ZuKU Review

Question 1

Which one of the following choices describes the correct order of putting on surgical attire and scrubbing for surgical personnel?

• Facemask, gown, hand scrub, gloves, hair cap
• Gown, hand scrub, gloves, hair cap, facemask
• Hand scrub, gown gloves, hair cap, facemask
• Hair cap, facemask, hand scrub, gown, gloves
• Facemask, hair cap, gown, gloves, hand scrub

Answer 1

Hair cap, facemask, hand scrub, gown, gloves

Gloving is important, but is not a substitute for proper scrubbing. There are three gloving methods:

1. Closed gloving (your scrubbed hand is inside the gown as you handle the glove).
2. Open gloving (your scrubbed hand touches the inside of the glove as you put it on).
3. Assisted gloving (an assistant who is already gloved holds your glove open as you put your scrubbed hand in).

Question 2

Fumonism intoxication is primarily associated with which clinical signs?

• Leukoencephalomalacia, hypertension
• Salivation, retching
• Estrogenism, vulvovaginitis
• Vomiting, immunosuppression
• Terminal necrosis of extremities, gangrene

Answer 2

-Leukoencephalomalacia, hypertension

Fumonisin is another Fusarium spp.mycotoxin associated with moldy corn. In equids, look for CNS disease (Equine leukoencephalomalacia). In pigs, see hypertension and pulmonary edema (porcine pulmonary edema-PPE).

• Think of reproductive dysfunction (estrogenism, vulvovaginitis) with zearalenone, the only known mycotoxin with primarily estrogenic effects.
• Slaframine toxicosis causes profuse salivation, primarily in horses and occasionally in cattle. Due to the fungus Rhizoctonia leguminocola (black patch disease) on red clover (Trifolium pratense) especially in wet, cool years.
• Trichothecenes are a group of related cytotoxic mycotoxins associated with many fungi. Think of vomitoxin (and vomiting) and also of immunosuppression. Refusal to eat contaminated feed is a typical sign, due to taste aversion. Macrocyclic trichothecene-related diseases have several specific names, including the best known, stachybotryotoxicosis.

Question 3

A dozen young chickens at a broiler-raising facility are found dead on their backs and sides with no premonitory signs. Other birds appear cyanotic, with distended and reddened abdomens and congested blood vessels. Affected birds have an increased respiratory rate and reduced exercise tolerance. Necropsy of a dead chicken shows typical lesions below. What is the clinical diagnosis?

• Flip over disease
• Ascites syndrome
• Spontaneous cardiomyopathy
• Infectious bursal disease
• Disecting aneurysm

Answer 3

Ascites syndome
This is ascites in a chicken. Suddenly dead or cyanotic, panting chickens with abdomens distended by ascites fluid suggests ascites syndrome (waterbelly).
Essentially a form of right ventricular heart failure secondary to pulmonary hypertension or more rarely, hepatic failure.

Because broilers affected with ascites syndrome frequently die on their backs, differential diagnosis includes flip-over disease.

Another cardiomyopathy to remember is round heart disease (spontaneous cardiomyopathy), but that is a disease of turkeys.

Dissecting aneurysm is another cause of sudden death, but animals display severe hemorrhage on necropsy. Click here to see a necropsied chicken with frank abdominal hemorrhage and a ruptured aorta

Question 4

On a fecal examination of a 7 year old dog this organism is evident. Which one of the following drugs is the best treatment?

• Piperazine
• Diethyl Carbamizine
• Ivermectin
• Metronidazole
• Fenbendazole

Answer 4

Fenbendazole

This is a whipworm egg (Trichuris spp., looks like an American football). Rx with antihelmintics like fenbendazole (preferred treatment), febantel, praziquantel, pyrantel pamoate.

Can use milbemycin oxime as a preventive for chronic recurring cases, but must check dog with a heartworm test first.
Currently though, milbemycin is not available in the U.S. (recently taken off market).
May also see whipworms in ruminants and whipworms in pigs.

Question 5

Zearalenone intoxication is primarily associated with which clincal signs?

• Estrogenism, vulvovaginitis
• Salivation, vomiting
• Leukoenchephalomalacia, hypertension
• Immunosuppression, Hemorrhagic diathesis
• Terminal necrosis of extremities, gangrene

Answer 5

**Estrogenism, vulvovaginits **

Think of reproductive dysfunction (estrogenism, vulvovaginitis) with zearalenone, the only known mycotoxin with primarily estrogenic effects. Zearalenone is produced by Fusarium spp molds on plants and common feed grains like corn, barley and wheat. Often a second mycotoxin called deoxynivalenol is also prduced which causes decreased feed intake. The presence of deoxynivalenol may limit exposure to zearalenone if the animal eats less.

Fumonisin is another Fusarium spp.mycotoxin associated with moldy corn. In equids, look for CNS disease (Equine leukoencephalomalacia). In pigs, see hypertension and pulmonary edema (porcine pulmonary edema-PPE).

Ergotism is caused by ingestion of alkaloids in a parasitic fungus, Claviceps purpurea, that infects small grains (rye, wheat) and forage plants like bromes, bluegrass and ryegrass. Look for vasoconstriction with terminal necrosis of the extremities due to thrombosis-affected animals are predisposed to frostbite and gangrene. May have CNS effects, potent oxytocic action or pituitary effects (decreased prolactin leading to agalactia).

Slaframine toxicosis causes profuse salivation, primarily in horses and occasionally in cattle. Due to the fungus Rhizoctonia leguminocola (black patch disease) on red clover (Trifolium pratense) especially in wet, cool years.

Trichothecenes are a group of related cytotoxic mycotoxins associated with many fungi. Think of vomitoxin (and vomiting) and Estrogenism, vulvovaginits

Question 6

Foal heat diarrhea is typically associated with which choice?

• hemmoragic enteritis
• neutropenia and fever
• decreased suckeling
• alterations in diet
• warm and humid weather

Answer 6

Alterations in diet

Alterations in diet. Mild, self-limiting diarrhea in a foal 7-14 days of age is called foal heat diarrhea, because it coincides with the first estrus cycle post-foaling in the dam. Causes of foal heat diarrhea are poorly understood, but are thought to be related to a foal’s tendency to start sampling hay and grain and practice coprophagy by 5 to 7 days of age, with consequent alterations in bacterial flora.
Foals are active and alert, with a normal appetite and vital signs. Clinical signs such as fever and lethargy, hematochezia or melena, and laboratory findings such as neutropenia are not routinely observed.

Question 7

A three year old male neutered Weimaraner dog is presented with a two day history of worsening anorexia, lethargy, cough and exercise intolerance.
On physical exam, the mucous membranes are pale with a few petechiae.
T=99.8 F (37.7 C)..[N=99.5-102.5 F]
RR=24 brpm…..[N= 15-34]
HR=144 bpm….[N= 110-120]
A coagulation profile shows the following:
Thrombocytes= 343,500 per microliter..[N=200,000-900,000]
Buccal mucosal bleeding time (BMBT), normal
Activated partial thromboplastin time (aPTT), increased
Prothrombin time (PT), increased
Thrombin time (TT), normal
Fibrin degradation products (FDPs), normal

Which one of the following choices is the most appropriate diagnosis?

• Disseminated intravascular coagulation (DIC)
• Idiopathic thrombocytopenia
• Von Willebrand’s disease
• Anticoagulant rodenticide toxicity
• Neonatal isoerythrolysis

Answer 7

Anticoagulant rodenticide toxicity

Anticoagulant rodenticide toxicity Anticoagulant rodenticide toxicity (or liver disease) can demonstrate increased activated partial thromboplastin time (aPTT) and prothrombin time (PT).
Sometimes a mild to moderate thrombocytopenia may occur (50,000-150,000/?l). Proteins induced by vitamin K1 absence or antagonism (PIVKA) will be prolonged.
The PIVKA test is more sensitive than PT/aPTT but is not as widely available. A threefold increase in PT or PIVKA is supportive of anticoagulant rodenticide toxicosis.
Often there is no history of exposure to a rodenticide. Clinically, vague initial clinical signs like anorexia, lethargy and exercise intolerance may be the first manifestation of illness. With progression, you may see an acute hemorrhagic presentation.

Question 8

An 11 year old male neutered dog is presented with a 4 week history of worsening problems with urination. The dog appears to have abdominal pain and strains to urinate a small volume of reddish urine.
Urinalysis: USp.G=1.028, 15-20 WBC/hpf, RBC +++, protein +, bacterial rods +++
Which one of the following choices i the most likely diagnosis?
-Renal calculi with secondary nephrosis
-Struvite urolithiasis
-Amyloidosis
-Transitional cell carcinoma
-Benign prostatic hypertrophy

A pneumocystogram radiograph looks like this:

Answer 8

Transitional Cell Carcinoma
This is likely to be neoplasia, specifically, a transitional cell carcinoma seen here in the trigone of the bladder after pneumocystogram (air in bladder) and here after injection of contrast media.

Hematuria, pollakiuria, abdominal pain and bacterial cystitis in an older dog may also suggest urolithiasis, but if stones were visible on radiograph, they would be less likely to sit in the trigone.
The most common form of urolithiasis in dogs is struvite urolithiasis. Struvite urolithiasis is the second most common form of urolithiasis in the cat; calcium oxalate urolithiasis is the most common.
With renal calculi, look for classic “staghorns” in the kidneys on DV rads.
With prostatic hypertrophy look for prostate displacing the bladder cranially into the abdomen. The oval closest to the pelvis is the prostate, the larger oval cranial to it is the bladder.

Question 9

A 2 day old pup has a GGT level of 500 times the adult upper reference range. Which one of the following choices is the most likely interpretation?

• Associated with neonatal cholestasis
• Associated with bone development
• Caused by traumatic placental detachment
• Suggestive of a congential liver shunt
• Due to colostrum absorption

Answer 9

Due to Colostrum absorptionIn
In newborn pups, lambs, and calves, an increase in GGT up to 1000 times is normal when they receive high levels of colostrum from the dam.
High levels of GGT are produced in the mammary epithelium during lactation. When evaluating bloodwork, reference ranges specific for the age of the patient should be utilized.

Question 10

Which organism determines the minimum temperature needed to paseurize miik in the United States?

• Mycobacterium bovis
• Listeria monocytogenes
• Brucella abortus
• Coxiella burnetii
• Escherichia coli

Answer 10

Coxiella burnetti
Temperature of pasteurization is set by the toughest, most heat-resistant organism, which is Coxiella burnetii, the cause of Q fever. If the temperature is high enough, for long enough to kill Coxiella, it will also kill the other organisms.

Brucella and Listeria can also be transmitted in milk.
E. coli is typically a contaminant from unsanitary milking conditions.
Milk pasteurization standards in the United States are detailed in the 2011 Grade A Pasteurized Milk Ordinance. Basically, the higher the temp, the shorter the pasteurization time needed. ie: 90 C (194 F) for 0.5 seconds, or 100 C (212 F) for 0.01 seconds. (see item 16p

Question 11

A 5-year-old neutered domestic shorthair cat is presented for lethargy, vomiting and diarrhea. The owner saw the car licking up antifreeze spilled he was flushing his truck’s radiator yesterday.
The cat is markedly depressed and dehydrated on physical exam.
Which one of the following choices is the most appropriate treatment?
-Ethanol 20%
-Atipamezole, IV lactated ringer’s
-Activated charcoal
-Pralidoxime chloride (2-PAM)
-Calcium EDTA in 0.9% NaCl

Answer 11

Ethanol 20%
More than 3 hours after ingestion, ethanol is still the treatment of choice for cats with ethylene glycol toxicity.

Recent clinical trials suggest that Fomepizole (4 methyl pyrazole, 4-MP) can be a more effective treatment than ethanol in cats when administered

• • At high doses (extra-label) and
• • Within 3 hours of ingestion of ethylene glycol.

Do 4 things when you see a case of ethylene glycol toxicity:

1. Decrease EG absorption: Induce vomiting +/- gastric lavage (or both) followed by activated charcoal, sodium sulfate within 1-2 hr of ingestion.
2. Promote diuresis: IV fluids
3. Address metabolic acidosis: Add bicarbonate in fluids
4. Prevent metabolism of EG: 4-MP or ethanol treatment.

Question 12

This 3-year-old horse presents for evaluation of this dry, horny, wart-like mass on the distal forelimb. This horse also has smaller wart-like lesions on its muzzle. The other young horses in the herd have similar lesions. Which one of the following is the most likely diagnosis?

• Papillomatosis
• Melanomatosis
• Dermatophilosis
• Pediculosis
• Trombiculosis

Answer 12

Papillomatosis
These are warts, or papillomas, which is related to infection with equine papilloma virus.
Equine papillomatosis occurs most frequently in young horses and are most commonly found on the inner surfaces of the pinna, muzzle, distal limbs, and genitalia.
They are contagious, and since they usually resolve spontaneously, treatment is rarely pursued.

Question 13

An 8-year-old Yorkshire terrier is presented with a 48-hour history of vomiting. Which one of the following choices is the most likely diagnosis?

• Foreign body obstruction
• Gastroenteritis
• Intussusception
• Splenic neoplasia
• Retroperitoneal mass

Answer 13

Foreign body obstruction
The radiographs are indicative of a mechanical obstruction due to gastrointestinal foreign body. There are multiple loops of enlarged small intestine which are filled with gas and fluid.
There is a segment of bowel that is persistently filled with granular material, which is visible in the ventral abdomen on the lateral projections, and in the right side of the abdomen on the v/d. The spleen is moderately enlarged and normal in shape.
The remainder of the abdominal organs appear normal, and peritoneal detail is good

Question 14

A four-month old Jack Russel terrier puppy was playing outdoors. Later that evening the owner noticed that the puppy was wheezing and coughing. Based on the radiographs, what would be the best step to take next?

• Bronchoscopy
• Barium swallow
• Edrophonium challenge test
• Trans-tracheal wash
• Dental prophylaxis

Answer 14

Bronchoscopy
Bronchoscopy is the next best step. On radiographs of the thorax, there is an alveolar pulmonary pattern in the left cranial, and right middle lung lobes, with patchy increased opacity in the remaining lobes.
The trachea is narrowed at the thoracic inlet, with an apparent linear intraluminal opacity. There is dilation of the pharynx with air, and there is gas within the esophagus and gastrointestinal tract.
The tracheal narrowing and intraluminal opacity may indicate edema, mucus, or foreign material in this region. There is secondary upper airway obstruction as indicated by the dilated pharynx and aerophagia.
The alveolar pattern is due to bronchopneumonia.

Question 15

A 20-year-old Burnese python is presented for unusual lethary after of a rat. Which one of the following choices is the most likely diagnosis?

• Foreign Body
• Egg peritonitis
• Pneumonia
• Normal radiographs
• Dysecdysis

Answer 15

Foreign Body
The diagnosis is foreign body ingestion.
Linear amorphous heterogenous opacity consistent with fiber is visible throughout the proximal GI tract. A complete small animal skeleton, most likely the rat the snake also ingested, is visible immediately caudal to the fiber material.

Question 16

Which of the following correctly describes placement of the electrodes when performing an electrocardiogram on a dog or cat? (note arms = forelegs, legs = rear legs)

• White on left arm, black on right arm, red on right leg
• White on right arm, black on left arm, red on left leg
• Red on right arm, green on left leg, black on left arm
• Black on right arm, white on left leg, red on right leg
• Red on left leg, green on right arm, black on left arm

Answer 16

White on right arm, black on left arm, red on left leg
The electrodes used to record an ECG are always attached the same way. The white colored wire is attached to right arm, black to the left arm, and red to the left leg. When 4 are used, the green wire is attached to the right leg.
To record each lead (I, II, III), the ECG monitor automatically compares the electrical difference between the appropriate locations.
The different leads allow measurement of activity from different angles around the heart. This is useful for monitoring, as different leads are tried till a good waveform is found.
The waveforms vary with each lead, abnormal waveforms are seen with cardiac enlargement.

Question 17

What are ongoing losses in fluid therapy?

• Urine output
• Fluids given minus extracellular volume estimate
• The tears I shed when I can’t makke sense of fluid calcultion
• Vomit and diarrhea
• Percent dehydration multiplied by body weight

Answer 17

Vomit and Diarrhea
Ongoing losses are typically vomiting, diarrhea or other losses into a third compartment (pleura, abdomen etc). These are sometimes called “contemporary” losses. A classic example of a disease with significant ongoing losses is a puppy with parvovirus who has both diarrhea and vomiting.

Sensible losses are easily measured, like the fluids the animal loses by urination.

Insensible losses are the fluids an animal loses that are hard to measure, through breathing and via the skin. In humans and animals that sweat (like horses) sweating is part of insensible losses.

Remember that all three types of loss must be accounted for (or at least estimated) when calculating fluids needed to rehydrate a dehydrated animal.

Question 18

A 6 year old female spayed cocker spaniel is presented with a 2 day history of lethargy. Upon physical exam mucosal petechiae and ecchymoses and an ocular hemorrhage O.D. is noted
A coagulation profile shows the following:
Thrombocytes= 49,720..[N=200,000-900,000]
Buccal mucosal bleeding time (BMBT), increased
Activated partial thromboplastin time (aPTT), normal
Prothrombin time (PT), normal
Thrombin time (TT), normal

What is the diagnosis?

• Anticoagulant todenticide toxicity
• Disseminated intravascular coagulation (DIC)
• Hepatic insufficiency
• Idiopathic thrombocytopenia
• Von Willebrand’s disease

Answer 18

Idiopathic thrombocytopenia

The history, plus a lab pattern of low platelets, increased bleeding time and normal aPTT, PT and TT tests suggests thrombocytopenia. Idiopathic thrombocytopenia (often immune-mediated) is the most common cause of spontaneous bleeding in dogs.

Twice as common in females; cockers, poodles and old English sheepdogs are predilected, but can occur in any breed.
Of the common causes of coagulation disorders, only disseminated intravascular coagulation (DIC) also presents with thrombocytopenia.

Question 19

A stray dog is presented after being hit tby a car. The dog has hypotonic forelimbs and spastic paresis in the hinds. All four limbs have proprioceptive deficits and sensation loss-signs are worse in the forelimbs.
Where is the lesion?
-Cranial cervical: C1-C5
-Cannot say without cutaneous trunci reflex results
-Lumbosacral L4-S3
-Thoracolumbar T3-L3
-Cervicothoracic: C6-T2

Answer 19

Cervicothoracic: C6-T2

Cervicothoracic: C6-T2. Weak, hypotonic (Lower motor neuron-LMN) forelimbs and spastic paresis (Upper motor neuron-UMN) hindlimbs are signs of a cervicothoracic (C6-T2) lesion. May see worse signs in fores then hinds.
NOTE: This is the OPPOSITE presentation as Schiff-Sherrington syndrome ie: severe spinal cord trauma T3-L3, with thoracic limb extensor rigidity (UMN) and hind limb flaccid paralysis (LMN). Lesion is caudal to T2, typically see animal soon (hours) after a bad trauma, like hit by car.
Can localize T3-L3 lesion by checking cutaneous trunci reflex -The lesion is usually 1-2 vertebrae cranial to the line of analgesia (where dog does not feel pinching skin).
With C1-C5 would expect UMN signs in all 4 limbs, usually worse in hinds.
With a T3-L3, would see UMN hind limb signs and normal forelimbs.

Question 20

Which one of the following choices would be the best method for controling anaplasmosis in adult cattle in the United States?

• Long-acting oxytetracycline for entire herd
• Vaccination with a modified live vaccine
• Serotest and cull affected cows
• Spray pastures with carbaryl insecticide
• Imidocarb prophylaxis

Answer 20

Long-acting oxytetracycline for entire herd

Anaplasmosis is transmitted through tick vectors. Theoretically, tick control should eliminate the agent. Unfortunately, there is no effective method for controlling ticks on a range pasture.
Affected cattle are long term carriers, so effective control must be based upon minimizing the number of inapparently infected cattle within the herd. This is best accomplished with 2 to 4 weekly injections of long-acting oxytetracycline.

Imidocarb has been used for treating carrier cows in some countries, but the drug is not currently approved for use in the United States in cattle.

Modified live vaccines exist, but have variable efficacy, availability and adverse effects.

Question 21

What distinguishes lymphoma from leukemia?

• Lymphoma is benign
• Leukemia is derived only from myeloid cells
• Leukemia is the precursor to lymphoma
• Lymphoma originates in solid tissues
• Lymphoma occurs only in dogs

Answer 21

Lymphoma origniates in solid tissues

In general, lymphoma and leukemia both arise from malignant transformation of lymphoid cells and are named based on tumor location. Lymphoma=solid organs and bone marrow. Leukemia=blood circulation and bone marrow. Leukemias can also arise from myeloid cells (monocytes, basophils, eosinoiphils, megakaryocytes, erythrocytic precursor cells). Lymphoma is a tumor of lymphocytes that originates mainly in solid lymphoid tissues including the bone marrow, thymus, lymph nodes, and spleen. In addition, common extranodal sites include the skin, eye, CNS, testis, and bone.
Lymphomas are further distinguished according to their location (multicentric, cutaneous, CNS, GI).
Leukemia is a malignant neoplastic disease of the WBC or RBC precursors with neoplastic cells in the bone marrow and peripheral blood. Leukemias are further distinguished according to their behaviour (acute or chronic) and their precursor cell (lymphoid or myeloid), so you will see names like Acute Lymphocytic Leukemia (ALL) or Chronic Myeloid Leukemia (CML). In cats, FeLV infection is an important risk factor for both leukemia and lymphoma. FIV infected cats have a higher than expected incidence of FeLV-negative lymphomas.

Question 22

A 6-month old Manchester terrier is presented with a 4-week history of hindlimb lameness? A DV radiograph shown below. What is the diagnosis?

• Congenital sacroiliac malformation/degeneration
• Lumbosacral subluxation
• Osteochondrosis
• Aseptic necrosis of the femoral head
• Coxofemoral luxation

Answer 22

Aseptic necrosis of the femoral head

This is avascular/aseptic necrosis of the femoral head (Legg-Perthes). Typically a young dog (4-11 mo.) problem of small and miniature breeds. Think of a Yorkie, Miniature poodle or Chihuahua presenting with a hind lameness and these radiographic findings.
Manchester terriers have a genetic predisposition- do not breed affected animals. Unknown etiology. Typically Rx with NSAIDS, femoral head and neck osteotomy.

Question 23

A 4-year old quarterhorse presents with a 3 week history of diffuse patchy alopecia on the ventral midline and face, including a “bulls-eye” lesion in the center of the forehead.
There is a mild conjunctivitis and uveitis OU (both eyes). A punch skin biopsy looks like the image below. What is the most appropriate treatment?
-Ivermectin now, repeat in 4 months
-Trichlorfon drench, antibiotic ophthalmic ointment TID
-Do nothing
-Corticosteriods, benzimidazole-piperazine q. 12 weeks
-Topical DMSO, Oxybendazole q. 8 weeks

Answer 23

Ivermectin now, repeat in 4 months

The treatment of choice for Onchocerca spp. microfilaria is an avermection-family drug, with retreatment at 4 month intervals.Treated horses show marked improvement. Although adult filaria are not killed by avermectins, in practice most horses are free of disease within 6-12 months. Adult filaria live in calcified nodules in the ligamentum nuchae and produce microfilaria that migrate to the ventral midline, face, neck, and chest. The resulting dermatitis is thought to be a hypersensitivity to microfilarial antigens. Accumulation of microfilaria in the eye may also lead to conjunctivitis and uveitis.
Note that Culicoides spp.(no-see-ums, biting midges) carry the onchocerca microfilariae, but do not cause the problems listed above themselves. Instead, biting midges cause sweet itch, a very pruritic warm weather dermatitis that is also secondary to hypersensitivity.
Doing nothing is a poor choice in this symptomatic animal. Finding microfilaria in skin biopsies of asymptomatichorses is a common incidental finding. Because of this, some references debate the role of onchocera in the pathogenesis. It seems likely that variations in immune response play a role in severity of disease presentation.
In humans, Onchocerciasis is a well known cause of hypersensitivity-related superficial keratitis (river blindness)and dermatitis.

Question 24

Fractures of the proximal seasamoid bones in horses are often associated with damage to whic structure?

• Suspensory ligament
• Superior check ligament
• Deep digital flexor tendon
• Superficial digital flexor tendon
• Impar ligament

Answer 24

Suspensory ligament

The suspensory ligament is most likely to be damaged with fracture of the proximal sesamoids due to its insertion onto these bones. Proximal sesamoid fractures are relatively common, caused by overextension. The prognosis for return to soundness is often predicated on the extent of the damage to the suspensory apparatus. Proximal sesamoid fractures and their attendant suspensory apparatus problems are the number one cause of racetrack deaths.

Question 25

What is the most common clincal sign exhibited by a horse with cystic calculi (bladder stones)?

• Straining to defecate
• Colic
• Hematuria after exercise
• Uremic breath and urethral ulcers
• Inappetance

Answer 25

Hematuria after exercise

Bladder stones in horses are usually single, large spiculated stones composed of calcium carbonate. The most common clinical sign exhibited by horses with cystic calculi is hematuria after exercise. Hematuria is most evident toward the end of a voided urine stream. Other signs may include stranguria, pollakiuria and urinary incontinence. In adult male geldings, urethral obstruction may also be associated with cystitis. If there is urethral blockage by smaller uroliths, stranguria, pollakiuria, incontinence, restlessness, colic and stretched posture may be more prominent.

Question 26

Which one of the following diseases is characterized by schistocytes on a complete blood count?

• Disseminate intravascular coagulation
• Cyanocobalamin deficiency
• Systemic lupus erythematosus
• Methemoglobinemia
• Acetaminophen toxicity

Answer 26

Disseminated intravscular coagulation

Disseminated intravascular coagulation. Schistocytes are produced by the mechanical fragmentation of erythrocytes on intravascular fibrin strands. They are most commonly associated with conditions that affect blood flow or clotting like disseminated intravascular coagulation(DIC), heartworm, hemangiosarcoma and glomerulonephritis.

Cobalamin deficiency causes a macrocytic anemia (pernicious anemia).
Systemic lupus erythematosus may cause anemia, thrombocytopenia and leukopenia or leukocytosis.
Think of methemoglobinemia, heinz bodies and hepatotoxicity with acetaminophen toxicity in cats.

Question 27

What is the most common cause for the problem seen in this turtle?

• Septicemic cutaneous ulcerative disease (SCUD)
• Pasteurella multocida
• Nutritional secondary hyperarathyroidism
• Hypovitaminosis B (thiamine)
• Vitamin A deficiency

Answer 27

Vitamin A deficiency

This is an aural abscess, secondary to vitamin A deficiency.
Captive terrestrial box turtles are most at risk, usually due to diets containing little vitamin A.
Other presentations of hypovitaminosis A include froth from nose (a sign of respiratory disease) and renal disease.

Question 28

A petting zoo is experiencing a high mortality outbreak among young chickens, guinea fowl, pheasants and turkeys.
Affected birds huddle near heat sources. They are off feed and weak, with whitish feces pasted around their vents (diarrhea).
On necropsy, lesions include unabsorbed yolk sacs and gray nodules in the liver, spleen, lungs, heart, gizzard, and intestine. There are firm, cheesy cecal cores.
This presentation is highly suggestive of which diagnosis?
-Campylobacter jejuni
-Salmonella pullorum
-Avian spirochetosis
-Histomoniasis
-Coronaviral enteritis

Answer 28

Salmonella pullorum

This is the clinical picture of Salmonella pullorum, which usually causes very high mortality (potentially approaching 100%) in young birds.
Pullorum disease was once common in North America but has been eliminated from most commercial chicken stock. The disease may occur in other avian species (eg, guinea fowl, quail, pheasants, sparrows, parrots, canaries, and bullfinches)

Question 29

A ten year old neutered male cat is presented with an acute onset of vomiting and anorexia. On physical examination, the patient is dehydrated with a painful abdomen.
Bloodwork
ALB=2.2 g/dL…….[N=2.6-4.0], ALK PHOS=88 U/L..[N=3-65]
ALT=112 U/L……..[N=8.2-57], AMYL=2483 U/L..[N=270-1,462]
BUN=42 mg/dL…..[N=10-30], K=3.3…[N=3.5-5.1]
CL=108 mEq/L……[N=109-122], WBC=22,200..[N=3800-19,500]
LYMPHS=1404/uL..[N=1000-4800], NEUTS=15538/uL..[N=0-3000]
Ultrasound: Mass effect on the region of the pancreas
Radiographs: Decreased serosal detail in the cranial abdomen
In addition to supportive care (IV fluids, anti-emetics) and pain control, which one of the following treatment options is indicated?
-Prednisolone
-Tylosin; Cisapride
-Hypoallergenic diet
-Pancreatic enzyme replacement therapy
-Trimethoprim-sulfamethoxazole

Answer 29

Prednisolone

Prednisolone is a viable treatment option for some patients and may also mitigate associated diseases such as cholangiohepatitis and inflammatory bowel disease.
The mainstay of pancreatitis therapy is supportive care, with IV fluids, pain control (meperidine, butorphanol, fentanyl, buprenorphine) and antiemetics.

If vomiting can be controlled, judicious offering of low-fat food is indicated in cats.
Prednisolone is contraindicated in feline diabetes mellitus and canine pancreatitis. Antibiotics are only indicated in cases where an underlying cause can be identified that requires their use.

Question 30

A female veterinarian is pregnant and her physician tests her serologically for toxoplasmosis.

IgM is negative
IgG is postitive
What is the most appropriate interpretation?

• Mother is safe, baby at risk
• Mother at risk, baby is safe
• Both mother and baby are safe
• Need to re-check in 2 weeks for rising titers
• bother mother and baby at risk

Answer 30

Bother mother and baby are safe

Both mother and baby are safe. The toxoplasmosis organism causes birth defects in a developing fetus if a mother is infected for the first time in her life while pregnant (ie: IgM positive while pregnant).
Toxoplasmosis is not generally dangerous to immune-competent people and a positive IgG result suggests an old infection.
There are challenges to toxoplasmosis testing in pregnant women (false positives). If a pregnant woman is IgM positive, confirmatory tests must be done.

Question 31

A 12 year old neutered male black labrador retriever is presented with a 3 week history of limping on the right fore. The lateral digit is swollen and the nail is deviated ventrally, with ulceration of the nail bed.

A lytic bone lesion of the 2nd phalanx is visible on a radiograph and cytology of the mass suggests neoplasia. Chest radiographs are clear. Following amputation of the digit, histopathology indicates that the mass is a squamous cell carcinoma.

Which of the following is the best advice for the owner?

• 95% chance he will survive 1 year
• Chemotherapy is indicated
• Radiotherapy is indicated
• Guarded prognosis
• 50% chance he will survive 1 year

Answer 31

95% chance he will survive 1 year

The prognosis is good. 95% of dogs with digital squamous cell carcinoma (SCC) survive 1 year after amputation and 75% survive 2 years after amputation.
SCCs have a low metastatic rate; most have not metastasized at the time of diagnosis. Chest radiographs and aspiration of local lymph node(s) for cytology are necessary to accurately assess prognosis.

In contrast, malignant melanoma of the digit is an aggressive tumor, with substantial metastatic potential and poorer prognosis. Median survival with resection is 12 months, with a 30% local recurrence rate.

Question 32

Atresia coli in the claf is associated with which one of the following choices?

• Freemartins
• Rectal palpation in 1st 42 days of pregnancy
• HIstory of ketosis/hepatic lipidosis in dam
• Oral doxycycline
• Dry matter intake over 20% during dam’s peak lactation

Answer 32

Rectal palpation in 1st 42 days of pregnancy

Vascular damage secondary to amniotic vesicle palpation in the first 6 weeks of embryonic development can lead to intestinal ischemia and atresia in calves.
Inherited atresias of the intestine are relatively common in large animals. Only 30% of calves with atresia coli survive to adulthood.

Surgical correction is not recommended in Holstein calves because atresia coli is probably heritable in this breed.
Congenital atresia ani, (imperforate anus, seen most in cattle, sheep, pigs) occurs when the dorsal membrane separating the rectum and anus fails to rupture.

Clinical signs at birth include tenesmus, abdominal pain and distention, retention of feces, absence of an anal opening.