Week 2 Day 3 Flashcards
Topic: DKA in felids
You should recognize that this cat has many of the signs and findings of diabetic ketoacidosis.
Specifically, those signs in this case include PU/PD, anorexia, weight loss, azotemia, cystitis, dehydration, ketonuria, and hyperglycemia.
The most important treatments for this cat are gradual correction of dehydration, typically with isotonic crystalloids such as lactated Ringer’s solution supplemented with potassium. Concurrently with correction of dehydration, insulin therapy should be initiated with regular insulin at approximately 1 unit/kg/day with monitoring of blood glucose. This can be done with intermittent dosing or a continuous infusion of insulin. Parameters must be made in order to help determine if more or less insulin is needed.
Bicarbonate is useful in some cases but should only follow rehydration as overzealous bicarbonate therapy can lead to alkaline overshoot, hypokalemia, hypocalcemia, paradoxical CSF acidosis, hypernatremia, and hyperosmolality.
Ampicillin is a good antibiotic choice due to bactericidal activity against Gram-positive cocci and high urine concentrations pending urine culture and sensitivity results. It is not the most important treatment initially.
What additional testing should be run prior to starting treatment in a feline patient recently diagnosed with hyperthyroidism and why?
A chemistry panel should be run first prior to starting treatment in order to get baseline liver and kidney values. Hyperthyroidism tends to mask renal insufficiency. Once treatment begins, the insufficiency is unmasked and they become azotemic. Therefore, may clinicians begin hyperthyroidism treatment with methimazole then recheck renal function when the T4 is normal. If there is no evidence of underlying renal disease, a more permanent treatment option, such as I-131 therapy, is used. Additionally, methimazole can be hepatotoxic and hyperthyroidism itself can cause an increase in liver enzymes.
Note: Hyperthyroidism often causes increased renal perfusion and increased GFR.
Topic: Heartworm in Cats
- What are the most common clinical signs?
- Cats with heartworm may be asymptomatic but common clinical signs include a peracute death presentation due to worm emboli/migration. Chronic signs such as anorexia, weight loss, lethargy, and exercise intolerance may be seen occasionally. Heart failure, cough, and dyspnea can occur with this disease but often are not present due to the small worm burdens usually
carried by cats. Aelurostrongylus, Capillaria, and Paragonimus are lung parasites that can all cause coughing in a cat.
What are some common post-operative complications of a thyroidectomy in a hyperthyroid cat? Explain each.
A. Hypocalcemia can occur due to damage or excision of the parathyroid glands.
B. Horner’s syndrome occurs when the sympathetic trunk running through the neck is damaged.
C. Laryngeal paralysis occurs with damage to the recurrent laryngeal nerve running through the neck.
D. Hypothyroidism can occur secondary to removal of the affected thyroid gland or glands.
Taurine deficiency in cats is associated with?
Dilated cardiomyopathy and ECCENTRIC hypertrophy
Cats with taurine deficiency can develop feline central retinal degeneration (FCRD) in addition to cardiomyopathy. This is because photoreceptors contain large amounts of taurine and cats cannot synthesize it. The classic lesion is an elliptical area of tapetal hyperreflectivity starting in the area centralis dorsolateral to the optic disk that progresses to a horizontal band and eventually can involve the entire fundus. (see photo)
Polydactyly is an __________ ___________ trait.
Autosomal dominant
Strongyloides stercoralis mainly causes a _______ diarrhea and possibly _______ in puppies and kittens. It passed in the feces in the L1 _______ form. The best technique for recovering larvae is the ?
Strongyloides stercoralis mainly causes a mucoid diarrhea and possibly anemia in puppies and kittens. It passed in the feces in the L1 larvae form. The best technique for recovering larvae is the Baermann technique.
Topic: Isospora in Cats
Zoonotic concern?
Coccidiosis or infection with the protozoan Isospora is very common in young cats and dogs. The disease is very difficult to disinfect and rid from the environment. It is important to pick up the stools as soon as possible to avoid sporulation and contamination of the environment with cysts. Luckily,
Isospora is species-specific so zoonosis is not a concern.
What drugs are effective for treating Mycoplasma in cats? What side effect do you need to keep in mind when treating cats specifically?
Acceptable treatment options for mycoplasma in cats are doxycycline and enrofloxacin. Cats should be treated for 3 weeks in most cases. Remember that doxycycline can cause esophageal stricture in cats, and administration should be followed by water. This therapy should be effective in most cases but often does not completely eliminate the organism from the body, and cats may remain carriers of the pathogen.
Topic: Cholangiohepatitis
What treatment is indicated when discrete choleliths are seen or complete biliary obstruction is identified.
If this had been a more typical case of cholangiohepatitis without choleliths or complete biliary obstruction, the treatment of choice would be ?
Choleliths are relatively rare in dogs and cats compared to humans but are seen sporadically.
Surgical decompression
supportive care and fluid therapy plus treatment with ampicillin, metronidazole, ursodeoxycholic acid.
Topic: Foreign Body in Felids
A string that has been present for _____ than a couple of days or one with evidence of ________ of the intestines should not be ________ or _____ because the risk of intestinal perforation is _____.
A string that has been present for more than a couple of days or one with evidence of pleating of the intestines should not be pulled or cut because the risk of intestinal perforation is high.
What is the permanent dental formula formula for a cat?
2(13/3 C1/1 P3/2 M1/1).
Topic: Eosinophillic/Collagenolytic Granuloma
Feline eosinophilic granuloma complex consists of 3 separate clinical syndromes. Describe each.
1) The collagenolytic granuloma (also known as eosinophilic granuloma or linear granuloma) usually occurs on the nose, chin (as in this case), oral cavity, or caudal thighs. The lesions are typically raised and ulcerative or nodular as seen here.
2) The eosinophilic plaque occurs most frequently on the abdomen and medial thighs but can appear other places. They appear as single or multiple, raised, red, often ulcerated lesions of varying size (0.5-7 cm). They frequently have a cobblestone appearance and unlike eosinophilic ulcers, these are often pruritic. This condition is histopathologically similar to miliary dermatitis and is usually associated with underlying allergy.
3) The eosinophilic ulcer (also known as indolent ulcer) typically occurs on the upper lip and may be unilateral or bilateral. They often have a characteristic central area of yellow to pink tissue with a slightly raised circumferential edge
The underlying cause of eosinophilic ulcers and collagenolytic granulomas are unknown, although an underlying allergic cause such as arthropod bites and/or cutaneous hypersensitivity have been suggested.
Treatment of collagenolytic granulomas is also controversial so it is unlikely that you would be asked about treatment of this disorder on a board exam aside from knowing that you should attempt to identify and remove/treat underlying allergy or biting arthropod problems. Some cases respond to antibiotic therapy but most require glucocorticoid therapy.
Topic: Otodectes cynotis
- What is used to treat this condition?
- Milbemycin, Ivermectin, Selamectin (more effective as preventative than for immediate treatment)
Round cell tumors include?
lymphoma, mast cell tumor, plasma cell tumor, histiocytoma, transmissible venereal tumor, +/- melanoma and certain neuroendocrine tumors
A basal cell tumor is what type of tumor?
An epithelial tumor (epithelioma/carcinoma)
What are the clinical signs seen in cats with glaucoma?
Cats rarely show acute changes with glaucoma like dogs, so they often present with signs of chronic glaucoma which are:
A. Buphthalmos
B. Corneal fibrosis
C. Lens luxations
D. Mydriasis
E. Tapetal hyperreflectivity and retinal vascular attenuation
F. Pale optic discs.
Strabismus is not a component of glaucoma.
What drug is contraindicated in the tx of feline asthma and why?
Atropine b/c it thickens bronchial secretions and encourages mucous plugging of the airway.
What is the most likely cause of aortic saddle thrombi in cats? Describe the pathophysiology, treatment, and prognosis.
The most likely cause of aortic saddle thrombi in cats is cardiac disease; with the most common being hypertrophic cardiomyopathy, restrictive cardiomyopathy, and dilated cardiomyopathy. The left atrium becomes dilated, and turbulent blood flow through left atrium activates platelet aggregation.
Thrombi form in the left atrium and eventually dislodge into systemic circulation. Emboli can lodge in the brain, kidneys, Gl vessels, and aortic bifurcation. Even if treatment is successful, recurrence is common.
Successful treatment consists of appropriate pain medication, supportive therapy for typically 2-4 days, and treating the underlying cause while the thrombus is broken down. Use of thrombolytics should be used cautiously as adverse reactions are common.
What can happen in the immediate post-obstructive period in a cat that was recently unblocked?
In some cases, during the immediate post-obstructive period, cats will develop hypocalcemic tetany.
The mechanism is considered to be secondary to laws of mass action that drive down calcium as a result of existing hyperphosphatemia. Judicious use of calcium gluconate can quickly restore their electrolyte balance and prevent further complications such as hypocalcemic seizures.
While performing a ventral midline ovariohysterectomy you decide to use the spay hook. What structure are you hoping to retrieve with the spay hook?
The broad ligament
How do cutaneous mast cell tumors in cats differ from dogs?
Contrary to cutaneous mast cell tumors in dogs, young Siamese cats (less than 4yr) with the histiocytic subtype of mast cell neoplasia will typically have their tumors spontaneously regress.
Therefore, as long as the patient is not suffering it is reasonable to wait for these to resolve on their own. In general, it is safe to say that feline mast cell neoplasia is much less aggressive than is seen in dogs. Cutaneous mast cell tumors do not need the aggressive surgical margins that are typically recommended for Grade Il or Ill canine mast cell tumors. Furthermore, follow up radiation therapy is rarely indicated.
What types of bacteria are typically found in cat bite abscesses? What medications are typically used to treat them?
The most frequently isolated bacteria in cat bite abscesses are anaerobes. These include obligate anaerobes such as Fusobacterium spp., Bacteroides spp., and Clostridium spp. as well as facultative anaerobes such as Pasteurella spp. and Actinomyces spp.
Because anaerobes are the most common isolates, it is believed that most cat bite abscesses can be effectively treated by establishing good drainage. Nevertheless, many if not most veterinarians, elect to additionally treat these with antibiotics. Be sure to choose an antibiotic that will be effective against anaerobes such as clindamycin or amoxicillin with clavulanate.
Topic: Toxocara spp in Cats
What is typically found on histopathology in feline patients with IBD? How is this condition treated?
Lymphocytic plasmacytic enteritis is consistent with inflammatory bowel disease. The main treatments of this disease include controlling the underlying cause for the disease, controlling inflammation, and controlling bacterial overgrowth when needed. Steroids and hypoallergenic diet are the mainstay treatments for this disease. Prednisolone and budesonide are the two corticosteroids most often used.
Metronidazole can also aid in treatment.
Topic: Feline Asthma
Xray picture - add
What type of drug is Terbutaline?
Terbutaline is a beta-2 agonist that allows bronchial smooth muscle relaxation and along with oxygen, are two important aspects of the emergency management of a cat in acute respiratory distress from asthma.
SCC in cats usually appear around the?
Nose, ears, eyelids
How is Acromegaly diagnosed and treated in cats?
MRI of the head
Treatment for this condition includes radiation therapy to the pituitary tumor, high doses of insulin to try and control the diabetes, and somatostatin analogs (octreotide) to try and inhibit the release of growth hormone from the tumor. Surgical excision has been used as a form of treatment in people with pituitary tumors, but this has only been rarely reported in cats.
Topic: Sporotrichosis
- Caused by?
- C/S
- Diagnostics - what is seen?
- Treatment
Sporotrichosis is caused by Sporothrix schenckii. There are several clues that indicate this is Sporothirix. This fungal organism is cigar-shaped and often associated with thorns from roses. The cat had a history of a splinter in the right front paw.
Sporothrix is also known as rose grower’s disease. Dissemination is rare in dogs and occurs more commonly in cats. In dogs, it is hard to find Sporothrix on cytology and biopsy because special staining for Sporothrix is often necessary.
Treatment for Sporothrix is either antifungal therapy with an -azole like itraconazole or potassium iodine. Doxycycline is an antibiotic and would not be an appropriate choice.
Thiamine deficiency is seen in cats ?
fed raw fish diets when thiaminase depletes the body of thiamin, which causes neurologic symptoms.
Arginine is an essential ______ ____ in cats that is used to make _________, which binds to _________ that is formed from the catabolism of protein. Arginine deficiency results in build up of ________ and signs similar to ?
Arginine is an essential amino acid in cats that is used to make ornithine, which binds to ammonia that is formed from the catabolism of protein. Arginine deficiency results in build up of ammonia and signs similar to hepatic encephalopathy.
Niacin deficiency in cats causes ?
weight loss, anorexia, poor hair coat, ulceration and erythema of the tongue and palate, and diarrhea
Cobalamin deficiency causes ? in cats
inappetance, lethargy, and failure to thrive.
What are the five main treatment objectives for cats with megacolon?
There are five main treatment objectives for cats with megacolon. These include adequate hydration status, removal of impacted feces,
laxative therapy, promotility agents for the colon, and dietary fiber.
This cat may benefit from Cisapride, which is a benzamide prokinetic drug. Due to the chronic stretching of the colon from the feces impactions, the colon can no longer move the feces out of the body in a normal way. This medication has anecdotally been shown to help cats evacuate feces more efficiently, especially in mild or moderate cases. Some cats may also benefit from a fiber source such as psyllium or canned pumpkin.
If the constipation problems continue despite the above mentioned treatments, colectomy should be considered.
What are the post-operative concerns associated with a pancreatic mass removal?
When performing mass resections of the pancreas the ideal situation is a mass associated with the tail of the pancreas. Otherwise they can be very difficult to excise in their entirety and you run the risk of disrupting the flow of pancreatic enzymes into the duodenum. The pancreas is responsible for secreting insulin which is what stimulates glucose to be removed from the blood stream and taken into the cell.
A patient with a mass in the pancreas that is causing hypoglycemia has an insulinoma (seen in dogs). Removal of an insulinoma can occasionally lead to hyperglycemia and diabetes mellitus requiring insulin administration in dogs, but there is no indication of an insulinoma based on the normal blood glucose level on the chemistry panel indicated in the question.
Manipulation of the pancreas can result in pancreatitis and if the inflammation is severe enough an extrahepatic biliary obstruction could occur and result in elevated bilirubin levels. Extrahepatic billiary obstructions secondary to pancreatitis can require surgical intervention.
Clinical signs of pancreatitis will likely manifest themselves in the form of persistent abdominal pain and vomiting.
Since this patient has renal insufficiency it is important to monitor renal values closely. Remember that it takes about 75% of the kidneys to be damaged before the values go up so any elevation in renal values may be cause for alarm. This is particularly important if the patient was hypotensive during surgery and renal perfusion was potentially compromised.
Post anesthetic cortical blindness results from ?
poor perfusion during anesthesia. The visual cortex is extremely sensitive to the effects of hypoxia (poor perfusion/oxygenation) which can result in blindness. Not all arrhythmias will necessarily compromise tissue perfusion (for example isolated VPC’s or first degree AV block etc.). Hypersensitivity or allergy to anesthetic gases used (such as isoflurane gas) are rarely documented. Elevated end-tidal CO2 indicates poor ventilation (such as from inadequate fresh gas flow, increased dead space, saturated up soda-lyme, a deep anesthetic plane, etc.), but not necessarily poor perfusion.
What drugs are known to cause KCS in some dogs?
TMS = main one; any sulfa drug –> KCS
Atropine, general anesthetics, and etodolac can also cause KCS.
Topic: KCS
Treatment?
Cyclosporine
Topic: Progressive Retinal Atrophy
- Sometimes called?
- Is this disease inherited or acquired?
- Age of onset?
- Typical C/S?
- How does this differ from SARDS?
- Progressive retinal degeneration
- This disease is inherited. Most noticeably seen in Toy and Miniature Poodles.
- Age of onset is variable.
- Night blindness progressing to complete blindness due to loss of rods prior to cones. Retinal lesions are classically seen.
- Differs from SARDS because SARDS has a different clinical course AND there are not retinal lesions in acute SARDS.
Topic: SARDS
- This disease most commonly affects?
- What c/s are seen in these cases?
- How is this disease definitively diagnosed?
- No effective tx
- Brittany spaniels, miniature spaniels, daschunds, and pugs. Middle aged overweight female dogs are most likely affected.
- C/S consistent with Cushing’s disease, PU/PD, polyphagia, weight gain, and lethargy.
- Electroretinography.
- No effective tx
What is the difference between an incomplete and complete cataract?
Both are diffuse changes but animals can see through an incomplete cataract.
Describe the appearance of an indolent corneal ulcer when stained
List the c/s and breed most commonly affected?
An indolent corneal ulcer will have an intensely stained area surrounded by a halo of lighter stain.
Patient will present with blepharospasm of a few weeks uration, schirmer tear test and tonometry will be normal.
Boxers are frequently affected by this condition.
What is a potential side effect of chronic anterior uveitis in dogs?
Cataract formation and corneal scarring b/c inflammatory mediators in the anterior chamber can destroy corneal and lens proteins. It can lead to glaucoma when debris from uveitis plugs the iridocorneal angle.
Uveitis can not extend into the lacrimal glands and destroy them therefore it can not cause KCS.
Topic: Canine Glaucoma
You examine a Basset Hound with primary glaucoma in one eye. What would you tell the owner about his prognosis for the other eye?
It will probably develop glaucoma in 6-12 mo
Topic: Canine Familial Dermatomyositis
- What breeds are predisposed?
- What does the disease cause?
- How is this treated?
- Collies and Shetland Sheepdogs
- Atrophy of muscles and erosion, crusting, and alopecia of skin which is exacerbated by heat and sun exposure.
- This condition is treated with corticosteroids, Vitamin E, and omega-3 fatty acids. Often unrewarding
The disease is often cyclic and will regress
Familial dermatomyositis is a familial disease seen in Collies, Shetland sheepdogs, and other collie breeds. Diagnosis can be made with skin or muscle biopsies, but can be difficult as the clinical and histopathologic signs can wax and wane. Inciting causes can include vaccinations, sunlight, viral infections, or drugs. Some cases; however, will come and go without obvious inciting causes. Some cases can become severe enough to include muscle atrophy; megaesophagus has also been seen with this disease.
Treatments are often symptomatic and supportive and include Vitamin E supplements, Omega 3 fish oils, treatments for any secondary bacterial infections, and pentoxifylline. Prednisone can also be used to get more severe cases under control. Avoiding prolonged sun exposure can also help.
Educating the owner on the fact that signs will reoccur despite treatment can alleviate some owner frustrations. Often times signs will regress with or without treatments. Educate owners on neutering animals to prevent propagation of diseased animals.
List the most common methods used to remove/kill ticks. What method is not advised to be used?
Burning may cause the ticks to become agitated and regurgitate their stomach contents into the surrounding tissues they are feeding from. This will cause severe inflammation and pruritis, and can also lead to tick borne diseases. Burning can also harm the patient. The correct way to remove ticks is to grasp them with forceps just behind their heads and gently apply traction until they release. Twisting will cause the heads to stay lodged under the skin. For large numbers or ticks, as seen in this image, Fipronil pour-ons and Permethrin topicals can be used to kill off the ticks. Periodic pour-ons and bathing routinely can also be used in the face of severe intestations.
Topic: Acral Lick Dermatitis in Dogs
Acral lick dermatitis is considered a chronic and repetitive condition in which a dog continuously traumatizes a
region as a result of obsessive licking. The licking is usually secondary to pruritis from allergies and will lead to
infection. There could be multiple causes for this, such as a neuropathy or underlying orthopedic disease;
however, this behavior is considered to be obsessive-compulsive, and the patient may need to be evaluated for
other anxiety-related behaviors. Combination therapy with steroids, antibiotics, topicals, E-collars, and behavior
modification medications can be used help break the cycle and achieve healing of the lesion. Fluoxetine (aka
Prozac) is used to treat depression and obsessive-compulsive disorders.
Describe an ECG for A-fib.
Atrial fibrillation - THINK = RANDOM ATRIAL DEPOLARIZATION
- no discernible P wave, QRS complexes are narrow and tall
What drugs can be used to treat a-fib in dogs?
Digoxin: increased vagal tone to AV node to slow conduction & decrease HR
Atenolol: beta clocker; slows AV conduction
Procainamide: class 1A antiarrhythmis used to convert afib to normal sinus rhythm; rarely effective
Diltiazem: Ca channel blocker; slows AV conduction
What type of drug are the following:
Phenylephrine
Vasopressin
Dobutamine
Epinephrine
Isoproterenol
Phenylephrine: adrenergic vasoconstrictor
Vasopressin aka non-diuretic hormone: non-adrenergic vasoconstrictor
Dobutamine: vasodilator
Epinephrine: adrenergic vasoconstrictor
Isoproterenol: vasodilator
Mitral regurgitation in dogs eventually results in?
Eccentric hypertrophy of the LA and LV.
Mitral regurgitation is the process of blood flowing back from the left ventricle to the left atrium due to a defect in the valve. The excess blood flow causes volume overload of the left atrium leading to eccentric hypertrophy or dilation of the chamber. The excess blood volume will then return to the left ventricle during the next diastole, resulting in dilation and eccentric hypertrophy of the left ventricle as well. Concentric hypertrophy occurs in cardiac chambers when they are pressure overloaded, such as in the case of pulmonic stenosis or aortic stenosis.
An oxygen saturation of 98-100% corresponds to > ____ mm Hg oxygen in arterial blood
An oxygen saturation of 95% corresponds to ____ mm Hg
An oxygen saturation of 90% corresponds to ___ mm Hg
An oxygen saturation of 50% corresponds to ___ mm Hg
An oxygen saturation of 10% corresponds to __ mm Hg
An oxygen saturation of 98-100% corresponds to > 100 mm Hg oxygen in arterial blood
An oxygen saturation of 95% corresponds to 80 mm Hg
An oxygen saturation of 90% corresponds to 60 mm Hg
An oxygen saturation of 50% corresponds to 30 mm Hg
An oxygen saturation of 10% corresponds to 10 mm Hg
Topic: Pulmonic Stenosis
- Common in what breeds?
- C/S
- What is seen on diagnostics?
- Treatment?
- Pulmonic stenosis is a congenital defect commonly seen in English bulldogs, beagles, miniature schnauzers, samoyeds, mastiffs, fox terriers, and other small breed dogs.
- It is characterized by a systolic murmur heard best on the left side over the heart base.
- Concentric hypertrophy of the right ventricle results from pressure overload of the chamber. Radiographically, concentric hypertrophy may show as mild chamber enlargement. The enlarged pulmonary artery segment is the post stenotic dilatation.
Topic: Mild Subaortic Stenosis
Describe the prognosis for patients affected by this disease.
Prognosis is fair. Sudden death may occur at any time and the dog is at an increased risk for infective endocarditis
Most canine PDA’s are shaped like?
A funnel and are therefore amenable to coil embolization surgery. Others can be shaped like a cylinder and therefore require surgical ligation.
What blood parasite looks similar to Dirofilaria immitis?
Acanthocheilonema reconditum.
- This organism is not pathogenic and therefore not treated
The lack of deep pain with spinal cord trauma is a poor prognostic indicator, and even with surgical intervention at this point, there is less than a ____% chance of a return to function.
The lack of deep pain with spinal cord trauma is a poor prognostic indicator, and even with surgical intervention at this point, there is less than a 5% chance of a return to function.
Hansen’s Type 1 disc disease usually involves ___________ dogs (list examples). It is ______, _______, and should be considered an ______.
Hansen’s Type 1 disc disease usually involves chondrodystrophic dogs (Dachshunds, corgis, shih zhus). It is acute, painful, and should be considered an emergency.
Tick bite paralysis is relieved once?
The tick is removed
CN VII is called? And is responsible for? Deficits will result in?
The facial nerve; responsible for lacrimation.
Exposure keratitis
Loss of motor function in the muscles of mastication would occur in CN V (mandibular branch) deficits. Strabismus of the eyes would be caused by deficits in CN Ill (oculomotor nerve), CN IV (trochlear nerve) or CN VI (abducent nerve). Nystagmus occurs with CNS disease or CN VIII deficits.
What nerve is most commonly damaged from IM injections in dogs?
Sciatic nerve
Tetanus in dogs
The facial contraction and smirk is a characteristic sign of tetanus. Tetanus is caused by the neurotoxin produced by Clostridium tetani. This bacteria enters the body through a wound and begins producing tetanospasmin, a potent neurotoxin that blocks GABA release at the motor end plate and causes sustained muscle contraction.
Treatment involves wound debridement, sedation, antibiotics, and minimizing external stimuli as these animals are hyperesthetic. Tetanus antitoxin is given after an initial test dose to monitor for anaphylaxis. Antitoxin prevents further toxin binding but does not affect already bound toxin so it helps decrease progression of clinical signs but will not reverse the signs present.
The correct answer is injection of human rabies immune globulin followed by 4-5 injections of approved rabies vaccine.
The recommended protocol per the 2020 CDC guidelines is as follows: “Postexposure prophylaxis (PEP) consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days
3, 7, and 14.” HTTP://www.cdc.gov/rabies/
If you are not vaccinated, then you will need an injection of human rabies immune globulin immediately after exposure followed by 4-5 injections of an approved rabies vaccine IM over 2-4 weeks. If you have been vaccinated, all that is needed are two injections of an approved rabies vaccine 3 days apart. PEP is not required for accidental injection of animal rabies vaccine into a human.
metronidazole would be a good choice as a cause of central vestibular disease. Chlorheadine is a topical drug implicated in ototoxicity and peripheral vestibular disease.
Another excellent choice would be aminoglycosides including neomycin, kanamycin, tobramycin, amikacin and gentamicin.
