VetPrep Flashcards

Question

A dog presents to your clinic with tenesmus and swelling near the anus as seen in the image. On examination, there is a fluctuant swelling lateral to the anus, and on rectal exam, you note lateral dilatation of the rectum. Which of the following is the most common signalment for dogs presenting with this problem? * A) They are younger intact females * B) They are younger intact males * C) They are older intact females * D) They are older intact males * E) There is no age or sex predilection

Answer 1

D) They are older intact males This is a case of a **perineal hernia.** Older intact male dogs are most commonly affected. Overrepresented breeds include _Boxers, Collies, Kelpies, Pekingese, and Boston terriers_. The hernia results from a weakened pelvic diaphragm. It is thought that there may be a hormonal component which results in weakening with time. Wiki: *Perineal hernia is a hernia involving the perineum (pelvic floor). The hernia may contain fluid, fat, any part of the intestine, the rectum, or the bladder.* *_Dogs with benign prostatic hyperplasia have been found to have increased relaxin levels_ and suspected subsequent weakening of the pelvic diaphragm* *In cats, perineal hernias are seen most commonly following perineal urethrostomy surgery or secondary to megacolon.*

Answer 2

A) The thin, white, glistening amniotic membrane emerges from the vulva This case description is consistent with **stage I of labor** in the horse. The first stage of foaling typically lasts 30 minutes to 4 hours. During this stage, **mares act restless** and may exhibit signs similar to colic such as flank watching, pawing, and constantly getting up and down. **When the placenta ruptures ("water breaks"), there may be several gallons of allantoic fluid that come out**. Usually, within about 5 minutes, the **second stage** of labor begins and the **foals feet and nose appear at the vulva, _covered in the white, thin, glistening amnion_**. If a red, velvety, membrane is seen, this is the chorioallantois which indicates premature placental separation which can impair oxygen delivery to the fetus and can result in death of the foal. Usually, the muzzle will emerge from the amnion by the time the foal's hips pass through the pelvis but if not, the amnion can be gently broken and removed. Usually, the umbilical cord breaks naturally when the mare stands or foal begins to rise. Then, within 30 minutes to 3 hours after foaling, the placenta should be expelled.

Answer 3

A) Methocarbamol Pyrethrins alter the activity of the sodium ion channels of nerves, which **prolongs the period of sodium conductance**. This **increases the length of depolarization resulting in repetitive nerve firing.** **Cats are particularly sensitive** to pyrethrin-containing products and can develop clinical signs within hours after administration. Affected animals should be bathed to remove remaining product. Minor clinical signs such as hypersalivation and ear twitching are usually self-limiting and do not require treatment. **Control of marked tremors or seizures** can be achieved with **methocarbamol** (Robaxin).

Answer 4

A Toxoplasmosis gondii is a protozoal organism. The cat is the definitive host; the entire life cycle of the organism can be completed within this host. Most cats become infected when they consume an exposed rodent with bradyzoites encysted in their tissues. Only recently infected cats generally shed oocysts in their stool, and cats typically only **shed these oocysts for 1-2 weeks**. Most cats will only have one shedding episode in their lifetime. **A IgM (not IgG) titer of 1:64 or greater suggests recent or active infection** and that cat is at risk of shedding oocysts in their stools. **Oocysts are not infective until they sporulate. This process takes \> 24 hours, so emptying the litter box daily is advised, preferably by someone who is not pregnant.** If an owner has owned cats for a long while, it is **possible that they may have previously been exposed** and therefore have mounted an immune response to the organism. If so, it may be advisable to **test for Toxoplasma antibody** titers in the owner. A s**ufficient antibody titer will mean the client is protected from infection during the first trimester**.

Answer 5

C ## Footnote CAEV is a retrovirus and when it affects the udder it will cause **fibrosis and result in a firm udder with agalactia**. Treatment is ineffective and the goat should be culled. The disease is usually subclinical but can cause arthritis in adults and encephalitis in kids.

Answer 6

C) Acetylcysteine and S-adenosylmethionine **Acetaminophen toxicity** in cats usually occurs when owners administer the drug, unaware of its significant potential toxicity in cats. In this case, the cat's clinical signs are most consistent with acetaminophen toxicity based on the _Heinz body anemia_ that is present. Cats can die from _oxidative damage_ and _methemoglobinemia within 1-2 days of ingestion_. It may also be associated with hepatotoxicity in cats, although this is seen more frequently in dogs. Recall that _cats_ are particularly sensitive to acetaminophen because they have _decreased glucuronyl transferase_ activity which conjugates acetaminophen to glucuronic acid for excretion. As a result, _50-60 mg (a single tablet) may be fatal for a 4-5 kg cat_. Treatment should consist of _toxin removal_ if possible by inducing _emesis_ in some cases. As the cat in this case is already vomiting, this may not be necessary. _Activated charcoal is controversial_ and should only be given if ingestion occurred within hours and should be administered very carefully in cats due to the risk of aspiration. The specific antidote is **acetylcysteine** which _binds to some of the reactive metabolites of acetaminophen and increases the availability and synthesis of glutathione_. Other treatments may include **S-Adenosylmethionine** (SAMe) which has _hepatoprotective and antioxidant properties_. **Cimetidine** can be given to _inhibit the p450 oxidase in the liver and limit formation of toxic metabolites_. **Ascorbic acid** can also be used as an adjunct treatment to _bind toxic metabolites_. In cats with signs of hypoxemia from severe hemolytic anemia (PCV \<20%), a **transfusion** and further supportive care may be warranted.

Answer 7

C) BUN and creatinine levels Lily plant toxicosis is extremely serious and can cause rapid and fatal **acute renal failure in cats**. If ingestion is suspected, _decontamination and aggressive fluid therapy_, and _monitoring of renal values_ are recommended immediately. In this case, since **2 days have passed**, _inducing emesis and administering activated charcoal would not be helpful_. What you can do is _check renal values (BUN and creatinine) and treat for acute renal failure._ Ruling out an intestinal obstruction in a cat with this history is reasonable but not the best of the choices given. Web: *Lilies in the “true lily” and “daylily” families are very dangerous for cats. The entire lily plant is toxic: the stem, leaves, flowers, pollen, and even the water in a vase. Eating just a small amount of a leaf or flower petal, licking a few pollen grains off its fur while grooming, or drinking the water from the vase can cause your cat to develop fatal kidney failure in less than 3 days. _The toxin, which only affects cats, has not been identified. Dogs that eat lilies may have minor stomach upset but they don’t develop kidney failure._*

Answer 8

E) Thrombus at the aortic bifurcation (saddle thrombus) _Maine Coon_ cats are predisposed to development of _hypertrophic cardiomyopathy_ at a young age. Consequently, _left atrial enlargement_ predisposes to _atrial thrombus formation_, and these clots frequently _lodge in the arterial supply to the hindlimbs_. The _trifurcation_ is where the aorta divides into _the two external iliac arteries_ and the common origin of the internal iliac arteries. Classic findings due to a clot at the aortic trifurcation include _posterior paresis/paralysis, hindlimb pain, cyanotic nailbeds, absent femoral pulses, and a firm leg musculature_. Other signs of cardiac disease/failure (murmur or pulmonary edema) are often but not always evident at presentation. Neither cord lesions, tetanus, nor toxicities should cause the vascular compromise evident on this cat's physical exam.

Answer 9

A) Culture the discharge for bacteria The correct answer is to culture the discharge for bacteria. The most likely diagnosis for this horse is **equine strangles**. Strangles most commonly affects _younger_ horses (\<5 years of age), but can cause disease in any age horse. The etiologic agent of this disease is S_treptococcus equi subsp. equi_. The diagnostic test of choice to confirm this is _bacterial culture_. _While awaiting culture results_, the horse should be _separated_ from any other horses, as strangles is highly _contagious_ to other horses. Antibiotic therapy is controversial and thought to lengthen the course of disease rather than shorten it when given at this stage; also, it may possibly interfere with the natural immunity acquired from natural infection. S. equi infection is not reportable in all states (or countries), and so it may not need to be reported universally.

Answer 10

**CN VII**. This is the facial nerve which is responsible for _motor of the facial muscles_ as well as sensation in the ear and lacrimation. CN V is mostly responsible for sensation *(and motion/tone of the mastication muscles: masseter and temporal muscles)*. CN III is the oculomotor nerve and serves in movement of the eye. CN VI is also involved in movement of the eye. *Rappel:* * *NCVII : symétrie faciale (oreilles, ouvertures palpébrales\*, narines, lèvres, vibrisses). ,* * *\* aussi testé avec réflexe palpébraux (NCV) et réponse à la menace (NCII)* * *NCV:* *sensation au visage (réflexes palpébraux + stimulation du septum nasal) et muscles de la mastication (masséter, temporal)*

Answer 11

b) Left lung The correct answer is left lung. On a right lateral radiograph, the right side is down. In this situation, the _right lung lobes are compressed and the left lung lobes inflated, accentuating a mass in the left lung_. On a left lateral radiograph, the left lobes are compressed and a mass in the left lung can be concealed due to compression of the lung surrounding the mass.

Answer 12

d) Desmopressin acetate The correct answer is desmopressin acetate (DDAVP). Administration of desmopressin results in **release of von Willebrand factor**, which will help this patient with clotting. Given this dog's breed and _elevated BMBT there is a very strong likelihood she is afflicted with von Willebrand's disease_. In _Dobermans_ this results in an inability to form a clot. This can be life threatening if the dog is taken to surgery. _A whole blood transfusion does not provide an adequate source of von Willebrand factor_ but may be necessary if the patient's bleeding cannot be controlled despite appropriate pre-operative measures. 1,25 dihydrocholecalciferol is the active form of vitamin D which aids intestinal resorption of calcium. The _BMBT does not assess factors 2, 7, 9, or 10 and therefore vitamin K is not indicated._ *moi: test de saignement = hémostase primaire (formation du clou plaquettaire, impliquant facteur de VwB) et non pas secondaire (coagulation/consolidation du clou)*

Answer 13

a) Disruption of function of plumage Feathers serve a critical _waterproofing and insulatory_ function which is disrupted by oil and can rapidly result in _hypothermia_. Other concerns for oiled birds include GI irritation from ingestion of oil during preening, hemolytic anemia, and pneumonia due to inhalation of oil. Treatments include heat, supportive care, and activated charcoal. Once stabilized, frequent high pressure, warm, mild detergent baths and clean warm water rinses until water beads freely off of the feathers is important. Birds should be placed in warm air flow until dry and they should be maintained on self-skimming ponds for several days after washing to ensure full waterproofing.

Answer 14

b) Doxycycline There is also evidence that clindamycin can cause stricture formation. For this reason, it is recommended that after pilling a cat with doxycycline, it is followed with a small volume (5-10 mls) of water.

Answer 15

a) Streptococcus suis. Streptococcus suis and H. parasuis both cause _polyarthritis, polyserositis, fever, and pneumonia_ in young piglets up to several weeks of age. Both can cause _fibrinopurulent inflammation_ as well as _meningitis_ and _convulsions_. Erysipelas and M. hyosynoviae typically occur in grower and finisher pigs and do not result in pneumonia. Diamond-shaped skin lesions (thus the name "diamond skin disease") are pathognomonic for Erysipelas. Fusobacterium necrophorum causes lameness via footrot or laminitis.

Answer 16

d. Vesicular stomitis VS affects horses, cattle and pigs with similar clinical signs. It is a viral disease of high morbidity and low mortality that appears about every 7 to 10 years in the Southwestern United States. Yearly outbreaks occur in southern Mexico and northern South America. Black flies and midges appear to be the vectors. Affected premises should be quarantined.

Answer 17

b) Treat all calves for lice This is a _blood sucking genus of louse_, and c_an cause severe anemia_. The anemic calves become thin and m_ore susceptible to diseases like pneumonia_. You can tell this is a louse and not a tick or a mite because lice are insects with **6 legs** and ticks and mites are arachnids with 8 legs. The three genera of blood sucking cattle lice are Solenopotes, Linognathus, and Hematopinus.

Answer 18

a) Sulfadimethoxine (Albon) This is an image of **Isospora** from a cat. Isospora are parasitic _coccidia_ that can cause _diarrhea_ as this cat is showing. Treatment for coccidia is usually with _sulfonamides_ such as sulfadimethoxine or trimethoprim sulfa. For the other drugs listed: Droncit- Primarily for cestodes (tapeworms) Revolution- For fleas, heartworms, hookworms, roundworms, and ear mites Strongid- Primarily for roundworms and hookworms Clavamox- A broad spectrum antibacterial Metronidazole- Primarily for anaerobes, also used for giardia

Answer 19

C) **Feline infectious peritonitis is not a contagious disease** *(mais transmission indirecte par voie feco-orale possible non?)***.** 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. L-lysine is an anti-viral medication that may have some benefit for suppression of herpes virus but would not be a prevention or treatment choice for coronavirus. _The coronavirus is shed in the cat's feces during active infection with coronavirus. Some infected cats do not shed the virus. The virus attacks the intestinal tract and causes GI upset. PCR on the feces would detect coronavirus, but does not distinguish between the enteric coronavirus and the mutated FIP form of the virus_.

Answer 20

D) Perianal fistula This is seen mainly in _older German Shepherds_, and licking the anus is a common presenting complaint. The key finding is the presence of multiple draining tracts in the perianal region that can actually be quite deep.

Answer 21

E) A scotch tape test to confirm Oxyuris equi The correct answer is a scotch tape test to confirm Oxyuris equi, the equine pinworm. While all of these diagnostic tests are important when you suspect parasitism, the scotch tape test will enable you to _observe the eggs stuck to the hair_. The egg laying activity by the female worm is what causes the intense pruritis. Occasionally, eggs can be found in a flotation, which may give you a false negative interpretation if not found. A superficial skin scrape is a great alternative for this case; however, Chorioptes spp. tend to infest breeds with feathered legs. An _infestation of Strongyloides vulgaris or Cyathostomes will likely cause colic, diarrhea, and lethargy_.

Answer 22

E) Acidifying diet This cat most likely has a _struvite_ bladder stone. This cannot be determined without a stone analysis, but based on the signalment of the patient, the crystalluria, and the radiograph, this is the most likely type. These types of stones _typically form in urine with a high pH._ Therefore, an acidifying diet would be appropriate for stone dissolution. _Calcium oxalate_ stones are the most common type of stone to form in _acidic urine_. For this type, an alkalinizing diet would be the most appropriate. Clavamox would only be indicated if this cat had a urinary tract infection sensitive to this antibiotic. This cat had a negative urine culture. Metacam can be used short-term to help with pain and inflammation associated with the cystitis from this condition but unfortunately Metacam is no longer recommend for use in cats in the United States. Potassium citrate is a supplement that can be given in addition to an alkalinizing diet to prevent the formation of calcium oxalate stones. This would be contraindicated in this case.

Answer 23

B) Ivermectin Colic with an associated _painful mass at the root of the mesenery is suspicious for verminous arteritis_ caused by damage to the cranial mesenteric artery and its branches by **Strongylus vulgaris**. The _strongyle egg shown in the picture confirms the cause in this question_. A number of anthelmintics are effective including benzimidazoles, pyrantel and ivermectin. Praziquantel is effective against tapeworms. Rifampin and metronidazole are antibacterial drugs. Piperonyl butoxide is a pesticide synergist used in insecticide mixtures in horses.

Answer 24

C) Hypercalcemia, hypophosphatemia Patients with primary hyperparathyroidism would have hypercalcemia and normo to hypophosphatemia due to the law of mass action in which phosphorus decreases as calcium increases and vice versa.

Answer 25

3. Administer oxytocin (IM or IV) and lavage the uterus to facilitate removal * Most texts state that the placenta in a mare is retained after greater than **3 hours** post-parturition; therefore, this would be considered a retained placenta. **Oxytocin, along with uterine lavage**, will cause the uterus to **contract** and facilitate expulsion of the placenta. Strong physical traction on the retained placenta is generally considered contraindicated, as you may tear the placenta and leave remnants of it within the uterus, resulting in possible complications. Broad-spectrum antimicrobials are often administered to decrease the incidence of metritis but alone would not be appropriate.*

Answer 26

2. *Clostridium tetani* This camel is showing signs of tetanus. The organism was likely introduced into the body through the **castration wound.** It is recommended that camels are vaccinated against tetanus prior to castration. While rabies may cause paralysis of the tongue and difficulty swallowing, the recent history of castration in this camel makes tetanus most likely. Trypanosoma evansi is transmitted via biting flies and causes a slow wasting disease in camels.

Answer 27

2. Neorickettsia helminthoeca ## Footnote *The correct answer is Neorickettsia helminthoeca. This rickettsial organism is the causative agent of **salmon poisoning**. It is _carried in the fluke, Nanophyetus salmincola_, which _requires the snail, Oxytrema silicula_ in its life cycle. The snail is what confines occurrence of salmon poisoning to the northwest coast.*

Answer 28

4. This will regress within a year, and symptomatic support is needed for discomfort. * **Craniomandibular osteopathy** (CMO) is seen in **young** dogs and is exemplified in this radiograph. **Terrier** breeds predominate, but CMO can be seen in any breed. The disease is **self-limiting and regresses typically by 1 year old.** It is thought to be a type of **hypertrophic** osteodystrophy (HOD) and occurs mostly in the mandible but can also affect the tympanic bulla, temporal bones, and temporomandibular joints. Treatment is supportive with **nonsteroidal anti-inflammatories** to control pain, similar to HOD. Radiographic signs will also regress with time.*

Answer 29

4. VII, III **Closure** of the eyes is performed by the _orbicularis oculi_ muscle innervated by the _facial nerve_. **Opening** of the eye is by the _levator palpebrae superioris_ innervated by the _oculomotor nerve_. The trigeminal nerve supplies sensory innervation to the eye.

Answer 30

3. Esophagostomy tube feeding ## Footnote *The cat described likely has **hepatic lipidosis**. Cats that are greater than 2 years of age and obese have the greatest risk for hepatic lipidosis. Often these cats are indoor-only and have had a recent stress in their life. An **obese cat that is not eating with the above symptoms** is most likely to have hepatic lipidosis. **An ALP elevation that is greater in magnitude than GGT** is also suggestive of hepatic lipidosis. A bile duct obstruction, cholangiohepatitis, lymphoma, and FIP are other differentials but are less likely with the given information.*

Answer 31

2. Cyproheptadine Other appetite stimulants used for stimulating food consumption include mirtazipine, diazepam and oxazepam. *wiki (*Cyproheptadine)*: first-generation antihistamine with additional anticholinergic, antiserotonergic, and local anesthetic properties.*

Answer 32

Left cranial cruciate ligament rupture with meniscal cartilage tear ## Footnote *The correct answer is left cranial cruciate ligament rupture with meniscal cartilage tear. The **cranial motion** of the tibia and **medial thickening** of the joint (also known as medial buttress) is consistent with the commonly _torn cranial cruciate ligament_. The **clicking** heard on flexion and extension is consistent with _damaged medial meniscus cartilage_ found in the stifle.*

Answer 33

2. thelazia Thelazia is a genus of nematode worms (eyeworms) which are found in the **ocular tissues**. Adults are usually found in the eyelids, tear glands, tear ducts, or the nictitating membrane. They may be found in the eyeball itself under the conjunctiva or in the vitreous. Thelazia are **transmitted by Diptera (flies)** which do not bite but feed on tears. Toxocara, which causes ocular larval migrans, usually causes granulomas which may be seen in the retina and appear more circular.

Answer 34

3. Pyrrolizidine alkaloid ## Footnote *The correct answer is pyrrolizidine alkaloid. The clinical signs described are typical for pyrrolizidine alkaloid toxicity. Consumption of this **plant** typically results in **abnormalities in hepatic cell division**; thus resulting in **large hepatocytes known as megalocytosis.***

Answer 35

1. Mannheimia hemolytica ## Footnote *Other agents may also be isolated, but this is recognized as the worst pathogen in bovine pulmonary disease. It was formerly called Pasteurella hemolytica.*

Answer 36

1. Exploratory laparotomy to remove the ovarian remnant * This is a classic description of **ovarian remnant syndrome,** which is when a cat goes into estrus after previously having an ovariohysterectomy (OVH). This can occur anywhere from **weeks to years after OVH** and typically the **clinical signs consistent with estrus** are sufficient to conclude that the cat is in estrus and has ovarian tissue present. Additional diagnostic tests that are consistent with ovarian remnant syndrome include: Serum **estrogen \>70 p**mol/L indicate that the cat has estrogen production from the ovary. The problem with this test is that estrogen measurements may _fluctuate_ and can be unreliable. Serum **progesterone \>6 n**mol/L after induced ovulation is _sufficient to conclude that corpora lutea formed_ and released progesterone. Testing for serum LH levels can also help confirm the diagnosis. In intact queens, LH is consistently maintained at basal levels due to negative feedback from ovarian estradiol secretion. After OVH, this control is lost and LH concentrations increase. **LH \<1 ng/mL** is consistent with the presence of an ovary as it is in this case. **Surgery** is the treatment of choice. Many practitioners prefer to do surgery _during estrus or diestrus when the ovarian tissue is enlarged and easier to locate_. Remnants may be bilateral so a complete exploratory laparatomy is necessary. Ovarian tissue is _most commonly at the ovarian pedicle_ but can also be in the mesentery or elsewhere.*

Answer 37

2. C6-T2 * The correct answer is C6-T2. In a dog, the spinal cord is divided into the four regions listed above. Upper motor neuron signs include hyper-reflexia of spinal reflexes and increased muscle tone. Lower motor neuron signs include decreased or absent spinal reflexes and decreased muscle tone. A lesion between the C6-T2 spinal cord segments would result in **lower motor neuron signs in the thoracic limbs** and **upper motor neuron signs in the pelvic limbs**, as described in the patient in the question.* * A lesion between C1-C5 spinal cord segments would manifest as upper motor neuron signs in the thoracic and pelvic limbs. Lesions between T3-L3 spinal cord segments would not affect the thoracic limbs, but would manifest as upper motor neuron signs in the pelvic limbs. Lesions between L4-S3 spinal cord segments would result in normal thoracic limbs and lower motor neuron signs in the pelvic limbs.*

Answer 38

2. Moraxella bovis ## Footnote *The correct answer is Moraxella bovis. Thelazia is the eye worm. Histophilus somni is a cause of many syndromes, but is rarely found in the eye. E. coli is not an ocular pathogen.*

Answer 39

1. laminitis The correct answer is **laminitis secondary to endotoxemia.** _Laminitis, endotoxemia, and diarrhea_ are commonly associated with grain overload and appropriate therapy to evacuate any remaining stomach contents, ameliorate endotoxin and prevent laminitis should be instituted immediately. Laxatives such as mineral oil are commonly administered.

Answer 40

4. Hypercalcemia, hypophosphatemia The correct answer is hypercalcemia, hypophosphatemia. Patients with primary hyperparathyroidism would have hypercalcemia and normo to hypophosphatemia due to the law of mass action in which **phosphorus decreases as calcium increases** and vice versa.

Answer 41

4. Acidifying diet * This cat most likely has a struvite bladder stone. This _cannot be determined without a stone analysis,_ but based on the signalment of the patient, the crystalluria, and the radiograph, this is the most likely type. These types of stones typically _form in urine with a high pH_. Therefore, an **acidifying diet would be appropriate for stone dissolution.** Calcium oxalate stones are the most common type of stone to form in acidic urine. For this type, an alkalinizing diet would be the most appropriate. Clavamox would only be indicated if this cat had a urinary tract infection sensitive to this antibiotic. This cat had a negative urine culture. _Metacam_ can be used _short-term to help with pain and inflammation_ associated with the cystitis from this condition but unfortunately Metacam is _no longer recommend for use in cats in the United States_. _Potassium citrate_ is a supplement that can be given in addition to an alkalinizing diet to _prevent the formation of calcium oxalate stones_. This would be _contraindicated_ in this case* .

Answer 42

4. Tooth root abscess correct answer is tooth root abscess. Commonly the _first molar teeth_ are involved. Clinical signs include _weight loss, quidding_ (dropping half chewed feed), _halitosis, swelling,_ and unilateral _purulent nasal discharge_.

Answer 43

5. Bacillary hemoglobinuria Also known as redwater, bacillary hemoglobinuria is caused by germination of **Clostridium Novyi type D** spores in the liver _after anaerobic damage by migrating liver fluke larvae_ (douve). Cl. Novyi was formerly called Cl. hemolyticum. Vaccination can prevent this disease.

Answer 44

4. Fanconi syndrome The correct answer is Fanconi syndrome. Fanconi syndrome is an inherited disease in **Basenjis**. The disease involves renal **tubular defects causing an abnormal loss of electrolytes and solutes** leading to _hypophosphatemia, hypokalemia, and metabolic acidosis_. DM is less likely because serum glucose is normal. The lab abnormalities present in this dog are not consistent with pyelonephritis. Pyometra is not a viable choice as the signalment describes a male.

Answer 45

1. Infectious bronchitis The correct answer is infectious bronchitis. This is caused by a **coronavirus.** It is spread by aerosol and ingestion and usually affects all exposed birds. The clinical signs and necropsy findings are as described in the question. The disease can be _clinically indistinguishable from mild forms of Newcastle disease, laryngotracheitis, and infectious coryza. Virus isolation is needed_ to obtain a definitive diagnosis.

Answer 46

4. Thiopental The correct answer is thiopental. Thiopental is an ultra-short acting **barbiturate.** Recovery depends on redistribution to tissues, including fat. Because sighthounds have very **little fat,** they have _prolonged recoveries and greater complications_ with these drugs.

Answer 47

6. 0.16% You do not need to know anything about the disease in this question in order to get the correct answer. You are told that the disease is **recessive** and has a **carrier rate of 8%** Because the trait is recessive, homozygotes will be the only individuals affected. In order for a foal to be born homozygous for the trait, _BOTH parents MUST be carriers_. The chances of both parents being carriers is _8% x 8%_ (or 0.08 x 0.08) = 0.0064 or _0.64%_. If both parents are carriers, the _offspring has a 1 in 4 chance of inheriting two mutant_ _alleles_ (50% chance for each allele from each parent). Since the chances of both parents being carriers is 0.64% and the chance of having a homozygous offspring in that case is 1 in 4, the overall expected frequency of diseased foals is **0.0064 x 0.25= 0.0016 or 0.16%**.

Answer 48

5. Renal neoplasia The signalment and **progressive unilateral paresis** are most suspicious for renal neoplasia of budgerigars. Affected birds develop paresis due to **pressure exerted on the sciatic nerve by a renal tumor**. There is typically normal flexion and extension of the hip joint _with decreased flexion, extension, and sensation **below the knee**_ as described here. Disc disease is uncommon in birds. Lead toxicity can lead to peripheral neuropathy and paresis but typically there are more multifocal or other accompanying signs such as polyuria/polydipsia, gastrointestinal signs, wing droop, head tilt, or convulsions. Marek's disease typically affects younger animals. Botulism typically presents with flaccid paralysis of the legs, wings, and neck.

Answer 49

5. atipamezole Atipamezole (trade name: _Antisedan_), an **alpha-2 antagonist**, is the reversal agent for medetomidine (trade name: _Dormitor_). Medetomidine is an alpha-2 agonist. _Xylazine_ would be another example of an alpha-2 agonist. _Yohimbine_ is its reversal agent. Other alpha-2 agonists are clonidine, detomidine, dexmedetomidine and romifidine **2-pralidoxime** is a reversal agent for _cholinesterase inhibitors_. **Flumazenil** is a reversal agent for _benzodiazepines_ **Atropine** is a _mAChR antagonist_ and may be _dangerous to use after administration of alpha-2 agonists._ This is because alpha-2 agonists cause marked vasoconstriction and high afterload on the heart. Giving atropine and increasing the heart rate can place further stress on the heart. You do not want to set in motion peripheral vasoconstriction and compensatory bradycardia brought on by the alpha-2, then increase the heart rate against that high afterload. This could make for an unhappy heart in the event underlying subclinical heart disease is present.

Answer 50

4. High Ca, High P ## Footnote *Excessive intake of vitamin D is associated with an increase in 25-hydroxyvitamin D3 levels. At high levels, 25-hydroxyvitamin D3 competes with 1,25-dihydroxyvitamin D3 for its receptors on the intestines and bone causing **increased absorption of Ca and P** from the intestinal tract and **resorption of bone** causing increased levels of circulating Ca and P. A common source of confusion is that this is in contrast to _PTH which causes high Ca_ but generally causes _unchanged or normal phosphorus_ because it _also enhances renal phosphorus_ excretion*

Answer 51

2. Timothy hay ## Footnote *Of these choices, the only feed with **low potassium** is timothy hay. A low potassium diet is the most important nutritional modification in the treatment of HYPP. Regular exercise and feeding smaller, frequent meals can also reduce clinical signs. This disease is _inherited in an autosomal dominant_ fashion, and owners should be discouraged from breeding affected animals.*

Answer 52

4. Laminitis The correct answer is laminitis. Although the specific toxic principle in black walnuts responsible for causing laminitis or acute lameness in horses is _unknown_, evidence suggests juglone (a napthaquinone) plays a role. _Do not use black walnuts for horse bedding_.

Answer 53

4. Metronidazole The correct answer is metronidazole. You should know that **fenbendazole is actually the treatment of choice** for Giardia, but metronidazole has historically been the most widely accepted option. If fenbendazole is not offered as an answer choice, choose metronidazole. If fenbendazole were offered as an answer choice, it would be the best option.

Answer 54

4. Urate The correct answer is urate. Animals with portosystemic shunts are very predisposed to developing urate uroliths due to their **inability to metabolize purines** appropriately.

Answer 55

3. ACTH stimulation test The correct answer is ACTH stimulation test. The chemistry profile above is highly suggestive of **hypoadrenocorticism**. An ACTH stimulation test would give a definitive diagnosis for Addison's disease if the _plasma cortisol concentration is low after ACTH administration_. A bile acids test is not indicated since liver function is not in question. Thoracic radiographs may show microcardia, hypoperfused lungs, and rarely megaesophagus. **ECG** abnormalities would be consistent with hyperkalemia, which includes _wide, flat, or absent P_ waves, _widened QRS_ complexes, _tall spiking T_ waves, and _bradycardia_. (BUN et créatinine sont élevés car perte de Na = perte d'eau = déshydratation pré-rénale (hypoperfusion)

Answer 56

3. Zinc supplementation **Zinc responsive dermatopathy** occurs most frequently in the _Siberian Husky._ Other species such as cattle, goats, and humans have a similar condition. The exact cause is unknown, but it has been linked to _defective intestinal absorption of zinc._ Lesions may vary in severity. The response is typically seen within days. The key to answering this question appropriately was to recognize the signalment of the patient, the location of the lesions which is characteristic of zinc responsive dermatopathy, and the fact that there was _no infectious etiology such as demodex identified._

Answer 57

3. HYPP The correct answer is hyperkalemic periodic paralysis (HYPP). HYPP is seen in **Quarter Horses** due to a **point mutation in a key part of a skeletal muscle sodium channel** subunit *(wiki: The mutation causes single amino acid changes in parts of the channel which are important for inactivation. These mutations _impair "ball and chain" fast inactivation_ of SCN4A (gene codes for a voltage-gated sodium channel Nav1.4) following an action potential).* This results in elevation of the resting membrane potential to increase the likelihood of depolarizing. _Excess concentrations of potassium can result in failure of the sodium channels to inactivate_ (K+ doit sortir des cellules pour que la cellule retourne à son RMP de -70mv, difficile si K+ extracellulaire est trop élevé). Therefore, treatment is directed at decreasing dietary potassium.

Answer 58

5. String foreign body The correct answer is string foreign body. The radiographic description is classic for string foreign bodies. Panleukopenia is not likely because of the radiographic findings, and you would also expect more systemic signs such as respiratory disease and fever. With pancreatitis cats do not vomit as commonly as dogs. They usually show vague nonspecific signs. Hepatic lipidosis would not result in an acute onset of vomiting

Answer 59

5. Hypovitaminosis A The correct answer is hypovitaminosis A. The functions of vitamin A are related to epithelial maintenance, vision, and skeletal development. In birds, problems with the skeleton or vision are rarely seen with vitamin A deficiency. Vitamin A deficiency can manifest as **squamous metaplasia of the oral mucous membranes or glands.** Glands may be entirely _converted to squamous epithelium with keratin_ material and can look like abscesses or pustules but are essentially keratin cysts. They should be differentiated from lesions of pox, Candida, and Trichomonas. Lesions of the conjunctiva, nasolacrimal duct, upper GI tract, and upper respiratory tract can occur. Presenting signs may include _severe dyspnea or respiratory signs_

Answer 60

2. B. melitensis B. melitensis is a severe pathogen in humans, as are B. abortus from cattle, B. suis from pigs and B. canis from dogs.

Answer 61

2. Treat all calves for lice This is a **blood sucking genus of louse**, and can cause severe anemia. The anemic calves become _thin and more susceptible to diseases like pneumonia_. You can tell this is a louse and not a tick or a mite because lice are insects with **6 legs** and ticks and mites are arachnids with 8 legs. The three genera of blood sucking cattle lice are _Solenopotes, Linognathus, and Hematopinus_.

Answer 62

1. Perianal fistula The correct answer is perianal fistula. This is seen mainly in older **German Shepherds**, and **licking the anus** is a common presenting complaint. The key finding is the presence of **multiple draining tracts** in the perianal region that can actually be quite deep.

Answer 63

1. Tritrichomonas foetus, Ronidazole ## Footnote *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**. Paragonimus is a lung fluke. The eggs are typically passed in the feces. Fenbendazole and Praziquantel have been effective against this parasite. Giardia is unlikely if the ELISA is negative as it is a very sensitive test. Taenia is a tapeworm and is not a flagellated parasite. It is treated with Praziquantel. 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. Enterobius vermicularis, or pinworm, is a parasite of people and primates but not cats and dogs.*

Answer 64

4. EDM ## Footnote *The horse in this question has clinical signs most consistent with EDM; cervical vertebral malformation _(wobblers) is also a possibility_, but was not provided as an answer. The cause of EDM is unknown, but this disease _typically affects young horses_ (\< 2-3 years of age; but older horses can develop disease). Clinical signs are a result of **diffuse neuronal fiber degeneration of various portions of the central nervous system**. This disease has been associated with low serum **vitamin E** concentrations, suggesting that oxidative damage may play a role in the development of disease. EMND is typically associated with muscle tremors, shifting of weight while standing, muscle atrophy and recumbency. Botulism is associated with generalized muscle weakness. Cauda equina syndrome causes analgesia of the perineum. EPM can cause a range of clinical signs, but is typically with asymmetric neurologic deficits.*

Answer 65

1. Moxidectin now, in spring ## Footnote *This is a cattle warble called **Hypoderma.** The 2 species are H. bovis and H. lineatum. They undergo a long **migration** in tissues and only **emerge from the back** of the animal in spring. The crucial treatment time is **early fall** when l_arvae are just beginning to migrate_ in tissues. _Organophosphates_ or one of the _macrocyclic lactones_ (ivermectin, doramectin, eprinomectin or moxidectin) are effective.*

Answer 66

1. Topical cyclosporine and a topical steroid The correct answer is topical cyclosporine and a topical steroid. The treatment of KCS is aimed at **reducing immune destruction of the lacrimal glands**. Topical **cyclosporine** (Optimmune) and a topical **steroid** (frequently in a triple antibiotic/steroid ointment) are the treatment of choice. You should be _cautious using steroids_ in acute cases due to the risk of corneal _ulceration._

Answer 67

5. Administer ivermectin **twice** annually, once in the **early summer** and again in the **fall** ## Footnote *This case describes the appearance of the horse **bot fly, Gasterophilus spp.** Gasterophilus is _frequently asymptomatic_ but treatment is recommended because bots can cause _gastritis_ and frequently are a source of annoyance and stress to horses. In addition, the larval instars can cause _stomatitis, and colic_. The key to answering this question regarding optimal treatment and management is an understanding of the Gasterophilus life cycle. Gasterophilus undergoes complete metamorphosis, including three larval instars and only one generation is produced per year. The general _cycle typically begins_ with the female ovipositing 150-1,000 eggs on a horse during the **_early summer_** months directly on single _hairs of the horse's front legs_ (especially around the cannon bone area) as well as the abdomen, flanks, and shoulders. The eggs are approximately 1-2mm long and are pale to grayish yellow attached near the tip of the hair. The eggs develop into _first instar larvae within five days_ and they are stimulated to emerge by the _horse li_cking or biting at the fully developed eggs. The larvae then crawl to the mouth or are ingested and subsequently _bury themselves in the tongue or gingiva and remain for approximately 28 days_. The larvae molt to the _second stage_ and move into the _stomach_. The second and later third stage larvae typically _attach to the lining of the stomach in the non-glandular_ portion _near the junction_ of the esophageal and cardiac regions where they r_emain immobile for the following 9 to 12 months_. The third instar larvae are relatively large, between 1-2cm long with a rounded body, narrow, hooked mouthparts, and spines. The hooked mouthparts enable the larvae to securely attach to the lining of the stomach and intestinal tract. _After the third instar larvae have matured, they detach_ from the gastrointestinal tract and pass from the horse's body in the f_eces._ The larvae burrow into the _soil or dried manure where they pupate and remain for the next one to two months._ This stage of the life cycle occurs _between **late winter and early spring**._ Based on this life cycle, the recommended management protocol is typically to treat with an **avermectin** to control _adults and all larval stages_ by administering in the early summer, shortly after any eggs are seen and again in the fall at the end of the botfly season. Such a control program will substantially reduce fly numbers.*

Answer 68

3. Full body lyme sulfur dip, itraconazole ## Footnote *This cat has a ringworm infection caused by **Microsporum canis**. This fungi f**luoresces** blue under a Wood's lamp in **50%** of cases. The best treatment for ringworm infection would include a **combination topical and oral therapy**. **Lyme sulfur dip** or an _antifungal shampoo containing miconazole_ would be acceptable. _Oral antifungals such as itraconazole or fluconazole_ are most effective with the least side effects. Povidone-iodine scrub has not been shown to be effective against ringworm. Lufenuron is classified as an insect development inhibitor because of its ability to inhibit chitin synthesis, thus in the past has been said to have some effect against fungal infections. This has been debated and not widely supported as a treatment for ringworm. Doxycycline is an antibiotic and would not be effective in treatment of fungal disease. Athlete's foot cream (clotrimazole) may have some effect at treating the lesion. Most over-the-counter creams such as this also include a steroid like betamethasone which would not be desired. Although this lesion appears to be localized to the nasal area, ringworm may also be subclinical and this cat may have infection elsewhere in the skin that is not grossly visible. Therefore, the best therapy is a combination of topical and oral.*

Answer 69

5. Neomycin The correct answer is neomycin. **Aminoglycosides** are one of the most common causes of renal **tubular nephrosis** and acute renal failure. Of the aminoglycosides, _neomycin is probably the most nephrotoxic,_ followed by gentamicin, amikacin, and streptomycin. The other big class of nephrotoxic drugs is non-steroidal anti-inflammatory drugs.

Answer 70

4. Immiticide (melarsomine) ## Footnote *The correct answer is Immiticide (melarsomine). The dog in this radiograph has the classic findings for **heartworm disease**, including _right sided ventricular enlargement_ with very _prominent pulmonary arteries._ Heartworm in the dog is caused by **Dirofilaria immitis**. The treatment of choice for heartworm is **Immiticide** which is given by **intramuscular** injection. _Furosemide_ is a treatment for congestive heart failure, which this dog shows no evidence of. _Terbutaline_ is a bronchodilator, which would be of little use in this case. _Broad-spectrum antibiotics_ are useful for the treatment of pneumonia and other infections but are not effective against heartworm. _Pericardiocentesis_ is obviously the treatment for pericardial effusion, but this dog's radiographs do not show the classic globoid heart you might see with pericardial effusion. _Adulticidal treatments for heartworm_ are **melarsomine** and **thiacetarsamide**.*

Answer 71

The correct answer is 43 days gestation. The fetal skeleton **ossifies at 42-45 days** in the dog and _35-39 in the cat_. In the dog, a mineralized fetus can usually be seen around 42-46 days. The scapula, humerus, and femur can be made out around 46-51 days. The ribs can be seen at 52-59 days. Teeth and toes can be seen at 58-63 days.

Answer 72

1. Treatment is unlikely to be successful and the cow should be culled ## Footnote *This is a case of **Actinomyces bovis or "lumpy jaw"**. The keys to the diagnosis are the firm mass that is immobile over the mandible. The presence of "sulfur granules" in the discharge is also a characteristic finding with this disease. Unfortunately, simply making the diagnosis is not sufficient to answer this question correctly. All of the answer choices are potential treatments for lumpy jaw but this represents a moderate to severe case which is unlikely to respond to treatment due to difficulty in achieving the necessary antibiotic concentration over a sustained period. Therefore, the best answer choice in this case is to cull the cow.*

Answer 73

3. Squamous cell carcinoma (SCC, carcinome des cellules basales)

Answer 74

1. Low potassium ## Footnote *The cat in the image is exhibiting **cervical ventroflexion**, which is a general sign of weakness. The _most common cause for this presentation is hypokalemia (low potassium)_, which can be caused by a variety of reasons (such as _chronic renal failure_). This weakness can also be caused by a number of different problems other than low potassium, including _myasthenia gravis_; _polymyopathies_ caused by toxoplasmosis, _immune-mediated_ disease, or _hyperadrenocorticism;_ and neuropathies caused by _organophosphate poisoning_, _thiamine deficiency_, or _botulism._*

Answer 75

1. Clostridium perfringens type C ## Footnote *The _age_ of these affected pigs along with the _rapid course_ of hemorrhagic and necrotic enteritis help you come to this conclusion. As with many Clostridial diseases, _vaccination_ is the most effective means of control. Other important clostridial diseases of swine include C. perfringens type A, C. difficile, C. tetani, C. botulinum, C. novyi, C. septicum, and C. chauvoei.*

Answer 76

1. Dopamine The correct answer is dopamine. Adrenergic vasopressors are frequently used _to treat hypotension during anesthesia_. Drugs in this category are **dopamine, dobutamine, ephedrine, phenylephrine, and norepinephrine**. _Atropine\* and glycopyrrolate_ are anticholinergic drugs. _Hydralazine_ is a vasodilator used to treat hypertension. *\*Atropine increases the heart rate and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart.*

Answer 77

1. **insecticidal treatment of the environment** and Ornithonyssus sylviarum must be controlled by application of approved **pesticides to affected birds** _Dermanyssus gallinae_ (the common red mite) maintains the majority of the population in the _environment_ so it is important to monitor and treat the environment including the cracks and crevices where mites tend to reside. _Ornithonyssus_ sylviarum mites (northern fowl mites) spend their _entire life cycle on the bird._ This allows them to multiply more rapidly and makes it essential to treat the birds themselves to control the problem.

Answer 78

Hypothyroïdisme ## Footnote *The correct answer is hypothyroidism. The clinical signs, physical exam findings, and lab work abnormalities are classical for hypothyroidism. Other common abnormalities seen with hypothyroidism include pyoderma, neuromuscular signs (ataxia, knuckling, vestibular signs, etc), markedly elevated triglycerides, and a mild normocytic, normochromic anemia. _Hyperthyroidism_ rarely occurs in dogs. You would expect to see polyuria, polydipsia, and polyphagia with _hyperadrenocorticism_.*

Answer 79

3. Prednisone ## Footnote *This is a case of **lymphoma.** The cytology depicts the classic finding of a population of lymphoid cells that are **predominantly lymphoblasts** based on their size and characteristics. If you were unsure about their size due to magnification, there is a neutrophil in the lower left corner for comparison. The lymphoblasts are considerably l**arger than the neutrophil.** Mature lymphocytes would be smaller than a neutrophil. Note that there is a **mitotic figure** in the middle of the slide. There are many treatments and protocols for lymphoma and some of the main agents known to have efficacy are prednisone, doxorubicin, cyclophosphamide, vincristine, L-asparaginase, and lomustine. There are many other efficacious chemotherapeutics for lymphoma but carboplatin is not considered a first line treatment for lymphoma in dogs. The other drugs listed are antifungal (itraconazole), antibiotic (doxycycline) and anti-parasitic (milbemycin).*

Answer 80

1. Blood pressure * The correct answer is blood pressure. **Cats with hyperthyroidism are likely to develop hypertension**. If this is severe enough (\>180-200 mmHg systolic), they can be at **risk for acute retinal detachment or hemorrhage\*** resulting in blindness. Prompt resolution of the hypertension is critical to prevent further damage to the eye and other organs.* \*moi: hypertension = dommages vasculaires

Answer 81

3. Pseudomonas ## Footnote *The correct answer is Pseudomonas. Pseudomonas is the **most common agent causing bacterial keratitis in the horse**. The **gram negative** cytology provides further evidence that it is the likely culprit. _Staphylococcus_ can cause keratitis in horses but is _gram positive_. E. coli and Pasteurella are not agents that are commonly involved with keratitis in the horse.*

Answer 82

1. Auriculopalpébral ## Footnote *The correct answer is auriculopalpebral nerve block. Blocking this **branch of cranial nerve VII** (facial nerve) _disrupts the motor innervation to the orbicularis oculi_, which is the _muscle that closes the eye_. In the horse, this muscle is very strong and can prevent a thorough ocular exam. To perform this block, lidocaine is injected subcutaneously at the c_audal aspect of the zygomatic arch_ where the nerve is palpable. Because this is a motor nerve, the eye will not be able to close as well, but there is no anesthesia of the tissue.*

Answer 83

1. Osteosarcoma The correct answer is osteosarcoma. Chondrosarcoma, fibrosarcoma and hemangiosarcoma can all be primary bone tumors but are much less common in dogs than osteosarcoma.

Answer 84

4. Recipient red blood cells, donor plasma ## Footnote *The correct answer is recipient red blood cells, donor plasma. In a minor crossmatch, you are looking to see if the factors in the plasma of the donor are going to react to the recipient's red blood cells.*

Answer 85

3. Portal systemic shunt The correct answer is a portal-systemic shunt. **Ptyalism** is a sign commonly seen with PSS in _cats but not dogs_, and the **copper-colored iris** is a striking and **almost pathognomonic** finding in conjunction with other clinical findings. _Hemolytic anemia could cause icterus but not the change in iris color._ Animals with polycystic kidney disease would not have a copper-colored iris. Toxoplasma can cause ocular signs such as uveitis but would not have a copper iris.

Answer 86

1. Furosemide and enalapril * The radiograph here shows a severe symmetrical _alveolar pattern in the perihilar region_ extending to the right and left caudal lung lobes. _The heart is tall_ on the lateral view causing _dorsal elevation of the trachea._ This, in conjunction with the physical findings, is compatible with **congestive heart failure (CHF) secondary to mitral valve regurgitation**. The dog also has _hepatic congestion_ evident by enlargement on the radiograph. Treatment for CHF include **diuretics** (furosemide/Lasix, hydrochlorothiazide, spironolactone), **arterial vasodilators** (enalapril, benazepril, amlodipine, hydralazine), **positive inotropes** (pimobendan), and **venodilators** (nitroglycerine). Clavamox and enrofloxacin are antibiotics which could be used to treat pneumonia, but that is not this dog's problem. Immiticide is the treatment for heartworm. Atenolol is a beta blocker and not part of the management of mitral regurgitation or CHF. Atropine or a pacemaker would be indicated for conduction problems.* *moi: MDCVAV chez le chien; ici on débute avec des signes de d'insuffisance du coeur gauche (congestion pulmonaire) mais éventuellement des problèmes de retour veineux / insuffisance du coeur droig*

Answer 87

4. Tyzzer's disease The correct answer is Tyzzer's disease. This is the most likely cause because of the age of the foal and the **acute** nature of the disease. Tyzzer's disease is caused by **Clostridium piliformis**, which causes an **acute necrotizing hepatitis**. It affects only foals from about **1-6 weeks** of age. Theiler's disease is a condition of adult horses. Clostridium novyi is rare in horses and seen much more in sheep and cattle. Herpesvirus can cause hepatitis but is usually seen at or very soon after birth

Answer 88

4 to 8 liters of fresh whole blood IV ## Footnote *In the case of an **acute blood loss** such as this, the most important treatment is **whole blood.** Other s_odium-containing fluids may be beneficial while the blood is being collected_ if this will not result in losing time in getting the whole blood into this cow. In most cases the single blood transfusion results in recovery. After about 24 hours the cow will exhibit melena as the digested blood reaches the rectum.*

Answer 89

1. 60 ml The correct answer is 60 ml. In order to **raise the PCV 1%** you will need to give **1ml/kg** of packed red blood cells. So it takes 6 mls to raise this cat's PCV by 1%. If we are going to increase it by 10% we will need 60ml of packed red blood cells

Answer 90

*Streptococcus suis* The correct answer is Streptococcus suis. Streptococcus suis and H. parasuis both cause **polyarthritis, polyserositis, fever, and pneumonia** in **young** piglets up to several weeks of age. Both can cause **fibrinopurulent** inflammation as well as **meningitis** and convulsions. Erysipelas and M. hyosynoviae typically occur in grower and finisher pigs and do not result in pneumonia. Diamond-shaped skin lesions (thus the name "diamond skin disease") are pathognomonic for Erysipelas. Fusobacterium necrophorum causes lameness via footrot or laminitis.

Answer 91

3. Photosensitization Photosensitization mainly affects **unpigmented skin** where photodynamic agents have accumulated making the skin hyper-reactive to UV light. The cause of this photosensitization can be **primary**, in which case a _plant-derived_ compound (such as hypericum) or chemical is _injected, ingested or topically_ applied, is the cause. Alternatively, the cause can be **secondary** due to _hepatic damage/failure_ where the l_iver fails to remove ingested chlorophyll-breakdown products like phylloerythrin, which accumulates in the skin_ and results in UV damage (sunburn). You need to determine whether this is primary or secondary by c_hecking liver enzymes and bilirubin levels_.

Answer 92

5. Atracurium ## Footnote *The correct answer is atracurium. Atracurium is a non-depolarizing neuromuscular blocker. Other neuromuscular blockers include pancuronium, d-tubocurarine and succinylcholine. Succinylcholine is a depolarizing neuromuscular blocker. _Fentanyl_ is an opioid. _Naloxone_ is an opioid antagonist. _Edrophonium and neostigmine_ are cholinesterase inhibitors used to reverse neuromuscular blockers.*

Answer 93

3. Sheep ## Footnote *MCF virus is **ovine herpes virus-2** (OvHV-2) and is carried by 9**5-99%** of **sheep** in North America which show **no symptoms**. It is also carried by 75% of domestic goats, 40% of muskox, 37% of bighorn sheep, 25% of pronghorn antelope, 62% of mouflon sheep, and by a small percentage of elk, mule deer, and white tailed deer. **Susceptible hosts include cattle,** water buffalo, deer, pigs, and bison; bison are the most susceptible.*

Answer 94

5. Mosquitoe control ## Footnote *The condition described here is the **dry form of avian (fowl) pox**. This is a relatively slow spreading disease that can be spread by contact or by **mosquitoes** that may harbor infective virus for greater than a month. In the **dry form** of the disease, the main sign is raised, whitish _wart-like lesions on unfeathered areas_ (head, legs, vent, etc.). The lesions heal in about 2 weeks. Unthriftiness, decreased egg production and retarded growth may be seen. _Mortality is low_ with this form of the disease. The **wet form** mainly involves the _oral cavity and upper respiratory tract._ Lesions are diphtheritic and can ulcerate or erode mucous membranes. Marked respiratory involvement can lead to _mortality._ A diagnosis is usually based on flock history and presence of these lesions. This is a **pox virus** and there is **no specific effective treatment** but there is a **vaccine**. Disease control is best accomplished by preventive vaccine as sanitation alone will not prevent spread of disease. Several vaccines are available and a single application results in permanent immunity. There are not many tick borne poultry diseases but they may include spirochaetosis and Pasteurella infection. Raising the temperature 5 degrees may be part of the treatment for infectious bronchitis in chickens. Disinfecting pens +/- quarantine is done for quail bronchitis, aspergillosis, and ulcerative enteritis. Antibiotics in the drinking water are most effective for preventing secondary bacterial infections and for mycoplasma but not preventing spread of the virus.*

Answer 95

4. Sarcoptes ## Footnote *The key to this question is that Sarcoptic mange is **extremely pruritic** and can be **transmitted to people**, including this dog's owner. Diagnosis of this disease is usually based on clinical impression and potential for exposure to the mites. A positive skin scraping would be most definitive, but scrapes often come back negative and trial therapy would need to be instituted. _Demodex is not transmittable_ to people and _does not typically cause extreme pruritus_ like Sarcoptes. _Lymphoma and squamous cell carcinoma_ are less likely because they typically would occur in _older animals_ and neither are usually particularly itchy.*

Answer 96

1. Hemangiosarcoma * The correct answer is hemangiosarcoma. Hemangiosarcoma of the heart has a p_redilection for the right auricle_ of dogs, with _Golden Retrievers_ being predisposed. Stabilization of this patient will require _pericardiocentesis;_ prognosis is guarded and may include _chemotherapy,_ _pericardiectomy, or rarely auriculectomy._ Chemodectoma arises from the ascending aorta and heart base; lymphoma is rare in the heart of dogs and is more commonly metastatic than a single mass. Idiopathic pericardial hemorrhage is incorrect because of the clear evidence of a mass.* Note: Hemangiosarcoma (primaire) most commonly affects the spleen and heart of golden retrievers, Labrador retrievers and German shepherds.

Answer 97

1. Ileocolic artery The correct answer is ileocolic artery. The site for colonic resection is limited by **tension on the ileocolic artery when trying to suture your new end of colon to the rectum**. Sometimes the tension is too great and instead of a colocolic anastomosis, an ileocolic anastomosis must be performed. Essentially you are trying to connect a section of ascending colon to the rectum. Now that can be pretty far! Performing an ileocolic anastomosis is not ideal because you eliminate the ileocecal valve, and that may predispose the animal to bacterial overgrowth. The caudal mesenteric artery gives branches to the rectum and descending colon. The left colic artery also feeds the descending colon. The pudendal artery supplies the external genitalia. The **ileocolic artery** provides _blood supply to the ascending and transverse colon_.

Answer 98

2. CK ## Footnote *CK, also called, CPK, is found in muscle cells and is elevated in the serum when muscle damage occurs.*

Answer 99

4. Free gas bloat, failure to eructate This is sometimes called **Type 1 vagal indigestion**, or free gas bloat. It is **frequently associated with swollen mediastinal lymph nodes caused by pneumonia**. The signals to or from dorsal rumen receptors, which detect gas pressure and open the cardia, are compromised such that _eructation does not occur_ normally and free gas bloat occurs. This in turn causes the _calf to feel full and it eats poorly and loses weight_. One needs to _treat the pneumonia_ and perhaps create a temporary _rumen fistula_ to allow the escape of gas until eructation returns to normal.

Answer 100

2. Treat the dog with vitamin K1 for 6 weeks * The **bright green vomit confirms the owner's suspicion of rodenticide** ingestion because _many rat poisons contain a bright green dye_. Dogs that ingest these products may have bright green _vomit or stool._ Brodifacoum is a _vitamin K antagonist commonly used in rodenticides_. Ingestion of this compound _causes hemorrhaging after several days due to a lack of production of new clotting factors_. Treatment for this condition requires **vitamin K1 administration for 4-6 weeks**.* note: hémorragies 3-5 jours post-exposition suite à la déplétion des facteurs de coagulation 2,7,9,10. vitK1 = phylloquinone

Answer 101

20cm H2O Pressures above 20cm H20 may result in barotrauma. In an otherwise healthy patient it is not recommended to exceed this pressure. In patients with chronic atelectasis, anesthetists will be much more apprehensive about over ventilating or ventilating the lungs too quickly, as _acute expansion can trigger re-expansion pulmonary edema, which may then lead to acute respiratory distress syndrome and death_.

Answer 102

3. Hypoglycemia Hypoglycemia secondary to **insulinoma** is the most common cause of seizures in the adult ferret. _Keep in mind, a prolonged seizure can actually cause hypoglycemia, so the finding of low blood glucose in a seizuring ferret does not necessarily confirm a diagnosis of insulinoma_. **Idiopathic epilepsy has not been reported in ferrets**. Hypocalcemia and hepatic encephalopathy can cause seizures, but are not as commonly reported as hypoglycemia.

Answer 103

1. Urinary tract obstruction The correct answer is urinary tract obstruction due to calculi. This should be suspected in all **male** and castrated male goats (and sheep) with **non-specific signs of disease or discomfort** because it is **so common**. Common clinical signs associated with urinary tract obstruction are **vocalization** and **dribbling of urine**. **Heaving or forceful abdominal contractions** may be seen. Hematuria, dysuria, prolonged urination, and apparent abdominal pain are also common signs. The _most important step of evaluation is exteriorization of the penis and **examination of the urethral process**_ because this is the most common site of blockage. In severe cases the entire urethra may be filled with calculi.

Answer 104

4. Anterior uveitits * The correct answer is anterior uveitis. Rubiosis iridis along with other signs such as aqueous flare, hyphema, hypopyon, keratic precipitates, and decreased intraocular pressure are all suggestive of anterior uveitis which can be caused by a number of infectious, immune-mediated, traumatic, and idiopathic causes.* Note: rubiosis iridis: abnormal blood vessels (formed by neovascularization) are found on the surface of the iris

Answer 105

3. Feline Infectious Peritonitis The correct answer is FIP. This poor cat is infected with the dreaded **wet form of feline infectious peritonitis**. If you think about the pathogenesis of the virus, then these clinical signs make a lot of sense. With FIP, the classical lesion is _pyogranulomatous vasculitis_ due to _antigen-antibody complexes depositing in the venular endothelium_, which results in _pleural and peritoneal effusion_. The CBC findings are common for FIP but not too specific. In greater than 50% of cats with the wet form of FIP, there will be hyperproteinemia. In greater than 70% of cats with the dry form of FIP there is hyperproteinemia.

Answer 106

4. Melanoma The correct answer is melanoma. Melanoma is one of the most _common_ tumors in horses (about 10% of all neoplasms) and _gray horses_ are at high risk of around 80%. They can occur anywhere but appear _most frequently in the perineal region or ventral tail_ as is evident in this horse. In horses, they are usually _darkly_ pigmented (as opposed to dogs where amelanotic melanomas occur somewhat commonly). In horses, most are _slowly growing_ but can be _locally invasive_. Many treatments are out there, but there is no standard of care treatment. Depending on location and extent, consider surgical removal, benign neglect, chemotherapy (systemic or intralesional) and immunotherapy.

Answer 107

1. IV fluids with added sodium bicarbonate This calf is typical of those suffering from **nonspecific calf diarrhea**, most often associated with _enteropathogenic E coli, rotavirus, or cryptosporidium_. The calf develops **hypovolemia and metabolic acidosis** and requires **_sodium-containing IV fluids which contain additional alkali such as sodium bicarbonate_**. One can assess that the calf is **severely acidotic** given that it is _lethargic_ and _unable to stand_. While oral fluids may also be useful, _at this stage, the calf will require **IV**_ fluids.

Answer 108

The correct answer is Cushing's disease. The coat condition described is what horses with glucocorticoid excess develop; it is referred to as **hirsutism**. They will also be predisposed to infections including **laminitis** and **skin diseases such as Dermatophilus**. They are also frequently _polyuric, polydipsic, and polyphagic._

Answer 109

4. Tensilon response test The correct answer is a **Tensilon (edrophonium)** response test. Hopefully, you were able to identify the _mass in the cranial mediastinum_ on the chest radiograph, as this was one of the keys to this case. This, in conjunction with the dog's other signs, are suggestive that this dog has a **thymoma and associated secondary myasthenia gravis**. Tensilon (edrophonium) is a rapidly acting _anticholinesterase_ that _reverses signs of myasthenia_ within minutes in most dogs. A chest CT would be a valid test to confirm the presence of the mediastinal mass and might be an appropriate test before surgery but would not bring you closer to a diagnosis if you already have identified the mass. An MRI of the brain would assess a CNS cause of the dog's signs, which are unlikely, given the other findings. Similarly, a myelogram would assess if a spinal cord lesion caused the dog's signs, but the rest of the findings in this case should point you in a different direction.

Answer 110

Erysipelas is susceptible to **penicillins**, as well as tetracyclines (usually), lincomycin and tylosin. Chloramphenicol and nitroimidazoles (including metronidazole) are not approved for food animal use.

Answer 111

1. Hardbag ## Footnote *CAEV is a retrovirus and **when it affects the udder** it will cause **fibrosis** and result in a **firm udder with agalactia**. _Treatment is ineffective_ and the goat should be culled. The disease is usually subclinical but can cause arthritis in adults and encephalitis in kids.*