Week of Feb 10 Day 2 Flashcards
Helpful info
Topic: Squamous Cell Carcinoma in Cats
1. What are the treatment options for SCC?
2. What is the treatment of choice if SCC is small enough?
Depending on their size, they can be treated with surgery or radiation. If small enough, the treatment of choice is a single dose of radiation with a Strontium-90 probe which delivers high doses of radiation but does not penetrate more than a couple of millimeters and can only be used for small lesions.
Topic: Acetaminophen Toxicity in Cats
1. Acetaminophen toxicity in cats results in what major change to the blood? What is this a direct result of? Explain how this occurs.
2. What can be found on the RBCs?
- Dark brown blood, a direct result of methemoglobinemia which is caused by oxidative damage to the hemoglobin.
- Heinz bodies are usually present in animals with methemoglobinemia.
Topic: DKA in Cats
If a feline patient presents to you in DKA, what is the first form of insulin that you should use and why?
The recommended insulin type is Humulin-R, or regular insulin. This is a shorter acting insulin which will help to get the ketonuria to resolve more efficiently.
After the ketosis has resolved and the cat is hydrated, eating, drinking, and electrolytes are stable, the cat can be switched to a longer acting insulin such as Glargine or PZI. These insulin types are used for long term control in felines after the ketoacidosis has been corrected, but other insulin types can also be used.
A 4-year old FS indoor/outdoor cat presents for two seizure episodes over the last few days. Physical exam reveals aqueous flare in both eyes and a temperature of 103.5F. There are no other cats in the household, and the owner is feeding a raw meat diet. A comprehensive blood panel is submitted and results are as follows: FeLV/FIV/FCV negative, Heartworm antibody negative, Toxoplasma IgM 1:1024, IgG 1:512, Cryptococcus negative, neutrophils 28,000/uL (2,500-12,500/ul), chemistries all WNL. The cat is current on vaccinations including Rabies. Which of the following medications is indicated?
The neurologic symptoms and uveitis in this cat are being caused by the protozoan Toxoplasma gondii. Cats are the definitive host for this organism. The cat was likely infected through eating raw meat or infected prey. An elevated IgM titer shows active infection with the organism.
The most common symptoms are lethargy, decreased appetite, and fever. The disease can cause diarrhea, upper respiratory symptoms, inflammation of the eyes, and neurologic disease. The treatment for this infection is the antibiotic Clindamycin.
Doxycycline is an antibiotic used in treating other infections in cats such as Hemobartonella and Mycoplasma.
Thiamine deficiency can occur and lead to seizures in cats fed a diet deficient in this vitamin. Because this is an outdoor cat with capability of predation, a thiamine deficiency would be unlikely. There is a test for thiamine levels if deficiency is suspected. Further questioning of this cat’s raw diet would be helpful.
Fluconazole is an anti-fungal medication used in treating Cryptococcus neoformans, Coccidioides immitis, and other fungal diseases.
Phenobarbital would only be indicated if the seizures become frequent or severe. It is best to treat the underlying cause of the seizures first.
Topic: Toxoplasmosis in Cats
1. What is Toxoplasmosis?
2. Etiologic agent?
3. Transmission?
4. What are the most common clinical signs?
5. Diagnostics?
6. Treatment?
7. Prevention
- Toxoplasmosis is an protozoal disease of cats.
- Toxoplasma gondii
- Cat eats rat with bradyzoites in tissues. Cat can transmit to humans and/or other cats if it was recently infected because oocysts are only shed in the stool for 1-2 weeks.
- The most common symptoms are lethargy, decreased appetite, and fever. The disease can cause diarrhea, upper respiratory symptoms, inflammation of the eyes, and neurologic disease.
- An IgM titer of 1:64 or greater suggests recent or active infection and that cat is at risk of shedding oocysts in their stools.
- The treatment for this infection is the antibiotic Clindamycin.
- Oocysts are not infective until they sporulate. This process takes > 24 hours, so emptying the litter box daily is advised, preferably by someone who is not pregnant.
If an owner has owned cats for a long while, it is possible that they may have previously been exposed and therefore have mounted an immune response to the organism. If so, it may be advisable to test for Toxoplasma antibody titers in the owner. A sufficient antibody titer will mean the client is protected from infection during the first trimester.
What is the treatment of choice for fibrosarcomas and why?
These tumors are slow to metastasize but extremely aggressive locally. A radical excision of the mass will be your best opportunity at a surgical cure.
More megacolon info
Based on the radiographs, you should have diagnosed this cat with megacolon and colonic impaction. The components of treatment for this condition are to achieve and maintain optimal hydration, remove impacted feces, dietary fiber and/or laxative treatment and use of colonic prokinetic agents. An enema is probably indicated for this cat but was not part of the answer choices. Cisapride is no longer widely available because of cardiac toxicity in a small number of human patients, but veterinarians obtain cisapride from compounding pharmacists. Psyllium is a non-fermentable fiber that increases the transit rate of ingesta, increasing the frequency of defecation.
An enterotomy would be indicated for a small bowel obstruction but not for the colonic obstruction. Antibiotics as well as cimetidine and sucralfate would not be wrong for this cat but are not the most important aspects of managing this disease. Methimazole is a treatment for hyperthyroidism, which was not diagnosed in this cat.
If the cat does not respond to medical therapy, a sub-total colectomy may be indicated.
What is the ONLY infectious cause of corneal ulcers in CATS? Describe what the ocular lesions look like.
Herpesvirus is the only infectious cause of corneal ulcers in cats although they can become infected secondarily with bacteria.
Herpes causes characteristic ulcers which are linear or sometimes referred to as dendritic ulcers. The lesions tend to be unilateral but can be bilateral. Usually, this is a persistent or recurrent disease that often flares up with stress.
Topic: Cholangiohepatitis in Cats
- Define cholangiohepatitis.
- Etiology
- Concurrent diseases?
- Main treatment ?
The biopsy results show cholangiohepatitis which is inflammation of the biliary system and liver parenchyma. It can be autoimmune in nature, or may be triggered by underlying infection or neoplasia. Concurrent diseases often include pancreatitis and inflammatory bowel disease.
The main treatment of non-suppurative cholangiohepatitis is prednisolone since it is most often immune in origin. Ursodiol is often used for its immunomodulatory, hepatoprotectant, and antifibrotic effects. It helps with the flow of bile through the liver. Other helpful therapies include S-adenosylmethionine (SAMe) and Vitamin E.
Pancreazyme powder and vitamin B12 injections (cyanocobalamin) can be useful in chronic pancreatitis but would not be the best treatment for cholangiohepatitis.
Budesonide is a steroid that may be beneficial for inflammatory bowel disease but would likely not provide enough systemic anti-inflammatory effects for the liver disease.
Metronidazole or Clavamox are often used in conjunction with prednisolone if infection is suspected but is not the primary treatment for this disease. Antibiotics are more important in suppurative cases.
Chlorambucil is used as an immunosuppressant in refractory cases of cholangiohepatitis when the prednisolone is not enough to control the disease.
L-carnitine may be beneficial if hepatic lipidosis is a concurrent problem from the anorexia but is not a treatment for cholangiohepatitis.
Vitamin E is a good antioxidant for the liver. Vitamin K may be used in cases of liver failure especially prior to surgery for liver biopsies.
Topic: Unilateral Facial Nerve Paralysis
- Most common cause? Other etiologies?
- Main treatment option? What has been used in humans that is NOT useful in animals?
- Prognosis? What can become affected as well?
- Risk factors for developing facial nerve paralysis?
- Facial nerve paralysis has been seen in dogs with?
- Unfortunately, it is most commonly idiopathic; however in cats it can sometimes be caused by things such as nasopharyngeal polyps, neoplasia and trauma.
- 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.
- Prognosis for recovery is guarded and the clinical signs are typically permanent. The unaffected facial nerve can become affected as well.
- 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.
Topic: Hyperthyroidism in Cats
- What are the most common and classic clinical signs of hyperthyroidism in cats?
- What clinical signs are uncommon in cats with hyperthyroidism?
- What diagnostic tests should be run for a suspect hyperthyroid patient? Which test is more sensitive? Why is this helpful?
- What test result is occasionally elevated in NORMAL, non-hyperthyroid cats? What should be done when this happens?
- Thyroid technetium scan and/or methimazole trials should be run if what test result is normal?
- What test is run in canine hypothyroid patients?
- Polyphagia, weight loss, and hyperactivity are classical clinical signs in a cat with hyperthyroidism. Other signs might include a dull haircoat, PU/PD, vomiting, diarrhea, and aggression.
- Lethargy, anorexia, and weakness are uncommon but can occur in a rare form of the condition called apathetic hyperthyroidism.
- A free T4 in conjunction with total T4 should be run. Free T4 is a more sensitive test that is better at distinguishing mild hyperthyroidism from normal thyroid function, and the equilibrium dialysis assay is superior to other assays.
- Occasionally elevated free T4s are seen in normal cats, so a total T4 should be run in conjunction.
- Thyroid technetium scan and/or methimazole trials should be run if the free T4 is normal.
- Serum TSH is run in canine patients suspected of hypothyroidism.
Any dog or cat that presents with vestibular signs such a head tilt, nystagmus, and circling should have an ______ exam as part of its physical exam.
Vestibular disease can be central or peripheral in origin. Although, advanced imaging such as a _____ or _____ scan of the head is often recommended for vestibular disease to better characterize the brain and inner ear, an _____ exam is the least invasive way to evaluate the patient and should be the next step, even prior to ?
Also, it is important to check ______ ________ in an animal presenting with vestibular disease. ___________ and _________ accident can be an important cause to rule out. It is a good idea to get the _____ _________ before you draw the blood to minimize stress during the readings.
Any dog or cat that presents with vestibular signs such a head tilt, nystagmus, and circling should have an otic exam as part of its physical exam.
Vestibular disease can be central or peripheral in origin. Although, advanced imaging such as a MRI or CT scan of the head is often recommended for vestibular disease to better characterize the brain and inner ear, an otic exam is the least invasive way to evaluate the patient and should be the next step, even prior to running blood work.
Also, it is important to check blood pressure in an animal presenting with vestibular disease. Hypertension and vascular accident can be an important cause to rule out. It is a good idea to get the blood pressure before you draw the blood to minimize stress during the blood pressure readings.
Taurine deficiency in cats causes ________ degeneration as well as __________ _________________. Since most commercial cat diets have adequate taurine supplementation, it is now rare to see this occurrence unless the cat is on a _________-_________ diet.
Taurine deficiency in cats causes retinal degeneration as well as dilated cardiomyopathy. Since most commercial cat diets have adequate taurine supplementation, it is now rare to see this occurrence unless the cat is on a home- cooked diet.
What cell type is least affected in FIV patients? What cell types are most affected?
The correct answer is platelet. All are affected except for the platelet. After inoculation, replication occurs in lymphoid and salivary tissues.
Eventually, the virus spreads to mononuclear cells, while viremia is suppressed by the host immune response (asymptomatic carrier phase) that can last several years. A slow decline in the number of CD4+ cells is seen, resulting in failure of the immune system. Cats are often about 10-15 years old by the time this occurs.
An 8-year old female spayed domestic long hair presents for her yearly wellness examination. Her exam is within normal limits, but she is very stressed from the muzzle on her face and is difficult to examine due to her fractious nature. The owner states she has always been a “big drinker” but seems to be urinating normal amounts and otherwise acting fine. Her diet is Friskies and chicken. You perform a wellness blood profile, and the results show the following abnormalities:
BUN 35 mg/dL (19-34 mg/dl)
creatinine 2.4 mg/dL (0.9-2.2 mg/dl) glucose 285 mg/dL (60-120 mg/dl)
Her CBC shows:
neutrophils 15,800/uL (2,500-12,500/ul) lymphocytes 1,200/uL (1,500-7,000/ul)
Her urinalysis shows:
USG 1.049 (>1.035)
pH 6.0
negative for bacteria, leukocytes, glucose, crystals, and blood.
This patient likely has a stress induced hyperglycemia. Hyperglycemia in a stressed cat without the presence of glucosuria is strongly suggestive of a stress hyperglycemia rather than diabetes mellitus. The high specific gravity of the urine makes the mildly elevated renal values likely pre-renal (secondary to dehydration) and helps to rule out renal failure. Additionally, animals that are on a high protein diet can have an elevated BUN. The CBC findings are consistent with a stress leukogram. Given these findings, no treatments are indicated at this time. It may be a good idea to suggest a higher quality diet for an overall health benefit. Insulin injections should only be administered when diabetes mellitus has been confirmed. This is best confirmed with an elevated fasting blood glucose and glucosuria. If there is a question whether or not diabetes is occurring, a fructosamine level can sometimes help to differentiate this. Broad spectrum antibiotics are not indicated as this cat has no evidence of an infection. Daily subcutaneous fluids and a low protein, low phosphorus renal diet would be helpful in cats with chronic renal failure.
If you see a patient with hyperglycemia but NO glucosuria, what does that mean?
- That means that patient most likely has stress hyperglycemia rather than diabetes mellitus.
If a patient has a high specific gravity but their renal values are mildly elevated, what does that mean?
The high specific gravity of the urine makes the mildly elevated renal values likely pre-renal (secondary to dehydration) and helps to rule out renal failure. Additionally, animals that are on a high protein diet can have an elevated BUN.
Define a stress leukogram.
A stress leukogram is neutrophilia, monocytosis, lymphopenia, eosinopenia.
A cat that has retinal hemorrhages and a detached retina should have a ___________ __________ measured immediately. This quick and easy diagnostic step can determine if ____________ should be treated. Controlling ______________ can sometimes allow retinas to reattach and restore vision.
The next best test after measuring a ___________ ___________ would be to submit at least a _________ profile and _____. It is important to rule out ______________ and ________ disease because both conditions can cause hypertensive retinopathy.
Generally, retinal hemorrhages alone do not warrant measurement of ___________ parameters. A more serious ocular condition like non-traumatic hyphema would be a better indicator to run this test.
Feline ___________ serology is a good test to perform to evaluate underlying infectious causes of retinopathy if your other baseline tests are normal.
A cat that has retinal hemorrhages and a detached retina should have a blood pressure measured immediately. This quick and easy diagnostic step can determine if hypertension should be treated. Controlling hypertension can sometimes allow retinas to reattach and restore vision.
The next best test after measuring a blood pressure would be to submit at least a renal profile and T4. It is important to rule out hyperthyroidism and renal disease because both conditions can cause hypertensive retinopathy.
Generally, retinal hemorrhages alone do not warrant measurement of coagulation parameters. A more serious ocular condition like non-traumatic hyphema would be a better indicator to run this test.
Feline infectious serology is a good test to perform to evaluate underlying infectious causes of retinopathy if your other baseline tests are normal.
What is a classic lesion seen in feline patients with FIP and why?
Pyogranulomatous vasculitis will occur due to the deposition of antigen-antibody complexes in the venular endothelium. Complement-mediated inflammation results in pleural and peritoneal effusion (wet form) and partial cell-mediated immune response results in slow viral replication with granuloma formation (dry form). Negri bodies may be seen with rabies. Cellular degeneration and vascular cuffing are seen with many disease processes.
A 12-year-old female spayed Siamese cat presents for weight loss and progressive vomiting of 2 months duration. On physical exam, the intestines feel diffusely thickened and the cat has a body condition score of 2/9. Blood work shows a low albumin of 1.9 g/dL (normal 2.4-3.9 g/dL), and normal kidney and thyroid values. Abdominal ultrasound confirms the diffusely thickened intestines. There are also several mildly prominent and hypochoic mesenteric lymph nodes. You suspect the cat has cancer. What is the most appropriate treatment for the type of cancer you suspect in this patient?
Chlorambucil and prednisolone
Radiation therapy
Cyclophosphamide, vincristine, doxorubicin, and prednisone
Surgical resection
Carboplatin
The cat most likely has small cell or low-grade intestinal lymphoma based on the history and clinical findings. This is considered an indolent or slowly progressive form of lymphoma and can be effectively treated with chlorambucil and prednisolone.
This form of lymphoma is sometimes thought to develop from the progression of inflammatory bowel disease in cats. Chlorambucil is an oral alkylating agent that is usually well tolerated with few side effects. Many cats can live several years with this form of lymphoma and this treatment.
Cyclophosphamide, vincristine, doxorubicin, and prednisone are the drugs in a CHOP chemotherapy protocol used to treat dogs and cats (and people) with high grade or large cell lymphoma, which more commonly manifests as a large focal mass rather than diffusely thickened intestines. Surgery and radiation therapy are not good treatment options due to the diffuse nature of the cancer.
Carboplatin is not known to be an effective chemo agent for low-grade lymphoma in cats.
What is the holding layer of the abdomen?
The correct answer is external rectus sheath.
This is true for most species, not just cats. The submucosa is the holding layer for most of the gastrointestinal tract (esophagus, intestines)
- Explain the pathophysiology of Oak toxicity in cattle.
- What is the best way to prevent it?
- Ruminants are more susceptible to oak toxicity than what other species?
- Cattle can normally eat some oak and handle the tannins, but when the diet consists of mainly oak –> Oak tannins hydrolyzed in rumen to toxic gallic acid, pyrogallol –> GI mucosa disrupted –> gallic acid and pyrogallols destroy renal tubules / Some hydrolyzed tannins are absorbed and bound to plasma proteins and endothelial proteins –> leading to vascular damage and fluid and blood loss from vessels –> edema.
- The best way to prevent oak (Quercus) toxicity is to allow the animals to fill up on hay, since the grass is covered by snow.
- Ruminants are more susceptible than horses because of the hydrolysis of gallotannins in the rumen.
Which of these treatments is least effective for treating cyanide toxicity and why?
Sodium nitrate
Sodium thiosulfate
Supplemental oxygen
Methylene blue
The answer is supplemental oxygen. Cyanide blocks cellular respiration and blocks oxidative transport. As a result, hemoglobin cannot release oxygen to the tissues and venous blood stays saturated with oxygen and is bright red. Supplemental oxygen is unlikely to change this. The other three options are the usual treatments for cyanide toxicity.
- What is the main vector of Trypanosomiasis (Nagana in cattle or African sleeping sickness in man)?
- What are the most common clinical signs?
- Where is Nagana disease found?
- The correct answer is Tsetse fly. The usual Trypanosome responsible for Nagana is Trypanosoma brucei brucei.
- Typical clinical signs are fever, anemia, weight loss, and sleeping sickness.
- Nagana is found in Africa.
- What is the main vector of Trypanosomiasis (Chagas’ disease)?
- What body systems are affected?
- Where is Chagas’ disease found?
- The Reduvid beetle is responsible for vectoring Chagas’ disease, another Trypanosomal disease. Chagas’ disease is caused by Trypanosoma cruzi.
- It causes nervous system, digestive system and cardiac disease.
- Chagas’ disease is present in South America and some parts of the USA.
When performing a necropsy on a cow, you find multiple abnormalities including abomasal ulcers, interstitial pneumonia, pericardial effusion, and mastitis. You also see that the liver has a brown- (tan) and red-mottled lobular pattern described as a nutmeg liver. Which of these conditions in the cow could lead to the necropsy findings in the liver and why?
The appearance of a nutmeg liver occurs because there are red central veins and sinusoids between tan areas of swollen hepatocytes. This occurs with right sided heart failure from passive congestion of the sinusoids of hepatocellular hypoxia. Pericardial effusion causes right sided heart failure and is the cause of the liver’s appearance.
Topic: Freemartinism in Cattle
- Define Freemartinism.
- What is the pathophysiology of this disease?
- What is the chromosome pattern of the twins born?
- What clinical signs are exhibited?
- What are the reproductive consequences of this disease?
- & 2. Freemartinism is the normal result of mixed-sex twins in cattle. This occurs due to shared circulation of chorionic blood vessels in utero.
This allows antimullerian duct hormone and testosterone from the male fetus to inhibit development of the female tract. - Cytogenetic examination of freemartins reveals both XX and XY chromosome patterns. Interestingly, although some bulls born as mixed-sex twins show the presence of XX cells, they have normal conformation and external genitalia and are fertile.
- The heifer is intersex, infertile with masculinized behavior, non-functioning ovaries, and is genetically chimeric (XX/XY); the bull is phenotypically normal - The female has a short vagina that ends blindly without communication to the uterus. The heifer also frequently shows masculinized behavior.
Topic: Bovine Abortion
In cattle, ___________ is a significant risk factor for abortion.
Brucella abortus can cause abortion, but there are typically signs of severe ____________, including __________.
IBR virus can quickly _____ a bovine fetus, but as with _________ viruses in many hosts, there are signs of severe _________ throughout the fetus.
Listeria monocytogenes can cause abortion, but the fetus is usually __________ to a significant extent, and there are often _______ micro-
abscesses present.
Neosporum caninum can cause _________ or ________ patterns of abortion, but typically abortions occur earlier than ___ months and there is ________ of tissues. Frequently, there are _________ in the brain.
In cattle, twinning is a significant risk factor for abortion.
Brucella abortus can cause abortion, but there are typically signs of severe inflammation, including placentitis.
IBR virus can quickly kill a bovine fetus, but as with Herpes viruses in many hosts, there are signs of severe inflammation throughout the fetus.
Listeria monocytogenes can cause abortion, but the fetus is usually autolyzed to a significant extent, and there are often brain micro-
abscesses present.
Neosporum caninum can cause epidemic or enzootic patterns of abortion, but typically abortions occur earlier than 8 months and there is autolysis of tissues. Frequently, there are granulomas in the brain.
How is Neospora caninum spread? Other than cattle, what other hosts can be infected as intermediate hosts?
The canine is the definitive host and sheds oocysts in the feces, which cause the disease when consumed by cattle. Like cattle, deer may also be infected as intermediate hosts. The dogs are initially infected by eating infected tissues from the cattle, most commonly an aborted fetus.
The correct answer is approximately 3.5 years of age. A good rule of thumb is that the permanent incisors are fully erupted and in wear at 1.5, 2.5, 3.5 and 4.5 years of age (permanent incisors 11, 12, 13 and 14 respectively). The first permanent incisor erupts at 18 to 24 months, the second at 24 to 30 months, the third at 33 to 36 months, and the fourth erupts at 42 and 48 months. This means that the rough rule of thumb is a bit off for 11 in some animals, but it does help to remember these approximate times. There is some individual and some breed variability.
After eruption, each tooth takes about 6 months before it is in wear.
Topic: Ketosis
The oral propylene glycol will serve as a precursor for glucose production, and will help with the demands of lactation that are causing increased fat mobilization and ketosis. A fourth treatment that is sometimes used is corticosteroids, as they decrease milk production and increase gluconeogenesis.
Why do dairy cattle with rumenitis die from liver abscesses?
The low rumen pH causes rumenitis allowing bacteria to translocate through the mucosa and be filtered from the hepatic portal circulation by the liver, resulting in one or more hepatic abscesses.
How soon after administration of a dose of dexamethasone for induction of parturition in a cow do you expect parturition?
The correct answer is 48 hours. Parturition may occur anytime between 2 and 7 days but on average it occurs on the second day. A dose of 25-30 mg IM is sufficient.
__________ stones are the result of high intakes of ________ in mature range grasses, combined with other factors such as dehydration.
Struvites (3?) tend to be found in feedlot animals receiving large amounts of _______.
Calcium carbonate stones are most common in ________ grazing pastures high in ________ and _________.
Silicate stones are the result of high intakes of silica in mature range grasses, combined with other factors such as dehydration.
Struvites (ammonium, magnesium, and phosphate) tend to be found in feedlot animals receiving large amounts of grain.
Calcium carbonate stones are most common in sheep grazing pastures high in calcium and oxalates.
Topic: BVD
MD is the severe form of BVD, believed to occur chiefly when an animal born infected with the non-CPE (non cytopathic effect) form of
BVD virus is superinfected with CPE biotype of BVD virus, or the virus transforms to the CPE biotype. Severe ulcerations throughout the Gl tract can result in death.
A 2-year old nonlactating dairy cow in California has a sudden onset of head tilt and drooling. The owner also reports that she appears less active and less interested in feed than normal, and today is circling in one direction in the pen. You examine her and find T=105F (40.6 C), HR=96, and RR=32. There is ptosis, drooped ear, and weakness of the lips on the affected side. You take a lumbosacral spinal tap (see photo), and submit the CSF to your lab. The results show elevated protein and WBCs, with the cell type being mainly monocytes. The lab reports seeing some gram positive bacteria in the monocytes of the CSF. Based on these findings what is the best treatment for this condition?
The diagnosis is Listeriosis. Listeria monocytogenes can effectively be treated in the early stages of the disease with penicillin, ampicillin, or tetracycline. Intramuscular procaine penicillin for example has a withdrawal of 10 days for slaughter (meat) and 48 hours for milk if the animal is lactating. Other choices of approved antimicrobials would also likely be effective since L. monocytogenes is susceptible to most antimicrobials. For a list of approved animal drugs see www.farad.org/vetgram. FARAD is the United States Food Animal Residue Avoidance Databank which gives withdrawal information as well as a list of prohibited drugs. The other drugs listed as choices here are either not approved for Listeriosis as a label indication or prohibited and cannot be legally used in food animals in the USA.
Topic: Listeria in Cattle
- What are the most common clinical signs seen in cattle suffering from Listeria?
- Diagnostic testing ?
- Treatment
- What tx option has a withdrawal time?
- Ptosis, drooped ear, and weakness of the lips on the affected side as well as circling, head tilt, drooling, decrease in appetite. Pyrexia, tachycardia, and tachypnea can also be seen.
- CSF tap - monocytosis, elevated protein, +/- gram + bac (??)
- Listeria monocytogenes can effectively be treated in the early stages of the disease with penicillin, ampicillin, or tetracycline.
- Intramuscular procaine penicillin for example has a withdrawal of 10 days for slaughter (meat) and 48 hours for milk if the animal is lactating.
Other choices of approved antimicrobials would also likely be effective since L. monocytogenes is susceptible to most antimicrobials.
You arrive at a dairy in Northern California that has several lactating cows that are pale, icteric, and showing hemoglobinuria. You perform blood work and see no signs of methemoglobinemia or Heinz bodies. Phosphorus levels range between 1.6 and 2.0 mg/dl. What is your diagnosis?
Babesia
Postparturient hemoglobinuria
Copper toxicity
Anaplasmosis
‹Onion toxicosis
The correct answer is postparturient hemoglobinuria. The key to correctly answering this question is to know that phosphorus levels less than 2.0 mg/dl will most likely result in hemolysis. Paying attention to the fact that these cows are lactating should also help you to reach the correct diagnosis. Copper and onion toxicity will both cause methemoglobinemia. Anaplasmosis does not result in hemoglobinuria.
Over 80% of foot disease in cattle involving the digits involves the ______ digits. Additionally, approximately 85% of these involve the ______ aspect. This is because they bear the majority of their ______ limb weight on the ________ claw in the hind. In the front, cattle put most of their weight on their _______ claw.
Over 80% of foot disease involving the digits involves the rear digits. Additionally, approximately 85% of these involve the lateral aspect. This is because they bear the majority of their rear limb weight on the lateral claw in the hind. In the front, cattle put most of their weight on their medial claw.
Lice are ________ with ___ legs and ticks and mites are __________ with ___ legs.
Lice are insects with 6 legs and ticks and mites are arachnids with 8 legs.
The three genera of blood sucking cattle lice are Solenopotes, Linognathus, and Hematopinus.
A local purebred cattle herd has been increasingly affected with papillomas to the point that it is now a problem throughout the herd, and the owner is concerned. Which of the following treatment options would yield the best results?
Purchase commercially available vaccine
Depopulate the herd
Prepare an autogenous vaccine by isolating some warts from the herd
Treat herd with acyclovir
The correct answer is to prepare an autogenous vaccine by isolating some warts from the herd. The commercially available vaccine is thought to be effective only against the same strain; therefore, it is not curative in many cases. Treating with acyclovir is not recommended. The least desirable treatment option would be depopulation of the herd. This would potentially be financially devastating.
Photosensitization mainly affects unpigmented skin where photodynamic agents have accumulated making the skin hyper-reactive to UV light. The cause of this photosensitization can be primary, in which case a plant-derived compound (such as hypericum) or chemical is injected, ingested or topically applied, is the cause. Alternatively, the cause can be secondary due to hepatic damage/failure where the liver fails to remove ingested chlorophyll-breakdown products like phylloerythin, which accumulates in the skin and results in UV damage (sunburn). You need to determine whether this is primary or secondary by checking liver enzymes and bilirubin levels.
The correct answer is aspiration pneumonia. Cranioventral lung disease is the classical finding with aspiration pneumonia. If you think
about it, you realize that if an animal inhales particulate matter, gravity will influence its path and thus there will be cranioventral
involvement. Potential causes of aspiration pneumonia in calves include leaking nipples from milk bottles, mineral oil drenches,
pharyngeal paralysis (due to white muscle disease), gastric reflux, improper intubation, and hypoglycemia. A pneumothorax results in no
audible lung sounds dorsally. Fibrinous pleuropneumonia is a good differential, however the clinical signs will be more severe and lung
pathology will be more diffuse. For example, you will be able to hear crackles and wheezes in all areas, appreciate a soft cough, see nasal
discharge, and at times, pleural rubs may be audible if there is pleural effusion or a septic pleuritis. Fog fever is a respiratory disease of adult
cows that results when they suddenly consume lots of lush pasture. At this point, the plants are high in tryptophan which is subsequently
metabolized in the rumen to 3-methyl indole (toxic to the lungs).
Which of the following is the most common presentation for a patient with idiopathic epilepsy?
A 5-month old Yorkshire Terrier that has generalized tonic-clonic seizures, often after eating. The dog is sometimes obtunded between seizures.
A 2-month old Chihuahua that presents in status epilepticus after vomiting and not eating for a day. This is the first seizure the dog has been observed having
A 3-year old Labrador Retriever that recently began having generalized tonic-clonic seizures approximately once weekly, most frequently at night when resting. The dog appears and behaves normally between seizures.
A 9 year-old Boxer that recently began having focal motor seizures that began weekly but are now becoming more severe and frequent.
Despite the term, idiopathic epilepsy refers to a specific condition and should not be applied to any patient with seizures of unknown cause. Most dogs with idiopathic epilepsy begin having seizures between 1 and 5 years of age. Breeds commonly affected include Beagles, Keeshonds, Dachshunds, Labrador and Golden Retrievers, Shetland Sheepdogs, Irish Wolfhounds, Vizslas, and English Springer Spaniels.
Idiopathic epilepsy is much less common in cats.
While not always the case, the classic descriptions of patients with idiopathic epilepsy describe generalized tonic-clonic seizures without interictal abnormalities with seizures beginning during the 1 to 5 year age range.
The Yorkshire Terrier described shows signs most consistent with a portosystemic shunt.
The Chihuahua described shows signs most consistent with hypoglycemia.
The Boxer’s signalment and signs are most consistent with intracranial neoplasia.
Which is not a common treatment option for dogs with hyperadrenocorticism?
Ketoconazole
Adrenalectomy
Pituitary surgery
o,p’-DDD (Lysodren or Mitotane)
The correct answer is pituitary surgery. Pituitary surgery is the most common mode of treatment in humans with hyperadrenocorticism, but it is rarely performed in dogs. Adrenalectomy is a dangerous surgery, but it is often performed with adrenal tumors causing adrenal dependent hyperadrenocorticism. Lysodren is essentially the insecticide DDT. It is commonly used to treat PDH and causes selective necrosis of the zona fasciculata and zona reticularis. Ketoconazole inhibits production of all steroids and is used as a medical treatment option for functional adrenal
Phenobarbital is primarily metabolized by the liver. It is contraindicated in cases of severe liver or kidney disease. It can cause an elevation of liver enzymes. There is no direct effect on the kidney by barbiturates, but with high doses, renal impairment can occur due to hypotension from the drug. Liver and kidney values should be frequently monitored in patients on phenobarbital.
The correct answer is the dog suffered a brachial plexus avulsion and will most likely need to have the leg amputated. Dogs that are hit by cars or who jump out of moving cars often suffer brachial plexus avulsions. Complete nerve root avulsions are not treatable and usually require amputation of affected limbs. Partial avulsions carry a better prognosis but require large amounts of time and physical therapy before seeing any improvement. The lack of deep pain and motor function in the limb is a negative prognostic indicator supporting the diagnosis of a complete brachial plexus avulsion.
The most commonly reported organisms recovered in animals with endocarditis include ?
The most commonly reported organisms recovered in animals with endocarditis include Staphylococcus aureus, Streptococcus sp., Corynebacterium sp., Pseudomonas aeruginosa, Erysipelothrix, E. coli, and Bartonella sp.
The maximum safe rate of potassium infusion is ?
0.5 mEq/kg/hr
Urate stones in a small breed dog are usually secondary to a portosystemic shunt until proven otherwise. A portosystemic shunt results in blood from the abdomen being shunted away from the liver and into the main circulation. If shunted, the liver does not have an opportunity to detoxify the blood, which among other toxins, is very high in ammonia. The excess ammonia is excreted via the kidneys.
High levels of ammonia can result in formation of ammonium biurate crystals and ultimately stones.
An ACTH stimulation test is used to help diagnose hypoadrenocorticism and hyperadrenocorticism. A low dose dexamethasone test is used to help diagnose hyperadrenocorticism. Creatine kinase levels are evaluated when there is a suspected myopathy.
Chlorhexadine is a topical drug implicated in _________ and ?
Chlorhexadine is a topical drug implicated in ototoxicity and peripheral vestibular disease.
A 5-year old female Golden Retriever presents for lethargy, dark runny stool, and dehydration. Bloodwork from yesterday showed markedly
elevated plasma endogenous ACTH levels, K+ = 6.2 (3.9-5.1 mEq/L), Na+ = 135 (142-152 mEq/L), BUN = 62 mg/dl (8-28 mg/dl). Long-term
maintenance therapy for this patient should most likely include:
Mineralocorticoid supplementation alone
Supplementation with physiologic doses of prednisone
IV fluids and daily doses of IV dexamethasone sodium phosphate
Mineralocorticoid, glucocorticoid, and NaCl supplementation
Correct Answer
The correct answer is mineralocorticoid, glucocorticoid, and NaCl supplementation. This dog has hypoadrenocorticism which is usually a
deficiency in both glucocorticoids and mineralocorticoids. Elevated endogenous plasma ACTH concentrations with hypoadrenocorticism
means the disease is due to primary adrenocortical insufficiency and failure to produce both types of corticosteroids (as opposed to
secondary adrenocortical insufficiency, when the pituitary does not produce sufficient ACTH). Maintenance treatment of this disease
includes supplementation with mineralocorticoids (e.g. Fludrocortisone acetate), glucocorticoids (e.g. Prednisone), and sodium chloride in
the diet. IV fluids and dexamethasone sodium phosphate is used in an acute crisis.
During what phases of a dog’s menstrual cycle do female dogs attract male dogs? During what phase is the female dog willing to stand to be mated?
Proestrus and estrus. During both of these phases, the female attracts males but she will only stand to be mated during estrus.
Topic: Diabetes Insipidus
The production and release of ADH (vasopressin) is controlled by __________ __________ and ______ _________ in a normal dog. With central diabetes insipidus, the patient has a problem with the function of the ____________ (ADH ___________) and/or ____________/__________ ___________ (ADH _________) so the patient cannot respond to the changes in serum osmolality or blood volume and pressure. The urine specific gravity of a CDI patient is usually _______-______. The ___________ have no problem responding to ADH in CDI patients. There is a _______ of the hormone, not an ?
The production and release of ADH (vasopressin) is controlled by serum osmolality and blood volume in a normal dog. With central diabetes insipidus, the patient has a problem with the function of the hypothalamus (ADH production) and/or neurohypophysis/posterior pituitary (ADH release) so the patient cannot respond to the changes in serum osmolality or blood volume and pressure. The urine specific gravity of a CDI patient is usually 1.001-1.007. The kidneys have no problem responding to ADH in CDI patients. There is a lack of the hormone, not an over-abundance.
Topic: Fibrocartilaginous embolism (FCE)
- What are FCE’s caused by?
- Etiology
- Treatment
- Prognosis
- FCE is caused by an embolus of disc material in the spinal vasculature.
- It is unknown how the disc material gets into the vasculature.
- Most dogs with FCE usually get better on their own with nursing care.
- The prognosis of dogs with FCE varies. The loss of pain perception and lower motor neuron signs are poor prognostic indicators.
Topic: Alopecia X
- What is Alopecia X?
- Pathogenesis?
- Signalment
- Most common clinical signs
- Diagnostics
- Treatment of choice?
- Prognosis
- What medication may help?
- Hair cycle arrest (Alopecia X) is non-inflammatory skin condition, results in hair loss for dogs.
- The pathogenesis of this disease is not known.
- This condition is common in Pomeranians, Chow Chows, Alaskan Malamutes, Toy Poodles, and Samoyeds.
- The most common clinical signs are truncal alopecia and hyperpigmentation.
- Rule out endocrinopathies
- The treatment of choice (if the dog is intact) is to neuter.
- It is not uncommon to see a relapse in clinical signs 1-2 years after neutering.
- Melatonin may help new hair to grow if a relapse occurs.
What does initial stabilization of a patient suffering from a GDV look like?
Initial stabilization frequently involves rapid administration of IV crystalloids through the cephalic vein, appropriate diagnostic assessment, and stomach decompression. This can frequently be a surgical emergency to reposition the stomach. Even if the patient can initially be adequately treated non-surgically, a gastropexy should be performed to prevent the high risk of a subsequent episode of GDV.
If you have been treating a patient for demodicosis with Ivermection 1 month and at their followup appointment their skin scrape is negative, what do you do in terms of further medical management?
Resolution of demodicosis and cessation of treatment requires two negative skin scrapes one month apart even if all clinical signs have resolved. Re-evaluate in one month for another skin scrape. If the skin scrape is negative you can discontinue Ivermectin use.
What is the difference between Trigeminal neuropathy and Masticatory Muscle Myositis?
Trigeminal neuropathy is a disease affecting the trigeminal nerve (CN V). CN V has primarily a sensory function, with the exception of innervating the muscles of mastication. Masticatory muscle myositis is an autoimmune condition that chronically leads to atrophy of the same muscle group. The difference between the two is that Trigeminal neuropathy results in the patient’s inability to close the mouth while masticatory myositis results in the patient’s inability to open the mouth.
What is idiopathic polyradiculoneuritis?
Idiopathic polyradiculoneuritis is the medical term for a condition sometimes referred to as Coonhound paralysis, which is a condition that diffusely affects all motor nerves.
What radiographic view helps visual the cardiac silhouette in a patient with pleural effusion?
The correct answer is ventrodorsal. Pleural effusion obscures the heart completely on a dorsoventral radiograph and at least partially on lateral radiographs. Ventrodorsal positioning usually moves the pleural fluid away from the heart and allows for a radiographic view of the heart to be obtained. Of course, in dyspneic animals, it may not be wise to position them ventrodorsally.
The neurological exam findings, signalment, and history are all consistent with intervertebral disc disease. All small breed dogs are predisposed to disc herniation as compared to larger breeds. The most over-represented breed is the Dachshund.
The findings in the neurological exam that help determine the location are the following:
1) Conscious proprioceptive deficits only in the hind
2) Hyper-reflexive patellar reflex
3) Loss of motor in the hind
4) Lack of superficial pain in the hind
These findings should help you realize that the lesion is between T3-L3 or L3-S1. However, hyper-reflexia in the hind should stand out.
Hyper-reflexia in the hind limbs is an upper motor neuron sign and is supportive of a T3-L3 lesion. Therefore, L4-L5 is not the best answer.
Approximately 80% of T3-L3 herniations are located in the T13-L1 region.
There is no indication of forelimb involvement or neck pain which makes neck involvement less likely.
Based on the radiograph, you should be concerned about the likelihood of heartworm disease. On the V/D projection, the heart shape is a reverse D, indicative of right sided heart enlargement. There is enlargement of the caudal pulmonary arteries and a caudodorsal pulmonary interstitial pattern. There is no evidence of right heart failure in the films, but these changes are suggestive of heartworm. The antigen test is a sensitive test for this disease in dogs.
What urinary bladder stones are NOT visible on Xray?
Urate stones (and cysteine stones) are radiolucent, so they can’t be detected by radiography. Remember “I can’t C U”: (“C” is for cysteine, and “U” is for urate).
Portosystemic shunts are often accompanied by?
The dog is described as having a portosystemic shunt which is often accompanied by urate stones in the bladder.
A 7-year old female Standard Poodle presents to you for acute onset of vomiting and weakness after the owners returned from vacation. On physical exam, you estimate that the dog is 7% dehydrated, has a respiratory rate of 36 breaths per minute, heart rate of 44 beats per minute and temperature of 99 degrees F. You quickly attach ECG leads and expect to see which of the following abnormalities?
No P waves
Inverted T waves
Ventricular tachycardia
Tall, narrow QRS complexes
Based on the history and the physical exam findings of dehydration and bradycardia, you should be concerned about hypoadrenocorticism. Hypoadrenocorticism patients are typically hyperkalemic. ECG abnormalities with hyperkalemia include wide, flat,
or absent P waves, widened QRS complexes, tall spiking T waves, and bradycardia.
What is the most important treatment method for canine patients with exocrine pancreatic insuffciency?
The correct answer is enzyme supplementation. Because enzyme deficiency is behind the pathogenesis of this disorder, pancreatic
enzyme supplementation is the cornerstone of therapy. Enzyme supplementation can best be administered with either powdered extract given with each meal or with chopped ox or pig pancreas given with each meal. A high-fiber or low-protein diet would both be
contraindicated because these animals already are having difficulty digesting their food and protein. Therefore, a more digestible diet with adequate protein is more appropriate. Long-term corticosteroids are rarely needed in EPI patients.
Raccoons carry rabies and what other zoonotic disease?
The correct answer is Baylisascaris. Baylisascaris procyonis is an ascarid parasite of raccoons that causes mild signs in raccoons but can undergo aberrant migration in humans and cause fatal central nervous system signs.
What is the treatment of choice for traumatic proptosis? Explain.
Tarsorrhaphy is the treatment of choice for proptosis. In this procedure, the eyelids are pulled in front of the proptosed globe rather than pushing the eye in and then temporarily suturing the lids shut.
What is the hormonal profile of a female dog in estrus? This hormonal profile leads to?
The correct answer is falling estrogen, rising progesterone. This is what stimulates the LH surge and leads to ovulation and the behavioral change in estrus where a female will stand to be bred.
Define Exenteration.
Exenteration is a procedure used to remove eyes with neoplasia that is infiltrating into the surrounding structures.
Define bone spavin.
Bone spavin is osteoarthritis of the distal intertarsal joint and/or tarsometatarsal joint.
Define bog spavin.
Bog spavin is synovial distention of the tarsocrural joint.
What is the difference between first degree, second degree, and third degree AV blocks?
First-degree, second-degree, and third-degree blocks are associated with delays in conduction at the level of the atrioventricular conduction system.
In a first-degree block, the impulse is still able to transmit through the atrioventricular conduction system; however, it takes longer.
Therefore, you will see an increased P-R interval.
Second-degree AV block is associated with intermittent AV block in which some but not all P waves are conducted to the ventricles.
In third-degree block, there is complete dissociation between the P waves and the QRS complexes. Frequently in third-degree block, the heart rate is slower than normal (20 beats/min) because a subservient pacemaker (i.e. in the AV node or ventricle) has to fire to cause ventricular contraction.
The correct answer is persistent corpus luteum. Progesterone made by the corpus luteum prevents estrus. There will be follicles in the ovaries, and the horse may still ovulate but is non-receptive to stallions. The corpus luteum is usually not palpable. A granulosa cell tumor is less likely because usually the involved ovary is large and the other small, unless there are bilateral tumors, which is uncommon. Gonadal dysgenesis is a chromosomal abnormality, and the mare would not have been able to have had a normal pregnancy previously. Pituitary tumor in a 5 year old would be very unusual, and she appears normal (no failure to shed out). Pituitary tumor is a possible cause but very unlikely. Pregnancy has been ruled out by your rectal palpation, since it has been months.
Centaurea solstitialis, aka yellow star thistle, grows in dry fields in California. Centaurea repens, or Russian knapweed, can also cause the same disorder. Some horses appear to avoid it; others appear to eat it with impunity, while some eat it and develop nigropallidal encephalomalacia. The loss of these upper motor ganglia results in loss of inhibition and dystonia, making it impossible for the animal to eat. Slow starvation results.
An 8 day old foal presents with diarrhea. What is the etiology?
The correct answer is foal heat diarrhea. The exact cause of this is unknown and is termed foal heat diarrhea because of the relationship to
the occurrence of post foaling estrous in the mare. However, we don’t believe it is caused by estrous. It is possible that consumption of
grain and hay may play a role in altering the gastrointestinal flora such that diarrhea develops. Foal heat will occur at 7-14 days of age. S.
vulgaris and S. westeri will usually cause diarrhea later on in life due to their life cycles. Cryptosporidium may be a cause of diarrhea, but it
is also found in healthy foals.
What is the most common cause of pneumonia in both foals and adult horses? What are some other common causes?
What is a common cause of pneumonia in foals 2-6 mo old?
Streptococcus is a common cause of pneumonia in both foals and in adult horses; however, polymicrobial infections are also common. Other common bacterial isolates associated with pneumonia include E. coli, Klebsiella sp, and various anaerobic bacteria. Rhodococcus (Corynebacterium) equi is also a common cause of pneumonia in foals 2-6 months of age. Actinobacillus can be associated with pneumonia, but the other two answers are not commonly isolated from equine pneumonia.
Topic: Theiler’s Disease
- Define Theiler’s disease.
- Etiology
- Most common clinical signs
- What is a top differential diagnosis?
- Theiler’s disease, or serum hepatitis, is an acute, diffuse, necrotizing hepatitis that occurs most commonly in association with introduction of an equine origin compound.
- The most commonly implicated product is tetanus antitoxin, which is an antiserum of equine origin.
- The disease usually occurs 4-10 weeks after administration and presents as malaise and weight loss, progressing to acute hepatoencephalopathy and icterus, and can be rapidly progressive and fatal.
- Pyrrolizidine alkaloids can also cause similar clinical signs but are distinguishable pathologically by the presence of the histologic triad of megalocytosis, fibrosis, and bile duct proliferation.
What is Tyzzer’s Disease? Etiologic agent?
Bacillus or Clostridium piliformis is the cause of Tyzzer’s disease; this is a hepatopathy seen usually in foals.
Topic: Lameness in Horses - Clubfoot
- Define Clubfoot
- Etiology
- Treatment
- Clubfoot is a severe flexural deformity of the distal interphalangeal joint.
- This is typically a congenital condition in young horses although it can be acquired. A genetic component is suspected.
- Mild cases can sometimes be managed conservatively with NSAIDs, farriery, exercise and nutritional changes. Severe cases often require surgery; the surgical procedure of choice is desmotomy of the accessory ligament of the deep digital flexor tendon (also known as inferior check ligament desmotomy). The accessory ligament of the deep digital flexor tendon (inferior check ligament) runs from the palmar surface of the proximal metacarpus to the deep flexor tendon in the mid-metacarpal region.
Topic: Cervical Stenotic Myelopathy in Horses
- Cervical stenotic myelopathy is also known as?
- Define
- Forms
- Treatment
- Wobbler Syndrome
- There are two forms of cervical vertebral stenotic myelopathy (aka wobbler syndrome). One form is called cervical vertebral instability. In this case, ventroflexion of the neck results in spinal cord compression. Most commonly affected sites are C3-4 and C4-5. The other form is known as cervical static stenosis. In this case, the compression is continuous regardless of the neck position. Clinical signs are usually in the form of a wide-based stance, conscious proprioceptive deficits, ataxia, paresis, and spasticity which is worse in the hindlimbs.
- Anti-inflammatories and stall rest may temporarily decrease clinical signs but are typically not a long-term therapy. Surgery is required so that you may stabilize the cervical vertebrae and decompress the spinal cord.
Lethal white foals have ______________ of the intestines which leads to (5)?
Lethal white foals have aganglionosis of the intestines which leads to hypomotility, megacolon, constipation, colic, and death.
What kind of murmur in horses is described as harsh and decrescendo holodiastolic with point of maximum intensity at the left base of the heart? Does this type of murmur impact performance? Can it be treated?
Aortic regurgitation due to degeneration of the aortic valve and should have no impact on performance.
Aortic regurgitation in the horse is usually a degenerative change and there isn’t much that can be done about it. Horses are rarely impaired by development of the murmur. In a true pre-purchase exam, you would be wise to recommend a full cardiac work-up to definitively diagnosis the source of the heart murmur. The potential buyer may decline further diagnostics, but at least you will have offered the choice and have provided the proper information to the client.
___________ _____ ____________ is the most commonly reported gastric neoplasia in the horse
Squamous cell carcinoma is the most commonly reported gastric neoplasia in the horse
Calcium carbonate stones in horses have a higher likelihood of forming in __________ urine. Mucoproteins in urine may serve as a _____ for stone formation but is not specific for calcium carbonate stones.
Calcium carbonate stones in horses have a higher likelihood of forming in alkaline urine. Mucoproteins in urine may serve as a nidus for stone formation but is not specific for calcium carbonate stones.
