Week of March 31 - VP

Question 1

Tricuspid dysplasia is similar to mitral valve dysplasia in the irregular valve leaflets, chordae tendinae, or papillary muscles of the valve. Labrador Retrievers, German Shepherd Dogs, and other ________ breed _______ (sex) are predisposed to the disease. Signs of _______ -sided heart failure, such as ________ and __________ occur in advanced disease. The prognosis for these animals is __________ to _____ depending on the severity of the regurgitation.

Answer 1

Tricuspid dysplasia is similar to mitral valve dysplasia in the irregular valve leaflets, chordae tendinae, or papillary muscles of the valve. Labrador Retrievers, German Shepherd Dogs, and other large breed males are predisposed to the disease. Signs of right heart failure, such as ascites and hepatomegaly occur in advanced disease. The prognosis for these animals is guarded to poor depending on the severity of the regurgitation.

Question 2

Tetralogy of Fallot is a congenital defect of the heart which includes _____________ stenosis, dextro-positioned ________ (over-riding), ______-sided ventricular hypertrophy, and a _____________ septal defect. It causes shunting of venous blood across the _____ into the arterial circulation which leads to ___________, and an increased drive for erythropoiesis, causing _____________.

Affected animals tend be underdeveloped in size and have a history of exercise intolerance, dyspnea, tachypnea, or syncope due to hypoxemia. Thoracic radiographs usually show a normal to ________ enlarged cardiac silhouette with right ventricular enlargement and pulmonary _____________ due to the shunting of venous blood into the arterial circulation.

Answer 2

Tetralogy of Fallot is a congenital defect of the heart which includes pulmonic stenosis (not aortic stenosis), dextro-positioned aorta (over-riding), RIGHT ventricular hypertrophy, and a ventricular septal defect. It causes shunting of venous blood across the VSD into the arterial circulation which leads to hypoxemia, and an increased drive for erythropoiesis, causing polycythemia.

Affected animals tend be underdeveloped in size and have a history of exercise intolerance, dyspnea, tachypnea, or syncope due to hypoxemia. Thoracic radiographs usually show a normal to mildly enlarged cardiac silhouette with right ventricular enlargement and pulmonary hypoperfusion due to the shunting of venous blood into the arterial circulation.

Question 3

How long should exercise be restricted in canine heartworm patients?

Answer 3

Strict activity restriction of the dog is very important once treatment is initiated. Dogs should be restricted in activity at least 4-6 weeks post treatment to decrease the likelihood of thromboembolic events and to allow the lungs to recover from injury due to worm death.

Question 4

Which of the following has the least effect on heart rate?
A. Propofol
B. Morphine
C. Thiopental
D. Ketamine

Answer 4

Answer: A

The correct answer is propofol. Ketamine causes an increase in heart rate and blood pressure. It is considered seizureogenic and has poor muscle relaxation effects, however it provides good analgesia. Thiopental is an ultra fast acting thiobarbiturate that causes an increased heart rate, increased blood pressure, and decreased cardiac contractility. It is also an arrhythmogenic agent. Morphine is an opioid that causes bradycardia. Propofol does not result in any significant cardiac changes. It is ultra-short in duration, can cause apnea and myoclonus, and is considered anticonvulsive. It may cause a mild bradycardia but you mainly see that when used in combination with other opiates. More recently propofol has been associated with myocardial depression and hypotension in critically ill dogs and may not be the induction agent of choice as a result. Despite these findings, propofol still has the least effect on heart rate.

Question 5

What ECG is pictured here? How is it treated?

Answer 5

There are several general guidelines/recommendations regarding treatment of ventricular premature contractions which is what is shown on the ECG strip:

1. HR must be > 180 bpm
2. Presence of pulse deficits
3. C/S of cardiomyopathy (arrhythmia, etc)
4. VPCs > 20 seconds

There are many dogs with intermittent VPCs that are not of clinical importance.

However, it is recommended that the patient be evaluated regularly and ideally have a consultation with a cardiologist to ensure the progression of heart disease is being minimized.

Medical tx for VPCs = Mexilitene (anti-arrhythmic)

Question 6

Define Electrical alterans and pulsus paradoxus.

Answer 6

Electrical alternans is an ECG finding in which the height of QRS complexes alternate due to the physical swinging of the heart as it contracts within the pericardial effusion.

Pulsus paradoxus is an exaggerated decrease in arterial pulse quality during inspiration caused by increased right-sided filling at the expense of reduced left ventricular filling because the heart is constrained by the pericardial effusion.

Question 7

Define cardiac tamponade. List some possible causes.

Answer 7

Cardiac tamponade comes from excessive accumulation of fluid in the pericardium resulting in an increased intra-pericardial pressure impairing diastolic filling of the heart.

Causes include: Hemangiosarcoma, heart base tumors, right sided congestive heart failure, idiopathic pericardial hemorrhage, peritoneopericardial diaphragmatic hernia, infectious pericarditis, trauma, foreign body, coagulopathy, and hypoalbuminemia.

Question 8

Complete, or 3rd degree AV block, in the dog most commonly develops due to ______-related degeneration/fibrosis of the cardiac conduction system. Medical therapy for 3rd degree AV block involves increasing the heart rate with __________ or __________; however, success with medical therapy is limited, so _________ implantation is the therapy of choice.

Answer 8

Complete, or 3rd degree AV block, in the dog most commonly develops due to age-related degeneration/fibrosis of the cardiac conduction system. Medical therapy for 3rd degree AV block involves increasing the heart rate with atropine or isoproterenol; however, success with medical therapy is limited, so pacemaker implantation is the therapy of choice.

Question 9

What test should be run to monitor the efficacy of treatment for an Addisonian dog being treated with supplemental mineralocorticoids and glucocorticoids?

A. Serum chloride and phosphorus
B. ACTH stimulation test
C. Resting cortisol level
D. Urine cortisol creatinine ratio
E. Serum sodium and potassium

Answer 9

Answer: E

Question 10

Topic: Parathyroid adenoma

Post-operatively, it is important to monitor for hypocalcemia daily for the first seven days regardless of the absence of clinical signs for hypocalcemia. The higher the pre-operative serum calcium concentration, the more likely the patient will become hypocalcemic post-operatively. Post-operative monitoring of serum calcium should be daily for the first seven days, then weekly for 4 weeks. Vitamin D and calcium supplementation should be given accordingly. Serum calcium concentration should be maintained in the low normal range, not below normal, to stimulate production of PTH by the parathyroid cells.

Question 11

In a dog with normal kidneys, glucose does not begin to spill into the urine until the blood glucose is around ______ mg/dl. In a cat, glucose does not begin to spill into the urine until the blood glucose reaches between _____-___ mg/dl. Another cause for the PU, PD should be sought in this patient. When the blood glucose is high enough to spill into the urine, the polyuria seen is caused by an osmotic diuresis resulting from the osmotic pull of the glucose in the urine. The kidneys are not refractory to antidiuretic hormone with DM.

Answer 11

In a dog with normal kidneys, glucose does not begin to spill into the urine until the blood glucose is around 180 mg/dl. In a cat, glucose does not begin to spill into the urine until the blood glucose reaches between 200-280 mg/dl. Another cause for the PU, PD should be sought in this patient. When the blood glucose is high enough to spill into the urine, the polyuria seen is caused by an osmotic diuresis resulting from the osmotic pull of the glucose in the urine. The kidneys are not refractory to antidiuretic hormone with DM.

Question 12

What conditions can disrupt a diabetic cat’s glycemic control, making them go into DKA?

Answer 12

Pancreatitis, urinary tract infection, or other underlying infections are responsible for disrupting a diabetic’s glycemic control, making them go into DKA.

Question 13

How can you tell if a patient’s insulin regimen is working for them?

Answer 13

If BG Nadir is between 80-150
If the insulin duration of action is appropriate
Majority of values < 250

Question 14

Cats with hyperthyroidism are likely to develop hypertension. If this is severe enough (>_____-_______ mmg ________), they can be at risk for acute retinal detachment or hemorrhage resulting in blindness.

Answer 14

Cats with hyperthyroidism are likely to develop hypertension. If this is severe enough (>180-200 mmg systolic), they can be at risk for acute retinal detachment or hemorrhage resulting in blindness.

Question 15

Facial pruritis leading to self-induced excoriations is one of the side effects that can be seen with methimazole therapy. If it occurs, it is typically seen during the first ________ months of therapy. Along with facial excoriations, clinical signs can also include crusting of the ears.
The recommended treatment is to discontinue methimazole and either switch to the Hill’s y/d diet or consider surgery or I-131 therapy.

Other causes of skin lesions include atopy, food allergy, and allergic flea dermatitis, but methimazole sensitivity should be considered in any cat with facial excoriations regardless of how long they have been taking the drug.

Answer 15

Facial pruritis leading to self-induced excoriations is one of the side effects that can be seen with methimazole therapy. If it occurs, it is typically seen during the first three months of therapy. Along with facial excoriations, clinical signs can also include crusting of the ears.
The recommended treatment is to discontinue methimazole and either switch to the Hill’s y/d diet or consider surgery or I-131 therapy.

Other causes of skin lesions include atopy, food allergy, and allergic flea dermatitis, but methimazole sensitivity should be considered in any cat with facial excoriations regardless of how long they have been taking the drug.

Question 16

The two 9-week-old Weimaraners in the photo came in to see you about 4 hours ago for puppy exams. They both appeared healthy and you administered pyrantel orally, applied selamectin topically, and vaccinated both dogs against distemper and parvovirus. They now present and the dog on the left in the photo has developed angioedema primarily affecting the head. The sibling is unaffected. Before you complete your exam, the dog becomes very restless and starts vomiting. Which is the most appropriate intervention to reverse the signs of anaphylactic shock?

A. Administer diphenhydramine orally
B. Administer diphenhydramine intravenously
C. Administer meloxicam intravenously
D. Administer prednisone orally
E. Administer epinephrine intravenously

Answer 16

Answer: E

The dog’s clinical presentation is consistent with anaphylaxis from a vaccine reaction. The most important intervention for dogs in anaphylactic shock is intravenous epinephrine, which can reverse bronchial constriction and portal-mesenteric vasodilation that occurs.
Additional supportive measures such as fluids to support the dog’s blood pressure are also critical. Because of the rapid onset, antihistamines and oral medications do not provide sufficient benefit. Intravenous diphenhydramine can potentially cause severe hypotension and is not recommended.

Question 17

Why is 4-MP the preferred EG treatment?

Answer 17

B/c 20% ethanol can cause severe CNS depression, hyperosmality and MA. 4-MP is given IV.

Question 18

A 10-year old intact Siberian Husky presents with a history of regurgitation and exercise intolerance. On physical examination, you note the patient is thin. Blood work is unremarkable other than a stress leukogram and a slightly decreased albumin. What is the next diagnostic test you wish to recommend?

A. Chest radiographs
B. Prescaputar lymph node aspirate
C. Abdominal ultrasound
D. Brain MRI

Answer 18

The correct answer is chest radiographs. Based on the clinical signs of regurgitation and exercise intolerance, you should be considering a thymoma. These tumors arise in the cranial mediastinum and are associated with causing myasthenia gravis and megaesophagus as paraneoplastic syndromes. If a cranial mediastinal mass is present, your top two differentials should be thymoma or lymphoma.
As long as thymomas are well encapsulated, the prognosis is relatively good, and surgery via a median sternotomy should be recommended.
An abdominal ultrasound would be reasonable but not the next best choice as a diagnostic test. There are no examination findings that would indicate the necessity of a brain MRI. A prescapular lymph node aspirate will likely be low-yield given the presentation and the fact that there was no enlargement indicated on physical examination.

Question 19

What is the isotonic crystalloid shock dose in dogs? Cats?

Answer 19

The isotonic crystalloids shock dose in dogs is 90 ml/kg. 1/4 to 1/3 of this volume should be administered initially and the patient reassessed. In cats, the isotonic crystalloids shock dose is 40-60 ml/kg. Synthetic colloids can be administered at a dose of 10-20 ml/kg in dogs and 5-10 ml/kg in cats and hypertonic saline at a dose of 5 ml/kg.

Question 20

Which of the following is true about doxorubicin used in cats?
It causes neurotoxicity
It causes sterile hemorrhagic cystitis
It commonly causes heart failure
It causes renal toxicity

Answer 20

In cats, doxorubicin does not cause clinical problems with the heart as commonly as it does in dogs. Its effects on the kidneys is generally thought to be more of a concern in cats. Sterile hemorrhagic cystitis is caused by cyclophosphamide in dogs, but not in cats. 5-fluorouracil causes neurotoxicity in cats and should never be used in

Question 21

Question 22

The correct answer is a large percentage of cats are seropositive for Toxoplasma gondii but are not necessarily shedding oocysts. Infected cats will usually only shed oocysts for ___-___ _______ when they are initially infected. They usually don’t shed again unless they become severely immune-compromised. Paired serum titers should be taken 1-2 weeks apart in order to determine the stage of infection. A rise in the consecutive titers would mean the cat was recently infected. Titers that aren’t significantly different can be interpreted as the cat having an old infection and is less likely to be actively shedding oocysts. Infectivity of the oocysts occurs with sporulation, which occurs within 1-5 days after shedding.

Answer 22

The correct answer is a large percentage of cats are seropositive for Toxoplasma gondii but are not necessarily shedding oocysts. Infected cats will usually only shed oocysts for 1-2 weeks when they are initially infected. They usually don’t shed again unless they become severely immune-compromised. Paired serum titers should be taken 1-2 weeks apart in order to determine the stage of infection. A rise in the consecutive titers would mean the cat was recently infected. Titers that aren’t significantly different can be interpreted as the cat having an old infection and is less likely to be actively shedding oocysts. Infectivity of the oocysts occurs with sporulation, which occurs within 1-5 days after shedding.

Question 23

Topic: Nitrate Toxicity Pathophysiology

Nitrates are converted in the rumen to __________, which convert hemoglobin to __________ (Fe+3), which cannot ______ or _______ oxygen.

Answer 23

Nitrates are converted in the rumen to nitrites, which convert hemoglobin to methemoglobin (Fe+3), which cannot bind or transport oxygen.

Question 24

Since Mycoplasma lack a cell wall, drugs that act on the cell wall such as __________ and __________ are never the best choice.

Answer 24

Since Mycoplasma lack a cell wall, drugs that act on the cell wall such as penicillins and cephalosporins are never the best choice.

Question 25

The correct answer is Equine Herpes Virus Myeloencephalitis. Clinical signs that are common with EHV myeloencephalitis include bladder paralysis with urine dribbling, fecal retention, and hindlimb ataxia. The xanthochromic CSF with the high protein and normal cell count (albuminocytologic dissociation) is also very suggestive of EHV myeloencephalitis. Virus isolation can be attempted on buffy coat samples, nasal swabs, and/or CS in an attempt to identify the virus. REVIEW

Question 26

Aside from Ponazuril, what other drugs can be used to treat EPM?

Answer 26

TMS and pyrimethamine

Question 27

Which of these would you least expect to find in an adult horse that had ingested preformed Clostridium botulinum toxin? A. Dyspnea B. Propriocepive deficits C. Mydriasis D. Tongue hanging out

Answer 27

Answer: B

Question 28

Yellow star thistle is Centaurea solstitialis. In some horses which ingest large quantities, it can cause ____________ _____________, which is loss of the globus pallidus and substantia nigra, and extrapyramidal nuclei, which control muscles of _________. Loss of these nuclei causes tremors and dystonia of the lip muscles and tongue. Centaurea repens (Russian knapweed) can also cause similar lesions.

Answer 28

Yellow star thistle is Centaurea solstitialis. In some horses which ingest large quantities, it can cause nigropallidal encephalomalacia, which is loss of the globus pallidus and substantia nigra, and extrapyramidal nuclei, which control muscles of prehension. Loss of these nuclei causes tremors and dystonia of the lip muscles and tongue. Centaurea repens (Russian knapweed) can also cause similar lesions.

Question 29

A horse presents with vestibular signs. Which of the following findings allows the clinician to differentiate between central vestibular and peripheral vestibular disease? Nystagmus Proprioceptive deficits Circling Head tilt

Answer 29

The correct answer is proprioceptive deficits. Observation of proprioceptive deficits helps localize the lesion centrally. In addition to proprioceptive deficits, any animal with multiple cranial nerve signs along with other vestibular signs is considered to have central vestibular disease. Nystagmus, circling, ataxia, and head tilt is seen in both central and peripheral vestibular disease.

Question 30

Which of the tumors listed is considered a "soft tissue sarcoma" due its locally invasive behavior and relatively low metastatic rate for most low and intermediate grade tumors? A. Basal cell tumor B. Osteosarcoma C. Hemangiosarcoma D. Peripheral nerve sheath tumor E. Histiocytic sarcoma F. Mast celt tumor

Answer 30

Soft tissue sarcomas include a group of mesenchymal tumors with similar biologic behavior, namely a locally invasive growth pattern and a metastatic rate of less than 20% for low- and intermediate-grade tumors. High-grade tumors have up to a 50% metastatic rate. These tumors include peripheral nerve sheath tumors (PNST), hemangiopericytomas (HPC), fibrosarcomas (FSA), liposarcomas, malignant fibrous histiocytomas, myxosarcomas, rhabdomyosarcomas, and leiomyosarcomas. Hemangiosarcoma and osteosarcoma are mesenchymal in origin but are not lumped into this category due to their highly metastatic behavior. Histiocytic sarcoma and mast cell tumors are considered of round cell origin. Basal cell tumors are epithelial in origin.

Question 31

The mandibular branch of the trigeminal nerve supplies motor innervation to the muscles of ___________ (temporalis, masseter, medial and lateral pterygoids, rostral digastricus, and mylohyoid). The maxillary and ophthalmic branches contain _________ afferents to the eyes, face, eyelids, pinnae, corneas, nasal septum, etc. There is no such thing as the facial branch of the trigeminal nerve. The facial nerve is CN VII.

Answer 31

The mandibular branch of the trigeminal nerve supplies motor innervation to the muscles of mastication (temporalis, masseter, medial and lateral pterygoids, rostral digastricus, and mylohyoid). The maxillary and ophthalmic branches contain sensory afferents to the eyes, face, eyelids, pinnae, corneas, nasal septum, etc. There is no such thing as the facial branch of the trigeminal nerve. The facial nerve is CN VII.

Question 32

What can be seen in the xray below?

Answer 32

Orange - megaesophagus Yellow - aspiration pneumonia

Question 33

Spastic paresis, also known as Elso heel, affects cattle of many breeds (as well as pygmy goats) beginning from three weeks to 1 year of age. It is believed to be caused by a combination of genetic and environmental factors which somehow cause over stimulation of the gamma motor neurons of the spinal cord.

Answer 34

Some years ago float tanks appeared commercially. They are the most effective means of managing down cows, and have success rates over 50% if the cow is floated soon after the problem occurs and if there is no other underlying problem such as fracture, hypocalcemia, spinal tumor, peritonitis etc. The tank on wheels is moved next to the down cow, and the cow is rolled onto a mat next to the tank. She is then winched into the tank, the ends are attached in place, and 102-105F water is run into the tank. The cow floats up as it fills and is eventually able to stand using flotation to aid her. This improves circulation and prevents further pressure damage to nerves and muscles. If there is one leg that is knuckling, a splint or fiberglass cast can be applied when the tank is drained in 24 hours, after which she is again floated. Slings do not work well for cattle.

Question 35

What is the difference in CSF tap results between a bovid with listeria and a bovid with TEME?

Answer 35

CSF tap is most important for distinguishing Listeriosis from thromboembolic meningoencephalitis (TEME), in which you will see a neutrophilic pleocytosis on CSF cytologic examination (with listeria you will see mononuclear pleocytosis). Remember with Listeria, you will often observe CNS signs, an increased number of monocytes and macrophages. Also remember that Listeria is usually contracted from ingesting silage that has been stored at a pH > 5.0.

Question 36

You are asked to examine a pen of very young dairy calves (4 to 8 weeks of age) with the complaints of aural discharges, head tilts (see image), and ataxia. You also find one with facial paralysis and another with unilateral nystagmus as you examine them. The affected ones have fevers of 103 to 105F (39.4 to 40.6 C). What organism is most likely to be causing these signs? Salmonella dublin Mannheimia hemolytica Histophilus somni E. coli Mycoplasma bovis

Answer 36

M. bovis may be spread to young calves via milk. In very young dairy calves it can cause otitis media with aural discharge, head tilt, nystagmus, ataxia, and even facial nerve paralysis. It also causes respiratory disease and can cause arthritis and tenosynovitis in older calves. Mastitis, abortion and other signs can also be caused by M. bovis.

Question 37

Which of these is the best measure of liver function in the dog from a routine chemistry panel? A. Creatinine B. BUN C. Alkaline phosphatase (ALP) D. Alanine aminotransferase (ALT)

Answer 37

Answer: B Explanation The correct answer is blood urea nitrogen (BUN). ALT and ALP are liver enzymes and can indicate ongoing damage to the liver or cholestasis but do not tell you anything about liver function. Creatinine is produced by muscle and cleared by the kidney so it tells you nothing about liver function. Urea is produced by the liver and is one measure of liver function; it will be low in cases of liver failure. Other tests of liver function on a routine chemistry panel are cholesterol, glucose, bilirubin, and albumin. Bile acids also test liver function but are not on a routine chemistry panel. It is important to realize that in cases of end-stage liver failure, the liver function parameters will be affected, while frequently, liver enzymes will be normal.

Question 38

Adverse effects are uncommon with appropriate doses of apomorphine but can include ?

Answer 38

A. Profound CNS depression or hyperexcitabilty B. Tachycardia or bradycardia C. Respiratory depression Xylazine is the emetic of choice in cats, and yohimbine, tolazoline, or atipamezole can be used for reversal.

Question 39

A 3-year old Miniature Poodle presents for an acute, painful swelling on the left ventral neck. You perform a fine needle aspirate and draw back a stringy, blood-tinged fluid with few cells. What is the most likely diagnosis? A. Mast cell tumor B. Reactive lymph node C. Mucocele D. Abscess

Answer 39

Answer: C Explanation The correct answer is mucocele. 2-4 year old poodles are the classic signalment for this condition. The usual presentation is a mass that may be painful and may produce saliva on aspiration. An abscess, mast cell tumor, or reactive lymph node would all be more cellular.

Question 40

When performing surgery on the intestinal tract, which forceps are most appropriate for clamping of the intestines? A. Doyen forceps B. Rochester-Carmalt forceps C. Kelly forceps D. Mosquito forceps

Answer 40

Answer: A Explanation The correct answer is Doyen forceps. They are the least traumatic of the answer choices and provide good clamping without severely disrupting blood supply.

Question 41

Answer 41

Question 42

Answer 42

The case described is consistent with lymphocytic portal hepatitis. Clinically, this condition can appear similar to chronic cholangiohepatitis in terms of signalment, clinical signs and laboratory findings. The key to this diagnosis is the liver biopsy. Typical findings for lymphocytic portal hepatitis is infiltration of lymphocytes and plasma cells but not neutrophils into portal areas. This is in contrast to chronic cholangiohepatitis which typically has neutrophils in portal areas. Chronic cholangiohepatitis carries a fair prognosis with about half of cats doing poorly (dead or euthanized within 3 months) and half of cats responding favorably to treatment with long term survival. For cats with lymphocytic portal hepatitis, although treatment can be challenging, the disease is very slowly progressive and the reported mean survival is approximately 3 years. Cholangiohepatitis in cats can be due to ascending infection or immune-mediated damage to the liver and is commonly seen in conjunction with inflammatory bowel disease and/or pancreatitis. In cases of Cholangiohepatitis, you will see an elevation in ALT, ALP, and GGT

Question 43

Cryptosporidium is a coccidian that invades the small intestinal villi after ingestion of infected oocysts. It can be diagnosed with PCR. It is treated with clindamycin, azithromycin, or tylosin most commonly. It is usually an opportunist, so evaluation for underlying disease is appropriate.

Question 44

A copper iris in a 6 month kitten, along with ptaylism, is a clincal sign of?

Answer 44

portosystemic shunt

Question 45

You are treating a colicky 8-year old horse and pass a stomach tube to assess gastric reflux. The 20 liters of reflux is hemorrhagic, orange-brown in color, and foul-smelling. On physical exam, you find T=101.5F (38.6 C), HR=70, and RR=35 and overall depressed attitude. There are few auscultable gut sounds. Oral mucous membranes are injected. On rectal exam, there are multiple dilated fluid-filled loops of bowel palpated. Peritoneal fluid is serosanguinous with a 3.5 gm/dl protein and a WBC count of 7000. After decompressing the stomach, the horse appears less painful, but remains depressed. Based on these findings, what is the best tentative diagnosis? Duodenitis proximat jejunitis Large bowel torsion Verminous arteritis caused by strongylus vulgaris Impaction colic (large bowel impaction) Acute small intestinal obstruction

Answer 45

Explanation Duodenitis-proximal jejunitis, also known as either anterior enteritis, or proximal enteritis best fits this case because of the characteristic reflux, fever, peritoneal fluid characteristics, rectal findings, the depression and relatively less pain than would be expected with an obstruction. The cause is still uncertain, but a relationship of this disease to positive cultures of reflux for Clostridioides difficile has been found. Typically these cases are treated medically, which would include repeated decompression of the stomach, IV fluids, replacement of electrolyte deficiencies, analgesics and correction of any acid-base abnormalities.

Question 46

Question 47

Answer 47

Question 48

During a necropsy of a 3-year old cow with a history of weight loss and diarrhea, you notice thickened mucosal folds in the abomasum (with less shiny mucous than normal), and thousands of larvae are detected when you digest and stain the abomasal mucosa. What did this cow potentially die from? Type ll Ostertagiasis Giardiasis Type | Haemonchus contortus Type | Ostertagiasis Coccidiosis

Answer 48

Explanation The correct answer is Type Il Ostertagiasis. This is a classic description of postmortem findings. Type I Ostertagiasis is found in naive calves and is not associated with large numbers of larvae with few adult worms in the abomasum. Type Il Haemonchus contortus is possible, but it mainly causes anemia, as it is a blood sucker. Also, H. contortus most commonly severely affects sheep and goats. Coccidiosis and giardiasis are mainly calf diseases. Ostertagiasis = moroccan leather/cobblestone appearance in abomasum

Question 49

Answer 49

Johnne's Disease

Question 50

A 10 year old female spayed German shepherd dog presents for collapse and difficulty breathing. Your physical exam shows pale mucous membranes, a fluid wave in the abdomen and a splenic mass. Aspiration of the abdominal fluid shows hemorrhagic effusion that does not clot. Which of the following is commonly found with your presumed diagnosis? Tumor lysis syndrome Hypercalcemia Factor VIII deficiency Disseminated intravascular coagulation Von Willebrand's disease

Answer 50

Explanation The presumed diagnosis based on the given signalment, physical findings, and diagnostics is splenic hemangiosarcoma, which is often associated with DIC.

Question 51

You perform a CBC on a 5-year old Basenji at a routine wellness exam. Your technologist asks you to look at the blood smear because she has found something interesting. You assess the blood smear and see the organism shown below. There are two species of microfilariae that can be seen in the peripheral blood in dogs. What are they? A. Uncinaria stenocephala and Filaroides osleri B. Acanthocheilonema (Dipetalonema) reconditum and Filaroides osleri C. Drofilaria immitis and Acanthocheilonema (Dipetalonema) reconditum D. Dirofilaria immitis and Uncinaria stenocephala

Answer 51

The correct answer is Dirofilaria immitis and Acanthocheilonema (previously Dipetalonema) reconditum. Acanthocheilonema reconditum is a blood parasite that looks similar to the microfilariae of Dirofilaria immitis, the agent of heartworm disease. The two parasites must be differentiated because Acanthocheilonema reconditum is not pathogenic and is therefore not treated. Uncinaria stenocephala and Filaroides osleri would not be found in the blood. Incidentally, the organism in this blood smear is D. immitis

Question 52

The mean circulating life span of a neutrophil in the dog is approximately ______ A. 5-9 days B. 5-9 hours C. 120 minutes D. 48 hours

Answer 52

The correct answer is 5-9 hours. Neutrophil lifespans in all species, as far as we know, are less than 24 hours. Cows-16 hours; Horses- 10-11 hours. Platelets have a circulating half-life of 5-7 days and red blood cells have an approximate life span of 110 days in dogs The approximate life span of red blood cells in other species (in days) is as follows: cats-70, cow-160, horse-145, pig-86, sheep-150.

Question 53

A. Plasma transfusion, vitamin K supplementation B. Erythropoietin injections and iron supplementation C. Platelet-rich-plasma transfusion and anti-inflammatory doses of corticosteroids D. Packed red blood cell transfusion, immunosuppressive doses of corticosteroids E. Fresh whole blood transfusion, Ampicillin

Answer 53

Question 54

Question 55

A 4-week old intact male Gordon Setter presents for an acutely swollen face and lethargy. On physical examination you note pronounced submandibular lymphadenopathy, and occasional pustules on the face in addition to the swelling. Cytology does not reveal an infectious cause. Which of the following is an appropriate treatment? A. Cephalexin B. Anti-inflammatory doses of glucocorticoids C. Immunosuppressive doses of glucocorticoids D. Ketoconazole

Answer 55

This is a classic clinical presentation for juvenile cellulitis (puppy strangles). This disease is characterized by sterile granulomas and pustules that respond dramatically to glucocorticoids. The cause is thought to be an underlying immune dysfunction. Immunosuppressive glucocorticoid therapy should not be started until other infectious diseases have been ruled out. At a minimum a deep skin scrape, skin cytology, and trichogram should be performed to rule out Demodex, bacteria, and fungal infection.

Question 56

Question 57

One of your clients recently purchased a horse that she plans to add to her stable. She is concerned about potential exposure of the horse to Streptococcus equi subsp. equi. Which of the following is the most sensitive test for detecting carriers of the disease? Serology for antibodies to S. equi M protein (SeM) PCR of a guttural pouch wash for the S. equi M protein (SeM) gene Nasopharyngeal culture on Columbia CNA (colistin, nalidixic acid agar with 5% sheep or horse blood Guttural pouch culture Columbia CNA (colistin, nalidixic acid) agar with 5% sheep or horse blood

Answer 57

Question 58

The Coggin's test is a test for an antibody; therefore, it carries several drawbacks/limitations. In acute episodes of equine infectious anemia (EIA), there is often not yet adequate production of antibody to detect by this test. In foals, false positives can occur due to acquisition of the antibody in colostrum. Persistently infected horses constitute the majority of cases, and because they are under constant antigenic stimulation, they maintain antibody production and can be very accurately diagnosed with the condition by the Coggin's test.

Question 59

Arabian foals that are homozygous for the SCID gene appear normal at birth but then develop fatal infections, often from unusual organisms like Pneumocystis. The SCID trait is autosomal recessive. A genetic test now exists for this disease. Arabian foals can develop combined immunodeficiency (CID) characterized by a lack of production of functional lymphocytes. No curative treatment exists, and foals will succumb to infection. In a CID foal, the foal typically has immunity from maternal antibodies for the first few months of life. However, as maternal antibodies begin to wane after 2-3 months, foals with CID will begin to develop recurrent infections that are responsive to antimicrobials. Once antimicrobials are discontinued, infection returns. Owners should be advised on the heritable nature of this disease. A genetic blood test is available to determine if a horse is a carrier of the CID trait.

Question 60

Question 61

Question 62

Answer 62

Question 63

Which of these is the most useful indicator of whether anemia in a horse is regenerative or not? Mean cell volume Reticulocyte count Bone marrow examination Degree of anisocytosis

Answer 63

Explanation The correct answer is bone marrow examination. In horses, reticulocyte counts are not useful because horses don't release reticulocytes into circulation. Red blood cell indices such as mean corpuscular volume and anisocytosis may be altered in a regenerative response, but the only accurate way to gauge response to anemia in a horse is with bone marrow examination or serial CBCs taken daily for many days.

Question 64

The correct answer is demodex mites are commensal organisms that can be found in skin without clinical signs. Focal demodex lesions will usually resolve spontaneously without any treatment. Demodex are found down at the hair follicle, so diagnosis is made by a deep skin scraping. The most commonly affected areas on a dog include the face, muzzle, periorbital region, and thoracic limbs. The correct answer is Demodex. Demodex is an normal inhabitant of the skin and causes disease when there is either a genetic predisposition or systemic disease that allows Demodex to proliferate, resulting in skin pathology. Therefore it is not contagious in dogs. Demodex gatoi in cats is thought to be contagious amongst cats.

Question 65

Microsporum gypseum is geophilic (meaning that it loves to grow in soil). This species often affects dogs that like to dig. Trichophyton mentagrophytes is zoophilic and usually rodents serve as the host; dogs such as hunting dogs or roaming cats are most commonly affected. Microsporum canis is most commonly contracted from cats. It is extremely important to know which species of dermatophyte is causing the infection in order to prevent re-exposure. For example, in dogs with Microsporum gypseum, preventing them digging in the yard is going to be an important part of the treatment plan.

Question 66

A 5-year-old Doberman presents for chronic pruritus and recurrent bacterial skin infections. The patient has been on a 4-week course of Cephalexin and continues to get new skin lesions despite this treatment. You suspect methicillin resistance and recommend a skin culture. The owner declines a culture and would like you to select another antibiotic empirically. Which antibiotic would be the best choice considering side effects and efficacy? A. Cefovecin (Convenia) B. Clindamycin C. Cefpodoxime (Simplicef) D. Chloramphenicol E. Trimethoprim-sulfa

Answer 66

Since you are suspicious of methicillin resistance, using any cephalosporins such as Convenia or Simplicef would not be useful. Trimethoprim-sulfa will probably be effective; however, this antibiotic should be avoided in Dobermans as they are prone to side effects such as anemia, thrombocytopenia, arthritis, and renal toxicity. These side effects are due to a type-three hypersensitivity. Chloramphenicol may also be effective against the infection, but clindamycin would be a better choice, as it has fewer side effects. Chloramphenicol can cause peripheral neuropathy, gastrointestinal upset, bone marrow suppression, and hepatotoxicity. Additionally, chloramphenicol can also cause aplastic anemia in humans. Clindamycin can also cause gastrointestinal upset but seems to be better tolerated than chloramphenicol.

Question 67

Question 68

A 3-yr-old indoor only spayed female domestic short-haired cat presents with hair loss on the ventral abdomen. Analysis of the hairs shows blunt, "barbered" tips, although no crusts or excoriations are present. Which of the following is the LEAST likely cause? Flea allergy dermatitis Atopic dermatitis Psychogenic alopecia Food allergy

Answer 68

Explanation The "barbered" tips indicate that the cat is excessively grooming her abdomen. Nevertheless, the most likely diagnosis is some type of allergic dermatitis. Psychogenic alopecia is extremely rare in cats and is a diagnosis of exclusion. Allergic dermatitis in cats can present as an apparently non-inflammatory alopecia; the ventral abdomen may be the only site affected.

Question 69

A. Place a penrose drain for 4 days B. Prescribe a 7 day course of amoxicillin C. Prescribe a 7 day course of meloxicam D. Give an injection of penicillinG intramuscularly E. Prescribe a 10 day course of clindamycin

Answer 69

This is a description of a cat bite abscess based on the clinical description of the cat's condition and the purulent fluid that is drained. Because most cat bite abscesses are predominated by anaerobes, the most important measure you take to promote healing is to prevent the wound from closing back up, allowing continued drainage and preventing an anaerobic environment from being re-established. A penrose drain is an effective method to maintain drainage. Penrose drains are typically left in place for 3-5 days days and are then removed depending on how productive the wound is. Although many veterinarians prescribe antibiotics to cats after draining abscesses, this is believed to be unnecessary for most

Question 70

A 1-year-old domestic short hair presents for patchy alopecia that is most severe around the eyes. The owner reports that the other cats in the household have similar lesions and the cats are itchy. You are very suspicious of Demodex. Which diagnostic test would be most useful? A. Fungal culture B. Superficial skin scrape C. Bacterial culture E. Trichogram E. Deep skin scrape

Answer 70

Explanation The key to this question lies in realizing that the cat most likely has Demodex gatoi since this is the only Demodex species that is contagious. Also Demodex gatoi is often very itchy. Demodex gatoi differs from Demodex cati in that it infects the epithelium and not the hair follicle. Thus, the best test would be a superficial skin scrape. The best diagnostic test for Demodex cati would be a deep skin scrape. A trichogram refers to analyzing hair and is a useful test for dermatophytes and follicular mites. A bacterial culture may be indicated if you have a secondary infection. A fungal culture is not useful for Demodex.

Question 71

A 1-year old female stray domestic short hair cat was presented for pruritus. Your physical exam revealed a generalized miliary dermatitis and dark brown flecks in the fur. Which of the following findings are most consistent with the most likely diagnosis? A. Anemia, peripheral eosinophilia, tapeworm infestation B. Mites found on ear swabbing, peripheral eosinophilia, anemia C. Mites found on skin scraping, peripheral eosinophilia, and anemia D. Yeast organisms found on impression smear

Answer 71

The correct answer is anemia, peripheral eosinophilia, tapeworm infestation. The cat has flea allergy dermatitis, which often manifests as a miliary dermatitis. Anemia occurs when there is a large burden of fleas feeding on the cat, peripheral eosinophilia is seen with allergies or parasite infestations, and tapeworms are transmitted by the ingestion of fleas carrying tapeworm eggs. The brown flecks in the fur found on physical exam are flea dirt, which are the feces of fleas after ingesting blood. (We know this a somewhat vague question, but we feel you need to get accustomed to these types of questions.

Question 72

Question 73

Cuterebra are large bee-like flies that do not bite or feed. They lay their eggs on stones, vegetation, or near the openings of animal burrows. The natural hosts of this organism are rabbits and rodents. Cats and dogs become infested when they come into contact with the larvae on rocks, vegetation, or near the openings of rabbit and rodent dens. The larvae attach to the fur as the animal passes and enter the body during grooming or via open wounds. They do not typically enter through the skin. Larvae undergo aberrant migration and localize to the skin of the neck, head, and trunk. Cuterebra infestations are seen most commonly in the late summer and fall.

Question 74

Question 75

During a routine pre-purchase exam of a 5-year old Thoroughbred, many yellowish eggs are noted on the medial aspect of the cannon bone. Given the location of these eggs, what is the most likely diagnosis? A. Stomach worm eggs B. Flea eggs C. Horse bot eggs D. Pinworm eggs

Answer 75

Explanation The correct answer is horse bot eggs. Horse bots (Gasterophilus spp.) can lay their eggs anywhere. However, Gasterophilus intestinalis, which is the common bot, typically will lay their yellowish eggs on the medial aspect of the forelimb cannon bones. Stomach worm (Habronema spp.) eggs are actually ingested by houseflies which are then ingested by horses. Sometimes the infective larvae leave the fly as it is feeding around the lips of the horse and goes on to infect the horse. Pinworm (Oxyuris spp.) eggs are laid by gravid females around the perineum by cementing the eggs around the anus. Flea infestations are not typical in horses.

Question 76

Question 77

Question 78

Question 79

A 5-year old female spayed Labrador Retriever presents for further evaluation after jumping out of the back of a pick-up truck. What are the most likely regions for a traumatic hernia to occur? A. Flank and prepubic region B. Diaphragmatic and umbilical region C. Umbilical region and perineal region D. Perineal and diaphragmatic region

Answer 79

Traumatic injuries are more likely to cause a flank or prepubic hernia than any other type of reported hernia. Umbilical hernias are almost exclusively congenital in nature. Perineal hernias are seen in older male dogs and is thought to be secondary to excessive hormones that result in weakening of the pelvic diaphragm. Finally, diaphragmatic hernias can occur secondary to trauma but are not as commonly noted as flank and prepubic. Whenever a patient presents with unknown trauma or after being hit by a car, it is appropriate to take x-rays as 20% of dogs with diaphragmatic hernias will present several weeks after injury as a result of missing the diagnosis on physical examination alone.

Question 80

A 3-year-old male castrated German Shepherd presents with difficulty rising and laying down in the pelvic limbs. You perform pelvic radiograph that reveal severe hip dysplasia on the right side, while the left side appears normal. The owner does not have the funds for a total hip replacement surgery. Which of the following would be the best long-term treatment option for this dog? A. Triple Pelvic Osteotomy (TPO) B. Femoral head ostectomy (FHO) C. Amputation D. Prolotherapy

Answer 80

Explanation The correct answer is a femoral head ostectomy. Since the hip issue is only on one side, and since a total hip replacement will not be an option for this dog due to finances, removing the affected joint would be the best long-term option to relieve the pain. Triple pelvic osteotomy should only be performed in young dogs (less than a year old) that have minimal secondary degenerative changes and deep acetabulums. NSAIDs are often used to medically manage patients with dysplastic hips, but since this dog is only 3 years of age, medical management only would not be ideal for the long term. Prolotherapy is an alternative method of treatment, where the joint is injected with an irritant solution and is supposed to cause scar tissue formation to help re-stabilize the joint. Because this joint is proliferative and painful, this would not be an ideal treatment option for the longer term. Amputation would be extreme and not necessary for this condition.

Question 81

This case is most consistent with immune-mediated polyarthritis (IMPA). IMPA is often classified as being erosive or nonerosive. This case is an example of the nonerosive form based on the lack of radiographic evidence of cartilage or subchondral bone destruction. The erosive form is rare and is thought to account for <1% of the cases of IMPA. Nonerosive IMPA can be associated with a variety of systemic diseases or precipitating factors including systemic infectious, inflammatory or neoplastic disease or reactions to drugs or vaccines but it is most commonly idiopathic with no association to another disease process. In the described case, no risk factors or signs of concurrent disease were mentioned. Tick-borne arthropathy is less likely with the negative tick titers obtained, but since not every type of tick can be tested for, some clinicians may opt to treat with an antibiotic like doxycycline concurrently with the immunosuppressive drugs. The clinical signs associated with IMPA are anorexia, weight loss, fever, lethargy, and lymphadenopathy. Up to 25% of dogs present with only nonspecific signs of systemic illness and without apparent gait abnormality or joint effusion. It is an important consideration for dogs with fever of unknown origin and may be the cause up to 20% of the time. IMPA is diagnosed by synovial fluid analysis although additional baseline diagnostics are indicated to screen for potential systemic or infectious causes. Normal synovial fluid is clear and viscous with <2.5 g/dl protein and <3,000 cells/ul with predominantly mononuclear cells. Joint fluid in IMPA may be thin, turbid, and increased in volume with higher amounts of protein and cells, often primarily nondegenerate neutrophils. Treatment of idiopathic IMPA centers on immunosuppressive therapy, often starting with prednisone and sometimes including an additional immunosuppressive drug such as azathioprine or cyclophosphamide. About 80% of dogs will respond to immunosuppressive doses of prednisone; however, about one half of dogs require long-term or additional drug therapy to maintain remission.

Question 82

Elbow dysplasia is a global term for several congenital conditions which can occur. These include an ununited anconeal process, osteochondrosis of the humeral condyle, elbow incongruency, and a fragmented medial coronoid process. The fragmented medial coronoid process tends to be the most commonly encountered condition. Left untreated, the abnormal region may not only be fragmented and painful, but can also result in eventual cartilage eburnation of the apposing humeral condyle. The coronoid process is located on the ulna. In elbow dysplasia, osteochondrosis dissecans is always associated with the medial humeral condyle. Osteochondrosis dissecans does not occur at the level of the medial coronoid process of the ulna. One theory of why dogs develop a fragmented medial coronoid process is that excessive stress along the medial aspect of the limb results in overloading of the medial coronoid process, which leads to its eventual fragmentation.

Question 83

With articular fractures, the 3 major goals of the clinician are: 1) Rigid fixation of the fracture fragments; neglecting to do this will result in loose fracture fragments within the joints that will promote osteoarthritis. 2) Anatomic realignment (50% or even 75% is not adequate with articular fractures, in contrast to long bone fractures) 3) Early return to function. With long bone fractures, extended rest is recommended to promote stability and healing of the bone. The opposite is true in articular fractures where prolonged rest after repair will promote fibrosis, causing decreased range of motion in the joint.

Question 84

Treatment of stringhalt in a horse involves which of the following? Tenectomy of the lateral digital extensor Correct Answer Suspensory ligament desmotomy Your Answer -Palmar digital neurectomy Splinting the leg in extension Explanation The correct answer is tenectomy of the lateral digital extensor. Stringhalt is a myoclonic disease affecting one or both pelvic limbs. It causes spasmodic hyperflexion of the leg. The etiology is unknown but sweet pea poisoning is thought to be associated with the condition. Diagnosis is based on clinical signs, but electromyography can be used to confirm the diagnosis. Treatment involves tenectomy of the lateral digital extensor; however, not all cases respond to the treatment.

Question 85

Question 86

Answer 86

Question 87

Hyperkalemic Periodic Paralysis (HYPP) in horses is caused by what autosomal dominant trait? Defect in voltage-dependent sodium channels Defect in voltage-dependent calcium channels Defect in voltage-dependent potassium channels Defect in voltage-dependent magnesium channels

Answer 87

Explanation In horses with HYPP, the defect is in the sodium channel. In this disease, a population of sodium channels fail to inactivate and remain open. This, in turn, results in depolarization of the muscle membrane (closer to threshold) and hyperexcitability of the muscle. With further depolarization, the muscle cell membrane becomes unexcitable and paralysis may occur. The reason for the hyperkalemia is partially because of the movement of potassium out of the muscle cell as the myocyte repolarizes.

Question 88

In addition to the usual side effects of chemotherapeutic drugs such as myelosuppression and Gl side effects, a major concern with adriamycin administration is dose dependent ____________. The drug that causes ileus is __________. The drug that causes anaphylaxis is ______________. The drug that causes nephrotoxicity is ___________. The drug that causes cystitis is _______________.

Answer 88

In addition to the usual side effects of chemotherapeutic drugs such as myelosuppression and Gl side effects, a major concern with adriamycin administration is dose dependent cardiotoxicity. The drug that causes ileus is vincristine. The drug that causes anaphylaxis is L-asparaginase. The drug that causes nephrotoxicity is cisplatin. The drug that causes cystitis is cyclophosphamide.

Question 89

Which of these drugs is known to cause significant release of histamine? A. Butorphanol B. Ketamine C. Morphine D. Acepromazine

Answer 89

The correct answer is morphine. Morphine should probably not be used in patients with mast cell tumors for this reason. Butorphanol causes no increase in histamine even though it is also an opioid. Acepromazine actually has some antihistamine effect. Ketamine does not affect histamine levels.

Question 90

What profile would you expect in a dog with hypervitaminosis D? High Ca, High P Low Ca, High P Low Ca, Low P High Ca, Low P

Answer 90

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

Question 91

Answer 91

Question 92

Which of the following is true about doxycycline used in dogs? A. It may be given as an adjunctive treatment for inflammatory bowel disease B. It can cause esophageal stricture if the drug remains in the esophagus for an extended period of time. C. It can cause cartilage abnormaities in growing puppies D. It is an anti fungal used in systemic mycotic infections

Answer 92

Doxycycline is a tetracycline antibiotic that can cause esophageal stricture formation if it remains in the esophagus for an extended period of time. A small amount of food or water is usually given after the pill to ensure the tablet is not lodged in the esophagus. It can also cause teeth abnormalities in growing animals and often causes Gl upset. It is not an anti-fungal and is not used to treat inflammatory bowel disease. Fluoroquinolone antibiotics such as enrofloxacin can cause cartilage formation abnormalities in growing animals.

Question 93

Which of the following is incorrect concerning feline heartworm disease? A. Migration of larvae to ectopic regions (outside of the heart and pulmonary arteries) is less common than in dogs B. Cats typically have much lower adult worm burdens than dogs C. Antibody tests can detect the exposure of the host to both male and female worms D. A negative microfilaria test does not rule out heartworm disease

Answer 93

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.

Question 94

Which of the following gas anesthetic agents will result in the quickest recovery? A. sevolurane B. Halothane C. Isoflurane D. Ether

Answer 94

The correct answer is sevoflurane. The reason for this is that it has a very low blood-gas partition coefficient. This means that sevoflurane does not readily dissolve in the blood. As a result, the alveolar concentration is close to the same concentration present in the brain, and the concentrations will reach equivalence very rapidly. This is in contrast to ether, which is very soluble in blood, resulting in accumulation of ether in other tissues. This accumulation results in longer times for a patient to fall asleep and wake up. Halothane and isoflurane are not as soluble as ether, but sevoflurane has the least solubility. Do not confuse solubility with MAC (minimum alveolar concentration). Remember, MAC represents the concentration at which half the population would be anesthetized. For example, the MAC of sevoflurane is approximately 2.4 whereas that for Halothane is 0.89.

Question 95

Dextrose, insulin, sodium bicarbonate and calcium gluconate are all drugs used to treat life-threatening hyperkalemia in emergencies such as urethral obstructions. All these drugs, except one, work to lower potassium via intracellular translocation. Which drug has a different mechanism of action in treating hyperkalemia? A. Sodium bicarbonate B. Calcium gluconate C. Insulin D. Dextrose

Answer 95

Dextrose, insulin, and sodium bicarbonate infusions all drive potassium intracellularly. Calcium gluconate does nothing to lower the measurable serum potassium. Calcium gluconate is used to treat hyperkalemia by antagonizing the effects of elevated serum potassium on the myocardium. Its action is targeted at keeping the myocardial tissue normally excitable so the heart rhythm does not develop a life threatening bradycardia as seen with untreated hyperkalemia.

Question 96

Because cats lack __________ and the enzyme ___________ _____________, acetaminophen is metabolized differently. Cats accumulate toxins that result in ____________ and cell _______. The blood becomes _______ and the cats become dyspneic and develop facial ________. Immediate gastrointestinal decontamination is needed if the ingestion was within ? (time) Treatment includes ?

Answer 96

Because cats lack glutathione and the enzyme glucoronyl transferase, acetaminophen is metabolized differently. Cats accumulate toxins that result in methemoglobinemia and cell death. The blood becomes dark and the cats become dyspneic and develop facial edema. Immediate gastrointestinal decontamination is needed if the ingestion was within 2-3 hours. Treatment includes N-acetylcysteine, SAMe, vitamin C and supportive care.

Question 97

Which of these drugs is used as a premedication prior to anesthesia to decrease salivary secretions, facilitating intubation in cats? A. Atropine B. Morphine C. Midazolam D. Acepromazine

Answer 97

The correct answer is atropine. Atropine is an anticholinergic drug sometimes used as a premedication in order to decrease secretions. It also is frequently used to counteract some of the effects of other drugs on the heart.

Question 98

One cold December morning you are presented with a 5-year old Holstein dairy cow which freshened the day before. This morning she was found down in the corral and unable to rise. On physical examination you find T=98F, 36.7C, HR=90 (and the heart is difficult to hear), and RR=10. She has her neck turned back toward her thorax, and it has an "S" shaped curve in it. Her nose is dry, she is non-responsive to being handled, and her rumen motility is absent. The rectal exam shows that her bladder is full. The mammary glands and the uterine lochia appear normal. Based on these findings, which of the following disorders is most likely? A. Spinal lymphoma B. Coliform mastitis C. Left displaced abomasum (LDA) D. Hypothyroidism E. Milk Fever

Answer 98

A cow with a history of recent parturition with clinical signs such as these should be considered as having hypocalcemia until proven otherwise. The cow needs treatment to restore normal calcium levels.

Question 99

Which of the following is NOT a benefit of providing a DCAD (dietary cation-anion difference) diet to cattle? A. Parathyroid hormone function is enhanced B. Cows absorb calcium more readily C. There is a lower incidence of milk fever D. Cows remain relatively more alkalotic

Answer 99

DCAD is used to help prevent milk fever. Cows eating a DCAD diet are actually more acidotic which enhances parathyroid hormone function along with a better ability to utilize dietary calcium. The easy measure is to check urine pH (it should be acid) on cows to be sure they are ingesting the diet. To review, DCAD is dietary cation-anion difference. A DCAD diet is enhanced with more anionic salts containing the strong ions chloride and sulfur, and has decreased amounts of strong cations such as sodium and potassium.

Question 100

Both Japanese yew (Taxus cuspidata) and English yew (T. baccata) contain alkaloids called taxines that are highly toxic and depress myocardial conduction by blocking sodium movement through membranes. Collapse and sudden death are commonly seen when this plant is ingested, often when clippings are consumed by livestock. Oleander causes similar clinical scenarios.

Question 101

Perilla mint = pneumotoxin The pneumotoxicant results in an atypical pneumonia, and mortality is pretty high since there is no good treatment for exposure. Ponderosa pine needles cause abortion in the last trimester and retained placentas. Lupine is a cause of "crooked calf disease" which leads to arthrogryposis, malpositioning in the uterus, and cleft palate. Nightshade is an atropine containing plant which can cause CNS signs such as dilated pupils, progressive paralysis, and depression. Water hemlock is extremely toxic (especially the leaves). Clinical signs occur as fast as six hours post ingestion. You will see grand mal seizures, salivation, tachypnea, tachycardia, birth defects similar to lupine, and death.

Question 102

Malignant catarrhal fever (MCF) in North America is caused by sheep-associated ovine herpesvirus-2. A very high percentage of sheep and goats in North America are infected with OHV-2 and can transmit the virus to susceptible cattle, bison, deer, and other related species, even if only in close proximity and not in direct contact. The virus causes lymphocytic vasculitis and can be fatal.

Question 103

A dog presents to your clinic for coughing and fever a week after going hunting. You work the dog up, perform bronchoscopy and remove a plant awn from the lungs. What bacterial infection is this dog predisposed to? A. Nocardia B. Pasteurella multocida C. Staphylococcus pseudointermedius D. Staphylococcus aureus E. Actinomyces

Answer 103

The correct answer is Actinomyces. This is a filamentous, branching, gram positive bacteria that is a normal inhabitant of the mouth and oropharynx. It is commonly associated with grass awn migration. These are usually contaminated in the oropharynx and then migrate through the body from the respiratory or Gl tracts. Many times it takes months to years to make a diagnosis. Nocardia is a ubiquitous soil saprophyte found everywhere and is usually introduced via the respiratory tract.

Question 104

Which is a cause of primary bacterial pneumonia in dogs? A. Bacillus spp. B. Pseudomonas spp. C. Pasteurella multocida D. Bordetella bronchiseptica

Answer 104

Answer: D Explanation Although not common, Bordetella infections can develop into a primary pneumonia, particularly if the dog has a weakened immune system. The other choices require an underlying problem such as aspiration, foreign body, viral infection, neoplasia, etc. to be present in order to create an infection. Secondary bacterial infections can be extremely severe and need to be diagnosed and treated appropriately and aggressively.

Question 105

You need to start treatment for a dog that has been diagnosed with Valley Fever (Coccidioides immitis. The fluconazole that you normally use is on backorder, and the human version is extremely expensive. You decide to start ketoconazole in the interim. Which of these is an important potential side effect of ketoconazole administration? A. Increased appetite B. Decrease GFR C. Facial excoriation D. Elevated liver enzymes

Answer 105

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.

Question 106

Stertor is a ____________ noise usually generated in the ______ _____________ while stridor is a ______-pitched sound usually generated near the ________. Both noises are audible without the aid of a stethoscope and indicate an ____________ problem.

Answer 106

Stertor is a gurgling noise usually generated in the nasal passages while stridor is a high-pitched sound usually generated near the larynx. Both noises are audible without the aid of a stethoscope and indicate an extrathoracic problem.

Question 107

Which of these is most likely to provide a definitive diagnosis that a dog with chronic nasal discharge has nasal aspergillosis? Cytology Histopathology Fungal culture Serology CT sean

Answer 107

The correct answer is histopathology. Diagnosis of nasal aspergillosis is based on demonstrating the organism in diseased tissue. - A CT is great for looking at turbinate destruction but can look very similar if there is a nasal tumor. - Cytology usually does not reveal fungal hyphae. - Fungal culture is very unreliable; about one third of dogs with nasal tumors may have growth on fungal culture. - Serology is also riddled with false negatives and positives. Histopathology usually reveals pyogranulomatous inflammation and necrosis with numerous fungal hyphae. The yield of biopsies can be greatly improved with assistance from rhinoscopy where white fungal plaques are often visualized. Diagnosis is sometimes made from rhinoscopy alone although this is less definitive than histopathology.

Question 108

Julio is a 1.5-year old male neutered domestic short hair previously feral but now an indoor only cat. He presents to you today for difficulty breathing and x-rays showed pleural fluid. You remove 200mL of serosanguinous fluid and you are concerned about the possibility of feline infectious peritonitis (FIP). Which of the following tests would be most convincing in confirming a diagnosis of FIP (which has the highest positive predictive value)? A. Presence of anti-coronavirus antibodies in serum B. Presence of immune complexes in serum measured by ELISA C. Immunofluorescence staining for coronavirus in macrophages in effusion fluid D. Rivalta's test

Answer 108

Of the tests listed, immunofluorescence staining for coronavirus in macrophages in effusion fluid has the highest positive predictive value for confirming FIP (reportedly as high as 100%). The NPV of this test is relatively low (57%) so a negative test doesn't rule out FIP. Rivalta's test has a low PPV (58-86% depending on the population tested) and a high NPV (93-97%). The presence of anti-coronavirus antibodies in serum has a PPV=0.44 and NPV=0.90 although high concentrations (>1:1600) has a higher PPV=0.94. The presence of immune-complexes in serum is also not specific for coronavirus with a reported PPV=0.67 and NPV=0.84.

Question 109

Calicivirus is a common virus that can cause upper respiratory symptoms as well as oral ulcerations and stomatitis in cats. The stomatitis is often associated with concurrent bacterial infection of the mouth. An antibiotic such as clindamycin, doxycycline liquid, or amoxicillin-clavulanic acid (Clavamox) should be administered. Sucralfate in a slurry can help to coat the ulcerations for quicker healing. An analgesic, such as buprenorphine, should also be considered. An esophagostomy tube may be useful in severe cases when the cat will not eat on his own despite initial therapy.

Question 110

Cisplatin causes fatal pulmonary edema in cats. The famed statement, "cis-plat splats cats" is quite appropriate. 5-fluorouracil is also contraindicated for use in cats, but it is neurotoxic.

Question 111

Question 112

A. Toxocara cati and fenbendazole B. Aelurostrongylus abstrusus and ivermectin C. Spirocerca lupi and ivermectin D. Strongylus endentatus and fenbendazole

Answer 112

Question 113

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Question 118

What is a potential side effect of administering diethylstilbesterol in an incontinent bitch? A. Bone marrow suppression B. Keratoconjunctivitis sicca C. Hemolysis D. Hemorrhagic diarrhea

Answer 118

The correct answer is bone marrow suppression. This is a hormone, and like many other hormones, can result in bone marrow suppression. This is one of the reasons veterinarians choose to use phenylpropanolamine for urinary incontinence. This drug is a weak alpha agonist and works on the muscles of the urethra to increase sphincter tone. KCS is more likely to occur with sulfa containing drugs. Most drugs can cause some sort of diarrhea as a side effect, but rarely will it be hemorrhagic.

Question 119

A 10-year old Shih Tzu presents for collapse. A diagnostic work up shows a mass on the right kidney, which was subsequently removed and biopsied as renal carcinoma. Which one of the following can be associated with renal carcinoma? A. Polycythemia B. Thrombocytopathy C. Hypercalcemia D. Hyperadrenocorticism E. Hyperestrogenism

Answer 119

Renal carcinomas have been associated with erythropoietin secretion, causing elevations in hematocrit as a paraneoplastic syndrome. Hypercalcemia is associated with anal sac adenocarcinomas, lymphomas and other tumors. Thrombocytopathy can be seen with hemangiosarcoma and multiple myeloma. Hyperestrogenism can be seen with Sertoli cell tumors. Hyperadrenocorticism is caused by functional adrenal or pituitary tumors.

Question 120

Tubulointerstitial nephritis Pyelonephritis Thrombosis Protein-losing nephropathy Glomerulonephritis

Answer 120

Due to the organization of vasculature and circulation in the kidney, renal infarcts typically appear as triangular lesions, fanning out from the medulla to the cortex.

Question 121

Fanconi syndrome is an inherited disease in Basenjis. The disease involves renal tubular defects causing an abnormal loss of electrolytes and solutes leading to hypophosphatemia, hypokalemia, and metabolic acidosis, +/- glucosuria

Question 122

Which of the following is most suggestive of pyelonephritis? A. Pain on abdominal palpation B. Bacteria or white blood cells in the urine C. Small, irregular kidneys on ultrasound D. Bacterial or white blood cell casts in urine

Answer 122

The correct answer is bacterial or white blood cell casts in urine. Bacterial or white blood cell casts are highly suggestive of a past or present bacterial infection in the kidneys. Bacteria or white blood cells in the urine may be due to cystitis. Small, irregular kidneys may be due to any chronic pathology in the kidneys. Pain on abdominal palpation can be caused by pain from any abdominal organ or structures adjacent to the abdomen. Other signs associated with pyelonephritis include fever, anorexia, depression, and vomiting. A nephropyelogram may show blunted, dilated calices and dilated, tortuous ureters. Renal biopsy and culture would give the definitive diagnosis of pyelonephritis.

Question 123

You can often see abnormal cells on the urinalysis, but use the caution in diagnosing on urinalysis alone, as inflammation can cause a similar appearance with a much more positive prognosis. Biopsy is needed for definitive diagnosis. Chemotherapy can help these patients shrink the tumor for a time (for a better quality of life); however, the overall prognosis is grave.

Question 124

Leptospirosis causes ________ renal failure, not ______.

Answer 124

Acute, chronic

Question 125

Which of the following is an indication for performing a urine culture? Calcium crystalluria Isosthenuria Low urine pH Bilirubinuria

Answer 125

The correct answer is isosthenuria. Isosthenuria, or low urine specific gravity, makes it difficult to identify bacteria in the sample since it is so dilute. A culture is the most sensitive way to determine if there is an infection present. Bacteria seen on a UA should be cultured to determine the type of bacteria present and the type of antibiotics to which it is sensitive. The presence of white blood cells in urine is indicative of a urinary tract infection, indicating that a culture should be performed. A urine culture should always be performed on a sterile sample. An elevated pH could be an indication of an infection in some patients, as could the presence of struvite crystals (not calcium) which form in a higher pH environment.

Question 126

Transitional cell carcinoma of the bladder in dogs can be palliatively managed with non-steroidal anti-inflammatory drugs such as piroxicam. Progression-free interval and survival can be extended with the addition of chemotherapy. The most commonly used agents are carboplatin, cisplatin, and mitoxantrone. Although cisplatin is effective against TCC, it has increased nephrotoxicity with piroxicam and is less commonly used these days in the author's experience. Secondary infections can be treated with appropriate antibiotics.

Question 127

The four components of nephrotic syndrome are proteinuria, hypoproteinemia, hypercholesterolemia, and ascites or edema. This syndrome occurs with protein-losing nephropathies such as glomerulonephritis or amyloidosis. Hypercoagulability is not a component of nephrotic syndrome, although it can occur with protein-losing nephropathies due to the loss of antithrombin Ill.

Question 128

The marked proteinuria suggests glomerular disease. The necropsy finding of a waxy kidney is highly suggestive of amyloidosis. Shar-Pei dogs are predisposed to this condition. In hydronephrosis, you would see extensive dilation of the renal pelvis and calyces at postmortem. With renal infarcts, you see triangular or pyramidal shaped lesions. Lyme disease can lead to glomerulonephritis where the surface of the kidney is covered by hemorrhagic spots.

Question 129

A cystotomy is on the schedule for today on a 4 year old male Chihuahua. What suture would you not use for closing the bladder? Vicryl Polydioxanone (PDS) Silk Dexon

Answer 129

Explanation The correct answer is silk. This suture is non absorbable and thus contraindicated. Leaving non-absorbable suture in the bladder is a potential nidus for infection.

Question 130

Question 131

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.

Question 132

Having just repaired a femoral fracture on an 8 year old male Labrador with mild chronic renal insufficiency, your technician asks you for post operative orders. Which of these drugs is contraindicated for analgesia in your patient? Butorphanol Dexmedetomidine Gabapentin Tramadol Ketamine Carprofen

Answer 132

Answer: Carprofen

Question 133

A. Meibomian gland B. Conjunctival goblet cells C. Nasolacrimal ducts D. Lacrimal gland and gland of the 3rd eyelid

Answer 133

The correct answer is lacrimal gland and gland of the 3rd eyelid. KCS comes from a decrease of the aqueous portion of the tear film. This is produced by the lacrimal gland and the gland of the 3rd eyelid. Remember, there are three layers of the tear film. The mucous portion lies against the cornea and keeps the tear film adhered to it. This is made by conjunctival goblet cells. The aqueous portion has nutritional and immunologic factors and is in the middle. It is produced by the lacrimal gland and the gland of the 3rd eyelid. The lipid portion of the tear film is the most outer part, and it allows for even spreading and prevents evaporation of tears. It is produced by the meibomian glands.

Question 134

A. Topical cyclosporine and systemic corticosteroids B. Systemic antibiotics and corticosteroids C. Systemic cyclosporine and antibiotics D. Topical cyclosporine and a topical steroid

Answer 134

Answer: D The correct answer is topical cyclosporine and a topical steroid. The treatment of KCS is aimed at reducing immune destruction of the lacrimal glands. Topical cyclosporine (Optimmune) and a topical steroid (frequently in a triple antibiotic/steroid ointment) are the treatment of choice. You should be cautious using steroids in acute cases due to the risk of corneal ulceration.

Question 135

A. Endophthatmitis B. Orbital neoplasia C. Intraocular neoplasia D. Retrobutbar abscess

Answer 135

The correct answer is orbital neoplasia. These are the typical signs of orbital neoplasia, which is somewhat common in older dogs. Infections are usually accompanied by more systemic signs and localized pain and erythema. Endophthalmitis and intraocular neoplasia would not cause exophthalmos but would manifest with intraocular signs.

Question 136

A 7-year old female spayed Cocker Spaniel presents for an inflamed and buphthalmic left eye. She has a history of bilateral cataracts but can still see relatively well. Intraocular pressures were taken and the left eye was found to be high, while the right eye was within normal limits. What is the most likely cause for the increased intraocular pressure in the left eye? A. Increased production of aqueous due to inflammation B. Sequela of the cataracts C. A retrobutbar mass D. Inherited glaucoma

Answer 136

The correct answer is inherited glaucoma. Cocker Spaniels are predisposed to developing eye problems such as cataracts, distichiasis, retinal abnormalities, and primary glaucoma. Even though only the left eye currently has increased intraocular pressures, the right eye should be treated as well because it will likely develop glaucoma in the future.

Question 137

What changes are seen on electroretinogram (ERG) with sudden acquired retinal degeneration syndrome (SARDS) in dogs? A. Increased ERG amplitude (exaggerated response) B. Decreased ERG amplitude (weakened response) C. Flat-line ERG (no response) D. Normal ERG amplitude

Answer 137

The correct answer is flat-line ERG. By definition, an animal with SARDS has a flat-line ERG from day 1 of onset of the condition

Question 138

A 6-month old male Newfoundland presents for a physical exam. Cardiac auscultation reveals a 3/6 left systolic murmur at the heart base. Further diagnostics reveal the diagnosis of mild to moderate subaortic stenosis. What should you tell the owner? A. The prognosis is fair. Sudden death may occur at any time, and the dog has an increased risk for infective endocarditis. B. The prognosis is relatively good. Balloon dilation of the stenotic region is the treatment of choice and has a high success rate. C. The prognosis is poor. Most cases of mild to moderate aortic stenosis do not live past 4 years of age despite all therapy. D. The prognosis is good if the dog has not developed congestive heart failure yet. Prophylactic treatment with furosemide for congestive heart failure should be prescribed.

Answer 138

Answer: A The correct answer is the prognosis is fair. For dogs with very mild subaortic stenosis, the prognosis is good. Dogs with moderate or severe disease, however have a much more guarded prognosis. Sudden death may occur at any time, and the dog has an increased risk for infective endocarditis. Ventricular arrhythmias can occur and may be the factor leading to sudden death in these patients. Animals with aortic stenosis are at increased risk for infective endocarditis and should be placed on prophylactic antibiotics whenever they undergo a surgical procedure, dental procedure, get an open wound, or experience anything that may potentially lead to bacteremia. Balloon dilation does not improve the prognosis for dogs with subaortic stenosis, though does improve the prognosis for dogs with pulmonic stenosis. Tx for Aortic Stenosis: - Beta blockers such as atenolol are often used to reduce myocardial oxygen demand, thus reducing the frequency of ventricular arrhythmias. - The owners should also be warned that the dog will need prophylactic antibiotics for any situation in which the dog may develop a bacteremia, since it is at high risk of developing infective endocarditis. - Starting furosemide before the onset of congestive heart failure is NOT advised. Only do it if the patient is in CHF Aortic and mitral valve = increased risk of infective endocarditis

Question 139

Question 140

Which of the following is a non-adrenergic vasoconstrictor that can be used in dogs? Vasopressin Dobutamine Phenylephrine Isoproterenol Epinephrine

Answer 140

Explanation The correct answer is vasopressin. Epinephrine and phenylephrine are adrenergic vasoconstrictors. Isoproterenol and dobutamine cause vasodilation. Vasopressin (also known as anti-diuretic hormone) is a V-1 receptor, non-adrenergic, vasoconstrictor.

Question 141

A 10-year old male castrated Collie presents for what the owner calls heart failure. Which of the following is not a typical sign of right heart failure? Muscle wasting Coughing Tachypnea Hepatomegaly Exercise intolerance

Answer 141

Explanation The correct answer is cough. Coughing is typically a sign of left heart failure that occurs with the development of pulmonary edema and/or bronchial compression from an enlarged left atrium. In right heart failure, tachypnea and dyspnea can develop due to pleural effusion. Hepatomegaly occurs due to venous congestion from the damming of blood into the liver. Exercise intolerance develops because a decrease in cardiac output causes a decrease in oxygenation of tissues. Muscle wasting occurs from loss of protein into effusions and from hepatic and Gl malfunction. Other signs of right heart failure include lethargy, weakness, venous distention, ascites, and peripheral edema.

Question 142

Canine degenerative myelopathy is a progressive, degenerative spinal cord disease that occurs most commonly in German Shepherd Dogs between 5-9 years of age. This disease causes random axonal degeneration in all spinal cord segments, but it is usually most severe in the thoracic cord. It is a diffuse myelopathy that can look like a transverse myelopathy, and is often confused with hip dysplasia.

Question 143

Question 144

With paradoxical vestibular disease, the lesion is in certain regions of the?

Answer 144

cerebellum

Question 145

Question 146

Question 147

Which of the following is the most common presentation for a patient with idiopathic epilepsy? A. 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. B. 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: C. A 5 month old Yorkshire Terrier that has generalized tonie elonie seizures, often after eating. The dog is sometimes obtunded between seizures. D. A 9-year old Boxer that recently began having focal motor seizures that began weekly but are now becoming more severe and frequent.

Answer 147

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.

Question 148

How long after receiving a puncture wound would you expect to see clinical signs of tetanus if a horse was infected? A. 1-2 hours B. 12-24 hours C. 3-4 weeks D. 3-5 days E. 10-14 days

Answer 148

The correct answer is 10-14 days. Typically, the incubation period for tetanus is about 2 weeks, because it takes time for the spores to grow in an anaerobic environment before they produce toxin that can then be picked up by the nerves.

Question 149

When should tetanus antitoxin be given? What about the toxoid?

Answer 149

Antitoxin given after any surgery or injury. Toxioid at 3,4,12 months and then annually and then 1-2 mo prior to foaling.

Question 150

The best tx for wobbler's in HORSES is?

Answer 150

Surgical spinal stabilization

Question 151

You are called out to visit a feedlot experiencing an outbreak of disease among its beef cattle during the early spring. Several animals are anorectic and appear disoriented, getting stuck in corners, circling, and leaning against objects. One heifer has a drooping ear, deviated muzzle and flaccid lip on the right side as well as a decreased menace response. The same animal is salivating continuously. You perform cerebrospinal fluid analysis on that animal and note an elevated protein concentration of 100mg/dl (normal 11-30mg/dl) and a mild increase in CSF cell count of 50/ul (normal 0-10/ul), all monocytes. You perform a necropsy on a recently deceased affected animal and note congestion of the meninges. CNS histopathology shows microabscesses of the pons, medulla oblongata, and anterior spinal cord. Which of the following is the best treatment option for the animals on the feedlot? Penicillin Thiamine supplementation Ivermectin Cull all exposed animals

Answer 151

Explanation The clinical description is highly suggestive of Listeriosis. The CSF findings (elevated protein and monocytosis) and description and location of CNS microabscesses make Listeria the clear top differential. High doses of penicillin are generally considered effective against Listeriosis although more severely affected animals have a poorer prognosis. It is not considered necessary to cull all exposed animals.

Question 152

Measuring which of the following physiological parameters can help provide an indication of the welfare of animals when undergoing transitory procedures: A. Stress hormones and approachability B. Heart rate and lameness scoring C. Brain waves and body condition scoring D. Plasma glucocorticoid and heart rate levels

Answer 152

Answer: D

Question 153

Question 154

A 6-week old mixed breed dog acquired from a shelter presents for diarrhea, increased respiratory effort, and seizures. You suspect the puppy has distemper. What is the definitive diagnostic test for canine distemper? A. Enamet hypoptasia B. Hyperkeratosis of foot pads C. Detection of virus via serology D. The combination of gastrointestinal, respiratory, and neurologic clinical signs E. Immunofluorescent assay on affected epithelium

Answer 154

The correct answer is immunofluorescent assay on affected epithelium. Although the clinical signs are supportive for distemper, the definitive diagnosis is examination of blood or tissue by immunofluorescent assay. This can be performed on tracheal, vaginal, respiratory, or other epithelium. These samples may be negative if the dog is only showing neurologic signs or if a circulating antibody is present. The diagnosis can then be made by serology for distemper IgM or increased CSF to serum virus specific IgG. In addition, a distemper PCR test is now available and is performed on swabs of ocular or nasal discharge. The test can have false positives in some vaccinated animals; however, animals showing signs consistent with distemper that are PCR positive should be considered likely infected with distemper.

Question 155

A client brings in her dog that recently ingested rodenticide. You check the box and see that the active ingredient is cholecalciferol. The dog appears clinically normal right now. What would you be concerned might happen if you do nothing at this time? Development of intestinal perforation Development of organ mineralization Development of liver failure Development of coagulopathy Development of neurologic signs

Answer 155

Explanation The correct answer is development of tissue mineralization. Cholecalciferol (Vitamin D3) acts by becoming converted to calcitriol and increases calcium and phosphorus levels leading to mineralization of organs, especially the kidneys.

Question 156

Which of the following increases an animal's anesthetic requirement? Hyperthermia Pregnancy Hyponatremia Old age

Answer 156

Explanation The correct answer is hyperthermia. Elevated temperature increases the rate of metabolism of anesthetics and thus, increases the amount of anesthetic needed. Hyponatremia, pregnancy, and old age all require decreased amounts of anesthetics to give the same effects.

Question 157

Which of the fungal infections is considered contagious, either to other animals or to man (zoonotic)? A. Aspergillosis B. Sportrichosis C. Cryptococcosis D. Coccidioidomycosis E. Blastomycosis

Answer 157

The correct answer is Sporotrichosis. All of these fungal diseases can infect both animals and people. However, they are not considered contagious (not to be confused with infectious) with the exception of Sporothrix. This is because they are mainly acquired from the environment, and transmission from animal to animal is rare. Sporothrix, especially in cats, is a high risk to veterinarians and care should be taken to limit contact with exudates and lesions in cats.

Question 158

Question 159

Question 160

Question 161

Disseminated intravascular coagulation is a complex disorder that can be described as widespread activation of the coagulation system, resulting in a pro-coagulant state with systemic thromboses and secondary diffuse hemorrhage throughout the body. DIC is secondary to pathologic conditions such as sepsis, localized infections, colitis, neoplasia, trauma, hepatic or renal failure, vasculitis, and various other disorders. DIC is associated with thrombocytopenia (from platelet consumption), prolongation of coagulation times such as PT and aPTT (from consumption of coagulation factors), elevations in D dimers (from degradation of fibrin), and low antithrombin Ill (from consumption). Thus the correct answer to this question is shortened aPTT. These criteria for DIC apply to all species, not just horses.

Question 162

Which of the following causes primarily early embryonic death and infertilty, although it can also cause sporadic abortions in cattle? Neospora caninum Campyobacter fetus subsp venerealis Brucella abortus Epizootic bovine abortion Explanation

Answer 162

The correct answer is Campylobacter fetus. The other choices result in abortions ranging from mid to late gestation.

Question 163

A 13-year-old, male neutered Labrador retriever patient presents for a quality of life consult. The owner is concerned that his dog has progressively become more painful in the hips. He was diagnosed with hip dysplasia at a young age and the owner elected to treat him conservatively by providing low impact exercise, maintaining a lean body weight, and administering non-steroidal anti-inflammatories as necessary for pain. There are several nutraceuticals available that have been touted as having some benefit in patients with osteoarthritis. Which of the following will result in an increased production of less inflammatory eicosanoids? Chondroitin Glucosamine Omega-3 fatty acids Carnitine

Answer 163

Explanation Consuming a high concentration of omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) has been shown to result in the preferential use of these compounds to form eicosanoids. Eicosanoids derive from either omega-3 or omega-6 fatty acids. Omega-6 eicosanoids are generally pro-inflammatory, while omega-3 eicosanoids are less inflammatory. Omega-3 fatty acid supplementation results in a decrease in pro-inflammatory omega-6 eicosanoids; providing potential benefit to patients with osteoarthritis. Carnitine is thought to potentially aid in weight loss as it is involved in fat metabolism, but there are limited studies demonstrating significant clinical benefit to supplementation at this time. Glucosamine is a precursor of glycosaminoglycans which is a major constituent of the joint and thought to be of great importance for joint health. Chondroitin is also an important constituent of cartilage and helps provide resistance to compressive force. It is commonly administered in conjunction with glucosamine. The amount of clinical benefit of glucosamine and chondroitin supplementation is not currently well established.