ACVIM Consensus Statements Flashcards
(453 cards)
1
Q
What is the effect of any antimicrobial use on resistance?
A
Exerts selection pressure, potentially contributing to resistance in both pathogens and commensals.
2
Q
What does prudent use of antimicrobials aim to achieve?
A
Select the right drug, dose, and duration, avoiding unnecessary or overly broad-spectrum treatments.
3
Q
What is a significant issue regarding AMR genes?
A
AMR genes and pathogens move between animals and humans (bidirectional zoonosis).
4
Q
Does antimicrobial use in animals drive AMR in humans?
A
Yes, in some zoonotic pathogens like Salmonella, Campylobacter, and MRSA.
5
Q
What shared resistance gene is found in pets and humans?
A
blaCTX-M.
6
Q
What types of resistant pathogens have been identified in pets?
A
Human-derived MRSA and multidrug-resistant (MDR) Enterococcus clones.
7
Q
List some animal pathogens associated with therapeutic use causing AMR.
A
- MRSP (dogs)
- MRSA (horses)
- Macrolide/rifampin-resistant Rhodococcus equi (foals)
- Cefovecin/cephalexin-resistant E. coli (dogs)
8
Q
What can the use of zinc in pig feed cause?
A
Co-select for resistance due to gene linkage.
9
Q
Are MDR pathogens inherently more virulent?
A
Not inherently more virulent.
10
Q
What do MDR pathogens often result in?
A
Delayed effective therapy, associated with higher costs, morbidity, and mortality.
11
Q
What strategies can reduce AMR in clinical practice?
A
- Prevent disease
- Use antimicrobials only when appropriate
- Emphasize diagnostics
12
Q
What preventive measures can be taken to reduce AMR?
A
- Improve husbandry
- Vaccination
- Hygiene
- Hospital infection control
13
Q
What should be avoided when using antimicrobials?
A
Treating viral, immune-mediated, or inflammatory diseases with antibiotics.
14
Q
What is key before initiating antimicrobial therapy?
A
Perform diagnostic testing when possible.
15
Q
What is essential for effective antimicrobial treatment?
A
Culture/sensitivity testing.
16
Q
What is a problem with treating colonization?
A
No clinical benefit, resistance risk.
17
Q
What should be avoided in compounding practices?
A
Bulk drug compounding.
18
Q
What should be avoided regarding culture in asymptomatic animals?
A
Avoid culture except in infection control programs.
19
Q
What type of antimicrobial use is discouraged?
A
Routine prophylactic use.
20
Q
What is the status of generic antimicrobials?
A
Generic is OK if bioequivalence proven.
21
Q
What is the issue with human generics in veterinary use?
A
May have poor absorption in dogs.
22
Q
What should be defined more practically in future directions?
A
Critical antimicrobial tiers.
23
Q
Define cardiomyopathy.
A
Myocardial structural or functional abnormality in absence of other cardiovascular disease sufficient to explain findings.
24
Q
What is the phenotype classification for HCM?
A
↑ LV wall thickness (regional or diffuse) with normal chamber size.
25
What characterizes RCM?
Normal wall thickness; biatrial enlargement due to impaired filling.
26
What is the definition of DCM?
LV dilation and systolic dysfunction ± atrial dilation.
27
What does ARVC stand for and what is its definition?
Arrhythmogenic Right Ventricular Cardiomyopathy; severe RV dilation ± arrhythmia; may involve RA/LV.
28
What is a nonspecific phenotype in cardiomyopathy?
Atypical cases that don’t clearly fit above categories.
29
What distinguishes Stage B1 from Stage B2?
B1 is subclinical, low risk for CHF/ATE, while B2 is subclinical, high risk.
30
What is the prevalence of HCM in the general population of cats?
15–29% prevalence.
31
What factors increase the risk of HCM?
* Male * Older cats * Murmurs * Breed predisposition (Maine Coon, Ragdoll, British Shorthair)
32
What mutations are associated with HCM in Maine Coons and Ragdolls?
* Maine Coon: MyBPC3 A31P * Ragdoll: MyBPC3 R820W
33
What is NT-proBNP used for in cats?
High utility in dyspnea (CHF vs respiratory), low utility to detect mild CM.
34
What treatment is suggested for Stage B2 (Subclinical, High Risk) HCM?
Antithrombotic: Clopidogrel 18.75 mg q24h.
35
What is the initial treatment for acute CHF in Stage C?
* Furosemide IV 1–2 mg/kg bolus or CRI * Thoracocentesis if effusion
36
What medications are used in Stage D (Refractory CHF)?
* Torsemide * Spironolactone * Taurine (if DCM phenotype) * Pimobendan (if systolic dysfunction present)
37
What is the significance of LA size and function in cardiomyopathy?
Most critical risk predictor for CHF/ATE.
38
What should be avoided in asymptomatic disease based on current evidence?
* ACEi * Spironolactone
39
What is the definition of chronic enteropathy (CE)?
≥3 weeks of GI signs not explained by other disease.
40
What are the key components for diagnosing LPE and LGITL?
Integration of:
* Clinical signs
* Imaging
* Histopathology
* Immunohistochemistry (IHC)
* Clonality (PARR)
41
What infectious agents are commonly associated with LGITL?
LGITL cats often FeLV/FIV negative; regressive FeLV infection possible.
42
What percentage of LGITL cases have concurrent LPE?
~60%.
43
What is the median age for cats diagnosed with LPE?
8 years.
44
What is the median age for cats diagnosed with LGITL?
13 years.
45
What laboratory finding is more common in LGITL?
Cobalamin ↓.
46
What imaging modality is critical but not diagnostic for LPE and LGITL?
Abdominal Ultrasound (AUS).
47
What histopathological feature differentiates LPE from LGITL?
Infiltrate:
* LPE: Polymorphic lymphocytes, plasma cells
* LGITL: Monomorphic small T cells.
48
What is the best diagnostic combination for distinguishing LPE from LGITL?
Histopathology + IHC + PARR.
49
What does the Ki-67 marker indicate in the context of LGITL?
Proliferation marker (↑ in neoplasia).
50
What are the histologic features of LGITL?
Effacement, plaques, epitheliotropism.
51
What is the significance of CD3 in immunohistochemistry for LGITL?
T cells (LGITL typically CD3⁺).
52
What is the recommended number of biopsies for proper diagnosis?
Minimum: 6 duodenal and 3–5 ileal biopsies.
53
What does PARR detect in the context of lymphoproliferation?
Clonal rearrangements of T-cell receptor genes.
54
True or False: Clonality detected by PARR is definitive for cancer.
False.
55
What imaging findings are more likely in LGITL compared to LPE?
Jejunal thickening, hypoechoic rounded lymph nodes, mild abdominal effusion.
56
Define Chronic Hepatitis (CH).
Histologically defined by:
* Mononuclear inflammation (lymphocytes, plasma cells, macrophages ± neutrophils or eosinophils)
* Hepatocellular death (necrosis/apoptosis)
* Fibrosis ± regeneration
* Distribution: portal, lobular, interface (spillover into lobule)
57
What is NOT considered Chronic Hepatitis?
Nonspecific reactive hepatopathy: response to extrahepatic disease without hepatocyte necrosis or fibrosis.
58
What is the most common identifiable cause of Chronic Hepatitis?
Copper (Cu) associated CH (CuCH)
59
List some common breeds predisposed to Copper-associated Chronic Hepatitis (CuCH).
* Labrador Retrievers
* Bedlington Terriers
* Doberman Pinschers
* Dalmatians
* West Highland White Terriers (WHWT)
60
What are the diagnostic criteria for Copper-associated CH (CuCH)?
* CH histology with Zone 3 Cu accumulation
* Rhodanine-positive staining for Cu in centrilobular areas
* Liver Cu >1000 μg/g dry weight (but threshold varies)
61
What are the supporting features for immune-mediated Chronic Hepatitis?
* Lymphocytic infiltrate
* Expression of MHC II antigens
* Autoantibodies (in some breeds)
* Female predisposition (Labrador, Doberman, ESS)
* Association with other autoimmune diseases
62
What are the average age and common clinical signs of dogs with Chronic Hepatitis?
Average age ~7.2 years; Clinical signs include:
* Nonspecific: lethargy, anorexia, PU/PD, vomiting
* Specific: jaundice, ascites, HE, melena (late-stage)
63
What is the best screening test for Chronic Hepatitis?
ALT (Alanine Aminotransferase)
64
What is required for a definitive diagnosis of Chronic Hepatitis?
Liver biopsy
65
What are some specific treatments for Copper-associated Chronic Hepatitis (CuCH)?
* D-penicillamine: 10–15 mg/kg BID (empty stomach)
* Zinc gluconate/acetate: 5–10 mg/kg BID (2 hrs apart from meals)
* Low-Cu diet (≤5 mg/kg DM)
66
What is the gold standard chelator for Copper-associated Chronic Hepatitis?
D-penicillamine
67
Fill in the blank: The average age of dogs diagnosed with Chronic Hepatitis is ______.
7.2 years
68
What should be monitored post-biopsy for hemorrhage?
Monitor post-biopsy q2h for hemorrhage (6–12 hrs)
69
What are the common enzyme elevations seen in Chronic Hepatitis?
* ALT
* ALP
* GGT
* AST
* TSBA
* Albumin ↓
* BUN/cholesterol ↓
70
What should be avoided in the treatment of Chronic Hepatitis?
NSAIDs and hepatotoxic drugs (e.g., phenobarbital)
71
What are the mechanisms involved in platelet destruction in ITP?
* FcγR-mediated clearance (macrophages)
* Complement-mediated lysis
* Cytotoxic T cells
* Desialylation + Ashwell-Morell clearance
72
What is the role of thrombopoietin (TPO) in ITP?
Often inappropriately low in ITP.
73
List common clinical signs of ITP.
* Petechiae
* Ecchymoses
* Melena
* Hematuria
* Epistaxis
74
What is the mortality rate associated with ITP in dogs and cats?
10–30% due to hemorrhage or treatment side effects.
75
What is the initial platelet count criteria for diagnosing ITP?
Platelet count <100,000/μL, confirmed via blood smear.
76
What does the 'Possible' diagnostic certainty level for Primary ITP require?
Persistent thrombocytopenia, no clear cause.
77
What does the 'Probable' diagnostic certainty level for Primary ITP require?
Exclusion of mimics, +/- immunologic support (PSAIG).
78
What findings may suggest ITP based on platelet indices?
Only reticulated platelets may help suggest ITP.
79
What is the typical platelet count in dogs with ITP?
Usually <20,000/μL.
80
What are the recommended coagulation and hemostasis tests for ITP?
* PT
* aPTT
* D-dimers
81
What does PSAIG positivity indicate in the context of ITP?
Immune component, but has low specificity and overlaps with non-immune causes.
82
What is the significance of bleeding severity scoring in ITP?
Correlates with transfusion needs and hospitalization.
83
What comorbidity has high-level evidence for triggering ITP?
Ehrlichia canis.
84
What is a key diagnostic highlight for ITP in dogs and cats?
Confirm true thrombocytopenia (<100,000/μL) and exclude major causes.
85
True or False: Severe thrombocytopenia (<20k) confirms ITP.
False, it supports but does not confirm ITP.
86
What does IMHA stand for?
Immune-Mediated Hemolytic Anemia.
87
What are the diagnostic criteria for IMHA?
Anemia, evidence of immune-mediated destruction, evidence of hemolysis.
88
What test is preferred for diagnosing anemia in IMHA?
Spun PCV, not calculated HCT.
89
What is required for a firm diagnosis of IMHA?
2 of the 3 following tests: Positive Saline Agglutination Test, Direct Antiglobulin Test, or Flow Cytometry.
90
What does a Positive Saline Agglutination Test (SAT) indicate?
High specificity (95–100%) for immune-mediated destruction.
91
What is the sensitivity and specificity of the Direct Antiglobulin Test (DAT) in dogs?
Sensitivity: 61–82%; Specificity: 94–100%.
92
What are the criteria for evidence of hemolysis in IMHA?
* Spherocytosis
* Hyperbilirubinemia
* Hemoglobinemia/Hemoglobinuria
* Erythrocyte Ghosts.
93
What is the diagnostic category for definitive IMHA?
Anemia + 2 immune markers OR persistent agglutination + 1 hemolysis marker.
94
What are the high evidence pathogens associated with IMHA in dogs?
* Babesia gibsoni
* Babesia vogeli
* B. conradae
* Rangelia
* Theileria.
95
What is the high evidence pathogen associated with IMHA in cats?
Mycoplasma haemofelis.
96
True or False: There is strong evidence linking cancer to IMHA.
False.
97
Which drugs have been associated with IMHA in dogs?
* Antimicrobials (especially cephalosporins)
* Zinc
* Acetaminophen
* Phenylbutazone.
98
What is the integrated metric of evidence (IME) used for?
To objectively rank the strength of association between comorbidity and IMHA.
99
What is the threshold for negligible evidence in IME?
IME < 2.95.
100
What should be evaluated to potentially avoid long-term immunosuppressants in IMHA?
Comorbidities.
101
Fill in the blank: The test preferred by 5/8 panelists for diagnosing IMHA is the ______.
Direct Antiglobulin Test (DAT).
102
What are the two main categories of movement disorders?
* Hyperkinetic
* Hypokinetic
103
What is dyskinesia?
Umbrella term for involuntary movement disorders, divided into paroxysmal vs persistent and exercise-induced vs spontaneous.
104
Which structures are included in the basal nuclei?
* Caudate
* Putamen
* Globus Pallidus (GP)
* External Pallidal Nucleus (EPN)
* Substantia Nigra (SNr, SNc)
* Pedunculopontine Nucleus (PPTN)
* Subthalamic Nucleus
105
How does dopamine influence movement?
Promotes movement through increased D1 activity and decreased D2 activity.
106
What is the role of the cerebellum in movement disorders?
Cerebello-thalamo-BN pathway is implicated in dystonia.
107
Define dystonia.
Sustained abnormal postures and twisting movements.
108
What characterizes tremor?
Sinusoidal, rhythmic movement occurring at rest, postural, or kinetic.
109
What is myoclonus?
Shock-like, jerky movements that may mimic tremor if rhythmic.
110
What are the common causes of peripheral nerve hyperexcitability (PNH)?
* Ion channelopathies (VGKC)
* Autoimmune factors
* Toxins
* Metabolic issues
111
What distinguishes myoclonus from tremor?
Myoclonus is more abrupt and less rhythmic.
112
What are the characteristics of paroxysmal dyskinesias (cPxDs)?
* Self-limiting abnormal movement episodes
* No loss of consciousness
* No postictal signs
113
What are the two classifications of cPxDs?
* Inherited
* Acquired
114
What is the most common type of cPxD?
PNKD (Primary Non-Kinetic Dyskinesia).
115
What are the characteristics of dystonia?
* Sustained or intermittent contractions
* Twisted postures
* Often cocontraction of antagonists
116
Which breed is associated with episodic falling?
Cavalier King Charles.
117
What genetic mutation is linked to myokymia?
KCNJ10.
118
What steps should be taken in the clinical approach to characterize movement?
* Identify hyperkinetic vs hypokinetic
* Determine paroxysmal vs persistent
* Assess exercise-induced or spontaneous
119
What is a common misclassification of cPxD?
Often misclassified as seizures.
120
Which species of Ehrlichia primarily affects dogs' monocytes?
Ehrlichia canis
121
What is the geographic distribution of Ehrlichia canis?
Global (tropical/subtropical)
122
What is the vector for Ehrlichia canis?
Rhipicephalus sanguineus
123
Which Ehrlichia species affects platelets in dogs?
Ehrlichia platys
124
Fill in the blank: The gold standard for serological diagnostics for Ehrlichia is _____
IFA
125
What does a positive titer for Ehrlichia not necessarily indicate?
Active infection
126
What is a common limitation of PCR in diagnosing Ehrlichial infections?
Cost and inconsistent lab quality
127
What are common findings in a CBC for Ehrlichial infections?
* Thrombocytopenia
* Nonregenerative anemia
* Pancytopenia (chronic cases)
* Granular lymphocytosis
128
What are the clinical signs of feline ehrlichiosis?
* Fever
* Lethargy
* Anemia
* Thrombocytopenia
* Hyperglobulinemia
129
What is the recommended treatment for Ehrlichial infections in dogs and cats?
Doxycycline 10 mg/kg PO q24h x 28 days
130
What is the duration of acute Ehrlichial disease in dogs?
2–4 weeks
131
List the clinical signs associated with chronic Ehrlichial disease in dogs.
* Pancytopenia
* Cachexia
* Bone marrow suppression
132
What alternative treatments can be used for Ehrlichial infections?
* Imidocarb dipropionate: 5 mg/kg IM x2 doses, 2–3 weeks apart
* Chloramphenicol
* Minocycline
* Enrofloxacin (ineffective for E. canis)
133
How long may hyperglobulinemia take to resolve after treatment?
6–9 months
134
What are the pros of screening healthy dogs for Ehrlichial infections?
* Sentinel surveillance
* Kennel management
* Reduce chronic disease burden
135
What should be confirmed alongside positive serology for Ehrlichia?
Clinical signs or PCR
136
What can affect treatment response in Ehrlichial infections?
Coinfections (e.g., Babesia, Bartonella)
137
How long may PCR of splenic aspirates stay positive after clinical resolution of Ehrlichia?
Long after clinical resolution
138
What are the five clinical criteria that must be met for a diagnosis of IBD?
* Chronic GI signs >3 weeks (vomiting, diarrhea, weight loss, anorexia)
* Histopathologic evidence of mucosal inflammation
* Exclusion of other causes (e.g., parasites, metabolic, neoplasia)
* Inadequate response to dietary/antibiotic/anthelmintic therapy
* Positive response to immunosuppressants (e.g., prednisone, cyclosporine)
139
Is histopathologic inflammation alone sufficient for an IBD diagnosis?
No
140
What are the histologic features of the gastric body/antrum?
* Morphologic: Surface/pit epithelial injury, glandular atrophy, fibrosis
* Inflammatory: IELs, LP lymphocytes/plasma cells, eosinophils, neutrophils, lymphoid follicles
141
What are the histologic features of the duodenum?
* Morphologic: Villus stunting, epithelial injury, crypt distension, lacteal dilation, mucosal fibrosis
* Inflammatory: IELs, LP lymphocytes/plasma cells, eosinophils, neutrophils
142
What are the histologic features of the colon?
* Morphologic: Epithelial injury, crypt dilation/distortion, fibrosis
* Inflammatory: LP lymphocytes/plasma cells, eosinophils, neutrophils, macrophages
143
What is the significance of IEL (intraepithelial lymphocytes) counts in cats vs dogs?
IELs are normally higher in cats than dogs, and differences in baseline counts matter.
144
How is tissue classified in biopsy quality assessment?
* Adequate: Includes full mucosal thickness, ≥3 villi or glands
* Marginal: Partial mucosa, distorted architecture
* Inadequate: Villous tips only, no lamina propria
145
What is the minimum number of adequate or marginal duodenal samples needed to detect crypt lesions in dogs?
* 13 adequate
* 28 marginal
146
What advanced diagnostics can be used to distinguish IBD from small-cell lymphoma?
* IHC (CD3, CD79a)
* Clonality (TCRγ PCR)
147
True or False: IBD and small-cell lymphoma can be histologically indistinguishable.
True
148
What clinical indicators more reliably predict severe disease in IBD?
* CRP
* Hypoalbuminemia
149
When should an endoscopic examination be performed?
* Moderate to severe disease
* Hypoalbuminemia, ultrasonographic infiltrates
* Weight loss, poor BCS
150
When should an endoscopic examination NOT be performed?
* Mild GI signs in healthy animals
* Acute GI disease <3 weeks
151
What does IHC assess?
Cell lineage (T vs B)
152
What does clonality PCR detect?
Monoclonality (suggests lymphoma)
153
What are significant findings in the evaluation of GI inflammation?
* Villous atrophy
* Crypt distension
* Lacteal dilation
154
What is needed if histology is equivocal for small-cell lymphoma in cats?
IHC + PCR
155
What can cause gastritis?
* IBD
* NSAIDs
* Helicobacter
* Systemic disease
156
What additional information might an ileal biopsy yield compared to a duodenal biopsy?
Additional information about the condition
157
Name the five key pathogens associated with bacterial diarrhea in small animals.
* Clostridium difficile
* Clostridium perfringens
* Salmonella spp.
* Campylobacter spp.
* Escherichia coli (AIEC in Boxers)
## Footnote
These pathogens are critical in diagnosing and treating diarrhea in dogs and cats.
158
What is the pathogenesis of Clostridium difficile?
Toxin-mediated disease involving TcdA, TcdB ± binary toxin CDT
## Footnote
Infection requires colonization with toxigenic strains.
159
What is the recommended diagnostic method for Clostridium difficile?
Toxin ELISA (TcdA/B) + PCR or GDH antigen
## Footnote
Culture/PCR alone is insufficient due to asymptomatic shedding.
160
What is the preferred treatment for Clostridium difficile infections?
Supportive therapy preferred; Metronidazole if needed
## Footnote
Avoid vancomycin due to resistance concerns.
161
What percentage of healthy dogs may carry Clostridium perfringens?
Present in >80% of both healthy and diarrheic dogs
## Footnote
CPE detected in up to 34% of diarrheic and 14% of healthy dogs.
162
What is the best diagnostic method for Clostridium perfringens?
CPE ELISA + PCR for toxin genes
## Footnote
Culture alone is not diagnostic.
163
What is the treatment recommendation for Salmonella spp. infections?
Do NOT treat uncomplicated cases; treat systemic illness with ampicillin + enrofloxacin
## Footnote
Strict hygiene is crucial to prevent zoonosis.
164
What is the most common species of Campylobacter found in dogs?
C. upsaliensis
## Footnote
C. helveticus is common in cats.
165
What is the most sensitive diagnostic method for Campylobacter spp.?
PCR (e.g., cpn60-based)
## Footnote
Gram stain is non-specific.
166
What is the treatment for adherent-invasive Escherichia coli (AIEC) in Boxers?
Enrofloxacin 10 mg/kg PO q24h × 8 weeks
## Footnote
Resistance is common; testing sensitivity is recommended.
167
True or False: A positive test result for enteropathogenic bacteria always indicates the cause of diarrhea.
False
## Footnote
Positive results do not necessarily correlate with clinical signs.
168
What is a key consideration when interpreting test results for bacterial infections?
Always correlate test results with clinical signs
## Footnote
Important for accurate diagnosis and treatment.
169
What conditions are targeted for therapy regarding the use of GI protectants?
* Gastroduodenal ulceration and erosion (GUE)
* Reflux esophagitis
* NSAID/corticosteroid use
* Renal/hepatic disease
170
True or False: PPIs are the most effective for treating acid-related injury.
True
171
What is the primary mechanism of action for PPIs?
Irreversibly bind H⁺/K⁺ ATPase
172
How long does it take for the full effect of PPIs to be observed?
2–4 days
173
What should be done if PPIs are used for more than 3–4 weeks?
They should be tapered to prevent rebound acid hypersecretion (RAH)
174
What is a significant side effect of H2RAs?
Tolerance develops rapidly (3–13 days)
175
What are the limitations of antacids?
* Short effect (<1 hr)
* Impractical
* Interfere with drug absorption
176
Which medication is effective only for NSAID-associated ulcers?
Misoprostol
177
What is the primary use of sucralfate?
As a mucosal coating agent
178
What is the effect of omeprazole on intragastric pH?
Strong increase (pH >4 for 16+ hrs)
179
What is a caution associated with the use of PPIs?
Can alter microbiota leading to dysbiosis and bacterial overgrowth
180
What should be done if NSAIDs must be used and PPIs are contraindicated?
Use misoprostol
181
What is the recommendation for corticosteroid use regarding gastroprotectants?
Not indicated, as there is no evidence of benefit
182
What is the clinical recommendation for non-erosive gastritis?
No evidence supports acid suppression for vomiting alone
183
What is the concern with using sucralfate in dogs?
Tablets may not dissolve; use liquid formulation
184
What is the effect of abrupt withdrawal from H2RAs?
Rebound acid hypersecretion (RAH)
185
What is a notable adverse effect of misoprostol?
Diarrhea and abdominal pain
186
List the recommended drug for reflux esophagitis.
Omeprazole + sucralfate
187
What is the use of misoprostol in NSAID ulcer prevention?
Preferred if NSAIDs must be used and PPIs are contraindicated
188
How many species of Helicobacter exist?
Over 30 species exist.
189
Which Helicobacter species have been isolated from dogs and cats?
* H. felis
* H. bizzozeronii
* H. salomonis
* H. heilmannii
* H. pylori (rare)
190
Where does colonization of Helicobacter typically occur?
Gastric mucosal (foveolar, glandular, or parietal cell associations).
191
What percentage of clinically normal dogs and cats harbor gastric Helicobacter spp.?
>80%
192
Is Helicobacter infection usually symptomatic or asymptomatic in dogs and cats?
Typically chronic and persistent without overt clinical signs.
193
What local immune response is observed with Helicobacter infection?
* Lymphoplasmacytic and neutrophilic infiltrates
* Mild glandular epithelial degeneration
* Mucous metaplasia
194
What is frequently observed alongside Helicobacter colonization?
Gastric lymphoid follicle formation.
195
What type of gastritis is usually present in Helicobacter infection?
Usually mild and non-ulcerative.
196
Is there a consistent correlation between bacterial colonization and histologic severity of inflammation?
No consistent correlation.
197
What stains are used in histopathology to detect Helicobacter organisms?
* Warthin-Starry
* Giemsa stains
198
What does urease testing detect?
Bacterial urease activity.
199
What is a limitation of PCR in diagnosing Helicobacter?
Detects colonization but does not correlate with disease state.
200
What gastric disease is associated with Helicobacter in dogs?
Chronic vomiting, mild gastritis in some cases.
201
Is there a strong association between Helicobacter spp. and gastric ulcers in dogs and cats?
No, not strongly associated.
202
What are the indications for treatment of Helicobacter infection?
* Clinical signs + moderate/severe gastritis + documented infection
* Refractory vomiting where other causes ruled out
203
What is the standard triple therapy for Helicobacter treatment?
* Amoxicillin
* Metronidazole
* Proton pump inhibitor (or H2 blocker) for 7–14 days
204
Does standard treatment for Helicobacter always eliminate colonization?
Often does not eliminate colonization.
205
What are key takeaways regarding Helicobacter spp. in dogs and cats?
* Commonly found but usually do not cause clinical disease
* Diagnosis requires correlation with histopathology and clinical signs
* Treatment rarely necessary unless significant gastritis and compatible signs
206
Are Helicobacter spp. in small animals strongly linked to ulcers or gastric cancer?
No, unlike humans.
207
What is the likely status of many Helicobacter species in most cases?
Commensal status.
208
What are the common clinical signs that increase suspicion for HAC?
PU/PD, polyphagia, panting, endocrine alopecia, abdominal distension
## Footnote
PU/PD refers to polyuria and polydipsia.
209
List less common signs of HAC.
* Lethargy
* Hyperpigmentation
* Poor hair regrowth
* Comedones
210
What are some uncommon signs of HAC?
* Thromboembolism
* Pseudomyotonia
* Ligament rupture
* Testicular atrophy
211
What laboratory abnormalities support but do not confirm HAC?
* Stress leukogram (neutrophilia, lymphopenia, eosinopenia)
* Thrombocytosis
* ↑ ALP, ALT, cholesterol, triglycerides, glucose
* Isosthenuria (SG < 1.020), proteinuria, UTI indicators
212
When should testing for HAC not be performed?
* No clinical signs present
* Concurrent serious illness (can skew results)
* Isolated lab changes without supportive clinical signs
213
What is the sensitivity of the Low-Dose Dexamethasone Suppression Test (LDDST)?
85–100%
214
What is the specificity of the LDDST?
44–73%
215
What is the recommended use of the ACTH stimulation test?
Preferred for diagnosing iatrogenic HAC.
216
What is the sensitivity of the Urinary Corticoid:Creatinine Ratio (UCCR)?
75–100%
217
What are the doses for the Low-Dose Dexamethasone Suppression Test?
0.01–0.015 mg/kg IV dexamethasone sodium phosphate.
218
What does lack of suppression in the Low-Dose Dexamethasone Suppression Test indicate?
HAC.
219
What is suggested by an inverse pattern in the Low-Dose Dexamethasone Suppression Test?
Suggestive of PDH.
220
What is the preferred method for diagnosing spontaneous HAC?
cACTH measurement.
221
What handling is critical for cACTH testing?
Use EDTA tube, chilled, frozen.
222
What is the suppression dose for the High-Dose Dexamethasone Suppression Test (HDDST)?
0.1 mg/kg IV dexamethasone.
223
What does suppression in HDDST indicate?
PDH.
224
What is the role of ultrasound in diagnosing HAC?
Evaluate adrenal gland size, symmetry, contralateral atrophy, vascular invasion.
225
What is the importance of CT/MRI in HAC diagnosis?
Assess tumor size, invasion, metastasis.
226
What defines 'occult HAC'?
Dogs with suggestive signs but normal standard tests.
227
What hormones are theorized to drive 'occult HAC'?
* 17-OHP
* Progesterone
* Androstenedione
228
What is a key finding when considering 'occult HAC'?
Low post-ACTH cortisol despite strong clinical suspicion.
229
What is the ACVIM consensus on the preferred screening test for HAC?
LDDST.
230
What is the best test for iatrogenic HAC according to ACVIM?
ACTH stim.
231
What is the best differentiating test for HAC?
cACTH.
232
What should be done before pursuing testing for 'occult HAC'?
Exclude other causes.
233
Which species of Borrelia primarily causes disease in dogs in North America?
B. burgdorferi sensu stricto (Bb)
## Footnote
Over 52 Borrelia spp. exist, with 21 in the Lyme borreliosis (LB) group.
234
What are the key vectors for Lyme borreliosis in the United States?
Ixodes scapularis (NE/Midwest US) and I. pacificus (West Coast)
## Footnote
Coinfection with Anaplasma phagocytophilum and Ehrlichia muris is common.
235
What is the typical transmission time for Bb after a tick attachment?
36–48 hours
## Footnote
Bb transmission occurs generally after this duration of attachment.
236
What clinical manifestations are primarily seen in dogs with Lyme borreliosis?
Lyme arthritis and Lyme nephritis
## Footnote
Most seropositive dogs remain asymptomatic.
237
What is Lyme nephritis characterized as?
Immune-complex glomerulonephritis (ICGN)
## Footnote
It is the most serious form of Lyme disease in dogs.
238
Which serological targets are preferred for diagnosing Lyme borreliosis?
C6, VlsE, OspF
## Footnote
These targets are not present in vaccines and represent natural infection.
239
What is the recommended treatment for Lyme arthritis in dogs?
Doxycycline at 10 mg/kg/day for 28 days
## Footnote
Response is rapid, often within 1–3 days.
240
What management strategies are suggested for Lyme nephritis?
Antimicrobials, RAAS inhibitors, Omega-3s, protein/phosphorus restriction, antithrombotics, BP control
## Footnote
Immunosuppressives may be added if progressive or severe.
241
What is the recommendation for annual screening of dogs in endemic areas?
Annual Bb screening is recommended
## Footnote
Follow up with UPC, CBC, chemistry.
242
What products are recommended for tick control?
Isoxazolines (e.g., fluralaner, afoxolaner), Permethrin, Amitraz collars
## Footnote
Environmental control measures are also important.
243
What are the pros and cons of Lyme vaccination?
Pros:
* High efficacy (in controlled settings)
* May reduce transmission
Cons:
* Short duration of immunity
* Limited evidence of efficacy in the field
* No cross-protection between strains
* Not helpful in seropositive dogs
## Footnote
Controversial; 3/6 panelists recommend routine Bb vaccination.
244
What is the significance of Quant C6 titers post-treatment?
They decrease but do not predict illness
## Footnote
Important for monitoring after treatment.
245
What is the definition of Status Epilepticus (SE)?
Seizure >5 min or ≥2 seizures without full recovery of consciousness
246
What defines Cluster Seizures (CS)?
>2 self-limiting seizures within 24 hours
247
At what time does treatment initiation for SE begin?
5 minutes
248
What pathophysiological changes begin at 30 minutes of SE?
Neuronal damage and irreversible pathophysiology begins
249
What are the stages of Status Epilepticus?
* Impending (5–10 min)
* Established (10–30 min)
* Refractory (>30 min)
* Super-refractory (>24 hrs)
250
What is the primary neurotransmitter imbalance in the Impending stage of SE?
NT release imbalance
251
What are the signs of Non-Convulsive Status Epilepticus (NCSE)?
* Altered mentation
* Subtle twitching
252
True or False: NCSE is often overdiagnosed due to the lack of EEG.
False
253
What percentage of studies on SE in dogs were considered high-quality?
17%
254
What is the first-line treatment for SE?
Benzodiazepines (BZDs)
255
What is the preferred route for out-of-hospital treatment of SE in dogs?
IN-midazolam
256
What is the recommended BZD choice due to its faster onset and fewer adverse effects?
Midazolam
257
Fill in the blank: After 2 ineffective BZD boluses, proceed to BZD _______.
CRI (Continuous Rate Infusion)
258
What should be avoided when using DZP CRI in cats?
Hepatotoxicity risk
259
What is a second-line maintenance ASM for dogs?
Levetiracetam
260
What anesthetic is used for refractory SE in dogs?
Ketamine
261
What is the risk associated with propofol use in cats?
Heinz body anemia
262
What are the pharmacologic adjuncts for Super-Refractory SE?
* IV Magnesium
* Allopregnanolone
263
What is the recommended temperature range for mild hypothermia in Super-Refractory SE?
36.7–37.7°C
264
What is the taper rate for discontinuing anesthetics after the last seizure?
↓ 25–50% every 4–6 hrs
265
What is the key recommendation regarding BZD timing?
<5 min to effect, <10 min seizure-free
266
What is preferred before using propofol/barbiturates in refractory SE?
Ketamine + Dexmedetomidine
267
What are the stages of Myxomatous Mitral Valve Disease (MMVD) in dogs?
* Stage A: Dogs at risk, no murmur or structural change
* Stage B1: Asymptomatic, murmur present, no cardiac remodeling
* Stage B2: Asymptomatic, with LA/LV enlargement that meets criteria
* Stage C: Current or prior clinical signs of CHF
* Stage D: Refractory CHF, requiring advanced/specialized therapy
268
What are the diagnostic criteria for Stage B2 MMVD?
* Murmur: ≥ Grade 3/6
* LA:Ao Ratio: ≥ 1.6
* LVIDDN: ≥ 1.7
* VHS: > 10.5 (or breed-adjusted value)
* VLAS ≥ 3 may help if echo unavailable.
269
What is the treatment recommendation for Stage B1 MMVD?
* No medications or diet changes (Class I, LOE: expert opinion)
* Recheck echo or rads in 6–12 months
270
What is the recommended dosage of Pimobendan for Stage B2 MMVD?
0.25–0.3 mg/kg PO BID (Class I, LOE: strong)
271
What is the treatment for Stage C MMVD during acute hospital-based care?
* Furosemide 2 mg/kg IV q1h (up to 8 mg/kg) or CRI
* Pimobendan PO (or IV outside US)
* O₂ therapy, thoracocentesis/paracentesis if needed
* Butorphanol or Buprenorphine + acepromazine for dyspnea/anxiety
* Dobutamine for poor contractility (2.5–10 mcg/kg/min)
* Sodium nitroprusside CRI (1–15 mcg/kg/min)
* ACEI optional in acute setting.
272
What is the chronic home management for Stage C MMVD?
* Furosemide 2 mg/kg PO BID
* ACEI: 0.5 mg/kg PO BID, monitor creatinine/electrolytes in 3–14 days
* Spironolactone: 2 mg/kg PO SID (Class I, LOE: moderate)
* Pimobendan: continue 0.25–0.3 mg/kg PO BID
* No beta blockers started during CHF.
273
What are the treatment options for Stage D MMVD in a hospital-based setting?
* Torsemide instead of furosemide (0.1–0.3 mg/kg PO SID-BID)
* Sodium nitroprusside + dobutamine CRIs for cardiogenic edema
* Hydralazine 0.5–2 mg/kg PO or amlodipine 0.05–0.1 mg/kg PO
* Sildenafil: 1–2 mg/kg PO TID for PH.
274
What is the benefit of surgical intervention for MMVD?
Mitral valve repair can reverse remodeling and provide long-term resolution of CHF, especially indicated in younger or refractory patients (Class I–IIa).
275
What is a key pearl regarding the use of Pimobendan?
Pimobendan is the cornerstone of Stage B2–D treatment.
276
True or False: NT-proBNP is helpful in ruling out CHF.
True
277
What is the significance of a resting respiratory rate greater than 30-35?
It is the most sensitive CHF predictor.
278
Fill in the blank: Torsemide is ~______ times as potent as furosemide.
10
279
What should not be started during CHF treatment?
Beta blockers
280
What is the key feature of Acute Pancreatitis (AP)?
Inflammation that is reversible with removal of the inciting cause; often severe.
281
What characterizes Chronic Pancreatitis (CP)?
Irreversible histopathologic change with fibrosis ± persistent inflammation.
282
What is the necropsy prevalence of pancreatitis in cats?
66.1% (mostly chronic).
283
What is the most common cause of pancreatitis in cats?
Idiopathic (>95%).
284
Which infections are considered rare triggers for feline pancreatitis?
* Toxoplasma
* Coronavirus
* Calicivirus
* Herpesvirus
285
What proposed mechanism leads to autodigestion in pancreatitis?
Premature trypsinogen activation.
286
List some nonspecific clinical signs of pancreatitis in cats.
* Lethargy
* Anorexia
* Vomiting
* Weight loss
* Diarrhea
* Dyspnea
287
What does CBC reveal in cases of pancreatitis?
Neutrophilia or neutropenia, DIC signs (PT/aPTT ↑, platelets ↓).
288
Fill in the blank: The DGGR lipase assay is widely used but is _______ for pancreatitis.
non-specific.
289
What are the findings in cytology for acute pancreatitis?
Neutrophils + necrosis ± dysplastic acinar cells.
290
What is the gold standard for diagnosing pancreatitis?
Histopathology.
291
What type of fluid therapy is recommended for acute pancreatitis?
LRS or similar isotonic crystalloids.
292
What nutritional support is recommended for cats with pancreatitis?
Early enteral feeding with highly digestible, moderate-fat diets.
293
What management strategies may benefit chronic pancreatitis?
* Intermittent corticosteroids
* Appetite stimulants
* Analgesia
294
What is critical to recovery in cases of pancreatitis?
Early enteral feeding.
295
What are some potential electrolyte imbalances in pancreatitis?
* Hypokalemia
* Hypocalcemia
* Hyponatremia
296
What is a common finding in urinalysis for acute kidney injury (AKI) related to pancreatitis?
Isosthenuria.
297
What are the methods for detecting Proteinuria?
* Dipstick/SSA (semi-quantitative)
* Urine protein-to-creatinine ratio (UPC)
* Microalbuminuria tests (ELISA or point-of-care immunoassay)
## Footnote
These methods vary in quantification and specificity.
298
What characterizes Prerenal Proteinuria?
Excess abnormal plasma proteins (e.g., hemoglobin, Bence-Jones proteins) with normal glomerular filtration.
## Footnote
It is caused by abnormal plasma conditions.
299
What characterizes Renal Proteinuria?
Functional or pathologic renal lesions, including glomerular, tubular, and interstitial issues.
## Footnote
This type can indicate significant kidney damage.
300
What characterizes Postrenal Proteinuria?
Protein added in the collecting system or genital tract due to inflammation, hemorrhage, or contamination.
## Footnote
It reflects issues outside the kidneys.
301
What are the types of Proteinuria within the Renal category?
* Functional – mild, transient (e.g., fever, exercise)
* Pathologic:
* Glomerular – ↑ permeability, can be severe (UPC ≥2.0)
* Tubular – impaired resorption, low-grade
* Interstitial – inflammation (e.g., pyelonephritis)
## Footnote
Each type has different causes and implications for diagnosis.
302
What is the 7-Step Localization Process for assessing Proteinuria?
* Rule out extra-urinary postrenal: Cystocentesis sample
* Rule out prerenal: Evaluate for plasma dysproteinemia
* Urinary postrenal? Inflammatory sediment?
* Interstitial renal? Evidence of nephritis (fever, tender kidneys)
* Glomerular? UPC ≥2.0
* Functional renal? Mild/transient proteinuria that resolves
* Tubular or low-grade glomerular? Mild, persistent UPC <2.0
## Footnote
This process is critical for accurate diagnosis.
303
What are the components of the Assessment Triad for Proteinuria?
* Localization
* Persistence
* Magnitude
## Footnote
These components help in understanding the severity and cause of Proteinuria.
304
What does a UPC of ≥2.0 indicate in dogs?
Likely glomerular disease.
## Footnote
This threshold is significant for diagnosing kidney issues.
305
What is the implication of UPC ≥1.0 in azotemic dogs?
Increased uremic risk.
## Footnote
This emphasizes the need for monitoring and intervention.
306
What is the recommended protocol for testing Proteinuria?
* Always test urine when CBC/chem performed
* Include proteinuria screening in chronic illness & wellness checks
* Recommended protocol:
* Dipstick or SSA → confirm positives
* If confirmed → UPC
* If dipstick negative but suspicion high → microalbuminuria ELISA
## Footnote
Routine checks can help catch issues early.
307
What species requires a ≥40% change in UPC to confirm a trend?
Dogs.
## Footnote
This is important for monitoring kidney health over time.
308
What species requires a ≥90% change in UPC to confirm a trend?
Cats.
## Footnote
Cats have a different sensitivity for detecting changes in proteinuria.
309
What is the recommended action for a UPC of ≥2.0 in nonazotemic dogs?
Investigate + Intervene (diet + ACEi ± aspirin).
## Footnote
Early intervention can prevent progression of kidney disease.
310
What dietary recommendations are made for treating Proteinuria?
Restricted, high-quality protein + omega-3 FA.
## Footnote
Diet plays a crucial role in managing kidney health.
311
Fill in the blank: In late-stage CKD, UPC may decline due to _______.
nephron loss.
## Footnote
This decline may not always indicate improvement in kidney function.
312
Define Pulmonary Hypertension (PH).
Increased pressure in the pulmonary vasculature, with a gold standard of Mean PAP ≥25 mmHg at rest.
313
What is the gold standard measurement for diagnosing PH?
Mean PAP ≥25 mmHg at rest (measured via right heart catheterization).
314
How is PH commonly diagnosed in dogs?
Via echocardiography due to limited access to right heart catheterization.
315
List the types of Pulmonary Hypertension (PH).
* Precapillary PH
* Postcapillary PH
* Combined (C-PH)
* Isolated Postcapillary (Ipost-PH)
316
What characterizes Precapillary PH?
↑ PAP, normal PAWP (<15 mmHg), ↑ PVR, no LA enlargement.
317
What characterizes Postcapillary PH?
↑ PAP, ↑ PAWP (>15 mmHg), LA enlargement.
318
What characterizes Combined PH?
↑ PAP, ↑ PAWP, ↑ PVR.
319
What characterizes Isolated Postcapillary PH?
↑ PAWP, normal PVR, LA enlargement.
320
What are the six groups of PH classification?
* Group 1: Pulmonary arterial hypertension
* Group 2: PH due to left heart disease
* Group 3: PH due to respiratory disease/hypoxia
* Group 4: PH due to PE/PT/PTE
* Group 5: PH due to parasitic disease
* Group 6: PH with multifactorial or unclear mechanisms
321
Which group of PH is most common in dogs?
Group 2 (left heart disease).
322
Name three clinical signs strongly suggestive of PH.
* Syncope (exertional)
* Right-sided CHF
* Cyanosis
323
What echocardiographic tool is key for diagnosing PH?
Tricuspid Regurgitation Velocity (TRV).
324
What TRV value indicates a high probability of PH?
TRV >3.4 m/s.
325
How can systolic PAP be estimated?
PAP = 4(TRV)² + RA pressure estimate.
326
What are some ancillary echo signs of PH?
* RV hypertrophy/dilation
* Interventricular septal flattening
* Pulmonary artery enlargement
* RA/caudal vena cava dilation
* PR jet velocity >2.5 m/s
* Decreased RPAD index (<30%)
327
When should PH be suspected?
Based on clinical signs, thoracic rads showing dilated PA, enlarged RA/RV, and comorbid diseases.
328
What is the diagnostic algorithm for PH?
Echocardiography → Assign PH probability (low, intermediate, high) → Classify PH into groups 1–6.
329
What are general supportive strategies for treating PH?
* Restrict exercise
* Vaccinate for respiratory pathogens
* Dirofilaria prevention
* Avoid high altitudes, pregnancy, unnecessary anesthesia
330
What treatment is recommended for Group 1 PH?
* Treat shunts if left→right
* Periodic phlebotomy or hydroxyurea for right→left shunts + polycythemia
* PDE5i (sildenafil) as the mainstay for idiopathic PAH.
331
What is the first-line treatment for Group 2 (LHD-Associated PH)?
Manage heart disease first; do not use sildenafil as first-line.
332
What is the role of sildenafil in PH treatment?
PDE5i; mainstay in Group 1; off-label use common.
333
What are the key risks associated with cytotoxic drug exposure?
Mutagenic, carcinogenic, teratogenic, and abortifacient effects, linked to spontaneous abortions, chromosomal aberrations, infertility and cancer risk in healthcare workers.
334
True or False: Chronic low-level exposure to cytotoxic drugs is less harmful than acute high-dose exposure.
False
335
What are the environmental safety recommendations for handling hazardous drugs?
* Dedicated HD storage and compounding areas
* Use Class II BSCs
* Negative pressure rooms preferred
* Prohibit food, drink, cosmetics, gum, smoking in HD areas
336
Fill in the blank: The most critical risk window for reproductive safety is during the _______.
first trimester
337
What guidelines should be followed during drug preparation?
* Two-person verification (dose, patient ID)
* Perform in BSC with CSTD
* Use plastic-backed absorbent pad
338
How long can Doxorubicin be detected in excreta?
21 days
339
True or False: All urine, feces, and vomit from a chemotherapy patient should be treated as hazardous for at least 3 days.
True
340
What are the recommended indications to start AED therapy?
Indications include:
* Identifiable structural brain lesion or prior brain injury
* Status epilepticus or acute repetitive seizures
* ≥5 minutes of continuous seizure
* ≥3 seizures within 24 hours
* ≥2 or more seizures within 6 months
* Severe or prolonged postictal signs
## Footnote
Early treatment may reduce epileptogenesis and drug resistance.
341
What is the first-line AED option for dogs in the U.S.?
Phenobarbital
## Footnote
It is the most studied, inexpensive, and has high efficacy.
342
What is the recommended initial monitoring for Phenobarbital?
2 & 6 weeks after start; then q6m or after dose change
## Footnote
Target level is 15–35 µg/mL.
343
What are the types of adverse effects categorized in the guidelines?
Adverse effects are categorized into:
* Type I: Predictable (dose-dependent)
* Type II: Idiosyncratic (unpredictable/life-threatening)
* Type III: Cumulative (organ damage over time)
* Type IV: Delayed (e.g., carcinogenic, teratogenic)
## Footnote
Each drug has specific adverse effects associated with these categories.
344
What is the recommendation for adding a second AED?
Add if:
* Seizure control is inadequate
* Clusters/status
* Side effects limit monotherapy dosage
## Footnote
Common combinations include Phenobarbital + KBr and Phenobarbital + Zonisamide.
345
What is the efficacy data for Phenobarbital as monotherapy?
% >50% Seizure Reduction: ~82%
% Seizure-Free: ~31%
## Footnote
It is the best studied AED.
346
What is the first-line recommendation for KBr in terms of initial monitoring?
6–12 weeks; then yearly or if signs change
## Footnote
Target level is 800–2500 µg/mL (with PB) or up to 3000 (solo).
347
What is the recommendation regarding Primidone?
Not recommended
## Footnote
It has higher hepatotoxicity than phenobarbital.
348
What is the target serum level for Zonisamide?
10–40 µg/mL
## Footnote
Caution for renal tubular acidosis.
349
What are the common adjunct AEDs to Phenobarbital?
Common adjuncts include:
* Levetiracetam
* Zonisamide
* Imepitoin
## Footnote
Levetiracetam may require dose adjustment.
350
What is the outcome for breeds like Border Collies and Aussies in terms of seizure management?
They may have worse outcomes.
## Footnote
Cluster seizures and status epilepticus are negative prognostic indicators.
351
What is the recommendation for monitoring liver enzymes and electrolytes?
Monitor liver enzymes and electrolytes for Zonisamide
## Footnote
Type II and III adverse effects include rare hepatopathy and possible increased ALP.
352
What is the recommended cuff width for accurate blood pressure measurement?
30–40% of limb/tail circumference
## Footnote
Ensures accurate BP readings.
353
What is the normal systolic blood pressure (SBP) range for dogs?
~130–150 mmHg
## Footnote
This can vary by breed and method of measurement.
354
What is the normal systolic blood pressure (SBP) range for cats?
~120–140 mmHg
## Footnote
There is no clear breed effect; age may mildly increase BP.
355
What is Secondary Hypertension?
Caused by diseases like CKD, hyperthyroidism, HAC, DM, or drugs/toxins.
## Footnote
These underlying conditions must be identified and treated.
356
What findings indicate Target Organ Damage (TOD) in the kidney?
* Proteinuria
* ↓GFR
* Progression of CKD
## Footnote
Diagnostics include UA, UPC, SDMA, and GFR.
357
What is the risk level classification for SBP <140 mmHg?
Normotensive
## Footnote
This indicates minimal risk.
358
What is the immediate treatment recommendation for SBP ≥160 mmHg with TOD?
Treat immediately
## Footnote
This is crucial to prevent further organ damage.
359
What class of drugs is Enalapril and Benazepril?
ACE inhibitors
## Footnote
They are good for dogs with proteinuria and have a modest effect on SBP.
360
What is the first-line treatment for cats with hypertension?
Amlodipine (0.625–1.25 mg/cat/day)
## Footnote
Higher doses may be required for SBP >200 mmHg.
361
What is the goal SBP for hypertensive dogs?
SBP <160 mmHg (minimal) or ideally <140 mmHg (optimal)
## Footnote
This target helps to minimize risk of TOD.
362
What should be monitored in patients receiving treatment for hypertension?
* Hypotension
* Worsening azotemia
* Blood pressure trends
## Footnote
Regular monitoring helps to adjust treatment as necessary.
363
True or False: Amlodipine is equally effective in both cats and dogs.
False
## Footnote
Amlodipine is highly effective in cats but less so in dogs.
364
What is the recommended frequency for rechecking blood pressure until stable?
q7–10 days
## Footnote
After stabilization, recheck can be reduced to q4–6 months.
365
What is the risk associated with using RAAS inhibitors?
Worsening azotemia
## Footnote
Particularly important to monitor in patients with existing kidney issues.
366
What is the significance of ocular TOD in cats?
It is often the first clinical clue for hypertension.
## Footnote
Retinal detachment can be indicative of severe hypertension.
367
What is the primary cause of acute paraparesis/paraplegia in dogs?
Acute TL-IVDE
368
What type of herniation is TL-IVDE classified as?
Hansen Type I herniation
369
Which breeds are most commonly affected by TL-IVDE?
Chondrodystrophic breeds
370
What is the primary result of TL-IVDE?
Extrusion of mineralized nucleus pulposus leading to spinal cord contusion and compression
371
What are the two main management strategies for TL-IVDE?
Conservative (medical) or surgical (usually hemilaminectomy)
372
What is the gold standard imaging modality for TL-IVDE?
MRI
373
What is the sensitivity percentage of MRI in diagnosing TL-IVDE?
>98.5%
374
What does CT stand for in the context of TL-IVDE diagnostics?
Computed Tomography
375
What is a key advantage of CT over MRI for TL-IVDE?
Faster and cheaper for diagnosing mineralized discs
376
What is the sensitivity range of CT-Myelography for TL-IVDE?
53–97%
377
What are the four severity classifications of TL-IVDE?
* Pain only
* Paraparesis
* Non-ambulatory paraparesis
* Paraplegia
378
What is the medical outcome percentage for dogs with pain only?
~80%
379
What is the surgical outcome percentage for paraplegic dogs with deep pain perception?
~61%
380
What are the components of medical management for TL-IVDE?
* Rest
* Analgesia
* Corticosteroids
* Rehabilitation
381
What is the preferred surgical technique for TL-IVDE?
Hemilaminectomy
382
What term describes the technique that reduces recurrence of TL-IVDE?
Fenestration
383
What are neuroprotective strategies mentioned for TL-IVDE?
* DMSO
* PEG
* MPSS
* GM6001
384
What is the postoperative pain management protocol for TL-IVDE?
* IV or SC opioids for 24–48 hrs
* Fentanyl patch for 3–5 days
* NSAIDs for 7 days
* Gabapentin/pregabalin
385
What is a common risk associated with retained urine in dogs post-surgery?
Increased UTI risk
386
What is the preferred method for bladder management in TL-IVDE recovery?
Intermittent catheterization
387
Fill in the blank: The use of _______ is not routinely recommended for medical management of TL-IVDE.
Corticosteroids
388
What is the effect of delay in decompression on recovery for TL-IVDE?
Does not preclude recovery
389
What should be evaluated for pain management up to 6 weeks postoperatively?
Chronic pain development
390
What should be avoided in fenestration due to increased complication risk?
L5-6, L6-7
391
What are the treatment goals for ITP?
Platelet count ≥100,000/μL with no bleeding, on or off treatment
392
Define 'No Response' in the context of ITP treatment.
Platelets <30,000/µL or ongoing bleeding ≥14 days
393
Define 'Partial Response' in ITP treatment.
Platelets 30–99,000/µL, ≥2× baseline, no bleeding
394
Define 'Complete Response' in ITP treatment.
Platelets ≥100,000/µL, no bleeding
395
What is the typical dosing of Prednisone for dogs in ITP treatment?
2 mg/kg/day
396
What is the dosing for Vincristine in dogs?
0.02 mg/kg IV once (max 0.5 mg/m² if >25 kg)
397
What is the effect of Vincristine on platelet recovery?
Accelerates platelet recovery (~2.5–4.9 days)
398
Is Vincristine recommended as a first-line adjunct in cats?
No, insufficient evidence of efficacy
399
What is the dose of Human IV Immunoglobulin (hIVIg) for dogs?
0.5–1.0 g/kg IV over 6–12 hrs
400
What are reasonable second-line immunosuppressives for dogs?
* Cyclosporine (modified) * Azathioprine (not for cats!) * Leflunomide * Mycophenolate mofetil (MMF)
401
What are the transfusion options for ITP?
* Vincristine-loaded platelets (experimental) * Platelet-rich plasma (PRP) or concentrate * Fresh whole blood (FWB)
402
What special therapy can be used in refractory ITP?
Romiplostim (TPO receptor agonist)
403
What is the last resort treatment for refractory pITP?
Splenectomy
404
What should be done first in secondary ITP treatment?
Treat underlying disease first (infection, neoplasia, drugs)
405
True or False: GC monotherapy works for most dogs and some cats.
True
406
What is the recommendation for adding second immunosuppressives in ITP?
Add if no response, GC side effects, or relapse; do not exceed two immunosuppressives
407
What is the risk associated with splenectomy in ITP treatment?
Risky if comorbid infection present
408
Fill in the blank: The recommended empirical treatment for possible tick-borne disease in sITP is _______.
Doxycycline
409
When should immunosuppressive therapy be started in dogs with IMHA?
After diagnostics (DAT, PCR, cancer staging) are complete, if delay is not life-threatening.
## Footnote
Starting treatment too early can obscure infections or neoplasia.
410
What should be performed in all transfusion-naive dogs with persistent autoagglutination?
Cross-matching
## Footnote
Manufacturer protocols must be consulted when agglutination is present.
411
What are the indications for transfusion in dogs with IMHA?
Administer pRBC or whole blood based on:
* Clinical signs
* PCV/Hct
* Lactate levels or signs of poor oxygenation
## Footnote
Individualized thresholds should be used for PCV/Hct.
412
What is the recommended age for blood products used in transfusions?
Fresh pRBC (<7–10 days)
## Footnote
Older blood is linked with increased mortality, transfusion reactions, and decreased RBC half-life.
413
What should be avoided in transfusion therapy for dogs with IMHA?
Bovine Hemoglobin Solutions (BHS)
## Footnote
BHS can increase mortality risk and cause volume overload.
414
What is the recommendation strength for avoiding routine fresh frozen plasma?
Strong
415
What is the recommended dose for prednisone/prednisolone in dogs with IMHA?
2–3 mg/kg/day or 50–60 mg/m²/day if >25 kg
## Footnote
IV dexamethasone can be used if oral is not tolerated.
416
When should a high dose of glucocorticoids be tapered?
To ≤2 mg/kg/day within 1–2 weeks if PCV is stable/rising
## Footnote
Early tapering is recommended if the initial high dose is effective.
417
Under what conditions should a second immunosuppressive drug be considered?
If:
* Life-threatening disease
* ↓ PCV ≥5% within 24h during first 7 days
* Ongoing transfusion requirement after 7 days
* Severe steroid side effects
## Footnote
The recommendation strength for this is weak.
418
List the second-line immunosuppressive options for dogs with IMHA.
* Azathioprine: 2 mg/kg PO SID → EOD after 2–3 wks
* Cyclosporine: 5 mg/kg PO BID ± TDM
* Mycophenolate mofetil: 8–12 mg/kg PO BID
* Leflunomide: 2 mg/kg PO SID ± TDM
## Footnote
The recommendation strength for these options is weak.
419
What immunosuppressive drug is strongly advised against due to increased mortality?
Cyclophosphamide
420
Is IVIG recommended as routine therapy for IMHA in dogs?
Not recommended routinely
## Footnote
IVIG can be considered in non-responders after dual immunosuppression, but no survival benefit has been shown.
421
What are some poor prognostic markers in dogs with IMHA?
* High bilirubin
* Elevated urea/BUN
* Icterus
* ASA score ≥3
## Footnote
Monitoring these can inform prognosis or escalation of care.
422
What are the ACVIM Board pearls regarding IMHA treatment?
* Prednisone 2–3 mg/kg/day = first-line; taper early if effective
* Fresh pRBC preferred; avoid BHS or plasma unless specific indication
* Avoid cyclophosphamide
* Dual immunosuppression early in severe or transfusion-dependent dogs
* Treat underlying triggers if secondary IMHA suspected
* Immunosuppressive escalation should follow clinical response and side-effect profile
## Footnote
These pearls summarize key recommendations for IMHA management.
423
What are the two main phases of micturition?
* Storage Phase
* Voiding Phase
424
Which nervous systems govern the storage phase of micturition?
* Sympathetic (hypogastric n.)
* Somatic (pudendal n.)
425
What is the role of the parasympathetic system during the voiding phase?
Controls detrusor contraction and urethral relaxation.
426
How is urinary incontinence classified?
* Storage disorders
* Voiding disorders
427
Name three types of storage disorders.
* Urethral sphincter mechanism incompetence (USMI)
* Ectopic ureters (EU)
* Detrusor instability
428
What is the purpose of the postvoid residual volume (PVRV) assessment?
To indicate voiding dysfunction.
429
What is the significance of urinalysis and culture in diagnosing urinary incontinence?
Essential to rule out UTI, which may complicate or mimic UI.
430
What diagnostic imaging techniques may identify anatomical abnormalities in urinary incontinence?
* Ultrasound
* Contrast radiography
* Advanced imaging (CT, MRI)
431
What is cystoscopy used for in the context of urinary incontinence?
Direct visualization of the lower urinary tract, especially for EU and intraluminal lesions.
432
What is the medical treatment for Urethral Sphincter Mechanism Incompetence (USMI)?
* PPA (phenylpropanolamine)
* Estrogens
* Combination therapy
433
What surgical treatment is associated with Urethral Sphincter Mechanism Incompetence (USMI)?
* Artificial urethral sphincters (AUS)
* Bulking agents (e.g., ReGain)
* Colposuspension or prostatopexy
434
How is detrusor instability managed?
* Anticholinergic drugs (e.g., oxybutynin)
* Tricyclic antidepressants (e.g., imipramine)
435
What are the treatments for Functional Outflow Obstruction (FOO)?
* α-antagonists (e.g., prazosin)
* Skeletal muscle relaxants (e.g., diazepam)
436
What causes Mechanical Outflow Obstruction (MOO)?
* Urethral strictures
* Neoplasia
* Uroliths
437
What are the three major categories of recommendations in the guidelines?
Management of Lower Urinary Tract Uroliths, Management of Upper Urinary Tract Uroliths, Urolith Prevention Strategies
438
What is the first-line therapy for Struvite Uroliths?
Medical dissolution
439
List three conditions under which medical dissolution of Struvite Uroliths is not recommended.
* Medications/therapeutic diets are not tolerated
* Obstruction prevents contact with modified urine
* There’s a refractory UTI
440
Which minimally invasive techniques are preferred for the removal of symptomatic urocystoliths?
* Voiding urohydropropulsion
* Basket retrieval
* Percutaneous cystolithotomy
* Laser lithotripsy
441
When should asymptomatic obstruction-prone stones be removed?
When smooth stones near urethral lumen diameter are present
442
What is the recommended treatment for Urethroliths?
Intracorporeal Lithotripsy ± Basket Retrieval
443
What are the risks associated with Urethrotomy/Urethrostomy?
* Hemorrhage
* Stricture
* Leakage
* Chronic UTI
444
What are the indications for treating problematic Nephroliths?
* Obstruction
* Recurrent UTI
* Pain
* Compression of renal parenchyma
445
What is required for dissolving Struvite Nephroliths?
* Urease-positive UTI control
* Stent placement
446
What is the diagnostic indicator for obstruction in hydronephrosis and hydroureter?
Renal pelvic dilation >13 mm
447
What influences the treatment of Ureterolith composition?
* Struvite → dissolve
* Oxalate → stent ± lithotripsy
* Urate/cystine → stent + medical diet
448
What is the prevalence of UTIs in dogs with ureteral obstruction?
59%
449
What dietary strategies are recommended for preventing sterile Struvite?
* Use low-Mg, low-P, urine-acidifying therapeutic diets
* Maintain pH <6.5
450
How can calcium oxalate stone risk be reduced?
* Reduce USG: Dogs ≤1.020; Cats <1.030
* Encourage high moisture (>75%) diets
* Avoid urine acidification
451
Fill in the blank: For urate prevention, increase urine volume, alkalinize (pH ≥7.0), limit _______.
purines
452
What should be avoided in cystine prevention?
Methionine- and cystine-rich proteins
453
What is a common treatment for recurrent cases of calcium oxalate stones?
Thiazide diuretics
