Week 2 Feb 17 Day 1 Flashcards
What causes cutaneous larval migrans in humans? Describe the pathogenesis. Is this a self-limiting disease?
Ancylostoma. These are hookworms; when they come in contact with unprotected skin, the infective larvae penetrate the epidermis but generally cannot penetrate the basement membrane. They therefore migrate aimlessly, and the disease is usually self-limiting in humans.
Topic: Chin Acne in Canids
- Is this an acute or chronic disorder?
- This condition is typically seen in what age group? What breed?
- What is this condition characterized by?
- What can develop if this condition becomes more advanced?
- Would switching to a different water bowl material help?
- How should this be treated?
Chin acne is a chronic inflammatory disorder of young short coated animals. It is characterized by folliculitis and furunculosis. Secondary bacterial infections can develop if it becomes more advanced. There has been some association seen after contact with plastic water and food bowls, and switching to a different material may help; however, the evidence is more anecdotal and is extrapolated from studies in humans and cats. The chin and lips should be kept as clean as possible with frequent bathing and antibiotic ointment to prevent plugging of the follicles.
Some cases can be simply managed by modifying behaviors that can traumatize the chin (chasing balls) and topical antibiotics. Severe cases will need long courses of systemic antibiotics to resolve the infection and then topical corticosteroids to prevent new lesions. The papules should not be expressed, as this can increase inflammation.
Benzoyl peroxide is good choice for a topical antibiotic since it has follicular flushing action. Keep in mind that topical application of benzoyl peroxide can be irritating to the skin if overused.
Topic: Canine Heartworm
See radiograph image
Heartworm in the dog is caused by Dirofilaria immitis. The treatment of choice for heartworm is Immiticide which is given by intramuscular injection.
Topic: Canine Dilated Cardiomyopathy
**See vet prep power pages **
What type of medication is Enalapril? How does it work?
Enalapril is an ACE-inhibitor, which blunts the adverse effects of the renin-agiotensin-aldosterone system thereby reducing sodium and fluid retention.
Additionally, ACE-inhibitors cause mild vasodilation by
preventing the production of angiotensin-ll, which reduces ventricular afterload.
Lastly, enalapril and other ACE-inhibitors are protective to cardiac muscle by blunting aldosterone and other hormones which induce cardiac remodeling.
Topic: Avascular Necrosis of the Femoral Head
1. Also known as?
2. Etiology & pathogenesis of this disease.
3. Signalment. Explain why. When do patients start showing clinical signs?
4. This condition is unilateral or bilateral?
5. Diagnostics?
6. How is this condition treated?
7. What is a top differential for this disease?
- Legg-Calves-Perthes disease
- Results in a collapse or fragmentation of the femoral epiphysis (as seen on the radiographs) because of a disruption in blood flow. The cause of blood flow interruption is unknown.
- The condition occurs in young small-breed dogs prior to closure of the capital femoral physis. Dogs are usually 6-7 months of age when they first start showing clinical signs but the age may range from 3-13 months.
- The condition can be seen bilaterally in 10-17% of patients.
- Radiographs will typically show a shortening of the femoral neck as well as osteochondrosis with chronicity, as appreciated in this patient.
Note the significant muscle atrophy of the patient’s left limb as compared to the right. - Treatment with a femoral head and neck ostectomy (FHO) generally yields excellent results. Alternatively, if owners demand perfect biomechanics, a total hip replacement may be considered, but most veterinarians tend to recommend an FHO.
- Patellar luxation should always be a differential in any small breed dog and this should be ruled out via palpation since the patient may not necessarily be luxated at the time the radiograph was taken. The patient’s patellas are in a normal position in this.
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Describe the best/ideal candidate for urohydropulsion. Explain why
Urohydropropulsion is the expulsion of cystic calculi after anesthetizing an animal by application of manual pressure to the urinary bladder to expel the stone through the urethra. Urohydropropulsion should not be attempted in male dogs because they have long, narrow urethras compared to females and an os penis which increases the likelihood of the calculi becoming lodged in the urethra. Obesity (and large size in general) makes it more difficult to manipulate the bladder effectively.
When does the canine fetal skeleton ossify? Feline?
The correct answer is 43 days gestation. The fetal skeleton ossifies at 42-45 days in the dog and 35-39 in the cat.
A 9 year old male Labrador Retriever presents for acute onset of circling to the right, head tilt to the right, nystagmus to the left, and vomiting.
The rest of the physical exam is unremarkable. CBC, chemistry panel, urinalysis, and otic exam were unremarkable. After 14 days of supportive care, the dog has completely recovered on its own. What is the most likely disease this dog had?
A. Canine idiopathic vestibular disease (Old dog vestibular disease)
B. Otitis interna
C. Inflamed polyp in the middle ear
D. Bacterial meningitis
The correct answer is canine idiopathic vestibular disease (Old dog vestibular disease). This disease is usually diagnosed after all other vestibular causes have been ruled out. Otitis interna would be ruled out with an otic exam, CBC, and lack of pain and fever. Bacterial meningitis could be ruled out by a CBC and lack of pain and fever. Polyps in the ear rarely occur in dogs; most aural polyps occur in cats. In addition, an otic exam would rule this out
Osteolytic lesions along the distal femur are highly suspicious of osteosarcoma (OSA). Given the age and clinical history it should be your first differential. The other differential would be fungal disease such as coccidioidomycosis (Valley Fever). This fungal infection is seen predominantly in the southwestern United States, but should not be excluded without full testing. The appropriate next step to differentiate OSA from Valley Fever would be thoracic radiographs to look for metastases and fungal serology to determine exposure and antibody levels to fungal diseases. Chest films are available for review below which show metastatic disease. Of note, coccidioidomycosis can also affect the lungs, leading to an interstitial, bronchiolar, multifocal, or alveolar pattern as well.
Gold standards for diagnosis of OSA are biopsy of the affected boney lesion. Remember OSA should not cross the joint. Elevations in alkaline phosphatase and/or gross visible metastatic lesions give a worse prognosis with shorter longevity, even with aggressive treatments.
A 2 year old male castrated Husky presents for crusting and hyperkeratosis of the mucocutaneous junctions and extremities. What heritable disease is the most likely cause?
The correct answer is zinc responsive dermatosis. This disease commonly affects Huskies, Malamutes, and German Shorthaired Pointers.
The defect causes an increased requirement for zinc. Clinical signs are usually responsive to oral supplementation with zinc.
What is Familial dermatomyositis?
Familial dermatomyositis is an inflammatory disease of the skin and muscles of Collies and Shetland Sheepdogs.
What is Lupoid dermatosis
Lupoid dermatosis is a fatal disease that initially causes crusting and scaling of the dorsum and head in young German Shorthaired Pointers.
What is color dilution alopecia?
Color dilution alopecia is a heritable alopecia that develops in animals with less melanin in their hair shafts than normal; one example would be a fawn colored Doberman Pinscher.
Topic: Spinal Chord Localization (watch video)
The correct answer is C1-C5 of the spinal cord. All 4 limbs are showing signs of an upper motor neuron lesion, which would be consistent
with a C1-C5 myelopathy or multifocal spinal lesions. A C6-T2 lesion would manifest as lower motor neuron signs in the thoracic limbs
and upper motor neuron signs in the pelvic limbs. A T3-L3 lesion would manifest as upper motor neuron signs in the pelvic limbs with
normal thoracic limbs. A L4 and caudal lesion would manifest as lower motor neuron signs in the pelvic limbs with normal thoracic limbs.
Remember that multifocal lesions in different areas of the spinal cord can make neuroanatomic localization trickier.
What is the most reasonable treatment option for canine patients with a histiocytoma?
Histiocytomas are typically benign and will often present as a small, raised mass that may or may not be ulcerated. Fortunately, these masses usually regress on their own, and surgical or medical intervention is typically not necessary.
Atropine is an _____________, often used during premedication and intraoperatively to increase _______ ______. It causes a decrease in ____ secretion, ________ secretion, and _____ tone and motility. Atropine reduces the influence of the _________ nerve on the heart but does not _______ it completely. ________ is used to treat VPCs.
Atropine is an anticholinergic, often used during premedication and intraoperatively to increase heart rate. It causes a decrease in tear secretion, salivary secretion, and Gl tone and motility. Atropine reduces the influence of the vagus nerve on the heart but does not block it completely. Lidocaine is used to treat VPCs.
What is an important side effect of ketoconazole?
Ketoconazole is hepatotoxic and can cause elevated liver enzymes. It is a potent inhibitor of P450 enzymes and can significantly affect metabolism of other drugs. It can cause adrenal insufficiency and actually is sometimes used as an alternative treatment for Cushing’s.
Anorexia is a common and important side effect, especially in cats.
The kidneys and GFR are not significantly bothered by ketoconazole. Facial excoriation is a potential side effect of methimazole, not ketoconazole.
Definitive diagnosis of multiple myeloma requires satisfying at least ________ of the following criteria:
Definitive diagnosis of multiple myeloma requires satisfying at least two of the following criteria:
1. Monoclonal gammopathy
2. Radiographic evidence of osteolytic bone lesions (satisfied in this case)
3. >5% neoplastic cells or >10-20% plasma cells in the bone marrow
4. Immunoglobulin light chain proteinuria (Bence-Jones proteinuria)
Topic: Addison’s Disease
1. Primary hypoadrenocorticism causes destruction of what hormones? Where are these hormones produced?
2. The less common form of Hypoadrenocorticism is caused by?
Primary hypoadrenocorticism is caused by destruction or atrophy of all layers of the adrenal cortex, causing a deficiency in both types of corticosteroids. Remember, mineralocorticoids come from the zona glomerulosa, and glucocorticoids come from both the zona fasciculata and zona reticularis.
The less common form of hypoadrenocorticism is caused by inadequate ACTH production by the pituitary and results in a deficiency of glucocorticoids only.
Topic: Central Venous Pressure
Central venous pressure is a ________ measure of blood pressure in the _____________. __________ blood volume, venous vessel _____, and cardiac __________ determine the CVP. CVP is an _________ of preload, not a direct measurement. Cardiac output is one of the factors along with venous tone and venous blood volume in obtaining CVP.
Central venous pressure is a direct measure of blood pressure in the cranial vena cava. Venous blood volume, venous vessel tone, and cardiac output determine the CVP. CVP is an estimate of preload, not a direct measurement. Cardiac output is one of the factors along with venous tone and venous blood volume in obtaining CVP. Afterload is the force against which the myocardium must contract.
What is the most common side effect of Ivermectin?
Starting dogs on low dose (0.1mg/kg) of ivermectin and gradually increasing dose to therapeutic levels (0.6mg/kg) is recommended to monitor for signs o neurotoxicity. Starting at a low dose of ivermectin is necessary so the owner can evaluate for neurological signs. The goal is to have the owner see mild neurological signs like mydriasis and tremors and are able to stop the medication before more severe signs such as seizures and coma occur. Common signs of toxicity include ataxia, head tilt, and lethargy. Signs typically resolve within 24-48 hours after stopping ivermectin when seen. Worst-case scenarios are those with collie breeds or other dog breeds that have the ABCB1 (formerly the MDR-1) gene mutation. This leads to toxic accumulation of drugs intracellularly, leading to severe neurological signs including comas and possibly death.
Melanoma
The cytology shows cells with large nuclei, stippled chromatin with prominent and sometimes multiple nucleoli (labeled with 1). A few cells (labeled with a 2) have dark green/black melanin granules.
Melanoma is an important differential for a nail bed tumor. At this site, they are frequently malignant and the local lymph node should be palpated and aspirated. Additional staging (thoracic radiographs and abdominal ultrasound) should also be considered. If there is no evidence of metastasis, the affected digit should be amputated.
In addition to a blood glucose, all newly diagnosed diabetic patients should have what done? Explain why.
All newly diagnosed diabetic patients should have their urine cultured. Diabetics are prone to getting urinary tract infections due to the chronic presence of glucose in their urine. Any underlying infection can lead to insulin resistance and make regulation of diabetes difficult to achieve.
Fructosamine level is helpful in trying to determine if a cat actually has diabetes if their glucose level is elevated and also as a follow up to determine regulation. Cats that have markedly elevated glucose levels, glucosuria, and clinical symptoms of diabetes do not necessarily need to have a fructosamine checked at the time of diagnosis.
IMHA in cats
List the most important side effects of tricyclic antidepressants:
Side effects of clomiprimine include vomiting, constipation, decreased appetite or anorexia, dry mouth, tachycardia, arrythmia, and sedation.
Topic: Mammary Tumors in Felids
Mammary tumors in cats are almost always _______ and the large majority of them will eventually __________. This is in contrast to mammary tumors in dogs, in which _____% are malignant, and ____% of those that are malignant will eventually metastasize. Similar to dogs, cats that are _______ after they have had one or more heat cycles have a much greater risk of developing mammary tumors.
If staging shows no visible evidence of metastasis, treatment is generally aimed at _______ removal of the tumor followed by _________ to try and slow the development of metastasis. Generally, the type of surgery that is recommended is a ____________ ____________ to remove all of the glands on the affected side to reduce the risk of recurrence in those glands. The tumor is also greater than 2 cm in size, which is associated with a worse prognosis in cats.
Mammary tumors in cats are almost always malignant and the large majority of them will eventually metastasize. This is in contrast to mammary tumors in dogs, in which 50% are malignant, and 50% of those that are malignant will eventually metastasize. Similar to dogs, cats that are spayed after they have had one or more heat cycles have a much greater risk of developing mammary tumors.
If staging shows no visible evidence of metastasis, treatment is generally aimed at surgical removal of the tumor followed by chemotherapy to try and slow the development of metastasis. Generally, the type of surgery that is recommended is a unilateral mastectomy to remove all of the glands on the affected side to reduce the risk of recurrence in those glands. The tumor is also greater than 2 cm in size, which is associated with a worse prognosis in cats.
What is a classic blood work finding in a patient with an upper GI obstruction?
Hypochloremic metabolic alkalosis is a classic finding in a pet with an upper Gl obstruction and should be ruled out first, especially in a young cat with these clinical signs.
Topic: Tumors of the Skin (See Vet Prep page)
What is the most common skin cell tumor in cats?
A. Give the approximate %.
B. Describe the morphological appearance of these tumors.
C. Where on the body are they typically found?
D. Are they typically benign or malignant?
Basal cell tumors are the most common skin tumor in the cat.
A. About 20% of all feline skin tumors.
B. These tumors are usually hairless, dome-shaped, raised masses as described.
C. They are most frequently found on the head, neck, and shoulders.
D. They are almost always benign although histologically, they may have aggressive characteristics.
Topic: Chylothorax
- Etiology
- Diagnostics?
- Treatment - both acute and long term
- Chylothorax is usually idiopathic in origin
- Radiographs
- The immediate life-saving procedure will be to remove the fluid that is causing the respiratory distress. Most cases ultimately require surgery which is usually a combination of ligation of the thoracic duct and a sub-total pericardiectomy.
Topic: Feline Heartworm
- Can heartworm adulticidal drugs, such as Melarsomine, be used to treat heartworm disease in cats?
- Do cats have fewer or more adult heartworms than dogs? Explain why.
- Are cats often microfilaria + or - despite active infection?
- Larvae are likely to do what in catws with heartworm?
- Heartworm adulticidal drugs can be life-threatening in cats and immiticide is contraindicated in this species.
Infected cats are frequently managed with supportive treatment, especially when they are symptomatic. The best therapy for the disease is to control the underlying inflammation associated with the infection with corticosteroids. Bronchodilators and anti-emetics may also be beneficial in some cases. Heartgard can be used as a slow kill for adult heartworms. The most common complication concerning heartworms in general is an embolism to the lung and sudden death associated with respiratory failure. - Cats do typically have fewer adult worms than dogs because of increased natural resistance.
- Cats are often microfilaria negative despite an active infection (either from all male worm infections, or occult disease).
- Antibody testing can detect exposure to both male and female worms; however, in cats, larvae are more likely to migrate to ectopic locations such as the brain, skin, and ocular tissue.
Describe what a PLR looks like in a patient with a pre-chiasmal lesion?
Normally, when light is directed into the eye, the signal is transferred from the retina, through the optic nerve, past the chiasm and down the optic tract. From there, it is directed to both oculomotor nerves to cause pupil constriction bilaterally. When there is a pre-chiasmal lesion, light shining in the abnormal eye will have an interrupted signal that cannot get past the chiasm and both pupils stay dilated. When light is shone into the normal eye, both pupils will constrict due to cross-over fibers that stimulate the oculomotor nerve of the abnormal eye.
For cases involving a previously known client and patient, in which the possibility of euthanasia is discussed in advance of an anesthetic
procedure, verbal consent via phone is acceptable. Having more than one staff member confirm the consent for euthanasia via phone and
document the conversation is recommended. In such a case, written consent is not essential, and insisting on written consent may create
more stress for the client. When accepting consent for euthanasia via phone, having a second staff member confirm the client’s wishes is
recommended. If verbal consent for euthanasia has been given and the procedure has already been completed, then written consent is
unnecessary. Having the owner return to the clinic to sign a written consent form may create more stress for the client. However, some
type of owner consent is required prior to humane euthanasia. Consent prior to euthanasia is always necessary.
Medetomidine is a strong sedative that causes _________ ____________ and
___________ as side effects. Acepromazine is a __________ sedative. Yohimbine and atipamezole are reversal agents for
_________________ (they are ____________), and thiopental is a _____________.
Medetomidine is a strong sedative that causes peripheral vasoconstriction and bradycardia as side effects. Acepromazine is a phenothiazine sedative. Yohimbine and atipamezole are reversal agents for alpha-2 adrenergic agonists (they are alpha-2 adrenergic blockers), and thiopental is a barbiturate.
Topic: Cytazoon felis
Cytauxzoon felis is a ____________ organism and transmission to cats is through _______ bites. Cats usually show clinical signs ____-_____ _______ after infection. Signs can be ? Cats will also commonly have a marked __________.
The organism invades the reticuloendothelial cells of the ? so cranial __________ can often be present. The ___________ can be affected causing ___________. Thrombocytopenia is likely related to the development of _______, which can cause spontaneous bleeding. There is no effective _________ and prognosis is ______ to _____. Current treatment recommendations include the antimalarial drug ________ combined with the antimicrobial _________ as well as _______, ________ and supportive care.
Anti-protozoal medications such as imidocarb have been used with varying success. Corticosteroids and antibiotics such as doxycycline, enrofloxacin, and marbofloxacin are commonly used to treat Mycoplasma haemofelis, but they are ineffective against Cytauxzoon.
______, _______, ________ should also be considered as differentials.
Cytauxzoon felis is a protozoal organism and transmission to cats is through tick bites. Cats usually show clinical signs 1-3 weeks after infection. Signs can be non specific and include anorexia, lethargy, dyspnea, and icterus. Cats will also commonly have a marked pyrexia.
The organism invades the reticuloendothelial cells of the lungs, spleen, liver, lymph nodes, and other organs so cranial organomegaly can often be present. The bone marrow can be affected causing pancytopenias. Thrombocytopenia is likely related to the development of disseminated intravascular coagulation, which can cause spontaneous bleeding. There is no effective therapy and prognosis is poor to grave. Current treatment recommendations include the antimalarial drug atovaquone combined with the antimicrobial azithromycin as well as fluids, heparin and supportive care.
Anti-protozoal medications such as imidocarb have been used with varying success. Corticosteroids and antibiotics such as doxycycline, enrofloxacin, and marbofloxacin are commonly used to treat Mycoplasma haemofelis, but they are ineffective against Cytauxzoon.
Immune mediated hemolytic anemia, cholangiohepatitis, and FIP should also be considered as differentials.
Topic: Diabetes in Cat
A low carbohydrate canned diet will help to improve glycemic control in a diabetic cat. It may even help to put the cat into diabetic remission for a period of time, where she will not require exogenous insulin. High fiber diets are helpful in the regulation of canine diabetes mellitus.
Topics: Pyrethrin toxicity.
Many cats are sensitive to flea medications, especially some over the counter varieties. The medication should be quickly ________ off with a _____. The ______ should also be carefully rinsed depending on the status of the cat if ________ is suspected. This often happens with cats that groom then ______ the medication from the paws. _______ and _____ should be started immediately. ____________, a ______ ______, is the first best choice to stop the tremoring. If this is unsuccessful, ______ can also be used, and if active seizures are occurring should be given immediately. ______ or _______ drip can be given if seizures are refractory.
Flea collars are often ineffective and many cats are sensitive to these as well. If the owner would like flea control, a veterinarian prescribed medication would be advised. Good choices for flea control include feline
________ or ______.
Many cats are sensitive to flea medications, especially some over the counter varieties. The medication should be quickly washed off with a bath. The mouth should also be carefully rinsed depending on the status of the cat if ingestion is suspected. This often happens with cats that groom then lick the medication from the paws. IV catheter and fluids should be started immediately. Methocarbamol, a muscle relaxant, is the first best choice to stop the tremoring. If this is unsuccessful, valium can also be used, and if active seizures are occurring should be given immediately. Phenobarbital or Propofol drip can be given if seizures are refractory.
Flea collars are often ineffective and many cats are sensitive to these as well. If the owner would like flea control, a veterinarian prescribed medication would be advised. Good choices for flea control include feline Frontline or Revolution.
Topics: Eosinophilic granuloma. Eosinophilic granulomas or linear granulomas are usually _____ in shape and _____-_____ in color located on the _____ thigh. Typically, they don’t _____ and are not usually ____. They are thought to be due to hypersensitivity and allergies to ? However, they are often ?
Treatment is aimed at controlling the hypersensitivity. Antibiotics and corticosteroids are sometimes used. In cats younger than 1 year many ?
Eosinophilic granulomas or linear granulomas are usually linear in shape and pink-yellow in color located on the caudal thigh. Typically, they don’t crust and are not usually pruritic. They are thought to be due to hypersensitivity and allergies to fleas, food, or inhalants. However, they are often idiopathic. Treatment is aimed at controlling the hypersensitivity. Antibiotics and corticosteroids are sometimes used. In cats younger than 1 year many spontaneously regress over 3-5 months.
Topic: Toxoplasmosis (See photo in question)
Toxoplasmosis is a _______ disease. Cats are the ______. Clinical signs are typically seen in younger cats but can occur in older cats or immunocompromised cats as well. Signs can vary from ?
_______ are shed in the feces, where they take around ___ days to sporulate and become infective. _______ the affected animal will decrease risk of transmission to other animals.
Cleaning the litterbox ______ will decrease the risk of exposure of infective oocysts to humans. Toxoplasmosis can cause ? 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 ___________.
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.
Since this cat is still eating some of her meals, the best choice would be to treat the renal failure with IV fluids, gastric protectants, and an appetite stimulant like mirtazapine. Mirtazapine works by antagonizing central pre-synaptic alpha-2 receptors. By antagonizing these receptors, the negative feedback loop that inhibits the release of norepinephrine (NE) is shut down causing an increased build up of NE.
Norepinephrine then acts at other receptors to increase appetite. The drug also has antiemetic effects by inhibiting 5H2 and 5HT3 receptors.
Topic: Cat Scratch Fever
This disease is caused by ? Usually, you will see a ______ at the site of inoculation followed by _____ and ? one week later. The lymphadenopathy will last _______ but is self-limiting. Neat! Cats are generally ________.
This disease is caused by Bartonella henselae. Usually, you will see a papule at the site of inoculation followed by fever and local lymphadenopathy one week later. The lymphadenopathy will last months but is self-limiting. Neat! Cats are generally asymptomatic.
This is a case of plasma cell pododermatitis which is a relatively uncommon idiopathic disorder of cats. While the history and description of the lesions is consistent with this uncommon disorder, other differentials could include pemphigus foliaceus, pemphigus vulgaris, or lupus erythematosus. A chemical or physical trauma could cause lesions such as these but do not fit well with the history. Neoplasia, infection, or sterile pyogranulomas are possible but would be unlikely to affect all paws simultaneously. Eosinophilic granuloma complex is also possible.
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