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1

A 2-year old thoroughbred mare has a 1-month history of poor race performance. The mare slows down markedly near the end of races with labored breathing, excessive swallowing and a bilateral epistaxis which resolves with time. She coughs after exercise, but otherwise acts normally and has a good appetite. 

With the horse calm and well rested, no obvious abnormalities are visible on endoscopic exam. A transtracheal wash shows the following image 

What should the owner be told? 

A - This may be a case of bastard strangles
B - The horse should improve on antihistamines
C - We need to biopsy for ethmoid hematoma
D - Prognosis is poor-suspect gastric ulcer reflux
E - This is a very common problem in thoroughbreds

E- This is very common problem in thoroughbreds

his is a classic description of exercise-induced pulmonary hemorrhage (EIPH)-Very common (43-75% of flat racers). Hemorrhage from lungs possibly may occur in ALL Thoroughbreds.

Note that only ~ 10% of horses with EIPH may show epistaxis- look instead for a Hx of exercise intolerance.

On trans-tracheal wash (TTW) see alveolar macrophages containing hemosiderin (dark pigment granules left from phagoscytized RBCs). To maximize your chances of seeing blood in trachea, do endoscopy AFTER exercise.

Two other big rule outs for epistaxis are:
1. Ethmoid hematoma and
2. Guttural pouch mycosis.

2

Hyperadrenocorticism is suspected in a 9-year old female spayed dog with a two-month history of increased appetite, thirst and urinary accidents.

Which of the following diagnostic test is most reliable when results are positive?

Urine Cortisol Creatinine Ratio (UCCR). Sensitivity=90% , Specificity =25%
ACTH Stimulation. Sensitivity=80% , Specificity =85%
Low Dose Dexamethasone Suppression. Sensitivity=95% , Specificity =50% 

A - Low Dose Dexamethasone Suppression (LDDS)
B - ACTH Stimulation 
C - Urine Cortisol Creatinine Ratio
D - Cannot say without knowing the positive predictive value 
E - Cannot say without knowing the negative predictive value 

B- ACTH stimulation

ACTH Stimulation. The two diagnostic screening tests used most commonly for diagnosis of hyperadrenocorticism are the ACTH stimulation test and the LDDS. Remember your Ps and Ns.

ACTH Stim is the most sPecific (fewer false Pos, so trust a POS test more).

LDDS is more seNsitive (fewer false Negs, so trust NEG test more).
Click here for a diagram

Either way, these 2 tests are useful to screen for Cushing's, but a confirmatory test is usually required if you get a positive, to differentiate between a pituitary HAC or an adrenal HAC case [high-dose dexamethasone suppression test (HDDST) or ACTH concentration].

The Urine Cortisol Creatinine Ratio (UCCR) has a low specificity (~25%), which means high false positives. 75% of dogs with non-adrenal illness will have a UCCR result consistent with HAC.

So, a positive UCCR is not useful to identify HAC, however, a negative is very useful to rule-out HAC as dogs with a normal UCCR cannot have HAC.

3

A 6-year old male intact Great Dane presents with a 2-week history of difficulty rising and hindlimb lameness. He has been intermittently anorexic.

The dog is febrile, and displays kyphosis (hunched back), stiff gait and spinal pain over the T3-L3 region with neurologic deficits. CBC shows a hematocrit of 38%..[N=37-55%], WBC=17,500..[N=500.4-15,300], U/A shows pyuria.

On a lateral spinal radiograph irregular lysis crossing the vertebral end plates is visible with collapse of at least one disc space, suggesting a diagnosis of diskospondylitis.

What test is indicated?



A - Transtracheal wash
B - Chest radiographs, 3 views
C - Myelography
D - Brucella canis titers
E - Fungal culture, Aspergillus

D. Brucella canis titers

 

Brucella canis titers are indicated. Diskospondylitis is a vertebral infection from hematogenous spread of bacteria (or fungi) from another site. Typically seen middle-aged big breeds, especially German Shepherds, Great Danes.

Usually caused by hematogenous spread of STAPH AUREUS from primary infection elsewhere. See bacteremia, pyuria in 50%. Blood cultures positive in 75%.

Diskospondylitis can be caused by Brucella canis, and sexually intact animals with suspected diskospondylitis should have Brucella titers measured. Recurrence is common with B. canis.

Remember Brucella in horses with fistulous withers too- do serum agglutination titer for Brucella abortus, ESPECIALLY when horse has had contact with cattle.

4

An alpaca is presented in poor body condition with an unkempt coat, patchy alopecia and severe pruritis and crusting of the extremities. A photo of an affected limb is shown below.

What is the most appropriate diagnostic step?http://www.merckmanuals.com/vet/zk/multimedia/v4734770/n/x.html

A - Tell Yoda you found his brother
B - Test skin crusts for contagious ecthyma parapoxviruses
C - Check thyroid status and bluetongue titers
D - Punch biopsy
E - Skin scraping and microscopic exam

Like most other species, South American camelids get sarcoptic mange (scabies). A skin scrape and microscopic exam can rapidly confirm the diagnosis. Treatment is an avermectin-family drug, SQ every 2 weeks. One report suggests amitraz is also effective.

If you see a severely pruritic dog that looks like this, think of canine sarcoptic mange.

If you see a severely pruritic cow that looks like this, think of bovine sarcoptic mange.

In contrast, some things may look like mange, but aren't. The dog in this image is NOT pruritic, he is severely affected with dermatophytosis (ringworm). A skin scrape will help tell you the difference.

5

An outbreak of diarrheal disease of piglets has occurred which affected the healthiest animals in the herd, 1-2 weeks after weaning.

Some affected piglets had no signs except peracute death. Other affected piglets exhibit diarrhea, ataxia, paralysis, and recumbency.

What condition is at the top of the differential diagnosis list?

A - Clostridium perfringens type C enteritis
B - Edema disease
C - Porcine proliferative enteritis
D - Epidemic transmissible gastroenteritis (TGE)
E - Hemagglutinating encephalomyelitis virus (HEV)

B Edema disease

Edema disease is caused by entertoxigenic E. coli (ETEC). Look for severe acute illness ranging from peracute death with no signs to CNS involvement with ataxia, paralysis, and recumbency in healthiest pigs 1-2 weeks after weaning.

Hemagglutinating encephalomyelitis virus (HEV), is almost exclusive to piglets less than 4 weeks old. Two clinical presentations: Vomiting and wasting disease (VWD) and encephalitic.

Clostridium perfringens type C enteritis ,also called enterotoxemia in other species is characterized by a HEMORRHAGIC diarrhea in 1-3 day old piglets.

Porcine proliferative enteritis is principally a diarrheal disease of growing finishing (40- to 80-lb) pigs and young breeding pigs.

Epidemic transmissible gastroenteritis (TGE) in non-immune pig herds characterized by HIGH MORBIDITY and HIGH MORTALITY in piglets less than 1 week old.

6

A group of 2 1/2 month old feeder pigs are presented with non-pruritic keratinized skin lesions and mild lethargy. One severely affected animal is depressed and anorexic.

Click here to see image 1
Click here to see image 2

What treatment is most appropriate for the presumptive diagnosis?

A - Supplement dietary zinc 
B - High dose trimethoprim-sulfonamide 7-10 days
C - Copper sulphate bath or sprays
D - Ivermectin SQ now, repeat in 2 weeks
E - Spray with malathion (0.05%)

A supplement dietary zinc

n pigs, zinc deficiency causes parakeratosis. Zinc supplementation will resolve clinical signs.
Starter diets should contain 125 ppm zinc (and 0.9% calcium)
Grower diets should contain 75 ppm zinc (and 0.60-0.65% calcium)
Finisher diets should contain 50 ppm zinc (and 0.45 to 0.50% calcium)

Parakeratosis may resemble exudative dermatitis ("greasy pig disease"), caused by Staphylococcus hyicus. Exudative dermatitis is more typically seen in younger suckling piglets and treated with antibiotics.

Sarcoptic mange (Sarcoptes scabiei var suis) is typically pruritic and treated with antiparasitics like ivermectin or pigs may be sprayed with lindane (0.05-0.1%) or malathion (0.05%).

7

A 3-year old male neutered Labrador retriever from the Ohio river valley basin is presented with chronic large bowel diarrhea and signs of respiratory disease (cough, fever).

A lymph node smear shows round to ovoid (1-4 micrometers) encapsulated structures inside macrophages and giant cells. The organisms have thin cell walls, with thin clear zone between cell wall and cytoplasm.

Click here to see image

What is the diagnosis?

A - Histoplasmosis
B - Coccidioidomycosis
C - Blastomycosis
D - Cryptococcosis 
E - Aspergillosis 

Think of Histoplasmosis in a dog with these findings (possible respiratory and diarrheal fungal disease, with tiny organisms in macrophages).

Histoplasmosis is seen in the river valleys of the central United States, associated with bird and bat droppings in soil.

The big DDX is blastomycosis, also seen in the same area, with a respiratory presentation. Histo is more a chronic diarrheal and respiratory disease in dogs and a respiratory disease in cats.

Note that histoplasma organisms are much smaller (1-4 micrometer for histo vs. 8-25 micrometers for blasto), and UNLIKE blasto, histoplasma organisms are difficult to detect with routine H&E stain.

Use PAS, Gomoris methenamine silver or Gridley's fungal stains to see yeast forms in macrophages and giant cells(round to ovoid structures(1-4 micrometers), thin cell wall, thin, clear zone between cell wall and cytoplasm.

Coccidioidomycosis is seen in the arid and semiarid Southwestern U.S., Mexico and Central America. Organisms vary in size (20-80 micrometers to 200 micrometers) spherules with a double-contoured wall.

Mature spherules (sporangia) contain tiny endospores (sporangiospores) 2-5 micrometers in diameter. THINK DUSTY DESERT. Spores are carried on dust and inhaled. Epidemics may occur after dust storms or excavation.

Because it is ubiquitous, positive culture results for aspergillus should be supported by demonstration of narrow, hyaline, septate, branching hyphae. Usually a nasal presentation in dogs.

Think of Cryptococcus in cats with a granulomatous rhinitis and sinusitis. This nasal cavity disease in cats sometimes causes a swollen "roman nose" appearance. Seen in other species as well (cows, dogs) but with varying presentations.

8

During the necropsy of an 8 year-old mixed breed dog from the Southern United States, reactive granulomas in the esophagus containing bright red worms, 40 mm to 70 mm long are found.

What is the diagnosis?

A - Ollulanus tricuspis
B - Haemonchus placei
C - Spirocerca lupi
D - Gastrophilus spp.
E - Physaloptera spp.

C. Spirocerca lupi 

A disease of dogs in the Southern U.S. and tropical climates, Spirocerca lupi (esophageal worms) make reactive granulomas of variable size in the esophageal, gastric or aortic walls.

Spirocercosis may also lead to aneurysm in the thoracic aorta or an ossifying spondylitis of the posterior thoracic vertebrae.

Typically asymptomatic, but large granuloma can cause esophageal obstruction. Large granomas may become neoplastic (osteosarcoma, fibrosarcoma).

Some dogs develop spondylitis or enlargement of the extremities characteristic of hypertrophic osteopathy.

All four of the other choices are gastric parasites.
Ollulanus tricuspis is an uncommon gastric parasite of cats.
Physaloptera spp. is a stomach worm that may cause vomiting, anorexia, dark feces in dogs and cats.
Haemonchus spp., Ostertagia spp. and Trichostrongylus spp. are found in the abomasum of ruminants.
Gastrophilus spp. are the larvae of horse bot flies, found in the stomach of horses.

9

A 9 year-old male neutered domestic shorthair cat is presented with a 4 week history of occasional disorientation and bumping into things. The cat does not visually track a ball rolled in front of him and has decreased pupillary light reflexes OU.

On fundoscopic exam, the retinal vessels and disc are obscured by something in the way. (see image, below)

What testing is indicated to assess the two most common underlying causes of this condition in cats?
 

A - CSF analysis, CBC
B - Thyroid function, BUN/Creatinine
C - Adrenal function, Arterial pressure
D - Hepatic function, Serum globulins
E - Urinalysis, Pancreatic function, fasting blood glucose

B Thyroid function, BUN/creatinine

Thyroid function, BUN/Creatinine. This presentation of vision loss in an older cat suggests retinal detachment, typically secondary to HYPERTENSION.

Chronic renal disease may lead to HYPERtension and retinal detachment-Physical exam, history and BUN/creatinine will rule this disease in or out.

HYPERthyroidism can ALSO cause HYPERtension. Your physical exam and history, plus a measure of T4 will help you evaluate this condition.

Other diseases associated with retinal detachment include your alphabet diseases and 2 T's:
FIP, FeLV, FIV
Toxoplasmosis and Trauma

Follow these links to see classic retinal detachment in a dog with renal disease and focal retinal detachment in a cat with cryptococcosis.

Remember you can see hemorrhage with retinal detachment, as in this example from a young dog with Collie-eye anomaly.

For comparison, see this example of another big retinal disease, Progressive retinal atrophy (PRA)- think of SLOW loss 

10

A 4 month old filly is presented with a 4 day history of lethargy, heavy breathing, cough and decreased appetite.

T=104.9 F (40.5 C)..[N=99-101.3 F]
HR=72 bpm.............[N=28-40]
RR=44 brpm............[N=10-14]

On lung auscultation asymmetrically-distributed crackles and wheezes are audible. Some areas have no breath sounds and a dull resonance on thoracic percussion. A lateral chest radiograph shows consolidated nodular lung lesions and mediastinal lymphadenopathy.

What is the treatment of choice?

A - Erythromycin and Rifampin
B - Chloramphenicol and Aminophylline
C - Vancomycin. Atropine if see bronchspasm
D - High dose procaine penicillin G after abcesses rupture 
E - Thoracocentesis and Amikacin. Saline cathartic if see diarrhea

A. Erthromycin and Rifampin

Erythromycin and Rifampin. This is the clinical picture of a foal with pneumonia. In this case, a chest radiograph with consolidated nodular lung lesions and mediastinal lymphadenopathy is highly suggestive of Rhodococcus equi in a foal under 5 months of age. Treat long term 4 to 10 weeks with Erythromycin and Rifampin (expensive).
If a foal under 5 months with signs of pneumonia had diarrhea or gram positive pleomorphic rods (like Chinese letters) in a transtracheal wash, these signs would also suggest Rhodococcus.

Click here to see an ultrasound video from Merck of a 3 month-old foal with rhodococcal pneumonia.

Click here for examples of imaging of Rhodococcus lungs from the VetNext website.

11

A client is considering the purchase of a 12-year old prize-winning thoroughbred mare for breeding. The pathology report from an endometrial biopsy says the mare is category III by the Kenney scoring system. 

What advice is most appropriate to give the client? 

A - Don't buy this mare for breeding
B - 10%-50% chance of bringing a foal to term 
C - 80%-90% chance of bringing a foal to term 
D - 50%-80 chance of bringing a foal to term 
E - Best to breed by artificial insemination

A Don't buy this mare for breeding

Don't purchase a category III mare for breeding. Endometrial biopsy predicts a mare's ability to carry a foal to term and category III is the worst news. (Remember "3 strikes and you are out").

Endometrial biopsies are classified into 3 types by the Kenney system according to degree of periglandular uterine fibrosis and scarring. The Kenney system gives a % probability that a mare can carry a foal to term. Category I is best. Most horses fall in category II. Category III is worst.

Category I No changes
 (80%-90%)
Category IIA Minor changes
 (50%-80%)
Category IIB Moderate changes
 (10%-50%)
Category III Severe changes.
 Less than 10% probability can carry a foal to term.

12

During a routine dental cleaning under isoflurane anesthesia on an 8-year old male neutered Doberman, the ECG monitor shows the following pattern.

The dog is stable and doing fine. What is this pattern?

[DOG ECG]  

A - Atrial fibrillation
B - Ventricular premature complexes
C - Atrioventricular (AV) block
D - Accelerated idioventricular rhythm
E - Sinus arrhythmia 
 

B Ventricular premature complexes

These are ventricular premature complexes (VPCs).

You had better be thinking the dog is in early stages of Dilated Cardiomyopathy (DCM).

According to Merck, 9th ed. "...ventricular premature contractions on a routine ECG in a presumed healthy DOBERMAN Pinscher or BOXER is HIGHLY SUGGESTIVE of CARDIOMYOPATHY".

Echocardiography is the test of choice for definitive diagnosis of DCM.

Remember this mnemonic for DCM breed predispositions: "DCM in a BOX" (ie: "D_obes, C_ockers, M_assive dogs (giant breeds), in a BOX_er"

ALWAYS FATAL. Death usually in 6 to 24 months after Dx. WORSE Prognosis in DOBES, generally survive less than 6 months from Dx.

13

In which category of drugs are isoproterenol and dobutamine classified? 

A - Beta adrenergic agonists 
B - Angiotensin-converting enzyme (ACE) inhibitors
C - Phosphodiesterase (PDE) inhibitors
D - Calcium channel blockers
E - Negative chronotropes
 

A Beta adrenergic agonists

Isoproteronol and dobutamine are beta adrenergic agonists and positive inotropes (increase cardiac contraction strength). Dopamine and epinephrine are also B-agonists.

Two other categories of positive inotropes are cardiac glycosides (digoxin, digitoxin) and
phosphodiesterase (PDE) inhibitors like milrinone and amrinone.

14

A 2-week old calf is presented that is dehydrated and almost emaciated from weight loss. She has a 1 week history of watery, foamy diarrhea and exhibits tenesmus during examination. 

The calf is the only sick one in a mixed group of calves that range from 3 weeks to 2 months of age

What is the diagnosis? 

A - Colibacillosis
B - Cryptosporidiosis
C - Coccidiosis
D - Ostertagiasis
E - Coronavirus

B Cryptosporidiosis

Watery diarrhea in a SINGLE animal (1-4 weeks) in a group, plus emaciation suggests Cryptosporidiosis.

Expect a more acute, lethal presentation of hemorrhagic diarrhea in 1-4 DAY old calves with Colibacillosis, and multiple cases with the viral diarrheas like Rotavirus - (5d-2 wks old, self limiting); Coronavirus, (4-30d).

OLDER-animal diarrheas on this list include Coccidiosis ( Older than 21 days and in ALL ages, bloody diarrhea, tenesmus) Ostertagiasis (anorexia, poor growth, diarrhea in less than 2 year olds on pasture- a chronic disease).

15

Which one of the following choices is the most appropriate treatment for the male guinea pig seen in this image?

Click here to see image 

A - Fipronil SQ
B - Griseofulvin PO
C - Ivermectin SQ
D - Penicillin G IM
E - Amitraz dips, once weekly
 

B Griseofulvin PO

The preferred answer is griseofulvin. This is ringworm in guinea pigs, which is usually self-limiting with good husbandry and sanitation.

Treat isloated lesions with topical miconazole, griseofulvin or butefanine.

Systemic treatments include fluconzole or griseofulvin. Remember that griseofulvin is teratogenic and must not be given to pregnant females.

Avoid fipronil and penicillins in guinea pigs. Amitraz is used against demodectic mange, not ringworm.

16

A 6-year old quarterhorse gelding is presented in September in North America with a three-day history of depression, poor appetite, fever and worsening gait. The owner says the horse seems weak on his hind legs, stumbles and sometimes presses his head against the wall of his stall.

The horse is ataxic and hypermetric in all four legs. Serum antibody titers to EEE, WEE, and VEE are low. A Western Blot test of CSF for antibodies toSarcocystis neurona is negative.

Which one of the following diagnostic tests should be performed next? 

A - Serum IgM capture ELISA for West Nile Virus
B - MRI to rule out nigropallidal encephalomalacia
C - CSF tap and test for Japanese encephalitis
D - Plasma antibody test for St. Louis encephalitis
E - Serum AGID for equine infectious anemia
 

A Serum IgM capture ELISA for west nile virus

Serum IgM capture ELISA for West Nile Virus. Think of the equine encephalidities in a febrile horse, especially in the fall months. Because serum antibody tests for EEE, WEE and VEE are low, West Nile virus encephalitis is the big remaining rule out.

Look for variable and nonspecific signs like depression, low-grade fever and anorexia in combination with neurologic signs like head-pressing (image), ataxia (often hind-end weakness or paralysis) and visual impairment. IgM capture ELISA is the test of choice.

Remember that in most states and provinces, you must REPORT a horse with clinical signs of encephalomyelitis, even if the test results are not in yet.

With equine infectious anemia (EIA), think of recurrent fever, weight loss, dependent edema, petechial hemorrhages (image) and icterus.

Think of ataxia and atrophy with equine protozoal myeloencephalitis (EPM) due to Sarcocystis neurona.

17

A 1-week old male quarterhorse foal is presented who was born weak. The foal required a neonatal intensive care unit and a lot of handling in his first few days of life.

He has 4-day history of wet dribbling, swollen umbilical area and a scalded ventrum.

Click here to see image

What is the diagnosis? 

A - Hypospadias
B - Omphalophlebitis
C - Umbilical hernia
D - Uroperitoneum
E - Patent urachus

E Patent urachus

his is a classic history for acquired patent urachus. The dripping tissue tag in front is the umbilicus; penis is caudal. Follow this link to see an image of equine umbilical anatomy.

Recall that the urachus connects fetal bladder to allantoic sac by way of the umbilicus during gestation. Normally, urachus closes in the first days after birth.

A COMMON problem. Can be congenital, but MOSTLY associated with EXCESSIVE HANDLING, (ie: improper lifting, handling umbilicus too much). In fact, patent urachus develops in high % of foals in neonatal intensive care. Also associated with umbilical infection. One review of 16 foals with umbilical infections found 13 (81%) also had patent urachus.

With Uroperitoneum, look for stranguria, enlarging abdomen.

Umbilical hernias may become hot and infected, and possibly leak a little pus, but are not characterized by clear fluids leaking out for days.

Expect urine leaking from the penile anatomy, not the umbilicus with Hypospadias.

18

A cow is presented with pruritus and crusts around the face, as shown in image 1. Image 2 shows the result of a skin scrape.

What is the diagnosis?

Click here to see image 1

Click here to see image 2 

A - Psoroptic mange
B - Trombiculidiasis
C - Cutaneous onchocerciasis
D - Chorioptic mange
E - Sarcoptic mange

E Sarcoptic mange 

This is Sarcoptic mange. Sarcoptes NOT common in cattle (think pigs, dogs).

Look for crusty pruritus starting on the head and neck. Follow this link to see a Merck image of canine sarcoptic mange.

On skin scrape, look for short legs and long UNsegmented pedicles on sarcoptes. In CONTRAST to the long legs and short UNsegmented pedicles of chorioptes (Merck images, both).

19

Which one of the following diseases causes hock sitting, ataxia, and paralysis in chicks 1-2 weeks of age and blue opacity of the lens in those that survive the acute phase of the disease? The disease can affect chickens, pheasants, quail, and turkeys.

A - Avian encephalomyelitis
B - Infectious laryngotracheitis
C - Mycoplasma gallisepticum
D - Fowl cholera
E - Avian metapneumonia 
 

A Avian encephalomyelitis

Avian Encephalomyelitis, also called epidemic tremor, is the most likely diagnosis. This disease has about 60% morbidity and 25% mortality.

Other differentials would include vitamin E deficiency, thiamine deficiency, Newcastle disease, and Marek's disease, however, these do not typically cause cataracts.

M gallisepticum typically causes a chronic respiratory disease in chickens and infectious sinusitis in turkeys.

20

Which choice describes inflammation of an acquired bursa over the dorsal carpus in the horse?

A - Hygroma
B - Ulceroproliferative stomatitis
C - Atheroma
D - Villonodular synovitis
E - Suspensory desmitis

A. Hygroma

hygroma is inflammation of an acquired bursa that develops where normally there is no bursa due to trauma to the dorsum of the carpus. In dogs, you frequently see hygromas at bony, unpadded areas like the elbow.

Villonodular synovitis is an inflammation of the synovial membrane of the dorsoproximal aspect of the forelimbfetlock joints.

Ulceroproliferative stomatitis is a progressively worsening gingivitis and stomatitis in cats. The glossopalatine arches often have severely ulcerated, friable, inflamed, and proliferative lesions. Click here to see a cat with ulceroproliferative stomatitis.

A sebaceous cyst in the dorsolateral aspect of the nasal diverticulum (false nostril) is an atheroma. In humans, an atheroma usually refers to a fatty deposit in the intima (inner lining) of an artery, resulting from atherosclerosis.

21

An 11 year old neutered male Doberman pinscher presents with a 2 week history of limping on the left fore.

The medial digit is swollen and the nail is deviated laterally. Ulceration and proliferation are present in the ventral nail bed.

Cytology of the mass is inconclusive. Chest radiographs are clear. Following amputation of the digit, histopathology indicates that the mass is a malignant melanoma.

Which of the following is the most correct long term prognosis for this case?

A - Poor
B - Excellent
C - Good
D - Fair
E - Cannot say
 

A Poor

 

The long term prognosis is poor. Median survival with resection is 12 months, with a 30% local recurrence rate.Melanoma of the digit is an aggressive, infiltrative tumor, with substantial metastatic potential and a poorer prognosis than cutaneous melanoma or other types of neoplasia.

Some reports indicate that melanomas are not very responsive to radiotherapy, especially if used alone. However, it is utilized for palliative therapy and is recommended following resection, especially when complete excision is not possible.

The efficacy of chemotherapy for subungual melanomas is unclear, but some patients have responded well. Therapy with a DNA vaccine has shown promise in some cases.

Good info here: Brockley LK, MA Cooper MA, & Bennett PF. 2013. Malignant melanoma in 63 dogs (2001–2011): the effect of carboplatin chemotherapy on survival. New Zealand Vet Journal, 61(1): 25-31.

Remember - malignant melanoma may present as swelling of the digit, often with loss of the nail and destruction of bone, much like osteomyelitis. Radiographs and a biopsy are indicated for older dogs that present with a festering, swollen toe.

Click here to see a radiograph of osteomyelitis in a dog's toe.

In contrast, the prognosis is good for dogs with digital squamous cell carcinoma (SCC). 95% of dogs with digital 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.

Ref: Cote, Clinical Vet Advisor-Dogs and Cats, 2nd ed. pp. 711-13, 1046-8, Blackwell's 5-Min. Vet Consult Canine-Feline, 4thed. pp. 878-9, 1290, and the Merck Veterinary Manual online edition.

22

A 5-year old Arabian mare is presented. The owner is not happy. This same horse was treated for strangles 2 weeks ago, and now the mare is sick again.

The horse has a 48-hour history of urticarial wheals on its skin that progressed to sharply demarcated edema of the muzzle, eyes, belly and limbs. She reacts as if it is painful when the edema is checked .

The horse breathes heavily, with stridor, dyspnea and diarrhea.

There is petechiation and ecchymoses on the mucous membranes and the muzzle is a reddish, mulberry color.

T=102.2 F (39 C)..[N=99-101.3 F]
HR=32 bpm..........[N=28-40]
RR=12 brpm.........[N=10-14]

What is the clinical diagnosis?

A - Potomac Horse Fever 
B - Equine salmonellosis
C - Lyme disease
D - Purpura hemorrhagica
E - Equine viral arteritis (EVA)
 

You chose D, the correct answer! 

Purpura hemorrhagica. History of strangles, Streptococcus equi equi followed 2 weeks later by a mixed clinical picture(ie: afebrile, purpura, painful edema, respiratory difficulty, diarrhea or colic) is a classic presentation for Purpura hemorrhagica. Most common cause is sensitization to Strep equi from strangles or Strep equi bacterin vaccine. Less commonly see after Equine influenza, or chronic suppurating wounds. Due to immune complexes damaging vasculature.

For edema in horses, remember "Big 3 are PEE" Purpura, EIA, EVA.

Potomac Horse Fever (Neorickettsia risticii) presents as a febrile colitis/diarrhea, with laminitis 3-5 d after diarrhea: A big rule out is Salmonella (think septicemia/fever + diarrhea). PHF occurs in northeastern U.S. river valleys in JULY and AUGUST.

Lyme disease presents as lameness. ie: arthritic joint(s), low grade fever, reluctant to move. More a dog, human disease.

With Equine viral arteritis (EVA) see conjunctivitis, rhinitis. If very sick, see severe depression, cough, ventral edema, limb edema.

Refs: Colahan and Mayhew, Eq Med and Surg 5th ed. pp. 1457-8, Pasquini's Guide to Equine Clinics, 3rd ed. pp. 42-3, 136-144, and the Merck Veterinary Manual online edition.

23

A client is considering the purchase of a 12-year old prize-winning thoroughbred mare for breeding. The pathology report from an endometrial biopsy says the mare is category III by the Kenney scoring system.


What advice is most appropriate to give the client?

A - Don't buy this mare for breeding
B - 10%-50% chance of bringing a foal to term 
C - 80%-90% chance of bringing a foal to term 
D - 50%-80 chance of bringing a foal to term 
E - Best to breed by artificial insemination

You chose A, the correct answer! 

 

 

Don't purchase a category III mare for breeding. Endometrial biopsy predicts a mare's ability to carry a foal to term and category III is the worst news. (Remember "3 strikes and you are out").

Endometrial biopsies are classified into 3 types by the Kenney system according to degree of periglandular uterine fibrosis and scarring. The Kenney system gives a % probability that a mare can carry a foal to term. Category I is best. Most horses fall in category II. Category III is worst.

Category I No changes
 (80%-90%)
Category IIA Minor changes
 (50%-80%)
Category IIB Moderate changes
 (10%-50%)
Category III Severe changes.
 Less than 10% probability can carry a foal to term.

24

A middle-aged, depressed, coughing, exercise-intolerant Doberman pinscher is presented. The dog has a rapid and irregular heart rate.

What disease is at the top of the differential diagnosis list?

A - Dilated cardiomyopathy
B - Mitral regurgitation
C - Left-sided congestive heart failure 
D - Wolf Parkinson White syndrome 
E - Tricuspid insufficiency

You chose A, the correct answer! 

 

 

This is a classic presentation for dilated cardiomyopathy. Prognosis is GUARDED- with Rx may live 6 mos-2 years. Px especially poor for Dobies.

Rx varies, but foundation includes the "3 D's" -- Diet (Low salt), vasoDilators (Enalapril), Diuretics (Furosemide), +/- Digoxin (+ inotrope to strengthen contraction). NOTE that Dobies can be sensitive to digitalis, so may need lower doses.

So, remember your "DCM D's" : "Depressed Dilated Dobies need Diet, Dilators, Diuretics (and maybe Digoxin, but overDose is Doom)."

25

Which diuretic is a competitive antagonist for aldosterone sometimes used in treatment of congestive heart failure?

A - Thiazides (chlorothiazide, hydrochlorothiazide)
B - Furosemide
C - Osmotic diuretics (Mannitol, DMSO)
D - Carbonic anhydrase inhibitors (Acetazolamide)
E - Potassium-sparing diuretics (Spironolactone, Amiloride)
 

You chose E, the correct answer! 

Potassium-sparing diuretics (spironolactone, amiloride) are aldosterone antagonists sometimes used with furosemide as part of the treatment plan for congestive heart failure (CHF).

Aldosterone, the mineralocorticoid produced in the adrenal cortex, acts on the distal convoluted tubules (and collecting ducts) of the nephron to retain Na+ and water, secrete K+ and increase blood pressure. Clinically, look forincreased aldosterone secretion (increased blood pressure) with CHF.

In contrast, see decreased aldosterone secretion (and decreased blood pressure) with hypoadrenocorticism.

26

In June, a 7 year old quarterhorse gelding is presented with ulcerative and granulomatous skin lesions at the medial canthus of the eye, cheek and the penile sheath.

Expression of one granuloma reveals yellow, calcified dead larvae the size of rice grains. What is recommended to the owner to prevent this problem in other horses on the farm?


A - Quarantine affected horse, Rx herd with slow-acting thiabendazole
B - Isolate affected horses, Rx with ivermectin, intralesional prednisone
C - Rotate pasture, dichorvos for all horses in April and August
D - Rx herd with pyrantel pamoate, avoid lush pasture in summer
E - Regular antihelmintics, regular manure removal, fly control

You chose E, the correct answer! 

 

 

Regular antihelmintics, regular manure removal and fly control.

This is cutaneous habronemiasis ("summer sores") caused by the larvae of Habronema muscae, H. microstoma and Draschia megastoma. Prevention of disease is based on regular antihelmintics, regular manure removal and fly control.

Treatment outcomes for affected horses are poor (ivermectin, intralesional prednisone, topical organophosphates, surgical removal or cautery) in part because multiple lesions in sensitive locations.

27

Which choice is not one of the four core feline vaccines?

A - Feline infectious peritonitis
B - Feline herpesvirus-1
C - Panleukopenia
D - Feline viral rhinotracheitis
E - Feline calicivirus

You chose A, the correct answer! 

 

 

Feline infectious peritonitis (FIP) is not a core feline vaccine.

According to American Association of Feline Practitioners (AAFP) vaccination guidelines, there are 4 core feline vaccines-
Rabies
Feline calicivirus
Feline panleukopenia
Feline viral rhinotracheitis (herpesvirus-1).

Although Feline leukemia (FeLV) vaccine is not a core vaccine, it is highly recommended for kittens.

One way to keep diseases and vaccines straight is to look for connections with other species you remember. For example:

Feline viral rhinotracheitis (FVR), Infectious bovine rhinotracheitis (IBR) and Equine viral rhinopenumonitis (EVR) are all caused by herpesviruses which cause upper respiratory presentations.

Feline viral rhinotracheitis and feline calicivirus are the biggest causes of Feline respiratory disease complex.

Panleukopenia in cats is caused by a parvovirus that is a cousin to the canine parvovirus. Both cause diarrhea, vomiting and low white blood cells.

28

Which parasite has been associated with a hypoadrenocorticism-like syndrome and has been suggested as a cause for cecocolic intussusception in dogs? Image
A - Ancylostoma caninum

B - Physaloptera spp
C - Trichuris vulpis
D - Toxocara canis 
E - Spirocerca lupi

You chose C, the correct answer! 

 

 

Whipworms, (Trichuris spp) are typically found in the cecum and large intestine. Mainly in dogs, rare in cats. Trichuris suis in pigs can cause unthriftiness in younger animals.

If clinical, look for signs of large bowel diarrhea (frequent urgent defecation of loose watery feces, possibly with mucus or fresh blood). Can be associated with a hypoadrenocorticism-like syndrome (hyponatremia, hyperkalemia, azotemia, metabolic acidosis).

Whipworm infection has been suggested as one cause of cecocolic intussusception.

Physaloptera spp (Stomach worms) may cause vomiting, anorexia, dark feces.

Spirocerca lupi makes nodules in the esophageal, gastric, or aortic walls. Typically asymptomatic.

Roundworms (Toxocara canis) may cause visceral and ocular larva migrans.

Hookworms (Ancylostoma spp) may cause cutaneous larva migrans.

29

In September, two Quarter Horse mares horses are presented that are pastured in a group of 5 in Oklahoma. The horses eat pasture grass supplemented by alfalfa hay and a small amount of grain.

One mare was found peracutely dead this morning. The other is depressed, anorexic and colicy.

Physical exam reveals dark, congested mucous membranes with small ulcer-like erosions. The mare makes frequent attempts to urinate, yielding red urine (hematuria) with a urine specific gravity (USG) of 1.006. She makes repeated attempts to drink small amounts of water and keeps her muzzle submerged in the water trough.

T=102.7 F (39.3 C)..[N=99-101.3 F]
HR=40 bpm............[N=28-40]
RR=20 brpm...........[N=10-14]

Necropsy of the other mare shows that the stomach and bladder linings are irritated and hemorrhagic.

What is the diagnosis?

A - Clostridium perfringens type A
B - Arsenic toxicity
C - Sorghum cystitis
D - Cantharidin toxicity
E - Enzootic hematuria

You chose D, the correct answer! 

 

This is Cantharidin toxicity caused by blister beetles (Epicauta spp) which swarm in alfalfa hay during harvest.

Cantharidin is a potent irritant: see colic, renal disease, hematuria, peracute death. Follow this link to see a Merck image of Hemorrhagic gastritis. Follow this link to see a Merck image of Hemorrhagic cystitis.

Enzootic hematuria is a cow disease thought to be caused by Bracken fern toxicity. In horses, see thiaminase-related STAGGERS with bracken fern and with Horsetail (Equisetum spp) on U.S. West Coast.

Sorghum cystitis/ataxia is characterized by cystitis, urinary incontinence ("dribbling" ), posterior incoordination.

30

What is wrong with this picture?  Click here to see image 

A - T3-L3 intervertebral disc disease
B - Cartilaginous exostoses
C - Diskospondylitis
D - Pulmonary emphysema
E - Hemivertebra

E-hemivertebra

This is hemivertebra, a wedge-shaped vertebra, which can be an asymptomatic finding, or may present with scoliosis, kyphosis, and paresis, ataxia. Typically thoracic.

Think screw-tailed dogs (ie: bulldog, pug). Inherited in German shorthaired pointer

Click here to see a horse with lordosis and radiograph of the same horse

31

Which choice is associated with osteosarcoma and hypertrophic osteopathy? 

A - Spirocerca lupi
B - Coccidioidomycosis
C - Habronema spp.
D - Blastomycosis
E - Ollulanus tricuspis

You chose A, the correct answer! 

 

 

A disease of dogs in the Southern U.S. and tropical climates, Spirocerca lupi (esophageal worms) make reactive granulomas of variable size in the esophageal, gastric or aortic walls.

Large granulomas may become neoplastic (osteosarcoma, fibrosarcoma). Some dogs develop spondylitis or enlargement of the extremities characteristic of hypertrophic osteopathy.

Typically asymptomatic, but large granulomas can cause esophageal obstruction. Spirocercosis may also lead to aneurysm in the thoracic aorta or an ossifying spondylitis of the posterior thoracic vertebrae.

Habronema spp. (Habronema muscae, H. microstoma and Draschia megastoma) in horses can cause tumorlike stomach nodules and sometimes cutaneous lesions.

Blastomycosis, most common in dogs, cats and humans is characterized by pyogranulomatous lesions in various tissues.

Placental infection in horses with Coccidioides immitis have been described, leading to abortion and osteomyelitis.

32

If the following image is seen on necropsy, what would be recommended as a treatment plan for the remaining group of pigs?

Click here to see image 

A - There is no effective treatment
B - Morantel PO 
C - Lincomycin IM 
D - Decrease non-protein nitrogen in diet
E - Antihelminthics 

You chose E, the correct answer! 

 

 

Antihelminthics are the treatment of choice.

This is ascarid (roundworm) infestation and these are classic "milk spots"- liver scars left by migrating ascarid larva traveling to the lungs. In heavy infestation, larvae can cause pulmonary edema, consolidation, severe respiratory distress. May see icterus.
 A fecal exam would show eggs that look like this.

Rx with antihelminthics, like benzimidazoles, ivermectin, pyrantel, levamisole. May need antibiotics to treat secondary bacterial pneumonia, but primary Rx is antihelminthics.

Lincomycin is a lincosamide antibiotic used in pigs against mycoplasma pneumonia.

Clorsulon is used to treat liver flukes in cattle and sheep. Click here to see an adult ruminant liver fluke, Fasciola hepatica.
Click here to see a fluke egg.
Click here to see gross hepatic lesions in a cow liver due to fluke migration.

33

What is the correct order of radiographic density of the following tissues, from least radiographically dense to most radiographically dense? 

Urine-filled bladder
Humerus
Transarticular pin
Inflated lung
Abdominal fat 

A - Transarticular pin, Humerus, Urine-filled bladder, Abdominal fat, Inflated lung
B - Inflated lung, Urine-filled bladder, Humerus, Transarticular pin, Abdominal fat
C - Urine-filled bladder, Abdominal fat, Transarticular pin, Inflated lung, Humerus
D - Inflated lung, Abdominal fat, Urine-filled bladder, Humerus, Transarticular pin
E - Humerus, Abdominal fat, Inflated lung, Transarticular pin, Urine-filled bladder,

You chose D, the correct answer! 

 

 

Radiographic density from least dense (black on x-ray) to most dense (white on x-ray) goes in this order: AIR-FAT-WATER-BONE-METAL.

Have a look at this radiograph of a dog who swallowed a metal coin to see example of differing radiographic densities. Depending on mineral density, a urolith in a urine-filled bladder may be more dense or less dense that the surrounding tissue.

Here is a mnemonic to help you remember the 5 types of radiographic density:

1. Bubbles -Air (black)
2. Blubber -Fat (black)
3. Blood -Water, liquids (grey)
4. Bones -Bone and mineral (white)
5. Bullets -Metal (white)

34

Which description correctly matches stringhalt? 

A - Involuntary hyperflexion of the hock towards the abdomen
B - Thickening of the plantar tarsal ligament
C - Effusion in the tarsal sheath of the deep digital flexor tendon
D - Avulsion of the extensor process of the third phalanx
E - Progressive unilateral or bilateral hyperextension of the hindlimb

You chose A, the correct answer! 

 

 

Stringhalt is a myoclonic disease characterized by spasmodic hyperflexion of one or both hindlimbs. The presenting complaint is usually an involuntary hyperflexion of the hock towards the abdomen. Click here to see a video of a horse with classic stringhalt (classic symptoms start about 30 seconds into the video). Etiology is unknown.

In contrast, progressive unilateral or bilateral hyperextension of the hindlimb is typically the presentation of spastic paresis (Elso heel) seen in cattle. Click here to see a cow with spastic paresis.

Thickening or bowing of the plantar tarsal ligament is called curb.

Thoroughpin is distention/effusion/inflammation of the tarsal sheath of the deep digital flexor tendon proximal to the tarsus.

Pyramidal disease describes avulsion or periostitis of the extensor process of the third phalanx.

35

A canine coagulation profile indicates increased values for APTT, PT, TT and FDPs.
Thrombocytes= 62,513 per microliter (normally greater than 211,000 per microliter)

What is the typical prognosis for a dog with the condition suggested by this pattern? 

A - Good
B - Fair
C - Grave
D - Excellent
E - Need more information

You chose C, the correct answer! 

 

 

Grave. A lab pattern of low platelets and across the board increases in bleeding time, APTT, PT, TT and FDP tests suggests disseminated intravascular coagulation (DIC). Remember that DIC also stands for "Death Is Coming". Prognosis is typically grave and mortality is high even with treatment.

DIC is not a disease in its own right. It is a complex hemostatic defect characterized by enhanced coagulation and fibrinolysis, secondary to other diseases. Fibrinolysis and depletion of clotting factors leads to hemorrhage. Many diseases, all of them bad, can precipitate DIC.

Remember your "H diseases" associated with DIC:
Heartworm
Heart failure
Hemolytic anemia
Hemangiosarcoma
Hemorrhagic gastroenteritis
Hepatic disease, esp. hepatic lipidosis in cats.
Gastric dilatation-volvulus (GDV), mammary gland carcinoma and pancreatitis can also lead to DIC.

Follow this link to see a table of the four most important coagulation disorder patterns

 

 

36

An 8-year-old spayed female DSH cat is presented with lethargy, weight loss, and increased respiratory rate.
VD

lateral
Which one of the following choices is the prominent finding?

A - Pleural effusion
B - Vascular pattern
C - Bronchiolar pattern
D - Pulmonary edema
E - Alveolar pattern

You chose A, the correct answer! 

 

 

This cat has a pleural effusion.

There is uniform opacification of the cranioventral thorax. Several short air bronchograms to the cranial lung lobes are identified on the lateral projections.

There is poor visualization of the cardiovascular structures on all projections. There is evidence of a mild pneumothorax with multiple gas bubbles present throughout the thorax.

These may be located in the pleural space or within the lungs. There is evidence of pleural thickening at one of the partially retracted caudal lung lobes.

Click here to see normal feline thoracic radiographs.

37

You are an associate veterinarian paid a base salary of $55,000 annually, plus a 8 % bonus based on receipts in above your monthly production goal of $23,000.

Bonuses are paid quarterly. Your last three month's production were 

$23,000, $28,000, and $27,000

How much is your quarterly bonus ? 

A - $720
B - $840
C - $670
D - $810
E - $900

You chose A, the correct answer! 

 

 

$720If $23,000 is the monthly production goal, then the month you brought in $23,000 does not count towards a bonus.

In the second month, $ 28,000 = $5000 above goal
In the third month $ 27,000 = $4000 above goal

Total above production goal = $5000+$4000= $9000
$9000 X (0.08 bonus rate) = $720

Many practices use a combination system with a base salary and a production-based bonus if you bring in more than a monthly production goal, but no penalty if you are below that monthly goal, which is good if you are a new graduate, and helps in low traffic months at the clinic.

 

38

Which choice is the pastern joint? 

A - Metacarpophalangeal joint
B - Proximal interphalangeal joint (PI-PII)
C - Distal interphalangeal joint (PII-PIII)
D - Carpometacarpal joint
E - Intermetacarpal joint
 

You chose B, the correct answer! 
 

The proximal interphalangeal joint (PI-PII) is the pastern. Follow this link to see a fetlock and pastern anatomy image.

Clinically important because one of the 3 most important nerve blocks, the foot block (also called pastern or abaxial sesamoid nerve block (ASNB)) is done just above the pastern.

Can use a pastern block to make a horse with acute laminitis comfortable.

Follow this link to see a horse "leaning back" in classic laminitis posture.

 

 

39

Which one of the following organisms causes "chronic respiratory disease" in chickens and "infectious sinusitis" in turkeys?
image  

A - Mycoplasma gallisepticum
B - Ornithobacterium rhinotracheale
C - Pasteurella multocida
D - Chlamydophila psittaci
E - Avibacterium paragallinarum

A-mycoplasma gallisepticum

Mycoplasma gallisepticum causes these diseases. It is the most pathogenic avian mycoplasma.

Morbidity is high and mortality low in chickens. Symptoms include respiratory distress, sneezing, nasal discharge, and frothiness about the eyes.

40

An immunochromatographic test kit for detection of fecal canine parvoviruses (CPV) antigen is being tested in a local cat shelter where as many as 10% of the cats there may have panleukopenia secondary to infection with the canine parvovirus.

Here are simulated test results, compared to a gold standard test for CPV.

.....................CPV pos.......CPV neg.............Total

Test kit positive..........128..............734...........862

Test kit negative..........63............1575...........1638

Total.........................191............2309...........2500

What is the sensitivity of this test kit?

A - 128/191
B - 128/734
C - 1575/2309
D - 734/862
E - 1575/1638

You chose A, the correct answer! 

 

 

Sensitivity=128/191 (67%) a/(a+c)
This is a classic example of a 2x2 table in epidemiology, used to compare a new test (the immunochromatographic test kit) to a gold standard test (the CPV test). Draw a 2x2 table, and label the boxes a,b,c,d. Sensitivity = a/(a+c). Click here to see a Basic 2X2 table.

Feline panleukopenia virus(FPV) is closely related to type 2 canine parvoviruses(CPV-2, CPV-2a, CPV-2b). CPV-2a and CPV-2b have been shown to cause a panleukopenia-like illness in domestic cats. Click here for a PDF summary onCanine and Feline Parvovirus in Animal Shelters (may take a half minute to load) by Dr. Cynda Crawford, Maddie's Shelter Medicine Program, Univ. Florida College Vet Med.

41

A 14-year-old male neutered Labrador retriever is presented with a two day history of hematuria with clots.

Based on the ultrasound images shown below, where in the urinary tract is the location of the problem?
image 1

image 2
A - Apex
B - Ureter
C - Urethra
D - Prostate
E - Trigone
 

You chose A, the correct answer! 

 

 

Apex. This dog has a transitional cell carcinoma in the bladder wall.

There is a large, irregularly bordered, broad-based, mineralized mass at the apex of the urinary bladder. There is loss of wall layering adjacent to this mass.

There is blood flow detected within this mass. The trigone is within normal limits.

42

Which of the following choices is a common cause of the Cheyne-Stokes breathing pattern?

(Fast breathing, then slowing down, then no breathing, then cycle starts again). 

A - Brain damage, Animal too deeply anesthetized
B - Pulmonary hypertension and emphysema
C - Hypovolemia and low intracranial pressure
D - Light levels (phase I) of inhalant anesthesia
E - Severe metabolic acidosis, Diabetic ketoacidosis

You chose A, the correct answer! 

 

 

Damage to respiratory centers of the brain can cause Cheyne-Stokes respiration. (Fast breathing, then slowing down, then no breathing, then cycle starts again). Cheyne-Stokes occurs with increased intracranial pressure, ischemia, or direct brain damage.

Click here to see a diagram of Cheyne-Stokes respiration.

Cheyne-Stokes respiration is a usually a bad sign - herniation of the brain may be imminent.

Cheyne-Stokes is also seen in patients under anesthesia who are too deep, and is reported as a side effect of morphine in humans.

Click here for a nice summary of common abnormal respiratory patterns.

43

How long after a booster rabies vaccination is a dog, cat or ferret considered to be currently vaccinated and protected against rabies? 

A - Immediately
B - After 24 hours
C - After 48 hours
D - After 7 days
E - After 14 days

You chose A, the correct answer! 

 

 

Immediately. According to the Compendium for Rabies Control, a peak rabies virus antibody titer is reached 28 days after initial vaccination andimmediately after booster vaccination.

Here are some thoughts on rabies:
When in doubt, it is never wrong to check with your local health department.

Basically all potential rabies exposures boil down to 2 questions:
1. Who is involved?
Animal-Animal exposure (less alarm bells)
Animal bites/exposes human (more alarm bells)

2. Was animal vaccinated/up to date on vaccination?
Up to date on vaccs (less alarm bells, shorter observation)
Vaccinated, but not up to date (Handle on case-by-case basis)
Un-vaccinated pet (more alarm bells, euthanize or long observation period)
Wild animal, esp. bats, raccoon, skunk (euthanize, send head to state lab)

When dealing with rabies questions, ask yourself if this seems like a HIGH-riskexposure (ie: wild raccoon bites a child)
or a LOWER risk exposure (ie: Up-to-date vaccinated dog messes with woodchuck but no bite wounds on dog).

For high risk lean towards euthanasia/testing or long quarantine. For low risk lean towards short observation period (10 days) and a rabies booster.

44

Which one of the following choices is the basic structural component that constitutes a urine cast? 

A - Desquamated epithelial cells
B - Leukocytes
C - Mucus
D - Red blood cells
E - Tamm-Horsfall protein

e- Tamm-Horsfall protein

Casts are made up of Tamm-Horsfall proteins. These are high molecular weight mucoprotein produced by the distal tubular epithelial cells of the kidney. 

The presence of casts may indicate tubular damage but not the severity of the change. Casts may also contain cellular debris (WBC, RBC, epithelial cells) or fat. 

Within urine sediment, mucus looks like homogeneous, ribbon-like material.
 

45

The 12-year-old spayed female cat shown below is presented with a history of weakness for the past 2 days. She has neck ventroflexion and a stiff, stilted gait.
image 
Which one of the following is in the top of the differential list?

A - Caudal occipital malformation
B - Hypokalemic myopathy
C - Hyperkalemic periodic paralysis
D - Cervical vertebral malformation
E - Bilateral otitis media/interna

B Hypokalemic myopathy

The posture is classic for hypokalemia and other neuromyopathies (e.g., myasthenia gravis, organophosphate intoxication) in cats. 

Hyperkalemic periodic paralysis has not been reported in cats.

46

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?

A - Associated with bone development
B - Caused by traumatic placental detachment
C - Associated with neonatal cholestasis
D - Suggestive of a congenital a liver shunt
E - Due to colostrum absorption

Very high GGT levels are seen with colostrum absorption

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.
 

47

In which species is this a normal finding?

Click here to see image.

A - Ferrets 
B - Goats
C - Pot belly pigs
D - Llamas 
E - Chinchillas

B Goats

This is marked poikilocytosis, often seen in normal GOATS.

Remember Camelids (llamas, camels, alpaca) have ellipsoid red blood cells (RBCs).

Remember that it is normal for birds and reptiles to have nucleated RBCs.

48

A farmer presents several chicks ranging from 10-14 days of age. Most have curled up toes and walk on their hocks, but a few have paraparesis with splayed legs.

The leg muscles are atrophied and flabby.

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

Image courtesy, Dr L Mahin.

A - Riboflavin deficiency
B - Marek's disease
C - Newcastle disease
D - Granulomatous neuritis
E - Floppy chick disease

A Riboflavin deficiency

This is an example of riboflavin deficiency which causes decreased egg production and decreased hatching of eggs. The deficiency affects the myelin sheaths of main nerves causing a curled toe paralysis.

Marek's disease also shows symptoms of "spread-leg" paralysis, but is not seen in chicks less than 3 weeks of age.

49

A Holstein cow presents with large patches of erythema and edema. There are also vesicles, scabbing and ulceration.

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

Image courtesy, Dr L Mahin.

A - Photosensitization
B - Tick bite hypersensitivity
C - Squamous cell carcinoma
D - Dermatophytosis
E - Contagious ecthyma

A photosensitization

This is an example of Photosensitization. Notice that the areas covered by black fur are not affected. The most common cause in cattle is impaired hepatobiliary excretion (secondary or type III photosensitization).

Dermatophytosis causes hair loss, but not the vesicles and ulceration seen with photosensitization.

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A rescued Peking duck is presented for non-weight bearing lameness of the left pelvic limb and fever.

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

rad 1

rad 2


A - Septic arthritis

B - Panosteitis
C - Normal radiographs
D - Bumblefoot
E - Egg binding

A Septic arthritis

The duck has septic arthritis. There is diffuse soft tissue swelling of the left pelvic limb.

There also appears to be intracapsular soft tissue swelling of the left tibiotarsal jointcausing the joint space to widen asymmetrically. An osseous fragment is noted at the medial aspect of the joint.

The articular margins of the tibiotarsus and the tarsometatarsus appear lytic and irregular.

Egg-binding symptoms are nonspecific but sometimes the bird will adopt a penguin-like posture. Egg-binding is more often seen during the spring and summer.

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What are the two main causes of pregnancy toxemia in guinea pig sows?

A - Ketosis and hypertension
B - Hypocalcemia and thrombocytopenia
C - Hyperlipidemia and hyperglycemia
D - Anemia and hyperkalemia
E - Hypocalcemia and anemia

A. Ketosis and hypertension 

The two types of pregnancy toxemia in guinea pigs are-
1. Ketosis secondary to a negative energy balance and
2. Ischemia due to the uterine compression of the vascular supply of the uterus, GI tract, or kidneys resulting in hypertension.

Clinical signs of pregnancy ketosis are ketone breath, lethargy, incoordination, dyspnea, paralysis, and death. Treatment of pregnancy-related hypertension may require an emergency cesarean section.

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A 6-month-old kitten is presented with increased respiratory effort and decreased size compared to the littermates.

Which one of the following choices is the most likely diagnosis?
Rad 1

Rad 2

A - Pectus excavatum
B - Portosystemic shunt
C - Hiatal hernia
D - Tracheal hypoplasia
E - Feline infectious peritonitis

A Pectus excavatum 

The kitten has pectus excavatum. The d/v projection is mismarked with the right side designated as left.

The sternum is concave in appearance, and deviates dorsally toward the spine. This has resulted in deviation of the heart to the left hemithorax.

The seventh and eighth sternal segments are not visible. The cardiac silhouette appears enlarged, and the vasculature is prominent.

Click here to see normal feline thoracic radiographs.

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A 21-year-old scarlet macaw is presented with polydipsia, watery droppings and inappetence. On examination, the bird was fluffed and depressed with minimal pectoral muscle atrophy. The crop was fluctuant.

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

rad 1

rad 2

A - Retained egg
B - Thymoma
C - Vitamin D toxicosis
D - Air sacculitis
E - Normal radiographs

A. retained egg

This bird has a retained egg.

The lateral radiograph demonstrated a 4.5 cm diameter, well-circumscribed, soft tissue opacity in the central abdominal area. It extended from the caudal hepatic border to the caudal pelvic region.

Its dorsal margin was relatively distinct and did not silhouette with the kidneys. Evidence of calcification was not identified.

Increased endosteal opacity was present in the pelvic extremities. The remainder of the study was unremarkable except for mild decreased liver size.

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A newborn foal is examined two hours after birth. The foal has a heart rate of 100 bpm [N=100-120], and a continuous murmur loudest on the left side.

Which one of the following choices is the most likely explanation for these findings?


A - Incipient septicemia
B - Hypoxic ischemic encephalopathy
C - Foal dysmaturity
D - Normal in a neonatal foal
E - Ventricular septal defect

D. Normal in a neonatal foal

These findings are NORMAL in a neonatal foal. The heart rate and a finding of a continuous murmur on the left side (due to slight opening of the ductus arteriosis, which usually closes within 4-5 days) are normal in newborn foals. Persistent patent ductus arteriosis is rare in horses.

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An associate veterinarian is paid on a commission-only basis of 18%.

Last month the net gross production was $25,000 and the gross salary was
$4500.

How much does the gross production need to be this month in order to increase the gross salary to $6000?

A - $33,333
B - $29,888
C - $28,333
D - $34,350
E - $32,666

A. $33,333

Just write it out, one step at a time.

If ($25,000 gross production)X(0.18)=$4500 monthly salary

then ($ ? gross production)X(0.18)=$6000 monthly salary

gross production = $6000/0.18 = $ 33,333

A new graduate may prefer a straight salary to a commission-based salary for the stability it gives. Many practices use a combination system with a base salary and a production-based bonus if you bring in more than a monthly production goal, but no penalty if you are below that monthly goal.

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Which of the following nerves are targeted with a paravertebral block used to perform a standing laparotomy in a cow?

A - T13, L1, and L2
B - L1-3, and S1-5
C - L2, L3, S1, and S2
D - L1, L2, L3
E - L1, L2, and L4

A- T13, L1 and L2 

The spinal nerves, T13, L1, and L2 must be blocked to completely desensitize the flank of a cow. The paravertebral (PV)nerve block targets these nerves. It can be performed via two techniques – the proximal or distal PV block.

The proximal block places local anesthetic in the space just caudal to the transverse processes of the vertebrae - T13, L1, and L2.

The distal block is placed at the ends of the transverse processes of the vertebrae – L1, L2, and L4 as the nerves gradually coarse caudally after they exit the spinal foramen.

Proper placement of the anesthetic results in warming of the skin from vasodilation, anesthesia of the skin and body wall, and a curvature of the spine in some cows.

The latter is caused by relaxation of the epaxial musculature on the affected side; the spine curves in a convex manner.

See this very good pdf on Local Anesthesia and Analgesia by Dr. Lyon Lee, OK State CVM; pp. 12-14.

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Whats wrong with this picture?
Rad

A - Pleural effusion
B - Pulmonary edema
C - Dilated cardiomyopathy
D - Vena caval syndrome
E - Diaphragmatic hernia

A Pleural effusion

This is severe PLEURAL EFFUSION. Note the raised trachea, with lung lobes floating in the dorsal chest; lung borders outlined clearly by opacity, but the cardiac silhouette indistinct. See Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 1080-81, for details on pleural effusion.

DDX includes NOTHING GOOD---neoplasia, CHF, hypoalbuminemia (secondary to protein-losing nephropathy/liver disease), heartworm, diaphragmatic hernia, trauma/hemothorax, lung lobe torsion to name a few.

Pulmonary edema looks different-Think splotchy, cotton-ball lungs, where the tissue of the lung itself is heavy with fluid.

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A 3 year old Standardbred mare is presented with a 2-month history of exercise intolerance. Endoscopy shows the following image.
Click here to see image

What is the diagnosis?

A - Laryngeal hemiplegia
B - Cleft palate 
C - Pharyngeal lymphoid hyperplasia (PLH)
D - Dorsal displacement of soft palate
E - Epiglottic entrapment 

D. Dorsal displacement of soft palate

This is Dorsal displacement of the soft palate (DDSP). The caudal free margin of the soft palate moves dorsal to epiglottis, obstructing the airway and causing exercise intolerance. Rx conservatively, eliminating possible contributing diseases first (ie: rest, anti-inflammatories). Surgical treatments (Sternothyrohyoideus myectomy or soft palate resection) have mixed success rates around 50%.

Epiglottic entrapment is a big DDX for DDSP. Outline of the epiglottis can still be seen with epiglottic entrapment,UNlike DDSP.

Cleft palate is a newborn disease. See difficulty suckling, dysphagia, MILK DRIPPING from NOSTRILS. Click here to see a Cleft palate. Euthanize if severe. Surgical closure if small.

Laryngeal hemiplegia ("Roarers") present with inspiratory noise during exercise and exercise intolerance. Click here to see laryngeal hemiplegia. More than 90% occur on LEFT side. Rx is surgery.

Pharyngeal lymphoid hyperplasia (PLH) is common. Thought to be a normal immunologic event in younger horses.

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A dog is presented with the following findings.

Blood Gas
PCO2 venous=28.3 mm Hg....[N=35-44], pH=7.27..[N=7.31-7.53]
PO2 arterial=85.2 mm Hg....[N=85-95] HCO3-=13.9 mEq/l..[N=25-35]

Blood chemistry
Na=136.2.................[N=146-156], Cl=91.3..[N=109-122]
Ca=9.1.....................[N=9.6-11.6], K=3.5..[N=3.8-5.6]
P=9.3.......................[N=2.5-6.2], TCO2=14.2 mmM/l..[N=17-27]
ALT=331...................[N=8.2-57], LDH=354..[N=24-219]
AST=14....................[N=13-15], SDH=6..[N=3.1-7.6]
GGT=20....................[N=1.0-9.7],Glucose=150..[N=79-126]
Alk Phos=1018..........[N=1-114], BUN=28 mg/dL..[N=7.0-26]
Bilirubin (total)=0.3....[N=0.0-0.4]

What is the anion gap?

A - 28.1
B - 34.5
C - 28.3
D - 31.2
E - 42.2

B- 34.5 

Anion gap= (Positives)-(Negatives) = (Na+ and K+) -(Cl- and HCO3-).
If you did not do a blood gas analysis, then substitute TCO2 for HCO3-, and the AG value is about the same, (34.2 in this case).

Anion Gap (AG) = [136.2 (Na+) + (3.5(K+)] - [91.3 (Cl-) + 13.9(HCO3-)]
AG= [139.7 cations] - [105.2 anions]=34.5 anion gap

Typically see increased anion gap with:
Diabetic ketoacidosis
Renal insufficiency
Ethylene glycol toxicity
Lactic acidosis from grain overload or strenuous exercise

Decreased anion gap is UNcommon. Think hemodilution, hypoalbuminemia, hypercalcemia.

60

Which of the following pairs of tissues can both cause increased serum alanine aminotransferase (ALT) levels in dogs and cats?

A - Kidneys and pancreas
B - Liver and muscle
C - Spleen and liver
D - Heart and kidneys
E - Pancreas and intestine

B liver and muscle

61

Oxalate is the toxic agent found in which one of the following plants?

A - Hypericum perforatum (Klamathweed) 
B - Hordeum spp (Foxtail)
C - Sarcobatus vermiculatus (Greasewood)
D - Delphinium spp (Larkspur)
E - Solanum spp (Nightshade)

62

A 9 month old Cairn terrier neutered male is presented for the complaints of smaller than normal size for age, intermittent anorexia and vomiting, lethargy, ataxia, and occasional seizures.

Physical examination is unremarkable other than palpation of a smaller than normal liver.

Initial laboratory testing results include a mild nonregenerative anemia with microcytic normochromic red blood cells, mild increases in hepatic enzymes, low blood urea nitrogen concentration, hypoglycemia, and hypoalbuminemia.

Which one of the following diagnostic tests would be a logical next step?

A - Serum bile acids
B - Measurement of urinary cysteine
C - Creatinine clearance test
D - Serum vitamin C levels
E - Plasma protein H levels

A- Serum bile acids

Serum bile acids. This is the clinical presentation of a portosystemic shunt (PSS) in a dog.

General laboratory tests reveal chronic hepatopathy; specific diagnostic testing methods include measurement of pre and postprandial serum bile acids, fasting serum ammonia levels, plasma protein C levels, abdominal ultrasound, portal scintigraphy, radiographic mesenteric portography, computed tomography angiography, and liver biopsy.

Animals usually present at a young age with complaints of stunted growth, gastrointestinalissues, and neurologic signs (secondary to hepatic encephalopathy).

Congenital PSS can be intrahepatic (more common in large breed dogs) or extrahepatic (more common in small breed dogs).

Commonly affected breeds include Miniature schnauzers, Yorkshire terriers, Irish wolfhounds, Cairn terriers, Maltese, Australian shepherds, Golden and Labrador retrievers, and Old English sheepdogs.

Acute treatment includes supportive care, restricted protein diets, lactulose, and antimicrobial therapy followed by surgical ligation of the shunt.

Click here to see a good summary on portosystemic shunts with images, courtesy of the American College of Veterinary Surgeons (ACVS).

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