Question 78

• majority of PSS are….
• & Signalment (dogs)
• sign in cats

Answer 78

• 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).

Question 79

Clinical Signs of PSS in dogs

Answer 79

Clinical signs vary:

● 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

Question 80

Working out Polyphagia

Answer 80

Question 81

What parasite can often be confused for canine heartworm, but is not pathogenic and therefore does NOT need to be treated…

Answer 81

• 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.

Question 82

Uncinaria stenocephala

Answer 82

• 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

Question 83

Strongyloides stercoralis

Answer 83

• 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.

Question 84

Filaroides osleri

Answer 84

• 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.

Question 85

When performing a perineal urethrostomy which nerve must you preserve?

What are the main 3 nerves involved with urinary continence and what are their roles?

Answer 85

• 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

Question 86

Plication

Answer 86

• a fold or corrugation.

the manner of folding or condition of being folded

ex: may see in a Rx of intussusception

Question 87

What tumor type is a cat predisposed to developing at vaccination sites?

Answer 87

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

Question 88

My Third Sunken Toe

DIfferentials you need to rule out with this SYNDROME to confirm idiopathic

Answer 88

HORNERS SYNDROME

• Miosis
• Third Eyelid Protrusion
• Sunken Eye - enopthalmia
• Ptosis - droopy eye

Guttural Pouch mycosis (in horses), otisis media and Brachial Plexus Avulsion (torn attachment from SC)

Question 89

What enzyme are cats and ferrets both deficient in?

(plays a part in Acetominophen deficiency)

Answer 89

• 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.

Question 90

Smaller Breed Dogs and complete fractures…

Answer 90

• 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

Question 91

clicking heard on flexion and extension of stifle joint

Answer 91

often consistent with damaged medial meniscus cartilage found in the stifle

Question 92

Salter Harris Fractures

Answer 92

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

Question 93

Baylisascaris procyonis

Answer 93

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

Question 94

Which tumor type is frequently testosterone-dependent and is therefore found most frequently in dogs that are intact males or have testosterone-secreting tumors

Answer 94

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

Question 95

Hepatic Encephalopathy Patients Need what Diet change?

Additional changes? (3)

Answer 95

• 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

Question 96

What cranial nerve is responsible for lacrimation?

Answer 96

CN VII is responsible for lacrimation.

Deficits in lacrimation would cause exposure keratitis

Question 97

Post-op Calcium levels for Parathyroid Adenoma removal

Answer 97

• 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.

Question 98

You are seeing a dog that you suspect has iatrogenic Cushing’s disease from high-dose prednisone administration. What would you expect on blood samples submitted for ACTH and cortisol levels submitted to a commercial lab?

Answer 98

• 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.

Question 99

In how many cases is cholesterol elevated with Hyperadrenocorticism?

what do you expect levels of BUN, ALT, ALP (SAP), T4, Potassium to do?

Answer 99

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)

Question 100

Normal CVP? (cmH20)

Answer 100

• 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.

Question 101

Dalmations are most prone to which urolith?

Answer 101

• 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

Question 102

What is the isotonic crystalloid total “shock dose” in dogs?

cats?

colloids dose? hypertonic saline?

Answer 102

• 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.

Question 103

• Taurine deficiency in the English Cocker Spaniel has been associated with?
• what can also happen in cats with taurine deficiency?

Answer 103

• 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.

Question 104

What opthalmic issue can be caused by trimethoprim sulfa antibiotics?

Answer 104

• 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

Question 105

Is FIP contagious between cats?

What demographic of cat is most likely to get FIP?

Answer 105

• 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.

Question 106

Major Causes of Non-Cardiogenic Pulmonary Oedema

(9)

Answer 106

Often depends on age or presentation!

• Vasculitis
• Liver Disease
• Electrocution
• Seizures
• Toxins
• Envenomation (venom injection)
• DIC
• Direct Trauma
• Sepsis

Question 107

Common Treatment Options for Hyperthyroidism

(in cats)

Answer 107

• 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

Question 108

What is important to evaluate when a neck mass is present?

Answer 108

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

Question 109

You perform thoracocentesis on a cat with pleural effusion. The fluid has a hazy gold color and a protein content of 7 g/dl and 7,000 cells/uL. These cells are primarily non-degenerative neutrophils with lesser numbers of other white blood cells and mesothelial cells. What is the most appropriate interpretation of these findings?

Answer 109

• 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

Question 110

Cryptococcosis

Diagnostics?

Answer 110

• 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

Question 111

Pleocytosis

Answer 111

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

Question 112

You have a cat that needs to stay on inhalation anesthesia and remain recumbent following a major surgery. What pulmonary complication is likely to occur from prolonged recumbency and anesthesia in this patient?

Answer 112

• 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.

Question 113

What is the only species of Demodex that is contagious?

What clinical sign do you often see?

Diagnostic Test?

Answer 113

• 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

Question 114

What is a trichogram and what can it tell you?

Answer 114

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

Question 115

How do you diagnose a chylothorax?

What breeds of cat are predisposed?

dog?

Answer 115

• 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

Question 116

What is Chyle?

What about a pseudochylous effusion?

Thoracic Lymphangiectasia?

Answer 116

• 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

Question 117

What disease processes can lead to alteration in the flow through the thoracic duct leading to leakage of chyle ( likely leading to chylothorax) - what is the most common cause?

Cardiac causes? (5)

Non-cardiac? (5)

Trauma?

Idiopathic?

Answer 117

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

Question 118

Most efficient way of diagnosing suspected FIP? (which has the highest positive predictive value)

Other tests you can use?

Answer 118

• 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.

Question 119

An 11-year old female spayed Siamese cat presents for further evaluation after developing a mass over the scapular region. The mass is approximately 2cm in diameter. An aspirate of the mass confirms your suspicion, what is your surgical plan?

Answer 119

• 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.

Question 120

Chemosis

Answer 120

• 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

Question 121

What disease in cats most commonly causes severe chemosis in the absence of other systemic signs?

Answer 121

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.

Question 122

According to recommendations by the Vaccine-Associated Feline Sarcoma Task Force, which of these is the appropriate protocol for vaccinating a cat?

Answer 122

• 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.

Question 123

Are Opioids a common cause of gastric ulcers in cats and dogs?

Answer 123

• 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

Question 124

What chemotherapeutic drug cause fatal pulmonary edema in cats?

what drug is neurotoxic?

what chemotherapeutic drugs are commonly used in cats? (3)

Answer 124

• 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.

Question 125

What is the permanent dental formula for a cat?

Answer 125

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

Question 126

What is the permanent dental formula for a dog?

Answer 126

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

Question 127

Normal Gestation Period in Cats

Answer 127

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.

Question 128

Discospondylitis

Answer 128

• 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

Question 129

4 Coagulation Disorder Patterns

Answer 129

Question 130

Iris Coloboma

Answer 130

• 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

Question 131

Brachial Plexus Avulsion

Answer 131

• 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

Question 132

Yew Tree Toxicity

Answer 132

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

Question 133

Sago Palm Toxicity

Answer 133

• 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%

Question 134

Foxglove Toxicity

Answer 134

• 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

Question 135

Pelger-Huet Anomaly

(PHA)

Answer 135

• 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.

Question 136

Von Willebrands Disease

Answer 136

• 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)

Question 137

Infectious Canine Hepatitis

Answer 137

• 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)

Question 138

What is the main mode of transmission for feline leukemia virus? (FeLV)

Answer 138

• 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.

Question 139

Salmon Poisoning Disease in Dogs

Answer 139

• 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.

Question 140

Diagnosis of FeLV

Answer 140

• 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

Question 141

Diagnosis of FIV

Answer 141

• 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

Question 142

Staphylectomy

Answer 142

• 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

Question 143

Pemphigus Foliaceus

Answer 143

• 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

Question 144

Gnathostoma

Answer 144

• 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!

Question 145

Hiatal Hernias

Answer 145

• 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

Question 146

Myelography in Spinal Injuries

(Dogs)

Answer 146

• 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

Question 147

Hypophysectomy

Answer 147

• 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)

Question 148

Discoid Lupus Eryhthematosus

Answer 148

• 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.

Question 149

Strangles in Puppies

Answer 149

• 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.

Question 150

Thyroid Testing in Dogs & Cats

Answer 150

Question 151

You are seeing a dog that you suspect has iatrogenic Cushing’s disease from high-dose prednisone administration.

What would you expect on blood samples submitted for ACTH and cortisol levels submitted to a commercial lab?

Answer 151

• 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

Question 152

What region of the bone is affected in hypertrophic osteodystrophy (HOD)?

Answer 152

• 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 abnormal 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.

Question 153

Treatment of Entropion

Answer 153

• 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.

Question 154

Hypertrophic Osteodystrophy

(HOD)

Answer 154

• 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

Question 155

treatment for HOD and Panosteitis?

prognosis?

Answer 155

• 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.

Question 156

Panosteitis

Answer 156

• 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

Question 157

Possible features of feline herpes viral infection

(4)

Answer 157

• 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

Question 158

Congenital Pathophysiologies of BOAS

Answer 158

• 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

Question 159

Elongated Soft Palate Treatment

(BOAS)

Answer 159

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

Question 160

Everted Laryngeal Saccules

Answer 160

• 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!

Question 161

Hypoplastic Trachea

Answer 161

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

Question 162

Pruritic Dog?

What are the 4 most likely differentials?

Answer 162

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!

Question 163

Lichenification

Answer 163

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

Question 164

Lesion location often seen with FAD

Answer 164

Question 165

Skin Allergy Lesions in Cats

What 2 reaction patterns are most important to note in a cat?

Answer 165

Question 166

Feline Indolent Ulcer

Answer 166

• 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

Question 167

Diagnosing Allergic Skin Disease

Answer 167

Question 168

Rule-Out Process for Pruritis

(5)

Answer 168

Question 169

PTH Pathway

(normal, in response to low Ca levels)

Answer 169

Question 170

3 Grades of Mast Cell Tumors

Answer 170

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

Question 171

What is the classic pathological finding for rabies?

Answer 171

• 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)

Question 172

How long does epidural morphine last?

what type of Sx is it good for?

Answer 172

• 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

Question 173

What is a pleuroperitoneal diaphragmatic hernia?

Answer 173

• 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.

Question 174

Diagnosis of Diabetes Mellitus

Answer 174

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

Question 175

Treatment for a “Healthy Diabetic”

Answer 175

• 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

Question 176

treatment of Severe DKA patient

Answer 176

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

Question 177

What indicates a stress leukogram in dogs?

Answer 177

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

Question 178

What sex of dog is predisposed to Addison’s Disease

(Hypoadrenocorticism)

Answer 178

• 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

Question 179

Treatments for Px’s with Immune Mediated Thrombocytopenia

Answer 179

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

Question 180

What region are most T3-L3 herniations located?

(ex: Intervertebral Disc Disease)

Answer 180

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

Question 181

Fibrocartilagenous embolism

(FCE)

Answer 181

• 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.

Question 182

onychectomy

Answer 182

• De-clawing

Question 183

What can be concluded from a urine specific gravity of 1.004 in a dog?

Answer 183

• 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.

Question 184

What neoplastic process is shown by this cytology?

Answer 184

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

Question 185

Hemivertebrae in Dogs

Answer 185

Typically around T8-T9 area

Question 186

SRMA

(Steroid Responsive Meningitis-Arteritis)

Answer 186

• 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.

Question 187

What levels of blood glucose would be seen to have glucosuria in dogs and cats?

Answer 187

• 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

Question 188

Which of these chemotherapeutic drugs causes irreversible tissue sloughing if the drug is perivascularized or given any route other than IV to a dog?

Answer 188

• 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

Question 189

Primary “Spontaneous” Pneumothorax

Answer 189

• “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

Question 190

2 phases of rabies in canines/felines

Answer 190

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 around day 5 if the animal hasn’t already succumbed

Question 191

Interpretation of UP:UC in Dogs & Cats

Answer 191

• 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

Question 192

Urine Cortisol/Creatinine Ratio

Answer 192

• 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!

Question 193

any dog that has waxing and waning signs like decreased appetite, weight loss, diarrhea, vomiting, or just general “poor doing,”…..

what should you always consider?

Answer 193

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

Question 194

C-reactive protein

Answer 194

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

Question 195

Issues with raw food diets

(which we don’t recommend atm!)

more disadvantages than advantages via published works

Answer 195

• 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

Question 196

What cardiac condition can be seen with taurine deficiency in dogs?

Answer 196

• 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

Question 197

What does an oxygen saturation reading of 98-100% correlate to on the pulse ox?

95%?

90%?

50%?

10%?

How low can it get before you are worried about hypoxia in a patient receiving 100% oxygen under anaesthesia?

Answer 197

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

Question 198

Treatment for Mycoplasma in cats

Answer 198

• 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.

Question 199

Innervation of the Bladder + Micturition

Answer 199

• 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.

Question 200

Life Span of RBC’s in dogs?
cats?

Answer 200

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

Question 201

Dipylidium caninum

Answer 201

• 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)

Question 202

Pythium

Answer 202

• 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

Question 203

Pyometra usually occurs when a dog is primarily under the influence of which hormone?

Answer 203

Progesterone

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

Question 204

Apomorphine

Answer 204

• 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

Question 205

what is the holding layer of hollow viscera?

(in suturing?)

Answer 205

• SUBMUCOSA

Question 206

Common paraneoplastic syndrome of a thymoma

Answer 206

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

Question 207

Enrofloxacin in young animals?

Tetracyclines?

Answer 207

• 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.

Question 208

Cricopharyngeal achalasia

Answer 208

• 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

Question 209

Phenoxybenzamine

Answer 209

• 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.