VetPrep NAVLE Flashcards
An 8-year old Thoroughbred gelding was presented for acute onset of trembling, excessive recumbency, constant shifting of body weight while standing, and muscle atrophy. The horse is housed in a dry lot with no pasture availability. Diet consists of moderate quality grass hay and sweet feed. The CBC is normal with abnormalities on biochemistry analysis including mild elevation in creatine kinase (CK) and aspartate aminotransferase (AST). Cerebrospinal fluid (CSF) analysis shows no remarkable findings. Based on this information, what disease process do you suspect?
Equine Herpes Myeloencephalopathy (EHV-1)
Equine Motor Neuron Disease (EMND)
Equine Protozoal Myeloencephalitis (EPM, Sarcocystis neurona)
Verminous encephalomyelitis (Halicephalobus deletrix)
Cervical Vertebral Malformation (Wobbler Syndrome)
Answer: Equine Motor Neuron Disease (EMND)
The correct answer is EMND. This is a neurologic disease associated with dietary vitamin E deficiency which is believed to contribute to oxidative damage to the CNS. However, the precise pathophysiology is unknown.
Retrospective studies have noted that horses with EMND are commonly housed on dry lots with little to no availability to pasture or good quality hay (perhaps contributing to low blood vitamin E concentrations). The clinical signs in this question are classic for EMND whereas horses afflicted with the other options do not typically demonstrate trembling or shifting of body weight.
Dr. Jones is examining Snuggles, an 8-year-old male castrated Domestic Shorthair cat. Snuggles’ owner is Anna, who is a physician. Anna noted that Snuggles wasn’t eating well two days ago. Today Snuggles began vocalizing in the litterbox. Snuggles lives with two other cats, so Anna is not sure whether he is urinating successfully. On palpation of the abdomen, Dr. Jones feels a large, turgid urinary bladder. Which of the following is the most appropriate way for Dr. Jones to begin a discussion about urethral obstruction in cats?
- Do you already know about urethral obstruction in cats?
- Most clients aren’t familiar with urethral obstruction in cats.
- I’m sure you know all about urethral obstruction in cats.
- How familiar are you with urethral obstruction in cats?
Answer: How familiar are you with urethral obstruction in cats?
Use of a question to gauge the client’s current knowledge base is recommended. This option does not suggest an assumption of the client’s level of knowledge. This option is posed as an open question, which maximizes the amount of information that the client is likely to share. The use of open-ended questions is encouraged to improve client communication. Open-ended questions allow the client to provide a comprehensive answer, which gives the most information to the medical team. Additionally, this option does not lead the client toward a particular answer. Questions beginning with “do” are closed questions, or questions for which there is only one answer (yes or no).
Closed questions limit the information the client is being invited to provide. Both statement options assume the level of knowledge the client possesses and should therefore be avoided.
Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 14 and 31-33.
A cat is having a dental procedure and you notice some debris in the ears. You flush the ear canals gently and clean away the debris. Upon recovery from anesthesia, you notice the cat has a protrusion of the right nictitating membrane and the right pupil is miotic. The left eye appears normal. What is the most likely cause of these clinical symptoms?
- Trauma to spinal cord between T1-T4 while under anesthesia
- Vascular accident from anesthesia induced hypertension
- Rupture of tympanic membrane
- Inner ear polyp
Answer: Rupture of tympanic membrane
Horner’s syndrome occurs from a disruption of the sympathetic innervation to the eye. In addition to the clinical signs mentioned, a droopy upper eyelid, enophthalmos, nystagmus, and sometimes a head tilt can occur. Because this cat was normal before the procedure, the likely cause of the Horner’s syndrome is a tympanic membrane (eardrum) rupture or trauma that occurred during the ear flush. This is because the sympathetic innervation to the eye runs through the middle ear. An inner ear polyp could also cause this syndrome; however, because it came on acutely after an ear flush, a ruptured ear drum is most likely.
Anesthesia typically causes hypotension, not hypertension, so a vascular accident is very unlikely to occur in a young healthy cat.
A spinal cord lesion at 11-14 could also cause this syndrome due to the sympathetic preganglionic cell bodies located in this area, but a significant trauma would have to occur for this to result in Horner’s syndrome, and it is less likely in this anesthetized cat.
You go to a dairy which is having trouble with sudden death in calves and decreased reproductive efficiency in cows. Which plant toxin should you have on your differential list?
- Tansy ragwort
- Moldy sweet clover
- Larkspur
- St John’s-wort
- Gossypol
Answer: Gossypol
The correct answer is gossypol (found in cotton seed in varying amounts) toxicity.
Gossypol is a cardiotoxin and can kill calves less than 4 months of age. In adults, if fed at high levels, it usually causes sterility in bulls and decreased conception in cows.
Moldy sweet clover inhibits vitamin K and causes a coagulopathy.
St. John’s-wort contains hypericin and results in photosensitivity.
Tansy ragwort is a pyrrolizidine alkaloid and causes liver disease.
Larkspur causes general nonspecific signs such as salivation, bloat, muscle fasciculation, collapse, staggering, and death.
You are doing a summer externship in South America and performing physical exams on a variety of animals. You are performing a fundic exam on the eye of a horse and note what appears to be a worm migrating through the conjunctiva. Because of the location and appearance of this parasite, you suspect this is which of the following?
Answer: 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: 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: Yellow star thistle.
Yellow star thistle is Centaurea solstitialis. In some horses which ingest large quantities, it can cause nigropallidal encephalomalacia, which is loss of the globus pallidus and substantia nigra, and extrapyramidal nuclei, which control muscles of prehension. Loss of these nuclei causes tremors and dystonia of the lip muscles and tongue.
Centaurea repens (Russian knapweed) can also cause similar lesions.
When formulating late gestation anionic diets for dairy cows to help prevent hypocalcemia in the last 2 to 3 weeks prior to calving, what formula is used?
- DCAD = (Na - Cl) + (K - S)
- DCAD = (Na - K) + (P - S)
- DCAD = (Na + S) - (K + Cl)
- DCAD = (Na + K) - (Cl + S)
- DCAD = (Na + Cl) - (K + S)
Answer: DCAD = (Na + K) - (Cl + S)
DCAD stands for Dietary Cation Anion Difference. Na=sodium, K=potassium, Cl=chloride, and S=sulfur. These are the 4 most important strong ions to be considered. When the diet is optimal the urine pH of Holstein cows should range between 6.2 and 6.8 for cows on the ration.
Which of the following is true about porcine reproductive and respiratory syndrome (PRRS)?
- Treatment of the herd involves prolonged, aggressive antibiotic therapy added to the food
- Infected boars may be infertile due to poor sperm quality
- Clinical signs are seen only in pigs at breeding age
- The disease is caused by a herpes virus
Answer: Infected boars may be infertile due to poor sperm quality
The correct answer is infected boars may be infertile due to poor sperm quality. PRRS is caused by an arterivirus and affects pigs of all ages. Affected neonatal pigs experience diarrhea and recurrent fevers. Weaned pigs may become anorexic, develop a cough, dyspnea (or “thumps”), and purple ear tips and tails due to vasculitis.
Gestating sows have reproductive failure in the form of abortions, mummies, and early embryonic death. Boars may be infertile due to interference with spermatogenesis. Treatment of a herd may involve depopulating the herd, or closing the herd for several months and following titers.
A 10-year old male castrated schnauzer presents laterally recumbent and minimally responsive. The owners just returned from vacation and his pet sitter noted he seemed normal yesterday. His temperature is 97 F (36.1 C), heart rate is 50 beats per minute (normal 60-160 beats per minute), and respiratory rate is 50 breaths per minute (normal 10-30 breaths per minute). You determine he is approximately 8% dehydrated based on skin turgor. Systolic blood pressure is 80 mmHg (normal 100-140 mmHg). He groans when his abdomen is palpated. You find a small pocket of ascites on a brief ultrasound exam. Cytology of the fluid shows a moderate amount of neutrophils with no obvious bacteria. An in-house chemistry panel is within normal limits (glucose 145, sodium 145, potassium 4.10, lactate 0.8). The ascites glucose is 100 and lactate is 2.8. What is your recommendation to the owners?
Start active warming and give a dose of atropine
Crystalloid fluid therapy and antibiotics
Surgical exploratory laparotomy
Colloid fluid therapy and antibiotics
Anwer: Surgical exploratory laparotomy
This dog has a septic abdomen and requires surgical intervention. Sepsis is suspected if the glucose in the ascites is at least 20mg/dL less than the peripheral blood. A blood lactate level of 2.0mmol/L lower than the ascites lactate level is also highly suggestive of a septic abdomen. The presence of intracellular bacteria would also be diagnostic for a septic abdomen. The hypotension, bradycardia, and hypothermia can be attributed to the sepsis as well. An abdominal ultrasound may help to determine the source. Rehydration and antibiotics are necessary components of treatment but ultimately surgical exploration is necessary.
You diagnose this 15-year old mare in the picture with a mild, acute laminitis. Which of the following can be used as treatment for this horse?
- Phenoxybenzamine
- Prednisone
- Application of horse shoes
- Trimethoprim sulfa
Answer: Phenoxybenzamine
The correct answer is phenoxybenzamine.
Phenoxybenzamine is an alpha-adrenergic antagonist promoting vasodilation and restoration of blood flow to the digits. Prednisone is contraindicated in laminitis because corticosteroids are believed to induce the condition. Antibiotics are not indicated unless a secondary bacterial infection develops. Application of a horse shoe would not help and would be very painful in an already sensitive and painful condition. Other medications used to restore blood flow to the digits include acepromazine, isoxsuprine hydrochloride, dimethylsulfoxide (DMSO), heparin, and nitroglycerine.
Every time an owner shears his sheep, 10% develop large abscesses in their lymph nodes several weeks or even months after shearing. What should the owner do to control/prevent this problem the next time he shears his sheep?
Disinfect shears before shearing and between shearing sheep
Pretreat all animals by dipping in a solution of dilute Betadine (an aqueous iodine compound) in a dip tank
To eliminate carriers of the disease from the flock, treat all affected animals with long acting tetracycline when you lance the abscesses later
Develop a closed flock in which all replacements come from within the flock
Answer: Disinfect shears before shearing and between shearing sheep
The correct answer is to disinfect shears before beginning and between shearing sheep. The sheep are most likely being infected with caseous lymphadenitis (also commonly called boils) which is caused by Corynebacterium pseudotuberculosis. This organism is highly contagious and commonly transmitted at shearing when nicks and cuts occur. When you lance these abscesses, make sure to clean up the area thoroughly and decontaminate everything to avoid spreading the disease.The rancher should also consider vaccination against caseous lymphadenitis.Dipping in Betadine would be prohibitively expensive and likely to stain the wool and be ineffective. Neither other choice is useful in controlling caseous lymphadenitis.
You are called to a small goat dairy to examine three ill does, which are in the final stages of late pregnancy, have stopped eating, and appear to be weak. One has actually died just before you arrived, and you perform a post mortem exam on her. You are amazed to find 5 dead near-term fetuses inside, as well as a pale fatty liver (see photo). Based on this and the appearance of the others, you check their urine and find ketones. What is your diagnosis?
Hypocalcemia
Gossypol toxicity
Hypomagnesemia
Pregnancy toxemia
Hepatotoxicity
Answer: Pregnancy toxemia.
Multiple fetuses can become a space-occupying lesion, making the rumen more difficult to fill, just as the doe requires maximum caloric intake. As she tips over into negative energy balance, utilizes her omental fat stores and develops a fatty liver, she becomes keto-acidotic and develops pregnancy toxemia. To be saved, the other affected animals must have IV glucose and an immediate C section, followed by excellent nutritional support.
They may also need calcium, magnesium and other electrolytes.
Which of these drugs is a neuromuscular blocker when given to a dog?
Naloxone
Neostigmine
Atracurium
Edrophonium
Fentanyl
Answer: Atracurium.
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.
What species is the principle carrier and vector of Malignant Catarrhal Fever (MCF) virus in North America?
Bison
Horse
Cattle
Sheep
Donkey
Answer: Sheep.
MCF virus is ovine herpes virus-2 (OvHV-2) and is carried by 95-99% 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.
What is the primary mode of transmission of West Nile Virus (WNV) between birds?
- Via feces
- Via placenta
- Via mosquitoes
- Via Cnemidocoptes mites
- Via saliva
Answer: via mosquitoes.
Mosquito vectors are the primary mode of transmission for WNV between birds and other hosts (horses, humans). There are infrequent documented cases of the disease being spread by feces or saliva. No mites have been documented to transmit the disease. Birds do not have a placenta.
A backyard hen presents with a history of being previously active followed by sudden death with no premonitory signs. Gross examination reveals an obese hen with pale, friable liver and broad blood clots attached to the liver capsule and extending into the abdomen. There is no evidence of external trauma. The most likely diagnosis is:
Vitamin K deficiency
Histomonas meleagridis infection
Vitamin E deficiency
Larval ascarid migration
Fatty liver/hemorrhagic syndrome
Answer: Fatty liver/hemorrhagic syndrome
Excess lipid accumulation in liver of hens can promote fractures and fatal hepatic hemorrhage.
Which of the following is the causative agent of fowl cholera?
- Mycoplasma gallisepticum
- Chlamydophila psittaci
- Reticuloendotheliosis virus
- Pasteurella multocida
Answer: Pasteurella multocida
The correct answer is Pasteurella multocida.
The bacterium is a gram negative rod. It causes fever, mucoid discharge from the mouth, diarrhea, petechia, ecchymoses, increased pericardial and peritoneal fluid, and death. The chronic form of the disease usually causes localized disease. Diagnosis is based on identifying the organism from samples in conjunction with clinical signs. Vaccines are available for prevention of the disease. Sulfa antibiotics are used for treatment.
A 2-year old MN DSH has recently been treated for a urethral obstruction. He went home last week from the hospital on an acidifying canned diet for this condition.
The owner reports he is passing urine in moderate amounts, but he is still straining frequently. You reexamine the cat and find that the bladder is empty on palpation and the wall feels a little thickened. You are confident that the cat has not re-blocked and the cat’s bloodwork shows normal electrolytes and renal values.
Which of the following medications may help the cat with this problem?
- Amitriptyline
- Phenoxybenzamine
- Phenylpropanolamine
- Methocarbamol
- Prednisolone
Answer: Phenoxybenzamine
This cat is likely suffering from hypertonicity of urethral muscle, which was incited from the recent obstruction and urinary catheter. This can cause spasms, which makes urinating painful and not easily controlled.
Phenoxybenzamine can be used in this case to reduce internal urethral sphincter tone such that the cat may urinate more easily.
Methocarbamol is a muscle relaxant but would not directly help spasms of the urethra.
Prednisolone is not used to help reduce inflammation or spasms in the urethra and may predispose the cat to contracting a urinary infection, especially while his bladder and urethra are compromised.
Phenylpropanolamine is used to treat urinary incontinence from urethral hypotonicity most often in dogs and would be contraindicated in this case.
Amitriptyline is an anti-depressant medication that has been implicated as part of a treatment plan for cats with cystitis, although benefit has never been proven. Because cats with cystitis can flare up during times of stress, the amitriyptyline has been thought to help prevent this. This medication would not work to stop spasms in the urethra.
Which of the following swine pathogens is known to attach to and disrupt the pulmonary mucociliary apparatus?
- Mycoplasma hypneumoniae
- Salmonella choleraesuis
- Porcine reproductive and respiratory syndrome virus (PRRSv)
- Actinobacillus pleuropneumoniae
- Porcine circovirus type 2 (PCV2)
Answer: Mycoplasma hyopneumoniae
The correct answer is Mycoplasma hyopneumoniae. The bacteria attach to the pulmonary mucociliary apparatus and thus prevent it from functioning properly. This in turn makes the lungs much more susceptible to other bacterial infections.
Which of these inhalant anesthetics has the fastest onset of action in the dog?
Desflurane
Isoflurane
Diethyl ether
Halothane
Answer: Desflurane
The correct answer is desflurane. Speed of action of inhalant anesthetics is most directly related to blood-gas solubility. There is an inverse relationship between rapidity of action and the anesthetic’s solubility in the blood, meaning the lower an inhalant’s solubility, the faster its onset of action. This is expressed as the bloodigas partition coefficient. Desflurane has the lowest bloodigas partition coefficient and therefore, has the fastest time of action. In order from fastest to slowest, the inhalants are (desflurane, NO, sevoflurane, isoflurane, enflurane, halothane, diethyl ether, methoxyflurane).
A 1-year old male neutered Siamese presents to you with the clinical signs seen in the image. He is an indoor only cat and the owners recently adopted an 8 week old kitten that he is in contact with. His clinical signs were initially mild and unilateral but progressed to these findings three days later. What are the two most likely pathogens affecting this cat and what is the treatment of choice?
- Feline Calicivirus and Feline Leukemia Virus, topical trifluridine
- Chlamydophilia felis and Cornybacterium
Spp., topical prenisone acetate - Feline Calicivirus and Chlamydophilia felis, oral clavamox
- Feline Herpesvirus-1 and Chlamydophila felis, topical tetracycline
- Mycoplasma felis and Feline Calicivirus, oral amoxicillin
Answer: Feline Herpesvirus-1 and Chlamydophila felis, topical tetracycline
The most common cause of bacterial conjunctivitis in feline patients is Chlamydophila felis. This disease cannot be distinguished from feline Herpesvirus-1 based on clinical appearance alone.
Frequently, feline patients with these symptoms are infected with both of these diseases simultaneously. Diagnosis of Chlamydophila felis is made by visualizing typical elementary bodies in the cytoplasm of conjunctival epithelial cells or obtaining a positive fluorescent antibody (FA) test on a conjunctival scraping. The treatment of Chlamydophila felis is topical tetracycline QID for one week post resolution of clinical signs.
A 10-year-old female spayed DSH presents for dropping food and drooling from the left side. She has no history of trauma but recently has had thick ocular discharge which the owner has had to clean regularly. You perform a neurologic exam and find the following (see image).
The rest of the exam is within normal limits. What do you inform the owner?
- The recommended treatment is a ventral bulla osteotomy
- The cause is most likely idiopathic and carries a good prognosis
- Treatment involves corticosteroid
administration but prognosis for recovery is still guarded - The other side may start to show the same signs within a few weeks to months
Answer: The other side may start to show the same signs within a few weeks to months
This patient has the classic finding associated with unilateral facial nerve paresis.
Unfortunately, it is most commonly idiopathic; however in cats it can sometimes be caused by things such as nasopharyngeal polyps, neoplasia and trauma.
Prognosis for recovery is guarded and the clinical signs are typically permanent. The unaffected facial nerve can become affected as well.
Treatment for idiopathic disease is supportive including eye lubrication and management of corneal ulcers. Drooling usually resolves over several weeks. Steroids have been used in humans with Bell’s palsy but it has not been shown to be effective in animals.
Otitis media-interna and chronic ear disease can make animals at higher risk for nerve paralysis and a CT of the bulla is recommended rather than radiographs. Bulla osteotomy may be
recommended for animals with middle ear disease or those prone to chronic otitis media-interna. In dogs, facial paralysis has been seen with hypothyroidism.
A client brings in her dog that recently ingested rodenticide. You check the box and see that the active ingredient is cholecalciferol. The dog appears clinically normal right now. What would you be concerned might happen if you do nothing at this time?
- Development of organ mineralization
- Development of coagulopathy
- Development of liver failure
- Development of intestinal perforation
- Development of neurologic signs
Answer: Development of organ mineralization
Explanation
The correct answer is development of tissue mineralization. Cholecalciferol (Vitamin D3) acts by becoming converted to calcitriol and increases calcium and phosphorus levels leading to mineralization of organs, especially the kidneys.
A 10 year old female spayed Dachshund presents for further evaluation of progressive lameness in the hind.
The owner notes that she has begun intermittently scuffing her hind limbs, has somewhat of a weak or drunken gait in the hind as she walks, and is having trouble rising. Given the answer choices below, what is the best treatment?
- Femoral head ostectomy
- Total hip replacement bilaterally
- Prolonged antibiotic therapy with clindamycin
- Dorsal laminectomy
Answer: Dorsal laminectomy
Explanation
This patient’s clinical signs are consistent with neurological deficits. Although you do not have all of the information necessary to reach a definitive diagnosis, you should have been able to deduce that this patient probably needs a dorsal laminectomy to relieve disc compression.
In order to definitively diagnose the condition you would want to proceed with a complete exam, basic bloodwork, and a CT or MRI of the lumbosacral region. Although this patient does exhibit evidence of hip dysplasia radiographically, the clinical signs are not characteristic of a dog with pain secondary to hip dysplasia. There is no indication of osteomyelitis on these radiographs and the clinical signs are not necessarily suggestive of osteomyelitis.
It is important not to skip ahead to image interpretation without carefully reading the question. Doing so in this case would likely lead you to select the incorrect answer.
Radiographs provided by Adrien Hesperian, DVM, MS, DACVR and University of Tennessee College of Veterinary Medicine
A cat with a Cryptococcus infection and liver failure should not be treated with ketoconazole for which of the following reasons?
- It causes hypoadrenocorticism in cats
- It is nephrotoxic to cats
- diarrhea in cats
- It is hepatotoxic and causes vomiting
- It is not effective in treating Cryptococcus
Answer: It is hepatotoxic and causes vomiting
Explanation
The correct answer is it is hepatotoxic and causes vomiting and diarrhea in cats.
Ketoconazole is an azole antifungal. It is effective against Cryptococcus, but it causes severe Gl upset and anorexia, particularly in cats. It is also hepatotoxic, making it a poor choice for the cat described in the question.
What is the primary goal in the initial treatment of diabetic ketoacidotic dogs?
- Getting the animal to eat
- Controlling obesity or concurrent disorders causing insulin resistance
- Lowering the elevated blood glucose
- Correction of acidosis, electrolyte abnormalities, and hyperosmolality
Answer: Correction of acidosis, electrolyte abnormalities, and hyperosmolality
The correct answer is correction of acidosis, electrolyte abnormalities, and hyperosmolality.
Initial treatment of DKA patients is aimed at correcting acidosis by administering bicarbonate (if the total bicarbonate is markedly low), correcting electrolyte abnormalities with IV fluids, potassium and phosphorus supplementation, and correction of hyperosmolality. Regulating blood glucose, getting the animal to eat, controlling obesity and concurrent disease should be addressed after immediate life-threatening issues are resolved.
A dog presents to you after being struck in the head with a baseball bat. The dog is obtunded, but the rest of the physical exam is normal. Which of the following factors should you try to achieve in this patient to minimize intracranial pressure?
- High Pa02
- Low mean arterial pressure
- High PaCO2
- High cerebral metabolic rate
Answer: High Pa02
Explanation
The correct answer is high PaO2.
PaCO2, blood pressure, PaO2, cerebral metabolism, and certain drugs can affect cerebral blood volume and intracranial pressure. In head trauma patients, you want to prevent an increase in intracranial pressure by keeping cerebral blood flow relatively low without causing hypoxia. To keep cerebral blood flow in the low-normal range, the cerebral metabolic rate and PaCO2 should be kept low.
Factors that would cause the cerebral metabolic rate to go up include fever, seizures, pain, etc.
Mean arterial pressure should be maintained in the normal range to prevent hypotension, hypoxia, and cerebral ischemia.
You have a 6-year old female spayed Golden Retriever patient with inappetence and vomiting. You diagnose diabetic ketoacidosis based on a blood glucose of 641 mg/dL (76-119 mg/dL), 3+ glucose (normal- negative) and 3+ ketones (normal- negative) in the urine, and blood pH of 7.12 (7.35-7.45). You would like to treat with the shortest acting, most potent insulin type. Which of the following would you choose?
- Ultralente
- NPH
- PZI
- Regular
- Lente
Answer: Regular.
Listed from shortest acting and most potent to longest acting and least potent: Regular, NPH, Lente, PZI, Ultralente. The treatment of DKA involves IV fluids and regular insulin, given either by CRI or the intermittent IM dosing technique.
Regular insulin is continued until the patient is eating well and is hydrated, and can be switched to a longer-acting insulin, to be given SQ at home.
Dr. Jones has just read a new study regarding anthelmintic use in puppies. The study suggests that the practice should change its standard operating procedure regarding fecal parasite testing and anthelmintic administration schedules for puppies. The current intestinal parasite management protocol for puppies has been in place for over a decade, and Dr.Jones recognizes that he is likely to encounter resistance to the necessary changes. Dr. Jones’ staff consists of one Licensed Veterinary Technician and four unlicensed Veterinary Assistants. Which of the following options is the most appropriate method for sharing the results of the study with the veterinary staff?
Create a presentation for the staff which focuses on the descriptive statistics and discussion portions of the study.
Prepare a brief presentation for the staff, create visual aids, and provide an informal written summary of the study.
Instruct the staff members to read the study, tell the staff to come to you with any questions, and give the staff a test on the material.
Give the staff members a copy of the study and have the staff prepare a presentation on the findings.
Answer: Prepare a brief presentation for the staff, create visual aids, and provide an informal written summary of the study
Explanation
Using a combination of communication formats - verbal, visual and written - to explain concepts is ideal.
Informal language should be used to communicate with lay staff. Highly technical terminology should be avoided. While having the staff read the study independently might sound ideal, some individuals do not possess the knowledge of statistics and medical terminology required to fully understand a study. Requiring staff to take test or create a presentation on unfamiliar material might create anxiety. While creating a presentation for the staff is a good idea, focusing on the descriptive statistics is not recommended. Highly technical or advanced terminology should be avoided.
Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 127-148.
The most appropriate method for Dr. Jones to share the study results with the veterinary staff is to prepare a brief presentation, create visual aids, and provide an informal written summary of the study. This approach combines verbal, visual, and written communication, ensuring the information is accessible without overwhelming the staff with technical details. Avoiding highly technical terminology and using informal language will help in effectively conveying the necessary changes to the team.
A new client has presented a ten-year-old female spayed domestic shorthair cat for evaluation. The client reports that the patient has been losing weight and urinating outside of her litterbox for the past six months. The patient had been eating well until three days ago, when she stopped eating and began vomiting. Physical examination reveals that the patient is emaciated and severely dehydrated. A glucometer reading shows that the blood glucose is too high to register. The client reports that they do not have the financial resources for further testing or treatment of a major illness, and they wish to proceed with humane euthanasia. What is the most appropriate next step?
- Escort the client and patient to a quiet, comfortable space prior to humane euthanasia.
- Discuss options for handling the patient’s remains prior to humane euthanasia.
- Confirm client ownership of the patient prior to humane euthanasia.
- Obtain verbal consent from the client prior to humane euthanasia.
Answer: Confirm client ownership of the patient prior to humane euthanasia
Explanation
Confirming client ownership of the patient is the most appropriate next step since the client and patient are not previously known to the clinic/ veterinarian. While obtaining client consent is important prior to humane euthanasia, verbal consent is less appropriate than written consent when the client and patient are not previously known to the clinic/veterinarian. Discussing options for handling the patient’s remains and escorting the client to a comfortable, quiet area are important prior to humane euthanasia, however confirming client ownership should be completed first.
Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 55-56.
The most appropriate next step is to confirm client ownership of the patient before proceeding with humane euthanasia, especially since the client and patient are new to the clinic. While obtaining written consent and discussing options for the patient’s remains are important, verifying ownership should be prioritized to ensure proper and ethical procedures are followed.
Annabelle is a twelve-year-old Labrador Retriever with progressive hindlimb pain and weakness. The pet is unable to stand without assistance and walks with a stiff gait when assisted to a standing position. The owner does not wish to pursue additional testing or treatment. Today a euthanasia appointment was scheduled by the owner. However, upon arrival the owner expresses doubt about whether euthanasia is the right thing to do. Which is the most appropriate response to the owner’s concerns?
- Explain that feeling doubt regarding a euthanasia decision is unusual and indicates that the owner is not yet ready to make a decision regarding euthanasia.
- Assure the owner that feeling doubt regarding a euthanasia decision is normal and encourage the client to complete a quality-of-life score for the patient.
- Discuss the reasons that the owner is experiencing doubt about a euthanasia decision and assure the owner that euthanasia is the best choice.
- Tell the owner that feeling doubt regarding a euthanasia decision is natural and list the reasons why euthanasia is your best recommendation.
Answer: Assure the owner that feeling doubt regarding a euthanasia decision is normal and encourage the client to complete a quality-of-life score for the patient.
Explanation
Doubt is a normal part of the emotional response to considering humane euthanasia. Reviewing quality of life indicators can help clients feel more confident and experience less doubt regarding euthanasia decisions. Feeling doubt surrounding humane euthanasia is normal. When doubt is encountered, encouraging the owner to evaluate their own feelings surrounding euthanasia is preferred. While providing a clinical opinion about the appropriateness of humane euthanasia is helpful, the veterinarian should avoid pressuring the owner into performing humane euthanasia.
Encouraging a dialogue with the owner regarding the pet’s quality of life is more helpful in managing client doubts than listing clinical evidence in support of euthanasia.
Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 69-72.
The most appropriate response is to assure the owner that feeling doubt about a euthanasia decision is normal and encourage the client to complete a quality-of-life score for the patient. Doubt is a common emotional response, and reviewing quality of life indicators can help the owner make a more confident decision without feeling pressured. Engaging in a dialogue about the pet’s quality of life is more supportive than listing clinical reasons for euthanasia.
Dr. Santos diagnoses a patient with an emerging disease. There has been some speculation in the veterinary community that Substance A might be useful for treating this new disease. Dr. Santos treats the patient with Substance A, and the patient makes a full recovery. Dr. Santos is excited about Substance A and wants to let the veterinary community know about the case’s success. She decides to write a case report for publication in a major veterinary journal. Which of the following statements most accurately describes the scientific usefulness of the case report?
- The results are as scientifically useful as those from a controlled clinical trial.
- The results generate a hypothesis which can be tested in further studies.
- The results confirm the hypothesis that Substance A is an effective treatment.
- The results show that Substance A caused improvement in the patient’s symptoms.
Answer: The results generate a hypothesis which can be tested in further studies
Explanation
The purpose of a case study is to generate a hypothesis. Case studies cannot be used to test a hypothesis. Further research is needed to test the hypothesis that Substance A has a clinical benefit.
Case studies carry less strength of evidence than clinical trials. Case reports are not used to test hypotheses. A hypothesis may be generated in a case report, but it cannot be confirmed without further study. A cause-and-effect relationship cannot be established in a case report because there is no control group.
Source: (1) Reviewing the Evidence: How to be a discriminating Reader. Litster, A. L. American College of Veterinary Internal Medicine
(2) Conference Proceedings, 2017. (2) Guideline on writing a case report. Alsaywid, B. S. and Abdulhaq,
N. M. Urology annals, 2019, 11(2), pages 126-131.
Case reports are valuable for generating hypotheses, but they cannot test or confirm a hypothesis on their own. They provide preliminary observations that need to be investigated through controlled studies to establish a cause-and-effect relationship and determine the efficacy of treatments like Substance A.
Dr. Jenkins is reviewing lab work results for a 10-year-old female spayed Domestic Shorthair cat named Flopsy. Flopsy was presented yesterday for a routine wellness examination. Dr. Jenkins noted that the patient had lost 2.5 pounds since the previous wellness visit 12 months ago. Flopsy’s owner mentioned that she had been vomiting occasionally and drinking more water recently, but she was eating well and otherwise seemed to feel great. Results show the total T4 measurement is 7 pg/dL. Which of the following is the most appropriate option for discussing treatment with the owner?
- Hyperthyroidism is usually treated with a medication called methimazole. It can be given orally or applied to the ear. There are several other options that we can discuss if the medication doesn’t work well for Flopsy.
- We have a lot of options for treatment of hyperthyroidism. I will send comprehensive information via e-mail that should help you decide which treatment is best for Flopsy. If you have any questions after reading the information, please give me a call.
- There are several options for treatment of hyperthyroidism. I will review the options with you today, and I would like to e-mail some more detailed information for you to review before you decide which you would like to use for Flopsy.
- The best option for treatment of hyperthyroidism is radioactive iodine therapy, but most people don’t choose this option because it is very expensive. So, we will start a medication called methimazole and see how Flopsy responds.
Answer: There are several options for treatment of hyperthyroidism. I will review the options with you today, and I would like to e-mail some more detailed information for you to review before you decide which you would like to use for Flopsy.
Explanation
In this option, complex information is presented in small, manageable chunks. The client is receiving initial information directly from the veterinarian and can also review the written information at their own pace. This option involves repetition, which is helpful in reinforcing the information.
Finally, this answer incorporates both verbal and written communication to aid understanding.
While methimazole or radioiodine therapy are acceptable treatment options for hyperthyroidism, in each of these scenarios the veterinarian is making assumptions about the client’s goals. In the option that addresses methimazole therapy, the veterinarian has not adequately reviewed the other therapeutic options and has therefore not established informed consent. In the option that addresses radioactive iodine therapy, the veterinarian assumes that the client does not wish to incur the expense of therapy and leads the client toward therapy with methimazole instead.
While providing comprehensive information via e-mail is a wonderful idea, a combination of verbal and written communication is preferred.
Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett.
Wiley-Blackwell, 2010. Page 32-33.
The most appropriate option is to inform the owner that there are several treatment options for hyperthyroidism and to review these options together during the visit. Additionally, offering to e-mail detailed information allows the owner to review the options at their own pace before deciding on the best treatment for Flopsy. This approach ensures informed consent and combines verbal and written communication, which reinforces understanding and supports the decision-making process.
George is a long-term client who presents a deceased Golden Retriever for private cremation. The dog belonged to George’s mother, who recently suffered a stroke. George’s mother lived several states away at the time of the stroke, but she was moved into an assisted living facility near George’s home this week. George had been caring for the dog for the past two days until a more permanent placement could be made. However, the dog bolted out through the front door this morning and was hit by a car. George is visibly upset and repeatedly says hes not sure what he’s going to do. Which of the following is the most appropriate response?
- Recognize that the client is experiencing a secondary loss and conclude that they are not in need of contact information for pet bereavement services.
- Recognize that the client is experiencing a primary loss and suggest they perform an internet search for a pet loss support group.
- Recognize that the client is experiencing an ambiguous loss and provide contact information for a virtual pet bereavement group.
- Recognize that the client is experiencing a symbolic loss and provide contact information for a therapist experienced in pet bereavement counseling.
Answer: Recognize that the client is experiencing a symbolic loss and provide contact information for a therapist experienced in pet bereavement counseling.
Explanation
The best answer involves recognizing that the client is experiencing a symbolic loss. Symbolic pet losses occur when companion animals represent another loss in a client’s life. Providing contact information for a therapist experienced in pet bereavement counseling is a good choice for ensuring that the client is adequately supported.
Primary loss is felt following the death of a client’s personal pet. Secondary losses include the disruptions to the life of the client that are created by the primary loss. Ambiguous loss is experienced when the client does not know the fate of their companion animal, such as in cases of lost pets.
When a client experiences any type of pet loss, providing contact information for pet bereavement services is recommended. Having the information on-hand and readily available to clients is important.
Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 68-69 and 95-98.
As shown in the photo below, cardiac hemangiosarcoma in dogs is most commonly found on what area of the heart?
- Left atrium
- Left ventricle
- Right atrium
- Right ventricle
Answer: Right atrium
Explanation
The correct answer is right atrium. Although the reason for this predilection is unknown, this is the most common site in the heart for hemangiosarcoma to occur.
***PowerPage: Hemangiosarcoma
A 2-year old male neutered indoor/outdoor Maine Coon presents for diarrhea for the past week. On exam he is bright, alert, and responsive. His temperature is 103.4 F (39.7 C), heart rate is 140 beats per minute, and respiration rate is 40 breaths per minute. Mucoid brown to green diarrhea is found on rectal examination. The cat is still eating well and has normal activity levels. Blood work shows a monocytosis and eosinophilia. On fecal exam you see tiny oocysts (see image). You should inform the owner of which of the following?
- Lifelong signs may reoccur with flare ups in the future
- Treatment will be long and the cat should be isolated
- Treatment could have potential adverse ettects
- Clean litterbox daily and wash hands thoroughly. Immunocompromised people should avoid the litter box.
Answer: Clean litterbox daily and wash hands thoroughly. Immunocompromised people should avoid the litter box.
Explanation
Toxoplasmosis is a zoonotic disease. Cats are the reservoir. Clinical signs are typically seen in younger cats but can occur in older cats or immunocompromised cats as well. Signs can vary from diarrhea to fever, malaise, orthopedic diseases, uveitis, or neurological signs. Oocysts are shed in the feces, where they take around 5 days to sporulate and become infective. Isolating the affected animal will decrease risk of transmission to other animals.
Cleaning the litterbox daily will decrease the risk of exposure of infective oocysts to humans.
Toxoplasmosis can cause birth defects or still births in humans, so pregnant women should avoid the litter box. Immunocompromised people should also avoid cleaning the litter box. Treatment of choice for cats is typically clindamycin.
Your client raises show rabbits and her cat named Neffer has been eating the rabbit feces. She brings Neffer’s fecal matter in for examination and the fecal float reveals Eimeria (see image). Which of the following treatments are indicated for this cat?
- Fenbendazole
- Sulfasalazine
- Doxycycline
- Sulfadimethoxine
- No treatment is necessary
Answer: No treatment is necessary
Explanation
This coccidian is not parasitic in dogs and cats and no treatment is necessary for the cat. The parasite has shown up on fecal exam because it is merely passing through the digestive tract secondary to coprophagy.
Eimeria is identified as having 4 sporocysts or a distinct micropyle cap. Eimeria are parasitic in birds, reptiles, and herbivores. The owner should be informed of the parasite, and her rabbits should be treated.
Isospora is the infectious coccidian in dogs and cats and is treated with Sulfadimethoxine (Albon).
